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Medisan ; 25(6)2021. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1356480


La rótula baja es una enfermedad infrecuente, de causa congénita o adquirida, caracterizada por dolor en la zona anterior de la rodilla y limitación del movimiento articular. La radiografía simple, en proyección lateral, ayuda al diagnóstico a través de determinadas mediciones; asimismo, el tratamiento conservador no resulta muy exitoso, de ahí que las modalidades quirúrgicas son más empleadas. Debido a la importancia de esta temática y a la escasa información disponible en la bibliografía nacional e internacional, en el presente artículo se comenta brevemente al respecto, con el objetivo de brindar información sobre esta enfermedad para que sirva como guía de trabajo.

The low patella is an uncommon disease, of congenital or acquired cause, characterized by pain in the anterior area of the knee and limitation of the articular movement. The simple x-ray, in lateral projection, helps to make a diagnosis through certain measurements; also, the conservative treatment is not very successful, so that surgical modalities are the most used. Due to the importance of this subject matter and the lack of information available in the national and international bibliography, it is shortly commented in this work, aimed at offering information on this disease so that it serves as working guide.

Patella , Patella/surgery , Patellar Ligament
Rev. bras. ortop ; 56(6): 741-746, Nov.-Dec. 2021. tab, graf
Article in English | LILACS | ID: biblio-1357143


Abstract Objective To evaluate and compare clinically and functionally patients undergoing primary total knee arthroplasty (TKA) with preservation or replacement of the patella. Methods In a cross-sectional study, the functional results were evaluated and compared, using the Western Ontario and McMaster Universities (WOMAC) and Lequesne scores, of 158 patients undergoing primary TKA (162 knees); in 81 knees the patella was submitted to arthroplasty and in 81 the joint surface of the patella was preserved. Results No significant differences were identified in terms of the Lequesne score (p = 0.585), global WOMAC score (p = 0.169), nor in terms of its subdivisions regarding stiffness (p = 0.796) and functional capacity (p = 0.190). There was a significant difference only in terms of the subdivision that evaluates pain in the WOMAC score, being lower in the group undergoing patellar arthroplasty (p = 0.036). Conclusion In the present study, there was no difference in functional assessment in patients who underwent or not patellar replacement during primary knee arthroplasty surgery. However, individuals in whom the patella was preserved reported more pain.

Resumo Objetivo Avaliar e comparar clínica e funcionalmente pacientes submetidos a artroplastia total primária do joelho (ATJ) com preservação ou substituição da patela. Métodos Em um estudo transversal, foram avaliados e comparados os resultados funcionais, usando escores de Western Ontario and McMaster Universities (WOMAC, na sigla em inglês) e Lequesne, de 158 pacientes submetidos a artroplastia total primária o joelho (162 joelhos), sendo que em 81 joelhos a patela foi submetidaa artroplastiae em 81 a superfície articular da patela foi preservada. Resultados Não foram identificadas diferenças significativas quanto ao escore de Lequesne (p = 0,585), escore global de WOMAC (p = 0,169), nem quanto às subdivisões deste quanto a rigidez (p = 0,796) e a capacidade funcional (p= 0,190). Evidenciou-se diferença significativa apenas quanto à subdivisão que avalia a dor no escore de WOMAC, sendo menor no grupo submetido a artroplastia patelar (p = 0,036). Conclusão No presente estudo, não houve diferença na avaliação funcional em pacientes submetidos a substituição ou não da patela durante a cirurgia de artroplastia primária do joelho. Entretanto, os indivíduos nos quais a patela foi preservada relataram mais dor.

Humans , Male , Female , Pain , Patella , Cross-Sectional Studies , Arthroplasty, Replacement, Knee , Osteoarthritis, Knee
Rev. bras. ortop ; 56(2): 147-153, Apr.-June 2021. tab
Article in English | LILACS | ID: biblio-1251340


Abstract Patellar instability is a multifactorial clinical condition that affects a significant number of patients and occurs due to morphological variations of the joint and patellofemoral alignment. The present literature review study aimed to identify and summarize current concepts on patellar instability, in relation to associated risk factors, diagnostic criteria, and the benefits and risks of conservative and surgical treatments. For this purpose, a search was conducted in the following electronic databases: MEDLINE (via Pubmed), LILACS and Cochrane Library. It is concluded that the accurate diagnosis depends on the detailed clinical evaluation, including the history and possible individual risk factors, as well as imaging exams. The initial treatment of patellar instability is still controversial, and requires the combination of conservative and surgical interventions, taking into consideration both soft tissues and bone structures, the latter being the most common reason for choosing surgical treatment, especially lateral patellar instability.

Resumo A instabilidade patelar é uma condição clínica multifatorial, que acomete um número expressivo de pacientes, ocorrendo devido a variações anatómicas, morfológicas da articulação e do alinhamento patelofemoral. O presente estudo de revisão e atualização da literatura teve como objetivos identificar e sumarizar os conceitos atuais sobre instabilidade patelar em relação aos fatores de risco associados, os critérios diagnósticos e os benefícios e riscos dos tratamentos conservador e cirúrgico. Para tanto, foi realizado um levantamento nas bases de dados eletrónicas MEDLINE (via Pubmed), LILACS e Cochrane Library. Conclui-se que o diagnóstico preciso depende da avaliação clínica detalhada, incluindo o histórico e possíveis fatores de risco individuais, além de exames de imagem. O tratamento inicial da instabilidade patelar é ainda controverso, e requer a combinação de intervenções conservadoras e cirúrgicas, levando em consideração tanto os tecidos moles quanto as estruturas ósseas, sendo estas últimas a razão mais comum para a escolha do tratamento cirúrgico, principalmente instabilidade patelar lateral.

