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Orthopaedic Surgery Jan 2022To confirm whether a novel sagittal patellar angle linear equation used for evaluating patellar height by calculating expected sagittal patellar angle (SPA) at any...
OBJECTIVE
To confirm whether a novel sagittal patellar angle linear equation used for evaluating patellar height by calculating expected sagittal patellar angle (SPA) at any degree of knee flexion angle is suitable for patients older than 17 years and its reliability compared with other commonly used methods.
METHODS
From September 2016 to September 2019, a total number of 202 consecutive outpatients' knee lateral X-ray radiographs were retrospectively measured and evaluated using a recently proposed linear equation Y = 1.94 + 0.74 × knee flexion(KF) angle. Patients were divided by ages into ayounger group, whose ages were between 17-49 years, and an older group, whose ages were older than 49 years, which has not been validated in the original study. Parameters such as KF, SPA, patella and patella tendon length and so on were measured on computer with picture archiving and communication system by two independent observers at an interval of 1 month. Insall-Salvati (IS) index, Caton-Deschamps (CD) index and Y value, correlation coefficients were calculated and compared using SPSS 22.0 software.
RESULTS
In the younger group, 143 patients (165 knees) were included, ages were 17-49 (31.62 ± 11.38) years, males/females were 70 (48.95%)/73 (51.05%), left knees/right knees were 83 (50.30%)/82 (49.70%), mean value of Y was 31.50° ± 10.07°, and SPA was 34.38° ± 12.38°, mean value of IS was 1.06 ± 0.17, mean value of CD was 1.04 ± 0.18. While in older group, 59 patients (78 knees) were included, ages were 50-60 (mean 54.61 ± 2.99) years, there were 32 males (54.24%) and 27 females (45.76%), 42 knees were left (53.85%) and 36 knees were right (46.15%), mean values of Y and SPA were 25.90° ± 11.55° and 29.36° ± 14.22°, mean IS index in older group was 1.06 ± 0.18, mean CD index was 1.00 ± 0.16. Intra- and inter-observer reliabilities of Y in younger and older groups were 0.999, 0.999, 1.000 and 0.999, meaning high reliability and reproducibility, but low Pearson's correlation coefficients with IS and CD index were showed as -0.213 and - 0.216 in younger group and - 0.113 and - 0.316 in older group.
CONCLUSIONS
In patients older than 17 years, the linear equation Y = 1.94 + 0.74 × KF is a reliable and practical method to evaluate SPA regardless of age and knee flexion angle, but has weak correlation coefficients with the IS and CD index.
Topics: Adolescent; Adult; Biomechanical Phenomena; Body Weights and Measures; Female; Humans; Knee Joint; Male; Middle Aged; Patella; Radiography; Range of Motion, Articular; Reproducibility of Results; Young Adult
PubMed: 34783159
DOI: 10.1111/os.13166 -
Annals of the Royal College of Surgeons... Jun 2022We present a rare, previously undescribed case of a superior patella sleeve fracture in a skeletally immature adolescent male, just 1 month following surgery for an...
We present a rare, previously undescribed case of a superior patella sleeve fracture in a skeletally immature adolescent male, just 1 month following surgery for an ipsilateral traumatic inferior pole patella fracture. This was initially missed resulting in a delay to surgery. We recommend a high index of suspicion is key in these patients who re-present following subsequent trauma and alternative X-ray views such as a flexed lateral can be extremely beneficial.
Topics: Adolescent; Fracture Fixation, Internal; Fractures, Bone; Humans; Knee Injuries; Male; Patella; Radiography; Range of Motion, Articular
PubMed: 35174716
DOI: 10.1308/rcsann.2021.0286 -
The Journal of Knee Surgery May 2023The purpose of this study was to investigate whether differences exist in preventing lateral patellar translation between three distinct medial patellofemoral complex...
