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ERIC Educational Resources Information Center

|Chondromalacia is the degeneration of the hyaline cartilage on the under surface of the kneecap. Its causes include patella maltracking (the kneecap does not glide properly over the joint), posttraumatic condition, and chronic overuse. The treatment can be a controlled rehabilitation program, various bracing techniques, foot orthoses, or, in…

Connors, G. Patrick



ERIC Educational Resources Information Center

Chondromalacia is the degeneration of the hyaline cartilage on the under surface of the kneecap. Its causes include patella maltracking (the kneecap does not glide properly over the joint), posttraumatic condition, and chronic overuse. The treatment can be a controlled rehabilitation program, various bracing techniques, foot orthoses, or, in…

Connors, G. Patrick


A novel biological approach to treat chondromalacia patellae.  


Mesenchymal stem cells from several sources (bone marrow, synovial tissue, cord blood, and adipose tissue) can differentiate into variable parts (bones, cartilage, muscle, and adipose tissue), representing a promising new therapy in regenerative medicine. In animal models, mesenchymal stem cells have been used successfully to regenerate cartilage and bones. However, there have been no follow-up studies on humans treated with adipose-tissue-derived stem cells (ADSCs) for the chondromalacia patellae. To obtain ADSCs, lipoaspirates were obtained from lower abdominal subcutaneous adipose tissue. The stromal vascular fraction was separated from the lipoaspirates by centrifugation after treatment with collagenase. The stem-cell-containing stromal vascular fraction was mixed with calcium chloride-activated platelet rich plasma and hyaluronic acid, and this ADSCs mixture was then injected under ultrasonic guidance into the retro-patellar joints of all three patients. Patients were subjected to pre- and post-treatment magnetic resonance imaging (MRI) scans. Pre- and post-treatment subjective pain scores and physical therapy assessments measured clinical changes. One month after the injection of autologous ADSCs, each patient's pain improved 50-70%. Three months after the treatment, the patients' pain improved 80-90%. The pain improvement persisted over 1 year, confirmed by telephone follow ups. Also, all three patients did not report any serious side effects. The repeated magnetic resonance imaging scans at three months showed improvement of the damaged tissues (softened cartilages) on the patellae-femoral joints. In patients with chondromalacia patellae who have continuous anterior knee pain, percutaneous injection of autologous ADSCs may play an important role in the restoration of the damaged tissues (softened cartilages). Thus, ADSCs treatment presents a glimpse of a new promising, effective, safe, and non-surgical method of treatment for chondromalacia patellae. PMID:23700485

Pak, Jaewoo; Lee, Jung Hun; Lee, Sang Hee



The modified tibial tubercle osteotomy for anterior knee pain due to chondromalacia patellae in adults  

PubMed Central

Objectives To assess the effectiveness of a modified tibial tubercle osteotomy as a treatment for arthroscopically diagnosed chondromalacia patellae. Methods A total of 47 consecutive patients (51 knees) with arthroscopically proven chondromalacia, who had failed conservative management, underwent a modified Fulkerson tibial tubercle osteotomy. The mean age was 34.4 years (19.6 to 52.2). Pre-operatively, none of the patients exhibited signs of patellar maltracking or instability in association with their anterior knee pain. The minimum follow-up for the study was five years (mean 72.6 months (62 to 118)), with only one patient lost to follow-up. Results A total of 50 knees were reviewed. At final follow-up, the Kujala knee score improved from 39.2 (12 to 63) pre-operatively to 57.7 (16 to 89) post-operatively (p < 0.001). The visual analogue pain score improved from 7.8 (4 to 10) pre-operatively to 5.0 (0 to 10) post-operatively. Overall patient satisfaction with good or excellent results was 72%. Patients with the lowest pre-operative Kujala score benefitted the most. Older patients benefited less than younger ones. The outcome was independent of the grade of chondromalacia. Six patients required screw removal. There were no major complications. Conclusions We conclude that this modification of the Fulkerson procedure is a safe and useful operation to treat anterior knee pain in well aligned patellofemoral joints due to chondromalacia patellae in adults, when conservative measures have failed.

Jack, C. M.; Rajaratnam, S. S.; Khan, H. O.; Keast-Butler, O.; Butler-Manuel, P. A.; Heatley, F. W.



Chondromalacia Patella  


... Patellofemoral pain syndrome usually causes a dull, aching pain in the front of your knee. This pain can be aggravated when you: Walk up or ... happens. But certain steps may help prevent the pain. Maintain strength. Strong quadriceps and hip abductor muscles help keep the knee balanced during ...


Noninvasive acceleration measurements to characterize knee arthritis and chondromalacia  

Microsoft Academic Search

Devising techniques and instrumentation for early detection of knee arthritis and chondromalacia presents a challenge in the\\u000a domain of biomedical engineering. The purpose of the present investigation was to characterize normal knees and knees affected\\u000a by osteoarthritis, rheumatoid arthritis, and chondromalacia using a set of noninvasive acceleration measurements. Ultraminiature\\u000a accelerometers were placed on the skin over the patella in four

Narender P. Reddy; Bruce M. Rothschild; Mita Mandal; Vineet Gupta; Srikanth Suryanarayanan



Isolated unilateral absent patella and contralateral small patella.  


Isolated bilateral absent patella is seen very rarely. It is generally encountered as a part of nail-patella syndrome. An 18-year-old male patient presented with left absent patella and right small patella. PMID:24001732

Duygun, Fatih; Sertkaya, Omer; Aldemir, Cengiz; Dogan, Ali



Displaced patella fractures.  


Displaced patella fractures often result in disruption of the extensor mechanism of the knee. An intact extensor mechanism is a requirement for unassisted gait. Therefore, operative treatment of the displaced patella fracture is generally recommended. The evaluation of the patella fracture patient includes examination of extensor mechanism integrity. Operative management of patella fractures normally includes open reduction with internal fixation, although partial patellectomy is occasionally performed, with advancement of quadriceps tendon or patellar ligament to the fracture bed. Open reduction with internal fixation has historically been performed utilizing anterior tension band wiring, although comminution of the fracture occasionally makes this fixation construct inadequate. Supplementation or replacement of the tension band wire construct with interfragmentary screws, cerclage wire or suture, and/or plate-and-screw constructs may add to the stability of the fixation construct. Arthrosis of the patellofemoral joint is very common after healing of patella fractures, and substantial functional deficits may persist long after fracture healing has occurred. PMID:23966286

Della Rocca, Gregory J



Chondromalacia of trochlear notch after healing of olecranon stress fracture: a case report  

Microsoft Academic Search

Introduction: Chondromalacia of the trochlear notch and stress fracture of olecranon are uncommon injuries in the throwing athletes. Materials and methods: We report an 18-year-old high school pitcher who had persistent postero-lateral elbow pain after a healed olecranon stress fracture of the right elbow. Diagnostic arthroscopy revealed chondromalacia of the trochlear notch. Results: After treatment with arthroscopic drilling and abrasion

Cheng-Chang Lu; Shen-Kai Chen; Chih-Wei Wang; Pei-Hsi Chou



The ''hot'' patella  

SciTech Connect

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.

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



[Familial nail patella-syndrome].  


Nail patella-syndrome is a rare hereditary (autosomal dominant) disorder resulting from a heterogenous loss of function in the LMXB1 gene on chromosome 9q34. It is associated with multiple deformities. Patients have a characteristic tetrad of pathologic symptoms including fingernail dysplasia, hypoplastic or absence patella, radial head dislocation, iliac horns and in some cases nephropathy and ophtalmo-logical findings (glaucoma). In this study four affected members in one family are presented. All of the familly members presented absence or hypoplastic patella and fingernails dysplasia. There were not indications for surgical treatment dislocated radial heads or subluxated dysplastic patella. Genetic counseling is recomended because nail patella syndrome is an autosomal dominant disease. PMID:16521531

Or?owski, Jan



Patella baja after total knee arthroplasty: Is it really patella baja?  

Microsoft Academic Search

In the prosthetic knee, narrowing of the space between the patella and the tibial polyethylene can be due to distal positioning of the patella or to a proximal transfer of the joint line. In the former case, one is dealing with patella baja. In the latter case, the patella is in its normal position relative to the femur, a situation

Ronald P. Grelsamer



[Patella fragmentation in cerebral palsy].  


In 16 patients with cerebral palsy 23 painful fragmentations at the lower pole of the patella were observed and surgically removed. In all cases pain was relieved immediately. Patellar fragmentations usually appeared in children between 12 and 16 years, in males twice as often in females. Patella alta was seen in all cases. All patients were walkers, however, 4 with hand supports only. In 14 of the 16 children there was knee flexion deformity during gait of 20-60 degrees. The cause of fragmentation is regarded to be overload of the quadriceps muscle in a juvenile bone condition, and is related to the "jumper's knee" due to fatigue. In 9 of the 16 patients an achilles tendon lengthening had been performed several years before, without overcorrection. All patients were of reasonable intelligence. PMID:2140647

Feldkamp, M


Patella fracture in a boy with bilateral inferior pole bipartite patellae.  


We present the case of a 12 year old boy who had bilateral inferior pole fragment (Saupe type 1) bipartite patellae, and who sustained a traumatic separation through the right patella while playing basket ball, the left remaining asymptomatic. We have reviewed and discussed the previously published literature and case reports. PMID:22436328

Peek, A C; Barry, M



Patella fractures associated with injuries of the knee ligament  

Microsoft Academic Search

Concurrent fractures of the patella and knee ligament ruptures are rare. From September 1985 to November 1989, 112 fractures of the patella were treated operatively at the Department of Traumatology at Celje General Hospital. In six patients (5%), associated badly injured ligaments of the knee joint were noted. During the operation, osteosynthesis of the patella was performed after the injured

M. Kosanovi?; R. Komadina; M. Batista



Osteosarcoma of the patella: a case report.  


We present a rare case of osteosarcoma involving the patella. A 30-year-old Japanese woman first consulted our out-patient clinic with a 2-year history of knee pain. Radiographs showed an enlargement of the patella with irregular distribution of both osteolytic and sclerotic lesions. Computed tomography and magnetic resonance imaging demonstrated soft tissue extension at the anterior part of the patella. Incisional biopsy showed abundant osteoid formation by spindle-shaped malignant cells, and the histological diagnosis was conventional osteosarcoma. The patient underwent preoperative chemotherapy, but there was no response. Furthermore, she developed a pathological fracture during chemotherapy. She underwent above-the-knee amputation with postoperative chemotherapy. She developed multiple metastases in the thoracic vertebrae 20 months after the surgery. At the most recent examination, she remains alive with multiple spinal metastases without paralysis 4 years after the surgery. PMID:22200101

Chida, Shuichi; Nagasawa, Hiroyuki; Okada, Kyoji; Shimada, Yoichi



Osteosarcoma of the patella: A case report  

PubMed Central

We present a rare case of osteosarcoma involving the patella. A 30-year-old Japanese woman first consulted our out-patient clinic with a 2-year history of knee pain. Radiographs showed an enlargement of the patella with irregular distribution of both osteolytic and sclerotic lesions. Computed tomography and magnetic resonance imaging demonstrated soft tissue extension at the anterior part of the patella. Incisional biopsy showed abundant osteoid formation by spindle-shaped malignant cells, and the histological diagnosis was conventional osteosarcoma. The patient underwent preoperative chemotherapy, but there was no response. Furthermore, she developed a pathological fracture during chemotherapy. She underwent above-the-knee amputation with postoperative chemotherapy. She developed multiple metastases in the thoracic vertebrae 20 months after the surgery. At the most recent examination, she remains alive with multiple spinal metastases without paralysis 4 years after the surgery.

Nagasawa, Hiroyuki; Okada, Kyoji; Shimada, Yoichi



Use of a trabecular metal patella for marked patella bone loss during revision total knee arthroplasty  

Microsoft Academic Search

This study evaluates the short-term results following patellar resurfacing with a trabecular metal patella shell in the setting of marked patellar bone loss at the time of revision total knee arthroplasty (TKA). Twenty consecutive patients undergoing revision TKA with the use of a trabecular metal patella were evaluated at a mean 23-month follow-up. All patients had marked patellar bone loss

Charles L Nelson; Jess H Lonner; Ashkan Lahiji; Jane Kim; Paul A Lotke



Sagittal osteotomy of the patella after Morscher  

PubMed Central

The aim of this study was to present long-term results of sagittal osteotomy of the patella after Morscher. The study included 70 patients treated for patellar dysplasia with a postoperative follow-up from nine to 20 years. There were 59 females and 11 males with an average age of 21 years at the time of operation. Results were evaluated for the entire group of 70 patients and then presented separately for the 30 patients in whom sagittal osteotomy of the patella was performed as a single procedure and 40 patients in whom, in addition to sagittal osteotomy of the patella, medialisation and ventralisation or distalisation of the tibial tuberosity were also performed. The mean value of the Wiberg patellar angle was 112 degrees preoperatively and 140 degrees postoperatively. In the whole group of patients excellent results were obtained in 24 (35%), good results in 30 (42%), fair results in 13 (19%) and poor results in three (4%) patients. In 30 patients with sagittal osteotomy as a single operation excellent results were obtained in 13 (43%), good results in 14 (47%) and fair results in three (10%) patients, while in the 40 patients with sagittal osteotomy and additional surgical procedures, 11 (27%) were excellent, 16 (40%) good, ten (25%) fair and three (8%) had poor results. Sagittal osteotomy of the patella after Morscher is an enrichment of the spectrum of the secondary-causal and preventive procedures for the treatment of patello-femoral disorders.

Pecina, Marko; Hudetz, Damir; Smoljanovic, Tomislav; Jankovic, Sasa



Intra-Articular Dislocation of the Patella  

PubMed Central

We present an unusual case of a chronic, irreducible intra-articular dislocation of the patella in an elderly nursing home resident. The patient had been unable to weight bear for 3 weeks. Radiographs in the emergency department (ED) confirmed the intra-articular dislocation with the superior pole lodged in the intercondylar notch. She underwent two failed closed reduction attempts and subsequently required an open reduction under general anaesthesia.

McHugh, Gavin; Ryan, Ed; Cleary, May; Kenny, Paddy; O'Flanagan, Shea; Keogh, Peter



Tophaceous Gout of the Patella: A Report of Two Cases  

PubMed Central

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.

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



Patella fractures associated with injuries of the knee ligament.  


Concurrent fractures of the patella and knee ligament ruptures are rare. From September 1985 to November 1989, 112 fractures of the patella were treated operatively at the Department of Traumatology at Celje General Hospital. In six patients (5%), associated badly injured ligaments of the knee joint were noted. During the operation, osteosynthesis of the patella was performed after the injured ligaments had been reconstructed. It is essential to examine the knee ligaments under general anesthesia before performing osteosynthesis of the patella. We have found no reports on this uncommon injury in the literature. PMID:9457353

Kosanovi?, M; Komadina, R; Batista, M



Surgical Treatment of Habitual Patella Dislocation with Genu Valgum  

PubMed Central

Habitual dislocation of patella is a rare disorder. Sometimes it is associated with angular deformity such as genu valgum. We experienced habitual patella dislocation associated with genu valgum that was treated with corrective osteotomy of distal femur and soft tissue realignment procedure including lateral release and medial reefing.

Kwak, Ji Hoon; Sim, Jae Ang; Kim, Nam Ki



Stress analysis in patella by three-dimensional photoelasticity  

NASA Astrophysics Data System (ADS)

In this paper, stress distribution in patella was studied by 3-D photoelastic experiments and finite element calculations. The experimental conditions were in good agreement with that of body mechanics: (1) The ratios of m. quadriceps femoris force FQ to lig. patella force FP were 1.03 - 1.42. (2) The angles between FQ and FP were 8.4 degree(s) - 18.7 degree(s). (3) The ratio of modulus of elasticity for epoxy resin and silicon rubber matched that for patella and cartilage, i.e., 145:1. The principal stresses and their path line, normal stresses, and contact stresses between patella and ossis femoris were determined in various flexion angles (15 degree(s), 30 degree(s), 45 degree(s), 60 degree(s), 75 degree(s), 90 degree(s)). Two of the correlations were: (1) Maximum principal stress in the front of patella; (sigma) max equals 35.8Wexp(0.024(alpha) ) KPa. (2) Maximum contact stress between patella and ossis femoris; (sigma) max equals -(6.86 - 0.14(alpha) + 0.02(alpha) 2)W KPa where W was body weight subjected by a single foot. It was proved that the transverse break of patella resulted from the case that the principle stress in the front of patella exceeded ultimate tensile strength. And Tension Band Wiring (TBW) therapy conformed to the law of physiological stress field. A modified K-needles position in TBW therapy was suggested. These results are useful for further research of human patella mechanics and recovery therapy. No similar result has been found in American MEDLIN Data Bank.

Chen, Riqi; Zhang, Jianxing; Jiang, Kunsheng



Patella malalignment, pain and patellofemoral progression: The Health ABC Study  

PubMed Central

Objective Patellofemoral (PF) joint OA is strongly correlated with lower extremity disability and knee pain. Risk factors for pain and structural progression in patellofemoral OA are poorly understood. Our objective was to determine the association between patella malalignment and its relation to pain severity, and PF OA disease progression. Methods We conducted an analysis of data from the Health ABC knee OA study. Health ABC is a community based, multi-center cohort study of 3,075 Caucasian and Black men and women aged 70–79 at enrollment. Weight bearing skyline knee x-rays were obtained in a subset (595) of subjects, with and without knee pain, at year 2 and year 5 (mean follow-up 36 months). Films were read paired, and patellofemoral osteophytes (OST) and narrowing (JSN) were scored on a 0–3 scale using the OARSI atlas. We defined progression of PF OA as any increase in JSN score. 3 measures of patella malalignment were made: sulcus angle; patella tilt angle; and patella subluxation medially or laterally (bisect offset). Knee symptoms were assessed using a knee specific WOMAC knee pain subscale. We assessed the relationship between baseline patella malalignment and pain severity (linear regression for WOMAC) and compartment specific PF OA progression (logistic regression for dichotomous outcomes). We classified continuous measures of patella alignment into quartile groups. We performed multivariable adjusted logistic regression models, including age, gender and BMI to assess the relation of baseline patella alignment to the occurrence of PF JSN progression using generalized estimating equations. Results The subjects had a mean age 73.6 (SD 2.9), BMI 28.8 (SD 4.9), 40.3% male, and 46% were Black. Medial displacement of the patella predisposed to medial JSN progression; odds for each quartile 1, 1.2, 1.2, 2.2 (p for trend=0.03), whilst protecting from lateral JSN progression; odds for each quartile 1, 0.7, 0.6, 0.4 (p for trend=0.0004). Increasing patella tilt protected from medial JSN progression; odds for each quartile 1, 0.8, 0.5, 0.2 (p<0.0001) and trended to increasing pain severity (p=0.09). Conclusion Patella malalignment is associated with PF disease progression. Medial displacement and tilt of the patella predisposes to medial JSN progression, whilst lateral displacement is predictive of lateral JSN progression. The influence of patella malalignment has important implications since it is potentially modifiable through footwear, taping and/ or knee bracing.

Hunter, DJ; Zhang, YQ; Niu, JB; Felson, DT; Kwoh, K; Newman, A; Kritchevsky, S; Harris, T; Carbone, L; Nevitt, M



Osteomyelitis of the patella caused by Legionella anisa.  


A 51-year-old man with a history of stage IV angioimmunoblastic T-cell lymphoma was diagnosed with osteomyelitis of the patella. Legionella anisa was identified by 16S rRNA gene sequencing and culture. The patient had pneumonia 2 months prior to this osteomyelitis episode. L. anisa was retrospectively detected in his lung tissue by 16S rRNA gene sequencing and was considered the source of the L. anisa that caused his patella osteomyelitis. PMID:23761141

Sanchez, Martha Cristina; Sebti, Rani; Hassoun, Patrice; Mannion, Ciaran; Goy, Andre H; Feldman, Tatyana; Mato, Anthony; Hong, Tao



Biologic resurfacing of the patella: current status.  


The techniques of biologic resurfacing of the patella, like other joint surfaces, are still evolving. Currently none of them is free from criticism. In this regard it is our hope that progress in the basic science will offer in the near future new and more optimistic therapeutic possibilities (i.e., the restoration of a reparative cartilage that is structurally and functionally comparable to the native one). The greater expectancies come perhaps from the present experimental investigations about the combined use of tissue-engineered implants embedded with staminal cells and growth factors. Many problems remain to be solved, however, before reliable applicability in humans. From a general point of view, stem cells obtained from various sources (e.g., adult bone marrow, umbilical cord) offer the same finalities as the embryonic stem cells, without the ethical obstacles related to the latter. Therefore, it may be that restoration of part or all of the articular surface of a joint will be possible by way of these mesenchymal progenitors that have the ability to differentiate into the chondrogenic and osteogenic lines, which is required for the restoration of the various layers of a normal articular cartilage and subchondral bone. PMID:12365242

Scapinelli, Raphaele; Aglietti, Paolo; Baldovin, Marino; Giron, Francesco; Teitge, Robert



Shift and Tilt of the bony patella in total knee replacement  

Microsoft Academic Search

Summary  \\u000a Resurfacing the patella or not in total knee arthroplasty is generally still a quite controversial topic. In that context\\u000a we felt a necessity to get more informations about the natural history of a non resurfaced patella in the prosthetic surrounding\\u000a than only in comparison with a replaced patella. By the fact that we haven't been replacing patellae apart from

B. E. Gerber; F. Maenza



Surgical treatment for permanent dislocation of the patella in adults.  


Permanent dislocation of the patella in adults is a rare condition that presents with complete irreducible lateral dislocation of the patella, combined with secondary changes, such as valgus deformity and leg-length discrepancy. Because these secondary changes cannot heal spontaneously after skeletal maturation if left untreated, the patients frequently possess pathology not limited to the knee joint and extending to the whole lower extremity, such as malalignment or leg-length discrepancy, that can develop into osteoarthritis of the knee. However, to our knowledge, few surgeons advocate the significance of correcting the malalignment in treating adult patients. We treated a 34-year-old woman with permanent dislocation of the patella in a 2-stage surgery, consisting of first-stage correction of valgus deformity and limb shortening using a Ilizarov external fixator and second-stage realignment of the dislocated patella over the trochlea. A follow-up examination conducted 3 years after the second operation revealed plantigrade gait with normal alignment of the lower extremity without limping and medial thrust. The patella was tracking centrally in the patellofemoral groove. Radiographs showed a neutral mechanical axis of the lower extremity, no evidence of patellar subluxation, and no deteriorating osteoarthritic changes at the tibiofemoral joint. This case highlights the importance of correcting secondary changes, such as valgus deformity and leg-length discrepancy, to reduce the risk of future osteoarthrosis and postoperative dislocation, especially when these deformities are substantial. PMID:22146216

Noda, Mitsuaki; Saegusa, Yasuhiro; Kashiwagi, Naoya; Seto, Yoichi



Case Report: Patella Baja After Retrograde Femoral Nail Insertion  

PubMed Central

Patella baja is a rare condition that can result from conditions involving trauma around the knee. Risk factors are believed to include scar tissue formation in the retropatellar fat pad, extensor mechanism dysfunction, and immobilization in extension. Early recognition and aggressive treatment are critical components in minimizing long-term disability. We present a case report of a woman with a fracture of the femoral diaphysis who underwent retrograde placement of an intramedullary nail. Subsequent followup revealed development of patella baja with resultant disability. The diagnosis was made late and the treatment was ineffective. Although patella baja has been reported in trauma around the knee, causative factors include retrograde femoral nailing. We believe early recognition and institution of treatment are important.

Mirza, Amer



A case of nail-patella syndrome associated with thyrotoxicosis  

PubMed Central

Nail-patella syndrome, also known as hereditary onycho-osteodystrophy, is a rare autosomal dominant disorder with pleiotropic phenotypic expression. The present report is of a nail-patella syndrome patient, a 26-year-old female, admitted to our NeuroMuscular Rehabilitation Clinic Division for neurological symptoms, secondary to a severe spondylolysthesis with bilateral L5 pedicle fracture. During hospitalization, she was also diagnosed with mild thyrotoxicosis, but interestingly enough, the bone mineral density, assessed at multiple sites, was quasi-normal. Abbreviations BMD – bone mineral density, BMI – body mass index, DXA – dual-energy X-ray absorptiometry, FT4 – serum free thyroxin, HOOD – Hereditary onycho-osteodystrophy, NPS – Nail-patella syndrome, TSH – thyroid-stimulating hormone

Haras, B; Vulpoi, F; Onose, Gh



Superior dislocation of the patella: a case report  

PubMed Central

Background Superior dislocation of the patella is an uncommon condition that mainly occurs in knees with a high patella and medial femorotibial degenerative arthritis. There are no previous reports of this condition occurring in association with tibial valgus osteotomy. Case report: We report the case of a patient in whom vertical dislocation recurred twice at 4 months after tibial valgus osteotomy. To avert additional recurrence or new dislocations, the patient was treated surgically to remove the existing osteophytes. Conclusions: An arthroscopic approach was decided because of the lower associated morbidity and good results with this technique compared to open surgery.

Cusco, Xavier; Seijas, Roberto; Ares, Oscar; Cugat, Jose R; Garcia-Balletbo, Montserrat; Cugat, Ramon



Development of microsatellite loci for the black-footed limpet, Patella depressa , and cross-amplification in two other Patella species  

Microsoft Academic Search

Limpets (Patella spp.) are suitable organisms to investigate the effects of climate change in marine systems. They are widespread over NE\\u000a Atlantic intertidal rocky shores and have been extensively studied in terms of population dynamics and ecology. Within genus\\u000a Patella, microsatellites have only been developed for Patella caerulea and cross-species tests are unknown. In this work, we describe 11 primer

M. Pérez; M. Branco; A. Llavona; P. A. Ribeiro; A. M. Santos; S. J. Hawkins; J. A. Dávila; P. Presa; P. Alexandrino



Bilateral recurrent patellar dislocation in a patient with isolated patella aplasia-hypoplasia.  


Patella aplasia-hypoplasia is a rare condition characterized by the congenital absence or marked reduction of the patellar bone. It is well known that patella aplasia-hypoplasia occurs in nail-patella syndrome, small patella syndrome, and several other syndromes. However, isolated patella aplasia-hypoplasia without associated clinical or radiologic anomalies, first described by Kutz in 1949, is an extremely rare condition. This report describes 12 years' follow-up after medial patellofemoral ligament reconstruction surgery performed for bilateral recurrent patellar dislocation in a 29-year-old patient with isolated patella aplasia-hypoplasia. The patient had no radiographic findings of elbow abnormalities, exostoses of the ilia, or abnormal ossification of the ischiopubic junction. The right patella was severely subluxated, and the left patella was mildly subluxated. The preoperative Kujala score was 28 points for the right patella and 23 points for the left. Medial patellofemoral ligament reconstruction, wide lateral release, and patellaplasty with multiple drilling were done in July 1993 for the left knee and in August 1993 for the right. At 12 years' follow-up, the Kujala score was 68 points for the right patella and 73 points for the left, and the patient was satisfied with the result. Magnetic resonance images showed both patellae without subluxation and bulky regenerated ligaments. PMID:17916489

Nomura, Eiki; Inoue, Motoyasu; Kobayashi, Shigeru



Patellar maltracking is prevalent among patellofemoral pain subjects with patella alta: an upright, weightbearing MRI study.  


The purpose of this study is to determine if patellar maltracking is more prevalent among patellofemoral (PF) pain subjects with patella alta compared to subjects with normal patella height. We imaged 37 PF pain and 15 pain free subjects in an open-configuration magnetic resonance imaging scanner while they stood in a weightbearing posture. We measured patella height using the Caton-Deschamps, Blackburne-Peel, Insall-Salvati, Modified Insall-Salvati, and Patellotrochlear indices, and classified the subjects into patella alta and normal patella height groups. We measured patella tilt and bisect offset from oblique-axial plane images, and classified the subjects into maltracking and normal tracking groups. Patellar maltracking was more prevalent among PF pain subjects with patella alta compared to PF pain subjects with normal patella height (two-tailed Fisher's exact test, p<0.050). Using the Caton-Deschamps index, 67% (8/12) of PF pain subjects with patella alta were maltrackers, whereas only 16% (4/25) of PF pain subjects with normal patella height were maltrackers. Patellofemoral pain subjects classified as maltrackers displayed a greater patella height compared to the pain free and PF pain subjects classified as normal trackers (two-tailed unpaired t-tests with Bonferroni correction, p<0.017). This study adds to our understanding of PF pain in two ways-(1) we demonstrate that patellar maltracking is more prevalent in PF pain subjects with patella alta compared to subjects with normal patella height; and (2) we show greater patella height in PF pain subjects compared to pain free subjects using four indices commonly used in clinics. PMID:23165335

Pal, Saikat; Besier, Thor F; Beaupre, Gary S; Fredericson, Michael; Delp, Scott L; Gold, Garry E



Tuberculosis of the patella masquerading as prepatellar bursitis.  


Tuberculosis of bone is an uncommon entity in the western world. We present a case of tuberculosis of the patella mimicking prepatellar bursitis in an otherwise fit and well woman of Bangladeshi origin. We believe tuberculosis of bone should form a differential diagnosis of the swollen knee in high-risk patients. PMID:23317718

MacLean, S; Kulkarni, S



Molecular analysis of early specification in the mollusc Patella vulgata  

Microsoft Academic Search

Mollusken (o.a. slakken) maken deel uit van de enorm grote groep van\\u000ainvertebraten. De vroege ontwikkeling van de mollusk Patella vulgata is bestudeerd\\u000aals modelsysteem voor de mollusken. De vroege ontwikkeling van deze zeeslakken\\u000akenmerkt zich door enerzijds de manier van klieven, namelijk spiraalklieving, en\\u000aanderzijds door de vorming van een larvaal stadium, de trochophora larve. De\\u000atrochophora beweegt zich

J. H. E. M. Klerkx



Development of the musculature in the limpet Patella (Mollusca, Patellogastropoda)  

Microsoft Academic Search

Whole-mount technique using fluorescent-labelled phalloidin for actin staining and confocal laser scanning microscopy as\\u000a well as semi-thin serial sectioning, scanning and transmission electron microscopy were applied to investigate the ontogeny\\u000a of the various muscular systems during larval development in the limpets Patella vulgata L. and P. caerulea L. In contrast to earlier studies, which described a single or two larval

A. Wanninger; Bernhard Ruthensteiner; Susanne Lobenwein; Willibald Salvenmoser; Wim J. A. G. Dictus; Gerhard Haszprunar



Secondary Aneurysmal Bone Cyst Following Chondroblastoma of the Patella  

PubMed Central

Aneurysmal bone cyst (ABC) is a rare benign cystic lesion of the bone that composes 1-2% of the entire bone tumors. Some are idiopathic, and some occur secondary to other tumors such as giant cell tumor and chondroblastoma. In this article, we report the clinical, radiographic, and histological findings of a secondary ABC following chondroblastoma of the patella with a review of the literature.

Tomoyuki, Kato; Susa, Michiro; Nakayama, Robert; Watanabe, Itsuo; Horiuchi, Keisuke; Toyama, Yoshiaki; Morioka, Hideo



Management of the Deficient Patella in Revision Total Knee Arthroplasty  

PubMed Central

There are a number of options available to manage the patella when revising a failed total knee arthroplasty. If the previous patellar component is well-fixed, undamaged, not worn, and compatible with the femoral revision component, then it can be retained. When a patellar component necessitates revision and is removed with adequate remaining patellar bone stock, an onlay-type all-polyethylene cemented implant can be used. Management of the patella with severe bony deficiency remains controversial. Treatment options for the severely deficient patella include the use of a cemented all-polyethylene biconvex patellar prosthesis, patellar bone grafting and augmentation, patellar resection arthroplasty (patelloplasty), performing a gull-wing osteotomy, patellectomy, or the use of newer technology such as a tantalum (trabecular metal) patellar prosthesis. Severe patellar bone deficiency is a challenging situation because restoration of the extensor mechanism, proper patellar tracking, and satisfactory anatomic relationships with the femoral and tibial components are critical for an optimal clinical outcome. Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Kraay, Matthew J.; Conroy-Smith, Patricia A.; Goldberg, Victor M.



The associations between indices of patellofemoral geometry and knee pain and patella cartilage volume: a cross-sectional study  

PubMed Central

Background Whilst patellofemoral pain is one of the most common musculoskeletal disorders presenting to orthopaedic clinics, sports clinics, and general practices, factors contributing to its development in the absence of a defined arthropathy, such as osteoarthritis (OA), are unclear. The aim of this cross-sectional study was to describe the relationships between parameters of patellofemoral geometry (patella inclination, sulcus angle and patella height) and knee pain and patella cartilage volume. Methods 240 community-based adults aged 25-60 years were recruited to take part in a study of obesity and musculoskeletal health. Magnetic resonance imaging (MRI) of the dominant knee was used to determine the lateral condyle-patella angle, sulcus angle, and Insall-Salvati ratio, as well as patella cartilage and bone volumes. Pain was assessed by the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) VA pain subscale. Results Increased lateral condyle-patella angle (increased medial patella inclination) was associated with a reduction in WOMAC pain score (Regression coefficient -1.57, 95% CI -3.05, -0.09) and increased medial patella cartilage volume (Regression coefficient 51.38 mm3, 95% CI 1.68, 101.08 mm3). Higher riding patella as indicated by increased Insall-Salvati ratio was associated with decreased medial patella cartilage volume (Regression coefficient -3187 mm3, 95% CI -5510, -864 mm3). There was a trend for increased lateral patella cartilage volume associated with increased (shallower) sulcus angle (Regression coefficient 43.27 mm3, 95% CI -2.43, 88.98 mm3). Conclusion These results suggest both symptomatic and structural benefits associated with a more medially inclined patella while a high-riding patella may be detrimental to patella cartilage. This provides additional theoretical support for the current use of corrective strategies for patella malalignment that are aimed at medial patella translation, although longitudinal studies will be needed to further substantiate this.



Medial patellofemoral ligament injury patterns and associated pathology in lateral patella dislocation: an MRI study  

Microsoft Academic Search

BACKGROUND: Lateral Patella dislocations are common injuries seen in the active and young adult populations. Our study focus was to evaluate medial patellofemoral ligament (MPFL) injury patterns and associated knee pathology using Magnetic Resonance Imaging studies. METHODS: MRI studies taken at one imaging site between January, 2007 to January, 2008 with the final diagnosis of patella dislocation were screened for

Patrick Guerrero; Xinning Li; Ketan Patel; Michael Brown; Brian Busconi



Diagnosis and treatment of stress fracture of the patella in atheletes  

Microsoft Academic Search

Five cases of stress fracture of the patella in athletes are presented. Four of these occurred transversally in the lower part and one longitudinally in the lateral part of the patella. Three of the patients were females (endurance runner, high jumper, and orienteerer) and two males (volleyball and soccer player). The diagnosis was made 2–8 months from the onset of

S. Orava; S. Taimela; M. Kvist; J. Karpakka; A. Hulkko; U. Kujala



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

Microsoft Academic Search

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

Robert L. Barrack



Superior dislocation of the patella with early onset patellofemoral arthritis: a case report and literature review  

Microsoft Academic Search

Among the traumatic patellar dislocations, superior dislocation of patella without patellar ligament injury is very rare. We present in this article, a case of superior dislocation of the patella trapped by interlocked osteophytes in a 38-year-old female who had concurrent bilateral knee arthrosis. Succesful reduction was achieved by closed manipulation without anesthesia. Neither redislocation nor symptoms of instability was seen

Onder Ofluoglu; Davud Yasmin; Rakesh Donthineni; Muzaffer Yildiz



Biomechanical comparison of a new staple technique with tension band wiring for transverse patella fractures  

Microsoft Academic Search

BackgroundThe tension band wiring technique is the most common method of transverse patella fracture fixation. Since post-operative instabilities have been reported for this technique, alternative osteosynthesis solutions are of interest. We investigated the biomechanical behaviour of a new staple technique for treatment of transverse patella fractures in a cadaveric model.

Bernd Schnabel; Martin Scharf; Karsten Schwieger; Markus Windolf; Bas van der Pol; Volker Braunstein; Andreas Appelt



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


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

Barrack, Robert L



Knee flexion deformity and patella alta in spastic cerebral palsy.  


A study on spastic knee flexion deformity has revealed a recurrence rate of 32 per cent following attempted surgical correction on 170 knees (103 patients). This rate appeared to be unrelated to concomitant surgery for correction of hip and ankle deformity. An additional study demonstrated patella alta in 72 per cent of 100 spastic knees (50 patients) and only 2 per cent and 50 knees of a comparable group of 25 non-spastic patients. It is suggested that restoration of a normal patello-femoral relationship may reduce both the functional disability and recurrence rate of spastic knee flexion deformity when this disease is managed surgically. PMID:939346

Lotman, D B



Surgical versus conservative management of patella fractures in cats: A retrospective study  

PubMed Central

This study compared the clinical outcome in cats with patella fractures treated by surgery to those treated conservatively. Six cats with 9 patella fractures were treated. Six fractures were treated surgically and 3 were treated conservatively. Medical records of all 6 patients were reviewed for age, breed, gender, trauma, and fracture conformation. All patients had follow-up which consisted of a physical examination, radiographs, and an interview with the client between 1 and 4.5 y after surgery or diagnosis. All cats treated conservatively returned to normal activity with no gait abnormalities. In cats that had surgery, 4/6 had breakdown of the surgical repair but all cats went on to full recovery with normal activity and gait. The conclusions of this preliminary study are that surgical repair of cat patella fractures has a high rate of implant failure and that conservative management of cat patella fractures results in excellent clinical outcome.

Salas, Nicole; Popovitch, Catherine



Medial Quadriceps Tendon-Femoral Ligament: Surgical Anatomy and Reconstruction Technique to Prevent Patella Instability  

PubMed Central

Detailed anatomic dissections of the deep medial knee retinaculum have shown a consistent prominent anatomic structure extending from the distal deep quadriceps tendon to the adductor tubercle region, forming a distinct medial quadriceps tendon–femoral ligament (MQTFL). Reconstruction of this anatomic structure has yielded consistent medial stabilization of the patellofemoral joint without drilling into the patella over more than 3 years in patients with recurrent patella instability and dislocation. Results are similar to those of MPFL reconstruction but with reduced risk of patella fracture, a known and serious complication of MPFL reconstruction. The reconstruction graft is secured at the anatomic femoral origin of the MQTFL and brought under the vastus medialis such that it may be woven and attached to the deep distal medial quadriceps tendon to provide a secure, reliable reproduction of the MQTFL and excellent stabilization of the patellofemoral joint without risk of patella fracture.

Fulkerson, John P.; Edgar, Cory



Unknown syndrome: mental retardation with dysmorphic features, early balding, patella luxations, acromicria, and hypogonadism  

PubMed Central

A patient is described with severe mental retardation, a peculiar face with small palpebral fissures and premature balding, habitual patella luxations, small hands and feet, and hypogonadism, a combination which appears to represent a new syndrome. Images

Scholte, F A; Begeer, J H; Essen, A J Van



Effect of a Muscle Relaxant on the Biomechanics of the Patella Reflex.  

National Technical Information Service (NTIS)

The thesis is on the development of a device and technique for the simple and direct measurement of the biomechanical parameters of reflex movements, such as displacement, velocity, and acceleration. The biomechanical profile of the patella reflex of heal...

R. K. Jarvik



Early PROMs Following Total Knee Arthroplasty-Functional Outcome Dependent on Patella Resurfacing.  


Patella resurfacing during primary total knee arthroplasty (TKA) remains controversial. Variation in published results for patella resurfacing may potentially be explained by differences in design between TKA brands. We interrogated NJR-PROMs data to ascertain whether there is an early functional benefit to resurfacing the patella, both overall and for each of the five most popular primary knee designs through use of the Oxford Knee Score. A total of 8103 resurfaced TKAs and 15,290 nonresurfaced TKAs were studied. There was a large variation in the proportion of knees undergoing patella resurfacing by brand (Nexgen=16% versus Triathlon=52%). Patellar resurfacing did not significantly influence the magnitude of improvement in overall knee function or anterior knee-specific function irrespective of TKA brand or for cruciate retaining versus sacrificing designs. PMID:23769662

Baker, Paul N; Petheram, Timothy; Dowen, Daniel; Jameson, Simon S; Avery, Peter J; Reed, Mike R; Deehan, David J




Microsoft Academic Search

This article examines the presence, distribution, nature and sources of 19 Polycyclic Aromatic Hydrocarbons (PAH), in Patellae (patella vulgate L.) and seaweed (vulva) sampled in different stations of Sicilian coastal environments and analyzed for their polycyclic aromatic hydrocarbon (PAH) content.Analysis was performed by gas chromatography\\/mass spectrometry (GC\\/MS) with selected ion monitoring (SIM), after saponification of the sample and clean up

Antonio Gianguzza; Santino Orecchio



Locked knee from superior dislocation of the patella-diagnosis and management of a rare injury.  


Knee locking is often caused by a torn meniscus or loose body. A rare cause of knee locking is a superior dislocation of the patella following trauma with less than 20 reported cases in the English literature. An unusual case of a locked knee secondary to interlocking osteophytes between the medial femoral condyle and the inferior pole of the patella without any history of trauma is presented. PMID:21127839

Siddiqui, Mashfiqul A; Tan, M H



Reducing the Lateral Force Acting on the Patella Does Not Consistently Decrease Patellofemoral Pressures  

Microsoft Academic Search

Background: Extensor mechanism procedures that decrease the lateral component of the patellar tendon or quadriceps force acting on the patella do not consistently reduce pain.Hypothesis: Patellofemoral treatments do not consistently decrease patellofemoral pressures because of variations in the moments acting on the patella.Study Design: Computer simulation study.Methods: Computational models of 4 knees were constructed to characterize the patellofemoral pressure distribution

John J. Elias; Jennifer A. Cech; David M. Weinstein; Andrew J. Cosgrea



Automated segmentation for patella from lateral knee X-ray images.  


X-ray image segmentation is an important issue in medical image analysis. Due to inconsistent X-ray absorption, the intensities are usually unevenly distributed and noisy in the processed organ, thus the object segmentation becomes difficult. In this paper we propose a new segmentation method for patella from the lateral knee X-ray images based on the active shape model (ASM). At first, a patella shape model is constructed by principal component analysis (PCA) of corresponding landmarks obtained from a set of training shape. As the knee X-ray image usually contains many anatomical structures, we design a strategy based on edge tracing to place the initial shape model as close to the patella boundary as possible. Then, the shape model is deformed and fitted to the patella boundary by using a dual-optimization approach that includes a genetic algorithm (GA) to get the global geometric transform and ASM to deform the shape model iteratively. Consequently, the proposed method can cope with different knee X-ray images and can segment the patella in an automatic procedure. In the experiment, 20 images were tested and promising results are obtained by the proposed method. This method is found useful for the clinical evaluation and biomechanical study of knee. PMID:19963588

Chen, H C; Wu, C H; Lin, C J; Liu, Y H; Sun, Y N



Elongated patellae at the final stage of Osgood-Schlatter disease: a radiographic study.  


Aetiology of Osgood-Schlatter disease (OSD) is still unknown. Relative length of the patellar articular surface with the length of the patella, relative height of the tibial tubercle with the sagittal diameter of the tibia, Insall-Salvati, Blackburne-Peel, and Caton-Deschamps indexes, as well as Grelsamer-morphology type of the patella were measured from preoperative plain X-rays in 82 knees of 20-year-old males with OSD and in 87 knees of 20-year-old male controls with normal MRI findings of the knee. Seventy-eight of the OSD patients had separate ossicles. Their mean patellar morphology index was 1.44 and that of the controls was 1.28 (p<0.001), indicating significant lengthening of the patellar body among the OSD group. OSD patients had also significantly more often Grelsamer type II (elongated patellae) than the controls. Tibial tuberosity was significantly higher among OSD patients, but was not correlated with the lengthening of the patella. An increased patellar height among OSD patients was shown by the Blackburne-Peel and Caton-Deschamps indexes (p<0.001) and the Insall-Salvati index (p=0.018). OSD patients exhibit elongated patellae and patellar tendons which may result from long-standing tension of the extensor apparatus during growth spurt, when femoral growth exceeds that of the anterior structures of the knee. PMID:17407814

Visuri, T; Pihlajamäki, H K; Mattila, V M; Kiuru, M



Recurrent atraumatic superior dislocation of the patella: case report and review of the literature.  


Recurrent atraumatic superior dislocation of the patella with spontaneous reduction prevented by interlocking osteophytes has not been previously reported. Eight previous case reports were noted in the literature with single episodes of interlocking by osteophytes in a superior dislocation, none with recurrence, and all treated by closed reduction. The presentation of a 60-year-old woman with recurrent atraumatic superior dislocation of the patella on three separate occasions required closed reduction due to interlocking patella and trochlear osteophytes that were preventing spontaneous reduction. Arthroscopic debridement of these osteophytes resulted in no functional limitation or recurrence of dislocation at 28-month follow-up. This case demonstrates successful arthroscopic treatment of this previously unreported condition. In light of the increasingly active aging population with coexistent patellofemoral joint osteoarthritis, this presentation may become more frequent. PMID:1466719

Teuscher, D D; Goletz, T H



Linkage analysis in two large Italian pedigrees affected with nail patella syndrome.  


Nail patella syndrome (NPS) or osteo-onychodysplasia, is an autosomal dominant disorder characterised by nail dysplasia, absent or hypoplastic patellae, iliac horns and nephropathy. Previous studies have demonstrated linkage of the nail patella locus to the ABO and adenylate kinase loci on human chromosome 9q34. Recently, informative recombination events placed the NPS locus within a 1-2 cM interval within D9S60 and the AK1 gene. We describe here linkage analysis performed in two large Italian pedigrees with 10 and 11 members affected, respectively. A set of highly informative markers have been analysed and the allele segregation in the two families confirmed the linkage to chromosome 9. The presence of three recombination events allows definition of the critical region with a centrometric boundary between markers D9S1881 and D9S1840 and a telomeric boundary between markers D9S315 and D9S290. PMID:9781042

Melchionda, S; Seri, M; Carella, M; Piemontese, M R; Zhang, X X; Zelante, L; Romeo, G; Gasparini, P


Patella Infera in an HIV Positive Patient Following Total Knee Arthroplasty  

PubMed Central

A lowering of the patella after total knee arthroplasty is accompanied by pain and a restriction of the range of motion. With its etiology being unclear at present, a multifactorial genesis is under discussion. For the first time, we present a case report describing an HIV infection as a possible cause of patella infera. A 54-year-old HIV-positive woman developed patella infera (Insall-Salvati ratio 0.6) with a painful restriction of motion 18 months after implantation of a bicondylar surface prosthesis. By changing to a partially coupled endoprosthesis, distalization of the joint line and partial patellar resection, the patient was free of symptoms with a ROM of 0°/0°/110°. All risk factors known from the literature could be excluded in this case, so that the presence of an HIV infection has to be discussed as a possible cause.

Matziolis, Georg; Morawietz, Lars; Matziolis, Doerte; Perka, Carsten



Fixed-angle plates in patella fractures - a pilot cadaver study  

PubMed Central

Objective Modified anterior tension wiring with K-wires and cannulated lag screws with anterior tension wiring are currently the fixation of choice for patellar fractures. Failure of fixation, migration of the wires, postoperative pain and resulting revision surgery, however, are not uncommon. After preliminary biomechanical testing of a new fixed-angle plate system especially designed for fixation of patella fractures the aim of this study was to evaluate the surgical and anatomical feasibility of implanting such a plate-device at the human patella. Methods In six fresh unfixed female cadavers without history of previous fractures around the knee (average age 88.8 years) a bilateral fixed-angle plate fixation of the patella was carried out after previous placement of a transverse central osteotomy. Operative time, intra-operative problems, degree of retropatellar arthritis (following Outerbridge), quality of reduction and existence of any intraarticular screw placement have been raised. In addition, lateral and anteroposterior radiographs of all specimens were made. Results Due to the high average age of 88.8 years no patella showed an unimpaired retropatellar articular surface and all were severely osteoporotic, which made a secure fixation of the reduction forceps during surgery difficult. The operation time averaged 49 minutes (range: 36-65). Although in postoperative X-rays the fracture gap between the fragments was still visible, the analysis of the retropatellar surface showed no residual articular step or dehiscence > 0.5 mm. Also in a total of 24 inserted screws not one intraarticular malposition was found. No intraoperative complications were noticed. Conclusions Osteosynthesis of a medial third patella fracture with a bilateral fixed-angle plate-device is surgically and anatomically feasible without difficulties. Further studies have to depict whether the bilateral fixed-angle plate-osteosynthesis of the patella displays advantages over the established operative procedures.



Medial patellofemoral ligament reconstruction for recurrent dislocation of the patella: a preliminary report.  


We present a surgical technique for the treatment of recurring dislocation of the patella. The procedure, based on Galleazzi's tenodesis of the semitendinosus, uses minimal dissection and small incisions to improve cosmetic results and speed recovery. A polyester ligament is passed through a bone tunnel at the midline of the patella and fixed at the medial condyle, thus creating a medial patellofemoral neoligament. We have reviewed the results of 30 knees in 30 patients with an average follow-up of 39 months. Twenty-five patients (83.3%) showed significant improvement of their initial complaints. PMID:1418205

Ellera Gomes, J L



Medial patellofemoral ligament injury patterns and associated pathology in lateral patella dislocation: an MRI study  

PubMed Central

Background Lateral Patella dislocations are common injuries seen in the active and young adult populations. Our study focus was to evaluate medial patellofemoral ligament (MPFL) injury patterns and associated knee pathology using Magnetic Resonance Imaging studies. Methods MRI studies taken at one imaging site between January, 2007 to January, 2008 with the final diagnosis of patella dislocation were screened for this study. Of the 324 cases that were found, 195 patients with lateral patellar dislocation traumatic enough to cause bone bruises on the lateral femoral trochlea and the medial facet of the patella were selected for this study. The MRI images were reviewed by three independent observers for location and type of MPFL injury, osteochondral defects, loose bodies, MCL and meniscus tears. The data was analyzed as a single cohort and by gender. Results This study consisted of 127 males and 68 females; mean age of 23 yrs. Tear of the MPFL at the patellar attachment occurred in 93/195 knees (47%), at the femoral attachment in 50/195 knees (26%), and at both the femoral and patella attachment sites in 26/195 knees (13%). Attenuation of the MPFL without rupture occurred in 26/195 knees (13%). Associated findings included loose bodies in 23/195 (13%), meniscus tears 41/195 (21%), patella avulsion/fracture in 14/195 (7%), medial collateral ligament sprains/tears in 37/195 (19%) and osteochondral lesions in 96/195 knees (49%). Statistical analysis showed females had significantly more associated meniscus tears than the males (27% vs. 17%, p = 0.04). Although not statistically significant, osteochondral lesions were seen more in male patients with acute patella dislocation (52% vs. 42%, p = 0.08). Conclusion Patients who present with lateral patella dislocation with the classic bone bruise pattern seen on MRI will likely rupture the MPFL at the patellar side. Females are more likely to have an associated meniscal tear than males; however, more males have underlying osteochondral lesions. Given the high percentage of associated pathology, we recommend a MRI of the knee in all patients who present with acute patella dislocation.

Guerrero, Patrick; Li, Xinning; Patel, Ketan; Brown, Michael; Busconi, Brian



Latero-distal transposition of the tibial crest in cases of medial patellar luxation with patella alta.  


