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Sample records for chondromalacia patellae

  1. Thermography in the detection and follow up of chondromalacia patellae.

    PubMed Central

    Vujcić, M; Nedeljković, R

    1991-01-01

    Although diagnostic criteria for chondromalacia patellae exist, the disease is often accompanied by physical signs which are limited or non-diagnostic. Thermographic examination was performed in 157 patients with clinical diagnosis of chondromalacia patellae in 86 patients after surgical treatment for chondromalacia, and in 308 controls. Thermography can help the clinicians in establishing the diagnosis of chondromalacia patellae, but by itself is not sufficiently specific. The specificity of thermography was dependent on age, ranging from 90% for the 15-24 year age group to 65% for the 45-54 year age group. Sensitivity of the method was 68%. Thermography can disclose other knee disorders which imitate chondromalacia patellae. Images PMID:1768161

  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:23700485

  3. 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…

  4. Value of computed tomography scanning in chondromalacia patellae

    SciTech Connect

    Boven, F.; Bellemans, M.A.; Geurts, J.; de Boeck, H.; Potvliege, R.

    1982-06-01

    Sixtyseven patients with pain in the knee were studied. A computed tomography (CT) score indicating chondromalacia was devised, based on the results of CT after arthrography. This score takes account of the regularity, the congruity, and the imbibition of contrast material. Thus the patients could be divided into four groups: those who definitely have chondromalacia (++), probably (+), probably not (+-), and definitely not (-). These results were compared with the clinical diagnosis based on clinical signs, arthroscopy, or operation. Eighteen patients had clinically proved chondromalacia, CT scored 14++, 3+ and 1+-. Twentynine patients had no chondromalacia, CT scored 19-, 8+-, and 2+. Twenty patients had an uncertain clinical diagnosis. Arthrography was less accurate in detecting chondromalacia.

  5. The Diagnostic Value of the Clarke Sign in Assessing Chondromalacia Patella

    PubMed Central

    Doberstein, Scott T; Romeyn, Richard L; Reineke, David M

    2008-01-01

    Context: Various techniques have been described for assessing conditions that cause pain at the patellofemoral (PF) joint. The Clarke sign is one such test, but the diagnostic value of this test in assessing chondromalacia patella is unknown. Objective: To (1) investigate the diagnostic value of the Clarke sign in assessing the presence of chondromalacia patella using arthroscopic examination of the PF joint as the “gold standard,” and (2) provide a historical perspective of the Clarke sign as a clinical diagnostic test. Design: Validation study. Setting: All patients of one of the investigators who had knee pain or injuries unrelated to the patellofemoral joint and were scheduled for arthroscopic surgery were recruited for this study. Patients or Other Participants: A total of 106 otherwise healthy individuals with no history of patellofemoral pain or dysfunction volunteered. Main Outcome Measure(s): The Clarke sign was performed on the surgical knee by a single investigator in the clinic before surgery. A positive test was indicated by the presence of pain sufficient to prevent the patient from maintaining a quadriceps muscle contraction against manual resistance for longer than 2 seconds. The preoperative result was compared with visual evidence of chondromalacia patella during arthroscopy. Results: Sensitivity was 0.39, specificity was 0.67, likelihood ratio for a positive test was 1.18, likelihood ratio for a negative test was 0.91, positive predictive value was 0.25, and negative predictive value was 0.80. Conclusions: Diagnostic validity values for the use of the Clarke sign in assessing chondromalacia patella were unsatisfactory, supporting suggestions that it has poor diagnostic value as a clinical examination technique. Additionally, an extensive search of the available literature for the Clarke sign reveals multiple problems with the test, causing significant confusion for clinicians. Therefore, the use of the Clarke sign as a routine part of a knee examination is not beneficial, and its use should be discontinued. PMID:18345345

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

    PubMed Central

    Hauser, Ross A.; Sprague, Ingrid Schaefer

    2014-01-01

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

  7. [MRT-specific staging of chondromalacia patellae with the aid of a special knee compressor: a comparison with the arthroscopic findings].

    PubMed

    Andresen, R; Radmer, S; Knig, H; Wolf, K J

    1993-12-01

    The present study proposes a new MRI-specific staging of chondromalacia patellae (CMP) which is based on cartilage thickness decrease and signal intensity behaviour under compression as well as cartilage morphology in the plain image. The investigation was performed in 30 patients with varying knee complaints who underwent arthroscopy after MR imaging. It was demonstrated that three CMP stages can already be differentiated by MRI under compression in arthroscopically healthy cartilage. This proves a marked improvement in the early diagnosis of CMP. PMID:8298114

  8. 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)

  9. 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.

  10. Genetics Home Reference: nail-patella syndrome

    MedlinePlus

    ... is characterized by abnormalities of the nails, knees, elbows, and pelvis. The features of nail-patella syndrome ... also commonly have skeletal abnormalities involving the knees, elbows, and hips. The kneecaps (patellae) are small, irregularly ...

  11. Primary tumors of the patella.

    PubMed

    Song, Mingzhi; Zhang, Zhen; Wu, Yuxuan; Ma, Kai; Lu, Ming

    2015-01-01

    The patella is an uncommon location for cancerous occurrence and development. The majority of tumors of the patella are benign, with a significant incidence of giant cell tumors and chondroblastoma. With the development of modern diagnostic technologies, there appear however many other histological types which raise challenges of diagnosis and treatment. In this article, we review the reported histological types of primary patellar tumors. Specifically, epidemiology, symptomatology, imageology, histopathology, and treatment options for these histological lesions will be discussed, respectively. As there is an increasing focus on the diagnosis and the treatment of these lesions, the availability of the integrated information about primary patellar tumors becomes more significant. PMID:25906772

  12. 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

  13. 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.

  14. 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

  15. Femoral Nerve Palsy with Patella Fracture

    PubMed Central

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

    2013-01-01

    Femoral neuropathy may be associated with various etiologies and can cause severe walking disability. We present the case of a 25-year-old woman who underwent surgical repair for a patella fracture and complained of lower extremity pain, paresthesia, and weakness postoperatively. Electromyography and magnetic resonance imaging (MRI) revealed partial peripheral neuropathy of the left femoral nerve associated with the patella fracture. To our knowledge, this is the first reported case of femoral neuropathy associated with a patella fracture. PMID:24369003

  16. Congenital dislocation of the patella - clinical case.

    PubMed

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

    2016-01-01

    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

  17. 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

  18. On the development of the patella.

    PubMed

    Eyal, Shai; Blitz, Einat; Shwartz, Yulia; Akiyama, Haruhiko; Schweitzer, Ronen; Zelzer, Elazar

    2015-05-15

    The current view of skeletal patterning fails to explain the formation of sesamoid bones. These small bones, which facilitate musculoskeletal function, are exceptionally embedded within tendons. Although their structural design has long puzzled researchers, only a limited model for sesamoid bone development has emerged. To date, sesamoids are thought to develop inside tendons in response to mechanical signals from the attaching muscles. However, this widely accepted model has lacked substantiation. Here, we show that, contrary to the current view, in the mouse embryo the patella initially develops as a bony process at the anteriodistal surface of the femur. Later, the patella is separated from the femur by a joint formation process that is regulated by mechanical load. Concurrently, the patella becomes superficially embedded within the quadriceps tendon. At the cellular level, we show that, similar to bone eminences, the patella is formed secondarily by a distinct pool of Sox9- and Scx-positive progenitor cells. Finally, we show that TGF? signaling is necessary for the specification of patella progenitors, whereas the BMP4 pathway is required for their differentiation. These findings establish an alternative model for patella development and provide the mechanical and molecular mechanisms that underlie this process. More broadly, our finding that activation of a joint formation program can be used to switch between the formation of bony processes and of new auxiliary bones provides a new perspective on plasticity during skeletal patterning and evolution. PMID:25926361

  19. 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

  20. Sagittal osteotomy of the patella after Morscher

    PubMed Central

    Pećina, Marko; Hudetz, Damir; Smoljanović, Tomislav; Janković, Saša

    2009-01-01

    The aim of this study was to present long-term results of sagittal osteotomy of the patella after Morscher. The study included 70 patients treated for patellar dysplasia with a postoperative follow-up from nine to 20 years. There were 59 females and 11 males with an average age of 21 years at the time of operation. Results were evaluated for the entire group of 70 patients and then presented separately for the 30 patients in whom sagittal osteotomy of the patella was performed as a single procedure and 40 patients in whom, in addition to sagittal osteotomy of the patella, medialisation and ventralisation or distalisation of the tibial tuberosity were also performed. The mean value of the Wiberg patellar angle was 112 degrees preoperatively and 140 degrees postoperatively. In the whole group of patients excellent results were obtained in 24 (35%), good results in 30 (42%), fair results in 13 (19%) and poor results in three (4%) patients. In 30 patients with sagittal osteotomy as a single operation excellent results were obtained in 13 (43%), good results in 14 (47%) and fair results in three (10%) patients, while in the 40 patients with sagittal osteotomy and additional surgical procedures, 11 (27%) were excellent, 16 (40%) good, ten (25%) fair and three (8%) had poor results. Sagittal osteotomy of the patella after Morscher is an enrichment of the spectrum of the secondary-causal and preventive procedures for the treatment of patello-femoral disorders. PMID:19998034

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

    PubMed Central

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

    2012-01-01

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

  2. The basic science of the patella: structure, composition, and function.

    PubMed

    Fox, Alice J S; Wanivenhaus, Florian; Rodeo, Scott A

    2012-05-01

    The patella is the largest sesamoid bone in the body. The patellofemoral joint provides an integral articulating component of the extensor mechanism of the knee joint. A detailed description of patella anatomy, embryology and development, neurovascular anatomy, biomechanical function, and imaging modalities is provided in this article. Common patellar pathologies such as patellar instability, trochlear dysplasia, patella alta and baja, and patellofemoral joint arthritis as well as patellofemoral arthroplasty as a treatment option are also discussed. An understanding of the normal anatomy and biomechanics of the patella is a necessary prerequisite for understanding the pathogenesis of disorders involving the knee. PMID:22928430

  3. Avulsion fracture involving the body of the patella.

    PubMed Central

    Hughes, A W

    1985-01-01

    A report on an unusual transverse fracture through the body of the patella in a 13 year old high jumper is presented. The clinic features and treatment of the more usual avulsion injury of the patella is discussed. Images p119-a Fig. 1 p120-a PMID:4027495

  4. Chondroblastoma of the patella with aneurysmal bone cyst.

    PubMed

    Tan, Honglue; Yan, Mengning; Yue, Bing; Zeng, Yiming; Wang, You

    2014-01-01

    Chondroblastoma of the patella is rare. Aneurysmal bone cysts, which develop from a prior lesion such as a chondroblastoma, are seldom seen in the patella. The authors report a case of a 36-year-old man who presented with 2 years of right knee pain without calor, erythema, pain on palpation, or abnormal range of motion. Radiological studies suggested aneurysmal bone cyst. The lesion was excised with curettage and the residual cavity filled with autogenous bone graft. Histopathology revealed chondroblastoma associated with a secondary aneurysmal bone cyst. In the follow-up period, the patient demonstrated normal joint activities with no pain. Normal configuration of the patella and bone union were shown on plain radiographs. The authors present a review of the literature of all cases of patellar chondroblastoma with aneurysmal bone cyst. This case is the 14th report of aneurysmal bone cyst arising in a chondroblastoma of the patella. According to the literature, computed tomography and magnetic resonance imaging are useful in the study of these lesions. The pathologic diagnosis is based on the presence of chondroblastoma and aneurysmal bone cyst. Treatment of this lesion includes patellectomy, curettage alone, and curettage with bone grafting. Despite the risk of recurrence of this lesion in the patella, the authors first recommend curettage followed by filling the cavity with bone graft. To protect the anterior tension of the patella intraoperatively, the bone window should be made at the medial edge of the patella to perform the curettage and bone grafting. PMID:24683664

  5. 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

  6. 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

  7. Cartilage lesions of the patella: management after acute patellar dislocation.

    PubMed

    Metzler, Adam V; Lattermann, Christian; Johnson, Darren L

    2015-05-01

    Articular cartilage injuries to the patella are frequent after patellar dislocation. The management of these acute cartilage injuries in the acute setting can be challenging. It is well documented that acute fixation is the optimal choice for treatment of osteochondral injuries. This article discusses the challenges and potential treatment options for acute chondral/osteochondral injuries to the patella after acute patellar dislocation. PMID:25970358

  8. 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

  9. Fractures of the patella in children and adolescents.

    PubMed

    Schmal, Hagen; Strohm, Peter C; Niemeyer, Philipp; Reising, Kilian; Kuminack, Kerstin; Sudkamp, Norbert P

    2010-10-01

    Fractures of the patella in children and adolescents are rare injuries with particular characteristics. The aim of this study was an analysis of epidemiology, treatment strategy and outcome of this injury. Between 1992 and 2006 all fractures of the patella in patients with an age 5 16 years were included in a case control study. Besides outcome analysis using the modified HSS knee score, radiological follow-up was evaluated. During that time period, 23 children (6 girls, 17 boys) with patella fractures were seen in our institution; the incidence of patellar fractures was 0.44%. The average age was 12.4 years. The fractures mainly occurred during sports and leisure activities, followed by traffic accidents. Specific to children are avulsions of the lower or upper pole of the patella. Eleven children were non-operatively treated. Surgical techniques used were screw osteosynthesis, tension band wiring, transosseous suture, and refixation with biodegradable pins. In 7 cases an arthroscopy was performed in order to evaluate intraarticular lesions. Twenty-one children were recruited for a follow-up examination after an average of 40 months. A very good result was achieved in 16 cases and a good result in 5 cases. The radiological result at short term did not correlate with the clinical outcome. Patella fractures in children are a rare injury with a good shortterm prognosis ; long term outcome may significantly depend on the accompanying cartilage damage. In two cases an Autologous Chondrocyte Implantation was performed two years after the injury. PMID:21138220

  10. Tuberculosis of the patella imitating chronic knee synovitis

    PubMed Central

    Prakash, Jatin; Vijay, Vipul

    2014-01-01

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

  11. Magnetic Resonance Imaging Findings in Small Patella Syndrome.

    PubMed

    Kim, Hyoung-Soo; Yoo, Jeong-Hyun; Park, Noh-Hyuck; Chang, Jun-Hee; Ban, Yun-Seong; Song, Sang-Heon

    2016-03-01

    Small patella syndrome (SPS) is characterized by aplasia or hypoplasia of the patella and pelvic girdle abnormalities, including bilateral absence or delayed ossification of the ischiopubic junction and infra-acetabular axe-cut notches. Here, we report a case of SPS in a 26-year-old female. Magnetic resonance image (MRI) showed a small patella with thick eccentric non-ossified patellar cartilage and femoral trochlear dysplasia with hypoplastic patellar undersurface. To our knowledge, this is the first report of MRI findings in SPS. MRI findings could be clinically relevant because elongation of the medial patellofemoral ligament and trochlear dysplasia with eccentric non-ossified patellar cartilage might lead to patellofemoral maltracking with an osteochondral lesion or acute dislocation or an extensor mechanism injury. Though the patient presented in this case report only had a gastrocnemius injury at the origin site, physicians should carefully examine abnormalities with MRI when an SPS patient has a trauma to the knee. PMID:26955616

  12. Magnetic Resonance Imaging Findings in Small Patella Syndrome

    PubMed Central

    Kim, Hyoung-Soo; Yoo, Jeong-Hyun; Park, Noh-Hyuck; Chang, Jun-Hee; Ban, Yun-Seong

    2016-01-01

    Small patella syndrome (SPS) is characterized by aplasia or hypoplasia of the patella and pelvic girdle abnormalities, including bilateral absence or delayed ossification of the ischiopubic junction and infra-acetabular axe-cut notches. Here, we report a case of SPS in a 26-year-old female. Magnetic resonance image (MRI) showed a small patella with thick eccentric non-ossified patellar cartilage and femoral trochlear dysplasia with hypoplastic patellar undersurface. To our knowledge, this is the first report of MRI findings in SPS. MRI findings could be clinically relevant because elongation of the medial patellofemoral ligament and trochlear dysplasia with eccentric non-ossified patellar cartilage might lead to patellofemoral maltracking with an osteochondral lesion or acute dislocation or an extensor mechanism injury. Though the patient presented in this case report only had a gastrocnemius injury at the origin site, physicians should carefully examine abnormalities with MRI when an SPS patient has a trauma to the knee. PMID:26955616

  13. 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

  14. 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

  15. 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

  16. [A young soccer player with a painful patella].

    PubMed

    Nelissen, Rob G H H; Rosendaal, Frits R

    2012-01-01

    A 12-year-old boy presented with pain at the knee. At physical examination there was no knee effusion, a maximum knee function, but with local tenderness during palpation of the lower patellar bone. Radiographs showed osseous fusion abnormalities at the lower third of the patella at the lateral and axial knee radiographs. The diagnosis was a Sinding-Larsen-Johansson syndrome. Treatment was centered at providing equilibrium between exercise and rest. PMID:22784597

  17. 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

  18. 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

  19. 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

  20. [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

  1. 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

  2. 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 ossification centres and/or changes in knee joint conformation, where enhancement of extensor muscle leverage would be more beneficial. PMID:26740056

  3. 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

  4. 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.

  5. [Immobilization of the fractured patella by an embracing ring device].

    PubMed

    Zhou, Z; Zang, H; Li, H

    1990-06-01

    48 cases of fractured patella treated by embracing ring device from 1976-1988 were reported. Among the group, there were 31 males and 17 females, aged 20-80 years. The types of fractures were transverse 28 cases, comminuted 8 cases, fissure or stellate 12 cases; closed 43 cases, opened 5 cases. The methods were adopted, namely: (1) Simple immobilization with embracing ring device. (2) Cylinder plaster cast combined with embracing ring device. (3) Open-reduction with internal fixation combined with embracing ring device. According to the holistic concept the authors adopted both external and topical application of paste to relieve local swelling and oral administration of traditional Chinese medicine. After bone-union the embracing ring device was removed in conjunction with external lotion and active exercises. The 48 cases were followed up ranging from 5 months to 6 years. Satisfactory results were obtained in 41 cases (85.42%). Finally the authors emphasized that the preservation of patella plays an important role in maintaining the extensor mechanism of the knee from physiological and biomechanic views, if the articular surface can be perfectly restored. The nature of embracing ring device and related problems were also discussed. PMID:2397555

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

    PubMed

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

    2014-05-01

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

  7. Early PROMs following total knee arthroplasty--functional outcome dependent on patella resurfacing.

    PubMed

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

    2014-02-01

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

  8. Medial Quadriceps Tendon–Femoral Ligament: Surgical Anatomy and Reconstruction Technique to Prevent Patella Instability

    PubMed Central

    Fulkerson, John P.; Edgar, Cory

    2013-01-01

    Detailed anatomic dissections of the deep medial knee retinaculum have shown a consistent prominent anatomic structure extending from the distal deep quadriceps tendon to the adductor tubercle region, forming a distinct medial quadriceps tendon–femoral ligament (MQTFL). Reconstruction of this anatomic structure has yielded consistent medial stabilization of the patellofemoral joint without drilling into the patella over more than 3 years in patients with recurrent patella instability and dislocation. Results are similar to those of MPFL reconstruction but with reduced risk of patella fracture, a known and serious complication of MPFL reconstruction. The reconstruction graft is secured at the anatomic femoral origin of the MQTFL and brought under the vastus medialis such that it may be woven and attached to the deep distal medial quadriceps tendon to provide a secure, reliable reproduction of the MQTFL and excellent stabilization of the patellofemoral joint without risk of patella fracture. PMID:23875137

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

    PubMed Central

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

    1991-01-01

    A patient is described with severe mental retardation, a peculiar face with small palpebral fissures and premature balding, habitual patella luxations, small hands and feet, and hypogonadism, a combination which appears to represent a new syndrome. Images PMID:2002488

  10. 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

  11. 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

  12. 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

  13. 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.

  14. An isolated articular surface fracture of the distal patella: an unusual and previously unreported paediatric injury.

    PubMed

    Shivji, Faiz S; Ramoutar, Darryl N; Hunter, James B

    2013-01-01

    Paediatric patella fractures are uncommon, accounting for less than 1% of all paediatric fractures. This case report describes a previously undocumented patella fracture in a child, with a clear mechanism of injury. We present a case of a previously healthy 14-year-old boy who fell directly onto his right knee after coming off his pushbike. He sustained an isolated fracture involving the articular surface of the distal part of the patella with minimal displacement. The patient was managed conservatively in a Richard splint for three weeks, followed by a knee brace with gradually increasing degrees of flexion. He was instructed to be nonweight bearing for two weeks and then partial weight bearing for six weeks. At the final followup, after 9 weeks, the patient had full return of function and standard radiographs show the fracture to be healed. This case report has demonstrated how direct compression to the paediatric patella can cause a fracture isolated to its articular surface. It has detailed the natural progression of this injury to radiographic union, using a conservative management strategy. The authors believe that this case report provides an interesting insight into the variation of paediatric patella fractures and their contrasting management strategies. PMID:24383029

  15. 3-D printouts of the tracheobronchial tree generated from CT images as an aid to management in a case of tracheobronchial chondromalacia caused by relapsing polychondritis

    PubMed Central

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

    2013-01-01

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

  16. 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

  17. Minimum 5-Year Results With Duracon Press-Fit Metal-Backed Patellae.

    PubMed

    Hedley, Anthony K

    2016-02-01

    Negative outcomes of earlier metal-backed patella designs have overshadowed reports of positive outcomes achieved with careful attention paid to component design, patellar tracking, and surgical technique. Much as reported elsewhere, we found earlier component failures were caused by poor locking mechanisms, thin polyethylene, poor tracking, and minimal femur contact. Over the past decade, however, our outcomes with Duracon metal-backed patellae have been encouraging. We think these positive outcomes, seen over a minimum 5-year follow-up, are largely attributable to the thicker polyethylene and improved articular conformity of this component relative to earlier designs. PMID:26866314

  18. The biomechamcal and surgical solutions for patella implant in total knee arthroplasty.

    PubMed

    Mendes, D G; Said, M; Head, S; Sabo, E; Nachman, R; Boss, J H

    2000-01-01

    A basic fault in designs of patella implants that calls for a prompt remedy is the inadequate polyethylene thickness in contact areas. The requirement for thickness of patella implants should be similar to the requirement set up by the FDA in 1993 regarding the tibial implants, that is, a minimal thickness of 8 mm. A solution is presented for the optimal design of the patella implant and for the appropriate surgical technique. The implant's undersurface that fixes to bone is concave and has a 1-cm wide but 5 to 6 mm short central peg that does not risk the integrity of the bone. Fixation of the concave aspect to the convex aspect of the bony patella strongly enhances resistance to medio-lateral and supero-inferior shear forces. The circumferential facet of the implant 8 mm thick assures uniform thickness of the entire implant and assures optimal mechanical properties of the polyethylene. The articulating surface is tailored to conform to the corresponding femoral trochlear groove and condyles. It can be made to fit any femoral component of any knee implant. PMID:10999361

  19. 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

  20. 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

  1. [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

  2. 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

  3. Giant cell tumor of the patella: An uncommon cause of anterior knee pain

    PubMed Central

    SHIBATA, TATSUYA; NISHIO, JUN; MATSUNAGA, TAIKI; AOKI, MIKIKO; IWASAKI, HIROSHI; NAITO, MASATOSHI

    2015-01-01

    The patella is a rare site for the development of primary tumors. This is the case report of a giant cell tumor (GCT) occurring in the patella in a 25-year-old woman. The patient presented with a 1-year history of occasional right anterior knee pain. The radiological characteristics suggested a benign condition. The intraoperative pathological diagnosis was GCT of the bone. The lesion was treated by radical curettage with adjuvant therapy comprising phenol and ethanol and injection of calcium phosphate cement. Histologically, the tumor consisted of round or spindle-shaped mononuclear cells admixed with numerous osteoclastic giant cells. The patient was asymptomatic and there was no evidence of local recurrence or distant metastasis 16 months after surgery. Although rare, patellar GCT may be included in the differential diagnosis of anterior knee pain and/or swelling, particularly in young adults. PMID:25469296

  4. [Shift and tilt of the bony patella in total knee replacement].

    PubMed

    Gerber, B E; Maenza, F

    1998-09-01

    Resurfacing the patella or not in total knee arthroplasty is generally still a quite controversial topic. In that context we felt a necessity to get more informations about the natural history of a non resurfaced patella in the prosthetic surrounding than only in comparison with a replaced patella. By the fact that we haven't been replacing patellae apart from special cases since up to five years, we have available a patient selection on which this question can be studied. Thirty primary total knee replacements with documented 2 year's follow up have been investigated by calculation of the radiological patellar shift and tilt relative to the natural groove on preoperative X-rays and to the prosthetic groove in the postoperative evolution. These results were matched with the range of motion obtained after two years and with persisting pain. Only mobile polyethylene inlays had been used. With regard to the patella no difference was found for one single complete tibial tray or two separately implanted unicompartimental tibial trays. As a rule an adaptation of the bony patellar contour to the prosthetic groove was observed with an increased density of the bony contact area with or without a fibrous interstitial layer. Based on their clinical follow up examination seven patients had to be adjointed to a "residual problem group", as they presented persisting pain (3) or a poor range of motion of 90/0/0 degree of flexion/extension or less. Only in this group we found cases with a postoperative shift over 5 mm (2) and a postoperative tilt over 15 degrees (3). Inside this group, also with a significant difference from the group without residual problems, there was furthermore a correlation between persisting pain and an important preoperative tilt and between a diminished range of motion and a considerable preoperative shift. It has to be pointed out that even the cases without long severe malposition before the arthroplasty but with unsatisfactory realignement referring to the patellar tilt (7 degrees-15 degrees) have been found pain free at the last follow up. One patient with a severe secondary increase of disalignment (16 mm/139 degrees) due to an aseptic tibial loosening represents a particular case. After corrective revision of the tibial implants this patient also got again a complete pain relief and a good range of motion without any surgical measure to the patella and inspite of an evident residual tilt. Thus we have to conclude that it is justified to take important pains with the realignment to obtain a residual patellar shift of less than 5 mm. Apart from usual operative steps during the implantation to favour a good patellar tracking, e.g. a high quadriceps release or a medially transposed refixation of the detached tibial tubercle can get necessary. On the other hand a residual tilt up to 15 degrees is well tolerated, as the unresurfaced patella presents an astonishing ability of adaptation to the prosthetic groove by remodelling of the bony contour and structure. Nevertheless in the included cases of severe preoperative malposition, in which we didn't replace the patella because of a good intraoperative bone quality, we had to put up with an increased incidence of late problems even with normalized patellar tracking. In such cases an extended indication to a patellar resurfacing may be considered. PMID:9810579

  5. The structure of ulithiacyclamide B. Antitumor evaluation of cyclic peptides and macrolides from Lissoclinum patella.

    PubMed

    Williams, D E; Moore, R E; Paul, V J

    1989-01-01

    The major cytotoxic metabolites of Lissoclinum patella from Pohnpei have been isolated and identified. Most of the cytotoxicity is attributed to a new cyclic peptide, ulithiacyclamide B [4], which is closely related to ulithiacyclamide [1]. The proposed structure of 4 is based on spectroscopic analysis and chemical degradation. Compound 4 exhibits an IC50 of 17 ng/ml against the KB cell line but does not show selective cytotoxicity against solid tumor cells in the Corbett assay. PMID:2809606

  6. 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

  7. 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

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

    PubMed

    Potini, Vishnu C; Gehrmann, Robin M

    2015-06-01

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

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

    PubMed Central

    2012-01-01

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

  10. 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

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

    PubMed Central

    Sandokji, Abdullah

    2015-01-01

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

  12. Recurrent Dislocation of the Patella in Kabuki Make-Up Syndrome

    PubMed Central

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

    2012-01-01

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

  13. Different effects of femoral and tibial rotation on the different measurements of patella tilting: An axial computed tomography study

    PubMed Central

    Lin, Yeong-Fwu; Jan, Mei-Hwa; Lin, Da-Hon; Cheng, Cheng-Kung

    2008-01-01

    Background The various measurements of patellar tilting failed to isolate patellar tilting from the confounding effect of its neighboring bone rotation (femoral and tibial rotation) in people sustaining patellofemoral pain (PFPS). Abnormal motions of the tibia and the femur are believed to have an effect on patellofemoral mechanics and therefore PFPS. The current work is to explore the various effects of neighboring bone rotation on the various measurements of patellar tilting, through an axial computed tomography study, to help selecting a better parameter for patella tilting and implement a rationale for the necessary intervention at controlling the limb alignment in the therapeutic regime of PFPS. Methods Forty seven patients (90 knees), comprising of 34 females and 11 males, participated in this study. Forty five knees, from randomly selected sides of bilaterally painful knees and the painful knees of unilaterally painful knees, were enrolled into the study. From the axial CT images in the subject knees in extension with quadriceps relaxed, the measurements of femoral rotation, tibial rotation, femoral rotation relative to tibia, and 3 parameters for patella tilting were obtained and analyzed to explore the relationship between the different measurements of patella tilt angle and the measurements of its neighboring bone rotation (femoral, tibial rotation, and femoral rotation relative to tibia). Results The effect of femoral, tibial rotation, and femoral rotation relative to tibia on patella tilting varied with the difference in the way of measuring the patella tilt angle. Patella tilt angle of Grelsamer increased with increase in femoral rotation, and tibial rotation. Patella tilt angle of Sasaki was stationary with change in femoral rotation, tibial rotation, or femoral rotation relative to tibia. While, modified patella tilt angle of Fulkerson decreased with increase in femoral rotation, tibial rotation, or femoral rotation relative to tibia. Conclusion The current study has demonstrated various effects of regional bony alignment on the different measurements of the patellar tilt. And the influence of bony malalignment on the patellar tilt might draw a clinical implication that patellar malalignment can not be treated, separately, independent of the related limb alignment. This clinical implication has to be verified by further works, with a comprehensive evaluation of the various treatments of patellar malalignment. PMID:18269751

  14. The Meier-Gorlin syndrome, or ear-patella-short stature syndrome, in sibs.

    PubMed

    Loeys, B L; Lemmerling, M M; Van Mol, C E; Leroy, J G

    1999-05-01

    The Meier-Gorlin syndrome, first described by Meier and Rothschild [1959: Helv Paediatr Acta 14:213-216] and further delineated by Gorlin et al. [1975: A Selected Miscellany, p 39-50], is characterized by short stature, slender body build, craniofacial anomalies, microtia, delayed skeletal development, hypogonadism, and absence of the patellae. It has also been called the ear-patella-short stature syndrome [Boles et al., 1994: Clin Dysmorphol 3:207-214]. We report on two brothers with Meier-Gorlin syndrome, the younger of whom was more severely affected. Both patients had severe deafness and congenital labyrinthine anomalies, which have not previously been described as features of this syndrome. The neuromotor and mental development of these patients was adversely affected by late diagnosis, deafness, and their sociocultural environment, but their cognitive ability fell within the range observed in other Meier-Gorlin patients. Neuroradiographic imaging and functional inner ear investigations are recommended in the diagnostic workup of this rather specific, probably autosomal recessive mental retardation syndrome with multiple congenital anomalies. PMID:10213048

  15. Role of suture anchors in management of fractures of inferior pole of patella

    PubMed Central

    Anand, Ashish; Kumar, Manish; Kodikal, Gautam

    2010-01-01

    Background: The traditional recommendation for displaced comminuted inferior pole fractures is excision of the comminuted pole followed by reattachment of the patellar tendon with transosseous suture. To the best of our knowledge there has been no previous published study mentioning the use of suture anchors for fracture inferior pole of patella. We present a retrospective analysis of five cases of patients doing well at final follow-up of two years. Materials and Methods: Five patients treated at our institute using suture anchors for repair of comminuted inferior pole fractures of patella between January 2007 to March 2007. (range 28 years-55 years). There were three males and two females. Results: The average follow-up was 25 months (range 24 months-26 months). The patients were evaluated for range of motion, strength, patellofemoral scores and any alteration of patellar height. The outcome of the procedure was assessed with use of the patellofemoral scoring system of Noyes et al,5 as adapted by Saltzman et al.6 The final patellofemoral score (maximum 100 points) was 94.6 (range 93-96). Conclusion: We believe it is a novel extended indication of the use of suture anchors and should be in the armament of every trauma surgeon. PMID:20697489

  16. Treatment of Patella Alta in Patients with Episodic Patellar Dislocation: A Systematic Review

    PubMed Central

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

    2013-01-01

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

  17. 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

  18. 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

  19. [Progress on treatment of transverse patella fractures with tension band fixation].

    PubMed

    Yu, Xiu-ling; Xu, Chao; Li, Shun-dong; Zhan, Jian-dong; Xu, Zai-qiang

    2015-11-01

    Transverse fracture is the most common in patella fracture and tension band fixation is one of the most effective methods. Surgical wire tension band technique is simple, the use of materials is also simple, but it is not strong and difficult to promote. Kirschner tension band technique can get satisfactory reduction with reliable fixation, but it is easy to complicate with steel wire breakage and Kirschner loosening. Screw tension band technique inherits the traditional advantages of simple manipulation and reliable fixation, also overcomes the disadvantages of early activity limitations caused soft tissue irritation of tension band around knee, the slippage and breakage of internal fixation, and the technique can be popularized generally. PMID:26757540

  20. Knee pain and swelling: An atypical presentation of metastatic colon cancer to the patella

    PubMed Central

    Gasagranda, Bethany; Leeman, Kimberly; Heller, Matthew T.

    2015-01-01

    Knee pain is a common reason for a patient to seek medical evaluation. Of the many causes of knee pain, malignancy is one of the least common. When malignancy is the etiology of the pain, it is usually due to a primary tumor of the osseous structures or soft tissues of the knee joint. Metastatic disease involving the knee joint is uncommon, with few cases reported in the literature. Of these reported cases, metastatic colon cancer is exceedingly rare. However, in a patient with new onset knee pain and the proper clinical history, metastatic disease should be considered as a potential explanation of symptoms. We report a case of knee pain and swelling due to metastatic colon cancer to the patella.

  1. 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

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

    PubMed

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

    2013-02-01

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

  3. 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 ...

  4. Effect of femoral component designs on the contact and tracking characteristics of the unresurfaced patella in total knee arthroplasty

    PubMed Central

    Tanzer, Michael; McLean, Christopher A.; Laxer, Eric; Casey, John; Ahmed, Abdul M.

    2001-01-01

    Objectives To determine the effect of 5 different femoral components used in total knee arthroplasty (TKA) on the contact area and tracking characteristics of the nonresurfaced patella and to identify any design features that might adversely affect these characteristics. Design An in-vitro study. Setting The biomechanics laboratory, Department of Mechanical Engineering, McGill University, Montreal. Specimens Six fresh-frozen cadaveric knee-joint specimens. Interventions An unconstrained quadriceps simulator was used to apply the conditions of static lifting to the specimens first in their normal state and then sequentially implanted with femoral and tibial components of various designs (Miller/Galante II, Anatomic Modular Knee [AMK] System, Whiteside Ortholoc Modular, press-fit condylar and Insall–Burstein II). Outcome measures Patellar 3-dimensional tracking characteristics, determined by using a 6 degrees-of-freedom electromechanical goniometer attached directly to the patella, and patellar contact pressure measurements, obtained using low-range Fuji Prescale film. Results Articulation of the normal patella on a prosthetic femoral component resulted in alterations in the normal patellofemoral contact and tracking characteristics. The exact departure depended on the design of the prosthetic trochlea. Although all of the selected prostheses demonstrated satisfactory contact characteristics near extension, marked alterations occurred at higher flexion angles. With 90° or more of flexion, there was incompatibility between the geometries of the prosthetic notch of 2 femoral designs (AMK and PFC) and the normal knee. Conclusion The design of the prosthetic femoral component must be taken into account when determining whether or not to resurface the patella at the time of TKA. PMID:11308236

  5. Retinoid level dynamics during gonad recycling in the limpet Patella vulgata.

    PubMed

    Gesto, M; Ruivo, R; Páscoa, I; André, A; Castro, L F C; Santos, M M

    2016-01-01

    Germ cell commitment and meiosis initiation are among the multitude of physiological roles of retinoic acid (RA) in vertebrates. Acting via receptor-mediated transcription, RA induces the expression of meiotic factors, triggering meiosis. Contrasting with vertebrates, invertebrate RA metabolism is scarcely understood. Still, some physiological processes appear to be conserved. Here we set to evaluate the role of retinoids in the gonad maturation process of the marine gastropod Patella vulgata. We found that retinoid concentration in gonadal tissue, namely RA, varies between breeding and resting specimens, with maxima attained in the latter. Additionally, we isolated and quantified the expression of both the retinoic acid receptor (RAR) and the retinoid X receptor (RXR) in gonads. In view of the stability of retinoid receptor expression, we suggest that the balance of RA levels operates through the enzymatic control of synthetic and catabolic processes. Overall, the reported data are supportive for a developmental role of RA during gonadal maturation in P. vulgata, which should be addressed in other protostome lineages. PMID:26597622

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

    PubMed

    Agnusdei, D; Camporeale, A; Gennari, C

    1991-01-01

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

  7. 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

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

    PubMed Central

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

    2014-01-01

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

  9. 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

  10. TBX4 mutations (small patella syndrome) are associated with childhood-onset pulmonary arterial hypertension

    PubMed Central

    Kerstjens-Frederikse, Wilhelmina S; Bongers, Ernie M H F; Roofthooft, Marcus T R; Leter, Edward M; Douwes, J Menno; Van Dijk, Arie; Vonk-Noordegraaf, Anton; Dijk-Bos, Krista K; Hoefsloot, Lies H; Hoendermis, Elke S; Gille, Johan J P; Sikkema-Raddatz, Birgit; Hofstra, Robert M W; Berger, Rolf M F

    2013-01-01

    Background Childhood-onset pulmonary arterial hypertension (PAH) is rare and differs from adult-onset disease in clinical presentation, with often unexplained mental retardation and dysmorphic features (MR/DF). Mutations in the major PAH gene, BMPR2, were reported to cause PAH in only 10–16% of childhood-onset patients. We aimed to identify more genes associated with childhood-onset PAH. Methods We studied 20 consecutive cases with idiopathic or heritable PAH. In patients with accompanying MR/DF (n=6) array-comparative genomic hybridisation analysis was performed, with the aim of finding common deletion regions containing candidate genes for PAH. Three patients had overlapping deletions of 17q23.2. TBX2 and TBX4 were selected from this area as candidate genes and sequenced in all 20 children. After identifying TBX4 mutations in these children, we subsequently sequenced TBX4 in a cohort of 49 adults with PAH. Because TBX4 mutations are known to cause small patella syndrome (SPS), all patients with newly detected TBX4 mutations were screened for features of SPS. We also screened a third cohort of 23 patients with SPS for PAH. Results TBX4 mutations (n=3) or TBX4-containing deletions (n=3) were detected in 6 out of 20 children with PAH (30%). All living patients and two parents with TBX4 mutations appeared to have previously unrecognised SPS. In the adult PAH-cohort, one TBX4 mutation (2%) was detected. Screening in the cohort of (predominantly adult) SPS patients revealed no PAH. Conclusions These data indicate that TBX4 mutations are associated with childhood-onset PAH, but that the prevalence of PAH in adult TBX4 mutation carriers is low. PMID:23592887

  11. 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

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

    PubMed Central

    Karimzadehfini, Atiye; Zolaktaf, Vahid; Vahdatpour, Babak

    2014-01-01

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

  13. 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.

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

    PubMed

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

    2014-05-01

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

  15. 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 the CMC team had no negative impact on patella alignment, as no patella baja, which is a common complication after these kinds of surgeries, has been observed. The applied functional rehabilitation programme enabled patients to keep the proper patella alignment, similar to the alignment recorded before the surgery.

  16. 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

  17. Differential cross-linking and radio-protective effects of genipin on mature bovine and human patella tendons.

    PubMed

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

    2013-03-01

    Gamma irradiation is a proven sterilization method, but is not widely used on allografts for anterior cruciate ligament reconstruction (e.g., patella tendon) due to radiation-induced decreases in mechanical strength. Addressing this drawback would improve the safety and supply of allografts to meet current and future demand. It was hypothesized that genipin-induced collagen cross-linking would increase the tensile modulus of patella tendon tissue such that 5 MRad gamma irradiation would not reduce the tissue mechanical strength below the original untreated values. Optimized genipin treatment increased the tensile modulus of bovine tendons by ~2.4-fold. After irradiation, genipin treated tissue did not significantly differ from native tissue, proving the hypothesis. Optimized genipin treatment of human tendons increased the tensile modulus by ~1.3-fold. After irradiation, both control and genipin-treated tissues possessed ~50-60% of their native tendon modulus, disproving the hypothesis. These results highlight possible age- and species- dependent effects of genipin cross-linking on tendon tissue. Cross-linking of human allografts may be beneficial only in younger donor tissues. Future research is warranted to better understand the mechanisms and applications of collagen cross-linking for clinical use. PMID:22350064

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

    PubMed Central

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

    2013-01-01

    Gamma irradiation is a proven sterilization method, but is not widely used on allografts for anterior cruciate ligament (ACL) reconstruction (e.g., patella tendon) due to radiation-induced decreases in mechanical strength. Addressing this drawback would improve the safety and supply of allografts to meet current and future demand. It was hypothesized that genipin-induced collagen cross-linking would increase the tensile modulus of patella tendon tissue such that 5 MRad gamma irradiation would not reduce the tissue mechanical strength below the original untreated values. Optimized genipin treatment increased the tensile modulus of bovine tendons by ~2.4-fold. After irradiation, genipin treated tissue did not significantly differ from native tissue, proving the hypothesis. Optimized genipin treatment of human tendons increased the tensile modulus by ~1.3-fold. After irradiation, both control and genipin-treated tissues possessed ~50–60% of their native tendon modulus, disproving the hypothesis. These results highlight possible age- and species-dependent effects of genipin cross-linking on tendon tissue. Cross-linking of human allografts may be beneficial only in younger donor tissues. Future research is warranted to better understand the mechanisms and applications of collagen cross-linking for clinical use. PMID:22350064

  19. 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

  20. 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

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

    PubMed

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

    2015-05-01

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

  2. 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

  3. [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

  4. 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

  5. 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.

  6. 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

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

    PubMed

    Chung, Jin Wha; Lee, Hwa Sung

    2014-03-01

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

  8. 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.

  9. 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.