The purpose of this study was to investigate whether differences exist in preventing lateral patellar translation between three distinct medial patellofemoral complex (MPFC) reconstruction procedures at varying knee flexion angles. Six cadaveric knee specimens were dissected, potted, and placed in a customized jig for testing. Lateral patellar displacement was measured at intervals between 0 and 90 degrees of knee flexion using a tensile testing machine with a 20 N lateral force applied to the patella. Each specimen was tested with the MPFC intact, sectioned, and after each of the three reconstruction techniques: MPFL, hybrid, and medial quadriceps-tendon femoral (MQTFL) reconstructions. There was significantly increased lateral patellar displacement following MPFC sectioning when compared with the intact state in early degrees of flexion (10-30 degrees) ( < 0.05). All three reconstruction groups restored patella stability and reduced lateral patellar displacement following sectioning from 0 to 30 degrees of flexion ( < 0.05). When compared with the intact group, all three reconstruction groups demonstrated reduced patella translation at full knee extension, while the MPFL and hybrid reconstruction groups additionally demonstrated significant reduction in patella translation at 10 degrees of flexion ( < 0.05). No significant differences were observed between the three reconstruction groups. This biomechanical study demonstrates the efficacy of three MPFC reconstruction techniques in patella stabilization following sectioning. Our results suggest that MPFL reconstruction may provide the most robust patella stabilization, whereas MQTFL reconstruction may be the most forgiving construct. This study suggests that MQTFL and hybrid reconstructions provide adequate resistance to lateral translation and may be used as an alternative to MPFL reconstruction.
Topics: Humans; Patella; Patellofemoral Joint; Ligaments, Articular; Biomechanical Phenomena; Cadaver; Knee Joint
PubMed: 35144302
DOI: 10.1055/s-0041-1741549 -
BMC Musculoskeletal Disorders Jan 2022As several studies have detected correlations between patellar and femoral trochlear development, this raises the question of whether patellar shape is associated with...
BACKGROUND
As several studies have detected correlations between patellar and femoral trochlear development, this raises the question of whether patellar shape is associated with trochlear developmental outcomes.
METHODS
Patellar shape and femoral trochlear morphology were retrospectively analyzed in 183 subjects, of whom 61 each were classified as having Wiberg type I, II, and III patellae (groups A, B, and C, respectively). The sulcus angle (SA), lateral trochlea inclination angle (LTA), medial trochlear inclination angle (MTA), lateral facet length (LFL), medial facet length (MFL), lateral trochlear height (LTH), medial trochlear height (MTH), trochlea sulcus height (TH), and lateral-medial trochlear facet distance (TD) were analyzed as a means of evaluating trochlear morphology. Trochlear depth, trochlear condyle asymmetry, and trochlear facet asymmetry were additionally calculated, and differences in trochlear morphology and correlations between trochlear morphology and patellar shape were evaluated.
RESULTS
The femoral trochlear parameters of patients in group A differed significantly from those of patients in groups B and C. No significant differences between groups B and C were evident. Patellar shape was positively correlated with LTA, MTA, MFL, trochlear condyle asymmetry, and trochlear facet asymmetry, and was negatively correlated with SA.
CONCLUSIONS
These data indicated that patellar shape and trochlear morphology are related to one another,which suggest normalized patella morphology surgery and trochlear surgery are better choices for patients with patella instability.
TRIAL REGISTRATION
Retrospectively registered.
