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American Journal of Physical Medicine &... May 2024
PubMed: 38726958
DOI: 10.1097/PHM.0000000000002545 -
Orthopaedic Journal of Sports Medicine May 2024The Victorian Institute of Sport Assessment-Patella (VISA-P) questionnaire is a widely accepted instrument for measuring the severity of symptoms and pain in patients...
BACKGROUND
The Victorian Institute of Sport Assessment-Patella (VISA-P) questionnaire is a widely accepted instrument for measuring the severity of symptoms and pain in patients having sustained patellar tendinopathy.
PURPOSE
To adapt the VISA-P questionnaire cross-culturally to a traditional Chinese version (VISA-P-Ch) and validate its psychometric properties.
STUDY DESIGN
Cohort study (diagnosis); Level of evidence, 3.
METHODS
The VISA-P questionnaire was adapted to a traditional Chinese version following international recommended guidelines, including translation, synthesis, back translation, revision by expert committee, pretesting, and validation. The psychometric properties were tested in 15 healthy controls and 15 participants with patellar tendinopathy. Face validity was judged by the authors and participants. Known-groups validity was tested by comparing the VISA-P-Ch scores between symptomatic and asymptomatic participants using an independent test. Concurrent validity was determined by comparing the Blazina classification of the participants against VISA-P-Ch scores using the Spearman correlation coefficient. Test-retest reliability was assessed by calculating the intraclass correlation coefficient (ICC) following a 24- to 48-hour interval. Internal consistency was determined by the Cronbach alpha.
RESULTS
The expert committee and participants reported good face validity of the VISA-P-Ch. Significantly higher scores were found in the control group than in the patellar tendinopathy group (98.47 ± 3.04 vs 65 ± 11.9; < .001). Concurrent validity showed a high correlation between VISA-P-Ch and the Blazina classification system ( = -0.899; < .01). The test-retest reliability was excellent (ICC = 0.964). Internal consistency was found to be good for both the first and second assessments (Cronbach α = 0.834 and 0.851).
CONCLUSION
The VISA-P-Ch was proven to be a reliable and valid questionnaire with similar psychometric properties as the original VISA-P.
PubMed: 38726236
DOI: 10.1177/23259671241248165 -
Frontiers in Bioengineering and... 2024The separate vertical wire (SVW) technique and the improved candy box (CB) technique have been proposed for treating inferior pole patellar fractures. However, there is...
Computational evaluation of wire position using separate vertical wire technique and candy box technique for the fixation of inferior pole patellar fractures: a finite element analysis.
The separate vertical wire (SVW) technique and the improved candy box (CB) technique have been proposed for treating inferior pole patellar fractures. However, there is still a lack of clear explanation regarding the location of the wire passing through the patella. Five models of SVW techniques were established in different positions. Finite element analysis was then conducted to determine the optimal bone tunnel position for the SVW technique. Based on these findings, six groups of finite element models were created for CB techniques. The maximum displacement and stress on both the patella and steel wire were compared among these groups under 100-N, 200-N, 300-N, 400-N, and 500-N force loads. The results indicated that, in the SVW technique, the steel wire group near the fracture end of the longitudinal bone tunnel showed minimal displacement and stress on the patella when subjected to different forces. On the other hand, in the CB technique, both the patella and wire experienced minimal stress when a transverse bone tunnel wire was placed near the upper posterior aspect of patella. In conclusion, the SVW technique may require the bone tunnel wire to be positioned near the fractured end of the lower pole of the patella. On the other hand, in CB technique, the transverse bone tunnel wire passing through the patella may be close to its upper posterior aspect. However, further validation is necessary through comprehensive finite element analysis and additional biomechanical experiments.
PubMed: 38720880
DOI: 10.3389/fbioe.2024.1353901 -
Quantitative Imaging in Medicine and... May 2024The newly defined angle, quadriceps-patella angle (QPA), reflects the combined force transmitted to the patella by the quadriceps muscles and patellar tendon. An...
BACKGROUND
The newly defined angle, quadriceps-patella angle (QPA), reflects the combined force transmitted to the patella by the quadriceps muscles and patellar tendon. An increase in QPA may correlate with an increased force on the patella, which is significant in diagnosing patellofemoral instability and pain syndrome. In our study, we examined how various angles and pathologies vary depending on lateral patellar tilt angle (LPTA). QPA and patellar malalignment was investigated. Thus, the importance of understanding patellar malalignment and the research gap.
