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International Journal of Surgery Case... Jan 2024A bipartite patella is a rare anatomical variant of the patella. A patella bipartite is often asymptomatic and is often an incidental finding on radiological imaging....
INTRODUCTION
A bipartite patella is a rare anatomical variant of the patella. A patella bipartite is often asymptomatic and is often an incidental finding on radiological imaging. The patella remains bipartite when secondary ossification centers fail to fuse. Herein, a case of bipartite patella improved after knee arthroscopy and surgical removal.
PRESENTATION OF THE CASE
A 57-year-old male with a history of polytrauma. He complained of progressive pain in the right knee area. A radiological investigation reported a right bipartite patella. The condition improved after the open removal of the accessory patella.
DISCUSSION
This case is considered type III according to Saupe's classification. Due to its location and radiological appearance, it is a painful synchondrosis of a bipartite patella.
CONCLUSION
After the failure of conservative management, the removal of the bipartite patella was necessary and unavoidable to restore everyday activities.
PubMed: 38142546
DOI: 10.1016/j.ijscr.2023.109165 -
Radiology Case Reports Mar 2022Bipartite patella is a normal variation in ossification development. This variation is usually asymptomatic but can cause persistent and debilitating anterior knee pain...
Bipartite patella is a normal variation in ossification development. This variation is usually asymptomatic but can cause persistent and debilitating anterior knee pain with an injury. We report the case of a 56-year-old man complaining of persistent anterior left knee pain following trauma. Standard knee radiographs show a bilateral Bipartite Patella appearance, and magnetic resonance imaging shows discrete bony edema of the cancellous bone of the accessory bone and about the synchondrosis explaining the anterior knee pain, associated with a crack in the posterior compartment of the medial meniscus. Conservative care including medical treatment with non-steroidal anti-inflammatory drugs, physical therapy was used. Magnetic resonance imaging is the most valuable diagnostic tool for evaluating detailed morphologic and pathologic changes in patients with the bipartite patella.
PubMed: 35003469
DOI: 10.1016/j.radcr.2021.12.007 -
Radiology Case Reports Apr 2019Normal development of the patella typically involves fusion of secondary ossification centers into a single bone during adolescence, with failure of fusion resulting in...
Normal development of the patella typically involves fusion of secondary ossification centers into a single bone during adolescence, with failure of fusion resulting in bipartite and tripartite patellae. In such variants, injury to incomplete ossification center fusion, though uncommon, has been reported to occur in the setting of traumatic quadriceps tendon rupture. The authors present a rare and complex case of traumatic bipartite fragment separation, patellar avulsion, and a complex partial quadriceps tendon tear confirmed surgically in a 36-year-old male. In this case, a tear in the lateral aspect of the quadriceps tendon attached to the nonfused patellar ossification center resulted in retraction of the band containing the bipartite fragment and separation of the patellar fragments, with superior displacement of the smaller bony avulsion likely due to complex attachments from the medial aspect of the quadriceps tendon. Knowledge of the classical locations of a bipartite and tripartite patella can aid in the differentiation of the anatomic variant versus patellar avulsion. Additionally, knowledge of the variable and complex nature of the quadriceps tendon aids in understanding the process of patellar avulsions and various tears, leading to the appropriate orthopedic management.
PubMed: 30906491
DOI: 10.1016/j.radcr.2018.10.003 -
Craniomaxillofacial Trauma &... Sep 2016The complex three-dimensional relationships in congenital craniofacial reconstruction uniquely lend themselves to the ability to accurately plan and model the result...
The complex three-dimensional relationships in congenital craniofacial reconstruction uniquely lend themselves to the ability to accurately plan and model the result provided by computer-aided design and manufacturing (CAD/CAM). The goal of this study was to illustrate indications where CAD/CAM would be helpful in the treatment of congenital craniofacial anomalies reconstruction and to discuss the application of this technology and its outcomes. A retrospective review was performed of all congenital craniofacial cases performed by the senior author between 2010 and 2014. Cases where CAD/CAM was used were identified, and illustrative cases to demonstrate the benefits of CAD/CAM were selected. Preoperative appearance, computerized plan, intraoperative course, and final outcome were analyzed. Preoperative planning enabled efficient execution of the operative plan with predictable results. Risk factors which made these patients good candidates for CAD/CAM were identified and compiled. Several indications, including multisuture and revisional craniosynostosis, facial bipartition, four-wall box osteotomy, reduction cranioplasty, and distraction osteogenesis could benefit most from this technology. We illustrate the use of CAD/CAM for these applications and describe the decision-making process both before and during surgery. We explore why we believe that CAD/CAM is indicated in these scenarios as well as the disadvantages and risks.
