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1.
Arthroscopy ; 37(4): 1212-1213, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33812524

RESUMO

Trochlear dysplasia is one of the primary morphologic abnormalities associated with patellar instability. Although qualitative classifications based on trochlear shape such as the Dejour classification exist, radiographic measurements to quantify the severity of trochlear dysplasia are numerous and varied. Each measurement addresses a different element of the complex and wide-ranging presentations that exist along a spectrum of abnormalities in trochlear morphology, and the reported reliability of such measurements are mixed. Overall, our understanding of trochlear dysplasia continues to evolve, and the ability to quantify the morphology of the trochlea, as well as its influence on patellar stability, remains a work in progress. Future directions include developing improved 3-dimensional descriptions of trochlear anatomy, as well as standardizing measurement methods and image slice selection, to better evaluate trochlear morphology in the assessment of patellar instability.


Assuntos
Instabilidade Articular , Articulação do Joelho , Fêmur/diagnóstico por imagem , Humanos , Instabilidade Articular/diagnóstico por imagem , Articulação do Joelho/diagnóstico por imagem , Patela/diagnóstico por imagem , Reprodutibilidade dos Testes
2.
Leg Med (Tokyo) ; 47: 101778, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32829289

RESUMO

Sex estimation is an important part of creating a biological profile, and ultimately assisting in creating a presumptive identification of unidentified skeletal remains. However, manual methods of anthropometric are time-consuming and prone to observer variability. The present study is an attempt to estimation of sex from automatic measurement of patella by multidetector computed tomography (MDCT) in a contemporary Chinese population. Four measurements for every patella, including maximum height (MAXH), maximum breadth (MAXB), maximum thickness (MAXT) and patellar volume (PV), were automatically provided by the software from CT image of 300 Chinese. The sample is composed of 156 males and 144 females with an average age of 41.44 and 45.68 years, respectively. The statistical analyses showed that all variables were sexually dimorphic. Receiver operating characteristic (ROC) analysis was performed to estimate sex from patella. The univariate analysis of each patellar parameter yielded a sex classification accuracy rate of 73.1% to 85.7%. The classification accuracy rates of sex estimation using the combination of the patellar parameters are 81.9% to 91.6%. This paper provides indications that the patella is important bone for sex estimation and it may be used as an alternative in forensic cases when the skull and pelvis are unavailable.


Assuntos
Antropologia Forense/métodos , Tomografia Computadorizada Multidetectores , Patela/anatomia & histologia , Patela/diagnóstico por imagem , Determinação do Sexo pelo Esqueleto/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Asiático , Feminino , Humanos , Imageamento Tridimensional , Masculino , Pessoa de Meia-Idade , Curva ROC , Sensibilidade e Especificidade , Adulto Jovem
3.
AJR Am J Roentgenol ; 215(2): 458-464, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32507014

RESUMO

OBJECTIVE. The purpose of this study is to assess the use of cross-sectional imaging to qualitatively and quantitatively categorize trochlear dysplasia as low grade (type A) or high grade (types B-D) according to the Dejour classification. MATERIALS AND METHODS. A retrospective review of CT and MRI knee examinations performed before patients underwent deepening trochleoplasty was independently conducted by two musculoskeletal radiologists. Each case of trochlear dysplasia was qualitatively assigned a Dejour type. Subsequently, quantitative measurements of the sulcus angle, distance from the tibial tubercle to the trochlear groove, trochlear depth, lateral trochlear inclination, trochlear facet asymmetry, and degree of patellar lateralization were performed. RESULTS. A total of 35 patients (29 female patients and six male patients; mean age, 21.1 years) with 39 affected knees (17 right knees and 22 left knees) were included. Readers had exact qualitative agreement using Dejour classification for 30 of 39 knees (77% [κ = 0.77; 95% CI, 0.62-0.91]) and agreement on classification of low-grade versus high-grade dysplasia for 36 of 39 knees (92%). For these 36 knees, the mean differences in measurements of low- versus high-grade dysplasia, respectively, were as follows: for sulcus angle, 153° versus 168° (p < 0.001); for trochlear depth, 4 versus 1 mm (p < 0.001); for lateral trochlear inclination, 12 versus 7 mm (p < 0.02); and for decreased trochlear facet asymmetry, 13% versus 92% (p < 0.001). Trochlear depth, lateral trochlear inclination, and trochlear facet asymmetry were also different in comparisons of knees with Dejour type B and C trochlear dysplasia versus those with Dejour types B and D (all p < 0.05). No quantitative measurement differentiated between trochlear dysplasia of Dejour types C and D. The distance from the tibial tubercle to the trochlear groove and the degree of patellar lateralization were not statistically different between low- and high-grade dysplasia. CONCLUSION. Qualitative use of the Dejour classification accurately categorizes trochlear dysplasia as low grade or high grade in 92% of cases, with exact agreement reached in 77% of cases. Furthermore, the trochlear depth, lateral trochlear inclination, trochlear facet asymmetry, and sulcus angle can differentiate between low-grade and high-grade dysplasia, with trochlear depth, lateral trochlear inclination, and trochlear facet asymmetry useful for differentiating between Dejour types B and C and Dejour types B and D.


