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1
Timofeev, Igor V., Elena Yu Dyakonova, Aleksei A. Gusev, Ekaterina A. Romanova, and Polina V. Khrolenko. "Arthroscopic treatement of patella fractures in children." Pediatric Traumatology, Orthopaedics and Reconstructive Surgery 5, no. 1 (2017): 53–57. http://dx.doi.org/10.17816/ptors5153-57.
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Introduction. The frequency of patellar fractures is approximately 0.5% to 1.5% of all skeletal injuries. The following types of fractures can be distinguished: avulsive, transverse, longitudinal, and comminuted. In cases of displacement of more than 2–3 mm and quadriceps tendon injuries open reduction and internal fixation with the restoration of the articular surface is more preferable. In cases of longitudinal fractures, arthroscopy is regarded as a highly effective method of surgical treatment.
 Materials and methods. Using arthroscopy, we have operated on 4 patients with longitudinal fracture of the patella. The average age of the injured persons was 15.4 years (14–17). These were 3 males and 1 female. All patients had sport-related injuries.
 Because of the longitudinal fracture of the patella, the lateral knee extensor mechanism remained intact, and arthrosopy-assisted surgical intervention with closed reposition of fragments and transcutaneous wire fixation was performed without wire suturing.
 Results and discussion. Minimal invasiveness, the possibility of visual control over the recovery quality of patellar surface, the reliability of fragment fixation, and a significant reduction in the subsequent rehabilitation make arthroscopy a highly effective method of surgical treatment for patellar fractures.
2
Kluczynski, Melissa A., Luis Miranda, and John M. Marzo. "Prevalence and Site of Medial Patellofemoral Ligament Injuries in Patients With Acute Lateral Patellar Dislocations: A Systematic Review and Meta-analysis." Orthopaedic Journal of Sports Medicine 8, no. 12 (2020): 232596712096733. http://dx.doi.org/10.1177/2325967120967338.
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Background: Medial patellofemoral ligament (MPFL) injuries are common in patients with acute lateral patellar dislocations, but the pattern of MPFL injuries is unclear, especially with respect to patient age. Purpose: The primary aim was to determine the prevalence of MPFL injuries according to the site of injury in patients with acute lateral patellar dislocations. The secondary aim was to compare the site of MPFL injuries in patients aged ≤16 versus >16 years. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic literature search was performed with PubMed, Embase, and CINAHL to identify articles published from January 1, 1999, to May 31, 2019, that examined the site of MPFL injuries in patients with acute patellar dislocations. The study design, sample size, age at injury, technique used for diagnosing MPFL injuries (magnetic resonance imaging, ultrasound, and/or surgery), and prevalence and site of MPFL injuries were extracted from each study. The pooled estimate of the proportion of MPFL injuries at each site was calculated (femur, patella, midsubstance, and combined sites of injury) as well as proportions stratified by age group (≤16 and >16 years). Results: The literature search yielded 420 unique articles, of which 52 were screened for eligibility; of these, 17 were excluded. Thus, a total of 35 articles (2558 patients) were included in the final analysis. The overall prevalence of MPFL injuries was 94.7% (95% CI, 91.2%-96.8%). Most MPFL injuries occurred at the patella (37.1% [95% CI, 30.8%-43.9%]), followed by the femur (36.8% [95% CI, 31.0%-43.0%]), combined sites (25.1% [95% CI, 20.7%-30.1%]), and the midsubstance (15.6% [95% CI, 13.2%-18.4%]). In patients aged ≤16 years, most MPFL injuries occurred at the patella (39.3% [95% CI, 27.9%-51.9%]), and in patients aged >16 years, most MPFL injuries occurred at the femur (47.2% [95% CI, 40.6%-54.0%]). Conclusion: The prevalence of MPFL injuries in patients with acute patellar dislocations varied by site of injury and by age. MPFL injuries at the patella were most prevalent overall and in children and adolescents, and MPFL injuries at the femur were more prevalent in adults.
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Spivey, Matthew G., Michael P. Campbell, Lee G. Gammon, and Alexander R. Vap. "Patellar Tendon Allograft Reconstruction." Video Journal of Sports Medicine 1, no. 4 (2021): 263502542110114. http://dx.doi.org/10.1177/26350254211011485.
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Background: Chronic patellar tendon injuries can cause significant functional deficits due to anterior knee pain, extension weakness, and extensor lag. With chronic injuries, the tissue is inadequate and of poor quality. Chronic injuries require autograft or allograft for augmentation or reconstruction. We present reconstruction of a chronic patellar tendon injury with Achilles tendon allograft. Indications: Chronic patellar tendon injuries causing functional deficits, including knee extension weakness, extensor lag, and anterior knee pain. Technique Description: A longitudinal incision is made over the patellar tendon, and the patellar tendon is excised. Two guide pins are drilled in a retrograde fashion through the patella and are overdrilled with a reamer. A trough is made at the tibial tubercle using an oscillating saw. The Achilles allograft calcaneal bone block is contoured to the appropriate size, and then press fit into the trough. Two 4.0-mm fully threaded cannulated screws with washers are used to secure the bone block. The fresh frozen Achilles allograft is doubled over, and a double Krackow running locking suture is placed. A V-Y advancement of the quadriceps tendon is performed to ensure adequate advancement of the patella. The limbs of the Krackow suture are pulled through the patella drill holes and tied with knee in full extension. Results: At 1 year, patients can expect near full range of motion with minimal extensor lag. Reconstruction results in improved pain and function as compared with preoperatively, as well as return to activities. Conclusion: Achilles tendon allograft is a good option for reconstructing chronic patellar tendon injuries. Advantages of the Achilles allograft include the bone-to-bone healing at the tibia, lack of donor site morbidity, and the large amount of tissue available for reconstruction.
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Sessions, William, Matthew Herring, and Walter Truong. "Extensor Mechanism Injury in the Pediatric Population—A Clinical Review." Journal of Knee Surgery 31, no. 06 (2018): 490–97. http://dx.doi.org/10.1055/s-0038-1625955.
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AbstractThe extensor mechanism of the knee—consisting of the four muscles of the quadriceps, the quadriceps tendon, the patella, and the patellar ligament—is essential for lower extremity function during both standing and ambulation. The presence of articular cartilage and growing physes in the pediatric knee, coupled with the generation of significant tensile force, creates an opportunity for pathology unique to the pediatric population.Tibial tubercle fractures and patella injuries are quite rare, and even pediatric-trained orthopaedic surgeons may not be exposed to these injuries on a regular basis. It is the intent of this article to discuss the current literature regarding the mechanism of injury, diagnostic workup, classification, indications for surgical versus non-surgical management, and techniques for operative management for both tibial tubercle and patella (transverse and sleeve) fractures.
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Mistry, Jaydev, Kevin Bonner, Chukwuweike Gwam, Melbin Thomas, Jennifer Etcheson, and Ronald Delanois. "Management of Injuries to the Medial Patellofemoral Ligament: A Review." Journal of Knee Surgery 31, no. 05 (2017): 439–47. http://dx.doi.org/10.1055/s-0037-1604142.
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AbstractThe medial patellofemoral ligament (MPFL) is thought to be the most important medial structure providing restraint to lateral subluxation of the patella. After an initial patellar dislocation, the MPFL is frequently injured and can usually be treated with conservative measures. However, these patients often suffer from recurrent dislocations, which thereby necessitate operative intervention. In the setting of normal anatomy and kinematics, isolated reconstruction of the MPFL is an effective treatment for preventing recurrent dislocations. Various surgical techniques have been described, with differences in fixation and graft selection. The treatment of MPFL injuries should aim to provide patellar stabilization and restore normal kinematics throughout the joint. This review will discuss the following: (1) anatomy of the MPFL, (2) presentation and assessment of MPFL injuries, (3) management of patients with MPFL injuries, and (4) complications following MPFL reconstruction.
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Stanescu, A., Anh-Vu Ngo, Marguerite Parisi, Ramesh Iyer, and Ezekiel Maloney. "The Pediatric Patella: Normal Development, Anatomical Variants and Malformations, Stability, Imaging, and Injury Patterns." Seminars in Musculoskeletal Radiology 22, no. 01 (2018): 081–94. http://dx.doi.org/10.1055/s-0037-1608004.
