Sample records for chondromalacia patellae

  1. Patellofemoral Arthralgia, Overuse Syndromes of the Knee, and Chondromalacia Patella

    PubMed Central

    Welsh, R. Peter

    1985-01-01

    Patellofemoral arthralgia is a very common syndrome affecting athletes. Most often, examination fails to define true pathology. Conservative treatment, an active exercise program, and sports may be undertaken without harm to the knee. The patellofemoral arthralgia syndrome must be differentiated from true chondromalacia patella, where there is actual degeneration of the patella's articular cartilage, and from other sources of internal derangement such as meniscal disease or osteochondral lesions. Careful attention to the history of onset, and provoking activities such as climbing stairs, kneeling, and crouching, will allow the physician to recognize patellofemoral arthralgia. Other common overuse syndromes also should be looked for, and differentiated from problems due to true internal derangement. PMID:21274228

  2. Outcomes of Prolotherapy in Chondromalacia Patella Patients: Improvements in Pain Level and Function

    PubMed Central

    Hauser, Ross A.; Sprague, Ingrid Schaefer

    2014-01-01

    We retrospectively evaluated the effectiveness of prolotherapy in resolving pain, stiffness, and crepitus, and improving physical activity in consecutive chondromalacia patients from February 2008 to September 2009. Sixty-nine knees that received prolotherapy in 61 patients (33 female and 36 male) who were 18–82 years old (average, 47.2 years) were enrolled. Patients received 24 prolotherapy injections (15% dextrose, 0.1% procaine, and 10% sarapin) with a total of 40 cc in the anterior knee. At least 6 weeks after their last prolotherapy session, patients provided self-evaluation of knee pain upon rest, activities of daily living (ADL) and exercise, range of motion (ROM), stiffness, and crepitus. Symptom severity, sustained improvement of symptoms, number of pain pills needed, and patient satisfaction before treatment and improvement after treatment were recorded. Following prolotherapy, patients experienced statistically significant decreases in pain at rest, during ADL, and exercise. Stiffness and crepitus decreased after prolotherapy, and ROM increased. Patients reported improved walking ability and exercise ability after prolotherapy. For daily pain level, ROM, daily stiffness, crepitus, and walking and exercise ability, sustained improvement of over 75% was reported by 85% of patients. Fewer patients required pain medication. No side effects of prolotherapy were noted. The average length of time from last prolotherapy session was 14.7 months (range, 6 months to 8 years). Only 3 of 16 knees were still recommended for surgery after prolotherapy. Prolotherapy ameliorates chondromalacia patella symptoms and improves physical ability. Patients experience long-term improvement without requiring pain medications. Prolotherapy should be considered a first-line, conservative therapy for chondromalacia patella. PMID:24596471

  3. Outcomes of prolotherapy in chondromalacia patella patients: improvements in pain level and function.

    PubMed

    Hauser, Ross A; Sprague, Ingrid Schaefer

    2014-01-01

    We retrospectively evaluated the effectiveness of prolotherapy in resolving pain, stiffness, and crepitus, and improving physical activity in consecutive chondromalacia patients from February 2008 to September 2009. Sixty-nine knees that received prolotherapy in 61 patients (33 female and 36 male) who were 18-82 years old (average, 47.2 years) were enrolled. Patients received 24 prolotherapy injections (15% dextrose, 0.1% procaine, and 10% sarapin) with a total of 40 cc in the anterior knee. At least 6 weeks after their last prolotherapy session, patients provided self-evaluation of knee pain upon rest, activities of daily living (ADL) and exercise, range of motion (ROM), stiffness, and crepitus. Symptom severity, sustained improvement of symptoms, number of pain pills needed, and patient satisfaction before treatment and improvement after treatment were recorded. Following prolotherapy, patients experienced statistically significant decreases in pain at rest, during ADL, and exercise. Stiffness and crepitus decreased after prolotherapy, and ROM increased. Patients reported improved walking ability and exercise ability after prolotherapy. For daily pain level, ROM, daily stiffness, crepitus, and walking and exercise ability, sustained improvement of over 75% was reported by 85% of patients. Fewer patients required pain medication. No side effects of prolotherapy were noted. The average length of time from last prolotherapy session was 14.7 months (range, 6 months to 8 years). Only 3 of 16 knees were still recommended for surgery after prolotherapy. Prolotherapy ameliorates chondromalacia patella symptoms and improves physical ability. Patients experience long-term improvement without requiring pain medications. Prolotherapy should be considered a first-line, conservative therapy for chondromalacia patella. PMID:24596471

  4. [Chronic chondromalacia of the patella: comparison of morphological (magnetic resonance) and functional findings (isokinetic parameters) after rehabilitation].

    PubMed

    Felicetti, G; Avanza, F; Fiori, M; Brignoli, E; Rovescala, R

    1996-01-01

    The knee is a common site for injuries of the cartilage, capsule and ligament, which calls for the use of noninvasive techniques to assess injury severity properly and to plan adequate rehabilitation. Our study was aimed at comparing MR with isokinetic findings. To this purpose, 40 patients were examined; they were all affected with chondromalacia patellae, grades I-III, previously diagnosed at arthroscopy. Namely, 8 patients had grade I and 32 grades II and III chondromalacia. After MR and isokinetic exams, all patients were submitted to a standardized rehabilitation program. Our results indicate a marked decrease in quadriceps strength, especially in the most severe cases; in less severe cases, recovery was complete at 6 months, while the deficit remained in grades II and III injuries. MR yield was not relevant in 4 of 8 cases, while isokinetic findings were negative in one case. Both methods were positive in the most severe cases. At 6 months, both functional and MR findings were normal in grade I injuries, while some alterations remained in the others. PMID:8966275

  5. Snapping plicae associated with radiocapitellar chondromalacia

    Microsoft Academic Search

    Samuel A Antuna; Shawn W O’Driscoll

    2001-01-01

    Purpose: Painful snapping of the elbow joint is usually attributed to intra-articular loose bodies, instability, or medial dislocation of the triceps muscle over the medial epicondyle. We report our experience with 14 patients who were treated arthroscopically for snapping elbow that was found to be caused by hypertrophic synovial folds associated with radiocapitellar chondromalacia. Type of Study: Case series. Methods:

  6. The patella thinning osteotomy

    Microsoft Academic Search

    J. Vaquero; R. Arriaza

    1992-01-01

    The authors describe an original procedure, the patella thinning osteotomy, as an alternative to advancement of the tibial tuberosity or patellectomy in cases of severe anterior knee pain. They present an experimental study on cadaveric knees prior to a clinical trial. This study on 13 knee specimens, using Fujifilm Prescale barosensitive film, shows that thinning of the patella by 7

  7. The ''hot'' patella

    SciTech Connect

    Kipper, M.S.; Alazraki, N.P.; Feiglin, D.H.

    1982-01-01

    Increased patellar uptake on bone scans is seen quite commonly but the possible or probable etiologies of this finding have not been previously well described. A review of 100 consecutive bone scans showed that the incidence of bilateral ''hot'' patellae is 15%. Identified etiologies include osteoarthritic degenerative disease (35%), fracture, possible metastatic disease, bursitis, Paget's disease, and osteomyelitis. The value of careful history, physical examination, and radiographs is stressed.

  8. Habitual dislocation of patella: A review

    PubMed Central

    Batra, Sumit; Arora, Sumit

    2014-01-01

    Habitual dislocation of patella is a condition where the patella dislocates whenever the knee is flexed and spontaneously relocates with extension of the knee. It is also termed as obligatory dislocation as the patella dislocates completely with each flexion and extension cycle of the knee and the patient has no control over the patella dislocating as he or she moves the knee1. It usually presents after the child starts to walk, and is often well tolerated in children, if it is not painful. However it may present in childhood with dysfunction and instability. Very little literature is available on habitual dislocation of patella as most of the studies have combined cases of recurrent dislocation with habitual dislocation. Many different surgical techniques have been described in the literature for the treatment of habitual dislocation of patella. No single procedure is fully effective in the surgical treatment of habitual dislocation of patella and a combination of procedures is recommended. PMID:25983506

  9. Floating patella associated with lymphoedema

    PubMed Central

    Vun, Shen Hwa; Bayam, Levent; Drampalos, Efstathios; Jesry, Mohammed; Fadel, George

    2015-01-01

    Ipsilateral injury of more than one component of the knee extensor apparatus is rare. It is mostly associated with previous trauma, surgery, immunosuppression therapy and systemic disease. We present the first documented case of a spontaneous bifocal disruption of the knee extensor apparatus (i.e. floating patella) associated with lymphoedema. This case highlights the importance of considering lymphoedema as another risk factor for rupture of the knee extensor apparatus. It also highlights the importance of assessing all components of the knee extensor apparatus in patients presenting with acute knee injuries. PMID:25802253

  10. Patella baja following chronic quadriceps tendon rupture

    Microsoft Academic Search

    Michael Hockings; John C. Cameron

    2004-01-01

    Patella baja is a complication of chronic quadriceps tendon rupture. In this case we present the treatment of this problem by the proximal transfer of the tibial tubercle allowing an environment in which the quadriceps tendon can heal.

  11. [Temporomandibular fibro-chondromalacia. Physiological basis. Classification on the basis of clinical characteristics and course. Spongialisation (author's transl)].

    PubMed

    Couly, G; Dautrey, J

    1982-01-01

    The temporomandibular joints are neural structures which develop from the cephalic ectomesenchyme of the neural crests. They are analogous to the effector organs. Their lesional abnormalities have two characteristics:--pain sensation,--"foreign body". A classification is suggested on the basis of clinical characteristics and course of articular signs due to temporo-menisco-condylar stress resulting from occlusion problems, and concomitant lesions of the articular fibrocartilage: closed and open fibro-chondromalacia. Emphasis is placed upon the constant dissociation between articular clinical features and nosography. Spongialisation, or the property of regeneration of fibrocartilage from spongy bone tissue fully justifies the technique of condyloplasty to remodel the temporomandibular joints in the presence of fibro-chondromalacia. The future lies in the distinction between fibro-chondromalacia secondary to occlusive stress and that due to primary ischaemia of bone. PMID:6954631

  12. Radiographic findings in the nail-patella syndrome

    PubMed Central

    Louis, Thomas H.

    2015-01-01

    Nail-patella syndrome is a rare disorder characterized classically by the tetrad of nail hypoplasia or aplasia, aplastic or hypoplastic patellae, elbow dysplasia, and the presence of iliac horns. Iliac horns are considered pathognomonic, and the presence of hypoplastic or aplastic patellae in conjunction with nail abnormalities is a cardinal feature of diagnosis. Elbow dysplasia is present in most cases and can exhibit features typical of the syndrome. Herein we present the radiographic findings of the elbows, knees, and pelvis of a woman with nail-patella syndrome. PMID:26130880

  13. Tophaceous Gout of the Patella: A Report of Two Cases

    PubMed Central

    Hopper, Graeme; Gupta, Sanjay; Bethapudi, Sarath; Ritchie, David; MacDuff, Elaine; Mahendra, Ashish

    2012-01-01

    Introduction. Tophaceous gout of the patella is rare and may masquerade as a tumour or tumour-like condition. Cases. We report two patients with gout involving the patella, one complicated by a pathological fracture and the other occurring in a bipartite patella in a young adult. Discussion. Typical imaging appearances and measurement of serum urate will usually confirm the diagnosis but, occasionally, the serum urate level may be normal in active gout and in such cases, a biopsy will be required. Conclusion. Gout of the patella may masquerade as a tumour or tumour-like condition and it is important to consider gout in the differential diagnosis. PMID:23198243

  14. [Surgical Techniques for Patella Replacement in Cases of Deficient Bone Stock in Revision TKA].

    PubMed

    Ritschl, P; Machacek, F; Strehn, L; Kloiber, J

    2015-06-01

    The patella replacement in revision surgery is a challenge especially in cases of unsufficient bone stock. Depending on the extent of the bone defect, the following videos demonstrate different approaches: Video 1: bone sparing removal of the patella implant: onlay-type patella implants. Video 2: complete cortical bone rim of the patella, residual thickness between 6 to 10?mm: biconvex patella implant. Video 3 and 4: small defects of the cortical bone rim of the patella, residual thickness 1 to 5?mm (patella shell): gull-wing osteotomy, patella bone grafting techniques. Video 5: partial necrosis/defect of the patella shell with incomplete cortical bone rim: porous tantalum patella prosthesis. On account of the various surgical options for different bone defects of the patella, patellectomy and pure patelloplasty should be avoided to prevent functional shortcomings. PMID:26114564

  15. 3D Statistical Shape Models of Patella for Sex Classification

    Microsoft Academic Search

    Mohamed Mahfouz; Ahmed Badawi; Brandon Merkl; Emam E. Abdel Fatah; Emily Pritchard; Katherine Kesler; Megan Moore; Richard Jantz

    2006-01-01

    This paper proposes a new sex classification method from patellae using a novel automated feature extraction technique. A dataset of 228 patellae (95 females and 133 males) was collected and CT scanned. After the CT data was segmented, a set of features was automatically extracted, normalized, and ranked. These features include geometric features, moments, principal axes, and principal components. A

  16. Patella cubiti: a case report and literature review.

    PubMed

    Mittal, Ravi; Sampath Kumar, Venkatesan; Gupta, Tushar

    2014-04-01

    Patella cubiti is a rare elbow anomaly in which either the entire olecranon or a part of it remains separate from the proximal ulna. Pain and stiffness are the usual presenting symptoms while some patients are diagnosed incidentally following a minor trauma. Our case report is of a 24-year-old male wrestler with bilateral patella cubiti which was painful on right side and asymptomatic on the left. We also mention an additional cause of pain in patella cubiti-intra-articular loose bodies. These loose bodies were removed surgically and the patient remained asymptomatic at 6-months follow-up. Presence of growth disturbance in the secondary epiphyseal centre of first lumbar vertebra supports the 'developmental theory' of origin of patella cubiti. A compilation of data available in the literature on patella cubiti has been included. PMID:24493466

  17. Separation of a bipartite patella combined with quadriceps tendon rupture: A case report

    Microsoft Academic Search

    Hisahiro Tonotsuka; Yasuhiro Yamamoto

    2008-01-01

    Separation of a bipartite patella is very rare. We found only seven cases in the literature [Carter SR. Traumatic separation of a bipartite patella. Injury 1989;20:244; Ireland ML, Chang JL. Acute fracture bipartite patella; case report and literature review. Med Sci Sports Exerc 1995; 27:299–302; Ishii M, Yabuno K, Ishikawa T, Tsujino H, Yamaguchi K. A case of bipartite patella

  18. Congenital dislocation of the patella — the genetics and conservative management

    Microsoft Academic Search

    A. H. N. Robinson; A. Aladin; A. J. Green; D. J. Dandy

    1998-01-01

    A 13-year-old boy presented to the orthopaedic clinic with bilateral congenital dislocation of the patella. One knee had been unsuccessfully treated elsewhere by soft tissue realignment. Following this, conservative management has given a satisfactory functional outcome, despite persistence of the dislocation. Two other family members have been reviewed, the patient's father and grandmother. Both have bilateral patellar dislocations and neither

  19. Introduction Nail-patella syndrome (also called hereditary onycho-

    E-print Network

    Witzgall, Ralph - Naturwissenschaftliche Fakultät III

    -patella syndrome were reported in the LMX1B gene (6­8). The findings in patients are corrob- orated by the fact in the middle; while the Lin-11, Is1-1, Mec-3 (LIM) domains are felt to represent the interface will no longer be able to recognize its target genes. Since a mutant LMX1B gene has been described that contains

  20. Orthopaedic crossfire ®—All patellae should be resurfaced during primary total knee arthroplasty: In opposition

    Microsoft Academic Search

    Robert L. Barrack

    2003-01-01

    After more than 20 years of debate, the decision on whether to resurface the patella in primary total knee arthroplasty (TKA) remains controversial. Laboratory testing suggests that performing a TKA alters knee kinematics. Every study to date has suggested that kinematics are more abnormal when the patella is resurfaced than when it is retained. In addition, patellofemoral contact areas are

  1. Orthopaedic crossfire--All patellae should be resurfaced during primary total knee arthroplasty: in opposition.

    PubMed

    Barrack, Robert L

    2003-04-01

    After more than 20 years of debate, the decision on whether to resurface the patella in primary total knee arthroplasty (TKA) remains controversial. Laboratory testing suggests that performing a TKA alters knee kinematics. Every study to date has suggested that kinematics are more abnormal when the patella is resurfaced than when it is retained. In addition, patellofemoral contact areas are higher and contact stresses are lower with the native patella compared with the resurfaced patella after TKA. Virtually every clinical study of bilateral knee arthroplasty in which one patella has been resurfaced and the other has not has shown either equivalent results or a preference for the unresurfaced side. Laboratory and clinical data indicate that not resurfacing the patellar is a viable if not preferable option in most TKA patients. PMID:12730926

  2. Ipsilateral femoral shaft and vertical patella fracture: a case report

    PubMed Central

    Ozkan, Korhan; Eceviz, Engin; Sahin, Adem; Ugutmen, Ender

    2009-01-01

    Introduction A femoral shaft fracture with an ipsilateral patella fracture has been, to our knowledge, given only cursory attention in English-speaking literature. Case presentation A 15 year old male patient had hitten by a car to his motorcycle came to emergency room and he had been operated for his femoral shaft freacture and vertical patellar fracture which was iniatally missed. Conclusion To us it is vital to obtain CT scan of the patient’s knee if there is an ipsilateral femoral fracture with an ipsilateral knee effusion and a punction which reveals hematoma even in the absence of a fracture line seen in AP and lateral projections. PMID:19829933

  3. Human identification through the patella--Report of two cases.

    PubMed

    Silva, Rhonan Ferreira; Franco, Ademir; Mendes, Solon Diego Santos Carvalho; Picoli, Fernando Fortes; de Azevedo Marinho, Décio Ernesto

    2014-05-01

    The human identification process is often performed by the comparison between acquired post-mortem (PM) fingerprints, dental patterns, or DNA sample with ante-mortem (AM) databases. However, in some special situations alternative sources of human identifiers reveal valuable part as forensic tools. In this context, medical records of surgical interventions and morphological bone traits are useful in the anthropological environment, specifically for the PM examination of skeletal remains. The present study reports two cases of positive human identifications by the comparative analysis between AM and PM radiographic medical records of surgically treated human patella. The present outcome highlights the importance of storing and updating medical records in order to aid human identification processes in special forensic situations. PMID:24656324

  4. The influence of patella alta on patellofemoral joint stress during normal and fast walking

    Microsoft Academic Search

    Samuel R. Ward; Christopher M. Powers

    2004-01-01

    Objective: To determine if persons with patella alta exhibit elevated patellofemoral joint stress compared to pain-free controls during normal and fast walking speeds.Subjects: Twenty-four subjects (13 patella alta, 11 pain-free controls) participated.Methods: Sagittal and axial magnetic resonance images of the knee were obtained to quantify subject specific knee extensor mechanics and patellofemoral joint contact area. Instrumented gait analysis was used

  5. Brown tumor of the patella caused by primary hyperparathyroidism: a case report.

    PubMed

    Irie, Tomoko; Mawatari, Taro; Ikemura, Satoshi; Matsui, Gen; Iguchi, Takahiro; Mitsuyasu, Hiroaki

    2015-01-01

    It has been reported that the common sites of brown tumors are the jaw, pelvis, ribs, femurs and clavicles. We report our experience in a case of brown tumor of the patella caused by primary hyperparathyroidism. An initial radiograph and CT showed an osteolytic lesion and MR images showed a mixed solid and multiloculated cystic tumor in the right patella. One month after the parathyroidectomy, rapid bone formation was observed on both radiographs and CT images. PMID:25995691

  6. A case report of an Irish family displaying Nail-Patella syndrome

    Microsoft Academic Search

    N. Downey

    1993-01-01

    Summary  This is a case report of an Irish family displaying classical features of Nail-Patella Syndrome — also known as Osteo-onycho\\u000a Dystrophy — involving four members over three generations. This rare autosomal dominant disorder is well defined with four\\u000a classical characteristics: dysplasia of finger nails, hypoplastic or absent patellae, hypoplasia of the head of the radius\\u000a and often the capitulum of

  7. Brown Tumor of the Patella Caused by Primary Hyperparathyroidism: A Case Report

    PubMed Central

    Irie, Tomoko; Ikemura, Satoshi; Matsui, Gen; Iguchi, Takahiro; Mitsuyasu, Hiroaki

    2015-01-01

    It has been reported that the common sites of brown tumors are the jaw, pelvis, ribs, femurs and clavicles. We report our experience in a case of brown tumor of the patella caused by primary hyperparathyroidism. An initial radiograph and CT showed an osteolytic lesion and MR images showed a mixed solid and multiloculated cystic tumor in the right patella. One month after the parathyroidectomy, rapid bone formation was observed on both radiographs and CT images. PMID:25995691

  8. The influence of kinematic conditions and design on the wear of patella-femoral replacements

    PubMed Central

    Maiti, Raman; Fisher, John; Rowley, Liam

    2014-01-01

    The success rate of patella-femoral arthroplasty varies between 44% and 90% in 17 years of follow-up. Several studies have been performed previously for assessing the surface wear in the patella-femoral joint. However, they have not included all six degrees of freedom. The aim of this study was to develop a six-axis patella-femoral joint simulator to assess the wear rate for two patellae designs (round and oval dome) at different kinematic conditions. An increase in patellar rotation from 1° to 4° led to a significantly (p<0.049) increased wear rate of round dome from 8.6 mm3/million cycles to 12.3 mm3/million cycles. The wear rate for oval dome increased from 6.3 mm3/million cycles to 14.5 mm3/million cycles. However, the increase was nonsignificant (p>0.08). The increase in wear rate was likely due to the higher cross shear. A decrease in patellar medial lateral displacement from passive to constrained resulted in a nonsignificant reduction in wear (p>0.06). There was no significant difference in wear rate between the two patellae designs (p>0.28). The volumetric wear under all conditions was positively correlated with the level of passive patellar tilt (rho>0.8). This is the first report of preclinical wear simulation of patella-femoral joint in a six-axis simulator under different kinematic conditions. PMID:24477888

  9. Automatic Determination of an Anatomical Coordinate System for a Three-Dimensional Model of the Human Patella

    PubMed Central

    Rainbow, Michael J; Miranda, Daniel L; Cheung, Roy T.H.; Schwartz, Joel B; Crisco, Joseph J; Davis, Irene S; Fleming, Braden C

    2013-01-01

    Measuring the in vivo 3-D kinematics of the patella requires a repeatable anatomical coordinate system (ACS). The purpose of this study was to develop an algorithm to determine an ACS using the patella’s unique morphology. An ACS was automatically constructed that aligned the proximal/distal (PD) axis with the posterior vertical ridge. Inter-subject ACS repeatability was determined by registering all patellae and their associated ACSs to a reference patella. The mean angle between the reference patella ACS and each subject's axes was less than 2.5° and the 95%CI was1.0°?4.0. Here, we presented an anatomical coordinate system that is independent of the observer’s subjective judgement or orientation of the knee within the scanner. PMID:23791087

  10. 3-D printouts of the tracheobronchial tree generated from CT images as an aid to management in a case of tracheobronchial chondromalacia caused by relapsing polychondritis.

    PubMed

    Tam, Matthew David; Laycock, Stephen David; Jayne, David; Babar, Judith; Noble, Brendon

    2013-08-01

    This report concerns a 67 year old male patient with known advanced relapsing polychondritis complicated by tracheobronchial chondromalacia who is increasingly symptomatic and therapeutic options such as tracheostomy and stenting procedures are being considered. The DICOM files from the patient's dynamic chest CT in its inspiratory and expiratory phases were used to generate stereolithography (STL) files and hence print out 3-D models of the patient's trachea and central airways. The 4 full-sized models allowed better understanding of the extent and location of any stenosis or malacic change and should aid any planned future stenting procedures. The future possibility of using the models as scaffolding to generate a new cartilaginous upper airway using regenerative medical techniques is also discussed. PMID:24421951

  11. Arthropathy and proteinuria: nail-patella syndrome revisited

    PubMed Central

    Albishri, Jamal

    2014-01-01

    Nail-patella syndrome (NPS) is a pleiotropic autosomal-dominant disorder due to mutations in the gene LMX1B. It has traditionally been characterized by a tetrad of dermatologic and musculoskeletal abnormalities. However, one of the most serious manifestations of NPS is kidney disease, which may be present in up to 40% of affected individuals. Although diagnosis can be made at birth, it is often missed, presumably due to the rarity of the condition. A 35-year-old female presented to our clinic with history of small joint pain of 6 months duration. In addition she complained of pedal edema off and on for the last 12 years. Prior to her current presentation she had been managed by a local doctor symptomatically. On evaluation, a nephrotic syndrome was obvious, but no secondary cause could be found. However, her physical examination was characteristic of NPS and keeping in view the autosomal dominant nature of the disorder all her three siblings were screened who too showed classical features of NPS. This rare syndrome as a cause of nephrotic range proteinuria is discussed in this report. The report underlines the importance of a good physical examination in a given clinical setting. PMID:25408626

  12. A comparison between the patella and the calcaneus using ultrasound velocity and attenuation as predictors of bone mineral density

    NASA Astrophysics Data System (ADS)

    Han, S. M.; Davis, J.

    1997-10-01

    The bone mineral density (BMD), ultrasound velocity (UV) and attenuation were examined in sixteen matched sets of human patellae and calcanei. For the sixteen calcanei, BMD was strongly correlated with all ultrasound parameters. Calcaneal UV appeared to be inferior to attenuation in the ability to predict BMD. For the sixteen patellae, the average UV was found to be greater in the superior/inferior direction than in the anterior/posterior and medial/lateral directions. It was found that patella BMD was significantly correlated with each of three directional ultrasound velocities. The relationship between BMD and ultrasound attenuation parameters was not significant in the patella. A comparative study of the two different bone sets demonstrated that the BMDs of the patella and calcaneus were significantly correlated with each other. Ultrasound velocity of calcaneus, measured in the medial/lateral direction, was not significantly associated with any of three directional ultrasound velocities in the patella. Similarly, ultrasound attenuation parameters of calcaneus were not significantly correlated with those of patella. The present study also demonstrated evidence that when predicting BMDs at their respective sites using ultrasound, the calcaneus appeared to be superior to the patella.

  13. Acquired permanent dislocation of the patella in a patient with rheumatoid genu valgum.

    PubMed

    Nishikawa, Masataka; Owaki, Hajime; Kaneshiro, Shoichi; Fuji, Takeshi; Shi, Kenrin

    2015-06-01

    A case of acquired permanent dislocation of the patella associated with severe genu valgum in a patient with rheumatoid arthritis (RA) is herein reported. The pain and genu valgum progressed because of poor RA control. The patient had no history of major trauma of the knee before or after the onset of RA. The most reasonable hypothesis to explain this patient's pathology is that occult patellar dislocation developed after a minor trauma and progressed to permanent dislocation; poor RA control then worsened both the patellar dislocation and genu valgum. Total knee arthroplasty (TKA) with patella reduction was successfully performed with release of the lateral retinaculum and extension of the extensor mechanism by partial snipping of the rectus femoris tendon. Two years after the operation, the patient exhibited improvement in her Knee Society Knee and Function Scores from preoperative scores of 18 and 20 to postoperative scores of 94 and 80, respectively. Acquired permanent dislocation of the patella associated with severe genu valgum in patients with RA is rare. Excellent results were obtained with TKA, and the proximal realignment method was a useful procedure for patella reduction. PMID:25983519

  14. Influence of patellofemoral articular geometry and material on mechanics of the unresurfaced patella.

    PubMed

    Fitzpatrick, Clare K; Rullkoetter, Paul J

    2012-07-26

    Patellar resurfacing during knee replacement is still under debate, with several studies reporting higher incidence of anterior knee pain in unresurfaced patellae. Congruency between patella and femur impacts the mechanics of the patellar cartilage and strain in the underlying bone, with higher stresses and strains potentially contributing to cartilage wear and anterior knee pain. The material properties of the articulating surfaces will also affect load transfer between femur and patella. The purpose of this study was to evaluate the mechanics of the unresurfaced patella and compare with natural and resurfaced conditions in a series of finite element models of the patellofemoral joint. In the unresurfaced analyses, three commercially available implants were compared, in addition to an 'ideal' femoral component which replicated the geometry, but not the material properties, of the natural femur. Hence, the contribution of femoral component material properties could be assessed independently from geometry changes. The ideal component tracked the kinematics and patellar bone strain of the natural knee, but had consistently inferior contact mechanics. In later flexion, compressive patellar bone strain in unresurfaced conditions was substantially higher than in resurfaced conditions. Understanding how femoral component geometry and material properties in unresurfaced knee replacement alters cartilage contact mechanics and bone strain may aid in explaining why the incidence of anterior knee pain is higher in the unresurfaced population, and ultimately contribute to identifying criteria to pre-operatively predict which patients are suited to an unresurfaced procedure and reducing the incidence of anterior knee pain in the unresurfaced patient population. PMID:22727469

  15. Vertical open patella fracture, treatment, rehabilitation and the moment to fixation.

    PubMed

    Larangeira, Joao Alberto; Bellenzier, Liliane; Rigo, Vanessa da Silva; Ramos Neto, Elias Josue; Krum, Francisco Fritsch Machry; Ribeiro, Tiango Aguiar

    2015-02-01

    Patella fracture is relatively uncommon and the vertical trace fracture represents almost 12-17%. The open patella fracture expresses 6-30%. The association of these two uncommon conditions was the aim of this case report even as the treatment and the moment of fixation (definitive surgical treatment). A 27-year-old man after a motorcycle accident showed an open patella fracture classified as a Gustilo and Anderson type IIIA lesion. The patient was immediately treated with precocious surgery fixation with a modified tension band which consists of two parallel K-wires positioned orthogonal to the fracture line and a cerclage wire shaped anteriorly at patella as an eight. The premature fixation benefited the infection prevention and provided earlier joint motion, which increased the nutrition of articular cartilage. Six months postoperatively, the patient had a satisfactory joint motion with full extension and 116° of joint flexion and returned to his daily life activities without restriction. Twelve months postoperatively, the patient had full extension and 120° of knee flexion without pain, joint effusion and instability. Muscle strength force was considered normal at grade V. In conclusion, early chirurgic treatment and precocious articular mobilization improve prognosis, suggesting that the employment of these practices should be adopted whenever possible in most of the open fractures. PMID:25436033

  16. Finite element analysis of resurfacing depth and obliquity on patella stress and stability in TKA.

    PubMed

    Amirouche, Farid; Choi, Kwang Won; Goldstein, Wayne M; Gonzalez, Mark H; Broviak, Stefanie

    2013-06-01

    Patella resurfacing in total knee arthroplasty (TKA) reduces postoperative complications and revisions; however, the optimal cutting depth and angle that minimize patellar strain and fracture remain unclear. We performed three-dimensional finite element analysis (FEA) of resurfacing cutting depth and obliquity to assess the stresses in each component of the knee joint, and fatigue testing to determine cyclic loading conditions over the expected life span of the implant. Maximum stress on the patella increased as cutting depth increased up to 8mm; peak stresses on the idealized button further increased at 10-mm depth. Medial superior obliquities below 3° showed the lowest stress on the patella and button and the highest fatigue life. An oblique cut of 3° with respect to the inferior end increased patellar stress and reduced fatigue life, making this the least successful approach. Taken together, our FEA supports the use of minimal cutting depths at -3° with respect to the superior end for patellar resurfacing in TKA in order to minimize stresses in the structure and improve TKA durability. Future studies will assess the effect of patella button placement to account for real-world practice variations. PMID:23523209

  17. Patella Tendon Injuries Secondary to Cement Spacers Used at First-Stage Revision of Infected Total Knee Replacement

    PubMed Central

    Wilson, Katherine; Kothwal, Rahul; Khan, Wasim S.; Williams, Rhodri; Morgan-Jones, Rhidian

    2015-01-01

    We describe a series of three patients who sustained patella tendon injuries in infected total knee arthroplasties following the use of a static cement spacer at first-stage knee revision. The patella tendon injuries resulted in significant compromise to wound healing and knee stability requiring multiple surgeries. The mid-term function was poor with an Oxford score at 24?months ranging from 12 to 20. Based on our experience, we advise caution in the use of static cement spacer blocks. If they are to be used, we recommend that they should be keyed in the bone to prevent patella tendon injuries. PMID:25905106

  18. A novel technique of patella fracture fixation facilitating early mobilization and reducing re-operation rates

    PubMed Central

    Agarwala, Sanjay; Agrawal, Pranshu; Sobti, Anshul

    2015-01-01

    Objective Fractures of patella constitute 1% of all fractures. Various techniques have been described for internal fixation of patella fractures. Superiority of one technique over the other has long been debated. We reviewed a series of fifty-one patients with transverse or comminuted fractures of patella treated with a novel technique to assess if it had any advantages over the existing methods of fixation. Design Retrospective. Setting A tertiary care centre. Patients & methods Fifty-one patients with patella fracture OTA 34C, with a mean age of 39 years (range 18–61) were treated with technique of cerclage and two tension bands at our institute. Forty-eight patients completed the study. Main outcome measurements Range of Motion and evidence of radiological union were assessed at regular follow-ups. Results Forty-four out of forty-eight patients had gained up-to 90 degrees of active flexion at the end of 1 week. Two patients (4.2%) developed superficial infection. All fractures had united at the end of 12 weeks. Five patients (10.3%) underwent a second surgery; four (8.3%) due to implant related complications. Malunion or non-union was not noted in any of the cases. Conclusion The advantages of the described method are early mobilization, elimination of k-wire related complications, and ease of use in comminuted fracture pattern as well and a lower reoperation rates as compared to the available literature. We strongly recommend its use in cases of displaced comminuted/transverse fractures of patella as an alternate method of treatment. Level of evidence Level III.

  19. Quadriceps Weakness, Patella Alta and Structural Features of Patellofemoral Osteoarthritis: The Multicenter Osteoarthritis Study

    PubMed Central

    Stefanik, Joshua J.; Guermazi, Ali; Zhu, Yanyan; Zumwalt, Ann C.; Gross, K. Douglas; Clancy, Margaret; Lynch, John A.; Segal, Neil A.; Lewis, Cora E.; Roemer, Frank W.; Powers, Christopher M.; Felson, David T.

    2011-01-01

    Objective To determine the relationship between quadriceps weakness and cartilage damage and bone marrow lesions (BMLs) in the patellofemoral joint (PFJ), and if this relationship is modified by patella alta. Methods The Multicenter Osteoarthritis (MOST) Study is a cohort study of persons aged 50–79 years with or at risk for knee OA. Concentric knee extensor strength was measured using an isokinetic dynamometer. Patella alta was measured using the Insall-Salvati ratio (ISR) on the lateral radiograph, and cartilage damage and bone marrow lesions (BMLs) were graded on MRI in the PFJ. We determined the association between quadriceps weakness with cartilage damage and BMLs in the PFJ among those knees with (ISR?1.2) and without patella alta (ISR<1.2) using multiple binomial regression. Results 807 knees were studied (mean age 62 years, BMI 30, ISR 1.10), 64% from female subjects. Compared with knees in the highest strength tertile, those in the lowest had 10.2% {95% Confidence Interval (CI) 3–18}, 9.1% (95% CI 2–16), and 7.1% (95% CI 1–13) higher prevalence of lateral PFJ cartilage damage, medial PFJ cartilage damage, and lateral PFJ BMLs, respectively. The association between quadriceps weakness with cartilage damage and BMLs was not different between knees with and with out patella alta in the lateral PFJ. Conclusion Quadriceps weakness was associated with PFJ cartilage damage and BMLs. While both patella alta and quadriceps weakness are associated with PFJ damage, the combination of the two was not associated with more damage than either of these factors alone. PMID:21702087

  20. Biodegradable wire fixation in olecranon and patella fractures combined with biodegradable screws or plugs and compared with metallic fixation

    Microsoft Academic Search

    T. Juutilainen; H. Patiälä; P. Rokkanen; P. Törmälä

    1995-01-01

    The outcome of olecranon and patella fractures fixed with biodegradable implants (self-reinforced poly-l-lactide wire combined with self-reinforced polyglycolide screw or self-reinforced poly-l-lactide plug) or with metallic implants (tension band wiring, Kirschner wire and metallic cerclage wire) was compared in a prospective, randomized study. Twenty-five olecranon fractures (15 with biodegradable implants and 10 with metallic ones) and 10 patella fractures (6

  1. Nail-patella syndrome and IgA nephropathy in a Chinese woman.

    PubMed

    Chuah, K L; Tan, P H; Choong, H L; Lai, D; Chiang, G

    1999-11-01

    Nail-patella syndrome (NPS), also known as hereditary onycho-osteodysplasia, is an autosomal dominant pleiotropic disorder characterized by nailbed dysplasia or hypoplasia, absent or hypoplastic patellae, iliac horns and deformation or luxation of the radial head. Nephropathy is a known serious complication associated with NPS. In this report, we describe an adult Chinese woman with the clinical and radiological features of NPS who presented with the nephrotic syndrome. Renal biopsy disclosed focal segmental glomerulosclerosis on light microscopy, while immunofluorescence revealed predominant staining for IgA in the glomerular mesangium and along some capillary walls. Ultrastructural study confirmed the presence of paramesangial deposits as well as subendothelial collagen fibrils in the glomeruli. The histological findings were those of combined NPS and IgA disease, an association which has rarely been described. PMID:10643004

  2. Molecular cytogenetic detection of 9q34 breakpoints associated with nail patella syndrome

    Microsoft Academic Search

    Asli Silahtaroglu; Frans A Hol; Peter KA Jensen; Martin Erdel; Hans-Christoph Duba; Monique PA Geurds; Nine VAM Knoers; Edwin CM Mariman; Zeynep Tümer; Gerd Utermann; Jutta Wirth; Merete Bugge; Niels Tommerup

    1999-01-01

    The nail patella syndrome (NPS1) is an autosomal dominant disorder characterised by dysplasia of the finger nails and skeletal abnormalities. NPS1 has been mapped to 9q34, to a 1 cM interval between D9S315 and the adenylate kinase gene (AK1). We have mapped the breakpoints within the candidate NPS1 region in two unrelated patients with balanced translocations. One patient [46,XY,t(1;9)(q32.1;q34)] was

  3. Nail-Patella Syndrome: Identification of Mutations in the LMX1B Gene in Dutch Families

    Microsoft Academic Search

    NINE V. A. M. KNOERS; ERNIE M. H. F. BONGERS; SYLVIA E. C. VAN BEERSUM; ED J. P. LOMMEN; HANS VAN BOKHOVEN; FRANS A. HOL

    2000-01-01

    Nail-patella syndrome is an autosomal dominant dis- order characterized by dyplasia of finger nails, skeletal anom- alies, and, frequently, renal disease. It has recently been shown that this disorder is caused by putative loss-of-function muta- tions in a transcription factor ( LMX1B) belonging to the LIM- homeodomain family, members of which are known to be important for pattern formation during

  4. Metaphylogenomic and Potential Functionality of the Limpet Patella pellucida’s Gastrointestinal Tract Microbiome

    PubMed Central

    Dudek, Magda; Adams, Jessica; Swain, Martin; Hegarty, Matthew; Huws, Sharon; Gallagher, Joe

    2014-01-01

    This study investigated the microbial diversity associated with the digestive tract of the seaweed grazing marine limpet Patella pellucida. Using a modified indirect DNA extraction protocol and performing metagenomic profiling based on specific prokaryotic marker genes, the abundance of bacterial groups was identified from the analyzed metagenome. The members of three significantly abundant phyla of Proteobacteria, Firmicutes and Bacteroidetes were characterized through the literature and their predicted functions towards the host, as well as potential applications in the industrial environment assessed. PMID:25334059

  5. Patella kinematics and patello-femoral contact areas in patients with genu varum and mild osteoarthritis

    Microsoft Academic Search

    S Hinterwimmer; R von Eisenhart-Rothe; M Siebert; F Welsch; T Vogl; H Graichen

    2004-01-01

    Background. Patients with genu varum of the knee and moderate to severe osteoarthritis often suffer from additional symptoms of the patello-femoral joint. These patients have a poor prognosis following high tibial osteotomy. It is unclear whether varus knees with only mild femoro-tibial osteoarthritis are also associated with alterations of patella biomechanics, and affect the prognosis of intended high tibial osteotomy.Methods.

  6. Metaphylogenomic and potential functionality of the limpet Patella pellucida's gastrointestinal tract microbiome.

    PubMed

    Dudek, Magda; Adams, Jessica; Swain, Martin; Hegarty, Matthew; Huws, Sharon; Gallagher, Joe

    2014-01-01

    This study investigated the microbial diversity associated with the digestive tract of the seaweed grazing marine limpet Patella pellucida. Using a modified indirect DNA extraction protocol and performing metagenomic profiling based on specific prokaryotic marker genes, the abundance of bacterial groups was identified from the analyzed metagenome. The members of three significantly abundant phyla of Proteobacteria, Firmicutes and Bacteroidetes were characterized through the literature and their predicted functions towards the host, as well as potential applications in the industrial environment assessed. PMID:25334059

  7. Intra-Articular Dislocation of the Patella With Associated Hoffa Fracture in a Skeletally Immature Patient.

    PubMed

    Potini, Vishnu C; Gehrmann, Robin M

    2015-06-01

    Since 1887, approximately 50 cases of an intra-articular patellar dislocation have been reported in the worldwide literature. The vast majority of patients required an open reduction of the patella or closed reduction under general anesthesia. This injury has never been reported in association with a coronal shear fracture of the femoral condyle. A 14-year-old boy presented to our institution with his left knee locked in flexion after a direct blow. Radiographs showed the patella rotated on its horizontal axis and lying in a transverse position within the knee joint, as well as a concomitant femoral condyle fracture. After a successful closed reduction of the patella, the patient underwent open reduction and rigid fixation of the femoral condyle fracture with countersunk interfragmentary screws. At 12 months, the patient was ambulating on the left leg and had painless motion of the knee. We present a rare injury pattern in a skeletally immature patient after a direct blow to the knee. By treating the injuries in a sequential manner and providing a stable fixation construct, the patient was able to achieve a satisfactory return to function even after sustaining a considerable injury to the knee. PMID:26047005

  8. Extensor mechanism reconstruction: a novel technique for bone patella allograft post partial patellectomy failure.

    PubMed

    Drexler, Michael; Blumberg, Nehemia; Haim, Amir; Arbel, Ron; Morag, Guy

    2011-06-01

    Extensor mechanism disruption, whether due to patella fracture or tendon rupture, generally occurs after low-energy trauma and frequently involves an indirect mechanism. When the fracture is comminuted and reconstruction is impossible, a partial or total patellectomy may be indicated. Although some authors advocate total patellectomy, partial patellectomy remains the standard treatment, especially for young and active patients. In the rare instance of a failed tendon repair after partial or total patellectomy, inadequate tissue is usually available for adequate restoration of the extensor mechanism. Extensor mechanism allograft, using the tibial tuberosity, patellar tendon, patella, and quadriceps tendon in continuity or the Achilles' tendon with calcaneal bone-block in continuity has been reported for extensor mechanism repair after total knee arthroplasty in patients who did not undergo patellectomy. We present a novel technique, using the bone patellar tendon bone allograft to reconstruct a posttraumatic defect of the extensor mechanism in a 28-year-old, active patient with a failed partial patellectomy following fracture of his patella. Union of the allograft was seen on x-ray after 4 months. After 6 months, the patient reached full range of motion and returned to his previous sporting activities. PMID:21874949

  9. Patella re-alignment in children with a modified Grammont technique

    PubMed Central

    2012-01-01

    Background and purpose In skeletally immature patients, surgical options due to recurrent patella dislocation are limited, because bony procedures bear the risk of growth disturbances. In this retrospective study, we report the long-term functional and radiographic outcome in skeletally immature patients using the modified Grammont surgical technique. Patients Between 1999 and 2004, 65 skeletally immature knees (49 children) were treated with a modified Grammont procedure: an open lateral release and a shift of the patella tendon insertion below the growth plate on the tuberositas tibia, allowing the tendon to medialize. At mean 8 (5.6–11) years after surgery, 58 knees in 43 patients were evaluated by clinical examination, from functional scores (Lysholm, Tegner), and from radiographs of the knees. Results Mean Lysholm score was 82 postoperatively. Tegner score decreased from 6.2 to 5. Eight knees had a single dislocation within 3 months of surgery. 3 knees had repeated late dislocations, all with a high grade of trochlea dysplasia. 6 knees showed mild signs of osteoarthritis. No growth disturbances were observed. Interpretation The modified Grammont technique in skeletally immature patients allows restoration of the distal patella tendon alignment by dynamic positioning. Long-term results showed that there were no growth disturbances and that there was good functional outcome. However, patients with a high grade of trochlea dysplasia tended to re-dislocate. PMID:23039166

  10. Stifle disorders: cranial cruciate ligament, meniscus, upward fixation of the patella.

    PubMed

    Pentecost, Rebecca; Niehaus, Andrew

    2014-03-01

    Stifle injury in cattle can be a debilitating condition. Stifle injuries often present as nonspecific lameness with subtle clinical signs. Physical examination with manipulation of the stifle joint, radiographs, and analysis of the joint fluid can help to make a diagnosis. Cranial cruciate and collateral ligament injuries are among the most common traumatic injuries of the stifle joint. Although the prognosis is guarded, better success and less degenerative change are expected with early diagnosis and treatment. Meniscal injuries and upward fixation of the patella are less commonly diagnosed, but their clinical signs, treatment, and prognosis are discussed in this article. PMID:24534669

  11. Arthroscopic treatment of an aneurysmal bone cyst of the patella: A case report

    PubMed Central

    Sandokji, Abdullah

    2015-01-01

    Aneurysmal bone cyst is a benign tumor-like bone lesion. This report concerns a 43 year-old male patient diagnosed with a primary aneurysmal bone cyst of his right patella. His main presentation was anterior knee pain. The patient was treated with arthroscopic excisional biopsy of the cyst and curettage, followed by filling the cavity with bone cement at a second stage. During the 5-year follow-up, the patient remained symptom free, with a normal range of motion. The arthroscopic approach is a less-invasive procedure with low morbidity and enabled us to determine which site should be going through. PMID:25901136

  12. Associations of Bone Mineral Density and Lead Levels in Blood, Tibia, and Patella in Urban-Dwelling Women

    Microsoft Academic Search

    Keson Theppeang; Thomas A. Glass; Karen Bandeen-Roche; Andrew C. Todd; Charles A. Rohde; Jonathan M. Links; Brian S. Schwartz

    2008-01-01

    Objective: The objective of this study was to evaluate the relations between bone mineral density (BMD) and lead in blood, tibia, and patella and to investigate how BMD modifies these lead biomarkers in older women. Design: In this study, we used cross-sectional analysis. Participants: We studied 112 women, 50-70 years of age, including both whites and African Americans, residing in

  13. Freehand resection of the patella in total knee arthroplasty referencing the attachments of the quadriceps tendon and patellar tendon

    Microsoft Academic Search

    Adolph V. Lombardi; Thomas H. Mallory; Paul D. Maitino; Stephen M. Herrington; Cheryl A. Kefauver

    1998-01-01

    A freehand technique of patellar resurfacing using anatomic references was prospectively evaluated. This technique utilizes an osteotomy beginning at the inferior pole of the patella just posterior to the insertion of the patellar tendon and is carried proximally posterior to the insertion of the quadriceps tendon. Evaluation of 55 total knee arthroplasties in 41 patients showed an average restored patellar

  14. Spontaneous patella fracture associated with anterior tibial tubercle pseudarthrosis in a revised knee replacement following knee Arthrodesis

    PubMed Central

    2013-01-01

    Background Conversion of a knee arthrodesis to a Total Knee Arthroplasty is an uncommon procedure. Revision Total Knee Arthroplasty in this setting presents the surgeon with a number of challenges including the management of the extensor mechanism and patella. Case presentation We describe a unique case of a 69 years old Caucasian man who underwent a revision Total Knee Arthroplasty using a tibial tubercle osteotomy after a previous conversion of a knee arthrodesis without patella resurfacing. Unfortunately 9 months following surgery a tibial tubercle pseudarthrosis and spontaneous patella fracture occurred. Both were managed with open reduction and internal fixation. At 30 months follow-up the tibial tubercle osteotomy had completely consolidated while the patella fracture was still evident but with no signs of further displacement. The patient was completely satisfied with the outcome and had a painless range of knee flexion between 0-95°. Conclusions We believe that patients undergoing this type of surgery require careful counseling regarding the risk of complications both during and after surgery despite strong evidence supporting improved functional outcomes. PMID:24195600

  15. Orthopaedic crossfire--All patellae should be resurfaced during primary total knee arthroplasty: in the affirmative.

    PubMed

    Hanssen, Arlen D

    2003-04-01

    Patients with inflammatory arthritis, crystalline deposition disease, or severe patellofemoral arthritis have superior functional results with patellar resurfacing as compared with patellar retention. The only remaining issue is whether there is any advantage to resurfacing or retention in patients with osteoarthritic knees in the absence of severe patellofemoral arthritis. Although the answer is still unclear from available prospective randomized clinical trials, the evidence leans toward routine resurfacing of the patella during primary total knee arthroplasty in osteoarthritic knees too. Evidence exists that the results of patellar retention in osteoarthritic knees deteriorate with longer follow-up study. Long-term follow-up evaluations of available prospective clinical trials will be needed to assess this controversy more definitively. PMID:12730925

  16. Nail-patella syndrome-a novel mutation in the LMX1B gene.

    PubMed

    Nair, Rajesh R; Unni, Vavullipathy N; Indu, Kadevalappil N; Nampoothiri, Sheela; Mathew, Anil; Kurian, George; Vimala, Avadaiammal

    2013-06-01

    Nail-patella syndrome (NPS) is an autosomal-dominant pleiotropic disorder characterized by dyplasia of finger nails, skeletal anomalies and frequently renal disease. In the reported case, genetic analysis revealed a new missense mutation in the homeodomain of LMX1B, presumed to abolish DNA binding (c.725T>C, p.Val242Ala). A missense mutation at codon 725 was identified, where thymine was replaced by cytosine which led to the replacement of valine by alanine at position 242. It was not detected in both parents. A 2005 study by Bongers et al. described a significant association between the presence of clinically relevant renal involvement in an NPS patient and a positive family history of nephropathy, which was lacking in our case. PMID:26064490

  17. Nail patella syndrome: a rare cause of renal failure in a young adult

    PubMed Central

    Senguttuvan, Nagendra Boopathy; Sivaraman, Arjun; Kandasamy, Devasenathipathy; Marimuthu, Kanniraj

    2011-01-01

    Nail Patella Syndrome (NPS) is a rare hereditary disease affecting multiple systems with predominant involvement of Kidney, Bones and Nails and Eyes. We report a case of NPS which presented as renal failure in a 22 year old male. The patient was admitted with decreased urine output and features of fluid overload and was being evaluated for renal failure. Physical examination revealed associated bony deformities which raised the suspicion of NPS as a possible etiology. This was confirmed by the radiological evaluation which showed the classical features of NPS. Though NPS is a rare clinical condition, physicians should complete knowledge about the components of NPS for appropriate diagnosis and for early detection of other systems involvement. PMID:22145064

  18. Nail-patella syndrome—a novel mutation in the LMX1B gene

    PubMed Central

    Nair, Rajesh R.; Unni, Vavullipathy N.; Indu, Kadevalappil N.; Nampoothiri, Sheela; Mathew, Anil; Kurian, George; Vimala, Avadaiammal

    2013-01-01

    Nail-patella syndrome (NPS) is an autosomal-dominant pleiotropic disorder characterized by dyplasia of finger nails, skeletal anomalies and frequently renal disease. In the reported case, genetic analysis revealed a new missense mutation in the homeodomain of LMX1B, presumed to abolish DNA binding (c.725T>C, p.Val242Ala). A missense mutation at codon 725 was identified, where thymine was replaced by cytosine which led to the replacement of valine by alanine at position 242. It was not detected in both parents. A 2005 study by Bongers et al. described a significant association between the presence of clinically relevant renal involvement in an NPS patient and a positive family history of nephropathy, which was lacking in our case.