Assuntos
Doenças Ósseas/diagnóstico por imagem , Doenças Ósseas/patologia , Fêmur/diagnóstico por imagem , Fêmur/patologia , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/patologia , Imagem por Ressonância Magnética , Patela/diagnóstico por imagem , Patela/patologia , Tomografia Computadorizada por Raios X , Adolescente , Feminino , Humanos , Masculino , Estudos Retrospectivos , Adulto Jovem
4.
Medicine (Baltimore) ; 99(12): e19576, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32195969

RESUMO

RATIONALE: Tension band wiring is the most widely accepted technique for the treatment of patellar fractures but the technique is associated with common complications like wire migration, prominence, and breakage. To reduce these complications, we developed and propose a modified technique that has a superior biomechanical strength and a potential to reduce such postoperative complications. PATIENT CONCERNS: The patient presented with pain and mild swelling in his left knee after he slipped on the floor and fell on his left knee. He has no significant past medical or surgical history. The patient took the tension band wiring as the first choice because of the wide acceptance. But he worried about the complications. DIAGNOSES: X-ray showed a transverse fracture of the left patella with an inferior pole occult fracture. INTERVENTIONS: The patient was operated with a modified technique of the classic tension band wiring for patellar fractures. In our 4-step procedure, double tension cerclage wires were wrapped under the exposed ends of the Kirschner wires (K-wires) and the tendons in figure-of-8 fashion. The aim was to increase the biomechanical strength so that when one of the tension wires fail, the other one can hold the fragments together. OUTCOMES: The patient recovered very well and without any complications. The patient was followed-up for 1 year and the fracture has united very well, with satisfying knee range of motion. LESSONS: From this case study, we can detect the biomechanical advantages of our technique which can increase the stability of the fracture and that allows early functional exercise and additionally the micromotion at the fracture site has a beneficial effect of fracture union. Based on the perfect outcomes, our technique is worthy of clinical application.


Assuntos
Fios Ortopédicos/normas , Traumatismos do Joelho/cirurgia , Patela/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Fios Ortopédicos/efeitos adversos , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Humanos , Articulação do Joelho/patologia , Masculino , Pessoa de Meia-Idade , Patela/diagnóstico por imagem , Patela/patologia , Radiografia/métodos , Resultado do Tratamento
5.
Knee ; 27(1): 81-88, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31902670

RESUMO

BACKGROUND: This study aimed to develop and validate a reference coordinate system for the human patella, based on the registration of bony landmarks on a computed tomography (CT) scan. METHODS: Thirty-three native cadaveric specimens were scanned, and an observer marked a set of seven anatomical landmarks on each of them. Such markers were used to define the reference coordinate system. In order to validate its robustness, statistical distribution of the point registration was then studied. Afterwards, three different observers marked the anatomical landmarks on a sub-sample of six specimens and the intra-observer and inter-observer variability of the point registration was performed. RESULTS: Results of this study showed the highest values to be 1.46 mm (intra) and 4.08 mm (inter), both observed for the patellar ridge top. The intra-class correlation coefficient (ICC) for inter-observer variability ranked higher than 0.8 for all the landmarks used for the identification of the reference frame, and ranged from 0.4-0.9 for other landmarks. CONCLUSIONS: This study demonstrates low intra-observer and inter-observer variability in the CT registration of landmarks that define and validate a robust coordinate system of the patella that could be used to perform accurate biomechanical and clinical studies.


Assuntos
Patela/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Fenômenos Biomecânicos , Cadáver , Humanos , Patela/fisiologia , Reprodutibilidade dos Testes
6.
J Am Acad Orthop Surg ; 28(8): 316-323, 2020 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-31934927

RESUMO

Patella baja in total knee arthroplasty can result in impingement, pain, and decreased range of motion. Etiology can range from previous knee surgeries such as anterior cruciate ligament reconstruction, retrograde femoral nail, infrapatellar fat pad resection, and previous total knee arthroplasty. Diagnosis can be confirmed by one of a number of measurements of patellar height including Insall-Salvati and Blackburne-Peel ratios. It is important to differentiate between true patella baja and pseudopatella baja by patellar height ratio. Treatment includes correct identification of the underlying etiology and appropriate management. Surgical management strategies include tibial tubercle osteotomy, distal femoral augment and revision, proximalization of the patellar component, modification of the anterior tibial component, and/or Z-plasty of the patellar tendon. We review the outcomes for each of these procedures.


Assuntos
Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/métodos , Patela/anormalidades , Complicações Pós-Operatórias , Humanos , Patela/diagnóstico por imagem , Resultado do Tratamento
7.
Am J Sports Med ; 48(2): 341-350, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31834811