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AbstractWe discuss the pediatric patella, with an emphasis on diagnostic imaging. Topics include normal patellar development, anatomical variants and their physiologic significance, genetic syndromes that alter the appearance of the patella, physiology of patellar tracking and stability, patellofemoral instability, and injury patterns and classification. Recognition of appropriate development on imaging prevents diagnostic error and unnecessary evaluation. Knowledge of the pertinent features of syndromes associated with morphological patellar abnormalities can aid in generating a succinct and relevant differential diagnosis. In patellofemoral instability, the patient's baseline anatomy, factors that predispose to instability, and the specific injuries that occur as a result are critical considerations for determining the course of treatment. Patellar sleeve fractures are unique to pediatric patients, and timely identification is critical to achieving an optimal treatment outcome.
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Delagrammaticas, Dimitri E., and Scott D. Cordes. "A Rare Case of an Irreducible Patella Dislocation." Case Reports in Medicine 2016 (2016): 1–3. http://dx.doi.org/10.1155/2016/3728425.
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Reports of irreducible patellar dislocations are exceedingly sparse throughout the literature. Obvious radiographic or physical exam findings including fracture or inversion of the patella are often present to explain the block to reduction. Not described previously in the literature is the instance of an irreducible patella dislocation in the setting of innocuous appearing injury imaging. We present a case of a healthy thirty-two-year-old female who sustained an irreducible lateral patella dislocation while participating in a dance aerobics class. Closed means of reduction were unsuccessful, necessitating open reduction. Intraoperative findings suggest incarceration of a nondisplaced fracture and a chondral defect as the block to reduction. Following open reduction, the patient has had no further episodes of pain or instability related to the patella at one-year follow-up. Irreducible patellar dislocations are exceedingly rare injuries, where associated osseous or chondral lesions may necessitate open reduction despite innocuous appearing initial imaging. A high index of suspicion to proceed with open reduction may limit repeated attempts at closed reduction and further injury.
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Osipenko, N. E. "Case of patellar arthroplasty." Kazan medical journal 69, no. 6 (1988): 448. http://dx.doi.org/10.17816/kazmj99752.
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Knee fractures account for 1.5-2.2% of all skeletal injuries. While fractures of the patella without displacement are treated conservatively by applying a deep posterior plaster cast with a "drying" cast placed on the anterior surface of the joint, displaced fractures require surgical intervention. In the case of multiple comminuted and fractured patellar fractures with displacement, in which it is impossible to bring all fragments together using P-shaped lavsan or sutures, the best outcomes can be achieved by endoprosthesis, that is, removal of the entire fractured patella and replacing it with an endoprosthesis. In this report, we would like to share our experience with patellar endoprosthesis according to G.S. Samoilov performed for a multiaxial fracture in the hospital.
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Pinheiro, Ana Costa, Filomena Ferreira, Margarida Areias, Carolina Oliveira, Cristina Sousa, and Miguel Leal. "Injuries of Children and Young People in Sports: Stress Fractures and Fracture of the Sleeve Sleeve." Orthopaedic Journal of Sports Medicine 6, no. 6_suppl3 (2018): 2325967118S0005. http://dx.doi.org/10.1177/2325967118s00053.
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Introduction: With the dramatic increase in the competitive sports of children and young people, overuse injuries have become more important in the pediatric population. Among these, the most frequent injuries in young athletes are stress fractures. The absence of evident traumatic history and the subtle radiographic changes can cause a diagnostic difficulty and delay the treatment. Fracture of the patella sleeve is a rare fracture only occurs in children. The diagnosis is difficult, both clinically and radiologically. High patella and hemarthrosis are important signs to diagnose this fracture. Presentation of 2 clinical cases of injuries in children and young people in sports: stress fractures and fracture of the patella sleeve. Methods: Retrospective descriptive method with reports of clinical cases based on patients’ electronic clinical processes. Results: We present a case of a child, a 13-year-old soccer practitioner who had mentioned well localized pain in the anterior aspect of the right leg with 5 days of evolution and analgesic gait and no history of trauma. The radiographs and CT showed a juxtaposed cortical lesion with apparent contact with the cortical bone without associated periosteal reaction. NMR confirmed stress fracture of the proximal tibial shaft. It was treated conservatively with immobilization with plaster and discharge. We present the case of an 11-year-old boy who suffered a fracture of the patella sleeve. In the imaging study, a fragment of bone with a displacement from the lower pole of the patella was visible. An open fracture reduction was performed. During the surgery confirmed avulsion fracture of a small osteochondral fragment, configuration of a sleeve-like fracture. The amount of cartilage was small, so it was decided to reinsert the 2 anchorages for patellar tendon. After fracture healing and rehabilitation, both returned to sports activity without sequelae or functional limitations. Discussion/Conclusion: A knowledge of the fracture of the patella sleeve, together with its clinical and radiological features, is important to avoid misdiagnosis and treatment delay. Care should be taken not to disturb the proximal tibial process. Although relatively uncommon in the pediatric age, the incidence of fractures described stress have been increasing in this age group. A high degree of suspicion is required to make the diagnosis and avoid too invasive treatment. REFERENCES Ray JM, Hendrix J. Incidence, mechanism of injury, and treatment of fractures of the patella in children. J Trauma 1992;32:464–7. Bates DG, Hresko MT, Jaramillo D. Patellar sleeve fracture: demonstration with MR imaging. Radiology 1994;193:825–7. Wu CD, Huang SC, Liu TK. Sleeve fracture of the patella in children. A report of five cases. Am J Sports Med 1991;19:525– 8. Houghton GR, Ackroyd CE. Sleeve fractures of the patella in children: a report of three cases. J Bone Joint Surg Br 1979;61:165–8. Shands PA, McQueen DA. Demonstration of avulsion fracture of the inferior pole of the patella by magnetic resonance imaging. A case report. J Bone Joint Surg Am 1995;77:1721–3. Dai LY, Zhang WM. Fractures of the patella in children. Knee Surg Sports Traumatol Arthrosc 1999;7:243–5. Fredericson M, Bergman G, Hoffman KL, et al. Tibial stress reaction in runners: correlation of clinical symptoms and scintigraphy with a new magnetic resonance imaging grading system. Am J Sports Med 1995; 23: 472-81. Hunter-Griffin LY. Clinics in sports medicine: overuse injuries. Philadelphia (PA): W.B. Saunders, 1987. Jackson DW, Bailey D. Shin splints in the young athlete: a non-specific diagnosis. Phys Sports Med 1975; 3: 45-51.
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Miles, Rebecca, Christian Cruz, and Brian J. Mannino. "Bilateral multipartite patellae avulsions associated with a unilateral quadriceps tendon rupture." BMJ Case Reports 14, no. 12 (2021): e246902. http://dx.doi.org/10.1136/bcr-2021-246902.
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Multipartite (or bipartite) patella is a developmental anomaly that occurs in 2%–6% of individuals. In 50%, the variant is bilateral. Multipartite patella is usually an asymptomatic condition. Quadriceps tendon rupture is also a rare entity occurring mostly in men aged >40 years and usually results from an acute eccentric quadriceps contracture. The authors present a case of a patient with bilateral multipartite patellae that sustained bilateral multipartite avulsions as well as an associated unilateral quadriceps tendon rupture. This constellation of injuries has never been reported in the literature. The patient was treated with excision of the multipartite patella fragments and quadriceps tendon repair on the side with the extensor mechanism disruption. He was treated non-operatively for the contralateral lower extremity multipartite patella avulsion. This report, along with a thorough review of the literature, serves to demonstrate the clinical and radiographic characteristics of this unusual injury.
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Samagh, Sanjum P., Fernando A. Huyke, Lucas Buchler, Michael A. Terry, and Vehniah K. Tjong. "Treatment of a Neglected Patellar Tendon Rupture with a Modified Surgical Technique: Ipsilateral Semitendinosus Autograft Reconstruction with Suture Tape Augmentation." Case Reports in Orthopedics 2018 (July 8, 2018): 1–5. http://dx.doi.org/10.1155/2018/2037638.
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Patellar tendon ruptures are rare, but debilitating injuries are typically seen in young active males in the third and fourth decades of life. They can occur as a single acute injury or from repetitive microtrauma weakening the tendon. Patients typically present complaining of knee pain, swelling, and an inability to perform a straight leg raise. Most conventionally, these injuries are classified as acute (less than two weeks) or chronic (greater than two weeks) based upon the timing of presentation. In patients with patellar tendon ruptures and inability to perform a straight leg raise, patellar tendon repair is most often recommended. A subset of patients with chronic patellar tendon ruptures, however, presents several months after their initial injuries. These neglected patella tendon ruptures present a particularly challenging clinical scenario in which primary repair is often difficult or not possible. This case report describes a modification to an existing surgical technique for reconstructing the patellar tendon using an ipsilateral semitendinosus tendon autograft with suture tape augmentation.
