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Prosthetics and Orthotics International May 2024Gritti-Stokes amputation (GSA) is a knee disarticulation variant, where the femur is transected at the level of the epicondyle and the patella is fixated to the distal...
Gritti-Stokes amputation (GSA) is a knee disarticulation variant, where the femur is transected at the level of the epicondyle and the patella is fixated to the distal end. GSA results in a long residual limb with little postoperative swelling and less potential for muscular atrophy, so stable limb volume may allow the use of seal-in suction for suspension for preparatory prostheses. The purpose of this case series was to report on the efficacy of seal-in suction preparatory prostheses for 2 adults with traumatic GSA. Between October and December of 2021, 2 participants with unilateral traumatic Gritti-Stokes amputation, who had received seal-in suction suspension for their preparatory prostheses, were recruited. Information was extracted from medical charts regarding prosthetic care and mobility at preparatory and definitive prosthesis evaluation, and participants underwent standardized measurement of their residual limb and prosthesis. Duration of preparatory prosthesis use was >6 months; neither participant reported loss of suspension nor significant complications with socket fit. Participant 1 required socket replacement because of residual limb pain secondary to osteophyte formation, and Participant 2 required component replacement because of weight gain. At definitive prosthesis evaluations, both participants were unlimited community ambulators; both successfully returned to work before provision of their definitive prostheses. Results indicate that seal-in suction suspension may be viable for preparatory prostheses among adults with traumatic GSA, but knee center height discrepancies persist. GSA may yield highly functional outcomes for adults with traumatic amputation. Further research is required to substantiate these findings.
PubMed: 38771747
DOI: 10.1097/PXR.0000000000000359 -
Knee Surgery, Sports Traumatology,... May 2024We aimed to establish patient-reported outcome measure (PROM) reference data for a cohort of patients with prior patellar dislocation without previous knee surgery.
Adolescents with prior patellar dislocation report affected quality of life and function, as measured using the Banff Patella Instability Instrument, Kujala and EQ-5D-5L index scores.
PURPOSE
We aimed to establish patient-reported outcome measure (PROM) reference data for a cohort of patients with prior patellar dislocation without previous knee surgery.
METHODS
All inhabitants of the Faroe Islands aged 15-19 years were sent an online survey via secure email to establish a national cohort. They were asked to answer questions regarding demographics, whether they had prior patellar dislocation and to complete the PROMs: the Banff Patella Instability Instrument (BPII), Kujala, Marx activity and EQ-5D-5L questionnaires. Participants who had undergone knee surgery were excluded. Participants who had prior patellar dislocation underwent radiographic examinations to diagnose trochlear dysplasia. The study included three cohorts: the general population, prior patellar dislocation and prior patellar dislocation and trochlear dysplasia cohorts.
RESULTS
Of the 3749 individuals contacted, 1119 completed the survey and responded to at least one PROM. Of these, 102 reported a history of patellar dislocation and 57 of them had trochlear dysplasia. All PROMs, except the Marx score, reflected a worse quality of life and function after patellar dislocation than in the general population cohort; this was most pronounced in the BPII. The percentage of people experiencing problems in EQ-5D-5L dimensions was higher in the patellar dislocation and trochlear dysplasia cohorts than in the general population cohort in all EQ-5D-5L domains, except anxiety/depression.
CONCLUSION
Adolescents who had patellar dislocation reported reduced quality of life and function according to the BPII, Kujala and EQ-5D-5L index values, as well as all EQ-5D-5L domains, except for anxiety/depression. However, their activity levels remained high.
LEVEL OF EVIDENCE
Level III.
PubMed: 38769842
DOI: 10.1002/ksa.12270 -
Knee Surgery, Sports Traumatology,... May 2024The association between the prevalence of patellofemoral arthritis (PFA) and femoral tunnel positioning following isolated medial patellofemoral ligament reconstruction...
Nonanatomical femoral tunnel positioning in isolated MPFL reconstruction is not associated with an increased risk of patellofemoral osteoarthritis after a minimum follow-up of 10 years.
PURPOSE
The association between the prevalence of patellofemoral arthritis (PFA) and femoral tunnel positioning following isolated medial patellofemoral ligament reconstruction (MPFLr) has not been well described. The aim of this study was to analyse the relationship between femoral tunnel positioning and the prevalence of PFA.
METHODS
This was a single-centre study of patients undergoing an isolated MPFLr between 2006 and 2011 with a minimum of 10 years of follow-up. Outcomes assessed were the presence of PFA on radiographs, recurrence of instability requiring revision surgery and patient-reported outcomes, including Kujala, Tegner and IKDC scores. Tunnel positioning was assessed on postoperative radiographs using two radiographic methods: Schöttle's point and the grid method to localise the femoral tunnel. Patients were grouped based on tunnel positioning and compared.