Medial patellar luxation is defined as medial displacement of the patella from the trochlear groove. In dogs, medial luxations account for 75% of all patellar luxation cases, and are frequently associated with patella alta. Common surgical treatments for medial luxation are trochleoplasty and lateral transposition of the crest to drive the patella into the correct anatomical alignment. Postoperative complications for this procedure are estimated to be between 18-29% of cases, with up to 48% of complications involving reluxation. It was previously hypothesized that in cases of medial luxation involving patella alta, the addition of a distal component to the lateral tibial crest transposition will result in repositioning of the patella into its proper position in the trochlear groove, thus reducing the recurrence of luxation. We performed this modified procedure on 14 dogs (17 limbs) that were suffering from medial luxation combined with patella alta, and our results led to favourable clinical outcomes. This modified surgical procedure places the patella into a more normal proximo-distal anatomical position, is simple to perform, and may become common practice for surgical treatment of medial patellar luxation with an alta component. PMID:22535480

Segal, U; Or, M; Shani, J



Velocity of ultrasound at the patella: Influence of age, menopause and estrogen replacement therapy  

Microsoft Academic Search

Determination of apparent velocity of ultrasound (AVU) in bone has been proposed as a valuable tool for discriminating between normal and osteoporotic women. We have studied the influence of age, menopause and estrogen replacement therapy (ERT) on AVU at the patella in a large sample of pre- and postmenopausal women. Three hundred and eighteen woman aged 40–60 year participated in

R. Lehmann; M. Wapniarz; H. M. Kvasnicka; K. Klein; B. Allolio



Sex determination by discriminant analysis: an evaluation of the reliability of patella measurements  

Microsoft Academic Search

Recently, a method which estimates the sex of unknown skeletal remains by discriminant function analysis of the patella has received much recognition. With seven simple measurements and a sexing accuracy of almost 84% this morphometric approach would be very suitable both in the forensic and anthropological context. In order to put this method to the test, 52 unfractured and non-pathological

Ariane Kemkes-Grottenthaler



Rare predation by the intertidal crab Pachygrapsus marmoratus on the limpet Patella depressa  

Microsoft Academic Search

The predatory eˇects of Pachygrapsus marmoratus on populations of the intertidal limpet Patella depressa were analysed on rocky shores located on the central coast of Portugal. Nocturnal observations on crab feeding behaviour were conducted and experimental exclusion cages were set in the substratum to assess density eˇects on limpets. The results indicated that although crabs feed on adult limpets the

Ana Silva; Diana Boaventura; Augusto Flores; Stephen J. HawkinsO



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


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

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



Anatomical transverse patella double tunnel reconstruction of medial patellofemoral ligament with a hamstring tendon autograft for recurrent patellar dislocation  

Microsoft Academic Search

Introduction  The purpose of this study was to describe our transverse patella double tunnel technique to reconstruct the medial patellofemoral\\u000a ligament (MPFL) with a hamstring tendon autograft in patients who suffered recurrent dislocation of the patella, and to evaluate\\u000a the intermediate-term outcomes of reconstruction treatment.\\u000a \\u000a \\u000a \\u000a \\u000a Materials and methods  Fifty-nine consecutive knees (52 patients) with recurrent dislocation of the patella without marked predisposing

Hua Han; Yayi Xia; Xiangdong Yun; Meng Wu



Defining the Lateral and Accessory Views of the Patella: An Anatomic and Radiographic Study with Implications for Fracture Treatment.  


OBJECTIVE:: The majority of orthopaedic surgeons rely on a lateral fluoroscopic image to assess reduction during patella fracture osteosynthesis. However, a comprehensive radiographic description of the lateral view of the patella has not been previously performed, and no accessory views to better visualize specific anatomic features have been developed. The purpose of this study was to provide a detailed anatomic description of all radiographic features of the true lateral of the patella, describe reproducible accessory views for assessing specific features of the patella and demonstrate their utility in a fracture model. METHODS:: 12 cadaver knee specimens free of patellofemoral pathology were utilized, and imaging was performed using standard C-arm fluoroscopy. For each specimen, a true lateral radiographic projection of the patella was obtained and distinct features noted. Next, an arthrotomy was made and steel wire was contoured and fixed to various anatomic regions of the patella so as to obliterate the radiographic densities on the true lateral projection, thus confirming their anatomic correlate. Ideal views of the lateral and medial facets themselves were determined using radiographic markers and varying amounts of internal or external rotation (IR & ER) of the specimen. Lastly, a transverse osteotomy was created in each patella and the ability of the true lateral and accessory views to detect malreduction was assessed. RESULTS:: The true lateral projection of the patella was obtained with the limb in neutral alignment. Constant radiographic features of the lateral view of the patella include the articular tangent, a secondary articular density of variable length and a dorsal cortical density. The articular tangent was produced by the central ridge between the medial and lateral facets in all specimens. The secondary articular density was created by a confluence of the edge of the lateral and edge of the medial facets in 5 patellas, a confluence of the edge of the lateral facet and the intersection of the odd and medial facet in 6 patellas and the edge of the lateral facet alone in 1 patella. The edge of the lateral facet gave a constant contribution to the appearance of the secondary articular density in all cases. A distinct accessory view of the tangent of the lateral facet could be seen with an average of 17 degrees of patella ER (range 12-35 degrees ER), and the tangent of the medial facet with an average of 26.5 degrees of IR (range 15-45 degrees). These accessory views were better able to visualize malreduction than the single lateral projection in a fracture model in all specimens. CONCLUSION:: Described here is a comprehensive description of the true lateral radiographic view of the patella and accessory views. These views can be employed in the evaluation of minimally displaced patella fractures if a CT scan is not desired to better assess the true amount displacement and when assessing intraoperative reduction during patella fracture osteosynthesis. PMID:23681415

Berkes, Marschall B; Little, Milton Tm; Pardee, Nadine C; Lazaro, Lionel E; Helfet, David L; Lorich, Dean G



Knee locking secondary to osteochondral fracture of the patella: an unusual presentation.  


Acute locking is a sign of internal derangement of the knee and is an orthopaedic surgical emergency. Differential diagnoses of this condition are torn meniscus, intra-articular loose bodies and torn anterior cruciate ligament. We present a 15-year-old schoolboy who developed acute locking of the knee during dancing. Arthroscopy revealed that he had sustained an osteochondral fracture of the patella and the loose fragment from it caused locking of the knee. That this was not pseudo-locking was confirmed by examination of the knee under anaesthesia. Locking of the knee by a loose osteochondral fragment following acute dislocation of the patella, though rare, should be considered as a possible cause of true locking. PMID:18581027

Goh, S K; Koh, J S B; Tan, M H



[Non-traumatic osteonecrosis of the patella, a rare cause of knee pain].  


Non-traumatic osteonecrosis of the patella is a rare cause of knee pain that must be present in the diagnostic discussion of disability of the knee with subacute character. The author describes a case in which the characteristic images had an important role in defining the etiology of disabling knee pain, developing pathophysiological hypotheses that may have contributed to the clinical presentation, including situations of overuse of the joint. PMID:23149642

Coelho, Paulo Clemente


Study of metals concentration levels in Patella piperata throughout the Canary Islands, Spain  

Microsoft Academic Search

In order to assess the extent of metal contamination at rocky shores of the Canarian Archipelago, metal concentrations have\\u000a been measured in Patella piperata (Gould, 1846), using the standard atomic absorption spectrophotometer technique. Ranges of elements concentrations measured\\u000a (in ?g g?1) found in the biota were: Cd (0.36 0.26 ?g g?1 dry wt.), Cu (2.05 0.91 dry wt.), Pb (1.57

Oscar Bergasa; Rubén Ramírez; Cayetano Collado; J. Joaquín Hernández-Brito; María Dolores Gelado-Caballero; María Rodríguez-Somozas; Ricardo J. Haroun



Osteochondrosis of the superior pole of the patella: two cases with histologic correlation.  


Two cases of osteochondrosis of the superior pole of the patella are reported with histologic findings. Both patients were young girls; one had mild cerebral palsy. Sixteen cases of this disorder have been documented but without histologic study. The histologic features of these two cases showed osteonecrosis with reparative changes. These findings support that this entity is similar to other osteochondroses of the quadriceps mechanism: Osgood-Schlatter disease and Sinding-Larsen-Johansson disease. PMID:12180619

Tyler, Wakenda; McCarthy, Edward F



Osteochondrosis of the Superior Pole of the Patella: Two Cases with Histologic Correlation  

PubMed Central

Two cases of osteochondrosis of the superior pole of the patella are reported with histologic findings. Both patients were young girls; one had mild cerebral palsy. Sixteen cases of this disorder have been documented but without histologic study. The histologic features of these two cases showed osteonecrosis with reparative changes. These findings support that this entity is similar to other osteochondroses of the quadriceps mechanism: Osgood-Schlatter disease and Sinding-Larsen-Johansson disease.

Tyler, Wakenda; McCarthy, Edward F



Mobile- versus fixed-bearing modern total knee replacements - which is the more patella-friendly design?  

PubMed Central

Objectives Our study aimed to examine if a mobile-bearing total knee replacement (TKR) offered an advantage over fixed-bearing designs with respect to rates of secondary resurfacing of the patella in knees in which it was initially left unresurfaced. Methods We examined the 11-year report of the New Zealand Joint Registry and identified all primary TKR designs that had been implanted in > 500 knees without primary resurfacing of the patella. We examined how many of these were mobile-bearing, fixed-bearing cruciate-retaining and fixed-bearing posterior-stabilised designs. We assessed the rates of secondary resurfacing of the patella for each group and constructed Kaplan-Meier survival curves. Results Our study showed a significantly higher rate of revision for secondary resurfacing of the patella in the fixed-bearing posterior-stabilised TKR designs compared with either fixed-bearing cruciate-retaining or mobile-bearing designs (p = 0.001 and p = 0.036, respectively). Conclusions This New Zealand Registry study shows that during the last 11 years, revision procedures to resurface an unresurfaced patella in primary TKR occurred at a higher rate in fixed-bearing posterior-stabilised designs.

Wyatt, M. C.; Frampton, C.; Horne, J. G.; Devane, P.



A Tale of Two Limpets (Patella vulgata and Patella stellaeformis): Evaluating a New Proxy for Late Holocene Climate Change in Coastal Areas  

NASA Astrophysics Data System (ADS)

Shells of the European limpet, Patella vulgata, from Late Holocene archaeological deposits potentially contain critical information about climate change in coastal areas. Before deciphering climate information preserved in these zooarchaeological records, we studied the controls on oxygen isotope ratios (?18O) in modern specimens. We tested the hypothesis that P. vulgata precipitates its shell in isotopic equilibrium with ambient water by comparing ?18OSHELL with expected values. Expected ?18OSHELL was constructed using the calcite-water fractionation equation, observed sea surface temperature (SST), and assuming ?18OWATER is +0.10‰ (VSMOW). Comparison between expected and measured ?18OSHELL revealed a +1.51±0.21‰ (VPDB) offset from expected values. Consequently, estimated SST calculated from ?18OSHELL was 6.50±2.45°C lower than observed SST. However, because the offset was relatively uniform, an adjustment can be made to account for this predictable vital effect and past SST can be reliably reconstructed. To further investigate the source of offset in this genus, we analyzed a fully marine tropical species (Patella stellaeformis) to minimize seasonal variation in environmental factors that influence ?18OSHELL. P. stellaeformis was evaluated to determine whether it has a similar offset from equilibrium as P. vulgata. We tested the hypotheses that: (1) ?18OSHELL in tropical species also displays vital effects; and (2) the offset from equilibrium (if any) would be constant and predictable. Our results indicated: (1) aragonite comprises most of P. stellaeformis' shell; and (2) ?18OSHELL is statistically indistinguishable from expected values calculated using the aragonite-water fractionation equation (Kolmogorov-Smirnov test statistic=0.61, D0.05[56, 57]=1.36) in contrast with our observations in P. vulgata. Differences in mineralogy or growth rates at different latitudes may play a role in mechanisms that influence vital effects.

Fenger, T. L.; Surge, D. M.; Schoene, B. R.; Carter, J. G.; Milner, N.



Augmentation with Transcortical Wiring of an Onlay-type Prosthesis for a Deficient Patella during Revision Total Knee Arthroplasty  

PubMed Central

The management of patellae with a severe bony deficiency during revision total knee arthroplasty is a challenging problem. However, using a technique of augmentation with transcortical wiring of an onlay-type prosthesis allowed the authors to revise a deficient patellae successfully. After making the decision to revise the existing patellar component, the procedure was found to be technically straightforward. Furthermore, the procedure does not require sophisticated instruments, only an onlay-type prosthesis, cement and wires. This technique entails fixing wires to the three pegs of the patellar component, passing the wires through drill holes in the anterior cortex and, after compression of a cemented prosthesis, augmenting the fixation by twisting the wires anteriorly. We believe that stable fixation and painless articulation will be obtained with the described technique for deficient patellae.

Seo, Jai-Gon; Moon, Young-Wan; Lim, Seung-Jae; Lim, Ji-Soon




PubMed Central

1. In view of widely diverse views held about the identity and structure of the Golgi apparatus in neurons of Mollusca, particularly gastropods, a study has been made on neurons of the common limpet, Patella vulgata, both by light and electron microscopy. A report is given also of observations made on epithelial cells of Patella by electron microscopy. 2. As revealed by Kolatchev's method, the Golgi apparatus in neurons consists basically of black filaments lying to one side of the nucleus. The filaments generally anastomose to form networks of various complexity. Rarely some cells contain only discrete filaments. Associated with some of the filaments is a weakly osmiophilic substance identified as archoplasm. Kolatchev's method also revealed spheroidal bodies (neutral red bodies, "lipochondria," etc.). 3. It has not been possible to demonstrate the Golgi apparatus using either iron-haematoxylin or Sudan black. 4. Examination of Kolatchev's preparations by electron microscopy has revealed that some of the Golgi filaments consist of chromophilic and chromophobic components. The chromophilic component consists of dense lamellae. 5. After fixation in buffered osmium tetroxide solution and examination by electron microscopy, it has been concluded that (a) the chromophilic component of the Golgi apparatus corresponds to a system of paired membranes (which usually enclose an inner dense substance), (b) the chromophobic component corresponds to a substance lying within small dilations of the paired membrane, and (c) the archoplasm corresponds to numerous small vesicles. 6. The paired membranes branch, anastomose, and can often be traced back to a common source. They are interpreted as lamelliform folds, and occasionally tubular processes, of essentially a single Golgi membrane. In cells containing a Golgi network it is suggested that the membrane extends through the whole of the apparatus in such a way that the substance it encloses may be regarded as being in a continuous phase. 7. Epithelial cells of Patella contain a juxtanuclear Golgi apparatus with an ultrastructure similar to that described for neurons.

Lacy, Dennis



Recurrent Dislocation of the Patella in Kabuki Make-Up Syndrome  

PubMed Central

Two patients with Kabuki make-up syndrome with bilateral recurrent dislocation of the patella are presented. They had generalized ligamentous laxity and patellofemoral dysplasia. Both developed patellar dislocation in adolescence and required surgery, with medial transfer of the tibial tuberosity associated with vastus medialis plasty (Insall technique). One postoperative complication occurred in one case: a nondisplaced tibia fracture at the sixth postoperative week that healed with conservative means. Final results were good in both cases. Good surgical results can be achieved in patellar dislocation in patients with Kabuki syndrome.

Rouffiange, Lucie; Dusabe, Jean-Paul; Docquier, Pierre-Louis



Mutation analysis of LMX1B gene in nail-patella syndrome patients.  

PubMed Central

Nail-patella syndrome (NPS), a pleiotropic disorder exhibiting autosomal dominant inheritance, has been studied for >100 years. Recent evidence shows that NPS is the result of mutations in the LIM-homeodomain gene LMX1B. To determine whether specific LMX1B mutations are associated with different aspects of the NPS phenotype, we screened a cohort of 41 NPS families for LMX1B mutations. A total of 25 mutations were identified in 37 families. The nature of the mutations supports the hypothesis that NPS is the result of haploinsufficiency for LMX1B. There was no evidence of correlation between aspects of the NPS phenotype and specific mutations.

McIntosh, I; Dreyer, S D; Clough, M V; Dunston, J A; Eyaid, W; Roig, C M; Montgomery, T; Ala-Mello, S; Kaitila, I; Winterpacht, A; Zabel, B; Frydman, M; Cole, W G; Francomano, C A; Lee, B



[Misunderstanding about the tension band principle in the treatment of patella fractures].  


Kirschner's wire tension band was the first choice in the treatment of patella fracture. But the principle of tension band had been misunderstood for long time. In the traditional principle, it was believed that tension band could change the separating force between fracture fragments into compressing stress when exercising. Eccentric fixation and articular surface cracking were disadvantageous. These could make the fracture fragments separate either at resting or exercising, which cause the gaps without pressure. Thus excercising could not change the separating force into compressing stress. PMID:20345037

Wang, Li-ming; Cui, Yong-feng



Metallothionein concentrations in a population of Patella aspera: variation with size.  


The determination of metallothionein (MT) concentrations in species with different feeding habits is important from the ecotoxicological point of view because it provides a better understanding of the role of these proteins in metal uptake pathways. The main objective was study the variation of MT and metal (Cd, Cu and Zn) concentrations with size and weight in the limpets Patella aspera. In addition investigate the relationship between MT and metal concentrations in limpets from different metal load environments of the south coast of Portugal with the aim to use MT in P. aspera as a biomarker of metal exposure. MT concentrations in the whole soft tissues of P. aspera increased with size and weight while metals decrease with size and weight. MT concentrations showed no significant relationship with Cd or Cu concentrations in the limpets from the South Portuguese Coast. However, a negative exponential relationship detected between MT and Zn concentrations suggest that Zn bound to MT might be displaced by Cd or Cu ions. The ability of limpets to store both Cd and Cu bound to MT may be responsible for the tolerance of this species to contaminated environments. The relationship between MT concentrations and Zn indicates that MT seems to play a minor role in binding Zn in Patella species. PMID:12493193

Bebianno, M J; Cravo, A; Miguel, C; Morais, S



Treatment of patella alta in patients with episodic patellar dislocation: a systematic review.  


PURPOSE: While there are numerous anatomic contributors to patellar instability, the role of patella alta has been traditionally under-appreciated. The goal of this systematic review is to identify the described techniques for treating patella alta in skeletally mature patients with episodic patellar dislocation (EPD) and review their published results. METHODS: A comprehensive literature review was performed to identify published surgical techniques and their results. Tibial tubercle distalization is the primary described treatment for patellar alta in patients with EPD, and five studies reporting results of this procedure were reviewed. RESULTS: Tibial tubercle distalization was generally successful in normalizing patellar height and preventing recurrent patellar dislocation. Physical examination tests for instability such as patellar apprehension remained positive in 15 to 33 % of patients. Patient-reported outcomes were rarely reported and difficult to interpret given the lack of pre-operative values or comparison groups. CONCLUSION: Tibial tubercle distalization is an effective technique for correction of patellar height and preventing recurrent patellar dislocations. More comparative studies are required to evaluate patient-reported outcomes of this technique, the effect of an associated tubercle medialization, and the results of supplementing distalization with procedures such as MPFL reconstruction. LEVEL OF EVIDENCE: Systematic review of case series, Level IV. PMID:23392290

Magnussen, Robert A; De Simone, Vito; Lustig, Sebastien; Neyret, Philippe; Flanigan, David C



Molecular cytogenetic study of three common Mediterranean limpets, Patella caerulea, P. rustica and P. ulyssiponensis (Archaeogastropoda, Mollusca).  


The present paper shows the results of chromosome banding and rDNA-FISH study performed on several specimens of different populations of Patella caerulea, Patella rustica and Patella ulyssiponensis. The taxonomic attribution of specimens was ascertained by the molecular phylogenetic analysis of the mitochondrial 16S rRNA gene. P. caerulea and P. rustica had 2n = 18 chromosomes with first seven of biarmed pairs and the remaining two uniarmed pairs. P. ulyssiponensis had 2n = 16 with all biarmed chromosomes. Ag-NOR loci were on the short arms of the first metacentric pair in the three studied limpets, whereas they showed a different pattern of heterochromatin distribution and composition. A chromosome mosaicism was observed in several P. caerulea specimens, which exhibited an unpaired metacentric element and loss of a telocentric pair. The obtained results suggest that in the genus Patella specific diversification was accompanied by variations in heterochromatin distribution and composition and reduction of chromosome number by Robertsonian centric fusion. PMID:19777161

Petraccioli, Agnese; Guarino, Fabio Maria; Maio, Nicola; Odierna, Gaetano



Metal Concentrations in the Radula of the Common Limpet, Patella vulgata L., from 10 Sites in the UK  

Microsoft Academic Search

Metal (Al, As, Ca, Cd, Cu, Fe, K, Mg, Mn, Na, Pb, Zn) levels in the feeding organ or radula of the common limpet Patella vulgata L. were surveyed in 10 populations over a ~150-km stretch of coastline in north-east England. The most northern population was at Beadnell in Northumberland and the most southern was at Port Mulgrave in North

Mark S. Davies; Donna J. Proudlock; A. Mistry



Adult Congenital Permanent Bilateral Dislocation of the Patella with Full Knee Function: Case Report and Literature Review  

PubMed Central

Congenital permanent dislocation of the patella is a rare disorder of the knee joint in which the patella is permanently displaced, even in extension and is fixed on the lateral aspect of the femoral condyle. The dislocation is irreducible without surgical techniques. This rare condition is usually detected within the first decade of life, because of inability of active extension in the knee and impaired ability during walking. This report presents an unusual case of a 51-year-old man with bilateral congenital permanent dislocation of the patella. The pathology had never been treated because there were few symptoms. The patient presented with right knee pain caused by a fall on the knee during his work. The right knee was painful on the lateral side and the clinical signs were positive for pathology of the lateral meniscus, confirmed by MRI. The clinical and the imaging findings suggested a lesion of the lateral meniscus as the probable cause of the pain. Therefore we performed a knee arthroscopy, whose intra-operative findings confirmed the MRI findings. During the surgery we performed just a selective arthroscopic meniscectomy, without correcting patella dislocation, because the condition was unusually asymptomatic before the trauma.

Bistolfi, Alessandro; Massazza, Giuseppe; Backstein, David; Ventura, Stefano; Cerlon, Raul; Crova, Maurizio



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

PubMed Central

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.

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



[The nail-patella syndrome: rare genetically determined cause of proteinuria].  


Nail-patella syndrome (NPS) is rare genetic disorder with autosomal mode of inheritance resulting from mutations in the LMX1B gene mapped on the long arm of chromosome 9 (9q34), encoding transcription factor, also named LMX1B. This syndrome is characterized by a skeletal malformations, such as dysplasia of the knees (with typical patellar hypoplasia or aplasia), elbows and nails as well as characteristic protuberaces of ilium named ,,iliac homes". Chronic nephropathy and nails dysplasia are most common extraosseal signs of NPS. Familial, genetic proved (missense mutation -G599A (R200Q) case of NPS in the mother and her son was presented. Clinical features characteristic for this syndrome and observed in both our patients were compared to the data published previously. PMID:18634531

Zarzecki, Mi?osz; Nieszporek, Teresa; Chudek, Jerzy; Wiecek, Andrzej



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


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

Hanssen, Arlen D



Microbial diversity of biofilm communities in microniches associated with the didemnid ascidian Lissoclinum patella.  


We assessed the microbial diversity and microenvironmental niche characteristics in the didemnid ascidian Lissoclinum patella using 16S rRNA gene sequencing, microsensor and imaging techniques. L. patella harbors three distinct microbial communities spatially separated by few millimeters of tunic tissue: (i) a biofilm on its upper surface exposed to high irradiance and O(2) levels, (ii) a cloacal cavity dominated by the prochlorophyte Prochloron spp. characterized by strong depletion of visible light and a dynamic chemical microenvironment ranging from hyperoxia in light to anoxia in darkness and (iii) a biofilm covering the underside of the animal, where light is depleted of visible wavelengths and enriched in near-infrared radiation (NIR). Variable chlorophyll fluorescence imaging demonstrated photosynthetic activity, and hyperspectral imaging revealed a diversity of photopigments in all microhabitats. Amplicon sequencing revealed the dominance of cyanobacteria in all three layers. Sequences representing the chlorophyll d containing cyanobacterium Acaryochloris marina and anoxygenic phototrophs were abundant on the underside of the ascidian in shallow waters but declined in deeper waters. This depth dependency was supported by a negative correlation between A. marina abundance and collection depth, explained by the increased attenuation of NIR as a function of water depth. The combination of microenvironmental analysis and fine-scale sampling techniques used in this investigation gives valuable first insights into the distribution, abundance and diversity of bacterial communities associated with tropical ascidians. In particular, we show that microenvironments and microbial diversity can vary significantly over scales of a few millimeters in such habitats; which is information easily lost by bulk sampling. PMID:22134643

Behrendt, Lars; Larkum, Anthony W D; Trampe, Erik; Norman, Anders; Sřrensen, Sřren J; Kühl, Michael



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

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

S. Nandini; S. S. S. Sarma



A neurological phenotype in nail patella syndrome (NPS) patients illuminated by studies of murine Lmx1b expression  

Microsoft Academic Search

Nail patella syndrome (NPS) is an autosomal dominant disorder affecting development of the limb, kidney and eye. NPS is the result of heterozygous loss-of-function mutations in the LIM-homeodomain transcription factor, LMX1B. Recent studies suggest that the NPS phenotype may be more extensive than recognized previously including neurologic and neurobehavioral aspects. To determine whether these findings correlated with the expression of

Jennifer A Dunston; Tyler Reimschisel; Yu-Qiang Ding; Elizabeth Sweeney; Randy L Johnson; Zhou-Feng Chen; Iain McIntosh



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

PubMed Central

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 Baltimore, Maryland. Measurements We measured lumbar spine BMD, blood and bone lead by dual energy X-ray absorptiometry, anodic stripping voltammetry, and 109Cd-induced K-shell X-ray fluorescence, respectively. We measured vitamin D receptor and apolipoprotein E (APOE) genotypes using standard methods. Results Mean (± SD) BMD and lead levels in blood, tibia, and patella were 1.02 ± 0.16 g/cm2, 3.3 ± 2.2 ?g/dL, 19.7 ± 13.2 ?g/g, and 5.7 ± 15.3 ?g/g, respectively. In adjusted analysis, higher BMD was associated with higher tibia lead levels (p = 0.03). BMD was not associated with lead levels in blood or patella. There was evidence of significant effect modification by BMD on relations of physical activity with blood lead levels and by APOE genotype on relations of BMD with tibia lead levels. There was no evidence that BMD modified relations between tibia lead or patella lead and blood lead levels. Conclusions We believe that BMD represents the capacity of bone that can store lead, by substitution for calcium, and thus the findings may have relevance for effect-size estimates in persons with higher BMD. Relevance to clinical practice The results have implications for changes in lead kinetics with aging, and thus the related risk of health effects associated with substantial early- and midlife lead exposure in older persons.

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



Assessment of heavy metal contamination of seawater and marine limpet, Patella vulgata L., from Northwest Spain.  


In the present work, both seawater and limpets (Patella vulgata L.) were collected from different sampling points in the Vigo estuary area (Galicia, NW Spain) and their heavy metal concentrations (Zn, Cd, Pb, Cu) were determined by means of a voltammetric technique. The results showed a direct relationship between the heavy metal levels in seawater and the content in biological samples, especially those obtained from limpet soft tissues, directly related to the increasing importance of anthropogenic environmental contamination. Heavy metal concentrations were usually higher in soft tissues than in shell, with a maximum difference corresponding to Cd and Zn (average of 93.6 and 86 folds, respectively). As expected, heavy metal content was higher in animal samples situated in inner part of the estuary zone, except for cadmium content in soft tissues, where a maximum of 5.62 ppm was quantified in limpet soft tissues collected next to the open sea area. Statistical analysis allowed the establishment of a clear relationship between Zn and Cd content in both shells and soft tissues from limpet, and especially between Zn and Cu in soft tissues (p < 0.001). PMID:14672319

Pérez-López, M; Alonso, J; Nóvoa-Valińas, M C; Melgar, M J



Neuronal control of the cardiac responses to osmotic stress in the gastropod limpet Patella caerulea.  


Mediterranean limpets Patella caerulea were exposed to different salinity conditions and treated with drugs interfering with neuronal control of heartbeat. Heart rate was monitored using a non-invasive method. Limpets were superfused with control (33 g l(-1)), hyposaline (0 and 10 g l(-1)) or hypersaline (56 and 66 g l(-1)) artificial seawater. Under osmotic stress the limpets showed an initial increase of heart rate, followed by acardia, particularly under hyposalinity. The tachycardia observed after exposure to 56 g l(-1) was abolished in the animals injected with a selective sodium channel blocker, tetrodotoxin (TTX), or with a serotoninergic antagonist, methysergide. Injection of TTX also partly prevented the acardia occurring at 0 g l(-1). The acardia was completely prevented after injection with atropine and benzoquinonium, two selective cholinergic antagonists. These findings indicate that cardiac responses of P. caerulea to variations in external salinity are regulated by an extrinsic neuronal control involving the serotoninergic and the cholinergic systems in the tachycardic and acardic responses, respectively. PMID:16646089

Bini, Giada; Pugliese, Anna Maria; Pepeu, Giancarlo; Chelazzi, Guido



The role of cyclins in the maturation of Patella vulgata oocytes.  

PubMed Central

We have cloned and sequenced the cDNAs encoding Patella vulgata cyclins A and B. The cDNA clones contain an open reading frame of 426 and 408 amino acids respectively, which present similarity with cyclins from other species. Cyclin A and B RNAs are present as polyadenylated and non-polyadenylated RNA in prophase oocytes and are completely polyadenylated in metaphase I. During the first cleavages after fertilization the level of cyclin A and B mRNAs is high and drops when the free swimming stage is reached. Using p13suc1-Sepharose bead precipitation we demonstrate that cyclin synthesis is triggered during maturation and that inhibition of protein synthesis makes the cyclins disappear rapidly from the metaphase I oocytes, which shift to interphase condition. By microinjecting antisense oligonucleotides into metaphase I oocytes, we demonstrate that in vivo ablation of cyclin A and B messengers together gives the same result, whereas microinjection of only one oligonucleotide does not show any effect. Images

van Loon, A E; Colas, P; Goedemans, H J; Neant, I; Dalbon, P; Guerrier, P



Congenital total absence of the quadriceps muscle and patella: a case report with computed tomography scan and three-dimensional reconstructions.  


In this study, we present three-dimensional computed tomography (CT) scan image findings of a case with congenital total absence of the quadriceps muscle and patella and partial absence of the sartorius muscle, which caused fixed flexion contracture of the knee joint. Physical examination, radiography, three-dimensional CT scan, and chromosome analysis of the patient were done. On physical examination, the knee joint was at 85 degree fixed flexion contracture. Radiographic views demonstrated soft tissue defects around left femur. Chromosome analysis was normal. CT scan showed total absence of the quadriceps femoris muscle and patella. Congenital absence of the extensor mechanism and patella are very rare anomalies. This case differed from other patellar aplasia or dysplasia syndromes with the presence of fixed flexion knee contracture and aplasia of the extensor mechanism. PMID:22146563

Oner, Mithat; Halici, Mehmet; Guney, Ahmet




PubMed Central

1. Structurally the "sensory bristles" in Euplotes patella are typical cilia, but no ciliary rootlets connect their bases. 2. The "neuromotor fibrils" are composed of filaments 21 mµ in diameter. At the point of junction of the filaments with the peripheral ciliary fibrils a granular structure 65 to 90 mµ in diameter is seen which has dense central and peripheral zones separated by a less dense layer. Information on the interconnection of organelles is expanded. 3. A system of subpellicular fibrils is described. The external fibrillar system described by others could not be found. 4. The motorium is shown to be a mass of intertwining rootlet filaments. 5. The micronucleus is shown to have a spongy, dense material in a less dense material, all of which is surrounded by a double-layered membrane. 6. The double-layered macronuclear membrane contains annuli whose outside diameter is 70 mµ; the macronuclear bodies are sometimes closely applied to the membrane. In the macronuclear reorganization bands, the solution plane is a fine network, while the reconstruction plane is devoid of structure at the level of resolution observed. 7. The mitochondria are composed of tubules, only occasionally oriented, usually embedded in a surrounding material of lower density. 8. Microbodies whose diameters are 250 to 350 mµ are frequently observed in close association with mitochondrial surfaces. 9. The food vacuoles, contractile vacuoles, and ciliary vacuoles are bounded by single-layered membranes. In the food vacuoles, the bacteria are surrounded by membranes individually or in small groups. 10. Cytoplasmic rods localized in the oral region, and cytoplasmic granules dispersed at random, are described. No typical ergastoplasm, endoplasmic reticulum, or Golgi material was observed.

Roth, L. E.



Quantification of midkine gene expression in Patella caerulea (Mollusca, Gastropoda) exposed to cadmium  

NASA Astrophysics Data System (ADS)

The release of cadmium into many coastal areas represents a threat to ecosystems and human health; cadmium is carcinogenic in mammals and in both marine invertebrates and vertebrates. The use of molluscs to assess the ecologic risk associated with contaminants is strongly recommended on account of their ecological role and on their highly conserved control and regulatory pathways that are often homologous to vertebrate systems. We previously identified a midkine family protein in the limpet Patella caerulea; the midkine is a recently discovered cytokines family with unequivocal informative value on repairing injury and neoplastic processes in mammals. Here we report on midkine (mdk) and ?-tubulin (?-tub) gene expression patterns in P. caerulea exposed to cadmium. Limpets, collected on two occasions from a breakwater at a marina (Tyrrhenian Sea) were exposed to sublethal cadmium concentrations (0.5 and 1 mg l-1 Cd) over a 10-day exposure period. RNA was extracted from the viscera of unexposed and exposed specimens. Real time TaqMan RT-PCR was performed to measure the relative mdk and ?-tub gene expression levels. A remarkable mdk over-expression was observed in all exposed animals with respect to unexposed ones; mdk over-expression was significantly higher in both treatments when compared with un-treatment (mean expression levels: 23- and 38-fold, for 0.5 and 1 mg l-1 Cd treatment, respectively; ANOVA, for both P < 0.01). The study also indicates that the mdk up-regulation was significantly Cd-concentration dependent (P < 0.05). A significant up-regulation of the constitutive ?-tub gene was also observed in 1 mg l-1 Cd-treated animals (mean expression level: 4-fold; ANOVA, P < 0.05). In conclusion, these data provide the first evidence paving the way for the use of the midkine as a promising new biomarker of effect in the environment risk assessment policy.

Stillitano, Francesca; Mugelli, Alessandro; Cerbai, Elisabetta; Vanucci, Silvana



Deterioration of long-term clinical results after the Elmslie-Trillat procedure for dislocation of the patella.  


We examined 39 patients (45 knees) who had undergone an Elmslie-Trillat procedure for recurrent or habitual dislocation of the patella with a follow-up of more than ten years. The mean age at the time of surgery was 18.4 years; the mean follow-up was 161 months (120 to 238). Using Fulkerson's functional knee score, 41 knees (91%) had an excellent or good result at a mean follow-up of 45 months, and this was maintained in 29 (64%) at the final review. The main cause of deterioration in the clinical results was the onset or worsening of patellofemoral joint pain, not patellar instability. PMID:12211679

Nakagawa, K; Wada, Y; Minamide, M; Tsuchiya, A; Moriya, H



Bioabsorbable Pins for Treatment of Osteochondral Fractures of the Knee after Acute Patella Dislocation in Children and Young Adolescents  

PubMed Central

A retrospective study was performed on the use of bioabsorbable pins in the fixation of osteochondral fractures (OCFs) after traumatic patellar dislocation in children. Eighteen children (13 females, 5 males) aged 11 to 15 years (mean age 13.1 years) with osteochondral fracture (OCF) of the knee joint were treated at the authors' institution. Followup ranged from 22 months to 5 years. Diagnosis was verified by X-ray and magnetic resonance imaging (MRI) of the knee and patella. In seven patients the osteochondral fragment was detached from the patella and in 11 it was detached from the lateral femoral condyle. All patients were subjected to open reduction and fixation of the lesion with bioabsorbable pins. Postoperatively, the knee was immobilized in a cast and all patients were mobilized applying a standardized protocol. Bone consolidation was successful in 17 of the 18 patients. Bioabsorbable pins reliably fix OCF in children and adolescents, demonstrating a high incidence of consolidation of the detached osteochondral fragment in short- and middle-term followup without requiring further operative procedures.

Gkiokas, A.; Morassi, L. G.; Kohl, S.; Zampakides, C.; Megremis, P.; Evangelopoulos, D. S.



Patterns of colonization, evolution and gene flow in species of the genus Patella in the Macaronesian Islands.  


The study of phylogeographical patterns may contribute to a better understanding of factors affecting the dispersal of organisms in ecological and historical times. For intertidal organisms, islands are particularly suitable models allowing the test of predictions related to the efficacy of pelagic larvae dispersal. Here, we study the phylogeographical patterns and gene flow within three groups of species of the genus Patella present in the Macaronesian Islands that have been previously shown to be monophyletic. The genetic variability of around 600 bp of the mitochondrial gene cytochrome c oxidase subunit I was studied by single strand conformation polymorphism and/or sequencing for seven species of limpets. A total of 420 samples were analysed from the Macaronesian archipelagos, North Africa, and Atlantic and Mediterranean shores of the Iberian Peninsula. No clear geographical pattern or temporal congruence was found between the three groups of species, pointing to independent histories and colonization events. However, for the three groups, the split between the Macaronesian and the mainland forms most probably occurred before 3.9 million years ago, predating the establishment of the current circulation patterns. The presence of pelagic larvae in these species is shown to be insufficient to ensure gene flow between continental and Macaronesian populations and between the Macaronesian archipelagos. In the endangered Azorean populations of Patella candei, there is restricted gene flow to Flores and Graciosa. PMID:18179442

Sá-Pinto, Alexandra; Branco, Madalena; Sayanda, Diogo; Alexandrino, Paulo



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

PubMed Central

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.

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



Outcomes After Knee Joint Extensor Mechanism Disruptions: Is It Better to Fracture the Patella or Rupture the Tendon?  


OBJECTIVES: The purpose of this study was to compare the outcome after the operative treatment of patella fractures (PFs) as compared with those of quadriceps tendon and patella tendon (PT) ruptures. DESIGN: This pertains to a retrospective case control. SETTING: The setting was in academic teaching hospitals. PATIENTS: Ninety-four patients with 99 extensor mechanism disruptions were treated operatively. Of these, 50 (50%) were PFs; 36 (37%) were quadriceps ruptures; and 13 (13%) were PT ruptures. MAIN OUTCOME MEASURES: The patients were evaluated at 6 and 12 months and were tested for range of motion, quadriceps circumference and strength, SF36, Lysholm, and Tegner outcome scores by independent observers. Radiographs of the knee were obtained to assess bony healing, posttraumatic arthritis, and heterotopic ossification RESULTS: A minimum of 12-month follow-up (range 12-81 months) was available for 76 patients (77%). PFs were seen more commonly in women (P < 0.001) and PT ruptures tended to occur in younger males (P < 0.001), with no difference in the body mass index. Thigh circumference was significantly smaller than normal in PFs at 1 year as compared with tendon injuries. At latest follow-up, there were no significant differences noted with respect to knee range of motion, radiographic arthritis, Tegner, Lysholm, or SF36 scores. CONCLUSIONS: There were no significant differences with regard to outcome in patients sustaining these injuries. PMID:22487903

Tejwani, Nirmal C; Lekic, Nikola; Bechtel, Christopher; Montero, Nicole; Egol, Kenneth A



Expression patterns of fork head and goosecoid homologues in the mollusc Patella vulgata supports the ancestry of the anterior mesendoderm across Bilateria  

Microsoft Academic Search

We have characterised orthologues of the genes fork head and goosecoid in the gastropod Patella vulgata. In this species, the anterior-posterior (AP) axis is determined just before gastrulation, and leads to the specification of two mesodermal components on each side of the presumptive endoderm, one anterior (ectomesoderm), and one posterior (endomesoderm). Both fork head and goosecoid are expressed from the

Nicolas Lartillot; Martine Le Gouar; André Adoutte



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


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 O(2) 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 O(2) 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

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



A novel SOX9 H169Q mutation in a family with overlapping phenotype of mild campomelic dysplasia and small patella syndrome.  


The phenotypic similarities have been demonstrated between non-lethal campomelic dysplasia (CD) and small patella syndrome (SPS), in which different genetic defects have been identified. We report on a familial case of skeletal dysplasia with overlapping phenotype of mild CD and SPS, including defective ischio-pubic ossification, elongated femoral neck, hypoplastic patellae, and increased space between the first and the second toes (sandal gap). Direct sequencing analysis demonstrated a novel missense mutation (p.H169Q) within the coding region of the SOX9 gene and negative for TBX4 mutations. Functional analysis of the p.H169Q mutant revealed reduced but not fully abolished transactivation capacity of the mutated protein. Retained residual SOX9 function might contribute to an extremely mild CD phenotype in the present cases. © 2013 Wiley Periodicals, Inc. PMID:24038782

Matsushita, Masaki; Kitoh, Hiroshi; Kaneko, Hiroshi; Mishima, Kenichi; Kadono, Izumi; Ishiguro, Naoki; Nishimura, Gen



Adaptation of bone to altered loading environment: a biomechanical approach using x-ray absorptiometric data from the patella of a young woman  

Microsoft Academic Search

Loading induced changes in the bone mineral apparent density (BMAD) and average strain magnitude (strain index) of the patella were estimated using a novel analytic method of dual energy X-ray absorptiometric (DXA) and isometric strength data obtained from repeated measurements of a 26-year-old woman. The strain index was used as a major determinant of bone adaptation to physical loading. The

H. Sievänen; A. Heinonen; P. Kannus



High sensitivity C-reactive protein is associated with lower tibial cartilage volume but not lower patella cartilage volume in healthy women at mid-life  

Microsoft Academic Search

INTRODUCTION: Elevated serum high sensitivity C-reactive protein (hsCRP) has been reported in established osteoarthritis (OA). The aim of this study was to determine whether serum levels of hsCRP are associated with the variation in tibial and patella cartilage volumes in women without evidence of OA. METHODS: Participants were recruited from a database established from the Australian electoral roll, and were

Fahad S Hanna; Robin J Bell; Flavia M Cicuttini; Sonia L Davison; Anita E Wluka; Susan R Davis



[Histomorphological analyse of accelerating the fibrocartilage layer repair of patella-patellar tendon junction in rabbits by low intensity pulsed ultrasound stimulation].  


Objective: To analyse the effect of low intensity pulsed ultrasound stimulation (LIPUS) on accelerating the fibrocartilage layer repair of patella-patellar tendon junction. Methods: A total of 60 mature female New Zealand white rabbits undergoing standard partial patellectomy were divided into 2 groups randomly. The control group was given comfort threatment and the treatment group was given LIPUS treatment starting from day 3 to the end of week 6 postoperatively. The scheduled time points of animal euthanization would be at week 6, week 12 and week 18 postoperatively. The patella-patellar tendon (PPT) complex would be harvested and cut into sections after decalcification for H&E staining, Safranine o/fast green staining. The thickness and gray value of fibrocartilage layer were analyzed by SANO Microscope Partner image analyzer. Results: At week 6, week 12 and week 18 postoperatively, the fibrocartilage layer in the treatment group was significantly thicker than that in the control group (P<0.01), and the gray value of fibrocartilage layer was significantly smaller than that in the control group (P<0.01). Conclusion: LIPUS helps to accelerate the fibrocartilage layer repair of patella-patellar tendon junction in rabbit models. PMID:23981992

Zhang, Baoliang; Lü, Hongbin; Hu, Jianzhong; Xu, Daqi; Zhou, Jingyong; Wang, Ye



Putative midkine family protein up-regulation in Patella caerulea (Mollusca, Gastropoda) exposed to sublethal concentrations of cadmium.  


A cDNA sequence of a putative midkine (MK) family protein was identified and characterised in the mollusc Patella caerulea. The midkine family consists of two members, midkine and pleiotrophin (PTN), and it is one of the recently discovered cytokines. Our results show that this putative midkine protein is up-regulated in specimens of P. caerulea exposed to sublethal cadmium concentrations (i.e. 0.5 and 1 mg l(-1) Cd) over a 10-day exposure period. Semiquantitative RT-PCR and quantitative Real time RT-PCR estimations indicate elevated expression of midkine mRNA in exposed specimens compared to controls. Moreover, RT-PCR Real time values were higher in the viscera (here defined as the part of the soft tissue including digestive gland plus gills) than in the foot (i.e. foot plus head plus heart) of the limpets. At present, information on the functional signalling significance of the midkine family proteins suggests that the up-regulation of P. caerulea putative midkine family protein is a distress signal likely with informative value on health status of the organism and with potential prognostic capability. PMID:16253353

Vanucci, Silvana; Minerdi, Daniela; Kadomatsu, Kenji; Mengoni, Alessio; Bazzicalupo, Marco



Brachidontes variabilis and Patella sp. as quantitative biological indicators for cadmium, lead and mercury in the Lebanese coastal waters.  


The mussel, Brachidontes variabilis, and the limpet, Patella sp., were used as indicators to monitor cadmium, lead and mercury concentrations along the Lebanese coast. Studies were carried out in order to define the best strategy for assessing and minimizing the effects of size and physiological condition on the metal contents of the molluscs, and corrective models were constructed. Metal concentrations in surface water were measured to estimate bioconcentration factors (BCFs). The BCFs varied from 8.3 x 10(3) to 3.4 x 10(4), from 7.5 x 10(3) to 8.0 x 10(3) and from 3.0 x 10(4) to 3.2 x10(4), for Cd, Pb and Hg, respectively. For limpets, BCFs varied from 1.7 x 10(4) to 7.4 x 10(4) for Cd, from 2.5 x 10(3) to 6 x 10(3) for Pb and remained fairly constant at around 10(4) for Hg. The highest BCFs were associated with lowest contamination levels. The results of the geographical survey exhibited a similar large-scale spatial pattern for the two species and followed the metal concentration distributions measured in the waters. PMID:16343717

Nakhlé, Khaled F; Cossa, Daniel; Khalaf, Ghaby; Beliaeff, Benoit



Analysis of a deep transcriptome from the mantle tissue of Patella vulgata Linnaeus (Mollusca: Gastropoda: Patellidae) reveals candidate biomineralising genes.  


The gastropod Patella vulgata is abundant on rocky shores in Northern Europe and a significant grazer of intertidal algae. Here we report the application of Illumina sequencing to develop a transcriptome from the adult mantle tissue of P. vulgata. We obtained 47,237,104 paired-end reads of 51 bp, trialled de novo assembly methods and settled on the additive multiple K method followed by redundancy removal as resulting in the most comprehensive assembly. This yielded 29,489 contigs of at least 500 bp in length. We then used three methods to search for candidate genes relevant to biomineralisation: searches via BLAST and Hidden Markov Models for homologues of biomineralising genes from other molluscs, searches for predicted proteins containing tandem repeats and searches for secreted proteins that lacked a transmembrane domain. From the results of these searches we selected 15 contigs for verification by RT-PCR, of which 14 were successfully amplified and cloned. These included homologues of Pif-177/BSMP, Perlustrin, SPARC, AP24, Follistatin-like and Carbonic anhydrase, as well as three containing extensive G-X-Y repeats as found in nacrein. We selected two for further verification by in situ hybridisation, demonstrating expression in the larval shell field. We conclude that de novo assembly of Illumina data offers a cheap and rapid route to a predicted transcriptome that can be used as a resource for further biological study. PMID:22865210

Werner, Gijsbert D A; Gemmell, Patrick; Grosser, Stefanie; Hamer, Rebecca; Shimeld, Sebastian M



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

PubMed Central

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.

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.



Bioaccumulation of metals in the soft tissue of Patella aspera: Application of metal/shell weight indices  

NASA Astrophysics Data System (ADS)

Patella aspera limpets were taken from a marine clean site (MCS) and an estuarine contaminated site (ECS). The concentrations of Fe, Mn, Zn, Cu, Cd, Ni and Co were determined individually over the available size range. Since there were significant differences in the soft tissue weight between populations, but shell characteristics were similar (length and weight), metal/shell weight indices (MSI) were calculated in order to compare populations. For both populations iron, zinc and manganese/shell weight indices were consistently higher, in the order Fe ? Zn ? Mn than those of Cu, Ni, Co and Cd. The results exhibited a marked intra- and inter-population variability. The highest intra-variability was observed at ECS, particularly where a strong effect of shell weight upon the metal accumulation in the soft tissue was evident. Due to this effect, the comparison of populations was carried out between three selected shell weight ranges representative of light shells (0.45-1.95 g), intermediate shells (2.95-4.45 g) and heavy shells (5.45-7.33 g). The results indicate that, in general, MSI at ECS (a sewage contaminated site), except for Cd, was higher than at MCS possibly reflecting a higher environmental bioavailability of these metals. The resolution between populations was higher when the smallest range of limpets was considered and it decreased with the increase of shell weight. The highest discrimination amongst populations was found for zinc/shell weight index that showed much higher values than those of Mn, Cu, Cd, Ni and Co/shell weight indices, and spatial differentiation between populations persisted amongst the selected shell weight ranges.

Cravo, A.; Bebianno, M. J.



Seasonal variation in glycoconjugates of the pedal glandular system of the rayed Mediterranean limpet, Patella caerulea (Gastropoda: Patellidae).  


Glycoconjugates secreted by the pedal system of the rayed limpet, Patella caerulea, were characterised in situ by histochemical and lectin-histochemical methods in individuals collected around the annual cycle, in November, March, and June. Stainings with periodic acid-Schiff (PAS), Alcian blue pH 2.5 (AB pH 2.5), Alcian blue pH 1.0 (AB pH 1.0), high-iron diamine-Alcian blue pH 2.5 and lectin binding assays with 9 lectins (Con A, WGA, succinylated-WGA, PNA, DBA, SBA, AAA, UEA-I, LTA) were performed. Four secreting cell types were observed in the sole, one in the peripheric region, and two in the sidewall. Glycoconjugate composition varied among cell types and also in one and the same cell type throughout the year. ?-Elimination followed by PAS and AB pH 2.5 stainings indicated that most saccharidic chains were O-linked to the protein backbone. Secretion by sole and peripheric region was acidic, carboxylated and/or sulfated, whereas that of the sidewall was neutral. Glucosaminylated and 1,4-fucosylated residuals were predominant in the cell types along the year, 1,2-fucosylated residuals being observed only in the sidewall cells in June. Mannosylated and/or glycosylated residuals were observed in all cells mostly in November. Galactosylated/galactosaminylated residuals were present mostly in the sidewall cells and in the sole subepidermal mucocytes in June. Mannosylated and/or glycosylated residuals in November are probably linked to gonad maturation or to higher locomotion and foraging activity, whereas galactosaminylation in the sole cells and 1,2-fucosylation and glucosaminylation in the sidewall cells in June are linked to a prolonged stationary state, increasing water adsorption to counteract dehydration and/or to modulate microbial interactions. PMID:23683552

Petraccioli, Agnese; Maio, Nicola; Guarino, Fabio Maria; Scillitani, Giovanni



A Comparison of Patella Retention versus Resurfacing for Moderate or Severe Patellar Articular Defects in Total Knee Arthroplasty: Minimum 5-year Follow-up Results  

PubMed Central

Purpose The purpose of this study is to assess the clinical and radiological results of patients who underwent patellar retention or resurfacing for moderate or severe patellar articular defects during total knee arthroplasty and evaluate the clinical efficacy of patellar resurfacing according to the articular defect of the patella. Materials and Methods From May 2003 to March 2006, 252 patients (277 cases) underwent total knee arthroplasty by one surgeon. Intraoperatively, we divided these patients into a moderate articular defect group (50-75%: group I) and a severe articular defect group (75-100%: group II) and randomly performed patellar resurfacing. The average age was 67.2 years. There were 234 female and 17 male patients. The average follow-up period was 74.6 months. Clinical outcomes were analyzed using the Knee Society (KS) knee score. Functional score, Hospital for Special Surgery (HSS) score, Feller patellar score and range of motion (ROM). Radiological outcomes were analyzed using the congruence angle, Insall-Salvati ratio and patella tilt angle. Results The KS knee score and functional score at the last follow-up were 84.4/73.1 in the retention group and 85.2/71.8 in the resurfacing group (p=0.80, p=0.63) in group I. In group II, the values were 82.1/75.1 and 87.0/71.2, respectively (p=0.51, p=0.26). The HSS score and Feller patella score were 86.7/20.3 in the retention group and 84.3/21.7 in the resurfacing group (p=0.31, p=0.29) in group I. In group II, the values were 91.6/21.2 and 85.5/22.1, respectively (p=0.37/p=0.30). The knee ROM (p=0.36/p=0.41), congruence angle (p=0.22/p=0.16), Insall-Salvati ratio (p=0.16/p=0.21) and patella tilt angle (p=0.12/p=0.19) were not statistically different between the two groups. Conclusions In this study, we could not find any correlations between the degree of patellar articular defect and patellar resurfacing in terms of the clinical and radiological results. Therefore, patellar articular defects is thought to be less meaningful in determining patellar resurfacing.

