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Sample records for atraumatic patellar prosthesis

  1. Atraumatic patellar prosthesis dislocation with patellar tendon injury following a total knee arthroplasty: a case report

    Directory of Open Access Journals (Sweden)

    Singh Alka

    2010-01-01

    Full Text Available Abstract Introduction Total knee arthroplasty is a well-established procedure with gratifying results. There is no consensus in the literature whether to routinely resurface the patella while performing total knee arthroplasty or not. Although an extremely rare occurrence in clinical practice, patellar prosthesis dislocation is a possible complication resulting from total knee arthroplasty. Case presentation We report a rare case of atraumatic spontaneous dislocation of patellar prosthesis in a 63-year-old Caucasian man of British origin with patellar tendon injury. The patient was treated successfully through a revision of the patellar component and tendon repair. In two years follow-up the patient is asymptomatic with no sign of loosening of his patellar prosthesis. Conclusions A thorough understanding of knee biomechanics is imperative in performing total knee arthroplasty in order to achieve a better functional outcome and to prevent early prosthetic failure.

  2. 21 CFR 888.3580 - Knee joint patellar (hemi-knee) metallic resurfacing uncemented prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Knee joint patellar (hemi-knee) metallic... § 888.3580 Knee joint patellar (hemi-knee) metallic resurfacing uncemented prosthesis. (a) Identification. A knee joint patellar (hemi-knee) metallic resurfacing uncemented prosthesis is a device made of...

  3. Prosthesis

    Science.gov (United States)

    A prosthesis is a device designed to replace a missing part of the body or to make a part of the body work better. Diseased or missing eyes, arms, hands, legs, or joints are commonly replaced by prosthetic devices. False teeth are known as dental prostheses. ...

  4. Fracture of an uncemented tantalum patellar component

    Directory of Open Access Journals (Sweden)

    Nathan L. Grimm, MD

    2016-06-01

    Full Text Available A 62-year-old man presented with the acute, atraumatic onset of pain 3 years after uncemented right total knee arthroplasty. He complained of new mechanical locking with the knee held in extension on examination and unable to flex the knee. On the plain radiographs, the patellar component peg was fractured and the plate was dislocated. The knee was immobilized, and revision to a cemented 3-peg component was performed. Fracture of a single-peg, tantalum-backed uncemented patellar component has not been described. Clinical suspicion for this should be given in the setting of acute locking. We recommend revision with a cemented polyethylene component.

  5. Recurrent Patellar Instabilty Culminating in a Vertically Rotated and a Locked Patellar Dislocation – A Rare Entity

    Science.gov (United States)

    A, Devgan; R, Rohilla; A, Jain; H, Mehta; S, Singh

    2016-01-01

    Introduction: Locked vertical patellar dislocations are rare and pose a therapeutic challenge. This case is more unusual, as the patient was a known case of recurrent patellar dislocation and presented with an atraumatic locked and vertically rotated patellar dislocation. This type of presentation has never been reported in literature to the best of our knowledge. Case presentation: A 14-year-old healthy male child with previous history of recurrent lateral dislocation of patella presented to accident & emergency department with complaints of inability to walk or bear weight on his left lower limb after he spontaneously dislocated his patella while running on uneven ground. Radiographs revealed a laterally displaced and vertically rotated patella along its long axis with the medial patellar edge locked and dipping into the lateral gutter. Open reduction was performed along with lateral patellar retinacular release with medial patellar retinaculum plication, to achieve satisfactory patellar stability and patellofemoral tracking. Conclusion: We would recommend that in the settings of patella being vertically dislocated and locked, open reduction would be the management of choice, as these types of dislocations are difficult to relocate by closed reduction. Repeated attempts of closed reduction may cause osteochondral damage. Open reduction not only yields better outcomes but also allows the surgeon to perform patellar realignment procedures in order to prevent further patellar dislocations in cases of prior patellar instability. PMID:27703948

  6. Patellar Tendinitis

    Science.gov (United States)

    ... Patellar tendinitis Symptoms & causes Diagnosis & treatment Doctors & departments Advertisement Mayo Clinic does not endorse companies or products. ... a Job Site Map About This Site Twitter Facebook Google YouTube Pinterest Mayo Clinic is a not- ...

  7. Spontaneous Atraumatic Mediastinal Hemorrhage

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    Morkos Iskander BSc, BMBS, MRCS, PGCertMedEd

    2013-04-01

    Full Text Available Spontaneous atraumatic mediastinal hematomas are rare. We present a case of a previously fit and well middle-aged lady who presented with acute breathlessness and an increasing neck swelling and spontaneous neck bruising. On plain chest radiograph, widening of the mediastinum was noted. The bruising was later confirmed to be secondary to mediastinal hematoma. This life-threatening diagnostic conundrum was managed conservatively with a multidisciplinary team approach involving upper gastrointestinal and thoracic surgeons, gastroenterologists, radiologists, intensivists, and hematologists along with a variety of diagnostic modalities. A review of literature is also presented to help surgeons manage such challenging and complicated cases.

  8. Imaging patellar complications after knee arthroplasty

    Energy Technology Data Exchange (ETDEWEB)

    Melloni, Pietro [Unitat de Imatge d' Alta Tecnologia, Centre Diagnostic, Corporacio Parc Tauli, Universitat Autonoma de Barcelona, Sabadell (Barcelona) (Spain)], E-mail: pmelloni@cspt.es; Valls, Rafael; Veintemillas, Maite [Unitat de Imatge d' Alta Tecnologia, Centre Diagnostic, Corporacio Parc Tauli, Universitat Autonoma de Barcelona, Sabadell (Barcelona) (Spain)

    2008-03-15

    The purpose of this study is to describe complications affecting the patella in patients with total or partial knee arthroplasty. We respectively analysed plain-film radiographs, as well as ultrasound images when acquired, in a consecutive series of 1272 patients. The mean interval from knee replacement to patellar complications was 5 years and 7 months (range, 5 months to 14 years). The complications described include fracture, instability, dislocation or luxation, necrosis of the patella, infection of the patella, erosion of the patella, patellar impingement on the prosthesis and patellar or quadricipital tendon tear. We discuss the pathological imaging findings in the patella and their differential diagnosis after knee arthroplasty. Patellar complications after knee arthroplasty are uncommon but often potentially serious.

  9. Primary traumatic patellar dislocation

    Directory of Open Access Journals (Sweden)

    Tsai Chun-Hao

    2012-06-01

    Full Text Available Abstract Acute traumatic patellar dislocation is a common injury in the active and young adult populations. MRI of the knee is recommended in all patients who present with acute patellar dislocation. Numerous operative and non-operative methods have been described to treat the injuries; however, the ideal management of the acute traumatic patellar dislocation in young adults is still in debate. This article is intended to review the studies to the subjects of epidemiology, initial examination and management.

  10. Proximal patellar tendinosis and abnormalities of patellar tracking

    Energy Technology Data Exchange (ETDEWEB)

    Allen, G.M. [Royal Hospital Haslar, Gosport (United Kingdom); Tauro, P.G. [Northern Hospital,Victoria (Australia); Ostlere, S.J. [Nuffield Orthopaedic Hospital, Oxford (United Kingdom)

    1999-04-01

    Objective. To assess whether an association exists between patellar tendinosis and abnormal patellar tracking. Design and patients. The MRI examinations of 630 patients (i.e. 860 knees) referred with anterior knee pain over a 4-year period were assessed in retrospect for the presence of patellar tendinosis and abnormal patellar tracking. The images of the patients with patellar tendinosis were reviewed and the location within the patellar tendon was recorded. Results. There were 44 knees with proximal patellar tendinosis. Twenty-four of these were considered to have normal patellar tracking and 20 to have abnormal patellar tracking. In the group of 816 knees without proximal patellar tendinosis, 581 were considered to have normal patellar tracking and 235 knees to have abnormal patellar tracking. When the two groups were compared there was a statistically significant difference in the ratio of patients with and without abnormal tracking. Conclusion. In patients referred with anterior knee pain or suspected abnormal patellar tracking there is a significant association between proximal patellar tendinosis and abnormal patellar tracking. (orig.) With 2 figs., 5 tabs., 10 refs.

  11. Atraumatic restorative treatment (ART) in Pediatric Dentistry

    National Research Council Canada - National Science Library

    Rafi Ahmad Togoo

    2011-01-01

    Atraumatic restorative treatment (ART) is an alternative treatment for dental caries and is an easy, low cost and painless restorative technique where soft infected dentin is removed with sharp hand instruments retaining the reversible...

  12. ATRAUMATIC RESTORATIVE TREATMENT – A REVIEW

    OpenAIRE

    Sangameshwar; Deepa; Dipak; Saujanya; Mohd. Inayatullah

    2013-01-01

    ABASTRACT: Atraumatic Restorative Treatment (ART) was origina lly developed in field settings in African subcontinent (Tanzania) by Univ ersity of Dar el Salaam in 1980s; subsequently World Health Organization (WHO) promote s the use of ART especially with children. As the name indicates Atraumatic Restorat ive Treatment (ART) is basically a minimally invasive procedure that involves removing of softened carious dentine using hand instruments and then restorin...

  13. Injection treatments for patellar tendinopathy

    NARCIS (Netherlands)

    van Ark, Mathijs; Zwerver, Johannes; van den Akker-Scheek, Inge

    2011-01-01

    Objective Injection treatments are increasingly used as treatment for patellar tendinopathy. The aim of this systematic review is to describe the different injection treatments, their rationales and the effectiveness of treating patellar tendinopathy. Methods A computerised search of the Medline,

  14. Atraumatic suction tip for microsurgery: technical note.

    NARCIS (Netherlands)

    Menovsky, T.; Vries, J. de

    2004-01-01

    During microneurosurgery, frequent suction is essential for a successful operative course. A new self-made disposable suction tip is described which facilitates atraumatic suction, even near vital anatomical structures. The efficacy of this suction tip was confirmed in selected operative procedures.

  15. Patellar osteochondroma: case report,

    Directory of Open Access Journals (Sweden)

    Frederico Barra de Moraes

    2014-04-01

    Full Text Available The aim was to report on a rare case of patellar osteochondroma. A 60-year-old man presented a tumor on his left patella that had developed over a 10-year period, which is a rare occurrence, considering the patient's age and the site at which the tumor appeared. The clinical condition comprised mild pain and the presence of a mass, without limitation of flexion-extension or any neurovascular deficit. The tumor dimensions were 8 cm longitudinally × 6 cm transversally × 3 cm anteroposteriorly. It was hardened and was adhering to the patellar bone plane. On radiographs and tomographic scans, we observed areas of greater density corresponding to bone and other less dense areas that could correspond to slow-growing cartilage, with irregularities on the patellofemoral joint surface. Simple resection of the tumor was performed, and the anatomopathological examination confirmed that it was a patellar osteochondroma. Osteochondroma, or osteocartilaginous exostosis, includes a large proportion of the benign bone tumors. It results from cell alterations that trigger unregulated production of spongy bone. It is basically treated by means of surgical removal of the tumor mass. This is not essential, but is recommended in order to avoid lesions caused by contiguity and the risk of malignant transformation.

  16. Patellar Sleeve Fracture With Ossification of the Patellar Tendon.

    Science.gov (United States)

    Damrow, Derek S; Van Valin, Scott E

    2017-03-01

    Patellar sleeve fractures make up greater than 50% of all patellar fractures. They are essentially only seen in the pediatric population because of the thick periosteum and the distal patellar pole apophysis in this group. These fractures can lead to complications if not treated appropriately and in a timely fashion. Complications of missed or untreated patellar sleeve fractures include patella alta, anterior knee pain, and quadriceps atrophy. These can all result in severe limitations in activity. The authors describe a case of a 16-year-old boy who sustained a patellar sleeve fracture 3 years prior to presentation. On presentation, he had patella alta, diminished strength, 5° of extensor lag, and radiographs that revealed bone formation along the patellar tendon. Despite this, he was able to maintain a high level of activity. This case report explores how the patient could have maintained a high level of activity despite having a patellar sleeve fracture. Also, because of the delayed presentation, the patella was ossified and the quadriceps was retracted, which led to a novel approach to reconstructing his distal extensor mechanism. This approach included a V-Y advancement of the quadriceps tendon and patellar tendon reconstruction using the patient's hamstring tendon (semitendinosus). This technique, combined with physical therapy postoperatively, resulted in his return to varsity high school soccer. To the best of the authors' knowledge, this technique has not been reported for this rare condition. [Orthopedics. 2017; 40(2):e357-e359.]. Copyright 2016, SLACK Incorporated.

  17. Atraumatic Anterior Dislocation of the Hip Joint

    Directory of Open Access Journals (Sweden)

    Tadahiko Ohtsuru

    2015-01-01

    Full Text Available Dislocation of the hip joint in adults is usually caused by high-energy trauma such as road traffic accidents or falls from heights. Posterior dislocation is observed in most cases. However, atraumatic anterior dislocation of the hip joint is extremely rare. We present a case of atraumatic anterior dislocation of the hip joint that was induced by an activity of daily living. The possible causes of this dislocation were anterior capsule insufficiency due to developmental dysplasia of the hip, posterior pelvic tilt following thoracolumbar kyphosis due to vertebral fracture, and acetabular anterior coverage changes by postural factor. Acetabular anterior coverage changes in the sagittal plane were measured using a tomosynthesis imaging system. This system was useful for elucidation of the dislocation mechanism in the present case.

  18. ATRAUMATIC RESTORATIVE TREATMENT IN TEMPORARY DENTITION

    Directory of Open Access Journals (Sweden)

    Ana PETCU

    2017-03-01

    Full Text Available Atraumatic restorative treatment (ART is a minimally invasive method of treatment of dental caries that uses only hand tools. ART was originally developed in Tanzania in the 1980’s as part of an oral health program, created by the need to find a method of teeth preservation in people of all ages from disadvantaged communities, where resources like water, electricity and conventional dental equipment were rarely available

  19. Atraumatic restorative treatment and minimal intervention dentistry.

    Science.gov (United States)

    Frencken, J E

    2017-08-11

    Too many people worldwide suffer from the consequences of untreated dentine carious lesions. This finding reflects the inability of the currently used traditional mode of treatments to manage such lesions. A change is needed. Dental training institutions should depart from the traditional 'drill and fill' treatments and embrace the holistic oral healthcare approach that is minimal intervention dentistry (MID) and includes within it minimally invasive operative skills. Dental caries is, after all, a preventable disease. The atraumatic restorative treatment (ART) concept is an example of MID. ART consists of a preventive (ART sealant) and a restorative (ART restoration) component. ART sealants using high-viscosity glass-ionomer (HVGIC) have a very high dentine carious lesion preventive effect. The survival rate of these sealants is not significantly different from that of sealants produced with resin. The survival rate of ART/HVGIC restorations matches those of amalgam and resin composite in single- and multiple-surface cavities in primary teeth and in single-surface cavities in permanent teeth. The principles of carious tissue removal within a cavity recommended by the International Caries Consensus Collaboration are in line with those of treating a cavity using ART. Owing to its good performance and the low levels of discomfort/pain and dental anxiety associated with it, ART and/or other evidence-based atraumatic care procedures should be the first treatment for a primary dentine carious lesion. Only if the use of ART is not indicated should other more invasive and less-atraumatic care procedures be used in both primary and permanent dentitions.

  20. Bionic prosthesis

    OpenAIRE

    МЫЛЬНИКОВ А.М.

    2015-01-01

    The real achievement in the prosthetics has become artificial joints that function as well as natural joints. Bionic limbs are the most advanced type of prosthesis at the moment. These electronic devices are made from synthetic materials, but the person can manage them using his/her own nervous system through the targeted muscle reinnervation (recovery disturbed innervation of organs and tissues surgically).Principle of operation of bionic prosthesis. After the amputation because of a serious...

  1. [Atraumatic hip pain in young adults].

    Science.gov (United States)

    González Murillo, M; Turcu, V; De Nicolás Navas, M B; Yeguas Bermejo, A

    2016-01-01

    Hip pain in the young adult is a disabling pathophysiological process may be related to multiple etiologies. The process must be determined in order to make a diagnosis and follow-up treatment. The case is presented of a 29 year old woman with anemia, atraumatic hip pain on the right side, and a limp of one month onset. The differential diagnosis includes infectious, rheumatological, tumor, avascular necrosis of hip, hip impingement, hip dysplasia, osteoarthritis and other syndromes. Copyright © 2014 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  2. Bilateral, atraumatic, proximal tibiofibular joint instability.

    Science.gov (United States)

    Morrison, Troy D; Shaer, James A; Little, Jill E

    2011-01-01

    Dislocation of the tibiofibular joint is rare and usually results from a traumatic event. Only 1 case of atraumatic proximal tibiofibular joint instability in a 14-year-old girl has been reported in the literature, however this condition might occur more frequently than once thought. A wide range of treatment options exist for tibiofibular dislocations. Currently, the first choice is a conservative approach, and when this fails, surgical means such as resection of the fibula head, arthrodesis, and reconstruction are considered. However, no consensus exists on the most effective treatment. This article reports a unique case of bilateral, atraumatic, proximal tibia and fibular joint instability involving a 30-year-old man with a 20-year history of pain and laxity in the right knee. The patient had no trauma to his knees; he reported 2 immediate family members with similar complaints, which suggests that this case is likely congenital. After conservative approaches proved to be ineffective, the patient underwent capsular reconstruction using free autologous gracilis tendon. At 6-month postoperative follow-up, the patient was pain free with no locking and instability. He then underwent surgery on the left knee. At 1-year follow-up after the second surgery, the patient had no symptoms or restrictions in mobility. We provide an alternative surgical approach to arthrodesis and resection for the treatment of chronic proximal tibiofibular instability. In the treatment of chronic tibiofibular instability, we believe that reconstruction of the tibiofibular joint is a safe and effective choice. Copyright 2011, SLACK Incorporated.

  3. Injection treatments for patellar tendinopathy.

    Science.gov (United States)

    van Ark, Mathijs; Zwerver, Johannes; van den Akker-Scheek, Inge

    2011-10-01

    Injection treatments are increasingly used as treatment for patellar tendinopathy. The aim of this systematic review is to describe the different injection treatments, their rationales and the effectiveness of treating patellar tendinopathy. A computerised search of the Medline, Embase, CINAHL and Web of Knowledge databases was conducted on 1 May 2010 to identify studies on injection treatments for patellar tendinopathy. 11 articles on seven different injection treatments (dry needling, autologous blood, high-volume, platelet-rich plasma, sclerosis, steroids and aprotinin injections) were found: 4 randomised controlled trials (RCTs), 1 non-RCT, 4 prospective cohort studies and 2 retrospective cohort studies. All studies reported positive results. The Delphi scores of the four RCTs ranged from 5 to 8 out of 9. Different and sometimes contradictory rationales were used for the injection treatments. All seven different injection treatments seem promising for treating patellar tendinopathy. Unlike the other injection treatments, steroid treatment often shows a relapse of symptoms in the long term. Results should be interpreted with caution as the number of studies is low, few high-quality studies have been conducted and the studies are hard to compare due to different methodology. More high-quality studies using the same cross-cultural reliable and valid outcome measure are needed, as well as further research into the pathophysiology. Finally, some implications are provided for clinicians who want to use injection treatments as a part of their treatment for patellar tendinopathy, distinguishing between reactive and degenerative phase of patellar tendinopathy.

  4. Jumper's Knee (Patellar Tendonitis) (For Parents)

    Science.gov (United States)

    ... Safe Videos for Educators Search English Español Jumper's Knee (Patellar Tendonitis) KidsHealth / For Parents / Jumper's Knee (Patellar ... prevent continued damage to the knee. How the Knee Works To understand how jumper's knee happens, it ...

  5. Patellar Tendinopathy: Diagnosis and Treatment.

    Science.gov (United States)

    Figueroa, David; Figueroa, Francisco; Calvo, Rafael

    2016-12-01

    Patellar tendinopathy is a common cause of pain in athletes' knees. Historically, it has been related to jumping sports, such as volleyball and basketball. Repetitive jumping generates a considerable load of energy in the extensor mechanism, leading to symptoms. The main pathophysiologic phenomenon in patellar tendinopathy is tendinosis, which is a degenerative disorder rather than an inflammatory disorder; therefore, the other popular term for this disease, tendinitis, is not appropriate. The nonsurgical treatment of patellar tendinopathy is focused on eccentric exercises and often has good results. Other experimental options, with variable levels of evidence, are available for recalcitrant cases. Surgical treatment is indicated for cases that are refractory to nonsurgical treatment. Open or arthroscopic surgery can be performed; the two methods are comparable, but arthroscopic surgery results in a faster recovery time.

  6. Tendinopatia patelar Patellar tendinopathy

    Directory of Open Access Journals (Sweden)

    Moisés Cohen

    2008-08-01

    Full Text Available A tendinopatia do patelar ou jumper's knee (joelho do saltador é uma afecção que acomete freqüentemente atletas praticantes de atividades de salto ou aquelas que exigem força de impacto repetitivo. Histologicamente, a sobrecarga excessiva no tendão pode provocar alterações na matriz extracelular, resultando em pequenas lesões que, cronicamente, poderão levar a um quadro de tendinose, principalmente na região do pólo inferior da patela. A dor na região anterior do joelho é o primeiro sintoma relatado pelo paciente portador dessa afecção. Seu início é insidioso e gradual, principalmente após atividade física, mas, com a progressão da doença, pode tornar-se freqüente durante ou já no início da atividade. O diagnóstico de tendinopatia do patelar é eminentemente clínico, caracterizado por dor à palpação no pólo inferior da patela e adjacências e, nos casos mais avançados, nódulo palpável e edema associado podem ser visualizados. Exames complementares, como radiografia, ultra-sonografia (US e ressonância magnética (RM auxiliam no diagnóstico. O US e a RM são os mais indicados, pois podem definir o local exato da lesão, sua extensão, como também identificar a presença ou não de alterações degenerativas, sendo a RM o que fornece melhor resolução. O tratamento inicial da tendinopatia é clínico, com repouso relativo, correção dos fatores etiológicos, além de crioterapia e medidas fisioterápicas. A utilização da medicação analgésica e antiinflamatória é controversa. Nos casos que não respondem ao tratamento clínico, o cirúrgico é opção, e várias técnicas são descritas, a literatura demonstrando índices variados de bons resultados.Patellar tendinopathy, or jumper's knee, is often seen in athletes that practice jumping modalities, or modalities that require repetitive impact strength. Histologically, the excessive load on the tendon may cause changes in the extracellular matrix and

  7. Predictors of patellar alignment during weight bearing: an examination of patellar height and trochlear geometry.

    Science.gov (United States)

    Teng, Hsiang-Ling; Chen, Yu-Jen; Powers, Christopher M

    2014-01-01

    Patellar malalignment is thought to be an etiological factor with respect to the development of patellofemoral pain. Although previous studies have suggested that the geometry of the femoral trochlea and the height of the patella play an important role in determining patellar alignment, no investigation has systematically examined these relationships during weight bearing. The aim of this study was to determine whether patellar height and/or trochlear geometry predicts patellar alignment (lateral patellar displacement and lateral patellar tilt) during weight bearing. MR images of the patellofemoral joint were acquired from 36 participants during weight bearing (25% of body weight) at 4 knee flexion angles (0°, 20°, 40° and 60°). Using the axial images, patellar alignment (lateral displacement and tilt) and femoral trochlear geometry (sulcus angle and inclination of the lateral femoral trochlea) were measured. Patellar height (Insall-Salvati ratio) was measured on reconstructed sagittal plane images. Stepwise regression analysis revealed that at 0° of knee flexion, the height of the patella was the best predictor of lateral patellar tilt while the lateral trochlea inclination angle was the best predictor of lateral patellar displacement. Lateral trochlear inclination was the best predictor of patellar lateral displacement and tilt at 20°, 40° and 60° of knee flexion. Similar to a previous study performed under non-weight bearing condition, our findings suggest that lateral trochlear inclination is an important determinant of patellar alignment in weight bearing. Level III. © 2013. Published by Elsevier B.V. All rights reserved.

  8. Effect of patellar strap and sports tape on pain in patellar tendinopathy : A randomized controlled trial

    NARCIS (Netherlands)

    Vries , de A.; Zwerver, J.; Diercks, R.; Tak, I.; van Berkel, S.; van Cingel, R.; van der Worp, H.; van den Akker-Scheek, I.

    2016-01-01

    Numerous athletes with patellar tendinopathy (PT) use a patellar strap or sports tape during sports. This study's aim was to investigate the short-term effect of these orthoses on patellar tendon pain. Participants performed the single-leg decline squat, vertical jump test, and triple-hop test under

  9. Effect of patellar thickness on early results of total knee replacement with patellar resurfacing.

    Science.gov (United States)

    Lee, Qunn Jid; Yeung, Sze Tsun; Wong, Yiu Chung; Wai, Yuk Leung

    2014-12-01

    Patellar thickness is a concern in total knee replacement with patellar resurfacing because of the risk of patellar fracture or implant loosening. The aim of this study was to evaluate if patellar thickness is related to clinical outcome in the absence of patellar fracture or implant loosening. Early results of 169 patients who underwent total knee replacement with patellar resurfacing were reviewed to assess the effect of patellar thickness on clinical outcome. The mean follow-up was 13 months. The range of motion, Knee Society Score, Function Score and WOMAC Score were assessed preoperatively, at day 0, 6 months and 1 year. Radiographs were assessed for patellar fracture or implant loosening. Thirty-one percent of all patients had preoperative thickness thickness after patellar cut, all were female. Twenty-three percent had ≥1 mm increase of thickness after surgery. Radiographs did not show any patellar fracture or implant loosening. However, preoperative patellar thickness thickness. Residual thickness thickness ≥1 mm postoperatively was associated with lower gain in WOMAC score at 6 months. Early results of patellar resurfacing with preoperative thickness thickness thickness was also found to have inferior clinical results. II.

  10. Atraumatic femoral neck fracture secondary to prolonged lactation induced osteomalacia

    Directory of Open Access Journals (Sweden)

    Dhammapal Sahebrao Bhamare

    2013-01-01

    Full Text Available Presenting a case of atraumatic fracture neck femur secondary to 2 years of prolonged lactation. A 26-year-old lactating mother presented with pain in left hip from last 12 months. She was apparently alright before and during pregnancy. Plain radiograph showed a complete undisplaced fracture of femoral neck. Osteomalacia was diagnosed by radiological and serological investigations. The fracture was fixed using AO type cannulated cancellous screws. The fracture showed good clinical and radiological union at 3 months. Literature review shows that this is a first case of atraumatic fracture of neck femur due to prolonged lactational osteomalacia. It showed that even apparently healthy Indians are susceptible to osteomalacia, more so during pregnancy and lactation and can be presented as atraumatic fracture. Although considered relatively stable, a compression type incomplete fracture neck femur may progress to a complete fracture if not treated in time.

  11. Achilles and Patellar Tendinopathy Loading Programmes

    DEFF Research Database (Denmark)

    Malliaras, Peter; Barton, Christian J; Reeves, Neil D

    2013-01-01

    INTRODUCTION: Achilles and patellar tendinopathy are overuse injuries that are common among athletes. Isolated eccentric muscle training has become the dominant conservative management strategy for Achilles and patellar tendinopathy but, in some cases, up to 45 % of patients may not respond...... mechanism that was consistently associated with improved clinical outcomes in both Achilles and patellar tendon rehabilitation was improved neuromuscular performance (e.g. torque, work, endurance), and Silbernagel-combined (Achilles) HSR loading (patellar) had an equivalent or higher level of evidence than...

  12. MRI of atraumatic sports injuries of the shoulder

    Energy Technology Data Exchange (ETDEWEB)

    Sasaki, Taisuke; Saito, Yoko; Sasaki, Yukio; Yodono, Hiraku; Takekawa, Shoichi; Nakamura, Ryujiro; Harata, Seiko (Hirosaki Univ., Aomori (Japan). School of Medicine)

    1992-05-01

    MRI of operatively or arthroscopically proven atraumatic sports injuries of 12 shoulders were reviewed retrospectively. Although it is difficult to diagnose the lesions localised at the superior glenoid labrum and to decide whether rotator interval is injured or not by MRI, MRI could detect thickening of subacromial bursae or rotator cuff injuries due to impingement syndrome and glenoid labrum injuries, such as Bankart lesion. On our limited experience, MRI was more valuable examination than arthrography and CT arthrography. MRI is a useful modality for screening or preoperative evaluation of atraumatic sports injuries of the shoulder. (author).

  13. Neglected Ipsilateral Anterior Cruciate Ligament and Patellar ...

    African Journals Online (AJOL)

    Simultaneous ipsilateral ACL and Patellar tendon rupture is a rare entity. Although treatment protocol has been varied and shrouded in controversy, the general consensus is that a 2- staged early repair of patellar tendon with delayed reconstruction of the ACL gives best functional result. The rehabilitation differs depending ...

  14. Patellar tendinopathy : physical therapy and injection treatments

    NARCIS (Netherlands)

    van Ark, Mathijs

    2015-01-01

    Patellar tendinopathy, commonly known as jumper’s knee, is an overuse injury of the patellar tendon. It is a frequent injury, particularly in jumping athletes such as volleyball and basketball players. Jumper’s knee is often a long-lasting injury and can have a major impact on sports and even work

  15. Routine patellar resurfacing using an inset patellar technique.

    LENUS (Irish Health Repository)

    Hurson, Conor

    2012-02-01

    The management of the patella in total knee arthroplasty still causes controversy. Whether or not to resurface the patella in primary total knee arthroplasty remains unclear. In this study we examined 220 consecutive total knee replacements, by a single surgeon, where the patella was routinely resurfaced using the inset technique. All patellae were suitable for resurfacing. Patellar thickness was not altered in 54.5% of patellae. In 97.2% the patella was within 2 mm of the original thickness. There were no significant complications. In this study we have found that the inset technique of patella resurfacing in total knee replacement is a simple and safe resurfacing procedure.

  16. Surgical Management of Patellar Fractures.

    Science.gov (United States)

    Kakazu, Rafael; Archdeacon, Michael T

    2016-01-01

    The patella plays a crucial role in the extensor mechanism to increase the mechanical advantage of the quadriceps. Fractures can be classified based on displacement, comminution, and fracture pattern, which often guide treatment. Modern treatment options include internal fixation using tension bands with Kirschner wires or cannulated screws, lag screw fixation, partial patellectomy, and rarely total patellectomy. Nondisplaced, closed patellar fractures or fractures with less than 2-mm articular steps can be successfully treated conservatively. Open fractures, articular step of 2 mm or greater, and loss of knee extension are indications for surgical intervention. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Challenges in prosthesis classification.

    Science.gov (United States)

    Robertsson, Otto; Mendenhall, Stan; Paxton, Elizabeth W; Inacio, Maria C S; Graves, Stephen

    2011-12-21

    Accurate prosthesis classification is critical for total joint arthroplasty surveillance and assessment of comparative effectiveness. Historically, prosthesis classification was based solely on the names of the prosthesis manufacturers. As a result, prosthesis designs changed without corresponding name changes, and other prostheses' names changed over time without substantial design modifications. As the number of prostheses used in total joint arthroplasty on the market increased, catalog and lot numbers associated with prosthesis descriptions were introduced by manufacturers. Currently, these catalog and lot numbers are not standardized, and there is no consensus on categorization of these numbers into brands or subbrands. Classification of the attributes of a prosthesis also varies, limiting comparisons of prostheses across studies and reports. The development of a universal prosthesis classification system would standardize prosthesis classification and enhance total joint arthroplasty research collaboration worldwide. This is a current area of focus for the International Consortium of Orthopaedic Registries (ICOR).

  18. Magnetic resonance images of chronic patellar tendinitis

    Energy Technology Data Exchange (ETDEWEB)

    Bodne, D.; Quinn, S.F.; Murray, W.T.; Cochran, C.; Bolton, T.; Rudd, S.; Lewis, K.; Daines, P.; Bishop, J.

    1988-01-01

    Chronic patellar tendinitis can be a frustrating diagnostic and therapeutic problem. This report evaluates seven tendons in five patients with chronic patellar tendinitis. The etiologies included 'jumper's knee' and Osgood-Schlatter disease. In all cases magnetic resonance images (MRI) showed thickening of the tendon. Some of the tendons had focal areas of thickening which helped establish the etiology. All cases had intratendinous areas of increased signal which, in four cases, proved to be chronic tendon tears. MRI is useful in evaluating chronic patellar tendinitis because it establishes the diagnosis, detects associated chronic tears, and may help determine appropriate rehabilitation. (orig.)

  19. Medial patellar ossification after patellar instability: a radiographic finding indicative of prior patella subluxation/dislocation

    Energy Technology Data Exchange (ETDEWEB)

    Jerabek, Seth A. [Harvard Combined Orthopaedic Surgery Residency Program, Boston, MA (United States); Asnis, Peter D.; Poon, Steven K.; Gill, Thomas J. [Massachusetts General Hospital, Department of Orthopaedic Surgery, Boston, MA (United States); Bredella, Miriam A.; Ouellette, Hugue A. [Massachusetts General Hospital, Department of Radiology, Boston, MA (United States)

    2009-08-15

    To describe the correlation between medial patellar ossification and prior patella subluxation and/or dislocation. A retrospective billing database search identified 544 patients who had been diagnosed with patellar instability over a 13-year period. One hundred twenty-eight patients met the inclusion criteria. After review by a staff orthopedic surgeon and two musculoskeletal radiologists, 28 patients were found to have medial patellar ossification. The size and location of medial patellar ossification was recorded. Of the 28 patients (20 males, eight females, age 13-66 years, mean 28 years) who were found to have medial patellar ossification, 22 had radiographs, 16 had magnetic resonance imaging, and ten had both. The medial patellar ossification ranged in size from 2 to 18 mm with an average of 6.8 mm. Twelve were located in the medial patellofemoral ligament (MPFL), 14 in the medial joint capsule, and two in both the MPFL and joint capsule. Twenty-seven of 28 patients had a single ossification, and one patient had two ossifications. The timing from injury to first imaging of the lesion ranged from 10 days to a chronic history ({>=}35 years) of patellar instability. Medial patellar ossification correlates with a history of prior patella subluxation and/or dislocation. The medial ossification can be seen within the MPFL or the medial joint capsule, suggesting remote injury to these structures. The presence of this lesion will prompt physicians to evaluate for patellar instability. (orig.)

  20. A Case of Acute Atraumatic Compartment Syndrome of the Thigh.

    Science.gov (United States)

    Gutfraynd, Alexander; Philpott, Sheila

    2016-09-01

    In the absence of trauma, compartment syndrome of the thigh is rare. Several case reports have described compartment syndrome in the presence of trauma, comorbid medical conditions, and acute muscle overuse. Very few reports have demonstrated an acute onset of atraumatic thigh compartment syndrome. A 24-year-old man presented to the Emergency Department (ED) with a painful and swollen left thigh immediately after a night of dancing at a concert. He was found to have an elevated intracompartmental quadriceps pressure of 45 mm Hg in the ED, which led to his transfer to the operating room for an emergent fasciotomy. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although acute, atraumatic compartment syndrome of the thigh is a rare entity, failure to diagnose it promptly can lead to muscle necrosis, permanent neurologic deficits, and amputation. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Longevity of atraumatic restorations performed by undergraduate dentistry students

    OpenAIRE

    FERREIRA, Luale Leão; Ferreira-Nóbilo,Naiara de Paula; Gibilini, Cristina; Sousa, Maria da Luz Rosário de

    2014-01-01

    INTRODUCTION:Atraumatic restorative treatment (ART) is a simple technique that enables the treatment of caries with hand tools and without anesthesia where clinic access is lacking.OBJECTIVE: To evaluate the effectiveness of ART conducted in the primary dentition of 4-11-year-olds in 2009 and 2010 by graduate dental students in Piracicaba, SP, and the longevity of restorations at 6 and 12 months.METHOD: Descriptive data analysis was performed. Differences between groups were assessed using th...

  2. Treating patellar tendinopathy with Fascial Manipulation.

    Science.gov (United States)

    Pedrelli, Alessandro; Stecco, Carla; Day, Julie Ann

    2009-01-01

    According to Fascial Manipulation theory, patellar tendon pain is often due to uncoordinated quadriceps contraction caused by anomalous fascial tension in the thigh. Therefore, the focus of treatment is not the patellar tendon itself, but involves localizing the cause of this incoordination, considered to be within the muscular fascia of the thigh region. Eighteen patients suffering from patellar tendon pain were treated with the Fascial Manipulation technique. Pain was assessed (in VAS) before (VAS 67.8/100) and after (VAS 26.5/100) treatment, plus a follow-up evaluation at 1 month (VAS 17.2/100). Results showed a substantial decrease in pain immediately after treatment (p<0.0001) and remained unchanged or improved in the short term. The results show that the patellar tendon may be only the zone of perceived pain and that interesting results can be obtained by treating the muscular fascia of the quadriceps muscle, whose alteration may cause motor incoordination and subsequent pathology.

  3. A ganglion of the patellar tendon in patellar tendon-lateral femoral condyle friction syndrome.

    Science.gov (United States)

    Touraine, Sébastien; Lagadec, Matthieu; Petrover, David; Genah, Idan; Parlier-Cuau, Caroline; Bousson, Valérie; Laredo, Jean-Denis

    2013-09-01

    Intratendinous ganglia are rare. We report the case of a sedentary woman with chronic mechanical anterolateral pain of the knee and an extensive ganglion of the patellar tendon as indicated on magnetic resonance (MR) and ultrasound (US) examinations. There was evidence of a high-riding patella, patellar malalignment and patellar tendon-lateral femoral condyle friction syndrome with significantly close contact between the patellar tendon and the lateral facet of the femoral trochlea. The ultrasound-guided aspiration of the ganglion enabled a localized injection of an anti-inflammatory drug (cortivazol) and the cytopathological examination of the fluid, which confirmed the diagnosis. Clinical improvement was maintained with knee rehabilitation and was satisfactory at follow-up after 1 year. To our knowledge, we report the first case of a ganglion of the patellar tendon subsequent to patellar tendon-lateral femoral condyle friction syndrome. We found that this case was illustrative of mucoid degeneration in connective tissue due to chronic repetitive microtraumas. Additionally, this case provided the opportunity to discuss the management of this condition in a sedentary individual with a high-riding patella and patellar malalignment.

  4. Simultaneous bilateral patellar tendon rupture without

    Directory of Open Access Journals (Sweden)

    LU Hua-ding

    2012-04-01

    Full Text Available 【Abstract】There is a dearth of case reports de-scribing simultaneous bilateral patellar tendon ruptures in the medical literature. These ruptures are often associated with systemic disorders such as lupus erythematosus or chronic steroid use. The author describes a case of a 24-year-old man who sustained traumatic bilateral patellar ten-don ruptures without any history of systemic disease or steroidal medication. We repaired and reattached the rup-tured tendons to the patella and augmented our procedure with allogeneic tendon followed by wire loop reinforcement. One year after operation, the patient regained a satisfactory range of motion of both knees with good quadriceps strength and no extensor lag. The recurrent microtrauma from a history of intense sports activity and a high body mass index may have played an important role in this trauma event. Key words: Patella; Patellar ligament; Rupture; Ten-don injuries; Knee

  5. Atraumatic medial collateral ligament oedema in medial compartment knee osteoarthritis

    Energy Technology Data Exchange (ETDEWEB)

    Bergin, D.; Keogh, C.; O' Connell, M.; Zoga, A. [Department of Radiology, Mater Misericordiae Hospital, Dublin (Ireland); Rowe, D.; Shah, B. [Boston Univ., MA (United States). Medical Center; Fitzpatrick, P. [Department of Public Health and Epidemiology, University College Dublin (Ireland); Eustace, S. [Department of Radiology, Mater Misericordiae Hospital, Dublin (Ireland); X-Ray Department, Cappagh National Orthopedic Hospital, Dublin (Ireland)

    2002-01-01

    Objective: To describe and determine the prevalence of atraumatic medial collateral oedema identified in patients with medial compartment osteoarthritis. Design and patients: Sixty patients, 30 patients with medial compartment knee osteoarthritis (Kellgren and Lawrence grade 2 to 4) and 30 age-matched patients with atraumatic knee pain without osteoarthritis, referred for MR imaging over a 2 year period were included in the study. In each case, severity of osteoarthritis was recorded on radiographs and correlated with the presence or absence of medial collateral ligament oedema at MR imaging. Results: Medial collateral oedema was identified in 27 of the 30 patients with osteoarthritis, of whom 14 had grade 1 oedema and 13 had grade 2 oedema compared with the presence of medial collateral ligament oedema (grade 1) in only two of the 30 control patients without osteoarthritis (P<<0.0001). Conclusion: Medial collateral oedema is common in patients with osteoarthritis in the absence of trauma. When identified, medial collateral ligament oedema should be considered to be a feature of osteoarthritis and should not be incorrectly attributed to an acute traumatic injury. (orig.)

  6. Mechanical properties of the patellar tendon in elite volleyball players with and without patellar tendinopathy.

    Science.gov (United States)

    Helland, Christian; Bojsen-Møller, Jens; Raastad, Truls; Seynnes, Olivier R; Moltubakk, Marie M; Jakobsen, Vidar; Visnes, Håvard; Bahr, Roald

    2013-09-01

    Although differences in mechanical properties between symptomatic and healthy tendons have been observed for the Achilles tendon, the impact of tendinopathy on patellar tendon mechanics is not fully documented. The aim of the present case-control study was to assess the mechanical properties of the tendon and jump performance in elite athletes with and without patellar tendinopathy. We identified 17 male volleyball players with patellar tendinopathy and 18 healthy matched controls from a 5-year prospective cohort study on junior elite volleyball players. Outcome variables included three measures of maximal vertical jump performance and ultrasound-based assessments of patellar tendon cross-sectional area, stiffness and Young's modulus. The proximal cross-sectional area of the patellar tendon was significantly larger in the tendinopathic group (133 ± 11 vs 112 ± 9 mm(2), respectively; p jump height and the squat jump height (3.4 ± 2.2 vs 1.2 ± 1.5 cm, p = 0.005) was significantly higher in the tendinopathic group compared with the control group. Patellar tendinopathy is associated with a decrease in the mechanical and material properties of the tendon in elite athletes subjected to a high volume of jumping activity. However, compared with their healthy counterparts, tendinopathic volleyball players have a better ability to utilise the stretch-shortening cycle when jumping.

  7. Outcome of Inferior Patellar Pole Avulsion Fractures

    Directory of Open Access Journals (Sweden)

    Ruban Raj Joshi

    2016-12-01

    Full Text Available Introduction: The optimal treatment for inferior pole patella avulsion fractures has still been a topic of debate. The options include (a internal fixation of the pole fragment and (b resection of the avulsed fragment and repair of the patellar ligament to the patella. We present the comparative outcomes for patients with displaced inferior pole patella treated by resection and transosseous Ethibond® Krackow suture repair of patellar ligament with open reduction and internal fixation with modified tension band wiring and circumferential wiring. Methods: During a three year period between August 2013 and September 2016, twenty consecutive patients with distal pole fractures of the patella were prospectively enrolled in this study. These patients were divided into two groups. Group-T patients were treated with open reduction and internal fixation with modified tension band wire and  group-R patients by resection of the avulsed fragment and reattachment of the patellar ligament to the patella with #5 Ethibond®. Data entry and analysis was done by using SPSS version 20. Anatomical and functional outcome were compared. Results: Consecutive 20 patients were treated either with resection lower patellar pole (n=10 or with open reduction internal fixation with tension band wiring (n=10. Demographics were matched in two groups. Group-T required a longer hospital stay (U=13.5, p=0.005. Complications were seen more often in Goup-T compared to Group-R (p=0.005. Group-R had better scores (Bostman score U=6, p=0.001; SFMA U=7.5, p=0.001 and range of movement (p<0.05. Conclusion: Resection of the avulsed fragment and reattachment of the patellar ligament to the patella had better outcome according to the Bostman and SFMA dysfunction score, shorter hospital stay, and less complications as compared to open reduction and internal fixation with tension band wire and circumferential wiring.

  8. Atraumatic restorative treatment (ART): rationale, technique, and development.

    Science.gov (United States)

    Frencken, J E; Pilot, T; Songpaisan, Y; Phantumvanit, P

    1996-01-01

    Despite long-term efforts to use appropriate dental equipment for treating dental caries in economically less developed countries, the predominant treatment remains extraction. The reasons for this failure to save teeth are given in this paper. Supported by results of research undertaken in economically developed countries, a 15-step treatment module for dental caries is presented. This technique, which is called Atraumatic Restorative Treatment (ART), is based on removing decalcified tooth tissue using only hand instruments and restoring the cavity with an adhesive filling material. The technique does not require electricity. The advantages and limitations of the technique are discussed and its use in a school oral health program in Zimbabwe presented. We conclude that ART can make restorative oral care more available to a larger part of the world population than it is today.

