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Medicine Jun 2024This study aimed to evaluate the clinical and radiological features of the patella fixation technique using Toggleloc suspension system in a single ellipsoidal blind...
BACKGROUND
This study aimed to evaluate the clinical and radiological features of the patella fixation technique using Toggleloc suspension system in a single ellipsoidal blind patellar tunnel during medial patellofemoral ligament (MPFL) reconstruction.
METHODS
This study included 52 patients (25 men, 27 women) who underwent MPFL reconstruction using a semitendinosus tendon graft. The graft was fixed to the ellipsoidal single blind tunnel opened on the medial side of the patella with an endobutton and was fixed to the femoral tunnel by using bioabsorbable screw. Clinical scores (Kujala score, Lysholm score, Tegner activity score and the visual analog scale [VAS] score) were evaluated preoperatively and at the end-follow up. Preoperative and postoperative radiological measurements (trochlea depth, sulcus angle, patellar height, patellar congruence angle, patellar tilt angle and lateral patellofemoral angle) were evaluated with X-ray (Merchant X-ray, anteroposterior and lateral radiography) and computed tomography (CT) of the knee.
RESULTS
Postoperative patellar redislocation or subluxation was not observed in any patient. Patellar congruence angle, patellar tilt angle and lateral patellofemoral angle mean values were found to return to normal values in the postoperative period and the results were statistically significant. Also statistically significant improvement in all clinical scores postoperatively. According to the Insall-Salvati index (ISI) and Caton-Deschamps index (CDI) on lateral radiography of the knee at 30° flexion, patellar height decreased in the postoperative period statistically significant. The CDI was above 1.3 in 17 (%32) of our patients. Thirteen of these values decreased to normal values. No radiological progression of patellofemoral osteoarthritis was observed in all patients at the final follow-up evaluation.
CONCLUSION
In cases of patellofemoral instability, fixation of the tendon graft in blind ellipsoid tunnel using the Toggleloc suspension system provides satisfactory patellar graft fixation strength, significant functional improvement and a low failure rate.
Topics: Humans; Female; Male; Adult; Patellofemoral Joint; Follow-Up Studies; Patella; Plastic Surgery Procedures; Young Adult; Ligaments, Articular; Treatment Outcome; Adolescent
PubMed: 38941440
DOI: 10.1097/MD.0000000000038379 -
Knee Surgery, Sports Traumatology,... Jun 2024This study aimed to investigate the development of patellofemoral joint (PFJ) cartilage lesions following anterior cruciate ligament reconstruction (ACLR) using...
PURPOSE
This study aimed to investigate the development of patellofemoral joint (PFJ) cartilage lesions following anterior cruciate ligament reconstruction (ACLR) using hamstring tendon (HT) autograft through a systematic review.
METHODS
A comprehensive search was conducted in PubMed, Embase, Cochrane Library and Google Scholar databases to find articles published from database inception until 15 November 2023. The search terms were [('Anterior Cruciate Ligament' [mesh] OR 'anterior cruciate ligament' OR 'ACL') AND 'reconstruction' AND 'cartilage' AND ('second look arthroscopy' OR 'second-look arthroscopy' OR 'MRI' OR 'magnetic resonance imaging')]. Inclusion criteria were studies that reported on the occurrence of PFJ cartilage lesions following ACLR using HT autograft, as determined by second-look arthroscopy or follow-up magnetic resonance imaging (MRI).
RESULTS
Fifteen studies (1084 patients) met the inclusion criteria, with follow-up periods ranging from 1 to 5 years. In the results of second-look arthroscopy, cartilage grade deterioration was observed, ranging from MDs of 0.1 to 2.0 in the patella and from 0 to 1.0 in the trochlea. Follow-up MRI results reported the incidence of PFJ cartilage degeneration with rates ranging from 20% to 44%. Patient-reported outcome measures often showed no significant association with PFJ cartilage lesions. The studies included in this review reported various risk factors for cartilage lesion development.
CONCLUSION
Cartilage lesions in the PFJ, detected using second-look arthroscopy or follow-up MRI, frequently develop shortly after ACLR using HT autograft. At this stage, patients might not show specific symptoms; however, those with risk factors require careful observation and evaluation by clinicians during follow-up.
LEVEL OF EVIDENCE
Level IV.
PubMed: 38932612
DOI: 10.1002/ksa.12339 -
Animals : An Open Access Journal From... Jun 2024Estimating a dog's patellar position involves various methods, which categorize it as norma, alta (high), or baja (low). However, they require various calculations. We...
