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Orthopedics Nov 2018Patella fractures comprise 1% of all fractures. Treatment options vary based on fracture displacement, classification, and patient factors. Traditionally, nonoperative... (Review)
Review
Patella fractures comprise 1% of all fractures. Treatment options vary based on fracture displacement, classification, and patient factors. Traditionally, nonoperative treatment has been reserved for nondisplaced fractures. Many operative treatments are available with differing indications and levels of success. Tension band constructs have been the most commonly employed approach to fixation, with cerclage wiring for comminuted fractures. Recently, plate fixation of patella fractures has become more popular. Plating constructs offer a low-profile design with stable fixation, allowing for earlier mobilization and potentially improved functional outcomes. Data regarding the long-term outcomes of plating techniques are limited, and further studies are needed. [Orthopedics. 2018; 41(6):e747-e755.].
Topics: Bone Plates; Bone Wires; Fracture Fixation, Internal; Fractures, Bone; Fractures, Comminuted; Humans; Knee Injuries; Patella
PubMed: 30321439
DOI: 10.3928/01477447-20181010-08 -
Swiss Medical Weekly Jan 2020The role of the patella is paramount in the transmission of the quadriceps muscle forces, the increase of the lever arm, the distribution of the forces on the trochlea... (Review)
Review
The role of the patella is paramount in the transmission of the quadriceps muscle forces, the increase of the lever arm, the distribution of the forces on the trochlea and the centring of the extensor apparatus. Despite the low incidence of patellar factures in comparison with other lower limb fractures, the painful and functional complications, such as knee stiffness, loss of extension and patellofemoral osteoarthritis, can be very disabling and will often compromise the return to a professional or recreational activity and induce falls in the elderly population. Treatment can be conservative or surgical, provided that it is adapted to the type of fracture. Undisplaced fractures with an intact extensor mechanism can be treated nonoperatively. Surgical treatment is recommended for fractures that either disrupt the extensor mechanism or have more than 2 to 3 mm of step-off and more than 1 to 4 mm of displacement. Tension band fixation is the most commonly employed surgical technique. In most cases, hardware has to be removed after fracture healing because of implant-related pain. Operative treatment of comminuted patellar fractures presents a significant challenge to surgeons. Failure to restore the articular surface contour results in posttraumatic arthritis. Anatomical reconstruction of the articular surface is the only way to prevent the development of posttraumatic osteoarthritis. Typically, fracture classification and thus treatment choice are based on anteroposterior and lateral radiographs of the knee, but when computed tomography of the knee was performed pre-operatively, both the classification and treatment were modified thanks to a better understanding of the fracture complexity. The purpose of this article is to review current treatment strategies and optimise the management of adult patients with patellar fractures.
Topics: Fractures, Bone; Humans; Knee Injuries; Orthopedic Procedures; Patella
PubMed: 31940427
DOI: 10.4414/smw.2020.20165 -
The Journal of the American Academy of... Mar 2021Patellar fracture morphology varies based on the mechanism of injury. Most fractures are either a result of direct impact or through an indirect eccentric extensor...
Patellar fracture morphology varies based on the mechanism of injury. Most fractures are either a result of direct impact or through an indirect eccentric extensor contraction injury. Each fracture pattern requires appropriate preoperative planning and individualization of the fixation method. Displaced fractures affect the extension apparatus, and often require surgical fixation. Surgical treatment is recommended in fractures with any of the following features: articular step-off > 2 mm, > 3 mm of fracture displacement, open fractures, and displaced fractures affecting the extensor mechanism. Meticulous handling of the soft-tissue envelope is of the utmost importance, given the patella's tenuous blood supply and limited soft-tissue envelope. Incongruent articular surface can result in detrimental long-term effects; therefore, surgical treatment is directed toward anatomic reduction and fixation. The evolution of patellar fracture fixation continues to maximize options to balance rigid fixation with low-profile fixation constructs. Improving functional outcomes, minimizing soft-tissue irritation, and limiting postoperative complications are possible by using the therapeutic principles of rigid anatomical fixation and meticulous soft-tissue handling.
Topics: Fracture Fixation, Internal; Fractures, Bone; Humans; Knee Injuries; Patella; Plastic Surgery Procedures; Treatment Outcome
PubMed: 33405488
DOI: 10.5435/JAAOS-D-20-00591 -
Zeitschrift Fur Orthopadie Und... Dec 2022Patella fractures are rare injuries, accounting for 0.5 - 1.5% of all fractures, but they can lead to severe functional limitations if they do not heal properly. In...
Patella fractures are rare injuries, accounting for 0.5 - 1.5% of all fractures, but they can lead to severe functional limitations if they do not heal properly. In addition to a prompt diagnosis, surgical treatment is usually necessary for multi-fragment fractures. The goals of every treatment are a biomechanically stable joint as well as a congruent restoration of the retropatellar joint surface. These results often remain a challenge, especially in multiple fragment fractures. The surgical treatment strategies have steadily evolved from tension band and screw osteosyntheses in combination with wire cerclages. Currently, angular stable plate systems are increasingly being used. This article gives an overview of the fracture anatomy, the classification and diagnosis of patella fractures and the currently used surgical treatment options.
