-
BMC Medical Imaging Jan 2021To investigate the morphological parameters of the vastus medialis obliquus (VMO) muscle and delineate its importance in the maintenance of patellofemoral joint...
BACKGROUND
To investigate the morphological parameters of the vastus medialis obliquus (VMO) muscle and delineate its importance in the maintenance of patellofemoral joint stability.
METHODS
The magnetic resonance imaging data of seventy-five knees (fifty-four patients) with recurrent lateral patella dislocation (LPD) and seventy-five knees (seventy patients) without recurrent LPD were retrospectively analysed. Five morphological parameters related to the VMO (elevation in the sagittal plane and coronal plane, craniocaudal extent, muscle-fibre angulation, cross-sectional area ratio) and two patella tilt parameters (patella tilt angle, bisect offset ratio) were measured in MR images. The independent-samples t test or chi-square test was used for statistical comparisons.
RESULTS
The mean ages of the patients in the recurrent LPD group and control group were 22.1 ± 9.9 years and 24.0 ± 6.5 years, respectively. Eighteen out of seventy-five (24%) patients MRI showed VMO injuries. Compared with the control group, the patients with recurrent LPD showed significantly higher sagittal VMO elevation (10.4 ± 2.3 mm vs. 4.1 ± 1.9 mm), coronal VMO elevation (15.9 ± 5.7 mm vs. 3.9 ± 3.7 mm), muscle-fibre angulation (35.4 ± 8.0° vs. 27.9 ± 6.3°), patella tilt angle (25.9 ± 10.7° vs. 9.1 ± 5.2°), and bisect offset ratio values (0.9 ± 0.3 vs. 0.5 ± 0.1) and significantly lower craniocaudal extent (13.7 ± 5.3 mm vs. 16.7 ± 5.1 mm) and cross-sectional area ratio values (0.05 ± 0.02 vs. 0.07 ± 0.02).
CONCLUSIONS
The results showed that abnormalities in the VMO and patella tilt were clearly present in recurrent LPD patients compared with normal people.
Topics: Adolescent; Adult; Atrophy; Child; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Patella; Patellar Dislocation; Quadriceps Muscle; Recurrence; Retrospective Studies; Young Adult
PubMed: 33407236
DOI: 10.1186/s12880-020-00542-8 -
Cartilage Dec 2021This study aimed to systematically analyze the postoperative clinical, functional, and imaging outcomes, complications, reoperations, and failures following...
PURPOSE
This study aimed to systematically analyze the postoperative clinical, functional, and imaging outcomes, complications, reoperations, and failures following patellofemoral cartilage restoration surgery.
METHODS
This review was conducted according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). PubMed, EMBASE, and Cochrane Library databases were searched up to August 31, 2018, to identify clinical studies that assessed surgical outcomes of patellofemoral cartilage restoration surgery. The Methodological Index for Non-Randomized Studies (MINORS) was used to assess study quality.
RESULTS
Forty-two studies were included comprising 1,311 knees (mean age of 33.7 years and 56% males) and 1,309 patellofemoral defects (891 patella, 254 trochlear, 95 bipolar, and 69 multiple defects, including the patella or trochlea) at a mean follow-up of 59.2 months. Restoration techniques included autologous chondrocyte implantation (56%), particulated juvenile allograft cartilage (12%), autologous matrix-induced chondrogenesis (9%), osteochondral autologous transplantation (9%), and osteochondral allograft transplantation (7%). Significant improvement in at least one score was present in almost all studies and these surpassed the minimal clinically important difference threshold. There was a weighted 19%, 35%, and 6% rate of reported complications, reoperations, and failures, respectively. Concomitant patellofemoral surgery (51% of patients) mostly did not lead to statistically different postoperative outcomes.
CONCLUSION
Numerous patellofemoral restoration techniques result in significant functional improvement with a low rate of failure. No definitive conclusions could be made to determine the best surgical technique since comparative studies on this topic are rare, and treatment choice should be made according to specific patient and defect characteristics.