Seo, Seung Suk; Moon, Sang Won



A review of lower limb overuse injuries during basic military training. Part 1: Types of overuse injuries.  


Lower limb injuries present the greatest source of medical problems during basic military training. These main overuse lower limb injuries, anterior compartment syndrome, stress fractures, Achilles tendinitis, plantar fasciitis, shin splints, and chondromalacia patellae, are reviewed with respect to current knowledge of rates, diagnosis, and treatment. Part 2 shall review possible etiological factors involved in the causation of these injuries. PMID:8361601

Ross, J



Arthroscopic Assessment and Treatment of Dancers' Knee Injuries.  

ERIC Educational Resources Information Center

|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)|

Silver, Daniel M.; Campbell, Pat



Metal concentrations in the radula of the common limpet, Patella vulgata L., from 10 sites in the UK.  


Metal (Al, As, Ca, Cd, Cu, Fe, K, Mg, Mn, Na, Pb, Zn) levels in the feeding organ or radula of the common limpet Patella vulgata L. were surveyed in 10 populations over a approximately 150-km stretch of coastline in north-east England. The most northern population was at Beadnell in Northumberland and the most southern was at Port Mulgrave in North Yorkshire; sites included unspoilt bays and areas heavily affected by industrial contamination such as the River Tees estuary. We hypothesized that the radula might be used as an indicator of environmental contamination. There were significant differences between the sites in the ratio of radula length to shell length. Limpets from Whitburn had the smallest radula fraction (mean = 1.665), while those from Port Mulgrave the largest (mean = 1.998). Such variation is common in the literature and we detected no correlate and propose no cause. Iron was clearly the dominant metal in the radulae, with an overall of mean of 1.46% of radular weight, though this is rather low in comparison to values in the literature. Iron is naturally secreted into the developing radula as a putative hardening agent. The next most abundant metals, in descending order, were Na (at approximately 2000-8000 microg g(-1)), K, Mg, Ca (approximately 1000-1500 microg g(-1)), Zn, Cu, Al, Pb (approximately 7-75 microg g(-1)), Mn, As, Cd (approximately 0-1 microg g(-1)). All but Al and Cd showed significant differences between the sites, but not in any consistent or convincing geographic manner. Nevertheless, the variations in metal levels between sites (e.g. Fe > 72%, Cu and Zn > 10-fold) suggest an environmental cause, but we are unable to offer any responsible factor, for example, there appeared little effect of the River Tees estuary. Cadmium is at a relatively low level in the radula in comparison to published data on pedal mucus and the flesh, but Pb is relatively high in pedal mucus and the radula and this might suggest that the radula is a detoxification route for Pb. Although the relationship between radula metal content and environmental metal content is unknown, the radula is constantly replaced and so may yet have the potential to be of use as a bioindicator, integrating metal exposure over much shorter periods than whole body burdens. PMID:16385740

Davies, Mark S; Proudlock, Donna J; Mistry, A



Paleoclimate of the Neoglacial and Roman Warm Period Reconstructed from Oxygen Isotope Ratios of Limpet Shells (Patella vulgata), Northwest Scotland  

NASA Astrophysics Data System (ADS)

Paleoclimate reconstructions from different regions have reported abrupt climate change around 2800-2700 cal yr B.P. The timing of this abrupt climate change is close to the boundary between the Neoglacial (3300-2500 cal yr B.P.) and Roman Warm Period (2500-1600 cal yr B.P.). However, temporal and spatial variability observed in this climate change event raises controversies about the forcing factors driving it and why it has regional variability. Scotland lies in the North Atlantic Ocean, which responds sensitively to climate change. Therefore, even in the case of subtle climate change, the climate variability of Scotland should be able to capture such change. In this study, we expect that paleoclimate reconstructions of the Neoglacial and Roman Warm Period in Scotland will help improve our knowledge of abrupt climate change at 2800-2700 cal yr B.P. Archaeological shell deposits provide a rich source of climate proxy data preserved as oxygen isotope ratios in shell carbonate. Croig Cave on the Isle of Mull, Scotland, contains a nearly continuous accumulation of shells ranging from 800 BC-500 AD and possibly older. This range represents a broad chronology of human use from the late Bronze to Iron Ages and spans the Neoglacial through Roman Warm Period climate episodes. Here, we present seasonal temperature variability of the two climate episodes based on oxygen isotope ratios of ten limpet shells (Patella vulgata) from Croig Cave. Based on AMS dating (2 sigma calibration), the oldest shell was from 3480-3330 cal yr B.P. and the youngest shell was from 2060-1870 cal yr B.P. Our results indicated that estimated temperatures from the Neoglacial limpets average 6.44±0.56°C for coldest winters and 15.06±0.67°C for warmest summers. For the Roman Warm Period limpets, the average is 5.68±0.36°C for coldest winters and 14.14±0.81°C for warmest summers. We compared our estimated temperatures to the present sea surface temperature (SST) from 1961 to 1990 near our study area, which averages 7.40±0.35°C for coldest month and 14.12±0.54°C for warmest month. Our reconstructed temperatures from the Neoglacial limpets showed slightly (0-1°C) colder winters, similar or warmer (1-1.8°C) summers compared to present SST record. One shell captured a year without a summer likely resulting from an eruption of the Katla volcanic system in Iceland. The reconstructed temperatures from the Roman Warm Period limpets showed colder winters (up to 2°C) and similar summers compared with present SST record. Our findings represent the first insights of SST variability at seasonal time scales for these two climate episodes in northwest Scotland.

Wang, T.; Surge, D. M.; Mithen, S.



The use of enzymatic biomarkers in two marine invertebrates Nereis diversicolor and Patella vulgata for the biomonitoring of Tangier's bay (Morocco).  


The fast increase of anthropogenic activities has led to a continual influx of xenobiotics into the marine ecosystems. Quantifying biochemical parameters in marine invertebrates makes possible the evaluation of pollutants' damaging effect. In fact, to examine the health state of Tangier's bay, we focused on the study of catalase, esterase, acetylcholinesterase and alpha-amylase activities as biomarkers in two species of marine invertebrates Nereis diversicolor (Polychaeta, Nereidae) and Patella vulgata (Mollusca, Prosobranchia), collected from different sites along the Mediterranean coastline of Tangier. Our results showed that these biochemical parameters are disturbed following the level of decreasing environmental quality, and for this reason they are promising in the biomonitoring studies of the Moroccan marine environment. PMID:18786724

Douhri, Hikmat; Sayah, Fouad



Intraarticular reaction associated with the use of freeze-dried, ethylene oxide-sterilized bone-patella tendon-bone allografts in the reconstruction of the anterior cruciate ligament  

Microsoft Academic Search

One hundred nine patients over a 3 year period under went reconstruction for chronic ACL ruptures using a freeze-dried, ethylene oxide-sterilized bone-patella ten don-bone allograft. Seven patients (6.4%) developed a characteristic persistent intraarticular reaction. This re action was characterized by persistent synovial effusion with collagenous particulates and cellular inflammatory response. Synovial biopsies in all cases showed a similar chronic inflammatory

Douglas W. Jackson; Gary E. Windler; Timothy M. Simon



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

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

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



MRI of Cartilage: Pathological Findings  

Microsoft Academic Search

\\u000a The most important clinical indications for magnetic resonance imaging (MRI) are assessment of cartilage in osteoarthritis\\u000a (OA), chronic or acute osteochondral injury including sports injuries, osteochondritis dissecans, chondromalacia patellae,\\u000a and inflammatory arthropathies (in particular before invasive therapy). In addition dedicated cartilage imaging is required\\u000a after invasive cartilage repair procedures or conservative therapies, including pharmacological therapies, to monitor treatment\\u000a effect. MR

Thomas M. Link


Prevalence and influence of tibial tunnel widening after isolated anterior cruciate ligament reconstruction using patella-bone-tendon-bone-graft: long-term follow-up  

PubMed Central

The aim of the present study was to evaluate incidence, degree and impact of tibial tunnel widening (TW) on patient-reported long-term clinical outcome, knee joint stability and prevalence of osteoarthritis (OA) after isolated anterior cruciate ligament (ACL) reconstruction. On average, 13.5 years after ACL reconstruction via patella-bone-tendon-bone autograft, 73 patients have been re-evaluated. Inclusion criteria consisted of an isolated anterior cruciate ligament rupture and reconstruction, a minimum of 10-year follow-up and no previous anterior cruciate ligament repair or associated intra-articular lesions. Clinical evaluation was performed via the International Knee Documentation Committee (IKDC) score and the Tegner and Lysholm scores. Instrumental anterior laxity testing was carried out with the KT-1000™ arthrometer. The degree of degenerative changes and the prevalence of osteoarthritis were assessed with the Kellgren-Lawrence score. Tibial tunnel enlargement was radiographically evaluated on both antero-posterior and lateral views under establishment of 4 degrees of tibial tunnel widening by measuring the actual tunnel diameters in mm on the sclerotic margins of the inserted tunnels on 3 different points (T1–T3). Afterwards, a conversion of the absolute values in mm into a 4 staged ratio, based on the comparison to the results of the initial drill-width, should provide a better quantification and statistical analysis. Evaluation was performed postoperatively as well as on 2 year follow-up and 13 years after ACL reconstruction. Minimum follow-up was 10 years. 75% of patients were graded A or B according to IKDC score. The mean Lysholm score was 90.2±4.8 (25–100). Radiological assessment on long-term follow-up showed in 45% a grade I, in 24% a grade II, in 17% a grade III and in additional 12% a grade IV enlargement of the tibial tunnel. No evident progression of TW was found in comparison to the 2 year results. Radiological evaluation revealed degenerative changes in sense of a grade II OA in 54% of patients. Prevalence of a grade III or grade IV OA was found in 20%. Correlation analysis showed no significant relationship between the amount of tibial tunnel enlargement (P>0.05), long-term clinical results, anterior joint laxity or prevalence of osteoarthritis. Tunnel widening remains a radiological phenomenon which is most commonly observed within the short to midterm intervals after anterior cruciate ligament reconstruction and subsequently stabilises on mid and long- term follow-up. It does not adversely affect long-term clinical outcome and stability. Furthermore, tunnel widening doesn't constitute an increasing prevalence of osteoarthritis.

Struewer, Johannes; Efe, Turgay; Frangen, Thomas Manfred; Schwarting, Tim; Buecking, Benjamin; Ruchholtz, Steffen; Schuttler, Karl Friedrich; Ziring, Ewgeni



Prevalence and influence of tibial tunnel widening after isolated anterior cruciate ligament reconstruction using patella-bone-tendon-bone-graft: long-term follow-up.  


The aim of the present study was to evaluate incidence, degree and impact of tibial tunnel widening (TW) on patient-reported long-term clinical outcome, knee joint stability and prevalence of osteoarthritis (OA) after isolated anterior cruciate ligament (ACL) reconstruction. On average, 13.5 years after ACL reconstruction via patella-bone-tendon-bone autograft, 73 patients have been re-evaluated. Inclusion criteria consisted of an isolated anterior cruciate ligament rupture and reconstruction, a minimum of 10-year follow-up and no previous anterior cruciate ligament repair or associated intra-articular lesions. Clinical evaluation was performed via the International Knee Documentation Committee (IKDC) score and the Tegner and Lysholm scores. Instrumental anterior laxity testing was carried out with the KT-1000™ arthrometer. The degree of degenerative changes and the prevalence of osteoarthritis were assessed with the Kellgren-Lawrence score. Tibial tunnel enlargement was radiographically evaluated on both antero-posterior and lateral views under establishment of 4 degrees of tibial tunnel widening by measuring the actual tunnel diameters in mm on the sclerotic margins of the inserted tunnels on 3 different points (T1-T3). Afterwards, a conversion of the absolute values in mm into a 4 staged ratio, based on the comparison to the results of the initial drill-width, should provide a better quantification and statistical analysis. Evaluation was performed postoperatively as well as on 2 year follow-up and 13 years after ACL reconstruction. Minimum follow-up was 10 years. 75% of patients were graded A or B according to IKDC score. The mean Lysholm score was 90.2±4.8 (25-100). Radiological assessment on long-term follow-up showed in 45% a grade I, in 24% a grade II, in 17% a grade III and in additional 12% a grade IV enlargement of the tibial tunnel. No evident progression of TW was found in comparison to the 2 year results. Radiological evaluation revealed degenerative changes in sense of a grade II OA in 54% of patients. Prevalence of a grade III or grade IV OA was found in 20%. Correlation analysis showed no significant relationship between the amount of tibial tunnel enlargement (P>0.05), long-term clinical results, anterior joint laxity or prevalence of osteoarthritis. Tunnel widening remains a radiological phenomenon which is most commonly observed within the short to midterm intervals after anterior cruciate ligament reconstruction and subsequently stabilises on mid and long- term follow-up. It does not adversely affect long-term clinical outcome and stability. Furthermore, tunnel widening doesn't constitute an increasing prevalence of osteoarthritis. PMID:22802989

Struewer, Johannes; Efe, Turgay; Frangen, Thomas Manfred; Schwarting, Tim; Buecking, Benjamin; Ruchholtz, Steffen; Schüttler, Karl Friedrich; Ziring, Ewgeni



c.194 A>C (Q65P) mutation in the LMX1B gene in patients with nail-patella syndrome associated with glaucoma  

PubMed Central

Purpose To report the clinical, ophthalmic, extraophthalmic, and genetic characteristics of nail-patella syndrome (NPS) in a Chilean family and to investigate the expressivity of open angle glaucoma (OAG) and ocular hypertension (OHT) in the family members. Methods Five family members affected with NPS and two unaffected members underwent a complete ophthalmologic examination, including computerized visual field, optical coherence tomography (OCT) of the optic disc and ultrasound pachymetry. Renal function was assessed by urinalysis and blood tests. Orthopedic evaluations were also performed, including radiological studies of the wrist, elbow and hip joints. Genomic DNA was extracted from peripheral leukocytes of the five affected and two unaffected family members. Exons 2–6 of the LIM homeobox transcription factor 1-beta (LMX1B) gene were screened for mutations by DNA sequencing of the proband. We also screened for mutations in exon 2 by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) of the other participants and 91 blood donors. Results Five living family members from three generations were positively diagnosed with NPS, three of them with varying degrees of OAG and one with OHT. Retinal nerve fiber layer (RNFL) thickness measured by spectral domain OCT was below normal values in three individuals. All subjects evaluated had normal nephrologic function. Orthopedic, clinical, and radiological alterations were compatible with NPS. Screening for mutations in exons 2- 6 of LMX1B showed a heterozygous missense mutation c.194 A>C changing glutamine to proline within exon 2 in codon 65 (Q65P) of the coding sequence. This mutation was present in all NPS subjects and absent in the unaffected family members and in 91 Chilean blood donors. Conclusions This is the first report of c.194 A>C mutation in LMX1B in a Chilean family with NPS and the second worldwide. The phenotype associated with this mutation is variable within the family, although we noted a close connection between the presence of the c.194 A>C mutation and the presence of OHT or OAG and probably also with an early onset of OHT in patients with NPS. All subjects older than 21 years had either OHT or OAG. We also suggest that the LMX1B mutation may be related to affective disorders.

Romero, Pablo; Sanhueza, Felipe; Lopez, Pamela; Reyes, Loreto



COL5A1: 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  

SciTech Connect

COL5A1, the gene for the {alpha}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{prime}-untranslated region RFLPs to exclude COL5A1 as a candidate gene in families with tuberous sclerosis 1, Ehlers-Danlos syndrome type H, and nail-patella syndrome. In addition, we describe a polymorphic simple sequence repeat (SSR) within a COL5A1 intron. This SSR is used to exclude COL5A1 as a candidate gene in hereditary hemorrhagic telangiectasia (Osler-Rendu-Weber disease) and to add COL5A1 to the existing map of {open_quotes}index{close_quotes} markers of chromosome 9 by evaluation of the COL5A1 locus on the CEPH 40-family reference pedigree set. This genetic mapping places COL5A1 between markers D9S66 and D9S67. 14 refs., 1 fig., 2 tabs.

Greenspan, D.S. [Univ. of Wisconsin Medical School, Madison, WI (United States); Northrup, H.; Au, K.S. [Univ. of Texas Medical School, Houston, TX (United States)] [and others



[Injuries and damage caused by excessive stress in classical ballet].  


Typical injuries of highly professional classical ballet dancers were evaluated in 108 members of German opera companies. We demonstrated the predominance of overuse-syndromes to acute injuries related to the excessive training-extends. Disorders of the feet, particularly tendinitis followed by low-back pain, chondromalacia patellae, jumpers knee, shin splints and muscle strains are most frequent. Considerable time often elapsed before diagnosing was made because complaints were ignored by dancers. Our inquiry includes range of motion of the spine and the extremities, serial x-rays and a systematic review of ballet-related injuries, training-programs and techniques. PMID:2566215

Goertzen, M; Ringelband, R; Schulitz, K P


Limp Affecting the Hip and Knee in Children  

PubMed Central

Limp and pain are common findings about the hip and knee in growing children. Epiphyseal growth peculiarities in children account for many of the specific disease entities. Simple but specific physical examination and mandatory simple X-rays will virtually always give or exclude a diagnosis. problems about the hip are usually serious, for example Legg-Perthes, slipped epiphysis and septic arthritis. Most childhood knee problems are annoying but not serious. Chondromalacia patellae and Osgood-Schlatter's disease seldom require treatment—but the knee is the most common site for osteogenic sarcoma.

Bobechko, Walter P.



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


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

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



Change of patellor height with age and sex.  


Patellar height is one of the important parameter in patellar stability. Growth spurt or excessive physical strain can lead to high-riding patella or patella alta. But this is not yet proved. This study was mainly targeted at eliciting the influence of age on Insall-Salvati index, one of the important index to measure patellar height. As the present study is meant for measuring the patellar height separately in male and female, it is also to find out the effect of gender on patellar height if any. The study was been conducted in North Bengal Medical College and Hospital among 93 subjects covering both adult and adolescent age groups. Patellar height of respective subjects was measured radiologically using Insall-Salvati Index; results were extrapolated for statistical analysis. It revealed that value of Insall-Salvati index was higher in adult compared to adolescent group but the difference was not statistically significant. Statistical tests shows no significant difference in Insall-Salvati index according to sex. While screening the athletes patella alta must be kept in mind as this can be associated with patellofemoral pain syndrome, chondromalacia patellae, knees with apophysitis of tibial tubercle (Osgood-Schiatter disease). Not only that, significant cause of recurrent patellar dislocation can be associated with patella alta PMID:23936959

Kar, Maitreyee Nandi; Bhakta, Abhijit; Mondal, Gopal Chandra; Bandyopadhyay, Maitreyi; Kar, Chinmaya; Nandi, Sujit Narayan



Ganglion cyst on the posterior cruciate ligament: a case report  

PubMed Central

Objective: To present the diagnostic and clinical features of a ganglion cyst located on the posterior cruciate ligament and create awareness amongst clinicians of this uncommon diagnosis. Clinical Features: A 24-year old woman complaining of intermittent left knee pain brought on by an increase in mileage during her training for a half-marathon. A diagnosis of mild chondromalacia patella and a ganglion cyst on the posterior cruciate ligament was made via diagnostic imaging. Intervention and outcome: Patient was followed up with imaging. The patient chose to withdraw a surgical consult due to patient preference. No conservative treatment was provided. Conclusion: Although chondromalacia patella is the more probable, a secondary diagnostic consideration in this patient could be a ganglion cyst. A ganglion cyst on the posterior cruciate ligament is an uncommon diagnosis and the clinical manifestations are variable and non-specific. It is important to be aware of its clinical features and to obtain appropriate methods of imaging to generate the diagnosis promptly.

Durante, Jaclyn A.




PubMed Central

1. The functional unity of cirri and membranelles can result structurally only from extensions of the ciliary membrane. 2. The pellicle is composed of an outer pellicular membrane and an inner cytoplasmic membrane. 3. The ciliary rootlets are composed of numerous filaments 120 A in diameter with central areas of low density. They have no periodic structure. 4. The ciliary membrane is a double-layered structure continuous with the pellicular membrane. The cilia show the typical arrangement of nine double, peripheral and two single, central fibrils. All fibrils pass into the basal region, the peripheral ones joining with the rootlet filaments, while the central fibrils from the extreme proximal position of the basal region turn back toward the pellicle and appear to unite just beneath the cytoplasmic membrane. 5. The cilia (300 mµ diameter) taper at their tips to a diameter at least as small as 50 mµ. At a diameter of about 150 mµ, the fibrils begin to show a reduction in number. 6. The central ciliary fibrils may determine the possible directions of ciliary beat. These fibrils show an intrafibrillar structure in their basal portion, which involves regularly spaced 40 A granules. 7. These observations on Euplotes, together with the other evidence cited, are consistent with the hypothesis that ciliary motion is produced by the contraction of the peripheral fibrils, while the central fibrils perhaps determine the plane in which the cilia can bend.

Roth, L. E.



Arthroscopic surgery of the knee: its role in the support of U.S. troops during Operation Desert Shield on USNS mercy.  


The role of arthroscopy in the preconflict deployment of a large number of military troops is not well defined. Between September 1990 and January 1991, while deployed to the Persian Gulf for Operation Desert Shield 73 patients underwent on-board elective arthroscopy on the USNS Mercy. There were 71 men and two women with an average age of 27 years (range 19-47). Indications for arthroscopy included clinical diagnosis of meniscus tear, acute hemarthrosis, chronic effusion, and intra-articular loose body. Findings at the time of arthroscopy included 34 patients (47%) with meniscus tears; 17 (23%) with anterior cruciate ligament tears; five (7%) with isolated grade II-IV chondromalacia involving the patella, trochlea, femoral condyles, or tibial plateaus; six (8%) with synovitis; four (5%) with osteochondritis dissecans of the medial femoral condyle; two (3%) with a medial retinacular tear secondary to patella dislocation; and 10 (14%) with normal arthroscopic examinations. Forty-nine patients (66%) were returned to duty at an average of 6 days postoperatively, obviating the need to evacuate these patients from the Middle East theatre. PMID:1418209

Buckley, S L; Alexander, A; Jones, M; Culp, R W; Smallman, T



Correlation between trochlear dysplasia and anterior cruciate ligament injury.  


PURPOSE. To evaluate the correlation between trochlear dysplasia and anterior cruciate ligament (ACL) injury METHODS. Magnetic resonance images (MRIs) of 95 knees in 54 males and 36 females aged 4 to 74 (mean, 28) years who had anterior knee pain and suspected ligamentous injury were reviewed. The MRIs were independently reviewed by 2 musculoskeletal radiologists on 2 occasions. According to the Dejour classification, trochlear dysplasia was classified into types A, B, C, and D. Intra-articular injuries/ disorders of the patients included patellofemoral osteoarthritis, chondromalacia patella, meniscal tears, and ligamentous injuries. Intra- and inter-observer variability was calculated. RESULTS. 58 of the knees had trochlear dysplasia, 38 of which were Dejour type A. The intra- and inter-observer variability was good to excellent (Kappa=0.76-1). ACL tear was the most common injury (n=13). No ACL injury occurred in patients without trochlear dysplasia. The odds of having sustained an ACL injury were 8.8 fold greater in Dejour type-A knees than in non-type-A knees (p=0.023). CONCLUSION. Dejour type-A trochlear dysplasia was associated with ACL injuries. PMID:24014781

Botchu, Rajesh; Obaid, Haron; Rennie, W J



Arthroscopy of the knee in children.  


Diagnostic arthroscopy was performed in 174 consecutive patients under the age of 18 years. Eight arthroscopies were bilateral. The clinical diagnosis was confirmed in only three of 17 knees in children under aged 14 years and in 44 per cent of the knees in older children. The most commonly disproved diagnoses were torn meniscus and chondromalacia patella. Arthroscopy seldom changed the diagnosis in cases of osteochondritis dissecans. In 38 per cent of the knees, arthroscopy revealed no surgical treatable abnormality, and unnecessary arthrotomy was avoided. Arthroscopy in acute hemarthrosis revealed that ligamentous tears are rather common in children; in nine of 25 knees a partial or complete tear of the anterior cruciate ligament was demonstrated at arthroscopy. The clinical diagnosis was confirmed in eight knees in cases of hemarthrosis. There was no significant difference between the hemarthrosis group and the remaining group as regards a disproved clinical diagnosis. We conclude that arthrotomy should always be preceded by diagnostic arthroscopy in children and adolescents if the clinical diagnosis leaves any doubt. PMID:3630661

Eiskjaer, S; Larsen, S T



Proximal realignment surgery for unilateral chronic patella dislocation in Morquio syndrome: a case report.  


Mucopolysaccharidosis IVA (MPS IVA: Morquio A syndrome) is a lysosomal storage disorder caused by a deficiency of N-acetylgalactosamine-6-sulfate sulfatase. Patients with MPS IVA appear healthy at birth. Morquio-specific radiographic changes can be observed prior to clinical signs and symptoms. Patients are usually affected by a severe joint degeneration from the 2nd or 3rd decade. Hyperlaxity of the joints is prominent due to the excess of intermediate metabolites. We report a patient with inherited dwarfism, in which a proximal soft tissue realignment procedure was performed to treat chronic patellar dislocation. PMID:22245826

Baz, Ali Bülent; Akalin, Serdar; Arik, Hasan; Ergün, Ali



Predation by small mobile aquatic predators regulates populations of the intertidal limpet Patella vulgata (L.)  

Microsoft Academic Search

Highly mobile aquatic predators are known to forage in the intertidal during periods of immersion. There is limited quantitative information, however, on the extent to which these predators influence the abundance of grazing molluscs which are known to have a key role in structuring intertidal assemblages. Our preliminary video observations revealed that crabs and small fish were abundant on shores

A. C. F. Silva; S. J. Hawkins; D. M. Boaventura; R. C. Thompson



The Effect of a Muscle Relaxant on the Biomechanics of the Patella Reflex.  

National Technical Information Service (NTIS)

A device and technique for the simple and direct measurement of the biomechanical parameters of reflex movement, i.e. displacement, velocity, and acceleration, was developed. The effects of the Jendrassik maneuver and arm exercise facilitation were studie...

R. K. Jarvik



AT1 receptor characteristics of angiotensin analogue binding in human synovium.  

PubMed Central

1. Angiotensin II (AII) reduces blood flow, modulates vascular remodelling and is a growth factor. Human inflammatory arthritides are characterized by synovial hypoperfusion, hypoxia and proliferation. We aimed to localize and characterize receptors for AII in human synovium. 2. We used quantitative in vitro receptor autoradiography with [125I]-(Sar1, Ile8)AII and [125I]-AII on human synovium from patients with chondromalacia patellae, osteoarthritis and rheumatoid arthritis. 3. [125I]-(Sar1, Ile8)AII and [125I]-AII bound to similar sites on synovial blood vessels, lining cells and stroma. Binding to microvessels (< 100 microns diameter) was more dense than to arteriolar media, and vascular binding was more dense than that to lining cells and stroma. 4. Microvessels and arterioles which displayed angiotensin converting enzyme-like immunoreactivity also displayed specific binding of [125I]-(Sar1, Ile8)AII. 5. Specific binding of [125I]-(Sar1, Ile8)AII to each structure was completely inhibited by 10 microM dithiothreitol and was inhibited by unlabelled ligands with the rank order of potency (Sar1, Ile8)AII > AII > losartan = SKF108566 > PD123319 indicating an AT1 subclass of angiotensin receptor. 6. GTP gamma S (1 microM) abolished specific binding of [125I]-AII and abolished the high affinity component of the binding inhibition curve for AII against [125I]-(Sar1, Ile8)AII, indicating G protein coupling. 7. The distribution of [125I]-(Sar1, Ile8)AII binding sites was similar in all disease groups and no significant differences in binding densities, affinities or specificities were observed between disease groups. 8. Locally generated AII may act on synovial AT1 receptors to modulate synovial perfusion and growth. Specific AT1 receptor antagonists should help elucidate the role of angiotensins in human arthritis. Images Figure 1 Figure 2

Walsh, D. A.; Suzuki, T.; Knock, G. A.; Blake, D. R.; Polak, J. M.; Wharton, J.



Slipped capital femoral epiphysis: the importance of early diagnosis.  


Slipped capital femoral epiphysis typically occurs in adolescents. Presentation may include limp or vague pain in the hip, thigh or knee. Knee pain, in particular, is a common complaint among adolescents and may be due to patello-femoral syndromes, Osgood-Schlatter disease, patellar tendonitis, or chondromalacia patella, to name a few. However, it is vital to remember that the complaint of knee pain may be present because of referred pain from pathology at the hip. Every child presenting with a complaint of hip, thigh or knee pain must undergo a hip examination. Likewise, a "groin pull" is exceedingly rare in children and must be a diagnosis of exclusion. Any child with complaints of hip, thigh, or knee pain, or physical examination findings of out-toeing, decreased internal rotation, or obligate external rotation with flexion, should be presumed to have SCFE until proven otherwise. There is a high rate of delay in diagnosis of SCFE, which leads to opportunities for progression of deformity, which in turn leads to increased risk of arthritis. Delay in diagnosis also may allow a stable SCFE to become an unstable one, with a much higher risk of development of AVN. When suspected, the diagnosis is confirmed with x-rays (AP and frog-lateral of the pelvis). Therefore, a high index of suspicion for this disorder, and the attainment of appropriate radiographs, should allow for prompt diagnosis and referral for treatment. Treatment is urgent and surgical. Early diagnosis and proper treatment are the mainstays of prevention of adverse sequelae. PMID:16493917

Katz, Daniellle A



Comparison of the Insall–Salvati ratio of the patella in patients with and without an ACL tear  

Microsoft Academic Search

The object of this prospective study is to compare the Insall–Salvati ratio between the patients who have an anterior cruciate ligament (ACL) tear and receive arthroscopic–assistant ACL reconstruction and the patients who have no ACL tear but do have an internal disorder of the knee and receive arthroscopic surgery. We prospectively and consecutively collected into two groups a total of

Chien-Fu Jeff Lin; Jiunn-Jer Wu; Teng-Shung Chen; Tung-Fu Huang



Patellamide A and C biosynthesis by a microcin-like pathway in Prochloron didemni, the cyanobacterial symbiont of Lissoclinum patella  

PubMed Central

Prochloron spp. are obligate cyanobacterial symbionts of many didemnid family ascidians. It has been proposed that the cyclic peptides of the patellamide class found in didemnid extracts are synthesized by Prochloron spp., but studies in which host and symbiont cells are separated and chemically analyzed to identify the biosynthetic source have yielded inconclusive results. As part of the Prochloron didemni sequencing project, we identified patellamide biosynthetic genes and confirmed their function by heterologous expression of the whole pathway in Escherichia coli. The primary sequence of patellamides A and C is encoded on a single ORF that resembles a precursor peptide. We propose that this prepatellamide is heterocyclized to form thiazole and oxazoline rings, and the peptide is cleaved to yield the two cyclic patellamides, A and C. This work represents the full sequencing and functional expression of a marine natural-product pathway from an obligate symbiont. In addition, a related cluster was identified in Trichodesmium erythraeum IMS101, an important bloom-forming cyanobacterium.

Schmidt, Eric W.; Nelson, James T.; Rasko, David A.; Sudek, Sebastian; Eisen, Jonathan A.; Haygood, Margo G.; Ravel, Jacques



Novel and conserved roles for orthodenticle \\/ otx and orthopedia \\/ otp orthologs in the gastropod mollusc Patella vulgata  

Microsoft Academic Search

The orthodenticle\\/otx and orthopedia\\/otp classes of homeobox gene families have been identified in all three major classes of bilaterians: deuterostomes, lophotrochozoans, and ecdysozoans. Otx genes have been studied extensively and play a role in the development of anterior neural structures. Otp genes have been found to be involved in nervous system development in mouse and Drosophila. To date, no members

Alexander J. Nederbragt; Pascal te Welscher; Sander van den Driesche; André E. van Loon; Wim J. Dictus



Metals in marine environment (mollusc Patella sp., fish Labrus bergylta, crustacean Cancer pagurus, beach sand) in a nuclear area, the North Cotentin (France).  


The results of a 1-year long survey of trace metals concentrations (Al, Cd, Cr, Co, Cu, Fe, Mn, Hg, Ni, Pb, Zn) measured in beach sand, limpets and, occasionally, in fish and shellfish from the North Cotentin area (France), where nuclear industries are implanted, are presented. The objective of these study was to provide useful data for the validation of models predicting the impact of these industries on the marine environment. Even if differences were noted between sites for various metals, the levels are consistent with existing data published for similar site and do not appear to give evidence of contamination by industrial sites. PMID:19452254

Connan, Olivier; Tack, Karine



Tibial fixation comparison of semitendinosus-bone composite allografts fixed with bioabsorbable screws and bone-patella tendon-bone grafts fixed with titanium screws.  


Tibial fixation remains the weak link of ACL reconstruction over the first 8-12 weeks postoperatively. This study compared the biomechanical properties of tibial fixation for a bone-patellar tendon-bone (BPTB) graft and a novel semitendinosus-bone composite (SBC) allograft with mixed cortical-cancellous bone dowels at each end. Seven paired, fresh frozen cadaveric knees (20-45 years) were stripped of all soft tissue attachments and randomly assigned to receive either the BPTB graft or SBC allograft. Grafts were placed into tibial tunnels via a standard protocol and secured with either a 10 mmx28 mm bioabsorbable (SBC) or titanium (BPTB) screw. Grafts were cycled ten times in a servo hydraulic device from 10-50 N prior to pull to failure testing at a rate of 20 mm/min with the force vector aligned with the tibial tunnel ("worst case scenario"). Wilcoxon Signed Rank Tests were used to evaluate biomechanical differences between graft types ( p<0.05). Tibial bone mineral density and interference screw insertion torque were statistically equivalent between graft types. The mode of failure for all constructs was direct screw and graft construct pullout from the tibial tunnel. Significant differences were not observed between graft types for maximum load at failure strength (BPTB=620.8+/-209 N vs. SBC=601.2+/-140 N, p=0.74) or stiffness (BPTB=69.8 N/mm+/-29 N/mm vs SBC=47.1+/-31.6 N/mm, p=0.24). The SBC allograft yielded significantly more displacement prior to failure than the BPTB graft (15.1+/-4.9 mm vs 9.2+/-1.3 mm, p=0.04). Increased construct displacement appeared to be due to fixation failure, with some evidence of graft tissue tearing around the sutures: Bioabsorbable screw (10 x 28 mm) fixation of the SBC allograft produced unacceptable displacement levels during testing. Further study is recommended using a titanium interference screw or a longer bioabsorbable screw for SBC graft fixation under cyclic loading conditions. PMID:12845425

Kocabey, Y; Klein, S; Nyland, J; Caborn, D



Autoarthroplasty of knee cartilage defects by osteoperiosteal grafts  

Microsoft Academic Search

Five fresh osteochondral fractures of the knee, which could not be fixed because of extensive fragmentation, were treated by excision of the fragments and reconstruction of the joint surface defect by an autogenous osteoperiosteal graft. The procedure was also used for joint surface reconstruction in sclerotic osteochondritis of the femoral condyle (nine knees) and grave patellofemoral chondromalacia (three knees). Plaster

O. M. Kuokkanen; H. O. M. Kuokkanen



[Diagnostic and therapeutic management of primary and recurrent patellar dislocations - analysis of a nationwide survey and the current literature].  


Aim: Patellar dislocations are a common injury of the knee joint. During patella dislocations injuries of soft-tissue structures can occur that can destabilise the patella and lead to recurrent dislocations. There are also congenital pathologies that predispose to patella dislocations. In the current literature, diagnostics and treatment of patellar dislocations are frequently discussed. Therefore the aim of our survey was to analyse and summarise actual diagnostic and therapeutic strategies regarding primary and recurrent patella dislocations. Methods: An online questionnaire form was sent to 735 orthopaedic and/or trauma departments in Germany. The departments were invited to participate in an anonymous survey concerning diagnostics and treatment of primary and recurrent patellar dislocations. The questionnaire consisted of multiple choice questions and was divided into three sections. The first section included questions concerning the department structure. The second part contained questions regarding diagnostics and treatment of primary patella dislocations. The third part involved diagnostic and treatment strategies for recurrent patella dislocations. A systematic review of outcome after treatment of patellar dislocation was performed and discussed with the results of the survey. Results: 245 hospitals (33.3 %) returned the questionnaire. Among the participants were 23 % orthopaedic surgery departments, 32 % trauma surgery departments and 45 % combined departments. 12 % were university hospitals and 53 % academic teaching hospitals. Clinical examination was performed by nearly all participants after primary and recurrent patella dislocations. MRI was used as diagnostic tool in 81 % after primary patella dislocation and in 85 % after recurrent patella dislocation. Conventional X-rays were performed in 58 % (primary) and 51 % (recurrent patella dislocations). Computed tomography scans for measurement of the tuberositas tibiae-trochlea groove distance were used in 35 % after recurrent dislocations and in 20 % after primary patella dislocations. 69 % of the participating departments performed non-operative therapies after primary patella dislocations, especially when no associated injuries and no congenital pathologies were observed. Reconstruction of the medial retinaculum was the most frequent surgical therapy (52 %) followed by the reconstruction of the medial patellofemoral ligament (36 %) after primary patella dislocation. Following recurrent patella dislocations reconstruction of the medial patellofemoral ligament (58.5 %) was the most performed surgery and a tuberositas transfer was done in 58 % of participating departments after recurrent patella dislocation. Conclusion: The results of our survey showed diagnostic and therapeutic procedures in the participating departments which are in accordance with recommendations in recent publications. The clinical importance of the MPFL reconstruction was observed for primary and recurrent patella dislocation. In addition, conservative treatment is still the most common treatment after primary dislocation of the patella. PMID:23963985

Hohlweck, J; Quack, V; Arbab, D; Spreckelsen, C; Tingart, M; Lüring, C; Rath, B



Surgical treatment of patellar dislocation in children with Down syndrome: a 3- to 11-year follow-up study  

Microsoft Academic Search

We report results of surgical treatment of ten knees affected by patellar dislocation in six children with Down syndrome.\\u000a Four knees showed a dislocatable patella (grade III according to Dugdale), two a dislocated reducible patella (grade IV) and\\u000a four a dislocated irreducible patella (grade V). Symptoms included frequent falls, limping and pain. In all the cases a Roux–Goldthwait–Campbell\\u000a procedure was

Camilla Bettuzzi; Manuele Lampasi; Marina Magnani; Onofrio Donzelli



Medial patellofemoral ligament reconstruction for subluxating patellofemoral arthroplasty.  


Patellofemoral joint (PFJ) arthroplasty has become a successful operation for patellofemoral osteoarthritis. The post-operative complication of patella subluxation is uncommon. We report the stabilisation of a subluxating patella following PFJ arthroplasty using autogenous hamstring tendons. Medial patellofemoral ligament reconstruction may be considered a method of stabilising a subluxating patellofemoral replacement in patients for whom revision arthroplasty is not recommended. PMID:20619661

Carmont, M R; Crane, T; Thompson, P; Spalding, T



Medial patellofemoral ligament reconstruction: indications and technique.  


Lateral instability of the patella is a common problem that often requires reconstruction of the proximal soft tissue restraints. The medial patellofemoral ligament (MPFL) has been demonstrated to be the major soft tissue stabilizer to prevent abnormal lateral displacement of the patella. In this chapter we will discuss the anatomy, biomechanics, indications, and technique for surgical reconstruction of the medial patellofemoral ligament. PMID:22878657

Schepsis, Anthony A; Rogers, Andrew J



Iliotibial band release as an adjunct to the surgical management of patellar stress fracture in the athlete: a case report and review of the literature  

Microsoft Academic Search

Stress fracture of the patella is rare. In this report, a case of patellar stress fracture occurring in an amateur athlete is presented, and an operative adjunct to the surgical management of this condition is proposed. A review of the English literature identified 21 previous cases of stress fracture of the patella, the majority in young athletes. None of these

Anthony Keeley; Paul Bloomfield; Peter Cairns; Robert Molnar



Isokinetic knee extension strength and pain before and after advancement osteotomy of the tibial tuberosity  

Microsoft Academic Search

Summary  In 30 patients with patellofemoral chondromalacia and osteoarthrosis the maximal isokinetic knee extension strength was measured.\\u000a The pain evoked during the recordings was rated on a nine-grade scale. The peak extension torques were markedly lower than\\u000a in the non-diseased knee and in a reference group of healthy volunteers. Twenty months after advancement of the tibial tuberosity,\\u000a the muscle strength was

Bengt Nordgren; Lars-Olof Nordesjii; Wolfgang Rauschning



MIS Patellofemoral Arthroplasty  

Microsoft Academic Search

\\u000a The prevalence of isolated patellofemoral arthritis is high, occurring in as many as 11% of men and 24% of women older than\\u000a the age of 55 years with symptomatic osteoarthritis of the knee in one study.1 Symptomatic patellofemoral chondromalacia occurs with even greater frequency and is a very common reason for presentation\\u000a for orthopedic evaluation, particularly in women between the

Jess H. Lonner


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

Microsoft Academic Search

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

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



Chronic overuse injuries of the piso-triquetral joint in racquet game players.  

PubMed Central

Three squash racquets and one badminton player presented with pain in the base of the hypothenar eminence, due to minor degrees of subluxation of the pisiform bone. Two of them also showed chondromalacia of the articular cartilage of the pisotriquetral joint. All four patients were relieved by excision of the pisiform bone and had returned to their normal daily and sporting activities within three months of their operation. Images Fig. 1-2 Fig. 3 Fig. 4 Fig. 5-6 Fig. 7

Helal, B.



Fast identification & modelling of osteoarthritic holes in the human knee with contour interpolated radial basis functions.  


In this article, we propose a new method for the fast 3D reconstruction of simulated osteoarthritic holes in a human patella. Initially, clean patella slices were extracted from MRI scans of the knee using Region-Based Segmentation (region-growing) and Bounding Box techniques. Osteoarthritic (OA) holes were then simulated in the patella slices. Our contour interpolation/RBF (CI/RBF) method was then used to detect the hole automatically and reconstruct 3D models of both the patella and OA hole separately. The method presented here proves fast, reliable and efficient for reconstructing a 3D model of the patella from MRI images with an extremely low error of 0.33%. PMID:24110718

Javaid, Zarrar; Unsworth, Charles P; Boocock, Mark; McNair, Peter



Content of aliphatic hydrocarbons in limpets as a new way for classification of species using artificial neural networks.  


It is demonstrated that biological species like limpets can be classified according to their level of n-alkanes when artificial neural networks are applied. Marine intertidal and subtidal limpets of the Canary Islands (Spain), Patella piperata, Patella candei crenata and Patella ulyssiponensis aspera were selected as bioindicator organisms. Samples were collected at four stations on the coasts of Fuerteventura. Concentration of n-alkanes in the soft tissues of the limpets has been determined by gas chromatography. Data were treated with artificial neural networks (ANNs) and it was found that using suitable architecture of a supervised artificial neural network, the limpets can be successfully distinguished (classified) up to 98%. PMID:14664834

Hernández-Borges, J; Corbella-Tena, R; Rodríguez-Delgado, M A; García-Montelongo, F J; Havel, J



An Uncommon Cause of Anterior Knee Pain: Patellar Chondroma.  


A 16-year-old boy presented with a patellar mass and anterior knee pain without any trauma. On physical and radiologic assessment, a mass at the superolateral edge of the patella and a hyperintense lesion on T2 sequences of magnetic resonance imaging was detected. Excisional biopsy revealed a chondroma of patella. Primary bone tumors of the patella are extremely rare and occurence of chondroma in this localization is very uncommon. Although anterior knee pain is a very frequent and usually harmless, it is essential to consider the more severe disorders such as bone tumors. PMID:23669736

Kaymaz, Burak; Eroglu, Mehmet; Kaymaz, Nazan; Ucar, Mehmet



Patellar blastomycosis in a dog.  


A 4-year-old, spayed female, mixed-breed dog was presented for evaluation of chronic left hind-limb lameness. Lytic lesions were observed in the left patella on radiographs of the stifle. A biopsy of the patella led to a histopathological diagnosis of blastomycosis. Surgical debridement followed by a 90-day course of itraconazole and physical rehabilitation resolved the clinical signs and stopped the progression of radiographic lesions. Blastomycosis should be considered as a differential diagnosis for stifle joint lameness with lytic lesions in the patella. PMID:19723847

Oshin, Abimbola; Griffon, Dominique; Lemberger, Karin; Naughton, James; Barger, Anne


Knee pain (image)  


... knee is commonly related to injuries to the collateral ligaments, arthritis, or tears to the meniscuses. Pain ... associated with damage or problems with the meniscuses, collateral ligaments, or patella tracking.


Patellar (Kneecap) Fractures  


... 2010 American Academy of Orthopaedic Surgeons Patellar (Kneecap) Fractures Because your kneecap (patella) acts like a shield ... for example, is a common cause of patellar fractures. These fractures are serious injuries and often require ...


Bone scanning in the assessment of patellar viability following knee replacement.  


In an attempt to diagnose avascular necrosis (AVN) of the patella, a potential complication of the surgical procedure, 99mTc-MDP bone scanning was performed pre- and postoperation in 37 patients treated by 41 total knee arthroplasties. The normal immediate postoperative scan should demonstrate increased radionuclide uptake in the patella when compared to preoperative scans. Decreased uptake was seen in four cases in the early postoperative period. This latter group was believed to be at risk for osteonecrosis and stress fracture of the patella. For this reason, prophylactic restriction of activity was instituted, with subsequent return of normal radionuclide uptake in the patella. Bone scanning provides an effective method of early diagnosis of patients at risk for the development of AVN and secondary patellar fractures following total knee arthroplasty. PMID:4042481

Wetzner, S M; Bezreh, J S; Scott, R D; Bierbaum, B E; Newberg, A H



[Knee extensor mechanism ruptures].  


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

Duthon, V B; Fritschy, D



A long-term follow-up study after medial patellofemoral ligament reconstruction using the transferred semitendinosus tendon for patellar dislocation.  


The management of patellar dislocation syndrome has traditionally been difficult. There are no golden standard methods for patellar dislocations probably due to the many etiologies. However, it is known that medial patellofemoral ligament (MPFL) is damaged when the patella is dislocated. The purpose of this study is to examine whether our method of MPFL reconstruction is useful for the treatment of dislocated patellae and unstable patellae. Forty-six knees (43 patients) of 68 knees (65 patients) that were operated on using our surgical procedure for MPFL reconstruction with the advancement of the vastus medialis or the MPFL reconstruction with Insall's procedure were followed up for at least 5 years. The patient age ranged from 6 to 43 years. These knees consisted of six habitual dislocation patellae, twenty-six recurrent dislocation patellae, ten traumatic dislocation patellae, and four unstable patellae. The patients were evaluated pre-operatively and more than three times post-operatively at 6, 12, 36, 60, or 120 months. No patient experienced patellar dislocation after surgery. Their post-operative Kujala's scores were significantly improved. On conventional X-ray and on stress X-ray evaluations, the mean values for congruence angle, tilting angle, lateral shift ratio, medial stress shift ratio, and lateral stress shift ratio at the final follow-up (60 or 120 months) were demonstrated to be within the normal range. We conclude that our MPFL reconstruction method with the advancement of the vastus medialis or with Insall's procedure might be recommended for the treatment of habitual, recurrent, and indeed any other type of patellar dislocation, as well as for unstable patellae. PMID:15968532

Deie, Masataka; Ochi, Mitsuo; Sumen, Yoshio; Adachi, Nobuo; Kobayashi, Kenji; Yasumoto, Masanori



Isolated loss of inferior pubic ramus: a case report  

Microsoft Academic Search

INTRODUCTION: It has been stated that regulation of the development of the iliac bone is different from that of the ischium and pubis. There are well-known clinical syndromes concerned with hypoplasia of ischiopubic bone, such as small patella syndrome, nail-patella syndrome, ischiopubic-patellar hypoplasia, and ischiopubic hypoplasia. CASE PRESENTATION: A fit and otherwise healthy 35-year-old woman presented with pain in the

Aly Saber



Hallux sesamoid disorders.  


Sesamoid disorders are common causes of forefoot pain. Because of the significant mechanical stresses and anatomic variations involved, the sesamoid complex appears to be affected by numerous pathologic processes. These include acute fractures, stress fractures, nonunions, osteonecrosis, chondromalacia, and various inflammatory conditions labeled sesamoiditis. Treatment options include conservative management with orthotics and immobilization, as well as operative interventions that range from fracture/nonunion fixation to various approaches for sesamoidectomy. This article outlines the diagnosis and treatment of these entities and reviews the results of these treatments. PMID:19232995

Cohen, Bruce E



Hamato-lunate impingement: an uncommon cause of ulnar-sided wrist pain.  


It has been reported that almost 50% of lunates have a separate medial facet on the distal surface for articulation with the hamate; about a quarter of these have erosion of the cartilage with exposed subchondral bone on the proximal pole of the hamate. We describe 4 cases of ulnar-sided wrist pain caused by hamato-lunate impingement that resulted in chondromalacia. The pain could be reproduced by a modification of the Lichtman test. The diagnosis was confirmed by arthroscopy. All 4 patients responded favorably to resection of the head of the hamate. PMID:10882452

Thurston, A J; Stanley, J K


The patellofemoral joint: 30 degrees, 60 degrees, and 90 degrees views.  


In 70 patients evaluated for abnormality of the patellofemoral (PF) joint, axial radiographs at 30 degrees, 60 degrees (Ficat views) were obtained, with positive studies in 19. The examination technique and the interpretation of the Ficat views are discussed. In selected patients, the examination can yield valuable information not obtainable by other methods about the PF articulation, allowing differentiation of numerous patellar abnormalities from a torn meniscus. Its value in arthrography is also discussed, as well as its usefulness in evaluating chondromalacia and recurrent patellar subluxation. PMID:7422862

Newberg, A H; Seligson, D



Automatic anatomical structures location based on dynamic shape measurement  

NASA Astrophysics Data System (ADS)

New image processing methods and active photonics apparatus have made possible the development of relatively inexpensive optical systems for complex shape and object measurements. We present dynamic 360° scanning method for analysis of human lower body biomechanics, with an emphasis on the analysis of the knee joint. The anatomical structure (of high medical interest) that is possible to scan and analyze, is patella. Tracking of patella position and orientation under dynamic conditions may lead to detect pathological patella movements and help in knee joint disease diagnosis. The processed data is obtained from a dynamic laser triangulation surface measurement system, able to capture slow to normal movements with a scan frequency between 15 and 30 Hz. These frequency rates are enough to capture controlled movements used e.g. for medical examination purposes. The purpose of the work presented is to develop surface analysis methods that may be used as support of diagnosis of motoric abilities of lower limbs. The paper presents algorithms used to process acquired lower limbs surface data in order to find the position and orientation of patella. The algorithms implemented include input data preparation, curvature description methods, knee region discrimination and patella assumed position/orientation calculation. Additionally, a method of 4D (3D + time) medical data visualization is proposed. Also some exemplary results are presented.

