Sample records for chondromalacia patellae

  1. Joint hypermobility in patients with chondromalacia patellae

    Microsoft Academic Search

    Z. AL-RAWI; A. H. NESSAN

    1997-01-01

    SUMMARY The relationship between joint mobility and chondromalacia patellae was reported in a prospective study. A total of 115 patients with chondromalacia patellae were compared with 110 healthy individuals without chondromalacia patellae, matched for age and sex, who served as a control group. The degree of joint mobility was scored on a scale of 0-9. The number of individuals with

  2. Chondromalacia of the patella in Chinese. A postmortem study.

    PubMed

    Marar, B C; Orth, M C; Pillay, V K

    1975-04-01

    Two hundred knees of 100 Chinese cadavera were studied with reference to factors which have been implicated in the etiology of chondromalacia of the patella. The findings were as follows: chondromalacia of the patella was less common in Chinese than in Europeans, did not always start in the medial patellar facet, and showed no relationship to the presence of abnormal menisci or to the anatomical characteristics of the medial femoral condyle which have been suggested as causative factors. PMID:1123388

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

    PubMed Central

    Hauser, Ross A.; Sprague, Ingrid Schaefer

    2014-01-01

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

  4. Chondromalacia induced by patellar subluxation in the rabbit.

    PubMed

    Møller, B N; Møller-Larsen, F; Frich, L H

    1989-04-01

    A unilateral patellar malalignment was induced in 20 young and 20 mature rabbits by lateral displacement of the tibial tuberosity, the other knee serving as osteotomized in situ control. At 6 weeks, all the knees appeared macroscopically normal, but histologically definite cartilage degeneration was found on the experimental side. At 3 months, macroscopic changes occurred in 5 of 10 mature rabbits, and histologic cartilage degeneration was found in all the experimental knees, most pronounced in mature animals, and particularly in joint facets submitted to high pressure. This experimental model produces changes resembling chondromalacia patellae and early arthrotic changes suggesting the importance of malalignment in the development of patellofemoral cartilage degeneration. PMID:2728881

  5. [Patella instability.

    PubMed

    Blønd, Lars

    2014-03-17

    In respect to the risk of recurrent patella instability, new biomechanical factors have been ruled out, and among these trochlear dysplasia is the most important single factor. The algorithm for operative intervention should be based upon X-rays and MRI scans. Medial implication is considered obsolete and distal realignment as well as lateral release procedures should be minimized, based upon deteriorating results. Reconstruction of medial structures becomes increasingly frequent, based upon good results, however, in cases of higher degree of trochlear dysplasia, trochleoplasty should be considered. PMID:25350888

  6. Snapping plicae associated with radiocapitellar chondromalacia

    Microsoft Academic Search

    Samuel A Antuna; Shawn W O’Driscoll

    2001-01-01

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

  7. [Patella dislocation in athletes].

    PubMed

    Frosch, K H; Akoto, R; Schmeling, A

    2014-10-01

    Most dislocations of the patella occur during sports activities. The entities instability, maltracking and loss of tracking should be defined by patient history, clinical examination and radiological evaluation including magnetic resonance imaging (MRI). Based on these criteria a new classification of patella dislocations (5 types) was established which allows a standardized treatment algorithm. Type 1 is a simple (traumatic) dislocation without maltracking and without instability. Type 2 has a high redislocation risk (defined as instability) without maltracking. An isolated stabilizing surgical procedure, such as medial patellofemoral ligament (MPFL) augmentation is successful in most cases. Type 3 is characterized by instability and maltracking. Maltracking can be caused by soft tissue contracture or muscular deficits (type 3a), patella alta (type 3b), pathological tibial tuberosity to trochlear groove (TT-TG) distance (type 3c), genu valgum (type 3d) and torsional deformities (type 3e). In these types an isolated soft tissue procedure is usually not sufficient. The bony pathologies additionally need to be addressed to regain physiological patella tracking. Type 4 includes severe trochlea dysplasia with loss of patella tracking. Usually trochleaplasty is needed to stabilize the patella and to prevent redislocation. Type 5 is based on patella maltracking without instability and can be found in patients with a pathological knee baseline or special forms of torsional deformities. Although patella dislocations in trained athletes are seldom due to the stabilizing muscular status, the treatment strategy is similar to that of normal persons. Additional cartilage injuries, type of sports and time for rehabilitation have to be considered for optimal treatment. PMID:25182007

  8. The ''hot'' patella

    SciTech Connect

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

    1982-01-01

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

  9. Patella Dislocation with Vertical Axis Rotation: The “Dorsal Fin” Patella

    PubMed Central

    Gamble, David; Carrothers, Andrew D.; Khanduja, Vikas

    2015-01-01

    A 44-year-old woman presented following minor trauma to her right knee. While dancing she externally rotated around a planted foot and felt sudden pain in her right knee. She presented with her knee locked in extension with a “dorsal fin” appearance of the soft tissues tented over the patella. This was diagnosed as a rare case of an intraarticular patella dislocation, which was rotated 90 degrees about the vertical axis. Closed reduction in the emergency room was unsuccessful but was achieved in theatre under general anaesthetic with muscle relaxation. Postreduction arthroscopy demonstrated that no osteochondral or soft tissue damage to the knee had been sustained. In patients presenting with a knee locked in extension with tenting of skin over the patella (the “dorsal fin” appearance), intra-articular patella dislocation should be suspected. Attempts to reduce vertical patella dislocations under sedation with excessive force or repeatedly without success should be avoided to prevent unnecessary damage to the patellofemoral joint. In this clinical situation we recommend closed reduction under general anaesthetic followed by immediate knee arthroscopy under the same anaesthetic to ensure that there is no chondral damage to the patella or femoral trochlea and to rule out an osteochondral fracture.

  10. Spontaneous bilateral fracture of patella.

    PubMed

    Moretti, Biagio; Speciale, Domenico; Garofalo, Raffaele; Moretti, Lorenzo; Patella, Silvio; Patella, Vittorio

    2008-03-01

    Bilateral patellae fractures represent a rare entity, accounting for approximately 2.9% of all lesions interesting in this anatomical district. In most cases found in the published work, they are described as stress fractures or as complications of chronic diseases such as osteoporosis, renal failure and secondary hyperparathyroidism. Although many pathogenetic mechanisms have been supposed, none have been proved for certain. Insufficiency fractures of the patellae are rare events and no data has been published on their incidence. We present a case of bilateral fracture of the patellae due to an indirect trauma occurring in an 85-year-old patient affected by Parkinson's disease, osteoporosis and diffuse degenerative osteoarthritis. X-ray of the knees (anteroposterior and lateral) and magnetic resonance imaging evaluation confirmed the fractures. The patient was treated conservatively. She had a good result, returning to her previous autonomous ambulation. This case is unusual because there was no direct trauma to the knees because of bilaterality, but confirmed previous observations about insufficiency fractures of patellae in the presence of comorbidity. Insufficiency fractures of patellae can be an insidious condition in elderly people. Prepatellar pain, a common symptom in the relapse phase of degenerative arthritis of the knee, should not be underestimated, particularly in patients with diseases influencing metabolism of bone and with an elevated risk of fall. A periodical clinical and instrumental follow up should be done in these patient. Moreover, we underline the necessity of a multidisciplinary approach. PMID:18713190

  11. Habitual dislocation of patella: A review

    PubMed Central

    Batra, Sumit; Arora, Sumit

    2014-01-01

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

  12. Femoral Nerve Palsy with Patella Fracture

    PubMed Central

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

    2013-01-01

    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. PMID:24369003

  13. Floating patella associated with lymphoedema.

    PubMed

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

    2015-01-01

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

  14. Cercaria patellae Lebour, 1911 developing in Patella vulgata is the cercaria of Echinostephilla patellae (Lebour, 1911) n. comb. (Digenea, Philophthalmidae)

    Microsoft Academic Search

    Astrid H. Kollien

    1996-01-01

    The echinostome cercaria,Cercaria patellae Lebour, 1911, which develops in the limpetPatella vulgata (Prosobranchia, Diotocardia, Patellidae), was investigated by light and scanning microscopy. The highest prevalence of limpets with rediae\\/cercariae occurred on bare rocks on the upper part of the shore. The prevalence was higher in larger snails and in those which had an orange foot-sole. The cercariae penetrated into other

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

    Microsoft Academic Search

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

    2006-01-01

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

  16. Results of arthroscopic joint debridement in different stages of chondromalacia of the knee joint

    Microsoft Academic Search

    Thomas Krüger; David Wohlrab; Andreas Birke; Werner Hein

    2000-01-01

    A retrospective study was performed of 161 patients who had undergone arthroscopic operation for chondromalacia of the knee\\u000a joint. After an average follow-up period of 40 (range 10–72) months, patients with severe articular cartilage lesions who\\u000a had undergone articular lavage alone showed significantly poorer results (P < 0.001). With the same stage of chondromalacia and having undergone the same surgical

  17. Inferior sleeve fracture of the patella.

    PubMed

    Lin, Shu-Yuan; Lin, Wei-Chun; Wang, Jing-Wein

    2011-02-01

    Patella sleeve fracture is a rare fracture that only occurs in children. Diagnosis is difficult both clinically and radiologically. A high-riding patella and hemarthrosis are important signs when diagnosing this fracture. We report a case of an 11-year-old boy who suffered from patella sleeve fracture without visible bony fragments on a lateral radiograph. Open reduction with transosseous tunneling and patellotibial cerclage wiring for anastomosis protection was performed. Early weight bearing was achieved together with a satisfactory range of knee motion. Premature anterior physeal arrest was noted because of insertion of cerclage wire in the open physis. However, no genu recurvatum was present 2 years after the initial operation. An awareness of sleeve fracture, together with its characteristic clinical and radiological features, is important to avoid misdiagnosis and treatment delay. If the cerclage wire technique is used, care should be taken not to disturb the proximal tibial apophysis. PMID:21354089

  18. ESWT in the management of patella tendinopathy

    Microsoft Academic Search

    Stephen Motto

    2011-01-01

    Lecture 21Patella tendinopathy is still a potentially career ending injury if not accurately diagnosed and actively managed. Prevalence has been reported to be in the range of 7–40% in the athletic population. There are still concerns regarding the aetiology, although the mechanical strain theory is the most accepted – repeat heavy loading initiating pathological extracellular and cellular dysfunction with eventual

  19. Infrapatellar contracture syndromeAn unrecognized cause of knee stiffness with patella entrapment and patella infera

    Microsoft Academic Search

    Lonnie E. Paulos; Thomas D. Rosenberg; John Drawbert; James Manning; Paul Abbott

    1987-01-01

    Infrapatellar Contracture Syndrome (IPCS) is an infre quently recognized cause of posttraumatic knee mor bidity. Unique to this group of patients is the combina tion of restricted knee extension and flexion associated with patella entrapment. IPCS can occur primarily as an exaggerated pathologic fibrous hyperplasia of the anterior soft tissues of the knee beyond that associated with normal healing. It

  20. Giant-cell tumor of the patella.

    PubMed

    Yoshida, Yukihiro; Kojima, Toshio; Taniguchi, Masashi; Osaka, Shunzo; Tokuhashi, Yasuaki

    2012-01-01

    We report a 38-year old man with a giant-cell tumor in a rare site, the patella. Primary patellar neoplasms are highly unusual. According to a survey by the Bone and Soft Tissue Tumor Committee of the Japanese Orthopaedic Association, of more than 2,126 giant-cell tumors of bone reported since 1972, only 22 were primary patellar neoplasms. We present a case of this rare entity along with its clinical and radiographic features. The first clinical symptom was anterior knee pain. Though anterior knee pain has numerous and varied causes, it is necessary to consider patellar bone tumors in the differential diagnosis. PMID:22358142

  1. The prosthetic group of the green chromoprotein of Patella ova

    Microsoft Academic Search

    W. H. Bannister; M. Choussy; M. Vuillaume; M. Barbier

    1970-01-01

    Résumé Les ovaires des PatellesPatella vulgata etPatella caerulea contiennent un chromoprotéide vert qui a été précédemment étudié. Dans le présent travail, le groupe prosthétique de ce pigment est identifié. Il s'agit d'un tètrapyrrole dont la structure est proche de celle de la chlorophyllea. L'identification repose sur l'isolement des esters méthyliques du phéophorbidea d'une part (à partir des gonades entières) et

  2. [Imaging manifestation and medicolegal significance of bipartite patella].

    PubMed

    Ying, Chong-liang; Wang, Ya-hui; Wan, Lei

    2010-02-01

    Bipartite patella is uncommon in clinical medicine. It is formed by two or more ossification centers It is repeatedly misdiagnosed as patellar fracture in clinical practice. which do not fused in adolescence. In order to elevate the recognition of imaging signs of bipartite patella and to avoid the fault in medicolegal expertise testimony, three cases of bipartite patella were analyzed in combination of literature review, and the possible causes, histological changes, imaging signs, and clinical manifestation of bipartite patella were also discussed. The three cases concerned were all adults, two male and one female. They all felt pain after knee joint injury and were diagnosed as patellar fracture in medical institutions. Two cases were appraised on the degree of injury and one was on the degree of disability. According to Saupe's grouping, two cases were group III, and one was group II and III. In the practice of medicolegal expertise testimony, recognizing imaging signs of bipartite patella could provide more rigorous and objective conclusion. PMID:20232744

  3. Surgical treatment options for patella tendon rupture, Part I: Acute.

    PubMed

    Greis, Patrick E; Holmstrom, Michael C; Lahav, Amit

    2005-07-01

    Patella tendon rupture is a debilitating injury. Prompt diagnosis and treatment is essential to prevent retraction of the patella with subsequent adhesions and quadriceps contractures. In a young patient with an acute rupture, primary repair usually is possible with various methods described to protect the repair. In acute injuries with inadequate tissue, augmentation with hamstring tendons or allograft generally is necessary. Because of the different types of rupture and the possibility for poor quality tissue, the surgeon should always be prepared to combine different techniques to obtain tthe best repair. Continuous passive motion generally can be initiated early with a secure repair. In patients with a patella tendon ruptured that is promptly diagnosed, securely repaired, and followed closely through their rehabilitation, good results can be expected. PMID:16119282

  4. Superior dislocation of the patella: a case report

    PubMed Central

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

    2009-01-01

    Background Superior dislocation of the patella is an uncommon condition that mainly occurs in knees with a high patella and medial femorotibial degenerative arthritis. There are no previous reports of this condition occurring in association with tibial valgus osteotomy. Case report: We report the case of a patient in whom vertical dislocation recurred twice at 4 months after tibial valgus osteotomy. To avert additional recurrence or new dislocations, the patient was treated surgically to remove the existing osteophytes. Conclusions: An arthroscopic approach was decided because of the lower associated morbidity and good results with this technique compared to open surgery. PMID:19642996

  5. Surgical treatment options for patella tendon rupture, part II: chronic.

    PubMed

    Greis, Patrick E; Lahav, Amit; Holmstrom, Michael C

    2005-08-01

    Patella tendon rupture is a debilitating injury that often occurs in the setting of preexisting tendon degeneration. Prompt diagnosis and treatment is essential to prevent retraction of the patella with subsequent adhesions and quadriceps contractures. In the setting of a chronic rupture, augmentation with hamstring tendons or allograft reconstruction generally is necessary. Patients who undergo delayed repair are at risk for a compromised result secondary to loss of full knee flexion and decreased quadriceps strength, although a functional extensor mechanism is likely to be reestablished. Overall the results of chronic repair are less satisfactory than the acute repair, but still provide an extensor mechanism for the patient and thus provide function. PMID:16119741

  6. Lateral release of the patella: Indications and contraindications

    Microsoft Academic Search

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

    1990-01-01

    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,

  7. [Traumatic separation of a type I patella bipartite in a sportsman.

    PubMed

    Ottesen, Casper Smedegaard; Barfod, Kristoffer Weisskirchner; Holck, Kim

    2014-05-12

    This is a case report of a 44-year-old sportsman who experi-enced acute onset of strong pain and loss of ability to extend his right knee during a game of beach volley. X-ray imaging showed a patella in two parts with rounded edges and with a diastasis of more than 2 cm. Intra-operatively atrophic fibrocartilage was found on both parts of the patella. Asymptomatic patella bi-partite was found on X-ray imaging of the patient's left knee, and he was diagnosed to have traumatic separation of a type I patella bipartite. The diagnosis was confirmed by surgical and radiological findings. PMID:25351835

  8. Patella fracture and proximal patellar tendon rupture following arthroscopic anterior cruciate ligament reconstruction.

    PubMed

    Miller, M D; Nichols, T; Butler, C A

    1999-09-01

    The central one-third bone-patella tendon-bone graft is a popular choice for arthroscopic anterior cruciate ligament reconstruction. Complications following graft harvesting are unusual, but several reports have been published. We report an unusual case involving a simultaneous patella fracture and patellar tendon rupture that occurred 6 weeks postoperatively. PMID:10495182

  9. Linkage analysis of the Nail-patella syndrome

    SciTech Connect

    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

    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.

  10. MPFL reconstruction for recurrent patella dislocation: a new surgical technique and review of the literature.

    PubMed

    Panagopoulos, A; van Niekerk, L; Triantafillopoulos, I K

    2008-05-01

    Recurrent dislocation, subluxation and functional instability due to patellofemoral pain might be present in 30 % to 60 % of patients managed non-operatively for posttraumatic patella instability. Disruption of the capsule, medial patella retinaculum and/or vastus medialis obliquus have been associated with recurrent patella instability but recently the medial patellofemoral ligament (MPFL) has been recognised as the most important ligamentous stabiliser preventing lateral dislocation of the patella. Many nonanatomical surgical techniques for the treatment of recurrent patellar dislocation have been described in the literature. These procedures alter the pre-morbid patella mechanics by several principles, including the release of tight lateral ligaments, tensioning of loose medial structures and distal realignment of the extensor mechanism or a combination of these. Very few address the principle site of pathology in patella dislocation, i.e., the torn MPFL. The outcomes are inconsistent and many studies have reported recurrent dislocations and patellofemoral pain and arthritis in up to 40 %. We describe a simple technique of MPFL reconstruction using a single hamstring tendon graft which is passed through the medial intermuscular septum at the adductor's magnus insertion and is fixed to the superomedial pole of the patella. A comprehensive review of the existing techniques of MPFL reconstruction using semitendinosus tendon autografts is also provided. PMID:17879883

  11. The mineralization and hardness of the radular teeth of the limpet Patella vulgata L

    Microsoft Academic Search

    N. W. Runham; P. R. Thornton; D. A. Shaw; R. C. Wayte

    1969-01-01

    A study of the Patella vulgata radula has been made using: the scanning electron microscope in its normal and compositional contrast modes of operation, the electron microprobe analyser, ion etching with argon ions and microhardness testing.

  12. Congenital medial dislocation of the patella with multiple congenital anomalies: case report and method of treatment.

    PubMed

    Yazdi, Hamidreza; Monshizadeh, Siamak; Bozorgi, Zahra

    2014-03-01

    Lateral dislocation of the patella is reported frequently in orthopaedics references but congenital medial patellar dislocation is reported rarely. An 8-year-old girl was referred to our department for knee surgery. She had genuvarum, knee flexion contracture and tibial internal rotation. She had multiple congenital anomalies at birth. The patella was palpated in the medial side of knee and its reduction to the midline was impossible. We performed an operative procedure for her medial dislocation of the patella. At the 1-year follow-up, the patella was in midline and there was no medial subluxation on range of motion of the knee. In infants with genuvarum, knee flexion contracture and tibial internal rotation, the possibility of medial patellar instability should be considered. For correction of patellar tracking and prevention of bone deformities, surgical management should be performed. PMID:24296651

  13. Effects of competition on an endangered limpet Patella ferruginea (Gastropoda: Patellidae): Implications for conservation

    Microsoft Academic Search

    Free Espinosa; José M. Guerra-García; Darren Fa; J. Carlos García-Gómez

    2006-01-01

    Spatial and trophic competitive interactions were analysed for the seldom-studied limpet Patella ferruginea (which is considered as an “extinction risk”). Spatial patterns of distribution of P. ferruginea were studied using quadrats of 1×1 m2 at several transects along the coastline, whereas trophic interactions were studied through manipulations of densities of P. ferruginea and Patella caerulea in experimental plots located at

  14. Challenges in imaging and histopathological assessment of a giant cell tumour with secondary aneurysmal cyst in the patella.

    PubMed

    Low, Soo Fin; Hanafiah, Mohammad; Nurismah, Md Isa; Suraya, Aziz

    2013-01-01

    The patella is an uncommon site for all primary and metastatic bone tumours and primary intra-osseous tumours of the patella are very rare. A majority of the patella tumours are benign. We report a patient with a sudden onset swelling and pain of the right knee following a staircase fall. The plain radiograph showed an expansile multiseptated patella lesion and it was further assessed with an MRI. The radiological findings and the initial histopathological features from a limited sample were suggestive of a primary aneurysmal bone cyst. However, the final histopathological diagnosis from a more adequate specimen was a giant cell tumour with a secondary aneurysmal bone cyst. PMID:24057334

  15. Early revisions of the Femoro-Patella Vialla joint replacement.

    PubMed

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

    2013-06-01

    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

  16. Patella Resurfacing during Total Knee Arthroplasty: Have We Got the Issue Covered?

    PubMed Central

    Alao, Uthman; Salamut, Wazirl; Weitzel, Stefan; Skinner, J.A.

    2014-01-01

    Background Management of the patella during total knee arthroplasty (TKA) is controversial. Multiple studies have examined mechanical and clinical results of TKA with native and resurfaced patellae with no clear consensus. Methods We surveyed a large cohort of consultant surgeons in a questionnaire based study in order to assess the indications for patella resurfacing and to correlate practice with degree of specialization, experience and volume of procedures performed. Results Six hundred and nineteen surgeons were included. The main indication for patella resurfacing was patellofemoral arthritis. The ratio of those who always:sometimes:never resurfaced was 1:2:1 irrespective of experience or volume performed. There was no difference between knee specialists and non-specialists (p = 0.977) or between high and lower volume surgeons (p = 0.826). Senior and high volume surgeons tended to always resurface. Conclusions The majority of surgeons only sometimes resurfaced the patella. The number who always and never resurfaced were similar. There was a tendency for more experienced and high volume surgeons to always resurface. PMID:25436059

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

    PubMed Central

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

    2014-01-01

    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. PMID:24719149

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

    Microsoft Academic Search

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

    1993-01-01

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

  19. Vertical Open Patella Fracture, Treatment, Rehabilitation and the Moment to Fixation

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  1. Patella Fracture Fixation with Suture and Wire: you Reap what you Sew

    PubMed Central

    Egol, Kenneth; Howard, Daniel; Monroy, Alexa; Crespo, Alexander; Tejwani, Nirmal; Davidovitch, Roy

    2014-01-01

    Introduction Operative fixation of displaced inferior pole patella fractures has now become the standard of care. This study aims to quantify clinical, radiographic and functional outcomes, as well as identify complications in a cohort of patients treated with non-absorbable braided suture fixation for inferior pole patellar fractures. These patients were then compared to a control group of patients treated for mid-pole fractures with K-wires or cannulated screws with tension band wiring. Methods In this IRB approved study, we identified a cohort of patients who were diagnosed and treated surgically for a displaced patella fracture. Demographic, injury, and surgical information were recorded. All patients were treated with a standard surgical technique utilizing non-absorbable braided suture woven through the patellar tendon and placed through drill holes to achieve reduction and fracture fixation. All patients were treated with a similar post-operative protocol and followed up at standard intervals. Data were collected concurrently at follow up visits. For purpose of comparison, we identified a control cohort with middle third patella fractures treated with either k-wires or cannulated screws and tension band technique. Patients were followed by the treating surgeon at regular follow-up intervals. Outcomes included self-reported function and knee range of motion compared to the uninjured side. Results Forty-nine patients with 49 patella fractures identified retrospectively were treated over 9 years. This cohort consisted of 31 females (63.3%) and 18 males (36.7%) with an average age of 57.1 years (range 26 - 88 years). Patients had an average BMI of 26.48 (range 19 - 44.08). Thirteen patients with inferior pole fractures underwent suture fixation and 36 patients with mid-pole fractures underwent tension band fixation (K-wire or cannulated screws with tension band). In the suture cohort, one fracture failed open repair (7.6%), which was revised again with sutures and progressed to union. Of the 36 fractures repaired with a tension band fixation, 11 underwent secondary surgery due to hardware pain or fixation failure (30.6%). At one year, no difference was seen in knee range of motion between cohorts. All fractures healed radiographically. Those patients who required reoperation or removal of hardware had significantly diminished range of motion about their injured knee (p > 0.005). Conclusions Patients who sustain inferior pole patella fractures have limited options for fracture fixation. Suture repair is clinically acceptable, yielding similar results to patella fractures repaired with metal implants. Importantly, patients undergoing suture repair appear to have fewer hardware related postoperative complications than those receiving wire fixation for midpole fractures. PMID:25328461

  2. Patella distal pole avulsion secondary to osteomyelitis in a healthy adult

    PubMed Central

    Arshad, H; Davis, B

    2013-01-01

    Primary haematogenous patella osteomyelitis in an adult is a rare condition. Cases published in the literature relate predominantly to the paediatric population or are associated with risk factors such as intravenous drug abuse, human immunodeficiency virus and penetrating trauma. The rarity of this condition and its atypical presentation should be borne in mind while treating a patient with anterior knee pain. It is crucial to evaluate radiography of diagnostic quality carefully. PMID:23827281

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

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

    2008-01-01

    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. PMID:18726657

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

    PubMed Central

    2012-01-01

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

  6. Anterior Cruciate Ligament Reconstruction: Clinical Outcomes of Patella Tendon and Hamstring Tendon Grafts

    PubMed Central

    Gulick, Dawn T.; Yoder, Heather N.

    2002-01-01

    An injury to the ACL can result in significant functional impairment. It has been estimated that more than 100,000 new ACL injuries occur each year. Surgeons employ numerous techniques for reconstruction of the ACL. Of critical importance is the source of the graft to replace the damaged ACL. The graft choices include autografts (the patient's own tissue), allografts (donor tendon), and synthetic/prosthetic ligaments. Tissue harvest sites for autografting include the middle third of the patella tendon, the quadriceps tendon, semitendinosus tendon, gracilis tendon, iliotibial band, tensor fascia lata, and the Achilles tendon. Selection of the type of graft material is predicated upon the tissue's ability to tolerate high levels of stress. Likewise, the clinical presentation and functional outcome is related to the graft material selected. This manuscript specifically examined the patella tendon and hamstring tendon grafts. Numerous manuscripts that studied the outcomes of these graft materials were compiled to help the clinician appreciate the advantages and disadvantages of each of the graft materials. Outcome measures such as thigh circumference, knee range of motion, isokinetic strength, knee stability, pain, and vertical jump/1-leg hop were incorporated. The purpose of this manuscript was to compare and contrast the clinical presentation of patients who underwent an ACL reconstruction using the patella tendon versus the hamstring tendons. This information can be valuable to the clinician when considering the rehabilitation protocol after ACL reconstruction. PMID:24701126

  7. 3-D printouts of the tracheobronchial tree generated from CT images as an aid to management in a case of tracheobronchial chondromalacia caused by relapsing polychondritis.

    PubMed

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

    2013-08-01

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

  8. 3-D printouts of the tracheobronchial tree generated from CT images as an aid to management in a case of tracheobronchial chondromalacia caused by relapsing polychondritis

    PubMed Central

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

    2013-01-01

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

  9. Correction of malformative patellar instability in patients with nail-patella syndrome: a case report and review of the literature.

    PubMed

    Lippacher, S; Mueller-Rossberg, E; Reichel, H; Nelitz, M

    2013-10-01

    Nail-patella syndrome (NPS) or hereditary onycho-osteodysplasia is a relatively rare autosomal dominant disorder with the classic tetrad of fingernail abnormalities, hypoplastic patellae, radial head dislocation and iliac horns. The anatomic abnormalities in NPS often lead to subluxation or dislocation of the patellaeca causing knee instability and pain. Although most existing literature regarding the knee manifestation of this syndrome has focused on the clinically and radiological changes, only a few articles discussed the surgical treatment. This study reports the clinical, radiological and arthroscopical findings and a 24-month follow-up after operative stabilisation considering the underlying pathomorphology of malformative patellar instability in an 11-year-old girl. The findings of this study confirm the unique pathology of NPS with a synovial band preventing the engagement of the patella into the trochlear groove. NPS is a rare disorder and has to be considered in cases with untypical patella dislocation. The underlying pathology differs completely from patients with patellofemoral instability. The aim of orthopaedic surgery should be correction of the underlying pathology with resection of the synovial band and an additional realignment of the patella by recentering of the quadriceps muscle. Considering the underlying pathology good clinical results can be expected. PMID:24029584

  10. Anterior knee pain following total knee replacement correlates with the OARSI score of the cartilage of the patella

    PubMed Central

    Vorobjov, Sigrid; Lepik, Katrin; Märtson, Aare

    2014-01-01

    Background Attempts to relate patellar cartilage involvement to anterior knee pain (AKP) have yielded conflicting results. We determined whether the condition of the cartilage of the patella at the time of knee replacement, as assessed by the OARSI score, correlates with postsurgical AKP. Patients and methods We prospectively studied 100 patients undergoing knee arthroplasty. At surgery, we photographed and biopsied the articular surface of the patella, leaving the patella unresurfaced. Following determination of the microscopic grade of the patellar cartilage lesion and the stage by analyzing the intraoperative photographs, we calculated the OARSI score. We interviewed the patients 1 year after knee arthroplasty using the HSS patella score for diagnosis of AKP. Results 57 of 95 patients examined had AKP. The average OARSI score of painless patients was 13 (6–20) and that of patients with AKP was 15 (6–20) (p = 0.04). Patients with OARSI scores of 13–24 had 50% higher risk of AKP (prevalence ratio = 1.5, 95% CI: 1.0–2.3) than patients with OARSI scores of 0–12. Interpretation The depth and extent of the cartilage lesion of the knee-cap should be considered when deciding between the various options for treatment of the patella during knee replacement. PMID:24954482

  11. Bilateral rotational osteotomies of the proximal tibiae and tibial tuberosity distal transfers for the treatment of congenital lateral dislocations of patellae: a case report and literature review.