RESUMO

BACKGROUND: Developing bone is highly adaptable and, as such, is susceptible to pathological shape deformation. Thus, it is imperative to quantify if changes in patellofemoral morphology are associated with adolescent-onset patellofemoral pain, as a pathway to improve our understanding of this pain's etiology. PURPOSE: To quantify and compare patellofemoral morphology in adolescent patients with patellofemoral pain with matched healthy adolescent controls and determine if a relationship exists between patellofemoral shape and kinematics (measured during active flexion-extension). STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Using 3-dimensional static magnetic resonance images acquired during a previous study, we measured patellar, trochlear, and lateral patellar width; trochlear and patellar depth; Wiberg index; patellar-height ratio; lateral trochlear inclination; cartilage length; and lateral femoral shaft length. Student t test was used to compare shape parameters between adolescents with patellofemoral pain and controls. Pearson correlations and stepwise linear regression models were used to explore the relationship among morphology, kinematics (medial-lateral shift/tilt), and pain. RESULTS: Relative to controls, adolescents with patellofemoral pain had larger sulci (mean ± SD, 6.6 ± 0.7 vs 6.0 ± 1.1 mm; 95% CI, 0.6 mm; P = .043; d = 0.66), lateral patellar width (23.1 ± 2.4 vs 21.4 ± 2.6 mm; 95% CI, 1.6 mm; P = .033; d = 0.70), and patella-trochlear width ratio (1.2 ± 0.1 vs 1.1 ± 0.1; 95% CI, 0.1; P < .001; d = 1.26). Shape correlated with kinematics in both cohorts and in the entire population. In the patellofemoral pain group, lateral shaft length (r = 0.518; P = .019), Wiberg index (r = 0.477; P = .033), and patellar-height ratio (r = -0.582; P = .007) were correlated with medial shift. A moderate correlation existed between patellar-height ratio and lateral patellar tilt (r = 0.527; P = .017). Half of the variation in patellar shift in the patellofemoral pain cohort was explained by the patellar-height ratio and Wiberg index (R2 = 0.487; P = .003). Linear correlations with pain were not found. CONCLUSION: This study provides direct evidence that patellofemoral morphology is altered and influences maltracking in adolescents with patellofemoral pain, highlighting the multifactorial etiology of this pain. Neither morphology nor kinematics (measured during active flexion-extension) correlated with pain. Both increases and decreases in these parameters likely lead to pain, negating a direct linear correlation.


Assuntos
Fêmur/patologia , Dor , Patela/patologia , Articulação Patelofemoral/patologia , Adolescente , Fenômenos Biomecânicos , Estudos de Casos e Controles , Criança , Estudos Transversais , Feminino , Fêmur/diagnóstico por imagem , Humanos , Imageamento Tridimensional , Modelos Lineares , Imagem Cinética por Ressonância Magnética , Patela/diagnóstico por imagem , Articulação Patelofemoral/diagnóstico por imagem
8.
Injury ; 51(2): 466-472, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31839426

RESUMO

PURPOSE: To evaluate intraoperative and early postoperative clinical outcomes using the Nice knot as an auxiliary reduction technique in displaced comminuted patellar fractures. METHODS: Thirty-nine patients with unilateral closed displaced comminuted patellar fractures received open reduction and internal fixation (ORIF), utilizing either Nice knot (the NK group, 24 patients) or traditional reduction (the TR group, 23 patients) techniques, were retrospectively reviewed in this study. Intra-operative surgical time and peri-operative hemoglobin were recorded. Post-operative clinical outcomes were measured using visual analgesic score, range of motion of the knee joint and the Böstman scales, and radiographic outcomes were used to evaluate fracture healing. Complications including infection, bone non-union, implant loosening, fragment displacement and painful hardware were also assessed. RESULTS: In-hospital records indicated significantly shorter surgical duration (32.6 min) in the NK group than in the TR group (63.9 min). Intraoperative blood loss was also significantly decreased in the NK group (64.7 ml) compared to the TR group (189.1 ml). Patients in the NK and TR groups were followed for mean of 12.9 months and 12.5 months respectively. The union rate was 100% (24/24) in the NK group and 91.3% (21/23) in the TR group. In the TR group, there were two non-unions, including one infected non-union. There was no difference in the visual analgesic score, the range of motion of the knee joint or the Böstman scale at last follow-up between the two groups. CONCLUSION: The sliding, self-stabilizing Nice knot was associated with reduced surgical time, decreased intraoperative blood loss, and satisfactory postoperative outcomes in the treatment of displaced patellar fractures. Future studies are needed to ensure the generalizability of these findings to additional patient populations at other institutions.


Assuntos
Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Fraturas Cominutivas/cirurgia , Articulação do Joelho/cirurgia , Patela/cirurgia , Acidentes por Quedas , Acidentes de Trânsito , Adulto , Idoso , Perda Sanguínea Cirúrgica , Feminino , Consolidação da Fratura , Fraturas Cominutivas/diagnóstico por imagem , Humanos , Articulação do Joelho/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Patela/diagnóstico por imagem , Patela/lesões , Radiografia , Amplitude de Movimento Articular , Estudos Retrospectivos , Suturas , Titânio/uso terapêutico , Resultado do Tratamento
9.
Knee Surg Sports Traumatol Arthrosc ; 28(7): 2224-2232, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31792598