Estimating a dog's patellar position involves various methods, which categorize it as norma, alta (high), or baja (low). However, they require various calculations. We aimed to evaluate the clinical applicability of a new method, the tibial plateau-patella angle (TPPA). This could aid in planning patella luxation surgery, estimating the patella position after TPLO and various osteotomies. We conducted a two-step study: first, on 15 stifles without pathologies from nine canine cadavers, and second, using 100 patient X-rays from the archive. Three stifle angle positions (45 ± 5°, 90 ± 5°, and 135 ± 5°) and three weight groups (S, M, and L) were evaluated in the first part of this study. Based on these results, the second part of this study was conducted using 100 pathology-free radiographs at the optimal stifle angle (90 ± 5°) from the archive. All radiographs were measured by three observers with varying levels of experience. Our results indicate that the stifle angle significantly impacted the TPPA, whereby lower values were detected with higher stifle angles, which remained consistent within the weight groups. High inter- and intra-observer agreement was achieved. The physiological TPPA values ranged from 26.7° to 48.8°, remaining consistent within the various weight groups. Observer 3 in Group S exhibited a 20% (insignificant) deviation, possibly due to challenges in determining the caudal point of the tibial plateau. In contrast with humans, TPPA values in dogs are negatively correlated with stifle angles, independent of weight. Our reliable and reproducible protocol suggests the potential benefits of training on small-breed dogs stifles.
PubMed: 38929417
DOI: 10.3390/ani14121798 -
Knee Surgery, Sports Traumatology,... Jun 2024The purpose of our study is to describe a magnetic resonance imaging quantitative parameter to assess the morphology of the trochlea that could be measurable from...
PURPOSE
The purpose of our study is to describe a magnetic resonance imaging quantitative parameter to assess the morphology of the trochlea that could be measurable from normal to high-grade trochlear dysplasia while evaluating the most proximal slice with trochlear cartilage.
METHODS
Two groups of patients have been compared: patients with no patellofemoral pain, no previous trauma and undergoing surgery for a suspected isolated meniscal tears (group A) and patients with objective patellar instability (group B). The cranial trochlear orientation (CTO) angle is defined as the angle between the posterior bicondylar line and the most lateral and most medial points on the subchondral bone covered by cartilage digitised on the first and most cranial image with the trochlear cartilage clearly visible.
RESULTS
The final cohort included 253 patients (109 in group A and 144 in group B). CTO was significantly higher in group B (-2.5 ± 8.4 vs. -10.8 ± 5,1; p < .001). Moreover, 75% of knees in group B had a CTO > -7°, while 75% of knees in group A had a CTO < -7°. CTO was measurable in all 253 knees, whereas the lateral trochlear inclination and the sulcus angle were measurable in only 202 knees. The entire cohort was also divided into knees with CTO ≤ 0° and CTO > 0°. All knees with a CTO > 0 were in group B, and 49% of knees with CTO < 0 were in group B. CTO was positively correlated with lateral patellar tilt.
CONCLUSIONS
CTO is the only parameter that can be measured on the most cranial slice, in every patient, even in high-grade trochlear dysplasia. According to this new system, the axial trochlear shape may be divided into two types: a positive CTO and a negative CTO, with the trochlea serving, respectively, as a medial and lateral barrier.
LEVEL OF EVIDENCE
Level III.
PubMed: 38923584
DOI: 10.1002/ksa.12314 -
The Archives of Bone and Joint Surgery 2024A 47-year-old male with swelling over the patella and associated pain, subsiding with medicines but recurring after a few days. Diagnosed as prepatellar bursitis by the...
CASE
A 47-year-old male with swelling over the patella and associated pain, subsiding with medicines but recurring after a few days. Diagnosed as prepatellar bursitis by the family physician, it eventually turns out to be osteomyelitis of the patella. Treated with curettage, biopsy, and placement of bio-composite mixed with antibiotics. Intra-operative findings and histopathology confirmed tuberculosis of the patella. On follow-up after 6 years and the completion of anti-tuberculosis treatment, the patient showed full functional and radiological recovery without recurrence.
CONCLUSION
Early treatment with antibiotics and surgery gives excellent results. Identifying it as a tuberculous osteomyelitis is challenging when the condition is closely resembles pre-patellar bursitis.
PubMed: 38919747
DOI: 10.22038/ABJS.2024.77845.3597 -
Journal of Orthopaedic Surgery and... Jun 2024The infrapatellar fat pad (IPFP) lies extrasynovial and intracapsular, preserving the joint cavity and serving as a biochemical regulator of inflammatory reactions....
The thickness change ratio and preservation ratio of the infrapatellar fat pad are related to anterior knee pain in patients following medial patellofemoral ligament reconstruction.