    PubMed

    Ramaswamy, Rajesh; Kosashvili, Yona; Murnaghan, John J; Yau, Cameron Kin-Mo; Cameron, John C

    2009-12-01

    Congenital dislocation of patella (CDP) causes varying degree of disability. Patients may present as late walkers with asymmetric gait, habitual or recurrent dislocators or even non-walkers if the condition is bilateral. Patellar instability is often associated with soft tissue or bony pathology. Soft tissue anomalies include lateral soft tissue contractures, shortened quadriceps as well as vastus medialis dysplasia (abnormal origin and insertion). Bony anomalies include shallow trochlear groove and hypoplastic patella or lateral femoral condyle. Soft tissue etiologies result in an imbalance of the dynamic forces acting on the patella while in bony etiologies the static stabilizers to resist lateral dislocation are compromised. External tibial torsion is an additional etiology, often under diagnosed due to the difficulty in measuring the Q angle of dislocated patella. We report a case of bilateral congenital lateral dislocations of the patellae treated with bilateral tibial rotational osteotomies with an 8 year and a 4 year follow up. PMID:19464186

  12. THE GOLGI APPARATUS IN NEURONS AND EPITHELIAL CELLS OF THE COMMON LIMPET PATELLA VULGATA

    PubMed Central

    Lacy, Dennis

    1957-01-01

    1. In view of widely diverse views held about the identity and structure of the Golgi apparatus in neurons of Mollusca, particularly gastropods, a study has been made on neurons of the common limpet, Patella vulgata, both by light and electron microscopy. A report is given also of observations made on epithelial cells of Patella by electron microscopy. 2. As revealed by Kolatchev's method, the Golgi apparatus in neurons consists basically of black filaments lying to one side of the nucleus. The filaments generally anastomose to form networks of various complexity. Rarely some cells contain only discrete filaments. Associated with some of the filaments is a weakly osmiophilic substance identified as archoplasm. Kolatchev's method also revealed spheroidal bodies (neutral red bodies, "lipochondria," etc.). 3. It has not been possible to demonstrate the Golgi apparatus using either iron-haematoxylin or Sudan black. 4. Examination of Kolatchev's preparations by electron microscopy has revealed that some of the Golgi filaments consist of chromophilic and chromophobic components. The chromophilic component consists of dense lamellae. 5. After fixation in buffered osmium tetroxide solution and examination by electron microscopy, it has been concluded that (a) the chromophilic component of the Golgi apparatus corresponds to a system of paired membranes (which usually enclose an inner dense substance), (b) the chromophobic component corresponds to a substance lying within small dilations of the paired membrane, and (c) the archoplasm corresponds to numerous small vesicles. 6. The paired membranes branch, anastomose, and can often be traced back to a common source. They are interpreted as lamelliform folds, and occasionally tubular processes, of essentially a single Golgi membrane. In cells containing a Golgi network it is suggested that the membrane extends through the whole of the apparatus in such a way that the substance it encloses may be regarded as being in a continuous phase. 7. Epithelial cells of Patella contain a juxtanuclear Golgi apparatus with an ultrastructure similar to that described for neurons. PMID:13475392

  13. Recurrent dislocation of the patella in kabuki make-up syndrome.

    PubMed

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

    2012-01-01

    Two patients with Kabuki make-up syndrome with bilateral recurrent dislocation of the patella are presented. They had generalized ligamentous laxity and patellofemoral dysplasia. Both developed patellar dislocation in adolescence and required surgery, with medial transfer of the tibial tuberosity associated with vastus medialis plasty (Insall technique). One postoperative complication occurred in one case: a nondisplaced tibia fracture at the sixth postoperative week that healed with conservative means. Final results were good in both cases. Good surgical results can be achieved in patellar dislocation in patients with Kabuki syndrome. PMID:23320229

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

    PubMed Central

    Sandokji, Abdullah

    2015-01-01

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

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

    PubMed Central

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

    2014-01-01

    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. PMID:24788869

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

    PubMed

    Shafizadeh, Sven; Balke, Maurice

    2014-02-01

    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

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

    PubMed Central

    Behrendt, Lars; Larkum, Anthony W D; Trampe, Erik; Norman, Anders; Sørensen, Søren J; Kühl, Michael

    2012-01-01

    We assessed the microbial diversity and microenvironmental niche characteristics in the didemnid ascidian Lissoclinum patella using 16S rRNA gene sequencing, microsensor and imaging techniques. L. patella harbors three distinct microbial communities spatially separated by few millimeters of tunic tissue: (i) a biofilm on its upper surface exposed to high irradiance and O2 levels, (ii) a cloacal cavity dominated by the prochlorophyte Prochloron spp. characterized by strong depletion of visible light and a dynamic chemical microenvironment ranging from hyperoxia in light to anoxia in darkness and (iii) a biofilm covering the underside of the animal, where light is depleted of visible wavelengths and enriched in near-infrared radiation (NIR). Variable chlorophyll fluorescence imaging demonstrated photosynthetic activity, and hyperspectral imaging revealed a diversity of photopigments in all microhabitats. Amplicon sequencing revealed the dominance of cyanobacteria in all three layers. Sequences representing the chlorophyll d containing cyanobacterium Acaryochloris marina and anoxygenic phototrophs were abundant on the underside of the ascidian in shallow waters but declined in deeper waters. This depth dependency was supported by a negative correlation between A. marina abundance and collection depth, explained by the increased attenuation of NIR as a function of water depth. The combination of microenvironmental analysis and fine-scale sampling techniques used in this investigation gives valuable first insights into the distribution, abundance and diversity of bacterial communities associated with tropical ascidians. In particular, we show that microenvironments and microbial diversity can vary significantly over scales of a few millimeters in such habitats; which is information easily lost by bulk sampling. PMID:22134643

  18. Transient Patellar Dislocation Resulting in Simultaneous Osteochondral Fractures of Patella and Lateral Femoral Condyle – A Case Report

    PubMed Central

    Morey, Vivek Machhindra; Mittal, Ravi; Pannu, Chaitanya Dev

    2014-01-01

    Transient Patellar dislocations are commonly associated with bony contusions or osteochondral fractures involving the medial facet of patella or lateral femoral condyle. Simultaneous osteochondral fractures are rare and have not been reported in the adult. The authors report a case of combined osteochondral fracture of patella and lateral femoral condyle following acute patellar dislocation in an adult, which was misdiagnosed as meniscal injury. Both the osteochondral fracture fragments were rigidly fixed with headless compression screws and repair of the medial retinaculum was done. At latest follow up after two years, patient had regained full range of motion with no further episodes of patellar dislocation. The rarity of this combination of injury along with difficulty in interpreting radiographs makes this case interesting. PMID:25478378

  19. On the Role of the Patella, ACL and Joint Contact Forces in the Extension of the Knee

    PubMed Central

    Cleather, Daniel J.; Southgate, Dominic F. L.; Bull, Anthony M. J.

    2014-01-01

    Traditional descriptions of the knee suggest that the function of the patella is to facilitate knee extension by increasing the moment arm of the quadriceps muscles. Through modelling and evidence from the literature it is shown in this paper that the presence of the patella makes the ability of the quadriceps to rotate the thigh greater than their ability to rotate the tibia. Furthermore, this difference increases as the knee is flexed, thus demonstrating a pattern that is consistent with many human movements. This paper also shows that the anterior cruciate ligament plays a previously unheralded role in extending the shank and that translation at the tibiofemoral and patellofemoral joints is important in improving the capacity for thigh rotation when the knee is flexed. This study provides new insights as to how the structure of the knee is adapted to its purpose and illustrates how the functional anatomy of the knee contributes to its extension function. PMID:25536067

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

    PubMed Central

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

    1998-01-01

    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. PMID:9568563

  1. A Viscoelastic Constitutive Model Can Accurately Represent Entire Creep Indentation Tests of Human Patella Cartilage

    PubMed Central

    Pal, Saikat; Lindsey, Derek P.; Besier, Thor F.; Beaupre, Gary S.

    2013-01-01

    Cartilage material properties provide important insights into joint health, and cartilage material models are used in whole-joint finite element models. Although the biphasic model representing experimental creep indentation tests is commonly used to characterize cartilage, cartilage short-term response to loading is generally not characterized using the biphasic model. The purpose of this study was to determine the short-term and equilibrium material properties of human patella cartilage using a viscoelastic model representation of creep indentation tests. We performed 24 experimental creep indentation tests from 14 human patellar specimens ranging in age from 20 to 90 years (median age 61 years). We used a finite element model to reproduce the experimental tests and determined cartilage material properties from viscoelastic and biphasic representations of cartilage. The viscoelastic model consistently provided excellent representation of the short-term and equilibrium creep displacements. We determined initial elastic modulus, equilibrium elastic modulus, and equilibrium Poisson’s ratio using the viscoelastic model. The viscoelastic model can represent the short-term and equilibrium response of cartilage and may easily be implemented in whole-joint finite element models. PMID:23027200

  2. A viscoelastic constitutive model can accurately represent entire creep indentation tests of human patella cartilage.

    PubMed

    Keenan, Kathryn E; Pal, Saikat; Lindsey, Derek P; Besier, Thor F; Beaupre, Gary S

    2013-06-01

    Cartilage material properties provide important insights into joint health, and cartilage material models are used in whole-joint finite element models. Although the biphasic model representing experimental creep indentation tests is commonly used to characterize cartilage, cartilage short-term response to loading is generally not characterized using the biphasic model. The purpose of this study was to determine the short-term and equilibrium material properties of human patella cartilage using a viscoelastic model representation of creep indentation tests. We performed 24 experimental creep indentation tests from 14 human patellar specimens ranging in age from 20 to 90 years (median age 61 years). We used a finite element model to reproduce the experimental tests and determined cartilage material properties from viscoelastic and biphasic representations of cartilage. The viscoelastic model consistently provided excellent representation of the short-term and equilibrium creep displacements. We determined initial elastic modulus, equilibrium elastic modulus, and equilibrium Poisson's ratio using the viscoelastic model. The viscoelastic model can represent the short-term and equilibrium response of cartilage and may easily be implemented in whole-joint finite element models. PMID:23027200

  3. Distribution of subchondral bone density and cartilage thickness in the human patella.

    PubMed Central

    Eckstein, F; Müller-Gerbl, M; Putz, R

    1992-01-01

    Subchondral bone density (by means of CT osteoabsorptiometry), and cartilage thickness (directly measured on photocopies of frozen sections), were examined in 30 human patellae, with an age range from 47 to 90 y. A surface demonstration of the distribution was prepared, and representative pictures produced by summation with a computer. Subchondral bone-density maxima were found in the proximal part of the lateral facet, and the density pattern interpreted as the expression of the long-term distribution of stress in the joint. It is reasonable to assume that cartilage thickness, of which two-thirds of the maximum values occupy a lateral position, is also dependent on the local stress. The 2 distributions show correlation coefficients > 0.5 in approximately a third of the cases we examined. Displacement of the higher values of cartilage thickness relative to the subchondral density maxima is attributed to incongruence in the medial part of the joint. Images Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 7 PMID:1487436

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

    PubMed Central

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

    1991-01-01

    We have cloned and sequenced the cDNAs encoding Patella vulgata cyclins A and B. The cDNA clones contain an open reading frame of 426 and 408 amino acids respectively, which present similarity with cyclins from other species. Cyclin A and B RNAs are present as polyadenylated and non-polyadenylated RNA in prophase oocytes and are completely polyadenylated in metaphase I. During the first cleavages after fertilization the level of cyclin A and B mRNAs is high and drops when the free swimming stage is reached. Using p13suc1-Sepharose bead precipitation we demonstrate that cyclin synthesis is triggered during maturation and that inhibition of protein synthesis makes the cyclins disappear rapidly from the metaphase I oocytes, which shift to interphase condition. By microinjecting antisense oligonucleotides into metaphase I oocytes, we demonstrate that in vivo ablation of cyclin A and B messengers together gives the same result, whereas microinjection of only one oligonucleotide does not show any effect. Images PMID:1655419

  5. Influence of Gradual Elongation to the Patella Tendon Insertion in Rabbits

    PubMed Central

    Mutsuzaki, Hirotaka; Nakajima, Hiromi; Wadano, Yasuyoshi; Watanabe, Shintarou; Sakane, Masataka

    2014-01-01

    The purpose of this study was to examine the histological changes at the patella tendon (PT) insertion site under gradual elongation in rabbits. Gradual elongation of the PT was performed using external fixation for 4 weeks, with a lengthening speed of 0.5 mm/day (elongation group; n = 24). Rabbits in the sham group underwent the same surgical procedure without gradual elongation (sham group; n = 24). Eight animals were sacrificed 1, 2 and 4 weeks after surgery in each group, respectively. Average thicknesses of stained glycosaminoglycan (GAGs) areas by Safranin-O staining in the total cartilage layer and the uncalcified fibrocartilage layer in the elongation group were significantly higher than that in the sham group at 4 weeks (p < 0.05) and that in the intact PT group (n = 6, p < 0.05). In the elongation group, the peak in the average thicknesses of the stained GAGs areas in the total cartilage layer and the uncalcified fibrocartilage layer were observed at 4 weeks. Gradual elongation of PT insertion significantly affected the increase in the average thicknesses of the stained GAGs areas in the cartilage layer especially in the uncalcified fibrocartilage layer at 4 weeks in rabbits. Clinically, insertions of tendon and ligament can extend during gradual elongation using external fixation more than 4 weeks after the operation. PMID:25153635

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

    PubMed Central

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

    2014-01-01

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

  7. The effect of an augmentation patella prosthesis versus patelloplasty on revision patellar kinematics and quadriceps tendon force: an ex vivo study.

    PubMed

    Mountney, John; Wilson, David R; Paice, Michael; Masri, Bassam A; Greidanus, Nelson V

    2008-12-01

    The purpose of this study was to assess the effect of 2 revision reconstructive interventions on patellofemoral joint mechanics in comparison to control. We flexed 8 cadaver knee specimens from 0 degrees to 60 degrees of flexion in a test rig designed to simulate weight-bearing flexion and extension (Oxford rig). Quadriceps tendon extensor force and patellar kinematics were recorded for control total knee arthroplasty (TKA) (normal primary TKA with patella resurfaced) and then for each of the 2 revision patellar interventions (after patelloplasty of typical revision knee patellar bone defect to leave a simple bony shell, and after TKA with augmentation patella resurfacing). Our results demonstrate that patellar kinematics and quadriceps extensor force are optimized when the patella is reconstructed to normal anteroposterior thickness. PMID:18534488

  8. The Middle Miocene ape Pierolapithecus catalaunicus exhibits extant great ape-like morphometric affinities on its patella: inferences on knee function and evolution.

    PubMed

    Pina, Marta; Almécija, Sergio; Alba, David M; O'Neill, Matthew C; Moyà-Solà, Salvador

    2014-01-01

    The mosaic nature of the Miocene ape postcranium hinders the reconstruction of the positional behavior and locomotion of these taxa based on isolated elements only. The fossil great ape Pierolapithecus catalaunicus (IPS 21350 skeleton; 11.9 Ma) exhibits a relatively wide and shallow thorax with moderate hand length and phalangeal curvature, dorsally-oriented metacarpophalangeal joints, and loss of ulnocarpal articulation. This evidence reveals enhanced orthograde postures without modern ape-like below-branch suspensory adaptations. Therefore, it has been proposed that natural selection enhanced vertical climbing (and not suspension per se) in Pierolapithecus catalaunicus. Although limb long bones are not available for this species, its patella (IPS 21350.37) can potentially provide insights into its knee function and thus on the complexity of its total morphological pattern. Here we provide a detailed description and morphometric analyses of IPS 21350.37, which are based on four external dimensions intended to capture the overall patellar shape. Our results reveal that the patella of Pierolapithecus is similar to that of extant great apes: proximodistally short, mediolaterally broad and anteroposteriorly thin. Previous biomechanical studies of the anthropoid knee based on the same measurements proposed that the modern great ape patella reflects a mobile knee joint while the long, narrow and thick patella of platyrrhine and especially cercopithecoid monkeys would increase the quadriceps moment arm in knee extension during walking, galloping, climbing and leaping. The patella of Pierolapithecus differs not only from that of monkeys and hylobatids, but also from that of basal hominoids (e.g., Proconsul and Nacholapithecus), which display slightly thinner patellae than extant great apes (the previously-inferred plesiomorphic hominoid condition). If patellar shape in Pierolapithecus is related to modern great ape-like knee function, our results suggest that increased knee mobility might have originally evolved in relation to enhanced climbing capabilities in great apes (such as specialized vertical climbing). PMID:24637777

  9. The Middle Miocene Ape Pierolapithecus catalaunicus Exhibits Extant Great Ape-Like Morphometric Affinities on Its Patella: Inferences on Knee Function and Evolution

    PubMed Central

    Pina, Marta; Almécija, Sergio; Alba, David M.; O'Neill, Matthew C.; Moyà-Solà, Salvador

    2014-01-01

    The mosaic nature of the Miocene ape postcranium hinders the reconstruction of the positional behavior and locomotion of these taxa based on isolated elements only. The fossil great ape Pierolapithecus catalaunicus (IPS 21350 skeleton; 11.9 Ma) exhibits a relatively wide and shallow thorax with moderate hand length and phalangeal curvature, dorsally-oriented metacarpophalangeal joints, and loss of ulnocarpal articulation. This evidence reveals enhanced orthograde postures without modern ape-like below-branch suspensory adaptations. Therefore, it has been proposed that natural selection enhanced vertical climbing (and not suspension per se) in Pierolapithecus catalaunicus. Although limb long bones are not available for this species, its patella (IPS 21350.37) can potentially provide insights into its knee function and thus on the complexity of its total morphological pattern. Here we provide a detailed description and morphometric analyses of IPS 21350.37, which are based on four external dimensions intended to capture the overall patellar shape. Our results reveal that the patella of Pierolapithecus is similar to that of extant great apes: proximodistally short, mediolaterally broad and anteroposteriorly thin. Previous biomechanical studies of the anthropoid knee based on the same measurements proposed that the modern great ape patella reflects a mobile knee joint while the long, narrow and thick patella of platyrrhine and especially cercopithecoid monkeys would increase the quadriceps moment arm in knee extension during walking, galloping, climbing and leaping. The patella of Pierolapithecus differs not only from that of monkeys and hylobatids, but also from that of basal hominoids (e.g., Proconsul and Nacholapithecus), which display slightly thinner patellae than extant great apes (the previously-inferred plesiomorphic hominoid condition). If patellar shape in Pierolapithecus is related to modern great ape-like knee function, our results suggest that increased knee mobility might have originally evolved in relation to enhanced climbing capabilities in great apes (such as specialized vertical climbing). PMID:24637777

  10. Indentation response of human patella with elastic modulus correlation to localized fractal dimension and bone mineral density.

    PubMed

    Kerrigan, Jason R; Sanchez-Molina, David; Neggers, Jan; Arregui-Dalmases, Carlos; Velazquez-Ameijide, Juan; Crandall, Jeff R

    2014-05-01

    The goal of this study was to determine material properties for the anterior cortex and subcortical regions of human patellae and relate those properties to mineral density and fractal dimension of the bone. Ten human patellae were obtained from eight fresh frozen human cadavers and subjected to anteriorly-directed spherical indentation-relaxation experiments using two different sized indenters to two different indentation depths. Response data were fit to a three-mode viscoelastic model obtained through elastic-viscoelastic correspondence of the Hertzian contact relation for spherical indentation. A location-specific effective bone density measurement that more heavily weighted bone material close to the indentation site (by von Mises stress distribution) was determined from micro-computed tomography (38µm resolution) data captured for each specimen. The same imagery data were used to compute location specific fractal dimension estimates for each indentation site. Individual and averaged patella material models verified the hypothesis that when the larger indenter and greater indentation depth is used to engage the surface and deeper (trabecular) bone, the bone exhibits a more compliant response than when only the surface (cortical) bone was engaged (instantaneous elastic modulus was 325MPa vs. 207MPa, p<0.05). Effective bone mineral density was shown to be a significant predictor of the elastic modulus for both small and large indentation types (p<0.05) despite relatively low correlations. Exponential regressions of fractal dimension on elastic modulus showed significant relationships with high correlation for both the small (R(2)=0.93) and large (R(2)=0.97) indentations. PMID:23972564

  11. Restorative effects of exercise rehabilitation and bracing on females with lateral displacement of patella

    PubMed Central

    Karimzadehfini, Atiye; Zolaktaf, Vahid; Vahdatpour, Babak

    2014-01-01

    Background: This investigation compared the effects of exercise rehabilitation and bracing on muscle flexibility and strength as well as knee proprioception and pain in female sufferers of lateral displacement of patella (LDP). Materials and Methods: Twenty-two females with unilateral LDP were randomly divided into two groups to receive exercises (n = 12) or patellar brace (n = 10). Both groups were evaluated before and after 8 weeks with isokinetic dynamometer (Biodex System 3 Pro) for muscle strength and proprioception, with SLR, Active Knee Flexion, and Sit and Reach tests for flexibility assessment and with a visual analog scale for pain. Results: Muscle flexibility in both exercise and bracing groups improved (F(1,20)?5.99 and P ? 0.024), whereas improvement in bracing group was not significant. Significant interaction was observed in favor of exercise group in 2 strength tests of knee flexion and knee extension (F(1,20)?6.564 and P ? 0.019). For proprioception, a significant interaction was observed in favor of bracing group (F(1,20) =7.944 and P = 0.011). Also the results showed both exercise rehab and brace decreased significantly pain severity during stair ascending and descending. Conclusion: These results suggest that better flexibility and more strength in exercise group somehow reduced the stress on patellofemoral joint and it, in turn, alleviated the symptoms and pain. It is also likely that relieving effects of brace and improvement of proprioception by it allows patients to be more physically active and it could have, more or less, effects similar to exercise. Therefore both exercise and brace could be prescribed for patients with LDP. It seems application of the patellar brace combined with exercise might be a better treatment for these patients, because they could improve strength, flexibility and proprioception. PMID:25221768

  12. An electron microscope study of the cytology of the protozoan Euplotes patella.

    PubMed

    ROTH, L E

    1957-11-25

    1. Structurally the "sensory bristles" in Euplotes patella are typical cilia, but no ciliary rootlets connect their bases. 2. The "neuromotor fibrils" are composed of filaments 21 mmicro in diameter. At the point of junction of the filaments with the peripheral ciliary fibrils a granular structure 65 to 90 mmicro in diameter is seen which has dense central and peripheral zones separated by a less dense layer. Information on the interconnection of organelles is expanded. 3. A system of subpellicular fibrils is described. The external fibrillar system described by others could not be found. 4. The motorium is shown to be a mass of intertwining rootlet filaments. 5. The micronucleus is shown to have a spongy, dense material in a less dense material, all of which is surrounded by a double-layered membrane. 6. The double-layered macronuclear membrane contains annuli whose outside diameter is 70 mmicro; the macronuclear bodies are sometimes closely applied to the membrane. In the macronuclear reorganization bands, the solution plane is a fine network, while the reconstruction plane is devoid of structure at the level of resolution observed. 7. The mitochondria are composed of tubules, only occasionally oriented, usually embedded in a surrounding material of lower density. 8. Microbodies whose diameters are 250 to 350 mmicro are frequently observed in close association with mitochondrial surfaces. 9. The food vacuoles, contractile vacuoles, and ciliary vacuoles are bounded by single-layered membranes. In the food vacuoles, the bacteria are surrounded by membranes individually or in small groups. 10. Cytoplasmic rods localized in the oral region, and cytoplasmic granules dispersed at random, are described. No typical ergastoplasm, endoplasmic reticulum, or Golgi material was observed. PMID:13481030

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

    PubMed Central

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

    2013-01-01

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

  14. Tibial Tubercle Fracture in a 14-Year-Old Athlete with Bilateral Lower Pole Bipartite Patella and Osgood-Schlatter Disease

    PubMed Central

    Pascarella, Fabio; Ziranu, Antonio; Maccauro, Giulio

    2015-01-01

    We present a case of tibial tubercle fracture in a young male athlete with both bilateral bipartite patella at the lower pole (Saupe type I) and Osgood-Schlatter disease. Open reduction and internal fixation were performed to restore the extensor mechanism of the knee. PMID:25785215

  15. Gonad development and fatty acid composition of Patella depressa Pennant (Gastropoda: Prosobranchia) populations with different patterns of spatial distribution, in exposed and sheltered sites

    Microsoft Academic Search

    Sofia Morais; Diana Boaventura; Lu??s Narciso; Pedro Ré; Stephen J. Hawkins

    2003-01-01

    The present study examines the effect of shore exposure on the feeding performance (assessed by fatty acid analyses of the whole body) and gonad condition (stage of development and gonad somatic index, GSI) of Patella depressa populations. Male and female limpets were collected at exposed and sheltered sites, during winter and summer. The population at the exposed site was at

  16. Knee Injuries Approved by the UHS Patient Education Committee

    E-print Network

    . Patellofemoral pain syndrome (PFPS) is a frequently encountered overuse disorder that involves the patellofemoral, patellofemoral joint syndrome and chondromalacia patellae are also used to describe this condition. The pain comes from the joint under the kneecap ("patella") where it slides up and down over the thigh bone

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

    PubMed

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

    2010-08-01

    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

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

    PubMed Central

    Hoeksema, Bert W.

    2014-01-01

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

  19. Circumferential electrocautery of the patella in primary total knee replacement without patellar replacement: a meta-analysis and systematic review

    PubMed Central

    Fan, Lihong; Ge, Zhaogang; Zhang, Chen; Li, Jia; Yu, Zefeng; Dang, Xiaoqian; Wang, Kunzheng

    2015-01-01

    The purpose of this meta-analysis and systematic review was to identify and assess whether circumferential electrocautery is useful for improving outcomes after primary total knee replacement(TKR). We searched MEDLINE, EMBASE, PubMed, SpringerLink, Web of Knowledge, OVID CINAHL, OVID EBM and Google Scholar and included articles published through January 2014. A total of 6 articles met the inclusion criteria. Of the 776 cases included in the analysis, 388 cases involved patellar denervation, and 388 cases were designated as the control group. The meta-analysis revealed no significant difference in the incidence of anterior knee pain (AKP, p = 0.18) or in the visual analogue scale score (VAS, p = 0.23) between the two groups. In addition, AKSS Function Score indicated no significant difference between the two groups (p = 0.28). However, the OKS (p = 0.02), patellar score (p = 0.01), AKSS-Knee Score (p = 0.004), range of motion (ROM, p < 0.0001) and WOMAC Score (p = 0.0003) indicated that circumpatellarelectrocautery improved clinical outcomes compared with non-electrocautery. The results indicate that circumferential electrocautery of the patella does not significantly improve AKP compared with non-electrocautery techniques but that circumferential electrocautery significantly improves patients' knee function after surgery. Therefore, we believe that circumferential electrocautery is beneficial to the outcome of primary TKR surgery without patellar replacement. PMID:25801456

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

    SciTech Connect

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

    1987-04-01

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

  1. Circumferential electrocautery of the patella in primary total knee replacement without patellar replacement: a meta-analysis and systematic review.

    PubMed

    Fan, Lihong; Ge, Zhaogang; Zhang, Chen; Li, Jia; Yu, Zefeng; Dang, Xiaoqian; Wang, Kunzheng

    2015-01-01

    The purpose of this meta-analysis and systematic review was to identify and assess whether circumferential electrocautery is useful for improving outcomes after primary total knee replacement(TKR). We searched MEDLINE, EMBASE, PubMed, SpringerLink, Web of Knowledge, OVID CINAHL, OVID EBM and Google Scholar and included articles published through January 2014. A total of 6 articles met the inclusion criteria. Of the 776 cases included in the analysis, 388 cases involved patellar denervation, and 388 cases were designated as the control group. The meta-analysis revealed no significant difference in the incidence of anterior knee pain (AKP, p = 0.18) or in the visual analogue scale score (VAS, p = 0.23) between the two groups. In addition, AKSS Function Score indicated no significant difference between the two groups (p = 0.28). However, the OKS (p = 0.02), patellar score (p = 0.01), AKSS-Knee Score (p = 0.004), range of motion (ROM, p < 0.0001) and WOMAC Score (p = 0.0003) indicated that circumpatellarelectrocautery improved clinical outcomes compared with non-electrocautery. The results indicate that circumferential electrocautery of the patella does not significantly improve AKP compared with non-electrocautery techniques but that circumferential electrocautery significantly improves patients' knee function after surgery. Therefore, we believe that circumferential electrocautery is beneficial to the outcome of primary TKR surgery without patellar replacement. PMID:25801456

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

    PubMed Central

    2014-01-01

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

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

    PubMed

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

    2005-05-01

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

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

    PubMed Central

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

    2014-01-01

    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. PMID:24904762

  5. A simple technique for reconstruction of medial patellofemoral ligament with bone-fascia tunnel fixation at the medial margin of the patella: a 6-year-minimum follow-up study

    PubMed Central

    2014-01-01

    Background Medial patellofemoral ligament (MPFL) reconstruction has become an accepted technique to treat patellofemoral instability, and numerous surgical techniques have been described to reconstruct the MPFL. We describe a MPFL reconstruction procedure where bone-fascia tunnel fixation occurs at the medial margin of the patella for recurrent patellar dislocation. Objective MPFL reconstruction is the preferred operative treatment for recurrent patellar dislocation. The purpose of this study was to report a simple technique for reconstruction of medial patellofemoral ligament with bone-fascia tunnel fixation at the medial margin of the patella for recurrent patellar dislocation and to evaluate the results at 6-year-minimum follow-up. Methods The study included 65 patients (28 males, 37 females; mean age, 29.4?±?5.6 years) who underwent MPFL reconstruction using the bone-fascia tunnel fixation at the medial margin of the patella technique and who were followed for a mean duration of 78.5?±?3.8 months. Objective assessment, Kujala scale, Lysholm score, and Tegner activity score were obtained preoperatively and at the time of final follow-up. Results There were no patellar complications, including redislocation, in the present study. The congruence angle had significant improvement from 19.2°?±?6.3° before surgery to ?6.03°?±?0.50° at the last follow-up. The lateral patellar angle had significant improvement from ?6.9°?±?3.5° before surgery to 5.1°?±?2.4° at the last follow-up. The patellar tilt angle had significant improvement from 24.5°?±?5.2° before surgery to 12.30°?±?1.90° at the last follow-up. The Kujala score was significantly increased from 52.9?±?3.2 points preoperatively to 90.1?±?5.8 points postoperatively (P?patella fracture, anatomically to restore physiological kinematics and stability, and economically to reduce costs with bone-fascia tunnel fixation at the medial margin of the patella. PMID:25123919

  6. MRI of Cartilage: Pathological Findings

    Microsoft Academic Search

    Thomas M. Link

    \\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

  7. Retropatellar Chondromalacia Associated with Medial Osteoarthritis after Meniscus Injury

    Microsoft Academic Search

    C. Burger; K. Kabir; M. Mueller; C. Rangger; T. Minor; R. H. Tolba

    2006-01-01

    Background\\/Aims: In an ovine meniscal repair model, the patellofemoral (PF) osteoarthritis due to a non-sutured tear or failed repair was investigated. Methods: A radial meniscus tear was either sutured with polydioxanone (PDS), with a slow degrading polylactide long-term suture(LTS) or left without treatment. Knee joint cartilage in the PF and medial compartment was evaluated compared to normal knees (healthy controls).

  8. Clinical characteristics of patellar disorders in young athletes.

    PubMed

    Reider, B; Marshall, J L; Warren, R F

    1981-01-01

    The clinical histories of 50 young athletes who complained of patellar instability or pain were analyzed, and their physical findings were compared to those of 50 controls. The patients were divided into three groups, based on their symptoms. Analysis of their physical findings confirmed the validity of these divisions. Those who complained of frank dislocation of the patella exhibited the most pronounced stigmata of quadriceps dysplasia, including vastus medialis deficiency and infrapatellar fat pad enlargement, and had increased general ligamentous laxity, increased mean patellar mobility, and out-facing patellae with concomitantly decreased Q angles in chronic, recurrent cases. Patients who complained of the classic patellar pain pattern, often called "chondromalacia patella," but who denied swelling were designated CMP. They had normal mean ligamentous laxity and mean patellar mobility, an increased incidence of in-facing patellae with concomitantly increased mean Q angle, and frequently palpable lateral patellofemoral bands. Patients who complained of pain and swelling had physical findings intermediate to the other two groups, and generally correspond to what is usually termed subluxation of the patella. They exhibited normal general laxity but increased mean patellar mobility, normal mean Q angle but an increased incidence of patellar infacing, and fat pad enlargement. PMID:7258473

  9. Arthralgia in Children

    PubMed Central

    Brown, Douglas C. S.

    1983-01-01

    Arthralgia is joint pain unaccompanied by obvious clinical signs of arthritis or trauma. In most children and adolescents, the affected joint is the knee, hip, ankle, or less commonly an arm joint. Causes of arthralgia include arthritis; systemic disease; tumor; infection; growing pains; transient synovitis of the hip; osteochondroses; ostochondritis dissecans; traction syndrome; chondromalacia of the patella and post-traumatic synovitis. Some pains can be diagnosed with confidence with history, examination, X-ray, and laboratory studies. Other pains are vague, but careful observation of wasting and gait analysis may allow the physician to make a diagnosis. PMID:21283477

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

    PubMed

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

    2011-01-01

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

  11. Fracture of the unresurfaced patella after total knee arthroplasty: a report of two cases.

    PubMed

    Seijas, Roberto; Orduna, Juan Manuel; Castro, M C; Granados, Nuria; Baliarda, Jordi; Alcantara, Emili

    2009-08-01

    Patellar fractures are unusual in total knee arthroplasty without patellar resurfacing. We present 2 such cases that occurred within postoperative 2 months and were managed conservatively. Both patients had their knee function preserved. PMID:19721167

  12. The patella ligament insertion angle influences quadriceps usage during walking of anterior cruciate ligament deficient patients.

    PubMed

    Shin, Choongsoo S; Chaudhari, Ajit M; Dyrby, Chris O; Andriacchi, Thomas P

    2007-12-01

    Following ACL injury a reduction in the peak knee flexion moment during walking (thought to be created by a decrease of quadriceps contraction) has been described as an adaptation to reduce anterior tibial translation (ATT) relative to the femur. However, the amount of ATT caused by quadriceps contraction is influenced by the patellar ligament insertion angle (PLIA). The purpose of this study was to test the hypothesis that quadriceps usage during walking correlates to individual anatomical variations in the extensor mechanism as defined by PLIA. PLIA and gait were measured for ACL-deficient knees, using subjects' contralateral knees as controls. In ACL-deficient knees, PLIA was negatively correlated (R2 = 0.59) to peak knee flexion moment (balanced by net quadriceps moment), while no correlation was found in contralateral knees. Reduction in peak flexion moment in ACL-deficient knees compared to their contralateral knees was distinctive in subjects with large PLIA, possibly to avoid excessive ATT. These results suggest that subject-specific anatomic variability of knee extensor mechanism may account for the individual variability previously observed in adaptation to a quadriceps reduction strategy following ACL injury. The average (+/-1 SD) PLIA of ACL-deficient knees (21.1 +/- 3.4 degrees) was less than the average PLIA of contralateral knees (23.9 +/- 3.1 degrees). This altered equilibrium position of the tibiofemoral joint associated with reduced PLIA and adaptations of gait patterns following ACL injury may be associated with degenerative changes in the articular cartilage. In the future, individually tailored treatment and rehabilitation considering individuals' specific extensor anatomy may improve clinical outcomes. PMID:17593539

  13. Adaptive time-frequency analysis of knee joint vibroarthrographic signals for noninvasive screening of articular cartilage pathology.

