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Archives of Orthopaedic and Trauma... Nov 2018The aim of this systematic review is to determine the effect of patella height on clinical outcomes after isolated MPFL reconstruction for patella instability. Our... (Review)
Review
INTRODUCTION
The aim of this systematic review is to determine the effect of patella height on clinical outcomes after isolated MPFL reconstruction for patella instability. Our primary hypothesis is that patients with patella alta report similar outcomes after isolated MPFL reconstruction compared to patients with normal patella height.
METHODS
A review of the literature was performed according to the PRISMA guidelines. PubMed, EMBASE, and the Cochrane Library were searched from inception to January 10th 2018. Studies were identified using synonyms for "medial patellofemoral ligament", "reconstruction" and "patella alta".
RESULTS
The search resulted in 467 reports on PubMed, 175 on EMBASE and 3 on the Cochrane Library. We included and analyzed in detail six studies describing outcomes after isolated medial patellofemoral ligament reconstruction with regard to patellar height. We found that both patients with patella alta and normal patella height reported satisfactory outcomes after isolated medial patellofemoral ligament reconstruction. However, because of applied exclusion criteria in the included studies the total number of patients with severe patella alta was small (13/74 patients with patella alta, 18%).
CONCLUSIONS
Based on the current literature we suggest that additional tibial tubercle distalisation is not mandatory in patients with mild patella alta (Caton-Deschamps Index 1.2-1.4). To assess the best indications for different surgical procedures for patients with patella instability future research is needed to develop a clear and uniform definition of relevant patella alta.
LEVEL OF EVIDENCE
III.
Topics: Female; Humans; Joint Instability; Ligaments, Articular; Male; Patella; Patellar Dislocation; Patellofemoral Joint; Plastic Surgery Procedures; Tibia; Treatment Outcome
PubMed: 29948223
DOI: 10.1007/s00402-018-2971-4 -
Aging Dec 2020In this study, we investigated whether the measurement of patellar tracking can be used as a diagnostic parameter of patellofemoral joint disease. Patellar tracking is... (Review)
Review
In this study, we investigated whether the measurement of patellar tracking can be used as a diagnostic parameter of patellofemoral joint disease. Patellar tracking is defined as the movement of the patella in relation to the femorotibial joint within the full range of flexion and extension of the knee joint. The PubMed, EMBASE, Medline, PsychINFO, and AMED databases were used to find relevant articles. Analyzed were the patellar tracking coordinate system and the measurement objects, precision, methods used in those studies, as well as the results obtained. Origin points for coordinate systems varied across the studies. The research object and methods of patellar tracking varied in the studies. Most studies focused on a static description of the internal and external displacement and the internal and external inclination. The , noninvasive, and six degrees of freedom evaluation of patellar tracking reflect patellar motion more comprehensively, though each of these methods does so in different ways. Dynamic and quantitative evaluation of patellar tracking is still lacking in clinical work. Accurate and quantitative patellar tracking measurement could provide clinicians with a comprehensive evaluation of the stability of the knee joint.
Topics: Biomechanical Phenomena; Humans; Knee Joint; Patella; Patellofemoral Joint; Range of Motion, Articular
PubMed: 33260153
DOI: 10.18632/aging.202161 -
Veterinary Medicine and Science May 2023A 2-day-old Cleveland Bay colt was referred to the Equine Emergency Service of the Farm Animal and Equine Veterinary Medical Center at North Carolina State University's...
A 2-day-old Cleveland Bay colt was referred to the Equine Emergency Service of the Farm Animal and Equine Veterinary Medical Center at North Carolina State University's College of Veterinary Medicine for evaluation of decreased nursing behaviour and right hindlimb lameness of 2 days' duration. When assisted to stand, the foal was unable to extend either hindlimb or bear weight on the hindlimbs, the right patella was luxated laterally and unable to be reduced, and the foal assumed a crouched position. Stifle radiographs revealed minimal, heterogeneous, ill-defined ossification of both patellae. Due to the severity of the musculoskeletal defects, humane euthanasia was elected. Post-mortem examination identified a congenital malformation of both patella bones with failure of ossification and cardiac changes suggestive of right atrioventricular valve dysplasia. Histology of the patellae showed no evidence of osteoid deposition or ossification. To our knowledge, bilateral congenital patellar aplasia has not been previously described in foals.
