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European Journal of Trauma and... Dec 2022Basic epidemiological data on patella fractures derived from large nationwide and multicenter studies are scarce. This observational register study describes patient... (Observational Study)
Observational Study
BACKGROUND
Basic epidemiological data on patella fractures derived from large nationwide and multicenter studies are scarce. This observational register study describes patient epidemiology, fracture classification and treatment of patella fractures in adults in a Swedish population.
METHODS
We conducted an observational study on data derived from the Swedish Fracture Register (SFR) on all patella fractures classified as non-periprosthetic and non-pathological, registered between 2014 and 2018 in individuals aged ≥ 18years. Epidemiological data on sex, age, side, seasonal variation, trauma mechanism, fracture classification (according to AO/OTA), and treatment were analyzed.
RESULTS
3194 patella fractures were analyzed, occurring at a median age of 67 (range 19-100) years. 64% of all patients were female. Most fractures were caused by low-energy trauma, with 70% due to falling from a standing height. 1796 (56%) of the fractures were transverse compared to 845 (26%) vertical fractures. Most fractures (N=2148, 67%) were treated non-operatively. Operative treatment consisted mainly of Tension Band Wiring (TBW) performed in 774 (24%) patients.
CONCLUSIONS
Patella fractures mainly occur in elderly women (> 65 years), commonly caused by low-energy trauma. The main treatment is non-operative (67%), except for transverse (AO/OTA C3) fractures. TBW remains the most used operative treatment of choice. These results may help health care providers, researchers and clinicians better understand the panorama of patella fractures in Sweden.
Topics: Adult; Aged; Humans; Female; Young Adult; Middle Aged; Aged, 80 and over; Male; Patella; Sweden; Registries; Fractures, Bone; Fracture Fixation, Internal; Knee Injuries
PubMed: 35644894
DOI: 10.1007/s00068-022-01993-0 -
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 -
PloS One 2022The patella-patellar tendon angle (PPTA) assessing the sagittal patellar tilt was reported to be related with anterior knee pain. Herein, clinical effect of PPTA in...
The patella-patellar tendon angle (PPTA) assessing the sagittal patellar tilt was reported to be related with anterior knee pain. Herein, clinical effect of PPTA in patients with medial patellar plica (MPP) syndrome, chondromalacia patella, and infrapatellar fat pad (IPFP) syndrome, the most common causes of anterior knee pain, was evaluated. In this retrospective study, 156 patients with anterior knee pain who underwent magnetic resonance imaging (MRI) and arthroscopic surgery that confirmed isolated MPP syndrome, chondromalacia patella, or IPFP syndrome from June 2011 to January 2021 were included in the study group and 118 patients without knee pathology on MRI during the same period were included in the control group. The PPTA was measured on knee MRI and compared between the two groups. A receiver operating characteristic (ROC) analysis was used to evaluate the value of PPTA for predicting the risk of patellofemoral joint disorder. The mean PPTA was significantly smaller in study group (138.1 ± 4.2°) than control group (142.1 ± 4.3°) (p < 0.001). However, there was no significant difference in PPTA among the patients with MPP syndrome, chondromalacia patella, and IPFP syndrome. Furthermore, the ROC analysis revealed that the area under curve, sensitivity, and specificity for predicting the risk of patellofemoral joint disorders were 0.696, 70.3% and 57.6%, respectively, at a PPTA cutoff of 138.3°. Therefore, the smaller PPTA may be associated with MPP syndrome, chondromalacia patella, and IPFP syndrome. Furthermore, PPTA could be a predictive factor for the risk of patellofemoral joint disease in patients with anterior knee pain.
Topics: Adipose Tissue; Cartilage Diseases; Humans; Joint Diseases; Knee Joint; Lipomatosis; Magnetic Resonance Imaging; Obesity; Pain; Patella; Patellar Ligament; Retrospective Studies; Synovitis
PubMed: 35298516
DOI: 10.1371/journal.pone.0265331 -
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 -
Orthopaedics & Traumatology, Surgery &... Nov 2021Symptomatic Ligamentous Genu Recurvatum (SLGR) is characterized by an asymmetrical hyperextension of the knee associated with pain and a feeling of instability occurring...