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Li, Xinning, Natalie M. Nielsen, Hanbing Zhou, Beth Shubin Stein, Yvonne A. Shelton, and Brian D. Busconi. "Surgical treatment of a chronically fixed lateral patella dislocation in an adolescent patient." Orthopedic Reviews 5, no. 2 (2013): 9. http://dx.doi.org/10.4081/or.2013.e9.
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Acute patellar dislocation or subluxation is a common cause for knee injuries in the United States and accounts for 2% to 3% of all injuries. Up to 49% of patients will have recurrent subluxations or dislocations. Importance of both soft tissue (predominantly, the medial patellofemoral ligament, MPFL, which is responsible for 60% of the resistance to lateral dislocation) and bony constraint of femoral trochlea in preventing subluxation and dislocation is well documented. Acute patella dislocation will require closed reduction and management typically consist of conservative or surgical treatment depending on the symptoms and recurrence of instability. Most patients are diagnosed and treated in a timely manner. We present a 15 years old male with a missed traumatic lateral patella dislocation during childhood. The patient presented as an adolescent with a chronically fixed lateral patella dislocation and was management with surgery. The key steps in the surgical reconstruction of this patient required first mobilizing the patella with a lateral retinacular release and V-Y lengthening of the shortened or contracted quadriceps tendon. Then a combination of MPFL reconstruction using the semi-tendinosis autograft, tibial tubercle osteotomy with anterio-medialization, and lateral facetectomy was performed. At the one-year follow-up, our patient had improved knee range of motion and decrease in pain. Chronically fixed lateral dislocated patella is a rare and complex problem to manage in older patients that will require a thorough work-up and appropriate surgical planning along with reconstruction.
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S., Nikhilesh P., Hari Sivanandan, Anandanarayan M., and A. E. Manoharan. "Functional outcome of surgical management in cases of fracture patella in a tertiary care hospital in Salem." International Journal of Research in Orthopaedics 7, no. 3 (2021): 507. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20211602.
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<p><strong>Background: </strong>Fractures of the patella are serious injuries with a broad range of subtypes. These injuries account for about 1% of all skeletal injuries and are most prevalent within the age group of 20-50 years. The underlying mechanisms of open fractures are mostly high-velocity accidents. To assess the functional outcome of various surgical procedures done for fracture patella.</p><p><strong>Methods: </strong>A longitudinal study was conducted from the department of orthopedics, Vinayaka missions Kirupananda Variyar medical college and hospital, Salem for one year in August 2019 and July 2020. All the adult patients admitted with the diagnosis of patellar fracture were included in the study. A complete local examination was conducted and an X-ray of AP and the lateral view was taken for all the patients.</p><p><strong>Results: </strong>Transverse patella fracture is being the most common fracture and for that modified tension band wiring (TBW) was the most common procedure performed and for comminuted fracture partial patellectomy was the most common procedure and for 1 patient total patellectomy was performed.</p><p><strong>Conclusions:</strong><strong> </strong>The study shows that the treatment of patella fractures with modified tension band wiring is a definitive treatment with minimal complications and excellent functional outcomes.</p>
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Gobbi, Riccardo Gomes, Betina Bremer Hinckel, Paulo Renan Lima Teixeira, et al. "The Vastus Medialis Insertion Is More Proximal and Medial in Patients With Patellar Instability: A Magnetic Resonance Imaging Case-Control Study." Orthopaedic Journal of Sports Medicine 7, no. 12 (2019): 232596711988084. http://dx.doi.org/10.1177/2325967119880846.
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Background: The anatomy and function of the quadriceps muscle play a role in patellofemoral stability. Few studies have evaluated anatomic differences in the vastus medialis between patients with and without patellar instability. Purpose: To compare the anatomy of the vastus medialis using magnetic resonance imaging in patients with patellar instability to a control group. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A group of patients with patellar instability were sex-matched with a control group with anterior cruciate ligament tears, meniscal injuries, or sprains; patients younger than 15 years were excluded. The anatomy of the vastus medialis was examined by the distance between the distal origin of the vastus medialis in the femur and the medial femoral condyle, the distance from the proximal pole of the patella to the most distal insertion of the muscle and its ratio to the length of the articular surface of the patella, and a qualitative description of the insertion position of the muscle fibers (directly in the patella or the medial retinaculum). Results: Both groups comprised 78 knees (48 female; 61.5%). The mean age in the control and patellar instability groups was 30.2 ± 7.8 years and 25.6 ± 7.5 years, respectively ( P = .001). The distance from the vastus origin to the condyle was 27.52 ± 3.49 mm and 26.59 ± 3.43 mm, respectively ( P = .041); the distance from the proximal pole of the patella to the most distal muscle insertion was 17.59 ± 5.54 mm and 15.02 ± 4.18 mm, respectively ( P < .001); and the ratio of this distance to the joint surface was 0.586 ± 0.180 and 0.481 ± 0.130, respectively ( P < .001). In 75.6% of knees in the patellar instability group, the insertion of the vastus was into the medial retinaculum and not into the patella compared with 52.6% in the control group ( P = .003; odds ratio, 2.8). Conclusion: The distal insertion of the vastus medialis differed in knees with patellar instability, with a more proximal insertion and less patellar coverage relative to controls, and was more frequently found in the retinaculum instead of directly in the patella.
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Salunke, Abhijeet Ashok, Abhijeet Savale, Chirayu Dwivedi, et al. "HOFFA’S FRACTURE WITH IRREDUCIBLE PATELLAR DISLOCATION: APPROACH TO AVOID COMPLICATIONS IN A RARE INJURY." Journal of Musculoskeletal Research 20, no. 04 (2017): 1772001. http://dx.doi.org/10.1142/s0218957717720010.
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Hoffa’s fracture is coronal oriented fracture of distal femur with the fracture line extending through the femoral condyles. Hoffa’s fracture is rarely associated with ipsilateral femur and tibia fractures. Proper clinical examination and radiographic evaluation is necessary to diagnose associated injuries around the knee joint with Hoffa’s fracture. Closed reduction of dislocated patella in emergency room and field triage should be avoided to prevent patellar tendon incarcenation, patellar tendon rupture and osteochondral damage. We report a rare case of Hoffa’s fracture with irreducible patellar dislocation and tibial intercondylar eminence fracture following road traffic accident.
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Güney, Ahmet, Ali Saltuk Argün, Murat Kahraman, İbrahim Karaman, and Ökkeş Bilal. "Arthroscopical Fixation of Patellar Osteochondral Fracture in a Pediatric Patient." Orthopaedic Journal of Sports Medicine 2, no. 11_suppl3 (2014): 2325967114S0020. http://dx.doi.org/10.1177/2325967114s00200.
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Objectives: Aim of this article is to present a pediatric patient with patellar osteochondral fracture treated by arthroscopical fixation and discuss through the literature. Patellar osteochondral fractures are kind of injuries mostly seen in adolescents and young adults, generally occur after trauma causing dislocation of patella and frequently accompanied by chondral damage in the lateral femoral condyle. Surgical intervention is indicated for the displaced and intraarticular fragments. Methods: Thirteen-year-old male patient referred our clinic with a swollen knee, limitation in knee movements, after he had fallen on his right knee while skating 2 weeks previously and was also unable to stand on his right leg. Plain radiogram, computerized tomography and magnetic resonance images of the right knee evaluated in our clinic and a chondral defect (17x10mm in size) in distal of medial marge of patella and an intraarticular osteochondral fragment just inferomedial to patella and anterior to lateral femoral condyle was determined. Results: In the arthroscopical evaluation osteochondral defect and intraarticular fragment were observed. In addition there was chondral lesion on the chondral surface of lateral femoral condyle. Osteochondral fragment was replaced to the distal part of medial marge of patella as arthroscopically, then retrograde fixed using 2 compressive screws (24x2.7 mm and 26x2.7 mm) from patella to the fragment. Conclusion: As patellar osteochondral fractures usually occur following acute dislocation of patella, rarely may occur without dislocation. We could find 2 cases in the literature which aren't accompanied by dislocation of patella. One of them is a non-displaced fracture and the other one is an osteochondral fragment with 15x20 mm in size which was resected due to inconformity. Eighty percent of acute dislocations of patella are accompanied by contusions on lateral femoral condyle and intraarticular fragments are present in 11 to 74 percent of cases. In this article we present 13 year-old male patient with an osteochondral fracture in the inferior of medial marge of patella without dislocation of patella, which was displaced into joint space and accompanied by a chondral lesion on the lateral femoral condyle, and then treated by artroscopical reduction and fixation. Our case seems to be original due to occuring without dislocation of patella and being the first case treated by arthroscopical intervention. Displaced and intraarticular patellar osteochondral fractures should be replaced and fixed by surgically. We consider that when compared with open joint surgery, arthroscopical replacement and fixation of osteochondral fractures causes lower morbidity and helps to improve rehabilitation of the patient.