RESULTS
Fifty patients were analysed at a mean follow-up of 12.4 years. Thirty-three patients (66%) had a femoral tunnel position within 7 mm of Schöttle's point and 39 (78%) within the anatomic quadrant, with the most common location according to the grid method in D4 (28%) and E4 (26%), respectively. Thirty-seven patients (74%) had a satisfactory (>80 versus <80) Kujala score at long-term follow-up. None of the examined tunnel assessment methods demonstrated a significant relationship with Tegner, Kujala or International Knee Documentation Committee scores. Patients with a femoral tunnel position >7 mm outside Schöttle's point or were considered to be in a nonanatomic position were not significantly more likely to result in unsatisfactory Kujala scores at the last follow-up. Tunnel positioning and the other tested parameters were not found to be significantly associated with the development of PFA.
CONCLUSION
No correlation between femoral tunnel position and risk of PFA or poor outcomes was observed in patients undergoing isolated MPFLr at long-term follow-up. The impact of femoral tunnel placement on long-term outcomes in patients with PFI may be less significant than originally considered.
LEVEL OF EVIDENCE
Level IV.
PubMed: 38769805
DOI: 10.1002/ksa.12264 -
Journal of ISAKOS : Joint Disorders &... May 2024We report the case of a 26-year-old woman who presented with a profound gait disturbance and total disability following a medial patellofemoral ligament (MPFL)...
We report the case of a 26-year-old woman who presented with a profound gait disturbance and total disability following a medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar dislocation. It is common knowledge that patellar instability is associated with multiple risk factors, including but not limited to loss of the MPFL, trochlear dysplasia, patella alta, an abnormally placed tibial tuberosity on the tibia, quadriceps contracture, genu valgum, excess of femoral anteversion, excess of external tibial torsion, and foot pronation. Since the relative importance of each is unknown, it is imperative that pre-operative evaluation considers these. Two additional surgeries failed to improve her severe disability. Subsequent evaluation, 8 years after her initial MPFL reconstruction, revealed the presence of an excess of external tibial torsion and genu valgum. Complete resolution of disability resulted following tibial osteotomy, suggesting the importance of torsional deformity contributing to patellofemoral instability. Gait disturbance is an unrecognised complication after MPFL reconstruction.
PubMed: 38768814
DOI: 10.1016/j.jisako.2024.05.010 -
Seminars in Musculoskeletal Radiology Jun 2024Patellofemoral instability results from impaired engagement of the patella in the trochlear groove at the start of flexion and may lead to pain and lateral patellar... (Review)
Review
Patellofemoral instability results from impaired engagement of the patella in the trochlear groove at the start of flexion and may lead to pain and lateral patellar dislocation. It occurs most frequently in adolescents and young adults during sporting activities. Trochlear dysplasia, patella alta, and excessive lateralization of the tibial tuberosity are the most common risk factors for patellar instability. The main role of imaging is to depict and assess these anatomical factors and highlight features indicating previous lateral dislocation of the patella.
Topics: Humans; Joint Instability; Patellofemoral Joint; Patella; Patellar Dislocation; Magnetic Resonance Imaging; Risk Factors
PubMed: 38768591
DOI: 10.1055/s-0044-1785538 -
Journal of Clinical Orthopaedics and... May 2024Effective management of postoperative pain in total knee arthroplasty (TKA) poses a significant challenge for surgeons. Achieving rapid recovery without pain and...
INTRODUCTION
Effective management of postoperative pain in total knee arthroplasty (TKA) poses a significant challenge for surgeons. Achieving rapid recovery without pain and promoting early ambulation in immediate and early postoperative periods are essential for patient satisfaction. There are many pain management protocols including nerve blocks. Nerve blocks procedures were done using USG and anaesthetist dependent. This cadaveric study aimed to define the VMO (Vastus medialis obliquus) triangle to target the 'safe zone' of the saphenous nerve during TKA: A surgeon's friendly technique.
METHODS
12 formalin-fixed embalmed cadaveric lower limbs were dissected to explore anatomy, trajectory, the relation of saphenous nerve and measured the distances from the nearby palpable bony landmarks.
RESULTS
The average distance to target the saphenous nerve i.e target point from midpoint of superior pole of the patella was 10.6cm, the average angle to target the saphenous nerve is the angle between the line joining the medial epicondyle to the midpoint of the superior pole of the patella is found to be 64.2°. The average distance from midpoint of superior pole patella to medial epicondyle is found to be 8.1cm. Therefore, triangle so formed using these three points (1. Medial epicondyle, 2. The midpoint of superior pole of the patella, 3. Target point of the saphenous nerve) is called a VMO triangle.