    PubMed

    Krishnan, S; Rangayyan, R M; Bell, G D; Frank, C B

    2000-06-01

    Vibroarthrographic (VAG) signals emitted by human knee joints are nonstationary and multicomponent in nature; time-frequency distributions (TFD's) provide powerful means to analyze such signals. The objective of this paper is to construct adaptive TFD's of VAG signals suitable for feature extraction. An adaptive TFD was constructed by minimum cross-entropy optimization of the TFD obtained by the matching pursuit decomposition algorithm. Parameters of VAG signals such as energy, energy spread, frequency, and frequency spread were extracted from their adaptive TFD's. The parameters carry information about the combined TF dynamics of the signals. The mean and standard deviation of the parameters were computed, and each VAG signal was represented by a set of just six features. Statistical pattern classification experiments based on logistic regression analysis of the parameters showed an overall normal/abnormal screening accuracy of 68.9% with 90 VAG signals (51 normals and 39 abnormals), and a higher accuracy of 77.5% with a database of 71 signals with 51 normals and 20 abnormals of a specific type of patellofemoral disorder. The proposed method of VAG signal analysis is independent of joint angle and clinical information, and shows good potential for noninvasive diagnosis and monitoring of patellofemoral disorders such as chondromalacia patella. PMID:10833852

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

    Microsoft Academic Search

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

    2010-01-01

    Paleoclimate reconstructions from different regions have reported abrupt climate change around 2800-2700 cal yr B.P. The timing of this abrupt climate change is close to the boundary between the Neoglacial (3300-2500 cal yr B.P.) and Roman Warm Period (2500-1600 cal yr B.P.). However, temporal and spatial variability observed in this climate change event raises controversies about the forcing factors driving

  15. [Implant-free anterior cruciate ligament reconstruction with the patella ligament and press-fit double bundle technique].

    PubMed

    Hertel, P; Behrend, H

    2010-07-01

    Anterior cruciate ligament (ACL) reconstruction using autologous tendons (BTB patellar tendon, hamstrings, quadriceps tendon) in an implant-free fixation technique is becoming more and more popular due to biological and economical reasons. In 1987 an implant-free press-fit fixation technique of a BTB graft from the medial side of the patellar tendon (via mini-arthrotomy) was introduced and first published during the 4th ESKA Conference 1990 in Stockholm. Special emphasis is given to the anatomical orientation of the BTB graft. During the inside-out femoral press-fit fixation the bone-ligament margin of the graft is placed directly into the femoral insertion line of the natural ACL adapting its double-bundle structure. The graft is fixed by press-fit within the tibial metaphysis and its ligamentous part is secured in the metaphysis by harvested cancellous bone blocks driven into the joint line from the outside. The postoperative regime includes weight-bearing as tolerated and free motion. Out of 159 patients 95 could be seen for follow-up after an average of 10.7 years. The final IKDC knee score revealed 22.1% in group A (very good) and 62.1% in group B (good). The Tegner activity level was 6.8 preinjury and 6.0 postoperatively. The average KT 1,000 side-to-side difference was 1.8 mm. Subjectively no patient complained of instability and 99% of the patients could kneel on hard ground with minimal or no complaints. ACL revision surgery due to graft failure was not necessary in any of the patients. Advantages of the described procedure are a narrow anatomical orientation including the double bundle structure of the ACL, rapid graft incorporation by bone-to-bone healing, lack of bone resorption at the graft-host interface, decreased donor site morbidity, cost-effectiveness and ease of possible revision surgery. PMID:20607510

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

    PubMed Central

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

    2014-01-01

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

  17. Advantage of Minimal Anterior Knee Pain and Long-term Survivorship of Cemented Single Radius Posterior-Stabilized Total Knee Arthroplasty without Patella Resurfacing

    PubMed Central

    Ji, Hyung-Min; Baek, Ji-Hoon; Ko, Young-Bong

    2015-01-01

    Background The single radius total knee prosthesis was introduced with the advantage of reduced patellar symptoms; however, there is no long-term follow-up study of the same. The purpose of this study was to determine the survival rate of single radius posterior-stabilized total knee arthroplasty and patellofemoral complication rates in a consecutive series. Methods Seventy-one patients (103 knees) who underwent arthroplasty without patellar resurfacing using a single radius posterior-stabilized total knee prosthesis were followed up for a minimum 10 years. Clinical evaluation using Knee Society knee and function scores and radiologic evaluation were performed at regular intervals. Anterior knee pain as well as patellofemoral complications were evaluated with a simple questionnaire. The Kaplan-Meier product-limit method was used to estimate survival. Results Seventeen patients (23 knees) were excluded due to death (12 knees) or lost to follow-up (11 knees). Of the 80 knees enrolled, all femoral components and 78 tibial components were well fixed without loosening at final follow-up. Two revisions were performed because of tibial component loosening and periprosthetic joint infection. One patient with tibial component loosening refused to have revision surgery. No obvious tibial insert polyethylene wear was observed. The survivorships at 132 months were 96.7% using revision or pending revision as end points. Anterior knee pain was present in 6 patients (6 knees, 7.5%) at the latest follow-up. No patellofemoral complication requiring revision was encountered. Conclusions The single radius posterior-stabilized total knee prosthesis demonstrated an excellent minimum 10-year survivorship. The low rates of implant loosening and 7.5% of anterior knee pain as a patellofemoral complication are comparable with those reported for other modern total knee prosthesis. PMID:25729519

  18. Medial Patellofemoral Ligament Reconstruction: A Technique With a “V”-Shaped Patellar Tunnel

    PubMed Central

    Ahmad, Riaz; Jayasekera, Narlaka; Schranz, Peter; Mandalia, Vipul

    2014-01-01

    Patellofemoral dislocation is a common problem affecting the young and active population. The medial patellofemoral ligament (MPFL) is torn when the patella dislocates as it acts as a checkrein to lateral displacement. This leads to patellar instability, and MPFL reconstruction is required if the dislocation recurs after a trial of rehabilitation. We describe a “V”-shaped patellar tunnel technique to reconstruct the MPFL using an autologous gracilis graft. This modification of the patellar tunnel does not breach the lateral cortex of the patella, and it allows a broader attachment of the tendon graft to the patella, which mimics the normal anatomic attachment of the MPFL to the patella. PMID:25473612

  19. Medial patellofemoral ligament reconstruction: a technique with a "v"-shaped patellar tunnel.

    PubMed

    Ahmad, Riaz; Jayasekera, Narlaka; Schranz, Peter; Mandalia, Vipul

    2014-10-01

    Patellofemoral dislocation is a common problem affecting the young and active population. The medial patellofemoral ligament (MPFL) is torn when the patella dislocates as it acts as a checkrein to lateral displacement. This leads to patellar instability, and MPFL reconstruction is required if the dislocation recurs after a trial of rehabilitation. We describe a "V"-shaped patellar tunnel technique to reconstruct the MPFL using an autologous gracilis graft. This modification of the patellar tunnel does not breach the lateral cortex of the patella, and it allows a broader attachment of the tendon graft to the patella, which mimics the normal anatomic attachment of the MPFL to the patella. PMID:25473612

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

    Technology Transfer Automated Retrieval System (TEKTRAN)

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

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

    PubMed Central

    Pitsillides, Andrew A.; Hutchinson, John R.

    2014-01-01

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

  2. Biology and augmentation of tendon-bone insertion repair

    Microsoft Academic Search

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

    2010-01-01

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

  3. Grossly apparent cartilage erosion of the patellar articular surface in dogs with congenital medial patellar luxation.

    PubMed

    Daems, R; Janssens, L A; Béosier, Y M

    2009-01-01

    One hundred and forty-five stifles of client-owned dogs that underwent corrective surgery for congenital medial patellar luxation were inspected for cartilage erosion on the articular surface of the patella. The lesions were mapped in surface percentage ranges of 20% and by location. Two-thirds of the patellae had cartilage erosion. Cartilage erosion varied between 0 and 100% of the total patellar articular surface and was localised mainly on the medial and distal side of the patella. Dogs with Grade IV patellar luxations and heavier dogs were more affected. The majority of dogs in our study with congenital medial patellar luxation had grossly apparent cartilage erosion on the articular surface of the patella, which may help to explain why certain patients do not function well clinically after technically successful corrective surgery. PMID:19448865

  4. Genetics Home Reference: Genitopatellar syndrome

    MedlinePLUS

    ... patellae, scrotal hypoplasia, renal anomalies, facial dysmorphism, and mental retardation GPS For more information about naming genetic conditions, ... gene ; histone ; hypoplasia ; hypotonia ; inheritance ; inheritance pattern ; joint ; ... microcephaly ; micrognathia ; molecule ; muscle tone ; nervous system ; pelvis ; ...

  5. Running and Jogging Injuries

    MedlinePLUS

    ... the leg is cause for referral to a sports medicine specialist. The patella (kneecap) is a common site ... to you by the American Orthopaedic Society for Sports Medicine. They provide general information only and are not ...

  6. How I Manage Osteochondritis Dissecans.

    ERIC Educational Resources Information Center

    DiStefano, Vincent J.

    1986-01-01

    Osteochondritis dissecans, a lesion found most often on the femur at the knee joint, occurs most frequently in active adolescents. This article describes treatment for preadolescents, adolescents, and adults. Osteochondritus dissecans of the patella is also presented. (MT)

  7. Meniscus Tears

    MedlinePLUS

    ... is made up of three bones: the thighbone (femur), the shinbone (tibia), and the kneecap (patella), as ... the soft tissue that connects them. Between your femur and your tibia are two C-shaped discs ...

  8. Jumper's Knee (Patellar Tendonitis) (For Parents)

    MedlinePLUS

    ... the knee to function properly: Bones like the femur (thighbone), the tibia (shinbone), and the patella (kneecap) ... Exam: Knee Bones, Muscles, and Joints Osgood-Schlatter Disease Medial Collateral Ligament (MCL) Injuries Preventing Children's Sports ...

  9. Jumper's Knee (Patellar Tendonitis)

    MedlinePLUS

    ... the knee to function properly: Bones like the femur (thighbone), the tibia (shinbone), and the patella (kneecap) ... Safety Tips: Soccer Safety Tips: Basketball Osgood-Schlatter Disease Sports and Exercise Safety 5 Ways to Prepare ...

  10. Revision of failed metal-backed patellar component of Miller\\/Galante-I total knee prosthesis

    Microsoft Academic Search

    Makoto Kobori; Susumu Kamisato; Masahiro Yoshida; Kaori Kobori

    2000-01-01

    Of 38 Miller\\/Galante-I total knee prostheses implanted between 1987 and 1990, 20 (53%) were revised. Failed metal-backed\\u000a patella (15 knees; 40%) was the most frequent reason for revision. In most patients, the components were found well fixed\\u000a to bone. The purpose of this study was to describe the revision technique we used for failed metal-backed patella. Total revision\\u000a of all

  11. Progressive trypsin digestion and serum inhibition in articular cartilage monitored using high-frequency ultrasound in situ

    Microsoft Academic Search

    Q. Wang; Y. P. Zheng; X. Guo; S. Z. Wang

    2008-01-01

    This study investigated the trypsin digestion and serum inhibition in articular cartilage monitored using high-frequency ultrasound system in situ. Three normal bovine patellae were obtained from a local butcher shop. Four full-thickness cartilage-bone specimens were prepared from the lower medial side of each patella and divided into 4 groups: Group A, B, C and D. Group A was treated as

  12. MR Pharmacokinetic Modeling of the Patellar Cartilage Differentiates Normal From Pathological Conditions

    Microsoft Academic Search

    Roberto Sanz; Luis Marti ´-Bonmati ´; JoseLuis Rodrigo; David Moratal

    2008-01-01

    Purpose: To study the pharmacokinetic parameters de- rived from dynamic contrast-enhanced magnetic reso- nance imaging (DCE-MRI) of the patellar cartilage under normal and pathological conditions. Materials and Methods: DCE-MRI was obtained in 22 cases. There were 17 patients with degenerative patellar conditions (eight with chondromalacia and nine with osteoarthritis) and five normal subjects. The cartilage pharmacokinetic parame- ters of Ktrans

  13. Patellofemoral disorders and instability.

    PubMed

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

    2010-01-01

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

  14. Medial Patellofemoral Ligament Reconstruction With Semitendinosus Autograft

    PubMed Central

    Wylie, James D.; Burks, Robert T.

    2013-01-01

    Patellar instability is a common complaint after traumatic dislocation of the patella. Traumatic dislocation always leads to tearing of the medial patellofemoral ligament (MPFL). Treatment consists of recovery from the traumatic injury, followed by reconditioning and physical therapy to strengthen the dynamic stabilizers of the patella. In patients with recurrent instability, detailed evaluation of the cause is required to determine the needed interventions. In patients with an incompetent MPFL and recurrent instability, reconstruction is indicated, along with other procedures to address other contributing factors. This article details our technique for MPFL reconstruction using semitendinosus autograft, which can be performed alone or in concert with other realignment procedures. PMID:24400192

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

    SciTech Connect

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

    1989-11-01

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

  16. “Central” Quadriceps Tendon Harvest With Patellar Bone Plug: Surgical Technique Revisited

    PubMed Central

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

    2013-01-01

    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. PMID:24400194

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

    Microsoft Academic Search

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

    2004-01-01

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

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

    Microsoft Academic Search

    Daniela Brakstad; Hilde Elise Heldal; Kjersti Sjøtun

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

  19. Postoperative pain after anterior cruciate ligament reconstruction using a transligamentous approach

    Microsoft Academic Search

    Eirik Solheim; Torbjørn Strand

    1993-01-01

    Anterior cruciate ligament reconstruction by free patel lar tendon graft was performed using 2 different surgical approaches to the intercondylar notch in 67 consecu tive patients with chronic anterior cruciate ligament insufficiency. In the first 30 patients (Group A), the traditional medial parapatellar arthrotomy with lateral luxation of the patella was done, whereas in the last 37 patients (Group B)

  20. Age-Dependent Changes in Matrix Composition and Organization at the Ligament-to-Bone Insertion

    E-print Network

    Lu, Helen H.

    of Arthritis and Musculoskeletal and Skin Diseases, Department of Health and Human Services, National reconstruction options: bone-patella tendon-bone (BPB), and hamstring tendon-based grafts. Use of hamstring tendon- based grafts has increased due to limitations commonly associated with BPB grafts, for exam- ple

  1. BY ALYSSA SCHNUGG Staff Writer

    E-print Network

    Tchumper, Gregory S.

    office on the second floor was repainted but escaped any major damage. Most of the heavy damage cardiology, advanced heart failure, peripheral vascular disease and arrhythmia management. Oxford Heart at the junction of the kneecap (patella) and thighbone (femur), is one of the most common problems in sports

  2. The quantitative measurement of normal passive medial and lateral patellar motion limits

    Microsoft Academic Search

    Thomas C. Skalley; Glenn C. Terry; Robert A. Teitge

    1993-01-01

    To quantify normal motion, medial and lateral passive patellar motion limits were measured in 67 high school athletes randomly selected from a group of 1340 ath letes undergoing preseason physical examinations. Pa tellar displacement was measured at knee flexion an gles of 0° and 35°, using both a Patella Pusher (a hand held force gauge) and a manual technique, and

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

    Microsoft Academic Search

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

    1992-01-01

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

  4. COMMON OVERUSE INJURIES ATTRIBUTED TO CYCLING, AND WAYS TO MINIMIZE THESE INJURIES

    E-print Network

    the handle bars can cause the muscles around your shoulder blades to become sore (Rhomboids, middle. This is a difficult ex- ercise, because the anterior neck muscles (neck flexors) are generally the weakest muscles. 3. Strains and sprains of the calf muscles. 4. Achilles and Patella tendinitis. 5. Strains

  5. Is cartilage thickness different in young subjects with and without patellofemoral pain?

    E-print Network

    Delp, Scott

    Is cartilage thickness different in young subjects with and without patellofemoral pain? C. E genders. To determine the differences in load-bearing cartilage thickness between pain-free controls and individuals with patellofemoral pain. Methods: The articular cartilage thickness of the patella and anterior

  6. Evaluation of patellar height and measurement methods after valgus high tibial osteotomy

    Microsoft Academic Search

    Hayrettin Kesmezacar; Rifat Erginer; Tahir Ogut; Aksel Seyahi; Muharrem Babacan; Yuksel Tenekecioglu

    2005-01-01

    Several controversies exist regarding the surgical difficulties and the results of total knee arthroplasty performed after failed valgus high tibial osteotomy (HTO), and the main subject is the change in patellar height that results as patella baja or infera. The purpose of this retrospective study was to evaluate patellar height after valgus HTO and the measurement methods that were actually

  7. Soft Tissue Restraints to Lateral Patellar Translation in the Human Knee

    Microsoft Academic Search

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

    1998-01-01

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

  8. Lateral patellofemoral ligament reconstruction using a free gracilis autograft.

    PubMed

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

    2014-07-01

    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

  9. Periprosthetic fractures of the femur after total knee arthroplasty

    PubMed Central

    McGraw, Phil

    2010-01-01

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

  10. JAMA Patient Page: Knee Replacement

    MedlinePLUS

    Total Knee Replacement Femur Femoral component Plastic spacer Tibial component Patellar implant Patella Total Knee R Prosthesis Tibia M U S C U L ... National Institute of Arthritis and Musculoskeletal and Skin Diseases www.niams.nih.gov INFORM YOURSELF To find ...

  11. Trace metals in seagrass, algae and molluscs from an uncontaminated area in the Mediterranean

    Microsoft Academic Search

    L Campanella; M. E Conti; F Cubadda; C Sucapane

    2001-01-01

    The concentrations of Cd, Cr, Cu, Pb and Zn were measured in specimens of four marine organisms — the seagrass Posidonia oceanica (L.) Delile, the brown algae Padina pavonica (L.) Thivy, and the two gastropod molluscs Monodonta turbinata Born and Patella caerulea L. — selected as possible cosmopolitan biomonitors of trace metals in the Mediterranean area. The organisms were collected at five

  12. Inelastic compression increases venous ejection fraction more than elastic bandages in patients with superficial venous reflux

    Microsoft Academic Search

    G Mosti; V Mattaliano; H Partsch

    2008-01-01

    Aim: To investigate the influence of compression bandages, manufactured using materials with different elastic properties, on the impaired venous pumping function in patients with venous insufficiency. Methods: Ejection volume (EV) and ejection fraction (EF) were measured using strain gauge plethysmography distal from the patella without and with elastic and inelastic compression bandages in a total of 30 patients with major

  13. Finding and defining the ideal patellar resection plane in total knee arthroplasty.

    PubMed

    Anglin, C; Fu, C; Hodgson, A J; Helmy, N; Greidanus, N V; Masri, B A

    2009-10-16

    Asymmetric resection of the patella during total knee arthroplasty (TKA) correlates with anterior knee pain, bony impingement and patellar maltracking. Despite this, there is no consensus regarding the desired landmarks; the cut is often done freehand; and there has been no quantitative comparison of proposed resection planes. The objectives of this study were to: determine the intra- and inter-surgeon repeatability of two radiographic resection definitions (medial-divot, MD, and medial-lateral extents, MLE); calculate two additional definitions from the radiographic patellar circumferences (parallel to the anterior surface, ANT, and perpendicular to the anteroposterior tangent points, PERP); compare the clinical resection line to the previous four definitions before and after introducing the MD method clinically; and identify distinguishing features of patellae with better vs. worse resection angles. We hypothesized that the MD method would improve repeatability both radiographically and clinically, that the different radiographic definitions would produce comparable angles, and that we could identify distinguishing features. For the radiographic study, three surgeons drew lines on 40 preoperative X-rays plus 9 interspersed repetitions of 3 of these X-rays. For the clinical study, we compared the patellar resection angle for 20 patients immediately before and after implementing the new method. Given that the clinical goal is to have equal distances from the resection surface to the anterior surface, we compared all results to the ANT definition as the theoretically ideal definition. Confirming the first hypothesis, intra-surgeon repeatability (10 repetitions of 3 X-rays) and inter-surgeon repeatability (3 surgeons x 40 X-rays) were both significantly better using the new MD method compared to the MLE method (p<0.001). Contrary to the second hypothesis, clinical use of the MD method did not improve resection symmetry. Contrary to the third hypothesis, the PERP definition was significantly different from the other three definitions. In agreement with the fourth hypothesis, female patellae and more deformed patella had significantly greater asymmetry (p<0.001). Given the inherent variability shown in drawing the 'patellar horizon', we encourage researchers to draw the line several times and average the results when comparing tilt or the resection angle to this horizon. Based on the distinguishing characteristics of asymmetrically resurfaced patellae in our series, we recommend that clinicians be particularly careful when resecting laterally deformed patellae and the patellae of female patients. PMID:19699480

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

    PubMed Central

    2013-01-01

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

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

    PubMed

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

    2011-04-01

    Meier-Gorlin syndrome (ear, patella and short-stature syndrome) is an autosomal recessive primordial dwarfism syndrome characterized by absent or hypoplastic patellae and markedly small ears¹?³. Both pre- and post-natal growth are impaired in this disorder, and although microcephaly is often evident, intellect is usually normal in this syndrome. We report here that individuals with this disorder show marked locus heterogeneity, and we identify mutations in five separate genes: ORC1, ORC4, ORC6, CDT1 and CDC6. All of these genes encode components of the pre-replication complex, implicating defects in replication licensing as the cause of a genetic syndrome with distinct developmental abnormalities. PMID:21358632

  16. Genu recurvatum following paediatric femoral diaphyseal - fracture : salter type v injury revisit.

    PubMed

    Cogan, A; Donell, St

    2013-11-01

    A 17-year old boy with a history of a right femoral shaft fracture, fixed with a reamed intramedullary nail four years earlier, presented with a 15° genu recurvatum deformity, presumably due to premature closure of the anterior proximal tibial physeal plate following a Salter type V injury. He was treated with a supra-tubercular anterior opening wedge osteotomy, fixed with two Puddu plates and grafted with bone matrix substitute. The patient went on to unite without complication, but came back to clinic six years later with anterior knee pain and patella infera. The paper discusses genu recurvatum after growth plate arrest and the various techniques to address the problem. Moving the tibial tubercle by including it in the osteotomy should be considered to avoid the complication of patella infera. PMID:25674307

  17. Simultaneous medial and lateral patellofemoral ligament reconstruction for combined medial and lateral patellar subluxation.

    PubMed

    Saper, Michael G; Shneider, David A

    2014-04-01

    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. PMID:24904765

  18. Guidelines for medial patellofemoral ligament reconstruction in chronic lateral patellar instability.

    PubMed

    Sanchis-Alfonso, Vicente

    2014-03-01

    The standard surgical approach for chronic lateral patellar instability with at least two documented patellar dislocations is to stabilize the patella by using an anatomic medial patellofemoral ligament reconstruction with a mini-open technique and a graft that is stronger than the native ligament to compensate for the uncorrected predisposing factors underlying patellar instability. Even though medial patellofemoral ligament reconstruction has evolved notably during the past two decades, many aspects of the surgical technique need to be refined, and more information is needed toward this end. Adequate positioning of the graft on the femur, as well as inducing the appropriate degree of tension, are critical steps for the overall outcome of medial patellofemoral ligament reconstruction. Moreover, it is necessary in some cases to pair medial patellofemoral ligament reconstruction with other surgical procedures to address additional patellar instability risk factors, such as trochlear dysplasia, malalignment, and patella alta. PMID:24603827

  19. Diagnosis and Treatment of Lateral Patellar Compression Syndrome

    PubMed Central

    Saper, Michael G.; Shneider, David A.

    2014-01-01

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

  20. Reconstruction of a ruptured patellar tendon using ipsilateral semitendinosus and gracilis tendons with preserved distal insertions: two case reports

    PubMed Central

    2013-01-01

    Background Acute patellar tendon ruptures with poor tissue quality. Ruptures that have been neglected are difficult to repair. Several surgical techniques for the repair of the patellar tendon have been reported, however, these techniques remain difficult because of contractures, adhesions, and atrophy of the quadriceps muscle after surgery. Case presentation We report the cases of 2 Japanese patients (Case 1: a 16-year-old male and Case 2: a 43-year-old male) with patellar tendon ruptures who were treated by reconstruction using semitendinosus-gracilis (STG) tendons with preserved distal insertions. Retaining the original insertion of the STG appears to preserve its viability and provide the revascularization necessary to accelerate healing. Both tendons were placed in front of the patella, in a figure-of-eight fashion, providing stability to the patella. Conclusion Both patients recovered near normal strength and stability of the patellar tendon as well as restoration of function after the operation. PMID:24010848

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

    PubMed

    Roy, Dennis R

    2011-09-01

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

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

    SciTech Connect

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

    1986-06-01

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

  3. Descriptions of the lower limb skeleton of Homo floresiensis

    Microsoft Academic Search

    W. L. Jungers; S. G. Larson; W. Harcourt-Smith; M. J. Morwood; T. Sutikna; Rokhus Due Awe; T. Djubiantono

    2009-01-01

    Bones of the lower extremity have been recovered for up to nine different individuals of Homo floresiensis – LB1, LB4, LB6, LB8, LB9, LB10, LB11, LB13, and LB14. LB1 is represented by a bony pelvis (damaged but now repaired), femora, tibiae, fibulae, patellae, and numerous foot bones. LB4\\/2 is an immature right tibia lacking epiphyses. LB6 includes a fragmentary metatarsal

  4. Isolated patellar revisions for failed metal-backed components

    Microsoft Academic Search

    Joyce S. B. Koh; Seng-Jin Yeo; Ngai-Nung Lo; Ser-Kiat Tan; Boon-Keng Tay; Kang-Hong Seow

    2004-01-01

    Results of isolated patellar revisions for failed metal-backed patellae remain controversial. Isolated patellar revisions from April 1993 to April 2000 were assessed for complication rates, the Knee Society score (KSS), implant survival, and radiological loosening. Twenty-nine knees were revised in patients aged 71.0 years (range, 61–87; SD, 6.2). At 67.0 months (range, 24–98 months; SD, 22.0), no patient underwent further

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

    Microsoft Academic Search

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

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

  6. Assessment of rat articular cartilage maturation using 50MHz quantitative ultrasonography

    Microsoft Academic Search

    E. Chérin; B. Pellaumail; D. Loeuille; P. Laugier; P. Gillet; P. Netter; G. Berger

    2001-01-01

    Objective The objective was to assess the relationship between maturation-related structural changes of articular cartilage and variations of acoustic parameters estimated using high frequency ultrasonography.Design Patellae taken from 48 immature Wistar male rats and divided into six age groups (from five to 11 weeks old) were explored in vitro using 50-MHz scanning acoustic microscopy, then assessed by histology for the

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

    Microsoft Academic Search

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

    1998-01-01

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

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

    Microsoft Academic Search

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

    1995-01-01

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

  9. Marine Protected Areas: A Tool for Coastal Areas Management

    Microsoft Academic Search

    C. F. Boudouresque; G. Cadiou; L. Diréac'h

    Marine biodiversity is threatened by human impact. Though few marine species are regarded as being extinct due to Man, many\\u000a species are critically endangered (e.g. the monk seal Monachus monachus), endangered (e.g. the Mediterranean giant limpet\\u000a Patella ferruginea) or vulnerable, i.e. dwindling rapidly, although not threatened with extinction in the immediate future\\u000a (e.g. the large mollusk Pinna nobilis). There are

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

    Microsoft Academic Search

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

    1997-01-01

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

  11. Bursae around the knee joints.

    PubMed

    Chatra, Priyank S

    2012-01-01

    A bursa is a fluid-filled structure that is present between the skin and tendon or tendon and bone. The main function of a bursa is to reduce friction between adjacent moving structures. Bursae around the knee can be classified as those around the patella and those that occur elsewhere. In this pictorial essay we describe the most commonly encountered lesions and their MRI appearance. PMID:22623812

  12. Bone Mineral Density in the Chronic Patellofemoral Pain Syndrome

    Microsoft Academic Search

    J. Leppälä; P. Kannus; A. Natri; H. Sievänen; M. Järvinen; I. Vuori

    1998-01-01

    .   Bone mineral density (BMD) and clinical status of 40 patients with a chronic, unilateral patellofemoral pain syndrome (PFPS)\\u000a were determinated. The mean duration of the disease at the time of the follow-up was 7.6 ± 1.8 (SD) years. The BMD was measured\\u000a at the spine (L2–L4), and the femoral neck, trochanter area of the femur, distal femur, patella, proximal

  13. Bursae around the knee joints

    PubMed Central

    Chatra, Priyank S

    2012-01-01

    A bursa is a fluid-filled structure that is present between the skin and tendon or tendon and bone. The main function of a bursa is to reduce friction between adjacent moving structures. Bursae around the knee can be classified as those around the patella and those that occur elsewhere. In this pictorial essay we describe the most commonly encountered lesions and their MRI appearance. PMID:22623812

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

    Microsoft Academic Search

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

    2008-01-01

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

  15. Unicondylar knee arthroplasty in a patient with poliomyelitis.

    PubMed

    Middleton, Fiona R; Boardman, David R; Abbassian, Ali; Maurice, Hugh D

    2009-01-01

    Osteoarthritis in patients who have had poliomyelitis creates a significant challenge. The loss, or reduction of power in the quadriceps, combined with recurvatum and often patella baja can cause problems when considering total knee arthroplasty. The authors present the first case report of a unicondylar knee arthroplasty in such a patient. Functional knee scores improved, although some persistent degree of disability remained due to the preexisting poor muscle power. PMID:19327264

  16. Evaluation of patellar height and measurement methods after valgus high tibial osteotomy.

    PubMed

    Kesmezacar, Hayrettin; Erginer, Rifat; Ogut, Tahir; Seyahi, Aksel; Babacan, Muharrem; Tenekecioglu, Yuksel

    2005-10-01

    Several controversies exist regarding the surgical difficulties and the results of total knee arthroplasty performed after failed valgus high tibial osteotomy (HTO), and the main subject is the change in patellar height that results as patella baja or infera. The purpose of this retrospective study was to evaluate patellar height after valgus HTO and the measurement methods that were actually used. Eighty-five knees that were subjected to valgus HTO were evaluated both preoperatively and postoperatively according to the Insall-Salvati Index (ISI), Blackburne-Peel Index (BPI), and Caton Index (CI) to assess any alteration of patellar tendon height that was present. All cases underwent closing wedge osteotomy with three staples or plate internal fixation and were allowed early range of motion. Significant decrease in mean patellar height ratios was detected according to all three indexes at 85 months of mean follow-up. The percentages of the decrease were 8.26% in ISI, 9.08% in BPI, and 6.34% in CI. Two knees showed patella infera according to ISI, one according to BPI and three according to CI. There were no significant correlations between the indexes and clinical status of the patients. Elevation of patella relative to the femur in closing wedge valgus HTO procedure due to the shortening of the segment between tibial tuberosity and joint line is normally expected. A significant decrease in patellar height according to ISI suggests that there should be patellar tendon shortening as patellar height cannot be changed. BPI and CI for determining patellar height in valgus HTO do not accurately measure the alteration of patella because they may affect the tibial inclination and antero-posterior translation of the proximal fragment. Another measuring system based on femoral reference points should be proposed to determine the exact change of patellar height in the valgus HTO procedure. PMID:15645214

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

    PubMed Central

    Ridgway, S. A.

    1998-01-01

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

  18. LMX1B Mutations Cause Hereditary FSGS without Extrarenal Involvement

    PubMed Central

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

    2013-01-01

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

  19. 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

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

    2012-01-01

    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. PMID:22570846

  20. The equine hind limb is actively stabilized during standing

    PubMed Central

    Schuurman, Simon O; Kersten, Wim; Weijs, Wim A

    2003-01-01

    Horses spend much of their life standing, and they are believed to be able to keep their limbs straight without muscular effort. We tested the hypothesis that the stifle (knee) and hock (tarsal) joints could be stabilized merely with the help of a passive lock mechanism whereby the patella is secured behind a hook, formed by the medial femoral trochlea. In anaesthetized animals and isolated limbs the stifle and hock flex readily under compression. In isolated limbs this collapse was prevented by a small force applied to the patella, mimicking the action of the vastus medialis muscle. In vivo, when the limb was planted loosely on the ground none of the muscles with a connection to the patella was active. However, during weight-bearing the vastus medialis (but no other muscle) was active, providing the necessary traction to stabilize the stifle. The required tension was estimated to be less than 2% of the force that would be needed in absence of a lock mechanism. Diagnosis and treatment of patellar fixation should include the possibility of overactive vastus medialis muscle as a possible cause of the disorder. PMID:12739613

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

    PubMed

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

    2014-10-01

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

  2. Patellar malalignment treatment in total knee arthroplasty

    PubMed Central

    Gasparini, Giorgio; Familiari, Filippo; Ranuccio, Francesco

    2013-01-01

    Summary The patella, with or without resurfacing, plays a fundamental role in the success of a total knee arthroplasty (TKA). Patellofemoral joint complications are due to problems related to the patient, to the surgical technique, or to the design of the components. Patellar tracking is influenced by several factors: a severe preoperative valgus, the presence of pre-existing patellofemoral dysplasia, the design of the femoral component, the surgical approach, the Q angle, the mechanical alignment of the limb, the tightness of the lateral retinaculum, the positioning of the patellar component in the proximal-distal and medial-lateral directions, the patella height, the patella (native or resurfaced) thickness, the size of the femoral and the tibial components, and the alignment and rotation of the components. Several factors are crucial to prevent patellar maltracking in TKA: the use of an anatomical femoral component, a meticulous surgical technique, careful dynamic intraoperative assessment of patellar tracking, and, if necessary, the achievement of an adequate lateral release. PMID:25606506

  3. Minimally invasive reconstruction of the medial patellofemoral ligament using quadriceps tendon.

    PubMed

    Fink, Christian; Veselko, Matjaz; Herbort, Mirco; Hoser, Christian

    2014-06-01

    Reconstruction of the medial patellofemoral ligament (MPFL) for the treatment of patellar instability has received increased attention over the past few years. Most operative techniques use hamstring grafts fixed with bone tunnels and/or anchors on the patella. Despite good clinical results using these techniques, complications such as implant breakage, patellar fractures through bone tunnels, and loss of knee motion have occurred. We present a minimally invasive technique for MPFL reconstruction using a strip of quadriceps tendon. With the use of specially designed instruments, the graft is harvested through a 3-cm transverse incision at the proximal pole of the patella. The tendon strip is then dissected distally on the patella, left attached, and diverged 90° medially underneath the medial prepatellar tissue. The graft is fixed on the femur in 20° of knee flexion in a bone tunnel with a bioabsorbable interference screw (adults) or a bone anchor (children). We think that this technique presents a valuable alternative to common hamstring techniques for primary MPFL reconstruction in children and adults, as well as for MPFL revision surgery. PMID:25126496

  4. [MRI after patellar dislocation: assessment of risk factors and injury to the joint].