LEVEL OF EVIDENCE
Level IV, systematic review of level II to IV studies.
Topics: Adult; Aged; Cartilage Diseases; Cartilage, Articular; Chondrocytes; Female; Humans; Male; Middle Aged; Patella; Transplantation, Autologous
PubMed: 31845590
DOI: 10.1177/1947603519893076 -
Journal of Orthopaedic Surgery (Hong... 2019This study evaluated the functional and clinical outcomes of the subjects with symptomatic osteochondral lesions on articular surface of patella, who were treated with...
PURPOSE
This study evaluated the functional and clinical outcomes of the subjects with symptomatic osteochondral lesions on articular surface of patella, who were treated with autologous osteochondral transplantation (AOT) method.
STUDY PLAN
AOT method was applied for the treatment of 14 subjects (eight men and six women; mean age 29.7 years; range 19-49 years) with symptomatic patellar osteochondral lesions between March 2008 and April 2013. After a mean follow-up period of 3.7 years (range 32-80 months), pre- and postoperative clinical and functional evaluations of the patients were performed using Visual Pain Scale (VPS), Lysholm Knee Scoring Scale, and Kujala Anterior Knee Pain Scale. Wilcoxon test was used for statistical evaluation of pre- and postoperative outcomes. Improvement of the lesions was assessed by magnetic resonance imaging (MRI) at year 1 postoperatively at the earliest.
RESULTS
The mean lesion size was 1.32 cm (range 0.8-1.8 cm). The mean pre- and postoperative VPS values were calculated to be 75.5 ± 12.32 (range 46-92) and 17.57 ± 10.21 (range 0-40), respectively ( p < 0.01). The mean pre- and postoperative Lysholm knee scores were 44.57 ± 9.35 (range 26-65) and 80 ± 6.9 (range 70-94), respectively ( p < 0.01), and the mean pre- and postoperative Kujala anterior knee pain scores were 48.21 ± 7.78 (range 38-68) and 78.42 ± 7.06 (range 70-96), respectively ( p < 0.01). MRI taken at year 1 postoperatively showed that the autograft bone tissue was sufficiently incorporated into the recipient site in all patients; an even articular surface was formed, but the thickness of the cartilage tissue was mostly uneven between the adjacency of the recipient site and the autograft, which caused no negative effect on clinical and functional outcomes.
CONCLUSIONS
Despite the difference in thickness of the cartilage tissue between the recipient and the donor site, the AOT technique for the treatment of patellar osteochondral lesions resolves the symptoms of the patient and ensures an apparent functional and clinical improvement even if an articular surface could be created.
Topics: Adolescent; Adult; Arthroscopy; Bone Transplantation; Chondrocytes; Female; Follow-Up Studies; Humans; Knee Joint; Magnetic Resonance Imaging; Male; Middle Aged; Osteochondrosis; Patella; Postoperative Period; Time Factors; Transplantation, Autologous; Young Adult
PubMed: 31177943
DOI: 10.1177/2309499019851620 -
The Bone & Joint Journal Nov 2016Fractures around total knee arthroplasties pose a significant surgical challenge. Most can be managed with osteosynthesis and salvage of the replacement. The techniques... (Review)
Review
Fractures around total knee arthroplasties pose a significant surgical challenge. Most can be managed with osteosynthesis and salvage of the replacement. The techniques of fixation of these fractures and revision surgery have evolved and so has the assessment of outcome. This specialty update summarises the current evidence for the classification, methods of fixation, revision surgery and outcomes of the management of periprosthetic fractures associated with total knee arthroplasty. Cite this article: Bone Joint J 2016;98-B:1489-96.
Topics: Arthroplasty, Replacement, Knee; Evidence-Based Medicine; Femoral Fractures; Fracture Fixation, Internal; Humans; Knee Prosthesis; Patella; Periprosthetic Fractures; Prosthesis Failure; Radiography; Reoperation; Tibial Fractures
PubMed: 27803224
DOI: 10.1302/0301-620X.98B11.BJJ-2016-0029.R1 -
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 -
BMC Musculoskeletal Disorders Sep 2023To investigate the differences of patellofemoral joint pressure and contact area between the process of stair ascent and stair descent.