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Sinha, Ritesh, Amit Joshi, Nirab Kayastha, and Bharat Prasad Singh. "Bilateral Traumatic Patella Fracture." Medical Journal of Shree Birendra Hospital 13, no. 1 (2015): 43–45. http://dx.doi.org/10.3126/mjsbh.v13i1.13005.
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Fracture of Patella is rare and constitutes almost 1% of all skeletal injuries. Bilateral fracture of patella is even rarer accounting for 2.9% of all patella lesion. Very few cases of bilateral patella fractures have been reported in literature. We report the rare case of bilateral patella fracture in a healthy female and discuss the management challenges. doi: http://dx.doi.org/10.3126/mjsbh.v13i1.13005
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Baryeh, Kwaku, and Fanuelle Getachew. "Patella dislocation: an overview." British Journal of Hospital Medicine 82, no. 8 (2021): 1–10. http://dx.doi.org/10.12968/hmed.2020.0429.
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Patella dislocation is one of the most common knee injuries, accounting for 3% of acute knee injuries. Despite its prevalence, patella dislocation is often missed, with a haemarthrosis often the only sign, albeit a non-specific one. A thorough history and examination are necessary to identify patella dislocation and its potential causes. Investigations should include cross-sectional imaging to evaluate both osseous and soft tissue structures in order to guide management. Management in the acute setting is normally non-operative, but damage to structural supports, osteochondral defects or recurrent dislocation should prompt consideration of operative treatment. Operative treatment should address the soft tissue stabilisers and/or osseus deformities that predispose to, or occur secondary to, patella dislocation.
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Rath, Björn, Malte Asseln, Marcel Betsch, Andreas Prescher, Markus Tingart, and Jörg Eschweiler. "Impact of Simulated Knee Injuries on the Patellofemoral and Tibiofemoral Kinematics Investigated with an Electromagnetic Tracking Approach: A Cadaver Study." BioMed Research International 2018 (2018): 1–13. http://dx.doi.org/10.1155/2018/7189714.
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Purpose.The purpose of this study was to evaluate the approach of using an electromagnetic tracking (EMT) system for measuring the effects of stepwise, simulated knee injuries on patellofemoral (PF) and tibiofemoral (TF) kinematics.Methods.Three cadaver knees were placed in a motion rig. EMT sensors were mounted on the patella, the medial/lateral femoral epicondyles, the tibial condyle, and the tibial tuberosity (TT). After determining the motion of an intact knee, three injuries were simulated and the resulting bony motion was tracked.Results.Starting with the intact knee fully extended (0° flexion) and bending it to approximately 20°, the patella shifted slightly in the medial direction. Then, while bending the knee to the flexed position (90° flexion), the patella shifted progressively more laterally. After transecting the anterior cruciate ligament (ACL), the base of the medial menisci (MM) at the pars intermedia, and the medial collateral ligament (MCL), individual changes were observed. For example, the medial femoral epicondyle displayed a medial lift-off in all knees.Conclusion.We demonstrated that our EMT approach is an acceptable method to accurately measure PF joint motion. This method could also enable visualization and in-depth analysis of in vivo patellar function in total knee arthroplasty, if it is established for routine clinical use.
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Patel, Karan, Vivek Kalia, Nabeel Salka, and Eileen Crawford. "DOES THE NUMBER OF PATELLOFEMORAL INSTABILITY EPISODES CORRELATE WITH THE PREVALENCE AND SEVERITY OF CHONDRAL AND OSTEOCHONDRAL LESIONS IN PEDIATRIC AND ADOLESCENT PATIENTS?" Orthopaedic Journal of Sports Medicine 8, no. 4_suppl3 (2020): 2325967120S0018. http://dx.doi.org/10.1177/2325967120s00186.
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Disclosures: None Background: Current literature indicates that the risk of chondral and osteochondral injuries following patellofemoral instability events ranges from 40 to 96%. It is unclear based on current literature if there is an association between the number of instability events and the prevalence and severity of chondral and osteochondral injuries. Hypothesis/Purpose: The purpose of this study was to investigate the prevalence and severity of chondral and osteochondral injury following patellar dislocations based on number of dislocations and accounting for other patellofemoral instability risk factors (patella alta, trochlear dysplasia, growth status). Methods: Retrospective chart review was performed for patients under the age of 18 years with a prior history of traumatic patellar dislocation, documented number of instability events, and MRI available for review. Patients were grouped into those with 1 dislocation and >1 dislocation. A priori power analysis based on previous literature demonstrated a required minimum of 82 patients in each group (alpha=.05, power=90%, p1= 70%, p2=90%). Chart review was performed on all patients with diagnosis of patellofemoral instability for past 3 years to determine inclusion and record number of dislocations. MRI and radiographs were independently reviewed by a Musculoskeletal Radiologist and Orthopaedic Surgeon. Chondral injury severity (none, partial thickness, full thickness, osteochondral), location of injury, skeletal maturity, Caton-Deschamps index (CDI), and sulcus angle were recorded. Any discrepancies were settled by review by senior author. Poisson multivariate regression, chi-square, and descriptive statistics were used as appropriate. Results: 99 patients were included in each group. There was no statistically significant difference in the prevalence of chondral injury between patients with one dislocation versus more than one dislocation (64.65% versus 55.56%, p=.19) (Table 1). Multivariate regression analysis determined that no factor (patella alta, trochlear dysplasia, skeletal maturity, number of dislocations) was associated with prevalence of chondral injury. Multivariate regression analysis determined patella alta (CDI >1.3) was a significant factor in severity of chondral injury (p=.016). Conclusion: A history of multiple patellar dislocations is not associated with a higher prevalence or increased severity of chondral injury compared to a single patellar dislocation event. In patients with patella alta, a lower threshold for surgical management may be warranted due to its association with more severe cartilage injury, if not already present. [Table: see text]
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Ramu, Chokkarapu, Rajender K., Anjaneyulu B., Keertana B., and Shanmuga Raju P. "Management of patella fractures with different modalities." International Journal of Research in Orthopaedics 5, no. 3 (2019): 422. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20191455.
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<p class="abstract"><strong>Background:</strong> Patella fracture is quite a common injury for all ages of patients, constituting approximately 1% of all skeletal injuries. Patella is the largest sesamoid bone in the body. The aim of study was to assess the functional outcome of patella fractures treated with modified tension band wiring using K wires and cannulated cancellous screws with tension band construct.</p><p class="abstract"><strong>Methods:</strong> This study was a prospective clinical study to be conducted at the Department of Orthopaedic Surgery, Chalameda Anand Rao Institute of Medical Sciences, Karimnagar from October 2016 to November 2018. Total, 20 patients with transverse patellar fractures were studied and divided into 2 groups according to the surgical technique: 10 patients were in the MKTB group and 10 patients in the CSTB group.<strong></strong></p><p class="abstract"><strong>Results:</strong> Total 20 patella fractures were included in this study.<strong> </strong>The Bostman’s score of ROM, pain, atrophy of quadriceps femoris, and effusion were all higher in the CSTB group than in the MKTB group.</p><p class="abstract"><strong>Conclusions:</strong> We conclude that compared with the MKTB technique, CSTB fixation is an effective surgical procedure for treatment of displaced transverse patellar fractures.</p>
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Beasley, Michael A., Andrea Stracciolini, Kesley D. Tyson, and Cynthia J. Stein. "Knee Injury Patterns in Young Irish Dancers." Medical Problems of Performing Artists 29, no. 2 (2014): 70–73. http://dx.doi.org/10.21091/mppa.2014.2016.
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OBJECTIVE: To characterize knee injury patterns in Irish dancers. METHODS: A retrospective chart review was performed for Irish dancers under age 19 who presented with knee injuries to the sports medicine or orthopedic clinic from January 1, 2000 to December 31, 2010. Data were collected on all knee injuries partially or directly related to Irish dance. Injury was defined as dance-related pain or damage to the structures in the knee that resulted in evaluation in the clinic. Survey data were collected to determine the number of different schools/studios represented by the dancers in the study. RESULTS: Sixty-seven Irish dancers with 86 knee injuries were evaluated. Half (50.7%) of these patients received more than one diagnosis during these visits. Overuse injuries accounted for 90.7% of knee injuries. Time to presentation ranged from less than 1 week to over 1 year. There was a significant difference in time to presentation, with traumatic injuries being evaluated sooner than overuse injuries. The most common diagnoses, accounting for 53.5% of injuries, were patellar tracking disorders, including patellofemoral syndrome, hypermobile patella, and patellar subluxation. CONCLUSION: In Irish dance overuse injuries represent the great majority of knee injuries, and patellofemoral tracking disorders are the most common diagnosis. For many dancers, there is often a delay of weeks to months between the onset of symptoms and evaluation in clinic. Prevention programs could potentially eliminate a large portion of knee pain experienced by young Irish dancers.