Patella , Patellar Dislocation , Patellofemoral Joint , Joint Instability
Article in Chinese | WPRIM | ID: wpr-921918


OBJECTIVE@#To compare the effects of tension band combined with patellar cerclage and memory alloy patellar concentrator fixation in the treatment of comminuted fracture of the lower pole of patella.@*METHODS@#From July 2015 to July 2019, 60 patients with distal patellar fracture were treated and were divided into two groups according to different operation methods. In group A, 30 patients were fixed with memory alloy patellar concentrator (NiTi PC), 17 males and 13 females, aged 20 to 71 (39.4±9.9) years, including 19 cases of falling injury, 9 cases of traffic injury and 2 cases of sports injury. The time from injury to operation was 10 to 75 (33.1±7.8) hours; 30 cases in group B were fixed with tension band andcerclage, 15 males and 15 females, aged 21 to 76 (38.6±10.2) years, including 17 cases of falling injury, 12 cases of traffic injury and 1 case of smashing injury. The time from injury to operation was 10 to 91 (34.5±9.1) hours. The curative effects of two groups were observed and compared.@*RESULTS@#All 60 patients were followed up for 9 to 30 months. There was no significant difference in intraoperative bleeding, operation time, follow-up time and fracture healing time between the two groups. Six months after operation, according to the Bostman function score of knee joint:30 cases in group A, the total score was 28.6±4.7, of which 26 cases were excellent and 4 cases were good. The total score of 30 cases in group B was 25.5±4.4, of which 20 cases were excellent, 8 cases were good and 2 cases were poor. There were significant differences in Bostman total score and curative effect evaluation between two groups (@*CONCLUSION@#Memory alloy patellar concentrator is strong and reliable in the treatment of inferior patellar fracture. It can take early rehabilitation exercise after operation, with good recovery of joint function and range of motion and less complications.

Adult , Aged , Bone Wires , Case-Control Studies , Female , Fracture Fixation, Internal , Fractures, Bone/surgery , Fractures, Comminuted/surgery , Humans , Male , Middle Aged , Patella/surgery , Treatment Outcome , Young Adult
Article in Chinese | WPRIM | ID: wpr-887503


OBJECTIVE@#To explore the ultrasonic anatomical characteristics and needle-knife insertion approach of common tendon lesions in knee osteoarthritis (KOA), so as to provide the references for accurate release of KOA by needle- knife along tendon lesions based on meridian sinew theory.@*METHODS@#Sixty patients with one-knee KOA were selected. High-frequency musculoskeletal ultrasound was used to collect sonograms at the anatomical positions of "Hedingci" "Binwaixia" "Binneixia" and "Yinlingshang". The anatomic levels were marked on the sonograms. The anatomic levels and sonographic features of lesions were compared and analyzed, and the relevant data of needle-knife simulation approach was measured.@*RESULTS@#The "Hedingci" lesions were mainly located at the attachment of quadriceps tendon to patella and suprapatellar bursa. The "Binwaixia" and "Binneixia" lesions were mainly located at the attachment of retinaculum patellae laterale and retinaculum patellae mediale to patella and infrapatellar fat pad. The "Yinlingshang" lesions were mainly located at the attachment of goose foot tendon to medial tibial condyle and bursa of goose foot. With "Hedingci" as an example, when the needle-knife entry point was 1 cm above the patella, the attachment of quadriceps tendon to patella was released, and the average depth of needle-knife was (3.60±0.10) cm, and the needle body was perpendicular to the skin. The average depth of needle-knife for releasing suprapatellar bursa was (2.35±0.17) cm, and the needle body was 45° towards head.@*CONCLUSION@#The musculoskeletal ultrasound could clearly show the local detailed anatomical level, ultrasonic characteristics and anatomical level of common tendon lesions of KOA, and could improve the accuracy of needle-knife along tendon lesions with non-direct vision, which has important reference value for needle-knife medical standardization and standardized operation.

Humans , Knee Joint/surgery , Meridians , Osteoarthritis, Knee/surgery , Patella , Tendons/surgery , Ultrasonography
Article in Chinese | WPRIM | ID: wpr-879406


OBJECTIVE@#To investigate the clinical effect of high tibial osteotomy combined with arthroscopic lateral retinacular release in the treatment of knee varus osteoarthritis.@*METHODS@#From October 2017 to April 2019, a retrospective analysis was performed on 43 patients with knee varus osteoarthritis and lateral patellar compression syndrome treated by high tibial osteotomy combined with arthroscopic lateral retinacular release. There were 15 males and 28 females, aged 53 to 72(62.05±5.17) years. The visual analogue scale(VAS), Lysholm, and the knee range of motion were used to evaluate knee pain and functional recovery before operation, 2 weeks, 3 months and 12 months after operation. And the congruence angle (CA), patellar tilt angle (PTA), and femala-tibial angle (FTA) were measured respectively before and 12 months after operation to evaluate the congruence of patellar joint, and the improvement of line of gravity of lower limb.@*RESULTS@#All 43 patients were followed up for more than 12 months, with a follow-up time of 14 to 28 (19.60±4.50) months. The VAS scores decreased from 6.65±0.65 before operation to 2.16±0.95, 0.51±0.77 and 0.33±0.64 at 2 weeks, 3 months and 12 months after operation, and the difference was statistically significant (@*CONCLUSION@#High tibial osteotomy combined with arthroscopic lateral retinacular release can relieve weight-bearing pain in frontal axis and improve the function of knee in sagittal axis.