CONCLUSIONS
The saphenous nerve course, relations, and the distances from intraoperative bony landmarks for the VMO triangle during TKA which is a reproducible triangle so may be useful for arthroplasty surgeons to achieve successful saphenous nerve block and to avoid related complications during total knee arthroplasty (TKA).
PubMed: 38766386
DOI: 10.1016/j.jcot.2024.102424 -
Forensic Sciences Research Jun 2024The biological profile estimation is the first step toward positive identification. However, it is not always possible to access a complete and well-preserved skeleton...
The biological profile estimation is the first step toward positive identification. However, it is not always possible to access a complete and well-preserved skeleton due to postmortem damage and taphonomic changes. As such, there is a need to develop new alternatives to analyze different bones of the human skeleton. The present study aims to analyze the patellar osteometry, with attention to its degree of sexual dimorphism, to establish a simple method for estimating sex in Portuguese adults. Six measurements were taken from 222 patella pairs, including 117 females and 105 males from the XXI Century Identified Skeleton Collection of the University of Coimbra. Subsequently, this method was validated in a different sample of 50 individuals equally representing both sexes. Maximum height stands out with a 77.0% of correct sex estimation, reaching 98.0% when applied to the new sample. The linear discriminant function analysis containing all the six variables showed the best results, with 80.2% of correct classification after cross-validation and 96.0% when applied to the independent sample.
PubMed: 38765698
DOI: 10.1093/fsr/owae015 -
The Journal of Arthroplasty May 2024Periprosthetic knee fractures (PPKFs) following total knee arthroplasty (TKA) are uncommon, but potentially serious injuries. We analyze the risk and risk factors for a...
BACKGROUND
Periprosthetic knee fractures (PPKFs) following total knee arthroplasty (TKA) are uncommon, but potentially serious injuries. We analyze the risk and risk factors for a PPKF in standard primary TKA patients who have osteoarthritis and a minimally (cruciate-retaining TKAs without a femoral box cut) or posterior-stabilized TKA. In addition, we report the risk for patients who have other underlying knee disorders and/or a higher level of TKA constraint.
METHODS
All primary TKAs were identified from the Danish National Patient Register and the Danish Knee Arthroplasty Register using data between 1997 and 2022. Subsequent fractures were identified through the International Classification of Diseases diagnosis code, Nordic Medico-Statistical Committee procedure code, or indication for revision TKA.
RESULTS
We included 120,642 standard primary TKA patients who had 1,434 PPKFs. The cumulated proportions were 0.4% (95% confidence interval (CI) 0.3 to 0.4) at 2 years 0.8% (0.7 to 0.8) at 5 years. At 10 years, the cumulated proportion was 1.7% (1.6 to 1.8), with 1.3% in the femur, 0.2% in the patella, and 0.2% in the tibia. Significant risk factors were (hazard ratio [HR] [95% CI]); ipsilateral hip arthroplasty (2.3 [2.0 to 2.6]); women (2.1 [1.8 to 2.4]), osteoporosis (1.4 [1.2 to 1.7]); age 80+ (1.4 [1.3 to 1.6]), uncemented TKA (1.3 (1.1 to 1.5) and Charlson Comorbidity Index score 3+ (1.4 [1.1 to 1.8]). An additional 22,624 primary TKA patients who had other underlying knee disorders and/or a higher level of implant constraint were included with 485 PPKFs. The 10-year cumulated proportions were 8.3% (95% CI 6.9 to 9.8) when the underlying disorder was a previous fracture, 2.8% (2.2 to 3.5) for rheumatic disorders, and 5.2% (2.6 to 10.6) for osteonecrosis. In patients who had condylar constrained knees, it was 6.9% (5.1 to 9.4), and 12.4% (8.0 to 16.04) for hinges.
CONCLUSIONS
In standard primary TKA patients, the 10-year cumulated proportion of PPKFs was 1.7%, and ipsilateral hip arthroplasty, women, osteoporosis, advanced age, uncemented TKA and higher Charlson Comorbidity Index increased the risk. Higher risks were observed in non-osteoarthritis patients and/or patients who had a higher level of TKA constraint.
PubMed: 38759816
DOI: 10.1016/j.arth.2024.05.033 -
Journal of ISAKOS : Joint Disorders &... May 2024Autologous tenocyte implantation (OrthoATI™) therapy has demonstrated efficacy in treating patients with tendinopathy at various anatomical sites. This study evaluates...
