Medial condyle hypoplasia in adolescent and young adult patients with trochlear dysplasia: a retrospective study / Hipoplasia do côndilo medial em pacientes adolescentes e adultos jovens com displasia troclear: estudo retrospectivo

Abstract Objective: To determine the association between medial femoral condyle hypoplasia and trochlear dysplasia by analyzing the knee magnetic resonance imaging scans of young patients with or without trochlear dysplasia. Materials and Methods: This was a retrospective analysis of magnetic resonance imaging scans of the knees of young individuals (16-35 years of age): 30 patients with trochlear dysplasia and 30 individuals with no signs of patellofemoral instability. The ratios between the depth, width, and height of the medial and lateral femoral condyles (dLC/dMC, wLC/wMC, and hLC/hMC, respectively) were calculated, as was the ratio between the width of the medial condyle and the total width of the femur (wMC/FW). All of the values were determined in consensus by two radiologists. Results: We evaluated 60 patients: 30 with trochlear dysplasia and 30 without. The mean dLC/dMC, wLC/wMC, and hLC/hMC ratios were higher in the patients than in the controls (p < 0.05), whereas the mean wMC/FW ratio was lower in the patients (p < 0.05). The optimal cutoff values, obtained by calculating the areas under the receiver operating characteristic curves, were 1.0465 for the dLC/dMC ratio (76% sensitivity and 63.3% specificity), 0.958 for the wLC/wMC ratio (80% sensitivity and 73.3% specificity), and 1.080 for the hLC/hMC ratio (93.3% sensitivity and 93.3% specificity). Conclusion: Our findings confirm our hypothesis that trochlear dysplasia is associated with medial condyle hypoplasia.

Resumo Objetivo: Determinar a associação entre hipoplasia do côndilo femoral medial e displasia troclear mediante análise de ressonância magnética do joelho de pacientes jovens com displasia troclear e sem displasia troclear. Materiais e Métodos: Análise retrospectiva de exames de ressonância magnética de joelhos de indivíduos jovens (16 a 35 anos de idade), sendo 30 pacientes com displasia troclear e 30 indivíduos sem sinais de instabilidade femoropatelar. As razões entre a profundidade, largura e altura dos côndilos femorais mediais e laterais (dLC/dMC, wLC/wMC e hLC/hMC, respectivamente) foram calculadas, assim como a razão entre a largura do côndilo medial e a largura total do fêmur (wMC/FW). Todos os valores foram determinados em consenso por dois radiologistas Resultados: Foram incluídos no estudo 60 adolescentes e adultos jovens, 30 com displasia troclear e 30 sem displasia troclear. A média das razões dLC/dMC, wLC/wMC, hLC/hMC foi maior nos pacientes do que nos controles (p < 0,05), enquanto a média da razão wMC/FW foi menor nos pacientes (p < 0,05). Os valores de corte ótimos obtidos da área sob a curva característica de operação do receptor foram 1,0465 para dLC/dMC (sensibilidade de 76% e especificidade de 63,3%), 0,958 para wLC/wMC (sensibilidade de 80% e especificidade de 73,3%) e 1,080 para hLC/hMC (sensibilidade de 93,3% e especificidade de 93,3%). Conclusão: Nossos resultados confirmam nossa hipótese de que a displasia troclear está associada a hipoplasia do côndilo medial.

Patella cubiti - a continuing etiological mystery / Patella cubiti: un misterio etiológico continuo

SUMMARY: A sesamoid bone in the elbow joint is a rare anatomical variation described as a Patella cubiti. Although this variation has been known for centuries its exact etiology is still unclear. Congenital, developmental, and traumatic hypotheses have been proposed. It seldom causes clinical manifestations than elbow stiffness or hypomobility. Herein, we present a case of a 31-year-old patient admitted to our department with complaints of swelling and erythema in the right elbow. An X-ray image revealed a triangular accessory bone with rounded edges, which was diagnosed as a Patella cubiti in combination with olecranon bursitis. Knowledge of this rare elbow abnormality is paramount for orthopedic surgeons and roentgenologists in their daily medical practice.

Un hueso sesamoideo en la articulación del codo es una rara variación anatómica descrita como Patella cubiti. Aunque esta variación se conoce desde hace siglos, su etiología exacta aún no está clara. Se han propuesto hipótesis congénitas, de desarrollo y traumáticas. Rara vez causa manifestaciones clínicas que no sean rigidez o hipomovilidad del codo. Presentamos el caso de un paciente de 31 años que ingresó en nuestro servicio por presentar tumefacción y eritema en el codo derecho. Una imagen de rayos X reveló un hueso accesorio triangular con márgenes redondeados, que se diagnosticó como una Patella cubiti en combinación con bursitis del olécranon. El conocimiento de esta rara anomalía del codo es fundamental para los cirujanos ortopédicos y los médicos radiólogos en su práctica médica diaria.