Aged , Female , Humans , Knee Joint/surgery , Male , Middle Aged , Osteoarthritis, Knee/surgery , Osteotomy , Patella , Retrospective Studies , Tibia/surgery , Treatment Outcome
Article in Chinese | WPRIM | ID: wpr-879383


OBJECTIVE@#To study mechanism of improvement of stress concentration on patellofemoral joint by stiletto needle releasing lateral patellar retinaculum guided by the theory of Jinshugu() and based on the finite element model of knee joint. and to elucidate the biomechanical mechanism of stiletto needle releasing changing patellar trajectory and reducing patellofemoral joint pressure.@*METHODS@#CT data of knee joint from a normal male (aged 29, heighted 171 cm, weighted 58 kg) was selected. Starting with construction of three-dimensional model of knee joint by using finite element software, the finite element model of knee joint with complete tendonand bone structures were established through several steps, such as geometric reconstruction, reverse engineering, meshing, material assignment and loading analysis. The loading condition was set as 500 N load on knee joint, and the average tensile stress of quadriceps femoris tendon was about 200 N. To simulate the release of lateral patellar retinaculum by stiletto needle at 30 and 90 position of knee flexion in finite element model separately, and to compare the improvement of stress concentration of patellofemoral joint by stiletto needle intervention under different knee flexion conditions.@*RESULTS@#The peak stress of patellofemoral joint and tibiofemoral joint decreased after stiletto needle releasing of patellofemoral lateral retinaculum compared with before intervention, which was(1) knee flexion at 30 degrees:patellar cartilage decreased by 0.498 MPa (decreased 9.06%), femoral trochlea decreased by 0.886 MPa(decreased 16.27%);(2) knee flexion at 90 degrees:patellar cartilage decreased by 0.558 MPa (decreased 8.6%), femoral trochlea decreasedby 0.607 MPa (decreased 9.94%).@*CONCLUSION@#Releasing lateral patellofemoral retinaculum with stiletto needle could effectively alleviate the stress concentration of patellofemoral joint and reduce local stress peak value, which it is helpful to improve patellar trajectory and make stress distribution more uniform.

Adult , Biomechanical Phenomena , Finite Element Analysis , Humans , Knee Joint , Male , Patella , Patellofemoral Joint , Quadriceps Muscle , Range of Motion, Articular
Article in Spanish | LILACS, BINACIS | ID: biblio-1353911


Introducción: Las lesiones condrales de la rótula son un reto para el cirujano, principalmente en pacientes jóvenes y activos. La mayoría de los defectos condrales de la rótula son lesiones superficiales y pueden ser manejadas con técnicas de preservación articular; sin embargo, las lesiones profundas pueden requerir otro tipo de manejo. El objetivo de este artículo es comunicar el tratamiento de defectos osteocondrales de la rótula en pacientes jóvenes, mediante la técnica de aloinjerto fresco de donante cadavérico. materiales y métodos: Se seleccionaron pacientes con dolor anterior de rodilla, lesión condral de la rótula grado III-IV y que habían recibido o no algún tipo de manejo médico o quirúrgico. En estos pacientes, se usó un aloinjerto fresco de rótula con el fin de solucionar el cuadro y mejorar la función. Resultados: Todos los pacientes recuperaron la función y los arcos de movilidad, y no refirieron dolor. Se comprobó la integración del aloinjerto fresco al área receptora, sin evidencia de rechazos del tejido o infecciones. Conclusiones: El uso de aloinjerto fresco de rótula para tratar defectos osteocondrales amplios es una téc-nica quirúrgica valiosa, fácil de implementar, que no requiere una curva de aprendizaje extensa y que mejora considerablemente el dolor y la función en pacientes jóvenes. Nivel de Evidencia: IV

Introduction: Chondral lesions of the patella are a challenge for the surgeon, mainly in young and active patients. Most patellar chondral defects are superficial injuries and can be managed with joint preservation techniques; however, deep injuries may require other types of management. The objective of this article is to manage osteochondral defects of the patella in young patients, using the technique of fresh allograft from a cadaveric donor. Materials and methods: Patients with anterior knee pain, with grade III - IV chondral lesion of the patella and who had or had not undergone some type of medical or surgical management were included. They received a fresh patellar allograft that sought to provide a solution and improvement of the functionality. Results: In all cases, recovery of functionality and mobility, absence of pain and integration of the fresh allograft into the recipient area were achieved, without evidence of tissue rejection or infection. Discussion: The use of fresh patellar allograft for the management of wide osteochondral defects is a valuable surgical technique, easy to implement, that does not require a long learning curve and that considerably improves pain and functionality in young patients. Conclusions: The advent of fresh osteochondral grafts allows adequate management and evolution of patients, with the aim of favoring joint preservation and avoiding total knee arthroplasty over time. Level of Evidence: IV

Osteochondritis , Patella/surgery , Patella/pathology , Allografts
Article in Spanish | LILACS, BINACIS | ID: biblio-1353924


