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Orthopaedics & Traumatology, Surgery &... Feb 2019Patellar complications are a source of poor total knee arthroplasty (TKA) outcomes that can require re-operation or prosthetic revision. Complications can occur with or... (Review)
Review
Patellar complications are a source of poor total knee arthroplasty (TKA) outcomes that can require re-operation or prosthetic revision. Complications can occur with or without patellar resurfacing. The objective of this work is to answer six questions. (1) Have risk factors been identified, and can they help to prevent patellar complications? Patellar complications are associated with valgus, obesity, lateral retinacular release, and a thin patella. Selecting a prosthetic trochlea that will ensure proper patellar tracking is important. Resurfacing is an option if patellar thickness is greater than 12mm. (2) What is the best management of patellar fracture? The answer depends on two factors: (a) is the extensor apparatus disrupted? and (b) is the patellar implant loose? When either factor is present, revision surgery is needed (extensor apparatus reconstruction, prosthetic implant removal). When neither factor is present, non-operative treatment is the rule. (3) What is the best management of patellar instability? Rotational malalignment should be sought. In the event of femoral and/or tibial rotational malalignment, revision surgery should be considered. If not performed, options consist of medial patello-femoral ligament reconstruction and/or medialization tibial tuberosity osteotomy. (4) What is the best management of patellar clunk syndrome? When physiotherapy fails, arthroscopic resection can be considered. Recurrence can be treated by open resection, despite the higher risk of complications with this method. (5) What is the best management of anterior knee pain? The patient should be evaluated for causes amenable to treatment (fracture, instability, clunk, osteonecrosis, bony impingement on the prosthetic trochlea). If patellar resurfacing was performed, loosening should be considered. Otherwise, secondary resurfacing is appropriate only after convincingly ruling out other causes of pain. A painstaking evaluation is mandatory before repeat surgery for anterior knee pain: surgery is not in order in the 10% to 15% of cases that have no identifiable explanation. (6) What can be done to treat patellar defects? Available options include re-implantation (with bone grafting, cement, a biconvex implant, or a metallic frame), bone grafting without re-implantation, patellar reconstruction, patellectomy (best avoided due to the resulting loss of strength), osteotomy, and extensor apparatus allograft reconstruction. LEVEL OF EVIDENCE: V, expert opinion.
Topics: Arthralgia; Arthroplasty, Replacement, Knee; Bone Transplantation; Fractures, Bone; Humans; Knee Prosthesis; Orthopedic Procedures; Osteonecrosis; Patella; Patellar Dislocation; Prosthesis Failure; Risk Factors
PubMed: 29990602
DOI: 10.1016/j.otsr.2018.04.028 -
Swiss Medical Weekly Jan 2020The role of the patella is paramount in the transmission of the quadriceps muscle forces, the increase of the lever arm, the distribution of the forces on the trochlea... (Review)
Review
The role of the patella is paramount in the transmission of the quadriceps muscle forces, the increase of the lever arm, the distribution of the forces on the trochlea and the centring of the extensor apparatus. Despite the low incidence of patellar factures in comparison with other lower limb fractures, the painful and functional complications, such as knee stiffness, loss of extension and patellofemoral osteoarthritis, can be very disabling and will often compromise the return to a professional or recreational activity and induce falls in the elderly population. Treatment can be conservative or surgical, provided that it is adapted to the type of fracture. Undisplaced fractures with an intact extensor mechanism can be treated nonoperatively. Surgical treatment is recommended for fractures that either disrupt the extensor mechanism or have more than 2 to 3 mm of step-off and more than 1 to 4 mm of displacement. Tension band fixation is the most commonly employed surgical technique. In most cases, hardware has to be removed after fracture healing because of implant-related pain. Operative treatment of comminuted patellar fractures presents a significant challenge to surgeons. Failure to restore the articular surface contour results in posttraumatic arthritis. Anatomical reconstruction of the articular surface is the only way to prevent the development of posttraumatic osteoarthritis. Typically, fracture classification and thus treatment choice are based on anteroposterior and lateral radiographs of the knee, but when computed tomography of the knee was performed pre-operatively, both the classification and treatment were modified thanks to a better understanding of the fracture complexity. The purpose of this article is to review current treatment strategies and optimise the management of adult patients with patellar fractures.
Topics: Fractures, Bone; Humans; Knee Injuries; Orthopedic Procedures; Patella
PubMed: 31940427
DOI: 10.4414/smw.2020.20165 -
British Journal of Sports Medicine Apr 2007Eccentric training has become a popular treatment for patellar tendinopathy. Our purpose was to review the evolution of eccentric strength training programmes for... (Review)
Review
BACKGROUND AND AIM
Eccentric training has become a popular treatment for patellar tendinopathy. Our purpose was to review the evolution of eccentric strength training programmes for patellar tendinopathy with a focus on the exercise prescriptions used, to help clinicians make appropriate choices and identify areas needing further research.