  10. 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

  11. 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

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

    PubMed

    Douhri, Hikmat; Sayah, Fouad

    2009-02-01

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

  13. 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)

  14. Incidence and Risk Factors for Chronic Anterior Knee Pain.

    PubMed

    Kusnezov, Nicholas; Watts, Nathaniel; Belmont, Philip J; Orr, Justin D; Waterman, Brian

    2016-04-01

    Chronic anterior knee pain is a common clinical entity, more so in the active individual. The incidence and risk factors, however remain unexplored. We investigated the correlation of demographic and occupational risk factors as well as the incidence of chronic anterior knee pain in an active military population. We performed a retrospective review of all U. S. Military active duty service members with the diagnosis of chondromalacia patellae, representative of the clinical syndrome of chronic anterior knee pain, between 2006 and 2012 using the Defense Medical Epidemiology Database. The demographic and occupation risk factors were categorized and the subgroup and overall incidence rates were determined via multivariable analysis. A total of 42,040 cases of chondromalacia patellae were identified in an at-risk population of 9,723,449, corresponding to an incidence rate of 4.32 cases per 1,000 person-years. Increasing chronological age, female sex, Black race, junior enlisted rank, and primary ground forces (Marines and Army) significantly correlated with an increased risk for chronic anterior knee pain. This study is the first report of incidence and risk factors for chondromalacia patellae in a large athletic population. We determined that sex, age, race, branch of service, and rank all correlated with the incidence of chondromalacia patellae in an active population. PMID:26166427

  15. 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

  16. 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

  17. 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

  18. 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

  19. Muscular control of the patella.

    PubMed

    Malone, Terry; Davies, George; Walsh, W Michael

    2002-07-01

    Patellofemoral patients are among the most common yet most challenging individuals presenting for orthopedic care. The key word in the previous sentence is individual. A single protocol of care is not sufficient for these special "individuals." Many concepts have been evaluated through review of the peer-reviewed literature with the following highlights: (1) the concept of VMO isolation through specific exercise should no longer be part of our lexicon; (2) patellofemoral patients improve when they are able to enhance quadriceps functional patterns by way of pain-free exercise; (3) patellofemoral patients do not fit into a single "box" but rather require an evaluation-based classification and specific interventional pattern. Many of the special techniques used by clinicians in treating these patients have not been well defined through research and also are lacking in evidence of clinical efficacy. We also must recognize, however, that good clinical observations can be the first step in defining what questions should be asked and how they can be answered. It is vital that we answer the questions without allowing "bad science" through dogma and anecdote to prevail. Likewise, we need to be diligent in determining our successes and failures through well designed and implemented clinical and research studies. PMID:12365232

  20. Patellofemoral pain.

    PubMed

    Crossley, Kay M; Callaghan, Michael J; Linschoten, Robbart van

    2016-02-01

    Patellofemoral pain refers to pain behind or around the patella (also known as patellofemoral pain syndrome, anterior knee pain, runner's knee, and, formerly, chondromalacia patellae). Patellofemoral pain is common, accounting for 11-17% of all knee pain presentations to general practice.(1 2) While it typically occurs in physically active people aged <40 years, it also affects people of all activity levels and ages.(1 2) Patellofemoral pain can be diagnosed in the clinic, and evidence based treatments can reduce pain and improve function, allowing patients to maintain a physically active lifestyle. PMID:26834209

  1. 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.

  2. Kinematic CT and MR imaging of the patellofemoral joint.

    PubMed

    Muhle, C; Brossmann, J; Heller, M

    1999-01-01

    Anterior knee pain is a frequently encountered orthopedic symptom and is often associated with patellofemoral malalignment, which may cause chondromalacia of the patella. The difficulty in determining the patellar position between 0 degrees and 30 degrees of knee flexion with a conventional axial radiographic examination is well known. The introduction of computed tomography (CT) and magnetic resonance (MR) imaging for the diagnosis of knee joint abnormalities has enabled assessment of the patellar position in this critical range. More recently, emphasis has been placed on dynamic visualization of patellar motion to detect an abnormal tracking pattern. The important influence of the quadriceps muscle on the patellar tracking pattern is well known and has been examined during active knee extension by the use of ultrafast CT, and motion-triggered and ultrafast MR imaging. This article provides an overview of the current status of kinematic CT and MR imaging in the diagnosis of patellofemoral alignment, its clinical implications, and future directions. PMID:10087126

  3. Localized deposition of amyloid in articular cartilage.

    PubMed

    Athanasou, N A; Sallie, B

    1992-01-01

    The frequency, nature and tissue distribution of localized amyloid deposits in articular cartilage of young and elderly patients, with and without evidence of arthritic disease, was determined. Localized amyloid deposits in articular cartilage were not found in young patients with osteoarthritis of the hip or chondromalacia/osteoarthritis of the patella. However, in elderly patients with osteoarthritis of the hip, amyloid deposits were commonly found, although at no greater frequency than in elderly patients with no evidence of arthritis. Amyloid deposits were commonly present (in 95% of cases) in osteoarthritis of the knee joint and in the articular cartilage of all joints containing pyrophosphate deposits. Similar deposits of amyloid were also found in the articular cartilage of 40-45% of rheumatoid joints. These findings indicate that localized amyloid deposits in the articular cartilage are largely age-related and not due to specific pathological alterations affecting articular cartilage. PMID:1737625

  4. [Arthroscopic meniscectomy in anterior cruciate ligament deficient knees].

    PubMed

    Kwiatkowski, K

    1995-01-01

    Results of 107 meniscectomies in 100 patients with long-lasting ACL deficiency are presented. Meniscectomy aggravates symptoms of ACL deficiency, worsening function of the knee. Bucket handle tear was observed most often--45 cases (36 displaced ones). The patients were reevaluated 3 years after surgery on an average using Tegner scale and pivot shift test. Tegner scale assessment rendered 62 per cent of excellent and good results, 32 per cent fair and poor results. Pivot shift was found in 21 patients prior to meniscectomy and in 37 patients at the follow-up examination; 18 patients were directed for ACL reconstruction. Arthroscopic meniscectomy in ACL deficient knee in most of the cases does not impair knee function if the activity level required is low. Evident pivot shift test, tear of the posterior horn of the medial meniscus and chondromalacia patellae are among unfavorable prognostic signs. PMID:7671747

  5. Experimentally produced fractures of articular cartilage and bone. The effects of shear forces on the pig knee.

    PubMed

    Tomatsu, T; Imai, N; Takeuchi, N; Takahashi, K; Kimura, N

    1992-05-01

    Experimental injuries of cartilage and bone were produced by applying shear force to the articular surfaces of the lateral femoral condyles of six-month-old pigs under various loading conditions. The lesions were divided into two groups, 'open' or 'closed', depending on the presence of a crack on the articular surface. Each was further divided into four types according to the depth of penetrating injury: (1) splitting of uncalcified cartilage; (2) splitting at the subchondral plate; (3) subchondral fracture; and (4) intra-articular fracture. When shear force was applied at high speed but with low energy, the articular cartilage surface was the first to crack. At low speed and low energy, splits occurred in the deeper layers first. As the energy increased, both loading conditions eventually resulted in similar open lesions. Experimentally produced shear injuries are useful models for clinical osteochondral fracture, osteochondritis dissecans, and chondromalacia patellae. PMID:1587902

  6. [The role of MRI in dislocations of the patella and other knee pathologies].

    PubMed

    Mauch, F; Ammann, B; Kraus, M

    2014-03-01

    In addition to ultrasound and conventional x-ray, magnetic resonance imaging (MRI) plays an important role in the visualization of lesions of the knee. It allows the orthopaedic surgeon to safely detect ruptures of the cruciate ligaments, the meniscus, osteochondral lesions and other ligamentary structures such as the collateral ligaments and the medial patellofemoral ligament (MPFL). In patellar dislocations, risk factors for recurrent dislocations can be determined and the therapy can be adjusted accordingly.This articles aims to give the reader a comprehensive overview on current concepts and techniques in the use of MRI for lesions of the knee. It focuses on patellar dislocations, where MRI plays a dominant role in supporting decision making for the best therapeutic strategy. PMID:24557452

  7. 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. Bioelectromagnetics. 37:81-88, 2016. © 2016 Wiley Periodicals, Inc. PMID:26756278

  8. 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

  9. 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

  10. Quadriceps tendon rupture and periosteal sleeve avulsion fracture of the proximal patella pole in an active adolescent.

    PubMed

    Bimmel, R; Reddy, K

    2008-07-01

    A unique case of anterior knee pain in an active adolescent is described: a periosteal sleeve avulsion and quadriceps rupture in a young basketball player. The trauma mechanism was without any direct trauma on the knee. A review of overuse-related anterior knee pain in the young and active is presented. A quadriceps rupture with a periosteal sleeve avulsion fracture in an active adolescent is very rare. To our knowledge there are no similar cases described. This article presents a case of a 14-year-old adolescent boy who sustained a quadriceps rupture with a periosteal sleeve avulsion. PMID:19292365

  11. [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

  12. Bifocal osseous avulsion of the patellar tendon from the distal patella and tibial tuberosity in a child.

    PubMed

    Hermansen, Lars L; Freund, Knud G

    2016-03-01

    This case report describes a 12-year-old boy, who suffered an injury to the right knee in a skateboard accident. Radiographs and surgery confirmed the extremely rare bifocal avulsion fracture including the distal patellar pole and tibial tuberosity. Open reduction and internal fixation was accomplished, and 4-month follow-up demonstrated a good outcome. PMID:26410095

  13. 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

  14. 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

  15. Orthopedic services

    MedlinePlus

    ... Rotator cuff tendinitis Separation Torn labrum SLAP tears Knee: Cartilage and meniscus injuries Dislocation of the kneecap (patella) Ligament sprains or tears (anterior cruciate, posterior cruciate, medial collateral, ...

  16. 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

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

    Technology Transfer Automated Retrieval System (TEKTRAN)

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

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

    PubMed

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

    2013-01-01

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

  19. 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

  20. Thermal chondroplasty of chondromalacic human cartilage. An ex vivo comparison of bipolar and monopolar radiofrequency devices.

    PubMed

    Edwards, Ryland B; Lu, Yan; Nho, Shane; Cole, Brian J; Markel, Mark D

    2002-01-01

    We compared the effects of treatment with bipolar and monopolar radiofrequency energy on 30 osteochondral sections harvested from 22 patients with spontaneously occurring chondromalacia who were undergoing knee arthroplasty. Specimens with chondromalacia grades 2 or 3 were randomly assigned to one of two bipolar or one monopolar treatment groups. All samples were marked and mounted on a jig to allow simulation of an arthroscopic surgical procedure with a flow rate of 100 ml/min of a balanced electrolyte solution at 22 degrees C. Under arthroscopic visualization, the designated area was treated until smooth, and the total treatment time was recorded. There was no difference in patients' ages, chondromalacia grade, or cartilage thickness among groups. Significant chondrocyte death, as determined by cell viability staining with confocal laser microscopy, was observed with each group. The bipolar devices produced significantly greater depths of chondrocyte death (2228 +/- 1003 microm and 2810 +/- 517 microm) than did the monopolar device (737 +/- 391 microm). The bipolar devices caused cell death to subchondral bone significantly more often (13 of 20 specimens) than did the monopolar device (0 of 10 specimens). Caution should be used in treating fibrillated cartilage with radiofrequency energy, particularly with the bipolar devices tested. PMID:11799002

  1. 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

  2. Kneecap dislocation

    MedlinePlus

    ... patella) dislocates to the outside of the knee Knee pain and tenderness Knee swelling "Sloppy" kneecap -- you can ... knee and you notice: Increased instability in your knee Pain or swelling return after they went away Your ...

  3. 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)

  4. Kneecap dislocation - aftercare

    MedlinePlus

    ... kneecap (patella) sits over the front of your knee joint. As you bend or straighten your knee, the ... groove in the bones that make up your knee joint. A kneecap that slides out of the groove ...

  5. 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

  6. Runner's Knee

    MedlinePlus

    ... skiing. Runner's knee happens when the kneecap (patella) tracks incorrectly over a groove in the thighbone (femur) ... move it out of place, causing it to track incorrectly along the femoral groove. Excessive training or ...

  7. 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 ...

  8. 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

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

    PubMed Central

    Pitsillides, Andrew A.; Hutchinson, John R.

    2014-01-01

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

  10. Patellofemoral malalignment and chondral damage: current concepts

    PubMed Central

    MAZZOLA, CLAUDIO; MANTOVANI, DAVIDE

    2013-01-01

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

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

    PubMed

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

    2010-11-21

    The Insall-Salvati ratio (ISR) is important for detecting two common clinical signs of knee disease: patella alta and patella baja. Furthermore, large inter-operator differences in ISR measurement make an objective measurement system necessary for better clinical evaluation. In this paper, we define three specific bony landmarks for determining the ISR and then propose an x-ray image analysis system to localize these landmarks and measure the ISR. Due to inherent artifacts in x-ray images, such as unevenly distributed intensities, which make landmark localization difficult, we hence propose a registration-assisted active-shape model (RAASM) to localize these landmarks. We first construct a statistical model from a set of training images based on x-ray image intensity and patella shape. Since a knee x-ray image contains specific anatomical structures, we then design an algorithm, based on edge tracing, for patella feature extraction in order to automatically align the model to the patella image. We can estimate the landmark locations as well as the ISR after registration-assisted model fitting. Our proposed method successfully overcomes drawbacks caused by x-ray image artifacts. Experimental results show great agreement between the ISRs measured by the proposed method and by orthopedic clinicians. PMID:21030753

  12. A Rare Combination of Avulsion Fractures Around the Knee -A Case Report.

    PubMed

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

    2015-09-01

    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

  13. 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

  14. 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

  15. Patellofemoral anatomy and biomechanics: current concepts

    PubMed Central

    ZAFFAGNINI, STEFANO; DEJOUR, DAVID; GRASSI, ALBERTO; BONANZINGA, TOMMASO; MUCCIOLI, GIULIO MARIA MARCHEGGIANI; COLLE, FRANCESCA; RAGGI, FEDERICO; BENZI, ANDREA; MARCACCI, MAURILIO

    2013-01-01

    The patellofemoral joint, due to its particular bone anatomy and the numerous capsuloligamentous structures and muscles that act dynamically on the patella, is considered one of the most complex joints in the human body from the biomechanical point of view. The medial patellofemoral ligament (MPFL) has been demonstrated to contribute 60% of the force that opposes lateral displacement of the patella, and MPFL injury results in an approximately 50% reduction in the force needed to dislocate the patella laterally with the knee extended. For this reason, recent years have seen a growing interest in the study of this important anatomical structure, whose aponeurotic nature has thus been demonstrated. The MPFL acts as a restraint during motion, playing an active role under conditions of laterally applied stress, but an only marginal role during natural knee flexion. However, it remains extremely difficult to clearly define the anatomy of the MPFL and its relationships with other anatomical structures. PMID:25606512

  16. Closed Reduction of Subacute Patellar Dislocation Using Saline Joint Insufflation: A Technical Trick.

    PubMed

    Ding, David Y; Egol, Kenneth A

    2015-07-01

    Patellar dislocations often spontaneously reduce or are reduced easily by experienced professionals. However, some dislocations can prove difficult to reduce and may require sedation or operative management. Our case report suggests an alternative method to facilitate reduction of patellar dislocations. Our technical trick involves insufflation of the knee joint with sterile normal saline, resulting in improved clearance of the patella over the femoral condyles. This low-risk technique can aid in the reduction of a dislocated patella and save the patient from unnecessary sedation or a surgical operation. PMID:26161756

  17. Unusual localisation of tophaceous gout. A report of four cases and review of the literature.

    PubMed

    Reber, P; Crevoisier, X; Noesberger, B

    1996-01-01

    We report four cases with very unusual manifestations of tophaceous gout. All patients were male, aged between 29 and 67 years. Only one patient had an acute gouty arthritis in his medical history, whereas the other three had never developed clinical symptoms from their hyperuricemia. Two patients had gout tophi in the patella, while the others showed gout tophi in the space of bipartite bones, one in a bipartite patella and one in a tripartite sesamoid bone of the first toe. To our knowledge, gout tophi in the space of bi- or tripartite bones has never been described before. PMID:8836466

  18. 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.

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

    PubMed

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

    2013-01-01

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

  20. 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

  1. Patellofemoral Syndrome: Therapeutic Regimen Based on Biomechanics

    PubMed Central

    Strother, R.T.; Samoil, D.

    1989-01-01

    The clinician needs to rehabilitate the patient with the patellofemoral syndrome based on biomechanics and anatomy. If we understand the function of the patella and the forces acting upon it, we can educate our patients to ensure their compliance through both the treatment phase and future maintenance. PMID:21248869

  2. 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,…

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

    PubMed Central

    2010-01-01

    We present an instructive case of habitual left patellar dislocation in which the patella had appeared odd due to lateral tilt relative to contralateral side, but had been radiologically confirmed to be on the trochlea at 1 year prior to the referral. An 11-year-old girl presented to our hospital 2 years after the left patella had dislocated with a 'giving way' when cutting to the left. Our physical and radiological examinations confirmed that the left patella was laterally tilted in the patellar groove with the knee in extension but was dislocated in flexion beyond 45°. In spite of these findings, she had been untreated at the previous hospital since all plain X-rays, including a skyline patellar view, had failed to demonstrate the dislocation. Consequently, in addition to reconstruction of medial patellofemoral ligament, she had to undergo a lateral retinacular release, which might have been unnecessary if treated earlier. This case illustrates that first-time patellar dislocation can gradually lead to habitual dislocation subsequently, and that cautious physical examinations in regard to patella tracking are essential since radiological examinations do not always reveal the pathophysiology of patellar instability. PMID:20840770

  4. Functional evaluation of patello-femoral incongruence by computer tomography.

    PubMed

    P?omi?ski, Janusz; Zabicka, Magda; Kwiatkowski, Krzysztof

    2004-06-30

    Background. The purpose of this study was to specify the types of incongruence detected in the patellofemoral joint by computer tomography. The joints were examined in both internal and external rotation of the lower leg. Material and methods. We examined 16 patients with pain in the anterior compartment of the knee joint (12 women, 4 men, average age 34.2 years). CT scans of the patellofemoral joint were performed in two positions: with the knee flexed 20 degrees and 30 degrees . The measurements were taken at rest and during contracture of the quadriceps, and in both internal and external rotation of the lower leg. The results were used to calculate the lateral angle of the patella, the congruence angle, and the angle of the intercondylar sulcus. Results. Contracture of the quadriceps causes an increase in the lateral angle of the patella, both in the patient group and in the controls. In 12 cases, internal rotation of the lower leg caused increased values for the lateral angle of the patella, while external rotation reduced this angle. In the control group, in 20 degrees and 30 degrees flexion of the knee, tension in the quadriceps increased the lateral angle of the patella. Rotation in either direction did not affect the congruence angle. In 12 patients we diagnosed incongruence of the lateralization type and deviation of the patella. In 4 cases we observed reduction of the congruence angle. External rotation diminished this angle. In these patients we diagnosed incongruence of the medialization type. Conclusions. Our research confirms the suitability of computer tomography in examining the patello-femoral joint in flexion from 0 to 30 degrees. The functional examination method described here using rotation of the lower leg dives now possibilities for the exact specification of the type of incongruence in the knee joint. PMID:17675993

  5. 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

  6. 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

  7. 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.

  8. 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, lower axial femorotibial rotation after TKA might lead to patella maltracking. Changing the design of the prosthesis or a special way of patella shaping might increase the conformity of the patella to trochlea to maintain natural contact patterns. PMID:23802712

  9. 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

  10. 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

  11. Tibial tubercle osteotomy for patello-femoral joint disorders.

    PubMed

    Hall, Matthew J; Mandalia, Vipul I

    2016-03-01

    Tibial tubercle osteotomy has a long history in the management of patella instability and patello-femoral arthritis. This review aims to provide a comprehensive review of the literature describing the biomechanics of the patello-femoral joint and the rationale behind the use of the tibial tubercle osteotomy in modern day practice. Several different tibial tubercle osteotomies are available and we aim to detail the concepts behind their use and the subsequent clinical results. With continued developments of chondrocyte implantation techniques, the potential to fill defects on the chondral surface of either the patella or trochlea in conjunction with a tibial tubercle osteotomy may well become more commonplace in a group that is commonly young and difficult to manage. Level of evidence III. PMID:25326765

  12. A novel freehand method for patellar resurfacing in total knee replacement.

    PubMed

    Assiotis, Angelos; Ng Man Sun, Stephen; Mordecai, Simon; Hollingdale, John

    2015-06-01

    Patellar resurfacing in the context of primary total knee replacement (TKR) and in the presence of patella-femoral osteoarthritis is common and widespread practice, as it reduces the rate of re-operation and anterior knee pain. There are several measuring devices and cutting jigs available in the market, which aim to aid with accurately resecting the patellar articular surface. A common characteristic of these jigs is that the patella needs to be everted at some stage to apply them and use them. The senior author of this paper has developed a method of performing patellar resection with the use of simple instruments with no need to evert it and while it engages the trochlea in a physiological position. We propose that this method is reproducible and produces cuts that are parallel to the trochlea. PMID:26280977

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

    PubMed Central

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

    2015-01-01

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

  14. 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

  15. 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

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

    PubMed Central

    Zanon, Giacomo; Marullo, Matteo; Benazzo, Francesco

    2013-01-01

    Medial patellofemoral ligament (MPFL) reconstruction is an established method to prevent patellofemoral instability. Nevertheless, the anatomy and the biomechanical behavior of native MPFL are still under investigation, but in recent years they have become more defined. We propose a technique for MPFL reconstruction based on the results of recent anatomic studies regarding the patellar insertion of the MPFL. A double-bundle MPFL is reconstructed by use of the semitendinosus tendon passed through a single patellar tunnel, which crosses the patella from the midpoint of its medial border until its superolateral corner is reached. This method permits a strong patellar fixation, potentially reducing the risk of patellar fracture compared with double–patellar tunnel techniques. Moreover, it requires no fixation devices at the patella and only a single interference screw on the femoral side. PMID:24400189

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

    PubMed

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

    2014-06-01

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

  18. Biomarkers of Lead Exposure and DNA Methylation within Retrotransposons

    PubMed Central

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

    2010-01-01

    Background DNA methylation is an epigenetic mark that regulates gene expression. Changes in DNA methylation within white blood cells may result from cumulative exposure to environmental metals such as lead. Bone lead, a marker of cumulative exposure, may therefore better predict DNA methylation than does blood lead. Objective In this study we compared associations between lead biomarkers and DNA methylation. Methods We measured global methylation in participants of the Normative Aging Study (all men) who had archived DNA samples. We measured patella and tibia lead levels by K-X-Ray fluorescence and blood lead by atomic absorption spectrophotometry. DNA samples from blood were used to determine global methylation averages within CpG islands of long interspersed nuclear elements-1 (LINE-1) and Alu retrotransposons. A mixed-effects model using repeated measures of Alu or LINE-1 as the dependent variable and blood/bone lead (tibia or patella in separate models) as the primary exposure marker was fit to the data. Results Overall mean global methylation ( SD) was 26.3 1.0 as measured by Alu and 76.8 1.9 as measured by LINE-1. In the mixed-effects model, patella lead levels were inversely associated with LINE-1 (? = ?0.25; p < 0.01) but not Alu (? = ?0.03; p = 0.4). Tibia lead and blood lead did not predict global methylation for either Alu or LINE-1. Conclusion Patella lead levels predicted reduced global DNA methylation within LINE-1 elements. The association between lead exposure and LINE-1 DNA methylation may have implications for the mechanisms of action of lead on health outcomes, and also suggests that changes in DNA methylation may represent a biomarker of past lead exposure. PMID:20064768

  19. Patello-femoral and tibio-femoral contact forces during kicking type of activity

    SciTech Connect

    Engin, A.E.; Tumer, S.T.

    1996-12-31

    In this paper patello-femoral and tibia-femoral contact forces during kicking type of activity is presented by means of a dynamic model of the knee joint which includes tibio-femoral and patello-femoral articulations, and the major ligaments of the joint. The model shows that the patella can be subjected to very large transient patello-femoral contact forces during a strenuous lower limb activity such as kicking even under conditions of small knee-flexion angles.

  20. Discrete element analysis for characterizing the patellofemoral pressure distribution: model evaluation.

    PubMed

    Elias, John J; Saranathan, Archana

    2013-08-01

    The current study was performed to evaluate the accuracy of computational assessment of the influence of the orientation of the patellar tendon on the patellofemoral pressure distribution. Computational models were created to represent eight knees previously tested at 40 deg, 60 deg, and 80 deg of flexion to evaluate the influence of hamstrings loading on the patellofemoral pressure distribution. Hamstrings loading increased the lateral and posterior orientation of the patellar tendon, with the change for each test determined from experimentally measured variations in tibiofemoral alignment. The patellar tendon and the cartilage on the femur and patella were represented with springs. After loading the quadriceps, the total potential energy was minimized to determine the force within the patellar tendon. The forces applied by the quadriceps and patellar tendon produced patellar translation and rotation. The deformation of each cartilage spring was determined from overlap of the cartilage surfaces on the femur and patella and related to force using linear elastic theory. The patella was iteratively adjusted until the extension moment, tilt moment, compression, and lateral force acting on the patella were in equilibrium. For the maximum pressure applied to lateral cartilage and the ratio of the lateral compression to the total compression, paired t-tests were performed at each flexion angle to determine if the output varied significantly (p < 0.05) between the two loading conditions. For both the computational and experimental data, loading the hamstrings significantly increased the lateral force ratio and the maximum lateral pressure at multiple flexion angles. For the computational data, loading the hamstrings increased the average lateral force ratio and maximum lateral pressure by approximately 0.04 and 0.3 MPa, respectively, compared to experimental increases of 0.06 and 0.4 MPa, respectively. The computational modeling technique accurately characterized variations in the patellofemoral pressure distribution caused by altering the orientation of the patellar tendon. PMID:23719962

  1. 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

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

    PubMed Central

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

    2012-01-01

    We investigated whether there were regional differences in the quadriceps enthesis and the patella bone structure that could suggest unequal force transmission to the patella. Quadriceps tendon enthesis was removed by cutting the patellae transversally in the middle and the quadriceps tendon approximately 1 cm from the bone. Tissues were post-fixed, decalcified, dehydrated through and embedded in paraffin wax. Serial longitudinal sections were cut, mounted on glass slides at 1-mm intervals and slides were stained. Trabecular architecture was analysed from digital images taken from the histological slides, and regional differences at the enthesis in the thickness of the uncalcified fibrocartilage and the cortical zone of calcified tissue (calcified cartilage and lamellar bone) were evaluated. At the quadriceps enthesis, the thickness of the cortical zone of calcified tissue was significantly greater in the central part of the enthesis than medially and laterally. The trabeculae were thicker in the central and lateral parts compared with the medial region. Similarly, the zone of uncalcified fibrocartilage was thicker laterally and centrally than medially. Bone structure and the thickness of uncalcified fibrocartilage presented a similarity between the centre and the lateral parts; however, the medial side was different. We suggest that the mechanical stress at the proximal quadriceps tendon enthesis is higher laterally and centrally compared with medially. This could induce a lateral patellar translation, which is potentially a risk factor for knee osteoarthritis. PMID:22458636

  3. 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

  4. Surgical features of Trevor's disease of the patella☆☆☆

    PubMed Central

    de Moraes, Frederico Barra; Filho, Geraldo dos Passos Barcelos; Lobo, Guilherme Felipe Faria; Santos, Cícero Almeida; Reis, Luiz Augusto Alves; dos Santos, Mauro Rodrigues

    2014-01-01

    The aim of this study was to describe surgical features of resection of hemimelic epiphyseal dysplasia of the patella. We already described the clinical and imaging features in another article. The patient was a six-year-old boy with a tumor in his right knee measuring 12 cm longitudinally and 6 cm transversally, which was adhering to the patella and had been slowly growing for two years. Biopsy findings were suggestive of a benign osteochondromatous lesion, without a defined diagnosis. Imaging examinations such as radiography and tomography showed areas of bone formation and radiotransparent areas, while magnetic resonance imaging showed areas of hypo and hypersignal in T1 and T2, of estimated size 8.5 cm longitudinally and 6 cm transversally. The tumor growth was surgically resected and curettage was performed on the epiphyseal nucleus of ossification of the upper and medial centers of the patella, with good patellar remodeling and normal development. The patient did not present any recurrence of the lesion up to the time of reaching skeletal maturity. PMID:26229838

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

    PubMed Central

    Kim, Tae-Hoon; Lee, Jong-Soo

    2014-01-01

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

  6. [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

  7. 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

  8. 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 independent influence on plasma lead levels. It will be important to determine whether the degree of this influence increases during times of heightened bone turnover (e.g., pregnancy and lactation). Images Figure 1 Figure 2 PMID:9681974

  9. 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 and that consumption of high calcium content foods may protect against the accumulation of lead in bone. Images Figure 1. Figure 1. Figure 2. Figure 2. PMID:8930549

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

    NASA Astrophysics Data System (ADS)

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

    2007-12-01

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

  11. Autoarthroplasty of knee cartilage defects by osteoperiosteal grafts.

    PubMed

    Korkala, O L; Kuokkanen, H O

    1995-01-01

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

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

    PubMed

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

    2006-10-01

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

  13. Approach to the active patient with chronic anterior knee pain.

    PubMed

    Atanda, Alfred; Ruiz, Devin; Dodson, Christopher C; Frederick, Robert W

    2012-02-01

    The diagnosis and management of chronic anterior knee pain in the active individual can be frustrating for both the patient and physician. Pain may be a result of a single traumatic event or, more commonly, repetitive overuse. "Anterior knee pain," "patellofemoral pain syndrome," and "chondromalacia" are terms that are often used interchangeably to describe multiple conditions that occur in the same anatomic region but that can have significantly different etiologies. Potential pain sources include connective or soft tissue irritation, intra-articular cartilage damage, mechanical irritation, nerve-mediated abnormalities, systemic conditions, or psychosocial issues. Patients with anterior knee pain often report pain during weightbearing activities that involve significant knee flexion, such as squatting, running, jumping, and walking up stairs. A detailed history and thorough physical examination can improve the differential diagnosis. Plain radiographs (anteroposterior, anteroposterior flexion, lateral, and axial views) can be ordered in severe or recalcitrant cases. Treatment is typically nonoperative and includes activity modification, nonsteroidal anti-inflammatory drugs, supervised physical therapy, orthotics, and footwear adjustment. Patients should be informed that it may take several months for symptoms to resolve. It is important for patients to be aware of and avoid aggravating activities that can cause symptom recurrence. Patients who are unresponsive to conservative treatment, or those who have an underlying systemic condition, should be referred to an orthopedic surgeon or an appropriate medical specialist. PMID:22508250

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

    PubMed

    Mariee, I C; Gröne, A; Theyse, L F H

    2014-06-01

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

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

    PubMed Central

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

    2010-01-01

    Purpose: To study the interrelationship between patella cartilage T2 relaxation time, other knee abnormalities, and physical activity levels in asymptomatic subjects from the Osteoarthritis Initiative (OAI) incidence cohort. Materials and Methods: The study had institutional review board approval and was HIPAA compliant. One hundred twenty subjects from the OAI without knee pain (age, 45–55 years) and with risk factors for knee osteoarthritis (OA) were studied by using knee radiographs, 3.0-T knee magnetic resonance (MR) images (including intermediate-weighted fast spin-echo and T2 mapping sequences), and the Physical Activity Scale for the Elderly. MR images of the right knee were assessed by two musculoskeletal radiologists for the presence and grade of abnormalities. Segmentation of the patella cartilage was performed, and T2 maps were generated. Statistical significance was determined by using analysis of variance, χ2 analysis, correlation coefficient tests, the Cohen κ, and a multiple linear regression model. Results: Cartilage lesions were found in 95 (79.0%) of 120 knees, and meniscal lesions were found in 54 (45%) of 120 knees. A significant correlation between patella cartilage T2 values and the severity and grade of cartilage (P = .0025) and meniscus (P = .0067) lesions was demonstrated. Subjects with high activity levels had significantly higher prevalence and grade of abnormalities and higher T2 values (48.7 msec ±4.35 vs 45.8 msec ±3.93; P < .001) than did subjects with low activity levels. Conclusion: Middle-aged asymptomatic individuals with risk factors for knee OA had a high prevalence of cartilage and meniscus knee lesions. Physically active individuals had more knee abnormalities and higher patellar T2 values. Additional studies will be needed to determine causality. © RSNA, 2010 PMID:20019141

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

    PubMed

    Kohlhof, Hendrik; Heidt, Christoph; Bhler, 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

  17. 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

  18. 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

  19. 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 BTJ and will serve as critical benchmark parameters for current efforts in BTJ repair.

  20. 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

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

    NASA Astrophysics Data System (ADS)

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

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

  2. Biomechanical comparison of extensile exposures in total knee arthroplasty.

    PubMed

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

    2010-06-01

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

  3. SURGICAL TREATMENT OF OSTEOCHONDRAL LESIONS OF THE KNEE BY MEANS OF MOSAICPLASTY

    PubMed Central

    De Almeida Lira Neto, Ozório; Da Silveira Franciozi, Carlos Eduardo; De Mello Granata Júnior, Geraldo Sérgio; De Queiroz, Antonio Altenor Bessa; Filho, Mario Carneiro; Navarro, Ricardo Dizioli

    2015-01-01

    Objective: To evaluate the functional results from the technique of mosaicplasty, in the knees of patients with osteochondral lesions. Methods: Between August 1999 and March 2005, 27 patients underwent mosaicplasty on their knees. Twenty-one were male and six were female. The patients' ages ranged from 16 to 64 years (mean of 38.1 years). Seventeen lesions were located on the right knee and ten on the left knee. The lesion was located on the lateral femoral condyle in four patients (15%), on the medial femoral condyle in 18 patients (66.5%) and on the patella in five patients (18.5%). The lesion sizes ranged from 1 to 8 cm2 (mean of 2.7 cm2). The patients were evaluated before and after the operation using Lysholm's functional scale, with a mean follow-up of 2.5 years. Results: Before the operation, the mean was 62.7 points, and after the operation, the mean was 95.4 points. The patients who underwent mosaicplasty on the lateral femoral condyle presented a mean of 51.5 points before the operation, and a mean of 100 points after the operation. In relation to the medial femoral condyle, the mean before the operation was 64.1 points, and it was 95.4 points after the operation. In relation to the patella, the mean before the operation was 66.4 points, and it was 92 points after the operation. Conclusion: Mosaicplasty proved to be a good alternative for treating osteochondral lesions of the knee. It presented better evolution in relation to lesions of the femoral condyles than in relation to lesions located on the patella.

  4. 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

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

    PubMed Central

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

    2015-01-01

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

  6. Diagnostic Algorithm for Residual Pain After Total Knee Arthroplasty.

    PubMed

    Park, Caroline N; White, Peter B; Meftah, Morteza; Ranawat, Amar S; Ranawat, Chitranjan S

    2016-03-01

    Although total knee arthroplasty is a successful and cost-effective procedure, patient dissatisfaction remains as high as 50%. Postoperative residual knee pain after total knee arthroplasty, with or without crepitation, is a major factor that contributes to patient dissatisfaction. The most common location for residual pain after total knee arthroplasty is anteriorly. Because residual pain has been associated with an un-resurfaced patella, this review includes only registry data and total knee arthroplasty with patella replacement. Some suggest that the pathogenesis of residual knee pain may be related to mechanical stimuli that activate free nerve endings around the patellofemoral joint. Various etiologies have been implicated in residual pain, including (1) low-grade infection, (2) midflexion instability, and (3) component malalignment with patellar maltracking. Less common causes include (4) crepitation and patellar clunk syndrome; (5) patellofemoral symptoms, including overstuffing and avascular necrosis of the patella; (6) early aseptic loosening; (7) hypersensitivity to metal or cement; (8) complex regional pain syndrome; and (9) pseudoaneurysm. Because all of these conditions can lead to residual pain, identifying the etiology can be a difficult diagnostic challenge. Often, patients with persistent pain and normal findings on radiographs and laboratory workup may benefit from a diagnostic injection or further imaging. However, up to 10% to 15% of patients with residual pain may have unexplained pain. This literature review summarizes the findings on the causes of residual pain and presents a diagnostic algorithm to facilitate an accurate diagnosis for residual pain after total knee arthroplasty. [Orthopedics. 2016; 39(2):e246-e252.]. PMID:26811953

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

    PubMed Central

    Goodrich, Jaclyn M; Snchez, Brisa N; Dolinoy, Dana C; Zhang, Zhenzhen; Hernndez-vila, Mauricio; Hu, Howard; Peterson, Karen E; Tllez-Rojo, Martha M

    2015-01-01

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

  8. [Isolated ruptures of the tendon of the biceps femoris muscle].

    PubMed

    Rehm, O; Linke, R; Schweigkofler, U; Hoffmann, R F; Jäger, A

    2009-03-01

    Traumatic ruptures of tendons in the region of the knee joint are often accompanied by substantial degenerative and inflammatory alterations, especially when the patella and quadriceps tendons are affected. Isolated ruptures of the tendon of the distal biceps femoris muscle at the dorsolateral aspect of the knee are rare and result in an acute reduction of flexion capability. However, tears of the biceps femoris tendon are not associated with degenerative changes. This article reports on the diagnosis and treatment of a 27-year-old football player who suffered an acute isolated rupture of the biceps femoris tendon. PMID:19224187

  9. 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

  10. Medial Patellofemoral Ligament Reconstruction Using a Femoral Loop Button Fixation Technique

    PubMed Central

    Godin, Jonathan A.; Karas, Vasili; Visgauss, Julia D.; Garrett, William E.

    2015-01-01

    Medial patellofemoral ligament (MPFL) reconstruction is a common procedure used to treat both acute and chronic patellar instability. Although many variations of MPFL reconstruction have been described, there is no consensus regarding the optimal surgical technique. We describe a technique for MPFL reconstruction with a looped gracilis tendon autograft using suture anchors to secure the graft to the patella and a suspensory loop button system for fixation to the femur. This technique replicates the native shape of the MPFL while minimizing the risk of patellar fracture and allowing for gradual tensioning of the graft. PMID:26900561

  11. 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

  12. 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

  13. 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.

  14. 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.

  15. [MR of the knee joint. Imaging of the normal anatomy and pathological findings using surface coils].

    PubMed

    Steinbrich, W; Beyer, D; Friedmann, G; Ermers, J W; Buess, G; Schmidt, K H

    1985-08-01

    A special surface coil was developed with the intention of producing optimal resolution and signal-to-noise ratio for the examination of the knee joint by MRI. Eight volunteers and 25 patients with various abnormalities of the knee have been examined. Normal anatomical structures can be differentiated and there is high diagnostic reliability for lesions of the meniscus, as confirmed by arthroscopy and surgery. Cartilage lesions are less well demonstrated. Total rupture of cruciate ligaments is clearly shown, but partial rupture can often be recognised on the basis of indirect signs only. Good diagnostic results were obtained in cases of osteochondritis dissecans and chondropathia of the patella. PMID:2992030

  16. Surgical Management of Patellar Fractures.

    PubMed

    Kakazu, Rafael; Archdeacon, Michael T

    2016-01-01

    The patella plays a crucial role in the extensor mechanism to increase the mechanical advantage of the quadriceps. Fractures can be classified based on displacement, comminution, and fracture pattern, which often guide treatment. Modern treatment options include internal fixation using tension bands with Kirschner wires or cannulated screws, lag screw fixation, partial patellectomy, and rarely total patellectomy. Nondisplaced, closed patellar fractures or fractures with less than 2-mm articular steps can be successfully treated conservatively. Open fractures, articular step of 2 mm or greater, and loss of knee extension are indications for surgical intervention. PMID:26614923

  17. Total Knee Arthroplasty after Complete Patellectomy: A Review.

    PubMed

    Stroh, D Alex; Issa, Kimona; Scillia, Anthony; Issa, Sargoun; Festa, Anthony; Mont, Michael A

    2015-01-01

    The absence or dysfunction of the knee extensor mechanism accelerates degenerative joint disease and complicates knee arthroplasty. Various treatment strategies have been suggested to improve outcomes in total knee arthroplasties after patellectomy (semi- or constrained components, autograft, allograft, prosthetic reconstruction), but the optimal management of this condition is not known. The purpose of this report is to review the relevant basic biology and biomechanics of the patella and the extensor mechanism, and to review the current literature on the management of complete patellectomy during total knee arthroplasty. Tissue engineered heart valves, BMMSCs, oscillatory shear stress, nicotine, F-actin filaments, cell differentiation, endothelial cells. PMID:26756555

  18. 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

  19. 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 based on an element elimination method available in the LS-DYNA code. No validation study was conducted to determine if this method is suitable when simulating fractures of biological tissues. More work is still needed to further validate the FE model of the KTH complex to increase its reliability in the assessment of various impact loading conditions associated with vehicular crash scenarios. PMID:17096270

  20. Accurate assessment of patellar tracking using fiducial and intensity-based fluoroscopic techniques.

    PubMed

    Tang, T S Y; MacIntyre, N J; Gill, H S; Fellows, R A; Hill, N A; Wilson, D R; Ellis, R E

    2004-09-01

    Accuracies of a point-based and an intensity-based fluoroscopic methods of assessing patella tracking were determined by comparing the pattern of patellar motion with respect to orientation (flexion, internal rotation, and lateral tilt) and translation (lateral, proximal, and anterior) with the pattern of patellar motion measured using Roentgen stereophotogrammetric analysis in three cadaver knee specimens. Each pose in the patellar motion could be obtained from single as well as multiple calibrated fluoroscopic images. The errors using the intensity-based method were slightly higher than those of the point-based method, but they appear to be sufficiently low to detect clinically significant differences in patellar kinematics. PMID:15450227

  1. Rheumatic diseases in Neolithic and Medieval populations of western Switzerland.

    PubMed

    Kramar, C; Lagier, R; Baud, C A

    1990-01-01

    An investigation of three groups from ancient populations (Neolithic, Early Middle Ages, Middle Ages) was performed on 273 adult skeletons. Despite unequal preservation of the remains, a study of a series of large joints and spinal segments permitted some conclusions: rheumatoid arthritis, ankylosing spondylitis, and osteoarthrosis of large joints (hip, knee, shoulder) were not found. The main findings were: osteoarthrosis in spinal zygapophyseal joints (particularly at cervical level); intervertebral osteochondrosis (particularly at the cervical and lumbar levels); Schmorl's nodes (particularly at the thoracic and lumbar levels); enthesopathic osteophytes (particularly in the spine, iliac crest, patella, and calcaneus). Such deformities seemed more frequent in the Middle Ages than in the Neolithic period. PMID:2085056

  2. Surgical approaches in total knee arthroplasty

    PubMed Central

    SANNA, MARCO; SANNA, CRISTINA; CAPUTO, FRANCESCO; PIU, GIUSEPPE; SALVI, MASSIMILIANO

    2013-01-01

    Total knee replacement surgery begins with correct planning of both the incision and the exposure of the joint. Indeed, these are factors that are just as crucial to an optimal outcome as choosing the right implant, positioning the components, and balancing the ligaments. While it is true that the standard incision and arthrotomy (with which we are most familiar) will, in most primary implant cases, provide adequate joint exposure, it is also true that cases characterized by certain conditions, such as previous cutaneous incisions, a stiff knee or patella baja, present specific skin and exposure problems that need to be recognized, planned for and overcome. PMID:25606515

  3. The bruise which depicted the pattern of subjacent bone.

    PubMed

    Wankhede, Ashesh Gunwantrao

    2009-04-15

    Reported here is a very rare case in which the bruises were caused to the lower anterior region of the right thigh by the impact of the rim of a scooter's seat made up of a slightly flexible plastic sheet covered with artificial leather. The bruises depicted the pattern of the subjacent lower end of the femur and the upper pole of the patella. The bruises also displayed the following color changes: yellow color at the center and purple at the edge, with the fading beginning at the center and proceeding towards its periphery, which was found to be contradictory to the present literature about bruises. PMID:19250780

  4. 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.

  5. [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

  6. Lead Exposure and Fear-Potentiated Startle in the VA Normative Aging Study: A Pilot Study of a Novel Physiological Approach to Investigating Neurotoxicant Effects

    PubMed Central

    Grashow, Rachel; Miller, Mark W.; McKinney, Ann; Nie, Linda H.; Sparrow, David; Hu, Howard; Weisskopf, Marc G.