Witkowski, Marcin; Rapp, Walter; Sitnik, Robert; Kujawinska, Malgorzata; Vander Sloten, Jos; Haex, Bart; Bogaert, Nico; Heitmann, Kjell



Automatic Insall-Salvati ratio measurement on lateral knee x-ray images using model-guided landmark localization  

NASA Astrophysics Data System (ADS)

The Insall-Salvati ratio (ISR) is important for detecting two common clinical signs of knee disease: patella alta and patella baja. Furthermore, large inter-operator differences in ISR measurement make an objective measurement system necessary for better clinical evaluation. In this paper, we define three specific bony landmarks for determining the ISR and then propose an x-ray image analysis system to localize these landmarks and measure the ISR. Due to inherent artifacts in x-ray images, such as unevenly distributed intensities, which make landmark localization difficult, we hence propose a registration-assisted active-shape model (RAASM) to localize these landmarks. We first construct a statistical model from a set of training images based on x-ray image intensity and patella shape. Since a knee x-ray image contains specific anatomical structures, we then design an algorithm, based on edge tracing, for patella feature extraction in order to automatically align the model to the patella image. We can estimate the landmark locations as well as the ISR after registration-assisted model fitting. Our proposed method successfully overcomes drawbacks caused by x-ray image artifacts. Experimental results show great agreement between the ISRs measured by the proposed method and by orthopedic clinicians.

Chen, Hsin-Chen; Lin, Chii-Jeng; Wu, Chia-Hsing; Wang, Chien-Kuo; Sun, Yung-Nien



Patellofemoral disorders and instability.  


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

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



Transient lateral patellar dislocation: review of imaging findings, patellofemoral anatomy, and treatment options.  


Transient patellar dislocation is a common sports-related injury in young adults. Although patients often present to the emergency department with acute knee pain and hemarthrosis, spontaneous reduction frequently occurs, and half of cases are unsuspected clinically. Characteristic magnetic resonance imaging (MRI) findings often lead to the diagnosis. The purpose of this review is to illustrate the MRI findings of lateral patellar dislocation and concomitant injuries, such as kissing contusions of the medial patella and lateral femoral condyle; osteochondral and avulsion fractures; and injuries of the medial patellofemoral ligament/retinacular complex. This article will also briefly review patellofemoral anatomy and passive, active, and static stabilizers. Predisposing factors for patellar instability, including trochlear dysplasia, patella alta, and lateralization of the patella or tibial tuberosity and their relevant measurements will also be highlighted. Treatment options, including surgery, such as medial patellofemoral ligament reconstruction, tibial tuberosity transfer, and trochleoplasty, and their postoperative imaging appearances will also be discussed. PMID:22941569

Earhart, Christina; Patel, Dakshesh B; White, Eric A; Gottsegen, Christopher J; Forrester, Deborah M; Matcuk, George R



Lateral patellofemoral ligament reconstruction.  


Abstract Medial dislocation of the patella is a disabling condition; there are several reports in the literature describing this condition and its association with failed lateral retinacular release. The diagnosis and treatment of medial subluxation of the patella may be difficult. Direct repair or imbrication of the lateral retinaculum provides initial stability but a noticeable increase in medial excursion usually reappears. In this article, we describe a simple and reproducible technique to reconstruct the lateral patellofemoral ligament with autogenous tissue that is based on the basic principles of all ligament reconstruction. Reconstruction of the lateral patellofemoral ligament is useful in eliminating the symptoms related to medial instability of the patella after failed lateral retinacular release; however, it must be considered a salvage procedure because it does not address the pathomechanics that led to the initial patellofemoral symptoms. PMID:15525935

Teitge, Robert A; Torga Spak, Roger



A technique for reconstruction of the medial patellofemoral ligament.  


Additional medial patellofemoral ligament reconstruction was performed successfully on six consecutive patients with recurrent dislocation of the patella because of residual patellar instability after medial transfer of the tibial tubercle. A technique for medial patellofemoral ligament reconstruction is described, and complications and postoperative management are discussed. The reconstruction was performed using a double strand hamstring tendon graft in five patients and iliotibial allograft in one. Good stabilization of the patella was achieved in all six patients, resulting in improved confidence in higher levels of activity. The satisfactory outcome of additional medial patellofemoral ligament reconstruction suggests the possibility that the procedure may be part of the optional procedure in proximal realignment for recurrent dislocation of the patella. PMID:10078138

Muneta, T; Sekiya, I; Tsuchiya, M; Shinomiya, K



[Knee dislocation treatment with temporary tibio-patellar fixation (patellar olecranization)].  


Four patients with traumatic dislocation of the knee has been treated with olecranization of the patella. Mean age was 44.4 years (range 27-75 years). Three of them were politrauma patients, but none had popliteal artery injury or peroneal nerve palsy. Olecranization of the patella was performed on the day of injury. Results were assessed according to the Marshall scale. Three results were rated excellent and good with near normal knee function. In one case result was rated fair since despite stable knee and full range of motion pain persisted and marked vascular changes, not related to the injury were present. PMID:10423917

Nied?wiedzki, T; H?adki, W; Mierniczek, W



Clinical, roentgenographic, and scintigraphic results after interruption of the superior lateral genicular artery during total knee arthroplasty  

SciTech Connect

Forty-eight patients treated by primary bilateral simultaneous total knee arthroplasty, in which one knee had a lateral release and the other did not, were evaluated clinically and roentgenographically from one to 12 years postoperatively. Thirty of these patients also had a technetium-99 bone scan. Mean clinical scores at the last follow-up examination were 90 for both groups. Roentgenographically, there were no subluxations, dislocations, or fractures in either group. There were two metal-backed patellae (one in each group) with signs of polyethylene wear and developed debris. Bone scans showed no difference between the two groups and no signs of osteonecrosis of the patella.

Ritter, M.A.; Keating, E.M.; Faris, P.M. (Center for Hip and Knee Surgery, Mooresville, IN (USA))



[Modelling of the knee joint loading conditions in the view of mechanics].  


The results of mathematic modelling of work of femoropatellar joint in normal conditions and in the presence of dysplastic deformity were adduced. There was established, that a knee joint (KJ) by its external appearance and function constitutes a classic cam mechanism. Biomechanical scheme of interaction between the femoral bone processus and patella was elaborated. In accordance to scheme of cam mechanism its experimental roentgenometric investigations were performed. According to statistical analysis performed, in conditions of dysplasia in femoropatellar joint the changes in the KJ occur, which may cause its blockade; the patella position in the KJ depends on peculiarities of anatomical structure of the femoral bone processuses. PMID:23705484

Pustovo?t, K B; Karpins'ky?, M Iu



Mutations in the Pre-Replication Complex cause Meier-Gorlin syndrome  

PubMed Central

Meier-Gorlin syndrome (ear, patella, short stature syndrome) is an autosomal recessive primordial dwarfism syndrome characterised by absent/hypoplastic patellae and markedly small ears1-3. Both pre and post-natal growth are impaired in this disorder and although microcephaly is often evident, intellect is usually normal. We report here that this disorder shows marked locus heterogeneity and we identify mutations in five separate genes: ORC1, ORC4, ORC6, CDT1 and CDC6. All encode components of the pre-replication complex, implicating defects in replication licensing as the cause of a genetic syndrome with distinct developmental abnormalities.

Bicknell, Louise S.; Bongers, Ernie M.H.F.; Leitch, Andrea; Brown, Stephen; Schoots, Jeroen; Harley, Margaret E.; Aftimos, Salim; Al-Aama, Jumana Y.; Bober, Michael; Brown, Paul A. J.; van Bokhoven, Hans; Dean, John; Edrees, Alaa Y.; Feingold, Murray; Fryer, Alan; Hoefsloot, Lies H.; Kau, Nikolaus; Knoers, Nine V.A.M.; MacKenzie, James; Opitz, John M.; Sarda, Pierre; Ross, Alison; Temple, I. Karen; Toutain, Annick; Wise, Carol A.; Wright, Michael; Jackson, Andrew P.



Periprosthetic fractures of the femur after total knee arthroplasty  

PubMed Central

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.

McGraw, Phil



Stair climbing results in more challenging patellofemoral contact mechanics and kinematics than walking at early knee flexion under physiological-like quadriceps loading  

Microsoft Academic Search

The mechanical environment during stair climbing has been associated with patellofemoral pain, but the contribution of loading to this condition is not clearly understood. It was hypothesized that the loading conditions during stair climbing induce higher patellofemoral pressures, a more lateral force distribution on the trochlea and a more lateral shift and tilt of the patella compared to walking at

Ioannis G. Goudakos; Christian König; Philip B. Schöttle; William R. Taylor; Navrag B. Singh; Ian Roberts; Florian Streitparth; Georg N. Duda; Markus O. Heller



The complete type of suprapatellar plica in a professional baseball pitcher: Consideration of a cause of anterior knee pain  

Microsoft Academic Search

We report the case of a professional baseball pitcher who achieved complete relief of an anterior knee pain after resection of a complete type of suprapatellar plica under arthroscopy. The 27-year-old male professional baseball pitcher had complained of right anterior knee pain while pitching for more than 2 years. On physical examination, the mobility of his patella was limited and

Nobuo Adachi; Mitsuo Ochi; Yuji Uchio; Kenzo Kawasaki; Keiichirou Yamasaki



Knee function and neuromuscular adaptations following ACL rupture and reconstruction  

Microsoft Academic Search

In order to alleviate symptoms associated with progressive knee dysfunction and deterioration following anterior cruciate ligament (ACL) injury, patients undergo either conservative non-operative rehabilitative regimens or early reconstructive surgery using the patella tendon (PT) or combined semitendinosus and gracilis tendon (STGT) grafts. Following treatment, ACL deficient (ACLD) and ACL reconstructed (ACLR) patients demonstrate varying levels of knee function with compensatory

Adam L Bryant



Electrical stimulation of vastus medialis and stretching of lateral thigh muscles in patients with patello-femoral symptoms  

Microsoft Academic Search

Thirty patients with unilateral patello-femoral symptoms and a hypotrophic vastus medialis muscle were treated with transcutaneous electrical stimulation of the vastus medialis obliquus and stretching of the lateral thigh muscles twice daily for 10 weeks. Before and after treatment the position of the patella at fixed knee flexion angles and the area of the vastus medialis and vastus lateralis muscles

S. Werner; H. Arvidsson; I. Arvidsson; E. Eriksson



In vivo motion of the rectus femoris muscle after tendon transfer surgery  

Microsoft Academic Search

Abstract Rectus femoris transfer surgery is performed,to convert the rectus femoris muscle,from a knee extensor to a knee flexor. In this surgery, the distal tendon of the rectus femoris is detached from the patella and reattached to one of the knee flexor tendons. The outcomes of this procedure are variable, and it is not known if the surgery successfully converts

Deanna S. Asakawa; Silvia S. Blemker; Garry E. Gold; Scott L. Delp


ASB pre-doctoral young investigator award 2001 In vivo motion of the rectus femoris muscle after tendon transfer surgery  

Microsoft Academic Search

Rectus femoris transfer surgery is performed to convert the rectus femoris muscle from a knee extensor to a knee flexor. In this surgery, the distal tendon of the rectus femoris is detached from the patella and reattached to one of the knee flexor tendons. The outcomes of this procedure are variable, and it is not known if the surgery successfully

Deanna S. Asakawa; Silvia S. Blemker; Garry E. Gold; Scott L. Delp




... of Orthopaedic Surgeons Sesamoiditis Most bones in the human body are connected to each other at joints. But there are a few bones that are not connected to any other bone. Instead, they are connected only to tendons or are embedded in muscle. These are the sesamoids. The kneecap (patella) is ...


The use of ultrasound in vivo to determine acute change in the mechanical properties of bone following intense physical activity.  


The velocity of ultrasound was measured transcutaneously across the patella and tibia in 98 volunteers both before and after running the 26 mile Boston Marathon. Absolute sound velocities were 2.9% higher in those runners finishing before 3 h when compared to runners finishing after 3 h. Tibial velocities in males were 8.8% higher than in female runners. The mean velocity across the patella of three wheelchair racers was 28% lower than the mean combined patella velocity measured in all runners. These data suggest that 'faster' velocities are associated with bone that is better suited for high functional demands. Surprisingly, when pre- and post-race velocities were compared in each runner, there was a 1.6% increase in ultrasonic velocity across the tibia, and a 3.5% increase across the patella. An increase in ultrasonic velocity following extreme physical activity suggests that adaptive mechanisms exist in healthy bone to withstand, or possibly avoid, the microdamage which might be caused by repetitive cyclic loading. PMID:3308891

Rubin, C T; Pratt, G W; Porter, A L; Lanyon, L E; Poss, R



Intraobserver and Interobserver Agreements of Leg Circumference Measurements by Tape Measure Based on 3 Reference Points  

Microsoft Academic Search

The objective of this study was to evaluate the intraobserver and interobserver agreements in tape measurements of the ankle and calf circumference with due emphasis on the 3 main reference points, the patella, the tibial tuberosity, and the medial malleolus. The leg circumference at 2 locations was measured in 66 patients in the mornings of 2 consecutive days by 6

Recep Tunc; Aygul Caglayan-Tunc; Gurcan Kisakol; Gulhan Kanat Unler; Taha Hidayetoglu; Hasan Yazici



Soft Tissue Restraints to Lateral Patellar Translation in the Human Knee  

Microsoft Academic Search

The purpose of this investigation was to identify and quantify the soft tissue restraints, both medially and laterally, to lateral patellar translation. These restraints to lateral patellar translation at 20° of knee flexion were tested biomechanically on a universal testing instrument in nine fresh-frozen cadaveric knees. After preconditioning the tissues, the patella of each intact knee was translated laterally to

Stephen M. Desio; Robert T. Burks; Kent N. Bachus



Radiographic patterns of osteoarthritis of the knee joint in the community: the importance of the patellofemoral joint  

Microsoft Academic Search

The intimate relation which the patella has with the knee joint and quadriceps muscle suggests that patellofemoral joint osteoarthritis is likely to be an important cause of knee pain and disability. Two hundred and seventy three subjects who reported knee pain in a postal questionnaire survey and 240 control subjects consented to have anteroposterior weightbearing and lateral knee radiographs. Each

T E McAlindon; S Snow; C Cooper; P A Dieppe



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

Microsoft Academic Search

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),

Daniela Brakstad; Hilde Elise Heldal; Kjersti Sjřtun


Knee Pain  


... when the triangular bone (patella) that covers the front of your knee slips out of place, usually to the outside of your knee. In some cases, the kneecap may stay displaced and you'll be able to see the dislocation. Hip or foot pain. If you have hip or foot pain, you ...


Transpatellar access for intramedullary stabilisation of the tibia.  


Postoperative deformities of the knee and sequaelae after intraarticular surgery can interfere with a standard parapetallar approach for intramedullary stabilisation of the tibia. Even the suprapatellar approach can be rendered impossible. For these rare indications we describe the patella osteotomy and transpatellar approach. PMID:23362565

Gerich, T; Backes, F; Pape, D; Seil, R



Preliminary results after total knee arthroplasty without femoral trochlea: evaluation of clinical results, quality of life and gait function  

Microsoft Academic Search

Evaluation of the clinical and functional results of a new prosthetic knee design with conservation of the physiologic properties of the patellofemoral joint. After total knee arthroplasty there are often patella problems. Some of them may be a result of excessive retropatellar pressure caused by the prosthetic design. Twelve patients with an average age of 68.6 years were evaluated after a

Susanne Fuchs; Adrian Skwara; Dieter Rosenbaum



Patellar tracking after total knee arthroplasty. The effect of tibial tray malrotation and articular surface configuration.  


The effect of total knee arthroplasty (TKA) with neutrally aligned and malrotated tibial trays was studied in five fresh anatomic specimen knees. Patellar shift, tilt, and rotation, and the rotational position of the tibia were measured in normal knees and after TKA with the Ortholoc Modular knee system. Both semiconstrained and unconstrained articular surfaces were assessed in the neutral position and at anatomic, 15 degrees internal, and 15 degrees external rotation of the tibial tray. After TKA, the patellae shifted slightly medially in the early phase of knee flexion because the anterior lateral flange of the femoral component was longer than the lateral trochlea of the femur and because the tibia rotated internally. The raised lateral flange on the femoral component tilted the patella medially at full extension after TKA. The semiconstrained tray allowed minimal tibial rotation because of its articular configuration. As much as 15 degrees malrotation of the unconstrained tibial tray did not affect patellar tracking. The semiconstrained tibial tray in the neutral position had almost the same patellar tracking as the unconstrained tray, but at 15 degrees external rotation, the semiconstrained tray internally rotated the tibia, leading to medial shift of the patella. Although 15 degrees internal rotation caused external rotation of the tibia, the patella did not shift as much laterally, despite the increase in the Q angle. PMID:8020227

Nagamine, R; Whiteside, L A; White, S E; McCarthy, D S



3-D Anatomically Based Dynamic Modeling of the Human Knee to Include TibioFemoral and Patello-Femoral Joints  

Microsoft Academic Search

An anatomical dynamic model consisting of three body segments, femur, tibia and patella, has been developed in order to determine the three-dimensional dynamic response of the human knee. Deformable contact was allowed at all articular surfaces, which were math- ematically represented using Coons' bicubic surface patches. Nonlinear elastic springs were used to model all ligamentous structures. Two joint coordinate systems

Dumitru I. Caruntu; Mohamed Samir Hefzy



Patellofemoral Syndrome: Therapeutic Regimen Based on Biomechanics  

PubMed Central

The clinician needs to rehabilitate the patient with the patellofemoral syndrome based on biomechanics and anatomy. If we understand the function of the patella and the forces acting upon it, we can educate our patients to ensure their compliance through both the treatment phase and future maintenance.

Strother, R.T.; Samoil, D.



Reconstruction of medial patellofemoral ligament for chronic patellar instability  

PubMed Central

Background: Disruption of the capsule, medial patellar retinaculum, and/or vastus medialis obliqus has been associated with recurrent patellar instability. Biomechanical studies have shown that the medial patellofemoral ligament (MPFL) is the main restraint against lateral patella displacement and reconstruction of the MPFL has become an accepted surgical technique to restore patellofemoral stability in patients having recurrent patellar dislocation. We report a prospective series of patients of chronic patellar instability treated by reconstruction of medial patellofemoral ligament. Materials and Methods: Twelve patients (15 knees) with recurrent dislocation of patella, were operated between January 2006 and December 2008. All patients had generalised ligament laxity with none had severe grade of patella alta or trochlear dysplasia. The MPFL was reconstructed with doubled semitendinosus tendon. Patients were followed up with subjective criteria, patellar inclination angle, and Kujala score. Results: The mean duration of followup after the operative procedures was an average of 42 months (range 24–60 months) 10 knees showed excellent results, 3 knees gave good results, and 2 knees had a fair result. The average patellar inclination angle decreased from 34.3° to 18.6°. The average preoperative Kujala functional score was 44.8 and the average postoperative score was 91.9. Conclusion: MPFL reconstruction using the semitendinosus tendon gives good results in patients with chronic patellar instability without predisposing factors like severe patella alta and high-grade trochlear dysplasia, and for revision cases.

Raghuveer, Reddy K; Mishra, Chandra Bdr



Recurrent patellar dislocation after medial patellofemoral ligament reconstruction.  


We report on three cases of recurrent lateral patellar dislocation following a medial patellofemoral ligament (MPFL) reconstruction for patellar instability. In all three cases, an isolated MPFL reconstruction was performed with a double autogenous gracilis graft. The patellar fixation was done through bone tunnels. All three patients presented with a definite moderate to severe traumatic episode resulting in a recurrent patella dislocation and a transverse avulsion fracture at the medial rim of the patella. All three were treated by an open reduction and internal fixation with good results. No complication or recurrent dislocations occurred. We suggest that this complication is caused by the original underlying pathology such as dysplastic trochlea, abnormal TT-TG, patella alta and hyperlaxity, resulting a greater reliance upon the reconstructed MPFL for patellar stability. When subjected to a severe stress, the graft, which is stronger and stiffer than the original MPFL, will cause a fracture through the medial edge of the patella. This weak area results from the previous drill holes, which act as stress risers. PMID:17973099

Thaunat, Mathieu; Erasmus, Pieter J



The MRI appearance of cystic lesions around the knee  

Microsoft Academic Search

This review presents a comprehensive illustrated overview of the wide variety of cystic lesions around the knee. The aetiology, clinical presentation, MRI appearances and differential diagnosis are discussed. Bursae include those related to the patella as well as pes anserine, tibial collateral ligament, semimembranosus–tibial collateral ligament, iliotibial and fibular collateral ligament–biceps femoris. The anatomical extension, imaging features and clinical significance

Catherine L. McCarthy; Eugene G. McNally




Microsoft Academic Search

The taxonomic literature of protozoölogy includes many references to species of Protozoa which are said to be found in both salt and fresh water. Especially is this true for the Ciliata. Kudo (1931) lists numerous species of this class as found in both habitats. Among them are two species of Euplotes, E. patella and E. charon. Having made considerable study



The role of patellar entesophyte in jumper's knee. ultrasound findings in 18 athletes' knees  

Microsoft Academic Search

IntroductionPatellar tendinopathy (jumper's knee) is a common injury in those sports causing high-torque forces on the patella. Several investigations have tried to elucidate its aetiology, being structural changes in the tendon insertion at the inferior patellar pole the most studied finding. Although the overload at the pole seems to be the cause of the formation of the entesophyte, its role

D Martínez Silván; F Baró Pazos; A Roldán Valero; X Díaz Justo; T Fernández Jaén



Digital imaging in lower limb bone deformities—standards and new perspectives  

Microsoft Academic Search

The gold standard for radiographic assessment and correction planning of lower limb deformities is the long standing radiograph (LSR). Additional computer tomography (CT) can measure exact length and torsion. For correct positioning in LSR the patella should be centered on the femoral condyles (knee forward position—KFP). The flexion extension axis of the knee (KFEA) is mainly defined by the shape

P. H. Thaller; R. Baumgart; R. Burghardt; S. Knüllig; D. Bürklein; W. Mutschler



The pathophysiology of Osgood-Schlatter disease: a magnetic resonance investigation.  


Osgood-Schlatter disease (OSD) is a well-described clinical condition, although its origin remains controversial. Mechanical, growth or traumatic factors are suggested as causes of this lesion. Thirty-five patients were included in this study. Twenty of them had OSD (study group) and the remaining 15 adolescents constituted the control group. Magnetic resonance imaging of the knees was performed in all patients. The distance between the distal pole of the patella and the proximal margin of patellar tendon attachment to the tibial apophysis (A), the distance between the distal pole of the patella and the tibial tubercle epiphysis (B), the distance between the proximal margin of the patellar tendon attachment to the tibia and the tibial tubercle epiphysis (C) and the distance between the knee joint level and the tibial tubercle epiphysis (D) were measured. The ratio of the distance between the distal pole of the patella and the proximal margin of the patellar tendon attachment to the tibia to the distance between the distal pole of the patella and the tibial tubercle epiphysis (A : B) was lower in the study group. The ratio of the distance between the proximal margin of the patellar tendon attachment point to the tibia and the tibial tubercle epiphysis to the distance between the knee joint level and the tibial tubercle epiphysis (C : D) was higher in the control group. We conclude that if the patellar tendon attaches more proximally and in a broader area to the tibia, this might probably cause OSD. PMID:15599229

Demirag, Burak; Ozturk, Cagatay; Yazici, Zeynep; Sarisozen, Bartu



Lower extremity finite element model for crash simulation  

Microsoft Academic Search

A lower extremity model has been developed to study occupant injury mechanisms of the major bones and ligamentous soft tissues resulting from vehicle collisions. The model is based on anatomically correct digitized bone surfaces of the pelvis, femur, patella and the tibia. Many muscles, tendons and ligaments were incrementally added to the basic bone model. We have simulated two types

D. A. Schauer; S. A. Perfect



First-time patellar dislocation with resultant habitual dislocation two years later, which was not demonstrated on plain X-rays halfway: a case report  

PubMed Central

We present an instructive case of habitual left patellar dislocation in which the patella had appeared odd due to lateral tilt relative to contralateral side, but had been radiologically confirmed to be on the trochlea at 1 year prior to the referral. An 11-year-old girl presented to our hospital 2 years after the left patella had dislocated with a 'giving way' when cutting to the left. Our physical and radiological examinations confirmed that the left patella was laterally tilted in the patellar groove with the knee in extension but was dislocated in flexion beyond 45°. In spite of these findings, she had been untreated at the previous hospital since all plain X-rays, including a skyline patellar view, had failed to demonstrate the dislocation. Consequently, in addition to reconstruction of medial patellofemoral ligament, she had to undergo a lateral retinacular release, which might have been unnecessary if treated earlier. This case illustrates that first-time patellar dislocation can gradually lead to habitual dislocation subsequently, and that cautious physical examinations in regard to patella tracking are essential since radiological examinations do not always reveal the pathophysiology of patellar instability.



Trace metals with seasonal considerations in coastal algae and molluscs from Beirut, Lebanon  

Microsoft Academic Search

Twelve species of intertidal algae and molluscs from Ras Beirut, Lebanon have been investigated for their heavy metal content. Atomic absorption spectrophotometric analysis showed that the algae and molluscs concentrated similar levels of most metals. However, of the twelve organisms, Brachydontes variabilis had the highest copper, Patella coerulea and Colpomenia sinuosa had the highest iron, and Pinctada radiata had the

J. G. Shiber



Interaction between a fucoid canopy and limpet grazing in structuring a low shore intertidal community  

Microsoft Academic Search

The relative roles of a macroalgal canopy, Fucus serratus L., and a grazer, Patella vulgata L., in structuring a low shore community of a sheltered, rocky intertidal site were examined using a factorial experimental design. Canopy removal and grazer exclusion treatments were used to determine the effects of both factors on the understorey community. Re-establishment of the canopy was studied

Stuart R. Jenkins; Stephen J. Hawkins; Trevor A. Norton



Intraobserver and interobserver agreements of leg circumference measurements by tape measure based on 3 reference points.  


The objective of this study was to evaluate the intraobserver and interobserver agreements in tape measurements of the ankle and calf circumference with due emphasis on the 3 main reference points, the patella, the tibial tuberosity, and the medial malleolus. The leg circumference at 2 locations was measured in 66 patients in the mornings of 2 consecutive days by 6 observers. Finally, a blinded couple measured leg circumferences at a line created on calves with a ballpoint pen of 68 outpatients to calculate interobserver agreement for lined regions. Leg circumference measurement was accepted as correct when the difference was less than 0.6 cm in 2 occasions. Intraobserver and interobserver agreements were calculated as the percentage of correct measurements. Chi-square test was used to compare intraobserver and interobserver agreements for each reference point. At the calf region, intraobserver and interobserver agreements based on the tibial tuberosity (88% and 81%) were better than those of the patella (65% and 57%) and the medial malleolus (73% and 65%). On the other hand, at above the ankle region, the agreements (79% and 62%) were also better than those of the patella (60% and 43%) and nearly the same as those of the medial malleolus (86% and 65%). Finally, interobserver agreement of the measurements at the created line with ballpoint pen (96%) was better when compared to those of the tibial tuberosity (81%), the patella (57%), and medial malleolus (65%) (p = 0.005, p < 0.001, and p < 0.001, respectively). The results of this study suggest that the tibial tuberosity as a reference point for leg circumference measurement has better intraobserver and interobserver agreements than those of the patella and the medial malleoli. PMID:18024943

Tunc, Recep; Caglayan-Tunc, Aygul; Kisakol, Gurcan; Unler, Gulhan Kanat; Hidayetoglu, Taha; Yazici, Hasan


The influence of patellar bracing on patellar and knee load-distribution and kinematics: an experimental cadaver study.  


The aim of this study was to analyze the biomechanical consequences of patella bracing in order to evaluate possible mechanisms supporting its clinical application. The hypothesis is that the patellar bracing reduces patellofemoral pressure by influencing patellar and knee kinematics, and load distribution. Physiologic isokinetic knee extension motions were simulated on ten human knee cadaver specimens using a knee kinematic simulator. Joint kinematics were evaluated using an ultrasound-based motion analysis system and patellofemoral contact pressure was measured using a thin-film piezoresistive pressure measuring system. Infrapatellar tissue pressure was analyzed using a closed sensor-cell. Three different patella braces were fitted to the knee cadavers and their influence on the kinematic and kinetic biomechanical parameters were evaluated and compared to the physiologic situation. Patellar bracing resulted in a significant (p = 0.05) proximalization of the patella up to 3 mm. Depending on the type of brace used, a decrease in the infrapatellar fat pad pressure was found and the patellofemoral contact area was decreased significantly (p = 0.05) between 60 degrees of knee flexion and full extension (maximum 22%). Patella bracing significantly (p = 0.05) reduced the patellofemoral contact pressure an average of 10%, as well as the peak contact pressure which occurred. Patellar bracing significantly influences patella biomechanics in a reduction of the patellofemoral contact area and contact pressure as well as a decrease in the infrapatellar tissue pressure. The application of infrapatellar straps is suggested for the treatment and prevention of anterior knee pain, especially in high level sports. PMID:18000652

Bohnsack, Michael; Halcour, Andre; Klages, Phillip; Wilharm, Arne; Ostermeier, Sven; Rühmann, Oliver; Hurschler, Christof



Triple fracture during rehabilitation after revision total knee arthroplasty.  


PURPOSE: The incidence of periprosthetic fractures after knee-joint implant revisions is increasing in prevalence. We present a method of treatment for a patient who sustained a triple fracture-a periprosthetic femur fracture, a patella fracture, and a tibial shaft fracture. METHODS: The femoral fracture was treated with a specially designed intramedullary nail, the patella fracture with a figure-of-eight suture, and the tibial shaft fracture by a minimal-invasive plate osteosynthesis using a percutaneous plating technique. RESULTS: Osseous consolidation was confirmed, and the patient presented a satisfying range of movement under full-weight-bearing conditions after mobilisation. CONCLUSIONS: Simultaneous multiple periprosthetic fractures are a special challenge, and in situ coupling of the endoprosthesis with a slotted hollow nail presents a valuable option for the treatment. LEVEL OF EVIDENCE: Level V, Expert opinion. PMID:23716014

Meyer, Christof; Szalay, Gabor; Alt, Volker; Schnettler, Reinhard



Ultrastrukturelle Untersuchungen zur Morphologie und Genese der Spermien von Archaeogastropoda  

NASA Astrophysics Data System (ADS)

The sperm cells of Patella coerulea (Patellacea), Monodonta turbinata, and Gibbula tumida (Trochacea) were investigated by means of transmission electron microscopy. They belong to the primitive type (sensu Franzén) and have more features in common with primitive Bivalvia sperms than with Neritacea. Their head contains an apical acrosome and a roundish nucleus followed by 4 or 5 mitochondria and a centriolar apparatus which consists of two centrioles, one of which bears a flagellum. The sperm cells of Monodonta and Gibbula are very similar to each other and differ mainly in size; Patella exhibits more differences (very small acrosome, subacrosomal space, variable number of spherical mitochondria (origin of spermic dimorphism ?). The development of the sperm cells shows no peculiarities.

Kohnert, R.; Storch, V.



Neglected patellar tendon rupture: a case of reconstruction without quadriceps lengthening  

PubMed Central

Neglected rupture of the patellar tendon is a rare, can be easily missed in a group of patients. We present a 24 year old, male patient who sustained right femoral diaphyseal and tibial plateau fractures and a patellar tendon rupture following a motor vehicle accident. The fractures were treated by open reduction internal fixation but the patellar tendon rupture was missed and the diagnosis was delayed by 7 months. Patella was migrated proximally. It was moved distally to the original location and neglected patellar tendon rupture treated successfully with modified Ecker technique. Neither preoperative traction nor additional intraoperative procedures were performed to relocate the patella to its anatomic position in the extended knee and good functional result was achieved with intensive rehabilitation.

Demiralp, B.; Komurcu, M.; Sehirlioglu, A.



Tibial tuberosity transfer for episodic patellar dislocation.  


Numerous surgical techniques have been described to address episodic patellar dislocations. Some of them involve the soft tissues whereas others primarily address a bony correction. Four principal anatomic factors have been identified that increase the risk for episodic patellar dislocations: trochlear dysplasia, patella alta, patellar tilt, and an excessive tibial tubercle-trochlear groove distance. A treatment algorithm has been proposed to correct each of these factors. It includes the tibial tuberosity transfer, which is able to correct both a patella alta and an excessive tibial tubercle-trochlear groove distance. The tibial tuberosity can be transferred distally or medially or more frequently a combination of both. It will realign the extensor mechanism and increase patellofemoral stability. This procedure may be associated with a medial patellofemoral ligament reconstruction in case of excessive patellar tilt or rarely with a trochleoplasty for major abnormal patellar maltracking. PMID:17505319

Servien, Elvire; Verdonk, Peter C; Neyret, Philippe



Kinematic differences between gender specific and traditional knee implants.  


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

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



Mutations in the pre-replication complex cause Meier-Gorlin syndrome.  


Meier-Gorlin syndrome (ear, patella and short-stature syndrome) is an autosomal recessive primordial dwarfism syndrome characterized by absent or hypoplastic patellae and markedly small earsą?ł. Both pre- and post-natal growth are impaired in this disorder, and although microcephaly is often evident, intellect is usually normal in this syndrome. We report here that individuals with this disorder show marked locus heterogeneity, and we identify mutations in five separate genes: ORC1, ORC4, ORC6, CDT1 and CDC6. All of these genes encode components of the pre-replication complex, implicating defects in replication licensing as the cause of a genetic syndrome with distinct developmental abnormalities. PMID:21358632

Bicknell, Louise S; Bongers, Ernie M H F; Leitch, Andrea; Brown, Stephen; Schoots, Jeroen; Harley, Margaret E; Aftimos, Salim; Al-Aama, Jumana Y; Bober, Michael; Brown, Paul A J; van Bokhoven, Hans; Dean, John; Edrees, Alaa Y; Feingold, Murray; Fryer, Alan; Hoefsloot, Lies H; Kau, Nikolaus; Knoers, Nine V A M; Mackenzie, James; Opitz, John M; Sarda, Pierre; Ross, Alison; Temple, I Karen; Toutain, Annick; Wise, Carol A; Wright, Michael; Jackson, Andrew P



Sinding-Larsen-Johansson syndrome: A case report.  


The Sinding-Larsen-Johansson syndrome has a pathogenesis similar to that of the Osgood-Schlatter disorder and is the result of excessive force exerted by the patellar tendon on the lower pole of the patella. Clinically it is characterized by pain, which increases when the patellar is loaded during flexion, subpatellar swelling and functional limitation. The authors present a case of a 13-year-old boy who was a competitive youth team football player. He presented with anterior, spontaneous knee pain and swelling at the inferior pole of the patella. Ultrasonography (US) confirmed clinical diagnosis showing lesions typical of the Sinding-Larsen-Johansson syndrome. The patient was told to refrain from sports activity; after five months recovery was complete and US follow-up revealed no anomaly. The authors consider the case worthy of reporting because it is paradigmatic and to emphasize the role of US in the evaluation of the Sinding-Larsen-Johansson syndrome. PMID:23396672

Valentino, M; Quiligotti, C; Ruggirello, M



Sinding-Larsen-Johansson syndrome: A case report  

PubMed Central

The Sinding-Larsen-Johansson syndrome has a pathogenesis similar to that of the Osgood-Schlatter disorder and is the result of excessive force exerted by the patellar tendon on the lower pole of the patella. Clinically it is characterized by pain, which increases when the patellar is loaded during flexion, subpatellar swelling and functional limitation. The authors present a case of a 13-year-old boy who was a competitive youth team football player. He presented with anterior, spontaneous knee pain and swelling at the inferior pole of the patella. Ultrasonography (US) confirmed clinical diagnosis showing lesions typical of the Sinding-Larsen-Johansson syndrome. The patient was told to refrain from sports activity; after five months recovery was complete and US follow-up revealed no anomaly. The authors consider the case worthy of reporting because it is paradigmatic and to emphasize the role of US in the evaluation of the Sinding-Larsen-Johansson syndrome.

Valentino, M.; Quiligotti, C.; Ruggirello, M.



The immature athlete.  


The skeletally immature athlete poses unique problems in diagnosis and treatment of injuries to the extensor mechanism of the knee. An accurate and detailed history and physical examination of the knee are essential for making a specific diagnosis and formulating an appropriate treatment plan. This article presents an overview of acute and chronic injuries of the extensor mechanism of the knee that are unique to skeletally immature athletes. The subjects of femoral trochlear dysplasia and medial subluxation of the patella are briefly discussed. The etiopathology, clinical evaluation, and management (non-operative and operative) of sleeve fractures of the patella and avulsion fractures of the tibial tubercle in children and adolescents are discussed. The pathoanatomy, clinical features, and management of synovial plica syndrome, Hoffa's syndrome, Osgood-Schlatter disease, and Sinding-Larsen-Johansson disease are presented. PMID:12365238

Duri, Zaid A A; Patel, Dipak V; Aichroth, Paul M



Anatomical double-bundle MPFL reconstruction with an aperture fixation.  


Since biomechanical studies have shown that the medial patellofemoral ligament (MPFL) is the main restraint against lateral patella displacement, reconstruction of the MPFL has become an accepted method of restoring patellofemoral stability and numerous techniques were described. Due to biomechanical examinations and clinical results, an anatomical double-bundle reconstruction of the "sail-like" MPFL is a reasonable method for achieving stability during complete extension and lower flexion degree. This method also serves to avoid rotation of the patella, providing immediate stability throughout the normal range of motion. However, until today, an aperture fixation technique at the patellar insertion with two bundles has not been described previously. This technique can provide an immediate stability to allow an early rehabilitation with full range of motion. PMID:19593547

Schöttle, Philip B; Hensler, Daniel; Imhoff, Andreas B



The podocyte-specific inactivation of Lmx1b, Ldb1 and E2a yields new insight into a transcriptional network in podocytes  

Microsoft Academic Search

Patients with nail-patella syndrome, which among other symptoms also includes podocyte-associated renal failure, suffer from mutations in the LMX1B gene. The disease severity among patients is quite variable and has given rise to speculations on the presence of modifier genes. Promising candidates for modifier proteins are the proteins interacting with LMX1B, such as LDB1 and E47. Since human kidney samples

Hani Suleiman; Daniel Heudobler; Anne-Sarah Raschta; Yangu Zhao; Qi Zhao; Irmgard Hertting; Helga Vitzthum; Marcus J. Moeller; Lawrence B. Holzman; Reinhard Rachel; Randy Johnson; Heiner Westphal; Anne Rascle; Ralph Witzgall



Medial Patellofemoral Ligament Reconstruction Using Hamstring Autograft in Children and Adolescents  

PubMed Central

We introduce an anatomic reconstruction technique for the medial patellofemoral ligament using a free hamstring autograft in skeletally immature patients. We dock the 2 ends of the graft in the superior-medial patella using sockets and secure the femoral graft attachment in a socket tunnel distal to the physis. This technique minimizes the risk of injury to the growth plate and still enables accurate and successful anatomic positioning of the hamstring autograft.

Ladenhauf, Hannah N.; Berkes, Marschall B.; Green, Daniel W.



Anatomical double-bundle MPFL reconstruction with an aperture fixation  

Microsoft Academic Search

Since biomechanical studies have shown that the medial patellofemoral ligament (MPFL) is the main restraint against lateral\\u000a patella displacement, reconstruction of the MPFL has become an accepted method of restoring patellofemoral stability and numerous\\u000a techniques were described. Due to biomechanical examinations and clinical results, an anatomical double-bundle reconstruction\\u000a of the “sail-like” MPFL is a reasonable method for achieving stability during

Philip B. Schöttle; Daniel Hensler; Andreas B. Imhoff



Diagnostiek en behandeling van de jumper’s knee  

Microsoft Academic Search

De jumper’s knee (patellatendinopathie) is een frequent voorkomende, lastig te behandelen blessure die gekenmerkt wordt door\\u000a belastingafhankelijke pijn ter plaatse van de apex patellae. De etiologie is multifactorieel: aanleg, overbelasting en verstoringen\\u000a in de spierpeesfunctie en bewegingsketen lijken een belangrijke rol te spelen. Histopathologisch is er bij een chronische\\u000a patellatendinopathie sprake van een gestoord regeneratieproces (tendinose) en niet zoals vaak

Hans Zwerver; Anton Slagers


A technique for treating patello-femoral instability in immature patients: the tibial tubercle periosteum transfer  

Microsoft Academic Search

Patello-femoral problems are frequently encountered in knee clinic. The most important role of the patella is to increase\\u000a the quadriceps efficiency, although this function could be altered in the patello-femoral instability. Active stability of\\u000a the patello-femoral joint is provided by the surrounding muscles and ligaments, passive stability is provided by the bony\\u000a and cartilage structures. Patellofemoral instability is defined, from

Eugenio Savarese; Salvatore Bisicchia; Francesco Carotenuto; Ernesto Ippolito



Non-Contact Evaluation of Osmosis-Induced Shrinkage and Swelling Behavior of Articular Cartilage In-Situ Using High-Frequency Ultrasound  

Microsoft Academic Search

The aim of the present study was to use high?frequency ultrasound for the investigation of the transient osmosis?induced free shrinkage?swelling behaviors of normal articular cartilage in situ. Full?thickness cartilage?bone specimens were prepared from normal bovine patellae. The transient shrinkage and swelling strains of the cartilage induced by changing the bathing solution between physiological saline (0.15 M) and hypertonic saline (2 M) were

Q. Wang; Y. P. Zheng



Photosynthesis of Prochloron as Affected by Environmental Factors  

Microsoft Academic Search

:   The effects of light intensity, pH, temperature, and UV irradiation on the photosynthetic rate of Prochloron isolated from the ascidian host Lissoclinum patella, collected from Palau, were examined. Photosynthesis increased with light intensity with saturation at 500 ?mol\\/m2 per second. It was maximum at pH 8 to 9 but almost completely suppressed below pH 7. The optimum temperature was

Maribel L. Dionisio-Sese; Tadashi Maruyama; Shigetoh Miyachi



Non-host organisms affect transmission processes in two common trematode parasites of rocky shores  

Microsoft Academic Search

The transmission of free-living trematode stages is mediated by various environmental factors, of which the presence of ambient\\u000a organisms within the host space is a potential major determinant. In two laboratory mesocosm experiments, we investigated\\u000a the influence of four intertidal rocky shore species on transmission success of cercariae of the digenean trematodes Echinostephilla\\u000a patellae (encysting in the tissue of blue

Katrin Prinz; Thomas C. Kelly; Ruth M. O’Riordan; Sarah C. Culloty



Sodium MRI of human articular cartilage in vivo.  


Preliminary results from in vivo sodium MRI of human patellar articular cartilage are presented. Sodium images generated of an in vitro bovine patella clearly distinguish the region of proteoglycan depletion from the region of healthy cartilage. This provides the first evidence that sodium imaging may be used to detect changes due to osteoarthritis in vivo. The process of optimizing imaging time and signal-to-noise ratio, as well as potential implications in the detection of osteoarthritic change, are discussed. PMID:9581599

Reddy, R; Insko, E K; Noyszewski, E A; Dandora, R; Kneeland, J B; Leigh, J S



Sex differences in knee cartilage volume in adults: role of body and bone size, age and physical activity  

Microsoft Academic Search

Objective. To test the hypothesis that sex differences in knee cartilage volume may be mediated through body and bone size, age and\\/or physical activity. Methods. A cross-sectional convenience sample of 372 subjects (males 43%; mean age 45 yr, range 26-61) was studied. Articular cartilage volumes and bone size were determined at the patella, medial and lateral tibia by processing images

C. Ding; F. Cicuttini; F. Scott; M. Glisson; G. Jones



Regional variations in human patellar trabecular architecture and the structure of the proximal patellar tendon enthesis  

PubMed Central

Proximal patellar tendinopathy occurs as an overuse injury in sport and is also characteristic of ankylosing spondylitis patients. It particularly affects the posteromedial part of the patellar tendon enthesis, although the reason for this is unclear. We investigated whether there are regional differences in the trabecular architecture of the patella or in the histology of the patellar tendon enthesis that could suggest unequal force transmission from bone to tendon. Trabecular architecture was analysed from X-rays taken with a Faxitron radiography system of the patellae of dissecting room cadavers and in magnetic resonance images of the knees of living volunteers. Structural and fractal analyses were performed on the Faxitron digital images using MatLab software. Regional differences at the enthesis in the thickness of the uncalcified fibrocartilage and the subchondral plate were evaluated histologically in cadaveric material. The radiological studies showed that the quantity of bone and the apparent trabecular thickness in the patella were greatest medially, and that in the lateral part of the patella there were fewer trabeculae which were orientated either antero-posteriorly or superiorly inferiorly. The histological study showed that the uncalcified fibrocartilage was most prominent medially and that the subchondral plate was thinner laterally. Overall, the results indicate that mechanical stress at the proximal patellar tendon enthesis is asymmetrically distributed and greater on the medial than on the lateral side. Thus, we suggest that the functional anatomy of the knee is closely related to regional variations in force transmission, which in turn relates to the posteromedial site of pathology in proximal patellar tendinopathy.

Toumi, H; Higashiyama, I; Suzuki, D; Kumai, T; Bydder, G; McGonagle, D; Emery, P; Fairclough, J; Benjamin, M



Development of femoral trochlear groove in growing rabbit after patellar instability  

Microsoft Academic Search

Purpose  The geometry of an articular surface is an important determinant of joint function. Although the geometry of the trochlear\\u000a groove is considered to be important in the pathogenesis of patellofemoral joint disorders, the effects of the patella during\\u000a the development of the femoral trochlear groove are unclear. This animal study aimed to investigate the relationship between\\u000a the position of the

Gazi Huri; Ozgur Ahmet Atay; Bilge Ergen; K?vanc Atesok; Darren L. Johnson; Mahmut Nedim Doral


Evaluation of Acoustical Parameter Sensitivity to Age-Related and Osteoarthritic Changes in Articular Cartilage Using 50MHz Ultrasound  

Microsoft Academic Search

The current study reports the sensitivity of acoustical parameters estimated at high frequency to the osteoarthritic morphological and structural changes in patellar cartilage in rat knees. Osteoarthritis (OA) was induced by a single intra-articular injection of mono-iodo-acetic acid in right knees. OA patellas and their contralateral controls were excised at regular intervals after injection and were examined in vitro with

Emmanuel Chérin; Amena Sä?ed; Pascal Laugier; Patrick Netter; Genevičve Berger




Microsoft Academic Search

Relatively few investigations have been published on seasonal changes in the biochemical composition of marine prosobranch gastropods. Blackmore (1969) followed seasonal changes in the level of polysaccharide, lipid, non-protein and protein nitrogen in the limpet Patella v'ulgata. Several papers have been published on seasonal changes in the biochemical level and content of the abalone Ha1iotis cracherodii (Giese, 1969 ; Webber



Trace element levels in mollusks from clean and polluted coastal marine sites in the Mediterranean, Red and North Seas  

Microsoft Academic Search

The trace element contamination levels in mollusks were evaluated for different marine coastal sites in the Mediterranean\\u000a (Israeli coast), Red (Israeli coast) and North (German coast) Seas. Three bivalve species (Mactra corallina, Donax sp, and Mytilus\\u000a edulis) and two gastropod species (Patella sp.and Cellana rota) were sampled at polluted and relatively clean sites, and their soft tissue analyzed for Hg,

Barak Herut; Nurit Kress; Edna Shefer; Hava Hornung



Cardiac responses to salinity variations in two differently zoned Mediterranean limpets  

Microsoft Academic Search

Cardiac activity of two Mediterranean limpets was tested at different salinities. Patella caerulea inhabits the lower midlittoral where it is exposed to variations in salinity, while P. aspera experiences more stable salinity conditions in the infralittoral fringe. When exposed to moderate hypo- and hypersalinity\\u000a (23?g?l?1 and 43?g?l?1) for 24?min, P. caerulea showed no significant variation in heart rate with respect

M. De Pirro; G. Santini; G. Chelazzi



Patellar clunk syndrome after posterior stabilized total knee arthroplasty  

Microsoft Academic Search

Two hundred thirty-six posterior stabilized total knee arthroplasties (TKAs) were performed consecutively. Twenty-seven patellar clunk syndromes were identified in 25 patients. Insall-Salvati ratio, position of joint line, postoperative patellar height, and anterior-posterior position of tibial tray were measured. It was found that postoperative low-lying patella (P<.001) and anterior placement of tibial tray (P=.011) was associated with patellar clunk syndrome. Thirteen

Wai-Pan Yau; Jimmy W. K Wong; Kwong-Yuen Chiu; Tze-Pui Ng; Wai-Man Tang



A Three-Dimensional Musculoskeletal Model of the Human Knee Joint. Part 1: Theoretical Construction  

Microsoft Academic Search

A three-dimensional model of the knee is developed to study the interactions between the muscles, ligaments, and bones during activity. The geometry of the distal femur, proximal tibia, and patella is based on cadaver data reported for an average-size knee. The shapes of the femoral condyles are represented by high-order polynomials: the tibial plateaux and patellar facets are approximated as




A Three-Dimensional Musculoskeletal Model of the Human Knee Joint. Part 2: Analysis of Ligament Function  

Microsoft Academic Search

A three-dimensional model of the knee is used to study ligament function during anterior-posterior (a-p) draw, axial rotation, and isometric contractions of the extensor and flexor muscles. The geometry of the model bones is based on cadaver data. The contacting surfaces of the femur and tibia are modeled as deformable; those of the femur and patella are assumed to be




Medial patellofemoral ligament reconstruction using hamstring autograft in children and adolescents.  


We introduce an anatomic reconstruction technique for the medial patellofemoral ligament using a free hamstring autograft in skeletally immature patients. We dock the 2 ends of the graft in the superior-medial patella using sockets and secure the femoral graft attachment in a socket tunnel distal to the physis. This technique minimizes the risk of injury to the growth plate and still enables accurate and successful anatomic positioning of the hamstring autograft. PMID:23875142

Ladenhauf, Hannah N; Berkes, Marschall B; Green, Daniel W



Medial patellofemoral ligament reconstruction for patellar maltracking following total knee arthroplasty is effective.  


