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1

Thermography in the detection and follow up of chondromalacia patellae.  

PubMed Central

Although diagnostic criteria for chondromalacia patellae exist, the disease is often accompanied by physical signs which are limited or non-diagnostic. Thermographic examination was performed in 157 patients with clinical diagnosis of chondromalacia patellae in 86 patients after surgical treatment for chondromalacia, and in 308 controls. Thermography can help the clinicians in establishing the diagnosis of chondromalacia patellae, but by itself is not sufficiently specific. The specificity of thermography was dependent on age, ranging from 90% for the 15-24 year age group to 65% for the 45-54 year age group. Sensitivity of the method was 68%. Thermography can disclose other knee disorders which imitate chondromalacia patellae. Images

Vujcic, M; Nedeljkovic, R

1991-01-01

2

Chondromalacia patellae: a system of classification.  

PubMed

Degeneration of the cartilage on the under surface of the patella is shown to be the most frequent cause of "internal derangement of the knee" (63%). The axial view of the patellofemoral joint in 4 angles of flexion constitutes the procedure of choice for diagnostic exploration of patellar cartilage with, perhaps, the restriction for the medial compartment where arthroscopy is probably preferrable. The information obtained from single contrast arthrography of the patellofemoral joint has contributed greatly to the understanding of the sometimes confusing problem of chondromalacia of the patella. It has given an anatomic basis to the patellar syndrome and has served as a basis for a precise typographic system of classification. From this, we have been able to correlate localization and etiology which has then allowed logical solutions to be proposed for each group, based upon biomechanical considerations in both the frontal and saggital planes of the knee. PMID:535251

Ficat, R P; Philippe, J; Hungerford, D S

1979-10-01

3

Current concepts of etiology and treatment of chondromalacia patellae.  

PubMed

Chondromalacia patellae is a distinct clinical entity characterized by retropatellar pain that is associated with recognizable changes in the articular cartilage of the posterior surface of the patella. Several factors may be involved in the etiology, such as severe patella alta, trauma, and, in rare cases, abnormal patellar tracking. Clinical symptoms and signs are reliable in only 50% of cases, but measurable quadriceps wasting, palpable patellofemoral crepitus, and effusion are strongly suggestive. Diagnosis must be confirmed by arthroscopy or direct examination of the posterior surface of the patella. Radiologic measurements of patellofemoral relations are of limited value in diagnosis. The initial pathologic finding is usually surface cartilage breakdown. Radioisotope studies show cartilage cell replication which suggests a healing capacity in early cases following treatment that alters the load through the affected cartilage. There is no evidence of progression to patellofemoral osteoarthritis, which is probably a different entity. The treatment should be conservative where possible with isometric quadriceps exercises and simple anti-inflammatory drugs such as aspirin. Operative treatment is indicated for patients with persistent pain and macroscopic involvement of more than half a centimeter of the articular cartilage surface. The simplest effective procedure that avoids quadriceps dysfunction and fibrosis is a distal patellar tendon medial realignment with lateral release and medial reefing of the quadriceps expansion. Patellectomy is indicated in more extensive involvement of the patella of 2 or more centimeters in diameter, but this must be performed only when the patient has excellent quadriceps function before surgery and is motivated to exercise after surgery. PMID:6383677

Bentley, G; Dowd, G

1984-10-01

4

[Chondromalacia of the patella and intraosseous pressure. A study of 43 patients].  

PubMed

There are some hints concerning a relationship between the intraosseous pressure and degenerative changes in hyaline cartilage. With a specially constructed cannula we evaluated the intraosseous pressure in 43 patients in relation to the joint position (Extension/Flexion). In two groups we compared patients with and without degenerative changes in the hyaline cartilage, diagnosed by arthroscopy. Our results show, that patients with a chondromalacia have an increase of intramedullary pressure. These changes were discussed in the possible role of the pathology of chondromalacia patellae and retropatellar arthrosis. PMID:1492453

Graf, J; Christophers, R; Schneider, U; Niethard, F U

1992-01-01

5

The association of patellofemoral joint morphology with chondromalacia patella: a quantitative MRI analysis.  

PubMed

The relationship of patellofemoral congruency with chondromalacia patellae (CP) was retrospectively evaluated. Lateral patellar tilt angle (LPTA), sulcus angle (SA), trochlear depth (TD), and patella angle (PA) were measured at 301 knee magnetic resonance images and compared between groups with and without CP. In the CP group, LPTA and TD were significantly low (P<.01), SA was high (P<.01), while PA showed no difference (P>.05). The parameters were also compared between groups with mild and severe CP, and no significant difference was found (P>.05). Our results demonstrate that patellar tilt and trochlear dysplasia are related to the presence but not the degree of CP. PMID:24651059

Tuna, Burcu Kaya; Semiz-Oysu, Asl?han; Pekar, Bilhan; Bukte, Yasar; Hayirlioglu, Alper

2014-01-01

6

Chondromalacia of the patella. Physical signs in relation to operative findings.  

PubMed

Cartilaginous changes on the patella are common and were demonstrated in 50 out of 100 patients who underwent operation for intraarticular disease of the knee joint. In order to clarify further the signs of this condition, the physical signs were related to the operative findings. Retropatellar crepitation was present in most cases, but cannot be called pathognomonic. Pain on grating and tenderness on palpation of the patella in fact occurred together only in cases with cartilaginous changes on the patella. On the other hand, cartilaginous changes were found in several cases without such signs, a condition which perhaps should be interpreted as cartilaginous changes only, not as the symptom complex chondromalacia of the patella in which there ought to be a history of symptoms. PMID:1180029

Stougård, J

1975-09-01

7

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

PubMed

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

Hauser, Ross A; Sprague, Ingrid Schaefer

2014-01-01

8

[Modification of sagittal osteotomy of the patella as treatment of excentric chondromalacia or retropatellar arthrosis. Preliminary communication (author's transl)].  

PubMed

The author presents a modification of Morscher's sagittal osteotomy of the patella especially for the treatment of excentric chondromalacia. Congruity of the joint spaces in this modification is achieved through removal of an anteriorly based bone wedge from the patella after sagittal wedge osteotomy allowing the lifting of one or the other patellar facet. This osteotomy is indicated in all cases of unilateral chondromalacia or arthrosis with narrowing of the two joint spaces viewed on tangential patello-femoral X-rays. Following the ideas of Pauwels and Maquet, restoration of a wide joint space and reduction of local excessive stress result in reparative mechanisms of the cartilage involved. The to date preliminary clinical results in 5 cases (1 year max. follow-up) are encouraging. PMID:7467728

Griss, P

1980-10-01

9

The effect of anterior displacement of the tibial tuberosity in idiopathic chondromalacia patellae: a prospective randomized study.  

PubMed

In 42 patients with idiopathic chondromalacia patellae, the effect of anterior displacement of the tibial tuberosity was evaluated in a prospective and randomized study. The operation performed was a modified Bandi procedure, and it resulted in significant relief of the patellofemoral pains, compared with the effect of a standard shaving procedure. Shaving alone was done in 22 patients of whom 6 (27 per cent) were classified as good, a result which may have been due to the placebo effect. In another 20 patients shaving was combined with anterior displacement of the tibial tuberosity resulting in pain relief in 18 (9 degrees per cent). The lack of unambiguously good results may be due to the fact that, although an anterior displacement reduces the retropatellar pressure, it cannot by itself compensate for an abnormal, dynamic tracking pattern of the patella. PMID:7064673

Hejgaard, N; Watt-Boolsen, S

1982-02-01

10

[Diagnosis and operative treatment of chondromalacia patellae by osteotomy and ventral or ventral and medial transposition of the tuberositas tibiae (Maquet/Bandi-procedure) (author's transl)].  

PubMed

The clinical picture of chondromalacia patellae is outlined by the patellar syndrome. The diagnostic value of double contrast arthrography by tangential X-ray (skyline-view)-technique of the femoro-patellar-joint is stressed. If conservative treatment is not satisfactory, osteotomy and ventral transposition of the tuberositas tibiae should be performed. When the patella and the extensor apparatus are dislocated laterally, it is necessary to displace the tuberositas in medial direction. From 1976 to 1980 159 patients have been treated this way. Follow-up study in 86 cases (1 to 5 years after operation) shows excellent and good results in a percentage of 77. PMID:7234197

Zippel, H; Weiss, R

1981-01-01

11

[Retropatellar knee pain and chondropathy patella].  

PubMed

The phenomenon of the painful knee occurring at the patellofemoral joint of the adolescent knee is known as chondromalacia patellae. The constellation of signs and symptoms that fall with in the generally accepted criteria for this diagnosis may well cover more than one pathologic process. Chondromalacia patellae is a term descriptive of changes present on the patellar articular surface and not a single pathologic entity. PMID:7106668

Hohmeister, R

1982-06-10

12

[Traumatic chondropathia patellae, its significance for medical insurance in expert testimony concerning accident sequellae therapy].  

PubMed

The connection between chondropathia patellae and a trauma is discussed. Apart from direct traumas the indirect ones can also cause a chondropathia patellae as a result of the incongruence in the femoropatellar joint. In compiling the case history a preceding trauma of different forms and intensity can be found out in about 17 per cent out of all chondropathia patellae patients. When giving an expert's opinion on a case of chondromalacia sport and occupational lesions must be differentiated from genuine traumatic chondropathy. A chondropathia patellae is characterized by the above-mentioned patellar syndrome. The arthroscopy is considered the most reliable diagnostic method. The indication for operative treatment must take into consideration both the degree of the chondropathia patellae and the cause of the disorder. PMID:7406826

Mbaruk, A

1980-04-01

13

[Chondropathia patellae].  

PubMed

Chondropathia patellae on a constitutional basis, in the narrow sense of the term, is predominantly responsible for producing the painful or irritated knee in juveniles and adolescents, with an incidence peak around the 20th year of life. The traumatic form associated with signs will often produce the same disorders of the patellar gliding path and of the gliding areas, such as the hyperpression and lateralisation syndrome, as well as habitual luxation. Clinically, degenerative articular damage may temporarily exacerbate into a kind of synovitis "chondsrodetritica", especially on overstraining and after microtraumas. On reviewing the case history, the retropatellar pain after prolonged seating and on walking downhill, is particularly characteristic; this pain can also radiate in medial direction. It is also often reported that the knee tends to "give way" suddenly, and to "interlock" or "become entangled". The leading clinical symptom is, besides a feeling of roughness, the "characteristic" pain caused by the gliding pressure of the patella. Conservative treatment, consisting of physiotherapy, isometric exercises of the quadriceps femoris muscle preceded or if permissible followed by heat and massage treatment, and therapy directed at protecting the cartilage - while avoiding cortisone preparations - should be discontinued if the success of treatment does not last significantly longer than the application. Satisfactory results can be obtained with the three basic operations such as proximolateral relief operation (longitudinal splitting of the retinacula), distal relief surgery (lifting of the tuberositas) and smoothening or more vertical excision of the focus of cartilaginification, in conjunction with further surgical interventions. PMID:6999763

Mau, H

1980-04-01

14

Excessive pronation: a major biomechanical determinant in the development of chondromalacia and pelvic lists.  

PubMed

Based on statistical analysis of 97 chronic low back patients, a pelvic list model has been proposed explaining the correlation between leg length discrepancies (LLD) and sciatica. This model suggests that asymmetrical pronation patterns (one pedal arch dropping more than the contralateral pedal arch) initiates a forward downward rotation within the sacroiliac joint. Entrapment of the sciatic nerve between the piriformis muscle and sacrospinous ligament occurs. Clinically, paresis is observed: numbness, weakness and eventually paralysis of the affected limb. Based on this work, the authors have comprised a classification dividing LLD into two main categories: functional and anatomical. Functional LLD have been subdivided into two types of lists: static and dynamic. Treatment based on a combination of chiropractic and podiatric therapy is presented with a 6-month follow-up. Analysis of the success in this tandem approach is very promising. Concurrently, a chondromalacia model is proposed explaining the pathomechanical events associated with oblique tracking patellar syndrome. The authors suggest that excessive pronation is the causative factor directing asynchronous rotation between the shank and femur. This forces the patella out of its normal tracking groove, which, in turn, generates erosion between the inferior margin of the patella and femoral epicondyles. PMID:2976805

Rothbart, B A; Estabrook, L

1988-10-01

15

Malignant lymphoma involving the patella  

Microsoft Academic Search

The majority of skeletal lesions affecting the patella are benign and include entities such as chondroblastoma, giant cell\\u000a tumor, osteomyelitis, and gout. Malignant processes involving the patella are distinctly unusual. Isolated occurrences of\\u000a plasmacytoma, osteosarcoma, hemangiosarcoma, and metastatic disease have been reported. Malignant lymphoma involving the patella\\u000a is extremely uncommon, although lymphomatous infiltration of the skeletal system is not a

S. Cha; Elizabeth Schultz; Barbara McHeffey-Atkinson; David Sherr

1996-01-01

16

[The optimization of chondromalacia patellae diagnosis by NMR tomography. The use of an apparatus for cartilage compression].  

PubMed

The aim of this study was to improve the MRI diagnosis of CMP, with special reference to the early stages and accurate staging. For this purpose, the retropatellar cartilage was examined by MRI while compression was carried out, using 21 patients and five normal controls. The compression was applied by means of a specially constructed device. Changes in cartilage thickness and signal intensity were evaluated quantitatively during FLASH and FISP sequences. In all patients the results of arthroscopies were available and in 12 patients, cartilage biopsies had been obtained. CMP stage I could be distinguished from normal cartilage by reduction in cartilage thickness and signal increase from the oedematous cartilage during compression. In CMP stages II/III, abnormal protein deposition of collagen type I could be demonstrated by its compressibility. In stages III and IV, the method does not add any significant additional information. PMID:1878541

König, H; Dinkelaker, F; Wolf, K J

1991-08-01

17

Femoral Nerve Palsy with Patella Fracture  

PubMed Central

Femoral neuropathy may be associated with various etiologies and can cause severe walking disability. We present the case of a 25-year-old woman who underwent surgical repair for a patella fracture and complained of lower extremity pain, paresthesia, and weakness postoperatively. Electromyography and magnetic resonance imaging (MRI) revealed partial peripheral neuropathy of the left femoral nerve associated with the patella fracture. To our knowledge, this is the first reported case of femoral neuropathy associated with a patella fracture.

Lee, Sang Hyoung; Lee, Tong Joo; Woo, Min Su

2013-01-01

18

Cement penetration after patella venting.  

PubMed

There is a high rate of patellofemoral complications following total knee arthroplasty. Optimization of the cement-bone interface by venting and suction of the tibial plateau has been shown to improve cement penetration. Our study was designed to investigate if venting the patella prior to cementing improved cement penetration. Ten paired cadaver patellae were allocated prior to resurfacing to be vented or non-vented. Bone mineral density (BMD) was measured by DEXA scanning. In vented specimens, a 1.6 mm Kirschner wire was used to breach the anterior cortex at the center. Specimens were resurfaced with standard Profix instrumentation and Versabond bone cement (Smith and Nephew PLC, UK). Cement penetration was assessed from Faxitron and sectioned images by a digital image software package (ImageJ V1.38, NIH, USA). Wilcoxon rank sum test was used to assess the difference in cement penetration between groups. The relationship between BMD and cement penetration was analyzed by Pearson correlation coefficient. There was a strong negative correlation between peak BMD and cement penetration when analyzed independent of experimental grouping (r(2)=-0.812, p=0.004). Wilcoxon rank sum testing demonstrated no significant difference (rank sum statistic W=27, p=0.579) in cement penetration between vented (10.53%+/-4.66; mean+/-std dev) and non-vented patellae (11.51%+/-6.23; mean+/-std dev). Venting the patella using a Kirschner wire does not have a significant effect on the amount of cement penetration achieved in vitro using Profix instrumentation and Versabond cement. PMID:19010682

Jones, Christopher W; Lam, Li-On; Butler, Adam; Wood, David J; Walsh, William R

2009-01-01

19

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

2009-01-01

20

Giant-cell tumors of the patella.  

PubMed

This study describes the clinical, radiographic, and histopathologic features, and discusses the management options of 11 cases of benign giant-cell tumors of the patella seen over 20 years. Fine needle aspiration cytology was a useful preoperative diagnostic tool. Ptellectomy and reconstruction of the extensor apparatus is the favored treatment option with curettage and bone grafting restricted to selected localized lesions. PMID:12138961

Agarwal, Sanjeev; Jain, U K; Chandra, T; Bansal, G Jyoti; Mishra, U S

2002-07-01

21

Arthroscopic management of temporomandibular joint disc perforations and associated advanced chondromalacia by discoplasty and abrasion arthroplasty: preliminary results.  

PubMed

This article describes the arthroscopic surgical treatment of disc perforations by discoplasty to mobilize the disc and reduce joint friction. Grade IV chondromalacia with exposed bone was treated by abrasion arthroplasty with the goal of resurfacing the bone with fibrocartilage. Preliminary data on the results of these procedures are presented. PMID:8040731

Quinn, J H

1994-08-01

22

Tophaceous gout of the patella: a report of two cases.  

PubMed

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

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

2012-01-01

23

Recreational runners with patellofemoral pain exhibit elevated patella water content.  

PubMed

Increased bone water content resulting from repetitive patellofemoral joint overloading has been suggested to be a possible mechanism underlying patellofemoral pain (PFP). To date, it remains unknown whether persons with PFP exhibit elevated bone water content. The purpose of this study was to determine whether recreational runners with PFP exhibit elevated patella water content when compared to pain-free controls. Ten female recreational runners with a diagnosis of PFP (22 to 39years of age) and 10 gender, age, weight, height, and activity matched controls underwent chemical-shift-encoded water-fat magnetic resonance imaging (MRI) to quantify patella water content (i.e., water-signal fraction). Differences in bone water content of the total patella, lateral aspect of the patella, and medial aspect of the patella were compared between groups using independent t tests. Compared with the control group, the PFP group demonstrated significantly greater total patella bone water content (15.4±3.5% vs. 10.3±2.1%; P=0.001), lateral patella water content (17.2±4.2% vs. 11.5±2.5%; P=0.002), and medial patella water content (13.2±2.7% vs. 8.4±2.3%; P<0.001). The higher patella water content observed in female runners with PFP is suggestive of venous engorgement and elevated extracellular fluid. In turn, this may lead to an increase in intraosseous pressure and pain. PMID:24906520

Ho, Kai-Yu; Hu, Houchun H; Colletti, Patrick M; Powers, Christopher M

2014-09-01

24

Periosteal transplantation to the rabbit patella.  

PubMed

Autologous periosteal transplantation (without chondrocyte cell transplantation) for treating traumatic articular cartilage defects of the patella gives pain relief in uncontrolled clinical studies. To study the whole transplanted area macroscopically and microscopically, animal studies are motivated. In this pilot study, we reproduce the surgical technique for periosteum transplantation on human patella to a rabbit model. A full-thickness cartilage defect of the whole patella was created in eight adult female rabbits. The defect was treated with autologous periosteal transplantation. After surgery, the rabbits were allowed free activity. This is the difference compared to the treatment in humans, where our group uses CPM for 5 days and non-weight-bearing for 12 weeks. After 21 weeks, there was a diffuse synovitis in all transplanted knees, and in five of eight knees there were signs of osteoarthritis in the patello-femoral joint. Histologically, in three animals, small islands of hyaline cartilage surrounded by fibrocartilage were seen in the transplanted area. In the other five animals, fibrocartilage was the predominant tissue. In contrast to previous experimental studies using a rabbit model, we did not achieve hyaline cartilage resurfacing. PMID:17072658

Olofsson, Lisbeth Brax; Svensson, Olle; Lorentzon, Ronny; Lindström, Inger; Alfredson, Håkan

2007-05-01

25

Theoretical Analysis: The Mechanical Characteristics of the Patella.  

National Technical Information Service (NTIS)

The authors have performed a theoretical static moment analysis of the knee joint, the quadriceps mechanism, and the patella. They have demonstrated that, theoretically, it should be impossible to extend the knee towards 180 degrees (maximum extension) ag...

D. Miller E. H. Miller R. Kroll

1971-01-01

26

Clinical features and classification of bipartite or tripartite patella.  

PubMed

The purposes of this study were to report clinical features of the developmental anomaly of ossification type bipartite or tripartite patella using a large series and to propose a new classification for the developmental anomaly of ossification type bipartite or tripartite patella. The first author prospectively examined 111 patients with symptomatic or asymptomatic bipartite (131 knees) or tripartite (8 knees) patellae. Eighty-six (77%) were male and 25 (23%) were female. Forty-three patients (39%) showed right knee involvement and 40 (36%) showed left, while 28 (25%) showed involvement in both knees. Forty-six bipartite and 4 tripartite patellae (36%) were symptomatic and 85 bipartite and 4 tripartite patellae (64%) were asymptomatic at initial examination. The median age at onset of pain of symptomatic patients (50 knees) was 15.6 ± 8.1 years (range, 10-51 years). The most common symptom was pain at the separated fragments during or after strenuous activity in all 50 knees. Physical examination revealed localized tenderness over the separated fragments in all 50 knees. Bipartite or tripartite patellae were classified by evaluating location and number of fragments. One hundred fifteen knees (83%) were classified as supero-lateral bipartite type, 16 (12%) were lateral bipartite type, 6 (4%) were supero-lateral and lateral tripartite type, and 2 (1%) were supero-lateral tripartite type. For the developmental anomaly of ossification type bipartite or tripartite patella, a classification based on both location and number of fragments is simple and easy to understand and applicable to all types of bipartite or tripartite patella. PMID:20111951

Oohashi, Yoshikazu; Koshino, Tomihisa; Oohashi, Yoshinori

2010-11-01

27

Pain in the knee associated with osteoporosis of the patella.  

PubMed Central

Four patients, all of whom complained of pain in the knee, were found to have radiological evidence of osteoporosis particularly marked in the patella. In 3 a neurological lesion at the appropriate spinal segment was present, and the fourth patient, who was frankly hysterical, had an autonomic disturbance. If radiological porosis is isolated to the patella a distant cause such as nerve irritation should be sought. Images

Corbett, M; Colston, J R; Tucker, A K

1977-01-01

28

Osteomyelitis of the Patella Caused by Legionella anisa  

PubMed Central

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.

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

2013-01-01

29

Treatment of patella infera by patellar tendon lengthening and augmentation with tibialis anterior tendon allograft.  

PubMed

Management of patella infera remains a difficult therapeutic endeavor. We report a case of a 21-year-old man, who had development of patella infera and knee flexion contracture after a patella fracture. Patella infera was treated by patellar tendon lengthening and augmentation with a tibialis anterior tendon allograft fixed with bioabsorbable cross-pins. The patient regained an anatomic patellar position and full range of motion at two years after surgery. PMID:24231623

Jeong, Ju Seon; Wang, Joon Ho

2014-03-01

30

Tuberculosis of the patella imitating chronic knee synovitis.  

PubMed

Tuberculosis of patella is a rare occurrence with incidence of less than 0.15% in the literature. Owing to its rarity the diagnosis is usually missed. Here we present a case of tuberculosis of the patella, being treated as chronic synovitis elsewhere. An 11-year-old boy presented to us with chronic knee swelling and a draining sinus of 5 months duration. He was being treated with broad spectrum antibiotics and incision and drainage. Standard X-rays revealed a lytic area with surrounding coke such as sequestrum in patella. MRI was suggestive of osteomyelitis of the patella with soft tissue oedema. Diagnosis was confirmed on biopsy. The patient was managed by curettage and excision of the sinus tract along with antitubercular treatment. The patient responded well to antitubercular therapy and gained excellent functional range of movement. In today's era of potent antituberculous drugs and decreasing tuberculosis incidence the rare and unusual locations of tuberculosis such as patella should be borne in mind while dealing with chronic lesions of the knee especially in tubercular endemic areas. A timely diagnosis helps in regaining good range of motion and a satisfactory outcome. PMID:24810456

Prakash, Jatin; Vijay, Vipul

2014-01-01

31

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

2008-01-01

32

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

PubMed Central

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.

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

2012-01-01

33

Lateral release of the patella: Indications and contraindications  

Microsoft Academic Search

Charts were reviewed on patients at the Salt Lake Knee and Sports Medicine Clinic who had had a lateral release of the patella. Patients were divided into two groups. Group I contained patients who were entirely satisfied with the procedure, and Group II included patients who were complete failures (defined as a need for further surgical procedures). In Group I,

Patricia A. Kolowich; Lonnie E. Paulos; Thomas D. Rosenberg; Steve Farnsworth

1990-01-01

34

Skeletal Integrity in Patients with Nail Patella Syndrome  

Microsoft Academic Search

Nail patella syndrome (NPS) is a rare autosomal dominant disorder resulting from a heterogenous loss of function in the LMX1B gene. It is associated with multiple skeletal deformi- ties, yet it is unknown whether this is associated with osteo- porosis. To examine bone mass and the prevalence of fragility fractures, we assessed bone mineral density (BMD) of the spine and

Adele L. Towers; Cheryl A. Clay; Susan M. Sereika; Iain McIntosh; Susan L. Greenspan

35

Tuberculosis of the patella masquerading as prepatellar bursitis.  

PubMed

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

2013-01-01

36

Tuberculosis of the patella masquerading as prepatellar bursitis  

PubMed Central

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.

Kulkarni, S

2013-01-01

37

Sex determination by discriminant analysis of patella measurements  

Microsoft Academic Search

The authors have analyzed 80 skeletons (40 males and 40 females) from the collection at the Institute of Legal Medicine of the University of Bari belonging to a known contemporary Southern Italian population; time of death was around 1970 and ages ranged from 25 to 80 years. Seven measurements taken on 80 intact, undeformed right patellae (max height, max width,

Francesco Introna; Giancarlo Di Vella; Carlo Pietro Campobasso

1998-01-01

38

[Experiences and results of 1300 indentation operations for proximal medialization of the patella].  

PubMed

Of 1039 patients, 1300 knee joints were operated on for chondropathia patellae or patellofemoral osteoarthrosis; the results are arranged in tabular form. The basic operation was proximal medialization of the patella by indent operation. Additional interventions like retropatellar should be indicated by an experienced surgeon. The excellent results found 6, 12, 40, and 60 months after the operation recommmend this procedure for the treatment of chondropathia patellae or osteoarthrosis. PMID:7408582

Villiger, K J

1980-07-01

39

Treatment of the patellar syndrome in non dislocated patellae.  

PubMed

Forty patients who had previously been treated in a conservative way, were operated. The surgery involved the section of the external lateral patella expansion. When reviewing the patients the following criteria were taken into considerations: subjective symptomatology, clinical and radiological examinations as well as the time factor in taking up work again. The results after operation were as follows: 87% good or excellent and 13% mediocre. PMID:7458611

Delgado-Martins, H

1980-01-01

40

Secondary aneurysmal bone cyst following chondroblastoma of the patella.  

PubMed

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. PMID:24179655

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

2013-01-01

41

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

2013-01-01

42

Nail-Patella Syndrome Associated with Respiratory Chain Disorder  

Microsoft Academic Search

Nail-patella syndrome (NPS) has not been described to be associated with a respiratory chain disorder (RCD) before. In a 42-year-old man with the typical phenotype of an NPS, weakness and wasting of the shoulder girdle muscles, muscle cramps, fatigability, hyperhidrosis, chest pain and creatine kinase elevation were observed. Echocardiography revealed left ventricular hypertrabeculation. Needle electromyography was myopathic, lactate stress testing

Josef Finsterer; Claudia Stöllberger; Julia Wanschitz; Michaela Jaksch; Herbert Budka

2001-01-01

43

[Course of recurrent dislocation of the patella, patellar syndrome without dislocation and femoropatellar osteoarthritis].  

PubMed

The frequency of recurrent dislocation of the patella is increased by the young age of onset, the presence of patella alta and permanent subluxation of the patella. The natural history of the patellar syndrome appears to be fairly favourable in everyday activities, but discomfort is often marked in the intermediate term in sports activities. Isolated femoropatellar osteoarthritis rarely causes major functional impairment of gait. Medial or lateral femorotibial osteoarthritis occurs secondarily. Painful cases often present with subchondral anomalies of the lateral patellar facet, lateral tibial osteophytosis and patella alta. PMID:8239455

Glimet, T

1993-01-01

44

The patella in total knee arthroplasty: to resurface or not is the question.  

PubMed

The decision to resurface the patella during total knee arthroplasty remains controversial. Even though some surgeons routinely resurface the patella to avoid the increased rates of postoperative anterior knee pain and reoperation for secondary resurfacing, others selectively resurface based on the presence of anterior knee pain, notably damaged articular cartilage, inflammatory arthritis, isolated patellofemoral arthritis, and patellar subluxation and maltracking. The anatomy and biomechanics of the patellofemoral joint, combined with advances in surgical technique and prostheses must be taken into account when making a decision to resurface the patella. Accurate component implantation is imperative for a successful outcome if the patella is resurfaced. PMID:24706154

Abdel, Matthew P; Parratte, Sébastien; Budhiparama, Nicolaas C

2014-06-01

45

The bovine patella as a model of early osteoarthritis.  

PubMed

The bovine patella model has been used extensively for studying important structure-function aspects of articular cartilage, including its degeneration. However, the degeneration seen in this model has, to our knowledge, never been adequately compared with human osteoarthritis (OA). In this study, bovine patellae displaying normal to severely degenerate states were compared with human tissue displaying intact cartilage to severe OA. Comparisons of normal and OA features were made with histological scoring, morphometric measurements, and qualitative observations. Differential interference contrast microscopy was used to image early OA changes in the articular cartilage matrix and to investigate whether this method provided comparable quality of visualisation of key structural features with standard histology. The intact bovine cartilage was found to be similar to healthy human cartilage and the degenerate bovine cartilage resembled the human OA tissues with regard to structural disruption, cellularity changes, and staining loss. The extent of degeneration in the bovine tissues matched the mild to moderate range of human OA tissues; however, no bovine samples exhibited late-stage OA. Additionally, in both bovine and human tissues, cartilage degeneration was accompanied by calcified cartilage thickening, tidemark duplication, and the advancement of the cement line by protrusions of bony spicules into the calcified cartilage. This comparison of degeneration in the bovine and human tissues suggests a common pathway for the progression of OA and thus the bovine patella is proposed to be an appropriate model for investigating the structural changes associated with early OA. PMID:24111904

Hargrave-Thomas, E J; Thambyah, A; McGlashan, S R; Broom, N D

2013-12-01

46

Magnetic resonance imaging of the patella: a comparison of the morphology of the patella in normal and dysplastic knees.  

PubMed

We retrospectively analysed the MR scans of 25 patients with patellofemoral dysplasia and ten control subjects, to assess whether there was any change in the morphology of the patella along its vertical length. Ratios were calculated comparing the size of the cartilaginous and subchondral osseous surfaces of the lateral and medial facets. We also classified the morphology using the scoring systems of Baumgartl and Wiberg. There were 18 females and seven males with a mean age of 20.2 years (10 to 29) with dysplasia and two females and eight males with a mean age of 20.4 years (10 to 29) in the control group. In the patient group there was a significant difference in morphology from proximal to distal for the cartilaginous (Analysis of variance (ANOVA) p = 0.004) and subchondral osseous surfaces (ANOVA, p = 0.002). In the control group there was no significant difference for either the cartilaginous (ANOVA, p = 0.391) or the subchondral osseous surface (ANOVA, p = 0.526). Our study has shown that in the dysplastic patellofemoral articulation the medial facet of the patella becomes smaller in relation to the lateral facet from proximal to distal. MRI is needed to define clearly the cartilaginous and osseous morphology of the patella before surgery is considered for patients with patellofemoral dysplasia. PMID:17613500

Barnett, A J; Gardner, R O E; Lankester, B J A; Wakeley, C J; Eldridge, J D J

2007-06-01

47

Ipsilateral femoral shaft and vertical patella fracture: a case report  

PubMed Central

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

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

2009-01-01

48

Spontaneous patella fracture presenting as osteomyelitis in focal dermal hypoplasia.  

PubMed

We report the first case of the assessment and treatment of a spontaneous patellar fracture in a patient with Goltz syndrome-a rare dermal hypoplasia. This case illustrates the non-straightforward presentation of a spontaneous patellar fracture in seemingly osteoporotic bone stock further complicated by the inability to rule out osteomyelitis. In this confusing presentation, a high index of suspicion for patella fracture should be maintained for patients with knee pain and osteoporosis on x-ray with a dysplastic syndrome. PMID:22000280

Altschuler, Eric L; Yoon, Richard S; Dentico, Richard; Liporace, Frank A

2012-08-01

49

Linkage analysis of the Nail-patella syndrome  

SciTech Connect

Nail-patella syndrome (NPS) is an autosomal dominant disorder characterized by dysplasia of nails and patella, decreased mobility of the elbow, iliac horns, and, in some cases, nephropathy. The disorder has been mapped to the long arm of chromosome 9, but the precise localization and identity of the NPS gene are unknown. Linkage analysis in three NPS families, using highly informative dinucleotide repeat polymorphisms on 9q33-q34, confirmed linkage of NPS to this chromosome. Recombinations were detected, by two-point linkage analysis, between NPS and the centromeric markers D9S60 and the gelsolin gene and the telomeric markers D9S64 and D9S66, in one of the families. Haplotype analysis suggested an additional recombination between NPS and the argininosuccinate synthetase (ASS) gene. These results localize the NPS gene to an interval on 9q34.1, distal to D9S60 an proximal to ASS, comprising a genetic distance of {approximately}9 cM. This represents a significant refinement in the localization of the NPS gene. 25 refs., 2 figs., 1 tab.

Campeau, E.; Watkins, D.; Rouleau, G.A. [Montreal General Hospital, Quebec (Canada); Babul, R.; Der Kaloustian, V.M. [McGill Univ., Montreal (Canada); Buchanan, J.A.; Meschino, W. [North York General Hospital (Canada)

1995-01-01

50

Radiologically hyperdense zones of the patella seem to be partial osteonecroses subsequent to fracture treatment.  

PubMed

The blood supply to the proximal patella is provided primarily via intraosseous vessels from the inferior patella. Two vascular systems within the patella are distinguished: Tiny arteries penetrate the middle third of the anterior patellar surface via vascular foramina and continue in a proximal direction. Additional vessels enter the patella at its distal pole, between the patellar ligament and the articular surface, and also run proximally. As a result of the double vascular supply to the distal portion and the vulnerable blood supply to the proximal part, localized osteonecroses subsequent to fracture may occur within the patella and nearly exclusively affect the upper portion of the patella. Such focal regions of osteonecrosis may appear radiographically as localized regions of hyperdensity within the patella. The aim of this study was to investigate the extent to which radiologically hyperdense areas, possibly representing localized osteonecrosis, may occur subsequent to surgical treatment of a patella fracture and the influence that they have on the outcome of the fracture. Retrospective analysis of 100 patients who had been treated operatively for a patella fracture from January 1998 to December 2008 was conducted. The subjective pain rating, clinical scores, and patient satisfaction scores were recorded. Existing X-rays were assessed with regard to possible increased radiological dense areas. After an average of 60.61 ( ± 33.88) months, it was possible to perform a clinical follow-up on 60 patients aged 45.48 ( ± 18.51) years. Radiographic follow-up of all patients revealed that nine patients (9%) exhibited a hyperdense area in the proximal patella portion. X-rays showed radiopaque areas between 1 and 2 months after surgery. In seven cases, the radiological finding disappeared after six months. In two patients with persisting radiologically dense areas, bone necrosis was verified by means of magnetic resonance imaging (MRI) examination and a histological assessment, respectively. The clinical outcome of these patients with a hyperdense area on the patella, in this small series, was not shown to be worse than those who demonstrated normal healing. Radiologically hyperdense areas subsequent to patella fracture may represent partial osteonecrosis caused by localized vascular compromise. This was confirmed by MRI and histological examinations in two patients with persistent hyperdense lesions. The clinical outcome of patients with hyperdense zones seems to be poorer than that of patients without such findings, but no statistical difference was shown in this small series. It is possible that earlier surgical treatment and thus a shorter ischemic period as well as tissue-conserving operative techniques could prevent the occurrence of partial necroses. This hypothesis would require further study. PMID:23288779

Schüttrumpf, Jan Philipp; Behzadi, Cyrus; Balcarek, Peter; Walde, Tim Alexander; Frosch, Stephan; Wachowski, Martin Michael; Stürmer, Klaus Michael; Frosch, Karl-Heinz

2013-10-01

51

Human identification through the patella-Report of two cases.  

PubMed

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

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

2014-05-01

52

[The patella and the femoro-patellar joint during rheumatoid polyarthritis].  

PubMed

The authors report 2 series of cases of rheumatoid arthritis, one prospective of 115 cases, the other retrospective of 72 cases, and note the frequency of clinical and radiological patellar and femoro-patellar involvement during this disease. Signs of active rheumatoid disease in the patella were present in 31 cases. The most common lesions of the femoro-patellar joint space are narrowing and lateral dislocation of the patella. The femoro-patellar lesions evolve in parallel to the femoro-tibial lesions, but dissociation is possible. The early detection of a femoro-patellar syndrome permits effective treatment by isometric rehabilitation of the quadriceps. On the most advanced lesions, and when pain is limited to the femur and patella, an operation of reaxation of the patella may provide remarkable functional improvement. PMID:504947

Amor, B; Heuleu, J N; Pariente, J; Ghozlan, R

1979-01-01

53

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

2011-01-01

54

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

1971-01-01

55

Structure and Function of the Human Patella: The Role of Cancellous Bone.  

National Technical Information Service (NTIS)

The structure and properties of the cancellous bone of the human patella are reviewed. Contact areas for various angles of flexion are presented and are correlated with the primary structural features. The spatial variation of stiffnesses of the cancellou...

P. R. Townsend R. E. Miegel R. M. Rose E. L. Radin

1975-01-01

56

Excision of Painful Bipartite Patella: Good Long-term Outcome in Young Adults  

PubMed Central

Excision of the accessory bipartite fragment is widely used, but its long-term outcome is not known. We evaluated the outcome after surgical excision of a symptomatic accessory bipartite or multipartite patella fragment in young adult men performing their compulsory military service and determined the incidence of painful bipartite patellae in this group of skeletally mature adults. We followed 25 of 32 patients for a minimum of 10 years (mean, 15 years; range, 10–22 years). The incidence of painful, surgically treated bipartite patella was 9.2 per 100,000 recruits. Patients’ median age at surgery was 20 years. There were 19 superolateral and six lateral bipartite fragments. Other radiographic findings were rare. At followup, the Kujala score mean was 95 points (range, 75–100 points), and osteoarthrotic changes (Kellgren-Lawrence Grade 1) were seen in two knees. No reoperations related to bipartite patella occurred during the followup. Symptomatic bipartite patella is rare and does not seem primarily associated with anatomic deviations, but when incapacitating pain persists despite nonoperative treatment, surgical excision seems to yield reasonable functional outcome and quick recovery with no apparent adverse sequelae. Our data suggest there is no reason to avoid this technically undemanding procedure for treating persistent symptoms of bipartite patella in young adults. Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Parviainen, Mickael; Pihlajamaki, Harri K.

2008-01-01

57

Early revisions of the Femoro-Patella Vialla joint replacement.  

PubMed

The aim of this study was to review the early outcome of the Femoro-Patella Vialla (FPV) joint replacement. A total of 48 consecutive FPVs were implanted between December 2007 and June 2011. Case-note analysis was performed to evaluate the indications, operative histology, operative findings, post-operative complications and reasons for revision. The mean age of the patients was 63.3 years (48.2 to 81.0) and the mean follow-up was 25.0 months (6.1 to 48.9). Revision was performed in seven (14.6%) at a mean of 21.7 months, and there was one re-revision. Persistent pain was observed in three further patients who remain unrevised. The reasons for revision were pain due to progressive tibiofemoral disease in five, inflammatory arthritis in one, and patellar fracture following trauma in one. No failures were related to the implant or the technique. Trochlear dysplasia was associated with a significantly lower rate of revision (5.9% vs 35.7%, p = 0.017) and a lower incidence of revision or persistent pain (11.8% vs 42.9%, p = 0.045). Focal patellofemoral osteoarthritis secondary to trochlear dysplasia should be considered the best indication for patellofemoral replacement. Standardised radiological imaging, with MRI to exclude overt tibiofemoral disease should be part of the pre-operative assessment, especially for the non-dysplastic knee. PMID:23723274

Williams, D P; Pandit, H G; Athanasou, N A; Murray, D W; Gibbons, C L M H

2013-06-01

58

Sex determination by discriminant analysis of patella measurements.  

PubMed

The authors have analyzed 80 skeletons (40 males and 40 females) from the collection at the Institute of Legal Medicine of the University of Bari belonging to a known contemporary Southern Italian population; time of death was around 1970 and ages ranged from 25 to 80 years. Seven measurements taken on 80 intact, undeformed right patellae (max height, max width, thickness, height and width of the external facies articularis, height and width of the internal facies articularis) were used to determine sex by multivariate discriminant analysis. One function associating two parameters (max width and thickness) obtained the highest value of correct sex determination with a rate of 83.3%; other functions showed a higher percentage of misclassification (up to 17.5%). This study tests the success rate of correct sex prediction based exclusively on patellar dimensions. The discriminant factors carried out by statistical analysis may aid the forensic anthropologist when no other human skeletal remains suitable for sex determination are available. PMID:9718670

Introna, F; Di Vella, G; Campobasso, C P

1998-07-01

59

Structure and function of the human patella: the role of cancellous bone.  

PubMed

Total joint and other prosthesis often require the removal and replacement of considerable quantities of cancellous bone, and often are anchored in place by grouting into cancellous bone. Thus, a possible source of failure or loosening of many types of prostheses may be rooted in the lack of understanding of the structure, properties, and function of this material. In addition, as we have pointed out before, cancellous bone may play an important biomechanical role in the etiology of joint degeneration. With these considerations in mind, the architecture of the cancellous bone in the human patella was studied by serial sectioning and microradiography, using an improved technique developed in our laboratory. Volumes of cancellous bone with apparently different functional roles were identified. Stereological techniques were used to quantify the structural characteristics and geometrical relationships throughout the patella. These results led to a structural model for the cancellous bone of the patella, and a comprehensive picture of the internal architecture. The distribution of mechanical compliance and yield stress was also measured, as a function of location and orientation, by a specially constructed microcompression testing machine. The measurements reflected the distribution of trabecular architecture, and both the properties and architecture reflected the gross biomechanical function of the patella. Furthermore, a true structure-function relationship was derived. Patellar contact area studies were performed on fresh cadavers and mapped for various angles of flexion. The variation in contact areas and the spatial variations in stiffness are discussed relative to the biomechanics and clinical aspects of the patella. PMID:947922

Townsend, P R; Miegel, R E; Rose, R M

1976-07-01

60

Medial and lateral retinaculum plasty for congenital patellar dislocation due to small patella syndrome.  