RESUMO

PURPOSE: The trochlear dysplastic femur has a specific morphotype previously characterised by not only dysplastic features of the trochlea but also by specific features of the notch and posterior femur. In this study the morphology of the tibia and patella was investigated to gain further insight in the complete geometrical complexity of the trochlear dysplastic knee. METHODS: Arthro-CT scan-based 3D models of 20 trochlear dysplastic and 20 normal knees were uniformly scaled and landmarks and landmark-based reference planes were created to quantify a series of morphometric characteristics of the tibia and patella. RESULTS: In the mediolateral direction, the 3D-analysis revealed a 3% smaller medial tibial plateau (30.4 ± 1.6 mm vs 31.5 ± 1.6 mm), a 3% smaller overall width of the tibial plateau (73.6 ± 2.0 mm vs 75.7 ± 2.0 mm), a 16% smaller medial facet (17.3 ± 2.2 mm vs 20.1 ± 1.3 mm) and a 4% smaller overall width of the patella (41.7 ± 2.5 mm vs 43.4 ± 2.3 mm) in trochlear dysplastic knees. In the anteroposterior direction, the lateral tibial plateau of trochlear dysplastic knees was 5% larger (37.2 ± 2.3 mm vs 35.5 ± 3.1 mm). A correlation test between the width of the femur and the width of the tibia revealed that trochlear dysplastic knees show less correspondence between the femur and tibia compared to normal knees. CONCLUSION: Significant differences in the morphology of the tibial plateau and patella were detected between trochlear dysplastic and normal knees. Both in the trochlear dysplastic tibial plateau and patella a narrower medial compartment leads to a significant smaller overall mediolateral width. These findings are important for the understanding of knee biomechanics and the design of total knee arthroplasty components. LEVEL OF EVIDENCE: III.


Assuntos
Pontos de Referência Anatômicos/diagnóstico por imagem , Pontos de Referência Anatômicos/patologia , Patela/diagnóstico por imagem , Patela/patologia , Tíbia/diagnóstico por imagem , Tíbia/patologia , Adolescente , Adulto , Artroplastia do Joelho , Artroscopia , Fenômenos Biomecânicos , Simulação por Computador , Feminino , Humanos , Imageamento Tridimensional , Masculino , Patela/cirurgia , Valores de Referência , Tíbia/cirurgia , Tomografia Computadorizada por Raios X , Adulto Jovem
10.
Ann Biomed Eng ; 48(2): 556-567, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31576504

RESUMO

Early degenerative changes of articular cartilage are detected using contrast-enhanced computed tomography (CT) with a cationic contrast agent (CA). However, cationic CA diffusion into degenerated cartilage decreases with proteoglycan depletion and increases with elevated water content, thus hampering tissue evaluation at early diffusion time points. Furthermore, the contrast at synovial fluid-cartilage interface diminishes as a function of diffusion time hindering accurate cartilage segmentation. For the first time, we employ quantitative dual-energy CT (QDECT) imaging utilizing a mixture of three CAs (cationic CA4+ and non-ionic gadoteridol which are sensitive to proteoglycan and water contents, respectively, and bismuth nanoparticles which highlight the cartilage surface) to simultaneously segment the articulating surfaces and determine of the cartilage condition. Intact healthy, proteoglycan-depleted, and mechanically injured bovine cartilage samples (n = 27) were halved and imaged with synchrotron microCT 2-h post immersion in triple CA or in dual CA (CA4+ and gadoteridol). CA4+ and gadoteridol partitions were determined using QDECT, and pairwise evaluation of these partitions was conducted for samples immersed in dual and triple CAs. In conclusion, the triple CA method is sensitive to proteoglycan depletion while maintaining sufficient contrast at the articular surface to enable detection of cartilage lesions caused by mechanical impact.


Assuntos
Cartilagem Articular/diagnóstico por imagem , Meios de Contraste/farmacologia , Patela/diagnóstico por imagem , Microtomografia por Raio-X , Animais , Bovinos
11.
Knee Surg Sports Traumatol Arthrosc ; 28(7): 2147-2156, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31612265

RESUMO

PURPOSE: The purposes of this study were to investigate the anatomical risk factors of grade 3 J-sign and analyse the influence of J-sign grades on the short-term clinical outcomes of patients with recurrent patellar dislocation. METHODS: From 2016 to 2018, a total of 168 patients with recurrent patellar dislocation (187 knees) underwent medial patellofemoral ligament reconstruction with or without tibial tuberosity medialization. Pre-operative J-sign severity was graded according to a previously described classification (grades 1-3). Potential anatomical risk factors of J-sign were explored. Comparisons were assessed between patients with different grades of J-sign using univariate and binary logistic regression analyses. The Kujala score was assessed and compared with pre-operative values, and stress fluoroscopy was performed to assess medial patellofemoral ligament residual graft laxity. Among the 130 included cases, 104 knees with at least 1-year follow-up were included in the clinical outcome analyses to explore the influence of several anatomical factors and J-sign grade on short-term clinical outcomes. RESULTS: A total of 118 patients (130 knees) were included in the present study. The median age at surgery was 21 years (range 13-38), and 111 affected knees belonged to female patients (85%). Univariate and multivariate logistic regressions between the grade 3 group and the grade 1-2 groups showed that increased femoral anteversion, excessive external tibial torsion, and patella alta were three independent risk factors of grade 3 J-sign in patients with recurrent patellar dislocation. A total of 104 knees with at least a 1-year follow-up were included in the clinical outcome analyses. The median Kujala score improved from 54 (range, 38-72) pre-operatively to 86 (range, 70-100) post-operatively. Although no re-dislocation was reported during the follow-up, 6 out of 32 patients in the grade 3 group demonstrated "MPFL residual graft laxity" based on post-operative stress radiography (18.8%), which was significantly higher than in the grade 1-2 groups (0%, p < 0.001). Subgroup analysis showed that patients with grade 3 J-sign had significantly lower post-operative Kujala scores than those with grade 1-2 J-sign (p < 0.001). Moreover, increased femoral anteversion (≥ 30°) was correlated with an inferior post-operative Kujala score (p = 0.023). CONCLUSION: The three independent anatomic risk factors of grade 3 J-sign in patients with recurrent patellar dislocation were increased femoral anteversion, excessive external tibial torsion, and patella alta. A pre-operative grade 3 J-sign was correlated with a lower post-operative Kujala score and more "MPFL residual graft laxity" in patients with recurrent patellar dislocation treated with MPFL reconstruction with or without tibial tuberosity medialization at a minimum 1-year follow-up. LEVEL OF EVIDENCE: III.


