Bilateral double-layered patella in a patient with advanced knee osteoarthritis.

Double layered patella (DLP) is a rare anomaly of the patella that may go undiagnosed, especially in patients with progressive knee dysfunction and early degenerative changes. Clinical symptoms such as motion-dependent pain and anterior knee pain most typically occur in adolescents or young adults; however, gradually increasing pain and early generalised degenerative changes have also been seen in patients over 40 years old. Diagnosis of DLP could be difficult, especially in cases with coexisting arthrosis. DLP is considered to be pathognomonic for the diagnosis of multiple epiphyseal dysplasia and usually coexists with other anomalies seen in this syndrome, such as hip dysplasia. In extremely rare cases, DLP can occur as a solitary disorder. The prevalence of such cases, however, is unknown, and they could be easily misdiagnosed. Computed tomography and magnetic resonance imaging are the most sensitive radiological methods used in DLP diagnosis. This case report presents a case of a bilateral DLP incidentally found in a 47-year-old patient with advanced arthritis referred for arthroplasty because of increasing symptoms of knee joint failure with no other abnormalities recorded. An important goal of our case study is to raise the awareness of this abnormality with radiologists and orthopaedic surgeons.

The effect of activated platelet-rich plasma (PRP) on tricalcium hydroxyapatite phosphate healing in experimental, partial defects of long bone shafts in animal models.

The purpose of the study was to assess the effect of autologous activated platelet-rich plasma on healing of a bone substitute - tricalcium phosphate hydroxyapatite in experimental long bone defects using an animal model. The experiment involved an animal model of femoral defect. 24 Termond white rabbits were used in the study. We evaluated the effect of autologous platelet-rich plasma on tricalcium phosphate using classical radiology, micro-CT studies, strength tests and histological evaluation. Radiological and histological assessment did not show a beneficial effect of PRP together with a bone substitute in comparison to filling the defects only with bone replacement material. The only benefit of adding platelet-rich plasma to a bone substitute was shown in microCT imaging. Autologous, activated platelet-rich plasma combined with hydroxyapatite tricalcium phosphate has a positive effect on the remodeling of the newly formed bone tissue, increasing its density.

Autologous activated platelet-rich plasma (PRP) in bone tissue healing - does it work? Assessment of PRP effect on bone defect healing in animal models.

INTRODUCTION: Platelet-rich plasma (PRP) preparations can be used in bone tissue healing but there are numerous doubts among clinical orthopedists about effectiveness of this method. MATERIALS AND METHODS: The studies were carried out in 12 rabbits of white termond breed. In operating room we operationally generated cylindrical, unicortical defects of the diameter of 4 mm in the middle of the shafts of both femurs. The defects in the left bones were left without filling and served as controls, and 0.7 ml of the ready-to-use PRP was administered to the defects in the right bones (experimental group). We evaluated the usefulness of the diagnostic methods applied: biomechanical tests, micro-CT tests, densitometry, typical radiology, macroscopic measurements, histopathological examinations. RESULTS: The macroscopic measurements showed a statistically significant increase in the dimension in the area of the right defect filled with PRP in relation to the control group. In experimented group, the assessment of the X-ray images showed the formation of a callus cuff around the defects. Densitometric examinations showed no statistically significant differences between defects in the experimental and control group. The analysis of the micro-CT examina- tions showed an increase in the total volume of the tissue examined (Vb) and the low density tissue fraction (Vb2) in the experimental group. The biomechanical examinations revealed signi- ficant decrease in the maximum breaking force (F max) necessary to break the bone in the experi- mental group in relation to the control group. CONCLUSIONS: Platelet-rich plasma (PRP) stimulates bone formation in the area of bone defects and may accelerate bone regeneration.

The use of osteochondral allograft with bone marrow-derived mesenchymal cells and hinge joint distraction in the treatment of post-collapse stage of osteonecrosis of the femoral head.

Osteonecrosis of the femoral head is an entity which occurs mainly in young and active patients aged between 20 and 50. The success of hip joint preserving treatments ranges from 15% to 50% depending on the stage and amount of osteonecrotic lesion. Total hip replacement is indicated in late post-collapse hips but it has unsatisfactory survival because of the wear and osteolysis in young and active patients. Osteochondral allografts have been reported in the treatment of large articular lesions with defects in underlying bone in knee, talus and shoulder. By combining osteoconductive properties of osteochondral allograft with osteogenic abilities of bone marrow-derived mesenchymal cells it has a potential to be an alternative to an autologous graft. The adjunct of hinged joint distraction should minimize stresses in subchondral bone to promote creeping substitution and prevent femoral head collapse. Unlike current treatment modalities, it would provide both structural support and allow bony and articular substitution.

Treatment of Achilles tendinopathy with platelet-rich plasma.

Non-insertional Achilles tendinopathy commonly impedes the functioning of active persons. Treatment methods vary, as do their results. The aim of the study was to evaluate the effectiveness of non-insertional Achilles tendinopathy treatment with autologous platelet-rich plasma (PRP). Autologous PRP was injected into the affected Achilles tendon of 14 prospectively selected patients (15 Achilles tendons). Before PRP administration, all patients were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) scale for the hind foot, and the Victorian Institute of Sport Assessment - Achilles (VISA-A) scale. Ultrasonography (US) and Power-Doppler ultrasonography (PDUS) of the area was also performed. Identical physical and imaging evaluations were performed at 6 weeks, and at 3, 6, and 18 months after injection. During follow up, a significant improvement was observed in the clinical and imaging results. The AOFAS scale improved from a baseline median of 55 points to 96 points at 18 months (p=0.000655), while the VISA-A scale improved from a baseline of 24 to 96 (p=0.000655) in the final evaluations. During the final evaluation, one subject experienced minor pain following prolonged daily activity, while another subject complained of pain following overloading activity. Local, accurate PRP administration improved symptoms of non-insertional Achilles tendinopathy.