PubMed

The objective of this study was to explore the clinical effect of medial and lateral retinaculum plasty for congenital patellar dislocation due to small patella syndrome. Twelve patients with congenital patellar dislocation due to small patella syndrome treated at the authors' hospital between January 2005 and February 2010 were enrolled in the study. The study group comprised 4 men (4 knees) and 8 women (8 knees) with an average age of 10.58±6.91 years. All patients underwent medial and lateral retinaculum plasty. Clinical evaluation included the number of patellar redislocations, patellar apprehension sign, Kujala score, subjective questionnaire score, and patella lateral shift and patellar tilt angle measured using a cross-sectional computed tomography scan. All patients were followed up, and the shortest follow-up time was 2 years. Kujala scores improved from 49.20±6.20 preoperatively to 80.10±5.80 postoperatively. Subjective questionnaire scores indicated that the excellent and good rate was 75%. In addition, a significant difference existed in the patellar tilt angle and patella lateral shift between pre- and postoperative results (P<.05). Medial and lateral retinaculum plasty for patients with congenital patellar dislocation due to small patella syndrome can be effective to correct the tracking of the patellofemoral joint and improve knee function. PMID:24200447

Wang, Cheng-hai; Shu, Lei; Ma, Long-fei; Zhou, Jian-wei; Ji, Gang; Wang, Fei; Wang, Juan

2013-11-01

61

Isolated Repair of the Medial Patellofemoral Ligament in Primary Dislocation of the Patella: A Prospective Randomized Study  

Microsoft Academic Search

Purpose: The purpose of this study was to evaluate the effect of surgical reinsertion of the medial patellofemoral ligament (MPFL) to the adductor tubercle compared with conservative treatment in patients with primary dislocation of the patella. Methods: Eighty patients with primary patella dislocation were included in the study. Delayed arthroscopy (mean, 50 days after injury) was performed to assess cartilage

Svend Erik Christiansen; Bent Wulff Jakobsen; Bent Lund; Martin Lind

2008-01-01

62

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

2011-01-01

63

Patella Infera in an HIV Positive Patient Following Total Knee Arthroplasty.  

PubMed

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. PMID:21270952

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

2011-01-01

64

Separate Vertical Wiring for the Fixation of Comminuted Fractures of the Inferior Pole of the Patella  

PubMed Central

Purpose Among patients over 50 years of age, separate vertical wiring alone may be insufficient for fixation of fractures of the inferior pole of the patella. Therefore, mechanical and clinical studies were performed in patients over the age of 50 to test the strength of augmentation of separate vertical wiring with cerclage wire (i.e., combined technique). Materials and Methods Multiple osteotomies were performed to create four-part fractures in the inferior poles of eight pairs of cadaveric patellae. One patella from each pair was fixed with the separate wiring technique, while the other patella was fixed with a combined technique. The ultimate load to failure and stiffness of the fixation were subsequently measured. In a clinical study of 21 patients (average age of 64 years), comminuted fractures of the inferior pole of the patellae were treated using the combined technique. Operative parameters were recorded from which post-operative outcomes were evaluated. Results For cadaveric patellae, whose mean age was 69 years, the mean ultimate loads to failure for the separate vertical wiring technique and the combined technique were 216.4±72.4 N and 324.9±50.6 N, respectively (p=0.012). The mean stiffness for the separate vertical wiring technique and the combined technique was 241.1±68.5 N/mm and 340.8±45.3 N/mm, respectively (p=0.012). In the clinical study, the mean clinical score at final follow-up was 28.1 points. Conclusion Augmentation of separate vertical wiring with cerclage wire provides enough strength for protected early exercise of the knee joint and uneventful healing.

Song, Hyung Keun; Yoo, Je Hyun; Byun, Young Soo

2014-01-01

65

Nail-Patella Syndrome Associated with Short Stature: A Case Series  

PubMed Central

Introduction. Nail-patella syndrome (NPS) is a rare genetic disorder that is characterized by a pleiotropic malformation affecting the nail, the skeleton, and occasionally the central nervous system and the kidneys. Case Presentation. We report two paediatric cases, which are of two sisters, who aged, respectively, two and five years. They are admitted to explore short stature. The initial clinical examination and radiologic findings confirmed the diagnosis of Nail-patella syndrome. Conclusion. Skeletal, ophthalmologic, and renal involvements were mostly associated with NPS. The association with short stature was exceptional.

Haddad, Samir; Ghedira-Besbes, Leila; Bouafsoun, Chahra; Hammami, Sabeur; Chouchene, Slaheddine; Ben Meriem, Chebil; Guediche, Mohamed-neji

2010-01-01

66

Partitioning of trace metals between soft tissues and shells of Patella aspera  

Microsoft Academic Search

This paper describes the partitioning of iron, manganese, zinc, copper, cadmium, cobalt, nickel and lead between the soft tissues and the shells of the gastropod mollusc Patella aspera. Specimens of the limpet P. aspera were collected from a clean coastal marine site (CMS) and from an estuarine contaminated site (ECS) on the south coast of Portugal. Fe and Zn concentrations

A. Cravo; M. J. Bebianno; P. Foster

2004-01-01

67

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

Microsoft Academic Search

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

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

2003-01-01

68

Topography, structure and function of the patella and the patelloid in marsupials.  

PubMed

The patella is a sesamoid bone that is found in most mammals and is regularly located in the insertion tendon of the quadriceps femoris muscle. Up to now, only a little has been known about the topography, structure and function of the patella in marsupials. Therefore the stifles of 61 marsupials of 30 different species were studied by radiography, necropsy and light microscopy. It was found that only the family of bandicoots (Peramelidae) possessed a typical patella. The other species revealed a patelloid consisting of fibrocartilage. The structure of the patelloid revealed common characteristic features in the following families of marsupials: (1) Dasyuridae, Phalangeridae. Pseudocheriidae, and Potoroidae; (2) Burramyidae; (3) Phascolarctidae, Vombatidae, and Dendrolagus; and (4) Superfamily Macropodoidea (except Dendrolagus and Potoroidae). Our results imply that the degree of differentiation in the fibrocartilage of the patelloid was strongly correlated to the mechanical forces acting on the patelloid which are a result of the specific kind of locomotion and the way of life. Generally the bony patella does not belong to the phylogenetic programme of the marsupials--with the exception of the bandicoots which are very closely related to the subclass of placental mammals (Eutheria). PMID:11688739

Reese, S; Pfuderer, U R; Bragulla, H; Loeffler, K; Budras, K D

2001-10-01

69

Short-term outcomes of unresurfaced patellas in total knee arthroplasty.  

PubMed

Selective patellar resurfacing continues in total knee arthroplasty (TKA). We define the demographics of patients selected for this procedure and report their short-term, aseptic revision rate. A community-based Total Joint Replacement Registry (TJRR) comprising 39,000 TKAs with median follow-up of 24.5 months was evaluated. Patients who underwent bicompartmental TKA were younger (p < 0.001), suffered posttraumatic arthrosis (p < 0.001), and receive hybrid fixation (p < 0.001). In multivariate analysis, the unresurfaced patella is an independent risk factor for early revision with a relative increased risk of 2.3 (95% CI, 1.4-3.7). The cumulative survivorship at 6 years for tricompartmental TKA is 98.1 versus 93.6% for bicompartmental knees (p < 0.001). Despite selecting patients with presumably healthier patellofemoral joints for bicompartmental TKA, the unresurfaced patella remains a risk factor for early revision. PMID:23288761

Khatod, Monti; Inacio, Maria C S; Bini, Stefano

2013-04-01

70

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

PubMed

In order to assess the extent of metal contamination at rocky shores of the Canarian Archipelago, metal concentrations have been measured in Patella piperata (Gould, 1846), using the standard atomic absorption spectrophotometer technique. Ranges of elements concentrations measured (in microg g(-1)) found in the biota were: Cd (0.36 +/- 0.26 microg g(-1) dry wt.), Cu (2.05 +/- 0.91 dry wt.), Pb (1.57 +/- 1.14 microg g(-1)dry wt.) and Zn (10.37 +/- 4.60 microg g(-1) dry wt.). Variation in metal concentrations in Patella, was tested by using non-parametric statistical methods. Cd content had a maximum in the Archipelago Chinijo, northward of Lanzarote Island. The metal concentrations recorded at the clean stations may be considered carefully if they are used like background levels. PMID:17171292

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

2007-04-01

71

Aperture fixation instead of transverse tunnels at the patella for medial patellofemoral ligament reconstruction  

Microsoft Academic Search

Purpose  Medial patellofemoral ligament (MPFL) reconstruction is an effective option for the treatment of recurrent patellar instability.\\u000a Most techniques utilize the passage of a tendon graft through tunnels at the patella with the risk of patellar fracture. The\\u000a purpose of this study was to investigate the strength of the recent MPFL reconstruction techniques (transverse tunnel, interference\\u000a screw, anchor, and docking technique).

Onur HapaErtug; Ertu?rul Ak?ahin; Raif Özden; Murad Pepe; Ahmet Nedim Yanat; Yunus Do?ramac?; Ergun Bozda?; Emin Sünbülo?lu

72

Minor and trace elements in the shell of Patella aspera (Röding 1798)  

Microsoft Academic Search

Specimens of the limpet Patella aspera were collected from a clean, coastal marine site and a contaminated estuary on the south coast of Portugal. The shells were analysed individually for their minor (Mg, Sr) and trace element (Fe, Mn, Zn) content. Mean concentrations of these elements in the shell of P. aspera were 4651, 1318, 35.8, 29.9 and 5.5 ?g

A Cravo; P Foster; M. J Bebianno

2002-01-01

73

To Resurface or Not to Resurface the Patella in Total Knee Arthroplasty  

PubMed Central

The management of the patellar articular surface at the time of primary total knee arthroplasty (TKA) is controversial. We used expected-value decision analysis to determine whether the patella should be resurfaced in TKA, and also whether secondary resurfacing on an unresurfaced patella is worthwhile. Outcome probabilities and utility values were derived from randomized controlled trials only. A decision tree was constructed and fold-back analysis was performed to ascertain the best treatment path. Sensitivity analyses were performed to determine the effect on decision-making of varying outcome probabilities and utilities. Our model showed patellar resurfacing is the best management strategy for the patella at the time of primary TKA. This decision is robust to changes in the specific data: the best path would remain the same as long as the incidence of persistent anterior knee pain (AKP) with resurfacing remains less than 29% (current mean, 12%) or the incidence of AKP after nonresurfacing falls below 12% (current mean, 26%). Delayed (ie, secondary) patellar resurfacing for ongoing patellar pain provides inferior results for the majority of patients. Level of Evidence: Level II, decision analysis. See the Guidelines for Authors for a complete description of levels of evidence.

Helmy, Naeder; Anglin, Carolyn; Greidanus, Nelson V.

2008-01-01

74

The effect of patella taping on vastus medialis oblique and vastus laterialis EMG activity and knee kinematic variables during stair descent  

Microsoft Academic Search

The purpose of this study was to evaluate the effect of patella taping in normal subjects. Previous work has established positive effects of patella taping on patellofemoral pain syndrome patients, but the mode of action remains unclear. It has been hypothesized that taping brings about subtle changes in the internal physiological environment of the joint. It could be expected that

Lee Herrington; Sharon Malloy; Jim Richards

2005-01-01

75

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

2012-01-01

76

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

PubMed

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

2013-02-01

77

Osteosarcoma of the patella mimicking giant cell tumor: imaging features with histopathological correlation.  

PubMed

Patellar tumors represent an uncommon etiology of anterior knee pain and their diagnosis is often delayed. We present an unusual case of conventional osteosarcoma arising in the patella of a 47-year-old man. The patient presented with a 1-year history of increasing anterior knee pain and swelling. Plain radiographs revealed a multi-locular lytic lesion in the inferolateral side of the patella. Computed tomography scans demonstrated an intraosseous lytic lesion with cortical thinning/breakthrough anteriorly. On magnetic resonance imaging, the lesion exhibited low signal intensity on T1-weighted images and heterogeneous high signal intensity on T2-weighted images. Fluid-fluid levels were also observed on T2-weighted images. Contrast-enhanced fat-suppressed T1-weighted images demonstrated strong enhancement of the lesion. These imaging features were suggestive of a benign condition; however, the diagnosis of osteosarcoma was confirmed by histopathology. After neoadjuvant chemotherapy, a wide resection with a free anterolateral thigh flap was performed. The patient subsequently underwent adjuvant chemotherapy and had no evidence of local recurrence or distant metastasis six months after surgery. Our case highlights the difficulty in the diagnosis of patellar osteosarcoma and the importance of performing a biopsy before definitive treatment. PMID:24778073

Aoki, Mikiko; Nishio, Jun; Iwasaki, Hiroshi; Masaki, Michio; Kawakami, Yoshihisa; Nishino, Takefumi; Ohjimi, Hiroyuki; Tamura, Kazuo; Nabeshima, Kazuki; Naito, Masatoshi

2014-05-01

78

Host Control of Symbiont Natural Product Chemistry in Cryptic Populations of the Tunicate Lissoclinum patella  

PubMed Central

Natural products (secondary metabolites) found in marine invertebrates are often thought to be produced by resident symbiotic bacteria, and these products appear to play a major role in the symbiotic interaction of bacteria and their hosts. In these animals, there is extensive variation, both in chemistry and in the symbiotic bacteria that produce them. Here, we sought to answer the question of what factors underlie chemical variation in the ocean. As a model, we investigated the colonial tunicate Lissoclinum patella because of its rich and varied chemistry and its broad geographic range. We sequenced mitochondrial cytochrome c oxidase 1 (COXI) genes, and found that animals classified as L. patella fall into three phylogenetic groups that may encompass several cryptic species. The presence of individual natural products followed the phylogenetic relationship of the host animals, even though the compounds are produced by symbiotic bacteria that do not follow host phylogeny. In sum, we show that cryptic populations of animals underlie the observed chemical diversity, suggesting that the host controls selection for particular secondary metabolite pathways. These results imply novel approaches to obtain chemical diversity from the oceans, and also demonstrate that the diversity of marine natural products may be greatly impacted by cryptic local extinctions.

Kwan, Jason C.; Tianero, Ma. Diarey B.; Donia, Mohamed S.; Wyche, Thomas P.; Bugni, Tim S.; Schmidt, Eric W.

2014-01-01

79

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

PubMed

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

2003-01-01

80

Patellar Shape-Memory Fixator for the Treatment of Comminuted Fractures of the Inferior Pole of the Patella  

NASA Astrophysics Data System (ADS)

Comminuted and displaced fractures of the inferior pole of the patella are not easy to reduce and it is difficult to fix the fragments soundly enough to allow early movement of the knee. The purpose of this study is to evaluate the clinical effectiveness of the internal fixation technique with Patellar Shape-Memory Fixator (PSMF) in acute comminuted fractures of the inferior pole of the patella. We retrospectively studied 25 patients with comminuted fractures of the inferior pole of the patella who were treated with PSMF and followed up for a mean period of 26 months (14 to 60). All the fractures healed at a mean of 6 weeks (5 to 7). The mean grading at the final follow-up was 29.5 points (27 to 30) using the Bostman score, with no observable restriction of movement. No breakage of the PSMF or infection occurred. No delayed union, nonunion, and infection were seen. This technique preserved the length of the patella, reduced the comminuted fragments of the inferior pole and avoided long-term immobilization of the knee.

Liu, Xin-Wei; Shang, Hui-Juan; Xu, Shuo-Gui; Wang, Zhi-Wei; Zhang, Chun-Cai; Fu, Qing-Ge

2011-07-01

81

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

PubMed Central

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

2013-01-01

82

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

PubMed

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

2010-02-01

83

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

Microsoft Academic Search

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)

A. Cravo; M. J. Bebianno

2005-01-01

84

Genitopatellar syndrome: a new condition comprising absent patellae, scrotal hypoplasia, renal anomalies, facial dysmorphism, and mental retardation  

PubMed Central

We report on the association of absent patellae, genital and renal anomalies, dysmorphic features, and mental retardation in seven children (six boys and one girl) belonging to five unrelated families. Flexion deformities of the knees and hips with club feet and absent patellae were consistently observed and scrotal hypoplasia and cryptorchidism were present in all boys (6/6). Dysmorphic features included a coarse face, a large nose with a high nasal bridge, and microcephaly. Other features included renal anomalies (multicystic kidneys or hydronephrosis, 7/7), agenesis of the corpus callosum (4/7), swallowing difficulties, micrognathia (4/7), and pulmonary hypoplasia (3/7). Bilateral hypoplasia of the ischia and brachydactyly were also consistently observed (5/5). In two out of seven cases, prenatal ultrasound detection of microcephaly and renal anomalies led to termination of the pregnancy at 27 weeks. Three children died during the first years of life and the remaining two who survived exhibit severe developmental delay. High resolution cytogenetic studies performed on lymphocytes or fibroblasts or both were normal in all cases. Recurrence in two families suggests an autosomal recessive mode of inheritance. We propose that this unusual association, similar to that observed in a 4 year old boy by Goldblatt et al, represents a new syndrome distinct from previously reported hypoplastic patella syndromes. ???Keywords: patella; genital anomalies; renal anomalies; mental retardation

Cormier-Daire, V.; Chauvet, M.; Lyonnet, S.; Briard, M.; Munnich, A.; Le Merrer, M.

2000-01-01

85

Mutations in the Human TBX4 Gene Cause Small Patella Syndrome  

PubMed Central

Small patella syndrome (SPS) is an autosomal-dominant skeletal dysplasia characterized by patellar aplasia or hypoplasia and by anomalies of the pelvis and feet, including disrupted ossification of the ischia and inferior pubic rami. We identified an SPS critical region of 5.6 cM on chromosome 17q22 by haplotype analysis. Putative loss-of-function mutations were found in a positional gene encoding T-box protein 4 (TBX4) in six families with SPS. TBX4 encodes a transcription factor with a strongly conserved DNA-binding T-box domain that is known to play a crucial role in lower limb development in chickens and mice. The present identification of heterozygous TBX4 mutations in SPS patients, together with the similar skeletal phenotype of animals lacking Tbx4, establish the importance of TBX4 in the developmental pathways of the lower limbs and the pelvis in humans.

Bongers, Ernie M. H. F.; Duijf, Pascal H. G.; van Beersum, Sylvia E. M.; Schoots, Jeroen; van Kampen, Albert; Burckhardt, Andreas; Hamel, Ben C. J.; Losan, Frantisek; Hoefsloot, Lies H.; Yntema, Helger G.; Knoers, Nine V. A. M.; van Bokhoven, Hans

2004-01-01

86

Treatment of habitual dislocation of patella in an adult arthritic knee  

PubMed Central

Habitual dislocation of the patella (HDP) is a common presentation in pediatric age unlike adults. Many surgical procedures using proximal realignment and distal realignment have been reported to treat HDP in children with satisfactory results. However, late presentation of habitual patellar dislocation with osteoarthritis is rare and treatment plan has not yet been established. We present a case of neglected iatrogenic habitual patellar dislocation with osteoarthritis in a 50-year-old woman. Two-staged procedure was planned, first with patellar realignment and later with definitive total knee arthroplasty. Quadricepsplasty, medial patello-femoral ligament reconstruction, lateral release and tibial tuberosity transfer was done as primary procedure and total knee arthroplasty, which was planned as secondary procedure, was deferred as the patient improved functionally.

Reddy, Raghuveer K; Kondreddi, Vamsi

2013-01-01

87

Medial patellofemoral ligament reconstruction: a new technique for graft fixation at the patella without implants.  

PubMed

Patellofemoral instability is a complex disorder that is often accompanied by insufficiency or tearing of the medial patellofemoral ligament. Over the past few years, several techniques using free tendon grafts for medial patellofemoral ligament reconstruction have become popular because of their reproducible effect and good outcome. Whereas most surgeons prefer femoral fixation of the graft using an interference screw, the possibilities of patellar fixation are numerous. All of the different techniques have their own advantages and pitfalls. We describe a technique in which we drill 2 blind-ending tunnels (1 cm) at the medial aspect of the patella, where the doubled graft (not the free ends) is pulled in and fixed. By using a special technique for shuttling the sutures, there is no need for an additional skin incision and no need for implants, allowing very secure graft fixation without a relevant risk of fracture. PMID:24749029

Shafizadeh, Sven; Balke, Maurice

2014-02-01

88

Medial Patellofemoral Ligament Reconstruction: A New Technique for Graft Fixation at the Patella Without Implants  

PubMed Central

Patellofemoral instability is a complex disorder that is often accompanied by insufficiency or tearing of the medial patellofemoral ligament. Over the past few years, several techniques using free tendon grafts for medial patellofemoral ligament reconstruction have become popular because of their reproducible effect and good outcome. Whereas most surgeons prefer femoral fixation of the graft using an interference screw, the possibilities of patellar fixation are numerous. All of the different techniques have their own advantages and pitfalls. We describe a technique in which we drill 2 blind-ending tunnels (1 cm) at the medial aspect of the patella, where the doubled graft (not the free ends) is pulled in and fixed. By using a special technique for shuttling the sutures, there is no need for an additional skin incision and no need for implants, allowing very secure graft fixation without a relevant risk of fracture.

Shafizadeh, Sven; Balke, Maurice

2014-01-01

89

The gonadotropin releasing hormone (GnRH)-like molecule in prosobranch Patella caerulea: potential biomarker of endocrine-disrupting compounds in marine environments.  

PubMed

It has been reported that endocrine disrupter compounds (EDCs) interfere with the endocrine system, mimicking the action of sex steroid hormones in different species of mollusks. Prosobranchs are frequently used as a reliable bioindicator to evaluate EDC exposure. In this article, we evaluate the effects of the xenoestrogen 4-n-nonylphenol (NP) in the prosobranch gastropod Patella caerulea, which exhibits protandrous hermaphroditism as its reproductive strategy. We isolated a partial sequence of a GnRH-like molecule from the gonads of Patella caerulea. The deduced amino acid sequence is highly homologous to that reported for the Lottia gigantea GnRH. Patella caerulea GnRH (pGnRH) mRNA expression is widespread in both male and female germ lines during gametogenesis. We suggest pGnRH as a novel biomarker for the early assessment of presence of EDCs and monitoring short and long-term impacts on Patella caerulea community structure. PMID:23387848

De Lisa, Emilia; Carella, Francesca; De Vico, Gionata; Di Cosmo, Anna

2013-02-01

90

Trabecular Metal Patella - Is it really doomed to fail in the totally patellar-deficient knee? A case report of patellar reconstruction with a novel technique.  

PubMed

Reconstruction of the patella poses real problems for the revision TKR surgeon, particularly when the patella is absent, fractured or profoundly deficient. The Trabecular Metal Patella was introduced in an attempt to address these issues. However the largest series of such cases published to date cast serious doubts on the validity of using Trabecular Metal (TM) in cases where there is no residual patellar bone stock at all. We present a case where the TM Patellar implant has survived satisfactorily for 8years post reconstruction in a knee with no residual patella bone, resulting in greatly improved symptoms and function. We believe that this success might be related to specific technical details in the reconstruction and we present the technique. PMID:24613586

Kumar Nanjayan, Shashi; Wilton, Timothy

2014-06-01

91

Knee joint reconstruction after hemiarticular resection using pedicled patella and vascularized fibular graft.  

PubMed

Between 1999 and 2005, seven patients had resection of tumors around the knee joint that involved half of the articular surface of the femoral or tibial side. Average age of the patients was 28 years (range, 14-40). Tumor pathology was giant cell tumor in four patients, osteoblastoma in two, and benign fibrous histocytoma in one patient. Two patients had recurrent tumors. The tumor was located in the distal femur in five patients and in the proximal tibia in the remaining two. The ipsilateral patella pedicled on the infrapatellar fat pad was used to substitute the resected articular surface and a vascularized fibula osteoseptocutaneous flap was used to reconstruct the metaphyseal defect. Average follow-up period was 6.5 years (range, 3.5-10 years). All flaps survived. Average time to bone union was 3.5 months (range, 3-4 months), and average time to full weight-bearing was 5 months (range, 4-6 months). No radiological signs of avascular necrosis of the patella were observed in any patient. Two patients required secondary procedures for correction of instability. One patient had local recurrence. At final follow-up, the median range of knee motion was from 10° to 100°. The average Knee Society Score (KSS) was 76 points (range; 50-85 points), and the average KSS functional score was 76.6 points (range, 70-90 points). In conclusion, the procedure is a reliable option for after resection of tumors that involve half the articular surface of the femur or the tibia. PMID:20853338

El-Gammal, Tarek A; El-Sayed, Amr; Kotb, Mohamed M; Saleh, Waleed Riad; Ragheb, Yasser Farouk

2010-11-01

92

Thickness of the subchondral mineralised tissue zone (SMZ) in normal male and female and pathological human patellae  

PubMed Central

The objective of this paper was to analyse sex differences of the thickness of the subchondral mineralised tissue zone (SMZ), and to find out whether systematic changes of SMZ thickness are associated with naturally occurring, non-full-thickness cartilage lesions of human patellae. In 32 methyl-methacrylate-embedded specimens (16 normal, 8 with focal medial, and 8 with lateral lesions) the SMZ thickness was determined, using a binocular macroscope and an image analysing system. In each case, the thickness distribution was reconstructed throughout the entire joint surface. The maximal and mean SMZ thicknesses were significantly higher in males than in females (P<0.01). In normal patellae and those with lateral lesions, the thickness was significantly thicker laterally than medially (P<0.05), but it was not in specimens with medial damage. Patellae with medial damage exhibited a significantly lower total mean and lateral mean (P<0.05). A lower SMZ thickness was found directly beneath medial lesions than beneath lateral ones, but the local thickness was always in the range of that observed in normal specimens. We conclude that differences of patellar SMZ thickness exist between males and females. Naturally occurring cartilage lesions appear, however, not to be associated with local changes of SMZ thickness, but they may be associated with an altered regional distribution pattern within the joint surface.

ECKSTEIN, FELIX; MILZ, STEFAN; ANETZBERGER, HERMANN; PUTZ, REINHARD

1998-01-01

93

Genitopatellar syndrome: a new condition comprising absent patellae, scrotal hypoplasia, renal anomalies, facial dysmorphism, and mental retardation.  

PubMed

We report on the association of absent patellae, genital and renal anomalies, dysmorphic features, and mental retardation in seven children (six boys and one girl) belonging to five unrelated families. Flexion deformities of the knees and hips with club feet and absent patellae were consistently observed and scrotal hypoplasia and cryptorchidism were present in all boys (6/6). Dysmorphic features included a coarse face, a large nose with a high nasal bridge, and microcephaly. Other features included renal anomalies (multicystic kidneys or hydronephrosis, 7/7), agenesis of the corpus callosum (4/7), swallowing difficulties, micrognathia (4/7), and pulmonary hypoplasia (3/7). Bilateral hypoplasia of the ischia and brachydactyly were also consistently observed (5/5). In two out of seven cases, prenatal ultrasound detection of microcephaly and renal anomalies led to termination of the pregnancy at 27 weeks. Three children died during the first years of life and the remaining two who survived exhibit severe developmental delay. High resolution cytogenetic studies performed on lymphocytes or fibroblasts or both were normal in all cases. Recurrence in two families suggests an autosomal recessive mode of inheritance. We propose that this unusual association, similar to that observed in a 4 year old boy by Goldblatt et al, represents a new syndrome distinct from previously reported hypoplastic patella syndromes. PMID:10882755

Cormier-Daire, V; Chauvet, M L; Lyonnet, S; Briard, M L; Munnich, A; Le Merrer, M

2000-07-01

94

[Ultrasound transmission velocity in the patella of normal subjects and in patients with postmenopausal osteoporosis].  

PubMed

Recently, ultrasound transmission velocity (UTV) has been used to assess skeletal status. The basic principle of UTV measurement of bone is that the speed at which ultrasounds propagate in bone is determined by the mass density and by the index of elasticity, which is intimately correlated with bone strength. Theoretically UTV should provide more information about bone fragility than the absorptiometric techniques of measurement of bone mass. To test this hypothesis, UTV was measured using the SIGNET(TM) (Osteo Technology, Framingham, MA, USA) in the patella of 79 postmenopausal nonobese women. The subjects were divided into 2 groups: 29 postmenopausal normal women (NPM) and 50 patients with at least one vertebral crush fracture due to postmenopausal osteoporosis (PMO). Besides UTV measurements in all subjects lumbar spine bone mineral density (BMD) was measured by dual energy Rx (Hologic QDR 1000). UTV in NPM (mean age 57.9 +/- 8 SD years) averaged 1867 +/- 62 m/sec, and in PMO (mean age 63.5 +/- 7.8 SD years) averaged 1771 +/- 74 m/sec. It follows that the difference between the two groups was about 96 m/sec. UTV correlated significantly with BMD measured in the lumbar spine (r = 0.51; p less than 0.001), giving a discrimination power virtually identical to that obtained by using spine BMD values. This preliminary data are promising for the use of this new technique which offers a simple, noninvasive measure of bone quality without the limitation of radiation exposure. PMID:1770921

Agnusdei, D; Camporeale, A; Gennari, C

1991-01-01

95

Seasonality recorded in Modern and Viking Limpet Shells ( Patella vulgata), Quoygrew, Orkney, UK  

NASA Astrophysics Data System (ADS)

Climate archives contained in shells of the European limpet, Patella vulgata, from Viking shell middens can potentially provide much needed information about seasonality in mid-latitude coastal areas prior to the complicating effects of industrialization. P. vulgata shells are common in the stratified middens accumulated by the Viking inhabitants of Quoygrew, Orkney, and were likely used for baiting fish. Radiocarbon dates and artifacts place these middens between the 9th/10th and 13th centuries. This interval coincides with the Medieval Warm Period. Little is known about the seasonal temperature variation during this time of pre-industrial warming. Before reconstructing climate information from Viking shells, we determined whether P. vulgata preserves environmental and ecological information. Previous work on live-collected specimens from Whitley Bay near Newcastle-upon-Tyne, England, confirmed that: (1) oxygen isotope ratios served as a proxy for sea surface temperature after accounting for a uniform +1.01 +/-0.21 ‰ offset; and (2) annual growth lines occurred during the winter given this location is within the cold-temperature biogeographic province. Winter growth lines and increments are common growth patterns found in marine bivalves from the cold-temperate province along the western North Atlantic. Preliminary isotope data from the 9th/10th century reveals similar winter and summer temperature relative to today and annual growth lines formed during winter, typical of a cold-temperate habitat.

Surge, D.; Barrett, J. H.; Milner, N.

2007-12-01

96

Minor and trace elements in the shell of Patella aspera (Röding 1798).  

PubMed

Specimens of the limpet Patella aspera were collected from a clean, coastal marine site and a contaminated estuary on the south coast of Portugal. The shells were analysed individually for their minor (Mg, Sr) and trace element (Fe, Mn, Zn) content. Mean concentrations of these elements in the shell of P. aspera were 4651, 1318, 35.8, 29.9 and 5.5 microg g(-1), respectively. The elemental concentrations exhibited both a marked intra- and inter-population variability. Despite the variability within individual populations, significant differences in the trace element composition were apparent between the shells taken from the two sites. Small shells (< 2 g) provided the best resolution between sites for both manganese and iron. Differences in zinc were best resolved for larger shells. The shell of P. aspera has an extraordinarily high magnesium concentration, which is insensitive to gross salinity differences, and a trace metal assemblage that can be interpreted in terms of environmental exposure. On these grounds, it is recommended that the shell of P. aspera is a tissue for potential use in environmental trace metal monitoring. PMID:12220116

Cravo, A; Foster, P; Bebianno, M J

2002-09-01

97

Partitioning of trace metals between soft tissues and shells of Patella aspera.  

PubMed

This paper describes the partitioning of iron, manganese, zinc, copper, cadmium, cobalt, nickel and lead between the soft tissues and the shells of the gastropod mollusc Patella aspera. Specimens of the limpet P. aspera were collected from a clean coastal marine site (CMS) and from an estuarine contaminated site (ECS) on the south coast of Portugal. Fe and Zn concentrations were significantly lower on both populations and less variable in the shells than in the soft tissues. In contrast Mn concentrations were higher in the shells than in the soft tissues at ECS. The partitioning factor (PF), defined as the ratio between the mean metal concentrations in soft tissues and in the shells, was maximum for iron and minimum for manganese. Between the soft tissues and the shells, only manganese at ECS recorded a significant relationship between metal concentrations, suggesting that the mechanism that controls the accumulation of this essential metal in both tissues was different from the others. From the obtained data, in biomonitoring sewage contamination studies, shells of P. aspera can be considered as a good indicator for Mn while the soft tissues for Zn. As copper, cadmium, nickel and cobalt concentrations were much higher in the soft tissues than in the shells (< 0.1 microg g(-1)), this indicates that the shells were not a good indicator for these metals because they do not reflect the environmental bioavailability as do the soft tissues. PMID:14664868

Cravo, A; Bebianno, M J; Foster, P

2004-03-01

98

Morphological analysis of the femoral trochlea in patients with recurrent dislocation of the patella using three-dimensional computer models.  

PubMed

We investigated the three-dimensional morphological differences of the articular surface of the femoral trochlea in patients with recurrent dislocation of the patella and a normal control group using three-dimensional computer models. There were 12 patients (12 knees) and ten control subjects (ten knees). Three-dimensional computer models of the femur, including the articular cartilage, were created. Evaluation was performed on the shape of the articular surface, focused on its convexity, and the proximal and mediolateral distribution of the articular cartilage of the femoral trochlea. The extent of any convexity, and the proximal distribution of the articular cartilage, expressed as the height, were shown by the angles about the transepicondylar axis. The mediolateral distribution of the articular cartilage was assessed by the location of the medial and lateral borders of the articular cartilage. The mean extent of convexity was 24.9 degrees sd 6.7 degrees for patients and 11.9 degrees sd 3.6 degrees for the control group (p < 0.001). The mean height of the articular cartilage was 91.3 degrees sd 8.3 degrees for the patients and 83.3 degrees sd 7.7 degrees for the control group (p = 0.03), suggesting a wider convex trochlea in the patients with recurrent dislocation of the patella caused by the proximally-extended convex area. The lateral border of the articular cartilage of the trochlea in the patients was more laterally located than in the control group. Our findings therefore quantitatively demonstrated differences in the shape and distribution of the articular cartilage on the femoral trochlea between patients with dislocation of the patella and normal subjects. PMID:17613498

Yamada, Y; Toritsuka, Y; Yoshikawa, H; Sugamoto, K; Horibe, S; Shino, K

2007-06-01

99

[Late results of different methods of surgical treatment of experimental retropatellar cartilage defects].  

PubMed

The result of the experimental studies encouraged us to treat our patients with chondro-malacia patellae not only by superficially rasping the damaged cartilage, but also by drilling several holes down to the subchondral layer. This allows a type of tissue repair by connective tissue. In addition we prefer a section of the retinacula and an anteposition of the patella ligament. PMID:659234

Kinzl, L; von Mathei, F; Burri, C

1978-05-01

100

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

PubMed

We measured the stiffness of the cartilage of the human femoral condyles via an ultrasonic tactile sensor under arthroscopic control. The stiffness and the degeneration of articular cartilage were assessed in 105 knees in 74 patients (39 men, 35 women, age: 9-72 years) who underwent arthroscopic observation or surgery. Twenty-five knees suffered from traumatic cartilage injury, 14 from osteochondritis dissecans, 13 from osteoarthritis, 11 from meniscal injury and six from ligamentous injury, bipartita patellae (three knees), and symptomatic plica synovialis (two knees). The degeneration of cartilage was classified according to Outerbridge's grading system. The relationships between the stiffness and the grade of cartilage degeneration, and gender were analyzed. The stiffness of grade I (softening) and II (fissuring less than 0.5 inches in length) was significantly lower than that of intact cartilage. In contrast, the stiffness of grade IV (exposed subchondral bone) was significantly higher than that of any other group. The cartilage stiffness of the patella in women was significantly lower than that in men. The tactile sensor was useful for determining the intraoperative stiffness of healthy and diseased human cartilage in all grades. PMID:12135651

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

2002-07-01

101

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

PubMed Central

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

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

2013-01-01

102

DIFFERENTIAL CROSS-LINKING AND RADIO-PROTECTIVE EFFECTS OF GENIPIN ON MATURE BOVINE AND HUMAN PATELLA TENDONS  

PubMed Central

Gamma irradiation is a proven sterilization method, but is not widely used on allografts for anterior cruciate ligament (ACL) reconstruction (e.g., patella tendon) due to radiation-induced decreases in mechanical strength. Addressing this drawback would improve the safety and supply of allografts to meet current and future demand. It was hypothesized that genipin-induced collagen cross-linking would increase the tensile modulus of patella tendon tissue such that 5 MRad gamma irradiation would not reduce the tissue mechanical strength below the original untreated values. Optimized genipin treatment increased the tensile modulus of bovine tendons by ~2.4-fold. After irradiation, genipin treated tissue did not significantly differ from native tissue, proving the hypothesis. Optimized genipin treatment of human tendons increased the tensile modulus by ~1.3-fold. After irradiation, both control and genipin-treated tissues possessed ~50–60% of their native tendon modulus, disproving the hypothesis. These results highlight possible age- and species-dependent effects of genipin cross-linking on tendon tissue. Cross-linking of human allografts may be beneficial only in younger donor tissues. Future research is warranted to better understand the mechanisms and applications of collagen cross-linking for clinical use.

Ng, Kenneth W.; Wanivenhaus, Florian; Chen, Tony; Abrams, Valarian D.; Torzilli, Peter A.; Warren, Russell F.; Maher, Suzanne A.

2013-01-01

103

The use of the knee joint-line balancer to control patella position in revision total knee arthroplasty.  

PubMed

In revision total knee arthroplasty (TKA), control of the patellar height and the joint line is difficult. Therefore, we developed an adjustable flexion-extension spacer, the Knee Joint-line Balancer (KJB(R)). This device simulates femur component sizes, polyethylene sizes, the joint-line level, and distal femur wedges. The goal of this study is to evaluate the use of an adjustable knee spacer to control patellar height and joint-line during revision total knee surgery. The subjects of the study were the first 10 consecutive patients who had undergone revision of a primary TKA where the KJB was used. A reference group composed of the last 10 patients treated without the use of the KJB was also evaluated. The joint-line position and the patellar height were determined before and after revision TKA. The method described by Figgie et al. was used. The patellar height in the reference group averaged 7.7 mm. Seven of 10 patients had a patella baja, and two of these patients had patellar impingement. One patient needed a proximalisation of the tuberositas. The patellar height in the KJB group averaged 14.6 mm after revision, with only one patient having a patella baja. This new device, adjustable kneespacer for revision TKA ("the KJB"), seems to provide better control of the patellar position in total knee revision. PMID:15749441

ten Ham, Arno M; Wymenga, Ate B; Jacobs, Wilco C H

2005-04-01

104

Heavy metals in Patella caerulea (Mollusca, Gastropoda) in polluted and non-polluted areas from the Iskenderun Gulf (Mediterranean Turkey).  

PubMed

The concentrations of Cd, Cu, Zn, Fe, Pb, Ni, and Co were measured in gastropod mollusks Patella caerulea in the Mediterranean area. The organisms were collected at two coastal sites in Iskenderun Gulf during winter, spring, summer, and autumn 2008. Samples of the digestive gland, gill, and muscle were analyzed for heavy metals. The aim of study is to determine heavy metal levels in tissues of P. caerulea in different locations. Tissues of P. caerulea from the polluted site showed metal concentrations appreciably higher than unpolluted organisms. The highest metal levels were registered in the digestive gland of P. caerulea. Generally, digestive gland and gills showed higher metal concentrations than muscle. The average concentrations of heavy metals analyzed exhibited the following decreasing order: Fe>Zn>Cu>Ni>Cd>Pb>Co for both stations 1 and 2. Seasonal changes in metal concentrations were observed in the tissues of P. caerulea from a polluted and an unpolluted population. PMID:19543988

Yüzerero?lu, T A; Gök, G; Co?un, H Y; Firat, O; Aslanyavrusu, Sabahattin; Maruldali, Onur; Kargin, F

2010-08-01

105

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

PubMed Central

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

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

2012-01-01

106

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

PubMed

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

2013-10-01

107

Tibial rotational osteotomy and distal tuberosity transfer for patella subluxation secondary to excessive external tibial torsion: surgical technique and clinical outcome.  

PubMed

PURPOSE: Recurrent patella subluxation may be secondary to excessive external tibial torsion. The purpose of this study is to evaluate the clinical and radiographic outcome of patients undergoing tibial derotation osteotomy and tibial tuberosity transfer for recurrent patella subluxation in association with excessive external tibial torsion. METHODS: A combined tibial derotation osteotomy and tibial tuberosity transfer was performed in 15 knees (12 patients) with recurrent patella subluxation secondary to excessive external tibial torsion. Clinical evaluation was carried out using preoperative and post-operative Knee Society Score (KSS), Kujala Patellofemoral score, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire, the short form-12 (SF-12) and a visual analogue score (VAS) pain scale. RESULTS: The median follow-up period was 84 months (range 15-156) and median patient age was 34 years (range 19-57 years). The median preoperative external tibial torsion was 62° (range 55°-70°), with a median rotational correction of 36° (range 30°-45°) after surgery. Significant improvement (p < 0.05) was found in the KSS part I (37 ± 14 to 89 ± 11 points), KSS part II (25 ± 26 to 85 ± 14 points), Kujala score, the SF-12 outcome, WOMAC score and VAS score (8.8 ± 1.9 to 2.4 ± 1.5). Two patients had a nonunion of the tibial osteotomy site; one patient required bone grafting, while another patient required revision to total knee arthroplasty. CONCLUSION: Patients presenting with recurrent patella subluxation secondary to excessive external tibial torsion >45° who underwent tibial derotation osteotomy and tibial tuberosity transfer achieved a satisfactory outcome in terms of pain relief and improved function. A significant complication was seen in 2/15 patients. LEVEL OF EVIDENCE: Case series, Level IV. PMID:23740327

Drexler, M; Dwyer, T; Dolkart, O; Goldstein, Y; Steinberg, E L; Chakravertty, R; Cameron, J C

2013-06-01

108

Secondary Aneurysmal Bone Cystic Change of the Chondroblastoma, Mistaken for a Primary Aneurysmal Bone Cyst in the Patella  

PubMed Central

A 29-year-old woman complained of a 3-month history of left knee pain without trauma history. X-ray showed a well-defined osteolytic lesion with a sclerotic margin in the patella and magnetic resonance imaging showed T1-low and T2-high signal intensity with different fluid level. Our impression was an aneurysmal bone cyst. At surgery, the lesion was a blood-filled cystic cavity, surrounded by a gray or brownish tissue. Hemorrhagic soft tissues with recognizable bone fragments were observed. Curettage and autogenous bone graft was done. Microscopically, sheets of tumor cells were intermingled with some areas of eosinophilic chondroid matrix. The tumor cells showed oval-shaped nuclei with moderate eosinophilic cytoplasm. Several multinucleated giant cells and blood filled cystic cavities were observed. The final diagnosis was a chondroblastoma with a secondary aneurysmal bone cyst. At the post-operative 1.5-year follow-up, grafted bones were well incorporated radiographically and there were no recurrent evidence or any other abnormal symptoms.

Chung, Jin Wha

2014-01-01

109

Secondary aneurysmal bone cystic change of the chondroblastoma, mistaken for a primary aneurysmal bone cyst in the patella.  