  19. Population growth of Lepadella patella (O. F. Müller, 1786) at different algal (Chlorella vulgaris) densities and in association with Philodina roseola Ehrenberg, 1832

    Microsoft Academic Search

    S. Nandini; S. S. S. Sarma

    2001-01-01

    Population growth of Lepadella patella was studied using Chlorella as the sole food at five concentrations ranging from 0.25 × 106 to 4.0 × 106 cells ml-1 at 25 °C for 22 days. The population densities increased with increasing algal concentration up to 1.0 × 106 cells ml-1. The population growth of L. patella was lower at algal concentration of

  20. Bilateral sleeve fractures of the patella in a 12-year-old boy with hereditary spastic paraparesis and crouch gait.

    PubMed

    Malone, Ailish; Kiernan, Damien; O Brien, Tim

    2013-01-01

    This is the first reported case of bilateral sleeve fractures of the patellae in a child with crouch gait. A 12-year-old boy with hereditary spastic paraparesis (HSP), who was found to have mid-stance crouch of 20° on previous gait analysis, presented with pain of gradual onset and limited mobility. There was no history of trauma. Three-dimensional gait analysis showed that extensor mechanism function during loading response was intact, but knee flexion in swing was significantly reduced, indicating protective guarding by rectus femoris. X-rays showed bilateral minimally displaced sleeve fractures of the patellae. These were treated with immobilisation in cylinder casts in extension for 4 weeks. Follow-up X-rays showed that the fractures had successfully united and the patient progressed to full weight bearing and mobility as tolerated. PMID:24306432

  1. Lower genetic diversity in the limpet Patella caerulea on urban coastal structures compared to natural rocky habitats

    Microsoft Academic Search

    Cecile Fauvelot; Francesca Bertozzi; Federica Costantini; Laura Airoldi; Marco Abbiati

    2009-01-01

    Human-made structures are increasingly found in marine coastal habitats. The aim of the present study was to explore whether\\u000a urban coastal structures can affect the genetic variation of hard-bottom species. We conducted a population genetic analysis\\u000a on the limpet Patella caerulea sampled in both natural and artificial habitats along the Adriatic coast. Five microsatellite loci were used to test for

  2. Responses of the endangered limpet Patella ferruginea to reintroduction under different environmental conditions: survival, growth rates and life?history

    Microsoft Academic Search

    F. Espinosa; A. R. González; M. J. Maestre; D. Fa

    2008-01-01

    The mollusc Patella ferruginea, endemic to the Mediterranean, is the most endangered marine species of the list of the European Council Directive 92\\/43\\/EEC and it is presently under serious risk of extinction. Survival, growth rates and life?history of this species were studied for the first time in this species. A total of 570 specimens (420 introduced in a new habitat

  3. Localization of a gene for familial patella aplasia-hypoplasia (PTLAH) to chromosome 17q21-22.

    PubMed Central

    Mangino, M; Sanchez, O; Torrente, I; De Luca, A; Capon, F; Novelli, G; Dallapiccola, B

    1999-01-01

    Patella aplasia-hypoplasia (PTLAH) is a rare genetic defect characterized by congenital absence or marked reduction of the patella. PTLAH can occur either as an isolated defect or in association with other malformations, and it characteristically occurs in the nail-patella syndrome and in some chromosome imbalances. We report the first evidence of linkage for isolated PTLAH in an extended Venezuelan family. After exclusion of the candidate chromosome regions where disorders associated with PTLAH have been mapped, a genomewide scan was performed that supported mapping of the disease locus within a region of 12 cM on chromosome 17q22. Two marker loci (D17S787 and D17S1604) typed from this region gave maximum LOD scores >3. Accordingly, multipoint analysis gave a maximum LOD score of 3.39, with a most likely location for the disease gene between D17S787 and D17S1604. Sequencing of the noggin gene, a candidate mapping between these markers, failed to reveal any mutation in affected subjects. PMID:10417287

  4. Two Patients with Osteochondral Injury of the Weight-Bearing Portion of the Lateral Femoral Condyle Associated with Lateral Dislocation of the Patella

    PubMed Central

    Inoue, Hiroaki; Atsumi, Satoru; Ichimaru, Shohei; Fujiwara, Hiroyoshi; Kubo, Toshikazu

    2014-01-01

    Complications of patellar dislocation include osteochondral injury of the lateral femoral condyle and patella. Most cases of osteochondral injury occur in the anterior region, which is the non-weight-bearing portion of the lateral femoral condyle. We describe two patients with osteochondral injury of the weight-bearing surface of the lateral femoral condyle associated with lateral dislocation of the patella. The patients were 18- and 11-year-old females. Osteochondral injury occurred on the weight-bearing surface distal to the lateral femoral condyle. The presence of a free osteochondral fragment and osteochondral injury of the lateral femoral condyle was confirmed on MRI and reconstruction CT scan. Treatment consisted of osteochondral fragment fixation or microfracture, as well as patellar stabilization. Osteochondral injury was present in the weight-bearing portion of the lateral femoral condyle in both patients, suggesting that the injury was caused by friction between the patella and lateral femoral condyle when the patella was dislocated or reduced at about 90° flexion of the knee joint. These findings indicate that patellar dislocation may occur and osteochondral injury may extend to the weight-bearing portion of the femur even in deep flexion, when the patella is stabilized on the bones of the femoral groove. PMID:25506015

  5. Screening of vibroarthrographic signals via adaptive segmentation and linear prediction modeling

    Microsoft Academic Search

    Zahra M. K. Maussavi; Rangaraj M. Rangayyan; G. Douglas Bell; Cyril B. Frank; K. O. Ladly

    1996-01-01

    This paper proposes a noninvasive method to di- agnose chondromalacia patella at its early stages by recording knee vibration signals (also known as vibroarthrographic or VAG signals) over the mid-patella during normal movement. An adaptive segmentation method was developed to segment the nonstationary VAG signals. The least squares modeling method was used to reduce the number of data samples to

  6. Insight into the 3D-trabecular architecture of the human patella.

    PubMed

    Hoechel, Sebastian; Schulz, Georg; Müller-Gerbl, Magdalena

    2015-07-01

    The subchondral bone plate (SBP), a dynamic component of the osteochondral unit, shows functional adaptation to long-term loading by distribution of the mineral content in a manner best serving the mechanical demands. Since the received joint-load is transmitted into the trabecular system, the spongy bone also exhibits differences in strain energy density which models it for optimal support. To evaluate the regional variations in trabecular architecture, in accordance with the density distribution of the SBP revealing its long-term load intake, CT- and ?CT-datasets of ten physiologic patellae were analysed for defined parameters of bony structure. For the SBP, the density distributions as well as area measurements were used. The trabecular architecture was described using parameters of bone morphology comprising the first 5mm (examined in 1mm steps) below the SBP. The obtained measurements are: Bone volume fraction (BV/TV); Bone surface density (BS/TV); Trabecular number (Tb.N); Trabecular separation (Tb.Sp); Trabecular thickness (Tb.Th); structure model index (SMI); and the Degree of anisotropy (DA). The evaluated architectural parameters varied within the trabecular system and showed an inhomogeneous distribution pattern. It proved to be distinctive with maxima of material and stability situated below areas of the highest long-term load intake. With increasing depth, the pattern of distribution was persistent but lessened in intensity. The parameters significantly correlated with the density distribution of the SBP within the first and second millimetres. With increasing depth down to the fifth millimetre, the coefficients of correlation decreased for all values. The trabecular network adapts to its mechanical needs and is therefore not homogenously built. Dependent upon the long-term load intake, the trabecular model optimizes the support with significant correlation to the density distribution of the SBP. PMID:25835353

  7. Intra-crystalline protein diagenesis (IcPD) in Patella vulgata. Part II: Breakdown and temperature sensitivity

    PubMed Central

    Demarchi, B.; Collins, M.J.; Tomiak, P.J.; Davies, B.J.; Penkman, K.E.H.

    2013-01-01

    Artificial diagenesis of the intra-crystalline proteins isolated from Patella vulgata was induced by isothermal heating at 140 °C, 110 °C and 80 °C. Protein breakdown was quantified for multiple amino acids, measuring the extent of peptide bond hydrolysis, amino acid racemisation and decomposition. The patterns of diagenesis are complex; therefore the kinetic parameters of the main reactions were estimated by two different methods: 1) a well-established approach based on fitting mathematical expressions to the experimental data, e.g. first-order rate equations for hydrolysis and power-transformed first-order rate equations for racemisation; and 2) an alternative model-free approach, which was developed by estimating a “scaling” factor for the independent variable (time) which produces the best alignment of the experimental data. This method allows the calculation of the relative reaction rates for the different temperatures of isothermal heating. High-temperature data were compared with the extent of degradation detected in sub-fossil Patella specimens of known age, and we evaluated the ability of kinetic experiments to mimic diagenesis at burial temperature. The results highlighted a difference between patterns of degradation at low and high temperature and therefore we recommend caution for the extrapolation of protein breakdown rates to low burial temperatures for geochronological purposes when relying solely on kinetic data. PMID:23956808

  8. Intra-crystalline protein diagenesis (IcPD) in Patella vulgata. Part I: Isolation and testing of the closed system.

    PubMed

    Demarchi, B; Rogers, K; Fa, D A; Finlayson, C J; Milner, N; Penkman, K E H

    2013-04-01

    This study successfully isolates a fraction of intra-crystalline proteins from shells of the marine gastropod Patella vulgata and assesses the suitability of these proteins for IcPD (Intra-crystalline Protein Diagenesis) geochronology. We discuss the mineralogical composition of this gastropod, investigated for the first time by X-ray diffraction mapping, and use the results to inform our sampling strategy. The potential of the calcitic rim and of a bulk sample (containing both apex and rim) of the shell to act as stable repositories for the intra-crystalline proteins during diagenesis is examined. The composition and the diagenetic behaviour of the intra-crystalline proteins isolated from different locations within the shell are compared, highlighting the necessity of targeting consistent sampling positions. We induced artificial diagenesis of both intra-crystalline and whole-shell proteins by conducting high-temperature experiments in hydrous environment; this allowed us to quantify the loss of amino acids by leaching and therefore evaluate the open- or closed-system behaviour of the different fractions of proteins. The results obtained provide further confirmation that patterns of diagenesis vary according to the protein sequence, structure, and location within or outside the intra-crystalline fraction. As Patella is frequently found in the fossil record, both in archaeological and geological contexts, the application of IcPD geochronology to this biomineral opens up the possibility to obtain reliable age information from a range of sites in different areas of the world. PMID:23956807

  9. Intra-crystalline protein diagenesis (IcPD) in Patella vulgata. Part II: Breakdown and temperature sensitivity.

    PubMed

    Demarchi, B; Collins, M J; Tomiak, P J; Davies, B J; Penkman, K E H

    2013-04-01

    Artificial diagenesis of the intra-crystalline proteins isolated from Patella vulgata was induced by isothermal heating at 140 °C, 110 °C and 80 °C. Protein breakdown was quantified for multiple amino acids, measuring the extent of peptide bond hydrolysis, amino acid racemisation and decomposition. The patterns of diagenesis are complex; therefore the kinetic parameters of the main reactions were estimated by two different methods: 1) a well-established approach based on fitting mathematical expressions to the experimental data, e.g. first-order rate equations for hydrolysis and power-transformed first-order rate equations for racemisation; and 2) an alternative model-free approach, which was developed by estimating a "scaling" factor for the independent variable (time) which produces the best alignment of the experimental data. This method allows the calculation of the relative reaction rates for the different temperatures of isothermal heating. High-temperature data were compared with the extent of degradation detected in sub-fossil Patella specimens of known age, and we evaluated the ability of kinetic experiments to mimic diagenesis at burial temperature. The results highlighted a difference between patterns of degradation at low and high temperature and therefore we recommend caution for the extrapolation of protein breakdown rates to low burial temperatures for geochronological purposes when relying solely on kinetic data. PMID:23956808

  10. Autosomal recessive multiple epiphyseal dysplasia with homozygosity for C653S in the DTDST gene: double-layer patella as a reliable sign.

    PubMed

    Mäkitie, Outi; Savarirayan, Ravi; Bonafé, Luisa; Robertson, Stephen; Susic, Miki; Superti-Furga, Andrea; Cole, William G

    2003-10-15

    Mutations in the diastrophic dysplasia sulfate transporter (DTDST) gene result in a family of skeletal dysplasias, which comprise lethal (achondrogenesis type 1B and atelosteogenesis type 2) and non-lethal conditions (diastrophic dysplasia and recessive multiple epiphyseal dysplasia (rMED)). The most frequent mutation is R279W, which in a homozygous state results in rMED with bilateral clubfoot, MED, and "double layered" patella. We describe three patients with rMED caused by a previously unreported homozygous mutation in the DTDST gene. The three patients (from two families) were born to healthy, non-consanguineous parents. All developed signs of hip dysplasia in early childhood and two had episodes of recurrent patella dislocation. Two underwent bilateral total hip replacements at ages 13 and 14 years. The feet, external ears, and palate were normal. Stature was normal in all cases. Radiographs showed dysplastic femoral heads, mild generalized epiphyseal dysplasia, abnormal patella ossification, and normal hands and feet. Direct sequence analysis of genomic DNA demonstrated a homozygous 1984T > A (C653S) change in the DTDST gene in all patients. The clinically normal parents were heterozygous for the change. This is the first description of a homozygous C653S mutation of the DTDST gene. Hip dysplasia and patella hypermobility dominates the otherwise mild phenotype. These patients further expand the range of causative mutations in the DTD skeletal dysplasia family. PMID:12966518

  11. Annual variation in soft-body dry weight, reporductive cycle and sex ratios in populations of Patella vulgata at adjacent sites in the Orkney Islands

    Microsoft Academic Search

    J. M. Baxter

    1983-01-01

    The relationships of shell length and internal volume with soft-body dry weight for three populations of Patella vulgata L. at Sandwick Bay in the Orkney Islands were studied between August, 1979 and March, 1982. Seasonal and annual fluctuations in the regression constants were explained by age-related variations both in overall growth rates and in the amount of effort directed toward

  12. Presence of Gamma-Aminobutyric Acid (Gaba) in the Pedal Mucus of the Critically Endangered Species Patella ferruginea.

    PubMed

    Rivera-Ingraham, G A; Espinosa, F; Krock, B

    2015-05-01

    Patella ferruginea is a giant patellid limpet endemic to the Mediterranean Sea. It presently is in danger of extinction, and many have called for developing conservation measures including the mass production of spats for re-introduction projects. However, so far all attempts have been relatively unsuccessful. Previous work analyzing the effects of gamma-aminobutyric acid (GABA) on the recruitment of patellid limpets has shown that larvae respond to the presence of this signaling molecule. This response could explain the gregarious distribution typical of this species. In the present study, we demonstrated that GABA is naturally secreted by P. ferruginea in the pedal mucus. GABA is preferentially secreted during the summer, coinciding with the reproductive resting period of the species. Further research should aim to analyze the effects of GABA on larval development and metamorphosis in order to assess its potential use to improve conservation efforts. PMID:25902959

  13. The "Fungia patella group" (Scleractinia, Fungiidae) revisited with a description of the mini mushroom coral Cycloseris boschmai sp. n.

    PubMed

    Hoeksema, Bert W

    2014-01-01

    The recent taxonomic history of extant free-living Cycloseris species is briefly reviewed, resulting in the description of Cycloseris boschmai sp. n. (Scleractinia, Fungiidae) and a discussion on the validity of two other recently described species. Some Cycloseris species were previously considered to belong to the Fungia patella group, which also concerned misidentified museum specimens that actually belong to the new species. Other specimens of C. boschmai sp. n. were photographed and collected in the course of 30 years of fieldwork. The new mushroom coral is compared with other free-living Cycloseris species by means of an identification key. With a maximum diameter of 50 mm, it is the smallest free-living mushroom coral discovered so far. It can also be distinguished by its large primary order costae and variable colouration. Its distribution range is limited to the Coral Triangle, where it can be observed as an uncommon species on lower reef slopes. PMID:24493954

  14. Microenvironmental Ecology of the Chlorophyll b-Containing Symbiotic Cyanobacterium Prochloron in the Didemnid Ascidian Lissoclinum patella

    PubMed Central

    Kühl, Michael; Behrendt, Lars; Trampe, Erik; Qvortrup, Klaus; Schreiber, Ulrich; Borisov, Sergey M.; Klimant, Ingo; Larkum, Anthony W. D.

    2012-01-01

    The discovery of the cyanobacterium Prochloron was the first finding of a bacterial oxyphototroph with chlorophyll (Chl) b, in addition to Chl a. It was first described as Prochloron didemni but a number of clades have since been described. Prochloron is a conspicuously large (7–25??m) unicellular cyanobacterium living in a symbiotic relationship, primarily with (sub-) tropical didemnid ascidians; it has resisted numerous cultivation attempts and appears truly obligatory symbiotic. Recently, a Prochloron draft genome was published, revealing no lack of metabolic genes that could explain the apparent inability to reproduce and sustain photosynthesis in a free-living stage. Possibly, the unsuccessful cultivation is partly due to a lack of knowledge about the microenvironmental conditions and ecophysiology of Prochloron in its natural habitat. We used microsensors, variable chlorophyll fluorescence imaging and imaging of O2 and pH to obtain a detailed insight to the microenvironmental ecology and photobiology of Prochloron in hospite in the didemnid ascidian Lissoclinum patella. The microenvironment within ascidians is characterized by steep gradients of light and chemical parameters that change rapidly with varying irradiances. The interior zone of the ascidians harboring Prochloron thus became anoxic and acidic within a few minutes of darkness, while the same zone exhibited O2 super-saturation and strongly alkaline pH after a few minutes of illumination. Photosynthesis showed lack of photoinhibition even at high irradiances equivalent to full sunlight, and photosynthesis recovered rapidly after periods of anoxia. We discuss these new insights on the ecological niche of Prochloron and possible interactions with its host and other microbes in light of its recently published genome and a recent study of the overall microbial diversity and metagenome of L. patella. PMID:23226144

  15. Gracilis tendon transfer associated with distal alignment for patella alta with recurrent dislocations: an original surgical technique.

    PubMed

    Marteau, E; Burdin, P; Brilhault, J-M

    2011-06-01

    Many surgical techniques for the medial patellofemoral ligament have recently been suggested, all of which included problems identifying the femoral anchorage point and determining the proper extent of knee flexion for the transplant. P. Burdin proposed a different and original approach consisting in performing a gracilis muscle transfer to the medial edge of the patella, thus obtaining progressive tension of the transfer during knee flexion by means of the myotatic reflex. We report the results herein. We retrospectively assessed 17 knees treated for patellofemoral instability using this technique. Two cases presented subjective patellofemoral instability and 15 presented objective patellofemoral instability. The patients' mean age was 17.4 years (range, 8-47 years) during the first episode of dislocation. Two cases of instability were secondary to advanced neuromuscular disease. Two knees had already undergone two stabilization attempts. Fifteen knees presented trochlear dysplasia (four stage A, eight stage B, and three stage C). The mean age at surgery was 28.2 years (range, 16-47 years). In 15 cases, the gracilis transfer was associated with lowering the anterior tibial tuberosity (mean, 10mm). No patellar fracture occurred. A persistent sensory deficit of the anterior branch of the internal saphenous nerve was observed in 15 cases. One knee remained painful and retained subjective instability; total knee arthroplasty was performed 3 years after the intervention. The mean follow-up at revision was 5.5 years (range, 1.5-16.5 years). No recurrence of dislocation was reported. Eight cases retained subjective instability. The SF-36 and IKDC scores were good or excellent in 12 cases and the KOOS was good or excellent in 13 cases. Radiologically, patellar tilt persisted in six cases out of 14, translation persisted in two cases out of 14, and secondary patella baja was observed in one. Medial patellofemoral osteoarthritis was observed in five cases: one case IWANO stage I and four cases IWANO stage II. These satisfactory results seem stable over time and were acquired using a simple procedure with reduced morbidity, making it possible to avoid significant displacement of the anterior tibial tuberosity and stabilize the extensor apparatus. It can also be hoped that the onset of secondary patellofemoral osteoarthritis, undoubtedly inevitable, has been delayed. PMID:21530441

  16. Novel treatment of a failed quadriceps tendon repair in a diabetic patient using a patella-quadriceps tendon allograft.

    PubMed

    Druskin, Sasha C; Rodeo, Scott A

    2013-07-01

    Recurrent quadriceps tendon rupture is a debilitating condition that may be challenging to treat, especially in the presence of systemic disease such as diabetes mellitus (Bedi et al., J Shoulder Elbow Surg 19:978-988, 2010; Chbnou and Frenette, Am J Physiol Regul Integr Comp Physiol 5:R952-R957, 2004; Chen et al., J Shoulder Elbow Surg 5:416-421, 2003). Many surgical treatment protocols have been proposed (Azar, in Canale and Beatty, eds., Campbell's Operative Orthopedics, Mosby/Elsevier, Philadelphia, PA, 2008; Ilan et al., J Am Acad Orthop Surg 3:192-200, 2003; Rodeo and Izawa, in Garrett et al., eds., Principles and Practice of Orthopedic Sports Medicine, Lippincott Williams & Wilkins, Philadelphia, PA, 2000). We report the case of a diabetic male with multiple treatment failures. He ultimately sustained a good outcome following treatment with a novel surgical technique that utilized a patella quadriceps tendon allograft. Tendon allograft-to-native bone healing had previously failed in this patient, so we used a bone-tendon construct allograft to provide an allograft bone-to-native bone healing site. Now, 13 months postoperative, the patient has increased strength, minimal pain, 20 ° of extensor lag and 130 ° of flexion. PMID:24426867

  17. Statistical assessment of a sampling pattern for evaluation of changes in mercury and zinc concentrations in Patella coerulea

    SciTech Connect

    Puel, D.; Zsuerger, N.; Breittmayer, J.P.

    1987-04-01

    The validity and representativeness of sampling, whether in temporal or in geographic terms, are always a problematical aspect of the evaluation of metal pollution in coastal sea water. Numerous field studies have underscored the great variety in metal levels in a given site, even in the very short term. The choice of sedentary test species disposes of the variation factor associated with those that move from place to place. Because they are ubiquitous and easy to collect, mollusks have very often been used for this purpose. This is particularly true of the mussel and the oyster because they are eaten by man. The limpet (Patella) is a primary herbivore consumer and would seem an equally elective test organism. Its very localized feeding habits (grazing the algae colonizing the rocks where it lives) are less prone to sudden changes than those of the filtering mollusks. Indeed, it has already been employed in campaigns evaluating pollution by hydrocarbons and metals. To be able to compare several areas in this way, however, or follow their progress over the course of time, it is essential to work out a representative sampling plan. This paper reports an investigation of this aspect of the question with regard to two metals: mercury, which is toxic and plays no part in any natural metabolic process, and zinc, a cation required in weak concentrations by certain enzyme systems.

  18. The association between patella alta and the prevalence and worsening of structural features of patellofemoral joint osteoarthritis: The Multicenter Osteoarthritis Study

    PubMed Central

    Stefanik, J.J.; Zhu, Y.; Zumwalt, A.C.; Gross, K.D.; Clancy, M.; Lynch, J. A.; Frey Law, L.A.; Lewis, C.E.; Roemer, F.W.; Powers, C.M.; Guermazi, A.; Felson, D.T.

    2010-01-01

    Objective To examine the relationship between patella alta and the prevalence and worsening at follow-up of structural features of patellofemoral joint (PFJ) osteoarthritis (OA) on MRI. Methods The Multicenter Osteoarthritis (MOST) Study is a cohort study of persons aged 50-79 years with or at risk for knee OA. Patella alta was measured using the Insall-Salvati ratio (ISR) on the baseline lateral radiograph and cartilage damage, bone marrow lesions (BMLs), and subchondral bone attrition (SBA) were graded on MRI at baseline and at 30 months follow-up in the PFJ. We examined the association of the ISR with the prevalence and worsening of cartilage damage, BMLs, and SBA in the PFJ using logistic regression. Results 907 knees were studied (mean age 62, BMI 30, ISR 1.10), 63% from female subjects. Compared with knees in the lowest ISR quartile at baseline, those in the highest had 2.4 (95% CI 1.7, 3.3), 2.9 (2.0, 4.3), and 3.5 (2.3, 5.5) times the odds of having lateral PFJ cartilage damage, BMLs, and SBA respectively, and 1.5 (95% CI 1.1, 2.0), 1.3 (0.9, 1.8), and 2.2 (1.4, 3.4) times the odds of having medial PFJ cartilage damage, BMLs, and SBA respectively. Similarly, those with high ISRs were also at risk for worsening of cartilage damage and BMLs over time than those with low ISRs. Conclusion A high ISR, indicative of patella alta, is associated with structural features of OA in the PFJ. Additionally, the same knees have increased risk of worsening of these same features over time. PMID:20506169

  19. The Patella Pro study — effect of a knee brace on patellofemoral pain syndrome: design of a randomized clinical trial (DRKS-ID:DRKS00003291)

    PubMed Central

    2014-01-01

    Background Patellofemoral pain syndrome (PFPS) is a frequent cause of anterior knee pain predominantly affecting young female patients who do not have significant chondral damage. Development of PFPS is probably multifactorial, involving various knee, hip, and foot kinematic factors. Biomechanical studies have described patellar maltracking and dynamic valgus (functional malalignment) in patients with patellofemoral pain syndrome. The literature provides evidence for short-term use of nonsteroidal anti-inflammatory drugs; short-term medially directed taping; and exercise programs focusing on the lower extremity, hip, and trunk muscles. Evidence supporting the use of patellar braces is limited because previous studies have been low quality. The aim of this article is to publish the design of a prospective randomized trial that examines the outcomes of patients with PFPS after treatment with a new patellar brace (Patella Pro) that applies medially directed force on the patella. Methods/Design For this multicenter trial, 156 patients (adolescents and young adults) with PFPS were recruited from orthopedic practices and orthopedic hospitals and randomly allocated to 3 months of supervised physiotherapy in combination with the Patella Pro brace or supervised physiotherapy alone. The primary outcome measures are pain (numerical analog scale); knee function (Kujala score and Knee Injury and Osteoarthritis Outcome Score); and self-reported perception of recovery at baseline, 6 weeks, 3 months, and 1 year. Discussion Only limited evidence for the use of a patellar brace for the treatment of PFPS exists in the literature. Disputable evidence for the use of orthoses for PFPS patients has been presented in one meta-analysis, in which only one of three studies found the effect of a medially directed patellar brace to be significant. Because of these low-quality studies, the authors concluded that this evidence should be regarded as limited, and we feel there is a need for further well-designed studies to evaluate the effect of patellar bracing on PFPS-related pain. The Patella Pro study is a prospective randomized trial in which supervised physiotherapy in combination with a patellar brace is compared with supervised physiotherapy alone. This trial started in April 2012 and finished in October 2013. Trial registration DRKS-ID:DRKS00003291, January 3rd, 2012 PMID:24917049

  20. Arthroscopic Assessment and Treatment of Dancers' Knee Injuries.

    ERIC Educational Resources Information Center

    Silver, Daniel M.; Campbell, Pat

    1985-01-01

    Arthroscopic examination of 16 dancers with dance-related knee injuries which defied conservative treatment showed 15 meniscal tears and 4 cases of chondromalacia patellae. Partial arthroscopic meniscectomy was used to treat the tears. The results were excellent, with 13 of the 16 returning to preoperative levels of dance activity. (MT)

  1. A Microdeletion of Chromosome 9q33.3 Encompasses the Entire LMX1B Gene in a Chinese Family with Nail Patella Syndrome

    PubMed Central

    Jiang, Shujuan; Zhang, Jiubin; Huang, Dan; Zhang, Yuanyuan; Liu, Xiaoliang; Wang, Yinzhao; He, Rong; Zhao, Yanyan

    2014-01-01

    Nail patella syndrome (NPS) is an autosomal dominant disorder characterized by nail malformations, patellar apoplasia, or patellar hypoplasia. Mutations within the LMX1B gene are found in 85% of families with NPS; thus, this gene has been characterized as the causative gene of NPS. In this study, we identified a heterozygous microdeletion of the entire LMX1B gene using multiplex ligation-dependent probe amplification (MLPA) in a Chinese family with NPS. The determination of the deletion breakpoints by Illumina genome-wide DNA analysis beadchip showed that the deletion was located in chromosome 9q33.3 and spanned about 0.66 Mb in size. This heterozygous deletion provides strong evidence for haploinsufficiency as the pathogenic mechanism of NPS. PMID:25380522

  2. COL5a1: fine genetic mapping and exclusion as candidate gene in families with nail-patella syndrome, tuberous sclerosis 1, hereditary hemorrhagic telangiectasia, and Ehlers—Danlos syndrome type II

    Microsoft Academic Search

    Daniel S. Greenspan; Hope Northrup; Kit-Sing Au; Kimberly A. McAllister; Clair A. Francomano; Richard J. Wenstrup; Douglas A. Marchuk; David J. Kwiatkowski

    1995-01-01

    COL5A1, the gene for the ?1 chain of type V collagen, has been considered a candidate gene for certain diseases based on chromosomal location and\\/or disease phenotype. We have employed 3?-untranslated region RFLPs to exclude COL5A1 as a candidate gene in families with tuberous sclerosis 1, Ehlers—Danlos syndrome type II, and nail-patella syndrome. In addition, we describe a polymorphic simple

  3. Field testing the Unified Classification System for periprosthetic fractures of the femur, tibia and patella in association with knee replacement: an international collaboration.

    PubMed

    Van der Merwe, J M; Haddad, F S; Duncan, C P

    2014-12-01

    The Unified Classification System (UCS) was introduced because of a growing need to have a standardised universal classification system of periprosthetic fractures. It combines and simplifies many existing classification systems, and can be applied to any fracture around any partial or total joint replacement occurring during or after operation. Our goal was to assess the inter- and intra-observer reliability of the UCS in association with knee replacement when classifying fractures affecting one or more of the femur, tibia or patella. We used an international panel of ten orthopaedic surgeons with subspecialty fellowship training and expertise in adult hip and knee reconstruction ('experts') and ten residents of orthopaedic surgery in the last two years of training ('pre-experts'). They each received 15 radiographs for evaluation. After six weeks they evaluated the same radiographs again but in a different order. The reliability was assessed using the Kappa and weighted Kappa values. The Kappa values for inter-observer reliability for the experts and the pre-experts were 0.741 (95% confidence interval (CI) 0.707 to 0.774) and 0.765 (95% CI 0.733 to 0.797), respectively. The weighted Kappa values for intra-observer reliability for the experts and pre-experts were 0.898 (95% CI 0.846 to 0.950) and 0.878 (95% CI 0.815 to 0.942) respectively. The UCS has substantial inter-observer reliability and 'near perfect' intra-observer reliability when used for periprosthetic fractures in association with knee replacement in the hands of experienced and inexperienced users. PMID:25452371

  4. Get a kick out of this: the spectrum of knee extensor mechanism injuries.

    PubMed

    Tuong, Betty; White, Jeremy; Louis, Luck; Cairns, Robyn; Andrews, Gordon; Forster, Bruce B

    2011-02-01

    At the end of this article, the reader should be able to (1) recognise normal anatomy and anatomical variants of the extensor mechanism of the knee on various imaging modalities, including plain film, ultrasound and MRI; (2) diagnose a broad spectrum of EM injuries in adult and paediatric patients including patellar and quadriceps tendinopathy, Osgood-Schlatter disease, Sindig-Larsen-Johansson syndrome, chondromalacia patellae and patellar fractures on various imaging modalities; and (3) appreciate the important role of imaging in the diagnosis of musculoskeletal injuries. PMID:20966035

  5. Genetics Home Reference: Nail-patella syndrome

    MedlinePLUS

    ... hereditary osteo-onychodysplasia Osterreicher syndrome pelvic horn syndrome Turner-Kieser syndrome For more information about naming genetic conditions, see the Genetics Home Reference Condition Naming Guidelines and How are genetic conditions and genes named? in the Handbook. What if I still ...

  6. Selective Patellar Resurfacing: A Literature Review.

    PubMed

    Antholz, Casey R; Cherian, Jeffrey J; Elmallah, Randa K; Jauregui, Julio J; Pierce, Todd P; Mont, Micael A

    2015-05-01

    Whether to resurface the patella during total knee arthroplasty (TKA) remains a controversial topic among orthopaedic surgeons, and we are still no closer to identifying which technique provides the best outcomes. Advocates for patellar resurfacing have adopted this technique in order to avoid the potential for post-operative anterior knee pain that may be associated with the need for future reoperations. However, reports have indicated that patellar resurfacing may be associated with increased complications such as patellar implant loosening, fracture, osteonecrosis, tendon injury, wear, and instability. More recently, studies have highlighted possible patient-specific and surgical factors, such as weight, body mass index, degree of chondromalacia, and patellar alignment, which may influence functional outcomes, and thus surgical decision making. However, currently there are minimal clear guidelines to help surgeons decide whether or not to resurface the patella. Our aim was to assess the current literature and present the evidence for and against patellar resurfacing, as well as to assess factors that may aid in deciding which procedure is more suitable for the specific patient. Ultimately, we believe there is a need for further research to identify the most appropriate candidates for patellar resurfacing. PMID:26055032

  7. Bifocal disruption of the knee extensor apparatus ("floating patella") in a 72-year-old patient.

    PubMed

    Chappuis, Julien; Penders, Walter; Cherchel, Alexandra; Lamraski, Guyve

    2011-08-01

    We present the unusual case of a simultaneous ipsilateral rupture of the quadriceps tendon and the patellar ligament in a 72-year-old male patient. No predisposing factors were diagnosed. After surgical treatment, the patient healed with full function and full range of motion. PMID:21954769

  8. Isokinetic and anterior cruciate ligament reconstruction with hamstrings or patella tendon graft: analysis of literature.

    PubMed

    Dauty, M; Tortellier, L; Rochcongar, P

    2005-09-01

    We report isokinetic results of anterior cruciate ligament reconstruction with patellar tendon or hamstring graft from the literature analysis. The literature was defined from two search "textwords": Isokinetic and Anterior cruciate ligament reconstruction, and from three databases: Medline, Pascal, and Herasmus. Two independent physicians (Physical Medicine and Rehabilitation) carried out an analysis according to the French National Accreditation and Health Evaluation Agency recommendations. Fifty-three studies were selected: 29 reported isokinetic results after anterior cruciate ligament reconstruction with patellar tendon graft, 15 reported isokinetic results after anterior cruciate ligament reconstruction with hamstring graft, and 9 studies compared the two surgical procedures. After discussing different bias and in reference to prospective randomised and comparative studies, the anterior cruciate ligament reconstruction with patellar tendon graft involves a knee extensors deficit during several months. The hamstring surgical procedure involves a less important knee extensor deficit (from 6 to 19 % against 8 to 21 %). Knee sprain and intra-articular surgery involve a long-lasting knee extensors deficit. Anterior cruciate ligament reconstruction with hamstrings graft involves a knee flexors deficit over several months. The patellar tendon surgical procedure involves a less important knee flexors deficit (from 1 to 15 % against 5 to 17 %). In reference to isokinetic parameters, no difference between the two surgical procedures (patellar tendon graft or hamstring graft) is shown after more than twenty-four post-surgical months. PMID:16195995

  9. Fracture unicondylienne latérale sagittale du fémur associée à une fracture homolatérale verticale de la patella

    PubMed Central

    Sasbou, Youness; Boussaidane, Mohammed; Lukulunga, Loubet Unyendje; Azzouz, Mohammed; Mhammdi, Youness; Benchebba, Driss; Chagar, Belkacem

    2015-01-01

    Un patient de 24 ans a subit un traumatisme du genou droit suite à un accident de la voie publique occasionnant une fracture simultanée uni condylienne latérale et patellaire verticale. Cette association est exceptionnelle et aucun cas n'as été retrouvé dans la littérature. Un diagnostic précis clinique et radiologique suivi d'une prise en charge précoce et adaptée par une ostéosynthèse interne et une rééducation fonctionnelle ont permis d'obtenir de bons résultats à long terme. PMID:26113949

  10. Sclerochronology and geochemical variation in limpet shells (Patella vulgata): A new archive to reconstruct coastal sea

    E-print Network

    Schöne, Bernd R.

    the hypothesis that P. vulgata precipitates its shell in isotopic equilibrium with the ambient water by comparing temperature (SST) records and the equilibrium fractionation equation for calcite and water. We assumed on oxygen and carbon isotope ratios (d18 O and d13 C, respectively) in modern specimens. We tested

  11. Percutaneous Cannulated Screws with Tension Band Wiring Technique in Patella Fractures

    PubMed Central

    2013-01-01

    Introduction Most patellar fractures are transverse involving the central third. Open reduction and stabilization of transverse patellar fractures is indicated if there is more than 2-3 mm of fragment separation and/or articular incongruity. Surgical Technique This study describes a percutaneous 2 cannulated screws and modified tension band wiring technique to treat transverse patellar fractures. Materials and Methods We performed 30 cases of displaced transverse patellar fractures with this technique. The clinical outcomes of these patients were evaluated with simple radiographs, range of motion and Lyshom score. Results This technique has shown to provide satisfactory clinical results and excellent knee functions. Conclusions This technique provide stable fixation, allows early motion exercise by minimizing injury to extensor mechanism and reduce cosmetic problem in scar. PMID:24369000

  12. Arthroscopic assessment of human cartilage stiffness of the femoral condyles and the patella with a new tactile sensor

    Microsoft Academic Search

    Y Uchio; M Ochi; N Adachi; K Kawasaki; J Iwasa

    2002-01-01

    We measured the stiffness of the cartilage of the human femoral condyles via an ultrasonic tactile sensor under arthroscopic control. The stiffness and the degeneration of articular cartilage were assessed in 105 knees in 74 patients (39 men, 35 women, age: 9–72 years) who underwent arthroscopic observation or surgery. Twenty-five knees suffered from traumatic cartilage injury, 14 from osteochondritis dissecans,

  13. Low-grade fibromyxoid sarcoma around the knee involving the proximal end of the tibia and patella: A rare case report

    PubMed Central

    BAJPAI, JEETENDRA; SHUKLA, SAURAV; JAH, MOAZZAM; SINGH, ALOK KUMAR; GOEL, MOHIT; MOURYA, AMIT; SACHDEVA, NIKHIL

    2014-01-01

    Low-grade fibromyxoid sarcoma (LGFMS) is a distinctive variant of fibrosarcoma. LGFMS is a rare soft tissue tumor that tends to develop in the deep soft tissue of young adults and has the potential for local recurrence or distant metastasis. The current case report presents a 22-year-old male complaining of a slow growing painless mass in the right knee over a period of 10 years. Following complete evaluation by radiological and histopathological examination, a diagnosis of LGFMS was confirmed and a wide excision was performed. Currently, the patient has been under follow-up for the last five years without any evidence of metastasis. The present case report provides further information concerning the diagnosis, imaging and management of LGFMS. PMID:24944715

  14. Clinical comparison of the Autologous Quadriceps Tendon (BQT) and the Autologous Patella Tendon (BPTB) for the reconstruction of the Anterior Cruciate Ligament

    Microsoft Academic Search

    O. Gorschewsky; A. Klakow; A. Pütz; H. Mahn; W. Neumann

    2007-01-01

    The use of the BPTB-autograft is a very common method for ACL reconstruction. Nevertheless, the problem of the typical donor-site-morbidity\\u000a is unresolved. Recently, a transplant of quadriceps tendon, with an attached bone block (BQT) has been increasingly relied\\u000a upon. The purpose of this study was to examine the clinical results of a group of patients after arthroscopic ACL reconstruction\\u000a using

  15. Development of functionally distinct fibrocartilages at two sites in the quadriceps tendon of the rat: the suprapatella and the attachment to the patella

    Microsoft Academic Search

    J. R. Ralphs; R. N. S. Tyers; M. Benjamin

    1992-01-01

    This paper describes the post-natal development of two fibrocartilages in the quadriceps tendon of the rat. The compression-resisting fibrocartilage of the suprapatella was derived from a cell population present in neonates and positioned on the deep surface of the tendon of vastus intermedius. The cells secreted a metachromatic, coarsely fibrous extracellular matrix that was rich in chondroitin sulphate but lacked

  16. Cutis Laxa

    MedlinePLUS

    ... Syndrome Marfan Syndrome Osteochondrodysplasias Osteogenesis Imperfecta Pseudoxanthoma Elasticum Nail-Patella Syndrome Cutis laxa is a rare disorder of connective tissue that causes the skin to ...

  17. Taxonomy and phylogenetic relationships of two species of hypocrea with Trichoderma anamorphs

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Hypocrea patella is reevaluated. Its Trichoderma anamorph is described and the phylogenetic position of the species is determined through sequences of the ITS regions of rDNA. It is sister to a clade that includes Trichoderma longibrachiatum/H. schweinitzii. Hypocrea patella f. tropica is accepted ...

  18. EDITORIAL COMMENTARY How are podocytes affected in nailpatella syndrome?

    E-print Network

    Witzgall, Ralph - Naturwissenschaftliche Fakultät III

    EDITORIAL COMMENTARY How are podocytes affected in nail­patella syndrome? Ralph Witzgall Received 2008 # IPNA 2007 Abstract Nail­patella syndrome is an autosomal-dominant hereditary disease named factor of the Cys2His2-zinc finger family, had been found responsible for the podocytopathies Denys

  19. An alternative cruciate reconstruction graft: The central quadriceps tendon

    Microsoft Academic Search

    John P. Fulkerson; Rolf Langeland

    1995-01-01

    The central quadriceps tendon, above the patella, is thicker and wider than the patella tendon. Using precise technique, one can obtain a tendon graft for cruciate reconstruction with 50% greater mass than a patellar tendon bone-tendonbone graft of similar width. The central quadriceps tendon graft may be harvested by a second surgeon while the first surgeon is simultaneously accomplishing notchplasty

  20. Structure, ontogeny and evolution of the patellar tendon in emus (Dromaius novaehollandiae) and other palaeognath birds

    PubMed Central

    Pitsillides, Andrew A.; Hutchinson, John R.

    2014-01-01

    The patella (kneecap) exhibits multiple evolutionary origins in birds, mammals, and lizards, and is thought to increase the mechanical advantage of the knee extensor muscles. Despite appreciable interest in the specialized anatomy and locomotion of palaeognathous birds (ratites and relatives), the structure, ontogeny and evolution of the patella in these species remains poorly characterized. Within Palaeognathae, the patella has been reported to be either present, absent, or fused with other bones, but it is unclear how much of this variation is real, erroneous or ontogenetic. Clarification of the patella’s form in palaeognaths would provide insight into the early evolution of the patella in birds, in addition to the specialized locomotion of these species. Findings would also provide new character data of use in resolving the controversial evolutionary relationships of palaeognaths. In this study, we examined the gross and histological anatomy of the emu patellar tendon across several age groups from five weeks to 18 months. We combined these results with our observations and those of others regarding the patella in palaeognaths and their outgroups (both extant and extinct), to reconstruct the evolution of the patella in birds. We found no evidence of an ossified patella in emus, but noted its tendon to have a highly unusual morphology comprising large volumes of adipose tissue contained within a collagenous meshwork. The emu patellar tendon also included increasing amounts of a cartilage-like tissue throughout ontogeny. We speculate that the unusual morphology of the patellar tendon in emus results from assimilation of a peri-articular fat pad, and metaplastic formation of cartilage, both potentially as adaptations to increasing tendon load. We corroborate previous observations of a ‘double patella’ in ostriches, but in contrast to some assertions, we find independent (i.e., unfused) ossified patellae in kiwis and tinamous. Our reconstructions suggest a single evolutionary origin of the patella in birds and that the ancestral patella is likely to have been a composite structure comprising a small ossified portion, lost by some species (e.g., emus, moa) but expanded in others (e.g., ostriches). PMID:25551026

  1. Histopathology of ossicular implants.

    PubMed

    Merchant, S N; Nadol, J B

    1994-08-01

    Ossicular and cortical bone grafts maintain their morphologic structure for long periods of time and show varying amounts of replacement of nonviable bone by new bone through a slow process of creeping substitution. Cartilage grafts develop chondromalacia, lose stiffness, and tend to be resorbed over time. Plastipore prostheses elicit foreign body giant cell responses with microscopic biodegradation of the implants. There is a great need for the study of well-documented human temporal bone cases with in situ ossicular implants. PMID:7984378

  2. [Knee extensor mechanism ruptures].

    PubMed

    Duthon, V B; Fritschy, D

    2011-08-10

    Knee extensor mechanism is composed of the quadriceps and its tendon, patella and patellar tendon. Rupture of either the quadriceps or patellar tendon, or of the patella itself, lead to a disruption of the knee extensor mechanism. Clinical examination reveals an inability to actively extend the knee. Standard radiographs of the knee show a suprapatellar swelling of the soft tissues in case of quadriceps tendon rupture, or a displaced patellar fracture, or a patella alta in case of patellar tendon rupture. Echography and MRI confirm the diagnosis and may reveal associated injuries. In case of knee extensor mechanism rupture, early surgical reconstruction of quadriceps or patellar tendon, or patella osteosynthesis, are mandatory to achieve early functional recovery. PMID:21919393

  3. Mexican American dropouts in the Valley--their reasons for leaving school and their educational and occupational status projections

    E-print Network

    Wages, Sherry

    1971-01-01

    and Anthropology who have made my graduate school days pleasant and viii a very rewarding experience. To mention a few: my very dear and close friend Dannette Spiekerman, Betty Campbell, Lyn Dunsavage, Margaret Cannon, Vickie Patella, Mike Kleibrink, Mike...

  4. DEVELOPMENT 3133RESEARCH ARTICLE

    E-print Network

    Liu, X. Shirley

    of mechanical stress (such as the patella in the tendon of the quadriceps femoris); the periosteal bones, which bones are classified into three categories: the sesamoid bones, which form in tendons as a result

  5. Automatic Segmentation of Menisci in MR Images Using Pattern Recognition and Graph

    E-print Network

    Lunds Universitet

    between the femur (thigh bone) and patella (shin bone) in the knee and has several functions examinations produced in Landskrona hospital from a Philips 1.5T machine using a spin-echo sequence. The result

  6. Biology and augmentation of tendon-bone insertion repair

    Microsoft Academic Search

    Pauline Po-Yee Lui; Peng Zhang; Kai-Ming Chan; Ling Qin

    2010-01-01

    Surgical reattachment of tendon and bone such as in rotator cuff repair, patellar-patella tendon repair and anterior cruciate ligament (ACL) reconstruction often fails due to the failure of regeneration of the specialized tissue (\\

  7. Intra-articular knee injuries in patients with knee extensor mechanism ruptures

    Microsoft Academic Search

    Bart McKinney; Stuart Cherney; James Penna

    2008-01-01

    The knee extensor mechanism is composed of the quadriceps tendon, patella and patellar tendon. Rupture of either the quadriceps\\u000a tendon or patella tendon is a rare but significant injury. The purpose of our study is to determine if there are any associated\\u000a injuries with these ruptures necessitating the need for further evaluation such as MRI or arthroscopy. We retrospectively\\u000a reviewed

  8. Differences in patellofemoral contact stresses between mobile-bearing and fixed-bearing total knee arthroplasties: a dynamic in vitro measurement

    Microsoft Academic Search

    Adrian Skwara; Carsten O. Tibesku; Sven Ostermeier; Christina Stukenborg-Colsman; Susanne Fuchs-Winkelmann

    2009-01-01

    Introduction  Anterior knee pain is one of the most common problems after total knee arthroplasty (TKA). Mobile-bearing designs should improve\\u000a patella tracking with a reduced rate of patella tilt as well as reduced patellofemoral contact stresses and improve knee flexion.\\u000a The aim of this dynamic in vitro investigation was to evaluate the changes of patellofemoral contact stresses after TKA using\\u000a fixed

  9. Patellofemoral malalignment and chondral damage: current concepts

    PubMed Central

    MAZZOLA, CLAUDIO; MANTOVANI, DAVIDE

    2013-01-01

    Patellofemoral disorders can be classified according to specific criteria, and the most well-known classification systems are Insall’s classification and Merchant’s classification. In this work, after completion of an in-depth literature review, we will analyze the most frequent patellofemoral pathologies with the aim of determining the correct clinical-diagnostic-therapeutic course. Pathologies of greater clinical frequency will be examined in detail to provide the most relevant didactic scope. We will therefore address the following pathologies: excessive lateral patellar compression syndrome; patellar dislocations and subluxations; patellar chondromalacia; and patellofemoral osteoarthritis. PMID:25606514

  10. Patellofemoral disorders and instability.

    PubMed

    Lesi?, Alekandar R; Bumbasirevi?, Marko; Sudji?, Vojo S; Mitkovi?, Milan M; Tuli?, Goran Dz; Ivancevi?, Nenad; Jakovljevi?, Aleksandar; Bajec, Djordje D

    2010-01-01

    Originally the main idea was to obtain a stable patella, i.e., to stabilize the "slipping patella". In the past many conditions like patella alta, ligamentous laxity, PF bone hypoplasia, weakness of the quadriceps muscle, genu valgum or genu recurvatum were thought to predispose to patellar instability. For a long period muscle exercises were instituted to strengthen the weak m.vastus medialis and to make vastus lateralis stronger. This pulls the patella laterally, especially during running or jumping, when lateral luxation of the patella occurs. Muscle imbalance as well as anatomical abnormalities are the basis both for patellar instabilities and reasonable surgical procedures were: proximal extensor mechanism realignment, proximal capsular reefing, patellar tendon splitting and its medial transfer. On the other hand bone procedures on the hypoplastic lateral femoral condyle were also performed by Albee, as well as tibial tubercle transfer and trochleoplasty by deepening of the trochlea (Dejour). An understanding of the pathoanatomic basis is the corner stone for PMID:21446216

  11. Split Fracture: A Complication of Cerclage Wiring of Acute Patellar Fracture

    PubMed Central

    Lo, Cho Yau; Lui, Tun Hing; Sit, Yan Kit

    2014-01-01

    Introduction: Iatrogenic patellar fracture is reported as a complication of patella procedures, such as medial patellofemoral ligament reconstruction, reconstruction of the anterior cruciate ligament of the knee using bone-patellar tendon-bone technique, and resurfacing the patella in total knee arthroplasty. Case Presentation: A 65-year-old lady with right patella fracture was treated with open reduction and cerclage wiring. An iatrogenic split fracture was noted during tension of the cerclage wire and was successfully managed by screw fixation of the split fracture. Conclusions: Split fracture is a rare complication of circumferential cerclage wiring of patellar fracture. The surgeon should be aware of the contributing factors in order to avoid this complication. PMID:25593896

  12. Influence of bone resorption on the mobilization of lead from bone among middle-aged and elderly men: the Normative Aging Study.

    PubMed Central

    Tsaih, S W; Korrick, S; Schwartz, J; Lee, M L; Amarasiriwardena, C; Aro, A; Sparrow, D; Hu, H

    2001-01-01

    Bone stores of lead accrued from environmental exposures and found in most of the general population have recently been linked to the development of hypertension, cognitive decrements, and adverse reproductive outcomes. The skeleton is the major endogenous source of lead in circulating blood, particularly under conditions of accelerated bone turnover and mineral loss, such as during pregnancy and in postmenopausal osteoporosis. We studied the influence of bone resorption rate on the release of lead from bone in 333 men, predominantly white, middle-aged and elderly (mostly retired) from the Boston area. We evaluated bone resorption by measuring cross-linked N-telopeptides of type I collagen (NTx) in 24-hr urine samples with an enzyme-linked immunosorbent assay. We used K-X-ray fluorescence to measure lead content in cortical (tibia) and trabecular (patella) bone; we used graphite furnace atomic absorption spectroscopy and inductively coupled plasma mass spectroscopy to measure lead in blood and urine, respectively. After adjustment for age and creatinine clearance, the positive relation of patella lead to urinary lead was stronger among subjects in the upper two NTx tertiles (beta for patella lead > or =0.015) than in the lowest NTx tertile (beta for patella lead = 0.008; overall p-value for interactions = 0.06). In contrast, we found no statistically significant influence of NTx tertile on the relationship of blood lead to urinary lead. As expected, the magnitude of the relationship of bone lead to urinary lead diminished after adjustment for blood lead. Nevertheless, the pattern of the relationships of bone lead to urinary lead across NTx tertiles remained unchanged. Furthermore, after adjustment for age, the relation of patella lead to blood lead was significantly stronger in the upper two NTx tertiles (beta for patella lead > or =0.125) than in the lowest NTx tertile (beta for patella lead = 0.072). The results provide evidence that bone resorption influences the release of bone lead stores (particularly patella lead) into the circulation. PMID:11675263

  13. A rare case of open bicondylar Hoffa fracture with extensor mechanism disruption

    PubMed Central

    Kini, Sunil Gurpur; Sharma, Mrinal; Raman, Rajeev

    2013-01-01

    The incidence of open bicondylar Hoffa fractures is extremely rare. We report one such case of a 42-year-old woman who presented to the emergency department with an open injury over the knee. Imaging revealed bicondylar Hoffa fracture. The patient was taken up for debridement and internal fixation. Intraoperative findings included an entrapped patella between the fracture fragments and extensor mechanism disruption. Hoffas fracture was fixed with lag screws and patellar tendon repaired on to the inferior patella. The patient was started on early postoperative range of motion exercises. The fracture united at 12?weeks with 120° knee flexion at 2?year follow-up. PMID:23645653

  14. Bull. Br. arachnol. Soc. (2009) 14 (8), 339346 Contributions on the wolf spider fauna (Araneae,

    E-print Network

    Paulus, Hannes F.

