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Musculoskeletal Surgery Jun 2023Patella maltracking is among the most frequent causes of poor outcomes and early failure after total knee arthroplasty (TKA), with an incidence that ranges from 1 to... (Review)
Review
PURPOSE
Patella maltracking is among the most frequent causes of poor outcomes and early failure after total knee arthroplasty (TKA), with an incidence that ranges from 1 to 20%. Even if there is agreement between authors regarding the preoperative and intraoperative management of patella maltracking in TKA, less clear are postoperative conducts. The purpose of this systematic review is to summarize and compare surgical techniques used to treat patella maltracking after TKA.
METHODS
A systematic review of the literature was performed with a primary search on Medline through PubMed. The PRISMA 2009 flowchart and checklist were used to edit the review. Screened studies had to provide clinical, functional and radiological results and complications of the proposed treatment to be included in the review.
RESULTS
A total of 21 articles were finally included. Three main types of surgical procedures and other minor techniques have been identified to manage patella maltracking after TKA. The choice of the proper technique to use in the specific case depends on several factors, first of all the malpositioning of the prosthetic components.
CONCLUSION
Patella maltracking after TKA represents a frequent and challenging problem for orthopedic surgeons. Treatments described in the literature are often able to correct an abnormal patellar tracking; nevertheless, authors report variable percentages of residual knee pain and dissatisfaction in re-treated patients. Therefore, it would be desirable to prevent the maltracking condition at the time of primary arthroplasty, using proper surgical precautions.
Topics: Humans; Arthroplasty, Replacement, Knee; Patella; Knee Joint; Radiography
PubMed: 36197592
DOI: 10.1007/s12306-022-00764-9 -
The Journal of Knee Surgery Apr 2022Knee dislocations, aka multiligamentous injuries, are uncommon but devastating injuries often following high-energy trauma. Tears of the major knee stabilizers are well... (Review)
Review
Knee dislocations, aka multiligamentous injuries, are uncommon but devastating injuries often following high-energy trauma. Tears of the major knee stabilizers are well documented; however, injuries of the knee extensor mechanism are less commonly reported. The extensor mechanism is comprised of the patella, patellar tendon, and quadriceps tendons. Magnetic resonance imaging (MRI) is the preferred imaging modality of internal derangements of the knee due to its excellent soft tissue contrast. In this article, we will discuss the normal imaging findings of the extensor mechanism and review abnormalities following knee dislocation.
Topics: Humans; Knee Dislocation; Knee Injuries; Knee Joint; Patella; Patellar Ligament; Tendon Injuries
PubMed: 35226944
DOI: 10.1055/s-0042-1743224 -
Environmental Health : a Global Access... Dec 2021Lead (Pb) exposure is a global health hazard causing a wide range of adverse health outcomes. Yet, the mechanisms of Pb toxicology remain incompletely understood,...
BACKGROUND
Lead (Pb) exposure is a global health hazard causing a wide range of adverse health outcomes. Yet, the mechanisms of Pb toxicology remain incompletely understood, especially during pregnancy. To uncover biological pathways impacted by Pb exposure, this study investigated serum metabolomic profiles during the third trimester of pregnancy that are associated with blood Pb and bone Pb.
METHODS
We used data and specimens from 99 women enrolled in the Programming Research in Obesity, Growth, Environment, and Social Stressors birth cohort in Mexico City. Maternal Pb exposure was measured in whole blood samples from the third trimester of pregnancy and in the tibia and patella bones at 1 month postpartum. Third-trimester serum samples underwent metabolomic analysis; metabolites were identified based on matching to an in-house analytical standard library. A metabolome-wide association study was performed using multiple linear regression models. Class- and pathway-based enrichment analyses were also conducted.
RESULTS
The median (interquartile range) blood Pb concentration was 2.9 (2.6) µg/dL. Median bone Pb, measured in the tibia and patella, were 2.5 (7.3) µg/g and 3.6 (9.5) µg/g, respectively. Of 215 total metabolites identified in serum, 31 were associated with blood Pb (p < 0.05). Class enrichment analysis identified significant overrepresentation of metabolites classified as fatty acids and conjugates, amino acids and peptides, and purines. Tibia and patella Pb were associated with 14 and 8 metabolites, respectively (p < 0.05). Comparing results from bone and blood Pb, glycochenodeoxycholic acid, glycocholic acid, and 1-arachidonoylglycerol were positively associated with blood Pb and tibia Pb, and 7-methylguanine was negatively associated with blood Pb and patella Pb. One metabolite, 5-aminopentanoic acid, was negatively associated with all three Pb measures.