Impact of asymptomatic genu recurvatum on patellar mobility in young males / Impacto do genu recurvatum assintomático na mobilidade patelar em jovens do sexo masculino

BACKGROUND: Genu recurvatum is one of the most commonly presented lower extremity postural malalignments in individuals. Though genu recurvatum and its impact on impaired knee proprioception, anterior cruciate injuries and posterior soft tissue dysfunctions are reported, its association with patellar mobility is scarcely reported and warrants exploration. OBJECTIVES: To evaluate the medial and lateral patellar mobility differences in adult young males with genu recurvatum and normal knee alignment. METHODS: The ethical approval for this cross-sectional study protocol was obtained and the study was conducted in Research Department of Alva's College of Physiotherapy and Research Centre, Moodubidire, DK, Karnataka, India. The study participants were recruited through an institutional-based musculoskeletal and sports clinic. The estimated sample size for this study was 174. A total of 87 young males with genu recurvatum and 87 young males with normal knee alignment fulfilling the selection criteria were enrolled in two groups. Participants' knee joint was examined by an assessor and individuals with > 5° knee hyperextension were assigned to genu recurvatum group, and individuals with knee extension < 5° from neutral were assigned to the normal knee alignment group. Further, the patellar glide test was performed to examine the presence of patellar hypermobility in both groups. RESULTS: The mean age of the participants in genu recurvatum and normal knee alignment group was 22.04 + 1.860 and 21.91 + 1.869, respectively. A significant higher proportion (86.2%) of participants with genu recurvatum identified with patellar hypermobility compared to normal knee alignment. Within the genu recurvatum subjects, 66.66& and 19.54% were observed to have medial and lateral patellar hypermobility. The odds for occurrence of patellar hypermobility in genu recurvatum was estimated to be 13.007 (95%, CI, 5.481 ­ 30.866), respectively. CONCLUSION: The study result suggests that medial patellar hypermobility is more common in individuals with genu recurvatum. Further study investigating on the mechanism contributing towards medial patellar mobility in genu recurvatum populations could validate the present study findings.

INTRODUÇÃO: Genu recurvatum é um dos desalinhamento posturais dos membros inferiores mais comumente apresentado em indivíduos. Embora o genu recurvatum e seu impacto na propriocepção prejudicada do joelho, lesões cruzadas anteriores e disfunções dos tecidos moles posteriores sejam relatados, sua associação com a mobilidade patelar é pouco relatada e merece exploração. OBJETIVOS: Avaliar as diferenças de mobilidade patelar medial e lateral em homens adultos do sexo masculino com genu recurvatum e alinhamento normal do joelho. MÉTODOS: O protocolo do estudo foi explicado e a aprovação ética para o protocolo do estudo foi obtida e o estudo foi conduzido no Departamento de Pesquisa do Alva's College of Physiotherapy and Research Centre, Moodubidire, DK, Karnataka, India. Os participantes do estudo foram recrutados por meio de clínica musculoesquelética e esportiva de base institucional. O tamanho estimado da amostra para este estudo foi de 174. Um total de 87 jovens do sexo masculino com genu recurvatum e 87 jovens do sexo masculino com alinhamento normal do joelho foram incluídos em dois grupos. A articulação do joelho dos participantes foi examinada por um avaliador e os indivíduos com hiperextensão do joelho > 5° foram designados para o grupo Genu recurvatum, e os indivíduos com extensão do joelho < 5° do neutro foram designados para o grupo de alinhamento normal do joelho. Além disso, o teste de deslizamento patelar foi realizado para examinar a presença de hipermobilidade patelar. RESULTADOS: A média de idade dos participantes do grupo genu recurvatum e alinhamento normal do joelho foi 22,04 + e 21,91 + 1,869, respectivamente. Uma proporção significativamente maior (86,2%) de participantes com genu recurvatum identificados com hipermobilidade patelar em comparação com indivíduos com alinhamento normal do joelho. Entre os indivíduos com genu recurvatum, observou-se que 66,66% e 19,54% apresentavam hipermobilidade patelar medial e lateral. Entre aqueles com alinhamento normal do joelho, 44,83% apresentaram hipermobilidade patelar. A razão de chances para ocorrência de hipermobilidade patelar no genu recurvatum foi estimada em 13,007 (95%, IC, 5,481 ­ 30,866), respectivamente. CONCLUSÃO: O resultado do estudo sugere que a hipermobilidade patelar medial é mais comum em indivíduos com genu recurvatum. Um estudo mais aprofundado que investigue o mecanismo detalhado que contribui para a mobilidade patelar medial em populações de genu recurvatum poderia validar os resultados do presente estudo.

The Variation of the Patellar Height in Total Knee Arthroplasties and its Relationship with the Replacement or not of the Patella / Variação da altura patelar nas artroplastias totais do joelho e sua relação com a substituição ou não da patela

Abstract Objective To compare the measurement of patellar height in the pre- and postoperative period of total knee arthroplasties (TKAs) and its variation in patients with and without patellar replacement. Methods Retrospective evaluation of radiographs of patients submitted to TKA between 2014 and 2020. Profile radiographs were evaluated using the modified Caton-Deschamps patellar height index, comparing the pre- and postoperative measurements of 90 patients, with a total of 100 knees. Next, two groups were compared with a different surgical technique, considering the replacement or not of the patella. All patients who had x-rays evaluated had indication of TKA by osteoarthrosis without previous procedures that could interfere at patellar height. Results The statistical analysis showed a statistically significant difference, with the preoperative index superior to the postoperative rate, evidencing an overall decrease in patellar height. The Caton-Deschamps index modified for mean preoperative TKA was 1.41 (±0.25), and it was 1.31 (± 0.25), p< 0.001for postoperative TKA. No significant difference was found in the variation of this index when comparing the groups with and without patellar replacement. The mean difference of the index in the group without patella was 0.11, and 0.08 in the group with patella, and this difference was considered nonsignificant, p= 0.510. Conclusion We can conclude that patellar height had significant variation in the total group, with reduction of patellar height in the postoperative period. However, the height did not vary significantly between the postoperative groups with and without patellar replacement, regardless of the choice of the surgeon.