    2013-01-01

    Background Physiologically-based indicators of neural plasticity in humans could provide mechanistic insights into toxicant actions on learning in the brain, and perhaps prove more objective and sensitive measures of such effects than other methods. Objectives We explored the association between lead exposure and classical conditioning of the acoustic startle reflex (ASR)—a simple form of associative learning in the brain—in a population of elderly men. Fifty-one men from the VA Normative Aging Study with cumulative bone lead exposure measurements made with K-X-Ray-Fluorescence participated in a fear-conditioning protocol. Results The mean age of the men was 75.5 years (standard deviation [sd]=5.9) and mean patella lead concentration was 22.7μg/g bone (sd=15.9). Baseline ASR eyeblink response decreased with age, but was not associated with subsequent conditioning. Among 37 men with valid responses at the end of the protocol, higher patella lead was associated with decreased awareness of the conditioning contingency (declarative learning; adjusted odds ratio [OR] per 20 μg/g patella lead=0.91, 95% confidence interval [CI]: 0.84, 0.99, p=0.03). Eyeblink conditioning (non-declarative learning) was 0.44sd less (95% CI:−0.91, 0.02; p=0.06) per 20 μg/g patella lead after adjustment. Each result was stronger when correcting for the interval between lead measurement and startle testing (awareness: OR=0.88, 95% CI: 0.78, 0.99, p = 0.04; conditioning: −0.79sd less, 95% CI: −1.56, 0.03, p = 0.04). Conclusions This initial exploration suggests that lead exposure interferes with specific neural mechanisms of learning and offers the possibility that the ASR may provide a new approach to physiologically explore the effects of neurotoxicant exposures on neural mechanisms of learning in humans with a paradigm that is directly comparable to animal models. PMID:23603705

  7. 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.

  8. 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.

  9. [Trauma of the knee joint--radiological diagnosis].

    PubMed

    Kramer, J; Scheurecker, A; Chocholka, P

    2001-01-01

    The knee, the largest joint in the human body, is composed of the distal femur, the proximal tibia, the patella, and a complex arrangement of ligaments and menisci. This joint is particularly vulnerable because of its anatomic, functional, and mechanical characteristics. Depending on the severity and the specific mechanism of the trauma, injuries of soft tissue structures or bony elements or even a combination of both may be present. In case of severe pain caused by traumatic events clinical tests may be insufficient for exact diagnosis and radiological examinations are mandatory for an effective planing of the therapeutic management. PMID:11762245

  10. 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

  11. [Iatrogenic "metalloma" (titanoma) caused by implant failure in "metal-backed" patellar joint surface replacement].

    PubMed

    Büttner-Janz, Karin; Müller, M; Müller, K M; Friemann, J

    2002-03-01

    Patellofemoral problems frequently provide the cause for revisions after total knee replacements (TKR). Problems with metal-backed patellae, in particular, have been reported on in the past, with a failure rate of 33%. As a result of implant failure, there is an increase of polyethylene and metallic wear, which eventually leads to a synovialitis and metallosis. We report a case of a iatrogenic induced metallosis of the knee joint resulting from failure of a metal-backed patella component with the formation of a substantial pseudotumor within the popliteal fossa. Intraoperatively, a browny-grey, knotted and hard structure was to be seen, which histologically imposed as a hyalinated scar tissue with black particular deposits. Energy dispersive X-ray microanalysis showed a high level of titanium within the intra- and extracellular deposits. In differential diagnosis these findings were postulated as "metalloma" (titanoma). In cases of periprosthetic pseudotumors, particular those with implant failure, a iatrogenic-induced metalloma should be considered. PMID:11995225

  12. Characteristics of patients with primary acute lateral patellar dislocation and their recovery within the first 6 months of injury.

    PubMed

    Atkin, D M; Fithian, D C; Marangi, K S; Stone, M L; Dobson, B E; Mendelsohn, C

    2000-01-01

    We prospectively studied the characteristics and early recovery of an unselected population of patients who had acute first-time lateral patellar dislocation. The recovery program used standardized rehabilitation, emphasizing range of motion, muscle strength, and return of function. Patients returned to stressful activities including sports as tolerated when they regained full passive range of motion, had no effusion, and when quadriceps muscle strength was at least 80% compared with the noninjured limb. Seventy-four patients met the enrollment criteria; 37 men and 37 women. The average age was 19.9 years, and preinjury sports participation was similar to that of ligament-injury patients. Four percent of patients (N = 3) had a history of birth complications, 3% (N = 2) had a history of lower extremity problems as an infant or child, and 9% (N = 7) had a family history of patellar dislocation. Radiographs revealed a 50% incidence (N = 37) of patella alta; all patients demonstrated lateral patellar overhang. Patients regained range of motion (mean, 0 degrees to 132 degrees) by 6 weeks. Sports participation remained significantly reduced throughout the first 6 months after injury, with the greatest limitations in kneeling and squatting. At 6 months, 58% of patients (N = 43) noted limitation in strenuous activities. The patients who had acute primary patellar dislocation were young and active. Most injuries occurred during sports, and few patients had abnormal physical features, contradicting any stereotype of an overweight, sedentary, adolescent girl whose patella dislocates with little or no trauma. PMID:10921637

  13. Unusual small bone metastases from epithelial malignancies: diagnosis by fine-needle aspiration cytology with histologic confirmation.

    PubMed

    Singh, H K; Silverman, J F; Ballance, W A; Park, H K

    1995-10-01

    Although epithelial malignancies can have bone metastases, involvement of small bones is exceedingly rare, representing either first manifestation of an occult carcinoma or late disseminated disease. Small bone metastases may mimic primary skeletal diseases leading to misdiagnosis and delayed treatment. We report three cases of metastatic epithelial malignancies diagnosed by computed tomography (CT)-guided fine-needle aspiration (FNA) biopsy in two patients with lytic calcaneal lesions and a patellar lesion in a third patient; all with histologic confirmation. Case 1, a 63-year-old female, presented with heel pain. FNA and tissue biopsy of the calcaneus revealed a clear cell malignancy consistent with a renal primary. Follow-up abdominal CT scan revealed a renal lesion consistent with renal cell carcinoma. Case 2, a 37-yr-old male with squamous cell carcinoma of the esophagus, presented with foot pain. FNA and tissue biopsy of the calcaneous revealed metastatic squamous cell carcinoma. Case 3, a 52-yr-old male with a history of squamous cell carcinoma of floor of mouth, presented with knee pain and swelling. FNA and tissue biopsy of the patella revealed metastastic squamous cell carcinoma. To the best of our knowledge, this is the first complete FNA cytology report with histologic confirmation of unusual small bone metastases of the feet and patella from epithelial malignancies and shows the value of FNA cytology in establishing a correct diagnosis, and excluding primary skeletal diseases. PMID:8575276

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

    PubMed

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

    2008-01-01

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

  15. Spontaneous bilateral avulsion fracture of the tuberositas tibiae in a New Zealand White rabbit - a counterpart to Osgood-Schlatter disease in humans?

    PubMed

    Nehrbass, D; Arens, D; Zeiter, S

    2015-02-01

    The first reported case describing a spontaneous bilateral avulsion fracture of the tuberositas tibiae in a New Zealand White rabbit is presented. So far in animals, this condition has been only described in dogs and horses. In humans, this condition is also called Osgood-Schlatter disease (OSD) or syndrome, traction apophysitis of the tibial tubercle (ATT) or patellar tendon enthesopathy of the tibial tuberosity respectively. It is mainly seen in young adolescents coinciding with periods of growth spurts. In humans, its pathogenesis is believed to be caused by repetitive tendon/muscle strain at the insertion of the patellar tendon to the immature tibial tuberosity, which has its own secondary ossification center. Morphologically this case is characterized by bilateral chronic avulsion with incomplete separation of the tuberositas tibae, and proximal dislocation of the patella (patella alta). Despite these marked pathological changes, the animal was clinically without findings. Nevertheless, this case emphasizes the need for thorough clinical and radiological examination of rabbits intended for preclinical research studies prior to study begin, especially in orthopedic research. PMID:25435475

  16. A method of repair for quadriceps tendon or patellar ligament (tendon) ruptures without cast immobilization. Preliminary report.

    PubMed

    Levy, M; Goldstein, J; Rosner, M

    1987-05-01

    The quadriceps tendon and patellar tendon (ligament) were repaired with a Dacron vascular graft used as a tension suture material. In cases of quadriceps tendon ruptures, the Dacron graft is passed transversely through the patellar ligament just below the patella and crossed transversely at the level of the musculotendinous junction with two loops applying tension to the tendon, which brings the tendon ends together by creating a solid structure. In cases of patellar ligament ruptures, the Dacron graft is passed through a hole in the tibia posteriorly to the tibial tuberosity instead of through the patellar ligament below the patella. This technique enables early mobilization on the first day after surgery. The technique was first tested on six dogs with severed quadriceps tendons and patellar ligaments that were repaired with this suture method. All of the animals recovered from surgery and walked and ran normally on the repaired legs within 27 days and with only mild limping after 17 days. The technique was then used on six patients, four with complete quadriceps tendon rupture and two with complete tear (avulsion) of the patellar ligament (tendon). In all of the patients, excellent surgical results were obtained and leg immobilization was virtually eliminated. Physical therapy was prescribed the first day after surgery. The rehabilitation period was significantly reduced. PMID:2952384

  17. Evaluating factors affecting patellar component fixation strength in total knee arthroplasty.

    PubMed

    Wagner, Russell A; Lesley, Nathan E; Coté, René E; Tayag, Tristan J

    2013-09-01

    Complications related to the patellofemoral joint after total knee arthroplasty (TKA) represent up to 50% of TKA reoperations. Shear forces across the knee produce wear and occasionally result in failure of fixation of all-polyethylene patellar components. We conducted a study to evaluate the effect of 2 factors on the shear strength of patellar component fixation: time between cement mixing and application of the patellar component, and amount of pressure applied during implantation. Fifty-four patellae were harvested from 27 cadavers and were prepared as for a TKA, allowing 3 different amounts of time for the cement to set or cure before application, and using 3 different pressures. The patellae were mounted and tested for fixation strength with a materials testing machine. Fixation was significantly stronger (P = .006) at 42 pounds of pressure after curing the cement for 8 minutes (compared with 2 minutes) and was significantly stronger (P = .005) after 2 minutes of curing at 42 pounds of pressure (compared with 62 pounds of pressure). We concluded that allowing the cement to cure while cementing the femoral and tibial components does not jeopardize fixation of the patellar component and that excessive compression of a patellar clamp may weaken fixation. PMID:24078966

  18. Statistical modeling to characterize relationships between knee anatomy and kinematics.

    PubMed

    Smoger, Lowell M; Fitzpatrick, Clare K; Clary, Chadd W; Cyr, Adam J; Maletsky, Lorin P; Rullkoetter, Paul J; Laz, Peter J

    2015-11-01

    The mechanics of the knee are complex and dependent on the shape of the articular surfaces and their relative alignment. Insight into how anatomy relates to kinematics can establish biomechanical norms, support the diagnosis and treatment of various pathologies (e.g., patellar maltracking) and inform implant design. Prior studies have used correlations to identify anatomical measures related to specific motions. The objective of this study was to describe relationships between knee anatomy and tibiofemoral (TF) and patellofemoral (PF) kinematics using a statistical shape and function modeling approach. A principal component (PC) analysis was performed on a 20-specimen dataset consisting of shape of the bone and cartilage for the femur, tibia and patella derived from imaging and six-degree-of-freedom TF and PF kinematics from cadaveric testing during a simulated squat. The PC modes characterized links between anatomy and kinematics; the first mode captured scaling and shape changes in the condylar radii and their influence on TF anterior-posterior translation, internal-external rotation, and the location of the femoral lowest point. Subsequent modes described relations in patella shape and alta/baja alignment impacting PF kinematics. The complex interactions described with the data-driven statistical approach provide insight into knee mechanics that is useful clinically and in implant design. PMID:25991502

  19. An Algorithmic Approach to the Management of Recurrent Lateral Patellar Dislocation.

    PubMed

    Weber, Alexander E; Nathani, Amit; Dines, Joshua S; Allen, Answorth A; Shubin-Stein, Beth E; Arendt, Elizabeth A; Bedi, Asheesh

    2016-03-01

    ?High-level evidence supports nonoperative treatment for first-time lateral acute patellar dislocations.?Surgical intervention is often indicated for recurrent dislocations.?Recurrent instability is often multifactorial and can be the result of a combination of coronal limb malalignment, patella alta, malrotation secondary to internal femoral or external tibial torsion, a dysplastic trochlea, or disrupted and weakened medial soft tissue, including the medial patellofemoral ligament (MPFL) and the vastus medialis obliquus.?MPFL reconstruction requires precise graft placement for restoration of anatomy and minimal graft tension. MPFL reconstruction is safe to perform in skeletally immature patients and in revision surgical settings.?Distal realignment procedures should be implemented in recurrent instability associated with patella alta, increased tibial tubercle-trochlear groove distances, and lateral and distal patellar chondrosis.?Groove-deepening trochleoplasty for Dejour type-B and type-D dysplasia or a lateral elevation or proximal recession trochleoplasty for Dejour type-C dysplasia may be a component of the treatment algorithm; however, clinical outcome data are lacking. In addition, trochleoplasty is technically challenging and has a risk of substantial complications. PMID:26935465

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

    PubMed

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

    2011-01-01

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

  1. Anterior knee pain in children with cerebral palsy.

    PubMed

    Senaran, Hakan; Holden, Candice; Dabney, Kirk W; Miller, Freeman

    2007-01-01

    Anterior knee pain arising from the patellofemoral joint may be a significant problem in the cerebral palsy (CP) population. The aim of this study was to classify patients with anterior knee pain based on etiology and organize orthopaedic management based on this classification. This study was a retrospective chart review of patients with CP and anterior knee pain admitted to the orthopaedic outpatient clinic between 1991 and 2003. Children with CP who had intractable anterior knee pain despite 6 months of conservative treatment with at least 2 years' follow-up were identified and included. The medical records, radiographs, and treatment protocols were screened. Patients were classified into 3 groups according to pathology. Group I consisted of 7 children with patella alta only. Group II consisted of 7 children with patellar inferior pole fractures. Group III consisted of 13 children with subluxated or dislocated patellas. Conservative treatment methods such as anti-inflammatory drugs, local ice packs, stretching exercises, and braces should be the first step in treatment. For those patients in whom conservative treatment was not effective, surgical treatment alternatives were discussed. Knee pain resolved in all patients after surgical treatment of the underlying pathology. Gait analysis can be performed for patients with patellofemoral subluxations to evaluate the rotational malalignment of the tibia and femur. In conclusion, anterior knee pain arising from the patellofemoral joint in patients with CP should be evaluated and treated to prevent future functional deterioration. PMID:17195790

  2. Progression of Gene Expression Changes following a Mechanical Injury to Articular Cartilage as a Model of Early Stage Osteoarthritis

    PubMed Central

    McCulloch, R. S.; Ashwell, M. S.; Maltecca, C.; O'Nan, A. T.; Mente, P. L.

    2014-01-01

    An impact injury model of early stage osteoarthritis (OA) progression was developed using a mechanical insult to an articular cartilage surface to evaluate differential gene expression changes over time and treatment. Porcine patellae with intact cartilage surfaces were randomized to one of three treatments: nonimpacted control, axial impaction (2000 N), or a shear impaction (500 N axial, with tangential displacement to induce shear forces). After impact, the patellae were returned to culture for 0, 3, 7, or 14 days. At the appropriate time point, RNA was extracted from full-thickness cartilage slices at the impact site. Quantitative real-time PCR was used to evaluate differential gene expression for 18 OA related genes from four categories: cartilage matrix, degradative enzymes and inhibitors, inflammatory response and signaling, and cell apoptosis. The shear impacted specimens were compared to the axial impacted specimens and showed that shear specimens more highly expressed type I collagen (Col1a1) at the early time points. In addition, there was generally elevated expression of degradative enzymes, inflammatory response genes, and apoptosis markers at the early time points. These changes suggest that the more physiologically relevant shear loading may initially be more damaging to the cartilage and induces more repair efforts after loading. PMID:25478225

  3. Progression of Gene Expression Changes following a Mechanical Injury to Articular Cartilage as a Model of Early Stage Osteoarthritis.

    PubMed

    McCulloch, R S; Ashwell, M S; Maltecca, C; O'Nan, A T; Mente, P L

    2014-01-01

    An impact injury model of early stage osteoarthritis (OA) progression was developed using a mechanical insult to an articular cartilage surface to evaluate differential gene expression changes over time and treatment. Porcine patellae with intact cartilage surfaces were randomized to one of three treatments: nonimpacted control, axial impaction (2000 N), or a shear impaction (500 N axial, with tangential displacement to induce shear forces). After impact, the patellae were returned to culture for 0, 3, 7, or 14 days. At the appropriate time point, RNA was extracted from full-thickness cartilage slices at the impact site. Quantitative real-time PCR was used to evaluate differential gene expression for 18 OA related genes from four categories: cartilage matrix, degradative enzymes and inhibitors, inflammatory response and signaling, and cell apoptosis. The shear impacted specimens were compared to the axial impacted specimens and showed that shear specimens more highly expressed type I collagen (Col1a1) at the early time points. In addition, there was generally elevated expression of degradative enzymes, inflammatory response genes, and apoptosis markers at the early time points. These changes suggest that the more physiologically relevant shear loading may initially be more damaging to the cartilage and induces more repair efforts after loading. PMID:25478225

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

    NASA Technical Reports Server (NTRS)

    Finck, A.

    1982-01-01

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

  5. Arthritis in a Glyptodont (Mammalia, Xenarthra, Cingulata)

    PubMed Central

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

    2014-01-01

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

  6. 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

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

    SciTech Connect

    Lesser, M.P.; Stochaj, W.R. )

    1990-06-01

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

  8. Patellofemoral pain: Challenging current practice - A case report.

    PubMed

    Smith, Benjamin E; Hendrick, Paul; Logan, Pip

    2016-04-01

    Patellofemoral pain (PFP) is a common problem in young people, with 1 in 6 suffering at any one time. It is unclear which management approach is the optimal method for treating PFP in the long term, with traditional physiotherapy examination focusing on assessing for specific structural dysfunction. A rationale for a different assessment and treatment approach, one that moves the focus away from a biomedical/tissue pathology model towards one directed at the neurophysiology of pain, has been suggested. The patient was a 21 year old male with a 6 year history of PFP with previous failed physiotherapeutic treatment. He reported previous multiple healthcare practitioners' advice to avoid activities that were painful as reasons for being unable to participate in sporting activities. No specific structural testing was performed, such as specific muscle strength, length, foot position, patella movement and position, or movement patterns. Descriptions of tissue based pathology models of pain, e.g. patella mal-tracking, were actively discouraged and challenged. The patient was taught to perform one uncomfortable/painful exercise as part of his rehabilitation programme twice a day. The patient achieved 80% improvement in his symptoms over 7 appointments and a return to physical activity following a 5 month rehabilitation programme purposively designed to elicit pain by means of gradually exercising and loading the tissues. This case report highlights the need for further research into exercise protocols for patients suffering with PFP based upon neurophysiology models of pain. PMID:26394748

  9. 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.

  10. Custom rotating-hinge total knee replacement in patients with spina bifida and severe neuromuscular dysfunction.

    PubMed

    Sewell, M D; Al-Hadithy, N; Hanna, S A; Al-Khateeb, H; Carrington, R W J; Blunn, G W; Skinner, J A; Briggs, T W R

    2012-09-01

    Spina bifida (SB) is a congenital disorder which may result in a number of musculoskeletal problems. Total knee replacement (TKR) in this patient group is technically demanding due to bone deformity, soft tissue contracture, muscle tone abnormality and ligament insufficiency. This is a retrospective review of three patients with SB and disabling knee arthritis who were managed with a custom rotating-hinge (RHK) total knee system. All patients reported an improvement in knee pain and stability at mean follow-up 47 months (43-53). Mean Oxford Knee score improved from 21 preoperatively to 32 at final follow-up. One patient required revision of tibial and patella components at 37 months for lateral patella instability and excessive wear. Custom RHK for patients with SB, severe neuromuscular dysfunction and bone deformity relieves pain, restores stability and improves early knee function; however there is a significant risk of extensor mechanism complications and functional outcome is worse than primary TKR in the general population. PMID:22718075

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

    PubMed Central

    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

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

    NASA Astrophysics Data System (ADS)

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

    2014-11-01

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

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

    PubMed

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

    2014-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2014-03-01

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

  15. Periprosthetic Fractures Following Total Knee Arthroplasty

    PubMed Central

    Kim, Nam Ki

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  17. Patellar Subluxation With Early-Phase Synovial Chondromatosis of the Knee.

    PubMed

    Bashaireh, Khaldoon M

    2016-01-01

    Primary synovial chondromatosis is a rare, benign, monoarticular disease process that affects the synovial membrane of the joint, the synovial sheath, or the bursa around the joint. The etiology is unknown, but it has been associated with trauma in some cases. Although it is a benign lesion, if left untreated, it may lead to early secondary osteoarthritis of the joint. The knee joint is affected in 50% to 65% of cases, followed by the elbow and the hip. This article reports a 30-year-old active woman who presented to the author's clinic with a large infrapatellar mass that caused lateral subluxation of the patella, swelling, and episodic pain with crepitations 14 months after direct trauma to the knee. Clinical examination, magnetic resonance imaging, and arthroscopy revealed a large infrapatellar mass causing lateral subluxation of the patella with no loose bodies. Hoffa's disease, para-articular osteochondroma, and early-phase synovial chondromatosis were considered in the differential diagnosis. The histopathologic and clinical features were consistent with early synovial chondromatosis. The patient underwent local excision of the mass through a medial parapatellar arthrotomy. At 5 years of follow-up, she had no recurrence of the lesion or progression of the disease. Early diagnosis of synovial chondromatosis with local excision offers a reliable cure. However, long-term follow-up is advised because of the high recurrence rates as well as the risk of metaplastic transformation. [Orthopedics. 2016; 39(1):e176-e179.]. PMID:26726983

  18. Comparative anatomical measurements of osseous structures in the ovine and human knee.

    PubMed

    Osterhoff, Georg; Löffler, Sabine; Steinke, Hanno; Feja, Christine; Josten, Christoph; Hepp, Pierre

    2011-03-01

    The ovine stifle has been increasingly used as a large animal model for the human knee. Still, comparative anatomical measurements of the knee in sheep and humans are missing. Thus, the purpose of this study was to describe and measure the osseous anatomy of the ovine stifle in comparison to the human knee. Twenty-four stifles of skeletal-mature merino-sheep and 24 human cadaver knees were obtained and distances between selected anatomical structures of the distal femur, the proximal tibia, and the patella were measured digitally and documented. Based on these, intercondylar ratio, tibial aspect ratio, patella aspect ratio and the cortical index were calculated. Regarding epicondylar width, lateral condylar width, medial condylar width and the tibial dimensions, the ovine stifle can be considered as a human knee scaled down by one third. However, sheep have a smaller trochlear width and a narrower femoral intercondylar notch than humans resulting in lower relative values for intercondylar width and intercondylar height. The distal femur's cortical index is the same in both species. In contrast, sheep have a massive bone stock below their tibial plateau and a proximal tibial shaft with remarkably thick cortical bone. The ovine stifle can be regarded as a useful model for the human knee. However, future studies should consider the differences in the femoral intercondylar notch width, the patellofemoral joint's biomechanics and the proximal tibia's cortical bone stock. PMID:20188573

  19. Conservative management of patellofemoral dysfunction.

    PubMed

    Shelton, G L

    1992-06-01

    Treating PFD starts with a thorough evaluation so that an accurate diagnosis can be made and a specific treatment plan established. A standardized, cookbook treatment approach can be avoided by adapting each rehabilitation program to the patient's specific needs without creating additional symptoms. Although many different strengthening modes have been used over the years, current trends are oriented less toward strength of the quadriceps and VMO and more toward improving VMO control of the patella. Functional strengthening modes are replacing more traditional methods. Improved lateral retinacular mobility and muscular flexibility enhance tracking of the patella and this in turn is facilitory to the VMO. Patient awareness of symptoms throughout the rehabilitation process helps avoid inappropriate activities. Although the therapeutic exercise components are of primary importance, other adjunct treatments may also be helpful. Medication and icing may facilitate better VMO activity by controlling inflammation. Patellar taping assists patellar tracking, which provides for better patellofemoral stability and reduced mechanical stress. While EMS may provide some strengthening effect to weakened musculature, BFB provides the patient with a way to monitor and enhance their own exercise efforts and improve motor learning for functional activities. Education of the patient to the etiology, biomechanics, treatment, and prevention of PFD enhances the short-term acquisition of rehabilitation skills, long-term patterns of motor control, and provides a lasting knowledge base with which the patient can functionally progress with minimum symptoms. PMID:1609008

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

    PubMed Central

    Balcarek, Peter; Oberthür, Swantje; Frosch, Stephan; Schüttrumpf, Jan Philipp; Stürmer, Klaus Michael

    2014-01-01

    The morphology of the vastus medialis obliquus (VMO) muscle in the anatomical setting of an unstable patella has not been described. Therefore, the purpose of this study was to investigate the morphological parameters of the VMO muscle that delineate its importance in the maintenance of patellofemoral joint stability. Eighty-two consecutive subjects were prospectively enrolled in this study. The groups were composed of thirty patients with an acute primary patellar dislocation, thirty patients with recurrent patellar dislocation, and twenty-two controls. Groups were adjusted according to sex, age, body mass index, and physical activity. Magnetic resonance imaging was used to measure the VMO cross-sectional area, muscle-fiber angulation, and the craniocaudal extent of the muscle in relation to the patella. No significant difference was found with respect to all measured VMO parameters between primary dislocation, recurrent dislocation, and control subjects with a trend noted for only the VMO cross-sectional area and the VMO muscle-fiber angulation. This finding is notable in that atrophy of the VMO has often been suggested to play an important role in the pathophysiology of an unstable patellofemoral joint. PMID:24868524

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

    PubMed

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

    1991-04-01

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

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

    PubMed Central

    2011-01-01

    Background A retrospective study concerning patients presenting with patella instability, treated using a Roux-Elmslie-Trillat reconstruction operation and followed up for 10 years following surgery, is presented. Methods Pre-operative and follow-up radiographic evaluation included the weight-bearing anteroposterior and merchant views. Evaluation was carried out using the Insall-Salvati index, sulcus and congruence angle. The Roux-Elmslie-Trillat reconstruction operation was performed on 18 patients. The clinical evaluation at follow-up was performed using the Knee-Society-Score (KSS) and Tegner-Score. Results Subjective results of the operation were classed as excellent or good in 16 of the 18 patients ten years after surgery; persistent instability of the patella was recorded in only one of the 18 patients. The majority of patients returned to the same level of sporting activity after surgery as they had participated in before injury. Conclusions The Roux-Elmslie-Trillat procedure could be recommended in cases presenting with an increased q-angle, trochlea dysplasia or failed soft tissue surgery. In the present study the majority of patients report a return to previous sporting activity ten years after surgery. PMID:21329530

  3. [Comparative study of echography and conventional radiology in the evaluation of the Insall-Salvati index].

    PubMed

    Martino, F; Ettorre, G C; Macarini, L; Tritto, D; Patella, V; Moretti, B; Pesce, V

    1992-12-01

    For the study of painful patello-femoral syndromes, the authors suggest the use of US for the evaluation of the so-called Insall-Salvati ratio--i.e., length of patellar ligament/patellar length--whose alteration is suggestive of vertical patello-femoral malalignement (patella alta and patella infera). Ten normal volunteers (20 knees) were examined by means of both US and conventional radiology, and the Insall-Salvati ratio was calculated for each knee. US and radiologic measurements were statistically compared by the correlation-coefficient method: the result was 0.802. US measurements were repeated twice with 0.778 interobserver variability according to the Spearman correlation index. Based on their results, the authors conclude that, in the evaluation of the Insall-Salvati ratio, the diagnostic accuracy of US is almost the same as that of conventional radiology; the former method may even be preferred for it is a simple, quick and repeatable technique not needing ionizing radiations. PMID:1494674

  4. Impact of a phosphate fertilizer plant on the contamination of marine biota by heavy elements.

    PubMed

    Aoun, Maria; Arnaudguilhem, Carine; El Samad, Omar; Khozam, Rola Bou; Lobinski, Ryszard

    2015-10-01

    Due to their toxicity, persistence, and bioaccumulation, metals are important marine environment pollutants, especially in low renewal rate water such as the Mediterranean Sea, receiving a lot of untreated industrial waste. The impact of a phosphate fertilizer plant on the marine biota metal contamination was studied. Several types of organisms: crabs, mussels, patella and fish were collected from two areas of the Lebanese coast, one subjected to the impact of the plant and another away from it; samples were analyzed for Zn, U, Cr, V, Mn, Ni, Co, Cu, As, Cd and Pb by ICP-MS. Higher accumulation was in crabs, patella, and mussels. Fish accumulated principally Zn, Cu, and Cd; a difference was observed between species and tissues. Cytosol metal fractionation using size-exclusion LC-ICP-MS showed principally Pb, As, Co, and Mn in the low molecular weight fraction (<1.8 Da); Cd, Zn, and Cu in the metallothionein fraction (1.8--18 k Da), and Ni in high molecular weight fraction (>20 kDa). PMID:26002362

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

    PubMed

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

    2014-01-01

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

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

    PubMed Central

    Moore, A.; Burris, D.L.

    2013-01-01

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

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

    PubMed

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

    1998-09-01

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

  8. [Two siblings with bilateral congenital knee dislocations: case report].

    PubMed

    Kubinec, V; Polakovičová, L; Kantarská, D

    2015-01-01

    Congenital dislocation of the knee and congenital permanent dislocation of the patella are rare disorders usually associated with complex syndromes. Two cases of siblings, girl and boy, who had the same clinical phenotype of this disorder are presented. The diagnosis of Desbuquois dysplasia was made and its autosomal recessive heredity was confirmed by genetic analysis. DNA samples were sent for a molecular genetic analysis of the skeletal dysplasia. The girl was surgically treated for a complete (grade 3) anterior dislocation of the tibia on the femur in the first year of life. Redressing casts had not previously been applied to avoid the risk of damaging the epiphysis. The left knee was operated on by the method, as described by Curtis and Fisher, at the age of six months. The Kirschner wire was removed after one month and a plaster cast was applied to maintain the flexion required. At seven post-operative weeks physiotherapy was started with temporary use of a knee brace. The right knee was managed by a similar procedure at four months after the first surgery. Normal walking was achieved at the age of 21 months. Knee motion was symmetrically restricted, with 5 to 90 degrees of flexion. The boy was first seen at our out-patient department after his sister had achieved full walking ability. He was 10 years old at that time and presented with walking problems due to nearly 30 degrees of bilateral knee contractures. Permanent dislocation of both patellae was treated by the surgical technique described by Stanisavljevic. Revision surgery of the right knee due to patellar lateralization was required two years after the primary surgery; it was performed using the Campbell's technique. A corrective osteotomy of the left proximal tibia because of progressive genu valgum was carried out at four years following the first operation. At the last follow-up, the boy was 16 years old and the knee range of motion bilaterally was 0 to 120 degrees with good alignment of both knees. As a result of surgical treatment the two patients gained ability to walk without problems. Key words: bilateral congenital knee dislocation, patella, Desbuquois dysplasia, siblings, skeletal dysplasia, case report. PMID:26317189

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

    NASA Astrophysics Data System (ADS)

    Lodwick, Camille J.

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

  10. [Posterior knee instability].

    PubMed

    Hoffman, F

    2004-01-01

    Due to improved diagnostic methods, posterior knee instabilities are detected more often. Up to now, however, the natural history of isolated ruptures of the posterior cruciate ligament is not known exactly. After conservative treatment, the first degenerative changes occur after about 10-15 years, mainly in the femoropatellar joint and the medial compartment. In complex posterior instabilities with lesions of the secondary stabilizers, the posterolateral structures, the lateral collateral ligament, and the leg alignment play an important role. Conservative or operative treatment of posterior knee instabilities depends on the extent of the lesion, the violated structures, and the impairment of the patient. For replacement of the posterior cruciate ligament, grafts from the patella ligament, the quadriceps tendon, and the hamstrings are used most frequently. In simultaneous lesions of the posterolateral corner of the knee joint, additional ligament-stabilizing methods are necessary. PMID:14994754

  11. Ultrasound Backscattering Is Anisotropic in Bovine Articular Cartilage.

    PubMed

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

    2015-07-01

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

  12. A new species of scorpion of the genus Neoscorpiops Vachon, 1980 (Scorpiones: Euscorpiidae) from India.

    PubMed

    Mirza, Zeeshan Ayaz; Sanap, Rajesh V; Upadhye, Raman

    2014-02-01

    A new species of scorpion of the genus Neoscorpiops Vachon, 1980 is described from Northern Maharashtra. Neoscorpiops maharashtraensis sp. nov. is a medium-sized scorpion species ranging from 36 to 42mm. Carapace, mesosoma and metasoma brown, legs and telson yellow; pedipalp in a shade of brown with carinae dark drown to black. Granulation on carapace coarse, with a few smooth patches; on mesosoma, which is restricted to the posterior half. Anterior margin of carapace with a moderately deep "U"-shaped emargination medially lacking elevated edges. Pectines well developed 7/7. Trichobothria on patella ventral 13-16. Pedipalp chela narrow and elongate in males, length-to-width ratio in males is 4.86-5.05. PMID:24581809

  13. Massage Therapy Protocol for Post–Anterior Cruciate Ligament Reconstruction Patellofemoral Pain Syndrome: A Case Report

    PubMed Central

    Zalta, Jennifer

    2008-01-01

    Background: The intent of the present study was to determine the effectiveness of massage therapy in the rehabilitation of post–anterior cruciate ligament reconstruction patellofemoral pain syndrome. The primary complications following surgical repair of the anterior cruciate ligament—classified as patellofemoral pain syndrome—are hamstring flexion contracture and quadriceps weakness, leading to patellofemoral dysfunction and retropatellar pain. Methods: Treatment included lymphatic drainage, myofascial release, neuromuscular techniques including trigger point release, muscle energy techniques and cross-fiber friction. Orthopedic physical assessment tests were used to chart changes in patellofemoral function and changes in range of motion in the knee during the course of the massage interventions. Subjective reporting on pain level and function were also documented. Results: A decrease in pain level, hamstring flexion contracture and lateral tracking of the patella were documented. Conclusion: Massage therapy was determined to be an effective complementary therapy in the treatment of patellofemoral pain syndrome. PMID:21589717

  14. Laryngeal squamous cell carcinoma with knee and heel skin metastases: a case report.

    PubMed

    Kavgaci, Halil; Yildiz, Bulent; Cobanoglu, Umit; Fidan, Evren; Ozdemir, Feyyaz; Aydin, Fazil

    2010-01-01

    Distant metastases from laryngeal carcinoma are frequently seen in the lung, bone and liver, while skin metastases are rarely observed. In these cases presented as case reports in the literature, the supradiaphragmatic region is usually involved. Skin metastasis in lower extremity has only been reported in a few cases. While being an indicator of poor prognosis, skin metastasis is also considered as a messenger of distant organ metastasis. Survival is very short after development of skin metastasis. In our case, nodular skin metastasis was found both in the superior-lateral margin of the left patella and in the right heel. This is the first case reported in the literature on laryngeal carcinoma metastasizing to these localizations. PMID:20361886

  15. Bilateral patellar tendon rupture associated with statin use

    PubMed Central

    Kearns, Marie C.; Singh, Vinay K.

    2016-01-01

    Patellar tendon rupture is an uncommon clinical presentation, which generally affects the under 40s who are active in sport. Bilateral rupture of both tendons is much rarer. It occurs most frequently in patients with predisposing factors such as corticosteroid use or systemic diseases. The authors present the case of a 56-year-old male on long-term statin therapy who sustained this injury following a fall on ice. He had no known risk factors for tendon rupture. Surgical treatment involved tendon repair using Krakow suture via bony tunnels in the patella. Statins have previously been associated with tendon ruptures at other sites but there have been no published cases of bilateral patellar tendon rupture linked to statin use. We review the literature regarding the association between statins and tendon rupture. PMID:27165749

  16. Cam Femoroacetabular Impingement as a Possible Explanation of Recalcitrant Anterior Knee Pain

    PubMed Central

    Sanchis-Alfonso, Vicente; Tey, Marc; Monllau, Joan Carles

    2016-01-01

    We present a case of a patient with chronic anterior knee pain (AKP) recalcitrant to conservative treatment who returned to our office for severe hip pain secondary to Cam femoroacetabular impingement (Cam FAI) at 10 months after the onset of knee pain. This case highlights the fact that the main problem is not in the patella but in the hip in some patients with AKP. We hypothesize that there is an external femoral rotation in order to avoid the impingement and therefore the hip pain in patients with Cam FAI. This functional femoral rotation could provoke a patellofemoral imbalance that may be, in theory, responsible for patellofemoral pain in this particular patient. In our case, Cam FAI resolution was related to the resolution of AKP.

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

    PubMed

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

    2015-06-01

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

  18. Gravity Reception and Cardiac Function in the Spider

    NASA Technical Reports Server (NTRS)

    Finck, A.

    1985-01-01

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

  19. First evidence of a Late Upper Palaeolithic human presence in Ireland

    NASA Astrophysics Data System (ADS)

    Dowd, Marion; Carden, Ruth F.

    2016-05-01

    The colonisation of North West Europe by humans and fauna following the Last Glacial Maximum (LGM) has been the subject of considerable discussion in recent decades and within multiple disciplines. Here we present new evidence that pushes back the date of human footfall in Ireland by up to 2500 cal BP to the Upper Palaeolithic. An assemblage of animal bones recovered from a cave in the west of Ireland during antiquarian excavations in 1903 included a butchered brown bear bone (patella) which was recently subjected to two independent radiocarbon dating processes; the resultant dates were in agreement: 12,810-12,590 cal BP and 12,810-12,685 cal BP. This find rewrites the antiquity of human occupation of Ireland and challenges the traditional paradigm that certain biota may have naturally colonised the island prior to human arrival.

  20. Is the Patellar Pubic Percussion Test useful to diagnose only femur fractures or something else? Two case reports.

    PubMed

    Segat, M; Casonato, O; Margelli, M; Pillon, S

    2016-02-01

    In the literature, the utility of the Patellar Pubic Percussion Test (PPPT) to diagnose occult fractures of the femur is well described. However, up to now there are no studies demonstrating the efficacy of this test in recognizing fractures of the pelvis. In this two case report a positive PPPT allowed the therapist to recognize clinical conditions requiring caution, protecting patients from a potentially unsuitable treatment. Both patients had a negative pelvis and femur x-ray after a fall, but the clinical findings and a positive PPPT lead the physiotherapist to suggest further examinations. In these two cases the PPPT seemed to be a useful diagnostic tool to identify periacetabular, ileo-pubic and ischio-pubic ramus fractures. These findings suggest that PPPT could be positive even for a bone lesion in any of the transit points of the vibration, from the patella to the pubic symphysis. PMID:26403611

  1. Development and validation of a multi-body model of the canine stifle joint.

    PubMed

    Stylianou, Antonis P; Guess, Trent M; Cook, James L

    2014-01-01

    Multi-body musculoskeletal models that can be used concurrently to predict joint contact pressures and muscle forces would be extremely valuable in studying the mechanics of joint injury. The purpose of this study was to develop an anatomically correct canine stifle joint model and validate it against experimental data. A cadaver pelvic limb from one adult dog was used in this study. The femoral head was subjected to axial motion in a mechanical tester. Kinematic and force data were used to validate the computational model. The maximum RMS error between the predicted and measured kinematics during the complete testing cycle was 11.9 mm translational motion between the tibia and the femur and 4.3° rotation between patella and femur. This model is the first step in the development of a musculoskeletal model of the hind limb with anatomically correct joints to study cartilage loading under dynamic conditions. PMID:22594487

  2. [Testing the usefulness of a provisional polyester prosthesis for augmentation in reconstructive operations of knee joint ligaments].

    PubMed

    Urban, J; Rutowski, R; Staniszewska-Kuś, J

    2000-01-01

    Prosthesis from polyester fibres 5 mm wide with loose knitting finished on both ends with teflon handles for fixing bones with a wholly aphid screw made by Tricomed company in Lódź according to its own idea was the subject of the test. The tests were made on 7 piglets. The prosthesis together with an autogenic graft taken from the middle third of a patella ligaments was implanted into the place of the excised front sacral ligament. The implanted prosthesis was characterised with a high biocompatibility, satisfying mechanical resistance and easiness of fixing of the tested graft. We noticed clinically and pertaining to autopsy the possibility of removing the allogenic graft after achieving the full healing of the autogenic graft without the possibility of hurting that last one. PMID:11064885

  3. Divergent transcriptional activities determine limb identity.

    PubMed

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

    2010-01-01

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

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

    PubMed

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

    2014-01-01

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

  5. Determination of menthol and menthol glucuronide in human urine by gas chromatography using an enzyme-sensitive internal standard and flame ionization detection.

    PubMed

    Kaffenberger, R M; Doyle, M J

    1990-04-27

    The rate of peppermint oil absorption and excretion, following peroral administration, was determined by measuring urinary levels of menthol glucuronide. Menthol, a major component of peppermint oil, was liberated from its glucuronide metabolite by treating raw urine with beta-D-glucuronidase (Patella vulgata). Phenyl glucuronide was employed as an enzyme-sensitive internal standard. Menthol and phenol were recovered by ethyl acetate extraction and quantitated by capillary gas chromatography using flame ionization detection. Standard curves were linear between 25 and 250 micrograms/ml with a detection limit (signal-to-noise ratio = 2) of 0.25 microgram/ml. Assay precision was shown to be +/- 1.2% relative standard deviation. PMID:2365793

  6. In-game Management of Common Joint Dislocations

    PubMed Central

    Skelley, Nathan W.; McCormick, Jeremy J.; Smith, Matthew V.

    2014-01-01

    Context: Sideline management of sports-related joint dislocations often places the treating medical professional in a challenging position. These injuries frequently require prompt evaluation, diagnosis, reduction, and postreduction management before they can be evaluated at a medical facility. Our objective is to review the mechanism, evaluation, reduction, and postreduction management of sports-related dislocations to the shoulder, elbow, finger, knee, patella, and ankle joints. Evidence Acquisition: A literature review was performed using the PubMed database to evaluate previous and current publications focused on joint dislocations. This review focused on articles published between 1980 and 2013. Study Design: Clinical review. Level of Evidence: Level 4. Results: The clinician should weigh the benefits and risks of on-field reduction based on their knowledge of the injury and the presence of associated injuries. Conclusion: When properly evaluated and diagnosed, most sports-related dislocations can be reduced and initially managed at the game. PMID:24790695

  7. Surgical management of acute quadriceps tendon rupture (a case report with literature review)

    PubMed Central

    Ennaciri, Badr; Montbarbon, Eric; Beaudouin, Emmanuel

    2015-01-01

    Quadriceps tendon rupture is uncommon and often overlooked in emergency. Tearing affects weakening tendon by systemic diseases or some medications. The mechanism is generally indirect. Inability to actively extend the knee associated to a supra-patellar defect evoke easily the diagnosis without other investigations. Surgical repair is realized in emergency to completely restore the extension. We report a case of a patient who has sustained of complete quadriceps tendon tear after a long period of tendon weakening by statin therapy, hypertension and diabetes. The repair has consisted on end-to-end Krackow sutures associated with bone suture to the proximal pole of the patella. Surgeons and emergency physicians must think to this form of extensor apparatus rupture, because early diagnosis leads to early treatment and to best outcomes.

