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Sample records for chondromalacia patellae

  1. Chondromalacia.

    ERIC Educational Resources Information Center

    Connors, G. Patrick

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

  2. A novel biological approach to treat chondromalacia patellae.

    PubMed

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

    2013-01-01

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

  3. Anterior Knee Pain (Chondromalacia Patellae).

    ERIC Educational Resources Information Center

    Garrick, James G.

    1989-01-01

    This article presents a pragmatic approach to the definition, diagnosis, and management of anterior knee pain. Symptoms and treatment are described. Emphasis is on active involvement of the patient in the rehabilitation exercise program. (IAH)

  4. 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.

  5. Simultaneous, Isolated Traumatic Bilateral Patella Fractures

    PubMed Central

    Madi, Sandesh; Naik, Monappa; Rao, Sharath; Vijayan, Sandeep

    2016-01-01

    Introduction Isolated traumatic fractures of both Patellae, occurring at the same time, in an otherwise healthy person, are very rare. The Patella, as a subcutaneous and a cancellous bone, is vulnerable to injury. However, simultaneous injury to both Patellae without the involvement of any other bony injuries occurs infrequently, and only a few cases have been reported in the literature. Case Presentation We report a rare case of isolated, traumatic bilateral Patella fracture with unusual fracture patterns and briefly review the literature. Conclusions In simultaneous bilateral Patella fractures, good functional outcome can be expected following a stable surgical fixation and a structured rehabilitation regime. However, personality of the fracture determines salvage versus sacrifice of the Patella. PMID:27218047

  6. Recurrent Dislocation of the Patella

    PubMed Central

    Benítez, Gustavo

    2015-01-01

    Purpose: To evaluate results of medial patellofemoral ligament (MPFL) reconstruction associated with lateral release and advancement of vastus medialis in recurrent dislocation of the patella. Methods: We retrospectively evaluated 11 patients with a mean follow-up of 19 months. Mean age was 23, mainly women. We did MPFL reconstruction with semitendinosus or gracilis tendon depending on BMI, associated with advancement of vastus medialis and lateral release. Results: Mean Kujala score improved from 46,54 pts. preoperative to 88,36 postoperative. Our main complication was 1 patient with rigid knee, who required movilization under anesthesia and arthroscopic arthrolisis to improve her outcome. Conclusion: The combination of this techniques are a good alternative to treat patients with recurrent patella disclocation, with good short and mid-term results. Biomechanic intra and postop complications of MPFL reconstruction are related to patellar fixation, anatomic positioning of femoral tunnel and knee position of the graft fixation.

  7. Cement penetration after patella venting.

    PubMed

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

    2009-01-01

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

  8. Genetics Home Reference: nail-patella syndrome

    MedlinePlus

    ... are usually the most severely affected. In many people with this condition, the areas at the base of the nails (lunulae) are triangular instead of the usual crescent shape. Individuals with nail-patella ... of the patella is common. Some people with this condition may not be able to ...

  9. Floating patella associated with lymphoedema

    PubMed Central

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

    2015-01-01

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

  10. Medial Patella Subluxation: Diagnosis and Treatment

    PubMed Central

    McCarthy, Mark A.; Bollier, Mathew J.

    2015-01-01

    Medial patella subluxation is a disabling condition typically associated with previous patellofemoral instability surgery. Patients often describe achy pain with painful popping episodes. They often report that the patella shifts laterally, which occurs as the medial subluxed patella dramatically shifts into the trochlear groove during early knee flexion. Physical examination is diagnostic with a positive medial subluxation test. Nonoperative treatment, such as focused physical therapy and patellofemoral stabilizing brace, is often unsuccessful. Primary surgical options include lateral retinacular repair/imbrication or lateral reconstruction. Prevention is key to avoid medial patella subluxation. When considering patellofemoral surgery, important factors include appropriate lateral release indications, consideration of lateral retinacular lengthening vs release, correct MPFL graft placement and tension, and avoiding excessive medialization during tubercle transfer. This review article will analyze patient symptoms, diagnostic exam findings and appropriate treatment options, as well as pearls to avoid this painful clinical entity. PMID:26361441

  11. Transverse Stress Fracture of the Proximal Patella

    PubMed Central

    Atsumi, Satoru; Arai, Yuji; Kato, Ko; Nishimura, Akinobu; Nakazora, Shigeto; Nakagawa, Shuji; Ikoma, Kazuya; Fujiwara, Hiroyoshi; Sudo, Akihiro; Kubo, Toshikazu

    2016-01-01

    Abstract Among stress fractures associated with sports activities, patellar stress fracture is rare. Regarding patella stress fractures, so far only distal transverse or lateral longitudinal fractures have been reported, but there are no reports of transverse fractures occurring in the proximal patella. We describe an extremely rare case of transverse stress fracture of proximal patella in a 9-year-old athlete. A 9-year old boy, who participated in sports (sprints and Kendo) presented with left knee pain without any external injury. In plain radiographs, a fracture line was observed in the proximal 1/3 of the left patella, and a patella stress fracture was diagnosed. For treatment, because 7 months of conservative therapy showed no improvement, internal fixation was carried out using Acutrak screws, and bone union was thus achieved. Three months after the operation, he was able to return to his previous level of athletic sports activity. Regarding the mechanism of onset, it is believed that the causes are longitudinal traction force and patellofemoral contact pressure. On the other hand, the contact region of the patella with the femur changes with the flexion angle of the knee. In the current case, the fracture occurred at a site where the patella was in contact with the femur at a flexion angle of >90°, so it is believed that it occurred as a clinical condition from being subjected to repeated longitudinal traction force and patellofemoral contact pressure at a flexion angle of >90°, during the sports activities of sprints and Kendo. The nonunion of the transverse stress fracture of his proximal patella was successfully treated with internal fixation using Acutrak screws. PMID:26871789

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

    PubMed

    Peek, A C; Barry, M

    2012-10-01

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

  13. 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. PMID:25883819

  14. Breeding implications resulting from classification of patellae luxation in dogs.

    PubMed

    van Grevenhof, E M; Hazewinkel, H A W; Heuven, H C M

    2016-08-01

    Patellar luxation (PL) is one of the major hereditary orthopaedic abnormalities observed in a variety of dog breeds. When the patellae move sideways out of the trochlear groove, this is called PL. The PL score varies between dogs from normal to very severe. Reducing the prevalence of PL by breeding could prevent surgery, thereby improve welfare. Orthopaedic specialists differentiate between normal and loose patellae, where the patellae can be moved to the edge of the trochlear groove, considering scoring loose patellae as normal in the future. Loose patellae are considered acceptable for breeding so far by the breeding organization. The aim of this study was to analyse the genetic background of PL to decide on the importance of loose patellae when breeding for healthy dogs. Data are available from two dog breeds, that is Flat-coated Retrievers (n = 3808) and Kooiker dogs (n = 794), with a total of 4602 dogs. Results show that loose patellae indicate that dogs are genetically more susceptible to develop PL because family members of the dogs with loose patellae showed more severe PL. In addition, the estimated breeding values for dogs with loose patellae indicate that breeding values of dogs with loose patellae were worse than breeding values obtained for dogs with a normal score. Given these results, it is advised to orthopaedic specialists to continue to score loose patellae as a separate class and to dog breeders to minimize the use of dogs in breeding with a genetically higher susceptibility for PL. PMID:26403830

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

    PubMed

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

    2015-06-01

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

  16. Patella dislocation following distal femoral replacement after bone tumour resection

    PubMed Central

    Akiyama, Toru; Kanda, Shotaro; Maeda, Akinori; Endo, Minoru; Saita, Kazuo

    2014-01-01

    We report the case of a 16-year-old girl with patella dislocation following distal femur replacement for a malignant tumour. We performed a medial plication and lateral release procedure to treat her persistent patellar dislocation after distal femur replacement following malignant tumour resection. This treatment improved the patient's gait ability dramatically. A distal femur reconstruction with a total knee arthroplasty (TKA) system for tumour resection is a frequently performed procedure. The reported incidence of patella dislocation following distal femur reconstruction with a TKA is 2.3%. However, treatment procedures for patella dislocation following a distal femur replacement after malignant tumour resection have not been studied extensively. To the best of our knowledge, this is the first English case report about patella dislocation following distal femoral replacement focusing on surgical treatment. Our experience suggests that treatment for patella dislocation following distal femur reconstruction with a TKA should be considered positively. PMID:25073529

  17. Arthroscopic removal of separated bipartite patella causing snapping knee syndrome.

    PubMed

    Yoo, Jae Ho; Kim, Eung Ha; Ryu, Ho Kwang

    2008-07-01

    The bipartite patella is a developmental osseous variant that is found in approximately 2% to 6% of the population, and is bilateral in 50%. The proposed etiologies include old nonunion, osteochondritis, and congenital growth defect. It is often found incidentally around the inferior pole, lateral margin, or superolateral border of the patella. It is usually asymptomatic, but may be related to anterior knee pain. However, separation of the bipartite patella is rare, with 9 cases reported in the literature. The symptomatic snapping knee syndrome may be caused by multiple intra-articular and extra-articular pathology including discoid meniscus, tumors, iliotibial band, popliteus, gracilis, semitendinosus, or biceps femoris tendon. However, no reports exist on separated bipartite patella as the feasible cause of the snapping knee syndrome in the orthopedic literature. This article presents a case of snapping knee syndrome due to separated bipartite patella. The accessory bone was removed by arthroscopy, which has rarely been described in the literature. PMID:19292364

  18. Human Identification via Lateral Patella Radiographs: A Validation Study.

    PubMed

    Niespodziewanski, Emily; Stephan, Carl N; Guyomarc'h, Pierre; Fenton, Todd W

    2016-01-01

    This research examines the utility of patella outline shape for matching 3D scans of patellae to knee radiographs using elliptical Fourier analysis and subjective methods of human visual comparison of patellae across radiographs for identification purposes. Repeat radiographs were captured of cadaver's knees for visual comparison before patellae were extracted and skeletonized for quantitative comparisons. Quantitative methods provided significant narrowing down of the candidate pool to just a few potential matches (<5% of original sample), while the human analysts showed high capacity for correctly matching radiographs, irrespective of educational level (positive predictive value = 99.8%). The successful computerized matching based on a single quantified patella trait (outline shape) helps explain the potency achieved by subjective visual examination. This work adds to a growing body of studies demonstrating the value of single isolated infracranial bones for human identification via radiographic comparison. PMID:26234529

  19. Early outcomes of patella resurfacing in total knee arthroplasty

    PubMed Central

    Clements, Warren J; Miller, Lisa; Whitehouse, Sarah L; Graves, Stephen E; Ryan, Philip

    2010-01-01

    Background Patella resurfacing in total knee arthroplasty is a contentious issue. The literature suggests that resurfacing of the patella is based on surgeon preference, and little is known about the role and timing of resurfacing and how this affects outcomes. Methods We analyzed 134,799 total knee arthroplasties using data from the Australian Orthopaedic Association National Joint Replacement Registry. Hazards ratios (HRs) were used to compare rates of early revision between patella resurfacing at the primary procedure (the resurfacing group, R) and primary arthroplasty without resurfacing (no-resurfacing group, NR). We also analyzed the outcomes of NR that were revised for isolated patella addition. Results At 5 years, the R group showed a lower revision rate than the NR group: cumulative per cent revision (CPR) 3.1% and 4.0%, respectively (HR = 0.75, p < 0.001). Revisions for patellofemoral pain were more common in the NR group (17%) than in the R group (1%), and “patella only” revisions were more common in the NR group (29%) than in the R group (6%). Non-resurfaced knees revised for isolated patella addition had a higher revision rate than patella resurfacing at the primary procedure, with a 4-year CPR of 15% and 2.8%, respectively (HR = 4.1, p < 0.001). Interpretation Rates of early revision of primary total knees were higher when the patella was not resurfaced, and suggest that surgeons may be inclined to resurface later if there is patellofemoral pain. However, 15% of non-resurfaced knees revised for patella addition are re-revised by 4 years. Our results suggest an early beneficial outcome for patella resurfacing at primary arthroplasty based on revision rates up to 5 years. PMID:19968604

  20. Congenital dislocation of the patella – clinical case☆

    PubMed Central

    Miguel Sá, Pedro; Raposo, Filipa; Santos Carvalho, Manuel; Alegrete, Nuno; Coutinho, Jorge; Costa, Gilberto

    2015-01-01

    Congenital patellar dislocation is a rare condition in which the patella is permanently dislocated and cannot be reduced manually. The patella develops normally as a sesamoid bone of the femur. This congenital dislocation results from failure of the internal rotation of the myotome that forms the femur, quadriceps muscle and extensor apparatus. It usually manifests immediately after birth, although in some rare cases, the diagnosis may be delayed until adolescence or adulthood. Early diagnosis is important, thereby allowing surgical correction and avoiding late sequelae, including early degenerative changes in the knee. A case of permanent dislocation of the patella is presented here, in a female child aged seven years. PMID:26962496

  1. Injury of a bipartite patella in a young upcoming sportsman.

    PubMed

    Stocker, Roland L; van Laer, Lutz

    2011-01-01

    The aim of this study was to report the clinical features of a young athletic patient with bipartite patella, and review the literature to discuss the entity of this rare anomaly. In the course of an athletics competition, a 12-year-old top sportsman felt an intense pain around his left knee-cap while taking off from a jumping-board and broke down the competition. X-rays and magnetic resonance imaging showed an isolated distal pole of the patella with just minor diastasis; however, the X-rays did not suggest a recent fracture but rather hint at an atypically injured bipartite patella. A conservative therapy of 5 weeks with brace followed including a ban on sport activities for 12 weeks. Ten weeks later, the radiographs revealed a complete consolidation. Six months after the injury, MRI only presented a generally inconspicuous horizontal sclerosed structure. A fracture or separation of the bipartite patella was retrospectively diagnosed. PMID:20490524

  2. Transverse Stress Fracture of the Proximal Patella: A Case Report.

    PubMed

    Atsumi, Satoru; Arai, Yuji; Kato, Ko; Nishimura, Akinobu; Nakazora, Shigeto; Nakagawa, Shuji; Ikoma, Kazuya; Fujiwara, Hiroyoshi; Sudo, Akihiro; Kubo, Toshikazu

    2016-02-01

    Among stress fractures associated with sports activities, patellar stress fracture is rare. Regarding patella stress fractures, so far only distal transverse or lateral longitudinal fractures have been reported, but there are no reports of transverse fractures occurring in the proximal patella. We describe an extremely rare case of transverse stress fracture of proximal patella in a 9-year-old athlete.A 9-year old boy, who participated in sports (sprints and Kendo) presented with left knee pain without any external injury. In plain radiographs, a fracture line was observed in the proximal 1/3 of the left patella, and a patella stress fracture was diagnosed. For treatment, because 7 months of conservative therapy showed no improvement, internal fixation was carried out using Acutrak screws, and bone union was thus achieved. Three months after the operation, he was able to return to his previous level of athletic sports activity.Regarding the mechanism of onset, it is believed that the causes are longitudinal traction force and patellofemoral contact pressure. On the other hand, the contact region of the patella with the femur changes with the flexion angle of the knee. In the current case, the fracture occurred at a site where the patella was in contact with the femur at a flexion angle of >90°, so it is believed that it occurred as a clinical condition from being subjected to repeated longitudinal traction force and patellofemoral contact pressure at a flexion angle of >90°, during the sports activities of sprints and Kendo. The nonunion of the transverse stress fracture of his proximal patella was successfully treated with internal fixation using Acutrak screws. PMID:26871789

  3. Pain in the knee associated with osteoporosis of the patella.

    PubMed Central

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

    1977-01-01

    Four patients, all of whom complained of pain in the knee, were found to have radiological evidence of osteoporosis particularly marked in the patella. In 3 a neurological lesion at the appropriate spinal segment was present, and the fourth patient, who was frankly hysterical, had an autonomic disturbance. If radiological porosis is isolated to the patella a distant cause such as nerve irritation should be sought. Images PMID:856068

  4. Biologic resurfacing of the patella: current status.

    PubMed

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

    2002-07-01

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

  5. Current concepts review: Fractures of the patella

    PubMed Central

    Gwinner, Clemens; Märdian, Sven; Schwabe, Philipp; Schaser, Klaus-D.; Krapohl, Björn Dirk; Jung, Tobias M.

    2016-01-01

    Fractures of the patella account for about 1% of all skeletal injuries and can lead to profound impairment due to its crucial function in the extensor mechanism of the knee. Diagnosis is based on the injury mechanism, physical examination and radiological findings. While the clinical diagnosis is often distinct, there are numerous treatment options available. The type of treatment as well as the optimum timing of surgical intervention depends on the underlying fracture type, the associated soft tissue damage, patient factors (i.e. age, bone quality, activity level and compliance) and the stability of the extensor mechanism. Regardless of the treatment method an early rehabilitation is recommended in order to avoid contractures of the knee joint capsule and cartilage degeneration. For non-displaced and dislocated non-comminuted transverse patellar fractures (2-part) modified anterior tension band wiring is the treatment of choice and can be combined – due to its biomechanical superiority – with cannulated screw fixation. In severe comminuted fractures, open reduction and fixation with small fragment screws or new angular stable plates for anatomic restoration of the retropatellar surface and extension mechanism results in best outcome. Additional circular cerclage wiring using either typical metal cerclage wires or resorbable PDS/non-resorbable FiberWires increases fixation stability and decreases risk for re-dislocation. Distal avulsion fractures should be fixed with small fragment screws and should be protected by a transtibial McLaughlin cerclage. Partial or complete patellectomy should be regarded only as a very rare salvage operation due to its severe functional impairment. PMID:26816667

  6. Current concepts review: Fractures of the patella.

    PubMed

    Gwinner, Clemens; Märdian, Sven; Schwabe, Philipp; Schaser, Klaus-D; Krapohl, Björn Dirk; Jung, Tobias M

    2016-01-01

    Fractures of the patella account for about 1% of all skeletal injuries and can lead to profound impairment due to its crucial function in the extensor mechanism of the knee. Diagnosis is based on the injury mechanism, physical examination and radiological findings. While the clinical diagnosis is often distinct, there are numerous treatment options available. The type of treatment as well as the optimum timing of surgical intervention depends on the underlying fracture type, the associated soft tissue damage, patient factors (i.e. age, bone quality, activity level and compliance) and the stability of the extensor mechanism. Regardless of the treatment method an early rehabilitation is recommended in order to avoid contractures of the knee joint capsule and cartilage degeneration. For non-displaced and dislocated non-comminuted transverse patellar fractures (2-part) modified anterior tension band wiring is the treatment of choice and can be combined - due to its biomechanical superiority - with cannulated screw fixation. In severe comminuted fractures, open reduction and fixation with small fragment screws or new angular stable plates for anatomic restoration of the retropatellar surface and extension mechanism results in best outcome. Additional circular cerclage wiring using either typical metal cerclage wires or resorbable PDS/non-resorbable FiberWires increases fixation stability and decreases risk for re-dislocation. Distal avulsion fractures should be fixed with small fragment screws and should be protected by a transtibial McLaughlin cerclage. Partial or complete patellectomy should be regarded only as a very rare salvage operation due to its severe functional impairment. PMID:26816667

  7. A case of nail-patella syndrome associated with thyrotoxicosis.

    PubMed

    Haras, B; Vulpoi, F; Onose, Gh

    2012-02-22

    Nail-patella syndrome, also known as hereditary onycho-osteodystrophy, is a rare autosomal dominant disorder with pleiotropic phenotypic expression.The present report is of a nail-patella syndrome patient, a 26-year-old female, admitted to our NeuroMuscular Rehabilitation Clinic Division for neurological symptoms, secondary to a severe spondylolysthesis with bilateral L5 pedicle fracture. During hospitalization, she was also diagnosed with mild thyrotoxicosis, but interestingly enough, the bone mineral density, assessed at multiple sites, was quasi-normal. PMID:22574102

  8. Patellar anomaly — a case review of quadripartite patella

    PubMed Central

    Grilliot, James R

    1985-01-01

    A case of quadripartite patella of the right knee is presented. Although multipartite patellar anomalous development is not uncommon, its differential diagnosis is critical to appropriate patient management. This case is somewhat unique in that it not only presented with multiple centers of nonunion, but was unilateral and symptomatic. ImagesFigure 1Figure 2

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

    PubMed Central

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

    2012-01-01

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

  10. Failure of total knee arthroplasty with or without patella resurfacing

    PubMed Central

    2011-01-01

    Background and purpose Patella resurfacing during primary total knee arthroplasty (TKA) is disputed and new prosthesis designs have been introduced without documentation of their survival. We assessed the impact on prosthesis survival of patella resurfacing and of prosthesis brand, based on data from the Norwegian Arthroplasty Register. Patients and methods 5 prosthesis brands in common use with and without patella resurfacing from 1994 through 2009 were included n = 11,887. The median follow-up times were 9 years for patella-resurfaced implants and 7 years for implants without patella resurfacing. For comparison of prosthesis brands, also brands in common use with only one of the two treatment options were included in the study population (n = 25,590). Cox regression analyses were performed with different reasons for revision as endpoints with adjustment for potential confounders. Results We observed a reduced overall risk of revision for patella resurfaced (PR) TKAs, but the statistical significance was borderline (RR = 0.84, p = 0.05). At 15 years, 92% of PR and 91% of patella non resurfaced (NR) prostheses were still unrevised. However, PR implants had a lower risk of revision due to pain alone (RR = 0.1, p < 0.001), but a higher risk of revision due to loosening of the tibial component (RR = 1.4, p = 0.03) and due to a defective polyethylene insert (RR = 3.2, p < 0.001). At 10 years, the survival for the reference NR brand AGC Universal was 93%. The NR brands Genesis I, Duracon, and Tricon (RR = 1.4–1.7) performed statistically significantly worse than NR AGC Universal, while the NR prostheses e.motion, Profix, and AGC Anatomic (RR = 0.1–0.7), and the PR prostheses NexGen and AGC Universal (RR = 0.4–0.5) performed statistically significantly better. LCS, NexGen, LCS Complete (all NR), and Tricon, Genesis I, LCS, and Kinemax (all PR) showed no differences in this respect from the reference brand. A lower risk of revision (crude) was found for TKAs

  11. Differential diagnosis of BPOP arising in relation to patella

    PubMed Central

    Pal, Jitendra Nath; Kar, Maitreyee; Hazra, Sunit; Basu, Anindya

    2015-01-01

    Introduction: Solitary exostosis is common at the metaphysis of long bones, and rarely may it develop in the lower pole of the patella. Usually it stops growing after skeletal maturity unless complicated. When the growth continues after skeletal maturity, other rare possibilities need to be considered such as bizarre parosteal osteochondromatous proliferation (BPOP). Though solitary exostosis is common at the metaphysis of long bones, very rarely it also develops in lower pole of the patella. Usually they stop growing after skeletal maturity unless complicated. When it starts after skeletal maturity and continues to grow, other rare possibilities like bizarre parostealosteochondromatousproliferation (BPOP) are to be thought of. Case Report: 21 years male student presented with anterior midline painless progressive swelling over right knee joint of one year duration which was hard, non-tender, fixed to patella but mobile with patella. X ray showed midline heterogeneously radio-opaque swelling attached to inferolateral aspect of the anterior surface of patella. Patellar out line is fully maintained except the narrow site of tumour attachment. After exposing through midline incision, the swelling was found to incorporate the patellar tendon completely and an anterior vertical midline cleavage was found. The mass was deliberately detached along the cleavage and from intact patellar tendon. Almost full range of knee movement is obtained in operation table. Immediate post operative 10° quadriceps lag was corrected with quadriceps setting exercises in two weeks time. Histopathological examination demonstrated thin layer of cartilage cover, irregular lamellar bone in deeper zone and spindle cells between them without cytoplasmic atypia. Plenty of cartilage cells in different stages of maturation are seen without column formation. Marrow elements are absent. Periosteum could not be demonstrated and there was no other evidence of malignancy. Features simulate

  12. Congenital patella dislocation in a child with Rubinstein-Taybi syndrome.

    PubMed

    Ceynowa, Marcin; Mazurek, Tomasz

    2009-01-01

    A child with Rubinstein-Taybi syndrome was diagnosed at birth with contraction of the left knee in flexion. A sonography of both knees, performed at 4 months of age, resulted in diagnosing a laterally displaced, hypoplastic left patella. Surgery was performed at 8 months of age as described by Stanisavljevic, which resulted in correct alignment of the patella. Follow-up examination at 2.5 years of age showed a contracture in flexion of 10 degrees , passively redressible with application of gentle force and clinically correct alignment of the patella. Sonography showed the left patella to be similar in size, shape, and position to the right patella. The child still did not walk because of mental retardation, but stood upright unsupported. Stanisavljevic procedure in this case gave good results. Sonography gives excellent view of the unossified patella, as well as other nearby soft tissues, and is sufficient for a correct diagnosis. PMID:19436246

  13. Ewings sarcoma of patella: A rare entity treated with a novel technique of extensor mechanism reconstruction using tendoachilles auto graft

    PubMed Central

    Valsalan, Rejith Mannambeth; Zacharia, Balaji

    2015-01-01

    We report a case of Ewings sarcoma (ES) involving the patella in a young female. ES of patella is a rare entity. The patient was presented with anterior knee pain and swelling arising from the patella. She was treated with neoadjuvant chemotherapy followed by wide excision of the patella and reconstruction of the extensor mechanism using split tendoachilles auto graft. The patella is an uncommon site for primary or metastatic tumors of the bone. ES, though rare, should be included in the differential diagnosis of swellings arising from the patella. Auto graft from the tendoachilles is a good alternative for reconstructing the extensor mechanism of the knee. PMID:26495252

  14. Secondary Aneurysmal Bone Cyst Following Chondroblastoma of the Patella

    PubMed Central

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

    2013-01-01

    Aneurysmal bone cyst (ABC) is a rare benign cystic lesion of the bone that composes 1-2% of the entire bone tumors. Some are idiopathic, and some occur secondary to other tumors such as giant cell tumor and chondroblastoma. In this article, we report the clinical, radiographic, and histological findings of a secondary ABC following chondroblastoma of the patella with a review of the literature. PMID:24179655

  15. Secondary aneurysmal bone cyst following chondroblastoma of the patella.

    PubMed

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

    2013-01-01

    Aneurysmal bone cyst (ABC) is a rare benign cystic lesion of the bone that composes 1-2% of the entire bone tumors. Some are idiopathic, and some occur secondary to other tumors such as giant cell tumor and chondroblastoma. In this article, we report the clinical, radiographic, and histological findings of a secondary ABC following chondroblastoma of the patella with a review of the literature. PMID:24179655

  16. The bovine patella as a model of early osteoarthritis

    PubMed Central

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

    2013-01-01

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

  17. Locked lateral patella dislocation: the role for the skyline view in the trauma setting

    PubMed Central

    Fleming, Tom

    2016-01-01

    Objective: Acute traumatic dislocation of the patella is a common problem. These cases often either spontaneously reduce or undergo successful closed reduction in Emergency Departments. We describe a rare case of an irreducible patella dislocation in a 15 year old boy following direct trauma. Method: Intra-operative skyline views revealed lateral dislocation of the patella with the patella ‘locked’ in internal rotation. Result: Closed reduction in theatre failed and open reduction was required. Conclusion: This case illustrates the benefit of the skyline view in the radiograph series following failed closed reduction, aiding the identification of atypical dislocations and osteochondral fracture fragments.

