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Surgical and Radiologic Anatomy : SRA Dec 2021Morphometric analysis of the patella and the patellar ligament is crucial in diagnosing and surgical corrections of knee injuries and patellofemoral joint disorders....
PURPOSE
Morphometric analysis of the patella and the patellar ligament is crucial in diagnosing and surgical corrections of knee injuries and patellofemoral joint disorders. Dimensions of the patella and the patellar ligament are frequently used in implant design and ACL reconstruction. This study aims to obtain detailed morphometric data on the patellar ligament and its localization based on gross anatomical dissections in the adult cadavers.
METHODS
The present study consisted of 50 lower limbs from formalin-fixed male adult cadavers aged about 70 years (45-85) belonging to the South Indian population. Total length of the quadriceps tendon, patellar height, patellar ligament height, proximal width, distal width and thickness of the patellar ligament were measured meticulously. Mean, standard deviation, median scores of each parameter were computed for groups using SPSS 16.0. Level of significance was considered as p < 0.05. Wilcoxon signed-rank test was used to compare the various parameters on the right and left limbs. The relationships between all parameters were analyzed using Spearman's rank correlation test.
RESULTS
There was no statistically significant difference in the various measurements of the patella and patellar ligament between the right and left lower limbs. Patellar ligament length showed positive correlation with ligament thickness (r = 0.36; p = 0.078 for right limb and r = 0.33; p = 0.104 for left limb). Proximal width of ligament showed significant positive correlation with distal width (r = 0.41; p = 0.041 for right limb and r = 0.54; p = 0.006 for left limb).
CONCLUSION
This morphometric data and analysis might be fundamental in understanding various knee conditions in situ and necessary to orthopedic surgeons for successful planning and execution for ACL reconstruction using patellar ligament graft and other patellofemoral joint disorders.
LEVEL OF EVIDENCE
I.
Topics: Adult; Aged; Anterior Cruciate Ligament Injuries; Cadaver; Humans; Male; Patella; Patellar Ligament; Patellofemoral Joint; Tendons
PubMed: 34570285
DOI: 10.1007/s00276-021-02837-z -
BMC Surgery Sep 2022Inferior pole fracture of the patella (IPFP) has small and comminuted fracture blocks that are hard to immobilize, and early mobilization may lead to loss of fracture...
BACKGROUND
Inferior pole fracture of the patella (IPFP) has small and comminuted fracture blocks that are hard to immobilize, and early mobilization may lead to loss of fracture reduction and immobilization failure. Therefore, a difficulty of treatment is to achieve rigid immobilization with early functional exercise. Here, a new treatment method of tension-free external immobilization is put forward.
METHODS
The clinical data of 11 IPFP patients treated with tension-free external immobilization from May 2016 to June 2019 were retrospectively analyzed. There were six males and five females aged 39.0 ± 12.8 years (range 18-53 years). IPFP was caused by traffic accidents in five cases and falls in six cases. All cases had unilateral closed injuries, including four in the left knee and seven in the right knee. The preoperative range of motion of the knee was 22.0 ± 7.5° (10-30°). The time from injury to operation was 4.5 ± 1.3 d (3-7 d). The operation-related indices were recorded, and the function of the affected knee was assessed by the Böstman score.
RESULTS
All operations were successful. The operation time was 56.4 ± 8.4 mi (45-70 min), the intraoperative blood loss was 54.1 ± 14.6 mL (40-80 mL), and the length of hospital stay was 7.5 ± 1.9 d (5-11 d). The mean follow-up time was 20.4 ± 7.6 months (12-36 months), the duration of fracture healing was 8.9 ± 1.5 weeks (7-12 weeks), and the removal time of the external immobilization device was 10.4 ± 0.9 weeks (9-12 weeks). At the last follow-up, the range of motion had no significant difference between the affected knee (129.7 ± 3.3°, range 125-135°) and the unaffected knee (130.8 ± 3.8°, range 126-137°) (t = 0.718, p < 0.05). The Böstman score of the knee was 29.2 ± 1.0 points (27-30 points), including 10 excellent cases (90.9%) and one good case (9.1%).