PubMed

A 29-year-old woman complained of a 3-month history of left knee pain without trauma history. X-ray showed a well-defined osteolytic lesion with a sclerotic margin in the patella and magnetic resonance imaging showed T1-low and T2-high signal intensity with different fluid level. Our impression was an aneurysmal bone cyst. At surgery, the lesion was a blood-filled cystic cavity, surrounded by a gray or brownish tissue. Hemorrhagic soft tissues with recognizable bone fragments were observed. Curettage and autogenous bone graft was done. Microscopically, sheets of tumor cells were intermingled with some areas of eosinophilic chondroid matrix. The tumor cells showed oval-shaped nuclei with moderate eosinophilic cytoplasm. Several multinucleated giant cells and blood filled cystic cavities were observed. The final diagnosis was a chondroblastoma with a secondary aneurysmal bone cyst. At the post-operative 1.5-year follow-up, grafted bones were well incorporated radiographically and there were no recurrent evidence or any other abnormal symptoms. PMID:24639947

Chung, Jin Wha; Lee, Hwa Sung

2014-03-01

110

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

PubMed

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

Druskin, Sasha C; Rodeo, Scott A

2013-07-01

111

Recessive multiple epiphyseal dysplasia (rMED) with homozygosity for C653S mutation in the DTDST gene - Phenotype, molecular diagnosis and surgical treatment of habitual dislocation of multilayered patella: Case report  

PubMed Central

Background Multiple epiphyseal dysplasia (MED) is one of the more common generalised skeletal dysplasias. Due to its clinical heterogeneity diagnosis may be difficult. Mutations of at least six separate genes can cause MED. Joint deformities, joint pain and gait disorders are common symptoms. Case Presentation We report on a 27-year-old male patient suffering from clinical symptoms of autosomal recessive MED with habitual dislocation of a multilayered patella on both sides, on the surgical treatment and on short-term clinical outcome. Clinical findings were: bilateral hip and knee pain, instability of femorotibial and patellofemoral joints with habitual patella dislocation on both sides, contractures of hip, elbow and second metacarpophalangeal joints. Main radiographic findings were: bilateral dislocated multilayered patella, dysplastic medial tibial plateaus, deformity of both femoral heads and osteoarthritis of the hip joints, and deformity of both radial heads. In the molecular genetic analysis, the DTDST mutation g.1984T > A (p.C653S) was found at the homozygote state. Carrier status was confirmed in the DNA of the patient's parents. The mutation could be considered to be the reason for the patient's disease. Surgical treatment of habitual patella dislocation with medialisation of the tibial tuberosity led to an excellent clinical outcome. Conclusions The knowledge of different phenotypes of skeletal dysplasias helps to select genes for genetic analysis. Compared to other DTDST mutations, this is a rather mild phenotype. Molecular diagnosis is important for genetic counselling and for an accurate prognosis. Even in case of a multilayered patella in MED, habitual patella dislocation could be managed successfully by medialisation of the tibial tuberosity.

2010-01-01

112

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

NASA Astrophysics Data System (ADS)

Climate archives contained in shells of the European limpet, Patella vulgata, accumulated in archaeological deposits can potentially provide much needed information about Holocene environmental change in midlatitude coastal areas. Before reconstructing climate information preserved in these zooarchaeological records, we studied the controls on oxygen and carbon isotope ratios (?18O and ?13C, respectively) in modern specimens. We tested the hypothesis that P. vulgata precipitates its shell in isotopic equilibrium with the ambient water by comparing ?18OSHELL with predicted values. Predicted ?18OSHELL was constructed using observed sea surface temperature (SST) records and the equilibrium fractionation equation for calcite and water. We assumed a constant ?18OWATER value of +0.10‰ (VSMOW) based on published regional measurements. Comparison of ?18OSHELL with predicted values revealed that ?18OSHELL values were higher than expected by +1.01 ± 0.21‰. Consequently, estimated SST calculated from ?18OSHELL was 4.2 ± 2.3°C lower than observed SST. However, because of the relatively uniform offset between observed and expected ?18O, an adjustment can be made to account for this predictable vital effect. Thus past climate can be reliably reconstructed using this temperature proxy once the offset is taken into account. ?13C values have a similar cyclicity to the ?18O variation and therefore vary seasonally. However, ?13C is slightly out of phase relative to ?18O. An overall negative shift in ?13CSHELL over the lifetime of the individual indicates a vital effect associated with ontogeny. Further study of environmental and ecological factors that influence shell ?13C is required to evaluate fully the potential of carbon isotope ratios as a useful environmental proxy.

Fenger, Tracy; Surge, Donna; SchöNe, Bernd; Milner, Nicky

2007-07-01

113

Loss-of-function mutations in the LIM-homeodomain gene, LMX1B, in nail-patella syndrome.  

PubMed

Nail-patella syndrome (NPS) is an inherited developmental disorder most commonly involving maldevelopment of the fingernails, kneecaps and elbow joints. NPS exhibits wide variation in phenotypic expression within and among families with respect to these features. Other skeletal abnormalities such as hip dislocation and club foot have also been reported in some individuals with NPS. There is an association between NPS and renal disease, and between NPS and open-angle glaucoma (OAG), but it is not known whether mutations in a single gene cause the observed skeletal, renal and ophthalmic abnormalities. Recently, LMX1B , a transcription factor of the LIM-homeodomain type with homologs that are important for limb development in vertebrates, was mapped to the same general location as NPS at 9q34. We sequenced a large segment of LMX1B from the genomic DNA of probands from four families with NPS and OAG, and identified four mutations: two stop codons, a deletion causing a frameshift and a missense mutation in a functionally important residue. The presence of these putative loss-of-function mutations in the DNA of individuals with NPS indicates that haploinsufficiency of LMX1B underlies this disorder. These findings help to explain the high degree of variability in the NPS phenotype, and suggest that the skeletal defects in NPS are a result of the diminished dorsoventral patterning activity of LMX1B protein during limb development. The results further suggest that the NPS and OAG phenotypes in the families studied result from mutations in a single gene, LMX1B. PMID:9618165

Vollrath, D; Jaramillo-Babb, V L; Clough, M V; McIntosh, I; Scott, K M; Lichter, P R; Richards, J E

1998-07-01

114

Recessively inherited multiple epiphyseal dysplasia with normal stature, club foot, and double layered patella caused by a DTDST mutation.  

PubMed

We have observed over 25 different mutations in the diastrophic dysplasia sulphate transporter gene (DTDST) in association with the recessive disorders achondrogenesis 1B, atelosteogenesis 2, and diastrophic dysplasia. The c862t (R279W) transition is the most common mutation in non-Finnish patients, but in these disorders it is usually combined with other DTDST mutations. We had not seen a case of homozygosity for c862t (R279W) until we analysed DNA from a 36 year old male with tall-normal stature (180 cm) who asked for genetic counselling for suspected multiple epiphyseal dysplasia. He was treated for club foot and hip dysplasia at birth. Skeletal changes consistent with multiple epiphyseal dysplasia, with the peculiar finding of a double layered patella, were recognised during childhood. Cleft palate, swelling of the ear pinna, and hitch hiker thumb were absent. He was found to be homozygous, and both healthy parents heterozygous, for the R279W mutation in DTDST, and his fibroblasts showed a sulphate incorporation defect typical of DTDST disorders. Counselling was given for a recessive disorder, thereby considerably reducing the probability of affected offspring. Multiple epiphyseal dysplasia is more frequently caused by dominant mutations in the COMP (EDM1, McKusick 132400) and COL9A2 genes (EDM2, McKusick 600204). A few other patients and families with features similar to our proband have been described previously and considered to have autosomal recessive MED (EDM4, McKusick 226900). This observation confirms the existence of this entity and assigns it to the phenotypic spectrum associated with mutations at the DTDST locus. PMID:10465113

Superti-Furga, A; Neumann, L; Riebel, T; Eich, G; Steinmann, B; Spranger, J; Kunze, J

1999-08-01

115

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

PubMed

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

2013-06-01

116

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

PubMed Central

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

2014-01-01

117

Tension-band wiring of transverse fractures of patella. The effect of site of wire twists and orientation of stainless steel wire loop: a biomechanical investigation.  

PubMed

Tension-band wiring is commonly used to treat transverse patella fractures. The most common configuration has parallel Kirschner (K) wires and a stainless steel wire loop placed in a vertically oriented figure of eight. Early mobilisation is important but can cause detrimental displacement at the fracture site. A wooden model of a transversely fractured patella was used to compare different fixation constructs. The fracture was fixed using two K wires and a stainless steel wire loop. One or two wire twists were used, placed either arbitrarily or at corners of the loop. The loop was oriented either vertically or horizontally. Interfragmentary compression at the point of wire breakage and permanent displacement on cyclic loading was measured for each construct. Placement of the figure of eight in a horizontal orientation with two wire twists at the corner improved interfragmentary compression by 63% (p<0.05, Tukey post hoc test). On cyclic loading, all constructs with vertical figure of eight but none with a horizontal construct failed (p=0.01; Fisher's exact test). Permanent fracture displacement after cyclic loading was 67% lower with horizontal figure of eight constructs (p<0.05; t test). Placing wire twists at the corner and a horizontal placement of figure of eight improves stability of the construct. PMID:17033766

John, J; Wagner, W W; Kuiper, J H

2007-10-01

118

Tension-band wiring of transverse fractures of patella. The effect of site of wire twists and orientation of stainless steel wire loop: a biomechanical investigation  

PubMed Central

Tension-band wiring is commonly used to treat transverse patella fractures. The most common configuration has parallel Kirschner (K) wires and a stainless steel wire loop placed in a vertically oriented figure of eight. Early mobilisation is important but can cause detrimental displacement at the fracture site. A wooden model of a transversely fractured patella was used to compare different fixation constructs. The fracture was fixed using two K wires and a stainless steel wire loop. One or two wire twists were used, placed either arbitrarily or at corners of the loop. The loop was oriented either vertically or horizontally. Interfragmentary compression at the point of wire breakage and permanent displacement on cyclic loading was measured for each construct. Placement of the figure of eight in a horizontal orientation with two wire twists at the corner improved interfragmentary compression by 63% (p<0.05, Tukey post hoc test). On cyclic loading, all constructs with vertical figure of eight but none with a horizontal construct failed (p=0.01; Fisher’s exact test). Permanent fracture displacement after cyclic loading was 67% lower with horizontal figure of eight constructs (p<0.05; t test). Placing wire twists at the corner and a horizontal placement of figure of eight improves stability of the construct.

Wagner, W. W.; Kuiper, J. H.

2006-01-01

119

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

1985-01-01

120

Medial Patellofemoral Ligament Reconstruction With a Looped Semitendinosus Tendon, Using Knotless Anchor Fixation on the Patella and Hybrid Fixation on the Femur  

PubMed Central

Medial patellofemoral ligament (MPFL) reconstruction is a reliable surgical method for stabilizing a dislocating patella, with multiple techniques previously described. Although outcomes are generally favorable, the procedure is technically demanding and relies on precise identification of native MPFL insertion sites, secure fixation of the graft to these sites, and appropriate graft tension. We describe a technique for MPFL reconstruction with a looped semitendinosus tendon. The 2 free limbs of the graft are secured into blind-end patellar sockets with knotless anchors, and the looped end is initially secured into a medial femoral socket with a button on the opposite (lateral) cortex. Use of an adjustable-loop button allows for gradual adjustment of graft tension, as well as re-tensioning after cycling of the knee, before final aperture fixation on the femur with an interference screw.

Golant, Alexander; Quach, Tony; Rosen, Jeffrey E.

2014-01-01

121

Quantitative T2 mapping of the patella at 3.0 T is sensitive to early cartilage degeneration, but also to loading of the knee  

PubMed Central

Objective The aim of the study was to explore the sensitivity and robustness of T2 mapping in the detection and quantification of early degenerative cartilage changes at the patella. Materials and methods Forty-two patients (22 women, 20 men) with a mean age of 30.3 years and a symptomatic cartilage defect of ICRS grade ?2 were examined using a 3 T MRI with an 8-channel knee coil. The cartilage lesion was graded based on high-resolution PD TSE and 3D isotropic TrueFISP images. T2 maps were calculated from a standard MESE-sequence, performed at the beginning and at the end of the scan (40 min in-between). Depending on the defect size, a region-of-interest (ROI) analysis was performed on 1–3 consecutive slices. Mean T2 values for the deep, superficial, and global layer as well as the zonal variation were compared among defect grades (ANOVA, post hoc Duncan-test) and over time (Student's t-test). Results T2-measurements directly correlated with the extent of cartilage defect (ICRS grade) at all layers and at both time-points. However, correlations were closer for the second measurement at the end of the scan. In this unloaded state, differences in T2-values became more pronounced and were significant even between cartilage of normal appearance adjacent to the defect and healthy cartilage of control patients (both ICRS grade 0). In contrast, there were no such differences among grades in the zonal variation at any time. Conclusion T2 mapping might be a sensitive method for the detection of early cartilage degeneration at the patella in the unloaded joint.

Apprich, S.; Mamisch, T.C.; Welsch, G.H.; Stelzeneder, D.; Albers, C.; Totzke, U.; Trattnig, S.

2012-01-01

122

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

2012-01-01

123

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

2011-01-01

124

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

125

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)] [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] [Univ. of Texas Medical School, Houston, TX (United States); and others

1995-02-10

126

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

PubMed

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

2011-02-01

127

CT arthrography and MRI of the patella.  

PubMed

The importance of CT scanning in the diagnosis of patello-femoral disorders is reviewed and illustrated. CT double-contrast technique is compared to Magnetic Resonance Imaging (MRI) using both clinical examples and a cadaver study. The authors demonstrate the superiority of MRI to CT in detecting retropatellar cartilage lesions. PMID:2603672

Handelberg, F; Shahabpour, M; Van Betten, F; Jerome, C P; Casteleyn, P P; Opdecam, P

1989-01-01

128

Genetics Home Reference: Nail-patella syndrome  

MedlinePLUS

... at the base of the nails (lunulae) are triangular instead of the usual crescent shape. Individuals with ... about genetic testing , particularly the difference between clinical tests and research tests . To locate a healthcare provider, ...

129

Biomechanics of the patellofemoral joint and its clinical relevance.  

PubMed

An analysis of the patellofemoral joint based on experimental determinations of pressure distributions on the patellar cartilage and vectorial calculations is presented. The extension torque of all quadriceps muscles is similar. The force transmitted to the patella by the retinacula is small in all knee positions. Because the rigid patella has its own lever arms and tendon insertions at different heights, the forces on patellar and quadriceps tendons are unequal. The small patellar contact areas change according to flexion and are dependent on quadriceps force. Retropatellar pressure is thereby limited and becomes independent of flexion angle. By virtue of the direct force transmission of the quadriceps tendon to the femur, the increase in the retropatellar force is strongly limited beyond 70 degrees. The lateral-to-medial ratio of contact areas, pressing forces, cartilage areas, and bone mass is always 1.6:1, whereas the mean pressure is the same on both facets. The osseous form of the patella does not allow identification of dysplasia because cartilage compensates for apparent incongruence, especially about the medial ridge. This permits the rigid patella to adapt itself to very different abutments. Its individual form results from functional adaptation and does not explain chondromalacia. The ventralization of the tibial tuberosity does not alter retropatellar loading. The mediodistal transfer results in a high increase of pressure on both facets. PMID:2394060

Hehne, H J

1990-09-01

130

Lateral retinaculum release in adolescent patellofemoral disorders: its relationship to peripheral nerve injury in the lateral retinaculum.  

PubMed

Adolescent patellofemoral disorders which are associated with recognizable change in the articular cartilage of the patella are called chondromalacia patellae. This is a clinical syndrome characterized by persistent retropatellar pain, but not always associated with histopathological changes of the articular cartilage. When lateral retinacular release is performed in such patients, pain is frequently eased even though lateral release does not always cause an appreciable change in patellofemoral contact pressure. This suggests that pain, at times, may emanate from the peripatellar retinacular supports themselves. Thirty-five knees of 22 patients suffering from anterior knee pain (with or without an unstable patella) were investigated histologically. Pathological changes in nerves were graded on a 0 to 3 + scale of severity. There was severe degenerative neuropathy in nine knees, moderate change in nine, and slight change in 11; the remaining six knees were normal. Histological investigation of the resected lateral retinaculum suggested that pain originated in the lateral retinaculum in many patients, and that degenerative changes in the nerves of the lateral retinaculum may be an important cause of pain in patients with patellofemoral disorders. PMID:1666010

Mori, Y; Fujimoto, A; Okumo, H; Kuroki, Y

1991-01-01

131

Ulnohumeral Chondral and Ligamentous OverloadBiomechanical Correlation for Posteromedial Chondromalacia of the Elbow in Throwing Athletes  

Microsoft Academic Search

Background: Previous studies have documented increased posteromedial contact forces with the elbow at lower flexion angles associated with valgus extension overload; however, the authors believe that posteromedial elbow impingement in association with valgus laxity is a complex pathological process that may occur throughout the entire throwing motion in the form of ulnohumeral chondral and ligamentous overload.Hypothesis: Valgus laxity with the

Daryl C. Osbahr; Joshua S. Dines; Nathan M. Breazeale; Xiang-Hua Deng; David W. Altchek

2010-01-01

132

The trichorhinophalangeal syndrome with repeated dislocation of the patella.  

PubMed

The trichorhinophalangeal syndrome associated with laxity of the skin and joints has been mistaken for Ehlers-Danlos syndrome (Jones 1988). We report a case of the trichorhinophalangeal syndrome which we mistook for the Larsen syndrome. Literature and published photographs of the Larsen syndrome are reviewed to highlight the similarities between these two entities. These observations may be of value in the genetic mapping of the Larsen syndrome, which perhaps is a contiguous gene syndrome. PMID:1563087

Puliyel, J M; Puliyel, M M; Varughese, S

1992-03-01

133

Correlation between trochlear dysplasia and anterior cruciate ligament injury.  

PubMed

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

2013-08-01

134

[Imaging of external instabilities of the patella. State of the art].  

PubMed

External femoropatellar instability is a dynamic abnormality from various origins: osseous, cartilaginous or musculotendinous; X-rays films cannot give a precise enough description of this phenomenon. Attention is drawn by anterior pain or a sensation of instability. Clinical analysis distinguishes between permanent, traumatic or transient dislocations which are now more frequently discovered as part of a femoro-patellar syndrome with or without cartilage involvement. Conventional imaging, CT-scan and MR imaging are based on faultless techniques. Lateral views precisely report femoropatellar architectural abnormalities and patellar instability. Skyline views are able to quantify the various parts of the dysplasia. Dynamic tests increase the sensitivity of the plain films. But the main shortcoming of these techniques is the lack of visualization of the initial patellar engagement in the trochlea. The femoropatellar component of the knee arthrography visualizes rather large cartilaginous lesions. CT-scan, better than skyline views, allows examining the patellar bone without interference with the trochlea (extended knee), during the engagement (15 degrees flexed knee) and after the engagement (30 degrees flexed knee). However, the examination technique varies from one author to another according to his own pathophysiologic understanding. With the bicondylar plane reference, the reliability of the CT-scan measurements are better than skyline views. Like the dynamic tests during the beginning of the patellar engagement at 15 degrees, flexion is more sensitive than those at 30 degrees. Finally, CT-scan arthrography demonstrates thinner cartilaginous lesions than conventional arthrography. Presently the main contribution of MR imaging consists of detecting transient patellar dislocation that a single clinical examination cannot differentiate from other internal knee disorders. MR imaging is more precise in analyzing the cartilaginous structure. Kinematic MR imaging, still in an experimental stage, offers a new approach to the dynamic study of the patellar tracking. PMID:8815227

Frot, B; Zeitoun, F; Stérin, P; Silbermann, O; Drapé, J L; Thivet, A; Benacerraf, R

1996-01-01

135

Pseudotumor of gout in the patella of a kidney transplant recipient  

Microsoft Academic Search

Background A 33-year-old renal transplant recipient presented with painless swelling of the right knee. Physical examination revealed an impressive knee joint effusion with no signs of inflammation. The patient did not remember a recent trauma, but he mentioned a strain 3 years earlier; radiographic findings had been normal at that time. The patient had suffered from end-stage renal disease due

Tanja Staub-Zähner; Daniela Garzoni; Christian Fretz; Christoph Lampert; Christian Öhlschlegel; Rudolf P Wüthrich; Thomas Fehr

2007-01-01

136

Results of total knee replacement with/without resurfacing of the patella  

PubMed Central

Objective To study the difference of post-op patellofemoral pain, clunk and crepitus in patients with/without resurfacing at 5 years who had pre-op patellofemoral pain. To study the incidence of post-operative patellofemoral pain, clunk and crepitus following patelloplasty in both the groups. Methods Retrospective review of 765 patients who had total knee replacement with/without resurfacing.Patients were asked about both pre-operative pain and also post-operative pain 5 years after the operation. Patients were examined by a specialist nurse at 5 years post-operatively to check for any patellofemoral clunk/crepitus. Conclusion In patients with pre-op PF pain, there is significant (p<0.005) higher incidence of post-op clunk in the R group. In patients without pre-op PF pain, there is significantly (p<0.005) higher incidence of post-op crepitus in the R group. In patients with/without pre-op PF pain, the incidence of post-op PF pain, clunk and crepitus is lower than in patients who underwent patelloplasty when compared to the other members of the NR group (statistically significant p<0.005). Level of Evidence: Type 4, Case series.

Khan, Abdul; Pradhan, Nikhil

2012-01-01

137

Prevention of hip and knee injuries in ballet dancers.  

PubMed

Hip problems form about 10% (7.0 to 14.2%) of most published series of ballet injuries. The abnormally large range of external rotation needed for a perfect turnout is primarily due to soft tissue adaptation, more readily achieved in the young dancer. Insufficient range of motion at the hip throws considerable stress on the other lower limb segments. The snapping hip syndrome is common (43.8% of hip problems), with about one-third associated with pain. A tight iliotibial band may contribute to this, and balanced flexibility requires special attention to abductor stretching. The external clicking hip must be distinguished from the internal clicking hip, which is associated with the joint and psoas tendon. Stress fractures of the hip are easily overlooked and, if undetected, they may progress to a complete fracture. Knee problems account for 14.0 to 20% of complaints, and over 50% of these are peri- or retropatellar problems. This includes synovial plica, medial chondromalacia, lateral patella facet syndrome, subluxing patella and the fat pad syndrome. Specific diagnosis leads to specific treatment and the best chance of cure. Mild hyperextension of the knee may be aesthetically desirable, but excessive range leads to symptoms in the posterior capsule and poor control. Young dancers with a tendency to very lax joint structures should be identified early and protected from overstretching. In the author's series, meniscal lesions did not appear to be as big a problem as reported elsewhere in the literature. Ballerinas appear to have less leg strength than other groups of athletes, having only 77% of the weight-predicted norms. The introduction of strength training for male and female dancers may reduce injuries and improve balance, but it requires an intensive educational programme to dispense with the many myths. There are several references to the development of early arthritis but, while relatively common in the foot, symptomatic arthrosis in ballet dancers' hips and knees is not more prevalent than in the general population. The young age at which serious dance training begins, the long and rigorous hours of practice, the thin ballet slipper, dancing en pointe and unusual dietary regimens may all contribute to injury patterns in varying degrees. PMID:3064238

Reid, D C

1988-11-01

138

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

2005-01-01

139

Species specific marine radiocarbon reservoir effect: a comparison of ?R values between Patella vulgata (limpet) shell carbonate and Gadus morhua (Atlantic cod) bone collagen  

Microsoft Academic Search

A number of recent studies of the UK coastal environment have assessed the 14C marine radiocarbon reservoir effect (MRE) via quantification of ?R values for several periods throughout the Holocene using marine mollusc shells. However, none have employed fish bone as the marine sample, and the importance of being able to use this material as a reliable dating tool is

N. Russell; G. T. Cook; P. Ascough; J. H. Barrett; A. Dugmore

2011-01-01

140

Sleeve fracture of the patella with lateral slip of the retinaculum: a case report in an 11-year-old child.  

PubMed

Adolescents are susceptible to patellar sleeve fractures. We present an interesting case of a patellar sleeve fracture in an 11-year-old child with lateral slip of the retinacular sleeve. Clinical assessment was difficult; however, an MRI scan confirmed the diagnosis. Surgical repair was undertaken, and the retinacular sleeve was repaired along with repair of the patellar tendon. The patient recovered well after surgery and underwent physiotherapy. A patellar sleeve fracture should always be suspected in patients less than 16 years of age, particularly in those with indirect acute trauma to the knee. Prompt surgical repair is important to achieve full functional recovery. PMID:24887051

Majeed, Haroon; Datta, Praveen; Dos Remedios, Ian

2014-09-01

141

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

PubMed

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

2010-06-01

142

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

PubMed Central

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

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

2014-01-01

143

Patellar (Kneecap) Fractures  

MedlinePLUS

... displacement) between the broken pieces of the patella. Comminuted fracture. This type of break is very unstable. ... bone shatters into three or more pieces. A comminuted fracture of the patella. Open fracture. In this ...

144

Segmental arthroscopic resection of the hypertrophic mediopatellar plica.  

PubMed

In a retrospective review of 64 knees (58 patients) treated during a 36-month period by segmental arthroscopic resection of a hypertrophic mediopatellar plica, each patient was questioned and/or examined a minimum of one year after surgery. Medial or retropatellar pain (95%), buckling (32%), swelling (25%), and snapping (16%) were symptoms associated with a hypertrophic mediopatellar plica. Findings during physical examination of medial and retropatellar tenderness (74%) suggest the presence of the condition. Thirty percent of knees had localized chondromalacia of the medial femoral condyle, while in 13% chondromalacia was localized to the medial patellar facet. Good to excellent results were obtained in 86% of knees with a hypertrophic mediopatellar plica, with or without localized chondromalacia. In patients who had associated conditions, the lesions were also treated arthroscopically; good to excellent results were obtained in 69% of these knees. PMID:6883849

Richmond, J C; McGinty, J B

1983-09-01

145

[Displacement of the tibial tuberosity in retropatellar cartilage damage and recurrent patellar dislocation].  

PubMed

In our hospital in the years 1980 till 1986 37 displacements of the tuberositas tibiae were performed in chondropathia patellae and recurrent luxation of the patella. The follow-up examination took into consideration the radiological and clinical findings, the subjective complaints and the ability of going in for sports. These clinical experiences and pressure measurements in the femoro-patellar joint show the best results after the displacement of the tuberositas tibiae according to Blauth. Additionally we recommend an accurate indication for chondropathia patellae and recurrent luxation of the patella and accompanying surgical measures. PMID:2565653

Krause, R; Paar, O; Bernett, P; Mayr, B

1989-02-01

146

Congenital patellar syndrome.  

PubMed

Congenital patellar syndrome is bilateral isolated absence of patella. Congenital patellar aplasia or hypoplasia associated with genetic disorders belongs to a clinically diverse and genetically heterogeneous group of lower limb malformations. Absence of patella as an isolated anomaly is extremely rare and we discuss such a case in a 9-year-old boy. PMID:19434325

Jerome, J Terrence Jose; Varghese, M; Sankaran, B

2009-01-01

147

MUSCLE FIRING PATTERNS IN TWO ARACHNIDS USING DIFFERENT METHODS OF PROPULSIVE LEG EXTENSION  

Microsoft Academic Search

Summary Activity patterns of six morphologically similar, homologous muscles were recorded from the fourth leg pair in two species of arachnids that use different mechanisms to extend the femur-patella (knee) joint during locomotion. The giant whipscorpion Mastigoproctus giganteus (Uropygi) lacks femur-patella extensor muscles but extends this joint with hydraulic pressure, a mechanism that appears to be phylogenetically primitive in arachnids.

JEFFREY W. SHULTZ

1992-01-01

148

Articular changes in experimentally induced patellar trauma  

Microsoft Academic Search

Only a few studies have described the microscopic pathology of the articular cartilage after trauma. In the present animal study, we demonstrate the effect of trauma on the articular cartilage of the patella and determine the histological changes. Traumatic injury of the patella was experimentally induced in 45 white New Zealand rabbits aged 4 to 6 months old. The articular

Ioannis K. Triantafillopoulos; Panayiotis J. Papagelopoulos; Panorea K. Politi; Panayiotis A Nikiforidis

2002-01-01

149

Calcified cartilage, subchondral and cancellous bone morphometry within the knee of normal subjects  

Microsoft Academic Search

This study examined calcified cartilage and bone structure in the development of age-related cartilage changes in the knee. Image analysis was used to examine the calcified cartilage and bone structure. There was a significant decrease in bone volume fraction with increasing age in the knee except for the patella. The study found the cancellous network of the patella to be

Barbara Koszyca; Nicola L. Fazzalari; Barrie Vernon-Roberts

1996-01-01

150

JAMA Patient Page: Septic Arthritis  

MedlinePLUS

CROSS SECTION THROUGH KNEE Synovial Membrane (Around Joint Space) Patella (Kneecap) Arthrocentesis of the Knee Patella Joint Space and Fluid T I BIA T IB I ... orally or by vein). Often, the infected joint space must be drained to eradicate the infection, hasten ...

151

[Anatomy and biomechanics of the patellofemoral joint: physiological conditions and changes after total knee arthroplasty].  

PubMed

The patellofemoral joint constitutes a complex anatomical and functional entity. The tensile force of the quadriceps femoris muscle is transmitted through the patella and patellar ligament onto the tibial tuberosity. This particular three-dimensional arrangement increases the torsional moment acting on the knee joint. Dynamic alignment of the patella is determined by trochlear geometry and is supported by active muscular and passive connective tissue stabilizers. In addition to the retinaculum of the patella, the medial patellofemoral ligament is attracting increasing clinical attention. Multidirectional motion of the patella is closely connected to retropatellar pressure distribution which can be modulated by moving the patellar ligament insertion. Implantation of a knee endoprosthesis changes the joint surface geometry and consequently patella kinematics and retropatellar pressure distribution. Finite element analysis provides the possibility to assess retropatellar pressure distribution before and after implantation of prostheses. PMID:21938492

Steinbrück, A; Milz, S; Woiczinski, M; Schröder, C; Utzschneider, S; Jansson, V; Fottner, A

2011-10-01

152

Modified pre-curved patellar basket plate, reconstruction of the proper length and position of the patellar ligament--a biomechanical analysis.  

PubMed

Biomechanical properties of basket plate fixation for fracture dislocation in the distal part of the patella were studied on 22 fresh-frozen lower extremities (human cadaveric knees). The patella and the patellar ligament with the proximal tibia were removed. A comminuted fracture of the distal part of the patella was created with a chisel. The fractured patella, patellar ligament and tibial tuberosity of each specimen were fixed with a basket plate and mounted into the jaws of the testing machine. The measured load to failure was 421.66+/-45.90 N, which is approximately 70% higher than the results in other studies. The results of the measurements verified the results of finite element analysis. The modified precurved patellar basket plate developed in this study showed improved performance compared to the pre-existing fixation methods. PMID:17433694

Krkovic, M; Bombac, D; Balazic, M; Kosel, F; Hribernik, M; Senekovic, V; Brojan, M

2007-06-01

153

Serum and Exudate Calcitonin Precursors as Predictors of Wound Infection and Dehiscence in Wartime Penetrating Injuries. Addendum.  

National Technical Information Service (NTIS)

To date, we have enrolled 148 patients into the study that have either been wounded in Iraq or Afghanistan and 5 control tissue patients who hae had their patella tendon repaired and donated pieces of the Autologous tendon.

B. K. Potter

2011-01-01

154

Knee pain (image)  

MedlinePLUS

... front of the knee can be due to bursitis, arthritis, or softening of the patella cartilage as ... knee. Overall knee pain can be due to bursitis, arthritis, tears in the ligaments, osteoarthritis of the ...

155

Prepatellar (Kneecap) Bursitis  

MedlinePLUS

... acting as cushions to help reduce friction. Prepatellar bursitis is an inflammation of the bursa in the ... the patella and the skin. ( Right ) In prepatellar bursitis, the bursa becomes inflamed and swollen. (Left) Reproduced ...

156

"Central" Quadriceps Tendon Harvest With Patellar Bone Plug: Surgical Technique Revisited  

PubMed Central

The objective of this article is to review the surgical technique for quadriceps tendon graft harvest while highlighting an additional technical note that has not been previously emphasized. The quadriceps tendon typically inserts eccentrically on the superior pole of the patella. By shifting the soft-tissue harvest to a location just off the medial edge of the tendon, the adjoining patellar bone plug will be centered on the superior pole of the patella, reducing the risk of an iatrogenic patellar fracture.

Scully, William F.; Wilson, David J.; Arrington, Edward D.

2013-01-01

157

Factors affecting fertilization success in two species of patellid limpet (Mollusca: Gastropoda) and development of fertilization kinetics models  

Microsoft Academic Search

Laboratory experiments were undertaken to examine fertilization success in the intertidal prosobranch limpets Patella ulyssiponensis and Patella vulgata. Alkalization of eggs (10 min in pH 9.0 sea water) prior to fertilization trials improved fertilization rates greatly. Fertilization\\u000a success was found to be a function of sperm concentration, gamete age and contact time. Sperm concentration needed for optimum\\u000a fertilization success in vivo

Alan N. Hodgson; Will J. F. Le Quesne; Stephen J. Hawkins; John D. D. Bishop

2007-01-01

158

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

2008-01-01

159

FOSSIL BLOOD DROPLETS IN MIOCENE DOMINICAN AMBER YIELD CLUES TO SPEED AND DIRECTION OF RESIN SECRETION  

Microsoft Academic Search

Two spiders (Filistatidae) in Miocene Dominican Republic amber, one newly identified and only the second known fossil of this family, have autospasized legs (detached at a predetermined locus of weakness when restrained by a non-self-induced source) at the patella-tibia joint. In both specimens, droplets of haemolymph (blood) are preserved exiting the patellae. The autospasized legs and the presence of haemolymph

DAVID PENNEY

2005-01-01

160

[Muscle training techniques and retropatellar chondropathy].  

PubMed

The authors have studied the efficacy of 3 different muscle training programs (electromyostimulation, isokinetic training and isometric training) in cases of patellar chondromalacia. The evaluation of the results was made by measuring the isokinetic strength on a Cybex II+ dynamometer at a low (30 degrees/sec) and a high (300 degrees/sec) angular velocity. The clinical evaluation was based on a modified score determined by the Arpege group. The results showed a better improvement of the muscular strength after electromyostimulation or isokinetic training. The clinical improvement was better on patients of groups I and III. PMID:1579841

Gobelet, C; Frey, M; Bonard, A

1992-01-01

161

Secondary Patellar Resurfacing after Primary Bicondylar Knee Arthroplasty did Not Meet Patients' Expectations  

PubMed Central

Secondary patella resurfacing is a controversial procedure which is applied in patients with anterior knee pain after a bicondylar knee arthroplasty (with unresurfaced patella). A group of 46 patients were submitted to this procedure and their satisfaction, range of motion and pain improvement was evaluated. 52.2% of the patients were satisfied with the procedure, with an improvement in pain (Visual Analogue Scale) of 65% and an improvement in range of motion in 56,5%, with roundabout half of the patients having no resolution to their complaints. Whilst an improvement was not achieved in all patients, as it was initially hypothesised, this procedure should be considered when a revision knee arthroplasty is performed with an unresurfaced patella.

Correia, Joao; Sieder, Marc; Kendoff, Daniel; Citak, Mustafa; Gehrke, Thorsten; Klauser, Wolfgang; Haasper, Carl

2012-01-01

162

Sports medicine in children: knee pain.  

PubMed

Knee pain is one of the most common issues among young athletes. A medical history and physical examination are required to categorize the pain. Athletic knee injuries can be chronic or acute. Chronic knee pain is commonly secondary to inflammation of the apophysis of the patella or the tibial tuberosity. Repetitive microtrauma of the subchondral bone is another etiology of chronic pediatric knee pain. Acute knee pain typically is associated with a traumatic injury. Patella contact or dislocation can occur because of a noncontact traumatic event. PMID:24555727

Taylor, Randolph

2014-02-01

163

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

PubMed

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

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

2013-01-01

164

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

2010-01-01

165

Patellar taping increases vastus medialis oblique activity in the presence of patellofemoral pain  

Microsoft Academic Search

A common rehabilitation strategy for patellofemoral pain syndrome (PFPS), which lacks scientific evidence, includes pulling the patella medially with tape to reduce pain and increase the vastus medialis oblique (VMO) muscle activity.The purpose of this study was to examine the effect of various patellar taping procedures on force production, EMG activity of the VMO and vastus lateralis (VL) muscles, and

Evangelos A. Christou

2004-01-01

166

Patellar taping increases vastus medialis oblique activity in the presence of patellofemoral pain  

Microsoft Academic Search

A common rehabilitation strategy for patellofemoral pain syndrome (PFPS), which lacks scientific evidence, includes pulling the patella medially with tape to reduce pain and increase the vastus medialis oblique (VMO) muscle activity. The purpose of this study was to examine the effect of various patellar taping procedures on force production, EMG activity of the VMO and vastus lateralis (VL) muscles,

Evangelos A. Christou

2004-01-01

167

Arthroscopic extraarticular reconstruction of the medial patellofemoral ligament with gracilis tendon autograft - surgical technique.  

PubMed

The standard approach to reconstruct the medial patellofemoral ligament (MPFL) is by mini-open incision at its patellar insertion and femoral origin. At the medial patella rim, the MPFL insertion may be visualized in most cases by dissection during surgery. On the femur, it is more difficult to localize the MPFL remnants by a mini-open incision due to soft tissue covering the anatomical origin. Therefore, the femoral MPFL origin is usually identified by intraoperative lateral fluoroscopy. However, the insertion and origin of the MPFL at the patella and femur might be directly visualized using an arthroscopic extraarticular approach from the knee joint through a window of the synovial layer. This is especially helpful on the femoral side but also at the patella to find the individual anatomical MPFL footprints. Arthroscopic extraarticular reconstruction may then be performed using one additional medial mid-parapatellar portal. The major advantages of this technique are an individualized anatomical procedure, which is minimal invasive and cosmetically appealing. The aim of this study was to describe the arthroscopic extraarticular approach to the MPFL insertion at the patella and origin at the femur through synovial windows and to explain the procedure of arthroscopic MPFL reconstruction with a gracilis tendon autograft. Level of evidence Expert opinion, surgical technique, Level V. PMID:22484369

Siebold, Rainer; Borbon, Carlo Angelo V

2012-07-01

168

[X-ray diagnosis of retropatellar diseases (author's transl)].  

PubMed

The article reports on a comprehensive, stepwise diagnosis in diseases of the knee joints. This includes a description of the indication, the technique of taking x-ray films, and x-ray findings, as well as arthrography of the femoropatellar joint in retropatellar diseases such as chondropathia patellae, osteochondrosis dissecans, traumas of the knee joints and arthrosis deformans. PMID:462098

Wahlers, B

1979-08-01

169

[Computed tomography of patellar chondropathy. Experimental and clinical results].  

PubMed

Experimental studies of patellae at autopsy and clinical CT-arthrographic examinations of 36 patients show that CT provides good demonstration of the retropatellar cartilage and its lesions. The value of the method compared with conventional radiographic examinations, arthroscopy and surgery is discussed. PMID:6421696

Lingg, G; Hering, L

1983-12-01

170

Total knee arthroplasty in a pseudoachondroplastic dwarfism patient with bilateral patellar dislocation.  

PubMed

Late presentation of congenital patellar dislocation with advanced osteoarthritis is rare. This article presents a case of a 59-year-old man with underlying pseudoachondroplastic dwarfism. Advanced osteoarthritis due to bilateral neglected congenital patellar dislocation was treated with total knee arthroplasty without patella relocation surgery. Two years later, the patient had an improvement in Knee Society scores, painless function, and stability. PMID:23177661

Oh, Kwang-Jun; Yoon, Jung-Ro; Yang, Jae-Hyuk

2013-01-01

171

Lateral patellofemoral ligament reconstruction using a free gracilis autograft.  

PubMed

Medial patellofemoral instability is a rare, disabling condition that is often associated with the wrong indication for lateral retinacular release or overcorrection with medializing tibial tubercle osteotomy. It is an even less common complication after total knee arthroplasty (TKA). The lateral patellofemoral ligament is an important lateral stabilizer of the patella against medial subluxation or dislocation. Until now, no report in the literature has described lateral patellofemoral ligament reconstruction with a free gracilis tendon autograft. Furthermore, there has not been a single case report of lateral patellofemoral ligament reconstruction after TKA. The authors describe a novel technique for reconstruction of the lateral patellofemoral ligament in a symptomatic medial subluxated patella resulting from TKA and extended lateral release in a 62-year-old patient. The result 1 year postoperatively was deemed successful. Clinically, the patella was stable, with correct tracking, and radiologically the patella was correctly positioned. With a technique similar to that used for the medial patellofemoral ligament, the lateral patellofemoral ligament can be reconstructed with a gracilis tendon autograft to permit stabilization independent of resting scar tissue of the lateral retinaculum. This operation can be performed in a minimally invasive way, without opening the joint, therefore decreasing the risk of joint infection. The authors showed a successful clinical and radiologic outcome 1 year after lateral patellofemoral ligament reconstruction in a patient with medial patellar instability after TKA and lateral release. PMID:24992066

Borbas, Paul; Koch, Peter P; Fucentese, Sandro F

2014-07-01

172

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

2012-01-01

173

A biomonitoring study: trace metals in algae and molluscs from Tyrrhenian coastal areas  

Microsoft Academic Search

Marine organisms were evaluated as possible biomonitors of heavy metal contamination in marine coastal areas. Concentrations of Cd, Cr, Cu, Pb, and Zn were measured in the green algae Ulva lactuca L., the brown algae Padina pavonica (L.) Thivy, the bivalve mollusc Mytilus galloprovincialis Lamarck, and the two gastropod molluscs Monodonta turbinata Born and Patella cerulea L. collected at six

Marcelo Enrique Conti; Gaetano Cecchetti

2003-01-01

174

Genetic Disorders of Glomerular Basement Membranes  

Microsoft Academic Search

This review provides current information about glomerular disorders that arise directly from inherited abnormalities in extracellular matrix proteins intrinsic to the glomerular basement membrane (Alport syndrome, thin basement membrane nephropathy, HANAC syndrome and Pierson syndrome). The authors also discuss disorders involving genetic defects in cellular proteins that result in structural defects in glomerular basement membranes (MYH9-related disorders, nail-patella syndrome).

Clifford E. Kashtan; Yoav Segal

2011-01-01

175

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

2004-01-01

176

[Chronic patellofemoral instability].  