Resumo Objetivo Comparar a medida da altura patelar no pré- e pós-operatório das artroplastias totais do joelho (ATJs) e sua variação nos pacientes com e sem substituição patelar. Métodos Avaliação retrospectiva de radiografias de pacientes submetidos a ATJ entre 2014 e 2020. Foi feita a avaliação de radiografias em perfil, usando o índice de altura patelar de Caton-Deschamps modificado, comparando as medidas do pré- e pós-operatório de 90 pacientes, totalizando 100 joelhos. A seguir, foi feita a comparação de dois grupos, com técnica cirúrgica distinta, considerando a substituição ou não da patela. Todos os pacientes que tiveram radiografias avaliadas tiveram indicação de ATJ por osteoartrose sem procedimentos prévios que pudessem interferir na altura patelar. Resultados A análise estatística demonstrou uma diferença estatisticamente significativa, sendo o índice pré-operatório superior ao pós-operatório; evidenciando um abaixamento global da altura patelar. O índice Caton-Deschamps modificado para ATJ pré-operatório médio foi de 1,41 (±0,25), e o pós foi de 1,31 (±0,25), p< 0,001. Não foi encontrada diferença significativa na variação deste índice quando comparados os grupos com e sem substituição patelar. A diferença média do índice no grupo sem patela foi de 0,11 e no grupo com patela foi de 0,08, sendo esta diferença considerada não significativa, p= 0,510. Conclusão Podemos concluir que a altura patelar teve variação significativa no grupo total, com redução da altura patelar no pós-operatório. Entretanto, a altura não variou de forma significativa entre os grupos pós-operatórios com e sem substituição patelar, independentemente da opção do cirurgião.

Reconstrucción de aparato extensor en sarcoma fibromixoide de bajo grado en rodilla: reporte de caso

Introducción: El sarcoma fibromixoide de bajo grado es una tumoración maligna con alto riesgo de desarrollar recurrencia y metástasis, siendo la resección quirúrgica con márgenes amplios el tratamiento principal, la preservación de la extremidad y su reconstrucción es de alta demanda para los cirujanos. Reporte de caso: Presentamos el caso de una mujer de 67 años con recurrencia de tumoración en rodilla desde hace 12 meses, operado dos años antes. Se realizo resección oncológica de tumoración con reconstrucción de articulación de rodilla con prótesis Endo Model y reconstrucción de aparato extensor con injerto sintético de malla de polipropileno más autoinjerto de semitendinoso y gracilis. La patela se reconstruyó con autoinjerto de cóndilo femoral posterior. A los 16 meses de seguimiento la paciente se encuentra libre de enfermedad, con puntaje de 27 en la escala para miembro inferior de la MSTS (Musculoskeletal Tumour Society). Conclusión: La combinación de injerto sintético con autoinjerto de isquiotibiales puede disminuir la tasa de falla de la reconstrucción del aparato extensor por resecciones oncológicas.

Introduction: Low-grade fibromyxoid sarcoma is a malignant tumor with a high risk of developing recurrence and metastasis, surgical resection with wide margins is the main treatment, limb preservation and reconstruction is in high demand for surgeons. Case of report: We present the case of a 67-year-old woman with a recurrence of a knee tumor that had been operated on two year earlier. Oncological resection of the tumor was performed with reconstruction of the knee joint with an Endo Model prosthesis and extensor mechanism reconstruction with a synthetic polypropylene mesh graft plus a semitendinosus and gracilis autograft. The patella was reconstructed with posterior femoral condyle autograft. At 16 months of patient follow-up, she is free of disease, with a score of 27 on the lower limb scale of the MSTS (Musculoskeletal Tumor Society). Conclusion: The combination of synthetic graft with hamstring autograft can reduce the failure rate of extensor mechanism reconstruction due to oncological resections.