  18. When and How Is Patella Tracking Best Assessed in Total Knee Arthroplasty Surgery?

    PubMed

    Westerman, Richard W; Bhangoo, Navjot S; James, Peter

    2016-05-01

    Much emphasis has been placed on the role of patella resurfacing in total knee arthroplasty (TKA), yet the impact of soft tissue balancing has frequently been understated. The authors used a novel system to precisely assess patellofemoral joint (PFJ) tracking intraoperatively, to determine the impact of both retinacular reconstruction and tourniquet use on PFJ kinematics. PFJ kinematics assessed intraoperatively for 20 consecutive TKA patients. Measurements were recorded using both the "no thumb technique" and following reconstruction of the retinaculum with two positional sutures. The tourniquet was deflated and both measurements were repeated. Tourniquet inflation was not found to have a significant impact on the patella tracking (mean translation 0.9 mm, p = 0.15). Patella retinacular reconstruction generated a significant medialization of the patella by a mean of 5.5 mm (p < 0.0001) when compared with the traditional retinacular open "no thumb technique." The use of a tourniquet has been shown to have no effect on patella tracking. Reconstruction of the patella retinaculum markedly improves patella tracking, generating a mean medialization of 15%. The authors advocate the routine use of two positional sutures to restore the patella retinaculum, before trialing the patella component, as a reproducible means of assessing the PFJ kinematics. PMID:26266552

  19. [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

  20. Is Electrocautery of Patella Useful in Patella Non-Resurfacing Total Knee Arthroplasty?: A Prospective Randomized Controlled Study.

    PubMed

    Kwon, Sae Kwang; Nguku, Levis; Han, Chang Dong; Koh, Yong-Gon; Kim, Dong-Wook; Park, Kwan Kyu

    2015-12-01

    There is controversy over the need for electrocauterization of the patella in non-resurfacing total knee arthroplasty (TKA). We investigated whether this procedure is beneficial through a prospective randomized controlled trial. Fifty patients who underwent electrocautery were compared with 50 patients who did not undergo this procedure. We determined cartilage status, preoperative and postoperative American Knee Society (AKS) score, the Western Ontario and McMaster Universities score (WOMAC) and the Patellofemoral (PF) scores for a minimum of 5 years. The two groups did not differ significantly in demographics, intraoperative cartilage status, or preoperative or postoperative outcomes. No complications were detected in either group. We found no benefits of electrocautery of the patella in patellar non-resurfacing TKA up to 5 years. PMID:26100474

  1. Anatomy, morphology and evolution of the patella in squamate lizards and tuatara (Sphenodon punctatus).

    PubMed

    Regnault, Sophie; Jones, Marc E H; Pitsillides, Andrew A; Hutchinson, John R

    2016-05-01

    The patella (kneecap) is the largest and best-known of the sesamoid bones, postulated to confer biomechanical advantages including increasing joint leverage and reinforcing the tendon against compression. It has evolved several times independently in amniotes, but despite apparently widespread occurrence in lizards, the patella remains poorly characterised in this group and is, as yet, completely undescribed in their nearest extant relative Sphenodon (Rhynchocephalia). Through radiography, osteological and fossil studies we examined patellar presence in diverse lizard and lepidosauromorph taxa, and using computed tomography, dissection and histology we investigated in greater depth the anatomy and morphology of the patella in 16 lizard species and 19 Sphenodon specimens. We have found the first unambiguous evidence of a mineralised patella in Sphenodon, which appears similar to the patella of lizards and shares several gross and microscopic anatomical features. Although there may be a common mature morphology, the squamate patella exhibits a great deal of variability in development (whether from a cartilage anlage or not, and in the number of mineralised centres) and composition (bone, mineralised cartilage or fibrotendinous tissue). Unlike in mammals and birds, the patella in certain lizards and Sphenodon appears to be a polymorphic trait. We have also explored the evolution of the patella through ancestral state reconstruction, finding that the patella is ancestral for lizards and possibly Lepidosauria as a whole. Clear evidence of the patella in rhynchocephalian or stem lepidosaurian fossil taxa would clarify the evolutionary origin(s) of the patella, but due to the small size of this bone and the opportunity for degradation or loss we could not definitively conclude presence or absence in the fossils examined. The pattern of evolution in lepidosaurs is unclear but our data suggest that the emergence of this sesamoid may be related to the evolution of secondary

  2. Effect of bone block removal and patellar prosthesis on stresses in the human patella.

    PubMed

    Friis, E A; Cooke, F W; McQueen, D A; Henning, C E

    1994-01-01

    Thermoelastic stress analysis was used to examine stresses on the anterior surface of patellae after patellar bone block excision for autogenous graft anterior cruciate ligament reconstruction. Complications of anterior cruciate ligament injury often lead to degenerative changes in the knee that can require total knee joint replacement. It was hypothesized that stresses in a bone block-compromised patella may be increased even further by insertion of a patellar prosthesis. All patellae were first tested intact and then were retested after a sequence of surgical modifications including patellar prosthesis implantation, tapered bone block excision, square bone block excision, and both shapes of excised bone blocks with a patellar prosthesis in place. Stresses in patellae with bone blocks excised were significantly greater than stresses in intact patellae. The anterior surface stress pattern in the loaded patella was significantly altered by excision of a bone block. There were no significant differences between maximum stress in patellae with tapered and square bone blocks excised. A finite element analysis showed that excision of a larger trapezoid-shaped bone block greatly increased maximum stress levels. Insertion of a patellar prosthesis did not significantly alter stress patterns or maximum stress levels in the patella. PMID:7810796

  3. Linkage analysis of the Nail-patella syndrome

    SciTech Connect

    Campeau, E.; Watkins, D.; Rouleau, G.A.; Babul, R.; Der Kaloustian, V.M.; Buchanan, J.A.; Meschino, W.

    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.

  4. Analysis of Impingement between Patella Bone and Bearing Post in Cruciate-Substituting High-Flexion Total Knee Arthroplasty

    PubMed Central

    Chon, Jegyun; Shin, Sangyeop; Jang, Gunil; Jeon, Taehyeon

    2016-01-01

    Background We investigated the causes of impingement between the patella bone and the bearing post during high flexion in cruciate-substituting total knee arthroplasty and proposed a treatment strategy. Methods This prospective cohort study included 218 cases that had undergone cruciate-substituting total knee arthroplasty from February 2014 to January 2015; a single surgeon performed the operation using the same method without patellar resurfacing in all patients. Results In these patients, the occurrence of impingement was determined by performing more than 120° high knee flexion after inserting a bearing perioperatively. The incidence of impingement was significantly associated with bearing design, femoral implant size, patella bone length, and patella inferior pole angle (p < 0.05). The impingement was resolved by resection of the lower articular side of the patella bone. Conclusions In the cruciate-substituting high-flexion total knee arthroplasty, impingement between the patella bone and bearing post was more common in patients with mobile bearing, small-size femoral component, and a long patella or a large inferior pole angle. In cases of intraoperative impingement between the patella bone and the bearing post, resection in the lower portion of the patella prevented impingement of the bearing with soft tissue or the patella by widening the space between the patella and the bearing post, which in turn prevented postoperative reduction in range of motion. PMID:27247740

  5. Bipartite patella causing knee pain in young adults: a report of 5 cases.

    PubMed

    Vaishya, Raju; Chopra, Surender; Vijay, Vipul; Vaish, Abhishek

    2015-04-01

    We report on 5 patients who underwent arthroscopic excision or open reduction and internal fixation for bipartite patella. All patients presented with refractory anterior knee pain. The diagnosis of bipartite patella was made using radiography, and confirmed with magnetic resonance imaging or computed tomographic arthrography. All 5 patients achieved complete resolution of symptoms after surgery, and remained pain-free after a mean followup period of 13 months. PMID:25920661

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

    PubMed Central

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

    2015-01-01

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

  7. Superior Dislocation of the Patella in a Young Woman without Osteophytes: A Case Report.

    PubMed

    Kataoka, Tatsunori; Iizawa, Norishige; Takai, Shinro

    2016-01-01

    Superior dislocation of the patella without patellar ligament injury is an extremely rare condition. A review of the English-language literature found only 23 reported cases. In addition, the primary factor for dislocation in most of these cases was considered to be osteophytes in the inferior pole of the patella and the anterior surface of the femoral condyle; only 1 case had no osteophytes. We treated a 19-year-old woman who sustained a painful locking of the left knee after colliding with a friend. Plain radiography and computed tomography showed superior-lateral dislocation of the patella and an interlocking between notches in the inferior pole of the patella and the anterior surface of the femoral condyle. Closed reduction without sedation was performed without difficulty, and the patient was able to walk home without pain. After 1 week, the knee was without problems. The patient had no osteophytes in the knee and had no other common risk factors, such as patella alta, ligamentous laxity, genu recurvatum, and paralytic disorders. After a comparison with previously reported cases of superior patella dislocation, we concluded that the primary factor in the present case might have been a different condition. PMID:26960585

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

    PubMed Central

    Maiti, Raman; Fisher, John; Rowley, Liam

    2014-01-01

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

  9. 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

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

    PubMed Central

    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

  11. OSTEOCHONDRAL AUTOLOGOUS TRANSPLANTATION FOR TREATING CHONDRAL LESIONS IN THE PATELLA

    PubMed Central

    Cohen, Moises; Amaro, Joicemar Tarouco; Fernandes, Ricardo de Souza Campos; Arliani, Gustavo Gonçalves; Astur, Diego da Costa; Kaleka, Camila Cohen; Skaf, Abdalla

    2015-01-01

    Objective: The primary aim of this study was to assess the clinical and functional evolution of patients with total-thickness symptomatic cartilaginous injury of the patellar joint surface, treated by means of osteochondral autologous transplantation. Methods: This prospective study was conducted from June 2008 to March 2011 and involved 17 patients. The specific questionnaires of Lysholm, Kujala and Fulkerson were completed preoperatively and one year postoperatively in order to assess the affected knee, and SF-36 was used to assess these patients’ general quality of life. The nonparametric paired Wilcoxon test was used for statistical analysis on the pre and postoperative questionnaires. The data were analyzed using the SPSS for Windows software, version 16.0, and a significance level of 5% was used. Results: The Lysholm preoperative and postoperative average scores were 54.59 and 75.76 points (p < 0.05). The Fulkerson pre and postoperative average scores were 52.53 and 78.41 points (p < 0.05). Conclusions: We believe that autologous osteochondral transplantation is a good treatment method for total-thickness symptomatic chondral lesions of the joint surface of the patella. PMID:27042645

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

    PubMed

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

    2007-06-01

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

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

    PubMed

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

    1976-07-01

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

  14. Fine mapping of the nail-patella syndrome locus at 9q34.

    PubMed Central

    McIntosh, I; Clough, M V; Schäffer, A A; Puffenberger, E G; Horton, V K; Peters, K; Abbott, M H; Roig, C M; Cutone, S; Ozelius, L; Kwiatkowski, D J; Pyeritz, R E; Brown, L J; Pauli, R M; McCormick, M K; Francomano, C A

    1997-01-01

    Nail-patella syndrome (NPS), or onychoosteodysplasia, is an autosomal dominant, pleiotropic disorder characterized by nail dysplasia, absent or hypoplastic patellae, iliac horns, and nephropathy. Previous studies have demonstrated linkage of the nail-patella locus to the ABO and adenylate kinase loci on human chromosome 9q34. As a first step toward isolating the NPS gene, we present linkage analysis with 13 polymorphic markers in five families with a total of 69 affected persons. Two-point linkage analysis with the program MLINK showed tight linkage of NPS and the anonymous markers D9S112 (LOD = 27.0; theta = .00) and D9S315 (LOD = 22.0; theta = .00). Informative recombination events place the NPS locus within a 1-2-cM interval between D9S60 and the adenylate kinase gene (AK1). PMID:8981956

  15. Diagnosis and treatment of stress fracture of the patella in athletes.

    PubMed

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

    1996-01-01

    Five cases of stress fracture of the patella in athletes are presented. Four of these occurred transversally in the lower part and one longitudinally in the lateral part of the patella. Three of the patients were females (endurance runner, high jumper, and orienteerer) and two males (volleyball and soccer player). The diagnosis was made 2-8 months from the onset of the symptoms. Conservative treatment was successful in only one patient; all others were treated surgically, with good end result. Drilling of the fracture line was performed twice with metal wire cerclage fixation, excision of the lateral fragment was carried out once, and a bone graft with K wires and cerclage compression (tension band) was performed once. In all cases the patellar retinaculum was intact, indicating a stress injury. Stress fracture of the patella is a rare overuse injury, and therefore difficulties and delays in the diagnosis and treatment may occur. In cases with delayed diagnosis we recommend operative treatment. PMID:9046504

  16. OCD Lesions Of The Patella And Trochlea In Children

    PubMed Central

    Kramer, Dennis E.; Yen, Yi-Meng; Simoni, Michael; Miller, Patricia; Micheli, Lyle J.; Kocher, Mininder S.; Heyworth, Benton E.

    2015-01-01

    Objectives: The purpose of this report is to evaluate the functional outcomes of surgical management of OCD lesions of the patella and trochlea in children. Secondary aims include elucidating predictors for higher functional outcomes, determining complication rates, surgical satisfaction and ability to return to sports. Methods: Patients age ≤ 18 years who were surgically treated for OCD of the patellar or trochlea were identified. Charts were queried to record patient/lesion data, surgical procedure, results and complications. Pre- and postoperative imaging was reviewed. Patients were asked to complete a follow-up athletic questionnaire and a Pediatric International Knee Documentation Committee (Pedi-IKDC) score. Statistical analysis was conducted to look for predictors for reoperation, residual pain, ability to return to sports and lower Pedi-IKDC scores. Results: Twenty-six children (9 female, 17 male, 3 bilateral) were identified. Mean age was 14.7 (range: 9-18), 21/29 (72%) had open physes, and median follow-up was 3.8 years (range: 1-9 years). The most common location was the trochlea (17/29, 59%). Twenty-two lesions (76%) underwent transarticular drilling (n=14) or drilling with fixation (8), while 7 underwent excision and marrow stimulation. Four patients (14%) required unplanned re-operation. Internal fixation was predictive of reoperation (OR= 8.7, 95% CI= 2.8-26.9, P=0.04). At final follow up, 14 knees (48%) were pain-free, 14 (48%) had mild residual pain. Female gender was predictive of residual pain (OR= 9, 95% CI= 2-56, P=0.02). Twenty-two patients (85%) returned to sports. Longer duration of preoperative pain negatively impacted return to sports (OR= 0.32, 95% CI= 0.05-0.97, P=0.04). On postoperative imaging, the lesion appeared completely healed in 5 cases (42%) and partially healed in 12 cases (58%). All 15 survey respondents were satisfied with surgery. The mean Pedi-IKDC score was 82.4 ± 17.8 (range: 40.2 -100). Conclusion: Surgical treatment

  17. PLATEAU-PATELLA ANGLE: AN OPTION FOR ASSESSING PATELLAR HEIGHT ON PROXIMAL TIBIA OSTEOTOMY

    PubMed Central

    BONADIO, MARCELO BATISTA; TORRES, JÚLIO AUGUSTO DO PRADO; MAZZARO, VICENTE; HELITO, CAMILO PARTEZANI; GOBBI, RICCARDO GOMES; DEMANGE, MARCO KAWAMURA

    2016-01-01

    ABSTRACT Objective: To compare the plateau-patella angle method to the methods already established for patellar height measurement in patients undergoing high tibial osteotomy. Methods: This is a retrospective study of 13 patients undergoing medial opening tibial osteotomy. The patellar height was measured in pre and post-operative radiographs by the methods from Insall-Salvati, Caton-Deschamps, Blackburne-Peel and patella-plateau angle, as well as the tibial slope and length of the patellar tendon. Measurements were performed by two knee surgeons at two different times. Results: The mean age was 41.33 ± 01.09 years old. The average rates of Caton-Deschamps, Blackburne-Peel, Insall-Salvati and plateau-patella angle were, respectively, 1.00; 0.89; 1.10; and 23.15° preoperatively, and 0.89; 0.78; 1.11; and 20.46°, postoperatively. The correlation of Caton-Deschamps, Blackburne-Pell, and Insall-Salvati indexes and plateau-patellar angle interobserver was 0.72 (p <0.001), 0:54 (p <0.001), 0.65 (p <0.001), and 0.67 (w <0.001), respectively. Conclusion: The plateau-patella angle method undergoes changes that are correlated with changes in tibial slope after osteotomy, unlike the classical methods. This fact may lead to overestimate the reduction of patellar height after osteotomy. Level of evidence IV. Case Series. PMID:27217812

  18. Contact stresses with an unresurfaced patella in total knee arthroplasty: the effect of femoral component design.

    PubMed

    Matsuda, S; Ishinishi, T; Whiteside, L A

    2000-03-01

    Compressive contact stresses between the patella and the anterior femur were measured with a digital electronic sensor before and after total knee arthroplasty (TKA) in 10 cadaver knee specimens. Contact stresses were measured first in normal knees, then after TKA with the Insall-Burstein Total Condylar, Miller Galante II, Ortholoc II, Porous Coated Anatomic, and Profix knee prostheses implanted without resurfacing the patella. The Insall-Burstein, Miller-Galante II, and Ortholoc II prostheses had significantly higher contact stresses than the normal knee throughout the flexion arc. The Porous Coated Anatomic, which has a smooth patellar groove, maintained contact area as in the normal knee and did not have significantly higher contact stresses at flexion angles <90 degrees. At flexion angles > or =105 degrees, patellofemoral contact occurred in two small areas as the patella encountered the intercondylar notch in all components except the Profix. The Profix maintained full contact and low compressive stresses throughout the full flexion arc because of its posteriorly extended patellar groove. Design features of the patellofemoral portion of TKA components are important factors that affect contact stresses in the patellofemoral joint. These features likely will affect the clinical results of TKA with an unresurfaced patella. PMID:10741365

  19. Aneurysmal bone cyst secondary to a giant cell tumor of the patella: A case report

    PubMed Central

    YU, XIAOLONG; GUO, RUNSHENG; FAN, CONGLIANG; LIU, HUCHENG; ZHANG, BIN; NIE, TAO; TU, YI; DAI, MIN

    2016-01-01

    The patella is an unusual location for primary and metastatic bone tumors to develop. The most frequently encountered primary osteolytic lesions at the patella include giant cell tumors of the bone (GCT), chondroblastoma and aneurysmal bone cysts (ABC). However, the presentation of an ABC originating secondary to a GCT at the patella is rare. The present study describes such a case in a 46-year-old female. The differential diagnosis of the condition was extensive. The patient underwent curettage and the addition of bone cement to fill the defect. Pathological analysis of the resected tissue demonstrated that the lesion was consistent with an ABC forming secondary to a GCT. A 3-month follow-up was completed subsequent to the surgery, with a computed tomography scan demonstrating no evidence of recurrence. However, frequent and continuous observations of the patient following diagnosis are planned in order to evaluate the long-term efficacy of the surgical treatment. To the best of our knowledge, the present study describes the third reported case in the literature of this rare, double synchronous, benign tumor located at the patella. PMID:26893764

  20. Computational Modelling of Patella Femoral Kinematics During Gait Cycle and Experimental Validation

    NASA Astrophysics Data System (ADS)

    Maiti, Raman

    2016-06-01

    The effect of loading and boundary conditions on patellar mechanics is significant due to the complications arising in patella femoral joints during total knee replacements. To understand the patellar mechanics with respect to loading and motion, a computational model representing the patella femoral joint was developed and validated against experimental results. The computational model was created in IDEAS NX and simulated in MSC ADAMS/VIEW software. The results obtained in the form of internal external rotations and anterior posterior displacements for a new and experimentally simulated specimen for patella femoral joint under standard gait condition were compared with experimental measurements performed on the Leeds ProSim knee simulator. A good overall agreement between the computational prediction and the experimental data was obtained for patella femoral kinematics. Good agreement between the model and the past studies was observed when the ligament load was removed and the medial lateral displacement was constrained. The model is sensitive to ±5 % change in kinematics, frictional, force and stiffness coefficients and insensitive to time step.

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

    PubMed Central

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

    2015-01-01

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

  2. [Sleeve fracture of the patella: A diagnosis not to be underestimated].

    PubMed

    Le Petit, C; Desdoits, A; Laquievre, A; Dolet, N; Bronfen, C

    2016-04-01

    Fracture of the patella is quite rare in children. However, sleeve fractures of the patella are specific to the child. We report on the case of a 12-year-old boy who suffered complete functional incapacity with hemarthrosis and symptoms that suggested rupture of the extensor apparatus. It occurred after abrupt extension of the knee during a high jump. The x-ray showed an ascended patella. The diagnosis was made and emergency surgical exploration showed a sleeve fracture. Surgical repair provided a good result, with a 2-year follow-up. A literature review found 59 cases in 20 studies with a majority of case reports with only two series over ten cases. The ages and mechanisms are identical to those observed in our study. Diagnosis is difficult and must be clearly determined. The two important signs are the ascension of the patella and the depression to its lower extremity. The prognosis is most often conditioned by rapid surgical repair. PMID:26971135

  3. Giant cell tumor of the patella with a secondary aneurysmal bone cyst: A case report

    PubMed Central

    SONG, MINGZHI; DAI, WEI; SUN, RAN; LIANG, HONGFENG; LIU, BINGWU; WU, YUXUAN; MA, KAI; LU, MING

    2016-01-01

    The substance of the patella is an uncommon location for tumor occurrence and development. The present study reports a case of giant cell tumor (GCT) of the patella, combined with an aneurysmal bone cyst (ABC). To the best of our knowledge, this is the second report of GCT with ABC published in English. GCT is the most common type of benign tumor. Secondary ABC is frequently associated with GCT, but this symbiotic tumor rarely occurs in the patella. A 27-year-old male patient was examined at the outpatient clinic, and clinicopathological characteristics of the tumor were observed. X-ray and computed tomography (CT) scans revealed a lytic lesion located in the center of the right patella. Curettage, followed by autogenic and allograft bone grafting, was performed. Histopathologically, the lesion was diagnosed as a GCT with secondary ABC. No recurrence or metastasis was identified during the 1-year follow-up period. The present study reports a case of GCT with secondary ABC, and discusses the rare location and histopathological type of this tumor, in order to improve diagnosis and treatment of patellar tumors in general. PMID:27313738

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

    PubMed

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

    2015-02-01

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

  5. A new concept for precise patella resection in total knee arthroplasty.

    PubMed

    Nagamine, R; Miura, H; Urabe, K; Matsuda, S; Hirata, G; Moro-oka, T; Kawano, T; Iwamoto, Y

    2001-01-01

    We developed a new patella-cutting guide that simplifies proper alignment and enables resection of the correct thickness of bone. This guide consists of a central shaft, two support frames, and a ring. The ring consists of upper and lower disks, with a slot between the disks. The central shaft and the lower disk have holes for fixation pins. The distance from the distal end of the central shaft to the lowest level of the slot is 8 mm. Bone of the same thickness as that of the patellar component can be automatically resected using this guide. A feeler gauge is inserted through the slot, and the periarticular region is felt. This procedure enables the guide to be set at the correct angulation. A laboratory study using fresh-frozen cadaver patella specimens and a clinical study showed that proper alignment and proper resection were achieved using this guide. PMID:11703035

  6. Does patella resurfacing really matter? Pain and function in 972 patients after primary total knee arthroplasty

    PubMed Central

    Espehaug, Birgitte; Havelin, Leif Ivar; Vollset, Stein Emil; Furnes, Ove

    2010-01-01

    Background and purpose Resurfacing of the patella during primary total knee arthroplasty (TKA) is often recommended based on higher revision rates in non-resurfaced knees. As many of these revisions are insertions of a patella component due to pain, and since only patients with a non-resurfaced patella have the option of secondary resurfacing, we do not really know whether these patients have more pain and poorer function. The main purpose of the present paper was therefore to assess pain and function at least 2 years after surgery for unrevised primary non-resurfaced and resurfaced TKA, and secondary among prosthesis brands. Methods Information needed to calculate subscales from the knee injury and osteoarthritis outcome score (KOOS) was collected in a questionnaire given to 972 osteoarthritis patients with intact primary TKAs that had been reported to the Norwegian Arthroplasty Register. Pain and satisfaction on visual analog scales and improvement in EQ-5D index score ΔEQ-5D) were also used as outcomes. Outcomes were measured on a scale from 0 to 100 units (worst to best). To estimate differences in mean scores, we used multiple linear regression with adjustment for possible confounders. Results We did not observe any differences between resurfacing and non-resurfacing in any outcome, with estimated differences of ≤ 1.4 units and p-values of > 0.4. There was, however, a tendency of better results for the NexGen implant as compared to the reference brand AGC for symptoms (difference = 4.9, p = 0.05), pain (VAS) (difference = 8.3, p = 0.004), and satisfaction (VAS) (difference = 7.9, p = 0.02). However, none of these differences reached the stated level of minimal perceptible clinical difference. Interpretation Resurfacing of the patella has no clinical effect on pain and function after TKA. Differences between the brands investigated were small and they were assumed to be of minor importance. PMID:20158405

  7. MPFL Reconstruction with TTT Versus TTT Alone for Recurrent Patella Instability

    PubMed Central

    Annear, Peter; Damasena, Iswadi; Blythe, Murray; Wysocki, David

    2016-01-01

    Purpose: Reconstruction of the medial patellofemoral ligament (MPFL) is increasingly used to restore the primary ligamentous restraint to patella dislocation. The purpose of this randomised controlled trial is to compare the 5 year results of the addition of autograft MPFL reconstruction to tibial tubercle transfer (TTT) and lateral release (LR) (reconstruction group) to TTT and LR alone (control group) for recurrent patella dislocation. Methods: Thirty-four patients (36 knees) were randomised to two groups. Two patients in the control group (TTT + LR) and three patients in the reconstruction group (MPFL + TTT + LR) group were lost to follow up at 5 years. Results: There were no significant differences in Kujala and Tegner scores or “insecurity” Visual Analogue Scale (VAS) at any time period. There was a trend to a lower average VAS in the reconstruction group at six weeks but also poorer average flexion. There were no significant differences in time to return to school, work or sports. Quantitative CT scans showed the reconstruction group had a significant improvement in average patella tilt (6 degrees vs -8 degrees, p = 0.03) and average congruence angle (13 degrees vs -11 degrees, p = 0.03) in the quadriceps contracted state. At 5 years the MPFL/TTT reconstruction group had a lower revision rate (2/17) compared to the control group of TTT alone (5/16). Conclusion: Patients who underwent an MPFL reconstruction in addition to a TTT had a comparatively significant improved patella congruence on quantitative CT Scan. At 5 years the MPFL/TTT reconstruction group had a lower but non significant revision rate compared to the control group of TTT alone.

