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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 -
Journal of Orthopaedic Surgery and... Mar 2023Patellar height is a risk factor for patellar instability, correlated with the tibia length/femur length (T/F) ratio. This study aimed to explore the changes in the T/F...
PURPOSE
Patellar height is a risk factor for patellar instability, correlated with the tibia length/femur length (T/F) ratio. This study aimed to explore the changes in the T/F ratio in patients with patella instability and the potential correlation with the morphology of the patellofemoral joint and extensor moment arm.
METHOD
A retrospective analysis was performed to assess the ratio of lower limb length morphological characteristics of the patellofemoral by full weight-bearing long-leg standing radiographs, magnetic resonance imaging, and computed tomography in 75 patients with patellar instability and 75 participants from a randomly selected control group from January 2020 to September 2021. A total of eight parts were measured, including mechanical tibia length/femur length (mT/F) ratio, anatomical tibia length/femur length (aT/F) ratio, hip-knee-ankle angle, femoral neck-shaft angle, femoral valgus cut angle, patellar height, Dejour classification, sulcus angle, trochlear angle, medial trochlear inclination, lateral trochlear inclination, patella tilt angle and patellar tendon moment arm to evaluate the difference of morphology between patient group and control groups.
RESULTS
The mT/F (0.840 ± 0.031 vs. 0.812 ± 0.026, p < 0.001) and aT/F (0.841 ± 0.033 vs. 0.808 ± 0.028, p < 0.001) ratios in the patient group were significantly greater than that in the control group. There was a significant correlation between patellar height and increased mT/F and aT/F ratios (p < 0.05).
CONCLUSION
Patients with patellar instability had a larger lower limb length ratio, and the change in lower limb length ratio was correlated with patellar height.
Topics: Humans; Joint Instability; Knee Joint; Lower Extremity; Patella; Patellar Dislocation; Patellofemoral Joint; Retrospective Studies; Tibia; Case-Control Studies
PubMed: 36945045
DOI: 10.1186/s13018-023-03720-w -
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... Feb 2022This systematic review evaluated the clinical outcomes of hardware-free MPFL reconstruction techniques in patients with recurrent patellofemoral instability, focusing on... (Review)
Review
PURPOSE
This systematic review evaluated the clinical outcomes of hardware-free MPFL reconstruction techniques in patients with recurrent patellofemoral instability, focusing on patient-reported outcome measures (PROMs), redislocation rate, and complications. The hypothesis was that hardware-free MPFL reconstruction in patients with recurrent patellofemoral instability is safe and effective.
METHODS
This systematic review was conducted following the PRISMA guidelines. PubMed, Scopus, and Virtual Health Library databases were accessed in October 2021. All the clinical studies investigating the efficacy and feasibility of hardware-free MPFL reconstruction were screened for inclusion. Only studies with a minimum 24-month follow-up were considered eligible. Kujala Anterior Knee Pain Scale improvement and redislocation rate after surgical treatment were evaluated as primary outcomes. The rate of postoperative complications was evaluated as a secondary outcome. The quality of the methodological assessment was assessed using the Modified Coleman Methodology Score.
RESULTS
Eight studies were included in the present systematic review. The quality of the methodological assessment was moderate. Short- to long-term improvement of Kujala score was observed in all included studies. Mean score improvement ranged from + 13.2/100 to + 54/100, with mean postoperative scores ranging from 82/100 to 94/100. Patellar redislocation was observed in 8.33% (8 of 96) patients.
CONCLUSION
Hardware-free MPFL reconstruction with or without associated soft-tissue or bony realignment procedures provided reliable clinical improvements and was associated with a low rate of redislocation in patients with recurrent patellofemoral instability. Advantages such as safety, femoral physis preservation, and comparable complication profiles with implant-based techniques endorse its implementation. Orthopedic surgeons in cost-sensitive environments may also benefit their patients with lower costs, no need for implants, lack of implant-related complications, or surgery for implant removal.
LEVEL OF EVIDENCE
Level IV.
Topics: Humans; Joint Instability; Ligaments, Articular; Orthopedic Procedures; Patella; Patellar Dislocation; Patellofemoral Joint; Postoperative Complications
PubMed: 35193641
DOI: 10.1186/s13018-022-03008-5 -
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 -
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 -
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 -
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 Veterinary Science Sep 2020An inappropriate Q angle may affect the biomechanics of the canine patellofemoral joint.