  8. Dynamic simulation of tibial tuberosity realignment: model evaluation.

    PubMed

    Purevsuren, Tserenchimed; Elias, John J; Kim, Kyungsoo; Kim, Yoon Hyuk

    2015-01-01

    This study was performed to evaluate a dynamic multibody model developed to characterize the influence of tibial tuberosity realignment procedures on patellofemoral motion and loading. Computational models were created to represent four knees previously tested at 40°, 60°, and 80° of flexion with the tibial tuberosity in a lateral, medial and anteromedial positions. The experimentally loaded muscles, major ligaments of the knee, and patellar tendon were represented. A repeated measures ANOVA with post-hoc testing was performed at each flexion angle to compare data between the three positions of the tibial tuberosity. Significant experimental trends for decreased patella flexion due to tuberosity anteriorization and a decrease in the lateral contact force due to tuberosity medialization were reproduced computationally. The dynamic multibody modeling technique will allow simulation of function for symptomatic knees to identify optimal surgical treatment methods based on parameters related to knee pathology and pre-operative kinematics. PMID:25025488

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

    PubMed

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

    2011-04-01

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

  10. Bilateral Proximal Tibial Sleeve Fractures in a Child: A Case Report

    PubMed Central

    Williams, Daniel; Kahane, Steven; Chou, Daud; Vemulapalli, Krishna

    2015-01-01

    Introduction: A sleeve fracture classically describes an avulsion of cartilage or periosteum with or without osseous fragments and usually occurs at the inferior margin of the patella. Tibial tubercle sleeve fractures in the skeletally immature are extremely rare. Case Presentation: In this report the authors describe a 12-year-old boy with no systemic disease and no steroid use who sustained bilateral proximal tibial sleeve fractures whilst playing football. Both ruptures were associated with rupture of the medial patellofemoral ligament and tear of the medial retinaculum. Treatment was performed with primary end-to-end repair, reinforcement with bone anchors and cerclage wires with an excellent outcome. Conclusions: We feel this rare, currently unclassified variant of a tibial tubercle avulsion fracture should be recognised and consideration taken to adding it to existing classification systems. PMID:26566509

  11. Advances in pain management: game changers in knee arthroplasty.

    PubMed

    Berend, M E; Berend, K R; Lombardi, A V

    2014-11-01

    Over the past 30 years there have been many improvements in implant fixation, correction of deformity, improved polyethylene wear, and survival after knee replacement. The work over the last decade has focused on less invasive surgical techniques, multimodal pain management protocols, more rapid functional recovery and reduced length of stay, aiming to minimise the side effects of treatment while maintaining function and implant durability. When combined and standardised these pre-, intra- and post-operative factors have now facilitated outpatient knee replacement procedures for unicompartmental replacement, patella femoral arthroplasty and total knee replacement (TKR). We have found liposomal bupivacaine, with potential for longer therapeutic action, to be a helpful adjunct and describe our current pain management program. The next step in our multimodal program is to improve the duration of patient satisfaction and reduce cost and length of stay after TKR. PMID:25381400

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

    NASA Astrophysics Data System (ADS)

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

    2015-02-01

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

  13. RELATIONSHIP BETWEEN PATELLAR HEIGHT AND RANGE OF MOTION AFTER TOTAL KNEE ARTHROPLASTY

    PubMed Central

    Júnior, Lúcio Honório de Carvalho; Soares, Luiz Fernando Machado; Gonçalves, Matheus Braga Jacques; Pereira, Marcelo Lobo; Lessa, Rodrigo Rosa; Costa, Lincoln Paiva

    2015-01-01

    To evaluate whether, after total knee arthroplasty, there is any correlation between patellar height and range of motion (ROM) achieved by patients six months after the operation. Methods: Forty-five patients who underwent total knee arthroplasty were assessed at least 12 months after the operation (total of 54 knees). The maximum and minimum ROM of all the knees was recorded under fluoroscopy, along with patellar height according to the Blackburne and Peel ratio. Two possible correlations were evaluated: patellar height and ROM; and patellar height and ROM variation from before to after the operation. Results: A correlation was found between patellar height and postoperative ROM (p = 0.04). There was no correlation between patellar height and ROM variation (p = 0.182). Conclusion: After total knee arthroplasty, the lower the patella is, the worse the ROM is.

  14. Chondral Injury in Patellofemoral Instability

    PubMed Central

    Lustig, Sébastien; Servien, Elvire; Neyret, Philippe

    2014-01-01

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

  15. Identification of

    PubMed

    Helfrich; Ross; King; Turner; Larkum

    1999-03-01

    [8-vinyl]-Protochlorophyllide a1 was isolated from a Prochloron sp. associated with the host ascidian, Lissoclinum patella. To obtain sufficient amounts for identification of the purified pigment, suitable extraction procedures and HPLC systems were developed. The structure was finally elucidated by UV-VIS and fluorescence spectroscopy, mass spectrometry and NMR (rotating-frame Overhauser enhancement spectroscopy). [8-vinyl]-Protochlorophyllide a was originally detected only as an intermediate in chlorophyll biosynthesis. Although its presence as a light-harvesting pigment was previously suggested in some prochlorophytes and eukaryotic algae, this is the first unequivocal demonstration of [8-vinyl]-protochlorophyllide a in an oxygenic phototroph. We also show that [8-vinyl]-protochlorophyllide a occurs in Prochloron species of four other ascidians as well as in Micromonas pusilla and Prochlorococcus marinus. The possible role of this pigment in photosynthesis is discussed. PMID:10082792

  16. Answer to last month's radiology case and image: Bilateral patellar tendon rupture.

    PubMed

    Riojas, Ramon A; Folio, Les

    2009-07-01

    Patellar tendon rupture is a rare occurrence usually associated with chronic degeneration within the tendon, systemic illness, and fluoroquinolone therapy as mentioned previously. However in healthy adults, overweight men in their 3rd or 4th decade of life may be at increased risk when partaking in athletic activities, especially jumping activities. Patella alta is a key finding on physical exam and on radiographs as was evident in our case. Imaging can also be performed with ultrasound and MRI to confirm tendon rupture and rule out other concurrent injuries. Prompt surgical management and early rehabilitation are key to regaining normal function of the extensor mechanism. Preventive medicine education may be important for those at increased risk of injury. PMID:19685852

  17. Successful conservative management of symptomatic bilateral dorsal patellar defects presenting with cartilage involvement and bone marrow edema: MRI findings.

    PubMed

    Kwee, Thomas C; Sonneveld, Heleen; Nix, Maarten

    2016-05-01

    The dorsal patellar defect is a relatively rare entity that involves the superolateral quadrant of the patella. It is usually considered to represent a delayed ossification process, although its exact origin remains unclear. Because of its usually innocuous nature and clinical course, invasive interventions are generally deemed unnecessary, although curretage has been successfully performed on symptomatic cases. This case report presents a rather unusual case of symptomatic bilateral dorsal patellar defects with cartilage involvement and widespread surrounding bone marrow edema as demonstrated by magnetic resonance imaging (MRI). Both cartilage involvement and bone marrow edema should be considered part of the spectrum of associated MRI findings that can be encountered in this entity. Furthermore, the presented case shows that symptomatic dorsal patellar defects can be treated conservatively with success and that (decrease of) pain symptoms are likely related to (decrease of) bone marrow edema. PMID:26810333

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

    PubMed Central

    Lee, Sung-Eun; Cho, Sung-Hyoun

    2013-01-01

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

  19. Synchronous quadriceps tendon rupture and unilateral ACL tear in a weightlifter, associated with anabolic steroid use.

    PubMed

    Fenelon, Christopher; Dalton, David M; Galbraith, John G; Masterson, Eric L

    2016-01-01

    Synchronous quadriceps tendon rupture is rare. A 29-year-old man, an amateur weight lifter, taking androgenic-anabolic steroids (AAS), developed sudden onset bilateral pain and swelling of his anterior thighs when attempting to squat 280 kg (620 lb). Examination revealed gross swelling superior to the patella and palpable gaps in both quadriceps tendons. He underwent successful operative repair. MRI revealed a partial tear of the anterior cruciate ligament (ACL) of the right knee. This was not reconstructed. Only a few case reports of the association between AAS and quadriceps rupture exist in the literature, with none to the best of our knowledge in the past 10 years. ACL rupture coexisting is very rare, with only two reported cases. PMID:27154985

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

    PubMed Central

    Haupert, Alexander; Lorbach, Olaf

    2015-01-01

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

  1. [Diagnosis and treatment of patellar chondroblastoma].

    PubMed

    Cheng, Qiang; Huang, Wei

    2013-12-01

    Chondroblastoma of the patella, rare occurred in patellar,is a kind of an uncommon benign bone tumor. Compared with giant cell tumor, the morbidity of chondroblastoma is lower. Meanwhile, its clinical manifestations are various, and images are very complicated. Therefore, the understanding of this kind of tumors may be limited even to the orthopedist. The differences of patellar chondroblastoma between other tumor in X-ray, CT and MRI is a spot in recent years. Sometimes patellar chondroblastoma coexists with aneurysmal bone cyst, which is a challenge to obtain an accurate pathological and radiological diagnosis. For the treatment, curettage and bone grafting is one the most popular method, but whether to perform a biopsy before surgery still remain controversy. Some new technique still has an unknown prospect for the treatment such as radiofrequency ablation. PMID:24654528

  2. Report of prochloron research, IPE-7 (Palau, February 1982)

    NASA Technical Reports Server (NTRS)

    Lewin, R. A.; Cheng, L.

    1983-01-01

    Various aspects of Prochloron research are discussed. At suitable low-tide periods about 5-6 new sites were surveyed as possible convenient sources of symbiotic didemnids. The Kanori Channel site peviously surveyed during IPE-VI remains by far the best, in terms of species, quantities and accessibility. Prochloron from the six major species of symbiotic didemnids was compared serum, cell size and vacuolation, etc. Tadpoles from Lissoclinum patella colonies were observed emerging from cloacal apertures; about 400 were collected. All but 4 carried a girdle of symbiotic Prochloron cells (about 40,000 per larva). Observations were made on cell viability indicated that a marked increase in protoplasm viscosity of the cell contents was associated with cell death. Living cells, in 5 microlitres of buffered sea water under a coverslip, when pressed with a 2 kg weight for 10 seconds, attempts made to culture Prochloron in sea-water media.

  3. The difficult primary total knee arthroplasty: a review.

    PubMed

    Baldini, A; Castellani, L; Traverso, F; Balatri, A; Balato, G; Franceschini, V

    2015-10-01

    Primary total knee arthroplasty (TKA) is a reliable procedure with reproducible long-term results. Nevertheless, there are conditions related to the type of patient or local conditions of the knee that can make it a difficult procedure. The most common scenarios that make it difficult are discussed in this review. These include patients with many previous operations and incisions, and those with severe coronal deformities, genu recurvatum, a stiff knee, extra-articular deformities and those who have previously undergone osteotomy around the knee and those with chronic dislocation of the patella. Each condition is analysed according to the characteristics of the patient, the pre-operative planning and the reported outcomes. When approaching the difficult primary TKA surgeons should use a systematic approach, which begins with the review of the existing literature for each specific clinical situation. PMID:26430084

  4. Microcephaly, short stature, and developmental delay associated with a chemotactic defect and transient hypogammaglobulinaemia in two brothers.

    PubMed Central

    Say, B; Barber, N; Miller, G C; Grogg, S E

    1986-01-01

    Two brothers presented with unusual facial features, microcephaly, developmental delay, and severe postnatal growth retardation. They both developed eczema in infancy and have had recurrent infections. Additional physical findings in both boys included hypogonadism, flexion contractures, hypoplastic patellae, and scoliosis. Their facial similarity was striking with sloping foreheads, beaked noses, large, protruding ears, and micrognathia. Low levels of serum gammaglobulins and defective chemotaxis were present in both boys in infancy. The hypogammaglobulinaemia was transient and improved, reaching normal levels by 3 1/2 years and 15 months, respectively. Defective chemotaxis and recurrent infections have persisted to the present. Both parents were normal. The mode of inheritance was not clear, as both X linked and autosomal recessive patterns were possible. Although patients with congenital malformations who also had immunodeficiency have previously been reported, immune system abnormalities, especially those of a transient nature, may frequently go unrecognised. Images PMID:3746838

  5. Checklist and distribution of ciliates from the family Euplotidae Ehrenberg, 1838 (Protista: Ciliophora: Spirotrichea) in Slovakia, Central Europe.

    PubMed

    Tirjaková, Eva; Botlíková, Simona; Vďačný, Peter

    2015-01-01

    A checklist of ciliates from the family Euplotidae recorded in the territory of Slovakia, Central Europe was assembled. Altogether, 11 species belonging to three genera of the family Euplotidae have been reported there: Euplotes alatus, Euplotes charon, Euplotes moebiusi, Euplotoides aediculatus, Euplotoides eurystomus, Euplotoides patella, Euplotoides woodruffi, Euplotopsis affinis, Euplotopsis finki, Euplotopsis muscicola, and Euplotopsis novemcarinata. However, records of the marine species E. alatus and E. charon are doubtful and very likely represent misidentifications of E. moebiusi. Since the euryhaline species E. woodruffi was found for the first time in Slovakia, its morphology is described. Based on the literature data and our own observations, the present checklist is also accompanied with distribution data on the 11 aforementioned species. As concerns ecology, Slovak euplotids typically occurred in freshwater bodies having higher trophic levels. Only two species, E. finki and E. muscicola, were isolated from terrestrial habitats, especially, from mosses, leaf-litter, and decaying wood mass. PMID:25781253

  6. Bilateral patellar tendon rupture associated with statin use.

    PubMed

    Kearns, Marie C; Singh, Vinay K

    2016-01-01

    Patellar tendon rupture is an uncommon clinical presentation, which generally affects the under 40s who are active in sport. Bilateral rupture of both tendons is much rarer. It occurs most frequently in patients with predisposing factors such as corticosteroid use or systemic diseases. The authors present the case of a 56-year-old male on long-term statin therapy who sustained this injury following a fall on ice. He had no known risk factors for tendon rupture. Surgical treatment involved tendon repair using Krakow suture via bony tunnels in the patella. Statins have previously been associated with tendon ruptures at other sites but there have been no published cases of bilateral patellar tendon rupture linked to statin use. We review the literature regarding the association between statins and tendon rupture. PMID:27165749

  7. Extensor mechanism disruption after total knee arthroplasty.

    PubMed

    Bates, Michael D; Springer, Bryan D

    2015-02-01

    Extensor mechanism disruption is a rare and potentially devastating complication associated with total knee arthroplasty. Disruption can occur at the quadriceps or patellar tendons or, in the setting of a fracture, at the patella. Recognition of the risk factors for disruption and prevention via meticulous surgical technique are critical to avoid this complication. Various management techniques and the challenges associated with treatment have been described. Nonsurgical management consists of the use of walking aids and/or knee braces, which may not be acceptable for the active patient. Surgical options include primary repair and reconstructive techniques using allograft, autograft, synthetic material, and gastrocnemius rotational flaps. However, no single method has reliably demonstrated satisfactory outcomes. Although research on reconstructive procedures with synthetic materials has been promising, further study is need to assess the use of these materials. PMID:25624362

  8. Primary TKA with a zirconia ceramic femoral component.

    PubMed

    Bal, B Sonny; Greenberg, David D; Buhrmester, Luke; Aleto, Thomas J

    2006-04-01

    This article presents the 2-year clinical results of primary total knee arthroplasty (TKA) performed with a zirconia ceramic femoral component. A posterior-stabilized TKA was performed for degenerative arthritis in 36 patients (39 knees). The components included a zirconia femoral component, a cobalt-chrome alloy tibial baseplate, and a polyethylene patella; all were implanted with bone cement. The ultra-high molecular-weight polyethylene-bearing insert had a deep-dish, ultra-congruent design. At the 2-year interval, mean Western Ontario and McMaster Universities (WOMAC) osteoarthritis indices improved from 41 to 86, and mean Knee Society Scores improved from 40 to 92. Revision to constrained implants was necessary in one patient for persistent knee instability after trauma. These early results are encouraging, but more data are needed to determine whether ceramics are a suitable alternative to metal countersurfaces in TKAs. PMID:16642883

  9. The Prochloron symbiosis

    NASA Technical Reports Server (NTRS)

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

    1984-01-01

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

  10. Patellofemoral Dysfunction in Sports Trochleoplasty: Indications and Techniques.

    PubMed

    Ryzek, Don-Felix; Schöttle, Philip

    2015-08-01

    Patellofemoral instability (PFI) is a pathological knee syndrome that frequently affects young patients. The patellofemoral joint's structural morphology is the determining factor in the extent of PFI. Structural factors that play leading roles in patellofemoral stability can be classified into static (bone morphology), passive (ligamentous), and active (muscular). The predominant static factor leading to patella dislocation and thus patellofemoral dysfunction is trochlear dysplasia, which we focus on in this review. After orienting clinical examinations, MRI can provide the best information about trochlear dysplasia. This includes trochlear shape, orientation, and tibial tuberosity to trochlear groove distance. In convex trochleas or trochlea dysplasia with PFI at flexion over 30 degrees, we recommend performing a deepening trochleoplasty to correct for static pathomorphology. In this review, we will focus on the pathology of trochlea dysplasia, its role in PFI, the correct indication for trochleoplasty as a primary intervention, and the role of a simultaneous medial patellofemoral ligament reconstruction. PMID:25581230

  11. First-time patellar dislocation: surgery or conservative treatment?

    PubMed

    Sillanpää, Petri J; Mäenpää, Heikki M

    2012-09-01

    Primary patellar dislocation injures the medial patellofemoral ligament (MPFL), the major soft-tissue stabilizer of the patella, which may lead to recurrent patellar instability. Recurrent patellar dislocation are common and may require surgical intervention. The variation in location of injury of the MPFL and the presence of an osteochondral fracture produces challenges in clinical decision making between nonoperative and operative treatment, including the surgical modality, to repair or reconstruct the MPFL. Current evidence suggests that not all primary dislocations should undergo the same treatment. MPFL reconstruction may theoretically be more reliable than repair, but the optimal time to perform additional bony corrections is not known. A normal or minor dysplastic patellofemoral joint may be suitable for nonoperative treatment, whereas a higher grade of trochlear dysplasia or other significant abnormalities may benefit from surgical treatment. In this paper, we present a treatment algorithm for primary patellar dislocation. PMID:22878653

  12. I: Staging and Co-Morbidities

    PubMed Central

    Lattermann, Christian; Luckett, Matthew R

    2014-01-01

    Articular cartilage lesions of the distal femur and patella are common. In order to provide an accurate diagnosis of a clinically symptomatic cartilage lesion and subsequent appropriate planning for potential treatment options a proper staging is required. This includes clinical exam, radiographic imaging, and arthroscopy. Once the staging is completed other co-morbidities may need to be addressed that may require additional surgical procedures. These can either be planned as staged procedures of concomitantly with a cartilage repair procedure. This article will discuss this staging and evaluation process in depth in order to serve as a guideline to the orthopaedic surgeon engaged in the treatment of cartilage defects in patients with early posttraumatic osteoarthritis. PMID:22303751

  13. Endoscopy-Assisted Iliotibial Tract Harvesting for Skull Base Reconstruction: Feasibility on a Cadaveric Model

    PubMed Central

    Villaret, Andrea Bolzoni; Schreiber, Alberto; Battaglia, Paolo; Bignami, Maurizio

    2011-01-01

    During the last years, multiple methods and a wide set of materials for skull base reconstruction have been described. In our experience, the ideal graft for duraplasty is the iliotibial tract due to its favorable characteristics in terms of thickness, pliability, and strength. In this report, we show the iliotibial tract-harvesting technique under endoscopic guidance with a minimally invasive approach using a cadaveric model. Two longitudinal incisions of 1 cm each were made at 4 cm down a line drawn between the anterior-superior iliac spine and the lateral margin of patella at the extremities of the middle third of the thigh. By using a set of instruments for endoscopic face-lifting, the graft was easily set up and harvested. The endoscopic approach is associated with less visible scars, but longer operative time in comparison with open traditional procedure. The pros and cons in terms of morbidity need to be evaluated by further studies on actual cases. PMID:22451823

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

    PubMed

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

    2015-07-16

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

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

    PubMed

    Scott, Jeremiah E; Marean, Curtis W

    2009-09-01

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

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed Central

    Kwan, Jason C.; Schmidt, Eric W.

    2013-01-01

    Intracellular symbiosis is known to be widespread in insects, but there are few described examples in other types of host. These symbionts carry out useful activities such as synthesizing nutrients and conferring resistance against adverse events such as parasitism. Such symbionts persist through host speciation events, being passed down through vertical transmission. Due to various evolutionary forces, symbionts go through a process of genome reduction, eventually resulting in tiny genomes where only those genes essential to immediate survival and those beneficial to the host remain. In the marine environment, invertebrates such as tunicates are known to harbor complex microbiomes implicated in the production of natural products that are toxic and probably serve a defensive function. Here, we show that the intracellular symbiont Candidatus Endolissoclinum faulkneri is a long-standing symbiont of the tunicate Lissoclinum patella, that has persisted through cryptic speciation of the host. In contrast to the known examples of insect symbionts, which tend to be either relatively recent or ancient relationships, the genome of Ca. E. faulkneri has a very low coding density but very few recognizable pseudogenes. The almost complete degradation of intergenic regions and stable gene inventory of extant strains of Ca. E. faulkneri show that further degradation and deletion is happening very slowly. This is a novel stage of genome reduction and provides insight into how tiny genomes are formed. The ptz pathway, which produces the defensive patellazoles, is shown to date to before the divergence of Ca. E. faulkneri strains, reinforcing its importance in this symbiotic relationship. Lastly, as in insects we show that stable symbionts can be lost, as we describe an L. patella animal where Ca. E. faulkneri is displaced by a likely intracellular pathogen. Our results suggest that intracellular symbionts may be an important source of ecologically significant natural products in animals. PMID:24324632

  18. Quantifying the problem of kneeling after a two incision bone tendon bone arthroscopic anterior cruciate ligament reconstruction

    PubMed Central

    Riaz, Osman; Nisar, Sohail; Phillips, Hannah; Siddiqui, Asim

    2015-01-01

    Summary Introduction the aims of this study was to investigate the post-operative incidence of anterior knee pain and quantify the problem of kneeling in patients who have underwent anterior cruciate ligament (ACL) reconstruction with a bone tendon bone (BTB) graft. Methods prospective study of 71 male patients who participated in competitive sports and underwent BTB ACL reconstruction using a two incision approach between August 2008 and May 2011. The patella defect was packed with bone graft, and the peritenon was preserved and repaired. A questionnaire was used to evaluate pain and kneeling capability. All patients had pre and post operative Lysholm/Tegner scores, KT1000 evaluation and hop tests to assess knee stability and function. Results 71 patients were operated and had a follow up of 42 months, mean age 29.8. 22 patients had anterior knee pain on kneeling, paraesthesia of anterior knee was found in 23 patients. 65 patients were still able to kneel and 6 found they were unable. 36 were able to kneel for unrestricted periods, 9 for 5–15 minutes, 15 kneel for 1–5 minutes and 5 for >1 minute. Anterior knee pain was compared to kneeling time (P=0.001). Paraesthesia and kneeling time, (P=0.001). Anterior knee pain when compared with Lysholm score (P=0.540), hop test (P=0.277), and Lachman’s (P=0.254). Conclusions two incision BTB grafting of the patella and repair of the paritenon minimises the length of scar at the front of the knee. This reduces any palpable defects which could be causation factor for pain whilst kneeling. We have quantified kneeling and pain, thus aiding patients and surgeons in making the right decision for graft choice for ACL reconstruction. PMID:26605192

  19. Bilateral Variability of the Quadriceps Angle (Q angle) in an Adult Indian Population

    PubMed Central

    Raveendranath, Raveendranath; Nachiket, Shankar; Sujatha, Narayanan; Priya, Ranganath; Rema, Devi

    2011-01-01

    Objective(s) The objective of this study was to document and explain bilateral differences in the Q angle. Materials and Methods Two hundred limbs of healthy adult Indian volunteers were studied. The Q angle was measured using a goniometric method with the subjects supine, quadriceps relaxed and lower limbs in neutral rotation. The relative lateral placement of the tibial tuberosity with respect to the centre of the patella was measured. Appropriate statistical tests were used to determine the bilateral variability in the Q angle and the lateral placement of the tibial tuberosity. Inter-observer variation of the above mentioned parameters were studied in twenty limbs. Results The average Q angle value of all the 200 limbs was 12.73 °C; the mean value on the right was 12.86 °C and 12.60 °C on the left. When the Q angle and the lateral placement of the tibial tuberosity were considered in pairs a significant difference was noted in males. The Q angle value on the right side was more often greater than the left. The relative lateral placement of the tibial tuberosity showed a significant positive correlation with the Q angle. The intra-class correlation coefficient was 0.66 for the Q angle and 0.8 for the lateral placement of the tibial tuberosity. Conclusion The present study shows that bilateral variability in the Q angle could be attributed to an alteration of the relative placement of the tibial tuberosity with respect to the centre of the patella. PMID:23493777

  20. Influence of the Rotational Alignment of the Femoral and Patellar Components on Patellar Tilt in Total Knee Arthroplasty

    PubMed Central

    Yoo, Byeong-Wook; Kim, Chul-Woong

    2015-01-01

    Purpose The purpose of this study was to analyze the influence of rotational alignment of the femoral and patellar components on patellar tilt after total knee arthroplasty (TKA). Materials and Methods A total of 56 patients (76 knees) who underwent TKA using Advance Medial Pivot Knee system between May 2009 and April 2011 and were available for minimum 1-year follow-up were enrolled in this study. Whiteside's line and the transepicondylar line were used to determine the rotational alignment of the femoral component. Patella cut was aimed to be parallel to the anterior patellar cortex during surgery. Radiographic evaluation was performed using plain axial radiographs. The rotational alignment of the femoral component was measured as the angle between the anterior condylar axis and the surgical transepicondylar axis. The patellar resection angle was measured between the patellar resection axis and the anterior cortical line of the patella. Patellar tilt was evaluated to investigate the correlation with the rotation of the femoral component and patellar resection angle. Results The mean rotation of the femoral component was 0.42°±3.18° of internal rotation. The mean patellar resection angle was 1.82°±3.44°, indicating medial overresection. The mean patellar tilt was 6.12°±4.31° of lateral tilt. The rotational angle of the femoral component showed a negative correlation with patellar tilt in the linear regression analysis (p=0.749), but the patellar resection angle showed a positive correlation with patellar tilt (p<0.001). Conclusions Accurate patellar resection is recommended for proper patellar tracking in TKA. PMID:26389069

  1. Meier-Gorlin syndrome.

    PubMed

    de Munnik, Sonja A; Hoefsloot, Elisabeth H; Roukema, Jolt; Schoots, Jeroen; Knoers, Nine V A M; Brunner, Han G; Jackson, Andrew P; Bongers, Ernie M H F

    2015-01-01

    Meier-Gorlin syndrome (MGS) is a rare autosomal recessive primordial dwarfism disorder, characterized by microtia, patellar applasia/hypoplasia, and a proportionate short stature. Associated clinical features encompass feeding problems, congenital pulmonary emphysema, mammary hypoplasia in females and urogenital anomalies, such as cryptorchidism and hypoplastic labia minora and majora. Typical facial characteristics during childhood comprise a small mouth with full lips and micro-retrognathia. During ageing, a narrow, convex nose becomes more prominent. The diagnosis MGS should be considered in patients with at least two of the three features of the clinical triad of microtia, patellar anomalies, and pre- and postnatal growth retardation. In patients with short stature and/or microtia, the patellae should be assessed with care by ultrasonography before age 6 or radiography thereafter. Mutations in one of five genes (ORC1, ORC4, ORC6, CDT1, and CDC6) of the pre-replication complex, involved in DNA-replication, are detected in approximately 67-78% of patients with MGS. Patients with ORC1 and ORC4 mutations appear to have the most severe short stature and microcephaly. Management should be directed towards in-depth investigation, treatment and prevention of associated problems, such as growth retardation, feeding problems, hearing loss, luxating patellae, knee pain, gonarthrosis, and possible pulmonary complications due to congenital pulmonary emphysema with or without broncho- or laryngomalacia. Growth hormone treatment is ineffective in most patients with MGS, but may be effective in patients in whom growth continues to decrease after the first year of life (usually growth velocity normalizes after the first year) and with low levels of IGF1. At present, few data is available about reproduction of females with MGS, but the risk of premature labor might be increased. Here, we propose experience-based guidelines for the regular care and treatment of MGS patients. PMID:26381604

  2. Relationship between patellar tendon shortening and in vitro kinematics in the ovine stifle joint.

    PubMed

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

    2013-04-01

    Post-operative patellar tendon shortening induces a distal positioning of the patella in the femoral trochlear groove, which has been associated with pain and impeded mobility. An idealized in vitro model was used to examine the effects of shortening on patellar kinematics. The PT length was progressively reduced by up to 5 mm (1-mm instalments) using a device secured onto the tendon in n = 9 ovine stifles. In vitro 6 degrees-of-freedom motion data for the patellofemoral and tibiofemoral joints under conditions of passively induced flexion-extension was acquired electromagnetically. Patellar motion was analysed as a function of both tibial and patellar flexion angles relative to the femoral co-ordinate frame. Linear regression with contrasts was used to compare kinematic changes for each shortening level, with significance set at P<0.01. A mean maximum percentage length reduction of 8.2% was achieved. Patellar flexion was linearly correlated with tibial flexion angle in the intact joint, and this correlation persisted after tendon shortening (R = 0.977, P < 0.01). Patellar kinematics expressed as a function of tibial flexion angle were significantly altered by a mean length decrease of 8.2%, while flexion and proximo-distal shift patterns were significantly affected at lesser shortening levels of 3.1% and 4.7%, respectively. Patellar kinematics expressed as a function of patellar flexion angle remained unchanged. These results suggest that patellar motion within the trochlear groove in the ovine stifle joint follows a repeatable three-dimensional path and that patellar tendon shortening advances the position of the patella along this path, without significantly altering it. PMID:23637219

  3. [In vivo determination of patello-femoral separation and linear impulse forces].

    PubMed

    Komistek, R D; Dennis, D A; Mabe, J A

    1998-09-01

    Problems associated with the patellofemoral joint account for nearly half of all total knee arthroplasty (TKA) revisions. Under in vivo conditions, we previously determined that TKA subjects experience patellofemoral separation while performing dynamic, weight-bearing activities. This study investigates the impulse loading conditions that may exist at the time the patella impacts the femur during knee flexion. Fifty-seven subjects (68 knees) performed three successive deep knee bends under fluoroscopic surveillance. Eleven subjects (14 knees) had a posterior cruciate retaining (PCR) TKA, 19 subjects (25 knees) had a posterior cruciate substituting (PS) TKA, 15 subjects (17 knees) had a normal knee, and 12 subjects (12 knees) had an anterior cruciate ligament deficient (ACLD) knee. Velocities of each subjects' patella relative to a fixed point on the tibia were used as input to a mathematical model incorporating the impulse-momentum equation. At full extension, 12 of 14 PCR knees, 11 of 25 PS knees, 1 of 12 ACLD knees, and none of the 17 normal knees exhibited patellofemoral joint separation. The maximum separation, detected in a PCR knee, was 12 mm. The relative force determined upon patellofemoral impact was minimal (1.0 N). Simulated walking conditions for each subject were then entered into the mathematical model at a rate of 100 Hz and the calculated patellofemoral impact forces ranged from 78 N to 213 N. Since impulse loading conditions occur over a very small period of time, it was concluded that capturing fluoroscopy images at a rate of 30 Hz was too slow. Under simulated walking conditions, the impact forces due to impulse loading could contribute to polyethylene failure if these conditions induce fatigue of the polyethylene. PMID:9810576

  4. Femoropatellar radiographic alterations in cases of anterior cruciate ligament failure☆

    PubMed Central

    de Vasconcelos, Diego Protásio; de Paula Mozella, Alan; de Sousa Filho, Pedro Guilme Teixeira; Oliveira, Gustavo Cardilo; de Araújo Barros Cobra, Hugo Alexandre

    2015-01-01

    Objective To make a comparative analysis on three femoropatellar radiographic parameters, between knees with chronic failure of the anterior cruciate ligament (ACL) and normal knees. Methods Thirty volunteer patients with a diagnosis of unilateral isolated chronic ACL injury for more than one year and a normal contralateral knee were selected. Digital radiographs were produced for all the patients, on both knees in absolute lateral view at 30° of flexion, with and without load-bearing on one leg, and in axial view of the patella at 30°. The Caton–Deschamps patellar height index, Merchant patellar congruence angle and Laurin lateral patellar tilt angle were measured on the radiographs obtained from the normal knees and knees with ACL injuries, and comparative analysis was performed between these two groups. Results The patellar height was statistically significantly lower (p < 0.001) in the knees with ACL failure than in the normal knees, both on radiographs without loading and on those with single-foot loading. The Merchant patellar congruence angle was significantly smaller (p < 0.001) in the normal knees and the lateral patellar tilt angle was smaller (p < 0.001) in the knees with ACL failure. Conclusion Chronic ACL failure gave rise to a statistically significant change in the femoropatellar radiographic values studied (p < 0.001). Knees with injuries to this ligament presented lower patellar height values, greater tilt and lateral displacement of the patella, in relation to the femoral trochlea, in comparison with the normal contralateral knees. PMID:26229895

  5. MRI-based three-dimensional bone shape of the knee predicts onset of knee osteoarthritis: Data from the Osteoarthritis Initiative

    PubMed Central

    Neogi, Tuhina; Bowes, Michael; Niu, Jingbo; De Souza, Kevin; Vincent, Graham; Goggins, Joyce; Zhang, Yuqing; Felson, David T.

    2013-01-01

    Objective To examine whether MRI-based 3D bone shape predicts the onset of radiographic knee osteoarthritis (OA). Methods We conducted a case-control study within the Osteoarthritis Initiative by identifying knees that developed incident tibiofemoral radiographic knee OA (case knees) over follow-up, and matching them to two random control knees. Using knee MRI's, we used active appearance modeling of the femur, tibia and patella and linear discriminant analysis to identify vectors that best classified knees having OA vs. not. Vectors were scaled such that -1 and +1 represented the mean non-OA and mean OA shapes, respectively. We examined the relation of 3D bone shape to incident OA (new onset Kellgren and Lawrence (KL) grade ≥2) occurring 12 months later using conditional logistic regression. Results 178 case knees (incident OA) were matched to 353 control knees. The whole joint (i.e., tibia, femur, and patella) 3D bone shape vector had the strongest magnitude of effect, with knees in the highest tertile having 3.0 times higher likelihood of developing incident radiographic knee OA 12 months later compared with those in the lowest tertile (95% CI 1.8-5.0, p<0.0001). The associations were even stronger among knees that showed completely normal radiographs before incidence (KL grade 0) (OR 12.5, 95% CI 4.0-39.3). Bone shape at baseline, often several years before incidence, predicted later OA. Conclusions MRI-based 3D bone shape predicted the later onset of radiographic OA. Further study is warranted to determine whether such methods can detect treatment effects in trials and provide pathophysiologic insight into OA development. PMID:23650083

  6. The application of k-shell x-ray fluorescence to determine bone lead burden and its correlation with hypertension among African Americans in Gadsden County, Florida

    NASA Astrophysics Data System (ADS)

    Jackson-Edwards, Patrice

    Photons from k shell x-ray fluorescence illuminates lead atoms by measuring the characteristic x-rays which indicate the abundance of 210Pb present in a sample. The measurement utilizes a 109Cd source and a low-energy germanium detector, which has emerged as the best available technique for estimating cumulative exposure to lead in adults and for predicting lead-associated risks for adult chronic disease outcomes such as hypertension. The main focus of this study, was to show the correlation between bone lead concentration at the tibia (mean +/- standard deviation of 7+/-1 ppm) and patella (mean +/- standard deviation of 6+/-1 ppm) bone sites and hypertension (mean +/- standard deviation of the systolic standing 143+/-18mmHg, systolic sitting 140+/-17mmHg, diastolic standing 88+/-14 mmHg, and diastolic sitting 81+/-9 mmHg), among the 67 Gadsden County subjects that participated in this study. This was accomplished using FAMU's setup for the detector. The gamma rays emitted by the 109Cd source are scattered by atomic electrons in the k-shell. Excited electrons in the k-shell then spontaneously fluoresce at 88 keV as a signature of lead in the bone. The 88 keV photons are then detected at an angle of 180 degrees with respect to the incident x-ray direction and are detected by the Canberra Germanium solid-state detector bathed in liquid nitrogen. Results show that in this population all lead biomarkers (tibia lead, patella lead, and blood lead) were not significant contributors to the occurrence of hypertension. In the final logistic regression analysis, age and gender were predictors for the occurrence of hypertension at the p<0.05 level in the overall population. This study will help contribute to the understanding of the body's management of lead toxicity and to KXRF techniques currently used in physics research.

  7. In vivo patellar tracking induced by individual quadriceps components in individuals with patellofemoral pain

    PubMed Central

    Lin, Fang; Wilson, Nicole A.; Makhsous, Mohsen; Press, Joel M.; Koh, Jason L.; Nuber, Gordon W.; Zhang, Li-Qun

    2009-01-01

    Patellofemoral pain is a common knee disorders with a multi-factorial etiology related to abnormal patellar tracking. Our hypothesis was that the pattern of 3-dimensional rotation and translation of the patella induced by selective activation of individual quadriceps components would differ between subjects with patellofemoral pain and healthy subjects. Nine female subjects with patellofemoral pain and seven healthy female subjects underwent electrical stimulation to selectively activate individual quadriceps components (vastus medialis obliquus, VMO; vastus medialis lateralis, VML; vastus lateralis, VL) with the knee at 0° and 20° flexion, while three-dimensional patellar tracking was recorded. Normalized direction of rotation and direction of translation characterized the relative amplitudes of each component of patellar movement. VMO activation in patellofemoral pain caused greater medial patellar rotation (distal patellar pole rotates medially in frontal plane) at both knee positions (p<0.01), and both VMO and VML activation caused increased anterior patellar translation (p<0.001) in patellofemoral pain compared to healthy subjects at 20° knee flexion. VL activation caused more lateral patellar translation (p<0.001) in patellofemoral pain compared to healthy subjects. In healthy subjects the 3-D mechanical action of the VMO is actively modulated with knee flexion angle while such modulation was not observed in PFP subjects. This could be due to anatomical differences in the VMO insertion on the patella and medial quadriceps weakness. Quantitative evaluation of the influence of individual quadriceps components on patellar tracking will aid understanding of the knee extensor mechanism and provide insight into the etiology of patellofemoral pain. PMID:19878947

  8. Clear regression of harvested intertidal mollusks. A 20-year (1994-2014) comparative study.

    PubMed

    Riera, Rodrigo; Pérez, Óscar; Álvarez, Omar; Simón, David; Díaz, Dácil; Monterroso, Óscar; Núñez, Jorge

    2016-02-01

    Intertidal mollusks are subjected to an intense environmental pressure, from human-induced stressors, mainly harvesting, to competition for food and space with other species. Here we used mollusk shell size as a measure of size distribution and reproductive potential of intertidal limpets. Two species of exploited limpets (Patella candei crenata and Patella aspera) were monitored throughout the littoral of Tenerife (Canary Islands, NE Atlantic Ocean), an overpopulated island with a high coastal pressure. The exploitation of these two limpet species is controlled by regional legislation, with seasonal closures and limits of harvest for professional (10 kg) and recreational harvesters (3-5 kg). A long-term comparison (1994-2014) of limpet size has been conducted as a surrogate of the state of conservation of these two limpets. Both species showed populations dominated largely by small-sized individuals (<30 mm) and a lack of large adults (>60 mm). The proximity to coastal settlements was not a factor to explain limpet assemblage structure. The temporal (1994-2014) comparative study showed a sharp decrease in the mean size of both limpet species (7 mm in P. aspera and 5 mm in P. candei crenata). These results might be indicative of overharvesting of both species in Tenerife. The conservation of the two studied species needs to be accomplished by the strict fulfillment of current protective strategies, as well as the creation of marine protected areas where intertidal harvesting is totally banned all over the year. PMID:26606106

  9. Molecular Characterization of Articular Cartilage from Young Adults with Femoroacetabular Impingement

    PubMed Central

    Hashimoto, Shingo; Rai, Muhammad Farooq; Gill, Corey S.; Zhang, Zhiqi; Sandell, Linda J.; Clohisy, John C.

    2013-01-01

    Background: Femoroacetabular impingement is a frequent cause of hip pain and may lead to secondary osteoarthritis, yet little is known about the molecular events linking mechanical hip impingement and articular cartilage degeneration. The first goal of this study was to quantify the expression of inflammatory cytokine and chemokine, matrix-degrading, and extracellular matrix genes in articular cartilage harvested from control hips and hips with femoroacetabular impingement and end-stage osteoarthritis. The second goal was to analyze the relative expression of these genes in articular cartilage harvested at various stages of osteoarthritis. Methods: Cartilage samples were obtained from thirty-two hips undergoing hip preservation surgery for femoroacetabular impingement or hip arthroplasty. Three control cartilage samples were also analyzed. Specimens were graded intraoperatively with regard to the severity of cartilage damage, the radiographic osteoarthritis grade was recorded, and quantitative RT-PCR (real-time polymerase chain reaction) was performed to determine relative gene expression. Results: Except for interleukin-1β (IL-1β) and CXCL2, the mRNA (messenger RNA) expression of all other chemokine (IL-8, CXCL1, CXCL3, CXCL6, CCL3, and CCL3L1), matrix-degrading (matrix metalloproteinase [MMP]-13 and ADAMTS-4), and structural matrix (COL2A1 [collagen, type II, alpha] and ACAN [aggregan]) genes was higher overall in cartilage from hips with femoroacetabular impingement compared with hips with osteoarthritis and normal controls. The differences reached significance (p ≤ 0.05) for seven of these ten quantified genes, with CXCL3, CXCL6, and COL2A1 being elevated in the femoroacetabular impingement group compared with only the control group and IL-8, CCL3L1, ADAMTS-4, and ACAN being elevated compared with both the osteoarthritis and control groups. When samples were grouped according to the stage of the degenerative cascade, mRNA expression was relatively higher in one of the two middle stages of femoroacetabular impingement (chondromalacia or cleavage/thinning), with the difference reaching significance for IL-8, CXCL2, CXCL3, CCL3L1, and ACAN. ACAN expression was diminished in hips with osteoarthritis compared with femoroacetabular impingement but elevated compared with the control articular cartilage. Conclusions: Articular cartilage from the impingement zone of hips with femoroacetabular impingement (and particularly those hips in the cleavage/thinning stage) expressed higher levels of certain inflammatory, anabolic, and catabolic genes, representing a heightened metabolic state. Clinical Relevance: The articular cartilage from the impingement zone of hips with femoroacetabular impingement was metabolically hyperactive, supporting the concept that such impingement is a structural precursor to hip osteoarthritis. PMID:23965695

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

    PubMed

    Hartmann, Hagen; Wirth, Klaus; Klusemann, Markus

    2013-10-01

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

  11. Magnetic Resonance Imaging of the Throwing Elbow in the Uninjured, High School–Aged Baseball Pitcher

    PubMed Central

    Hurd, Wendy J.; Eby, Sarah; Kaufman, Kenton R.; Murthy, Naveen S.