    2009-01-01

    Islands is thus still very incomplete and many species are only known from one sex (Wunderlich, 1992 the epigynes with a needle and boiling in 4% KOH. To determine the species the works by Knülle (1959), Lugetti; cl= carapace length; cw=carapace width; Tr=trochanter; Fe=femur; Pa=patella; Ti=tibia; Mt

  15. Bilateral patellar tendon rupture without predisposing systemic disease or steroid use: a case report and review of the literature

    Microsoft Academic Search

    Richard Kellersmann; Thomas R. Blattert; Arnulf Weckbach

    2005-01-01

    Simultaneous bilateral patella tendon ruptures are very rare injuries of the knee extensor complex often associated with systemic disorders such as lupus erythematosus or rheumatoid arthritis. We describe the case of a 34-year-old man without concomitant systemic disease or steroid use and provide the most comprehensive review of the German and English literature. Furthermore, we discuss the predisposing factors and

  16. Simultaneous rupture of the quadriceps tendon with contralateral rupture of the patellar tendon in an otherwise healthy athlete

    Microsoft Academic Search

    N I Munshi; C E Mbubaegbu

    1996-01-01

    A case of a healthy athlete with simultaneous rupture of quadriceps tendon and rupture of the contralateral patella tendon is reported. Both tendons rupturing in the same patient is rare and this is the first reported case in a previously healthy person. Different mechanisms are implicated in the different ruptures. The rarity is because the simultaneous presence of contributory factors

  17. Repair of quadriceps tendon ruptures using suture anchors

    Microsoft Academic Search

    David P. Richards; F. Alan Barber

    2002-01-01

    The repair of ruptured quadriceps tendon is commonly performed by weaving sutures through the ruptured tendon and then attaching the tendon to the bone by passing these sutures through tunnels in the superior patella. This technical note is the first report we are aware of in the English language literature of a technique that uses suture anchors to attach the

  18. The Coffin-Siris syndrome

    Microsoft Academic Search

    Q H Qazi; L S Heckman; D Markouizos; R S Verma

    1990-01-01

    We report a white female infant with typical features of Coffin-Siris syndrome including thick eyebrows, flat nasal bridge, anteverted, wide nose tip, generalised hypertrichosis, scalp hypotrichosis, absence of the fifth fingernails and toenails, absence of the distal phalanges of the fifth fingers and of the second to fifth toes, small patellae, inguinal hernia, and sucking and feeding difficulties. There was

  19. Electron Microscopy of Molluscan Crossed-Lamellar Microstructure

    Microsoft Academic Search

    N. V. Wilmot; D. J. Barber; J. D. Taylor; A. L. Graham

    1992-01-01

    The morphology of the molluscan shell microstructure cross-lamellar structure (XLM) was studied by a scanning electron microscopy (SEM) examination of a variety of species (Patella vulgata, Littorina littorea, L. nigrolineata, L. obtusata, L. saxatilis, Oliva sayana, Conus litteratus, C. magus, Pomatias elegans, Acanthopleura brevispinosa, and Arca tetragona). Two of the gastropod species (O. sayana and L. littorea) were also examined

  20. The distribution of technetium-99 in a marine ecosystem in western Norway

    Microsoft Academic Search

    Daniela Brakstad; Hilde Elise Heldal; Kjersti Sjøtun

    In the present study, we have investigated the distribution of Tc-99 in selected long-lived and common animals of a fucoid dominated, sheltered and rocky intertidal community. We were focusing on animals with different feeding habits, including blue mussel (Mytilus edulis), a filter feeder, common limpet (Patella vulgata) and common periwinkle (Littorina littorea), two general grazers, and flat periwinkle (Littorina obtusata),

  1. A method for spatial and temporal assessment of gastropod grazing intensity in the field: the use of radula scrapes on wax surfaces

    Microsoft Academic Search

    R. C Thompson; L. E Johnson; S. J Hawkins

    1997-01-01

    The feeding apparatus of many marine molluscan herbivores leaves distinctive marks on the surface of dental wax. This method can be used in the field to assess the spatial and temporal patterns of gastropod grazing on rocky shores. Among the common gastropod grazers of intertidal habitats on the Isle of Man, distinctive rasping marks were made by docoglossan (Patella vulgata.),

  2. METAL LEVELS IN SEVEN SPECIES OF MOLLUSC AND IN SEAWEEDS FROM THE SHANNON ESTUARY

    Microsoft Academic Search

    Caitriona O'Leary; John Breen

    1997-01-01

    Metal levels (iron, zinc, manganese, cobalt, chromium, copper and nickel) were determined in Cerastoderma edule, Mytilus edulis, Monodonta lineata, Patella vulgata, Nucella lapillus, Littorina obtusata and L. littorea at two sites close to the mouth of the Shannon Estuary (Ireland) in November 1993 and May 1994, using standard atomic absorption spectrophotometer techniques. Samples of seaweeds were included at one shore

  3. Marine molluscs as biomonitors for heavy metal levels in the Gulf of Suez, Red Sea

    Microsoft Academic Search

    Mohamed A. Hamed; Ahmed M. Emara

    2006-01-01

    Levels of the heavy metals Copper (Cu), Zinc (Zn), Lead (Pb), Cadmium (Cd), Chromium (Cr), Nickel (Ni), Iron (Fe) and Manganese (Mn) were determined in coastal water, sediments and soft tissues of the gastropod limpet, Patella caerulea, and the bivalve, Barbatus barbatus, from seven different stations in the western coast of the Gulf of Suez. The concentrations of heavy metals

  4. Communicating pork value to the retailer

    E-print Network

    Lorenzen, Carol Lee

    1993-01-01

    muscles were cut into pork cubes (UPC 3196). Fresh hams (IMPS 401) were first skinned and defatted. Os coxae, femur, patella and tibia were removed yielding a boneless ham. The ham then was separated into a boneless tip roast (UPC 3410), boneless top...

  5. Total Knee Replacement for Women

    MedlinePLUS Videos and Cool Tools

    ... on the medial side, so I’m not real happy with that, so I’m going to freshen that up a little bit. Are there any cases where you just ream the patella instead of osteotomizing it? No. I osteotomize it every time. But if I’m too thick then you ...

  6. Periprosthetic fractures of the femur after total knee arthroplasty

    PubMed Central

    McGraw, Phil

    2010-01-01

    Periprosthetic fracture following total knee arthroplasty is a potentially serious complication. This injury can involve the distal femur, proximal tibia or the patella. This review article analyzes the prevalence, risk factors, classification and treatment options for periprosthetic fractures of the femur. PMID:20661762

  7. Saphenous neuropathy in a patient with low back pain

    Microsoft Academic Search

    Tannaz Ahadi; Gholam Reza Raissi; Mansoureh Togha; Parisa Nejati

    2010-01-01

    Saphenous nerve, a pure sensory nerve, may compromise as a result or complication of a surgical procedure or secondary to trauma or insidiously. We present a male patient with low back pain concomitant with pain in medial portion of left thigh in addition to pain and numbness in medial part of leg and inferior part of patella after a strenuous

  8. From stress and strain to spikes: mechanotransduction in spider slit sensilla

    Microsoft Academic Search

    Andrew S. French; Päivi H. Torkkeli; Ernst-August Seyfarth

    2002-01-01

    This review focuses on the structure and function of a single mechanoreceptor organ in the cuticle of spiders. Knowledge emerging from the study of this organ promises to yield general principles that can be applied to mechanosensation in a wide range of animal systems. The lyriform slit sense organ on the antero-lateral leg patella of the spider Cupiennius salei is

  9. Spectrum of intra-articular findings of the acute and subacute painful hip with multiple epiphyseal dysplasia/spondyloepiphyseal dysplasia.

    PubMed

    Roy, Dennis R

    2011-09-01

    Seven patients (10 hips), five with multiple epiphyseal dysplasia and two with spondyloepiphyseal dysplasia, were studied as to the etiology of a significant change in their baseline symptoms. Patients presented with decreased activity due to increased pain and mechanical symptoms and had a positive impingement test on physical examination. Three patients had a sudden increase in pain during normal walking and had subsequent difficulty with weight bearing. Arthrotomy or arthroscopy was used to identify the intra-articular pathology. Findings included loose bodies, chondromalacia, and labral pathology. Chondral avulsion fractures were found in the three patients who had a sudden increase in symptoms. Significant intra-articular pathology can develop in patients with multiple epiphyseal dysplasia or spondyloepiphyseal dysplasia. PMID:21691226

  10. The knee: Surface-coil MR imaging at 1. 5 T

    SciTech Connect

    Beltran, J.; Noto, A.M.; Mosure, J.C.; Weiss, K.L.; Zuelzer, W.; Christoforidis, A.J.

    1986-06-01

    Seven normal knees (in five volunteers) and seven injured knees (in seven patients) were examined by high-resolution magnetic resonance (MR) imaging at 1.5 T with a surface coil. Seven medial meniscal tears, three anterior cruciate ligament tears, one posterior cruciate ligament avulsion, an old osteochondral fracture, femoral condylar chondro-malacia, and one case of semimembranous tendon reinsertion were identified. MR images correlated well with recent double-contrast arthrograms or results of surgery. All tears were identified in both the sagittal and coronal planes. Because of its ability to demonstrate small meniscal lesions and ligamentous injuries readily, MR imaging with a surface coil may eventually replace the more invasive arthrography.

  11. Patellofemoral contact patterns before and after total knee arthroplasty: an in vitro measurement

    PubMed Central

    2013-01-01

    Background Patellofemoral complications are one of the main problems after Total Knee Arthroplasty (TKA). Retropatellar pressure distribution after TKA can contribute to these symptoms. Therefore we evaluated retropatellar pressure distribution subdivided on the ridge, medial and lateral surface on non-resurfaced patella before and after TKA. Additionally, we analyzed axial femorotibial rotation and quadriceps load before and after TKA. Methods Seven fresh frozen cadaver knees were tested in a force controlled knee rig before and after TKA (Aesculap, Tuttlingen, Germany, Columbus CR) while isokinetic flexing the knee from 20° to 120° under weight bearing. Ridge, medial and lateral retropatellar surface were defined and pressure distribution was dynamically measured while quadriceps muscles and hamstring forces were applied. Aside axial femorotibial rotation and quadriceps load was recorded. Results There was a significant change of patella pressure distribution before and after TKA (p?=?0.004). In physiological knees pressure distribution on medial and lateral retropatellar surface was similar. After TKA the ridge of the patella was especially in higher flexion grades strongly loaded (6.09 +/?1.31 MPa) compared to the natural knee (2.92 +/?1.15 MPa, p?patella maltracking. Changing the design of the prosthesis or a special way of patella shaping might increase the conformity of the patella to trochlea to maintain natural contact patterns. PMID:23802712

  12. Nonoperative management of a partial patellar tendon rupture after bone-patellar tendon-bone graft harvest for ACL reconstruction.

    PubMed

    Benner, Rodney W; Shelbourne, K Donald; Freeman, Heather

    2013-12-01

    This is a case report of a young athlete who sustained a partial tear of the patellar tendon after anterior cruciate ligament (ACL) reconstruction with a bone-patellar tendon-bone (BPTB) autograft. The injury, diagnostic workup, and decision-making process that lead to the choice of nonsurgical treatment are described. Furthermore, the rehabilitation process is described in detail. The patient returned to his previous level of sports activity and had a good clinical outcome as measured by range of motion, isokinetic quadriceps muscle strength testing, single leg hop testing, and the modified Noyes survey. In the absence of extensor mechanism incompetence or radiographic evidence of significant patella alta, partial ruptures of the patella tendon after ACL reconstruction using a BPTB autograft may be treated nonoperatively. PMID:23288745

  13. Patellar Tendon Rupture after Lateral Release without Predisposing Systemic Disease or Steroid Use

    PubMed Central

    De Giorgi, S.; Notarnicola, A.; Vicenti, G.; Moretti, B.

    2015-01-01

    Arthroscopic technique for lateral release is the most widely used procedure for the correction of recurrent dislocations of the patella. In the relevant literature, several complications of lateral release are described, but the spontaneous patellar tendon rupture has never been suggested as a possible complication of this surgical procedure. Patellar tendon rupture is a rather infrequent and often unilateral lesion. Nevertheless, in case of systemic diseases (LES, rheumatoid arthritis, and chronic renal insufficiency) that can weaken collagen structures, bilateral patellar tendon ruptures are described. We report a case of a 24-year-old girl with spontaneous rupture of patellar tendon who, at the age of 16, underwent an arthroscopic lateral release for recurrent dislocation of the patella. This is the first case of described spontaneous patellar tendon rupture that occurred some years after an arthroscopic lateral release. PMID:25960904

  14. Extensor-mechanism-reconstruction of the knee joint after traumatic loss of the entire extensor apparatus.

    PubMed

    Raschke, D; Schüttrumpf, J P; Tezval, M; Stürmer, K M; Balcarek, P

    2014-06-01

    Injuries to the extensor apparatus of the knee joint have an incidence of 0.5% to 6%. Although previous studies have described the advantages and disadvantages of operative treatment in cases of patellar tendon rupture, patella fracture or quadriceps tendon lesions, a report on the reconstruction of the extensor apparatus after traumatic loss of the patella, the patellar tendon, the tibial tuberosity and parts of the lateral quadriceps muscle is absent from the literature. We present the case of a young motorcyclist who underwent a reconstruction of the extensor apparatus using autologous tendon grafts. At a 24-month follow-up, the patient has a nearly physiological range of motion of the knee joint and is able to cope well with everyday life. PMID:24702824

  15. Diagnosis and Treatment of Lateral Patellar Compression Syndrome

    PubMed Central

    Saper, Michael G.; Shneider, David A.

    2014-01-01

    Chronic anterior knee pain with a stable patella is often associated with overload and increased pressure on the lateral facet due to pathologic lateral soft-tissue restraints. “Lateral pressure in flexion” is a term describing the pathologic process of increasing contact pressure over the lateral patellar facet as knee flexion progresses. This report describes a surgical technique developed in response to lateral pressure in flexion and the shortcomings of traditional arthroscopic lateral release procedures. The technique is performed open with the knee in flexion, and the lateral release is repaired with a rotation flap of iliotibial band to close the defect and prevent patellar subluxation. The technique effectively decreases lateral patellar pressure and centers the patella correctly in the trochlear groove with minimal risk of iatrogenic patellar instability. PMID:25473620

  16. Kinematic differences between gender specific and traditional knee implants.

    PubMed

    Saevarsson, Stefan K; Sharma, Gulshan B; Ramm, Heiko; Lieck, Robert; Hutchison, Carol R; Werle, Jason; Matthiasdottir, Sigrun; Montgomery, Spencer J; Romeo, Carolina I; Zachow, Stefan; Anglin, Carolyn

    2013-10-01

    In the ongoing debate about gender-specific (GS) vs. traditional knee implants, there is limited information about patella-specific outcomes. GS femoral component features should provide better patellar tracking, but techniques have not existed previously to test this accurately. Using novel computed tomography and radiography imaging protocols, 15 GS knees were compared to 10 traditional knees, for the 6 degrees of freedom of the patellofemoral and tibiofemoral joints throughout the range of motion, plus other geometric measures and quality of life (QOL). Significant differences were found for patellar medial/lateral shift, where the patella was shifted more laterally for the GS femoral component. Neither group demonstrated patellar maltracking. There were no other significant differences in this well-functioning group. PMID:23623459

  17. Consideration of growth factors and bio-scaffolds for treatment of combined grade II MCL and ACL injury

    Microsoft Academic Search

    Natasha Anoka; John Nyland; Mark McGinnis; Dave Lee; Mahmut Nedim Doral; David N. M. Caborn

    The literature suggests that a Grade II medial collateral ligament (MCL) injury in combination with anterior cruciate ligament\\u000a (ACL) injury will heal naturally and not compromise patient outcome following ACL reconstruction. Evidence based on bone-patella\\u000a tendon-bone autograft use is stronger than evidence supporting anatomically placed soft tissue graft use. Current ACL reconstruction\\u000a practices make greater use of soft tissue grafts,

  18. Acro-spondylo-pubic dysostosis associated with cataracts, microcephaly, and normal intelligence.

    PubMed

    Chacon-Camacho, Oscar F; Villegas-Ruiz, Vanessa; Buentello-Volante, Beatriz; Piña-Aguilar, Raul E; Peláez-González, Hugo; Ramírez, Magdalena; González-Rodríguez, Johanna; Zenteno, Juan Carlos

    2015-02-01

    We report on an adult male with normal intelligence who exhibited an unusual combination of microcephaly, dysostoses of limbs, vertebrae, patellae, and pubic bone, camptodactyly of all fingers, and syndactyly of toes, absent nails on thumbs and some fingers, bilateral cataract, cryptorchidism, polythelia, and nipple-like skin pigmentations of shoulders and upper back. We have been unable to find a description of a similar combination of manifestations in literature. The cause of the anomalies remains unknown. PMID:25427842

  19. UV-absorbing substances in the tunic of a colonial ascidian protect its symbiont, Prochloron sp., from damage by UV-B radiation

    Microsoft Academic Search

    M. L. Dionisio-Sese; M. Ishikura; T. Maruyama; S. Miyachi

    1997-01-01

    Photosynthesis by cells of Prochloron sp. freshly isolated from the ascidian host, Lissoclinum patella, collected from shallow waters in Palau, was severely inhibited by ultraviolet (UV) irradiation. No photoinhibition, however,\\u000a was observed in Prochloron cells isolated from intact colonies after UV irradiation, suggesting some protection by the ascidian host. It was shown that\\u000a UV protection was brought about by the

  20. Differential concentration of Technetium99 ( 99Tc) in common intertidal molluscs with different food habits

    Microsoft Academic Search

    K. Sjøtun; H. E. Heldal; D. S. Brakstad

    2011-01-01

    Concentration of 99Tc has been measured in fucoids and molluscs, sampled in a sheltered intertidal at the southwest coast of Norway from February to November 2006. The concentrations of 99Tc in molluscs differed significantly between species. The filtering bivalve Mytilus edulis had the lowest concentrations with averages of 2.3–5.9Bqkg?1d.w., while the herbivorous gastropods Littorinalittorina, Littorina obtusata and Patella vulgata had

  1. Early Motion After Quadriceps and Patellar Tendon RepairsOutcomes With Single-Suture Augmentation

    Microsoft Academic Search

    Jesse L. West; James S. Keene; Lee D. Kaplan

    2008-01-01

    Background: Complications of immobilization after quadriceps and patellar tendon repairs include decreased patellar mobility, limited flexion, persistent pain, muscle weakness, and patella baja. In contrast, early motion limits muscle atrophy, accelerates tendon healing, and prevents joint stiffness.Hypothesis: Quadriceps and patellar tendon repairs protected with a “relaxing suture” are strong enough to safely permit early motion, full weightbearing, and brace-free ambulation.Study

  2. Quadriceps tendon and patellar ligament: Cryosectional anatomy and structural properties in young adults

    Microsoft Academic Search

    H.-U. Stäubli; L. Schatzmann; P. Brunner; L. Rincón; L.-P. Nolte

    1996-01-01

    Structural tensile properties analyses of 10-mm-wide central sections of quadriceps tendon-bone (QT-B) and bone-patellar ligament (B-PL) complexes from young male donors (mean age 24.9 years, range 19–32 years) were complemented by a cryosectional analysis: each QT-B complex was composed of the segment of the quadriceps tendon with the proximal half of the patella attached, each B-PL complex was composed of

  3. Efficacy and Tolerability of Lornoxicam versus Tramadol in Postoperative Pain

    Microsoft Academic Search

    Henrik Staunstrup; Janne Ovesen; Ulf Thyge Larsen; Karsten Elbæk; Ulla Larsen; Karsten Krøner

    1999-01-01

    This randomized double-blind study compared the analgesic efficacy and tolerability of intramuscular lornoxicam and tramadol in 76 patients with moderate to unbearable pain following arthroscopic reconstruction of the anterior cruciate ligament using the patella bone-tendon-bone technique. Patients receiving a single dose of lornoxicam 16 mg experienced significantly greater total pain relief than patients receiving tramadol 100 mg over the following

  4. Distal realignment and patellar autologous chondrocyte implantation: mid-term results in a selected population

    Microsoft Academic Search

    Antonio Gigante; Davide Enea; Francesco Greco; Corrado Bait; Matteo Denti; Herbert Schonhuber; Piero Volpi

    2009-01-01

    The aim of this prospective observational study was to assess the 3-year clinical outcome of distal realignment and membrane-seeded\\u000a autologous chondrocyte implantation (MACI®) in selected patients with patellofemoral malalignment and large, isolated, patellar cartilage lesions. Twelve patients (14\\u000a knees; 6 females, 6 males; mean age 31 years) with Fulkerson type II patellofemoral malalignment (lateralized and tilted patella)\\u000a and Outerbridge grade

  5. Tips to diagnose uncommon nail disorders.

    PubMed

    Schneider, Samantha L; Tosti, Antonella

    2015-04-01

    This article reviews 6 nail disorders that, although easy to diagnose, are misdiagnosed frequently by dermatologists and general practitioners. Diagnostic clues are emphasized to familiarize readers with features that indicate the correct diagnosis. We focus on two common tumors (onychomatricoma and onychopapilloma), two rare genetic conditions that can be diagnosed owing to nail changes (Darier disease and nail patella syndrome), and two uncommon acquired disorders (the yellow nail syndrome and lichen striatus). PMID:25828712

  6. Chronic septic arthritis and osteomyelitis in a prosthetic knee joint due to Clostridium difficile

    Microsoft Academic Search

    B. Pron; J. Merckx; P. Touzet; A. Ferroni; C. Poyart; P. Berche; J. L. Gaillard

    1995-01-01

    A case of chronic septic arthritis and osteomyelitis in a prosthetic knee joint due toClostridium difficile is reported. A knee prosthesis was installed in a 16-year-old boy for surgical treatment of an osteosarcoma of the femur. Later, the patient suffered a traumatic closed fracture of his patella, and a sterile fluid was aspirated. One month later, the joint displayed inflammation.

  7. Patellofemoral contact pressure following high tibial osteotomy: a cadaveric study

    Microsoft Academic Search

    Karl Stoffel; Craig Willers; Omar Korshid; Markus Kuster

    2007-01-01

    Patella infera is a known complication of high tibial osteotomy (HTO) that can cause anterior knee pain due to excessive stresses\\u000a associated with abnormal patellofemoral (PF) joint biomechanics. However, the translation of these abnormal biomechanics to\\u000a native cartilage pressure has not been explored. The present study was designed to compare the PF contact pressures of three\\u000a different HTOs in a

  8. Effect of mechanical convection on the partitioning of an anionic iodinated contrast agent in intact patellar cartilage.

    PubMed

    Entezari, Vahid; Bansal, Prashant N; Stewart, Rachel C; Lakin, Benjamin A; Grinstaff, Mark W; Snyder, Brian D

    2014-10-01

    To determine if mechanical convection accelerates partitioning of an anionic contrast agent into cartilage while maintaining its ability to reflect the glycosaminoglycan (GAG) content in contrast-enhanced computed tomography (CECT) of cartilage. Bovine patellae (N?=?4) were immersed in iothalamate and serially imaged over 24?h of passive diffusion at 34°C. Following saline washing for 14?h, each patella was serially imaged over 2.5?h of mechanical convection by cyclic compressive loading (120N, 1?Hz) while immersed in iothalamate at 34°C. After similar saline washing, each patella was sectioned into 15 blocks (n?=?60) and contrast concentration per time point as well as GAG content were determined for each cartilage block. Mechanical convection produced 70.6%, 34.4%, and 16.4% higher contrast concentration at 30, 60, and 90?min, respectively, compared to passive diffusion (p?

  9. Maternal Dietary Intake of Polyunsaturated Fatty Acids Modifies the Relationship between Lead Levels in Bone and Breast Milk1,2

    PubMed Central

    Arora, Manish; Ettinger, Adrienne S.; Peterson, Karen E.; Schwartz, Joel; Hu, Howard; Hernández-Avila, Mauricio; Tellez-Rojo, Martha Maria; Wright, Robert O.

    2008-01-01

    Whereas dietary fats are known to influence bone mineral density, little is known about their effect on the skeletal stores of lead that are a pervasive source of fetal and infant lead exposure from heightened mobilization during pregnancy and lactation. This cross-sectional study examined the potential influence of maternal dietary intake of saturated and unsaturated fats on the relationship of lead levels in bone and breast milk during lactation. Lead was measured in blood, breast milk, and bone (patella and tibia) at 1 mo postpartum in 310 women in Mexico City. Dietary nutrient intake was assessed using a validated FFQ. Multivariate linear regression analyses were used to study the influence of dietary saturated and unsaturated fats on the association between bone and breast milk lead. In multivariate models that included both the dietary intake of SFA and PUFA, an interquartile range increase in patella lead [~20 µg/g (0.097 µmol/g)] was associated with a 24% (95% CI = 5–43) higher increase in breast milk lead in women in the lowest tertile of PUFA intake compared with those in the highest tertile of PUFA intake. Monounsaturated fatty acids did not modify the relationship between lead levels in patella and breast milk. In conclusion, higher maternal dietary intake of PUFA may limit the transfer of lead from bone to breast milk. PMID:18156407

  10. Correlates of bone and blood lead levels in carpenters.

    PubMed

    Watanabe, H; Hu, H; Rotnitzky, A

    1994-08-01

    In the course of a health screening for construction carpenters, 127 subjects underwent blood lead testing, administration of detailed questionnaires, and in vivo measurement of bone lead levels with a 109Cd K-X-ray fluorescence (K-XRF) instrument. The mean age of subjects was 48.5 (SD = 9.8) years. Blood lead levels were low, with a mean of 8.2 (SD = 4.0) micrograms/dl. Bone lead levels had means of 9.8 (SD = 9.3) micrograms/g bone mineral for the tibia and 14.0 (SD = 13.8) micrograms/g bone mineral for the patella (which consist primarily of cortical bone and trabecular bone, respectively). In multivariate regression models, age was the dominant predictor of both tibia and patella bone lead, with years since last worked and welding/brazing contributing an additional small amount of influence over tibia bone lead, and carpet laying, paint stripping, and regular exercise contributing an additional small amount of influence over patella bone lead. Demolition, carpet laying, and alcohol ingestion were significant predictors of blood lead. We conclude that age is the most important predictor of bone lead levels among workers with intermittent exposures to lead; in addition, K-XRF is useful in generating hypotheses on additional factors that may influence lead burden. PMID:7977400

  11. Patellar instability.

    PubMed

    Koh, Jason L; Stewart, Cory

    2014-07-01

    Patella instability can cause significant pain and functional limitations. Several factors can predispose to patella instability, such as ligamentous laxity, increased anterior TT-TG distance, patella alta, and trochlear dysplasia. Acquired factors include MPFL injury or abnormal quadriceps function. In many cases, first-time dislocation can successfully be managed with physical therapy and other nonoperative management; however, more than one dislocation significantly increases the chance of recurrence. Surgical management can improve stability, but should be tailored to the injuries and anatomic risk factors for recurrent dislocation. Isolated lateral release is not supported by current literature and increases the risk of iatrogenic medial instability. Medial repair is usually reserved for patients with largely normal anatomy. MPFL reconstruction can successfully stabilize patients with medial soft tissue injury but is a technically demanding procedure with a high complication rate and risks of pain and arthrosis. Tibial tubercle osteotomy can address bony malalignment and also unload certain articular cartilage lesions while improving stability. Trochleoplasty may be indicated in individuals with a severely dysplastic trochlea that cannot otherwise be stabilized. A combination of procedures may be necessary to fully address the multiple factors involved in causing pain, loss of function, and risk of recurrence in patients with patellar instability. PMID:24993410

  12. Cumulative Lead Exposure and Age-related Hearing Loss: The VA Normative Aging Study

    PubMed Central

    Park, Sung Kyun; Elmarsafawy, Sahar; Mukherjee, Bhramar; Spiro, Avron; Vokonas, Pantel S.; Nie, Huiling; Weisskopf, Marc G.; Schwartz, Joel; Hu, Howard

    2010-01-01

    Although lead has been associated with hearing loss in occupational settings and in children, little epidemiologic research has been conducted on the impact of cumulative lead exposure on age-related hearing loss in the general population. We determined whether bone lead levels, a marker of cumulative lead exposure, are associated with decreased hearing ability in 448 men from the Normative Aging Study, seen between 1962 and 1996 (2,264 total observations). Air conduction hearing thresholds were measured at 0.25 to 8 kHz and pure tone averages (PTA) (mean of 0.5, 1, 2 and 4 kHz) were computed. Tibia and patella lead levels were measured using K x-ray fluorescence between 1991 and 1996. In cross-sectional analyses, after adjusting for potential confounders including occupational noise, patella lead levels were significantly associated with poorer hearing thresholds at 2, 3, 4, 6 and 8 kHz and PTA. The odds of hearing loss significantly increased with patella lead levels. We also found significant positive associations between tibia lead and the rate change in hearing thresholds at 1, 2, and 8 kHz and PTA in longitudinal analyses. Our results suggest that chronic low-level lead exposure may be an important risk factor for age-related hearing loss and reduction of lead exposure could help prevent or delay development of age-related hearing loss. PMID:20638461

  13. Patellar instability following experimental medial patellar desmotomy in horses.

    PubMed

    Baccarin, R Y A; Martins, E A N; Hagen, S C F; Silva, L C L C

    2009-01-01

    A controlled study was designed in order to evaluate the effects of medial patellar desmotomy (MPD), combined with exercise restriction, on clinically and radiographically normal femoropatellar joints, and to identify the patellar instability by radiographic examination. MPD was performed on the right hind limb and the horses were rested for 120 days. Both hind limbs were radiographed before surgery and at 15, 30, 60, 90, and 120 days after MPD, obtaining lateromedial, flexed lateromedial, caudocranial and cranioproximal-craniodistal (skyline) views. The femorotibial and femoropatellar angles were assessed on the lateromedial views, and the distance between the medial and lateral cortex of the femur, and the distance between the medial cortex of the femur and the lateral border of the patella were evaluated in the caudocranial views. An increase in the angle between the proximal articular surface of the patella and the cranial distal surface of the femur along with enthesophyte formation and lateral deviation of the patella were found on the radiographs of the right stifles after MPD. Therefore, MPD leads to patellar instability, which can be demonstrated by the radiographic changes. The 120 days rest did not prevent the lesions caused by postsurgical patellar instability. PMID:19151867

  14. Patellofemoral crepitus after total knee arthroplasty: etiology and preventive measures.

    PubMed

    Conrad, David N; Dennis, Douglas A

    2014-03-01

    Patellofemoral crepitus and clunk syndrome are infrequent, yet troublesome complications of total knee arthroplasty with a reported incidence of 0%-18%. They are primarily associated with implantation of posterior cruciate substituting designs. These entities are the result of peripatellar fibrosynovial hyperplasia at the junction of the superior pole of the patella and the distal quadriceps tendon which becomes entrapped within the superior aspect of the intercondylar box of the femoral component during knee flexion. When the knee extends, a crepitant sensation occurs as the fibrosynovial tissue exits the intercondylar box. Numerous etiologies have been proposed such as femoral component designs with a high intercondylar box ratio, previous knee surgery, reduced patellar tendon length, thinner patellar components, reduced patella-patellar component composite thickness, and smaller femoral components. Preventative measures include choice of femoral components with a reduced intercondylar box ratio, use of thicker patellar components, avoidance of over-resection of the patella, and debridement of the fibrosynovial tissue at the time of knee arthroplasty. Most patients with crepitus are unaware of the problem or have minimal symptoms so that no treatment is required. If significant disability is incurred, symptoms can be eliminated in a high percentage of patients with arthroscopic debridement of the fibrosynovial hyperplasia. PMID:24605184

  15. LMX1B mutations cause hereditary FSGS without extrarenal involvement.

    PubMed

    Boyer, Olivia; Woerner, Stéphanie; Yang, Fan; Oakeley, Edward J; Linghu, Bolan; Gribouval, Olivier; Tête, Marie-Josèphe; Duca, José S; Klickstein, Lloyd; Damask, Amy J; Szustakowski, Joseph D; Heibel, Françoise; Matignon, Marie; Baudouin, Véronique; Chantrel, François; Champigneulle, Jacqueline; Martin, Laurent; Nitschké, Patrick; Gubler, Marie-Claire; Johnson, Keith J; Chibout, Salah-Dine; Antignac, Corinne

    2013-07-01

    LMX1B encodes a homeodomain-containing transcription factor that is essential during development. Mutations in LMX1B cause nail-patella syndrome, characterized by dysplasia of the patellae, nails, and elbows and FSGS with specific ultrastructural lesions of the glomerular basement membrane (GBM). By linkage analysis and exome sequencing, we unexpectedly identified an LMX1B mutation segregating with disease in a pedigree of five patients with autosomal dominant FSGS but without either extrarenal features or ultrastructural abnormalities of the GBM suggestive of nail-patella-like renal disease. Subsequently, we screened 73 additional unrelated families with FSGS and found mutations involving the same amino acid (R246) in 2 families. An LMX1B in silico homology model suggested that the mutated residue plays an important role in strengthening the interaction between the LMX1B homeodomain and DNA; both identified mutations would be expected to diminish such interactions. In summary, these results suggest that isolated FSGS could result from mutations in genes that are also involved in syndromic forms of FSGS. This highlights the need to include these genes in all diagnostic approaches to FSGS that involve next-generation sequencing. PMID:23687361

  16. Discrepancies of Patellofemoral Indices between Supine and Standing Merchant Views

    PubMed Central

    Kim, Tae-Hoon; Lee, Jong-Soo

    2014-01-01

    Purpose This research was conducted to compare supine and standing Merchant views, to observe radiographic changes of the patellofemoral joint according to weight-bearing conditions, and to evaluate correlation factors affecting patellofemoral joint indices. Materials and Methods Forty-four patients without skeletal problems were selected for this study. Patellar tilt angle, lateral patellofemoral angle, congruence angle, lateral subluxation distance and lateral patellar displacement were measured on each radiograph and evaluated for statistical significance. Possible correlation factors that can affect the radiographic discrepancy were analyzed using the univariate and multivariate regression analysis. Results In the standing Merchant view, the patellar tilt angle, congruence angle and lateral patellar displacement were significantly decreased (p<0.001), whereas the lateral patellofemoral angle was significantly increased (p<0.001) compared to that in the supine Merchant view. Thigh width (p<0.001, r2=0.22) and radiographic Q-angle (p<0.001, r2=0.34) were found correlated with the radiographic discrepancy of congruence angle. Discrepancy of the lateral patella displacement increased as radiographic Q-angle increased (p=0.027, r2=0.112). Conclusions Compared with the supine Merchant view, standing (weight-bearing) Merchant view showed decreased patella tilt angle, congruence angle, and lateral patella displacement. The results indicate that both supine and standing Merchant views should be considered in the radiographic evaluation of the patellofemoral joint. PMID:24639943

  17. Seasonality Records From Stable Isotopes and Trace Elements in Mussel and Limpet Shells From Archaeological Sites on Gibraltar

    NASA Astrophysics Data System (ADS)

    Fa, D.; Ferguson, J. E.; Atkinson, T. C.; Barton, R. N.; Ditchfield, P.; Finlayson, G.; Finlayson, J. C.; Henderson, G. M.

    2007-12-01

    Seasonal resolution climate records from mid and high latitudes would allow investigation of the role of seasonality in controlling mean climate on diverse timescales, and of the evolution of climate systems such as the North Atlantic Oscillation (NAO). But achieving such seasonal resolution is difficult for regions outside the growth range of surface corals. Marine mollusc shells provide a possible archive and contain growth increments varying in scale from tidal to annual. However, finding and dating sequences of marine mollusc shells spanning long periods of time is difficult due to sea-level change and the destructional nature of most coastal environments. In this study, we have made use of the habit of hominins on Gibraltar to collect molluscs for food over at least the last 120 kyr. In archaeological excavations of two caves (Gorham's and Vanguard Caves), mollusc shells were found, in habitation levels and in sediment blown into the caves. Existing 14C, OSL, and U-series chronologies provide a chronological framework for this suite of samples. The species found are predominantly Mytilus (mussels) or Patella (limpets). Gibraltar is an interesting location for paleoclimate reconstruction due to its proximity to the boundary of modern day climate belts but also due to its anthropological and archaeological importance. To gain a quantitative understanding of the local controls on stable isotopes and trace elements within Gibraltarian shells, we have initiated a water-sampling programme; emplaced a temperature and salinity logger near the sampling site; and marked live Patella and Mytilus with fluorescent dye to firmly establish growth rates and controls on chemical composition. We have also conducted stable-isotope and trace-element analysis of modern and fossil Patella and Mytilus shells by micromilling. Recent Patella and Mytilus shells show that the oxygen isotope composition of modern shells allow the accurate reconstruction of the full seasonal range in sea-surface temperature. Analysis of three fossil Mytilus samples contained within a Neanderthal occupation level from approximately 115 kyr show clear annual cycles in ? 18O but with different absolute values. Patella samples have also been analysed from the last glacial and from 800-300B.C. Results allow an assessment of past changes in seasonality and of the utility of this archeological shell material as an archive for past change.

  18. [Clinical examination for patellofemoral problems].

    PubMed

    Pagenstert, G I; Bachmann, M

    2008-09-01

    Patellofemoral pain and instability account for 25% of all sports-related knee problems. However, definitive analysis seems to be difficult. Descriptive findings like "anterior knee pain", "patellofemoral pain syndrome", or "chondromalacia" are used instead of diagnosis. One reason may be the complex pathomechanics of the patellofemoral joint which is suspended between the pelvis, the femur, and the tibia and subsequently is influenced by the whole lower extremity from the hip down to the foot. On the other hand, different signs and functional tests are in use with at times lack of quantification and ambiguous interpretation. The current manuscript reviews the commonly used signs and functional tests, analyzes them based on the current literature, and arranges them in a practical manner for physical examination. A MEDLINE literature search and special textbooks regarding patellofemoral disorders were used; 43 signs and tests were found. The examiner can quantify 18 of these findings on a nominal and 15 on an ordinal scale. Thus, this manuscript provides a standardized algorithm for physical examination with a collection of quantifiable findings, which are of growing importance to justify adequate diagnostics and treatment. PMID:18719886

  19. A retrospective study of the relationship between tracheal collapse and bronchiectasis in dogs.

    PubMed

    Marolf, Angela; Blaik, Margaret; Specht, Andrew

    2007-01-01

    Tracheal collapse is common in middle age toy and miniature breed dogs. Cartilaginous defects have been identified histologically and are considered a form of chondromalacia. In addition to tracheal cartilaginous changes, concurrent lower airway histologic changes indicative of inflammation have been noted in dogs with tracheal collapse and these changes may lead t o concurrent bronchiectasis. The purpose of this study was to investigate the prevalence of bronchiectasis in dogs with a previous radiographic diagnosis of tracheal collapse. The thoracic radiographs of 60 dogs with tracheal collapse were evaluated for evidence of concurrent bronchiectasis. Eighteen of 60 (30%) dogs had evidence of bronchiectasis, and all were cylindrical in morphology. The signalment of affected dogs was similar to that previously reported. The occurrence of bronchiectasis in this group of dogs with tracheal collapse (18 dogs) was six times higher (P < 0.05) than the expected prevalence within a random sample population (three dogs). The results of this study provide evidence of a link between tracheal collapse and bronchiectasis. A finding of bronchiectasis with tracheal collapse should encourage further evaluation for chronic lower airway disease in these patients. PMID:17508504

  20. Hip Microfracture

    PubMed Central

    McGill, Kevin C.; Bush-Joseph, Charles A.; Nho, Shane J.

    2010-01-01

    Microfracture is a marrow-stimulating technique used in the hip to treat cartilage defects associated with femoro-acetabular impingement, instability, or traumatic hip injury. These defects have a low probability of healing spontaneously and therefore often require surgical intervention. Originally adapted from the knee, microfracture is part of a spectrum of cartilage repair options that include palliative procedures such as debridement and lavage, reparative procedures such as marrow-stimulating techniques (abrasion arthroplasty and microfracture), and restorative procedures such as autologous chondrocyte implantation and osteochondral allograft/autografts. The basic indications for microfracture of the hip include focal and contained lesions typically less than 4 cm in diameter, full-thickness (Outerbridge grade IV) defects in weightbearing areas, unstable lesions with intact subchondral bone, and focal lesions without evidence of surrounding chondromalacia. Although not extensively studied in the hip, there are some small clinical series with promising early outcomes. Although the widespread use of microfracture in the hip is hindered by difficulties in identifying lesions on preoperative imaging and instrumentation to circumvent the femoral head, this technique continues to gain acceptance as an initial treatment for small, focal cartilage defects.

  1. Absence of the medial sesamoid bone associated with metatarsophalangeal pain.

    PubMed

    Kanatli, Ulunay; Ozturk, Akif Muhtar; Ercan, Nil Gulizar Tokgoz; Ozalay, Metin; Daglar, Bulent; Yetkin, Haluk

    2006-10-01

    Pain at the first metatarsophalangeal (MTP) joint can result from inflammation, chondromalacia, flexor hallucis brevis tendinitis, osteochondritis dessecans, fracture of a sesamoid bone, avascular necrosis of sesamoids, inflamed bursae, intractable keratoses, infection, sesamoiditis, gout arthropathy, and rheumatoid arthritis. Congenital absence of a sesamoid bone is extremely rare. We present a 17-year-old male patient with pain at the plantar aspect of the right MTP joint associated with congenital absence of the medial sesamoid. There was tenderness and the range of motion was minimally restricted. He described the pain as necessitating changes in his social life. On radiographs, the medial hallucial sesamoid was absent on the right side. The MTP joint was also evaluated using magnetic resonance imaging (MRI). A metatarsal pad was prescribed and the patient was satisfied with the treatment at the 2 months follow-up period. MRI revealed no pathological tissue at the medial sesamoid site. Hallucial sesamoids absorb pressure, reduce friction, protect the tendons, act like a fulcrum to increase the mechanical force of the tendons, and provide a dynamic function to the great toe by elevating first metatarsal head. Congenital absence of these bones is very rare but we must consider it in a patient with MTP joint pain. PMID:16506237

  2. Reconstruction of the anterior cruciate ligament: a comparison between bone-patellar tendon-bone grafts and fourstrand hamstring grafts

    PubMed Central

    Razi, Mohammad; Sarzaeem, Mohammad Mahdi; Kazemian, Gholam Hossein; Najafi, Farideh; Najafi, Mohammad Amin

    2014-01-01

    Background: Disruption of anterior cruciate ligament (ACL) is a common ligamentous injury of the knee. The choice of graft for (ACL) reconstruction remains controversial. This prospective, randomized clinical trial aimed to compare clinical results of bone-patellar tendon-bone (BPTB) grafts and four-strand semitendinosus-gracilis (ST) grafts for ACL reconstruction over a 3-year follow-up interval. Methods: Seventy-one patients with an average age of 29± 4.5yearswere treated for torn ACL between 2008 and 2009. Forty-sixpatients underwent reconstruction with BPTB autograft, and 41 were treated with ST autograft. At the time of final follow-up, 37 patients in patella group and 34 patients in hamstring group were evaluated in terms of return to pre-injury activity level, pain, knee stability, range of motion, IKDC (International Knee Documentation Committee) score and complications. Results: At 36thmonth of follow-up, 34 (92%) and 28 (82%) patients in BPTB and ST group, respectively had good-to-excellent IKDC score (p > 0.05). The activity levels were higher in BPTB group (p> 0.05). At 3rd yearof follow up, the Lachman test was graded normal, for 23 (62%) and 11 (32%) patients in BPTB and ST group, respectively (p=0.019). Regarding the pivot-shift test, 29 (79%) and 15 (44%) patients in patella and hamstring group, respectively had normal test at the latest follow-up (p=0.021).There were no significant differences in terms of thigh circumference difference, effusion, knee range of motion, pain and complications. Conclusion: The results indicate a trend toward increased graft laxity and pivot-shift grades in patients undergoing reconstruction with hamstring autograft compared with patella tendon. However, the two groups had comparable results in terms of activity level and knee function. PMID:25694992

  3. Computational Wear Simulation of Patellofemoral Articular Cartilage during In Vitro Testing

    PubMed Central

    Li, Lingmin; Patil, Shantanu; Steklov, Nick; Bae, Won; Temple-Wong, Michele; D'Lima, Darryl D.; Sah, Robert L.; Fregly, Benjamin J.

    2011-01-01

    Though changes in normal joint motions and loads (e.g., following anterior cruciate ligament injury) contribute to the development of knee osteoarthritis, the precise mechanism by which these changes induce osteoarthritis remains unknown. As a first step toward identifying this mechanism, this study evaluates computational wear simulations of a patellofemoral joint specimen wear tested on a knee simulator machine. A multi-body dynamic model of the specimen mounted in the simulator machine was constructed in commercial computer-aided engineering software. A custom elastic foundation contact model was used to calculate contact pressures and wear on the femoral and patellar articular surfaces using geometry created from laser scan and MR data. Two different wear simulation approaches were investigated – one that wore the surface geometries gradually over a sequence of 10 one-cycle dynamic simulations (termed the “progressive” approach), and one that wore the surface geometries abruptly using results from a single one-cycle dynamic simulation (termed the “non-progressive” approach). The progressive approach with laser scan geometry reproduced the experimentally measured wear depths and areas for both the femur and patella. The less costly non-progressive approach predicted deeper wear depths, especially on the patella, but had little influence on predicted wear areas. Use of MR data for creating the articular and subchondral bone geometry altered wear depth and area predictions by at most 13%. These results suggest that MR-derived geometry may be sufficient for simulating articular cartilage wear in vivo and that a progressive simulation approach may be needed for the patella and tibia since both remain in continuous contact with the femur. PMID:21453922

  4. Can 3D ultrasound identify trochlea dysplasia in newborns? Evaluation and applicability of a technique.

    PubMed

    Kohlhof, Hendrik; Heidt, Christoph; Bähler, Alexandrine; Kohl, Sandro; Gravius, Sascha; Friedrich, Max J; Ziebarth, Kai; Stranzinger, Enno

    2015-06-01

    Femoro-patellar dysplasia is considered as a significant risk factor of patellar instability. Different studies suggest that the shape of the trochlea is already developed in early childhood. Therefore early identification of a dysplastic configuration might be relevant information for the treating physician. An easy applicable routine screening of the trochlea is yet not available. The purpose of this study was to establish and evaluate a screening method for femoro-patellar dysplasia using 3D ultrasound. From 2012 to 2013 we prospectively imaged 160 consecutive femoro-patellar joints in 80 newborns from the 36th to 61st gestational week that underwent a routine hip sonography (Graf). All ultrasounds were performed by a pediatric radiologist with only minimal additional time to the routine hip ultrasound. In 30° flexion of the knee, axial, coronal, and sagittal reformats were used to standardize a reconstructed axial plane through the femoral condyle and the mid-patella. The sulcus angle, the lateral-to-medial facet ratio of the trochlea and the shape of the patella (Wiberg Classification) were evaluated. In all examinations reconstruction of the standardized axial plane was achieved, the mean trochlea angle was 149.1° (SD 4.9°), the lateral-to-medial facet ratio of the trochlea ratio was 1.3 (SD 0.22), and a Wiberg type I patella was found in 95% of the newborn. No statistical difference was detected between boys and girls. Using standardized reconstructions of the axial plane allows measurements to be made with lower operator dependency and higher accuracy in a short time. Therefore 3D ultrasound is an easy applicable and powerful tool to identify trochlea dysplasia in newborns and might be used for screening for trochlea dysplasia. PMID:25843417

  5. Study of the control strategy of the quadriceps muscles in anterior knee pain.

    PubMed

    Cesarelli, M; Bifulco, P; Bracale, M

    2000-09-01

    Anterior knee pain (AKP) is a common pathological condition, particularly among young people and athletes, associated to an abnormal motion of the patella during the bending of the knee and possibly dependent on a muscular or structural imbalance. A lack of synergy in the quadriceps muscles results in a dynamic misalignment of the patella, which in turn produces pain. AKP rehabilitative therapy consists of conservative treatment whose main objective is to strengthen the Vastus Medialis. The aim of this article is to study the quadriceps muscle control strategy in AKP patients during an isokinetic exercise. Analysis of the muscle activation strategy is important for an objective measurement of the knee functionality in that it helps to diagnose and monitor the rehabilitative treatment. Surface electromyography (EMG) from the three superficial muscles of the femoral quadriceps during a concentric isokinetic exercise has been analyzed along with the signals of knee joint position and torque. A group of 12 AKP patients has been compared with a group of 30 normal subjects. Analysis of the grand ensemble average of the EMG linear envelopes in AKP patients reveals significant modifications in Vastus Medialis activity compared to the other quadriceps muscles. In order to study the synergy of the muscles, temporal identifiers have been associated to the EMG linear envelopes. To this end, EMG linear envelope decomposition in Gaussian pulses turned out to be effective and the results highlight an appreciable delay in the activation of the Vastus Medialis in AKP patients. This muscular unbalance can explain the abnormal motion of the patella. PMID:11001513

  6. Relationships between lead biomarkers and diurnal salivary cortisol indices in pregnant women from Mexico City: a cross-sectional study

    PubMed Central

    2014-01-01

    Background Lead (Pb) exposure during pregnancy may increase the risk of adverse maternal, infant, or childhood health outcomes by interfering with hypothalamic-pituitary-adrenal-axis function. We examined relationships between maternal blood or bone Pb concentrations and features of diurnal cortisol profiles in 936 pregnant women from Mexico City. Methods From 2007–11 we recruited women from hospitals/clinics affiliated with the Mexican Social Security System. Pb was measured in blood (BPb) during the second trimester and in mothers’ tibia and patella 1-month postpartum. We characterized maternal HPA-axis function using 10 timed salivary cortisol measurements collected over 2-days (mean: 19.7, range: 14–35 weeks gestation). We used linear mixed models to examine the relationship between Pb biomarkers and cortisol area under the curve (AUC), awakening response (CAR), and diurnal slope. Results After adjustment for confounders, women in the highest quintile of BPb concentrations had a reduced CAR (Ratio: ?13%; Confidence Interval [CI]: ?24, 1, p-value for trend?patella Pb concentrations were not associated with CAR, but diurnal cortisol slopes were suggestively flatter among women in the highest patella Pb quantile compared to women in the lowest quantile (Ratio: 14%; CI: ?2, 33). BPb and bone Pb concentrations were not associated with cortisol AUC. Conclusions Concurrent blood Pb levels were associated with cortisol awakening response in these pregnant women and this might explain adverse health outcomes associated with Pb. Further research is needed to confirm these results and determine if other environmental chemicals disrupt hypothalamic-pituitary-adrenal-axis function during pregnancy. PMID:24916609

  7. [Jumper's knee--a review].

