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The Journal of Knee Surgery Sep 2023The objective of this study was to compare rates of anterior cruciate ligament (ACL) failure among adolescent patients to evaluate patella alta as a high-risk variable....
The objective of this study was to compare rates of anterior cruciate ligament (ACL) failure among adolescent patients to evaluate patella alta as a high-risk variable. Demographic and surgical data were retrospectively queried for patients ≤18 years of age with primary ACL reconstruction performed at a single academic center between 2011 and 2016 and minimum of 2-year clinical surveillance. Patellar height indices, including Caton-Deschamps index (CDI) and Insall-Salvati index (ISI), were retrospectively calculated from preoperative imaging to assess the presence of patella alta. Failure was defined as (1) ACL graft rerupture, (2) Lachman's grade 2 + , (3) presence of pivot shift, and (4) side-to-side difference of 3 mm on KT-1000 arthrometer. A total of 184 patients (84 females and 100 males) and 192 knees were identified, with an average age of 16.2 ± 1.8 years. Of these, 30 (15.63%) experienced ACL failure. Male sex was the only significant risk factor for rerupture ( = 0.026). The mean CDI was 1.06 ± 0.17 and mean ISI was 1.04 ± 0.15. Of the 49 knees that met criteria for patella alta on radiographic evaluation, rerupture occurred in seven (14.29%). Patella alta was not a significant risk factor for ACL failure among adolescent patients ( = 0.359 and 0.277). Only male sex was associated with increased rates of ACL failure. Age, graft selection technique, fixation construct, and presence of patella alta were not risk factors for reinjury. This study is a therapeutic case series and reflects level of evidence IV.
Topics: Female; Humans; Male; Adolescent; Anterior Cruciate Ligament; Patella; Retrospective Studies; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction
PubMed: 35798345
DOI: 10.1055/s-0042-1749608 -
BMC Musculoskeletal Disorders Jul 2020Ti-Ni shape-memory patella concentrator (TNSMPC) has been designed as an alternative approach for fixation of patella fracture, which has some advantages like higher...
Clinical outcomes of Ti-Ni shape-memory patella concentrator combined with cannulated compression screws in the treatment of C2 and C3 patella fracture: a retrospective study of 54 cases.
BACKGROUND
Ti-Ni shape-memory patella concentrator (TNSMPC) has been designed as an alternative approach for fixation of patella fracture, which has some advantages like higher hardness, higher tenacity, better wearing resistance, excellent corrosion resistance and desired histocompatibility. The present study was to investigate the efficiency of TNSMPC combined with cannulated compression screws in the treatment of comminuted patella fractures.
METHODS
Between January 2014 and December 2017, 54 patients of C2 and C3 patella fractures underwent open reduction and internal fixation with TNSMPC combined with cannulated compression screws. All the patients got standard postoperative rehabilitation programs and were regularly followed up for at least 12 months after the operation. X-rays, knee functions and life quality were evaluated during the follow-up.
RESULTS
All the patients achieved bone healing and recovery of knee function with low incidence of complications according to outcomes of X-rays and questionnaires. The average operation time and blood loss during surgery were 77.5 ± 25.12 min and 24.25 ± 4.70 ml respectively. The Knee Outcome Survey Activities of Daily Living Scale, the range of motion and the 36-item short-form heath survey after the operation were all improved. According to the Bostman's criteria, the excellent to good rate was 92.6%.
CONCLUSION
TNSMPC combined with cannulated compression screws is an effective internal fixation method for C2 and C3 patella fracture with excellent clinical outcomes. In addition, the operation does not increase extra technique difficulty or tissue damage relatively, which is worth promotion.
Topics: Activities of Daily Living; Bone Screws; Fracture Fixation, Internal; Fractures, Bone; Fractures, Comminuted; Humans; Nickel; Patella; Retrospective Studies; Titanium; Treatment Outcome
PubMed: 32736553
DOI: 10.1186/s12891-020-03536-3 -
Bulletin of the Hospital For Joint... Jun 2018Predicting satisfaction following total knee arthroplasty (TKA) continues to be a clinical challenge. We sought to quantify radiographic variables associated with...