    2014-01-01

    Background Tissue adaptations in response to pitching are an expected finding during magnetic resonance imaging (MRI) evaluation of the throwing elbow of adult pitchers. These changes are considered normal in the absence of symptom complaints. It is unclear when during the playing career these tissue adaptations are initiated. Hypothesis Abnormalities in the appearance of the throwing elbow compared with the nonthrowing elbow would be visible during MRI assessment of this asymptomatic population of high school–aged throwers. Study Design Cross-sectional study; Level of evidence, 3. Methods Twenty-three uninjured, asymptomatic male high school–aged baseball pitchers (mean age, 16 years) with no history of elbow injury were recruited for the study. Participants had a minimum of 3 years’ experience with pitching as their primary position (mean experience, 6 years). Bilateral elbow MRI examinations were performed using a standardized protocol including fast spin-echo proton-density (axial and coronal), T1-weighted (sagittal), and T2-weighted fat-saturated (axial, sagittal, and coronal) sequences. Osteoarticular, ligamentous, musculotendinous, and neural structures were evaluated and compared bilaterally. The images were reviewed by a musculoskeletal radiologist who was blinded to all the gathered data on these athletes, including limb dominance. Results Three participants (13%) had no abnormalities. Fifteen individuals (65%) had asymmetrical anterior band ulnar collateral ligament thickening, including 4 individuals who also had mild sublime tubercle/anteromedial facet edema. Fourteen participants (61%) had posteromedial subchondral sclerosis of the ulnotrochlear articulation, including 8 (35%) with a posteromedial ulnotrochlear osteophyte, and 4 (17%) with mild posteromedial ulnotrochlear chondromalacia. Ten individuals (43%) had multiple abnormal findings in the throwing elbow. Conclusion Thickening of the anterior band of the ulnar collateral ligament and posteromedial subchondral sclerosis of the trochlea are common findings in the high school–aged pitcher and may be considered normal clinical findings in the absence of symptom complaints. Other changes in tissue appearance of the throwing elbow are uncommon in this age group and should be regarded with a higher level of caution when evaluating for the presence of injury. An understanding of the MRI appearance of the uninjured youth pitcher is necessary for clinicians to distinguish between normal adaptations and the presence of injury. PMID:21228309

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

    PubMed

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

    2012-11-01

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

  13. Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Instability Using a Gracilis Autograft without Bone Tunnel

    PubMed Central

    Kim, Tae-Seong; Kim, Hee-June; Ra, In-Hoo

    2015-01-01

    Background Several tendon graft and fixation methods have been introduced in medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar dislocation. The purpose of this study was to evaluate the results of MPFL reconstruction using a gracilis autograft fixation without bone tunnel in patients with recurrent patellar instability. Methods Nine patients (four males and five females) diagnosed with recurrent patellar instability from July 2009 to January 2013 and had MPFL reconstruction using a gracilis autograft were included. The average age of the patients was 24.6 years (range, 13 to 48 years), and the average follow-up period was 19.3 months (range, 12 to 30 months). For every patient, femoral attachment was fixed using suture anchors securing the patella by suturing the periosteum and surrounding soft tissue. Clinical evaluation included the Kujala, Lysholm, and Tegner scores; in addition, patients were examined for any complication including recurrent dislocation. The congruence angle and patella alta were assessed radiologically before and after surgery. Results The Kujala score improved from an average of 42.7 ± 8.4 before surgery to 79.6 ± 13.6 (p = 0.008) at final follow-up; the Lysholm score improved from 45.8 ± 5.7 to 82.0 ± 10.5 (p = 0.008); and the Tegner score improved from 2.8 ± 0.8 to 5.6 ± 1.5 (p = 0.007). The Insall-Salvati ratio changed from 1.16 ± 0.1 (range, 0.94 to 1.35) before surgery to 1.14 ± 0.1 (range, 0.96 to 1.29; p = 0.233) at the final follow-up without significance. The congruence angle significantly improved from 26.5° ± 10.6° (range, 12° to 43°) before surgery to -4.0° ± 4.3° (range, -12° to 5°; p = 0.008) at final follow-up. Subluxation was observed in one patient and hemarthrosis occurred in another patient 2 years after surgery, but these patients were asymptomatic. Conclusions We achieved good results with a patellar fixation technique in MPFL reconstruction using a gracilis autograft employing soft tissue suturing in patients with recurrent patellar dislocation. PMID:26640628

  14. Comparing different post-mortem human samples as DNA sources for downstream genotyping and identification.

    PubMed

    Calacal, Gayvelline C; Apaga, Dame Loveliness T; Salvador, Jazelyn M; Jimenez, Joseph Andrew D; Lagat, Ludivino J; Villacorta, Renato Pio F; Lim, Maria Cecilia F; Fortun, Raquel D R; Datar, Francisco A; De Ungria, Maria Corazon A

    2015-11-01

    The capability of DNA laboratories to perform genotyping procedures from post-mortem remains, including those that had undergone putrefaction, continues to be a challenge in the Philippines, a country characterized by very humid and warm conditions all year round. These environmental conditions accelerate the decomposition of human remains that were recovered after a disaster and those that were left abandoned after a crime. When considerable tissue decomposition of human remains has taken place, there is no other option but to extract DNA from bone and/or teeth samples. Routinely, femur shafts are obtained from recovered bodies for human identification because the calcium matrix protects the DNA contained in the osteocytes. In the Philippines, there is difficulty in collecting femur samples after natural disasters or even human-made disasters, because these events are usually characterized by a large number of fatalities. Identification of casualties is further delayed by limitation in human and material resources. Hence, it is imperative to test other types of biological samples that are easier to collect, transport, process and store. We analyzed DNA that were obtained from body fluid, bone marrow, muscle tissue, clavicle, femur, metatarsal, patella, rib and vertebral samples from five recently deceased untreated male cadavers and seven male human remains that were embalmed, buried for ∼ 1 month and then exhumed. The bodies had undergone different environmental conditions and were in various stages of putrefaction. A DNA extraction method utilizing a detergent-washing step followed by an organic procedure was used. The utility of bone marrow and vitreous fluid including bone marrow and vitreous fluid that was transferred on FTA(®) cards and subjected to autosomal STR and Y-STR DNA typing were also evaluated. DNA yield was measured and the presence or absence of PCR inhibitors in DNA extracts was assessed using Plexor(®)HY. All samples were amplified using PowerPlex(®)21 and PowerPlexY(®)23 systems and analyzed using the AB3500 Genetic Analyzer and the GeneMapper(®) ID-X v.1.2 software. PCR inhibitors were consistently detected in bone marrow, muscle tissue, rib and vertebra samples. Amplifiable DNA was obtained in a majority of the samples analyzed. DNA recovery from 0.1g biological material was adequate for successful genotyping of most of the non-bone and bone samples. Complete DNA profiles were generated from bone marrow, femur, metatarsal and patella with 0.1 ng DNA template. Using 0.5 ng DNA template resulted in increased allele recovery and improved intra- and inter-locus peak balance. PMID:26275611

  15. Prospective identification of postmenopausal osteoporotic women at high vertebral fracture risk by radiography, bone densitometry, quantitative ultrasound, and laboratory findings: results from the PIOS study.

    PubMed

    Glüer, Maren Gesina; Minne, Helmut W; Glüer, Claus-Christian; Lazarescu, A Doina; Pfeifer, Michael; Perschel, Frank H; Fitzner, Rudolf; Pollähne, Wolfgang; Schlotthauer, Tamara; Pospeschill, Markus

    2005-01-01

    Women with established osteoporosis are at high risk to sustain additional vertebral fractures. Treatment may affect the predictive power of bone densitometry and biochemical techniques. There are few prospective studies comparing fracture prediction by dual-energy X-ray absorptiometry (DXA) and other techniques in treated women with established osteoporosis. The objective of this study was to prospectively assess the predictive power of various DXA and quantitative ultrasound (QUS) techniques for identification of women at high risk to develop new fractures over 1-2 yr. Moreover, we wanted to investigate whether previous or ongoing therapy precluded the use of common clinical laboratory blood tests and bone turnover markers for prediction of fracture risk. We measured prevalent fracture status; bone mineral density (BMD) of the whole body, spine, and hip by DXA; QUS of the calcaneus and the patella; hormones and various markers of bone resorption and formation; and took standard blood tests in 124 women (age 64.9 yr +/- 7.9) with manifest and variously treated postmenopausal osteoporosis. Subsequently, new spine fractures were assessed after 1 yr and, in a subset of 87 women, after 2 yr. Prevalent fractures turned out to be the strongest predictor of subsequent vertebral fractures with an age-adjusted odds ratio (OR) of 3.9 per prevalent fracture over 2 yr. Furthermore, our results underline the predictive power of spinal BMD (sOR = 2.1; standardized OR per 1 standard deviation population variance decrease), whole body BMD (sOR: 2.4), and QUS stiffness index of the calcaneus (sOR: 2.8) for vertebral fracture prediction. QUS of the patella did not predict vertebral fractures. Blood sedimentation rate was predictive in the first year (sOR: 1.9). The predictive power of bone turnover markers, however, appeared to be too low to be detectable in a group of this sample size and it may have been reduced because most women were already receiving treatment. In conclusion, radiographic measures, but not the tested laboratory bone turnover markers, enabled us to identify women (from a population of osteoporotic women who have been treated for some time with a variety of medications) who are at highest risk for developing new vertebral fractures within 1-2 yr. PMID:16311422

  16. Simultaneous segmentation of the bone and cartilage surfaces of a knee joint in 3D

    NASA Astrophysics Data System (ADS)

    Yin, Y.; Zhang, X.; Anderson, D. D.; Brown, T. D.; Hofwegen, C. Van; Sonka, M.

    2009-02-01

    We present a novel framework for the simultaneous segmentation of multiple interacting surfaces belonging to multiple mutually interacting objects. The method is a non-trivial extension of our previously reported optimal multi-surface segmentation. Considering an example application of knee-cartilage segmentation, the framework consists of the following main steps: 1) Shape model construction: Building a mean shape for each bone of the joint (femur, tibia, patella) from interactively segmented volumetric datasets. Using the resulting mean-shape model - identification of cartilage, non-cartilage, and transition areas on the mean-shape bone model surfaces. 2) Presegmentation: Employment of iterative optimal surface detection method to achieve approximate segmentation of individual bone surfaces. 3) Cross-object surface mapping: Detection of inter-bone equidistant separating sheets to help identify corresponding vertex pairs for all interacting surfaces. 4) Multi-object, multi-surface graph construction and final segmentation: Construction of a single multi-bone, multi-surface graph so that two surfaces (bone and cartilage) with zero and non-zero intervening distances can be detected for each bone of the joint, according to whether or not cartilage can be locally absent or present on the bone. To define inter-object relationships, corresponding vertex pairs identified using the separating sheets were interlinked in the graph. The graph optimization algorithm acted on the entire multiobject, multi-surface graph to yield a globally optimal solution. The segmentation framework was tested on 16 MR-DESS knee-joint datasets from the Osteoarthritis Initiative database. The average signed surface positioning error for the 6 detected surfaces ranged from 0.00 to 0.12 mm. When independently initialized, the signed reproducibility error of bone and cartilage segmentation ranged from 0.00 to 0.26 mm. The results showed that this framework provides robust, accurate, and reproducible segmentation of the knee joint bone and cartilage surfaces of the femur, tibia, and patella. As a general segmentation tool, the developed framework can be applied to a broad range of multi-object segmentation problems.

  17. Effect of Joint Line Elevation after Posterior-stabilized and Cruciate-retaining Total Knee Arthroplasty on Clinical Function and Kinematics

    PubMed Central

    Ji, Song-Jie; Zhou, Yi-Xin; Jiang, Xu; Cheng, Zhi-Yuan; Wang, Guang-Zhi; Ding, Hui; Yang, Ming-Lei; Zhu, Zhong-Lin

    2015-01-01

    Background: Joint line (JL) is a very important factor for total knee arthroplasty (TKA) to restore. The objective of this study was to evaluate the early clinical and kinematic results of TKAs with posterior-stabilized (PS) or cruciate retaining (CR) implants in which the JL was elevated postoperatively. Methods: Data were collected from patients who underwent TKA in our department between April 2011 and April 2014. The patients were divided into two groups based on the prosthesis they received (PS or CR). At 1-year postoperatively, clinical outcomes were evaluated by the American Knee Society (AKS) knee score, AKS function score, and patella score. In vivo kinematic analysis after TKA was performed on all patients and a previously validated three-dimensional to two-dimensional image registration technique was used to obtain the kinematic data. Anteroposterior (AP) translation of the medial and lateral femoral condyles, and axial rotation relative to the tibial plateau, were analyzed. The data were assessed using the Mann–Whitney test. Results: At time of follow-up, there were differences in the AKS knee scores (P = 0.005), AKS function scores (P = 0.025), patella scores (P = 0.015), and postoperative range of motions (P = 0.004) between the PS group and the CR group. In the PS group, the magnitude of AP translation for the medial and lateral condyle was 4.9 ± 3.0 mm and 12.8 ± 3.3 mm, respectively. Axial rotation of the tibial component relative to the femoral component was 12.9 ± 4.5°. In the CR group, the magnitude of AP translation for the medial and lateral condyle was 4.3 ± 3.5 mm and 7.9 ± 4.2 mm, respectively. The axial rotation was 6.7 ± 5.9°. There were statistically different between PS group and CR group in kinematics postoperatively. Conclusion: Our results demonstrate that postoperative JL elevation had more adverse effects on the clinical and kinematic outcomes of CR TKAs than PS TKAs. PMID:26521783

  18. The effect of design variables of condylar total knees on the joint forces in step climbing based on a computer model.

    PubMed

    Yu, C H; Walker, P S; Dewar, M E

    2001-08-01

    The ability to climb a steep step or rise from a low chair after total knee replacement may be enhanced if the required force in the quadriceps muscle is reduced. This can potentially be achieved if the total knee produces a large lever arm measured from the femoral-tibial contact point to the patellar ligament. A reduced quadriceps force would also reduce the patello-femoral force and the femoral-tibial contact force. The contact point location is likely to be a function of the geometry of the femoral and tibial components in the sagittal plane, including the relative distal and posterior radii of the femoral profile, the location of the bottom-of-the-dish of the tibial surface, the radius of the tibial surface, and the presence or absence of the posterior cruciate ligament. A three-dimensional model of the knee was developed including the quadriceps and various ligaments. In the study, the motion was confined to flexion extension and displacement in the sagittal plane. The quadriceps was assumed to be the only muscle acting. A standard software package (Pro/Mechanica) was used for the analysis. For a femoral component with a smaller distal radius, there was 12% reduction in the quadriceps muscle force and up to 11% reduction in the patello-femoral force from about 100 up to 60 degrees flexion. However, apart from that, there were less than 10% differences in all the forces as a function of all of the design variables studied. This was attributed to the relatively small changes in the lever arm of the patella tendon, since the tendon moves in an anterior-posterior direction along with the femur. An additional factor explaining the results was the change in the anterior-posterior contact point as controlled by the forces in the patella tendon and in the soft tissues. The results imply that for a standard condylar replacement knee, the muscle and contact forces are not greatly affected by the geometrical design variables. PMID:11448693

  19. Reconstruction of medial patellofemoral ligament using quadriceps tendon combined with reconstruction of medial patellotibial ligament using patellar tendon: initial experience☆

    PubMed Central

    Hinckel, Betina Bremer; Gobbi, Riccardo Gomes; Bonadio, Marcelo Batista; Demange, Marco Kawamura; Pécora, José Ricardo; Camanho, Gilberto Luis

    2016-01-01

    Objective To describe a surgical technique for anatomical reconstruction of the medial patellofemoral ligament using the quadriceps tendon, combined with reconstruction of the medial patellotibial ligament using the patellar tendon; and to present the initial results from a case series. Method The proposed technique was used on a series of cases of patients with diagnoses of patellofemoral instability and indications for surgical treatment, who were attended by the Knee Group of HC-IOT, University of São Paulo. The following were evaluated before and after the operation: range of motion (ROM), apprehension test, lateral translation test, patellar inclination test, inverted J sign, subluxation upon extension, pain from compression of the patella and pain from contraction of the quadriceps. After the operation, the patients were asked whether any new episode of dislocation had occurred, what their degree of satisfaction with the surgery was (on a scale from 0 to 10) and whether they would be prepared to go through this operation again. Results Seven knees were operated, in seven patients, with a mean follow-up of 5.46 months (±2.07). Four patients who presented apprehension before the operation did not show this after the operation. The lateral translation test became normal for all the patients, while the patellar inclination test remained positive for two patients. The patients with an inverted J sign continued to be positive for this sign. Five patients were positive for subluxation upon extension before the operation, but all patients were negative for this after the operation. None of the patients presented any new episode of dislocation of the patella. All of them stated that they were satisfied: five gave a satisfaction score of 9 and two, a score of 10. All of them said that they would undergo the operation again. Only one patient presented a postoperative complication: dehiscence of the wound. Conclusion Reconstruction of the medial patellofemoral ligament using the quadriceps tendon, combined with reconstruction of the medial patellotibial ligament using the patellar tendon, was technically safe and presented good objective and subjective clinical results in this case series with a short follow-up. PMID:26962504

  20. Acute traumatic patellar dislocation.

    PubMed

    Duthon, V B

    2015-02-01

    Inaugural traumatic patellar dislocation is most often due to trauma sustained during physical or sports activity. Two-thirds of acute patellar dislocations occur in young active patients (less than 20 years old). Non-contact knee sprain in flexion and valgus is the leading mechanism in patellar dislocation, accounting for as many as 93% of all cases. The strong displacement of the patella tears the medial stabilizing structures, and notably the medial patellofemoral ligament (MPFL), which is almost always injured in acute patellar dislocation, most frequently at its femoral attachment. Lateral patellar glide can be assessed with the knee in extension or 20° flexion. Displacement by more than 50% of the patellar width is considered abnormal and may induce apprehension. Plain X-ray and CT are mandatory to diagnose bony risk factors for patellar dislocation, such as trochlear dysplasia or increased tibial tubercle-trochlear groove distance (TT-TG), and plan correction. MRI gives information on cartilage and capsulo-ligamentous status for treatment planning: free bodies or osteochondral fracture have to be treated surgically. If patellar dislocation occurs in an anatomically normal knee and osteochondral fracture is ruled out on MRI, non-operative treatment is usually recommended. PMID:25592052

  1. Patellar ultrasound transmission velocity in healthy children and adolescents.

    PubMed

    Lappe, J M; Recker, R R; Malleck, M K; Stegman, M R; Packard, P P; Heaney, R P

    1995-04-01

    Apparent velocity of ultrasound (AVU) (Signet, Osteo-Technology Cambridge, MA) at the patella was measured on 568 children and adolescents, aged 8 to 18 years. Trend analysis revealed a significant trend (p < 0.004) toward increasing AVU with increasing age and increasing Tanner stage. Height and weight were positively correlated with AVU in both sexes, while dietary intake of calories, protein, and calcium were positively correlated with AVU in males, but not in females. Multiple linear regression revealed that 29% of the variance of AVU in females was described by Tanner stage (p < 0.002) and height (p < 0.007). The best regression model for males accounted for 48% of the variance in AVU and included age (p < 0.0001) and protein intake (p < 0.01). Bone quality has a distribution in children which is similar to the distribution of bone mass and density. Our patellar AVU values can be used as a baseline for much-needed prospective research with children and adolescents. PMID:7626312

  2. Traumatic articular-bursal fistula in a collegiate football player.

    PubMed

    Diduch, David R; Lee, Gregory P; Barr, Michelle

    2005-10-01

    A collegiate football player suffered a direct blow to the distal quadriceps mechanism, resulting in a partial tear of the vastus medialis obliquus. Over time, he began to develop activity-related swelling of his prepatellar bursa. By 6 weeks after his injury, an area of swelling the size of a golf ball would rapidly develop with just 5 minutes of quadriceps exercises. Swelling would diminish within a few hours of rest. A magnetic resonance imaging examination suggested a fistula track from the articular space through the vastus medialis obliquus into the prepatellar bursal area. When prolonged rest did not improve his symptoms, he was taken to surgery. Arthroscopic visualization confirmed a traumatic fistula between the articular space and the prepatellar bursa, allowing free egress of fluid. A spinal needle was used to localize the fistula tract to allow this to be identified for an open, layered suture closure. An area of traumatic chondrosis on the medial side of the patella with loose chondral flaps was also debrided as the probable "fluid generator." The patient enjoyed a full recovery and was back to playing college football 10 weeks after surgery. PMID:16226657

  3. Organophosphorous biocides reduce tenacity and cellular viability but not esterase activities in a non-target prosobranch (limpet).

    PubMed

    Browne, Mark Anthony; Dissanayake, Awantha; Galloway, Tamara S

    2015-08-01

    Detecting impacts of organophosphorus biocides (OP) is facilitated by analysing "biomarkers" - biological responses to environmental insults. Understanding is hampered by studying biomarkers in isolation at different levels of biological response and limited work on ecologically-important species. We tested the relevance of esterases as biomarkers of OP-exposure in limpets (Patella vulgata), abundant prosobranchs that structure the assemblages on rocky shores through their grazing. We characterized esterases in haemolymph and tissue, and quantified their dose-dependent inhibition by chlorfenvinphos (0.1-3.0 mM) in vitro. To determine whether esterases are useful biomarkers we exposed limpets to chlorfenvinphos (0-10 μg L(-1)). Despite reduced tenacity (ability to stick to a surface) and haemocyte-viability, esterases remained unaffected. Tenacity was reduced by >50% at 5 μg L(-1) and by 95% at 10 μg L(-1), whilst haemocyte-viability was more sensitive with >40% reductions at concentrations of 0.5 μg L(-1) and above. We discuss results in relation to linking sub-lethal and ecological impacts at contaminated sites. PMID:25919192

  4. Patellofemoral Pain in Adolescence and Adulthood: Same Same, but Different?

    PubMed

    Rathleff, M S; Vicenzino, B; Middelkoop, M; Graven-Nielsen, T; van Linschoten, R; Hölmich, P; Thorborg, K

    2015-11-01

    The mainstay of patellofemoral pain (PFP) treatment is exercise therapy, often in combination with adjunct treatments such as patient education, orthoses, patella taping and stretching, making the intervention multimodal in nature. The vast majority of randomised controlled trials among patients with PFP have investigated the effect of treatment among adults (>18 years of age). So, while systematic reviews and meta-analyses provide evidence-based recommendations for treating PFP, these recommendations are largely based upon the trials in adults. In the present article, we have summarised the findings on the efficacy of multimodal treatment (predominantly exercise) from the three largest trials concerning patients with PFP, focusing on the long-term success-rate 1 year after receiving multimodal treatment, and with a particular focus on the success rate across the different age groups, including both adolescents, young adults and adults. The results of this paper show that there appears to be a difference in the success rate between adolescents and adults, despite providing similar exercise treatment and having similar exercise compliance. While PFP may present in a similar fashion in adolescence and adults, it may not be the same underlying condition or stage, and different treatments may be required. Collectively, this highlights the importance of increasing our understanding of the underlying pathology, pain mechanisms and why treatment may-or may not-work in adolescents and adults with PFP. PMID:26178330

  5. Articular Cartilage Increases Transition Zone Regeneration in Bone-tendon Junction Healing

    PubMed Central

    Qin, Ling; Lee, Kwong Man; Leung, Kwok Sui

    2008-01-01

    The fibrocartilage transition zone in the direct bone-tendon junction reduces stress concentration and protects the junction from failure. Unfortunately, bone-tendon junctions often heal without fibrocartilage transition zone regeneration. We hypothesized articular cartilage grafts could increase fibrocartilage transition zone regeneration. Using a goat partial patellectomy repair model, autologous articular cartilage was harvested from the excised distal third patella and interposed between the residual proximal two-thirds bone fragment and tendon during repair in 36 knees. We evaluated fibrocartilage transition zone regeneration, bone formation, and mechanical strength after repair at 6, 12, and 24 weeks and compared them with direct repair. Autologous articular cartilage interposition resulted in more fibrocartilage transition zone regeneration (69.10% ± 14.11% [mean ± standard deviation] versus 8.67% ± 7.01% at 24 weeks) than direct repair at all times. There was no difference in the amount of bone formation and mechanical strength achieved. Autologous articular cartilage interposition increases fibrocartilage transition zone regeneration in bone-tendon junction healing, but additional research is required to ascertain the mechanism of stimulation and to establish the clinical applicability. PMID:18987921

  6. New Invertebrate Vectors of Okadaic Acid from the North Atlantic Waters—Portugal (Azores and Madeira) and Morocco

    PubMed Central

    Silva, Marisa; Rodriguez, Inés; Barreiro, Aldo; Kaufmann, Manfred; Neto, Ana Isabel; Hassouani, Meryem; Sabour, Brahim; Alfonso, Amparo; Botana, Luis M.; Vasconcelos, Vitor

    2015-01-01

    Okadaic acid and its analogues are potent phosphatase inhibitors that cause Diarrheic Shellfish Poisoning (DSP) through the ingestion of contaminated shellfish by humans. This group of toxins is transmitted worldwide but the number of poisoning incidents has declined over the last 20 years due to legislation and monitoring programs that were implemented for bivalves. In the summer of 2012 and 2013, we collected a total of 101 samples of 22 different species that were made up of benthic and subtidal organisms such echinoderms, crustaceans, bivalves and gastropods from Madeira, São Miguel Island (Azores archipelago) and the northwestern coast of Morocco. The samples were analyzed by UPLC-MS/MS. Our main objective was to detect new vectors for these biotoxins. We can report nine new vectors for these toxins in the North Atlantic: Astropecten aranciacus, Arbacia lixula, Echinaster sepositus, Holothuria sanctori, Ophidiaster ophidianus, Onchidella celtica, Aplysia depilans, Patella spp., and Stramonita haemostoma. Differences in toxin contents among the species were found. Even though low concentrations were detected, the levels of toxins that were present, especially in edible species, indicate the importance of these types of studies. Routine monitoring should be extended to comprise a wider number of vectors other than for bivalves of okadaic acid and its analogues. PMID:26670254

  7. Effects of three intramedullary pinning techniques on proximal pin location and articular damage in the canine tibia.

    PubMed

    Dixon, B C; Tomlinson, J L; Wagner-Mann, C C

    1994-01-01

    The effects of three different techniques of intramedullary (IM) pin placement on pin location and incidence of stifle joint injury were evaluated using 70 cadaver canine tibiae after mid-disphyseal osteotomy. In 50 tibiae, pins were placed retrograde in either a nondirected (group A) or a craniomedially directed fashion (group B) with 25 tibiae in each group. Pins were driven normograde (group N) in 20 tibiae. All the stifles were dissected to qualitatively evaluate pin interference with different joint structures. End-on radiographs of the tibial plateaus were used to quantitatively evaluate pin location. Interference with the caudal cruciate ligament, medial meniscus, lateral meniscus, or meniscal ligaments was not observed in any group. There was a significant association between pinning technique and incidence of involvement of the cranial cruciate ligament (P < .005), patella (P < .001), patellar ligament (P < .005), and femoral condyle (P < .01). Pin location for group A was significantly different from either other group in a cranial-caudal direction (P = .003), and was significantly different from group N in a medial-lateral direction (P = .005). No significant difference was observed between pin location for groups B and N in either plane. It was concluded that although nondirected retrograde pinning cannot be recommended, retrograde pins directed craniomedially may be an acceptable technique for the repair of proximal to mid-diaphyseal tibial fractures if care is taken to properly seat the pins. PMID:7871708

  8. Scintigraphic evaluation of the stifle in normal horses and horses with forelimb lameness.

    PubMed

    Dyson, Sue; McNie, Kristen; Weekes, Jo; Murray, Rachel

    2007-01-01

    We tested the hypotheses that mature horses without lameness have a repeatable radiopharmaceutical uptake pattern in the stifle, which is bilaterally symmetric; immature horses have a different radiopharmaceutical uptake pattern; and forelimb lameness alters the radiopharmaceutical uptake pattern in the stifle. The objectives of the study were to describe the normal radiopharmaceutical uptake patterns using region of interest (ROI) analysis; to compare uptake patterns between left and right stifles of the same horse and between mature and immature horses; to compare radiopharmaceutical uptake in mature normal horses with those with forelimb lameness. Lateral scintigraphic images of the stifle from 51 horses aged 2-16 years were evaluated using seven ROIs and a reference site (midfemur). After subtraction of a background count, ratios between the mean counts per pixel for each ROI to the reference site were calculated. There was a repeatable radiopharmaceutical uptake pattern in mature normal horses that was bilaterally symmetrical. The caudoproximal aspect of the tibia and the patella had the highest ratios. Radiopharmaceutical uptake patterns in horses with forelimb lameness were not significantly different. Immature normal horses had a different symmetric pattern, with greatest radiopharmaceutical uptake ratios in the caudoproximal aspect of the tibia and the tibial crest. It was concluded that there are symmetric, repeatable radiopharmaceutical uptake patterns in both immature and mature horses, which are not altered by forelimb lameness. PMID:17691640

  9. Rupture of the quadriceps tendon. A case report in a young dog.

    PubMed

    Arnault, F; Dembour, T; Gallois Bride, H; Chancrin, J L

    2009-01-01

    A five-month-old, male, 16 kg, mixed breed dog was presented for an acute non-weight bearing lameness of the right hind limb. A subtotal avulsion of the quadriceps tendon at its patellar insertion was diagnosed through radiography and ultrasonography. Two nylon sutures secured with a stainless steel crimp were placed in a locking loop pattern in the quadriceps tendon and through a transverse 2.7 mm drill-hole in the patella. No external coaptation was used postoperatively. A full functional recovery was observed, and was followed for one year postoperatively. Quadriceps tendon rupture has not been described in the veterinary literature to our knowledge; in humans, quadriceps tendon rupture is a well known entity, often due to systemic disease resulting in weakening of the tendinous structures. In the case presented herein, the dog's history, young age and location, without underlying biochemical abnormalities, led us to believe that the observed lesion was of traumatic origin. The surgical treatment performed was based on that performed in humans and also that which has been investigated experimentally in the dog. PMID:19151876

  10. Effects of complete stress-shielding on the mechanical properties and histology of in situ frozen patellar tendon.

    PubMed

    Ohno, K; Yasuda, K; Yamamoto, N; Kaneda, K; Hayashi, K

    1993-07-01

    The effects of freezing and stress-shielding on the mechanical properties and histology of the patellar tendon (PT) were studied with the use of 28 mature Japanese white rabbits. The PT was frozen in situ by liquid nitrogen to kill the fibroblasts and then, for stress-shielding, a stainless-steel wire, installed between the patella and the tibial tubercle, was stretched to release all tension in the PT. After being allowed unrestricted activity in their cages for 1, 2, 3, or 6 weeks, the animals were killed, and the PTs were excised for mechanical and histological study. The cross-sectional area of the frozen and stress-shielded PT started to increase significantly 1 week after the treatment and leveled off at 3 weeks. In contrast, the tensile strength and elastic modulus began to decrease significantly at 1 week, falling to 15% of the control values at 6 weeks. Histologically, cells were absent until 2 weeks after freezing and stress-shielding, although new cells appeared by 3 weeks. Splitting and fragmentation of collagen bundles were observed beginning at 2 weeks. These results indicate that complete stress-shielding led to substantial changes in the mechanical properties of the once-frozen PT, even in the absence of the tissue remodeling process by fibroblasts. PMID:8340831

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

    PubMed Central

    Han, Jin Tae; Lee, Jung-hoon

    2014-01-01

    [Purpose] The purpose of this study was to identify the effects of kinesiology taping on repositioning error of the knee joint after quadriceps muscle fatigue. [Subjects] Thirty healthy adults with no orthopaedic or neurological problems participated in this study. [Methods] The repositioning error of the knee joint was measured using a digital goniometer when the subjects extended their dominant-side knee to a random target angle (30°, 45°, or 60°) with their eyes closed, before and after a quadriceps muscle fatigue protocol, and after application of kinesiology tape. [Results] We found that repositioning errors of the dominant-side knee joint increased after quadriceps fatigue compared with no-fatigue conditions. However, kinesiology taping of the quadriceps muscle and patella after quadriceps fatigue significantly decreased repositioning errors of the knee joint. [Conclusion] These results suggest that quadriceps fatigue increases the repositioning error of the knee joint, whereas application of kinesiology tape decreases fatigue-induced joint repositioning error. PMID:25013297

  12. Effects of kinesiology taping on repositioning error of the knee joint after quadriceps muscle fatigue.

    PubMed

    Han, Jin Tae; Lee, Jung-Hoon

    2014-06-01

    [Purpose] The purpose of this study was to identify the effects of kinesiology taping on repositioning error of the knee joint after quadriceps muscle fatigue. [Subjects] Thirty healthy adults with no orthopaedic or neurological problems participated in this study. [Methods] The repositioning error of the knee joint was measured using a digital goniometer when the subjects extended their dominant-side knee to a random target angle (30°, 45°, or 60°) with their eyes closed, before and after a quadriceps muscle fatigue protocol, and after application of kinesiology tape. [Results] We found that repositioning errors of the dominant-side knee joint increased after quadriceps fatigue compared with no-fatigue conditions. However, kinesiology taping of the quadriceps muscle and patella after quadriceps fatigue significantly decreased repositioning errors of the knee joint. [Conclusion] These results suggest that quadriceps fatigue increases the repositioning error of the knee joint, whereas application of kinesiology tape decreases fatigue-induced joint repositioning error. PMID:25013297

  13. Management of the knees in arthrogryposis.

    PubMed

    Pontén, Eva

    2015-12-01

    Arthrogryposis is defined as limited range of motion in three or more joints in two or more body parts. This article will describe treatment options for the arthrogrypotic knee. In all types of arthrogryposis, and in both extension and flexion deformities, very early treatment is favorable. Just after birth, traction and mobilization followed by serial casting could often greatly improve the range of motion. In the hyperextended knee, surgical lengthening of the extensor apparatus may be needed. Flexion deformities could be improved with temporary physeal arrest of the anterior distal femur by fixing two-hole plates over the physis on both sides of patella. The plates will result in a constrained growth of the anterior physis, and thus a very slow extension of the knee, which will give the nerves and vessels time to adjust. Pterygium, webbing of the knee joint, is a special subgroup that in selected mild cases could be treated with extensive surgical release of the webbing and orthotics. Arthrogrypotic knees can be treated with early reduction and maintenance with orthotics. PMID:26499453

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

    SciTech Connect

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

    2015-02-26

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

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

    DOE PAGESBeta

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

    2015-02-26

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

  16. Evaluation of the marsh deer stifle joint by imaging studies and gross anatomy.

    PubMed

    Shigue, D A; Rahal, S C; Schimming, B C; Santos, R R; Vulcano, L C; Linardi, J L; Teixeira, C R

    2015-12-01

    This study aimed to evaluate the stifle joint of marsh deer using imaging studies and in comparison with gross anatomy. Ten hindlimbs from 5 marsh deer (Blastocerus dichotomus) were used. Radiography, computed tomography (CT) and magnetic resonance imaging (MRI) were performed in each stifle joint. Two hindlimbs were dissected to describe stifle gross anatomy. The other limbs were sectioned in sagittal, dorsal or transverse planes. In the craniocaudal radiographic view, the lateral femoral condyle was broader than the medial femoral condyle. The femoral trochlea was asymmetrical. Subsequent multiplanar reconstruction revealed in the cranial view that the external surface of the patella was roughened, the medial trochlea ridge was larger than the lateral one, and the extensor fossa at the lateral condyle was next to the lateral ridge. The popliteal fossa was better visualized via the lateral view. Sagittal MRI images identified lateral and medial menisci, caudolateral and craniomedial bundles of cranial cruciate ligament, caudal cruciate ligament, patellar ligament and common extensor tendon. In conclusion, the marsh deer stifle presents some anatomical characteristics of the ovine stifle joint. PMID:25376635

  17. [Intraoperative Evaluation of Total Knee Arthroplasty: Anatomic and Kinematic Assessment with Trial Components].

    PubMed

    von Roth, P; Pfitzner, T; Fuchs, M; Perka, C

    2015-06-01

    The intraoperative use of trial components in total knee arthroplasty (TKA) is of paramount importance to prevent inadequate ligament balance and to achieve optimal position of the definitive components. This review demonstrates an 8-step algorithm to assess the anatomy of the femoral, tibial and patellar component as well as the kinematics of the tibiofemoral and patellofemoral joints. Trial components allow an easy assessment of the anatomic fit of the final implants. Upon the trials insertion, bone coverage and the component overhang should be evaluated. The femoral rotation should be assessed using the transepicondylar axis and for the tibial component rotation assessment, the tibial tuberosity would be the most reliable bony landmark. Addressing the patella, sizing and bone coverage should be thoroughly evaluated. In order to restore physiological kinematics the remnants of the meniscus rim can be used to determine the correct reconstruction of the joint line. A tight extension gap results in limited extension, whereas a tight or unbalanced flexion gap leads to "booking" or "spin-out" of the inlay. The POLO test (pull-out, lift- off) allows an easy assessment of the posterior cruciate ligament tension and the size of the flexion gap as well. To prevent postoperative dislocation and overstuffing, specific tests for correct patellar positioning and tracking support should be performed. The anatomy and kinematics of total knee arthroplasty have to be evaluated by trial components on a routine basis before inserting the final implants in order to identify implant positioning errors and inadequate ligament balance. PMID:26114563

  18. Chronic rupture of a patellar tendon: a technique for reconstruction with Achilles allograft.

    PubMed

    Falconiero, R P; Pallis, M P

    1996-10-01

    Chronic ruptures of the patellar tendon fortunately are an uncommon event. These ruptures are often difficult to repair because they are generally accompanied by quadriceps muscle contracture and a great deal of scar tissue formation. We report the case of a repair of a chronic patellar tendon rupture. The patient's right patellar tendon was reconstructed approximately 10 months after the injury using quadricepsplasty and an Achilles tendon allograft with a suprapatellar wire for tension release. Four weeks postoperatively, he had attained 60 degrees of flexion and full active extension. At 8 weeks, the suprapatellar wire was removed allowing the distribution of stresses on the reconstructed patellar tendon. At 6 months, the patient had 130 degrees of flexion and full extension, but showed a persistent 40% deficit in right quad strength. The technique accomplished the preoperative goals of restoring quadriceps function, restoring the anatomic position of the patella, and allowing early mobilization after surgery. Although the use of a suprapatellar wire to reduce tension on the reconstructed tendon required a second operation for removal, it allowed early mobilization and better healing of the repair. PMID:8902139

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  2. Current Concepts for Patellar Dislocation

    PubMed Central

    Petri, Maximilian; Ettinger, Max; Stuebig, Timo; Brand, Stephan; Krettek, Christian; Jagodzinski, Michael; Omar, Mohamed

    2015-01-01

    Context: Patellar dislocation usually occurs to the lateral side, leading to ruptures of the Medial Patellofemoral Ligament (MPFL) in about 90% of the cases. Even though several prognostic factors are identified for patellofemoral instability after patellar dislocation so far, the appropriate therapy remains a controversial issue. Evidence Acquisition: Authors searched the Medline library for studies on both surgical and conservative treatment for patellar dislocation and patellofemoral instability. Additionally, the reference list of each article was searched for additional studies. Results: A thorough analysis of the anatomical risk factors with a particular focus on patella alta, increased Tibial Tuberosity-Trochlear Groove (TT-TG) distance, trochlear dysplasia as well as torsional abnormalities should be performed early after the first dislocation to allow adequate patient counseling. Summarizing the results of all published randomized clinical trials and comparing surgical and conservative treatment after the first-time patellar dislocation until today indicated no significant evident difference for children, adolescents, and adults. Therefore, nonoperative treatment was indicated after a first-time patellar dislocation in the vast majority of patients. Conclusions: Surgical treatment for patellar dislocation is indicated primarily in case of relevant concomitant injuries such as osteochondral fractures, and secondarily for recurrent dislocations. PMID:26566512

  3. Current concepts in the management of tendon disorders.

    PubMed

    Rees, J D; Wilson, A M; Wolman, R L

    2006-05-01

    Primary disorders of tendons are common and constitute a high proportion of referrals to rheumatologists. Certain tendons are particularly vulnerable to degenerative pathology; these include the Achilles, patella, elements of the rotator cuff, forearm extensors, biceps brachi and tibialis posterior tendons. Disorders of these tendons are often chronic and can be difficult to manage successfully in the long term. Significant advances have been made in understanding the pathophysiology of these conditions. Histopathological evidence, together with advances in imaging techniques, has made us more appreciative of the degenerative (rather that inflammatory) nature of these conditions. Additionally the presence of neovascularization is now well-recognized in long-standing tendinopathy. We review the mechanical, vascular and developing neural theories that attempt to explain the aetiology of degenerative tendinopathy. We also explore theories of why specific tendons (such as the Achilles and supraspinatus tendons) are particularly prone to degenerative pathology. Traditionally, treatments have placed a heavy emphasis on anti-inflammatory strategies, which are often inappropriate. Recently, however, significant advances in the practical management of tendon disorders have been made. In particular the advent of 'eccentric loading' training programmes has revolutionized the treatment of Achilles tendinopathy in some patients. This concept is currently being extended to include other commonly injured tendons. Other current treatments are reviewed, as are potential future treatments. PMID:16490749

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

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

    2012-01-01

    Our objective was to monitor chondrocyte gene expression at 0, 3, 7, and 14 days following in vitro impaction to the articular surface of porcine patellae. Patellar facets were either axially impacted with a cylindrical impactor (25 mm/sec loading rate) to a load level of 2000 N or not impacted to serve as controls. After being placed in organ culture for 0, 3, 7, or 14 days, total RNA was isolated from full thickness cartilage slices and gene expression measured for 17 genes by quantitative real-time RT-PCR. Targeted genes included those encoding proteins involved with biological stress, inflammation, or anabolism and catabolism of cartilage extracellular matrix. Some gene expression changes were detected on the day of impaction, but most significant changes occurred at 14 days in culture. At 14 days in culture, 10 of the 17 genes were differentially expressed with col1a1 most significantly up-regulated in the impacted samples, suggesting impacted chondrocytes may have reverted to a fibroblast-like phenotype. PMID:23027577

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

    PubMed

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

    2007-07-01

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

  7. Co-existent medial collateral ligament injury seen following transient patellar dislocation: observations at magnetic resonance imaging.