    PubMed

    Tibesku, C O; Pässler, H H

    2005-06-01

    Jumper's knee has been defined as painful chronic overuse injury of the extensor mechanism of the knee joint. The disease has a high incidence in jumping sports and depends on training frequency and level of performance. Its natural course is protracted, repetitive, and often bilaterally occurring. Its etiology is a chronic overload of the knee extensor mechanism which is triggered by jumping sports (volleyball, basketball etc.) as well as different intrinsic (ligamentous laxity, Q-angle, patella height, tenderness, pattern of force development) and extrinsic dispositions (frequency of training, level of performance, hardness of underground). The place of pathology most often is the osteo-tendinous transition zone of the proximal patellar tendon. Histologic evaluation of the tendon showed that the disease is rather degenerative than inflammatory. The diagnosis is primarily based on the typical sports history, physical examination, and ultrasound. MRI is helpful in operation planning. Plain radiography, CT, and bone scans are used to rule out differential diagnoses. Therapy should be chosen according to the stage of the disease and usually starts with a non-surgical approach. This includes rest from sports activities, immobilisation, non-steroid antiphlogistics, para-tendinous cortisone injections, massage, electric therapy, ultrasound and extracorporal shock waves. Afterwards an increase of activities is begun (moderate training, adequate warm-up, ice cooling after activity, muscle stretching, eccentric strengthening of the quadriceps). Patella straps and soft insoles are used as prevention. Up to 42 % of patients need surgical therapy after failure of long-lasting non-surgical measures, carried out either open or arthroscopically. Surgical principles include excision of the para-tendon, excision of the degenerative tissue, resection of the lower patella pole, and longitudinal incisions into the tendon. Most patients are pain-free after surgery but return to sports only at a lower level. PMID:15918127

  8. Quality control and statistical modeling for environmental epigenetics: a study on in utero lead exposure and DNA methylation at birth.

    PubMed

    Goodrich, Jaclyn M; Sánchez, Brisa N; Dolinoy, Dana C; Zhang, Zhenzhen; Hernández-Ávila, Mauricio; Hu, Howard; Peterson, Karen E; Téllez-Rojo, Martha M

    2015-01-01

    DNA methylation data assayed using pyrosequencing techniques are increasingly being used in human cohort studies to investigate associations between epigenetic modifications at candidate genes and exposures to environmental toxicants and to examine environmentally-induced epigenetic alterations as a mechanism underlying observed toxicant-health outcome associations. For instance, in utero lead (Pb) exposure is a neurodevelopmental toxicant of global concern that has also been linked to altered growth in human epidemiological cohorts; a potential mechanism of this association is through alteration of DNA methylation (e.g., at growth-related genes). However, because the associations between toxicants and DNA methylation might be weak, using appropriate quality control and statistical methods is important to increase reliability and power of such studies. Using a simulation study, we compared potential approaches to estimate toxicant-DNA methylation associations that varied by how methylation data were analyzed (repeated measures vs. averaging all CpG sites) and by method to adjust for batch effects (batch controls vs. random effects). We demonstrate that correcting for batch effects using plate controls yields unbiased associations, and that explicitly modeling the CpG site-specific variances and correlations among CpG sites increases statistical power. Using the recommended approaches, we examined the association between DNA methylation (in LINE-1 and growth related genes IGF2, H19 and HSD11B2) and 3 biomarkers of Pb exposure (Pb concentrations in umbilical cord blood, maternal tibia, and maternal patella), among mother-infant pairs of the Early Life Exposures in Mexico to Environmental Toxicants (ELEMENT) cohort (n = 247). Those with 10 ?g/g higher patella Pb had, on average, 0.61% higher IGF2 methylation (P = 0.05). Sex-specific trends between Pb and DNA methylation (P < 0.1) were observed among girls including a 0.23% increase in HSD11B2 methylation with 10 ?g/g higher patella Pb. PMID:25580720

  9. Infrared Thermal Imaging in Patients with Medial Collateral Ligament Injury of the Knee - A Retrospective Study

    PubMed Central

    Yang, HyunJung; Park, HaeIn; Lim, Chungsan; Park, SangKyun; Lee, KwangHo

    2014-01-01

    Objectives: Digital infrared thermographic imaging (DITI) has been used widely for various inflammatory diseases, circulatory diseases, skin diseases, musculoskeletal diseases and cancers. In cases of ligament injury, obviously the temperature of the damaged area increases due to local inflammation; however, whether the temperature also increases due to DITI has not been determined. The purpose of the present study was to identify whether or not the changes of temperature in patient’s with medial collateral ligament injury were really due to infrared thermography and to determine the applicability of DITI for assessing ligament injuries. Methods: Twenty patient’s who underwent DITI for a medial collateral ligament injury from September 2012 to June 2014 were included in the current study. The thermographic images from the patient’s knees were divided to cover seven sub-areas: the middle of the patella, and the inferomedial, the inferolateral, the superomedial, the superolateral, the medial, and the lateral regions of patella. The temperatures of the seven regions were measured, and the temperature differences between affected and unaffected regions were analyzed by using the Wilcoxon signed rank test. Results: The 20 patient’s were composed of 14 women (70%) and 6 men (30%), with a mean age of 62.15 ± 15.71 (mean ± standard deviation (SD)) years. The temperature of the affected side, which included the middle of the patella, and the inferomedial, the superomedial, the superolateral, and the medial regions, showed a significant increase compared to that of the unaffected side (P < 0.05). The inferolateral and the lateral regions showed no significant changes. Conclusion: Our study results suggest that DITI can show temperature changes if a patient has a ligament injury and that it can be applied in the evaluation of a medial collateral ligament injury. PMID:25780719

  10. Lateral Patellofemoral Ligament Reconstruction Using a Quadriceps Tendon Graft

    PubMed Central

    Saper, Michael G.; Shneider, David A.

    2014-01-01

    Medial patellar subluxation (MPS) is normally described after a lateral retinacular release. However, isolated MPS in the absence of a previous lateral release does occur. This type of patellar instability is often overlooked, and a high index of suspicion is needed for appropriate diagnosis and treatment. This report describes a technique developed in response to episodes of isolated MPS. The technique uses a partial-thickness graft from the quadriceps tendon to reconstruct the lateral patellofemoral ligament and provide stability to the lateral side of the patella. PMID:25264506

  11. Primary total knee replacement: a comparison of a nationally agreed guide to best practice and current surgical technique as determined by the North West Regional Arthroplasty Register.

    PubMed Central

    Malik, M. H. A.; Chougle, A.; Pradhan, N.; Gambhir, A. K.; Porter, M. L.

    2005-01-01

    INTRODUCTION: In 1999, a statement of best practice in primary total hip replacement was approved by the Council of the British Orthopaedic Association (BOA) and by the British Association for Surgery of the Knee (BASK) to provide a basis for regional and national auditable standards: we have compared practice in the North West of England to this document to ascertain adherence to this guide to best practice. MATERIALS AND METHODS: A direct comparison of data held on the North West Hip Arthroplasty Register for 2001/2002 and BASK/BOA guidelines was performed. 86 surgeons from 26 hospitals were included in the study. RESULTS: A mean of 93.3% of operations were performed in the surgeon's usual theatre. All of these theatres had vertical laminar air flow systems. 42.2% of respondents routinely used exhaust suits and 68.1% of respondents routinely used impermeable disposable gowns. All surgeons use some form of anti-thromboembolic prophylaxis; 66.2% use a combination of both mechanical and chemical means. All surgeons used antibiotic prophylaxis. The most popular choice of antibiotic was a cephalosporin. 93.7% of surgeons routinely use antibiotic-loaded cement. The PFC and Kinemax prostheses were the most commonly used prostheses. Interestingly, 97.7% of all first-choice implants were cemented. Only 2 surgeons used uncemented total knee replacement. 69.8% of surgeons used a posterior cruciate retaining design. A midline longitudinal skin incision is used by 87.2% of surgeons, a medial longitudinal skin incision by 7.0% and a lateral longitudinal skin incision by 5.8% of surgeons. A medial parapatellar capsular incision is preferred by 91.9% with the remainder using mid vastus or trivector retaining capsulotomy. Closure of capsulotomies is performed in flexion by 65.1% and in extension by 34.9%. In patients with osteoarthritis, 38.4% routinely resurfaced the patella, 34.9% never resurfaced the patella and 26.7% selectively resurfaced. This was in direct contrast to practice for patients with rheumatoid arthritis in whom 66.3% routinely resurfaced the patella, 22.1% never resurfaced the patella and 11.6% selectively resurfaced. DISCUSSION AND CONCLUSIONS: This study has demonstrated variation of practice in hip arthroplasty across the North West region and significant divergence from the BASK/BOA statement of best practice. The introduction of a properly funded national arthroplasty register will surely help to clarify the effect of such diverse practice on patient outcome. PMID:15826423

  12. Intraoperative /sup 99m/Tc bone imaging in the treatment of benign osteoblastic tumors

    SciTech Connect

    Sty, J.; Simons, G.

    1982-05-01

    Benign bone tumors can be successfully treated by local resection with the use of intraoperative bone imaging. Intraoperative bone imaging provided accurate localization of an osteoid osteoma in a patella of a 16-year-old girl when standard radiographs failed to demonstrate the lesion. In a case of osteoblastoma of the sacrum in a 12-year old girl, intraoperative scanning was used repeatedly to guide completeness of resection. In these cases in which routine intraoperative radiographs would have failed, intraoperative scanning proved to be essential for success.

  13. Ultrasound-Guided Thrombin Injection of Genicular Artery Pseudoaneurysm.

    PubMed

    Rachakonda, Aditya; Qato, Khalil; Khaddash, Tamim; Carroccio, Alfio; Pamoukian, Vicken; Giangola, Gary

    2015-07-01

    Pseudoaneurysm is a rare complication after arthroscopic procedures involving the knee. A 38-year-old man presented 1 month after right-knee arthroscopy with a 2-cm pulsating mass on the medial side of the right knee. Duplex ultrasound evaluation revealed 2.5 × 2.1-cm pseudoaneurysm just distal to the patella with arterialized flow communicating with the inferior medial genicular artery. Ultrasound-guided thrombin injection was performed in an office setting, and the resolution of active flow within the pseudoaneurysm was confirmed with duplex ultrasonography. PMID:25796189

  14. SURGICAL CORRECTION OF BILATERAL PATELLAR LUXATION IN AN AMERICAN BLACK BEAR CUB (URSUS AMERICANUS).

    PubMed

    Bennett, Katarina R; Desmarchelier, Marion R; Bailey, Trina R

    2015-06-01

    A wild orphaned male American black bear cub ( Ursus americanus ) presented with hind limb gait abnormalities and was found to have bilateral grade 3 laterally luxating patellas. There were no other significant abnormalities detected on neurologic, radiographic, or hematologic examinations. The trochlear grooves were deepened with a chondroplasty, and the redundant soft tissues imbricated. There was a marked improvement in the bear's gait postoperatively, with an apparent full return to function. To the authors' knowledge, patellar luxation has not been reported in the Ursidae family, and the success in this case suggests that this technique may be used in large wild or captive carnivore cubs. PMID:26056894

  15. Intracellular coagulation inhibits the extraction of proteins from Prochloron

    NASA Technical Reports Server (NTRS)

    Fall, R.; Lewin, R. A.; Fall, L. R.

    1983-01-01

    Protein extraction from the prokaryotic alga Prochloron LP (isolated from the ascidian host Lissoclinum patella) was complicated by an irreversible loss of cell fragility in the isolated algae. Accompanying this phenomenon, which is termed intracellular coagulation, was a redistribution of thylakoids around the cell periphery, a loss of photosynthetic O2 production, and a drastic decrease in the extractability of cell proteins. Procedures are described for the successful preparation and transport of cell extracts yielding the enzymes glucose-6-phosphate dehydrogenase and 6-phosphogluconate dehydrogenase as well as other soluble proteins.

  16. Sodium multiple quantum spectroscopy of articular cartilage: effects of mechanical compression.

    PubMed

    Duvvuri, U; Kaufman, J H; Patel, S D; Bolinger, L; Kneeland, J B; Leigh, J S; Reddy, R

    1998-09-01

    The effects of mechanical compression on the multiple quantum coherences generated from sodium ions in articular cartilage were investigated. Cartilage samples obtained from bovine patellae were studied during compression at 0.7 MPa (100 psi) for 1 hour. The double quantum filtered spectra showed marked lineshape changes in the compressed samples. Compression did not seem to influence the lineshapes of the single quantum and triple quantum filtered spectra significantly. We found that the residual quadrupolar interaction was reduced in the compressed samples. Changes in the ordering of collagen fibers may be responsible for the observed effect. PMID:9727939

  17. Patellar tendon repair with suture anchors using a combined suture technique of a Krackow-Bunnell weave.

    PubMed

    Gaines, Robert J; Grabill, Scott E; DeMaio, Marlene; Carr, Donald

    2009-01-01

    Suture repair of the ruptured patellar tendon is the treatment of choice for patients requiring operative management. This standard technique includes fixation through transosseous tunnels in the patella. The use of suture anchor fixation has several advantages over the standard approach, including less dissection, decreased surgical time, more accurate suture placement, and a low-profile construct. Additionally, the pullout strength of suture anchors warrants consideration of this technique in these repairs. This article describes using suture anchors for repair of the acute ruptured patellar tendon with a combination of Krackow and Bunnell sutures. PMID:19104306

  18. A spider and other arachnids from the Devonian of New York, and reinterpretations of Devonian Araneae

    E-print Network

    Selden, Paul A.; Shear, William A.; Bonamo, Patricia M.

    1991-06-01

    easier, facilitates references to earlier papers on the Gi lboa l 248 PALAEONTOLOGY. VOLUME 34 Slide No. AMNH No. Illustration Brief description Atlercopus fimbriunguis 329.1 43162 PI. 3. fig. 4: Text-fig. 6o palpal femur + patella 329.3 43163 PI. 3... land . J ames Locke and W.A.S . carried ou t a detailed pho tog raph ic study o f the specimen (British M u s e u m (Na tu ra l His tory) ( B M ( N H ) ) In 24670) in 1987 and 1988. T h e fossil is in a small ch ip of chert m o u n t e d on a...

  19. Minor element partitioning and mineralogy in limpets from the Ischia CO2 vent site

    NASA Astrophysics Data System (ADS)

    Langer, Gerald; Sadekov, Aleksey; Nehrke, Gernot; Baggini, Cecilia; Rodolfo-Metalpa, Riccardo; Hall-Spencer, Jason; Bijma, Jelle; Elderfield, Henry

    2015-04-01

    Specimens of the patellogastropod limpet Patella caerulea were collected within and outside a CO2 vent site at Ischia, Italy. The shells were sectioned transversally and scanned for polymorph distribution by means of confocal Raman microscopy. Minor element to calcium ratios were measured using laser-ablation-inductively-coupled-plasma-mass-spectroscopy (LA-ICPMS). Mg/Ca, Sr/Ca, and Li/Ca ratios were determined in calcitic as well as aragonitic parts of the shells. This approach allows for investigating the effects of the polymorph and the seawater carbonate chemistry on minor element partitioning separately.

  20. A new high-elevation scorpion species of the genus Scorpiops Peters, 1861 (Scorpiones: Euscorpiidae: Scorpiopinae) from the Himalayas, India.

    PubMed

    Zambre, Amod; Sanap, Rajesh V; Mirza, Zeeshan A

    2014-06-01

    A new high-elevation scorpion species of the genus Scorpiops is described from the Indian state of Himachal Pradesh. Scorpiops spitiensis sp. nov. is the second highest-elevation scorpion species in Asia and the first one from India occurring at elevations above 4200 m. The new species closely resembles Scorpiops petersii, but it can be distinguished from it based on a suit of characters, one of which is the presence of 16 trichobothria on the external aspect of the patella, which is unique to the new species. PMID:24961560

  1. [A patellar giant-cell tumor with soft tissue involvement: an alternative treatment method and review of the literature].

    PubMed

    Görmeli, Gökay; Görmeli, Cemile Ay?e; Mara? Özdemir, Zeynep; Sevimli, Re?it; Akpolat, Nusret

    2015-08-01

    In this article, we report a case of a giant-cell tumor of the patella which occurred in an atypical location with soft tissue involvement, which makes our case clinically and radiologically unique. A 24-year-old patient was admitted to our clinic with a complaint of anterior knee pain. Radiological examination and percutaneous fine needle biopsy showed a diagnosis of giant-cell tumor of the patella. The patient underwent patellectomy with en-bloc resection of the lesion with totally involved soft tissue components and the extensor mechanism was reconstructed with two Achilles allografts. After surgery, the diagnosis was confirmed by histopathological examination. At 12 months, the patient had no recurrence with 110° flexion and 30° extension of the range of motion of the knee. Lysholm knee score was 72. At 90°/sec isokinetic muscle strength test, the muscle strength loss was found to be 51.1% in the extensor and 21.1% in the flexor, compared to non-involved knee. In conclusion, giant cell tumors are difficult to treat, as they are destructive lesions with high recurrence rates. Despite reduced range of motion and muscle strength, based on our study results, we believe that our surgical treatment modality may be an alternative for the treatment of patellar giant cell tumors. PMID:26165715

  2. Periprosthetic Fractures Following Total Knee Arthroplasty

    PubMed Central

    Kim, Nam Ki

    2015-01-01

    Periprosthetic fractures after total knee arthroplasty may occur in any part of the femur, tibia and patella, and the most common pattern involves the supracondylar area of the distal femur. Supracondylar periprosthetic fractures frequently occur above a well-fixed prosthesis, and risk factors include anterior femoral cortical notching and use of the rotational constrained implant. Periprosthetic tibial fractures are frequently associated with loose components and malalignment or malposition of implants. Fractures of the patella are much less common and associated with rheumatoid arthritis, use of steroid, osteonecrosis and malalignment of implants. Most patients with periprosthetic fractures around the knee are the elderly with poor bone quality. There are many difficulties and increased risk of nonunion after treatment because reduction and internal fixation is interfered with by preexisting prosthesis and bone cement. Additionally, previous soft tissue injury is another disadvantageous condition for bone healing. Many authors reported good clinical outcomes after non-operative treatment of undisplaced or minimally displaced periprosthetic fractures; however, open reduction or revision arthroplasty was required in displaced fractures or fractures with unstable prosthesis. Periprosthetic fractures around the knee should be prevented by appropriate technique during total knee arthroplasty. Nevertheless, if a periprosthetic fracture occurs, an appropriate treatment method should be selected considering the stability of the prosthesis, displacement of fracture and bone quality. PMID:25750888

  3. Arthroscopic quadriceps tendon repair: two case reports.

    PubMed

    Saito, Hidetomo; Shimada, Yoichi; Yamamura, Toshiaki; Yamada, Shin; Sato, Takahiro; Nozaka, Koji; Kijima, Hiroaki; Saito, Kimio

    2015-01-01

    Recently, although some studies of open repair of the tendon of the quadriceps femoris have been published, there have been no reports in the literature on primary arthroscopic repair. In our present study, we present two cases of quadriceps tendon injury arthroscopically repaired with excellent results. Case 1 involved a 68-year-old man who was injured while shifting his weight to prevent a fall. MRI showed complete rupture at the insertion of the patella of the quadriceps tendon. The rupture was arthroscopically repaired using both suture anchor and pull-out suture fixation methods via bone tunnels (hereafter, pull-out fixation). Two years after surgery, retearing was not observed on MRI and both Japan Orthopedic Association (JOA) Knee and Lysholm scores had recovered to 100. Case 2 involved a 50-year-old man who was also injured when shifting his weight to prevent a fall. MRI showed incomplete superficial rupture at the insertion of the patella of the quadriceps tendon. The rupture was arthroscopically repaired using pull-out fixation of six strand sutures. One year after surgery, MRI revealed a healed tendon and his JOA and Lysholm scores were 95 and 100, respectively. Thus, arthroscopic repair may be a useful surgical method for repairing quadriceps tendon injury. PMID:25815224

  4. Arthroscopic Quadriceps Tendon Repair: Two Case Reports

    PubMed Central

    Saito, Hidetomo; Shimada, Yoichi; Yamamura, Toshiaki; Yamada, Shin; Sato, Takahiro; Nozaka, Koji; Kijima, Hiroaki; Saito, Kimio

    2015-01-01

    Recently, although some studies of open repair of the tendon of the quadriceps femoris have been published, there have been no reports in the literature on primary arthroscopic repair. In our present study, we present two cases of quadriceps tendon injury arthroscopically repaired with excellent results. Case 1 involved a 68-year-old man who was injured while shifting his weight to prevent a fall. MRI showed complete rupture at the insertion of the patella of the quadriceps tendon. The rupture was arthroscopically repaired using both suture anchor and pull-out suture fixation methods via bone tunnels (hereafter, pull-out fixation). Two years after surgery, retearing was not observed on MRI and both Japan Orthopedic Association (JOA) Knee and Lysholm scores had recovered to 100. Case 2 involved a 50-year-old man who was also injured when shifting his weight to prevent a fall. MRI showed incomplete superficial rupture at the insertion of the patella of the quadriceps tendon. The rupture was arthroscopically repaired using pull-out fixation of six strand sutures. One year after surgery, MRI revealed a healed tendon and his JOA and Lysholm scores were 95 and 100, respectively. Thus, arthroscopic repair may be a useful surgical method for repairing quadriceps tendon injury. PMID:25815224

  5. 18S ribosomal DNA sequences provide insight into the phylogeny of patellogastropod limpets (Mollusca: Gastropoda).

    PubMed

    Yoon, Sook Hee; Kim, Won

    2007-02-28

    To investigate the phylogeny of Patellogastropoda, the complete 18S rDNA sequences of nine patellogastropod limpets Cymbula canescens (Gmelin, 1791), Helcion dunkeri (Krauss, 1848), Patella rustica Linnaeus, 1758, Cellana toreuma (Reeve, 1855), Cellana nigrolineata (Reeve, 1854), Nacella magellanica Gmelin, 1791, Nipponacmea concinna (Lischke, 1870), Niveotectura pallida (Gould, 1859), and Lottia dorsuosa Gould, 1859 were determined. These sequences were then analyzed along with the published 18S rDNA sequences of 35 gastropods, one bivalve, and one chiton species. Phylogenetic trees were constructed by maximum parsimony, maximum likelihood, and Bayesian inference. The results of our 18S rDNA sequence analysis strongly support the monophyly of Patellogastropoda and the existence of three subgroups. Of these, two subgroups, the Patelloidea and Acmaeoidea, are closely related, with branching patterns that can be summarized as [(Cymbula + Helcion) + Patella] and [(Nipponacmea + Lottia) + Niveotectura]. The remaining subgroup, Nacelloidea, emerges as basal and paraphyletic, while its genus Cellana is monophyletic. Our analysis also indicates that the Patellogastropoda have a sister relationship with the order Cocculiniformia within the Gastropoda. PMID:17464213

  6. Articular Cartilage Zonal Differentiation via 3D Second Harmonic Generation Imaging Microscopy

    PubMed Central

    Chaudhary, Rajeev; Campbell, Kirby R.; Tilbury, Karissa B.; Vanderby, Ray; Block, Walter F.; Kijowski, Richard; Campagnola, Paul J.

    2015-01-01

    Purpose The collagen structure throughout the patella has not been thoroughly investigated by 3D imaging, where the majority of the exiting data comes from histological cross sections. It is important to have a better understanding of the architecture in normal tissues, where this could then be applied to imaging of diseased states. Methods To address this shortcoming, we investigated the combined use of collagen specific Second Harmonic Generation (SHG) imaging and measurement of bulk optical properties to characterize collagen fiber orientations of the histologically defined zones of bovine articular cartilage. Forward and backward SHG intensities from sections from superficial, middle and deep zones were collected as a function of depth and analyzed by Monte Carlo simulations to extract the SHG creation direction, which is related to the fibrillar assembly. Results Our results revealed differences in SHG forward-backward response between the three zones, where these are consistent with a previously developed model of SHG emission. Some of the findings are consistent with that from other modalities; however, SHG analysis showed the middle zone had the most organized fibril assembly. While not distinct, we also report bulk optical property values for these different zones within the patella. Conclusions Collectively, these results provide quantitative measurements of structural changes at both the fiber and fibril assembly of the different cartilage zones and reveals structural information not possible by other microscope modalities. This can provide quantitative insight to the collagen fiber network in normal cartilage, which may ultimately be developed as a biomarker for osteoarthritis. PMID:25738523

  7. Arthritis in a glyptodont (Mammalia, Xenarthra, Cingulata).

    PubMed

    Barbosa, Fernando Henrique de Souza; Porpino, Kleberson de Oliveira; Fragoso, Ana Bernadete Lima; Oliveira, Edison Vicente

    2014-01-01

    Arthritic lesions have been frequently diagnosed in the fossil record, with spondyloarthropathy (a type of erosive and pan-mammalian arthritis) being one of the most common types described to date for mammals, though not restricted to this group. Here, we identify spondyloarthropathy in fossil bones from the late Pleistocene in Brazil assignable to a large glyptodont individual. Bone erosions in the peripheral joints (viz., the ulna, radius, left femur and tibiae-fibulae) associated with osteosclerosis allow the diagnosis of spondyloarthropathy. The presence of osteophytes in seven bones of the forelimbs (viz., the ulna and radius) and hind limbs (viz., the tibiae-fibulae, left femur and patellae) and a subchondral cyst in one element (viz., the left femur) indicate secondary osteoarthritis. A calcified deposition on the articular surface of the left patella indicates the presence of calcium pyrophosphate deposition disease, which, like the observed osteoarthritic alterations, likely represents a complication of spondyloarthropathy. This is the first report of spondyloarthropathy for xenarthrans. PMID:24551126

  8. Amino acid geochronology of raised beaches in south west Britain

    NASA Astrophysics Data System (ADS)

    Bowen, D. Q.; Sykes, G. A.; Reeves (nee Henry), Alayne; Miller, G. H.; Andrews, J. T.; Brew, J. S.; Hare, P. E.

    Based on (1) the epimerization of L:isoleucine to D:alloisoleucine ( {D}/{L} ratios) in Patella vulgata, Littorina littorea, L. littoralis, L. saxatilis, Littorina species and Nucella lapillus from raised beaches in south west Britain, (2) statistical analysis of the {D}/{L} ratios, and (3) lithostratigraphic and geomorphic evaluation, three ( {D}/{L}) Stages are proposed. The {D}/{L} ratios for all the species measured are converted to a Patella vulgata standard. The three ( {D}/{L}) Stages are: (1) The Minchin Hole ( {D}/{L}) Stage, {D}/{L} ratios 0.175 ± 0.014, defined at a stratotype in Minchin Hole Cave, Gower, Wales. (2) A provisionally defined, but as yet, unamed ( {D}/{L}) Stage, because of the current unavailability of a suitable stratotype, with {D}/{L} ratios of 0.135 ± 0.014 (3) The Pennard ( {D}/{L}) Stage, {D}/{L} ratios 0.105 ± 0.016, defined at a stratotype in Minchin Hole Cave, Gower, Wales. Two geochronological models of the three high sea-level events representing the {D}/{L} Stages are constrained by uranium-series age determinations on stalagmite interbedded with marine beds in Minchin Hole and Bacon Hole Caves, Gower, Wales. A potential 'fixed point' in model evaluation is an age determination which is equivalent to Oxygen Isotope Sub-stage 5e (122 ka). The two models are:

  9. A laterally positioned concave trochlear groove prevents patellar dislocation.

    PubMed

    Hing, Caroline B; Shepstone, Lee; Marshall, Tom; Donell, Simon T

    2006-06-01

    Patellofemoral instability is a disabling condition that occurs in adolescence. Recurrence after patellar dislocation has been reported in 2-50% of patients. We compared the distal femur in patients with patellofemoral instability with distal femura of a healthy cohort using mathematical quantification of two-dimensional shape variation at the same position in different knees. One hundred eight computed tomography scans from 54 patients with patellofemoral instability were compared with 197 computed tomography scans from 102 subjects with normal knees. We used principal components analysis to quantify variation in shape of the trochlear groove as it allows comparison of knees with patellofemoral instability to healthy knees. We found that subjects who had dislocated their patella had a flattened trochlear groove, whereas normal knees had a more concave groove. The position of the trochlear groove was more medial in patients with patellofemoral instability compared with normal knees. Groove position was more important than shape when predicting which patellae were likely to dislocate. PMID:16467625

  10. Effect of cervicolabyrinthine impulsation on the spinal reflex apparatus

    NASA Technical Reports Server (NTRS)

    Yarotskiy, A. I.

    1980-01-01

    In view of the fact that the convergence effect of vestibular impulsation may both stimulate and inhibit intra and intersystemic coordination of physiological processes, an attempt was made to define the physiological effect on the spinal reflex apparatus of the convergence of cervicolabyrinthine impulsation on a model of the unconditioned motor reflex as a mechanism of the common final pathway conditioning the formation and realization of a focused beneficial result of human motor activities. More than 100 persons subjected to rolling effect and angular acceleration during complexly coordinated muscular loading were divided according to typical variants of the functional structure of the patella reflex in an experiment requiring 30 rapid counterclockwise head revolutions at 2/sec with synchronous recording of a 20 item series of patella reflex acts. A knee jerk coefficient was used in calculations. In 85 percent of the cases 2 patellar reflexograms show typical braking and release of knee reflex and 1 shows an extreme local variant. The diagnostic and prognostic value of these tests is suggested for determining adaptive possibilities of functional systems in respect to acceleration and proprioceptive stimuli.

  11. Sex determination using discriminant analysis of upper and lower extremity bones: New approach using the volume and surface area of digital model.

    PubMed

    Lee, U-Young; Kim, In-Beom; Kwak, Dai-Soon

    2015-08-01

    This study used 110 CT images taken from donated Korean cadavers to create 3-D models of the following upper and lower limb bones: the clavicle, scapula, humerus, radius, ulna, hip bone (os coxa), femur, patella (knee cap), tibia, talus, and calcaneus. In addition, the bone volume and surface area were calculated to determine sex differences using discriminant analysis. Significant sex differences were found in all bones with respect to volume and surface area (p<0.01). The order of volume was the same in females and males (femur>hip bone>tibia>humerus>scapula), although the order of surface area was different. The largest surface area in men was the femur and in women was the hip bone (p<0.01). An interesting finding of this study was that the ulna is the bone with the highest accuracy for sex determination (94%). When using the surface area of multiple bones, the maximum accuracy (99.4%) was achieved. The equation was as follows: (discriminant equation of surface area; female<0patella+(-0.052)×fibula+0.043×talus-11.548. These results show that bone volume and surface area of extremity bones can be used for sex determination. PMID:26117502

  12. Hearing preservation in vestibular schwannoma stereotactic radiosurgery: what really matters?

    PubMed

    Linskey, Mark E

    2013-12-01

    Stereotactic radiosurgery (SRS) for vestibular schwannomas has evolved and improved over time. Although early short-term follow-up reports suggest that fractionation yields hearing preservation rates equivalent to modern single-dose SRS techniques, significant questions remain regarding long-term tumor control after the use of fractionation in a late responding tumor with a low proliferative index and ?/? ratio. With single-dose SRS, critical hearing preservation variables include: 1) strict attention to prescription dose 3D conformality so that the ventral cochlear nucleus (VCN) receives ? 9 Gy; 2) careful delineation of the 3D tumor margin to exclude the cochlear nerve when visualizable with contrast-enhanced T2-weighted MR volumetric imaging techniques and exclusion the dura mater of the anterior border of the internal auditory canal; 3) a tumor margin dose prescription ? 12 Gy; 4) optimization of the tumor treatment gradient index without sacrificing coverage and conformality; and 5) strict attention to prescription dose 3D conformality so that the modiolus and the basal turn of the cochlea receive the lowest possible dose (ideally < 4-5.33 Gy). Testable correlates for the relative importance of the VCN versus cochlear dose given the tonotopic organization of each structure suggests that VCN toxicity should lead to preferential loss of low hearing frequencies, while cochlear toxicity should lead to preferential loss of high hearing frequencies. The potential after SRS for hearing toxicity from altered endolymph and/or perilymph fluid dynamics either via impaired fluid production and/or absorption has yet to be explored. Serous otitis media, ossicular or temporal bone osteonecrosis, and chondromalacia are not likely to be relevant factors or considerations for hearing preservation after SRS. PMID:25077325

  13. Patellofemoral Friction Syndrome: MRI correlation of morphologic and T2 cartilage imaging

    PubMed Central

    Subhawong, Ty K.; Thakkar, Rashmi S.; Padua, Abraham; Flammang, Aaron; Chhabra, Avneesh; Carrino, John A.

    2014-01-01

    OBJECTIVE To investigate whether patellofemoral T2 cartilage changes are associated with lateral patellofemoral friction syndrome (PFS), as indicated by edema-like signal within the superolateral infrapatellar (Hoffa) fat pad. METHODS In this IRB-approved retrospective study of 510 consecutive patients, 49 patients with 50 knee MR imaging exams demonstrating normal or low-grade patellofemoral cartilage abnormalities (WORMS score ?2) were included. 22 exams with PFS (cases) were compared with an age- and gender-matched cohort of 28 exams without PFS (controls). 3T MR imaging was performed with multi-echo, spin echo T2 mapping. Two readers measured in consensus malalignment parameters, including patellar height index, tibial tuberosity to trochlear groove distance (TT-TG), and sulcus angle. Bulk T2 cartilage values in the lateral and medial patellofemoral compartment, central weight-bearing medial and lateral femoral condyles were measured independently. Interobserver agreement was quantified using concordance correlation coefficients (CCC). Demographics, anatomic measurements, WORMS scores, and cartilage T2 values were compared between cases and controls using Fisher’s exact test, Wilcoxon rank-sum, and mixed effects models. RESULTS Cases demonstrated higher patellar height index (p=0.002) and TT-TG (p=0.02). Interobserver agreement for T2 values was good overall (CCC range: 0.65–0.93). Cases demonstrated higher medial facet patellar bulk T2 (38.1±7.5 ms) versus controls (33.6±7.3 ms) (p=0.02); otherwise there were no significant differences in regional T2 values. CONCLUSION T2 mapping in patients with PFS demonstrates increased cartilage T2 in the medial patellar facet, possibly reflecting collagen alteration from early chondromalacia (softening) or increased water content related to altered contact pressures. PMID:24448504

  14. Radiofrequency (electrosurgical) ablation of articular cartilage: a study in sheep.

    PubMed

    Turner, A S; Tippett, J W; Powers, B E; Dewell, R D; Mallinckrodt, C H

    1998-09-01

    The objective of this study was to examine the effect of a bipolar ablation probe on experimentally roughened articular cartilage and compare it with the traditional mechanical shaving technique using the knee joint of sheep. Twenty-eight skeletally mature ewes were divided randomly into two groups: one group was treated with a rotating shaving device and another group was treated using the bipolar ablation probe (Bipolar Arthroscopic Probe; Electroscope, Inc, Boulder, CO). Animals were killed at 0, 6, 12, and 24 weeks, and histological sections of the experimental limbs were compared with sections of the opposite limb using a modified Mankin scale. The following variables were used to determine scores: surface (0-6), cells (0-4), hypocellularity (0-3), matrix staining (transitional zone [0-4], radiate zone [0-4], and focal empty lacunae or hypereosinophilic cells (0-3). Differences in scores for all response variables were calculated as treated limb minus sham limb. Response variables were formed: score >0 recoded as 1 (favorable response treated better than sham), score of 0 recoded as 2 (neutral response no differences), and score <0 recoded as 3 (unfavorable response treated worse than sham). Bipolar ablative probe-treated limbs had 14.29% favorable responses and 35.71% favorable or neutral responses, whereas shave-treated limbs had 0% favorable and only 7.14% favorable or neutral responses. For all variables, bipolar ablative probe-treated limbs had more favorable responses. The less severe histological change in the bipolar ablative probe-treated joints compared with the shave-treated joints suggests that bipolar ablation of articular cartilage may be a better treatment for chondromalacia than the usual shaving methods of debridement. Further, there were no pathological changes in the subchondral bone. PMID:9754476

  15. An analytical model to predict interstitial lubrication of cartilage in migrating contact areas

    PubMed Central

    Moore, A.; Burris, D.L.

    2013-01-01

    For nearly a century, articular cartilage has been known for its exceptional tribological properties. For nearly as long, there have been research efforts to elucidate the responsible mechanisms for application toward biomimetic bearing applications. It is now widely accepted that interstitial fluid pressurization is the primary mechanism responsible for the unusual lubrication and load bearing properties of cartilage. Although the biomechanics community has developed elegant mathematical theories describing the coupling of solid and fluid (biphasic) mechanics and its role in interstitial lubrication, quantitative gaps in our understanding of cartilage tribology have inhibited our ability to predict how tribological conditions and material properties impact tissue function. This paper presents an analytical model of the interstitial lubrication of biphasic materials under migrating contact conditions. Although finite element and other numerical models of cartilage mechanics exist, they typically neglect the important role of the collagen network and are limited to a specific set of input conditions, which limits general applicability. The simplified approach taken in this work aims to capture the broader underlying physics as a starting point for further model development. In agreement with existing literature, the model indicates that a large Peclet number, Pe, is necessary for effective interstitial lubrication. It also predicts that the tensile modulus must be large relative to the compressive modulus. This explains why hydrogels and other biphasic materials do not provide significant interstitial pressure under high Pe conditions. The model quantitatively agrees with in-situ measurements of interstitial load support and the results have interesting implications for tissue engineering and osteoarthritis problems. This paper suggests that a low tensile modulus (from chondromalacia or local collagen rupture after impact, for example) may disrupt interstitial pressurization, increase shear stresses, and activate a condition of progressive surface damage as a potential precursor of osteoarthritis. PMID:24275436

  16. Quantification of anatomic, geometric, and load transfer characteristics of the wrist joint.

    PubMed

    Patterson, R M; Viegas, S F; Elder, K; Buford, W L

    1995-01-01

    The work reported here is an assimilation of 8 years of research, the purpose of which was to gain a better understanding of the normal and abnormal workings of the wrist joint. The results are summarized in three major areas of concentration: descriptive anatomic studies, which include direct measurements of cadaver specimens, biomechanical loading studies to define load distribution through normal and abnormal wrists, and three-dimensional (3D) anatomy studies using solid models derived from computed tomographic (CT) images of in vivo and cadaver wrists. The descriptive anatomic studies used 393 cadaver wrists to evaluate the incidence and distribution of anatomic features, arthroses, chondromalacia, and soft-tissue lesions. The data were analyzed for any statistically significant associations among different variables. The biomechanical studies characterized the biomechanics of the human wrist in a variety of normal, simulated traumatic, and surgically treated conditions. The results of the load studies have provided clinically relevant information on the normal anatomy and functional mechanics of the wrist as well as guidelines for the treatment of a number of different fractures and ligament injuries. The 3D anatomic studies use quantitative analysis of 3D reconstructions of CT scan data to build a normative database of carpal bone morphology. Thirty-five wrists were imaged in a CT scanner. Quantitative measurements of volume, surface area, maximum length, and intercarpal distances were than assessed. A reliable 3D carpal height ratio (3DCHR) was calculated by dividing the capitate maximum length by the carpal height, which is the minimum distance between the fourth metacarpal and the radius. PMID:10155681

  17. Mathematical simulations of photon interactions using Monte Carlo analysis to evaluate the uncertainty associated with in vivo K X-ray fluorescence measurements of stable lead in bone

    NASA Astrophysics Data System (ADS)

    Lodwick, Camille J.

    This research utilized Monte Carlo N-Particle version 4C (MCNP4C) to simulate K X-ray fluorescent (K XRF) measurements of stable lead in bone. Simulations were performed to investigate the effects that overlying tissue thickness, bone-calcium content, and shape of the calibration standard have on detector response in XRF measurements at the human tibia. Additional simulations of a knee phantom considered uncertainty associated with rotation about the patella during XRF measurements. Simulations tallied the distribution of energy deposited in a high-purity germanium detector originating from collimated 88 keV 109Cd photons in backscatter geometry. Benchmark measurements were performed on simple and anthropometric XRF calibration phantoms of the human leg and knee developed at the University of Cincinnati with materials proven to exhibit radiological characteristics equivalent to human tissue and bone. Initial benchmark comparisons revealed that MCNP4C limits coherent scatter of photons to six inverse angstroms of momentum transfer and a Modified MCNP4C was developed to circumvent the limitation. Subsequent benchmark measurements demonstrated that Modified MCNP4C adequately models photon interactions associated with in vivo K XRF of lead in bone. Further simulations of a simple leg geometry possessing tissue thicknesses from 0 to 10 mm revealed increasing overlying tissue thickness from 5 to 10 mm reduced predicted lead concentrations an average 1.15% per 1 mm increase in tissue thickness (p < 0.0001). An anthropometric leg phantom was mathematically defined in MCNP to more accurately reflect the human form. A simulated one percent increase in calcium content (by mass) of the anthropometric leg phantom's cortical bone demonstrated to significantly reduce the K XRF normalized ratio by 4.5% (p < 0.0001). Comparison of the simple and anthropometric calibration phantoms also suggested that cylindrical calibration standards can underestimate lead content of a human leg up to 4%. The patellar bone structure in which the fluorescent photons originate was found to vary dramatically with measurement angle. The relative contribution of lead signal from the patella declined from 65% to 27% when rotated 30°. However, rotation of the source-detector about the patella from 0 to 45° demonstrated no significant effect on the net K XRF response at the knee.

  18. Mechanical effects of surgical procedures on osteochondral grafts elucidated by osmotic loading and real-time ultrasound

    PubMed Central

    2009-01-01

    Introduction Osteochondral grafts have become popular for treating small, isolated and full-thickness cartilage lesions. It is recommended that a slightly oversized, rather than an exact-sized, osteochondral plug is transplanted to achieve a tight fit. Consequently, impacting forces are required to insert the osteochondral plug into the recipient site. However, it remains controversial whether these impacting forces affect the biomechanical condition of the grafted articular cartilage. The present study aimed to investigate the mechanical effects of osteochondral plug implantation using osmotic loading and real-time ultrasound. Methods A full-thickness cylindrical osteochondral defect (diameter, 3.5 mm; depth, 5 mm) was created in the lateral lower quarter of the patella. Using graft-harvesting instruments, an osteochondral plug (diameter, 3.5 mm as exact-size or 4.5 mm as oversize; depth, 5 mm) was harvested from the lateral upper quarter of the patella and transplanted into the defect. Intact patella was used as a control. The samples were monitored by real-time ultrasound during sequential changes of the bathing solution from 0.15 M to 2 M saline (shrinkage phase) and back to 0.15 M saline (swelling phase). For cartilage sample assessment, three indices were selected, namely the change in amplitude from the cartilage surface (amplitude recovery rate: ARR) and the maximum echo shifts from the cartilage surface and the cartilage-bone interface. Results The ARR is closely related to the cartilage surface integrity, while the echo shifts from the cartilage surface and the cartilage-bone interface are closely related to tissue deformation and NaCl diffusion, respectively. The ARR values of the oversized plugs were significantly lower than those of the control and exact-sized plugs. Regarding the maximum echo shifts from the cartilage surface and the cartilage-bone interface, no significant differences were observed among the three groups. Conclusions These findings demonstrated that osmotic loading and real-time ultrasound were able to assess the mechanical condition of cartilage plugs after osteochondral grafting. In particular, the ARR was able to detect damage to the superficial collagen network in a non-destructive manner. Therefore, osmotic loading and real-time ultrasound are promising as minimally invasive methods for evaluating cartilage damage in the superficial zone after trauma or impact loading for osteochondral grafting. PMID:19725961

  19. Cyclic peptide marine metabolites and CuII.

    PubMed

    Comba, Peter; Dovalil, Nina; Gahan, Lawrence R; Hanson, Graeme R; Westphal, Michael

    2014-02-01

    Cyclic pseudo-peptides derived from marine metabolites of the genus Lissoclinum bistratum and Lissoclinum patella have attracted scientific interest in the last two decades. Their structural properties and solution dynamics have been analyzed in detail, elaborate synthetic procedures for the natural products and synthetic derivatives developed, the biosynthetic pathways studied and it now is possible to produce them biosynthetically. Initially, these macrocyclic ligands were studied due to their medicinal and pharmaceutical potential - some of the isolated cyclic pseudo-peptides show high cytotoxic and antiviral activity. A major focus in the last decade has been on their Cu(II) coordination chemistry, as a number of studies have indicated that dinuclear Cu(II) complexes of cyclic peptides may be involved in the ascidians' metabolism, and this is the focus of the present review. PMID:24202205

  20. Quantitative, Comparative Assessment of Gait Between Single-Radius and Multi-Radius Total Knee Arthroplasty Designs.

    PubMed

    Larsen, Bethany; Jacofsky, Marc C; Jacofsky, David J

    2015-06-01

    Gait of single-radius (SR, n=16) and multi-radius (MR, n=16) posterior stabilized total knee arthroplasties was compared, along with controls (n=16), pre-op and 1year post-op. Computer navigation and standard order sets controlled confounding variables. Post-operatively, SR knees did not differ from controls while MR knees continued to differ in important knee kinetic and kinematic properties. MR knees remained more extended (P=0.019) and had decreased power absorption (P=0.0001) during weight acceptance compared to the SR knees. Both surgical groups had similar KSS for Knee Scores (P=0.22) and Function Scores (P=0.58). The significant biomechanical differences are likely influenced by patella-femoral moment arm geometry and changing ligament laxity throughout the active range of motion. PMID:25677936

  1. Patellar tendon reconstruction with semitendinosus-gracilis autograft.

    PubMed

    Harris, Joshua D; Fazalare, Joseph J; Phieffer, Laura S; Flanigan, David C

    2013-12-01

    We present a case of a 24-year-old, otherwise healthy, man who sustained a right knee injury after a fall. A small, comminuted inferior pole patella fracture with medial and lateral retinacular tears was encountered that required a small, nonarticular partial patellectomy and patellar tendon repair. An uneventful postoperative course was complicated by a fall onto a flexed knee and rerupture of the patellar tendon at 3 months following surgery. Intraoperatively, a significant tissue void was seen in the area of the prior repair. The patellar tendon was reconstructed with semitendinosus and gracilis autograft. At 1 year follow-up, the patient had regained a normal gait, had no pain, and had full range-of-motion without extensor lag. PMID:23288729

  2. Ultrasound Backscattering Is Anisotropic in Bovine Articular Cartilage.

    PubMed

    Inkinen, Satu I; Liukkonen, Jukka; Tiitu, Virpi; Virén, Tuomas; Jurvelin, Jukka S; Töyräs, Juha

    2015-07-01

    Collagen, proteoglycans and chondrocytes can contribute to ultrasound scattering in articular cartilage. However, anisotropy of ultrasound scattering in cartilage is not fully characterized. We investigate this using a clinical intravascular ultrasound device with ultrasound frequencies of 9 and 40 MHz. Osteochondral samples were obtained from intact bovine patellas, and cartilage was imaged in two perpendicular directions: through articular and lateral surfaces. At both frequencies, ultrasound backscattering was higher (p < 0.05) when measured through the lateral surface of cartilage. In addition, the composition and structure of articular cartilage were investigated with multiple reference methods involving light microscopy, digital densitometry, polarized light microscopy and Fourier infrared imaging. Reference methods indicated that acoustic anisotropy of ultrasound scattering arises mainly from non-uniform distribution of chondrocytes and anisotropic orientation of collagen fibers. To conclude, ultrasound backscattering in articular cartilage was found to be anisotropic and dependent on the frequency in use. PMID:25933711

  3. Simultaneous rupture of the patellar tendon and the anterior cruciate ligament: report of three cases.

    PubMed

    Mariani, Pier Paolo; Cerullo, Guglielmo; Iannella, Germano

    2013-12-01

    This study describes three cases of simultaneous ruptures of the patellar tendon (PT) and the anterior cruciate ligament (ACL). The treatment and the pathogenesis of this rare lesion are discussed. All three cases demonstrated lesions of all structures at the medial compartment. Unlike other reported cases, where an eccentric contraction of the quadriceps was present, the patients of the present study had sustained a forceful valgus injury with external rotation. We detected no displacements of the patella in any patients. All cases underwent a staged surgical procedure. Repair of the PT and of medial peripheral structures was performed immediately after injury; then, once the patients regained a full range of motion (ROM), they underwent an arthroscopic reconstruction of the ACL with ipsilateral hamstrings. At the follow-up stage, all cases showed a stable knee without restricted ROM. PMID:23288778

  4. Anatomic Reconstruction of the Medial Patellofemoral Ligament Using the Fascia Lata as an Autograft

    PubMed Central

    Haupert, Alexander; Lorbach, Olaf

    2015-01-01

    The medial patellofemoral ligament (MPFL) ensures stability of the patella against lateral forces. In cases of recurrent lateral patellar luxation, surgical reconstruction of the MPFL has an important role in treating lateral patellar instability. Several biomechanical studies have presented valuable pieces of information about various techniques for re-creating this medial patellofemoral complex mainly using the gracilis tendon as an autograft. However, with the increasing number of MPFL reconstructions, there are also an increasing number of patients requiring revision MPFL reconstruction. Therefore alternative graft options may become more relevant. Furthermore, the gracilis tendon as a tubular graft may not be able to fully restore patellofemoral kinematics compared with the native MPFL. This article introduces a surgical technique using the fascia lata as an alternative graft option for the anatomic reconstruction of the MPFL. PMID:25973375

  5. Simultaneous bilateral patellar tendon rupture without predisposing systemic disease or steroid use: a case report.

    PubMed

    Lu, Hua-Ding; Cai, Dao-Zhang; Wang, Kun; Zeng, Chun

    2012-01-01

    There is a dearth of case reports describing simultaneous bilateral patellar tendon ruptures in the medical literature. These ruptures are often associated with systemic disorders such as lupus erythematosus or chronic steroid use. The author describes a case of a 24-year-old man who sustained traumatic bilateral patellar tendon ruptures without any history of systemic disease or steroidal medication. We repaired and reattached the ruptured tendons to the patella and augmented our procedure with allogeneic tendon followed by wire loop reinforcement. One year after operation, the patient regained a satisfactory range of motion of both knees with good quadriceps strength and no extensor lag. The recurrent microtrauma from a history of intense sports activity and a high body mass index may have played an important role in this trauma event. PMID:22300921

  6. The effect of McConnell taping on vastus medialis and lateralis activity during squatting in adults with patellofemoral pain syndrome

    PubMed Central

    Lee, Sung-Eun; Cho, Sung-Hyoun

    2013-01-01

    This study aims to examine the effect of McConnell taping to patients with patellofemoral pain syndrome on the change of the muscle activity of vastus medialis and vastus lateralis during squatting. The total numbers of participants are 16 patients with pain in their knee. There are three different experiments: no-taping, placebo taping, and McConnell taping. As a result, both the muscle activity of vastus medialis and muscle activity ratio of vastus medialis to vastus lateralis increased in placebo taping compared to no-taping, which wasn’t statistically significant. However, the muscle activity of vastus medialis and muscle activity ratio of vastus medialis to vastus lateralis increased in McConnell taping compared to no-taping, which was statistically significant. These results suggest that McConnell taping affects the activity of quadriceps by changing the position of the patella, and thus can effectively be applied in the treatment of patellofemoral pain syndrome. PMID:24278879

  7. The Role of Trochleoplasty in Patellofemoral Instability

    PubMed Central

    Duncan, Stephen T.; Noehren, Brian S.; Lattermann, Christian

    2014-01-01

    The management of recurrent patellofemoral instability is challenging. The etiology of the instability is multifactorial, requiring the examination of lower limb alignment, relationship of the patella to the trochlear groove and tibial tubercle, and the soft-tissue restraints. As initial surgical efforts were aimed at isolated soft-tissue repair or reconstruction, patients often had continued instability. Thus, a heightened interest in trochleoplasty has occurred as trochlear dysplasia has been found in 85% of patients with recurrent instability. Different types of trochleoplasties have been developed depending on the type of dysplasia including the trochlear lengthening osteotomy, the proximal open trochleoplasty, the deepening trochleoplasty, and the arthroscopic deepening trochleoplasty. The techniques, benefits, and results of these trochleoplasties will be presented in this review. PMID:22878658

  8. Patellofemoral pain: an update on diagnostic and treatment options.

    PubMed

    McCarthy, Moira M; Strickland, Sabrina M

    2013-06-01

    Patellofemoral pain is a frequent and often challenging clinical problem. It affects females more than males and includes many different pathologic entities that result in pain in the anterior aspect of the knee. Diagnosis of the specific cause of pain can be difficult and requires assessment of lower extremity strength, alignment, and range of motion, as well as specific patella alignment, tracking, and mobility. The treatment for patellofemoral pain is usually conservative with anti-inflammatory medications, activity modification, and a specific physical therapy program focusing on strengthening and flexibility. Infrequently, surgical treatment may be indicated after a non-operative program fails. The outcomes of surgical management may include debridement, lateral release, and realignment of the extensor mechanism to unload the patellofemoral articulation are favorable. PMID:23456237

  9. [The use of nails to diagnosis diseases].

