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Journal of Healthcare Engineering 2019Patellofemoral pain syndrome has a high morbidity, and its pathology is closely associated with patellofemoral joint kinematics. A series of and studies have been... (Review)
Review
Patellofemoral pain syndrome has a high morbidity, and its pathology is closely associated with patellofemoral joint kinematics. A series of and studies have been conducted to explore patellofemoral kinematics, and the findings are relevant to the diagnosis, classification, and management of patellofemoral diseases and even the whole knee joint. However, no definite conclusion on normal patellofemoral kinematics has been established. In this study, the measurement methodologies of patellofemoral kinematics (including data collection methods, loading conditions, and coordinate system) as well as their advantages and limitations were reviewed. Motion characteristics of the patella were analyzed. During knee flexion, the patellar flexion angle lagged by 30-40% compared to the tibiofemoral joint flexion. The patella tilts, rotates, and shifts medially in the initial stage of knee flexion and subsequently tilts, rotates, and shifts laterally. The finite patellar helical axis fluctuates near the femoral transepicondylar axis or posterior condylar axis. Moreover, factors affecting kinematics, such as morphology of the trochlear groove, soft tissue balance, and tibiofemoral motion, were analyzed. At the initial period of flexion, soft tissues play a vital role in adjusting patellar tracking, and during further flexion, the status of the patella is determined by the morphology of the trochlear groove and patellar facet. Our findings could increase our understanding of patellofemoral kinematics and can help to guide the operation plan for patients with patellofemoral pain syndrome.
Topics: Biomechanical Phenomena; Female; Femur; Humans; Knee Joint; Male; Patella; Patellofemoral Joint; Patellofemoral Pain Syndrome; Range of Motion, Articular; Research Design; Stress, Mechanical
PubMed: 31019669
DOI: 10.1155/2019/9159267 -
Sao Paulo Medical Journal = Revista... 2022The relationships between the morphometric structure of the patellofemoral joint, patella type and chondromalacia patella are still a matter of debate.
BACKGROUND
The relationships between the morphometric structure of the patellofemoral joint, patella type and chondromalacia patella are still a matter of debate.
OBJECTIVE
To identify the prevalence of chondromalacia patella by determining the patella type and making patellofemoral morphometric measurements.
DESIGN AND SETTING
Retrospective cohort study in an orthopedics and traumatology clinic in Turkey, conducted between June 2017 and November 2019.
METHODS
This study involved 562 knees of 522 patients with anterior knee pain (246 males and 316 females; mean age 46.59 years). The patients were grouped according to presence of chondromalacia patella (group I) or absence of chondromalacia patella (group II). The patella type, lateral trochlear inclination, medial trochlear inclination, trochlear angle, sulcus angle, patellar tilt and Insall-Salvati index were assessed. Group comparisons were made using chi-square tests or Student t tests. The r value was used to determine the magnitude of relationships between pairs of variables.
RESULTS
Among the 562 knees evaluated, 265 (50.71%) presented type I patella, 195 (36.7%) type II, 100 (12.3%) type III and 2 (0.3%) type IV. Group I consisted of 448 knees and group II consisted of 114 knees. Significant differences were found between the groups in terms of age, gender, patella type and lateral inclination angles (P < 0.05).
CONCLUSION
Detecting the patella type and making lateral inclination measurements in patients with anterior knee pain are of great importance for diagnosing suspected chondromalacia patella, particularly in the early degenerative period.
Topics: Male; Female; Humans; Middle Aged; Patella; Retrospective Studies; Prevalence; Magnetic Resonance Imaging; Chondromalacia Patellae; Pain
PubMed: 36102448
DOI: 10.1590/1516-3180.2021.0206.R2.10012022 -
The Journal of the American Osteopathic... Dec 2016
Topics: Adult; Female; Humans; Patella; Radiography
PubMed: 27893149
DOI: 10.7556/jaoa.2016.158 -
Journal of ISAKOS : Joint Disorders &... Oct 2023To analyze the effect of patellofemoral anatomical variations (patella alta, increased tibial tubercle-trochlear groove [TT-TG] distance, and trochlear dysplasia) on... (Review)
Review
OBJECTIVES
To analyze the effect of patellofemoral anatomical variations (patella alta, increased tibial tubercle-trochlear groove [TT-TG] distance, and trochlear dysplasia) on clinical outcomes after isolated medial patellofemoral ligament (MPFL) reconstruction.
METHODS
A comprehensive search from PubMed, Embase, and the Cochrane Library databases was conducted to identify studies that compared outcomes based on the presence or absence of patella alta, elevated tibial tubercle-trochlear groove (TT-TG) distance, and/or trochlear dysplasia. Exclusion criteria included reviews and meta-analyses, studies that included patients who underwent associated bony procedures, and those reporting outcomes after isolated MPFL reconstruction with no comparison between varying anatomical groups.
