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The Journal of Arthroplasty Jul 2023The decision to resurface the patella in total knee arthroplasty (TKA) is controversial. While there is some consensus that leaving the patella unresurfaced increases...
BACKGROUND
The decision to resurface the patella in total knee arthroplasty (TKA) is controversial. While there is some consensus that leaving the patella unresurfaced increases risk of reoperation, there is conflicting evidence about patient reported outcomes or indications for resurfacing. This study sought to determine recent rates of patellar resurfacing, examine factors affecting rates of resurfacing, and analyze the associations between patellar resurfacing and both revision rates and patient-reported outcome measures (PROMs).
METHODS
The American Joint Replacement Registry was used to identify primary TKAs performed for osteoarthritis between 2012 and 2021. Cases were classified as resurfaced patella and unresurfaced patella (URP). Outcomes analyzed included trends in patellar resurfacing, factors influencing rate of resurfacing, revision rates, operative time, and 2 PROMs.
RESULTS
Rates of patellar resurfacing decreased and rates of URP increased significantly faster in ambulatory surgery centers and among high volume surgeons. Operative time was significantly lower in URP versus resurfaced patella (88.15 versus 89.90 minutes). The URP were significantly more likely to require revision surgery (odds ratio = 1.206 (1.078, 1.35), P = .0011). There was no significant difference in the likelihood of achieving the minimal clinically important difference in PROMs between resurfaced and nonresurfaced TKAs at 1 year (odds ratio = 1.060 (0.710, 1.581), P = .7755).
CONCLUSION
There was no difference in minimal clinically important difference between resurfaced and URPs and no clinically relevant difference in operative time. However, URPs were more likely to require revision surgery. Therefore, the decision not to resurface should be made carefully considering the known risk of revision and the uncertain benefit.
Topics: Humans; Arthroplasty, Replacement, Knee; Patella; Survivorship; Osteoarthritis, Knee; Reoperation; Treatment Outcome; Knee Joint; Knee Prosthesis
PubMed: 36858125
DOI: 10.1016/j.arth.2023.02.060 -
Clinical Biomechanics (Bristol, Avon) Jul 2022Anterior knee pain can arise from several sources. One of the main sources of pain in patients with anterior knee pain is the patella. Increased patellofemoral joint...
BACKGROUND
Anterior knee pain can arise from several sources. One of the main sources of pain in patients with anterior knee pain is the patella. Increased patellofemoral joint loading is the prime source of patellar pain. Elevated intraosseous pressures have been measured in painful patellae and increasing the intraosseous fluid pressure in the patella causes pain. Whether elevated fluid pressure is an independent source of pain or if the patellar deformation under load leads to elevated pressure and pain has not been determined. Our hypothesis was that the patella deforms measurably under physiologic loads and that intraosseous pressure increase is related to that deformation. The relationship may be linear as measured by correlation or nonlinear as measured by the sum of squared error.
METHODS
Part I: Assessment of patellar load-deformation profiles were obtained in 2 intact cadaver patellae and 1 bisected patella under physiologic loads. Part II: Measurements of intraosseous pressure were obtained in 9 cadaver patellae as the patellae were compressed with physiologic loads. Pressures were recorded at sequential levels of anterior-posterior patellar compression.
FINDINGS
Cadaver patellae compress up to 3.5 mm in the anterior-posterior plane. Compression with physiologic forces raises intraosseous pressure to more than 40 mmHg.
INTERPRETATION
Load-deformation of cadaver patellae results in deformation and an increase in intraosseous pressure. These findings may help explain previous studies of patellofemoral pain where elevated patellar intraosseous pressures have been found in vivo.
Topics: Biomechanical Phenomena; Cadaver; Humans; Knee Joint; Pain; Patella; Patellofemoral Joint
PubMed: 35661891
DOI: 10.1016/j.clinbiomech.2022.105681 -
Journal of Radiology Case Reports Jun 2022A radiographically lucent patellar lesion may represent a variety of etiologies, ranging from more commonly seen degenerative, metabolic, infectious, developmental,...