    PubMed

    Baran, Robert

    2014-11-01

    For those interested in nails, a fairly good knowledge of the anatomy of the nail unit is indispensable. But nothing will replace a careful, clinical examination of the nail apparatus. The shape of the nail, surface abnormalities and coloration, with or without a magnifying glass, may well provide a medical diagnosis not only in dermatology but also for medicine in general. Pits on the surface of the nail plate may be enough to diagnose psoriasis on a limited area of scalp dandruff. Even partial detachment of the nail apparatus might lead to the suspicion of psoriatic arthritis. A triangular lunula is associated with the absence of patellas. Finally, no pulmonary examination of a smoker is complete without looking for clubbing. It is high time to pay tribute to the nail. PMID:25443634

  10. Chondral Injury in Patellofemoral Instability

    PubMed Central

    Lustig, Sébastien; Servien, Elvire; Neyret, Philippe

    2014-01-01

    Objective: Patellofemoral instability is common and affects a predominantly young age group. Chondral injury occurs in up to 95%, and includes osteochondral fractures and loose bodies acutely and secondary degenerative changes in recurrent cases. Biomechanical abnormalities, such as trochlear dysplasia, patella alta, and increased tibial tuberosity-trochlear groove distance, predispose to both recurrent dislocations and patellofemoral arthrosis. Design: In this article, we review the mechanisms of chondral injury in patellofemoral instability, diagnostic modalities, the distribution of lesions seen in acute and episodic dislocation, and treatments for articular cartilage lesions of the patellofemoral joint. Results: Little specific evidence exists for cartilage treatments in patellofemoral instability. In general, the results of reparative and restorative procedures in the patellofemoral joint are inferior to those observed in other compartments of the knee. Conclusion: Given the increased severity of chondral lesions and progression to osteoarthritis seen with recurrent dislocations, careful consideration should be given to early stabilisation in patients with predisposing factors. PMID:26069693

  11. Saphenous neuropathy in a patient with low back pain.

    PubMed

    Ahadi, Tannaz; Raissi, Gholam Reza; Togha, Mansoureh; Nejati, Parisa

    2010-01-01

    Saphenous nerve, a pure sensory nerve, may compromise as a result or complication of a surgical procedure or secondary to trauma or insidiously. We present a male patient with low back pain concomitant with pain in medial portion of left thigh in addition to pain and numbness in medial part of leg and inferior part of patella after a strenuous activity. Preliminary diagnosis suggested that the patient had radiculopathy but electrodiagnostic tests revealed the absence of left saphenous response both in medial leg and infrapatellar region, while normal findings were recorded from right side. Needle electromyography in L4 innervated muscles were normal. The patient had saphenous nerve entrapment in left thigh. Two months later symptoms relieved with conservative therapy. PMID:20205890

  12. Saphenous neuropathy in a patient with low back pain

    PubMed Central

    2010-01-01

    Saphenous nerve, a pure sensory nerve, may compromise as a result or complication of a surgical procedure or secondary to trauma or insidiously. We present a male patient with low back pain concomitant with pain in medial portion of left thigh in addition to pain and numbness in medial part of leg and inferior part of patella after a strenuous activity. Preliminary diagnosis suggested that the patient had radiculopathy but electrodiagnostic tests revealed the absence of left saphenous response both in medial leg and infrapatellar region, while normal findings were recorded from right side. Needle electromyography in L4 innervated muscles were normal. The patient had saphenous nerve entrapment in left thigh. Two months later symptoms relieved with conservative therapy. PMID:20205890

  13. Gravity Reception and Cardiac Function in the Spider

    NASA Technical Reports Server (NTRS)

    Finck, A.

    1985-01-01

    The following features of the arachnid gravity system were studied. (1) the absolute threshold to hyper-gz is quite low indicating fine proprioreceptive properties of the lyriform organ, the Gz/vibration detector; (2) the neurogenic heart of the spider is a good dependent variable for assessing its behavior to Gz and other stimuli which produce mechanical effects on the exoskeleton; (3) Not only is the cardiac response useful but it is now understood to be an integral part of the system which compensates for the consequences of gravity in the spider (an hydraulic leg extension); and (4) a theoretical model was proposed in which a mechanical amplifier, the leg lever, converts a weak force (at the tarsus) to a strong force (at the patella), capable of compressing the exoskeleton and consequently the lyriform receptor.

  14. Genome streamlining and chemical defense in a coral reef symbiosis

    PubMed Central

    Kwan, Jason C.; Donia, Mohamed S.; Han, Andrew W.; Hirose, Euichi; Haygood, Margo G.; Schmidt, Eric W.

    2012-01-01

    Secondary metabolites are ubiquitous in bacteria, but by definition, they are thought to be nonessential. Highly toxic secondary metabolites such as patellazoles have been isolated from marine tunicates, where their exceptional potency and abundance implies a role in chemical defense, but their biological source is unknown. Here, we describe the association of the tunicate Lissoclinum patella with a symbiotic ?-proteobacterium, Candidatus Endolissoclinum faulkneri, and present chemical and biological evidence that the bacterium synthesizes patellazoles. We sequenced and assembled the complete Ca. E. faulkneri genome, directly from metagenomic DNA obtained from the tunicate, where it accounted for 0.6% of sequence data. We show that the large patellazoles biosynthetic pathway is maintained, whereas the remainder of the genome is undergoing extensive streamlining to eliminate unneeded genes. The preservation of this pathway in streamlined bacteria demonstrates that secondary metabolism is an essential component of the symbiotic interaction. PMID:23185008

  15. Chondral fracture of the lateral trochlea of the femur occurring in an adolescent: mechanism of injury.

    PubMed

    Oohashi, Yoshikazu; Oohashi, Yoshinori

    2007-11-01

    The trochlea of the femur is a very unusual site for chondral fracture. Little is known of the mechanism of injuries confined to the articular cartilage of the trochlea of the femur. A very unusual case of chondral fracture of the lateral trochlea of the femur occurring in an adolescent is reported here. The mechanism by which this injury occurred could be evaluated in this patient. The cartilage on the convex surface of the lateral trochlea was likely avulsed proximally by shear force of the patella during rapid extension of the weight-bearing knee from a flexed position. From a viewpoint of mechanism, this injury differs from the more usual osteochondral or chondral fractures of the weight bearing area of the femoral condyle, which are usually accompanied by twisting forces. PMID:17024462

  16. Anatomic Reconstruction of the Medial Patellofemoral Ligament in Children and Adolescents Using a Pedicled Quadriceps Tendon Graft

    PubMed Central

    Nelitz, Manfred; Williams, Sean Robert M.

    2014-01-01

    Reconstruction of the medial patellofemoral ligament (MPFL) has recently become a popular procedure for children and adolescents with patellofemoral instability. Nevertheless, high complication rates of up to 26% have been reported. The traditionally used technique requires patellar bone tunnels that may place the proportionately smaller patella at higher risk of fracture. Because of the adjacent physis of the femoral insertion, anatomic reconstruction of the MPFL has the risk of injury to the growth plate. This technical report therefore presents a technique for anatomic reconstruction of the MPFL in a skeletally immature population using a pedicled superficial quadriceps tendon graft, hardware-free patellar graft attachment, and anatomic femoral fixation distal to the femoral physis. The advantages of this technique include avoidance of bony patellar complications, an anatomically truer reconstruction, a single incision, and sparing of the hamstring tendons for reconstruction of any future ligamentous injuries. PMID:24904782

  17. Nail bed expansion: A new technique for correction of multiple isolated congenital micronychia.

    PubMed

    Ghaffarpour, Gholamhossein; Faghihi, Alireza; Ghasemi, Mohammadreza; Ghaffarpour, Gelareh

    2014-01-01

    Congenital micronychia may involve big toes or may involve other nails. The etiology of micronychia is not clear but amniotic bands, teratogens (drugs, alcohol), Nail Patella Syndrome etc. A 44-year-old woman with multiple isolated congenital micronychia over her hands and feet was selected. The major affected nails were thumbs and Index fingers. Surgical method were done step by step: Anesthesia of the area, extraction of short nail, elevation of nail bed, longitudinal nail bed incisions, suturing the lateral nail bed to the nail wall, covering the nail bed by a splint of plastic suction tube, bandage with gauze Vaseline. Finally, we hypnotized that in congenital micronychia, the main pathology is in nail bed; through this theory by nail bed expansion better outcomes are coming. PMID:24804179

  18. [Idiopathic bilateral patellar tendon rupture].

    PubMed

    Choufani, C; Barthélemy, R; Danis, J; Demoures, Th; Rigal, S

    2015-04-01

    In the absence of systemic disease, specific treatment or sport tendonitis, simultaneous bilateral patellar tendon rupture is rare. Often missed on the first glance, it represents a diagnostic difficulty that should not be overlooked at the initial medical visit. The loss of active extension of the lower limb and a radiographic patella alta, even in a bilateral context, should raise suspicion of this diagnosis. It is then necessary to search for predisposing causes and to evoke the differential, or frequently associated, diagnoses. The present report illustrates these diagnostic difficulties and summarizes some clinical considerations that might help to avoid neglecting these different elements at the first medical visit (positive diagnosis, associated lesions, favouring factors). PMID:26054172

  19. Four-Year Follow Up Outcome Study of Patellofemoral Arthroplasty at a Single Institution.

    PubMed

    Goh, Graham Seow-Hng; Liow, Ming Han Lincoln; Tay, Darren Keng-Jin; Lo, Ngai Nung; Yeo, Seng Jin

    2015-06-01

    Patellofemoral arthroplasty (PFA) is an option for younger patients with isolated patellofemoral arthritis. Older PFAs had high failure rates due to poor design. This retrospective study reports the outcomes of PFA at a single institution using a second-generation implant. Fifty-one patients (51 knees) with isolated patellofemoral arthritis underwent PFA. Mean follow-up was 4.1years (range, 2.2-6.1). Mean Knee Society objective and function scores, Oxford Knee score, Melbourne Knee score and Physical Component Score improved significantly. 76% had their expectations fulfilled and 76% experienced good satisfaction. Mean Insall-Salvati and Caton-Deschamps ratios increased significantly. Two wound infections (3.92%) were encountered. Survivorship was 92.2% with four revisions, two due to progression of arthritis, one due to patella maltracking, and one due to anterior knee pain. PMID:25660614

  20. Midterm clinical results of the Autocentric II patellofemoral prosthesis.

    PubMed

    van Wagenberg, J M F; Speigner, B; Gosens, T; de Waal Malefijt, J

    2009-12-01

    We studied the outcome of patellofemoral arthroplasties using the Autocentric prosthesis implanted in our clinic between 1994 and 2004. New insight on indications and contraindications motivated us to find risk factors in the failure of this prosthesis. Twenty-four patients had surgery for patellofemoral arthritis not responding to exhaustive nonoperative measures. The mean age at the time of patellofemoral arthroplasty (PFA) was 63.4 (SD 11.3, range 38-81) years with a mean follow-up of 4.8 (SD 2.9, range 2-11) years. Additional interventions were necessary in 21 knees during follow-up in our population, and seven knees required total knee arthroplasty (TKA) mainly due to progressive tibiofemoral osteoarthritis and maltracking of the patella. The patient outcomes and quality of life scores showed disappointing results, even after revision to TKA. This retrospective analysis underlines the importance of strict indications for patellofemoral arthroplasty and, in particular, of contraindications. PMID:19224212

  1. Cumulative exposure to lead and cognition in persons with Parkinson’s disease

    PubMed Central

    Weuve, Jennifer; Press, Daniel Z.; Grodstein, Francine; Wright, Robert O.; Hu, Howard; Weisskopf, Marc G.

    2012-01-01

    Background Dementia is an important consequence of Parkinson’s disease (PD), with few known modifiable risk factors. Cumulative exposure to lead, at levels experienced in the community, may exacerbate PD-related neural dysfunction, resulting in impaired cognition. Methods Among 101 persons with PD (“cases”) and, separately, 50 persons without PD (“controls”), we evaluated cumulative lead exposure, gauged via tibia and patella bone lead concentrations, in relation to cognitive function, assessed using a telephone battery developed and validated in a separate sample of PD patients. We also assessed the interaction between lead and case-control status. Results After multivariable adjustment, higher tibia bone lead concentration among PD cases was associated with worse performance on all of the individual telephone tests. In particular, tibia lead levels corresponded to significantly worse performance on a telephone analogue of the Mini-Mental State Examination and tests of working memory and attention. Moreover, higher tibia bone lead concentration was associated with significantly worse global composite score encompassing all the cognitive tests (P=0.04). The magnitude of association per standard deviation increment in tibia bone lead level was equivalent to the difference in global scores among controls in our study who were about seven years apart in age. The tibia lead-cognition association was notably stronger within cases than within controls (Pdifference=0.06). Patella bone lead concentration was not consistently associated with performance on the tests. Conclusions These data provide evidence suggesting that cumulative exposure to lead may result in worsened cognition among persons with PD. PMID:23143985

  2. The manipulation of strain, when stress is controlled, modulates in vivo tendon mechanical properties but not systemic TGF-?1 levels

    PubMed Central

    McMahon, Gerard E; Morse, Christopher I; Burden, Adrian; Winwood, Keith; Onambélé-Pearson, Gladys L

    2013-01-01

    Modulators of loading-induced in vivo adaptations in muscle–tendon complex (MTC) mechanical properties remain unclear. Similarly contentious, is whether changes in MTC characteristics are associated with growth factor levels. Four groups were subjected to varying magnitudes of stress/strain: Group 1 trained with the MTC at a shortened position (MTCS; n = 10); Group 2 at a lengthened position (MTCL; n = 11; stress levels matched to MTCS); Group 3 over a wide range of motion (MTCX; n = 11); and Group 4 (n = 10) was the control population (no training). Patella tendon Stiffness (P < 0.001), Young's modulus, and quadriceps torque (P < 0.05) increments (only seen in the training groups), showed MTCL and MTCX groups responses to be superior to those of MTCS (P < 0.05). In addition, MTCL and MTCX better maintained adaptations compared to MTCS (P < 0.05) following detraining, with a pattern of slower loss of improvements at the early phase of detraining in all training groups. There were no significant changes (P > 0.05) in antagonist cocontraction, patella tendon dimensions or circulating transforming growth factor beta (TGF-?1) levels following training or detraining in any of the groups. We conclude that chronically loading the MTC in a relatively lengthened position (which involves greater strains) enhances its mechanical properties, more so than loading in a shortened position. This is true even after normalizing for internal stress. The underlying endocrine mechanisms do not appear to be mediated via TGF-?1, at least not at the systemic level. Our findings have implications with regard to the effectiveness of eccentric loading on improved tendon structural and mechanical properties. PMID:24303165

  3. Acute and old ruptures of the extensor apparatus of the knee in adults (excluding knee replacement).

    PubMed

    Saragaglia, D; Pison, A; Rubens-Duval, B

    2013-02-01

    Rupture of the extensor apparatus of the knee in adults is infrequent and dominated by patellar fracture, which in our experience is six times as frequent as quadriceps or patellar tendon tear. Patellar fracture poses few diagnostic problems and treatment is now well codified. Tension-band osteosynthesis is generally used, involving two longitudinal K-wires and wire in a figure-of-eight pattern looped over the anterior patella; sometimes, for more complex fractures, cerclage wiring is added to the tension band. Non-union is rare and generally well tolerated. Quadriceps tendon tear mainly affects patients over 40 years of age, in a context of systemic disease. Diagnosis is easily suggested by inability to actively extend the knee, but is unfortunately still often overlooked in emergency. In most cases, early surgical management is needed to reinsert the tendon at the proximal pole of the patella by bone suture. For chronic lesions, it is often necessary to lengthen the quadriceps tendon by V-Y plasty or the Codivilla technique. Patellar tendon tear, on the other hand, typically occurs in patients under 40 years of age, often involved in sports. Diagnosis is again clinically straightforward, but again may be missed in emergency, especially in case of incomplete tear. Surgery is mandatory in all cases. The procedure depends on the type of lesion: either end-to-end suture or transosseous reinsertion. In most cases repair is protected by tendon augmentation. Old lesions often require tendon graft or a tendon-bone-tendon-bone graft taken from the opposite side. PMID:23352566

  4. Quadriceps tendon rupture: a biomechanical comparison of transosseous equivalent double-row suture anchor versus transosseous tunnel repair.

    PubMed

    Hart, Nathan D; Wallace, Matthew K; Scovell, J Field; Krupp, Ryan J; Cook, Chad; Wyland, Douglas J

    2012-09-01

    Quadriceps rupture off the patella is traditionally repaired by a transosseous tunnel technique, although a single-row suture anchor repair has recently been described. This study biomechanically tested a new transosseous equivalent (TE) double-row suture anchor technique compared with the transosseous repair for quadriceps repair. After simulated quadriceps-patella avulsion in 10 matched cadaveric knees, repairs were completed by either a three tunnel transosseous (TT = 5) or a TE suture anchor (TE = 5) technique. Double-row repairs were done using two 5.5 Bio-Corkscrew FT (fully threaded) (Arthrex, Inc., Naples, FL, USA) and two 3.5 Bio-PushLock anchors (Arthrex, Inc., Naples, FL, USA) with all 10 repairs done with #2 FiberWire suture (Arthrex, Inc., Naples, FL). Cyclic testing from 50 to 250 N for 250 cycles and pull to failure load (1 mm/s) were undertaken. Gap formation and ultimate tensile load (N) were recorded and stiffness data (N/mm) were calculated. Statistical analysis was performed using a Mann-Whitney U test and survival characteristics examined with Kaplan-Meier test. No significant difference was found between the TE and TT groups in stiffness (TE = 134 +/- 15 N/mm, TT = 132 +/- 26 N/mm, p = 0.28). The TE group had significantly less ultimate tensile load (N) compared with the TT group (TE = 447 +/- 86 N, TT = 591 +/- 84 N, p = 0.04), with all failures occurring at the suture eyelets. Although both quadriceps repairs were sufficiently strong, the transosseous repairs were stronger than the TE suture anchor repairs. The repair stiffness and gap formation were similar between the groups. PMID:23150161

  5. Prenatal Lead Exposure and Weight of 0- to 5-Year-Old Children in Mexico City

    PubMed Central

    Peterson, Karen E.; Sánchez, Brisa N.; Cantonwine, David; Lamadrid-Figueroa, Héctor; Schnaas, Lourdes; Ettinger, Adrienne S.; Hernández-Avila, Mauricio; Hu, Howard; Téllez-Rojo, Martha M.

    2011-01-01

    Background: Cumulative prenatal lead exposure, as measured by maternal bone lead burden, has been associated with smaller weight of offspring at birth and 1 month of age, but no study has examined whether this effect persists into early childhood. Objective: We investigated the association of perinatal maternal bone lead, a biomarker of cumulative prenatal lead exposure, with children’s attained weight over time from birth to 5 years of age. Methods: Children were weighed at birth and at several intervals up until 60 months. Maternal tibia and patella lead were measured at 1 month postpartum using in vivo K-shell X-ray fluorescence. We used varying coefficient models with random effects to assess the association of maternal bone lead with weight trajectories of 522 boys and 477 girls born between 1994 and 2005 in Mexico City. Results: After controlling for breast-feeding duration, maternal anthropometry, and sociodemographic characteristics, a 1-SD increase in maternal patella lead (micrograms per gram) was associated with a 130.9-g decrease in weight [95% confidence interval (CI), –227.4 to –34.4 g] among females and a 13.0-g nonsignificant increase in weight among males (95% CI, –73.7 to 99.9 g) at 5 years of age. These associations were similar after controlling for concurrent blood lead levels between birth and 5 years. Conclusions: Maternal bone lead was associated with lower weight over time among female but not male children up to 5 years of age. Given that the association was evident for patellar but not tibial lead levels, and was limited to females, results need to be confirmed in other studies. PMID:21715242

  6. A novel LMX1B mutation in a family with end-stage renal disease of ‘unknown cause’

    PubMed Central

    Edwards, Noel; Rice, Sarah J.; Raman, Shreya; Hynes, Ann Marie; Srivastava, Shalabh; Moore, Iain; Al-Hamed, Mohamed; Xu, Yaobo; Santibanez-Koref, Mauro; Thwaites, David T.; Gale, Daniel P.; Sayer, John A.

    2015-01-01

    End-stage renal disease (ESRD) presenting in a familial autosomal dominant pattern points to an underlying monogenic cause. Nail-patella syndrome (NPS) is an autosomal dominant disorder that may lead to ESRD caused by mutations in the transcription factor LMX1B. Renal-limited forms of this disease, termed nail-patella-like renal disease (NPLRD), and LMX1B nephropathy have recently been described. We report a large family, from the North East of England, with seven affected members with varying phenotypes of renal disease, ranging from ESRD at 28 years of age to microscopic haematuria and proteinuria and relatively preserved renal function. In this family, there were no extra-renal manifestations to suggest NPS. Genome-wide linkage studies and inheritance by descent (IBD) suggested disease loci on Chromosome 1 and 9. Whole exome sequencing (WES) analysis identified a novel sequence variant (p.R249Q) in the LMX1B gene in each of the three samples submitted, which was confirmed using Sanger sequencing. The variant segregated with the disease in all affected individuals. In silico modelling revealed that R249 is putatively located in close proximity to the DNA phosphoskeleton, supporting a role for this residue in the interaction between the LMX1B homeodomain and its target DNA. WES and analysis of potential target genes, including CD2AP, NPHS2, COL4A3, COL4A4 and COL4A5, did not reveal any co-inherited pathogenic variants. In conclusion, we confirm a novel LMX1B mutation in a large family with an autosomal dominant pattern of nephropathy. This report confirms that LMX1B mutations may cause a glomerulopathy without extra-renal manifestations. A molecular genetic diagnosis of LMX1B nephropathy thus provides a definitive diagnosis, prevents the need for renal biopsies and allows at risk family members to be screened. PMID:25713721

  7. Effects of Low-Intensity Pulsed Ultrasound on New Trabecular Bone during Bone–Tendon Junction Healing in a Rabbit Model: A Synchrotron Radiation Micro-CT Study

    PubMed Central

    Lu, Hongbin; Zheng, Cheng; Wang, Zhanwen; Chen, Can; Chen, Huabin; Hu, Jianzhong

    2015-01-01

    This study was designed to evaluate the effects of low-intensity pulsed ultrasound on bone regeneration during the bone–tendon junction healing process and to explore the application of synchrotron radiation micro computed tomography in three dimensional visualization of the bone–tendon junction to evaluate the microarchitecture of new trabecular bone. Twenty four mature New Zealand rabbits underwent partial patellectomy to establish a bone–tendon junction injury model at the patella–patellar tendon complex. Animals were then divided into low-intensity pulsed ultrasound treatment (20 min/day, 7 times/week) and placebo control groups, and were euthanized at week 8 and 16 postoperatively (n = 6 for each group and time point). The patella–patellar tendon specimens were harvested for radiographic, histological and synchrotron radiation micro computed tomography detection. The area of the newly formed bone in the ultrasound group was significantly greater than that of control group at postoperative week 8 and 16. The high resolution three dimensional visualization images of the bone–tendon junction were acquired by synchrotron radiation micro computed tomography. Low-intensity pulsed ultrasound treatment promoted dense and irregular woven bone formation at week 8 with greater bone volume fraction, number and thickness of new trabecular bone but with lower separation. At week 16, ultrasound group specimens contained mature lamellar bone with higher bone volume fraction and thicker trabeculae than that of control group; however, there was no significant difference in separation and number of the new trabecular bone. This study confirms that low-intensity pulsed ultrasound treatment is able to promot bone formation and remodeling of new trabecular bone during the bone–tendon junction healing process in a rabbit model, and the synchrotron radiation micro computed tomography could be applied for three dimensional visualization to quantitatively evaluate the microarchitecture of new bone in bone–tendon junction. PMID:25874957

  8. Comparison of articulating and static spacers regarding infection with resistant organisms in total knee arthroplasty

    PubMed Central

    2011-01-01

    Introduction The result of treatment of infections involving antibiotic-resistant organisms in total knee arthroplasty (TKA) is often poor. We evaluated the efficacy of 2-stage revision in TKAs infected with resistant organisms and compared the clinical outcomes with articulating and conventional static spacers, in terms of both infection control and function. Methods In a prospective manner, from June 2003 to January 2007 selected patients with a TKA infected with resistant organisms were enrolled and treated with 2-stage re-implantation. The 45 patients were divided into 2 groups: group A (23 patients) implanted with the articulating spacers and group S (22 patients) implanted with static spacers. All patients followed the same antibiotic protocols and had the same re-implantation criteria. The efficacy of infection control was evaluated using re-implantation rate, recurrence rate, and overall success rate. The functional and radiographic results were interpreted with the Hospital of Special Surgery (HSS) knee score and the Insall-Salvati ratio. Results With mean 40 (24–61) months of follow-up, 22 of 23 knees were re-implanted in group A and 21 of 22 were re-implanted in group S. Of these re-implanted prostheses, 1 re-infection occurred in group A and 2 occurred in group S. Range of motion after re-implantation, the final functional scores, and the satisfaction rate were better in group A. One third of the patients in group S, and none in group A, had a patella baja. Interpretation After 2-stage re-implantation of TKAs originally infected with resistant organisms, the clinical outcome was satisfactory—and similar to that reported after treatment of TKAs infected with low-virulence strains. Treatment with an articulating spacer resulted in better functional outcome and lower incidence of patella baja. PMID:21883049

  9. Patellar tilt: the physical examination correlates with MR imaging.

    PubMed

    Grelsamer, Ronald P; Weinstein, Craig H; Gould, Jason; Dubey, Ashok

    2008-01-01

    Patella malalignment is a recognized cause of knee pain, tilt being one of its more common forms. Although patellar tilt has been described both on the physical examination and on computerized imaging, to date the correlation between the two has not been established. A strong correlation would strengthen the value of each. Moreover, in situations where tilt cannot be clinically assessed (e.g. obesity), CT or MR imaging could be an adequate substitute for the clinical determination of tilt. We propose to correlate the physical examination with the magnetic resonance examination by way of an MR Tilt Angle. This angle is measured in a manner similar to the assessment of tilt on the physical examination, in that a line is drawn across the medial and lateral borders of the patella and referenced off the posterior femoral condyles. Most tilt angles use the slope of the lateral facet as a measure of tilt. These tilt angles paradoxically diminish as patellar tilt increases, a potential source of confusion. In this study, we use an MRI tilt angle that increases in the same direction as the actual tilt, which is more intuitive. We examined 30 patients with tilt and 51 patients without tilt. Patients with significant tilt on the physical examination can be expected to have an MRI Tilt Angle that is 10 degrees or greater whereas an angle of less than 10 degrees is associated with the absence of significant tilt on the physical examination. This MRI Tilt Angle fills the need for an easy, objective, intuitive measure of tilt and is an excellent adjunct to the physical examination. PMID:18023186

  10. Ultrasound biomicroscopy imaging for monitoring progressive trypsin digestion and inhibition in articular cartilage.

    PubMed

    Wang, Qing; Zheng, Yong-Ping

    2009-09-01

    This study reports an ultrasound biomicroscopy (UBM) imaging approach to monitor the progressive trypsin-induced depletion of proteoglycan (PG) and its inhibition in articular cartilage. Three fresh, normal bovine patellae were obtained and four full-thickness cartilage-bone specimens were prepared from the lower medial side of each patella. One sample was used as a control and the other three were divided into three groups: Groups A, B and C (n=3 for each group). After a 40min 0.25% trypsin digestion, samples from group A were continuously digested in trypsin solution, while those in groups B and C were immersed in physiologic saline and fetal bovine serum (FBS), respectively, for another 280min. The trypsin penetration front was observed by UBM and M-mode images were acquired using 50MHz focused ultrasound and custom-developed software. The results show that the 40min trypsin digestion degraded nearly the whole surface layer of the cartilage tissue. Further digestion in trypsin or residual digestion in saline for 280min depleted most of the PG content, as observed in groups A and B. The replacement of trypsin with a physiologic saline solution only slightly slowed the digestion process (group B), while trypsin inhibitors in FBS stopped the digestion in approximately 1.5h (group C). The normalized digestion fractions of the digested tissues were calculated from ultrasound data and histology sections, and then compared between the groups. Without the use of FBS, 80% to 100% of the full thickness was digested, while this number was only approximately 50% when using FBS. Our findings indicate that the UBM imaging system could provide two-dimensional (2-D) visual information for monitoring progressive trypsin-induced PG depletion in articular cartilage. The system also potentially offers a useful tool for preparing cartilage degeneration models with precisely controlled PG depletion. PMID:19616365

  11. Patellar anthropometry in sex differentiation--a study ii the northern part of West Bengal, India.

    PubMed

    Jana, Tapan Kumar; Giri, Susmita; Roy, Hironmoy; Kar, Maitreye; Santra, Sabyasachi; Das, Suvam

    2013-10-01

    As in many cases long bones get available in fragments, so gender determination from short as well as robust bones like patella paid importance now-a-days. So far the literature reviewed such records are little in Indians especially from West Bengal. The present study is aimed to demonstrate the gender differentiability of different patellar anthropometric parameters viz, length, breadth, surface areas of articular surfaces, patellar Index, etc, amongst population of northern part of West Bengal in India. A total 46 intact patellae of which 23 belonged to males and 23 belonged to females, were taken out from human corps of 20 to 50 years of age group, brought for postmortem in the forensic department, NB Medical College, Sushrutanagar. Patellar vertical length, width, different measurements of the individual articular facet, angulations at the vertical ridge, patellar index and total surface area of the posterior surface and articular part, etc, were measured. In males patellar height, diameter, index, dry weight, articular surface area would be more than 3.75cm, 4.1cm, 108.23, 18g and 11.67cm2 respectively and values less than those will be for females. But in contrary angulation at the vertical ridge between medial and lateral articular facets will be more than 119.28 degrees in females, and less than for males. The results of this study revealed that we can determine sex of North Bengal population just by using the patellar measurements, when other long bones, skull and pelvis get not available, or fragmented. But there remains a scope for multicentric study throughout the India to validate the fact. PMID:24968491

  12. Altered frontal and transverse plane tibiofemoral kinematics and patellofemoral malalignments during downhill gait in patients with mixed knee osteoarthritis.

    PubMed

    Farrokhi, Shawn; Meholic, Brad; Chuang, Wei-Neng; Gustafson, Jonathan A; Fitzgerald, G Kelley; Tashman, Scott

    2015-07-16

    Patients with knee osteoarthritis often present with signs of mixed tibiofemoral and patellofemoral joint disease. It has been suggested that altered frontal and transverse plane knee joint mechanics play a key role in compartment-specific patterns of knee osteoarthritis, but in-vivo evidence in support of this premise remains limited. Using Dynamic Stereo X-ray techniques, the aim of this study was to compare the frontal and transverse plane tibiofemoral kinematics and patellofemoral malalignments during the loading response phase of downhill gait in three groups of older adults: patients with medial tibiofemoral compartment and coexisting patellofemoral osteoarthritis (n=11); patients with lateral tibiofemoral compartment and coexisting patellofemoral osteoarthritis (n=10); and an osteoarthritis-free control group (n=22). Patients with lateral compartment osteoarthritis walked with greater and increasing degrees of tibiofemoral abduction compared to the medial compartment osteoarthritis and the control groups who walked with increasing degrees of tibiofemoral adduction. Additionally, the medial and lateral compartment osteoarthritis groups demonstrated reduced degrees of tibiofemoral internal rotation compared to the control group. Both medial and lateral compartment osteoarthritis groups also walked with increasing degrees of lateral patella tilt and medial patella translation during the loading response phase of downhill gait. Our findings suggest that despite the differences in frontal and transverse plane tibiofemoral kinematics between patients with medial and lateral compartment osteoarthritis, the malalignments of their arthritic patellofemoral joint appears to be similar. Further research is needed to determine if these kinematic variations are relevant targets for interventions to reduce pain and disease progression in patients with mixed disease. PMID:26087880

  13. Are Articular Cartilage Lesions and Meniscus Tears Predictive of IKDC, KOOS, and Marx Activity Level Outcomes after ACL Reconstruction? A 6-Year Multicenter Cohort Study

    PubMed Central

    Cox, Charles L.; Huston, Laura J.; Dunn, Warren R.; Reinke, Emily K.; Nwosu, Samuel K.; Parker, Richard D.; Wright, Rick W.; Kaeding, Christopher C.; Marx, Robert G.; Amendola, Annunziata; McCarty, Eric C.; Wolf, Brian R.; Harrell, Frank E.; Spindler, Kurt P.

    2014-01-01

    Background Identifying risk factors for inferior outcomes after ACL reconstruction (ACLR) is important for prognosis and future treatment. The goal of this study was to determine whether articular cartilage and meniscal variables are predictive of 3 validated sports outcome instruments after ACLR. Hypothesis/Purpose We hypothesized that articular cartilage lesions and meniscus tears/treatment would be predictors of the IKDC, KOOS (all 5 subscales), and Marx activity level at 6 years following ACLR. Study Design Prospective cohort, Level 1 Methods Between 2002 and 2004, 1512 ACLR subjects were prospectively enrolled and followed longitudinally with the IKDC, KOOS, and Marx activity score completed at entry, 2, and 6 years. A logistic regression model was built incorporating variables from patient demographics, surgical technique, articular cartilage injuries, and meniscus tears/treatment to determine the predictors (risk factors) of IKDC, KOOS, and Marx at 6 years. Results We completed a minimum follow-up on 86% (1307/1512) of our cohort at 6 years. The cohort was 56% male, had a median age of 23 years at the time of enrollment, with 76% reporting a non-contact injury mechanism. Incidence of concomitant pathology at the time of surgery consisted of the following: articular cartilage (medial femoral condyle [MFC]-25%, lateral femoral condyle [LFC]-20%, medial tibial plateau [MTP]-6%, lateral tibial plateau [LTP]-12%, patella-20%, trochlear-9%) and meniscal (medial-38%, lateral-46%). Both articular cartilage lesions and meniscal tears were significant predictors of 6-year outcomes on IKDC and KOOS. Grade 3 or 4 articular cartilage lesions (excluding patella) significantly reduced IKDC and KOOS scores at 6 years. IKDC demonstrated worse outcomes with the presence of a grade 3-4 chondral lesion on the MFC, MTP, and LFC. Likewise, KOOS was negatively affected by cartilage injury. The sole significant predictor of reduced Marx activity was the presence of a grade 4 lesion on the MFC. Lateral meniscus repairs did not correlate with inferior results, but medial meniscus repairs predicted worse IKDC and KOOS scores. Lateral meniscus tears left alone significantly improved prognosis. Small partial meniscectomies (<33%) on the medial meniscus fared worse, but conversely, larger excisions (>50%) on either the medial or lateral menisci improved prognosis. Analogous to previous studies, other significant predictors of lower outcome scores were lower baseline scores, higher BMI, lower education level, smoking, and ACL revisions. Conclusions Both articular cartilage injury and meniscal tears/treatment at the time of ACLR were significant predictors of IKDC and KOOS scores 6 years following ACLR. Similarly, having a grade 4 MFC lesion significantly reduced a patient’s Marx activity level score at 6 years. PMID:24647881

  14. Clinical outcomes after repair of quadriceps tendon rupture: a systematic review.

    PubMed

    Ciriello, Vincenzo; Gudipati, Suribabu; Tosounidis, Theodoros; Soucacos, P N; Giannoudis, Peter V

    2012-11-01

    The existing evidence regarding the management of quadriceps tendon rupture remains obscure. The aim of the current review is to investigate the characteristics, the different techniques employed and to analyse the clinical outcomes following surgical repair of quadriceps tendon rupture. An Internet based search of the English literature of the last 25 years was carried out. Case reports and non-clinical studies were excluded. The methodological quality of the included studies was assessed using the Coleman Methodology Score. All data regarding mechanism and site of rupture, type of treatment, time elapsed between diagnosis and repair, patients' satisfaction, clinical outcome, return to pre-injury activities, complications and recurrence rates were extracted and analysed. Out of 474 studies identified, 12 met the inclusion criteria. The average of Coleman Methodology Score was 50.46/100. In total 319 patients were analysed with a mean age of 57 years (16-85). The mean time of follow-up was 47.5 months (3 months to 24 years). The most common mechanism of injury was simple fall (61.5%). Spontaneous ruptures were reported in 3.2% of cases. The most common sites of tear were noted between 1cm and 2 cm of the superior pole of the patella and, in the older people, at the osseotendinous junction. The most frequently used repair technique was patella drill holes (50% of patients). Simple sutures were used in mid-substance ruptures. Several reinforcement techniques were employed in case of poor quality or retraction of the torn ends of tendon. The affected limb was immobilised in a cast for a period of 3-10 weeks. Quadriceps muscular atrophy and muscle strength deficit were present in most of the cases. Worst results were noted in delayed repairs. Reported complications included heterotopic ossifications in 6.9% of patients, deep venous thrombosis or pulmonary embolism in 2.5%, superficial infection in 1.2% and deep infection in 1.1%. It appears that the type of surgical repair does not influence the clinical results. The majority of the studies reported good or excellent ROM and return to the pre-injury activities. The overall rate of re-rupture was 2%. PMID:22959496

  15. Quantitative cartilage volume measurement using MRI: comparison of different evaluation techniques.

    PubMed

    Maataoui, Adel; Graichen, Heiko; Abolmaali, Nasreddin D; Khan, Mohammad F; Gurung, Jessen; Straub, Ralf; Qian, Jun; Hinterwimmer, Stefan; Ackermann, Hanns; Vogl, Thomas J

    2005-08-01

    This study was aimed to investigate the accuracy and time saving of MRI Argus application in the assessment of cartilage volume in osteoarthritic knees. Twelve knees of patients suffering from osteoarthritis were scanned with a 1.5 T MRI using a 3D gradient echo sequence with selective water excitation. Cartilage volume of the tibial and patellar compartment was determined with a validated multiprocessing computer system (Octane Duo, Silicon Graphics, Mountain View, Calif., USA). The calculated cartilage volumes were compared to the results acquired by the Argus (Siemens Inc., Erlangen, Germany) application software using the MRI data sets. Compared to the multiprocessing computer system a time saving of at least 30 min for cartilage volume determination was achieved. The mean differences of Argus versus the multiprocessing computer system were 4.26+/-0.84 and 7.80+/-0.87% for the medial and lateral tibial plateau and 5.94+/-0.59% for the patella (no statistical significant difference; P>0.05). The applied Argus software can be used for fast and accurate determination of cartilage volume in the knee joint. PMID:15856246

  16. Efficacy and tolerability of lornoxicam versus tramadol in postoperative pain.

    PubMed

    Staunstrup, H; Ovesen, J; Larsen, U T; Elbaek, K; Larsen, U; Krøner, K

    1999-08-01

    This randomized double-blind study compared the analgesic efficacy and tolerability of intramuscular lornoxicam and tramadol in 76 patients with moderate to unbearable pain following arthroscopic reconstruction of the anterior cruciate ligament using the patella bone-tendon-bone technique. Patients receiving a single dose of lornoxicam 16 mg experienced significantly greater total pain relief than patients receiving tramadol 100 mg over the following 8 hours. Lornoxicam had greater analgesic efficacy than tramadol in patients with moderate baseline pain but was of equivalent efficacy in those with severe/unbearable baseline pain. Fewer patients in the lornoxicam group required rescue medication (58% vs. 77%, respectively). Patients' global impression of efficacy showed lornoxicam to be superior to tramadol with 82% and 49% of patients, respectively, rating treatment as good, very good, or excellent. Following multiple-dose administration of lornoxicam (8 mg tid) or tramadol (100 mg tid) for 3 days, efficacy profiles similar to those following a single dose were obtained. Thus, slightly fewer patients in the lornoxicam group required rescue medication, and patients' global impression of efficacy again favored lornoxicam. Adverse events were reported by 38 of the 76 patients and were mainly mild to moderate in severity. Significantly fewer patients reported one or more adverse events with lornoxicam than with tramadol (14 vs. 24, respectively). Thus, intramuscular lornoxicam offers a useful alternative to tramadol for the treatment of moderate to severe postoperative pain. PMID:10434236

  17. Neglected rupture of the quadriceps tendon in a patient with chronic renal failure (case report and review of the literature)

    PubMed Central

    Hassani, Zouhir Ameziane; Boufettal, Moncef; Mahfoud, Moustapha; Elyaacoubi, Moradh

    2014-01-01

    Spontaneous ruptures of the quadriceps tendon are infrequent injuries, it is seen primarily in patients with predisposing diseases such as gout, rheumatoid arthritis and chronic renal failure. A 32-year-old man had a history of end stage renal disease and received regular hemodialysis treatment for more than 5 years. He was admitted in our service for total functional impotence of the right lower limb with knee pain after a common fall two months ago. The radiogram showed a ‘'patella baja” with suprapatellar calcifications. The ultrasound and MRI showed an aspect of rupture of the quadriceps tendon in its proximal end with retraction of 3 cm. Quadriceps tendon repair was performed with a lengthening plasty, and the result was satisfactory after a serial rehabilitation program. The diagnosis of quadriceps tendon ruptures needs more attention in patients with predisposing diseases. They should not be unknown because the treatment of neglected lesions is more difficult. We insist on the early surgical repair associated with early rehabilitation that can guarantee recovery of good active extension.

  18. Management of extensor mechanism rupture after TKA.

    PubMed

    Rosenberg, A G

    2012-11-01

    Disruption of the extensor mechanism in total knee arthroplasty may occur by tubercle avulsion, patellar or quadriceps tendon rupture, or patella fracture, and whether occurring intra-operatively or post-operatively can be difficult to manage and is associated with a significant rate of failure and associated complications. This surgery is frequently performed in compromised tissues, and repairs must frequently be protected with cerclage wiring and/or augmentation with local tendon (semi-tendinosis, gracilis) which may also be used to treat soft-tissue loss in the face of chronic disruption. Quadriceps rupture may be treated with conservative therapy if the patient retains active extension. Component loosening or loss of active extension of 20° or greater are clear indications for surgical treatment of patellar fracture. Acute patellar tendon disruption may be treated by primary repair. Chronic extensor failure is often complicated by tissue loss and retraction can be treated with medial gastrocnemius flaps, achilles tendon allografts, and complete extensor mechanism allografts. Attention to fixing the graft in full extension is mandatory to prevent severe extensor lag as the graft stretches out over time. PMID:23118397

  19. Autologous hamstring tendon used for revision of quadiceps tendon tears.

    PubMed

    McCormick, Frank; Nwachukwu, Benedict U; Kim, Jaehon; Martin, Scott D

    2013-04-01

    A paucity of literature exists on quadriceps tendon reruptures. Failed quadriceps tendon repair can cause significant morbidity and disability. Surgical management of quadriceps tendon rerupture can be challenging due to tissue degeneration, tendon retraction, muscle atrophy, and poor bone fixation. A lack of guidance in the literature exists on the appropriate surgical techniques for managing quadriceps tendon reruptures.This article describes the case of a male recreational athlete with a failed primary quadriceps tendon repair who presented 10 months after rerupture. Examination was significant for morbid obesity, assisted ambulation, and a significant defect at the superior pole of the patella on the affected side. Intraoperative findings were consistent with a 2.0- to 4.5-cm tendon defect across the extensor mechanism with complete retinaculi tears. The authors performed a novel surgical approach for revision of quadriceps tears using a bilateral hamstring autograft through a quadriceps tendon weave and a transosseous patellar repair. Tendon length was restored, and extensor mechanism tension was reapproximated. Postoperatively, the patient achieved a good outcome and had returned to full, painless, sport participation at 2-year follow-up.This surgical technique is suitable for revision quadriceps tendon repairs of large tendon gap defects, repairs desiring tendon-to-bone in-growth, and repairs requiring large-force transmission across the repair. PMID:23590798

  20. Recurrent patellar tendon rupture in a patient after intramedullary nailing of the tibia: reconstruction using an achilles tendon allograft.

    PubMed

    Jagow, Devin M; Garcia, Branden J; Yacoubian, Stephan V; Yacoubian, Shahan V

    2015-05-01

    Various complications after intramedullary (IM) nailing of the tibia have been reported, the most common of which are anterior knee pain and symptoms similar to patella tendonitis. Complete rupture of the patellar tendon after IM nailing of the tibia has been reported on 2 occasions, in conjunction with predisposing patient factors, such as systemic disease or a proud tibial nail. Patellar tendon ruptures are disabling injuries that can be technically difficult to repair because of the poor quality of remaining tendon tissue, quadriceps muscle atrophy and/or contracture, and scar-tissue formation. Many methods have described the surgical reconstruction of the knee extensor mechanism, which is most commonly performed after total knee arthroplasty. We report the successful surgical and clinical outcome of patellar tendon reconstruction using an Achilles tendon allograft in a patient subject to late and recurrent ruptures after IM nailing of the tibia through a mid-patellar tendon-splitting approach. Seven months after tendon reconstruction, the patient exhibited full knee flexion, an extension lag of 10º, 4/5 quadriceps strength, and return to her baseline ambulatory status. PMID:25950545

  1. The management of extensor mechanism complications in total knee arthroplasty. AAOS exhibit selection.

    PubMed

    Nam, Denis; Abdel, Matthew P; Cross, Michael B; LaMont, Lauren E; Reinhardt, Keith R; McArthur, Benjamin A; Mayman, David J; Hanssen, Arlen D; Sculco, Thomas P

    2014-03-19

    Complications involving the knee extensor mechanism and patellofemoral joint occur in 1% to 12% of patients following total knee arthroplasty and have major negative effects on patient outcomes and satisfaction. The surgeon must be aware of intraoperative, postoperative, and patient-related factors that can increase the rate of these problems. This review focuses on six of the most commonly encountered problems: patellar tendon disruption, quadriceps tendon rupture, patellar crepitus and soft-tissue impingement, periprosthetic patellar fracture, patellofemoral instability, and osteonecrosis of the patella. The goals of this report are to (1) review the relevant anatomy of the knee extensor mechanism, (2) present risk factors that may lead to extensor mechanism complications, (3) provide a diagnostic and treatment algorithm for each of the aforementioned problems, and (4) review the specific surgical techniques of Achilles tendon allograft reconstruction and synthetic mesh augmentation. Extensor mechanism disorders following total knee arthroplasty remain difficult to manage effectively. Although various surgical techniques have been used, the results in patients with a prior total knee arthroplasty are inferior to the results in the young adult without such a prior procedure. Surgical attempts at restoration of the knee extensor mechanism are usually warranted; however, the outcomes of treatment of these complications are often poor, and management of patient expectations is important. PMID:24647514

  2. Brefeldin A or monensin inhibits the 3D organizer in gastropod, polyplacophoran, and scaphopod molluscs.

    PubMed

    Gonzales, Eric E; van der Zee, Maurijn; Dictus, Wim J A G; van den Biggelaar, Jo

    2007-02-01

    In molluscs, the 3D vegetal blastomere acts as a developmental signaling center, or organizer, and is required to establish bilateral symmetry in the embryo. 3D is similar to organizing centers in other metazoans, but detailed comparisons are difficult, in part because its organizing function is poorly understood. To elucidate 3D function in a standardized fashion, we used monensin and brefeldin A (BFA) to rapidly and reversibly interfere with protein processing and secretion, thereby inhibiting the signaling interactions that underlie its specification and patterning. In the gastropods, Patella vulgata and Lymnaea stagnalis, the polyplacophoran, Mopalia muscosa, and the scaphopod, Antalis entalis, treatments initiated before the organizer-dependent onset of bilateral cleavage resulted in radialization of subsequent development. In radialized P. vulgata, L. stagnalis, and M. muscosa, organizer specification was blocked, and embryos failed to make the transition to bilateral cleavage. In all four species, the subsequent body plan was radially symmetric and was similarly organized about a novel aboral-oral axis. Our results demonstrate that brefeldin A (BFA) and monensin can be used to inhibit 3D's organizing function in a comparative fashion and that, at least in M. muscosa, the organizer-dependent developmental architecture of the embryo predicts subsequent patterns of morphogenetic movements in gastrulation and, ultimately, the layout of the adult body plan. PMID:17120024

  3. Combined magnetic fields accelerate bone-tendon junction injury healing through osteogenesis.

    PubMed

    Hu, J; Zhang, T; Xu, D; Qu, J; Qin, L; Zhou, J; Lu, H

    2015-06-01

    The objective of this study was to explore the effect of combined magnetic fields (CMFs) on osteogenesis and the remodeling of newly formed bone at bone-tendon (BT) junction. Forty-eight mature rabbits in whom partial patellectomy was performed were used to establish a BT junction injury model at the patella-patellar tendon (PPT) complex and were then allocated to CMF treatment group (CMF group) or placebo treatment group (control group). Daily CMF therapy was delivered continuously from post-operative day 3 to weeks 4, 8, and 16. At each time point, the animals were sacrificed, and the PPT complexes were harvested for radiographic, histological, peripheral quantitative computed tomography, and micro-computed tomography (micro-CT) evaluation. The area, length, and bone mineral density of the newly formed bone in the CMF group were significantly greater than the control group at post-operative weeks 8 and 16. The micro-CT results showed that the newly formed bone in the CMF group contained more and thicker trabeculae than the control group at weeks 8 and 16. Histologically, the CMF group showed better remodeling of the BT junction. In conclusion, CMF treatment was able to accelerate osteogenesis during BT junction repair, thus facilitating the healing of BT junction injury. PMID:24845774

  4. Correlation between the forearm plus little finger length and the femoral length.

    PubMed

    Naik, Monappa A; Sujir, Premjit; Tripathy, Sujit Kumar; Goyal, Tarun; Rao, Sharath K

    2013-08-01

    PURPOSE. To assess the correlation between the forearm plus little finger length and the femoral length in 100 volunteers. METHODS. The forearm plus little finger length and the ipsilateral femoral length of 68 male and 32 female volunteers aged 19 to 55 (mean, 35.8) years were measured using a measuring tape. The forearm plus litter finger length was measured from the tip of the olecranon to the tip of the little finger, whereas the femoral length was measured from the tip of the greater trochanter to the level of proximal pole of the patella over the outer aspect of thigh. Two observers made the measurements on 2 separate occasions. Intra- and inter-observer variations were calculated. A value of 0.75 or greater indicated excellent agreement. RESULTS. The mean forearm plus little finger length and femoral length were 39.87 (SD, 2.73) and 39.85 (SD, 2.44) cm, respectively. The mean difference between these 2 measurements was 0.028 (95% CI, -0.109 to 0.165) cm. The correlation between these 2 measurements was 0.861 (p<0.001). Patient age, sex, and body mass index did not affect this correlation. The intra- and inter-observer reliability was excellent. CONCLUSION. The forearm plus little finger length correlated with the femoral length. This method is simple, radiation-free, and can be applied in day-today practice. PMID:24014776

  5. Local Interleukin-1-Driven Joint Pathology Is Dependent on Toll-Like Receptor 4 Activation

    PubMed Central

    Abdollahi-Roodsaz, Shahla; Joosten, Leo A.B.; Koenders, Marije I.; van den Brand, Ben T.; van de Loo, Fons A.J.; van den Berg, Wim B.