Topics: Femur; Humans; Joint Instability; Magnetic Resonance Imaging; Patella; Patellofemoral Joint
PubMed: 35039027
DOI: 10.1186/s12891-022-05000-w -
Medicina (Kaunas, Lithuania) Feb 2022: Currently, total knee arthroplasty is one of the most common surgeries, increasing with the increase in life expectancy. Whether or not to replace the patella has been... (Meta-Analysis)
Meta-Analysis Review
: Currently, total knee arthroplasty is one of the most common surgeries, increasing with the increase in life expectancy. Whether or not to replace the patella has been a subject of debate over the years, remaining in controversy and without reaching a consensus. Over the years, different meta-analyses have been carried out in order to provide evidence on the subject, although, in recent times, there have not been many new studies in this regard. Therefore, it is considered necessary that the latest works form part of a new meta-analysis. : We searched the literature using PUBMED, SCOPUS, the Cochrane database and VHL from 2010 to 2020. The search terms used were "patellar" AND "resurfacing" OR "Replacement" and "no resurfacing" OR "no replacement". A meta-analysis was performed with Stata software (Stata version 15.1). Forest plots were generated to illustrate the overall effect of knee arthroplasty interventions. : As a result, it was obtained that there is a significantly higher risk of suffering AKP in the non-resurfacing group, in addition to a significant increase in the risk of undergoing a reoperation in the non-resurfacing group. On the other hand, significant differences were obtained in favor of the resurfacing group in both the clinical and Feller KSS, with functional KSS being inconclusive. After analyzing different variables throughout the literature, it does seem clear that the non-resurfacing group may present a higher risk of reoperation than the resurfacing group. : For all these reasons, we think that, although it does seem that not replacing the patella can precipitate a reoperation, it is not clear whether this reoperation is a direct consequence of not having replaced the patella. Therefore, in our opinion, the treatment must be individualized for each patient.
Topics: Arthroplasty, Replacement, Knee; Humans; Knee Joint; Osteoarthritis, Knee; Patella; Randomized Controlled Trials as Topic; Reoperation; Treatment Outcome
PubMed: 35208551
DOI: 10.3390/medicina58020227 -
Clinical Orthopaedics and Related... Oct 2018
Review
Topics: Arthroscopy; Cartilage Diseases; Cartilage, Articular; Chondromalacia Patellae; Hip Joint; Humans; Knee Joint; Observer Variation; Patella; Predictive Value of Tests; Prognosis; Reproducibility of Results; Severity of Illness Index; Shoulder Joint; Terminology as Topic
PubMed: 29533246
DOI: 10.1007/s11999.0000000000000255 -
Journal of Orthopaedic Surgery and... May 2022Patellar dislocation can cause a series of changes in the trochlear groove and patella. However, the influence of patellar dislocation on the medialis (VM) and vastus...
Electrophysiological and pathological changes in the vastus medialis and vastus lateralis muscles after early patellar reduction and nerve growth factor injection in rabbits with patellar dislocation.
BACKGROUND
Patellar dislocation can cause a series of changes in the trochlear groove and patella. However, the influence of patellar dislocation on the medialis (VM) and vastus lateralis (VL) muscles and whether nerve growth factor (NGF) is beneficial to proprioceptive rehabilitation for patellar dislocation are unknown. The purpose of this study was to investigate the effects on VM and VL after the injection of NGF and early reduction in rabbits for patellar dislocation with electrophysiological and pathological analysis.
METHODS
Sixty 2-month-old rabbits were randomly divided into four groups (15 rabbits in each group). Rabbits in Group 1, Group 2, and Group 3 underwent patellar dislocation surgery, and rabbits in Group 4 underwent sham surgery. One month later, patellar reduction was performed in Groups 1 and 2. NGF was injected into the rabbits of Group 1. The electrophysiological and pathological changes in VM and VL were analyzed at 1 month and 3 months after patellar reduction.
RESULTS
The electrophysiological and pathological indices in Groups 1 and 2 were significantly different from those in Group 3 at 1 and 3 months after patellar reduction. There were significant differences between NGF injection Group 1 and Group 2 without NGF injection. There was no significant difference between Group 1 and Group 4 at 3 months after patellar reduction.
CONCLUSIONS
Patellar dislocation can cause abnormal electrophysiological and pathological effects on VM and VL. Patellar reduction should be performed as early as possible, and NGF injection may be beneficial to the rehabilitation of proprioception.