Double-pulley combined with suture bridge technique for fixation of comminuted fractures of distal patella pole / 中国骨伤

OBJECTIVE@#To investigate the clinical effect of double pulley combined with suture bridge in the treatment of comminuted fracture of the lower pole of the patella.@*METHODS@#From January 2018 to June 2020, 15 patients with comminuted fracture of the lower pole of the patella were treated with double pulley and suture bridge technology, including 9 males and 6 females, aged 28 to 68 years old with an average of (42.4±9.6) years old. All patients had obvious knee joint pain and limited movement after injury. All knee joints were examined by X-ray and CT, which confirmed that they were all comminuted fractures at the lower level of the patella. After operation, X-ray films of the knee joint were taken regularly to understand the fracture healing, the Insall Salvati index was measure, the range of motion of the joint was recorded, and the function of the knee joint was evaluateed by the Bostman scoring system.@*RESULTS@#All the 15 patients were followed up for 7 to 24 months with an average of (11.4±4.2) months, and there was no obvious anterior knee pain. At the last follow-up, the knee joint range of motion of the affected limb was 105° to 140° with an average of (128.5±12.8) °, and the Insall Salvati index was 0.79 to 1.12 with an average of (0.92±0.18). The X-ray film showed that the patella was bone healing, and no anchor fell off, broken, or displaced fracture block was found. Bostman patellar fracture function score was 27.85±2.06, 13 cases were excellent, 2 cases were good.@*CONCLUSION@#Double pulley technique combined with suture bridge technique is reliable for reduction and fixation of comminuted fracture of the lower pole of patella, and patients can start functional exercise early after operation.

Tumores óseos de la rótula

Introducción: Los tumores alrededor de la rodilla son frecuentes, a excepción de la rótula donde su localización es ocasional. En esta estructura anatómica existen características clínicas y epidemiológicas muy específicas según el tipo de tumor. Objetivo: Actualizar y brindar información sobre los tumores de la rótula. Métodos: La búsqueda y análisis de la información se realizó en un periodo de 62 días (primero de noviembre al 31 de diciembre de 2022) y se emplearon las siguientes palabras: patellar bone tumors, bone tumor AND patella, knee bone tumors a partir de la información obtenida se realizó una revisión bibliográfica de un total de 153 artículos publicados en las bases de datos: PubMed, Hinari, SciELO y Medline mediante el gestor de búsqueda y administrador de referencias EndNote, de ellos se utilizaron 30 citas seleccionadas para realizar la revisión, 28 de los últimos cinco años. Resultados: Se menciona la incidencia de los tumores benignos más frecuentes que afectan esta estructura anatómica, como el tumor de células gigantes. Se hace referencia a los tumores óseos malignos más reportados y su comportamiento clínico e imagenológico en especial el osteosarcoma. Se abordaron las metástasis de la rótula en particular las provenientes del pulmón. Conclusiones: Los tumores óseos de la rótula son lesiones infrecuentes, al comparar su incidencia con otros tumores de la rodilla. La presentación depende del tipo histológico y grado de afección ósea.

Introduction: Tumors around the knee are frequent, except for the patella, where its location is occasional. In this anatomical structure there are very specific clinical and epidemiological characteristics depending on the type of condition. Objective: To update and provide information on patella tumors. Methods: The search and analysis of the information was carried out in a period of 62 days (November 1st to December 31st, 2022) and the following words were used: patellar bone tumors, bone tumor AND patella, knee bone tumors. From the information obtained a bibliographic review was carried out, a total of 153 articles published in the PubMed, Hinari, SciELO and Medline databases through the EndNote search manager and reference manager were found, of which 30 selected citations were used to carry out the review, 28 of the last five years. Results: The incidence of the most frequent benign tumors that affect this anatomical structure, such as the Giant Cell Tumor, is mentioned. Reference is made to the most reported malignant bone tumors and their clinical and imaging behavior, especially Osteosarcoma. Metastases of the patella were addressed, particularly those of the lung. Conclusions: Bone tumors of the patella are infrequent lesions, when comparing their incidence with tumors from the rest of the knee joint. Presentation depends on the histological type and degree of bone involvement.

A Low-Energy Patella Vertical Dislocation in an Adolescent: A Case Report

@#Intra-articular dislocation of the patella is considered a rare case where it was reported that limited cases are existing in the literature and the exact mechanism of the injury is still undetermined. Patellar dislocation is divided into extraarticular and intra-articular dislocation. We report a patient with vertical dislocation of the patella caused by a lowenergy injury that is very rare according to the previous study. The patient came with a deformity, skin tenting, and pain with pressure on the superior and medial sides of the patella. During the physical examination, a deformation of skin tenting was observed with the characteristic of a “dorsal-fin” appearance over the laterally displaced patella. This paper will discuss the dislocation of the patella, which can be further classified into extra-articular and intraarticular. Vertical patellar dislocation most commonly occurred in adolescence. The outcome was considered satisfactory, and this case provides further knowledge of the mode of injury of vertical dislocation and also the possible risk factors.

A Case Report of Nail-Patella Syndrome / 罕见病研究

Nail-patella syndrome (NPS) is a hereditary rare disease that can involve fingernail, patella, elbow, and iliac bones. In this article, we report a case of a girl-9 and 1 quarter years old who had asthmatic contractures in both elbows, thumbnail hypoplasia in both hands, patellar dislocation of both knees, iliac angle protrusion of both sides, and scoliosis. Whole exome sequencing suggests the presence of a LMX1B NM_002316.4:c.706G > C(p.Ala236Pro) mutation. NPS is an autosomal dominant disease associated with gene mutation of LMX1B, which can be diagnosed by combining the patient′s clinical manifestations and genetic results. The treatment now only targets on symptoms, relieving the localized severe lesion but not cure right now.