    PubMed

    Diederichs, G; Scheffler, S

    2013-07-01

    Patellar dislocation is the lateral displacement of the patella from the femoral trochlea. Affected individuals typically have underlying anatomic risk factors of variable magnitude, which, in conjunction with leg rotation, cause the event. Magnetic resonance imaging (MRI) permits straightforward diagnosis of the typical features of recent patellar dislocation: contusion edema of the inferomedial patella and the lateral femoral condyle as well as rupture of the medial patellofemoral ligament. In case of concomitant osteochondral injury, early surgical refixation may be indicated, depending on the size. After a first dislocation, which can damage the capsuloligamentous stabilizers, subjects may sustain further dislocations or even develop chronic patellofemoral instability, depending on the presence and severity of anatomic variants. A wide range of conservative and surgical treatments are available. While a first patellar dislocation is often treated conservatively, surgical strategies after a second dislocation depend on the pattern of injury and the severity of underlying anatomic risk factors. The most relevant predisposing variants are trochlear dysplasia, patella alta, and an abnormal tibial tubercle to trochlear groove distance (TT-TG). The radiologist's report should give a quantitative estimate of both the injuries resulting from dislocation and the underlying anatomic risk factors. An accurate characterization of the individual pathomechanism is crucial for tailoring treatment. PMID:23494506

  5. Patellar instability.

    PubMed

    Koh, Jason L; Stewart, Cory

    2014-07-01

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

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

    PubMed

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

    1999-02-01

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

  7. sEMG during Whole-Body Vibration Contains Motion Artifacts and Reflex Activity

    PubMed Central

    Lienhard, Karin; Cabasson, Aline; Meste, Olivier; Colson, Serge S.

    2015-01-01

    The purpose of this study was to determine whether the excessive spikes observed in the surface electromyography (sEMG) spectrum recorded during whole-body vibration (WBV) exercises contain motion artifacts and/or reflex activity. The occurrence of motion artifacts was tested by electrical recordings of the patella. The involvement of reflex activity was investigated by analyzing the magnitude of the isolated spikes during changes in voluntary background muscle activity. Eighteen physically active volunteers performed static squats while the sEMG was measured of five lower limb muscles during vertical WBV using no load and an additional load of 33 kg. In order to record motion artifacts during WBV, a pair of electrodes was positioned on the patella with several layers of tape between skin and electrodes. Spectral analysis of the patella signal revealed recordings of motion artifacts as high peaks at the vibration frequency (fundamental) and marginal peaks at the multiple harmonics were observed. For the sEMG recordings, the root mean square of the spikes increased with increasing additional loads (p < 0.05), and was significantly correlated to the sEMG signal without the spikes of the respective muscle (r range: 0.54 - 0.92, p < 0.05). This finding indicates that reflex activity might be contained in the isolated spikes, as identical behavior has been found for stretch reflex responses evoked during direct vibration. In conclusion, the spikes visible in the sEMG spectrum during WBV exercises contain motion artifacts and possibly reflex activity. Key points The spikes observed in the sEMG spectrum during WBV exercises contain motion artifacts and possibly reflex activity The motion artifacts are more pronounced in the first spike than the following spikes in the sEMG spectrum Reflex activity during WBV exercises is enhanced with an additional load of approximately 50% of the body mass PMID:25729290

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

    PubMed

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

    2015-01-01

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

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

    PubMed Central

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

    2014-01-01

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

  10. Dynamic measurement of patellofemoral kinematics and contact pressure after lateral retinacular release: an in vitro study.

    PubMed

    Ostermeier, Sven; Holst, Marc; Hurschler, Christof; Windhagen, Henning; Stukenborg-Colsman, Christina

    2007-05-01

    The purpose of this study was to investigate the influence of lateral retinacular release and medial and lateral retinacular deficiency on patellofemoral position and retropatellar contact pressure. Human knee specimens (n = 8, mean age = 65 SD 7 years, all male) were tested in a kinematic knee-simulating machine. During simulation of an isokinetic knee extension cycle from 120 degrees to full extension, a hydraulic cylinder applied sufficient force to the quadriceps tendon to produce an extension moment of 31 Nm. The position of the patella was measured using an ultrasound based motion analysis system (CMS 100, Zebris). The amount of patellofemoral contact pressure and its pressure distribution was measured using a pressure sensitive film (Tekscan, Boston). Patellar position and contact pressure were first investigated in intact knee conditions, after a lateral retinacular release and a release of the medial and lateral retinaculum. After lateral retinacular release the patella continuously moved from a significant medialised position at flexion (P = 0.01) to a lateralised position (P = 0.02) at full knee extension compared to intact conditions, the centre of patellofemoral contact pressure was significantly medialised (0.04) between 120 degrees and 60 degrees knee flexion. Patellofemoral contact pressure did not change significantly. In the deficient knee conditions the patella moved on a significant lateralised track (P = 0.04) through the entire extension cycle with a lateralised centre of patellofemoral pressure (P = 0.04) with a trend (P = 0.08) towards increased patellofemoral pressure. The results suggest that lateral retinacular release did not inevitably stabilise or medialise patellar tracking through the entire knee extension cycle, but could decrease pressure on the lateral patellar facet in knee flexion. Therefore lateral retinacular release should be considered carefully in cases of patellar instability. PMID:17225178

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

    PubMed

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

    2014-01-01

    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

  12. Molecular Structure of Ascidiacyclamide benzene solvate

    NSDL National Science Digital Library

    2003-04-09

    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.

  13. 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

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

    2011-01-01

    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

  14. Patellar resurfacing in total knee arthroplasty for osteoarthritis: a meta-analysis

    Microsoft Academic Search

    Yonghui FuGuangbin; Guangbin Wang; Qin Fu

    Purpose  Whether to resurface the patella during a primary total knee arthroplasty remains a controversial issue. The aim of this study\\u000a was to determine the advantages and disadvantages of patellar resurfacing during total knee arthroplasty for osteoarthritis\\u000a through an evaluation of the current literature.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  A meta-analysis of randomized controlled trials comparing patellar resurfacing with nonresurfacing during total knee arthroplasties\\u000a was performed.

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

    PubMed Central

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

    2014-01-01

    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. PMID:25061385

  16. Inhibition of the spider heartbeat by gravity and vibration

    NASA Technical Reports Server (NTRS)

    Finck, A.

    1984-01-01

    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.

  17. MPFL reconstruction: technique and results.

    PubMed

    Reagan, Jeffrey; Kullar, Raj; Burks, Robert

    2015-01-01

    Patellar instability is a common problem, and medial patellofemoral ligament (MPFL) injury is inherent with traumatic patellar dislocations. Initial nonoperative management is focused on reconditioning and strengthening the dynamic stabilizers of the patella. For those patients who progress to recurrent instability, further investigation into the predisposing factors is required. MPFL reconstruction is indicated in patients with recurrent instability and insufficient medial restraint due to MPFL injury. A technique of MPFL reconstruction is outlined. This procedure may also be performed in combination with other realignment procedures. PMID:25435045

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

    PubMed

    Saper, Michael G; Shneider, David A

    2014-07-01

    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

  19. Lateral Patellofemoral Ligament Reconstruction Using a Quadriceps Tendon Graft.

    PubMed

    Saper, Michael G; Shneider, David A

    2014-08-01

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

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

    SciTech Connect

    Sty, J.; Simons, G.

    1982-05-01

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

  1. “A 40-year-old female with painless, slow growing prepatellar mass”?

    PubMed Central

    Arora, Sumit; Batra, Sahil; Rao, Seema; Maini, Lalit; Gautam, V.K.

    2014-01-01

    A 40-year-old woman from India presented with a mass in the front of her left knee which had been present for 8 months. Local examination revealed a globular mass of approximate size 5 cm × 4 cm × 4 cm in front of the lower pole of left patella. The patient was investigated with imaging studies and laboratory tests. Plain radiograph of the chest was normal. In addition, contrast enhanced Magnetic Resonance Imaging (MRI) of the left knee was performed. Based on the history, physical examination, laboratory and imaging studies, what is the differential diagnosis?

  2. Biology and augmentation of tendon-bone insertion repair

    PubMed Central

    2010-01-01

    Surgical reattachment of tendon and bone such as in rotator cuff repair, patellar-patella tendon repair and anterior cruciate ligament (ACL) reconstruction often fails due to the failure of regeneration of the specialized tissue ("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. PMID:20727196

  3. Effect of cervicolabyrinthine impulsation on the spinal reflex apparatus

    NASA Technical Reports Server (NTRS)

    Yarotskiy, A. I.

    1980-01-01

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

  4. Successful management of bilateral patellar tendon rupture in a dog.

    PubMed

    Shipov, A; Shahar, R; Joseph, R; Milgram, J

    2008-01-01

    A seven-year-old, 41 kg, intact, cross breed dog, was presented with a history of bilateral hind limb lameness after falling from a height of 1 m. Clinical and radiographic findings were consistent with bilateral patellar tendon rupture. Surgical repair was performed bilaterally. The tendons were sutured primarily, and an internal splint of nylon leader was added. Good apposition of the severed tendon ends had been achieved intraoperatively; however, post operative radiographs showed supra-trochlear displacement of both patellae. The casts used to immobilize the stifle joints slipped distally and three days post operatively the tendon repair had broken down, bilaterally. Revision surgery was undertaken and the tendons were re-sutured. Nylon leader was placed through holes that had been drilled in the patellae and tibiae. The stifle joints were immobilized with type I external skeletal fixators (ESFs). Both freeform polymethylmethacrylate (PMMA) connecting bars were found to be broken at the level of the stifle joints two days later, without any disruption of the primary tendon repair. Each connecting bar was replaced with two connecting bars of PMMA reinforced with 3 mm steel wire. The dog was fully weight-bearing with a reduced range of motion in flexion immediately after removal of the ESFs at six weeks and was still sound 18 months post-operatively. Primary tendon repair in combination with adequate immobilization allowed for an excellent outcome in a complicated bilateral pathology. PMID:18545725

  5. Arthroscopic Quadriceps Tendon Repair: Two Case Reports

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2014-01-01

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

  7. 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)

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

    2014-11-01

    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.

  8. A minimally invasive medial patellofemoral ligament arthroscopic reconstruction.

    PubMed

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

    2014-02-01

    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

  9. Periprosthetic Fractures Following Total Knee Arthroplasty

    PubMed Central

    Kim, Nam Ki

    2015-01-01

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

  10. Sectioning the medial patellofemoral ligament alters patellofemoral joint kinematics and contact mechanics.

    PubMed

    Stephen, Joanna M; Kader, Deiary; Lumpaopong, Punyawan; Deehan, David J; Amis, Andrew A

    2013-09-01

    Medial patellofemoral ligament (MPFL) disruption may alter patellofemoral joint (PFJ) kinematics and contact mechanics, potentially causing pain and joint degeneration. In this controlled laboratory study, we investigated the hypothesis that MPFL transection would change patellar tracking and PFJ contact pressures and increase the distance between the attachment points of the MPFL. Eight fresh frozen dissected cadaveric knees were mounted in a rig with the quadriceps and ITB loaded to 205 N. An optical tracking system measured joint kinematics, and pressure sensitive film between the patella and trochlea measured PFJ contact pressures. Length patterns of the distance between the femoral and patellar attachments of the MPFL were measured using a suture led to a linear displacement transducer. Measurements were repeated with the MPFL intact and following MPFL transection. A significant increase in the distance between the patellar and femoral MPFL attachment points was noted following transection (p < 0.05). MPFL transection resulted in significantly increased lateral translation and lateral tilt of the patella in early flexion (p < 0.05). Peak and mean medial PFJ contact pressures were significantly reduced and peak lateral contact pressures significantly elevated in early knee flexion following MPFL transection (p < 0.05). MPFL transection resulted in significant alterations to PFJ tracking and contact pressures, which may affect articular cartilage health. PMID:23629829

  11. 18S ribosomal DNA sequences provide insight into the phylogeny of patellogastropod limpets (Mollusca: Gastropoda).

    PubMed

    Yoon, Sook Hee; Kim, Won

    2007-02-28

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

  12. Periprosthetic fractures following total knee arthroplasty.

    PubMed

    Yoo, Jae Doo; Kim, Nam Ki

    2015-03-01

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

  13. Arthroscopic findings associated with the unstable ankle.

    PubMed

    Komenda, G A; Ferkel, R D

    1999-11-01

    Before lateral ankle stabilization, arthroscopic surgery was performed on 54 patients (55 ankles) with chronic ankle instability. All patient charts, x-rays, operative reports, and surgical videotapes were reviewed. A detailed questionnaire was answered by all patients. The study population included 31 males and 23 females, with a mean age of 31 years (range, 14-64 years). The right ankle was involved in 64% of cases. Average follow-up was 9.6 months. Arthroscopic surgery was performed using small joint instrumentation including 30 degrees and 70 degrees 2.7-mm arthroscopes and a 30 degrees 1.9-mm arthroscope. At surgery, 51 ankles (93%) had intra-articular abnormalities including loose bodies (12), synovitis (38), osteochondral lesions of the talus (9), ossicles (14), osteophytes (6), adhesions (8), and chondromalacia (12). The most common arthroscopic procedures were synovectomy, removal of loose bodies and ossicles, excision and drilling of osteochondral lesions, debridement of the lateral gutter, excision of osteophytes, and removal of adhesions and scar tissue. There was a 25% incidence of chondral injuries, which differs considerably from the results of Taga et al., who found chondral injuries in 95% of ankles with lateral instability. Overall, there were excellent or good results in 96% of ankles. The incidence of excellent results was lower in the worker's compensation patients because of a greater incidence of complaints of pain with activity. There was no correlation between the presence of osteochondral lesions or amount of talar tilt and results. PMID:10582846

  14. The efficacy of combined cryotherapy and compression compared with cryotherapy alone following anterior cruciate ligament reconstruction.

    PubMed

    Waterman, Brian; Walker, John J; Swaims, Chad; Shortt, Michael; Todd, Michael S; Machen, Shaun M; Owens, Brett D

    2012-05-01

    While cryotherapy has been shown to decrease postoperative pain after anterior cruciate ligament (ACL) reconstruction, less is known of the effects of combined cryotherapy and compression. The goal of this study was to compare subjective and objective patient outcomes following ACL reconstruction with combined compression and cryotherapy compared with traditional ice therapy alone. Patients undergoing ACL reconstruction were randomized to cryotherapy/compression device (group 1) or a standardized ice pack (group 2). Both groups were instructed to use the ice or cryotherapy/compression device three times per day and return to the clinic at 1, 2, and 6 weeks postoperatively. Patient-derived outcome measurements used in this study consisted of the visual analog scale (VAS), the Lysholm knee score, Short Form-36 (SF-36), and single assessment numerical evaluation (SANE). Circumferential measurements of the knee at three locations (1 cm proximal to patella, mid-patella, and 1 cm distal to patella) were also obtained as a measure of postoperative edema. Narcotic medication use was recorded by questionnaire. The primary outcome measure (VAS) was significantly different among groups in the preoperative measurement, despite similarities in group demographics. Baseline VAS for group 1 was 54.9 compared with group 2 at 35.6 (p = 0.01). By 6 weeks, this had lowered to 28.1 and 40.3, respectively, resulting in a significant 27-point decrease in mean VAS for group 1 (p < 0.0001). However, the small increase in VAS for group 2 was not significant (p = 0.34). No significant differences were noted for the Lysholm, SF-36, or SANE scores either between groups or time points. Furthermore, no significant differences were noted for any of the circumferential measurements either between groups or time points. Of all patients, 83% of group 1 discontinued narcotic use by 6 weeks, compared with only 28% of group 2 (p = 0.0008). The use of combined cryotherapy and compression in the postoperative period after ACL reconstruction results in improved, short-term pain relief and a greater likelihood of independence from narcotic use compared with cryotherapy alone. PMID:22928433

  15. [Leishmaniasis with multiple cutaneous nodules].

    PubMed

    Stosiek, N; Bogdan, C; Solbach, W; Hornstein, O P

    1992-11-13

    Six weeks after a holiday trip to Yugoslavia, a previously well 48-year-old man developed a reddish-livid, firm nodule, 0.5 cm in diameter, on the proximal joint of the right thumb. A similar nodule appeared nearby, as well as over the left patella. Eleven additional nodules occurred over the next 4 months. His general health remained good and physical examination merely noted the liver edge palpable 3 cm below the costal margin. The histology of one of the nodules showed a tuberculoid, plasma-rich inflammatory reaction reminiscent of leishmaniasis or brucellosis. No organisms were seen. Immunohistochemistry of a frozen section demonstrated Leishmania-associated antigens, and the Western-blot test was characteristic for leishmaniasis. No systemic treatment was undertaken because of likely alcoholic toxic liver damage. On local treatment with paromomycin-containing ointment the cutaneous nodules healed without scar within 3 months. PMID:1425295

  16. Bone Ingrowth in Well-Fixed Retrieved Porous Tantalum Implants

    PubMed Central

    Hanzlik, Josa A.; Day, Judd S.

    2013-01-01

    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. PMID:23518432

  17. The use of rapid prototyped implants to simulate knee joint abnormalities for in vitro testing: a validation study with replica implants of the native trochlea.

    PubMed

    Van Haver, Annemieke; De Roo, Karel; De Beule, Matthieu; Van Cauter, Sofie; Labey, Luc; De Baets, Patrick; Claessens, Tom; Verdonk, Peter

    2014-08-01

    To investigate the biomechanical effect of skeletal knee joint abnormalities, the authors propose to implant pathologically shaped rapid prototyped implants in cadaver knee specimens. This new method was validated by replacing the native trochlea by a replica implant on four cadaver knees with the aid of cadaver-specific guiding instruments. The accuracy of the guiding instruments was assessed by measuring the rotational errors of the cutting planes (on average 3.01° in extension and 1.18° in external/internal rotation). During a squat and open chain simulation, the patella showed small differences in its articulation with the native trochlea and the replica trochlea, which could partially be explained by the rotational errors of the implants. This study concludes that this method is valid to investigate the effect of knee joint abnormalities with a replica implant as a control condition to account for the influence of material properties and rotational errors of the implant. PMID:25205750

  18. Long-term response after 6-year treatment with anakinra and onset of focal bone erosion in neonatal-onset multisystem inflammatory disease (NOMID/CINCA).

    PubMed

    Rigante, Donato; Leone, Antonio; Marrocco, Raffaella; Laino, Maria Elena; Stabile, Achille

    2011-12-01

    The exact elucidation of skeletal and cartilagineous involvement in neonatal-onset multisystem inflammatory disease (NOMID) is still poorly known, and there are few data providing the long-term response to treatment with the available interleukin-1 inhibitors. We present here a 13-year-old boy with NOMID treated with anakinra and low-dose methylprednisolone since he was 7 years old for an overall period of 6 years. Every clinical manifestation was highly responsive to interleukin-1 blockade, with the exception of his bone abnormalities. At the comparison of radiography and magnetic resonance imaging of his knees made respectively at 7 and 13 years, we noticed a bone erosion on the posterior surface of the patella combined with the progression of distal femoral overgrowth and endosteal thinning of both meta-epiphyses. This report must encourage clinicians in a precocious institution of interleukin-1 antagonists to thwart the occurrence of irreversible bone changes. PMID:21240490

  19. Biomechanical consequences of patellar component medialization in total knee arthroplasty.

    PubMed

    Anglin, Carolyn; Brimacombe, Jill M; Wilson, David R; Masri, Bassam A; Greidanus, Nelson V; Tonetti, Jérôme; Hodgson, Antony J

    2010-08-01

    The optimal amount of patellar component medialization in knee arthroplasty is unknown. We measured the impact, on patellofemoral kinematics and contact force distribution, of 0.0-, 2.5-, and 5.0-mm patellar component medialization in 7 cadaveric specimens implanted with knee arthroplasty components. The knees were flexed dynamically in a weight-bearing rig. Medialization led to lateral shift of the patellar bone, slight medial shift of the patellar component in the femoral groove, lateral tilt of the patella, reduced patellofemoral contact force in later flexion, and lateral shift of the center of pressure in early flexion. Effects on shift and tilt were proportional to the amount of medialization. As a result of this investigation, we recommend medializing the patellar component slightly-on the order of 2.5 mm. PMID:19643568

  20. Injury risk management plan for volleyball athletes.

    PubMed

    James, Lachlan P; Kelly, Vincent G; Beckman, Emma M

    2014-09-01

    Volleyball is an increasingly popular team sport. As with any competitive sport, there is an inherent risk of injury that must be recognized and collaboratively managed. This article provides a practical approach to the management of volleyball injuries within a team or organization. A brief review of the epidemiological data is presented which establishes (i) ankle sprain, (ii) shoulder overuse injury, (iii) patella tendinopathy, and (iv) anterior cruciate ligament injury as the primary injuries to address amongst these athletes. The interaction of modifiable and non-modifiable risk factors for these injuries are used to classify athletes into high-, medium- and low-risk groups. Targeted training interventions are suggested, based upon the risk level of the athlete, to minimize the occurrence of these injuries. Practical methods for integrating these activities into a training plan are also discussed. PMID:24849543

  1. Anterior cruciate ligament reconstruction best practice: A review of graft choice.

    PubMed

    Shaerf, Daniel A; Pastides, Philip S; Sarraf, Khaled M; Willis-Owen, Charles A

    2014-01-18

    There is much literature about differing grafts used in anterior cruciate ligament (ACL) reconstruction. Much of this is of poor quality and of a low evidence base. We review and summarise the literature looking at the four main classes of grafts used in ACL reconstruction; bone-patella tendon-bone, hamstrings, allograft and synthetic grafts. Each graft has the evidence for its use reviewed and then compared, where possible, to the others. We conclude that although there is no clear "best" graft, there are clear differences between the differing graft choices. Surgeon's need to be aware of the evidence behind these differences, in order to have appropriate discussions with their patients, so as to come to an informed choice of graft type to best suit each individual patient and their requirements. PMID:24649411

  2. Saphenous neuropathy in a patient with low back pain

    PubMed Central

    2010-01-01

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

  3. Three Dimensional CT-based Virtual Patellar Resection in Female Patients Undergoing Total Knee Replacement: A Comparison between Tendon and Subchondral Method

    PubMed Central

    Park, Do Young; Ji, Hyung-Min; Kwak, Kyu-Sung; Nair, Surej Gopinathan

    2012-01-01

    Background Due to its small size, variable shape, and lack of distinct anatomical landmarks, osteoarthritic knees make a precise patellar resection extremely difficult. Methods We performed virtual patellar resection with digital software using three dimensional computed tomography scans of knees from 49 patients who underwent primary total knee replacement at our hospital. We compared 2 commonly used resection methods, the tendon method (TM) and the subchondral method, to determine an ideal resection plane with respect to the symmetry and thickness of the patellar remnant. Results The TM gave a thicker resected patella, and a less oval cut surface shape, which gives better coverage for a domed prosthesis. Both methods, however, gave a symmetric resection both superior-inferiorly, as well as mediolaterally. Conclusions Although TM appears statistically better with respect to the thickness and cut surface shape, only further intraoperative studies with long-term clinical follow-up may provide us with the most appropriate patellar resection method. PMID:22949950

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

    PubMed

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

    2010-01-01

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

  5. Scorpiops ingens sp. n. and an updated key to the Scorpiops from China (Scorpiones, Euscorpiidae, Scorpiopinae)

    PubMed Central

    Yin, Shijin; Zhang, Yunfeng; Pan, Zhaohui; Li, Shaobin; Di, Zhiyong

    2015-01-01

    Abstract A new species, Scorpiops ingens sp. n., from Xizang, is described and illustrated. Scorpiops ingens sp. n. is characterized by yellow-brown color, large size (length of adults above 70.0 mm), small and dense granules on tegument, a pair of small median eyes, 17 external trichobothria (5 eb, 2 esb, 2 em, 4 est, 4 et), and 7 or 8 (usually 7) ventral trichobothria in the pedipalp patella, chela with a length/width ratio average of 2.2 in males and females, pedipalp chela fingers on adult females and males scalloped, pectinal teeth count 6–8, pectinal fulcra absent. With the description of this new species, the number of known species of Scorpiops from China is raised to 12. An updated identification key to Scorpiops from China is presented.

  6. Anatomic reconstruction of the medial patellofemoral ligament in children and adolescents using a pedicled quadriceps tendon graft.

    PubMed

    Nelitz, Manfred; Williams, Sean Robert M

    2014-04-01

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

  7. Valgus instability as a cause for recurrent lateral patellar dislocation: a new mechanism for patellofemoral instability?

    PubMed

    Hermans, Kristof; Claes, Steven; Bellemans, Johan

    2013-10-01

    An association between lateral patellar dislocation (LPD) and medial collateral ligament injury (MCL) has recently been demonstrated on MRI. The same valgus injury that disrupts the femoral MCL insertion can also cause a simultaneous MPFL tear at its femoral insertion, due to the close anatomical relationship of both ligamentous structures. Valgus laxity due to MCL-deficiency increases the Q-angle and further adversely affects patellar stability. A knee diagnosed with a severe MCL tear, should be evaluated for patellofemoral instability, as a temporary patella dislocation could have been caused by the same injury and an acute LPD indicating a tear of the MPFL can be associated with a concomitant injury of the MCL. In case of recurrent symptoms of patellofemoral instability in a MCL-deficient knee, both the MPFL and MCL should be managed operatively. An isolated MPFL reconstruction in this knee is likely to fail due to a persistent increase of the Q-angle. PMID:24350508

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

    PubMed

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

    2011-04-01

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

  9. A highly conspicuous mineralized composite photonic architecture in the translucent shell of the blue-rayed limpet

    NASA Astrophysics Data System (ADS)

    Li, Ling; Kolle, Stefan; Weaver, James C.; Ortiz, Christine; Aizenberg, Joanna; Kolle, Mathias

    2015-02-01

    Many species rely on diverse selections of entirely organic photonic structures for the manipulation of light and the display of striking colours. Here we report the discovery of a mineralized hierarchical photonic architecture embedded within the translucent shell of the blue-rayed limpet Patella pellucida. The bright colour of the limpet’s stripes originates from light interference in a periodically layered zig-zag architecture of crystallographically co-oriented calcite lamellae. Beneath the photonic multilayer, a disordered array of light-absorbing particles provides contrast for the blue colour. This unique mineralized manifestation of a synergy of two distinct optical elements at specific locations within the continuum of the limpet’s translucent protective shell ensures the vivid shine of the blue stripes, which can be perceived under water from a wide range of viewing angles. The stripes’ reflection band coincides with the spectral range of minimal light absorption in sea water, raising intriguing questions regarding their functional significance.

  10. Divergent transcriptional activities determine limb identity

    PubMed Central

    Ouimette, Jean-François; Jolin, Marisol Lavertu; L'honoré, Aurore; Gifuni, Anthony; Drouin, Jacques

    2010-01-01

    Limbs develop using a common genetic programme despite widely differing morphologies. This programme is modulated by limb-restricted regulators such as hindlimb (HL) transcription factors Pitx1 and Tbx4 and the forelimb (FL) Tbx5. Both Tbx factors have been implicated in limb patterning and growth, but their relative activities and underlying mechanisms remain unclear. In this paper, we show that Tbx4 and Tbx5 harbour conserved and divergent transcriptional regulatory domains that account for their roles in limb development. In particular, both factors share an activator domain and the ability to stimulate limb growth. However, we find that Tbx4 is the primary effector of HL identity for both skeletal and muscle development; this activity relies on a repressor domain that is inactivated by a human TBX4 small-patella syndrome mutation. We propose that limb identity is largely achieved by default in FL, whereas a specific repressor activity unique to Tbx4 determines HL identity. PMID:20975709

  11. DNA preservation in skeletal elements from the World Trade Center disaster: recommendations for mass fatality management.

    PubMed

    Mundorff, Amy Z; Bartelink, Eric J; Mar-Cash, Elaine

    2009-07-01

    The World Trade Center (WTC) victim identification effort highlights taphonomic influences on the degradation of DNA from victims of mass fatality incidents. This study uses a subset of the WTC-Human Remains Database to evaluate differential preservation of DNA by skeletal element. Recovery location, sex, and victim type (civilian, firefighter, or plane passenger) do not appear to influence DNA preservation. Results indicate that more intact elements, as well as elements encased in soft tissue, produced slightly higher identification rates than more fragmented remains. DNA identification rates by element type conform to previous findings, with higher rates generally found in denser, weight-bearing bones. However, smaller bones including patellae, metatarsals, and foot phalanges yielded rates comparable to both femora and tibiae. These elements can be easily sampled with a disposable scalpel, and thus reduce potential DNA contamination. These findings have implications for DNA sampling guidelines in future mass fatality incidents. PMID:19486445

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

    PubMed

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

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

    2011-01-01

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

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

    PubMed Central

    Kwan, Jason C.; Schmidt, Eric W.

    2013-01-01

    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. PMID:24324632

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

    PubMed Central

    van Raaij, T. M.

    2006-01-01

    We analysed 20 patients with 24 knees affected by idiopathic genu recurvatum who were treated with an anterior opening wedge osteotomy of the proximal tibia because of anterior knee pain. We managed to attain full satisfaction in 83% of the patients with a mean follow-up of 7.4 years. The mean Hospital for Special Surgery score was 90.3 (range 70.5–99.5), and the mean Knee Society score score was 94.6 (70–100) for function and 87.7 (47–100) for pain. The mean Western Ontario and McMaster University Osteoarthritis Index score for knee function was 87.5 (42–100), for stiffness 82.8 (25–100) and for pain 87.3 (55–100). Radiographs showed a significant increase in posterior tibial slope of 9.4 deg and a significant decrease of patellar height according to the Blackburne–Peel method of 0.16 postoperatively. No cases of non-union, deep infection or compartment syndrome were seen. No osteoarthritic changes in the lateral or medial knee compartment were found with more than 5 years’ follow-up in 16 patients with 19 affected knees. Three out of the four dissatisfied patients had a patella infera which led to patellofemoral complaints. One patient in the study underwent a secondary superior displacement of the patella with excellent results. We conclude that in a selected group of patients with idiopathic genu recurvatum and anterior knee pain an opening wedge osteotomy of the proximal tibia can be beneficial. PMID:16521014

  17. Load-Dependent Variations in Knee Kinematics Measured with Dynamic MRI

    PubMed Central

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

    2013-01-01

    Subtle changes in knee kinematics may substantially alter cartilage contact patterns and moment generating capacities of soft tissues. The objective of this study was to use dynamic magnetic resonance imaging (MRI) to measure the influence of the timing of quadriceps loading on in vivo tibiofemoral and patellofemoral kinematics. We tested the hypothesis that load-dependent changes in knee kinematics would alter both the finite helical axis of the tibiofemoral joint and the moment arm of the patellar tendon. Eight healthy young adults were positioned supine in a MRI-compatible device that could impose either elastic or inertial loads on the lower leg in response to cyclic knee flexion-extension. The elastic loading condition induced concentric quadriceps contractions with knee extension, while an inertial loading condition induced eccentric quadriceps contractions with knee flexion. Peak internal knee extension moments ranged from 23–33 Nm, which is comparable to loadings seen in normal walking. We found that anterior tibia translation, superior patella glide, and anterior patella translation were reduced by an average of 5.1 mm, 5.8 mm and 2.9 mm when quadriceps loading coincided with knee flexion rather than knee extension. These kinematic variations induced a distal shift in the finite helical axis of the tibiofemoral joint and a reduction in the patellar tendon moment arm. We conclude that it may be important to consider such load-dependent changes in knee kinematics when using models to ascertain soft tissue and cartilage loading during functional tasks such as gait. PMID:23806309

  18. Clinical Outcomes of Patellar Chondral Lesions Treated with Juvenile Particulated Cartilage Allografts

    PubMed Central

    Buckwalter, JA; Bowman, GN; Albright, JP; Wolf, BR; Bollier, M

    2014-01-01

    Background Juvenile particulated cartilage allograft (DeNovo NT®, Zimmer, Warsaw, IN) transplantation is a relatively new technology for the treatment of high-grade cartilage lesions. To date there is limited literature demonstrating its effectiveness and safety. The present study specifically looks at the short-term efficacy of DeNovo NT® allograft for symptomatic high-grade cartilage lesions of the patella. Clinical outcomes and complications are reported. Methods Seventeen cases of DeNovo NT® allograft transplantation at our institution were retrospectively reviewed from 2010 to 2013. Thirteen patients had the procedure performed for patellar lesions and are included in the present study. A chart review was performed to record demographic data, surgical technique, and complications. In addition, we analyzed preoperative and postoperative KOOS outcome scores. Results The mean age was 22.5 years (range, 14 - 34), with 3 males and 10 females. Mean follow-up was 8.2 months (range, 0.67 - 32.7). Six of the patients had concomitant anteromedialization of the tibial tubercle. DeNovo NT® allograft transplantation resulted in improvement for each outcome measure used. Overall KOOS score significantly improved from a mean of 58.4+15.7 to 69.2+18.6 (P = 0.04). Improvement in KOOS subscales of pain, ADL, and symptoms all approached but did not reach statistical significance (P values between 0.05 and 0.10). There were no infections or hardware complications. Conclusions This series demonstrates that DeNovo NT® allograft transplantation for symptomatic high-grade cartilage lesions of the patella results in pain relief and improved outcomes in the short term. Further studies are needed to better evaluate this new technology. Level of Evidence: Level IV, therapeutic case series PMID:25328458

  19. How to treat knee ligament injuries?

    PubMed

    Järvinen, M; Kannus, P; Johnson, R J

    1991-01-01

    Indications for conservative treatment of knee ligament injuries can be established for all grade I or II sprains (partial tears), as well as isolated grade III sprains (complete tears) of the posterior cruciate ligament (PCL) and medial collateral ligament (MCL). These injuries should be treated with immediate mobilization. Only in isolated partial anterior cruciate ligament (ACL) tears without a positive pivot shift phenomenon is conservative treatment justified. However, many of these injuries may require operative reconstruction later. In complete ACL tears the surgical treatment consists of primary reconstruction or augmented primary repair. Today, the middle third of the patella tendon with the bone blocks is regarded as the "gold standard" for augmented repairs and late reconstructions. For the present, there is no place for synthetic prostheses in the treatment of an acute ACL rupture. Allograft replacement of the ACL must now be considered an experimental procedure. In the reconstruction of the PCL the above mentioned patella tendon graft is also preferable. Lateral collateral ligament (LCL) tears, especially if they are combined with ruptures of posterolateral ligament complex, should be repaired immediately after the injury. In these injuries late reconstructions are difficult and the results are poor. Conservative treatment of partial tears and postoperative treatment of reconstructed ligaments is twofold: on the one hand, the healing tissue should be protected and on the other hand, atrophy and wasting of uninjured tissue should be avoided. Overload and stretching of the injured ligaments should be eliminated with the aid of a suitable knee brace, but early range of motion exercises of the knee are allowed immediately.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1897879

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  2. Does form follow function in trochlear dysplasia? Case report of patellar instability in a below-knee amputee?