PubMed: 27516839
DOI: 10.1055/s-0036-1584391 -
Skeletogenic Capacity of Human Perivascular Stem Cells Obtained Via Magnetic-Activated Cell Sorting.Tissue Engineering. Part A Dec 2019Human perivascular stem/stromal cells (PSC) are a multipotent mesenchymal progenitor cell population defined by their perivascular residence. PSC are increasingly...
Human perivascular stem/stromal cells (PSC) are a multipotent mesenchymal progenitor cell population defined by their perivascular residence. PSC are increasingly studied for their application in skeletal regenerative medicine. PSC from subcutaneous white adipose tissue are most commonly isolated via fluorescence-activated cell sorting (FACS), and defined as a bipartite population of CD146CD34CD31CD45 pericytes and CD34CD146CD31CD45 adventitial cells. FACS poses several challenges for clinical translation, including requirements for facilities, equipment, and personnel. The purpose of this study is to identify if magnetic-activated cell sorting (MACS) is a feasible method to derive PSC, and to determine if MACS-derived PSC are comparable to our previous experience with FACS-derived PSC. In brief, CD146 pericytes and CD34 adventitial cells were enriched from human lipoaspirate using a multistep column approach. Next, cell identity and purity were analyzed by flow cytometry. multilineage differentiation studies were performed with MACS-defined PSC subsets. Finally, application was performed in nonhealing calvarial bone defects in mice. Results showed that human CD146 pericytes and CD34 adventitial cells may be enriched by MACS, with defined purity, anticipated cell surface marker expression, and capacity for multilineage differentiation. , MACS-derived PSC induce ossification of bone defects. These data document the feasibility of a MACS approach for the enrichment and application of PSC in the field of tissue engineering and regenerative medicine. Impact Statement Our findings suggest that perivascular stem/stromal cells, and in particular adventitial cells, may be isolated by magnetic-activated cell sorting and applied as an uncultured autologous stem cell therapy in a same-day setting for bone defect repair.
Topics: Adipose Tissue; Adult; Antigens, CD34; Biomarkers; Cell Differentiation; Cell Lineage; Cell Separation; Humans; Magnetic Phenomena; Osteogenesis; Skull; Stem Cells; Wound Healing
PubMed: 31020920
DOI: 10.1089/ten.TEA.2019.0031 -
Orthopaedic Journal of Sports Medicine Jan 2021Bipartite patella (BPP) is a developmental anomaly that forms when incomplete patellar ossification leaves a residual fibrocartilaginous synchondrosis between...
BACKGROUND
Bipartite patella (BPP) is a developmental anomaly that forms when incomplete patellar ossification leaves a residual fibrocartilaginous synchondrosis between ossification centers. Repetitive traction forces across the synchondrosis can cause knee pain, most commonly presenting in adolescence. Symptoms frequently resolve with nonoperative management. Few surgical case series exist to guide treatment approaches for refractory pain.
PURPOSE
To investigate the clinical features, surgical techniques, and outcomes associated with operative treatment of symptomatic BPP in pediatric and adolescent athletes and to compare features of the series with a large control group managed nonoperatively.
STUDY DESIGN
Cohort study; Level of evidence, 3.
METHODS
A retrospective medical record review was conducted of all patients aged ≤20 years who were diagnosed with symptomatic, radiologically confirmed BPP between 2003 and 2018 at a single tertiary-care pediatric hospital (N = 266). Demographic and clinical variables were analyzed, and additional radiologic and perioperative variables were collected for the surgical subcohort.