BACKGROUND
Predicting satisfaction following total knee arthroplasty (TKA) continues to be a clinical challenge. We sought to quantify radiographic variables associated with clinical improvement and satisfaction following TKA.
METHODS
We reviewed a consecutive series of primary TKAs performed by a single surgeon with a minimum 2-year follow-up. Radiographic variables assessed included preoperative and postoperative mechanical axis alignment, osteophyte size and location, and the presence of tibial or patella subluxation. Measurements were taken using a calibrated ruler and goniometer using digital radiographs. Knee Society Scores (KSS), satisfaction, and range of motion (ROM) were prospectively collected.
RESULTS
A total 155 TKAs were followed with a minimum 2.3 year follow-up (mean: 4.2 ± 0.85). Eleven were not satisfied, 9 were satisfied with minor complaints, and 131 were completely satisfied after TKA. Increasing size of patella and lateral compartment osteophytes, particularly greater than 5 mm, was significantly associated with improvement in KSS knee scores (p < 0.05). Patient satisfaction was also strongly associated with these variables and appeared independent of mechanical axis alignment. A regression model demonstrated that lateral patella osteophytes and lateral compartment osteophytes continued to have a significant.
Topics: Aged; Arthrometry, Articular; Arthroplasty, Replacement, Knee; Biomechanical Phenomena; Female; Humans; Joint Diseases; Knee Joint; Male; Middle Aged; Osteophyte; Patella; Patient Satisfaction; Predictive Value of Tests; Range of Motion, Articular; Recovery of Function; Retrospective Studies; Time Factors; Treatment Outcome
PubMed: 29799369
DOI: No ID Found -
Knee Surgery, Sports Traumatology,... Nov 2018The infrapatellar fat pad (IFP) is a common cause of knee pain and loss of knee flexion and extension. However, its anatomy and behavior are not consistently defined.
PURPOSE
The infrapatellar fat pad (IFP) is a common cause of knee pain and loss of knee flexion and extension. However, its anatomy and behavior are not consistently defined.
METHODS
Thirty-six unpaired fresh frozen knees (median age 34 years, range 21-68) were dissected, and IFP attachments and volume measured. The rectus femoris was elevated, suprapatellar pouch opened and videos recorded looking inferiorly along the femoral shaft at the IFP as the knee was flexed. The patellar retinacula were incised and the patella reflected distally. The attachment of the ligamentum mucosum (LMuc) to the intercondylar notch was released from the anterior cruciate ligament (ACL), both menisci and to the tibia via meniscotibial ligaments. IFP strands projecting along both sides of the patella were elevated and the IFP dissected from the inferior patellar pole. Magnetic resonance imaging (MRI) of one knee at ten flexion angles was performed and the IFP, patella, tibia and femur segmented.
RESULTS
In all specimens the IFP attached to the inferior patellar pole, femoral intercondylar notch (via the LMuc), proximal patellar tendon, intermeniscal ligament, both menisci and the anterior tibia via the meniscotibial ligaments. In 30 specimens the IFP attached to the anterior ACL fibers via the LMuc, and in 29 specimens it attached directly to the central anterior tibia. Proximal IFP extensions were identified alongside the patella in all specimens and visible on MRI [medially (100% of specimens), mean length 56.2 ± 8.9 mm, laterally (83%), mean length 23.9 ± 6.2 mm]. Mean IFP volume was 29.2 ± 6.1 ml. The LMuc, attached near the base of the middle IFP lobe, acting as a 'tether' drawing it superiorly during knee extension. The medial lobe consistently had a pedicle superomedially, positioned between the patella and medial trochlea. MRI scans demonstrated how the space between the anterior tibia and patellar tendon ('the anterior interval') narrowed during knee flexion, displacing the IFP superiorly and posteriorly as it conformed to the trochlear and intercondylar notch surfaces.