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Bradko, Viachaslau, William T. Stoll, Lee S. Haruno, Scott B. Rosenfeld, and Scott D. McKay. "Two cases of combined patellar tendon avulsion from the tibia and patella." SICOT-J 4 (2018): 17. http://dx.doi.org/10.1051/sicotj/2018014.
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Avulsion fractures of the inferior pole of the patella and proximal tibial apophysis are independently rare injuries. They occur in children due to the relative weakness of the apophyseal cartilage compared to the ligaments and tendons. The combination of these two fractures, is exceedingly rare, with only a few previously described cases in the literature. Due to the infrequent presentation of this injury, careful examination and consideration of advanced imaging is important for diagnosis and preoperative planning. Here we present two cases of combined sleeve fractures of the inferior pole of the patella and tibial apophysis, with discussion of the pathophysiology, classification, identification and management of the injury.
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V. Chawda, Rajesh, Parag M. Tank, Vijay J. Patel, and Yash S. Shah. "A prospective study of 50 cases of patella fractures treated with different modalities." International Journal of Research in Orthopaedics 4, no. 5 (2018): 783. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20183682.
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<p class="abstract"><strong>Background:</strong> Fractures of patella account for 1% of all skeletal injuries. There is no universal accepted treatment for patellar fractures. After a fracture of the patella, the best results are obtained by accurate reduction and stable internal fixation. Partial or total patellectomy is generally indicated when the patella is so severely comminuted that an accurate reduction and reconstruction of the retropatellar joint surface cannot be achieved.</p><p class="abstract"><strong>Methods:</strong> The prospective study of 50 cases of patellar fractures was carried out at the department of orthopaedics for the period from May 2015 to December 2017. The maximum period of follow up was 18 months with a minimum period of follow up of 5 months (average 11.68 months). Operative treatment was done in patella fractures for more than 2 mm of articular displacement or 3 mm of fragment separation. Surgical options includes internal fixation with tension band wiring with k wire and partial patellectomy with extensor mechanism repair.<strong></strong></p><p class="abstract"><strong>Results:</strong> We have studied 50 patients where 7 cases were treated conservatively. In the present series 22 patients were treated with internal fixation out of which 13 patients had excellent results. 6 patients had good results. 21 patients were treated with partial patellectomy where 6 patients had excellent results, 11 patients had good and 4 patients had fair results.</p><p class="abstract"><strong>Conclusions:</strong> Patella should be preserved and Osteosynthesis whenever possible has better chance for excellent results. A good surgical technique, optimal operation room environment and judicious use of antibiotics will reduce the possibility of infection.</p>
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Shah, Ishani P., and James A. Fernandes. "Injuries to the distal femur and patella." Surgery (Oxford) 38, no. 9 (2020): 554–59. http://dx.doi.org/10.1016/j.mpsur.2020.06.014.
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Shah, Ishani P., and James A. Fernandes. "Injuries to the distal femur and patella." Orthopaedics and Trauma 32, no. 5 (2018): 319–24. http://dx.doi.org/10.1016/j.mporth.2018.07.010.
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Alassaf, Nabil. "Acute presentation of Sinding-Larsen-Johansson disease simulating patella sleeve fracture: A case report." SAGE Open Medical Case Reports 6 (January 2018): 2050313X1879924. http://dx.doi.org/10.1177/2050313x18799242.
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Objectives: Diagnosis of Sinding-Larsen-Johansson disease may not be an easy task. Several sport-related conditions affect the distal pole of the patella in the adolescent, and treatment varies considerably. The article describes a patient that had radiographic features of Sinding-Larsen-Johansson disease associated with an atypical acute presentation. Methods: Case report and literature review. Results: A 10-year-old boy presented with a sudden pain after a noncontact soccer injury. He had tenderness and swelling over the patella. Radiographs showed minimally displaced distal patellar ossicle. Magnetic resonance imaging excluded sleeve cartilaginous injury and documented Sinding-Larsen-Johansson disease. The knee was immobilized briefly. There was complete healing of the injury in 4-week follow-up radiographs. Conclusion: Emergency physicians, radiologists, and orthopedic surgeons should be aware of the acute presentation of Sinding-Larsen-Johansson disease after knee injuries.
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Bruijn, J. D., R. J. Sanders, and B. R. H. Jansen. "Ossification in the patellar tendon and patella alta following sports injuries in children." Archives of Orthopaedic and Trauma Surgery 112, no. 3 (1993): 157–58. http://dx.doi.org/10.1007/bf00449996.
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Migliorini, Filippo, Emanuela Marsilio, Francesco Cuozzo, et al. "Chondral and Soft Tissue Injuries Associated to Acute Patellar Dislocation: A Systematic Review." Life 11, no. 12 (2021): 1360. http://dx.doi.org/10.3390/life11121360.
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Introduction: Chondral and soft tissue injuries can be associated with first time patellar dislocation, but it is unclear how common they are, and which tissues are affected. A systematic review of the literature was performed to investigate the frequency, location, and extent of chondral and medial patellofemoral ligament (MPFL) injuries in patients following first time patellar dislocation. Methods: This systematic review was conducted according to the PRISMA guidelines. PubMed, Google Scholar, Embase, and Web of Science databases were accessed in November 2021. All the published clinical studies reporting the frequency, location, and extent of soft tissue lesions following first time patellar dislocation were accessed. Studies reporting data on habitual, congenital, or recurrent patellofemoral instability were excluded. Results: Data from 42 articles (2254 patients, mean age 21.6 ± 7.3 years) were retrieved. Ninety-eight percent of patients who experienced first time patellar dislocation demonstrated MPFL rupture at MRI. Forty-eight percent of MPFL ruptures were located at the patellar side, 34% at the femoral insertion site, and 18% in the midportion. Eighty-five percent of patients showed signs of patellar chondral damage at MRI, and trochlear chondral injuries were evidenced in 47% of patients. Intra-articular loose bodies were observed in 11.5% of patients. At arthroscopy, the medial facet and the crest of the patella more commonly exhibited chondral lesions than the lateral facet and femoral trochlea. Conclusions: Most patients suffer chondral damage and MPFL tears following after a first time patellar dislocation.
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Ponnan, Prakash, and Manoj Murungodiyil Kunjappan. "Evaluation of Functional Outcome of Patients with Transverse Fracture of Patella Treated with Tension Band Wiring - A Prospective Study Conducted at Trichur, Kerala." Journal of Evidence Based Medicine and Healthcare 8, no. 30 (2021): 2757–62. http://dx.doi.org/10.18410/jebmh/2021/506.
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BACKGROUND Patella is the largest sesamoid bone in the human body, which plays important role in biomechanics of the knee. It is one of the few bones without periosteal surrounding. Fracture of patella constitute almost 1 % of all skeletal injuries with high prevalence in age group of 20 - 50 years. Fracture of patella may be due to direct/indirect force. Direct force often results in displaced or comminuted fractures. Fracture caused by indirect mechanisms result from a violent contraction of quadriceps muscle with knee flexion. Most of the patella fractures are combination of direct and indirect forces. Most significant effects of fracture patella are loss of continuity of the extensor mechanism of the knee and potential incongruity of the patellofemoral articulation. Treatment option includes reconstruction of entire patella or partial patellectomy and tendon repair or total patellectomy with extensor mechanism repair. Advancement in surgical techniques treatment option being shifted from patellectomy to reconstruction, preservation, and restoration of extensor mechanism. The purpose of this study was to evaluate the functional outcome of transverse fracture of patella treated with tension band wiring. METHODS This prospective study was done among 35 patients, who sustained transverse patellar fractures and were admitted in Department of Orthopaedics, Government Medical College, Thrissur from 01 October 2019 to 01 October 2020. Functional and clinical outcome was assessed at 2 weeks, 4 weeks, 3 months, and 6 months using Goodfellow’s scoring system. RESULTS The mean age was found to be 43 years, males were predominant. In 62.86 % of study population, right side was involved. In 63 % of study population, fracture occurred due to road traffic accidents (RTA). Average union was achieved in 11 - 13 weeks. Functional outcome was excellent to good in 85.71 % of study population. CONCLUSIONS Transverse fracture of patella can be treated with modified tension band wiring without much complications and early weight bearing is possible with good functional outcome. KEYWORDS Transverse Fracture Patella, Prospective Study, Tension Band Wiring, Good Fellows Score
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Calvo Gonell, Alfonso, Loreto Macia Soler, and Joaquin Moncho. "The Relationship between the Anteroposterior Diameter of the Patellar Tendon, Pain and Functionality in Volleyball Players – An Observational Study." Revista Fisioterapia Invasiva / Journal of Invasive Techniques in Physical Therapy 02, no. 01 (2019): 18–28. http://dx.doi.org/10.1055/s-0039-1685232.