RESULTS
Of the 266 patients included, 27 were treated operatively (10.2%). When compared with those treated nonoperatively (with rest, physical therapy, cryotherapy, and anti-inflammatory medications), the operatively managed group experienced a longer duration of symptoms before first presentation (21.5 vs 7.6 months; < .001) and were more likely to be older (mean age, 15.4 vs 12.4 years; < .001), female (59.3% vs 35.6%; = .03), and competitive athletes (100% vs 84.5%; = .02). In the 27 patients treated operatively, procedures were categorized as isolated fragment excision (n = 9), fragment excision with lateral release (n = 8), isolated lateral release (n = 5), fragment screw fixation (n = 4), and synchondrosis drilling (n = 1). The mean time between surgery and return to sports was 2.2 months. Four patients (14.8%) reported residual symptoms requiring secondary surgery, including lateral release (n = 1), excision of residual fragment (n = 1), and fixation screw removal (n = 2).
CONCLUSION
BPP can cause knee pain in adolescent athletes and is generally responsive to nonoperative treatment. Patients undergoing surgical treatment-most commonly female competitive athletes with prolonged symptoms-represented 10% of cases. A variety of surgical techniques may be effective, with a 15% risk of persistent or recurrent symptoms warranting reoperation. Prospective multicenter investigations are needed to identify optimal candidates for earlier interventions and the optimal operative treatment technique.
PubMed: 33457432
DOI: 10.1177/2325967120967125 -
Insights Into Imaging Feb 2023Synthetic computed tomography (sCT) images are magnetic resonance imaging (MRI)-based images, generated using artificial intelligence. This study aimed to determine the...
BACKGROUND
Synthetic computed tomography (sCT) images are magnetic resonance imaging (MRI)-based images, generated using artificial intelligence. This study aimed to determine the prevalence of anatomical variants of sacroiliac joints (SIJ) on sCT images and the correlation with age, sex and body weight.
METHODS
MRI of the SIJ including sCT images of 215 patients clinically suspected for sacroiliitis were retrospectively analyzed. The presence of anatomical variants of the SIJ was assessed. Age, sex and body mass index at the time of the MRI were recorded.
RESULTS
SIJ variants were found in 82.8% (356/430) of the evaluated joints. The most frequent variants were iliosacral complex (27.7%), bipartite iliac bony plate (27.2%) and crescent iliac bony plate (27%). One new variant was identified, consisting of an accessory facet of the SIJ on the superior side. Overall, SIJ variants were slightly more frequent in women (85.8% vs. 77.8%), but iliosacral complex was significantly more frequent in men. Isolated synostosis was more prevalent with advancing age, in contrast to semicircular defect and unfused ossification center. The occurrence of iliosacral complex was associated with higher BMI, while crescent iliac bony plate occurred more in patients with lower BMI.
CONCLUSION
Over 80% of patients in this study, who were all suspected of sacroiliitis, had at least one SIJ variant. These variants may actually represent subtypes of the normal SIJ. sCT enables detection of very small or subtle findings including SIJ variants.
PubMed: 36750489
DOI: 10.1186/s13244-023-01373-1 -
Scientific Reports Oct 2018The vascular wall within adipose tissue is a source of mesenchymal progenitors, referred to as perivascular stem/stromal cells (PSC). PSC are isolated via fluorescence...
The vascular wall within adipose tissue is a source of mesenchymal progenitors, referred to as perivascular stem/stromal cells (PSC). PSC are isolated via fluorescence activated cell sorting (FACS), and defined as a bipartite population of pericytes and adventitial progenitor cells (APCs). Those factors that promote the differentiation of PSC into bone or fat cell types are not well understood. Here, we observed high expression of WISP-1 among human PSC in vivo, after purification, and upon transplantation in a bone defect. Next, modulation of WISP-1 expression was performed, using WISP-1 overexpression, WISP-1 protein, or WISP-1 siRNA. Results demonstrated that WISP-1 is expressed in the perivascular niche, and high expression is maintained after purification of PSC, and upon transplantation in a bone microenvironment. In vitro studies demonstrate that WISP-1 has pro-osteogenic/anti-adipocytic effects in human PSC, and that regulation of BMP signaling activity may underlie these effects. In summary, our results demonstrate the importance of the matricellular protein WISP-1 in regulation of the differentiation of human stem cell types within the perivascular niche. WISP-1 signaling upregulation may be of future benefit in cell therapy mediated bone tissue engineering, for the healing of bone defects or other orthopaedic applications.
