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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 -
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 -
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 -
Medicina (Kaunas, Lithuania) May 2023: Hallux valgus is one of the most common chronic foot complaints, with prevalences of over 23% in adults and up to 35.7% in older adults. However, the prevalence is... (Review)
Review
: Hallux valgus is one of the most common chronic foot complaints, with prevalences of over 23% in adults and up to 35.7% in older adults. However, the prevalence is only 3.5% in adolescents. The pathological causes and pathophysiology of hallux valgus are well-known in various studies and reports. A change in the position of the sesamoid bone under the metatarsal bone of the first toe is known to be the cause of the initial pathophysiology. : The relationships between the changes in the location of the sesamoid bone and each radiologically measured angle and joint congruency in the hallux valgus remain as yet unknown. Therefore, this study investigated the relationships of sesamoid bone subluxation with the hallux valgus angle, intermetatarsal angle, and metatarsophalangeal joint congruency in hallux valgus patients. The goal is to know the hallux valgus angle, the intermetatarsal angle, and metatarsophalangeal joint congruency's correlation with hallux valgus severity and prognosis by revealing the relationship between each measured value and sesamoid bone subluxation. : We reviewed 205 hallux valgus patients who underwent radiographic evaluation and subsequent hallux valgus correction surgery in our orthopedic clinic between March 2015 and February 2020. Sesamoid subluxation was assessed using a new five-grade scale on foot radiographs, and other radiologic measurements were assessed, such as hallux valgus angle, the intermetatarsal angle, distal metatarsal articular angle, joint congruency, etc. : Measurements of the hallux valgus angle, interphalangeal angle, and joint congruency exhibited high interobserver and intraobserver reliabilities in this study. They also showed correlations with sesamoid subluxation grade.
Topics: Adolescent; Humans; Aged; Hallux Valgus; Foot; Metatarsal Bones; Orthopedic Procedures; Sesamoid Bones; Retrospective Studies; Treatment Outcome
PubMed: 37241108
DOI: 10.3390/medicina59050876 -
BMC Veterinary Research Oct 2022The present study evaluated the frequency of supinator sesamoid bones (SSB) on radiography and computed tomography (CT). Interobserver agreement was evaluated in the...
BACKGROUND
The present study evaluated the frequency of supinator sesamoid bones (SSB) on radiography and computed tomography (CT). Interobserver agreement was evaluated in the detection of the SSBs in both methods. A correlation between the existence of SSBs and elbow diseases (ED) was assessed. For these purposes, radiographs, and CT scans of 100 dogs were scored by 3 observers.
RESULTS
The SSB was identified as a round to oval-shaped opacity and measured 0.5-6.56 mm × 0.5-6.2 mm. SSBs were reported in an average of 8,33% of dogs on radiographs and 26% of dogs on CT; a bilateral sesamoid bone was present in 43,52% and 76,92% of these dogs, respectively. Seventy-two percent of the SSBs was identified on CT were not detected on radiographs. The Kappa test showed a substantial agreement (κ = 0.691) and a perfect agreement (κ = 1) between the observers in the detection of SSBs on radiography and on CT scans respectively. Additionally, a weak positive correlation was detected between ED and the existence of SSBs.
CONCLUSION
A supinator sesamoid bone can be detected occasionally in the evaluation of the canine elbow joints by routine radiography. CT is superior to radiography for assessing SSBs with a higher interobserver agreement. The correlation of the existence of the SSBs and ED, needs further evaluations to prove a probable pathophysiological connection.
Topics: Dogs; Animals; Sesamoid Bones; Forelimb; Tomography, X-Ray Computed; Radiography; Muscle, Skeletal
PubMed: 36280865
DOI: 10.1186/s12917-022-03450-x -
Folia Morphologica 2021The sesamoid bones are small, usually oval bone structures often found in joints and under the tendons. Although their precise function is not fully understood, it is...
BACKGROUND
The sesamoid bones are small, usually oval bone structures often found in joints and under the tendons. Although their precise function is not fully understood, it is agreed upon that they protect the joints and make movements faster and less energy consuming. Sesamoid bones are found in hands, especially around first, second and fifth metacarpophalangeal joint and the interphalangeal joint of the thumb.
MATERIALS AND METHODS
This study compares a group of 32 young musicians to 30 non-musicians of similar age and posture. The hands of the subjects were examined by ultrasound imaging for the presence of sesamoid bones. The results were noted and observed sesamoids were measured.
RESULTS
The results seem to prove that although there are no difference in the amount or the location of the sesamoid bones between the musicians and the non-musicians, there is statistically significant tendency for the musicians to have bigger sum of the sesamoid's volume per hand (Fisher's test p-value = 0.034 < 0.05).
CONCLUSIONS
There was also observed an unusually shaped "Bactrian" sesamoid bone at the interphalangeal joint of the thumb in 8 cases in the musicians' group and 1 case in the control group. All participants with the aforementioned structure were female.
Topics: Female; Hand; Humans; Radiography; Sesamoid Bones; Tendons; Thumb
PubMed: 32639576
DOI: 10.5603/FM.a2020.0066 -
Anatomical Record (Hoboken, N.J. : 2007) Jan 2022The sesamoid bone in the tendon of the m. abductor digiti primi longus is considered present in most dog breeds and is described to be radiologically detectable at the...
The sesamoid bone in the tendon of the m. abductor digiti primi longus is considered present in most dog breeds and is described to be radiologically detectable at the level of the carpus from the age of 4 months. However, an extensive investigation of this sesamoid bone has not been conducted before. The aim of this study was therefore to determine its prevalence in different dog breeds, to describe its histological development, and to determine the age at which it becomes radiologically visible. The prevalence of the sesamoid bone was assessed on radiographic images of the carpus or by dissection of the carpal region in 743 adult dogs of 115 breeds. Its development was studied by dissection and histological analysis in 45 puppies and its timing of radiological appearance was evaluated in 209 puppies. At least one sesamoid bone was present in all adult dogs, except for 14 dogs of six breeds of predominantly the small breed category. The lowest prevalence rate of 38.46% was exhibited in the French bulldog. The histological development could be divided into five stages. The first radiographic appearance corresponded to the coalescence of smaller ossification centers into one big nucleus (stage 4). The mean time of radiographic appearance was 108.4 days. This study provides extensive data on the prevalence and timing of the radiographic appearance of a sesamoid at the carpus of the dog. The data on radiographic appearance may be helpful in the age estimation of puppies.
Topics: Animals; Dogs; Finger Phalanges; Muscle, Skeletal; Sesamoid Bones; Tendons
PubMed: 33943018
DOI: 10.1002/ar.24648