Effect of patellar tilt angle after total knee arthroplasty without patellar resurfacing / 中华骨科杂志

Objective:To analyze the effect of patellar tilt angle on postoperative outcomes after total knee arthroplasty (TKA) without patella resurfacing.Methods:A total of 143 patients with end-stage knee osteoarthritis who underwent TKA without patellar replacement in the First Affiliated Hospital of Nanjing Medical University from October 2020 to October 2021 were retrospectively analyzed. There were 32 males and 111 females, aged 68.44±6.79 years (range, 52-86 years). Patients were divided into three groups according to the postoperative patellar tilt angle: tilt angle<5° was the mild tilt group (97 cases), 5°≤tilt angle<10° was the moderate tilt group (31 cases), and tilt angle≥10° was the severe tilt group (15 cases). All patients were followed up in the outpatient clinic at 3, 6 and 12 months after surgery, and knee visual analogue score (VAS), Hospital for Special Surgery (HSS) score and patella Feller score were observed and recorded to compare the postoperative knee pain and function of patients in different patella tilt groups.Results:All patients were followed up for 1.16±0.23 years (range, 1.0-2.0 years). There was no significant difference in baseline data between the groups. There were significant differences in the intra-group comparison of the VAS score before and after surgery among the three groups ( F=51.12, P<0.001; F=36.90, P<0.001; F=15.76, P<0.001). The VAS scores at 3, 6 and 12 months after operation were significantly lower than those before operation ( P<0.05). The knee VAS of the severe group was higher than that of the mild and moderate groups at 3, 6 and 12 months after surgery, and the difference was statistically significant ( P<0.05). There were statistically significant differences in knee HSS scores before and after surgery among the three groups ( F=81.12, P<0.001; F=36.05, P<0.001; F=32.93, P<0.001). The knee HSS scores at 3, 6 and 12 months after surgery were higher than those before surgery, and the difference was statistically significant ( P<0.05). The knee HSS scores of the severe tilt group at 3, 6 and 12 months after surgery were lower than those of the mild and moderate groups, and the difference was statistically significant ( P<0.05). There were statistically significant differences in the intra-group comparison of the patella Feller score before and after surgery among the three groups ( F=88.81, P<0.001; F=49.59, P<0.001; F=37.40, P<0.001). The patellar Feller score at 3, 6 and 12 months after surgery was higher than that before surgery, and the difference was statistically significant ( P<0.05). The patellar Feller score of the severe group at 3, 6 and 12 months after surgery was lower than that of the mild and moderate groups, and the difference was statistically significant ( P<0.05). Conclusion:Patellar tilt angle after TKA without patellar resurfacing will increase knee pain and limit joint function.

Uso de placa malla en el manejo de fracturas conminutas de patela: reporte de caso / Use of mesh plate for the treatment of comminuted patellar fractures: case report

OBJETIVOS Describir la técnica quirúrgica para el uso de placa malla en un caso de fractura conminuta de patela y sus resultados en el seguimiento a mediano plazo. MATERIALES Y MÉTODOS Presentamos un caso de fractura conminuta de patela manejada con el uso de una placa malla y un tornillo canulado asociado, evitando de esta forma la patelectomía parcial y sus posibles complicaciones. RESULTADOS El paciente presentó una evolución satisfactoria, con rango de movimiento de rodilla completo y en condiciones de alta laboral a los cuatro meses desde la cirugía, sin complicaciones ni reintervenciones. DISCUSIÓN El uso de placas malla permite el manejo de fracturas conminutas de patela preservando stock óseo y restaurando la indemnidad del aparato extensor, con una osteosíntesis estable y poco prominente. Casos en que antiguamente la única alternativa era la patelectomía parcial y reinserción del tendón patelar ahora tienen etas placas como opción de manejo. CONCLUSIÓN El uso de placas malla en fracturas conminutas de patela es una alternativa atractiva por la estabilidad que brindan, la capacidad de reservar stock óseo, y la baja tasa de reintervenciones

OBJETIVE To describe the surgical technique for the use of a mesh plate in a case of comminuted patellar fracture and the mid-term follow up outcomes. MATERIALS AND METHODS We present a case of comminuted patella fracture managed with the use of a mesh plate and an associated cannulated screw, thus avoiding partial patellectomy and its possible complications. RESULTS Four months postoperatively, the patient presented full knee range of motion and could be discharged to return to work, with no complications or reinterventions. DISCUSSION The use of mesh plates enables the management of comminuted patellar fractures preserving bone stock and restoring the extensor mechanism with a stable and little prominent osteosynthesis. Cases which previously would only have been treated by partial patellectomy and patellar tendon reinsertion can be treated with these plates. CONCLUSION The use of mesh plates for comminuted patellar fractures is an attractive option due to their stability, their ability to preserve bone stock, and the low rates of reintervention.