    PubMed Central

    Salzmann, Gian M.; Dovi-Akue, David; Wätzig, Klaus; Südkamp, Norbert P.; Niemeyer, Philipp

    2013-01-01

    INTRODUCTION Patellar instability can be considered as a rapidly increasing musculoskeletal subject of interest. It is now well accepted that multiple factors can produce this pathological condition, isolated, but more often in concert. One major static compound is found to be in trochlear dysplasia. It has been stated that the form of the trochlear surface is primary and genetically bilaterally determined already before use. According to these data, recurrent dislocation of the patella has been described as a hereditary disease with autosomal dominant transmission. Against this assumption, we hypothesize that subjects may devise a flattened trochlea when there is no significant biomechanical interplay and thus input between the patella and the distal femur during developmental growth; according to the assumption form follows function. PRESENTATION OF CASE In this context, we report the case of a 16-year old male who previously suffered from a traumatic patellar dislocation during sporting activity in his below-knee amputated lower extremity, which occured at age of 18 months. The patient was allocated with a high-grade trochlear dysplasia in his previously amputated limb, while presenting a normal trochlear shape at his healthy contralateral leg. DISCUSSION This rare case therefore reprents the history of an individuum with identic genetic predisposition and different biomechanical influences during childhood, which makes it of high clinical interest. In presence of trochlear dysplasia the patient suffered reluxation and concurrent subjective instability on the lower limb affected by the amputation which was treated with medial patellofemoral ligament (MPFL) plasty using an autologous gracilis graft. CONCLUSION One has to consider that a certain biomechanical input may be required for the development of a physiologic trochlear groove. PMID:24441714

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

    PubMed

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

    2013-10-01

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

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

    PubMed

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

    2014-04-01

    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

  5. Assessment of depth and degeneration dependences of articular cartilage refractive index using optical coherence tomography in vitro.

    PubMed

    Wang, Shu-Zhe; Huang, Yan-Ping; Wang, Qing; Zheng, Yong-Ping; He, Yong-Hong

    2010-01-01

    In this study, optical coherence tomography (OCT) with an axial resolution of 15 mum was used to investigate the depth and degeneration dependences of the refractive index (RI) of articular cartilage collected from bovine patellae in vitro. Eighteen disks of articular cartilage with a diameter of 6.35 mm harvested from different patellae were successfully prepared. Each disk was cut into two halves and three horizontal cartilage slices (n = 18 x 2 x 3) with an approximately equal thickness of 0.5 mm were further prepared from each half disk. The cartilage slices were digested by two different enzymes, collagenase and trypsin, to disturb collagen fibrils and proteoglycans, respectively. The samples were submerged in the physiological saline and tested using OCT before and after the enzyme digestion and the RI for each specimen was calculated. The RI of articular cartilage from the superficial to deep regions was 1.361 +/- 0.032 (mean +/- SD), 1.338 +/- 0.036, and 1.371 +/- 0.041 for normal specimens; 1.357 +/- 0.036, 1.331 +/- 0.030, and 1.392 +/- 0.037 for trypsin digested specimens; and 1.361 +/- 0.032, 1.336 +/- 0.048, and 1.376 +/- 0.043 for those treated by collagenase, respectively. Two-factor repeated measure ANOVA revealed that for all the three groups of specimens, the RI in different depths was significantly different (p < 0.05). However, we found that the trypsin and collagenase treatments did not exert a significant effect on the RI (p > 0.05). The results suggested that the depth dependence of articular cartilage should be taken into account when OCT is used for related measurement. PMID:20067415

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

    PubMed Central

    Moore, A.; Burris, D.L.

    2013-01-01

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

  7. Anterior instability in the throwing shoulder.

    PubMed

    Savoie, Felix H; O'Brien, Michael J

    2014-06-01

    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

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

    PubMed

    Moore, A C; Burris, D L

    2014-01-01

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

  9. Correlation of Radiographic Patellofemoral Indices with Tibial Tubercle Transfer Distance in Fulkerson Osteotomy Pl

    PubMed Central

    Edwards, Alan; Larson, Evan; Albright, John

    2014-01-01

    Background A laterally tracking patella is commonly seen in patients with chronic recurrent lateral patellar dislocations. Clinical appearance of the J-sign occurs when the patella is congruent with the trochlear groove in flexion and moves over the lateral border of the femoral condyle as the lower leg reaches complete extension. A Fulkerson osteotomy procedure corrects this maltracking of the patella by medially transferring the tibial tubercle. There are many radiographic patellofemoral indices that can be used describe this incongruence about the patelloformal joint. The current literature supports the use of the tibial tubercle-trochlear groove (TT- TG) index in determining the appropriate amount medialization of the extensor mechanism. However there is little agreement in how far to transfer the tibial tubercle to best achieve maximum patello- femoral congruency. It is the senior author's belief that lateral patellar edge (LPE) measure on voluntary quadriceps active hyperextension MRI scan has the strongest correlation with final operative tibial tubercle transfer distance needed to achieve maximum patellofemoral congruency. Purpose The purpose of this study was to show that the voluntary quadriceps active hyperextension MRI measurement of lateral patellar edge (LPE) has the strongest correlation with tibial tubercle transfer distance required to achieve maxium patellofemoral congruency intraoperatively in the terminal 30 degrees of active knee extension compared to all other patellofemoral indices measured on axial MRI scans with the knee in voluntary active knee extension to 30 degrees of flexion, passive full extension, and voluntary quadriceps active hyperextension. Study Design Retrospective case series via review of the electronic medical record. Methods Forty-three Fulkerson osteotomy patient charts were reviewed retrospectively. Three different pre-operative axial MRI views were then examined and measured for Tibial Tubercle- Troch-lear Groove (tt-tg), lateral patellar edge (LPE), bisect offset (BSO), and lateral patellar displacement (LPD). Each patient had three MRIs: one with the knee resting in extension, one in voluntary quadriceps active hyperextension, and one in voluntary quadriceps active 30 degree flexion. Statistics were then calculated using Statistical Package for the Social Sciences (SPSS) (IBM corp). Results Tibial tubercle transfer distances required to achieve congruency intraoperatively correlated moderately (0.500-0.300) and were statistically significant (alpha. 050) for passive extension MRI measurement of TT-TG (Pearson- 0.403, alpha 0.010) and LPD (Pearson. 362, alpha 0.022); voluntary quadriceps active hyperextension TT-TG (Pearson 0.487, alpha, 0.001); voluntary quadriceps active flexion TT-TG (Pearson. 548, alpha< 0.001), LPE (Pearson. 332, alpha 0.029), and LPD (Pearson 0.446 alpha. 003). Conclusion The hypothesis that voluntary quadriceps active hyperextension MRI LPE measurement best correlated with tibial tubercle transfer distance was incorrect. The data collected showed correlation and statistical significance for voluntary quadriceps active flexion LPE with required tibal tubercle transfer distance (Pearson 0.34, alpha 0.026). The MRI measurement that best correlated with tibial tubercle transfer distance was voluntary quadriceps active flexion measure of TT-TG (Pearson. 556, alpha< 0.001). PMID:25328455

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

    PubMed

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

    2013-09-01

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

  11. [Use of extracorporeal shockwave therapy (ESWT)in sports orthopedics].

    PubMed

    Steinacker, T; Steuer, M

    2001-06-01

    From 11/97 to 10/99 409 patients have been treated with the extracorporal shockwave therapy (ESWT) in the sport orthopaedic ambulance. An ultrasound controlled treatment was applied in the low and middle energy range, using energy densities of 0.09 to 0.36 mJ/mm2. The ESWT came into application as an operation avoiding procedure after exhausting the conventional conservative therapy measures. Among the 409 patients, 65 persons were competitive sportsmen. Besides the established indications for the application of the shock wave therapy, this method also has been applied with specific sport orthopaedic indications like achillodynia, patella-top-syndrome, medial shin-syndrome, morbus Schlatter or tendinosis of the shoulder. The results were collected three months after the application of the ESWT using a standardized questionnaire. The performed examination exhibits that for conservatively treated tendinoses of the competitive sportsmen, similarly good therapy results concerning the application of ESWT can be reached compared with the classical orthopaedic shockwave therapy. Therefore, for the treatment of a tendinosis, a shock wave therapy should always be taken into account to avoid long exercise and competition breaks due to operative interventions. PMID:11475621

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

    PubMed Central

    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

    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. PMID:17823382

  13. Lower limb joint replacement in rheumatoid arthritis

    PubMed Central

    2012-01-01

    Introduction There is limited literature regarding the peri-operative and surgical management of patients with rheumatoid disease undergoing lower limb arthroplasty. This review article summarises factors involved in the peri-operative management of major lower limb arthroplasty surgery for patients with rheumatoid arthritis. Methods We performed a search of the medical literature, using the PubMed search engine (http://www.pubmed.gov). We used the following terms: ‘rheumatoid’ ‘replacement’ ‘arthroplasty’ and ‘outcome’. Findings The patient should be optimised pre-operatively using a multidisciplinary approach. The continued use of methotrexate does not increase infection risk, and aids recovery. Biologic agents should be stopped pre-operatively due the increased infection rate. Patients should be made aware of the increased risk of infection and periprosthetic fracture rates associated with their disease. The surgical sequence is commonly hip, knee and then ankle. Cemented total hip replacement (THR) and total knee replacement (TKR) have superior survival rates over uncemented components. The evidence is not clear regarding a cruciate sacrificing versus retaining in TKR, but a cruciate sacrificing component limits the risk early instability and potential revision. Patella resurfacing as part of a TKR is associated with improved outcomes. The results of total ankle replacement remain inferior to THR and TKR. RA patients achieve equivalent pain relief, but their rehabilitation is slower and their functional outcome is not as good. However, the key to managing these complicated patients is to work as part of a multidisciplinary team to optimise their outcome. PMID:22697352

  14. The young osteoarthritic knee: dilemmas in management

    PubMed Central

    2013-01-01

    As a result of increasing life expectancies, continuing physical careers, lifestyles into later life and rising obesity levels, the number of younger patients presenting with osteoarthritis (OA) of the knee is increasing. When conservative management options have been exhausted, the challenge for the orthopedic surgeon is to offer a procedure that will relieve symptoms and allow a return to a high level of function but not compromise future surgery that may be required as disease progresses or prostheses fail and require revision. We discuss the options available to this group of patients and the relative benefits and potential negative points of each. Total knee replacement (TKR) in the young patient is associated with high risk of early failure and the need for future revision surgery. After TKR, most surgeons advise limitation of sporting activities. If osteoarthritis is limited to only one compartment in the knee there may be surgical options other than TKR. Osteotomy above or below the knee may be considered and works by redirecting the load passing through the joint into the relatively unaffected compartment. A unicompartmental knee replacement (UKR) or patella-femoral joint (PFJ) replacement only replaces the articular surfaces in the affected compartment, leaving the unaffected compartments untouched with better preservation of the soft tissues. Which of these options is best for a particular patient depends upon the patient's symptoms, precise pathology, lifestyle, and expectations. PMID:23331908

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

    PubMed Central

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

    2014-01-01

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

  16. An investigation into the architecture of the vastus medialis oblique muscle in athletic and sedentary individuals: An in vivo ultrasound study.

    PubMed

    Benjafield, A J; Killingback, A; Robertson, C J; Adds, P J

    2015-03-01

    There is thought to be a relationship between the vastus medialis oblique muscle (VMO) and patellofemoral pain syndrome (PFPS), a condition that has a high prevalence in young athletic individuals. Following a suggestion that there may be a link between the architecture of the VMO and an individual's activity level, the aim of this study was to determine any differences in two measurable parameters of the VMO between two populations with widely differing activity levels. The parameters measured were VMO fiber angle and insertion ratio, which is the proportion of the medial patellar border with VMO fibers inserting onto it (%). Eighty-two knees from 26 athletic volunteers and 15 sedentary volunteers (aged 20-28 years) were assessed using ultrasound. Activity level was defined using the Tegner scoring system. The mean VMO angle (°) for the athletic group was significantly higher than for the sedentary group at 67.8° and 53.6°, respectively. There was no significant difference in insertion ratio between the athletic group, 43.0%, and the sedentary group, 39.5%. This study found that greater VMO fiber angles were seen in individuals with higher activity levels, exerting a stronger medial stabilizing force on the patella. This has important implications for the treatment of PFPS, particularly in athletic patients, which frequently focus on VMO strengthening exercises. Clin. Anat. 28:262-268, 2015. © 2014 Wiley Periodicals, Inc. PMID:25244030

  17. High elastic modulus nanoparticles: a novel tool for subfailure connective tissue matrix damage.

    PubMed

    Empson, Yvonne M; Ekwueme, Emmanuel C; Hong, Jung K; Paynter, Danielle M; Kwansa, Albert L; Brown, Chalmers; Pekkanen, Allison M; Roman, Maren; Rylander, Nichole M; Brolinson, Gunnar P; Freeman, Joseph W

    2014-09-01

    Subfailure matrix injuries such as sprains and strains account for a considerable portion of ligament and tendon pathologies. In addition to the lack of a robust biological healing response, these types of injuries are often characterized by seriously diminished matrix biomechanics. Recent work has shown nanosized particles, such as nanocarbons and nanocellulose, to be effective in modulating cell and biological matrix responses for biomedical applications. In this article, we investigate the feasibility and effect of using high stiffness nanostructures of varying size and shape as nanofillers to mechanically reinforce damaged soft tissue matrices. To this end, nanoparticles (NPs) were characterized using atomic force microscopy and dynamic light scattering techniques. Next, we used a uniaxial tensile injury model to test connective tissue (porcine skin and tendon) biomechanical response to NP injections. After injection into damaged skin and tendon specimens, the NPs, more notably nanocarbons in skin, led to an increase in elastic moduli and yield strength. Furthermore, rat primary patella tendon fibroblast cell activity evaluated using the metabolic water soluble tetrazolium salt assay showed no cytotoxicity of the NPs studied, instead after 21 days nanocellulose-treated tenocytes exhibited significantly higher cell activity when compared with nontreated control tenocytes. Dispersion of nanocarbons injected by solution into tendon tissue was investigated through histologic studies, revealing effective dispersion and infiltration in the treated region. Such results suggest that these high modulus NPs could be used as a tool for damaged connective tissue repair. PMID:24924347

  18. Patellofemoral pain syndrome in Iranian female athletes.

    PubMed

    Nejati, Parisa; Forogh, Bijan; Moeineddin, Reza; Baradaran, Hamid Reza; Nejati, Mina

    2011-01-01

    Patellofemoral pain syndrome (PFPS) is the most common overuse syndrome in athletes. It is one of the causes of anterior knee pain in athletic population who come to the sports medicine clinic. Patellofemoral pain is more common among female athletes especially adolescents and young adults. Symptoms include: persistent pain behind the patella or peripatella. Pain increases on ascending and descending stairs and squatting and prolonged sitting. The aim of this study was to evaluate the prevalence of PFPS in Iranian female athletes. 418 female athletes aged 15-35 years were examined in five sports: Soccer (190), volleyball (103), running (42), fencing (45) and rock climbing (38). The athletes who had non- traumatic onset anterior knee pain of at least 3 months that increased in descending and ascending stairs and squatting, had no other causes of anterior knee pain such as ligament instability, bursitis, meniscal injury, tendonitis and arthritis and no history of knee surgery during the one past year were diagnosed as PFPS. 26/190 (13.68 %) soccer players, 21/103(20.38 %) volleyball players, 7/42 (16.66 %) runners, 6/45(13.33 %) fencers and 10/38 (26.31%) rock climbers had patellofemoral pain. Among the 418 female athletes who were evaluated 70 had PFPS. Rock climbers were the most common athletes with PFPS followed by volleyball players and runners. PMID:21681705

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

    PubMed Central

    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

    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

  20. Osteology and radiographic anatomy of the pelvis and hind limb of healthy ring-tailed lemurs (Lemur catta).

    PubMed

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

    2014-06-01

    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

  1. Phenotype-genotype analysis of cryopyrin-associated periodic syndromes (CAPS): description of a rare non-exon 3 and a novel CIAS1 missense mutation.

    PubMed

    Jesus, Adriana A; Silva, Clovis A; Segundo, Gesmar R; Aksentijevich, Ivona; Fujihira, Erika; Watanabe, Mônica; Carneiro-Sampaio, Magda; Duarte, Alberto J S; Oliveira, João B

    2008-03-01

    We describe in this paper the phenotype-genotype analysis of a Brazilian cohort of patients with cryopyrin-associated periodic syndromes (CAPS). Patient 1 presented with an urticarial rash and recurrent fever exacerbated by cold weather, arthritis, and anterior uveitis, thus, receiving a clinical diagnosis of familial cold autoinflammatory syndrome. CIAS1 sequencing identified the T436I mutation, previously associated to a clinical phenotype of chronic infantile neurological cutaneous and articular/neonatal onset multisystem inflammatory disease. Patient 2 developed a papular exanthema with daily fever shortly after birth, frontal bossing, patellae enlargement, and cognitive and motor impairments. Sequencing identified the exceedingly rare G755R CIAS1 mutation in exon 4. Patient 3 developed skin rash and articular symptoms 6 h after birth, followed by aseptic meningitis. He was found to have the novel C148Y missense mutation in CIAS1. This report expands the spectrum of CIAS1 mutations associated to clinical disease, suggests that the same mutation can be associated with different clinical syndromes, and supports the evidence that CAPS patients should always be screened for mutations outside exon 3. PMID:18080732

  2. Improved description of the bipolar ciliate, Euplotes petzi, and definition of its basal position in the Euplotes phylogenetic tree.

    PubMed

    Di Giuseppe, Graziano; Erra, Fabrizio; Paolo Frontini, Francesco; Dini, Fernando; Vallesi, Adriana; Luporini, Pierangelo

    2014-08-01

    Data improving the characterization of the marine Euplotes species, E. petzi Wilbert and Song, 2008, were obtained from morphological, ecological and genetic analyses of Antarctic and Arctic wild-type strains. This species is identified by a minute (mean size, 46 ?m × 32 ?m) and ellipsoidal cell body which is dorsally decorated with an argyrome of the double-patella type, five dorsal kineties (of which the median one contains 8-10 dikinetids), five sharp-edged longitudinal ridges, and a right anterior spur. Ventrally, it bears 10 fronto-ventral, five transverse, two caudal and two marginal cirri, 30-35 adoral membranelles, and three inconspicuous ridges. Euplotes petzi grows well at 4 °C on green algae, does not produce cysts, undergoes mating under the genetic control of a multiple mating-type system, constitutively secretes water-borne pheromones, and behaves as a psychrophilic microorganism unable to survive at >15 °C. While the ?-tubulin gene sequence determination did not provide useful information on the E. petzi molecular phylogeny, the small subunit rRNA (SSU rRNA) gene sequence determination provided solid evidence that E. petzi clusters with E. sinicus Jiang et al., 2010a, into a clade which represents the deepest branch at the base of the Euplotes phylogentic tree. PMID:25051516

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

    NASA Technical Reports Server (NTRS)

    Acharya, Raj S.; Shackelford, Linda

    1995-01-01

    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.

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

    SciTech Connect

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

    1995-12-31

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

  5. Assessment of Lower Limb Prosthesis through Wearable Sensors and Thermography

    PubMed Central

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

    2014-01-01

    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

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

    PubMed Central

    Litscher, Gerhard; Ofner, Michael; Litscher, Daniela

    2013-01-01

    Background: Manual Khalifa therapy has been practiced in Hallein, Austria, for more than 30 years; however, there are no scientific results available on the topic. Aims: The goal of the present study was to investigate possible acute effects of Khalifa therapy on regional oxygen saturation of knee tissues in patients with completely ruptured anterior cruciate ligament. Materials and Methods: We investigated 10 male patients (mean age ± standard deviation (SD) 35.9 ± 6.1 year) using a four-channel oximeter. The sensors were applied anterolaterally and anteromedially, beside the patella, on both the injured and the healthy (control) knee. Results: The results of the controlled study showed that values of oxygen saturation on the knee with the ruptured ligament were significantly increased (P < 0.001) immediately after Khalifa therapy, whereas the values on the control knee showed insignificant increases. Baselines values of the anterolateral side of the injured knee were significantly (P < 0.001) different from those of the anterolateral side of the control knee. The same effect was present on the anteromedial side; however, with a lower degree of significance (P < 0.05). Conclusions: Khalifa therapy was clinically successful in all 10 patients. Further, investigations and analyzes are necessary to explain the underlying mechanism. PMID:23814763

  7. The Results of Adductor Magnus Tenodesis in Adolescents with Recurrent Patellar Dislocation

    PubMed Central

    Malecki, Krzysztof; Fabis, Jaroslaw; Flont, Pawel; Niedzielski, Kryspin Ryszard

    2015-01-01

    Recurrent dislocation of the patella is a common orthopaedic problem which occurs in about 44% of cases after first-time dislocation. In most cases of first-time patellar dislocation, the medial patellofemoral ligament (MPFL) becomes damaged. Between 2010 and 2012, 33 children and adolescents (39 knees) with recurrent patellar dislocation were treated with MPFL reconstruction using the adductor magnus tendon. The aim of our study is to assess the effectiveness of this surgical procedure. The outcomes were evaluated functionally (Lysholm knee scale, the Kujala Anterior Knee Pain Scale, and isokinetic examination) and radiographically (Caton index, sulcus angle, congruence angle, and patellofemoral angle). Four patients demonstrated redislocation with MPFL graft failure, despite the fact that patellar tracking was found to be normal before the injury, and the patients had not reported any symptoms. Statistically significant improvements in Lysholm and Kujala scales, in patellofemoral and congruence angle, were seen (P < 0.001). A statistically significant improvement in the peak torque of the quadriceps muscle and flexor was observed for 60°/sec and 180°/sec angular velocities (P = 0.01). Our results confirm the efficacy of MPFL reconstruction using the adductor magnus tendon in children and adolescents with recurrent patellar dislocation. PMID:25785271

  8. A highly conspicuous mineralized composite photonic architecture in the translucent shell of the blue-rayed limpet

    PubMed Central

    Li, Ling; Kolle, Stefan; Weaver, James C.; Ortiz, Christine; Aizenberg, Joanna; Kolle, Mathias

    2015-01-01

    Many species rely on diverse selections of entirely organic photonic structures for the manipulation of light and the display of striking colours. Here we report the discovery of a mineralized hierarchical photonic architecture embedded within the translucent shell of the blue-rayed limpet Patella pellucida. The bright colour of the limpet’s stripes originates from light interference in a periodically layered zig-zag architecture of crystallographically co-oriented calcite lamellae. Beneath the photonic multilayer, a disordered array of light-absorbing particles provides contrast for the blue colour. This unique mineralized manifestation of a synergy of two distinct optical elements at specific locations within the continuum of the limpet’s translucent protective shell ensures the vivid shine of the blue stripes, which can be perceived under water from a wide range of viewing angles. The stripes’ reflection band coincides with the spectral range of minimal light absorption in sea water, raising intriguing questions regarding their functional significance. PMID:25716102

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

    PubMed Central

    Clifford, Amanda M.; Harrington, Elaine

    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. PMID:24146711

  10. How reliable is MRI in diagnosing cartilaginous lesions in patients with first and recurrent lateral patellar dislocations?

    PubMed Central

    2010-01-01

    Background Lateral dislocation of the patella (LPD) leads to cartilaginous injuries, which have been reported to be associated with retropatellar complaints and the development of patellofemoral osteoarthritis. Therefore, the purpose of this study was to determine the reliability of MRI for cartilage diagnostics after a first and recurrent LPD. Methods After an average of 4.7 days following an acute LPD, 40 patients (21 with first LPDs and 19 with recurrent LPDs) underwent standardized 1.5 Tesla MRI (sagittal T1-TSE, coronal STIR-TSE, transversal fat-suppressed PD-TSE, sagittal fat-suppressed PD-TSE). MRI grading was compared to arthroscopic assessment of the cartilage. Results Sensitivities and positive predictive values for grade 3 and 4 lesions were markedly higher in the patient group with first LPDs compared to the group with recurrent LPDs. Similarly, intra- and inter-observer agreement yielded higher kappa values in patients with first LPDs compared to those with recurrent LPDs. All grade 4 lesions affecting the subchondral bone (osteochondral defects), such as a fissuring or erosion, were correctly assessed on MRI. Conclusions This study demonstrated a comparatively good diagnostic performance for MRI in the evaluation of first and recurrent LPDs, and we therefore recommend MRI for the cartilage assessment after a LPD. PMID:20602779

  11. Tourniquet-Related Iatrogenic Femoral Nerve Palsy after Knee Surgery: Case Report and Review of the Literature

    PubMed Central

    Mingo-Robinet, Juan; Castañeda-Cabrero, Carlos; Alvarez, Vicente; León Alonso-Cortés, José Miguel; Monge-Casares, Eva

    2013-01-01

    Purpose. Tourniquet-induced nerve injuries have been reported in the literature, but even if electromyography abnormalities in knee surgery are frequent, only two cases of permanent femoral nerve palsies have been reported, both after prolonged tourniquet time. We report a case of tourniquet-related permanent femoral nerve palsy after knee surgery. Case Report. We report a case of a 58-year-old woman who underwent surgical treatment of a patella fracture. Tourniquet was inflated to 310?mmHg for 45 minutes. After surgery, patient complained about paralysis of the quadriceps femoris with inability to extend the knee. Electromyography and nerve conduction study showed a severe axonal neuropathy of the left femoral nerve, without clinical remission after several months. Discussion. Even if complications are not rare, safe duration and pressure for tourniquet use remain a controversy. Nevertheless, subtle clinical lesions of the femoral nerve or even subclinical lesions only detectable by nerve conduction and EMG activity are frequent, so persistent neurologic dysfunction, even if rare, may be an underreported complication of tourniquet application. Elderly persons with muscle atrophy and flaccid, loose skin might be in risk for iatrogenic nerve injury secondary to tourniquet. PMID:24371536

  12. Common controversies in total knee replacement surgery: Current evidence

    PubMed Central

    Nikolaou, Vasileios S; Chytas, Dimitrios; Babis, George C

    2014-01-01

    Total knee replacement (TKR) is a widely used operation that has radically improved the quality of life of millions of people during the last few decades. However, some technical details, concerning the surgical procedure and the rehabilitation following total knee arthroplasty, are still a matter of a strong debate. In this review of the literature, we have included the best evidence available of the last decade, in an effort to shed light on some of the most controversial subjects related to TKR surgery. Posterior-stabilized or cruciate-retaining prosthesis? To use a tourniquet during operation or not? Do patients need continuous passive motion for their post-surgery rehabilitation? To resurface patella or not? These are some of the most controversial topics that until now have been persistent dilemmas for the orthopedic surgeon. Results of this systematic review of the literature are highly controversial. These conflicting results are an indication that larger and more well conducted high quality trials are needed in order to gain more secure answers. At the same time, it is becoming apparent that a meticulous operative technique, respecting the soft tissue envelope and knowing the principles of alignment and soft tissue balancing, are some of the parameters that might contribute more to achieving the optimal results for the patients. PMID:25232522

  13. Hip Abduction Can Prevent Posterior Edge Loading of Hip Replacements

    PubMed Central

    van Arkel, Richard J; Modenese, Luca; Phillips, Andrew TM; Jeffers, Jonathan RT

    2013-01-01

    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. PMID:23575923

  14. Lower limb entheseal morphology in the Neandertal Krapina population (Croatia, 130,000 BP).

    PubMed

    Mariotti, Valentina; Belcastro, Maria Giovanna

    2011-06-01

    Although the Neandertal locomotor system has been shown to differ from Homo sapiens, characteristics of Neandertal entheses, the skeletal attachments for muscles, tendons, ligaments and joint capsules, have never been specifically investigated. Here, we analyse lower limb entheses of the Krapina Neandertal bones (Croatia, 130,000 BP) with the aim of determining how they compare with modern humans, using a standard developed by our research group for describing modern human entheseal variability. The entheses examined are those of the gluteus maximus, iliopsoas and vastus medialis on the femur, the quadriceps tendon on the patella, and soleus on the tibia. For the entheses showing a different morphological pattern from H. sapiens, we discuss the possibility of recognising genetic versus environmental causes. Our results indicate that only the gluteus maximus enthesis (the gluteal tuberosity), falls out of the modern human range of variation. It displays morphological features that could imply histological differences from modern humans, in particular the presence of fibrocartilage. In both H. sapiens and the Krapina Neandertals, the morphological pattern of this enthesis is the same in adult and immature femurs. These results can be interpreted in light of genetic differences between the two hominins. The possibility of functional adaptations to higher levels of mechanical load during life in the Neandertals seems less likely. The particular morphology and large dimensions of the Krapina enthesis, and perhaps its fibrocartilaginous nature, could have been selected for in association with other pelvic and lower limb characteristics, even if genetic drift cannot be ruled out. PMID:21481920

  15. Do patients with chronic patellar tendinopathy have an altered somatosensory profile? A Quantitative Sensory Testing (QST) study.

    PubMed

    van Wilgen, C P; Konopka, K H; Keizer, D; Zwerver, J; Dekker, R

    2013-03-01

    The prevalence of tendinopathies in sports is high. The etiology and pain mechanisms of tendinopathies are not completely understood. Currently, little is known whether, or to which degree, somatosensory changes within the nervous system may contribute to the pain in tendinopathies. We conducted a patient controlled study in which we used the standardized QST protocol developed by the German Research Network on Neuropathic Pain. This protocol consists of seven different tests that measures 13 somatosensory parameters and can be seen as the gold standard to measure somatosensory function. Twelve athletes with clinically diagnosed chronic patellar tendinopathy (PT) mean duration 30 months (range 6-120) and 20 controls were included in the study. In two of the 13 QST parameters namely Mechanical Pain Threshold (P < 0.05) and Vibration Disappearance Threshold (P < 0.5) injured athletes were significantly more sensitive for the applied stimuli. None of the athletes had signs of Dynamic Mechanical Allodynia. Reduced mechanical pain thresholds or pinprick allodynia reflects the involvement of central sensitization upon the myelinated (A?-fibre) nociceptive input. From this explorative study, we conclude that sensitization may play a prominent role in the pain during and after sports activity in patella tendinopathy patients. PMID:22092832

  16. Apparent Skin Discoloration about the Knee Joint: A Rare Sequela of Metallosis after Total Knee Replacement

    PubMed Central

    Jayasekera, Narlaka; Gouk, Conor; Patel, Amit; Eyres, Keith

    2015-01-01

    Introduction. Metallosis is a phenomenon most commonly associated with hip replacement. However it can occur in any metallic implant subject to wear. Wear creates metal debris, which is deposited in the surrounding soft tissue. This leads to many local adverse reactions including, but not limited to, implant loosening/osteolysis, pain, and effusion. In the deeper joints, for example, the hip, metal deposits are mostly only seen intraoperatively. Case Study. A 74-year-old lady represented to orthopaedic outpatient clinic. Her principle complaint was skin discolouration, associated with pain and swelling over the left knee, on the background of a previous total knee replacement with a metal backed patella resurfacing six years. A plain radiograph revealed loosening of the patellar prosthesis. A diagnosis of metallosis was made; the patient underwent debridement of the stained soft tissue and primary revision of the prosthesis. She remained symptom-free five years after revision. Discussion. Metallosis results in metallic debris which causes tissue staining, often hidden within the soft tissue envelope of the hip, but more apparent in the knee. Metallosis may cause pain, effusion, and systemic symptoms because of raised levels of serum-metal ions. Surgical intervention with revision and debridement can have good functional results.