  8. Semitendinosus Tendon Transfer Associated With Distal Alignment for Patella Alta in a Patient With Recurrent Dislocations

    PubMed Central

    Calderazzi, Filippo; Pellegrini, Andrea; Coviello, Gianluca; Groppi, Giulia; Ceccarelli, Francesco

    2015-01-01

    Patellofemoral instability is characterized by pain during normal daily activities and frequent dislocation events. In the reported case, an adolescent girl, aged 15 years, affected by left patellofemoral instability, underwent surgery with a double technique comprising tibial tubercle distalization and medial patellofemoral ligament reconstruction. In case of patella alta associated with patellofemoral instability, surgical treatment should focus on medial patellofemoral ligament repair and on recurrent instability prevention. PMID:26900548

  9. 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

  10. Nail-patella-syndrome in a young patient followed up over 10 years: relevance of the sagittal trochlear septum for patellofemoral pathology

    PubMed Central

    Konrads, Christian; Reppenhagen, Stephan; Plumhoff, Piet; Rudert, Maximilian; Steinert, Andre; Barthel, Thomas

    2016-01-01

    Introduction: Nail-patella-syndrome (NPS) is a rare autosomal-dominant inherited disease with pathologies of nails, skeleton, kidneys, and eyes. Linkage to a mutated gene was found. It codes for the transcription-factor LMX1B. In most cases knees are symptomatic. Patients have hypoplastic patellae, which are laterally subluxated. In those individuals a sagittal trochlear fibrous septum was found, dividing the anterior knee-joint-space. In the literature the etiology and clinical significance of this anatomic abnormality is unclear. Based on clinical and intraoperative findings we developed a theory regarding knee pathology in nail-patella-syndrome. Successful treatment via early resection of the septum with sustained good outcome is presented. Methods: In a symptomatic six-year-old boy with nail-patella-syndrome we resected the fibrous sagittal septum adherent to the trochlea femoris and we balanced the patella via lateral release and medial plication in both knee joints. We analyzed the clinical outcome of this procedure prospectively over 10 years. Results: Postoperatively the hypoplastic patellae stayed centered and stable during further skeletal development. The patient was still pain free with normal range of motion of both operated knee joints after 10 years of follow-up. Discussion: In patients with nail-patella-syndrome and a subluxated or dislocated patella we recommend diagnostics with magnetic-resonance-imaging and early surgical treatment via resection of the trochlear septum and soft-tissue-balancing of the patella. When the septum displaces the patella and prevents physiological articulation of the patella with the trochlea femoris, early septum resection is likely to be important for a good functional outcome and proper development of the patellofemoral joint during growth. PMID:27247258

  11. Position of the Patella among Emirati Adult Knees. Is Insall-Salvati Ratio Applicable to Middle-Easterners?

    PubMed Central

    Althani, Saeed; Shahi, Alisina; Tan, Timothy L.; Al-Belooshi, Ali

    2016-01-01

    Background: Abnormal patellar height is associated with anterior knee pain and several conditions that affect the patellofemoral joint. The aim of this study was to 1) report the incidence of patella alta and patella baja and 2) investigate whether the normal limits of the Insall-Salvati ratio is applicable in adult Middle-Easterners. Methods: A radiographic review of the lateral radiographs of 736 Middle-Eastern knees were performed. Patellar tendon length (TL) and the patellar length (TP) was digitally measured and the ratios of these measures was used to calculate the Insall-Salvati ratio. Results: The overall mean TL/PL ratio was 1.20±0.17. The Insall-Salvati ratio was higher (p=0.0013) in males (1.22± 0.12) than in females (1.18±0.17). According to our measurement, the recommended levels for defining abnormal patellar position should be 0.86 for patella baja and 1.54 for patella alta. Conclusion: The use of TL/PL ratio demonstrated a higher incidence of patella alta and a higher mean TL/PL ratio compared to other techniques. The normal ranges for the TL/PL differs from western populations and may be attributed to lifestyle differences. PMID:27200391

  12. 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

  13. Effect of femoral component design on unresurfaced patellas in knee arthroplasty.

    PubMed

    Whiteside, Leo A; Nakamura, Takashi

    2003-05-01

    Three total knee designs were evaluated to test the hypothesis that femoral component design affects the clinical and mechanical functions of the unresurfaced patella after total knee arthroplasty. Patients with the Ortholoc II, Advantim, and Profix femoral components were followed up for as many as 14 years and revision rate, anterior knee pain, and generalized knee pain were compared. A laboratory protocol was devised to evaluate pressure in the patellofemoral joint of knees from cadavers with a pressure-sensitive transducer using the same three designs at various degrees of knee flexion. Thirty Ortholoc II knee components were followed up for 14 years. Nineteen patients (63%) had severe anterior knee pain and 15 patients (50%) had reoperation to resurface the patella within 2 years. Two hundred one patients (222 knees) with Advantim components were followed up for 10 years and 305 patients (330 knees) with Profix components were followed up for 5 years. No patients with these two knee designs had severe anterior knee pain or reoperation for patellar resurfacing. A significantly higher rate of mild anterior knee pain was seen in the patients with Advantim components than in the patients with Profix components. No apparent relationship was seen between the severity of patellar wear found at the time of surgery and the incidence of anterior knee pain. Patients with rheumatoid arthritis receiving either the Advantim or Profix knee component performed as well as patients with osteoarthritis when the patella was not resurfaced. Pressure was significantly higher in the patellofemoral joints of the laboratory knee specimens with Ortholoc II components than in the specimens with either the Advantim or Profix components. The specimens with Advantim components had significantly higher pressure than did the specimens with normal knees, and the specimens with Profix components differed little from those with normal knees. PMID:12771830

  14. Modified Ilizarov in difficult Fracture of the Patella. A case report

    PubMed Central

    Baruah, Ranjit Kr.

    2016-01-01

    Introduction: Ilizarov technique yields satisfactory results in difficult situations. Widely displaced fracture of the patella after failed osteosynthesis is a difficult situation. We are reporting one such case in a 27 years old male treated by modified Ilizarov technique. Case report: A 27-years old male with transverse fracture of the patella was fixed with tension band wiring. He indulged in heavy manual work including bicycling after 15 days of operation contrary to advice that led to loosening of implants and failure of reduction. He reported after 2 months of failure. A modified Ilizarov technique was contemplated. Implants were removed. After cleaning the margins, opposite olive wires (2 in each fragment) mounted in traction units were attached to two full rings, each fixed to distal femur and tibia. Sub-acute docking was done on the table followed by gradual docking till the fragments came in contact to each other. Compression was applied across the fracture site after confirmation of docking by X-ray at the rate of 0.25 mm every 3rd day till 1.0 mm of compression was achieved. Full weight bearing was possible immediately after surgery. Regular follow up was carried out to look for any pin site problems and loss of compression. Assembly was removed after X-ray confirmed sound healing after 2 months. Initially there was restriction of movements at the knee joint which improved gradually with physiotherapy. At one year follow-up, the patientcould squat completely. Conclusion: Widely displaced fracture of the patella after failed osteosynthesis is a difficult situation Modified Ilizarov technique is beneficial for treating such a situation in terms of function and restoration of anatomy as it avoids soft tissue scarring which may follow in an attempt to do an open reduction. Gradual stretching of the soft tissue and subsequent controlled compression at the fracture site is the advantage of this technique. PMID:27299120

  15. Comparison of the Insall-Salvati ratio of the patella in patients with and without an ACL tear.

    PubMed

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

    2005-01-01

    The object of this prospective study is to compare the Insall-Salvati ratio between the patients who have an anterior cruciate ligament (ACL) tear and receive arthroscopic-assistant ACL reconstruction and the patients who have no ACL tear but do have an internal disorder of the knee and receive arthroscopic surgery. We prospectively and consecutively collected into two groups a total of 217 patients who had sport injuries and received arthroscopic surgery. The study group included 115 patients who had an ACL tear and received arthroscopic-assistant ACL reconstruction with middle-third bone-patella tendon-bone graft. The control group included 102 patients with internal disorders of the knee joint, including meniscus tear, plicae, or other chondral lesion, but without an ACL tear. We measured the patellar Insall-Salvati ratio [12] on the pre-operative X-ray films for all patients. The Insall-Salvati ratio in the ACL-tear study group is significantly smaller than the control group of internal disorders of the knee (0.99+/-0.11 vs 1.05+/-0.12, p=0.001). There is no significant difference in age, gender, the side of the involved knee, duration of symptoms, patella length and patella tendon length between the two groups. In conclusion, our study shows that patella infra has an association with ACL tears, and patella infra may be a risk factor for ACL tears. In patients with an ACL tear who had patella baja, the middle-third patellar tendon may not be an ideal graft for reconstruction. PMID:15654645

  16. Extreme femoral valgus and patella dislocation following lateral plate fixation of a pediatric femur fracture.

    PubMed

    Ezzat, Ahmed; Iobst, Christopher

    2016-07-01

    A 15-year-old boy presented with a 35° femoral valgus deformity, leg-length discrepancy, painful retained hardware, and a lateral dislocation of the patella 4 years after undergoing lateral plate fixation of a distal femur fracture. Femoral valgus is a possible complication of lateral plate fixation in up to 30% of pediatric distal femur fractures. With this patient's unusual combination of deformities as an example, we suggest early hardware removal after fracture union to prevent the development of deformity. If plate removal is not chosen, then continued close monitoring of the patient is necessary until skeletal maturity. PMID:27243610

  17. An Unexpected Complication after Headless Compression Screw Fixation of an Osteochondral Fracture of Patella

    PubMed Central

    Aydoğmuş, Suavi; Keçeci, Tolga

    2016-01-01

    This study evaluated complications associated with implant depth in headless compression screw treatment of an osteochondral fracture associated with a traumatic patellar dislocation in a 21-year-old woman. Computed tomography and X-rays showed one lateral fracture fragment measuring 25 × 16 mm. Osteosynthesis was performed with two headless compression screws. Five months later, the screws were removed because of patella-femoral implant friction. We recommend that the screw heads be embedded to a depth of at least 3 mm below the cartilage surface. Further clinical studies need to examine the variation in cartilage thickness in the fracture fragment. PMID:27051547

  18. Activation of polyphosphoinositide metabolism at artificial maturation of Patella vulgata oocytes.

    PubMed

    Borg, B; De Renzis, G; Payan, P; Ciapa, B

    1992-01-01

    The metabolism of polyphosphoinositides (PPI) has been investigated during the meiosis reinitiation of the oocytes of a prosobranch mollusk, the limpet Patella vulgata. Meiosis reinitiation which leads to germinal vesicle breakdown (GVBD) and metaphase-1 spindle formation was artificially induced by treating the prophase-blocked oocytes with 10 mM NH4Cl, pH 8.2. This treatment, which results in a rise in intracellular pH, triggered a general increase in polyphosphoinositide synthesis. Determinations of phosphorus content showed that maturation induced a 30 to 50% increase in both phosphatidylinositol (PI) and phosphatidylinositol-1 monophosphate (PIP) concentrations. Incorporations of 32PO4 and [3H]inositol have been measured in three classes of polyphosphoinositides: PI, PIP, and phosphatidylinositol 4,5-bisphosphate (PIP2). By comparing incorporation rates of the radiolabeled precursors into PPI before and after meiosis reinitiation, we found that artificial maturation by ammonia induced a 50-fold increase in the turnover of these lipids. No significant burst of inositol 1,4,5-trisphosphate (IP3) was observed after maturation. We suggest that modifications in PPI metabolism occurring at maturation of Patella oocytes might ensure the formation of an important stock of PPI that would be available for the profuse production of IP3, the messenger responsible for the Ca2+ signal at fertilization. PMID:1309456

  19. Giant Cell Tumor of the Patella Tendon Sheath Presenting as a Painful Locked Knee

    PubMed Central

    Panagopoulos, Andreas; Tsoumpos, Pantelis; Tatani, Irini; Iliopoulos, Ilias; Papachristou, Dionysios

    2015-01-01

    Patient: Male, 26 Final Diagnosis: Giant cell tumor of the patella tendon seath Symptoms: Efusion • locking knee • pain Medication: None Clinical Procedure: Arthroscopy and open resection of the tumor Specialty: Orthopedics and Traumatology Objective: Rare disease Background: The giant cell tumor of the tendon sheath (GCT-TS) is a benign proliferative synovial tumor manifesting as an intra-articular solitary nodule. When it involves the infrapatellar fat pad it can present acutely as a painful locked knee. Case Report: A 26-year-old white male presented with a 2-week history of painful locking in his right knee. Clinical examination revealed lack of extension by approximately 20°. To help establish the diagnosis, an MRI scan of the right knee was performed, showing a large (5×4×2 cm), oval, well-circumscribed mass with a low-intensity homogenous signal. The size of the mass prohibited the removal by arthroscopy and we therefore proceeded with an open arthrotomy. Histological examination showed a tendosynovial giant cell tumor of the patella tendon sheath. At the latest follow-up, 2 years postoperatively, there was no local tumor recurrence. Conclusions: These rare tumorous lesions should be included in the differential diagnosis of painful locking knee, especially in the absence of definite traumatic history. PMID:26302970

  20. 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

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

    NASA Astrophysics Data System (ADS)

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

    2011-07-01

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

  2. Standardization of a Patella spp. (Mollusca, Gastropoda) embryo-larval bioassay and advantages of its use in marine ecotoxicology.

    PubMed

    Pérez, Sara; Fernández, Nuria; Ribeiro, Pedro A

    2016-05-01

    The use of three limpet species, Patella vulgata Linnaeus, 1758, Patella depressa Pennant, 1777 and Patella ulyssiponensis Gmelin, 1791 as model organisms in marine ecotoxicology has been evaluated. Initial laboratory experiments were aimed to standardize a biological test with embryos and larvae of Patella spp, establishing the percentage of normal trochophore larvae as endpoint. Before conducting in vitro fertilization, oocytes must be maturated artificially by incubation in an alkaline solution; therefore, alkalinizing agent, pH and time of eggs alkalinization were evaluated. Moreover, time of sperm activation, optimum sperm and oocytes concentration during fertilization, gamete contact time, use of stirring during the fertilization, egg concentration and incubation temperature were examined. Minimum sample size per treatment was also estimated. Exposure of oocytes for 10min to FSW alkalinized with NH4OH at pH 9.0, the use of undiluted sperm pre-activated during 45min and a concentration of 200 oocytesmL(-1), a gamete-contact time of 180min and egg incubation at 18°C during 24h at a concentration of 80 eggsmL(-1) were the conditions allowing maximal embryo-larval development success. With an error of 0.05, a sampling size ≥320 allows a 95% confidence in the estimate. This Patella spp. acute bioassay fulfills a number of important a priori requirements to be used in ecotoxicological studies. Nevertheless, in vitro fertilization requires considerable handling, which may lead to failure in fecundation. Such difficulties are also addressed, in order to facilitate the routine use of this protocol by other laboratories. PMID:26845705

  3. 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

  4. Knee Problems

    MedlinePlus

    ... be FRACTURED and/or you may have seriously TORN some LIGAMENTS in the internal area of the ... the stairs? Yes Your symptoms may be from TORN CARTILAGE, a TORN LIGAMENT or CHONDROMALACIA PATELLAE, the ...

  5. Joint pain

    MedlinePlus

    ... or conditions. It may be linked to arthritis , bursitis , and muscle pain . No matter what causes it, ... Autoimmune diseases such as rheumatoid arthritis and lupus Bursitis Chondromalacia patellae Crystals in the joint: gout (especially ...

  6. Femoro Patella Vialla patellofemoral arthroplasty: An independent assessment of outcomes at minimum 2-year follow-up

    PubMed Central

    Halai, Mansur; Ker, Andrew; Anthony, Iain; Holt, Graeme; Jones, Bryn; Blyth, Mark

    2016-01-01

    AIM To determine outcomes using the Femoro-Patella Vialla (FPV) arthroplasty and if there is an ideal patient for this implant. METHODS A total of 41 FPV patellofemoral joint replacements were performed in 31 patients (22 females, 9 males, mean age 65 years). Mean follow-up was 3.2 years (minimum 2 years). Radiographs were reviewed preoperatively and postoperatively. We assessed whether gender, age, previous surgery, patella atla or trochlear dysplasia influenced patient satisfaction or patient functional outcome. RESULTS The median Oxford Knee Score was 40 and the median Melbourne Patellofemoral Score was 21 postoperatively. Seventy-six percent of patients were satisfied, 10% unsure and 14% dissatisfied postoperatively. There was no radiological progression of tibiofemoral joint arthritis, using the Ahlback grading, in any patient. One patient, who was diagnosed with rheumatoid arthritis postoperatively, underwent revision to total knee replacement. There were no intraoperative lateral releases and no implant failures. Gender, age, the presence of trochlear dysplasia, patella alta or bilateral surgery did not influence patient outcome. Previous surgery did not correlate with outcome. CONCLUSION In contrast to the current literature, the FPV shows promising early results. However, we cannot identify a subgroup of patients with superior outcomes.

  7. Simulation of patella alta and the implications for in vitro patellar tracking in the ovine stifle joint.

    PubMed

    Bertollo, Nicky; Pelletier, Matthew H; Walsh, William R

    2012-11-01

    Patella alta is associated with adverse cartilage adaptations, patellofemoral pain, and instability. It is defined by a relatively long patellar tendon and patella positioned in a more proximal location within the patellar groove of the femur. This study used the ovine stifle joint model to investigate the effect of patellar tendon lengthening on the 3D passive kinematics of the patellofemoral and tibiofemoral joints. Eight patellar tendons were lengthened in 2 mm increments up to a maximum of 12 mm (20%) using a device placed in series with the transected patellar tendon. Three-dimensional kinematics were measured in the intact joint and at each increment of patellar tendon length (L(T)) during passively induced tibiofemoral flexion. Patellar flexion angle was linearly correlated with tibial flexion angle in the intact joint, and this correlation persisted after tendon lengthening (R = 0.897-0.965, p < 0.01). Patellofemoral kinematics expressed as a function of tibial flexion angle were significantly altered by L(T) increases >9%. In contrast, when patellofemoral kinematics were expressed as a function of patellar flexion angle they were not significantly altered by increases in L(T). Tibiofemoral kinematics were not affected by the L(T) increases. These results demonstrate that for a given tibial flexion angle, patellar tendon lengthening alters the patellar flexion angle. However, for a given patellar flexion angle, the orientation of the patella in the remaining five degrees of freedom is unchanged, implying a repeatable path of patellar motion. PMID:22581606

  8. Retrospective 5-Year Analysis of Revision Rate and Functional Outcome of TKA With and Without Patella Implant.

    PubMed

    Albrecht, Dominique C; Ottersbach, Andreas

    2016-05-01

    The aim of this study was to compare a patient cohort after total knee arthroplasty (TKA) in terms of the revision rate and the functional outcome, with and without patella resurfacing. Sixty-six patients (71 TKAs) were implanted with the mobile-bearing knee prosthesis system e.motion UC (Aesculap AG, Tuttlingen, Germany). These patients were divided into 2 groups, 1 of which received primary patella resurfacing (PPR; 51 TKAs) and 1 of which did not (non-PPR; 20 TKAs), with an average follow-up of 65.6 months (±6.9). The cohort was recorded consecutively. The evaluation was performed using the Knee Society Score and selected questions relating to the Knee Injury and Osteoarthritis Outcome Score, as well as with radiographs. Results showed that PPR was no better than non-PPR in terms of functional outcome. Two knees (10%) were revised in the non-PPR group, and 1 knee (1.96%) in the PPR group (not significant). In this cohort, 100% of implants, including the 5 TKAs of patients who did not attend the follow-up examination, had neither explanted nor loosened at the time of follow-up examination. The authors concluded that the revision rate for PPR is slightly lower, and this avoids the need for secondary patella resurfacing. The risk for complications is low, and the functional outcome is comparable. [Orthopedics. 2016; 39(3):S31-S35.]. PMID:27219724

  9. Influence of gradual elongation to the patella tendon insertion in rabbits.

    PubMed

    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

  10. 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

  11. 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

  12. The influence of simulated exploitation on Patella vulgata populations: protandric sex change is size-dependent.

    PubMed

    Borges, Carla D G; Hawkins, Stephen J; Crowe, Tasman P; Doncaster, C Patrick

    2016-01-01

    Grazing mollusks are used as a food resource worldwide, and limpets are harvested commercially for both local consumption and export in several countries. This study describes a field experiment to assess the effects of simulated human exploitation of limpets Patella vulgata on their population ecology in terms of protandry (age-related sex change from male to female), growth, recruitment, migration, and density regulation. Limpet populations at two locations in southwest England were artificially exploited by systematic removal of the largest individuals for 18 months in plots assigned to three treatments at each site: no (control), low, and high exploitation. The shell size at sex change (L 50: the size at which there is a 50:50 sex ratio) decreased in response to the exploitation treatments, as did the mean shell size of sexual stages. Size-dependent sex change was indicated by L 50 occurring at smaller sizes in treatments than controls, suggesting an earlier switch to females. Mean shell size of P. vulgata neuters changed little under different levels of exploitation, while males and females both decreased markedly in size with exploitation. No differences were detected in the relative abundances of sexual stages, indicating some compensation for the removal of the bigger individuals via recruitment and sex change as no migratory patterns were detected between treatments. At the end of the experiment, 0-15 mm recruits were more abundant at one of the locations but no differences were detected between treatments. We conclude that sex change in P. vulgata can be induced at smaller sizes by reductions in density of the largest individuals reducing interage class competition. Knowledge of sex-change adaptation in exploited limpet populations should underpin strategies to counteract population decline and improve rocky shore conservation and resource management. PMID:26843935

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

    PubMed

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

    2015-07-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2007-10-01

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

  15. 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

  16. 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

  17. MRI Evaluation of Patella Alignment Before and After Anatomical Reconstruction of ACL Undergoing Unified Rehabilitation Programme Introduced by CMC Physical Therapy Team

    PubMed Central

    Straszewski, Dariusz; Plenzler, Marcin; Szczepaniak, Joanna; Śmigielski, Robert; Ciszkowska-Łysoń, Beata; Popieluch, Marcin; Kopko, Szymon