PURPOSE: Maltracking of the patella after total knee arthroplasty (TKA) remains a well-recognized problem. The medial patellofemoral ligament (MPFL) has shown to be important for patellar stabilization and reconstructions of the MPFL have already shown excellent functional outcomes for patellar instability of the native knee. Nevertheless, there is only limited literature on using an MPFL reconstruction for correction of patellar maltracking after TKA. In this retrospective study, a consecutive case series was evaluated. METHODS: Between 2007 and 2010, nine patients (nine knees) with anterior knee pain and symptomatic (sub)luxations of the patella after primary or revision TKA were treated by reconstruction of the MPFL in combination with a lateral release. In two cases, an additional tibial tuberosity transfer was performed, due to insufficient per-operative correction. Pre-operative work-up included a CT scan to rule out component malrotation and disorders in limb alignment. Pre- and post-operative patellar displacement and lateral patellar tilt were measured on axial radiographs. Clinical outcome was evaluated using the visual analogue scale (VAS) satisfaction, VAS pain, dislocation rate and Bartlett patella score. RESULTS: Median patellar displacement improved from 29 mm (0-44) to 0 mm (0-9) post-operatively. Median lateral patellar tilt was 45° (23-62) pre-operative and changed to a median 15° (-3 to 21) post-operative. Median VAS satisfaction was 8 (5-9) and only one patient reported a subluxing feeling afterwards. The Bartlett patella score displayed a diverse picture. CONCLUSIONS: Patellar maltracking after primary or revision TKA without malrotation can effectively be treated by MPFL reconstruction in combination with a lateral release. Only in limited cases, an additional tibial tuberosity transfer is needed. LEVEL OF EVIDENCE: IV. PMID:23108684

van Gennip, Stijn; Schimmel, Janneke J P; van Hellemondt, Gijs G; Defoort, Koen C; Wymenga, Ate B



Imaging for Knee and Shoulder Injuries  

Microsoft Academic Search

\\u000a \\u000a Knee  ? Knee radiographs of the acutely injured knee in the emergency department are rarely useful for determining therapy, except\\u000a in patients with any of the following conditions: isolated tenderness of the patella, tenderness at the head of fibula, inability\\u000a to flex 90°, inability to bear weight both immediately and in the emergency department for a total of four steps, or

Ricardo Restrepo; Christopher Schettino


Ultrasound, densitometry, and extraskeletal appendicular fracture risk factors: A cross-sectional report on The Saunders County Bone Quality Study  

Microsoft Academic Search

The Saunders County Bone Quality Study was designed to determine the feasibility of ultrasonic bone measurement, at the patella, as a predictor of low-trauma fractures in a runal population-based study. At the first visit of this 4-year longitudinal study, anthropometric and clinical measurements and medical, surgical, and fracture histories were obtained for the 1428 participants (899 women and 529 men).

D. Travers-Gustafson; M. R. Stegman; R. P. Heaney; R. R. Recker



Revision anterior cruciate ligament reconstruction using autografts with a polyester fixation device  

Microsoft Academic Search

Twenty-nine patients who had undergone anterior cruciate ligament (ACL) revision were evaluated retrospectively between 1992 and 2000. A similar surgical technique was used in all cases. Twenty-six patients underwent revision following failed primary and revision surgery with the ABC scaffold ligament. There were 2 failed primary semitendinosus\\/gracilis (STG) autografts and one failed bone patella tendon bone (BPTB) autograft. Autologous hamstring

Peter J. Fules; Rohit T. Madhav; Richard K. Goddard; Michael A. S. Mowbray



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

Microsoft Academic Search

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,

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


Bursae around the knee joints  

PubMed Central

A bursa is a fluid-filled structure that is present between the skin and tendon or tendon and bone. The main function of a bursa is to reduce friction between adjacent moving structures. Bursae around the knee can be classified as those around the patella and those that occur elsewhere. In this pictorial essay we describe the most commonly encountered lesions and their MRI appearance.

Chatra, Priyank S



Oestrogen is important for maintenance of cartilage and subchondral bone in a murine model of knee osteoarthritis  

PubMed Central

Introduction Oestrogen depletion may influence onset and/or progression of osteoarthritis. We investigated in an ovariectomized mouse model the impact of oestrogen loss and oestrogen supplementation on articular cartilage and subchondral bone in tibia and patella, and assessed bone changes in osteoarthritis development. Methods C3H/HeJ mice were divided into four groups: sham-operated, oestrogen depletion by ovariectomy (OVX), OVX with estradiol supplementation (OVX+E) and OVX with bisphosphonate (OVX+BP). Each mouse had one knee injected with low-dose iodoacetate (IA), and the contralateral knee was injected with saline. Cartilage was analysed histologically 12 weeks postsurgery; bone changes were monitored over time using in vivo micro-computed tomography. Results In tibiae, OVX alone failed to induce cartilage damage, but OVX and IA combination significantly induced cartilage damage. In patellae, OVX alone induced significant cartilage damage, which was enhanced by IA. In both tibiae and patellae, OVX in combination with IA significantly decreased subchondral cortical thickness in an additive manner. OVX+E and OVX+BP inhibited tibial and patellar subchondral cortical thinning, inhibited patellar and tended to diminish tibial cartilage damage. In patellae, IA interacted with BP, leading to increased subchondral cortical and trabecular bone. Conclusions This study demonstrates the significance of oestrogen for articular cartilage and subchondral bone and maintenance of healthy joints, supporting an etiological role for altered oestrogen signaling in osteoarthritis either by directly affecting cartilage or increasing susceptibility for an osteoarthritis trigger. The data strongly support the concept of involvement of subchondral bone plate in osteoarthritis.



The magnitude and character of resistance-training-induced increase in tendon stiffness at old age is gender specific  

Microsoft Academic Search

Human tendon mechanical properties are modified with loading. Moreover, there are indications that the training response in\\u000a the tendon is gender specific. The aim of the current study was to examine whether in vivo patella tendon stiffness (K) differentially alters with training in older males compared with females. We also aimed to identify which endocrine pathway\\u000a underlies the responses. Maximal

Gladys Leopoldine Onambele-Pearson; Stephen John Pearson



Microsoft Academic Search

The purpose of this study was to assess changes in psychophysiological fitness following reconstructive knee surgery and early phase (2.5 months) physical rehabilitation. Nine patients (7 male, 2 female; mean age, 29.9 years) electing to undergo anterior cruciate ligament reconstructive surgery (central third, bone-patella tendon-bone graft) were assessed on four separate assessment occasions post-surgery. Repeated measures ANOVAs showed significant condition

Nigel Gleeson; Gaynor Parfitt; Claire Minshull; Andrea Bailey; David Rees


Arthroscopy of the knee in children and adolescents.  


Arthroscopy of the knee was performed in 104 patients under 18 years of age, 41 in children (aged 8 to 15) and 63 in adolescents (aged 16 to 18). Most frequently lesions of the patella were found (in 45% of all diagnoses in children and 29% in adolescents), in most cases because of acute or recurrent dislocation of the patella. The incidence of meniscal lesions increased with age. The most frequent therapeutic procedure performed in children was a lateral release (34%), in adolescents a partial meniscal resection (31%). In children 43% of arthroscopies were diagnostic, in adolescents 21%. Preoperative diagnosis was shown to be incorrect or incomplete arthroscopy in 41% of children and 24% of adolescents taking arthroscopic findings as a golden standard. Preoperative diagnosis had highest accuracy for dislocation of the patella, 90% of dislocations were diagnosed correctly before arthroscopy. The lowest accuracy of clinical diagnosis was found for meniscal lesions; only 36% of meniscal tears were suspected preoperatively. In 35 of 38 patients with hemarthrosis a relevant knee lesion was found, in 23 of these patients arthroscopic therapy was performed. This justifies our concept for arthroscopy of every knee hemarthrosis. Besides superficial chondral lesions in 8 patients there were no complications associated with the procedure. It is concluded that arthroscopy of the knee in children and adolescents is a safe procedure with high diagnostic and therapeutic value. PMID:1610746

Ure, B M; Tiling, T; Röddecker, K; Klein, J; Rixen, D



A Comparison of the Clinical and Radiographic Results of Press Fit Condylar Rotating-Platform High-Flexion and Low Contact Stress Mobile Bearing Prosthesis in Total Knee Arthroplasty: Short term Results  

PubMed Central

Purpose This study compared the results of rotating-platform high-flexion (RP-F) total knee arthroplasty with low contact stress (LCS) for clinical and radiographical assessment after a short-term period. Materials and Methods 68 total knee arthroplasties using a RP-F and LCS system were analyzed retrospectively. Thirty-five of the 68 were osteoarthritic knees and were followed-up for more than 2 years. The clinical evaluation included range of motion (ROM), Knee Society Knee Score and Function Score (KSKS and KSFS), tailor position and kneeling. The radiographic evaluation included femorotibial angle, position of implants, radiolucent line and position of patella. Results The postoperative ROM, KSKS, and KSFS improved statistically in both implants. Comparing RP-F with LCS there were statistically no differences in ROM (p=0.863), KSKS (p=0.835), KSFS (p=0.535) and tailor position (p=0.489). There were no significant radiographic differences. Conclusions Total knee arthroplasty with RP-F and LCS showed similar clinical and radiographic results; it also showed excellent and predictable results at the short-term follow up. However, in RP-F there was 1 case of early osteolysis, 1 case of patella clunk syndrome and 1 case of painful patella crepitus; therefore, further case studies and follow-up are needed.

Nam, Shin Woo; Lee, Yong Seuk; Kwak, Ji Hoon; Kim, Nam Ki



Accuracy of biplane x-ray imaging combined with model-based tracking for measuring in-vivo patellofemoral joint motion  

PubMed Central

Background Accurately measuring in-vivo motion of the knee's patellofemoral (PF) joint is challenging. Conventional measurement techniques have largely been unable to accurately measure three-dimensional, in-vivo motion of the patella during dynamic activities. The purpose of this study was to assess the accuracy of a new model-based technique for measuring PF joint motion. Methods To assess the accuracy of this technique, we implanted tantalum beads into the femur and patella of three cadaveric knee specimens and then recorded dynamic biplane radiographic images while manually flexing and extending the specimen. The position of the femur and patella were measured from the biplane images using both the model-based tracking system and a validated dynamic radiostereometric analysis (RSA) technique. Model-based tracking was compared to dynamic RSA by computing measures of bias, precision, and overall dynamic accuracy of four clinically-relevant kinematic parameters (patellar shift, flexion, tilt, and rotation). Results The model-based tracking technique results were in excellent agreement with the RSA technique. Overall dynamic accuracy indicated errors of less than 0.395 mm for patellar shift, 0.875° for flexion, 0.863° for tilt, and 0.877° for rotation. Conclusion This model-based tracking technique is a non-invasive method for accurately measuring dynamic PF joint motion under in-vivo conditions. The technique is sufficiently accurate in measuring clinically relevant changes in PF joint motion following conservative or surgical treatment.

Bey, Michael J; Kline, Stephanie K; Tashman, Scott; Zauel, Roger



Management of a difficult knee problem.  


Chronic disabling patellofemoral (PF) pain and instability can have significant effects on patient function and lifestyle. Although the management of PF pain has improved greatly, there is still a category of patient who tends to have recalcitrant symptoms, which are difficult to manage. The patient often bounces from practitioner to practitioner, physiotherapist as well as surgeon, for some relief of symptoms. However, often the underlying source of the pain is not well understood, so treatment can aggravate the symptoms. The following case report demonstrates the effectiveness of physiotherapy in managing a complex clinical case of a 40 year old patient with bilateral PF symptoms of severe right knee pain and a subluxing left patella, as well as left hip pain. Some background is given as to the source of the right knee pain with magnetic resonance imaging (MRI) supporting the diagnosis and treatment progression. The initial MRI demonstrated marked redundancy of the patellar tendon, resulting in patella baja (infera). Two years and ten treatments later, the patient, who originally could barely walk, was playing tennis for the first time in 25 years. Her MRI showed a complete resolution of the patella baja (infera), indirectly implying an improvement in quadriceps tone, as well as, resolution of the subchondral bone marrow oedema at the lateral patellar facet. Physiotherapists should not give up on patients with chronic musculoskeletal conditions as much can be done for them. These patients need clinicians to persevere, because certainly, for both patient and therapist, the rewards are great. PMID:22748203

McConnell, Jenny



Posttraumatic chronic patellar dislocation treated by distal femoral osteotomy and medial patellofemoral ligament reconstruction.  


Chronic patellar dislocation is a rare condition where the patella remains dislocated throughout knee range of motion during flexion and extension. In adults, the delayed presentation of this condition is often due to symptoms caused by the onset of severe secondary osteoarthritis. To the authors' knowledge, all of the cases reported in the literature have been treated by patellofemoral or total knee replacements depending on patient age and the extent of the arthritis. This article describes a rare case of a 22-year-old woman who sustained a traumatic chronic patellar dislocation for 5 months. Clinical examination revealed a valgus deformity of the left leg secondary to childhood injury and that the patella lay lateral to the lateral femoral condyle throughout flexion and extension. Radiographs of the knee revealed patellar dislocation. Long-leg radiographs of the left leg showed an anatomic tibiofemoral angle of 17° valgus. The anatomical (74°) and mechanical (80°) lateral distal femoral angles were abnormal, whereas the medial proximal tibial angle (87°) was normal, confirming that the valgus deformity was due to the abnormal distal femur. The authors performed a distal femoral osteotomy to correct the valgus deformity. Medial patellofemoral ligament reconstruction using a hamstring autograft was performed to stabilize the patella. PMID:23127463

Purushothaman, Balaji; Agarwal, Amit; Dawson, Matt



Joint Gap Changes with Patellar Tendon Strain and Patellar Position During TKA  

PubMed Central

Balancing of the joint gap in extension and flexion is a prerequisite for success of a total knee arthroplasty. The joint gap is influenced by patellar position. We therefore hypothesized the state of the knee extensor mechanism (including the patellar tendon) would influence the joint gap. In 20 knees undergoing posterior-stabilized type total knee arthroplasties, we measured the joint gap and the patellar tendon strain from 0° to 135° flexion with the femoral component in position. When the patella was reduced, the joint gap was decreased at 90° and 135° (by 1.9 mm and 5.5 mm, respectively) compared with the gap with the patella everted. The patellar tendon strain increased with knee flexion. Patellar tendon strain at 90° flexion correlated with the joint gap difference with the patella in everted and reduced positions. This suggests that in addition to the collateral ligaments, the knee extensor mechanism may have an influence on the joint gap. Therefore, accounting for extensor mechanism tightness may be important in achieving the optimal joint gap balance during total knee arthroplasty. Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Morita, Yuji; Matsushita, Isao; Sugimori, Kazuhito; Kimura, Tomoatsu



A cladistic phylogeny of the family Patellidae (Mollusca: Gastropoda)  

PubMed Central

A phylogenetic hypothesis for the patellid limpets is reconstructed by cladistic analysis of morphological characters from 37 species, representing all but one of the living members of the family. Characters included in the analysis are derived from shell shape and microstructure, headfoot and pallial complex, radula and sperm. The species fall into four clades, providing the basis for a new phylogenetic classification into four monophyletic genera: Helcion (four species; southern Africa), Cymbula (eight species; southern Africa, eastern Atlantic, southern Indian Ocean), Scutellastra (17 species; southern and southwestern Africa, Australia, Indo-West Pacific, Eastern Pacific) and Patella (nine species; northeastern Atlantic and Mediterranean). The analysis suggests sister-group relationships between Helcion and Cymbula, and between Scutellastra and Patella. In combination with present-day patterns of geographical distribution, this phylogenetic hypothesis is used to discuss the historical biogeography of the Patellidae. Scutellastra may have originated in southern Africa and dispersed across the Pacific, or alternatively may be a primitively Tethyan group. Both Helcion and Cymbula appear to have originated in southern Africa, but three Cymbula species have dispersed respectively to northwest Africa, St Helena and the southern Indian Ocean. The patellids of the northeastern Atlantic form a single clade, Patella (including P. pellucida), which may have arrived by northward dispersal of an ancestor from southern Africa, or possibly by vicariance of a widespread ancestral Tethyan distribution. The known fossil record of patellids is too fragmentary to permit choice between these alternatives.

Ridgway, S. A.



Traumatic Bone Bruises in the Athlete's Knee  

PubMed Central

Context: Mobile water within the bone marrow is a physiological phenomenon that is identifiable on magnetic resonance (MR) imaging, and signal changes can result from blood pooling, reactive hyperemia, edema, and microfracture. When these MR lesions are associated with an acute traumatic event, the findings are referred to as bone bruises and so represent a unique manifestation of injury. This review discusses bone bruises in anterior cruciate ligament (ACL) tears, patella dislocations, occult fractures, and contusions. Methods: A PubMed search of the literature from 1982 to December 2009 was conducted with the terms knee and bone bruise. Results: Bone bruises are associated with ACL tears, patella dislocations, occult fractures, and contusions. For each injury, a unique pattern of bone bruising is found on MR imaging, which results from the acute trauma. When acute trauma produces a subchondral lesion with low T1-weighted and high T2-weighted signal intensity, the resulting bony contusion is best described as a bone bruise. Conclusions: Bone marrow edema is identified using MR imaging and may result from traumatic or atraumatic causes. Bone bruises can be characterized by their pattern at presentation, by the mechanism of injury, and by their associated injuries. This type of bone edema can accompany contact and noncontact ACL ruptures as well as patella dislocations. Although increased marrow edema can be associated with an occult fracture, the long-term significance of these lesions is unclear.

DeAngelis, Joseph P.; Spindler, Kurt P.



A case of patellar fractures in monozygotic twin gymnasts  

PubMed Central

We present a case of near identical patellar fractures in adolescent monozygotic twins who are both high-level competitive gymnasts. These patients presented 14 months apart with almost identical history and clinical findings. Both had an intense training regime involving over 30 hours per week of load-bearing exercise. Clinical and radiological examinations suggested avulsion or sleeve fracture of the inferior pole of the patella with minimal displacement. Diagnoses of patellar stress fracture with avulsion of the distal pole and symptomatic bipartite patella could not be reliably excluded. Both fractures were treated conservatively with immobilisation of the knee in extension. An excellent functional result was observed in both patients with return to full activity at 8 weeks. This is the first published case of identical injury to the patella in monozygotic twins. A significant genetic influence on bone mineral density (BMD) has been reported and low BMD is associated with increased susceptibility to fracture. These injuries corroborate a genetic influence on susceptibility to fracture. There is a requirement for further work to investigate genetic factors influencing susceptibility to fracture.



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

PubMed Central

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.

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



Multiple osteochondroses of bilateral knee joints.  


We experienced a patient with a combination of multiple osteochondroses: Blount's disease, bipartite patella, and Sinding-Larsen-Johansson disease in the left knee, and a combination of bipartite patella and Osgood-Schlatter disease in the right knee. The patient was a healthy, active 12-year-old boy with bilateral knee pain. He had been diagnosed with Blount's disease of the left tibia at 2 years of age, and had been treated with open wedge osteotomy. He was diagnosed with bilateral bipartite patellae at the age of 9 years, and was diagnosed with Osgood-Schlatter disease in the right knee and Sinding-Larsen-Johansson disease in the left knee at 10 years of age. The second growth spurt was observed during this period. At 11 years of age, he was diagnosed with an osteochondral fracture of the left lateral femoral condyle and was observed without surgery. This patient showed the sequential appearance of an ossification disorder, probably due to the abnormal response of enchondral ossification to mechanical stress. Overuse in this growth period may have played a role in the development of these osteochondroses. The osteochondral fracture was probably caused by a disruption at one of the weakest parts of the developing skeleton, between the ossification center and the overlying cartilage in the background of an ossification disorder. PMID:11484125

Segawa, H; Omori, G; Koga, Y



Evaluation of acoustical parameter sensitivity to age-related and osteoarthritic changes in articular cartilage using 50-MHz ultrasound.  


The current study reports the sensitivity of acoustical parameters estimated at high frequency to the osteoarthritic morphological and structural changes in patellar cartilage in rat knees. Osteoarthritis (OA) was induced by a single intra-articular injection of mono-iodo-acetic acid in right knees. OA patellas and their contralateral controls were excised at regular intervals after injection and were examined in vitro with a scanning acoustical microscope operating with a poly(vinylidene di-fluoride) (PVDF) 80-MHz focused transducer. Cartilage thickness was estimated using B-scan images. The quantitative analysis of the radiofrequency signal backscattered by the cartilage was performed using integrated reflection coefficient (IRC) and apparent integrated backscatter (AIB), which were estimated in the 20-60-MHz frequency range. One week after injection, a cartilage thickness decrease was detected (-6%, on average) that preceded the significant hypertrophy (20.1%) that occurred 2 weeks after injection and could be due to tissue repair. From 1 week to 3 weeks after injection, the IRC of OA patellas was significantly lower than that of control patellas. The IRC difference increased with time from -3.3 +/- 2.4 dB at 1 week to -8.4 +/- 1.7 dB at 3 weeks. An AIB decrease was observed with time for both OA and control patellas (-2.9 to -4.2 dB per week). An AIB difference between OA and control patellas was detected from 1 week to 3 weeks after injection. This difference decreased with time. IRC variation reflects a change in acoustical impedance of the superficial layer of the cartilage and could be linked to a change in constituent content and/or to a disruption of fibers of the collagen network that led to the fibrillation of the cartilage surface. AIB variation reflects a change in shape, size and/or density of the scatterers and could be related to changes in the constituent content and in the organization of the matrix in the internal layer of the cartilage. IRC and AIB could provide information about the structural modifications of the cartilage due to osteoarthritis or to cartilage maturation. PMID:9587990

Chérin, E; Saďed, A; Laugier, P; Netter, P; Berger, G



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

NASA Astrophysics Data System (ADS)

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.

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



Modified track shoes and their effect on the EMG activity of calf muscles.  


Although track and field spike shoes are crafted for runners, these shoes are not designed for regular walking. With such shoes, runners may eventually encounter serious chronic injuries such as plantar fasciitis, shin splints, achilles tendinitis, chondromalacia, and iliotibial band syndrome. To address this problem, a modified spike shoe was tested and compared to a regular spike shoe. The modification consists of adding a removable heel to the shoe sole in order to reduce the flexion of the foot and properly level the foot for walking. Nine healthy participants performed walking drills at 2 and 3 mph, using the original and the modified shoes. Electromyography (EMG) measurements were used to evaluate muscle activities. Participants also rated their discomfort on a 0-10 scale. Results show that the use of modified shoes resulted in a reduction of 22% and 24.25% EMG activity for the tibialis and gastrocnemius muscles, respectively. Comfort ratings increased by an average of 2.7, 2.6, 3.9, and 4.2 points at the knees, calves, ankles, and feet, respectively. PMID:22316968

Greensword, Marlon; Aghazadeh, Fereydoun; Al-Qaisi, Saif



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


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

Marolf, Angela; Blaik, Margaret; Specht, Andrew


Histopathology of Ossicular Grafts and Implants in Chronic Otitis Media  

PubMed Central

Objectives We describe the histopathology of ossicular grafts and implants so as to provide insight into factors that may influence functional results after surgery for chronic otitis media. Methods Histopathologic observations were made on 56 cases: 50 surgical specimens and 6 temporal bone cases in which the graft was sectioned in situ. Results and Conclusions Autogenous malleus, incus, and cortical bone grafts behaved in a similar manner and maintained their morphological size, shape, and contour for extended periods of time, at least up to 30 years. These histopathologic observations support the continued use of autograft ossicular and cortical bone grafts for middle ear reconstruction. Cartilage grafts developed chondromalacia with resulting loss of stiffness and showed a tendency to undergo resorption. Synthetic prostheses made of porous plastic (Plastipore, Polycel) elicited foreign body giant cell reactions with various degrees of biodegradation of the implants. Prostheses made of hydroxyapatite and Bioglass were enveloped by a lining of connective tissue and mucosal epithelium. The Bioglass material was broken down into small fragments and partially resorbed by a host response within the middle ear. These results warrant caution in the use of prostheses made of porous plastic or Bioglass.

Bahmad, Fayez; Merchant, Saumil N.



Autoarthroplasty of knee cartilage defects by osteoperiosteal grafts.  


Five fresh osteochondral fractures of the knee, which could not be fixed because of extensive fragmentation, were treated by excision of the fragments and reconstruction of the joint surface defect by an autogenous osteoperiosteal graft. The procedure was also used for joint surface reconstruction in sclerotic osteochondritis of the femoral condyle (nine knees) and grave patellofemoral chondromalacia (three knees). Plaster cast immobilization for 3 weeks was used in the two early cases. In all other cases, we employed a passive motion apparatus for 2 days postoperatively, followed by active mobilization in a knee brace with extension-flexion 30 to 90 degrees (femoral condyle reconstruction) or 0 to 45 degrees (patellar reconstruction). Gradual free movements were started 3 weeks postoperatively. The results after 1.5 to 6.5 years were satisfactory in all but one case. One arthroscopic removal of the loose graft was performed, as were two arthroscopic graft margin shavings. Three other reoperations were unrelated to the osteoperiosteal reconstruction. It appears that periosteal reconstruction should be considered in local osteochondral lesions, where excision of the injured cartilage is mandatory. The results were best in fresh trauma cases and younger people. PMID:7577214

Korkala, O L; Kuokkanen, H O



Case Reports: Anteroinferior Acetabular Rim Damage Due to Femoroacetabular Impingement.  


BACKGROUND: The most common location of labral tears and chondral damage in the hip is the anterosuperior region of the acetabulum, which is associated with pain in flexion and rotation. We describe a case series of patients with labral tears, ganglion formation, and chondromalacia isolated to the anteroinferior acetabulum. Clinically, patients had pain in extension and internal rotation. CASE DESCRIPTIONS: Isolated anteroinferior labral hypertrophy and ganglion were first observed in a patient with coxa valga. We retrospectively reviewed clinical and radiographic records and identified nine hips in seven patients with isolated anteroinferior damage. One patient with bilateral valgus femoral head tilt after slipped capital femoral epiphysis (SCFE) had impingement of the anteromedial metaphysis on the acetabulum from 3 to 6 o'clock. Five of seven had valgus neck-shaft angles and all had acetabular anteversion with damage isolated to the anteroinferior acetabular rim. LITERATURE REVIEW: Series on the diagnostic efficacy of MR arthrogram have noted anteroinferior damage adjacent to superior acetabular rim lesions. However, these do not describe isolated anteroinferior rim damage. In addition, available case series of patients with valgus SCFE do not describe a location of impingement or intraarticular damage. PURPOSES AND CLINICAL RELEVANCE: In this small case series of patients with isolated anteroinferior chondrolabral damage, there are two potential causative mechanisms: (1) primary anteroinferior impingement with femoral extension and internal rotation and (2) posterior extraarticular ischiotrochanteric impingement causing secondary anterior instability of the femur. The pathoanatomy appears to be multifactorial, necessitating an individualized treatment approach. PMID:23508843

Tibor, Lisa M; Ganz, Reinhold; Leunig, Michael



A molecular phylogeny of the patellid limpets (Gastropoda: Patellidae) and its implications for the origins of their antitropical distribution.  


The geographical distribution of the limpet family Patellidae is essentially antitropical, with 18 species in southern Africa, 10 in the northeastern Atlantic, and only 11 species elsewhere (although 4 of these do occur in the tropics). One possible explanation for this distribution is the suggestion of a recent, perhaps Early Pliocene, migration from southern Africa northward. We tested this hypothesis by constructing a molecular phylogeny, derived from partial sequences of the 12S and 16S mitochondrial genes, obtained from 34 of the 38 patellid species. Five species of Nacellidae and 3 of Lottiidae were included as potential outgroups. Analysis revealed that two patellid clades are represented in the northeastern Atlantic. The typical European patellids (Patella sensu stricto) form a single clade within which there is little molecular divergence, but are distant from all other patellids, thus refuting the idea of recent southern ancestry. From the limited fossil record and estimated rates of molecular divergence, we suggest that Patella s.s. may have originated at least as early as the Upper Cretaceous and that its northern distribution may have been achieved at the same time. The second patellid clade present in the northeastern Atlantic is the genus Cymbula, of which the single species Cymbula safiana extends from West Africa to the Mediterranean. In contrast to Patella s.s., C. safiana is indeed a member of an otherwise southern African clade and may have attained its present distribution more recently, during the Miocene. The geographical origin of the family remains unclear, but a Mesozoic radiation in southern Gondwana is possible. By optimizing morphological characters on our molecular tree, we consider the evolution of shell mineralogy and sperm ultrastructure. We also discuss the phylogenetic classification of the patellids and present some evidence that the family may not be monophyletic. PMID:10082617

Koufopanou, V; Reid, D G; Ridgway, S A; Thomas, R H



[Patellar osteochondral injury as onset of patellar instability].  


Patellar osteochondral fractures with no dislocation are uncommon and usually affect the centromedial facet of the patella. We present the case of a 10 year-old, overweight, female patient. She was seen in the emergency room after suffering an accidental fall, assessed as an osteochondral fracture-dislocation of the right patella with upper-outer displaced free fragments. By patient interview, she referred to no previous episodes of patellar dislocation. To complete the study, we performed an MRI which showed a medial facet patellar fracture, with two osteochondral fragments located in the sub-quadricipital recess, associated with other lesions suggesting patellar subluxation. We considered that the best treatment was surgery, so the following was performed: an open reduction and internal fixation with absorbable bars, lateral patellar release (Ficat technique), patellar coverage by medial portion of quadriceps (Insall technique) and internal moving of the lateral half of the patellar tendon (Goldwaith technique). The injury was checked one year later using arthroscopy. It confirmed a good reconstruction of the articular surface, and right patellar centering. At follow-up, during the physiotherapy period, the patient began to have repeated episodes of instability in the contralateral patella. The CT scan confirmed the patellar lateralisation (TAGT 17). Centering surgery was indicated due to the occurrence of multiple dislocation episodes. The patient currently carries out normal physical activity and she has a complete range of movement. Patellar osteochondral fracture is an injury frequently associated with patellar instability, which may onset in the first episode. The medial location of the lesions and the involvement of the system of medial knee stability is a fundamental finding. This fact reinforces the diagnosis of pre-fracture patellar dislocation. This is not a fracture-dislocation, but a dislocation-fracture. We may, therefore, treat the injury and its cause. PMID:23177946

Cepero-Campŕ, S; Ullot-Font, R; Pérez-López, L M



Medial patellofemoral ligament reconstruction: a novel technique using the patellar ligament.  


In patients with chronic patellofemoral instability, more than 2 episodes of dislocation, and an anterior tuberosity trochlear groove of less than 20 mm as measured on computed tomography or nuclear magnetic resonance imaging, we have developed a technique for medial patellofemoral ligament reconstruction that uses a medial strip of the patellar ligament (PL). The incision started proximally at the level of the superior margin of the patella, centrally between the patellar medial margin and the medial epicondyle. A descending incision was then made, directed toward the superomedial margin of the tibial tubercle. We performed a plane-by-plane dissection up to the peritenon of the PL. With an osteotome, we could remove a 2-cm bone fragment concerning the medial third of the distal insertion of the PL or keep the distal end free. Using a No. 11 scalpel blade, we carefully detached the PL from the patella up to the transition between the proximal third and medial third of the patella. We placed the stitches between the periosteum and the ligament using FiberWire absorbable threads (Arthrex, Naples, FL) to safely rotate the graft. After that, we dissected the medial capsule and approached the femoral medial epicondyle. Then we placed a Krackow suture in the free tendon end using absorbable threads or anchored the threads into 2 holes that were previously drilled, and we secured the end with an absorbable interference screw or anchors. The fixation should be performed with the knee at 15 degrees to 30 degrees of flexion. Then we sutured the distal edge of the vastus medialis muscle to the graft, which bestows a dynamic component upon the reconstruction, and we immobilized the knee with a removable brace. PMID:17210439

Camanho, Gilberto Luis; Bitar, Alexandre C; Hernandez, Arnaldo J; Olivi, Rogério



Patellar Cartilage: T2 Values and Morphologic Abnormalities at 3.0-T MR Imaging in Relation to Physical Activity in Asymptomatic Subjects from the Osteoarthritis Initiative1  

PubMed Central

Purpose: To study the interrelationship between patella cartilage T2 relaxation time, other knee abnormalities, and physical activity levels in asymptomatic subjects from the Osteoarthritis Initiative (OAI) incidence cohort. Materials and Methods: The study had institutional review board approval and was HIPAA compliant. One hundred twenty subjects from the OAI without knee pain (age, 45–55 years) and with risk factors for knee osteoarthritis (OA) were studied by using knee radiographs, 3.0-T knee magnetic resonance (MR) images (including intermediate-weighted fast spin-echo and T2 mapping sequences), and the Physical Activity Scale for the Elderly. MR images of the right knee were assessed by two musculoskeletal radiologists for the presence and grade of abnormalities. Segmentation of the patella cartilage was performed, and T2 maps were generated. Statistical significance was determined by using analysis of variance, ?2 analysis, correlation coefficient tests, the Cohen ?, and a multiple linear regression model. Results: Cartilage lesions were found in 95 (79.0%) of 120 knees, and meniscal lesions were found in 54 (45%) of 120 knees. A significant correlation between patella cartilage T2 values and the severity and grade of cartilage (P = .0025) and meniscus (P = .0067) lesions was demonstrated. Subjects with high activity levels had significantly higher prevalence and grade of abnormalities and higher T2 values (48.7 msec ±4.35 vs 45.8 msec ±3.93; P < .001) than did subjects with low activity levels. Conclusion: Middle-aged asymptomatic individuals with risk factors for knee OA had a high prevalence of cartilage and meniscus knee lesions. Physically active individuals had more knee abnormalities and higher patellar T2 values. Additional studies will be needed to determine causality. © RSNA, 2010

Liebl, Hans; Krug, Roland; Lane, Nancy E.; Nevitt, Michael C.; Lynch, John; McCulloch, Charles E.; Link, Thomas M.



Taping for knee osteoarthritis.  


Taping can be used to reduce pain in knee osteoarthritis. There are different methods of taping, but the common effect is to exert a medially directed force on the patella to increase the patellofemoral contact area, thereby decreasing joint stress and reducing pain. Taping can be performed by a physiotherapist, but self taping can be taught, which enhances self management. Taping for knee osteoarthritis has National Health and Medical Research Council (NHMRC) Level I evidence of efficacy for pain relief and is associated with negligible adverse effects that generally include minor skin irritation. PMID:24130976



Complications associated with 696 tibial plateau leveling osteotomies (2001-2003).  


A total of 696 tibial plateau leveling osteotomy (TPLO) procedures were performed over a 30-month period following TPLO training. The overall complication rate was 18.8%. Complications were classified as perioperative (1%), short-term (9.3%), and long-term (8.5%). Examples of complications encountered during the study were hemorrhage, swelling at the incision site, premature staple removal by the dog, tibial tuberosity fracture, patella tendon swelling, and implant complications. Based on the rate of complications observed, clinical outcomes of TPLO procedures within 30 months of TPLO training were considered good. PMID:16397194

Stauffer, Kent D; Tuttle, Trent A; Elkins, A D; Wehrenberg, Aaron P; Character, Ben J


Total hip arthroplasty: first experiences with pinless THA software to determine leg length and offset.  


A rigid body fixation on the proximal femur is required for navigation during total hip arthroplasty. In surgery requiring a small incision, the fixation mechanism (C clamp or screw) may cause soft tissue damage and may force enlargement of the approach. New software available for the OrthoPilot navigation system (B. Braun Aesculap, Tuttlingen, Germany) eliminates the need for a rigid body at the femur. Only one rigid body is placed on the iliac crest. Two additional palpations, one at the greater trochanter and one at the patella, establish the system of coordinates between pelvis and femur so that leg length and offset changes can be indicated. PMID:17983113

Schmerwitz, Ulf



Osteomyelitis variolosa: a case report.  


Osteomyelitis variolosa is an infection of bone and joints by smallpox virus variola major, most commonly in the elbows, wrists, ankles, hands, and feet. We report one such case in a 70-year-old woman who presented with deformities of the right knee, both elbows and ankles, and the left hand, and a history of childhood fever with rashes. Her lateral femoral condyle of the right knee was hypoplastic with patella baja. Her right elbow was ankylosed and her left elbow was dislocated with multidirectional instability. Her third and fourth metacarpals on the left hand were shortened. Both ankles were stiff with valgus deformity; both taluses were destroyed. PMID:21519093

Balaji, Douraiswami



Bilateral simultaneous rupture of the quadriceps tendon in an adult amateur tennis player.  


Bilateral simultaneous quadriceps tendon rupture is a relatively rare injury, requiring prompt diagnosis and surgical repair. It is more common in patients older than 50 years and is usually associated with underlying metabolic or inflammatory diseases. Its occurrence is very rare in healthy individuals. We report a case of bilateral quadriceps tendon rupture in a healthy young adult that occurred while he was playing tennis. This patient presented with acute knee swellings, total inability to extend the legs, and a palpable gap above the patella. PMID:16484878

Katz, Tiberin; Alkalay, Daphna; Rath, Ehud; Atar, Dan; Sukenik, Shaul



[Medial patellofemoral ligament reconstruction with gracilis autograft for patellar instability].  


We describe a technique for patellar stabilization by reconstruction of the medial patellofemoral ligament with the gracilis tendon. The tendon is anchored posteriorly on the soft tissue of the medial femoral epicondyle and anteriorly on the medial border of the patella. The plasty is completed by suture of the medial patellar wing. Inferior or medial transposition of the tibial tubercle may be associated. We have used this technique since 1995 for 145 knees with patellar instability. The small incisions have the advantages of minimally invasive surgery, particularly for the postoperative period and the cosmetic effect. PMID:16158548

Chassaing, V; Trémoulet, J



Quadriceps myofibrosis. A complication of intramuscular injections.  


Cases of fibrofatty replacement of the quadriceps muscles following repeated intramuscular injections into the thighs of infants and young children are being reported with increasing frequency. In such cases, the knee shows progressive painless limitation of flexion, habitual dislocation of the patella, or both. The recommended treatment is surgical release, done early before secondary adaptive changes occur in the soft tissues, cartilage, and bones comprising the joint. Full flexion should be obtained at the time of surgery. In children, the lag in extension that follows extensive release will usually disappear spontaneously. PMID:7351417

Alvarez, E V; Munters, M; Lavine, L S; Manes, H; Waxman, J



A 10 year follow-up study after Roux-Elmslie-Trillat treatment for cases of patellar instability  

Microsoft Academic Search

Background  A retrospective study concerning patients presenting with patella instability, treated using a Roux-Elmslie-Trillat reconstruction\\u000a operation and followed up for 10 years following surgery, is presented.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Pre-operative and follow-up radiographic evaluation included the weight-bearing anteroposterior and merchant views. Evaluation\\u000a was carried out using the Insall-Salvati index, sulcus and congruence angle. The Roux-Elmslie-Trillat reconstruction operation\\u000a was performed on 18 patients. The clinical

Stefan Endres; Axel Wilke



Patellofemoral knee pain treatment using neuromuscular retraining of the hip musculature in an adolescent female: a case report.  


The purpose of this case study is to demonstrate the treatment of patella-femoral knee pain in an adolescent female athlete with emphasis on neuromuscular training of the knee and hip in synergy movement strategies. A 1.67-m, 61.5-kg, 15-year-old woman athlete reported to rehabilitation with the complaint of a 1-year history of bilateral knee pain. The patient noted that the symptoms were exacerbated with any sports-specific training. The patient played softball as an infielder. The athlete was referred by her family practice physician. After the patient was assessed, a clinical hypothesis was generated. It was thought that neuromuscular dysfunction of the hips and knees was causing faulty knee mechanics. These abnormal mechanics were presenting as patella-femoral knee pain. Initially, the athlete was assigned a home exercise program of side-lying hip abduction and lateral step-downs. At her first follow-up appointment, she noted increased symptoms that were aggravated with her home program. Upon inspecting her exercise technique, faulty step-down mechanics were contributing to her symptoms. Step-downs were discontinued, and the patient was instructed in and performed a chair squatting exercise, which was added to her home program. At her next follow-up, the patient noted being asymptomatic for 2 days. Her exercises were increased in intensity to include a Stairmaster and hip abduction and adduction on a 4-way hip machine. Eventually, over her treatment course, perturbation and proprioceptive training were initiated. By the sixth visit, the patient reported no symptoms and felt comfortable with self-management. A phone interview 3 months later indicated that the patient had no recurrent symptoms and was participating in sports without difficulty. This case demonstrates effectiveness of using hip and knee joint synergy to treat patella-femoral pain (PFP). The use of this synergy promotes proper patella–femoral alignment and improved knee mechanics. This case also is unique in the lack of physical agents and taping used to improve the patient's condition. It reinforces how exercise technique can carry over to functional athletic activities. This study provides a case for the use of hip and knee mechanical retraining in the treatment of PFP in adolescent female athletes who do not exhibit abnormal foot mechanics in weight bearing. It is important that sports medicine professionals be aware of these treatment options and are able to use them to correct these deficits in order to facilitate return to training and competition as quickly and safely as possible. PMID:22043475

Frounfelter, Gregory G; Stutzriem, David E



Radiologic study of patellar height in Osgood-Schlatter disease.  


There are contradictory reports regarding patellar position in the Osgood-Schlatter disease. We present a prospective statistical study of 17 patients with Osgood-Schlatter disease and 12 adolescents without anterior knee pain. The Caton-Deschamps index was assessed on strictly the lateral radiograph of the knee. The findings indicate a strong association between Osgood-Schlatter disease and patella alta. This increase in patellar height would require an increase in the force needed from the quadriceps to achieve full extension. This mechanism could be responsible for the apophyseal lesion. PMID:8989704

Aparicio, G; Abril, J C; Calvo, E; Alvarez, L


Musculoskeletal injuries in adolescents.  


This article reviews the anatomy of the physis and the most common classification of injuries or fractures through the physis. The common apophyseal injuries of Osgood-Schlatter, Severs disease and iliac apophysitis, are reviewed in addition to a review of the most common osteochondritides, including Panner's disease and Osteochondritis Dessicans of the femur and talus. An understanding of these is key to diagnosis and treatment of adolescent musculoskeletal injuries. This article also reviews slipped capital femoral epiphysis, little leaguer's elbow, anterior cruciate and collateral ligament injuries, patella problems, ankle sprains and several common fractures in children. PMID:9469924

Kaeding, C C; Whitehead, R



Evaluation of intra-articular delivery of hyaluronic acid functionalized biopolymeric nanoparticles in healthy rat knees.  


The aim of this study is to evaluate the toxicity of nanoparticles of poly(D,L-lactic acid) (PLA) or poly(D,L-lactic-co-glycolic acid) (PLGA) covered by chemically esterified amphiphilic hyaluronate (HA) which will be used for intra-articular injection as a drug carrier for the treatment of arthritis (RA) and/or osteoarthritis (OA). PLA and PLGA are FDA approved polymers that are already used for the preparation of nano or microparticles. HA is a natural polysaccharide already present in the articulations known to interact with the CD44 receptors of the cells (especially chondrocytes). Therefore, we can envisage that the HA covering can improve the interactions between the cells and the nanoparticles, leading to better targeting or biodistribution. The knee of healthy male rats was injected one to two times weekly, with various concentrations of nanoparticles encapsulating Dextran-FITC. The synovial membranes and the patellae were collected aseptically and histologically analyzed to assess the effects and localization of the nanocapsules in the knee joint. We did not observe significant modifications in the synovial membranes (weak hyperplasia) or patellae integrity after local administration of nanodevices into the rats. While we found some nanoparticles in the synovial membrane, none were detected in the patellae. Moreover, the histological observations for patellae were confirmed by radiosulfate intake, which depicted no decrease in proteoglycans biosynthesis in nanoparticles treated animals. Concerning the safety towards synovial membranes, we also had a look at the inflammatory response after injections of nanoparticles covered by amphiphilic HA or polyvinyl alcohol (PVA) by monitoring the mRNA expression levels of some specific early cytokines (IL-1? and TNF-?). Once again, no differences were observed between the control rats and the rats treated with nanoparticles. Considering these preliminary results obtained in healthy rats, we can establish that neither the amphiphilic HA-covered PLGA nanoparticles nor their degradation products induce major modifications of articular tissues functions, while injected into the knee of healthy rats. These results should be confirmed in OA or RA rat models, in order to confirm that nanoparticles do not worsen already altered (degenerative or inflamed) articular tissues. Once confirmed, such tuneable nanoparticles could be proposed as a safe drug delivery system for the treatment of articular disease, allowing a wide range of encapsulating molecules. PMID:20930333

Zille, Hervé; Paquet, Joseph; Henrionnet, Christel; Scala-Bertola, Julien; Leonard, Michčle; Six, Jean Luc; Deschamp, Frantz; Netter, Patrick; Vergčs, José; Gillet, Pierre; Grossin, Laurent



Barriers to gene flow in the marine environment: insights from two common intertidal limpet species of the Atlantic and Mediterranean.  


Knowledge of the scale of dispersal and the mechanisms governing gene flow in marine environments remains fragmentary despite being essential for understanding evolution of marine biota and to design management plans. We use the limpets Patella ulyssiponensis and Patella rustica as models for identifying factors affecting gene flow in marine organisms across the North-East Atlantic and the Mediterranean Sea. A set of allozyme loci and a fragment of the mitochondrial gene cytochrome C oxidase subunit I were screened for genetic variation through starch gel electrophoresis and DNA sequencing, respectively. An approach combining clustering algorithms with clinal analyses was used to test for the existence of barriers to gene flow and estimate their geographic location and abruptness. Sharp breaks in the genetic composition of individuals were observed in the transitions between the Atlantic and the Mediterranean and across southern Italian shores. An additional break within the Atlantic cluster separates samples from the Alboran Sea and Atlantic African shores from those of the Iberian Atlantic shores. The geographic congruence of the genetic breaks detected in these two limpet species strongly supports the existence of transpecific barriers to gene flow in the Mediterranean Sea and Northeastern Atlantic. This leads to testable hypotheses regarding factors restricting gene flow across the study area. PMID:23239977

Sá-Pinto, Alexandra; Branco, Madalena S; Alexandrino, Paulo B; Fontaine, Michaël C; Baird, Stuart J E



Barriers to Gene Flow in the Marine Environment: Insights from Two Common Intertidal Limpet Species of the Atlantic and Mediterranean  

PubMed Central

Knowledge of the scale of dispersal and the mechanisms governing gene flow in marine environments remains fragmentary despite being essential for understanding evolution of marine biota and to design management plans. We use the limpets Patella ulyssiponensis and Patella rustica as models for identifying factors affecting gene flow in marine organisms across the North-East Atlantic and the Mediterranean Sea. A set of allozyme loci and a fragment of the mitochondrial gene cytochrome C oxidase subunit I were screened for genetic variation through starch gel electrophoresis and DNA sequencing, respectively. An approach combining clustering algorithms with clinal analyses was used to test for the existence of barriers to gene flow and estimate their geographic location and abruptness. Sharp breaks in the genetic composition of individuals were observed in the transitions between the Atlantic and the Mediterranean and across southern Italian shores. An additional break within the Atlantic cluster separates samples from the Alboran Sea and Atlantic African shores from those of the Iberian Atlantic shores. The geographic congruence of the genetic breaks detected in these two limpet species strongly supports the existence of transpecific barriers to gene flow in the Mediterranean Sea and Northeastern Atlantic. This leads to testable hypotheses regarding factors restricting gene flow across the study area.

Sa-Pinto, Alexandra; Branco, Madalena S.; Alexandrino, Paulo B.; Fontaine, Michael C.; Baird, Stuart J. E.



Estimation of actinide skeletal content in humans based on bone samples collected at autopsy.  


The USTUR has developed simple linear and multiple regression models for estimating skeletal actinide concentrations on the basis of bone samples collected at autopsies of non-whole body tissue donors. Bone samples usually collected include a clavicle, the patella(e), one or more ribs, the sternum, and a vertebral wedge cut from within the abdominal cavity. The described models were derived by regression analyses with the analytical results from those bones and the entire skeletons of eight whole body donations to the USTUR. With the model, skeletal concentrations of 238Pu, (239+240)Pu, and 241Am can be estimated from wet or ashed actinide concentrations in one to five of the bones usually collected at autopsy and analyzed. Application of the models to a selected USTUR non-whole body donation (Case 0240) indicated that the skeletal actinide concentration estimates were reasonably precise and that there was good agreement between the results from individual bones with wet or ashed actinide concentrations. The USTUR will apply the model that is based on wet concentrations of bones to estimate skeletal concentrations of actinides in all non-whole body autopsy cases for the sake of consistency because of the large number of early cases for which ashed weights of bones were not recorded. PMID:12498516

Filipy, R E; Alldredge, J R; Hall, C A; McInroy, J F; Glover, S E; Qualls, S



A 10 year follow-up study after Roux-Elmslie-Trillat treatment for cases of patellar instability  

PubMed Central

Background A retrospective study concerning patients presenting with patella instability, treated using a Roux-Elmslie-Trillat reconstruction operation and followed up for 10 years following surgery, is presented. Methods Pre-operative and follow-up radiographic evaluation included the weight-bearing anteroposterior and merchant views. Evaluation was carried out using the Insall-Salvati index, sulcus and congruence angle. The Roux-Elmslie-Trillat reconstruction operation was performed on 18 patients. The clinical evaluation at follow-up was performed using the Knee-Society-Score (KSS) and Tegner-Score. Results Subjective results of the operation were classed as excellent or good in 16 of the 18 patients ten years after surgery; persistent instability of the patella was recorded in only one of the 18 patients. The majority of patients returned to the same level of sporting activity after surgery as they had participated in before injury. Conclusions The Roux-Elmslie-Trillat procedure could be recommended in cases presenting with an increased q-angle, trochlea dysplasia or failed soft tissue surgery. In the present study the majority of patients report a return to previous sporting activity ten years after surgery.



Conformity of behaviors among medical students: impact on performance of knee arthrocentesis in simulation.  


Although the development of collaborative relationships is considered a requirement for medical education, the functioning of these relationships may be impaired by a well-documented social-psychological phenomenon known as group conformity. The authors hypothesized that students would insert a needle into an incorrect location relative to the patella when performing a knee arthrocentesis if they believed that their peers had also inserted a needle in the same incorrect location. This was a randomized controlled study conducted in 2011 with 60 medical students (24 male; 40.0 %) who were randomly assigned to either using a knee model that had a skin with holes left by peers inserting needles in the wrong location, or a knee with no marks in the skin. Each student's aspiration site was measured with a fibreglass ruler to determine whether it was correctly located within the superior third, 1 cm medial to the patella. The researchers determined that students who used the marked skin were more likely to insert the needle in the incorrect location compared to those who used the clean skin (n = 31, 86.11 vs. n = 14, 58.33 %), Fisher's exact test (1) = 5.93, p < 0.05, Cramer's ? = 0.31. This study demonstrates incorrect performance of the knee arthrocentesis procedure in simulation when students use a damaged model, which may be due to conformity. It suggests that further research on the impact of conformity in medical education is warranted. PMID:22936210

Beran, Tanya N; McLaughlin, Kevin; Al Ansari, Ahmed; Kassam, Aliya



[Uncemented endoprosthesis in a female patient with chronic juvenile monoarthritis of the knee (case report)].  


A case report of an 18 year-old female patient with juvenile rheumatoid monoarthritis (JRA) of the knee joint, whose treatment the authors have been following up during the last 14 years is presented. Previously known and reported difficulties and complications in the diagnosis of chronic juvenile rheumatoid monoarthritis are related with special reference to a specific case, a female patient in whose case the correct diagnosis and adequate treatment was begun three years after the first onset of symptoms. At the age of 15, the patient developed knee ankylosis of 20 degrees in flexion. Following this dezarthrodesis of the knee joint, cementless total knee arthroplasty was performed. The postoperative results are very encouraging, the knee joint is stable, the passive range of movement is 5/90 degrees, while the active range of motion is 10/80 degrees. Total knee arthroplasty helped to correct the previously present inegality of the lower extremities, while the problem of an exceptionally thick patella was resolved by coronary (frontal) osteotomy of the patella. The presented case once again confirms that in selected JRA patients cementless knee arthroplasty can achieve excellent results. PMID:7651066

Pe?ina, M; Haspl, M; Prohi?, A


Photoadaptation and protection against active forms of oxygen in the symbiotic procaryote Prochloron sp. and its ascidian host  

SciTech Connect

Superoxide dismutase, ascorbate, peroxidase, and catalase activities were studied in the symbiotic photosynthetic procaryote Prochloron sp. and its ascidian host Lissoclinum patella. The protein-specific activities of these antioxidant enzymes in the Prochloron sp. and L. patella collected at different depths from the Great Barrier Reef, Australia, were directly proportional to irradiance, whereas the pigment concentrations in the Prochloron sp. were inversely proportional to irradiance. The presence of a cyanide-sensitive superoxide dismutase, presumably a Cu-An metalloprotein, in the Prochloron sp. extends the possible phylogenetic distribution of this protein. The concentration of UV-absorbing mycosporine-like amino acids in inversely proportional to irradiance in both the host and symbiont, suggesting that these compounds may not provide sufficient protection against UV radiation in high-irradiance environments. The significant differences in the specific activities of these antioxidant enzymes, cellular photosynthetic pigment concentrations, and UV-absorbing compounds from high- and low-irradiance habitats constitute an adaptive response to different photic environments. These photoadaptive responses are essential to prevent inhibition of photosynthesis by high fluxes of visible and UV radiation.