Topics: Animals; Rabbits; Nerve Growth Factor; Patella; Patellar Dislocation; Proprioception; Quadriceps Muscle
PubMed: 35570303
DOI: 10.1186/s13018-022-03170-w -
Cartilage 2022The study was performed to evaluate cartilage within the knee following a first-time patellar dislocation, using elevated MRI-based T1ρ relaxation times as an indicator...
OBJECTIVE
The study was performed to evaluate cartilage within the knee following a first-time patellar dislocation, using elevated MRI-based T1ρ relaxation times as an indicator of low proteoglycan concentration. The hypothesis is that MRI-based T1ρ relaxation times for patellofemoral and tibiofemoral cartilage are significantly longer for knees being treated for patellar dislocation than for healthy control knees.
DESIGN
Twenty-one subjects being treated for a first-time, unilateral dislocation of the patella and 16 healthy controls participated in MRI-based T1ρ relaxation time mapping. Mean relaxation times were quantified for patellofemoral and tibiofemoral regions for injured knees, the contralateral knees, and healthy controls. T1ρ values for each region were compared between the 3 groups with generalized estimating equations. Linear regressions were also performed to correlate T1ρ relaxation times with time from injury.
RESULTS
The knees with a disloction had longer T1ρ relaxation times than the contralateral knees and control group at the medial patella and longer relaxation times than the control group at the lateral tibia ( < 0.05). T1ρ relaxation times at the medial patella also decreased with time from injury (r = 0.21, = 0.037).
CONCLUSIONS
Compositional changes to cartilage on the medial patella are related to traumatic impact during a dislocation. Potential exists for cartilage properties at the medial patella to improve with time. Cartilage degradation at the lateral tibia is not directly related to traumatic impact. The current baseline data are a starting point to characterize the pathway from a first-time dislocation to progressive cartilage degradation and osteoarthritis.
Topics: Cartilage, Articular; Humans; Joint Dislocations; Knee Joint; Patella; Patellar Dislocation; Tibia
PubMed: 35676874
DOI: 10.1177/19476035221102570 -
BMC Musculoskeletal Disorders Jan 2023Patella fractures account for approximately 1% of all skeletal injuries. Treatment options are vast and no definitive conclusion on what option is the most beneficial...
BACKGROUND
Patella fractures account for approximately 1% of all skeletal injuries. Treatment options are vast and no definitive conclusion on what option is the most beneficial could be made so far. Plate osteosynthesis appears to gain in importance. We aim to give insight into the more recent trends and developments as well as establish the epidemiology of patella fractures in Germany by analysing treatment and epidemiological data from a national database.
METHODS
Anonymised data was retrieved form a national database. In the period of 2006 to 2020, all patients with patella fractures as defined in ICD-10 GM as their main diagnosis, who were treated in a German hospital were included. Patients were divided into subgroups based on gender and age. Age groups were created in 10-year intervals from 20 years old up to 80 years old with one group each encompassing all those above the age of 80 years old and below 20 years old and younger. Linear regression was performed were possible to determine statistical significance of possible trends.
RESULTS
A total of 151,435 patellar fractures were reported. 95,221 surgical interventions were performed. Women were about 1.5 times more likely to suffer from patella fracture than men. The relative number of surgical interventions rose from about 50% in 2006 to 75% in 2020. Most surgical interventions are performed in those over the age of 50. The incidence of complex fractures and plate osteosynthesis has significantly increased throughout the analysed period.
CONCLUSIONS
We found a clear trend for surgical treatment in Germany with an increase in surgical procedures. We could also show that this ratio is age-related, making it more likely for younger patients in the age groups from 0 to 70 years old to receive surgical treatment for their patella fracture.
Topics: Male; Humans; Female; Child; Aged, 80 and over; Infant, Newborn; Infant; Child, Preschool; Adolescent; Young Adult; Adult; Middle Aged; Aged; Patella Fracture; Fractures, Bone; Patella; Fracture Fixation, Internal; Germany; Knee Injuries
PubMed: 36721108
DOI: 10.1186/s12891-023-06162-x -
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