    2014-01-01

    Objectives: The aim of the study was to asses the impact of the functional rehabilitation on patella alignment with MRI imaging in patients who underwent the ACL reconstruction. The surgical approach with the use of patellar tendon graft is known to carry the risk of lowering patella height (patella baja), which, in turn, may lead to accelerated cartilage wear in patellofemoral joint. Methods: 30 patients after the anatomical reconstruction of ACL took part in this study (23 male, and 7 female, mean age = 28 ± 10,6 years). During the procedure a patellar tendon graft was used. The Insali-Salvati ratio measured with MRI (images taken pre-procedural, and 9 months after the surgery) was used for the assessment of patellar alignment. The measurements were taken by one radiology specialist on MRI scans in sagittal view in PD sequence. During the examination, patellar joint was in flexion (approx.10 degrees). As the point of reference for patella’s position ISR ratio was in the range of 0.8 - 1.2. All patients were operated on by the same team of surgeons and underwent an unified rehabilitation programme led by a team of selected physiotherapists. The main features of the programme were: an early muscle activation (second day after the procedure); mobilisation of the patella and tissues of the anterior compartment of the knee; weight bearing co-contraction exercises, and the sensomotoric training of the entire kinetic chain of the lower limb. The data recorded was statistically analysed using the Wilcoxon signed-rank test in order to establish parameters’ changes within the study group.. Results: The mean ISR value before the procedure was 0.84 (± 0,1), whereas 9 months after the surgery it was 0.85 (± 0,1). The results’ analysis did not show any statistically significant changes between ISR values. Nine months after the procedure patella baja has not been observed in any of the evaluated patients. Conclusion: The functional rehabilitation programme designed by

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

    PubMed Central

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

    2013-01-01

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

  19. 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

  20. TUMORS OF THE PATELLA: THE EXPERIENCE OF INSTITUTE OF ORTHOPEDICS AND TRAUMATOLOGY AT UNIVERSITY OF SÃO PAULO, BRAZIL

    PubMed Central

    BAPTISTA, ANDRÉ MATHIAS; SARGENTINI, SYLVIO CESAR; ZUMÁRRAGA, JUAN PABLO; CAMARGO, ANDRÉ FERRARI DE FRANÇA; CAMARGO, OLAVO PIRES DE

    2016-01-01

    ABSTRACT Objective: To obtain epidemiological data from the tumors of the patella diagnosed and treated at the Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Universidade de São Paulo (IOT-HC-FMUSP) between 1998 and 2015. Methods: Series of cases with retrospective evaluation of patients diagnosed with tumors located in the patella. The data was obtained from the records and patients' charts at the Department of Pathology of IOT-HC-FMUSP. Results: A total of 2220 medical records from patients with anatomopathological reports were included in the study. Only eight (0.3%) patients had patellar tumors. We found that six (75%) of these were benign, one (12.5%) was a pseudotumoral lesions and one (12.5%) was reported as malignant. Among benign tumors, the giant cell tumor (GCT) was the most frequently reported corresponding to 50% of the cases. Hemagioendothelioma was the only case of malignant tumor in this series. As for the pseudotumoral lesions, we found a brown tumor. Conclusion: From the data obtained retrospectively in a 17 year time frame, in a service that treats benign, malignant and pseudotumoral bone lesions, we conclude that our casuistry in patellar tumors is similar to that reported in scientific literature, where benign tumors are predominant in a 7:1 ratio over malignant tumors, being a rare location of appearance, with the GCT as the most common diagnosis . Level of Evidence IV, Case Series. PMID:27217817

  1. Nail-Patella Syndrome in Saudi Arabia With New Features and Surgical Procedures: The First Described Study

    PubMed Central

    Juma, Abdullah H. A

    2004-01-01

    The purpose of this study was to reveal the occurrence of nail-patella syndrome (NPS) in Saudi Arabia together with the detection of abnormal attachment of lateral meniscus in the left knee and new surgical procedures applied to the right and left knee, reported for the first time in this study. This was a case study of a 23-year-old young man presenting with bilateral knee pain, giving way and locking since the age of 15 years. Clinically, most of the NPS features were noted, including ocular problems. The complex features affected both knees, especially the previous attempted surgeries for recurrent dislocation of patellae. Deficient ligaments were reconstructed using the Leeds-Keio ligament, starting with the right knee and continuing with the left knee 6 months later. Early and late follow-up showed favorable outcome of surgery revealed as independent ambulation and stable right and left knees. In conclusion, NPS, although rare, presents a complex problem and unexpected surgical outcome, and we recommend this procedure with close follow-up. PMID:15266233

  2. Eccentric Exercise Protocols for Patella Tendinopathy: Should we Really be Withdrawing Athletes from Sport? A Systematic Review

    PubMed Central

    Saithna, Adnan; Gogna, Rajiv; Baraza, Njalalle; Modi, Chetan; Spencer, Simon

    2012-01-01

    The 2007 review by Visnes and Bahr concluded that athletes with patella tendinopathy should be withdrawn from sport whilst engaging in eccentric exercise (EE) rehabilitation programs. However, deprivation of sport is associated with a number of negative psychological and physiological effects. Withdrawal from sport is therefore a decision that warrants due consideration of the risk/benefit ratio. The aim of this study was to determine whether sufficient evidence exists to warrant withdrawal of athletes from sport during an eccentric exercise rehabilitation program. A systematic review of the literature was performed to identify relevant randomised trials. Data was extracted to determine whether athletes were withdrawn from sport, what evidence was presented to support the chosen strategy and whether this affected the clinical outcome. Seven studies were included. None of these reported high quality evidence to support withdrawal. In addition, three studies were identified in which athletes were not withdrawn from sport and still benefited from EE. This review has demonstrated that there is no high quality evidence to support a strategy of withdrawal from sport in the management of patella tendinopathy. PMID:23248727

  3. Effect of strength training on human patella tendon mechanical properties of older individuals

    PubMed Central

    Reeves, N D; Maganaris, C N; Narici, M V

    2003-01-01

    This study investigated the effect of strength training on the mechanical properties of the human patella tendon of older individuals. Subjects were assigned to training (n = 9; age 74.3 ± 3.5 years, body mass 69.7 ± 14.8 kg and height 163.4 ± 9.1 cm, mean ±s.d.) and control (n = 9; age 67.1 ± 2 years, body mass 73.5 ± 14.9 kg and height 168.3 ± 11.5 cm) groups. Strength training (two series of 10 repetitions at 80 % of five-repetition maximum) was performed three times per week for 14 weeks using leg extension and leg press exercises. Measurements of tendon elongation during a ramp isometric knee extension were performed before and after training and control periods in vivo using ultrasonography. Training caused a decreased tendon elongation and strain at all levels of force and stress (P < 0.01). Baseline tendon elongation and strain at maximal tendon load were 4.7 ± 1.1 mm and 9.9 ± 2.2 %, respectively (maximum force: 3346 ± 1168 N; maximum stress: 40 ± 11 MPa). After training, these values decreased to 2.9 ± 1.2 mm and 5.9 ± 2.4 % (P < 0.01), respectively (maximum force: 3555 ± 1257 N; maximum stress: 42 ± 11 MPa). Tendon stiffness increased by 65 % (2187 ± 713 to 3609 ± 1220 N mm−1; P < 0.05) and Young's modulus increased by 69 % (1.3 ± 0.3 to 2.2 ± 0.8 GPa; P < 0.01). As a result of these changes, the rate of torque development increased by 27 % (482.8 ± 302.5 to 612.6 ± 401 N m s−1; P < 0.01) following training. No significant changes occurred in any measured variables in the control group (P > 0.05). This study shows for the first time that strength training in old age increases the stiffness and Young's modulus of human tendons. This may reduce the risk of tendon injury in old age and has implications for contractile force production and the rapid execution of motor tasks. PMID:12626673

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

    PubMed

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

    2003-10-15

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

  5. Reconstruction of the medial patellofemoral ligament in cases of acute traumatic dislocation of the patella: current perspectives and trends in Brazil☆☆☆

    PubMed Central

    Arliani, Gustavo Gonçalves; da Silva, Adriano Vaso Rodrigues; Ueda, Léo Renato Shigueru; Astur, Diego da Costa; Yazigi Júnior, João Alberto; Cohen, Moises

    2014-01-01

    Objective To evaluate the approaches and procedures used by knee surgeons in Brazil for treating medial patellofemoral lesions (MPFL) of the knee in cases of acute traumatic dislocation of the patella. Materials and methods A questionnaire comprising 15 closed questions on topics relating to treating MPFL of the knee following acute dislocation of the patella was used. It was applied to Brazilian knee surgeons during the three days of the 44th Brazilian Congress of Orthopedics and Traumatology, in 2012. Results 106 knee surgeons completely filled out the questionnaire and formed part of the sample analyzed. Most of them were from the southeastern region of Brazil. The majority (57%) reported that they perform fewer than five MPFL reconstruction procedures per year. Indication of non-surgical treatment after a first episode of acute dislocation of the patella was preferred and done by 93.4% of the sample. Only 9.1% of the participants reported that they had never observed postoperative complications. Intraoperative radioscopy was used routinely by 48%. The professionals who did not use this tool to determine the point of ligament fixation in the femur did not have a statistically greater number of postoperative complications than those who used it (p > 0.05). Conclusions There are clear evolutionary trends in treatments and rehabilitation for acute dislocation of the patella due to MPFL, in Brazil. However, further prospective controlled studies are needed in order to evaluate the clinical and scientific benefit of these trends. PMID:26229852

  6. 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

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

    PubMed Central

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

    2012-01-01

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

  8. Anisometry of Medial Patellofemoral Ligament Reconstruction in the Setting of Patella Alta and Increased Tibial Tubercle-Trochlear Groove (TT-TG) Distance

    PubMed Central

    Redler, Lauren H.; Meyers, Kathleen N.; Munch, Jacqueline; Dennis, Elizabeth R.; Nguyen, Joseph; Stein, Beth E. Shubin

    2016-01-01

    Objectives: Medial patellofemoral ligament (MPFL) reconstruction is a common procedure to treat recurrent patellofemoral instability. However, the effects of an elevated tibial tubercle-trochlear groove (TT-TG) distance and patella alta, as measured by the Caton-Deschamps (C/D) ratio, on MPFL isometry remain unclear. We hypothesized that increased lateralization and proximalization of the tibial tubercle (TT) will have increasingly adverse effects on the isometry of the MPFL. Methods: Ten fresh-frozen cadaveric knees were placed on a custom testing fixture, with a fixed femur and tibia mobile through 120 degrees of flexion. The quadriceps tendon was loaded with 10.8 N in an anatomic direction using a weighted pulley system. A 0.2 N patellar lateral displacement load was used to simulate an intact lateral retinaculum to avoid over-medializing the patella. A tunnel was drilled under fluoroscopic guidance from Schottle’s point on the medial distal femur through the lateral cortex. A suture anchor was placed at the upper 66% of the medial border of the patella and the sutures were shuttled through to the lateral side and attached to a pulley with a 1 N weight. Retroreflective markers were attached to the femur, tibia, patella, and suture. MPFL length change, as measured by suture marker motion, was assessed using a 3D motion capture system through a range of motion between 0 deg and 110 deg with the native TT anatomy. Recordings were repeated after a flat TT osteotomy and transfer to a TT-TG of 20 mm and 25 mm and a C/D ratio of 1.2 and 1.4, including all combinations. Generalized estimating equation (GEE) modeling technique was used to analyze and control for the clustered nature of the data. SAS version 9.3 (SAS Inc., Cary, NC) was used for all data analyses. Results: Analysis was performed on 9 specimens secondary to significant deviations in the baseline normative data. Intact knees showed MPFL isometry through 20-70 degrees range of motion. Tibial tubercle

  9. [A biomechanical study of anterior cruciate ligaments reconstructed with patella tendons augmented by absorbable artificial materials. A biomechanical study in rabbits].

    PubMed

    Hayashi, H

    1998-06-01

    The purpose of this study was to investigate the biomechanical properties of anterior cruciate ligament (ACL) reconstruction using an absorbable artificial material in rabbits. Experimental studies were carried out on 58 New Zealand white rabbits. After total resection of ACL, 22 knees were reconstructed with patella tendons alone (non-augmented group) and 27 knees with patella tendons augmented by polyglactin 910 mesh (augmented group). The animals were sacrificed for biomechanical testing at 0, 2, 4, 6, 8, 12 and 24 weeks, respectively, after the operation. The stiffness of reconstructed ACL in the augmented group showed a mean of 26.58 +/- 5.78 N/mm at 8 weeks, and that of the non-augmented group 16.47 +/- 11.34 N/mm. There were significant differences between the augmented and non-augmented groups (p < 0.05). The ultimate load and energy of the reconstructed ACL were also significantly higher in the augmented group than in the non-augmented group at 8 weeks. The mean elastic module was higher in the augmented than in the non-augmented group, but the differences were not significant. The mean tan delta of both groups was significantly higher than that of the normal ACL at 24 weeks. These results suggests that polyglactin 910 mesh induces earlier maturation of transplanted patella tendons biomechanically, and may be a useful material for ACL reconstruction. PMID:9656706

  10. The comparison of anterior knee pain in severe and non severe arthritis of the lateral facet of the patella following a mobile bearing unicompartmental knee arthroplasty.

    PubMed

    Pongcharoen, Boonchana; Reutiwarangkoon, Chaivet

    2016-01-01

    In the past, medial osteoarthritis (OA) knee with symptomatic patellofemoral (PF) arthritis has not been recommended for a unicompartmental knee arthroplasty (UKA). However, recent studies have reported that UKA has shown good results in patients with medial OA of the knee, including those with PF arthritis. The purpose of this study is to compare the results between patients with medial OA knees; those with severe arthritis of the lateral facet of the patella and patients without severe arthritis of the lateral facet of the patella following mobile bearing UKA. We have prospectively evaluated 104 patients (114 knees) who had undergone an Oxford mobile bearing UKA. The mean follow-up was 19.05 months (range 12.30-29.70 months). The patients were divided into two groups: group I consisted of eighty patients (88 knees) who did not have severe arthritis of the lateral facet (Outerbridge grade 0-2) and group II had twenty-four patients (26 knees) who had severe arthritis of the lateral facet (Outerbridge grade 3, 4). We recorded the incidence of anterior knee pain, knee scores, pain scores, and functional scores in comparison of the two groups. The visual analog scale (VAS) and incidence of post-operative anterior knee pain had not shown any significant differences. The VAS for post-operative anterior knee pain was 0.11 (SD 0.56, range 0-3 point) versus 0.12 (SD 0.59, range 0-3 point) for group I and group II patients, respectively (P = 0.98). The incidence of post-operative anterior knee pain was 4.5 versus 3.8 % for group I and group II patients, respectively (P = 0.88). The pain scores and functional scores had not exhibited any differences. However, the knee scores of patients with severe arthritis of the lateral facet of the patella was worse than those seen in patients without severe arthritis of the lateral facet of the patella with a statistical significance. It was scored as 96.78 (SD 4.56, range 85-100) versus 94.43 (SD 4.50, range 81-100) for group I

  11. Organiser role of the stem cell of the mesoderm in prototroch patterning in Patella vulgata (Mollusca, Gastropoda).

    PubMed

    Damen, P; Dictus, W J

    1996-05-01

    During early development of the gastropod mollusc Patella vulgata, the stem cell of the mesoderm (3D-macromere) is induced. As a result of this induction, the embryo becomes dorsoventrally organised. At about the same time in development, ciliated cells, so-called trochoblasts, are formed. Later in development, some trochoblasts deciliate and, together with the ciliated trochoblast, form the dorsoventrally organised prototroch, the locomotory organ of the larva. In order to study the role of the 3D-macromere in the specification of trochoblasts and in the induction of the dorsoventral organisation of the prototroch, induction of 3D has been prevented in various ways. it is shown that preventing 3D-induction results in the formation of a radially symmetrical prototroch. The trochoblasts of all four quadrants developed like corresponding trochoblasts of the A-quadrant. Somewhere between 30 and 120 min after fifth cleavage the 3D-macromere induces the formation of specific trochoblasts and organises the dorsoventral pattern of the prototroch. Besides a role of the 3D-macromere, a role of other cells has been demonstrated in the conditionally specified deciliation of trochoblasts. PMID:8798146

  12. 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

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

    PubMed

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

    2013-04-01

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

  14. Spatial diversity of rocky midlittoral macro-invertebrates associated with the endangered species Patella ferruginea (Mollusca: Gastropoda) of Tunisian coastline

    NASA Astrophysics Data System (ADS)

    Tlig-Zouari, Sabiha; Rabaoui, Lotfi; Fguiri, Hosni; Diawara, Moctar; Ben Hassine, Oum Kalthoum

    2010-04-01

    The present study focuses on horizontal spatial variability of benthic macrofauna associated with Patella ferruginea. Thirty-six samples collected at 12 transects belonging to 4 midlittoral sites along the rocky Tunisian coastline, were examined. A total of 44 species belonging to 5 taxa were found. Multivariate analysis applied on gathered data did not show a horizontal spatial variability at small scale (between transects), but at large scale, between sites as well as sectors. Thus, three groups of communities were identified (GI: Korbous and El Haouaria; GIIa: Zembra Island and GIIb: Kelibia). The distribution of species abundance within these groups revealed that crustaceans were the most abundant taxon, due to the overwhelming dominance of Chthamalus stellatus. This substratum appeared to create favourable micro-habitats for the installation of molluscs including gastropods. Regarding the low diversity index ( H') and evenness ( J), they seemed to reflect a disturbance and a demographic unbalance within these communities. The heterogeneity of substrate surface, created by C. stellatus specimens appeared to be caused by various complex interactions established between the key components of these communities in particular suspension feeders, predators, herbivorous molluscs and macroalgae. Thus, the dynamic status of each of these communities is the result of these complex interactions.

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

    NASA Astrophysics Data System (ADS)

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

    2015-03-01

    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.

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

    PubMed

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

    1999-08-01

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

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

    NASA Astrophysics Data System (ADS)

    Cravo, A.; Bebianno, M. J.

    2005-11-01

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

  18. 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

  19. Outcome of medial patellar ligament desmoplasty for treatment of intermittent upward fixation of the patella in 24 horses (2005–2012)

    PubMed Central

    Peitzmeier, Maggie D.; Koontz, Zachary D.; Lynch, Timothy M.; Hughes, Faith E.; Slone, Donnie E.

    2015-01-01

    This retrospective study provides long-term results of medial patellar ligament (MPL) desmoplasty in horses with intermittent upward fixation of the patella (UFP) that were treated at a single referral hospital over a 7-year period. Follow-up interviews were conducted with owners, trainers, or referring veterinarians using a standardized questionnaire. Overall, 71% of horses returned to their intended use with only 18% at a higher level. Recurrence of UFP was noted in 33% of cases. Satisfaction with the procedure was generally low, with only 50% of owners being completely satisfied. Further investigation is warranted to determine appropriate medical and/or surgical therapy. PMID:25694670

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

    PubMed Central

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

    2014-01-01

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

  1. 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

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

    ERIC Educational Resources Information Center

    Silver, Daniel M.; Campbell, Pat

    1985-01-01

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

  3. Concurrent Validation of the Banff Patella Instability Instrument to the Norwich Patellar Instability Score and the Kujala Score in Patients With Patellofemoral Instability

    PubMed Central

    Hiemstra, Laurie A.; Kerslake, Sarah; Lafave, Mark; Mohtadi, Nicholas G.

    2016-01-01

    Background: The Banff Patella Instability Instrument (BPII) is a disease-specific, patient-reported, quality-of-life outcome measure designed to assess patients with patellofemoral instability. The iterative assessment of the validity, reliability, and responsiveness of a health-related patient-reported outcome measure is vital to the development of a high-quality evaluation tool. Purpose: To assess the concurrent validity of the BPII to the Norwich Patellar Instability (NPI) score and the Kujala score. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 74 patients with a confirmed diagnosis of recurrent patellofemoral instability completed the BPII, NPI, and Kujala scores at the initial orthopaedic consultation. A Pearson r correlation coefficient was computed to determine the relationship between each of these patient-reported outcomes. Results: There were statistically significant correlations between the BPII and the NPI score (r = −0.53; P < .001) as well as the BPII and the Kujala score (r = 0.50; P < .001). Conclusion: This study demonstrated a moderately strong correlation of the BPII to other outcome measures used to evaluate patients with patellofemoral instability. This study adds further validity to the BPII in accordance with the COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) guidelines. PMID:27231700

  4. Draft genome assemblies and predicted microRNA complements of the intertidal lophotrochozoans Patella vulgata (Mollusca, Patellogastropoda) and Spirobranchus (Pomatoceros) lamarcki (Annelida, Serpulida).

    PubMed

    Kenny, Nathan J; Namigai, Erica K O; Marlétaz, Ferdinand; Hui, Jerome H L; Shimeld, Sebastian M

    2015-12-01

    MicroRNAs (miRNA) are small non-coding RNAs that act post-transcriptionally to regulate gene expression levels. Some studies have indicated that microRNAs may have low homoplasy, and as a consequence the phylogenetic distribution of microRNA families has been used to study animal evolutionary relationships. Limited levels of lineage sampling, however, may distort such analyses. Lophotrochozoa is an under-sampled taxon that includes molluscs, annelids and nemerteans, among other phyla. Here, we present two novel draft genomes, those of the limpet Patella vulgata and polychaete Spirobranchus (Pomatoceros) lamarcki. Surveying these genomes for known microRNAs identifies numerous potential orthologues, including a number that have been considered to be confined to other lineages. RT-PCR demonstrates that some of these (miR-1285, miR-1287, miR-1957, miR-1983 and miR-3533), previously thought to be found only in vertebrates, are expressed. This study provides genomic resources for two lophotrochozoans and reveals patterns of microRNA evolution that could be hidden by more restricted sampling. PMID:26319627

  5. A low-riding patella in posterior stabilised total knee replacements alters quadriceps' mechanical advantage, resulting in reduced knee flexion moments.

    PubMed

    Ward, T R; Pandit, H; Hollinghurst, D; Zavatsky, A B; Gill, H S; Thomas, N P; Murray, D W

    2012-08-01

    Abnormal in vivo Total Knee Replacement (TKR) kinetics is influenced by a range of factors, particularly by changes to the knee's geometric parameters such as the patellar tendon moment arm (PTMA). In this study, ground reaction force (GRF) measurements were combined with simultaneous fluoroscopic image measurements to investigate the relationship between abnormal TKR kinetics and geometric parameters. Nine Scorpio Cruciate Retaining (CR) TKR (Stryker, Newbury, UK), nine Scorpio Posterior Stabilized (PS) TKR and seven normal subjects performed a step-up activity on a forceplate in view of a fluoroscope. The TKR subjects were part of a larger ongoing randomised controlled trial. The maximum external knee flexion moment was 22.0% lower in the Scorpio PS group compared to the Scorpio CR group. No significant differences in PTMA were found between the groups. The Scorpio PS had a low-riding patella, with a 30.7% reduction in patellar height compared to the Scorpio CR. This was probably due to using a thick tibial insert after PCL release in the PS, and led to an 8° increase in patellar flexion angle which altered the patellar mechanism and reduced quadriceps' mechanical advantage. Consequently, PS subjects stepped-up more cautiously with a reduced knee flexion moment. PMID:22015171

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

    PubMed

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

    2014-12-01

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

  7. Cross-cultural Adaptation and Validation of the Victorian Institute of Sport Assessment-Patella Questionnaire for French-Speaking Patients With Patellar Tendinopathy.

    PubMed

    Kaux, Jean-François; Delvaux, François; Oppong-Kyei, Julian; Beaudart, Charlotte; Buckinx, Fanny; Croisier, Jean-Louis; Forthomme, Bénédicte; Crielaard, Jean-Michel; Bruyère, Olivier

    2016-05-01

    Study Design Clinical measurement study. Background The Victorian Institute of Sport Assessment-Patella (VISA-P), originally developed in English, assesses the severity of patellar tendinopathy symptoms. To date, no French version of the questionnaire exists. Objectives The aim of our study was to translate the VISA-P into French and verify its psychometric properties. Methods The translation and cultural adaptation were performed according to international recommendations in 6 steps: initial translation, translation merging, back translation to the original language, use of an expert committee to reach a prefinal version, test of the prefinal version, and expert committee appraisal of a final version. Afterward, the psychometric properties of the final French version (VISA-PF) were assessed in 92 subjects, divided into 3 groups: pathological subjects (n = 28), asymptomatic subjects (n = 22), and sports-risk subjects (n = 42). Results All members of the expert committee agreed with the final version. On a scale ranging from 0 to 100, with 100 representing an asymptomatic subject, the average ± SD scores on the VISA-PF were 53 ± 17 for the pathological group, 99 ± 2 for the healthy group, and 86 ± 14 for the sports-risk group. The test-retest reliability of the VISA-PF was excellent, with good internal consistency. Correlations between the VISA-PF and divergent validity of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) were low, and the correlation coefficient values measured between the VISA-PF scores and converged items of the SF-36 were higher. Conclusion The VISA-PF is understandable, valid, and suitable for French-speaking patients with patellar tendinopathy. J Orthop Sports Phys Ther 2016;46(5):384-390. Epub 21 Mar 2016. doi:10.2519/jospt.2016.5937. PMID:26999409

  8. 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 < 0.05). The mean Lysholm score was significantly increased from 47.2 ± 5.2 to 92.5 ± 6.2 points postoperatively (P < 0.05). The Tegner activity score improved

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

    PubMed Central

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

    2011-01-01

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

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

    PubMed

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

    2012-05-01

    The aim of the present study was to evaluate incidence, degree and impact of tibial tunnel widening (TW) on patient-reported long-term clinical outcome, knee joint stability and prevalence of osteoarthritis (OA) after isolated anterior cruciate ligament (ACL) reconstruction. On average, 13.5 years after ACL reconstruction via patella-bone-tendon-bone autograft, 73 patients have been re-evaluated. Inclusion criteria consisted of an isolated anterior cruciate ligament rupture and reconstruction, a minimum of 10-year follow-up and no previous anterior cruciate ligament repair or associated intra-articular lesions. Clinical evaluation was performed via the International Knee Documentation Committee (IKDC) score and the Tegner and Lysholm scores. Instrumental anterior laxity testing was carried out with the KT-1000™ arthrometer. The degree of degenerative changes and the prevalence of osteoarthritis were assessed with the Kellgren-Lawrence score. Tibial tunnel enlargement was radiographically evaluated on both antero-posterior and lateral views under establishment of 4 degrees of tibial tunnel widening by measuring the actual tunnel diameters in mm on the sclerotic margins of the inserted tunnels on 3 different points (T1-T3). Afterwards, a conversion of the absolute values in mm into a 4 staged ratio, based on the comparison to the results of the initial drill-width, should provide a better quantification and statistical analysis. Evaluation was performed postoperatively as well as on 2 year follow-up and 13 years after ACL reconstruction. Minimum follow-up was 10 years. 75% of patients were graded A or B according to IKDC score. The mean Lysholm score was 90.2±4.8 (25-100). Radiological assessment on long-term follow-up showed in 45% a grade I, in 24% a grade II, in 17% a grade III and in additional 12% a grade IV enlargement of the tibial tunnel. No evident progression of TW was found in comparison to the 2 year results. Radiological evaluation revealed

  11. COL5A1: Genetic mapping and exclusion as candidate gene in families with nail-patella syndrome, tuberous sclerosis 1, hereditary hemorrhagic telangiectasia, and Ehlers-Danlos syndrome type II

    SciTech Connect

    Greenspan, D.S.; Northrup, H.; Au, K.S.