Lesser, M.P.; Stochaj, W.R. (Univ. of Maine, Orono (USA))



Using Real-Time MRI to Quantify Altered Joint Kinematics in Subjects with Patellofemoral Pain and to Evaluate the Effects of a Patellar Brace or Sleeve on Joint Motion  

PubMed Central

Abnormal patellofemoral joint motion is a possible cause of patellofemoral pain, and patellar braces are thought to alleviate pain by restoring normal joint kinematics. We evaluated whether females with patellofemoral pain exhibit abnormal patellofemoral joint kinematics during dynamic, weight-bearing knee extension and assessed the effects of knee braces on patellofemoral motion. Real-time magnetic resonance (MR) images of the patellofemoral joints of 36 female volunteers (13 pain-free controls, 23 patellofemoral pain) were acquired during weight-bearing knee extension. Pain subjects were also imaged while wearing a patellar-stabilizing brace and a patellar sleeve. We measured axial-plane kinematics from the images. Females with patellofemoral pain exhibited increased lateral translation of the patella for knee flexion angles between 0° and 50° (p = 0.03), and increased lateral tilt for knee flexion angles between 0° and 20° (p = 0.04). The brace and sleeve reduced the lateral translation of the patella; however, the brace reduced lateral displacement more than the sleeve (p = 0.006). The brace reduced patellar tilt near full extension (p = 0.001), while the sleeve had no effect on patellar tilt. Our results indicate that some subjects with patellofemoral pain exhibit abnormal weight-bearing joint kinematics and that braces may be effective in reducing patellar maltracking in these subjects.

Draper, Christine E.; Besier, Thor F.; Santos, Juan M.; Jennings, Fabio; Fredericson, Michael; Gold, Garry E.; Beaupre, Gary S.; Delp, Scott L.



Diffusely increased bone scintigraphic uptake in patellofemoral pain syndrome  

PubMed Central

Objectives: Painful disorders of the patellofemoral joint are one of the most frequent complaints in orthopaedic and sports medicine. The aims of this study were to determine whether bone scintigrams of patients suffering from patellofemoral pain syndrome (PFPS) show diffuse uptake and in what bony compartment of the knee uptake, if any, was localised. Methods: Fifty eight patients with chronic PFPS were examined. All patients underwent a detailed clinical history and a thorough physical examination of the knee. Anterior and lateral static images of both knees were made using a gamma camera 3 h after injection of 550 MBq of 99mTc-HMDP. Two experienced radiologists visually evaluated the scans blindly and separately. As 51 patients had bilateral pain, 109 painful knees are included in the results. Results: Diffuse uptake on bone scintigrams was found in 48 knees in 30 of the patients. In 33 knees the uptake was localised to only one bone compartment, in 10 knees diffuse uptake was found in two of the bones forming the knee joint, and in six knees all three bone compartments (the distal femur, the patella, and the proximal tibia) exhibited diffuse uptake. Conclusions: Scintigrams of approximately half of the patients with PFPS will show diffuse uptake in one or more of the bony compartments of the knee joint and radioactive tracer accumulation will occur as often in the proximal tibia as in the patella.

Naslund, J; Odenbring, S; Naslund, U; Lundeberg, T



Atlas-based knee cartilage assessment.  


Magnetic resonance imaging analysis of knee cartilage properties at corresponding anatomic locations could be a valuable tool in studies of knee osteoarthritis by enabling accurate comparisons at practically any region. A technique of this kind is presented in this study. The proposed technique is based on gray-level bone matching using affine transformations and free-form deformations thus eliminating the need of bone segmentations and landmark matching. Sixteen subjects of the osteoarthritis initiative with knee osteoarthritis (10 from baseline; 6 from 24-month follow-up) were included in this study. Baseline subjects were used to create a gray-level atlas of the patella with its corresponding mean cartilage thickness and T2 maps. Follow-up subjects were used to validate atlas-based point-to-point cartilage comparisons. All registrations were qualitatively evaluated with fused gray-level images of registered patellas. Quantitative evaluation was performed based on mean values of minimum Euclidean distances between matched bone-cartilage interfaces. A mean distance of 0.554 mm was obtained between the subjects used to build the atlas, and a mean distance of 0.633 mm was found between the atlas and validation subjects. The technique can be applied to other anatomical regions and with other cartilage measures. Qualitative and quantitative results demonstrate the accuracy of the technique and warrant its application in larger cross-sectional and longitudinal studies of osteoarthritis. PMID:21773988

Carballido-Gamio, Julio; Majumdar, Sharmila



A mini-invasive adductor magnus tendon transfer technique for medial patellofemoral ligament reconstruction: a technical note.  


Patellar dislocations are associated with injuries to the medial patellofemoral ligament (MPFL). Several techniques for MPFL reconstruction have been recently published with some disadvantages involved, including large skin incisions and donor site morbidity. Arthroscopic stabilizing techniques carry the potential of inadequate restoration of MPFL function. We present a minimally invasive technique for MPFL reconstruction using adductor magnus tendon autograft. This technique is easily performed, safe, and provides a stabilizing effect equal to current MPFL reconstructions. Skin incision of only 3-4 cm is located at the level of the proximal half of the patella. After identifying the distal insertion of the adductor magnus tendon, a tendon harvester is introduced to harvest the medial two-thirds of the tendon, while the distal insertion is left intact. The adductor magnus tendon is cut at 12-14 cm from its distal insertion and transferred into the patellar medial margin. Two suture anchors are inserted through the same incision at the superomedial aspect of the patella in the anatomic MPFL origin. The graft is tightened at 30 degrees knee flexion. Aftercare includes 4 weeks of brace treatment with restricted range of motion. PMID:19165466

Sillanpää, Petri J; Mäenpää, Heikki M; Mattila, Ville M; Visuri, Tuomo; Pihlajamäki, Harri



Acute patellar dislocation. What to do?  


Acute patellar dislocation is a common knee injury that occurs most often in adolescents, frequently associated with sporting and physical activities. Patellar re-dislocation after the first episode appears to depend primarily on the medial patellofemoral ligament injury which represents the primary ligamentous restraint, providing about 50-60 % of the restraining force against lateral patellar displacement. Clinically, up to 94-100 % of patients suffer from medial patellofemoral ligament rupture after first-time patellar dislocation. Controversy regarding how patients with first patellar dislocation should be managed still exists. Though most authors have reported good results with the conservative treatment after a first-time dislocation, several circumstances may warrant surgical intervention. A surgical approach would be necessary in the presence of severe cartilage damage or a relevant disruption of the medial stabilizers with subluxation of the patella. In these cases, the repair/reconstruction of medial stabilizers should follow the treatment of the chondral injury. Medial patellofemoral ligament reconstruction may be a more reliable method of stabilizing the patella than its repair, which has limitations related to the medial patellofemoral ligament injury location. Nowadays, there is no evidence available where osseous abnormalities should be addressed in addition to restoring the medial patellofemoral ligament. PMID:23242381

Panni, Alfredo Schiavone; Vasso, Michele; Cerciello, Simone



Dual tunnel medial patellofemoral ligament reconstruction for patients with patellar dislocation using a semitendinosus tendon autograft.  


The purpose of this study was to describe a safer and more anatomical technique of MPFL reconstruction and to report the short-term results. The subjects included 20 patients with patellar dislocation with a mean age of 23. The operation was performed using a double-looped autogenous semitendinosus tendon graft. Two small bone tunnels were made at the medial edge of the patella, mimicking the wide patellar insertion of the MPFL and a bone tunnel was made at the femoral insertion site. The free ends of the graft attached to the patella and the loop end was fixed to the femoral side. Five patients were available for follow-up interviews by telephone and the remaining 15 were directly examined by physical examination and radiographic evaluation at 2 years or longer postoperatively. The average follow-up period was 30 months. Re-dislocation or patellar fracture was not seen in any patients. The average Kujala's score was 96 with a range from 84 to 100. Six patients were classified as excellent and 14 as good, according to the Crosby and Insall grading system. Radiographically, narrowing of the patellofemoral joint space was observed in 2 cases with previous osteochondral fracture out of those who were directly examined. The dual tunnel MPFL reconstruction produces favorable results in subjective and functional assessment of outcome without complications. PMID:20684880

Toritsuka, Yukiyoshi; Amano, Hiroshi; Mae, Tatsuo; Uchida, Ryohei; Hamada, Masayuki; Ohzono, Kenji; Shino, Konsei



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


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

Yoon, Sook Hee; Kim, Won



[Biomechanical studies of change in the patellar tendon after transplant removal].  


The reconstruction of the anterior cruciate ligament deficient knee with the patellar tendon is the "gold standard". Dislocation of the patella, rupture of the patellar tendon and fracture of the patella were reported to occur. In this biomechanical investigation on the changes of the patellar tendon following harvesting of a graft, 51 sheep knee underwent destructive testing at t0 (n = 11), 4 weeks p.op. (n = 5), 3 months p.op. (n = 14), 6 months p.op. (n = 15), and 12 months p.op. (n = 6). Harvesting of a graft produces a stiffness and strength of the patellar tendon of 50-70% of normal. There was no significant change of free patellar tendon length up to 12 months p.op. The cross-sectional area is definitely increased (p < 0.05). The tensile stress is always above normal, nevertheless the strength shows a massive decline until 6 months p.op. and does not regain normal strength by one year p.op. Stiffness shows comparable biomechanical pattern like tensile stress. There are time-dependent changes, the structural weakness is compensated by an increase of cross-sectional area. There is no restitution of the patellar tendon ad integrum, the remainder is a defect with scar tissue and alterated biomechanical properties. Revision surgery using the same host patellar tendon cannot be recommended. PMID:8101030

Scherer, M A; Früh, H J; Ascherl, R; Siebels, W



Baseline trace metals in seagrass, algae, and mollusks in a southern Tyrrhenian ecosystem (Linosa Island, Sicily).  


Trace elements were analyzed in organisms collected at five sampling stations along coastal areas of Linosa Island, Sicily (southern Tyrrhenian Sea, Italy). Concentrations of Cd, Cr, Cu, Pb, and Zn were measured in Posidonia oceanica L. Delile tissues, the two brown algae Padina pavonica (L.) Thivy and Cystoseira sp., and the two gastropod mollusks Monodonta turbinata Born and Patella caerulea L. Seawater samples were also collected at each site to assess soluble metal concentrations and to gain relevant information on their bioaccumulation ability. Data were processed by multivariate techniques, such as principal component analysis (PCA) and linear discriminant analysis on PCA factors. The scoreplots obtained showed that the pollutant distribution is more significantly correlated with species than with sites. For seaweeds, P. oceanica was associated with higher Cd, Cu, and Zn levels; Padina species had higher Cr concentrations, and Cystoseira had higher Pb levels. For mollusks, Monodonta species had high concentrations of Cu and Cr and Patella species were associated with Cd. Some general metal bioaccumulation patterns are described but no one sampling site was more contaminated than the others. The hypothesis of Linosa island serving as a reference ecosystem for baseline trace metal levels in southern Tyrrhenian areas is indeed supported by the statistical comparison among other southern Tyrrhenian ecosystems performed with Kruskall Wallis and Mann-Whitney tests. For P. oceanica leaves, P. pavonica, M. turbinata, and P. caerulea, this study confirms their usefulness as possible cosmopolitan biomonitors of trace metals in marine Mediterranean areas. PMID:19458990

Conti, Marcelo Enrique; Bocca, Beatrice; Iacobucci, Marta; Finoia, Maria Grazia; Mecozzi, Mauro; Pino, Anna; Alimonti, Alessandro



Three-dimensional mathematical model analysis of the patellofemoral joint.  


This paper is concerned with a mathematical model analysis of the patellofemoral joint in the human knee, taking into account the articular surface geometry and mechanical properties of the ligament. It was made by the application of a computer-aided design theory (previously studied) and it was possible to express the articular surface geometries in a mathematical formulation and hence elucidate the joint movement mechanics. This method was then applied to a three-dimensional geometrical model of the patellofemoral joint. For the modelling of tendofemoral contact at large angles of knee flexion, the geodestic line theory was adopted. Applying the Newton-Raphson method and the Runge-Kutta Gil method to the model, variables such as patellar attitudes, patellofemoral contact force and tensile force of the patellar ligament for various knee flexion angles were computed. Applying the Hertzian elastic theory, contact stress was also computed. These results showed good agreement with the previously reported experimental results. As an application for the model, some parameter analyses were performed in terms of the contact stress variations and compared with those of the normal knee. The simulation results indicated that both the Q-angle increase and decrease increased contact stress, the patella alta showed undulating variations of stress while the patella infera showed little change of stress, and the tibial tuberositas elevation showed 20-30% reduction of stress. PMID:1918090

Hirokawa, S



[Overuse injury syndromes of the knee].  


Overuse injuries are frequent in the knee joint. The reason for this is that the knee joint is engaged in all sports activities. Furthermore, the joint area has numerous attachment points for muscles and tendons and numerous bursae. Another reason is that the specific joint between the patella and femur (patellofemoral joint) constitutes a part of the knee joint. Speaking in general terms, all overuse injuries in the knee joint can be divided in four groups according to the aspect: anterior aspect--patellofemoral pain syndrome, patellar tendinitis (jumper's knee), Osgood-Schlatter disease, Sinding Larson Johanson disease, stress fracture of the patella, fat pad syndrome; medial aspect--plica syndrome, semimembranosus tendinitis, pes anserinus tendinitis (bursitis), breaststroker's knee, medial retinaculitis; lateral aspect--Iliotibial band friction syndrome (runner's knee), Popliteal Tendinitis, Bicipital tendinitis; posterior aspect--fabellitis, medial gastrocnemius strain. There are numerous possible reasons for pain caused by overuse injuries around the knee joint, but two are the most frequent: patellar tendinitis (jumper's knee) and Iliotibial band friction syndrome (runner's knee). This paper gives a brief overview of overuse injuries of the knee joint including their definition, anatomy, aetiology, clinical symptoms and signs, and non-operative and surgical treatment. PMID:11831126

Pe?ina, M; Bojani?, I; Haspl, M



Transplantation of free tibial periosteal grafts for the repair of articular cartilage defect: An experimental study  

PubMed Central

Background: Articular chondrocytes have got a long lifespan but rarely divides after maturity. Thus, an articular cartilage has a limited capacity for repair. Periosteal grafts have chondrogenic potential and have been used to repair defects in the articular cartilage. The purpose of the present study is to investigate the differentiation of free periosteal grafts in the patellofemoral joint where the cambium layer faces the subchondral bone and to investigate the applicability of periosteal grafts in the reconstruction of articular surfaces. Materials and Methods: The study was carried out over a period of 1 year on 25 adult, male Indian rabbits after obtaining permission from the institutional animal ethical committee. A full-thickness osteochondral defect was created by shaving off the whole articular cartilage of the patella of the left knee. The defect thus created was grafted with free periosteal graft. The patella of the right knee was taken as a control where no grafting was done after shaving off the articular cartilage. The first animal was used to study the normal histology of the patellar articular cartilage and periosteum obtained from the medial surface of tibial condyle. Rest 24 animals were subjected to patellectomy, 4 each at serial intervals of 2, 4, 8, 16, 32 and 48 weeks and the patellar articular surfaces were examined macroscopically and histologically. Results: The grafts got adherent to the underlying patellar articular surface at the end of 4 weeks. Microscopically, graft incorporation could be appreciated at 4 weeks. Mesenchymal cells of the cambium layer were seen differentiating into chondrocytes by the end of 4 weeks in four grafts (100%) and they were arranged in a haphazard manner. Till the end of 8 weeks, the cellular arrangement was mostly wooly. At 16 weeks, one graft (25%) had wooly arrangement of chondrocytes and three grafts (75%) had columnar formation of cells. Same percentage was maintained at 32 weeks. Four grafts (100%) at 48 weeks showed columnar orientation. The control side showed no changes over the shaved off articular surface in all the rabbits. One rabbit at 4 weeks had a dislocation of the patella on the control side. None of the rabbits developed any infection or wound dehiscence. Conclusion: Autologous periosteal graft transplantation can be a promising substitute for articular cartilaginous defects.

Singh, Ravijot; Chauhan, Vijendra; Chauhan, Neena; Sharma, Sansar



Severe valgus deformity of the knee with permanent patellar dislocation associated with melorheostosis: A case report and review of the literature.  


We present a case of an 8-year-old boy diagnosed with melorheostosis who was suffering from severe genu valgum, permanent dislocation of the patella, knee flexion contracture and leg length shortening. Soft tissue contracture of the limb and subsequent joint deformities were reported to represent clinical manifestations of pediatric melorheostosis. As the epiphyseal plate had not closed, patellar reduction was achieved by soft tissue surgical stabilization, including lateral retinacular release, medial retinaculum plication, and transfer of the lateral half of the patellar tendon. At 4years postoperatively, as a result of improved limb alignment and knee flexion contracture, the leg length shortening has improved, and the patient does not limp and participates in sports activities. Surgical intervention should be performed as early as possible, because genu valgum and external rotation of the tibia may deteriorate with age, rendering the patellar dislocation irreversible in patients with melorheostosis before epiphyseal closure. PMID:23306029

Kitta, Yuki; Niki, Yasuo; Udagawa, Kazuhiko; Enomoto, Hiroyuki; Toyama, Yoshiaki; Suda, Yasunori



The composite anterolateral thigh flap for knee extensor and skin reconstruction.  


The simultaneous reconstruction of a skin defect and lost extensor mechanism of the knee joint is difficult. We present a 31-year-old male who lost the patella and had a 9 × 10 cm skin defect after a total patellectomy for an infected open patellar fracture. A composite anterolateral thigh (ALT) flap including vascularized skin and fascia lata (FL) was elevated. The FL was folded and sutured to the remaining patellar tendon. The skin flap covered the skin defect. The wound healed uneventfully. Thirty months later, the active range of motion of the knee joint was 0°-120° and the extension strength of the knee joint was normal. He could stand on his right leg and walk without assistance. The composite ALT flap is a valuable option in knee reconstruction after a total patellectomy. PMID:23975419

Song, Seung Han; Choi, Sangmun; Kim, Young-Mo; Lee, Seung Ryul; Choi, Young Woong; Oh, Sang-Ha



The use of limpets as monitor of PAHs pollution in the Cantabrian coast  

NASA Astrophysics Data System (ADS)

The concentrations of 24 parental and methylated polycyclic aromatic hydrocarbon (PAH) levels in common limpet ( Patella vulgata) were measured in 15 coastal localities of the southern Bay of Biscay and 2 sites per locality for 2 years (spring and autumn of 2004 and 2005, respectively). Although the average concentrations shown a wide variability among the sites and the season, several sites showed a remarkable high concentration (PAH tot>900 ng g -1 d.w.) or medium (300-800 ng g -1 d.w) levels, but in most of the cases the initial high concentrations decreased sharply from one campaign to the following. Moreover, based on ratios of individual isomers concentration, petrogenic and pyrolitic sources were distinguished suggesting more than one source. Finally, based on the results of this work and comparing with previously reported data, it can concluded that limpets can be used as sentinel organisms in coastal environmental monitoring, even when oil spills are involved.

Bartolomé, L.; Bustamante, M.; Navarro, P.; Tajadura, J.; Gorostiaga, J. M.; Díez, I.; Zuloaga, O.; Etxebarria, N.



Simultaneous Rupture of the Patellar Tendon and the Anterior Cruciate Ligament: Report of Three Cases.  


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

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



Reconstructive versus non-reconstructive treatment of anterior cruciate ligament insufficiency. A retrospective matched-pair long-term follow-up.  


In this retrospective case series 80 patients divided in 40 matched pair groups with an arthroscopically proven ACL insufficiency were followed up for 15 years. One half was reconstructed using an autologous BTB patella graft, the other half was treated by a conservative physiotherapeutic based rehabilitation program. At follow-up the clinical scores (Lysholm, IKDC) showed no significant differences between subjects who had undergone ACL reconstruction and those who had not. Furthermore there was no detectable difference in the incidence of osteoarthritis between the cohorts. Patients having a negative pivot shift test showed significantly less signs of radiographic osteoarthritis and better functional assessment scores whether reconstructed or not. Based on these results and a review of the literature there is no clear evidence that ACL reconstruction reduces the rate of OA development or improves the long-term symptomatic outcome. Probably review of reconstruction by an anatomical approach will be more successful than operative techniques decades ago. PMID:21127860

Streich, Nikolaus A; Zimmermann, David; Bode, Gerrit; Schmitt, Holger



The chopstick-noodle twist: an easy technique of percutaneous patellar fixation in minimally displaced patellar fractures.  


We report six cases of minimally displaced two-part patellar fractures with skin injury over the patella that were treated with percutaneous K wire fixation and compression applied using stainless steel (SS) wire. This technique makes it possible to perform early operative treatment in cases where unhealthy skin is not amenable to conventional tension band wiring. The technique employs two K wires inserted through the two fracture fragments under local or regional anaesthesia. They are then compressed using simple SS wire knots at the two ends - making it look like noodles at the end of two chopsticks. The fixation is subsequently augmented with a cylindrical plaster-of-Paris cast. The technique is simple, cheap and does not cause soft tissue injury. PMID:22290109

Muzaffar, Nasir; Ahmad, Nawaz; Ahmad, Aejaz; Ahmad, Nissar



Floating Knee Injury Associated with Patellar Tendon Rupture: A Case Report and Review of Literature  

PubMed Central

Floating knee injuries are frequently associated with other concomitant injuries to the ipsilateral limb or other parts of body of which injury to the ipsilateral knee ligaments carries significance for various reasons. A middle-aged man sustained a floating knee injury following RTA. DCS fixation by bridge plating technique for the distal femur and lateral buttress plating by MIPO technique for proximal tibia were planned and executed under spinal anesthesia with image intensifier. In addition, there were patellar tendon rupture along with avulsion of VMO from the medial border of patella and torn MPFL, which we have missed initially. To the best of our knowledge no similar case has been reported in English literature so far. We have reviewed the literature and proposed a different interpretation of Blake and McBride classification.

Vaidyanathan, Singaravadivelu; Panchanathan Ganesan, Jagannath; Moongilpatti Sengodan, Mugundhan



[Treatment and outcome of fractures around the knee in the older patients].  


From the age of 50 the risk of fracture during the remaining years of life is estimated to be 40% in women and 20% men. The management of a fracture in the elderly is complex for several reasons, including decreased bone strength, a frequent association with previous joint replacement surgery or another orthopaedic implant, a high risk for anesthesia, difficulty in following postoperative recommendations, and an increased postoperative mortality. This article offers a review of fractures around the knee: distal femur, proximal tibia, patella and periprosthetic fractures. The vast majority of these fractures are treated surgically. When surgery is indicated, treatment should be initiated as soon as possible according to the patient's general condition in order to minimize the risk of complications and deconditioning. PMID:23346747

Lauper, Nicolas; Hoffmeyer, Pierre; Suva, Domizio



Patellar eversion does not adversely affect quadriceps recovery following total knee arthroplasty.  


Although avoiding patellar eversion during a total knee arthroplasty (TKA) has theoretical benefit in quadriceps recovery, there has been paucity of supportive objective clinical results. We prospectively designed the study whether TKA without patellar eversion has better quadriceps recovery in an objective, dynamometer study. Seventy-two knees undergoing TKA with midvastus approach were randomized into two groups according to patellar eversion or not. Clinical data and objective quadriceps recovery using a dynamometer were investigated preoperatively and postoperative at 6weeks, 3months, 6months and 1year. There were no statistical differences between two groups throughout the follow-up periods in recovery of quadriceps force or power and clinical data. Choosing to evert patella during TKA using midvastus approach would not adversely affect postoperative quadriceps recovery. PMID:23153598

Umrani, Salil P; Cho, Kye-Youl; Kim, Kang-Il



Bone ingrowth in well-fixed retrieved porous tantalum implants.  


While first generation porous coatings have had clinical success, aseptic loosening remains a leading cause of revision. The purpose of this study was to investigate the reasons for revision and to assess the amount of bone ingrowth in retrieved porous tantalum components. In a prospective multicenter retrieval program, 76 porous tantalum acetabular shells, 5 femoral stems, 7 patellas and 36 tibial trays were collected from revision surgeries. A subset of the implants was analyzed for bone ingrowth. The main reason for revision was infection for acetabular shells (1.4 years implantation time) and instability for tibial trays (1.8 years implantation time). Two of the thirty primary surgery acetabular shells and one of the thirty-six primary surgery tibial trays were revised for implant loosening. We observed full depth penetration of bone into the porous tantalum layer for the acetabular shells and femoral stems. PMID:23518432

Hanzlik, Josa A; Day, Judd S



Medial patellofemoral ligament reconstruction: a novel approach.  


Recurrent patellar instability is common, and multiple procedures have been described for its treatment. Medial patellofemoral ligament reconstruction can be successful in patients who have an incompetent medial patellofemoral ligament or who have failed medial patellofemoral ligament repair and present with recurrent patellar instability. This article describes a novel approach to medial patellofemoral ligament reconstruction using a folded hamstring allograft with a new knotless suture anchor and bio-interference screw fixation. The principal advantage of this construct is the ability to definitively fix the medial patellofemoral ligament soft-tissue graft on the femur and provisionally fix the graft to the patella while assessing for reasonable medial patellofemoral ligament isometry throughout the arc of knee motion. PMID:18686487

Anbari, Ammar; Cole, Brian J



The role of trochlear dysplasia in patellofemoral instability.  


Trochlear dysplasia is characterized by abnormal trochlear morphology and a shallow groove. It is associated with recurrent patellar dislocation, but it is unclear whether the dysplasia is congenital, the result of lateral tracking and chronic instability, or caused by a combination of factors. Lateral radiographs elucidate the crossing sign and characteristic trochlear prominence. Recurrent patellofemoral instability is multifactorial, and each component must be considered in determining treatment. Managing other factors associated with recurrent instability may compensate for a deficient trochlea and provide stability. Medial patellofemoral ligament reconstruction is recommended for patellofemoral instability in the presence of trochlear dysplasia in patients without patella alta or increased tibial tubercle-trochlear groove distance. Trochleoplasty should be reserved for severe dysplasia in which patellofemoral stability cannot otherwise be obtained. PMID:21205763

Bollier, Matthew; Fulkerson, John P



Reconstruction of the medial patellofemoral ligament using a longitudinal patellar tunnel technique  

PubMed Central

Patellar instability is a common clinical problem affecting a young, active population. A large number of procedures have been described to treat patellar instability. We present the clinical results in a case series of 25 medial patellofemoral ligament reconstructions in 21 patients with up to 30 months follow-up (mean: 7.3). Reconstruction was performed using either the gracilis or semitendinosus tendon autograft. The Tegner activity score improved overall from 3 to 4.4 at follow-up and the mean follow-up Kujala score was 87 (range: 55–100). No patella redislocations were observed. Five patients (20%) required a manipulation under anaesthetic but subsequently regained a satisfactory range of motion. Medial patellofemoral reconstruction with both gracilis and semitendinosus tendon graft using a longitudinal tunnel technique provided good post-operative stability restoring the primary soft tissue restraint to pathological lateral patellar displacement with no complications of post-operative patellar fracture.

Schranz, Peter



Sensory conduction study of the infrapatellar branch of the saphenous nerve.  


Although neuropathies of the infrapatellar nerve (infrapatellar branch of the saphenous nerve, IPBSN) have been reported clinically, no electrophysiological method has been defined to evaluate IPBSN conduction. We therefore studied a total of 60 saphenous nerves and 60 IPBSNs from 36 volunteers. The IPBSN was stimulated medially with a surface electrode 2 cm below the patella. The response was recorded with a needle electrode located close to the nerve 1 cm lateral to the femoral artery in the inguinal region. Sensory nerve action potentials were obtained from each subject; mean latency of the first positive peak was 8.1 +/- 0.9 ms, conduction velocity was 54 +/- 4.4 m/s, and response amplitude was 1.3 +/- 1.1 microV. The method that we describe may be an easy and useful electrophysiological test for neuropathies of the IPBSN. PMID:17068766

Bademkiran, Fikret; Obay, Basra; Aydogdu, Ibrahim; Ertekin, Cumhur



Mutations in origin recognition complex gene ORC4 cause Meier-Gorlin syndrome.  


Meier-Gorlin syndrome is a rare autosomal recessive genetic condition whose primary clinical hallmarks include small stature, small external ears and small or absent patellae. Using marker-assisted mapping in multiple families from a founder population and traditional coding exon sequencing of positional candidate genes, we identified three different mutations in the gene encoding ORC4, a component of the eukaryotic origin recognition complex, in five individuals with Meier-Gorlin syndrome. In two such individuals that were negative for mutations in ORC4, we found potential mutations in ORC1 and CDT1, two other genes involved in origin recognition. ORC4 is well conserved in eukaryotes, and the yeast equivalent of the human ORC4 missense mutation was shown to be pathogenic in functional assays of cell growth. This is the first report, to our knowledge, of a germline mutation in any gene of the origin recognition complex in a vertebrate organism. PMID:21358631

Guernsey, Duane L; Matsuoka, Makoto; Jiang, Haiyan; Evans, Susan; Macgillivray, Christine; Nightingale, Mathew; Perry, Scott; Ferguson, Meghan; LeBlanc, Marissa; Paquette, Jean; Patry, Lysanne; Rideout, Andrea L; Thomas, Aidan; Orr, Andrew; McMaster, Chris R; Michaud, Jacques L; Deal, Cheri; Langlois, Sylvie; Superneau, Duane W; Parkash, Sandhya; Ludman, Mark; Skidmore, David L; Samuels, Mark E



Imaging pediatric sports injuries: lower extremity.  


Injuries to pediatric athletes, which are becoming increasingly common, take the form of acute injuries and chronic overuse injuries. Acute injuries of the lower extremity include avulsions of the pelvic apophyses, muscle-tendon injuries, transient dislocation of the patella, ankle sprains, and acute tears of the anterior cruciate ligament and menisci. Magnetic resonance (MR) imaging of the latter 2 injuries should approach the accuracy of MR imaging of the adult knee. Chronic overuse injuries of the lower extremity in this age group include stress fractures, which are most common in the tibia; ankle impingement syndromes; osteochondritis dissecans of the knee and osteochondral lesions of the talus; and traction apophysitis, most commonly presenting as Osgood-Schlatter disease and Sinding-Larsen-Johannson disease, affecting the patellar tendon. Imaging findings of all these lesions are characteristic, and allow radiologists to assist their clinical colleagues in diagnosing and treating pediatric athletic injuries. PMID:21094407

Davis, Kirkland W



Histopathological study of nonosseous tarsal coalition.  


Histopathological analysis was performed on 55 feet in 48 patients with nonosseous tarsal coalitions. Histological findings were similar to those observed at the tendinous attachment site of Osgood-Schlatter disease, accessory navicular, and bipartite patellae. No nerve elements were observed in the fibrocartilaginous tissue at the coalition. Nerve elements were present only in periosteum and articular capsule surrounding the coalition. Pain in the tarsal coalition is not mediated by nerve elements at the coalition site itself. It is assumed that the pain is caused by mechanical abnormality that results from incomplete coalition. Incomplete coalition produces microfractures and remodelings on the boundaries between bone and the coalition, which then lead to degenerative changes. This mechanical abnormality seems to induce pain via free nerve endings in the periosteum and in the articular capsule surrounding the coalition. PMID:9728699

Kumai, T; Takakura, Y; Akiyama, K; Higashiyama, I; Tamai, S



[Osgood-Schlatter disease].  


Osgood-Schlatter disease is a painful affection of the knee which touches particularly the active teenagers. Etiology of this frequent affection is unknown. This disease appears as an anterior knee pain and swelling started and worsened by the sports activities. Diagnosis is especially clinical. X-Rays, ultrasounds or IRM are not necessary for the diagnosis. Treatment is based on eviction of sports, analgesics and sometimes physiotherapy. Surgery is rarely proposed. Knee pain stops at the end of the growth. Long-term outcome is good for the majority of the patients. Some studies suggest a patella alta at the end of the growth, without an established correlation with knee arthritis. PMID:18946967

Vargas, Bernardo; Lutz, Nicolas; Dutoit, Michel; Zambelli, Pierre Yves



Apophyseal injuries in the young athlete.  


Apophyseal injuries, which are unique in the adolescent athlete, cause inflammation at the site of a major tendinous insertion onto a growing bony prominence. These injuries typically occur in active adolescents between the ages of eight and 15 years and usually present as periarticular pain associated with growth, skeletal immaturity, repetitive microtrauma and muscle-tendon imbalance. Common apophyseal injuries, and their sites, include Sever's disease (posterior calcaneus), Osgood-Schlatter disease (tibial tuberosity), Sindig-Larsen-Johansson syndrome (inferior patella), medial epicondylitis (humeral medial epicondyle) and apophysitis of the hip (iliac crest, ischial tuberosity). Conservative therapy, including rest, ice, compression, elevation, nonsteroidal anti-inflammatory agents, modification of the athlete's activity level and exercises for increased flexibility and strengthening, is usually effective. PMID:7762480

Peck, D M



Bioindicator organisms: heavy metal pollution evaluation in the Ionian Sea (Mediterranean Sea--Italy).  


Trace metal concentrations of mercury, cadmium, lead and chromium in Patella caerulea, and Mullus barbatus were investigated to provide information on pollution of Ionian Sea, since these metals have the highest toxic potential. High chromium levels (0.47-0.97 microg g(-1) ww) were registered in limpet samples collected from two station near the Gulf of Taranto, while elevated concentration of mercury (0.31-1.50 microg g(-1) ww) were found in mullet specimens from Sicily. The metal concentrations recorded at the clean stations may be considered as useful background levels to which to refer for comparison within the Mediterranean area. On the contrary, the high levels of chromium and mercury found respectively in the areas near the Gulf of Taranto and at Capo Passero being of concern in terms of environmental health need frequent monitoring. PMID:15869184

Storelli, Maria M; Marcotrigiano, Giuseppe O



Load-dependent variations in knee kinematics measured with dynamic MRI.  


Subtle changes in knee kinematics may substantially alter cartilage contact patterns and moment generating capacities of soft tissues. The objective of this study was to use dynamic magnetic resonance imaging (MRI) to measure the influence of the timing of quadriceps loading on in vivo tibiofemoral and patellofemoral kinematics. We tested the hypothesis that load-dependent changes in knee kinematics would alter both the finite helical axis of the tibiofemoral joint and the moment arm of the patellar tendon. Eight healthy young adults were positioned supine in a MRI-compatible device that could impose either elastic or inertial loads on the lower leg in response to cyclic knee flexion-extension. The elastic loading condition induced concentric quadriceps contractions with knee extension, while an inertial loading condition induced eccentric quadriceps contractions with knee flexion. Peak internal knee extension moments ranged from 23 to 33 N m, which is comparable to loadings seen in normal walking. We found that anterior tibia translation, superior patella glide, and anterior patella translation were reduced by an average of 5.1, 5.7 and 2.9 mm when quadriceps loading coincided with knee flexion rather than knee extension. These kinematic variations induced a distal shift in the finite helical axis of the tibiofemoral joint and a reduction in the patellar tendon moment arm. We conclude that it may be important to consider such load-dependent changes in knee kinematics when using models to ascertain soft tissue and cartilage loading during functional tasks such as gait. PMID:23806309

Westphal, Christopher J; Schmitz, Anne; Reeder, Scott B; Thelen, Darryl G



Contact forces in several TKA designs during squatting: A numerical sensitivity analysis.  


Total knee arthroplasty (TKA) is a very successful procedure, but pain or difficulties during activities still persist in patients. Patient outcomes in TKA surgery can be affected by implant design, alignment or patient-related anatomical factors. This paper presents a numerical sensitivity analysis of several TKA types: a fixed bearing, posterior stabilized prosthesis, a high flexion fixed bearing guided motion prosthesis, a mobile bearing prosthesis and a hinge prosthesis. Each prosthesis was virtually implanted on the same cadaver leg model and it underwent a loaded squat, in 10s, between 0° and 120°, similar to several previous experimental tests performed on knee kinematics simulators. The aim of this examination was to investigate the sensitivity of the patello-femoral (PF) and tibio-femoral (TF) contact forces to patient-related anatomical factors, and component position in the different implant types. The following parameters were used for the sensitivity study: the proximo-distal patellar position, the patellar component tilting, the tibial component position and orientation, the locations of the medial and lateral collateral ligaments with respect to femur and tibia and the patellar tendon length. The sensitivity analysis showed that PF contact forces are mostly affected by patella height (increases up to 67% for one TKA type in patella-alta configuration), by an anterior tibial component translation (increases up to 30%), and by patellar component tilting (increases up to 29%); TF contact forces are mostly affected by the anterior displacement of the insertion points of the medial collateral ligament with respect to the reference position (increases up to 48%). PMID:21435645

Innocenti, Bernardo; Pianigiani, Silvia; Labey, Luc; Victor, Jan; Bellemans, Johan



Hox11 genes establish synovial joint organization and phylogenetic characteristics in developing mouse zeugopod skeletal elements.  


Hox11 genes are essential for zeugopod skeletal element development but their roles in synovial joint formation remain largely unknown. Here, we show that the elbow and knee joints of mouse embryos lacking all Hox11 paralogous genes are specifically remodeled and reorganized. The proximal ends of developing mutant ulna and radius elements became morphologically similar and formed an anatomically distinct elbow joint. The mutant ulna lacked the olecranon that normally attaches to the triceps brachii muscle tendon and connects the humerus to the ulna. In its place, an ulnar patella-like element developed that expressed lubricin on its ventral side facing the joint and was connected to the triceps muscle tendon. In mutant knees, both tibia and fibula fully articulated with an enlarged femoral epiphyseal end that accommodated both elements, and the neo-tripartite knee joint was enclosed in a single synovial cavity and displayed an additional anterior ligament. The mutant joints also exhibited a different organization of the superficial zone of articular cartilage that normally exerts an anti-friction function. In conclusion, Hox11 genes co-regulate and coordinate the development of zeugopod skeletal elements and adjacent elbow and knee joints, and dictate joint identity, morphogenesis and anatomical and functional organization. Notably, the ulnar patella and tripartite knee joints in the mouse mutants actually characterize several lower vertebrates, including certain reptiles and amphibians. The re-emergence of such anatomical structures suggests that their genetic blueprint is still present in the mouse genome but is normally modified to the needs of the mammalian joint-formation program by distinct Hox11 function. PMID:20978074

Koyama, Eiki; Yasuda, Tadashi; Minugh-Purvis, Nancy; Kinumatsu, Takashi; Yallowitz, Alisha R; Wellik, Deneen M; Pacifici, Maurizio



Phenotypic and genetic trends of patellar luxation in Dutch Flat-Coated Retrievers.  


Canine patellar luxation has been described in various dog breeds, with high prevalence especially in smaller dogs. Most dogs suffer from medial displacement of the patella, although in larger dogs lateral displacement is also seen. A sex predisposition has been described for females. Patellar luxation is considered a polygenic, multifactorial disorder. From 1990 to 2007, in total 3834 Flat-Coated Retrievers were screened; 23.6% of those animals were affected with patellar luxation. Lateral displacement of the patella was most common in this breed (61% of cases), whereas medial (31% of cases) and lateral and medial (8% of cases) were less common. Unilateral involvement (51% of cases) was just as often observed as was bilateral involvement (49% of cases). Females were more often affected with patellar luxation (30% of all tested females) than were males (17% of all tested males). The heritability of patellar luxation was 0.17 ± 0.03 in this population, and breeding with one affected parent increased the prevalence of patellar luxation in offspring by 45% compared to that with two unaffected parents. Since the start of the screening program, there was an initial decrease from 28% to 18% in incidence, but this stagnated thereafter. The annual average estimated breeding values followed the same pattern. With approximately one quarter of the Dutch Flat-Coated Retrievers being affected with patellar luxation, this population shows unusually high prevalence compared with reports in other large-breed dogs. The heritability for patellar luxation in this population was moderate (0.17), indicating that environmental factors play a large role in the manifestation of the disorder. A screening program reduced the prevalence of patellar luxation in this breed, but improvement has recently stagnated. Inclusion of breeding values in the screening program could improve its effectiveness. PMID:24033452

Lavrijsen, I C M; Heuven, H C M; Breur, G J; Leegwater, P A J; Meutstege, F J; Hazewinkel, H A W



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

PubMed Central

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.



TKA following high tibial osteotomy versus primary TKA - a matched pair analysis  

PubMed Central

Background High tibial osteotomy (HTO) is a well established technique for the treatment of medial osteoarthritis of the knee with varus malalignment. Results of total knee arthroplasty (TKA) after previous HTO are still discussed controversially. The aim of this study was to elucidate the clinical and radiological results as well as perioperative data of prior HTO on TKA. Methods Forty-one TKA after HTO were compared to 41 primary TKA at minimum of six years follow-up. Patients were matched according to age, gender, follow-up, etiology, and prosthetic design. Surgical data and complications were evaluated. Clinical outcome was assessed using a number of clinical scores and the visual analogue scale (VAS) for pain. X-rays were evaluated by the method of the American Knee Society. The patellar position was measured by the Insall-Salvati ratio. Results There was no significant difference in mean operation time (p = 0.47) and complication rate (p = 0.08). The Knee Score of the KSS (p = 0.0007) and the ROM (p = 0.006 for extension and p = 0.004 for flexion, respectively) were significantly better in the control group. Mid-term results of the VAS, WOMAC, Lequesne, UCLA, Feller's Patellar Score and SF-36 showed no significant difference. Femoral and tibial component alignment were similar in both groups. One tibial component showed suspect radiolucencies in the HTO group. The Insall-Salvati ratio showed three patients with patella alta and one patient with patella baja in the HTO group. At latest follow-up all implants were still in place. Conclusions Evaluating the clinical and radiological outcome, significant differences were only detected for range of motion and the Knee Score of the KSS. The present study suggests that the results of TKA with and without prior HTO are mainly identical. Although patients with a previous HTO had more complications, no statistically significant differences were noted with this group size.



Extra articular arthroscopic release in post-traumatic stiff knees: a prospective study of endoscopic quadriceps and patellar release.  


Knee stiffness due to mismanaged trauma is still common in underdeveloped countries. Many patients with distal femoral fractures, patellar injuries or other local trauma present with intra-articular and extra-articular adhesions between the quadriceps and anterior femur. Nineteen knees with post trauma stiffness due to combined intra- and extra- articular aetiology were taken up for arthroscopic aided release after failing an aggressive physiotherapy protocol. Ultrasound was used to identify the extra-articular adhesions. The intra-articular part of the release was done by a standard protocol involving the release of all infrapatellar, suprapatellar and gutter adhesions, and then the extra-articular proximal adhesions were released by using special long periosteal elevators and arthroscopic scissors. We were able to release the adhesions as high as 9 inches above the patella, and in one case bony ankylosis between the patella and the femur was arthroscopically osteotomised (after 11 years of stiffness). Delay before surgery averaged 2.7 years (6 months-11.3 years). Mean active flexion at one year follow-up improved from 27.3 degrees to 119.3 degrees (average increase: 92 degrees). Mean preoperative extension lag reduced from 6 degrees to 1 degrees postoperatively. No CPM machine was available, and patients had to undergo daily manual and assisted therapy, with appropriate analgesia. Overall patient satisfaction was excellent; one patient developed a supracondylar fracture (infected old fracture with bone loss and severe contracture) and was retrospectively a wrong case selection. Arthroscopic aided quadriceps adhesion release is a good option in cases of neglected trauma; results are excellent even without sophisticated CPM machines, and the periosteal elevators needed are cheap and indigenous. PMID:16152854

Dhillon, Mandeep S; Panday, Awadesh K; Aggarwal, Sameer; Nagi, Onkar N



Association between Prenatal Lead Exposure and Blood Pressure in Children  

PubMed Central

Background: Lead exposure in adults is associated with hypertension. Altered prenatal nutrition is associated with subsequent risks of adult hypertension, but little is known about whether prenatal exposure to toxicants, such as lead, may also confer such risks. Objectives: We investigated the relationship of prenatal lead exposure and blood pressure (BP) in 7- to 15-year-old boys and girls. Methods: We evaluated 457 mother–child pairs, originally recruited for an environmental birth cohort study between 1994 and 2003 in Mexico City, at a follow-up visit in 2008–2010. Prenatal lead exposure was assessed by measurement of maternal tibia and patella lead using in vivo K-shell X-ray fluorescence and cord blood lead using atomic absorption spectrometry. BP was measured by mercury sphygmomanometer with appropriate-size cuffs. Results: Adjusting for relevant covariates, maternal tibia lead was significantly associated with increases in systolic BP (SBP) and diastolic BP (DBP) in girls but not in boys (p-interaction with sex = 0.025 and 0.007 for SBP and DBP, respectively). Among girls, an interquartile range increase in tibia lead (13 ?g/g) was associated with 2.11-mmHg [95% confidence interval (CI): 0.69, 3.52] and 1.60-mmHg (95% CI: 0.28, 2.91) increases in SBP and DBP, respectively. Neither patella nor cord lead was associated with child BP. Conclusions: Maternal tibia lead, which reflects cumulative environmental lead exposure and a source of exposure to the fetus, is a predisposing factor to higher BP in girls but not boys. Sex-specific adaptive responses to lead toxicity during early-life development may explain these differences.

Zhang, Aimin; Sanchez, Brisa N.; Ettinger, Adrienne S.; Park, Sung Kyun; Cantonwine, David; Schnaas, Lourdes; Wright, Robert O.; Lamadrid-Figueroa, Hector; Tellez-Rojo, Martha Maria



Mid-term survivorship results for a rotating-platform knee prosthesis.  


Interest in mobile-bearing knee prostheses is increasing in the US market. We studied results at 2 to 5 years with a mobile-bearing system that includes a cobalt-chrome tibial tray and femoral component with a polyethylene cruciate-retaining tibial component insert that allows rotation around a central axis and can be used with cruciate-retaining or posterior-stabilized femoral components. The inserts used in this study were cruciate retaining and did not include the posterior-stabilized design. The goal of this study was to demonstrate the function and safety of this prosthesis along with the lack of spinout, which is a major concern in the mobile-bearing knee. Four hundred thirty-five knees constituted the study cohort and underwent survivorship analysis and complication reporting. Routine clinic evaluations included pre- and postoperative radiographs and Knee Society knee and function scores at 6 and 12 weeks and every 2 years. The most recent follow-up data within 2 to 5 years was included for the study along with survey data. Flexion at most recent follow-up averaged 125°. Knee Society score at most recent visit averaged 88 of 100. Knee Society function score averaged 83 of 100. Radiographic results were available for 226 knees, with 97.3% assessed as normal and 6 with these issues: patella stress fracture (3), aseptic tibial loosening (1), patellar osteolysis (1), and patella aseptic loosening (1). In comparison with the fixed-bearing knee equivalent, this mobile-bearing knee demonstrated at least equivalent results in terms of survivorship, function, and patient satisfaction in the short- and mid-term. PMID:21210627

Goldstein, Wayne M; Gordon, Alexander C; Youderian, Ari; Branson, Jill J; Murphy, Jeffrey A



Stress avulsion of the tibial tuberosity after tension band wiring of a patellar fracture: a case report  

PubMed Central

Introduction To the best of our knowledge there is no other report of an elderly patient who was surgically treated for a patellar fracture with tension band wiring and who subsequently suffered from an avulsion fracture of the tibial tuberosity. The combination of a patellar fracture and avulsion of the patellar ligament has only been described as complication after bone-patellar tendon-bone anterior cruciate ligament reconstructions. However, due to demographic changes and more elderly patients treated this injury may become more frequent in future. Case presentation We present the case of an 81 year old female who sustained an oblique patellar fracture after a direct contact injury of the left knee when falling on ice. Consequently the patellar fracture was openly reduced and stabilized with tension band wiring. The follow-up was uneventful till three months after surgery when the patient noticed a spontaneous avulsion fracture of the tibial tuberosity (Ogden type 3). The tibial tuberosity fragment was reattached with two non-resorbable sutures looped around two modified AO cortical 3.5 mm long neck screws. Intraoperatively multiple bone cysts were seen. Biopsies were not taken to prevent further fragmentation of the tibial tuberosity. The patient was followed up with anteroposterior and lateral full weight bearing radiographs and clinical assessment at 6, 12 weeks and 6 months after surgery. Recovery was completely pain free with full satisfaction. Conclusion In conclusion in elderly patients with a patella fracture a possible associated but not obvious fracture of the tibial tuberosity should be ruled out and the postoperative rehabilitation protocol after tension band wiring of the patella might have to be individually adjusted to bone quality and course of the fracture.



Anterior opening wedge osteotomy of the proximal tibia for anterior knee pain in idiopathic hyperextension knees  

PubMed Central

We analysed 20 patients with 24 knees affected by idiopathic genu recurvatum who were treated with an anterior opening wedge osteotomy of the proximal tibia because of anterior knee pain. We managed to attain full satisfaction in 83% of the patients with a mean follow-up of 7.4 years. The mean Hospital for Special Surgery score was 90.3 (range 70.5–99.5), and the mean Knee Society score score was 94.6 (70–100) for function and 87.7 (47–100) for pain. The mean Western Ontario and McMaster University Osteoarthritis Index score for knee function was 87.5 (42–100), for stiffness 82.8 (25–100) and for pain 87.3 (55–100). Radiographs showed a significant increase in posterior tibial slope of 9.4 deg and a significant decrease of patellar height according to the Blackburne–Peel method of 0.16 postoperatively. No cases of non-union, deep infection or compartment syndrome were seen. No osteoarthritic changes in the lateral or medial knee compartment were found with more than 5 years’ follow-up in 16 patients with 19 affected knees. Three out of the four dissatisfied patients had a patella infera which led to patellofemoral complaints. One patient in the study underwent a secondary superior displacement of the patella with excellent results. We conclude that in a selected group of patients with idiopathic genu recurvatum and anterior knee pain an opening wedge osteotomy of the proximal tibia can be beneficial.

van Raaij, T. M.



Infrapatellar Straps Decrease Patellar Tendon Strain at the Site of the Jumper's Knee Lesion  

PubMed Central

Background: The impetus for the use of patellar straps in the treatment of patellar tendinopathy has largely been based on empirical evidence and not on any mechanistic rationale. A computational model suggests that patellar tendinopathy may be a result of high localized tendon strains that occur at smaller patella–patellar tendon angles (PPTAs). Hypothesis: Infrapatellar straps will decrease the mean localized computational strain in the area of the patellar tendon commonly involved in jumper’s knee by increasing the PPTA. Study Design: Controlled laboratory study. Methods: Twenty adult males had lateral weightbearing and nonweightbearing radiographs of their knees taken with and without 1 of 2 infrapatellar straps at 60° of knee flexion. Morphologic measurements of PPTA and patellar tendon length with and without the straps were used as input data into a previously described computational model to calculate average and maximum strain at the common location of the jumper’s knee lesion during a simulated jump landing. Results: The infrapatellar bands decreased the predicted localized strain (average and maximum) in the majority of participants by increasing PPTA and/or decreasing patellar tendon length. When both PPTA and patellar tendon length were altered by the straps, there was a strong and significant correlation with the change in predicted average localized strain with both straps. Conclusion: Infrapatellar straps may limit excessive patella tendon strain at the site of the jumper’s knee lesion by increasing PPTA and decreasing patellar tendon length rather than by correcting some inherent anatomic or functional abnormality in the extensor apparatus. Clinical Relevance: The use of infrapatellar straps may help prevent excessive localized tendon strains at the site of the jumper’s knee lesion during a jump landing.