RESULTS
After application of selection criteria, 19 studies were included. Patella alta was not predictive of failure or poorer outcomes among 13 studies; however, 2 studies demonstrated poorer patient-reported outcome scores and/or higher failure rates with increasing patellar height. Increasing TT-TG distance demonstrated a statistically significant correlation with poorer outcomes in only one study, whereas 12 other studies showed no association. Trochlear dysplasia resulted in worse outcomes and greater failure rates in 6 studies, while 10 studies showed no statistically significant correlation between trochlear dysplasia and postoperative outcomes.
CONCLUSION
Patella alta and increased TT-TG distance did not adversely affect outcomes following isolated MPFL reconstruction in the preponderance of reviewed studies. Data are mixed regarding the impact of trochlear dysplasia on the outcomes of isolated MPFL reconstruction.
LEVEL OF EVIDENCE
IV.
Topics: Humans; Patellar Dislocation; Patellofemoral Joint; Patella; Joint Instability; Recurrence; Patient Reported Outcome Measures
PubMed: 37562573
DOI: 10.1016/j.jisako.2023.08.001 -
The Bone & Joint Journal Feb 2017
Topics: Arthroplasty, Replacement, Knee; Humans; Joint Instability; Knee Joint; Patella
PubMed: 28148653
DOI: 10.1302/0301-620X.99B2.38085 -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... Aug 2021To review research progress of surgical treatment of patellar fractures. (Review)
Review
OBJECTIVE
To review research progress of surgical treatment of patellar fractures.
METHODS
The domestic and foreign literature about patellar fracture treatment in recent years was extensively consulted, and the advantages, disadvantages, and indications of various surgical treatments were summarized.
RESULTS
The patella plays an important role in knee flexion and extension activities, and the fracture significantly affects the patient's quality of life. At present, the surgical methods include open reduction and internal fixation and patella resection. The internal fixation methods include ring/binding patella fixation, tension band wiring and improved technology, tension band wiring combined with other methods, screw fixation (including absorbable screws), steel plate fixation, and patella fixator fixation. Each surgical method has different indications, advantages, and disadvantages. Choosing an appropriate treatment plan plays a crucial role in clinical prognosis.
CONCLUSION
There are many surgical treatments for patellar fractures. In order to improve the effectiveness and reduce postoperative complications, it is necessary to choose the most appropriate treatment strategy for the type of fracture.
Topics: Bone Screws; Bone Wires; Fracture Fixation, Internal; Fractures, Bone; Humans; Patella; Quality of Life
PubMed: 34387438
DOI: 10.7507/1002-1892.202104068 -
Orthopaedics & Traumatology, Surgery &... Feb 2023Good patellar tracking is needed for functionally successful total knee arthroplasty (TKA), and depends on several factors. The aim of the present Instructional Lecture... (Review)
Review
Good patellar tracking is needed for functionally successful total knee arthroplasty (TKA), and depends on several factors. The aim of the present Instructional Lecture is to identify the main factors and how to control them so as to optimize patellar tracking: more or less "patella-friendly" prosthetic trochlea design, requiring precise assessment and choice of model; patellar component design; type of tibial implant; surgical approach and management of peripatellar structures, and any lateral release; distal and posterior femoral bone cuts, determining femorotibial alignment, femoral component rotation and patellar height; tibial implant rotation with respect to the anterior tibial tubercle; patellar cut characteristics in resurfacing. In case of instability or patellar maltracking despite correct implant positioning, there are 2 main surgical techniques: medial patellofemoral ligament reconstruction, and anterior tibial tubercle medialization. To obtain optimal patellar tracking, correction of other factors should be associated: trochlear component design, distal and posterior femoral bone cuts, tibial implant positioning, patellar component shape and positioning, etc.
Topics: Humans; Arthroplasty, Replacement, Knee; Patella; Knee Joint; Femur; Tibia
PubMed: 36302447
DOI: 10.1016/j.otsr.2022.103458 -
PloS One 2018The patella is a sesamoid bone embedded within the quadriceps tendon and the patellar tendon that articulates with the femur. However, how is it formed is still unknown....
The patella is a sesamoid bone embedded within the quadriceps tendon and the patellar tendon that articulates with the femur. However, how is it formed is still unknown. Therefore, here we have evaluated, computationally, how three theories explain, independently, the patella onset. The first theory was proposed recently, in 2015. This theory suggested that the patella is initially formed as a bone eminence, attached to the anterodistal surface of the femur, while the quadriceps tendon is forming. Thereafter, a joint develops between the eminence and the femur, regulated by mechanical load. We evaluated this theory by simulating the biochemical environment that surrounds the tendon development. As a result, we obtained a patella-like structure embedded within the tendon, especially for larger flexion angles. The second and third theories are the most accepted until now. They state that the patella develops within tendons in response to the mechanical environment provided by the attaching muscles. The second theory analyzed the mechanical conditions (high hydrostatic stress) that (according to previous Carter theories) lead to the differentiation from tendon to fibrocartilage, and then, to bone. The last theory was evaluated using the self-optimizing capability of biological tissue. It was considered that the development of the patella, due to tissue topological optimization of the developing quadriceps tendon, is a feasible explanation of the patella appearance. For both theories, a patella onset was obtained as a structure embedded within the tendon. This model provided information about the relationship between the flexion angle and the patella size and shape. In conclusion, the computational models used to evaluate and analyze the selected theories allow determining that the patella onset may be the result of a combination of biochemical and mechanical factors that surround the patellar tendon development.