Assuntos
Ligamentos Articulares/cirurgia , Patela/diagnóstico por imagem , Luxação Patelar/diagnóstico por imagem , Articulação Patelofemoral/cirurgia , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Feminino , Fêmur , Humanos , Imageamento Tridimensional , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Masculino , Luxação Patelar/cirurgia , Período Pós-Operatório , Radiografia , Estudos Retrospectivos , Fatores de Risco , Tíbia/cirurgia , Resultado do Tratamento , Adulto Jovem
12.
J Arthroplasty ; 35(2): 557-562, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31615703

RESUMO

BACKGROUND: The available evidence on pseudo-patella baja (PPB) is limited. The purpose of this study is to investigate prospectively the occurrence of PPB after primary total knee arthroplasty and its clinical consequences in a large series of patients with a minimum follow-up of 2 years. PPB was defined as a patella distally displaced in relationship to the femoral trochlea with absence of patellar tendon shortening (Grelsamer RP. J Arthroplasty 2002;17:66-69) due to elevation of the joint line. METHODS: This study is a prospective case series of 354 patients with a mean age of 71.7 (range 52-87) years. Clinical evaluation was performed by the Knee Society Scores (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short-Form 12-item (SF12), and range of motion. Patellar height was assessed by the Insall-Salvati and Blackburne-Peel ratios. RESULTS: The mean follow-up was 3.6 (range 2.0-6.6) years. Postoperatively, 286 (80.7%) patients had a normal patellar height, 17 (4.8%) had true patella baja (TPB), and 51 (14.4%) had PPB. There were no significant differences between the 3 groups in mean KSS-function (P = .107), range of motion (P = .408), WOMAC-pain (P = .095), WOMAC-stiffness (P = .279), or SF12-mental (P = .363). Between normal and PPB groups, there were no significant differences in mean KSS-knee (P = .903), WOMAC-function (P = .294), or SF12-physical (P = .940). However, the TPB group had significantly lower mean KSS-knee (P = .031), WOMAC-function (P = .018), and SF12-physical (P = .005) as compared with either 2 other groups. CONCLUSION: PPB was a relatively common finding, but no significant differences in terms of clinical outcomes were found as compared to patients with postoperative normal patellar height. TPB was infrequent, but these patients had significantly worse clinical outcomes than those with PPB or normal patellar height.


Assuntos
Artroplastia do Joelho , Osteoartrite do Joelho , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/efeitos adversos , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Pessoa de Meia-Idade , Osteoartrite do Joelho/cirurgia , Patela/diagnóstico por imagem , Patela/cirurgia , Estudos Prospectivos , Amplitude de Movimento Articular
13.
Injury ; 51(2): 457-465, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31676073

RESUMO

INTRODUCTION: Treatment of comminuted patella fractures with tension band has resulted in impaired functional outcomes because the relationship between tension band and the tendons is always underestimated. We developed a modified enlacement (ME) technique to better place the tension-band under the quadriceps and patellar tendons and close to the patella. The study aimed to compare the ME with conventional enlacement (CE) technique regarding recovery of knee function. PATIENTS AND METHODS: 51 patients with comminuted patella fractures operated between January 2012 and December 2016 were reviewed retrospectively. 22 patients in the ME group (9 males and 13 females) with a mean age of 51.3 years, 29 patients in the CE group (16 males and 13 females) with a mean age of 47.1 years. ROM was measured at postoperative intervals of 1, 2, 4, 12, and 48 weeks; Knee function was evaluated using the Rasmussen scores at 4, 12, and 48 weeks postoperative. RESULTS: There was no difference (P = 0.082) regarding the fracture healing time between the two groups. Patients with the ME technique had clinically and statistically significantly higher ROM recovery throughout the study period (P < 0.001) with an earlier recovery. The Rasmussen scores also demonstrated significant improvements in patients with ME technique than CE group at all time-points (P < 0.05). Three patients in the CE group had migration of K-wires, with no migration observed in the ME group. CONCLUSION: The ME technique enables improved clinical outcomes and functional performance for the treatment of comminuted patella fractures.