PubMed

Chronic patellofemoral instability may lead to pain and early osteoarthrosis. Recurrent dislocations of the patella, lateral subluxation and chronic dislocation are summarized under this generic term. There are five different factors which may be responsible of the development of chronic patellofemoral instability: 1) elongation of the medial patellofemoral ligament (MPFL), 2) patella alta, 3) increased distance between tibial tuberosity and trochlea groove (TTTG) distance, 4) trochlea dysplasia and 5) torsional malalignment. To rule out these factors clinical examination, radiological diagnostics (luxation, subluxation in the Defilée view, trochlea morphology, patella alta) and magnetic resonance imaging (MRI) of TTTG distance and trochlea morphology are crucial. The indications of operative treatment are chronic pain with subluxation, chronic dislocation and recurrent dislocation. Currently the former frequently and universally used lateral release is only indicated in cases of subluxation and positive tilt. Biomechanical studies have shown that a lateral release will otherwise increase patellofemoral instability. The choice of the surgical technique depends on the factors underlying patellofemoral instability, the conditions of growth plate and cartilage damage. Among the different surgical options proximal and distal realignment procedures are differentiated. In cases of MPFL elongation and mild passive instability a medial reefing might be successful. In cases of MPFL elongation, high passive instability up to 30° of flexion (with or without trochlear dysplasia) MPFL reconstruction may be the treatment of choice. A trochleoplasty is rarely indicated. This treatment may be considered in cases of high grade trochlea dysplasia and passive instability at more than 30° of flexion. If the TTTG distance is increased (>20 mm) or in cases of patella alta distal realignment with tibial tubercle transfer should be considered. This operation might also be useful in the presence of lateral cartilage damage as an anteromedialization of the patella. PMID:22588526

Petersen, W; Forkel, P; Achtnich, A

2012-05-01

177

Evidence of accumulated stress in Achilles and anterior knee tendons in elite badminton players.  

PubMed

Tendon-related injuries are a major problem, but the aetiology of tendinopathies is unknown. In tendinopathies as well as during unaccustomed loading, intra-tendinous flow can be detected indicating that extensive loading can provoke intra-tendinous flow. The aim of present study is to evaluate the vascular response as indicated by colour Doppler (CD) activity in both the Achilles and patella tendon after loading during high-level badminton matches. The Achilles tendon was subdivided into a mid-tendon, pre-insertional, and insertional region and the anterior knee tendons into a quadriceps-, patella- and tuberositas region. Intra-tendinous flow was measured using both a semi-quantitative grading system (CD grading) and a quantitative scoring system (CF) on colour Doppler. Intra-tendinous flow in the Achilles and anterior knee tendons was examined in fourteen single players before tournament and after 1st and 2nd match, respectively on both the dominant and non-dominant side. All players had abnormal intra-tendinous flow (Colour Doppler ? grade 2) in at least one tendon in at least one scan during the tournament. At baseline, only two of the 14 players had normal flow in all the tendons examined. After 1st match, tendencies to higher intra-tendinous flow were observed in both the dominant patella tendon and non-dominant quadriceps tendon (P-values n.s.). After 2nd match, intra-tendinous flow was significant increased in the dominant patella tendon (P = 0.009). In all other locations, there was a trend towards a stepwise increase in intra-tendinous flow. The preliminary results indicate that high amount of intra-tendinous flow was found in elite badminton players at baseline and was increased after repetitive loading, especially in the patella tendon (dominant leg). The colour Doppler measurement can be used to determine changes in intra-tendinous flow after repetitive loading. PMID:20652535

Boesen, Anders Ploug; Boesen, Morten Ilum; Koenig, Merete Juhl; Bliddal, Henning; Torp-Pedersen, Soren; Langberg, Henning

2011-01-01

178

[The depth of the patellar groove of the femur (author's transl)].  

PubMed

The authors have measured the depth of the patellar groove in a 100 human cadavers. An angle of about 143 degrees have been found to be present in normal knees, confirming the work of Brattström. When the angle was more than 150 degrees, the groove was considered to be dysplastic and likely to lead to patellar instability. In contrast when the angle was less than 138 degrees, the groove was thought to be excessively deep. This was present in 19 cases, in 13 of which there were obvious lesions of the articular cartilage. This study in cadavers has been confirmed by a scan study of 148 patients complaining of femoro-patellar syndrome. Deep patellar grooves were frequent in this series, the mean angle being 129 degrees. 80 p. 100 of the patients had an angle less than 135 degrees. It is concluded that deep patellar grooves with a lower angle than normal favour the development of patellar chondromalacia. PMID:6211733

Buard, J; Benoit, J; Lortat-Jacob, A; Ramadier, J O

1981-01-01

179

Arthroscopic partial medial meniscectomy: an analysis of unsatisfactory results.  

PubMed

Results of 150 arthroscopic partial medial meniscectomies were analyzed by computer to identify the factors that lead to an unsatisfactory (fair or poor) outcome. The average follow-up for the group was 36 months (range 24-60 months). One-hundred ten men and 40 women were involved, with an average age of 48 years. The overall results were 58% excellent-good, 28% fair, and 14% poor. Most tears involved the posterior horn (76%). Bucket-handle, longitudinal, and flap tears were rated 88% excellent-good, whereas horizontal cleavage and degenerative and complex tears had only 45% excellent-good scores. The results were adversely affected by the severity of the chondromalacia, work-related injury, prior knee surgery, simultaneous lateral meniscectomy, and increased knee laxity. Because degenerative posterior horn tears had such a high percentage of unsatisfactory results, the question remains as to whether all these tears need to be removed. PMID:4091909

Ferkel, R D; Davis, J R; Friedman, M J; Fox, J M; Del Pizzo, W; Snyder, S J; Berasi, C C

1985-01-01

180

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

SciTech Connect

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

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

1986-06-01

181

Protecting a Patellar Ligament Reconstruction after Proximal Tibial Resection: A Simplified Approach  

PubMed Central

Limb salvage in tumor surgery has encouraged the development of megaprostheses. However, reattaching the ligamentum patellae poses a particular problem: avulsion and/or extensor lag may lead to poor function. We describe a new technique of patellar ligament reconstruction. The technique involves reattachment of the patellar ligament to the tibial tuberosity of the proximal tibial megaprosthesis, which has a porous surface created, and the repair is protected with a cerclage wire through the patella and the prosthesis. In 10 consecutive patients, the range of motion averaged 95° (median, 90°; range, 70°–120°), and the mean extension lag averaged 4° (median, 0°; range, 0°–20°). We had one case of patellar ligament avulsion. This technique resulted in good quadriceps function and a low incidence of complications. Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Titus, Vijay

2008-01-01

182

Double-Bundle Medial Patellofemoral Ligament Reconstruction With a Single Patellar Tunnel  

PubMed Central

Medial patellofemoral ligament (MPFL) reconstruction is an established method to prevent patellofemoral instability. Nevertheless, the anatomy and the biomechanical behavior of native MPFL are still under investigation, but in recent years they have become more defined. We propose a technique for MPFL reconstruction based on the results of recent anatomic studies regarding the patellar insertion of the MPFL. A double-bundle MPFL is reconstructed by use of the semitendinosus tendon passed through a single patellar tunnel, which crosses the patella from the midpoint of its medial border until its superolateral corner is reached. This method permits a strong patellar fixation, potentially reducing the risk of patellar fracture compared with double–patellar tunnel techniques. Moreover, it requires no fixation devices at the patella and only a single interference screw on the femoral side.

Zanon, Giacomo; Marullo, Matteo; Benazzo, Francesco

2013-01-01

183

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

PubMed

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

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

2014-06-01

184

A Novel Surgical Technique for Patellar Fracture: Application of Extra-articular Arthroscopy With Hanger-Lifting Procedure.  

PubMed

We describe a novel operative technique for patellar fracture. The patient is placed in the supine position for setup of both an image intensifier and arthroscopy. After routine intra-articular inspection with an arthroscope, an extra-articular space including the prepatellar bursa is developed. The space is created with a lifting hanger applied from a portal wherein an arthroscope can then afford both intra- and extra-articular observation of the articular and bony surface of the patella. By use of an image intensifier, the fracture can be treated and fixed in percutaneous fashion with the aid of an arthroscope. This new technique offers surgeons a magnified view of the patella, both intra- and extra-articularly, through a minimally invasive procedure. Although it includes inherent risks and limitations, this new application of arthroscopy would certainly help surgeons to treat patellar fracture. PMID:24265998

Maeno, Shinichi; Hashimoto, Daijo; Otani, Toshiro; Masumoto, Ko; Fujita, Nobuyuki; Saito, Seiji

2013-01-01

185

Simultaneous Medial and Lateral Patellofemoral Ligament Reconstruction for Combined Medial and Lateral Patellar Subluxation  

PubMed Central

Medial patellar subluxation (MPS) is a disabling, often iatrogenic patellar instability due to previous lateral release for patellar instability. Lateral release destabilizes the patella on the lateral side, worsening the initial lateral instability and causing MPS. MPS is poorly recognized and may range from subluxation to true dislocation. This report describes a technique developed in response to episodes of medial and lateral patellar subluxation after failed lateral release for patellar instability. The technique uses a graft that extends from the medial patellofemoral ligament origin through the quadriceps tendon to the lateral epicondyle, thereby reconstructing both the medial and lateral patellofemoral ligaments, as well as providing simultaneous stability to both the medial and lateral sides of the patella.

Saper, Michael G.; Shneider, David A.

2014-01-01

186

Triple fracture during rehabilitation after revision total knee arthroplasty.  

PubMed

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

2013-05-29

187

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

PubMed

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. PMID:16420378

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

2006-01-01

188

Tibial axis and patellar position relative to the femoral epicondylar axis during squatting  

Microsoft Academic Search

A laboratory-based study was performed to describe the tibial axis and patellar position relative to the femoral epicondylar (FE) axis during squatting. During the squat, the angle between the tibial and FE axes averaged 90.5°, and 66% of internal rotation of the tibia occurred before 15° flexion. In the mid-sagittal plane of the femur, the patella followed a circular arc,

Kathryn M Coughlin; Stephen J Incavo; David L Churchill; Bruce D Beynnon

2003-01-01

189

Le instabilità della rotula: evoluzione delle strategie chirurgiche  

Microsoft Academic Search

\\u000a Abstract  Over the past century more than one hundred surgical techniques have been described for the treatment of patella instability\\u000a without specific indications. In the latest years very important studies have been published and surgery became more selective\\u000a and less invasive. The recent literature reports good results of medial patellofemoral ligament reconstruction used alone\\u000a or with additional bony procedures.

M. Bianchi

2008-01-01

190

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

191

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

Microsoft Academic Search

In this retrospective case series 80 patients divided in 40 matched pair groups with an arthroscopically proven ACL insufficiency\\u000a were followed up for 15 years. One half was reconstructed using an autologous BTB patella graft, the other half was treated\\u000a by a conservative physiotherapeutic based rehabilitation program. At follow-up the clinical scores (Lysholm, IKDC) showed\\u000a no significant differences between subjects

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

2011-01-01

192

[Operative therapy in patellar chondropathy].  

PubMed

A critical appraisal of the results of conservative and surgical treatment of chondropathia patellae revealed that it has not yet proved possible to achieve a good surgical result in excess of 75%. Findings with a new direct method of measuring retropatellar pressure distribution on human specimens, and the knowledge thus obtained, are discussed in connection with clinical results. They show that more detailed knowledge of the cause of the chondropathy is required if surgical treatment is to be successful. PMID:6666250

Jäger, M; Plitz, W

1983-01-01

193

Water distribution patterns inside bovine articular cartilage as visualized by 1H magnetic resonance imaging  

Microsoft Academic Search

Objective To develop a magnetic resonance imaging (MRI) technique to non-invasively map water volume fraction (WVF) in articular cartilage. Special emphasis was placed on spatial resolution and temporal considerations, aimed at creating a procedure feasible for eventual human studies.DesignAbsolute proton density MR images of intact, ex vivo bovine patellae were calculated from fullyT1 relaxed, short echo time images. This was

E. M. Shapiro; A. Borthakur; J. H. Kaufman; J. S. Leigh; R. Reddy

2001-01-01

194

Measurement of depth-dependence and anisotropy of ultrasound speed of bovine articular cartilage in vitro  

Microsoft Academic Search

The inhomogeneous and anisotropic mechanical properties and structural components of articular cartilage (artC) may cause complex acoustic properties in this important tissue. In this study, we used 50-MHz ultrasound (US) to measure in vitro the depth-dependence and anisotropy of the US speed of artC collected from the bovine patellae. The US speeds of 18 disk artC specimens sampled from 18

S. G. Patil; Y. P. Zheng; J. Y. Wu; J. Shi

2004-01-01

195

Medial patellofemoral ligament reconstruction - A novel technique?  

PubMed Central

Patellofemoral instability is initially treated conservatively and surgical treatment is reserved for resistant cases. Reconstruction of medial patellofemoral ligament has gained popularity these days as it attempts at restoring soft tissue anatomy and biomechanics of medial patellar restraint back to normal. Here we describe our novel transverse patella single tunnel and femoral interference screw technique to reconstruct the medial patellofemoral ligament using free autologous gracilis and semitendinosus grafts.

Kalra, Mukesh; Mahapatra, Sudhir; Patralekh, Mohit Kumar; Kanojia, R.K.

2012-01-01

196

Geleidelijk ontstane pijn aan de anterieure zijde van beide knieën bij een 74-jarige sportieve man  

Microsoft Academic Search

Heel geleidelijk kreeg een 74-jarige man pijn rond zijn beide patellae, links meer dan rechts. Hij voelde de pijn vooral als\\u000a hij veel aan lichaamsbeweging had gedaan; hij speelde twee keer per week golf en deed regelmatig aan nordic walking. Na een\\u000a jaar begon hij ook nachtelijke kniepijn te krijgen. Deze pijn was anders van karakter en trad alleen op

Koos Nugteren

197

Integra artificial skin in the management of severe tissue defects, including bone exposure, in injured children.  

PubMed

A dermal substitute, Integra (Integra Neurosciences Implants SA, Sophia Antipolis, France) artificial skin, was used for wound management on three children with lower limb injuries in our institutions. In one case this biosynthetic material was applied directly to a bony surface (patella). This technique allows an early wound coverage and provides a satisfactory preparation for autograft. It can be a useful adjunct in the treatment of severe tissue defects in child limb injuries. PMID:16093952

Violas, Philippe; Abid, Abdelazis; Darodes, Philippe; Galinier, Philippe; de Gauzy, Jérome Sales; Cahuzac, Jean-Philippe

2005-09-01

198

Biomarkers of Lead Exposure and DNA Methylation within Retrotransposons  

PubMed Central

Background DNA methylation is an epigenetic mark that regulates gene expression. Changes in DNA methylation within white blood cells may result from cumulative exposure to environmental metals such as lead. Bone lead, a marker of cumulative exposure, may therefore better predict DNA methylation than does blood lead. Objective In this study we compared associations between lead biomarkers and DNA methylation. Methods We measured global methylation in participants of the Normative Aging Study (all men) who had archived DNA samples. We measured patella and tibia lead levels by K-X-Ray fluorescence and blood lead by atomic absorption spectrophotometry. DNA samples from blood were used to determine global methylation averages within CpG islands of long interspersed nuclear elements-1 (LINE-1) and Alu retrotransposons. A mixed-effects model using repeated measures of Alu or LINE-1 as the dependent variable and blood/bone lead (tibia or patella in separate models) as the primary exposure marker was fit to the data. Results Overall mean global methylation (± SD) was 26.3 ± 1.0 as measured by Alu and 76.8 ± 1.9 as measured by LINE-1. In the mixed-effects model, patella lead levels were inversely associated with LINE-1 (? = ?0.25; p < 0.01) but not Alu (? = ?0.03; p = 0.4). Tibia lead and blood lead did not predict global methylation for either Alu or LINE-1. Conclusion Patella lead levels predicted reduced global DNA methylation within LINE-1 elements. The association between lead exposure and LINE-1 DNA methylation may have implications for the mechanisms of action of lead on health outcomes, and also suggests that changes in DNA methylation may represent a biomarker of past lead exposure.

Wright, Robert O.; Schwartz, Joel; Wright, Rosalind J.; Bollati, Valentina; Tarantini, Letizia; Park, Sung Kyun; Hu, Howard; Sparrow, David; Vokonas, Pantel; Baccarelli, Andrea

2010-01-01

199

[Isokinetic torque of the knee extensor and flexor in patients with recurrent patellar dislocation].  

PubMed

In order to establish the role of muscle strength in the recurrent dislocation of the patella, an isokinetic study was performed using BIODEX, by which the concentric (CC) and passive eccentric (PEC) torques of the quadriceps and hamstrings were measured. The angle velocity was set at 30 degrees and 90 degrees/sec. The subjects were divided into three groups: (I) non-surgical, (II) surgical and (III) normal control. In each group 20 knees were tested, and the following results were obtained. 1. Peak torque: At either 30 degrees/sec or 90 degrees/sec of velocity, it was significantly smaller in group I. On the other hand, the torque in group II was similar to that of group III. 2. E/C (eccentric torque/concentric torque) ratio: PEC was divided by CC to express a muscular strength balance. At 30 degrees/sec velocity, group I showed a significantly high E/C ratio. Conclusion: The knees with recurrent dislocation of the patella exhibited significantly lower peak torque and irregular curve patterns. The muscle strength, has been restored to a near-normal level in the surgical group, therefore, the muscle weakness in this disorder can be considered to be a secondary factor. The eccentric torque appeared to play a major role in the development of recurrent dislocation of the patella. PMID:1512478

Sakuraba, K

1992-07-01

200

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

2010-01-01

201

Results of a second-generation constrained condylar prosthesis in primary total knee arthroplasty.  

PubMed

This is a prospective study of the results of a second-generation modular constrained condylar knee (CCK) prosthesis in primary total knee arthroplasty. Of 418 consecutive total knee arthroplasties performed by 1 surgeon, a second-generation modular CCK prosthesis was indicated for intraoperative stability in 30 knees (7.2%). Three knees were lost to follow-up, and 27 knees had a mean follow-up time of 5.4 years (range, 2-11.5 years). All tibial components had a cemented 35-mm stem extension, and 26 femoral components had a 100-mm uncemented stem extension. The indication for use of the CCK components was most commonly severe valgus deformity and incompetent medial collateral ligament. There were no revisions for loosening, patella problems, or tibial post fracture. A lateral retinacular release of the patella was performed in 6 knees (22%). An asymptomatic, minimally displaced patella fracture was noted in 2 knees (7.4%). Constrained condylar knees are used infrequently now but are successful for the treatment of the unstable primary knee that cannot be balanced. These results may be design specific. PMID:21778031

Lachiewicz, Paul F; Soileau, Elizabeth S

2011-12-01

202

Discrepancies of Patellofemoral Indices between Supine and Standing Merchant Views  

PubMed Central

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

Kim, Tae-Hoon; Lee, Jong-Soo

2014-01-01

203

Regional variations in human patellar trabecular architecture and the structure of the quadriceps enthesis: a cadaveric study  

PubMed Central

We investigated whether there were regional differences in the quadriceps enthesis and the patella bone structure that could suggest unequal force transmission to the patella. Quadriceps tendon enthesis was removed by cutting the patellae transversally in the middle and the quadriceps tendon approximately 1 cm from the bone. Tissues were post-fixed, decalcified, dehydrated through and embedded in paraffin wax. Serial longitudinal sections were cut, mounted on glass slides at 1-mm intervals and slides were stained. Trabecular architecture was analysed from digital images taken from the histological slides, and regional differences at the enthesis in the thickness of the uncalcified fibrocartilage and the cortical zone of calcified tissue (calcified cartilage and lamellar bone) were evaluated. At the quadriceps enthesis, the thickness of the cortical zone of calcified tissue was significantly greater in the central part of the enthesis than medially and laterally. The trabeculae were thicker in the central and lateral parts compared with the medial region. Similarly, the zone of uncalcified fibrocartilage was thicker laterally and centrally than medially. Bone structure and the thickness of uncalcified fibrocartilage presented a similarity between the centre and the lateral parts; however, the medial side was different. We suggest that the mechanical stress at the proximal quadriceps tendon enthesis is higher laterally and centrally compared with medially. This could induce a lateral patellar translation, which is potentially a risk factor for knee osteoarthritis.

Toumi, Hechmi; Larguech, Gaith; Filaire, Edith; Pinti, Antonio; Lespessailles, Eric

2012-01-01

204

Correlates of bone and blood lead levels in carpenters.  

PubMed

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

Watanabe, H; Hu, H; Rotnitzky, A

1994-08-01

205

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

2012-01-01

206

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.

2008-01-01

207

The role of osteonecrosis in canine coronoid dysplasia: arthroscopic and histopathological findings.  

PubMed

Coronoid dysplasia (CD) or medial coronoid disease is part of canine elbow dysplasia and eventually results in osteoarthrosis. Although CD was originally attributed to disturbed endochondral ossification, more recent data point to the subchondral bone. The objective of this study was to assess dysplastic bone and cartilage of dogs that underwent unilateral or bilateral arthroscopic subtotal coronoidectomy for the treatment of CD. Arthroscopic findings and histopathology of bone and cartilage removed from elbow joints with CD were compared. The most common arthroscopic finding was fragmentation with softening of the subchondral bone of the central part of the medial coronoid process. In dogs without obvious fragmentation, CD was characterised by bone softening and chondromalacia. During arthroscopic intervention dysplastic bone and cartilage were collected for histopathological assessment. Forty-five slices of formalin-fixed, paraffin-embedded bone and cartilage samples were stained using haematoxylin and eosin and evaluated. Histopathological findings primarily consisted of osteonecrosis of subchondral bone with necrosis within the marrow spaces. Histopathological changes in the articular cartilage were characterised by fibrillation, chondrocyte clone formation, and focal cartilage necrosis. The pathology was found primarily in the subchondral bone and not in the articular cartilage. Vascular compromise may play a role in the pathogenesis of osteonecrosis in CD. PMID:24797106

Mariee, I C; Gröne, A; Theyse, L F H

2014-06-01

208

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

PubMed

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

2007-01-01

209

Computational Wear Simulation of Patellofemoral Articular Cartilage during In Vitro Testing  

PubMed Central

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

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

2011-01-01

210

The very surface states on GaAs(001) surface by means of electronic and optical techniques  

NASA Astrophysics Data System (ADS)

Until now, Reflectance-Anisotropy Spectroscopy (RAS) in the visible has been the most used technique to quantify the anisotropy of these surfaces [1]. Low-energy electrons are believed to perturb more than photons and have not been employed to this purpose, despite their shorter penetration depth. In our presentation we show experimental results of High-Resolution Electron-Energy-Loss Spectroscopy (HREELS) applied to investigate the anisotropy of the GaAs(001)-c(4x4) and beta2(2x4) surfaces. We demonstrate the higher surface sensitivity of HREELS compared to RAS. Measurements are performed on high-quality samples grown in situ by Molecular Beam Epitaxy (MBE). The loss spectra taken in the two orthogonal surface directions have different intensities, particularly close to the fundamental gap, where surface like resonances, involving dimers, are observed. We discuss our HREELS and RAS data to identify the source of the anisotropy close to the critical point transitions where surface and bulk like excitations coexist. Our data are in very good agreement with DFT-LDA calculations for loss energies up to 3.5 eV [2]. The exposure of the reconstructed surfaces to molecular oxygen affects strongly the spectral features. [1] D.E.Aspnes, J.P.Harbison, A.A.Studna, L.T.Florez, Phys. Rev. Lett. 59 (1987) 1687; I.Kamiya, D.E.Aspnes, L.T.Florez, and J.T.Harbison, Phys. Rev. B 46 (1992) 15894. [2] A.Balzarotti, F.Arciprete, M.Fanfoni, F.Patella, E. Placidi, G.Onida, R.Del Sole, Surf. Sci. Lett. 524, L71 (2003); A.Balzarotti, E.Placidi, F.Arciprete, M.Fanfoni, F.Patella, Physical Review B, 67 115332 (2003); F.Arciprete, C. Goletti, E. Placidi, M.Fanfoni, F.Patella, P. Chiaradia, C. Hogan and A. Balzarotti, Phys. Rev. B 68 125328 (2003).

Placidi, Ernesto

2004-03-01

211

Tibial Tuberosity Osteotomy for Patellofemoral Realignment Alters Tibiofemoral Kinematics  

PubMed Central

Background Tibial tuberosity realignment surgery is performed to improve patellofemoral alignment, but could also alter tibiofemoral kinematics. Hypothesis Following tuberosity realignment in the malaligned knee, the reoriented patella tendon will pull the tuberosity back toward the pre-operative position, thereby altering tibiofemoral kinematics. Study Design Controlled laboratory study. Methods Ten knees were tested at 40°, 60° and 80° of flexion in vitro. The knees were loaded with a quadriceps force of 586 N, with 200 N divided between the medial and lateral hamstrings. The position of the tuberosity was varied to represent lateral malalignment, with the tuberosity 5 mm lateral of the normal position, tuberosity medialization, with the tuberosity 5 mm medial of the normal position, and tuberosity anteromedialization, with the tuberosity 10 mm anterior of the medial position. Tibiofemoral kinematics were measured using magnetic sensors secured to the femur and tibia. A repeated measures ANOVA with a post-hoc Student-Newman-Keuls test was used to identify significant (p < 0.05) differences in the kinematic data between the tuberosity positions at each flexion angle. Results Medializing the tibial tuberosity primarily rotated the tibia externally, compared to the lateral malalignment condition. The largest average increase in external rotation was 13° at 40° of flexion, with the increase significant at each flexion angle. The varus orientation also increased significantly by an average of 1.5° at 40° and 80°. The tibia shifted significantly posteriorly at 40° and 60° by an average of 4 mm and 2 mm, respectively. Shifting the tuberosity from the medial to the anteromedial position translated the tibia significantly posteriorly by an average of 2 mm at 40°. Conclusions Following tibial tuberosity realignment in the malaligned knee, the altered orientation of the patella tendon alters tibiofemoral kinematics. Clinical Relevance The kinematic changes reduce the correction applied to the orientation of the patella tendon and could alter the pressure applied to tibiofemoral cartilage.

Mani, Saandeep; Kirkpatrick, Marcus S.; Saranathan, Archana; Smith, Laura G.; Cosgarea, Andrew J.; Elias, John J.

2011-01-01

212

[Jumper's knee--a review].  

PubMed

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

Tibesku, C O; Pässler, H H

2005-06-01

213

Tensile properties of the medial patellofemoral ligament: The effect of specimen orientation  

PubMed Central

For recurrent patellar dislocation, reconstruction of the medial patellofemoral ligament (MPFL) with replacement autografts has often been performed but with only little data on the tensile properties of the MPFL to guide graft selection. With its complex anatomy and geometry, these properties are difficult to obtain. In this study, we showed how the orientation of the femur-MPFL-patella complex (FMPC) during uniaxial tensile testing can have a significant effect on its structural properties. Twenty two FMPCs were isolated from porcine stifle joints and randomly assigned to two groups of 11 each. For the first group, the specimens were loaded to failure with the patella oriented 30 degrees away from the direction of the applied load to mimic its orientation in situ, called natural orientation. In the second group, the patella was aligned in the direction of the tensile load, called non-natural orientation. The stiffness for the natural orientation group was 65 ± 13 N/mm, 32% higher than that for the non-natural orientation group (50 ± 17 N/mm; p < 0.05). The ultimate loads were 438 ± 128 N and 386 ± 136 N, respectively (p > 0.05). Ten out of 11 specimens in the natural orientation group failed at the femoral attachment (the narrowest portion of the MPFL) compared to 6 out of 11 in the non-natural orientation group. Our findings suggest that the specimen orientation that mimics the in-situ loading conditions of the MPFL should be used to obtain more representative data for the structural properties of the FMPC.

Kim, Kwang E.; Hsu, Shan-Ling; Woo, Savio L-Y.

2014-01-01

214

A Dominant-Negative Mutation of Mouse Lmx1b Causes Glaucoma and Is Semi-lethal via LBD1-Mediated Dimerisation.  

PubMed

Mutations in the LIM-homeodomain transcription factor LMX1B cause nail-patella syndrome, an autosomal dominant pleiotrophic human disorder in which nail, patella and elbow dysplasia is associated with other skeletal abnormalities and variably nephropathy and glaucoma. It is thought to be a haploinsufficient disorder. Studies in the mouse have shown that during development Lmx1b controls limb dorsal-ventral patterning and is also required for kidney and eye development, midbrain-hindbrain boundary establishment and the specification of specific neuronal subtypes. Mice completely deficient for Lmx1b die at birth. In contrast to the situation in humans, heterozygous null mice do not have a mutant phenotype. Here we report a novel mouse mutant Icst, an N-ethyl-N-nitrosourea-induced missense substitution, V265D, in the homeodomain of LMX1B that abolishes DNA binding and thereby the ability to transactivate other genes. Although the homozygous phenotypic consequences of Icst and the null allele of Lmx1b are the same, heterozygous Icst elicits a phenotype whilst the null allele does not. Heterozygous Icst causes glaucomatous eye defects and is semi-lethal, probably due to kidney failure. We show that the null phenotype is rescued more effectively by an Lmx1b transgene than is Icst. Co-immunoprecipitation experiments show that both wild-type and Icst LMX1B are found in complexes with LIM domain binding protein 1 (LDB1), resulting in lower levels of functional LMX1B in Icst heterozygotes than null heterozygotes. We conclude that Icst is a dominant-negative allele of Lmx1b. These findings indicate a reassessment of whether nail-patella syndrome is always haploinsufficient. Furthermore, Icst is a rare example of a model of human glaucoma caused by mutation of the same gene in humans and mice. PMID:24809698

Cross, Sally H; Macalinao, Danilo G; McKie, Lisa; Rose, Lorraine; Kearney, Alison L; Rainger, Joe; Thaung, Caroline; Keighren, Margaret; Jadeja, Shalini; West, Katrine; Kneeland, Stephen C; Smith, Richard S; Howell, Gareth R; Young, Fiona; Robertson, Morag; van T' Hof, Rob; John, Simon W M; Jackson, Ian J

2014-05-01

215

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

PubMed Central

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

2014-01-01

216

Biomechanical comparison of extensile exposures in total knee arthroplasty.  

PubMed

The "banana peel" exposure is a novel technique for knee joint exposure that consists of partially peeling the patellar tendon off the tibia, leaving the extensor mechanism intact distally and laterally. Although good clinical results have been reported with this technique with no disruption of the extensor mechanism, concerns exist that it could cause extensor lag, quadriceps weakness, or patellar tendon rupture. We compared the banana peel exposure repair to tibial tubercle osteotomy repair, which we chose as our benchmark procedure because much is known about its associated healing and rehabilitation protocols. In our study of 16 paired, fresh-frozen human knee specimens, the 2 techniques were used alternately for the right and left knees. To measure acute strength, 10 pairs were tested. The patella was clamped and pulled superiorly at 25 mm/min until failure. For cyclical testing (6 pairs), the knee was extended from 90 degrees of flexion to 0 degrees for 2000 cycles at 0.25 Hz while we monitored the distance between the inferior pole of the patella and the tibial diaphysis using a passive optical kinematic measuring system. Mean failure strengths of the banana peel and osteotomy groups were 2642+/-1104 N and 2123+/-562 N, respectively, suggesting that the banana peel repair is not weaker than the osteotomy repair. Neither group had a significant increase (via paired Student t test, P>.05) in the distance between the inferior pole of the patella and the tibial diaphysis, suggesting that neither exposure would result in extensor lag. PMID:20806776

Wall, Simon J; Rose, David M; Khanuja, Harpal S; Sutter, Edward G; Knight, Trevor A; Belkoff, Stephen M; Mears, Simon C

2010-06-01

217

A Dominant-Negative Mutation of Mouse Lmx1b Causes Glaucoma and Is Semi-lethal via LBD1-Mediated Dimerisation  

PubMed Central

Mutations in the LIM-homeodomain transcription factor LMX1B cause nail-patella syndrome, an autosomal dominant pleiotrophic human disorder in which nail, patella and elbow dysplasia is associated with other skeletal abnormalities and variably nephropathy and glaucoma. It is thought to be a haploinsufficient disorder. Studies in the mouse have shown that during development Lmx1b controls limb dorsal-ventral patterning and is also required for kidney and eye development, midbrain-hindbrain boundary establishment and the specification of specific neuronal subtypes. Mice completely deficient for Lmx1b die at birth. In contrast to the situation in humans, heterozygous null mice do not have a mutant phenotype. Here we report a novel mouse mutant Icst, an N-ethyl-N-nitrosourea-induced missense substitution, V265D, in the homeodomain of LMX1B that abolishes DNA binding and thereby the ability to transactivate other genes. Although the homozygous phenotypic consequences of Icst and the null allele of Lmx1b are the same, heterozygous Icst elicits a phenotype whilst the null allele does not. Heterozygous Icst causes glaucomatous eye defects and is semi-lethal, probably due to kidney failure. We show that the null phenotype is rescued more effectively by an Lmx1b transgene than is Icst. Co-immunoprecipitation experiments show that both wild-type and Icst LMX1B are found in complexes with LIM domain binding protein 1 (LDB1), resulting in lower levels of functional LMX1B in Icst heterozygotes than null heterozygotes. We conclude that Icst is a dominant-negative allele of Lmx1b. These findings indicate a reassessment of whether nail-patella syndrome is always haploinsufficient. Furthermore, Icst is a rare example of a model of human glaucoma caused by mutation of the same gene in humans and mice.

Cross, Sally H.; Macalinao, Danilo G.; McKie, Lisa; Rose, Lorraine; Kearney, Alison L.; Rainger, Joe; Thaung, Caroline; Keighren, Margaret; Jadeja, Shalini; West, Katrine; Kneeland, Stephen C.; Smith, Richard S.; Howell, Gareth R.; Young, Fiona; Robertson, Morag; van t' Hof, Rob; John, Simon W. M.; Jackson, Ian J.

2014-01-01

218

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

NASA Astrophysics Data System (ADS)

The trace element contamination levels in mollusks were evaluated for different marine coastal sites in the Mediterranean (Israeli coast), Red (Israeli coast) and North (German coast) Seas. Three bivalve species (Mactra corallina, Donax sp, and Mytilusedulis) and two gastropod species (Patella sp.and Cellana rota) were sampled at polluted and relatively clean sites, and their soft tissue analyzed for Hg, Cd, Zn, Cu, Mn and Fe concentrations. Representative samples were screened for organic contaminants [(DDE), polychlorinated biphenyls PCBs and polycyclic aromatic hydrocarbons (PAHs)] which exhibited very low concentrations at all sites. In the Red Sea, the gastropod C. rota showed low levels of Hg (below detection limit) and similar Cd concentrations at all the examined sites, while other trace elements (Cu, Zn, Mn, Fe) were slightly enriched at the northern beach stations. Along the Mediterranean coast of Israel, Hg and Zn were enriched in two bivalves (M. corallina and Donax sp.) from Haifa Bay, both species undergoing a long-term decrease in Hg based on previous studies. Significant Cd and Zn enrichment was detected in Patella sp. from the Kishon River estuary at the southern part of Haifa Bay. In general, Patella sp. and Donax sp. specimens from Haifa Bay exhibited higher levels of Cd compared to other sites along the Israeli Mediterranean coast, attributed to the enrichment of Cd in suspended particulate matter. Along the German coast (North Sea) M. edulis exhibited higher concentrations of Hg and Cd at the Elbe and Eider estuaries, but with levels below those found in polluted sites elsewhere.

Herut, Barak; Kress, Nurit; Shefer, Edna; Hornung, Hava

219

Giant intra-articular synovial osteochondromata of the knee  

PubMed Central

Background/Aim: Synovial chondromatosis associated, intra-articular loose bodies are usually small in size. Giant intra-articular loose bodies are rare. Case report: We present the case of a patient with synovial chondromatosis associated giant intra-articular loose bodies located under the patella and the intercondylar fossa, treated successfully with combined arthroscopic and open excision. Conclusion: Giant intra-articular loose bodies should be considered when treating patients with synovial chondromatosis. Arthroscopy confirms the diagnosis, allows the thorough examination of the knee joint, and subsequent excision of small or medium size attached synovial nodules or intra-articular loose bodies. Arthrotomy may be needed to excise giant loose bodies.

Sourlas, I; Brilakis, EV; Mavrogenis, AF; Stavropoulos, NA; Korres, DS

2013-01-01

220

Quadriceps and patellar tendon pie-crusting as a treatment for limited flexion in total knee arthroplasty.  

PubMed

The pie-crusting method of ligament and tendon lengthening has been used successfully in various tissues but is not reported in the literature as an option for patellar or quadriceps tendons to address flexion limitation. Our case report discusses a patient with longstanding flexion limitation who underwent primary total knee arthroplasty. The report reviews the literature on intraoperative treatments, which primarily pertains to the condition of patella baja, and demonstrates that the pie-crusting technique should be included as a treatment option for a tight extensor mechanism while having some advantages over tibial tubercle osteotomy or Z-plasty. PMID:24730010

Burge, J Ross; Sanchez, Hugo B; Wagner, Russell A

2014-04-01

221

Ultrasound-guided intra-articular knee injection in an obese patient.  

PubMed

A 35-yr-old woman was referred to our outpatient clinic for a right intra-articular knee aspiration and injection. She had a medical history notable for lymphedema and morbid obesity (Fig. 1). Her body mass index was recently calculated at greater than 60 kg/m(2). She had a history of four previous nonguided knee joint injections performed elsewhere that provided no significant improvement in pain. On physical examination, it was difficult to localize common knee joint bony landmarks, including the medial and lateral borders of the patella (Fig. 2). Consequently we opted to utilize ultrasound guidance for the knee joint injection via the technique described herein. PMID:22157502

Hurdle, Mark-Friedrich B; Wisniewski, Steve J; Pingree, Matthew J

2012-03-01

222

Anatomical basis of the role of vastus medialis muscle in femoro-patellar degenerative arthropathy.  

PubMed

In order to evaluate the femoro-patellar syndrome, more especially to better define the vastus medialis/vastus lateralis imbalance, we performed 44 anterior thigh region examinations in dissecting room subjects. Vastus medialis morphological aspect was always found regular without definite separation. One the other hand we found two innervation possibilities: either only one nerve pedicle from femoral nerve, associated with cartilage degeneration (arthrosis) located on the patella lateral facet, or two pedicles from femoral nerve, associated with either no arthrosis, or diffuse cartilage degeneration. The innervation mode seems to be determinant to explain the two functions of vastus medialis (knee extension and patellar alignment). PMID:7597569

Galtier, B; Buillot, M; Vanneuville, G

1995-01-01

223

Diurnal rhythm in the cell-division frequency of prochloron (prochlorophyta) in nature  

NASA Technical Reports Server (NTRS)

Frequencies of cell division stages in suspensions of Prochloron cells, expressed at regular intervals throughout a natural day-night cycle from several colonies of four species of host didemnid, are given. The proportion of dividing cells of Prochloron living symbiotically in colonies of a didemnid, Diplosoma virens, rises from about 4% during the night (20.00-04.00 hrs.) to about 13% in the morning (0,.00-12.00 hrs.), and then falls again in the afternoon. Similiar, though less pronounced, changes were observed among Prochloron cells in two other symbiotic didemnids, Lissoclinum patella and L. voeltzkowi.

Lewin, R. A.; Cheng, L.; Matta, J.

1983-01-01

224

Taping for knee osteoarthritis.  

PubMed

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

2013-10-01

225

Molecular Structure of Ascidiacyclamide benzene solvate  

NSDL National Science Digital Library

Ascidiacyclamide is part of the family of cyclic peptides and is usually found in coral reef systems throughout the tropical pacific. Ascidians use the molecule as a defense mechanism since it is cytotoxic. Ascidiacyclamide is isolated from the ascidian lissoclinum patella, which harbors a photosynthetic alga called procloron. There has been a great deal of speculation in the literature about this association and which one or both organisms biosynthesizes the peptides, although there is little hard evidence to support the speculation. Several research groups have reported syntheses of various members of the peptide family; there are also reports that these peptides sequester metals.

2003-04-09

226

Inhibition of the spider heartbeat by gravity and vibration  

NASA Technical Reports Server (NTRS)

The rate and vigor of the spider heartbeat is controlled by an external pacemaker. A mechanical feature of the spider cardio-vascular system is the production of high serum pressure in the prosoma and the legs. This appears to be the source for leg extension. The lyriform organ on the patella of the leg is sensitive to vibratory and kinesthetic stimuli. This sensitivity depends upon the degree of leg extension. Thus the activity of the heart and the response characteristics of the sense receptor are related. The effect of a supra-threshold vibratory or gravitational stimulus is to produce an inhibition and a tachycardia of the spider heartbeat.

Finck, A.

1984-01-01

227

[Patellar metastasis of colon carcinoma. A rarity in differential diagnosis of acute knee pain. Case report].  

PubMed

Although bone tumors are often located in the knee area, primary tumors of the patella are rare, and patellar metastases extremely rare. Only a few cases were reported in the literature originating from different primary tumors, mostly lung and breast [1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 18, 19, 20, 22]. There is only one other case description of a colon carcinoma [21]. We present a rare case of primary sigma carcinoma and patellar metastasis. Because of the increasing rate of colon carcinomas, neoplastic disease must be considered in the differential diagnosis in any patient with otherwise unexplained knee pain. PMID:11569159

Griener, B; Müller-Färber, J

2001-08-01

228

Deformation of the patellofemoral joint caused by synovial hemangioma: a case report.  

PubMed

A 15-year-old girl with synovial hemangioma of the knee joint presented with gait pain and occasional sudden swelling for over 7 years. Plain radiographs showed an irregular joint line and a lateral shift of the patella caused by malformation of the patellar groove. Arthroscopy was performed to resect the tumor and to release the lateral patellar retinaculum. If the synovial hemangioma exists in the patellofemoral joint during the growth period, we propose that early surgical treatment is necessary to avoid the deformation of the joint. PMID:24626098

Maeyama, Akira; Saeki, Kazuhiko; Hamasaki, Makoto; Kato, Yuki; Naito, Masatoshi

2014-07-01

229

Photosymbiotic ascidians from Pari Island (Thousand Islands, Indonesia).  

PubMed

Photosymbiotic ascidian fauna were surveyed in the subtidal zone off Pari Island in the Thousand Islands (Java Sea, Indonesia). Nine species were recorded: Didemnum molle, Trididemnum miniatum, Lissoclinum patella, L. punctatum, L. timorense, Diplosoma gumavirens, D. simile, D. simileguwa, and D. virens. All of these species have been previously recorded in the Ryukyu Archipelago, Japan. Diplosoma gumavirens and D. simileguwa were originally described from the Ryukyu Archipelago in 2009 and 2005, respectively, and all of the observed species are potentially widely distributed in Indo-West Pacific coral reefs. PMID:25061385

Hirose, Euichi; Iskandar, Budhi Hascaryo; Wardiatno, Yusli

2014-01-01

230

Bilateral patellar Köhler's disease in an eleven-year-old child with growth retardation: a case report.  

PubMed

Osteochondrosis of the primary ossification centre of the patella (Köhler's disease) has been reported as a rare cause of anterior knee pain in children between 5 and 9 years of age. The aetiology remains unclear. This is the first case report presenting a late bilateral patellar osteochondrosis with unilateral involvement of the proximal pole in an 11-year old boy with documented growth retardation. This case highlights the importance to thoroughly investigate young patients with patellar osteochondrosis for growth retardation. This case might indicate that growth retardation rather than growth spurt is an important aetiological factor of osteochondrosis. PMID:19492571

Corten, Kristoff; Vandenneucker, Hilde; Molenaers, Guy; Bellemans, Johan; Moens, Pierre

2009-04-01

231

Medial patellar subluxation without previous lateral release: a case report.  