    2009-01-01

    Toll-like receptors (TLRs) may contribute to the pathogenesis of chronic inflammatory destructive diseases through the recognition of endogenous ligands produced on either inflammation or degeneration of the extracellular matrix. The presence of endogenous TLR agonists has been reported in rheumatoid joints. In the present study, we investigated the significance of TLR2 and TLR4 activation by locally- produced endogenous ligands in the severity of joint inflammation and destruction. Local joint pathology independent of systemic immune activation was induced by overexpression of interleukin (IL)-1 and TNF in naive joints using adenoviral gene transfer. Here, we report that at certain doses, IL-1-induced local joint inflammation, cartilage proteoglycan depletion, and bone erosion are dependent on TLR4 activation, whereas TLR2 activation is not significantly involved. In comparison, tumor necrosis factor ?-driven joint pathology seemed to be less dependent on TLR2 and TLR4. The severity of IL-1-induced bone erosion and irreversible cartilage destruction was markedly reduced in TLR4?/? mice, even though the degree of inflammation was similar, suggesting uncoupled processes. Furthermore, the expression of cathepsin K, a marker for osteoclast activity, induced by IL-1? was dependent on TLR4. Overexpression of IL-1? in the joint as well as ex vivo IL-1 stimulation of patellae provoked the release of endogenous TLR4 agonists capable of inducing TLR4-mediated cytokine production. These data emphasize the potential relevance of TLR4 activation in rheumatoid arthritis, particularly with respect to IL-1-mediated joint pathology. PMID:19834062

  6. Trabecular bone remodeling around smooth and porous implants in an equine patellar model.

    PubMed

    Cheal, E J; Snyder, B D; Nunamaker, D M; Hayes, W C

    1987-01-01

    The objective of this investigation was to examine the stress-morphology relationships for trabecular bone around implants with different surface characteristics. Stainless steel spheres with either a polished surface or a sintered-bead porous coating were implanted unilaterally into equine patellae and maintained for a 6 month period. Stereological methods were used to quantify the trabecular bone morphology and finite element analyses were performed to predict the trabecular bone stresses. In general, the remodeling response around the smooth implants was greater than that around those porous implants that exhibited bone ingrowth. In accordance with these differences, the finite element models predicted greater changes in the stresses adjacent to the smooth implants due to the nonlinear boundary conditions. However, it did not appear that the trajectorial theory, in its simplest form, was applicable to the remodeling induced by the implants. A linear relationship between the change in bone areal density and the change in von Mises effective stress provides support for the hypothesis that the architecture of trabecular bone corresponds to an optimal structure. The results also demonstrated that, under certain circumstances, small changes in the stress state may result in large changes in the principal material orientation. PMID:3429458

  7. Two Modes of Weight Training Programs and Patellar Stabilization

    PubMed Central

    Wong, Yiu-ming; Chan, Suk-tak; Tang, Kwok-wing; Ng, Gabriel Y.F

    2009-01-01

    Context: Underconditioned patellar stabilizing muscles could be a predisposing factor for patellar instability. Objective: To examine the effect of 2 modes of weight training on the size of the vastus medialis obliquus (VMO), the resting position and passive mobility of the patella, and the strength of the knee extensor muscles. Design: Prospective intervention, repeated measures in 3 groups. Setting: Orthopaedic and sports sciences research laboratory. Patients or Other Participants: 48 healthy adults free from back and lower extremity injuries. Intervention(s): Participants were randomly assigned to muscle hypertrophy training, muscle strength training, or the control group. Those in the training groups pursued training 3 times per week for 8 weeks. Main Outcome Measure(s): Magnetic resonance imaging and ultrasound cross-sectional area of the VMO, patellar tilt angle on magnetic resonance imaging, instrumented passive patellar mobility, and isometric knee extension torque of the dominant leg. Results: Participants in both training groups had comparable gains in VMO size, passive patellar stability, and knee extension force, all of which were greater than for the control group (P < .05). Conclusions: Both short-term muscle hypertrophy and strength training programs can reinforce the patellar stabilizers in previously untrained volunteers. PMID:19478844

  8. Identifying bacterial genes and endosymbiont DNA with Glimmer

    PubMed Central

    Delcher, Arthur L.; Bratke, Kirsten A.; Powers, Edwin C.; Salzberg, Steven L.

    2008-01-01

    Motivation: The Glimmer gene-finding software has been successfully used for finding genes in bacteria, archæa and viruses representing hundreds of species. We describe several major changes to the Glimmer system, including improved methods for identifying both coding regions and start codons. We also describe a new module of Glimmer that can distinguish host and endosymbiont DNA. This module was developed in response to the discovery that eukaryotic genome sequencing projects sometimes inadvertently capture the DNA of intracellular bacteria living in the host. Results: The new methods dramatically reduce the rate of false-positive predictions, while maintaining Glimmer's 99% sensitivity rate at detecting genes in most species, and they find substantially more correct start sites, as measured by comparisons to known and well-curated genes. We show that our interpolated Markov model (IMM) DNA discriminator correctly separated 99% of the sequences in a recent genome project that produced a mixture of sequences from the bacterium Prochloron didemni and its sea squirt host, Lissoclinum patella. PMID:17237039

  9. A Peculiar New Pampatheriidae (Mammalia: Xenarthra: Cingulata) from the Pleistocene of Argentina and Comments on Pampatheriidae Diversity.

    PubMed

    Góis, Flávio; González Ruiz, Laureano Raúl; Scillato-Yané, Gustavo Juan; Soibelzon, Esteban

    2015-01-01

    Pampatheriidae are a group of cingulates native to South American that are known from the middle Miocene to the lower Holocene. Two genera have been recognized between the lower Pleistocene and the lower Holocene: Pampatherium Gervais and Ameghino (Ensenadan, Bonaerian and Lujanian, lower Pleistocene-lower Holocene) and Holmesina Simpson (Blancan, Irvingtonian, upper Pliocene-lower Holocene). They have been mainly differentiated by their osteoderm morphology and cranio-dental characters. These taxa had a wide latitudinal distribution, extending from the southern part of South America (Península Valdés, Argentina) to North America (Florida, USA). In this contribution, we describe a new genus and species of Pampatheriidae for the lower and middle Pleistocene of Buenos Aires Province and for the upper Pleistocene of Santa Fe Province (Argentina).The new taxon is represented by disarticulated osteoderms, one skull element, two thoracic vertebrae and a right femur and patella. It has extremely complex osteoderm ornamentations and particular morphological characters of the cranial element and femur that are not found in any other species of the family. This new taxon, recorded in the lower-middle Pleistocene (Ensenadan Stage/Age) and in the upper Pleistocene-early Holocene (Lujanian Stage/Age), is incorporated to the Pleistocene mammal assemblage of South America. Finally, the Pampatheriidae diversity is greater during the Lujanian Stage/Age than the Ensenadan Stage/Age. PMID:26083486

  10. An aggressive case of pseudomyogenic haemangioendothelioma of bone with pathological fracture and rapidly progressive pulmonary metastatic disease: case report and review of the literature.

    PubMed

    Shah, Asad Rabbani; Fernando, Malee; Musson, Rachel; Kotnis, Nikhil

    2015-10-01

    Pseudomyogenic haemangioendothelioma (PMH) is a rare recently described vascular tumour typically presenting with soft tissue disease in distal extremities of young adults. Multi-focal and multi-layered involvement is commonly recognised. The majority of cases described so far have shown an indolent clinical course and distant metastatic spread is rare. We report a case of PMH in an 82-year-old male diagnosed following a pathological fracture of the distal tibia. Further bone lesions were identified in the fibula, patella and distal femur. The patient was found to have multiple nodules suspicious for pulmonary metastases on a CT scan at the time of diagnosis that showed significant progression at a follow-up scan 4 weeks later. To our knowledge, this is the first reported case of PMH presenting with a pathological fracture. The rapid progression of bone and distant metastatic disease in this case is highly unusual given the typically indolent clinical course reported in the literature to date. PMID:25982253

  11. Differential concentration of Technetium-99 (99Tc) in common intertidal molluscs with different food habits.

    PubMed

    Sjøtun, K; Heldal, H E; Brakstad, D S

    2011-11-01

    Concentration of 99Tc has been measured in fucoids and molluscs, sampled in a sheltered intertidal at the southwest coast of Norway from February to November 2006. The concentrations of 99Tc in molluscs differed significantly between species. The filtering bivalve Mytilus edulis had the lowest concentrations with averages of 2.3-5.9 Bq kg(-1) d.w., while the herbivorous gastropods Littorinalittorina, Littorina obtusata and Patella vulgata had higher concentrations. P. vulgata and L. obtusata had the highest concentrations, 40-47 and 26-30 Bq kg(-1)d.w., respectively. L. obtusata has a specialized habit of living, and prefers to feed on fucoids. P. vulgata can graze extensively on the fucoid Ascophyllum nodosum when available. Fucoids are known to have very high uptake of 99Tc, and this was also found in the present study. The high 99Tc-concentrations of L. obtusata and P. vulgata are most likely due to their habit of feeding on fucoids. PMID:21925686

  12. Stress Fractures of the Pelvis and Legs in Athletes

    PubMed Central

    Behrens, Steve B.; Deren, Matthew E.; Matson, Andrew; Fadale, Paul D.; Monchik, Keith O.

    2013-01-01

    Context: Stress fractures are common injuries in athletes, often difficult to diagnose. A stress fracture is a fatigue-induced fracture of bone caused by repeated applications of stress over time. Evidence Acquisition: PubMed articles published from 1974 to January 2012. Results: Intrinsic and extrinsic factors may predict the risk of stress fractures in athletes, including bone health, training, nutrition, and biomechanical factors. Based on their location, stress fractures may be categorized as low- or high-risk, depending on the likelihood of the injury developing into a complete fracture. Treatment for these injuries varies substantially and must account for the risk level of the fractured bone, the stage of fracture development, and the needs of the patient. High-risk fractures include the anterior tibia, lateral femoral neck, patella, medial malleolus, and femoral head. Low-risk fractures include the posteromedial tibia, fibula, medial femoral shaft, and pelvis. Magnetic resonance is the imaging test of choice for diagnosis. Conclusions: These injuries can lead to substantial lost time from participation. Treatment will vary by fracture location, but most stress fractures will heal with rest and modified weightbearing. Some may require more aggressive intervention, such as prolonged nonweightbearing movement or surgery. Contributing factors should also be addressed prior to return to sports. PMID:24427386

  13. Effects of Freeze–Thaw Cycle with and without Proteolysis Inhibitors and Cryopreservant on the Biochemical and Biomechanical Properties of Articular Cartilage

    PubMed Central

    Hirviniemi, Mikko; Tiitu, Virpi; Jurvelin, Jukka S.; Töyräs, Juha; Lammi, Mikko J.

    2014-01-01

    Objective: We investigated the effects of freeze-thawing on the properties of articular cartilage. Design: The reproducibility of repeated biomechanical assay of the same osteochondral sample was first verified with 11 patellar plugs from 3 animals. Then, 4 osteochondral samples from 15 bovine patellae were divided into 4 groups. The reference samples were immersed in phosphate-buffered saline (PBS) containing proteolysis inhibitors and biomechanically tested before storage for further analyses. Samples of group 1 were biomechanically tested before and after freeze-thawing in PBS in the absence and those of group 2 in the presence of inhibitors. Samples of the group 3 were biomechanically tested in PBS-containing inhibitors, but frozen in 30% dimethyl sulfoxide/PBS and subsequently tested in PBS supplemented with the inhibitors. Glycosaminoglycan contents of the samples and immersion solutions were analyzed, and proteoglycan structures examined with SDS-agarose gel electrophoresis. Results: Freeze-thawing decreased slightly dynamic moduli in all 3 groups. The glycosaminoglycan contents and proteoglycan structures of the cartilage were similar in all experimental groups. Occasionally, the diffused proteoglycans were partly degraded in group 1. Digital densitometry revealed similar staining intensities for the glycosaminoglycans in all groups. Use of cryopreservant had no marked effect on the glycosaminoglycan loss during freeze-thawing. Conclusion: The freeze-thawed cartilage samples appear suitable for the biochemical and biomechanical studies.

  14. Contact area and pressure distribution in the feline patellofemoral joint under physiologically meaningful loading conditions.

    PubMed

    Clark, A L; Herzog, W; Leonard, T R

    2002-01-01

    The purpose of this study was to determine contact area and mean and peak pressures in the healthy feline patellofemoral joint over the complete range of possible applied force. Furthermore, we wanted to improve upon the repeatability of previous measurements while maximizing the physiological relevance of the results obtained. The patellae and femora were secured in a loading frame approximating an in situ loading configuration. Low- and medium-grade Fuji film was used to assess patellofemoral contact area and pressure distribution, respectively. Constant force was applied to the patellofemoral joints for 2s (short duration trials) or 5min (long duration trials). For the short duration trials, contact area was shown to increase logarithmically with the force applied. In contrast, mean and peak pressures increased linearly with force. Furthermore, the rate of increase of peak pressure with force was approximately three times greater than that of mean pressure. For the long duration trials, contact area increased up to 33% compared to the short duration trials. This effect could no longer be detected with our approach after an unloading period of 5-10s. Increasing contact area is one mechanism that the feline patellofemoral joint may use to regulate the pressures experienced by the cartilage as the force applied to the joint increases. The attenuation of external forces inside a joint is achieved by the specific geometry of the articulating surfaces and the viscoelastic properties of the articular cartilage. It likely represents a natural protection of joints to high external load magnitudes. PMID:11747883

  15. Using Electromyography to Detect the Weightings of the Local Muscle Factors to the Increase of Perceived Exertion During Stepping Exercise

    PubMed Central

    Chang, Ya-Ju; Liu, Chin-Chih; Lin, Cheng-Hsiang; Tsaih, Peih-Ling; Hsu, Miao-Ju

    2008-01-01

    Rate of perceived exertion (RPE) is a clinically convenient indicator for monitoring exercise intensity in cardiopulmonary rehabilitation. It might not be sensitive enough for clinicians to determine the patients' physiological status because its association with the cardiovascular system and local muscle factors is unknown. This study used the electromyographic sensor to detect the local muscle fatigue and stabilization of patella, and analyzed the relationship between various local muscle and cardiovascular factors and the increase of RPE during stepping exercise, a common exercise program provided in cardiopulmonary rehabilitation. Ten healthy adults (4 males and 6 females) participated in this study. Each subject used their right bare foot to step up onto a 23-cm-high step at a constant speed until the RPE score reached 20. The RPE, heart rate (HR), and surface EMG of the rectus femoris (RF), vastus medialis, and vastus lateralis were recorded at 1-minute intervals during the stepping exercise. The generalized estimating equations (GEE) analysis indicated that the increase in RPE significantly correlated with the increase in HR, and decrease in median frequency (MF) of the EMG power spectrum of the RF. Experimental results suggest that the increase in RPE during stepping exercise was influenced by the cardiovascular status, localized muscle fatigue in the lower extremities. The weighting of the local muscle factors was more than half of the weighting of the cardiovascular factor.

  16. Statistical analysis of knee ligament lengths.

    PubMed

    Clément, B; Drouin, G; Shorrock, G; Gely, P

    1989-01-01

    Absolute locations of the main knee ligamentous structures' insertion sites on the femur, the tibia and the patella have been obtained for 30 knees originating from 18 fresh human cadavers. For each knee, the length of ten selected structures was deduced. These length data form the input of the statistical analysis presented in the paper. The correlations between the ligament lengths are presented. A comparison of the lengths from the left and right (laterality) knees of the same specimen is also done and shows no significant difference. The sex difference is also studied and does not seem to be a determinant parameter for the sample investigated. Prediction equations are proposed to estimate the ligament lengths for the knee in extension with respect to the three external parameters: height, weight and femoral condyle width. The menisco-femoral length, the patellar tendon length and the patellar length are not related to the external parameters and predictions are based on mean values. For the other six ligament lengths, the square multiple correlation coefficient with the external parameters ranges between 0.22 and 0.43. The condylar width is the most often used external parameter in these equations while the weight parameter is never present. PMID:2613711

  17. Incidence of patellar clunk syndrome in fixed versus high-flex mobile bearing posterior-stabilized total knee arthroplasty.

    PubMed

    Snir, Nimrod; Schwarzkopf, Ran; Diskin, Brian; Takemoto, Richelle; Hamula, Mathew; Meere, Patrick A

    2014-10-01

    The geometry of the intercondylar box plays a significant role in the development of patellar clunk syndrome. We reviewed the incidence of patella clunk at mid-to-long-term follow-up of a rotating high-flex versus fixed bearing posterior stabilized TKA design. 188-mobile and 223-fixed bearing TKAs were reviewed for complications, incidence of patellar clunk, treatment, recurrence rates, range of motion, and patient satisfaction. Patellar clunk developed in 22 knees in the mobile (11.7%) and in 4 (1.8%) in the fixed bearing group (P<0.001). 23 out of 26 cases resolved with a single arthroscopic treatment and 2 resolved with a second procedure. The mean postoperative range of motion was 122.4°. All but one patient reported overall satisfaction with the index procedure. In contrast with other recent studies we found a significant incidence of patellar clunk in high-flex mobile bearings. Despite the high rate of patellar clunk syndrome, overall patients did well and were satisfied with their outcomes. PMID:24961894

  18. Results of Gender-Specific Total Knee Arthroplasty: Comparative Study with Traditional Implant in Female Patients

    PubMed Central

    Kim, Jong-Min; Kim, Sang-Beom; Kim, Jong-Min; Lee, Dae-Hee; Lee, Bum-Sik

    2015-01-01

    Purpose To compare the incidence of overhang between two distinct femoral components and whether there is clinical and radiological benefit of gender-specific implants in short-term follow-up. Materials and Methods One hundred and four knees in consecutive 66 female patients who underwent primary total knee arthroplasty due to primary osteoarthritis were included in this study. Overhang was measured and recorded in every cut surface of femur with both gender-specific and traditional trial femoral components respectively in every patient. Then, the knees were divided into two groups according to the type of the permanent femoral component they received. Clinical and radiological outcomes were compared between 2 groups at minimum 3 years after operation. Results Mean follow-up duration was 41.3 months (range, 36 to 50 months). Sixty two knees (59.6%) showed femoral overhang at least in one area with a traditional trial component, while 26 knees (25.0%) did with a gender-specific trial component (p<0.001). In terms of range of motion, Hospital for Special Surgery knee score, radiographic result, patella tilt angle and displacement, no significant difference was observed between two groups. Conclusions The use of gender-specific implants substantially reduced the incidence of femoral overhang but did not demonstrate any clinical, functional or radiologic benefit in short-term follow-up. PMID:25750890

  19. Left-right asymmetric expression of dpp in the mantle of gastropods correlates with asymmetric shell coiling

    PubMed Central

    2013-01-01

    Background Various shapes of gastropod shells have evolved ever since the Cambrian. Although theoretical analyses of morphogenesis exist, the molecular basis of shell development remains unclear. We compared expression patterns of the decapentaplegic (dpp) gene in the shell gland and mantle tissues at various developmental stages between coiled-shell and non-coiled-shell gastropods. Results We analyzed the expression patterns of dpp for the two limpets Patella vulgata and Nipponacmea fuscoviridis, and for the dextral wild-type and sinistral mutant lineage of the pond snail Lymnaea stagnalis. The limpets had symmetric expression patterns of dpp throughout ontogeny, whereas in the pond snail, the results indicated asymmetric and mirror image patterns between the dextral and sinistral lineages. Conclusion We hypothesize that Dpp induces mantle expansion, and the presence of a left/right asymmetric gradient of the Dpp protein causes the formation of a coiled shell. Our results provide a molecular explanation for shell, coiling including new insights into expression patterns in post-embryonic development, which should aid in understanding how various shell shapes are formed and have evolved in the gastropods. PMID:23711320

  20. The genera Anafroptilum Kluge, 2011 and Neocloeon Traver, 1932, reinstated status, in North America, with remarks about the global composition of Centroptilum Eaton, 1869 (Ephemeroptera: Baetidae).

    PubMed

    Jacobus, Luke M; Wiersema, N A

    2014-01-01

    The mayfly genus Centroptilum Eaton, 1869, s.s., (Ephemeroptera: Baetidae), as presently understood, is not known to occur in North America. Nearctic species recently classified there belong either to Anafroptilum Kluge, 2011 or to Neocloeon Traver, 1932, reinstated genus. The North American endemic Neocloeon differs fundamentally from Anafroptilum in that it possesses a patella-tibial suture on the foreleg of larvae and female adults, a characteristic that is shared with certain other baetid genera. Neocloeon includes the obligate parthenogen N. triangulifer, new combination, and a sexual species, N. alamance, reinstated combination. Nearctic Anafroptilum include: A. album (McDunnough, 1926), new combination, A. asperatum (Traver, 1935), new combination, A. bifurcatum (McDunnough, 1924), A. conturbatum (McDunnough, 1929), new combination, A. minor (McDunnough, 1926), new combination, A. ozarkense (Wiersema & Burian, 2000), new combination, A. semirufum (McDunnough, 1926), new combination, and A. victoriae (McDunnough, 1938), new combination. Further study will be required to determine the species composition of Anafroptilum and Centroptilum, s.s., in the Palearctic and Oriental realms. Anafroptilum and Neocloeon are part of the Cloeon complex of genera, but Centroptilum, s.s., is not. PMID:24943435

  1. Tbx4 Interacts With the Short Stature Homeobox Gene Shox2 in Limb Development

    PubMed Central

    Glaser, Anne; Arora, Ripla; Hoffmann, Sandra; Li, Li; Gretz, Norbert; Papaioannou, Virginia E.; Rappold, Gudrun A.

    2014-01-01

    Background The short stature homeodomain transcription factors SHOX and SHOX2 play key roles in limb formation. To gain more insight into genes regulated by Shox2 during limb development, we analyzed expression profiles of WT and Shox2?/? mouse embryonic limbs and identified the T-Box transcription factor Tbx4 as a potential downstream target. Tbx4 is known to exert essential functions in skeletal and muscular hindlimb development. In humans, haploinsufficiency of TBX4 causes small patella syndrome, a skeletal dysplasia characterized by anomalies of the knee, pelvis, and foot. Results Here, we demonstrate an inhibitory regulatory effect of Shox2 on Tbx4 specifically in the forelimbs. We also show that Tbx4 activates Shox2 expression in fore- and hindlimbs, suggesting Shox2 as a feedback modulator of Tbx4. Using EMSA studies, we find that Tbx4/TBX4 is able to bind to distinct T-box binding sites within the mouse and human Shox2/SHOX2 promoter. Conclusions Our data identifies Tbx4 as a novel transcriptional activator of Shox2 during murine fore- and hindlimb development. Tbx4 is also regulated by Shox2 specifically in the forelimb bud possibly via a feedback mechanism. These data extend our understanding of the role and regulation of Tbx4 and Shox2 in limb development and limb associated diseases. PMID:24347445

  2. Effects of Open and Closed Kinetic Chains of Sling Exercise Therapy on the Muscle Activity of the Vastus Medialis Oblique and Vastus Lateralis

    PubMed Central

    Chang, Wen-Dien; Huang, Wei-Syuan; Lee, Chia-Lun; Lin, Hung-Yu; Lai, Ping-Tung

    2014-01-01

    [Purpose] The muscle strength of the quadriceps muscle is critical in patellofemoral pain syndrome. The quadriceps muscle supplies the power for dynamic patellar movement, and the vastus medialis oblique (VMO) and vastus lateralis (VL) enable the patella to stabilize during tracking. We followed the theories about open and closed kinetic chain exercises to design two exercises, sling open chain knee extension (SOCKE) exercise and sling closed chain knee extension (SCCKE) exercise. The purpose of our study was to research the changes in quadriceps muscle activity during both exercises. [Methods] Electromyographic analysis was used to explore the different effects of the two exercises. The MVC% was calculated for the VMO and VL during exercise for analysis. [Results] We found that the mean MVC% values of the VMO and VL during the SOCKE exercise were higher than those during the SCCKE exercise. The ratio of the VMO to VL was 1.0 ± 0.19 during the SOCKE exercise and 1.11 ± 0.15 during the SCCKE exercise. [Conclusions] The SOCKE exercise is targeted at quadriceps muscle training and has a recruitment effect on the VMO. The beneficial effect of the SOCKE exercise is better than that of the SCCKE exercise. PMID:25276016

  3. A Peculiar New Pampatheriidae (Mammalia: Xenarthra: Cingulata) from the Pleistocene of Argentina and Comments on Pampatheriidae Diversity

    PubMed Central

    Scillato-Yané, Gustavo Juan; Soibelzon, Esteban

    2015-01-01

    Pampatheriidae are a group of cingulates native to South American that are known from the middle Miocene to the lower Holocene. Two genera have been recognized between the lower Pleistocene and the lower Holocene: Pampatherium Gervais and Ameghino (Ensenadan, Bonaerian and Lujanian, lower Pleistocene–lower Holocene) and Holmesina Simpson (Blancan, Irvingtonian, upper Pliocene–lower Holocene). They have been mainly differentiated by their osteoderm morphology and cranio-dental characters. These taxa had a wide latitudinal distribution, extending from the southern part of South America (Península Valdés, Argentina) to North America (Florida, USA). In this contribution, we describe a new genus and species of Pampatheriidae for the lower and middle Pleistocene of Buenos Aires Province and for the upper Pleistocene of Santa Fe Province (Argentina).The new taxon is represented by disarticulated osteoderms, one skull element, two thoracic vertebrae and a right femur and patella. It has extremely complex osteoderm ornamentations and particular morphological characters of the cranial element and femur that are not found in any other species of the family. This new taxon, recorded in the lower–middle Pleistocene (Ensenadan Stage/Age) and in the upper Pleistocene–early Holocene (Lujanian Stage/Age), is incorporated to the Pleistocene mammal assemblage of South America. Finally, the Pampatheriidae diversity is greater during the Lujanian Stage/Age than the Ensenadan Stage/Age. PMID:26083486

  4. Metric Measurements and Attachment Levels of the Medial Patellofemoral Ligament: An Anatomical Study in Cadavers

    PubMed Central

    Aragão, José Aderval; Reis, Francisco Prado; de Vasconcelos, Diego Protásio; Feitosa, Vera Lúcia Corrêa; Nunes, Marco Antonio Prado

    2008-01-01

    OBJECTIVE To determine the metric measurements and to verify the attachment levels of the medial patellofemoral ligament in human cadavers. METHODS Seventeen knees (eight right and nine left knees) from 10 cadavers (nine male and one female) were dissected and stored in a 10% formaldehyde solution. All of the knees were whole and did not show any macroscopic signs of injuries. RESULTS The medial patellofemoral ligament was present in 88% of the knees studied, localized transversally between the medial femoral epicondyle and the medial margin of the patella. Its dimensions were quite variable, even between the knees of the same individual. The width of the patellar insertion ranged from 16 to 38.8 mm, with a mean of 27.90 mm, and its mean length was 55.67 mm. The margins of the ligament were concave or rectilinear. At the upper margin, the concave form predominated and was better characterized, while at the lower margin, the rectilinear form predominated. CONCLUSIONS The medial patellofemoral ligament is a very distinct structure with variable anatomical aspects and is always located in a plane inferior to the vastus medialis obliquus muscle. PMID:18719768

  5. SLC26A2 disease spectrum in Sweden - high frequency of recessive multiple epiphyseal dysplasia (rMED).

    PubMed

    Mäkitie, O; Geiberger, S; Horemuzova, E; Hagenäs, L; Moström, E; Nordenskjöld, M; Grigelioniene, G; Nordgren, A

    2015-03-01

    Diastrophic dysplasia (DTD) is an autosomal recessive skeletal dysplasia caused by SLC26A2 mutations. Clinical features include short stature, joint contractures, spinal deformities, and cleft palate. SLC26A2 mutations also result in other skeletal dysplasias, including the milder recessive multiple epiphyseal dysplasia (rMED). DTD is overrepresented in Finland and we speculated that this may have influenced the prevalence and spectrum of SLC26A2-related skeletal conditions also in Sweden. We reviewed the patient registry at Department of Clinical Genetics, Karolinska University Hospital, Stockholm to identify subjects with SLC26A2 mutations. Seven patients from six families were identified; clinical data were available for six patients. All but one patient had one or two copies of the Finnish SLC26A2 founder mutation IVS1+2T>C. Arg279Trp mutation was present in compound heterozygous form in five patients with phenotypes consistent with rMED. Their heights ranged from -2.6 to -1.4 standard deviation units below normal mean and radiographic features included generalised epiphyseal dysplasia and double-layered patellae. Two rMED patients had hypoplastic C2 and cervical kyphosis, a severe manifestation previously described only in DTD. Our study confirms a high prevalence of rMED in Sweden and expands the phenotypic manifestations of rMED. PMID:24598000

  6. The effects of substance P on pluripotent tendon cells: an in vitro and in vivo study.

    PubMed

    Zhou, B; Zhou, Y; Tang, K

    2014-09-01

    Pluripotent tendon cells (PTCs) play important roles in maintaining metabolic balance and the development of tendinopathy. Recently, substance P (SP) was identified as an important factor in the pathogenesis of tendinopathy. A better understanding of SP's effects on PTCs is essential to gain more insight into tendinopathy. This study aims to investigate the effects of SP on PTCs in vitro and in vivo. For the in vitro study, we quantified exogenous SP production by PTCs and determined the effects of SP on the proliferation and differentiation of PTCs. For the in vivo study, we used a rat patella tendon injection model to investigate the biological effects of SP on PTCs and tendons. Our results showed that exogenous SP production by PTCs was 1.80 pg/10(6) cells and SP significantly enhanced the proliferation of PTCs. Reverse transcription polymerase chain reaction (RT-PCR) results showed that SP upregulated the expression of non-tenocyte genes but downregulated the expression of tenocyte-related genes in the differentiation of PTCs. Moreover, Histological examination showed that SP induced disorganizes of tissue and tendinosis-like changes in vivo. Taken together, these findings indicate that SP enhanced PTCs' proliferation, induced non-tenocyte differentiation and plays an important role in the development of tendinopathy. PMID:25198231

  7. Periprosthetic fractures around total knee arthroplasty

    PubMed Central

    Sarmah, SS; Patel, S; Reading, G; El-Husseiny, M; Douglas, S; Haddad, FS

    2012-01-01

    INTRODUCTION The number of total knee arthroplasties performed continues to rise annually and it would be expected that complications, which include periprosthetic fractures, will also therefore become more commonplace. This article reviews the current literature regarding this injury and identifies the treatment principles that enable patients to regain optimal function. METHODS A comprehensive search of the Pubmed and Embase™ databases was performed to identify relevant articles. Keywords and MeSH (Medical Subject Headings) terms included in the search strategy were ‘periprosthetic fracture(s)’, ‘femur’, ‘tibia’, ‘patella(r)’, ‘complication(s)’, ‘failure(s)’, ‘risk(s)’, ‘prevalence’, ‘incidence’, ‘epidemiology’ and ‘classification(s)’. The search was limited to all articles published in English and reference lists from the original articles were reviewed to identify pertinent articles to include in this review. A total number of 43 studies were identified. RESULTS Common treatment aims have been identified when managing patients with a periprosthetic fracture around total knee arthoplasty. The main criterion that determines which option to choose is the degree of remaining bone stock and the amount of fracture displacement. CONCLUSIONS Treatment of a periprosthetic fracture around total knee arthroplasty will either be non-operative, osteosynthesis or revision arthroplasty. It is imperative that a suitable option is chosen and based on the published literature, pathways are outlined to aid the surgeon. PMID:22943223

  8. Anatomical variations of the plantaris muscle and a potential role in patellofemoral pain syndrome.

    PubMed

    Freeman, A Jay; Jacobson, Nathan A; Fogg, Quentin A

    2008-03-01

    The plantaris muscle has been given little attention in the reviewed literature. It is most commonly mentioned only when absent from a specimen. This study aimed to document the anatomy of the plantaris muscle and to discuss the clinical significance of the observations. Cadaveric knees (n = 46) were dissected to identify the possible variations of the plantaris muscle. The muscle conformed with standard descriptions (n = 26; 56.52%), was present but varied from previous descriptions (n = 14; 30.44%), or was absent (n = 6; 13.04%). The variations consisted of distinct interdigitations with the lateral head of the gastrocnemius muscle (n = 9; 19.57%) and a strong fibrous extension of the plantaris muscle to the patella (n = 5; 10.87%). The presence of interdigitations strengthen the argument that the plantaris muscle supplement the activity of the lateral head of the gastrocnemius muscle whereas the patellar extension suggests an involvement with patellofemoral dynamics and may play a role in the various presentations of patellofemoral pain syndrome. Greater understanding of the relationship between these and other posterior knee structures will facilitate more precise interpretation and treatment of knee injuries. PMID:18266282

  9. Positive and Negative Effects of Habitat-Forming Algae on Survival, Growth and Intra-Specific Competition of Limpets

    PubMed Central

    Marzinelli, Ezequiel M.; Burrows, Michael T.; Jackson, Angus C.; Mayer-Pinto, Mariana

    2012-01-01

    Understanding the effects of environmental change on the distribution and abundance of strongly interacting organisms, such as intertidal macroalgae and their grazers, needs a thorough knowledge of their underpinning ecological relationships. Control of grazer-plant interactions is bi-directional on northwestern European coasts: grazing by limpets structures populations of macroalgae, while macroalgae provide habitat and food for limpets. Scottish shores dominated by the macroalga Fucus vesiculosus support lower densities and larger sizes of limpets Patella vulgata than shores with less Fucus. These patterns may be due to differences in inter-size-class competitive interactions of limpets among shores with different covers of Fucus. To examine this model, densities of small and large limpets were manipulated in plots with and without Fucus. Amounts of biofilm were measured in each plot. The presence of Fucus increased survival but hindered growth of small (15 mm TL) limpets, which were negatively affected by the presence of large limpets (31 mm TL). In contrast, large limpets were not affected by the presence of Fucus or of small limpets. This suggests the occurrence of asymmetric inter-size-class competition, which was influenced by the presence of macroalgae. Macroalgae and increased densities of limpets did not influence amounts of biofilm. Our findings highlight the role of interactions among organisms in generating ecological responses to environmental change. PMID:23251589

  10. Giant Intra-Articular Extrasynovial Osteochondroma of the Knee: A Report of Two Cases

    PubMed Central

    De Maio, F; Bisicchia, S; Potenza, V; Caterini, R; Farsetti, P

    2011-01-01

    We report two cases of a giant extrasynovial osteochondroma of the knee located in the infrapatellar fat pad region, in two females who were 58 and 71 years old respectively. Both patients had noticed the mass many years before our first clinical observation. In both patients, at physical examination a solid, firm and hard mass was palpable in the anterior part of the knee in Hoffa’s fat pad region, and the range of motion of the knee was severely restricted and painful. CT scan examination with 3D-reconstruction showed two large, calcified neoformations behind the patellar tendon, between the apex of the patella and the proximal third of the tibia. In both cases, the mass was completely resected surgically through an anterior longitudinal approach. At histological examination, the excised masses consisted of an outer layer of hyaline cartilage without significant chondrocyte atypia and an inner region of bone trabeculae formed by endochondral ossification. At follow-up, 8 and 4 years after the operation, both patients were pain-free, with complete recovery of the range of motion of the knee and without any clinical or radiographic evidence of recurrence. The authors believe that intra-articular extrasynovial osteochondroma of the knee is a primary metaplasia of Hoffa’s fat pad. Usually, the tumor develops slowly and asymptomatically over many years. The treatment of choice is a marginal resection of the mass, although a biopsy should be considered in some cases. Recurrences are extremely rare. PMID:22114658

  11. Novel C59T leader peptide mutation in the MPZ gene associated with late-onset, axonal, sensorimotor polyneuropathy.

    PubMed

    Finsterer, J; Miltenberger, G; Rauschka, H; Janecke, A

    2006-10-01

    The objective of this study was to report a novel exon-1 mutation in the myelin protein zero (MPZ) gene, resulting in axonal Charcot-Marie-Tooth neuropathy with recurrent hyper-CK-emia. In a 64-year-old woman slowly progressive distal lower limb weakness, muscle cramps in the lower limb muscles, and stocking-type numbness had developed from the age of 61. Neurologic examination revealed discrete hip flexor weakness, weakness for foot extension, diffuse wasting of the distal lower limb muscles, reduced patella tendon reflexes, and absent Achilles tendon reflexes. There was recurrently elevated creatine kinase with a maximum of 607 U/l (n, <145 U/l). Stimulation of the peroneal and tibial nerves did not evoke a muscular response. Electromyography was neurogenic. Biopsy of the right sural nerve showed diffuse axonal degeneration and loss of axons of all diameters. Muscle biopsy showed increased fiber-size variability, angulated fibers, internalized nuclei, accumulations of nuclei, grouped atrophic muscle fibers, and fiber splitting. Molecular genetic analysis by PCR and direct nucleotide sequencing revealed the heterozygous C59T exon-1 MPZ gene mutation, resulting in the amino acid exchange S20F of the MPZ signal protein domain (leader peptide). The novel C59T mutation in the leader peptide of the MPZ gene is pathogenic and manifests as severe, late-onset, axonal, symmetric sensorimotor polyneuropathy (CMT2) and hyper-CK-emia. PMID:16987171

  12. Nail disorders in children: diagnosis and management.

    PubMed

    Richert, Bertrand; André, Josette

    2011-04-01

    Nail disorders in children can be divided into seven categories. The first is physiologic alterations, which every physician should be aware of in order to reassure parents. These usually disappear with age and do not require any treatment. Among congenital and inherited conditions, the nail-patella syndrome, with its pathognomonic triangular lunula, should not be missed as recognition of the disease allows early diagnosis of associated pathologies. The most common infection is the periungual wart, whose treatment is delicate. Herpetic whitlow should be distinguished from bacterial whitlow as their therapeutic approaches differ. Dermatologic diseases encompass eczema, psoriasis, lichen planus, lichen striatus, trachyonychia, and parakeratosis pustulosa. Lichen planus, when it presents as in adults, is important to recognize because, if not treated, it may lead to permanent nail loss. Systemic or iatrogenic nail alterations may be severe but are usually not the first clue to the diagnosis. Beau lines on several fingernails are very common in children after temperature crest. Tumors are rare in children. Radiographic examination allows confirmation of the diagnosis of subungual exostosis. Other cases should undergo biopsy. Single-digit longitudinal melanonychia in children is mostly due to nevi. Its management should be tailored on a case-by-case basis. Acute trauma should never be underestimated in children and hand surgeons should be involved if necessary. Onychophagia and onychotillomania are responsible for chronic trauma. PMID:21348541

  13. Biomechanical testing of implant free wedge shaped bone block fixation for bone patellar tendon bone anterior cruciate ligament reconstruction in a bovine model

    PubMed Central

    2010-01-01

    Background The use of an interference fit wedged bone plug to provide fixation in the tibial tunnel when using bone-patellar tendon-bone autograft for anterior cruciate ligament reconstruction offers many theoretic advantages including the potential to offer a more economical and biological alternative to screw fixation. This technique has not been subjected to biomechanical testing. We hypothesised that a wedged bone plug fixation technique provides equivalent tensile load to failure as titanium interference screw fixation. Methods In a controlled laboratory setting, anterior cruciate ligament reconstruction was performed in 36 bovine knees using bone-patella-bone autograft. In 20 knees tibial fixation relied upon a standard cuboid bone block and interference screw. In eight knees a wedge shaped bone block with an 11 mm by 10 mm base without a screw was used. In a further eight knees a similar wedge with a 13 mm by 10 mm base was used. Each specimen used a standard 10 mm tibial tunnel. The reconstructions were tested biomechanically in a physiological environment using an Instron machine to compare ultimate failure loads and modes of failure. Results Statistical analysis revealed no significant difference between wedge fixation and screw fixation (p = 0.16), or between individual groups (interference screw versus 11 mm versus 13 mm wedge fixation) (P = 0.35). Conclusions Tibial tunnel fixation using an impacted wedge shaped bone block in anterior cruciate ligament reconstruction has comparable ultimate tensile strength to titanium interference screw fixation. PMID:20813059

  14. Quadriceps tendon tear rupture in healthy patients treated with patellar drilling holes: clinical and ultrasonographic analysis after 36 months of follow-up

    PubMed Central

    Verdano, Michele Arcangelo; Zanelli, Matteo; Aliani, Davide; Corsini, Tiziana; Pellegrini, Andrea; Ceccarelli, Francesco

    2014-01-01

    Summary Background: quadriceps tendon subcutaneous rupture is an uncommon injury affecting predominantly middle-aged men as a result of direct or indirect trauma; aim of this work is to evaluate clinical outcome and tendon morphology in patients treated surgically with transpatellar drilling suture. Methods: 20 patients (20 male) with an average age of 54 (42–59) were evaluated with a mean follow-up of 36 months. Measurements of range of motion (ROM) and of tight circumference were collected. Lysholm and Rougraff Score were also performed. All the patients underwent a US evaluation the morphologic changes of the repaired tendon. Results: mean active ROM was 1°–117°; average difference in the circumference of the quadriceps was 2.6% 10 C and 3.3% 15 C. The mean Lysholm Score calculated was 88/100; the mean Rougraff Score 17/25. At ultrasonographic evaluation all tendons were continuous; heterotopic ossification was present in 18 quadriceps tendons. Thickness was augmented in 18 quadriceps tendons and in 5 patellar tendons. Vascularization was always conserved. Lateral subluxation of patella was reported in 1 case. Conclusions: patellar drilling holes repair is a non-demanding procedure, inexpensive and technically uncomplicated. US evaluation confirms tendon healing; tendon remodeling does not affect patient’s clinical outcome and quality of life. Level of incidence: IV PMID:25332935

  15. The relationship of bone and blood lead to hypertension: Further analyses of the normative aging study data

    SciTech Connect

    Hu, H.; Kim, Rokho; Korrick, S. [Harvard Medical School, Boston, MA (United States); [Harvard Health of Public Health, Boston, MA (United States); Rotnitzky, A. [Harvard School of Public Health, Boston, MA (United States)] [and others

    1996-12-31

    In an earlier report based on participants in the Veterans Administration Normative Aging Study, we found a significant association between the risk of hypertension and lead levels in tibia. To examine the possible confounding effects of education and occupation, we considered in this study five levels of education and three levels of occupation as independent variables in the statistical model. Of 1,171 active subjects seen between August 1991 and December 1994, 563 provided complete data for this analysis. In the initial logistic regression model, acre and body mass index, family history of hypertension, and dietary sodium intake, but neither cumulative smoking nor alcohol ingestion, conferred increased odds ratios for being hypertensive that were statistically significant. When the lead biomarkers were added separately to this initial logistic model, tibia lead and patella lead levels were associated with significantly elevated odds ratios for hypertension. In the final backward elimination logistic regression model that included categorical variables for education and occupation, the only variables retained were body mass index, family history of hypertension, and tibia lead level. We conclude that education and occupation variables were not confounding the association between the lead biomarkers and hypertension that we reported previously. 27 refs., 3 tabs.

  16. Micro-anatomical response of cartilage-on-bone to compression: mechanisms of deformation within and beyond the directly loaded matrix

    PubMed Central

    Thambyah, Ashvin; Broom, Neil

    2006-01-01

    The biomechanical function of articular cartilage relies crucially on its integration with both the subchondral bone and the wider continuum of cartilage beyond the directly loaded contact region. This study was aimed at visualizing, at the microanatomical level, the deformation response of cartilage including that of the non-directly loaded continuum. Cartilage-on-bone samples from bovine patellae were loaded in static compression until a near-equilibrium deformation was achieved, and then chemically fixed in this deformed state. Full-depth cartilage–bone sections, incorporating the indentation profile and beyond, were studied in their fully hydrated state using differential interference contrast microscopy. Morphometric measurements of the indented profile were used in combination with a force analysis of the tangential layer to investigate the extent to which the applied force is attenuated in moving away from the directly loaded region. This study provides microscopic evidence of a structure-related response in the transitional zone of the cartilage matrix. It is manifested as an intense chevron-type shear discontinuity arising from the constraints provided by both the strain-limiting articular surface and the osteochondral attachment. The discontinuity persists well into the non-directly loaded continuum of cartilage and is proposed as a force attenuation mechanism. The structural and biomechanical analyses presented in this study emphasize the important role of the complex microanatomy of cartilage, highlighting the interconnectivity and optimal recruitment of the load-bearing elements throughout the zonally differentiated cartilage depth. PMID:17062019

  17. Medial Patellofemoral Ligament Reconstruction: A Longitudinal Study Comparison of 2 Techniques with 2 and 5-Years Follow-Up

    PubMed Central

    Astur, Diego C; Gouveia, Gustavo B; Borges, José H. de Souza; Astur, Nelson; Arliani, Gustavo G; Kaleka, Camila C; Cohen, Moises

    2015-01-01

    Background : The purpose of this study was to compare the results of two popular surgical techniques for medial patellofemoral ligament MPFL reconstruction with a minimum of two-year follow-up. Methods : Fifty-eight patients with traumatic tear of the medial patellofemoral ligament were included in one of the two surgical groups. Group 1 MPFLs were reconstructed through graft endobutton fixation and Group 2 through graft anchor fixation into the patella. After two to five-year follow-up, patients were asked to answer knee function questionnaires (Fulkerson and Kujala) as well as the SF-36 life quality score. Results : There were no statistical difference among postoperative Kujala, Fulkerson, and SF-36 questionnaires scores between Groups 1 and 2. There were statistical significant differences favorable to patients in Group 1 with a shorter follow-up length (2-5 years) compared to those with a longer period of 5-10 years for both Kujala and Fulkerson scores and no difference for group 2. Conclusion : Both medial patellofemoral ligament reconstruction techniques had similar results in a two to ten-year follow-up according to functions and life quality questionnaires. Furthermore, endobutton fixation for the patellar edge of the graft had better results in patients with 2 years of follow-up than those with 5 years. Gender was not significant for surgical results. Moreover, group 1 patients had higher number of complications. PMID:26161157

  18. Fractal analysis of bone structure with applications to osteoporosis and microgravity effects

    SciTech Connect

    Acharya, R.S.; Swarnarkar, V.; Krishnamurthy, R.; Hausman, E. [State Univ. of New York, Buffalo, NY (United States). Biomedical Imaging Group; LeBlanc, A.; Lin, C. [Baylor Coll. of Medicine, Houston, TX (United States); Shackelford, L. [National Aeronautics and Space Administration, Houston, TX (United States). Johnson Space Center

    1995-12-31

    The authors characterize the trabecular structure with the aid of fractal dimension. The authors use Alternating Sequential filters to generate a nonlinear pyramid for fractal dimension computations. The authors do not make any assumptions of the statistical distributions of the underlying fractal bone structure. The only assumption of the scheme is the rudimentary definition of self similarity. This allows them the freedom of not being constrained by statistical estimation schemes. With mathematical simulations, the authors have shown that the ASF methods outperform other existing methods for fractal dimension estimation. They have shown that the fractal dimension remains the same when computed with both the X-Ray images and the MRI images of the patella. They have shown that the fractal dimension of osteoporotic subjects is lower than that of the normal subjects. In animal models, the authors have shown that the fractal dimension of osteoporotic rats was lower than that of the normal rats. In a 17 week bedrest study, they have shown that the subject`s prebedrest fractal dimension is higher than that of the postbedrest fractal dimension.

  19. Morphology of the Pelvis and Hind Limb of the Red Panda (Ailurus fulgens) Evidenced by Gross Osteology, Radiography and Computed Tomography.

    PubMed

    Makungu, M; du Plessis, W M; Groenewald, H B; Barrows, M; Koeppel, K N

    2014-10-13

    The red panda (Ailurus fulgens) is a quadrupedal arboreal animal primarily distributed in the Himalayas and southern China. It is a species commonly kept in zoological collections. This study was carried out to describe the morphology of the pelvis and hind limb of the red panda evidenced by gross osteology, radiography and computed tomography as a reference for clinical use and identification of skeletons. Radiography of the pelvis and right hind limb was performed in nine and seven animals, respectively. Radiographic findings were correlated with bone specimens from three adult animals. Computed tomography of the torso and hind limb was performed in one animal. The pelvic bone had a wide ventromedial surface of the ilium. The trochlea of the femur was wide and shallow. The patella was similar to that seen in feline species. The medial fabella was not seen radiographically in any animal. The cochlea grooves of the tibia were shallow with a poorly defined intermediate ridge. The trochlea of the talus was shallow and presented with an almost flattened medial ridge. The tarsal sesamoid bone was always present. The lateral process of the base of the fifth metatarsal (MT) bone was directed laterally. The MT bones were widely spaced. The morphology of the pelvis and hind limb of the red panda indicated flexibility of the pelvis and hind limb joints as an adaptation to an arboreal quadrupedal lifestyle. PMID:25308447

  20. The effects of squatting with visual feedback on the muscle activation of the vastus medialis oblique and the vastus lateralis in young adults with an increased quadriceps angle

    PubMed Central

    Hwangbo, Pil-Neo

    2015-01-01

    [Purpose] The purpose of this study was to identify the effects of performing squat exercises with visual feedback on the activation of the vastus medialis oblique (VMO) and vastus lateralis (VL) muscles in young adults with an increased quadriceps angle (Q-angle). [Subjects] This study used a motion analysis program (Dartfish, Switzerland) to select 20 young adults with an increased Q-angle, who were then divided into a squat group that received visual feedback (VSG, n=10) and a squat group that received no visual feedback (SG, n=10). [Methods] The intensity of exercises was increased every two weeks over a six-week exercise period in both groups. A visual marker was attached to the patella of the subjects in the VSG, and they then performed squat exercises with a maximum of 90° of knee flexion within a route marked on a mirror. The SG performed squat exercises with a maximum 90° of knee flexion without attaching a visual feedback device. [Results] Analysis of the muscle activation due to 90° squat exercises indicated that both groups had statistically significant increases in activation of the VL. The VSG exhibited statistically significant increases in activation of the VMO. [Conclusion] This study confirmed that squat exercises with visual feedback are effective in activation of the VMO and VL muscles. The findings are meaningful in terms of preventing the occurrence of patellofemoral pain.

  1. The mechanism of primary patellar dislocation

    PubMed Central

    Nietosvaara, Yrjänä; Aalto, Kari; Kallio, Pentti E

    2009-01-01

    Background and purpose Several mechanisms are responsible for patellar dislocation. We investigated how the primary pathomechanism relates to patient characteristics and the outcome. Methods 126 patients (81 females) with primary patellar dislocation reported the knee position before the episode, the movement during it, and whether the patella was locked in dislocation. The median age was 20 (9–47) years. The subjective outcome and Kujala, Hughston VAS, and Tegner scores were evaluated after an average of 7 years. Results 102 patients moved to flexion during the dislocation, 98 from a straight start and 4 from a well-bent start. 10 extended the knee from a well-bent start; they were older (mean 25 vs. 19 years) and more often had low trauma energy (5/10 vs. 15/102) and a locked dislocation (10/10 vs. 50/102). 4 had a direct hit to the knee and 1 only rotated it while stretching. 24 of 60 patients with open growth line of the tibial tubercle and 43 of 66 with closed tubercle had locked primary dislocation (p = 0.005). 33% of girls, 52% of boys, 57% of women, and 71% of men had locked primary dislocation. There was no correlation between trauma mechanism and outcome. Interpretation Movement to flexion occurred in 84% of primary patellar dislocations and movement to extension in 8%. Spontaneous patellar relocation is common in skeletally immature girls and locked dislocation is common in skeletally mature men. PMID:19593720

  2. Assessing the utility of elemental ratios as a paleotemperature proxy in shells of patelloid limpets

    NASA Astrophysics Data System (ADS)

    Graniero, Lauren; Surge, Donna; Gillikin, David

    2015-04-01

    Archaeological shell and fish middens are rich sources of paleoenvironmental proxy data. Carbonate hard part remains contained in such deposits have been used as archives of coastal marine climate and human-climate interactions. Oxygen isotope records from fast-growing limpet shells potentially capture summer and winter seasons, and thus, approach the full seasonal range of sea surface temperature (SST). Fast-growing shells are often short-lived, providing "snap-shots" of multi-year seasonal cycles. Patelloid limpet shells are common constituents in archaeological middens found along European, African, and South American coastlines. Oxygen isotope ratios of archaeological limpet shells from the genus, Patella, have been used to reconstruct seasonal SST and ocean circulation patterns during the Late Quaternary. Such studies depend on the ability to constrain the oxygen isotope ratio of seawater; therefore, alternative proxies are necessary for coastal localities where this is not possible. Elemental ratios (e.g., Sr/Ca, Mg/Ca) have been used as paleotemperature proxies in corals and foraminifera with varying degrees of success and appear problematic in bivalves. Here, we test whether such elemental ratios are useful as an alternative SST proxy in patelloid limpet shells.