METHODS
Three hundred and fifty patients who underwent knee magnetic resonance imaging (MRI) examinations were included. The cross-sectional study conducted retrospectively between the years of 2018-2020 in a tertiary care outpatient clinic. Shapiro-Wilk normality, Chi-square, Mann-Whitney-, Spearman correlation and receiver operating characteristic (ROC) curve analysis, statistical tests used for analysis. The patellar tendon length, patellar height, tibial tubercle-trochlear groove distance (TT-TG), patella angle, trochlear sulcus angle, trochlear groove depth (TGD), medial trochlea length (MT), lateral trochlea length (LT), medial trochlear/lateral trochlear length ratio (MT/LT), LPTA, patella-patellar tendon angle (PPTA), QPA, Insall-Salvati index (ISI), medial trochlear inclination (MTI), lateral trochlear inclination (LTI) were among these measurements. In addition, we aim to reveal whether there is a significant relationship between two important angles LPTA and QPA. Whether there is a significant increase in the development of chondromalacia for the patient group with LPTA >5°. We examined how the frequency of chondromalacia changes in the patient group with LPTA >5°.
RESULTS
Two hundred and seventy seven patients included in the study and many measurements were performed on MRI. Fad-pad edema was found to be significantly higher in the group with LPTA <5° (P=0.046). TT-TG distance was significantly higher, TGD and MT were significantly lower in patients with higher LPTA (P=0.001, P=0.002 and P=0.017, respectively). A low level of significant positive correlation was found between QPA and patellar tendon length. There is no significant difference between QPA and PPTA angles between the groups with LPTA <5° and >5° (P=0.503, P=0.188). In the ROC analysis performed to determine the cut-off value, the LPTA value ≤14.2° which significantly predicted the presence of fad-pad edema, had the highest sensitivity and specificity [sensitivity: 76.71%, specificity: 39.90%, area under the curve (AUC): 0.588, P=0.024].
CONCLUSIONS
QPA is independent from many angles of the knee and does not change significantly. As the patellar tendon length increases, QPA angle also increases. In patients with abnormal LPTA, the frequency of TT-TG distance and chondromalacia increased, while TGD and MT decreased. Patients with a low LPTA can be more carefully examined for chondromalacia and fad-pad edema in clinical and MRI examination.
PubMed: 38720855
DOI: 10.21037/qims-23-1592 -
Journal of the College of Physicians... May 2024To evaluate the relationship between bone mineral density (BMD) by measuring the prepatellar fat thickness with knee radiography and to gain a measurement method that...
OBJECTIVE
To evaluate the relationship between bone mineral density (BMD) by measuring the prepatellar fat thickness with knee radiography and to gain a measurement method that has not been done before in the literature.
STUDY DESIGN
Cross-sectional descriptive study. Place and Duration of the Study: Department of Physical Medicine and Rehabilitation, Training and Research Hospital, Sanliurfa, Turkiye, between January and June 2020.
METHODOLOGY
Patients' age, body mass index (BMI) data, prepatellar fat thickness (mm), L1-L4 total, bone mineral density femoral neck, femur trochanter major, and femur total T scores were recorded. The relationships between these three groups (normal, osteopenia, osteoporosis) and between prepatellar fat tissue measurement were evaluated. One-way analysis of variance (ANOVA) and Post Hoc Tukey tests were used in the analysis.
RESULTS
A statistically significant difference was found in terms of trochanter major T score measurements (X2 = 20.435; p <0.001) and BMI (X2 = 66.535; p <0.001) measurements of prepatellar fat thickness measurement. A statistically significant difference was found between the three groups in terms of prepatellar fat thickness measurement, L1-4 T-score, femoral neck, and femur total values (p <0.001).
CONCLUSION
Prepatellar fat thickness in postmenopausal Turkish women was positively correlated with BMD; BMD increases as the prepatellar fat thickness increases. This explains that perapatellar fat thickness creates a mechanical load on the bones and causes an increase in BMD.
KEY WORDS
Osteoporosis, Fat thickness, Bone mineral density.
Topics: Humans; Bone Density; Cross-Sectional Studies; Female; Middle Aged; Adipose Tissue; Aged; Patella; Body Mass Index; Osteoporosis; Male; Absorptiometry, Photon; Femur Neck; Adult; Bone Diseases, Metabolic; Femur
PubMed: 38720212
DOI: 10.29271/jcpsp.2024.05.533 -
The Archives of Bone and Joint Surgery 2024Medial patellofemoral ligament reconstruction is a standard treatment option for patients with patellar instability. The main purpose of this study was to determine...