    1995-02-10

    COL5A1, the gene for the {alpha}1 chain of type V collagen, has been considered a candidate gene for certain diseases based on chromosomal location and/or disease phenotype. We have employed 3{prime}-untranslated region RFLPs to exclude COL5A1 as a candidate gene in families with tuberous sclerosis 1, Ehlers-Danlos syndrome type H, and nail-patella syndrome. In addition, we describe a polymorphic simple sequence repeat (SSR) within a COL5A1 intron. This SSR is used to exclude COL5A1 as a candidate gene in hereditary hemorrhagic telangiectasia (Osler-Rendu-Weber disease) and to add COL5A1 to the existing map of {open_quotes}index{close_quotes} markers of chromosome 9 by evaluation of the COL5A1 locus on the CEPH 40-family reference pedigree set. This genetic mapping places COL5A1 between markers D9S66 and D9S67. 14 refs., 1 fig., 2 tabs.

  12. Knee joint examinations by magnetic resonance imaging: The correlation of pathology, age, and sex

    PubMed Central

    Avcu, Serhat; Altun, Ersan; Akpinar, Ihsan; Bulut, Mehmet Deniz; Eresov, Kemal; Biren, Tugrul

    2010-01-01

    Aims: The aim of our study was to investigate the incidence and coexistence of multiple knee joint pathologies and the distribution of knee joint pathologies according to age and sex. Patients and Methods: A retrospective analysis was performed using the clinical data of patients evaluated with magnetic resonance imaging (MRI) of the knee joint. Data from 308 patients examined between August 2002 and July 2003 were included into this study. A Pearson correlation analysis was performed to examine the relationship between the pathological findings and the age and sex of the patients. Results: The ages of the patients ranged between 1 and 74 years (mean: 43.3 years). Age was significantly correlated with meniscal degeneration and tears, medial collateral ligament degeneration, parameniscal cyst, and chondromalacia patellae. There was a significant correlation between male gender and anterior cruciate ligament injury. Meniscal injury was significantly correlated with bursitis, as well as medial collateral ligament injury. Bone bruise was significantly correlated with medial collateral ligament injury, lateral collateral ligament injury, Baker's cyst, and anterior cruciate ligament injury. Chondromalacia patellae was significantly correlated with anterior cruciate ligament injury, patellae alta, and osteochondral lesion. Bursitis (in 53.2% of the patients) followed by grade-II meniscal degeneration (in 43% of the patients) were the most common knee pathologies observed by MRI. Conclusions: MRI findings of select knee pathologies are significantly correlated with each other and the age and sex of the patient. PMID:22624141

  13. Technical considerations in total knee surgery. Management of patella problems.

    PubMed

    Goldberg, V M; Figgie, H E; Figgie, M P

    1989-04-01

    Patellofemoral symptoms are now the most common cause of aseptic knee revision; however, the majority of patello-femoral problems are self-limited and may be managed symptomatically and nonoperatively. A trial of anti-inflammatory medications, stretching exercises, and appropriate bracing is always indicated. Patellofemoral symptoms are usually related to mechanical malalignment of all three components of the total knee arthroplasty. Attention to the fundamental principles of total knee arthroplasty, including restoration of the bony mechanical alignment, soft tissue stability, and maintenance of the anatomic joint line, prevents many of the problems. Meticulous preoperative planning and anatomic placement of the component parts are important for a satisfactory long-term outcome. Present research is directed to providing kinematic analysis of the patellofemoral tracking mechanism and to minimizing patellofemoral contact stresses with appropriate new designs. PMID:2646562

  14. Patellar Articular Overlap on MRI Is a Simple Alternative to Conventional Measurements of Patellar Height

    PubMed Central

    Munch, Jacqueline L.; Sullivan, Jaron P.; Nguyen, Joseph T.; Mintz, Douglas; Green, Daniel W.; Shubin Stein, Beth E.; Strickland, Sabrina

    2016-01-01

    Background: Patella alta describes an abnormally high-riding patella in relationship to the femur and has been shown to correlate with patellofemoral pain, instability, chondromalacia, and arthrosis. Conventional measurements of patella alta involve multiple measurements and are often not defined on cross-sectional imaging as related to radiographs. Hypothesis: Patellar articular overlap on sagittal magnetic resonance imaging (MRI) will correlate well with conventional measurements of patella alta as measured by a standardized technique defined by our group. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: MRIs of 239 knees were reviewed by 3 attending surgeons with practices focusing on patellofemoral disease, as well as 2 sports medicine fellows and 1 musculoskeletal radiologist. Measurements included articular overlap, percentage of articular coverage, Caton-Deschamps index, Blackburne-Peel index, and modified Insall-Salvati index. Results: Interrater reliability was high for Caton-Deschamps, Blackburne-Peel, and modified Insall-Salvati indices (intraclass correlation coefficient [ICC], 0.877, 0.828, and 0.787, respectively). Articular overlap and percentage articular coverage correlated well with each other (ICC, 0.961; P < .001) and with the Caton-Deschamps (overlap r = –0.271, P < .001; coverage r = –0.131, P = .037) and Blackburne-Peel (overlap r = 0.343, P < .001; coverage r = –0.238, P < .001) indices. Articular overlap and percentage coverage failed to correlate with the modified Insall-Salvati index (overlap r = –0.117, P = .091; coverage r = 0.007, P = .918). Conclusion: Patellar articular overlap and percentage of patellar articular coverage show promise as a simpler alternative to conventional, ratio-based measurements of patellar height. Future studies are needed to evaluate the range of normal and the relationship to our traditionally used measurements. PMID:27482530

  15. Is there a role of pulsed electromagnetic fields in management of patellofemoral pain syndrome? Randomized controlled study at one year follow-up.

    PubMed

    Servodio Iammarrone, Clemente; Cadossi, Matteo; Sambri, Andrea; Grosso, Eugenio; Corrado, Bruno; Servodio Iammarrone, Fernanda

    2016-02-01

    Patellofemoral pain syndrome (PFPS) is a common cause of recurrent or chronic knee pain in young adults, generally located in the retropatellar region. Etiology is controversial and includes several factors, such as anatomical defects, muscular imbalance, or joint overuse. Good results have been reported with exercise therapy, including home exercise program (HEP). Joint inflammation with increase of pro-inflammatory cytokines levels in the synovial fluid might be seen especially when chondromalacia becomes evident. Biophysical stimulation with pulsed electromagnetic fields (PEMFs) has shown anti-inflammatory effects and anabolic chondrocyte activity. The purpose of this randomized controlled study was to evaluate if the combination of HEP with PEMFs was more effective than HEP alone in PFPS treatment. Thirty-one PFPS patients were enrolled in this study. All patients were instructed to train with HEP. Patients in the PEMFs group associated HEP with PEMFs. Function and pain were assessed with Victorian Institute of Sport Assessment score (VISA), Visual Analog Scale (VAS), and Feller's Patella Score at baseline at 2, 6, and 12 months of follow-up. Drug assumption was also recorded. Increase in VISA score was significantly higher in PEMFs group compared to controls at 6 and 12 months, as well as the increase in the Feller's Patella Score at 12 months. VAS score became significantly lower in the PEMFs group with respect to control group since 6 month follow-up. Pain reduction obtained with PEMFs enhanced practicing therapeutic exercises leading to a better recovery process; this is extremely important in addressing the expectations of young patients, who wish to return to sporting activities. PMID:26756278

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

    PubMed

    Dauty, M; Tortellier, L; Rochcongar, P

    2005-09-01

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

  17. Coordinated collagen and muscle protein synthesis in human patella tendon and quadriceps muscle after exercise.

    PubMed

    Miller, Benjamin F; Olesen, Jens L; Hansen, Mette; Døssing, Simon; Crameri, Regina M; Welling, Rasmus J; Langberg, Henning; Flyvbjerg, Allan; Kjaer, Michael; Babraj, John A; Smith, Kenneth; Rennie, Michael J

    2005-09-15

    We hypothesized that an acute bout of strenuous, non-damaging exercise would increase rates of protein synthesis of collagen in tendon and skeletal muscle but these would be less than those of muscle myofibrillar and sarcoplasmic proteins. Two groups (n = 8 and 6) of healthy young men were studied over 72 h after 1 h of one-legged kicking exercise at 67% of maximum workload (W(max)). To label tissue proteins in muscle and tendon primed, constant infusions of [1-(13)C]leucine or [1-(13)C]valine and flooding doses of [(15)N] or [(13)C]proline were given intravenously, with estimation of labelling in target proteins by gas chromatography-mass spectrometry. Patellar tendon and quadriceps biopsies were taken in exercised and rested legs at 6, 24, 42 or 48 and 72 h after exercise. The fractional synthetic rates of all proteins were elevated at 6 h and rose rapidly to peak at 24 h post exercise (tendon collagen (0.077% h(-1)), muscle collagen (0.054% h(-1)), myofibrillar protein (0.121% h(-1)), and sarcoplasmic protein (0.134% h(-1))). The rates decreased toward basal values by 72 h although rates of tendon collagen and myofibrillar protein synthesis remained elevated. There was no tissue damage of muscle visible on histological evaluation. Neither tissue microdialysate nor serum concentrations of IGF-I and IGF binding proteins (IGFBP-3 and IGFBP-4) or procollagen type I N-terminal propeptide changed from resting values. Thus, there is a rapid increase in collagen synthesis after strenuous exercise in human tendon and muscle. The similar time course of changes of protein synthetic rates in different cell types supports the idea of coordinated musculotendinous adaptation. PMID:16002437

  18. Dislocation of the patella in a patient with Rubinstein-Taybi syndrome--a case study.

    PubMed

    Tyrakowski, Marcin; Pietrzak, Szymon; Przybysz, Waldemar; Czubak, Jarosław

    2011-01-01

    The Rubinstein-Taybi syndrome is a rare syndrome of congenital disorders whose etiology is still unknown. Most RTS patients have musculoskeletal abnormalities which, if untreated, may significantly affect independent mobility. This paper presents the results of a surgical treatment of a 13-year-old patient with RTS and instability of the patellofemoral joint. The patient was followed up for 3 years. Surgery resulted in complete pain relief, increased knee range of motion and marked improvement in the patient's gait. An extensive plasty of the extensor apparatus of the knee joint increases the likelihood of a good and lasting treatment result in patients with RTS and instability of the patellofemoral joint. PMID:22147440

  19. The Meniscus-Deficient Knee

    PubMed Central

    Rao, Allison J.; Erickson, Brandon J.; Cvetanovich, Gregory L.; Yanke, Adam B.; Bach, Bernard R.; Cole, Brian J.

    2015-01-01

    Meniscal tears are the most common knee injury, and partial meniscectomies are the most common orthopaedic surgical procedure. The injured meniscus has an impaired ability to distribute load and resist tibial translation. Partial or complete loss of the meniscus promotes early development of chondromalacia and osteoarthritis. The primary goal of treatment for meniscus-deficient knees is to provide symptomatic relief, ideally to delay advanced joint space narrowing, and ultimately, joint replacement. Surgical treatments, including meniscal allograft transplantation (MAT), high tibial osteotomy (HTO), and distal femoral osteotomy (DFO), are options that attempt to decrease the loads on the articular cartilage of the meniscus-deficient compartment by replacing meniscal tissue or altering joint alignment. Clinical and biomechanical studies have reported promising outcomes for MAT, HTO, and DFO in the postmeniscectomized knee. These procedures can be performed alone or in conjunction with ligament reconstruction or chondral procedures (reparative, restorative, or reconstructive) to optimize stability and longevity of the knee. Complications can include fracture, nonunion, patella baja, compartment syndrome, infection, and deep venous thrombosis. MAT, HTO, and DFO are effective options for young patients suffering from pain and functional limitations secondary to meniscal deficiency. PMID:26779547

  20. Accuracy of clinical diagnosis in knee arthroscopy.

    PubMed Central

    Brooks, Stuart; Morgan, Mamdouh

    2002-01-01

    A prospective study of 238 patients was performed in a district general hospital to assess current diagnostic accuracy rates and to ascertain the use and the effectiveness of magnetic resonance imaging (MRI) scanning in reducing the number of negative arthroscopies. The pre-operative diagnosis of patients listed for knee arthroscopy was medial meniscus tear 94 (40%) and osteoarthritis 59 (25%). MRI scans were requested in 57 patients (24%) with medial meniscus tear representing 65% (37 patients). The correlation study was done between pre-operative diagnosis, MRI and arthroscopic diagnosis. Clinical diagnosis was as accurate as the MRI with 79% agreement between the preoperative diagnosis and arthroscopy compared to 77% agreement between MRI scan and arthroscopy. There was no evidence, in this study, that MRI scan can reduce the number of negative arthroscopies. Four normal MRI scans had positive arthroscopic diagnosis (two torn medial meniscus, one torn lateral meniscus and one chondromalacia patella). Out of 240 arthroscopies, there were only 10 normal knees (negative arthroscopy) representing 4% of the total number of knee arthroscopies; one patient of those 10 cases had MRI scan with ACL rupture diagnosis. Images Figure 1 Figure 2 PMID:12215031

  1. The Meniscus-Deficient Knee: Biomechanics, Evaluation, and Treatment Options.

    PubMed

    Rao, Allison J; Erickson, Brandon J; Cvetanovich, Gregory L; Yanke, Adam B; Bach, Bernard R; Cole, Brian J

    2015-10-01

    Meniscal tears are the most common knee injury, and partial meniscectomies are the most common orthopaedic surgical procedure. The injured meniscus has an impaired ability to distribute load and resist tibial translation. Partial or complete loss of the meniscus promotes early development of chondromalacia and osteoarthritis. The primary goal of treatment for meniscus-deficient knees is to provide symptomatic relief, ideally to delay advanced joint space narrowing, and ultimately, joint replacement. Surgical treatments, including meniscal allograft transplantation (MAT), high tibial osteotomy (HTO), and distal femoral osteotomy (DFO), are options that attempt to decrease the loads on the articular cartilage of the meniscus-deficient compartment by replacing meniscal tissue or altering joint alignment. Clinical and biomechanical studies have reported promising outcomes for MAT, HTO, and DFO in the postmeniscectomized knee. These procedures can be performed alone or in conjunction with ligament reconstruction or chondral procedures (reparative, restorative, or reconstructive) to optimize stability and longevity of the knee. Complications can include fracture, nonunion, patella baja, compartment syndrome, infection, and deep venous thrombosis. MAT, HTO, and DFO are effective options for young patients suffering from pain and functional limitations secondary to meniscal deficiency. PMID:26779547

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

    PubMed Central

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

    2005-01-01

    Prochloron spp. are obligate cyanobacterial symbionts of many didemnid family ascidians. It has been proposed that the cyclic peptides of the patellamide class found in didemnid extracts are synthesized by Prochloron spp., but studies in which host and symbiont cells are separated and chemically analyzed to identify the biosynthetic source have yielded inconclusive results. As part of the Prochloron didemni sequencing project, we identified patellamide biosynthetic genes and confirmed their function by heterologous expression of the whole pathway in Escherichia coli. The primary sequence of patellamides A and C is encoded on a single ORF that resembles a precursor peptide. We propose that this prepatellamide is heterocyclized to form thiazole and oxazoline rings, and the peptide is cleaved to yield the two cyclic patellamides, A and C. This work represents the full sequencing and functional expression of a marine natural-product pathway from an obligate symbiont. In addition, a related cluster was identified in Trichodesmium erythraeum IMS101, an important bloom-forming cyanobacterium. PMID:15883371

  3. [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

  4. Comparison of Indirect MR Arthrography With Conventional MRI in the Diagnosis of Knee Pathologies in Patients With Knee Pain

    PubMed Central

    Babaei Jandaghi, Ali; Mardani-Kivi, Mohsen; Mirbolook, Ahmadreza; Emami-Meybodi, Mohammad Kazem; Mohammadzadeh, Solmaz; Farahmand, Maral

    2016-01-01

    Background Knee pain is a common problem in the general population. In order to determine the extent of the injury and the appropriate treatment, MRI provides the most accurate imaging method. This may be done through conventional MRI techniques or by injecting a contrast material (MR arthrography). Objectives The purpose of this study was to compare the diagnostic value of these two methods. Patients and Methods The study involved the diagnostic evaluation on 60 patients with knee pain who received treatment over the course of a one-year period. Referred patients were randomly divided into two groups: indirect MR arthrography was performed on one group, and conventional MRI was performed on the other group. Both groups then underwent arthroscopy. The results from both groups were compared with the arthroscopic findings. Results In all of the pathologies studied, the sensitivity, specificity, and the positive and negative predictive values were evaluated. A high rate of accuracy was found between MR arthrography and arthroscopy (P < 0.05) for all knee injuries, however a similar rate of accuracy between conventional MRI and arthroscopy was only seen in patients with damage to the posterior cruciate ligament (PCL), the tibio-femoral articular cartilage, and patella chondromalacia (P < 0.05). The highest rate of accuracy was seen in cases where indirect MR arthrography was used for the diagnosis of anterior cruciate ligament (ACL) damage (K = 1). Conclusions Our results have shown that indirect MR arthrography had greater diagnostic accuracy in regards to the sensitivity, specificity, and positive and negative predictive values than conventional MRI in knee pathologies. PMID:27625998

  5. 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

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

    PubMed Central

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

    2015-01-01

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

  7. Knee arthroscopy - series (image)

    MedlinePlus

    ... knee problems such as: a torn knee disc (meniscus) a damaged knee bone (patella) a damaged ligament ... surgeon can see the ligaments, the knee disc (meniscus), the knee bone (patella), the lining of the ...

  8. Comparative evaluation of patellar height methods in the Brazilian population☆

    PubMed Central

    Behrendt, Christian; Zaluski, Alexandre; e Albuquerque, Rodrigo Pires; de Sousa, Eduardo Branco; Cavanellas, Naasson

    2015-01-01

    Objective The methods most used for patellar height measurement were compared with the plateau–patella angle method. Methods A cross-sectional study was conducted, in which lateral-view radiographs of the knee were evaluated using the three methods already established in the literature: Insall–Salvati (IS), Blackburne–Peel (BP) and Caton–Deschamps (CD). These were compared with the plateau–patella angle method. One hundred and ninety-six randomly selected patients were included in the sample. Results The data were initially evaluated using the chi-square test. This analysis was deemed to be positive with p < 0.0001. We compared the traditional methods with the plateau–patella angle measurement, using Fisher's exact test. In comparing the IS index with the plateau–patella angle, we did not find any statistically significant differences in relation to the proportion of altered cases between the two groups. The traditional methods were compared with the plateau–patella angle with regard to the proportions of cases of high and low patella, by means of Fisher's exact test. This analysis showed that the plateau–patella angle identified fewer cases of high patella than did the IS, BP and CD methods, but more cases of low patella. In comparing pairs, we found that the IS and CD indices were capable of identifying more cases of high patella than was the plateau–patella angle. In relation to the cases of low patella, the plateau–patella angle was capable of identifying more cases than were the other three methods. Conclusions The plateau–patella angle found more patients with low patella than did the classical methods and showed results that diverged from those of the other indices studied. PMID:26962492

  9. 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

  10. Development and validation of a weight-bearing finite element model for total knee replacement.

    PubMed

    Woiczinski, M; Steinbrück, A; Weber, P; Müller, P E; Jansson, V; Schröder, Ch

    2016-08-01

    Total knee arthroplasty (TKA) is a successful procedure for osteoarthritis. However, some patients (19%) do have pain after surgery. A finite element model was developed based on boundary conditions of a knee rig. A 3D-model of an anatomical full leg was generated from magnetic resonance image data and a total knee prosthesis was implanted without patella resurfacing. In the finite element model, a restarting procedure was programmed in order to hold the ground reaction force constant with an adapted quadriceps muscle force during a squat from 20° to 105° of flexion. Knee rig experimental data were used to validate the numerical model in the patellofemoral and femorotibial joint. Furthermore, sensitivity analyses of Young's modulus of the patella cartilage, posterior cruciate ligament (PCL) stiffness, and patella tendon origin were performed. Pearson's correlations for retropatellar contact area, pressure, patella flexion, and femorotibial ap-movement were near to 1. Lowest root mean square error for retropatellar pressure, patella flexion, and femorotibial ap-movement were found for the baseline model setup with Young's modulus of 5 MPa for patella cartilage, a downscaled PCL stiffness of 25% compared to the literature given value and an anatomical origin of the patella tendon. The results of the conducted finite element model are comparable with the experimental results. Therefore, the finite element model developed in this study can be used for further clinical investigations and will help to better understand the clinical aspects after TKA with an unresurfaced patella. PMID:26618541

  11. The Analysis of Risk Factors in No Thumb Test in Total Knee Arthroplasty

    PubMed Central

    Kim, Jee Hyoung; Ko, Dong Oh; Yoo, Chang Wook; Chun, Tae Hwan; Lee, Jung Soo

    2011-01-01

    Background We would like to analyze the risk factors of no thumb test among knee alignment tests during total knee arthroplasty surgery. Methods The 156 cases of total knee arthroplasty by an operator from October 2009 to April 2010 were analyzed according to preoperative indicators including body weight, height, degree of varus deformity, and patella subluxation and surgical indicators such as pre-osteotomy patella thickness, degree of patella degeneration, no thumb test which was evaluated after medial prepatella incision and before bone resection (1st test), no thumb test which was evaluated with corrective valgus stress (2nd test, J test), and the kind of prosthesis. We comparatively analyzed indicators affecting no thumb test (3rd test). Results There was no relation between age, sex, and body weight and no thumb test (3rd test). Patellar sulcus angle (p = 0.795), patellar congruence angle (p = 0.276) and preoperative mechanical axis showed no relationship. The 1st no thumb test (p = 0.007) and 2nd test (p = 0.002) showed significant relation with the 3rd no thumb test. Among surgical indicators, pre-osteotomy patella thickness (p = 0.275) and degeneration of patella (p = 0.320) were not relevant but post-osteotomy patellar thickness (p = 0.002) was relevant to no thumb test (3rd test). According to prosthesis, there was no significance with Nexgen (p = 0.575). However, there was significant correlation between Scorpio (p = 0.011), Vanguard (p = 0.049) and no thumb test (3rd test). Especially, Scorpio had a tendency to dislocate the patella, but Vanguard to stabilize the patella. Conclusions No thumb test (3rd test) is correlated positively with 1st test, 2nd test, and post-osteotomy patella thickness. Therefore, the more patella osteotomy and the prosthesis with high affinity to patellofemoral alignment would be required for correct patella alignment. PMID:22162789

  12. Patellar nomenclature: the Tower of Babel revisited.

    PubMed

    Grelsamer, Ronald P

    2005-07-01

    Because we communicate mainly through words, it is important that terms be understood in the same manner by all readers. Unfortunately, the study of the patellofemoral joint is complicated by the use of expressions that hold different meanings for different readers. Ideally, the community of musculoskeletal physicians should agree on a single definition of terms, but until then, authors and speakers should define their terms clearly. Some terms, such as chondromalacia and patellofemoral syndrome, should be abandoned altogether. I propose a glossary of confusing terms pertaining to the patellofemoral joint, the various interpretations of these terms, and possible resolutions of these conflicts. Words and terms included in this review include chondromalacia, patellofemoral syndrome, anterior knee pain, subluxation, malalignment, proximal realignment, Roux procedure, and "normal." PMID:15995421

  13. Ballet injuries: the Australian experience.

    PubMed

    Quirk, R

    1983-11-01

    There is a distinct difference between ballet injuries and sports injuries in general, and the sports medicine physician needs to study the technique of dance and the specific injuries that it may produce in order to treat dancers effectively. In Australia, which is typical of other countries where ballet is performed, ballet injuries include strained lumbar muscles, sprained ankle, Achilles tendinitis, clicking hip, jumper's knee, chondromalacia, stress fractures, patellar subluxation, and other knee and tendon problems. PMID:6652700

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

    PubMed

    Regnault, Sophie; 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

  15. Patellar Dislocations and Reduction Procedure.

    PubMed

    Ramponi, Denise

    2016-01-01

    Acute patellar dislocations are a common injury occurring in adolescents involved in sports and dancing activities. This injury usually occurs when the knee is in full extension and sustains a valgus stress on the knee. The medial patellofemoral ligament is the medial restraint that assists in stabilizing the patella from lateral dislocations. The patella usually dislocates laterally and is usually not difficult to reduce after patient evaluation and prereduction radiographs. After postreduction radiographs confirm proper position of the patella postreduction and the absence of fractures, the patient is usually treated conservatively with initial immobilization, orthopedic referral, and physical therapy. PMID:27139130

  16. 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)

  17. Outcomes of patellar resurfacing versus nonresurfacing in total knee arthroplasty: a 9-year experience based on a case series of scorpio PS knees.