A radiographically lucent patellar lesion may represent a variety of etiologies, ranging from more commonly seen degenerative, metabolic, infectious, developmental, posttraumatic, postoperative causes to rarer benign and malignant neoplasms. Clinical symptoms, surgical history, laboratory values, and radiographic features may help narrow the differential. In addition, radiographic features such as circumscribed borders and sharply delineated margins favor benign lesions while ill-defined margins suggest malignant etiologies. This case series illustrates the imaging findings and explores relevant clinical findings in a variety of interesting lucent patellar lesions.
Topics: Bone Neoplasms; Humans; Patella
PubMed: 35875365
DOI: 10.3941/jrcr.v16i6.4484 -
The Journal of Arthroplasty Nov 2021It has been hypothesized that the patella, working in conjunction with both medial and lateral femoral condyles, can influence kinematic parameters such as posterior...
BACKGROUND
It has been hypothesized that the patella, working in conjunction with both medial and lateral femoral condyles, can influence kinematic parameters such as posterior femoral rollback and axial rotation. The objective of this study is to determine the in vivo kinematics of subjects implanted with a fixed-bearing (FB) or mobile-bearing (MB) posterior-stabilized (PS) total knee arthroplasty (TKA), with a specific focus on evaluating the impact that Anatomic and Medialized Dome patellar components have on tibiofemoral kinematic patterns.
METHODS
Tibiofemoral kinematics were assessed for 40 subjects; 20 with an anatomic patella and 20 with a dome patella. Within these groups, 10 subjects received an FB PS TKA and 10 subjects received an MB PS TKA. All subjects were analyzed using fluoroscopy while performing a deep knee bend activity. Kinematics were collected during specific intervals to determine similarities and differences in regard to patella and bearing type.
RESULTS
The greatest variation in kinematics was detected between the 2 Anatomic patellar groups. Specifically, the MB-Anatomic subjects experienced greater translation of the lateral condyle, the highest magnitude of axial rotation, and the highest range of motion compared to the FB-Anatomic subjects. Subjects with a Dome Patella displayed much variability among the average kinematics, with all parameters between FB and MB cohorts being similar.
CONCLUSION
The findings in this study suggest that subjects with an Anatomic patellar component could have more normal kinematic patterns with an MB PS TKA as opposed to an FB PS TKA, while subjects with a Dome patella could achieve similar kinematics regardless of TKA type.
Topics: Arthroplasty, Replacement, Knee; Humans; Knee Joint; Knee Prosthesis; Patella; Range of Motion, Articular
PubMed: 34362598
DOI: 10.1016/j.arth.2021.07.006 -
International Orthopaedics Aug 2021The original Caton-Deschamps index (oCDI) detects functional patella height. It cannot be used in knees with an implanted endoprosthesis. The "modified Caton-Deschamps...
PURPOSE
The original Caton-Deschamps index (oCDI) detects functional patella height. It cannot be used in knees with an implanted endoprosthesis. The "modified Caton-Deschamps index" (mCDI) for knee arthroplasty can miss pseudo-patella-infera (PPI), which is common after TKA. A derivate of the oCDI could be a simple analogue to the index published in 1982 using a modified tibial reference point at the anterior proximal point of the inlay, which can indirectly be located on the lateral knee radiograph. It was the aim of this study to determine the intra- and inter-rater agreement of a derived Caton-Deschamps index (dCDI) for knee arthroplasty. We hypothesized that the derived Caton-Deschamps index (dCDI) is a reliable radiological measure for patella height in knee arthroplasty.
METHODS
Several patella height indices were measured by three independent raters in two passes. The second pass was performed after 6 weeks in random order. Intra- and inter-observer agreements were determined and analyzed using the intraclass correlation coefficient (ICC). For radiographic evaluation, digital lateral radiographs of 150 knees before and after primary TKA were used.
RESULTS
We found high interrater reliability for all analyzed indices. We found the highest agreements for the ISI preop (ICC = 0.914) and postop (ICC = 0.920), respectively. We also found very good intra-rater reliability for the CDI (ICCpreop = 0.954), dCDI (ICCpostop = 0.945), ISI (ICCpreop = 0.960; ICCpostop=0.940) and BPI (ICCpreop = 0.969; ICCpostop = 0.955). Fourteen cases (9.3%) with insignificant PPI were found.