Medial patellofemoral ligament reconstruction is a standard treatment option for patients with patellar instability. The main purpose of this study was to determine whether isolated anatomic medial patellofemoral ligament reconstruction using double folded, four-strand plantaris tendon autograft restores patellar stability in adolescent patients. Plantaris tendon autografts were harvested through proximal approach and used in four adolescent patients. A four-strand autograft was prepared in a double-limbed configuration and fixed on the patella and the femur with suture anchors and interference screws, respectively. The mean Kujala score improved significantly from 44 ± 24 SD (range, 19 to 69) points preoperatively to 94 ± 10 SD (range, 78 to 100) points postoperatively (P< 0.001). All patients reported excellent subjective outcomes and returned to their pre-injury level of sporting activities. The use of a four-strand plantaris tendon autograft in isolated anatomic medial patellofemoral ligament reconstruction can restore patellar stability in adolescents.
PubMed: 38716173
DOI: 10.22038/ABJS.2024.75154.3476 -
Cureus Apr 2024Background This study aimed to evaluate the safety and effectiveness of knee exercise within four hours after total knee arthroplasty (TKA) using a single-joint hybrid...
Safety and Efficacy of Early Rehabilitation With Assistance From a Single-Joint Hybrid Assistive Limb in Patients With Total Knee Arthroplasty: A Randomized Controlled Clinical Pilot Study.
Background This study aimed to evaluate the safety and effectiveness of knee exercise within four hours after total knee arthroplasty (TKA) using a single-joint hybrid assistive limb (HAL-SJ). Materials and methods This pilot single-blind randomized controlled trial included participants who underwent TKA for osteoarthritis and were randomly allocated to the early rehabilitation (n = 14) or control rehabilitation (n = 16) group. Knee rehabilitation exercises using the HAL-SJ began within four hours postoperatively in the early group and seven days after surgery in the control group. Knee circumference, range of motion (ROM), pain, muscle strength, and extension lag were assessed before and one and two weeks after surgery. Results Circumferences at 1 and 10 cm from the upper edge of the patella did not differ between the groups before surgery or one week postoperatively. The extension lag and knee flexion ROM after one week were significantly better in the early intervention group than in the control group. However, the quadriceps and hamstring isometric knee strength and pain scores did not differ between the groups at one and two weeks postoperatively. HAL-SJ-related complications were not reported. Conclusion Rehabilitation knee exercises using the HAL-SJ within four hours after TKA improved extension lag and knee flexion ROM without exacerbating knee swelling and pain.
PubMed: 38716002
DOI: 10.7759/cureus.57738 -
Journal of Orthopaedic Surgery and... May 2024The disparity in patient-reported outcomes between total knee arthroplasty (TKA) following high tibial osteotomy (HTO) and primary TKA has yet to be fully comprehended.... (Comparative Study)
Comparative Study
BACKGROUND
The disparity in patient-reported outcomes between total knee arthroplasty (TKA) following high tibial osteotomy (HTO) and primary TKA has yet to be fully comprehended. This study aims to compare the patient-reported outcomes, radiological parameters and complication rates between TKA following HTO and primary TKA.
METHODS
Sixty-five patients who underwent TKA following lateral closing-wedge HTO were compared to a matched group of primary TKA at postoperative 6-months and 1-year. Between-group confounders of age, gender, smoking status, Body Mass index, preoperative Numeric Rating Scale (NRS) pain in rest, Knee injury and Osteoarthritis Outcome Score-Physical function Shortform (KOOS-PS), EuroQol five-dimensional (EQ-5D) overall health score, and Oxford Knee Score (OKS) were balanced by propensity score matching. Patient-reported outcome measures were NRS pain in rest, KOOS-PS, EQ-5D overall health score, and OKS. Radiological parameters were femorotibial angle, medial proximal tibial angle, anatomical lateral distal femoral angle, posterior tibial slope, and patellar height assessed by Insall-Salvati ratio. The complication rates of TKA were compared between the two groups. The HTO survival time, the choice of staple removal before or during TKA in patients who underwent TKA following HTO patients, and the rate of patellar resurfacing were assessed. The p value < 0.0125 indicates statistical significance after Bonferroni correction.
RESULTS
After propensity score matching, no significant between-group differences in the patient-reported outcome measures, radiographical parameters and complication rates were found (p > 0.0125). In the TKA following HTO group, with an average HTO survival time of 8.7 years, staples were removed before TKA in 46 patients (71%) and during TKA in 19 patients, and 11 cases (17%) had patella resurfacing. In the primary TKA group, 15 cases (23%) had patella resurfacing.