    PubMed

    Epinette, Jean-Alain; Manley, Michael T

    2008-10-01

    Patellar resurfacing during total knee arthroplasty (TKA) is an actively debated issue. This prospective study addresses fundamental questions regarding whether to resurface the patella. To do this, we compared clinical results of Scorpio PS knees with and without patellar resurfacing to determine whether there was any statistically significant difference in survivorship, function, pain, and radiographic analyses. Our study failed to demonstrate any statistical difference between the 2 groups (resurfaced versus nonresurfaced) according to knee pain, walking abilities, stair climbing, range of motion, and radiologic findings, as well as cross-correlations between patellar pain and age, gender, obesity, or etiology. Our radiologic findings did not reveal any failures of bony structures facing the metallic flange. Some knee designs can thus be seen as "patella friendly." Given the significant cost of patella resurfacing and the resulting well-known complications, we continue to avoid systematic resurfacing of the patella during Scorpio TKA. PMID:18979932

  18. Three-dimensional anatomy of the ostrich (Struthio camelus) knee joint

    PubMed Central

    Regnault, Sophie; Allen, Vivian; Hutchinson, John R.

    2014-01-01

    The three-dimensional anatomy of the ostrich (Struthio camelus) knee (femorotibial, femorofibular, and femoropatellar) joint has scarcely been studied, and could elucidate certain mechanobiological properties of sesamoid bones. The adult ostrich is unique in that it has double patellae, while another similar ratite bird, the emu, has none. Understanding why these patellae form and what purpose they may serve is dually important for future studies on ratites as well as for understanding the mechanobiological characteristics of sesamoid bone development. For this purpose, we present a three-dimensional anatomical study of the ostrich knee joint, detailing osteology, ligaments and menisci, and myology. We have identified seven muscles which connect to the two patellae and compare our findings to past descriptions. These descriptions can be used to further study the biomechanical loading and implications of the double patella in the ostrich. PMID:25551024

  19. Three-dimensional anatomy of the ostrich (Struthio camelus) knee joint.

    PubMed

    Chadwick, Kyle P; Regnault, Sophie; Allen, Vivian; Hutchinson, John R

    2014-01-01

    The three-dimensional anatomy of the ostrich (Struthio camelus) knee (femorotibial, femorofibular, and femoropatellar) joint has scarcely been studied, and could elucidate certain mechanobiological properties of sesamoid bones. The adult ostrich is unique in that it has double patellae, while another similar ratite bird, the emu, has none. Understanding why these patellae form and what purpose they may serve is dually important for future studies on ratites as well as for understanding the mechanobiological characteristics of sesamoid bone development. For this purpose, we present a three-dimensional anatomical study of the ostrich knee joint, detailing osteology, ligaments and menisci, and myology. We have identified seven muscles which connect to the two patellae and compare our findings to past descriptions. These descriptions can be used to further study the biomechanical loading and implications of the double patella in the ostrich. PMID:25551024

  20. Knee joint replacement - series (image)

    MedlinePlus

    ... than 3 blocks because of knee pain Loose knee prosthesis Some knee fractures ... an incision over the affected knee. The patella (knee cap) is moved ... helps the prosthesis to adhere better. The two parts of the ...

  1. Knee pain (image)

    MedlinePlus

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

  2. Neofunctionalization of a Duplicate dachshund Gene Underlies the Evolution of a Novel Leg Segment in Arachnids.

    PubMed

    Turetzek, Natascha; Pechmann, Matthias; Schomburg, Christoph; Schneider, Julia; Prpic, Nikola-Michael

    2016-01-01

    The acquisition of a novel function, or neofunctionalization, protects duplicated genes from redundancy and subsequent loss, and is a major force that drives adaptive evolution. Neofunctionalization has been inferred for many duplicated genes based on differences in regulation between the parental gene and its duplicate. However, only few studies actually link the new function of a duplicated gene to a novel morphological or physiological character of the organism. Here we show that the duplication of dachshund (dac) in arachnids (spiders and allies) is linked with the evolution of a novel leg segment, the patella. We have studied dac genes in two distantly related spider species, the entelegyne spider Parasteatoda tepidariorum and the haplogyne spider Pholcus phalangioides. Both species possess two paralogous dac genes that duplicated before the split between entelegyne and haplogyne spiders. In contrast to the evolutionarily highly conserved dac1, its duplicate dac2 is strongly expressed in the patella leg segment during embryogenesis in both species. Using parental RNA interference in P. tepidariorum we show that dac2 is required for the development of the patella segment. If dac2 function is impaired, then the patella is fused with the tibia into a single leg segment. Thus, removing the function of dac2 experimentally reverts P. tepidariorum leg morphology into a stage before the duplication of dac and the evolution of the patella segment. Our results indicate that the origin of the patella is the result of the duplication and subsequent neofunctionalization of dac in the arachnid lineage. PMID:26443673

  3. 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

  4. Sesamoid disorders of the first metatarsophalangeal joint.

    PubMed

    Boike, Allan; Schnirring-Judge, Molly; McMillin, Sean

    2011-04-01

    The sesamoid complex is located centrally and plantar to the first metatarsal head, where they are imbedded within the plantar plate, which transmits 50% of body weight and more than 300% during push-off, is susceptible to numerous pathologies. These pathologies include sesamoiditis, stress fracture, avascular necrosis, osteochondral fractures, and chondromalacia, and are secondary to these large weight-bearing loads. This article discusses sesamoid conditions and their relationship with hallux limitus, and reviews the conditions that predispose the first metatarsophalangeal joint to osteoarthritic changes. PMID:21669339

  5. Radial displacement of lateral meniscus after partial meniscectomy.

    PubMed

    Choi, Nam-Hong

    2006-05-01

    Radial displacement or extrusion of the meniscus has been reported as a complication after meniscal transplantation and is sometimes observed in knees with advanced osteoarthritis. In this report, the case of a patient with radial displacement of the lateral meniscus after partial meniscectomy is presented. He had an incomplete discoid lateral meniscus with an anterior horn tear. The inner portion of the lateral meniscus was excised to leave a width of 8 to 10 mm. However, follow-up magnetic resonance imaging showed radial displacement of the mid-body of the lateral meniscus and a compatible finding of chondromalacia of the lateral compartment of the knee. PMID:16651179

  6. Soft-Tissue Loop for Medial Patellofemoral Ligament Reconstruction.

    PubMed

    Miswan, Mohd Fairudz Bin Mohd; Al-Fayyadh, Mohamed Zubair Mohamed; Seow Hui, Teo; Mohamed Ali, Mohamed Razif Bin; Ng, Wuey Min

    2016-04-01

    A patient with patellar instability frequently presents with anterior knee pain, patellar subluxation, or dislocation. Medial patellofemoral ligament (MPFL) has a key role for normal patella tracking and stability. Reconstruction of the MPFL using a hamstring graft is a commonly used procedure for the treatment of chronic lateral subluxation of patella. Anchor sutures and bony tunnels are used for the patellar attachment of the graft. This can be associated with complications such as patella fracture; besides, it does not produce an anatomical reconstruction for the native MPFL that can alter the direction of tension applied on the patella. To overcome these problems, a soft-tissue loop technique is used for MPFL reconstruction. During this procedure, a semitendinosus graft was passed through the prepatellar extensor retinaculum and secured with sutures. The free ends of the graft were then passed between the second and third layers of the medial patellofemoral retinaculum and fixed to a femoral tunnel on the medial femoral condyle with an interference screw. The desired amount of tension on the graft is achieved under direct vision of patella tracking arthroscopically. We found this method to be relatively safe and fast. It is more anatomical and can avoid the complications during the conventional bony procedures. PMID:27354953

  7. A Rare Combination of Avulsion Fractures Around the Knee –A Case Report

    PubMed Central

    Reddy, Hanumantha; Thonse, Chirag; Chikkanna, Jayanth Kumar Bangalore

    2015-01-01

    Patella fractures, tibial spine avulsion and Segond fractures are mainly due to trauma to the knee which may be direct or indirect injuries. While each entity is well documented when occurring in isolation, but bilateral inferior pole patella fracture, tibial spine avulsion in the right knee and bilateral segond fracture in a same patient is a rare occurrence. We report a case of 24-year-old male with such an injury. The diagnosis was confirmed by X-ray, CT scan and MRI imaging of right knee. Then the patient was treated with arthroscopic anterior cruciate ligament (ACL) avulsion fixation with pull through technique and suture disc; bilateral inferior pole patella was treated conservatively with knee brace, segond fracture was treated conservatively similarly. To the best of our knowledge, this is the rare case in the medical literature with all these injuries occurring simultaneously. PMID:26500971

  8. Twenty-year survivorship of cementless anatomic graduated component total knee arthroplasty.

    PubMed

    Ritter, Merrill A; Meneghini, R Michael

    2010-06-01

    There is a renewed interest in cementless total knee arthroplasty (TKA) due to improved biomaterials, desire for decreased surgical times and the potential increased longevity. Seventy-three cementless TKAs (AGC, Biomet, Warsaw, Ind) were performed from 1984 to 1986. All components were implanted without cement and without screws and obtained minimum 10 years of follow-up. No patient was lost to follow-up. Fifteen failures occurred, including 12 failed metal-backed patellae, and survivorship for aseptic loosening of any component was 76.4% at 20 years. Two tibial components failed of aseptic loosening at 1.1 and 2.2 years. Excluding patella failures, the survivorship for the cementless tibial component was 96.8% at 20 years. There were no femoral component failures. After eliminating patella failures, this cementless monoblock tibial component without screws demonstrated excellent 20-year survivorship. PMID:19427163

  9. Biological Reconstruction of the Knee Joint in a Case of Giant Cell Tumor of the Tibia of 15yrs Followup- A Case Report

    PubMed Central

    Ravindranath, V S; Sastri, V.R.K.

    2014-01-01

    Introduction: A 40 year old male patient presented to us with Giant Cell Tumor of upper end of Tibia involving both condyles with a breach in the posterior cortex. In this case report we tried to retain the joint function by biological reconstruction using the Patella after the wide excision of the tumor mass. Case Report: A radical excision of the upper end of the Tibia was done. The Patella was used as an articular surface supported by ipsilateral Fibula as struts, thus the joint was reconstructured biologically. The case was followed for 15years. Conclusion: The tumor was excised in toto, the knee joint was restored by the Patella and the Fibular struts. The results were discussed in details. PMID:27299004

  10. Instrumentation of the patellar osteotomy in total knee arthroplasty. The relationship of patellar thickness and lateral retinacular release.

    PubMed

    Greenfield, M A; Insall, J N; Case, G C; Kelly, M A

    1996-01-01

    This study investigates the influence of patellar thickness in total knee arthroplasty (TKA) with routine patellar resurfacing on the rate of lateral retinacular release. A study group comprised of 121 TKAs using surgical instrumentation allowing a measured resection of the patella was compared with a control group comprised of 100 TKAs using an "eye-ball" technique for patellar resurfacing without particular attention to patellar thickness. A composite without patellar thickness equal to or slightly less than the original patella was attempted in the study group. The average thickness difference of the patella in the study group was -1.58 mm. Lateral retinacular release for patellar maltracking was performed in 12.4% of knees in the study group compared with 55% of knees in the control group. The variation in patellar thickness in this series often led to a residual bone thickness < 15 mm. No clinical problems have been observed to date. PMID:8836354

  11. Imaging assessment of patellar instability and its treatment in children and adolescents.

    PubMed

    Meyers, Arthur B; Laor, Tal; Sharafinski, Mark; Zbojniewicz, Andrew M

    2016-05-01

    Transient patellar dislocation is a common entity in children and adolescents, characterized by lateral dislocation of the patella, usually with spontaneous reduction. Many predisposing conditions have been described, including trochlear dysplasia, excessive lateral patellar tilt, patella alta and lateralization of the tibial tuberosity. Associated injuries are bone bruises of the patella and lateral femoral condyle, tears of the medial retinaculum that include the medial patellofemoral ligament (MPFL), tears of the vastus medialis obliquus muscle, injuries of articular cartilage, and intra-articular bodies. Children who are refractory to conservative management, have a large cartilage defect, or are at substantial risk for recurrent dislocations are candidates for surgical procedures to prevent future dislocations. Procedures can include MPFL repair or reconstruction, tibial tubercle repositioning and lateral retinacular release. The purpose of this review is to illustrate the imaging findings of transient patellar dislocation in the acute setting, the normal imaging appearance after surgical intervention, and post-surgical complications. PMID:26860094

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

    PubMed Central

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

    2014-01-01

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

  13. Is There an Ideal Patellar Thickness Following Total Knee Arthroplasty?

    PubMed

    Pierce, Todd P; Jauregui, Julio J; Cherian, Jeffrey J; Elmallah, Randa K; Harwin, Steven F; Mont, Michael A

    2016-01-01

    Orthopedic surgeons resurface the patella during total knee arthroplasty to avoid complications such as pain, patello-femoral arthritis, and patellar maltracking and to reduce the risk for reoperation. However, many complications, such as decreased range of motion, increased fractures, and polyethylene wear, have been described with this procedure. One determinant when resurfacing a patella is the thickness of its cuts. This review aims to investigate the relationship between patellar thickness and outcome parameters such as range of motion, patient-reported outcomes, periprosthetic fractures, and reoperations. PMID:26726982

  14. 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. )

    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.

  15. Lateral patellar burnishing in total knee arthroplasty following medialization of the patellar button.

    PubMed

    Doerr, T E; Eckhoff, D G

    1995-08-01

    This case report describes a total knee revision necessitated by painful contact between the exposed lateral facet of the patella and the femoral component. Pain was resolved following repositioning and enlarging the patellar component. The clinical significance of this report is that the contemporary practice of medializing the patellar component to improve patellar tracking should be performed in moderation to avoid overexposure of the lateral patella. In the setting of persistent anterior knee pain following total knee arthroplasty, the etiology of the pain may be identified as contact between the patellar and femoral component on the sunrise radiograph. PMID:8523016

  16. Reducing the Risk of ACL Injury in Female Athletes

    ERIC Educational Resources Information Center

    McDaniel, Larry W.; Rasche, Adrienna; Gaudet, Laura; Jackson, Allen

    2010-01-01

    The Anterior Cruciate Ligament (ACL) is located behind the kneecap (patella) and connects the thigh bone (femur) to the shin bone (tibia). Stabilizing the knee joint is the primary responsibility of the ACL. Injuries that affect the ACL are three to five times more common in females than males. This is a result of anatomical, biomechanical,…

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

    PubMed Central

    Keeley, Anthony; Bloomfield, Paul; Cairns, Peter; Molnar, Robert

    2009-01-01

    Stress fracture of the patella is rare. In this report, a case of patellar stress fracture occurring in an amateur athlete is presented, and an operative adjunct to the surgical management of this condition is proposed. A review of the English literature identified 21 previous cases of stress fracture of the patella, the majority in young athletes. None of these reports discussed treatment addressing the pathological process contributing to patellar stress fracture. The subject of this case report is a young male netballer who presented with a transverse stress fracture in the inferior third of his patella, on a background of patellofemoral overload. The patient underwent open reduction and internal fixation of his patella, combined with release of the iliotibial band. He returned to training after 6 weeks. The previous literature suggests that operative fixation is indicated for the treatment of displaced patellar stress fractures. Iliotibial band release, as a surgical adjunct to this treatment, may address the pathology of these fractures, and facilitate a return to sport at the highest level. PMID:19642974

  18. An Unusual Prepatellar Bursa Swelling: Patellar Button Dissociation and Migration

    PubMed Central

    Hester, Thomas; Moftah, Farid

    2016-01-01

    Implant loosening is not a new phenomenon, nor is implant migration; however they are rarely seen after knee arthroplasty surgery. Complications with patellar buttons have been reported before with peg failure, loosening, and patella fracture; however extra-articular migration is extremely rare. We report an unusual case of patellar button migration 11 years after total knee arthroplasty to the prepatellar bursa. PMID:26885422

  19. Patellofemoral ligament reconstruction in a patient with Rubinstein-Taybi syndrome.

    PubMed

    Mirzatolooei, Fardin

    2014-01-01

    Recurrent dislocation of patella may occur in patients with ligament laxity. Method of treatment in this condition is controversial but patellofemoral ligament reconstruction is the most accepted method. We present a patient with Rubinstein-Taybi syndrome and recurrent patellar dislocation who managed successfully by patellofemoral ligament reconstruction. PMID:24901727

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

    PubMed

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

    2011-01-01

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

  1. A Finite Element Analysis of Medial Patellofemoral Ligament Reconstruction

    PubMed Central

    DeVries Watson, Nicole A.; Duchman, Kyle R.; Bollier, Matthew J.; Grosland, Nicole M.

    2015-01-01

    Background The medial patellofemoral ligament is the primary soft-tissue restraint to lateral patella translation. Medial patellofemoral ligament reconstruction has become a viable surgical option to provide patellar stability in patients with recurrent instability. The primary goal of this study was to determine the effect of medial patellofemoral ligament reconstruction on the lateral force-displacement behavior of the patella using finite element analyses. Methods A finite element model of the knee was created using cadaveric image data. Experimental testing was performed to validate the computational model. After validation, the model was modified to study the effect of various medial patellofemoral ligament reconstruction insertion sites, allowing comparison of patellofemoral contact force and pressure. Results For the intact anatomic model, the lateral restraining force was 80.0 N with a corresponding patellar contact area of 54.97 mm2. For the anatomic reconstructed medial patellofemoral ligament model, the lateral restraining force increased to 148.9 N with a contact area of 71.78 mm2. This compared favorably to the corresponding experimental study. The force required to laterally displace the patella increased when the femoral insertion site was moved anteriorly or distally. The lateral restraining force decreased when the femoral insertion site moved proximally and the patellar insertion site moved either proximal or distal by 5 mm. Conclusion The line of action was altered with insertion site position, which in turn changed the amount of force it took to displace the patella laterally. Considering the model constraints, an anterior femoral attachment may over constrain the patella and increase cartilage wear due to increase contact area and restraining force. Clinical Relevance A malpositioned femoral tunnel in MPFL reconstruction could increase restraining forces and PF contact pressure, thus it is suggested to use intra-operative fluoroscopy to confirm

  2. ADVANCES IN THE USE OF STEM CELLS IN ORTHOPEDICS

    PubMed Central

    Cristante, Alexandre Fogaça; Narazaki, Douglas Kenji

    2015-01-01

    Primordial cells or stem cells are multipotent undifferentiated cells with the capacity to originate any type of cell in the organism. They may have their origins in the blastocyst and thus are classified as embryonic, or tissues developed in fetuses, newborns or adults and thus are known as somatic stem cells. Bone marrow is one of the main locations for isolating primordial cells, and there are two lineages: hematopoietic and mesenchymal progenitor cells. There are several uses for these undifferentiated cells in orthopedics, going from cartilaginous lesions in osteoarthrosis, osteochondritis dissecans and patellar chondromalacia, to bone lesions like in pseudarthrosis or bone losses, or nerve lesions like in spinal cord trauma. Studying stem cells is probably the most promising field of study of all within medicine, and this is shortly going to revolutionize all medical specialties (both clinical and surgical) and thus provide solutions for diseases that today are difficult to deal with. PMID:27027022

  3. Fibromyalgia syndrome. New associations.

    PubMed

    Waylonis, G W; Heck, W

    1992-12-01

    Previous research has demonstrated a number of conditions, such as sleep disturbance, fatigue, depression, spastic colon and mitral valve prolapse, associated with fibromyalgia. The present report describes additional symptoms and medical conditions that appear to be associated with the syndrome based on a survey of 554 individuals with fibromyalgia compared with a group of 169 controls. Individuals with fibromyalgia self report a greater incidence of bursitis, chondromalacia, constipation, diarrhea, temporomandibular joint dysfunction, vertigo, sinus and thyroid problems. Symptomatic complaints found statistically more prevalent in fibromyalgia patients included concentration problems, sensory symptoms, swollen glands and tinnitus. Other associations occurring with significant increased frequency were chronic cough, coccygeal and pelvic pain, tachycardia and weakness. Our previous report on inheritance patterns in fibromyalgia was reaffirmed with 12% reporting symptomatic children and 25% reporting symptomatic parents. Of the respondents, 70% noted that their symptoms were aggravated by noise, lights, stress, posture and weather. PMID:1466872

  4. 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.

  5. 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 < 0.0001). Axial femorotibial rotation showed typical internal rotation with increasing flexion both before and after TKA, but postoperatively it was significantly lower. The average amount of axial rotation was 3.5° before and after TKA 1.3° (p = 0.001). Mean quadriceps loading after implantation of knee prosthesis did not change significantly (575 N ±60 N in natural knee and after TKA 607 N ±96 N; p = 0.28). Conclusions The increased retropatellar pressure especially on the ridge may be one important reason for anterior knee pain after TKA. The trochlea of the femoral component might highly influence the pressure distribution of the non-resurfaced retropatellar surface. Additionally

  6. Repair of fresh patellar tendon rupture: tension regulation at the suture line

    PubMed Central

    2009-01-01

    The reported complications of the repaired patellar tendon have been attributed to the influence of the mechanical environment on the healing process. This study postulates that the healing complications can be minimised through tension regulation at the suture line using an absorbable reinforcement device. Twelve patients with fresh patellar tendon rupture were included in the study. They were prospectively followed up for an average period of 45 months. The patients resumed their pre-injury activities at an average of 6.1 months. The active knee movement averaged 0–154.6° compared to 0–156.7° in the contralateral knee. Radiologically no patella alta, patella baja or degenerative changes in the patellofemoral joints were noted. The results support use of the absorbable reinforcement device for tension regulation at the suture line. PMID:19809813

  7. Osteochondroma at its rarest site

    PubMed Central

    Mittal, Ankur; Srinivasulu, PSB; Ramprasd, R; Prasad, Y Siva

    2015-01-01

    Introduction: Osteochondromas usually arise from the metaphyseal region of the growing skeleton but extraskeletal cartilaginous tumors are rarest. Case Report: A 65 year old woman presented with anterior knee pain and inability to flex her knee more than 90° since 1 year. Clinical examination and imaging studies revealed a nodular calcific mass in the anterior portion of the knee i.e. patella. Following excision, histopathology confirmed the diagnosis of extra-osseous osteochondroma-like soft tissue mass, with no recurrence in 36 weeks. Conclusion: An integrated clinical-pathologic diagnosis helps to clarify the nature of extraskeletal cartilaginous tumors that can arise at unusual anatomic site viz. patella. Complete local surgical excision is the management of choice. PMID:27299045

  8. The patellofemoral joint in total knee prostheses. Design considerations.

    PubMed

    Freeman, M A; Samuelson, K M; Elias, S G; Mariorenzi, L J; Gokcay, E I; Tuke, M

    1989-01-01

    Some desirable design features of the patellofemoral joint in a total knee arthroplasty condylar prosthesis are proposed. These are that the femoral element should be grooved, have a high anterior flange, and be circular as viewed from the side. The groove should be about 5 mm deep and have relatively vertical walls. The patellar component should have a saddle-shaped articular surface matching the femur and should be countersunk into the patella. The components should be placed so as to position the joint automatically. Results with such a design are reported; loosening, wear, dislocation, and fracture have been rare. Osteolysis of the patella has not been seen after 9 years, so that the cementless press-fit fixation of an H.D.P. patellar prosthesis to date seems safe and efficacious. PMID:2584990

  9. A subdivision-based parametric deformable model for surface extraction and statistical shape modeling of the knee cartilages

    NASA Astrophysics Data System (ADS)

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

    2006-03-01

    Subdivision surfaces and parameterization are desirable for many algorithms that are commonly used in Medical Image Analysis. However, extracting an accurate surface and parameterization can be difficult for many anatomical objects of interest, due to noisy segmentations and the inherent variability of the object. The thin cartilages of the knee are an example of this, especially after damage is incurred from injuries or conditions like osteoarthritis. As a result, the cartilages can have different topologies or exist in multiple pieces. In this paper we present a topology preserving (genus 0) subdivision-based parametric deformable model that is used to extract the surfaces of the patella and tibial cartilages in the knee. These surfaces have minimal thickness in areas without cartilage. The algorithm inherently incorporates several desirable properties, including: shape based interpolation, sub-division remeshing and parameterization. To illustrate the usefulness of this approach, the surfaces and parameterizations of the patella cartilage are used to generate a 3D statistical shape model.