Topics: Humans; Patella; Fractures, Bone; Bone Wires; Fracture Fixation, Internal; Bone Screws; Knee Injuries
PubMed: 35259771
DOI: 10.1055/a-1623-6906 -
Seminars in Musculoskeletal Radiology Jun 2024Patellofemoral instability results from impaired engagement of the patella in the trochlear groove at the start of flexion and may lead to pain and lateral patellar... (Review)
Review
Patellofemoral instability results from impaired engagement of the patella in the trochlear groove at the start of flexion and may lead to pain and lateral patellar dislocation. It occurs most frequently in adolescents and young adults during sporting activities. Trochlear dysplasia, patella alta, and excessive lateralization of the tibial tuberosity are the most common risk factors for patellar instability. The main role of imaging is to depict and assess these anatomical factors and highlight features indicating previous lateral dislocation of the patella.
Topics: Humans; Joint Instability; Patellofemoral Joint; Patella; Patellar Dislocation; Magnetic Resonance Imaging; Risk Factors
PubMed: 38768591
DOI: 10.1055/s-0044-1785538 -
Journal of Orthopaedic Trauma Jan 2018
Topics: Fractures, Bone; Humans; Patella
PubMed: 29256949
DOI: 10.1097/BOT.0000000000001059 -
European Journal of Human Genetics :... May 2019We review genetic diseases with identified molecular bases that include abnormal, reduced (hypoplasia), or absent (aplasia) patellae as a significant aspect of the... (Review)
Review
We review genetic diseases with identified molecular bases that include abnormal, reduced (hypoplasia), or absent (aplasia) patellae as a significant aspect of the phenotype. The known causal genes can be broadly organized according to three major developmental and cellular processes, although some genes may act in more than one of these: limb specification and pattern formation; DNA replication and chromatin structure; bone development and differentiation. There are also several genes whose phenotypes in mice indicate relevance to patellar development, for which human equivalent syndromes have not been reported. Developmental studies in mouse and chick embryos, as well as patellar involvement in human diseases with decreased mobility, document the additional importance of local environmental factors in patellar ontogenesis. Patellar anomalies found in humans can be an important clue to a clinical genetic diagnosis, and a better knowledge of the genetics of patellar anomalies will improve our understanding of limb development.
Topics: Biological Evolution; Bone Diseases; Chromatin; DNA Replication; Genetic Phenomena; Humans; Patella
PubMed: 30664715
DOI: 10.1038/s41431-018-0329-6 -
The New England Journal of Medicine Jun 2023
Topics: Humans; Bone Diseases; Joint Diseases; Patella
PubMed: 37306499
DOI: 10.1056/NEJMicm2213003 -
The Journal of the American Academy of... Apr 2020Patella baja in total knee arthroplasty can result in impingement, pain, and decreased range of motion. Etiology can range from previous knee surgeries such as anterior... (Review)
Review
Patella baja in total knee arthroplasty can result in impingement, pain, and decreased range of motion. Etiology can range from previous knee surgeries such as anterior cruciate ligament reconstruction, retrograde femoral nail, infrapatellar fat pad resection, and previous total knee arthroplasty. Diagnosis can be confirmed by one of a number of measurements of patellar height including Insall-Salvati and Blackburne-Peel ratios. It is important to differentiate between true patella baja and pseudopatella baja by patellar height ratio. Treatment includes correct identification of the underlying etiology and appropriate management. Surgical management strategies include tibial tubercle osteotomy, distal femoral augment and revision, proximalization of the patellar component, modification of the anterior tibial component, and/or Z-plasty of the patellar tendon. We review the outcomes for each of these procedures.
Topics: Arthroplasty, Replacement, Knee; Humans; Patella; Postoperative Complications; Treatment Outcome
PubMed: 31934927
DOI: 10.5435/JAAOS-D-19-00422 -
Arthroscopy : the Journal of... Jun 2023The medial patellofemoral complex (MPFC) is the term used to describe the primary soft tissue stabilizer of the patella, which consists of fibers that attach to the...
The medial patellofemoral complex (MPFC) is the term used to describe the primary soft tissue stabilizer of the patella, which consists of fibers that attach to the patella (medial patellofemoral ligament, or MPFL), and the quadriceps tendon (medial quadriceps tendon femoral ligament, or MQTFL). Despite the variability of its attachment on the extensor mechanism, the midpoint of this complex is consistently at the junction of the medial quadriceps tendon with the articular surface of the patella, indicating that either patellar or quadriceps tendon fixation can be used for anatomic reconstruction. Multiple techniques exist to reconstruct the MPFC, including graft fixation on the patella, quadriceps tendon, or both structures. Various techniques using several graft types and fixation devices have all reported good outcomes. Regardless of the location of fixation on the extensor mechanism, elements critical to the success of the procedure include anatomic femoral tunnel placement, avoiding placing undue tension on the graft, and addressing concurrent morphological risk factors when present. This infographic reviews the anatomy and techniques for the reconstruction of the MPFC, including graft configuration, type, and fixation, while addressing common pearls and pitfalls in the surgical treatment of patellar instability.
Topics: Humans; Patellofemoral Joint; Joint Instability; Ligaments, Articular; Patella; Tendons
PubMed: 37147068
DOI: 10.1016/j.arthro.2023.01.006