PubMed

Medial patellar subluxation (MPS) is normally described following a lateral release. We report on a 14-year-old girl with MPS without previous lateral release. Arthroscopic examination demonstrated MPS at 0 and 30° of flexion, and the patella was tight in flexion on the lateral side. A low lateral release with a tibial tubercle transfer was performed, followed by repair of the lateral release with an iliotibial band flap, and lateral patellofemoral ligament reconstruction. Excellent functional outcome was achieved. This type of patellar instability is often overlooked and a high index of suspicion is needed for appropriate diagnosis and treatment. PMID:24755851

Saper, Michael G; Shneider, David A

2014-07-01

232

Osteomyelitis variolosa: a case report.  

PubMed

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

2011-04-01

233

Biochemical (T2, T2* and magnetisation transfer ratio) MRI of knee cartilage: feasibility at ultra-high field (7T) compared with high field (3T) strength  

Microsoft Academic Search

Objective  This study compares the performance and the reproducibility of quantitative T2, T2* and the magnetisation transfer ratio (MTR)\\u000a of articular cartilage at 7T and 3T.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Axial MRI of the patella was performed in 17 knees of healthy volunteers (25.8?±?5.7 years) at 3T and 7T using a comparable\\u000a surface coil and whole-body MR systems from the same vendor, side-by-side. Thirteen knee joints

Goetz H. Welsch; Sebastian Apprich; Stefan Zbyn; Tallal C. Mamisch; Vladimir Mlynarik; Klaus Scheffler; Oliver Bieri; Siegfried Trattnig

2011-01-01

234

[Knee endoprostheses--advances and questions].  

PubMed

Given the complex biomechanical situation of the knee joint, and the peculiarities of the individual patient, implantation of a knee joint endoprosthesis makes great demands on both the implant and the surgeon. The correct choice of implant from among unconstrained, semiconstrained and constrained types of endoprosthesis, as well as from among cemented, hybrid and uncemented anchorage, is essential. In addition, a meticulous preoperative analysis of knee and leg axes, and appropriate detailed presurgical planning is a must, as is uncompromisingly intensive postoperative physiotherapy. Clinical experience identifies the patella, instability and axis deviations as the major problems of knee arthroplasty. PMID:10372474

Mittelmeier, W; Hauschild, M; Gradinger, R

1999-05-20

235

Photosymbiotic ascidians from Pari Island (Thousand Islands, Indonesia)  

PubMed Central

Abstract Photosymbiotic ascidian fauna were surveyed in the subtidal zone off Pari Island in the Thousand Islands (Java Sea, Indonesia). Nine species were recorded: Didemnum molle, Trididemnum miniatum, Lissoclinum patella, L. punctatum, L. timorense, Diplosoma gumavirens, D. simile, D. simileguwa, and D. virens. All of these species have been previously recorded in the Ryukyu Archipelago, Japan. Diplosoma gumavirens and D. simileguwa were originally described from the Ryukyu Archipelago in 2009 and 2005, respectively, and all of the observed species are potentially widely distributed in Indo–West Pacific coral reefs.

Hirose, Euichi; Iskandar, Budhi Hascaryo; Wardiatno, Yusli

2014-01-01

236

Biology and augmentation of tendon-bone insertion repair  

PubMed Central

Surgical reattachment of tendon and bone such as in rotator cuff repair, patellar-patella tendon repair and anterior cruciate ligament (ACL) reconstruction often fails due to the failure of regeneration of the specialized tissue ("enthesis") which connects tendon to bone. Tendon-to-bone healing taking place between inhomogenous tissues is a slow process compared to healing within homogenous tissue, such as tendon to tendon or bone to bone healing. Therefore special attention must be paid to augment tendon to bone insertion (TBI) healing. Apart from surgical fixation, biological and biophysical interventions have been studied aiming at regeneration of TBI healing complex, especially the regeneration of interpositioned fibrocartilage and new bone at the healing junction. This paper described the biology and the factors influencing TBI healing using patella-patellar tendon (PPT) healing and tendon graft to bone tunnel healing in ACL reconstruction as examples. Recent development in the improvement of TBI healing and directions for future studies were also reviewed and discussed.

2010-01-01

237

Vastus Medialis Obliquus Muscle Morphology in Primary and Recurrent Lateral Patellar Instability  

PubMed Central

The morphology of the vastus medialis obliquus (VMO) muscle in the anatomical setting of an unstable patella has not been described. Therefore, the purpose of this study was to investigate the morphological parameters of the VMO muscle that delineate its importance in the maintenance of patellofemoral joint stability. Eighty-two consecutive subjects were prospectively enrolled in this study. The groups were composed of thirty patients with an acute primary patellar dislocation, thirty patients with recurrent patellar dislocation, and twenty-two controls. Groups were adjusted according to sex, age, body mass index, and physical activity. Magnetic resonance imaging was used to measure the VMO cross-sectional area, muscle-fiber angulation, and the craniocaudal extent of the muscle in relation to the patella. No significant difference was found with respect to all measured VMO parameters between primary dislocation, recurrent dislocation, and control subjects with a trend noted for only the VMO cross-sectional area and the VMO muscle-fiber angulation. This finding is notable in that atrophy of the VMO has often been suggested to play an important role in the pathophysiology of an unstable patellofemoral joint.

Balcarek, Peter; Oberthur, Swantje; Frosch, Stephan; Schuttrumpf, Jan Philipp; Sturmer, Klaus Michael

2014-01-01

238

Knee extensor mechanism reconstruction with an extended gastrocnemius flap and a saphenous neurocutaneous flap.  

PubMed

A 35-year-old woman had multiple fractures due to pedestrian versus motor vehicle accident by a truck. An open comminuted patellar fracture was initially managed with a tension band and cerclage wiring and primary closure of the wound. Other fractures were managed with proper internal fixation. Unfortunately, the fractured patella and overlying soft tissue became totally infected and a wide necrosis occurred. To control the wound, a complete debridement of dead tissue was undertaken and the patella and its tendon were removed, leaving a large bone and soft tissue defect on the knee joint. To reconstruct the extensor mechanism, an extended medial gastrocnemius flap including a tendinous portion of the Achilles was used. A saphenous neurocutaneous flap was simultaneously used for additional soft tissue coverage around the proximal tibia and remaining patellar tendon. At 12 months postoperatively, she showed complete extension, 135 degrees of flexion, and grade IV knee extensor power and was able to ambulate without a walking aid. PMID:19318876

Park, Jong Woong; Lee, Yong Seuk; Oh, Jong Keon; Park, Jung Ho; Lee, Jae Wook; Park, Joon Soo

2009-04-01

239

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

PubMed

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

2013-10-01

240

A joint-constraint model-based system for reconstructing total knee motion.  

PubMed

Comprehending knee motion is an essential requirement for studying the causes of knee disorders. In this paper, we propose a new 2-D-3-D registration system based on joint-constraint model for reconstructing total knee motion. The proposed model that contains bone geometries and an articulated joint mechanism is first constructed from multipostural magnetic resonance volumetric images. Then, the bone segments of the model are hierarchically registered to each frame of the given single-plane fluoroscopic video that records the knee activity. The bone posture is iteratively optimized using a modified chamfer matching algorithm to yield the simulated radiograph which is the best fit to the underlying fluoroscopic image. Unlike conventional registration methods computing posture parameters for each bone independently, the proposed femorotibial and patellofemoral joint models properly maintain the articulations between femur, tibia, and patella during the registration processes. As a result, we can obtain a sequence of registered knee postures showing smooth and reasonable physiologic patterns of motion. The proposed system also provides joint-space interpolation to densely generate intermediate postures for motion animation. The effectiveness of the proposed method was validated by computer simulation, animal cadaver, and in vivo knee testing. The mean target registration errors for femur, tibia, and patella were less than 1.5 mm. In particular, small out-of-plane registration errors [less than 1 mm (translation) and 2° (rotation)] were achieved in animal cadaver assessments. PMID:23963191

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

2014-01-01

241

Anatomy of the rat knee joint and fibre composition of a major articular nerve.  

PubMed

Several recent reports discuss the role of joint nerves in arthritis. Many of these are based on studies in the rat. The aim of this study is to examine the anatomy of the rat knee joint, in search for a primary articular nerve, and to analyze the fibre composition of that nerve. The results show that the structure of the joint differs in some respects from the human knee. At the upper end of the bony patella a cartilaginous patella extends proximally, forming the anterior wall of the suprapatellar bursa. Distinct collateral ligaments are integrated in the joint capsule. The extensor digitorum longus muscle bridges the knee joint, originating from the lateral femoral epicondyle. The well-developed menisci contain pyramid-shaped ossicles. The cruciate ligaments are arranged like in the human knee. A large posterior (PAN) and a small medial (MAN) articular nerve can be identified. The PAN is composed of some 400 axons, about 80% of which are unmyelinated. All myelinated fibres are sensory. They present a unimodal size spectrum with a size range of 1-8 microns, and a predominance of small fibres. Specific denervations indicate that about 1/3 of the unmyelinated axons represent afferents, and some 2/3 are sympathetic efferents. Interestingly, neonatal capsaicin treatment did not influence the number of unmyelinated PAN axons. The functional significance of the numerous unmyelinated sympathetic and sensory PAN axons in the normal knee joint remains to be elucidated. PMID:2048758

Hildebrand, C; Oqvist, G; Brax, L; Tuisku, F

1991-04-01

242

Long-term impacts of human harvesting on shellfish: North Iberian top shells and limpets from the Upper Palaeolithic to the present  

NASA Astrophysics Data System (ADS)

Humans have contributed to phenotypic and demographic changes in their prey from very early on in the colonization of Europe, including the harvesting of shellfish in coastal ecosystems. We estimated trends in population growth (variation in the number of individuals) from DNA sequences of modern specimens in two North Iberian molluscs, top shells (Osilinus lineatus, from 24 sequences and 14 haplotypes) and limpets (Patella vulgata, taken from the bibliography), which were subjected to very different levels of harvesting pressure during the Upper Palaeolithic (~ 20000 to ~ 6000 years ago). The less harvested Osilinus top shells experienced fluctuations in population numbers coincident with climatic oscillations. Patella limpets, which were harvested in greater numbers, suffered clear and uninterrupted decreases in their numbers during the Upper Palaeolithic. These trends coincided with morphological changes in shell size (length or width) in the same direction (i.e., shell size decreased when population size decreased and vice versa). The differing trends seen in taxa subjected to different intensities of harvesting pressure suggest that climate effects were overcome by anthropogenic selection (leading to a smaller average length) in limpets. We suggest that intense fishing pressure may have induced irreversible shell length decreases in the most exploited species.

Turrero, Pablo; Muñoz-Colmenero, A. Marta; Prado, Andrea; Garcia-Vazquez, Eva

2014-11-01

243

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

PubMed

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

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

2014-01-01

244

Longitudinal changes in bone lead levels: the VA Normative Aging Study  

PubMed Central

Objective Bone lead is a cumulative measure of lead exposure that can also be remobilized. We examined repeated measures of bone lead over 11 years to characterize long-term changes and identify predictors of tibia and patella lead stores in an elderly male population. Methods Lead was measured every 3–5 years by k-x-ray fluorescence and mixed-effect models with random effects were used to evaluate change over time. Results 554 participants provided up to 4 bone lead measurements. Final models predicted a ?1.4% annual decline (95%CI: ?2.2,?0.7) for tibia lead and piecewise linear model for patella with an initial decline of 5.1% per year (95%CI: ?6.2,?3.9) during the first 4.6 years but no significant change thereafter (?0.4% (95% CI: ?2.4, 1.7)). Conclusions These results suggest that bone lead half-life may be longer than previously reported.

Wilker, Elissa; Korrick, Susan; Nie, Linda H; Sparrow, David; Vokonas, Pantel; Coull, Brent; Wright, Robert O.; Schwartz, Joel; Hu, Howard

2011-01-01

245

The influence of varied gravito-inertial fields on the cardiac response of orb-weaving spiders  

NASA Technical Reports Server (NTRS)

The Gz transfer function was described for the orb weaving spider A. sericatus. The functional relationship between the heartrate and the intensity of G is linear in the form of: Y = a Log Gz-1 +k. The heartrate in unrestrained animals was recorded by a laser plethysmograph developed specifically for this purpose. Following a control, sample heartrate were taken postrotation between 1.001 and 1.5 Gz in 6 steps. The underlying distribution of heartrates does not appear significantly different from a Gaussian distribution. A method of varnishing the legs of the spider was developed. This was done in order to compromise the lyriform organs, especially those located on the patellae. The lyriform organ is hypothesized to serve the receptor role in the transduction of gravity related stimuli. In preliminary animals the Gz function, post varnishing of the patellae, appears to be changed in the direction of poorer discrimination. We also observed that the resting heartrate following the varnish procedure is substantially increased.

Finck, A.

1982-01-01

246

Medial Patellofemoral Ligament Reconstruction Procedure Using a Suspensory Femoral Fixation System  

PubMed Central

Recurrent patellar dislocation has recently been treated with anatomic medial patellofemoral ligament (MPFL) reconstruction using a semitendinosus muscle tendon. Although it is necessary to add tension to fix the tendon graft without loading excess stress on the patellofemoral joint, adjustment of the tension can be difficult. To resolve this problem, we developed an MPFL reconstruction procedure using the ToggleLoc Fixation Device (Biomet, Warsaw, IN), in which the semitendinosus muscle tendon is folded and used as a double-bundle tendon graft and 2 bone tunnels and 1 bone tunnel are made on the patellar and femoral sides, respectively. The patellar side of the tendon graft is fixed with an EndoButton (Smith & Nephew, London, England), and the femoral side is fixed with the ToggleLoc. Stepless adjustment of tension of the tendon graft is possible by reducing the size of the loop of the ToggleLoc hung onto the tendon graft. It may be useful to position the patella in the center of the femoral sulcus by confirming the patellofemoral joint fitting. Stability can be confirmed by loading lateral stress on the patella in the extended knee joint. This procedure is less invasive because opening of the lateral side of the femur is not necessary, and it may be useful for MPFL reconstruction.

Nakagawa, Shuji; Arai, Yuji; Kan, Hiroyuki; Ueshima, Keiichiro; Ikoma, Kazuya; Terauchi, Ryu; Kubo, Toshikazu

2013-01-01

247

Histopathological studies of the acute inflammation in synovial tissue of rat knee joint following intra-articular injection of PLA2 from Chinese Cobra (Naja naja atra) venom.  

PubMed

A phospholipase A2 was purified from Chinese Cobra Naja naja atra by a two-step procedure: gel filtration on Superdex 75 and reverse-phase high-performance liquid chromatography (HPLC) on a NUCLEOSIL 5 C18 column. Purified phospholipase A2 was homogeneous, as indicated by capillary electrophoresis and electrospray mass spectrometry. It was a basic protein (pI = 8.2 +/- 0.03) with a molecular mass of 13,258 Da. Amino acid sequence analysis of the N-terminal demonstrated a high degree of homology with other related PLA2 from elapid venoms. The histopathological effects of the purified PLA2 on synovial tissue of knee joint were studied in Wistar rats. Rats were injected intra-articularly with 100 microl solution of PLA2 of different concentrations. Synovial tissue samples with patella were taken for light microscope study. Histopathological evaluation revealed a significant induction of acute inflammation in synovial tissue after injection, as indicated by synovial lining-cell hyperplasia, subsynovial cellular infiltration, and peri-articular soft-tissue cellular infiltration. Marked inflammatory and proliferative changes in synovial tissue were evident after repeated intra-articular injections of 100 microg PLA2. This study failed to show any significant histological changes in cartilage of patella as well as in the surrounding muscle tissue of the knee joints. These results suggest that PLA2 purified from Chinese Cobra venom induce time- and dose-dependent inflammatory changes in the synovial tissue of rat knee joint. PMID:10219989

Zhang, C; Gopalakrishnakone, P

1999-05-01

248

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.

2011-01-01

249

Intoeing--fact, fiction and opinion.  

PubMed

Intoeing in children is a common cause of parental concern. A normal neurologic examination and normal height and weight for age help the physician exclude most associated skeletal dysplasias, and neuromuscular or metabolic diseases. Three causes of intoeing affect otherwise normal newborns and infants. Metatarsus adductus is the diagnosis if a "C" shaped curve, rather than a straight border, is present on the lateral aspect of the foot. About 90 percent of cases resolve by one year of age. Internal tibial torsion, although a normal finding in the newborn, is usually a matter of concern at walking age. When the child is walking or standing, the patella can be seen to point forward, with the foot pointing inward. Children with excessive femoral anteversion, the most common cause of intoeing, walk or stand with both patella and feet pointing inward. Nonsurgical treatment, with the exception of casting in children with metatarsus adductus, has not been shown to be effective. Osteotomy, the only effective treatment for rotational abnormalities of the femur and tibia, has high complication rates and should not be considered until the patient is eight to 10 years of age. Since disability from intoeing is extremely rare and most cases resolve spontaneously, observation and parental education are important from the time of diagnosis. PMID:7942424

Dietz, F R

1994-11-01

250

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.

2012-01-01

251

Description of patellar movement by 3D parameters obtained from dynamic CT acquisition  

NASA Astrophysics Data System (ADS)

The patellofemoral joint is critical in the biomechanics of the knee. The patellofemoral instability is one condition that generates pain, functional impairment and often requires surgery as part of orthopedic treatment. The analysis of the patellofemoral dynamics has been performed by several medical image modalities. The clinical parameters assessed are mainly based on 2D measurements, such as the patellar tilt angle and the lateral shift among others. Besides, the acquisition protocols are mostly performed with the leg laid static at fixed angles. The use of helical multi slice CT scanner can allow the capture and display of the joint's movement performed actively by the patient. However, the orthopedic applications of this scanner have not yet been standardized or widespread. In this work we present a method to evaluate the biomechanics of the patellofemoral joint during active contraction using multi slice CT images. This approach can greatly improve the analysis of patellar instability by displaying the physiology during muscle contraction. The movement was evaluated by computing its 3D displacements and rotations from different knee angles. The first processing step registered the images in both angles based on the femu?s position. The transformation matrix of the patella from the images was then calculated, which provided the rotations and translations performed by the patella from its position in the first image to its position in the second image. Analysis of these parameters for all frames provided real 3D information about the patellar displacement.

de Sá Rebelo, Marina; Moreno, Ramon Alfredo; Gobbi, Riccardo Gomes; Camanho, Gilberto Luis; de Ávila, Luiz Francisco Rodrigues; Demange, Marco Kawamura; Pecora, Jose Ricardo; Gutierrez, Marco Antonio

2014-03-01

252

Effect of cervicolabyrinthine impulsation on the spinal reflex apparatus  

NASA Technical Reports Server (NTRS)

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

Yarotskiy, A. I.

1980-01-01

253

A minimally invasive medial patellofemoral ligament arthroscopic reconstruction.  

PubMed

The medial patellofemoral ligament reconstruction is recognized as a good choice for patients with recurrent patellar dislocation. Most techniques of the medial patellofemoral ligament reconstruction are open surgeries. Recently, we present a minimally invasive medial patellofemoral ligament arthroscopic reconstruction technique as a possible alternative method for recurrent patellar dislocation. The aim of the study was to describe a safe and effective technique to perform medial patellofemoral ligament reconstruction. The graft was prepared in shape to "Y." Two 5-mm incisions were made in the skin above the medial edge of the patella. Two docking bone tunnels were drilled from medial edge to the center of the patella, mimicking the wide patellar insertion of the medial patellofemoral ligament, and a bone tunnel was made at the femoral insertion site. Two free ends of the graft were fixed into the patellar tunnels by lateral cortical suspension, and the folded end was fixed into the femoral tunnel by bioabsorbable interference screw. Average patellar tilt and the congruence angle were 30.7° ± 7.5° and 52.7° ± 7.3° and were reduced to 12.8° ± 0.9° and 2.3° ± 11.5° after treatment. The Kujala score was increased from 63.0 ± 9.0 to 91.0 ± 7.0. The minimally invasive medial patellofemoral ligament arthroscopic reconstruction in this paper seems to be helpful to increase safe of operation and treatment effect and reduce complications. PMID:23412307

Zhou, Jian-Wei; Wang, Cheng-Hai; Ji, Gang; Ma, Long-Fei; Wang, Juan; Zhang, Feng; Dong, Jiang-Tao; Wang, Fei

2014-02-01

254

Primary repair of ruptured patellar tendon augmented by semitendinosus.  

PubMed

Prolonged immobilization of the knee after repair of the patellar tendon can result in decreased patellar mobility, limited flexion, persistent pain, muscle weakness, and patella infra. In contrast, early motion prevents many of these unwanted effects. We evaluated the outcome of surgical repairs augmented by a distally based semitendinosus autograft to allow early mobilization. Between January 2010 and October 2010, 15 patients with patellar tendon ruptures were admitted; their average age was 37 years (range, 28-53). By 6 weeks after surgery, 120 degrees of flexion and brace-free ambulation were reached in most patients. By 6 months, most patients had recovered their preinjury levels of activity. At a minimum follow-up of 24 months, results of surgical repair were assessed with the Lysholm scoring. Five cases were excellent, nine cases were good, and one case was poor. Patella tendon repair augmented by semitendinosus tendon was strong enough to permit early motion and weight bearing with achievement of good and excellent results. PMID:24272833

El-Desouky, Ihab I; Mohamed, Molham M; Al Assassi, Mohammed

2014-06-01

255

Intraarticular location predicts cartilage filling and subchondral bone changes in a chondral defect  

PubMed Central

Background and purpose The natural history of, and predictive factors for outcome of cartilage restoration in chondral defects are poorly understood. We investigated the natural history of cartilage filling subchondral bone changes, comparing defects at two locations in the rabbit knee. Animals and methods In New Zealand rabbits aged 22 weeks, a 4-mm pure chondral defect (ICRS grade 3b) was created in the patella of one knee and in the medial femoral condyle of the other. A stereo microscope was used to optimize the preparation of the defects. The animals were killed 12, 24, and 36 weeks after surgery. Defect filling and the density of subchondral mineralized tissue was estimated using Analysis Pro software on micrographed histological sections. Results The mean filling of the patellar defects was more than twice that of the medial femoral condylar defects at 24 and 36 weeks of follow-up. There was a statistically significant increase in filling from 24 to 36 weeks after surgery at both locations. The density of subchondral mineralized tissue beneath the defects subsided with time in the patellas, in contrast to the density in the medial femoral condyles, which remained unchanged. Interpretation The intraarticular location is a predictive factor for spontaneous filling and subchondral bone changes of chondral defects corresponding to ICRS grade 3b. Disregarding location, the spontaneous filling increased with long-term follow-up. This should be considered when evaluating aspects of cartilage restoration.

2010-01-01

256

Construction-conditioned rollback in total knee replacement: fluoroscopic results.  

PubMed

Firstly, the way of implementing approximatively the initial rollback of the natural tibiofemoral joint (TFJ) in a total knee replacement (AEQUOS G1 TKR) is discussed. By configuration of the curvatures of the medial and lateral articulating surfaces a cam gear mechanism with positive drive can be installed, which works under force closure of the femoral and tibial surfaces. Briefly the geometric design features in flexion/extension are described and construction-conditioned kinematical and functional properties that arise are discussed. Due to a positive drive of the cam gear under the force closure during the stance phase of gait the articulating surfaces predominantly roll. As a result of rolling, a sliding friction is avoided, thus the resistance to motion is reduced during the stance phase. Secondly, in vivo fluoroscopic measurements of the patella tendon angle during flexion/extension are presented. The patella tendon angle/ knee flexion angle characteristic and the kinematic profile in trend were similar to those observed in the native knee during gait (0°-60°). PMID:22098089

Wachowski, Martin Michael; Fiedler, Christoph; Walde, Tim Alexander; Balcarek, Peter; Schüttrumpf, Jan Philipp; Frosch, Stephan; Frosch, Karl-Heinz; Fanghänel, Jochen; Gezzi, Riccardo; Kubein-Meesenburg, Dietmar; Nägerl, Hans

2011-01-01

257

Anterior instability in the throwing shoulder.  

PubMed

The disabled throwing shoulder is a multifactorial problem. Laxity of the glenohumeral joint is necessary to achieve a satisfactory velocity. Normal wear and tear with throwing may convert this normal amount of excessive translation into instability. Instability in the throwing athlete manifests itself in 2 forms: traumatic anterior instability that happens to occur in a throwing athlete and excessive anterior subluxation because of overuse that occurs in conjunction with the disabled throwing shoulder. In most cases, it is difficult to determine by physical examination or imaging how much laxity is too much; therefore, the managing physician should always err on the side of caution. A trial of rest and rehabilitation should always be attempted before any consideration of surgery. The multifactorial issues in the disabled throwing athlete should be corrected during this phase of treatment, including assessment and treatment of hip abnormalities, restoration of satisfactory core strength, correction of scapular dyskinesis, and an evaluation and correction of any biomechanical abnormalities in the throwing mechanism. Surgical management of anterior instability in the throwing shoulder depends on the mechanism of injury. The traumatic anterior instability patient is managed by acute surgical repair without a shift, utilizing mattress sutures to prevent suture chondromalacia on the humeral head or glenoid. The anterior laxity management centers on the posterior superior labrum, although occasionally the anterior labrum or capsule may be involved as well. Overall, symptomatic anterior instability is less common in the throwing shoulder. Jobe and colleagues are credited with the first successful technique for the correction of anterior instability in the throwing athlete, the anterior capsulolabral reconstruction by a subscapularis split. The success of this technique paved the way for the adoption of the current arthroscopic techniques that are utilized to correct instability in the throwing athlete. PMID:24787726

Savoie, Felix H; O'Brien, Michael J

2014-06-01

258

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

PubMed

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

Moore, A C; Burris, D L

2014-01-01

259

Mild musculoskeletal and locomotor alterations in adult rats with white matter injury following prenatal ischemia.  

PubMed

Early brain injury including white matter damage (WMD) appears strongly correlated to perinatal hypoxia-ischemia and adverse neurological outcomes in preterm survivors. Indeed, WMD has been widely associated with subtle to major motor disturbances, sensory, behavioral and cognitive impairments in preterm infants who afterward develop cerebral palsy (CP). Prenatal ischemia (PI) has been shown to reproduce the main features of WMD observed in preterm infants. The present study was aimed at determining in adult rats the impact of PI on brain axons, musculoskeletal histology and locomotor activity. PI was induced by unilateral intrauterine artery ligation at E17 in pregnant rats. We found axonal degeneration and reactive astrogliosis in several white matter regions of adult PI rats. We found mild myopathic and secondary joint changes, including increased variability in myofiber size in several hind limb muscles, decreased myofibers numbers but increased Pax 7 cells and myofiber size in the gastrocnemius, and mild knee and ankle chondromalacia. Although treadmill locomotion appeared normal, several kinematic parameters, such as stride length, amplitude, velocity and leg joint angles were altered in adult PI rats compared to shams. Using intra- and inter-group variability of kinematic parameters, PI seemed to impair the maturation of locomotion on the treadmill. In addition, PI rats exhibited spontaneous hyperactivity in open-field test. Musculoskeletal changes appeared concomitant with mild impairments in gait and posture. Our rodent model of WMD based on PI reproduces the mild motor deficits and musculoskeletal changes observed in many preterm infants with a perinatal history of hypoxia-ischemia, and contributes towards a better understanding of the interplay between brain injury, musculoskeletal histopathology and gait disturbances encountered subsequently. PMID:21382470

Delcour, Maxime; Russier, Michael; Xin, Dong L; Massicotte, Vicky S; Barbe, Mary F; Coq, Jacques-Olivier

2011-10-01

260

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

NASA Astrophysics Data System (ADS)

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

Lodwick, Camille J.

261

A mutation in COL9A1 causes multiple epiphyseal dysplasia: further evidence for locus heterogeneity.  

PubMed

Multiple epiphyseal dysplasia (MED) is an autosomal dominantly inherited chondrodysplasia. It is clinically highly heterogeneous, partially because of its complex genetic background. Mutations in four genes, COL9A2, COL9A3, COMP, and MATR3, all coding for cartilage extracellular matrix components (i.e., the alpha2 and alpha 3 chains of collagen IX, cartilage oligomeric matrix protein, and matrilin-3), have been identified in this disease so far, but no mutations have yet been reported in the third collagen IX gene, COL9A1, which codes for the alpha1(IX) chain. MED with apparently recessive inheritance has been reported in some families. A homozygous R279W mutation was recently found in the diastrophic dysplasia sulfate transporter gene, DTDST, in a patient with MED who had a club foot and double-layered patella. The series consisted of 41 probands with MED, 16 of whom were familial and on 4 of whom linkage analyses were performed. Recombination was observed between COL9A1, COL9A2, COL9A3, and COMP and the MED phenotype in two of the families, and between COL9A2, COL9A3, and COMP and the phenotype in the other two families. Screening of COL9A1 for mutations in the two probands from the families in which this gene was not involved in the recombinations failed to identify any disease-causing mutations. The remaining 37 probands were screened for mutations in all three collagen IX genes and in the COMP gene. The probands with talipes deformities or multipartite patella were also screened for the R279W mutation in DTDST. The analysis resulted in identification of three mutations in COMP and one in COL9A1, but none in the other two collagen IX genes. Two of the probands with a multipartite patella had the homozygous DTDST mutation. The results show that mutations in COL9A1 can cause MED, but they also suggest that mutations in COL9A1, COL9A2, COL9A3, COMP, and DTDST are not the major causes of MED and that there exists at least one additional locus. PMID:11565064

Czarny-Ratajczak, M; Lohiniva, J; Rogala, P; Kozlowski, K; Perälä, M; Carter, L; Spector, T D; Kolodziej, L; Seppänen, U; Glazar, R; Królewski, J; Latos-Bielenska, A; Ala-Kokko, L

2001-11-01

262

Cumulative lead exposure in community-dwelling adults and fine motor function: comparing standard and novel tasks in the VA Normative Aging Study  

PubMed Central

Background and Aims Lead exposure in children and occupationally-exposed adults has been associated with reduced visuomotor and fine motor function. However, associations in environmentally-exposed adults remain relatively unexplored. To address this, we examined the association between cumulative lead exposure—as measured by lead in bone—and performance on the Grooved Pegboard (GP) manual dexterity task, as well as on handwriting tasks using a novel assessment approach, among men in the VA Normative Aging Study (NAS). Methods GP testing was done with 362 NAS participants, and handwriting assessment with 328, who also had tibia and patella lead measurements made with K-X-Ray Fluorescence (KXRF). GP scores were time (sec) to complete the task with the dominant hand. The handwriting assessment approach assessed the production of signature and cursive lowercase l and m letter samples. Signature and lm task scores reflect consistency in repeated trials. We used linear regression to estimate associations and 95% confidence intervals (CI) with adjustment for age, smoking, education, income and computer experience. A backward elimination algorithm was used in the subset with both GP and handwriting assessment to identify variables predictive of each outcome. Results The mean (SD) participant age was 69.1 (7.2) years; mean patella and tibia concentrations were 25.0 (20.7) ?g/g and 19.2 (14.6) ?g/g, respectively. In multivariable-adjusted analyses, GP performance was associated with tibia (? per 15 ?g/g bone = 4.66, 95% CI: 1.73, 7.58, p=0.002) and patella (? per 20 ?g/g = 3.93, 95% CI: 1.11, 6.76, p = 0.006). In multivariable adjusted models of handwriting production, only the lm-pattern task showed a significant association with tibia (? per 15 ?g/g bone = 1.27, 95% CI: 0.24, 2.29, p = 0.015), such that lm pattern production was more stable with increasing lead exposure. GP and handwriting scores were differentially sensitive to education, smoking, computer experience, financial stability, income and alcohol consumption. Conclusions Long-term cumulative environmental lead exposure was associated with deficits in GP performance, but not handwriting production. Higher lead appeared to be associated with greater consistency on the lm task. Lead sensitivity differences could suggest that lead affects neural processing speed rather than motor function per se, or could result from distinct brain areas involved in the execution of different motor tasks.

Grashow, Rachel; Spiro, Avron; Taylor, Kathryn M.; Newton, Kimberly; Shrairman, Ruth; Landau, Alexander; Sparrow, David; Hu, Howard; Weisskopf, Marc

2013-01-01

263

Synovial chondrosarcoma arising from synovial chondromatosis of the knee.  

PubMed

We report the case of a 51-year-old woman who had suffered from right knee pain and stiffness for 40 years. Her symptoms had gradually worsened over the past 5 years. One year previously, when she first visited our clinic, plain radiographs and CT scan images had revealed synovial chondromatosis over the right knee. At the current admission, follow-up MRI showed synovial masses around the knee and worsening of endosteal cortical scalloping in the patella, femoral condyle, and tibial plateau. After diagnosis on the basis of frozen sections, the patient had total excision of the lesions and total knee athroplasty. Histological examination revealed synovial chondromatosis in the joint cavity and grade 1 chondrosarcoma invasion into the adjacent bone. In long-standing synovial chondromatosis, presentation with aggravated symptoms and deterioration on imaging findings should alert clinicians to the potential for malignant change. PMID:23405488

Yao, M-S; Chang, C-M; Chen, C-L; Chan, W P

2012-01-01

264

Giant intra-articular synovial osteochondromata of the knee.  

PubMed

Background/Aim: Synovial chondromatosis associated, intra-articular loose bodies are usually small in size. Giant intra-articular loose bodies are rare. Case report: We present the case of a patient with synovial chondromatosis associated giant intra-articular loose bodies located under the patella and the intercondylar fossa, treated successfully with combined arthroscopic and open excision. Conclusion: Giant intra-articular loose bodies should be considered when treating patients with synovial chondromatosis. Arthroscopy confirms the diagnosis, allows the thorough examination of the knee joint, and subsequent excision of small or medium size attached synovial nodules or intra-articular loose bodies. Arthrotomy may be needed to excise giant loose bodies. PMID:24470744

Sourlas, I; Brilakis, Ev; Mavrogenis, Af; Stavropoulos, Na; Korres, Ds

2013-07-01

265

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

PubMed Central

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

Lee, Sung-Eun; Cho, Sung-Hyoun

2013-01-01

266

Bilateral osteochondrosis of the primary patellar ossification centers in a young athlete: a case report.  

PubMed

: Osteochondroses are a group of idiopathic self-limited conditions seen in skeletally immature individuals. The term describes disturbances in endochondral ossification affecting either the primary or secondary ossification centers. Osteochondrosis of the tarsal navicular was first described by Köhler in 1908; the eponym "Köhler's disease" is commonly used to refer to this condition. In his original paper, Köhler also described one instance of an osteochondrosis of the primary patellar ossification center, a clinical entity that has since rarely been reported. We present a case of isolated bilateral "Köhler's disease of the patellae" in an approximately 7-year-old male athlete demonstrated clinically and radiographically by both plain radiographs and magnetic resonance imaging. PMID:23797161

Dharamsi, Aisha S; Carl, Rebecca L

2014-01-01

267

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

PubMed Central

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

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

2014-01-01

268

Allografts in the treatment of anterior cruciate ligament injuries.  

PubMed

Symptomatic knee instability is a common complaint among athletic individuals after a torn anterior cruciate ligament (ACL) of the knee. Allograft ACL reconstruction has gained popularity for primary and revision reconstructions. This graft choice has become popular with good intermediate term results combined with decreased operative times, hospital costs, and improved immediate postoperative pain and function. Intermediate follow-up has demonstrated similar results with autograft reconstructions, without the addition of donor site morbidity. Multiple allograft options exist for ACL reconstruction. The most commonly selected grafts include patellar tendon, Achilles tendon, and tibialis allografts. The use of a tibialis allograft provides a stout graft for reconstruction, while minimizing bone tunnel size. Bone-patella-bone allografts provide bone to bone fixation options with flexibility in tunnel selection sizing. PMID:17700373

Kuhn, Michael A; Ross, Glen

2007-09-01

269

Isolated avulsion of the vastus lateralis tendon insertion in a weightlifter: a case report  

PubMed Central

Introduction We report a case of isolated, unilateral avulsion of the vastus lateralis tendon from its insertion at the patella. This was diagnosed by magnetic resonance imaging, and underwent successful surgical repair. Case presentation A healthy 32-year-old national level power lifter presented with an isolated avulsion of the vastus lateralis tendon. After a failed course of conservative therapy he underwent surgical repair and a graded physical therapy programme. One year later he returned to full training with no evidence of re-rupture. Conclusion This is the first reported case of an isolated vastus lateralis avulsion. Our experience suggests that magnetic resonance imaging is invaluable in the diagnosis of this condition and that surgical repair provides a good outcome in high demand patients.

Trikha, Paul S; Wood, David G

2009-01-01

270

Bone Ingrowth in Well-Fixed Retrieved Porous Tantalum Implants  

PubMed Central

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 reason 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 were analyzed for bone ingrowth. The main reason for revision was infection for acetabular shells (1.4 year 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.

Hanzlik, Josa A.; Day, Judd S.

2013-01-01

271

Acute rupture of the anterior cruciate ligament and patellar tendon in a collegiate athlete.  

PubMed

In rare incidences of combined ruptures of the ACL and patellar tendon, either the patellar tendon ruptures or the associated ACL tear is often initially missed. Even when recognized, there is no established treatment regimen. We report a case of an intercollegiate football player with a combined rupture of the ACL and patellar tendon that was successfully treated by primary augmented repair of the patellar tendon along with ACL reconstruction. Similar to other reported cases, the mechanism of injury involved forceful eccentric contraction of the quadriceps against a fixed foot. Superior displacement of the patella with a palpable defect of the patellar tendon, a positive Lachman test, and an inability to perform terminal knee extension noted during the on-field examination indicated the combined injury. Magnetic resonance and radiographic imaging confirmed conclusions from the on-field examination. The patient also underwent safe early mobilization and weight bearing following surgical repair. PMID:17210443

Futch, Lydia A; Garth, William P; Folsom, Greg J; Ogard, William K

2007-01-01

272

[New concept in therapy of distal tibial metaphyseal fractures and pilon fractures with minor dislocations and severe soft tissue damage].  

PubMed

The treatment of pilon fractures and distal metaphysial tibia fractures demands very high standards on the osteosynthesis material regarding the soft tissue and the essential joint reconstruction. The selection of the surgical entrance, particularly in case of a critical arterial or venous circulation and the possible irritation of the soft tissue caused by the osteosynthesis material led us to search for alternative osteosynthesis methods. After the elaboration of a pre-clinical study and good first results in the treatment of patella, olecranon and ankle joint fractures by means of the XS-nail the latter is now also employed for pilon fractures. Within a time period of 8 month 5 fibula fractures coming with pilon fractures had been treated with the XS-nail. This case report will demonstrate both the technique of treatment and the flexibility of the new implant. PMID:12219651

Gehr, J; Friedl, W

2002-07-01

273

Efficacy and mid term results of lateral parapatellar approach without tibial tubercle osteotomy for primary total knee arthroplasty in fixed valgus knees.  

PubMed

The lateral parapatellar approach, despite providing direct access to the pathological area has not been widely accepted for knee arthroplasty in valgus deformities. We performed a modified lateral (Keblish) approach which consisted of coronal z plasty of lateral retinaculum, quadriceps snip, titrated sequential lateral release and closure with expanded lateral structures in 32 arthritic fixed valgus knees. In 30 knees, either tendon of popliteus or lateral collateral ligament or both could be preserved. At an average follow-up of 5 years, the valgus alignment improved from 25.4° (11°-60°) to 4° (0°-10°) and knee society score improved from 34 to 95 points. There was no late instability or revisions. This approach is rational, eliminates patella maltracking, is applicable in severe deformities and with titrated release, can preserve the posterolateral knee stabilizers that are necessary for long term implant survival. PMID:23702269

Satish, Bhava R J; Ganesan, Jutty C; Chandran, Prakash; Basanagoudar, Praveen L; Balachandar, Damodharasamy

2013-12-01

274

The trivector approach for minimally invasive total knee arthroplasty: a technical note.  

PubMed

One of the main criticisms of minimally invasive approaches in total knee arthroplasty has been their poor adaptability in cases of major deformity or stiffness of the knee joint. When they are used in such cases, excessive soft-tissue tension is needed to provide appropriate joint exposure. Here, we describe the "mini trivector approach," which has become our standard approach for total knee replacement because it permits us to enlarge the indication for minimally or less invasive total knee replacement to many knees where quad sparing, a subvastus approach, or a mini quad or mini midvastus snip may not be sufficient to achieve correct exposure. It consists of a limited double snip of the VMO and the quadriceps tendon that reduces tension on the extensor mechanism and allows easier verticalization of the patella as well as good joint exposure. PMID:22527151

Benazzo, Francesco; Rossi, Stefano Marco Paolo

2012-09-01

275

I: Staging and Co-Morbidities  

PubMed Central

Articular cartilage lesions of the distal femur and patella are common. In order to provide an accurate diagnosis of a clinically symptomatic cartilage lesion and subsequent appropriate planning for potential treatment options a proper staging is required. This includes clinical exam, radiographic imaging, and arthroscopy. Once the staging is completed other co-morbidities may need to be addressed that may require additional surgical procedures. These can either be planned as staged procedures of concomitantly with a cartilage repair procedure. This article will discuss this staging and evaluation process in depth in order to serve as a guideline to the orthopaedic surgeon engaged in the treatment of cartilage defects in patients with early posttraumatic osteoarthritis.

Lattermann, Christian; Luckett, Matthew R

2014-01-01

276

Knee fusion--a new technique using an old Belgian surgical approach and a new intramedullary nail.  

PubMed

Knee arthrodesis is a useful procedure in difficult cases such as failed total knee arthroplasty, severe articular trauma, bone tumors, and infected knee joints. The most common techniques for knee fusion include external fixation and intramedullary nailing. Küntscher's nail is driven antegrade from the intertrochanteric region into the knee. We describe a new technique for knee arthrodesis using a new intramedullary nail and an old Belgian surgical approach to the knee joint published by Lambotte in 1913. This approach provides excellent exposure for the implantation of the nail by osteotomizing the patella vertically. The nail is implanted using HeyGroves method, whereby the nail is inserted retrograde into the femur and pulled distally anterograde into the tibia. We now use this technique as our standard procedure for knee fusion. PMID:11284271

Alt, V; Seligson, D

2001-02-01

277

Effects of retinacular release and tibial tubercle elevation in patellofemoral degenerative joint disease.  

PubMed

Release of the patellar retinaculum and tibial tubercle elevation have both been advocated for the treatment of patellofemoral degeneration. Questions remain, however, regarding the magnitude and predictability of such effects in diseased joints. Using cadaver knee joints exhibiting a range of patellofemoral cartilage degeneration, we investigated the effects on joint contact pressures on release of the patellar retinaculum, followed by tibial tubercle elevations of 1.25 and 2.5 cm. Retinacular release failed to alter the joint-loading parameters significantly. Tibial tubercle elevation reduced the patello-femoral joint contact area and contact force, but failed to cause a consistent change in contact pressure. Tibial tubercle elevation also caused a migration of the joint contact area superolaterally on the retropatellar surface. This migration occurred in conjunction with ventral tilting of the inferior pole of the patella as the tubercle was elevated, suggesting that significant changes in joint kinematics may result from this procedure. PMID:2213343

Lewallen, D G; Riegger, C L; Myers, E R; Hayes, W C

1990-11-01

278

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

PubMed

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

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

2014-01-01

279

Total knee arthroplasty in patients with a previous patellectomy.  