PURPOSE
To investigate the differences of patellofemoral joint pressure and contact area between the process of stair ascent and stair descent.
METHODS
The finite element models of 9 volunteers without disorders of knee (9 males) to estimate patellar cartilage pressure during the stair ascent and the stair descent. Simulations took into account cartilage morphology from magnetic resonance imaging, joint posture from weight-bearing magnetic resonance imaging, and ligament model. The three-dimension models of the patella, femur and tibia were developed with the medical image processing software, Mimics 11.1. The ligament was established by truss element of the non-linear FE solver. The equivalent gravity direction (-z direction) load was applied to the whole end of femur (femoral head) according to the body weight of the volunteers, and the force of patella was observed. A paired-samples t-test or Wilcoxon rank sum test to make comparisons between stair ascent and stair descent. Statistical analyses were performed using SPSS 22.0 using a P value of 0.05 to indicate significance.
RESULTS
During the stair descent (knee flexion at 30°), the contact pressure of the patella was 2.59 ± 0.06Mpa. The contact pressure of femoral trochlea cartilage was 2.57 ± 0.06Mpa. During the stair ascent (knee flexion at 60°), the contact pressure with patellar cartilage was 2.82 ± 0.08Mpa. The contact pressure of the femoral trochlea cartilage was 3.03 ± 0.11Mpa. The contact area between patellar cartilage and femoral trochlea cartilage was 249.27 ± 1.35mm during the stair descent, which was less than 434.32 ± 1.70mm during the stair ascent. The area of high pressure was located in the lateral area of patella during stair descent and the area of high pressure was scattered during stair ascent.
CONCLUSION
There are small change in the cartilage contact pressure between stair ascent and stair descent, indicating that the joint adjusts the contact pressure by increasing the contact area.
Topics: Male; Humans; Patellofemoral Joint; Knee Joint; Patella; Knee; Femur; Biomechanical Phenomena
PubMed: 37770867
DOI: 10.1186/s12891-023-06882-0 -
Knee Surgery, Sports Traumatology,... May 2022Focal, patellar cartilage defects are a challenging problem as most cases have an underlying multifactorial pathogenesis. This systematic review of current literature... (Review)
Review
Good clinical outcomes after patellar cartilage repair with no evidence for inferior results in complex cases with the need for additional patellofemoral realignment procedures: a systematic review.
PURPOSE
Focal, patellar cartilage defects are a challenging problem as most cases have an underlying multifactorial pathogenesis. This systematic review of current literature analysed clinical results after regenerative cartilage repair of the patella with a special focus on the assessment and treatment of existing patellofemoral malalignment.
METHODS
A systematic review was conducted to identify articles reporting clinical results after cartilage regenerative surgeries of the patella using the PubMed and Scopus database. The extracted data included patient-reported outcome measures (PROMS) and whether cartilage repair was performed alone or in combination with concomitant surgeries of underlying patellofemoral co-pathologies. In cases of isolated cartilage repair, specific exclusion criteria regarding underlying co-pathologies were screened. In cases of concomitant surgeries, the type of surgeries and their specific indications were extracted.
RESULTS
A total of 35 original articles were included out of which 27 (77%) were cohort studies with level IV evidence. The most frequently used technique for cartilage restoration of the patella was autologous chondrocyte implantation (ACI). Results after isolated cartilage repair alone were reported by 15 (43%) studies. Of those studies, 9 (60%) excluded patients with underlying patellofemoral malalignment a priori and 6 (40%) did not analyse underlying co-pathologies at all. Among the studies including combined surgeries, the most frequently reported concomitant procedures were release of the lateral retinaculum, reconstruction of the medial patellofemoral ligament (MPFL), and osteotomy of the tibial tubercle. In summary, these studies showed lower preoperative PROMS but similar final PROMS in comparison with the studies reporting on isolated cartilage repair. The most frequently used PROMS were the IKDC-, Lysholm- and the Modified Cincinnati Score.