Topics: Animals; Horses; Male; Patella; Hindlimb; Animals, Domestic; Horse Diseases
PubMed: 36734120
DOI: 10.1002/vms3.1083 -
The Journal of International Medical... Apr 2020To compare a modified two-tension-band (MTTB) technique with the AO tension band in treating patellar fractures.
OBJECTIVE
To compare a modified two-tension-band (MTTB) technique with the AO tension band in treating patellar fractures.
METHODS
This retrospective study included patients treated with AO tension band (group 1) or MTTB (group 2). Data obtained during serial follow-up evaluations of time to bony union, range of motion (ROM), Hospital for Special Surgery (HSS) score and complication rates, were analysed.
RESULTS
Fractures healed in all 51 patients included in the study (group 1, = 28; group 2, = 23), with no statistically significant between-group difference in time to bony union. Regarding function results, group 2 had better HSS scores at 3 and 6 months postoperatively; however, at 1 year postoperatively, both groups had similar HSS scores and achieved acceptable flexion and ROM. The overall complication rate was significantly lower in group 2, but average costs were higher in group 2 versus group 1.
CONCLUSION
MTTB provides secure fixation and improved knee function at 3 and 6 months postoperatively, and has a lower complication rate with early mobilization, compared with the AO tension-band technique.
Topics: Bone Screws; Bone Wires; Fracture Fixation, Internal; Fractures, Bone; Humans; Patella; Retrospective Studies; Treatment Outcome
PubMed: 31878827
DOI: 10.1177/0300060519893495 -
Journal of the American Academy of... Dec 2021Osteochondral fractures of the knee occur frequently after acute patellar subluxation or dislocation. They can be challenging to manage because of the difficulty in... (Review)
Review
Osteochondral fractures of the knee occur frequently after acute patellar subluxation or dislocation. They can be challenging to manage because of the difficulty in diagnosing and treating these injuries in a timely fashion, in addition to choosing the optimum fixation method. This review presents the background, considerations for patient evaluation, and the best treatment options available for osteochondral fractures.
Topics: Humans; Intra-Articular Fractures; Joint Dislocations; Knee Joint; Patella
PubMed: 34860734
DOI: 10.5435/JAAOSGlobal-D-21-00155 -
Archives of Orthopaedic and Trauma... Nov 2016Anterior knee pain (AKP) is a frequent complication after total knee arthroplasty (TKA). Patelloplasty, defined as reshaping the patella for optimal tracking in the... (Review)
Review
INTRODUCTION
Anterior knee pain (AKP) is a frequent complication after total knee arthroplasty (TKA). Patelloplasty, defined as reshaping the patella for optimal tracking in the trochlea, has been proposed to reduce the rate of this complication in patellar retaining implants. Aim of this study was to analyze the available literature regarding the outcomes of patelloplasty and to assess its methodological quality.
MATERIALS AND METHODS
A comprehensive review of the English literature was performed using the keywords "total knee arthroplasty", "patelloplasty" and "patellaplasty" with no limit regarding the year of publication. All the selected articles were evaluated with the Coleman score.
RESULTS
Seven full text articles were retrieved. The initial cohort included 461 knees in the study groups and 465 in the control groups. At an average FU of 70.6 months 447 knees were reviewed in the study group and 447 in the control groups. The global rate of AKP after patelloplasty was 11.3 % which compared to 7.9 % in the patella resurfacing control group. No signs of specific patellar complications due to patelloplasty were reported. Average Coleman score was 66.9.
CONCLUSION
Most of the literature has barely sufficient methodological quality. Patelloplasty aims at reducing patellar thickness and improve its tracking with TKA. This procedure is a safe and easy option with no reported adverse effects. In the included studies, outcome seemed to be superior in comparison with isolated osteophyte removal and denervation with a lower rate of AKP. The included studies, however, report a lower rate of AKP following TKA with patellar resurfacing. Patelloplasty may have the potential to improve the outcome of patellar retaining implants.