CONCLUSION
Tension-free external immobilization is a feasible treatment for IPFP. It can help with early functional exercise and achieve a satisfactory clinical effect.
Topics: Bone Wires; Female; Fracture Fixation, Internal; Fractures, Bone; Humans; Knee Injuries; Male; Patella; Retrospective Studies
PubMed: 36096769
DOI: 10.1186/s12893-022-01790-x -
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 -
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 Orthopaedic Surgery and... Aug 2021Open reduction internal fixation (ORIF) has long been the conventional procedure for managing displaced patella fracture. This surgical approach has certain drawbacks,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Open reduction internal fixation (ORIF) has long been the conventional procedure for managing displaced patella fracture. This surgical approach has certain drawbacks, which might affect clinical outcomes and patient prognosis. Minimally invasive percutaneous fixation (MIPF) was proposed to overcome these disadvantages. Few in-depth investigations have been performed to determine the superiority of MIPF over ORIF. The aim of this study was to compare the efficacies of MIPF and ORIF for patella fractures.
METHODS
The PubMed, Cochrane Library, Embase, and Scopus databases were searched for relevant studies from November 26 to December 17, 2020. Non-English publications and pediatric orthopedic articles were excluded. Statistical analysis was performed using Review Manager, version 5.4, with mean differences (MDs), standardized mean differences (SMDs), odds ratios (ORs), and respective 95% confidence intervals (CIs) calculated using a random effects model. The primary outcomes were the pain score, knee range of motion, and joint functionality. The secondary outcomes were the surgical time, complications, and implant removal rate.
RESULTS
Six articles with a total of 304 patients were included in the meta-analysis. Pooled analysis revealed that patients with MIPF had a significantly reduced pain score (MD = - 1.30, 95% CI = - 1.77 to -0.82; p < 0.00001) and increased knee extension angles (MD = 0.72, 95% CI = 0.18 to 1.25; p = 0.009) at 3-month follow-up. Furthermore, knee flexion angles (MD = 8.96, 95% CI = 5.81 to 12.1; p < 0.00001) and joint functionality (SMD = 0.54, 95% CI = 0.21 to 0.86; p = 0.001) had statistically improved at 2 years. However, no difference was observed between MIPF and ORIF with regard to the surgical time. The risk of complications (OR = 0.10, 95% CI = 0.05 to 0.18; p < 0.00001) and implant removal rate (OR = 0.20, 95% CI = 0.07 to 0.57; p = 0.003) were significantly lower with MIPF than with ORIF.
CONCLUSIONS
MIPF is more favorable than ORIF in terms of the pain score, knee range of motion, joint functionality, complications, and implant removal rate. Thus, it can be adopted as an alternative to ORIF.
Topics: Child; Fracture Fixation, Internal; Fractures, Bone; Humans; Knee Injuries; Open Fracture Reduction; Pain; Patella; Treatment Outcome
PubMed: 34404423
DOI: 10.1186/s13018-021-02612-1 -
Journal of Orthopaedic Surgery and... Jul 2021The objectives of this study were to investigate the anatomic morphology of patellar ridge using computed tomography-based three-dimensional (3D) computer models and to...
BACKGROUND
The objectives of this study were to investigate the anatomic morphology of patellar ridge using computed tomography-based three-dimensional (3D) computer models and to assess the center of the patellar ridge after virtual resections.
METHODS
We selected 80 patients, 40 males (age, 33.2±6.8 years) and 40 females (age, 30.6±7.2 years), who were slightly symptomatic with soft tissue injury of the knee joint. The right or left knees were scanned by computed tomography (CT). The CT data of 160 knees was used to construct 3D computer models by image analysis software (Mimics). Variables such as the angle between the patellar ridge and patellar long axis, the distance between the center of the patellar ridge and the center of patellar cut after virtual resections were measured. We detect differences between the sides and genders with the 3D computer models by Student's t test. Simple linear regression and correlation test was used to correlate the patellar ridge center to the center of the patellar cut.