METHODS
A computerised search of the entire MEDLINE database was performed on 1 September 2006 to identify prospective and randomised clinical trials with a focus on clinical outcome of eccentric training for patellar tendinopathy.
RESULTS
7 articles with a total of 162 patients and in which eccentric training was one of the interventions, all published after 2000, were included. The results were positive, but study quality was variable, with small numbers or short follow-up periods. The content of the different training programmes varied, but most were home-based programmes with twice daily training for 12 weeks. A number of potentially significant differences were identified in the eccentric programmes used: drop squats or slow eccentric movement, squatting on a decline board or level ground, exercising into tendon pain or short of pain, loading the eccentric phase only or both phases, and progressing with speed then loading or simply loading.
CONCLUSION
Most studies suggest that eccentric training may have a positive effect, but our ability to recommend a specific protocol is limited. The studies available indicate that the treatment programme should include a decline board and should be performed with some level of discomfort, and that athletes should be removed from sports activity. However, these aspects need further study.
Topics: Athletic Injuries; Exercise Therapy; Humans; Patella; Prospective Studies; Randomized Controlled Trials as Topic; Tendinopathy; Treatment Outcome
PubMed: 17261559
DOI: 10.1136/bjsm.2006.032417 -
European Journal of Human Genetics :... May 2019We review genetic diseases with identified molecular bases that include abnormal, reduced (hypoplasia), or absent (aplasia) patellae as a significant aspect of the... (Review)
Review
We review genetic diseases with identified molecular bases that include abnormal, reduced (hypoplasia), or absent (aplasia) patellae as a significant aspect of the phenotype. The known causal genes can be broadly organized according to three major developmental and cellular processes, although some genes may act in more than one of these: limb specification and pattern formation; DNA replication and chromatin structure; bone development and differentiation. There are also several genes whose phenotypes in mice indicate relevance to patellar development, for which human equivalent syndromes have not been reported. Developmental studies in mouse and chick embryos, as well as patellar involvement in human diseases with decreased mobility, document the additional importance of local environmental factors in patellar ontogenesis. Patellar anomalies found in humans can be an important clue to a clinical genetic diagnosis, and a better knowledge of the genetics of patellar anomalies will improve our understanding of limb development.
Topics: Biological Evolution; Bone Diseases; Chromatin; DNA Replication; Genetic Phenomena; Humans; Patella
PubMed: 30664715
DOI: 10.1038/s41431-018-0329-6 -
Sao Paulo Medical Journal = Revista... 2022The relationships between the morphometric structure of the patellofemoral joint, patella type and chondromalacia patella are still a matter of debate.
BACKGROUND
The relationships between the morphometric structure of the patellofemoral joint, patella type and chondromalacia patella are still a matter of debate.
OBJECTIVE
To identify the prevalence of chondromalacia patella by determining the patella type and making patellofemoral morphometric measurements.
DESIGN AND SETTING
Retrospective cohort study in an orthopedics and traumatology clinic in Turkey, conducted between June 2017 and November 2019.
METHODS
This study involved 562 knees of 522 patients with anterior knee pain (246 males and 316 females; mean age 46.59 years). The patients were grouped according to presence of chondromalacia patella (group I) or absence of chondromalacia patella (group II). The patella type, lateral trochlear inclination, medial trochlear inclination, trochlear angle, sulcus angle, patellar tilt and Insall-Salvati index were assessed. Group comparisons were made using chi-square tests or Student t tests. The r value was used to determine the magnitude of relationships between pairs of variables.
RESULTS
Among the 562 knees evaluated, 265 (50.71%) presented type I patella, 195 (36.7%) type II, 100 (12.3%) type III and 2 (0.3%) type IV. Group I consisted of 448 knees and group II consisted of 114 knees. Significant differences were found between the groups in terms of age, gender, patella type and lateral inclination angles (P < 0.05).
CONCLUSION
Detecting the patella type and making lateral inclination measurements in patients with anterior knee pain are of great importance for diagnosing suspected chondromalacia patella, particularly in the early degenerative period.
Topics: Male; Female; Humans; Middle Aged; Patella; Retrospective Studies; Prevalence; Magnetic Resonance Imaging; Chondromalacia Patellae; Pain
PubMed: 36102448
DOI: 10.1590/1516-3180.2021.0206.R2.10012022 -
Bulletin of the NYU Hospital For Joint... 2009This review describes the normal patellofemoral joint and detail the mechanism and anatomic elements that predispose patients to patellar instability. The treatment... (Review)
Review
This review describes the normal patellofemoral joint and detail the mechanism and anatomic elements that predispose patients to patellar instability. The treatment options for both acute and chronic injuries are described and the rationale behind their approach to this problem is explained. In general, most acute dislocations should be treated nonoperatively unless the instability is associated with an osteochondral injury. Chronic dislocators should be treated based on an understanding of the patient's individual reason for recurrent instability. This is achieved with a thorough history, physical examination, and imaging studies. This information can help the clinician select the most appropriate proximal and or distal procedure.