LEVEL OF EVIDENCE
4, systematic review.
Topics: Arthroplasty, Replacement, Knee; Humans; Knee Joint; Osteoarthritis, Knee; Patella; Treatment Outcome
PubMed: 27687176
DOI: 10.1007/s00402-016-2577-7 -
Journal of Anatomy May 2016The patella (kneecap) is the largest and best-known of the sesamoid bones, postulated to confer biomechanical advantages including increasing joint leverage and...
The patella (kneecap) is the largest and best-known of the sesamoid bones, postulated to confer biomechanical advantages including increasing joint leverage and reinforcing the tendon against compression. It has evolved several times independently in amniotes, but despite apparently widespread occurrence in lizards, the patella remains poorly characterised in this group and is, as yet, completely undescribed in their nearest extant relative Sphenodon (Rhynchocephalia). Through radiography, osteological and fossil studies we examined patellar presence in diverse lizard and lepidosauromorph taxa, and using computed tomography, dissection and histology we investigated in greater depth the anatomy and morphology of the patella in 16 lizard species and 19 Sphenodon specimens. We have found the first unambiguous evidence of a mineralised patella in Sphenodon, which appears similar to the patella of lizards and shares several gross and microscopic anatomical features. Although there may be a common mature morphology, the squamate patella exhibits a great deal of variability in development (whether from a cartilage anlage or not, and in the number of mineralised centres) and composition (bone, mineralised cartilage or fibrotendinous tissue). Unlike in mammals and birds, the patella in certain lizards and Sphenodon appears to be a polymorphic trait. We have also explored the evolution of the patella through ancestral state reconstruction, finding that the patella is ancestral for lizards and possibly Lepidosauria as a whole. Clear evidence of the patella in rhynchocephalian or stem lepidosaurian fossil taxa would clarify the evolutionary origin(s) of the patella, but due to the small size of this bone and the opportunity for degradation or loss we could not definitively conclude presence or absence in the fossils examined. The pattern of evolution in lepidosaurs is unclear but our data suggest that the emergence of this sesamoid may be related to the evolution of secondary ossification centres and/or changes in knee joint conformation, where enhancement of extensor muscle leverage would be more beneficial.
Topics: Animals; Biological Evolution; Fossils; Lizards; Patella; Phylogeny
PubMed: 26740056
DOI: 10.1111/joa.12435 -
Orthopedics 2023We describe the wiring technique and evaluate the radiographic and clinical outcomes of treatment with a pin and wire system (PWS) for comminuted patella fractures. From...
We describe the wiring technique and evaluate the radiographic and clinical outcomes of treatment with a pin and wire system (PWS) for comminuted patella fractures. From June 2013 to October 2018, 33 patients with comminuted patella fractures were treated using a PWS. Open reduction and internal fixation was performed with multiple pins and a wire. All patients were allowed full weight bearing without a brace. Radiographs were obtained to evaluate bone union, implant breakage, back-out of pins, and intra-articular gaps and step-off. Clinical outcomes and postoperative complications were assessed at final follow-up examination. All fractures were united. Thirteen cable wires in 13 patients were partially broken without displacement of fracture at an average of 7.4 months (range, 1-19 months) postoperatively. The average preoperative, postoperative, and final follow-up intra-articular gap and step-off were 11.7 mm, 0.5 mm, and 0.03 mm and 6.6 mm, 0.4 mm, and 0.2 mm, respectively. The average postoperative pin displacement was 0.1 mm (range, 0-0.8 mm). Deep infection was not observed after the surgery. The implant removal rate was 21% (7 of 33). Among these, the symptomatic implant removal rate was 9% (3 of 33). Additionally, 3 of 7 patients with implant removal had broken wires. The average flexion and extension of knee joints were 139.7° (range, 120°-150°) and -0.9° (range, -10° to 0°), respectively. A PWS prevents back-out of the pins and reduces intra-articular gaps and step-off distances to acceptable levels, even if the cable wire is partially broken. Therefore, a PWS is a good treatment option for comminuted patella fractures. [. 2023;46(5):291-296.].