  9. Longevity of atraumatic restorations performed by undergraduate dentistry students

    Directory of Open Access Journals (Sweden)

    Luale Leão FERREIRA

    Full Text Available INTRODUCTION:Atraumatic restorative treatment (ART is a simple technique that enables the treatment of caries with hand tools and without anesthesia where clinic access is lacking.OBJECTIVE: To evaluate the effectiveness of ART conducted in the primary dentition of 4-11-year-olds in 2009 and 2010 by graduate dental students in Piracicaba, SP, and the longevity of restorations at 6 and 12 months.METHOD: Descriptive data analysis was performed. Differences between groups were assessed using the chi-squared test with a 95% confidence interval.RESULT:The success rates of ART were 51.90% at 6 months and 47% at 12 months. Class I ARTs were more successful than class II ARTs at 6 and 12 months (p < 0.001.CONCLUSION: Approximately 50% of ART performed by undergraduates students have succeeded and was significantly better for class I carious lesions at both evaluation time points.

  10. Acute atraumatic compartment syndrome in an athlete: a case report.

    Science.gov (United States)

    Stollsteimer, G T; Shelton, W R

    1997-07-01

    To present the case of a college football player with acute, atraumatic, exercise-induced compartment syndrome in the leg. Acute, atraumatic, exercise-induced compartment syndrome is an infrequently reported cause of leg pain in the athlete. If left untreated, acute compartment syndrome can cause muscle necrosis. Chronic exertional compartment syndrome, medial tibial syndrome, stress fracture. Treatment consists of compartment fasciotomy. This previously healthy, but unconditioned, athlete developed severe anterolateral left leg pain after two days of fall practice in which he was unable to run a mile in 7.5 minutes. Physical examination by the team physician revealed acute compartment syndrome, and an emergency anterolateral compartment fasciotomy was performed. Second-look débridement performed 48 hours later revealed no significant change in the necrotic appearance of the anterior compartment soft tissue. Therefore, the dead muscle was completely débrided, and a free-flap latissumus dorsi graft was used for coverage of the wound. With recovery, strength returned to normal in the lateral compartment but remained 0/5 in the anterior compartment. The patient had persistent sensory loss in the distributions of the superficial and deep peroneal nerves. Although much less common than the more frequent causes of leg pain (ie, chronic exertional compartment syndrome, medial tibial syndrome, stress fracture), acute compartment syndrome is potentially more devastating. When the increased intracompartmental pressure within a closed tissue space exceeds capillary perfusion pressure, tissue perfusion is decreased, the soft tissue becomes ischemic, and cells die. The most important clinical diagnostic signs of compartment syndrome are pain with passive stretching of the compartment and pain out of proportion to the results of the physical examination.

  11. Patellar tracking during the gait cycle.

    Science.gov (United States)

    Abbas, Ghulam; Diss, Ceri

    2011-12-01

    To assess normal patellar tracking during walking using the 9-camera infrared system. Four men and 6 women aged 25 to 33 (mean, 29) years each performed 16 walking trials on one occasion. They had prominent patellae with minimal soft tissues (minimising skin artefacts), and their knees and lower limbs were normal and symmetrical. 12 retro-reflective markers (2.5 cm in diameter) were taped to anatomic landmarks of the lower body. Two additional markers (1.4 cm in diameter) were first placed on the medial and lateral points and then proximal and distal points of the patella. Patellar motion relative to the centre of the knee joint was defined as angles between the centre of the knee joint and the 2 sets of patellar markers (medial-lateral and proximal-distal). The mean, maximum, and minimum values of these angles in a standing position were recorded, as was patellar tracking during walking. The X, Y, and Z coordinates for each marker were smoothed out throughout the capturing time. A single gait cycle per trial was chosen for analysis. During walking, the centre of the knee joint and the patella did not move in unison, and the extent of separation was subject dependent. In 70% of the participants, the maximum angle between the centre of the knee joint and each set of markers occurred in the swing phase (0-43%) of the gait cycle. When analysing both sets of markers together, the percentage of participants became 60%. The extent of knee flexion was subject dependent. There was more medial-lateral motion (shift) of the patella than proximal-distal (tilt) motion during the gait cycle. These indicated that the maximum amount of patellar shift and tilt occurred in the swing and early stance phases of the gait cycle and that abnormal patellar motion can be detected if excessive shift or tilt occurs outside of these phases. Patella mal-tracking could be attributed to the position of the lower body segments rather than the absorption or generation of forces.

  12. Patellar tendinosis as an adaptive process: a new hypothesis

    OpenAIRE

    Hamilton, B.; Purdam, C

    2004-01-01

    Background: Patellar tendinosis (PT), or "jumper's knee" is a common condition in athletes participating in jumping sports, and is characterised by proximal patellar tendon pain and focal tenderness to palpation. Hypoechoic lesions observed in the proximal patellar tendon associated with the tendinosis are typically described as being a result of degenerative change or "failed healing". We propose a new model for the development of the hypoechoic lesion observed in PT, in which the aetiology ...

  13. The patellar extensor apparatus of the knee

    Energy Technology Data Exchange (ETDEWEB)

    Dwek, Jerry R. [University of California at San Diego, Department of Radiology, Children' s Hospital and Health Center, San Diego, CA (United States); Chung, Christine B. [University of California at San Diego, Department of Radiology, San Diego, CA (United States); VA Healthcare, San Diego, CA (United States)

    2008-09-15

    The patellar extensor apparatus is composed of the quadriceps muscles that converge to a central tendon that inserts on and invests the patella. It continues by the patellar tendon to act on the tibial tuberosity and thereby extends the leg at the knee. The structure can be thought of as a chain with pathology able to occur at each level. Pathological processes are generally caused by the great force experienced at each level both chronically and acutely. The forces are, however, greatly modified by the particular geometries present at each level. The various pathological processes and factors that modify them are reviewed at each level, beginning with the quadriceps musculature and ending at the terminal point of action, the tibial tuberosity. (orig.)

  14. Patellar tendinopathy - recent developments toward treatment.

    Science.gov (United States)

    Christian, Robert A; Rossy, William H; Sherman, Orrin H

    2014-01-01

    Patellar tendinopathy (PT) is a clinical and chronic overuse condition of unknown pathogenesis and etiology marked by anterior knee pain typically manifested at the inferior pole of the patella. PT has been referred to as "jumper's knee" since it is particularly common among populations of jumping athletes, such as basketball and volleyball players. Due to its common refractory response to conservative treatment, a variety of new treatments have emerged recently that include dry-needling, sclerosing injections, platelet-rich plasma therapy, arthroscopic surgical procedures, surgical resection of the inferior patellar pole, extracorporeal shock wave treatment, and hyperthermia thermotherapy. Since PT has an unknown pathogenesis and etiology, PT treatment is more a result of physician experience than evidence-based science. This review will summarize the current literature on this topic, identify current research efforts aimed to understand the pathological changes in abnormal tendons, provide exposure to the emerging treatment techniques, and provide suggested direction for future research.

  15. The Effect of Patellar Thickness on Intraoperative Knee Flexion and Patellar Tracking in Patients With Arthrofibrosis Undergoing Total Knee Arthroplasty.

    Science.gov (United States)

    Kim, Abraham D; Shah, Vivek M; Scott, Richard D

    2016-05-01

    We evaluated the intraoperative effect of patellar thickness on intraoperative passive knee flexion and patellar tracking during total knee arthroplasty (TKA) in patients with preoperative arthrofibrosis and compared them to patients with normal preoperative range of motion (ROM) documented in a prior study. Routine posterior cruciate ligament-retaining TKA was performed in a total of 34 knees, 23 with normal ROM and 11 with arthrofibrosis, defined as ≤100° of passive knee flexion against gravity under anesthesia. Once clinical balance and congruent patellar tracking were established, custom trial patellar components thicker than the standard trial by 2-mm increments (2-8 mm) were sequentially placed and trialed. Passive flexion against gravity was recorded using digital photograph goniometry. Gross mechanics of patellofemoral tracking were visually assessed. On average, passive knee flexion decreased 2° for every 2-mm increment of patellar thickness (P thickness had no gross effect on patellar subluxation and tilt in patients with arthrofibrosis as well as those with normal ROM. Patellar thickness had a modest effect on intraoperative passive flexion and no effect on patellar tracking in patients with arthrofibrosis undergoing TKA. There was no marked difference in intraoperative flexion and patellar tracking between patients with arthrofibrosis and patients with normal preoperative ROM. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. T2 mapping in patellar chondromalacia

    Energy Technology Data Exchange (ETDEWEB)

    Ruiz Santiago, Fernando, E-mail: ferusan12@gmail.com [Department of Radiology, Traumatology Hospital, University Hospital Virgen de las Nieves, Granada (Spain); Pozuelo Calvo, Rocío [Department of Rehabilitation and Physical therapy, Traumatology Hospital, University Hospital Virgen de las Nieves, Granada (Spain); Almansa López, Julio [Department of Physic, University Hospital Virgen de las Nieves, Granada (Spain); Guzmán Álvarez, Luis; Castellano García, María del Mar [Department of Radiology, Traumatology Hospital, University Hospital Virgen de las Nieves, Granada (Spain)

    2014-06-15

    Objective: To study the correlation between the T2 relaxation times of the patellar cartilage and morphological MRI findings of chondromalacia. Methods: This prospective study comprises 50 patients, 27 men and 23 women suffering of anterior knee pain (mean age: 29.7, SD 8.3 years; range: 16–45 years). MRI of 97 knees were performed in these patients at 1.5 T magnet including sagittal T1, coronal intermediate, axial intermediate fat sat and T2 mapping. Chondromalacia was assessed using a modified version of Noyes classification. The relaxation time, T2, was studied segmenting the full thickness of the patellar cartilage in 12 areas: 4 proximal (external facet–proximal–lateral (EPL), external facet–proximal–central (EPC), internal facet–proximal–central (IPC), internal facet–proximal–medial (IPM), 4 in the middle section (external facet–middle–lateral (EML), external facet–middle–central (EMC), internal facet–middle–central (IMC), internal facet–middle–medial (IMM) and 4 distal (external facet–distal–lateral (EDL), external facet–distal–central (EDC), internal facet–distal–central (IDC), internal facet–distal–medial (IDM). Results: T2 values showed a significant increase in mild chondromalacia regarding normal cartilage in most of the cartilage areas (p < 0.05), except in the internal distal facet (IDC and IDM), EPC, EDL, and IMM. Severe chondromalacia was characterized by a fall of T2 relaxation times with loss of statistical significant differences in comparison with normal cartilage, except in EMC and IMC, where similar values as mild chondromalacia were maintained (p < 0.05). Conclusions: Steepest increase in T2 values of patellar cartilage occurs in early stages of patellar cartilage degeneration. Progression of morphologic changes of chondromalacia to more severe degrees is associated to a new drop of T2 relaxation times approaching basal values in most of the areas of the patellar cartilage, except in the

  17. Preventing Advanced Carious Lesions with Caries Atraumatic Restorative Technique.

    Science.gov (United States)

    Byrd, Tammi O

    2016-06-01

    An alternative approach to controlling dental caries and preventing the associated pain, called atraumatic restorative technique (ART), is described for populations in need, where dental hygienists restore decayed teeth with glass ionomer restorations without prior removal of all decayed tooth structure. There are populations whose decay needs are not adequately being met within the current oral health care delivery system. These include those in poverty conditions, vulnerable children, and the elderly who are often in long-term care facilities without adequate resources or opportunities for traditional dentistry. ART provides a viable option for controlling caries and relieving the pain of untreated decay. The purpose of this article is to suggest that the evidence surrounding ART be viewed objectively and that dental hygienists, with additional education in this approach, can contribute to relieving the pain of untreated dental decay. Evidence suggests that teeth can be effectively restored with ART. Dental hygienists represent an appropriate workforce to provide ART with their current background and education combined plus a brief training program; it is suggested that dental hygiene educational programs include ART within the curriculum. Along with dental sealants and fluoride varnish application, ART can be an important component of a comprehensive preventive program to address the unmet needs of vulnerable populations. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Atraumatic restorative treatment and its use in public health dentistry

    Directory of Open Access Journals (Sweden)

    Suzely Das Saliba Moimaz

    2008-01-01

    Full Text Available In many countries, including Brazil, strictly curative traditional dentistry was unable to establish improved Oral Health indices, because in addition to the high prevalence of dental caries, both patients and professionals encounter economic barriers; the latter are frequently unable to obtain the equipment required for providing dental assistance. Atraumatic Restorative Treatment was proposed as a new approach to caries treatment, as the goal was to attend needy populations that lived under conditions without electrical power supply, as well as to reduce costs. This type of treatment also seeks to respect one of the main current concepts of dental practice, which is to create a favorable environment that halts the caries disease process by means of minimum intervention and maximum preservation of dental structures. In addition to the curative aspect of cavity preparations and restorations, there are the added advantages of concern focused on health promotion, education and patient motivation. In view of the above explanation, the purpose of this article is to expound and discuss the main aspect related to this type of restorative treatment linked to Public Health, by means of a literature review.

  19. Patellar tendinopathy : Causes, consequences and the use of orthoses

    NARCIS (Netherlands)

    de Vries, Astrid Johanna

    2016-01-01

    Patellar tendinopathy (PT), also known as jumper’s knee, is a painful overuse injury of the patellar tendon. This injury is common in jumping athletes. There are numerous treatment options currently available for PT, yet none of them guarantee full recovery. As a result, many athletes have

  20. Epidemiology of Patellar Tendinopathy in Elite Male Soccer Players

    NARCIS (Netherlands)

    Hägglund, Martin; Zwerver, Johannes; Ekstrand, Jan

    Background: Patellar tendinopathy is common among athletes in jumping sports and in sports with prolonged repetitive stress of the knee extensor apparatus. The epidemiology in soccer is not well described. Purpose: This study was undertaken to investigate and describe the epidemiology of patellar

  1. An Unusual Prepatellar Bursa Swelling: Patellar Button Dissociation and Migration.

    Science.gov (United States)

    Hester, Thomas; Moftah, Farid

    2016-01-01

    Implant loosening is not a new phenomenon, nor is implant migration; however they are rarely seen after knee arthroplasty surgery. Complications with patellar buttons have been reported before with peg failure, loosening, and patella fracture; however extra-articular migration is extremely rare. We report an unusual case of patellar button migration 11 years after total knee arthroplasty to the prepatellar bursa.

  2. A novel anatomical patellar plate for transverse patellar fracture – A biomechanical in-vitro study

    Directory of Open Access Journals (Sweden)

    Ahmet Karakasli

    2017-07-01

    Conclusion: In the operative treatment of displaced transverse patellar fractures, the strength of fixation obtained by titanium curved plates is highly stronger when compared to the fixation with a tension band-wire technique. Fixation with titanium curved plates provides satisfactory stability at the fracture site which allow withstanding the cyclic loads during the postoperative rehabilitation.

  3. Patellar tendon ossification after partial patellectomy: a case report

    Directory of Open Access Journals (Sweden)

    Guven Melih

    2010-02-01

    Full Text Available Abstract Introduction Patellar tendon ossification is a rare pathology that may be seen as a complication after sleeve fractures of the tibial tuberosity, total patellectomy during arthroplasty, intramedullary nailing of tibial fractures, anterior cruciate ligament reconstruction with patellar tendon autograft and knee injury without fracture. However, its occurrence after partial patellectomy surgery has never been reported in the literature. Case presentation We present the case of a 35-year-old Turkish man with a comminuted inferior patellar pole fracture that was treated with partial patellectomy. During the follow-up period, his patellar tendon healed with ossification and then ruptured from the inferior attachment to the tibial tubercle. The ossification was excised and the tendon was subsequently repaired. Conclusion To the best of our knowledge, this is the first report of patellar tendon ossification occurring after partial patellectomy. Orthopaedic surgeons are thus cautioned to be conscious of this rare complication after partial patellectomy.

  4. Rehabilitation of symptomatic atraumatic degenerative rotator cuff tears: A clinical commentary on assessment and management.

    Science.gov (United States)

    Bleichert, Sarah; Renaud, Genevieve; MacDermid, Joy; Watson, Lyn; Faber, Ken; Lenssen, Ross; Saulnier, Marie; Phillips, Paul; Evans, Tyler; Sadi, Jackie

    Clinical Commentary. Atraumatic rotator cuff (RC) disease, is one of the most common cause of shoulder pain, which encompasses a continuum from tendinopathy to full thickness cuff tears. Extrinsic, intrinsic and environmental factors have been implicated in the pathophysiology of this disorder, affecting the clinical presentation of symptoms including pain and irritability. Successful rehabilitation of symptomatic atraumatic degenerative rotator cuff (SADRC) tears must address the underlying mechanisms causing dysfunction and correct modifiable factors. The purpose of this paper is to review the shoulder complex anatomy, introduce atraumatic degenerative RC pathology, differentiate between symptomatic and asymptomatic degenerative RC tears, propose an assessment and introduce the Rotator Cuff Protocol 1 (RCP1) designed by the clinical reasoning of one of the lead authors (LW) as a rehabilitation management approach for those clients who present with SADRC tears. N/A for clinical commentary. The ability to identify SADRC tears should consider shoulder anatomy, extrinsic, intrinsic and environmental factors, and the consideration for the natural history of atraumatic partial and full thickness tears in the general population. A thorough clinical history and examination, which includes shoulder symptom modification tests, allows the examiner to determine at what phase the patient may start their exercise program. The RCP1 is a program that has been used clinically by many therapists and clients over the years and research is underway to test this protocol in atraumatic rotator cuff disease including SADRC tears. 5. Copyright © 2017 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

  5. The effect of a patellar strap on knee joint proprioception in healthy participants and athletes with patellar tendinopathy

    NARCIS (Netherlands)

    de Vries, Astrid J.; van den Akker-Scheek, Inge; Diercks, Ron L.; Zwerver, Johannes; van der Worp, Henk

    Objectives: The primary aim of this study is to investigate the effect of the use of a patellar strap on knee joint proprioception in both healthy participants and in patients with patellar tendinopathy (PT). Secondary aims are to examine whether there is a difference in effectiveness of the use of

  6. Traumatic patellar dislocation: nonoperative treatment compared with MPFL reconstruction using patellar tendon.

    Science.gov (United States)

    Bitar, Alexandre Carneiro; Demange, Marco Kawamura; D'Elia, Caio Oliveira; Camanho, Gilberto Luis

    2012-01-01

    Over the long term, acute patellar dislocations can result in patellar instability, with high recurrence rates after nonoperative treatment. To compare the results of operative (reconstruction of the medial patellofemoral ligament [MPFL]) versus nonoperative treatment of primary patellar dislocation. Randomized controlled trial; Level of evidence, 1. Thirty-nine patients (41 knees) (mean age, 24.2 years; range, 12-38 years) with acute patellar dislocation were randomized into 2 groups. One group was treated nonoperatively with immobilization and physiotherapy, the other was treated surgically with MPFL reconstruction; both groups were evaluated with minimum follow-up of 2 years. The Kujala questionnaire was applied to assess pain and quality of life, and recurrence was evaluated. Pearson χ(2) or Fisher exact test was used in the statistical evaluation. The statistical analysis showed that the mean Kujala score was significantly lower in the nonoperative group (70.8), when compared with the mean value of the surgical group (88.9; P = .001). The surgical group presented a higher percentage of "good/excellent" results (71.43%) on the Kujala score when compared with the nonoperative group (25.0%; P = .003). The nonoperative group presented a large number of recurrences and subluxations (7 patients; 35% of cases), whereas there were no reports of recurrences or subluxations in the surgical group. Treatment with MPFL reconstruction using the patellar tendon produced better results, based on the analyses of posttreatment recurrences and the better final results of the Kujala questionnaire after a minimum follow-up period of 2 years.

  7. To Compare the Effect of Pre and Post Weight Bearing Anxiety, Depression in Conventional and Modular Prosthesis on Unilateral Transtibial Amputees

    Directory of Open Access Journals (Sweden)

    R. Raja

    2014-01-01

    Full Text Available Aims and Objectives: To compare the effect of anxiety and depression on unilateral trans tibial amputees those who are using conventional and modular patellar tendon bearing (PTB prosthesis with stump exercises. Material and Methods: A sample of 40 persons with below knee amputation who were trained to wear prosthesis were studied with an experimental comparative study design. Patients who were admitted at Kempegowda Institute of Medical Sciences and Research Centre, Bangalore, K. S. Hegde Medical Academy and Research Centre Mangalore, (N=150 who underwent unilateral transtibial, transfemoral and other amputations between August 2009 - December 2011. To find out peri and postoperative prosthetic fitting, anxiety and depression level of transtibial amputees who wear conventional and modular PTB prosthesis. 3 years of experimental comparative study reveals that the outcome measures of peri and post-operative anxiety and depression level while using conventional PTB prosthesis with stump exercises and modular PTB prosthesis with stump exercises on unilateral transtibial amputees. Results: The unilateral transtibial amputees who were trained with modular prosthesis along with stump exercises group patients anxiety and depression levels are reduced as compared to the unilateral transtibial amputees who were trained with conventional PTB prosthesis along with stump exercises. There is no significant difference seen in both the groups while giving stump exercises alone. Conclusion: The unilateral transtibial amputees who were trained with modular prosthesis along with stump exercises group, patient’s anxiety and depression levels are reduced drastically.

  8. Atraumatic restorative treatment versus amalgam restoration longevity: a systematic review.

    Science.gov (United States)

    Mickenautsch, Steffen; Yengopal, Veerasamy; Banerjee, Avijit

    2010-06-01

    The aim was to report on the longevity of restorations placed using the atraumatic restorative treatment (ART) approach compared with that of equivalent placed amalgam restorations. Five databases were systematically searched for articles up to 16 March 2009. (1) titles/abstracts relevant to the topic; (2) published in English; (3) reporting on 2-arm longitudinal in vivo trials; (4) minimum follow-up period of 12 months. (1) insufficient random or quasi-random allocation of study subjects; (2) not all entered subjects accounted for at trial conclusion; (3) subjects of both groups not followed up in the same way. Fourteen from the initial search of 164 articles complied with these criteria and were selected for review. From these, seven were rejected and seven articles reporting on 27 separate datasets, accepted. Only identified homogeneous datasets were combined for meta-analysis. From the 27 separate computable dichotomous datasets, four yielded a statistically significant improvement of longevity of ART versus amalgam restorations: posterior class V, 28% over 6.3 years; posterior class I, 6% after 2.3 years and 9% after 4.3 years; posterior class II, 61% after 2.3 years. Studies investigating restorations placed in the primary dentition showed no significant differences between the groups after 12 and 24 months. In the permanent dentition, the longevity of ART restorations is equal to or greater than that of equivalent amalgam restorations for up to 6.3 years and is site-dependent. No difference was observed in primary teeth. More trials are needed in order to confirm these results.

  9. Infrapatellar Straps Decrease Patellar Tendon Strain at the Site of the Jumper’s Knee Lesion

    OpenAIRE

    Lavagnino, Michael; Arnoczky, Steven P.; Dodds, Julie; Elvin, Niell

    2011-01-01

    Background: The impetus for the use of patellar straps in the treatment of patellar tendinopathy has largely been based on empirical evidence and not on any mechanistic rationale. A computational model suggests that patellar tendinopathy may be a result of high localized tendon strains that occur at smaller patella–patellar tendon angles (PPTAs). Hypothesis: Infrapatellar straps will decrease the mean localized computational strain in the area of the patellar tendon commonly involved in jumpe...

  10. Patellar luxation in 70 large breed dogs.

    Science.gov (United States)

    Gibbons, S E; Macias, C; Tonzing, M A; Pinchbeck, G L; McKee, W M

    2006-01-01

    To report the signalment, history, clinical features, and outcome in dogs weighing greater than 15 kg, treated surgically and non-surgically for patellar luxation. Risk factors for the development of patellar luxation, postoperative complications, and outcome were evaluated. Details regarding signalment, bodyweight, breed, aetiology, unilateral or bilateral luxation, duration of lameness, grade of luxation, direction of luxation, grade of lameness at presentation, concomitant cranial cruciate ligament rupture, method of treatment, surgical technique, surgeon, and complications were obtained from the medical records. Outcome was graded as excellent, good, fair, or poor, according to the degree of lameness. Seventy dogs (45 males and 25 females) were included. Thirty-five had bilateral luxations (105 limbs). Mean age was two years, and mean weight was 30 kg. The relative risk for Labrador retrievers was 3.3 (Pbreed dogs should be managed with a femoral trochleoplasty, a tibial tuberosity transposition (stabilised with K-wires and a tension band wire), and soft tissue releasing and tightening procedures.

  11. Anuric renal failure after same-session bilateral atraumatic flexible ureteroscopy

    Directory of Open Access Journals (Sweden)

    Gaurav Bandi

    2007-04-01

    Full Text Available We report the first known case of anuric renal failure after same-session bilateral atraumatic flexible ureteroscopy for renal calculi. Although, there is no consensus about stenting patients who undergo same-session bilateral ureteroscopy due to the lack of prospective randomized studies; strong consideration should be given to stenting the ureter at least one side to avoid this complication.

  12. Physical-mechanical properties of glass ionomer cements indicated for atraumatic restorative treatment

    NARCIS (Netherlands)

    Bonifacio, C.C.; Kleverlaan, C.J.; Raggio, D.P.; Werner, A.; de Carvalho, R.C.R.; van Amerongen, W.E.

    2009-01-01

    Background:  This study evaluated mechanical properties of glass ionomer cements (GICs) used for atraumatic restorative treatment. Wear resistance, Knoop hardness (Kh), flexural (Fs) and compressive strength (Cs) were evaluated. The GICs used were Riva Self Cure (RVA), Fuji IX (FIX), Hi Dense (HD),

  13. Six-year follow up of atraumatic restorative treatment restorations placed in Chinese school children.

    NARCIS (Netherlands)

    Lo, E.C.; Holmgren, C.J.; Hu, D.; Palenstein Helderman, W.H. van

    2007-01-01

    OBJECTIVES: This study aimed to evaluate the clinical performance of atraumatic restorative treatment (ART) restorations placed in school children in China over a 6-year period. METHODS: This study was implemented in 1996 and 294 ART restorations were placed in 197 children aged 12-13 years by five

  14. The atraumatic restorative treatment (ART) technique in the English-speaking Caribbean.

    Science.gov (United States)

    Adewakun, A A

    1996-01-01

    FDI World has featured the atraumatic restorative technique on several occasions. In this article, Dr. Adenike A. Adewakun of the School of Dentistry, Faculty of Medical Sciences at the University of the West Indies, St. Augustine, Trinidad, describes a workshop which took place to introduce the concept and practicalities of the technique to nations in the Caribbean region.

  15. Twenty-five-year atraumatic restorative treatment (ART) approach: a comprehensive overview

    NARCIS (Netherlands)

    Frencken, J.E.; Leal, S.C.; Navarro, M.F.

    2012-01-01

    BACKGROUND: The atraumatic restorative treatment (ART) approach was born 25 years ago in Tanzania. It has evolved into an essential caries management concept for improving quality and access to oral care globally. RESULTS: Meta-analyses and systematic reviews have indicated that the high

  16. [Atraumatic restorative treatment in relation to pain, discomfort and dental treatment anxiety

    NARCIS (Netherlands)

    Frencken, J.E.F.M.; Flohil, K.A.; Baat, C. de

    2014-01-01

    Dental treatment anxiety usually develops during childhood due to a bad experience and the dental drill as well as the injection needle are the most common causes. The Atraumatic Restorative Treatment provides the opportunity to provoke little or no dental treatment anxiety because only hand

  17. Mechanical performance of encapsulated restorative glass-ionomer cements for use with Atraumatic Restorative Treatment (ART)

    NARCIS (Netherlands)

    Molina, G.F.; Cabral, R.J.; Mazzola, I.; Lascano, L.B.; Frencken, J.E.F.M.

    2013-01-01

    The Atraumatic Restorative Treatment (ART) approach was suggested to be a suitable method to treat enamel and dentine carious lesions in patients with disabilities. The use of a restorative glass-ionomer with optimal mechanical properties is, therefore, very important. OBJECTIVE: To test the

  18. Acceptance and discomfort from atraumatic restorative treatment in secondary school students in Egypt.

    NARCIS (Netherlands)

    Farag, A.; Frencken, J.E.F.M.

    2009-01-01

    OBJECTIVES: To assess the level of acceptance and discomfort experienced by secondary school students when undergoing an atraumatic restorative treatment (ART) restoration. SUBJECTS AND METHODS: Ninety secondary school students, aged 14 and 15 years, were included in the study. The ART restorations

  19. Dental practitioners' attitudes, subjective norms and intentions to practice atraumatic restorative treatment (ART) in Tanzania.

    NARCIS (Netherlands)

    Kikwilu, E.N.; Frencken, J.E.F.M.; Mulder, J.; Masalu, J.R.

    2009-01-01

    The aim of this study was to describe the attitude and subjective norm of dental practitioners towards practicing the atraumatic restorative treatment (ART) in Tanzania. A pre-tested questionnaire on attitudes and subjective norms to practice ART was mailed to all 147 dental practitioners working in

  20. Caries experience of Egyptian adolescents: does the atraumatic restorative treatment approach offer a solution?

    NARCIS (Netherlands)

    Mobarak, E.H.; Shabayek, M.M.; Mulder, J.; Reda, A.H.; Frencken, J.E.F.M.

    2011-01-01

    OBJECTIVES: To assess the prevalence and severity of dental caries amongst Egyptian adolescents and the prevalence of carious lesions treatable through the atraumatic restorative treatment (ART) approach. SUBJECTS AND METHODS: Using a convenient sample procedure, two secondary schools with a dental

  1. Investigating Achilles and patellar tendinopathy prevalence in elite athletics.

    Science.gov (United States)

    Janssen, Ina; van der Worp, Henk; Hensing, Sjoerd; Zwerver, Johannes

    2018-01-01

    Although injury surveillance in athletics is routinely conducted, discipline-specific Achilles and patellar tendinopathy prevalence remains unknown. The purpose of this study was to explore discipline-specific tendinopathy prevalence and identify whether injury-specific risk factors differed in athletes. Elite athletes were recruited and provided information on their sport training including Achilles and patellar tendon pain history. In order to ascertain whether between-discipline differences existed, data were categorized into discipline groups. Middle-distance athletes reported the highest prevalence of Achilles tendinopathy and the combined athletes reported the highest patellar tendinopathy prevalence. Greater calf stiffness was reported in athletes who experienced Achilles tendinopathy compared to those who did not. A substantial portion of athletes believed their performance decreased as a result of their tendon pain. In order to develop discipline-specific evidence-based injury prevention programmes, further discipline-specific research is required to quantify the mechanism for Achilles and patellar tendinopathy development in elite athletics.

  2. Patellar chondral defects: a review of a challenging entity.

    Science.gov (United States)

    Mouzopoulos, George; Borbon, Carlo; Siebold, Rainer

    2011-12-01

    The aim of this study was to perform a review of the management of patellar cartilage defects, identify prognostic factors for better clinical outcomes, and propose a treatment algorithm of this challenging entity. We conducted a review of multiple databases, evaluating the clinical outcomes after patellar cartilage lesion treatment. Because of the heterogeneity of data, a meta-analysis could not be performed. Twelve studies were identified for inclusion. Based on the clinical outcomes of these studies, a treatment algorithm was proposed. The clinical outcomes after patellar cartilage defects repair depend on the location and size of the articular defect, the age of the patient, the successful reconstruction of the patellar ridge, the repair of extensor mechanism malalignment, and the coexistence of chondromalacia. The optimal treatment for cartilaginous defects of the patella is still elusive. More prospective studies are needed, in order to identify which techniques are cost-effective especially on a long-term basis.

  3. An Unusual Prepatellar Bursa Swelling: Patellar Button Dissociation and Migration

    Directory of Open Access Journals (Sweden)

    Thomas Hester

    2016-01-01

    Full Text Available Implant loosening is not a new phenomenon, nor is implant migration; however they are rarely seen after knee arthroplasty surgery. Complications with patellar buttons have been reported before with peg failure, loosening, and patella fracture; however extra-articular migration is extremely rare. We report an unusual case of patellar button migration 11 years after total knee arthroplasty to the prepatellar bursa.

  4. Clinical signs and anatomical correlation of patellar tendinitis

    OpenAIRE

    Rath Ehud; Schwarzkopf Ran; Richmond John

    2010-01-01

    Background: Patellar tendinitis is one of the several differential diagnosis of anterior knee pain. The clinical diagnosis of patellar tendinitis is based on tenderness to palpation at the inferior pole of the patella. The tenderness has been noted to be maximal when the knee is extended and the quadriceps relaxed, but a definite clinical sign for diagnosis is lacking. The accuracy of two clinical signs was assesed by a two-stage study which included physical examination, MRI and a cadaveric ...

  5. Patellar calcar: MRI appearance of a previously undescribed anatomical entity

    Energy Technology Data Exchange (ETDEWEB)

    Collins, Mark S.; Tiegs-Heiden, Christin A. [Department of Radiology, Mayo Clinic, Rochester, Minnesota (United States); Stuart, Michael J. [Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota (United States)

    2014-02-15

    The femoral calcar is a constant anatomical structure within the proximal femur representing a condensation of bone trabeculae. It is our impression that a similar structure is present within the patella. The purpose of this retrospective study was to define the prevalence, appearance, location, and configuration of the patellar calcar on MRI examinations. One hundred consecutive unenhanced knee MRIs were retrospectively reviewed by two readers who were blinded to the clinical indication. The patellar calcar was defined as a dark signaling, linear or curvilinear structure subjacent to the patellar articular surface. If present, the patellar calcar was assigned to a ''well seen,'' ''moderately well seen,'' or ''faintly seen'' category. Location of the calcar within the patella, orientation, configuration, and thickness were recorded. Confounding variables, such as marrow edema, patellar chondromalacia, bipartite patella, or postoperative changes were also recorded. The patellar calcar was visualized in 81 out of 100 (81 %) MRIs. When detected, the calcar was well seen in 20 out of 81 (25 %), moderately well seen in 35 out of 81 (43 %), and faintly seen in 26 out of 81 (32 %). The anteroposterior width of the calcar measured at its thickest segment was: < 1 mm in 43 out of 81 (53 %), 1 mm in 28 out of 81 (35 %), and >1 mm in 10 out of 81 (12 %). The patellar calcar was seen in the majority of knee MRIs and had a consistent imaging appearance. The calcar may be obscured by degenerative arthrosis of the patella and rarely may mimic patellar stress fracture or osteochondritis dissecans. Radiologists and clinicians should be familiar with this normal anatomical structure. (orig.)

  6. Patella rings for treatment of patellar fracture.

    Science.gov (United States)

    Liu, Fucun; Wang, Shouli; Zhu, Yunli; Wu, Haishan

    2014-01-01

    To evaluate a new fixation technique for patellar fracture using patella rings. A total of 75 patients (average age of 51.3 years) with comminuted or transverse patellar fractures were treated by fixation with patella rings. The Böstman scores at the time of bone union and at 12 months postoperatively were recorded, as was the degree of pain on a visual analogue scale (VAS), the range of motion of the knee at 12 months postoperatively, and any signs of postoperative complications. The average Böstman scores for patients in the transverse fracture group were 25.2 and 29.4 at 3 and 12 months postoperatively, respectively, while the scores for patients in the comminuted fracture group were 27.6 and 28.7, at the same time points. Böstman scores were graded as excellent and good in more than 90 % for patients with either a transverse or comminuted fracture. At the time of 12 months after surgery, the VAS score for patients with comminuted fractures was 0.38, whereas the score for patients in the transverse fracture group was 0.35. No statistically significant difference was found in the range of motion between the affected and uninjured knee at 12 months after surgery for patients in both groups (P > 0.05). This new fixation technique using a patella ring resulted in good outcomes for both transverse fracture and comminuted fracture and is beneficial for patients wishing to commence early functional activity.

  7. VEGF Expression in Patellar Tendinopathy: A Preliminary Study

    Science.gov (United States)

    Lian, Øystein; Bahr, Roald; Hart, David A.; Duronio, Vincent

    2008-01-01

    Vascular function and angiogenesis are regulated by vascular endothelial growth factor-A (VEGF). The purpose of this preliminary study was to address the following questions: Is VEGF expression in the patellar tendon more prevalent in patients with patellar tendinopathy than in individuals with normal, pain-free patellar tendons? Which cell populations express VEGF in normal and tendinopathic tendon? Is there a difference in symptom duration between VEGF+ and VEGF− tendons? We collected patellar tendon tissue from 22 patients undergoing open débridement of the patellar tendon and from 10 patients undergoing intramedullary nailing of the tibia. VEGF expression was assessed immunohistochemically. Relevant inflammatory and repair cell types were immunolabeled. VEGF expression was absent from control tendons, but was present in a subset of patients with histopathological evidence of angiofibroblastic tendinosis. VEGF was expressed in the intimal layer of tendon vessels, but was absent in other cell types. Patients demonstrating VEGF expression in the patellar tendon had a shorter symptom duration (12 ± 7.8 months) than patients with no detectable VEGF (32.8 ± 23.5 months). VEGF may contribute to the vascular hyperplasia that is a cardinal feature of symptomatic tendinosis, particularly in cases with more recent onset. PMID:18459027

  8. Fractured patella in children: Preservation of the patellar dimensions

    Directory of Open Access Journals (Sweden)

    Elsayed Ibraheem Elsayed Massoud

    2012-12-01

    Full Text Available Objectives: The progressive understanding of the mechanicalfunction of the patella makes preservation of itsgeometry is mandatory, particularly during its reconstruction.Objectives of this study were to compare the patellardimensions after surgical and conservative treatment forpatellar fractures in children and to present influence ofthe changes in the patellar dimensions on the knee motions.Materials and methods: Two groups of children with patellarfractures their ages at time of injury averaged 12years. One group included five children, was treated surgicallyusing of the inter-fragmentary wiring technique andthe other group that includes seven children was treatedconservatively. Patients were prospectively followed for aperiod-averaged 65.5 months, the knee function and thepatellar dimensions were assessed clinically and radiographically.Results: The group was treated surgically reported insignificantincrease in the patellar longitudinal length andreported no extension lag; however, reported average 9°flexion deficit, which is possibly correlated to radiographicincrease of the patellar thickness. The group was treatedconservatively reported significant increase in the patellarlongitudinal length and reported extension lag averaged4.3° and flexion deficit averaged 7.14°.Conclusions: Surgical treatment preserved to great extentthe longitudinal patellar length but it failed to preservethe patellar thickness particularly in the comminuted patellarfractures. The patellar elongation caused extensionlag and flexion deficit while the mere increase of the patellarthickness produced flexion deficit without extensionlag.Key words: Patella, dimensions, fracture, knee motion,children

  9. Is proprioception diminished in patients with patellar tendinopathy?

    Science.gov (United States)

    Groot, H E; van der Worp, H; Nijenbanning, L; Diercks, R L; Zwerver, J; van den Akker-Scheek, I

    2016-03-01

    Patellar tendinopathy is a highly prevalent overuse injury, and most treatments are only effective to some extent. This persistence of complaints could be linked to changed proprioception. One study showed diminished proprioception in athletes with lateral epicondylitis. Aim of this study was to determine differences in proprioception, by measuring threshold to detect passive motion (TTDPM) between recreational athletes diagnosed with patellar tendinopathy and healthy controls. The TTDPM as measure of proprioception was determined in 22 recreational athletes with patellar tendinopathy and 22 healthy recreational athletes using a validated instrument. Amount of knee flexion and extension before the movement was noticed by the subject was determined. 80 measurements per athlete (left and right leg, towards extension and flexion and with two starting angles of 20° and 40° flexion) were performed. Mean TTDPM was compared between groups and among the injured recreational athletes between the affected and unaffected knee. No significant difference in TTDPM was found between recreational athletes with patellar tendinopathy and healthy controls. We did find a significant difference between the injured and non-injured knee in recreational athletes with patellar tendinopathy; mean TTDPM was 0.02° higher in the injured knee (p=0.044). No difference was found in proprioception between recreational athletes with patellar tendinopathy and healthy recreational athletes. It is unclear whether such a small difference in TTDPM between affected and unaffected knee is important in clinical setting. Copyright © 2016 Elsevier B.V. All rights reserved.

  10. Predicting the patellar tendon force generated when landing from a jump.

    Science.gov (United States)

    Janssen, Ina; Steele, Julie R; Munro, Bridget J; Brown, Nicholas A T

    2013-05-01

    Although high patellar tendon loading is believed to be the primary causative factor for patellar tendinopathy, research investigating factors that affect patellar tendon loading during landing is scarce. Therefore, the purpose of this study was to identify whether factors previously associated with the development of patellar tendinopathy, and selected variables characterizing landing technique, could predict patellar tendon loading incurred by volleyball players when landing from a jump. Ten highly skilled male, 20 skilled male, and 20 skilled female volleyball players performed a lateral stop-jump movement. Sex, skill level, quadriceps strength, quadriceps extensibility, and trunk moment of inertia were recorded. Landing kinematics (250 Hz) and kinetics (1500 Hz) were collected, and peak patellar tendon force and patellar tendon force loading rate were calculated. Backward multiple regression analyses identified which risk factors or landing technique variables were predictors of patellar tendon loading. Multiple regression analyses were able to estimate and predict 52% (F4,49 = 14.258, P volleyball players with greater quadriceps strength, who displayed increased ankle dorsiflexion velocity and trunk flexion velocity during landing, were predicted to incur higher patellar tendon loading. As frequent application of high patellar tendon loading has previously been identified as a causative factor for developing patellar tendinopathy, interventions designed to decrease ankle dorsiflexion velocity and trunk flexion velocity at landing, particularly in male players with strong quadriceps muscles, may be effective in reducing patellar tendon loading and, in turn, patellar tendinopathy prevalence in this population.

  11. Acceptability, feasibility and perceived satisfaction of the use of the Atraumatic Restorative Treatment approach for people with disability.

    NARCIS (Netherlands)

    Molina, G.F.; Faulks, D.; Frencken, J.E.

    2015-01-01

    Unmet caries treatment need is prevalent among people with disability, partly due to difficulties cooperating with conventional dental treatment. This study compared Atraumatic Restorative Treatment (ART) with conventional restorative treatment (CRT) in the clinic and under general anaesthesia (GA),

  12. Fibril morphology and tendon mechanical properties in patellar tendinopathy: effects of heavy slow resistance training

    DEFF Research Database (Denmark)

    Kongsgaard, Mads; Qvortrup, Klaus; Larsen, Jytte Overgaard

    2010-01-01

    BACKGROUND: Patellar tendinopathy is characterized by pathologic abnormalities. Heavy slow resistance training (HSR) is effective in the management of patellar tendinopathy, but the underlying functional mechanisms remain elusive. PURPOSE: To investigate fibril morphology and mechanical propertie...

  13. Re-revision of a patellar tendon rupture in a young professional martial arts athlete

    OpenAIRE

    Vadalà, A.; Iorio, R.; Bonifazi, A. M.; Bolle, G.; Ferretti, A.

    2011-01-01

    A 27-year-old professional martial arts athlete experienced recurrent right knee patellar tendon rupture on three occasions. He underwent two operations for complete patellar tendon rupture: an end-to-end tenorrhaphy the first time, and revision with a bone-patellar-tendon (BPT) allograft. After the third episode, he was referred to our department, where we performed a surgical reconstruction with the use of hamstring pro-patellar tendon, in a figure-of-eight configuration, followed by a care...

  14. Does the adolescent patellar tendon respond to 5 days of cumulative load during a volleyball tournament?

    NARCIS (Netherlands)

    van Ark, Mathijs; Docking, Sean I.; van den Akker-Scheek, Inge; Rudavsky, A; Rio, Ebonie; Zwerver, Johannes; Cook, Jill L.

    Patellar tendinopathy (jumper's knee) has a high prevalence in jumping athletes. Excessive load on the patellar tendon through high volumes of training and competition is an important risk factor. Structural changes in the tendon are related to a higher risk of developing patellar tendinopathy. The

  15. Differences in tendon properties in elite badminton players with or without patellar tendinopathy

    DEFF Research Database (Denmark)

    Couppé, C; Kongsgaard, M; Aagaard, P

    2012-01-01

    The aim of this study was to examine the structural and mechanical properties of the patellar tendon in elite male badminton players with and without patellar tendinopathy. Seven players with unilateral patellar tendinopathy (PT group) on the lead extremity (used for forward lunge) and nine players...