Introducción: La rotura del aparato extensor puede ocurrir a nivel óseo o tendinoso; la principal causa es la fractura de rótula, seguida de la rotura del tendón cuadricipital y la rotura del tendón rotuliano. Estas lesiones pueden deberse a traumas directos o indirectos. La rotura tendinosa del aparato extensor es poco frecuente: representa el 3% de todas las lesiones tendinosas. Se presenta con traumatismos relacionados con la actividad diaria, deportiva o asociada a enfermedades sistémicas. materiales y métodos: Presentamos una serie de 22 roturas tendinosas del aparato extensor de la rodilla (8 del tendón cuadricipital [2 bilaterales] y 14 del tendón rotuliano [1 bilateral]), tratadas mediante cirugía, entre junio de 2015 y enero de 2019. Todos los pacientes fueron evaluados inicialmente con radiografías y resonancia magnética. Se empleó la escala de Lysholm para la evaluación funcional posquirúrgica. Resultados: El seguimiento posquirúrgico fue mínimo de un año (rango 12-24); los resultados fueron excelentes en 13 casos, buenos en 7 casos y regulares en 2 casos. Conclusión: La reparación primaria, con sutura transósea de las roturas tendinosas del aparato extensor más cerclaje en 8 como aumento en las lesiones del tendón rotuliano brinda una reconstrucción estable, permite implementar un protocolo posquirúrgico de movilización temprana, y así lograr excelentes resultados funcionales con una tasa baja de complicaciones. Nivel de Evidencia: IV

Background: The rupture of the extensor mechanism can have its origin at bone or tendon level. Its main cause is patellar fracture, followed by quadriceps tendon rupture, and, finally, patellar tendon rupture. These ruptures can be due to direct or indirect trauma. Tendon ruptures of the extensor mechanism are rare, developing with trauma related to the daily routine, sports, or associated systemic diseases. They represent 3% of all tendon injuries. materials and methods: We presented 22 tendon ruptures of the knee extensor mechanism, surgically treated between June 2015 and January 2019, from which eight (8) ruptures were of the quadriceps tendon (2 bilateral) and fourteen (14) of the patellar tendon (1 bilateral). The cases were evaluated using the Lysholm score, radiographs, and MRI. Results: The minimum follow-up was one (1) year. According to the results of those twenty-two (22) surgeries, thirteen (13) cases had excellent results, seven (7) cases were good and two (2) of them were fair. Conclusion: In cases of patellar tendon injury, the primary repair with transosseous suture plus figure-of-eight cerclage as augmentation provides a stable reconstruction, allowing the implementation of an early mobilization post-surgery protocol, thus achieving excellent functional outcomes with low complication levels. Level of Evidence: IV

Adult , Middle Aged , Patella/injuries , Tendon Injuries , Knee Injuries , Knee Joint
Rev. bras. ortop ; 55(6): 800-803, Nov.-Dec. 2020. graf
Article in English | LILACS | ID: biblio-1156198


Abstract Intraarticular dislocation of the patella is an uncommon condition, with displacement in the horizontal or vertical plane, which may be associated with total or partial lesion/rupture of the quadriceps tendon, with osteochondral or collateral ligament injury. Risk factors are ligament laxity, patellar hypermobility, high patella, and trochlear dysplasia. This condition is more common in young people and may require blood reduction. Cases of intraarticular dislocation of the patella are rare events, requiring diagnostic suspicion and differentiated management. The aim of the present study is to report a rare case of intraarticular dislocation of the patella, as well as its clinical condition, diagnosis, management and literature review.

Resumo Luxação intra-articular da patela é uma afecção incomum, podendo ocorrer deslocamento no plano horizontal ou vertical; pode se associar com lesão/ruptura do tendão do quadríceps, total ou parcial, com lesão osteocondral ou dos ligamentos colaterais. Fatores de risco são: frouxidão ligamentar, hipermobilidade patelar, patela alta e displasia troclear, e é mais comum em jovens, podendo necessitar de redução cruenta. Casos de luxação intra-articular da patela são eventos raros, sendo necessários uma suspeição diagnóstica e um manejo diferenciado. O objetivo deste trabalho é relatar um caso raro de luxação intra-articular da patela, assim como seu quadro clínico, diagnóstico, conduta e revisão da literatura.

Humans , Female , Aged , Patella , Risk Factors , Collateral Ligaments , Patellar Dislocation , Joint Dislocations , Joint Instability , Knee Joint , Ligaments
Int. j. morphol ; 38(4): 933-939, Aug. 2020. tab, graf
Article in English | LILACS | ID: biblio-1124879


Sexual dimorphism is one of the most important ways to identify bone remains in mass disasters. Many of them have been used for this purpose; mainly skull, pelvis and long bones. However, only a few studies using the patella have been done and, to our knowledge, there are no assessments of previous results in the literature. Meta-analysis provides a useful strong tool to test, in a systematic way, the most relevant information about a given research field. The aim of this study is to apply the meta-analytic technique to assess the major studies concerning sexual dimorphism in the patella by measuring classical metric traits: maximum height and maximum width, with different techniques, such as caliper, radiography, tomography and magnetic resonance. The 17 papers found, involving a total sample size higher than 2600 patellae, showed a very high heterogeneity- around 93 % of I2 value, for height and width measurements when all the studies were analyzed together. Homogeneity increased when each study was classified according to the techniques used. In this case, a statistical difference appeared, among the several subgroups of techniques for the two measurements, suggesting the importance of the methodology used. Maximum height and maximum width were all showed to be statistically relevant in distinguishing both sexes.