Arteria lusoria in patients with a normal and a right-sided aortic arch diagnosed with multi-slice computed tomography: a report of two cases.

A retro-oesophageal course of the right subclavian artery is referred to as "arteria lusoria". It may be related to severe compression of the trachea and oesophagus, typically resulting in impaired swallowing. The paper presents two patients with arteria lusoria, which in one patient was an aberrant right subclavian artery and in the other an aberrant left subclavian artery, originating from the right-sided aortic arch. In both cases the diagnosis was made with multi-slice computed tomography. The embryology of the anomalies and clinical status of the patients is discussed. Arteria lusoria should be considered in differential diagnosis in patients with dyspnoea and dysphagia. Multi-slice computed tomography allows this anatomical variant to be reliably visualised.

Early results of one-stage knee extensor realignment and autologous osteochondral grafting.

We treated 49 patients with recurrent patellar dislocations or persistent patellar subluxations. Chondral defects were graded according to the International Cartilage Repair Society (ICRS). Thirty patients (group I) had chondral defects grade I or II, and 19 patients (group II) had chondral defects grade III or IV. All patients were treated with proximal and distal realignment of the knee extensor mechanism, but group II also had a simultaneous autologous osteochondral grafting of the chondral defect. Patients were followed for 2 years and clinically assessed using the Marshall score comparing the two groups. Apart from a slower recovery in group II, the clinical and functional results were almost the same at the final follow-up.

[Total knee replacement with modular Kinemax endoprosthesis in osteoarthritis and rheumatoid arthritis]. / Plastyka stawu kolanowego w chorobie zwyrodnieniowej i reumatoidalnym zapaleniu stawów endoproteza modularna Kinemax.

One to 7 years results (mean 3 years) of modular kinematic knee arthroplasty were compared in rheumatoid (RA, n = 29) and idiopathic (OA, n = 28) arthritis female patients. Comparisons of means showed lower age at surgery (59 yr. v. 66 yr., p = 0.002), lower body mass (66 kg v. 75 kg, p = 0.001) and lower Hospital for Special Surgery scoring (71.7 v. 80, p = 0.05) in RA patients. Two RA knees with prosthesis showed after 2-3 years deterioration of the previously good result. Late infections were indication for removal of the prosthesis in two patients with RA. Two patients of this group died due to complications of the disease. Authors point that knee arthroplasty carries higher risk in rheumatoid than in idiopathic osteoarthritis.

[Difficulties and complications while treating long bone fractures with locked intramedullary nailing]. / Trudnosci i powiklania leczenia zlaman kosci dlugich ryglowanymi zespoleniami sródszpikowymi.

Retrospective assessment of results of treatment for femoral or tibial fracture and/or malunion in 33 patients (10 females and 23 males) operated on at Orthopedic Department in Lublin during last 4 years are presented. All patients had locked intramedullary nailing done, all fractures healed. Pitfalls and complications of the method at every stage of treatment are presented on the basis of literature and author's own experience. Means for avoidance of the complications are discussed. The method of locked intramedullary nailing proved to be liberal for technical errors at surgery.

[Osteochondritis dissecans of the patella]. / Osteochondrosis (osteochondritis) dissecans patellae.

Symptoms and treatment of 16 years old patient who had osteochondritis dissecans of the patella is discussed. The separated cartilaginous fragment has been surgically removed, subchondral bone multiply drilled. After 3 months of exercises patient returned to the normal level of physical activity.

[Modular cemented knee prosthesis Kinemax--is manual mobilization during extended contraction justified?]. / Modularna cementowa proteza kolana Kinemax--czy reczne redresje przykurczu wyprostnego sa uzasadnione?

Early results of 12 total Kinemax knee replacements have been presented. Maximal active flexion has been recorded on 8th, 15th day and half a year after operation. Standard rehabilitation of the operated joint has been conducted. No manual mobilisation was employed despite of the only one case of knee flexion close to 90 degrees 2 weeks after surgery. Half a year later flexion has reached or exceeded the right angle in all cases.

[Partial patellectomy in treatment of fresh fractures of the patella]. / Patelektomie czesciowe w leczeniu swiezych zlaman rzepki.

The late results of partial patellectomy in treatment of fracture of the apex or the 1/3 of the peripheral patella have been presented. Fourteen patients were evaluated. Attention was paid to the dependence of the result on the correct surgical technique. Full painless range of movements in the operated on knee was achieved in 7 persons. In the other 7 patients, extension of the knee was full but flexion was moderately limited. Periodical pain occurs in 3 persons.

[Resection of the patella and plasty of the knee by the de la Caffiniere method]. / Wyciecie rzepki i plastyka aparatu wyprostnego kolana sposobem de la Caffinière.

The surgical technique of patellectomy with preservation of continuity of the extension apparatus of the knee by the de la Caffinière method and the early results of treatment in 8 operated on patients have been presented. The indications for surgery were: posttraumatic stiffness of the knee in extension in 4 patients, patello-femoral arthrosis with preserved wide range of movement in 3 patients, fresh multi-fragmented fracture of the patella without rupture of the extension apparatus in one patient. The good treatment result was obtained in 6 patients (3 treated for patello-femoral arthrosis, 1 for fresh fracture of the patella, and 2 for stiffness of the knee in extension). The poor results in the other 2 patients operated on or stiffness of the knee in extension were due to large damage of the cartilaginous surface of the condyles and extensive intra- and periarticular adhesions.