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BMJ Case Reports Mar 2022Acute patella dislocations account for approximately 2%-3% of knee injuries and are therefore a relatively common presentation in the accident and emergency department....
Acute patella dislocations account for approximately 2%-3% of knee injuries and are therefore a relatively common presentation in the accident and emergency department. The majority of patella dislocations can be reduced with simple manoeuvres or even spontaneously and can be managed conservatively by bracing and rehabilitation. The aim of this study is to identify and review the main causes of the unique and unexpected event of irreducible patella dislocation and their characteristic presentations. Irreducible patella dislocations can happen but are very rare. Currently, a limited number of case reports are available, prompting for a need for research on this topic. This case study can shed light on the possible pathogenesis and pathognomonic features of irreducible patella dislocations and provide insight on the available therapeutic approaches.
Topics: Humans; Joint Dislocations; Knee Injuries; Patella; Patellar Dislocation
PubMed: 35264391
DOI: 10.1136/bcr-2021-248398 -
Scientific Reports May 2022The relationship between the morphological characteristics of the infrapatellar fat pad (IFP) and joint deformity has yet to be fully elucidated. Therefore, the purpose...
The relationship between the morphological characteristics of the infrapatellar fat pad (IFP) and joint deformity has yet to be fully elucidated. Therefore, the purpose of this study was to clarify the morphological characteristics of the IFP and to identify the relationships between morphological characteristics of the IFP and degenerative grade of the articular surface of the patella. This investigation examined 41 legs from 25 Japanese cadavers. The IFP length, width, and volume were measured. It was categorized into three types: Type I, IFP proximal located on medial and lateral sides of the patella; Type II, the IFP proximal only located medially; and Type III, absence of the IFP proximal. Articular surfaces were graded as macroscopically intact or mildly altered (Grade I), moderately (Grade II), or severely (Grade III). Grade III was significantly more frequent than Grades I or II in Type III. IFP volume was significantly larger in Type I than in Types II or III. A negative correlation was found between the degenerative grade of the articular surface of the patella and IFP volume. It was suggested that a relationship between the degenerative grade of the articular surface of the patella and the IFP volume.
Topics: Adipose Tissue; Cadaver; Humans; Knee Joint; Patella
PubMed: 35624138
DOI: 10.1038/s41598-022-12859-1 -
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 -
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 -
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 -
Clinics in Orthopedic Surgery Feb 2023Patella baja with patellar tendon shortening due to traumatic or ischemic injury is a widely known complication after primary total knee arthroplasty (TKA)....
BACKGROUND
Patella baja with patellar tendon shortening due to traumatic or ischemic injury is a widely known complication after primary total knee arthroplasty (TKA). Pseudo-patella baja may arise from the elevation of the joint line after excessive distal femoral resection. The maintenance of original patellar height is important in revision TKA because postoperative patella baja and pseudo-patella baja can cause inferior biomechanical and clinical results. We investigated the incidence and risk factors of patella baja and pseudo-patella baja after revision TKA.
METHODS
We retrospectively reviewed data for 180 revision TKAs. Patella baja was defined as a truly low-lying patella with an Insall-Salvati ratio (ISR) of < 0.8 and a Blackburne-Peel ratio (BPR) of < 0.54. Pseudo-patella baja was defined as a relatively low-lying patella compared to the joint line within the normal range of ISR and with a BPR of < 0.54. Clinically, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and range of motion (ROM) were evaluated. Risk factors increasing the incidence of patella baja and pseudo-patella baja after revision TKA were evaluated using multiple regression analysis.
RESULTS
Before revision TKA, 169 knees did not exhibit patella baja or pseudo-patella baja, while 9 knees showed patella baja and 2 knees exhibited pseudo-patella baja. At 2 years after revision TKAs, 25 knees (13.9%) showed patella baja and 23 knees (12.8%) exhibited pseudo-patella baja. Despite no differences in the postoperative WOMAC score between groups with and without patella baja and pseudo-patella baja, the postoperative ROM was significantly smaller in the group with patella baja (113.3°) or pseudo patella baja (110.5°) than in the normal group (122.0°). Infection as the cause of revision TKA increased the risk of patella baja (odds ratio, 10.958; < 0.001), and instability increased the risk of pseudo-patella baja (odds ratio, 11.480; < 0.001).
CONCLUSIONS
Infection and instability resulted in increases in the incidence of patella baja and pseudo-patella baja after revision TKA. Information about the risk factors of patella baja and pseudo-patella baja will help TKA surgeons plan the height of the patella after revision TKA and improve clinical outcomes.
Topics: Humans; Arthroplasty, Replacement, Knee; Knee Joint; Patella; Retrospective Studies; Femur; Joint Diseases; Range of Motion, Articular
PubMed: 36778990
DOI: 10.4055/cios21154 -
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 -
Journal of Orthopaedic Surgery and... Mar 2021The decision to resurface the patella as part of total knee arthroplasty may be influenced by the surgeon's preference, education, training, tradition and geographic... (Comparative Study)
Comparative Study Review
BACKGROUND
The decision to resurface the patella as part of total knee arthroplasty may be influenced by the surgeon's preference, education, training, tradition and geographic location. Advocates for non-resurfacing or selectively resurfacing may claim no difference in patient reported outcomes, and that resurfacing is associated with increased risks such as extensor mechanism injury or malalignment, problems with the design of the patella component and technical issues intraoperatively.
AIMS
To critically examine factors that should be considered in addition to patient reported outcomes in the decision process of resurfacing or non-resurfacing of the patella in total knee arthroplasty.
METHOD
A comprehensive literature search was conducted to identify factors that may influence decision making in addition to knee specific patient reported outcome measures such as surgical risks, patient quality of life, procedure cost, re-operation rate, implant design, surgeons learning curve and the fate of remaining cartilage in native patellae.
RESULTS
Patient-reported outcomes are equivocal for resurfacing and non-resurfacing. Critical analysis of the available literature suggests that the complications of resurfacing the patella are historic, which is now lower with improved implant design and surgical technique. Routine resurfacing was cost-effective in the long term (potential saving £104 per case) and has lower rates of revision (absolute risk reduction 4%). Finally, surgical judgment in selective resurfacing was prone to errors.
CONCLUSION
Patella resurfacing and non-resurfacing had similar patient-reported outcomes. However, patella resurfacing was cost-effective and was associated with a lower rate of re-operation compared to non-resurfacing.
Topics: Arthroplasty, Replacement, Knee; Cost-Benefit Analysis; Humans; Patella; Reoperation
PubMed: 33706779
DOI: 10.1186/s13018-021-02295-8