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Objective To determine whether the anteroposterior (AP) diameter of the patellar tendon in volleyball players is associated with a greater sensation of pain and decreased functionality. Material and Methods A descriptive, observational, cross-sectional study conducted on volleyball players. The scores on the Victorian Institute of Sport Assessment–Patella (VISA-P) scale were registered, together with the visual analogue scale (VAS) and the AP diameter of the patellar tendon, at 5 and at 10 mm distal to the inferior pole of the patella. The demographic, anthropometric and playing characteristics were registered and multiple linear regression models were constructed in order to analyze the relationship between the study variables. Results The final sample comprised 112 players. The AP diameter was greater in men and showed a positive significant association with the score on the VAS scale and a negative significant association with the VISA-P for both tendons after adjusting for the remaining variables. Conclusions The measurement of the AP diameter of the patellar tendon may be useful for the prevention of sports injuries in volleyball players as a greater tendon diameter is significantly associated with increased perceived pain and decreased functionality. Future studies should include a biomechanical analysis of jump and reception techniques.
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Frings, Jannik, Tobias Dust, Jennifer Meyer, et al. "The Influence of Surgical Realignment Procedures on Dynamic Patellar Tracking: A Dynamic Magnetic Resonance Imaging-Controlled Feasibility Study." Diagnostics 12, no. 11 (2022): 2761. http://dx.doi.org/10.3390/diagnostics12112761.
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Persisting patellar maltracking following surgical realignment often remains unseen. The aim of this study was to analyze the effects of realignment procedures on patellofemoral kinematics in patients with patellofemoral instability (PFI) and patellofemoral maltracking (PM) by using dynamic magnetic resonance imaging (MRI). Patients planned for surgical patellar realignment due to PFI and a clinically and radiologically apparent PM between December 2019 and May 2022 were included. Patients without PM, limited range of motion, joint effusion, or concomitant injuries were excluded. Dynamic mediolateral translation (dMPT) and patella tilt (dPT) were measured preoperatively and three months postoperatively. In 24 patients (7 men, 17 women; mean age 23.0 years), 10 tibial tubercle transfers, 5 soft tissue patella tendon transfers, 6 trochleoplasties, 3 lateral lengthenings, 1 varizating distal femoral osteotomy (DFO), and 1 torsional DFO were performed. At final follow-up, dMPT (from 10.95 ± 5.93 mm to 4.89 ± 0.40 mm, p < 0.001) and dPT (from 14.50° ± 10.33° to 8.44° ± 7.46°, p = 0.026) were significantly improved. All static radiological parameters were corrected to physiological values. Surgical patellar realignment contributed to the significant improvement of patellofemoral kinematics, with an approximation to normal values. The postoperative application of dynamic MRI allowed for a quantification of the performed correction, allowing for a postoperative control of success.
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Vaidyanathan, Singaravadivelu, Jagannath Panchanathan Ganesan, and Mugundhan Moongilpatti Sengodan. "Floating Knee Injury Associated with Patellar Tendon Rupture: A Case Report and Review of Literature." Case Reports in Orthopedics 2012 (2012): 1–5. http://dx.doi.org/10.1155/2012/913230.
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Floating knee injuries are frequently associated with other concomitant injuries to the ipsilateral limb or other parts of body of which injury to the ipsilateral knee ligaments carries significance for various reasons. A middle-aged man sustained a floating knee injury following RTA. DCS fixation by bridge plating technique for the distal femur and lateral buttress plating by MIPO technique for proximal tibia were planned and executed under spinal anesthesia with image intensifier. In addition, there were patellar tendon rupture along with avulsion of VMO from the medial border of patella and torn MPFL, which we have missed initially. To the best of our knowledge no similar case has been reported in English literature so far. We have reviewed the literature and proposed a different interpretation of Blake and McBride classification.
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Tanos, Panayiotis, Mohamed Zubair Farook, and Andrea Volpin. "Arthroscopically reduced, irreducible patella dislocation." BMJ Case Reports 15, no. 3 (2022): e248398. http://dx.doi.org/10.1136/bcr-2021-248398.
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Acute patella dislocations account for approximately 2%–3% of knee injuries and are therefore a relatively common presentation in the accident and emergency department. The majority of patella dislocations can be reduced with simple manoeuvres or even spontaneously and can be managed conservatively by bracing and rehabilitation. The aim of this study is to identify and review the main causes of the unique and unexpected event of irreducible patella dislocation and their characteristic presentations. Irreducible patella dislocations can happen but are very rare. Currently, a limited number of case reports are available, prompting for a need for research on this topic. This case study can shed light on the possible pathogenesis and pathognomonic features of irreducible patella dislocations and provide insight on the available therapeutic approaches.
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Trojan, Jeffrey D., Joshua A. Treloar, Christopher M. Smith, Matthew J. Kraeutler, and Mary K. Mulcahey. "Epidemiological Patterns of Patellofemoral Injuries in Collegiate Athletes in the United States From 2009 to 2014." Orthopaedic Journal of Sports Medicine 7, no. 4 (2019): 232596711984071. http://dx.doi.org/10.1177/2325967119840712.
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Background: As many as 30% of patients with knee pain seen in sports medicine clinics have complaints related to the patellofemoral joint. There is a paucity of research available regarding patellofemoral injuries, mechanism of injury, and playing time lost in collegiate athletes. Purpose: To describe the rates, mechanisms, severity, and potential sex-based differences of patellofemoral injuries in collegiate athletes across 25 National Collegiate Athletic Association (NCAA) sports. Study Design: Descriptive epidemiology study. Methods: Data from the 2009-2010 through the 2013-2014 academic years were obtained from the NCAA Injury Surveillance Program and were analyzed to calculate patellofemoral injury rates, mechanisms of injury, time lost, and need for surgery. Rate ratios and injury proportion ratios were used to quantify discernible differences between sex-comparable sports and timing of injury (ie, practice vs competition), respectively. Results: The overall patellofemoral injury incidence rate was 16.10 per 100,000 athlete-exposures (AEs). Women’s volleyball had the highest incidence of all sports (39.57 per 100,000 AEs). Injuries were 66% more likely to occur in competition than during practice. Female athletes experienced significantly more patellofemoral injuries than males in similar sports. Patellar tendinitis accounted for 49.2% of all patellofemoral injuries and was the most common injury in 20 of 25 studied sports. Patellar subluxation accounted for the most total days missed, and patellar dislocation had the highest mean days missed per injury (11.42 days). Patella fracture was the most likely injury to require surgery (80%). Conclusion: Patellofemoral injuries were most common in sports that require jumping and quick changes of direction, specifically women’s volleyball, men’s and women’s basketball, and women’s soccer. The majority of patellofemoral injuries in this cohort were classified as patellar tendinitis caused by overuse. Most injuries resulted in no competition or practice time lost. This information may contribute to the development of prevention programs aimed at addressing the most prevalent types and mechanisms of injury in each sport to reduce the incidence of patellofemoral injury in these athletes.
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PARKS, A. H., and G. WYN-JONES. "Traumatic injuries of the patella in five horses." Equine Veterinary Journal 20, no. 1 (1988): 25–28. http://dx.doi.org/10.1111/j.2042-3306.1988.tb01447.x.
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A., Calvo Gonell, Macia Soler L., and Moncho J. "Relationship between the anteroposterior diameter of the patellar tendon. Pain and functionality in volleyball players." Revista Fisioterapia Invasiva / Journal of Invasive Techniques in Physical Therapy 02, no. 02 (2019): 067. http://dx.doi.org/10.1055/s-0039-3401888.