El dimorfismo sexual es una de las formas más importantes para identificar restos óseos en desastres masivos. Se han utilizado huesos como cráneo, pelvis y huesos largos para la diferenciación sexual. Sin embargo, solo se han realizado unos pocos estudios con la patela y, hasta donde sabemos, no hay evaluaciones de resultados anteriores en la literatura. El meta-análisis proporciona una herramienta sólida y útil para probar, de manera sistemática, la información más relevante sobre un cierto campo de investigación. El objetivo de este estudio consiste en aplicar la técnica metaanalítica para evaluar los principales estudios sobre dimorfismo sexual en la patela midiendo los rasgos métricos clásicos: altura máxima y anchura máxima, con diferentes técnicas: calibre, radiografía, tomografía y resonancia magnética. Los 17 de documentos encontrados, con un tamaño de muestra total superior a 2600 patelas, mostraron una heterogeneidad muy alta, alrededor del 93 % del valor de I2, para mediciones de altura y anchura cuando todos los estudios se analizaron juntos. La homogeneidad aumentó cuando cada estudio se clasificó de acuerdo con las técnicas utilizadas. En este caso, se observó diferencias estadísticas, entre los subgrupos de técnicas para las dos mediciones, lo que sugiere la importancia de la metodología utilizada. La altura máxima y la anchura máxima mostraron ser estadísticamente relevantes para distinguir ambos sexos.

Humans , Patella/anatomy & histology , Sex Determination Analysis/methods , Sex Characteristics
Rev. Asoc. Argent. Ortop. Traumatol ; 85(2): 99-106, jun. 2020. []
Article in Spanish | LILACS, BINACIS | ID: biblio-1125546


Objetivo: El enclavado endomedular de las fracturas metafisarias de tibia se asocia con algunas complicaciones relacionadas con la necesidad de flexionar la rodilla durante la introducción del clavo endomedular con la técnica infrarrotuliana clásica. Es por ello, que se han diseñado diferentes abordajes para la colocación del clavo en una posición de semiextensión de rodilla. El objetivo fue evaluar nuestros resultados, de forma retrospectiva, con el abordaje pararrotuliano medial en semiextensión, para el tratamiento de las fracturas metafisarias proximales y distales de tibia con clavo endomedular. Materiales y Métodos: Se incluyó a 23 pacientes con un seguimiento posoperatorio mínimo de un año. Doce eran fracturas distales de tibia; 9, proximales y 2, segmentarias. Se evaluaron el rango de movilidad de la rodilla, el dolor posoperatorio con la escala de Lysholm, el eje posoperatorio y la tasa de consolidación. Resultados: El arco de movilidad de la rodilla fue de 125° (rango 110-140). Al año de la cirugía, 16 de 23 pacientes no tenían dolor, 5 de 23 refirieron un leve dolor durante la actividad física y 2, dolores intensos durante la actividad física. En todos los casos, se consiguió un eje posoperatorio aceptable y la consolidación ósea. Un paciente requirió un aumento con una placa e injerto óseo. Conclusión: La colocación de un clavo de tibia a través de un abordaje pararrotuliano medial con la rodilla en semiextensión es una técnica segura y simple para el tratamiento de las fracturas metafisarias de tibia. Nivel de Evidencia: IV

Objective: To review the results of a series of metaphyseal tibial fractures treated with intramedullary nailing (IMN) in a semiextended position using a medial parapatellar approach. To report reduction quality, bone consolidation, range of motion (ROM) and postoperative knee pain at final follow-up. Materials and Methods: Twenty-three metaphyseal tibia fractures were treated with IMN. Twelve were distal tibial fractures (AO/OTA 43A), nine were proximal tibial fractures (AO/OTA 41A2/3), and two had segmental tibia fractures (AO/OTA 42C2). The minimum follow-up was 1 year. Results: Radiograph angulation at the fracture site was <5 degrees. All patients achieved bone healing. One patient (AO/OTA 42C2) required plate augmentation and bone autografting. Twenty-one out of 23 patients had knee pain scores of >20 according to the Lysholm scale. Conclusion: The parapatellar approach in a semi-extended position is a safe and useful technique for IMN of metaphyseal tibia fracture with no associated increased postoperative knee pain. Level of Evidence: IV

Adult , Middle Aged , Pain, Postoperative , Patella/surgery , Tibial Fractures/surgery , Range of Motion, Articular , Treatment Outcome , Fracture Fixation, Intramedullary/methods , Leg Injuries
Acta ortop. mex ; 34(1): 27-30, ene.-feb. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1345081


Resumen: Introducción: El cartílago rotuliano está sometido a altas demandas mecánicas y es una localización muy frecuente de lesiones. No existe consenso en cuanto a su tratamiento. El trasplante osteocondral autólogo puede ser una alternativa para los defectos condrales de pequeño o mediano tamaño con resultados variables en la bibliografía. Nuestro objetivo es analizar los resultados funcionales a mediano plazo de los pacientes con lesiones del cartílago patelar grado III-IV de la International Cartilage Repair Society (ICRS) tratados en nuestro centro. Material y métodos: Estudio retrospectivo con pacientes menores de 55 años, con un defecto condral patelar sintomático, diámetro menor de 2 cm, grado III-IV de la ICRS tratados mediante trasplante osteocondral autólogo entre los años 2012 y 2018. Se evalúan las siguientes variables: edad, sexo, tamaño de la lesión, faceta afectada, número de cilindros trasplantados, escala de Kujala pre y postoperatoria y escala visual analógica del dolor (EVA) pre y postoperatoria. Resultados: Integramos en nuestro estudio 11 pacientes. La mediana de edad fue de 47 años. La mediana del diámetro del defecto condral 1.3 cm. La mediana de seguimiento 3.9 años (1.84-5.58 años). La mediana del cuestionario Kujala preoperatoria es 33 y asciende a 89 al final del seguimiento (p = 0.003). La mediana de la puntuación EVA preoperatoria es nueve y dos al final del seguimiento (p = 0.003). Conclusión: El trasplante osteocondral autólogo generó una importante mejora subjetiva de la función y del dolor.