    PubMed

    Quinlan, J F; Farrelly, C; Kelly, G; Eustace, S

    2010-05-01

    This study reports on a series of patients who were diagnosed as having had a transient lateral patellar dislocation by magnetic resonance imaging (MRI). The images were reviewed with specific reference to the medial collateral ligament (MCL), a heretofore undescribed concomitant injury. Eighty patients were diagnosed on MRI as having had transient lateral patellar dislocation. Their mean age was 23.9 years (SD 7.5). Forty patients (50.0%) had co-existent MCL injuries. These injuries were classified as grade 1 (n = 20), grade 2 (n = 17) and grade 3 (n = 3). These results suggest that MCL injury commonly accompanies transient lateral patella dislocation, most likely due to a shared valgus injury. It appears to occur more commonly in male patients and if unidentified may explain both delayed recovery and persistent morbidity in more severe cases. In this setting, without specifically excluding co-existent MCL injury, the current vogue for early rehabilitation should be adopted with caution. PMID:19019901

  8. Columbus navigated TKA system: clinical and radiological results at a minimum of 5 years with survivorship analysis.

    PubMed

    Hakki, Sam; Saleh, Khaled J; Potty, Anish G; Bilotta, Victor; Oliveira, Daniel

    2013-03-01

    The major factors that determine a favorable long-term clinical and functional outcome after conventional total knee arthroplasty (TKA) include correct implant positioning and restoration of the mechanical axis with soft tissue balancing to reduce aseptic failure; hence, the need for further developmental strategies that improve the accuracy and reproducibility of the surgical technique remains paramount for contemporary navigation research. Not all navigation systems are the same. The literature published thus far on mid-term results of navigated TKA relies on software that has no step-by-step soft tissue balancing with the tibia-first technique. The results are equivalent to those of conventional TKA.Therefore, the current authors conducted a minimum 5-year follow-up of a soft tissue-based navigated TKA system with the goal of soft tissue balancing. They analyzed intraoperative alignment and range of motion measurements, functional outcomes, radiographic assessment, and survival rates of high-flexion, high-conformity unresurfaced patella TKAs. The results at 5 years revealed a component revision rate of 0% compared with other nonnavigated TKAs (2.8% revision rate). The authors achieved a well-balanced TKA with a 0°±2° mechanical axis and an improved range of motion from 95° preoperatively to 110° postoperatively. PMID:23464950

  9. Two Modes of Weight Training Programs and Patellar Stabilization

    PubMed Central

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

    2009-01-01

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

  10. Wave action modifies the effects of consumer diversity and warming on algal assemblages.

    PubMed

    Mrowicki, Robert J; O'Connor, Nessa E

    2015-04-01

    To understand the consequences of biodiversity loss, it is necessary to test how biodiversity-ecosystem functioning relationships may vary with predicted environmental change. In particular, our understanding will be advanced by studies addressing the interactive effects of multiple stressors on the role of biodiversity across trophic levels. Predicted increases in wave disturbance and ocean warming, together with climate-driven range shifts of key consumer species, are likely to have profound impacts on the dynamics of coastal marine communities. We tested whether wave action and temperature modified the effects of gastropod grazer diversity (Patella vulgata, Littorina littorea, and Gibbula umbilicalis) on algal assemblages in experimental rock pools. The presence or absence of L. littorea appeared to drive changes in microalgal and macroalgal biomass and macroalgal assemblage structure. Macroalgal biomass also decreased with increasing grazer species richness, but only when wave action was enhanced. Further, independently of grazer diversity, wave action and temperature had interactive effects on macroalgal assemblage structure. Warming also led to a reversal of grazer-macroalgal interaction strengths from negative to positive, but only when there was no wave action. Our results show that hydrodynamic disturbance can exacerbate the effects of changing consumer diversity, and may also disrupt the influence of other environmental stressors on key consumer-resource interactions. These findings suggest that the combined effects of anticipated abiotic and biotic change on the functioning of coastal marine ecosystems, although difficult to predict, may be substantial. PMID:26230022

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

    PubMed Central

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

    2014-01-01

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

  12. Patellofemoral instability: classification and imaging

    PubMed Central

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

    2013-01-01

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

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

    SciTech Connect

    Acharya, R.S.; Swarnarkar, V.; Krishnamurthy, R.; Hausman, E.; LeBlanc, A.; Lin, C.; Shackelford, L.

    1995-12-31

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

  14. Holocene geoarchaeology of the Sixteen Mile Beach barrier dunes in the Western Cape, South Africa

    NASA Astrophysics Data System (ADS)

    Compton, John S.; Franceschini, Giuliana

    2005-01-01

    Holocene evolution and human occupation of the Sixteen Mile Beach barrier dunes on the southwest coast of South Africa between Yzerfontein and Saldanha Bay are inferred from the radiocarbon ages of calcareous dune sand, limpet shell ( Patella spp.) manuports and gull-dropped white mussel shells ( Donax serra). A series of coast-parallel dunes have prograded seaward in response to an overall marine regression since the mid-Holocene with dated shell from relict foredunes indicating periods of shoreline progradation that correspond to drops in sea level at around 5900, 4500 and 2400 calibrated years before the present (cal yr B.P.). However, the active foredune, extensively covered by a layer of gull-dropped shell, has migrated 500 m inland by the recycling of eroded dune sand in response to an approximate 1 m sea level rise over the last 700 yr. Manuported limpet shells from relict blowouts on landward vegetated dunes indicate human occupation of coastal dune sites at 6200 and 6000 cal yr B.P. and help to fill the mid-Holocene gap in the regional archaeological record. Coastal midden shells associated with small hearth sites exposed in blowouts on the active foredune are contemporaneous (1600-500 cal yr B.P.) with large midden sites on the western margin of Langebaan Lagoon and suggest an increase in marine resource utilisation associated with the arrival of pastoralism in the Western Cape.

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

    PubMed

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

    2013-08-01

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

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

    PubMed Central

    Xing, Elizabeth M.; Knox, Van W.; O'Donnell, Patricia A.; Sikura, Tracey; Liu, Yuli; Wu, Susan; Casal, Margret L.; Haskins, Mark E.; Ponder, Katherine P.

    2013-01-01

    Mucopolysaccharidosis (MPS) VII is a lysosomal storage disease due to deficient activity of β-glucuronidase (GUSB), and results in glycosaminoglycan accumulation. Skeletal manifestations include bone dysplasia, degenerative joint disease, and growth retardation. One gene therapy approach for MPS VII involves neonatal intravenous injection of a gamma retroviral vector expressing GUSB, which results in stable expression in liver and secretion of enzyme into blood at levels predicted to be similar or higher to enzyme replacement therapy. The goal of this study was to evaluate the long-term effect of neonatal gene therapy on skeletal manifestations in MPS VII dogs. Treated MPS VII dogs could walk throughout their lives, while untreated MPS VII dogs could not stand beyond 6 months and were dead by 2 years. Luxation of the coxofemoral joint and the patella, dysplasia of the acetabulum and supracondylar ridge, deep erosions of the distal femur, and synovial hyperplasia were reduced, and the quality of articular bone was improved in treated dogs at 6 to 11 years of age compared with untreated MPS VII dogs at 2 years or less. However, treated dogs continued to have osteophyte formation, cartilage abnormalities, and an abnormal gait. Enzyme activity was found near synovial blood vessels, and there was 2% as much GUSB activity in synovial fluid as in serum. We conclude that neonatal gene therapy reduces skeletal abnormalities in MPS VII dogs, but clinically-relevant abnormalities remain. Enzyme replacement therapy will probably have similar limitations long-term. PMID:23628461

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

    NASA Astrophysics Data System (ADS)

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

    2009-11-01

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

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

    PubMed

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

    2007-02-01

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

  19. Development and Validation of a Novel LC-MS/MS Opioid Confirmation Assay: Evaluation of β-glucuronidase Enzymes and Sample Cleanup Methods.

    PubMed

    Yang, He S; Wu, Alan H B; Lynch, Kara L

    2016-06-01

    With the rise in the use and misuse of prescription opioids, there is an increasing need for the confirmed identification of opioid analgesics in toxicology laboratories. The goals of this study were to (i) systematically evaluate the hydrolysis efficiency of four β-glucuronidase enzymes under optimized condition; (ii) evaluate compound recovery, matrix effects and precision of three protein precipitation plates and (iii) develop and validate a qualitative liquid-chromatography mass spectrometry (LC-MS/MS) assay to identify 13 opioids in urine. A recombinant β-glucuronidase exhibited the best overall hydrolysis efficiency for seven opioid glucuronide conjugates compared with β-glucuronidase from red abalone, Escherichia coli and Patella vulgata One of the protein precipitation plates tested exhibited overall better recovery of the opioids and lower ion suppression compared with the other two plates. An ESI positive mode LC-MS/MS assay for qualitative opioid analysis was developed and validated. Linearity, LOD, precision, matrix effect, recovery, carryover and interference of the method were evaluated. Sixty-two patient samples were analyzed by both a legacy GC-MS opioid method and the LC-MS/MS method, and 22 samples were analyzed by the LC-MS/MS and an LC-MS/MS reference method. The results of the comparisons showed good concordance. Overall, we described an efficient sample preparation procedure for a sensitive qualitative opioid confirmation assay in urine. PMID:27121711

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

    PubMed

    Mariotti, Valentina; Belcastro, Maria Giovanna

    2011-06-01

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

  1. New Invertebrate Vectors of Okadaic Acid from the North Atlantic Waters--Portugal (Azores and Madeira) and Morocco.

    PubMed

    Silva, Marisa; Rodriguez, Inés; Barreiro, Aldo; Kaufmann, Manfred; Isabel Neto, Ana; Hassouani, Meryem; Sabour, Brahim; Alfonso, Amparo; Botana, Luis M; Vasconcelos, Vitor

    2015-12-01

    Okadaic acid and its analogues are potent phosphatase inhibitors that cause Diarrheic Shellfish Poisoning (DSP) through the ingestion of contaminated shellfish by humans. This group of toxins is transmitted worldwide but the number of poisoning incidents has declined over the last 20 years due to legislation and monitoring programs that were implemented for bivalves. In the summer of 2012 and 2013, we collected a total of 101 samples of 22 different species that were made up of benthic and subtidal organisms such echinoderms, crustaceans, bivalves and gastropods from Madeira, São Miguel Island (Azores archipelago) and the northwestern coast of Morocco. The samples were analyzed by UPLC-MS/MS. Our main objective was to detect new vectors for these biotoxins. We can report nine new vectors for these toxins in the North Atlantic: Astropecten aranciacus, Arbacia lixula, Echinaster sepositus, Holothuria sanctori, Ophidiaster ophidianus, Onchidella celtica, Aplysia depilans, Patella spp., and Stramonita haemostoma. Differences in toxin contents among the species were found. Even though low concentrations were detected, the levels of toxins that were present, especially in edible species, indicate the importance of these types of studies. Routine monitoring should be extended to comprise a wider number of vectors other than for bivalves of okadaic acid and its analogues. PMID:26670254

  2. UPDATING OF THE ANATOMY OF THE EXTENSOR MECHANISM OF THE KNEE USING A THREE-DIMENSIONAL VIEWING TECHNIQUE

    PubMed Central

    Astur, Diego Costa; Oliveira, Saulo Gomes; Badra, Ricardo; Arliani, Gustavo Gonçalves; Kaleka, Camila Cohen; Jalikjian, Wahi; Golanó, Pau; Cohen, Moisés

    2015-01-01

    The knee extensor mechanism is a complex structure formed by the quadriceps muscle and tendon, the patella, the patellar tendon and the ligaments that surround and help stabilize the knee. Through using a three-dimensional viewing technique on images of the knee extensor apparatus, we aimed to didactically show the structures that compose this bone-muscle-ligament complex. Anatomical dissection of the knee with emphasis on the structures of its extensor mechanism was performed, followed by taking photographs using a camera and lenses suitable for simulating human vision, through a technique for constructing three-dimensional images. Then, with the aid of appropriate software, pairs of images of the same structure from different angles simulating human vision were overlain with the addition of polarizing layer, thereby completing the construction of an anaglyphic image. The main structures of the knee extensor mechanism could be observed with a three-dimensional effect. Among the main benefits relating to this technique, we can highlight that in addition to teaching and studying musculoskeletal anatomy, it has potential use in training for surgical procedures and production of images for diagnostic tests. PMID:27027043

  3. Systematic arthroscopic investigation of the bovine stifle joint.

    PubMed

    Hagag, U; Tawfiek, M G; Brehm, W

    2015-12-01

    The objective of the present study was to establish a protocol for arthroscopic exploration of the bovine stifle joint using craniomedial, caudolateral and caudomedial approaches. An anatomic and arthroscopic study using 26 cadaveric limbs from 13 non-lame adult dairy cows was performed. The craniomedial approach was created between the middle and medial patellar ligaments to investigate the cranial pouches of the stifle joint. The inter-condylar eminence, the proximal aspect of the medial femoral trochlear ridge and the lateral aspect of the lateral femoral condyle were used as starting points for systematic examination of the medial femorotibial, the femoropatellar and the lateral femorotibial joints, respectively. The observed structures were: the suprapatellar pouch, articular surfaces of the patella, femoral trochlear ridges, cruciate ligaments, menisci, and the meniscotibial ligaments. The arthroscopic portal for the caudomedial femorotibial pouch was about 6-8 cm caudal to the medial collateral ligament. The proximal and distal caudolateral femorotibial pouches were explored 3 cm and 1.5 cm caudal to the ipsilateral collateral ligament, respectively. The observed structures were the caudal aspect of femoral condyles, menisci, caudal cruciate ligament, popliteal tendon and the meniscofemoral ligament. Restricted joint size and risk of common peroneal nerve damage were the major limitations for exploration of the caudal femorotibial compartments. The study described the arthroscopic portals and normal intra-articular anatomy of the bovine stifle joint but further investigations are warranted to validate these techniques in clinical cases. PMID:26549490

  4. The young osteoarthritic knee: dilemmas in management

    PubMed Central

    2013-01-01

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

  5. MECHANICAL RESISTANCE OF THE PATELLAR LIGAMENT AFTER REMOVAL OF THE MIDDLE THIRD THROUGH EITHER ONE LONGITUDINAL INCISION OR TWO MINI-TRANSVERSE INCISIONS

    PubMed Central

    De Lazari, Leandro Calil; Paccola, Cleber Antonio Jansen

    2015-01-01

    Objective: To evaluate the resistance and regeneration of the patellar ligament after harvesting a graft for reconstruction of the anterior cruciate ligament, using the traditional technique of a single longitudinal skin incision or a technique of two transverse mini-incisions, in sheep. Methods: Ten sheep were used. In the right knee, we removed the graft using the traditional method, and in the left knee, using the two-incision method. The animals were observed for six months. The specimens (patellar ligament, tibia and patella) were adapted to the mechanical test machine for ligament resistance tests. Results: No difference was found between the two proposed techniques in relation to the regeneration and resistance of the patellar ligament. However, we observed that shortening of the patellar ligament occurred in both groups, and that suturing of the superficial fascia of the patellar ligament did not influence the regeneration of the patellar ligament, according to the histology. Conclusion: The technique using two incisions in the skin presents the same patterns of regeneration and resistance of the remaining patellar ligament as shown by the traditional technique of a single, longitudinal incision. PMID:27022540

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

    NASA Technical Reports Server (NTRS)

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

    2002-01-01

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

  7. Three intraoperative methods to determine limb-length discrepancy in THA.

    PubMed

    Rice, Ian S; Stowell, R Lee; Viswanath, Purab C; Cortina, Gary J

    2014-05-01

    Limb-length discrepancy (LLD) is a common concern for both surgeon and patient in the setting of elective total hip arthroplasty (THA). There is a paucity of evidence guiding surgeons to an optimal method for measuring intraoperative LLD and minimizing postoperative LLD. The primary objective of this prospective, randomized, double-blinded study was to determine which of 3 intraoperative methods used at the authors' institution was best correlated to postoperative radiographic LLD. From 2011 to 2012, 81 patients undergoing either primary (75) or revision (6) THA with an anterolateral (Watson-Jones) approach were prospectively randomized and received intraoperative measurement of LLD via 1 of 3 methods: abductor shuck (AS), tranosseous pins with calibrated caliper (TP), or patella electrocardiogram (EKG) leads (PL). Intraoperative measurements of LLD were compared to clinical and radiographic postoperative measurements of LLD, and absolute differences and correlation coefficients were calculated for each method. Overall, the mean LLD preoperatively was 8.09 mm, and mean radiographic LLD postoperatively was 4.20 mm. The AS method was associated with the highest correlation to postoperative radiographic LLD (R=0.360; P<.05), whereas the other methods had mildly positive but statistically insignificant correlations (TP R=0.275; P>.05; PL R=0.301; P>.05). The AS method best correlates to postoperative radiographic LLD among the 3 techniques, although all methods were positively correlated. Clinical measurements of LLD correlate poorly with radiographic measurements and may be of limited utility. PMID:24810827

  8. Determination of trace metal baseline values in Posidonia oceanica, Cystoseira sp., and other marine environmental biomonitors: a quality control method for a study in South Tyrrhenian coastal areas.

    PubMed

    Conti, Marcelo Enrique; Mecozzi, Mauro; Finoia, Maria Grazia

    2015-03-01

    In this study, we investigated Cd, Cr, Cu, Pb, and Zn in the seagrass Posidonia oceanica (L.) Delile leaves and in the brown algae Cystoseira sp. sampled along a 280-km transect in the Tyrrhenian Sea, from the Ustica to Linosa Islands (Sicily, Italy) with the aim to determine their control charts (baseline levels). By applying the Johnson's (Biometrika 36:149-175, 1949) probabilistic method, we determined the metal concentration overlap ranges in a group of five biomonitors. Here, we propose the use of the indexes of bioaccumulation with respect to the lowest (L'i) and the highest (L i) extreme values of the overlap metal concentration ranges. These indexes allow the identification of the most opportune organism (or a suite of them) to better managing particular environmental conditions. Posidonia leaves have generally high L i indexes for Cd, Cu, Pb, and Zn, and this suggests its use as biomonitor for baseline marine areas. Our results confirm the high aptitude of Patella as a good biomonitor for Cd levels in seawater. From this study, Ustica resulted with higher levels of Cd, Cu, Pb, and Zn than the other Sicilian Islands. PMID:25253055

  9. Revision Surgery in Permanent Patellar Dislocation in DiGeorge Syndrome

    PubMed Central

    Berruto, Massimo; Parente, Andrea; Ferrua, Paolo; Pasqualotto, Stefano; Uboldi, Francesco; Usellini, Eva

    2015-01-01

    A 29-year-old patient, suffering from DiGeorge syndrome, came to our attention with a history of persistent pain and patellar instability in the left knee after failure of arthroscopic lateral release and Elmslie-Trillat procedure. The patient was unable to walk without crutches and severely limited in daily living activities. Because of arthritic changes of the patellofemoral joint and the failure of previous surgeries it was decided to perform only an open lateral release and medial patellofemoral ligament (MPFL) reconstruction using a biosynthetic ligament in order to obtain patellofemoral stability. At one year post-op range of motion (ROM) was 0–120 with a firm end point at medial patellar mobilization; patella was stable throughout the entire ROM. All the scores improved and she could be able to perform daily activity without sensation of instability. Bilateral patellar subluxation and systemic hyperlaxity are characteristics of syndromic patients and according to literature can be also present in DiGeorge syndrome. MPFL reconstruction with lateral release was demonstrated to be the correct solution in the treatment of patellar instability in this complex case. The choice of an artificial ligament to reconstruct the MPFL was useful in this specific patient with important tissue laxity due to her congenital syndrome. PMID:26783479

  10. Peripheral nerve blocks in patients with Ehlers-Danlos syndrome, hypermobility type: a report of 2 cases.

    PubMed

    Patzkowski, Michael S

    2016-03-01

    Ehlers-Danlos syndrome is an inherited disorder of collagen production that results in multiorgan dysfunction. Patients with hypermobility type display skin hyperextensibility and joint laxity, which can result in chronic joint instability, dislocation, peripheral neuropathy, and severe musculoskeletal pain. A bleeding diathesis can be found in all subtypes of varying severity despite a normal coagulation profile. There have also been reports of resistance to local anesthetics in these patients. Several sources advise against the use of regional anesthesia in these patients citing the 2 previous features. There have been reports of successful neuraxial anesthesia, but few concerning peripheral nerve blocks, none of which describe nerves of the lower extremity. This report describes 2 cases of successful peripheral regional anesthesia in the lower extremity. In case 1, a 16-year-old adolescent girl with hypermobility type presented for osteochondral grafting of tibiotalar joint lesions. She underwent a popliteal sciatic (with continuous catheter) and femoral nerve block under ultrasound guidance. She proceeded to surgery and tolerated the procedure under regional block and intravenous sedation. She did not require any analgesics for the following 15 hours. In case 2, an 18-year-old woman with hypermobility type presented for medial patellofemoral ligament reconstruction for chronic patella instability. She underwent a saphenous nerve block above the knee with analgesia in the distribution of the saphenous nerve lasting for approximately 18 hours. There were no complications in either case. Prohibitions against peripheral nerve blocks in patients with Ehlers-Danlos syndrome, hypermobility type, appear unwarranted. PMID:26897449

  11. Medial patellofemoral ligament reconstruction in patellar instability

    PubMed Central

    Krishna Kumar, MS; Renganathan, Sankarram; Joseph, Clement J; Easwar, TR; Rajan, David V

    2014-01-01

    Background: Medial patellofemoral ligament (MPFL) is one of the major static medial stabilising structures of the patella. MPFL is most often damaged in patients with patellar instability. Reconstruction of MPFL is becoming a common surgical procedure in treating patellar instability. We hypothesised that MPFL reconstruction was adequate to treat patients with patellar instability if the tibial tubercle and the centre of the trochlear groove (TT-TG) value was less than 20 mm and without a dysplastic trochlea. Materials and Methods: 30 patients matching our inclusion criteria and operated between April 2009 and May 2011 were included in the study. MPFL reconstruction was performed using gracilis tendon fixed with endobutton on the patellar side and bio absorbable interference screw or staple on the femoral side. Patients were followed up with subjective criteria, Kujala score and Lysholm score. Results: The mean duration of followup was 25 months (range 14-38 months). The mean preoperative Kujala score was 47.5 and Lysholm score was 44.7. The mean postoperative Kujala score was 87 and Lysholm score was 88.06. None of the patients had redislocation. Conclusion: MPFL reconstruction using gracilis tendon gives excellent results in patients with patellar instability with no redislocations. Some patients may have persistence of apprehension. PMID:25298558

  12. BIOMECHANICAL ACCESS METHOD FOR ANALYZING ISOMETRICITY IN RECONSTRUCTING THE MEDIAL PATELLOFEMORAL LIGAMENT

    PubMed Central

    Sadigursky, David; Gobbi, Riccardo Gomes; Pereira, César Augusto Martins; Pécora, José Ricardo; Camanho, Gilberto Luis

    2015-01-01

    Objective: To present a biomechanical device for evaluating medial patellofemoral ligament (MPFL) reconstruction and its isometricity. Methods: An accessible biomechanical method that allowed application of physiological and non-physiological forces to the knee using a mechanical arm and application of weights and counterweights was developed, so as to enable many different evaluations and have a very accurate measurement system for distances between different structures, for analysis on experiments. This article describes the assembly of this system, and suggests some practical applications. Six cadaver knees were studied. The knees were prepared in a testing machine developed at the Biomechanics Laboratory of IOT–HCFMUSP, which allowed dynamic evaluation of patellar behavior, with quantification of patellar lateralization between 0° and 120°. The differences between the distances found with and without load applied to the patella were grouped according to the graft fixation angle (0°, 30°, 60° or 90°) and knee position (intact, damaged or reconstructed). Results: There was a tendency for smaller lateral displacement to occur at fixation angles greater than 30 degrees of flexion, especially between the angles of 45° and 60° degrees of flexion, after the reconstruction. For the other angles, there was no statistical significance. Conclusion: The method developed is a useful tool for studies on the patellofemoral joint and the MPFL, and has a very accurate measurement system for distances between different structures. It can be used in institutions with fewer resources available. PMID:27047872

  13. Trace metals in different species of mollusca, water and sediments from Taiwan coastal area.

    PubMed

    Hung, T C; Meng, P J; Han, B C; Chuang, A; Huang, C C

    2001-08-01

    Since October 1994, a long-term program of Asia/Pacific Mussel Watch: Taiwan Regional Studies has been carried out. The results indicate that trace metal contents in mollusca varied among 30 different species and the environments (water and sediments) along the Taiwan coast. The orders of bioaccumulation of trace metals in mollusca were: Cu (over 200 microg/g), Thais clavigera > Isognomon legumen > Clibanarius rivescens > Crassostrea gigas; Zn (over 700 microg/g), Moruta granulata > C. gigas > Asiatica cypraea arabica > T. clavigera; Cd (over 5 microg/g), Trochus hanleyanus > Acanthopleura japonica > Nerita albicilla > Patella flexuosa; Pb (over 2 microg/g), P. flexuosa > C. gigas > T. hanleyanus > T. clavigera > C. gigas > Capiyulum mitella; Ni (over 10 microg/g), Meretrix lusoria > Philine sp. > Littoraria scabra > Tridacna squamosa > T. hanleyanus; Cr (over 30 microg/g), Littoraria undulata > T. hanleyanus > N. albicilla > Nerita chamaelor > M. granulata; As (over 20 microg/g), Perna viridis > L. scabra; and Sn (over 5 microg/g), P. viridis > L. undulata> C. mitella> C. gigas. Their seasonal and regional variations as well as their correlation are evaluated and discussed. PMID:11482676

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

    PubMed

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

    2014-08-01

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

  15. GROSS AND HISTOPATHOLOGIC CORRELATION OF LOW-FIELD MAGNETIC RESONANCE IMAGING FINDINGS IN THE STIFLE OF ASYMPTOMATIC HORSES.

    PubMed

    Santos, Marcos P; Gutierrez-Nibeyro, Santiago D; McKnight, Alexia L; Singh, Kuldeep

    2015-01-01

    With the recent introduction of a 0.25T rotating MRI system, clinical evaluation of the equine stifle joint is now possible in the average equine athlete. A recent publication described common abnormalities of horses with stifle lameness detected with a low-field MRI system; however, postmortem corroboration of the lesions detected was not possible. Therefore, our objective was to compare postmortem findings with low-field MRI findings in equine cadaver stifle joints. Ten fresh cadaver stifle joints from horses without clinical signs of stifle disease were evaluated using low-field MRI, gross dissection, and histopathology. In eight stifles, either the lateral or medial cranial meniscotibial ligament had an irregular shape, fiber separation, or moderate abnormal signal intensity (SI) on all sequences. In five stifles, the medial femoral condyle had articular cartilage fibrillation with or without an osteochondral defect over the weight bearing surface of the medial femoral condyle. All stifles had abnormal SI on all sequences within the patellar ligaments that corresponded with adipose tissue infiltrating between the collagen bundles. Other abnormalities identified included articular cartilage fibrillation of the tibial condyles in three stifles, and articular cartilage fibrillation with chondral defects in the patella in three stifles. All abnormalities detected with low-field MRI were corroborated by gross dissection. Findings from the current study supported the use of low-field MRI for detection of stifle joint lesions in horses and demonstrated that some stifle joint pathologies may be subclinical in horses. PMID:25545132

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

    PubMed

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

    2015-01-01

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

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

    PubMed Central

    Scillato-Yané, Gustavo Juan; Soibelzon, Esteban

    2015-01-01

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

  18. A Novel Association between Femoroacetabular Impingement and Anterior Knee Pain

    PubMed Central

    Sanchis-Alfonso, Vicente; Tey, Marc; Monllau, Joan Carles

    2015-01-01

    Background. For a long time it has been accepted that the main problem in the anterior knee pain (AKP) patient is in the patella. Currently, literature supports the link between abnormal hip function and AKP. Objective. Our objective is to investigate if Cam femoroacetabular impingement (FAI) resolution is related to the outcome in pain and disability in patients with chronic AKP recalcitrant to conservative treatment associated with Cam FAI. Material and Methods. A retrospective study on 7 patients with chronic AKP associated with FAI type Cam was performed. Knee and hip pain were measured with the visual analogue scale (VAS), knee disability with the Kujala scale, and hip disability with the Nonarthritic Hip Score (NAHS). Results. The VAS knee pain score and VAS hip pain score had a significant improvement postoperatively. At final follow-up, there was significant improvement in all functional scores (Kujala score and NAHS). Conclusion. Our finding supports the link between Cam FAI and AKP in some young patients. Assessment of Cam FAI should be considered as a part of the physical examination of patients with AKP, mainly in cases with pain recalcitrant to conservative treatment. PMID:26451254

  19. COL5A1: Fine genetic mapping, intron/exon organization, and exclusion as candidate gene in families with tuberous sclerosis complex 1, hereditary hemorrhagic telangiectasia, and Ehlers-Danlos syndrome type II

    SciTech Connect

    Greenspan, D.S.; Papenberg, K.A.; Marchuk, D.A.

    1994-09-01

    Type V collagen is the only fibrillar collagen which has yet to be implicated in the pathogenesis of genetic diseases in humans or mice. To begin examining the possible role of type V collagen in genetic disease, we have previously mapped COL5A1, the gene for the {alpha}1 chain of type V collagen, to 9q23.2{r_arrow}q34.3 and described two restriction site polymorphisms which allowed us to exclude COL5A1 as candidate gene for nail-patella syndrome. We have now used these polymorphisms to exclude COL5A1 as candidate gene for tuberous sclerosis complex 1 and Ehlers-Danlos syndrome type II. In addition, we describe a CA repeat, with observed heterozygosity of about 0.5, in a COL5A1 intron, which has allowed us to exclude COL5A1 as a candidate gene in hereditary hemorrhagic telangiectasia and to place COL5A1 on the CEPH family genetic map between markers D9S66 and D9S67. We have also determined the entire intron/exon organization of COL5A1, which will facilitate characterization of mutations in genetic diseases with which COL5A1 may be linked in future studies.

  20. Integrated assessment of oil pollution using biological monitoring and chemical fingerprinting.

    PubMed

    Lewis, Ceri; Guitart, Carlos; Pook, Chris; Scarlett, Alan; Readman, James W; Galloway, Tamara S

    2010-06-01

    A full assessment of the impact of oil and chemical spills at sea requires the identification of both the polluting chemicals and the biological effects they cause. Here, a combination of chemical fingerprinting of surface oils, tissue residue analysis, and biological effects measures was used to explore the relationship between spilled oil and biological impact following the grounding of the MSC Napoli container ship in Lyme Bay, England in January 2007. Initially, oil contamination remained restricted to a surface slick in the vicinity of the wreck, and there was no chemical evidence to link biological impairment of animals (the common limpet, Patella vulgata) on the shore adjacent to the oil spill. Secondary oil contamination associated with salvage activities in July 2007 was also assessed. Chemical analyses of aliphatic hydrocarbons and terpanes in shell swabs taken from limpet shells provided an unequivocal match with the fuel oil carried by the ship. Corresponding chemical analysis of limpet tissues revealed increased concentrations of polycyclic aromatic hydrocarbons (PAHs) dominated by phenanthrene and C1 to C3 phenanthrenes with smaller contributions from heavier molecular weight PAHs. Concurrent ecotoxicological tests indicated impairment of cellular viability (p < 0.001), reduced immune function (p < 0.001), and damage to DNA (Comet assay, p < 0.001) in these animals, whereas antioxidant defenses were elevated relative to un-oiled animals. These results illustrate the value of combining biological monitoring with chemical fingerprinting for the rapid identification of spilled oils and their sublethal impacts on biota in situ. PMID:20821580

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

    TOXLINE Toxicology Bibliographic Information

    Gonzales EE; van der Zee M; Dictus WJ; van den Biggelaar J

    2007-02-01

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

  2. A novel reductive transformation of oxazepam to nordiazepam observed during enzymatic hydrolysis.

    PubMed

    Fu, Shanlin; Lewis, John; Wang, Hongjie; Keegan, Jim; Dawson, Michael

    2010-06-01

    beta-Glucuronidase is an enzyme often employed to de-conjugate beta-glucuronides during urinary drug testing for benzodiazepines. It is commonly accepted that use of beta-glucuronidase is a preferred method of hydrolysis over acid-catalyzed hydrolysis, which is known to induce benzodiazepine degradation and transformation. Literature to date, however, has not reported any cases of benzodiazepine transformation initiated by commercial beta-glucuronidase products. In this study, urine specimens containing either oxazepam or oxazepam glucuronide were incubated with beta-glucuronidase enzymes obtained from Escherichia coli, Helix pomatia, and Patella vulgata under various incubation conditions. After liquid-liquid extraction, the extract was analyzed by both liquid chromatography-tandem mass spectrometry and gas chromatography-mass spectrometry for the presence of benzodiazepines. All three enzyme preparations examined were capable of reducing oxazepam or oxazepam glucuronide into nordiazepam (desmethyldiazepam). Nordiazepam formation was positively correlated with incubation temperature, incubation time, oxazepam concentration, and enzyme concentration. Under all enzymatic hydrolysis conditions investigated, the percentage of nordiazepam formation is < 2.5% relative to the amount of oxazepam present in the system. The findings of this study have both clinical and forensic implications, and it is clear that the detection of nordiazepam in biological samples subjected to testing involving enzyme-catalyzed hydrolysis should be interpreted with care. PMID:20529458

  3. Ex vivo evaluation of the effect of various surgical procedures on blood delivery to the patellar tendon of dogs.

    PubMed

    Johnson, Matthew D; Shmon, Cindy L; Linn, Kathleen A; Singh, Baljit

    2016-05-01

    OBJECTIVE To determine the effect of arthrotomy alone or in combination with osteotomy of the proximal portion of the tibia on blood delivery to the patellar tendon of dogs. SAMPLE 24 canine cadavers. PROCEDURES One hind limb from each cadaver was assigned to 1 of 4 treatment groups: medial arthrotomy (MA; MA group), lateral arthrotomy (LA; LA group), MA and LA with tibial tuberosity transposition (MALA group), and MA with tibial plateau leveling osteotomy (TPLO; TPLO group). The contralateral hind limb served as the control sample. Contrast solution (barium [33%], India ink [17%], and saline [0.9% NaCl] solution [50%]) was injected through an 8F catheter inserted in the caudal portion of the abdominal aorta. Limbs were radiographed to allow examination of vascular filling. The patella, patellar tendon, and tibial crest were harvested, radiographed to allow examination of tissue vascular filling, and fixed in 4% paraformaldehyde. Vessels perfused with contrast solution were counted in sections obtained from the proximal, middle, and distal regions of each patellar tendon. RESULTS Vessel counts did not differ significantly among the 3 tendon regions. Compared with results for the control group, delivery of contrast solution to the patellar tendon was significantly decreased in the MALA and TPLO groups but was not changed in the MA or LA groups. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that surgical procedures used to treat cranial cruciate injuries (ie, TPLO) and patellar luxation decreased blood delivery to the patellar tendon of canine cadavers, at least acutely. PMID:27111023

  4. Prediction of Glycosaminoglycan Content in Human Cartilage by Age, T1? and T2 MRI

    PubMed Central

    Keenan, Kathryn E; Besier, Thor F; Pauly, John M; Han, Eric; Rosenberg, Jarrett; Smith, R. Lane; Delp, Scott L; Beaupre, Gary S; Gold, Garry E

    2011-01-01

    Summary Objective A relationship between T1? relaxation time and glycosaminoglycan (GAG) content has been demonstrated in chemically degraded bovine cartilage, but has not been demonstrated with quantitative biochemistry in human cartilage. A relationship has also been established between T2 relaxation time in cartilage and osteoarthritis severity. We hypothesized that T1? relaxation time would be associated with GAG content in human cartilage with normal T2 relaxation times. Methods T2 relaxation time, T1? relaxation time, and glycosaminoglycan as a percentage of wet weight (sGAG) were measured for top and bottom regions at seven anatomical locations in twenty-one human cadaver patellae. For our analysis, T2 relaxation time was classified as normal or elevated based on a threshold defined by the mean plus one standard deviation of the T2 relaxation time for all samples. Results In the normal T2 relaxation time subset, T1? relaxation time correlated with sGAG in the full-thickness and bottom regions, but only marginally in the top region alone. sGAG decreased significantly with age in all regions. Conclusion In the subset of cartilage specimens with normal T2 relaxation time, T1? relaxation time was inversely associated with sGAG content, as hypothesized. A predictive model, which accounts for T2 relaxation time and the effects of age, might be able to determine longitudinal trends in GAG content in the same person based on T1? relaxation time maps. PMID:21112409

  5. Anterior knee pain following primary total knee arthroplasty

    PubMed Central

    Shervin, David; Pratt, Katelyn; Healey, Travis; Nguyen, Samantha; Mihalko, William M; El-Othmani, Mouhanad M; Saleh, Khaled J

    2015-01-01

    Despite improvements in technique and technology for total knee arthroplasty (TKA), anterior knee pain impacts patient outcomes and satisfaction. Addressing the prosthetic and surgical technique related causes of pain after TKA, specifically as it relates to anterior knee pain, can aid surgeons in addressing these issues with their patients. Design features of the femoral and patellar components which have been reported as pain generators include: Improper femoral as well as patellar component sizing or designs that result in patellofemoral stuffing; a shortened trochlear groove distance from the flange to the intercondylar box; and then surgical technique related issues resulting in: Lateral patellar facet syndrome; overstuffed patella/flange combination; asymmetric patellar resurfacing, improper transverse plane component rotation resulting in patellar subluxation/tilt. Any design consideration that allows impingement of extensor mechanism anatomical elements has the possibility of impacting outcome by becoming a pain generator. As the number of TKA procedures continues to increase, it is increasingly critical to develop improved, evidence based prostheses that maximize function and patient satisfaction while minimizing pain and other complications. PMID:26601061

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

    PubMed

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

    2011-11-01

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

  7. Knee cartilage extraction and bone-cartilage interface analysis from 3D MRI data sets

    NASA Astrophysics Data System (ADS)

    Tamez-Pena, Jose G.; Barbu-McInnis, Monica; Totterman, Saara

    2004-05-01

    This works presents a robust methodology for the analysis of the knee joint cartilage and the knee bone-cartilage interface from fused MRI sets. The proposed approach starts by fusing a set of two 3D MR images the knee. Although the proposed method is not pulse sequence dependent, the first sequence should be programmed to achieve good contrast between bone and cartilage. The recommended second pulse sequence is one that maximizes the contrast between cartilage and surrounding soft tissues. Once both pulse sequences are fused, the proposed bone-cartilage analysis is done in four major steps. First, an unsupervised segmentation algorithm is used to extract the femur, the tibia, and the patella. Second, a knowledge based feature extraction algorithm is used to extract the femoral, tibia and patellar cartilages. Third, a trained user corrects cartilage miss-classifications done by the automated extracted cartilage. Finally, the final segmentation is the revisited using an unsupervised MAP voxel relaxation algorithm. This final segmentation has the property that includes the extracted bone tissue as well as all the cartilage tissue. This is an improvement over previous approaches where only the cartilage was segmented. Furthermore, this approach yields very reproducible segmentation results in a set of scan-rescan experiments. When these segmentations were coupled with a partial volume compensated surface extraction algorithm the volume, area, thickness measurements shows precisions around 2.6%

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

    SciTech Connect

    Cretacci, Yan; Department of Environmental Health Sciences, School of Public Health, The University at Albany, P.O. Box 509, Albany, NY 12201-0509 ; Parsons, Patrick J.

    2010-01-15

    The principal aim of this study was to gain a better understanding of where lead (Pb) accumulates and how it is distributed, within the bones of dosed goats. Adult goats were periodically dosed with Pb over a number of years for the primary purpose of producing blood pools containing endogenously bound Pb, for the New York State Blood Lead Proficiency Testing Program. Bone samples (e.g., primarily tibia, femur, humerus, and radius) were collected post-mortem from 11 animals and were analyzed for Pb content by acid digestion and electrothermal atomic absorption spectrometry (ETAAS or GFAAS). Average tibia Pb levels were found to correlate strongly with the cumulative Pb dose (r{sup 2}=0.81). However, the concentration of Pb in different bones and even within a small area of the same bone varied tremendously. Blood-rich trabecular (spongy) bone, such as the patella and calcaneus, were much more enriched in Pb than was cortical (compact) bone. In some dosed animals, the Pb concentration in the tibia was markedly higher at the proximal and distal ends of the bone compared to the mid-shaft. The implications of these findings with regard to the noninvasive measurement of lead in bone by XRF methods are discussed.

  9. Impact induced failure of cartilage-on-bone following creep loading: a microstructural and fracture mechanics study.

    PubMed

    Thambyah, Ashvin; Zhang, Geran; Kim, Woong; Broom, Neil D

    2012-10-01

    Cartilage-on-bone samples obtained from healthy bovine patellae, with or without prior static compression (i.e. creep) at 2MPa for 3h, were delivered a single impact via an instrumented pendulum indenter at a velocity of 1.13m/s and an energy of 2.2J. Mechanical data was obtained and microstructural assessment of the region of failure was carried out using differential interference contrast (DIC) optical imaging. In addition, a fibrillar-level structural analysis using scanning electron microscopy (SEM) was conducted on a control batch of non-impacted samples that were subjected to either creep or non-creep loading protocols. Arising from the impact event the deepest levels of crack penetration into the articular cartilage occurred in those samples subjected to prior creep loading. Further the crack depth was inversely proportional to the rebound velocity of the indenter. By contrast, those impacted samples not subjected to prior creep loading had only short obliquely patterned microcracks confined to the upper one-third of the full cartilage depth. Ultrastructurally the creep-loaded cartilage matrix exhibited a substantial radial collapse or compaction of the fibrillar network in its primary radial zone. The increase in crack length in the prior creep-loaded cartilage is consistent with a reduction in its dissipative properties as indicated by a reduction in rebound velocity. An interpretation is offered in terms of classical fracture mechanics theory. PMID:22784816

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

    NASA Technical Reports Server (NTRS)

    Acharya, Raj S.; Shackelford, Linda

    1995-01-01

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

  11. Dynamic medial patellofemoral ligament reconstruction in recurrent patellar instability: A surgical technique

    PubMed Central

    Kiran, Kopuri Ravi; Srikanth, I Muni; Chinnusamy, Lenin; Deepti, K

    2015-01-01

    The medial patellofemoral ligament (MPFL) is the primary stabilizer of the patellofemoral joint; its reconstruction has been recommended in adults over the past decade after recurrent patellar instability. However, there has been no standardized technique for reconstruction, therefore, ideal graft and technique for reconstruction are yet undetermined. However, dynamic MPFL reconstruction studies claim to be superior to other procedures as it is more anatomical. This preliminary study aims at assessing the outcomes of MPFL reconstruction in a dynamic pattern using hamstring graft. We performed this procedure in four consecutive patients with chronic patellar instability following trauma. MPFL reconstruction was done with hamstring tendons detached distally and secured to patellar periosteum after being passed through a bony tunnel in the patella without an implant and using the medial collateral ligament as a pulley. In all 4 knees, the MPFL reconstruction was isolated and was not associated with any other realignment procedures. No recurrent episodes of dislocation or subluxation were reported at 24 months followup. PMID:26806970

  12. Pitfalls during biomechanical testing - Evaluation of different fixation methods for measuring tendons endurance properties.

    PubMed

    Hangody, Gy; Pánics, G; Szebényi, G; Kiss, R; Hangody, L; Pap, K

    2016-03-01

    The goal of the study was to find a proper technique to fix tendon grafts into an INSTRON loading machine. From 8 human cadavers, 40 grafts were collected. We removed the bone-patella tendon-bone grafts, the semitendinosus and gracilis tendons, the quadriceps tendon-bone grafts, the Achilles tendons, and the peroneus longus tendons from each lower extremity. We tested the tendon grafts with five different types of fixation devices: surgical thread (Premicron 3), general mounting clamp, wire mesh, cement fixation, and a modified clamp for an INSTRON loading machine. The mean failure load in case of surgical thread fixation was (381N ± 26N). The results with the general clamp were (527N ± 45N). The wire meshes were more promising (750N ± 21N), but did not reach the outcomes we desired. Easy slippages of the ends of the tendons from the cement encasements were observed (253N ± 18N). We then began to use Shi's clamp that could produce 977N ± 416N peak force. We combined Shi's clamp with freezing of the graft and the rupture of the tendon itself demonstrated an average force of 2198 N ± 773N. We determined that our modified frozen clamp fixed the specimens against high tensile forces. PMID:27030630

  13. Arthroscopic-assisted Arthrodesis of the Knee Joint With the Ilizarov Technique: A Case Report and Literature Review.

    PubMed

    Waszczykowski, Michal; Niedzielski, Kryspin; Radek, Maciej; Fabis, Jaroslaw

    2016-01-01

    Arthrodesis of the knee joint is a mainly a salvage surgical procedure performed in cases of infected total knee arthroplasty, tumor, failed knee arthroplasty or posttraumatic complication.The authors report the case of 18-year-old male with posttraumatic complication of left knee because of motorbike accident 1 year before. He was treated immediately after the injury in the local Department of Orthopaedics and Traumatology. The examination in the day of admission to our department revealed deformation of the left knee, massive scar tissue adhesions to the proximal tibial bone and multidirectional instability of the knee. The plain radiographs showed complete lack of lateral compartment of the knee joint and patella. The patient complained of severe instability and pain of the knee and a consecutive loss of supporting function of his left limb. The authors decided to perform an arthroscopic-assisted fusion of the knee with Ilizarov external fixator because of massive scar tissue in the knee region and the prior knee infection.In the final follow-up after 54 months a complete bone fusion, good functional and clinical outcome were obtained.This case provides a significant contribution to the development and application of low-invasive techniques in large and extensive surgical procedures in orthopedics and traumatology. Moreover, in this case fixation of knee joint was crucial for providing good conditions for the regeneration of damaged peroneal nerve. PMID:26817899

  14. Identification of a New Hesperornithiform from the Cretaceous Niobrara Chalk and Implications for Ecologic Diversity among Early Diving Birds

    PubMed Central

    Bell, Alyssa; Chiappe, Luis M.