PubMed

Post-patellectomy patients represent a specific subgroup of patients that may develop arthritis and persistent knee pain and potentially require treatment with total knee arthroplasty. This article reviews the treatment and functional outcomes following total knee arthroplasty in patients with prior patellectomy. A case report is presented as an example of the clinical management of a post-patellectomy patient with significant knee pain and disability treated with total knee arthroplasty. Emphasis will be placed in decision- making, specifically with the use of a posterior stabilized implant. In addition, postoperative strengthening of the quadriceps is essential to compensate for the lack of the patella and increase the success of total knee arthroplasty in this subgroup of patients. PMID:24151951

Maslow, Jed; Zuckerman, Joseph D; Immerman, Igor

2013-01-01

280

Use of fourteen gauge angiocatheter needle in orthopaedics  

PubMed Central

Backgrounds Wide-bore angiocatheter is readily available in the hospital in pre-sterilized packed form. There are various uses in medical and surgical field apart from its use for transfusion. Here we are outlining its various uses in orthopaedic surgeries. Method Fourteen gauge angiocatheter which internal diameter is 1.3 mm is used in fracture of patella, olecranon to pass the stainless steel (SS) wire, in scaphoid fracture fixation and hip arthroscopy and its efficacy is noted. Result Surgical procedure assisted by 14 gauge angiocatheter reduces surgical time, and soft tissues damage and it also helped in scaphoid fixation and hip arthroscopy. Conclusion Passing SS-wire through soft tissues and bone causes lots of trouble and time consuming. With the help of angiocatheter it overcomes these problems. So, its use in orthopaedic surgeries are rewarding.

Lal, Hitesh; Singh, Satya Prakash; Tanwar, Yashwant Singh; Habib, Masood

2013-01-01

281

Gravity Reception and Cardiac Function in the Spider  

NASA Technical Reports Server (NTRS)

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

Finck, A.

1985-01-01

282

Genome streamlining and chemical defense in a coral reef symbiosis  

PubMed Central

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

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

2012-01-01

283

[Soft tissue balancing in valgus gonarthrosis].  

PubMed

Implanting a condylar knee in patients with valgus deformity is challenging both for the surgeon and in terms of clinical instrumentation. Valgus deformity - defined as an anatomic angle >10 degrees - consists of a bony and a soft tissue component. Frequently, the lateral femoral condyle is hypoplastic and can create a secondary osteochondral lesion on the tibial plateau. Concomitantly, there is a soft tissue contracture of the lateral side with an elongation of the medial collateral ligament. Correction of the deformity and restoration of anatomic alignment should be achieved to maximize the longevity of the replaced components. Soft tissue balancing is crucial for successful treatment. This is achieved if a symmetrical flexion and extension gap together with a centralized patella position is obtained. We describe our surgical approach to address valgus deformities in primary total knee arthroplasty with special emphasize on a stepwise release of tight lateral capsular and ligamentous structures controlled by a knee balancer. PMID:17563870

Pape, D; Kohn, D

2007-07-01

284

The Prochloron symbiosis  

NASA Technical Reports Server (NTRS)

Colonies of L. patella were collected from inshore water adjacent to small islets near Babelthaup Island, Republic of Palau, for the purpose of studying Prochloron symbionts. Examination of the algal symbionts after fixing, dehydrating, and embedment in Epon, showed Prochloron's central body to consist of a granular ground substance with a few electron-dense inclusions and to be enclosed by prominent photosynthetic membranes. Also found around the central body were thylakoids in a concentric pattern. After comparing the results with those of former studies, it was suggested that Prochloron morphology is host specific. Finally the network of host tissue extensions that entraps the symbionts was noted as possibly being a site for metabolic exchange.

Pardy, R. L.; Lee, K.; Lewin, R. A.

1984-01-01

285

Effects of Kinesiology Taping on Repositioning Error of the Knee Joint after Quadriceps Muscle Fatigue  

PubMed Central

[Purpose] The purpose of this study was to identify the effects of kinesiology taping on repositioning error of the knee joint after quadriceps muscle fatigue. [Subjects] Thirty healthy adults with no orthopaedic or neurological problems participated in this study. [Methods] The repositioning error of the knee joint was measured using a digital goniometer when the subjects extended their dominant-side knee to a random target angle (30°, 45°, or 60°) with their eyes closed, before and after a quadriceps muscle fatigue protocol, and after application of kinesiology tape. [Results] We found that repositioning errors of the dominant-side knee joint increased after quadriceps fatigue compared with no-fatigue conditions. However, kinesiology taping of the quadriceps muscle and patella after quadriceps fatigue significantly decreased repositioning errors of the knee joint. [Conclusion] These results suggest that quadriceps fatigue increases the repositioning error of the knee joint, whereas application of kinesiology tape decreases fatigue-induced joint repositioning error.

Han, Jin Tae; Lee, Jung-hoon

2014-01-01

286

Virtual reality in surgical arthroscopic training.  

PubMed

Arthroscopy has become an irreplaceble method in diagnostics. The arthroscope, with optics and light source, and the exploratory probe are inserted into the knee joint through two small incisions underneath the patella. Currently, the skills required for arthroscopy are taught through hands-on clinical experience. Therefore, the Fraunhofer-Institut fuer Graphische Datenverarbeitung in Darmstadt, in cooperation with the Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, developed a highly interactive medical training system for arthroscopy through computer graphics and virtual reality (VR) techniques. Two main issues are addressed: the three-dimensional (3-D) reconstruction process and the 3-D interaction. The goal of the reconstruction process is to obtain a realistic representation of the knee joint derived from a magnetic resonance image sequence suitable for computer simulation. Moreover, the 3-D interaction of the training system must stimulate real arthroscopy, providing an intuitive handling of the instruments. PMID:9080349

Müller, W K; Ziegler, R; Bauer, A; Soldner, E H

1995-01-01

287

MRI of anterior knee pain.  

PubMed

Anterior knee pain is the most common knee complaint. It may be due to a variety of soft tissue or osseous abnormalities. Knowledge of the radiologic appearance of the abnormalities allows more accurate diagnosis of the cause of the pain including chondral abnormalities, patellar instability and dislocation, femoral trochlear dysplasia, abnormal patellar location, bipartite patella, various tendinopathies, bursal inflammation, traction apophysitis in pediatric and adolescent patients, and miscellaneous diseases including mediopatellar plica syndrome and Hoffa's disease. Radiographs are often obtained to exclude acute osseous abnormalities, such as fractures. Magnetic resonance (MR) imaging offers superior soft tissue contrast resolution and allows for more accurate evaluation of the underlying etiology and therefore may improve treatment and possible surgical planning. PMID:24473994

Samim, Mohammad; Smitaman, Edward; Lawrence, David; Moukaddam, Hicham

2014-07-01

288

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

PubMed Central

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

Nelitz, Manfred; Williams, Sean Robert M.

2014-01-01

289

Paleolithic hominin remains from Eshkaft-e Gavi (southern Zagros Mountains, Iran): description, affinities, and evidence for butchery.  

PubMed

Eshkaft-e Gavi is a cave located in the southern Zagros Mountains of Iran and is one of the few archaeological sites in the region to preserve both Middle Paleolithic and Upper Paleolithic occupations. Excavation of the site in the 1970s yielded an assemblage of lithic and faunal remains, including ten hominin specimens: a mandibular molar, four cranial fragments, a clavicular diaphysis, the proximal half of a metacarpal, a fragment of os coxa, the proximal diaphysis of a juvenile femur, and a patella. The bones derive from a minimum of four individuals, including two juveniles. Although many of these remains could be Epi-Paleolithic in age, one of the juvenile specimens-the mandibular molar-occurs at the base of the cave's Upper Paleolithic sequence. The remains are very fragmentary, but those that preserve diagnostic morphology indicate that they represent modern humans. The molar is taxonomically diagnostic, thus confirming the association of the Aurignacian-like Baradostian Industry with modern humans. Four of the specimens-a piece of frontal bone, the clavicle, the juvenile femur, and the patella-display clear evidence for intentional butchery in the form of stone-tool cutmarks. These cutmarked specimens, along with a fragment of parietal bone, are also burned. Although this evidence is consistent with cannibalism, the small sample makes it difficult to say whether or not the individuals represented by the hominin remains were butchered and cooked for consumption. Nevertheless, the cutmarked Eshkaft-e Gavi specimens add to a growing sample of hominin remains extending back into the Plio-Pleistocene that display evidence of intentional defleshing. PMID:19660782

Scott, Jeremiah E; Marean, Curtis W

2009-09-01

290

[Midterm results after treatment of injuries of the distal extensor mechanism with the MPT-fixateur. A critical analysis].  

PubMed

Between 1994 and 2000 at our institution 37 patients (8 women, 29 men) with fractures of the lower patellar pole and a proximal avulsion fracture of the patellar ligament underwent a primary surgical repair and patello-tibial fixateur for external protection. All patients underwent immediately after the reconstruction a functional rehabilitation program without any movement limitation and under early full weight bearing. Postoperative follow-up after an average of 58.5 months (range 14 to 102 months) was possible in 26 patients. Physical examination, roentgenographic evaluation and isokinetic testing were performed. The clinical evaluation was carried out according to the strict criteria of the IKDC-score. The radiological measurement of the patella height was carried out using the index of Blackburne & Peel; the femoropatellar changings were registered according to the score of Sperner. The clinical evaluation showed in 8 patients a normal, in 10 patients a nearly normal, in 7 patients an abnormal and only in 1 patient a severe abnormal result. The average muscle strength deficit in comparison to the contralateral knee joint was between 10 % and 20 %. All patients showed clinically and radiologically a sufficient distal knee extensor mechanism. The patella height ratio was in the average 0.82 on the injured and 0.79 on the non-injured side. In 17 cases we didn't saw any femoropatellar arthrosis. Eight patients showed a moderate femoropatellar arthrosis. There was no case with severe femoropatellar arthrosis. By good follow-up results in general we could demonstrate the value of the MPT-fixateur as a dynamic protection method after reconstructive operations of the distal knee extensor mechanism. PMID:12410448

Ziring, E; Ishaque, B A; Petermann, J; Gotzen, L

2002-10-01

291

Validated measurement of periarticular bone mineral density at the knee joint by dual energy x ray absorptiometry  

PubMed Central

OBJECTIVE—The association of inflammatory arthritis with loss of periarticular bone mineral density (BMD) has been well established. However, changes in bone density cannot be quantified by conventional radiography. This study aimed at developing a new technique for measurement of periarticular bone density at the knee joint by dual energy x ray absorptiometry (DXA) and assessing the precision of this technique for selected areas around the knee.?METHODS—To validate this technique for bone density assessment in both patient and control subjects, knee joints from healthy subjects and patients with inflammatory arthritis were selected for study. Posteroanterior (PA) and lateral scans of both knees were acquired with the Hologic 4500 elite bone densitometer. Each scan was repeated three times, with repositioning between scans. Knee scans were obtained with the forearm software and evaluated by subregion analysis. Seven femoral and seven tibial subregions of interest (ROIs) were selected on PA scans. Six ROIs were selected on lateral scans. Precision was determined for each ROI selected.?RESULTS—14 knee joints were studied in each group. Precision, expressed as percentage coefficient of variation (CV%), varied widely between subregions. PA scans were most appropriate for measurement of femoral bone density (CV% = 1.89-2.64%), whereas the best value obtained for ROIs within the tibia was on the lateral scan, where CV% for measurement of the proximal 5 mm was 2.67% in the patient group. CV% for BMD of the patella was excellent at 0.84% in the patient group.?CONCLUSION—This new application of DXA can be used to measure periarticular bone density at the knee joint. Regions within the distal femur and patella have been identified as the optimal areas to study??

Murphy, E; Bresnihan, B; FitzGerald, O

2001-01-01

292

Responsiveness of articular cartilage from normal and inflamed mouse knee joints to various growth factors.  

PubMed Central

OBJECTIVE--Disturbed anabolic signalling might contribute to the decreased chondrocyte proteoglycan (PG) synthesis during joint inflammation. Articular cartilage obtained from mouse knee joints with experimentally-induced arthritis exhibits a state of nonresponsiveness towards stimulation of chondrocyte PG synthesis by insulin-like growth factor-1 (IGF-1). Investigations were carried out on the role of other growth factors apart from IGF-1 on regulation of chondrocyte PG synthesis under pathological conditions, that is, during repair after IL-1 exposure as well as during early and later arthritis. METHODS--Mouse patellae were obtained from normal knee joints and joints injected with IL-1 or zymosan. The patellae were cultured with basic fibroblast growth factor [bFGF], platelet-derived growth factor [PDGF], epidermal growth factor [EGF] or transforming growth factor beta [TGF beta] for 24 hours in the presence or absence of IGF-1. Chondrocyte PG synthesis was measured by 35S-sulphate incorporation. RESULTS--In normal cartilage none of the tested growth factors elicited stimulatory effects on the chondrocyte PG synthesis as caused by IGF-1. EGF and TGF beta even caused significant inhibition of chondrocyte PG synthesis. Combination of bFGF or PDGF with IGF-1 exerted significant additional stimulation of the 35S-sulphate incorporation. IL-1 exposed cartilage displayed reactivity to IGF-1 as well as to the other growth factors similar to control cartilage. Cartilage obtained from joints with experimentally-induced arthritis exhibited a state of nonresponsiveness towards all individually tested growth factors as well as growth factor combinations. CONCLUSION--Arthritis causes nonresponsiveness to stimulation of chondrocyte PG synthesis by the tested growth factors, which might be caused by a general receptor function defect.

Verschure, P J; Joosten, L A; van der Kraan, P M; Van den Berg, W B

1994-01-01

293

Cumulative exposure to lead and cognition in persons with Parkinson's disease  

PubMed Central

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

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

2012-01-01

294

Bacterial Endosymbiosis in a Chordate Host: Long-Term Co-Evolution and Conservation of Secondary Metabolism  

PubMed Central

Intracellular symbiosis is known to be widespread in insects, but there are few described examples in other types of host. These symbionts carry out useful activities such as synthesizing nutrients and conferring resistance against adverse events such as parasitism. Such symbionts persist through host speciation events, being passed down through vertical transmission. Due to various evolutionary forces, symbionts go through a process of genome reduction, eventually resulting in tiny genomes where only those genes essential to immediate survival and those beneficial to the host remain. In the marine environment, invertebrates such as tunicates are known to harbor complex microbiomes implicated in the production of natural products that are toxic and probably serve a defensive function. Here, we show that the intracellular symbiont Candidatus Endolissoclinum faulkneri is a long-standing symbiont of the tunicate Lissoclinum patella, that has persisted through cryptic speciation of the host. In contrast to the known examples of insect symbionts, which tend to be either relatively recent or ancient relationships, the genome of Ca. E. faulkneri has a very low coding density but very few recognizable pseudogenes. The almost complete degradation of intergenic regions and stable gene inventory of extant strains of Ca. E. faulkneri show that further degradation and deletion is happening very slowly. This is a novel stage of genome reduction and provides insight into how tiny genomes are formed. The ptz pathway, which produces the defensive patellazoles, is shown to date to before the divergence of Ca. E. faulkneri strains, reinforcing its importance in this symbiotic relationship. Lastly, as in insects we show that stable symbionts can be lost, as we describe an L. patella animal where Ca. E. faulkneri is displaced by a likely intracellular pathogen. Our results suggest that intracellular symbionts may be an important source of ecologically significant natural products in animals.

Kwan, Jason C.; Schmidt, Eric W.

2013-01-01

295

Synthesis rates and binding kinetics of matrix products in engineered cartilage constructs using chondrocyte-seeded agarose gels.  

PubMed

Large-sized cartilage constructs suffer from inhomogeneous extracellular matrix deposition due to insufficient nutrient availability. Computational models of nutrient consumption and tissue growth can be utilized as an efficient alternative to experimental trials to optimize the culture of large constructs; models require system-specific growth and consumption parameters. To inform models of the [bovine chondrocyte]-[agarose gel] system, total synthesis rate (matrix accumulation rate+matrix release rate) and matrix retention fractions of glycosaminoglycans (GAG), collagen, and cartilage oligomeric matrix protein (COMP) were measured either in the presence (continuous or transient) or absence of TGF-?3 supplementation. TGF-?3's influences on pyridinoline content and mechanical properties were also measured. Reversible binding kinetic parameters were characterized using computational models. Based on our recent nutrient supplementation work, we measured glucose consumption and critical glucose concentration for tissue growth to computationally simulate the culture of a human patella-sized tissue construct, reproducing the experiment of Hung et al. (2003). Transient TGF-?3 produced the highest GAG synthesis rate, highest GAG retention ratio, and the highest binding affinity; collagen synthesis was elevated in TGF-?3 supplementation groups over control, with the highest binding affinity observed in the transient supplementation group; both COMP synthesis and retention were lower than those for GAG and collagen. These results informed the modeling of GAG deposition within a large patella construct; this computational example was similar to the previous experimental results without further adjustments to modeling parameters. These results suggest that these nutrient consumption and matrix synthesis models are an attractive alternative for optimizing the culture of large-sized constructs. PMID:24284199

Nims, Robert J; Cigan, Alexander D; Albro, Michael B; Hung, Clark T; Ateshian, Gerard A

2014-06-27

296

Acute knee dislocation: review of an elusive entity.  

PubMed

The knee consists of three articulations: the patellofemoral, the tibiofemoral, and the proximal tibiofibular joint. Any of these joints can dislocate. Dislocations are uncommon, tend to spontaneously reduce, and can be difficult to detect on clinical examination. There are, however, telltale imaging features and the radiologist may be the first to suggest the correct diagnosis. A timely diagnosis is important as some forms are associated with limb-threatening complications. Lateral patellofemoral dislocation, in the acute setting, is typically an injury of young athletes and usually spontaneously reduces at the time of trauma. In transient lateral dislocation, contusions may be seen in the inferomedial pole of the patella and the anterior lateral aspect of the nonarticular portion of the femur. The important magnetic resonance imaging findings include this characteristic contusion pattern and injury to the medial patellar soft-tissue restraints. These are frequently associated with osteochondral fractures, which may be an indication for surgery. Recurrent patellofemoral dislocations tend to be associated with abnormalities of bony and/or soft-tissue restraints. The important imaging considerations are the length of patellar tendon, the depth of trochlear groove, and the position of patella in relation to the trochlear groove. Tibiofemoral dislocations are rare and are usually associated with high-impact trauma. These are multi-ligamentous injuries, which most often involve both cruciate ligaments with either medial and/or lateral ligament tears. There is an associated risk of popliteal artery and peroneal nerve injury, even if reduced, at the time of presentation. Dislocations of the tibiofibular joint are also rare and are classified based on location of fibular head. The tibiofibular joint is lax in flexion, and thus, most dislocations tend to occur in the flexed knee position. Anterolateral dislocation is the most common, while posteromedial dislocation is frequently associated with peroneal nerve injury. The purpose of this article is to review the epidemiology of knee dislocations, important imaging findings, and the most common complications. PMID:19778658

Kapur, Sangita; Wissman, Robert D; Robertson, Michael; Verma, Sadhna; Kreeger, Michael C; Oostveen, Robert J

2009-01-01

297

Evaluation of the modified Elmslie-Trillat procedure for patellofemoral dysfunction.  

PubMed

The goal of this study was to evaluate the Elmslie-Trillat procedure for recurrent patellar dislocation, patellofemoral pain (with extensor mechanism malalignment), or a combination of both. Thirty-two patients underwent the modified Elmslie-Trillat procedure, consisting of a lateral retinacular release and medialization of the tibial tuberosity for recurrent patellar dislocation, patellofemoral pain, or both. Twenty-nine of 32 patients were available for follow-up. All patients were evaluated clinically and radiologically. Subjective scores were evaluated using the Cox grading system and objective scores using Fulkerson's functional knee score. Average patient age was 33 years. Mean follow-up was 45 months. Subjectively, using the Cox grading system, 10 patients (34%) had an excellent result, 8 (28%) had a good result, 8 (28%) had a fair result, and 3 (10%) had a poor result. All patients with patella dislocation had an excellent or good subjective result, while only 3 patients (34%) with the primary symptom of patellofemoral pain with extensor mechanism malalignment and 4 patients (44%) with a combination of both symptoms had a good or excellent result. Mean Fulkerson's functional knee score was excellent for patients with dislocation only, and fair for those with only pain or both pain and dislocation. The congruence angle was corrected in all patients with this technique. There were no further dislocations in our series. Two patients required hardware removal. The Elmslie-Trillat procedure is a good surgical option for treatment of recurrent patella instability following failed conservative therapy. However, the results are not as favorable for patients with patellofemoral pain without instability. PMID:20055341

Dannawi, Zaher; Khanduja, Vikas; Palmer, Chris R; El-Zebdeh, Mustafa

2010-01-01

298

Cumulative Exposure to Lead in Relation to Cognitive Function in Older Women  

PubMed Central

Background Recent data indicate that chronic low-level exposure to lead is associated with accelerated declines in cognition in older age, but this has not been examined in women. Objective We examined biomarkers of lead exposure in relation to performance on a battery of cognitive tests among older women. Methods Patella and tibia bone lead—measures of cumulative exposure over many years—and blood lead, a measure of recent exposure, were assessed in 587 women 47–74 years of age. We assessed their cognitive function 5 years later using validated telephone interviews. Results Mean ± SD lead levels in tibia, patella, and blood were 10.5 ± 9.7 ?g/g bone, 12.6 ± 11.6 ?g/g bone, and 2.9 ± 1.9 ?g/dL, respectively, consistent with community-level exposures. In multivariable-adjusted analyses of all cognitive tests combined, levels of all three lead biomarkers were associated with worse cognitive performance. The association between bone lead and letter fluency score differed dramatically from the other bone lead-cognitive score associations, and exclusion of this particular score from the combined analyses strengthened the associations between bone lead and cognitive performance. Results were statistically significant only for tibia lead: one SD increase in tibia lead corresponded to a 0.051-unit lower standardized summary cognitive score (95% confidence interval: ?0.099 to ?0.003; p = 0.04), similar to the difference in cognitive scores we observed between women who were 3 years apart in age. Conclusions These findings suggest that cumulative exposure to lead, even at low levels experienced in community settings, may have adverse consequences for women’s cognition in older age.

Weuve, Jennifer; Korrick, Susan A.; Weisskopf, Marc A.; Ryan, Louise M.; Schwartz, Joel; Nie, Huiling; Grodstein, Francine; Hu, Howard

2009-01-01

299

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

PubMed

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

2011-01-01

300

A novel multi-planar radiography method for three dimensional pose reconstruction of the patellofemoral and tibiofemoral joints after arthroplasty.  

PubMed

Determining the 3D pose of the patella after total knee arthroplasty is challenging. The commonly used single-plane fluoroscopy is prone to large errors in the clinically relevant mediolateral direction. A conventional fixed bi-planar setup is limited in the minimum angular distance between the imaging planes necessary for visualizing the patellar component, and requires a highly flexible setup to adjust for the subject-specific geometries. As an alternative solution, this study investigated the use of a novel multi-planar imaging setup that consists of a C-arm tracked by an external optoelectric tracking system, to acquire calibrated radiographs from multiple orientations. To determine the accuracies, a knee prosthesis was implanted on artificial bones and imaged in simulated 'Supine' and 'Weightbearing' configurations. The results were compared with measures from a coordinate measuring machine as the ground-truth reference. The weightbearing configuration was the preferred imaging direction with RMS errors of 0.48 mm and 1.32 ° for mediolateral shift and tilt of the patella, respectively, the two most clinically relevant measures. The 'imaging accuracies' of the system, defined as the accuracies in 3D reconstruction of a cylindrical ball bearing phantom (so as to avoid the influence of the shape and orientation of the imaging object), showed an order of magnitude (11.5 times) reduction in the out-of-plane RMS errors in comparison to single-plane fluoroscopy. With this new method, complete 3D pose of the patellofemoral and tibiofemoral joints during quasi-static activities can be determined with a many-fold (up to 8 times) (3.4mm) improvement in the out-of-plane accuracies compared to a conventional single-plane fluoroscopy setup. PMID:21536291

Amiri, Shahram; Wilson, David R; Masri, Bassam A; Sharma, Gulshan; Anglin, Carolyn

2011-06-01

301

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.

2010-01-01

302

Medial patellofemoral ligament (MPFL) reconstruction for the treatment of patellofemoral instability.  

PubMed

Patellofemoral instability can be a disabling problem. Numerous techniques are employed for its treatment. Medial patellofemoral ligament (MPFL) reconstruction in combination with other procedures has been explored by many orthopedic surgeons. The purpose of the study was to determine the effectiveness of isolated MPFL reconstruction in treating the symptoms associated with patellofemoral instability, preventing recurrence of patella dislocation, and returning patients to preinjury level of activity. This is a case series study. We conducted a clinical follow-up study on 56 knees (49 patients) after MPFL reconstruction for recurrent patellar instability with a mean follow-up of 4.3 years (range, 1.1-6.8). A single MPFL reconstruction technique was performed in all cases. Patient outcomes were evaluated using: International Knee Documentation Committee (IKDC) subjective knee form, Tegner activity score, functional hop test, and radiographs. Mean age at time of surgery was 24 years old (range, 13-49). Females comprised 75% of the sample. Mean interval from injury to surgery was 7.2?±?8.6 years (range, 51 days-37 years). At follow-up, there were no recurrent dislocations reported, patella subluxation in 6 (11%) cases, and radiographic degenerative changes were none to mild in all patients. The series mean IKDC scores at follow-up was 76.3?±?19.2 (range, 30-99), and Tegner activity scores were 5.6?±?2.5. MPFL reconstruction is an option for treating the symptoms of patellar instability, preventing recurrent dislocation, and returning patients near to their preinjury level of activity. The level of evidence is IV. PMID:24227396

Csintalan, Rick P; Latt, L Daniel; Fornalski, Stefan; Raiszadeh, Kian; Inacio, Maria Cs; Fithian, Donald C

2014-04-01

303

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

PubMed

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

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

2012-09-01

304

Influence of Prenatal Lead Exposure on Genomic Methylation of Cord Blood DNA  

PubMed Central

Background Fetal lead exposure is associated with adverse pregnancy outcomes and developmental and cognitive deficits; however, the mechanism(s) by which lead-induced toxicity occurs remains unknown. Epigenetic fetal programming via DNA methylation may provide a pathway by which environmental lead exposure can influence disease susceptibility. Objective This study was designed to determine whether prenatal lead exposure is associated with alterations in genomic methylation of leukocyte DNA levels from umbilical cord samples. Methods We measured genomic DNA methylation, as assessed by Alu and LINE-1 (long interspersed nuclear element-1) methylation via pyrosequencing, on 103 umbilical cord blood samples from the biorepository of the Early Life Exposures in Mexico to Environmental Toxicants (ELEMENT) study group. Prenatal lead exposure had been assessed by measuring maternal bone lead levels at the mid-tibial shaft and the patella using a spot-source 109Cd K-shell X-ray fluorescence instrument. Results We found an inverse dose–response relationship in which quartiles of patella lead correlated with cord LINE-1 methylation (p for trend = 0.01) and and tibia lead correlated with Alu methylation (p for trend = 0.05). In mixed effects regression models, maternal tibia lead was negatively associated with umbilical cord genomic DNA methylation of Alu (?= ?0.027; p = 0.01). We found no associations between cord blood lead and cord genomic DNA methylation. Conclusions Prenatal lead exposure is inversely associated with genomic DNA methylation in cord blood. These data suggest that the epigenome of the developing fetus can be influenced by maternal cumulative lead burden, which may influence long-term epigenetic programming and disease susceptibility throughout the life course.

Pilsner, J. Richard; Hu, Howard; Ettinger, Adrienne; Sanchez, Brisa N.; Wright, Robert O.; Cantonwine, David; Lazarus, Alicia; Lamadrid-Figueroa, Hector; Mercado-Garcia, Adriana; Tellez-Rojo, Martha Maria; Hernandez-Avila, Mauricio

2009-01-01

305

Are radiographs needed when MR imaging is performed for non-acute knee symptoms in patients younger than 45 years of age?  

PubMed Central

Objective The objective was to determine the value of radiographs in young adults with non-acute knee symptoms who are scheduled for magnetic resonance imaging (MRI). Materials and methods Nine hundred and sixty-one consecutive patients aged between 16 and 45 years with knee symptoms of at least 4 weeks’ duration were prospectively included in three participating hospitals. After applying exclusion criteria, 798 patients remained. Exclusion criteria were previous knee surgery (including arthroscopy) or MRI, history of rheumatoid arthritis, clinical diagnosis of retropatellar chondromalacia, contra-indication for MRI and recent trauma. We identified two groups: group A with no history of trauma (n?=?332), and group B with an old (>4 weeks) history of trauma (n?=?466). Patients had a standardized history taken, and underwent a physical exam, antero-posterior (AP) and lateral radiographs and MRI. We evaluated the radiographs and MRI for osseous lesions, articular surface lesions, fractures, osteoarthritis, loose bodies, bone marrow edema and incidental findings. Subsequently, patients with osseous abnormalities (Kellgren grade 1 and 2 excluded) on radiographs and a matched control group was evaluated again using MRI without radiographs. Results Median duration of symptoms was 20 weeks. In group A, radiographs showed 36 osseous abnormalities in 332 patients (10.8%). Only 13 of these, all Kellgren grade 1 osteoarthritis, were not confirmed on MRI. MRI showed 72 (21.7%) additional abnormalities not confirmed on radiographs. In group B, radiographs showed 40 osseous abnormalities (8.6%) in 466 patients. Only 15 of these, all Kellgren grade 1 osteoarthritis, were not confirmed on MRI. MRI showed 194 (41.6%) additional abnormalities not confirmed on radiographs. The second evaluation of MRI without radiographs in 34 patients was identical to the first MRI evaluation. Common lesions were significantly more often diagnosed with MRI than with radiographs. Conclusion Radiographs should not be obtained routinely when MRI is being performed in young adults with non-acute knee complaints because the yield and added value to MRI are low.

ter Braak, Bert P. M.; van Erkel, Arian R.; Bloem, Rolf M.; Napoleon, L. J.; Coene, M. N.; van Luijt, Peter A.; de Lange, Sam; Bloem, Johan L.

2007-01-01

306

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

PubMed

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

2013-10-01

307

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.

2010-01-01

308

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

2006-01-01

309

Bone loss in the lower leg during 35 days of bed rest is predominantly from the cortical compartment.  

PubMed

Immobilization-induced bone loss is usually greater in the epiphyses than in the diaphyses. The larger fraction of trabecular bone in the epiphyses than in the diaphyses offers an intuitive explanation to account for this phenomenon. However, recent evidence contradicts this notion and suggests that immobilization-induced bone loss from the distal tibia epiphysis is mainly from the cortical compartment. The aim of this study was to establish whether this pattern of bone loss was a general rule during immobilization. We monitored various skeletal sites with different tissue composition during 5 weeks of immobilization. Ten healthy male volunteers with mean age of 24.3 years (SD 2.6 years) underwent strict horizontal bed rest. Bone scans were obtained during baseline data collection, at the end of bed rest and after 14 days of recovery by peripheral Quantitative Computed Tomography (pQCT). Sectional images were obtained from the distal tibia epiphysis (at 4% of the tibia's length), from the diaphysis (at 38%), from the proximal metaphysis (at 93%) and from the proximal epiphysis (at 98%), as well as from the distal femur epiphysis (at 4% of the femur's length) and from the patella. Relative bone losses were largest at the patella, where they amounted to -3.2% (SD 1.8%, p<0.001) of the baseline values, and smallest at the tibia diaphysis, where they amounted to -0.7% (SD 1.0%, p=0.019). The relative losses were generally larger from cortical than from trabecular compartments (p=0.004), and whilst all skeletal sites depicted such cortical losses, substantial trabecular losses were found only from the proximal tibia epiphysis. Results confirm that the differential losses from the various skeletal sites cannot be explained on the basis of trabecular vs. cortical tissue composition differences, but that endocortical circumference can account for the different amounts of bone loss in the tibia. The present study therefore supports the suggestion of the subendocortical layer as a transitional zone, which can readily be transformed into trabecular bone in response to immobilization. The latter will lead to cortical thinning, a factor that has been associated with the risk of fracture and with osteoarthritis. PMID:19168165

Rittweger, Jörn; Simunic, Bostjan; Bilancio, Giancarlo; De Santo, Natale Gaspare; Cirillo, Massimo; Biolo, Gianni; Pisot, Rado; Eiken, Ola; Mekjavic, Igor B; Narici, Marco

2009-04-01

310

The effect of neonatal gene therapy on skeletal manifestations in mucopolysaccharidosis VII dogs after a decade.  

PubMed

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

2013-06-01

311

Breaking the Law of Valgus: the surprising and unexplained prevalence of medial patellofemoral cartilage damage  

PubMed Central

Objectives To compare the prevalence of medial and lateral patellofemoral (PF) cartilage damage in three large osteoarthritis (OA) studies and determine the relationship of this damage to varus, neutral, and valgus knee alignment. Methods In the Boston OA of the Knee (BOKS), Framingham OA (FOA), and Multicenter OA (MOST) studies, MRIs were read for cartilage morphology at the medial and lateral patella and trochlea femoris using Whole-Organ MRI Scores (WORMS). WORMS scores ? 2 (any cartilage defect), ? 3 (areas of partial thickness loss), ? 4 (diffuse partial thickness loss), and ? 5 (extensive full thickness loss) were all variously considered as thresholds to identify damage that may indicate OA. Full-limb radiographs were measured for mechanical alignment, and varus (< ?2°), neutral (?2° to 2°), and valgus (> 2°) knees were identified. Results The prevalence of medial PF cartilage damage exceeded that of lateral damage in all three OA studies and according to nearly every threshold. Only among severely involved knees (WORMS ? 4 or ? 5) did the prevalence of lateral PF cartilage damage approximate that of medial damage. The high prevalence of medial PF damage persisted in all strata of knee alignment. Even among knees with valgus malalignment, the prevalence of lateral PF cartilage damage equaled or surpassed that of medial PF damage only when the threshold was specific to severely involved knees. Conclusions Medial PF cartilage damage is at least as prevalent among older adults as lateral PF cartilage damage.

Gross, K. Douglas; Niu, Jingbo; Stefanik, Joshua J.; Guermazi, Ali; Roemer, Frank W.; Sharma, Leena; Nevitt, Michael C.; Segal, Neil A.; Lewis, Cora E.; Felson, David T.

2013-01-01

312

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

PubMed Central

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

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

2011-01-01

313

Painful knee arthroplasty: definition and overview.  

PubMed

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. PMID:22461811

Carulli, Christian; Villano, Marco; Bucciarelli, Giovanni; Martini, Caterina; Innocenti, Massimo

2011-05-01

314

T2 relaxation time measurements are limited in monitoring progression, once advanced cartilage defects at the knee occur  

PubMed Central

Purpose To study the natural evolution of cartilage T2 relaxation times in knees with various extents of morphological cartilage abnormalities, assessed with 3T MRI from the Osteoarthritis Initiative. Materials and Methods Right knee MRIs of 245, 45–60 year old individuals without radiographic OA were included. Cartilage was segmented and T2 maps were generated in five compartments (patella, medial and lateral femoral condyle, medial and lateral tibia) at baseline and two-year follow-up. We examined the association of T2 values and two-year change of T2 values with various Whole-Organ MR Imaging Scores (WORMS). Statistical analysis was performed with ANOVA and Students t-tests. Results Higher baseline T2 was associated with more severe cartilage defects at baseline and subsequent cartilage loss (P<0.001). However, longitudinal T2 change was inversely associated with both baseline (P=0.038) and follow-up (P=0.002) severity of cartilage defects. Knees that developed new cartilage defects had smaller increases in T2 than subjects without defects (P=0.045). Individuals with higher baseline T2 showed smaller T2 increases over time (P<0.001). Conclusion An inverse correlation of longitudinal T2 changes versus baseline T2 values and morphological cartilage abnormalities suggests that once morphological cartilage defects occur, T2 values may be limited for evaluating further cartilage degradation.

Jungmann, P.M.; Kraus, M.S.; Nardo, L.; Liebl, H.; Alizai, H.; Joseph, G.B.; Liu, F.; Lynch, J.; McCulloch, C.E.; Nevitt, M.C.; Link, T.M.

2014-01-01

315

A cross sectional study of 100 athletes with jumper's knee managed conservatively and surgically. The Victorian Institute of Sport Tendon Study Group.  

PubMed Central

OBJECTIVES: Jumper's knee causes significant morbidity in athletes of all standards. However, there are few reference data on the clinical course of this condition in a large number of patients, and the aim of this study was to rectify this. METHODS: A retrospective study of the course of jumper's knee in 100 athletes who presented to a sports medicine clinic over a nine year period was carried out. Subjects completed a questionnaire designed to collect details of sport participation, symptoms, and time out of sport. Ultrasonographic results were recorded from the radiologists' reports. Histopathological results were obtained for patients who had surgery. RESULTS: Forty eight subjects recalled that symptoms of jumper's knee began before the age of 20 years. Symptoms prevented 33 from participating in sport for more than six months, and 18 of these were sidelined for more than 12 months. Forty nine of the subjects had two or more separate episodes of symptoms. Ultrasonography showed a characteristics hypoechoic region at the junction of the inferior pole of the patella and the deep surface of the patellar tendon. Histopathological examination showed separation and disruption of collagen fibres on polarisation light microscopy and an increase in mucoid ground substance consistent with damage of tendon collagen without inflammation. CONCLUSIONS: Jumper's knee has the potential to be a debilitating condition for a sports person. About 33% of athletes presenting to a sports medicine clinic with jumper's knee were unable to return to sport for more than six months. Images Figure 1 Figure 2 Figure 3 Figure 4

Cook, J L; Khan, K M; Harcourt, P R; Grant, M; Young, D A; Bonar, S F

1997-01-01

316

Differences in metal ion release following cobalt-chromium and oxidized zirconium total knee arthroplasty.  

PubMed

Ions are released from all metals after implantation in the body through processes of corrosive and mechanical wear. The aim of this study was to investigate whether serum metal ion levels are raised in patients following total knee arthroplasty. Serum levels of chromium, cobalt, aluminium, molybdenum and zirconium were measured in two groups of patients at a minimum of 3 years after knee arthroplasty. Twenty three patients had a cobalt-chromium femoral component and 14 patients had an oxidized zirconium femoral component, acting as a control group as this femoral component is free from cobalt and chromium. All patients had the same titanium tibial base plates, and no patellae were resurfaced. Despite the lack of cobalt and chromium in the prostheses used in the control group, no statistically significant differences in serum cobalt and chromium ion levels were found between the groups. On the basis of these results there does not appear to be any significant rise in serum metal ion levels following total knee arthroplasty several years after implantation. PMID:20973359

Garrett, Simon; Jacobs, Neal; Yates, Piers; Smith, Anne; Wood, David

2010-08-01

317

Midterm results of cruciate retaining total knee arthroplasty in patellectomized patients  

PubMed Central

Background: Total knee arthroplasty (TKA) in patellectomized patients gives inferior results when compared with those in which the patella is present. The literature is ambiguous about the role of cruciate retaining or sacrificing implants for these knees. In this study, we assessed the midterm results of TKA in patellectomized knees using a cruciate retaining implant. Materials and Methods: Thirty three patients with a prior patellectomy underwent a cruciate retaining TKA and were followed up for an average of 9.3 years (range 2-14 years). At each followup visit, they were evaluated clinically, radiologically and by the Hospital for Special Surgery Scoring System. Results: Twenty one knees did not have any pain or difficulty in climbing stairs, 10 knees were slightly painful on stairs but pain free on walking on flat ground and two knees experienced mild to moderate pain on walking up and down stairs as well as on flat ground. The average range of motion preoperatively was 87°, which postoperatively increased to 118°. The average Hospital for Special Surgery Knee scores increased from 52 to 89 points. None of the knees showed any progressive radiolucencies or evidence of any loosening/osteolysis or fractures in followup. Conclusion: Cruciate retaining TKA offers good results at midterm followup in patients with a prior patellectomy.

Dahiya, Vivek; Gupta, Himanshu; Rajgopal, Ashok; Vasdev, Attique

2013-01-01

318

Bilateral simultaneous complete quadriceps rupture following chronic symptomatic tendinopathy: a case report  

PubMed Central

Introduction Quadriceps rupture is a disabling injury mostly seen in men over 40 years of age. Bilateral quadriceps rupture is a rare injury that is often secondary to predisposing medical conditions. Ultrasound is a cheap and reliable tool for diagnosis but is operator dependent. Thus, magnetic resonance imaging is the preferred method of investigation despite its cost and availability. Prompt diagnosis and early surgical repair are needed for an optimal end result. Case presentation We report the case of a healthy 54-year-old Caucasian male farmer who presented with bilateral simultaneous complete quadriceps rupture, which was managed surgically and he was followed up for three years. He was previously under our care for enthesopathy of the quadriceps on both sides. We believe that chronic enthesopathy of the superior pole of patella made his quadriceps susceptible to complete rupture on eccentric loading. Conclusion Only a few cases of bilateral simultaneous complete quadriceps rupture in patients with symptomatic enthesopathy have been previously reported. We stress the importance of warning patients of the risk of developing complete tendon rupture when they present with an enthesopathy around the knee.

2009-01-01

319

Characterization of microgravity effects on bone structure and strength using fractal analysis  

NASA Technical Reports Server (NTRS)

The effect of micro-gravity on the musculoskeletal system has been well studied. Significant changes in bone and muscle have been shown after long term space flight. Similar changes have been demonstrated due to bed rest. Bone demineralization is particularly profound in weight bearing bones. Much of the current techniques to monitor bone condition use bone mass measurements. However, bone mass measurements are not reliable to distinguish Osteoporotic and Normal subjects. It has been shown that the overlap between normals and osteoporosis is found for all of the bone mass measurement technologies: single and dual photon absorptiometry, quantitative computed tomography and direct measurement of bone area/volume on biopsy as well as radiogrammetry. A similar discordance is noted in the fact that it has not been regularly possible to find the expected correlation between severity of osteoporosis and degree of bone loss. Structural parameters such as trabecular connectivity have been proposed as features for assessing bone conditions. In this report, we use fractal analysis to characterize bone structure. We show that the fractal dimension computed with MRI images and X-Ray images of the patella are the same. Preliminary experimental results show that the fractal dimension computed from MRI images of vertebrae of human subjects before bedrest is higher than during bedrest.

Acharya, Raj S.; Shackelford, Linda

1995-01-01

320

Protozoan predation as a mechanism for the removal of cryptosporidium oocysts from wastewaters in constructed wetlands.  