Abstract: Introduction: Patellar cartilage is subject to high mechanical requests and is a very frequent location of injuries. There is no consensus on their treatment. Autologous osteochondral transplantation may be an alternative to small to medium-sized condral defects with varying results in the literature. Our goal is to analyze the medium-term functional outcomes of patients with grade III-IV patellar cartilage injuries from the International Cartilage Repair Society (ICRS) treated at our facility. Material and methods: Retrospective study in patients under 55 years of age, with a symptomatic patellar condral defect, diameter less than 2 cm, grade III-IV of ICRS treated by autologous osteochondral transplant between 2012 and 2018. The following variables are evaluated: age, sex, injury size, affected facet, number of transplanted cylinders, pre- and postoperative Kujala score, and pre- and postoperative analog visual pain scale (EVA). Results: Eleven patients integrated into our study. The median age was 47 years. The median diameter of the condral defect 1.3 cm. Median follow-up 3.9 years (1.84-5.58 years). The median of the preoperative Kujala questionnaire is 33 and is 89 at the end of the follow-up (p = 0.003). The median of the preoperative EVA score is 9 and 2 at the end of the follow-up (p = 0.003). Conclusion: Autologous osteochondral transplantation generated a significant subjective improvement in function and pain.

Humans , Patella , Bone Transplantation , Transplantation, Autologous , Cartilage , Retrospective Studies , Follow-Up Studies , Treatment Outcome , Middle Aged
Arq. bras. med. vet. zootec. (Online) ; 72(1): 107-114, Jan.-Feb. 2020. tab, ilus
Article in Portuguese | LILACS, VETINDEX | ID: biblio-1088916


O objetivo deste trabalho foi mensurar as dimensões da patela de cadáveres caninos e avaliar sua relação com a massa corporal. Para a realização das medidas patelares, foram utilizados 70 cadáveres de cães adultos, com massa corpórea de 1 a 50kg, sem evidência clínica de afecção na articulação femorotibiopatelar. Com auxílio de um paquímetro, foram mensurados os comprimentos externo e interno, a largura externa no terço médio, a largura e a espessura internas nos terços proximal, médio e distal das patelas. Também foram mensuradas a largura nos terços proximal, médio e distal, a profundidade nos terços proximal, médio e distal do sulco troclear; essas medidas foram exclusivamente internas. Observou-se, de forma geral, forte correlação entre as medidas patelares e a massa corporal de cadáveres de cães. Nas condições deste estudo, pode-se concluir que o tamanho da patela varia segundo a massa corporal do cão e que essas medidas devem ser consideradas ao se planejar uma substituição protética.(AU)

The aim of this study was to measure the canine cadaver patellar dimensions and evaluate its relationship with body mass. 70 cadavers of adult dogs were used, with a body mass between 1 and 50kg, without clinical evidence of affection in the stifle joint. The external and internal lengths, external width in the middle third, width and thickness of the proximal, middle and distal thirds were measured using a pachymeter. The width was also measured in the proximal third, middle third and distal third, depth in the proximal third, middle third and distal third of the trochlear groove; these measurements were exclusively internal. A strong correlation was observed between the patellar dimension and body mass of canine cadavers. Under this study conditions, it is possible to conclude that the patellar size varies according to the canine body mass and these measures should be considered when planning a prosthetic replacement.(AU)

Animals , Dogs , Patella/anatomy & histology , Prostheses and Implants/veterinary , Body Weight , Patellar Dislocation/veterinary , Cadaver
Artrosc. (B. Aires) ; 27(4): 155-161, 2020.
Article in Spanish | LILACS, BINACIS | ID: biblio-1177898


En este trabajo evaluaremos si existe regresión de los cambios degenerativos del cuádriceps tras la reparación diferida de una lesión del aparato extensor. La hipótesis es que esta reparación diferida favorece la regresión de cambios degenerativos del cuádriceps, relacionado con la precocidad de la reparación.Estudio experimental en quince ratones BKS machos: se seccionaron completamente ambos tendones patelares. Se definieron tres grupos de cinco animales cada uno, randomizados, según el momento en que se reparó el tendón derecho: Grupo 1: una semana postsección; Grupo 2: dos semanas; y Grupo 3: cuatro semanas postsección. El cuádriceps izquierdo, no reparado, se utilizó como control respectivo para cada grupo. Los animales fueron sacrificados a las cuatro semanas post-reparación. Un patólogo, ciego al estudio, analizó las características macroscópicas e histológicas. El análisis estadístico incluyó test para muestras pareadas e independientes (p<0.05).Macroscopia: hubo tres reparaciones fallidas, dos en el grupo 2 y una en el grupo 3. Solo se observaron diferencias significativas en la longitud cuadricipital del grupo 1 versus su control (p= 0.0422). No hubo diferencias estadísticas entre los grupos de intervención, ni contra los controles respectivos en los otros parámetros evaluados.Histología: no se encontraron diferencias estadísticamente significativas entre los grupos de intervención, ni contra sus controles respectivos.En este modelo experimental, la reparación diferida de una lesión completa del aparato extensor de la rodilla no demostró una reversibilidad de los cambios degenerativos musculares. La precocidad de la reparación se relacionó con menor número de fallas y mayor longitud cuadricipital. Se refuerza la importancia de priorizar la reparación temprana de lesiones completas del aparato extensor de la rodilla