    2015-01-01

    The Smoky Hill Member of the Niobrara Chalk in Kansas (USA) has yielded the remains of numerous members of the Hesperornithiformes, toothed diving birds from the late Early to Late Cretaceous. This study presents a new taxon of hesperornithiform from the Smoky Hill Member, Fumicollis hoffmani, the holotype of which is among the more complete hesperornithiform skeletons. Fumicollis has a unique combination of primitive (e.g. proximal and distal ends of femur not expanded, elongate pre-acetabular ilium, small and pyramidal patella) and derived (e.g. dorsal ridge on metatarsal IV, plantarly-projected curve in the distal shaft of phalanx III:1) hesperornithiform characters, suggesting it was more specialized than small hesperornithiforms like Baptornis advenus but not as highly derived as the larger Hesperornis regalis. The identification of Fumicollis highlights once again the significant diversity of hesperornithiforms that existed in the Late Cretaceous Western Interior Seaway. This diversity points to the existence of a complex ecosystem, perhaps with a high degree of niche partitioning, as indicated by the varying degrees of diving specializations among these birds. PMID:26580402

  15. Proteoglycan synthesis and osteophyte formation in 'metabolically' and 'mechanically' induced murine degenerative joint disease: an in-vivo autoradiographic study.

    PubMed Central

    van der Kraan, P. M.; Vitters, E. L.; van Beuningen, H. M.; van den Berg, W. B.

    1992-01-01

    We investigated the in-vivo proteoglycan synthesis in specific areas of murine knee joint articular cartilage after the induction of degenerative joint disease by means of 35S-sulphate autoradiography. Degenerative joint disease was induced either by direct interference with cartilage metabolism (papain and iodoacetate), or by the induction of joint instability (collagenase). Injection of iodoacetate and papain led to inhibition of proteoglycan synthesis mainly in the central parts of the patellae, patellaris femoris and the central part of the medial tibial plateau. Articular cartilage adjacent to the strongly inhibited areas frequently showed a significantly enhanced synthesis of proteoglycans. A strong inhibition of proteoglycan synthesis was observed in the central part of the medial plateau after collagenase injection while other cartilage sites and joint structures such as the capsule and ligaments were stimulated in their proteoglycan synthesis. This study shows that the localization of changes in cartilage metabolism in degenerative joint disease of the knee might be related to differences in the pathogenetic mechanism in different variants of this common joint disorder. Images Fig. 5 p341-a Fig. 2 Fig. 3 Fig. 4 Fig. 6 Fig. 7 Fig. 8 Fig. 9 PMID:1320394

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

    PubMed Central

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

    2013-01-01

    Edge loading causes clinical problems for hard-on-hard hip replacements, and edge loading wear scars are present on the majority of retrieved components. We asked the question: are the lines of action of hip joint muscles such that edge loading can occur in a well-designed, well-positioned acetabular cup? A musculoskeletal model, based on cadaveric lower limb geometry, was used to calculate for each muscle, in every position within the complete range of motion, whether its contraction would safely pull the femoral head into the cup or contribute to edge loading. The results show that all the muscles that insert into the distal femur, patella, or tibia could cause edge loading of a well-positioned cup when the hip is in deep flexion. Patients frequently use distally inserting muscles for movements requiring deep hip flexion, such as sit-to-stand. Importantly, the results, which are supported by in vivo data and clinical findings, also show that risk of edge loading is dramatically reduced by combining deep hip flexion with hip abduction. Patients, including those with sub-optimally positioned cups, may be able to reduce the prevalence of edge loading by rising from chairs or stooping with the hip abducted. © 2013 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 31:1172–1179, 2013. PMID:23575923

  17. High-Risk Stress Fractures: Diagnosis and Management.

    PubMed

    McInnis, Kelly C; Ramey, Lindsay N

    2016-03-01

    Stress fractures are common overuse injuries in athletes. They occur during periods of increased training without adequate rest, disrupting normal bone reparative mechanisms. There are a host of intrinsic and extrinsic factors, including biochemical and biomechanical, that put athletes at risk. In most stress fractures, the diagnosis is primarily clinical, with imaging indicated at times, and management focused on symptom-free relative rest with advancement of activity as tolerated. Overall, stress fractures in athletes have an excellent prognosis for return to sport, with little risk of complication. There is a subset of injuries that have a greater risk of fracture progression, delayed healing, and nonunion and are generally more challenging to treat with nonoperative care. Specific locations of high-risk stress fracture include the femoral neck (tension side), patella, anterior tibia, medial malleolus, talus, tarsal navicular, proximal fifth metatarsal, and great toe sesamoids. These sites share a characteristic region of high tensile load and low blood flow. High-risk stress fractures require a more aggressive approach to evaluation, with imaging often necessary, to confirm early and accurate diagnosis and initiate immediate treatment. Treatment consists of nonweight-bearing immobilization, often with a prolonged period away from sport, and a more methodic and careful reintroduction to athletic activity. These stress fractures may require surgical intervention. A high index of suspicion is essential to avoid delayed diagnosis and optimize outcomes in this subset of stress fractures. PMID:26972260

  18. Morphology of the pelvis and hind limb of the red panda (Ailurus fulgens) evidenced by gross osteology, radiography and computed tomography.

    PubMed

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

    2015-12-01

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

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

    PubMed Central

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

    2008-01-01

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

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

    PubMed Central

    Hwangbo, Pil-Neo

    2015-01-01

    [Purpose] The purpose of this study was to identify the effects of performing squat exercises with visual feedback on the activation of the vastus medialis oblique (VMO) and vastus lateralis (VL) muscles in young adults with an increased quadriceps angle (Q-angle). [Subjects] This study used a motion analysis program (Dartfish, Switzerland) to select 20 young adults with an increased Q-angle, who were then divided into a squat group that received visual feedback (VSG, n=10) and a squat group that received no visual feedback (SG, n=10). [Methods] The intensity of exercises was increased every two weeks over a six-week exercise period in both groups. A visual marker was attached to the patella of the subjects in the VSG, and they then performed squat exercises with a maximum of 90° of knee flexion within a route marked on a mirror. The SG performed squat exercises with a maximum 90° of knee flexion without attaching a visual feedback device. [Results] Analysis of the muscle activation due to 90° squat exercises indicated that both groups had statistically significant increases in activation of the VL. The VSG exhibited statistically significant increases in activation of the VMO. [Conclusion] This study confirmed that squat exercises with visual feedback are effective in activation of the VMO and VL muscles. The findings are meaningful in terms of preventing the occurrence of patellofemoral pain. PMID:26157251

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

    PubMed Central

    Clifford, Amanda M.; Harrington, Elaine

    Patellar taping is a treatment adjunct commonly used in the management of anterior knee pain. The aim of this cross sectional study was to investigate the effects of medial glide patellar taping on sagittal plane lower-limb joint kinematics and knee pain during a unilateral squat in a symptomatic population complaining of anterior knee pain. Ten participants with a history of unilateral or bilateral anterior knee pain were included in the study. Subjects were required to squat on the symptomatic leg under three conditions: placebo tape, patellar tape and no tape. Kinematic data was recorded using the CODA mpx64 motion analysis system and subjects’ pain was assessed using the Numerical Rating Scale. Patellar taping resulted in a significantly greater single-legged squat depth compared to placebo tape (p=0.008) and no tape (p=0.001) and a statistically significant reduction in pain during a squat compared to placebo tape (p=0.001) or no tape (p=0.001). Significant differences were not identified for maximum knee flexion in the patella taping compared to the no tape condition. This study may have significant clinical implications as participants reported less pain and alterations in sagittal plane movement following the application of patellar tape. PMID:24146711

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

    PubMed Central

    Cretacci, Yan; Parsons, Patrick J.

    2009-01-01

    The principal aim of this study was to gain a better understanding of where lead (Pb) accumulates and how it is distributed, within the bones of dosed goats. Adult goats were periodically dosed with Pb over a number of years for the primary purpose of producing blood pools containing endogenously bound Pb, for the New York State Blood Lead Proficiency Testing Program. Bone samples (e.g., primarily tibia, femur, humerus, and radius) were collected post-mortem from 11 animals and were analyzed for Pb content by acid digestion and electrothermal atomic absorption spectrometry (ETAAS or GFAAS). Average tibia-Pb levels were found to correlate strongly with the cumulative Pb dose (r2 = 0.81). However, the concentration of Pb in different bones and even within a small area of the same bone varied tremendously. Blood-rich trabecular (spongy) bone, such as the patella and calcaneus, were much more enriched in Pb than was cortical (compact) bone. In some dosed animals, the Pb concentration in the tibia was markedly higher at the proximal and distal ends of the bone compared to the mid-shaft. The implications of these findings with regard to the non-invasive measurement of lead in bone by XRF methods are discussed. PMID:19897186

  3. Clinical-radiographic correlation of the femoral insertion point of the graft in reconstruction of the medial patellofemoral ligament☆

    PubMed Central

    Pinheiro Júnior, Lúcio Flávio Biondi; Cenni, Marcos Henrique Frauendorf; Nicolai, Oscar Pinheiro; Carneiro, Guilherme Galvão Barreto; de Andrade, Rodrigo Cristiano; de Moraes, Vinícius Vidigal

    2015-01-01

    Objective To analyze the radiographic positioning of the femoral tunnel and correlate this with the postoperative clinical results among patients undergoing reconstruction of the medial patellofemoral ligament (MPFL) alone. Method This was a retrospective study in which 30 knees of 26 patients with recurrent dislocation of the patella that underwent MPFL reconstruction were evaluated. The femoral insertion point of the graft and the postoperative clinical condition were analyzed and correlated using the Kujala and Lysholm scales. Results 22 knees presented a femoral tunnel in the anatomical area (group A) and 8 outside of this location (group B). In group A, the mean score on the Kujala scale was 89.68 points and on the Lysholm scale was 92.45 points. In group B, the mean score on the Kujala scale was 84.75 points and on the Lysholm scale was 92 points. The difference between the means was not significant on either of the two scales. Conclusion Correlation with the clinical results did not show any difference in relation to the positioning of the femoral insertion of the graft.

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

    PubMed Central

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

    2015-01-01

    Introduction. Metallosis is a phenomenon most commonly associated with hip replacement. However it can occur in any metallic implant subject to wear. Wear creates metal debris, which is deposited in the surrounding soft tissue. This leads to many local adverse reactions including, but not limited to, implant loosening/osteolysis, pain, and effusion. In the deeper joints, for example, the hip, metal deposits are mostly only seen intraoperatively. Case Study. A 74-year-old lady represented to orthopaedic outpatient clinic. Her principle complaint was skin discolouration, associated with pain and swelling over the left knee, on the background of a previous total knee replacement with a metal backed patella resurfacing six years. A plain radiograph revealed loosening of the patellar prosthesis. A diagnosis of metallosis was made; the patient underwent debridement of the stained soft tissue and primary revision of the prosthesis. She remained symptom-free five years after revision. Discussion. Metallosis results in metallic debris which causes tissue staining, often hidden within the soft tissue envelope of the hip, but more apparent in the knee. Metallosis may cause pain, effusion, and systemic symptoms because of raised levels of serum-metal ions. Surgical intervention with revision and debridement can have good functional results. PMID:25878914

  5. Native cellular architecture of Treponema denticola revealed by cryo-electron tomography

    PubMed Central

    Izard, Jacques; Hsieh, Chyong-Ere; Limberger, Ronald J.; Mannella, Carmen A.; Marko, Michael

    2008-01-01

    Using cryo-electron tomography, we are developing a refined description of native cellular structures in the pathogenic spirochete Treponema denticola. Tightly organized bundles of periplasmic flagella were readily observed in intact plunge-frozen cells. The periplasmic space was measured in both wild-type and aflagellate strains, and found to widen by less than the diameter of flagella when the latter are present. This suggests that a structural change occurs in the peptidoglycan layer to accommodate the presence of the flagella. In dividing cells, the flagellar filaments were found to bridge the cytoplasmic cylinder constriction site. Cytoplasmic filaments, adjacent to the inner membrane, run parallel to the tightly organized flagellar filaments. The cytoplasmic filaments may be anchored by a narrow plate-like structure. The tapering of the cell ends was conserved between cells, with a patella-shaped structure observed in the periplasm at the tip of each cytoplasmic cylinder. Several incompletely characterized structures have been observed in the periplasm between dividing cells, including a cable-like structure linking two cytoplasmic cylinders and complex foil-shaped structures. PMID:18468917

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

    PubMed

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

    2015-04-01

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

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

    PubMed

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

    2015-03-01

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

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

    SciTech Connect

    Hu, H.; Kim, Rokho; Korrick, S.; Rotnitzky, A.

    1996-12-31

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

  9. The treatment of flexion contracture of the knee in myelomeningocele.

    PubMed

    Abraham, E; Verinder, D G; Sharrard, W J

    1977-11-01

    A follow-up study, on average four years after operation, of seventy-six cildren with myelomeningocele who had surgical treatment for flexion contracture of the knee, is reported. After a single operation sixty-eight knees (55 per cent) had a contracture of less than 20 degrees, which was the main criterion of success. About half of the cases of transplantation of the hamstrings to the femur, division or elongation of the hamstrings, or supracondylar osteotomy had successful results. Transfer of the hamstring tendons to the patella was successful in nine of twelve instances, so giving the lowest rate of failure. Forty-five patients were active walkers at follow-up as compared to eighteen before operation. However, only one of the eleven patients over twelve years of age with a motor level above T.12 was an active walker at review. Several conclusions are drawn. A flexion contracture of the hip greater than 30 degress should be corrected before operation of the knee. Supracondylar osteotomy as a primary procedure should only be used to correct flexion contracture of the knee secondary to malunited fractures. Faradic stimulation is useful in the evaluation of muslce function before operation. An intelligence quotient below 65 and weakness of the arms are relative contraindications for correction of the deformity of the knee. PMID:925053

  10. Identifying bacterial genes and endosymbiont DNA with Glimmer

    PubMed Central

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

    2008-01-01

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

  11. Assessment of lower limb prosthesis through wearable sensors and thermography.

    PubMed

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

    2014-01-01

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

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

    PubMed

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

    2014-02-01

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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

    Kim, Sung-Jae; Kumar, Praveen

    2010-01-01

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

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

    PubMed

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

    2001-01-01

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

  16. Outcome Following Surgical Correction of Grade 4 Medial Patellar Luxation in Dogs: 47 Stifles (2001-2012).

    PubMed

    Hans, Eric C; Kerwin, Sharon C; Elliott, Alan C; Butler, Ryan; Saunders, W Brian; Hulse, Don A

    2016-01-01

    Grade 4/4 medial patellar luxation (MPL) is a complex disease of the canine stifle that often requires surgical realignment of the patella to resolve clinical lameness. Outcome following surgery remains poorly described. Medical records were retrospectively reviewed for surgical correction of grade 4 MPL. Signalment and exam findings, surgical procedures performed, complications, and clinical outcome were reported. Data was statistically analyzed for association with major complication occurrence and unacceptable function following surgery. Forty-seven stifles from 41 dogs were included. The surgical procedures most frequently utilized for patellar realignment were the combination of femoral trochleoplasty, tibial tuberosity transposition, and joint capsule modification. Median in-hospital veterinary examination was performed at 69 days (range 30-179 days) following surgery. Full function was reported for 42.6% of cases (n=20). Acceptable function was reported for 40.4% of cases (n=19). Unacceptable function was reported for 17% of cases (n=8). The overall complication rate was 25.5% (n=12), with revision surgery for major complications required in 12.8% of cases (n=6). Corrective osteotomies were associated with major complications (P < 0.001). In general, pelvic limb function improves following surgical correction of grade 4 MPL; however, a return to full function should be considered guarded. PMID:27008322

  17. Impact of bone lead and bone resorption on plasma and whole blood lead levels during pregnancy.

    PubMed

    Téllez-Rojo, Martha María; Hernández-Avila, Mauricio; Lamadrid-Figueroa, Héctor; Smith, Donald; Hernández-Cadena, Leticia; Mercado, Adriana; Aro, Antonio; Schwartz, Joel; Hu, Howard

    2004-10-01

    The authors tested the hypotheses that maternal bone lead burden is associated with increasing maternal whole blood and plasma lead levels over the course of pregnancy and that this association is modified by rates of maternal bone resorption. A total of 193 Mexican women were evaluated (1997-1999) in the first, second, and third trimesters of pregnancy. Whole blood lead and plasma lead levels were measured in each trimester. Urine was analyzed for cross-linked N-telopeptides (NTx) of type I collagen, a biomarker of bone resorption. Patella and tibia lead levels were measured at 4 weeks postpartum. The relation between whole blood, plasma, and bone lead and NTx was assessed using mixed models. Plasma lead concentrations followed a U-shape, while NTx levels increased significantly during pregnancy. In a multivariate model, the authors observed a significant and positive interaction between NTx and bone lead when plasma lead was used as the outcome variable. Dietary calcium intake was inversely associated with plasma lead. Results for whole blood lead were similar but less pronounced. These results confirm previous evidence that bone resorption increases during pregnancy, with a consequential significant release of lead from bone, constituting an endogenous source of prenatal exposure. They also provide a rationale for testing strategies (e.g., nutritional supplementation with calcium) aimed at decreasing prenatal lead exposure. PMID:15383411

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

    PubMed

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

    2015-01-01

    Introduction. Metallosis is a phenomenon most commonly associated with hip replacement. However it can occur in any metallic implant subject to wear. Wear creates metal debris, which is deposited in the surrounding soft tissue. This leads to many local adverse reactions including, but not limited to, implant loosening/osteolysis, pain, and effusion. In the deeper joints, for example, the hip, metal deposits are mostly only seen intraoperatively. Case Study. A 74-year-old lady represented to orthopaedic outpatient clinic. Her principle complaint was skin discolouration, associated with pain and swelling over the left knee, on the background of a previous total knee replacement with a metal backed patella resurfacing six years. A plain radiograph revealed loosening of the patellar prosthesis. A diagnosis of metallosis was made; the patient underwent debridement of the stained soft tissue and primary revision of the prosthesis. She remained symptom-free five years after revision. Discussion. Metallosis results in metallic debris which causes tissue staining, often hidden within the soft tissue envelope of the hip, but more apparent in the knee. Metallosis may cause pain, effusion, and systemic symptoms because of raised levels of serum-metal ions. Surgical intervention with revision and debridement can have good functional results. PMID:25878914

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

    NASA Astrophysics Data System (ADS)

    Graniero, Lauren; Surge, Donna; Gillikin, David

    2015-04-01

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

  20. “The Superficial Quad Technique” for Medial Patellofemoral Ligament Reconstruction: The Surgical Video Technique

    PubMed Central

    Goyal, Deepak

    2015-01-01

    With the introduction of the superficial quad technique, there has been a recent revival of interest in the quadriceps tendon as a graft choice for medial patellofemoral ligament (MPFL) reconstruction. The superficial quad technique has many anatomic advantages because the length, breadth, and thickness of the graft are similar to those of the native MPFL; moreover, the graft provides a continuous patellar attachment at the superior half of the medial border of the patella. The technique requires neither a patellar bony procedure nor patellar hardware. Biomechanically, the mean strength and stiffness of the graft are very similar to those of the native MPFL. The anatomic and biomechanical advantages depend on correct identification of the anatomic superficial lamina of the quadriceps tendon; hence the correct harvesting technique for the superficial lamina is crucial. Various sub-techniques for harvesting the quadriceps graft have emerged recently, such as superficial strip, pedicled, or partial graft harvesting; these can create confusion for surgeons. Additional confusion related to the preparation and fixation of the graft should also be addressed to avoid any potential complications. A step-by-step video of the superficial quad technique is presented, covering the exact dissection of the graft material and its preparation, delivery, and fixation. PMID:26900556

  1. [Cost analysis of implant-free replacement of anterior cruciate ligament].

    PubMed

    Frenzel, G; Wuschech, H; Felmet, G; Ingenhoven, E; Schmidt, M; Ziesche, J-J

    2010-08-01

    Replacement of the anterior cruciate ligament (ACL) is presently routinely carried out with autologous transplantation of the ligamentum patellae (LP), semintendinosus-gracilis (SGS) or quadriceps (QS) tendons. The anatomical positioning of the drilling canals, transplant fixation, complication rate, revision aspects as well as economic aspects are still under discussion. Fixation of the transplant can be carried out mechanically with various anchoring systems or using biological implant-free healing (free of cost). The compulsory and private health insurance companies as well as staff medical insurance associations guarantee a constant remuneration according to the EBM (uniform evaluation standard), GOA (scale of fees for physicians) or UV-GOA (accident insurance scale of fees for physicians). At present all health insurances accept the costs for implantations in outpatient areas (minus 25 Euro own contribution for compulsory health insurance). For inpatient treatment remuneration is according to the flat-rate scale (diagnosis-related groups). Costs for implants, which are increasing over the years, diminish the economic result in this case. The technique of implant-free replacement of ACLs is cheaper, with fewer complications and achieves functional results for fixation of the transplant which are comparable to techniques with implants. This also applies to the double bundle technique. Implant-free replacement of ACLs with the patellar tendon is a suitable, uncomplicated operation technique with comparably low costs and belongs to the state of the art according to Hertel, Petersen and other authors. This method already has a valuable place in surgery of the ACL. PMID:20697862

  2. IPE 7

    NASA Technical Reports Server (NTRS)

    1983-01-01

    A description is given of the collection and treatment of samples of Prochloron cells. The cells of Prochloron were obtained and prepared in the following way. Colonies of the symbiotic host, the giant didemnid ascidian Lissoclinum patella, were collected at low-tide level on reef-flat sand between Kamori Island and Koror, Palau, Western Caroline Islands. The animal colonies were taken, immersed in sea water, to an 8,000-litre holding tank and kept with constantly running sea water at 30 deg. Individual colonies were picked clean of contaminants, rinsed in sea water buffered with 40 nM or 100 mM Tris buffer at pH 8.4, and squeezed by hand to express the algal cells from the cloacal atria. The algae were received in about an equal volume of the same buffered sea water; this neutralized the acids liberated by the bruised ascidians and thereby maintained the Ph high enough to keep the algal cells green. The Prochloron cells were washed twice with buffered sea water and concentrated by centrifugation at about 50 g for 90 seconds. Microscopic examination revealed that contamination by animal host cells or bacteria was negligible (much less than 1%).

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

    PubMed

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

    2014-01-01

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

  4. Multicenter-study of operative treatment of intraligamentous tears of the anterior cruciate ligament in children and adolescents: comparison of four different techniques.

    PubMed

    Gebhard, F; Ellermann, A; Hoffmann, F; Jaeger, J-H; Friederich, N F

    2006-09-01

    Tears of the anterior cruciate ligament in skeletally immature patients were operated with four different methods and their outcome compared to each other. Sixty-eight patients (33 males, 35 females), mean 12.5 years, were treated in four different centers from 1984 to 2001. Twenty-eight patients underwent the ACL-reconstruction with hamstring grafts, 16 patients with bone-patella-bone autografts, 12 patients with quadriceps grafts and 12 patients with facia lata. The mean follow-up was 32 months. Postoperative evaluation included radiographs, KT-1000/2000 stability measurements, Lysholm score, The Tegner activity scale and IKDC score. Neither leg length discrepancy nor angular deformities were noted. Mean KT-1000 difference was 2.1 mm, mean postoperative Lysholm knee score 93.3, IKDC 87% normal or nearly normal. The Tegner index decreased from 6.6 to 5.7. In total, six patients developed instability due to an adequate trauma 1 year after the index operation. Two patients showed mild arthrotic changes. All but two patients were able to return to the same level of preoperative sports participation. None of the four methods studied showed major differences in outcome compared to the other. No growth disturbance could be noted. PMID:16628459

  5. Die Makrofauna und ihre Verteilung im Nordost-Felswatt von Helgoland

    NASA Astrophysics Data System (ADS)

    Janke, Klaus

    1986-03-01

    The macrofauna and its distribution in the sheltered, rocky intertidal zone of Helgoland (North Sea) was studied at 9 vertically and/or morphologically different stations from March to September in 1984. Seasonal variations in the communities were described based on each species' “conspicuousness”. A total of 172 species was found. The macrofauna shows a zoned pattern, but also the different substrata, for example, affect its distribution. The number of species increases from the upper intertidal to the upper sublittoral zone from 23 to 133 species. The upper intertidal is characterized by Littorina saxatilis, Chaetogrammarus marinus and Hyale nilssonii. Typical and abundant species of the middle and lower intertidal are Flustrellidra hispida, Littorina mariae/obtusata, Littorina littorea, Mytilus edulis and Spirorbis spirorbis. The upper sublittoral zone is characterized by Gibbula cineraria and increasing species numbers of Bryozoa, Nemertini and Opisthobranchia. Only few species (e.g. Dynamena pumila, Laomedea flexuosa, Polydora ciliata, Fabricia sabella, Jaera albifrons, Carcinus maenas) occur in the entire intertidal zone. In comparison to other very sheltered shores in Great Britain, which are also dominated by Fucaceae, the macrofauna in the Helgoland intertidal zone lacks several littoral species, such as Patella spp., Monodonta lineata, Gibbula umbilicalis, Littorina neritoides, Chthamalus spp., whereas Littorina littorea and Gibbula cineraria are highly abundant.

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

    PubMed Central

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

    2015-01-01

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

  7. Anterior knee pain following primary total knee arthroplasty.

    PubMed

    Shervin, David; Pratt, Katelyn; Healey, Travis; Nguyen, Samantha; Mihalko, William M; El-Othmani, Mouhanad M; Saleh, Khaled J

    2015-11-18

    Despite improvements in technique and technology for total knee arthroplasty (TKA), anterior knee pain impacts patient outcomes and satisfaction. Addressing the prosthetic and surgical technique related causes of pain after TKA, specifically as it relates to anterior knee pain, can aid surgeons in addressing these issues with their patients. Design features of the femoral and patellar components which have been reported as pain generators include: Improper femoral as well as patellar component sizing or designs that result in patellofemoral stuffing; a shortened trochlear groove distance from the flange to the intercondylar box; and then surgical technique related issues resulting in: Lateral patellar facet syndrome; overstuffed patella/flange combination; asymmetric patellar resurfacing, improper transverse plane component rotation resulting in patellar subluxation/tilt. Any design consideration that allows impingement of extensor mechanism anatomical elements has the possibility of impacting outcome by becoming a pain generator. As the number of TKA procedures continues to increase, it is increasingly critical to develop improved, evidence based prostheses that maximize function and patient satisfaction while minimizing pain and other complications. PMID:26601061

  8. Revision Surgery in Permanent Patellar Dislocation in DiGeorge Syndrome.

    PubMed

    Berruto, Massimo; Parente, Andrea; Ferrua, Paolo; Pasqualotto, Stefano; Uboldi, Francesco; Usellini, Eva

    2015-01-01

    A 29-year-old patient, suffering from DiGeorge syndrome, came to our attention with a history of persistent pain and patellar instability in the left knee after failure of arthroscopic lateral release and Elmslie-Trillat procedure. The patient was unable to walk without crutches and severely limited in daily living activities. Because of arthritic changes of the patellofemoral joint and the failure of previous surgeries it was decided to perform only an open lateral release and medial patellofemoral ligament (MPFL) reconstruction using a biosynthetic ligament in order to obtain patellofemoral stability. At one year post-op range of motion (ROM) was 0-120 with a firm end point at medial patellar mobilization; patella was stable throughout the entire ROM. All the scores improved and she could be able to perform daily activity without sensation of instability. Bilateral patellar subluxation and systemic hyperlaxity are characteristics of syndromic patients and according to literature can be also present in DiGeorge syndrome. MPFL reconstruction with lateral release was demonstrated to be the correct solution in the treatment of patellar instability in this complex case. The choice of an artificial ligament to reconstruct the MPFL was useful in this specific patient with important tissue laxity due to her congenital syndrome. PMID:26783479

  9. [Post-traumatic knee joint arthroscopy in children and adolescents].

    PubMed

    Lauterburg, M T; Segantini, P

    1994-01-01

    In a retrospective study we analyzed the arthroscopic findings of 166 knee-arthroscopies performed in children and young people up to the age of 16 years. A sports related trauma was present in 54%, a traffic injury in 15% and in 11% an other casualty. In 4% the precise injury was not sure and 16% did not refer any injury. Among the sports injuries (n = 90) ski injuries were the most frequent with 30% of all, followed by gymnastic injuries in 28%, soccer in 25% and other indoor sport injuries in 12%. 57% of all arthroscopies presented a hemarthrosis. The main finding of all arthroscopies was an cartilage lesion. The anterior cruciate ligament was torn in 30% and a dislocated patella was established in 22% of the arthroscopy while a meniscus injury was found in 17%. The injury of the collateral ligaments or of the retinaculum was found in 22%. In all cases of hemarthrosis origin of bleeding was found and only in 6% (n = 10) of all arthroscopy no pathological finding was established. PMID:7921792

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

    PubMed

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

    2006-05-01

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

  11. Identification of a New Hesperornithiform from the Cretaceous Niobrara Chalk and Implications for Ecologic Diversity among Early Diving Birds.

    PubMed

    Bell, Alyssa; Chiappe, Luis M

    2015-01-01

    The Smoky Hill Member of the Niobrara Chalk in Kansas (USA) has yielded the remains of numerous members of the Hesperornithiformes, toothed diving birds from the late Early to Late Cretaceous. This study presents a new taxon of hesperornithiform from the Smoky Hill Member, Fumicollis hoffmani, the holotype of which is among the more complete hesperornithiform skeletons. Fumicollis has a unique combination of primitive (e.g. proximal and distal ends of femur not expanded, elongate pre-acetabular ilium, small and pyramidal patella) and derived (e.g. dorsal ridge on metatarsal IV, plantarly-projected curve in the distal shaft of phalanx III:1) hesperornithiform characters, suggesting it was more specialized than small hesperornithiforms like Baptornis advenus but not as highly derived as the larger Hesperornis regalis. The identification of Fumicollis highlights once again the significant diversity of hesperornithiforms that existed in the Late Cretaceous Western Interior Seaway. This diversity points to the existence of a complex ecosystem, perhaps with a high degree of niche partitioning, as indicated by the varying degrees of diving specializations among these birds. PMID:26580402

  12. Giant cell tumor of the tendon sheath in the knee of an 11-year-old girl.

    PubMed

    Abdullah, Arifaizad; Abdullah, Shalimar; Haflah, Nor Hazla Mohd; Ibrahim, Sharaf

    2010-01-01

    Giant cell tumors are commonly found over the flexor tendon sheath of the hand and wrist. However, giant cell tumors in the knee joint are rare, especially in children. We report an interesting case of an 11-year-old girl who presented with a painful lump on her right knee that enlarged over time. Clinically, she had fullness over the anterolateral part of her knee. Magnetic resonance imaging revealed an encapsulated mass inferior to the patella. The tumor measured 3 x 3.5 x 1.5 cm. Histopathological findings confirmed that it was a tenosynovial giant cell tumor. Because of initial mild symptoms, there was a delay of 2 years from the initial symptoms until tumor excision. Her follow-up period was 35 months, and her health to date is excellent with no recurrence. We believe that reporting this rare case will help clinicians update their knowledge on possible causes of lumps in the knee, and avoid diagnostic delay. It could also prove to be beneficial in arriving at a diagnosis in future cases. PMID:20103492

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

    PubMed Central

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

    2012-01-01

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

  14. Reduction of temazepam to diazepam and lorazepam to delorazepam during enzymatic hydrolysis.

    PubMed

    Fu, Shanlin; Molnar, Anna; Bowron, Peter; Lewis, John; Wang, Hongjie

    2011-04-01

    It has been previously reported that treatment of urinary oxazepam by commercial β-glucuronidase enzyme preparations, from Escherichia coli, Helix pomatia and Patella vulgata, results in production of nordiazepam (desmethyldiazepam) artefact. In this study, we report that this unusual reductive transformation also occurs in other benzodiazepines with a hydroxyl group at the C3 position such as temazepam and lorazepam. As determined by liquid chromatography-mass spectrometry analysis, all three enzyme preparations were found capable of converting urinary temazepam into diazepam following enzymatic incubation and subsequent liquid-liquid extraction procedures. For example, when H. pomatia enzymes were used with incubation conditions of 18 h and 50 °C, the percentage conversion, although small, was significant--approximately 1% (0.59-1.54%) in both patient and spiked blank urines. Similarly, using H. pomatia enzyme under these incubation conditions, a reductive transformation of urinary lorazepam into delorazepam (chlordesmethyldiazepam) occurred. These findings have both clinical and forensic implications. Detection of diazepam or delorazepam in biological samples following enzyme treatment should be interpreted with care. PMID:21298417

  15. Exposure to solar radiation drives organismal vulnerability to climate: Evidence from an intertidal limpet.

    PubMed

    Chapperon, Coraline; Volkenborn, Nils; Clavier, Jacques; Séité, Sarah; Seabra, Rui; Lima, Fernando P

    2016-04-01

    Understanding the physiological abilities of organisms to cope with heat stress is critical for predictions of species' distributions in response to climate change. We investigated physiological responses (respiration and heart beat rate) of the ectotherm limpet Patella vulgata to heat stress events during emersion and the role of seasonal and microclimatic acclimatization for individual thermal tolerance limits. Individuals were collected from 5 microhabitats characterized by different exposure to solar radiation in the high intertidal zone of a semi-exposed rocky shore in winter and summer of 2014. Upper thermal tolerance limits (heat coma temperatures - HCTs, and heart rate Arrhenius break temperatures - ABTs) were determined for individuals from each microhabitat in both seasons under laboratory conditions. While we found a clear seasonal acclimatization, i.e., higher HCTs and ABTs in summer than in winter, we did not find evidence for microhabitat-specific responses that would suggest microclimatic acclimatization. However, operative limpet temperatures derived from in-situ temperature measurements suggest that individuals from sun exposed microhabitats have a much narrower thermal safety margins than those from less exposed surfaces or within crevices. Microhabitat specific thermal safety margins caused by high thermal heterogeneity at small spatial scales and the lack of short term acclimatization will likely shape small scale distribution patterns of intertidal species in response to the predicted increase in the frequency and intensity of heat waves. PMID:27033044

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

    PubMed Central

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

    2015-01-01

    ABSTRACT Tarantulas extend the femur–patella (proximal) and tibia–metatarsal (distal) joints of their legs hydraulically. Because these two hydraulically actuated joints are positioned in series, hemolymph flow within each leg is expected to mechanically couple the movement of the joints. In the current study, we tested two hypotheses: (1) at lower temperatures, movement of the two in-series hydraulic joints within a leg will be less coupled because of increased hemolymph viscosity slowing hemolymph flow; and (2) at higher temperatures, movement of the two in-series hydraulic joints will be less coupled because the higher stride frequencies limit the time available for hemolymph flow. We elicited maximal running speeds at four ecologically relevant temperatures (15, 24, 31 and 40°C) in Texas Brown tarantulas (Aphonopelma hentzi). The spiders increased sprint speed 2.5-fold over the temperature range by changing their stride frequency but not stride length. The coefficient of determination for linear regression (R2) of the proximal and distal joint angles was used as the measure of the degree of coupling between the two joints. This coupling coefficient between the proximal and distal joint angles, for both forelegs and hind­legs, was significantly lowest at the highest temperature at which the animals ran the fastest with the highest stride frequencies. The coordination of multiple, in-series hydraulically actuated joints may be limited by operating speed. PMID:25833132

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

    PubMed Central

    Le Minor, J M

    1987-01-01

    The os peroneum is found in only a few primate families and seems to be completely absent in the non-primate pentadactyl mammals, in the Prosimii and in the Platyrrhinii (New World monkeys). In the Cercopithecidae (Catarrhinii, Old World monkeys) and the Hylobatidae, the os peroneum is a coffee bean-shaped constant, large and regular bone. The lateral surface of the bone is convex in all directions and non-articular. The medial surface is covered with hyaline cartilage and articulates by means of a synovial joint with the corresponding facet of the cuboid bone. The histological structure and the mode of ossification of the os peroneum are identical to that of other short bones of the skeleton. The os peroneum of the Cercopithecidae and Hylobatidae is an example of a new skeletal element that has appeared in a tendon subject to unusual mechanical stress. In the case of the peroneus longus tendon the stress is due to repetitive friction because of the functional importance of this muscle in the adduction and pseudo-opposability of the hallux. This osseous element is genetically fixed and hereditarily transmitted. Its mode of appearance is analogous to that accepted for the origin of the patella. In the Pongidae, the os peroneum is absent or rare. In man, this bone is relatively infrequent (approx 20% of mature individuals) and its shape is most irregular. In this case, the os peroneum appears as a regressive form of the typical bone observed in the above families, which is in the process of disappearing. Besides fundamental genetical factors, this regression is probably in relation to the disappearance of the functional importance of the peroneus longus muscle to the loss of the hallux opposability. Thus the mechanical factors cannot be dissociated from the genetic and phylogenetic factors in explaining the appearance and the regression of the os peroneum. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 PMID:3654363

  18. A polymorphism in the delta-aminolevulinic acid dehydratase gene may modify the pharmacokinetics and toxicity of lead.

    PubMed Central

    Smith, C M; Wang, X; Hu, H; Kelsey, K T

    1995-01-01

    Associations between the presence of a constitutional variant of delta-aminolevulinic acid dehydratase (ALAD-2) and lead concentrations in blood and bone, as well as between this allele and indices of kidney function, were investigated among 691 members of a construction trade union. The average blood lead level in this group was 7.78 micrograms/dl. No significant difference was observed in blood lead concentration in ALAD-2 carriers compared to those homozygous for the more common ALAD-1 allele (7.78 +/- 3.62 micrograms Pb/dl vs. 7.73 ( +/- 3.48 micrograms Pb/dl, respectively; p = 0.73). Bone lead was measured in a subset of 122 of the study subjects. Patella minus tibia lead concentrations for each individual averaged 3.35 +/- 11.99 micrograms Pb/g bone mineral in ALAD-1 homozygotes and 8.62 +/- 9.47 micrograms Pb/g bone mineral in ALAD-2 carriers (p = 0.06). Comparisons of blood urea nitrogen (BUN) and uric acid by genotype indicated elevated levels among ALAD-2 individuals (p = 0.03 and 0.07, respectively). In logistic regression models accounting for other variables potentially associated with BUN and uric acid levels, BUN was significantly associated with blood lead levels (p = 0.01). Associations of BUN and uric acid levels with ALAD-2 were of borderline statistical significance in these models (p = 0.06 and 0.07). Taken together, these results suggest that the ALAD-2 genotype may influence the pharmacokinetic distribution and chronic renal toxicity of lead, perhaps due to differential binding of lead to the variant protein. Images p248-a Figure 1. PMID:7768225

  19. Rehabilitation of Patellar Tendinopathy Using Hip Extensor Strengthening and Landing-Strategy Modification: Case Report With 6-Month Follow-up.