  16. Biomechanical Assessment of Patellar Advancement Procedures for Patella Alta.

    Science.gov (United States)

    Seidl, Adam; Baldini, Todd; Krughoff, Kevin; Shapiro, Joshua A; Lindeque, Bennie; Rhodes, Jason; Carollo, James

    2016-05-01

    Crouch gait deformity is common in children with cerebral palsy and often is associated with patella alta. Patellar tendon advancement typically is used to correct patella alta and restore normal knee mechanics. The purpose of this study was to determine the mechanical strength of surgical constructs used for fixation during patellar advancement procedures. This study used a cadaveric model to determine which of 3 surgical techniques is biomechanically optimal for patellar tendon advancement in treating patella alta. Twenty-four human cadaveric knees (8 per group) were prepared using 1 of 3 different common surgical techniques: tibial tubercle osteotomy, patellar tendon partial resection and repair at the distal patella, and patellar tendon imbrication. The patella was loaded from 25 to 250 N at 1 Hz for 1000 cycles. A significant difference in patella displacement under cyclical loading was found between surgical techniques. Tibial tubercle osteotomy exhibited significantly less displacement under cyclical loading than distal patella excision and repair (Ppatella excision and repair (P=.0006). Tibial tubercle osteotomy survived longest. Based on failure criteria of 5 mm of displacement, tibial tubercle osteotomy lasted between 250 and 500 cycles. The other 2 techniques failed by 25 cycles. This study offers quantitative evidence regarding the relative mechanical strength of each construct and may influence choice of surgical technique. [Orthopedics. 2016; 39(3):e492-e497.]. Copyright 2016, SLACK Incorporated.

  17. Clinical signs and anatomical correlation of patellar tendinitis

    Directory of Open Access Journals (Sweden)

    Rath Ehud

    2010-01-01

    Full Text Available Background: Patellar tendinitis is one of the several differential diagnosis of anterior knee pain. The clinical diagnosis of patellar tendinitis is based on tenderness to palpation at the inferior pole of the patella. The tenderness has been noted to be maximal when the knee is extended and the quadriceps relaxed, but a definite clinical sign for diagnosis is lacking. The accuracy of two clinical signs was assesed by a two-stage study which included physical examination, MRI and a cadaveric study. Materials and Methods: Two clinical signs, the "passive flexion-extension sign" and the "standing active quadriceps sign" were assessed in 10 consecutive patients with presumed patellar tendinitis. Five patients had an MRI, showed focal abnormality in the tendon. The location of the MRI finding corresponded, to the region of maximal tenderness. A cadaveric dissection was undertaken to describe the anatomy of the patella and the patellar tendon during these tests. Results: Both tests showed a significant decrease in tenderness at the area of inflammation when the patellar tendon was under tension. The cadaveric dissection showed that when the knee is flexed to 90΀ or when the quadriceps is tensioned the deep fibers of the tendon do not deform to anteriorly applied pressure. Conclusion: We suggest using these studies routinely in the evaluation of patients with anterior knee pain.

  18. Normative data of frontal plane patellar alignment in athletes.

    Science.gov (United States)

    Mendonça, Luciana De Michelis; Ocarino, Juliana Melo; Bittencourt, Natália Franco Netto; Santos, Thiago Ribeiro Teles; Barreto, Rafael Almeida; Fonseca, Sérgio Teixeira

    2015-05-01

    The objective of this study was to provide normative data of frontal plane patellar alignment according to McConnell and Arno angles, verify the association between theses angles and identify the presence of patellar rotation in different sports. Cross-sectional. Nine participants (18 knees) were assessed in a preliminary study to verify the intra and inter-examiner reliabilities of the patellar alignment measures. In the main study, 230 volleyball, basketball, gymnastics and soccer athletes (460 knees) were evaluated in order to obtain normative data of patellar alignment. Frontal plane patellar alignment (McConnell and Arno angles) measured in standing position by means of photogrammetry. The standardized method demonstrated intra and inter-examiner reliability coefficients varying from .85 to .98. The mean McConnell and Arno angles were 2.05° (±5.9) and 2.89° (±7.57), respectively. A low association was observed (r = .189, p angles. There was a difference in distribution of medial and lateral rotations, according to the McConnell angle, between different sports (p angles proved to be highly reliable. This made possible the establishment of normative data in a large sample of healthy athletes. Copyright © 2014 Elsevier Ltd. All rights reserved.

  19. Atraumatic extraction and immediate implant installation: The importance of maintaining the contour gingival tissues

    Science.gov (United States)

    Tavarez, Rudys Rodolfo De Jesus; dos Reis, Washigton Luís Machado; Rocha, Adrycila Teixeira; Firoozmand, Leily Macedo; Bandéca, Matheus Coêlho; Tonetto, Mateus Rodrigues; Malheiros, Adriana Santos

    2013-01-01

    There is an accelerated resorption in the first six months after the extraction of the dental element, both horizontally and vertically. These clinical changes normally undertake the aesthetic result of prosthetic rehabilitation, and implant installation after the extraction can be a resource to decrease resorption. The clinical case described in this paper demonstrates a sequence of clinical atraumatic extraction, and then the Immediate installation provisionalization. It is concluded that when carefully indicated and planned, this technique can provide an immediate result promising with maintaining the tooth gingival contour. How to cite this article: Tavarez RR, Machado dos Reis WL, Rocha AT, Firoozmand LM, Bandéca MC, Tonetto MR, Malheiros AS. Atraumatic extraction and immediate implant installation: The importance of maintaining the contour gingival tissues. J Int Oral Health 2013; 5(6):113-8 . PMID:24453455

  20. Reduction of dental fear and anxiety: the outlook of atraumatic restorative treatment

    OpenAIRE

    Domingos, Patricia Aleixo dos Santos; Fonseca, Livia Maria Prado; Oliveira, Ana Luisa Botta Martins de [UNESP

    2016-01-01

    AIM: This study aimed to report a case in which the technique used was the atraumatic Restorative Treatment (ART) in patients with fear of conventional treatment. MATERIAL AND METHODS: This procedure consisted in the treatment of carious lesions in the patient associated with the program of educational and preventive measures which the patient has undergone. The technique described here was performed on tooth 85, which presented atypical carious lesion cavity, through the removal of softened ...

  1. Multiple Atraumatic Osteoporotic Vertebral Fractures in an Adolescent with Suprasellar Germinoma: A Case Report

    Directory of Open Access Journals (Sweden)

    CC Wong

    2012-07-01

    Full Text Available We present the case of a patient with multiple atraumatic osteoporotic vertebral fractures in an adolescent with suprasellar germinoma and also review of relevant literature. The patient suffered from a rare adolescent brain tumour with common complications which are often overlooked and give rise to significant morbidity. Suprasellar germinoma is an intracranial neoplasm, that in addition to its rarity, has variable clinical presentation. Despite appropriate treatment and good outcome, tumour related morbidity is still of concern for these patients.

  2. Common Postmortem Computed Tomography Findings Following Atraumatic Death: Differentiation between Normal Postmortem Changes and Pathologic Lesions

    OpenAIRE

    Ishida, Masanori; Gonoi, Wataru; Okuma, Hidemi; Shirota, Go; Shintani, Yukako; Abe, Hiroyuki; Takazawa, Yutaka; Fukayama, Masashi; Ohtomo, Kuni

    2015-01-01

    Computed tomography (CT) is widely used in postmortem investigations as an adjunct to the traditional autopsy in forensic medicine. To date, several studies have described postmortem CT findings as being caused by normal postmortem changes. However, on interpretation, postmortem CT findings that are seemingly due to normal postmortem changes initially, may not have been mere postmortem artifacts. In this pictorial essay, we describe the common postmortem CT findings in cases of atraumatic in-...

  3. Surface roughness of glass ionomer cements indicated for atraumatic restorative treatment (ART)

    OpenAIRE

    Da Silva, Renata Cristiane [UNESP; Zuanon, Angela Cristina Cilense [UNESP

    2006-01-01

    The purpose of this study was to evaluate the surface roughness of four conventional chemically cured glass ionomer cements (Fuji IX, Ketac Molar, Vidrion R and Vitromolar) commonly used in atraumatic restorative treatment (ART) immediately after material preparation. Twenty specimens of each glass ionomer cement were fabricated and surface roughness was measured after material setting. The specimens were further examined under scanning electron microscopy. Data were analyzed statistically by...

  4. Fabrication and evaluation of an improved polymer-based cochlear electrode array for atraumatic insertion.

    Science.gov (United States)

    Gwon, Tae Mok; Min, Kyou Sik; Kim, Jin Ho; Oh, Seung Ha; Lee, Ho Sun; Park, Min-Hyun; Kim, Sung June

    2015-04-01

    An atraumatic cochlear electrode array has become indispensable to high-performance cochlear implants such as electric acoustic stimulation (EAS), wherein the preservation of residual hearing is significant. For an atraumatic implantation, we propose and demonstrate a new improved design of a cochlear electrode array based on liquid crystal polymer (LCP), which can be fabricated by precise batch processes and a thermal lamination process, in contrast to conventional wire-based cochlear electrode arrays. Using a thin-film process of LCP-film-mounted silicon wafer and thermal press lamination, we devise a multi-layered structure with variable layers of LCP films to achieve a sufficient degree of basal rigidity and a flexible tip. A peripheral blind via and self-aligned silicone elastomer molding process can reduce the width of the array. Measuring the insertion and extraction forces in a human scala tympani model, we investigate five human temporal bone insertion trials and record electrically evoked auditory brainstem responses (EABR) acutely in a guinea pig model. The diameters of the finalized electrode arrays are 0.3 mm (tip) and 0.75 mm (base). The insertion force with a displacement of 8 mm from a round window and the maximum extraction force are 2.4 mN and 34.0 mN, respectively. The electrode arrays can be inserted from 360° to 630° without trauma at the basal turn. The EABR data confirm the efficacy of the array. A new design of LCP-based cochlear electrode array for atraumatic implantation is fabricated. Verification indicates that foretells the development of an atraumatic cochlear electrode array and clinical implant.

  5. Anatomic patellar instability risk factors in primary lateral patellar dislocations do not predict injury patterns: an MRI-based study.

    Science.gov (United States)

    Tompkins, Marc A; Rohr, Sara R; Agel, Julie; Arendt, Elizabeth A

    2017-02-28

    The primary goal was to describe the injury patterns in a population of primary (first time) lateral patellar dislocators (LPD) to lend clarity to commonly held notions about injury patterns in this population. A prospective study identifying patients presenting with LPD between 2008 and 2012. Inclusion criteria were a history and physical exam consistent with primary LPD, and an MRI consistent with the diagnosis without other significant ligamentous injury. On MRI, location of cartilage, medial patellofemoral ligament (MPFL) injury, and bone bruising were noted. Severity was categorized as partial or complete for MPFL and cartilage lesions. Anatomic patellar instability risk factors (patella alta, trochlear dysplasia, increased TT-TG, and lateral patella tilt) were recorded and compared to the injury patterns. This study involved 157 patients; 107 patients were skeletally mature. Of the 157 patients, 26 had surgery for this injury due to clinician-perceived need for cartilage debridement. MPFL injury severity was complete rupture (N = 69, 44%), partial (N = 67, 43%), and none (N = 19, 13%). MPFL injury location was isolated femoral (N = 16, 10%), isolated patella (N = 26, 17%), isolated mid-substance (0%), multiple locations (N = 95, 61%), and none (N = 20, 13%). Chondral injury location was patella (N = 67, 43%), lateral femoral condyle (N = 11, 7%), multiple locations (N = 53, 34%), and none (N = 26, 17%). A majority (61%) of patellar chondral lesions were at its inferomedial aspect; all medial patellar retinacular partial injuries involved the inferomedial aspect of the patella, consistent with the insertion of the medial patellotibial ligament (MPTL). Skeletally immature patients had a greater risk of isolated patellar MPFL and chondral injury. No clear relationship was found between/across the location and/or severity of bone bruising, MPFL, or chondral injury. Underlying anatomic patellar instability risk factors

  6. Insertion forces and intracochlear trauma in temporal bone specimens implanted with a straight atraumatic electrode array.

    Science.gov (United States)

    Mirsalehi, Marjan; Rau, Thomas S; Harbach, Lenka; Hügl, Silke; Mohebbi, Saleh; Lenarz, Thomas; Majdani, Omid

    2017-05-01

    The aim of the study was to evaluate insertion forces during manual insertion of a straight atraumatic electrode in human temporal bones, and post-implantation histologic evaluation of the samples to determine whether violation of intracochlear structures is related to insertion forces. In order to minimize intracochlear trauma and preserve residual hearing during cochlear implantation, knowledge of the insertion forces is necessary. Ten fresh frozen human temporal bones were prepared with canal wall down mastoidectomy. All samples were mounted on a one-axis force sensor. Insertion of a 16-mm straight atraumatic electrode was performed from different angles to induce "traumatic" insertion. Histologic evaluation was performed in order to evaluate intracochlear trauma. In 4 of 10 samples, dislocation of the electrode into scala vestibuli was observed. The mean insertion force for all 10 procedures was 0.003 ± 0.005 N. Insertion forces measured around the site of dislocation to scala vestibuli in 3 of 4 samples were significantly higher than insertion forces at the same location of the cochleae measured in samples without trauma (p force during the whole insertion process of the straight atraumatic electrode is lower than reported by other studies using longer electrodes. Based on our study, insertion forces leading to basilar membrane trauma may be lower than the previously reported direct rupture forces.

  7. Atraumatic vertical tooth extraction: a proof of principle clinical study of a novel system.

    Science.gov (United States)

    Muska, Egon; Walter, Clemens; Knight, Alan; Taneja, Pankaj; Bulsara, Yogesh; Hahn, Michael; Desai, Mayur; Dietrich, Thomas

    2013-11-01

    The aim of this study was to evaluate the applicability and limitations of a novel atraumatic extraction system. Seventy-two patients with severely decayed teeth or root remnants not suitable for forceps extraction were consecutively recruited and had 111 teeth extracted with the use of a novel atraumatic vertical extraction system (Benex). Various patient, tooth, and procedure data were recorded and analyzed. Overall, 92 out of 111 teeth (83%) were successfully extracted. The success rate was higher in single-rooted teeth (89%) and lower in multirooted teeth (43%), with a risk ratio for failure of multirooted versus single-rooted teeth of 5.2 (95% confidence interval 2.5-10.7). The majority of failures were characterized by insufficient retention of the screw and/or root fracture, which mainly occurred as a result of caries in the root canal, misplacement/misalignment of the screw by the surgeon, or a fracture of the root in response to drilling and/or moderate input of traction force. The Benex extractor system may be successfully used for atraumatic tooth extraction. The system has a higher success rate with single-rooted teeth compared with multirooted teeth. Extraction failure is mostly associated with insufficient retention or misplacement of the screw and root fracture. Copyright © 2013 Elsevier Inc. All rights reserved.

  8. The effect of a patellar strap on knee joint proprioception in healthy participants and athletes with patellar tendinopathy.

    Science.gov (United States)

    de Vries, Astrid J; van den Akker-Scheek, Inge; Diercks, Ron L; Zwerver, Johannes; van der Worp, Henk

    2016-04-01

    The primary aim of this study is to investigate the effect of the use of a patellar strap on knee joint proprioception in both healthy participants and in patients with patellar tendinopathy (PT). Secondary aims are to examine whether there is a difference in effectiveness of the use of a patellar strap between participants with low and high proprioceptive acuity and if possible predictors of effectiveness can be determined. Case-control. The threshold to detect passive motion with and without a patellar strap was assessed in 22 healthy participants and 21 unilateral PT patients. The results from the mixed model analysis show that in both groups of participants a small but statistically significant improvement in proprioception was found, primarily in those who had low proprioceptive acuity. A notable finding was that in the symptomatic leg of the PT group no improvement in proprioception by wearing a strap could be determined. Male gender and having fewer symptoms were possible predictors of effectiveness in PT patients. As proprioception plays a role in optimising movements and reducing load to joint-related structures like tendons and ligaments, it is considered an important protection mechanism. Although the improvements in proprioception as a result of wearing the strap are small, it might be that the use of a patellar strap can potentially play a role in injury prevention since poor proprioception can be a risk factor for (re)-injury. Copyright © 2015 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  9. Delayed Repair of Infected Ruptured Patellar Tendon using Suture Anchors

    Directory of Open Access Journals (Sweden)

    Himanshu Kataria

    2017-10-01

    Full Text Available Patellar tendon rupture are rare injuries that are easily missed in acute phases if careful clinical examination is not carried out. The delayed condition is further difficult to treat and augmentation of end to end repair is generally required. However, literature presents no such case of delayed presentation with presence of infection. We here present one such case of delayed presentation of patellar tendon rupture at three weeks in a 52-year-old male patient. Usual techniques were not sufficient to allow early rehabilitation. Technique of suture anchors was planned for repair after thorough debridement. After this intervention, patient was put on aggressive rehabilitation protocol and he gained excellent range of motion. Patient was followed for one year and he showed no loss of movement or signs of infection. We thus recommend using anchor suture repair of patellar tendon that provides a stable and rigid fixation with possibility of early active rehabilitation even in delayed setting.

  10. Assessment Results of Patellar Fracture Treatment after Tension Band Wiring

    Directory of Open Access Journals (Sweden)

    S. Abdolhossein Mehdinasab

    2013-04-01

    Full Text Available Background: To assess the results of patellar fracture treatment by tension band wiring. Materials and Methods: This retrospective study was performed to evaluate clinical and radiological results of patellar fracture during past 6 years.Results: Twenty four patients were participated in follow-up. Union was occurred in the mean time of 2.67±0.61 months. Falling down and direct trauma were the most common cause of fracture. Most common complications were thigh muscle atrophy and pin irritation. Excellent and good results in 87.5% and fair results in 12.5% of the patients were seen.Conclusion: Fixation of patellar fractures with tension band wiring was associated with a high rate of union.

  11. Inferior patellar pole fragmentation in children: just a normal variant?

    Energy Technology Data Exchange (ETDEWEB)

    Kan, J.H.; Vogelius, Esben S.; Orth, Robert C.; Guillerman, R.P.; Jadhav, Siddharth P. [Texas Children' s Hospital, E.B. Singleton Pediatric Radiology, Houston, TX (United States)

    2015-06-15

    Fragmentary ossification of the inferior patella is often dismissed as a normal variant in children younger than 10 years of age. The purpose of this study was to determine whether fragmentary inferior patellar pole ossification is a normal variant or is associated with symptoms or signs of pathology using MRI and clinical exam findings as reference. A retrospective review was performed on 150 patients ages 5-10 years who underwent 164 knee radiography and MRI exams (45.1% male, mean age: 7.8 years). The presence or absence of inferior patellar pole fragmentation on radiography was correlated with the presence or absence of edema-like signal on MR images. Clinical notes were reviewed for the presence of symptoms or signs referable to the inferior patellar pole. These data were compared with a 1:1 age- and sex-matched control group without inferior pole fragmentation. Statistical analysis was performed using two-tailed t-tests. Forty of 164 (24.4%) knee radiographs showed fragmentary ossification of the inferior patella. Of these 40 knees, 62.5% (25/40) had edema-like signal of the inferior patellar bone marrow compared with 7.5% (3/40) of controls (P = 0.035). Patients with fragmentary ossification at the inferior patella had a significantly higher incidence of documented focal inferior patellar pain compared with controls (20% vs. 2.5%, P = 0.015). Inferior patellar pole fragmentation in children 5 to 10 years of age may be associated with localized symptoms and bone marrow edema-like signal and should not be routinely dismissed as a normal variant of ossification. (orig.)

  12. Bone growth into a revised porous-coated patellar implant

    DEFF Research Database (Denmark)

    Jensen, L N; Lund, B; Gotfredsen, K

    1990-01-01

    A noncemented and clinically stable porous-coated patellar component (PCA) was removed from a patient after 11 months because of infection. It was sectioned and examined histologically in undecalcified, thin-ground sections. The bone ingrowth into the porous space was measured at eight levels. Each...... histologic section was quantified by a conventional point-counting method using a square grid. There was inhomogeneous, but extensive, bone ingrowth, often extending to the core of the patellar component, with direct contact between bone and porous coating without any interstitial fibrous membrane....

  13. [Experimental study on Yougui recipe in preventing osteolysis surrounding artificial prosthesis].

    Science.gov (United States)

    Cai, Yun-Huo; Zhao, Peng; Mao, Qiang; Bao, Hang-Xing; Wang, Jin-Fa; Hu, Miao-Feng; Xiao, Lu-Wei; Tong, Pei-Jian

    2012-12-01

    To explore effects of Yougui recipe (see text) and salmon calcitonin acetate in preventing osteolysis surrounding artificial prosthesis. Thirty-two SD male rats with weighted (250 +/- 20) g, aged 8 weeks, were randomly divided into four groups: blank group, model group, salmon calcitonin acetate group and Yougui recipe (see text) group, and 8 rats in each group. Blank group did not undergo any process, other 24 rats underwent anesthesia by chloral hydrate, their knee joints were exposed through medial patellar side,drilling from fermoral condyle nest to marrow cavity,high density of polythlene particles were injected into hole, titanium nail were put into, bone wax closed the window, then suturing step by step. After the molding, saline were used to gavaged in blank group and model group, Yougui recipe (see text) for Yougui recipe (see text) group, salmon calcitonin maximus injection for calcitonin group. After 10 weeks' mediation, rats were executed, and arterial blood and bilateral femoral organization were collected to biochemical, imaging morphology, tissue pathology and molecular biology detection. The key gene expression of activiting osteoclast were inhibited in Yougui recipe (see text) group and calcitonin group. The level of OPG, Ca, ALP in Yougui recipe group were higher than calcitonin group (Partificial joint prosthesis, and Yougui recipe (see text) has better effect in promoting bone formation. The effect of Yougui recipe (see text) in promoting bone formation, inhibiting osteoclasts to provide a new method to treating surrounding osteolysis of artificial joint prosthesis.

  14. Mid-term Results of Rotating Hinged Knee Prosthesis

    Directory of Open Access Journals (Sweden)

    Abdul Buyuk

    2017-01-01

    Full Text Available Aim: In surgeries on patients with advanced ligament instabilities or severe bone defects rotating hinged knee prostheses are one of a limited number of appropriate options. The objective of our study is to evaluate the mid-term functional results and complications of several surgeries using this form of prothesis. Material and Method: The rotating hinged knee prosthesis (RHKP was applied to 23 knees of 19 patients in primary or revision surgeries at our instution between February 2009 and December 2011. Following their operations, patients underwent several retrospective evaluations to assess surgical success. The average follow-up period for the patients was 54 months. The average age of the patients at their last follow-up was 75. Results: The average Special Surgery Knee Scores, Knee Society Knee Scores, and Knee Society Functional Scores were 44, 27, and 18, respectively, before the surgery; and 83, 92, and 70 in the final post-surgery follow-ups. In addition, the average range of motion increased from the pre-operative level of 76 to 101 degrees at the final evaluation. Two patients had per-operative rupture of the patellar tendon, and four patients had various complications after the surgery, including periprosthetic fracture, deep infection, aseptic loosening, and patellofemoral instability. Discussion: Primary or revision knee arthroplasty using RKHP can be successful in cases with advanced ligament instability or severe bone defects; however, increased complication rates should be kept in mind.

  15. Isolated osteochondral fracture of the patella without patellar dislocation.

    Science.gov (United States)

    Bhatt, Jay; Montalban, Antonio Santa Cruz; Wang, Kook Hyun; Lee, Hee Du; Nha, Kyung Wook

    2011-01-03

    Chondral fractures of the patella are associated with acute dislocation of the patella. Osteochondral fracture in patellar dislocation is located in the medial facet of the patella. This article presents a case of a 15-year-old female ballerina with isolated displaced osteochondral fracture of the patella without patellar dislocation. She had no history of trauma. A Merchant's view of both knees showed mild subluxation of the patella, a small fragment on the lateral aspect of the knee, and a small defect of the centromedial patella. Axial magnetic resonance imaging (MRI) revealed an osteochondral fragment measuring 13 mm medial to the patella. However, the medial patellofemoral ligament and medial retinaculum were intact. An effusion on the medial side of the patella consistent with hemarthrosis was observed. An absence of a contusion or bone bruise on the lateral femoral condyle was shown. The loose body was removed arthroscopically. Intraoperative findings included a 1.5×2 cm osteochondral fragment. It is unusual that the osteochondral patellar defect site in this patient was in the inferior and central areas of the patella. Patellar chondral fractures without dislocation or patella fracture are rare. Therefore, the possibility of a trivial trauma leading to an osteochondral fracture should be kept in mind in adolescent and young adults who present with knee pain and hemarthrosis. Copyright 2011, SLACK Incorporated.

  16. Lateral patellar luxation in nine small breed dogs | Dona | Open ...

    African Journals Online (AJOL)

    The objective of this paper was to describe the clinical features, the management and the outcome of nine small breed dogs affected with lateral patella luxation referred during the period between January 2010 and December 2014. Patellar luxations were classified according to: breed, age, sex, weight, and grade of ...

  17. Foot posture and patellar tendon pain among adult volleyball players

    NARCIS (Netherlands)

    Groot, R. de; Malliaras, P.; Munteanu, S.; Payne, C.; Morrissey, D.; Maffulli, N.

    2012-01-01

    OBJECTIVE: We hypothesized that individuals with a normal foot posture would be less likely to experience patellar tendon pain and pathology than those with a pronated or supinated foot. DESIGN: Observational study. SETTING: Field-based study among competing athletes. PARTICIPANTS: Volleyball

  18. Is proprioception diminished in patients with patellar tendinopathy?

    NARCIS (Netherlands)

    Groot, H.E.; van der Worp, H.; Nijenbanning, L.; Diercks, R.L.; Zwerver, J.; van den Akker-Scheek, I.

    2016-01-01

    PURPOSE: Patellar tendinopathy is a highly prevalent overuse injury, and most treatments are only effective to some extent. This persistence of complaints could be linked to changed proprioception. One study showed diminished proprioception in athletes with lateral epicondylitis. Aim of this study

  19. High incidence of acute and recurrent patellar dislocations

    DEFF Research Database (Denmark)

    Gravesen, Kasper Skriver; Kallemose, Thomas; Blønd, Lars

    2017-01-01

    PURPOSE: The purpose of this study was to investigate the Danish population as a whole from 1994 to 2013 to find the incidence of acute and recurrent patellar dislocation. METHODS: The study was performed as a descriptive epidemiological study. The Danish National Patient Registry was retrospecti......PURPOSE: The purpose of this study was to investigate the Danish population as a whole from 1994 to 2013 to find the incidence of acute and recurrent patellar dislocation. METHODS: The study was performed as a descriptive epidemiological study. The Danish National Patient Registry...... was retrospectively searched from 1994 to 2013 to find the number of acute and recurrent patellar dislocation. National population data were collected from Statistics Denmark. RESULTS: The period 1994-2013 saw a total registration of 24,154 primary patellar dislocations. A mean incidence of 42 (95% CI 37-47) per 100......,000 person-years at risk was found, and young females aged 10-17 had the highest incidence of 108 (95% CI 101-116). In a 10-year follow-up, patients were at an overall risk of 22.7% (95% CI 22.2-23.2) of suffering a recurrent dislocation, with young girls aged 10-17 experiencing the highest risk, namely 36...

  20. Relationship between landing strategy and patellar tendinopathy in volleyball

    NARCIS (Netherlands)

    Bisseling, Rob W.; Hof, At L.; Bredeweg, Steef W.; Zwerver, Johannes; Mulder, Theo

    Objective: The aetiology of patellar tendinopathy ( jumper's knee) remains unclear. To see whether landing strategy might be a risk factor for the development of this injury, this study examined whether landing dynamics from drop jumps differed among healthy volleyball players ( CON) and volleyball

  1. Prevalence and genetics of patellar luxation in Kooiker dogs

    NARCIS (Netherlands)

    Wangdee, C; Leegwater, P A J; Heuven, H C M; van Steenbeek, F G; Meutstege, F J; Meij, B P; Hazewinkel, H A W

    The prevalence of patellar luxation (PL) and genetic factors potentially involved in the disorder were investigated in Dutch Kooiker dogs. A cohort of 842 Kooiker dogs, the offspring of 195 sires and 318 dams, was screened for PL from 1994 to 2011. The cohort was included in a pedigree of 1737

  2. Prevalence and genetics of patellar luxation in Kooiker dogs

    NARCIS (Netherlands)

    Wangdee, C.; Leegwater, P.A.J.; Heuven, H.C.M.; Steenbeek, van F.G.; Meutstege, F.J.; Meij, B.P.; Hazewinkel, H.A.W.

    2014-01-01

    The prevalence of patellar luxation (PL) and genetic factors potentially involved in the disorder were investigated in Dutch Kooiker dogs. A cohort of 842 Kooiker dogs, the offspring of 195 sires and 318 dams, was screened for PL from 1994 to 2011. The cohort was included in a pedigree of 1737

  3. Sex Variation in Patellar Tendon Kinetics During Running

    Directory of Open Access Journals (Sweden)

    Sinclair Jonathan

    2015-06-01

    Full Text Available Purpose. The aim of the current investigation was to determine whether female recreational runners exhibit distinct patellar tendon loading patterns in relation to their male counterparts. Methods. Twelve male (age 26.55 ± 4.11 years, height 1.78 ± 0.11 m, mass 77.11 ± 5.06 kg and twelve female (age 26.67 ± 5.34 years, height 1.67 ± 0.12 m, mass 63.28 ± 9.75 kg runners ran over a force platform at 4.0 m · s-1. Lower limb kinematics were collected using an eight-camera optoelectric motion capture system which operated at 250 Hz. Patellar tendon loads were examined using a predictive algorithm. Sex differences in limb, knee and ankle joint stiffness were examined statistically using independent samples t tests. Results. The results indicate that patellar tendon force (male = 6.49 ± 2.28, female = 7.03 ± 1.35 and patelllar tendon loading rate (male = 92.41 ± 32.51, female = 111.05 ± 48.58 were significantly higher in female runners. Conclusions. Excessive tendon loading in female runners indicates that female runners may be at increased risk of patellar tendon pathologies.

  4. Foot Posture and Patellar Tendon Pain Among Adult Volleyball Players

    NARCIS (Netherlands)

    de Groot, Reinier; Malliaras, Peter; Munteanu, Shannon; Payne, Craig; Morrissey, Dylan; Maffulli, Nicola

    Objective: We hypothesized that individuals with a normal foot posture would be less likely to experience patellar tendon pain and pathology than those with a pronated or supinated foot. Design: Observational study. Setting: Field-based study among competing athletes. Participants: Volleyball

  5. Avulsion fracture of the tibial tubercle associated with patellar ...

    African Journals Online (AJOL)

    We present a case of combined avulsion fracture of the tibial tubercle (AFTT) and avulsion of the patellar ligament in a 15-year-old boy. This injury was treated by open reduction and fixation of both lesions using staples with satisfactory results. This constellation of injury is rare but a high index of suspicion is needed when ...

  6. Effect of a patellar strap on the joint position sense of the symptomatic knee in athletes with patellar tendinopathy

    NARCIS (Netherlands)

    de Vries, Astrid J.; van den Akker-Scheek, Inge; Haak, Svenja L.; Diercks, Ron L.; van der Worp, Henk; Zwerver, Johannes

    2017-01-01

    Objectives: The primary aim of this study was to investigate the effect of a patellar strap on the proprioception of the symptomatic leg in PT. Secondary aims were to investigate a possible difference in effectiveness between athletes with high and low proprioceptive acuity, and whether predictors

  7. Effects of a Knee Brace With a Patellar Hole Versus Without a Patellar Hole in Patients With Knee Osteoarthritis: A Double-Blind, Randomized Controlled Trial.

    Science.gov (United States)

    Added, Marco Aurélio Nemitalla; Added, Caroline; Kasawara, Karina Tamy; Rotta, Viviane Perez; de Freitas, Diego Galace

    2017-01-01

    The objective of this study was to observe the immediate effect of a knee brace with a patellar hole versus without a patellar hole on pain perception in patients with knee osteoarthritis. To accomplish this, a double-blind, randomized controlled trial enrolled 108 patients divided into two groups (knee brace with a patellar hole or without a patellar hole). Patients were evaluated by the Visual Analogue Scale (VAS) in order to measure their pain sensation, the Timed Up and Go (TUG) test was used to evaluate their ability to walk, and the 8-m walking test (8MWT) was used to estimate their walking speed. Both groups presented significant reduction in pain perception, higher function of the lower extremities, and greater mobility while wearing a knee brace. However, the patients who wore a knee brace without a patellar hole presented more favorable results than those who wore a knee brace with a patellar hole: a 1.6-point reduction was found versus 1.1 points in the VAS, the patients presented 0.7 s less time versus 0.4 s in the TUG, and the speed was reduced by 1.4 s versus 0.8 s in the 8MWT. Therefore, the knee brace without a patellar hole presented more favorable results when compared with the knee brace with a patellar hole.

  8. Successful emergency splenectomy during cardiac arrest due to cytomegalovirus-induced atraumatic splenic rupture

    DEFF Research Database (Denmark)

    Glesner, Matilde Kanstrup; Madsen, Kristian Rørbæk; Nielsen, Jesper Meng Rahn

    2015-01-01

    A 27-year-old woman was admitted to the emergency department with fever and a petechial rash on suspicion of meningitis. Shortly after arriving she developed cardiac arrest. Blood work up showed severe lactate acidosis, anaemia and thrombocytopenia. A focused assessment with sonography in trauma...... for 14 days with ganciclovir and meropenem and discharged on recovery. Atraumatic splenic rupture caused by viral infection is a rare condition although well described. In the case of our patient, thrombocytopenia added to the severity of the splenic rupture. A multidisciplinary team approach...

  9. Magnetically retained silicone facial prosthesis

    African Journals Online (AJOL)

    straps, spectacle frames, extension from the denture, magnets, adhesives and implants material.[4] In this case report using maxillofacial silicone material and magnets, the prosthesis was constructed to camouflage the facial defect more esthetically. Case Report. A 67‑year‑old male patient was referred to the department.

  10. Magnetically retained silicone facial prosthesis

    African Journals Online (AJOL)

    Key words: Magnet retention, oro cutaneous fistula, silicone maxillofacial prosthesis. Date of Acceptance: 09-Jun-2013. Address for correspondence: Dr. Suresh Venugopalan, Department of Prosthodontics,. Saveetha Dental College, Ponamalle High Road,. Chennai ‑ 600 077, Tamil Nadu, India. E‑mail: ...

  11. Elektra prosthesis for trapeziometacarpal osteoarthritis

    DEFF Research Database (Denmark)

    Klahn, A; Nygaard, Mads; Gvozdenovic, R

    2012-01-01

    We present a prospective follow-up of 39 Elektra prostheses in 37 patients (32 women and five men), with a mean age of 56.5 (range 46-71) years; 34 patients had osteoarthritis and three had rheumatoid arthritis. Patients were followed using clinical examination, including measurement of pain...... be the key problem in treating trapeziometacarpal osteoarthritis using a total prosthesis....

  12. The fixed/detachable implant provisional prosthesis.

    Science.gov (United States)

    Cibirka, R M; Linebaugh, M L

    1997-06-01

    Interim modification and management of a complete denture following surgical uncovering of dental implants can be time-intensive and may fail to provide adequate patient benefit until the definitive prosthesis can be completed. Inadequate interim management can result in functional and tissue difficulties. Modification of the conventional complete denture to a fixed/detachable provisional prosthesis in a one-stage procedure provides the patient an opportunity to experience a fixed prosthesis. The incorporation of fixed, provisional cylinders to the existing denture base using autopolymerizing acrylic resin with a closed-mouth technique is described. The peripheral regions are reduced and the distal extension shortened to resemble a fixed/detachable prosthesis. This conversion technique can provide patient satisfaction and comfort until delivery of the definitive prosthesis. Esthetic concerns, home care problems, or patient difficulties with the provisional prosthesis can be rectified in the final prosthesis.

  13. Transient medial patellar dislocation: injury patterns at US and MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Le Corroller, Thomas; Champsaur, Pierre [Hopital Sainte-Marguerite, Radiology Department, Marseille (France); Faculte de Medecine de Marseille, Anatomy Department, Marseille (France); Dediu, Melania [Hopital Sainte-Marguerite, Radiology Department, Marseille (France)

    2009-05-15

    Medial dislocation of the patella is an unusual entity. It is usually an iatrogenic complication of surgical lateral retinacular release. We describe the clinical, ultrasound (US), and magnetic resonance (MR) imaging features of a transient medial patellar dislocation in a 19-year-old patient with trochlear groove dysplasia presenting no surgical history. US showed acute injury to the lateral patellar retinaculum with complete avulsion at its patellar insertion. MR imaging confirmed the complete tear of the lateral patellar retinaculum and disclosed contusion of the anteromedial portion of the medial femoral condyle and lateral patella. This case is noteworthy because the injury patterns of patellar soft tissue restraints differ markedly from the classical features of lateral patellar dislocation. (orig.)

  14. High resolution magnetic resonance imaging of the patellar retinaculum: normal anatomy, common injury patterns, and pathologies

    Energy Technology Data Exchange (ETDEWEB)

    Thawait, Shrey K. [Yale University - Bridgeport Hospital, Bridgeport, CT (United States); Soldatos, Theodoros; Thawait, Gaurav K.; Cosgarea, Andrew J.; Carrino, John A. [Johns Hopkins Hospital, Baltimore, MD (United States); Chhabra, Avneesh [Johns Hopkins Hospital, Baltimore, MD (United States); Johns Hopkins Hospital, Department of Radiology and Radiological Science, Baltimore, MD (United States)

    2012-02-15

    The medial patellar retinaculum (MPR) and the lateral patellar retinaculum (LPR) are vital structures for the stability of the patella. Failure to identify or treat injury to the patellar retinaculum is associated with recurrent patellar instability and contributes to significant morbidity. High-resolution magnetic resonance imaging (MRI) readily depicts the detailed anatomy of various components (layers) of the retinacula. In this review article, we discuss normal anatomy, important landmarks, common injury patterns, and other pathologies encountered in patellar retinacula. High field strength MRI is an excellent noninvasive tool for evaluation of patellar retinaculum anatomy and pathology. This article will help the reader become familiar with normal imaging findings and the most commonly occurring injuries/pathologies in MPR and LPR. (orig.)

  15. Decline eccentric squats increases patellar tendon loading compared to standard eccentric squats

    DEFF Research Database (Denmark)

    Kongsgaard, M; Aagaard, P; Roikjaer, S

    2006-01-01

    Recent studies have shown excellent clinical results using eccentric squat training on a 25 degrees decline board to treat patellar tendinopathy. It remains unknown why therapeutic management of patellar tendinopathy using decline eccentric squats offer superior clinical efficacy compared to stan...... to standard horizontal eccentric squats. This study aimed to compare electromyography activity, patellar tendon strain and joint angle kinematics during standard and decline eccentric squats....

  16. Endoscopic Resection of Gouty Tophus of the Patellar Tendon

    OpenAIRE

    Lui, Tun Hing

    2015-01-01

    Tophaceous deposition of tendon can result in spontaneous patellar tendon rupture. Surgical therapy may be needed to control symptoms and prevent tendon rupture. Open debridement of the lesion requires a lengthy incision over the lesion; this may result in symptomatic scar adhesion of the patellar tendon or an unhealed wound with persistent tophaceous discharge. Moreover, the other part of the patellar tendon cannot be examined through the incision. We describe a technique for endoscopic rese...

  17. Surgical Treatment of Chronic Patellar Tendinitis in a Collegiate Football Player

    OpenAIRE

    Beam, Joel W; Lozman, Philip R.; Uribe, John W.

    1995-01-01

    In the competitive athlete, there are many causes of anterior knee pain, one of which is patellar tendinitis. Repetition of explosive movements can cause microtrauma to the tendon and its insertion, resulting in patellar tendinitis and occasional tearing, either partial or total. Due to its refractory nature, the treatment of this disorder can be quite frustrating to all involved. A 20-year-old collegiate football player with patellar tendinitis was treated conservatively for more than 2 year...

  18. Combined rupture of the patellar tendon, anterior cruciate ligament and lateral

    OpenAIRE

    Tsarouhas, A; Iosifidis, M; Kotzamitelos, D; Traios, S

    2011-01-01

    Simultaneous rupture of both the patellar tendon and the anterior cruciate ligament is a relatively rare injury. Its diagnosis can easily be missed during the initial examination. Treatment options include immediate repair of the patellar tendon with either simultaneous or delayed reconstruction of the ACL. We present the case of a combined rupture of the patellar tendon, the anterior cruciate ligament and the lateral meniscus in a 38-year old recreational martial arts athlete after a direct ...

  19. [Simultaneous rupture of the anterior cruciate ligament and the patellar tendon: a case report].

    Science.gov (United States)

    Achkoun, Abdessalam; Houjairi, Khalid; Quahtan, Omar; Hassoun, Jalal; Arssi, Mohamed; Rahmi, Mohamed; Garch, Abdelhak

    2016-01-01

    Simultaneous rupture of both the patellar tendon and the anterior cruciate ligament is a relatively rare injury. Its diagnosis can easily be missed during the initial examination. Treatment options include immediate repair of the patellar tendon with either simultaneous or delayed reconstruction of the ACL. We present the case of a combined rupture of the patellar tendon, the anterior cruciate ligament in a 22-year old footballer. A two-stage treatment approach was performed with an excellent functional outcome.

  20. Should the position of the patellar component replicate the vertical median ridge of the native patella?

    Science.gov (United States)

    Lee, Rae Hyeong; Jeong, Hae Won; Lee, Jin Kyu; Choi, Choong Hyeok

    2017-01-01

    In total knee arthroplasty (TKA), the position of the patellar component can affect patellar tracking. However, the patellar component cannot always replicate the original high point of the patella because of anatomical variance. This study investigated whether altering the highest point of the patella can affect outcomes of primary TKA, especially in patients having a patella with a far-medialized median ridge. A retrospective review was performed for 177 knees (143 patients) treated with primary TKA between July 2011 and March 2014. Group 1 (34 knees) had the patellar component displaced over three millimeters from the median ridge, while Group 2 (143 knees) had the patellar component placed on the original median ridge position. The one-year follow-up outcomes were reviewed, including: patellar tilt angle, Knee Society Score, Feller Patellar Score, and modified Kujala Anterior Knee Pain Score. Mean (±standard deviation) displacement of the patellar component in Group 1 was 3.97±0.97mm lateral to the original position of the median ridge, with a significant decrease in lateral patellar tilt angle (Ppatella in primary TKA. Copyright © 2016 Elsevier B.V. All rights reserved.

  1. Walking, chair rising, and stair climbing after total knee arthroplasty: patellar resurfacing versus nonresurfacing.

    Science.gov (United States)

    Pollo, F E; Jackson, R W; Koëter, S; Ansari, S; Motley, G S; Rathjen, K W

    2000-01-01

    During the past decade, the technology and design of knee joint prostheses has progressed considerably. However, there is still much controversy on whether resurfacing the patella during routine total knee arthroplasty (TKA) is necessary. This study compares the biomechanics of the lower limb in patients after TKA with and without patellar resurfacing during level walking, stair climbing, and chair rising. Eighteen patients who underwent TKA by two different surgeons using the same prosthesis were studied after full rehabilitation while walking, stair climbing, and chair rising. Patients were divided between those who were resurfaced and those who were not resurfaced. An aged-matched control population was recruited for comparison. The Hospital for Special Surgery Knee Rating Scale was used to gather clinical information. Kinematic and kinetic parameters were collected using a 5-camera Motion Analysis System and an AMTI OR6-5 force platform. For level walking, patients were asked to walk at a self-selected speed down an 8-m walkway. For stair climbing, patients were asked to climb a 4-step staircase without handrail support and for chair rising, patients were asked to rise from a chair that was positioned at the height of their knee joint line. Five trials for each side were recorded for averaging and statistical analysis. Temporal-spatial parameters and kinematic and kinetic variables at the knee joint were tested for significance using the repeated measures analysis of variance (ANOVA). There were no significant differences in the biomechanics of walking, stair climbing, or chair rising between patients after TKA with and without a resurfaced patella.

  2. Two-year evaluation of the atraumatic restorative treatment approach in primary molars class I and II restorations

    NARCIS (Netherlands)

    da Franca, C.; Colares, V.; van Amerongen, E.