Lavagnino, Michael; Arnoczky, Steven P.; Dodds, Julie; Elvin, Niell



Southwick-Fulkerson Osteotomy with Intraoperative Femoral Nerve Guidance  

PubMed Central

Background Patellofemoral instability is a complex problem with most previous treatment plans addressing static alignment and static stabilizers. Although the quadriceps muscles are known to affect the tracking of the patella, they are rarely taken into account during a surgical procedure. Purpose The purpose of this study is to determine the two year minimum results of 37 knees which received a Southwick-Fulkerson Osteotomy and MPFL repair or reconstruction both under the guidance of femoral nerve stimulation Methods Patients underwent a Southwick-Fulk- erson Osteotomy and either medial patellofemoral ligament (MPFL) repair or reconstruction using femoral nerve stimulation as a means of dynamic intraoperative evaluation of patello-femoral con- gruity in terminal extension. Two year minimum outcomes of 26 patients, 31 knees (84% return rate) were evaluated using KOOS and IKDC scores, and physical exam features of apprehension and assessment of dynamic tracking in the last 30 degrees of knee extension. Variables were evaluated with t-tests and ANOVA. Results 29/31 knees reported they were happy with the procedure and reported they would do it again. One knee (3%) reportedly “redislocated”, but did not return for verification by exam. 30/31 had non-pathologic tracking. One knee displayed a small but residual J sign. 4/16 knees with MPFL repair only and 0/15 with MPFL repair and reconstruction exhibited a positive apprehension sign. Increased age and apprehension were correlated with lower outcome scores. Conclusions Intraoperative femoral nerve stimulation is an effective way of evaluating patellar tracking intraoperatively that leads to 97% stable patellae with near congruent patello-femoral tracking. MPFL reconstruction is superior to MPFL repair in eliminating the persistence of the apprehension sign.

Mellecker, Scott; Ebinger, Thomas; Butler, Paul; Albright, John



Constraints in posterior-stabilised TKA kinematics: a comparison of two generations of an implant.  


PURPOSE: This study tests the hypothesis that the design changes incorporated in the newer generation Triathlon posterior-stabilised TKA design result in kinematics that more closely reproduce the kinematics observed in healthy knees than those achieved by the older generation Scorpio posterior-stabilised TKA design. METHODS: Eleven patients with Triathlon posterior-stabilised TKA, twelve patients with Scorpio posterior-stabilised TKA, and 22 subjects with normal asymptomatic knees underwent fluoroscopic assessment of the knee during a step-up exercise and a weight-bearing deep knee bend. Two-dimensional and three-dimensional knee kinematics were assessed including the maximum flexion, the patella tendon angle (PTA), the patella flexion angle (PFA), the minimum distance between cam and post, and the tibio-femoral contact positions. RESULTS: The average maximum flexion achieved was 114° (SD 3°), 91° (SD 10°), and 143° (SD 14°) for the Triathlon, Scorpio, and Normal groups. The average cam/post mechanism engagement was at 63° (SD 24°) and 82° (SD 16°) for the Triathlon and Scorpio groups. The condylar contact points showed a paradoxical anterior slide for the Scorpio group which was not present in the Triathlon group. The PTA and PFA values of both implants showed significant differences from normal. CONCLUSION: Overall, the Triathlon implant design, as compared to Scorpio TKA, produced kinematics closer to that of normal knees as proposed by the hypothesis. However, despite being closer to normal, the kinematics exhibited by the Triathlon group were still different from normal. A comparison of kinematic performance, taking into account altered design parameters, will contribute to improved understanding and future design considerations. LEVEL OF EVIDENCE: Case-control study, retrospective, comparative study, Level III. PMID:23052124

Pandit, Hemant; van Duren, Bernard Hendrik; Price, M; Tilley, S; Gill, Harinderjit Singh; Thomas, Neil P; Murray, David W



Analysis of the load on the knee joint and vertebral column with changes in squatting depth and weight load.  


It has been suggested that deep squats could cause an increased injury risk of the lumbar spine and the knee joints. Avoiding deep flexion has been recommended to minimize the magnitude of knee-joint forces. Unfortunately this suggestion has not taken the influence of the wrapping effect, functional adaptations and soft tissue contact between the back of thigh and calf into account. The aim of this literature review is to assess whether squats with less knee flexion (half/quarter squats) are safer on the musculoskeletal system than deep squats. A search of relevant scientific publications was conducted between March 2011 and January 2013 using PubMed. Over 164 articles were included in the review. There are no realistic estimations of knee-joint forces for knee-flexion angles beyond 50° in the deep squat. Based on biomechanical calculations and measurements of cadaver knee joints, the highest retropatellar compressive forces and stresses can be seen at 90°. With increasing flexion, the wrapping effect contributes to an enhanced load distribution and enhanced force transfer with lower retropatellar compressive forces. Additionally, with further flexion of the knee joint a cranial displacement of facet contact areas with continuous enlargement of the retropatellar articulating surface occurs. Both lead to lower retropatellar compressive stresses. Menisci and cartilage, ligaments and bones are susceptible to anabolic metabolic processes and functional structural adaptations in response to increased activity and mechanical influences. Concerns about degenerative changes of the tendofemoral complex and the apparent higher risk for chondromalacia, osteoarthritis, and osteochondritis in deep squats are unfounded. With the same load configuration as in the deep squat, half and quarter squat training with comparatively supra-maximal loads will favour degenerative changes in the knee joints and spinal joints in the long term. Provided that technique is learned accurately under expert supervision and with progressive training loads, the deep squat presents an effective training exercise for protection against injuries and strengthening of the lower extremity. Contrary to commonly voiced concern, deep squats do not contribute increased risk of injury to passive tissues. PMID:23821469

Hartmann, Hagen; Wirth, Klaus; Klusemann, Markus



[Identification of species of Hyalomma asiaticum group (Ixodidae) in areas of their sympatry based on immature stages].  


Morphological characters of immature stages of three closely related tick species, Hyalomma asiaticum Schulze et Schlottke, 1929, H. dromedarii Koch, 1844 and H. schulzei Olenev, 1931, collected mainly in areas of their sympatry (Fig. 1) were investigated. The larvae and nymphs of these three species were collected in Egypt, Iran, Turkmenistan, Uzbekistan, Afghanistan and Tadjikistan: 159 larvae and 137 nymphs of H. asiaticum from 12 localities; 78 larvae and 167 nymphs of H. dromedarii from 5 localities; 30 larvae and 6 nymphs of H. schulzei from one locality. Both qualitative morphological features and measured character (in mkm) were used to discriminate these species. Main discriminant characters for larvae. H. asiaticum (Fig. 3). Scutum: length < 246, width < 389; base of capitulum: width < 158, dorsally hexagonal, apices of lateral projections directed forward; palpae (II and III segments): length < 106, width < 42; hypostome: length < 87, width < 25; the spur of coxa I small, equilateral triangular; patella: length < 154. H. dromedarii (Fig. 4). Scutum: length > 236, width > 379; base of capitulum: width > 158, dorsally almost triangular, apices of lateral projections directed laterally or backward; palpae: length > 110, width < 46; hypostome: length > 87, width < 26; the spur of coxa I large, isosceles triangular; patella: length > 115. H. schulzei (Fig. 5). Scutum: length > 249, width > 407; base of capitulum: width > 162, dorsally hexagonal, apices of lateral projections directed forward; palpae: length > 114, width > 44; hypostome: length > 89, width > 28; the spur of coxa I large, isosceles triangular; patella: length > 164. Main discriminant characters for nymphs: H. asiaticum (Fig. 3). Scutum: small, width < 650, length and width subequal, posterior margin widely rounded, lateral incisions weakly developed; spiracular plates with distinct, pointed dorsal projection, marginal row of perforations distant from the base of dorsal projection, submarginal row with a gap; base of capitulum: lateral projections situated in posterior half of capitulum; palpae (II segment) short and narrow; hypostome short and narrow, width < 69; pore of coxae I-III present. H. dromedarii (Fig. 4). Scutum: large, width > 650, length shorter than width, posterior margin widely rounded, lateral incisions moderately developed; spiracular plates: with distinct and wide dorsal projection, marginal row of perforations distant from the base of dorsal projection, submarginal row present, without gap; base of capitulum: lateral projections situated in the middle part of capitulum; palpae long and narrow; hypostome long and wide, width > 69; coxal pore lacking. H. schulzei (Fig. 5). Scutum: small, width < 630, length larger than width, posterior margin narrow rounded, lateral incisions weakly developed; spiracular plates: with weakly developed dorsal projections, marginal row of perforation situated just behind the base of dorsal projection, submarginal row with a gap; base capitulum: lateral projections situated in posterior half of capitulum; palpae short and wide; hypostome long and narrow, width < 73; coxal pore lacking. PMID:12325274

Apanaskevich, D A


The TOPGAME-study: effectiveness of extracorporeal shockwave therapy in jumping athletes with patellar tendinopathy. Design of a randomised controlled trial  

PubMed Central

Background Patellar tendinopathy is a major problem for many athletes, especially those involved in jumping activities. Despite its frequency and negative impact on athletic careers, no evidence-based guidelines for management of this overuse injury exist. Since functional outcomes of conservative and surgical treatments remain suboptimal, new diagnostic and therapeutic strategies have to be developed and evaluated. Extracorporeal shockwave therapy (ESWT) appears to be a promising treatment in patients with chronic patellar tendinopathy. ESWT is most often applied after the known conservative treatments have failed. However, its effectiveness as primary therapy has not been studied in athletes who keep playing sports despite having patellar tendon pain. The aim of this study is to determine the effectiveness of ESWT in athletes with patellar tendinopathy who are still in training and competition. Methods/design The TOPGAME-study (Tendinopathy of Patella Groningen Amsterdam Maastricht ESWT) is a multicentre two-armed randomised controlled trial with blinded participants and outcome assessors, in which the effectiveness of patient-guided focussed ESWT treatment (compared to placebo ESWT) on pain reduction and recovery of function in athletes with patellar tendinopathy will be investigated. Participants are volleyball, handball and basketball players with symptoms of patellar tendinopathy for a minimum of 3 to a maximum duration of 12 months who are still able to train and compete. The intervention group receives three patient-guided focussed medium-energy density ESWT treatments without local anaesthesia at a weekly interval in the first half of the competition. The control group receives placebo treatment. The follow-up measurements take place 1, 12 and 22 weeks after the final ESWT or placebo treatment, when athletes are still in competition. Primary outcome measure is the VISA-P (Victorian Institute of Sport Assessment - patella) score. Data with regard to pain during function tests (jump tests and single-leg decline squat) and ultrasound characteristics are also collected. During the follow-up period participants also register pain, symptoms, sports participation, side effects of treatment and additional medical consumption in an internet-based diary. Discussion The TOPGAME-study is the first RCT to study the effectiveness of patient-guided ESWT in athletes with patellar tendinopathy who are still in training and competition. Trial registration Trial registration number NTR1408.



Delta-aminolevulinic acid dehydratase polymorphism and the relation between low level lead exposure and the Mini-Mental Status Examination in older men: the Normative Aging Study  

PubMed Central

Objective To determine whether a polymorphism the in ??aminolevulinic acid dehydratase (ALAD) gene modifies the neurotoxicity of lead in older adults. Methods The authors studied men participating in the Department of Veterans Affairs' Normative Aging Study, assessing their recent exposure to lead by measuring blood lead (n?=?915) at each triennial clinic visit, and, beginning in 1991, assessing their cumulative exposure by measuring lead levels in tibia (n?=?722) and patella (n?=?720), using K?shell x ray fluorescence. Starting in 1993 and again at each triennial visit, the authors administered the Mini?Mental State Examination (MMSE) to assess their cognitive functioning. The relation of the lead biomarkers to MMSE score was evaluated and this association was compared among men who carried the variant allele, ALAD?2, versus men without the allele. Results Sixteen per cent of men carried the ALAD?2 allele. Median tibia and patella lead levels (first?third quartile) were 19 (13–28) and 27 (18–39) ?g/g. Blood lead levels were consistent with non?occupational exposure: only 6% of men had levels ?10??g/dl. In multivariable adjusted analyses, higher levels of blood lead were associated with poorer performance on the MMSE. This association was most pronounced among ALAD?2 carriers, among whom a 3??g/dl increment in blood lead (the interquartile range) was associated with a 0.26 point lower mean MMSE score (95% CI ?0.54 to 0.01), compared with a 0.04 point lower score (95% CI ?0.16 to 0.07) among non?carriers. The modest 0.22 point difference in these associations did not attain statistical significance, however (pinteraction?=?0.13). The associations between bone lead levels and MMSE score did not vary by ALAD?2 status. Conclusions Although not statistically significant, these findings suggest that ALAD genotype may modify blood lead's adverse association with cognition among older men who had community exposures to lead. However, despite a relatively large sample size and the use of sensitive methods for measuring lead burden, the evidence overall was fairly weak.

Weuve, J; Kelsey, K T; Schwartz, J; Bellinger, D; Wright, R O; Rajan, P; Spiro, A; Sparrow, D; Aro, A; Hu, H



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


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

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



A Study of Knee Joint Kinematics and Mechanics using a Human FE Model.  


Posterior translation of the tibia with respect to the femur can stretch the posterior cruciate ligament (PCL). Fifteen millimeters of relative displacement between the femur and tibia is known as the Injury Assessment Reference Value (IARV) for the PCL injury. Since the anterior protuberance of the tibial plateau can be the first site of contact when the knee is flexed, the knee bolster is generally designed with an inclined surface so as not to directly load the projection in frontal crashes. It should be noted, however, that the initial flexion angle of the occupant knee can vary among individuals and the knee flexion angle can change due to the occupant motion. The behavior of the tibial protuberance related to the knee flexion angle has not been described yet. The instantaneous angle of the knee joint at the timing of restraining the knee should be known to manage the geometry and functions of knee restraint devices. The purposes of this study are first to understand the kinematics of the knee joint during flexion, and second to characterize the mechanics of the knee joint under anterior-posterior loading. A finite element model of the knee joint, extracted from the Total Human Model for Safety (THUMS), was used to analyze the mechanism. The model was validated against kinematics and mechanical responses of the human knee joint. By tracking the relative positions and angles between the patella and the tibia in a knee flexing simulation, the magnitude of the tibial anterior protuberance was described as a function of the knee joint angle. The model revealed that the mechanics of the knee joint was characterized as a combination of stiffness of the patella-femur structure and the PCL It was also found that the magnitude of the tibial anterior protuberance determined the amount of initial stretch of the PCL in anterior-posterior loading. Based on the knee joint kinematics and mechanics, an interference boundary was proposed for different knee flexion angles, so as not to directly load the anterior protuberance of the tibial plateau in restraining of the knee. A frontal crash simulation was performed using a partial vehicle model with the THUMS seated. The performance and effects of the knee airbag, as one of the candidates for knee restraint devices, were evaluated through the simulation. PMID:17096271

Kitagawa, Yuichi; Hasegawa, Junji; Yasuki, Tsuyoshi; Iwamoto, Masami; Miki, Kazuo



Sex determination from the talus of South african whites by discriminant function analysis.  


The field of forensic anthropology involves the building of an antemortem profile of an individual from skeletal remains. This includes sex and race determination and age and stature estimation. Since most bones that are conventionally used for sex determination are often recovered either in a fragmented or incomplete state, it has become necessary to use denser bones that are often recovered intact, eg, the patella, calcaneus, and talus. Thus the aim of this study is to assess the sex-determining ability of each of the measurements of the talus and derive discriminant function equations for sex determination in the South African white population. Sixty male and 60 female tali of South African whites obtained from the Raymond A. Dart Collection of Human Skeletons were used. Nine measurements were taken on each talus. Descriptive statistics and discriminant function analysis were performed on the acquired data. The basic statistics showed that all measurements were sexually dimorphic. Univariate, stepwise, and direct discriminant function equations were generated for use in sex determination. The level of average accuracy of sex classification was 80% to 82% for the univariate method, 85% to 88% for the stepwise method, and 81% to 86% for the direct method. It is concluded that the talus of South African whites is useful for sex determination. PMID:14634469

Bidmos, Mubarak Ariyo; Dayal, Manisha Ramanlal



Extended Healing Validation of an Artificial Tendon to Connect the Quadriceps Muscle to the Tibia: 180-day Study  

PubMed Central

Whenever a tendon or its bone insertion is disrupted or removed, existing surgical techniques provide a temporary connection or scaffolding to promote healing, but the interface of living to nonliving materials soon breaks down under the stress of these applications, if it must bear the load more than acutely. Patients are thus disabled whose prostheses, defect size, or mere anatomy limit the availability or outcomes of such treatments. Our group developed the OrthoCoupler™ device to join skeletal muscle to prosthetic or natural structures without this interface breakdown. In this study, the goat knee extensor mechanism (quadriceps tendon, patella, and patellar tendon) was removed from the right hind limb in 16 goats. The device connected the quadriceps muscle to a stainless steel bone plate on the tibia. Mechanical testing and histology specimens were collected from each operated leg and contra lateral unoperated control legs at 180 days. Maximum forces in the operated leg (vs. unoperated) were 1400± 93N (vs. 1179± 61 N), linear stiffnesses were 33± 3 N/mm (vs. 37 ± 4N/mm), and elongations at failure were 92.1 ± 5.3 mm (vs. 68.4 ± 3.8 mm; mean ± SEM). Higher maximum forces (p = 0.02) and elongations at failure (p = 0.008) of legs with the device versus unoperated controls were significant; linear stiffnesses were not (p = 0.3). We believe this technology will yield improved procedures for clinical challenges in orthopaedic oncology, revision arthroplasty, tendon transfer, and tendon injury reconstruction.

Melvin, Alan J.; Litsky, Alan S.; Mayerson, Joel L.; Stringer, Keith; Juncosa-Melvin, Natalia



Influence of the bone block position on the tunnel enlargement in ACL reconstruction  

PubMed Central

Tunnel enlargement can appear after anterior cruciate ligament reconstruction. We investigated the influence of the bone block position of a patellar tendon autograft on the tunnel enlargement in the femur and in the tibia from two aspects. On the one hand, we examined the influence of the tunnel position in respect to the ap-diameter. On the other hand, we examined the influence of the bone block depth in respect to the joint line. In a crossover study over three years, 103 knees with primary ACL reconstruction were included. The incidence of tunnel enlargement measured on X-rays after one year was 52% (n=103) in the femur and 81% (n=103) in the tibia. The average diameter of enlargement was 1.4 mm (14%) in the femur and 2.7 mm (27%) in the tibia. No correlation between the tunnel position and the tunnel enlargement in the sagital plane could be found. However, there is a significant positive correlation between the size of tunnel enlargement and the bone block depth in the femur and in the tibia. There is an average tunnel enlargement of about 0.6 mm (6%) per 10 mm deeper bone plug depth. The relative excess length of the patella tendon favors the development of tunnel enlargement. The effect of the bone block depth on the tunnel enlargement is equal in the femur and the tibia.

Hoigne, Dominik J.; Ballmer, Peter M.



Arthroscopic treatment of chronic patellar tendinopathy in high-level athletes  

PubMed Central

Summary To present the results of arthroscopic treatment of patellar tendinopathy in high-level competition athletes. Eleven high-level athletes presented chronic patellar tendinopathy which did not respond to long term conservative treatment. Average age of the patients was 24.8 ±3.4 years old. All patients received an arthroscopic procedure with osteoplasty of the distal patellar pole, debridement of the underlying Hoffa fat pad and of the degenerated areas of the proximal posterior patella tendon and cauterization of the visible neo-vessels. Mean duration of follow-up was 17.4±4 months. Patients showed a major improvement in the Lysholm score from 49.9±5.2 to 92.5±7 and in the VISA P score from 41.2±5.2 to 86.8±14.9 on tenth post-operative week. All patients had returned to sports activities by the twelfth postoperative week. Arthroscopic treatment of chronic patellar tendinopathy found to be a minimal invasive and safe technique which produced satisfactory results.

Alaseirlis, Dimosthenis Artemis; Konstantinidis, George Athanasios; Malliaropoulos, Nikolaos; Nakou, Lamprini Stefanos; Korompilias, Anastasios; Maffulli, Nicola



Tetrodotoxin prevents copper-induced bradycardia in gastropod limpets.  


Acute exposure to waterborne copper is followed by a reduction in heart rate in gastropod limpets. In order to understand the mechanism of this effect, exposure to copper (0.25 or 0.5 mg l(-1); for 3 and 6 h) was combined with an injection of tetrodotoxin (TTX, 20 microl, 0.5 or 1 microM), a natural toxin that inhibits the propagation and transmission of impulses in excitable tissues. Experiments were performed on the Mediterranean limpet Patella caerulea, using a non-invasive method for the recording of cardiac activity. TTX did not affect the bradycardic effect of the cholinergic agonist carbachol. However, this toxin significantly antagonized the bradycardia induced by 0.25 and 0.5mg l(-1) of copper exposure and prevented the acardia observed in some limpets exposed to 0.5mg l(-1) of copper for 6h. These results are consistent with the hypothesis that the inhibitory action of copper on limpet cardiac activity involves an extrinsic, cholinergic neuronal control. PMID:15993526

Bini, Giada; Pugliese, Anna Maria; Pepeu, Giancarlo; Chelazzi, Guido



Bioavailable metals and cellular effects in the digestive gland of marine limpets living close to shallow water hydrothermal vents.  


The pressure exerted by shallow water hydrothermal vents on edible gastropods and their cellular responses triggered by these stresses are almost unknown. The aims of this study were to evaluate the bioavailability of metals in the Macaronesian endemic limpet Patella candei gomesii living close to shallow water hydrothermal vents, and the structural differences in their digestive gland as well as the levels of apoptosis in that organ. Limpets were sampled in four sites, two with the presence of hydrothermalism and the other two without it. Whole body concentrations of several metals (Ca, Cd, Cs, Co, Cu, Fe, Hg, Mg, Mn, Pb, Rb, Se, Sr, and Zn) were obtained, morphometry analysis of the digestive gland and TUNEL test for apoptosis were also performed. Results revealed that the presence of shallow water hydrothermal vents is a source of chronic metal stress to limpets, imposing modifications in the morphometry and cell composition of the digestive gland of those limpets that may constitute cell and tissue adaptations to the environment they live in. This study sets up new baseline data for further research on the influence of shallow water hydrothermal vents over communities living in these habitats. PMID:18166212

Cunha, Luís; Amaral, André; Medeiros, Vera; Martins, Gustavo M; Wallenstein, Francisco F M M; Couto, Ruben P; Neto, Ana I; Rodrigues, Armindo



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

NASA Astrophysics Data System (ADS)

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

Acharya, Raj S.; Leblanc, Adrian; Shackelford, Linda; Swarnakar, Vivek; Krishnamurthy, Ram; Hausman, E.; Lin, C.



Giant cell tumor of the tendon sheath: A rare case in the left knee of a 15-year-old boy  

PubMed Central

Localized forms of giant cell tumors are defined as giant cell tumors of the tendon sheath (GCTTS). GCTTS arises from the synovium of a joint, bursa or tendon sheath, and 85% of the tumors occur in the fingers. GCTTS in the knee is extremely rare. We report an unusual case of a 15-year-old boy who presented with an occult growing swelling and a 2-month history of infra-patellar pain in the left knee. Magnetic resonance imaging (MRI) demonstrated a well-circumscribed soft tissue mass in the infra-patellar fat pad posterior to the patella tendon. Excision biopsy was performed by surgical removal. Histopathological examination revealed that it was GCTTS. During the follow-up period, his recovery was propitious and there was no recurrence. Owing to its few and non-specific symptoms, and local recurrence varying from 9 to 44%, its proper, early diagnosis and appropriate treatment is necessary. The purpose for which we report the case is to emphasize the possibility of GCTTS where there is a mass with non-specific symptoms such as infra-patellar pain of the knee, and to avoid misdiagnosis where possible.




Manual Khalifa Therapy in Patients with Completely Ruptured Anterior Cruciate Ligament in the Knee: First Results from Near-Infrared Spectroscopy  

PubMed Central

Background: Manual Khalifa therapy has been practiced in Hallein, Austria, for more than 30 years; however, there are no scientific results available on the topic. Aims: The goal of the present study was to investigate possible acute effects of Khalifa therapy on regional oxygen saturation of knee tissues in patients with completely ruptured anterior cruciate ligament. Materials and Methods: We investigated 10 male patients (mean age ± standard deviation (SD) 35.9 ± 6.1 year) using a four-channel oximeter. The sensors were applied anterolaterally and anteromedially, beside the patella, on both the injured and the healthy (control) knee. Results: The results of the controlled study showed that values of oxygen saturation on the knee with the ruptured ligament were significantly increased (P < 0.001) immediately after Khalifa therapy, whereas the values on the control knee showed insignificant increases. Baselines values of the anterolateral side of the injured knee were significantly (P < 0.001) different from those of the anterolateral side of the control knee. The same effect was present on the anteromedial side; however, with a lower degree of significance (P < 0.05). Conclusions: Khalifa therapy was clinically successful in all 10 patients. Further, investigations and analyzes are necessary to explain the underlying mechanism.

Litscher, Gerhard; Ofner, Michael; Litscher, Daniela



Osteology and Radiographic Anatomy of the Pelvis and Hind Limb of Healthy Ring-Tailed Lemurs (Lemur catta).  


In family Lemuridae, anatomical variations exist. Considering its conservation status (near threatened) and presence of similarities between strepsirrhines and primitive animals, it was thought to be beneficial to describe the gross osteology and radiographic anatomy of the pelvis and hind limb of ring-tailed lemurs (Lemur catta) as a reference for clinical use and species identification. Radiography was performed in 14 captive adult ring-tailed lemurs. The radiographic findings were correlated with bone specimens from two adult animals. Additionally, computed tomography of the hind limbs was performed in one animal. The pelvic bone has a well-developed caudal ventral iliac spine. The patella has a prominent tuberosity on the cranial surface. The first metatarsal bone and digit 1 are markedly stouter than the other metatarsal bones and digits with medial divergence from the rest of the metatarsal bones and digits. Ossicles were seen in the lateral meniscus, inter-phalangeal joint of digit 1 and in the infrapatellar fat pad. Areas of mineral opacity were seen within the external genitalia, which are believed to be the os penis and os clitoris. Variations exist in the normal osteology and radiographic appearance of the pelvis and hind limb of different animal species. The use of only atlases from domestic cats and dogs for interpretative purposes may be misleading. PMID:23651234

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



Localized accumulation of lead within and among bones from lead-dosed goats  

PubMed Central

The principal aim of this study was to gain a better understanding of where lead (Pb) accumulates and how it is distributed, within the bones of dosed goats. Adult goats were periodically dosed with Pb over a number of years for the primary purpose of producing blood pools containing endogenously bound Pb, for the New York State Blood Lead Proficiency Testing Program. Bone samples (e.g., primarily tibia, femur, humerus, and radius) were collected post-mortem from 11 animals and were analyzed for Pb content by acid digestion and electrothermal atomic absorption spectrometry (ETAAS or GFAAS). Average tibia-Pb levels were found to correlate strongly with the cumulative Pb dose (r2 = 0.81). However, the concentration of Pb in different bones and even within a small area of the same bone varied tremendously. Blood-rich trabecular (spongy) bone, such as the patella and calcaneus, were much more enriched in Pb than was cortical (compact) bone. In some dosed animals, the Pb concentration in the tibia was markedly higher at the proximal and distal ends of the bone compared to the mid-shaft. The implications of these findings with regard to the non-invasive measurement of lead in bone by XRF methods are discussed.

Cretacci, Yan; Parsons, Patrick J.



Anteroposterior positioning of the tibial component and its effect on the mechanics of patellofemoral contact.  


The biomechanics of the patellofemoral joint can become disturbed during total knee replacement by alterations induced by the position and shape of the different prosthetic components. The role of the patella and femoral trochlea has been well studied. We have examined the effect of anterior or posterior positioning of the tibial component on the mechanisms of patellofemoral contact in total knee replacement. The hypothesis was that placing the tibial component more posteriorly would reduce patellofemoral contact stress while providing a more efficient lever arm during extension of the knee. We studied five different positions of the tibial component using a six degrees of freedom dynamic knee simulator system based on the Oxford rig, while simulating an active knee squat under physiological loading conditions. The patellofemoral contact force decreased at a mean of 2.2% for every millimetre of posterior translation of the tibial component. Anterior positions of the tibial component were associated with elevation of the patellofemoral joint pressure, which was particularly marked in flexion > 90°. From our results we believe that more posterior positioning of the tibial component in total knee replacement would be beneficial to the patellofemoral joint. PMID:20884990

Didden, K; Luyckx, T; Bellemans, J; Labey, L; Innocenti, B; Vandenneucker, H



Formation of mononuclear and chloro-bridged binuclear copper(II) complexes of patellamide D, a naturally occurring cyclic peptide: influence of anion and solvent.  


Patellamide D (patH(4)) is a cyclic octapeptide isolated from the ascidian Lissoclinum patella. The peptide possesses a 24-azacrown-8 macrocyclic structure containing two oxazoline and two thiazole rings, each separated by an amino acid. The present spectrophotometric, electron paramagnetic resonance (EPR) and mass spectral studies show that patellamide D reacts with CuCl(2) and triethylamine in acetonitrile to form mononuclear and binuclear copper(II) complexes containing chloride. Molecular modelling and EPR studies suggest that the chloride anion bridges the copper(II) ions in the binuclear complex [Cu(2)(patH(2))(mu-Cl)](+). These results contrast with a previous study employing both base and methanol, the latter substituting for chloride in the copper(II) complexes en route to the stable mu-carbonato binuclear copper(II) complex [Cu(2) (patH(2))(mu-CO(3))]. Solvent clearly plays an important role in both stabilising these metal ion complexes and influencing their chemical reactivities. PMID:15522413

van den Brenk, Anna L; Tyndall, Joel D A; Cusack, Rodney M; Jones, Alun; Fairlie, David P; Gahan, Lawrence R; Hanson, Graeme R



Evaluation of metallic personalized hemiarthroplasty: a canine patellofemoral model.  


The purpose of this study was to characterize the response of articular cartilage to weight bearing against a metallic personalized hemiarthroplasty prosthesis. Ten dogs each underwent surgery in which an elastomeric replica of the left femoral patellar groove was made. Using this replica, a 0.5-mm-thick prosthesis was cast in Co-Cr alloy and subsequently the surface was polished to a mirror finish which had a center line average roughness value in the range of human hemiarthroplasty implants. A second surgery was performed to resurface the left trochlea with this prosthesis. Five animals were sacrificed at 3 months and 5 at 6 months. Cartilage damage occurred primarily in the distal region of the patella, and was especially evident at 6 months. Mechanical indentation tests conducted on patellar cartilage in a saline bath at 37 degrees C indicated both increased deformation and residual deformation in the affected areas, indicative of degenerative change. Areas of fibrillation with a depletion of proteoglycans were identified histologically. These areas were only superficial at 3 months but became more extensive at 6 months. Rheological analysis of the synovial fluid of tests joints indicated that a decrease in viscosity occurred from 3 to 6 months, an additional indicator of progressive degeneration. This novel implant model showed that even if a metallic hemiarthroplasty implant had an identical geometry as the joint surface being replaced and had a reasonably smooth surface, cartilage degeneration inevitably resulted. PMID:1569116

LaBerge, M; Bobyn, J D; Drouin, G; Rivard, C H



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

PubMed Central

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.

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



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

PubMed Central

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.



Automated planning of MRI scans of knee joints  

NASA Astrophysics Data System (ADS)

A novel and robust method for automatic scan planning of MRI examinations of knee joints is presented. Clinical knee examinations require acquisition of a 'scout' image, in which the operator manually specifies the scan volume orientations (off-centres, angulations, field-of-view) for the subsequent diagnostic scans. This planning task is time-consuming and requires skilled operators. The proposed automated planning system determines orientations for the diagnostic scan by using a set of anatomical landmarks derived by adapting active shape models of the femur, patella and tibia to the acquired scout images. The expert knowledge required to position scan geometries is learned from previous manually planned scans, allowing individual preferences to be taken into account. The system is able to automatically discriminate between left and right knees. This allows to use and merge training data from both left and right knees, and to automatically transform all learned scan geometries to the side for which a plan is required, providing a convenient integration of the automated scan planning system in the clinical routine. Assessment of the method on the basis of 88 images from 31 different individuals, exhibiting strong anatomical and positional variability demonstrates success, robustness and efficiency of all parts of the proposed approach, which thus has the potential to significantly improve the clinical workflow.

Bystrov, Daniel; Pekar, Vladimir; Young, Stewart; Dries, Sebastian P. M.; Heese, Harald S.; van Muiswinkel, Arianne M.



Assessment of chemical species of lead accumulated in tidemarks of human articular cartilage by X-ray absorption near-edge structure analysis  

PubMed Central

A highly specific accumulation of the toxic element lead was recently measured in the transition zone between non-calcified and calcified normal human articular cartilage. This transition zone, the so-called ‘tidemark’, is considered to be an active calcification front of great clinical importance. However, little is known about the mechanisms of accumulation and the chemical form of Pb in calcified cartilage and bone. Using spatially resolved X-ray absorption near-edge structure analysis (µ-XANES) at the Pb L 3-edge, the chemical state of Pb in the osteochondral region was investigated. The feasibility of the µ-XANES set-up at the SUL-X beamline (ANKA synchrotron light source) was tested and confirmed by comparing XANES spectra of bulk Pb-reference compounds recorded at both the XAS and the SUL-X beamline at ANKA. The µ-XANES set-up was then used to investigate the tidemark region of human bone (two patella samples and one femoral head sample). The spectra recorded at the tidemark and at the trabecular bone were found to be highly correlated with the spectra of synthetic Pb-doped carbonated hydroxyapatite, suggesting that in both of these very different tissues Pb is incorporated into the hydroxyapatite structure.

Meirer, Florian; Pemmer, Bernhard; Pepponi, Giancarlo; Zoeger, Norbert; Wobrauschek, Peter; Sprio, Simone; Tampieri, Anna; Goettlicher, Joerg; Steininger, Ralph; Mangold, Stefan; Roschger, Paul; Berzlanovich, Andrea; Hofstaetter, Jochen G.; Streli, Christina



The Effect of Patellar Taping on Squat Depth and the Perception of Pain in People with Anterior Knee Pain  

PubMed Central

Patellar taping is a treatment adjunct commonly used in the management of anterior knee pain. The aim of this cross sectional study was to investigate the effects of medial glide patellar taping on sagittal plane lower-limb joint kinematics and knee pain during a unilateral squat in a symptomatic population complaining of anterior knee pain. Ten participants with a history of unilateral or bilateral anterior knee pain were included in the study. Subjects were required to squat on the symptomatic leg under three conditions: placebo tape, patellar tape and no tape. Kinematic data was recorded using the CODA mpx64 motion analysis system and subjects’ pain was assessed using the Numerical Rating Scale. Patellar taping resulted in a significantly greater single-legged squat depth compared to placebo tape (p=0.008) and no tape (p=0.001) and a statistically significant reduction in pain during a squat compared to placebo tape (p=0.001) or no tape (p=0.001). Significant differences were not identified for maximum knee flexion in the patella taping compared to the no tape condition. This study may have significant clinical implications as participants reported less pain and alterations in sagittal plane movement following the application of patellar tape.

Clifford, Amanda M.; Harrington, Elaine



Automatic segmentation of the bone and extraction of the bone-cartilage interface from magnetic resonance images of the knee.  


The accurate segmentation of the articular cartilages from magnetic resonance (MR) images of the knee is important for clinical studies and drug trials into conditions like osteoarthritis. Currently, segmentations are obtained using time-consuming manual or semi-automatic algorithms which have high inter- and intra-observer variabilities. This paper presents an important step towards obtaining automatic and accurate segmentations of the cartilages, namely an approach to automatically segment the bones and extract the bone-cartilage interfaces (BCI) in the knee. The segmentation is performed using three-dimensional active shape models, which are initialized using an affine registration to an atlas. The BCI are then extracted using image information and prior knowledge about the likelihood of each point belonging to the interface. The accuracy and robustness of the approach was experimentally validated using an MR database of fat suppressed spoiled gradient recall images. The (femur, tibia, patella) bone segmentation had a median Dice similarity coefficient of (0.96, 0.96, 0.89) and an average point-to-surface error of 0.16 mm on the BCI. The extracted BCI had a median surface overlap of 0.94 with the real interface, demonstrating its usefulness for subsequent cartilage segmentation or quantitative analysis. PMID:17327652

Fripp, Jurgen; Crozier, Stuart; Warfield, Simon K; Ourselin, Sébastien



Impact induced failure of cartilage-on-bone following creep loading: a microstructural and fracture mechanics study.  


Cartilage-on-bone samples obtained from healthy bovine patellae, with or without prior static compression (i.e. creep) at 2MPa for 3h, were delivered a single impact via an instrumented pendulum indenter at a velocity of 1.13m/s and an energy of 2.2J. Mechanical data was obtained and microstructural assessment of the region of failure was carried out using differential interference contrast (DIC) optical imaging. In addition, a fibrillar-level structural analysis using scanning electron microscopy (SEM) was conducted on a control batch of non-impacted samples that were subjected to either creep or non-creep loading protocols. Arising from the impact event the deepest levels of crack penetration into the articular cartilage occurred in those samples subjected to prior creep loading. Further the crack depth was inversely proportional to the rebound velocity of the indenter. By contrast, those impacted samples not subjected to prior creep loading had only short obliquely patterned microcracks confined to the upper one-third of the full cartilage depth. Ultrastructurally the creep-loaded cartilage matrix exhibited a substantial radial collapse or compaction of the fibrillar network in its primary radial zone. The increase in crack length in the prior creep-loaded cartilage is consistent with a reduction in its dissipative properties as indicated by a reduction in rebound velocity. An interpretation is offered in terms of classical fracture mechanics theory. PMID:22784816

Thambyah, Ashvin; Zhang, Geran; Kim, Woong; Broom, Neil D



High Proportion of Mutant Osteoblasts Is Compatible with Normal Skeletal Function in Mosaic Carriers of Osteogenesis Imperfecta*  

PubMed Central

Individuals with mosaicism for the autosomal dominant bone dysplasia osteogenesis imperfecta (OI) are generally identified by having more than one affected child. The mosaic carriers have both normal and mutant cell populations in somatic and germline tissues but are unaffected or minimally affected by the type I collagen mutation that manifests clinically in their heterozygous offspring. We determined the proportion of mutant osteoblasts in skeletal tissue of two mosaic carriers who each have a COL1A1 mutation in a high proportion of dermal fibroblasts. Both carriers had normal height and bone histology; the first carrier had normal lumbar spine measurements (L1–L4), as determined by dual-energy x-ray absorptiometry (Z = +1.17). In cultured cells from the first carrier, studied by labeled PCR and single-cell PCR over successive passages, the collagen mutation was present in 85% of fibroblasts and 50% and 75% of osteoblasts from her right iliac crest and left patella, respectively, with minimal selection. The second carrier was studied by PCR amplification of DNA from autopsy paraffin blocks. The proportion of heterozygous cells was 40% in calvarium, 65% in tracheal ring, and 70% in aorta. Thus, in OI, substantially normal skeletal growth, density, and histology are compatible with a 40%–75% burden of osteoblasts heterozygous for a COL1A1 mutation. These data are encouraging for mesenchymal stem-cell transplantation, since mosaic carriers are a naturally occurring model for cell therapy.

Cabral, Wayne A.; Marini, Joan C.



Proximal medial tibial biplanar retrotubercle open wedge osteotomy in medial knee arthrosis.  


The patellar tendon length changes and patella infera occurs in medial open wedge osteotomies. We hypothesized that patellar tendon length in the sagittal plane would not change in a proximal medial tibial biplanar retrotubercle open wedge osteotomy. Proximal medial tibial biplanar retrotubercle open wedge osteotomies were conducted on 23 knees of 22 patients; the mean patient age was 59 ± 7 years (range, 53-69 years). The surgical procedure used had some technical distinctions from those used in literature. The mean follow-up was 37 ± 11 months (range, 19-58 months). Preoperative and postoperative Hospital for Special Surgery Scoring System (HSS) scores, radiological tibial slope, Insall-Salvati, Blackburne-Peel, and Caton indices, femoro-tibial anatomical axis angle, the angle between the femoral condyle and tibial plateau, and the angle between the tibial plateau and tibial axis were measured and compared statistically. Postoperative HSS scores were statistically higher than the preoperative HSS scores. The femoro-tibial axis angle, the angle between the femoral condyle and tibial plateau, and the angle between the tibial plateau and tibial axes decreased significantly. No statistical difference was observed between the preoperative and postoperative Insall-Salvati, Blackburne-Peel, or Caton indices. When we performed proximal medial tibial biplanar retrotubercle open wedge osteotomy, clinical and radiological recovery was observed but patellar height did not change. PMID:21561777

Esenkaya, Irfan; Unay, Koray



The effect of neonatal gene therapy on skeletal manifestations in mucopolysaccharidosis VII dogs after a decade.  


Mucopolysaccharidosis (MPS) VII is a lysosomal storage disease due to deficient activity of ?-glucuronidase (GUSB), and results in glycosaminoglycan accumulation. Skeletal manifestations include bone dysplasia, degenerative joint disease, and growth retardation. One gene therapy approach for MPS VII involves neonatal intravenous injection of a gamma retroviral vector expressing GUSB, which results in stable expression in liver and secretion of enzyme into blood at levels predicted to be similar or higher to enzyme replacement therapy. The goal of this study was to evaluate the long-term effect of neonatal gene therapy on skeletal manifestations in MPS VII dogs. Treated MPS VII dogs could walk throughout their lives, while untreated MPS VII dogs could not stand beyond 6 months and were dead by 2 years. Luxation of the coxofemoral joint and the patella, dysplasia of the acetabulum and supracondylar ridge, deep erosions of the distal femur, and synovial hyperplasia were reduced, and the quality of articular bone was improved in treated dogs at 6 to 11 years of age compared with untreated MPS VII dogs at 2 years or less. However, treated dogs continued to have osteophyte formation, cartilage abnormalities, and an abnormal gait. Enzyme activity was found near synovial blood vessels, and there was 2% as much GUSB activity in synovial fluid as in serum. We conclude that neonatal gene therapy reduces skeletal abnormalities in MPS VII dogs, but clinically-relevant abnormalities remain. Enzyme replacement therapy will probably have similar limitations long-term. PMID:23628461

Xing, Elizabeth M; Knox, Van W; O'Donnell, Patricia A; Sikura, Tracey; Liu, Yuli; Wu, Susan; Casal, Margret L; Haskins, Mark E; Ponder, Katherine P



Do patients with chronic patellar tendinopathy have an altered somatosensory profile? A Quantitative Sensory Testing (QST) study.  


The prevalence of tendinopathies in sports is high. The etiology and pain mechanisms of tendinopathies are not completely understood. Currently, little is known whether, or to which degree, somatosensory changes within the nervous system may contribute to the pain in tendinopathies. We conducted a patient controlled study in which we used the standardized QST protocol developed by the German Research Network on Neuropathic Pain. This protocol consists of seven different tests that measures 13 somatosensory parameters and can be seen as the gold standard to measure somatosensory function. Twelve athletes with clinically diagnosed chronic patellar tendinopathy (PT) mean duration 30 months (range 6-120) and 20 controls were included in the study. In two of the 13 QST parameters namely Mechanical Pain Threshold (P < 0.05) and Vibration Disappearance Threshold (P < 0.5) injured athletes were significantly more sensitive for the applied stimuli. None of the athletes had signs of Dynamic Mechanical Allodynia. Reduced mechanical pain thresholds or pinprick allodynia reflects the involvement of central sensitization upon the myelinated (A?-fibre) nociceptive input. From this explorative study, we conclude that sensitization may play a prominent role in the pain during and after sports activity in patella tendinopathy patients. PMID:22092832

van Wilgen, C P; Konopka, K H; Keizer, D; Zwerver, J; Dekker, R



Lower limb joint replacement in rheumatoid arthritis  

PubMed Central

Introduction There is limited literature regarding the peri-operative and surgical management of patients with rheumatoid disease undergoing lower limb arthroplasty. This review article summarises factors involved in the peri-operative management of major lower limb arthroplasty surgery for patients with rheumatoid arthritis. Methods We performed a search of the medical literature, using the PubMed search engine ( We used the following terms: ‘rheumatoid’ ‘replacement’ ‘arthroplasty’ and ‘outcome’. Findings The patient should be optimised pre-operatively using a multidisciplinary approach. The continued use of methotrexate does not increase infection risk, and aids recovery. Biologic agents should be stopped pre-operatively due the increased infection rate. Patients should be made aware of the increased risk of infection and periprosthetic fracture rates associated with their disease. The surgical sequence is commonly hip, knee and then ankle. Cemented total hip replacement (THR) and total knee replacement (TKR) have superior survival rates over uncemented components. The evidence is not clear regarding a cruciate sacrificing versus retaining in TKR, but a cruciate sacrificing component limits the risk early instability and potential revision. Patella resurfacing as part of a TKR is associated with improved outcomes. The results of total ankle replacement remain inferior to THR and TKR. RA patients achieve equivalent pain relief, but their rehabilitation is slower and their functional outcome is not as good. However, the key to managing these complicated patients is to work as part of a multidisciplinary team to optimise their outcome.



Technical refinement in the management of circumferentially avulsed skin of the leg.  


Between 1989 and 1994, 42 patients with circumferential skin avulsion of lower extremities were treated with full-thickness skin graft from defatted avulsed flap. Among them, 39 patients were run over by rubber tires during car accidents; the remaining 3 patients were victims of industrial accidents by roller machines. The full-thickness skin grafts were prepared from the avulsed skin flap in attachment to avoid junctional hypertrophic scarring. They were then secured with multiple skin staples to their anatomical position to improve skin graft take. Initial take of graft averaged 91 percent (ranged from 75 percent to 100 percent). Twelve patients underwent secondary overgrafting after tangential excision of non-viable skin graft. Follow-up averaging 2.6 years revealed stable wounds in most of the patients. Ten patients experienced occasional breakdown of skin graft in the patella and popliteal fossa, which was treated conservatively. Except for five who had deformed contours of the leg due to muscle transfers, the patients were satisfied with the cosmetic appearance of their legs. Compared with conventional methods, this approach provided better appearance and less contracture. PMID:9385954

Jeng, S F; Wei, F C



Reconstruction of patellar articular cartilage with free autologous perichondrial grafts. An experimental study in dogs.  


The cartilaginous potential of the perichondrium has earlier been utilized to reconstruct articular cartilage in unloaded joints in adult rabbits. The present work in adult dogs has been performed to find out if the perichondrium can be used for the same purpose in joints subjected to pressure. In 13 knee joints the articular cartilage of the patella was excised completely and the resected surface was covered with an autologous perichondrial graft taken from the rib cartilage. After 3 weeks of immobilization the dogs were allowed to run freely until sacrifice 2 to 17 months later. In all 13 cases regeneration of cartilage took place. Within 8 months the regenerated cartilage showed no or only very slight degenerative signs but from 12 months and later such changes were common. In control cases where the resected surface was left without any graft no cartilage at all was found. Conclusively cartilage formation from grafted rib perichondrium is achieved in the knee joints of adult dogs, but it does not resist considerable pressure forces. PMID:542808

Engkvist, O



Mobile-bearing, congruent patellofemoral prosthesis: short-term results.  


PURPOSE. To report the short-term outcome of the low contact stress (LCS) patellofemoral prosthesis in 51 knees. METHODS. 12 men and 37 women aged 23 to 79 (mean, 53.4) years underwent 51 consecutive LCS patellofemoral replacements. All patients had symptomatic isolated arthritis in the patellofemoral joint with well-preserved tibiofemoral compartments. All knees were evaluated pre- and post-operatively. The new Oxford scoring system was used. Anteroposterior, lateral, and skyline weight-bearing radiographs were reviewed. RESULTS. The mean follow-up period was 4.2 years; no patient was lost to follow-up. The mean new Oxford Knee score was 13.9 preoperatively and improved by 13.7 at 3 months (p<0.001) and by further 7.1 at 12 months (p<0.001). Any change after 12 months was not significant (p=0.73). 18 of the knees developed patellar maltracking and resulted in subluxation and lateral tilt of the patella with severe polyethylene wear. 10 (20%) of the knees were revised; 8 with patellar maltracking were revised to total knee arthroplasty (n=3) or patellofemoral arthroplasty with a different implant (n=5), whereas 2 with disease progression were revised to total knee arthroplasty. The estimated survival rate of the prosthesis was 73% at 4.5 years and 48% at 5.5 years. CONCLUSION. The revision rate for the LCS patellofemoral prosthesis was high (20%). PMID:23255644

Yadav, B; Shaw, D; Radcliffe, G; Dachepalli, S; Kluge, W



Periosteal and perichondral grafting in reconstructive surgery.  


Periosteum consists of multipotent mesodermal cells, and the influence of the environment on differentiation of cells of free periosteal grafts has been demonstrated in experimental studies. Periosteum has the capacity to form all varieties of connective tissue. The periosteum has osteogenic capacity, but it can also be used to promote cartilage formation in a chondrotrophic environment. Free periosteal grafts transplanted to the completely chondrectomized articular surfaces of patellae in experimental animals differentiated into cartilage. Joint motion appeared to be one of the chondrogenesis-promoting factors. The authors are optimistic about the potential clinical results with these types of grafts. Also, periosteal resurfacing of the metatarsal head was found to be suitable in the treatment of hallux rigidus and Freiberg's disease. Findings in growing rabbits showed that spinal fusion can be achieved with free periosteal grafts. This technique has been used to treat lumbar lytic spondylolisthesis in young patients, and the method produced clinical and radiologic results that were comparable with those obtained using bone transplants. This work indicates that some of the adverse effects of lumbar spinal fusion (e.g., postoperative spinal stenosis) can be avoided by using osteoperiosteal fusion. Also, periosteal grafting has proved useful in the treatment of thoracolumbar scoliosis. Free periosteal grafting has been used to treat congenital clefts of the maxilla and tracheal cartilage defects. PMID:8168311

Ritsilä, V A; Santavirta, S; Alhopuro, S; Poussa, M; Jaroma, H; Rubak, J M; Eskola, A; Hoikka, V; Snellman, O; Osterman, K



COL5A1: Fine genetic mapping, intron/exon organization, and exclusion as candidate gene in families with tuberous sclerosis complex 1, hereditary hemorrhagic telangiectasia, and Ehlers-Danlos syndrome type II  

SciTech Connect

Type V collagen is the only fibrillar collagen which has yet to be implicated in the pathogenesis of genetic diseases in humans or mice. To begin examining the possible role of type V collagen in genetic disease, we have previously mapped COL5A1, the gene for the {alpha}1 chain of type V collagen, to 9q23.2{r_arrow}q34.3 and described two restriction site polymorphisms which allowed us to exclude COL5A1 as candidate gene for nail-patella syndrome. We have now used these polymorphisms to exclude COL5A1 as candidate gene for tuberous sclerosis complex 1 and Ehlers-Danlos syndrome type II. In addition, we describe a CA repeat, with observed heterozygosity of about 0.5, in a COL5A1 intron, which has allowed us to exclude COL5A1 as a candidate gene in hereditary hemorrhagic telangiectasia and to place COL5A1 on the CEPH family genetic map between markers D9S66 and D9S67. We have also determined the entire intron/exon organization of COL5A1, which will facilitate characterization of mutations in genetic diseases with which COL5A1 may be linked in future studies.

Greenspan, D.S. [Univ. of Wisconsin, Madison, WI (United States); Papenberg, K.A.; Marchuk, D.A. [Duke Univ., Durham, NC (United States)] [and others



WNT pathways and upper limb anomalies.  