CONCLUSION
Proximal IFP extensions are a novel description. The IFP is a dynamic structure, displacing significantly during knee motion, which is, therefore, vulnerable to interference from trauma or repetitive overload. Given that this trauma is often surgical, it may be appropriate that surgeons learn to minimize injury to the fat pad at surgery.
Topics: Adipose Tissue; Adult; Aged; Female; Humans; Knee Joint; Ligaments, Articular; Magnetic Resonance Imaging; Male; Middle Aged; Patella; Range of Motion, Articular; Young Adult
PubMed: 29679117
DOI: 10.1007/s00167-018-4943-1 -
Injury Aug 2016Anterior tension wiring using Kirschner wires (K-wires) is still considered the standard treatment for patella fractures, despite its high complication rate. The... (Observational Study)
Observational Study
INTRODUCTION
Anterior tension wiring using Kirschner wires (K-wires) is still considered the standard treatment for patella fractures, despite its high complication rate. The objective of this prospective clinical study was to evaluate intra- and perioperative complications as well as the clinical outcome of patients with patella fracture treated with a new developed bilateral, polyaxial, fixed-angle 2.7mm patella plate.
PATIENTS AND METHODS
Between 2011 and 2014 all patients with a patella fracture were included in this prospective study and treated with a fixed-angle patella plate. Avulsion fractures of the inferior or superior pole of the patella were excluded. All fractures were classified according to the AO/OTA fracture classification. During a twelve-month follow up period all intra- and postoperative complications were recorded as well as the time until fracture healing. One year postoperatively the Lysholm Score, the pre- and postoperative Tegner Score, the Hospital for Special Surgery Knee Score (HSS), the Turba Score, the Oxford Knee Score, the Knee injury and Osteoarthritis Outcome Score (KOOS), the Bostman Score and the Iowa Knee Score were surveyed. Altogether, 20 patella fractures in 19 patients were included in this prospective study. The most frequent type of fracture, n=10, was a simple transverse patella fracture (C1), followed by 7 comminuted patella fractures (C3) and 3 T-shaped patella fractures (C2).
RESULTS
During the 12-month follow up period two patients treated with the patella plate had a complication. In one patient a superficial wound infection occurred, which was treated successfully with hardware removal and in one patient a fracture dislocation due to an implant failure occurred. X-rays demonstrated complete bony healing in all fractures on average 3.2 months postoperatively. All knee scores showed good to excellent clinical results one year postoperatively.
CONCLUSION
The results of this first clinical study indicate that the fixed-angle patella plate is an effective and safe treatment option for patella fractures with a short operative learning curve. The treatment of communited patella fractures (C3) with a fixed-angle patella plate should be well-considered to avoid distending the indication and biomechanical properties.
Topics: Adult; Aged; Aged, 80 and over; Bone Plates; Bone Wires; Female; Fracture Fixation, Internal; Fracture Healing; Fractures, Bone; Fractures, Comminuted; Humans; Knee Joint; Male; Middle Aged; Patella; Prospective Studies; Treatment Outcome
PubMed: 27354301
DOI: 10.1016/j.injury.2016.06.018 -
Journal of Orthopaedic Trauma Sep 2014Operative treatment of displaced patella fractures with tension band fixation remains the gold standard, but is associated with a significant rate of complications and...
Operative treatment of displaced patella fractures with tension band fixation remains the gold standard, but is associated with a significant rate of complications and symptomatic implants. Despite the evolution of tension band fixation to include cannulated screws, surprisingly little other development has been made to improve overall patient outcomes. In this article, we present the techniques and outcomes of patella plating for displaced patella fractures and patella nonunions.