    2011-01-01

    Background.  Atraumatic restorative treatment (ART) has the advantages of reducing pain and fear and of being more cost-effective than the traditional approach. Aim.  The aim of this study was to investigate the survival of ART class I and II restorations in primary molars at 2 years. Design.  The

  3. Treatment of the lateral patellar luxation in toy poodles

    Directory of Open Access Journals (Sweden)

    Padilha Filho João Guilherme

    2005-01-01

    Full Text Available The purpose of this retrospective study was to report the occurrence of lateral patellar luxation in poodles. The animals were referred to the Orthopedics Service of the Veterinary Hospital, Faculdade de Ciências Agrárias e Veterinárias, - Jaboticabal Campus, São Paulo, Brazil, twelve client-owned poodles, seven females and five males poodles ranging in age from three to nine months. Clinical examination showed lameness, pain and deformities of the affected limbs. Surgical trochleoplasties were performed with medial retinacular overlap and medial tibial tuberosity transposition. The animals recovered their normal activity within a period of one to two weeks after surgery. Although this was a rarely occurring pathological condition in poodles, surgical repair was easy to execute because of its similarity to correction of medial patellar luxation. Lateral patellar luxation in small dogs is rare and, when present, is of congenital origin, at times progressing to marked functional impotence of the affected limbs.

  4. Does Patellar Eversion in Total Knee Arthroplasty Cause Patella Baja?

    Science.gov (United States)

    Sharma, Vineet; Tsailas, Panagiotis G.; Maheshwari, Aditya V.; Ranawat, Chitranjan S.

    2008-01-01

    Several proponents of minimally invasive surgery-total knee arthroplasty (MIS-TKA) have suggested patellar eversion during a standard exposure of the knee may cause shortening of the patellar tendon and poorer outcomes secondary to acquired patella baja. To explore this suggestion, we retrospectively reviewed 135 consecutive TKAs in 110 patients to ascertain the effect of TKA on the postoperative Insall-Salvati ratio. All surgeries were performed using standard TKA techniques with a midline incision, medial parapatellar arthrotomy, partial excision of the fat pad, and routine eversion of the patella. One patient developed a postoperative patella baja, defined as an Insall-Salvati ratio of less than 0.8. The Knee Society score for knee and function in this patient was 75 and 70, respectively. Five additional patients had a decrease in Insall-Salvati ratio by 10% or more but without patella baja. Mean Knee Society score for knee and function in these five patients was 94 (range, 73–99) and 96 (range, 90–100), respectively, as compared with 93 (range, 37–99) and 94 (range, 40–100) in the remaining 104 patients. Our data suggest the incidence of patella baja is low after TKA despite routine patellar eversion. Furthermore, a 10% or more decrease in the Insall-Salvati ratio without patella baja was not associated with a worse clinical outcome. Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:18568378

  5. Management of bilateral patellar luxation in an alpaca.

    Science.gov (United States)

    Abuja, Gustavo A; Kowaleski, Michael P; García-López, José M

    2014-05-01

    To report surgical management bilateral lateral patellar luxation in a mature alpaca using a combination of trochlear wedge recession (TWR), tibial tuberosity transposition (TTT), and joint capsule imbrication. Clinical case report. 9-year-old castrated male Alpaca. Bilateral, grade III/IV, lateral patellar luxation was identified by palpation, lameness examination and confirmed with radiography and ultrasonography. Surgical procedures were staged, with the left stifle treated first. Bilateral TWR, TTT, and joint capsule imbrication were performed. Outcome was assessed by radiography and follow up lameness examinations. An immediate improvement in weight bearing occurred after surgery of the left hind limb. Five months after initial surgery, right hind limb patella luxation was corrected. After surgery on the 2nd limb, the alpaca had progressive improvement in weight bearing during hospitalization. At 12 months, there were no signs of lameness and the alpaca had resumed normal activities. For bilateral lateral patellar luxation, a combination of TWR, TTT, and joint capsule imbrication resulted in excellent long-term outcome. © Copyright 2014 by The American College of Veterinary Surgeons.

  6. Recognizing the elbow prosthesis on conventional radiographs

    Directory of Open Access Journals (Sweden)

    Kamilcan Oflazoglu

    2016-09-01

    Full Text Available Abstract The objective of this study was to make an overview that can be useful in determining which type and brand of prosthesis a patient has when visiting the emergency department or outpatient clinic with a periprosthetic fracture, dislocation, or implant failure. The commonly used prostheses in Europe are opted for this list. The radiographs used for this list are obtained either from the company or from our own patients. This list contains the Coonrad/Morrey total elbow prosthesis, the Nexel total elbow prosthesis, the GSB III Elbow Prosthesis, the iBP Total Elbow System, the Discovery Elbow System, the NESimplavit Elbow System, the Latitude Elbow prosthesis, the Solar Elbow, and the Souter–Strathclyde total elbow. The characteristics of each prosthesis are described.

  7. Contact dermatitis from a prosthesis.

    Science.gov (United States)

    Munoz, Carla A; Gaspari, Anthony; Goldner, Ronald

    2008-01-01

    Patients wearing a prosthesis face a wide variety of medical problems. Skin complications have long been recognized, but their prevalence is still unknown. The most frequently reported disorders are allergic contact dermatitis (ACD), acroangiodermatitis, epidermoid cysts, epidermal hyperplasia, follicular hyperkeratosis, verrucous hyperplasia, bullous diseases, hyperhidrosis, infections, malignancies, and ulcerations. Contact dermatitis represents one-third of the dermatoses in amputees wearing prostheses. All patients who are suspected of having ACD should be patch tested with standard allergen series as well as materials from the patient's own prosthesis, topical medicaments, moisturizers, and cosmetics. We report a patient with an ACD to mixed dialkyl thiourea present in the rubber parts of his below-the-knee prosthesis. Thiourea derivates are used as accelerators in the manufacture of chloroprene rubber and as fixatives in photography and photocopy paper. Allergy to thiourea is relatively uncommon; different studies have shown a prevalence of 0.7% up to 2.4% in patch-tested patients. Thiourea derivates are often the allergic sources in ACD involving high-grade rubber products made of neoprene such as diving suits, protective goggles, knee braces, and continuous positive airway pressure masks. They are also present in the rubber material of prostheses, as in the case of our patient.

  8. Malrotation of the McGhan Style 510 prosthesis.

    NARCIS (Netherlands)

    Schots, J.M.; Fechner, M.R.; Hoogbergen, M.M.; Tits, H.W.H.J.

    2010-01-01

    BACKGROUND: Anatomically shaped cohesive silicone breast implants are frequently used in aesthetic and reconstructive surgery. After successful results with the Style 410 prosthesis, McGhan (Natrelle, Allergan) introduced the Style 510 prosthesis. After using this novel prosthesis, the authors

  9. Effect of patellar strap and sports tape on jumper's knee symptoms : Protocol of a randomised controlled trial

    NARCIS (Netherlands)

    De Vries, Astrid J.; den Akker-Scheek, Inge van; Diercks, Ronald; Zwerver, Johannes; der Worp, Henk van

    2013-01-01

    INTRODUCTION: Patellar straps or sports tapes are commonly used by athletes with patellar tendinopathy in order to reduce pain and to continue sports participation. Currently, there is no scientific evidence for the effectiveness of a patellar strap or sports tape in the management of this common

  10. Characterising the proximal patellar tendon attachment and its relationship to skeletal maturity in adolescent ballet dancers

    DEFF Research Database (Denmark)

    Rudavsky, Aliza; Cook, Jillianne; Magnusson, Stig Peter

    2017-01-01

    Background: It is unknown how and when the proximal attachment of the patellar tendon matures; puberty may be key in ensuring normal tendon formation. The aim of this study was to investigate the features of the proximal patellar tendon attachment at different stages of skeletal maturity, to help...

  11. Feasibility and reliability of pain pressure threshold measurements in patellar tendinopathy

    NARCIS (Netherlands)

    van Wilgen, Paul; van der Noord, Robert; Zwerver, Johannes

    2011-01-01

    Patellar tendinopathy is a common and often difficult to treat overuse injury which is characterized by activity-related anterior knee and focal palpation tenderness of the patellar tendon. The clinical diagnosis is mainly based on clinical examination, in which the yardstick is a non-standardized

  12. Clinical and molecular characterisation of human syndromes with congenital patellar malformations

    NARCIS (Netherlands)

    Bongers, M.H.F.

    2006-01-01

    In this thesis the results are described of clinical and molecular investigation of human syndromes with congenital patellar malformations as a hallmark feature, with emphasis on nail patella syndrome, small patella syndrome, isolated patellar aplasia or hypoplasia, and Meier-Gorlin syndrome. The

  13. Joint line and patellar height restoration after revision total knee arthroplasty

    Directory of Open Access Journals (Sweden)

    Jong-Keun Seon

    2016-01-01

    Conclusions: JL position can be sufficiently restored with appropriate distal femoral augment reconstruction after revision TKA, but the patellar height cannot be well improved, especially in the septic revision with obvious PT contracture. No correlation was found between the JL position and patellar height to the knee function post revision TKA.

  14. An analysis of knee anatomic imaging factors associated with primary lateral patellar dislocations.

    Science.gov (United States)

    Arendt, Elizabeth A; England, Kristin; Agel, Julie; Tompkins, Marc A

    2017-10-01

    Various knee anatomic imaging factors have been historically associated with lateral patellar dislocation. The characterization of these anatomic factors in a primary lateral patellar dislocation population has not been well described. Our purpose was to characterize the spectrum of anatomic factors from slice imaging measurements specific to a population of primary lateral patellar dislocation. A secondary purpose was to stratify these data by sex/skeletal maturity to better detail potential dimorphic characteristics. Patients with a history of primary lateral patellar dislocation between 2008 and 2012 were prospectively identified. Ten MRI measurements were analysed with results stratified by sex/skeletal maturity. A '4-factor' analysis was performed to detail the number of 'excessive' anatomic factors within a single individual. This study involved 157 knees (79 M/78 F), and 107 patients were skeletally mature. The measurements demonstrate more anatomic risk factors in this population than historical controls. Patella height and trochlear measurements are the most common 'dysplastic' anatomic factors in this population. There were differences based on sex for some patellar height measurements and for TT-TG; there were no differences based on skeletal maturity. Primary lateral patellar dislocation patients have MRI measurements of knee anatomic factors that are generally more dysplastic than the normal population; however, there is a broad spectrum of anatomic features with no pattern predominating. Characterizing knee anatomic imaging factors in the patient with a primary lateral patellar dislocation is a necessary first step in characterizing the (potential) differences between the primary and recurrent patellar dislocation patient. IV.

  15. Atraumatic restorative technique: case report on dental management of a patient with Moebius syndrome.

    Science.gov (United States)

    Pradhan, A; Gryst, M

    2015-06-01

    Clinical challenges associated with Moebius syndrome, a rare congenital neuromuscular disorder, include orofacial anomalies like microstomia, limited mouth opening and severe gag reflex. This case report presents the dental management of an anxious female with Moebius syndrome. For restorations, atraumatic restorative technique (ART), using glass ionomer cement was used with hand instruments. All necessary dental treatment was completed in the dental chair, thus avoiding the need for a general anaesthetic, and associated complications with airway management due to orofacial abnormalities. ART is an appropriate technique for people with microstomia and/or limited mouth opening, such as those with Moebius syndrome. The application of ART can be extended to other special needs patients (people with physical and intellectual disabilities, extreme anxiety, needle phobia and the frail elderly in aged care facilities), where access or cooperation is difficult or limited. © 2015 Australian Dental Association.

  16. Atraumatic Restorative Treatment (ART) in pediatric dentistry residency programs: a survey of program directors.

    Science.gov (United States)

    Kateeb, Elham; Warren, John; Damiano, Peter; Momany, Elizabeth; Kanellis, Michael; Weber-Gasparoni, Karin; Ansley, Tim

    2013-01-01

    The purpose of this study was to investigate the extent of clinical training on atraumatic restorative treatment (ART) among pediatric dentistry residency programs and assess program directors' attitudes toward ART. All U.S. Pediatric Dentistry residency programs' directors were asked to complete a web-based survey. Sixty-one of the 76 directors (80 percent) completed the survey, with no significant response bias. Eighty-nine percent of the responding programs provided clinical instruction on ART. Of these, 30 percent provided ART training often/very often. ART was used mostly in single-surface cavities (43 percent) and as an interim treatment in primary teeth (57 percent). Factors associated with ART clinical training included not placing amalgams in primary teeth (Ppediatric dentistry residency programs in the United States. Residency directors' attitudes were highly predictive of the amount of clinical training provided, suggesting that directors need to be better informed about the use of ART.

  17. Surface roughness of glass ionomer cements indicated for atraumatic restorative treatment (ART).

    Science.gov (United States)

    da Silva, Renata Cristiane; Zuanon, Angela Cristina Cilense

    2006-01-01

    The purpose of this study was to evaluate the surface roughness of four conventional chemically cured glass ionomer cements (Fuji IX, Ketac Molar, Vidrion R and Vitromolar) commonly used in atraumatic restorative treatment (ART) immediately after material preparation. Twenty specimens of each glass ionomer cement were fabricated and surface roughness was measured after material setting. The specimens were further examined under scanning electron microscopy. Data were analyzed statistically by Kruskal-Wallis test and Mann-Whitney test at 5% significance level. Two-by-two comparisons showed statistically significant difference (pKetac Molar and Vidrion R, which had statically similar results (p>0.05). Regarding their results of surface roughness, the materials can be presented in a crescent order, as follows: Ketac Molar Ketac Molar and Vidrion R presented acceptable surface roughness after setting reaction while Vitromolar showed remarkably higher surface roughness.

  18. The Association Between Use of Brain CT for Atraumatic Headache and 30-Day Emergency Department Revisitation.

    Science.gov (United States)

    Patterson, Brian W; Pang, Peter S; AlKhawam, Lora; Hamedani, Azita G; Mendonca, Eneida A; Zhao, Ying-Qi; Venkatesh, Arjun K

    2016-12-01

    The purpose of this article is to describe the association between initial CT for atraumatic headache and repeat emergency department (ED) visitation within 30 days of ED discharge. A retrospective observational study was performed at an academic urban ED with more than 85,000 annual visits. All adult patients with a chief complaint of headache from January through December 2010 who were discharged after ED evaluation were included in the analysis. Patients were excluded if they were transferred, died in the ED, or had a diagnosis indicating a traumatic mechanism. A propensity score-matched logistic regression model was used to determine whether the use of brain CT was associated with the primary outcome of ED revisitation within 30 days, controlling for potential confounding variables. Of 80,619 total patient visits to the ED during the study period, 922 ED discharges with a chief complaint of headache were included. A total of 139 (15.1%) patients revisited within 30 days. The return rate was 11.2% among patients who underwent CT at their initial visit and 21.1% among those who did not. In the adjusted analysis, controlling for age, race, sex, insurance status, triage vital signs, laboratory values, and triage pain level, the odds ratio for revisitation given CT performance was 0.49 (95% CI, 0.27-0.86). After adjustment for clinical factors, we found that patients who underwent a brain CT examination for atraumatic headache at an initial ED visit were less likely to return to the ED within 30 days. Future appropriate use quality metrics regarding ED imaging use may need to incorporate downstream health care use.

  19. Comparative validation of the radiographic and tomographic measurement of patellar height

    Directory of Open Access Journals (Sweden)

    Marco Antonio Schueda

    2013-09-01

    Full Text Available OBJECTIVE: To evaluate and validate the radiographic measurement of patellar height with computerized tomography scans. METHODS: Measured the patellar height through the lateral radiographic image supported by one foot and sagittal tomographic view of the knee in extension, flexion of 20°, and quadriceps contraction of 40 patients (80 knees, asymptomatic and no history of knee injuries using Insall-Salvati index. There were 20 adult females and 20 adult males. RESULTS: The height patellar index was higher in women of all images taken, in proportion. There was no statistical difference of patellar height index between the radiographics and tomographics images. CONCLUSION: The Insall-Salvati index in females was higher in all cases evaluated. Furthermore, it is possible to measure the patellar height index during tomographic study without distorting the results obtained, using to define the presence of patella alta or patella baja.

  20. Patellar Tendon Rupture after Lateral Release without Predisposing Systemic Disease or Steroid Use

    Directory of Open Access Journals (Sweden)

    S. De Giorgi

    2015-01-01

    Full Text Available Arthroscopic technique for lateral release is the most widely used procedure for the correction of recurrent dislocations of the patella. In the relevant literature, several complications of lateral release are described, but the spontaneous patellar tendon rupture has never been suggested as a possible complication of this surgical procedure. Patellar tendon rupture is a rather infrequent and often unilateral lesion. Nevertheless, in case of systemic diseases (LES, rheumatoid arthritis, and chronic renal insufficiency that can weaken collagen structures, bilateral patellar tendon ruptures are described. We report a case of a 24-year-old girl with spontaneous rupture of patellar tendon who, at the age of 16, underwent an arthroscopic lateral release for recurrent dislocation of the patella. This is the first case of described spontaneous patellar tendon rupture that occurred some years after an arthroscopic lateral release.

  1. Re-revision of a patellar tendon rupture in a young professional martial arts athlete.

    Science.gov (United States)

    Vadalà, A; Iorio, R; Bonifazi, A M; Bolle, G; Ferretti, A

    2012-09-01

    A 27-year-old professional martial arts athlete experienced recurrent right knee patellar tendon rupture on three occasions. He underwent two operations for complete patellar tendon rupture: an end-to-end tenorrhaphy the first time, and revision with a bone-patellar-tendon (BPT) allograft. After the third episode, he was referred to our department, where we performed a surgical reconstruction with the use of hamstring pro-patellar tendon, in a figure-of-eight configuration, followed by a careful rehabilitation protocol. Clinical and radiological follow-ups were realized at 1, 3, and 6 months and 1 and 2 years postop, with an accurate physical examination, the use of recognized international outcome scores, and radiograph and MRI studies. As far as we know, this is the first paper to report a re-revision of a patellar tendon rupture.

  2. Complications of medial patellofemoral ligament reconstruction using two transverse patellar tunnels.

    Science.gov (United States)

    Schiphouwer, Loes; Rood, Akkie; Tigchelaar, Siebren; Koëter, Sander

    2017-01-01

    The aim of this study was to report the complication rate after a medial patellofemoral ligament (MPFL) reconstruction using transverse patellar tunnels in a retrospective case series performed in a single institution. Case series of 179 patients (192 knees) that had an MPFL reconstruction, with or without additional bony realignment procedures, between January 2009 and March 2015. Data were obtained from available patient charts. Thirty-nine complications (20.3 %) were registered. Twenty-seven of these (14.7 %) were minor. Seven patients (3.6 %) sustained a patellar fracture without adequate trauma. Male gender was a risk factor for patellar fracture (p tunnel MPFL reconstruction are described. The use of transverse patellar tunnels increases the risk of sustaining a patellar fracture. IV.

  3. Patellar subluxation syndrome. Observation of the patellofemoral joint using CT-scan

    Energy Technology Data Exchange (ETDEWEB)

    Yagi, Tomonori; Sasaki, Tetsuto; Susuda, Koichi; Moji, Junichi (Hokkaido Univ., Sapporo (Japan). School of Medicine)

    1983-10-01

    Clinical symptoms of patellar subluxation syndrome associated with pain were investigated for 24 knees of 20 patients, and the state of patella dislocation was observed by CT-scan. The patients had high incidence of an apprehension sign, showing their fear of patellar luxation. Many of them complained of patello-femoral joint pain due to chondromalacia patellae. In order to derive patellar subluxation, the method of CT-Q-contraction was carried out at the extended position of the patellar joint. In patients with patellar subluxation syndrome, the rate of shift in the diseased side was significantly higher than that of the other side, suggesting decreased muscular strength of the musculus vastus of the diseased side. Improvement of the symptoms was seen in all except one of 12 knees operated by the combined method of Green's method with Blauth's more than 6 months before. Availability of this operation was verified by the CT-Q-contraction.

  4. Survival rate of Atraumatic Restorative Treatment (ART) restorations using a glass ionomer bilayer technique with a nanofilled coating: a bi-center randomized clinical trial

    NARCIS (Netherlands)

    Hesse, D.; Bonifácio, C.C.; Bönecker, M.; A.B. Guglielmi, C. de; da Franca, C.; van Amerongen, W.E.; Colares, V.; Raggio, D.P.

    2016-01-01

    Purpose: The high-viscosity consistency of glass ionomer cement (GIC) contributes to its inappropriate adaptation, while the material's premature exposure to humidity decreases its mechanical properties. This study's purposes were to: (1) investigate approximal atraumatic restorative treatment (ART)

  5. Bicomponent ultrashort echo time T2* analysis for assessment of patients with patellar tendinopathy.

    Science.gov (United States)

    Kijowski, Richard; Wilson, John J; Liu, Fang

    2017-11-01

    To compare bicomponent ultrashort echo time (UTE) T2* parameters of patellar tendon between healthy volunteers and patients with patellar tendinopathy. This study was performed with Institutional Review Board approval and with all subjects signing informed consent. A UTE- T2* mapping sequence was performed at 3.0T on the knees of 10 healthy volunteers and in 11 patients with patellar tendinopathy. The UTE- T2* relaxation times of the fast relaxing macromolecular bound water component ( T2*F) and the slow relaxing bulk water component ( T2*S) and the fraction of the fast relaxing macromolecular bound water component (F F ) of patellar tendon were measured in all subjects. Wilcoxon rank-sum tests were used to compare UTE- T2* parameters between healthy volunteers and patients with patellar tendinopathy. Mean T2*F, T2*S, and F F of the patellar tendon was 1.5 msec, 23.1 msec, and 79.5%, respectively, for healthy volunteers and 1.9 msec, 22.3 msec, and 75.5%, respectively, for patients with patellar tendinopathy. There were statistically significant differences between groups of subjects for T2*F (P = 0.01) and F F (P = 0.007) but not T2*S (P = 0.10) of the patellar tendon. Patients with patellar tendinopathy had significantly higher T2*F and significantly lower F F of patellar tendon than healthy volunteers, which suggests that bicomponent UTE- T2* parameters can detect changes in the composition and microstructure of degenerative tendon. 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017;46:1441-1447. © 2017 International Society for Magnetic Resonance in Medicine.

  6. Atraumatic Occult Odontoid Fracture in Patients with Osteoporosis-Associated Thoracic Kyphotic Deformity: Report of a Case and Review of the Literature

    OpenAIRE

    Mori, Kanji; Nishizawa, Kazuya; Nakamura, Akira; Imai, Shinji

    2015-01-01

    Anderson type II odontoid fractures are reported to be the most common injury of the odontoid process in patients over the age of 65. However, atraumatic occult Anderson type III odontoid fractures have been rarely described and remain a diagnostic challenge. In the present report, we illustrate a 78-year-old female with osteoporosis-associated marked thoracic kyphotic deformity who developed atraumatic Anderson type III occult odontoid fracture and raise awareness of this condition. Anterop...

  7. A magnetic resonance imaging study of abnormalities of the patella and patellar tendon that predispose children to acute patellofemoral dislocation.

    Science.gov (United States)

    Yılmaz, Barış; Çiçek, Esin Derin; Şirin, Evrim; Özdemir, Güzelali; Karakuş, Özgün; Muratlı, Hasan Hilmi

    This study compared 20 children hospitalised with acute patellofemoral dislocation with an age-matched healthy control group with no history of knee problems or patellar dislocation. The following morphological parameters were significantly different between the groups: the mean patellar width and length, mean sulcus depth, mean patellar tendon width and total patellar volume. The magnetic resonance imaging findings of this study suggested that structurally smaller than normal patella and patellar tendon volumes are predisposing factors for acute patellofemoral dislocation. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Prosthesis infections after orthopedic joint replacement

    DEFF Research Database (Denmark)

    Song, Zhijun; Borgwardt, Lotte; Høiby, Niels

    2013-01-01

    Prosthesis-related infection is a serious complication for patients after orthopedic joint replacement, which is currently difficult to treat with antibiotic therapy. Consequently, in most cases, removal of the infected prosthesis is the only solution to cure the infection. It is, therefore...

  9. Implant complications and failures: the fixed prosthesis.

    Science.gov (United States)

    Tinsley, D; Watson, C J; Preston, A J

    2002-11-01

    The implant-retained fixed prosthesis has been advocated as an effective restoration offering significant benefits over conventional prosthetics. The success of treatment depends on careful pre-surgical planning and prosthesis design. This paper outlines some common complications encountered during the planning, fabrication and maintenance of both large and small fixed prostheses and suggests how these complications can be minimized.

  10. BIORESORBABLE POLYMERIC MENISCAL PROSTHESIS: STUDY IN RABBITS

    Science.gov (United States)

    Cardoso, Tulio Pereira; de Rezende Duek, Eliana Aparecida; Amatuzzi, Marco Martins; Caetano, Edie Benedito

    2015-01-01

    Objective: To induce growth of a neomeniscus into the pores of a prosthesis in order to protect the knee joint cartilage. Methods: 70 knees of 35 New Zealand rabbits were operated. The rabbits were five to seven months old, weighed 2 to 3.8 kilograms, and 22 were male and 13 were female. Each animal underwent medial meniscectomy in both knees during a single operation. A bioabsorbable polymeric meniscal prosthesis composed of 70% polydioxanone and 30% L-lactic acid polymer was implanted in one side. The animals were sacrificed after different postoperative time intervals. The femoral condyles and neomeniscus were subjected to histological analysis. Histograms were used to measure the degradation and absorption of the prosthesis, the growth of meniscal tissue in the prosthesis and the degree of degradation of the femoral condyle joint cartilage. Results: The data obtained showed that tissue growth histologically resembling a normal meniscus occurred, with gradual absorption of the prosthesis, and the percentages of chondrocytes on the control side and prosthesis side. Conclusion: Tissue growth into the prosthesis pores that histologically resembled the normal rabbit meniscus was observed. The joint cartilage of the femoral condyles on the prosthesis side presented greater numbers of chondrocytes in all its layers. PMID:27022549

  11. Nasal prosthesis rehabilitation: a case report

    DEFF Research Database (Denmark)

    Jain, Sumeet; Maru, Kavita; Shukla, Jyotsana

    2011-01-01

    Facial defects resulting from neoplasm, congenital malformation or trauma can be restored with facial prosthesis using different materials and retention methods to achieve life-like look and function. A nasal prosthesis can re-establish esthetic form and anatomic contours for mid-facial defects, ...... a spectacle glass frame without inserting craniofacial implants....

  12. Outcome measures of bipolar hip arthroplasty for atraumatic hip disorders - A preliminary report

    Directory of Open Access Journals (Sweden)

    Dudani Baldev

    2005-01-01

    Full Text Available Background: Bipolar hip arthroplasty was devised for fracture neck femur in elderly patients. Subsequently, indications have been expanded to include conditions affecting acetabulum like rheumatoid arthritis, osteoarthritis and avascular necrosis of femoral head. Materials and methods: We have studied the results of bipolar hip arthroplasty in 38 such patients, with severely involved acetabulum due to rheumatoid arthritis, avascular necrosis of femoral head and primary osteoarthritis. Acetabulum was reamed to get a tight ′equatorial′ or ′rim′ fit of the prosthesis. Prosthesis selected was 1 mm bigger than the maximum size of reamer used. Cement was used in femur whenever there was marked osteoporosis or wide medullary canal. Post operatively all patients were regularly screened for pain, range of movement, protrusio acetabuli, loosening / sinking of prosthesis and radiographic assessment of movement in the two bearings of prosthesis. Results: Overall results achieved were good to excellent in 80% of patients. Conclusions: The ultimate outcome is comparable to total hip arthroplasty. The added advantage is of low cost, simplicity of procedure and easy future revision.

  13. Patellar taping for patellofemoral pain syndrome in adults.

    Science.gov (United States)

    Callaghan, Michael J; Selfe, James

    2012-04-18

    Patellofemoral pain syndrome refers to the clinical presentation of knee pain related to changes in the patellofemoral joint. Patellofemoral pain syndrome usually has a gradual onset of pain with none of the features associated with other knee diseases or trauma. It is often treated by physiotherapists, who use a variety of techniques including patellar taping. This involves the application of adhesive sports medical tape applied directly to the skin over the patella on the front of the knee. Patients often report an instantaneous improvement in pain and function after the tape is applied, but its longer term effects are uncertain. The objective was to assess the effects, primarily on pain and function, of patellar taping for treating patellofemoral pain syndrome in adults. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE, CINAHL, EMBASE, PEDro, SPORTDiscus, AMED, reference lists of articles, trial registers and conference proceedings. All were searched to August 2011. Randomised controlled trials and quasi-randomised controlled trials testing the effects of patellar taping on clinically relevant outcomes, pain and function, in adults with patellofemoral pain syndrome. We excluded studies testing only the immediate effects of tape application. Both review authors independently performed study selection, data extraction and assessment of risk of bias. Trialists were contacted for more information. Data were pooled where possible. Five small heterogeneous randomised controlled trials, all at high risk of performance bias and most at risk of at least one other type of bias, were included. These involved approximately 200 participants with a diagnosis of patellofemoral pain syndrome. All compared taping versus control (no or placebo taping) and all included one or more co-interventions given to both taping and control group participants; this was prescribed exercise in four

  14. Chondromalacia induced by patellar subluxation in the rabbit

    DEFF Research Database (Denmark)

    Møller, B.N.; Møller-Larsen, F.; Frich, Lars Henrik

    1989-01-01

    A unilateral patellar malalignment was induced in 20 young and 20 mature rabbits by lateral displacement of the tibial tuberosity, the other knee serving as osteotomized in situ control. At 6 weeks, all the knees appeared macroscopically normal, but histologically definite cartilage degeneration...... was found on the experimental side. At 3 months, macroscopic changes occurred in 5 of 10 mature rabbits, and histologic cartilage degeneration was found in all the experimental knees, most pronounced in mature animals, and particularly in joint facets submitted to high pressure. This experimental model...

  15. Patellofemoral Arthritis After Lateral Patellar Dislocation: A Matched Population-Based Analysis.

    Science.gov (United States)

    Sanders, Thomas L; Pareek, Ayoosh; Johnson, Nicholas R; Stuart, Michael J; Dahm, Diane L; Krych, Aaron J

    2017-04-01

    The rate of patellofemoral arthritis after lateral patellar dislocation is unknown. Purpose/Hypothesis: The purpose of this study was to compare the risk of patellofemoral arthritis and knee arthroplasty between patients who experienced a lateral patellar dislocation and matched individuals without a patellar dislocation. Additionally, factors predictive of arthritis after patellar dislocation were examined. The hypothesis was that the rate of arthritis is likely higher among patients who experience a patellar dislocation compared with those who do not. Cohort study; Level of evidence, 3. In this study, 609 patients who had a first-time lateral patellar dislocation between 1990 and 2010 were compared with an age- and sex-matched cohort of patients who did not have a patellar dislocation. Medical records were reviewed to collect information related to the initial injury, recurrent dislocation, treatment, and progression to clinically significant patellofemoral arthritis (defined as symptoms with degenerative changes on patellar sunrise radiographs). Factors associated with arthritis (age, sex, recurrence, osteochondral injury, trochlear dysplasia) were examined. At a mean follow-up of 12.3 ± 6.5 years from initial dislocation, 58 patients (9.5%) in the dislocation cohort were diagnosed with patellofemoral arthritis, corresponding to a cumulative incidence of arthritis of 1.2% at 5 years, 2.7% at 10 years, 8.1% at 15 years, 14.8% at 20 years, and 48.9% at 25 years. In the control cohort, 8 patients (1.3%) were diagnosed with arthritis, corresponding to a cumulative incidence of arthritis of 0% at 5 years, 0% at 10 years, 1.3% at 15 years, 2.9% at 20 years, and 8.3% at 25 years. Therefore, patients who experienced a lateral patellar dislocation had a significantly higher risk of developing arthritis (hazard ratio [HR], 7.8; 95% CI, 3.9-17.6; P arthritis after patellar dislocation. Patellar dislocation is a significant risk factor for patellofemoral arthritis, as

  16. Compromised Cardiopulmonary Exercise Capacity in Patients Early After Endoscopic Atraumatic Coronary Artery Bypass Graft: Implications for Rehabilitation

    OpenAIRE

    Hansen, Dominique; Roijackers, Ruben; Jackmaert, Lore; Robic, Boris; Hendrikx, Marc; Yilmaz, Alaaddin; Frederix, Ines; Rosseel, Michael; Dendale, Paul

    2016-01-01

    Objective: The purpose of this work was to test the hypothesis that cardiopulmonary exercise tolerance is better preserved early after endoscopic atraumatic coronary artery bypass graft (endo-ACAB) surgery versus coronary artery bypass graft (CABG) surgery. Design: Twenty endo-ACAB surgery patients, 20 CABG surgery patients, and 15 healthy subjects executed a maximal cardiopulmonary exercise test, with assessment and comparison of cycling power output, O2 uptake, CO2 output, respiratory ...

  17. Decline eccentric squats increases patellar tendon loading compared to standard eccentric squats.

    Science.gov (United States)

    Kongsgaard, M; Aagaard, P; Roikjaer, S; Olsen, D; Jensen, M; Langberg, H; Magnusson, S P

    2006-08-01

    Recent studies have shown excellent clinical results using eccentric squat training on a 25 degrees decline board to treat patellar tendinopathy. It remains unknown why therapeutic management of patellar tendinopathy using decline eccentric squats offer superior clinical efficacy compared to standard horizontal eccentric squats. This study aimed to compare electromyography activity, patellar tendon strain and joint angle kinematics during standard and decline eccentric squats. Thirteen subjects performed unilateral eccentric squats on flat-and a 25 degrees decline surface. During the squats, electromyography activity was obtained in eight representative muscles. Also, ankle, knee and hip joint goniometry was obtained. Additionally, patellar tendon strain was measured in vivo using ultrasonography as subjects maintained a unilateral isometric 90 degrees knee angle squat position on either flat or 25 degrees decline surface. Patellar tendon strain was significantly greater (Pcompared to the standard surface. The stop angles of the ankle and hip joints were significantly smaller during the decline compared to the standard squats (Pcompared to the standard squats (Pstandard and decline squats. The use of a 25 degrees decline board increases the load and the strain of the patellar tendon during unilateral eccentric squats. This finding likely explains previous reports of superior clinical efficacy of decline eccentric squats in the rehabilitative management of patellar tendinopathy.

  18. Concomitant posterior cruciate ligament injuries with direct injury-related patellar fractures.

    Science.gov (United States)

    Yoon, Yong-Cheol; Jeon, Sung-Soo; Sim, Jae-Ang; Kim, Byung-Kag; Lee, Beom-Koo

    2016-06-01

    Posterior cruciate ligament (PCL) injuries and direct injury-related patellar fractures have similar causative factors. However, the mechanisms underlying these injuries differ. We aimed to evaluate the incidence and relationship between PCL injuries and direct injury-related patellar fractures. Of the 195 patients diagnosed with a patellar fracture at our clinic during 2007-2011, 104 required surgical treatment and underwent the posterior drawer test under general anesthesia and magnetic resonance imaging. We assessed whether the causes of trauma, fracture classification, compression of the fracture fragment, and fracture displacement were related to the incidence of PCL injuries. Of the 104 patients, 26 had concomitant PCL injuries with direct injury-related patellar fractures. Most of the PCL injuries were grades 1 and 2, observed in 14 and 9 patients, respectively. Among three patients with grade 3 PCL injury, only two required PCL reconstruction. No significant relationship was observed between the causes of trauma and the incidence of PCL injury. According to the fracture classification, lower pole and comminuted fractures were associated with higher incidence rates of PCL injury than transverse and vertical fractures. Compressed and displaced patellar fractures were also associated with higher incidence rates of PCL injury. Although a PCL injury requiring surgical intervention was extremely rare, 25 % patients who required surgery for patellar fractures presented with a PCL injury. The incidence of a PCL injury was higher in the lower pole, comminuted, displaced, and compressed patellar fractures.

  19. A case of patellar fractures in monozygotic twin gymnasts

    Directory of Open Access Journals (Sweden)

    Beamish Andrew J

    2012-06-01

    Full Text Available Abstract We present a case of near identical patellar fractures in adolescent monozygotic twins who are both high-level competitive gymnasts. These patients presented 14 months apart with almost identical history and clinical findings. Both had an intense training regime involving over 30 hours per week of load-bearing exercise. Clinical and radiological examinations suggested avulsion or sleeve fracture of the inferior pole of the patella with minimal displacement. Diagnoses of patellar stress fracture with avulsion of the distal pole and symptomatic bipartite patella could not be reliably excluded. Both fractures were treated conservatively with immobilisation of the knee in extension. An excellent functional result was observed in both patients with return to full activity at 8 weeks. This is the first published case of identical injury to the patella in monozygotic twins. A significant genetic influence on bone mineral density (BMD has been reported and low BMD is associated with increased susceptibility to fracture. These injuries corroborate a genetic influence on susceptibility to fracture. There is a requirement for further work to investigate genetic factors influencing susceptibility to fracture.

  20. Causative factors and rehabilitation of patellar tendinopathy: A systematic review

    Directory of Open Access Journals (Sweden)

    Sanell Morgan

    2016-02-01

    Full Text Available Background: Patellar tendinopathy (PT is a common chronic pathology of the knee, with a high prevalence in athletes and the general population.Objectives: The objectives of this article were to systematically investigate all the evidence applicable to the intrinsic and extrinsic causative factors and rehabilitation of PT, and then integrate and link rehabilitation with the main causative factors identified.Method: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Various tools were used to evaluate the methodological quality of the eligible articles. Data were interpreted descriptively, and the causative factors and rehabilitation of PT were analysed.Results: Twenty studies were included in the review. The distinctive factor responsible for PT is the mechanical theory. Seven intrinsic and four extrinsic risk factors were identified, with the main intrinsic risk factors being muscle flexibility and strength, and extrinsic risk factors being acquisition and level of skills. PT can be treated with numerous different therapeutic modalities, although eccentric muscle training showed exceptional results. The intrinsic and extrinsic risk factors can only be transformed and reduced by rehabilitation, which is inevitable to improve PT pain and function.Conclusion: The essence of an integrated management protocol for PT is to identify the dominant contributing factors, whether intrinsic or extrinsic, and to reduce the load on the patellar tendon by modifying these factors by either rehabilitation intervention or direct modification of the equipment or environment to obtain a positive outcome towards pain management and function.

  1. Avulsion fracture of an ossified pes anserinus tendon post-lateral patellar dislocation.

    Science.gov (United States)

    Albtoush, Omar M; Taib, Abtehag A; Horger, Marius; Springer, Fabian

    2017-11-23

    The pes anserinus is a common tendon comprising the tendinous insertions of the sartorius, gracilis, and semitendinosus muscles. It inserts at the anteromedial aspect of the tibia and plays a significant role in stabilization of the medial side of the knee joint. The current article presents a case with recurrent lateral patellar dislocations causing chronic stress along the medial knee stabilizers and consecutive enthesophyte formation at the insertion of the pes anserinus tendon that showed a transverse fracture upon a subsequent incident of traumatic lateral patellar dislocation. Avulsion injuries of the pes anserinus tendon are rarely encountered, and to our knowledge, association with recurrent lateral patellar dislocations has not been described before.

  2. Patellar tendon donor-site healing during six and twelve months after Anterior Cruciate Ligament Reconstruction.

    Science.gov (United States)

    Yazdanshenas, Hamed; Madadi, Firooz; Madadi, Firoozeh; Washington, Eleby Rudolph; Jones, Kristofer; Shamie, Arya Nick

    2015-12-01

    Bone-Patellar Tendon-Bone Graft is one of the most acceptable methods of treatment for Anterior Cruciate Ligament rupture (ACL). This study evaluates the recovery process of the graft donor site. This study evaluates the graft donor site recovery in 23 patients with ACL reconstruction, 6 and 12 months after the patellar tendon graft surgery. In 70 percent of the cases, the healing process was completed after 6 months and the remaining 30 percent recovered after 12 months. Time is an important factor in the recovery process of the patellar tendon for reconstruction of the ACL.

  3. Five patellar proximodistal positioning indices compared in clinically normal Greenland sled dogs

    DEFF Research Database (Denmark)

    Miles, James E; Dickow, Marlene; Nielsen, Dorte H

    2012-01-01

    Patellar luxation in large-breed dogs is associated with abnormal proximodistal patellar positioning. Using a clinically normal population of Greenland sled dogs, measurement reliability and the effect of limb position were compared for five patellar proximodistal positioning indices based...... on the Insall-Salvati (IS), modified Insall-Salvati (mIS), de Carvalho (dC), patellotrochlear (PT) and Blackburne-Peel (BP) indices. Indices were measured at one knee angle in 44 dogs and two knee angles in 10 dogs. Index susceptibility to error was modelled for different errors in knee angle estimation. Two...

  4. Combined rupture of the patellar tendon, anterior cruciate ligament and lateral.

    Science.gov (United States)

    Tsarouhas, A; Iosifidis, M; Kotzamitelos, D; Traios, S

    2011-04-01

    Simultaneous rupture of both the patellar tendon and the anterior cruciate ligament is a relatively rare injury. Its diagnosis can easily be missed during the initial examination. Treatment options include immediate repair of the patellar tendon with either simultaneous or delayed reconstruction of the ACL. We present the case of a combined rupture of the patellar tendon, the anterior cruciate ligament and the lateral meniscus in a 38-year old recreational martial arts athlete after a direct kick on his left knee. A two-stage treatment approach was performed with an excellent functional outcome.

  5. Followup of a Dog with an Intraocular Silicone Prosthesis Combined with an Extraocular Glass Prosthesis

    Directory of Open Access Journals (Sweden)

    Gwendolyna Romkes

    2012-01-01

    Full Text Available Because of unpredictable corneal changes, evisceration and implantation of a silicone prosthesis does not always lead to a satisfying cosmetic result. This paper describes the use of an intraocular silicone prosthesis in combination with an extraocular glass prosthesis and shows a followup of two and a half years in a nonexperimental study. An intraocular silicone prosthesis was implanted after evisceration of the left eye in a five-month-old Bernese mountain dog. A glass prosthesis was fitted four weeks after evisceration. Two and a half years after the operation, the dog is in good health and free of medication. No short-term or long-term complications were seen. The owners do not have trouble with handling the glass prosthesis. The combination of both prostheses shows a perfect solution to retrieve a normal looking and moving eye after evisceration.

  6. Stretch due to Penile Prosthesis Reservoir Migration

    Directory of Open Access Journals (Sweden)

    E. Baten

    2016-03-01

    Full Text Available A 43-year old patient presented to the emergency department with stretch, due to impossible deflation of the penile prosthesis, 4 years after successful implant. A CT-scan showed migration of the reservoir to the left rectus abdominis muscle. Refilling of the reservoir was inhibited by muscular compression, causing stretch. Removal and replacement of the reservoir was performed, after which the prosthesis was well-functioning again. Migration of the penile prosthesis reservoir is extremely rare but can cause several complications, such as stretch.

  7. Unilateral Atraumatic Expulsion of an Ectopic Pregnancy in a Case of Bilateral Ectopic Pregnancy.

    Science.gov (United States)

    Sampson, Victoria; Mogekwu, Oluremi; Ahmed, Ammar; Bano, Farida

    2017-01-01

    Ectopic pregnancy occurs in 1-2% of pregnancies. The fallopian tube is the most common site; however, bilateral tubal ectopic pregnancy is an extremely rare phenomenon, seen in approximately 1/200,000 pregnancies. It is usually the result of assisted reproductive techniques (ART). Ultrasound (USS) and serial beta-hCG levels have shown poor efficacy for accurate diagnosis. Laparoscopy is the diagnostic gold standard. The majority of cases are managed surgically with bilateral salpingectomy. A 26-year-old female presented to our early pregnancy unit with pain and vaginal bleeding at 5-week gestation after IVF. USS was inconclusive and her b-hCG levels rose with worsening pain; therefore, a decision was made for diagnostic laparoscopy. Although there was a clear right sided ectopic pregnancy, the left tube was swollen and therefore a methylene blue dye test was carried out to confirm blockage. Atraumatic milking, to expose the dye, expelled necrotic tissue which histology confirmed to be a second ectopic pregnancy. She made a good recovery with falling beta-hCG levels and left tubal preservation. As the use of ART increases, bilateral ectopic pregnancies will become more common. Novel and established techniques should be used to help confirm the diagnosis and assist in tubal preservation.