Topics: Algorithms; Animals; Basic Helix-Loop-Helix Transcription Factors; Biomechanical Phenomena; Chondrogenesis; Computer Simulation; Femur; Finite Element Analysis; Humans; Models, Biological; Patella; Patellar Ligament; Range of Motion, Articular; Signal Transduction; Stress, Mechanical
PubMed: 30533045
DOI: 10.1371/journal.pone.0207770 -
Open Veterinary Journal 2021Patellar luxation (PL) is a common orthopedic affection among farm and pet animals with mostly congenital (environmental and/or genetic) background.
BACKGROUND
Patellar luxation (PL) is a common orthopedic affection among farm and pet animals with mostly congenital (environmental and/or genetic) background.
AIM
We report here the first observation of lateral PL in Hejazi goats bred in Libya.
METHODS
Five Hejazi goats aged between 4 months and 2 years with severe hind limb lameness were admitted to Al-Sorouh veterinary clinic in Tripoli during the period from 2016 to 2018. The goats were thoroughly examined clinically and radiographically. Two goats were surgically treated, and the other three cases were not because of either the cost limitation or expected poor prognosis. The surgical intervention involved femoral trochlear sulcoplasty, medial joint capsule imbrication, and tibial tuberosity transposition.
RESULTS
The clinical examination showed grade III-IV lateral PL. Radiologically, there were unilateral or bilateral, ventrocaudal, and dorsal PLs. Two cases were referred to surgical correction. One case almost restored the normal movement of stifle joint together with a good general status 1 year postsurgery. However, the surgical treatment was not effective in correcting the luxated patella in the second case.
CONCLUSION
Lateral PL is common among orthopedic affections in Hejazi goats in Libya, and its surgical treatment provided a quite convenient approach. An association between inbreeding and the PL was suggested in those cases.
Topics: Animals; Goats; Patella; Patellar Dislocation; Stifle; Tibia
PubMed: 34307087
DOI: 10.5455/OVJ.2021.v11.i2.14 -
Journal of Exposure Science &... Feb 2021Lead is a ubiquitous toxicant following three compartment kinetics with the longest half-life found in bones. Patella and tibia lead levels-validated measures of...
BACKGROUND
Lead is a ubiquitous toxicant following three compartment kinetics with the longest half-life found in bones. Patella and tibia lead levels-validated measures of cumulative exposure-require specialized X-ray-fluorescence-spectroscopy available only in a few centers worldwide. We developed minimally invasive biomarkers reflecting individual cumulative lead exposure using blood DNA methylation profiles-obtainable via Illumina 450K or IlluminaEPIC bead-chip assays.
METHODS
We developed and tested two methylation-based biomarkers from 348 Normative Aging Study (NAS) elderly men. We selected methylation sites with strong associations with bone lead levels via robust regressions analysis and constructed the biomarkers using elastic nets. Results were validated in a NAS subset, reporting specificity, and sensitivity.
FINDINGS
Participants were 73 years old on average (standard deviation, SD = 6), with moderate lead levels of (mean ± SD patella: 27 ± 18 µg/g; tibia:21 ± 13 µg/g). Methylation-based biomarkers for lead in patella and tibia included 59 and 138 DNA methylation sites, respectively. Estimated lead levels were significantly correlated with actual measured values, (r = 0.62 patella, r = 0.59 tibia) and had low mean square error (MSE) (MSE = 0.68 patella, MSE = 0.53 tibia). Means and distributions of the estimated and actual lead levels were not significantly different across patella and tibia bones (p > 0.05). Methylation-based biomarkers discriminated participants highly exposed (>median) to lead with a specificity of 74 and 73% for patella and tibia lead levels, respectively, with 70% sensitivity.
INTERPRETATION
DNA methylation-based lead biomarkers are novel tools that can be used to reconstruct decades' worth of individual cumulative lead exposure using only blood DNA methylation profiles and may help identify the consequences of cumulative exposure.
Topics: Adult; Aged; Aging; DNA Methylation; Environmental Exposure; Humans; Lead; Male; Patella; Tibia
PubMed: 31636367
DOI: 10.1038/s41370-019-0183-9