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

    PubMed Central

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

    2015-01-01

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

  11. Sonography of the canine stifle.

    PubMed

    Kramer, M; Stengel, H; Gerwing, M; Schimke, E; Sheppard, C

    1999-01-01

    When diagnosing disease of the stifle in dogs ultrasonography is a good addition to clinical and radiological examination. Radiology can evaluate the bony aspects of the joint and their relationship to each other. In contrast, sonography allows visualization of the soft tissue. For most evaluations the 7.5 MHz linear scanner is suited best. Normal stifles of 58 dogs of different breeds were evaluated using a standardized examination procedure. This procedure had been derived from that used in humans. The stifle is divided into several regions which are examined and evaluated. These are the suprapatellar, infrapatellar, lateral, caudal and medial region. One hundred twenty seven patients which had problems associated with the stifle joint were examined sonographically after a clinical and radiographic exam. Osteochondrosis dissecans, ruptured cranial cruciate ligament, meniscal damage, arthritis, tumor, post surgical conditions, injuries of the patella, patellar ligament or tibial tuberosity and luxating patella were examined sonographically and the findings recorded. PMID:10519309

  12. Management of Acute Patellar Dislocation: A Case Report

    PubMed Central

    Enix, Dennis E.; Sudkamp, Kasey; Scali, Frank; Keating, Robbyn; Welk, Aaron

    2015-01-01

    Objective The purpose of this case study is to describe the evaluation and management of patellar dislocations and the different approaches used from providers in different countries. Clinical Features An individual dislocated her left patella while traveling abroad and received subsequent care in Thailand, China, and the United States. Intervention and Outcome Nonoperative treatment protocols including manual closed reduction of the patella, casting of the leg, and rehabilitation exercises were employed. Conclusion Receipt of care when abroad can be challenging. The patient’s knee range of motion and pain continued to improve when she was diligent about performing the home exercise program. This case highlights the importance of a thorough examination, a proper regimen of care, and patient counseling to ensure a full recovery and minimize the chance of re-injury. PMID:26778935

  13. Studies on incidence and evaluation of the closed medial patellar desmotomy in lateral recumbency in bovines

    PubMed Central

    Singh, Ajit Kumar; Gangwar, A. K.; Devi, Kh. Sangeeta; Singh, H. N.

    2015-01-01

    Aim: The present study was conducted to find out the incidence and to evaluate the effectiveness of medial patellar desmotomy (MPD) in lateral recumbency in bovines. Material and Methods: One hundred and fifteen clinical cases of upward fixation of the patella in cattle and buffaloes were treated by closed MPD in lateral recumbency. Probable etiologies, symptoms and site of surgery including disease occurrence with respect to species, sex and season were also recorded. Results: In the present study, the highest incidence was reported in bullocks. A high success rate was obtained with the closed method in lateral recumbency. Conclusion: Based on the findings of this study, it can be concluded that the bullocks were more prone to upward fixation of patella and symptoms were exaggerated in winter season. Closed method of MPD was more suited in both cattle and buffaloes. PMID:27047077

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

    PubMed Central

    Munshi, N I; Mbubaegbu, C E

    1996-01-01

    A case of a healthy athlete with simultaneous rupture of quadriceps tendon and rupture of the contralateral patella tendon is reported. Both tendons rupturing in the same patient is rare and this is the first reported case in a previously healthy person. Different mechanisms are implicated in the different ruptures. The rarity is because the simultaneous presence of contributory factors for either injury in the same person is uncommon. Images Fig. 2 PMID:8799608

  15. Congenital deficiency of the fibula with ipsilateral iliac horn and absence of the kidney.

    PubMed

    Haga, N; Lee, K; Nakamura, K; Okazaki, Y; Mamada, K; Kurokawa, T

    1997-04-01

    Congenital deficiency of the fibula is sometimes accompanied by femoral hypoplasia, genu valgum, patellar a/hypoplasia or dislocation, tibial bowing, foot deformity, and toe deficiency in the affected limb. 'Iliac horns' are bony projections extending posterolaterally from the ilium and considered to be pathognomonic of nail-patella syndrome. We report a 5-year-old Japanese girl with congenital complete deficiency of the left fibula, ipsilateral iliac horn and absence of the left kidney. PMID:9134300

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

    PubMed Central

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

    2006-01-01

    Proximal patellar tendinopathy occurs as an overuse injury in sport and is also characteristic of ankylosing spondylitis patients. It particularly affects the posteromedial part of the patellar tendon enthesis, although the reason for this is unclear. We investigated whether there are regional differences in the trabecular architecture of the patella or in the histology of the patellar tendon enthesis that could suggest unequal force transmission from bone to tendon. Trabecular architecture was analysed from X-rays taken with a Faxitron radiography system of the patellae of dissecting room cadavers and in magnetic resonance images of the knees of living volunteers. Structural and fractal analyses were performed on the Faxitron digital images using MatLab software. Regional differences at the enthesis in the thickness of the uncalcified fibrocartilage and the subchondral plate were evaluated histologically in cadaveric material. The radiological studies showed that the quantity of bone and the apparent trabecular thickness in the patella were greatest medially, and that in the lateral part of the patella there were fewer trabeculae which were orientated either antero-posteriorly or superiorly inferiorly. The histological study showed that the uncalcified fibrocartilage was most prominent medially and that the subchondral plate was thinner laterally. Overall, the results indicate that mechanical stress at the proximal patellar tendon enthesis is asymmetrically distributed and greater on the medial than on the lateral side. Thus, we suggest that the functional anatomy of the knee is closely related to regional variations in force transmission, which in turn relates to the posteromedial site of pathology in proximal patellar tendinopathy. PMID:16420378

  17. Tips to diagnose uncommon nail disorders.

    PubMed

    Schneider, Samantha L; Tosti, Antonella

    2015-04-01

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

  18. Individuals with patellofemoral pain exhibit greater patellofemoral joint stress: a finite element analysis study

    PubMed Central

    Farrokhi, S.; Keyak, J.H.; Powers, C.M.

    2016-01-01

    Summary Objective To test the hypothesis that individuals with patellofemoral pain (PFP) exhibit greater patellofemoral joint stress profiles compared to persons who are pain-free. Methods Ten females with PFP and ten gender, age, and activity-matched pain-free controls participated. Patella and femur stress profiles were quantified utilizing subject-specific finite element (FE) models of the patellofemoral joint at 15° and 45° of knee flexion. Input parameters for the FE model included: (1) joint geometry, (2) quadriceps muscle forces, and (3) weight-bearing patellofemoral joint kinematics. Using a nonlinear FE solver, quasi-static loading simulations were performed to quantify each subject’s patellofemoral joint stress profile during a static squatting maneuver. The patella and femur peak and mean hydrostatic pressure as well as the peak and mean octahedral shear stress for the elements representing the chondro-osseous interface were quantified. Results Compared to the pain-free controls, individuals with PFP consistently exhibited greater peak and mean hydrostatic pressure as well as peak and mean octahedral shear stress for the elements representing the patella and femur chondro-osseous interface across the two knee flexion angles tested (15° and 45°). Conclusions The combined finding of elevated hydrostatic pressure and octahedral shear stress across the two kneeflexion angles supports the premise that PFPmay be associated with elevated joint stress. Therefore, treatments aimed at decreasing patellofemoral joint stress may be indicated in this patient population. PMID:21172445

  19. Reconstruction of medial patello-femoral ligament: Comparison of two surgical techniques.

    PubMed

    Criscenti, G; De Maria, C; Sebastiani, E; Tei, M; Placella, G; Speziali, A; Vozzi, G; Cerulli, G

    2016-06-01

    The medial patello-femoral ligament is considered the most important passive patellar stabilizer and its proper functionality is essential for the patello-femoral joint stability. In this work, 18 human knees were randomly divided into two groups and reconstructed through two different surgical techniques: the "Through tunnel tendon" and the "Double converging tunnel" reconstructions. Subsequently, the samples were mechanically tested to evaluate the structural properties of reconstructed femur-MPFL-Patella complex (rFMPC). Particular attention was given to maintain the anatomical orientation between the patella and the graft. Both procedures showed lower stiffness and higher ultimate strain and absorbed energy compared to the native MPFL, but the advantages of the double converging tunnel technique are related to the restoration of the native MPFL sail-shape, to a better stress distribution on the patella, to the use of a single interference screw as fixation device and to the simplicity, rapidity and cost-effectivity of the surgical procedure. The evaluation of the structural properties of rMPFL is fundamental to evaluate the adequacy of the different techniques to restore the physiological structural properties of the native MPFL. PMID:26894660

  20. Material and structural tensile properties of the human medial patello-femoral ligament.

    PubMed

    Criscenti, G; De Maria, C; Sebastiani, E; Tei, M; Placella, G; Speziali, A; Vozzi, G; Cerulli, G

    2016-02-01

    The medial patellofemoral ligament (MPFL) is considered the most important passive patellar stabilizer and acts 50-60% of the force of the medial soft-tissue which restrains the lateralization of the patella between 0° and 30°. In this work, 24 human knees have been tested to evaluate the material properties of MPFL and to determine the structural behavior of femur-MPFL-Patella complex (FMPC). Particular attention was given to maintain the anatomical orientation between the patella and MPFL and to the evaluation of the elongation during the mechanical tests. The ultimate stress of the isolated ligament was 16±11MPa, the ultimate strain was 24.3±6.8%, the Young׳s Modulus was 116±95MPa and the strain energy density was 2.97±1.69MPa. The ultimate load of the whole structure, FMPC, was 145±68N, the ultimate elongation was 9.5±2.9mm, the linear stiffness was 42.5±10.2N/mm and the absorbed energy was 818.8±440.7Nmm. The evaluation of material and structural properties of MPFL is fundamental to understand its contribution as stabilizer and for the selection of repair and reconstruction methods. PMID:26454357

  1. 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.

  2. Patellofemoral Crepitus after Total Knee Arthroplasty: Etiology and Preventive Measures

    PubMed Central

    Conrad, David N.

    2014-01-01

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

  3. [Surgical technique: reconstruction of deficient extensor apparatus of the knee - a case report].

    PubMed

    Wilken, F; Harrasser, N; Pohlig, F; Laux, F M; von Eisenhart-Rothe, R

    2015-04-01

    Injuries to the extensor apparatus of the knee are a rare but in case of their occurrence a serious injury. In the following discussion, the focus is on treatment of chronic patellar tendon tears. The aim of surgical treatment is the recovery of the active extension and full weight-bearing ability of the leg. The video presentation shows the operative treatment of a patient with a chronic extensor mechanism deficiency of the knee after multiple revision of a total knee arthroplasty due to periprosthetic infection and three-times occurrence of a patella tendon tear. A frame-shaped reinforcement between patella and tibial tuberosity by FiberTape® combined with a medial gastrocnemius flap was performed. This type of surgery is indicated in cases of large defects of the patellar tendon that cannot be treated with end-to-end suture or simple augmentation with autologous tendons (e.g. semitendinosus). In addition to augmentation of the tendon defect, cutaneous soft tissue defects around the knee and proximal lower leg can be covered. In general, the best treatment option is chosen according to size of the defect, the quality of the tendon tissue and possible previous surgery on the knee joint. There are no reports of large series of chronic patella tendon tears, but only isolated cases using a variety of techniques. In addition with low level of evidence, there is currently no established gold standard in the surgical treatment of insufficiencies of the extensor apparatus of the knee. PMID:25874403

  4. 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

  5. Minimally Invasive Reconstruction of the Medial Patellofemoral Ligament Using Quadriceps Tendon

    PubMed Central

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

    2014-01-01

    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

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

    PubMed

    Purushothaman, Balaji; Agarwal, Amit; Dawson, Matt

    2012-11-01

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

  7. Patellar dislocation with genu valgum treated by DFO.

    PubMed

    Kwon, Jae Ho; Kim, Jong In; Seo, Dong-Hyun; Kang, Kyung-Woon; Nam, Ji Ho; Nha, Kyung-Wook

    2013-06-01

    Congenital habitual patellar dislocation is a rare condition of the knee where the patella dislocates during flexion and relocates during extension. The congenital form is permanent, irreducible, and presents at birth. It is characterized by a short quadriceps and a major patellofemoral dysplasia and short height. This article presents a rare case of a 27-year-old woman with recurring bilateral habitual dislocation of the patella after a failed previous proximal and distal realignment procedure. Clinical examinations of both knees revealed genu valgus knees and lateral joint pain that recurred after several previous operations. Radiographs of both knees showed patellar dislocation and genu valgum associated with patellofemoral dysplasia and osteoarthritis of the lateral compartment. Long-leg standing radiographs showed an anatomic tibiofemoral angle of right 13° and left 6° valgus and a mechanical tibiofemoral angle of right 8° and left 2° valgus and weight-bearing line of 65% on the right and 48% on the left. The authors performed a distal femoral closing wedging osteotomy to correct the valgus deformity, and then percutaneous lateral release and medial reefing were performed to stabilize the patellas of both knees simultaneously. PMID:23746026

  8. PROTECTION DEVICE ON THE REPAIR OF RUPTURES OF KNEE EXTENSOR MECHANISM

    PubMed Central

    Arguello Frutos, Carlos Francisco; Arbix Camargo, Osmar Pedro; Severino, Nilson Roberto; Leite Cury, Ricardo de Paula; de Oliveira, Victor Marques; Aihara, Tatsuo; Avakian, Roger

    2015-01-01

    To evaluate results obtained using the protection device technique for osteosintesis or suture of extensor mechanism lesions. Material and Methods: The authors reviewed 18 charts of patients submitted to protection device technique due to traumatic lesion of extensor mechanism that had occurred between the anterior tibial tuberosity and the apical portion of patella. Age ranged from 22 to 69 years, with a mean of 44 years. Male patients prevailed, with 67% of the cases. The most affected spot was, in 83% of the cases, the apical distal third. A protocol was created to collect data, listing the patients and the clinical history from their medical records. Results: The authors observed consolidation of the patella fracture in all 17 patients, and cicatrization of the patellar ligament in one patient. Pain was described in four patients. There were no complications related to the procedure. Conclusion: The protection device showed to be efficient when used in surgical treatment of lesions between the apical patella and the anterior tibial tuberosity, providing active and passive mobility in the early postoperative time. PMID:26998454

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

    PubMed Central

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

    2010-01-01

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

  10. Muscle Damage following Maximal Eccentric Knee Extensions in Males and Females

    PubMed Central

    2016-01-01

    Aim To investigate whether there is a sex difference in exercise induced muscle damage. Materials and Method Vastus Lateralis and patella tendon properties were measured in males and females using ultrasonography. During maximal voluntary eccentric knee extensions (12 reps x 6 sets), Vastus Lateralis fascicle lengthening and maximal voluntary eccentric knee extensions torque were recorded every 10° of knee joint angle (20–90°). Isometric torque, Creatine Kinase and muscle soreness were measured pre, post, 48, 96 and 168 hours post damage as markers of exercise induced muscle damage. Results Patella tendon stiffness and Vastus Lateralis fascicle lengthening were significantly higher in males compared to females (p<0.05). There was no sex difference in isometric torque loss and muscle soreness post exercise induced muscle damage (p>0.05). Creatine Kinase levels post exercise induced muscle damage were higher in males compared to females (p<0.05), and remained higher when maximal voluntary eccentric knee extension torque, relative to estimated quadriceps anatomical cross sectional area, was taken as a covariate (p<0.05). Conclusion Based on isometric torque loss, there is no sex difference in exercise induced muscle damage. The higher Creatine Kinase in males could not be explained by differences in maximal voluntary eccentric knee extension torque, Vastus Lateralis fascicle lengthening and patella tendon stiffness. Further research is required to understand the significant sex differences in Creatine Kinase levels following exercise induced muscle damage. PMID:26986066

  11. 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

  12. Kinematic Magnetic Resonance Imaging of the Effect of Bracing on Patellar Position: Qualitative Assessment Using an Extremity Magnetic Resonance System

    PubMed Central

    Shellock, Frank G.; Mullin, Michael; Stone, Kevin R.; Coleman, Mark; Crues, John V.

    2000-01-01

    Objective: To use an extremity magnetic resonance system to perform kinematic magnetic resonance imaging (MRI) of the patellofemoral joint to qualitatively assess the effect of bracing on patellar position. Design and Setting: Subjects underwent kinematic MRI of the symptomatic extremity with a 0.2-Tesla extremity magnetic resonance system. Images were obtained using a knee coil and a T1-weighted, spin echo pulse sequence. Subjects: Seven female patients with patellofemoral joint symptoms. Measurements: Four different axial sections were obtained for each position: extension and 3 positions of flexion up to 36°. An appropriate-sized patellofemoral brace was applied, and the kinematic MRI procedure was repeated. Results: Six patients had lateral displacement of the patella, and 1 patient had medial displacement of the patella. After application of the brace, 6 patients (5 with lateral displacement and 1 with medial displacement, 86%) exhibited correction (5) or improvement (1 with lateral displacement) in the abnormal patellar positions, and 1 patient had worsening of the abnormal position of the patella. Conclusions: We used kinematic MRI to determine the presence of abnormal patellar positioning. Application of the brace counteracted the abnormal patellar positions in most of the patients studied. ImagesFigure 2.Figure 3. PMID:16558607

  13. Dietary and environmental determinants of blood and bone lead levels in lactating postpartum women living in Mexico City.

    PubMed Central

    Hernandez-Avila, M; Gonzalez-Cossio, T; Palazuelos, E; Romieu, I; Aro, A; Fishbein, E; Peterson, K E; Hu, H

    1996-01-01

    Despite the recent declines in environmental lead exposure in the United States and Mexico, the potential for delayed toxicity from bone lead stores remains a significant public health concern. Some evidence indicates that mobilization of lead from bone may be markedly enhanced during the increased bone turnover of pregnancy and lactation, resulting in lead exposure to the fetus and the breast-fed infant. We conducted a cross-sectional investigation of the interrelationships between environmental, dietary, and lifestyle histories, blood lead levels, and bone lead levels among 98 recently postpartum women living in Mexico City. Lead levels in the patella (representing trabecular bone) and tibia (representing cortical bone) were measured by K X-ray fluorescence (KXRF). Multivariate linear regression models showed that significant predictors of higher blood lead included a history of preparing or storing food in lead-glazed ceramic ware, lower milk consumption, and higher levels of lead in patella bone. A 34 micrograms/g increase in patella lead (from the medians of the lowest to the highest quartiles) was associated with an increase in blood lead of 2.4 micrograms/dl. Given the measurement error associated with KXRF and the extrapolation of lead burden from a single bone site, this contribution probably represents an underestimate of the influence of trabecular bone on blood lead. Significant predictors of bone lead in multivariate models included years living in Mexico City, lower consumption of high calcium content foods, and nonuse of calcium supplements for the patella and years living in Mexico City, older age, and lower calcium intake for tibia bone. Low consumption of milk and cheese, as compared to the highest consumption category (every day), was associated with an increase in tibia bone lead of 9.7 micrograms Pb/g bone mineral. The findings of this cross-sectional study suggest that patella bone is a significant contributor to blood lead during lactation

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

    NASA Astrophysics Data System (ADS)

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

    2007-12-01

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

  15. The influence of bone and blood lead on plasma lead levels in environmentally exposed adults.

    PubMed Central

    Hernández-Avila, M; Smith, D; Meneses, F; Sanin, L H; Hu, H

    1998-01-01

    There is concern that previously accumulated bone lead stores may constitute an internal source of exposure, particularly during periods of increased bone mineral loss (e.g., pregnancy, lactation, and menopause). Furthermore, the contribution of lead mobilized from bone to plasma may not be adequately reflected by whole-blood lead levels. This possibility is especially alarming because plasma is the main circulatory compartment of lead that is available to cross cell membranes and deposit in soft tissues. We studied 26 residents of Mexico City who had no history of occupational lead exposure. Two samples of venous blood were collected from each individual. One sample was analyzed by inductively coupled plasma-magnetic sector mass spectrometry for whole-blood lead levels. The other sample was centrifuged to separate plasma, which was then isolated and analyzed for lead content by the same analytical technique. Bone lead levels in the tibia and patella were determined with a spot-source 109Cd K-X-ray fluorescence instrument. Mean lead concentrations were 0.54 microg/l in plasma, 119 microg/l in whole blood, and 23.27 and 11.71 microg/g bone mineral in the patella and tibia, respectively. The plasma-to-whole-blood lead concentration ratios ranged from 0.27% to 0.70%. Whole-blood lead level was highly correlated with plasma lead level and accounted for 95% of the variability of plasma lead concentrations. Patella and tibia lead levels were also highly correlated with plasma lead levels. The bivariate regression coefficients of patella and tibia on plasma lead were 0.034 (p<0. 001) and 0.053 (p<0.001), respectively. In a multivariate regression model of plasma lead levels that included whole-blood lead, patella lead level remained an independent predictor of plasma lead level (ss = 0.007, p<0.001). Our data suggest that although whole-blood lead levels are highly correlated with plasma lead levels, lead levels in bone (particularly trabecular bone) exert an additional

  16. Accepted Trichoderma names in the year 2015.

    PubMed

    Bissett, John; Gams, Walter; Jaklitsch, Walter; Samuels, Gary J

    2015-12-01

    A list of 254 names of species and two names of varieties in Trichoderma with name or names against which they are to be protected, following the ICN (Melbourne Code, Art. 14.13), is presented for consideration by the General Committee established by the Congress, which then will refer them to the Nomenclature Committee for Fungi (NCF). This list includes 252 species, one variety and one form. Two new names are proposed: T. neocrassum Samuel (syn. Hypocrea crassa P. Chaverri & Samuels), T. patellotropicum Samuels (syn. Hypocrea patella f. tropica Yoshim. Doi). The following new combinations in Trichoderma are proposed: T. brevipes (Mont.) Samuels, T. cerebriforme (Berk.) Samuels, T. latizonatum (Peck) Samuels, and T. poronioideum (A. Möller) Samuels. The following species are lectotypified: T. americanum (Canham) Jaklitsch & Voglmayr, Gliocladium flavofuscum J.H. Miller, Giddens & A.A. Foster, T. inhamatum Veerkamp & W. Gams, T. konilangbra Samuels, O. Petrini & C.P. Kubicek, T. koningii Oudem., T. pezizoides (Berk. & Broome) Jaklitsch & Voglmayr, T. sulphureum (Schwein.) Jaklitsch & Voglmayr and T. virens (J.H. Miller, Giddens & A.A. Foster) Arx. Epitypes are proposed for the following species: T. albocorneum (Yoshim. Doi) Jaklitsch & Voglmayr, T. albofulvum (Berk. & Broome) Jaklitsch & Voglmayr, T. atrogelatinosum (Dingley) Jaklitsch & Voglmayr, T. corneum (Pat.) Jaklitsch & Voglmayr, T. cornu-damae (Pat.) Z.X. Zhu & W.Y. Zhuang, T. flaviconidium (P. Chaverri, Druzhinina & Samuels) Jaklitsch & Voglmayr, T. hamatum (Bonord.) Bain., T. hunua (Dingley) Jaklitsch & Voglmayr, T. patella (Cooke & Peck) Jaklitsch & Voglmayr, Hypocrea patella f. tropica Yoshim. Doi, T. polysporum (Link) Rifai, T. poronioideum (A. Möller) Samuels T. semiorbis (Berk.) Jaklitsch & Voglmayr, T. sulphureum (Schwein.) Jaklitsch & Voglmayr, and T. tropicosinense (P.G. Liu) P.G. Liu, Z.X. Zhu & W.Y. Zhuang. PMID:26734542

  17. 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 μg/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

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

    PubMed Central

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

    2011-01-01

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

  19. The distribution of superficial zone protein (SZP)/lubricin/PRG4 and boundary mode frictional properties of the bovine diarthrodial joint.