CONCLUSION
The derived Caton-Deschamps index (dCDI) can easily be used in knee arthroplasty and demonstrated high intra- and interrater agreement, which was similar to other commonly used and established patella height indices.
Topics: Arthroplasty, Replacement, Knee; Humans; Knee Joint; Patella; Radiography; Reproducibility of Results; Tibia
PubMed: 33471223
DOI: 10.1007/s00264-020-04931-0 -
Journal of Long-term Effects of Medical... 2019Patella height appears to have a crucial role in knee biomechanics. Patellar malalignment and maltracking are therefore believed to be associated with development and... (Observational Study)
Observational Study
Patella height appears to have a crucial role in knee biomechanics. Patellar malalignment and maltracking are therefore believed to be associated with development and progression of patellofemoral pain and disease. Published data are scant regarding the effect of everyday tasks on patella height and patellofemoral disease. We included 150 subjects in a retrospective observational study. Group A had 75 subjects (24 male and 51 female, with a mean age of 58.5 yr), whose daily activities included squatting (the traditional Muslim praying position called Sujud). Group B had 75 subjects (42 male and 33 female, with a mean age of 47.6 yr), who were non-Muslim. Patella height was measured using Insall-Salvati (IS) and Blackburne-Peel (BP) ratios. The mean IS ratio was 0.86 (confidence interval [CI]: 0.7-1.02) for group A and 1.1 (CI: 0.96-1.23) for group B. The mean BP ratio was 0.66 (CI: 0.49-0.83) for group A and 0.89 (CI: 0.73-1.04) for group B. We found 26 subjects (34.7%) in group B to have patella alta, when measured by either ratio, compared to one subject (1.3%) in group A (p < 0.01) with patella alta. We found 61 subjects (81.3%) in group A to have patella baja, when measured by either ratio, compared to 21 subjects (28%) in group A (p < 0.01) with patella baja. In group A, the IS ratio was reduced in 29 subjects (38.7%), the BP ratio was reduced in 59 subjects (78.7%), and both were reduced in 27 subjects (36%). A similar pattern was noted for group B. Our results show that a significant increase in patella baja was associated with repeated squatting/kneeling, compared to the predominance of patella alta in the control group. On the basis of these findings, we hypothesize that biomechanical stresses associated with repeated hyperflexion of the knee asymmetrically affect the more flexible quadriceps muscle fibers greater than patella tendon fibers. Thus, repeated hyperflexion in everyday tasks leads to elongation of quadriceps fibers and patella baja.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anatomic Variation; Arabs; Biomechanical Phenomena; Female; Humans; Islam; Knee Joint; Male; Middle Aged; Patella; Patellar Ligament; Retrospective Studies; Stress, Mechanical; Young Adult
PubMed: 32478985
DOI: 10.1615/JLongTermEffMedImplants.2019032873 -
Orthopedics Sep 2014Bipartite patella is a relatively rare phenomenon. This anomaly is typically asymptomatic but can become painful with overuse, strenuous activities, or trauma, which is... (Review)
Review
Bipartite patella is a relatively rare phenomenon. This anomaly is typically asymptomatic but can become painful with overuse, strenuous activities, or trauma, which is why it is typically seen in a young, athletic population. Although nonsurgical management is the initial treatment, if symptoms persist, surgical intervention may be necessary. Multiple surgical options exist, such as excision or fixation of the fragment or release of lateral soft tissue structures. The authors report the efficacy of various surgical interventions on a symptomatic bipartite patella, with outcomes related to symptom relief and ability to return to preoperative levels of activity. A systematic review was performed using multiple databases. Studies reporting outcomes of symptom relief or ability to return to activity following surgical intervention for a bipartite patella were included. Surgical technique, type of bipartite, and complications were recorded. Twenty-four articles with a total of 122 patients and 127 knees were included and reviewed. Relief of pain was achieved in 84.1% of patients, with 98.3% able to return to their preoperative activity levels after surgery. For patients with a symptomatic bipartite patella, return to preoperative activity levels with zero to minimal pain can be achieved with excellent results using any of the reported surgical methods.