Topics: Adolescent; Adult; Female; Fracture Fixation, Internal; Fractures, Bone; Fractures, Comminuted; Fractures, Ununited; Humans; Knee Injuries; Male; Middle Aged; Patella; Radiography; Young Adult
PubMed: 24343252
DOI: 10.1097/BOT.0000000000000039 -
Arthroscopically assisted fixation is a reliable option for patellar fractures: A literature review.Orthopaedics & Traumatology, Surgery &... Nov 2017Proper reduction and stable fixation of articular fractures is essential for an early recovery and to avoid late complications. Arthroscopically assisted techniques for... (Review)
Review
UNLABELLED
Proper reduction and stable fixation of articular fractures is essential for an early recovery and to avoid late complications. Arthroscopically assisted techniques for minimally invasive fixation have been introduced to reduce local morbidity and improve anatomic reduction of the fragments. However up to date no clear indications for surgery have been given. In addition, the precise rates of functional outcomes and complications are controversial. The hypothesis was the systematic analysis of the available literature would provide precise indications, outcomes and complications of arthroscopically assisted techniques for patellar fracture fixation. A comprehensive literature review was performed using the keywords "patellar fracture", "arthroscopy" with no limit regarding the year of publication. All the selected articles were in English language and were evaluated with the Coleman score by three independent surgeons. The interclass correlation coefficient between the three examiners was calculated. Six full text articles were retrieved. The initial cohort included 60 patients with a displaced transverse fracture in the majority of the cases. At an average FU of 27.2 months the Lysholm score was 91.3. The rate of complication was 7%; Average Coleman score for the three observers was 55.8±6.5 with an ICC of 0.89, indicating adequate inter-rater agreement. Arthroscopically assisted techniques for minimally invasive fixation of patellar fractures represent a reliable option. The positive clinical outcomes and low rates of complications must be confirmed with further studies including larger series and longer FU.
LEVEL OF EVIDENCE
Level IV, systematic review of retrospective series.
Topics: Arthroscopy; Fracture Fixation, Internal; Fractures, Bone; Humans; Knee Injuries; Patella; Retrospective Studies; Treatment Outcome
PubMed: 28629943
DOI: 10.1016/j.otsr.2017.04.010 -
Knee Surgery, Sports Traumatology,... Nov 2014The impact of patellar denervation with electrocautery in total knee arthroplasty (TKA) on post-operative outcomes has been under debate. This study aims to conduct a... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
The impact of patellar denervation with electrocautery in total knee arthroplasty (TKA) on post-operative outcomes has been under debate. This study aims to conduct a meta-analysis and systematic review to compare the benefits and risks of circumpatellar electrocautery with those of non-electrocautery in primary TKAs.
METHODS
Comparative and randomized clinical studies were identified by conducting an electronic search of articles dated up to September 2012 in PubMed, EMBASE, Scopus, and the Cochrane databases. Six studies that focus on a total of 849 knees were analysed. A random-effects model was conducted using the inverse-variance method for continuous variables and the Mantel-Haenszel method for dichotomous variables.
RESULTS
There was no significant difference in the incidence of anterior knee pain between the electrocautery and non-electrocautery groups. In term of patellar score and Knee Society Score, circumpatellar electrocautery improved clinical outcomes compared with non-electrocautery in TKAs. The statistical differences were in favour of the electrocautery group but have minimal clinical significance. In addition, the overall complications indicate no statistical significance between the two groups.
CONCLUSIONS
This study shows no strong evidence either for or against electrocautery compared with non-electrocautery in TKAs.
LEVEL OF EVIDENCE
Therapeutic study (systematic review and meta-analysis), Level III.
Topics: Arthroplasty, Replacement, Knee; Denervation; Electrocoagulation; Humans; Knee Joint; Osteoarthritis, Knee; Patella; Risk Assessment
PubMed: 23743580
DOI: 10.1007/s00167-013-2533-9 -
The Journal of Knee Surgery Aug 2021The main aim of this article was to examine the therapeutic evaluation of our modified partial lateral facetectomy of the patella for stage III lateral patellofemoral...