Effect of patellar resurfacing surgery on bleeding in total knee arthroplasty

SUMMARY OBJECTIVE: Postoperative bleeding is one of the most important factors affecting clinical and functional results in total knee arthroplasty. Therefore, many studies have been conducted on bleeding in arthroplasty patients. However, there are very few reports investigating the effect of patellar surface replacement on bleeding in knee arthroplasty. We, therefore, aimed to investigate the effect of patellar surface replacement on postoperative bleeding. METHODS: In this retrospective study, 30 with patellar resurfacing were compared with 39 without patellar resurfacing among patients who had undergone total knee replacement due to primary osteoarthritis. Demographic data, amount of transfusion, preoperative and postoperative hemoglobin and hematocrit values, and total, visible, and hidden blood loss values were recorded. RESULTS: No statistical difference was found between the two groups in terms of demographic values. There was no significant difference between the groups in terms of the amount of blood in the drain, total blood loss, hidden blood loss, and blood transfusion in patients who had and had not undergone patellar resurfacing. A positive significant correlation was found between postoperative drainage volume and total blood loss. CONCLUSION: Patellar component application in patients who had undergone total knee arthroplasty does not change the blood loss of the patients.

A morphologic and morphometric study of articular facets of Patella

Background: The patella plays a major role in flexion and extension of the knee. The patella morphology can be a predisposing factor in patella instability. The congruency between the patella and femur affects the kinematics of the patellofemoral joint, contact mechanics of the patellar cartilage, and strain in the underlying bone, whereby higher stresses and strains potentially contribute to cartilage wear and anterior knee pain. Aim and Objective: The present study was conducted to assess the morphology of facets of patella. Materials and Methods: The present study was conducted to assess the morphology of facets of patella. Ninety-six patella of unknown sex from bone store of Department of Anatomy were included in the study. The patellar morphology and morphometry were investigated. Statistical analysis was performed using the SPSS (v 12.01) software package (SPSS Inc., Chicago, Illinois). Statistical significance was set at P < 0.05. Results: In the present study; 96 patella of unknown sex from bone store of Department of Anatomy were included in the study. The mean size of the right lateral facet was 23.34 mm and left lateral facet patella was 23.06. P value was non-significant. The shape of lateral facet was concave in 93.9% in the left patella and 100% in the right patella. The shape of lateral facet was flat in 6.1% in the left patella and 0% in the right patella. The mean size of the right medial facet was 17.68 mm and left medial facet patella was 17.39 mm. P value was nonsignificant. The shape of medial facet was concave in 2% in the left patella and 10.6% in the right patella. The shape of medial facet was convex in 69.4% in the left patella and 61.7% in the right patella. The shape of medial facet was flat in 28.6% in the left patella and 27.6% in the right patella. P value was non-significant. Conclusion: The present study concluded that the mean size of the right lateral facet was more left lateral facet patella. The shape of lateral facet was concave in 93.9% in the left patella and 100% in the right patella. The shape of lateral facet was flat in 6.1% in the left patella and 0% in the right patella. The mean size of right medial facet was more than left medial facet patella. The shape of medial facet was concave in 2% in the left patella and 10.6% in the right patella. The shape of medial facet was convex in 69.4% in the left patella and 61.7% in the right patella. The shape of medial facet was flat in 28.6% in the left patella and 27.6% in the right patella.

Anesthetic Management in a Adult Male with Citrullinemia: A Case Report

Our case report is regarding a patient who is a k/c/o citrullinemia type 1 which is a defect in urea cycle posted for facture patella reduction surgery (tension band wiring). He was intellectual disabled because of persistent hyperammonaemia before diagnosis that was controlled with benzoate and L- arginine. Patient preoperative fasting was kept to the minimum and taken as 1st case in the operation theatre. Drugs taken orally on routine basis were continued along with serum ammonia monitoring. Clonidine with midazolam along with propofol infusion to decrease protein hypercatabolism due to stress and to get co-operation of the patient for femoral sciatic block. Postoperative ammonia levels were normal. Sedation is considered useful for preventing hyper ammonemia. Preoperative endocrinology consultation, perioperative serum ammonia level monitoring and coordination between various health departments (nephrologist and endocrinologist) for appropriate care in case of hyper ammonemia and hyperglycaemia perioperatively.

Comparison of hand plating system versus suture anchor fixation in treatment of patellar inferior pole fractures / 中华创伤骨科杂志

Objective:To compare the clinical efficacy between hand plating system (HPS) and classic suture anchor fixation in the treatment of patellar inferior pole fractures.Methods:The clinical data were analyzed retrospectively of the 56 patients who had been treated for patellar inferior pole fractures at Department of Orthopaedics, General Hospital of Northern Theatre Command from January 2018 to December 2019. They were assigned into 2 groups according to their internal fixation methods. In group A of 30 cases subjected to HPS fixation, there were 18 males and 12 females with an age of (61.7±11.3) years; in group B of 26 cases subjected to suture anchor fixation, there were 16 males and 10 females with an age of (60.0±10.5) years. The incision length, operation time, intraoperative bleeding, fracture union time, pain visual analog scale (VAS)and knee function one year postoperation, and follow-up complications were compared between the 2 groups.Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability( P>0.05). The operation time in group A [(59.4±10.8) min] was significantly shorter than that in group B [(66.5±12.3) min] ( P<0.05). There was no significant difference in the incision length or intraoperative bleeding between the 2 groups ( P>0.05). The bone union time was respectively(11.2±1.8) weeks and (12.1±2.4) weeks and the postoperative VAS respectively 0.85±0.12 and 0.91±0.14 for groups A and B, showing no significant difference between the 2 groups ( P>0.05). The knee flexion angle (124.5°±14.6°) and knee Bostman score (29.3±3.5) in group A were significantly better than those in group B (113.2°±11.1° and 26.2±2.9) one year postoperation( P<0.05). Follow-up revealed no complication in group A but 2 cases of implant failure in group B. Conclusion:Compared with the classical anchor suture fixation, HPS may obtain stronger fixation, shorter operation time and better knee function.