CONCLUSION
The short-term assessment of TKA following HTO indicates outcomes similar to primary TKA. A previous HTO does not impact the early results of subsequent TKA, suggesting that the previous HTO has minimal influence on TKA outcomes.
LEVEL OF EVIDENCE
III, cohort study.
Topics: Humans; Arthroplasty, Replacement, Knee; Male; Female; Osteotomy; Propensity Score; Tibia; Aged; Middle Aged; Patient Reported Outcome Measures; Osteoarthritis, Knee; Postoperative Complications; Treatment Outcome; Retrospective Studies
PubMed: 38715064
DOI: 10.1186/s13018-024-04760-6 -
European Heart Journal. Case Reports May 2024Nail-Patella syndrome (NPS) is an autosomal-dominant pleiotropic condition characterized by pelvic and skeletal abnormalities and most commonly affecting a tetrad of...
BACKGROUND
Nail-Patella syndrome (NPS) is an autosomal-dominant pleiotropic condition characterized by pelvic and skeletal abnormalities and most commonly affecting a tetrad of nails, knees, elbows, and iliac horns, the iliac horns being pathognomonic for the condition. The most well-documented extra-skeletal manifestation is renal involvement with alteration in Type III collagen. No documented cases of NPS with anomalous coronary arteries or aneurysms, acute coronary occlusion, or successfully coronary interventions exist in the medical literature.
CASE SUMMARY
A 62-year-old female with a medical history significant for NPS diagnosed 50 years ago presented to the emergency department with a chief complaint of chest pain. She recently developed end-stage renal disease managed with peritoneal dialysis within the last year. Angiography revealed 100% right coronary artery occlusion with an anomalous take-off from the left circumflex artery. She demonstrated diffuse coronary aneurysms in the right coronary artery, mid-left anterior descending artery, and other epicardial vessels. Two drug-eluting stents were placed in overlapping fashion. Following careful apposition, the aneurysmal segment was successfully stented without complication. The patient was discharged without complication 2 days later.
DISCUSSION
Our case shows the first reported case of coronary vascular anomalies and successful coronary revascularization in a patient with NPS in the medical literature. Given the recently reported vascular anomalies and known collagen alterations seen in patients with the genetic disorder, clinicians should suspect further systemic vascular anomalies with their own unique therapeutic challenges when encountering patients with this rare genetic syndrome.
PubMed: 38711683
DOI: 10.1093/ehjcr/ytae188 -
The Journal of Arthroplasty May 2024Routine patellar resurfacing during primary total knee arthroplasty (TKA) remains controversial. To our knowledge, there are no studies reporting the long-term...
Minimum 15-Year Survival of a Biconvex Inlay Patellar Component in Primary Total Knee Arthroplasty: An Analysis of 2,530 Total Knee Arthroplasties From a Single Institution.
BACKGROUND
Routine patellar resurfacing during primary total knee arthroplasty (TKA) remains controversial. To our knowledge, there are no studies reporting the long-term performance of a cemented biconvex all-polyethylene inlay component implanted at the time of primary TKA. The purpose of this study was to examine the 15-year survivorship and long-term clinical outcomes of this biconvex inlay patella used at our institution.
METHODS
We retrospectively reviewed our prospectively collected institutional database and identified 2,530 patients who underwent cemented TKA with a single prosthetic design (from 1996 to 2007) where the patella was resurfaced using this cemented biconvex inlay patella. The mean age at surgery was 68 years (range, 29 to 93). The mean body mass index was 33.0 (range, 16.4 to 76.3), with 61.9% women. At the time of analysis, the mean time from surgery was 20.4 years (range, 15 to 26). We used Kaplan-Meier analysis to calculate survivorship at 15 years. We analyzed clinical outcomes using 3 patient-reported outcome measures collected prospectively.
RESULTS
The 15-year survivorship with revision surgery for all causes as the end point was 97.1% (95% confidence interval 96.1 to 98.1%). The 15-year survivorship with revision surgery for a patella-related complication as the end point was 99.7% (95% confidence interval 99.4 to 1.0). At the final follow-up, patients showed significant improvement in scores for the Knee Society Clinical Rating System (P < .001), Western Ontario and McMaster University Osteoarthritis Index (P < .001), and Veterans Rand 12-Item Health Survey physical component (P < .001).
CONCLUSIONS
Routine patellar resurfacing using a biconvex inlay patellar component has excellent survivorship and a low rate of complications at 15 years post-TKA.
PubMed: 38710347
DOI: 10.1016/j.arth.2024.04.075