Evaluate the regression of degenerative changes in the quadricipital muscle after a delayed extensor mechanism repair. The hypothesis is that a delayed repair favors the regression of degenerative changes related to the precocity of the repair. Experimental study in fifteen BKS male mice: a complete section of both patellar tendons was made. Animals were randomly divided into three study groups (five mice per group), according to the week after the lesions at which the right quadriceps were repaired: Group 1: one week; Group 2: two weeks, and Group 3: four weeks. Left quadriceps remained unrepaired and was used as the corresponding control for each group. All animals were sacrificed four weeks after the repair. A blind pathologist analyzed macroscopic and histologic evaluations. Statistical analysis included tests for paired and independent samples (p=0.05).Macroscopy: there were three repair failures, two in group 2 and one in group 3. Quadricipital length in group 1 was the only significant difference (p=0.04222) observed between the intervened muscles and their corresponding control. No statistical differences were present between the intervention groups, neither when compared to their corresponding controls for the other macroscopic parameters. Histology: No statistical differences were present between the intervention groups, neither when compared to their corresponding controls for the other macroscopic parameters.A delayed repair of a complete knee extensor mechanism injury in this experimental model did not demonstrate the regression of the degenerative muscle changes. The precocity of the repaired correlated with fewer repair failures and a greater quadricipital length. The present experimental study enhances the importance of an early repair for complete knee extensor mechanism injury

Animals , Mice , Patella , Tendon Injuries , Quadriceps Muscle , Knee Joint/surgery
Rev. Salusvita (Online) ; 39(1): 103-110, 2020.
Article in Portuguese | LILACS | ID: biblio-1119728


A patela é o maior osso sesamoide do corpo humano, posicionado longitudinalmente na fáscia do músculo quadríceps, entre os tendões quadríceps e patelar. A patela bipartida dolorosa, também conhecida como "sincrondose dolorosa", é uma causa conhecida de dor no joelho anterior, é um diagnóstico de exclusão. Objetivo: Relatar um caso e revisar a literatura acerca desta lesão incomum. Materiais e Métodos: Revisão do prontuário do paciente no Hospital Luxemburgo, registro fotográfico do método diagnóstico e revisão da literatura. Resultados: Homem de 45 anos com dor no joelho direito há 01 ano, principalmente na região anterior, que piora ao agachar. Ao exame físico apresenta edema com dor a palpação da patela. A radiografia demonstra patela bipartida. A ressonância magnética (RM) do joelho direito demonstra patela bipartida com união fibrosa entre o fragmento bipartido superolateral e a patela, associada a lesões condrais e edema subcondrais, compatível com "sincondrose dolorosa" da patela. Conclusão: Este relato demonstra a dificuldade de diagnosticar está lesão, pois seu o exame físico é inespecífico e a radiografia demonstra apenas a variação da normalidade ­ patela bipartida, sem evidenciar as alterações próprias da doença, caracterizada apenas pela RM.

The patella is the largest sesamoid bone in thehuman body, positioned longitudinally in the quadriceps muscle fascia, between the quadriceps and patellar tendons. The painful bipartite patella, also known as "painful synchondrosis", is a known cause of anterior knee pain, is a diagnosis of exclusion.Objective: Report a case and review the literature about this uncommon lesion. Materials and Methods: We carried out a review of medical records at Hospital Luxemburgo, a photographic record of diagnostic methods, and a review from the literature. Results: 45-year-old man with right knee pain for 1 year, mainly in the anterior region, which worsens when crouching. Physical examination shows edema with pain on palpation of the patella. Right knee radiography demonstrates a bipartite patella. Magnetic resonance imaging (MRI) of the right knee demonstrates a bipartite patella with a fibrous union between the superolateral bipartite fragment and the patella, associated with chondral lesions and subchondral edema, compatible with patella "painful synchondrosis". Conclusion: This report demonstrates the difficulty of diagnosing this lesion, since its physical examination is nonspecific and the radiography shows only the normal variation ­ bipartite patella, without evidencing the disease alterations, characterized only by MRI.

Humans , Male , Adult , Patella/abnormalities , Patella/diagnostic imaging , Bone Diseases/diagnostic imaging , Pain/drug therapy , Pain/diagnostic imaging , Magnetic Resonance Imaging , Pregabalin/therapeutic use , Analgesics/therapeutic use
Article in Korean | WPRIM | ID: wpr-811279


Recently, as the elderly population increases, the incidence of total knee arthroplasty has increased, with a concomitant increase in the frequency of periprosthetic fractures. To determine the treatment plan for fractures, the treatment method should be determined by the patient's age, osteoporosis, fixation status of the implant, and type of fracture. In recent years, operative treatment with reduction and stable fixation, rather than non-operative treatment, was used to promote early joint movement and gait. On the other hand, it is necessary to select an appropriate operative method to reduce complications of surgery, such as nonunion and infection, and expect a good prognosis. In this review, periprosthetic fractures were divided into femur, tibia, and patella fractures, and their causes, risk factors, classification, and treatment are discussed.