CONCLUSIONS
This study identified serum metabolites in pregnant women associated with Pb measured in blood and bone. These findings provide insights on the metabolic profile around Pb exposure in pregnancy and information to guide mechanistic studies of toxicological effects for mothers and children.
Topics: Child; Female; Humans; Lead; Maternal Exposure; Mexico; Patella; Pregnancy; Pregnant Women
PubMed: 34893088
DOI: 10.1186/s12940-021-00810-2 -
Computational and Mathematical Methods... 2022Memory alloy patella claws for treating patella fractures have been used for more than 30 years with many desirable features including fast healing, quick recovery, and...
Memory alloy patella claws for treating patella fractures have been used for more than 30 years with many desirable features including fast healing, quick recovery, and avoidance of top abrasion of Kirschner wires and other complications. However, there are many models and it is difficult to choose the accurate claw for the patient. In this study, a finite element model of the butterfly-shaped patellar claw made of shape memory alloy was established, its mechanical structure was analyzed, and its clinical application was monitored. We used Solidworks Simulation software for modeling and mainly analyzed the force of the compression ring of the butterfly-shaped patellar claw. Clinically, we chose a closed fresh patella fracture case. After finite element analysis, the maximum stress that the compression ring of the butterfly-shaped patellar claw can withstand is 568.1 MPa. In this range, it always has elastic deformation resistance. The butterfly-shaped patella claw is fixed on the patella and will not break when subjected to a maximum force of 150 N on the encircling arm, and at the same time, there will be no pressure failure due to plastic deformation. A total of 27 cases were clinically used for the assessment of the clinical efficacy of the newly designed butterfly-shaped patella claws. The average follow-up time was 15.5 months, and the average fracture healing time was 8-12 weeks. All patients can get out of bed with crutches within 2 to 3 days after surgery. Among them, there were 15 cases with excellent functional ratings, 10 cases with good ratings, 2 cases with acceptable ratings, and no cases with poor ratings. The designed butterfly-shaped patella claws can provide an effective method for the treatment of patella fractures.
Topics: Adolescent; Adult; Biomechanical Phenomena; Computational Biology; Computer Simulation; Computer-Aided Design; Elastic Modulus; Female; Finite Element Analysis; Fracture Fixation, Internal; Humans; Internal Fixators; Intra-Articular Fractures; Male; Middle Aged; Nickel; Patella; Prosthesis Design; Shape Memory Alloys; Software; Stress, Mechanical; Tensile Strength; Titanium; Treatment Outcome; Young Adult
PubMed: 35154357
DOI: 10.1155/2022/2008668 -
European Journal of Orthopaedic Surgery... Oct 2023Periprosthetic patella fractures (PPPFs) are infrequent but potentially devastating complications after total knee arthroplasty (TKA) and revision TKA (rTKA). These... (Review)
Review
Periprosthetic patella fractures in total knee replacement and revision surgeries: how to diagnose and treat this rare but potentially devastating complication-a review of the current literature.
PURPOSE
Periprosthetic patella fractures (PPPFs) are infrequent but potentially devastating complications after total knee arthroplasty (TKA) and revision TKA (rTKA). These fractures may occur both in resurfaced and un-resurfaced patella. This review summarizes the current literature on PPPFs to help orthopedic surgeons diagnose and treat this uncommon but extremely challenging TKA complication.
METHODS
A comprehensive search was performed in three databases: PubMed, SCOPUS, and EMBASE. All relevant information was retrieved and summarized in this narrative review.
RESULTS
In the studies analyzed, there is a general trend in favor of nonsurgical treatment, except for implant loosening or extensor lag with extensor apparatus disruption, because surgery is often associated with poor clinical outcomes and high complication rates.