    PubMed

    Scattone Silva, Rodrigo; Ferreira, Ana Luisa G; Nakagawa, Theresa H; Santos, José E M; Serrão, Fábio V

    2015-11-01

    Study Design Case report. Background Although eccentric exercises have been a cornerstone of the rehabilitation of athletes with patellar tendinopathy, the effectiveness of this intervention is sometimes less than ideal. Athletes with patellar tendinopathy have been shown to have different jump-landing patterns and lower hip extensor strength compared to asymptomatic athletes. To our knowledge, the effectiveness of an intervention addressing these impairments has not yet been investigated. Case Description The patient was a 21-year-old male volleyball athlete with a 9-month history of patellar tendon pain. Pain was measured with a visual analog scale. Disability was measured with the Victorian Institute of Sport Assessment-patella questionnaire. These assessments were conducted before and after an 8-week intervention, as well as at 6 months after the intervention. Hip and knee kinematics and kinetics during drop vertical jump and isometric strength were also measured before and after the 8-week intervention. The intervention consisted of hip extensor muscle strengthening and jump landing strategy modification training. The patient did not interrupt volleyball practice/competition during rehabilitation. Outcomes After the 8-week intervention and at 6 months postintervention, the athlete was completely asymptomatic during sports participation. This favorable clinical outcome was accompanied by a 50% increase in hip extensor moment, a 21% decrease in knee extensor moment, and a 26% decrease in patellar tendon force during jump landing measured at 8 weeks. Discussion This case report provides an example of how an 8-week intervention of hip muscle strengthening and jump-landing modification decreased pain and disability and improved jump-landing biomechanics in an athlete with patellar tendinopathy. Level of Evidence Therapy, level 4. J Orthop Sports Phys Ther 2015;45(11):899-909. Epub 21 Sep 2015. doi:10.2519/jospt.2015.6242. PMID:26390271

  20. Metal-binding proteins as metal pollution indicators.

    PubMed Central

    Hennig, H F

    1986-01-01

    The fact that metal-binding proteins are a consequence of elevated metal concentration in organisms is well known. What has been overlooked is that the presence of these proteins provides a unique opportunity to reformulate the criteria of metal pollution. The detoxification effect of metal-binding proteins in animals from polluted areas has been cited, but there have been only very few studies relating metal-binding proteins to pollution. This lack is due partly to the design of most experiments, which were aimed at isolation of metal-binding proteins and hence were of too short duration to allow for correlation to adverse physiological effects on the organism. In this study metal-binding proteins were isolated and characterized from five different marine animals (rock lobster, Jasus lalandii; hermit crab, Diogenes brevirostris; sandshrimp, Palaemon pacificus; black mussel, Choromytilus meridionalis; and limpet, Patella granularis). These animals were kept under identical metal-enriched conditions, hence eliminating differences in method and seasons. The study animals belonged to different phyla; varied in size, mass, age, behavior, food requirements and life stages; and accumulated metals at different rates. It is possible to link unseasonal moulting in crustacea, a known physiological effect due to a metal-enriched environment, to the production of the metal-binding protein without evidence of obvious metal body burden. Thus a new concept of pollution is defined: the presence of metal-binding proteins confirms toxic metal pollution. This concept was then tested under field conditions in the whelk Bullia digitalis and in metal-enriched grass. PMID:3709437

  1. Patellar subluxation. A recent history.

    PubMed

    Hughston, J C

    1989-04-01

    For 15 years (1955 to 1970), I was plowing "new ground" pretty much by myself. When you plow behind an old mule and hit a stump hole full of cottonmouth moccasins, you have to get on the move in a hurry and figure out some solution to the predicament or you won't get your corn planted. So, I was not treating the overweight, knock-kneed, loose-jointed, teenaged girl, but the young boy or girl who thought that he or she was an athlete and had dreams of being a star. If rehabilitation did not work, then I thought a lateral release, an Elmslie, and nothing short of a full reconstruction would solve the problem. One had to develop as much vastus medialis obliquus power as this dysplastic muscle could generate, had to transfer the strong vastus lateralis to a more central pull, and, with the distal reconstruction, correct any patella alta and Q-angle abnormality. One had to give the knee every possible advantage in order to serve an athlete. As Hippocrates so wisely noted, one needed to study the athlete to know, with appropriate modifications, what is best for every patient, young or old. In the late 1960s and early 1970s, many fine young orthopedists were stimulated by the information of the AAOS postgraduate courses in sports medicine. They, after having gained further through their own experiences, have become the major contributors to our increasing knowledge of the patellofemoral joint, especially in athletes, and many of these fine "young" (now a little older) orthopedists are now the contributors to this issue. They are giving you their experiences, knowledge, and lessons. A close and repeated study of their information must be combined with compassion for your patient. Then, only experience will develop the desired fine tuning. PMID:2752433

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

    PubMed

    Stoffel, Karl; Willers, Craig; Korshid, Omar; Kuster, Markus

    2007-09-01

    Patella infera is a known complication of high tibial osteotomy (HTO) that can cause anterior knee pain due to excessive stresses associated with abnormal patellofemoral (PF) joint biomechanics. However, the translation of these abnormal biomechanics to native cartilage pressure has not been explored. The present study was designed to compare the PF contact pressures of three different HTOs in a human cadaveric model of valgus tibiofemoral correction. Nine fresh cadaveric knees underwent (1) medial opening wedge (OWHTO) with a proximal tuberosity osteotomy (PTO), (2) OWHTO with a distal tuberosity osteotomy (DTO), and (3) a lateral closing wedge (CWHTO). The specimens were mounted in a custom knee simulation rig, with muscle forces being simulated using a pulley system and weights. The PF contact pressure was recorded using an electronic pressure sensor at 15 degrees , 30 degrees , 60 degrees , 90 degrees , and 120 degrees of knee flexion, with results of the intact knees obtained as relative control. Compared to the intact knee, the DTO OWHTO and CWHTO did not significantly (P > 0.05) influence PF pressure at any flexion angle. On the other hand, PTO OWHTO lead to a significant elevation in PF cartilage pressure at 30 degrees (P < 0.05), 60 degrees (P < 0.005), and 90 degrees (P < 0.0005) knee flexion. We conclude from these results that DTO OWHTO maintains normal joint biomechanics and has no significant effect on PF cartilage pressure. In patients who complain of pre-existing anterior knee pain, DTO OWHTO or CWHTO should be considered. PMID:17342550

  3. Lower extremity finite element model for crash simulation

    SciTech Connect

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

    1996-03-01

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

  4. Conorfamide-Sr2, a gamma-carboxyglutamate-containing FMRFamide-related peptide from the venom of Conus spurius with activity in mice and mollusks

    PubMed Central

    Aguilar, Manuel B.; Luna-Ramírez, Karen S.; Echeverría, Daniel; Falcón, Andrés; Olivera, Baldomero M.; Heimer de la Cotera, Edgar P.; Maillo, María

    2008-01-01

    A novel peptide, conorfamide-Sr2 (CNF-Sr2), was purified from the venom extract of Conus spurius, collected in the Caribbean Sea off the Yucatan Peninsula. Its primary structure was determined by automated Edman degradation and amino acid analysis, and confirmed by electrospray ionization mass spectrometry. Conorfamide-Sr2 contains 12 amino acids and no Cys residues, and it is only the second FMRFamide-related peptide isolated from a venom. Its primary structure GPMγDPLγIIRI-nh2, (γ, gamma-carboxyglutamate;-nh2, amidated C-terminus; calculated monoisotopic mass, 1,468.72 Da; experimental monoisotopic mass, 1,468.70 Da) shows two features that are unusual among FMRFamide-related peptides (FaRPs, also known as RFamide peptides), namely the novel presence of gamma-carboxyglutamate, and a rather uncommon C-terminal residue, Ile. CNF-Sr2 exhibits paralytic activity in the limpet Patella opea and causes hyperactivity in the freshwater snail Pomacea paludosa and in the mouse. The sequence similarities of CNF-Sr2 with FaRPs from marine and freshwater mollusks and mice might explain its biological effects in these organisms. It also resembles FaRPs from polychaetes (the prey of C. spurius), which suggests a natural biological role. Based on these similarities, CNF-Sr2 might interact with receptors of these three distinct types of FaRPs, G-protein-coupled receptors, Na+ channels activated by FMRFamide (FaNaCs), and acid-sensing ion channels (ASICs). The biological activities of CNF-Sr2 in mollusks and mice make it a potential tool to study molecular targets in these and other organisms. PMID:18201803

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

    PubMed Central

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

    2013-01-01

    Objective: Differences in contrast agent diffusion reflect changes in composition and structure of articular cartilage. However, in clinical application the contrast agent concentration in the joint capsule varies, which may affect the reliability of contrast enhanced cartilage tomography (CECT). In the present study, effects of concentration of x-ray contrast agents on their diffusion and equilibrium distribution in cartilage were investigated. Design: Full-thickness cartilage discs (d = 4.0 mm, n = 120) were detached from bovine patellae (n = 24). The diffusion of various concentrations of ioxaglate (5, 10, 21, 50 mM) and iodide (30, 60, 126, 300 mM) was allowed only through the articular surface. Samples were imaged with a clinical peripheral quantitative computed tomography scanner before immersion in contrast agent, and after 1, 5, 9, 16, 25, and 29 hours in the bath. Results: Diffusion and partition coefficients were similar between different contrast agent concentrations. The diffusion coefficient of iodide (473 ± 133 µm2/s) was greater (P ≤ 0.001) than that of ioxaglate (92 ± 46 µm2/s). In full-thickness cartilage, the partition coefficient (at 29 h) of iodide (71 ± 5%) was greater (P ≤ 0.02 with most concentrations) than that of ioxaglate (62 ± 6%). Conclusions: Significant differences in partition and diffusion coefficient of two similarly charged (−1) contrast agents were detected, which shows the effect of steric interactions. However, the increase in solute concentration did not increase its partition coefficient. In clinical application, it is important that contrast agent concentration does not affect the interpretation of CECT imaging. PMID:26069649

  6. Metal-binding proteins as metal pollution indicators

    SciTech Connect

    Hennig, H.F.

    1986-03-01

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

  7. Marine Climate Archives across the Medieval Climate Anomaly-Little Ice Age Transition from Viking and Medieval Age Shells, Orkney, Scotland

    NASA Astrophysics Data System (ADS)

    Surge, D. M.; Barrett, J. H.

    2013-12-01

    Proxy records reconstructing marine climatic conditions across the transition between the Medieval Climate Anomaly (MCA; ~900-1350 AD) and Little Ice Age (LIA; ~1350-1850) are strongly biased towards decadal to annual resolution and summer/growing seasons. Here we present new archives of seasonal variability in North Atlantic sea surface temperature (SST) from shells of the European limpet, Patella vulgata, which accumulated in Viking and medieval shell and fish middens at Quoygrew on Westray, Orkney. SST was reconstructed at submonthly resolution using oxygen isotope ratios preserved in shells from the 12th and mid 15th centuries (MCA and LIA, respectively). MCA shells recorded warmer summers and colder winters by ~2 degrees C relative to the late 20th Century (1961-1990). Therefore, seasonality was higher during the MCA relative to the late 20th century. Without the benefit of seasonal resolution, SST averaged from shell time series would be weighted toward the fast-growing summer season, resulting in the conclusion that the early MCA was warmer than the late 20th century by ~1C. This conclusion is broadly true for the summer season, but not true for the winter season. Higher seasonality and cooler winters during early medieval times may result from a weakened North Atlantic Oscillation index. In contrast, the LIA shells have a more a variable inter-annual pattern. Some years record cooler summers and winters relative to the MCA shells and late 20th century, whereas other years record warmer summers and cooler winters similar to the MCA shells. Our findings provide a new test for the accuracy of seasonal amplitudes resulting from paleoclimate model experiments.

  8. Limpet Shells from the Aterian Level 8 of El Harhoura 2 Cave (Témara, Morocco): Preservation State of Crossed-Foliated Layers.

    PubMed

    Nouet, Julius; Chevallard, Corinne; Farre, Bastien; Nehrke, Gernot; Campmas, Emilie; Stoetzel, Emmanuelle; El Hajraoui, Mohamed Abdeljalil; Nespoulet, Roland

    2015-01-01

    The exploitation of mollusks by the first anatomically modern humans is a central question for archaeologists. This paper focuses on level 8 (dated around ∼ 100 ka BP) of El Harhoura 2 Cave, located along the coastline in the Rabat-Témara region (Morocco). The large quantity of Patella sp. shells found in this level highlights questions regarding their origin and preservation. This study presents an estimation of the preservation status of these shells. We focus here on the diagenetic evolution of both the microstructural patterns and organic components of crossed-foliated shell layers, in order to assess the viability of further investigations based on shell layer minor elements, isotopic or biochemical compositions. The results show that the shells seem to be well conserved, with microstructural patterns preserved down to sub-micrometric scales, and that some organic components are still present in situ. But faint taphonomic degradations affecting both mineral and organic components are nonetheless evidenced, such as the disappearance of organic envelopes surrounding crossed-foliated lamellae, combined with a partial recrystallization of the lamellae. Our results provide a solid case-study of the early stages of the diagenetic evolution of crossed-foliated shell layers. Moreover, they highlight the fact that extreme caution must be taken before using fossil shells for palaeoenvironmental or geochronological reconstructions. Without thorough investigation, the alteration patterns illustrated here would easily have gone unnoticed. However, these degradations are liable to bias any proxy based on the elemental, isotopic or biochemical composition of the shells. This study also provides significant data concerning human subsistence behavior: the presence of notches and the good preservation state of limpet shells (no dissolution/recrystallization, no bioerosion and no abrasion/fragmentation aspects) would attest that limpets were gathered alive with tools by Middle Palaeolithic (Aterian) populations in North Africa for consumption. PMID:26376294

  9. Theoretical Accuracy of Model-Based Shape Matching for Measuring Natural Knee Kinematics with Single-Plane Fluoroscopy

    PubMed Central

    Rahman, Haseeb A.; Banks, Scott A.

    2006-01-01

    Quantification of knee motion under dynamic, in vivo loaded conditions is necessary to understand how knee kinematics influence joint injury, disease, and rehabilitation. Though recent studies have measured three-dimensional knee kinematics by matching geometric bone models to single-plane fluoroscopic images, factors limiting the accuracy of this approach have not been thoroughly investigated. This study used a three-step computational approach to evaluate theoretical accuracy limitations due to the shape matching process alone. First, cortical bone models of the femur, tibia/fibula, and patella were created from CT data. Next, synthetic (i.e., computer generated) fluoroscopic images were created by ray tracing the bone models in known poses. Finally, an automated matching algorithm utilizing edge detection methods was developed to align flat-shaded bone models to the synthetic images. Accuracy of the recovered pose parameters was assessed in terms of measurement bias and precision. Under these ideal conditions where other sources of error were eliminated, tibiofemoral poses were within 2 mm for sagittal plane translations and 1.5 deg for all rotations while patellofemoral poses were within 2 mm and 3 deg. However, statistically significant bias was found in most relative pose parameters. Bias disappeared and precision improved by a factor of two when the synthetic images were regenerated using flat shading (i.e., sharp bone edges) instead of ray tracing (i.e., attenuated bone edges). Analysis of absolute pose parameter errors revealed that the automated matching algorithm systematically pushed the flat-shaded bone models too far into the image plane to match the attenuated edges of the synthetic ray-traced images. These results suggest that biased edge detection is the primary factor limiting the theoretical accuracy of this single-plane shape matching procedure. PMID:16121540

  10. KINEMATIC DETERMINANTS OF ANTERIOR KNEE PAIN IN CEREBRAL PALSY, A CASE_CONTROL STUDY

    PubMed Central

    Sheehan, Frances T.; Babushkina, Anna; Alter, Katharine E.

    2013-01-01

    Objective To quantify the role patellofemoral and tibiofemoral kinematics may play in development of anterior knee pain (AKP) in individuals with cerebral palsy (CP). Design Case-Control Setting Clinical Research Center Participants Twenty knees from individuals diagnosed with CP and 40 control knees were evaluated. Controls were matched for sex and age based on the group average. Matching by height and weight was a secondary priority. Subjects in the control cohort were asymptomatic with no history of lower leg abnormality, surgery, or major injury. Only individuals who were physically capable of sustaining slow cyclic knee flexion-extension for 2.5 minutes and had no contraindications to MR imaging were enrolled. Both groups were samples of convenience. Interventions Not applicable. Main Outcome Measure The 3D patellofemoral and tibiofemoral joint kinematics, acquired during active leg extension, under volitional control. Results Participants with CP and AKP (n=8) demonstrated significantly greater patellofemoral extension, valgus rotation, superior, and posterior displacement relative to controls and to the subgroup of participants with CP and no AKP (n=12). Patellofemoral extension discriminated AKP in individuals with CP with 100% accuracy. Conclusions In quantifying the 3D in vivo knee joint kinematics during a volitional extension task, kinematic markers that discriminate AKP in individuals with CP were identified. This provides an ability to predict which individuals with CP are most likely to advance into AKP and could enable aggressive conservative treatment, aimed at reducing patella alta and excessive PF extension to be prescribed prior to considering surgical options. The current findings will likely lead to improved clinical diagnostics and interventions for individuals with CP, with the ultimate goal of helping maintain, if not improve functional mobility throughout the lifespan. PMID:22465585

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

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

    2001-06-01

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

  14. A newly discovered muscle: The tensor of the vastus intermedius.

    PubMed

    Grob, K; Ackland, T; Kuster, M S; Manestar, M; Filgueira, L

    2016-03-01

    The quadriceps femoris is traditionally described as a muscle group composed of the rectus femoris and the three vasti. However, clinical experience and investigations of anatomical specimens are not consistent with the textbook description. We have found a second tensor-like muscle between the vastus lateralis (VL) and the vastus intermedius (VI), hereafter named the tensor VI (TVI). The aim of this study was to clarify whether this intervening muscle was a variation of the VL or the VI, or a separate head of the extensor apparatus. Twenty-six cadaveric lower limbs were investigated. The architecture of the quadriceps femoris was examined with special attention to innervation and vascularization patterns. All muscle components were traced from origin to insertion and their affiliations were determined. A TVI was found in all dissections. It was supplied by independent muscular and vascular branches of the femoral nerve and lateral circumflex femoral artery. Further distally, the TVI combined with an aponeurosis merging separately into the quadriceps tendon and inserting on the medial aspect of the patella. Four morphological types of TVI were distinguished: Independent-type (11/26), VI-type (6/26), VL-type (5/26), and Common-type (4/26). This study demonstrated that the quadriceps femoris is architecturally different from previous descriptions: there is an additional muscle belly between the VI and VL, which cannot be clearly assigned to the former or the latter. Distal exposure shows that this muscle belly becomes its own aponeurosis, which continues distally as part of the quadriceps tendon. Clin. Anat. 29:256-263, 2016. 2015 Wiley Periodicals, Inc. PMID:26732825

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

    PubMed

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

    2015-08-01

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

  16. Clinical evaluation of hip joint in sagittal plane using pelvifemoral angle

    PubMed Central

    Kamath, B. Jagannath; Saraswati, V.; Bansal, Ankush; Pai, Vishal

    2013-01-01

    Background Pelvifemoral angle has been described in early literature but the values have not been validated and no mention of distal bony point has been made. Methods Patients attending the Orthopaedic Outpatient in our hospital with complaints not related to the hip or knee were included in this study. Exclusion criteria included patients with history of hip pathology (Unilateral or Bilateral) and patients with Pelvis or Lower Limb fractures (Unilateral or Bilateral. Measurements were taken using a measuring tape, and angles were measured using a Goniometer Authors describe two clinical measurements of the hip joint in sagittal plane using Nelaton's line as reference for pelvis and line joining greater trochanter to 1. Superolateral pole of patella (α angle) and 2. Fibular head (β angle). Three hundred normal hips of 150 individuals were included in this study and angles were measured in supine and standing position. Results Mean values of these angles (in supine and standing) were 67 ± 1° (α angle) and 51 ± 1° (β angle) in males and 72 ± 2° (α angle) and 58 ± 2° (β angle) in females. These angles are independent of age, height, weight and hence, the body mass index of a person. Conclusion Authors are describing a simple yet accurate method of quantifying the clinical pelvifemoral angle which will reflect upon the fixed flexion deformity at the hip in unilateral/bilateral pathological hip cases where other conventional methods are either unreliable or painful to perform. PMID:26403877

  17. “Basket weave technique” for medial patellofemoral ligament reconstruction: Clinical outcome of a prospective study

    PubMed Central

    Kodkani, Pranjal S

    2016-01-01

    Background: Bone tunneling and implants with rigid fixations for medial patellofemoral ligament (MPFL) reconstruction are known to compromise results and are avoidable, especially in skeletally immature subjects. This study was to assess if these deficiencies were overcome with the technique devised by the author which avoids implants and bone tunnels. Results were assessed for complication rate and outcome. Materials and Methods: Fifty six knees of recurrent lateral patellar dislocation were treated in the past 49 months by MPFL reconstruction. Thirty nine were female and 17 male knees. The mean age was 20.6 years (range 9-48 years). Mean followup was 26 months. Five knees had previously failed stabilization procedures. Thirty one cases had Dejours Type A or B and 12 had Type C trochlear dysplasia. Arthroscopy was performed for associated injuries and loose bodies. Seven knees required loose body removal. Five knees underwent lateral retinacular release. Four knees had tibial tuberosity transfer. One knee had an associated anterior cruciate ligament reconstruction. An anatomical MPFL reconstruction was performed using hamstring autograft without the need for intraoperative fluoroscopy. Only soft tissue fixation was necessary with this newly devised technique and suturing. A rapid rehabilitation protocol was implemented with monthly followup until normalcy and 6 monthly thereafter. Results: All achieved full range of motion and normal mediolateral stability. There was no recurrence of dislocation. No major surgery related complications. One patella fracture at 8 months was due to a fall developed terminal restriction of flexion. Those in sports could return to their sporting activities (Tegner 1–9). Cases with osteochondral fractures had occasional pain that subsided in 1 year. Mean Kujala score improved from 64.3 to 99.69 with KOOS score near normal in all. Conclusion: This new method of MPFL reconstruction gives excellent results. It avoids complications related to bone tunneling and implants. It is a safe, effective, reliable and reproducible technique. PMID:26952121

  18. Vitamin D deficiency leads to sensory and sympathetic denervation of the rat synovium

    PubMed Central

    Tague, Sarah E.; Smith, Peter G.

    2014-01-01

    Vitamin D deficiency is associated with increased susceptibility to inflammatory arthritis. Sensory and sympathetic synovial nerves are critical to the development of inflammatory arthritis and spontaneously degenerate in the early phases of disease. These nerves contain vitamin D receptors and vitamin D influences nerve growth and neurotrophin expression. We therefore examined the density of synovial nerves and neurotrophin-containing cells in vitamin D deficient rats. Seven week old Sprague Dawley rats were fed either control or vitamin D deficient diets for four weeks. Knee synovium sections extending from patella to meniscus were immunostained for total nerves, myelinated and unmyelinated nerves, sympathetic nerves, peptidergic and non-peptidergic sensory nerves, and neurotrophins and immune cell markers. In control rats, intimal innervation by unmyelinated sensory fibers was denser than subintimal innervation. In contrast, sympathetic innervation was confined to the subintima. Many sensory axons contained markers for both peptidergic and non-peptidergic nerves. NGF was primarily expressed by intimal CD163-negative type B synoviocytes, while neurturin, a ligand selective for non-peptidergic sensory neurons, was expressed by synovial mast cells. In vitamin D deficient rats, there were significant reductions in sensory nerves in the intima and sympathetic nerves in the subintima. While there was no significant change in NGF-immunoreactivity, the number of neurturin-expressing mast cells was significantly reduced in the intima, suggesting that intimal reductions in sensory nerves may be related to reductions in neurturin. Vitamin D deficiency therefore may increase susceptibility to inflammatory arthritis by depleting sensory and sympathetic synovial nerves as a result of reduced synovial neurotrophin content. PMID:25193239

  19. Clinical anatomy and mechanical tensile properties of the rectus femoris tendon

    PubMed Central

    Zhu, Xing-Fei; Zhang, Xin-Chao

    2015-01-01

    Purpose: We aimed to provide anatomical data and mechanical tensile properties for the rectus femoris tendon to determine if it is a feasible substitute for the anterior cruciate ligament during knee joint reconstruction. Methods: The length and width of the quadriceps femoris tendon were measured from ten adult cadavers (20 knees; age =48±2 years). The anatomic features of the patellar insertion on the quadriceps femoris tendon were also documented. The rectus femoris tendon and anterior cruciate ligament were harvested from an additional five fresh specimens (10 knees; age =41±3 years). To minimize dehydration, each specimen was wrapped in saline-moistened paper towels and stored at -10°C. We imposed tensile stresses on a total of twenty samples in a sample-driven machine at 10 mm/min until the specimens failed. Results: The inserted and discrete widths of the rectus femoris tendon were 3.20±0.33 and 1.28±0.25 cm, respectively. The length of the tendon tissue was 6.96±0.80 cm and the length of mixing zone was 3.81±0.53 cm. The average thickness of the upper pole of the patella was 2.22±0.14 cm. In mechanical tensile properties, the unit modulus and unit maximum load of the rectus femoris tendon were both 63% of the anterior cruciate ligament. Conclusions: Based on its anatomical and mechanical tensile properties, the rectus femoris tendon is a feasible donor site to reconstitute the anterior cruciate ligament. PMID:26885205

  20. A Novel Quantitative Pain Assessment Instrument That Provides Means of Comparing Patient’s Pain Magnitude With a Measurement of Their Pain Tolerance

    PubMed Central

    Johnson, Lanny L.; Pittsley, Andrew; Becker, Ruth; Young, Allison De

    2015-01-01

    Background Traditional pain assessment instruments are subjective in nature. They are limited to subjective reporting of the presence and magnitude of pain. There is no means of validating their response or assessing their pain tolerance. The objective of this study was to determine the potential value of a novel addition to the traditional physical examination concerning a patient’s pain and more importantly their pain tolerance. Methods Extensive preliminary data were collected on 359 consecutive private practice knee patients referable the subject’s pain, including the magnitude, the most pain ever experienced, and their opinion of personal pain tolerance. The novel evaluation included physical testing of a series of small ball drops through a vertical tube from various fixed levels on the index finger and patella. The patient’s response to this impact testing provided quantitative information, from which a comparison was made to their pain opinion and also to that of other patients with similar demographics. Results Nine percent of the patients rated their pain tolerance below the midpoint on the visual analog scale. Seventy-one percent thought they were above the midpoint on the scale in regards to pain tolerance. There were discrepancies in both directions between the subject’s opinion on pain tolerance and their rating of their pain experience to the ball drop testing. Twenty-eight percent of the entire patient group rated themselves above 5 on tolerance, but experienced above the average discomfort compared to other subjects reporting on the finger impact testing. Conclusions This report introduces a novel method for collecting data concerning pain that can be subjected to quantification. The database included quantitative measures providing the opportunity to confirm, validate or refute the patient’s assertions concerning pain magnitude and tolerance. This method is best described as a patient pain profile. It has the potential to give both the patient and the physician quantified objective information rendering insight not otherwise available. PMID:26346200

  1. Trace elements in shells of common gastropods in the near vicinity of a natural CO2 vent: no evidence of pH-dependent contamination

    NASA Astrophysics Data System (ADS)

    McClintock, J. B.; Amsler, C. D.; Amsler, M. O.; Duquette, A.; Angus, R. A.; Hall-Spencer, J. M.; Milazzo, M.

    2014-04-01

    There is concern that the use of natural volcanic CO2 vents as analogs for studies of the impacts of ocean acidification on marine organisms are biased due to physiochemical influences other than seawater pH alone. One issue that has been raised is whether potentially harmful trace elements in sediments that are rendered more soluble and labile in low pH environments are made more bioavailable, and sequestered in the local flora and fauna at harmful levels. In order to evaluate this hypothesis, we analyzed the concentrations of trace elements in shells (an established proxy for tissues) of four species of gastropods (two limpets, a topshell and a whelk) collected from three sites in Levante Bay, Vulcano Island. Each sampling site increased in distance from the primary CO2 vent and thus represented low, moderate, and ambient seawater pH conditions. Concentrations of As, Cd, Co, Cr, Hg, Mo, Ni, Pb, and V measured in shells using ICP-OES were below detection thresholds for all four gastropod species at all three sites. However, there were measurable concentrations of Sr, Mn, and U in the shells of the limpets Patella caerulea, P. rustica, and the snail Osilinus turbinatus, and similarly, Sr, Mn, U, and also Zn in the shells of the whelk Hexaplex trunculus. Levels of these elements were within the ranges measured in gastropod shells in non-polluted environments, and with the exception of U in the shells of P. caerulea, where the concentration was significantly lower at the collecting site closest to the vent (low pH site), there were no site-specific spatial differences in concentrations for any of the trace elements in shells. Thus trace element enhancement in sediments in low-pH environments was not reflected in greater bioaccumulations of potentially harmful elements in the shells of common gastropods.

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

    PubMed Central

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

    2014-01-01

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

  3. Early T2 Changes predict Onset of Radiographic Knee Osteoarthritis – Data from the Osteoarthritis Initiative

    PubMed Central

    Liebl, Hans; Joseph, Gabby; Nevitt, Michael C.; Singh, Nathan; Heilmeier, Ursula; Subburaj, Karupppasamy; Jungmann, Pia M.; McCulloch, Chuck E.; Lynch, John A.; Lane, Nancy E.; Link, Thomas M.

    2014-01-01

    Objective To evaluate whether T2 relaxation time measurements obtained at 3 Tesla Magnetic Resonance Imaging (MRI) predict the onset of radiographic knee osteoarthritis (OA). Methods and Materials We performed a nested case-control study of incident radiographic knee OA in the Osteoarthritis Initiative (OAI) cohort. Cases were 50 knees with baseline KL grade of 0 that developed KL grade of 2 or more over a 4-year period. Controls were 80 knees with KL grade of 0 after four years of follow-up. Baseline T2 relaxation time measurements and laminar analysis of T2 in deep and superficial layers were performed in all knee compartments. The association of T2 values with incident OA was assessed with logistic regression and differences in T2 values by case-control status with linear regression, adjusting for age, sex, body mass index (BMI) and other covariates. Results Baseline T2 values in all compartments except the medial tibia were significantly higher in knees that developed OA compared to controls, and were particularly elevated in the superficial cartilage layers in all compartments. There was an increased likelihood of incident knee OA associated with higher baseline T2 values particularly in the patella, adjusted odds ratio (OR) per 1 SD increase in T2: 3.37 (95% CI: 1.72; 6.62), but also in the medial femur: 1.90 (1.07; 3.39), lateral femur: 2.17 (1.11; 4.25) and lateral tibia: 2.23 (1.16; 4.31). Conclusions These findings suggest that T2 values assessed when radiographic changes are not yet apparent may be useful in predicting the development of radiological tibiofemoral OA. PMID:24615539

  4. Observations and Experiments on the Biology and Life History of Riseriellus occultus (Heteronemertea: Lineidae).

    PubMed

    Beckers, Patrick; Bartolomaeus, Thomas; von Döhren, Jörn

    2015-12-01

    Studies on the biology and life history of nemerteans are scarce, mostly because these animals are nocturnal. In order to broaden the knowledge base on the life history of nemerteans as a prerequisite for comparative analyses, we studied a population of Riseriellus occultus (Heteronemertea: Lineidae) inhabiting the rocky intertidal in southern Brittany near Concarneau (France) for more than 10 years. Our studies show that R. occultus is an iteroparous, perennial species exclusively inhabiting rocky shore crevices that result from onionskin weathering of the granite. From September through October R. occultus reproduces by external fertilization and develops via a planktonic pilidium larva, which, under laboratory conditions, metamorphoses after about six weeks. Adults of R. occultus are nocturnal macrophagous predators that preferentially feed on the gastropods Gibbula umbilicalis and Patella species, but also consume the bivalve Mytilus edulis. Since R. occultus devours the snail inside the shell, we fixed individuals while feeding, and serially sectioned them. Reconstruction of the sections shows that R. occultus swallows the entire soft body and finally detaches the columellar muscle from the shell. Estimates on the density of R. occultus inside the rock crevices provide evidence for clustered distribution and locally high abundance on the rocky shore. These data strongly suggest that R. occultus affects the structure of the rocky shore gastropod community. Although our data are still fragmentary with respect to the ecology of this species and its role in the local food web, our knowledge has grown to such extent that R. occultus can now be regarded as one of the few well characterized nemertean species. PMID:26654036

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

    PubMed Central

    2011-01-01

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

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

    PubMed

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

    2010-03-01

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

  7. Chronic tendinopathy: effectiveness of eccentric exercise

    PubMed Central

    Woodley, Brett L; Newsham‐West, Richard J; Baxter, G David

    2007-01-01

    Objectives: To determine the effectiveness of eccentric exercise (EE) programmes in the treatment of common tendinopathies. Data sources: Relevant randomised controlled trials (RCTs) were sourced using the OVID website databases: MEDLINE (1966–Jan 2006), CINAHL (1982–Jan 2006), AMED (1985–Jan 2006), EMBASE (1988–Jan 2006), and all EBM reviews – Cochrane DSR, ACP Journal Club, DARE, and CCTR (Jan 2006). The Physiotherapy Evidence Database (PEDro) was also searched using the keyword: eccentric. Review methods: The PEDro and van Tulder scales were employed to assess methodological quality. Levels of evidence were then obtained according to predefined thresholds: Strong–consistent findings among multiple high‐quality RCTs. Moderate–consistent findings among multiple low‐quality RCTs and/or clinically controlled trials (CCTs) and/or one high‐quality RCT. Limited–one low‐quality RCT and/or CCT. Conflicting–inconsistent findings among multiple trials (RCTs and/or CCTs). No evidence–no RCTs or CCTs. Results: Twenty relevant studies were sourced, 11 of which met the inclusion criteria. These included studies of Achilles tendinopathy (AT), patella tendinopathy (PT) and tendinopathy of the common wrist extensor tendon of the lateral elbow (LET). Limited levels of evidence exist to suggest that EE has a positive effect on clinical outcomes such as pain, function and patient satisfaction/return to work when compared to various control interventions such as concentric exercise (CE), stretching, splinting, frictions and ultrasound. Levels of evidence were found to be variable across the tendinopathies investigated. Conclusions: This review demonstrates the dearth of high‐quality research in support of the clinical effectiveness of EE over other treatments in the management of tendinopathies. Further adequately powered studies that include appropriate randomisation procedures, standardised outcome measures and long‐term follow‐up are required. PMID:17062655

  8. Infrapatellar Straps Decrease Patellar Tendon Strain at the Site of the Jumper’s Knee Lesion

    PubMed Central

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

    2011-01-01

    Background: The impetus for the use of patellar straps in the treatment of patellar tendinopathy has largely been based on empirical evidence and not on any mechanistic rationale. A computational model suggests that patellar tendinopathy may be a result of high localized tendon strains that occur at smaller patella–patellar tendon angles (PPTAs). Hypothesis: Infrapatellar straps will decrease the mean localized computational strain in the area of the patellar tendon commonly involved in jumper’s knee by increasing the PPTA. Study Design: Controlled laboratory study. Methods: Twenty adult males had lateral weightbearing and nonweightbearing radiographs of their knees taken with and without 1 of 2 infrapatellar straps at 60° of knee flexion. Morphologic measurements of PPTA and patellar tendon length with and without the straps were used as input data into a previously described computational model to calculate average and maximum strain at the common location of the jumper’s knee lesion during a simulated jump landing. Results: The infrapatellar bands decreased the predicted localized strain (average and maximum) in the majority of participants by increasing PPTA and/or decreasing patellar tendon length. When both PPTA and patellar tendon length were altered by the straps, there was a strong and significant correlation with the change in predicted average localized strain with both straps. Conclusion: Infrapatellar straps may limit excessive patella tendon strain at the site of the jumper’s knee lesion by increasing PPTA and decreasing patellar tendon length rather than by correcting some inherent anatomic or functional abnormality in the extensor apparatus. Clinical Relevance: The use of infrapatellar straps may help prevent excessive localized tendon strains at the site of the jumper’s knee lesion during a jump landing. PMID:23016021

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

    PubMed Central

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

    2010-01-01

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

  10. Kinematic Analysis of a Posterior-stabilized Knee Prosthesis

    PubMed Central

    Zhao, Zhi-Xin; Wen, Liang; Qu, Tie-Bing; Hou, Li-Li; Xiang, Dong; Bin, Jia

    2015-01-01

    Background: The goal of total knee arthroplasty (TKA) is to restore knee kinematics. Knee prosthesis design plays a very important role in successful restoration. Here, kinematics models of normal and prosthetic knees were created and validated using previously published data. Methods: Computed tomography and magnetic resonance imaging scans of a healthy, anticorrosive female cadaver were used to establish a model of the entire lower limbs, including the femur, tibia, patella, fibula, distal femur cartilage, and medial and lateral menisci, as well as the anterior cruciate, posterior cruciate, medial collateral, and lateral collateral ligaments. The data from the three-dimensional models of the normal knee joint and a posterior-stabilized (PS) knee prosthesis were imported into finite element analysis software to create the final kinematic model of the TKA prosthesis, which was then validated by comparison with a previous study. The displacement of the medial/lateral femur and the internal rotation angle of the tibia were analyzed during 0–135° flexion. Results: Both the output data trends and the measured values derived from the normal knee's kinematics model were very close to the results reported in a previous in vivo study, suggesting that this model can be used for further analyses. The PS knee prosthesis underwent an abnormal forward displacement compared with the normal knee and has insufficient, or insufficiently aggressive, “rollback” compared with the lateral femur of the normal knee. In addition, a certain degree of reverse rotation occurs during flexion of the PS knee prosthesis. Conclusions: There were still several differences between the kinematics of the PS knee prosthesis and a normal knee, suggesting room for improving the design of the PS knee prosthesis. The abnormal kinematics during early flexion shows that the design of the articular surface played a vital role in improving the kinematics of the PS knee prosthesis. PMID:25591565

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed Central

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

    2004-01-01

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

  13. Relationship of Height to Site-Specific Fracture Risk in Postmenopausal Women.

    PubMed

    Armstrong, Miranda Eg; Kirichek, Oksana; Cairns, Benjamin J; Green, Jane; Reeves, Gillian K

    2016-04-01

    Height has been associated with increased risk of fracture of the neck of femur. However, information on the association of height with fractures at other sites is limited and conflicting. A total of 796,081 postmenopausal women, who reported on health and lifestyle factors including a history of previous fractures and osteoporosis, were followed for 8 years for incident fracture at various sites by record linkage to National Health Service hospital admission data. Adjusted relative risks of fracture at different sites per 10-cm increase in height were estimated using Cox regression. Numbers with site-specific fractures were: humerus (3036 cases), radius and/or ulna (1775), wrist (9684), neck of femur (5734), femur (not neck) (713), patella (649), tibia and/or fibula (1811), ankle (5523), and clavicle/spine/rib (2174). The risk of fracture of the neck of femur increased with increasing height (relative risk [RR] = 1.48 per 10-cm increase, 99% confidence interval [CI] 1.39-1.57) and the proportional increase in risk was significantly greater than for all other fracture sites (pheterogeneity  < 0.001). For the other sites, fracture risk also increased with height (RR = 1.15 per 10 cm, CI 1.12-1.18), but there was only very weak evidence of a possible difference in risk between the sites (pheterogeneity  = 0.03). In conclusion, taller women are at increased risk of fracture, especially of the neck of femur. © 2015 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research (ASBMR). PMID:26572496

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

    PubMed

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

    2014-05-01

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

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

    PubMed Central

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

    2015-01-01

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

  16. Marine molluscs in environmental monitoring. I. Cellular and molecular responses

    NASA Astrophysics Data System (ADS)

    Bresler, Vladimir; Abelson, Avigdor; Fishelson, Lev; Feldstein, Tamar; Rosenfeld, Michael; Mokady, Ofer

    2003-10-01

    The study reported here is part of an ongoing effort to establish sensitive and reliable biomonitoring markers for probing the coastal marine environment. Here, we report comparative measurements of a range of histological, cellular and sub-cellular parameters in molluscs sampled in polluted and reference sites along the Mediterranean coast of Israel and in the northern tip of the Gulf of Aqaba, Red Sea. Available species enabled an examination of conditions in two environmental 'compartments': benthic (Donax trunculus) and intertidal (Brachidontes pharaonis, Patella caerulea) in the Mediterranean; pelagic (Pteria aegyptia) and intertidal (Cellana rota) in the Red Sea. The methodology used provides rapid results by combining specialized fluorescent probes and contact microscopy, by which all parameters are measured in unprocessed animal tissue. The research focused on three interconnected levels. First, antixenobiotic defence mechanisms aimed at keeping hazardous agents outside the cell. Paracellular permeability was 70-100% higher in polluted sites, and membrane pumps (MXRtr and SATOA) activity was up to 65% higher in polluted compared to reference sites. Second, intracellular defence mechanisms that act to minimize potential damage by agents having penetrated the first line of defence. Metallothionein expression and EROD activity were 160-520% higher in polluted sites, and lysosomal functional activity (as measured by neutral red accumulation) was 25-50% lower. Third, damage caused by agents not sufficiently eliminated by the above mechanisms (e.g. single-stranded DNA breaks, chromosome damage and other pathological alterations). At this level, the most striking differences were observed in the rate of micronuclei formation and DNA breaks (up to 150% and 400% higher in polluted sites, respectively). The different mollusc species used feature very similar trends between polluted and reference sites in all measured parameters. Concentrating on relatively basic levels of biological organization—the molecular and cellular level—the parameters measured may have the capacity not only for biomonitoring environmental quality, but also for early warning.

  17. T1-weighted sodium MRI of the articulator cartilage in osteoarthritis: a cross sectional and longitudinal study.

    PubMed

    Newbould, Rexford D; Miller, Sam R; Upadhyay, Neil; Rao, Anil W; Swann, Peter; Gold, Garry E; Strachan, Robin K; Matthews, Paul M; Taylor, Peter C; Brown, Andrew P

    2013-01-01

    Structural magnetic resonance imaging (MRI) has shown great utility in diagnosing soft tissue burden in osteoarthritis (OA), though MRI measures of cartilage integrity have proven more elusive. Sodium MRI can reflect the proteoglycan content of cartilage; however, it requires specialized hardware, acquisition sequences, and long imaging times. This study was designed to assess the potential of a clinically feasible sodium MRI acquisition to detect differences in the knee cartilage of subjects with OA versus healthy controls (HC), and to determine whether longitudinal changes in sodium content are observed at 3 and 6 months. 28 subjects with primary knee OA and 19 HC subjects age and gender matched were enrolled in this ethically-approved study. At baseline, 3 and 6 months subjects underwent structural MRI and a 0.4ms echo time 3D T1-weighted sodium scan as well as the knee injury and osteoarthritis outcome score (KOOS) and knee pain by visual analogue score (VAS). A standing radiograph of the knee was taken for Kellgren-Lawrence (K-L) scoring. A blinded reader outlined the cartilage on the structural images which was used to determine median T1-weighted sodium concentrations in each region of interest on the co-registered sodium scans. VAS, K-L, and KOOS all significantly separated the OA and HC groups. OA subjects had higher T1-weighted sodium concentrations, most strongly observed in the lateral tibial, lateral femoral and medial patella ROIs. There were no significant changes in cartilage volume or sodium concentration over 6 months. This study has shown that a clinically-feasible sodium MRI at a moderate 3T field strength and imaging time with fluid attenuation by T1 weighting significantly separated HCs from OA subjects. PMID:23940822

  18. Meier–Gorlin syndrome genotype–phenotype studies: 35 individuals with pre-replication complex gene mutations and 10 without molecular diagnosis

    PubMed Central

    de Munnik, Sonja A; Bicknell, Louise S; Aftimos, Salim; Al-Aama, Jumana Y; van Bever, Yolande; Bober, Michael B; Clayton-Smith, Jill; Edrees, Alaa Y; Feingold, Murray; Fryer, Alan; van Hagen, Johanna M; Hennekam, Raoul C; Jansweijer, Maaike C E; Johnson, Diana; Kant, Sarina G; Opitz, John M; Ramadevi, A Radha; Reardon, Willie; Ross, Alison; Sarda, Pierre; Schrander-Stumpel, Constance T R M; Schoots, Jeroen; Temple, I Karen; Terhal, Paulien A; Toutain, Annick; Wise, Carol A; Wright, Michael; Skidmore, David L; Samuels, Mark E; Hoefsloot, Lies H; Knoers, Nine V A M; Brunner, Han G; Jackson, Andrew P; Bongers, Ernie M H F

    2012-01-01

    Meier–Gorlin syndrome (MGS) is an autosomal recessive disorder characterized by microtia, patellar aplasia/hypoplasia, and short stature. Recently, mutations in five genes from the pre-replication complex (ORC1, ORC4, ORC6, CDT1, and CDC6), crucial in cell-cycle progression and growth, were identified in individuals with MGS. Here, we report on genotype–phenotype studies in 45 individuals with MGS (27 females, 18 males; age 3 months–47 years). Thirty-five individuals had biallelic mutations in one of the five causative pre-replication genes. No homozygous or compound heterozygous null mutations were detected. In 10 individuals, no definitive molecular diagnosis was made. The triad of microtia, absent/hypoplastic patellae, and short stature was observed in 82% of individuals with MGS. Additional frequent clinical features were mammary hypoplasia (100%) and abnormal genitalia (42% predominantly cryptorchidism and hypoplastic labia minora/majora). One individual with ORC1 mutations only had short stature, emphasizing the highly variable clinical spectrum of MGS. Individuals with ORC1 mutations had significantly shorter stature and smaller head circumferences than individuals from other gene categories. Furthermore, compared with homozygous missense mutations, compound heterozygous mutations appeared to have a more severe effect on phenotype, causing more severe growth retardation in ORC4 and more frequently pulmonary emphysema in CDT1. A lethal phenotype was seen in four individuals with compound heterozygous ORC1 and CDT1 mutations. No other clear genotype–phenotype association was observed. Growth hormone and estrogen treatment may be of some benefit, respectively, to growth retardation and breast hypoplasia, though further studies in this patient group are needed. PMID:22333897

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

    PubMed

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

    2008-11-01

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

  20. Platelet-rich plasma as a treatment for chronic patellar tendinopathy: comparison of a single versus two consecutive injections

    PubMed Central

    Zayni, Rachad; Thaunat, Mathieu; Fayard, Jean-Marie; Hager, Jean-Philippe; Carrillon, Yannick; Clechet, Julien; Gadea, François; Archbold, Pooler; Sonnery Cottet, Bertrand

    2015-01-01

    Summary Background platelet-rich-plasma is increasingly used in chronic patellar tendinopathy. Ideal number of PRP injections needed is not yet established. This study compares the clinical outcomes of a single versus two consecutive PRP injections. Method between December 2009 and January 2012, 40 athletes with proximal patellar tendinopathy were treated by PRP injection. Patients received single (20 patients) or two PRP injections 2 weeks apart (20 patients). All patients underwent prospective clinical evaluation, including Victorian Institute of Sport Assessment-Patella (VISA-P) score, visual analog scale (VAS) for pain, and Tegner scale before PRP and after a minimum of 2 year follow-up. Results 9 patients failed PRP treatment and needed surgery. 1 patient was lost to follow-up. For the remaining patients, the VISA-P, VAS, and Tegner scores all significantly improved from 35.2 to 78.5 (p = 0.0001), 6.6 to 2.4 (p = 0.0001), and 4.8 to 6.9 (p = 0.0003). Patients who received two injections had better scores than those who received single injection with VAS of 1.07 versus 3.7 (p = 0.0005), Tegner score of 8.1 versus 5.9 (p = 0.0003) and VISA-P of 93.2 versus 65.7 (p = 0.0001). Conclusions two consecutive PRP injections in chronic patellar tendinopathy showed better improvement in outcomes when compared to single injection. Level of evidence randomized prospective consecutive series, Level 2. PMID:26261787