Assuntos
Fixação Interna de Fraturas/instrumentação , Fraturas Cominutivas/cirurgia , Patela/cirurgia , Traumatismos dos Tendões/cirurgia , Adulto , Idoso , Fios Ortopédicos/efeitos adversos , Feminino , Consolidação da Fratura/fisiologia , Força da Mão/fisiologia , Humanos , Traumatismos do Joelho/complicações , Traumatismos do Joelho/fisiopatologia , Traumatismos do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/métodos , Patela/diagnóstico por imagem , Patela/lesões , Ligamento Patelar/cirurgia , Período Pós-Operatório , Músculo Quadríceps/cirurgia , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos , Resultado do Tratamento
14.
J Knee Surg ; 33(1): 73-77, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30577049

RESUMO

Patellar fractures account for approximately 1% of all human body fractures. This study aimed to compare the surgical outcomes of open reduction and closed reduction for patellar fractures. This retrospective study included 62 patients (63 cases) who underwent surgical treatment of patellar fractures from 2008 to 2013. Of the 63 cases, open and closed reductions were performed in 42 and 21 cases, respectively. Plain radiography was used to assess fracture healing. Comminuted patellar fracture was the most common fracture type in both groups. Tension band wiring and cannulated screw fixation were mainly used in the open and closed reduction groups, respectively. There was no significant difference in the modified hospital for special surgery score, visual analog scale score for pain, and range of motion between the two groups. The mean union time was 3.2 and 3.0 months in open and closed reductions, respectively. Postoperative knee stiffness was noted in five cases of open reduction and in three cases of closed reduction. One patient in the open reduction group had a refracture. There were no notable differences in treatment outcomes between open and closed reductions. Thus, closed reduction may not be inferior to open reduction as a surgical treatment for patellar fractures.


Assuntos
Redução Fechada/métodos , Fraturas Ósseas/cirurgia , Fraturas Cominutivas/cirurgia , Redução Aberta/métodos , Patela/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Parafusos Ósseos , Fios Ortopédicos , Feminino , Fixação Interna de Fraturas/métodos , Consolidação da Fratura , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/fisiopatologia , Fraturas Cominutivas/diagnóstico por imagem , Fraturas Cominutivas/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Patela/diagnóstico por imagem , Patela/lesões , Patela/fisiopatologia , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
15.
J Knee Surg ; 33(6): 536-546, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30877687

RESUMO

The objectives of our study were to evaluate (1) patellar height changes when the knee axis correction was < 15 degrees and (2) the clinical effect after open wedge high tibial osteotomy (OWHTO). Sixty-nine patients (69 knees) undergoing OWHTO between January 2016 and June 2017 were enrolled in this prospective study. All patients underwent OWHTO using a three-dimensional (3D)-printed patient-specific instrument. We used X-ray and lower-limb computed tomography scan to measure the osteotomy angle, patellar height, and other patellofemoral joint indices. We used the hospital for special surgery knee (HSS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), and Kujala's scores to evaluate the clinical outcome. All knee axis corrections were less than 15 degrees. The change in posterior tibial slope (PTS) did not show a statistically significant difference. We observed that the patellar height was not altered when we used femur referenced measurement method. The change in modified Miura-Kawamura index (MKI) and Femoral patellar height index (FPHI) did not show a statistically significant difference. The differences in Blackburne-Peel index (BPI) and Caton-Deschamps index (CDI) were statistically significant, decreasing from 0.91 ± 0.12 and 1.06 ± 0.11 preoperatively to 0.79 ± 0.13 and 0.95 ± 0.11 postoperatively, respectively. In the axial plane, we did not observe a change in lateral patellar shift (LPS), but we found that lateral patellar tilt (LPT) showed a significant decrease from 8.67 ± 2.60 degrees preoperatively to 6.13 ± 2.30 postoperatively, respectively. The tuberositas tibae-trochlear groove (TT-TG) distance showed a significant decrease after OWHTO from 14.30 ± 4.10 mm preoperatively to 11.52 ± 3.63 mm postoperatively. The clinical score showed a significant increase after OWHTO, and all patients were satisfied with the outcome. After OWHTO, the patellar height was not altered when the knee axis correction was < 15 degrees. It was also found that there was still lateral displacement of the patella. Internal rotation of the distal tibia is an important cause of LPT reduction. After OWHTO, all patients achieved satisfactory clinical outcomes. At 1-year short-term follow-up, patients did not report discomfort in the patellofemoral joint. The Level of Evidence for this study was IV.


Assuntos
Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/cirurgia , Osteotomia , Patela/patologia , Adulto , Feminino , Fêmur , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações , Patela/diagnóstico por imagem , Patela/cirurgia , Articulação Patelofemoral/cirurgia , Estudos Prospectivos , Radiografia , Tíbia/cirurgia , Tomografia Computadorizada por Raios X
16.
Knee Surg Sports Traumatol Arthrosc ; 28(3): 869-875, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31089790