  8. Acceptance and discomfort from atraumatic restorative treatment in secondary school students in Egypt.

    Science.gov (United States)

    Farag, A; Frencken, J E

    2009-01-01

    To assess the level of acceptance and discomfort experienced by secondary school students when undergoing an atraumatic restorative treatment (ART) restoration. Ninety secondary school students, aged 14 and 15 years, were included in the study. The ART restorations were prepared in 90 cavities and restored using an encapsulated high-viscosity glass ionomer. The depth of the cavities was judged from radiographs and clinically into outer, middle and inner third of dentine. Using a graded periodontal probe, cavity size was measured, into approximately half the width of the mesiodistal and buccolingual/palatal distance of the occlusal surface. The students were asked about the level of sensation experienced during cavity preparation immediately after completion of restoration. chi(2)-Test was used to test the effect of cavity depth and size on sensitivity from the teeth. Of the 90 students, 6 (6.6%) and 26 (29.2%) experienced pain and discomfort, respectively, during cavity preparation, more often in large than in small cavities (p = 0.003) and in cavities extending into the inner third than in the middle and outer third of dentine (p ART approach to treat dental cavities was well accepted by this group of secondary school students. Only a few reported pain during cavity instrumentation, and this was more prevalent in large cavities and in cavities with the floor close to the pulp. Copyright 2008 S. Karger AG, Basel.

  9. Unilateral Atraumatic Expulsion of an Ectopic Pregnancy in a Case of Bilateral Ectopic Pregnancy

    Directory of Open Access Journals (Sweden)

    Victoria Sampson

    2017-01-01

    Full Text Available Ectopic pregnancy occurs in 1-2% of pregnancies. The fallopian tube is the most common site; however, bilateral tubal ectopic pregnancy is an extremely rare phenomenon, seen in approximately 1/200,000 pregnancies. It is usually the result of assisted reproductive techniques (ART. Ultrasound (USS and serial beta-hCG levels have shown poor efficacy for accurate diagnosis. Laparoscopy is the diagnostic gold standard. The majority of cases are managed surgically with bilateral salpingectomy. A 26-year-old female presented to our early pregnancy unit with pain and vaginal bleeding at 5-week gestation after IVF. USS was inconclusive and her b-hCG levels rose with worsening pain; therefore, a decision was made for diagnostic laparoscopy. Although there was a clear right sided ectopic pregnancy, the left tube was swollen and therefore a methylene blue dye test was carried out to confirm blockage. Atraumatic milking, to expose the dye, expelled necrotic tissue which histology confirmed to be a second ectopic pregnancy. She made a good recovery with falling beta-hCG levels and left tubal preservation. As the use of ART increases, bilateral ectopic pregnancies will become more common. Novel and established techniques should be used to help confirm the diagnosis and assist in tubal preservation.

  10. Microbiological assessment of saliva from children subsequent to atraumatic restorative treatment (ART).

    Science.gov (United States)

    Carvalho, C K S; Bezerra, A C B

    2003-05-01

    The aim of this study was to evaluate mutans streptococci (MS) in the saliva following use of the atraumatic restorative treatment (ART) technique. Sixteen 5-7-year-old children had restorations using the ART technique and employing FUJI IX glass-ionomer cement as the restorative material. Decayed tissue was manually excavated without local anaesthesia, being careful to avoid discomfort. Saliva was collected for microbiological assessment using Kit Caritest MS before treatment, one week, four weeks and one year after ART was used. The procedure for saliva collection, incubation, storage, and comparative reading of MS counts followed the manufacturer's instructions. The data were statistically analysed, using non-parametric tests (Wilcoxon Signed Ranks and Sign Test) at a significance level of 0.05. The results showed a significant reduction of MS levels in saliva when comparing the results before treatment with those obtained one week (95.95%; P = 0.003), four weeks (93.27%; P = 0.000) and one year (95.56%; P = 0.002) after ART. It is concluded from the results that the ART technique proved satisfactory and appeared to have produced a significant and sustained reduction in levels of MS. These results need to be confirmed in a larger study.

  11. Selection of restorative materials for the atraumatic restorative treatment (ART) approach: a review.

    Science.gov (United States)

    Yip, H K; Smales, R J; Ngo, H C; Tay, F R; Chu, F C

    2001-01-01

    The atraumatic restorative treatment (ART) technique or approach for the restoration of primary and permanent teeth has been widely adopted in, but not limited to, developing countries. However, the requirement for the placement of the restorative materials under often less-than-ideal conditions imposes significant restrictions on their selection; and there have been very few randomized clinical trials or reports comparing different types of restorative materials and treatments. Although conventional glass-ionomer cements (GICs) have relatively poor mechanical and adhesive strengths, their satisfactory biological features, ease of use, and low costs are distinct advantages. Most of the published reports of the clinical performance of the newer, high-strength esthetic conventional GICs specifically marketed for the ART approach have been from short-term studies. Satisfactory clinical performance has been demonstrated for single-surface posterior restorations only, over three years. Findings indicate that further improvements in restorative materials are still required for their use with the ART approach, together with further clinical investigations of the remineralization of shallow open caries lesions, as an alternative to placing definitive restorations.

  12. The atraumatic restorative treatment (ART) approach for primary teeth: review of literature.

    Science.gov (United States)

    Smales, R J; Yip, H K

    2000-01-01

    There is widespread interest in and increasing usage of the atraumatic restorative treatment (ART) technique or approach for the restoration of primary teeth, especially in developing countries. However, most of the published reports of the clinical performance of newer, more-viscous esthetic conventional glass ionomer restorative cements marketed for the technique have been from short-term studies, and there have been very few reports comparing different types of restorative materials and methods of cavity preparation. After 12 months, Class II/multisurface and Class III/IV ART restorations have generally shown success rates of approximately 55-75% and 35-55%, respectively. Failures were usually from restoration losses and fractures. Class I & V/single-surface ART restorations have had much better short-term success rates of approximately 80-90%. Recurrent caries was not a concern at this time, but occlusal wear was relatively high. Further improvements in the mechanical and adhesive properties of the newer cements are still required, together with further clinical investigations of the remineralization of shallow open preparations as an alternative to placing restorations. The ART approach is readily accepted by children and has resulted in the retention of many teeth that would otherwise have been extracted.

  13. Subclinical Partial Attritional Rupture of the Flexor Digitorum Profundus as an Etiology of Atraumatic Trigger Finger

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    D. Anthony Bastian

    2017-01-01

    Full Text Available Background. Trigger finger is a relatively common clinical entity. The etiology is most often attributable to stenosing tenosynovitis though traumatic cases have been described. When trigger finger is associated with an underlying flexor tendon rupture, previous cases have reported a clear association with overt laceration or previous trauma. Methods. We present the case of a 23-year-old male active duty military service member who presented with a characteristic history and clinical exam consistent with trigger finger. The symptomatic onset was gradual, with no history of inciting trauma. Results. Given symptomatic persistent triggering following failure of conservative management to include cortisone injections, the patient was taken for open A1 pulley release. Intraoperatively, the triggering was found to be attributable to a partial attritional rupture of the small finger flexor digitorum profundus tendon. Tendon debridement, tubularization, and A1 and partial A2 pulley releases were performed with subsequent resolution of triggering. Conclusion. We present the rare case of subclinical atraumatic attritional rupture of the FDP tendon to the small finger as a cause of clinically apparent trigger finger. This is an important consideration as the hand surgeon must be prepared to address more atypical pathologies.

  14. Mechanical performance of encapsulated restorative glass-ionomer cements for use with Atraumatic Restorative Treatment (ART

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    Gustavo Fabian MOLINA

    2013-06-01

    Full Text Available The Atraumatic Restorative Treatment (ART approach was suggested to be a suitable method to treat enamel and dentine carious lesions in patients with disabilities. The use of a restorative glass-ionomer with optimal mechanical properties is, therefore, very important. Objective To test the null-hypotheses that no difference in diametral tensile, compressive and flexural strengths exists between: (1 The EQUIA system and (2 The Chemfil Rock (encapsulated glass-ionomers; test materials and the Fuji 9 Gold Label and the Ketac Molar Easymix (hand-mixed conventional glass-ionomers; control materials; (3 The EQUIA system and Chemfil Rock. Material and Methods Specimens for testing flexural (n = 240 and diametral tensile (n=80 strengths were prepared according to standardized specifications; the compressive strength (n=80 was measured using a tooth-model of a class II ART restoration. ANOVA and Tukey B tests were used to test for significant differences between dependent and independent variables. Results The EQUIA system and Chemfil Rock had significantly higher mean scores for all the three strength variables than the Fuji 9 Gold Label and Ketac Molar Easymix (α=0.05. The EQUIA system had significant higher mean scores for diametral tensile and flexural strengths than the Chemfil Rock (α=0.05. Conclusion The two encapsulated high-viscosity glass-ionomers had significantly higher test values for diametral tensile, flexural and compressive strengths than the commonly used hand-mixed high-viscosity glass-ionomers.

  15. The effect of atraumatic restorative treatment on adhesive restorations for dental caries in deciduous molars

    Directory of Open Access Journals (Sweden)

    Eliane Batista de Medeiros Serpa

    2017-01-01

    Full Text Available Background: Minimal invasive approaches to managing caries, such as partial caries removal techniques and atraumatic restorative treatment (ART, are showing increasing evidence of improved outcomes over the conventional complete caries removal. Objective: To evaluate clinically and radiographically the effect of ART on restorations using restorative cement and glass ionomer cement (GIC for dental caries in the deciduous molars of children aged between 4 and 8 years. Settings and Design: The study design was a split-mouth, randomized, blind clinical trial. Materials and Methods: Eighty-six patients had 108 restorations placed with GIC (Ketac Molar Easy Mix – 3M ESPE and 108 restorations placed with composite resin (CR (Filtek Z250 – 3M ESPE. The restorations were assessed by means of images obtained with a digital camera and periapical radiographs at baseline and after 12 months of follow-up. Statistical Analysis: The Student's t-test, Pearson Chi-squared test, and Bonferroni paired comparison test were used to evaluate the differences in proportions and correlations between the variables. Results: After 12 months of follow-up, the restorations were considered clinically successful in 89.3% of cases and radiographically successful in 80.5% of cases. There was statistical difference neither between the two restorative materials used nor between the numbers of restored surfaces. Conclusions: GIC and CR can be used successfully for restorations of one or two dental surfaces after ART.

  16. Mechanical performance of encapsulated restorative glass-ionomer cements for use with Atraumatic Restorative Treatment (ART)

    Science.gov (United States)

    MOLINA, Gustavo Fabián; CABRAL, Ricardo Juan; MAZZOLA, Ignacio; BRAIN LASCANO, Laura; FRENCKEN, Jo. E.

    2013-01-01

    The Atraumatic Restorative Treatment (ART) approach was suggested to be a suitable method to treat enamel and dentine carious lesions in patients with disabilities. The use of a restorative glass-ionomer with optimal mechanical properties is, therefore, very important. Objective: To test the null-hypotheses that no difference in diametral tensile, compressive and flexural strengths exists between: (1) The EQUIA system and (2) The Chemfil Rock (encapsulated glass-ionomers; test materials) and the Fuji 9 Gold Label and the Ketac Molar Easymix (hand-mixed conventional glass-ionomers; control materials); (3) The EQUIA system and Chemfil Rock. Material and Methods: Specimens for testing flexural (n=240) and diametral tensile (n=80) strengths were prepared according to standardized specifications; the compressive strength (n=80) was measured using a tooth-model of a class II ART restoration. ANOVA and Tukey B tests were used to test for significant differences between dependent and independent variables. Results: The EQUIA system and Chemfil Rock had significantly higher mean scores for all the three strength variables than the Fuji 9 Gold Label and Ketac Molar Easymix (α=0.05). The EQUIA system had significant higher mean scores for diametral tensile and flexural strengths than the Chemfil Rock (α=0.05). Conclusion: The two encapsulated high-viscosity glass-ionomers had significantly higher test values for diametral tensile, flexural and compressive strengths than the commonly used hand-mixed high-viscosity glass-ionomers. PMID:23857657

  17. A Case of a Chronic Pancreatic Pseudocyst Causing Atraumatic Splenic Rupture without Evidence of Acute Pancreatitis

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    P. Moori

    2016-01-01

    Full Text Available Atraumatic splenic rupture is a rare complication of a pancreatic pseudocyst (PP, described in the setting of chronic pancreatitis. There is common understanding, within the literature, that an inflammatory process at the tail of the pancreas may disrupt the spleen and result in such splenic complications. The authors present a case report of a 29-year-old male with a PP, associated with chronic pancreatitis. The patient had a history of excessive alcohol intake and presented to the emergency department with a short history of abdominal pain and vomiting. He denied any significant history of trauma and serum amylase levels were normal. An admission computed tomography (CT scan of the abdomen confirmed the presence of a PP in direct contact with the spleen. The CT also demonstrated a heterogenous hypodense area of the splenic hilum, along with perisplenic fluid. The patient was admitted for observation. His abdominal pain progressed, and he became haemodynamically unstable. An emergency ultrasound scan (USS at this time revealed intra-abdominal haemorrhage. A subsequent CT confirmed splenic rupture, which was managed surgically with a full recovery. Few such cases are documented within the literature and more understanding of preempting such events is needed.

  18. A Case of a Chronic Pancreatic Pseudocyst Causing Atraumatic Splenic Rupture without Evidence of Acute Pancreatitis.

    Science.gov (United States)

    Moori, P; Nevins, E J; Wright, T; Bromley, C; Rado, Y

    2016-01-01

    Atraumatic splenic rupture is a rare complication of a pancreatic pseudocyst (PP), described in the setting of chronic pancreatitis. There is common understanding, within the literature, that an inflammatory process at the tail of the pancreas may disrupt the spleen and result in such splenic complications. The authors present a case report of a 29-year-old male with a PP, associated with chronic pancreatitis. The patient had a history of excessive alcohol intake and presented to the emergency department with a short history of abdominal pain and vomiting. He denied any significant history of trauma and serum amylase levels were normal. An admission computed tomography (CT) scan of the abdomen confirmed the presence of a PP in direct contact with the spleen. The CT also demonstrated a heterogenous hypodense area of the splenic hilum, along with perisplenic fluid. The patient was admitted for observation. His abdominal pain progressed, and he became haemodynamically unstable. An emergency ultrasound scan (USS) at this time revealed intra-abdominal haemorrhage. A subsequent CT confirmed splenic rupture, which was managed surgically with a full recovery. Few such cases are documented within the literature and more understanding of preempting such events is needed.

  19. Managing Early Childhood Caries with Atraumatic Restorative Treatment and Topical Silver and Fluoride Agents

    Directory of Open Access Journals (Sweden)

    Duangporn Duangthip

    2017-10-01

    Full Text Available Early childhood caries (ECC is a significant global health problem affecting millions of preschool children worldwide. In general, preschool children from families with 20% of the lowest family incomes suffered about 80% of the ECC. Most, if not all, surveys indicated that the great majority of ECC was left untreated. Untreated caries progresses into the dental pulp, causing pain and infection. It can spread systemically, affecting a child’s growth, development and general health. Fundamental caries management is based on the conventional restorative approach. Because preschool children are too young to cope with lengthy dental treatment, they often receive dental treatment under general anaesthesia from a specialist dentist. However, treatment under general anaesthesia poses a life-threatening risk to young children. Moreover, there are few dentists in rural areas, where ECC is prevalent. Hence, conventional dental care is unaffordable, inaccessible or unavailable in many communities. However, studies showed that the atraumatic restorative treatment had a very good success rate in treating dentine caries in young children. Silver diamine fluoride is considered safe and effective in arresting dentine caries in primary teeth. The aim of this paper is to review and discuss updated evidence of these alternative approaches in order to manage cavitated ECC.

  20. Choosing a Breast Prosthesis: A Survivor's Perspective

    Science.gov (United States)

    ... Request Permissions Choosing a Breast Prosthesis: A Survivor’s Perspective Andrea Zinn June 16, 2015 · Amber Bauer, ASCO ... body image breast cancer coping decision making patient perspective survivorship tips Related Resources: Breast Cancer - Introduction Talking ...

  1. SURGICAL CORRECTION OF TRAUMATIC PATELLAR LUXATION IN AN EURASIAN LYNX (LYNX LYNX).

    Science.gov (United States)

    Devesa-Garcia, V; Bañeres-De la Torre, A; Cabezas-Salamanca, M A; Lucas-Lucas, N; Rodriguez-Quiros, J

    2016-09-01

    The aim of this report is to describe the successful surgical repair of a traumatic medial patellar luxation in a 4-yr-old female Eurasian lynx ( Lynx lynx ). The animal presented with hind limb lameness. Physical and radiographic examinations were performed under sedation. After diagnosing a medial patellar luxation, surgical repair was recommended. A combination of soft tissue reconstructive techniques was used to repair the medial patellar luxation. The limb was not immobilized postoperatively, but the animal was confined to a cage for 1 mo. The recovery was uneventful and return to normal activity was observed within 1 mo. Soft tissue reconstructive techniques can be used as the only surgical treatment for the repair of a traumatic patellar luxation in both domestic and wild animals.

  2. Human syndromes with congenital patellar anomalies and the underlying gene defects.

    NARCIS (Netherlands)

    Bongers, E.M.H.F.; Kampen, A. van; Bokhoven, J.H.L.M. van; Knoers, N.V.A.M.

    2005-01-01

    Genetic disorders characterized by congenital patellar aplasia or hypoplasia belong to a clinically diverse and genetically heterogeneous group of lower limb malformations. Patella development involves different molecular and cellular mechanisms regulating dorso-ventral patterning, cartilage and

  3. Previously identified patellar tendinopathy risk factors differ between elite and sub-elite volleyball players.

    Science.gov (United States)

    Janssen, I; Steele, J R; Munro, B J; Brown, N A T

    2015-06-01

    Patellar tendinopathy is the most common knee injury incurred in volleyball, with its prevalence in elite athletes more than three times that of their sub-elite counterparts. The purpose of this study was to determine whether patellar tendinopathy risk factors differed between elite and sub-elite male volleyball players. Nine elite and nine sub-elite male volleyball players performed a lateral stop-jump block movement. Maximum vertical jump, training history, muscle extensibility and strength, three-dimensional landing kinematics (250 Hz), along with lower limb neuromuscular activation patterns (1500 Hz), and patellar tendon loading were collected during each trial. Multivariate analyses of variance (P volleyball players. Interventions designed to reduce landing frequency and improve quadriceps extensibility are recommended to reduce patellar tendinopathy prevalence in volleyball players. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  4. Results of Surgical Treatment of Chronic Patellar Tendinosis (Jumper's Knee): A Systematic Review of the Literature.

    Science.gov (United States)

    Brockmeyer, Matthias; Diehl, Nora; Schmitt, Cornelia; Kohn, Dieter M; Lorbach, Olaf

    2015-12-01

    To review the literature concerning surgical treatment options for chronic patellar tendinosis (jumper's knee), a common problem among athletes. When conservative treatment fails, surgical treatment is required. Systematic review of the literature concerning the results of current surgical treatment options for chronic patellar tendinosis. All articles of studies with an evidence level ≥IV from January 2000 until February 2015 presenting the surgical outcome after arthroscopic as well as open treatment of chronic patellar tendinosis were included. The literature research of the PubMed database was performed using the following key words: "patellar" and "tendinitis," "tendonitis," "tendinosis" or "tendinopathy"; "inferior patellar pole"; "jumper's knee"; "surgical treatment" and "open" or "arthroscopic patellar tenotomy." A systematic review of the literature was performed especially to point out the effectiveness of arthroscopic treatment of chronic patellar tendinosis. The results revealed good clinical results for arthroscopic as well as open treatment of chronic patellar tendinosis that is refractory to conservative treatment in athletes. An average success rate of 87% was found for the open treatment group and of 91% for the arthroscopic treatment group. However, after open surgery, the mean time of return to the preinjury level of activity is 8 to 12 months, with a certain number of patients/athletes who cannot return to the preinjury level of activity. Minimally invasive, arthroscopically assisted or all-arthroscopic procedures may lead to a significantly faster return to sporting activities and may, therefore, be the preferred method of surgical treatment. Level IV, systematic review of Level I-IV studies. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  5. In-vivo patellar tendon kinematics during weight-bearing deep knee flexion.

    Science.gov (United States)

    Kobayashi, Koichi; Sakamoto, Makoto; Hosseini, Ali; Rubash, Harry E; Li, Guoan

    2012-10-01

    This study quantified in-vivo 3D patellar tendon kinematics during weight-bearing deep knee bend beyond 150°. Each knee was MRI scanned to create 3D bony models of the patella, tibia, femur, and the attachment sites of the patellar tendon on the distal patella and the tibial tubercle. Each attachment site was divided into lateral, central, and medial thirds. The subjects were then imaged using a dual fluoroscopic image system while performing a deep knee bend. The knee positions were determined using the bony models and the fluoroscopic images. The patellar tendon kinematics was analyzed using the relative positions of its patellar and tibial attachment sites. The relative elongations of all three portions of the patellar tendon increased similarly up to 60°. Beyond 60°, the relative elongation of the medial portion of the patellar tendon decreased as the knee flexed from 60° to 150° while those of the lateral and central portions showed continuous increases from 120° to 150°. At 150°, the relative elongation of the medial portion was significantly lower than that of the central portion. In four of seven knees, the patellar tendon impinged on the tibial bony surface at 120° and 150° of knee flexion. These data may provide useful insight into the intrinsic patellar tendon biomechanics during a weight-bearing deep knee bend and could provide biomechanical guidelines for future development of total knee arthroplasties that are intended to restore normal knee function. Copyright © 2012 Orthopaedic Research Society.

  6. Patellar Height Decreasing After Distal Femur Endoprosthesis Reconstruction Does Not Affect Functional Outcome.

    Science.gov (United States)

    Etchebehere, Mauricio; Lin, Patrick P; Moon, Bryan S; Yu, Jun; Li, Liang; Lewis, Valerae O

    2016-02-01

    The patellar height can influence extensor mechanism and the knee function. Thus, during knee arthroplasty, the surgeon seeks to maintain the correct patellar height. However, it is more difficult to define and maintain the correct patella height in megaprosthesis reconstructions after tumor resections. The objective of this study was to evaluate patellar height after distal femur endoprosthesis reconstruction and its association to knee function. This retrospective analysis included 108 patients who underwent distal femur resections and endoprosthesis reconstruction. The minimum follow-up was 1 year or until the patients underwent patellar resurfacing or endoprosthesis revision. Patellar height was calculated using Insall-Salvati ratio (ISR) and Insall-Salvati patellar tendon insertion ratio (PTR) at 2 different times: postoperatively and at the final follow-up. The postoperative ratio was calculated using the best postoperative radiograph taken at least 1 month after the procedure. The final measures were based on the radiograph available at the last follow-up consultation. The ISR and PTR were associated to anterior knee pain (AKP), range of motion (ROM), and extension lag (EXL). The average follow-up was 4.5years. The mean postoperative ISR was 1.02, and the mean ISR at final follow-up was 0.95 (P<.0001). The mean postoperative PTR was 1.45, and the mean PTR at final follow-up was 1.40 (P=.016). There was no association between patellar height and AKP, ROM, and EXL. Patellar height decreases significantly after distal femur resections but does not affect AKP, ROM, and EXL. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Differences in tendon properties in elite badminton players with or without patellar tendinopathy.

    Science.gov (United States)

    Couppé, C; Kongsgaard, M; Aagaard, P; Vinther, A; Boesen, M; Kjaer, M; Magnusson, S P

    2013-03-01

    The aim of this study was to examine the structural and mechanical properties of the patellar tendon in elite male badminton players with and without patellar tendinopathy. Seven players with unilateral patellar tendinopathy (PT group) on the lead extremity (used for forward lunge) and nine players with no current or previous patellar tendinopathy (CT group) were included. Magnetic resonance imaging was used to assess distal patellar tendon dimensions. Patellar tendon mechanical properties were assessed using simultaneous tendon force and deformation measurements. Distal tendon cross-sectional area (CSA) normalized for body weight (mm(2) /kg(2/3) ) was lower in the PT group compared with the CT group on both the non-lead extremity (6.1 ± 0.3 vs 7.4 ± 0.2, P < 0.05) and the lead extremity (6.5 ± 0.6 vs 8.4 ± 0.3, P < 0.05). Distal tendon stress was higher in the PT group compared with the CT group for both the non-lead extremity (31 ± 1 vs 27 ± 1 MPa, P < 0.05) and the lead extremity (32 ± 3 vs 21 ± 3 MPa, P < 0.01). Conclusively, the PT group had smaller distal patellar tendon CSA on both the injured (lead extremity) and the uninjured side (non-lead extremity) compared with the CT group. Subsequently, the smaller CSA yielded a greater distal patellar tendon stress in the PT group. Therefore, a small tendon CSA may predispose to the development of tendinopathy. © 2012 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd.

  8. Evaluation in adolescents practitioners and non-practitioners of futsal to detect positivity for patellar chondromalacia

    OpenAIRE

    de Souza, Carlos Eduardo Alves; Silva, Thayse Alanne Bezerra; Duarte, Gabriella Wendy; Souza, Jéssica Priscila da Silva

    2017-01-01

    ABSTRACT BACKGROUND AND OBJECTIVES: An increasingly popular modality is futsal; with increased popularity, the number of adolescents practicing such sport is also increasing and, as consequence, related injuries are also increasing, becoming object of interest of healthcare professionals. This study aimed at comparing signs and symptoms in adolescents practicing and not practicing futsal, to suggest positivity for patellar chondromalacia. METHODS: To detect patellar chondromalacia, history ...

  9. Patellar tendon shortening for flexed knee gait in spastic diplegia.

    Science.gov (United States)

    Sossai, Roberto; Vavken, Patrick; Brunner, Reinald; Camathias, Carlo; Graham, H Kerr; Rutz, Erich

    2015-02-01

    We evaluated the outcome of three different approaches to the management of flexed knee gait patients with spastic diplegia. The three surgical procedures were patellar tendon shortening (PTS), PTS combined with rotational osteotomies of the femur and/or tibia, and PTS combined with supracondylar extension osteotomy (SEO) of the distal femur. The primary outcome measure was gait kinematics. The knee gait variable score (GVS) and the gait profile score (GPS) were derived from gait kinematics. 24 patients (16 male and 8 female), mean age 16.1 years (SD 5.8 years), who had surgery between 2002 and 2008, were followed for a mean of 22 months. Knee extension during gait improved by a mean of 20° throughout the gait cycle, with an improvement in the knee GVS of 14° (pdiplegia is both feasible and appropriate. Level III. Copyright © 2015 Elsevier B.V. All rights reserved.

  10. Surgical Correction of Patellar Luxation in a Rabbit

    Directory of Open Access Journals (Sweden)

    J. Riggs

    2013-01-01

    Full Text Available A two-and-a-half-year-old giant lop-eared rabbit, weighing 5.1 kg, presented with a one-month history of intermittent right hind limb lameness. The limb locked in extension during hopping. On examination, a grade-2 medial patellar luxation of the right hind was diagnosed, with associated stifle joint swelling. Radiographic findings of the right stifle comprised periarticular osteophyte formation consistent with mild degenerative joint disease and joint effusion. Surgical correction involving right trochlear wedge recession sulcoplasty and lateral imbrication was carried out to stabilise the patella in the trochlear groove. The right hind limb lameness resolved, and the patella was stable at a 6-month postoperative examination. One year postoperatively, the right patella was luxating again concurrent with bilateral stifle effusions. Euthanasia was performed twenty months after surgery due to recurrent lameness in the right hind limb.

  11. Clinical Applications of Platelet-Rich Plasma in Patellar Tendinopathy

    Directory of Open Access Journals (Sweden)

    D. U. Jeong

    2014-01-01

    Full Text Available Platelet-rich plasma (PRP, a blood derivative with high concentrations of platelets, has been found to have high levels of autologous growth factors (GFs, such as transforming growth factor-β (TGF-β, platelet-derived growth factor (PDGF, fibroblastic growth factor (FGF, vascular endothelial growth factor (VEGF, and epidermal growth factor (EGF. These GFs and other biological active proteins of PRP can promote tissue healing through the regulation of fibrosis and angiogenesis. Moreover, PRP is considered to be safe due to its autologous nature and long-term usage without any reported major complications. Therefore, PRP therapy could be an option in treating overused tendon damage such as chronic tendinopathy. Here, we present a systematic review highlighting the clinical effectiveness of PRP injection therapy in patellar tendinopathy, which is a major cause of athletes to retire from their respective careers.

  12. Does the adolescent patellar tendon respond to 5 days of cumulative load during a volleyball tournament?

    Science.gov (United States)

    van Ark, M; Docking, S I; van den Akker-Scheek, I; Rudavsky, A; Rio, E; Zwerver, J; Cook, J L

    2016-02-01

    Patellar tendinopathy (jumper's knee) has a high prevalence in jumping athletes. Excessive load on the patellar tendon through high volumes of training and competition is an important risk factor. Structural changes in the tendon are related to a higher risk of developing patellar tendinopathy. The critical tendon load that affects tendon structure is unknown. The aim of this study was to investigate patellar tendon structure on each day of a 5-day volleyball tournament in an adolescent population (16-18 years). The right patellar tendon of 41 players in the Australian Volleyball Schools Cup was scanned with ultrasound tissue characterization (UTC) on every day of the tournament (Monday to Friday). UTC can quantify structure of a tendon into four echo types based on the stability of the echo pattern. Generalized estimating equations (GEE) were used to test for change of echo type I and II over the tournament days. Participants played between eight and nine matches during the tournament. GEE analysis showed no significant change of echo type percentages of echo type I (Wald chi-square = 4.603, d.f. = 4, P = 0.331) and echo type II (Wald chi-square = 6.070, d.f. = 4, P = 0.194) over time. This study shows that patellar tendon structure of 16-18-year-old volleyball players is not affected during 5 days of cumulative loading during a volleyball tournament. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  13. Relationship between patellar mobility and patellofemoral joint cartilage degeneration after anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Ota, Susumu; Kurokouchi, Kazutoshi; Takahashi, Shigeo; Yoda, Masaki; Yamamoto, Ryuichiro; Sakai, Tadahiro

    2017-11-01

    Patellofemoral cartilage degeneration is a potential complication of anterior cruciate ligament reconstruction (ACLR) surgery. Hypomobility of the patella in the coronal plane is often observed after ACLR. Few studies, however, have examined the relationship between cartilage degeneration in the patellofemoral joint and mobility after ACLR. The present study investigated 1) the coronal mobility of the patella after ACLR, 2) the relationship between patellar mobility and cartilage degeneration of the patellofemoral joint, and 3) the relationship between patellar mobility and knee joint function after ACLR. Forty patients who underwent medial hamstring-based ACLR participated in the study. Lateral and medial patellar displacements were assessed with a modified patellofemoral arthrometer, and the absolute values of the displacements were normalized to patient height. The International Cartilage Repair Society (ICRS) cartilage injury classification of the patellar and femoral (trochlear) surfaces, and the Lysholm Knee Scoring Scale were used to evaluate knee function. Lateral and medial patellar displacements were reduced compared with the non-operated knee at the second-look arthroscopy and bone staple extraction operation (second operation; 24.4 ± 7.9 months after ACLR, Pmobility, however, were significantly correlated with the ICRS grade or the Lysholm score. Although patellar mobility at approximately 2 years after ACLR was decreased compared to the non-operated knee, small displacement of the patella was not related to cartilage degeneration or knee joint function at the time of the second operation.

  14. Surface Area of Patellar Facets: Inferential Statistics in the Iraqi Population

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    Ahmed Al-Imam

    2017-01-01

    Full Text Available Background. The patella is the largest sesamoid bone in the body; its three-dimensional complexity necessitates biomechanical perfection. Numerous pathologies occur at the patellofemoral unit which may end in degenerative changes. This study aims to test the presence of statistical correlation between the surface areas of patellar facets and other patellar morphometric parameters. Materials and Methods. Forty dry human patellae were studied. The morphometry of each patella was measured using a digital Vernier Caliper, electronic balance, and image analyses software known as ImageJ. The patellar facetal surface area was correlated with patellar weight, height, width, and thickness. Results. Inferential statistics proved the existence of linear correlation of total facetal surface area and patellar weight, height, width, and thickness. The correlation was strongest for surface area versus patellar weight. The lateral facetal area was found persistently larger than the medial facetal area, the p value was found to be <0.001 (one-tailed t-test for right patellae, and another significant p value of < 0.001 (one-tailed t-test was found for left patellae. Conclusion. These data are vital for the restoration of the normal biomechanics of the patellofemoral unit; these are to be consulted during knee surgeries and implant designs and can be of an indispensable anthropometric, interethnic, and biometric value.

  15. MRI appearances of the asymptomatic patellar tendon on gradient echo imaging

    Energy Technology Data Exchange (ETDEWEB)

    Reiff, D.B. [Dept. of Diagnostic Radiology, St. George`s Hospital, London (United Kingdom); Heenan, S.D. [Dept. of Diagnostic Radiology, St. George`s Hospital, London (United Kingdom); Heron, C.W. [Dept. of Diagnostic Radiology, St. George`s Hospital, London (United Kingdom)

    1995-02-01

    Thickening of the patellar tendon and foci of increased signal intensity have been described as characteristic features of ``jumper`s knee`` (chronic patellar tendinitis) on magnetic resonance imaging (MRI). It was our impression that such appearances may be seen in the patellar tendons of patients without symptoms referable to the anterior part of the knee when using gradient echo images. The appearances of the asymptomatic patellar tendon on three-dimensional gradient echo sequences were studied by retrospectively reviewing the images of 60 patients, none of whom had symptoms related to the anterior part of the knee. The anteroposterior width of the patellar tendon was measured at three levels (superior, middle and inferior) on the central sagittal image of a gradient echo sequence. The relative signal intensities at the same levels were recorded. In 97% of subjects the superior part of the tendon was wider than the midpoint, and in 97% the inferior part was wider than the midpoint. The range of widths was wide, and there was no significant difference between sexes. Focal increased signal intensity in the superior part was shown in 75%, and in the inferior part in 43%. The asymptomatic patellar tendon shows uniform thickness throughout most of its length, but there are focal expansions at the proximal and distal ends. It usually demonstrates low signal on MRI, but may contain foci of increased signal intensity at either or both ends when imaged on gradient-echo sequences. (orig.)

  16. The chopstick-noodle twist: an easy technique of percutaneous patellar fixation in minimally displaced patellar fractures.

    Science.gov (United States)

    Muzaffar, Nasir; Ahmad, Nawaz; Ahmad, Aejaz; Ahmad, Nissar

    2012-01-01

    We report six cases of minimally displaced two-part patellar fractures with skin injury over the patella that were treated with percutaneous K wire fixation and compression applied using stainless steel (SS) wire. This technique makes it possible to perform early operative treatment in cases where unhealthy skin is not amenable to conventional tension band wiring. The technique employs two K wires inserted through the two fracture fragments under local or regional anaesthesia. They are then compressed using simple SS wire knots at the two ends - making it look like noodles at the end of two chopsticks. The fixation is subsequently augmented with a cylindrical plaster-of-Paris cast. The technique is simple, cheap and does not cause soft tissue injury.

  17. Relationship between the trochlear groove angle and patellar cartilage morphology defined by 3D spoiled gradient-echo imaging

    Energy Technology Data Exchange (ETDEWEB)

    Harada, Yuko; Tokuda, Osamu; Matsunaga, Naofumi [Yamaguchi University Graduate School of Medicine, Department of Radiology, Yamaguchi (Japan); Fukuda, Kouji [Shunan Memorial Hospital, Division of Radiological Technology, Yamaguchi (Japan); Shiraishi, Gen; Motomura, Tetsuhisa [Shunan Memorial Hospital, Department of Orthopedics Surgery, Yamaguchi (Japan); Kimura, Motoichi [Customer Application Gr., GE Healthcare MR Sales and Marketing Department, Osaka (Japan)

    2012-05-15

    To examine whether the femoral trochlear groove angle (TGA) is a determinant of the patellar cartilage volume and patellar cartilage damage. Patellar cartilage was evaluated by MR imaging in 66 patients (22 males and 44 females) with knee pain. Fat-suppressed 3D spoiled gradient-echo images were used to calculate the cartilage volume and to grade the cartilage damage. The proximal and distal TGAs were measured from axial PD-weighted FSE MR images with fat suppression. For every increase in the TGA at the distal femur, the patellar cartilage volume was significantly increased by 6.07 x 10{sup -3} cm{sup 3} (95% CI: 1.27 x 10{sup -3}, 10.9 x 10{sup -3}) after adjustment for age, gender, and patellar bone volume (P < 0.05). The MR grade of medial patellar cartilage damage progressed as the distal TGA became narrower, although there was no significant correlation between the distal TGA and the MR grading of patellar cartilage damage. A more flattened distal TGA was associated with increased patellar cartilage volume. However, there was no association between TGA and patellar cartilage defects. (orig.)

  18. Is superolateral Hoffa fat pad edema a consequence of impingement between lateral femoral condyle and patellar ligament?

    Science.gov (United States)

    Campagna, Raphael; Pessis, Eric; Biau, David Jean; Guerini, Henri; Feydy, Antoine; Thevenin, Fabrice Stéphane; Pluot, Etienne; Rousseau, Julien; Drapé, Jean-Luc

    2012-05-01

    To evaluate whether knee extensor mechanism features are associated with superolateral Hoffa fat pad edema at magnetic resonance imaging. Institutional review board approval and written consent from all patients were obtained. Patients with superolateral Hoffa fat pad edema (n = 30) and a control group without edema of the fat pad (n = 60) were evaluated prospectively with magnetic resonance (MR) imaging. Demographic data and extensor mechanism features were compared, including trochlear depth, lateral trochlear inclination, patellar tilt angle, patellar height ratio, distance between patellar ligament and lateral trochlear facet, distance from the tibial tubercle to the trochlear groove, patellar facet asymmetry, and patellar ligament abnormalities. The following variables were associated with superolateral Hoffa fat pad edema in the multivariable models: patellar height ratio (P = .023), shortest distance between patellar ligament and lateral trochlear facet (P < .001), and distance from the tibial tubercle to the trochlear groove (P = .046). Of all demographic and degenerative variables, only age was significantly associated, with younger patients more likely to have superolateral Hoffa fat pad edema (P < .009). A high-riding patella, a short distance between the patellar ligament and the lateral trochlear facet, and an increased distance from the tibial tubercle to the trochlear groove are associated with superolateral Hoffa fat pad edema at MR imaging. These results are suggestive of impingement between the lateral femoral condyle and the posterior aspect of the patellar ligament in these patients.

  19. Effect of patellar strap and sports tape on jumper's knee symptoms: protocol of a randomised controlled trial.

    Science.gov (United States)

    de Vries, Astrid J; van den Akker-Scheek, Inge; Diercks, Ron L; Zwerver, Johannes; van der Worp, Henk

    2013-12-01

    Patellar straps or sports tapes are commonly used by athletes with patellar tendinopathy in order to reduce pain and to continue sports participation. Currently, there is no scientific evidence for the effectiveness of a patellar strap or sports tape in the management of this common injury. To investigate the effect of the use of a patellar strap and sports tape on pain and sports participation in subjects with patellar tendinopathy. The study is divided into two parts: a randomised controlled crossover experiment and a randomised controlled trial (parallel group design). 140 patients diagnosed with patellar tendinopathy recruited from sports medical centres and physiotherapist practices. In the first part of the study, participants serve as their own control by performing three functional tests under four different conditions (patellar strap, sports tape, placebo tape, and no orthosis). In the second part, participants keep a log for two weeks (control week and intervention week) about the pain experienced during and after sports and their level of sports participation. In the intervention week participants will use the orthosis assigned to them during training and competition. The amount of pain (both parts of the study) and sports participation (second part only) will be measured. To analyse the effects of the orthoses a Linear Mixed Model will be used. The knowledge gained in this study can be used by practitioners in their advice for athletes with patellar tendinopathy about using patellar strap and sports tape during sports. Copyright © 2013 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.

  20. The Prevalence of Patient-Prosthesis Mismatch Can Be Reduced Using the Trifecta Aortic Prosthesis.

    Science.gov (United States)

    Hernandez-Vaquero, Daniel; Diaz, Rocio; Pascual, Isaac; Rozado, Jose; De la Hera, Jesus M; Leon, Victor; Avanzas, Pablo; Martín, Maria; García-Iglesias, Daniel; Calvo, David; Silva, Jacobo; Moris, César

    2018-01-01

    Some important studies have shown that patient-prosthesis mismatch is a frequent occurrence after surgical aortic valve replacement that impairs survival. The Trifecta valve (St. Jude Medical Inc, St. Paul, MN) has special architecture designed to achieve the best hemodynamic profile. The aim of this study was to determine the prevalence of mismatch when using this prosthesis. This study included 1,302 patients at 3 months postoperatively, 339 patients with a Trifecta prosthesis and 963 patients (the control group) with a Mitroflow aortic valve (Sorin Group Inc, Mitroflow Division, Vancouver, Canada). Multinomial multivariate logistic regression was calculated to estimate the association between the Trifecta prosthesis and moderate or severe patient-prosthesis mismatch. Any degree of mismatch was present in 5.9% of the Trifecta group and in 42.4% in the Mitroflow group. Moderate patient-prosthesis mismatch was present in 3.8% of the patients with a Trifecta valve and in 32.6% in the Mitroflow group. Severe mismatch was present in 2.1% of the patients with a Trifecta prosthesis and in 9.8% of the patients with a Mitroflow valve. All differences were statistically significant (p < 0.001). The odds ratio of the Trifecta prosthesis as protector against mismatch was 16.9 (95% confidence interval, 9.5 to 30.4) and 11.9 (95% confidence interval, 5.3 to 26.7) for moderate or severe mismatch, respectively. The prevalence of patient-prosthesis mismatch using the Trifecta aortic prosthesis is extraordinary low. This finding may have great clinical repercussions in patients undergoing surgical aortic valve replacement. Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  1. Different techniques in fabrication of ocular prosthesis.

    Science.gov (United States)

    Cevik, Pinar; Dilber, Erhan; Eraslan, Oguz

    2012-11-01

    Loss of an eye caused by cancer, trauma, or congenital defect creates a deep psychological impact on an individual's life especially social and professional life. Custom-made prosthesis, compared to stock prosthesis, provides a better fit to the eye socket, better cosmetic results, and less discomfort to the patient in the long term. The main objective of this article was to describe 3 different alternative and practical techniques of fabricating custom-made ocular prosthesis. An impression of anophthalmic socket was made with the addition of cured silicone-based precision impression material in all techniques. A master cast was prepared and duplicated with condensation silicone. A self-cure acrylic resin was polymerized in the silicone model and was fitted into the patient's eye socket. A digital photograph of the patient's iris was made using a digital camera and printed on good-quality photo paper in various shades and sizes in the first and the second techniques. Then the photo paper was coated with PVC so as not to allow any color flowing. The proper iris was then inserted to the acrylic base. The prosthesis was final processed using orthodontic heat polymerizing clear acrylic resin.In the other technique, after the trying-in process with wax pattern, an acrylic base was fabricated using heat polymerizing scleral acrylic resin. The prosthetic iris was fabricated from a transparent contact lens by painting the lens with watercolor paints and attaching it to an acrylic resin with tissue conditioner. The final process was made with heat polymerizing transparent acrylic resin. Custom-made prosthesis allows better esthetic and functional results to the patient in comparison to stock prosthesis. Further follow-up is necessary to check the condition and fit of the ocular prosthesis in such patients.

  2. Paediatric dentistry education of atraumatic restorative treatment (ART) in Brazilian dental schools.

    Science.gov (United States)

    Camargo, L B; Fell, C; Bonini, G C; Marquezan, M; Imparato, J C P; Mendes, F M; Raggio, D P

    2011-12-01

    To evaluate the degree of knowledge, use and teaching of atraumatic restorative treatment (ART) of paediatric dentistry lecturers in dental schools throughout Brazil. A structured questionnaire was applied, containing questions regarding the use of ART, socio-demographic characteristics and academic degree background. Descriptive analysis and Poisson's regression were conducted in order to verify the association between exploratory variables and ART teaching (α=5%). Of the 721 questionnaires sent to dental schools, approximately 40% were returned (n=285). Some 98.2% of the participants teach ART. Concerning dental lecturers who teach ART, in multiple regression model, considering ART indication (emergency versus restorative treatment) the lecturers residents of the Mid-West (PR=1.66; CI:1.13-2.45) and Northeast region (PR=1.33; CI:1.02-1.72) and lecturers who use ART regularly (PR=3.73; CI:2.11-5.59) teach ART as restorative treatment. When the question was about reason for using ART (conservative technique versus other techniques failures/fast treatment), lecturers with a longer period of TG (time elapsed since graduation) (PR=1.30; CI:1.08- 1.56) and also lecturers who use ART regularly (PR=2.87; CI:1.95-4.22), teach it as being a conservative technique. Regarding the patients' age covered by ART (versus without limitation), women (PR=1.26; CI:1.06-1.50) and lecturers who use ART regularly (PR=1.28; CI:1.06-1.54), teach that there is no age restriction. ART has been widely taught in Brazilian dental schools, is regularly used in lecturer's clinical practices and has positively influenced the appropriate teaching of this technique.