  3. Maternal and fetal outcomes after introduction of magnesium sulphate for treatment of preeclampsia and eclampsia in selected secondary facilities: a low-cost intervention.

    PubMed

    Tukur, Jamilu; Ahonsi, Babatunde; Ishaku, Salisu Mohammed; Araoyinbo, Idowu; Okereke, Ekechi; Babatunde, Ayodeji Oginni

    2013-09-01

    The aim of this study was to evaluate whether a new low-cost strategy for the introduction of magnesium sulphate (MgSO4) for preeclampsia and eclampsia in low-resource areas will result in improved maternal and perinatal outcomes. Doctors and midwives from ten hospitals in Kano, Nigeria, were trained on the use of MgSO4. The trained health workers later conducted step-down training at their health facilities. MgSO4, treatment protocol, patella hammer, and calcium gluconate were then supplied to the hospitals. Data was collected through structured data forms. The data was analyzed using SPSS software. From February 2008 to January 2009, 1,045 patients with severe preeclampsia and eclampsia were treated. The case fatality rate for severe preeclampsia and eclampsia fell from 20.9 % (95 % CI 18.7-23.2) to 2.3 % (95 % CI 1.5-3.5). The perinatal mortality rate was 12.3 % as compared to 35.3 % in a center using diazepam. Introduction of MgSO4 in low-resource settings led to improved maternal and fetal outcomes in patients presenting with severe pre-eclampsia and eclampsia. Training of health workers on updated evidence-based interventions and providing an enabling environment for their practice are important components to the attainment of the Millennium Development Goals (MDG) in developing countries. PMID:22956402

  4. Lateral unicompartmental replacement: a road less traveled.

    PubMed

    Scott, Richard D

    2005-09-01

    Lateral unicompartmental replacement is performed less frequently than medial replacement and is technically more difficult. The ratio of medial to lateral arthroplasties is approximately 10:1. Differences in technique include the following: The patella is more vulnerable to impingement on the leading edge of the femoral component and must be carefully recessed. Because the wear pattern in lateral disease is more posterior than in medial disease, there often is residual cartilage on the distal femoral condyle. This is also the case when UKA is performed for the sequella of a lateral plateau fracture. To avoid this impingement, residual cartilage should probably be removed from the distal condyle before its resection and the femoral component should be undersized anteriorly. Initial tibial resection should be very conservative to avoid the need for very thick tibial components to restore alignment and stability. Err toward shifting the femoral component laterally and the tibial component medially to maximize mediolateral congruency. Consider a medial parapatellar approach (avoiding the anterior horn of the medial meniscus) to facilitate visibility and component alignment. Avoid excessive posterior tibial slope. PMID:16190078

  5. Clonus: definition, mechanism, treatment.

    PubMed

    Boyraz, Ismail; Uysal, Hilmi; Koc, Bunyamin; Sarman, Hakan

    2015-02-01

    Clonus is involuntary and rhythmic muscle contractions caused by a permanent lesion in descending motor neurons. Clonus may be found at the ankle, patella, triceps surae, wrist, jaw, biceps brachii. In general, clonus may occur in any muscle with a frequency of 5-8 Hz and the average period of oscillations of the ankle clonus is approximately 160-200 ms. Plantar flexion (PF) comprises 45% of the period, dorsifleksion (DF) comprises 55% of the period. The first beat is always longer, with the time shortening in continuing beats and becoming stable in the 4th or 5th period. The exact mechanism of clonus remains unclear. Two different hypotheses have been asserted regarding the development of clonus. The most widely accepted explanation is that hyperactive stretch reflexes in clonus are caused by self-excitation. Another alternative explanation for clonus is central generator activity that arises as a consequence of appropriate peripheral events and produces rhythmic stimulation of the lower motor neurons. The durations of clonus burst were found longer than the durations of Soleus medium-latency reflex (MLR). There is a similarity in their nature, although the speed and cause of the stretch of triceps surae differ in the MLR and the clonus, and there is a sufficient period of time for group II afferents and for other spinal mechanisms to be involved in the clonus, together with Ia afferents. Clonus can be treated by using baclofen, applying cold, botox or phenol injections. Key words: botulinum toxin, spasticity, upper motor disorder, gait disorder. PMID:25669332

  6. Modification of the Association between Lead Exposure and Amyotrophic Lateral Sclerosis by Iron and Oxidative Stress Related Gene Polymorphisms

    PubMed Central

    Eum, Ki-Do; Seals, Ryan M.; Taylor, Kathryn M.; Grespin, Matthew; Umbach, David M.; Hu, Howard; Sandler, Dale P.; Kamel, Freya; Weisskopf, Marc G.

    2015-01-01

    Objective To examine whether functional polymorphisms in hemochromatosis (HFE; H63D and C282Y), transferrin (TfC2), and glutathione-s-transferase Pi1 (GSTP1; Ile105Val) genes modify any lead-ALS association. Methods We measured blood lead using atomic absorption spectroscopy and bone lead—a biomarker of cumulative lead exposure—using K-shell-X-ray fluorescence in 100 neurologist-confirmed ALS cases and 194 controls, the latter recruited as part of two separate studies; all subjects lived in New England. Participants were considered variant carriers or wild-type for each polymorphism. To assess effect modification, we included cross-product terms between lead biomarkers and each polymorphism in separate adjusted polytomous logistic regression models. Results Compared with wild-type, the odds ratio (OR) per 15.6µg/g patella lead (interquartile range; IQR) was 8.24 (95% CI: 0.94–72.19) times greater among C282Y variant carriers, and 0.34 (95% CI: 0.15–0.78) times smaller among H63D variant carriers. Results were weaker for tibia lead. Compared with wild-type the OR per 2µg/dL blood lead (IQR) was 0.36 (95% CI: 0.19–0.68) times smaller among H63D variant carriers, and 1.96 (95% CI: 0.98–3.92) times greater among GSTP1 variant carriers. Conclusions We found that HFE and GSTP1 genotypes modified the association between lead biomarkers and ALS. Opposite modification by the HFE polymorphisms H63D and C282Y may suggest that the modification is not simply the result of increased iron. PMID:25293352

  7. High Body Mass Index is Associated with Increased Diurnal Strains in the Articular Cartilage of the Knee

    PubMed Central

    Widmyer, Margaret R.; Utturkar, Gangadhar M.; Leddy, Holly A.; Coleman, Jeremy L.; Spritzer, Charles E.; Moorman, CT; DeFrate, Louis E.; Guilak, Farshid

    2014-01-01

    Objective Obesity is an important risk factor for osteoarthritis and is associated with changes in both the biomechanical and inflammatory environments within the joint. However, the relationship between obesity and cartilage deformation is not fully understood. The goal of this study was to determine the effects of body mass index (BMI) on the magnitude of diurnal cartilage strain in the knee. Methods Three-dimensional maps of knee cartilage thickness were developed from 3T magnetic resonance images of asymptomatic age- and sex-matched subjects with normal (18.5–24.9 kg/m2) or high (25–31 kg/m2) BMI. Site-specific magnitudes of diurnal cartilage strain were determined using aligned images recorded at 8:00 AM and 4:00 PM on the same day. Results High BMI individuals had significantly thicker cartilage on the patella and femoral groove than the normal BMI individuals. Diurnal cartilage strains were dependent on location as well as BMI. Subjects with high BMI exhibited significantly higher compressive strain in tibial cartilage than did those with normal BMI. Cartilage thickness decreased significantly on both femoral condyles from the AM to PM time point; however, there was no significant effect of BMI on diurnal cartilage strain in the femur. Conclusions Increased BMI is associated with increased diurnal strains in the articular cartilage of both the medial and lateral compartments of the knee. The increased cartilage strains measured in high BMI individuals may, in part, explain the elevated OA risk associated with obesity or may reflect altered cartilage mechanical properties in subjects with high BMI. PMID:23818303

  8. An ultrasound study of altered hydration behaviour of proteoglycan-degraded articular cartilage

    PubMed Central

    2013-01-01

    Background Articular cartilage is a solid-fluid biphasic material covering the bony ends of articulating joints. Hydration of articular cartilage is important to joint lubrication and weight-wearing. The aims of this study are to measure the altered hydration behaviour of the proteoglycan-degraded articular cartilage using high-frequency ultrasound and then to investigate the effect of proteoglycan (PG) degradation on cartilage hydration. Methods Twelve porcine patellae with smooth cartilage surface were prepared and evenly divided into two groups: normal group without any enzyme treatment and trypsin group treated with 0.25% trypsin solution for 4 h to digest PG in the tissue. After 40-minute exposure to air at room temperature, the specimens were immerged into the physiological saline solution. The dehydration induced hydration behaviour of the specimen was monitored by the high-frequency (25 MHz) ultrasound pulser/receiver (P/R) system. Dynamic strain and equilibrium strain were extracted to quantitatively evaluate the hydration behaviour of the dehydrated cartilage tissues. Results The hydration progress of the dehydrated cartilage tissue was observed in M-mode ultrasound image indicating that the hydration behaviour of the PG-degraded specimens decreased. The percentage value of the equilibrium strain (1.84 ± 0.21%) of the PG-degraded cartilage significantly (p < 0.01) decreased in comparison with healthy cartilage (3.46 ± 0.49%). The histological sections demonstrated that almost PG content in the entire cartilage layer was digested by trypsin. Conclusion Using high-frequency ultrasound, this study found a reduction in the hydration behaviour of the PG-degraded cartilage. The results indicated that the degradation of PG decreased the hydration capability of the dehydrated tissue. This study may provide useful information for further study on changes in the biomechanical property of articular cartilage in osteoarthritis. PMID:24119051

  9. Painful knee prosthesis: surgical approach.

    PubMed

    Villano, Marco; Carulli, Christian; Puccini, Serena; Soderi, Stefano; Innocenti, Massimo

    2011-05-01

    There are many conditions that may be responsible of a painful knee prosthesis. The possible causes are not always easily diagnosed. Common causes of prosthetic failure, such as aseptic loosening, infection, instability, progressive patellar arthropathy and recurrent synovitis are associated with clearly defined radiographic and/or clinical evidence. Prosthetic infection should always be considered first until any other cause has been demonstrated. In the presence of an infected prosthesis we carry out a two-step revision. Aseptic loosening needs implant revision more often with increasing prosthesis stability. Varus-valgus, anteroposterior, global and patello-femoral instability are failures often due to technical errors; superstabilized or constrained implants are needed depending on the instability entity.In presence of patello-femoral pain it is necessary to evaluate the stability of the patellar component and any alterations in its motion. Patellar progressive arthropathy can often cause late-onset knee pain; in this case patella resurfacing is needed. Altered patellar tracking, may need a lateral release but in some cases is related to misalignment of the components and the revision procedure is mandatory. Nevertheless, the diagnosis and treatment of a painful knee prosthesis can be extremely difficult if there is no clear evidence of any of the most common causes of failure. Referred pain, ligament and tendon dysfunction, cutaneous neuromas, synovitis, a patellar clunk have to be diagnosed and treated.A possible aetiological understimated factor is painful knee prosthesis due to metals sensibilization, in particular to nickel. In this event the quantity of nickel in the revision prosthesis must be minimal. PMID:22461812

  10. Specificity of Fourier Transform Infrared (FTIR) Microspectroscopy to Estimate Depth-Wise Proteoglycan Content in Normal and Osteoarthritic Human Articular Cartilage

    PubMed Central

    Saarakkala, Simo; Julkunen, Petro

    2010-01-01

    Background: Fourier transform infrared (FTIR) microspectroscopy is a promising method for estimating the depth-wise composition of articular cartilage. The aim was to compare the specificity of two earlier introduced, presumably proteoglycan (PG)–specific FTIR parameters (i.e., absorption in the carbohydrate region with and without normalization with Amide I absorption) to estimate the reference PG content of normal and osteoarthritic human articular cartilage. This study is a direct continuation of our earlier studies, from which the presented data are reanalyzed. Design: Earlier, FTIR microspectroscopy, digital densitometry, histological analyses, and polarized light microscopy were conducted in vitro for articular cartilage samples of human patellae (n = 72). In the present study, earlier data were combined and statistically reanalyzed in a depth-wise manner to clarify the specificity of FTIR parameters introduced for the estimation of PG content of articular cartilage. Digital densitometry for Safranin O-stained samples was used to indicate reference PG content. Results: Direct absorption of the carbohydrate region estimated well the PG content in the middle and deep zones of articular cartilage and appeared to be superior compared to carbohydrate values normalized with Amide I absorption. However, in the superficial zone, the specificity of both FTIR-derived PG parameters was limited. Conclusions: Limitations of current FTIR-based PG parameters in the superficial zone of articular cartilage should be recognized and carefully taken into account in future studies using FTIR microspectroscopy for PG content estimation. Further research is needed to improve the specificity of FTIR parameters for the estimation of PG content of articular cartilage.

  11. An ultrastructural study of connective tissue in mollusc integument: II. Gastropoda.

    PubMed

    Bairati, A; Comazzi, M; Gioria, M

    2001-10-01

    We studied the ultrastructure of the subepidermal connective tissue (SEC) in different zones of the integument in terrestrial, marine and freshwater gastropods (eight species). In all cases, the SEC was a layer of loose connective tissue between the basal membrane (BM) of the epidermis and the connective tissue of the deeper muscle layers. It was of monotonous structure and not differentiated into layers such as are found in mammalian dermis. The extracellular matrix (ECM) consisted of a network of collagen fibrils of variable diameter, with abundant anchoring devices and proteoglycans. In six species, variables quantities of haemocyanin were present within haemocoelic sinuses present in the SEC. The thickness and density of the BM varied from species to species, as well as within species in the various zones of integument. The ultrastructure of the lamina densa (LD) was indistinguishable from that of BM in bivalves and similar to that in mammals, although basotubules and double pegs were absent. An irregularly spaced lamina lucida was usually present and was often shot thorough with filaments and small protrusions of the LD that connected with epithelial plasma membrane or with hemidesmosomes. A lamina fibroreticularis was not present. LD protrusions characterize the connection between BM and the ECM of SEC. In the terrestrial gastropods, a spongy matrix with ultrastructure closely similar to LD occupied large tracts of the SEC. In the mantle region of Arion rufus, the integumental SEC contained large cavities filled with spherical concretions, probably representing rudiments of a shell. In the mantle where the integument contained abundant muscle fibres, the BM was thick and directly connected to the ECM of the SEC which consisted of compact laminae of collagen fibrils with abundant anchoring devices. Along the edge of the foot of Patella ulyssiponensis, the SEC contained a layer of paramyosinic muscle fibres adhering to the epidermis. No differences or gradations in integumental SEC structure could be related to the phylogenetic position of the species examined. PMID:11949779

  12. Changes in triphasic mechanical properties of proteoglycan-depleted articular cartilage extracted from osmotic swelling behavior monitored using high-frequency ultrasound.

    PubMed

    Wang, Q; Zheng, Y P; Niu, H J

    2010-03-01

    This study aims to obtain osmosis-induced swelling strains of normal and proteoglycan (PG) depleted articular cartilage using an ultrasound system and to investigate the changes in its mechanical properties due to the PG depletion using a layered triphasic model. The swelling strains of 20 cylindrical cartilage-bone samples collected from different bovine patellae were induced by decreasing the concentration of bath saline and monitored by the ultrasound system. The samples were subsequently digested by a trypsin solution for approximately 20 min to deplete proteoglycans, and the swelling behaviors of the digested samples were measured again. The bi-layered triphasic model proposed in our previous study (Wang et al., J Biomech Eng-Trans ASME 2007; 129: 413-422) was used to predict the layered aggregate modulus Ha from the data of depth-dependent swelling strain, fixed charge density and water content. It was found that the region near the bone, for the normal specimens, had a significantly higher aggregate modulus (Ha1 = 20.6 +/- 18.2 MPa) in comparison with the middle zone and the surface layer (Ha2 = 7.8 +/- 14.5 MPa and Ha3 = 3.6 +/- 3.2 MPa, respectively) (p < 0.001). The normalized thickness of the deep layer h1 was 0.68 +/- 0.20. After the trypsin digestion, the parametric values decreased to Ha1 = 13.6 +/- 9.6 MPa, Ha2 = 6.7 +/- 11.5 MPa, Ha3 = 2.7 +/- 3.2 MPa, and h1 = 0.57 +/- 0.28. Other models were also used to analyze data and the results were compared. This study showed that high-frequency ultrasound measurement combined with the triphasic modeling was capable of nondestructively quantifying the alterations in the layered mechanical properties of the proteoglycan-depleted articular cartilage. PMID:20806723

  13. The clinical significance, natural history and predictors of bone marrow lesion change over eight years

    PubMed Central

    2014-01-01

    Introduction There is increasing evidence to suggest that bone marrow lesions (BMLs) play a key role in the pathogenesis of osteoarthritis (OA). However, there is a lack of long term data. The aim of this study was to describe the natural history of knee BMLs, their association with knee pain and examine predictors of BML change over eight years. Methods A total of 198 subjects (109 adult offspring of subjects who had a knee replacement and 89 community-based controls) were studied. Knee pain and BML size were assessed at two and ten year visits. Results At the two year visit, 64% of participants (n?=?127) had 229 BMLs (34% patella, 26% femoral and 40% tibial). Over eight years, 24% (55/229) increased in size, 55% (125/229) remained stable and 21% (49/229) decreased in size or resolved completely. Of the participants without BMLs at baseline, 52% (37/71) developed incident BMLs. After adjusting for confounders, eight year change in total BML size was associated with change in knee pain in offspring (??=?2.50, 95% confidence interval (CI) 0.96 to 4.05) but not controls. This association was stronger in males. Incident BMLs were associated with increase in pain (??=?3.60, 95% CI 1.14 to 6.05). Body mass index (BMI) and strenuous activity (but not radiographic osteoarthritis or smoking) were associated with an increase in BML size. Conclusion In this midlife cohort, the proportion of BMLs increasing in size was similar to those decreasing in size with the majority remaining stable. Change in BMLs was predicted by BMI and strenuous activity. An increase in BML size or a new BML resulted in an increase in pain especially in males and those with a family history of OA. PMID:25022807

  14. Epidemiology of Basketball, Soccer, and Volleyball Injuries in Middle-School Female Athletes

    PubMed Central

    Barber Foss, Kim D.; Myer, Greg D.; Hewett, Timothy E.

    2014-01-01

    Background An estimated 30 to 40 million school children participate in sports in the United States; 34% of middle-school participants become injured and seek medical treatment at an annual cost close to $2 billion. The purpose of the current study was to evaluate the injury incidence and rates in female athletes in the middle-school setting during the course of 3 seasons. Methods Female basketball, soccer, and volleyball players were recruited from a single county public school district in Kentucky consisting of 5 middle schools. A total of 268 female athletes (162 basketball, 26 soccer, and 80 volleyball) participated. Athletes were monitored for sports-related injury and number of athlete exposures (AEs) by an athletic trainer. Injury rates were calculated for specific types of injuries within each sport. Injury rates for games and practices were also calculated and compared for each sport. Results A total of 134 injuries were recorded during the 3 sport seasons. The knee was the most commonly injured body part (99 injuries [73.9%]), of which patellofemoral dysfunction (31.3%), Osgood-Schlatter disease (10.4%), and Sinding-Larsen-Johansson/patella tendinosis (9%) had the greatest incidence. The ankle was the second most commonly injured body part, accounting for 16.4% of all injuries. The overall rates of injury by sport were as follows: soccer, 6.66 per 1000 AEs; volleyball, 3.68 per 1000 AEs; and basketball, 2.86 per 1000 AEs. Conclusions Female middle-school athletes displayed comparable injury patterns to those seen in their high-school counterparts. Future work is warranted to determine the potential for improved outcomes in female middle-school athletes with access to athletic training services. Clinical Relevance As the participation levels and number of injuries continue to rise, middle-school athletes demonstrate an increasing need for medical services provided by a certified athletic trainer. PMID:24875981

  15. Differences in retinoid levels and metabolism among gastropod lineages: imposex-susceptible gastropods lack the ability to store retinoids in the form of retinyl esters.

    PubMed

    Gesto, Manuel; Castro, L Filipe C; Santos, Miguel Machado

    2013-10-15

    The presence of a complex retinoid system was long believed to be a chordate/vertebrate novelty. However, recent findings indicate otherwise since the gastropod mollusk Osilinus lineatus was found to have the capacity to store retinoids in the form of retinyl esters (REs), a key feature to maintain a homeostatic control of retinoid levels. Here, we investigated whether such a complex retinoid system is widely distributed among gastropod lineages. Additionally, since one of the most spectacular examples of endocrine disruption in the wild, the masculinization of female gastropods (imposex) by the retinoid X receptor (RXR) agonist, tributyltin (TBT), has been linked with perturbed retinoid signaling, we also investigated if retinoid storage mechanisms in the form of retinyl esters were present in imposex-susceptible gastropods. Initially, we determined the presence of both polar (active retinoic acid isomers) and nonpolar retinoids (retinol, REs) in selected gastropod species: the limpet Patella depressa and the imposex-susceptible whelks Nucella lapillus and Nassarius reticulatus. Although all species presented active retinoid forms, N. lapillus and N. reticulatus were shown to lack nonpolar retinoids. The absence of REs, which are the common retinoid storage form found in vertebrates and in O. lineatus suggest that those species are unable to use them to maintain a homeostatic control of their retinoid levels. In order to further clarify the retinoid metabolic pathways in imposex-susceptible gastropods, a retinoid exposure study was carried out with N. lapillus. The results demonstrate that although N. lapillus is able to metabolize several retinoid precursors, it lacks the capacity to store retinoids as REs. Whether the lack of retinoid storage mechanisms in the form of REs in imposex-susceptible gastropods plays an important role in the susceptibility to RXR agonists warrants additional studies. PMID:23981467

  16. A detailed and validated three dimensional dynamic model of the patellofemoral joint.

    PubMed

    Akbar, Mohammad; Farahmand, Farzam; Jafari, Ali; Foumani, Mahmoud Saadat

    2012-04-01

    A detailed 3D anatomical model of the patellofemoral joint was developed to study the tracking, force, contact and stability characteristics of the joint. The quadriceps was considered to include six components represented by 15 force vectors. The patellar tendon was modeled using four bundles of viscoelastic tensile elements. Each of the lateral and medial retinaculum was modeled by a three-bundle nonlinear spring. The femur and patella were considered as rigid bodies with their articular cartilage layers represented by an isotropic viscoelastic material. The geometrical and tracking data needed for model simulation, as well as validation of its results, were obtained from an in vivo experiment, involving MR imaging of a normal knee while performing isometric leg press against a constant 140 N force. The model was formulated within the framework of a rigid body spring model and solved using forth-order Runge-Kutta, for knee flexion angles between zero and 50 degrees. Results indicated a good agreement between the model predictions for patellar tracking and the experimental results with RMS deviations of about 2 mm for translations (less than 0.7 mm for patellar mediolateral shift), and 4 degrees for rotations (less than 3 degrees for patellar tilt). The contact pattern predicted by the model was also consistent with the results of the experiment and the literature. The joint contact force increased linearly with progressive knee flexion from 80 N to 210 N. The medial retinaculum experienced a peak force of 18 N at full extension that decreased with knee flexion and disappeared entirely at 20 degrees flexion. Analysis of the patellar time response to the quadriceps contraction suggested that the muscle activation most affected the patellar shift and tilt. These results are consistent with the recent observations in the literature concerning the significance of retinaculum and quadriceps in the patellar stability. PMID:22667680

  17. Distribution of Basement Membrane Molecules, Laminin and Collagen Type IV, in Normal and Degenerated Cartilage Tissues

    PubMed Central

    Toh, Wei Seong; Gomoll, Andreas H.; Olsen, Bjørn Reino; Spector, Myron

    2014-01-01

    Objective: The objective of the present study was to investigate the presence and distribution of 2 basement membrane (BM) molecules, laminin and collagen type IV, in healthy and degenerative cartilage tissues. Design: Normal and degenerated tissues were obtained from goats and humans, including articular knee cartilage, the intervertebral disc, and meniscus. Normal tissue was also obtained from patella-tibial enthesis in goats. Immunohistochemical analysis was performed using anti-laminin and anti–collagen type IV antibodies. Human and goat skin were used as positive controls. The percentage of cells displaying the pericellular presence of the protein was graded semiquantitatively. Results: When present, laminin and collagen type IV were exclusively found in the pericellular matrix, and in a discrete layer on the articulating surface of normal articular cartilage. In normal articular (hyaline) cartilage in the human and goat, the proteins were found co-localized pericellularly. In contrast, in human osteoarthritic articular cartilage, collagen type IV but not laminin was found in the pericellular region. Nonpathological fibrocartilaginous tissues from the goat, including the menisci and the enthesis, were also positive for both laminin and collagen type IV pericellularly. In degenerated fibrocartilage, including intervertebral disc, as in degenerated hyaline cartilage only collagen type IV was found pericellularly around chondrocytes but with less intense staining than in non-degenerated tissue. In calcified cartilage, some cells were positive for laminin but not type IV collagen. Conclusions: We report differences in expression of the BM molecules, laminin and collagen type IV, in normal and degenerative cartilaginous tissues from adult humans and goats. In degenerative tissues laminin is depleted from the pericellular matrix before collagen type IV. The findings may inform future studies of the processes underlying cartilage degeneration and the functional roles of these 2 extracellular matrix proteins, normally associated with BM.

  18. Further delineation of the KAT6B molecular and phenotypic spectrum.

    PubMed

    Gannon, Tamsin; Perveen, Rahat; Schlecht, Hélene; Ramsden, Simon; Anderson, Beverley; Kerr, Bronwyn; Day, Ruth; Banka, Siddharth; Suri, Mohnish; Berland, Siren; Gabbett, Michael; Ma, Alan; Lyonnet, Stan; Cormier-Daire, Valerie; Yilmaz, Rüstem; Borck, Guntram; Wieczorek, Dagmar; Anderlid, Britt-Marie; Smithson, Sarah; Vogt, Julie; Moore-Barton, Heather; Simsek-Kiper, Pelin Ozlem; Maystadt, Isabelle; Destrée, Anne; Bucher, Jessica; Angle, Brad; Mohammed, Shehla; Wakeling, Emma; Price, Sue; Singer, Amihood; Sznajer, Yves; Toutain, Annick; Haye, Damien; Newbury-Ecob, Ruth; Fradin, Melanie; McGaughran, Julie; Tuysuz, Beyhan; Tein, Mark; Bouman, Katelijne; Dabir, Tabib; Van den Ende, Jenneke; Luk, Ho Ming; Pilz, Daniela T; Eason, Jacqueline; Davies, Sally; Reardon, Willie; Garavelli, Livia; Zuffardi, Orsetta; Devriendt, Koen; Armstrong, Ruth; Johnson, Diana; Doco-Fenzy, Martine; Bijlsma, Emilia; Unger, Sheila; Veenstra-Knol, Hermine E; Kohlhase, Jürgen; Lo, Ivan Fm; Smith, Janine; Clayton-Smith, Jill

    2014-11-26

    KAT6B sequence variants have been identified previously in both patients with the Say-Barber-Biesecker type of blepharophimosis mental retardation syndromes (SBBS) and in the more severe genitopatellar syndrome (GPS). We report on the findings in a previously unreported group of 57 individuals with suggestive features of SBBS or GPS. Likely causative variants have been identified in 34/57 patients and were commonly located in the terminal exons of KAT6B. Of those where parental samples could be tested, all occurred de novo. Thirty out of thirty-four had truncating variants, one had a missense variant and the remaining three had the same synonymous change predicted to affect splicing. Variants in GPS tended to occur more proximally to those in SBBS patients, and genotype/phenotype analysis demonstrated significant clinical overlap between SBBS and GPS. The de novo synonymous change seen in three patients with features of SBBS occurred more proximally in exon 16. Statistical analysis of clinical features demonstrated that KAT6B variant-positive patients were more likely to display hypotonia, feeding difficulties, long thumbs/great toes and dental, thyroid and patella abnormalities than KAT6B variant-negative patients. The few reported patients with KAT6B haploinsufficiency had a much milder phenotype, though with some features overlapping those of SBBS. We report the findings in a previously unreported patient with a deletion of the KAT6B gene to further delineate the haploinsufficiency phenotype. The molecular mechanisms giving rise to the SBBS and GPS phenotypes are discussed.European Journal of Human Genetics advance online publication, 26 November 2014; doi:10.1038/ejhg.2014.248. PMID:25424711

  19. Bath Concentration of Anionic Contrast Agents Does Not Affect Their Diffusion and Distribution in Articular Cartilage In Vitro

    PubMed Central

    Jurvelin, Jukka S.; Tiitu, Virpi; Quinn, Thomas M.; Töyräs, Juha

    2013-01-01

    Objective: Differences in contrast agent diffusion reflect changes in composition and structure of articular cartilage. However, in clinical application the contrast agent concentration in the joint capsule varies, which may affect the reliability of contrast enhanced cartilage tomography (CECT). In the present study, effects of concentration of x-ray contrast agents on their diffusion and equilibrium distribution in cartilage were investigated. Design: Full-thickness cartilage discs (d = 4.0 mm, n = 120) were detached from bovine patellae (n = 24). The diffusion of various concentrations of ioxaglate (5, 10, 21, 50 mM) and iodide (30, 60, 126, 300 mM) was allowed only through the articular surface. Samples were imaged with a clinical peripheral quantitative computed tomography scanner before immersion in contrast agent, and after 1, 5, 9, 16, 25, and 29 hours in the bath. Results: Diffusion and partition coefficients were similar between different contrast agent concentrations. The diffusion coefficient of iodide (473 ± 133 µm2/s) was greater (P ? 0.001) than that of ioxaglate (92 ± 46 µm2/s). In full-thickness cartilage, the partition coefficient (at 29 h) of iodide (71 ± 5%) was greater (P ? 0.02 with most concentrations) than that of ioxaglate (62 ± 6%). Conclusions: Significant differences in partition and diffusion coefficient of two similarly charged (?1) contrast agents were detected, which shows the effect of steric interactions. However, the increase in solute concentration did not increase its partition coefficient. In clinical application, it is important that contrast agent concentration does not affect the interpretation of CECT imaging.

  20. Testosterone Reduces Knee Passive Range of Motion and Expression of Relaxin Receptor Isoforms via 5?-Dihydrotestosterone and Androgen Receptor Binding

    PubMed Central

    Dehghan, Firouzeh; Muniandy, Sekaran; Yusof, Ashril; Salleh, Naguib

    2014-01-01

    Ovarian steroids such as estrogen and progesterone have been reported to influence knee laxity. The effect of testosterone, however, remains unknown. This study investigated the effect of testosterone on the knee range of motion (ROM) and the molecular mechanisms that might involve changes in the expression of relaxin receptor isoforms, Rxfp1 and Rxfp2 in the patella tendon and lateral collateral ligament of the female rat knee. Ovariectomized adult female Wistar rats received three days treatment with peanut oil (control), testosterone (125 and 250 ?g/kg) and testosterone (125 and 250 ?g/kg) plus flutamide, an androgen receptor blocker or finasteride, a 5?-reductase inhibitor. Duplicate groups received similar treatment however in the presence of relaxin (25 ng/kg). A day after the last drug injection, knee passive ROM was measured by using a digital miniature goniometer. Both tendon and ligament were harvested and then analysed for protein and mRNA expression for Rxfp1 and Rxfp2 respectively. Knee passive ROM, Rxfp1 and Rxfp2 expression were significantly reduced following treatment with testosterone. Flutamide or finasteride administration antagonized the testosterone effect. Concomitant administration of testosterone and relaxin did not result in a significant change in knee ROM as compared to testosterone only treatment; however this was significantly increased following flutamide or finasteride addition. Testosterone effect on knee passive ROM is likely mediated via dihydro-testosterone (DHT), and involves downregulation of Rxfp1 and Rxfp2 expression, which may provide the mechanism underlying testosterone-induced decrease in female knee laxity. PMID:24642882

  1. Ultrasonography of entheseal insertions in the lower limb in spondyloarthropathy

    PubMed Central

    Balint, P; Kane, D; Wilson, H; McInnes, I; Sturrock, R

    2002-01-01

    Objective: To compare ultrasonography (US) with clinical examination in the detection of entheseal abnormality of the lower limb in patients with spondyloarthropathy (SpA). Methods: 35 patients with SpA (ankylosing spondylitis 27; psoriatic arthritis 7; reactive arthritis 1) underwent independent clinical and ultrasonographic examination of both lower limbs at five entheseal sites—superior pole and inferior pole of patella, tibial tuberosity, Achilles tendon, and plantar aponeurosis. US was performed using an ATL (Advanced Technology Laboratories, Bothell, Washington, USA) high definition imaging 3000 machine with linear 7–4 MHz and compact linear 10–5 MHz probes to detect bursitis, structure thickness, bony erosion, and enthesophyte (bony spur). An enthesitis score was formulated from these US findings giving a possible maximum total score of 36. Results: On clinical examination 75/348 (22%) entheseal sites were abnormal and on US examination 195/348 (56%) sites were abnormal. In 19 entheseal sites with bursitis on US, only five were detected by clinical examination. Compared with US, clinical examination had a low sensitivity (22.6%) and moderate specificity (79.7%) for the detection of enthesitis of the lower limbs. There was no significant correlation between the US score of enthesitis and acute phase parameters such as erythrocyte sedimentation rate (ESR) or C reactive protein (CRP). The intraobserver ? value for analysis of all sites was 0.9. Conclusions: Most entheseal abnormality in SpA is not detected at clinical examination. US is better than clinical examination in the detection of entheseal abnormality of the lower limbs in SpA. A quantitative US score of lower limb enthesitis is proposed but further studies are required to validate it in SpA. PMID:12228161

  2. Cartilage Repair Using Human Embryonic Stem Cell-Derived Chondroprogenitors

    PubMed Central

    Kapacee, Zoher; Peng, Jiang; Lu, Shibi; Lucas, Robert J.; Hardingham, Timothy E.

    2014-01-01

    In initial work, we developed a 14-day culture protocol under potential GMP, chemically defined conditions to generate chondroprogenitors from human embryonic stem cells (hESCs). The present study was undertaken to investigate the cartilage repair capacity of these cells. The chondrogenic protocol was optimized and validated with gene expression profiling. The protocol was also applied successfully to two lines of induced pluripotent stem cells (iPSCs). Chondrogenic cells derived from hESCs were encapsulated in fibrin gel and implanted in osteochondral defects in the patella groove of nude rats, and cartilage repair was evaluated by histomorphology and immunocytochemistry. Genes associated with chondrogenesis were upregulated during the protocol, and pluripotency-related genes were downregulated. Aggregation of chondrogenic cells was accompanied by high expression of SOX9 and strong staining with Safranin O. Culture with PluriSln1 was lethal for hESCs but was tolerated by hESC chondrogenic cells, and no OCT4-positive cells were detected in hESC chondrogenic cells. iPSCs were also shown to generate chondroprogenitors in this protocol. Repaired tissue in the defect area implanted with hESC-derived chondrogenic cells was stained for collagen II with little collagen I, but negligible collagen II was observed in the fibrin-only controls. Viable human cells were detected in the repair tissue at 12 weeks. The results show that chondrogenic cells derived from hESCs, using a chemically defined culture system, when implanted in focal defects were able to promote cartilage repair. This is a first step in evaluating these cells for clinical application for the treatment of cartilage lesions. PMID:25273540

  3. Navigated Cementless Total Knee Arthroplasty - Medium-Term Clinical and Radiological Results§

    PubMed Central

    Schüttrumpf, Jan P; Balcarek, Peter; Sehmisch, Stephan; Frosch, Stephan; Wachowski, Martin M; Stürmer, Klaus M; Walde, Hans-Joachim; Walde, Tim A

    2012-01-01

    Purpose: The objective of this prospective study was to evaluate the medium-term clinical and radiological results after navigated cementless implantation, without patella resurfacing, of a total knee endoprosthesis with tibial and femoral press-fit components, with a focus on survival rate and clinical outcome. The innovation is the non-cemented fixation together with the use of a navigation system. Scope and Methods: Sixty patients with gonarthrosis were included consecutively in this study. In all cases, the cementless Columbus total knee endoprosthesis with a coating out of pure titanium was implanted, using a navigation system. The Knee Society Score showed a statistically significant increase from 75 (± 21.26) before surgery to 180 (± 16.15) after a mean follow-up of 5.6 (± 0.25) years. The last radiological examination revealed no osteolysis. No radiolucent lines were seen at any time in the area of the femoral prosthetic components. In the tibial area, radiolucent lines were seen in 24.4 % of the cases, mostly in the distal uncoated part of the stem. During follow-up, no prosthesis had to be replaced because of aseptic loosening while in 2 cases revision surgery was necessary due to septic loosening and in 1 case due to unexplainable pain. Results and Conclusions: Navigated cementless implantation of the Columbus total knee endoprosthesis yielded good clinical and radiological results in the medium term. The excellent radiological osteointegration of the prosthetic components, coated with a microporous pure titanium layer and implanted with a press-fit technique, should be emphasized. PMID:22550552

  4. Muscles within muscles: a tensiomyographic and histochemical analysis of the normal human vastus medialis longus and vastus medialis obliquus muscles

    PubMed Central

    Travnik, Ludvik; Djordjevi?, Srdjan; Rozman, Sergej; Hribernik, Marija; Dahmane, Raja

    2013-01-01

    The aim of this study was to show the connection between structure (anatomical and histochemical) and function (muscle contraction properties) of vastus medialis obliquus (VMO) and vastus medialis longus (VML). The non-invasive tensiomyography (TMG) method was used to determine the contractile properties (contraction time; Tc) of VML and VMO muscle, as a reflection of the ratio between the slow and fast fibers in two groups of nine young men. VML and VMO significantly (P?patella in the femoral groove. Our results obtained by TMG provided additional evidence that muscle fibers within the segments of VM muscle were not homogenous with regard to their contractile properties, thereby confirming the histochemical results. Tc can be attributed to the higher percentage of slow-twitch fibers – type 1. The statistically shorter Tc (P???0.001) of VMO (22.8?±?4.0?ms) compared with VML (26.7?±?4.0?ms) in our study is consistent with previously found differences in histochemical, morphological and electrophysiological data. In conclusion, the results of this study provide evidence that the VML and VMO muscles are not only anatomically and histochemically different muscles, but also functionally different biological structures. PMID:23586984

  5. Oxaceprol, an atypical inhibitor of inflammation, reduces leukocyte adherence in mouse antigen-induced arthritis.

    PubMed

    Veihelmann, A; Hofbauer, A; Refior, H J; Messmer, K

    2001-06-01

    Oxaceprol (N-acetyl-L-hydroxyproline), an atypical inhibitor of inflammation, is an established drug forjoint disease without serious side-effects. Recent studies have emphasized that oxaceprol has an effect on the microcirculation. Since the exact mechanism of action remains unclear, the aim of our study was to investigate the leukocyte-endothelial cell interactions in oxaceprol-treated mice with antigen-induced arthritis (AiA) using intravital microscopy. In our study, Balb/c mice were allocated to 4 groups (n 7, 8, 8, 8): 2 control groups with saline or oxaceprol and 2 groups of arthritic animals which received saline or oxaceprol (100 mg/kg twice a day intraperitoneally). The severity of arthritis was quantified by the transverse knee joint diameter. For the intravital fluorescence microscopy measurements on day 10 after inducing arthritis, the patella tendon was partily resected to visualize the intraarticular synovial tissue of the knee joint. The number of rolling and adherent leukocytes as well as RBC velocity and functional capillary density (FCD) were quantified in synovial microvessels. Furthermore, leukocyte infiltration was determined in the histological sections with an established score. No significant changes in mean arterial blood pressure or functional capillary density were found in any of the groups. However, the leukocyte rolling fraction and number of leukocytes adherent to the endothelium were increased in postcapillary venules of the synovium in arthritic animals (0.16 to 0.31, 78 cells/mm2 to 220 cells/mm2). In animals with AiA treated with oxaceprol, leukocyte adherence and swelling were significantly reduced in comparison to the arthritic animals treated with saline. Furthermore, the histological score showed less leukocyte infiltration in the oxaceprol treated arthritic animals. Thus, oxaceprol reduces leukocyte adherence in vivo and leukocyte infiltration in mouse AiA, indicating an effect on synovial microcirculation. PMID:11480608

  6. CT of a Ptolemaic period mummy from the ancient Egyptian City of Akhmim.

    PubMed

    Chan, Steve S; Elias, Jonathan P; Hysell, Mark E; Hallowell, Michael J

    2008-01-01

    Mummies associated with the ancient city of Akhmim in Egypt provide an important portal for radiologic research concerning the ancient Egyptian population. As part of an ongoing investigation, a mummy of Akhmimic derivation owned by the Academy of Natural Sciences in Philadelphia, Pennsylvania, was scanned with a 16-detector row computed tomographic scanner. The resultant images helped confirm that the mummy was that of a female in her late teens. Although the deliberate omission of hieroglyphic texts on the painted coffin rendered the deceased individual anonymous, it is noteworthy that great care had been taken in preparing the corpse for burial. The mummy represents conscientious work by the embalmers, work that is broadly consistent with methods used during the early Ptolemaic period for well-to-do persons. Features of bodily decomposition, including the rotary dissociation of the C1 and C2 vertebral bodies and a missing right patella, point to neglect of the body prior to its recovery and mummification. The fact that the body was well prepared but thinly wrapped and interred in an uninscribed coffin further suggests that the deceased was not of the community that eventually performed the mummification. This evidence is not inconsistent with a scenario involving the body's postmortem immersion in water. Although it cannot be determined with certainty whether the deceased was a drowning victim, it appears that the treatment of the body followed protocols developed in connection with an ancient Egyptian tradition that persons dying in, or retrieved from, the Nile River were embalmed with special care. PMID:19001656

  7. Association of Trochlear Dysplasia with degenerative Abnormalities in the Knee

    PubMed Central

    Jungmann, Pia. M.; Tham, Seng-Choe; Liebl, Hans; Nevitt, Michael C; McCulloch, Charles E.; Lynch, John; Link, Thomas M.

    2013-01-01

    Objective To evaluate trochlear morphology as a potential risk factor for patellofemoral osteoarthritis, determined by morphological and quantitative measurements of cartilage degeneration using 3T magnetic resonance imaging (MRI) of the knee. Materials and Methods MR images of right knees of 304 randomly selected subjects, aged 45–60 years, from the Osteoarthritis Initiative (OAI) progression cohort were screened for trochlear dysplasia, defined by an abnormal trochlear depth. Out of 304 subjects, n=85 demonstrated a shallow trochlea (depth ?3mm; 28%). In these, and also in a random sample of controls with normal trochlear depth (n=50), the facetal ratio and the sulcus angle were calculated and knee structural abnormalities were assessed by using a modified Whole-Organ-MR-Imaging Score (WORMS). Cartilage segmentation was performed and T2 relaxation times and patellar cartilage volume were determined. ANOVA and multivariate regression models were used for statistical analysis of the association of MRI structural measures and trochlear morphology. Results Knees with a shallow trochlea showed higher patellofemoral degeneration (WORMS mean ±standard deviation, 11.2±0.5 versus 5.7±0.6; Multivariate regression, P<0.001) and lower patellar cartilage volume than controls (900±664mm3 versus 1671±671mm3; P<0.001). Knees with an abnormal medial-to-lateral facetal ratio (<0.4) showed increased patellofemoral WORMS scores (12.3±0.9 versus 8.3±0.5; P<0.001). Knees with an abnormal sulcus angle (>170°) also showed increased WORMS scores (12.2±1.1 versus 8.6±0.6; P=0.003). T2 values at the patella were significantly lower in the dysplasia group with a shallow trochlea. However, significance was lost after adjustment for cartilage volume (P=0.673). Conclusion Trochlear dysplasia, defined by a shallow trochlea, was associated with higher WORMS scores and lower cartilage volume, indicating more advanced osteoarthritis at the patellofemoral joint. PMID:23801099

  8. LOGISMOS—Layered Optimal Graph Image Segmentation of Multiple Objects and Surfaces: Cartilage Segmentation in the Knee Joint

    PubMed Central

    Zhang, Xiangmin; Williams, Rachel; Wu, Xiaodong; Anderson, Donald D.; Sonka, Milan

    2011-01-01

    A novel method for simultaneous segmentation of multiple interacting surfaces belonging to multiple interacting objects, called LOGISMOS (layered optimal graph image segmentation of multiple objects and surfaces), is reported. The approach is based on the algorithmic incorporation of multiple spatial inter-relationships in a single n-dimensional graph, followed by graph optimization that yields a globally optimal solution. The LOGISMOS method’s utility and performance are demonstrated on a bone and cartilage segmentation task in the human knee joint. Although trained on only a relatively small number of nine example images, this system achieved good performance. Judged by dice similarity coefficients (DSC) using a leave-one-out test, DSC values of 0.84 ± 0.04, 0.80 ± 0.04 and 0.80 ± 0.04 were obtained for the femoral, tibial, and patellar cartilage regions, respectively. These are excellent DSC values, considering the narrow-sheet character of the cartilage regions. Similarly, low signed mean cartilage thickness errors were obtained when compared to a manually-traced independent standard in 60 randomly selected 3-D MR image datasets from the Osteoarthritis Initiative database—0.11 ± 0.24, 0.05 ± 0.23, and 0.03 ± 0.17 mm for the femoral, tibial, and patellar cartilage thickness, respectively. The average signed surface positioning errors for the six detected surfaces ranged from 0.04 ± 0.12 mm to 0.16 ± 0.22 mm. The reported LOGISMOS framework provides robust and accurate segmentation of the knee joint bone and cartilage surfaces of the femur, tibia, and patella. As a general segmentation tool, the developed framework can be applied to a broad range of multiobject multisurface segmentation problems. PMID:20643602

  9. Topical glyceryl trinitrate treatment of chronic patellar tendinopathy: a randomised, double-blind, placebo-controlled clinical trial

    PubMed Central

    Steunebrink, Mirjam; Zwerver, Johannes; Brandsema, Ruben; Groenenboom, Petra; van den Akker-Scheek, Inge; Weir, Adam

    2012-01-01

    Objectives To assess if continuous topical glyceryl trinitrate (GTN) treatment improves outcome in patients with chronic patellar tendinopathy when compared with eccentric training alone. Methods Randomised double-blind, placebo-controlled clinical trial comparing a 12-week programme of using a GTN or placebo patch in combination with eccentric squats on a decline board. Measurements were performed at baseline, 6, 12 and 24?weeks. Primary outcome measure was the Victorian Institute of Sports Assessment-Patella (VISA-P) questionnaire. Secondary outcome measures were patient satisfaction and pain scores during sports. Generalised estimated equation was used to analyse the treatment, time and treatment×time effect. Analyses were performed following the intention-to-treat principle. Results VISA-P scores for both groups improved over the study period to 75.0±16.2 and 80.7±22.1 at 24?weeks. Results showed a significant effect for time (p<0.01) but no effect for treatment×time (p=0.80). Mean Visual Analogue Scores pain scores during sports for both groups increased over the study period to 6.6±3 and 7.8±3.1. Results showed a significant effect for time (p<0.01) but no effect for treatment×time (p=0.38). Patient satisfaction showed no difference between GTN and placebo groups (p=0.25) after 24?weeks, but did show a significant difference over time (p=0.01). Three patients in the GTN group reported some rash. Conclusion It seems that continuous topical GTN treatment in addition to an eccentric exercise programme does not improve clinical outcome compared to placebo patches and an eccentric exercise programme in patients with chronic patellar tendinopathy. PMID:22930695

  10. Patellofemoral arthroplasty with a custom-fit femoral prosthesis.

    PubMed

    Butler, James E; Shannon, Robert

    2009-02-01

    We reviewed the outcomes of a series of patellar arthroplasty operations with custom-fit femoral prostheses to examine the effectiveness of this procedure in relieving pain and restoring function in the knee. Twenty-two patellofemoral arthroplasty operations were performed in 21 patients (mean age, 48.6 years) at 2 institutions between 1994 and 2002. All patients had advanced patellofemoral arthritis and had undergone an average of 2.5 previous patellofemoral operations. The prosthesis, consisting of a custom-fit chrome cobalt trochlear component and an all-polyethylene patellar button, was implanted in a procedure designed to minimize bone resection. Patients later underwent three-view radiography of the knee to confirm that the prosthesis was positioned correctly. One patient required revision of an undersized patellar button 18 months postoperatively, and 2 other patients had postoperative arthrofibrosis necessitating arthroscopic debridement. No patient required revision of the trochlear component, and no loosening or migration of any component has been found since the first procedure was performed. However, the polyethylene patellar button has worn in 3 patients, and the patella broke in 1 patient. An average of 60 months postoperatively, patients used the Western Ontario and McMaster Universities Osteoarthritis Index to rate their preoperative and present joint pain, stiffness, and function. Patients' mean overall ratings (potential range, 24-96) were significantly lower for their present symptoms (28.4) than for their preoperative symptoms (63.4). Mean scores on each subscale also decreased: from 13.0 to 5.5 for pain, from 5.4 to 2.4 for stiffness, and from 45.0 to 20.6 for function. We conclude that, in carefully selected patients, patellofemoral arthroplasty with a custom-fit prosthesis is a viable surgical treatment for isolated patellofemoral arthritis. PMID:19301809

  11. LMX1B is essential for the maintenance of differentiated podocytes in adult kidneys.

    PubMed

    Burghardt, Tillmann; Kastner, Jürgen; Suleiman, Hani; Rivera-Milla, Eric; Stepanova, Natalya; Lottaz, Claudio; Kubitza, Marion; Böger, Carsten A; Schmidt, Sarah; Gorski, Mathias; de Vries, Uwe; Schmidt, Helga; Hertting, Irmgard; Kopp, Jeffrey; Rascle, Anne; Moser, Markus; Heid, Iris M; Warth, Richard; Spang, Rainer; Wegener, Joachim; Mierke, Claudia T; Englert, Christoph; Witzgall, Ralph

    2013-11-01

    Mutations of the LMX1B gene cause nail-patella syndrome, a rare autosomal-dominant disorder affecting the development of the limbs, eyes, brain, and kidneys. The characterization of conventional Lmx1b knockout mice has shown that LMX1B regulates the development of podocyte foot processes and slit diaphragms, but studies using podocyte-specific Lmx1b knockout mice have yielded conflicting results regarding the importance of LMX1B for maintaining podocyte structures. In order to address this question, we generated inducible podocyte-specific Lmx1b knockout mice. One week of Lmx1b inactivation in adult mice resulted in proteinuria with only minimal foot process effacement. Notably, expression levels of slit diaphragm and basement membrane proteins remained stable at this time point, and basement membrane charge properties also did not change, suggesting that alternative mechanisms mediate the development of proteinuria in these mice. Cell biological and biophysical experiments with primary podocytes isolated after 1 week of Lmx1b inactivation indicated dysregulation of actin cytoskeleton organization, and time-resolved DNA microarray analysis identified the genes encoding actin cytoskeleton-associated proteins, including Abra and Arl4c, as putative LMX1B targets. Chromatin immunoprecipitation experiments in conditionally immortalized human podocytes and gel shift assays showed that LMX1B recognizes AT-rich binding sites (FLAT elements) in the promoter regions of ABRA and ARL4C, and knockdown experiments in zebrafish support a model in which LMX1B and ABRA act in a common pathway during pronephros development. Our report establishes the importance of LMX1B in fully differentiated podocytes and argues that LMX1B is essential for the maintenance of an appropriately structured actin cytoskeleton in podocytes. PMID:23990680

  12. LMX1B is Essential for the Maintenance of Differentiated Podocytes in Adult Kidneys

    PubMed Central

    Burghardt, Tillmann; Kastner, Jürgen; Suleiman, Hani; Rivera-Milla, Eric; Stepanova, Natalya; Lottaz, Claudio; Kubitza, Marion; Böger, Carsten A.; Schmidt, Sarah; Gorski, Mathias; de Vries, Uwe; Schmidt, Helga; Hertting, Irmgard; Kopp, Jeffrey; Rascle, Anne; Moser, Markus; Heid, Iris M.; Warth, Richard; Spang, Rainer; Wegener, Joachim; Mierke, Claudia T.; Englert, Christoph

    2013-01-01

    Mutations of the LMX1B gene cause nail–patella syndrome, a rare autosomal-dominant disorder affecting the development of the limbs, eyes, brain, and kidneys. The characterization of conventional Lmx1b knockout mice has shown that LMX1B regulates the development of podocyte foot processes and slit diaphragms, but studies using podocyte-specific Lmx1b knockout mice have yielded conflicting results regarding the importance of LMX1B for maintaining podocyte structures. In order to address this question, we generated inducible podocyte-specific Lmx1b knockout mice. One week of Lmx1b inactivation in adult mice resulted in proteinuria with only minimal foot process effacement. Notably, expression levels of slit diaphragm and basement membrane proteins remained stable at this time point, and basement membrane charge properties also did not change, suggesting that alternative mechanisms mediate the development of proteinuria in these mice. Cell biological and biophysical experiments with primary podocytes isolated after 1 week of Lmx1b inactivation indicated dysregulation of actin cytoskeleton organization, and time-resolved DNA microarray analysis identified the genes encoding actin cytoskeleton-associated proteins, including Abra and Arl4c, as putative LMX1B targets. Chromatin immunoprecipitation experiments in conditionally immortalized human podocytes and gel shift assays showed that LMX1B recognizes AT-rich binding sites (FLAT elements) in the promoter regions of ABRA and ARL4C, and knockdown experiments in zebrafish support a model in which LMX1B and ABRA act in a common pathway during pronephros development. Our report establishes the importance of LMX1B in fully differentiated podocytes and argues that LMX1B is essential for the maintenance of an appropriately structured actin cytoskeleton in podocytes. PMID:23990680

  13. Impact response and biomechanical analysis of the knee-thigh-hip complex in frontal impacts with a full human body finite element model.