RESUMO

PURPOSE: Patella alta is a risk factor for patellofemoral pain and instability. Several measurement methods and imaging modalities are in use to measure patellar height. The first aim of this study was to determine the intra- and interrater reliability of different patellar height measurement methods on conventional radiography (CR), CT and MRI. The second aim was to examine the applicability of patellar height measurement methods originally designed for CR on CT and MRI. METHODS: Forty-eight patients who were treated for patellar instability were included. All patients had undergone a pre-operative conventional radiograph, CT scan and MRI. Five methods for measuring patellar height were performed on radiographs, CT and MRI by four observers. For each measurement, the intra- and interrater reliability was determined by calculating the intra-class correlation coefficient (ICC). A Bland-Altman analysis was performed for measurements with an ICC ≥ 0.70. RESULTS: The Insall-Salvati (IS) ratio was the only measurement that showed good intra- and inter-observer reliability on CR, CT and MRI. The intra- and inter-observer reliability of the patellotrochlear index (PTI) for MRI was good to excellent for all observers. The IS ratio showed a moderate to good reliability for comparison of all three imaging modalities with the best agreement between radiography and MRI. The other patellar height measurements showed only poor to moderate inter-method agreement. CONCLUSION: In this study, the Insall-Salvati ratio shows better intra- and inter-observer reliability than the Blackburne-Peel ratio, the Caton-Deschamps ratio and the modified Insall-Salvati ratio on all imaging modalities. Radiography and CT seem to have better reliability than MRI. The patellotrochlear index, however, shows good inter- and intra-observer reliability on MRI. Only for the IS method was there acceptable agreement between CR and MRI. This means that the established Insall-Salvati normal values could be used for MRI as well. This study shows that the most reliable method to measure patella height is the Insall-Salvati ratio measured on conventional radiographs or the patellotrochlear index on MRI. LEVEL OF EVIDENCE: Level II diagnostic.


Assuntos
Instabilidade Articular/diagnóstico por imagem , Patela/diagnóstico por imagem , Adolescente , Adulto , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Radiografia , Reprodutibilidade dos Testes , Tomografia Computadorizada por Raios X , Adulto Jovem
17.
Knee Surg Sports Traumatol Arthrosc ; 28(3): 926-933, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31214737

RESUMO

PURPOSE: The aim was to assess the influence of femoral derotational osteotomy on patella tilt (PT), axial patella engagement (AEI) and tibial tuberosity trochlear groove distance (TTTG). METHODS: Derotational femoral osteotomy was performed on ten lower limbs of body donors embalmed with alcohol-glycerine. Femoral torsion, tibial torsion, knee torsion, PT, AEI and TTTG were evaluated on axial CT slices for an absolute femoral torsion of 15°, 20°, 25°, 30°, 35° and 40°. A linear mixed model analysis was used to estimate the effect of femoral torsion on PT, AEI, TTTG and knee torsion adjusted for correlation due to repeated observations. Estimates with 95% confidence intervals were used to represent the mean change in the dependent variables for one unit of change (degree, mm or AEI) in the predictor variable. RESULTS: A significant correlation was observed between femoral torsion and AEI (p < 0.001), PT (p < 0.001) and TTTG distance (p = 0.002). In cases of increased internal femoral torsion, a significant decreased AEI (estimate - 0.003, 95% CI - 0.003 to - 0.002), an increased PT (estimate 0.3, 95% CI 0.2-0.4) and an increased TTTG distance (estimate 0.1, 95% CI 0.1-0.2) were observed. No correlation was seen between change in femoral torsion and knee torsion (n.s.). CONCLUSIONS: Derotational femoral osteotomy has a significant impact on patella tilt and axial patella engagement. Moreover, TTTG distance is slightly changed by a derotational femoral osteotomy, which has to be taken into account preoperatively when considering surgical procedures. LEVEL OF EVIDENCE: Level V.


Assuntos
Fêmur/cirurgia , Osteotomia/métodos , Patela/fisiologia , Tíbia/fisiologia , Idoso , Idoso de 80 Anos ou mais , Cadáver , Feminino , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/fisiologia , Modelos Lineares , Imagem por Ressonância Magnética/métodos , Masculino , Patela/diagnóstico por imagem , Tíbia/anatomia & histologia , Tíbia/diagnóstico por imagem
18.
Knee Surg Sports Traumatol Arthrosc ; 28(5): 1542-1550, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31218390

RESUMO

PURPOSE: Total knee arthroplasty (TKA) is the treatment of choice for severe osteoarthritis of the knee. Many studies have been performed comparing mobile- and fixed-bearing designs; however, there are insufficient data regarding the patellar position in either system. This study aimed to compare the resultant patellar position with a mobile- versus a fixed-bearing TKA and the influence of both designs on clinical outcomes. MATERIALS AND METHODS: In this prospective randomized study, between 2007 and 2009, 160 TKA patients were assessed; 79 received a mobile-bearing and 81 received a fixed-bearing implant, for medial compartment osteoarthritis. A posteriorly stabilized, HLS Noetos knee prosthesis (Tornier, Saint-Ismier, France) was used in all cases. The only difference between the groups was whether the tibial component incorporated a fixed or mobile bearing. The patella was resurfaced in all cases. The International Knee Society Score (KSS) and the patellar tilt and translation were compared post-operatively. Patellar translation and patellar tilt analyses were subdivided into two subgroups (< 5 mm vs > 5 mm and < 5° vs > 5°). RESULTS: The KSS was not statistically different between the groups at a mean follow-up of 7.4 years (range 5-11 years). Patellar translation and patellar tilt were not statistically different between the groups. When considering the patellar translation subgroup analysis, a significantly increased risk of patellar translation, greater than 5 mm, was found in the mobile-bearing group compared to fixed-bearing group (OR = 2.3; p = 0.048) without generating any meaningful difference in clinical outcomes. CONCLUSION: The theoretical advantages of mobile-bearing implants compared to fixed-bearing implants were not demonstrated in this randomized study, at mid-term follow-up. In daily practice, the choice between mobile-bearing and fixed-bearing designs should be based on the experience and clinical judgment of the surgeon. LEVEL OF EVIDENCE: Prospective randomized study, level I.