Topics: Humans; Patella Fracture; Treatment Outcome; Retrospective Studies; Fractures, Bone; Bone Wires; Fracture Fixation, Internal; Patella; Fractures, Comminuted
PubMed: 36921229
DOI: 10.3928/01477447-20230310-01 -
Skeletal Radiology Jan 2023The aim of this radiological study was to compare several relevant modified and newly applied patella height indices (PHI) in navigated primary total knee arthroplasty...
OBJECTIVE
The aim of this radiological study was to compare several relevant modified and newly applied patella height indices (PHI) in navigated primary total knee arthroplasty (TKA) to determine intra- and interobserver reliability in order to give a recommendation for clinical application in measuring patella height (PH) in primary TKA.
MATERIALS AND METHODS
A retrospective data analysis assessing different PHI (modified Insall-Salvati index (mISI), Caton-Deschamps index (mCDI), Blackburne-Peel index (mBPI), Plateau-Patella Angle (mPPA); Miura-Kawaramura index (MKI), Knee-Triangular index (KTI)) on lateral knee radiographs was performed by two blinded observers using the same software three months pre- and postoperatively. Concordance correlation coefficient and Pearson's correlation respectively were determined for intra- and interobserver rating as well as a categorization according to Landis and Koch and Cohen.
RESULTS
A total of 337/291 patients of a 5-year period could be analyzed pre-/postoperatively. Excellent postoperative interrater results according to the categorization of Landis and Koch were achieved for the mBPI (Pearson 0.98) > mPPA (0.90) > KTI (0.86), good results for the MKI (0.79) and the mCDI (0.69), and moderate results for the mISI (0.52) with a predominantly strong Cohen correlation in almost all cases. Preoperatively, the mBPI and the KTI were the best interrated PHI. No PH changes could be found postoperatively for the mISI, KTI, MKI, and mPPA.
CONCLUSION
The mBPI, the mPPA, and the KTI can be recommended for PH assessment in TKA. The mPPA might be the easiest one to use in a daily clinical set-up.
Topics: Humans; Patella; Arthroplasty, Replacement, Knee; Retrospective Studies; Reproducibility of Results; Knee Joint
PubMed: 35943544
DOI: 10.1007/s00256-022-04142-1 -
BMC Musculoskeletal Disorders Jan 2023Patella-shaped disorder has been considered as a predisposing factor for patella instability. But the influence of early patella reduction for patellar development...
BACKGROUND
Patella-shaped disorder has been considered as a predisposing factor for patella instability. But the influence of early patella reduction for patellar development remains unclear. This study aimed to evaluate whether early operation in patella instability could improve patella morphology in growing rabbits.
METHODS
Fifty rabbits (1-month-old) were included in the study. The control group underwent no surgical procedures. The two experimental groups (reduction group and non-reduced group), underwent medial soft tissue restraint release surgery. The reduction group, rabbits underwent the medial soft tissue sutura surgery in order to stabilize the patella 2 months after release surgery. The non-reduced group, rabbits did not undergo suture surgery. Computed Tomography (CT) scans analysis in two experimental endpoints (2, 5 months after release surgery) were selected to evaluate the transverse diameter, thickness, Wiberg index and Wiberg angle. Gross observation was conducted to assess morphological changes of the patella.
RESULTS
CT scans showed significant difference in the mean transverse diameter, Wiberg angle between the two experimental groups and the control group 2 months after release surgery. 5 months after release surgery, the indices of patella were found no statistically difference in the reduction group versus the control group. However, the transverse diameter, Wiberg angle in the non-reduced group were significantly differences than that in the reduction group (P < 0.05). Gross observation showed a flattened articular surface of the patella in the non-reduced group.
CONCLUSIONS
The results indicated that patella instability may lead to patella-shaped disorder, showing a flattened morphology. Early patella reduction can improve the patella morphology in growing rabbits.
Topics: Animals; Rabbits; Bone Diseases; Joint Instability; Patella; Tomography, X-Ray Computed
PubMed: 36717908
DOI: 10.1186/s12891-023-06183-6