    PubMed

    Ruan, Jesse S; El-Jawahri, Raed; Barbat, Saeed; Rouhana, Stephen W; Prasad, Priya

    2008-11-01

    Changes in vehicle safety design technology and the increasing use of seat-belts and airbag restraint systems have gradually changed the relative proportion of lower extremity injuries. These changes in real world injuries have renewed interest and the need of further investigation into occupant injury mechanisms and biomechanical impact responses of the knee-thigh-hip complex during frontal impacts. This study uses a detailed finite element model of the human body to simulate occupant knee impacts experienced in frontal crashes. The human body model includes detailed anatomical features of the head, neck, shoulder, chest, thoracic and lumbar spine, abdomen, pelvis, and lower and upper extremities. The material properties used in the model for each anatomic part of the human body were obtained from test data reported in the literature. The human body model used in the current study has been previously validated in frontal and side impacts. It was further validated with cadaver knee-thigh-hip impact tests in the current study. The effects of impactor configuration and flexion angle of the knee on biomechanical impact responses of the knee-thigh-hip complex were studied using the validated human body finite element model. This study showed that the knee flexion angle and the impact direction and shape of the impactors affected the injury outcomes of the knee-thigh-hip complex significantly. The 60 degrees flexed knee impact showed the least impact force, knee pressure, femoral von Mises stress, and pelvic von Mises stress but largest relative displacements of the Posterior Cruciate Ligament (PCL) and Anterior Cruciate Ligament (ACL). The 90 degrees flexed knee impact resulted in a higher impact force, knee pressure, femoral von Mises stress, and pelvic von Mises stress; but smaller PCL and ACL displacements. Stress distributions of the patella, femur, and pelvis were also given for all the simulated conditions. PMID:19085174

  14. A Novel Genetic Score Approach Using Instruments to Investigate Interactions between Pathways and Environment: Application to Air Pollution

    PubMed Central

    Bind, Marie-Abele; Coull, Brent; Suh, Helen; Wright, Robert; Baccarelli, Andrea; Vokonas, Pantel; Schwartz, Joel

    2014-01-01

    Air pollution has been associated with increased systemic inflammation markers. We developed a new pathway analysis approach to investigate whether gene variants within relevant pathways (oxidative stress, endothelial function, and metal processing) modified the association between particulate air pollution and fibrinogen, C-reactive protein (CRP), intercellular adhesion molecule-1 (ICAM-1), and vascular cell adhesion molecule-1 (VCAM-1). Our study population consisted of 822 elderly participants of the Normative Aging Study (1999–2011). To investigate the role of biological mechanisms and to reduce the number of comparisons in the analysis, we created pathway-specific scores using gene variants related to each pathway. To select the most appropriate gene variants, we used the least absolute shrinkage and selection operator (Lasso) to relate independent outcomes representative of each pathway (8-hydroxydeoxyguanosine for oxidative stress, augmentation index for endothelial function, and patella lead for metal processing) to gene variants. A high genetic score corresponds to a higher allelic risk profile. We fit mixed-effects models to examine modification by the genetic score of the weekly air pollution association with the outcome. Among participants with higher genetic scores within the oxidative stress pathway, we observed significant associations between particle number and fibrinogen, while we did not find any association among participants with lower scores (pinteraction?=?0.04). Compared to individuals with low genetic scores of metal processing gene variants, participants with higher scores had greater effects of particle number on fibrinogen (pinteraction?=?0.12), CRP (pinteraction?=?0.02), and ICAM-1 (pinteraction?=?0.08). This two-stage penalization method is easy to implement and can be used for large-scale genetic applications. PMID:24755831

  15. The Ergogenic Effect of Elastic Therapeutic Tape on Stride and Step Length in Fatigued Runners

    PubMed Central

    Ward, John; Sorrels, Kenneth; Coats, Jesse; Pourmoghaddam, Amir; Moskop, JoAnn; Ueckert, Kate; Glass, Amanda

    2014-01-01

    Objective The purpose of this study was to determine if elastic therapeutic tape placed on anterior lower limbs would affect stride and step length in fatigued runners’ gait. Methods Forty-two healthy participants were equally divided into a kinesiology tape group (Rocktape) and a no-tape control group. Participants in both groups underwent a baseline running gait test at 6 mph without tape. After this, participants engaged in an exhaustive lower body fatigue protocol until they reached maximal volitional exhaustion. Participants were then randomized to 1 of 2 interventions: (1) Experimental group, which had kinesiology tape placed under tension on the anterior aspect of their lower limbs bilaterally from the upper thigh to just below the patella, or (2) Control group, which did not receive taping. All participants then engaged in a similar 6-mph running gait postanalysis. Participant’s gait was analyzed for 90 seconds during each test iteration. Researchers used a 2-way repeated-measures analysis of variance considering fatigue (prefatigue, postfatigue) and group (tape, no-tape) as subject factors. Results After the fatigue protocol, the no-tape group demonstrated a significant decrease in step length of 14.2 mm (P = .041) and stride length of 29.4 mm (P = .043). The kinesiology tape group did not demonstrate a significant decline in these gait parameters. Conclusions In this preliminary study, placing elastic therapeutic tape over the anterior lower limbs demonstrated short-term preservation of runner step length and stride length in a fatigued state. PMID:25435835

  16. Identification of the First ATRIP–Deficient Patient and Novel Mutations in ATR Define a Clinical Spectrum for ATR–ATRIP Seckel Syndrome

    PubMed Central

    Stiff, Tom; Hobson, Emma; Limsirichaikul, Siripan; Carpenter, Gillian; Prescott, Katrina; Suri, Mohnish; Byrd, Philip J.; Matsuse, Michiko; Mitsutake, Norisato; Nakazawa, Yuka; Vasudevan, Pradeep; Barrow, Margaret; Stewart, Grant S.; Taylor, A. Malcolm R.; O'Driscoll, Mark; Jeggo, Penny A.

    2012-01-01

    A homozygous mutational change in the Ataxia-Telangiectasia and RAD3 related (ATR) gene was previously reported in two related families displaying Seckel Syndrome (SS). Here, we provide the first identification of a Seckel Syndrome patient with mutations in ATRIP, the gene encoding ATR–Interacting Protein (ATRIP), the partner protein of ATR required for ATR stability and recruitment to the site of DNA damage. The patient has compound heterozygous mutations in ATRIP resulting in reduced ATRIP and ATR expression. A nonsense mutational change in one ATRIP allele results in a C-terminal truncated protein, which impairs ATR–ATRIP interaction; the other allele is abnormally spliced. We additionally describe two further unrelated patients native to the UK with the same novel, heterozygous mutations in ATR, which cause dramatically reduced ATR expression. All patient-derived cells showed defective DNA damage responses that can be attributed to impaired ATR–ATRIP function. Seckel Syndrome is characterised by microcephaly and growth delay, features also displayed by several related disorders including Majewski (microcephalic) osteodysplastic primordial dwarfism (MOPD) type II and Meier-Gorlin Syndrome (MGS). The identification of an ATRIP–deficient patient provides a novel genetic defect for Seckel Syndrome. Coupled with the identification of further ATR–deficient patients, our findings allow a spectrum of clinical features that can be ascribed to the ATR–ATRIP deficient sub-class of Seckel Syndrome. ATR–ATRIP patients are characterised by extremely severe microcephaly and growth delay, microtia (small ears), micrognathia (small and receding chin), and dental crowding. While aberrant bone development was mild in the original ATR–SS patient, some of the patients described here display skeletal abnormalities including, in one patient, small patellae, a feature characteristically observed in Meier-Gorlin Syndrome. Collectively, our analysis exposes an overlapping clinical manifestation between the disorders but allows an expanded spectrum of clinical features for ATR–ATRIP Seckel Syndrome to be defined. PMID:23144622

  17. Approximation of the functional kinematics of posterior stabilised total knee replacements using a two-dimensional sagittal plane patello-femoral model: comparing model approximation to in vivo measurement.

    PubMed

    Van Duren, Bernard; Pandit, Hemant; Murray, David; Gill, Harinderjit

    2015-08-01

    Previous in vivo studies have observed that current designs of posterior stabilised (PS) total knee replacements (TKRs) may be ineffective in restoring normal kinematics in Late flexion. Computer-based models can prove a useful tool in improving PS knee replacement designs. This study investigates the accuracy of a two-dimensional (2D) sagittal plane model capable of predicting the functional sagittal plane kinematics of PS TKR implanted knees against direct in vivo measurement. Implant constraints are often used as determinants of anterior-posterior tibio-femoral positioning. This allowed the use of a patello-femoral modelling approach to determine the effect of implant constraints. The model was executed using motion simulation software which uses the constraint force algorithm to achieve a solution. A group of 10 patients implanted with Scorpio PS implants were recruited and underwent fluoroscopic imaging of their knees. The fluoroscopic images were used to determine relative implant orientation using a three-dimensional reconstruction method. The determined relative tibio-femoral orientations were then input to the model. The model calculated the patella tendon angles (PTAs) which were then compared with those measured from the in vivo fluoroscopic images. There were no significant differences between the measured and calculated PTAs. The average root mean square error between measured and modelled ranged from 1.17° to 2.10° over the flexion range. A sagittal plane patello-femoral model could conceivably be used to predict the functional 2D kinematics of an implanted knee joint. This may prove particularly useful in optimising PS designs. PMID:24559039

  18. A methodology to accurately quantify patellofemoral cartilage contact kinematics by combining 3D image shape registration and cine-PC MRI velocity data.

    PubMed

    Borotikar, Bhushan S; Sipprell, William H; Wible, Emily E; Sheehan, Frances T

    2012-04-01

    Patellofemoral osteoarthritis and its potential precursor patellofemoral pain syndrome (PFPS) are common, costly, and debilitating diseases. PFPS has been shown to be associated with altered patellofemoral joint mechanics; however, an actual variation in joint contact stresses has not been established due to challenges in accurately quantifying in vivo contact kinematics (area and location). This study developed and validated a method for tracking dynamic, in vivo cartilage contact kinematics by combining three magnetic resonance imaging (MRI) techniques, cine-phase contrast (CPC), multi-plane cine (MPC), and 3D high-resolution static imaging. CPC and MPC data were acquired from 12 healthy volunteers while they actively extended/flexed their knee within the MRI scanner. Since no gold standard exists for the quantification of in vivo dynamic cartilage contact kinematics, the accuracy of tracking a single point (patellar origin relative to the femur) represented the accuracy of tracking the kinematics of an entire surface. The accuracy was determined by the average absolute error between the PF kinematics derived through registration of MPC images to a static model and those derived through integration of the CPC velocity data. The accuracy ranged from 0.47 mm to 0.77 mm for the patella and femur and from 0.68 mm to 0.86 mm for the patellofemoral joint. For purely quantifying joint kinematics, CPC remains an analytically simpler and more accurate (accuracy <0.33 mm) technique. However, for application requiring the tracking of an entire surface, such as quantifying cartilage contact kinematics, this combined imaging approach produces accurate results with minimal operator intervention. PMID:22284428

  19. Prevalence of MRI-detected mediopatellar plica in subjects with knee pain and the association with MRI-detected patellofemoral cartilage damage and bone marrow lesions: data from the Joints On Glucosamine study

    PubMed Central

    2013-01-01

    Background The mediopatellar plica is a synovial fold representing an embryonic remnant from the developmental process of the synovial cavity formation in the knee. We aimed to examine the frequency of MRI-detected mediopatellar plica and its cross-sectional association with MRI-detected cartilage damage and bone marrow lesions (BMLs) in the patellofemoral joint (PFJ) in a cohort of subjects with knee pain. Methods 342 knees with chronic frequent knee pain were evaluated for MRI-detected mediopatellar plica (type A, B or C according to the modified Sakakibara classification). Cartilage damage (scored 0 to 6) and BMLs (scored 0 to 3) were semiquantitatively assessed in four subregions of the PFJ on MRI. Hoffa-synovitis and effusion-synovitis were graded 0 to 3. Patellar length ratio (PLR), lateral patellar tilt angle (LPTA), bisect offset (BO), and sulcus angle (SA) were measured on MRI. The presence of mediopatellar plica and its association with cartilage damage and BMLs in the PFJ was assessed using logistic regression after adjusting for age, gender, body mass index, PLR, LPTA, BO, SA, and Hoffa- and effusion-synovitis. Results 163 (47.7%) knees exhibited mediopatellar plica (76 (22.2%) type A, 69 (20.2%) type B, and 18 (5.3%) type C) on MRI. Significant cross-sectional associations of MRI-detected mediopatellar plica and cartilage damage were observed for the medial patella (adjusted odds ratio (aOR) 2.12, 95% CI 1.23-3.64 for all types combined, and aOR 4.20, 95% CI 1.92-9.19 for type B lesion), but not for the anterior medial femur or the lateral PFJ. No associations were found between the presence of MRI-detected mediopatellar plica and BMLs in any patellofemoral subregion. Conclusion On MRI, types A and B mediopatellar plicae were commonly observed in this cohort of subjects with knee pain. MRI-detected mediopatellar plica was cross-sectionally associated with higher likelihood of the presence of MRI-detected medial patellar cartilage damage after adjustment for confounders. PMID:24119160

  20. Inducement of semitendinosus tendon regeneration to the pes anserinus after its harvest for anterior cruciate ligament reconstruction-A new inducer grafting technique

    PubMed Central

    2012-01-01

    Purpose To investigate the usefulness of the “inducer grafting” technique for regeneration of the semitendinosus (ST) tendon after its harvest for anterior cruciate ligament (ACL) reconstruction. Methods Twenty knees of 20 patients (mean age at the time of surgery, 23.1?years) underwent ACL reconstruction with a double bundle autograft using the ST tendon (7 patients) and the ST + the gracilis (G) tendons (13 patients). “Inducer grafting” technique After harvesting the ST tendon, a passing pin with a loop thread is inserted along with the tendon stripper. The passing pin is pulled out from the medial thigh and the loop thread retained. As an inducer graft, the ST tendon branch is used. After the ACL graft has been secured, the inducer graft is sutured to the pes anserinus and the proximal end passed through by pulling the thread out. Then the inducer graft is placed within the tendon canal. The mean follow-up period was 15?months. The presence and morphology of the regenerated ST tendon were examined by MRI. And the isometric hamstring strength was examined at 45°, 90° and 120° of knee flexion. Results One month after the operation in all the patients, MRI demonstrated a low-intensity structure at the anatomical location of the ST, at the level of the superior pole of the patella and the joint line, apparently representing the regenerated ST tendon. Four months after the operation, the distal portion of the regenerated ST tendon had reached the pes anserinus in all patients. Twelve months after the operation, the regenerated ST tendon was hypertrophic in 19 of the 20 patients (95%). The isometric knee flexion torque of the ACL-reconstructed limb was significantly lower at 90° and 120° compared with the contralateral limb. Conclusion These results suggest that the “inducer grafting” technique is able to improve the regeneration rate of the harvested ST tendon and promote hypertrophy of the regenerated ST tendon, extending all the way to the pes anserinus. However, this technique couldn’t improve the deficits in knee flexion torque after ACL reconstruction. PMID:22607724

  1. The cell lineage of the polyplacophoran, Chaetopleura apiculata: variation in the spiralian program and implications for molluscan evolution.

    PubMed

    Henry, Jonathan Q; Okusu, Akiko; Martindale, Mark Q

    2004-08-01

    Polyplacophorans, or chitons, are an important group of molluscs, which are argued to have retained many plesiomorphic features of the molluscan body plan. Polyplacophoran trochophore larvae posses several features that are distinctly different from those of their sister trochozoan taxa, including modifications of the ciliated prototrochal cells, the postrochal position of the larval eyes or ocelli, epidermal calcareous spicules, and a collection of serially reiterated epidermal shell plates. Despite these differences, chitons demonstrate a canonical pattern of equal spiral cleavage shared by other spiralian phyla that permits the identification of homologous cells across this animal clade. Cell lineage analysis using intracellular labeling on one chiton species, Chaetopleura apiculata, shows that the ocelli are generated from different lineal precursors (second-quartet micromeres: 2a, 2c) compared to those in all other spiralians studied to date (first-quartet micromeres: 1a, 1c). This situation implies that significant changes have also occurred in terms of the inductive interactions that control eye development in the spiralians. Although radical departures from the spiralian developmental program are seen in some molluscs (i.e., cephalopods), the findings presented here indicate that important changes can occur even within the highly constrained framework of the spiral cleavage program. Among spiralians, variation has been reported for the origin of the anterior, sensory, apical organ, which arises from the 1c and 1d micromeres in C. apiculata. The prototroch of C. apiculata consists of two to three irregular rows of ciliated cells but arise from 1q and 2q daughters, similar to that of Ischnochiton rissoi, as well as the gastropod, Patella vulgata. Despite certain early claims, there is no supporting evidence that any of the shell plates arise pretrochally in C. apiculata. The first seven of eight definitive shell plates that arise in the larva originate from shell secreting grooves in the postrochal region (derived from 2c, 2d, 3d). Earlier descriptions indicate that the eighth plate arises later at metamorphosis, and as this is formed posteriorly, it too forms in the postrochal region. On the other hand, epidermal spicules originate from both pretrochal and postrochal cells (1a,1d, 2a, 2c, 3c, 3d). The significance of these observations is discussed in light of various hypotheses concerning the origin of the conchiferan shell. This study reveals conservation, as well as evolutionary novelty, in the assignment of specific cell fates in the spiralians. PMID:15242797

  2. Custom-designed orthopedic implants evaluated using finite element analysis of patient-specific computed tomography data: femoral-component case study

    PubMed Central

    Harrysson, Ola LA; Hosni, Yasser A; Nayfeh, Jamal F

    2007-01-01

    Background Conventional knee and hip implant systems have been in use for many years with good success. However, the custom design of implant components based on patient-specific anatomy has been attempted to overcome existing shortcomings of current designs. The longevity of cementless implant components is highly dependent on the initial fit between the bone surface and the implant. The bone-implant interface design has historically been limited by the surgical tools and cutting guides available; and the cost of fabricating custom-designed implant components has been prohibitive. Methods This paper describes an approach where the custom design is based on a Computed Tomography scan of the patient's joint. The proposed design will customize both the articulating surface and the bone-implant interface to address the most common problems found with conventional knee-implant components. Finite Element Analysis is used to evaluate and compare the proposed design of a custom femoral component with a conventional design. Results The proposed design shows a more even stress distribution on the bone-implant interface surface, which will reduce the uneven bone remodeling that can lead to premature loosening. Conclusion The proposed custom femoral component design has the following advantages compared with a conventional femoral component. (i) Since the articulating surface closely mimics the shape of the distal femur, there is no need for resurfacing of the patella or gait change. (ii) Owing to the resulting stress distribution, bone remodeling is even and the risk of premature loosening might be reduced. (iii) Because the bone-implant interface can accommodate anatomical abnormalities at the distal femur, the need for surgical interventions and fitting of filler components is reduced. (iv) Given that the bone-implant interface is customized, about 40% less bone must be removed. The primary disadvantages are the time and cost required for the design and the possible need for a surgical robot to perform the bone resection. Some of these disadvantages may be eliminated by the use of rapid prototyping technologies, especially the use of Electron Beam Melting technology for quick and economical fabrication of custom implant components. PMID:17854508

  3. Evaluation of the uncertainties associated with in vivo X-ray fluorescence bone lead calibrations

    NASA Astrophysics Data System (ADS)

    Lodwick, Jeffrey C.

    An anthropometric leg phantom developed at the University of Cincinnati (UC) was used to evaluate the effects that changes in leg position and variation between subjects has on in vivo x-ray fluorescence (XRF) measurements of stable lead in bone. The changes in leg position that were evaluated include changes in source-phantom distance ranging between 0.0 mm and 30.0 mm and phantom rotation over 40 degrees. Source-phantom distance was determined to have a significant effect on XRF measurement results particularly at source-phantom distances greater than 10.0 mm. Rotation of the leg phantom through 40 degrees was determined to have no significant effect on XRF measurement results. Between subject factors that were evaluated include bone calcium content and overlying tissue thickness. Bone calcium content was determined to have a significant effect on XRF measurements when measuring lead in micrograms per gram bone material. However, if measurement results of micrograms of lead per gram calcium (or per gram bone mineral) is used the normalization method makes the change in calcium content not significant. Overlying tissue thickness was determined to have no significant effect on XRF measurement results with tissue thickness ranging between 5.7 and 11.62 mm. The UC leg phantom was modified to include a fibula bone phantom so that the effect that the fibula has on XRF measurement results could be evaluated. The fibula was determined to have no significant effect on XRF measurement results and in the future need not be incorporated into in vivo XRF calibration phantoms. A knee phantom was also developed for purposes of calibrations of in vivo XRF measurement of lead in the patella. XRF measurement results using this phantom were compared to results of XRF measurements made using the plaster-of-Paris (POP) phantoms. A significant difference was observed between the normalized count rates of the two phantom types when either micrograms of lead per gram of bone material or micrograms of lead per gram calcium (bone mineral) is used as the lead content. This difference is consistent with what is observed in real in vivo XRF measurements and indicates the need for the correction factors that are used.

  4. Near-Infrared Laser-Assisted Indocyanine Green Imaging for Optimizing the Design of the Anterolateral Thigh Flap

    PubMed Central

    Sacks, Justin M.; Nguyen, Alexander T.; Broyles, Justin M.; Yu, Peirong; Valerio, Ian L.; Baumann, Donald P.

    2012-01-01

    Objective: The anterolateral thigh flap is a versatile flap that can be used in a free or pedicled fashion. Because of the large amount of potential soft tissue, low donor site morbidity, and long pedicle lengths, many researchers consider it to be the perfect free flap. However, dissection of this and other perforator flaps can become an arduous experience with learning curves to overcome. Near-infrared laser angiography using indocyanine green provides a useful adjunctive tool to more predictably assess direct perforator perfusion zones. Laser-assisted angiography with SPY-Q analysis gives live localization of the flap's dominant perforator perfusion zones while quantifying the relative tissue perfusion for immediate skin paddle design. Methods: Fifteen patients with head and neck cancer defects were reconstructed with a free anterolateral thigh flap using laser-assisted near-infrared indocyanine green perforator mapping. The mid-point of a line between the anterior superior iliac spine and the patella was determined and the laser was centered over this. Indocyanine green (12.5 mg) was injected intravenously and fluorescence patterns were recorded. Optimal perforators were chosen using real-time imaging and SPY-Q analysis software. The anterolateral thigh skin paddle was centered over perforators based on best relative perfusion values. The hand-held Doppler was not used to identify perforators. All flaps were elevated in standard fashion. Patient demographics, defect characteristics, reconstructive techniques, and clinical outcomes were assessed. Results: All 15 free flaps were raised with the assistance of laser-assisted angiography. Cutaneous Doppler did not aid in the design of the skin paddle. There was only 1 flap loss due to venous congestion. All donor defects were closed primarily without the need for a skin graft. Conclusions: Laser-assisted indocyanine green angiography using SPY-Q analysis software provides robust, intraoperative, objective data to optimize anterolateral thigh skin paddle design while potentially minimizing patient morbidity. Future studies will be needed to further evaluate the use of this new technology. PMID:22876337

  5. Tibiofemoral and patellofemoral joint 3D-kinematics in patients with posterior cruciate ligament deficiency compared to healthy volunteers

    PubMed Central

    2012-01-01

    Background The posterior cruciate ligament (PCL) plays an important role in maintaining physiological kinematics and function of the knee joint. To date mainly in-vitro models or combined magnetic resonance and fluoroscopic systems have been used for quantifying the importance of the PCL. We hypothesized, that both tibiofemoral and patellofemoral kinematic patterns are changed in PCL-deficient knees, which is increased by isometric muscle flexion. Therefore the aim of this study was to simultaneously investigate tibiofemoral and patellofemoral 3D kinematics in patients suffering from PCL deficiency during different knee flexion angles and under neuromuscular activation. Methods We enrolled 12 patients with isolated PCL-insufficiency as well as 20 healthy volunteers. Sagittal MR-images of the knee joint were acquired in different positions of the knee joint (0°, 30°, 90° flexion, with and without flexing isometric muscle activity) on a 0.2 Tesla open MR-scanner. After segmentation of the patella, femur and tibia local coordinate systems were established to define the spatial position of these structures in relation to each other. Results At full extension and 30° flexion no significant difference was observed in PCL-deficient knee joints neither for tibiofemoral nor for patellofemoral kinematics. At 90° flexion the femur of PCL-deficient patients was positioned significantly more anteriorly in relation to the tibia and both, the patellar tilt and the patellar shift to the lateral side, significantly increased compared to healthy knee joints. While no significant effect of isometric flexing muscle activity was observed in healthy individuals, in PCL-deficient knee joints an increased paradoxical anterior translation of the femur was observed at 90° flexion compared to the status of muscle relaxation. Conclusions Significant changes in tibiofemoral and patellofemoral joint kinematics occur in patients with isolated PCL-insufficiency above 30 degrees of flexion compared to healthy volunteers. Since this could be one reasonable mechanism in the development of osteoarthritis (OA) our results might help to understand the long-term development of tibiofemoral and/or patellofemoral OA in PCL-insufficient knee joints. PMID:23181354

  6. Interleukin-6 reduces cartilage destruction during experimental arthritis. A study in interleukin-6-deficient mice.

    PubMed Central

    van de Loo, F. A.; Kuiper, S.; van Enckevort, F. H.; Arntz, O. J.; van den Berg, W. B.

    1997-01-01

    Using interleukin (IL)-6-deficient (IL-6(0/0) mice or wild-type mice, we investigated the controversial role of IL-6 in joint inflammation and cartilage pathology during zymosan-induced arthritis (ZIA). Monoarticular arthritis was elicited by injection of zymosan into the right knee joint cavity. Production of IL-1, tumor necrosis factor (TNF), IL-6, and nitric oxide by the inflamed knee was assessed in washouts of joint capsule specimens. Plasma corticosterone was measured using a radioimmunoassay. Proteoglycan synthesis was assessed using [35S]sulfate incorporation into patellas ex vivo. Joint swelling was quantified by joint uptake of circulating 99mTechnetium pertechnetate. Histology was taken to evaluate cellular infiltration and cartilage damage. Zymosan caused a rapid increase in articular IL-1, IL-6, TNF, and NO levels. Except for IL-6, the released amounts and time course of these mediators were comparable in the IL-6-deficient mice and the wild-type mice. Elevated plasma corticosterone levels were measured during the first day of arthritis in both strains. At day 2 of ZIA, joint inflammation (joint swelling and cell exudate) in IL-6-deficient mice was comparable with that in the wild-type mice. The marked suppression of chondrocyte proteoglycan synthesis and proteoglycan degradation were on the average higher in the IL-6-deficient mice. Together this resulted in a more pronounced proteoglycan depletion in the IL-6-deficient mice as compared with the wild-type mice during the first week of arthritis. Injection of recombinant IL-6 into the joint cavity corrected the IL-6 deficiency and significantly reduced cartilage destruction. Inflammation was more chronic in the wild-type mice, and these mice also showed a higher prevalence for osteophyte formation. In ZIA, IL-6 plays a dual role in connective tissue pathology, reducing proteoglycan loss in the acute phase and enhancing osteophyte formation in the chronic phase. The latter could be related to the more severe joint inflammation as seen in the normal (IL-6-producing) animals during the chronic phase of arthritis. Images Figure 2 Figure 2 PMID:9212744

  7. Strength and cross-sectional area of human skeletal muscle.

    PubMed Central

    Maughan, R J; Watson, J S; Weir, J

    1983-01-01

    The maximum voluntary force (strength) which could be produced by the knee-extensor muscles, with the knee held at a right angle, was measured in a group of healthy young subjects comprising twenty-five males and twenty-five females. Both legs were tested: data from the stronger leg only for each subject were used in the present study. Computed tomography was used to obtain a cross-sectional image of the subjects' legs at mid-thigh level, measured as the mid-point between the greater trochanter and upper border of the patella. The cross-sectional area of the knee-extensor muscles was determined from the image obtained by computer-based planimetry. The subjects' height and weight were measured. An estimate of body fat content was obtained from measurements of skinfold thicknesses and used to calculate lean body mass. Male subjects were taller (P less than 0.001), heavier (P less than 0.001), leaner (P less than 0.001) and stronger (P less than 0.001) than the female subjects. No significant correlation was found to exist between strength of the knee-extensor muscles and body weight in the male or in the female subjects. In the male subjects, but not in the female group, there was a positive correlation (r = 0.50; P less than 0.01) between strength and lean body mass. Muscle cross-sectional area of the male subjects was greater than that of the female subjects (P less than 0.001). The ratio of strength to cross-sectional area for the male was 9.49 +/- 1.34 (mean +/- S.D.). This is greater but not significantly so, than that for females (8.92 +/- 1.11). In both male and female groups, there was a significant (P less than 0.01) positive correlation between muscle strength and cross-sectional area. A wide variation in the ratio of strength to muscle cross-sectional area was observed. This variability may be a result of anatomical differences between subjects or may result from differences in the proportions of different fibre types in the muscles. The variation between subjects is such that strength is not a useful predictive index of muscle cross-sectional area. Images Plate 1 PMID:6875963

  8. Changes in Morphological and Elastic Properties of Patellar Tendon in Athletes with Unilateral Patellar Tendinopathy and Their Relationships with Pain and Functional Disability

    PubMed Central

    Zhang, Zhi Jie; Ng, Gabriel Yin-fat; Lee, Wai Chun; Fu, Siu Ngor

    2014-01-01

    Background Patellar tendinopathy (PT) is one of the most common knee disorders among athletes. Changes in morphology and elasticity of the painful tendon and how these relate to the self-perceived pain and dysfunction remain unclear. Objectives To compare the morphology and elastic properties of patellar tendons between athlete with and without unilateral PT and to examine its association with self-perceived pain and dysfunction. Methods In this cross-sectional study, 33 male athletes (20 healthy and 13 with unilateral PT) were enrolled. The morphology and elastic properties of the patellar tendon were assessed by the grey and elastography mode of supersonic shear imaging (SSI) technique while the intensity of pressure pain, self-perceived pain and dysfunction were quantified with a 10-lb force to the most painful site and the Victorian Institute of Sport Assessment-patella (VISA-P) questionnaire, respectively. Results In athletes with unilateral PT, the painful tendons had higher shear elastic modulus (SEM) and larger tendon than the non-painful side (p<0.05) or the dominant side of the healthy athletes (p<0.05). Significant correlations were found between tendon SEM ratio (SEM of painful over non-painful tendon) and the intensity of pressure pain (rho ?=?0.62; p?=?0.024), VISA-P scores (rho ?=??0.61; p?=?0.026), and the sub-scores of the VISA-P scores on going down stairs, lunge, single leg hopping and squatting (rho ranged from ?0.63 to ?0.67; p<0.05). Conclusions Athletes with unilateral PT had stiffer and larger tendon on the painful side than the non-painful side and the dominant side of healthy athletes. No significant differences on the patellar tendon morphology and elastic properties were detected between the dominant and non-dominant knees of the healthy control. The ratio of the SEM of painful to non-painful sides was associated with pain and dysfunction among athletes with unilateral PT. PMID:25303466

  9. Determinants of bone and blood lead concentrations in the early postpartum period

    PubMed Central

    Brown, M. J.; Hu, H.; Gonzales-Cossio, T.; Peterson, K.; Sanin, L.; Kageyama, M. d.; Palazuelos, E.; Aro, A.; Schnaas, L.; Hernandez-Avila, M.

    2000-01-01

    OBJECTIVE—This study investigated determinants of bone and blood lead concentrations in 430 lactating Mexican women during the early postpartum period and the contribution of bone lead to blood lead.?METHODS—Maternal venous lead was measured at delivery and postpartum, and bone lead concentrations, measured with in vivo K-x ray fluorescence, were measured post partum. Data on environmental exposure, demographic characteristics, and maternal factors related to exposure to lead were collected by questionnaire. Linear regression was used to examine the relations between bone and blood lead, demographics, and environmental exposure variables.?RESULTS—Mean (SD) blood, tibial, and patellar lead concentrations were 9.5 (4.5) µg/dl, 10.2 (10.1) µg Pb/g bone mineral, and 15.2 (15.1) µg Pb/g bone mineral respectively. These values are considerably higher than values for women in the United States. Older age, the cumulative use of lead glazed pottery, and higher proportion of life spent in Mexico City were powerful predictors of higher bone lead concentrations. Use of lead glazed ceramics to cook food in the past week and increased patellar lead concentrations were significant predictors of increased blood lead. Patellar lead concentrations explained one third of the variance accounted for by the final blood lead model. Women in the 90th percentile for patella lead had an untransformed predicted mean blood lead concentration 3.6 µg/dl higher than those in the 10th percentile.?CONCLUSIONS—This study identified the use of lead glazed ceramics as a major source of cumulative exposure to lead, as reflected by bone lead concentrations, as well as current exposure, reflected by blood lead, in Mexico. A higher proportion of life spent in Mexico City, a proxy for exposure to leaded gasoline emissions, was identified as the other major source of cumulative lead exposure. The influence of bone lead on blood lead coupled with the long half life of lead in bone has implications for other populations and suggests that bone stores may pose a threat to women of reproductive age long after exposure has declined.???Keywords: postpartum; blood lead; bone lead PMID:10896960

  10. Ultrasound speed varies in articular cartilage under indentation loading.

    PubMed

    Lötjönen, Pauno; Julkunen, Petro; Tiitu, Virpi; Jurvelin, Jukka S; Töyräs, Juha

    2011-12-01

    In ultrasound elastography, tissue strains are determined by localizing changes in ultrasound echoes during mechanical loading. The technique has been proposed for arthroscopic quantification of the mechanical properties of cartilage. The accuracy of ultrasound elastography depends on the invariability of sound speed in loaded tissue. In unconfined geometry, mechanical compression has been shown to induce variation in sound speed, leading to errors in the determined mechanical properties. This phenomenon has not been confirmed in indentation geometry, the only loading geometry applicable in situ or in vivo. In the present study, ultrasound speed during indentation of articular cartilage was characterized and the effect of variable sound speed on the strain measurements was investigated. Osteochondral samples (n = 7, diameter = 25.4 mm), prepared from visually intact bovine patellae (n = 7), were indented with a plane-ended ultrasound transducer (diameter = 5.6 mm, peak frequency: 8.1 MHz). A sequence of three compression tests (strain-rate = 10%/s, 2700-s relaxation) was applied using the mean strains of 2.2%, 4.5%, and 6.4%. Then, ultrasound speed during the ramp and stress-relaxation phases was determined using the time-of- flight technique. To investigate the role of cartilage structure and composition for sound speed in loaded articular cartilage, a sample-specific fibril-reinforced poroviscoelastic (FRPVE) finite element model was constructed and fitted to experimental mechanical data. Ultrasound speed in articular cartilage decreased significantly during dynamic indentation (p <; 0.05). The magnitude of the decrease in speed during indentation was related to the applied strain. However, the relative error in acoustically determined tissue strain was inversely related to the magnitude of true strain. The modeling results suggested that the compression-related variation in sound speed is controlled by changes in the collagen architecture during dynamic indentation. To conclude, variation in sound speed during dynamic indentation of articular cartilage may lead to significant errors in the values of measured mechanical parameters. Because the relative errors are inversely proportional to applied strain, higher strains should be used to minimize the errors in, e.g., in vivo measurements. PMID:23443716

  11. Ultrashort Echo Time MR Imaging of Osteochondral Junction of the Knee at 3 T: Identification of Anatomic Structures Contributing to Signal Intensity1

    PubMed Central

    Bae, Won C.; Dwek, Jerry R.; Znamirowski, Richard; Statum, Sheronda M.; Hermida, Juan C.; D’Lima, Darryl D.; Sah, Robert L.; Du, Jiang

    2010-01-01

    Purpose: To image cartilage-bone interfaces in naturally occurring and experimentally prepared human cartilage-bone specimens at 3 T by using ultrashort echo time (TE) (UTE) and conventional pulse sequences to (a) determine the appearance of the signal intensity patterns and (b) identify the structures contributing to signal intensity on the UTE MR images. Materials and Methods: This study was exempted by the institutional review board, and informed consent was not required. Five cadaveric (mean age, 86 years ± 4) patellae were imaged by using proton density–weighted fat-suppressed (repetition time msec/TE msec, 2300/34), T1-weighted (700/10), and UTE (300/0.008, 6.6, with or without dual-inversion preparations at inversion time 1 = 135 msec and inversion time 2 = 95 msec) sequences. The UTE images were compared with proton density–weighted fat-suppressed and T1-weighted images and were evaluated by two radiologists. To identify the sources of signal on the UTE images, samples including specific combinations of tissues (uncalcified cartilage [UCC] only, calcified cartilage [CC] and subchondral bone [bone] [CC/bone], bone only; and UCC, CC, and bone [UCC/CC/bone]) were prepared and imaged by using the UTE sequence. Results: On the UTE MR images, all patellar sections exhibited a high-intensity linear signal near the osteochondral junction, which was not visible on protein density–weighted fat-suppressed or T1-weighted images. In some sections, focal regions of thickened or diminished signal intensity were also found. In the prepared samples, UCC only, CC/bone, and UCC/CC/bone samples exhibited high signal intensity on the UTE images, whereas bone-only samples did not. Conclusion: These results show that the high signal intensity on UTE images of human articular joints originates from the CC and the deepest layer of the UCC, without a definite contribution from subchondral bone. UTE sequences may provide a way of evaluating abnormalities at or near the osteochondral junction. © RSNA, 2010 PMID:20177096

  12. [Knee endoprostheses: problems and technological developments from the manufacturer's point of view].

    PubMed

    Blömer, W

    2000-08-01

    Modern-day knee arthroplasty is based principally on the experience gained in the course of the past three decades. In the 1980s and 1990s, for example, the full constraint models of the 1970s were replaced by surface replacement prostheses with a combined rolling/sliding motion approximating the natural motion of the human knee joint for a wide range of applications. Not all of the relevant questions in the areas of material science, biomechanics, tribology, implant fixation and surgical technique have been fully explored by any means. Nevertheless, the medium-term and long-term results presently attained by knee arthroplasty are comparable to those achieved in the field of hip-joint arthroplasty. Although the success achieved by today's knee-joint prostheses is impressive, a critical analysis of therapeutic failures and complications is necessary to discover areas where further research is necessary and to formulate the challenges presenting themselves in R&D and in the manufacture of artificial knee joints. Currently, research efforts are focused on optimizing materials (especially in light of the presently unsatisfactory wear behavior of artificial knee joints), biomechanically-assisted design optimization to achieve a better harmonization between mobility and stability in the knee joint to be treated, alternative anchoring concepts, including consistently cement-free anchoring, and solutions for simplifying implantation techniques and making them more precise. The latter area, in particular, appears to be of great importance, since the quality of artificial knee joints and the long-term therapeutic outcome of knee-joint arthroplasty depend to a great extent on the correct alignment of the leg axes, an optimal implant position, and the correct adjustment of soft tissue tension. Technical innovations in this area of implant technology exert a multifactorial impact on different aspects of arthroplasty--e.g., uniform force transfer to minimize wear, selective rotation of the femoral components to optimize patella tracking, and avoidance of load concentrations to improve fixation strength--and thus form the basis for a surgical approach that takes greater account of "the big picture". Today's sophisticated navigation systems are a case in point. The non-imaging systems, in particular, have proved to be exceptionally useful; their advantages lie in their simple handling which makes use of common surgical techniques, the avoidance of additional imaging data recording (e.g. CT images), and an inconsequential increase in operation times. PMID:11013911

  13. Lead Exposure and Tremor among Older Men: The VA Normative Aging Study

    PubMed Central

    Power, Melinda C.; Sparrow, David; Spiro, Avron; Hu, Howard; Louis, Elan D.; Weisskopf, Marc G.

    2015-01-01

    Background: Tremor is one of the most common neurological signs, yet its etiology is poorly understood. Case–control studies suggest an association between blood lead and essential tremor, and that this association is modified by polymorphisms in the ?-aminolevulinic acid dehydrogenase (ALAD) gene. Objective: We aimed to examine the relationship between lead and tremor, including modification by ALAD, in a prospective cohort study, using both blood lead and bone lead—a biomarker of cumulative lead exposure. Methods: We measured tibia (n = 670) and patella (n = 672) bone lead and blood lead (n = 807) among older men (age range, 50–98 years) in the VA Normative Aging Study cohort. A tremor score was created based on an approach using hand-drawing samples. ALAD genotype was dichotomized as ALAD-2 carriers or not. We used linear regression adjusted for age, education, smoking, and alcohol intake to estimate the associations between lead biomarkers and tremor score. Results: In unadjusted analyses, there was a marginal association between quintiles of all lead biomarkers and tremor scores (p-values < 0.13), which did not persist in adjusted models. Age was the strongest predictor of tremor. Among those younger than the median age (68.9 years), tremor increased significantly with blood lead (p = 0.03), but this pattern was not apparent for bone lead. We did not see modification by ALAD or an association between bone lead and change in tremor score over time. Conclusion: Our results do not strongly support an association between lead exposure and tremor, and suggest no association with cumulative lead biomarkers, although there is some suggestion that blood lead may be associated with tremor among the younger men in our cohort. Citation: Ji JS, Power MC, Sparrow D, Spiro A III, Hu H, Louis ED, Weisskopf MG. 2015. Lead exposure and tremor among older men: the VA Normative Aging Study. Environ Health Perspect 123:445–450;?http://dx.doi.org/10.1289/ehp.1408535 PMID:25633720

  14. Dynamic Mechanical Loading Enhances Functional Properties of Tissue-Engineered Cartilage Using Mature Canine Chondrocytes

    PubMed Central

    Bian, Liming; Fong, Jason V.; Lima, Eric G.; Stoker, Aaron M.; Ateshian, Gerard A.; Cook, James L.

    2010-01-01

    Objective The concept of cartilage functional tissue engineering (FTE) has promoted the use of physiologic loading bioreactor systems to cultivate engineered tissues with load-bearing properties. Prior studies have demonstrated that culturing agarose constructs seeded with primary bovine chondrocytes from immature joints, and subjected to dynamic deformation, produced equilibrium compressive properties and proteoglycan content matching the native tissue. In the process of translating these results to an adult canine animal model, it was found that protocols previously successful with immature bovine primary chondrocytes did not produce the same successful outcome when using adult canine primary chondrocytes. The objective of this study was to assess the efficacy of a modified FTE protocol using adult canine chondrocytes seeded in agarose hydrogel and subjected to dynamic loading. Method Two modes of dynamic loading were applied to constructs using custom bioreactors: unconfined axial compressive deformational loading (DL; 1?Hz, 10% deformation) or sliding contact loading (Slide; 0.5?Hz, 10% deformation). Loading for 3?h daily was initiated on day 0, 14, or 28 (DL0, DL14, DL28, and Slide14). Results Constructs with applied loading (both DL and Slide) exhibited significant increases in Young's modulus compared with free-swelling control as early as day 28 in culture (p?patella groove and condyle) cartilage. Conclusion Our findings successfully demonstrate an FTE strategy incorporating clinically relevant, adult chondrocytes and gel scaffold for engineering cartilage replacement tissue. These results, using continuous growth factor supplementation, are in contrast to our previously reported studies with immature chondrocytes where the sequential application of dynamic loading after transient transforming growth factor-?3 application was found to be a superior culture protocol. Sliding, which simulates aspects of joint articulation, has shown promise in promoting engineered tissue development and provides an alternative option for FTE of cartilage constructs to be further explored. PMID:20028219

  15. Effect of IL-1?-Induced Macromolecular Depletion on Residual Quadrupolar Interaction in Articular Cartilage

    PubMed Central

    Borthakur, Arijitt; Shapiro, Erik M.; Beers, Jennifer; Kudchodkar, Sagar; Kneeland, J. Bruce; Reddy, Ravinder

    2010-01-01

    Purpose Sodium multiple-quantum filtered (MQF) NMR spectroscopy may potentially be used to measure proteoglycan (PG) depletion in cartilage caused by osteoarthritis (OA). The purpose of this work was to quantify the effect of interleukin-1 (IL-1?)-induced macromolecule depletion on the residual quadrupolar interaction (RQI) of sodium in bovine cartilage plugs. Materials and Methods Fifteen 8-mm-diameter cartilage plug specimens were cored from the articular surface of fresh bovine patellae. All plugs were kept in culture media and nine of the plugs were subjected to interleukin-1 (IL-1?)-induced degeneration of cartilage for 4, 6, and 7 days. Sodium NMR spectra were obtained from each sample with a 1-cm-diameter solenoid coil in a 2T whole-body magnet interfaced to a custom-built spectrometer. We employed a previously described theoretical model to analyze triple-quantum filtered (TQF) and double-quantum filtered magic angle (DQFMA) spectra obtained from normal cartilage and cartilage treated with IL-1?. The model assumes a static Gaussian distribution of the RQI frequency, ?Q, in the sample. TQF and DQFMA spectra from each sample were fitted with the appropriate signal expressions to determine ? (the root mean square (RMS) ?Q), T2f, and T2s. An inversion-recovery sequence was used to determine T1 of each plug. A spectrophotometric assay was used to determine the amount of PG depleted from each plug. Histology was performed to visualize the PG loss in cartilage plugs. We defined ? as the measure of changes in macroscopic order in the tissue. Results Simulated spectra from the theoretical model were in excellent agreement with the experimental data. We were able to determine the relaxation times as well as ? of each specimen from their corresponding fits. T2f ranged between 2.26–3.50 msec, decreasing with increased PG loss. Over the range of PG depletion investigated, T2s increased from 12.3 msec to 14.9 msec, and T1 increased from 16 msec to 21 msec, while ? decreased from 180 Hz to 120 Hz. The order of macromolecules in the cartilage tissue decreased substantially with PG loss. Histology sections clearly showed qualitative visualization of the PG loss in cartilage following treatment with IL-1?. Conclusion We demonstrated that IL-?-induced macromolecule depletion in cartilage not only changes the relaxation characteristics of sodium but also changes RQI of the tissue. Using MQF sodium spectroscopy we quantified the changes in ? and showed that loss of macromolecules reduces the degree of order in the tissue. PMID:11891977

  16. Southwick Osteotomy Stabilised with External Fixator

    PubMed Central

    Grubor, Predrag; Mitkovic, Milorad; Grubor, Milan

    2014-01-01

    ABSTRACT Introduction: Epiphysiolysis of the femoral head is the most common accident occurring towards the end of pre-puberty and puberty growth. Case report: The author describes the experience in the treatment of chronic epiphysiolysis in two patients treated by Southwick osteotomy. The site is accessed by way of a 15-cm long lateral skin incision and the trochanteric region is reached through the layers. The osteotomy angles prepared beforehand on a thin aluminium model are used to mark the Southwick osteotomy site on the anterior and lateral sides at the level of the lesser trochanter. Before performing the trochanteric osteotomy, two Mitkovi? convergent pins type M20 are applied distally and proximally, above the planned osteotomy site. A tenotomy of the iliopsas muscle is performed, and then the previously marked bone triangle is redissected up to three quarters of the width of the femur. The distal part of the femur is rotated inwards, so that the patella is turned towards the ceiling. The osteotomised fragments of the femur are adapted, repositioned and fixated by installing an external fixator on the previously placed pins. Two more pins are placed, one proximally and one distally, with a view to adequately stabilising the femur. The patient was mobile from day two after the surgery. If, after the surgery, the lead surgeon realises that there is a requirement to make a correction of 5, 10 and 15 degrees of the valgus, varus, anteversion or retroversion deformity, the correction shall be performed without surgically opening the patient, using the fixator pins. Conclusion: After performing a Southwick osteotomy it is easier to adapt, reposition and fixate the osteotomised fragments of the femur using a fixator type M20. Adequate stability allows regaining mobility quickly, which in turn is the best prevention of chondrolysis of the hip. It is possible to make post-operative valgus, varus, anteversion and retroversion corrections of 5, 10 and 15 degrees without performing a surgery. Once the osteotomy is healed, the fixator type M20 is removed without any additional surgery. PMID:25568571

  17. Risk of Osteoporotic Fractures With Angiotensin II Receptor Blockers Versus Angiotensin-Converting Enzyme Inhibitors in Hypertensive Community-Dwelling Elderly.

    PubMed

    Butt, Debra A; Mamdani, Muhammad; Gomes, Tara; Lix, Lisa; Lu, Hong; Tu, Karen

    2014-11-01

    Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) are used to treat hypertension; however, in vivo and clinical studies suggest that ARBs and ACE inhibitors may exert different effects on bone. The association between long-term use of ARBs and ACE inhibitors and fracture requiring medical attention is limited. We conducted a population-based, retrospective cohort study with propensity score matching using administrative databases in Ontario, Canada, to examine the risk of osteoporosis-related fractures in hypertensive elderly treated with ARBs versus ACE inhibitors. We identified a cohort of newly treated hypertensive patients aged 66 years and older who initiated an ACE inhibitor from May 1, 2004, to March 31, 2012, and matched them to ARB users on propensity score, sex, and age at drug initiation. The primary outcome was hip fracture, and secondary outcomes were non-hip major osteoporotic fractures (other femoral, clinical vertebral, forearm, wrist, humerus) and other osteoporotic fractures (pelvis, clavicle, patella, shoulder, upper arm, tibia, fibula, ankle, scapula, ribs, sternum, trunk). We calculated hazard ratios (HRs) using Cox proportional hazards model with robust standard errors. Of the 87,635 patients who initiated treatment, 28,819 (32.9%) started ARBs and 58,816 (67.1%) started ACE inhibitors. Among new ARB users, 27,815 (96.5%) were successfully matched to ACE inhibitor users. Without dose adjustment, no significant association was observed for ARBs relative to ACE inhibitor users for hip fractures (HR?=?0.88; 95% confidence interval [CI] 0.70-1.11), with a decreased risk of other major osteoporotic fractures (HR?=?0.81; CI 0.70-0.93) and no significant association for other osteoporotic fractures (HR?=?0.88; CI 0.74-1.05). When adjusted for dosage, there was no significant difference between the effects of ARBs and ACE inhibitors on hip (HR?=?0.99; CI 0.78-1.25), other major osteoporotic (HR?=?0.87; CI 0.75-1.01), and other osteoporotic fractures (HR?=?0.90; CI 0.74-1.08). PMID:24806397