The various Wnt pathways that are related to upper limb anomalies are reviewed. Abnormalities in the Wnt7a pathway (located in the dorsal ectoderm) produce several clinically relevant conditions such as the palmar duplication syndrome, nail patella syndrome, ulnar ray deficiency, limb hypoplasia, polysyndactyly and the palmar nail syndrome. Abnormalities of the Wnt3/3a pathway (located in the apical ectodermal ridge) include tetra-amelia and loss of the distal phalanges/nails. Abnormalities of the Wnt5/5a pathway (located in the apical ectodermal ridge as well as in the mesoderm) will affect chondrogenesis of the developing limb and experimental Wnt5a(-/-) limbs have terminal adactyly. Chondrogenesis and limb muscle differentiation are both affected by several Wnt pathways and these will be reviewed in details. Abnormalities in LRP 5/6 (a co-receptor for Wnts) lead to congenital bone disease and Wnt4 is specifically involved in joint development. Finally, the relationship between the Wnt pathway and SALL4 (mutations of which cause Okihiro/Duane-radial ray deficiency in humans) are discussed. PMID:20709709

Al-Qattan, M M



In vivo kinematics of the extensor mechanism of the knee during deep flexion.  


While various factors have been assumed to affect knee joint biomechanics, few data have been reported on the function of the extensor mechanism in deep flexion of the knee. This study analyzed the patellofemoral joint contact kinematics and the ratio of the quadriceps and patellar tendon forces in living subjects when they performed a single leg lunge up to 150?deg of flexion. The data revealed that in the proximal-distal direction, the patellofemoral articular contact points were in the central one-third of the patellar cartilage. Beyond 90?deg of flexion, the contact points moved towards the medial-lateral edges of the patellar surface. At low flexion angles, the patellar tendon and quadriceps force ratio was approximately 1.0 but reduced to about 0.7 after 60?deg of knee flexion, implying that the patella tendon carries lower loads than the quadriceps. These data may be valuable for improvement of contemporary surgical treatments of diseased knees that are aimed to achieve deep knee flexion. PMID:23719832

Kobayashi, Koichi; Hosseini, Ali; Sakamoto, Makoto; Qi, Wei; Rubash, Harry E; Li, Guoan



Patellofemoral arthroplasty.  


Isolated patellofemoral arthritis can occur in as many as 9% of patients older than 40 years and is particularly common in women, who often have subtle patellofemoral maltracking or malalignment. In fact, 24% of women with symptomatic knee arthritis have localized patellofemoral arthritis. Arthroplasty options can provide predictable pain relief, whereas other surgical measures for refractory patellofemoral arthritis--arthroscopic debridement, cartilage grafting, patellectomy, tibial tubercle unloading procedures--often have unsatisfactory results. While total knee arthroplasty (TKA) yields excellent results in >90% of patients with isolated patellofemoral arthritis, it is not desirable in patients who are young and active. Therefore, patellofemoral arthroplasty has a legitimate role in the treatment of isolated anterior compartment arthritis. Early patellofemoral implants were plagued by a high incidence of patellar maltracking, catching and subluxation, due to design features of the trochlear components, inadequate soft tissue balancing, and component malposition. Most importantly, contemporary onlay style trochlear components, implanted perpendicular to the anteroposterior axis of the femur, have substantially reduced the patellar maltracking that was so prevalent with inlay style prostheses for 3 decades. With onlay trochlear designs, early patella instability problems have been reduced, leaving late tibiofemoral degeneration as the primary cause of failure of patellofemoral arthroplasties. Several long-term studies have shown a rate of tibiofemoral degeneration of approximately 20% at 15 years. Finally, the results of TKA do not seem to be compromised by the presence of a prior patellofemoral arthroplasty. PMID:20839682

Lonner, Jess H



Effect of bracing on dynamic patellofemoral contact mechanics.  


Decreases in patellofemoral pain have been demonstrated with bracing; however, the mechanisms of pain reduction remain unclear. Our purpose was to evaluate the hypothesis that patellofemoral bracing decreases peak pressure on the retropatellar surface through an increase in patellofemoral contact area. Nine cadaveric knees were tested during simulated free-speed walking with no brace, a knee sleeve, two different patellar stabilization sleeves, and a wrap-style patellar stabilization brace. Contact area and pressure were measured using a dynamic pressure sensor located in the patellofemoral joint. For the unbraced knee, contact area and peak pressure varied with knee flexion angle, ranging from 0.30 ± 0.3 cm(2) and 1.80 ± 1.7 MPa at full extension to 2.28 ± 0.5 cm(2) and 4.19 ± 1.7 MPa at peak knee flexion. All braces increased contact area, while the wrap-style brace decreased peak pressure (p < 0.001). Sleeve braces compress the quadriceps tendon causing the patella to engage the trochlear groove earlier during knee flexion. The wrap-style brace reduced peak pressure by shifting the location of highest pressure to a region with increased articular cartilage thickness. Sleeve braces may be useful for treatment of patellar subluxation disorders, while wrap-style braces may be effective for treatment of disorders associated with degenerative cartilage changes. PMID:20848366

Wilson, Nicole A; Mazahery, B Tom; Koh, Jason L; Zhang, Li-Qun



Integrated assessment of oil pollution using biological monitoring and chemical fingerprinting.  


A full assessment of the impact of oil and chemical spills at sea requires the identification of both the polluting chemicals and the biological effects they cause. Here, a combination of chemical fingerprinting of surface oils, tissue residue analysis, and biological effects measures was used to explore the relationship between spilled oil and biological impact following the grounding of the MSC Napoli container ship in Lyme Bay, England in January 2007. Initially, oil contamination remained restricted to a surface slick in the vicinity of the wreck, and there was no chemical evidence to link biological impairment of animals (the common limpet, Patella vulgata) on the shore adjacent to the oil spill. Secondary oil contamination associated with salvage activities in July 2007 was also assessed. Chemical analyses of aliphatic hydrocarbons and terpanes in shell swabs taken from limpet shells provided an unequivocal match with the fuel oil carried by the ship. Corresponding chemical analysis of limpet tissues revealed increased concentrations of polycyclic aromatic hydrocarbons (PAHs) dominated by phenanthrene and C1 to C3 phenanthrenes with smaller contributions from heavier molecular weight PAHs. Concurrent ecotoxicological tests indicated impairment of cellular viability (p < 0.001), reduced immune function (p < 0.001), and damage to DNA (Comet assay, p < 0.001) in these animals, whereas antioxidant defenses were elevated relative to un-oiled animals. These results illustrate the value of combining biological monitoring with chemical fingerprinting for the rapid identification of spilled oils and their sublethal impacts on biota in situ. PMID:20821580

Lewis, Ceri; Guitart, Carlos; Pook, Chris; Scarlett, Alan; Readman, James W; Galloway, Tamara S



Subvastus and medial parapatellar approaches in TKA: comparison of functional results.  


The purpose of this study was to compare the clinical results of total knee arthroplasty (TKA) in the early and late postoperative period using subvastus and medial parapatellar approach. A prospective randomized controlled study was conducted in a group of 169 patients (180 TKAs) with 2-year follow-up. Patients were divided into a study group (97 TKAs) with a subvastus approach and a control group (83 TKAs) with a parapatellar approach. Assessment of the results of both operating approaches was based on functional, clinical Knee Society Score, and pain (visual analog scale). Patients in the subvastus group achieved full active extension, better range of motion, and better Knee Society Score results at 12 days, 6 weeks, and 12 weeks earlier than patients in the medial parapatellar group. They also had less pain at 12 days. No statistically significant differences existed between assessed end points in both groups at 24- and 52-weeks, and 24-months postoperatively. The subvastus approach has given patients better early clinical results; however, at longer follow-up, both groups had similar outcomes. The potential benefits of the subvastus approach are: protection of the extensor mechanism from damage, less risk of damaging the blood supply to the patella, earlier clinical recovery, and less pain in the early postoperative period. The subvastus approach is an alternative to the standard medial parapatellar approach in TKA. It can be used with equally good results, especially taking into consideration positive clinical aspects in the early postoperative period. PMID:21667899

Dutka, Julian; Skowronek, Michal; Sosin, Pawel; Skowronek, Pawel



Using an iliotibial tract for patellar dislocation in children  

PubMed Central

Objective To evaluate the clinical and functional results of surgical treatment of patellar dislocation in children. Material and methods A prospective study was undertaken from January 1995 to December 2004. Patients who suffered from patellar dislocation after receiving intramuscular antibiotic injections to quadriceps were recruited. A complete history of each patient was recorded, and both a clinical and a roentgenographic examination were performed preoperatively. Patellar dislocation was classified according to Bensahel’s criteria. The iliotibial tract and lateral retinacula was released to restore the tension of the medial retinaculum. Quadricepsplasty was used in all patients for full flexion of knee. Results There were nine males and 65 females in this study. All 74 patients (76 knees) developed dislocation of the patella after repeated intramuscular injections of antibiotic(s) into the quadriceps muscle. Fifty-six knees (73.7%) were type 1, and 20 knees (26.3%) were type 2 (Bensahel’s classification). In all, we attained excellent results in 56 knees (73.7%), good results in 17 knees (22.4%), and fair results in three knees (3.9%). There have been no poor results or recurrences so far. Conclusion Use of the iliotibial tract, adequate lateral retinacular release, restoration of the tension of the medial retinaculum and associated quadricepsplasty achieved a high success rate. The technique is simple, safe and effective in skeletally immature children.



How reliable is MRI in diagnosing cartilaginous lesions in patients with first and recurrent lateral patellar dislocations?  

PubMed Central

Background Lateral dislocation of the patella (LPD) leads to cartilaginous injuries, which have been reported to be associated with retropatellar complaints and the development of patellofemoral osteoarthritis. Therefore, the purpose of this study was to determine the reliability of MRI for cartilage diagnostics after a first and recurrent LPD. Methods After an average of 4.7 days following an acute LPD, 40 patients (21 with first LPDs and 19 with recurrent LPDs) underwent standardized 1.5 Tesla MRI (sagittal T1-TSE, coronal STIR-TSE, transversal fat-suppressed PD-TSE, sagittal fat-suppressed PD-TSE). MRI grading was compared to arthroscopic assessment of the cartilage. Results Sensitivities and positive predictive values for grade 3 and 4 lesions were markedly higher in the patient group with first LPDs compared to the group with recurrent LPDs. Similarly, intra- and inter-observer agreement yielded higher kappa values in patients with first LPDs compared to those with recurrent LPDs. All grade 4 lesions affecting the subchondral bone (osteochondral defects), such as a fissuring or erosion, were correctly assessed on MRI. Conclusions This study demonstrated a comparatively good diagnostic performance for MRI in the evaluation of first and recurrent LPDs, and we therefore recommend MRI for the cartilage assessment after a LPD.



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

PubMed Central

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.

Aragao, Jose Aderval; Reis, Francisco Prado; de Vasconcelos, Diego Protasio; Feitosa, Vera Lucia Correa; Nunes, Marco Antonio Prado



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


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

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



Lower limb entheseal morphology in the Neandertal Krapina population (Croatia, 130,000 BP).  


Although the Neandertal locomotor system has been shown to differ from Homo sapiens, characteristics of Neandertal entheses, the skeletal attachments for muscles, tendons, ligaments and joint capsules, have never been specifically investigated. Here, we analyse lower limb entheses of the Krapina Neandertal bones (Croatia, 130,000 BP) with the aim of determining how they compare with modern humans, using a standard developed by our research group for describing modern human entheseal variability. The entheses examined are those of the gluteus maximus, iliopsoas and vastus medialis on the femur, the quadriceps tendon on the patella, and soleus on the tibia. For the entheses showing a different morphological pattern from H. sapiens, we discuss the possibility of recognising genetic versus environmental causes. Our results indicate that only the gluteus maximus enthesis (the gluteal tuberosity), falls out of the modern human range of variation. It displays morphological features that could imply histological differences from modern humans, in particular the presence of fibrocartilage. In both H. sapiens and the Krapina Neandertals, the morphological pattern of this enthesis is the same in adult and immature femurs. These results can be interpreted in light of genetic differences between the two hominins. The possibility of functional adaptations to higher levels of mechanical load during life in the Neandertals seems less likely. The particular morphology and large dimensions of the Krapina enthesis, and perhaps its fibrocartilaginous nature, could have been selected for in association with other pelvic and lower limb characteristics, even if genetic drift cannot be ruled out. PMID:21481920

Mariotti, Valentina; Belcastro, Maria Giovanna



Effects of murine recombinant interleukin 1 on synovial joints in mice: measurement of patellar cartilage metabolism and joint inflammation.  

PubMed Central

Murine recombinant interleukin 1 was injected intra-articularly into mice. It induced a clear effect on patellar cartilage within 24 hours. A low dose of interleukin 1 (1 ng) elicited a significant reduction in [35S]sulphate incorporation (50%) into proteoglycans and an accelerated breakdown (twofold) of 35S prelabelled proteoglycan. Proteoglycan breakdown returned to normal rates (approximately 10%/day) 48 hours after a single interleukin 1 injection. Recovery of proteoglycan synthesis was delayed by up to 72 hours, however, which implies that repair of the depleted cartilage matrix is retarded. Interleukin 1 induced only minor joint inflammation, too slight to be held responsible for the strong suppression of proteoglycan synthesis. Vehement joint inflammation was found after repeated interleukin 1 injections. The plasma extravasation and massive infiltration and exudation of leucocytes, predominantly polymorphonuclear leucocytes, were not a mere summation of single interleukin 1 effects, but point to interleukin 1 induced local hypersensitivity. The cartilage matrices of patella and femur were heavily depleted. Measurement of the extent of loss of 35S prelabelled proteoglycan and the prolonged inhibition of [35S]sulphate incorporation indicate that both inhibition of proteoglycan synthesis and enhanced loss of proteoglycan contributed substantially to this depletion. Images

van de Loo, A A; van den Berg, W B



Hip Abduction Can Prevent Posterior Edge Loading of Hip Replacements  

PubMed Central

Edge loading causes clinical problems for hard-on-hard hip replacements, and edge loading wear scars are present on the majority of retrieved components. We asked the question: are the lines of action of hip joint muscles such that edge loading can occur in a well-designed, well-positioned acetabular cup? A musculoskeletal model, based on cadaveric lower limb geometry, was used to calculate for each muscle, in every position within the complete range of motion, whether its contraction would safely pull the femoral head into the cup or contribute to edge loading. The results show that all the muscles that insert into the distal femur, patella, or tibia could cause edge loading of a well-positioned cup when the hip is in deep flexion. Patients frequently use distally inserting muscles for movements requiring deep hip flexion, such as sit-to-stand. Importantly, the results, which are supported by in vivo data and clinical findings, also show that risk of edge loading is dramatically reduced by combining deep hip flexion with hip abduction. Patients, including those with sub-optimally positioned cups, may be able to reduce the prevalence of edge loading by rising from chairs or stooping with the hip abducted. © 2013 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 31:1172–1179, 2013.

van Arkel, Richard J; Modenese, Luca; Phillips, Andrew TM; Jeffers, Jonathan RT



Synergetic and Antagonist Muscle Strength and Activity in Women With Knee Osteoarthritis.  


BACKGROUND AND PURPOSE:: People with knee osteoarthritis (OA) display limitations in daily activities and a lower quality of their life. The purpose of this study was to investigate the differences in strength balance and activation during maximum strength efforts between women with knee OA and asymptomatic women. METHODS:: Twelve women with knee OA (age 60.33 ± 6.66 years) and 11 controls (age 56.54 ± 5.46 years) performed maximum isokinetic eccentric and concentric knee extension and flexion tests at 60°/s, 120°/s, and 150°/s. Surface electromyography (EMG) was recorded from the biceps femoris (BF), vastus lateralis (VL), and vastus medialis (VM). Hamstrings-to-quadriceps moment ratios (H/Q), the synergetic (VL/VM), and co-contraction (BF/[VM + VL]) EMG ratios were calculated. RESULTS:: Analysis-of-variance designs showed that women experiencing knee OA had significantly higher H/Q moment ratios and VM/VL EMG ratios than controls (P < 0.05). The co-contraction index was significantly lower in the OA group only during knee flexion (P < 0.05). CONCLUSIONS:: Women with knee OA showed a higher H/Q moment ratios probably because of the need for better joint stability or a lower quadriceps capacity. This deficiency was accompanied by a higher VM activation, which probably serves to stabilize the patella upon maximum contraction as well as a higher activation of antagonist muscles. PMID:23635991

Patsika, Glykeria; Kellis, Eleftherios; Kofotolis, Nikolaos; Salonikidis, Konstantinos; Amiridis, Ioannis G



A biomechanical comparison between the central one-third patellar tendon and the residual tendon.  

PubMed Central

The purpose of this study was to compare the tensile strength of the central one third patellar tendon--as used for reconstruction of the anterior cruciate ligament--to that of the residual patellar tendon. Ten matched pairs of human cadaveric knees were used for this study, each specimen consisting of an intact patella-patellar tendon-proximal tibial unit. One knee from each pair was randomly selected for removal of both the medial and lateral one third of the patellar tendon, leaving the central one third intact. The contralateral knee of each pair underwent removal of the central one third of the patellar tendon, leaving the residual two thirds intact. Each specimen was then mounted in a materials testing machine and tensile tested to failure at a strain rate of 100%.s-1. The most important result to emerge from these experiments was that there was no significant difference in maximum force to failure for the residual patellar tendon compared to the central one third. Thus any thought that removal of the central one third as a graft still leaves a tendon twice as wide and therefore twice as strong as a graft is dispelled by these experiments. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5

Matava, M J; Hutton, W C



Effects of variation on extensor elements and operative procedures in patellofemoral disorders.  


The influence of both insertion and strength/elasticity of each extensor in patellofemoral disorders was fully investigated through a two-dimensional mathematical model analysis in a horizontal plane, in combination with experimental design theory for analyzing mutually correlated influences. In the model, patellofemoral joint profiles projected on a horizontal plane have been expressed as spline functions. Each muscle of the quadriceps has been represented as a string pulled by the respective force; fascias and tendons have been represented by springs. Nonlinear equations have been constructed to represent the forces involved, and then solved by numerical iteration. An analysis of variance was performed on the data derived from a series of simulations, obtaining the following results. The strength of most extensors has been shown to have an influence on the increase in lateral contact force but not patellar translation. The tibial tubercle position has significant influence on both patellar translation and lateral contact force. The quadriceps' insertion on the femur has no influence on patellar translation. The insertion of each extensor on the patella has been shown to have a strong effect on patellar translation but not on contact force. PMID:1491017

Hirokawa, S



Effect of laser acupuncture on disuse osteoarthritis: an ultrasound biomicroscopic study of patellar articular cartilage in rats.  


To investigate the effect of laser acupuncture (LA) on disuse changes in articular cartilage using ultrasound biomicroscopy (UBM), Eighteen rats were randomly divided into the control group (C), the tail-suspended group (T), and the tail-suspended with LA treatment group (L). During 28-day suspension period, group L were treated with LA at acupoints on the left hindlimb while group T had a sham treatment. Ultrasound roughness index (URI), integrated reflection coefficient (IRC), integrated backscatter coefficient (IBC), cartilage thickness, and ultrasonographic score (US) of articular cartilage at patella were measured by using an ultrasound biomicroscopy system (UBS). Compared with the group C, URI significantly (P < 0.01) increased by 60.9% in group T, increased by 38.1% in group L. In addition, unloading induced a significant cartilage thinning (P < 0.05) in group T, whereas cartilage thickness in group L was 140.22 ± 19.61??m reaching the level of the control group (147.00 ± 23.99??m). There was no significant difference in IRC, IBC, and US among the three groups. LA therapy could help to retain the quality of articular cartilage which was subjected to unloading. LA would be a simple and safe nonpharmacological countermeasure for unloading-induced osteoarthritis. The UBM system has potential to be a sensitive, specific tool for quantitative assessment of articular cartilage. PMID:22888368

Wang, Qing; Guo, Xia; Liu, Mu-Qing; Wang, Xiao-Yun; Zheng, Yong-Ping



Protoporphyrin IX distribution after intra-articular and systemic application of 5-aminolevulinic acid in healthy and arthritic joints  

NASA Astrophysics Data System (ADS)

Arthroscopic synovectomy, which is limited today to the large joints, is an important early treatment of rheumatoid arthritis (RA). Photodynamic therapy (PDT) is potentially to be a less invasive method of removing the synovial membrane. Therefore, in a rabbit model of RA, the accumulation of the photosensitizer Protoporphyrin IX (PPIX) after intra-articular and systemic application of ALA into arthritic rabbit knee joints was studied in skin, patella, synovial tissue, and meniscus by fluorescence microscopy. PPIX fluorescence was measured in biopsies taken at different times after application of neutral and acid ALA solutions. Significant PPIX fluorescence was observed in the synovial membrane and skin 2 and 4 hours after application. Using intra-articular application, ALA solutions prepared with pH 5.5 were at least as efficient as neutral solutions in sensitizing the synovial membrane. Skin also showed PPIX within 4 hours after application. After 24 hours, a marginal PPIX fluorescence was detected in these tissues. On the other hand, in cartilage and meniscus significant PPIX accumulation was still observed 24 hours after ALA injection. Systemic application of ALA also showed a good accumulation of PPIX. Further experiments are needed to show whether accumulation of the photosensitizer and tissue selectivity are sufficient for a successful treatment of rheumatoid synovitis.

Huettmann, Gereon; Hendrich, Christian; Birngruber, Reginald; Lehnert, Christiane; Seara, Jose; Siebert, Werner E.; Diddens, Heyke C.



Computational Assessment of the Influence of Vastus Medialis Obliquus Function on Patellofemoral Pressures: Model Evaluation  

PubMed Central

A study was performed to evaluate a computational model used to characterize the influence of vastus medialis obliquus (VMO) function on the patellofemoral pressure distribution. Ten knees were tested in vitro at 40°, 60° and 80° of knee flexion with quadriceps loads applied to represent a normal VMO, and with the VMO force decreased by approximately 50% to represent a weak VMO. The tests were performed with the cartilage intact and with a full thickness cartilage lesion centered on the lateral facet of the patella. The experimental tests were replicated computationally by applying discrete element analysis to a model of each knee constructed from MRI images. Repeated measures statistical comparisons were used to compare computational to experimental data and identify significant (p < 0.05) differences due to the lesion and the applied VMO force. Neither the lateral force percentage nor the maximum lateral pressure varied significantly between the computational and experimental data. Creating a lesion significantly increased the maximum lateral pressure for all comparisons, except for the experimental data at 40°. Both computationally and experimentally, decreasing the VMO force increased the lateral force percentage by approximately 10% for all cases, and each increase was statistically significant. The maximum lateral pressure increase was typically less than 10% but was still significant for the majority of the comparisons focused on VMO strength. The results indicate that computational modeling can be used to characterize how varying quadriceps loading influences the patellofemoral force and pressure distributions while varying the condition of cartilage.

Elias, John J.; Kilambi, Srianjana; Cosgarea, Andrew J.



Biomechanical Evaluation of Medial Patellofemoral Ligament Reconstruction  

PubMed Central

Background The medial patellofemoral ligament (MPFL) is the most frequently injured soft tissue structure following acute lateral patellar dislocation. MPFL reconstruction has become a popular option to restore patellar stability following lateral patellar dislocation due to the high incidence of recurrent instability following conservative management. Anatomic reconstruction of the MPFL minimizes graft length changes during full knee range of motion and restores patellar stability. Materials & Methods Four fresh frozen cadaver specimens underwent biomechanical testing in a materials testing machine. With the knee fixed in 30° of flexion, the patella was translated laterally a distance of 10 mm and continuous force-displace- ment data was collected with the intact MPFL and again following a newly described MPFL reconstruction technique. Lateral force-displacement and stiffness data were calculated, allowing comparison between the intact and reconstructed MPFL. Results The average lateral restraining force provided by the intact MPFL was 10.6 ± 5.7, 36.6 ± 2.7, and 69.0 ± 5.9 N while the lateral restraining force following MPFL reconstruction was 0.4 ± 4.3, 50.3 ± 16.3, and 110.2 ± 17.5 N at 1, 5, and 10 mm of lateral displacement, respectively. Conclusion Anatomic MPFL reconstruction displays similar lateral restraining force compared to the intact MPFL at low levels of lateral displacement. At higher levels of displacement, the reconstructed MPFL provides increased lateral restraining force compared to the intact MPFL, improving patellar stability in pathologic knees.

Duchman, Kyle R; DeVries, Nicole A; McCarthy, Mark A; Kuiper, Justin J; Grosland, Nicole M; Bollier, Matthew J



Painful knee arthroplasty: definition and overview  

PubMed Central

Summary Total Knee Arthroplasty (TKA) is one of the most successful procedures in Orthopaedic Surgery, with good clinical results and high survival rate in more than 90% of the cases at long-term follow-up. Since the increase of population’s mean age, worsening of articular degenerative alterations, and articular sequelae related to previous fractures, there is a persistent growing of the number of knee arthroplasties in every country each year, with expected increase of complications rates. Painful TKA is considered an unusual complication, but several reports focus on this challenging clinical issue. Common causes of painful TKA may be divided as early or late, and in referred, periarticular or intra-articular. Among the early, we recall implant instability (related to surgical and technical mistakes) and problems of extensor mechanism (patella not resurfaced, malalignment of femoral, tibial, or patellar component, tendons failure or degeneration). Late causes of painful TKA are almost related to aseptic loosening and infection, but also, even if unusual, reflex sympathetic dystrophy, synovitis, and hypersensitivity to metal implants are represented. Hypersensitivity to metal is a clinical issue with significative increase, but to date without a specific characterization. The Authors report about incidence, clinical features, and diagnostic pathways of hypersensitivity to metal implants, focusing on the prevention of this challenging problem.

Carulli, Christian; Villano, Marco; Bucciarelli, Giovanni; Martini, Caterina; Innocenti, Massimo



Infective endocarditis complicated by aortic graft infection and osteomyelitis: case report and review of literature  

PubMed Central

Primary aortic graft infection early after aortic graft insertion is well described in the literature. Here, we present a unique case of late aortic graft infection 5 years after insertion secondary to mitral valve endocarditis, resulting from cellulitis in a patient with severe venous varicosities. A 63-year-old male presented for severe low back pain, constipation, and low-grade fever. An abdominal computed tomography scan with oral and intravenous contrast showed a normal spine and urinary tract. Blood and urine cultures, done at the same time, grew Staphylococcus aureus. A transesophageal echocardiogram confirmed the diagnosis of endocarditis. Subsequently, a gallium scan showed increased uptake in the vertebral bodies, aortic graft, left patella, and left ankle. After 3 months of antibiotic therapy, the patient’s low back pain resolved with normalization of his laboratory values. He remained free of infection at a 2-year follow-up. We reviewed the literature concerning the atypical presentation of infective endocarditis, with a focus on distant metastases at initial presentation, such as osteomyelitis and aortic graft infection, as well as the different treatment modalities. This report describes successful medical treatment with intravenous followed by oral antibiotics for an infected endovascular graft without any surgical intervention.

Zouein, Elie; Wetz, Robert; Mobarakai, Neville; Hassan, Samer; Tong, Iris



Windows of lead exposure sensitivity, attained height, and BMI at 48 months  

PubMed Central

Objectives To examine longitudinal association of prenatal, infancy, and early childhood lead exposure during sensitive periods with height and BMI. Study design The 773 participants were recruited between 1994 and 2005 in Mexico City. We constructed lead exposure history categories for prenatal (maternal patella lead), infancy and childhood periods (mean child blood lead between birth to 24 months and 30 to 48 months, respectively). Linear regression models were used to study lead exposure history with height and BMI at 48 months. Results Children with blood lead levels higher than the median during infancy attained a mean height at 48 months that was significantly shorter (?0.84 cm, 95% CI= ?1.42 to ?0.25) than children with levels lower than the median. Prenatal lead exposure was not associated with height at 48 months. Results for attained BMI were in general in the same direction as for height. Conclusion Our study suggests an effect of early life lead exposure on height attainment at 48 months with an exposure window of greatest sensitivity occurring in infancy.

Afeiche, Myriam; Peterson, Karen E; Sanchez, Brisa N; Schnaas, Lourdes; Cantonwine, David; Ettinger, Adrienne S; Solano-Gonzalez, Maritsa; Hernandez-Avila, Mauricio; Hu, Howard; Tellez-Rojo, Martha M



Seasonal variations in zooplankton abundances in the Iturbide reservoir (Isidro Fabela, State of Mexico, Mexico).  


This studywas undertaken to quantify the seasonal variations of zooplankton (rotifers, cladocerans and copepods) and selected physico-chemical variables (temperature, pH, conductivity, Secchi disc transparency, dissolved oxygen, ammonia, nitrate and phosphate concentrations) in the Iturbide dam. Monthly zooplankton samples (50 l filtered through 50 microm mesh, in duplicates from each of the 4 stations) were collected from February 2008 to January 2009. Simultaneously physico-chemical variables were measured. The zooplankton samples were fixed in 4% formalin in the field. In general, the temperature ranged from 9 to 16 degrees C, rarely exceeding 20 degrees C. Secchi transparency was nearly 100% since the reservoir was shallow (< 2 m) even during the rainy seasons. Dissolved oxygen was generally high, 13-18 mg l(-1). Nitrate levels (10 to 170 microg l(-1)) were low while phosphates were relatively high (9 to 35 microg l(-1)). The Iturbide reservoir was dominated by rotifer species. We encountered in all, 55 taxa of rotifers, 9 cladocerans and 2 copepods. The rotifer families Trichocercidae and Notommatidae had the highest number of species (7 each) followed by Colurellidae and Lecanidae (6 and 5 species, respectively). Trichocerca elongata, Ascomorpha ovalis, K. americana, K. cochlearis, Lepadella patella and Pompholyx sulcata were the dominant rotifers during the study period. On an annual average, rotifer density ranged between 50-200 ind.(-1). Among crustaceans Chydorus brevilabris and Macrothrix triserialis were most abundant. The maximal density of these cladocerans was about 50 ind. l(-1). Copepods were much lower in numbers (< 20 ind. l(-1)). In general the density of zooplankton was higher during summer months (April to July) than during winter. Shannon-Wiener diversity index varied from 1.0 to 4.3 depending on the site and the sampling period. Based on the data of Secchi transparency and nutrient concentrations, the Iturbide reservoir appeared to be mesotrophic. PMID:22315826

Sarma, S S S; Osnaya-Espinosa, Lidia Rosario; Aguilar-Acosta, Claudia Romina; Nandini, S



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


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

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



Profile and multidrug resistance determinants of Chryseobacterium indologenes from seawater and marine fauna.  


The aim of this study was to investigate the prevalence and genetic basis of multidrug resistance in Chryseobacterium indologenes from seawater and marine invertebrates used for human consumption, in Kaštela Bay, Adriatic Sea, Croatia. Out of 16 samples of seawater, Mediterranean mussel (Mytilus galloprovincialis Lam.), Rayed Mediterranean limpets (Patella caerulea L.) and Purple sea urchins (Paracentrotus lividus Lam.) collected, 15 were positive for C. indologenes. In total, 41 isolates were randomly selected and tested for antibiotic susceptibility by disc-diffusion and broth microdilution methods. PCR was used to detect alleles encoding extended-spectrum (ESBLs) and metallo-?-lactamases (MBLs). The clonality of ?-lactamase-producing strains was evaluated by random amplified polymorphic DNA (RAPD) analysis. All C. indologenes isolates showed multiple resistance to at least 9 out of 16 antibiotics tested. Lowest resistance rates were found for piperacillin (9.7 %) and ciprofloxacin (24.4 %), whereas only piperacillin/tazobactam and trimethoprim/sulfamethoxazole showed 100 % activity. More than half of isolates carried bla (IND)-type gene, including 2 isolates carrying bla (IND-2) and 21 carrying bla (IND-7), that was identified as a major MBL genotype in isolates from Adriatic Sea. RAPD typing of IND-producing isolates revealed 6 major groups with no predominant clone in population. The presence of multidrug resistant and IND-producing C. indologenes in marine environment, including marine fauna, pose a risk for transmitting this opportunistic pathogen to humans through recreation or consummation of seafood. In addition, the antibiotic susceptibility test results have practical relevance for empirical treatment of C. indologenes infections. PMID:23132253

Maravi?, Ana; Sko?ibuši?, Mirjana; Samani?, Ivica; Puizina, Jasna



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

PubMed Central

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.

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



Anatomical variability of the anterolateral thigh flap perforators between sexes: a cadaveric study.  


BACKGROUND: Anterolateral thigh flap (ALTF) has gain popularity as a workhorse flap in the management of simple as well as complex tissue defects. The purpose of this study was to investigate the differences in ALTF's perforators' location in male and female human cadavers. METHODS: The study involved 30 fresh human cadavers of both sexes. A total of 60 flaps were examined. The flaps were raised as originally designed. After location of vessels, the distance from the anterior superior iliac spine (ASIS) to subsequent perforators was measured. Also, the kind of the perforator, its diameter and origin were marked. Perforators were designated according to Yu's classification (A, B, and C). The perforators were divided into thin (<0.5 mm), medium (0.5-1 mm), and thick (>1 mm). Ratio of the ASIS-patella distance to the distance of a given perforator from the ASIS (AP rate) was calculated. RESULTS: The mean AP rate (perforator location) was different in both sexes. Mean AP rate in men was calculated as 0.498 ± 0.117, and in women, 0.559 ± 0.114. Differences in AP rate between female and male were statistically significant (t = -3.144; p < 0.002). Mean flap thickness was 3.65 cm in women and 1.17 cm in men (t = -14.444; p < 0.00001). In men, 63 perforators originated from descending branch, and seven perforators originated from oblique branch. In women, there were 67 and one, respectively. CONCLUSIONS: In men, perforators are located closer to the ASIS in comparison to women. Clinically significant perforators (? > 0.5 mm), in majority of cases, occur in A and B positions. Thickness of the flap was higher in women. The oblique branch was more common in men. PMID:23439860

Zachara, Mateusz; Drozdowski, Piotr; Wysocki, Mariusz; Siewiera, Ireneusz; Wójcicki, Piotr



Stair climbing results in more challenging patellofemoral contact mechanics and kinematics than walking at early knee flexion under physiological-like quadriceps loading.  


The mechanical environment during stair climbing has been associated with patellofemoral pain, but the contribution of loading to this condition is not clearly understood. It was hypothesized that the loading conditions during stair climbing induce higher patellofemoral pressures, a more lateral force distribution on the trochlea and a more lateral shift and tilt of the patella compared to walking at early knee flexion. Optical markers for kinematic measurements were attached to eight cadaveric knees, which were loaded with muscle forces at instances of walking and stair climbing cycles at 12 degrees and 30 degrees knee flexion. Contact mechanics were determined using a pressure sensitive film. At 12 degrees knee flexion, stair climbing loads resulted in higher peak pressure (p=0.012) than walking, more lateral force distribution (p=0.012) and more lateral tilt (p=0.012), whilst mean pressure (p=0.069) and contact area (p=0.123) were not significantly different. At 30 degrees knee flexion, although stair climbing compared to walking loads resulted in significantly higher patellofemoral mean (p=0.012) and peak pressures (p=0.012), contact area (p=0.025), as well as tilt (p=0.017), the medial-lateral force distribution (p=0.674) was not significantly different. No significant differences were observed in patellar shift between walking and stair climbing at either 12 degrees (p=0.093) or 30 degrees (p=0.575) knee flexion. Stair climbing thus leads to more challenging patellofemoral contact mechanics and kinematics than level walking at early knee flexion. The increase in patellofemoral pressure, lateral force distribution and lateral tilt during stair climbing provides a possible biomechanical explanation for the patellofemoral pain frequently experienced during this activity. PMID:19656517

Goudakos, Ioannis G; König, Christian; Schöttle, Philip B; Taylor, William R; Singh, Navrag B; Roberts, Ian; Streitparth, Florian; Duda, Georg N; Heller, Markus O



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

PubMed Central

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 0.47mm–0.77mm for the patella and femur and 0.68mm–0.86 mm for the patellofemoral joint. For purely quantifying joint kinematics, CPC remains an analytically simpler and more accurate (accuracy < 0.33mm) 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.

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



Successful feed-forward strategies following ACL injury and reconstruction.  


The purpose of this study was to elucidate the most successful feed-forward strategies responsible for enhancing dynamic restraint following anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR). Ten male ACL deficient (ACLD) subjects (18-35 years) together with 27 matched males who had undergone ACLR (14 using a patella tendon graft and 13 using a combined semitendinosus and gracilis graft) and 22 matched-control subjects were recruited. After their knee functionality (0- to 100-point scale) was rated using the Cincinnati Knee Rating System, each subject performed a maximal, countermovement hop for distance on their involved limb while EMG data were collected from the vastus lateralis (VL), vastus medialis (VM), semitendinosus (ST) and biceps femoris (BF) muscles. Acceleration transients at the proximal tibia were recorded using a uniaxial accelerometer mounted at the level of the tibial tuberosity. Whilst pre-programmed muscle activation strategies and tibial acceleration transients when landing from a single-leg long hop for distance were not contingent upon ACL status, a number of significant correlations were identified between neuromuscular variables and knee functionality of ACLD and ACLR subjects. Increased hamstring preparatory activity together with a greater ability to control tibial motion during dynamic deceleration was associated with higher levels of knee functionality in the ACLD subjects. Successful feed-forward strategies following ACLR were related to graft selection; STGT subjects with superior knee function activated their quadriceps earlier and were better able to synchronise peak hamstring muscle activity closer to initial ground contact whilst more functional PT subjects demonstrated enhanced tibial control despite a lack of evidence supporting modified pre-programmed muscular activation patterns. Our conclusion was that more functional individuals used sensory feedback to build treatment-specific, feed-forward strategies to enhance dynamic restraint when performing a task known to stress the ACL. PMID:18656383

Bryant, Adam L; Newton, Robert U; Steele, Julie



Consistency in acceleration patterns of football players with different skill levels.  


The aims of the present study were to compare the consistency in the lower limb acceleration patterns during inside and instep kicks performed by players with different skill levels, and to investigate the correlation between subjective rating scores for skill level relative to their kicking performance and knee acceleration repeatability. Thirteen club-level male soccer players of ages between 15-16 years participated in this study. Skill levels of individual players were quantified previously by evaluating shooting performance as a numerical value ranging from 1 to 10. Further evaluations were held through tri-axial acceleration data recorded at proximal tibial tuberosity beneath each patella on the players' knees, in a procedure in which players were asked to complete four randomly ordered shooting trials of inside and instep kicks with 2-minute resting intervals. Hence, the mainstream data used in consistency calculations are in the form 4 by 1200 matrices (acceleration vs. time) per subject. In order to evaluate the consistency of acceleration data, the mean of the standard deviations (mSD) were calculated, and the associated Pearson-r correlation coefficients were incorporated to obtain mSD vs. skill correlations. As a result, repeatability was found to increase with skill level at z-axis acceleration for instep kicks only. However, it is possible to find the most appropriate orientation (for the two kicks) for meaningful correlations using vector rotations on the 3 orthogonal acceleration data, and this study shows that, after such suitable vector rotations, positive repeatability results could also be acquired for the inside kicks. Key pointsThe repeatability of the acceleration waveforms are well correlated with the skill level of the subjects.Accelerometry might be used as an objective and cost effective assessment that allows interpreting consistency of the action. PMID:24149630

Arpinar-Avsar, Pinar; Soylu, Abdullah Ruhi



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


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

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


Distal-less and dachshund pattern both plesiomorphic and apomorphic structures in chelicerates: RNA interference in the harvestman Phalangium opilio (Opiliones).  


The discovery of genetic mechanisms that can transform a morphological structure from a plesiomorphic (=primitive) state to an apomorphic (=derived) one is a cardinal objective of evolutionary developmental biology. However, this objective is often impeded for many lineages of interest by limitations in taxonomic sampling, genomic resources, or functional genetic methods. In order to investigate the evolution of appendage morphology within Chelicerata, the putative sister group of the remaining arthropods, we developed an RNA interference (RNAi) protocol for the harvestman Phalangium opilio. We silenced the leg gap genes Distal-less (Dll) and dachshund (dac) in the harvestman via zygotic injections of double-stranded RNA (dsRNA), and used in situ hybridization to confirm RNAi efficacy. Consistent with the conserved roles of these genes in patterning the proximo-distal axis of arthropod appendages, we observed that embryos injected with Dll dsRNA lacked distal parts of appendages and appendage-like structures, such as the labrum, the chelicerae, the pedipalps, and the walking legs, whereas embryos injected with dac dsRNA lacked the medial podomeres femur and patella in the pedipalps and walking legs. In addition, we detected a role for these genes in patterning structures that do not occur in well-established chelicerate models (spiders and mites). Dll RNAi additionally results in loss of the preoral chamber, which is formed from pedipalpal and leg coxapophyses, and the ocularium, a dorsal outgrowth bearing the eyes. In one case, we observed that an embryo injected with dac dsRNA lacked the proximal segment of the chelicera, a plesiomorphic podomere that expresses dac in wild-type embryos. This may support the hypothesis that loss of the cheliceral dac domain underlies the transition to the two-segmented chelicera of derived arachnids. PMID:23809698

Sharma, Prashant P; Schwager, Evelyn E; Giribet, Gonzalo; Jockusch, Elizabeth L; Extavour, Cassandra G



Mobile-bearing total knee arthroplasty: a full traumatic rotation of 180°.  


From February 2008 to September 2012 we implanted 204 mobile-bearing knee prostheses in 192 patients. All the prostheses were cemented (both femoral and tibial components), and the patella was not replaced. Only one early complication of the implants (1/204 = 0.004%) occurred after a traumatic event as a full 180° rotation of the mobile-bearing polyethylene insert. A 78-year-old woman presented with swelling and severe pain at her right knee. This traumatic event was the only case among our mobile-bearing insert patients. ?The failed polyethylene inserts were retrieved and studied using a scanning electron microscope (SEM, ZEISS EVO 50 EP, Cambridge, UK) operating at 20 kV. ?Scratching and pitting were found on the UHMWPE insert perpendicular to the machining tracks for the concave surface. SEM micrographs of the insert showed burnishing on the concave surfaces and longitudinal scratches were clearly detectable and well-marked on the analyzed surfaces. ?A traumatic, fully rotating, polyethylene insert is rare and our case is the first report describing a traumatic event with a complete 180 degree rotation mobile-bearing in a total knee prosthesis. ?In the literature few reports discuss clinical outcomes after total knee arthroplasty in patients with Parkinson's disease and they cite mixed results. However, some authors suggest that posterior-stabilized and cruciate-retaining TKA should work well while others prefer cruciate-retaining, condylar constrained kinetics, or hinged devices. Although we did not implant a posterior-stabilized mobile-bearing total knee prosthesis or a constrained prosthesis, we obtained good clinical and radiological results at the 2-year followup. PMID:23653296

Sudanese, Alessandra; Castiello, Emanuela; Affatato, Saverio



Clinical results of Hi-tech Knee II total knee arthroplasty in patients with rheumatoid athritis: 5- to 12-year follow-up  

PubMed Central

Background Total knee arthroplasty (TKA) is a common form of treatment to relieve pain and improve function in cases of rheumatoid arthritis (RA). Good clinical outcomes have been reported with a variety of TKA prostheses. The cementless Hi-Tech Knee II cruciate-retaining (CR)-type prosthesis, which has 6 fins at the anterior of the femoral component, posterior cruciate ligament (PCL) retention, flat-on-flat surface component geometry, all-polyethylene patella, strong initial fixation by the center screw of the tibial base plate, 10 layers of titanium alloy fiber mesh, and direct compression molded ultra high molecular weight polyethylene (UHMWPE), is appropriate for TKA in the Japanese knee. The present study was performed to evaluate the clinical results of primary TKA in RA using the cementless Hi-Tech Knee II CR-type prosthesis. Materials and methods We performed 32 consecutive primary TKAs using cementless Hi-Tech Knee II CR-type prosthesis in 31 RA patients. The average follow-up period was 8 years 3 months. Clinical evaluations were performed according to the American Knee Society (KS) system, knee score, function score, radiographic evaluation, and complications. Results The mean postoperative maximum flexion angle was 115.6°, and the KS knee score and function score improved to 88 and 70 after surgery, respectively. Complications, such as infection, occurred in 1 patient and revision surgery was performed. There were no cases of loosening in this cohort, and prosthesis survival rate was 96.9% at 12 years postoperatively. Conclusion These results suggest that TKA using the cementless Hi-Tech Knee II CR-type prosthesis is a very effective form of treatment in RA patients at 5 to 12 years postoperatively. Further long-term follow-up studies are required to determine the ultimate utility of this type of prosthesis.



Cognitive deficits and magnetic resonance spectroscopy in adult monozygotic twins with lead poisoning.  


Seventy-one-year-old identical twin brothers with chronic lead poisoning were identified from an occupational medicine clinic roster. Both were retired painters, but one brother (J.G.) primarily removed paint and had a history of higher chronic lead exposure. Patella and tibia bone lead concentrations measured by K-X-ray fluorescence in each brother were 5-10 times those of the general population and about 2.5 times higher in J.G. than in his brother (E.G.). Magnetic resonance spectroscopy (MRS) studies examined N-acetylaspartate:creatine ratios, a marker of neuronal density. Ratios were lower in J.G. than in his brother. Scores on neurocognitive tests that assess working memory/executive function were below expectation in both twins. Short-term memory function was dramatically worse in J.G. than in his brother. These results demonstrate some of the more subtle long-term neurologic effects of chronic lead poisoning in adults. In particular, they suggest the presence of frontal lobe dysfunction in both twins, but more dramatic hippocampal dysfunction in the brother with higher lead exposure. The MRS findings are consistent with the hypothesis that chronic lead exposure caused neuronal loss, which may contribute to the impairment in cognitive function. Although a causal relation cannot be inferred, the brothers were genetically identical, with similar life experiences. Although these results are promising, further study is necessary to determine whether MRS findings correlate both with markers of lead exposure and tests of cognitive function. Nevertheless, the results point to the potential utility of MRS in determining mechanisms of neurotoxicity not only for lead but also for other neurotoxicants as well. PMID:15064171

Weisskopf, Marc G; Hu, Howard; Mulkern, Robert V; White, Roberta; Aro, Antonio; Oliveira, Steve; Wright, Robert O



Air Pollution and Heart Rate Variability  

PubMed Central

Background Outdoor air pollution and lead exposure can disturb cardiac autonomic function, but the effects of both these exposures together have not been studied. Methods We examined whether higher cumulative lead exposures, as measured by bone lead, modified cross-sectional associations between air pollution and heart rate variability among 384 elderly men from the Normative Aging Study. We used linear regression, controlling for clinical, demographic, and environmental covariates. Results We found graded, significant reductions in both high-frequency and low-frequency powers of heart rate variability in relation to ozone and sulfate across the quartiles of tibia lead. Interquartile range increases in ozone and sulfate were associated respectively, with 38% decrease (95% confidence interval = -54.6% to -14.9%) and 22% decrease (-40.4% to 1.6%) in high frequency, and 38% decrease (-51.9% to -20.4%) and 12% decrease (-28.6% to 9.3%) in low frequency, in the highest quartile of tibia lead after controlling for potential confounders. We observed similar but weaker effect modification by tibia lead adjusted for education and cumulative traffic (residuals of the regression of tibia lead on education and cumulative traffic). Patella lead modified only the ozone effect on heart rate variability. Conclusions People with long-term exposure to higher levels of lead may be more sensitive to cardiac autonomic dysfunction on high air pollution days. Efforts to understand how environmental exposures affect the health of an aging population should consider both current levels of pollution and history of lead exposure as susceptibility factors.

Park, Sung Kyun; O'Neill, Marie S.; Vokonas, Pantel S.; Sparrow, David; Wright, Robert O.; Coull, Brent; Nie, Huiling; Hu, Howard; Schwartz, Joel



Reevaluation of (241)Am content in the USTUR case 0102 leg phantom.  


The (241)Am contents in the United States Transuranium and Uranium Registries' (USTUR) case 0102 leg phantom were previously estimated to be 1,243 ± 11 Bq. Recent analysis of the computed tomography images of the phantom revealed multiple bone structures missing from various regions of the phantom skeleton including: posterior ilium, anterior ilium, ischium, femur proximal end, femur middle shaft, femur distal end, patella, tibia distal shaft, fibula distal shaft, and fibula distal end. Additionally, the fifth metatarsal and all of the fifth-digit phalanges were found to be completely missing from the foot. A three-dimensional (3D) model of the leg phantom was created using 3D-Doctor software. Volumes of missing bone structures were outlined separately based on the anatomical assessment of those structures. Weights of the missing bone samples were calculated. Consequently, the value of total( 241)Am activity in the USTUR leg phantom is 1,218 ± 11 Bq. This activity is about 2.0% less than the previously published value of 1,243 ± 11 Bq. External gamma detector response was simulated considering both activity values (1,243 and 1,218 Bq) across the five different locations along the USTUR leg phantom: foot, middle leg, knee, middle thigh, and hip. Each counting position was chosen such that it was above the missing bone structure locations. The highest difference observed between the two counting efficiencies (each corresponding to the two different quantities of estimated activity) was 8.2% and 9.4% for locations above the foot and middle thigh, respectively. Other counting locations (middle leg, knee, and hip) showed efficiency variations of about 1%. PMID:23326860

Tabatadze, George; Brey, Richard R; Kramer, Gary H; Capello, Kevin; Meldrum, D Jeffrey



Descriptions of the lower limb skeleton of Homo floresiensis.  


Bones of the lower extremity have been recovered for up to nine different individuals of Homo floresiensis - LB1, LB4, LB6, LB8, LB9, LB10, LB11, LB13, and LB14. LB1 is represented by a bony pelvis (damaged but now repaired), femora, tibiae, fibulae, patellae, and numerous foot bones. LB4/2 is an immature right tibia lacking epiphyses. LB6 includes a fragmentary metatarsal and two pedal phalanges. LB8 is a nearly complete right tibia (shorter than that of LB1). LB9 is a fragment of a hominin femoral diaphysis. LB10 is a proximal hallucal phalanx. LB11 includes pelvic fragments and a fragmentary metatarsal. LB13 is a patellar fragment, and LB14 is a fragment of an acetabulum. All skeletal remains recovered from Liang Bua were extremely fragile, and some were badly damaged when they were removed temporarily from Jakarta. At present, virtually all fossil materials have been returned, stabilized, and hardened. These skeletal remains are described and illustrated photographically. The lower limb skeleton exhibits a uniquely mosaic pattern, with many primitive-like morphologies; we have been unable to find this combination of ancient and derived (more human-like) features in either healthy or pathological modern humans, regardless of body size. Bilateral asymmetries are slight in the postcranium, and muscle markings are clearly delineated on all bones. The long bones are robust, and the thickness of their cortices is well within the ranges seen in healthy modern humans. LB1 is most probably a female based on the shape of her greater sciatic notch, and the marked degree of lateral iliac flaring recalls that seen in australopithecines such as "Lucy" (AL 288-1). The metatarsus has a human-like robusticity formula, but the proximal pedal phalanges are relatively long and robust (and slightly curved). The hallux is fully adducted, but we suspect that a medial longitudinal arch was absent. PMID:19062072

Jungers, W L; Larson, S G; Harcourt-Smith, W; Morwood, M J; Sutikna, T; Due Awe, Rokhus; Djubiantono, T



An Artificial Tendon to Connect the Quadriceps Muscle to the Tibia  

PubMed Central

No permanent, reliable artificial tendon exists clinically. Our group developed the OrthoCoupler™ device as a versatile connector, fixed at one end to a muscle, and adaptable at the other end to inert implants such as prosthetic bones or to bone anchors. The objective of this study was to evaluate four configurations of the device to replace the extensor mechanism of the knee in goats. Within muscle, the four groups had: (A) needle-drawn uncoated bundles, (B) needle-drawn coated bundles, (C) barbed uncoated bundles, and (D) barbed coated bundles.