Application of 3D printing mirror models and segmentation models in preoperative planning for patellar fractures / 中华创伤骨科杂志

Objective:To explore the application of 3D printing mirror models and segmentation models in preoperative planning for patellar fractures.Methods:Retrospectively analyzed were the data of 46 patellar fractures which had been treated at Department of Orthopedics, Liyang City People's Hospital from January 2016 to August 2020 using 3D printing mirror models and segmentation models in preoperative planning. There were 26 males and 20 females, aged from 19 to 79 years (average, 51.5 years). All the fractures belonged to AO type C. According to the design requirements of a solid model, the patients with DICOM CT data of bilateral lower extremities were assigned into the mirror model group (24 cases) while those with DICOM CT data of only a unilateral lower extremity into the segmentation model group (22 cases). In the mirror model group, CT scans of bilateral knee joints and the proximal tibia exceeding 15 cm were required, while in the segmentation model group, CT scans of only the affected knee joint were required. The original DICOM data were extracted and imported into software Mimics 19.0. In the mirror model group, after the "three-level long-short axis control" method was used to judge the symmetry, the original fracture model and the mirror model were created and printed respectively. During the operation, the fracture line drawn by the mirror model was used to find the fracture fragments with a similar shape which were to be assembled and fixated. The fracture fragments in the segmentation model group were divided into independent entities, converted into STL files and printed separately before the bone fragments were assembled and fixated in sequence. X-ray films were taken after operation. Recorded were the simulated operation time, visual analog scale (VAS) of the knee joint at one month after operation, and B?stman scores at one and 6 months after operation.Results:All patients were followed up for 6 to 24 months (mean, 13.6 months). In preoperative planning, only the mirror model was suitable for patients with comminuted fracture with compression and impaction, both models were suitable for fractures without impaction, compression or impaction, and the segmentation model was suitable for patients with bilateral fractures at the same site, poliomyelitis, one limb missing, and previous fracture. In the mirror model group in which the patients were controlled bilaterally using the "three-level long-short axis control" method, there was no significant difference among the 6 sets of data at 3 levels on both sides ( P>0.05). For the segmentation model group and the mirror model group, the time for preoperative simulated operation averaged 11.2 min and 9.2 min respectively, the VAS score at one month after operation was both lower than 3 points, and the B?stman scores at one and 6 months after operation were both larger than 20 points. Conclusions:The mirror image model of the unaffected patella can be used as the fracture recovery model for the affected side, but the symmetry needs to be verified in advance in case of severe degeneration. Both the 3D printed mirror model and the 3D segmentation model are suitable for preoperative planning for patellar fractures as they are complementary. Patients in both groups can obtain good joint function after treatment.

Predictive factors for prepatellar subfascial gas in patients with closed patellar fracture and their impacts on early infection following internal fixation / 中华创伤骨科杂志

Objective:To explore the predictive factors for prepatellar subfascial gas in patients with closed patellar fracture and their impacts on the early infection following internal fixation.Methods:A retrospective analysis was performed in the 148 patients with closed patellar fracture who had been treated at Department of Orthopaedic Surgery, Zhangjiagang Hospital Affiliated to Soochow University from January 2018 through December 2021. All patients underwent preoperative three-dimensional CT examination of the knee joint and was treated by open reduction and internal fixation of patellar fractures. According to the presence or absence of gas in the prepatellar fascia, the patients were divided into 2 groups. In the gas group of 18 patients, there were 12 males and 6 females with an age of (58.3±14.5) years; in the gas-free group of 130 patients, there were 57 males and 73 females with an age of (60.5±14.6) years. The risk factors for prepatellar subfascial gas were screened out by comparing the gender, age, body mass index, injury mechanism, AO/OTA classification, diabetes, primary hypertension, neutrophil percentage, lymphocyte percentage, white blood cell count, neutrophil count, lymphocyte count, C-reactive protein, erythrocyte sedimentation rate, procalcitonin, and albumin before operation between the 2 groups. A receiver operating characteristic (ROC) curve for risk factors were made to identify the best screening points. The impacts of prepatellar subfascial gas were analyzed on early infection after internal fixation.Results:The preoperative neutrophil percentage was the risk factor for prepatellar subfascial gas ( P<0.05). The area under the ROC curve of preoperative neutrophil percentage for prediction of prepatellar subfascial gas was 0.700 (95% CI: 0.554 to 0.847), the optimal critical value was 78.45%, and the sensitivity and specificity were 0.556 and 0.831, respectively ( P=0.006). In the gas group, the incidence of early postoperative infection was insignificantly higher ( P=0.058) , but the time for postoperative antibiotic use was significantly longer and the dressing changes were significantly more frequent than those in the gas-free group ( P<0.05). Conclusions:In patients with closed patellar fracture, preoperative neutrophil percentage >78.45% can be used as an effective non-imaging indicator for prepatellar subfascial gas. A patient with prepatellar subfascial gas could be more prone to early postoperative infection.