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Abstract Introduction and Aim Overuse injuries in volleyball represent between 50% and 80% of total injuries, of which, 80% are patellar tendinopathies. Volleyball is the sport with the greatest prevalence of patellar tendinopathy, estimated at 44.6%, followed by basketball with 31.9%. The tendon thickness bears a close and direct relationship with abnormal and diffuse images with accumulation of ground substance, and affecting both sexes, although less marked in women. Aim To determine whether the antero-posterior diameter of the patellar tendon in volleyball players is associated with a greater sensation of pain and reduced functionality. Material and Methods An observational, descriptive, cross-sectional study on volleyball players. The scores on the VISA-P scale, the visual analog scale (VAS) and, using musculoskeletal ultrasound, the anteroposterior diameter of the patellar tendon at 5 and 10 mm distal to the inferior pole of the patella. Multiple linear regression models were constructed to adjust the effect of the anteroposterior diameter on the VAS and the VISA-P scores. Results The final sample comprised 112 players. The anteroposterior diameter was greater in men and was significantly associated with scores on the VAS and the VISA-P for both tendons, and therefore, the greater the score of the diameter, the greater the score on the VAS and the lesser the score on the VISA-P. Conclusions The measurement of the antero-posterior diameter of the patellar tendon using musculoskeletal ultrasound may be useful for the prevention of sports injuries in volleyball players, as it is significantly associated with a greater perception of pain and reduced functionality.
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Wang, Lin, Ling Qin, Hong-Bin Lu, et al. "Extracorporeal Shock Wave Therapy in Treatment of Delayed Bone-Tendon Healing." American Journal of Sports Medicine 36, no. 2 (2007): 340–47. http://dx.doi.org/10.1177/0363546507307402.
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Background Extracorporeal shock wave therapy is indicated for treatment of chronic injuries of soft tissues and delayed fracture healing and nonunion. No investigation has been conducted to study the effect of shock wave on delayed healing at the bone-tendon junction. Hypothesis Shock wave promotes osteogenesis, regeneration of fibrocartilage zone, and remodeling of healing tissue in delayed healing of bone-tendon junction surgical repair. Study Design Controlled laboratory study. Methods Twenty-eight mature rabbits were used for establishing a delayed healing model at the patella–patellar tendon complex after partial patellectomy and then divided into control and shock wave groups. In the shock wave group, a single shock wave treatment was given at week 6 postoperatively to the patella–patellar tendon healing complex. Seven samples were harvested at week 8 and 7 samples at week 12 for radiologic, densitometric, histologic, and mechanical evaluations. Results Radiographic measurements showed 293.4% and 185.8% more new bone formation at the patella–patellar tendon healing junction in the shock wave group at weeks 8 and 12, respectively. Significantly better bone mineral status was found in the week 12 shock wave group. Histologically, the shock wave group showed more advanced remodeling in terms of better alignment of collagen fibers and thicker and more mature regenerated fibrocartilage zone at both weeks 8 and 12. Mechanical testing showed 167.7% and 145.1% higher tensile load and strength in the shock wave group at week 8 and week 12, respectively, compared with controls. Conclusion Extracorporeal shock wave promotes osteogenesis, regeneration of fibrocartilage zone, and remodeling in the delayed bone-to-tendon healing junction in rabbits. Clinical Relevance These results provide a foundation for future clinical studies toward establishment of clinical indication for treatment of delayed bone-to-tendon junction healing.
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Adisthanaya, Surya, Putu Astawa, I. Gusti Ngurah Wien Aryana, and Febyan. "Semitendinosus and Gracilis Autograft for Neglected Patellar Tendon Rupture: A Surgical Reconstruction." Open Access Macedonian Journal of Medical Sciences 10, no. C (2022): 137–41. http://dx.doi.org/10.3889/oamjms.2022.9177.
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BACKGROUND: Neglected patellar tendon rupture is an extremely rare case among orthopedic injuries that severely compromises the function of the extensor mechanism of the knee. Therefore, a prompt and accurate diagnosis of a ruptured patellar tendon are a key to efficacious management, because a treatment delay is often associated with unsatisfactory functional outcomes. CASE PRESENTATION: We report the case of an adult male patient with traumatic patellar tendon rupture after 9 months of a motorcycle accident. The patient underwent reconstruction surgery using semitendinosus and gracilis tendon augmentation. This procedure restores the anatomical position of the patella and prevents extensor lag. At a 3-month follow-up, a full recovery of the structure and function of the extensor mechanism was perceived. The patient could return to normal daily activities following rehabilitation protocol. CONCLUSION: Semitendinosus and gracilis tendon autograft is the technique of choice to be applied in the surgical reconstruction of neglected patellar tendon rupture.
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Johnson, Alexander J., Katharine D. Harper, and Christopher Haydel. "Complete Traumatic Trifocal Failure of the Extensor Mechanism of the Knee: A Case Report and Review of the Literature." Case Reports in Orthopedics 2019 (November 11, 2019): 1–5. http://dx.doi.org/10.1155/2019/4695282.
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The unique case of a rare 3-level extensor mechanism failure in a 28-year-old male, involving a tibial tubercle avulsion fracture, a patellar tendon avulsion off the tibial tubercle fragment, and a severely comminuted patella fracture, and the surgical technique required to repair such an injury is presented. Focus is spent on the unique repair of a tendon injury when both proximal and distal bony attachments are damaged. Trifocal knee extensor mechanism is a rare clinical entity with minimal literature available—to date, this injury has only been reported in a retrospective review of combat-related injuries in military personnel. It is important to maintain an understanding of knee extensor mechanism anatomy and perform thorough investigation of high-energy knee injuries to ensure adequate treatment of all injuries. The outcome presented in this case shows that positive results after complex extensor mechanism injuries may be achieved, but limited data exists to elucidate optimum treatment. It is essential for surgeons to have firm grasp of techniques used to treat each segment of the extensor mechanism so that they may be combined when a patient presents with complex, multifocal injury.
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Reang, Santosh, Pulak Saha, and Tapan K. Das. "Bilateral patella fracture with unilateral refracture: a case report." International Journal of Research in Orthopaedics 7, no. 1 (2020): 175. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20205586.
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<p class="abstract">Patella fracture consists of approximately 1% of all skeletal fractures. However bilateral patella fracture is even rarer (2-3% of all patella fractures) and is seen mostly in either dash board injuries or in different pathological conditions. A 21 year old male presented with bilateral patella fracture, where right patella was fractured due to RTA and the left one got fractured due to a fall while he was being helped for an X-ray for the first one. Bilateral tension band wiring was done and patient was being regularly followed up with good range of movement recovery. But again he had a fall in bathroom 3 month post-operative and on right side suffered a re-fracture. Modified tension band wiring was done. Patient gained full range of movement on both sides and returned to his normal activities at 9 months post op of index surgery. A case of bilateral patella fracture where mechanism of fracture for each patella fracture are different is unheard of. A case of bilateral patella fracture with re-fracture has not been reported yet in literature so far we know/ searched. Here we report and discuss the challenges in management of such a case and protocol we followed.</p>
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Kosanović, M., R. Komadina, and M. Batišta. "Patella fractures associated with injuries of the knee ligament." Archives of Orthopaedic and Trauma Surgery 117, no. 1-2 (1997): 108–9. http://dx.doi.org/10.1007/s004020050206.
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Kosanović, M., R. Komadina, and M. Batista. "Patella fractures associated with injuries of the knee ligament." Archives of Orthopaedic and Trauma Surgery 117, no. 1-2 (1998): 108–9. http://dx.doi.org/10.1007/bf00703456.
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Cauvin, Eddy R. J., and Roger K. W. Smith. "Ultrasonography of the stifle." UK-Vet Equine 3, no. 3 (2019): 86–92. http://dx.doi.org/10.12968/ukve.2019.3.3.86.
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Stifle injuries are increasingly recognised as a major cause of hind limb lameness and commonly affect the soft tissues of the joint in adult horses, making ultrasonography a vital part of diagnostic imaging of this joint. This article aims to provide an introduction to stifle ultrasonography. To ensure comprehensive evaluation of the stifle, a systematic approach is necessary. The ultrasonographic examination is divided into five approaches: initially weight-bearing scans should be obtained of the cranial aspect (for the femoropatellar joint), medial aspect (for the medial femorotibial joint), and lateral aspect (for the lateral femorotibial joint), followed by flexed views from cranial (for the cranial aspect of the femorotibial joints) and, finally, in limited cases because pathology is rarer and the technique more demanding, weight-bearing views of the caudal aspect (for the caudal parts of both femorotibial joints). For the femoropatellar joint, ultrasound can be used to identify bruising (haematoma), injuries to the patellar ligaments, trochlear ridges (including osteochondrosis), and patella and tibial crest fractures. For the femorotibial joints, injuries to the menisci are the most common, but ultrasound can also identify rarer collateral and cruciate ligament injuries. and abnormalities of the weight-bearing surfaces of the femoral condyles, such as cartilage damage and subchondral bone cysts.