    PubMed

    Peng, Gordon; McNary, Sean M; Athanasiou, Kyriacos A; Reddi, A Hari

    2015-09-18

    The diarthrodial, knee joint is a remarkably efficient bearing system; articulating cartilage surfaces provide nearly frictionless performance with minimal wear. The low friction properties of the cartilage surfaces are due in part to the boundary lubricant, superficial zone protein (SZP); also known as lubricin or proteoglycan 4 (PRG4). In previous work, SZP localization and cartilage friction were examined across the femoral condyles. Studies in the literature have also individually investigated the other tissues that comprise the human knee and four-legged animal stifle joint, such as the meniscus or patella. However, comparisons between individual studies are limited due to the variable testing conditions employed. Friction is a system property that is dependent on the opposing articulating surface, entraining speed, and loading. A cross-comparison of the frictional properties and SZP localization across the knee/stifle joint tissues utilizing a common testing configuration is therefore needed. The objective of this investigation was to determine the friction coefficient and SZP localization of the tissues comprising the three compartments of the bovine stifle joint: patella, patellofemoral groove, femoral condyles, meniscus, tibial plateau, and anterior cruciate ligament. The boundary mode coefficient of friction was greater in tissues of the patellofemoral compartment than the lateral and medial tibiofemoral compartments. SZP immunolocalization followed this trend with reduced depth of staining and intensity in the patella and patellofemoral groove compared to the femoral condyles and tibial plateau. These results illustrate the important role of SZP in reducing friction in the tissues and compartments of the knee/stifle joint. PMID:26117076

  20. Fracture of articular cartilage.

    PubMed

    Chin-Purcell, M V; Lewis, J L

    1996-11-01

    Crack formation and propagation is a significant element of the degeneration process in articular cartilage. In order to understand this process, and separate the relative importance of structural overload and material failure, methods for measuring the fracture toughness of cartilage are needed. In this paper, two such methods are described and used to measure fracture properties of cartilage from the canine patella. A modified single edge notch (MSEN) specimen was used to measure J, and a trouser tear test was used to measure T, both measures of fracture toughness with units of kN/m. A pseudo-elastic modulus was also obtained from the MSEN test. Several potential error sources were examined, and results for the MSEN test compared with another method for measuring the fracture parameter for urethane rubber. Good agreement was found. The two test methods were used to measure properties of cartilage from the patellae of 12 canines: 4-9 specimens from each of 12 patellae, with 5 right-left pairs were tested. Values of J ranged from 0.14-1.2 kN/m. J values correlated with T and were an average of 1.7 times larger than T. A variety of failure responses was seen in the MSEN tests, consequently a grade of 0 to 3 was assigned to each test, where 0 represented a brittle-like crack with minimal opening and 3 represented plastic flow with no crack formation. The initial cracks in 12/82 specimens did not propagate and were assigned to grade 3. The method for reducing data in the MSEN test assumed pseudo-elastic response and could not be used for the grade 3 specimens. Stiffness did not correlate with J. Neither J nor T was statistically different between right-left pairs, but varied between animals. The test methods appear useful for providing a quantitative measure of fracture toughness for cartilage and other soft materials. PMID:8950659

  1. Complex Primary Total Knee Replacement (TKR) Using Prophylactic Gastrocnemius Flap and Rotating-Hinge Knee in Post-traumatic, Infective Arthritis of the Knee – A Case Report

    PubMed Central

    Patnaik, Sanjeev; Nayak, Biswaranjan; Mishra, Laxmikanta; Sahoo, Akshaya Kumar

    2015-01-01

    Introduction: Prophylactic gastrocnemius flap with primary rotating hinge knee is technically demanding in a case of neglected post-traumatic, infective arthritis of the knee, with challenges of compromised skin and soft tissues, articular bone defect, limb mal-alignment, gross instability, retained hardware and a contracted extensor mechanism with the patella fixed in the lateral gutter all in combination, is rarely reported. We report such a complex case in this study. Case Report: We report a 48 year male patient with a history of fracture lateral femoral condyle of right knee due to road traffic accident 10 years back, for which he got operated with open reduction and internal fixation with cancellous screws, which subsequently got infected. Primary procedure undertaken was removal of implants, debridement, placement of antibiotic-cement spacer followed by prophylactic medial gastrocnemius flap and a temporary joint spanning external fixator. Definitive procedure undertaken, after clearance of infection in 12 weeks was conversion to a rotating hinge TKR using a lateral para-patellar arthrotomy & tibial tubercle osteotomy to address the challenges of fixed patella in the lateral gutter and contracted ligamentum patellae. At one year follow up, the knee was painless, stable, with satisfactory range of motion and improved function without any infection or aseptic lysis. Conclusion: Prophylactic Gastrocnemius flap cover along with rotating hinge knee arthroplasty using a lateral para-patellar approach and tibial tubercle osteotomy in a case of neglected post-traumatic, infective arthritis of knee with the complexities of limb mal-alignment, compromised skin and soft tissue, articular bone loss and ligamentous instability is a satisfactory bail out option in such a highly complex joint scenario. PMID:27299096

  2. [Patellar osteochondral injury as onset of patellar instability].

    PubMed

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

    2012-01-01

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

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

    PubMed

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

    2015-06-01

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

  4. Characterization of calcium and zinc spatial distributions at the fibrocartilage zone of bone-tendon junction by synchrotron radiation-based micro X-ray fluorescence analysis combined with backscattered electron imaging

    NASA Astrophysics Data System (ADS)

    Lu, Hongbin; Chen, Can; Wang, Zhanwen; Qu, Jin; Xu, Daqi; Wu, Tianding; Cao, Yong; Zhou, Jingyong; Zheng, Cheng; Hu, Jianzhong

    2015-09-01

    Tendon attaches to bone through a functionally graded fibrocartilage zone, including uncalcified fibrocartilage (UF), tidemark (TM) and calcified fibrocartilage (CF). This transition zone plays a pivotal role in relaxing load transfer between tendon and bone, and serves as a boundary between otherwise structurally and functionally distinct tissue types. Calcium and zinc are believed to play important roles in the normal growth, mineralization, and repair of the fibrocartilage zone of bone-tendon junction (BTJ). However, spatial distributions of calcium and zinc at the fibrocartilage zone of BTJ and their distribution-function relationship are not totally understood. Thus, synchrotron radiation-based micro X-ray fluorescence analysis (SR-μXRF) in combination with backscattered electron imaging (BEI) was employed to characterize the distributions of calcium and zinc at the fibrocartilage zone of rabbit patella-patellar tendon complex (PPTC). For the first time, the unique distributions of calcium and zinc at the fibrocartilage zone of the PPTC were clearly mapped by this method. The distributions of calcium and zinc at the fibrocartilage zone of the PPTC were inhomogeneous. A significant accumulation of zinc was exhibited in the transition region between UF and CF. The highest zinc content (3.17 times of that of patellar tendon) was found in the TM of fibrocartilage zone. The calcium content began to increase near the TM and increased exponentially across the calcified fibrocartilage region towards the patella. The highest calcium content (43.14 times of that of patellar tendon) was in the transitional zone of calcified fibrocartilage region and the patella, approximately 69 μm from the location with the highest zinc content. This study indicated, for the first time, that there is a differential distribution of calcium and zinc at the fibrocartilage zone of PPTC. These observations reveal new insights into region-dependent changes across the fibrocartilage zone of

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

    PubMed Central

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

    2014-01-01

    For recurrent patellar dislocation, reconstruction of the medial patellofemoral ligament (MPFL) with replacement autografts has often been performed but with only little data on the tensile properties of the MPFL to guide graft selection. With its complex anatomy and geometry, these properties are difficult to obtain. In this study, we showed how the orientation of the femur-MPFL-patella complex (FMPC) during uniaxial tensile testing can have a significant effect on its structural properties. Twenty two FMPCs were isolated from porcine stifle joints and randomly assigned to two groups of 11 each. For the first group, the specimens were loaded to failure with the patella oriented 30 degrees away from the direction of the applied load to mimic its orientation in situ, called natural orientation. In the second group, the patella was aligned in the direction of the tensile load, called non-natural orientation. The stiffness for the natural orientation group was 65 ± 13 N/mm, 32% higher than that for the non-natural orientation group (50 ± 17 N/mm; p < 0.05). The ultimate loads were 438 ± 128 N and 386 ± 136 N, respectively (p > 0.05). Ten out of 11 specimens in the natural orientation group failed at the femoral attachment (the narrowest portion of the MPFL) compared to 6 out of 11 in the non-natural orientation group. Our findings suggest that the specimen orientation that mimics the in-situ loading conditions of the MPFL should be used to obtain more representative data for the structural properties of the FMPC. PMID:24332616

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

    PubMed Central

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

    2014-01-01

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

  7. Iliotibial band tension affects patellofemoral and tibiofemoral kinematics.

    PubMed

    Merican, Azhar M; Amis, Andrew A

    2009-07-22

    The iliotibial band (ITB) has an important role in knee mechanics and tightness can cause patellofemoral maltracking. This study investigated the effects of increasing ITB tension on knee kinematics. Nine fresh-frozen cadaveric knees had the components of the quadriceps loaded with 175 N. A Polaris optical tracking system was used to acquire joint kinematics during extension from 100 degrees to 0 degrees flexion. This was repeated after the following ITB loads: 30, 60 and 90 N. There was no change with 30 N load for patellar translation. On average, at 60 and 90 N, the patella translated laterally by 0.8 and 1.4mm in the mid flexion range compared to the ITB unloaded condition. The patella became more laterally tilted with increasing ITB loads by 0.7 degrees, 1.2 degrees and 1.5 degrees for 30, 60 and 90 N, respectively. There were comparable increases in patellar lateral rotation (distal patella moves laterally) towards the end of the flexion cycle. Increased external rotation of the tibia occurred from early flexion onwards and was maximal between 60 degrees and 75 degrees flexion. The increase was 5.2 degrees, 9.5 degrees and 13 degrees in this range for 30, 60 and 90 N, respectively. Increased tibial abduction with ITB loads was not observed. The combination of increased patellar lateral translation and tilt suggests increased lateral cartilage pressure. Additionally, the increased tibial external rotation would increase the Q angle. The clinical consequences and their relationship to lateral retinacular releases may be examined, now that the effects of a tight ITB are known. PMID:19481211

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

    PubMed

    Marolf, Angela; Blaik, Margaret; Specht, Andrew

    2007-01-01

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

  9. Histopathology of Ossicular Grafts and Implants in Chronic Otitis Media

    PubMed Central

    Bahmad, Fayez; Merchant, Saumil N.

    2008-01-01

    Objectives We describe the histopathology of ossicular grafts and implants so as to provide insight into factors that may influence functional results after surgery for chronic otitis media. Methods Histopathologic observations were made on 56 cases: 50 surgical specimens and 6 temporal bone cases in which the graft was sectioned in situ. Results and Conclusions Autogenous malleus, incus, and cortical bone grafts behaved in a similar manner and maintained their morphological size, shape, and contour for extended periods of time, at least up to 30 years. These histopathologic observations support the continued use of autograft ossicular and cortical bone grafts for middle ear reconstruction. Cartilage grafts developed chondromalacia with resulting loss of stiffness and showed a tendency to undergo resorption. Synthetic prostheses made of porous plastic (Plastipore, Polycel) elicited foreign body giant cell reactions with various degrees of biodegradation of the implants. Prostheses made of hydroxyapatite and Bioglass were enveloped by a lining of connective tissue and mucosal epithelium. The Bioglass material was broken down into small fragments and partially resorbed by a host response within the middle ear. These results warrant caution in the use of prostheses made of porous plastic or Bioglass. PMID:17419521

  10. Numerical Investigations of Interactions between the Knee-Thigh-Hip Complex with Vehicle Interior Structures.

    PubMed

    Kim, Yong Sun; Choi, Hyeong Ho; Cho, Young Nam; Park, Yong Jae; Lee, Jong B; Yang, King H; King, Albert I

    2005-11-01

    Although biomechanical studies on the knee-thigh-hip (KTH) complex have been extensive, interactions between the KTH and various vehicular interior design parameters in frontal automotive crashes for newer models have not been reported in the open literature to the best of our knowledge. A 3D finite element (FE) model of a 50(th) percentile male KTH complex, which includes explicit representations of the iliac wing, acetabulum, pubic rami, sacrum, articular cartilage, femoral head, femoral neck, femoral condyles, patella, and patella tendon, has been developed to simulate injuries such as fracture of the patella, femoral neck, acetabulum, and pubic rami of the KTH complex. Model results compared favorably against regional component test data including a three-point bending test of the femur, axial loading of the isolated knee-patella, axial loading of the KTH complex, axial loading of the femoral head, and lateral loading of the isolated pelvis. The model was further integrated into a Wayne State University upper torso model and validated against data obtained from whole body sled tests. The model was validated against these experimental data over a range of impact speeds, impactor masses and boundary conditions. Using Design Of Experiment (DOE) methods based on Taguchi's approach and the developed FE model of the whole body, including the KTH complex, eight vehicular interior design parameters, namely the load limiter force, seat belt elongation, pretensioner inlet amount, knee-knee bolster distance, knee bolster angle, knee bolster stiffness, toe board angle and impact speed, each with either two or three design levels, were simulated to predict their respective effects on the potential of KTH injury in frontal impacts. Simulation results proposed best design levels for vehicular interior design parameters to reduce the injury potential of the KTH complex due to frontal automotive crashes. This study is limited by the fact that prediction of bony fracture was

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

    NASA Astrophysics Data System (ADS)

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

    2015-04-01

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

  12. Modeling of the mechanical behavior of the human femur: Stress analysis and strain

    NASA Astrophysics Data System (ADS)

    Belaid, Dalila; Bouchoucha, Ali

    2015-12-01

    The strength of bone depends on its state of mineralization, its geometry, and even supported loads. The femur is the longest bone, the largest and strongest of the human skeleton. It provides standing and walking and running, due to its hip joints with the one side, and with the patella and tibia across. The approach of this paper is to numerically model the mechanical behavior of the femur to determine the stress and strain distribution field. Modeling is performed on the ANSYS software. The results show the influence of different positions of the femur in different cases of postures.

  13. Intracellular coagulation inhibits the extraction of proteins from Prochloron

    NASA Technical Reports Server (NTRS)

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

    1983-01-01

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

  14. 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.

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

    PubMed

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

    2015-06-01

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

  16. Arthroscopic treatment of painful Sinding-Larsen-Johansson syndrome in a professional handball player.

    PubMed

    Kajetanek, C; Thaunat, M; Guimaraes, T; Carnesecchi, O; Daggett, M; Sonnery-Cottet, B

    2016-09-01

    Sinding-Larsen-Johansson (SLJ) syndrome is a type of osteochondrosis of the distal pole of the patella most often caused by repeated microtrauma. Here, we describe the case of a professional athlete with painful SLJ syndrome treated arthroscopically. A 29-year-old male professional handball player presented with anterior knee pain that persisted after 4 months of an eccentric rehabilitation protocol and platelet-rich plasma injections. Despite this conservative treatment, the patient could not participate in his sport. The SLJ lesion was excised arthroscopically, which led to complete disappearance of symptoms and return to competitive sports after 5 months. PMID:27450859

  17. The interface between bone and tendon at an insertion site: a study of the quadriceps tendon insertion

    PubMed Central

    CLARK, JOHN; STECHSCHULTE, DANIEL J.

    1998-01-01

    Traumatic avulsions of ligament or tendon insertions rarely occur at the actual interface with bone, which suggests that this attachment is strong or otherwise protected from injury by the structure of the insertion complex. In this study we describe the terminal extent of quadriceps tendon fibres where they insert into the patellae of adult rabbits, humans, dogs and sheep. Specimens were examined by scanning electron microscopy (SEM) and light microscopy (LM). To facilitate tracing of tendon fibres the specimens were decalcified for SEM, and polarised light microscopy (PLM) was used in the LM segment of the study. By SEM it was possible to identify mature bone by the presence of osteocytes and a lamellar organisation. PLM and SEM showed that, unlike tendon fibres elsewhere, those in the calcified fibrocartilage were not crimped. No specific cement line was identified by SEM. Tendon fibres interdigitated among separate bone lamellar systems, (osteons or marrow spaces), but did not merge with the collagen systems of individual lamellae. The interdigitation was more extensive and the margin between tendon and bone was less distinct in the anterior third of the insertion. The segment of calcified tendon which interdigitated with bone stained less intensely blue and was less cellular than the more proximal calcified fibrocartilage zone adjacent to the tidemark. Lamellar collagen fibres of the bony trabeculae in the anterior patella were unusually parallel and longitudinal in orientation, making distinction of interposed tendon fibres difficult on LM and PLM sections. LM, SEM and transmission electron microscopy of rabbit patellae at birth revealed that anterior quadriceps tendon fibres extended over the patella in a fibrous cellular layer. By 2 wk of age, this layer had acquired chondroid features (i.e. cell lacunae and metachromasia) and contained vessels extending from patellar marrow. At 6 wk of age, part of this fibrocartilaginous layer was replaced by mature bone

  18. Selective hemiepiphyseodesis for patellar instability with associated genu valgum

    PubMed Central

    Kearney, Sean P.; Mosca, Vincent S.

    2015-01-01

    Background/Aims Patellar instability limits activity and promotes arthritis. Correcting genu valgum with selective hemiepiphyseodesis can treat patellar instability. Methods We retrospectively reviewed 26 knees with patellar instability and associated genu valgum that underwent hemiepiphyseodesis. Results Average anatomic lateral distal femoral angle (aLDFA) significantly corrected. Symptoms improved in all patients. All competitive athletes returned to sports. One complication occurred. Conclusions In genu valgum, the patella seeks an abnormal mechanical axis, resulting in patellar instability. By correcting the mechanical axis with hemiepiphyseodesis, patellar instability symptoms improve and patients return to sports. Complications are rare. Selective hemiepiphyseodesis is recommended when treating patellar instability with associated genu valgum. PMID:25829756

  19. Two cases of surgically treated feline patellar fractures.

    PubMed

    Guillaumot, P; Scotti, S; Carozzo, C; Bouvy, B; Genevois, J-P

    2008-01-01

    A transverse patellar fracture in a six-month-old cat was successfully treated by figure-of-eight dorsal wiring of the patella. A longitudinal patellar fracture with luxation of a large medial fragment in a 2.5-year-old cat was treated by lateral marginal patellectomy with a positive outcome. While adding material to the few veterinary reports in that species, in this brief communication, the authors discuss the aetiology, diagnosis, and the treatment of the presented cases with regards to findings in previously published feline cases. PMID:18545720

  20. [Application and development of kinematical alighment during total knee arthroplasty].

    PubMed

    Zhang Guo-dong; Yang, Chen; Yang, Guang; Qi, Xin

    2015-12-01

    Kinematical alignment during total knee arthroplasty is an emerging process, and draws more and more attentions from scholars. Knee joint is close to normal joint after TKA through kinematical alighment, which has good clinical results and functional scores, and not increase failure probility. Thus, it may increase joint stress of patella-femur joint, lead to patellar maltracking and increase abrasion. The paper summarized defination and basical principle, operative method, clinical outcomes and deficiency of kinematical alignment during total knee arthroplasty, in order to choose a better way for kinematical alignment during total knee arthroplasty. PMID:26911130

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

    NASA Technical Reports Server (NTRS)

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

    1983-01-01

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

  2. 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.

  3. 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

  4. A delta-aminolevulinic acid dehydratase (ALAD) polymorphism may modify the relationship of low-level lead exposure to uricemia and renal function: the normative aging study.

    PubMed Central

    Wu, Ming-Tsang; Kelsey, Karl; Schwartz, Joel; Sparrow, David; Weiss, Scott; Hu, Howard

    2003-01-01

    In this study we investigated whether a known delta-aminolevulinic acid dehydratase (ALAD) exon 4 polymorphism has a modifying effect on the association of blood or bone lead level with uricemia and indices of renal function among middle-aged and elderly men. We performed a cross-sectional study of subjects who participated between 1991 and 1995 in the Department of Veterans Affairs Normative Aging Study. Information on blood lead levels, bone lead levels (measured by K-shell X-ray fluorescence), serum uric acid, serum creatinine, estimated creatinine clearance, and ALAD polymorphism status was available in 709 subjects. Regression models were constructed to examine the relationships of serum uric acid, serum creatinine, and estimated creatinine clearance to blood or bone lead level, stratified by genotype. We also adjusted for age, body mass index, blood pressure, smoking, alcohol consumption, and ingestion of analgesic medications (n = 638). Of the 709 subjects, 7 (1%) and 107 (15%) were homozygous and heterozygous for the variant (ALAD-2) allele, respectively. The mean (range) serum uric acid and creatinine levels were 6.5 (2.9-10.6) and 1.2 (0.6-2.5) mg/dL. No significant differences were found in serum uric acid, serum creatinine, or estimated creatinine clearance by ALAD genotype. However, after adjusting for other potential confounders, we found a significant linear relationship between serum uric acid and patella bone lead (p = 0.040) among the ALAD 1-2/2-2 genotype individuals above a threshold patellar lead level of 15 micro g/g. In contrast, among the wild-type (ALAD 1-1) individuals, there was a suggestion of a significant linear relationship of serum uric acid with patella bone lead (p = 0.141), but only after a threshold of 101 micro g/g. There was evidence of a significant (p = 0.025) interaction of tibia lead with genotype (ALAD 1-1 vs. ALAD 1-2/2-2) regarding serum creatinine as an outcome, but in the same linear regression model tibia lead alone

  5. Clinics in diagnostic imaging (164). Morel-Lavallée lesion

    PubMed Central

    Cheong, Sook Chuei Wendy; Wong, Bak Siew Steven

    2016-01-01

    A 31-year-old male motorcyclist presented with prepatellar swelling of the left knee after a collision with a car. Magnetic resonance imaging of the knee showed no bony or ligamentous injury to the knee. Instead, a well-defined, thin-walled, T2-weighted hyperintense fluid collection with internal septations was identified in a prefascial location overlying the left patella and patellar tendon. The findings were in keeping with those of a Morel-Lavallée lesion, a closed internal degloving injury. Morel-Lavallée lesions are occasionally encountered after a blunt soft-tissue trauma. The presentation and imaging features are discussed. PMID:26831317

  6. 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.

  7. Resection arthroplasty for failed patellar components

    PubMed Central

    Alcerro, Jose C.; Drakeford, Michael K.; Tsao, Audrey K.; Krackow, Kenneth A.; Hungerford, David S.

    2008-01-01

    A total of 1,401 primary total knee arthroplasties (TKA) were reviewed; 44 (3.2%) had at least the patellar component revised. Nine of these knees (eight patients) had insufficient bone stock to allow reimplantation of another patellar component. Clinical data on the nine knees were obtained with recent follow-up evaluation, review of their medical records and radiographs. Evaluation included Hospital for Special Surgery (HSS) scores. Average follow-up was 4 years and 7 months, 2-year range (2 months to 8 years and 4 months). Common factors found in these nine knees included: thin patella after primary TKR status, osteoarthritis, good range of motion and patella alta. Results were good to excellent in seven knees and fair in two. The untoward associations with patellectomy such as quadriceps lag, extension weakness and anterior knee pain were not experienced. Resection of the patellar component, without reimplantation, is an acceptable alternative in revision TKA lacking adequate remaining bone stock. PMID:18956182

  8. A Dutch Survey on Circumpatellar Electrocautery in Total Knee Arthroplasty

    PubMed Central

    van Jonbergen, Hans-Peter W.; Barnaart, Alexander F.W.; Verheyen, Cees C.P.M.

    2010-01-01

    Introduction: Anterior knee pain following total knee arthroplasty is estimated to occur in 4-49% of patients. Some orthopedic surgeons use circumpatellar electrocautery (diathermy) to reduce the prevalence of postsurgical anterior knee pain; however, the extent of its use is unknown. Materials and Methodology: In April 2009, a postal questionnaire was sent to all 98 departments of orthopedic surgery in The Netherlands. The questions focused on the frequency of total knee arthroplasties, patellar resurfacing, and the use of circumpatellar electrocautery. Results: The response rate was 92%. A total of 18,876 TKAs, 2,096 unicompartmental knee arthroplasties, and 215 patellofemoral arthroplasties are performed yearly in The Netherlands by the responding orthopedic surgeons. Of the orthopedic surgeons performing TKA, 13% always use patellar resurfacing in total knee arthroplasty for osteoarthritis, 49% use selective patellar resurfacing, and 38% never use it. Fifty-six percent of orthopedic surgeons use circumpatellar electrocautery when not resurfacing the patella, and 32% use electrocautery when resurfacing the patella. Conclusion: There is no consensus among Dutch orthopedic surgeons on the use of patellar resurfacing or circumpatellar electrocautery in total knee replacement performed for osteoarthritis. A prospective clinical trial is currently underway to fully evaluate the effect of circumpatellar electrocautery on the prevalence of anterior knee pain following total knee arthroplasty. PMID:21228917

  9. Kinematics and Mechanical Properties of Knees following Patellar Replacing and Patellar Retaining Total Knee Arthroplasty.

    PubMed

    Huang, Rongying; Liu, Yanqiang; Zhu, Jun

    2015-01-01

    Knee injury is a common medical issue. A full understanding of the kinematics and mechanical properties of knees following total knee arthroplasty (TKA) repair utilizing patellar replacement (only the base of the patella is replaced) versus patellar retaining surgical techniques is still lacking. In the current paper, we investigated magnetic resonance (MR) imaging data from knees repaired by these two methods and evaluated total knee models created using imaging reconstruction technology that simulated gait conditions. Results revealed that patellar replacement had little influence on tibiofemoral kinematics, although the tibia-surface equivalent stress increased slightly. By contrast, patellar replacement had a significant influence on the patellofemoral joint; patellar internal rotation, external rotation, and medial-lateral translation were all increased. Moreover, the stress distribution on patellar prostheses was altered, resulting in an increased surface maximal equivalent stress on the corresponding area. Moreover, during the gait cycle, we found that the area with maximal equivalent stress shifted its position. Finally, the patellofemoral joint showed decreased motion stability. From the view of kinematics and mechanics, this paper suggests that patella should be retained during TKA if it is possible. The present study presented approaches and technologies for evaluating kinematics and mechanical properties of total knee joint after TKA under gait loads. PMID:27057134

  10. A new isometric quadriceps-strengthening exercise using EMG-biofeedback

    PubMed Central

    Kesemenli, Cumhur C; Sarman, Hakan; Baran, Tuncay; Memisoglu, Kaya; Binbir, Ismail; Savas, Yilmaz; Isik, Cengiz; Boyraz, Ismail; Koc, Bunyamin

    2014-01-01

    A new isometric contraction quadriceps-strengthening exercise was developed to restore the quadriceps strength lost after knee surgery more rapidly. This study evaluated the results of this new method. Patients were taught to perform the isometric quadriceps-strengthening exercise in the unaffected knee in the supine position, and then they performed it in the affected knee. First, patients were taught the classical isometric quadriceps-strengthening exercise, and then they were taught our new alternative method: “pull the patella superiorly tightly and hold the leg in the same position for 10 seconds”. Afterward, the quadriceps contraction was evaluated using a non-invasive Myomed 932 EMG-biofeedback device (Enraf-Nonius, The Netherlands) with gel-containing 48 mm electrodes (Türklab, The Turkey) placed on both knees. The isometric quadriceps-strengthening exercise performed using our new method had stronger contraction than the classical method (P < 0.01). The new method involving pulling the patella superiorly appears to be a better choice, which can be applied easily, leading to better patient compliance and greater quadriceps force after arthroscopic and other knee surgeries. PMID:25356122