Multi-dimensional fixation of patellar multi-fragmentary fractures with locking plates / 中华创伤骨科杂志

Objective:To report the surgical techniques and clinical outcomes of multi-dimensional fixation of patellar multi-fragmentary fractures with locking plates.Methods:A retrospective study was performed in the 26 patients with patellar multi-fragmentary fracture who had undergone open reduction and 3-D internal fixation with locking plates from November 2016 to July 2020 at Department of Orthopaedic Surgery, The Sixth People's Hospital Affiliated to Shanghai Jiao Tong University. There were 17 males and 9 females, with an average age of 62.6 years (from 31 to 90 years). The patellar fractures were exposed and reduced via the longitudinal anterior midline incision of the knee. After the reduction was initially maintained with a cerclage wire, a trimmed and pre-contoured 3.5 mm locking plate was applied onto the patellar surface. After-wards, locking screws were inserted from the lower pole to the upper pole of the patella, from the anterior to the posterior and from the lateral to the medial, respectively, to complete the multi-planar fixation. Follow-ups assessed the B?stman score, knee pain visual analogue scale (VAS), radiographic image and fracture healing, range of motion of the knee, and complications.Results:All the 26 patients were followed up for 12 to 56 months (average, 28 months). Crutches were used while walking until an average of 1.6 months (from 1 to 3 months) after operation in all patients. At the last follow-up, the B?stman score averaged 27.5 points (from 17 to 30 points), yielding 12 excellent, 13 good and 1 poor case with an excellent to good rate of 96.2% (25/26); the knee pain VAS averaged 1.2 points (from 0 to 5 points); the active knee flexion averaged 125° (from 100° to 150°). No breakage, loosening or displacement of the patellar plates or screws was observed during follow-up, but cerclage wire breakage occurred without any symptom in 11 cases. Four patients complained of hardware irritation, and 4 patients underwent hardware removal after fracture union.Conclusion:Multi-dimensional fixation with locking plates is a viable and safe surgical option for patellar multi-fragmentary fractures, due to its satisfactory therapeutic outcomes.

Application of fracture mapping in knee injuries / 中华创伤骨科杂志

Fracture mapping, also known as mapping of fracture lines, is a technique of drawing fracture lines based on 3D reconstruction of radiological images. Fracture mapping can be used to describe fracture morphology, calculate fracture line angle and fragment area, improve clinical practice, propose a new classification system, clarify a fracture mechanism, and establish a model of bone fracture. At present, fracture mapping has become a powerful tool for study of morphology and clinical decision in orthopaedics. Reviewing the development of fracture mapping techniques, this paper addresses their clinical application in knee injuries, tibial plateau fracture, distal femur fracture and patellar fracture in particular. In addition, considering the trend of fracture mapping techniques and the morphology-related studies at present, we offer suggestions concerning improvement of techniques and morphology studies in knee injuries.

Effect of "patellar pushing and knee extension" manipulation on integrin β1 and p-FAK in articular cartilage of rabbit model of knee osteoarthritis / 国际生物医学工程杂志

Objective:To observe the effects of "pushing patella and extending knee" manipulation on the protein and mRNA expression levels of integrin β1 (ITGβ1) and phosphorylated adhesion plaque kinase (p-FAK) in rabbit knee osteoarthritis (KOA) model, and to investigate the mechanism of manipulations in the treatment of KOA.Methods:Twenty healthy 6-month-old New Zealand rabbits were divided into the normal group, the model group, the acupuncture group, and the manipulation group according to the random number table method. Among them, the model group, the acupuncture group, and the manipulation group were modeled using the modified Hulth method for KOA. After 7 d of successful modeling, the normal group and the model group did not receive any intervention, while the acupuncture group and the manipulation group received one acupuncture intervention and one "pushing patella and extending knee" manipulation intervention daily, respectively. After 2 weeks of treatment, the rabbit KOA model was executed by air embolization, and the protein and mRNA expression levels of ITGβ1 and p-FAK in knee cartilage were measured by Western blot and real-time polymerase chain reaction (PCR), respectively.Results:Compared with the normal group, the ITGβ1 protein expression level was decreased ( P<0.05) and p-FAK protein expression level was increased ( P<0.05), and the mRNA expression levels of ITGβ1 and p-FAK did not change significantly (all P>0.05) in the model group. Compared with the model group, the ITGβ1 protein expression level was increased ( P<0.05), the p-FAK protein expression level decreased ( P<0.05), and the mRNA expression levels of both ITGβ1 and p-FAK increased (all P<0.05) in the acupuncture group. Compared with the acupuncture group, ITGβ1 protein expression level increased ( P<0.05), p-FAK protein expression level decreased ( P<0.05), and mRNA expression levels of both ITGβ1 and p-FAK increased (all P<0.01) in the manipulation group. Conclusions:The "pushing patella and extending knee" manipulation can optimize the protein and mRNA expression levels of ITGβ1 and p-FAK in the articular cartilage of the rabbit KOA model.