BACKGROUND
An inappropriate Q angle may affect the biomechanics of the canine patellofemoral joint.
OBJECTIVES
The purpose of this study was to evaluate the effects of changes in quadriceps angle (Q angle) on patellofemoral joint pressure distribution in dogs.
METHODS
Eight stifles were positioned at 45, 60, 75, 90, 105, and 120° of flexion , and 30% body weight was applied through the quadriceps. Patellofemoral contact pressure distribution was mapped and quantified using pressure-sensitive film. For the pressure area, mean pressure, peak pressure, medial peak pressure, and lateral peak pressure, differences between groups according to conditions for changing the Q angle were statistically compared.
RESULTS
Increases of 10° of the Q angle result in increases in the pressure area ( = 0.04), mean pressure ( = 0.003), peak pressure, and medial peak pressure ( ≤ 0.01). Increasing the Q angle by 20° increases the pressure area ( = 0.021), mean pressure ( ≤ 0.001), peak pressure ( ≤ 0.01), and medial peak pressure ( ≤ 0.01) significantly, and shows higher mean ( ≤ 0.001) and peak pressures than increasing by 10°. Decreasing the Q angle increases the mean pressure ( = 0.013), peak pressure, and lateral peak pressure ( ≤ 0.001).
CONCLUSIONS
Both increases and decreases in the Q angle were associated with increased peak patellofemoral pressure, which could contribute to the overloading of the cartilage. Therefore, the abnormal Q angle should be corrected to the physiologically normal value during patellar luxation repair and overcorrection should be avoided.
Topics: Animals; Biomechanical Phenomena; Cadaver; Dogs; Femur; Patella; Pressure; Range of Motion, Articular
PubMed: 33016016
DOI: 10.4142/jvs.2020.21.e69 -
Journal of Orthopaedic Surgery and... Jan 2021The double-bundle technique with two points of patellar fixation in the upper half of the patella replicating the broad attachment site of the native medial...
Reconstruction of the medial patellofemoral ligament using two blind transverse semi-patella tunnels and an implant-free technique for patellar fixation: a technical note.
BACKGROUND
The double-bundle technique with two points of patellar fixation in the upper half of the patella replicating the broad attachment site of the native medial patellofemoral ligament (MPFL) is the most commonly performed procedure for MPFL reconstruction. Complete transverse patella tunnels pose a threat to the integrity of the patella. We present an implant-free, double-bundle technique for MPFL reconstruction with gracilis autograft, overcoming the problem of complete patella bone tunnels and over-drilling.
METHODS
After standard gracilis graft harvesting, the anteromedial side of the patella is exposed. With the guidance of an anterior-cruciate-ligament (ACL) tibia-aiming device, two 2-mm parallel guide pins are inserted from medial to lateral at the upper half of the patella. The two guide pins are over-drilled with a cannulated 4.5-mm drill bit 2-cm deep, to create two transverse blind semi-patellar tunnels. For the femoral fixation, a 2.4-mm guide pin with an eyelet is drilled at the Schöttle point and over-reamed with a 6-mm cannulated reamer to a depth of 30 mm. The two free ends of the graft (with two running Krakow sutures placed) are pulled into the two patella tunnels and the graft sutures are tied together with tension for stable graft fixation at the lateral patella rim. With the help of a femoral suture loop (which is inserted in the femoral bone tunnel), the graft-loop is advanced into the femoral bone tunnel and the graft is finally fixed with a 7-mm interference screw at 30° of knee flexion.
RESULTS
The utilization of blind transverse tunnels (not trans-patellar tunnels) offers the advantage of avoiding stress risers at the patella. Thanks to the ACL tibia aiming device, multiple drilling, and breaching of the anterior patellar cortex or articular surface of the patella is avoided.
CONCLUSIONS
This implant-free, and consequently affordable technique, isolated or combined with bony procedures, minimizes possibilities for perioperative bony complications at the patella fixation site.
Topics: Gracilis Muscle; Humans; Ligaments, Articular; Orthopedic Procedures; Patella; Patellofemoral Joint; Plastic Surgery Procedures; Transplantation, Autologous
PubMed: 33413498
DOI: 10.1186/s13018-020-02161-z