  3. Dental practitioners' attitudes, subjective norms and intentions to practice atraumatic restorative treatment (ART in Tanzania

    Directory of Open Access Journals (Sweden)

    Emil N. Kikwilu

    2009-04-01

    Full Text Available The aim of this study was to describe the attitude and subjective norm of dental practitioners towards practicing the atraumatic restorative treatment (ART in Tanzania. A pre-tested questionnaire on attitudes and subjective norms to practice ART was mailed to all 147 dental practitioners working in the regional and district government clinics. The independent variables were: gender, working experience, qualification and ever heard of ART. The dependent variables were: attitude, subjective norm and intention to practice ART. Chi-square tests and multiple regression analysis were used to test for effects between independent and dependent variables. Significance level was set at 5%. A total of 138 practitioners returned completed questionnaires. More experienced dental practitioners encountered moderate social pressure than less experienced dental practitioners, who met strong social pressure (p=0.045. A total of 73.2% of dental practitioners felt that ART was worth introducing in Tanzania, 92.8% recommended ART training for all dental practitioners and 97.8% recommended inclusion of ART in dental curricula. Positive attitude, strong subjective norm and high intention to practice ART were recorded in 76.3%, 28.1% and 90.6% of the practitioners, respectively. Only subjective norm had a statistically significant influence on the intention to practice ART (p<0.0001. The results indicated that dental practitioners were willing to have ART introduced in Tanzania and had positive attitudes towards practicing this technique. Nevertheless, their intention to perform ART was strongly influenced by social pressures. Therefore, in order to have a successful introduction of ART in Tanzania, people who matter in the daily practice of dental practitioners need to accept and appraise the ART approach positively.

  4. Knowledge and conduct of public health system dentist about atraumatic restorative treatment

    Directory of Open Access Journals (Sweden)

    Josué Junior Araújo PIEROTE

    2017-03-01

    Full Text Available Abstract Objective To evaluate the knowledge and conduct of dentists of the Public Health System (Family Health Strategy – FHS regarding Atraumatic Restorative Treatment (ART. Material and method A census survey was conducted and all FHS dentists from the urban area of the city of Teresina, Piauí, Brazil were visited in their workplaces and invited to participate in this study. Data collection was carried out between July and October, 2014 through self-administered questionnaires. For statistical analysis the chi-square test with a significance level of 5% and the linear association test were applied. Result One hundred and eighty-three professionals participated in the study (with a response rate of 89.7%, mostly women (71.0%, aged twenty to thirty-nine years (49.2%, with twenty or more years’ experience since graduation (45.9%, working only in the public service (70.5%, and with expertise in the clinical area (44.3%. Most of them believe in ART (82.7% and 95.8% of them apply it (of those, 58.9% apply it only in public service. The professionals’ individual knowledge of ART was measured and most of them have correct information regarding the treatment. The knowledge level evaluation was significantly associated with age and time since graduation (p<0.05. Conclusion Most of the dentistsworking in the public health system of Teresina, Piauí, Brazil have a good knowledge of and show positive behavior towardentists ART, but improvement is needed regarding the technique and its correct indication.

  5. Dental practitioners' attitudes, subjective norms and intentions to practice atraumatic restorative treatment (ART) in Tanzania.

    Science.gov (United States)

    Kikwilu, Emil N; Frencken, Jo E; Mulder, Jan; Masalu, Joyce R

    2009-01-01

    The aim of this study was to describe the attitude and subjective norm of dental practitioners towards practicing the atraumatic restorative treatment (ART) in Tanzania. A pre-tested questionnaire on attitudes and subjective norms to practice ART was mailed to all 147 dental practitioners working in the regional and district government clinics. The independent variables were: gender, working experience, qualification and ever heard of ART. The dependent variables were: attitude, subjective norm and intention to practice ART. Chi-square tests and multiple regression analysis were used to test for effects between independent and dependent variables. Significance level was set at 5%. A total of 138 practitioners returned completed questionnaires. More experienced dental practitioners encountered moderate social pressure than less experienced dental practitioners, who met strong social pressure (p=0.045). A total of 73.2% of dental practitioners felt that ART was worth introducing in Tanzania, 92.8% recommended ART training for all dental practitioners and 97.8% recommended inclusion of ART in dental curricula. Positive attitude, strong subjective norm and high intention to practice ART were recorded in 76.3%, 28.1% and 90.6% of the practitioners, respectively. Only subjective norm had a statistically significant influence on the intention to practice ART (ppracticing this technique. Nevertheless, their intention to perform ART was strongly influenced by social pressures. Therefore, in order to have a successful introduction of ART in Tanzania, people who matter in the daily practice of dental practitioners need to accept and appraise the ART approach positively.

  6. Evaluation of Atraumatic Restorative Treatment restorations and sealants under field conditions.

    Science.gov (United States)

    Motsei, S M; Kroon, J; Holtshousen, W S

    2001-07-01

    Conventional restorative procedures require the use of dental materials, expensive equipment, instruments and electricity. This makes dental restorations costly and limits the availability and accessibility of the service to areas where these facilities are available. The new philosophy of restorative care requires minimal intervention and advocates early interception of the caries process through the use of glass-ionomers as sealants and as restorations. This new approach makes dental care accessible to all members of society in developing countries. The aim of this study was to evaluate the use of Atraumatic Restorative Treatment (ART) restorations and sealants under field conditions. Both were assessed for their retentive properties and the development of secondary caries adjacent to the procedures. A longitudinal study design was followed. ART restorations and sealants were assessed at intervals of 6 and 12 months. After 12 months 56.5% of ART restorations were still present in the primary dentition and 84% in the permanent dentition. Of these 85.1% had no defects in the primary and 78.6% no defects in the permanent teeth. 72.3% of primary and 92% of permanent teeth on which ART restorations were placed had no caries after 1 year. Even though most of the sealants were absent due to poor retention after 12 months (89.6%), 98.9% of the teeth where the sealant was initially placed had no caries. Only 6.3% of sealants present had marginal defects. The ART technique is strongly recommended for the management of small, occlusal carious lesions in primary and permanent teeth.

  7. Educational strategies and atraumatic restorative treatment effect on salivary characteristics: A controlled clinical trial.

    Science.gov (United States)

    Freitas, C N; Castelo, P M; Sousa, K G; Alonso, G C; Fonseca, Fla; Klein, M I; Barbosa, T S

    2017-11-01

    To evaluate educational strategies and atraumatic restorative treatment (ART)-restoration impact on salivary physicochemical and microbiological characteristics. Two groups of 6- to 7-year-old children were included: GART , with at least one decayed primary molar (n = 36), submitted to four sessions of oral health educational strategy (OHES) and ART restoration; GC , a paired caries-free group (n = 36), submitted to four sessions of OHES. Three evaluations were carried out: baseline, 1 week after OHES, and 1 month after OHES or ART, when biofilm and gingivitis frequencies, salivary flow, pH, buffer capacity, calcium and phosphorus concentrations were assessed. Total bacteria and Streptococcus mutans were quantified in unstimulated saliva (qPCR). Improvement in biofilm and gingivitis scores, salivary pH, and buffering capacity after OHES was observed in GC , with a decrease in total bacteria and S. mutans counts. GART also showed changes in salivary parameters, even before ART restoration was delivered, and total bacteria count remained lower than baseline 1 month after ART restoration, although a trend to increase the proportion of S. mutans was observed. Improvements in salivary physicochemical and microbiological characteristics were observed after educational strategies, thus reducing the caries risk of children with decayed teeth, although a trend to increase the S. mutans percentage was observed 1 month after ART restoration. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. All rights reserved.

  8. [Treatment of Displaced Patellar Fractures with Multiple Circular Cerclage].

    Science.gov (United States)

    Tříska, Z; Urban, J; Látal, P; Kloub, M

    2017-01-01

    PURPOSE OF THE STUDY The study aims to conduct a mid-term evaluation of results of the treatment of patellar fractures with multiple circular cerclage. MATERIAL AND METHODS The retrospective clinical study with its own group of patients who underwent surgery in our centre in the period from 2008 to 2014. The study included a total of 29 patients with displaced patellar fractures treated with multiple circular cerclage. The available radiographic documentation was assessed and the quality of perioperative reposition, fracture healing, loss of reposition and potential failure of osteosynthesis material was considered. During the clinical examination, the range of motion (ROM) of the operated knee was measured. The current pain was evaluated on the Visual Analogue Scale for Pain (VAS). For evaluation of functional outcomes, the KOOS and LEFS scoring systems were used. RESULTS A total of 27 fractures (93.1%) healed after a mean period of 10.3 weeks after the primary surgery. In 23 cases two circular loops and in six cases 3 loops were used. The mean follow-up period was 66.6 months (range 22-100). The mean duration of the surgery was 59.6 minutes with the mean length of the incision of 11.8 cm (range 9-15). The quality of reposition was evaluated as exact in 23 patients, as adequate in six patients. The mean extension and flexion was 0.2° and 135°, respectively. The individual mean KOOS scores were the following: pain 75.0, symptom 74.5, knee function in daily living 76.7, knee function in sports and recreational activities 48.1, quality of life 57.8. The mean LEFS score was 68.7. The mean VAS score was 2.4. Extraction of osteosynthesis material was done in a total of seventeen cases (58.6%) at a mean of 10 months after osteosynthesis (range 5-14). In altogether five cases (17.2%) the loss of reposition occurred. In two patients pseudoarthrosis developed. Osteosynthesis material failure was reported in two cases (6.9%). DISCUSSION In our study population, by using

  9. Primary Total Knee Arthroplasty: How Does Residual Patellar Thickness Affect Patient-Oriented Outcomes?

    Science.gov (United States)

    Alcerro, Jose C; Rossi, Mark D; Lavernia, Carlos J

    2017-12-01

    Maintenance of the native patellar thickness has been deemed important for proper clinical outcomes after total knee arthroplasty (TKA). Our objective was to study the effects of the change in patellar thickness on patient-perceived outcomes (PPOs) after TKA. We hypothesized that reestablishing native patellar thickness after TKA results in better PPOs. 819 consecutive patients undergoing primary TKA were studied. Patients were classified according to their postoperative patellar thickness into: (1) less than native patella thickness; (2) equal to native patella thickness; and (3) greater than native patella thickness. Difference in postoperative range of motion (ROM), PPOs and clinical scores, and delta-Δ-change were assessed. MANCOVA was used to assess for differences. No significant differences found based on postoperative patellar thickness (mean follow-up: 4.9 ± 2.1 years) for each ROM assessments. Those who reported more stiffness (Western Ontario and McMaster Universities Arthritis Index stiffness; P = .011) and lower knee active flexion (P = .046) preoperatively had "greater than native patella thickness" after surgery. Postoperatively, the "equal to native patella thickness" group reported significantly better quality of life (quality of well-being scale 7 total; P = .008) as well as better physical score (Short Form-36 role physical score; P = .03). The amount of improvement (delta-Δ-change), when restoring patellar thickness equal to the native demonstrated greatest improvements in quality of life (quality of well-being scale 7 total; P = .016) physical measures (Short Form-36 role physical [P = .025], and Western Ontario and McMaster Universities Arthritis Index stiffness scores [P = .006]). When compared with the native patellar thickness, a final postoperative difference (delta thickness) that ranges from -1.06 to 2.58 mm provides satisfactory results and does not seem to affect ROM after surgery. Copyright © 2017 Elsevier Inc. All

  10. 21 CFR 872.3950 - Glenoid fossa prosthesis.

    Science.gov (United States)

    2010-04-01

    ...) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices § 872.3950 Glenoid fossa prosthesis. (a) Identification. A glenoid fossa prosthesis is a device that is intended to be implanted in the temporomandibular...

  11. Patellar taping for patellofemoral pain: a systematic review and meta-analysis to evaluate clinical outcomes and biomechanical mechanisms.

    Science.gov (United States)

    Barton, Christian; Balachandar, Vivek; Lack, Simon; Morrissey, Dylan

    2014-03-01

    Patellar taping is frequently used to treat patellofemoral pain (PFP). This systematic review and meta-analysis (1) evaluates the efficacy of patellar taping for patients with PFP, (2) compares the efficacy of various taping techniques and (3) identifies potential biomechanical mechanisms of action. The MEDLINE, CINAHL, SPORTSDiscus, Web of Science and Google Scholar databases were searched in January 2013 for studies evaluating the effects of patellar taping on pain and lower-limb biomechanics in individuals with PFP. Three independent reviewers assessed each paper for inclusion and two assessed for quality. Means and SDs were extracted from each included study to allow effect size calculations. Twenty studies were identified. There is moderate evidence that (1) tailored (customised to the patient to control lateral tilt, glide and spin) and untailored patellar taping provides immediate pain reduction of large and small effect, respectively and (2) tailored patellar taping promotes earlier onset of vastus medialis oblique (VMO) contraction (relative to vastus lateralis contraction). There is limited evidence that (1) tailored patellar taping combined with exercise provides superior pain reduction compared to exercise alone at 4 weeks, (2) untailored patellar taping added to exercise at 3-12 months has no benefit and (3) tailored patellar taping promotes increased internal knee extension moments. Tailoring patellar taping application (ie, to control lateral tilt, glide and spin) to optimise pain reduction is important for efficacy. Evaluation of tailored patellar taping beyond the immediate term is limited and should be a research priority. Possible mechanisms behind patellar taping efficacy include earlier VMO onset and improved knee function capacity (ie, ability to tolerate greater internal knee extension moments).

  12. Middle ear vibrations with SMA prosthesis. Experimental research

    Directory of Open Access Journals (Sweden)

    Rusinek Rafal

    2018-01-01

    Full Text Available The paper focuses on experimental research of a middle ear prosthesis made of shape memory alloy. The prosthesis provides better adjustment to individual patient than classical prosthesis. The shape memory prosthesis is implemented to a fresh temporal bone and vibrations of the round window are recorded by means of the Laser Doppler Vibrometer. Finally, the results are presented in the form of transfer function and compared to the intact and damaged middle ear.

  13. 21 CFR 872.3960 - Mandibular condyle prosthesis.

    Science.gov (United States)

    2010-04-01

    ... (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices § 872.3960 Mandibular condyle prosthesis. (a) Identification. A mandibular condyle prosthesis is a device that is intended to be implanted in the human jaw to... requirement for premarket approval for any mandibular condyle prosthesis intended to be implanted in the human...

  14. 21 CFR 890.3500 - External assembled lower limb prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false External assembled lower limb prosthesis. 890.3500... (CONTINUED) MEDICAL DEVICES PHYSICAL MEDICINE DEVICES Physical Medicine Prosthetic Devices § 890.3500 External assembled lower limb prosthesis. (a) Identification. An external assembled lower limb prosthesis...

  15. 21 CFR 874.3695 - Mandibular implant facial prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Mandibular implant facial prosthesis. 874.3695... (CONTINUED) MEDICAL DEVICES EAR, NOSE, AND THROAT DEVICES Prosthetic Devices § 874.3695 Mandibular implant facial prosthesis. (a) Identification. A mandibular implant facial prosthesis is a device that is...

  16. 21 CFR 888.3780 - Wrist joint polymer constrained prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Wrist joint polymer constrained prosthesis. 888... SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3780 Wrist joint polymer constrained prosthesis. (a) Identification. A wrist joint polymer constrained prosthesis is a device made of...

  17. MR arthrography including abduction and external rotation images in the assessment of atraumatic multidirectional instability of the shoulder

    Energy Technology Data Exchange (ETDEWEB)

    Schaeffeler, Christoph [Technische Universitaet Muenchen, Department of Radiology, Munich (Germany); Kantonsspital Graubuenden, Musculoskeletal Imaging, Chur (Switzerland); Waldt, Simone; Bauer, Jan S.; Rummeny, Ernst J.; Woertler, Klaus [Technische Universitaet Muenchen, Department of Radiology, Munich (Germany); Kirchhoff, Chlodwig [Technische Universitaet Muenchen, Department of Traumatology, Munich (Germany); Haller, Bernhard [Technische Universitaet Muenchen, Institute for Medical Statistics and Epidemiology, Munich (Germany); Schroeder, Michael [Center for Sports Orthopedics and Medicine, Orthosportiv, Munich (Germany); Imhoff, Andreas B. [Technische Universitaet Muenchen, Department of Orthopedic Sports Medicine, Munich (Germany)

    2014-06-15

    To evaluate diagnostic signs and measurements in the assessment of capsular redundancy in atraumatic multidirectional instability (MDI) of the shoulder on MR arthrography (MR-A) including abduction/external rotation (ABER) images. Twenty-one MR-A including ABER position of 20 patients with clinically diagnosed MDI and 17 patients without instability were assessed by three radiologists. On ABER images, presence of a layer of contrast between the humeral head (HH) and the anteroinferior glenohumeral ligament (AIGHL) (crescent sign) and a triangular-shaped space between the HH, AIGHL and glenoid (triangle sign) were evaluated; centring of the HH was measured. Anterosuperior herniation of the rotator interval (RI) capsule and glenoid version were determined on standard imaging planes. The crescent sign had a sensitivity of 57 %/62 %/48 % (observers 1/2/3) and specificity of 100 %/100 %/94 % in the diagnosis of MDI. The triangle sign had a sensitivity of 48 %/57 %/48 % and specificity of 94 %/94 %/100 %. The combination of both signs had a sensitivity of 86 %/90 %/81 % and specificity of 94 %/94 %/94 %. A positive triangle sign was significantly associated with decentring of the HH. Measurements of RI herniation, RI width and glenoid were not significantly different between both groups. Combined assessment of redundancy signs on ABER position MR-A allows for accurate differentiation between patients with atraumatic MDI and patients with clinically stable shoulders; measurements on standard imaging planes appear inappropriate. (orig.)

  18. Comparison of atraumatic restorative treatment and conventional restorative procedures in a hospital clinic: evaluation after 30 months.

    Science.gov (United States)

    Gao, Wei; Peng, Dong; Smales, Roger J; Yip, Kevin H K

    2003-01-01

    The purpose of this study was to evaluate two glass-ionomer cements placed in the occlusal surfaces of permanent molar teeth, using two cavity preparation methods. Three dentists placed 149 restorations for 68 patients in a hospital clinic. Atraumatic restorative treatment or conventional cavity preparation methods were used for two encapsulated, high-strength conventional glass-ionomer cements: Fuji IX GP and Ketac-Molar. Non-gamma 2 amalgam alloy was used in conventional preparations for comparison. The restorative procedures were uneventful, but cavity preparations made with atraumatic restorative treatment hand instruments took approximately twice as long as did conventional rotary instrumentation. After 30 months, only one glass-ionomer cement restoration had failed. Both glass-ionomer cements showed high early losses of sealant material, but caries was not detected in the exposed fissures. Both glass-ionomer cements also showed relatively high restoration wear. At 30 months, the mean cumulative net occlusal wear was 119 +/- 12 mm for Fuji IX GP and 96 +/- 13 mm for Ketac-Molar; the difference was not statistically significant. Color matching improved significantly by 6 months; there was no significant difference in color match between the two glass-ionomer cements by 12 months. Minor surface tarnishing and marginal discrepancies were present in the amalgam restorations and increased with time. The occlusal restorations performed satisfactorily over periods of up to 30 months. However, the continued deterioration of the cements requires longer-term studies to be undertaken.

  19. The impact of physically demanding work of basketball and volleyball players on the risk for patellar tendinopathy and on work limitations

    NARCIS (Netherlands)

    Van Der Worp, H.; Zwerver, J.; Kuijer, P.P.F.M.; Frings-Dresen, M.H.W.; Van Den Akker-Scheek, I.

    Patellar tendinopathy is a common injury in jumping athletes. Little is known about work-related etiological factors for patellar tendinopathy and related work limitations. The aim of this study was to identify work-related etiological factors for patellar tendinopathy and to determine the relation

  20. Fabrication of a custom ocular prosthesis.

    Science.gov (United States)

    Sethi, Tania; Kheur, Mohit; Haylock, Colin; Harianawala, Husain

    2014-01-01

    Defects of the eye may follow removal of a part of or the entire orbit. This results in the patient becoming visually, esthetically and psychologically handicapped. Restoring the defect with a silicone- or acrylic-based prosthesis not only restores esthetics but also gives back the lost confidence to the patient. This is a case report of a patient with a 'pthisical eye' and details the steps in fabrication of an ocular prosthesis. Particular attention has been given to the laboratory process in this technique to minimize the residual monomer content in the artificial eye.

  1. BIORESORBABLE POLYMERIC MENISCAL PROSTHESIS: STUDY IN RABBITS

    OpenAIRE

    Cardoso, Tulio Pereira; de Rezende Duek, Eliana Aparecida; Amatuzzi,Marco Martins; Caetano, Edie Benedito

    2010-01-01

    Objective: To induce growth of a neomeniscus into the pores of a prosthesis in order to protect the knee joint cartilage. Methods: 70 knees of 35 New Zealand rabbits were operated. The rabbits were five to seven months old, weighed 2 to 3.8 kilograms, and 22 were male and 13 were female. Each animal underwent medial meniscectomy in both knees during a single operation. A bioabsorbable polymeric meniscal prosthesis composed of 70% polydioxanone and 30% L-lactic acid polymer was implanted in on...

  2. The wrinkled patellar tendon: An indication of abnormality in the extensor mechanism of the knee

    Energy Technology Data Exchange (ETDEWEB)

    Berlin, R.C.; Levinsohn, E.M. (State Univ. of New York, Syracuse, NY (USA). Dept. of Radiology); Chrisman, H. (State Univ. of New York, Syracuse, NY (USA). Coll. of Medicine)

    1991-04-01

    Rupture of the quadriceps tendon is an uncommon condition which requires early diagnosis and treatment to avert prolonged disability. In four patients who had surgically confirmed quadriceps tendon rupture, lateral radiographs of the knee and/or sagittal magnetic resonance (MR) images demonstrated a corrugated appearance to the patellar tendon. Sagittal MR images of the knee following patellectomy in one patient and radiographs of a transverse fracture of the patella in another also demonstrated this appearance. MRI has superb contrast resolution which provides optimal visualization of the contour of the patellar tendon on sagittal images. A retrospective review of 50 consecutive knee MRI examinations was carried out to evaluate the appearance of the normal patellar tendon. In 49 of 50 patients, the sagittal images demonstrated a straight or nearly straight patellar tendon. A corrugated appearance of the patellar tendon on sagittal images indicates a reduction in the normal tensile force applied to it and indicates the need for careful evaluation of the patella and quadriceps tendon mechanism. (orig.).

  3. Radiographic Assessment of Anatomic Risk Factors Associated with Acute, Lateral Patellar Dislocation in the Immature Knee

    Directory of Open Access Journals (Sweden)

    Thai Trinh

    2016-04-01

    Full Text Available Acute patellar dislocation remains a common injury in both adult and pediatric patients. Non-operative management has been advocated for patients without a history of recurrent instability. Although pathologic thresholds for consideration of operative management have previously been reported in adults, it is largely unknown in children. A retrospective review of all skeletally immature patients diagnosed with acute lateral patellar dislocation who had MRI imaging were included for analysis. An age-based control group was also identified. Six radiographic measurements were compared: lateral trochlear inclination (LTI, trochlear facet asymmetry (TFA, trochlear depth (TD, tibial tuberosity–trochlear groove (TT–TG, sulcus angle (SA and patellar height ratio. A total of 178 patients were included for analysis (study: n = 108, control: n = 70. The mean age of patients in the study and control groups was 13.7 and 12.1 years respectively (p ≤ 0.001. Study group patients had significant differences in all radiographic measurements including a decreased LTI (p < 0.001, increased TFA (p < 0.001 and SA (p < 0.001. The mean trochlear depth was 3.4 mm and 5.6 mm for patients in the study and control groups respectively (p < 0.001. Study group patients had an increased patellar height ratio (p < 0.001 and TT–TG distance (p < 0.001. Morphologic abnormalities may predispose skeletally immature patients to an increased risk of acute lateral patellar instability.

  4. Tubular manipulators: a new concept for intracochlear positioning of an auditory prosthesis

    Directory of Open Access Journals (Sweden)

    Rau Thomas S.

    2015-09-01

    Full Text Available The aim of this study was to investigate the applicability of tubular manipulators as an actuator mechanism for intracochlear positioning of the electrode array (EA of a cochlear implant (CI. This is motivated by the vision of an atraumatic insertion of the EA into the inner ear (cochlea without any damage to the intracochlear structures in combination with a well-defined final position. To realize this, an actuator mechanism is required which allows consideration of the patient-specific anatomy. We propose a tubular manipulator for this task. It consists of three concentric tubes: A straight outer tube serves as a guiding sleeve to enter the inner ear (cochlea and two additional telescoping, superelastic, helically precurved tubes. By selecting helical tube parameters of both tubes prior insertion, a patient-specific curling behaviour of the tubular manipulator can be achieved. For preliminary investigation, segmentation and skeletonization of 5 human scala tympani were performed to determine their centrelines. These centrelines were considered as individual ideal insertion paths. An optimization algorithm was developed to identify suitable tube set parameters (curvature, diameter, length, torsion, stiffness as well as configuration parameters (translation and rotation of the 2 inner tubes. Different error values describing the deviation of the shape of the tubes with respect to the insertion path were used to quantify the optimization results. In all cases tube set parameters for a final position within the cochlea were found, while keeping the maximum error below 1mm. These preliminary results are promising in terms of the potential applicability of tubular manipulators for positioning auditory prosthesis inside the scala tympani of the inner ear.

  5. The effects of immobilization on the mechanical properties of the patellar tendon in younger and older men

    DEFF Research Database (Denmark)

    Couppé, C; Suetta, C; Kongsgaard, M

    2012-01-01

    It remains unknown if inactivity changes the mechanical properties of the human patellar tendon in younger and older healthy persons. The purpose was to examine the effects of short-term unilateral immobilization on the structural and mechanical properties of the patellar tendon in older men and ...

  6. Increased versican content is associated with tendinosis pathology in the patellar tendon of athletes with jumper's knee

    OpenAIRE

    Scott, Alexander; Lian, Øystein; Roberts, Clive C.; Cook, Jill L.; Handley, Christopher J; Bahr, Roald; Samiric, Tom; Illic, Mirna Z.; Parkinson, John; Hart, David A.; Duronio, Vincent; Khan, Karim M.

    2007-01-01

    Expansion of the extracellular matrix is a prominent but poorly characterized feature of tendinosis. The present study aimed to characterize the extent and distribution of the large aggregating proteoglycan versican in patients with patellar tendinosis. We obtained tendon from tendinopathy patients undergoing debridement of the patellar tendon and from controls undergoing intramedullary tibial nailing. Versican content was investigated by Western blotting and immunohistochemistry. Microvessel...

  7. Patient guided Piezo-electric Extracorporeal Shockwave Therapy as treatment for chronic severe patellar tendinopathy : A pilot study

    NARCIS (Netherlands)

    Zwerver, J.; Dekker, F.; Pepping, G.J.

    2010-01-01

    Background and purpose: Patellar tendinopathy is a common overuse injury for which no evidence-based treatment guidelines exist. Extracorporeal Shock Wave Therapy (ESWT) seems to be an effective treatment for patellar tendinopathy but the most beneficial treatment strategies still need to be

  8. Risk factors for patellar tendinopathy in volleyball and basketball players : A survey-based prospective cohort study

    NARCIS (Netherlands)

    de Vries, A. J.; van der Worp, H.; Diercks, R. L.; van den Akker-Scheek, I.; Zwerver, J.

    2015-01-01

    Patellar tendinopathy (PT) is a common overuse injury of the patellar tendon in jumping athletes. In a recent large cross-sectional study from 2008 several factors were identified that may be associated with the etiology of PT. However, because of the study design no conclusions could be drawn about

  9. Jumper's Knee or Lander's Knee? : A Systematic Review of the Relation between Jump Biomechanics and Patellar Tendinopathy

    NARCIS (Netherlands)

    van der Worp, Henk; de Poel, H. J.; Diercks, R. L.; van den Akker-Scheek, I.; Zwerver, J.

    Patellar tendinopathy (jumper's knee) is a common injury in sports that comprise jump actions. This article systematically reviews the literature examining the relation between patellar tendinopathy and take-off and landing kinematics in order to uncover risk factors and potential prevention

  10. No effect of extracorporeal shockwave therapy on patellar tendinopathy in jumping athletes during the competitive season : A randomized clinical trial

    NARCIS (Netherlands)

    Zwerver, Johannes; Hartgens, Fred; Verhagen, Evert; van der Worp, Henk; van den Akker-Scheek, Inge; Diercks, Ronald

    Background: Patellar tendinopathy is a common overuse injury among jumping athletes. No evidence-based treatment guidelines exist. Extracorporeal shockwave therapy (ESWT) appears to be a promising treatment but its effectiveness has not been studied in athletes with patellar tendinopathy who have

  11. Prevalence and genetics of patellar luxation in Kooiker dogs.

    Science.gov (United States)

    Wangdee, C; Leegwater, P A J; Heuven, H C M; van Steenbeek, F G; Meutstege, F J; Meij, B P; Hazewinkel, H A W

    2014-09-01

    The prevalence of patellar luxation (PL) and genetic factors potentially involved in the disorder were investigated in Dutch Kooiker dogs. A cohort of 842 Kooiker dogs, the offspring of 195 sires and 318 dams, was screened for PL from 1994 to 2011. The cohort was included in a pedigree of 1737 Kooiker dogs comprising nine generations. PL was present in 24% of screened dogs, with unilateral and bilateral luxation being observed equally frequently. Medial PL was more common (61%) than lateral PL (32%) or bidirectional PL (7%). The frequency of PL was similar in male and female dogs, with a female:male relative risk of 1.15 (95% confidence interval, CI, 0.90-1.48). The heritability of PL in the screened population was 0.27 ± 0.07. Since the start of the screening programme, the prevalence of PL decreased from 28% to 19%. A genome-wide association study of PL with 48 cases and 42 controls suggested the possible involvement of a region on chromosome 3 (Praw = 1.32 × 10(-)(5), Pgenome = 0.142), but the involvement of this region could not be confirmed in a validation group. Breeding programmes for complex diseases, such as PL, would benefit from combining pedigrees, phenotypes and genotypes, i.e. from genomic selection, as is currently the method of choice for breeding of production animals. Copyright © 2014 Elsevier Ltd. All rights reserved.

  12. An Isolated Medial Patellofemoral Ligament Reconstruction with Patellar Tendon Autograft

    Directory of Open Access Journals (Sweden)

    Dariusz Witoński

    2013-01-01

    Full Text Available The aim of the study was to evaluate the results of the medial patellofemoral ligament reconstruction with a medial strip of patellar tendon autograft after a minimum 2-year followup. Ten patients (10 knees were operated on by one surgeon, according to the modified technique, described by Camanho, without any bone plug at free graft end. The mean age of the patients was 27.2 years (ranging from 18 to 42 years. The mean follow-up period was 3 years and 7 months. All patients were reviewed prospectively. At the last follow-up visit, all the patients demonstrated a significant improvement in terms of patellofemoral joint stability, all aspects of the KOOS questionnaire, and Kujala et al.’s score (59.7 points preoperatively and 84.4 points at the last followup. No patient revealed recurrent dislocation. The SF-36 score revealed a significant improvement in bodily pain, general health, physical role functioning, social role functioning, and physical functioning domains. The described MPFL reconstruction with the use of the medial 1/3rd of patella tendon is an effective procedure that gives satisfactorily patellofemoral joint functions, improves the quality of life, and provides much pain relief. It is relatively simple, surgically not extensive, and economically cost-effective procedure.

  13. Bilateral traumatic patellar fracture: a case report and

    Directory of Open Access Journals (Sweden)

    Vinay Gupta

    2012-06-01

    Full Text Available 【Abstract】Simultaneous isolated bilateral patellar fractures are very rare injuries and most often associated with systemic disorders such as hyperparathyroidism, osteoporosis, stress fracture and kidney failure. Isolated bilateral traumatic fracture of patella following an unusual mode of injury is seldomly reported in the literature. We reported such a case following a road traffic accident with-out any associated injuries or co-morbid condition. The patella on the right side had transverse open fracture which was fixed with two Kirschner wires following tension band principle, and that on the left side sustained upper pole comminution which was treated by partial patellectomy. The patient achieved good outcome: at 6 months he was able to squat and sit cross legged; at one year he obtained nearly normal muscle strength and full range of motion. We dis-cussed the injury mechanism, management and rehabilita-tion in such a case and reviewed the available literature regarding such a presentation. Key words: Fractures, bone; Patella; Wounds and injuries

  14. Evaluation of chronic patellar tendinitis by ultrasonography and MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Sa, Eun Jin; Song, In Sup; Park, Hyo Jin; Kim, Hyeon Joo; Kim, Yang Soo; Lee, Yong Chul; Kim, Kun Sang; Seo, Kyung Ho; Seo, Kyung Mook [Chungang University, Seoul (Korea, Republic of). Coll. of Medicine

    1998-06-01

    The purpose of this study is to evaluate the usefulness of magnetic resonance imaging (MRI) and ultrasonography (US) for the diagnosis of jumper`s knee in high school basketball players. In order to detect clinical cases of jumper`s knee, 40 sites of patellar tendon in 20 knees of ten basketball players were assessed by an evaluation of personal history and physical examination. US and MRI were used for detecting compatible findings of this condition; the diagnostic criteria were hypoechoic focus with focal thickening as seen on US, and increased signal intensity with focal thickening as seen on MRI. As an early finding of jumper`s knee a new sonographic criterion of focal hypoechoic focus with or without focal thickening, was also applied. At 19 of 40 sites (48 %), clinical jumper`s knee was diagnosed. For the detection of this condition according to known cliteria, sensitivity and specificity were, respectively, 63 % and 100 % (US) and 32 % and 90 % (MRI). Using the new criterion, the sensitivity and specificity of US were 84 % and 76 %, respectively. On the basis of known US and MRI criteria for jumper`s knee, the sensitivity and specificity of US were higher than those of MRI. We suggest that hypoechoic focus without focal thickening oas seen on US, is an early finding of jumper`s knee. (author). 10 refs., 3 tabs., 5 figs.

  15. A running controller for a powered transfemoral prosthesis.

    Science.gov (United States)

    Huff, Amanda M; Lawson, Brian E; Goldfarb, Michael

    2012-01-01

    This paper describes a running controller for a powered knee and ankle prosthesis. The running controller was implemented on a powered prosthesis prototype and evaluated by a transfemoral amputee subject running on a treadmill at a speed of 2.25 m/s (5.0 mph). The ability of the prosthesis and controller to provide the salient features of a running gait was assessed by comparing the kinematics of running provided by the powered prosthesis to the averaged kinematics of five healthy subjects running at the same speed. This comparison indicates that the powered prosthesis and running controller are able to provide essential features of a healthy running gait.

  16. Atraumatic Restorative Treatment compared to the Hall Technique for occluso-proximal cavities in primary molars : study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    Hesse, D.; Pinheiro de Araujo, M.; Olegário, I.C.; Innes, N.; Prócida Raggio, D.; Calil Bonifácio, C.

    2016-01-01

    Background: In many parts of the world, school-age children have high dental treatment needs; however, there is often low, or no, dental care provision. Although Atraumatic Restorative Treatment (ART) was developed to address this, its survival rate in occluso-proximal lesions is low. An

  17. Two-year survival rates of proximal atraumatic restorative treatment restorations in relation to glass ionomer cements and postrestoration meals consumed

    NARCIS (Netherlands)

    Kemoli, A.M.; Opinya, G.N.; van Amerongen, W.E.; Mwalili, S.M.

    2011-01-01

    Purpose: The purpose of this study was to investigate the influence of 3 glass ionomer cement (GIC) brands and the postrestoration meal consumed on the survival rate of proximal atraumatic restorative treatment (ART) restorations. Methods: A total of 804 proximal restorations were placed in primary

  18. Clinical and radiological outcome of conservative vs. surgical treatment of atraumatic degenerative rotator cuff rupture : design of a randomized controlled trial

    NARCIS (Netherlands)

    Heerspink, Frederik O. Lambers; Hoogeslag, Roy A. G.; Diercks, Ron L.; van Eerden, Pepijn J. M.; van den Akker-Scheek, Inge; van Raay, Jos J. A. M.

    2011-01-01

    Background: Subacromial impingement syndrome is a frequently observed disorder in orthopedic practice. Lasting symptoms and impairment may occur when a subsequent atraumatic rotator cuff rupture is also present. However, degenerative ruptures of the rotator cuff can also be observed in asymptomatic

  19. Atraumatic restorative treatment versus conventional restorative treatment for managing dental caries.

    Science.gov (United States)

    Dorri, Mojtaba; Martinez-Zapata, Maria José; Walsh, Tanya; Marinho, Valeria Cc; Sheiham Deceased, Aubrey; Zaror, Carlos

    2017-12-28

    Dental caries is a sugar-dependent disease that damages tooth structure and, due to loss of mineral components, may eventually lead to cavitation. Dental caries is the most prevalent disease worldwide and is considered the most important burden of oral health. Conventional treatment methods (drill and fill) involve the use of rotary burs under local anaesthesia. The need for an electricity supply, expensive handpieces and highly trained dental health personnel may limit access to dental treatment, especially in underdeveloped regions.To overcome the limitations of conventional restorative treatment, the Atraumatic Restorative Treatment (ART) was developed, mainly for treating caries in children living in under-served areas of the world where resources and facilities such as electricity and trained manpower are limited. ART is a minimally invasive approach which involves removal of decayed tissue using hand instruments alone, usually without use of anaesthesia and electrically driven equipment, and restoration of the dental cavity with an adhesive material (glass ionomer cement (GIC), composite resins, resin-modified glass-ionomer cement (RM-GICs) and compomers). To assess the effects of Atraumatic Restorative Treatment (ART) compared with conventional treatment for managing dental caries lesions in the primary and permanent teeth of children and adults. Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 22 February 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 1), MEDLINE Ovid (1946 to 22 February 2017), Embase Ovid (1980 to 22 February 2017), LILACS BIREME Virtual Health Library (Latin American and Caribbean Health Science Information database; 1982 to 22 February 2017) and BBO BIREME Virtual Health Library (Bibliografia Brasileira de Odontologia; 1986 to 22 February 2017). The US National Institutes of Health Trials Registry (Clinical

  20. Adjustable patella grapple versus cannulated screw and cable technique for treatment of transverse patellar fractures.

    Science.gov (United States)

    Yan, Ning; Yang, Anli; Liu, Xiaodong; Cai, Feng; Liu, Liang; Chang, Shimin

    2014-03-01

    Although the cannulated screw and cable (CSC) tension band technique is an effective method for fixation of transverse patellar fractures, it has shortcomings, such as extensive soft tissue damage, osseous substance damage, and complex manipulation. We conducted a retrospective comparison of the adjustable patella grapple (APG) technique and the CSC tension band technique. We retrospectively reviewed 78 patients with transverse patellar fractures (45 in the APG group and 33 in the CSC group). Follow-up was 18 months. Comparison criteria were operation time, fracture reduction, fracture healing time, the knee injury and osteoarthritis outcome score for knee function, and complications. The APG group showed shorter operation time and equal fracture reduction, fracture healing time, and knee function compared with the CSC group. Eleven patients in the APG group experienced skin irritation generated by implants. There was no complication in the CSC group. The APG technique should be considered as an alternative method for treatment of transverse patellar fractures.

  1. An Unusual Knee Trauma: Combined Rupture of Medial Collateral Ligament and Patellar Tendon

    Directory of Open Access Journals (Sweden)

    T. De Baere

    2014-01-01

    Full Text Available We present the case of a combined lesion of the medial collateral ligament (MCL and patellar tendon of the knee in a 45-year-old man, after a fall while skiing. Although there are numerous publications concerning associated tears of MCL and other knee ligaments, a combination of MCL tear with a rupture of the patellar tendon is very rare. After a review of the literature and treatment guidelines about these lesions, the clinical case is described and discussed. This knee trauma was treated with a transosseous reinsertion of the patellar tendon, which was reinforced by an allograft of fascia lata, followed by a direct suture of the MCL, which was reinforced with the lateral semitendinosus tendon.

  2. Imaging assessment of patellar instability and its treatment in children and adolescents

    Energy Technology Data Exchange (ETDEWEB)

    Meyers, Arthur B.; Sharafinski, Mark [Children' s Hospital of Wisconsin, Medical College of Wisconsin, Department of Radiology, P.O. Box 1997, Milwaukee, WI (United States); Laor, Tal; Zbojniewicz, Andrew M. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States)

    2016-05-15

    Transient patellar dislocation is a common entity in children and adolescents, characterized by lateral dislocation of the patella, usually with spontaneous reduction. Many predisposing conditions have been described, including trochlear dysplasia, excessive lateral patellar tilt, patella alta and lateralization of the tibial tuberosity. Associated injuries are bone bruises of the patella and lateral femoral condyle, tears of the medial retinaculum that include the medial patellofemoral ligament (MPFL), tears of the vastus medialis obliquus muscle, injuries of articular cartilage, and intra-articular bodies. Children who are refractory to conservative management, have a large cartilage defect, or are at substantial risk for recurrent dislocations are candidates for surgical procedures to prevent future dislocations. Procedures can include MPFL repair or reconstruction, tibial tubercle repositioning and lateral retinacular release. The purpose of this review is to illustrate the imaging findings of transient patellar dislocation in the acute setting, the normal imaging appearance after surgical intervention, and post-surgical complications. (orig.)

  3. Total knee arthroplasty with subvastus approach in patient with chronic post-traumatic patellar dislocation.

    Science.gov (United States)

    Junqueira, Jader Joel Machado; Helito, Camilo Partezani; Bonadio, Marcelo Batista; Pécora, Jose Ricardo; Demange, Marco Kawamura

    2016-01-01

    Chronic lateral dislocation of the patella is a rare condition and acquired causes are usually secondary to knee trauma. The neglected chronic dislocation leads to progressive genu valgum and external tibial torsion deformities with subsequent gonarthrosis, which becomes painful and debilitating. There is no consensus regarding treatment of these patients, but total knee arthroplasty (TKA) is a useful therapy in cases of painful symptomatic gonarthrosis. Few reports have shown that subvastus approach and lateral release may be a valid option for TKA, since it allows the correction of valgus deformity and patellar tracking without interrupting vascular blood supply of patella. This article reports a case of TKA and extensor mechanism realignment without patellar resurfacing in a patient with genu valgum and chronic post-traumatic patellar dislocation with satisfactory results after two years of follow-up.

  4. Case Report: Magnetically retained silicone facial prosthesis ...

    African Journals Online (AJOL)

    Prosthetic camouflaging of facial defects and use of silicone maxillofacial material are the alternatives to the surgical retreatment. Silicone elastomers provide more options to clinician for customization of the facial prosthesis which is simple, esthetically good when coupled with bio magnets for retention. Key words: Magnet ...

  5. Fusion around cervical disc prosthesis: case report.

    NARCIS (Netherlands)

    Bartels, R.H.M.A.; Donk, R.

    2005-01-01

    OBJECTIVE AND IMPORTANCE: Cervical arthroplasty is a relatively new method to maintain motion after cervical anterior discectomy. Two cases are presented in which bony fusion occurred around a cervical disc prosthesis. CLINICAL PRESENTATION: A 30-year-old man and a 49-year-old woman underwent a

  6. Three-dimensional transfer of the tibial tuberosity for patellar instability with patella alta.

    Science.gov (United States)

    Otsuki, Shuhei; Nakajima, Mikio; Oda, Shuhei; Hoshiyama, Yoshiaki; Fujiwara, Kenta; Jotoku, Tsuyoshi; Neo, Masashi

    2013-05-01

    Although patellar instability can be treated with several surgical procedures, the appropriate surgical treatment for patellar instability with patella alta has not yet been investigated. The objective of this study is to find out whether three-dimensional transfer of the tibial tuberosity elicits good knee functionality with improved patella alta and prevents further patellar dislocation. Twelve knees (10 patients) underwent surgery for patellar instability with patella alta from 2007 to 2011. The surgery performed was a three-dimensional transfer for the anteromedial distalization of the tibial tuberosity. Predisposing anatomical factors for patellar instability were evaluated preoperatively; femorotibial angle (FTA), patella alta (IS ratio), trochlear dysplasia (sulcus angle) and tilting angle (lateral tilt). The function of the knee was assessed before and after surgery by Lysholm and Kujala score. Before surgery, the IS ratio was 1.34 ± 0.13, lateral tilt was 22.4° ± 6.5°, and the sulcus angle was 151.7° ± 8.3°, indicating patella alta, laterality, and trochlear dysplasia. After surgery, the IS ratio and lateral tilt significantly improved to 0.95 ± 0.13, and 10.6° ± 3.4°, respectively. FTA and sulcus angle were not altered. Lysholm and Kujala score improved from 63.8 to 94.7 and 67.0 to 94.1 points, respectively. Most patients displayed good outcomes except for one patient who suffered re-dislocation by hitting their knee on the floor, 2.5 years after surgery. Three-dimensional tibial tuberosity transfer was shown to correct the patella position and result in a good clinical outcome. This method is introduced as an alternative surgery for patellar instability with patella alta.