CONCLUSION
This comprehensive literature review demonstrated good clinical outcomes after patellar cartilage repair with no evidence of minor results even in complex cases with the need for additional patellofemoral realignment procedures. However, a meaningful statistical comparison between isolated patellar cartilage repair and combined co-procedures is not possible due to very heterogeneous patient cohorts and a lack of analysis of specific subgroups in recent literature.
LEVEL OF EVIDENCE
Level IV.
Topics: Humans; Joint Instability; Knee Joint; Ligaments, Articular; Osteotomy; Patella; Patellar Dislocation; Patellofemoral Joint
PubMed: 34510221
DOI: 10.1007/s00167-021-06728-z -
Journal of Orthopaedic Surgery and... Jan 2021Whether resurface the patella or not in total knee arthroplasty (TKA) was controversial. In 2013, we conducted a meta-analysis of randomized controlled trials (RTCs).... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Whether resurface the patella or not in total knee arthroplasty (TKA) was controversial. In 2013, we conducted a meta-analysis of randomized controlled trials (RTCs). After that, plenty of studies have been carried out, but there still existed a great deal of controversy. In order to update our previous study, we conducted this update meta-analysis to evaluate the efficacy of patellar resurfacing in TKA.
METHODS
Databases were searched for RCTs comparing the outcomes of patellar resurfacing and nonresurfacing in TKA. Outcomes of knee relevant indicators were analysed. To see the short- and long-term effects, we calculated the data in total and divided the patients who were followed up for ≤ 3 years and ≥ 5 years into two subgroups as well.
RESULTS
Thirty-two trials assessing 6887 knees were eligible. There was a significant difference in terms of reoperation (in total and ≥ 5 years), Knee Society Score (KSS), function score (in total and ≥ 5 years) and noise. While no significant difference was found in the following items: reoperation (≤ 3 years), anterior knee pain (AKP), function score (≤ 3 years), range of motion (ROM), Oxford score, the Knee Injury and Osteoarthritis Outcome Score (KOOS), visual analogue score (VAS), Feller score, patellar tilt and the patients' satisfaction.
CONCLUSIONS
We found that patellar resurfacing could reduce the occurrence of reoperation and noise after surgery, as well as increase the KSS and function score, while it might not influence the outcomes such as AKP, ROM, Oxford score, KOOS, VAS, Feller score, patellar tilt and the patients' satisfaction. The results are different from our previous finding in the meta-analysis. In conclusion, we prefer patellar resurfacing in TKA.
Topics: Arthroplasty, Replacement, Knee; Female; Follow-Up Studies; Humans; Male; Patella; Randomized Controlled Trials as Topic; Reoperation; Time Factors; Treatment Outcome
PubMed: 33494774
DOI: 10.1186/s13018-020-02185-5 -
Orthopaedic Surgery Apr 2021To evaluate the patellar morphology of trochlear dysplasia and normal knees in different genders and in different severities of trochlear dysplasia on CT scans.
OBJECTIVE
To evaluate the patellar morphology of trochlear dysplasia and normal knees in different genders and in different severities of trochlear dysplasia on CT scans.
METHODS
A total of 75 patients with trochlear dysplasia (110 knees) treated at the Third Hospital of Hebei Medical University from December 2013 to December 2018 were included in an experimental group, and an age-matched and sex-matched cohort of 46 patients with normal trochlear shape (61 knees) were randomly selected into a control group. The experimental group was divided into a female experimental group (Group FE, 47 patients, 72 knees) and a male experimental group (Group ME, 28 patients, 38 knees); the control group was divided into a female control group (Group FC, 31 knees, 24 female patients) and a male control group (Group MC, 30 knees, 22 male patients). Furthermore, according to the severity of trochlear dysplasia, Group FE was divided into a female low-grade dysplasia group (Group FL, 20 knees) and a female high-grade dysplasia group (Group FH, 52 knees); Group ME was divided into a male low-grade dysplasia group (Group ML, 16 knees) and a male high-grade dysplasia group (Group MH, 22 knees). All participants had undergone CT scans in the supine position; the patellar width and thickness, the lateral patellar facet angle, the Wiberg angle, and the Wiberg index were measured and compared.