INTRODUCTION
Symptomatic Ligamentous Genu Recurvatum (SLGR) is characterized by an asymmetrical hyperextension of the knee associated with pain and a feeling of instability occurring even during walking. The ligamentous origin of the recurvatum is linked to a sprain in hyperextension responsible for a rupture of the posterior structures that may be associated or not with a rupture of the cruciate ligaments.
HYPOTHESIS
Tibial Flexion Osteotomy (TFO) allows control of a SLGR without rupture of the cruciate ligaments secondary to a sprain in hyperextension.
MATERIAL AND METHODS
Ten patients (12 knees) including 8 women, aged 30.8 years on average (16-52) with asymmetrical SLGR secondary to a hyperextension sprain without rupture of the cruciate ligaments underwent TFO. An anterior tibial tuberosity (ATT) osteotomy was performed with an associated trans-tuberosity anterior opening wedge osteotomy of the tibia in the sagittal plane. The ATT was secured by two compression screws with lowering of the patella culminating from the opening wedge procedure. The genu recurvatum angle (GRA), tibial slope (TSangle) and patellar height according to the Caton-Deschamps index (CDI) were established. All patients were assessed using the IKDC and Lecuire scores (anatomical and functional scores).
RESULTS
The average follow-up was 4.2 years (12-106 months). The GR angle was 7.3±3.2° preoperatively versus 22.7±4.1° postoperatively (p<0.01). The TS angle averaged 95.5±2.3° preoperatively versus 104.0±3.7° postoperatively (p<0.01). The CDI decreased from 1.17±0.21 preoperatively to 0.83±0.11 postoperatively (p<0.01). The IKDC and Lecuire scores improved.
CONCLUSION
Trans-tuberosity high tibial flexion osteotomy is an effective strategy in cases of Symptomatic Ligamentous Genu Recurvatum without rupture of the cruciate ligaments secondary to a hyperextension sprain, and with constitutional hyperlaxity. This procedure allows significant clinical improvement and correction of the recurvatum deformity in the medium term.
LEVEL OF EVIDENCE
IV, retrospective descriptive study.
Topics: Adult; Female; Humans; Knee Joint; Ligaments, Articular; Osteotomy; Patella; Retrospective Studies; Tibia
PubMed: 34329759
DOI: 10.1016/j.otsr.2021.103025 -
BMC Musculoskeletal Disorders Mar 2022Great difficulty and more failures were the descriptions of the treatment of congenital patella dislocation in pediatric patients. This study aims to evaluate the...
BACKGROUND
Great difficulty and more failures were the descriptions of the treatment of congenital patella dislocation in pediatric patients. This study aims to evaluate the outcomes of patients with congenital patellar dislocations treated with the modified Langenskiöld procedure.
METHODS
The medical records of 16 knees in 11 patients with a diagnosis of congenital patella dislocation were collected from September 2016 to March 2019. They were treated with the modified Langenskiöld procedure. The mean follow-up period was 37.8 months. The outcome measures were the Lysholm score, Kujala score, patellar stability, and knee range of motion.
RESULTS
Eleven patients, namely, eight girls and three boys, with 16 knees were enrolled. The mean age at the time of operation was 3.1 years. The post-operative mean Lysholm score was 94.8 (SD 5.1; 87-100), whereas the Kujala score was 95 (SD 5.9; 86-100). There were no recurrent dislocations, and all patients had full extension postoperatively.
CONCLUSION
The modified Langenskiöld procedure is a promising solution for the treatment of congenital patella dislocations.
LEVEL OF EVIDENCE
Level IV; Case Series; Treatment Study.
Topics: Child; Female; Humans; Knee Joint; Male; Patella; Patellar Dislocation; Range of Motion, Articular; Treatment Outcome
PubMed: 35279144
DOI: 10.1186/s12891-022-05192-1 -
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