RESULTS
According to the available data, there were significant gender differences in the length and width of patellar cut after virtual resections even with strict control for the height and weight of the patients. The angle between the patellar ridge and the patellar long axis was 11.24° ± 3.62°. The angle in male patients was 10.17° ± 4.82°, and it was 12.28°± 3.78° in female patients. The morphological difference was statistically significant (P < 0.05). After using the subchondral method to virtually resect the patellae, with reference to the center of the patellar cut, the center of the patellar ridge lies superiorly and medially in 88.75%, inferiorly and medially in 8.75%, laterally and superiorly in 2.5%, and in no case laterally and inferiorly. The intra-observer reliability regarding the dimensional measurements was excellent in this study.
CONCLUSIONS
Advances in 3D computer models had resulted in the availability of preoperative measurement and virtual planning. The anthropometric dimensions of this study could provide general information for guiding surgical management of the patella in total knee arthroplasty (TKA) and were useful in designing patellar implants.
CLINICAL RELEVANCE
The placement of the patellar component during TKA differs from one patella to another. The anatomic morphology information of the patellar ridge is helpful for surgeons to perform patellar resurfacing in TKA.
Topics: Adult; Anatomic Landmarks; Arthroplasty, Replacement, Knee; Computer Simulation; Female; Humans; Imaging, Three-Dimensional; Male; Patella; Sex Factors; Tomography, X-Ray Computed
PubMed: 34229682
DOI: 10.1186/s13018-021-02587-z -
Archives of Orthopaedic and Trauma... Aug 2023Vancomycin powder (VP) is an antibiotic first introduced in pediatric spinal surgery to prevent surgical site infections (SSI). Recently its topical application was...
INTRODUCTION
Vancomycin powder (VP) is an antibiotic first introduced in pediatric spinal surgery to prevent surgical site infections (SSI). Recently its topical application was expanded to total hip and knee arthroplasty (THA, TKA) and anterior cruciate ligament reconstruction (ACLR). Toxicity to cartilage is the subject of current research. The aim of this study was to prove the hypothesis that topical application of VP in TKA does not result in a degeneration of patella cartilage. We propagate that the conversion rate for secondary patella resurfacing is not influenced by its use.
MATERIALS AND METHODS
Between 2014 and 2021, 4292 joints were included in this monocentric retrospective cohort study. All patients underwent TKA without primary patella resurfacing. After a change of the procedure in the hospital, one group (VPG) was administered VP intraoperatively. The other group (nVPG) received no VP during surgery (nVPG). The remaining perioperative procedure was constant over the investigation period. Conversion rates for secondary patella resurfacing for both groups were determined without making distinctions in the indication. A second cohort was composed of patients presenting for follow-up examination 12 months after TKA and included 210 joints. Retrospective radiographic evaluations were performed preoperatively, before discharge and at follow-up examination. Patella axial radiographs were analyzed for patella tracking (lateral patellar tilt, patellar displacement) and patella degeneration (Sperner classification, patellofemoral joint space).
RESULTS
There was no significant difference in the conversion rate for secondary patella resurfacing (4.24% VPG, 4.97% nVPG). Patella tracking and patella degeneration did not differ significantly between both groups.
CONCLUSIONS
The topical application of VP does not influence the conversion rate for secondary patella resurfacing. Moreover, it does not result in a degeneration of patella cartilage in TK.
LEVEL OF EVIDENCE
Retrospective case series, Level III.
Topics: Humans; Child; Arthroplasty, Replacement, Knee; Patella; Retrospective Studies; Vancomycin; Powders; Knee Joint; Treatment Outcome; Osteoarthritis, Knee; Knee Prosthesis
PubMed: 36538161
DOI: 10.1007/s00402-022-04721-w -
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 -
Prague Medical Report 2021A 49-year-old female fell from standing. Her right knee extended into the air. She had acute right knee pain preventing weight-bearing. Her knee was most comfortable...