RESULTS
In trochlear dysplasia knees, the mean patellar width and thickness and the lateral patellar facet angle were significantly smaller; the mean Wiberg index was significantly larger than in normal knees, regardless of gender (P < 0.05); and there was no statistically significant difference in the mean Wiberg angle (P > 0.05). In the female groups, the mean patellar width and thickness and the Wiberg angle were significantly smaller; the mean lateral patellar facet angle was significantly larger than those in the male groups (P < 0.05); and there was no significant difference in the mean Wiberg index (P > 0.05). In the low-grade dysplasia group, the mean Wiberg index was smaller than that in the high-grade dysplasia group (P < 0.05), regardless of gender; however, there was no significant difference in the mean patellar width and thickness, the lateral patellar facet angle, and the Wiberg angle in low-grade and high-grade dysplasia (P > 0.05).
CONCLUSION
On CT scans, the patella in trochlear dysplasia had a smaller width, a thinner thickness, a lengthened lateral facet, and a more flattened articular facet. In addition, the patellar articular facet was more prominent in female patients. With the severity of trochlear dysplasia increased, the lateral patellar facet became longer. In addition, the abnormal stress distribution on the patella influenced the patellar morphology in trochlear dysaplasia.
Topics: Adult; Bone Diseases, Developmental; Female; Humans; Male; Patella; Patellofemoral Joint; Sex Factors; Tomography, X-Ray Computed; Young Adult
PubMed: 33491266
DOI: 10.1111/os.12825 -
Cartilage Dec 2021Chondral fractures are focal cartilage lesions without osseous attachment, most commonly seen in adolescent knees. They have limited capacity for intrinsic healing and...
OBJECTIVES
Chondral fractures are focal cartilage lesions without osseous attachment, most commonly seen in adolescent knees. They have limited capacity for intrinsic healing and traditional treatment has been removal of loose fragments. However, case reports of successful healing after fixation indicate that repair of the joint surface is possible. We wanted to evaluate the outcome in a cohort of patients who underwent fixation of acute chondral fractures in the knee.
DESIGN
Patients treated with fixation of a chondral fracture in the knee at our institution were invited to participate in a follow-up study. The mechanism of injury, fragment properties and complications were registered. Patients completed KOOS (Knee Injury and Osteoarthritis Outcome Score) and Lysholm questionnaires and performed a validated single leg hop test. Magnetic resonance imaging (MRI) was used to assess healing of the defect and the quality of the cartilage.
RESULTS
Ten patients with a median age at surgery of 15 years (12-17 years) and median follow-up of 5 years (2-9 years) were assessed. The lesions were located on the patella ( = 7), the trochlea ( = 2), and the lateral femoral condyle ( = 1). Median lesion size was 250 mm (1.9-6.0 cm) All patients were treated within 2 months of injury (4-58 days). All patients returned to preinjury level of sports and MRI showed retained fragments that integrated well with surrounding cartilage at follow-up. Mean Lysholm score at follow-up was 90 (73-100).
CONCLUSION
Fixation of traumatic chondral-only fragments using bioabsorbable implants may result in successful healing in adolescent patients and should be considered a treatment option in acute injuries.
Topics: Adolescent; Arthroscopy; Athletic Injuries; Cartilage, Articular; Female; Follow-Up Studies; Fractures, Cartilage; Humans; Knee Joint; Magnetic Resonance Imaging; Male; Patella; Postoperative Complications; Pregnancy
PubMed: 32672055
DOI: 10.1177/1947603520941213