Assuntos
Articulação do Joelho/cirurgia , Prótese do Joelho , Osteoartrite do Joelho/cirurgia , Patela/cirurgia , Idoso , Artroplastia do Joelho/efeitos adversos , Feminino , Humanos , Articulação do Joelho/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico por imagem , Patela/diagnóstico por imagem , Estudos Prospectivos , Desenho de Prótese , Amplitude de Movimento Articular , Tíbia/cirurgia
19.
J Pediatr Orthop ; 40(2): e96-e102, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31107711

RESUMO

BACKGROUND: Despite the critical role the trochlea plays in patellofemoral (PF) pathology, the development of the trochlea is poorly understood. The purpose of this study was 2-fold: (1) Describe quantitative osseous and soft tissue anatomy of the patella and trochlea in skeletally immature cadaveric specimens utilizing known measurements used in PF instability, and (2) evaluate additional measurement techniques in the sagittal plane as they relate to PF morphologic development. METHODS: Thirty-one skeletally immature fresh frozen cadaveric knees between the ages of 2 and 11 years old were evaluated using 0.625 mm computed tomography scans. In the axial plane, measurements included condylar height asymmetry, trochlear facet asymmetry, trochlear depth, osseous sulcus angle, cartilaginous sulcus angle, patella sulcus angle, and tibial tubercle-trochlear groove distance. In the sagittal plane, measurements included previously undescribed measurements of trochlear length and condylar height asymmetry which are based on the anterior femoral cortex. RESULTS: Analysis of trochlear morphology using condylar height asymmetry (both axial and sagittal), trochlear facet asymmetry, and trochlear depth and length demonstrated an increase in the size of the medial and lateral trochlea as age increased. There was more variability in the change of size of the medial trochlea (height, length, and facet length) than the lateral trochlea. The osseous sulcus angle, cartilaginous sulcus angle, and patella sulcus angle decreased (became deeper) with age until after 8 years and then plateaued. CONCLUSIONS: This cadaveric analysis demonstrated that there is an increase in the medial and lateral trochlear height as age increased by all measurements analyzed. The findings also demonstrate that the shape of the patella and trochlea change concurrently, which suggests that there may be interplay between the 2 during development. These new sagittal measurement techniques evaluating the medial, central, and lateral trochlear height and length with respect to age may help guide clinicians when investigating patellar instability in skeletally immature patients. LEVELS OF EVIDENCE: Level IV.


Assuntos
Fêmur/anatomia & histologia , Patela/anatomia & histologia , Articulação Patelofemoral/anatomia & histologia , Cadáver , Criança , Pré-Escolar , Epífises/anatomia & histologia , Epífises/diagnóstico por imagem , Epífises/crescimento & desenvolvimento , Feminino , Fêmur/diagnóstico por imagem , Fêmur/crescimento & desenvolvimento , Humanos , Masculino , Patela/diagnóstico por imagem , Patela/crescimento & desenvolvimento , Articulação Patelofemoral/diagnóstico por imagem , Articulação Patelofemoral/crescimento & desenvolvimento , Tíbia/anatomia & histologia , Tíbia/diagnóstico por imagem , Tomografia Computadorizada por Raios X
20.
Knee Surg Sports Traumatol Arthrosc ; 28(3): 975-983, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31289916

RESUMO

PURPOSE: Patellar height measurements on lateral radiographs are dependent on knee flexion which makes standardisation of measurements difficult. This study described a plain radiographic measurement of patellar sagittal height which reflects patellofemoral joint kinematics and can be used at all degrees of flexion. METHODS: The study had two parts. Part one involved 44 normal subjects to define equations for expected patellar position based on the knee flexion angles for three new patellar height measurements. A mixed model regression with random effect for individual was used to define linear and polynomial equations for expected patellar position relating to three novel measurements of patella height: (1) patellar progression angle (trochlea), (2) patellar progression angle (condyle) and (3) sagittal patellar flexion. Part two was retrospective and involved applying these measurements to a surgical cohort to identify differences between expected and measured patellar position pre- and post-operatively. RESULTS: All three measurements provided insight into patellofemoral kinematics. Sagittal patellar flexion was the most useful with the least residual error, was the most reliable, and demonstrated the greatest detection clinically. CONCLUSIONS: Clinically applied radiographic measurements have been described for patellar height which reflect the sagittal motion of the patella and can be used regardless of the degree of flexion in which the radiograph was taken. The expected sagittal patellar flexion linear equation should be used to calculate expected patellar height. LEVEL OF EVIDENCE: IV.


Assuntos
Patela/anatomia & histologia , Patela/fisiologia , Articulação Patelofemoral/anatomia & histologia , Articulação Patelofemoral/fisiologia , Adolescente , Adulto , Fenômenos Biomecânicos , Feminino , Humanos , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/patologia , Instabilidade Articular/fisiopatologia , Instabilidade Articular/cirurgia , Masculino , Pessoa de Meia-Idade , Movimento/fisiologia , Patela/diagnóstico por imagem , Patela/cirurgia , Articulação Patelofemoral/diagnóstico por imagem , Articulação Patelofemoral/cirurgia , Período Pós-Operatório , Estudos Prospectivos , Radiografia , Amplitude de Movimento Articular , Estudos Retrospectivos , Adulto Jovem
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