BACKGROUND
The infrapatellar fat pad (IPFP) lies extrasynovial and intracapsular, preserving the joint cavity and serving as a biochemical regulator of inflammatory reactions. However, there is a lack of research on the relationship between anterior knee pain (AKP) and the IPFP after medial patellofemoral ligament reconstruction (MPFLR). Pinpointing the source of pain enables clinicians to promptly manage and intervene, facilitating personalized rehabilitation and improving patient prognosis.
METHODS
A total of 181 patients were included in the study. These patients were divided into the AKP group (n = 37) and the control group (n = 144). Clinical outcomes included three pain-related scores, Tegner activity score, patient satisfaction, etc. Imaging outcomes included the IPFP thickness, IPFP fibrosis, and the IPFP thickness change and preservation ratio. Multivariate analysis was used to determine the independent factors associated with AKP. Finally, the correlation between independent factors and three pain-related scores was analyzed to verify the results.
RESULTS
The control group had better postoperative pain-related scores and Tegner activity score than the AKP group (P < 0.01). The AKP group had lower IPFP thickness change ratio and preservation ratio (P < 0.001), and smaller IPFP thickness (P < 0.05). The multivariate analysis revealed that the IPFP thickness change ratio [OR = 0.895, P < 0.001] and the IPFP preservation ratio [OR = 0.389, P < 0.001] were independent factors related to AKP, with a significant correlation between these factors and pain-related scores [|r| > 0.50, P < 0.01].
CONCLUSIONS
This study showed the lower IPFP change ratio and preservation ratio may be independent factors associated with AKP after MPFLR. Early detection and targeted intervention of the underlying pain sources can pave the way for tailored rehabilitation programs and improved surgical outcomes. LEVEL OF EVIDENCE LEVEL III.
Topics: Humans; Adipose Tissue; Male; Female; Adult; Young Adult; Plastic Surgery Procedures; Pain, Postoperative; Knee Joint; Patellofemoral Joint; Middle Aged; Patella; Retrospective Studies; Adolescent
PubMed: 38918867
DOI: 10.1186/s13018-024-04853-2 -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... Jun 2024To compare the effectiveness of intramedullary nailing fixation via suprapatellar approach and medial parapatellar approach in semi-extended position in the treatment of... (Comparative Study)
Comparative Study
[Comparison of effectiveness of tibial intramedullary nailing fixation via suprapatellar approach and medial parapatellar approach in treatment of multiple tibial fractures].
OBJECTIVE
To compare the effectiveness of intramedullary nailing fixation via suprapatellar approach and medial parapatellar approach in semi-extended position in the treatment of multiple tibial fractures.
METHODS
The clinical data of 43 patients with multiple tibial fractures treated with intramedullary nailing fixation between July 2018 and December 2022 were retrospectively analyzed, including 23 patients treated with suprapatellar approach in semi-extended position (group A) and 20 patients with medial parapatellar approach in semi-extended position (group B). There was no significant difference in gender, age, cause of injury, time from injury to operation, AO/Orthopaedic Trauma Association (AO/OTA) classification, preoperative visual analogue scale (VAS) score, and range of motion (ROM) of the knee joint between the two groups ( >0.05). The operation time, intraoperative blood loss, incision length, intraoperative fluoroscopy frequency, and fracture healing time were recorded and compared. The VAS score and ROM of the knee joint were analyzed at 4, 8, and 12 weeks after operation, and the incidence of postoperative complications was observed; knee function was evaluated by Lysholm score at last follow-up.
RESULTS
The operations were successfully completed in both groups, and there was no complication such as nerve and blood vessel injury during operation, and all incisions healed by first intention. There was no significant difference in operation time, intraoperative blood loss, and intraoperative fluoroscopy frequency between the two groups ( >0.05), but the incision length in group B was significantly longer than that in group A ( <0.05). Patients in both groups were followed up 12-30 months, with an average of 21.1 months. The VAS score decreased and ROM increased gradually in both groups with time after operation, showing significant differences between different time points ( <0.05). The VAS score of group B was significantly lower than that of group A at 4 and 8 weeks after operation ( <0.05); there was no significant difference in VAS score and ROM between the two groups at other time points ( >0.05). There was no significant difference in fracture healing time between the two groups ( >0.05). During the follow-up, there was no complication such as internal fixator loosening, breakage, and loss of fracture reduction. At last follow-up, the Lysholm score in group B was significantly better than that in group A ( <0.05).
CONCLUSION
Both the suprapatellar approach and the medial parapatellar approach in semi-extended position can achieve satisfactory results in the treatment of multiple tibial fractures. The medial parapatellar approach has lower symptoms of early knee pain and better long-term function.