PubMed

The removal of the protozoan parasite, Cryptosporidium parvum, from wastewaters is becoming of increasing importance in the UK, especially since contamination of raw waters by sewage effluents has been implicated in major waterborne outbreaks of cryptosporidiosis in recent years. Compared to conventional wastewater-treatment processes, constructed wetlands have demonstrated favourable removal rates for Cryptosporidium oocysts. The removal mechanisms, however, remain unknown. Predation by free-living ciliated protozoa, which are commonly found in constructed wetlands, was investigated as a possible mechanism for oocyst removal. In laboratory feeding experiments, ciliates (Euplotes patella, Stylonychia mytilus, Paramecium caudatum and an unidentified wetland ciliate species), were exposed to doses ranging from 10 to 10(6) oocysts/ml for between 5 and 60 minutes. Ciliate predatory activities were assessed by enumerating fluorescently labelled ingested oocysts using epifluorescence microscopy. Oocysts were found to be ingested by all species investigated. Paramecium demonstrated the highest mean ingestion rates (up to 170 oocysts/hr) followed by Stylonychia (up to 60 oocysts/hour). Euplotes and the wetland ciliate had lower mean grazing rates (4 and 10 oocysts/hr respectively). These results indicate that protozoan predation may be an important factor in the removal of Cryptosporidium oocysts from wastewaters in constructed wetlands. PMID:11804094

Stott, R; May, E; Matsushita, E; Warren, A

2001-01-01

321

Modified retro-tubercle opening-wedge versus conventional high tibial osteotomy.  

PubMed

Despite the fact that common surgical techniques for the treatment of genu varum usually correct the malalignment in the affected knee, these methods have significant complications and cause problems in the long term. Retro-tubercle opening-wedge high tibial osteotomy is among the newer techniques for the treatment of genu varum. The goal of this study was to compare the results of retro-tubercle opening-wedge high tibial osteotomy with those of medial opening-wedge osteotomy. In a randomized, controlled trial, 72 patients with varus knees who were scheduled for surgery were assigned into either the retro-tubercle opening-wedge high tibial osteotomy (n=34) or medial opening-wedge osteotomy groups (n=38). Groups were matched for age and sex. The position of the patella was compared with respect to the tuberosity and the upper tibial slope pre- and postoperatively. Patients were followed for an average of 13 months (range, 10-21 months). In the retro-tubercle opening-wedge high tibial osteotomy group, the length of the patellar tendon did not significantly differ pre- and postoperatively (P?.5); however, in the medial opening-wedge osteotomy group, a statistically significant shortening was noted in patellar tendon postoperatively (P?.05). Similarly, the tibial plateau inclination showed a statistically significant difference postoperatively in the medial opening-wedge osteotomy group, while the difference in the retro-tubercle opening-wedge high tibial osteotomy group did not reach statistical significance. PMID:21323292

Keyhani, Sohrab; Abbasian, Mohammad Reza; Kazemi, Seyed Morteza; Esmailiejah, Ali Akbar; Seyed Hosseinzadeh, Hamid Reza; Shahi, Ali Sina; Firouzi, Farzad

2011-02-01

322

Automatic knee cartilage delineation using inheritable segmentation  

NASA Astrophysics Data System (ADS)

We present a fully automatic method for segmentation of knee joint cartilage from fat suppressed MRI. The method first applies 3-D model-based segmentation technology, which allows to reliably segment the femur, patella, and tibia by iterative adaptation of the model according to image gradients. Thin plate spline interpolation is used in the next step to position deformable cartilage models for each of the three bones with reference to the segmented bone models. After initialization, the cartilage models are fine adjusted by automatic iterative adaptation to image data based on gray value gradients. The method has been validated on a collection of 8 (3 left, 5 right) fat suppressed datasets and demonstrated the sensitivity of 83+/-6% compared to manual segmentation on a per voxel basis as primary endpoint. Gross cartilage volume measurement yielded an average error of 9+/-7% as secondary endpoint. For cartilage being a thin structure, already small deviations in distance result in large errors on a per voxel basis, rendering the primary endpoint a hard criterion.

Dries, Sebastian P. M.; Pekar, Vladimir; Bystrov, Daniel; Heese, Harald S.; Blaffert, Thomas; Bos, Clemens; van Muiswinkel, Arianne M. C.

2008-04-01

323

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

NASA Astrophysics Data System (ADS)

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.

Fripp, Jurgen; Crozier, Stuart; Warfield, Simon K.; Ourselin, Sébastien

2007-03-01

324

Optimization of the geometry of total knee implant in the sagittal plane using FEA.  

PubMed

The aim of this research was to investigate the optimization of the geometry of an UHMWPE type of knee implant in the sagittal plane with minimum amount of wear. Finite element analysis has been used to analyze our proposed 780 models consisting of different design parameters. Maximum stress occurring in the whole tibial component, on the surface or subsurface of the plate, was considered as a design parameter to evaluate the wear condition. By avoiding the small contact area and high stresses in the tibial part, the maximum safe flexion angles have been determined. Other effective design factors such as implant stability, roll back distance, patella lever arm, and minimum bone resection have also been considered. Taking into account the variable parameters in the geometry of the implant parts, all possible models for the femoral component, which is made from metal, and the tibial component, which is made from UHMWPE, have been built in ANSYS and analyzed in the sagittal plane. By considering the effective mechanisms of wear in polyethylene, the results of the analyses were used to find the optimized geometry of a knee implant. This is the model, which is expected to experience the minimum wear, besides having some other properties of an ideal knee prosthesis. PMID:14646058

Dargahi, Javad; Najarian, Siamak; Amiri, Shahram

2003-01-01

325

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

326

Growth and maturational changes in dense fibrous connective tissue following 14 days of rhGH supplementation in the dwarf rat  

NASA Technical Reports Server (NTRS)

The purpose of this study was to investigate the impact of recombinant human growth hormone (rhGH) on patella tendon (PT), medial collateral ligament (MCL), and lateral collateral ligament (LCL) on collagen growth and maturational changes in dwarf GH-deficient rats. Twenty male Lewis mutant dwarf rats, 37 days of age, were randomly assigned to Dwarf + rhGH (n = 10) and Dwarf + vehicle (n = 10) groups. The GH group received 1.25 mg rhGH/kg body wt twice daily for 14 days. rhGH administration stimulated dense fibrous connective tissue growth, as demonstrated by significant increases in hydroxyproline specific activity and significant decreases in the non-reducible hydroxylysylpyridinoline (HP) collagen cross-link contents. The increase in the accumulation of newly accreted collagen was 114, 67, and 117% for PT, MCL, and LCL, respectively, in 72 h. These findings suggest that a short course rhGH treatment can affect the rate of new collagen production. However, the maturation of the tendon and ligament tissues decreased 18-25% during the rapid accumulation of de novo collagen. We conclude that acute rhGH administration in a dwarf rat can up-regulate new collagen accretion in dense fibrous connective tissues, while causing a reduction in collagen maturation. Copyright 2002 Elsevier Science Ltd.

Kyparos, Antonios; Orth, Michael W.; Vailas, Arthur C.; Martinez, Daniel A.

2002-01-01

327

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

1995-01-01

328

Major complications and risk factors associated with surgical correction of congenital medial patellar luxation in 124 dogs.  

PubMed

Dogs treated for congenital medial patellar luxation were reviewed for the purpose of determining the incidence of postoperative major complications requiring surgical revision and the risk factors for their occurrence. Major complications occurred in 18.5% of the patellar luxation stabilization procedures with implant associated complications being the most frequent, patellar reluxation the second, and tibial tuberosity avulsion the third most common major complication. Other complications included patellar ligament rupture and trochlear wedge displacement. When recession trochleoplasty was performed in addition to tibial tuberosity transposition, a 5.1-fold reduction in the rate of patellar reluxation was observed. Release of the cranial belly of the sartorius muscle further reduced the incidence of patellar reluxation, while patella alta (pre- or postoperative) and patellar luxation grade were not found to influence the rate of reluxation. Tibial tuberosity avulsion was 11.1-times more likely when using a single Kirschner wire to stabilize a transposition, compared with two Kirschner wires. Independent to the number of Kirschner wires used, the more caudodistally the Kirschner wires were directed, the higher the risk for tibial tuberosity avulsion. Tension bands were used in 24.4% of the transpositions with no tuberosity avulsion occurring in stifles stabilized with a tension band. Overall, grade 1 luxations had a significantly lower incidence of major complications than other grades, while body weight, age, sex, and bilateral patellar stabilization were not associated with risk of major complication development. PMID:24817090

Cashmore, R G; Havlicek, M; Perkins, N R; James, D R; Fearnside, S M; Marchevsky, A M; Black, A P

2014-07-21

329

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.

2010-01-01

330

Assessment of Lower Limb Prosthesis through Wearable Sensors and Thermography  

PubMed Central

This study aimed to explore the application of infrared thermography in combination with ambulatory wearable monitoring of temperature and relative humidity, to assess the residual limb-to-liner interface in lower-limb prosthesis users. Five male traumatic transtibial amputees were involved, who reported no problems or discomfort while wearing the prosthesis. A thermal imaging camera was used to measure superficial thermal distribution maps of the stump. A wearable system for recording the temperature and relative humidity in up to four anatomical points was developed, tested in vitro and integrated with the measurement set. The parallel application of an infrared camera and wearable sensors provided complementary information. Four main Regions of Interest were identified on the stump (inferior patella, lateral/medial epicondyles, tibial tuberosity), with good inter-subject repeatability. An average increase of 20% in hot areas (P < 0.05) is shown after walking compared to resting conditions. The sensors inside the cuff did not provoke any discomfort during recordings and provide an inside of the thermal exchanges while walking and recording the temperature increase (a regime value is ?+1.1 ± 0.7 °C) and a more significant one (?+4.1 ± 2.3%) in humidity because of the sweat produced. This study has also begun the development of a reference data set for optimal socket/liner-stump construction.

Cutti, Andrea Giovanni; Perego, Paolo; Fusca, Marcello C.; Sacchetti, Rinaldo; Andreoni, Giuseppe

2014-01-01

331

An Isolated Medial Patellofemoral Ligament Reconstruction with Patellar Tendon Autograft  

PubMed Central

The aim of the study was to evaluate the results of the medial patellofemoral ligament reconstruction with a medial strip of patellar tendon autograft after a minimum 2-year followup. Ten patients (10 knees) were operated on by one surgeon, according to the modified technique, described by Camanho, without any bone plug at free graft end. The mean age of the patients was 27.2 years (ranging from 18 to 42 years). The mean follow-up period was 3 years and 7 months. All patients were reviewed prospectively. At the last follow-up visit, all the patients demonstrated a significant improvement in terms of patellofemoral joint stability, all aspects of the KOOS questionnaire, and Kujala et al.'s score (59.7 points preoperatively and 84.4 points at the last followup). No patient revealed recurrent dislocation. The SF-36 score revealed a significant improvement in bodily pain, general health, physical role functioning, social role functioning, and physical functioning domains. The described MPFL reconstruction with the use of the medial 1/3rd of patella tendon is an effective procedure that gives satisfactorily patellofemoral joint functions, improves the quality of life, and provides much pain relief. It is relatively simple, surgically not extensive, and economically cost-effective procedure.

Witonski, Dariusz; Keska, Rafal; Synder, Marek; Sibinski, Marcin

2013-01-01

332

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

2011-01-01

333

Treatment of Habitual Patellar Dislocation in an Adult by Isolated Medial Patellofemoral Ligament Reconstruction  

PubMed Central

Habitual patellar dislocations are rare in adults. Treatment is difficult, and often associated with significant morbidity. A 30-year-old man, construction worker, presented a habitual patellofemoral dislocation which was caused by direct trauma to the knee as a child. Clinical examination showed a 3?cm leg-length discrepancy with no rotational deformities. The patient had a limp and loss of function; the patella was dislocated laterally and had locked at 20° of flexion with a range of motion of 0°/0°/30°. Open surgery was performed associating lateral retinacular release, reconstruction of the medial patellofemoral ligament with an ipsilateral gracilis tendon graft. The postoperative course was simple with no complications. Four months after surgery the patient has begun working normally. At the final 50-month clinical follow-up, knee range of motion was 0°/0°/130°, and functional results were excellent on clinical assessment scores of Kujala, Lysholm, and subjective IKDC. MPFL reconstruction alone seems effective in habitual posttraumatic patellar dislocation in adults without any associated bone anomalies.

Bohu, Yoann; Thaunat, Mathieu; Lefevre, Nicolas; Herman, Serge; Catonne, Yves

2014-01-01

334

Surgical treatment of chronic patellar tendinitis in a collegiate football player.  

PubMed

In the competitive athlete, there are many causes of anterior knee pain, one of which is patellar tendinitis. Repetition of explosive movements can cause microtrauma to the tendon and its insertion, resulting in patellar tendinitis and occasional tearing, either partial or total. Due to its refractory nature, the treatment of this disorder can be quite frustrating to all involved. A 20-year-old collegiate football player with patellar tendinitis was treated conservatively for more than 2 years. Despite aggressive training regimens, including quadriceps stretching, eccentric strengthening, and therapeutic modalities, the athlete was unable to participate at his preinjury level. Physical examination of his knee revealed inflammation and crepitation. Radiographs demonstrated an avulsion fragment from the inferior pole of the patella and magnetic resonance imaging showed cystic degeneration of the tendon. These findings confirmed the diagnosis of chronic patellar tendinitis. The patient underwent surgical debridement of the patellar tendon without complications. His postoperative rehabilitation was divided into three phases: passive range of motion, active strengthening, and sport-specific activities. At 14 weeks post-surgery, the athlete was able to return to his previous level of activity without pain. Follow-up 30 weeks postoperatively revealed no return of symptoms. At 40 weeks postsurgery, the athlete was participating at his preinjury level. This case report demonstrates the successful outcome of the surgical treatment of chronic patellar tendinitis, which was unresponsive to conservative treatment, in a competitive collegiate football player. PMID:16558360

Beam, J W; Lozman, P R; Uribe, J W

1995-10-01

335

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

1994-09-01

336

High-risk stress fractures: evaluation and treatment.  

PubMed

Stress fractures are common overuse injuries seen in athletes and military recruits. The pathogenesis is multifactorial and usually involves repetitive submaximal stresses. Intrinsic factors, such as hormonal imbalances, may also contribute to the onset of stress fractures, especially in women. The classic presentation is a patient who experiences the insidious onset of pain after an abrupt increase in the duration or intensity of exercise. The diagnosis is primarily clinical, but imaging modalities such as plain radiography, scintigraphy, computed tomography, and magnetic resonance imaging may provide confirmation. Most stress fractures are uncomplicated and can be managed by rest and restriction from the precipitating activity. A subset of stress fractures can present a high risk for progression to complete fracture, delayed union, or nonunion. Specific sites for this type of stress fracture are the femoral neck (tension side), the patella, the anterior cortex of the tibia, the medial malleolus, the talus, the tarsal navicular, the fifth metatarsal, and the great toe sesamoids. Tensile forces and the relative avascularity at the site of a stress-induced fracture often lead to poor healing. Therefore, high-risk stress fractures require aggressive treatment. PMID:11104398

Boden, B P; Osbahr, D C

2000-01-01

337

New intermediate phenotype between MED and DD caused by compound heterozygous mutations in the DTDST gene.  

PubMed

DTDST mutations cause a spectrum of diastrophic dysplasia disorders characterized by defects of proteoglycans sulfation. Reduction of sulfate/chloride antiporter activity is manifested by lower sulfate uptake and depends on a combination of mutations in DTDST. We analyzed a family with an autosomal recessive form of bone dysplasia. Three affected brothers from this family are compound heterozygotes for C653S/A715V mutations. We classified their phenotype as a new intermediate form between diastrophic dysplasia and multiple epiphyseal dysplasia, manifested by shortening of stature, metatarsus adductus/club foot, mild brachydactyly, proximally placed thumbs and clinodactyly of the fifth fingers. Radiographs document platyspondyly most marked in the lower thoracic and upper lumbar spine, epiphyseal dysplasia affecting predominantly the femoral heads, widening of the metaphyses, narrow growth cartilage and multilayered patellae. Exaggerated lesser trochanters of femur, that is, "monkey wrench" sign, elevated greater trochanters, thin upper pubic rami, grossly normal carpal/tarsal bones and severe, early onset osteoarthritis were other notable features. PMID:21077204

Czarny-Ratajczak, Malwina; Bieganski, Tadeusz; Rogala, Piotr; Glowacki, Maciej; Trzeciak, Tomasz; Kozlowski, Kazimierz

2010-12-01

338

Biomechanical study of patellofemoral joint instability  

NASA Astrophysics Data System (ADS)

Patellofemoral joint instability is a complex clinical problem. It may be a consequence of pre-existing anatomical abnormality or trauma. The objectives of this study were to use experimental mechanics to measure patellar stability and to quantify the effects of pathological abnormalities on patellar stability in vitro. Eight fresh-frozen cadaver knees were studies. The patellar stability was measured using an Instron material testing machine. A total load of 175N was applied to the quadriceps muscles. Patellar force-displacement was tested at different knee flexion angles as the patella was cyclically displaced 10mm laterally and medially. Three pathological abnormalities were applied; VMO malfunction, flat lateral trochlea, and medial retinacular structure rupturing. For the first time, this study has shown comparative and quantitative influence of pathological abnormalities on patellar stability. It was found that a flat lateral trochlea has greater effect than the medial retinacular rupturing whereas the medial retinacular rupturing has greater effect than VMO malfunction on patellar lateral stability. These results are important for future investigations on the treatment of patellofemoral instability.

Senavongse, Wongwit

2005-04-01

339

Fracture and dislocation classification compendium - 2007: Orthopaedic Trauma Association classification, database and outcomes committee.  

PubMed

The purpose of this new classification compendium is to republish the Orthopaedic Trauma Association's (OTA) classification. The OTA classification was originally published in a compendium of the Journal of Orthopaedic Trauma in 1996. It adopted The Comprehensive Classification of the Long Bones developed by Müller and colleagues and classified the remaining bones. In this compendium, the introductory chapter reviews new scientific information about classifying fractures that has been published in the last 11 years. The classification is presented in a revised format that is easier to follow. The OTA and AO classification will now have a unified alpha-numeric code eliminating the differences that have existed between the 2 codes. The code was significantly revised for the clavicle and scapula, foot and hand, and patella. Dislocations have been expanded on an anatomic basis and for most joints will be coded separately. This publication should stimulate new developments and interest in a unified language to code and classify fractures. Further improvements in classification will result in better patient care and clinical research. PMID:18277234

Marsh, J L; Slongo, Theddy F; Agel, Julie; Broderick, J Scott; Creevey, William; DeCoster, Thomas A; Prokuski, Laura; Sirkin, Michael S; Ziran, Bruce; Henley, Brad; Audigé, Laurent

2007-01-01

340

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

PubMed Central

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

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

2008-01-01

341

Diffusion and near-equilibrium distribution of MRI and CT contrast agents in articular cartilage.  

PubMed

Charged contrast agents have been used both in vitro and in vivo for estimation of the fixed charge density (FCD) in articular cartilage. In the present study, the effects of molecular size and charge on the diffusion and equilibrium distribution of several magnetic resonance imaging (MRI) and computed tomography (CT) contrast agents were investigated. Full thickness cartilage disks (Ø = 4.0 mm, n = 64) were prepared from fresh bovine patellae. Contrast agent (gadopentetate: Magnevist((R)), gadodiamide: Omniscan, ioxaglate: Hexabrix or sodium iodide: NaI) diffusion was allowed either through the articular surface or through the deep cartilage. CT imaging of the samples was conducted before contrast agent administration and after 1, 5, 9, 16, 25 and 29 h (and with three samples after 2, 3, 4 and 5 days) diffusion using a clinical peripheral quantitative computed tomography (pQCT) instrument. With all contrast agents, the diffusion through the deep cartilage was slower when compared to the diffusion through the articular surface. With ioxaglate, gadopentetate and gadodiamide it took over 29 h for diffusion to reach the near-equilibrium state. The slow diffusion of the contrast agents raise concerns regarding the validity of techniques for FCD estimation, as these contrast agents may not reach the equilibrium state that is assumed. However, since cartilage composition, i.e. deep versus superficial, had a significant effect on diffusion, imaging of the nonequilibrium diffusion process might enable more accurate assessment of cartilage integrity. PMID:19864699

Silvast, Tuomo S; Kokkonen, Harri T; Jurvelin, Jukka S; Quinn, Thomas M; Nieminen, Miika T; Töyräs, Juha

2009-11-21

342

Diffusion and near-equilibrium distribution of MRI and CT contrast agents in articular cartilage  

NASA Astrophysics Data System (ADS)

Charged contrast agents have been used both in vitro and in vivo for estimation of the fixed charge density (FCD) in articular cartilage. In the present study, the effects of molecular size and charge on the diffusion and equilibrium distribution of several magnetic resonance imaging (MRI) and computed tomography (CT) contrast agents were investigated. Full thickness cartilage disks (Ø = 4.0 mm, n = 64) were prepared from fresh bovine patellae. Contrast agent (gadopentetate: Magnevist®, gadodiamide: Omniscan™, ioxaglate: Hexabrix™ or sodium iodide: NaI) diffusion was allowed either through the articular surface or through the deep cartilage. CT imaging of the samples was conducted before contrast agent administration and after 1, 5, 9, 16, 25 and 29 h (and with three samples after 2, 3, 4 and 5 days) diffusion using a clinical peripheral quantitative computed tomography (pQCT) instrument. With all contrast agents, the diffusion through the deep cartilage was slower when compared to the diffusion through the articular surface. With ioxaglate, gadopentetate and gadodiamide it took over 29 h for diffusion to reach the near-equilibrium state. The slow diffusion of the contrast agents raise concerns regarding the validity of techniques for FCD estimation, as these contrast agents may not reach the equilibrium state that is assumed. However, since cartilage composition, i.e. deep versus superficial, had a significant effect on diffusion, imaging of the nonequilibrium diffusion process might enable more accurate assessment of cartilage integrity.

Silvast, Tuomo S.; Kokkonen, Harri T.; Jurvelin, Jukka S.; Quinn, Thomas M.; Nieminen, Miika T.; Töyräs, Juha

2009-11-01

343

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

2012-01-01

344

Wear debris pseudotumor following total knee arthroplasty: a case report  

PubMed Central

Introduction In patients who have undergone a total joint replacement, any mass occurring in or adjacent to the joint needs thorough investigation and a wear debris-induced cyst should be suspected. Case presentation An 81-year-old man presented with a painful and enlarging mass at the popliteal fossa and calf of his right knee. He had had a total right knee replacement seven years previously. Plain radiographs showed narrowing of the medial compartment. Magnetic resonance imaging showed a cystic lesion at the postero-medial aspect of the knee joint mimicking popliteal cyst or soft tissue sarcoma. Fine needle aspiration was non-diagnostic. A core-needle biopsy showed metallosis. Intraoperative findings revealed massive metallosis related to extensive polyethylene wear, delamination and deformation. Revision knee and patella arthroplasty was carried out after a thorough debridement of the knee joint. Conclusion Long-term follow-up is critical for patients with total joint replacement for early detection of occult polyethylene wear and prosthesis loosening. In these cases, revision arthroplasty may provide a satisfactory knee function.

2009-01-01

345

Hip abduction can prevent posterior edge loading of hip replacements.  

PubMed

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. PMID:23575923

van Arkel, Richard J; Modenese, Luca; Phillips, Andrew T M; Jeffers, Jonathan R T

2013-08-01

346

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

2013-01-01

347

Effective therapy of transected quadriceps muscle in rat: Gastric pentadecapeptide BPC 157.  

PubMed

We report complete transection of major muscle and the systemic peptide treatment that induces healing of quadriceps muscle promptly and then maintains the healing with functional restoration. Initially, stable gastric pentadecapeptide BPC 157 (GEPPPGKPADDAGLV, M.W. 1419, PL-10, PLD-116, PL 14736 Pliva, Croatia; in trials for inflammatory bowel disease; wound treatment; no toxicity reported; effective alone without carrier) also superiorly accelerates the healing of transected Achilles tendon. Regularly, quadriceps muscle completely transected transversely 1.0 cm proximal to patella presents a definitive defect that cannot be compensated in rat. BPC 157 (10 microg, 10 ng, 10 pg/kg) is given intraperitoneally, once daily; the first application 30 min posttransection, the final 24 h before sacrifice. It consistently improves muscle healing throughout the whole 72-day period. Improved are: (i) biomechanic (load of failure increased); (ii) function (walking recovery and extensor postural thrust/motor function index returned toward normal healthy values); (iii) microscopy/immunochemistry [i.e., mostly muscle fibers connect muscle segments; absent gap; significant desmin positivity for ongoing regeneration of muscle; larger myofibril diameters on both sides, distal and proximal (normal healthy rat-values reached)]; (iv) macroscopic presentation (stumps connected; subsequently, atrophy markedly attenuated; finally, presentation close to normal noninjured muscle, no postsurgery leg contracture). Thus, posttransection healing-consistently improved-may suggest this peptide therapeutic application in muscle disorders. PMID:16609979

Staresinic, Mario; Petrovic, Igor; Novinscak, Tomislav; Jukic, Ivana; Pevec, Damira; Suknaic, Slaven; Kokic, Neven; Batelja, Lovorka; Brcic, Luka; Boban-Blagaic, Alenka; Zoric, Zdenka; Ivanovic, Domagoj; Ajduk, Marko; Sebecic, Bozidar; Patrlj, Leonardo; Sosa, Tomislav; Buljat, Gojko; Anic, Tomislav; Seiwerth, Sven; Sikiric, Predrag

2006-05-01

348

[Analysis of human tibio-femoral joint relative kinematics based on 3D image registration].  

PubMed

This study sought to quantify normal human tibio-femoral joint kinematics in vivo. An eligible volunteer (a man in good health) was recruited, and a technical method of 3D image registration and coordinate transformation was used. The 3D point cloud models of his knee-flexion were illustrated by computed tomography. By use of the technique for 3D image registration, different models of several positions of knee-flexion were aligned to the same coordinate system. As for each model of the knee, the object coordinates of femur and tibia were built on the same location and direction in comparison with individual femur and tibia. Consequently, the error of constructing the object coordinate system in various coordinate systems can be avoided. Meanwhile, improved orthogonal coordinates systems were built on femur, tibia and patella. After orthogonal coordinates were built on each part of the knee, the Euler angle coordinate transformation was applied to acquire the data of the knee relative kinematics. Additionally, the data was proved to be effective, compared with that of recent literatures. With this method, arbitrary reference coordinates, or any alternative reference mode could be used in reconstruction of knee 3D kinematics images on a computer, and be applied in the kinematical analysis of other human joints or bones. PMID:20095499

Wang, Jianping; Han, Xuelian; Ji, Wenting; Wang, Chengtao

2009-12-01

349

Effect of Laser Acupuncture on Disuse Osteoarthritis: An Ultrasound Biomicroscopic Study of Patellar Articular Cartilage in Rats  

PubMed Central

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.

Wang, Qing; Guo, Xia; Liu, Mu-Qing; Wang, Xiao-Yun; Zheng, Yong-Ping

2012-01-01

350

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.

2013-01-01

351

[Osteotomy for approaches to the knee joint. Tibial tubercle, lateral epicondyle of the femur and head of the fibula].  

PubMed

The present article summarizes the different osteotomy techniques for an extension of standard surgical approaches to the knee joint in selected patients. The aim is to achieve satisfactory exposure and reduce potential postoperative complications compared to alternative techniques, such as the V-Y plasty or the quadriceps snip procedures. Osteotomy of the tibial tubercle is a reasonable extension of the anteromedial or the anterolateral surgical approach in selected patients undergoing revision total knee replacement. This osteotomy will provide excellent surgical exposure of the knee without the risk of avulsion of the patellar tendon and will preserve the blood supply of the patella and the surrounding soft tissue. Moreover, functional clinical outcome will be improved by minimizing damage to the extensor mechanism. Osteotomy of the lateral femoral condyle gives excellent exposure of the posterolateral aspect of the knee joint which might be necessary in some patients with fractures of the posterolateral tibial plateau as well as patients undergoing open allograft transplantation of the lateral meniscus. An alternative option for an extended exposure to the posterolateral knee joint is accomplished by osteotomy or partial resection of the fibular head which is also described as having good clinical results and a low complication rate. PMID:23632649

Lorbach, O; Anagnostakos, K; Kohn, D

2013-05-01

352

Biological activity of polyethylene wear debris produced in the patellofemoral joint.  

PubMed

Polyethylene wear is considered a threat to the long-term survival of total knee replacements. The aim of this study was to investigate the contribution that resurfacing the patella makes to wear debris-induced osteolysis following total knee replacement. Ultra-high molecular-weight polyethylene wear particles were isolated from simulator lubricant. Particle shape, size, and volume distributions were recorded allowing the osteolytic potential of the wear debris produced in the patellofemoral joint to be estimated using the concept of specific biological activity and functional biological activity. Values were compared with those reported for the tibiofemoral joint. Specific biological activity for the patellofemoral joint was not significantly different from the values for the tibiofemoral joint of total knee replacement devices, and therefore, has a similar potential to stimulate osteolytic cytokine release from macrophages. Functional biological activity was significantly lower for the patellofemoral joint compared with the tibiofemoral joint. Functional biological activity was significantly lower for the patellofemoral joint compared with the fixed bearing and rotating platform total knee replacement devices. However, as patellar resurfacing is commonly fitted as part of a total knee replacement system, this results in a 20% increase in overall functional biological activity for the system. Therefore, implanting a patellar resurfacing will increase the potential for osteolysis in the knee. PMID:22720390

Ellison, Peter; Tipper, Joanne L; Jennings, Louise M; Fisher, John

2012-05-01

353

Changes in chondrocyte gene expression following in vitro impaction of porcine articular cartilage in an impact injury model  

PubMed Central

Our objective was to monitor chondrocyte gene expression at 0, 3, 7, and 14 days following in vitro impaction to the articular surface of porcine patellae. Patellar facets were either axially impacted with a cylindrical impactor (25 mm/sec loading rate) to a load level of 2000 N or not impacted to serve as controls. After being placed in organ culture for 0, 3, 7, or 14 days, total RNA was isolated from full thickness cartilage slices and gene expression measured for 17 genes by quantitative real-time RT-PCR. Targeted genes included those encoding proteins involved with biological stress, inflammation, or anabolism and catabolism of cartilage extracellular matrix. Some gene expression changes were detected on the day of impaction, but most significant changes occurred at 14 days in culture. At 14 days in culture, 10 of the 17 genes were differentially expressed with col1a1 most significantly up-regulated in the impacted samples, suggesting impacted chondrocytes may have reverted to a fibroblast-like phenotype.

Ashwell, Melissa S.; Gonda, Michael G.; Gray, Kent; Maltecca, Christian; O'Nan, Audrey T.; Cassady, Joseph P.; Mente, Peter L.

2012-01-01

354

Changes in chondrocyte gene expression following in vitro impaction of porcine articular cartilage in an impact injury model.  

PubMed

Our objective was to monitor chondrocyte gene expression at 0, 3, 7, and 14 days following in vitro impaction to the articular surface of porcine patellae. Patellar facets were either axially impacted with a cylindrical impactor (25 mm/s loading rate) to a load level of 2,000 N or not impacted to serve as controls. After being placed in organ culture for 0, 3, 7, or 14 days, total RNA was isolated from full thickness cartilage slices and gene expression measured for 17 genes by quantitative real-time RT-PCR. Targeted genes included those encoding proteins involved with biological stress, inflammation, or anabolism and catabolism of cartilage extracellular matrix. Some gene expression changes were detected on the day of impaction, but most significant changes occurred at 14 days in culture. At 14 days in culture, 10 of the 17 genes were differentially expressed with col1a1 most significantly up-regulated in the impacted samples, suggesting impacted chondrocytes may have reverted to a fibroblast-like phenotype. PMID:23027577

Ashwell, Melissa S; Gonda, Michael G; Gray, Kent; Maltecca, Christian; O'Nan, Audrey T; Cassady, Joseph P; Mente, Peter L

2013-03-01

355

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

2012-01-01

356

Stress Fractures of the Pelvis and Legs in Athletes  

PubMed Central

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

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

2013-01-01

357

Collagen architecture and failure processes in bovine patellar cartilage  

PubMed Central

Cartilage fails by fibrillation and wearing away. This study was designed to identify the microscopic failure processes in the collagen network of bovine cartilage using scanning electron microscopy. Cartilage samples from fibrillated cartilage from the bovine patella were removed from the bone, fixed, digested to remove proteoglycans, freeze-fractured, and processed for SEM. The architecture of the collagen network in the normal cartilage was first defined, and then the failure processes were identified by examining sites of fibrillation and at crack tips. The bovine patellar cartilage was organised with a superficial layer composed of 3–5 lamina, attached to a sub-superficial tissue by angled bridging fibrils. Collagen in the sub-superficial tissue was organised in lamina oriented in the radial direction up to the transition zone. Failure of the system occurred by cracks forming in superficial layer and lamina, creating flaps of lamina that rolled up into the larger ‘fronds’. Larger cracks not following the laminar planes occurred in the transition, mid, and deep zones. Failure at the crack tips in the sub-superficial tissue appeared to be by peeling of collagen fibrils, as opposed to breaking of collagen fibrils, suggesting a ‘glue’ bonding the collagen fibrils in a parallel fashion. Cracks propagated by breaking these bonds. This bond could be a site of disease action, since weakening of the bond would accelerate crack propagation.

LEWIS, JACK L.; JOHNSON, SANDRA L.

2001-01-01

358

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

PubMed

The literature suggests that a Grade II medial collateral ligament (MCL) injury in combination with anterior cruciate ligament (ACL) injury will heal naturally and not compromise patient outcome following ACL reconstruction. Evidence based on bone-patella tendon-bone autograft use is stronger than evidence supporting anatomically placed soft tissue graft use. Current ACL reconstruction practices make greater use of soft tissue grafts, differing fixation methods, and anatomically lower placement on the inner wall of the lateral femoral condyle. Anatomical graft placement aligns the femoral bone tunnel more directly with valgus knee loading forces. Differences in the soft tissue graft-bone tunnel integration and ligamentization timetable following ACL reconstruction also increase concerns regarding residual Grade II MCL laxity and functional deficiency during accelerated functional rehabilitation. MCL dysfunction may increase susceptibility to early ACL graft slippage, elongation, outright failure, and medial femoral condyle lift-off with valgus knee loading. This concept paper discusses the potential role of growth factors and bio-scaffolds for improving Grade II MCL injury healing and mechanical integrity when the injury occurs in combination with an ACL injury that is reconstructed with a soft tissue graft and an anatomical surgical approach. PMID:21830112

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

2012-05-01

359

Correlation between trochlear groove depth and patellar position during open and closed kinetic chain exercises in subjects with anterior knee pain.  

PubMed

The purpose of this study was to correlate the trochlear shape and patellar tilt angle and lateral patellar displacement at rest and maximal voluntary isometric contraction (MVIC) exercises during open (OKC) and closed kinetic chain (CKC) in subjects with and without anterior knee pain. Subjects were all women, 20 who were clinically healthy and 19 diagnosed with anterior knee pain. All subjects were evaluated and subjected to magnetic resonance exams during OKC and CKC exercise with the knee placed at 15, 30, and 45 degrees of flexion. The parameters evaluated were sulcus angle, patellar tilt angle and patellar displacement using bisect offset. Pearson's r coefficient was used, with p < .05. Our results revealed in knee pain group during CKC and OKC at 15 degrees that the increase in the sulcus angle is associated with a tilt increase and patellar lateral displacement. Comparing sulcus angle, patellar tilt angle and bisect offset values between MVIC in OKC and CKC in the knee pain group, it was observed that patellar tilt angle increased in OKC only with the knee flexed at 30 degrees. Based on our results, we conclude that reduced trochlear depth is correlated with increased lateral patellar tilt and displacement during OKC and CKC at 15 degrees of flexion in people with anterior knee pain. By contrast, 30 degrees of knee flexion in CKC is more recommended in rehabilitation protocols because the patella was more stable than in other positions. PMID:22890436

Felicio, Lílian Ramiro; Saad, Marcelo Camargo; Liporaci, Rogério Ferreira; Baffa, Augusto do Prado; dos Santos, Antônio Carlos; Bevilaqua-Grossi, Débora

2012-07-01

360

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

2012-01-01

361

Easily missed injuries around the knee.  

PubMed

Most fractures around the knee are easily detected on high-quality radiographs. However, some fractures and musculotendinous and ligamentous injuries have subtle findings and may be difficult to detect even with optimal images; these injuries include tibial plateau fractures, Segond fractures, stress fractures, fibular head fractures and dislocations, injuries to the patella and extensor mechanism, and Salter type fractures. Clinically suspected tibial plateau fractures unseen on standard views may be seen on tangential or tunnel projections. Segond fractures usually have a characteristic appearance on anteroposterior radiographs but occasionally are seen only on tunnel views. Stress fractures of the proximal tibia may be accompanied by a vague band of increased sclerosis or endosteal callus on either side of the epiphyseal scar. Correct diagnosis of fibular head dislocations requires clinical suspicion, since these injuries often are not recognized on initial radiographs. Careful evaluation of the congruity of the tibiofibular joint on the lateral projection is the key to diagnosis. Vertical patellar fractures are often nondisplaced and are best evaluated with sunrise or Merchant views; avulsion fractures from the proximal or distal poles, with lateral views; and osteochondral fractures, with sunrise or internal oblique views. Salter I injuries can be visualized on oblique and anteroposterior views obtained with stress applied to the knee. Some occult Salter I fractures are diagnosed on follow-up radiographs, which show periosteal reaction. Imaging modalities other than radiography are rarely needed to diagnose fractures but are useful for evaluating the extent of displacement or confirming soft-tissue injuries. PMID:7855335

Capps, G W; Hayes, C W

1994-11-01

362

Deleterious effects of diluted povidone-iodine on articular cartilage.  

PubMed

A recent study has suggested that irrigation with povidone-iodine solution after knee arthroplasty significantly decreases rates of post-operative surgical site infection. However, there is only limited knowledge of potential chondrotoxic effects on the residual cartilage in patients with partial knee arthroplasties or unresurfaced patella in total knee arthroplasty. Macroscopically normal bovine cartilage explants (n=42) were exposed to different povidone-iodine concentrations for 1, 3 or 6 min, as well as saline control. The viability of superficial chondrocytes was measured by a Live/Dead cytotoxicity assay. Chondrotoxicity correlated positively with the length of exposure, regardless of the concentration. The extent of superficial chondrocyte death was significantly greater at higher concentrations of povidone-iodine solutions. 0.35% povidone-iodine solution was the least chondrotoxic of all concentrations, but still reduced cell viability significantly if applied for longer than 1 min. Our data suggest that povidone-iodine solution at all tested concentrations has a pronounced chondrotoxic effect on the superficial cartilage layer when used for time periods longer than 1 min. PMID:23528554

von Keudell, Arvind; Canseco, Jose A; Gomoll, Andreas H

2013-06-01

363

Ultrasound evaluation of mechanical injury of bovine knee articular cartilage under arthroscopic control.  

PubMed

A local cartilage injury can trigger development of posttraumatic osteoarthritis (OA). Surgical methods have been developed for repairing cartilage injuries. Objective and sensitive methods are needed for planning an optimal surgery as well as for monitoring the surgical outcome. In this laboratory study, the feasibility of an arthroscopic ultrasound technique for diagnosing cartilage injuries was investigated. In bovine knees (n = 7) articular cartilage in the central patella and femoral sulcus was mechanically degraded with a steel brush modified for use under arthroscopic control. Subsequently, mechanically degraded and intact adjacent tissue was imaged with a high frequency (40 MHz) intravascular ultrasound device operated under arthroscopic guidance. After opening the knee joint, mechanical indentation measurements were also conducted with an arthroscopic device at each predefined anatomical site. Finally, cylindrical osteochondral samples were extracted from the measurement sites and prepared for histological analysis. Quantitative parameters, i.e., reflection coefficient (R), integrated reflection coefficient (IRC), apparent integrated backscattering (AIB), and ultrasound roughness index (URI) were calculated from the ultrasound signals. The reproducibilities (sCV %) of the measurements of ultrasound parameters were variable (3.7% to 26.1%). Reflection and roughness parameters were significantly different between mechanically degraded and adjacent intact tissue (p < 0.05). Surface fibrillation of mechanically degraded tissue could be visualized in ultrasound images. Furthermore, R and IRC correlated significantly with the indentation stiffness. The present results are encouraging; however, further technical development of the arthroscopic ultrasound technique is needed for evaluation of the integrity of human articular cartilage in vivo. PMID:21244982

Virén, Tuomas; Saarakkala, Simo; Tiitu, Virpi; Puhakka, Jani; Kiviranta, Ilkka; Jurvelin, Jukka; Töyräs, Juha

2011-01-01

364

Effects of ultrasound beam angle and surface roughness on the quantitative ultrasound parameters of articular cartilage.  

PubMed

High-resolution arthroscopic ultrasound imaging provides a potential quantitative technique for the diagnostics of early osteoarthritis. However, an uncontrolled, nonperpendicular angle of an ultrasound beam or the natural curvature of the cartilage surface may jeopardize the reliability of the ultrasound measurements. We evaluated systematically the effect of inclining an articular surface on the quantitative ultrasound parameters. Visually intact (n = 8) and mechanically degraded (n = 6) osteochondral bovine patella samples and spontaneously fibrillated (n = 1) and spontaneously proteoglycan depleted (n = 1) osteochondral human tibial samples were imaged using a 50-MHz scanning acoustic system. The surface of each sample was adjusted to predetermined inclination angles (0, 2, 5 and 7 degrees ) and five ultrasound scan lines along the direction of the inclination were analyzed. For each scan line, reflection coefficient (R), integrated reflection coefficient (IRC) and ultrasound roughness index (URI) were calculated. Nonperpendicularity of the cartilage surface was found to affect R, IRC and URI significantly (p < 0.05). Importantly, all ultrasound parameters were able to distinguish (p < 0.05) the mechanically degraded samples from the intact ones even though the angle of incidence of the ultrasound beam varied between 0 and 5 degrees among the samples. Diagnostically, the present findings are important because the natural curvature of the articular surface varies, and a perfect perpendicularity between the ultrasound beam and the surface of the cartilage may be challenging to achieve in a clinical measurement. PMID:19541404

Kaleva, E; Saarakkala, S; Jurvelin, J S; Virén, T; Töyräs, J

2009-08-01

365

Ultrasonic measurement of articular cartilage swelling: preliminary results  

NASA Astrophysics Data System (ADS)

Articular cartilage (AC) is a biological weight-bearing tissue covering the bony ends of articulating joints. Subtle changes in structure or composition can lead to degeneration of AC such as in osteoarthritis. Currently, there is a lack of reliable diagnostic techniques for early signs of osteoarthritis. The objective of this study was to use ultrasound to probe the transient depth-dependent swelling of AC in vitro, and ultimately to develop a new approach for the early assessment of osteoarthritis. A 50 MHz ultrasound system was used to collect reflected and scattered echoes from AC specimens. The displacements of selected portions of ultrasound signals were measured using a cross-correlation tracking approach. Osteochondral cylinders prepared from fresh bovine patellae were used in this study. During a test, the AC specimen was fixed in a testing chamber filled with saline solution. AC swelling was induced by either changing the concentration of the saline solution or emerging dehydrated AC specimens into the saline solution. Our preliminary results demonstrated that ultrasound could be used to reliably monitor the transient depth-dependent swelling induced by both approaches. It was found that water was gradually absorbed by the AC, first in the superficial layer, and then deep layer. The ultrasound speeds of AC tissues bathed in different saline solutions were different.

Zheng, Yongping; Shi, Jun; Patil, Sushil G.; Qin, Ling; Mak, Arthur F. T.

2003-05-01

366

Mechanical properties of radiation-sterilised human Bone-Tendon-Bone grafts preserved by different methods.  