Aged , Arthroplasty , Arthroplasty, Replacement, Knee , Classification , Femur , Gait , Hand , Humans , Incidence , Joints , Knee , Methods , Osteoporosis , Patella , Periprosthetic Fractures , Prognosis , Risk Factors , Tibia
Article in English | WPRIM | ID: wpr-811123


BACKGROUND: We aimed to confirm the long-term effect of patellar nonresurfacing (patellar decompression) in preventing anterior knee pain after total knee arthroplasty (TKA) and to investigate the possible complications.METHODS: Among patients who underwent primary TKA after being diagnosed as having advanced osteoarthritis (Kellgren-Lawrence grade 4) at our institution from January 2004 to December 2010, 121 patients who were followed up for more than 7 years were included in this study. Patients who underwent TKA with and without patellar decompression were classified as the study group and control group, respectively. A clinical knee rating score was used to compare the postoperative clinical outcomes between groups. To identify complications after patellar decompression, simple radiographs (weight-bearing anteroposterior and lateral views, patella in 30° and 45° axial views, and whole scanogram) were taken during follow-up.RESULTS: There were no complications such as patellar fracture, osteonecrosis, and subluxation. At 2 years after surgery, the prevalence of anterior knee pain was 12.7% and 18.0% in the study group and control group, respectively (p = 0.42), and the number of patients with patellofemoral osteoarthritis grade II or over was lower in the study group (p = 0.03). At 7 years after surgery, the prevalence of anterior knee pain was 18.3% and 24.0% in the study group and control group, respectively (p = 0.45), and there was no statistically significant intergroup difference in the number of patients with patellofemoral osteoarthritis grade II or over (p = 0.11).CONCLUSIONS: Patellar nonresurfacing TKA reduces anterior knee pain in the early postoperative period. The procedure can be considered a relatively safe option with fewer complications; however, its effectiveness appears to decrease over time.

Arthroplasty, Replacement, Knee , Decompression , Follow-Up Studies , Humans , Knee , Osteoarthritis , Osteonecrosis , Patella , Postoperative Period , Prevalence
Article in Chinese | WPRIM | ID: wpr-828267


OBJECTIVE@#To construct a dynamic knee joint finite element model based on CT image data and verify the validity of the model. To provide a simulation model and basic data for biomechanical research of the knee joint by further finite element analysis.@*METHODS@#The CT data of a healthy male knee joint was selected. With the help of Mimics 19.0 and Hypermesh 12.0 software, a high simulation finite element model of knee joint was established following steps, including geometric reconstruction, reverse engineering, meshing and material characterization. The dynamic knee flexion model was generated by determining the boundary conditions and torque loading, and the validity of themodel was confirmed. The biomechanical changes of the tibiofemoral and patellofemoral joints under different knee flexion angles were analyzed by applying the loads (500 N) to the finite element model during knee flexion.@*RESULTS@#A finite element model of knee joint was established based on CT images and anatomical characteristics. The model included three-dimensional elements such as bone, ligament, cartilage, meniscus and patellar retinaculum. The different finite element models of knee flexion states were produced by applying different torques after establishing boundary conditions. According to equivalent conditions (knee flexion 30 degrees, quadriceps tendon under 200 N stretch), the peak stress value of patella was 2.209 MPa and the average Mises stress was 1.132 MPa; the peak stress value of femoral trochlear was 1.405 MPa and the average Mises stress was 0.936 MPa. The validity of the model was proved by the difference between the model and previous studies of 1% to 13.5%. Dynamic model loading showed that the Mises stressof tibiofemoral joint decreased with the increase of knee flexion angle, while the Mises stress of patellofemoral joint was positively correlated with knee flexion angle. The Mises stress of cartilage stress planes at different knee flexion angles was significantly different(<0.05).@*CONCLUSION@#The finite element model established in this study is more comprehensive and can effectively simulate the biomechanical characteristics of dynamic knee joint, which provides support for further simulation mechanics researches of the knee joint.

Biomechanical Phenomena , Finite Element Analysis , Humans , Knee Joint , Diagnostic Imaging , Male , Patella , Stress, Mechanical , Tomography, X-Ray Computed
Article in Chinese | WPRIM | ID: wpr-879325


OBJECTIVE@#To compare influence of retention or resection subpatellar fat pad on patella height during rheumatoid knee replacement.@*METHODS@#Totally 48 patients with rheumatoid arthritis who underwent total knee replacement from October 2013 to October 2017 were retrospectively analyzed and divided into resection and retention subpatellar fat pad group. There were 23 patients in resection subpatellar fat pad group, including 9 males and 14 females aged from 48 to 69 years old with an average of(55.83±5.65) years old; subpatellar fat pad were resected during opertaion. There were 25 patients in retention subpatellar fat pad group, including 6 males and 19 femlaes aged from 49 to 70 years old with an average age of (55.52± 6.28) years old;subpatellar fat pad were retentedduring opertaion. Postopertaive complications were observed between two groups, visual analogue scale (VAS) and Hospital for Special Surgery (HSS) at 1 year after operation were used to evaluate relieve pain degree and clnical effect of knee joint, Insall-Salvati ratio(I-S ratio) was used to compare changes of postoperative patella height at 1 year after operation.@*RESULTS@#All patients were followed up from 12 to 39 months with an average of (23.85± 8.82) months. The postoperative wound healed well without infection complications and no prosthetic loosening or revision. Postoperative VAS score at 1 year between two groups was lower than that of before opertaion(@*CONCLUSION@#Resection or retention subpatellar fat pad in rheumatoid knee replacement have advantages of relieving postoperative pain and improving functional recovery, however, retention of infrapatellar fat pad is beneficial to restoration of patellar height.

Adipose Tissue , Aged , Arthroplasty, Replacement, Knee/adverse effects , Female , Humans , Knee Joint/surgery , Male , Middle Aged , Patella/surgery , Retrospective Studies