Topics: Acute Disease; Biomechanical Phenomena; Chronic Disease; Femur; Humans; Joint Instability; Knee Joint; Magnetic Resonance Imaging; Orthopedic Procedures; Patella; Patellar Dislocation; Physical Examination; Recovery of Function; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 19302054
DOI: No ID Found -
BMJ Case Reports Mar 2022Acute patella dislocations account for approximately 2%-3% of knee injuries and are therefore a relatively common presentation in the accident and emergency department....
Acute patella dislocations account for approximately 2%-3% of knee injuries and are therefore a relatively common presentation in the accident and emergency department. The majority of patella dislocations can be reduced with simple manoeuvres or even spontaneously and can be managed conservatively by bracing and rehabilitation. The aim of this study is to identify and review the main causes of the unique and unexpected event of irreducible patella dislocation and their characteristic presentations. Irreducible patella dislocations can happen but are very rare. Currently, a limited number of case reports are available, prompting for a need for research on this topic. This case study can shed light on the possible pathogenesis and pathognomonic features of irreducible patella dislocations and provide insight on the available therapeutic approaches.
Topics: Humans; Joint Dislocations; Knee Injuries; Patella; Patellar Dislocation
PubMed: 35264391
DOI: 10.1136/bcr-2021-248398 -
Journal of Orthopaedic Surgery and... Mar 2021The decision to resurface the patella as part of total knee arthroplasty may be influenced by the surgeon's preference, education, training, tradition and geographic... (Comparative Study)
Comparative Study Review
BACKGROUND
The decision to resurface the patella as part of total knee arthroplasty may be influenced by the surgeon's preference, education, training, tradition and geographic location. Advocates for non-resurfacing or selectively resurfacing may claim no difference in patient reported outcomes, and that resurfacing is associated with increased risks such as extensor mechanism injury or malalignment, problems with the design of the patella component and technical issues intraoperatively.
AIMS
To critically examine factors that should be considered in addition to patient reported outcomes in the decision process of resurfacing or non-resurfacing of the patella in total knee arthroplasty.
METHOD
A comprehensive literature search was conducted to identify factors that may influence decision making in addition to knee specific patient reported outcome measures such as surgical risks, patient quality of life, procedure cost, re-operation rate, implant design, surgeons learning curve and the fate of remaining cartilage in native patellae.
RESULTS
Patient-reported outcomes are equivocal for resurfacing and non-resurfacing. Critical analysis of the available literature suggests that the complications of resurfacing the patella are historic, which is now lower with improved implant design and surgical technique. Routine resurfacing was cost-effective in the long term (potential saving £104 per case) and has lower rates of revision (absolute risk reduction 4%). Finally, surgical judgment in selective resurfacing was prone to errors.
CONCLUSION
Patella resurfacing and non-resurfacing had similar patient-reported outcomes. However, patella resurfacing was cost-effective and was associated with a lower rate of re-operation compared to non-resurfacing.
Topics: Arthroplasty, Replacement, Knee; Cost-Benefit Analysis; Humans; Patella; Reoperation
PubMed: 33706779
DOI: 10.1186/s13018-021-02295-8 -
Scientific Reports May 2022The relationship between the morphological characteristics of the infrapatellar fat pad (IFP) and joint deformity has yet to be fully elucidated. Therefore, the purpose...
The relationship between the morphological characteristics of the infrapatellar fat pad (IFP) and joint deformity has yet to be fully elucidated. Therefore, the purpose of this study was to clarify the morphological characteristics of the IFP and to identify the relationships between morphological characteristics of the IFP and degenerative grade of the articular surface of the patella. This investigation examined 41 legs from 25 Japanese cadavers. The IFP length, width, and volume were measured. It was categorized into three types: Type I, IFP proximal located on medial and lateral sides of the patella; Type II, the IFP proximal only located medially; and Type III, absence of the IFP proximal. Articular surfaces were graded as macroscopically intact or mildly altered (Grade I), moderately (Grade II), or severely (Grade III). Grade III was significantly more frequent than Grades I or II in Type III. IFP volume was significantly larger in Type I than in Types II or III. A negative correlation was found between the degenerative grade of the articular surface of the patella and IFP volume. It was suggested that a relationship between the degenerative grade of the articular surface of the patella and the IFP volume.
Topics: Adipose Tissue; Cadaver; Humans; Knee Joint; Patella
PubMed: 35624138
DOI: 10.1038/s41598-022-12859-1 -
Clinical Orthopaedics and Related... Apr 2011
Review
Topics: Fracture Fixation; Fracture Healing; Fractures, Bone; Humans; Patella; Radiography; Treatment Outcome
PubMed: 20740335
DOI: 10.1007/s11999-010-1537-8