OBJECTIVES
Autologous tenocyte implantation (OrthoATI™) therapy has demonstrated efficacy in treating patients with tendinopathy at various anatomical sites. This study evaluates the effect of patient age, gender, and tendon biopsy site on morphology, growth, and gene expression of autologous tendon cells used to treat chronic tendinopathy.
METHODS
Patients undergoing OrthoATI™ for tendinopathies between 2020 and 2022 were initially treated by biopsies taken from patella tendon (PT) or palmaris longus tendon (PL). The biopsies were sent to a Good Manufacturing Practice (GMP) cell laboratory where tendon cells were isolated, cultured, and expanded for four to six weeks. Cell morphology was assessed using phase contrast microscopy. Droplet digital PCR (ddPCR) was utilized for gene expression analysis. Dichotomous results were compared between groups using x or Fisher's exact tests with no adjustment for multiple comparisons. The nonparametric Mann-Whitney U and Kruskal-Wallis tests were utilized for the sex and age (<35y, 35-44y, 45-54y, >55y) analyses, respectively. All analyses were performed using IBM SPSS v27, and a two-tailed P-value of <0.05 was considered statistically significant.
RESULTS
149 patients were included in the analysis. The PT was biopsied in 63 patients, and PL in 86 patients. There were no observer effects for age and gender between the PT and PL groups. There was no statistical significance between the PT and PL tendons for cell morphology, average cell population doubling time (PDT) (PT 83.9 vs PL 82.7 h, p = 0.482), cellular yield (PT 16.2 vs PL 15.2 × 10, p = 0.099), and cell viability (PT 98.7 vs PL 99.0%, p = 0.277). Additionally, ddPCR analyses showed no statistical significance found in tenogenic gene expression, including collagen type I (COL1, p = 0.86), tenomodulin (TNMD, p = 0.837) and scleraxis (SCX, p = 0.331) between PT- and PL-derived tendon cells. An age stratification analysis found no effect on growth and gene expression. COL1 was found to be higher in males when compared to females (P < 0.001), but otherwise no difference was seen in growth and gene expression in the gender analysis. No postbiopsy clinical complications were reported for either group.
CONCLUSION
This study has shown that the growth and bioactivities of tendon cells from tendon biopsies for OrthoATI™ are not affected by tendon donor site and age.
LEVEL OF EVIDENCE
IV.
PubMed: 38754838
DOI: 10.1016/j.jisako.2024.05.007 -
Orthopaedic Journal of Sports Medicine May 2024The anatomy of the trochlea plays a significant role in patellar stability. The developmental anatomy of the trochlea and its relationship to patellar stability remains...
BACKGROUND
The anatomy of the trochlea plays a significant role in patellar stability. The developmental anatomy of the trochlea and its relationship to patellar stability remains poorly understood.
PURPOSE
To describe the developmental changes of the osseous and cartilaginous trochlear morphology in skeletally immature specimens.
STUDY DESIGN
Descriptive laboratory study.
METHODS
A total of 65 skeletally immature cadaveric knees between the ages of 2 months and 11 years were evaluated using computed tomography scans. The measurements in the axial plane of both cartilage and bone include medial, central, and lateral trochlear height; sulcus height; medial and later trochlear facet length; trochlear sulcus angle; patellar sulcus angle; condylar height asymmetry; and trochlear facet asymmetry. Additional measurements included trochlear depth and lateral trochlear inclination angle. In the sagittal plane, measurements included curvilinear trochlear length, direct trochlear length, condylar height, and patellar sulcus angle.
RESULTS
Analysis of trochlear morphology using condylar height, condylar height asymmetry, and trochlear depth all increased with increasing age. The osseous and cartilaginous sulcus angles became deeper with age until age 8 and then plateaued. This corresponded with an increase in trochlear depth that also plateaued around age 8. Osseous condylar asymmetry increased with age but flipped from a larger medial condyle to a larger lateral condyle around age 8. The continued growth of the trochlea with age was further demonstrated in all measures in the sagittal view.
CONCLUSION
This cadaveric analysis demonstrated that there is an increase in condylar height as age increased by all measurements analyzed. These changes in condylar height continued to be seen through age 11, suggesting a still-developing trochlea past this age. By age 8, a plateau in sulcus angle, and sulcus depth suggests more proportionate growth after this point. Similar changes in trochlear and patellar shape with age suggests that the 2 structures may affect each other during development.
CLINICAL RELEVANCE
This information can help design, develop, and determine timing of procedures that may alter the anatomy and stabilize the trochlear and patellofemoral joint.
PubMed: 38751851
DOI: 10.1177/23259671241249132