  7. Relation between ankle joint dynamics and patellar tendinopathy in elite volleyball players.

    Science.gov (United States)

    Richards, David P; Ajemian, Stanley V; Wiley, J Preston; Brunet, Jacques A; Zernicke, Ronald F

    2002-09-01

    Ankle joint complex dynamics developed during volleyball spike jumps take-offs and landings were quantified to assess potential relations between these joint dynamics and patellar tendinopathy. Three-dimensional kinematic data provided information about movements of the lower limbs, while the kinetic data permitted analysis of ground reaction forces as players took-off and landed from full-speed spike jumps. Simulated volleyball court with net in a biomechanics research laboratory. 10 members of the Canadian Men's National Volleyball Team. From history and physical examination, 3 of the 10 players had patellar tendon pain associated with activity and were diagnosed with patellar tendinopathy at the time of the study. Investigators were blinded about the injury status of the players. None. Three-dimensional kinematics and joint moments of the ankle, knee, and hip joints. Our analysis revealed that maximal external tibial rotation occurred at or near maximal dorsiflexion while maximal internal tibial rotation coincided with maximal plantarflexion. The plantarflexion moment was 3 to 10 times greater than all the other moments measured, with the maximal plantarflexor moment being calculated at 0.4 BWm (360 Nm). In blinded logistic regression analyses, we found one of the dynamics variables (inversion moment during the landing of the spike jump) was a significant predictor of patellar tendinopathy. Coupling the results of the current analysis of ankle joint complex dynamics with previously reported results of knee joint dynamics related to patellar tendinopathy suggests that a cluster of variables linked to patellar tendinopathy includes: high ankle inversion-eversion moments, high external tibial rotation and plantarflexion moments, large vertical ground reaction forces, and high rate of knee extensor moment development.

  8. Tear patterns, surgical repair, and clinical outcomes of patellar tendon ruptures after anterior cruciate ligament reconstruction with a bone-patellar tendon-bone autograft.

    Science.gov (United States)

    Benner, Rodney W; Shelbourne, K Donald; Urch, Scott E; Lazarus, David

    2012-08-01

    Patellar tendon ruptures are rare after graft harvest for anterior cruciate ligament (ACL) reconstruction. Few reports are available in the literature. To report the common tear patterns and results of treatment with tendon repair and cable augmentation. Case series; Level of evidence, 4. All tendon ruptures were repaired to bone with suture anchors and augmented with a Dall-Miles cable, followed by an aggressive rehabilitation protocol. The tear location was recorded. Range of motion, strength, and subjective survey testing were conducted preoperatively and postoperatively. Thirteen patellar tendon ruptures were found from our database of 5364 ACL reconstructions, for an incidence of 0.24%. Seven ruptures occurred from the patellar origin medially and the tibial attachment laterally in a Z-shaped pattern. Four were completely distal, and 2 were completely proximal ruptures. All patients exhibited early flexion loss, but 11 of 13 patients maintained full, terminal hyperextension throughout treatment. The mean postoperative side-to-side flexion deficit was 33° at 1 month, 6° at 3 months, and 3° at latest follow-up at a mean of 4.8 years after tendon repair (range, 1-16 years). By International Knee Documentation Committee (IKDC) criteria, 10 patients had normal flexion, and 3 were nearly normal at latest follow-up. Twelve patients had normal extension, and 1 had nearly normal extension at latest follow-up. Mean isokinetic quadriceps muscle strength was 68.7% of the other side at 3 months after repair and 100.0% at latest follow-up, occurring at a mean of 47.5 months (range, 12-120 months). At a mean of 2 years (range, 1-4 years) after repair, the mean modified Noyes subjective score was 89.8 ± 9.2. Patellar tendon ruptures are rare after ACL graft harvest. These ruptures usually occur in either a proximal-medial and distal-lateral pattern or an entirely distal pattern, in contrast to the proximal-only tear pattern commonly observed in unharvested patellar

  9. Reading visual Braille with a retinal prosthesis

    Directory of Open Access Journals (Sweden)

    Thomas Zaccarin Lauritzen

    2012-11-01

    Full Text Available Retinal prostheses, which restore partial vision to patients blinded by outer retinal degeneration, are currently in clinical trial. The Argus II retinal prosthesis system was recently awarded CE approval for commercial use in Europe. While retinal prosthesis users have achieved remarkable visual improvement to the point of reading letters and short sentences, the reading process is still fairly cumbersome. This study investigates the possibility of using an epiretinal prosthesis to stimulate visual Braille as a sensory substitution for reading written letters and words. The Argus II retinal prosthesis system, used in this study, includes a 10 x 6 electrode array implanted epiretinally, a tiny video camera mounted on a pair of glasses, and a wearable computer that processes the video and determines the stimulation current of each electrode in real time. In the Braille reading system, individual letters are created by a subset of dots from a 3 by 2 array of six dots. For the visual Braille experiment, a grid of six electrodes was chosen out of the 10 x 6 Argus II array. Groups of these electrodes were then directly stimulated (bypassing the camera to create visual percepts of individual Braille letters. Experiments were performed in a single subject. Single letters were stimulated in an alternative forced choice (AFC paradigm, and short 2-4-letter words were stimulated (one letter at a time in an open-choice reading paradigm. The subject correctly identified 89% of single letters, 80% of 2-letter, 60% of 3-letter, and 70% of 4-letter words. This work suggests that text can successfully be stimulated and read as visual Braille in retinal prosthesis patients.

  10. Reading visual braille with a retinal prosthesis.

    Science.gov (United States)

    Lauritzen, Thomas Z; Harris, Jordan; Mohand-Said, Saddek; Sahel, Jose A; Dorn, Jessy D; McClure, Kelly; Greenberg, Robert J

    2012-01-01

    Retinal prostheses, which restore partial vision to patients blinded by outer retinal degeneration, are currently in clinical trial. The Argus II retinal prosthesis system was recently awarded CE approval for commercial use in Europe. While retinal prosthesis users have achieved remarkable visual improvement to the point of reading letters and short sentences, the reading process is still fairly cumbersome. This study investigates the possibility of using an epiretinal prosthesis to stimulate visual braille as a sensory substitution for reading written letters and words. The Argus II retinal prosthesis system, used in this study, includes a 10 × 6 electrode array implanted epiretinally, a tiny video camera mounted on a pair of glasses, and a wearable computer that processes the video and determines the stimulation current of each electrode in real time. In the braille reading system, individual letters are created by a subset of dots from a 3 by 2 array of six dots. For the visual braille experiment, a grid of six electrodes was chosen out of the 10 × 6 Argus II array. Groups of these electrodes were then directly stimulated (bypassing the camera) to create visual percepts of individual braille letters. Experiments were performed in a single subject. Single letters were stimulated in an alternative forced choice (AFC) paradigm, and short 2-4-letter words were stimulated (one letter at a time) in an open-choice reading paradigm. The subject correctly identified 89% of single letters, 80% of 2-letter, 60% of 3-letter, and 70% of 4-letter words. This work suggests that text can successfully be stimulated and read as visual braille in retinal prosthesis patients.

  11. The Phenix expandable prosthesis: early American experience.

    Science.gov (United States)

    Wilkins, R M; Soubeiran, A

    2001-01-01

    One of the major dilemmas in limb preservation in skeletally immature children involves the ability to maintain leg length equality. Many attempts have been made to design a prosthesis that could be expanded easily either nonoperatively or through a minor surgical procedure. Most of these designs have had mechanical difficulty or the lengthening procedure becomes a major surgical endeavor. The Phenix technology has been used in France for several years. The basic principle involves storage of energy in a spring which is maintained compressed by an original locking system. Once implanted, prosthetic lengthening is achieved via exposure to an external electromagnetic field that pilots the locking system and allows controlled release of the spring energy. Seven Phenix prostheses have been implanted in six patients. All patients had been treated for Stage II-B osteosarcoma. Six of the seven prostheses were implanted during revision procedures in salvage situations; one prosthesis was implanted during an index procedure. The surgical procedures were completed without complications. One patient sustained a fracture of the prosthesis in a fall and had an infection develop after implantation of the second prosthesis. Twenty-one expansions have been performed in six patients (mean lengthening at each procedure, 8 mm). There were no acute complications attributable to the lengthening procedure. Prosthetic expansions required an average of 20 to 30 seconds and were accompanied by very mild discomfort, if any. Most patients were given an oral analgesic either before or during the lengthening procedure. The Phenix prosthesis shows promise in handling the difficult problem of limb preservation in a growing child. Additional investigation is underway regarding limb lengthening and other dynamic applications.

  12. [Acute bilateral lesion of the patellar tendon associated to diabetes mellitus. Case report].

    Science.gov (United States)

    Ramírez-Castillo, Héctor David; Carbajal-Contreras, Rubén; González-Morales, Diana Deyanira

    2010-01-01

    The bilateral patellar tendon tear is very infrequent. Various pathological conditions may affect the extensor mechanism including kidney disease, diabetes mellitus, hyperparathyroidism, rheumatoid arthritis, systemic lupus erythematosus, osteomalacia, infection, obesity, corticosteroid therapy and even osteogenesis imperfect. We present the case of a 43-year-old male with a history of type-2 diabetes mellitus, systemic hypertension and exogenous obesity, who sustained a bilateral patellar tendon tear. He received surgical and medical treatment and was followed-up for one year, with satisfactory functional outcomes.

  13. What is the Natural History of Patellar Dislocation in Skeletally Immature Patients?

    Science.gov (United States)

    Sanders, Thomas L.; Pareek, Ayoosh; Hewett, Timothy E.; Stuart, Michael J.; Dahm, Diane L.; Krych, Aaron John

    2017-01-01

    Objectives: Patellar dislocation can occur in isolation or be associated with chronicinstability. The goals of this study are to describe the rate and factors associated with additional patellar instability events (ipsilateral recurrence and contralateral dislocation), as well as the incidence of patellofemoral arthritis among skeletally immature patients following patellar dislocation. Methods: The study included a population-based cohort of 232 skeletally immature patients who experienced a first-time lateral patellar dislocation between 1990 and 2010. A chart review was performed to collect information related to the initial injury, treatment, and outcomes. Subjects were followed for a mean of 12.1 years to determine the rate of subsequent patellar dislocation (ipsilateral recurrence or contralateral dislocation) as well as clinically significant patellofemoral arthritis. Results: 104 patients had ipsilateral recurrent patellar dislocation. The cumulative incidence of recurrent dislocation was 11% at 1 year, 21.1% at 2 years, 37.0% at 5 years, 45.1% at 10 years, 54.0 % at 15 years, and 54.0% at 20 years. Patella alta (HR: 10.6, 95% CI: 3.6, 36.1), increased TT-TG distance (HR 18.7, 95% CI: 1.7, 228.2), and trochlear dysplasia (HR 23.7, 95% CI: 1.0, 105.2) were associated with recurrence. Similarly, 18 patients (7.8%) had contralateral patellar dislocation. The cumulative incidence of patellofemoral arthritis was 0% at 2 years, 1.0% at 5 years,2.0% at 10 years, 10.1% at 15 years, 17%% at 20 years, and 39.0% at 25 years. Osteochondral injury was associated with arthritis (HR 25.7, 95% CI: 6.2, 143.8). Conclusion: Skeletally immature patients have a high rate of recurrent patellarinstability that is associated with structural abnormalities such as patella alta and trochlear dysplasia. In contrast, the rate of subsequent contralateral dislocation is low. Osteochondral injury is associated with arthritis after patellar dislocation, but the overall incidence of

  14. Comparison of energy cost in transtibial amputees using "prosthesis" and "crutches without prosthesis" for walking activities.

    Science.gov (United States)

    Mohanty, R K; Lenka, P; Equebal, A; Kumar, R

    2012-05-01

    In a survey of 100 transtibial amputees (TTA) in the study place, it was noticed that nearly 30% of total activities performed by crutches. It was recorded nearly 52% of the amputees were totally independent, 39% had to use a crutch or cane and only 9% need not used any devices simply because they are unaware of current technology or availability. Out of 39 TTA, nine used crutches only for performing daily activities while 30 used both prosthesis and crutch. Walking is a major activity in lower limb amputees and therefore it is imperative to know the energy cost in both the mobility devices (prosthesis and crutches without prosthesis) for walking activities. The purpose of this study was to quantify and compare the difference in energy cost between the two most commonly used assistive devices (prosthesis and axillary crutches) in adults with Transtibial amputation by indirect calorimetric method at the self-selected speed in plane surface walking. Thirty adults who had a unilateral transtibial amputation participated in this study. Oxygen consumption was measured with a Cosmed K4 b(2) oxygen analysis telemetry unit (Rome, Italy) as the participants walked over level ground for 30 meters at a self-selected speed. The variables that were analyzed were VO(2) rate (mL/min), VO(2) cost (mL/kg/m), heart rate (bpm), self-selected walking velocity (m/min) and energy expenditure per minute (Kcal/min). It was observed that VO(2) uptake rate and EE comparisons were highly significant for both prosthesis and crutches without prosthesis walking in adults with transtibial amputation (Ptranstibial amputation using prosthesis walked with 21% more efficient in terms of VO(2) uptake rate and 92% more efficient in terms of EE/min as compared to crutches without prosthesis. The data on energy cost indicates that all below knee amputee groups walk with less effort by using prosthesis. It may be concluded that crutches without prosthesis may not be used as a permanent rehabilitative

  15. Treatment Options for Patellar Tendinopathy: A Systematic Review.

    Science.gov (United States)

    Everhart, Joshua S; Cole, Devon; Sojka, John H; Higgins, John D; Magnussen, Robert A; Schmitt, Laura C; Flanigan, David C

    2017-04-01

    To compare the efficacy of common invasive and noninvasive patellar tendinopathy (PT) treatment strategies. A systematic search was performed in PubMed, Google Scholar, CINAHL, UptoDate, Cochrane Reviews, and SPORTDiscus. Fifteen studies met the following inclusion criteria: (1) therapeutic outcome trial for PT, and (2) Victorian Institute of Sports Assessment was used to assess symptom severity at follow-up. Methodological quality and reporting bias were evaluated with a modified Coleman score and Begg's and Egger's tests of bias, respectively. A total of 15 studies were included. Reporting quality was high (mean Coleman score 86.0, standard deviation 9.7), and there was no systematic evidence of reporting bias. Increased duration of symptoms resulted in poorer outcomes regardless of treatment (0.9% decrease in improvement per additional month of symptoms; P = .004). Eccentric training with or without core stabilization or stretching improved symptoms (61% improvement in the Victorian Institute of Sports Assessment score, 95% confidence interval [CI] 53% to 69%). Surgery in patients refractory to nonoperative treatment also improved symptoms (57%, 95% CI 52% to 62%) with similar outcomes among arthroscopic and open approaches. Results from shockwave (54%, 95% CI 22% to 87%) and platelet-rich plasma (PRP) studies (55%, 95% CI 5% to 105%) varied widely though PRP may accelerate early recovery. Finally, steroid injection provided no benefit (20%, 95% CI -20% to 60%). Initial treatment of PT can consist of eccentric squat-based therapy, shockwave, or PRP as monotherapy or an adjunct to accelerate recovery. Surgery or shockwave can be considered for patients who fail to improve after 6 months of conservative treatment. Corticosteroid therapy should not be used in the treatment of PT. Level IV, systematic review of Level II-IV studies. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  16. Mobile Bearing Total Knee Arthroplasty for Valgus Knee Osteoarthritis with Permanent Patellar Dislocation: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Kohei Kamada

    2017-01-01

    Full Text Available Permanent patellar dislocation with tibiofemoral joint osteoarthritis is a relatively rare condition. To treat this condition, total knee arthroplasty with proximal or distal realignment of the extensor mechanism has been reported. We report a challenging case of an 80-year-old woman diagnosed with permanent patellar dislocation with tibiofemoral joint osteoarthritis treated by a mobile bearing total knee arthroplasty utilizing navigation system. Lateral retinaculum release was performed to improve patellar tracking; other proximal or distal realignment of the extensor mechanism was not necessary. Postoperative radiographs show stable patellar tracking and recurrent patellar dislocation was not observed. This clinical case indicates that the implant’s precise alignment and rotation during total knee arthroplasty could settle anatomical abnormalities of permanent patellar dislocation and the mobile bearing insert could contribute to stabilizing patellar tracking.

  17. Trabecular metal patella--is it really doomed to fail in the totally patellar-deficient knee? A case report of patellar reconstruction with a novel technique.

    Science.gov (United States)

    Kumar Nanjayan, Shashi; Wilton, Timothy

    2014-06-01

    Reconstruction of the patella poses real problems for the revision TKR surgeon, particularly when the patella is absent, fractured or profoundly deficient. The trabecular metal patella was introduced in an attempt to address these issues. However the largest series of such cases published to date cast serious doubts on the validity of using Trabecular Metal (TM) in cases where there is no residual patellar bone stock at all. We present a case where the TM Patellar implant has survived satisfactorily for 8 years post reconstruction in a knee with no residual patella bone, resulting in greatly improved symptoms and function. We believe that this success might be related to specific technical details in the reconstruction and we present the technique. Copyright © 2014 Elsevier B.V. All rights reserved.

  18. Proposal of e-learning strategy to teach Atraumatic Restorative Treatment (ART) to undergraduate and graduate students

    Science.gov (United States)

    2014-01-01

    Background The aim of this study was to evaluate e-learning strategy in teaching Atraumatic Restorative Treatment (ART) to undergraduate and graduate students. The sample comprised 76 participants—38 dental students and 38 pediatric dentistry students—in a specialization course. To evaluate knowledge improvement, participants were subjected to a test performed before and after the course. Results A single researcher corrected the tests and intraexaminer reproducibility was calculated (CCI = 0.991; 95% IC = 0.975–0.996). All students improved their performances after the e-learning course (Paired t-tests p ART. Mature students perform better in this teaching modality when it is applied exclusively via distance learning. PMID:25034167

  19. Jumper's knee or lander's knee? A systematic review of the relation between jump biomechanics and patellar tendinopathy.

    Science.gov (United States)

    Van der Worp, H; de Poel, H J; Diercks, R L; van den Akker-Scheek, I; Zwerver, J

    2014-07-01

    Patellar tendinopathy (jumper's knee) is a common injury in sports that comprise jump actions. This article systematically reviews the literature examining the relation between patellar tendinopathy and take-off and landing kinematics in order to uncover risk factors and potential prevention strategies. A systematic search of the Pubmed, Embase and Amed databases was performed to identify studies that reported kinematics of sport specific jumps in relation to patellar tendinopathy. A quantitative analysis was performed on 4 indentified studies. Differences were found only between controls and asymptomatic subjects with patellar tendon abnormalities. Most differences were found during horizontal landing after forward acceleration. A synthesis of the literature suggests that horizontal landing poses the greatest threat for developing patellar tendinopathy. A stiff movement pattern with a small post-touchdown range of motion and short landing time is associated with the onset of patellar tendinopathy. Accordingly, employing a flexible landing pattern seems to be an expedient strategy for reducing the risk for (re-) developing patellar tendinopathy. Together, these findings indicate that improving kinetic chain functioning, performing eccentric exercises and changing landing patterns are potential tools for preventive and/or therapeutic purposes. © Georg Thieme Verlag KG Stuttgart · New York.

  20. Platelet-rich plasma: evidence for the treatment of patellar and Achilles tendinopathy--a systematic review.

    Science.gov (United States)

    Di Matteo, B; Filardo, G; Kon, E; Marcacci, M

    2015-04-01

    Platelet-rich plasma (PRP) has been introduced in the clinical practice to treat a growing number of different musculoskeletal pathologies. It is currently applied in the treatment of Achilles and patellar tendinopathies, which are common sport-related injuries very challenging to manage. Aim of the present paper was to review systematically the available clinical evidence concerning the application of PRP in the treatment of patellar and Achilles tendinopathy. A systematic review of the literature was performed according to the following inclusion criteria for relevant articles: (1) clinical reports of any level of evidence, (2) written in the English language, (3) with no time limitation and (4) on the use of PRP to treat conservatively Achilles and patellar tendinopathy. Twenty-two studies were included and analyzed. Two studies on patellar tendinopathy were randomized controlled trials (RCTs), whereas just one RCT was published on Achilles tendon. All the papers concerning patellar tendon reported positive outcome for PRP, which proved to be superior to other traditional approaches such as shock-wave therapy and dry needling. In the case of Achilles tendon, despite the encouraging findings reported by case series, the only RCT available showed no significant clinical difference between PRP and saline solution. The main finding of this study was the paucity of high-level literature regarding the application of PRP in the management of patellar and Achilles tendinopathy. However, the clinical data currently available, although not univocal, suggest considering PRP as a therapeutic option for recalcitrant patellar and Achilles tendinopathies.

  1. Optimal patellar alignment with minimally invasive approaches in total knee arthroplasty after a minimum five year follow-up.

    Science.gov (United States)

    Huang, Ai-Bing; Wang, Hai-Jun; Yu, Jia-Kuo; Yang, Bo; Ma, Dong; Zhang, Ji-Ying

    2016-03-01

    Patellofemoral syndrome is still a common complication after total knee arthroplasty (TKA). However, the effects of specific surgical approaches on patellar tracking and alignment remain incompletely understood. In this study, we compared patellar alignment in patients who underwent TKA via three different techniques. A total of 96 patients who completed a minimum follow-up of five years were involved in three groups: 30 patients were treated with the traditional medial parapatellar approach (MPP group), 35 patients were treated with the mini-medial parapatellar approach (MMP group) and 31 were treated with a quadriceps-sparing approach (QS group). Radiographic data for patellar alignment and clinical results were compared. Patellar tilt and patellar displacement at the final follow-up evaluation differed significantly among the three groups [P  0.05, ANOVA). In addition, there were no correlations between postoperative patellar alignment and clinical scores. The results of this study indicate that TKA performed using minimally invasive approaches yields superior patellar alignment compared to the traditional MPP approach.

  2. Impact of Patellar Tendinopathy on Knee Proprioception: A Cross-Sectional Study.

    Science.gov (United States)

    Torres, Rui; Ferreira, João; Silva, Diogo; Rodrigues, Elisa; Bessa, Isabel M; Ribeiro, Fernando

    2017-01-01

    To determine whether high-level athletes with patellar tendinopathy have diminished knee proprioceptive acuity. Cross-sectional study. University research laboratory (institutional). Twenty-one basketball and volleyball players with patellar tendinopathy (13 men and 8 women; mean age 24.5 ± 3.6; body mass index = 22.5 ± 2.0 kg/m) and an equal number of athletes without symptoms of patellar tendinopathy injury were included in this study. Participants underwent knee proprioception assessments on a single day. Furthermore, age, sex, height, weight, VISA-P (Victorian Institute of Sport Assessment) questionnaire sports participation, medical history, knee injuries, previous treatment, and medication were obtained. Knee proprioception was evaluated by assessing sense of resistance, using a weight discrimination protocol, and joint position sense (JPS). No significant differences were observed in JPS at 30 and 60 degrees of knee flexion between groups (P = 0.165 and 0.481, respectively). In regard to the ability to discriminate weight, significant differences between the 2 groups were found with the tendinopathy group showing a higher percentage of error (P = 0.009), namely when the set of incremental weights varied by 10% from the standard weight. Athletes with patellar tendinopathy have a diminished perception of force signals required for weight discrimination, whereas JPS remains unaffected in these athletes.

  3. Corticosteroid injections, eccentric decline squat training and heavy slow resistance training in patellar tendinopathy

    DEFF Research Database (Denmark)

    Kongsgaard, M; Kovanen, V; Aagaard, P

    2009-01-01

    A randomized-controlled single-blind trial was conducted to investigate the clinical, structural and functional effects of peritendinous corticosteroid injections (CORT), eccentric decline squat training (ECC) and heavy slow resistance training (HSR) in patellar tendinopathy. Thirty-nine male...

  4. [Treatment of unrecent patellar tendon tear with semitendinous and gracilis tendons].

    Science.gov (United States)

    Estrada-Malacón, C A; García-Estrada, G A

    2011-01-01

    The patellar tendon lesion is very important due to the role of this tendon on the conformation of the extensor mechanism of the quadriceps. When the terminal end of this mechanism is injured, the extensor function of the knee is completely lost and thus the functional capability of the involved limb is completely disrupted.

  5. MRI evaluation of patellar tendon defect after harvesting its central third

    Energy Technology Data Exchange (ETDEWEB)

    Koseoglu, Kutsi E-mail: kutsikoseoglu@yahoo.com; Memis, Aysenur; Argin, Mehmet; Arkun, Remide

    2004-06-01

    Purpose: the purpose of this study was to evaluate defect width of patellar tendon after harvest for anterior cruciate ligament reconstruction. Materials and methods: we performed MRI at various time interval after graft harvest (2-96 months) on 28 patients who had had reconstruction of the anterior cruciate ligament using mid-third patellar tendon. T1 and T2 weighted axial images were obtained to assess donor site defect of the patellar tendon. Measurement of the defect width was performed at the level of menisci on the axial images. The patients were divided into two groups according to the time interval between operation and imaging. The defect width of patients with short time interval (2-12 months) was compared to the defect width of patients with long time interval (12-96 months). Results: the average defect width of patients with short time interval was 6.4 mm and it was 2.2 mm for the patients with long time interval. Decreased defect width was obtained from MRI images in the patients with long time interval. Closed donor site defect was detected in 1 out of 14 patients with short time interval and 6 out of 14 patients with long time interval. Discussion and conclusion: these results show that there is no complete closure of donor site defect up to 1 year. However, it seems to be nearly complete closure of patellar tendon defect in the long time period.

  6. Knee function after anterior cruciate ligament reconstruction with patellar or hamstring tendon: a meta-analysis.

    Science.gov (United States)

    Shi, Dong-Liang; Yao, Zhen-Jun

    2011-12-01

    There is currently no consensus regarding the best graft type for anterior cruciate ligament reconstruction. Therefore, the aim of this study was to investigate the effects of patellar and hamstring tendon grafts on long-term knee function after anterior cruciate ligament reconstruction. This meta-analysis was conducted according to the methodological guidelines outlined by the Cochrane Collaboration. An electronic search of the literature was performed and all trials published between January 1966 and August 2011 comparing knee function after anterior cruciate ligament reconstruction using patellar tendon grafts with knee function after reconstruction with hamstring tendon grafts were pooled. Six studies were included in the final meta-analysis. Anterior cruciate ligament reconstruction using hamstring tendon grafts resulted in greater pain upon kneeling than reconstruction using patellar tendon grafts (P = 0.001). However, both grafts resulted in similar levels of anterior tibial translation, and similar results regarding isokinetic extension/flexion tests, Lysholm scores, and the stair-hop test (P > 0.05). Anterior cruciate ligament reconstruction using patellar or hamstring tendon grafts results in similar long-term knee function.

  7. Tensile force transmission in human patellar tendon fascicles is not mediated by glycosaminoglycans

    DEFF Research Database (Denmark)

    Svensson, René B; Hassenkam, Tue; Hansen, Philip

    2011-01-01

    the mechanical properties of fascicles from human patellar tendon at two different deformation rates before and after removal of GAGs by treatment with chondroitinase ABC. Efficiency of enzyme treatment was quantified using dimethylmethylene blue assay. Removal of at least 79% of the GAGs did not significantly...

  8. Progression of patellar tendinitis following treatment with platelet-rich plasma: case reports

    NARCIS (Netherlands)

    Bowman, Karl F.; Muller, Bart; Middleton, Kellie; Fink, Christian; Harner, Christopher D.; Fu, Freddie H.

    2013-01-01

    The use of platelet-rich plasma (PRP) is becoming more attractive given its favourable side effect profile and autologous nature, leading to rapid clinical adoption in the absence of high-level evidence. We are presenting three patients who developed a progression of patellar tendinitis following

  9. Pain assessment in patellar tendinopathy using pain pressure threshold algometry: : An observational study

    NARCIS (Netherlands)

    Kregel, Jeroen; van Wilgen, Cornelis Paul; Zwerver, Johannes

    2013-01-01

    ObjectiveAssessing pain in patellar tendinopathy (PT) is difficult to perform in a standardized way. With this study, we measured pain in athletes with PT by means of pain pressure threshold (PPT) algometry in a standardized manner. Subsequently, the goal of this study is to determine normative

  10. Prevalence, genetics, and surgical treatment of patellar luxation in purebred dogs

    NARCIS (Netherlands)

    Wangdee, C.

    2014-01-01

    Patellar luxation (PL) is a common cause of lameness in small-breed dogs. The aims of the study are to investigate the outcome of surgical treatment of medial PL (MPL) using standard techniques, and a novel surgical technique in Pomeranians for treating bidirectional PL (BPL), and to study the

  11. Risk factors for patellar tendinopathy in basketball and volleyball players : A cross-sectional study

    NARCIS (Netherlands)

    Van der Worp, H.; Van Ark, M.; Zwerver, J.; Van den Akker-Scheek, I.

    2012-01-01

    Patellar tendinopathy (PT) has a multifactorial etiology, and many possible risk factors have been described in the literature. The findings are conflicting, though, and most research has been conducted on elite athletes. The aim of the current study is to determine the risk factors for PT in a

  12. The impact of patellar tendinopathy on sports and work performance in active athletes

    NARCIS (Netherlands)

    De Vries, Astrid J; Koolhaas, Wendy; Zwerver, Johannes; Diercks, Ron L.; Nieuwenhuis, Kari; Van Der Worp, Henk; Brouwer, Sandra; Van Den Akker-Scheek, Inge

    2017-01-01

    Greater insight into sports and work performance of athletes with patellar tendinopathy (PT) will help establish the severity of this common overuse injury. Primary aim of this study is to investigate the impact of PT on sports and work performance. Seventy seven active athletes with PT (50 males;

  13. Risk factors for patellar tendinopathy : A systematic review of the literature

    NARCIS (Netherlands)

    van der Worp, Henk; van Ark, Mathijs; Roerink, Saskia; Pepping, Gert-Jan; van den Akker-Scheek, Inge; Zwerver, Johannes

    Patellar tendinopathy (PT) is an injury with a high prevalence in sports. Knowledge of risk factors is essential for developing preventive measures and rehabilitation programmes. However, risk factors associated with PT have not yet been systematically studied. This review was undertaken to identify

  14. Treatment of Chronic Patellar Tendinopathy with Autologous Bone Marrow Stem Cells: A 5-Year-Followup

    Directory of Open Access Journals (Sweden)

    Cecilia Pascual-Garrido

    2012-01-01

    Full Text Available The purpose of this study is to determine if patients with chronic patellar tendinopathy will improve clinically after the inoculation of bone marrow mononuclear cells (BM-MNCs. Eight patients with chronic patellar tendinopathy were included. Patients averaged 24 years old (range 14–35. All patients were refractory to conservative treatment for at least 6 months before the procedure. BM-MNCs were harvested from the iliac bone crest and inoculated under ultrasound guide in the patellar tendon lesion. Improvement was assessed through established clinical scores and ultrasound. At 5-year followup, statistically significant improvement was seen for most clinical scores. Seven of eight patients said they would have the procedure again if they had the same problem in the opposite knee and were completely satisfied with the procedure. Seven of 8 patients thought that the results of the procedure were excellent. According to our results, inoculation of BM-MNCs could be considered as a potential therapy for those patients with chronic patellar tendinopathy refractory to nonoperative treatments.

  15. Medium-term evaluation of total knee arthroplasty without patellar replacement

    Directory of Open Access Journals (Sweden)

    José Wanderley Vasconcelos

    2013-06-01

    Full Text Available OBJECTIVE: To mid-term evaluate patients who were submitted to total knee arthroplasty without patellar resurfacing. METHODS: It was realized a retrospective cross-sectional study of patients who were submitted to total knee arthroplasty without patellar resurfacing. In all patients clinical examination was done based on the protocol of the Knee Society Scoring System, which assessed pain, range of motion, stability, contraction, knee alignment and function, and radiological evaluation. RESULTS: A total of 36 patients were evaluated. Of these, 07 were operated only on left knee, 12 only on right knee and 17 were operated bilaterally, totaling 53 knees. Ages ranged from 26 to 84 years. Of the 53 knees evaluated, 33 (62.26% had no pain. The maximum flexion range of motion averaged 104.7°. No knee had difficulty in active extension. As to the alignment for anatomical axis twelve knees (22.64% showed deviation between 0° and 4° varus. Thirty-nine (75.49% knees showed pace without restriction and the femorotibial angle ranged between 3° varus and 13° valgus with an average of 5° valgus. The patellar index ranged from 0.2 to 1.1. CONCLUSION: Total knee arthroplasty whitout patellar resurfacing provides good results in mid-term evaluation.

  16. Patient satisfaction with Mentor inflatable penile prosthesis.

    Science.gov (United States)

    Whalen, R K; Merrill, D C

    1991-06-01

    Patient satisfaction with the Mentor inflatable penile prosthesis was assessed by sending a thirty-six-item questionnaire to 251 patients who had undergone implantation of the device by the senior author (D.C.M.). A total of 152 (61%) of the patients responded. Recovery time, satisfaction, reasons for dissatisfaction, perceptions of erection quality, and psychosexual parameters were evaluated. Eight-eight percent of the patients were engaging in regular sexual activity. Depending on the definition of satisfaction, 81-89 percent of the respondents reported that they were satisfied with the prosthesis. Sixty-eight percent of the survey group were satisfied with the length, width, and firmness of their prosthetic-induced erection. The majority of patients reported improvement in psychosexual functioning after implantation. Reasons for dissatisfaction included inadequate penile length, insufficient firmness, and difficulty with inflation and deflation of the penile cylinders.

  17. Midterm results of "thrust plate" prosthesis.

    Science.gov (United States)

    Fink, Bernd; Wessel, Stephanie; Deuretzbacher, Georg; Protzen, Michael; Ruther, Wolfgang

    2007-08-01

    The aim of this investigation was to analyze the midterm results obtained with the metaphyseal fixation principle of the thrust plate prosthesis (TPP). Survival of 214 implants in 204 patients was analyzed. Clinical (Harris hip score) and radiologic examinations were carried out on 157 of 190 TPP with a postimplantation follow-up period of at least 5 years. Failure rate was 7.0% (9 aseptic and 6 septic loosening). Harris hip score increased from 36.9 +/- 13.5 points preoperatively to 91.2 +/- 13.1 points at follow-up. Eleven TPPs showed radiolucent lines not indicating prosthetic loosening. Thrust plate prosthesis is not an alternative to stemmed endoprostheses. It may be rarely indicated in very young patients where, because of their age, several revision operations can be expected.

  18. Tracheobronchial Foreign Body Aspiration: Dental Prosthesis

    Directory of Open Access Journals (Sweden)

    Ataman Köse

    2014-01-01

    Full Text Available It is important to extract foreign bodies for avoiding life-threatening complications. They can lead to death if they are not treated. Different signs and symptoms could occur according to the complete or partial airway obstruction. Foreign body aspiration is a rare incident in adults. The organic foreign materials such as foods are found to be aspirated more commonly and are usually settled in the right bronchial system. However, dental prosthesis and teeth aspirations are rare in literature. In our study, a 52-year-old male patient who had aspirated the front part of his lower dental prosthesis accidentally is presented and the foreign body is extracted by using rigid bronchoscopy. There are many causes of aspiration but dental prosthetic aspirations should be kept in mind during sleep. For this reason, dental apparatus must be taken out while asleep.

  19. Primary patellar dislocations without surgical stabilization or recurrence: how well are these patients really doing?

    Science.gov (United States)

    Magnussen, Robert A; Verlage, Megan; Stock, Elizabeth; Zurek, Lauren; Flanigan, David C; Tompkins, Marc; Agel, Julie; Arendt, Elizabeth A

    2017-08-01

    While a significant research has gone into identifying patients at highest risk of recurrence following primary patellar dislocation, there has been little work exploring the outcomes of patients who do not have a recurrent patellar dislocation. We hypothesize that patients without recurrent dislocation episodes will exhibit significantly higher KOOSs than those who suffer recurrent dislocations, but lower scores than published age-matched normative data. A retrospective review of patients with nonoperatively treated primary lateral patellar dislocations was carried out, and patients were contacted at a mean of 3.4 years (range 1.3-5.5 years) post-injury. Information regarding subsequent treatment and recurrent dislocations along with patient-reported outcome scores and activity level was collected. One hundred and eleven patients (29.8 %) of 373 eligible patients agreed to study participation, seven of whom were excluded because they underwent subsequent patellar stabilization surgery on the index knee. Seventy-six patients (73.1 %) reported no further dislocation events, and the mean KOOS subscales at follow-up were: symptoms-80.2 ± 18.8, pain-81.8 ± 16.2, ADL-88.7 ± 15.9, sport/recreation-72.1 ± 24.4, and QOL-63.9 ± 23.8 at a mean follow-up of 3.3 years (range 1.3-5.5 years). No significant differences in any of the KOOS subscales were noted between these patients and the group that reported recurrent patellar dislocations. Only 26.4 % of the patients without further dislocations reported they were able to return to desired sport activities without limitations following their dislocation. Patients who do not report recurrent patellar dislocations following nonoperative treatment of primary patellar dislocations are in many cases limited by this injury 3 years following the initial dislocation event. Retrospective cohort study, Level III.

  20. [Secondary intervention after hip prosthesis (author's transl)].

    Science.gov (United States)

    Suezawa, Y; Dietschi, C

    1977-04-01

    From 1965-1975 in the orthopedical Univ. Clinic Balgrist, Zurich, there were 177 reoperations after total hip prostheses necessary. In 91 replacements the interval between first and second operation was an average of 4.1 years, in 67 prosthesis-removements 2.1 years. The follow-up showed a relationship between bacteriological culture taken before and during operation and clinical results. The decision to change or remove the prostheses should be made on the positive or negative bacteriological results.

  1. Control of dental prosthesis system with microcontroller.

    Science.gov (United States)

    Kapidere, M; Müldür, S; Güler, I

    2000-04-01

    In this study, a microcontroller-based electronic circuit was designed and implemented for dental prosthesis curing system. Heater, compressor and valve were controlled by 8-bit PIC16C64 microcontroller which is programmed using MPASM package. The temperature and time were controlled automatically by preset values which were inputted from keyboard while the pressure was kept constant. Calibration was controlled and the working range was tested. The test results showed that the system provided a good performance.

  2. Gingival prosthesis: A treatment modality for recession

    Directory of Open Access Journals (Sweden)

    Pallavi Samatha Yalamanchili

    2013-01-01

    Full Text Available Gingival recession caused due to periodontal disease disturbs patients because of sensitivity and esthetics. Gingival prosthesis may be fixed or removable and can be made from silicones, acrylics, composite resins or ceramics according to what is best suited for the case. The gingival veneer is esthetically appealing and easy to maintain. This case report describes the use of gingival veneer as a treatment modality for recession.

  3. Evolution of the patellar sesamoid bone in mammals

    Science.gov (United States)

    Samuels, Mark E.; Regnault, Sophie

    2017-01-01

    The patella is a sesamoid bone located in the major extensor tendon of the knee joint, in the hindlimb of many tetrapods. Although numerous aspects of knee morphology are ancient and conserved among most tetrapods, the evolutionary occurrence of an ossified patella is highly variable. Among extant (crown clade) groups it is found in most birds, most lizards, the monotreme mammals and almost all placental mammals, but it is absent in most marsupial mammals as well as many reptiles. Here, we integrate data from the literature and first-hand studies of fossil and recent skeletal remains to reconstruct the evolution of the mammalian patella. We infer that bony patellae most likely evolved between four and six times in crown group Mammalia: in monotremes, in the extinct multituberculates, in one or more stem-mammal genera outside of therian or eutherian mammals and up to three times in therian mammals. Furthermore, an ossified patella was lost several times in mammals, not including those with absent hindlimbs: once or more in marsupials (with some re-acquisition) and at least once in bats. Our inferences about patellar evolution in mammals are reciprocally informed by the existence of several human genetic conditions in which the patella is either absent or severely reduced. Clearly, development of the patella is under close genomic control, although its responsiveness to its mechanical environment is also important (and perhaps variable among taxa). Where a bony patella is present it plays an important role in hindlimb function, especially in resisting gravity by providing an enhanced lever system for the knee joint. Yet the evolutionary origins, persistence and modifications of a patella in diverse groups with widely varying habits and habitats—from digging to running to aquatic, small or large body sizes, bipeds or quadrupeds—remain complex and perplexing, impeding a conclusive synthesis of form, function, development and genetics across mammalian evolution

  4. Longitudinal performance of an implantable vestibular prosthesis.

    Science.gov (United States)

    Phillips, Christopher; Ling, Leo; Oxford, Trey; Nowack, Amy; Nie, Kaibao; Rubinstein, Jay T; Phillips, James O

    2015-04-01

    Loss of vestibular function may be treatable with an implantable vestibular prosthesis that stimulates semicircular canal afferents with biphasic pulse trains. Several studies have demonstrated short-term activation of the vestibulo-ocular reflex (VOR) with electrical stimulation. Fewer long-term studies have been restricted to small numbers of animals and stimulation designed to produce adaptive changes in the electrically elicited response. This study is the first large consecutive series of implanted rhesus macaque to be studied longitudinally using brief stimuli designed to limit adaptive changes in response, so that the efficacy of electrical activation can be studied over time, across surgeries, canals and animals. The implantation of a vestibular prosthesis in animals with intact vestibular end organs produces variable responses to electrical stimulation across canals and animals, which change in threshold for electrical activation of eye movements and in elicited slow phase velocities over time. These thresholds are consistently lower, and the slow phase velocities higher, than those obtained in human subjects. The changes do not appear to be correlated with changes in electrode impedance. The variability in response suggests that empirically derived transfer functions may be required to optimize the response of individual canals to a vestibular prosthesis, and that this function may need to be remapped over time. This article is part of a Special Issue entitled . Copyright © 2014 Elsevier B.V. All rights reserved.

  5. Supersizing the penis following penile prosthesis implantation.

    Science.gov (United States)

    Shaeer, Osama

    2010-07-01

    Following implantation of a penile prosthesis, some couples are dissatisfied with penile length, girth, shaft, or glans engorgement. This may be delusional because of the procedure per se or preexisting risk factors such as neglected priapism, Peyronie's disease, radical prostatectomy, or overhanging suprapubic fat. In this work, we try to enhance penile size in patients dissatisfied with its dimensions following implantation of a penile prosthesis, using various augmentation techniques. Eighteen patients who have had penile prostheses implanted were enrolled in this study based on dissatisfaction with penile size. The complaint was relieved by counseling and administration of PDE5 inhibitors in seven patients. Two patients had elongation, girth augmentation, and glans injection; six had elongation and girth augmentation; and two had elongation and glans injection. Penile size, satisfaction, and sexual function. Average preoperative length and girth were 7.87 cm and 11.62 cm, respectively. Mean postoperative length and girth were 11.62 cm and 14.07 cm. The gain in length (47.6%) and girth (21%) were statistically significant (P < 0.005). All patients and partners were satisfied with the results following surgery except one who suffered graft loss. Implantation of a penile prosthesis may improve penile rigidity, yet may confound couple's satisfaction with penile size to variable degrees. Sex education may alleviate those concerns. In refractory cases, penile augmentation may enhance phallic size and increase patient/partner satisfaction.

  6. Patellar tendon strain is increased at the site of the jumper's knee lesion during knee flexion and tendon loading: results and cadaveric testing of a computational model.