Topics: Humans; Tibial Fractures; Fracture Fixation, Intramedullary; Range of Motion, Articular; Male; Female; Treatment Outcome; Knee Joint; Fracture Healing; Operative Time; Patella; Fractures, Multiple; Retrospective Studies; Bone Nails; Middle Aged; Adult
PubMed: 38918195
DOI: 10.7507/1002-1892.202403038 -
Cureus Jun 2024Articular cartilage defects are common injuries of the knee. The defects often progress in size and produce significant clinical symptoms due to the lack of intrinsic...
Articular cartilage defects are common injuries of the knee. The defects often progress in size and produce significant clinical symptoms due to the lack of intrinsic repair or regenerative capacity of articular cartilage. With the failure of nonoperative treatment options, surgical treatment is indicated and includes palliative, reparative, and regenerative options. For large defects of the femoral condyles, trochlea, or patella, autologous chondrocyte implantation can provide successful and long-lasting results. Presented is the case of a 37-year-old male with an 18-year follow-up to autologous chondrocyte implantation for extensive left knee articular cartilage defects of the medial and lateral femoral condyles. Recovery from articular cartilage defects is shown through both clinical improvement of the patient and arthroscopic photographs of robust autologous articular cartilage on the medial femoral condyle. This case supports the long-term benefits of autologous chondrocyte implantation as a surgical intervention for large, full-thickness articular cartilage defects of the knee.
PubMed: 38912077
DOI: 10.7759/cureus.62913 -
Trauma Case Reports Aug 2024Patella fractures account for 1 % of all skeletal fractures, and can interrupt the knee's extensor apparatus. They can also be serious if associated with a cutaneous...
INTRODUCTION
Patella fractures account for 1 % of all skeletal fractures, and can interrupt the knee's extensor apparatus. They can also be serious if associated with a cutaneous opening. We report the case of a fracture of the tip of the patella with a large loss of cutaneous substance.
CASE REPORT
A 22-year-old man was admitted for the management of a left knee trauma following a motorcycle accident. Clinical examination revealed a large loss of skin substance on the anteromedial aspect of the knee, with exposed bone, pain and lack of extension of the left knee. Standard X-ray of the left knee showed an avulsion fracture of the tip of the patella. The patient underwent patellar tendon reconstruction using transosseous stitches, reinforced by a quadricipital tendon reversal plasty, and protected by steel-wire patellotibial cerclage. A medial gastrocnemius flap was used to cover the loss of skin substance. After a functional rehabilitation protocol, the functional results were satisfactory, with a full return to activity after six months.
CONCLUSION
The stability of osteosynthesis using quadricipital tendon reversal plasty and patellotibial cerclage allows mobilization and immediate weight-bearing. This may lead to better clinical results.
PubMed: 38911220
DOI: 10.1016/j.tcr.2024.101051 -
Journal of Experimental Orthopaedics Jul 2024Patellar cartilage lesions are a frequent and challenging finding in orthopaedic clinical practice. This study aimed to evaluate a chitosan-based scaffold's mid-term...
PURPOSE
Patellar cartilage lesions are a frequent and challenging finding in orthopaedic clinical practice. This study aimed to evaluate a chitosan-based scaffold's mid-term clinical and imaging results patients with patellar cartilage lesions.
METHODS
Thirteen patients (nine men, four women, 31.3 ± 12.7 years old) were clinically evaluated prospectively at baseline, 12, 24 and at a final minimum follow-up of 60 months (80.2 ± 14.7) with International Knee Documentation Committee (IKDC) subjective, Knee Injury and Osteoarthritis Outcome Score and Tegner scores. A magnetic resonance analysis was performed at the last follow-up using the Magnetic resonance Observation of CArtilage Repair Tissue (MOCART) 2.0 score.
RESULTS
An overall significant clinical improvement in the scores was observed from baseline to all follow-ups, with stable clinical results from 24 months to the mid-term evaluation. The IKDC subjective score passed from 46.3 ± 20.0 at baseline to 70.1 ± 21.5 at the last follow-up ( = 0.029). Symptoms' duration before surgery negatively correlated with the clinical improvement from baseline to the final follow-up ( = 0.013) and sex influenced the improvement of activity level from the preoperative evaluation to the final follow-up, with better results in men ( = 0.049). In line with the clinical findings, positive results were documented in terms of cartilage repair quality with a mean MOCART 2.0 score of 72.4 ± 12.5.
CONCLUSIONS
Overall, the use of this chitosan-based scaffold provided satisfactory results with a stable clinical improvement up to mid-term follow-up, which should be confirmed by further high-level studies to be considered a suitable surgical option to treat patients affected by patellar cartilage lesions.
LEVEL OF EVIDENCE
Level IV, prospective case series.
PubMed: 38911189
DOI: 10.1002/jeo2.12065