The main aim of this article was to examine the therapeutic evaluation of our modified partial lateral facetectomy of the patella for stage III lateral patellofemoral osteoarthritis (PFOA), which includes (1) partial lateral patella articular facet that was resected; (2) coronal Z-shaped incision to lengthen lateral retinaculum; (3) patellar perimeter electrocoagulation to denervate. Between December 2008 and January 2013, 36 knees of 32 patients with severe patellofemoral (PF) osteoarthritis (OA) were treated with our modified partial patellar lateral facetectomy. All patients were stage III according to the Iwano scale, and their patellas were all Wiberg type III or Baumgartl type IV in shape. The study group included 6 males and 26 females with an average age of 54.03 years and an average disease course of 8.67 years. The modified Kujala scores were used to evaluate PF function, and the congruence angle was used to evaluate the patellar position. Knee Society Scores (KSS) were used to evaluate overall knee function. Six knees of five cases were lost to follow-up. Thirty knees of 27 cases were followed up for 5 years, with an average follow-up time of 60 ± 3.2 months. The average preoperative modified Kujala score was 15.93, and the average score at last follow-up was 32.03; The satisfactory PF function was achieved in 28 knees (93.33%). The congruence angle improved from preoperative +23. 07 degrees to 11. 91 degrees at the last follow-up. The average preoperative KSS were 110.40 points, which increased to 156.77 points at the last postoperative follow-up. Pain was significantly relieved, and the ability to climb stairs was significantly improved. All scores showed statistically significant improvements after surgery ( < 0.05). No complications were reported. Our modified partial lateral facetectomy of the patella for stage III lateral PFOA can relieve pain and partially improve function. This modified procedure is relatively simple, safe, and an effective treatment method for middle-aged and elderly patients with PFOA. Furthermore, this surgery can be used as an alternative or prephase to total knee arthroplasty. This is a Level IV, therapeutic study.
Topics: Arthroplasty, Replacement, Knee; Female; Follow-Up Studies; Humans; Knee Joint; Male; Middle Aged; Osteoarthritis, Knee; Patella; Treatment Outcome
PubMed: 32659822
DOI: 10.1055/s-0040-1713899 -
Incidence of Patella Baja Before and After Primary Total Knee Arthroplasty Based on Body Mass Index.Orthopedics Mar 2019In the setting of total knee arthroplasty, patella baja has been associated with decreased range of motion and increased risk of certain extensor mechanism...
In the setting of total knee arthroplasty, patella baja has been associated with decreased range of motion and increased risk of certain extensor mechanism complications. The goal of this study was to determine whether obese patients had an increased prevalence of patella baja before and/or after primary total knee arthroplasty. A multicenter retrospective review of 5089 unilateral total knee arthroplasties performed between 1998 and 2012 for osteoarthritis was conducted. Only total knee arthroplasties with cemented modular, metal-backed constructs and patellar resurfacing were included. An a priori power analysis determined that 500 patients (stratified into 5 World Health Organization body mass index groups, matched by age and sex) were needed to detect a significant Insall-Salvati ratio difference of 0.07. Patella baja was defined as an Insall-Salvati ratio of less than 0.8. Preoperative and postoperative Insall-Salvati ratios were compared between groups and analyzed using linear regression and analysis of variance. Preoperatively, there was a higher prevalence of patella baja in the higher body mass index groups (>25 kg/m) compared with normal weight patients (10% vs 6%; P=.02). Postoperatively, there was no difference in the prevalence of patella baja between the 2 groups (5% vs 5%; P=.91). On comparison of postoperative Insall-Salvati ratio with preoperative Insall-Salvati ratio, the higher body mass index groups had a greater change in Insall-Salvati ratio (Δ 0.10 vs Δ 0.07; P=.01). This is the first study to report an increased prevalence of patella baja in obese patients and to show that the prevalence normalizes to that of a control group after total knee arthroplasty. Obese patients undergoing primary total knee arthroplasty had a higher rate of preoperative patella baja. [Orthopedics. 2019; 42(2):90-94.].
Topics: Aged; Aged, 80 and over; Arthroplasty, Replacement, Knee; Body Mass Index; Female; Humans; Male; Middle Aged; Obesity; Patella; Postoperative Period; Preoperative Period; Range of Motion, Articular; Retrospective Studies
PubMed: 30889255
DOI: 10.3928/01477447-20190225-04