PubMed

Patellar tendon auto- and allo-grafts are commonly used in orthopedic surgery for reconstruction of the anterior cruciate ligaments (ACL). Autografts are mainly used for primary reconstruction, while allografts are useful for revision surgery. To avoid the risk of infectious disease transmission allografts should be radiation-sterilised. As radiation-sterilisation supposedly decreases the mechanical strength of tendon it is important to establish methods of allograft preservation and sterilisation assuring the best quality of grafts and their safety at the same time. Therefore, the purpose of this study was to compare the tensile strength of human patellar tendon (cut out as for ACL reconstruction), preserved by various methods (deep fresh freezing, glycerolisation, lyophilisation) and subsequently radiation-sterilised with doses of 0, 25, 50 or 100 kGy. Bone-Tendon-Bone grafts (BTB) were prepared from cadaveric human patella tendons with both patellar and tibial attachments. BTB grafts were preserved by deep freezing, glycerolisation or lyophilisation and were subsequently radiation-sterilised with doses of 0 (control), 25, 50 or 100 kGy. All samples were subjected to mechanical failure tensile tests with the use of Instron system in order to estimate their mechanical properties. All lyophilised grafts were rehydrated before performing of those tests. Obtained mechanical tests results of examined grafts suggest that deep-frozen irradiated grafts retain their initial mechanical properties to an extent which does not exclude their clinical application. PMID:18982427

Kami?ski, A; Gut, G; Marowska, J; Lada-Koz?owska, M; Biwejnis, W; Zasacka, M

2009-08-01

367

Lead Burden and Psychiatric Symptoms and the Modifying Influence of the ?-Aminolevulinic Acid Dehydratase (ALAD) Polymorphism  

PubMed Central

The authors evaluated the association between lead burden and psychiatric symptoms and its potential modification by a ?-aminolevulinic acid dehydratase (ALAD) polymorphism. Lead measurements in blood or bone and self-reported ratings on the Brief Symptom Inventory from 1991 to 2002 were available for 1,075 US men participating in the Department of Veterans Affairs (VA) Normative Aging Study. The authors estimated the prevalence odds ratio for the association between interquartile-range lead and abnormal symptom score, adjusting for potential confounders. An interquartile increment in tibia lead (14 µg/g) was associated with 21% higher odds of somatization (95% confidence interval of the odds ratio: 1.01, 1.46). An interquartile increment in patella lead (20 µg/g) corresponded to a 23% increase in the odds of global distress (95% confidence interval of the odds ratio: 1.02, 1.47). An interquartile increment in blood lead (2.8 µg/dl) was associated with 14% higher odds of hostility (95% confidence interval of the odds ratio: 1.02, 1.27). In all other analyses, lead was nonsignificantly associated with psychiatric symptoms. The adverse association of lead with abnormal mood scores was generally stronger among ALAD 1-1 carriers than 1-2/2-2 carriers, particularly regarding phobic anxiety symptoms (pinteraction= 0.004). These results augment evidence of a deleterious association between lead and psychiatric symptoms.

Rajan, Pradeep; Kelsey, Karl T.; Schwartz, Joel D.; Bellinger, David C.; Weuve, Jennifer; Sparrow, David; Spiro, Avron; Smith, Thomas J.; Nie, Huiling; Hu, Howard; Wright, Robert O.

2008-01-01

368

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

PubMed

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

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

2013-09-01

369

Sugioka's Modified Hungria-Kramer intertrochanteric osteotomy in the treatment of severe slipped capital femoral epiphysis.  

PubMed

From May 1990 to November 1997, 24 cases of severe slipped capital femoral epiphysis were treated by an osteotomy that is a modification of the Hungria-Kramer intertrochanteric osteotomy proposed by Sugioka (Hungria-Kramer-Sugioka osteotomy or HKS osteotomy). The degree of displacement as seen on the frog-leg lateral radiograph of the proximal femur was measured according to the deviation of the longitudinal axis of the epiphysis from the center line of the neck (Fish classification). All hips were considered as grade III and underwent HKS osteotomy. Sugioka's radiographic study (true AP view with the limb internally rotated until the patella is perpendicular to the x-ray beam, and lateral view with the hip in 90 degrees flexion and 45 degrees abduction) was performed before surgery to show that the real direction of the slip was posterior in relation to the neck. Clinical results were assessed according to Merle-D'Aubigné and Postel system modified by Charnley (hip score system that takes into consideration pain, gait, and joint motion). Roentgenographic results were considered good if none of the following was present: joint space decreased by more than 2 mm (chondrolysis), avascular necrosis of the femoral head, neck-shaft angle of less than 120 degrees, nonunion at the osteotomy site, and a epiphyseal plate still open. Follow-up varied from 31 to 120 months (average 65.1 months). PMID:15958893

Fujiki, Edison N; Kuwajima, Sergio S; Honda, Emerson K; Milani, Carlo; Porto, Luiz Carlos K; Chikude, Takeshi; Fukushima, Walter Y; Ono, Nelson K

2005-01-01

370

Combined application of low-intensity pulsed ultrasound and functional electrical stimulation accelerates bone-tendon junction healing in a rabbit model.  

PubMed

The objective of this study was to elucidate the combined use of low-intensity pulsed ultrasound (LIPUS) and functional electrical stimulation (FES) on patella-patellar tendon (PPT) junction healing using a partial patellectomy model in rabbits. LIPUS was delivered continuously starting day 3 postoperative until week 6. FES was applied on quadriceps muscles to induce tensile force to the repaired PPT junction 5 days per week for 6 weeks since week 7 postoperatively. Forty rabbits with partial patellectomy were randomly divided into four groups: control, LIPUS alone, FES alone, and LIPUS?+?FES groups. At week 12, the PPT complexes were harvested for histology, radiographs, peripheral quantitative computed tomography, and biomechanical testing. There was better remodeling of newly formed bone and fibrocartilage zone in the three treatment groups compared with the control group. LIPUS and/or FES treatments significantly increased the area and bone mineral content of new bone. The failure load and ultimate strength of PPT complex were also highly improved in the three treatment groups. More new bone formed and higher tensile properties were showed in the LIPUS?+?FES group compared with the LIPUS or FES alone groups. Early LIPUS treatment and later FES treatment showed the additive effects of accelerating PPT junction healing. PMID:24136665

Hu, Jianzhong; Qu, Jin; Xu, Daqi; Zhang, Tao; Qin, Ling; Lu, Hongbin

2014-02-01

371

The intraoperative gap difference (flexion gap minus extension gap) is altered by insertion of the trial femoral component.  

PubMed

A Tensor/Balancer device has been recently developed in order to assess soft tissue balancing in total knee arthroplasty (TKA) under more physiological conditions. This device allows us to measure the joint gap with a trial femoral component in place with the patella reduced. The purpose of this study was to clarify whether the placement of the component changes the intraoperative gap difference (flexion gap distance minus extension gap distance). We prospectively investigated the extension (0°) and flexion (90°) gaps in 73 posterior-stabilized TKAs under 30 lb of joint distraction force. Then, we compared the gap difference with and without the trial femoral component in place. Our results showed that the intraoperative gap difference with the trial femoral component in place was larger than the intraoperative gap difference without the trial component (p=0.00003; with the trial component: mean 4.7 mm (standard deviation (SD): 3.0mm); without the trial component: mean 2.7 mm (SD: 3.3mm)). We consider that the change in gap difference with or without femoral component was caused by a relative difference in the elasticity and/or tightness of the soft tissue in extension versus flexion. Surgeons should be aware of this effect of the femoral component when considering intraoperative soft tissue balancing which leads to postoperative stability of the knee joint consequently. PMID:21889347

Hananouchi, Takehito; Yamamoto, Kengo; Ando, Wataru; Fudo, Kazumasa; Ohzono, Kenji

2012-10-01

372

The influence of malrotation and femoral component material on patellofemoral wear during gait.  

PubMed

Complications involving the patellofemoral joint, caused by malrotation of the femoral component during total knee replacement, are an important cause of persistent pain and failure leading to revision surgery. The aim of this study was to determine and quantify the influence of femoral component malrotation on patellofemoral wear, and to determine whether or not there is a difference in the rate of wear of the patellar component when articulated against oxidised zirconium (OxZr) and cobalt-chrome (CoCr) components. An in vitro method was used to simulate patellar maltracking for both materials. Both rates of wear and changes in height on the patellar articular surface were measured. The mean rates of wear measured were very small compared to standard tibiofemoral wear rates. When data for each femoral component material were pooled, the mean rate of wear was 0.19 mm3/Mcycle (sd 0.21) for OxZr and 0.34 mm3/Mcycle (sd 0.335) for CoCr. The largest change in height on each patella varied from -0.05 mm to -0.33 mm over the different configurations. The results suggest that patellar maltracking due to an internally rotated femoral component leads to an increased mean patellar wear. Although not statistically significant, the mean wear production may be lower for OxZr than for CoCr components. PMID:21969433

Vanbiervliet, J; Bellemans, J; Verlinden, C; Luyckx, J P; Labey, L; Innocenti, B; Vandenneucker, H

2011-10-01

373

Sex change in the Mollusca.  

PubMed

Sex change in the Mollusca is almost exclusively protandric (male to female), and has only been reported among gastropods and bivalves. The adaptive value of protandry in these two classes most likely relates to the limited availability of females, and the consequent size-independent nature of male reproductive success (versus the size-dependent nature of reproductive success in females). In two well studied distantly related prosobranch gastropod superfamilies, Calyptracea and Patellacea, individuals of some species respond to local ecological changes by altering the age at which they change sex, although the critical ecological changes appear to be different. The physiological switch that activates sex change also appears to be different: it is found in the cemtral nervous system of the calyptracean Crepidula fornicata, and actually within the gonads of the patellacean Patella vulgata. Although the taxonomic breadth of studies on sex change is necessarily limited, and many questions remain to be answered, research on the Mollusca has produced a remarkable range of perspectives on sex change - from evolutionary to proximal; further research will benefit greatly from this breadth of knowledge. PMID:21227183

Wright, W G

1988-06-01

374

The "banana peel" exposure method in revision total knee arthroplasty.  

PubMed

We present an exposure technique, the "banana peel," that has been used exclusively for revision total knee arthroplasty (TKA) for more than 20 years. We retrospectively reviewed use of this technique in 102 consecutive patients (mean age, 62 years; range, 41-92 years) who underwent tibial-femoral stemmed revision TKA. There were 5 deaths, leaving 97 patients (98 knees) for the study. The technique involves peeling the patella tendon as a sleeve off the tibia, leaving the extensor mechanism intact with a lateral hinge of soft tissue. A quadriceps "snip" is also done proximally. Patients with a minimum follow-up of 24 months were included. Telephone interviews and chart reviews were conducted, and Knee Society scores were obtained. Mean follow-up was 39 months (range, 24-56 months). No patient reported disruption of the extensor mechanism or decreased ability to extend the operative knee. Mean Knee Society score was 176 (range, 95-200). Mean postoperative motion was 106 degrees. No patient reported pain over the tibial tubercle. The banana-peel technique for exposing the knee during revision TKA is a safe method that can be used along with a proximal quadriceps snip and does not violate the extensor mechanism, maintaining continuity of the knee extensors. PMID:18033563

Lahav, Amit; Hofmann, Aaron A

2007-10-01

375

Nail disorders in children: diagnosis and management.  

PubMed

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

Richert, Bertrand; André, Josette

2011-04-01

376

Effect of tibial plateau leveling osteotomy on patellofemoral alignment: a study using canine cadavers.  

PubMed

Tibial plateau leveling osteotomy (TPLO) has been shown to alter the biomechanics of the femorotibial joint; however, the effect of TPLO on patellofemoral (PF) joint alignment remains unknown. The purpose of this study was to evaluate PF joint kinematics before and after cranial cruciate ligament (CrCL) transection and following TPLO in a cadaveric stifle model with set patellar tendon load, tested in passive range of motion at 90°, 105°, 120°, 135° and 150° of flexion. The PF joint poses were measured on mediolateral projection radiographs using a two-dimensional computer digitization technique. In the subluxated CrCL-deficient stifle, the PF joint had an increase in patellar tilt angle. In the reduced CrCL-deficient stifle treated by TPLO, there was distal and caudal displacement of the patella relative to the femur and a decreased patellar tilt angle. The estimated patellar moment arm following TPLO was not different from the control stifle. On the basis of these results, TPLO alters PF joint kinematics. The changes in PF joint alignment induced by TPLO may be a biomechanical factor predisposing to patellar tendonitis following TPLO. PMID:23942049

Pozzi, Antonio; Dunbar, Nicholas J; Kim, Stanley E

2013-10-01

377

Treatment of habitual patellar dislocation in an adult by isolated medial patellofemoral ligament reconstruction.  

PubMed

Habitual patellar dislocations are rare in adults. Treatment is difficult, and often associated with significant morbidity. A 30-year-old man, construction worker, presented a habitual patellofemoral dislocation which was caused by direct trauma to the knee as a child. Clinical examination showed a 3?cm leg-length discrepancy with no rotational deformities. The patient had a limp and loss of function; the patella was dislocated laterally and had locked at 20° of flexion with a range of motion of 0°/0°/30°. Open surgery was performed associating lateral retinacular release, reconstruction of the medial patellofemoral ligament with an ipsilateral gracilis tendon graft. The postoperative course was simple with no complications. Four months after surgery the patient has begun working normally. At the final 50-month clinical follow-up, knee range of motion was 0°/0°/130°, and functional results were excellent on clinical assessment scores of Kujala, Lysholm, and subjective IKDC. MPFL reconstruction alone seems effective in habitual posttraumatic patellar dislocation in adults without any associated bone anomalies. PMID:24716064

Bohu, Yoann; Thaunat, Mathieu; Lefevre, Nicolas; Klouche, Shahnaz; Herman, Serge; Catonné, Yves

2014-01-01

378

Anatomical basis of distally based anterolateral thigh flap.  

PubMed

Soft tissue coverage around the knee has persisted as a challenge for plastic and reconstructive surgeons. The distally-based anterolateral thigh flap is often used for coverage. Nevertheless, few anatomical studies have investigated the retrograde vascular pedicle. This report clarifies the anatomy of the connection between the descending branch of the lateral circumflex femoral artery and the lateral superior genicular artery. This study examined 38 lower limbs from cadavers and recorded the numbers and locations of perforating vessels. Proximal and distal pivot points were also recorded. The proximal pivot point was 1.0-12.1 cm (average = 6.0 cm) from the inguinal ligament. The distal pivot point, found under the vastus lateralis muscle in all 38 specimens, was 4.0-13.6 cm (average = 9.8 cm) from the lateral superior edge of the patella. The most distal perforator was 8.2-28.0 cm (average = 18.9 cm) from the proximal pivot point. The most proximal perforator was 3.0-19.5 cm (average = 8.7 cm) from the distal pivot point. Details of the anastomosis of the descending branch and the superior lateral genicular artery were clarified. The distally-based anterolateral thigh flap presents one option for reconstruction around the knee. PMID:24256309

Yamada, Satoshi; Okamoto, Hideki; Sekiya, Isato; Wada, Ikuo; Kobayashi, Masaaki; Goto, Hideyuki; Mizutani, Jun; Nozaki, Masahiro; Hayashi, Katsuhiro; Murakami, Satona; Murase, Atsunori; Kawaguchi, Yohei; Inatani, Hiroyuki; Tatematsu, Naoe; Otsuka, Takanobu

2014-06-01

379

Relationships between Algae, Benthic Herbivorous Invertebrates and Fishes in Rocky Sublittoral Communities of a Temperate Sea (Mediterranean)  

NASA Astrophysics Data System (ADS)

In situ surveys were used to examine the contribution of benthic herbivorous invertebrates and fishes to the organization of Mediterranean rocky sublittoral communities. Shallow (1-3 m) and deep (6-8 m) sampling sites, in natural areas and on man-made structures, were characterized by a structural complexity index (cavity index and mean size of cavity aperture), algal cover (encrusting, turfy, shrubby and arborescent algae) and the density of benthic herbivorous invertebrates and fish. A relationship between structural complexity and biota was only evident for some fish species ( Diplodus spp. and Sarpa salpa) at deep sites, where they not only feed but also shelter. Three benthic herbivorous invertebrates, the sea urchins Paracentrotus lividus and Arbacia lixula, and the limpet Patella caerulea , are associated with communities dominated by encrusting algae. Variations in their abundance and role in structuring algal communities follow a depth gradient: P. caerulea and A. lixula are mainly present at shallow sites and P. lividus at deep sites. These benthic herbivorous invertebrates may account for the structure of shallow algal communities. In contrast, at deep sites, fishes (the omnivorous Diplodus spp. and the herbivorous S. salpa) have a potential importance in controlling sublittoral algae, in addition to invertebrates. It is suggested that the ecological impact of herbivorous and omnivorous fishes in temperate seas could be greater than is generally thought. Experiments should be designed to validate this postulate.

Ruitton, S.; Francour, P.; Boudouresque, C. F.

2000-02-01

380

Metals in molluscs and algae: a north-south Tyrrhenian Sea baseline.  

PubMed

We develop a 800 km long relative baseline of metal pollution for the Tyrrhenian Sea, from the north of Naples to south of Sicily (Italy), based on spatio-temporal (1997-2004) concentrations of trace metals in marine organisms and on the bioaccumulative properties of those organisms. The study concerns sites in the gulf of Gaeta-Formia, near Naples, and three islands north, west, and south of Sicily: Ustica, Favignana and Linosa. The five metals are: cadmium, chromium, copper, lead, and zinc; the species include: Monodonta turbinata (n=161), Patella caerulea (n=244) and the algae Padina pavonica (n=84). We use Johnson's (1949) [15] probabilistic method to determine the type of distribution that accounts for our data. It is a system of frequency curves that represents the transformation of the standard normal curves. We find an N-S pollution gradient in molluscs considered: the lowest metal pollution occurs around the Sicilian islands. Our method can accurately characterize marine pollution by contributing to: policy-making, coastal resources management, the assessments of environmental damages from marine accidents and other events. The method here presented is a useful tool for pollution comparisons purposes among ecosystems (i.e., risk monitoring) and it is an ideal starting point for its application on a global scale. PMID:20605327

Conti, Marcelo Enrique; Finoia, Maria Grazia

2010-09-15

381

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

PubMed

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

Sjøtun, K; Heldal, H E; Brakstad, D S

2011-11-01

382

Assessment of lower limb prosthesis through wearable sensors and thermography.  

PubMed

This study aimed to explore the application of infrared thermography in combination with ambulatory wearable monitoring of temperature and relative humidity, to assess the residual limb-to-liner interface in lower-limb prosthesis users. Five male traumatic transtibial amputees were involved, who reported no problems or discomfort while wearing the prosthesis. A thermal imaging camera was used to measure superficial thermal distribution maps of the stump. A wearable system for recording the temperature and relative humidity in up to four anatomical points was developed, tested in vitro and integrated with the measurement set. The parallel application of an infrared camera and wearable sensors provided complementary information. Four main Regions of Interest were identified on the stump (inferior patella, lateral/medial epicondyles, tibial tuberosity), with good inter-subject repeatability. An average increase of 20% in hot areas (P < 0.05) is shown after walking compared to resting conditions. The sensors inside the cuff did not provoke any discomfort during recordings and provide an inside of the thermal exchanges while walking and recording the temperature increase (a regime value is ~+1.1 ± 0.7 °C) and a more significant one (~+4.1 ± 2.3%) in humidity because of the sweat produced. This study has also begun the development of a reference data set for optimal socket/liner-stump construction. PMID:24618782

Cutti, Andrea Giovanni; Perego, Paolo; Fusca, Marcello C; Sacchetti, Rinaldo; Andreoni, Giuseppe

2014-01-01

383

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

PubMed

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

2014-06-01

384

Functionality and Safety of an Ultra-Congruent Rotating Platform Knee Prosthesis at 5.6 Years: More than 5- Year Follow-Up of the e.motion® UC-TKA  

PubMed Central

Background: Mobile bearing TKA prostheses were designed to minimize polyethylene wear by increasing implant conformity and reducing stresses between the articulating prosthesis components. It is the purpose of this study to assess the mid-term functionality and clinical outcome associated with a highly congruent mobile platform design, the e.motion® UC total knee prosthesis. Material and Methods: Functional and clinical outcomes were assessed after an average of 5.6 years (5.1 – 6.0 years) after total knee arthroplasty in 28 patients (24 women), aged 77.8±7.5 years. The Knee injury and Osteoarthritis Outcome Score (KOOS) was assessed. Secondary outcomes included the Knee Society Score (KSS), radiological evaluation of radiolucent lines and recording of adverse events. Results: The average KOOS subscore for the activities of daily life was 77.8 points after 5.6 years. Both the clinical and functional KSS improved at 2.4 and 5.6 years. Two patients showed radiolucent lines at 5.6 years. Adverse events over 5.6 years included 3 subluxations, 1 tilting and 1 misalignment of the patella. None of the prostheses were revised. Conclusion: This pilot study shows promising outcomes for the e.motion® UC prosthesis. In the small sample, the implant performed comparably to the LCS prosthesis (the gold standard). There were no loosenings or revisions observed at 5.6 years.

Chavoix, Jean-Baptiste

2013-01-01

385

The Effect of Neonatal Gene Therapy on Skeletal Manifestations in Mucopolysaccharidosis VII Dogs after a Decade  

PubMed Central

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.

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.

2013-01-01

386

Porous tantalum in reconstructive surgery of the knee: a review.  

PubMed

Porous tantalum represents an alternative metal for primary and revision total knee arthroplasty (TKA) with several unique properties. Tantalum is a transition metal, which in its bulk form has shown excellent biocompatibility and is safe to use in vivo as evidenced by its current application in pacemaker electrodes, cranioplasty plates, and as radiopaque markers. Current designs for orthopedic implants maintain a high volumetric porosity (70%-80%), low modulus of elasticity (3 MPa), and high frictional characteristics, making this metal conducive to biologic fixation. The low modulus of elasticity of such components allows for more physiologic load transfer and relative preservation of bone stock. Its more bioactive nature and ingrowth properties have led to its use in primary as well as revision knee components with good early clinical results reported. In revision arthroplasty, it has been used as a structural bone graft substitute. Formation of a bone-like apatite coating in vivo affords strong fibrous ingrowth properties and allows for substantial soft-tissue attachment with the potential for use in cases such as mega-prostheses and patella salvage. Although porous tantalum is in its early stages of evolution, the initial clinical data and basic science studies support its use as an alternative to traditional orthopedic implant materials. PMID:17665779

Levine, Brett; Sporer, Scott; Della Valle, Craig J; Jacobs, Joshua J; Paprosky, Wayne

2007-07-01

387

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

PubMed

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

Jacobus, Luke M; Wiersema, N A

2014-01-01

388

[Femoro-patellar prosthesis. A retrospective study of 45 consecutive cases with a follow-up of 3-12 years].  

PubMed

Forty-five consecutive patients operated between 1986 and 1995 were evaluated to assess the long term results of patellofemoral arthroplasty. Revision had to be performed in 8 cases for the following reasons: loosening (3), lateral impingement (3), malposition (1) and persistent patella instability (1). Two groups of patients were identified based upon the preoperative assessment: 21 had primary osteoarthritis without anatomic malalignment (group C) and 24 had a history of patellofemoral instability and trochlear dysplasia demonstrated by clinical and radiological evaluation (group D). Only 43% of good results were found in group C whereas in group D, the percentage of good results was close to 83%. The most common cause of poor results in group C was the degenerative involvement of the femorotibial compartments (5 patients had to undergo total knee arthroplasty subsequently). For group D patients, femorotibial osteoarthritis was not a determinant factor as regards the outcome of patellofemoral arthroplasty. To the authors, it appears that the best indication for patellofemoral arthroplasty is femoropatellar osteoarthritis with malalignment in patients having a normal femorotibial axis even in the presence of femorotibial osteoarthritis as long as the latter does not exceed grade II. PMID:10427798

De Cloedt, P; Legaye, J; Lokietek, W

1999-06-01

389

The Advantage of Arthroscopic Anterior Cruciate Ligament Reconstruction with Autograft from the Tendons of the Semitendinosus - Gracilis Muscles for the Recovery of the Stability of the Knee  

PubMed Central

ABSTRACT Anterior cruciate ligament (ACL) injuries remain a common orthopaedic disease, particularly in young adults. The treatment of choice for ACL injuries is ACL reconstruction (ligamentoplasty). ACL reconstruction is the surgical intervention used to replace the damaged ACL with a bone-patella tendon-bone (BTB) graft or with soft parts (semitendinosus – gracilis muscles (ST-G) – a method more frequently used nowadays). Materials and method: In the Clinic of Orthopedics and Traumatology of the University Emergency Hospital of Bucharest, during the period 01.01.2009 – 01.03.2011, a number of 37 arthroscopic ACL reconstructions with ST-G were studied, performed to treat ACL isolated injuries or injuries associated with complex trauma of the knee. Results: Clinical studies have shown that ACL reconstruction is highly superior to ACL repair (suturing). Arthroscopy was the main method of diagnosis in 28 cases, whereas the remaining ACL injuries were diagnosed using the MRI. Conclusions: The rehabilitation of the patients who underwent arthroscopic ACL reconstructions with ST-G was easier and faster in comparison with that following the surgical interventions performed with BTB graft during the previous years.

Cirstoiu, Catalin; Circota, Gheorghe; Panaitescu, Corina; Niculaita, Radu

2011-01-01

390

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

PubMed

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 rigid. Twelve elastic elements are used to describe the geometry and mechanical properties of the cruciate ligaments, the collateral ligaments, and the posterior capsule. The model is actuated by thirteen musculotendinous units, each unit represented as a three-element muscle in series with tendon. The calculations show that the forces applied during a-p draw are substantially different from those applied by the muscles during activity. Principles of knee-ligament function based on the results of in vitro experiments may therefore be overstated. Knee-ligament forces during straight a-p draw are determined solely by the changing geometry of the ligaments relative to the bones: ACL force decreases with increasing flexion during anterior draw because the angle between the ACL and the tibial plateau decreases as knee flexion increases; PCL force increases with increasing flexion during posterior draw because the angle between the PCL and the tibial plateau increases. The pattern of ligament loading during activity is governed by the geometry of the muscles spanning the knee: the resultant force in the ACL during isometric knee extension is determined mainly by the changing orientation of the patellar tendon relative to the tibia in the sagittal plane; the resultant force in the PCL during isometric knee flexion is dominated by the angle at which the hamstrings meet the tibia in the sagittal plane. PMID:11264809

Pandy, MARCUS G.; Sasaki, KOTARO

1998-01-01

391

The Effect of Tibial Tuberosity Realignment Procedures on the Patellofemoral Pressure Distribution  

PubMed Central

Purpose The study was performed to characterize the influence of tibial tuberosity realignment on the pressure applied to cartilage on the patella in the intact condition and with lesions on the lateral and medial facets. Methods Ten knees were loaded in vitro through the quadriceps (586 N) and hamstrings (200 N) at 40°, 60° and 80° of flexion while measuring patellofemoral contact pressures with a pressure sensor. The tibial tuberosity was positioned 5 mm lateral of the normal position to represent lateral malalignment, 5 mm medial of the normal position to represent tuberosity medialization, and 10 mm anterior of the medial position to represent tuberosity anteromedialization. The knees were tested with intact cartilage, with a 12 mm diameter lesion created within the lateral patellar cartilage, and with the lateral lesion repaired with silicone combined with a medial lesion. A repeated measures ANOVA and post-hoc tests were used to identify significant (p < 0.05) differences in the maximum lateral and medial pressure between the tuberosity positions. Results Tuberosity medialization and anteromedialization significantly decreased the maximum lateral pressure by approximately 15% at 60° and 80° for intact cartilage and cartilage with a lateral lesion. Tuberosity medialization significantly increased the maximum medial pressure for intact cartilage at 80°, but the maximum medial pressure did not exceed the maximum lateral pressure for any testing condition. Conclusions The results indicate that medializing the tibial tuberosity by 10 mm reduces the pressure applied to lateral patellar cartilage for intact cartilage and cartilage with lateral lesions, but does not overload medial cartilage.

Saranathan, Archana; Kirkpatrick, Marcus S.; Mani, Saandeep; Smith, Laura G.; Cosgarea, Andrew J.; Tan, Juay Seng; Elias, John J.

2011-01-01

392

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

PubMed Central

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

2013-01-01

393

Reevaluation of (241)Am content in the USTUR case 0102 leg phantom.  

PubMed

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

2013-01-01

394

Comparative anatomy and significance of the sesamoid bone of the peroneus longus muscle (os peroneum).  

PubMed Central

The os peroneum is found in only a few primate families and seems to be completely absent in the non-primate pentadactyl mammals, in the Prosimii and in the Platyrrhinii (New World monkeys). In the Cercopithecidae (Catarrhinii, Old World monkeys) and the Hylobatidae, the os peroneum is a coffee bean-shaped constant, large and regular bone. The lateral surface of the bone is convex in all directions and non-articular. The medial surface is covered with hyaline cartilage and articulates by means of a synovial joint with the corresponding facet of the cuboid bone. The histological structure and the mode of ossification of the os peroneum are identical to that of other short bones of the skeleton. The os peroneum of the Cercopithecidae and Hylobatidae is an example of a new skeletal element that has appeared in a tendon subject to unusual mechanical stress. In the case of the peroneus longus tendon the stress is due to repetitive friction because of the functional importance of this muscle in the adduction and pseudo-opposability of the hallux. This osseous element is genetically fixed and hereditarily transmitted. Its mode of appearance is analogous to that accepted for the origin of the patella. In the Pongidae, the os peroneum is absent or rare. In man, this bone is relatively infrequent (approx 20% of mature individuals) and its shape is most irregular. In this case, the os peroneum appears as a regressive form of the typical bone observed in the above families, which is in the process of disappearing. Besides fundamental genetical factors, this regression is probably in relation to the disappearance of the functional importance of the peroneus longus muscle to the loss of the hallux opposability. Thus the mechanical factors cannot be dissociated from the genetic and phylogenetic factors in explaining the appearance and the regression of the os peroneum. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5

Le Minor, J M

1987-01-01

395

The role of ultrasound in the assessment of osteoporosis.  

PubMed

There is increasing interest in assessing the role of ultrasound in the identification and management of osteoporosis. Using ultrasound, we may measure the velocity of sound through bone, or the increase in attenuation with frequency, generally referred as Broadband Ultrasonic Attenuation BUA. Although velocity measurements have previously been reported in the patella, current interest is concentrated on the calcaneum. The advantages of ultrasound technology include portability and ease of use of equipment. Measurements are typically performed within a few minutes with a minimal requirement for operator intervention. When comparing ultrasound data with that obtained from established techniques, care must be taken in the interpretation. Simple linear regression assumes that the two parameters measured are directly related. Although ultrasound measurements of the calcaneum significantly correlate with DXA measurements of the spine and hip, these relationships are too weak to permit accurate prediction of BMD by BUA with less than 50% of the variance is explained by density, with the additional dependence of BUA upon trabecular structure being a contributing factor. A more reliable assessment of the value of ultrasound measurements to identify osteoporosis may be obtained using statistical techniques such as diagnostic accuracy defined by ROC analysis and dynamic range. Since the ROC analysis is comparable for calcaneal BUA and lumbar BMD, these tests are of similar value in evaluating fracture risk. The prediction of fracture risk for the hip is greater than for the wrist and vertebrae, suggesting that the future perspectives for the ultrasonic assessment of osteoporosis will primarily be the measurement of elderly women. PMID:7750237

Langton, C M

1994-12-01

396

EPIDEMIOLOGY OF KNEE INJURIES AMONG US HIGH SCHOOL ATHLETES, 2005/06-2010/11  

PubMed Central

Purpose US high school athletes sustain millions of injuries annually. Detailed patterns of knee injuries, among the most costly sports injuries, remain largely unknown. We hypothesize that patterns of knee injuries in US high school sports differ by sport and gender. Methods US High school sports-related injury data were collected for 20 sports using the National High School Sports-Related Injury Surveillance System, High School RIO™. Knee injury rates, rate ratios, and injury proportion ratios were calculated. Results From 2005/06–2010/11, 5,116 knee injuries occurred during 17,172,376 athlete exposures (AEs) for an overall rate of 2.98 knee injuries per 10,000 AEs. Knee injuries were more common in competition than practice (RR 3.53, 95% CI 3.34–3.73). Football had the highest knee injury rate (6.29 per 10,000 AEs) followed by girls’ soccer (4.53) and girls’ gymnastics (4.23). Girls had significantly higher knee injury rates than boys in gender-comparable sports (soccer, volleyball, basketball, baseball/softball, lacrosse, swimming and diving, and track and field) (RR 1.52, 95% CI 1.39–1.65). The most commonly involved structure was the MCL (reported in 36.1% of knee injuries), followed by the patella/patellar tendon (29.5%), ACL (25.4%), meniscus (23.0%), LCL (7.9%), and PCL (2.4%). Girls were significantly more likely to sustain ACL injuries in gender-comparable sports (RR 2.38, 95% CI 1.91–2.95). Overall, 21.2% of knee injuries were treated with surgery; girls were more often treated with surgery than boys in gender-comparable sports (IPR 1.30, 95% CI 1.11–1.53). Conclusions Knee injury patterns differ by sport and gender. Continuing efforts to develop preventive interventions could reduce the burden of these injuries.

Swenson, David M.; Collins, Christy L.; Best, Thomas M.; Flanigan, David C.; Fields, Sarah K.; Comstock, R. Dawn

2012-01-01

397

Pulsatile blood flow in human bone assessed by laser-Doppler flowmetry and the interpretation of photoplethysmographic signals.  

PubMed

Human bone blood flow, mean blood speed and the number of moving red blood cells were assessed (in arbitrary units), as a function of time, during one cardiac cycle. The measurements were obtained non-invasively on five volunteers by laser-Doppler flowmetry at large interoptode spacing. The investigated bones included: patella, clavicle, tibial diaphysis and tibial malleolus. As hypothesized, we found that in all bones the number of moving cells remains constant during cardiac cycles. Therefore, we concluded that the pulsatile nature of blood flow must be completely determined by the mean blood speed and not by changes in blood volume (vessels dilation). Based on these results, it is finally demonstrated using a mathematical model (derived from the radiative transport theory) that photoplethysmographic (PPG) pulsations observed by others in the literature, cannot be generated by oscillations in blood oxygen saturation, which is physiologically linked to blood speed. In fact, possible oxygen saturation changes during pulsations decrease the amplitude of PPG pulsations due to specific features of the PPG light source. It is shown that a variation in blood oxygen saturation of 3% may induce a negative change of ?1% in the PPG signal. It is concluded that PPG pulsations are determined by periodic 'positive' changes of the reduced scattering coefficient of the tissue and/or the absorption coefficient at constant blood volume. No explicit experimental PPG measurements have been performed. As a by-product of this study, an estimation of the arterial pulse wave velocity obtained from the analysis of the blood flow pulsations give a value of 7.8 m s(-1) (95% confidence interval of the sample mean distribution: [6.7, 9.5] m s(-1)), which is perfectly compatible with data in the literature. We hope that this note will contribute to a better understanding of PPG signals and to further develop the domain of the vascular physiology of human bone. PMID:23443008

Binzoni, Tiziano; Tchernin, David; Hyacinthe, Jean-Noël; Van De Ville, Dimitri; Richiardi, Jonas

2013-03-01

398

Testosterone reduces knee passive range of motion and expression of relaxin receptor isoforms via 5?-dihydrotestosterone and androgen receptor binding.  

PubMed

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

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

2014-01-01

399

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

PubMed Central

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

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

2014-01-01

400

Genome-wide survey indicates involvement of loci on canine chromosomes 7 and 31 in patellar luxation in flat-coated retrievers  

PubMed Central

Background Patellar luxation is an orthopedic disorder in which the patella moves out of its normal location within the femoral trochlea of the knee and it can lead to osteoarthritis, lameness, and pain. In dogs it is a heritable trait, with both environmental and genetic factors contributing to the phenotype. The prevalence of patellar luxation in the Dutch Flat-Coated Retriever population is 24%. In this study, we investigated the molecular genetics of the disorder in this population. Results Genome-wide association analysis of 15,823 single nucleotide polymorphisms (SNPs) in 45 cases and 40 controls revealed that patellar luxation was significantly associated with a region on chromosome CFA07, and possibly with regions on CFA03, CFA31, and CFA36. The exons of the genes in these regions, 0.5 Mb combined, were analyzed further. These exons from 15 cases and a pooled sample from 15 controls were enriched using custom genomic hybridization arrays and analyzed by massive parallel DNA sequencing. In total 7257 variations were detected. Subsequently, a selection of 144 of these SNPs were genotyped in 95 Flat-Coated Retrievers. Nine SNPs, in eight genes on CFA07 and CFA31, were associated with patellar luxation (P <10-4). Genotyping of these SNPs in samples from a variety of breeds revealed that the disease-associated allele of one synonymous SNP in a pseudogene of FMO6 was unique to Flat-Coated Retrievers. Conclusion Genome-wide association analysis followed by targeted DNA sequencing identified loci on chromosomes 7 and 31 as being involved in patellar luxation in the Flat-Coated Retriever breed.

2014-01-01

401

Crystal-associated synovitis- ultrasonographic feature and clinical correlation.  

PubMed

The aim of this paper is to describe the ultrasonographic findings in rheumatologic pathology due to crystal deposition. There are four main types of crystals involved: monosodium urate, calcium pyrophosphate dihydrate, basic calcium phosphate (hydroxyapatite), and calcium oxalate. In gout the joint fluid is anechoic only at the first gouty attack; afterwards the synovium begins to proliferate. Double contuour sign, a focal or diffuse enhancement of the superficial margin of the articular cartilage is a specific finding. Bursitis has chronic features from the beginning. The ultrasonographic aspect of tophi depends on their age and size (at first small, hypoechoic and homogenous nodules, then echoic with hyperechoic edges and finally pseudotumoral, inhomogeneous). The depositions in the superficial layer are hyperechoic, well delimited only in the absence of inflammatory reaction. The depositions at the entheseal level are leading to the gouty enthesopathy. In knee involvement irregularities of the anterior surface of patella are found. In chondrocalcinosis the most important ultrasonographic signs are the thin hyperechoic band, parallel to the surface of the hyaline cartilage and the punctuated pattern of the fibrocartilage. In hydroxyapatite associated disease, calcifications are frequent in the shoulder or in the great trochanter of the hip, with aspects depending of the calcification phase. Milwakee shoulder is an advanced form of this pathology, associated with rotator cuff arthropathy. Oxalate crystal deposition disease is seen rarely, in patients with primary hyperoxaluria and in patients with end-stage renal disease. Therefore ultrasonography is useful in characterize the articular and juxta-articular alterations in crystal related diseases. PMID:18449120

Fodor, Danela; Albu, Adriana; Gherman, Claudia

2008-01-01

402

Hyperosmolaric contrast agents in cartilage tomography may expose cartilage to overload-induced cell death.  

PubMed

In clinical arthrographic examination, strong hypertonic contrast agents are injected directly into the joint space. This may reduce the stiffness of articular cartilage, which is further hypothesized to lead to overload-induced cell death. We investigated the cell death in articular cartilage while the tissue was compressed in situ in physiological saline solution and in full strength hypertonic X-ray contrast agent Hexabrix(TM). Samples were prepared from bovine patellae and stored in Dulbecco's Modified Eagle's Medium overnight. Further, impact tests with or without creep were conducted for the samples with contact stresses and creep times changing from 1 MPa to 10 MPa and from 0 min to 15 min, respectively. Finally, depth-dependent cell viability was assessed with a confocal microscope. In order to characterize changes in the biomechanical properties of cartilage as a result of the use of Hexabrix™, stress-relaxation tests were conducted for the samples immersed in Hexabrix™ and phosphate buffered saline (PBS). Both dynamic and equilibrium modulus of the samples immersed in Hexabrix™ were significantly (p<0.05) lower than those of the samples immersed in PBS. Cartilage samples immersed in physiological saline solution showed load-induced cell death primarily in the superficial and middle zones. However, under high 8-10 MPa contact stresses, the samples immersed in full strength Hexabrix™ showed significantly (p<0.05) higher number of dead cells than the samples compressed in physiological saline, especially in the deep zone of cartilage. In conclusion, excessive loading stresses followed by tissue creep might increase the risk for chondrocyte death in articular cartilage when immersed in hypertonic X-ray contrast agent, especially in the deep zone of cartilage. PMID:22206829

Turunen, M J; Töyräs, J; Lammi, M J; Jurvelin, J S; Korhonen, R K

2012-02-01

403

OPTOTRAK Measurement of the Quadriceps Angle Using Standardized Foot Positions  

PubMed Central

Objective: While there is evidence to suggest that the magnitude of the quadriceps (Q) angle changes with alterations in foot position, a detailed quantitative description of this relationship has not been reported. Our purpose was to determine the effect of varying foot placement on the magnitude of the Q angle. Design and Setting: A mixed between-within, repeated-measures design was used to compare Q angles derived under static weight-bearing conditions with the feet positioned in self-selected versus standardized stance positions. Subjects: Twenty healthy young-adult men and women with no history of acute injury to or chronic dysfunction of the lower limbs. Measurements: We placed light-emitting diodes bilaterally on the left and right anterior superior iliac spines, the tibial tuberosities, and the midpoints of the patellae to bilaterally define the Q angles. An OPTOTRAK motion-measurement system was used to capture x,y coordinate data at a sampling rate of 60 Hz. These data were subsequently filtered and used to calculate the magnitude of the left and right Q angles. Results: A repeated-measures analysis of variance revealed that when measured statically, Q angles differed significantly between stance positions (P < .001) and limbs (P < .05). Depending on the stance adopted, mean Q angles varied from 7.2° to 12.7° and 11.0° to 16.1° in the left and right lower limbs, respectively. Q-angle measurements taken in conjunction with the Romberg foot position most closely resembled those gathered with the feet in a self-selected stance (Pearson r = 0.86 to 0.92). Conclusions: Q-angle magnitude varies with changes in foot position, increasing or decreasing as the foot rotates internally or externally, respectively. These data demonstrate the need for a standardized foot position for Q-angle measurements.

Livingston, Lori A.; Spaulding, Sandi J.

2002-01-01

404

LIM homeobox transcription factor 1B expression affects renal interstitial fibrosis and apoptosis in unilateral ureteral obstructed rats.  

PubMed

LIM homeobox transcription factor 1B (LMX1B) is a transcription factor of the LIM homeodomain type and has been implicated in the development of diverse structures such as limbs, kidneys, eyes, and the brain. Furthermore, LMX1B has been implicated in nail-patella syndrome, which is predominantly characterized by malformation of limbs and nails, and in 30% of patients, nephropathy, including renal fibrosis, is observed. Since no reports were available that studied the link between LMX1B expression and renal interstitial fibrosis, we explored if LMX1B affects typical markers of fibrosis, e.g., extracellular matrix components, profibrotic factors, and apoptosis as the final detrimental consequence. We recently showed that LMX1B acts as a negative regulator of transforming growth factor-?l, collagen type III, fibronectin, cleaved caspase-3, and the cell apoptosis rate in a renal tubular ep