Topics: Adipose Tissue; Bone and Bones; CCN Intercellular Signaling Proteins; Cell Differentiation; Cell Separation; Cells, Cultured; Cellular Microenvironment; Fats; Flow Cytometry; Humans; Osteogenesis; Pericytes; Proto-Oncogene Proteins; Stem Cells; Tissue Engineering; Up-Regulation
PubMed: 30353078
DOI: 10.1038/s41598-018-34143-x -
Journal of the American Academy of... Feb 2024Talus bipartitus is a rare skeletal anomaly that may be mistaken for an os trigonum, a relatively common accessory ossicle found posterior to the talus. Both are...
BACKGROUND
Talus bipartitus is a rare skeletal anomaly that may be mistaken for an os trigonum, a relatively common accessory ossicle found posterior to the talus. Both are believed to be formed similarly with the failed fusion of the talus with a second ossification center. Os trigonum is often diagnosed incidentally or found on radiographs obtained in symptomatic patients with signs of os trigonum syndrome, which presents with posterolateral ankle pain. A bipartite talus may also present with similar symptoms but may be differentiated through its articular involvement.
CASE
In this article, we describe the rare presentation of tarsal tunnel syndrome in a patient caused by a bipartite talus. The patient underwent surgical decompression with the removal of the posterior fragment.
CONCLUSION
A bipartite talus is a rare entity that may be mistaken for an os trigonum, a common accessory ossicle. In this article, we describe an outcome of a bipartite talus fragment removal due to tarsal tunnel syndrome and illustrate a rare pathological consequence of a bipartite talus. We further highlight the importance of early surgical management in patients presenting with an identifiable structure contributing to tibial nerve compression.
Topics: Humans; Tarsal Tunnel Syndrome; Talus; Lower Extremity Deformities, Congenital; Arthralgia; Decompression, Surgical
PubMed: 38323932
DOI: 10.5435/JAAOSGlobal-D-23-00147 -
International Journal of Computer... Feb 2020Predicting changes in face shape from corrective surgery is challenging in growing children with syndromic craniosynostosis. A prediction tool mimicking composite bone...
PURPOSE
Predicting changes in face shape from corrective surgery is challenging in growing children with syndromic craniosynostosis. A prediction tool mimicking composite bone and skin movement during facial distraction would be useful for surgical audit and planning. To model surgery, we used a radial basis function (RBF) that is smooth and continuous throughout space whilst corresponding to measured distraction at landmarks. Our aim is to showcase the pipeline for a novel landmark-based, RBF-driven simulation for facial distraction surgery in children.
METHODS
An individual's dataset comprised of manually placed skin and bone landmarks on operated and unoperated regions. Surgical warps were produced for 'older' monobloc, 'older' bipartition and 'younger' bipartition groups by applying a weighted least-squares RBF fitted to the average landmarks and change vectors. A 'normalisation' warp, from fitting an RBF to craniometric landmark differences from the average, was applied to each dataset before the surgical warp. The normalisation was finally reversed to obtain the individual prediction. Predictions were compared to actual post-operative outcomes.
RESULTS
The averaged change vectors for all groups showed skin and bone movements characteristic of the operations. Normalisation for shape-size removed individual asymmetry, size and proportion differences but retained typical pre-operative shape features. The surgical warps removed the average syndromic features. Reversing the normalisation reintroduced the individual's variation into the prediction. The mid-facial regions were well predicted for all groups. Forehead and brow regions were less well predicted.
CONCLUSIONS
Our novel, landmark-based, weighted RBF can predict the outcome for facial distraction in younger and older children with a variety of head and face shapes. It can replicate the surgical reality of composite bone and skin movement jointly in one model. The potential applications include audit of existing patient outcomes, and predicting outcome for new patients to aid surgical planning.
Topics: Cephalometry; Child; Craniofacial Dysostosis; Craniosynostoses; Face; Female; Humans; Male; Osteogenesis, Distraction; Postoperative Period; Plastic Surgery Procedures
PubMed: 31673962
DOI: 10.1007/s11548-019-02063-4