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Rhind, John-Henry, Patrick Lancaster, Usman Ahmed, and Michael Carmont. "Soft tissue extensor mechanism tendon ruptures of the knee." British Journal of Hospital Medicine 82, no. 9 (2021): 1–9. http://dx.doi.org/10.12968/hmed.2021.0139.
Full textAbstract:
Ruptures of the extensor mechanism of the knee are serious injuries requiring prompt diagnosis and treatment. They can be divided into soft tissue and bony causes. Soft tissue tendon injuries can be either partial or complete. Rupture of the quadriceps tendon is an uncommon injury and is more frequent in patients over the age of 40 years. Patella tendon ruptures are even rarer and are more frequent in patients under the age of 40 years. Causes can be direct or indirect. Complete ruptures of the quadriceps tendon or patella tendon benefit from early surgical management, while partial ruptures may be managed non-operatively. This article gives an overview of the presentation, assessment and management of soft tissue extensor mechanism tendon ruptures for core surgical, acute care common stem and emergency medicine trainees.
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Bauer, Kathryn. "Osteochondral Injuries of the Knee in Pediatric Patients." Journal of Knee Surgery 31, no. 05 (2018): 382–91. http://dx.doi.org/10.1055/s-0038-1625956.
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AbstractOsteochondral injuries in pediatric patients may occur as a result of a traumatic injury or secondary to an osteochondritis dissecans (OCD) lesion. Lateral patella dislocation is a common traumatic cause of osteochondral injury that typically occurs at the medial facet of the patella or at the lateral aspect of the distal femur. Multiple theories have been proposed for the cause of an OCD lesion in the knee, including trauma or repetitive microtrauma, local vascular insufficiency, and family history. The most “classic” location for OCD lesions of the knee is the lateral aspect of the medial femoral condyle of the distal femur. Multiple treatment options are available for both traumatic osteochondral injuries and OCD lesions, with important determining factors of treatment being skeletal maturity of the patient, instability of the fragment, lesion location, and size of the lesion. Nonsurgical management is appropriate in some situations. Surgical options range from simple fragment excision to internal fixation of the fracture fragment to more complex cartilage restoration or replacement procedures. This special focus section will discuss the diagnosis and treatment options for traumatic osteochondral knee injuries, including the subset secondary to juvenile OCD lesions.
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Laddha, Mukesh, Anshul Pancholiya, and Sahu Gaura. "Clinical outcome of Patella stability after fixation of Osteochondral fracture in Acute Primary Traumatic Patella Dislocation without MPFL Repair or Reconstruction." Journal of Clinical Orthopaedics 7, no. 1 (2022): 110–15. http://dx.doi.org/10.13107/jcorth.2022.v07i01.489.
Full textAbstract:
Introduction: Conservative management is advisable for acute primary traumatic patella dislocation (PTPD). Surgical treatment is reserved for osteochondral fractures (OCF), medial patello femoral ligament (MPFL) avulsion/tear, compound injuries, and any underlying bony abnormalities requiring correction. MPFL repair (at avulsed site) or reconstruction along with underlying bony correction in PTPD is controversial. The purpose of this study is to evaluate patella stability after fixation of OCF in PTPD without performing MPFL repair or reconstruction, even in the presence of any underlying bony abnormalities. Material and Methods: This is a retrospective study of eight patients who had PTPD with OCF along with MPFL injury who presented between 2016 and 2019. Pre-operative X-rays and MRI were done to assess the status of MPFL, identify the presence of OCF and to calculate Insall-Salvati index, Tibial Tuberosity-Trochlear groove distance and Trochlear dysplasia. All patients underwent surgery by open approach and OCF fixation by bioabsorbable pins or suture material. MPFL was neither repaired at avulsed site nor reconstructed and even no bony corrections were done. Results: Average size of OCF fragments is 15*7 mm and all involving medial facet of patella. Lysholm score improved significantly from 32.8 to 94.8 and Kujala score from 49.1 to 96 at the end of 6 months. None of the patient had patella instability till latest follow-up, average follow-up period is 4.5 years (3–6 years). Clinically, apprehension test was negative in all cases with full ROM. Post-operative imaging including X-ray and MRI showed complete healing of the OCF along with complete healing/regeneration of MPFL with same pre-existing bony abnormalities if present preoperatively. Conclusion: This study shows excellent patella stability and full knee function along with complete union of OCF and complete healing/regeneration of MPFL in PTPD even in the presence of underlying bony abnormality. Hence, in PTPD with OCF, there is no need to repair/reconstruct MPFL or to correct underlying bony pathology, only OCF fixation is required.
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Wong, Yiu-ming, Suk-tak Chan, Kwok-wing Tang, and Gabriel Y. F. Ng. "Two Modes of Weight Training Programs and Patellar Stabilization." Journal of Athletic Training 44, no. 3 (2009): 264–71. http://dx.doi.org/10.4085/1062-6050-44.3.264.
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Abstract 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 &lt; .05). Conclusions: Both short-term muscle hypertrophy and strength training programs can reinforce the patellar stabilizers in previously untrained volunteers.
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Djuricic, Goran, Filip Milanovic, Sinisa Ducic, et al. "Morphometric Parameters and MRI Morphological Changes of the Knee and Patella in Physically Active Adolescents." Medicina 59, no. 2 (2023): 213. http://dx.doi.org/10.3390/medicina59020213.
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Background and Objectives: The immature skeleton in a pediatric population exposed to frequent physical activity might be extremely prone to injuries, with possible consequences later in adulthood. The main aim of this study is to present specific morphometric parameters and magnetic resonance imaging (MRI) morphological changes of the knee and patella in a physically active pediatric population. Additionally, we wanted to investigate the morphological risk factors for patellar instability. Materials and Methods: The study included the MRI findings of 193 physically active pediatric patients with knee pain. The participants underwent sports activities for 5 to 8 h per week. Two divisions were performed: by age and by patellar type. We evaluated three age groups: group 1 (age 11–14), group 2 (age 15–17), and group 3 (age 18–21 years). In addition, participants were divided by the patellar type (according to Wiberg) into three groups. The following morphometric parameters were calculated: lateral trochlear inclination (LTI), the tibial tubercle–trochlear groove distance (TT-TG), trochlear facet asymmetry (TFA), Insall–Salvati index, modified Insall–Salvati index, Caton–Deschamps index, articular overlap, morphology ratio and contact surface ratio. Results: We found a statistically significant association between patellar type groups in LTI (p < 0.001), TFA (p < 0.001), Insal–Salvati (p = 0.001) index, and Caton–Deschamps index (p = 0.018). According to age groups, we found statistical significance in the Caton–Deschamps index (p = 0.039). The most frequent knee injury parameter, according to Wiberg, in physically active pediatric patients was patella type 2 in boys and type 3 in girls. Conclusions: The MRI morphometric parameters observed in our study might be factors of prediction of knee injury in physically active children. In addition, it might be very useful in sports programs to improve the biomechanics of the knee in order to reduce the injury rate in sports-active children.
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Kulkarni, Shrihari L., Sunil Mannual, Manjunath Daragad, Naveenkumar Patil, and Deekshith Shetty. "Management of Patella Fractures Non-amenable to Tension Band Wiring: Series of Nine Cases with Review of Literature." Journal of Orthopaedic Case Reports 12, no. 3 (2022): 38–42. http://dx.doi.org/10.13107/jocr.2022.v12.i03.2708.
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Introduction: Patella fractures account for about 1% of all musculoskeletal injuries. Modified tension band wiring (TBW) is the most commonly used technique for the management of patella fractures. However, all patella fractures are not-amenable to TBW. In this series, we present nine cases managed with open reduction and internal fixation using non-absorbable braided polyester suture (Ethicon Ethibond Excel 5-0) with circumferential stainless-steel wiring. Case Series: This series included nine patients with fractured patella and managed with open reduction and internal fixation with non-absorbable sutures and circumferential wiring. Patient demographics, fracture type, time to union, functional outcome, and complications were recorded. Patients were followed up for minimum of 6 months (11.6 ± 3.7 months). All fractures went on to unite with average fracture healing time of 13.8 weeks. Mean Lyshom and Bostman score were 83 and 25.6, respectively. Seven patients had excellent to good outcome. One each had fair and poor outcomes. One patient developed superficial infection and knee stiffness. Conclusion: Open reduction and fixation with non-absorbable sutures augmented with circumferential wiring are an efficient method for the management of severely comminuted and multi-fragmentary lower pole patella fractures with minimum complications.