  17. [Suprapatellar approach to tibial medullary nailing with electromagnetic field-guided distal locking].

    PubMed

    Rueger, J M; Rücker, A H; Hoffmann, M

    2015-04-01

    Closed tibial shaft fractures are the domain of intramedullary nailing. With the introduction of new nail designs and technologies, even small, dislocated distal fragments can be anatomically aligned and safely fixed. Unsolved or to a lesser degree controlled are the problems of distal locking in the freehand technique, which can still be difficult and can lead to a significant radiation exposure, and how to control very short proximal tibial fragments in metaphyseal tibial fractures or tibial segmental fractures, where the proximal fracture line also runs through the metaphysis.By using a suprapatellar approach, i.e. a skin incision proximal to the patella with an entry point into the tibial bone from within the knee at the same site as for a standard infrapatellar approach, and then nailing the tibia in a semi-extended position, i.e. the knee is only flexed 10-20°, the intraoperative dislocation of a short proximal fragment can be avoided. The main indications for semi-extended tibial nailing are a short diaphyseal fragment in an isolated tibial shaft fracture, a segmental fracture where the proximal fracture line is metaphyseal and in patients where infrapatellar soft tissues are compromised.The use of the electromagnetic guidance system SureShot® generates reliable and reproducible results, reduces the operating time and is independent from radiation for distal locking. PMID:25835205

  18. Prediction of mechanical properties of trabecular bone using quantitative MRI

    NASA Astrophysics Data System (ADS)

    Lammentausta, E.; Hakulinen, M. A.; Jurvelin, J. S.; Nieminen, M. T.

    2006-12-01

    Techniques for quantitative magnetic resonance imaging (MRI) have been developed for non-invasive estimation of the mineral density and structure of trabecular bone. The R*2 relaxation rate (i.e. 1/T*2) is sensitive to bone mineral density (BMD) via susceptibility differences between trabeculae and bone marrow, and by binarizing MRI images, structural variables, such as apparent bone volume fraction, can be assessed. In the present study, trabecular bone samples of human patellae were investigated in vitro at 1.5 T to determine the ability of MRI-derived variables (R*2 and bone volume fraction) to predict the mechanical properties (Young's modulus, yield stress and ultimate strength). Further, the MRI variables were correlated with reference measurements of volumetric BMD and bone area fraction as determined with a clinical pQCT system. The MRI variables correlated significantly (p < 0.01) with the mechanical variables (r = 0.32-0.46), BMD (r = 0.56) and bone structure (r = 0.51). A combination of R*2 and MRI-derived bone volume fraction further improved the prediction of yield stress and ultimate strength. Although pQCT showed a trend towards better prediction of the mechanical properties, current results demonstrate the feasibility of combined MR imaging of marrow susceptibility and bone volume fraction in predicting the mechanical strength of trabecular bone and bone mineral density.

  19. Pseudoaneurysm of the superior lateral genicular artery: case report of a rare complication after total knee arthroplasty

    PubMed Central

    2013-01-01

    Background Pseudoaneurysm of superior lateral genicular artery following total knee arthroplasty is a rare complication and has been reported following lateral release performed for eversion of patella in a knee with tight lateral structures. Case presentation This report describes a case of pseudo aneurysm of superior lateral geniculate artery that developed after primary Total knee arthroplasty for a stiff knee in a 68 year old patient. Patient presented with pain and rapidly increasing swelling in early post operative period. Diagnosis was made on duplex ultrasound and confirmed by angiography. Angiographic coil embolisation of the pseudoaneurysm was performed. Since no lateral release was performed in this case, the probable mechanism was shear injury to the vessel. Conclusion Pseudoaneurysm of superior lateral genicular artery can occur in absence of lateral release by shear injury to an atherosclerotic vessel. Angiographic coil embolisation appears to be the best method for treating such post arthroplasty pseudoaneurysm because of less chance of infection, non interference with rehabilitation and diagnosis and treatment during same procedure. PMID:23687974

  20. Varying regional topology within knee articular chondrocytes under simulated in vivo conditions.

    PubMed

    Salzmann, Gian M; Buchberger, Maria S; Stoddart, Martin J; Grad, Sibylle; Milz, Stefan; Niemyer, Philipp; Sudkamp, Norbert P; Imhoff, Andreas B; Alini, Mauro

    2011-02-01

    Topographical cartilage variation across the knee joint has been previously reported, but there is only limited information on such gene expression profiles. Articular chondrocytes from eight different topographical regions of bovine knee joints were seeded within three-dimensional scaffolds and further cultured under static conditions (unloaded control group) or subjected to an artificial joint environment within a bioreactor (loaded group). Constructs were analyzed for glycosaminoglycan (GAG), DNA, and expression of Collagen-1,-2,-10, Aggrecan, COMP, Sox9, PRG-4, PTHrp, and MMP-1,-3,-13 mRNA after 2 weeks of in vitro culture. Exclusively among loaded constructs the overall GAG production was significantly different between regions. Patella chondrocytes had overall highest, and cells from the femoral notch had overall lowest GAG/DNA under loaded conditions. Gene expression was significantly different between regions for all targets except for Sox9, PRG-4, and PTHrp among controls and with the exception of Aggrecan, Sox9, and PTHrp among loaded samples. Under mechanical stimulation Collagen-1,-2 and Aggrecan was highest at the patello-femoral joint, whereas it was lowest at typical cartilage biopsy regions. There is a clear topographical variation among distinct regions across the knee joint for gene and matrix expression profiles under static and foremost under dynamic conditions. PMID:20807006

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

    PubMed Central

    2010-01-01

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

  2. Bioabsorbable expansion bolt fixation in anterior cruciate ligament reconstruction.

    PubMed

    Piltz, S; Steinbauer, T; Meyer, L; Plitz, W; Andress, H J; Lob, G

    2004-01-01

    The current study evaluated initial fixation strength of a bioabsorbable expansion bolt compared with interference screw fixation in anterior cruciate ligament reconstruction using a bone-patellar tendon-bone graft. Thirty calf tibial plateaus with adjacent patella and extensor ligaments were used. Bioabsorbable poly-L-lactide interference screws were used for graft fixation in Group I, titanium screws in Group II, and bioabsorbable poly-DL-lactide expansion bolts were used in Group III. The mean force-to-failure (+/- standard deviation) in the three groups was 487 +/- 205 N, 713 +/- 218 N, and 594 +/- 224 N, respectively. The differences between Groups I and II were significant. No statistical differences were found regarding stiffness. Graft damage was significantly less in Group III compared with screw fixation. The fixation concept of an expansion bolt shows similar fixation strength and less graft damage compared with the established interference screw fixation. Because of the total absence of torque forces in contrast to bioabsorbable screws, the risk of implant breakage is minimized. PMID:15043122

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

    PubMed

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

    2010-10-01

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

  4. Femur chondrosarcoma misdiagnosed as acute knee arthritis and osteomyelitis--further developing a hitherto unreported complication of tumor embolic ischemic ileal perforation after arthroscopic lavage.

    PubMed

    Chow, Louis Tsun Cheung

    2014-12-01

    The differentiation between osteomyelitis and bone tumor may be difficult due to their overlapping clinical and radiological features. A 25-year-old lady presented with left knee pain and joint effusion associated with redness and hotness. A sub-optimally taken plain radiograph showed mixed osteolytic and osteoblastic lesion in the left lower femur with surrounding soft tissue swelling. Since the clinical diagnosis was acute osteomyelitis and arthritis, arthroscopic lavage was performed as a diagnostic and therapeutic procedure. The removed loose bodies and fibrinous tissue showed pathological features suspicious of chondrosarcoma. Subsequent MRI revealed an infiltrative tumor eroding through the cortex and joint cartilage. En bloc excision of the left lower femur, upper tibia including the knee joint and patella was performed, and the final diagnosis was grade 2 chondrosarcoma. The patient developed bilateral pulmonary metastasis 33 months after operation. Five months later, she suffered from a hitherto undescribed complication of ischemic perforation of the terminal ileum secondary to tumor embolic arterial obstruction with no macroscopic intestinal or peritoneal tumor deposit. The patient developed multiple brain metastases and died 43 months after initial presentation. Our case illustrates that malignant bone tumor as a differential diagnosis of acute osteomyelitis and arthritis merits recognition and exclusion before arthroscopic lavage, which may enhance tumor dissemination and in our patient results in embolic ischemic ileal perforation. PMID:25242025

  5. Three-dimensional motion analysis of the patellar component in total knee arthroplasty by the image matching method using image correlations.

    PubMed

    Ishimaru, Masami; Shiraishi, Yoshitaka; Ikebe, Satoru; Higaki, Hidehiko; Hino, Kazunori; Onishi, Yoshio; Miura, Hiromasa

    2014-05-01

    In total knee arthroplasty (TKA), the patella is significantly associated with range of motion and gait performance. Currently, no highly accurate methods are available that can measure the 3D in vivo behavior of the TKA patellar component, as the component is made of x-ray-permeable ultra-high molecular weight polyethylene. Previously, we developed a computer simulation that matches CT scan and unidirectional radiographic images using image correlations, and applied it to kinematic studies of natural and TKA knees. The examination of the measurement accuracy for the patellar bone of a fresh-frozen pig knee joint yielded a root mean square error of 0.2 mm in translation and 0.2° in rotation. In this study, we recruited four patients who had a TKA and investigated 3D movements of the patellar component during squatting. We could visualize the patellar component using the position of the holes drilled for the component peg, and estimated and visualized the contact points between the patellar and femoral components. The principles and the utility of the simulation method are reported. This analytical method is useful for evaluating the pathologies and post-surgical conditions of the knee and other joints. PMID:24522960

  6. Cerebral palsy lifetime care - four musculoskeletal conditions.

    PubMed

    Murphy, Kevin P

    2009-10-01

    Cerebral palsy (CP) has always been considered a static condition in the neurological sense. Secondary and associated conditions that occur in the patient with CPcan progress over time and cause unwanted sequelae. This paper discusses four musculoskeletal conditions that present across the lifetime and can lead to progressive loss of function in the patient with CP. Patella alta can be particularly painful in the early adult years, limiting mobility particularly when associated with crouch gait. Adults with lower-extremity weight-bearing status having hip dysplasia, progressive over time, often develop pain and severe degenerative arthritis, with or without arthrodesis. Spondylolysis, particularly at the L5 S1 level, is fairly common in the ambulatory adult with diplegia and may, if not diagnosed early, progress to spondylolisthesis. Cervical stenosis appears to be more prevalent in adults with spastic quadriparesis and dystonia and is often associated with myelomalacia and/or radiculopathy. All four of these conditions may be lessened, or even prevented, with intervention and diagnosis in the younger years. Possible interventions and outcomes over time are discussed in the context of multidisciplinary team management of the individual with CP. PMID:19740208

  7. The acute toxicity of nickel to freshwater ciliates.

    PubMed

    Madoni, P

    2000-07-01

    The acute toxicity of nickel to 12 species of freshwater ciliates was examined in laboratory tests. After exposing standard cultures of the ciliates to a soluble compound of nickel (NiCl(2).6H(2)O) at several selected concentrations close to the lethal limit for 24 h, the mortality rate was registered and the LC(50) values (with 95% confidence intervals) were calculated. Large differences appeared in sensitivities of the 12 species to the metal. Ciliated protozoa such as Spirostomum teres (0.17 mg Ni l(-1), 24-h LC(50)) and Paramecium bursaria (0.36 mg Ni l(-1), 24-h LC(50)) showed the highest sensitivity to the nickel, while Euplotes patella (7.7 mg Ni l(-1), 24-h LC(50)) was the most tolerant species. A comparison of these results with data obtained for other heavy metals indicates that S. teres is an excellent and convenient bioindicator for evaluating the toxicity of waters polluted by heavy metals. PMID:15092912

  8. An Isolated Medial Patellofemoral Ligament Reconstruction with Patellar Tendon Autograft

    PubMed Central

    Wito?ski, Dariusz; K?ska, Rafa?; Synder, Marek; Sibi?ski, Marcin

    2013-01-01

    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. PMID:24224173

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

    PubMed Central

    Thambyah, Ashvin; Broom, Neil

    2006-01-01

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

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

    PubMed

    Lorbach, O; Anagnostakos, K; Kohn, D

    2013-05-01

    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

  11. Clinical value of SPECT/CT for evaluation of patients with painful knees after total knee arthroplasty- a new dimension of diagnostics?

    PubMed Central

    2011-01-01

    Background The purpose of our study was to evaluate the clinical value of hybrid SPECT/CT for the assessment of patients with painful total knee arthroplasty (TKA). Methods Twenty-three painful knees in patients following primary TKA were assessed using Tc-99m-HDP-SPECT/CT. Rotational, sagittal and coronal position of the TKA was assessed on 3D-CT reconstructions. The level of the SPECT-tracer uptake (0-10) and its anatomical distribution was mapped using a validated localization scheme. Univariate analysis (Wilcoxon-Mann-Whitney, Spearmean`s-rho test, p < 0.05) was performed to identify any correlations between component position, tracer uptake and diagnosis. Results SPECT/CT imaging changed the suspected diagnosis and the proposed treatment in 19/23 (83%) knees. Progression of patellofemoral OA (n = 11), loosening of the tibial (n = 3) and loosening of the femoral component (n = 2) were identified as the leading causes of pain after TKA. Patients with externally rotated tibial trays showed higher tracer uptake in the medial patellar facet (p = 0.049) and in the femur (p = 0.051). Patients with knee pain due to patellofemoral OA showed significantly higher tracer uptake in the patella than others (p < 0.001). Conclusions SPECT/CT was very helpful in establishing the diagnosis and guiding subsequent management in patients with painful knees after TKA, particularly in patients with patellofemoral problems and malpositioned or loose TKA. PMID:21294878

  12. Stress Fractures of the Pelvis and Legs in Athletes

    PubMed Central

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

    2013-01-01

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

  13. [Effectiveness and safety of Lubor capsules in patients with gonarthrosis and extra-articular rheumatism].

    PubMed

    Jaji?, I; Jaji?, Z

    1991-01-01

    We performed the double-blind study comparing the two groups of patients with osteoarthrosis. One group was receiving one Lubor ampoul a day during 14 days, while the other group received also one ampoul of Voltaren during 14 days. The other group consisted of patients with soft tissue rheumatism who were treated with Lubor or Ketonal cream during 14 days. The duration of the morning stiffness of the knee joint was shortened significantly in the patients who were treated by Lubor ampouls. The intensity of pain during various activities was also significantly reduced. The objective parameters: the distance between the top of the patella and the xypohoid process and the extent of movements were improved at the end of the therapy. In the patients treated with Lubor cream we observed the significant reducement of the intensity of the pain. Two new forms of Lubor (ampouls and cream) with capsules and suppositories enrich the large choice of this drug; it can be given in the large number of implications, it has the better adjustment of application and doses. Because of the very rare side-effects it provides the safety for the patient and physician. PMID:1809994

  14. Patellofemoral instability: classification and imaging

    PubMed Central

    BERRUTO, MASSIMO; FERRUA, PAOLO; CARIMATI, GIULIA; UBOLDI, FRANCESCO; GALA, LUCA

    2013-01-01

    Patellofemoral disorders must be approached through an appropriate process of diagnostic framing, performed using language that is, as far as possible, unequivocal and a validated and organic classification system. At present, the classification proposed by the Lyonnaise school, which fulfills these requirements, is the most complete. This classification divides patellofemoral disorders into three groups: objective patellar instability, potential patellar instability and painful patella syndrome. It also identifies three principal factors of instability: trochlear dysplasia, abnormal patellar height and pathological tibial tubercle-trochlear groove (TT-TG) distance. Imaging is crucial for correct classification and for identifying and measuring the principal factors of instability. Up to now, the emphasis has been placed on the contribution made by traditional diagnostic radiology and computed tomography. In recent years, however, growing attention has been paid to the use of magnetic resonance imaging in the assessment of the patellofemoral joint and in the study of factors of instability, even though there is still a need for validation of this approach before it can be routinely used in preoperative planning. PMID:25606511

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

    PubMed Central

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

    2014-01-01

    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

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

    PubMed Central

    2013-01-01

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

  17. Anterior knee pain after total knee arthroplasty: a narrative review.

    PubMed

    Petersen, Wolf; Rembitzki, Ingo Volker; Brüggemann, Gerd-Peter; Ellermann, Andree; Best, Raymond; Koppenburg, Andreas Gösele-; Liebau, Christian

    2014-02-01

    Anterior knee pain is one of the most common causes of persistent problems after implantation of a total knee replacement. It can occur in patients with or without patellar resurfacing. As a result of the surgical procedure itself many changes can occur which may affect the delicate interplay of the joint partners in the patello-femoral joint. Functional causes of anterior knee pain can be distinguished from mechanical causes. The functional causes concern disorders of inter- and intramuscular coordination, which can be attributed to preoperative osteoarthritis. Research about anterior knee pain has shown that not only the thigh muscles but also the hip and trunk stabilising muscles may be responsible for the development of a dynamic valgus malalignment. Dynamic valgus may be a causative factor for patellar maltracking. The mechanical causes of patello-femoral problems after knee replacement can be distinguished according to whether they increase instability in the joint, increase joint pressure or whether they affect the muscular lever arms. These causes include offset errors, oversizing, rotational errors of femoral or tibial component, instability, maltracking and chondrolysis, patella baja and aseptic loosening. In these cases, reoperation or revision is often necessary. PMID:24057656

  18. Biomechanical study of patellofemoral joint instability

    NASA Astrophysics Data System (ADS)

    Senavongse, Wongwit

    2005-04-01

    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.

  19. Congenital absence of the anterior cruciate ligament in monozygotic twins.

    PubMed

    Sonn, K A; Caltoum, C B

    2014-12-01

    Cases of congenital absence of the cruciate ligaments are seen rarely in the literature. When reported, they are almost exclusively associated with various additional lower extremity deformities. We report the cases of 15-year-old monozygotic twin brothers. Both brothers presented with right knee pain and instability and were found on magnetic resonance imaging (MRI) to have congenital absence of the right anterior cruciate ligament (ACL). Examination of full length leg radiographs and MRI of the knee showed no associated abnormalities. Twin B previously underwent partial medial meniscectomy performed by an outside orthopaedic surgeon at which time the absence of the ACL was noted but not repaired. After diagnosis at our practice, both twins underwent arthroscopically assisted ACL construction with bone-patella-bone-autograft. Following recovery from surgery, both twins returned to high level athletics. These cases are among few reports of isolated congenital absence of the ACL, and to our knowledge there are no other cases of isolated congenital absence of the ACL in monozygotic twins. PMID:25203652

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

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

    2007-02-01

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

  2. Arthroscopic treatment of chronic patellar tendinopathy in high-level athletes

    PubMed Central

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

    2012-01-01

    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. PMID:23738308

  3. Surgical Treatment of Chronic Patellar Tendinitis in a Collegiate Football Player

    PubMed Central

    Beam, Joel W.; Lozman, Philip R.; Uribe, John W.

    1995-01-01

    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. ImagesFig 1.Fig 2.Fig 3. PMID:16558360

  4. Mechanisms of non?contact ACL injuries

    PubMed Central

    Yu, Bing; Garrett, William E

    2007-01-01

    In soccer one of the most common knee injuries is the anterior cruciate ligament (ACL) tear, which usually occurs through non?contact mechanisms. Female soccer players are at higher risk of sustaining non?contact ACL injuries than male soccer players. A good understanding of ACL loading mechanisms is the basis for a good understanding of the mechanisms of non?contact ACL injuries, which in turn is essential for identifying risk factors and developing prevention strategies. Current literature demonstrates that sagittal plane biomechanical factors, such as small knee flexion angle, great posterior ground reaction force and great quadriceps muscle force, are the major ACL loading mechanisms. A great posterior ground reaction force may be associated with a great quadriceps muscle force, which would cause great anterior draw force at the knee. A small knee flexion is associated with a large patella tendon?tibia shaft angle and ACL elevation angle, which would result in great ACL loading. Current literature also demonstrates that the ACL is not the major structure of bearing knee valgus?varus moment and internal?external rotation loadings. Knee valgus?varus moment and internal?external rotation moment alone are not likely to result in isolated ACL injuries without injuring other knee structures. PMID:17646249

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

    PubMed

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

    2014-10-13

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

  6. Effect of temperature on leg kinematics in sprinting tarantulas (Aphonopelma hentzi): high speed may limit hydraulic joint actuation.

    PubMed

    Booster, N A; Su, F Y; Adolph, S C; Ahn, A N

    2015-04-01

    Tarantulas extend the femur-patella (proximal) and tibia-metatarsal (distal) joints of their legs hydraulically. Because these two hydraulically actuated joints are positioned in series, hemolymph flow within each leg is expected to mechanically couple the movement of the joints. In the current study, we tested two hypotheses: (1) at lower temperatures, movement of the two in-series hydraulic joints within a leg will be less coupled because of increased hemolymph viscosity slowing hemolymph flow; and (2) at higher temperatures, movement of the two in-series hydraulic joints will be less coupled because the higher stride frequencies limit the time available for hemolymph flow. We elicited maximal running speeds at four ecologically relevant temperatures (15, 24, 31 and 40°C) in Texas Brown tarantulas (Aphonopelma hentzi). The spiders increased sprint speed 2.5-fold over the temperature range by changing their stride frequency but not stride length. The coefficient of determination for linear regression (R(2)) of the proximal and distal joint angles was used as the measure of the degree of coupling between the two joints. This coupling coefficient between the proximal and distal joint angles, for both forelegs and hind-legs, was significantly lowest at the highest temperature at which the animals ran the fastest with the highest stride frequencies. The coordination of multiple, in-series hydraulically actuated joints may be limited by operating speed. PMID:25833132

  7. Trochleoplasty in dysplastic knee trochlea.

    PubMed

    Verdonk, R; Jansegers, E; Stuyts, B

    2005-10-01

    In patients complaining of recurrent patellar dislocations or persistent retropatellar pain due to a dysplastic femoral trochlea, we perform a Henri Dejour trochleoplasty. In this technique the femoral trochlea is deepened by removing the subchondral trochlear bone followed by incision, impaction and fixation of the cartilage flange along the trochlear groove. Between 1996 and 1999, 13 procedures were performed in 12 patients. Strictly lateral X-rays showed dysplasia of the trochlea, as defined by the "crossing sign", whether or not in combination with patella alta. Patients were assessed using the Larsen-Lauridsen score considering pain, stiffness, osteopatellar crepitus, flexion and loss of function. Although the majority of patients scored fair and poor on an objective scoring system, we achieved 77% good to very good subjective results. Although the result was not perfect, the patients were satisfied with the procedure. This technique might be a valuable alternative in cases of frank trochlear dysplasia associated with persistent retropatellar pain or recurrent patellar dislocations. PMID:15645215

  8. Deleterious effects of diluted povidone-iodine on articular cartilage.

    PubMed

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

    2013-06-01

    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

  9. Anterior Cruciate Ligament Reconstruction in Patients with Generalized Joint Laxity

    PubMed Central

    Kim, Sung-Jae; Kumar, Praveen

    2010-01-01

    Generalized joint laxity is a genetically determined component of overall joint flexibility. The incidence of joint laxity in the overall population is approximately 5% to 20%, and its prevalence is higher in females. Recently it was noticed that individuals with generalized joint laxity are not only prone to anterior cruciate ligament injuries but also have inferior results after a reconstruction. Therefore, an anterior cruciate ligament reconstruction in patients with generalized laxity should be undertaken with caution due to the higher expected failure rate from the complexity of problems associated with this condition. It is also necessary to identify the risk factors for the injury as well as for the post operative outcome in this population. A criterion that includes all the associated components is necessary for the proper screening of individuals for generalized joint laxity. Graft selection for an anterior cruciate reconstruction in patients with ligament laxity is a challenge. According to the senior author, a hamstring autograft is an inferior choice and a double bundle reconstruction with a quadriceps tendon-bone autograft yields better results than a single bundle bone-patella tendon-bone autograft. Future studies comparing the different grafts available might be needed to determine the preferred graft for this subset of patients. Improved results after an anterior cruciate ligament reconstruction can be achieved by proper planning and careful attention to each step beginning from the clinical examination to the postoperative rehabilitation. PMID:20808583

  10. Cold compressive dressing after total knee arthroplasty.

    PubMed

    Healy, W L; Seidman, J; Pfeifer, B A; Brown, D G

    1994-02-01

    The efficacy of a cold compressive dressing after total knee arthroplasty (TKA) was prospectively studied in 105 knees in 76 patients. All components were cemented. All patients were placed in continuous passive motion machines after operation. A cold compressive Cryocuff dressing was applied to 50 knees after operation. An ACE wrap and ice pack were applied to the knees of 55 control patients after operation. Postoperative range of motion was recorded as maximum active flexion at two to four days (interval one), at seven to 14 days (interval two), and four to six weeks (interval three). Swelling was measured at the same time intervals by circumference at the midpatella and circumference at the distal thigh one inch proximal to the superior pole of the patella. Use of postoperative narcotics was calculated for postoperative days zero to three and for postoperative days four to seven. Wound drainage was recorded for all knees. The use of a cold compressive dressing after TKA was not associated with an increase in range of motion at any point after the operation. The Cryocuff dressing did not appreciably reduce swelling around the knee after TKA. No significant difference was found in the amount of postoperative wound drainage between the two groups of patients. In patients undergoing unilateral TKA, no significant difference existed between the narcotic requirements of control patients and patients wearing the cold compressive dressing. PMID:7907012

  11. An artificial tendon to connect the quadriceps muscle to the tibia.

    PubMed

    Melvin, Alan; Litsky, Alan; Mayerson, Joel; Stringer, Keith; Melvin, David; Juncosa-Melvin, Natalia

    2011-11-01

    No permanent, reliable artificial tendon exists clinically. Our group developed the OrthoCoupler™ device as a versatile connector, fixed at one end to a muscle, and adaptable at the other end to inert implants such as prosthetic bones or to bone anchors. The objective of this study was to evaluate four configurations of the device to replace the extensor mechanism of the knee in goats. Within muscle, the four groups had: (A) needle-drawn uncoated bundles, (B) needle-drawn coated bundles, (C) barbed uncoated bundles, and (D) barbed coated bundles. The quadriceps tendon, patella, and patellar tendon were removed from the right hind limb in 24 goats. The four groups (n?=?6 for each) were randomly assigned to connect the quadriceps muscle to the tibia (with a bone plate). Specimens were collected from each operated leg and contralateral unoperated controls both for mechanical testing and histology at 90 days post-surgery. In strength testing, maximum forces in the operated leg (vs. unoperated control) were 1,288?±?123?N (vs. 1,387?±?118?N) for group A, 1,323?±?144?N (vs. 1,396?±?779?N) for group B, 930?±?125?N (vs. 1,337?±?126?N) for group C, and 968?±?109?N (vs. 1,528?±?146?N) for group D (mean?±?SEM). The strengths of the OrthoCoupler™ legs in the needled device groups were equivalent to unoperated controls (p?=?0.6), while both barbed device groups had maximum forces significantly lower than their controls (p?=?0.001). We believe this technology will yield improved procedures for clinical challenges in orthopaedic oncology, revision arthroplasty, tendon transfer, and tendon injury reconstruction. PMID:21520259

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

    PubMed

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

    2012-04-01

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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

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

    2014-01-01

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

  15. Descriptions of the lower limb skeleton of Homo floresiensis.

    PubMed

    Jungers, W L; Larson, S G; Harcourt-Smith, W; Morwood, M J; Sutikna, T; Due Awe, Rokhus; Djubiantono, T

    2009-11-01

    Bones of the lower extremity have been recovered for up to nine different individuals of Homo floresiensis - LB1, LB4, LB6, LB8, LB9, LB10, LB11, LB13, and LB14. LB1 is represented by a bony pelvis (damaged but now repaired), femora, tibiae, fibulae, patellae, and numerous foot bones. LB4/2 is an immature right tibia lacking epiphyses. LB6 includes a fragmentary metatarsal and two pedal phalanges. LB8 is a nearly complete right tibia (shorter than that of LB1). LB9 is a fragment of a hominin femoral diaphysis. LB10 is a proximal hallucal phalanx. LB11 includes pelvic fragments and a fragmentary metatarsal. LB13 is a patellar fragment, and LB14 is a fragment of an acetabulum. All skeletal remains recovered from Liang Bua were extremely fragile, and some were badly damaged when they were removed temporarily from Jakarta. At present, virtually all fossil materials have been returned, stabilized, and hardened. These skeletal remains are described and illustrated photographically. The lower limb skeleton exhibits a uniquely mosaic pattern, with many primitive-like morphologies; we have been unable to find this combination of ancient and derived (more human-like) features in either healthy or pathological modern humans, regardless of body size. Bilateral asymmetries are slight in the postcranium, and muscle markings are clearly delineated on all bones. The long bones are robust, and the thickness of their cortices is well within the ranges seen in healthy modern humans. LB1 is most probably a female based on the shape of her greater sciatic notch, and the marked degree of lateral iliac flaring recalls that seen in australopithecines such as "Lucy" (AL 288-1). The metatarsus has a human-like robusticity formula, but the proximal pedal phalanges are relatively long and robust (and slightly curved). The hallux is fully adducted, but we suspect that a medial longitudinal arch was absent. PMID:19062072

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

    PubMed Central

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

    2012-01-01

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

  17. Diurnal Variations in Articular Cartilage Thickness and Strain in the Human Knee

    PubMed Central

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

    2012-01-01

    Due to the biphasic viscoelastic nature of cartilage, joint loading may result in deformations that require times on the order of hours to fully recover. Thus, cartilaginous tissues may exhibit cumulative strain over the course of each day. The goal of this study was to assess the magnitude and spatial distribution of strain in the articular cartilage of the knee with daily activity. Magnetic resonance (MR) images of ten asymptomatic subjects (six males, four females) with mean age of 29 years were obtained at 8:00AM and 4:00PM on the same day using a 3T magnet. These images were used to create 3D models of the femur, tibia, and patella from which cartilage thickness distributions were quantified. Cartilage thickness generally decreased from AM to PM in all areas except the patellofemoral groove and was associated with significant compressive strains in the medial condyle and tibial plateau. From AM to PM, cartilage of the medial tibial plateau exhibited a compressive strain of ?5.1 ± 1.0% (mean ± SEM) averaged over all locations, while strains in the lateral plateau were slightly lower (?3.1 ± 0.6%). Femoral cartilage showed an average strain of ?1.9 ± 0.6%. The findings of this study show that human knee cartilage undergoes diurnal changes in strain that vary with site in the joint. Since abnormal joint loading can be detrimental to cartilage homeostasis, these data provide a baseline for future studies investigating the effects of altered biomechanics on diurnal cartilage strains and cartilage physiology. PMID:23102493

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

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

    2011-01-01

    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. PMID:22179930

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

    PubMed

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

    2013-11-01

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

  1. Cognitive deficits and magnetic resonance spectroscopy in adult monozygotic twins with lead poisoning.

    PubMed Central

    Weisskopf, Marc G; Hu, Howard; Mulkern, Robert V; White, Roberta; Aro, Antonio; Oliveira, Steve; Wright, Robert O

    2004-01-01

    Seventy-one-year-old identical twin brothers with chronic lead poisoning were identified from an occupational medicine clinic roster. Both were retired painters, but one brother (J.G.) primarily removed paint and had a history of higher chronic lead exposure. Patella and tibia bone lead concentrations measured by K-X-ray fluorescence in each brother were 5-10 times those of the general population and about 2.5 times higher in J.G. than in his brother (E.G.). Magnetic resonance spectroscopy (MRS) studies examined N-acetylaspartate:creatine ratios, a marker of neuronal density. Ratios were lower in J.G. than in his brother. Scores on neurocognitive tests that assess working memory/executive function were below expectation in both twins. Short-term memory function was dramatically worse in J.G. than in his brother. These results demonstrate some of the more subtle long-term neurologic effects of chronic lead poisoning in adults. In particular, they suggest the presence of frontal lobe dysfunction in both twins, but more dramatic hippocampal dysfunction in the brother with higher lead exposure. The MRS findings are consistent with the hypothesis that chronic lead exposure caused neuronal loss, which may contribute to the impairment in cognitive function. Although a causal relation cannot be inferred, the brothers were genetically identical, with similar life experiences. Although these results are promising, further study is necessary to determine whether MRS findings correlate both with markers of lead exposure and tests of cognitive function. Nevertheless, the results point to the potential utility of MRS in determining mechanisms of neurotoxicity not only for lead but also for other neurotoxicants as well. PMID:15064171

  2. Metal-binding proteins as metal pollution indicators

    SciTech Connect

    Hennig, H.F.