CONCLUSION
PPPF is a rare but catastrophic event in TKA and rTKA, occurring mainly in a reconstructed patella. Patient-, implant-, and surgical technique-related factors contribute to its multifactorial etiopathogenesis. Prevention plays a crucial role in reducing the PPPFs rate. Conservative management is the treatment of choice due to high surgery complication rates unless implant loosening, or extensor apparatus disruption occurs.
Topics: Humans; Arthroplasty, Replacement, Knee; Reoperation; Patella; Patella Fracture; Periprosthetic Fractures; Knee Injuries; Knee Prosthesis
PubMed: 37000239
DOI: 10.1007/s00590-023-03535-9 -
The Journal of International Medical... Apr 2020To compare a modified two-tension-band (MTTB) technique with the AO tension band in treating patellar fractures.
OBJECTIVE
To compare a modified two-tension-band (MTTB) technique with the AO tension band in treating patellar fractures.
METHODS
This retrospective study included patients treated with AO tension band (group 1) or MTTB (group 2). Data obtained during serial follow-up evaluations of time to bony union, range of motion (ROM), Hospital for Special Surgery (HSS) score and complication rates, were analysed.
RESULTS
Fractures healed in all 51 patients included in the study (group 1, = 28; group 2, = 23), with no statistically significant between-group difference in time to bony union. Regarding function results, group 2 had better HSS scores at 3 and 6 months postoperatively; however, at 1 year postoperatively, both groups had similar HSS scores and achieved acceptable flexion and ROM. The overall complication rate was significantly lower in group 2, but average costs were higher in group 2 versus group 1.
CONCLUSION
MTTB provides secure fixation and improved knee function at 3 and 6 months postoperatively, and has a lower complication rate with early mobilization, compared with the AO tension-band technique.
Topics: Bone Screws; Bone Wires; Fracture Fixation, Internal; Fractures, Bone; Humans; Patella; Retrospective Studies; Treatment Outcome
PubMed: 31878827
DOI: 10.1177/0300060519893495 -
Journal of Orthopaedic Research :... Aug 2022We combined mobile biplane X-ray imaging and magnetic resonance imaging to measure the regions of articular cartilage contact and cartilage thickness at the tibiofemoral...
We combined mobile biplane X-ray imaging and magnetic resonance imaging to measure the regions of articular cartilage contact and cartilage thickness at the tibiofemoral and patellofemoral joints during six functional activities: standing, level walking, downhill walking, stair ascent, stair descent, and open-chain (non-weight-bearing) knee flexion. The contact centers traced similar paths on the medial and lateral femoral condyles, femoral trochlea, and patellar facet in all activities while their locations on the tibial plateau were more varied. The translations of the contact centers on the femur and patella were tightly coupled to the tibiofemoral flexion angle in all activities (r > 0.95) whereas those on the tibia were only moderately related to the flexion angle (r > 0.62). The regions of contacting cartilage were significantly thicker than the regions of non-contacting cartilage on the patella, femoral trochlea, and the medial and lateral tibial plateaus in all activities (p < 0.001). There were no significant differences in thickness between contacting and non-contacting cartilage on the medial and lateral femoral condyles in all activities, except open-chain knee flexion. Our results provide partial support for the proposition that cartilage thickness is adapted to joint load and do not exclude the possibility that other factors, such as joint congruence, also play a role in regulating the structure and organization of healthy cartilage. The data obtained in this study may serve as a guide when evaluating articular contact motion in osteoarthritic and reconstructed knees.