A 49-year-old female fell from standing. Her right knee extended into the air. She had acute right knee pain preventing weight-bearing. Her knee was most comfortable fully-extended. She could not flex it due to pain, nor extend it against resistance. Tenderness and a horizontal defect were noted over the anterior knee. Bedside ultrasound demonstrated a horizontally-fractured patella (confirmed on X-ray) with intact femoral and patellar tendons. She was put in a knee immobilizer and underwent surgery, with return to full function and activities. Ultrasound can identify patella fractures and help with early evaluation, management, and specialty referral, as well as ordering more-focused imaging. In one study, POCUS (point-of-care ultrasound) for patella fracture had 95% sensitivity, 63% specificity, 86% positive predictive value, and 83% negative predictive value. The dynamic nature of ultrasound allows a ruptured patella (87% sensitivity) or quadriceps tendon (100% sensitivity) to be excluded with high certainty.
Topics: Humans; Middle Aged; Patella; Point-of-Care Systems
PubMed: 34924109
DOI: 10.14712/23362936.2021.29 -
Journal of Orthopaedic Surgery and... Oct 2022To investigate the change of the cross-sectional area (CSA) of vastus medialis oblique (VMO) in patients with recurrent patellar dislocation (RPD) treated by tibial...
Change of the cross-sectional area of vastus medialis oblique in patients with recurrent patellar dislocation treated by tibial tubercle transfer combined with medial patellofemoral ligament reconstruction on axial CT.
PURPOSE
To investigate the change of the cross-sectional area (CSA) of vastus medialis oblique (VMO) in patients with recurrent patellar dislocation (RPD) treated by tibial tubercle transfer combined with medial patellofemoral ligament (MPFL) reconstruction by imaging methods, and to guide clinical treatment and rehabilitation.
METHODS
From October 2015 to March 2022, 23 patients with RPD who underwent tibial tubercle transfer combined with MPFL reconstruction were retrospectively enrolled. All patients were assessed by CT in the supine position with the knee fully extended and the quadriceps relaxed. The CSA of VMO and the ratio of CSA of VMO to body weight (CSA/BW) were measured at the upper pole of the patella, 5 mm above the upper pole of the patella and 5 mm below the upper pole of patella. The differences of measured parameters were compared before surgery and at follow-up, including CSA of VMO and CSA/BW. Test level α = 0.05.
RESULTS
The tibial tubercle-trochlear groove (TT-TG) distance was significantly reduced at follow-up compared with that before surgery (27.91 ± 1.95 mm vs 12.33 ± 1.07 mm, P < 0.001). The CSA of VMO was significantly increased at follow-up compared with that before surgery at 5 mm below the upper pole of the patella (473.06 ± 106.32 mm vs 562.97 ± 157.90 mm, P < 0.001), at the upper pole of the patella (641.23 ± 188.45 mm vs 700.23 ± 177.55 mm, P = 0.029), and at 5 mm above the upper pole of the patella (788.25 ± 238.62 mm vs 849.79 ± 180.84 mm, P = 0.018). The CSA/BW was significantly increased at follow-up compared with that before surgery at 5 mm below the upper pole of the patella (7.83 ± 2.52 mm/kg vs 9.22 ± 3.54 mm/kg, P < 0.001), at the upper pole of the patella (10.48 ± 3.62 mm/kg vs 11.42 ± 4.14 mm/kg, P = 0.020), and at 5 mm above the upper pole of the patella (12.86 ± 4.65 mm/kg vs 13.68 ± 3.86 mm/kg, P = 0.017).
CONCLUSION
After tibial tubercle transfer combined with MPFL reconstruction, CSA of VMO increased in patients with RPD, which will help to enhance patellar stability and reduce recurrence.
Topics: Humans; Patellar Dislocation; Patellofemoral Joint; Quadriceps Muscle; Retrospective Studies; Ligaments, Articular; Tibia; Knee Joint; Patella; Joint Dislocations; Tomography, X-Ray Computed; Joint Instability
PubMed: 36307822
DOI: 10.1186/s13018-022-03367-z