    1986-03-01

    The fact that metal-binding proteins are a consequence of elevated metal concentration in organisms is well known. What has been overlooked is that the presence of these proteins provides a unique opportunity to reformulate the criteria of metal pollution. The detoxification effect of metal-binding proteins in animals from polluted areas has been cited, but there have been only very few studies relating metal-binding proteins to pollution. This lack is due partly to the design of most experiments, which were aimed at isolation of metal-binding proteins and hence were of too short duration to allow for correlation to adverse physiological effects on the organism. In this study metal-binding proteins were isolated and characterized from five different marine animals (rock lobster, Jasus lalandii; hermit crab, Diogenes brevirostris; sandshrimp, Palaemon pacificus; black mussel, Choromytilus meridionalis; and limpet, Patella granularis). These animals were kept under identical metal-enriched conditions, hence eliminating differences in method and seasons. The study animals belonged to different phyla; varied in size, mass, age, behavior, food requirements and life stages; and accumulated metals at different rates. It is possible to link unseasonal moulting in crustacea, a known physiological effect due to a metal-enriched environment, to the production of the metal-binding protein without evidence of obvious metal body burden. Thus a new concept of pollution is defined: the presence of metal-binding proteins confirms toxic metal pollution. This concept was then tested under field conditions in the whelk Bullia digitalis and in metal-enriched grass.

  3. Physical activity in relation to knee cartilage T2 progression measured with 3 T MRI over a period of 4 years: data from the Osteoarthritis Initiative

    PubMed Central

    Lin, W.; Alizai, H.; Joseph, G.B.; Srikhum, W.; Nevitt, M.C.; Lynch, J.A.; McCulloch, C.E.; Link, T.M.

    2013-01-01

    SUMMARY Objective The purpose of this study was to analyze the longitudinal association between physical activity levels and early degenerative cartilage changes in the knee, measured using T2 relaxation times over a period of 4 years in individuals without clinical or radiographic evidence of OA. Design Cartilage T2 was measured at baseline and after 2 and 4 years in 205 subjects aged 45–60 years from the Osteoarthritis Initiative (OAI) incidence and normal cohorts with no knee pain (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score of zero), and a Kellgren Lawrence (KL) score of <2 at baseline. Physical activity was scored using the Physical Activity Scale for the Elderly (PASE) questionnaire, which was obtained yearly over 4 years. The relationship between physical activity and T2 was studied using a mixed model linear regression, including random effects, and adjusted for age, sex, and body mass index (BMI). Results T2 values for all PASE tertiles progressed over the 4-year period. T2 progression was increased in the highest tertile of physical activity compared to the mid-tertile at the medial tibia (MT) (P = 0.041), patella (Pat) (P = 0.019), and average T2 of all knee compartments combined (P = 0.033). Subjects with the lowest 15% PASE scores showed significantly higher T2 progression compared to the mid-level physical activity group at the lateral femur (LF) (P = 0.025), lateral tibia (LT) (P = 0.043), medial femur (MF) (P = 0.044), tibiofemoral compartment (P = 0.017), patellofemoral compartment (P = 0.016), lateral compartments (P = 0.003), and average of all compartments (P = 0.043). Conclusion High and very low PASE scores were associated with greater progression of cartilage T2 measurements in asymptomatic, middle-aged individuals, suggesting accelerated cartilage matrix biochemical degeneration over time. PMID:23831632

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

    PubMed

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

    2001-06-01

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

  5. Mobile-bearing total knee arthroplasty: a full traumatic rotation of 180°.

    PubMed

    Sudanese, Alessandra; Castiello, Emanuela; Affatato, Saverio

    2013-06-25

    From February 2008 to September 2012 we implanted 204 mobile-bearing knee prostheses in 192 patients. All the prostheses were cemented (both femoral and tibial components), and the patella was not replaced. Only one early complication of the implants (1/204 = 0.004%) occurred after a traumatic event as a full 180° rotation of the mobile-bearing polyethylene insert. A 78-year-old woman presented with swelling and severe pain at her right knee. This traumatic event was the only case among our mobile-bearing insert patients. ?The failed polyethylene inserts were retrieved and studied using a scanning electron microscope (SEM, ZEISS EVO 50 EP, Cambridge, UK) operating at 20 kV. ?Scratching and pitting were found on the UHMWPE insert perpendicular to the machining tracks for the concave surface. SEM micrographs of the insert showed burnishing on the concave surfaces and longitudinal scratches were clearly detectable and well-marked on the analyzed surfaces. ?A traumatic, fully rotating, polyethylene insert is rare and our case is the first report describing a traumatic event with a complete 180 degree rotation mobile-bearing in a total knee prosthesis. ?In the literature few reports discuss clinical outcomes after total knee arthroplasty in patients with Parkinson's disease and they cite mixed results. However, some authors suggest that posterior-stabilized and cruciate-retaining TKA should work well while others prefer cruciate-retaining, condylar constrained kinetics, or hinged devices. Although we did not implant a posterior-stabilized mobile-bearing total knee prosthesis or a constrained prosthesis, we obtained good clinical and radiological results at the 2-year followup. PMID:23653296

  6. Ultrasonic measurement of depth-dependent transient behaviors of articular cartilage under compression.

    PubMed

    Zheng, Y P; Niu, H J; Arthur Mak, F T; Huang, Y P

    2005-09-01

    We previously reported an ultrasound method for measuring the depth-dependent equilibrium mechanical properties of articular cartilage using quasi-static compression. The objective of this paper was to introduce our recent development for nondestructively measuring the transient depth-dependent strains of full-thickness articular cartilage specimens prepared from bovine patellae. A 50 MHz focused ultrasound transducer was used to collect ultrasound echoes from articular cartilage specimens (n=8) and sponge phantoms with open pores (n=10) during tests of compression and subsequent stress-relaxation. The transient displacements of the tissues at different depths along the compression direction were calculated from the ultrasound echoes using a cross-correlation tracking technique. An LVDT sensor and a load cell were used to measure the overall deformation of the tissue and the applied force, respectively. Results showed that the tissues inside the cartilage layer continued to move during the stress-relaxation phase after the compression was completed. In the equilibrium state, the displacements of the cartilage tissues at the depths of 1/4, 1/2, and 3/4 of the full-thickness reduced by 51%+/-22%, 54%+/-17%, and 50+/-17%, respectively, in comparison with its peak value. However, no similar phenomenon was observed in the sponge phantoms. Our preliminary results demonstrated that this ultrasound method may provide a potential tool for the nondestructive measurement of the transient depth-dependent processes involved in biological and bioengineered soft tissues as well as soft biomaterials under dynamic loading. PMID:16023470

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

    PubMed

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

    2014-11-26

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

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

    PubMed

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

    2014-01-01

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

  9. Multi-center feasibility study evaluating recruitment, variability in risk factors and biomarkers for a diet and cancer cohort in India

    PubMed Central

    2011-01-01

    Background India's population exhibits diverse dietary habits and chronic disease patterns. Nutritional epidemiologic studies in India are primarily of cross-sectional or case-control design and subject to biases, including differential recall of past diet. The aim of this feasibility study was to evaluate whether a diet-focused cohort study of cancer could be established in India, providing insight into potentially unique diet and lifestyle exposures. Methods Field staff contacted 7,064 households within three regions of India (New Delhi, Mumbai, and Trivandrum) and found 4,671 eligible adults aged 35-69 years. Participants completed interviewer-administered questionnaires (demographic, diet history, physical activity, medical/reproductive history, tobacco/alcohol use, and occupational history), and staff collected biological samples (blood, urine, and toenail clippings), anthropometric measurements (weight, standing and sitting height; waist, hip, and thigh circumference; triceps, sub-scapula and supra-patella skin fold), and blood pressure measurements. Results Eighty-eight percent of eligible subjects completed all questionnaires and 67% provided biological samples. Unique protein sources by region were fish in Trivandrum, dairy in New Delhi, and pulses (legumes) in Mumbai. Consumption of meat, alcohol, fast food, and soft drinks was scarce in all three regions. A large percentage of the participants were centrally obese and had elevated blood glucose levels. New Delhi participants were also the least physically active and had elevated lipids levels, suggesting a high prevalence of metabolic syndrome. Conclusions A high percentage of participants complied with study procedures including biological sample collection. Epidemiologic expertise and sufficient infrastructure exists at these three sites in India to successfully carry out a modest sized population-based study; however, we identified some potential problems in conducting a cohort study, such as limited number of facilities to handle biological samples. PMID:21619649

  10. An Artificial Tendon to Connect the Quadriceps Muscle to the Tibia

    PubMed Central

    Melvin, Alan; Litsky, Alan; Mayerson, Joel; Stringer, Keith; Melvin, David; Juncosa-Melvin, Natalia

    2011-01-01

    No permanent, reliable artificial tendon exists clinically. Our group developed the OrthoCoupler™ device as a versatile connector, fixed at one end to a muscle, and adaptable at the other end to inert implants such as prosthetic bones or to bone anchors. The objective of this study was to evaluate four configurations of the device to replace the extensor mechanism of the knee in goats. Within muscle, the four groups had: (A) needle-drawn uncoated bundles, (B) needle-drawn coated bundles, (C) barbed uncoated bundles, and (D) barbed coated bundles. The quadriceps tendon, patella, and patellar tendon were removed from the right hind limb in 24 goats. The four groups (n=6 for each) were randomly assigned to connect the quadriceps muscle to the tibia (with a bone plate). Specimens were collected from each operated leg and contralateral unoperated controls both for mechanical testing and histology at 90 days post-surgery. In strength testing, maximum forces in the operated leg (vs. unoperated control) were 1288±123 N (vs. 1387±118 N) for group A, 1323±144 N (vs. 1396±779 N) for group B, 930±125 N (vs. 1337±126 N) for group C, and 968±109 N (vs. 1528±146 N) for group D (mean ± SEM). The strengths of the OrthoCoupler™ legs in the needled device groups were equivalent to unoperated controls (p=0.6), while both barbed device groups had maximum forces significantly lower than their controls (p=0.001). We believe this technology will yield improved procedures for clinical challenges in orthopaedic oncology, revision arthroplasty, tendon transfer, and tendon injury reconstruction. PMID:21520259

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

    PubMed Central

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

    2014-01-01

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

  12. Long-term outcome of low contact stress total knee arthroplasty with different mobile bearing designs

    PubMed Central

    SOLARINO, GIUSEPPE; SPINARELLI, ANTONIO; CARROZZO, MASSIMILIANO; PIAZZOLLA, ANDREA; VICENTI, GIOVANNI; MORETTI, BIAGIO

    2014-01-01

    Purpose to evaluate the differences in clinical outcome and survivorship of three different mobile bearings for total knee arthroplasty. Methods a retrospective study was conducted in 60 patients (53 females, 7 males, mean age: 68 years and 5 months) each submitted to total knee replacement using one of the three different mobile bearings of the LCS system (Depuy Johnson & Johnson, Warsaw, IN). The diagnosis was knee osteoarthritis in 57 cases and rheumatoid arthritis in three cases. Three different groups of 20 cases each were identified: total knee arthroplasties with mobile menisci (group 1); total knee arthroplasties with the rotating platform (group 2); and total knee arthroplasties with the anteroposterior glide platform (group 3). As regards the component fixation, 33 implants were cementless, three were cemented, and in 24 only the tibial component was cemented. The patella was not replaced. Results although the duration of follow-up differed between the three groups, the clinical and radiological results at final follow-up showed no revision of femoral and/or tibial components for mechanical or septic reasons, and no signs of impending failure. One meniscal bearing, showing polyethylene wear after 17 years, was successfully replaced. Conclusions the present retrospective study confirmed the long-term effectiveness of knee implants with mobile bearings, in which the congruity of the surfaces makes it possible to overcome the problem of high contact stresses that may result in polyethylene wear and osteolysis; at the same time, these implants eliminate constraint forces thereby reducing the risk of mechanical loosening. Level of evidence Level III, retrospective comparative study. PMID:25606553

  13. EPIDEMIOLOGY OF KNEE INJURIES AMONG US HIGH SCHOOL ATHLETES, 2005/06–2010/11

    PubMed Central

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

    2012-01-01

    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. PMID:23059869

  14. Antifouling and toxic properties of the bioactive metabolites from the seagrasses Syringodium isoetifolium and Cymodocea serrulata.

    PubMed

    Iyapparaj, Palanisamy; Revathi, Peranandam; Ramasubburayan, Ramasamy; Prakash, Santhiyagu; Palavesam, Arunachalam; Immanuel, Grasian; Anantharaman, Perumal; Sautreau, Asmita; Hellio, Claire

    2014-05-01

    The present study documents the antifouling and toxic properties of seagrasses Syringodium isoetifolium and Cymodocea serrulata. For that, the seagrasses S. isoetifolium and C. serrulata were extracted individually using organic solvents viz. dichloromethane, acetone and methanol. Amongst the extracts, the maximum antimicrofouling and antimacrofouling activities were exhibited by methanol extracts of both the seagrasses. The Minimal Inhibitory Concentration (MIC) of methanolic extracts of seagrasses was ranged from 1.0 to 10µg/ml against test biofilm bacteria and microalgal strains. Similarly, 100% fouling inhibition of limpet Patella vulgata was found at 6.0mg/ml of methanolic extracts of seagrasses. The mussel Perna indica showed 50% of byssal production and attachment inhibition at 21.51±2.03, 17.82±1.07µg/ml and the anticrustaecean activity for 50% mortality of Artemia salina was recorded at 732.14±9.21 and 394.16±5.16µg/ml respectively for methanolic extracts of S. isoetifolium and C. serrulata. The minimal inhibitory and higher lethal concentrations of active methanol extracts shows it?s less toxic nature. Based on the prolific results, methanol extracts of S. isoetifolium and C. serrulata were subjected to purification using silica gel column and thin layer chromatography. Then the active compounds of the bioassay guided fractions were partially characterized using gas chromatography coupled with mass spectroscopy (GC-MS) and keyed out that fatty acids (C16 to C24) were the major components which responsible for the antifouling properties of the candidate seagrasses. PMID:24576890

  15. Pre-radiographic MRI findings are associated with onset of knee symptoms: the most study

    PubMed Central

    Javaid, M. K.; Lynch, J. A.; Tolstykh, I.; Guermazi, A.; Roemer, F.; Aliabadi, P.; McCulloch, C.; Curtis, J.; Felson, D.; Lane, N. E.; Torner, J.; Nevitt, M.

    2010-01-01

    Summary Objective Magnetic resonance imaging (MRI) has greater sensitivity to detect osteoarthritis (OA) damage than radiographs but it is uncertain which MRI findings in early OA are clinically important. We examined MRI abnormalities detected in knees without radiographic OA and their association with incident knee symptoms. Method Participants from the Multicenter Osteoarthritis Study (MOST) without frequent knee symptoms (FKS) at baseline were eligible if they also lacked radiographic features of OA at baseline. At 15 months, knees that developed FKS were defined as cases while control knees were drawn from those that remained without FKS. Baseline MRIs were scored at each subregion for cartilage lesions (CARTs); osteophytes (OST); bone marrow lesions (BML) and cysts. We compared cases and controls using marginal logistic regression models, adjusting for age, gender, race, body mass index (BMI), previous injury and clinic site. Results 36 case knees and 128 control knees were analyzed. MRI damage was common in both cases and controls. The presence of a severe CART (P = 0.03), BML (P = 0.02) or OST (P = 0.02) in the whole knee joint was more common in cases while subchondral cysts did not differ significantly between cases and controls (P > 0.1). Case status at 15 months was predicted by baseline damage at only two locations; a BML in the lateral patella (P = 0.047) and at the tibial subspinous subregions (P = 0.01). Conclusion In knees without significant symptoms or radiographic features of OA, MRI lesions of OA in only a few specific locations preceded onset of clinical symptoms and suggest that changes in bone play a role in the early development of knee pain. Confirmation of these findings in other prospective studies of knee OA is warranted. PMID:19919856

  16. Effect of opening-wedge high tibial osteotomy on the three-dimensional kinematics of the knee.

    PubMed

    d'Entremont, A G; McCormack, R G; Horlick, S G D; Stone, T B; Manzary, M M; Wilson, D R

    2014-09-01

    Although it is clear that opening-wedge high tibial osteotomy (HTO) changes alignment in the coronal plane, which is its objective, it is not clear how this procedure affects knee kinematics throughout the range of joint movement and in other planes. Our research question was: how does opening-wedge HTO change three-dimensional tibiofemoral and patellofemoral kinematics in loaded flexion in patients with varus deformity?Three-dimensional kinematics were assessed over 0° to 60° of loaded flexion using an MRI method before and after opening-wedge HTO in a cohort of 13 men (14 knees). Results obtained from an iterative statistical model found that at six and 12 months after operation, opening-wedge HTO caused increased anterior translation of the tibia (mean 2.6 mm, p < 0.001), decreased proximal translation of the patella (mean -2.2 mm, p < 0.001), decreased patellar spin (mean -1.4°, p < 0.05), increased patellar tilt (mean 2.2°, p < 0.05) and changed three other parameters. The mean Western Ontario and McMaster Universities Arthritis Index improved significantly (p < 0.001) from 49.6 (standard deviation (sd) 16.4) pre-operatively to a mean of 28.2 (sd 16.6) at six months and a mean of 22.5 (sd 14.4) at 12 months. The three-dimensional kinematic changes found may be important in explaining inconsistency in clinical outcomes, and suggest that measures in addition to coronal plane alignment should be considered. PMID:25183593

  17. [Reconstruction of quadriceps femoris muscle function with muscle transfer].

    PubMed

    Fansa, H; Meric, C

    2010-08-01

    Femoral nerve palsy, mostly of iatrogen cause, leads to paresis of quadriceps muscle with complete loss of knee extension. Therapeutical options include neurolysis, nerve reconstruction or functional muscle transplantations. Another concept is the transfer of hamstring muscles as described in post polio surgery. We describe our experience of biceps femoris and semitendinosus muscle transfer for reconstruction of knee extension. From 2003 to 2007 seven patients (mean age 43) with complete loss of knee extension after femoral nerve lesion were treated. Nerve palsy was caused by direct lesion, traction, hematoma after collapse, lesion of lumbosacral plexus and an unclear muscle dystrophy. Indication for muscle transfer was due to long standing muscle paresis. All patients received a transfer of biceps femoris and semitendinosus muscle/tendon into the quadriceps tendon. Patients were immobilised in a cast for 6 weeks in extended knee position. Weight bearing started after 8 weeks. Operations went uneventfully. All patients were able to extend the knee postoperatively against gravity and were able to climb stairs without help. 4 Patients had complete knee extension, 2 had a lack of 20 degrees , one of 30 degrees. Daily routine was possible in all cases. No instability of knee joints occurred postoperatively. In a nerve lesion close to the muscle a nerve reconstruction should be aimed. If not performed or with unsuccessful outcome, muscle transfer is a good option to restore function. All recent studies describe good to excellent results with stable knees, allowing the patient to manage daily routine without assistance and to climb stairs up and down. Long term complications such as dislocation of patella or genu recurvatum were not observed in our patients. The latter results as typical complication in polio from weakening knee flexion through biceps femoris transfer, if the gastrocnemius muscle is not forceful enough. However in an isolated femoral nerve lesion this will rarely occur. PMID:20235008

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

    PubMed Central

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

    2012-01-01

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

  19. Lead exposure and rate of change in cognitive function in older women

    PubMed Central

    Power, Melinda C; Korrick, Susan; Tchetgen Tchetgen, Eric J; Nie, Linda H; Grodstein, Francine; Hu, Howard; Weuve, Jennifer; Schwartz, Joel; Weisskopf, Marc G

    2014-01-01

    Background Higher long-term cumulative lead exposure predicts faster cognitive decline in older men, but evidence of an association in women is lacking. Objective To determine if there is an association between lead exposure and cognitive decline in women. Methods This study considers a sample of 584 women from the Nurses’ Health Study who live in or near Boston, Massachusetts. We quantified lead exposure using biomarkers of lead exposure assessed in 1993–2004 and evaluated cognitive decline by repeated performance on a telephone battery of cognitive tests primarily assessing learning, memory, executive function, and attention completed in 1995–2008. All cognitive test scores were z-transformed for use in analyses. We used linear mixed models with random effects to quantify the association between each lead biomarker and change in cognition overall and on each individual test. Results Consideration of individual tests showed greater cognitive decline with increased tibia lead concentrations, a measure of long-term cumulative exposure, for story memory and category fluency. The estimated excess annual decline in overall cognitive test z-score per SD increase in tibia bone lead concentration was suggestive, although the confidence intervals included the null (0.024 standard units, 95% confidence interval: ?0.053 , 0.004 – an additional decline in function equivalent to being 0.33 years older). We found little support for associations between cognitive decline and patella or blood lead, which provide integrated measures of exposure over shorter timeframes. Conclusions Long-term cumulative lead exposure may be weakly associated with faster cognitive decline in community-dwelling women, at least in some cognitive domains. PMID:24529005

  20. A model of articular cruciate ligament reconstructive surgery: a validation construct and computational insights.

    PubMed

    Salehghaffari, Shahab; Dhaher, Yasin Y

    2014-05-01

    This study sought to develop a computational framework that emulates the articular cruciate ligament reconstruction surgery using transtibial portal technique. The proposed model included the tibia-femoral and patella-femoral joints, articular cartilage and menisci. Key surgical parameters were incorporated including bone-patellar-tendon-bone graft excision and pre-tensioning, tunnel morphology, bone plugs, and bone plug fixation. Several simulation steps were parameterized to reflect the clinically reported surgical procedure. Our focus was to explore the intra-operative effects of variations in tunnel directions on the selected metrics of joint mechanics during Lachman and Anterior Drawer tests. A mathematical construct capable of transforming the limited and heterogeneous experimental and surgical data to evidence-based validation was adopted to ensure the viability of the finite element models. We found that the proposed models, subject to a variation in tunnel directions, resulted in simulation outputs that favor the reported experimental data of Lachman and Anterior Drawer tests under uncertainty. Simulation results for a population of three-dimensional tunnel orientations provided insights into the graft-tunnel contact mechanics and the spatial stress distribution in the graft, insights that have been anecdotally observed in prior experimental studies. The intraarticular graft tension was found to be higher than the estimated in tunnel graft force, and larger differences were found for the least inclined tunnels exhibiting higher contact pressures, transverse bending and twisting of the graft and Von-Mises stress at the graft-femoral tunnel interface. Conversely, tunnels with high inclination angles exhibited higher intraarticular graft tension and Von-Mises stress at the graft-tibial bone plug interface. PMID:24690279

  1. A novel model for the study of synovial microcirculation in the mouse knee joint in vivo.

    PubMed

    Veihelmann, A; Szczesny, G; Nolte, D; Krombach, F; Refior, H J; Messmer, K

    1998-07-01

    A novel model for the investigation of the microcirculation in synovial tissue of the mouse knee joint is presented. The mouse knee joint was exposed on a specially designed plexiglass stage with a slight flexion. After partial resection of the skin, the patella tendon was cut transversally, which allowed for visualization of the "Hoffa's fatty body", an intraarticular fatty tissue containing synovial cells on the interior surface of the joint. An intravital fluorescence microscope was adjusted to observe the microcirculation of this intraarticular synovial tissue without opening of the joint capsula. For staining of the plasma, fluorescein isothiocyanate (FITC)-dextran was used, and for the staining of leukocytes rhodamine 6G was used. The tissue investigated presents with a high-density honeycomb-like capillary network, containing some postcapillary venules and a few arterioles. The following parameters were assessed off-line using a computer-assisted microcirculation analysis system: flow and diameter of arterioles and postcapillary venules, as well as functional capillary density. Moreover, leukocyte-endothelial cell interaction was quantified by counting the number of rolling cells and cells adhering to the endothelium in postcapillary venules. As an indication of endothelial leakage, macromolecular extravasation was also assessed. To validate the model, we investigated these parameters at three time points during an observation period of 60 min. There was no change in functional capillary density, nor in vessel diameter after 60 min of observation. Moreover, there was neither a change in the number of rolling cells, nor in the number of cells adhering to the endothelium nor in extravasation of FITC-dextran, thus indicating the stability of the preparation. The new model allows the quantitative analysis of the intraarticular microcirculation of the synovial fatty tissue in vivo. It provides insight into the dynamics of synovial microcirculation and leukocyte-endothelial cell interaction in acute or chronic joint inflammation. PMID:9706669

  2. Repeated freeze-thaw cycles reduce the survival rate of osteocytes in bone-tendon constructs without affecting the mechanical properties of tendons.

    PubMed

    Suto, Kaori; Urabe, Ken; Naruse, Kouji; Uchida, Kentaro; Matsuura, Terumasa; Mikuni-Takagaki, Yuko; Suto, Mitsutoshi; Nemoto, Noriko; Kamiya, Kentaro; Itoman, Moritoshi

    2012-03-01

    Frozen bone-patellar tendon bone allografts are useful in anterior cruciate ligament reconstruction as the freezing procedure kills tissue cells, thereby reducing immunogenicity of the grafts. However, a small portion of cells in human femoral heads treated by standard bone-bank freezing procedures survive, thus limiting the effectiveness of allografts. Here, we characterized the survival rates and mechanisms of cells isolated from rat bones and tendons that were subjected to freeze-thaw treatments, and evaluated the influence of these treatments on the mechanical properties of tendons. After a single freeze-thaw cycle, most cells isolated from frozen bone appeared morphologically as osteocytes and expressed both osteoblast- and osteocyte-related genes. Transmission electron microscopic observation of frozen cells using freeze-substitution revealed that a small number of osteocytes maintained large nuclei with intact double membranes, indicating that these osteocytes in bone matrix were resistant to ice crystal formation. We found that tendon cells were completely killed by a single freeze-thaw cycle, whereas bone cells exhibited a relatively high survival rate, although survival was significantly reduced after three freeze-thaw cycles. In patella tendons, the ultimate stress, Young's modulus, and strain at failure showed no significant differences between untreated tendons and those subjected to five freeze-thaw cycles. In conclusion, we identified that cells surviving after freeze-thaw treatment of rat bones were predominantly osteocytes. We propose that repeated freeze-thaw cycles could be applied for processing bone-tendon constructs prior to grafting as the treatment did not affect the mechanical property of tendons and drastically reduced surviving osteocytes, thereby potentially decreasing allograft immunogenecity. PMID:21116722

  3. Site-specific ultrasound reflection properties and superficial collagen content of bovine knee articular cartilage

    NASA Astrophysics Data System (ADS)

    Laasanen, Mikko S.; Saarakkala, Simo; Töyräs, Juha; Rieppo, Jarno; Jurvelin, Jukka S.

    2005-07-01

    Previous quantitative 2D-ultrasound imaging studies have demonstrated that the ultrasound reflection measurement of articular cartilage surface sensitively detects degradation of the collagen network, whereas digestion of cartilage proteoglycans has no significant effect on the ultrasound reflection. In this study, the first aim was to characterize the ability of quantitative 2D-ultrasound imaging to detect site-specific differences in ultrasound reflection and backscattering properties of cartilage surface and cartilage-bone interface at visually healthy bovine knee (n = 30). As a second aim, we studied factors controlling ultrasound reflection properties of an intact cartilage surface. The ultrasound reflection coefficient was determined in time (R) and frequency domains (IRC) at medial femoral condyle, lateral patello-femoral groove, medial tibial plateau and patella using a 20 MHz ultrasound imaging instrument. Furthermore, cartilage surface roughness was quantified by calculating the ultrasound roughness index (URI). The superficial collagen content of the cartilage was determined using a FT-IRIS-technique. A significant site-dependent variation was shown in cartilage thickness, ultrasound reflection parameters, URI and superficial collagen content. As compared to R and IRC, URI was a more sensitive parameter in detecting differences between the measurement sites. Ultrasound reflection parameters were not significantly related to superficial collagen content, whereas the correlation between R and URI was high. Ultrasound reflection at the cartilage-bone interface showed insignificant site-dependent variation. The current results suggest that ultrasound reflection from the intact cartilage surface is mainly dependent on the cartilage surface roughness and the collagen content has a less significant role.

  4. Graft selection in anterior cruciate ligament reconstruction.

    PubMed

    Miller, Suzanne L; Gladstone, James N

    2002-10-01

    Selecting the appropriate graft for ACL reconstruction depends on numerous factors including surgeon philosophy and experience, tissue availability (affected by anatomical anomalies or prior injury or surgery), and patient activity level and desires. Although the patella tendon autograft has the widest experience in the literature, and is probably the most commonly used graft source, this must be tempered with the higher reported incidences of potential morbidity and pitfalls associated with its use. The hamstring tendons are gaining increasing popularity, mostly due to reduced harvest morbidity and improved soft tissue fixation techniques, and many recent studies in the literature report equal results to BTB ACL reconstruction with respect to functional outcome and patient satisfaction. On the other hand, many of these studies report higher degrees of instrument (KT-100) tested laxity for hamstring reconstruction, and some have reported lower returns to preinjury levels of activity. One question that remains to be addressed is how closely objectively measured laxity tests correlate with subjectively assessed outcomes and ability to return to high levels of competitive sports. Allograft use, which decreased in popularity during the 1990s, appears to be undergoing a resurgence, with better sterilization processes and new graft sources (tibialis tendons), leading to increased availability and improved fixation techniques. The benefits of decreased surgical morbidity and easier rehabilitation must be weighed against the potential for greater failure of biologic incorporation, infection, and possibly slower return to activities. In our practice, for high-demand individuals (those playing cutting, pivoting, or jumping sports and skiing) BTB tends to be the graft of choice. For lower demand or older individuals, hamstring reconstructions will be performed. Allograft tissue will be used in older individuals (generally over 45 years old), those with signs of arthritis (and compelling evidence of instability), or those individuals who understand the pros and cons of allograft use fully and do not want their own tissue used. PMID:12528909

  5. Genome-wide survey indicates involvement of loci on canine chromosomes 7 and 31 in patellar luxation in flat-coated retrievers

    PubMed Central

    2014-01-01

    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. PMID:24886090

  6. Extended healing validation of an artificial tendon to connect the quadriceps muscle to the Tibia: 180-day study.

    PubMed

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

    2012-07-01

    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 non-living 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 contralateral unoperated control legs at 180 days. Maximum forces in the operated leg (vs. unoperated) were 1,400 ± 93 N (vs. 1,179 ± 61 N), linear stiffnesses were 33 ± 3 N/mm (vs. 37 ± 4 N/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 orthopedic oncology, revision arthroplasty, tendon transfer, and tendon injury reconstruction. PMID:22179930

  7. A novel method for determining articular cartilage chondrocyte mechanics in vivo.

    PubMed

    Abusara, Z; Seerattan, R; Leumann, A; Thompson, R; Herzog, W

    2011-03-15

    Work relating the mechanical states of articular cartilage chondrocytes to their biosynthetic responses is based on measurements in isolated cells or cells in explant samples removed from their natural in situ environment. Neither the mechanics nor the associated biological responses of chondrocytes have ever been studied in cartilage within a joint of a live animal, and no such measurements have ever been performed using physiologically relevant joint loading through muscular contractions. The purpose of this study was to design and apply a method to study the mechanics of chondrocytes in the exposed but fully intact knee of live animals, which was loaded near-physiologically through muscular contraction. In order to achieve this purpose, we developed an accurate and reliable method based on two-photon laser excitation microscopy. Near-physiological knee joint loading was achieved through controlled electrical activation of the knee extensor muscles that compress the articulating surfaces of the femur, tibia and patella. Accuracy of the system was assessed by inserting micro-beads of known dimensions into the articular cartilage of the mouse knee and comparing the measured volumes and diameters in the principal directions with known values of the beads. Accuracy was best in the plane perpendicular to the optical axis (average error = 1%) while it was slightly worse, but still excellent, along the optical axis (average error = 3%). Reliability of cell volume and shape measurements was 0.5% on average, and 2.9% in the worst-case-scenario. Pilot measurements of chondrocyte deformations upon sub-maximal muscular loading causing a mean articular contact pressure of 1.9 ± 0.2 MPa showed an "instantaneous" decrease in cell height (17 ± 4.5%) and loss of cell volume (22.3 ± 2.4%) that took minutes to recover upon deactivation of the knee extensor muscles. PMID:21145552

  8. Lower extremity finite element model for crash simulation

    SciTech Connect

    Schauer, D.A.; Perfect, S.A.

    1996-03-01

    A lower extremity model has been developed to study occupant injury mechanisms of the major bones and ligamentous soft tissues resulting from vehicle collisions. The model is based on anatomically correct digitized bone surfaces of the pelvis, femur, patella and the tibia. Many muscles, tendons and ligaments were incrementally added to the basic bone model. We have simulated two types of occupant loading that occur in a crash environment using a non-linear large deformation finite element code. The modeling approach assumed that the leg was passive during its response to the excitation, that is, no active muscular contraction and therefore no active change in limb stiffness. The approach recognized that the most important contributions of the muscles to the lower extremity response are their ability to define and modify the impedance of the limb. When nonlinear material behavior in a component of the leg model was deemed important to response, a nonlinear constitutive model was incorporated. The accuracy of these assumptions can be verified only through a review of analysis results and careful comparison with test data. As currently defined, the model meets the objective for which it was created. Much work remains to be done, both from modeling and analysis perspectives, before the model can be considered complete. The model implements a modeling philosophy that can accurately capture both kinematic and kinetic response of the lower limb. We have demonstrated that the lower extremity model is a valuable tool for understanding the injury processes and mechanisms. We are now in a position to extend the computer simulation to investigate the clinical fracture patterns observed in actual crashes. Additional experience with this model will enable us to make a statement on what measures are needed to significantly reduce lower extremity injuries in vehicle crashes. 6 refs.