Topics: Biomechanical Phenomena; Cartilage, Articular; Femur; Humans; Knee; Knee Joint; Magnetic Resonance Imaging; Patella; Range of Motion, Articular; Tibia
PubMed: 34878691
DOI: 10.1002/jor.25222 -
Biomedical Journal Oct 2023Pain-associated knee joint disorders are common in daily life. Practically, knee pain should be divided into the origin from the isolated tibiofemoral (TF), isolated... (Review)
Review
Pain-associated knee joint disorders are common in daily life. Practically, knee pain should be divided into the origin from the isolated tibiofemoral (TF), isolated patellofemoral (PF) joint, or a combination thereof. The TF joint controls the actions of level walking, while the PF joint controls knee flexion-extension. Owing to its sufficient inherent stability, non-traumatic disorders of the isolated TF joint in young individuals are uncommon. In contrast, because of its insufficient inherent stability, non-traumatic disorders of the isolated PF joint are common in young individuals. Patellar malalignment (PM) associated with knee pain is common in all age groups, and the most common predisposing factor is imbalanced peripatellar soft-tissue tension. The outward forces acting on the patella are caused by pulling from the quadriceps femoris during knee flexion to extension (manifested by the quadriceps angle [Q-angle]), and sliding backward of the iliotibial band (ITB) during knee extension to flexion. Once the muscle power of the vastus medialis (especially the vastus medialis obliquus [VMO]) decreases, which lowers the counteracting effect against outward forces, the patella displaces or rotates laterally. The reduced contact surface between the patella and the femoral condyle significantly increases the compressive pressure and injures the articular cartilage. Subsequently, progressive PF degeneration occurs. Although other factors may also cause PM, they are relatively uncommon. In principle, nonsurgical treatment of PM should be considered first, while surgical treatment should follow established indications. Some nonsurgical techniques are currently widely used that feature high satisfaction rates. Surgical techniques are continuously being developed, and their success rates have gradually improved. This study aimed to review the current literature for relevant studies and report related publications of the author's institution to emphasize the universality and importance of PM management. Conceptually, simply focusing on problems of the TF joint cannot treat all knee disorders.
Topics: Humans; Patella; Knee Joint; Patellofemoral Joint; Quadriceps Muscle; Pain
PubMed: 37678711
DOI: 10.1016/j.bj.2023.100658 -
Aging Dec 2020In this study, we investigated whether the measurement of patellar tracking can be used as a diagnostic parameter of patellofemoral joint disease. Patellar tracking is... (Review)
Review
In this study, we investigated whether the measurement of patellar tracking can be used as a diagnostic parameter of patellofemoral joint disease. Patellar tracking is defined as the movement of the patella in relation to the femorotibial joint within the full range of flexion and extension of the knee joint. The PubMed, EMBASE, Medline, PsychINFO, and AMED databases were used to find relevant articles. Analyzed were the patellar tracking coordinate system and the measurement objects, precision, methods used in those studies, as well as the results obtained. Origin points for coordinate systems varied across the studies. The research object and methods of patellar tracking varied in the studies. Most studies focused on a static description of the internal and external displacement and the internal and external inclination. The , noninvasive, and six degrees of freedom evaluation of patellar tracking reflect patellar motion more comprehensively, though each of these methods does so in different ways. Dynamic and quantitative evaluation of patellar tracking is still lacking in clinical work. Accurate and quantitative patellar tracking measurement could provide clinicians with a comprehensive evaluation of the stability of the knee joint.
Topics: Biomechanical Phenomena; Humans; Knee Joint; Patella; Patellofemoral Joint; Range of Motion, Articular
PubMed: 33260153
DOI: 10.18632/aging.202161 -
Scientific Reports Dec 2022The positional relationship between patellar and femoral articular surfaces may vary according to the degree of posterior rotation of the tibial condyle, which may...
The positional relationship between patellar and femoral articular surfaces may vary according to the degree of posterior rotation of the tibial condyle, which may influence the patellar configuration. We hypothesized that the configuration of the patella has a rhomboid transformation similar to that of the tibial condyle. This cohort study included 313 patients with knee pain who underwent lateral-view knee digital radiography. The length of the long axis, short axis of the patella, and patellar tendon length of the patellofemoral joint were measured. The patella axis ratio (length of long/short axis) as patellar configuration and Insall-Salvati ratio were calculated. Correlations between the configuration of the tibial condyle and the three length parameters and the Insall-Salvati ratio were assessed. Posterior rotation and the rhomboid transformation of the tibial condyle were positively correlated with the length of the long axis of the patella and negatively correlated with the Insall-Salvati ratio. The more the tibial articular surface shifted posteriorly due to posterior rotation and rhomboid transformation of the tibial condyle, the longer the long axis of the patella was, and the smaller the Insall-Salvati ratio was. The long axis of the patella became longer due to rhomboid transformation, similar to the tibial condyle.
Topics: Humans; Cohort Studies; Patella; Tibia; Patellar Ligament; Knee Joint
PubMed: 36528672
DOI: 10.1038/s41598-022-26459-6