Topics: Arthralgia; Arthroscopy; Humans; Musculoskeletal Abnormalities; Patella
PubMed: 25350615
DOI: 10.3928/01477447-20140825-07 -
Anthropologischer Anzeiger; Bericht... Aug 2022This study aimed to address whether the anthropometric features of the patella can be used to determine the sex of the individuals on the basis of the skeletal remains...
This study aimed to address whether the anthropometric features of the patella can be used to determine the sex of the individuals on the basis of the skeletal remains and to set limit values for anthropometric measurements and indicators of the patella in relation to each sex. 71 patellas (32 female and 39 male) from the Middle Ages from Wroclaw, Poland, were analyzed. The measurements (the greatest height, width, thickness, width of the lateral and medial joint surface and the height of these joint surfaces) and ratios were calculated (height to width, height to thickness as well as width to height of lateral and medial joint surfaces) and tested according to sexual dimorphism. The best parameter in terms of discriminatory assessment was the patella's highest height, which made it possible to classify the sex in 46.5% of cases. However, an index of the sum of the height, width and thickness measurements seems to be even better for differentiating between the sexes, making it possible to correctly classify the sex in 49.3% of cases. Due to some limitations of this study and the need of population-specific standard, it is recommend to employ the in sex determination only in cases of fragmented human remains and when no other method can be applied. Further investigation of possible factors influencing the variability of its size and shape should be explored in larger and geographically more diverse samples, and this could contribute to forensic, clinical, anatomical, and anthropological studies in this body part.
Topics: Anthropometry; Body Remains; Female; History, Medieval; Humans; Male; Middle Aged; Patella; Poland; Sex Characteristics; Sex Determination Analysis; Sex Determination by Skeleton
PubMed: 35403185
DOI: 10.1127/anthranz/2022/1450 -
JBJS Reviews Apr 2022An osteochondral fracture (OCF) of the patella or the femur is a frequent sequela after an episode of acute patellofemoral instability. (Review)
Review
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An osteochondral fracture (OCF) of the patella or the femur is a frequent sequela after an episode of acute patellofemoral instability.
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Patients commonly present with anterior knee pain after direct trauma to the patella or a noncontact twisting injury.
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Radiographs and magnetic resonance imaging (MRI) are the most common imaging modalities that are used to diagnose OCFs.
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Arthroscopy may be indicated in cases of displaced OCFs, and the decision regarding osteochondral fragment fixation or loose body removal depends on fragment size, location, and extent of injury.
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Most of the current literature suggests worse outcomes for patients with OCFs who undergo nonoperative treatment, no significant differences in outcomes for patients sustaining an acute patellar dislocation with or without an OCF, and inconclusive results concerning outcomes for patients treated with loose body removal compared with fixation.
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Current outcome data are limited by studies with low levels of evidence; therefore, well-designed randomized controlled trials are needed.
Topics: Fractures, Bone; Humans; Intra-Articular Fractures; Joint Loose Bodies; Knee Joint; Patella; Patellar Dislocation
PubMed: 35394969
DOI: 10.2106/JBJS.RVW.21.00242 -
Journal of Orthopaedic Trauma Aug 2016Patella fractures can be challenging to treat particularly in the presence of inferior pole comminution. In this video we present a novel surgical technique for the... (Review)
Review
Patella fractures can be challenging to treat particularly in the presence of inferior pole comminution. In this video we present a novel surgical technique for the treatment of patella fractures using a small fragment low profile mesh plate. Key points are the surgical exposure with direct visualization of the articular reduction, the preparation of the mesh plate to accommodate patellar anatomy and the augmentation of the construct using Krackow sutures to address inferior pole comminution. Low profile mesh plating allows for multiplanar fixation of patella fractures while avoiding implant and fixation problems related to tension band fixation. Our early experience with this technique is encouraging and it appears that this technique is useful for the treatment of the majority of patella fractures.
Topics: Bone Plates; Evidence-Based Medicine; Fracture Fixation, Internal; Fractures, Bone; Humans; Patella; Surgical Mesh; Treatment Outcome
PubMed: 27441934
DOI: 10.1097/BOT.0000000000000589