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

    PubMed Central

    2013-01-01

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

  10. MR Signal Characteristics of Viable and Apoptotic Human Mesenchymal Stem Cells in MASI for Treatment of Osteoarthritis

    PubMed Central

    Nedopil, Alexander; Klenk, Christopher; Kim, Cy; Liu, Siyuan; Wendland, Mike; Golovko, Daniel; Schuster, Tibor; Sennino, Barbara; McDonald, Donald M.; Daldrup-Link, Heike E.

    2010-01-01

    Objective To compare MR signal characteristics of contrast agent-labeled apoptotic and viable human mesenchymal stem cells (hMSCs) in matrix associated stem cell implants (MASI). Methods hMSCs were labeled with FDA approved ferumoxides nanoparticles. One group (A) remained untreated while a second group (B) underwent Mitomycin C-induced apoptosis induction. Viability of group A and apoptosis of group B was confirmed by Caspase-assays and TUNEL stains. Labeled viable hMSCs, unlabeled viable hMSCs, labeled apoptotic hMSCs and unlabeled apoptotic hMSCs (n=7 samples each) in an agarose scaffold were implanted into cartilage defects of porcine patellae specimens and underwent MR imaging at 7T, using T1 weighted SE sequences, T2-weighted SE sequences and T2*-weighted GE sequences. Signal to noise ratios (SNR) of the implants were calculated and compared between different experimental groups using linear mixed regression models (LMM). Results Ferumoxides-labeled hMSCs provided a strong negative T2 and T2*-enhancement. Corresponding SNR data of labeled hMSCs were significantly lower compared to unlabeled controls (p<0.05). Apoptosis induction resulted in a significant signal decline of ferumoxides-labeled hMSC transplants on short TE T2-weighted sequences. SNR data of labeled apoptotic hMSCs were significantly lower compared to labeled viable hMSCs (p<0.05). Conclusion Apoptosis of transplanted ferumoxides-labeled stem cells in cartilage defects can be visualized non-invasively by a significant signal decline on T2-weighted MR images. The described MR signal characteristics may serve as a non-invasive outcome measure for the assessment of MASI therapies in clinical practice. Additional studies are needed to further enhance the observed differences between viable and apoptotic cells, e.g. by further optimizing the applied MR pulse sequence parameters or by determining more robust T2-relaxation times. PMID:20808236

  11. Disease associated balanced chromosome rearrangements: a resource for large scale genotype-phenotype delineation in man

    PubMed Central

    Bugge, M.; Bruun-Petersen, G.; Brondum-Nielsen, K.; Friedrich, U.; Hansen, J.; Jensen, G.; Jensen, P.; Kristoffersson, U.; Lundsteen, C.; Niebuhr, E.; Rasmussen, K.; Rasmussen, K.; Tommerup, N.

    2000-01-01

    Disease associated balanced chromosomal rearrangements (DBCRs), which truncate, delete, or otherwise inactivate specific genes, have been instrumental for positional cloning of many disease genes. A network of cytogenetic laboratories, Mendelian Cytogenetics Network (MCN), has been established to facilitate the identification and mapping of DBCRs. To get an estimate of the potential of this approach, we surveyed all cytogenetic archives in Denmark and southern Sweden, with a population of ~6.6 million. The nine laboratories have performed 71 739 postnatal cytogenetic tests. Excluding Robertsonian translocations and chromosome 9 inversions, we identified 216 DBCRs (~0.3%), including a minimum estimate of 114 de novo reciprocal translocations (0.16%) and eight de novo inversions (0.01%). Altogether, this is six times more frequent than in the general population, suggesting a causal relationship with the traits involved in most of these cases. Of the identified cases, only 25 (12%) have been published, including 12 cases with known syndromes and 13 cases with unspecified mental retardation/congenital malformations. The remaining DBCRs were associated with a plethora of traits including mental retardation, dysmorphic features, major congenital malformations, autism, and male and female infertility. Several of the unpublished DBCRs defined candidate breakpoints for nail-patella, Prader-Willi, and Schmidt syndromes, ataxia, and ulna aplasia. The implication of the survey is apparent when compared with MCN; altogether, the 292 participating laboratories have performed >2.5 million postnatal analyses, with an estimated ~7500 DBCRs stored in their archives, of which more than half might be causative mutations. In addition, an estimated 450-500 novel cases should be detected each year. Our data illustrate that DBCRs and MCN are resources for large scale establishment of phenotype-genotype relationships in man.???Keywords: translocations; inversions; abnormal phenotypes; frequency PMID:11073540

  12. Posterior cruciate ligament balancing in total knee arthroplasty: a numerical study with a dynamic force controlled knee model

    PubMed Central

    2014-01-01

    Background Adequate soft tissue balancing is a key factor for a successful result after total knee arthroplasty (TKA). Posterior cruciate ligament (PCL) is the primary restraint to posterior translation of the tibia after cruciate retaining TKA and is also responsible for the amount of joint compression. However, it is complex to quantify the amount of ligament release with its effects on load bearing and kinematics in TKA and limited both in vivo and in vitro. The goal of this study was to create a dynamic and deformable finite element model of a full leg and analyze a stepwise release of the PCL regarding knee kinematics, pressure distribution and ligament stresses. Methods A dynamic finite element model was developed in Ansys V14.0 based on boundary conditions of an existing knee rig. A cruciate retraining knee prosthesis was virtually implanted. Ligament and muscle structures were simulated with modified spring elements. Linear elastic materials were defined for femoral component, inlay and patella cartilage. A restart algorithm was developed and implemented into the finite element simulation to hold the ground reaction force constant by adapting quadriceps force. After simulating the unreleased PCL model, two models were developed and calculated with the same boundary conditions with a 50% and 75% release of the PCL stiffness. Results From the beginning of the simulation to approximately 35° of flexion, tibia moves posterior related to the femur and with higher flexion anteriorly. Anterior translation of the tibia ranged from 5.8 mm for unreleased PCL to 3.7 mm for 75% PCL release (4.9 mm 50% release). A decrease of maximum von Mises equivalent stress on the inlay was given with PCL release, especially in higher flexion angles from 11.1 MPa for unreleased PCL to 8.9 MPa for 50% release of the PCL and 7.8 MPa for 75% release. Conclusions Our study showed that dynamic FEM is an effective method for simulation of PCL balancing in knee arthroplasty. A tight PCL led in silico to more anterior tibia translation, a higher collateral ligament and inlay stress, while retropatellar pressure remained unchanged. Surgeons may take these results in vivo into account. PMID:24990257

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

    PubMed Central

    2013-01-01

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

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

    PubMed Central

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

    2007-01-01

    Background Conventional knee and hip implant systems have been in use for many years with good success. However, the custom design of implant components based on patient-specific anatomy has been attempted to overcome existing shortcomings of current designs. The longevity of cementless implant components is highly dependent on the initial fit between the bone surface and the implant. The bone-implant interface design has historically been limited by the surgical tools and cutting guides available; and the cost of fabricating custom-designed implant components has been prohibitive. Methods This paper describes an approach where the custom design is based on a Computed Tomography scan of the patient's joint. The proposed design will customize both the articulating surface and the bone-implant interface to address the most common problems found with conventional knee-implant components. Finite Element Analysis is used to evaluate and compare the proposed design of a custom femoral component with a conventional design. Results The proposed design shows a more even stress distribution on the bone-implant interface surface, which will reduce the uneven bone remodeling that can lead to premature loosening. Conclusion The proposed custom femoral component design has the following advantages compared with a conventional femoral component. (i) Since the articulating surface closely mimics the shape of the distal femur, there is no need for resurfacing of the patella or gait change. (ii) Owing to the resulting stress distribution, bone remodeling is even and the risk of premature loosening might be reduced. (iii) Because the bone-implant interface can accommodate anatomical abnormalities at the distal femur, the need for surgical interventions and fitting of filler components is reduced. (iv) Given that the bone-implant interface is customized, about 40% less bone must be removed. The primary disadvantages are the time and cost required for the design and the possible need for a surgical robot to perform the bone resection. Some of these disadvantages may be eliminated by the use of rapid prototyping technologies, especially the use of Electron Beam Melting technology for quick and economical fabrication of custom implant components. PMID:17854508

  15. Intra-articular injection of mesenchymal stem cells leads to reduced inflammation and cartilage damage in murine antigen-induced arthritis

    PubMed Central

    2014-01-01

    Background Rheumatoid arthritis (RA) is a debilitating and painful disease leading to increased morbidity and mortality and novel therapeutic approaches are needed. The purpose of this study was to elucidate if mesenchymal stem cells (MSCs) injected in the joints of mice with arthritis are therapeutic, reducing joint swelling and cartilage destruction. Methods Murine mesenchymal stem cells (mMSCs) were isolated from bone marrow of C57Bl/6 mice and expanded in culture. Cells were tested for immunophenotype and their ability to form colonies and to differentiate into chondrocytes, osteocytes and adipocytes. Antigen-induced arthritis (AIA) was induced by intra-articular injection of methylated bovine serum albumin into the knee joints of preimmunized C57Bl/6 mice. After one day, when peak swelling occurs, 500,000 mMSCs labelled with red fluorescent cell tracker CM-DiI were injected intra-articularly in the right knee joint. Left knee joints were treated as controls by receiving PBS injections. Differences between groups were calculated by Mann Whitney U test or unpaired t tests using GraphPad Prism software version 5. Results Knee joint diameter (swelling) was measured as a clinical indication of joint inflammation and this parameter was significantly less in MSC-treated mice compared to control-treated animals 48 hours after arthritis induction. This difference continued for ~7 days. CM-DiI-labelled MSCs were clearly visualised in the lining and sublining layers of synovium, in the region of the patella and femoral and tibial surfaces. By day 3, parameters indicative of disease severity, including cartilage depletion, inflammatory exudate and arthritic index were shown to be significantly reduced in MSC-treated animals. This difference continued for 7 days and was further confirmed by histological analysis. The serum concentration of tumour necrosis factor ? was significantly decreased following MSC administration. Conclusions Our results reveal that MSCs injected in the joints of mice with AIA are therapeutic, reducing inflammation, joint swelling and cartilage destruction. These cells also integrate into the synovium in AIA. PMID:24893776

  16. Changes in Morphological and Elastic Properties of Patellar Tendon in Athletes with Unilateral Patellar Tendinopathy and Their Relationships with Pain and Functional Disability

    PubMed Central

    Zhang, Zhi Jie; Ng, Gabriel Yin-fat; Lee, Wai Chun; Fu, Siu Ngor

    2014-01-01

    Background Patellar tendinopathy (PT) is one of the most common knee disorders among athletes. Changes in morphology and elasticity of the painful tendon and how these relate to the self-perceived pain and dysfunction remain unclear. Objectives To compare the morphology and elastic properties of patellar tendons between athlete with and without unilateral PT and to examine its association with self-perceived pain and dysfunction. Methods In this cross-sectional study, 33 male athletes (20 healthy and 13 with unilateral PT) were enrolled. The morphology and elastic properties of the patellar tendon were assessed by the grey and elastography mode of supersonic shear imaging (SSI) technique while the intensity of pressure pain, self-perceived pain and dysfunction were quantified with a 10-lb force to the most painful site and the Victorian Institute of Sport Assessment-patella (VISA-P) questionnaire, respectively. Results In athletes with unilateral PT, the painful tendons had higher shear elastic modulus (SEM) and larger tendon than the non-painful side (p<0.05) or the dominant side of the healthy athletes (p<0.05). Significant correlations were found between tendon SEM ratio (SEM of painful over non-painful tendon) and the intensity of pressure pain (rho ?=?0.62; p?=?0.024), VISA-P scores (rho ?=??0.61; p?=?0.026), and the sub-scores of the VISA-P scores on going down stairs, lunge, single leg hopping and squatting (rho ranged from ?0.63 to ?0.67; p<0.05). Conclusions Athletes with unilateral PT had stiffer and larger tendon on the painful side than the non-painful side and the dominant side of healthy athletes. No significant differences on the patellar tendon morphology and elastic properties were detected between the dominant and non-dominant knees of the healthy control. The ratio of the SEM of painful to non-painful sides was associated with pain and dysfunction among athletes with unilateral PT. PMID:25303466

  17. The importance of previous fracture site on osteoporosis diagnosis and incident fractures in women.

    PubMed

    Morin, Suzanne N; Lix, Lisa M; Leslie, William D

    2014-07-01

    Previous fracture increases the risk of subsequent fractures regardless of the site of the initial fracture. Fracture risk assessment tools have been developed to guide clinical management; however, no discrimination is made as to the site of the prior fracture. Our objective was to determine which sites of previous nontraumatic fractures are most strongly associated with a diagnosis of osteoporosis, defined by a bone mineral density (BMD) T-score of ? -2.5 at the femoral neck, and an incident major osteoporotic fracture. Using administrative health databases, we conducted a retrospective historical cohort study of 39,991 women age 45 years and older who had BMD testing with dual-energy X-ray absorptiometry (DXA). Logistic regression and Cox proportional multivariate models were used to test the association of previous fracture site with risk of osteoporosis and incident fractures. Clinical fractures at the following sites were strongly and independently associated with higher risk of an osteoporotic femoral neck T-score after adjustment for age: hip (odds ratio [OR], 3.58; 95% confidence interval [CI], 3.04-4.21), pelvis (OR, 2.23; 95% CI, 1.66-3.0), spine (OR, 2.16; 95% CI, 1.77-2.62), and humerus (OR, 1.74; 95% CI, 1.49-2.02). Cox proportional hazards models, with adjustment for age and femoral neck BMD, showed the greatest increase in risk for a major osteoporotic fracture for women who had sustained previous fractures of the spine (hazard ratio [HR], 2.08; 95% CI, 1.72-2.53), humerus (HR, 1.70; 95% CI, 1.44-2.01), patella (HR, 1.54; 95% CI, 1.10-2.18), and pelvis (HR, 1.45; 95% CI, 1.04-2.02). In summary, our results confirm that nontraumatic fractures in women are associated with osteoporosis at the femoral neck and that the site of previous fracture impacts on future osteoporotic fracture risk, independent of BMD. PMID:24535832

  18. Efficacy of nonsurgical interventions for anterior knee pain: systematic review and meta-analysis of randomized trials.

    PubMed

    Collins, Natalie J; Bisset, Leanne M; Crossley, Kay M; Vicenzino, Bill

    2012-01-01

    Anterior knee pain is a chronic condition that presents frequently to sports medicine clinics, and can have a long-term impact on participation in physical activity. Conceivably, effective early management may prevent chronicity and facilitate physical activity. Although a variety of nonsurgical interventions have been advocated, previous systematic reviews have consistently been unable to reach conclusions to support their use. Considering a decade has lapsed since publication of the most recent data in these reviews, it is timely to provide an updated synthesis of the literature to assist sports medicine practitioners in making informed, evidence-based decisions. A systematic review and meta-analysis was conducted to evaluate the evidence for nonsurgical interventions for anterior knee pain. A comprehensive search strategy was used to search MEDLINE, EMBASE, CINAHL and Pre-CINAHL, PEDro, PubMed, SportDiscus, Web of Science, BIOSIS Previews, and the full Cochrane Library, while reference lists of included papers and previous systematic reviews were hand searched. Studies were eligible for inclusion if they were randomized clinical trials that used a measure of pain to evaluate at least one nonsurgical intervention over at least 2 weeks in participants with anterior knee pain. A modified version of the PEDro scale was used to rate methodological quality and risk of bias. Effect size calculation and meta-analyses were based on random effects models. Of 48 suitable studies, 27 studies with low-to-moderate risk of bias were included. There was minimal opportunity for meta-analysis because of heterogeneity of interventions, comparators and follow-up times. Meta-analysis of high-quality clinical trials supports the use of a 6-week multimodal physiotherapy programme (standardized mean difference [SMD] 1.08, 95% CI 0.73, 1.43), but does not support the addition of electromyography biofeedback to an exercise programme in the short-term (4 weeks: SMD -0.21, 95% CI -0.64, 0.21; 8-12 weeks: SMD -0.22, 95% CI -0.65, 0.20). Individual study data showed beneficial effects for foot orthoses with and without multimodal physiotherapy (vs flat inserts), exercise (vs control), closed chain exercises (vs open chain exercises), patella taping in conjunction with exercise (vs exercise alone) and acupuncture (vs control). Findings suggest that, in implementing evidence-based practice for the nonsurgical management of anterior knee pain, sports medicine practitioners should prescribe local, proximal and distal components of multimodal physiotherapy in the first instance for suitable patients, and then consider foot orthoses or acupuncture as required. PMID:22149696

  19. Evaluation and treatment of disorders of the infrapatellar fat pad.

    PubMed

    Dragoo, Jason L; Johnson, Christina; McConnell, Jenny

    2012-01-01

    The infrapatellar fat pad (IFP), also known as Hoffa's fat pad, is an intracapsular, extrasynovial structure that fills the anterior knee compartment, and is richly vascularized and innervated. Its degree of innervation, the proportion of substance-P-containing fibres and close relationship to its posterior synovial lining implicates IFP pathologies as a source of infrapatellar knee pain. Though the precise function of the IFP is unknown, studies have shown that it may play a role in the biomechanics of the knee or act as a store for reparative cells after injury. Inflammation and fibrosis within the IFP, caused by trauma and/or surgery can lead to a variety of arthrofibrotic lesions including Hoffa's disease, anterior interval scarring and infrapatellar contracture syndrome. Lesions or mass-like abnormalities rarely occur within the IFP, but their classification can be narrowed down by radiographical appearance. Clinically, patients with IFP pathology present with burning or aching infrapatellar anterior knee pain that can often be reproduced on physical exam with manoeuvres designed to produce impingement. Sagittal MRI is the most common imaging technique used to assess IFP pathology including fibrosis, inflammation, oedema, and mass-like lesions. IFP pathology is often successfully managed with physical therapy. Passive taping is used to unload or shorten an inflamed IFP, and closed chain quadriceps exercises can improve lower limb control and patellar congruence. Training of the gluteus medius and stretching the anterior hip may help to decrease internal rotation of the hip and valgus force at the knee. Gait training and avoiding hyperextension can also be used for long-term management. Injections within the IFP of local anaesthetic plus corticosteroids and IFP ablation with ultrasound guided alcohol injections have been successfully explored as treatments for IFP pain. IFP pathology refractory to physical therapy can be approached through a variety of operative treatments. Arthroscopic partial resection for IFP impingement and Hoffa's disease has showed favourable results; however, total excision of the IFP performed concomitantly with total knee arthroplasty (TKA) resulted in worse results when compared with TKA alone. Arthroscopic debridement of IFP fibrosis has been successfully used to treat extension block following anterior cruciate ligament reconstruction, and arthroscopic anterior interval release has been an effective treatment for pain associated with anterior interval scarring. Arthroscopic resection of infrapatellar plicae and denervation of the inferior pole of the patella have also been shown to be effective treatments for refractory infrapatellar pain. PMID:22149697

  20. Southwick Osteotomy Stabilised with External Fixator

    PubMed Central

    Grubor, Predrag; Mitkovic, Milorad; Grubor, Milan

    2014-01-01

    ABSTRACT Introduction: Epiphysiolysis of the femoral head is the most common accident occurring towards the end of pre-puberty and puberty growth. Case report: The author describes the experience in the treatment of chronic epiphysiolysis in two patients treated by Southwick osteotomy. The site is accessed by way of a 15-cm long lateral skin incision and the trochanteric region is reached through the layers. The osteotomy angles prepared beforehand on a thin aluminium model are used to mark the Southwick osteotomy site on the anterior and lateral sides at the level of the lesser trochanter. Before performing the trochanteric osteotomy, two Mitkovi? convergent pins type M20 are applied distally and proximally, above the planned osteotomy site. A tenotomy of the iliopsas muscle is performed, and then the previously marked bone triangle is redissected up to three quarters of the width of the femur. The distal part of the femur is rotated inwards, so that the patella is turned towards the ceiling. The osteotomised fragments of the femur are adapted, repositioned and fixated by installing an external fixator on the previously placed pins. Two more pins are placed, one proximally and one distally, with a view to adequately stabilising the femur. The patient was mobile from day two after the surgery. If, after the surgery, the lead surgeon realises that there is a requirement to make a correction of 5, 10 and 15 degrees of the valgus, varus, anteversion or retroversion deformity, the correction shall be performed without surgically opening the patient, using the fixator pins. Conclusion: After performing a Southwick osteotomy it is easier to adapt, reposition and fixate the osteotomised fragments of the femur using a fixator type M20. Adequate stability allows regaining mobility quickly, which in turn is the best prevention of chondrolysis of the hip. It is possible to make post-operative valgus, varus, anteversion and retroversion corrections of 5, 10 and 15 degrees without performing a surgery. Once the osteotomy is healed, the fixator type M20 is removed without any additional surgery. PMID:25568571

  1. Patient and surgery related factors associated with fatigue type polyethylene wear on 49 PCA and DURACON retrievals at autopsy and revision

    PubMed Central

    Rohrbach, Markus; Lüem, Martin; Ochsner, Peter E

    2008-01-01

    Background Polyethylene wear is an important factor for longevity of total knee arthroplasty. Proven and suspicious factors causing wear can be grouped as material, patient and surgery related. There are more studies correlating design and/or biomaterial factors to in vivo wear than those to patient and surgery related factors. Many retrieval studies just include revision implants and therefore may not be representative. This study is aimed to correlate patient- and surgery- related factors to visual wear score by minimizing design influence and include both autopsy and revision implants. Comparison between the groups was expected to unmask patient and surgery-related factors responsible for wear. Methods The amount of joint side wear on polyethylene retrievals was measured using a modification of an established visual wear score. Fatigue type wear was defined as summation of the most severe wear modes of delamination, pitting and cracks. Analysis of patient and surgery related variables suspicious to cause wear included prospectively sampled patient activity which was measured by self reported walking capacity. Statistical analysis was done by univariate analysis of variance. Activity level and implantation time were merged to an index of use and correlated to the wear score. Results Wear score after comparable implantation time was significantly less in the autopsy group. Even so, fatigue type wear accounted for 84 and 93 % of total wear score on autopsy and revision implants respectively. A highly significant influence on wear score was found in time of implantation (p = 0.002), level of activity (p = 0.025) and inserts belonging to revision group (p = 0.006). No influence was found for the kind of patella replacement (p = 0.483). Body mass index and accuracy of component alignment had no significant influence on visual wear score. Fatigue-type wear in the medial compartment was closely correlated to the index of use in the autopsy (R2 = 0.383) and the revision group (R2 = 0.813). Conclusion The present study's finding of substantial fatigue type wear in both autopsy and revision retrievals supports the theory that polyethylene fatigue strength is generally exceeded in this type of prosthesis. Furthermore, this study correlated fatigue-type polyethylene wear to an index of use as calculated by activity over time. Future retrieval studies may use activity over time as an important patient related factor correlated to the visual wear score. When evaluating total knee arthroplasty routine follow up, the surgeon must think of substantial wear present even without major clinical signs. PMID:18294372

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

    PubMed

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

    2004-08-01

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

  3. Evaluation of the uncertainties associated with in vivo X-ray fluorescence bone lead calibrations

    NASA Astrophysics Data System (ADS)

    Lodwick, Jeffrey C.

    An anthropometric leg phantom developed at the University of Cincinnati (UC) was used to evaluate the effects that changes in leg position and variation between subjects has on in vivo x-ray fluorescence (XRF) measurements of stable lead in bone. The changes in leg position that were evaluated include changes in source-phantom distance ranging between 0.0 mm and 30.0 mm and phantom rotation over 40 degrees. Source-phantom distance was determined to have a significant effect on XRF measurement results particularly at source-phantom distances greater than 10.0 mm. Rotation of the leg phantom through 40 degrees was determined to have no significant effect on XRF measurement results. Between subject factors that were evaluated include bone calcium content and overlying tissue thickness. Bone calcium content was determined to have a significant effect on XRF measurements when measuring lead in micrograms per gram bone material. However, if measurement results of micrograms of lead per gram calcium (or per gram bone mineral) is used the normalization method makes the change in calcium content not significant. Overlying tissue thickness was determined to have no significant effect on XRF measurement results with tissue thickness ranging between 5.7 and 11.62 mm. The UC leg phantom was modified to include a fibula bone phantom so that the effect that the fibula has on XRF measurement results could be evaluated. The fibula was determined to have no significant effect on XRF measurement results and in the future need not be incorporated into in vivo XRF calibration phantoms. A knee phantom was also developed for purposes of calibrations of in vivo XRF measurement of lead in the patella. XRF measurement results using this phantom were compared to results of XRF measurements made using the plaster-of-Paris (POP) phantoms. A significant difference was observed between the normalized count rates of the two phantom types when either micrograms of lead per gram of bone material or micrograms of lead per gram calcium (bone mineral) is used as the lead content. This difference is consistent with what is observed in real in vivo XRF measurements and indicates the need for the correction factors that are used.

  4. Committees

    NASA Astrophysics Data System (ADS)

    2012-11-01

    Leadership Team of the IAHR Committee for Hydraulic Machinery and Systems Eduard EGUSQUIZA, UPC Barcelona, Spain, Chair François AVELLAN, EPFL-LMH, Switzerland, Past Chair Richard K FISHER, Voith Hydro Inc., USA, Past Chair Fidel ARZOLA, Edelca, Venezuela Michel COUSTON, Alstom Hydro, France Niklas DAHLBÄCKCK, Vatenfall, Sweden Normand DESY, Andritz VA TECH Hydro Ltd., Canada Chisachi KATO, University of Tokyo, Japan Andrei LIPEJ, Turboinstitut, Slovenija Torbjørn NIELSEN, NTNU, Norway Romeo SUSAN-RESIGA, 'Politehnica' University Timisoara, Romania Stefan RIEDELBAUCH, Stuggart University, Germany Albert RUPRECHT, Stuttgart University, Germany Qing-Hua SHI, Dong Fang Electrical Machinery Co., China Geraldo TIAGO, Universidade Federal de Itajubá, Brazil International Advisory Committee Shouqi YUAN (principal) Jiangsu University China QingHua SHI (principal) Dong Fang Electrical Machinery Co. China Fidel ARZOLA EDELCA Venezuela Thomas ASCHENBRENNER Voith Hydro GmbH & Co. KG Germany Anton BERGANT Litostroj Power doo Slovenia B C BHAOYAL Research & Technology Centre India Hermod BREKKE NTNU Norway Stuart COULSON Voith Hydro Inc. USA Paul COOPER Fluid Machinery Research Inc USA V A DEMIANOV Power Machines OJSC Russia Bart van ESCH Technische Universiteit Eindhoven Netherland Arno GEHRER Andritz Hydro Graz Austria Akira GOTO Ebara Corporation Japan Adiel GUINZBURG The Boeing Company USA D-H HELLMANN KSB AG Germany Ashvin HOSANGADI Combustion Research and Flow Technology USA Byung-Sun HWANG Korea Institute of Material Science Korea Toshiaki KANEMOTO Kyushu Institute of Technology Japan Mann-Eung KIM Korean Register of Shipping Korea Jiri KOUTNIK Voith Hydro GmbH & Co. KG Germany Jinkook LEE Eaton Corporation USA Young-Ho LEE Korea Maritime University Korea Woo-Seop LIM Hyosung Goodsprings Inc Korea Jun MATSUI Yokohama National University Japan Kazuyoshi Mitsubishi H I Ltd, Japan MIYAGAWA Christophe NICOLET Power Vision Engineering Srl Switzerland Maryse PAGE Hydro Quebec IREQ, Varennes Canada Etienne PARKINSON Andritz Hydro Ltd. Switzerland B V S S S PRASAD Indian Institute of Technology Madras India Stefan RIEDELBAUCH Stuttgart University Germany Michel SABOURIN Alstom Hydro Canada Inc Canada Bruno SCHIAVELLO Flowserve Corporation USA Katsumasa SHIMMEI Hitachi Ltd Japan Christoph SINGRTüN VDMA Germany Ale? SKOTAK CKD Blansko Engineering, a s Czech Republic Toshiaki SUZUKI Toshiba Corporation Japan Andy C C TAN Queensland University of Technology Australia Geraldo TIAGO FILHO Universidade Federal de Itajuba Brazi Thi C VU Andritz Hydro Ltd Canada Satoshi WATANABE Kyushu University Japan S H WINOTO National University of Singapore Singapore Woo-Seong WOO STX Institute of Technology Korea International Technical Committee François AVELLAN (principal) EPFL-LMH Switzerland Xingqi LUO (principal) Xi'an University of Technology China Martin BÖHLE Kaiserslautern University Germany Gerard BOIS ENSAM France Young-Seok CHOI KITECH Korea Luca d'AGOSTINO University of Pisa Italy Eduard EGUSQUIZA Polytechnical University Catalonia Spain Arpad FAY University of Miskolcz Hungary Richard FISHER Voith Hydro Inc USA Regiane FORTES-PATELLA Institute Polytechnique de Grenoble France Aleksandar GAJIC University of Belgrade Serbia José GONZÁLEZ Universidad de Oviedo Spain François GUIBAULT Ecole Polytechnique de Montreal Canada Toshiaki IKOHAGI Tohoku University Japan Chisachi KATO University of Tokyo Japan Kwang-Yong KIM Inha University Korea Youn-Jea KIM Sungkyunkwan University Korea Smaine KOUIDRI Université Pierre et Marie Curie (Paris 6) France Shengcai LI Warwick University UK Adrian LUNGU Dunarea de Jos University of Galati Romania Torbjøm K NIELSEN NTNU Norway Michihiro NISHI Tsinghua University China Peter PELZ Darmstadt University Germany Frantisek POCHYLY Brno University Czech Republic Albert RUPRECHT University of Stuttgart Germany Rudolf SCHILLING Technische University München Germany Wei SHYY HKUST Hong Kong,China Romeo SUSAN-RESIGA Politehnica University of Timisoara Romania Kazuhiro TANAKA Kyushu Institute of

  5. Functional Outcomes of Mpfl Reconstruction VS. Graft Tissue Placement

    PubMed Central

    Larson, Evan; Edwards, Alan; Albright, John

    2014-01-01

    Background The medial patellofemoral ligament (MPFL) is essential for the maintenance of correct biomechanical function of the knee. Reconstruction of the MPFL is commonly used in the restoration of patellofemoral stability after traumatic lateral subluxation of the patella. Although a method to accurately determine the MPFL's insertion point has been described, it remains unclear if anatomic placement of MPFL graft tissue is essential for preservation of knee function after MPFL reconstruction. Thus, the purpose of this study was to determine the importance of anatomic placement of MPFL graft tissue for the preservation of knee function following MPFL reconstruction operations. Methods Twenty-seven subjects who underwent MPFL reconstruction operations were retrospectively analyzed. Postoperative radiographs were reviewed. Measurements were taken, and the placement of each patient's MPFL graft tissue was determined to be anatomic or non-anatomic based on radiographic methods previously described in the literature. Each subject's electronic medical record was then reviewed, and clinical data was recorded. Finally, the clinical outcomes of each patient were compared to placement location of the MPFL graft tissue in their procedure. Results Thirteen patients were found to have anatomic MPFL graft tissue placement, and 14 non-anatomic. A significant post-operative difference was found between groups in the following parameters: WOMAC pain (anatomic mean = 85.71 ± 11.34, non-anatomic mean = 75.00 ± 26.35 p = 0.018), function (anatomic mean = 85.85 ± 9.96, non-anatomic mean = 79.09 ± 24.45, p = 0.017) and in KOOS symptom (anatomic mean = 75.63 ± 11.79, non-anatomic mean = 67.83 ± 22.40, p = 0.024), pain (anatomic mean = 77.54 ± 8.61, non-anatomic mean = 71.39 ± 25.18, p = 0.01), ADL (anatomic mean = 85.85 ± 9.97, non-anatomic mean = 79.09 ± 24.45, p = 0.017) and overall (anatomic mean = 74.61 ± 10.33, non-anatomic mean = 69.41 ± 24.25, p = 0.01) scores. No significant difference was observed for post-op instability (p = 0.290) or apprehension (p = 0.496), improvement in WOMAC or KOOS, 2-week, 6-week, or final 1-year range of motion, WOMAC stiffness, or KOOS sport/recreation or QOL. Conclusion Within the range of graft placement values considered by this study, while no reduction in range of motion was seen, non-anatomic placement of MPFL graft tissue in MPFL reconstruction operations caused increased pain and decreased function, evidenced by post-operative KOOS and WOMAC scores. Clinical Relevance It seems that the pivotal step in MPFL reconstruction operations is ensuring correct patellofemoral tracking via intraoperative electrical femoral nerve stimulation. If this step of the procedure is performed correctly, non-anatomic placement will not limit range of motion, lead to continued apprehension, or affect the overall biomechanical functioning of the knee. PMID:25328457