    Science.gov (United States)

    Lavagnino, Michael; Arnoczky, Steven P; Elvin, Niell; Dodds, Julie

    2008-11-01

    Patellar tendinopathy (jumper's knee) is characterized by localized tenderness of the patellar tendon at its origin on the inferior pole of the patella and a characteristic increase in signal intensity on magnetic resonance imaging at this location. However, it is unclear why the lesion typically occurs in this area of the patellar tendon as surface strain gauge studies of the patellar tendon through the range of motion have produced conflicting results. The predicted patellar tendon strains that occur as a result of the tendon loads and patella-patellar tendon angles (PPTAs) experienced during a jump landing will be significantly increased in the area of the patellar tendon associated with patellar tendinopathy. Descriptive laboratory study. A 2-dimensional, computational, finite element model of the patella-patellar tendon complex was developed using anatomic measurements taken from lateral radiographs of a normal knee. The patella was modeled with plane strain rigid elements, and the patellar tendon was modeled with 8-node plane strain elements with neo-Hookean material properties. A tie constraint was used to join the patellar tendon and patella. Patella-patellar tendon angles corresponding to knee flexion angles between 0 degrees and 60 degrees and patellar tendon strains ranging from 5% to 15% were used as input variables into the computational model. To determine if the location of increased strain predicted by the computational model could produce isolated tendon fascicle damage in that same area, 5 human cadaveric patella-patellar tendon-tibia specimens were loaded under conditions predicted by the model to significantly increase localized tendon strain. Pre- and posttesting ultrasound images of the patella-patellar tendon specimens were obtained to document the location of any injured fascicles. Localized tendon strain at the classic location of the jumper's knee lesion was found to increase in association with an increase in the magnitude of applied

  7. Effects of Training Load and Leg Dominance on Achilles and Patellar Tendon Structure.

    Science.gov (United States)

    Esmaeili, Alireza; Stewart, Andrew M; Hopkins, William G; Elias, George P; Aughey, Robert J

    2017-04-01

    Detrimental changes in tendon structure increase the risk of tendinopathies. The aim of this study was to investigate the influence of individual internal and external training loads and leg dominance on changes in the Achilles and patellar tendon structure. The internal structure of the Achilles and patellar tendons of both limbs of 26 elite Australian footballers was assessed using ultrasound tissue characterization at the beginning and the end of an 18-wk preseason. Linear-regression analysis was used to estimate the effects of training load on changes in the proportion of aligned and intact tendon bundles for each side. Standardization and magnitude-based inferences were used to interpret the findings. Possibly to very likely small increases in the proportion of aligned and intact tendon bundles occurred in the dominant Achilles (initial value 81.1%; change, ±90% confidence limits 1.6%, ±1.0%), nondominant Achilles (80.8%; 0.9%, ±1.0%), dominant patellar (75.8%; 1.5%, ±1.5%), and nondominant patellar (76.8%; 2.7%, ±1.4%) tendons. Measures of training load had inconsistent effects on changes in tendon structure; eg, there were possibly to likely small positive effects on the structure of the nondominant Achilles tendon, likely small negative effects on the dominant Achilles tendon, and predominantly no clear effects on the patellar tendons. The small and inconsistent effects of training load are indicative of the role of recovery between tendon-overloading (training) sessions and the multivariate nature of the tendon response to load, with leg dominance a possible influencing factor.

  8. Patellar Tendon Repair Augmentation With a Knotless Suture Anchor Internal Brace: A Biomechanical Cadaveric Study.

    Science.gov (United States)

    Rothfeld, Alex; Pawlak, Amanda; Liebler, Stephenie A H; Morris, Michael; Paci, James M

    2018-02-01

    Patellar tendon repair with braided polyethylene suture alone is subject to knot slippage and failure. Several techniques to augment the primary repair have been described. Purpose/Hypothesis: The purpose was to evaluate a novel patellar tendon repair technique augmented with a knotless suture anchor internal brace with suture tape (SAIB). The hypothesis was that this technique would be biomechanically superior to a nonaugmented repair and equivalent to a standard augmentation with an 18-gauge steel wire. Controlled laboratory study. Midsubstance patellar tendon tears were created in 32 human cadaveric knees. Two comparison groups were created. Group 1 compared #2 supersuture repair without augmentation to #2 supersuture repair with SAIB augmentation. Group 2 compared #2 supersuture repair with an 18-gauge stainless steel cerclage wire augmentation to #2 supersuture repair with SAIB augmentation. The specimens were potted and biomechanically loaded on a materials testing machine. Yield load, maximum load, mode of failure, plastic displacement, elastic displacement, and total displacement were calculated for each sample. Standard statistical analysis was performed. There was a statistically significant increase in the mean ± SD yield load and maximum load in the SAIB augmentation group compared with supersuture alone (mean yield load: 646 ± 202 N vs 229 ± 60 N; mean maximum load: 868 ± 162 N vs 365 ± 54 N; P load: 495 ± 213 N vs 566 ± 172 N; P = .476; mean maximum load: 737 ± 210 N vs 697 ± 130 N; P = .721). Patellar tendon repair augmented with SAIB is biomechanically superior to repair without augmentation and is equivalent to repair with augmentation with an 18-gauge stainless steel cerclage wire. This novel patellar tendon repair augmentation is equivalent to standard 18-gauge wire augmentation at time zero. It does not require a second surgery for removal, and it is biomechanically superior to primary repair alone.

  9. A national survey of the physiotherapy management of patients following first-time patellar dislocation.

    Science.gov (United States)

    Smith, Toby O; Chester, Rachel; Clark, Allan; Donell, Simon T; Stephenson, Richard

    2011-12-01

    The purpose of this study was to determine how musculoskeletal physiotherapists in acute National Health Service (NHS) hospitals manage patients following a first time patellar dislocation. National survey study. All NHS acute hospitals with an accident and emergency and/or an orthopaedic department were surveyed. 306 institutions were surveyed. Each institution was sent a 14 question self-administered questionnaire pertaining to the assessment, treatment, evaluation and outcome of patients following a first time patellar dislocation. After 3 weeks, all non-respondents were sent a reminder letter. After a further 3 weeks, those who had not responded by this time were sent a final reminder and copy of the questionnaire. The survey response rate was 59%. The respondents indicated that first-time patellar dislocation was not a common musculoskeletal disorder managed by NHS physiotherapists, constituting an average of 2% of caseloads. The results suggested that physiotherapists most commonly assess for reduced quadriceps or VMO capacity, gait, patellar tracking and glide, and knee effusion when examining patients following a first-time patellar dislocation. The most common treatments adopted are reassurance, behaviour modification followed by proprioceptive, knee mobility, quadriceps and specific VMO exercises. Generic lower limb assessment and treatment strategies are widely used to manage this patient group. Given the previous paucity in this literature, further study is now recommended to assess the efficacy of these interventions to provide UK physiotherapists with an evidence-base to justify their management strategies. Copyright © 2011 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  10. The Relationship of Static Tibial Tubercle-Trochlear Groove Measurement and Dynamic Patellar Tracking.

    Science.gov (United States)

    Carlson, Victor R; Sheehan, Frances T; Shen, Aricia; Yao, Lawrence; Jackson, Jennifer N; Boden, Barry P

    2017-07-01

    The tibial tubercle to trochlear groove (TT-TG) distance is used for screening patients with a variety of patellofemoral joint disorders to determine who may benefit from patellar medialization using a tibial tubercle osteotomy. Clinically, the TT-TG distance is predominately based on static imaging with the knee in full extension; however, the predictive ability of this measure for dynamic patellar tracking patterns is unknown. To determine whether the static TT-TG distance can predict dynamic lateral displacement of the patella. Cohort study (Diagnosis); Level of evidence, 2. The static TT-TG distance was measured at full extension for 70 skeletally mature subjects with (n = 32) and without (n = 38) patellofemoral pain. The dynamic patellar tracking patterns were assessed from approximately 45° to 0° of knee flexion by use of dynamic cine-phase contrast magnetic resonance imaging. For each subject, the value of dynamic lateral tracking corresponding to the exact knee angle measured in the static images for that subject was identified. Linear regression analysis determined the predictive ability of static TT-TG distance for dynamic patellar lateral displacement for each cohort. The static TT-TG distance measured with the knee in full extension cannot accurately predict dynamic lateral displacement of the patella. There was weak predictive ability among subjects with patellofemoral pain ( r2 = 0.18, P = .02) and no predictive capability among controls. Among subjects with patellofemoral pain and static TT-TG distances 15 mm or more, 8 of 13 subjects (62%) demonstrated neutral or medial patellar tracking patterns. The static TT-TG distance cannot accurately predict dynamic lateral displacement of the patella. A large percentage of patients with patellofemoral pain and pathologically large TT-TG distances may have neutral to medial maltracking patterns.

  11. Immediately Loaded Intraorally Welded Complete-Arch Maxillary Provisional Prosthesis.

    Science.gov (United States)

    Albiero, Alberto Maria; Benato, Renato; Fincato, Andrea

    2015-01-01

    Guided implant surgery is not completely accurate when using computer-designed stereolithographic surgical guides. Complications are frequently reported when combining computer-guided flapless surgery with an immediately loaded prefabricated prosthesis. Achieving passive fit of a prefabricated prosthesis on the inserted implants the same day of the surgery can be difficult. The aim of this report is to show a new treatment approach to immediately loaded implants inserted with computer-guided surgery using an intraoral welded full-arch provisional prosthesis.

  12. Fabrication of a Cranial Prosthesis Combined with an Ocular Prosthesis Using Rapid Prototyping: A Case Report

    Directory of Open Access Journals (Sweden)

    Gayatri Shankaran

    2016-08-01

    Full Text Available Rapid prototyping (RP is a technique of manufacturing parts by the additive layer manufacturing technology; where, a three-dimensional (3D model created in a computer aided design (CAD system is sectioned into 2D profiles, which are further constructed by RP layer by layer. Its use is not limited to industrial or engineering fields and has extended to the medical field for the manufacturing of custom implants and prostheses, the study of anatomy and surgical planning. Nowadays, dentists are more frequently encountered with the individuals affected with craniofacial defects due to trauma. In such cases, the cranio-maxillofacial rehabilitation is a real challenge to bring the patients back to society and promote their well-being. The conventional impression technique for facial prosthesis fabrication has the disadvantage of deforming the soft tissue and causing discomfort for the patient. Herein, we describe the fabrication of a cranial prosthesis combined with an ocular prosthesis with RP and stereolithography.

  13. The impact of physically demanding work of basketball and volleyball players on the risk for patellar tendinopathy and on work limitations.

    Science.gov (United States)

    van der Worp, H; Zwerver, J; Kuijer, P P F M; Frings-Dresen, M H W; van den Akker-Scheek, I

    2011-01-01

    Patellar tendinopathy is a common injury in jumping athletes. Little is known about work-related etiological factors for patellar tendinopathy and related work limitations. The aim of this study was to identify work-related etiological factors for patellar tendinopathy and to determine the relation between patellar tendinopathy and work limitations. Basketball and volleyball players between 18 and 35 years were invited to complete an online-questionnaire concerning knee complaints, etiological risk factors for patellar tendinopathy and related work limitations. A total of 1505 subjects were included in the analysis. Risk factors for patellar tendinopathy were gender and heavy physically demanding work. The odds for having patellar tendinopathy were significantly higher for heavy physically demanding occupations compared to mentally demanding occupations. 30% of subjects with patellar tendinopathy with a physically demanding job reported to be impaired in their work and 17% reported to be less productive. Basketball and volleyball players with heavy physically demanding work seem to have an increased risk for developing patellar tendinopathy. This finding has important clinical relevance in the treatment of this injury. Working activities should be adjusted in order to reduce the total load on the patellar tendon and help prevention and recovery.

  14. Injury patterns of medial patellofemoral ligament after acute lateral patellar dislocation in children: Correlation analysis with anatomical variants and articular cartilage lesion of the patella

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Guang-ying; Ding, Hong-yu [Shandong Provincial Qianfoshan Hospital of Shandong University, Department of Ultrasonography, Jinan (China); Zheng, Lei; Ji, Bing-jun [Shandong Provincial Corps Hospital of Chinese People' s Armed Police Force, Department of Radiology, Jinan (China); Shi, Hao [Shandong Provincial Qianfoshan Hospital of Shandong University, Department of Radiology, Jinan (China); Feng, Yan [Affiliated Hospital of Binzhou Medical College, Department of Radiology, Binzhou (China)

    2017-03-15

    To assess the relationship between injury patterns of medial patellofemoral ligament (MPFL) and anatomical variants and patellar cartilage lesions after acute lateral patellar dislocation (LPD) in children. MR images were obtained in 140 children with acute LPD. Images were acquired and evaluated using standardised protocols. Fifty-eight cases of partial MPFL tear and 75 cases of complete MPFL tear were identified. Injuries occurred at an isolated patellar insertion (PAT) in 52 cases, an isolated femoral attachment (FEM) in 42 cases and an isolated mid-substance (MID) in five cases. More than one site of injury was identified in 34 cases. Compared with Wiberg patellar type C, Wiberg patellar type B predisposed to complete MPFL tear (P = 0.042). No correlations were identified between injury patterns of MPFL and trochlear dysplasia, patellar height and tibial tuberosity-trochlear groove distance (P > 0.05). Compared with partial MPFL tear, complete MPFL tear predisposed to Grade-IV and Grade-V patellar chondral lesion (P = 0.02). There were no correlations between incidence of patellar cartilage lesion and injury locational-subgroups of MPFL (P = 0.543). MPFL is most easily injured at the PAT in children. Wiberg patellar type B predisposes to complete MPFL tear. Complete MPFL tear predisposes to a higher grade of patellar chondral lesion. (orig.)

  15. A Method to Analyze Dynamics Properties of Transfemoral Prosthesis

    Directory of Open Access Journals (Sweden)

    Van Tuan Le

    2016-01-01

    Full Text Available Abstract.The methodto compute gait cycle forces and moments acting on the hip and knee joints of a lower limb with a trans-femoral prosthesis were investigated. A 3D model of the lower limb with prosthesis was created using CAD software and based on MRI data and real size dimension. The transfemoral prosthesis was modelled as a coupled of links with two revolution joints at hip and knee joint. This coupled link was connected to a bar with translation joint to description the distance walked of people in gait cycle. All parts of the prosthesis were measured and a full-size 3D model was created.The kinematics parameters of a lower limb with a prosthesis were determined from motion-captured system data. The reaction force was measured with a force sensor in the footplate. The 3D model of the prosthesis was exported to MatlabSimmechanics. The input data which are kinematic parameters were applied to calculate the forces and moments acting on the joints. The results of this study present a method to analyse the dynamic properties of transfemoral prosthesis including speed of the gait. It could be used to calculate the load transferred from the socket to the residual limb. They could also be used to design the structure of a prosthesis and optimize the dynamic characteristics of such a prosthesis.

  16. [Prosthesis use in pediatric patients with fibular hipoplasia].

    Science.gov (United States)

    Aparicio, Omar Carlos González; García, Felipe Haces; Leonori, Romáin Capdevila; García, Víctor Rosas

    2007-01-01

    To assess the prosthesis adaptability at use of pedestal and transtibial prosthesis, recognize the average average age of amputation surgery, and the complications of the amputation in patients with fibular hemimelia. 47 patients were evaluated, initially to adjust pedestal prosthesis and when this was not tolerated, we realize amputation and adaptation of transtibial prosthesis, we valued the average age of amputation surgery, the associate complications and the prosthesis adaptability we use the K system for functional ambulation. Of the 12 patients to actually use pedestal prosthesis 9 (75%) had a K.2 level, 3 (25%) had a K-3 level, of the 35 patients to use transtibial prosthesis 1 (3%) had a K-2 level, 19 (54%) K-3 level, and 15 (43%) in the K-4 level. The average age to amputation surgery was 3.9 years old, one case had a complication. The early prosthesis adaptability provides advantages in the functional ambulation, as demonstrated on the results. The goal of the transtibial amputation is to facilitate the prosthesis adaptability, is due to take advantage of the best functional adaptation the child in the first years of life, circumstance that improves the integral rehabilitation of the patient.

  17. Improved comfort and function of arm prosthesis after implantation of a Humerus-T-Prosthesis in trans-humeral amputees.

    Science.gov (United States)

    Witsø, Eivind; Kristensen, Tomm; Benum, Pål; Sivertsen, Svein; Persen, Leif; Funderud, Are; Magne, Tordis; Aursand, Hans Petter; Aamodt, Arild

    2006-12-01

    The use of arm prosthesis in trans-humeral amputees is limited; due to the cone form of the amputation stump. A Humerus-T-Prosthesis was implanted in three patients to create artificial humerus condyles. Two of the patients were successfully rehabilitated with the application of a new type trans-humeral arm prosthesis. This arm prosthesis had a socket which is suspended and stabilized by the humerus and implant only. Traction and rotational stability were secured by adjustable pressure adaptation around the artificial condyles. The third patient developed a pressure wound over the lateral part of the artificial condyle that later healed. He also was subject to a new trauma with a fracture of the ipsilateral scapula and until now has had limited the use of his new arm prosthesis. It was concluded that this new concept for prosthesis fitting of trans-humeral amputees looks promising, but alternative designs of the implant should be tested.

  18. Changes in oral health related knowledge, attitudes and behaviours following school based oral health education and atraumatic restorative treatment in rural Tanzania

    OpenAIRE

    Anne Nordrehaug Åstrøm

    2012-01-01

    Objectives: The following questions were addressed; to what extent is sugar consumption, tooth brushing, and oral health related attitudes and knowledge subject to change following a combined atraumatic restorative treatment (ART) /oral health education (OHE) program? Are changes in intended sugar avoidance associated with changes in cognitions as specified by the Theory of Planned Behaviour (TPB)? Are changes in oral health related knowledge associated with changes in attitudes and oral heal...

  19. An Atraumatic Symphysiolysis with a Unilateral Injured Sacroiliac Joint in a Patient with Cushing's Disease: A Loss of Pelvic Stability Related to Ligamentous Insufficiency?

    OpenAIRE

    H?ch, Andreas; Pieroh, Philipp; Dehghani, Faramarz; Josten, Christoph; B?hme, J?rg

    2016-01-01

    Glucocorticoids are well known for altering bone structure and elevating fracture risk. Nevertheless, there are very few reports on pelvic ring fractures, compared to other bones, especially with a predominantly ligamentous insufficiency, resulting in a rotationally unstable pelvic girdle. We report a 39-year-old premenopausal woman suffering from an atraumatic symphysiolysis and disruption of the left sacroiliac joint. She presented with external rotational pelvic instability and immobilizat...

  20. Microbiological evaluation of salivary Streptococcus mutans from children of age 5-7 years, pre- and post-atraumatic restorative treatment

    OpenAIRE

    N M Roshan; Shigli, Anand L.; Shobha D Deshpande

    2010-01-01

    Background and Objective: The objective of the study was to monitor Streptococcus mutans (SM) counts in saliva of children aged 5-7 years old over a period of 6 months with the subsequent use of Fuji IX, glass ionomer cement in atraumatic restorative technique (ART). Materials and Methods: One hundred children were selected to receive ART using Fuji IX glass ionomer cement. Caries status was recorded using DMFT index (WHO 1997) and revaluated after 6 months using DMFS index (WHO 1979). Saliva...

  1. Patellar tendinopathy in young elite soccer- clinical and sonographical analysis of a German elite soccer academy.

    Science.gov (United States)

    Bode, Gerrit; Hammer, Thorsten; Karvouniaris, N; Feucht, M J; Konstantinidis, L; Südkamp, N P; Hirschmüller, A

    2017-08-08

    The prevalence of patellar tendinopathy is elevated in elite soccer compared to less explosive sports. While the burden of training hours and load is comparably high in youth elite players (age elite soccer academy. One hundred nineteen male youth soccer players (age 15,97 ± 2,24 years, height 174, 60 ± 10,16 cm, BMI 21, 24 ± 2,65) of the U-13 to U-23 teams were part of the study. Data acquisition included sport specific parameters such as footwear, amount of training hours, leg dominance, history of tendon pathologies, and clinical examination for palpatory pain, indurations, muscular circumference, and range of motion. Subjective complaints were measured with the Victorian Institute of Sport Assessment Patellar (VISA-P) Score. Furthermore, sonographical examinations (Aplio SSA-770A/80; Toshiba, Tokyo, Japan) with 12-MHz multifrequency linear transducers (8-14 MHz) of both patellar tendons were performed with special emphasis on hyper- and hypo echogenic areas, diameter and neovascularization. The prevalence of patellar tendinopathies was 13.4%. Seventy-five percent of the players complained of pain of their dominant leg with onset of pain at training in 87.5%. The injured players showed a medium amount of 10.34 ± 3.85 training hours and a medium duration of symptoms of 11.94 ± 18.75 weeks. Two thirds of players with patellar tendinopathy were at the age of 15-17 (Odds ratio 1.89) while no differences between players of the national or regional league were observed. In case of patellar tendinopathy, VISA-P was significantly lower in comparison to healthy players (mean ± SD 76.80 ± 28.56 points vs. 95.85 ± 10.37). The clinical examination revealed local pain at the distal patella, pain at stretching, and thickening of the patellar tendon (p = 0.02). The mean tendon diameter measured 2 cm distally to the patella was 4.10 ± 0.68 mm with a significantly increased diameter of 0.15 mm in case of an underlying tendinopathy (p = 0

  2. The Use of Dual Reconstruction Plates for Failed Fixation of Patellar Fracture after Total Knee Replacement: A Case Report

    Directory of Open Access Journals (Sweden)

    Sa-ngasoongsong P

    2016-11-01

    Full Text Available Patellar fracture after total knee replacement (TKR is one of the challenging problems in periprosthetic fracture. Open reduction with internal fixation (ORIF, as tension band wiring (TBW, usually required in cases with extensor mechanism disruption. However, many studies reported a high failure rate after using this technique. In this report, we presented an interesting case of periprosthetic patellar fracture after TKR with TBW failure that was successfully treated with double non-locking reconstruction plates fixation and TBW augmentation.

  3. A soft patellar tendon on ultrasound elastography is associated with pain and functional deficit in volleyball players.

    Science.gov (United States)

    Ooi, Chin Chin; Richards, Paula J; Maffulli, Nicola; Ede, David; Schneider, Michal E; Connell, David; Morrissey, Dylan; Malliaras, Peter

    2016-05-01

    To investigate the diagnostic performance of grey scale Ultrasound (US), power Doppler (PD) and US elastography for diagnosing painful patellar tendinopathy, and to establish their relationship with Victorian Institute of Sport Assessment-Patella (VISA-P) scores in a group of volleyball players with and without symptoms of patellar tendinopathy. Cross-sectional study. Thirty-five volleyball players (70 patellar tendons) were recruited during a national university volleyball competition. Players were imaged with conventional US followed by elastography. The clinical findings of painful patellar tendons were used as the reference standard for diagnosing patellar tendinopathy. In addition, all participants completed the VISA-P questionnaires. Of the 70 patellar tendons, 40 (57.1%) were clinically painful. The diagnostic accuracy of grey scale US, PD and elastography were 60%, 50%, 62.9%, respectively, with sensitivity/specificity of 72.5%/43.3%, 12.5%/100%, and 70%/53.3%, respectively. Combined US elastography and grey scale imaging achieved 82.5% sensitivity, 33.3% specificity and 61.4% accuracy while routine combination technique of PD and grey scale imaging revealed 72.5% sensitivity, 43.3% specificity and 60.0% accuracy. Tendons in players categorized as soft on elastography had statistically significantly greater AP thickness (p<0.001) and lower VISA-P scores (p=0.004) than those categorized as hard. There was no significant association between grey scale US abnormalities (hypoechogenicities and/or fusiform swelling) and VISA-P scores (p=0.098). Soft tendon properties depicted by US elastography may be more related to patellar tendon symptoms compared to grey scale US abnormalities. The supplementation of US elastography to conventional US may enhance the sensitivity for diagnosing patellar tendinopathy in routine clinical practice. Copyright © 2015 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  4. [Total prosthesis arthroplasty in femur head necrosis].

    Science.gov (United States)

    Elke, R; Morscher, E

    1990-08-01

    In young patients with advanced necrosis of the femoral head, the short- and medium-term results of total prosthesis arthroplasty are the most satisfactory. However, the prospect of aseptic loosening hangs over such arthroplasties like Damocles' sword. Reports from the literature suggest that, in addition to the age of the patient, there is also an endogenous factor that can be responsible not only for the etiology and pathogenesis of the necrosis, but also for the early loosening of the prosthesis. We have followed up 54 patients (73 hip joints) who had total hip replacement as a result of necrosis of the femoral head between 1976 and 1988. Altogether, 3 acetabular and 5 femoral shafts had to be replaced (7 patients). This corresponds to a loosening rate of 10% after an average of 4.9 years. Hence, the prosthesis changing rate is lower than that reported by other authors, but is still higher than in patients with coxarthrosis. Only 2 of 52 cemented shaft prostheses had to be replaced; the average age of these patients was 61.4 years. Of the 21 cement-free shaft implantations, 3 had to be replaced, the average age of these patients being 42.9 years. The fact that the average age of the latter patients was lower may be the reason for the revision rate not being significantly higher for the non-cemented shafts. In view of the fact that necrosis of the femoral head can rapidly result in the patient becoming an invalid if it is allowed to follow its natural course, hip joint prostheses should also be offered to younger patients.

  5. Energy exchange between knee and ankle in a transfemoral prosthesis

    NARCIS (Netherlands)

    Koopman, Hubertus F.J.M.; Behrens, Sebastiaan Maria; Hekman, Edsko E.G.; Ünal, Ramazan

    2013-01-01

    In order to make an energy efficient transfemoral prosthesis, there should be energy exchange between knee and ankle of the prosthesis. A concept containing various spring elements is designed and tested for a single subject. It is shown that the concept of energy exchange can be realized; in this

  6. 21 CFR 872.3970 - Interarticular disc prosthesis (interpositional implant).

    Science.gov (United States)

    2010-04-01

    ... implant). 872.3970 Section 872.3970 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND... disc prosthesis (interpositional implant). (a) Identification. An interarticular disc prosthesis (interpositional implant) is a device that is intended to be an interface between the natural articulating surface...

  7. Fabrication of custom made ocular prosthesis with three different ...

    African Journals Online (AJOL)

    Loss of eye has a bad effect on the psychology of the patient. Eye prosthesis is fabricated to regain the patient's confidence by meticulous replacement of the missing eye. Immediate fitting of an anophthalmic socket with an artificial eye may not always be possible, and a delayed prosthesis delivery may result in settling and ...

  8. Three-piece Inflatable Penile Prosthesis: Surgical Techniques and ...

    African Journals Online (AJOL)

    implantation of the three-piece inflatable penile prosthesis and point out the major surgical pitfalls accompanying this procedure and their specific management. The psychological outcome of penile prosthesis surgery is also discussed. Different surgical approaches are available when performing the procedure. A number ...

  9. Three-piece Inflatable Penile Prosthesis: Surgical Techniques and ...

    African Journals Online (AJOL)

    Penile prosthesis surgery plays a vital role in the treatment of erectile dysfunction (ED). As far as outcome is concerned, it is one of the most rewarding procedures for both patients and surgeons. We describe our surgical technique for implantation of the three-piece inflatable penile prosthesis and point out the major surgical ...

  10. [Disappointing long-term experiences of patients with penile prosthesis

    NARCIS (Netherlands)

    Meuleman, E.J.H.; Deunk, L.; Schreuders-Bais, C.; Rabsztyn, P.

    2001-01-01

    OBJECTIVE: To describe the long-term experience with the implantation of a penile prosthesis as a last resort treatment for erectile dysfunction. DESIGN: Retrospective and descriptive. METHOD: During the period 1986-1996, 124 men received a penile prosthesis. Basic information was obtained from

  11. Risk factors associated with accidental ingestion of dental prosthesis ...

    African Journals Online (AJOL)

    Results: During the study period, eight patents were see, seven male and one female. Their ages ranged from 35 to 85 years with an average of 61.13 years. All the dental prosthesis retrieved from patients in this study were unsecured. Most of the patients with impacted dental prosthesis did not have the habit of removing ...

  12. Treatment of femoral neck fracture by Moore Prosthesis in Cotonou ...

    African Journals Online (AJOL)

    Treatment of femoral neck fracture by Moore Prosthesis in Cotonou. AHM Akue, M Lawson, S Madougou, R Zannou, J Padonou. Abstract. Keywords: Benin; hip; Moore prosthesis; results. Full Text: EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT.

  13. Design and wear testing of a temporomandibular joint prosthesis articulation

    NARCIS (Netherlands)

    van Loon, JP; Verkerke, GJ; de Vries, MP; de Bont, LGM

    As part of the development of a total temporomandibular joint prosthesis, a prosthesis articulation was designed. The articulation consists of a spherical head (ball) of the mandibular part, rotating against an enveloping ultra-high-molecular-weight polyethylene (UHMWPE) disc with a flat cranial

  14. 21 CFR 878.3750 - External prosthesis adhesive.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false External prosthesis adhesive. 878.3750 Section 878.3750 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... adhesive. (a) Identification. An external prosthesis adhesive is a silicone-type adhesive intended to be...

  15. Changes in morphological and elastic properties of patellar tendon in athletes with unilateral patellar tendinopathy and their relationships with pain and functional disability.

    Directory of Open Access Journals (Sweden)

    Zhi Jie Zhang

    Full Text Available Patellar tendinopathy (PT is one of the most common knee disorders among athletes. Changes in morphology and elasticity of the painful tendon and how these relate to the self-perceived pain and dysfunction remain unclear.To compare the morphology and elastic properties of patellar tendons between athlete with and without unilateral PT and to examine its association with self-perceived pain and dysfunction.In this cross-sectional study, 33 male athletes (20 healthy and 13 with unilateral PT were enrolled. The morphology and elastic properties of the patellar tendon were assessed by the grey and elastography mode of supersonic shear imaging (SSI technique while the intensity of pressure pain, self-perceived pain and dysfunction were quantified with a 10-lb force to the most painful site and the Victorian Institute of Sport Assessment-patella (VISA-P questionnaire, respectively.In athletes with unilateral PT, the painful tendons had higher shear elastic modulus (SEM and larger tendon than the non-painful side (p<0.05 or the dominant side of the healthy athletes (p<0.05. Significant correlations were found between tendon SEM ratio (SEM of painful over non-painful tendon and the intensity of pressure pain (rho  = 0.62; p = 0.024, VISA-P scores (rho  = -0.61; p = 0.026, and the sub-scores of the VISA-P scores on going down stairs, lunge, single leg hopping and squatting (rho ranged from -0.63 to -0.67; p<0.05.Athletes with unilateral PT had stiffer and larger tendon on the painful side than the non-painful side and the dominant side of healthy athletes. No significant differences on the patellar tendon morphology and elastic properties were detected between the dominant and non-dominant knees of the healthy control. The ratio of the SEM of painful to non-painful sides was associated with pain and dysfunction among athletes with unilateral PT.

  16. Clinical and radiological outcome of conservative vs. surgical treatment of atraumatic degenerative rotator cuff rupture: design of a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    van den Akker-Scheek Inge

    2011-01-01

    Full Text Available Abstract Background Subacromial impingement syndrome is a frequently observed disorder in orthopedic practice. Lasting symptoms and impairment may occur when a subsequent atraumatic rotator cuff rupture is also present. However, degenerative ruptures of the rotator cuff can also be observed in asymptomatic elderly individuals. Treatment of these symptomatic degenerative ruptures may be conservative or surgical. Acceptable results are reported for both treatment modalities. No evidence-based level-1 studies have been conducted so far to compare these treatment modalities. The objective of this study is to determine whether there is a difference in outcome between surgical reconstruction and conservative treatment of a degenerative atraumatic rotator cuff tendon rupture. Methods/Design A randomized controlled trial will be conducted. Patients aged between 45 and 75 with a symptomatic atraumatic rotator cuff rupture as diagnosed by MRI will be included. Exclusion criteria are traumatic rotator cuff rupture, frozen shoulder and diabetes mellitus. Patients will be randomized into two groups. Conservative treatment includes physical therapy according to a standardized protocol, NSAIDs and, if indicated, subacromial infiltration with a local anesthetic and corticosteroids. Surgical reconstruction is performed under general anesthesia in combination with an interscalenus plexus block. An acromioplasty with reconstruction of the rotator cuff tendon is performed, as described by Rockwood et al. Measurements take place preoperatively and 6 weeks, 3 months, 6 months and 1 year postoperatively. The primary outcome measure is the Constant score. Secondary measures include both disease-specific and generic outcome measures, and an economic evaluation. Additionally, one year after inclusion a second MRI will be taken of all patients in order to determine whether extent and localization of the rupture as well as the amount of fatty degeneration are prognostic

  17. Penile Corporeal Reconstruction during Difficult Placement of a Penile Prosthesis

    Directory of Open Access Journals (Sweden)

    Viet Q. Tran

    2008-01-01

    Full Text Available For some patients with impotence and concomitant severe tunical/corporeal tissue fibrosis, insertion of a penile prosthesis is the only option to restore erectile function. Closing the tunica over an inflatable penile prosthesis in these patients can be challenging. We review our previous study which included 15 patients with severe corporeal or tunical fibrosis who underwent corporeal reconstruction with autologous rectus fascia to allow placement of an inflatable penile prosthesis. At a mean follow-up of 18 months (range 12 to 64, all patients had a prosthesis that was functioning properly without evidence of separation, herniation, or erosion of the graft. Sexual activity resumed at a mean time of 9 weeks (range 8 to 10. There were no adverse events related to the graft or its harvest. Use of rectus fascia graft for coverage of a tunical defect during a difficult penile prosthesis placement is surgically feasible, safe, and efficacious.

  18. Amputation and prosthesis implantation shape body and peripersonal space representations.

    Science.gov (United States)

    Canzoneri, Elisa; Marzolla, Marilena; Amoresano, Amedeo; Verni, Gennaro; Serino, Andrea

    2013-10-03

    Little is known about whether and how multimodal representations of the body (BRs) and of the space around the body (Peripersonal Space, PPS) adapt to amputation and prosthesis implantation. In order to investigate this issue, we tested BR in a group of upper limb amputees by means of a tactile distance perception task and PPS by means of an audio-tactile interaction task. Subjects performed the tasks with stimulation either on the healthy limb or the stump of the amputated limb, while wearing or not wearing their prosthesis. When patients performed the tasks on the amputated limb, without the prosthesis, the perception of arm length shrank, with a concurrent shift of PPS boundaries towards the stump. Conversely, wearing the prosthesis increased the perceived length of the stump and extended the PPS boundaries so as to include the prosthetic hand, such that the prosthesis partially replaced the missing limb.

  19. Modified basket plate for inferior patellar pole avulsion fractures—A report of three cases

    Directory of Open Access Journals (Sweden)

    Hui-Cheng Huang

    2012-11-01

    Full Text Available In patients who have sustained an avulsion fracture of the inferior patellar pole, the extensor mechanism is disrupted and should be repaired. The normal height of the patella can be maintained by preserving the patellar pole, but fractures of the inferior pole of the patella are not easy to reduce and fix firmly. In contrast with partial patellectomy, which requires postoperative immobilization, internal fixation with a basket plate allows for immediate mobilization and early weight-bearing. Owing to the unavailability of the basket plate in Taiwan, we have modified the plate with the titanium mesh as a possible alternative. We present three cases of this modified basket plate, which took place between 2008 and 2010. This technique avoided long-term immobilization of the knee with good clinical results.

  20. Influence of aging on the in vivo properties of human patellar tendon

    DEFF Research Database (Denmark)

    Carroll, CC; Dickinson, J M; Haus, J M

    2008-01-01

    Tendons are important for optimal muscle force transfer to bone and play a key role in functional ability. Changes in tendon properties with aging could contribute to declines in physical function commonly associated with aging. We investigated the in vivo mechanical properties of the patellar te...... of the tendon is altered with aging; however, the physiological and functional consequence of this finding requires further study.......Tendons are important for optimal muscle force transfer to bone and play a key role in functional ability. Changes in tendon properties with aging could contribute to declines in physical function commonly associated with aging. We investigated the in vivo mechanical properties of the patellar.......05), respectively, in men compared with women. After normalization of mechanical properties to a common force, no age differences were apparent; however, stress and strain were 26 and 22% higher, respectively, in women compared with men (P

  1. Acute Traumatic Patellar Tendon Rupture at the Tibial Tuberosity Attachment without Avulsion Fracture

    Directory of Open Access Journals (Sweden)

    Shuichi Miyamoto

    2017-01-01

    Full Text Available Patellar tendon rupture in children is especially rare. The fact that the area of traumatic rupture has wide variations makes surgical treatment difficult. We present an 11-year-old boy with acute traumatic patellar tendon rupture at the tibial tuberosity attachment without avulsion fracture. Primary end-to-end repair and reinforcement using 1.5 mm stainless steel wires as a surgical strategy were undertaken. Early range of motion began with a functional knee brace and the reinforced stainless wire was removed 3 months after surgery. Knee function at the final follow-up was satisfactory. We suggest that this strategy may provide a useful option for surgical treatment.

  2. Difficult factors in Management of Impacted Dental Prosthesis in Esophagus

    Directory of Open Access Journals (Sweden)

    Efiaty A. Soepardi

    2005-03-01

    Full Text Available A dental prosthesis which ingested and impacted in esophagus, is an emergency case and life threatening, so require immediate esophagoscopy intervention for removing. The objective of this study is to assess some factors can caused dtfficulties in diagnosing and treating the ingested and impacted dental prosthesis in the esophagus and their complications. This retrospective study analyzed patient’s chart whose underwent esophagoscopy for removing the impacted dental prosthesis in Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia during a period between January 1997 and December 2003. Neck-chest X-ray and esophagoscopy were performed in all patients to identify the existence of the dental prosthesis as a diagnostic and treatment procedure. The length of time for removing the dental prosthesis was recorded and stated as a less difficult esophagoscopy when it takes time less than 60 minutes and as a difficult  esophagoscopy takes 60 minutes or longer. Some risk difficulties factors were statistically analyzed. There were 53 patients of ingested dental prosthesis in esophagus. Only 51 cases were analyzed According to the length of time for removing the dental prosthesis by esophagoscopy, 22 patients were recorded as less difficult cases and 29 patients as difficult cases. Two cases among the cases needed cervicotomy after unsuccessful esophagoscopy removal. The difficulties to diagnose an impacted dental prosthesis in the esophagus caused by unreliable clinical history, unclear signs and symptoms, unable to be detected by X-ray and was not found during esophagoscopy. The difficulties in treating due to mucosal laceration, edema, bleeding, failure of the first extraction and conformity with the size and shape, the wire outside the dental prosthesis and the length of time stayed in the esophagus. (Med J Indones 2005; 14: 33-6Keywords: ingested dental prosthesis, radioluscent foreign body, length of time of esophagoscopy

  3. Fixation of an osteochondral fragment after acute patellar dislocation in an immature skeleton,

    Directory of Open Access Journals (Sweden)

    Rodrigo Pires e Albuquerque

    2014-04-01

    Full Text Available Fixation of an osteochondral fracture after acute patellar dislocation is an infrequent form of treatment. Likewise, the location of this fragment in the lateral region of the lateral femoral condyle, functioning as a free body, is uncommon. The aim of this study was to present a case of osteochondral fracture of the patella at an unusual site, along with the therapy used and the clinical follow-up.

  4. Internal fixation of patellar apex fractures with the basket plate: 25 years of experience.

    Science.gov (United States)

    Matejčić, Aljoša; Ivica, Mihovil; Jurišić, Darko; Ćuti, Tomislav; Bakota, Bore; Vidović, Dinko

    2015-11-01

    Comminution of the patellar apex is amenable to internal fixation by standard techniques and usually requires partial patellectomy. In our institution, multifragmentary fractures of the distal pole are treated with the basket plate, which is shaped to fit the geometry of the patellar apex. This implant has been used in our institution for over 25 years. The aim of this study was to evaluate long-term results of internal fixation of comminuted fractures of the patellar apex with the basket plate. A total of 142 patients with fracture of the distal pole of the patella were treated with the basket plate between 1988 and 2013. Functional evaluation was conducted using the modified Cincinnati knee rating system. A total of 98 patients were available for late functional evaluation. There were no infections or implant-related problems during the follow-up period. All fractures healed within 8 to 10 weeks. There were three cases of early revision because of improper use of the implant and incorrect indication. Functional outcome following internal fixation with the basket plate was excellent in 80 patients and good in 18; there were no poor results. Internal fixation with the basket plate is recommended for management of multifragmentary fractures of the patellar apex because this method enables early, unrestricted knee motion, and provides reliable healing and good functional outcome. This method is an alternative to partial patellectomy and is considered a patella-saving procedure; therefore, the use of the basket plate is strongly recommended for the treatment of distal pole fractures. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. Surgical treatment of recurrent patellar dislocation in children associated with patello-femoral dysplasia

    OpenAIRE

    vergara- amador, Enrique; Universidad nacional de colombia; castro, Ricardo; Universidad nacional de colombia

    2014-01-01

    The aim of this paper is to show the results in a small series of patients withpatellofemoral instability or recurrent patellar dislocation in children operated with theproximal realignment technique. Materials and methods: It is a series of 10 knees in7 children, with proximal patela realignment patela using the Insall technique. The mostimportant role of the patela is to increase the quadriceps efficiency. The patelo -femoralinstability is defined as a condition in which there is insufficie...

  6. Impact of patellar height on unicompartment knee arthroplasty: does patella baja lead to an inferior outcome?

    Science.gov (United States)

    Neogi, Devdatta Suhas; Bae, Ji Hoon; Seok, Chang Woo; Lim, Hong Chul

    2014-03-01

    Though a number of series with long-term results have been published, there is still a paucity of literature on the role of patellar height after unicompartment knee arthroplasty (UKA). The present study was conducted with a hypothesis that patella baja may lead to a poor outcome at follow-up. A retrospective review of 134 knees was performed and patellar height calculated before and after UKA by Blackburne-Peel index (BPI) and the Insall-Salvati ratio (ISR) on true lateral radiographs of the patients in 30° of flexion taken pre-operatively and at 1 year, 2 years and final follow-up (minimum 5 years). Statistical analysis was performed to evaluate the outcomes. There was a decrease in ISR in 14.18 % and in BPI in 19.4 % at final follow-up. There was a significant decrease in BPI values while the decrease was not significant for ISR. After eliminating the pre-operative patella baja, 7.3 % developed post-operative patella baja, according to ISR, while 11.5 % developed patella baja as per BPI. At final follow-up there was a statistically significant decrease in stair climbing scores in patients with patella baja when compared to patients with normal ISR. Patients with a decrease in patellar height as per ISR have a decrease in stair climbing score at mid-term follow-up while the overall KSS, and pain scores are not affected by a change in patellar height and neither is there a significant progress in patellofemoral osteoarthritis among patients with patella baja compared to normal patella.

  7. Two-year evaluation of the atraumatic restorative treatment approach in primary molars class I and II restorations.

    Science.gov (United States)

    da Franca, Carolina; Colares, Viviane; Van Amerongen, Evert

    2011-07-01

    Atraumatic restorative treatment (ART) has the advantages of reducing pain and fear and of being more cost-effective than the traditional approach. The aim of this study was to investigate the survival of ART class I and II restorations in primary molars at 2 years. The sample consisted of 190 restorations and placed in 155 children 6-7 years old of both genders. The treatment was performed by two final-year dental students. All patients were treated in a completely supine position on tables available in the schools. The restorations were evaluated at 1, 12, and 24 months. The best results were found for class I in each period of follow-up. After 1 month, the success of class I restorations was 94.6% and class II restorations 70.1%. After 12 months, the success rate was 50.6% for class I and 15.2% for class II. The most frequent failure characteristics were totally or partially lost and gross marginal defect. The rate of success of restorations using the ART approach was significantly lower for class II. © 2011 The Authors. International Journal of Paediatric Dentistry © 2011 BSPD, IAPD and Blackwell Publishing Ltd.

  8. Teaching atraumatic restorative treatment in U.S. dental schools: a survey of predoctoral pediatric dentistry program directors.

    Science.gov (United States)

    Kateeb, Elham T; Warren, John J; Damiano, Peter; Momany, Elizabeth; Kanellis, Michael; Weber-Gasparoni, Karin; Ansley, Tim

    2013-10-01

    The International Dental Federation and World Health Organization have promoted the use of Atraumatic Restorative Treatment (ART) in modern clinical settings worldwide. In the United States, the practice of ART is not believed to be widely used, which may be a result of little attention given to ART training in predoctoral pediatric dentistry curricula in U.S. dental schools. This study investigated the extent of clinical and didactic instruction on ART provided in U.S. dental schools by surveying the predoctoral pediatric dentistry programs in 2010. Of the fifty-seven directors asked to complete the survey, forty-four responded for a response rate of 77 percent. Of these forty-four programs, 66 percent reported providing clinical training on ART, though only 14 percent provide this training often or very often. The types of ART training provided often or very often included interim treatment (18 percent) and single-surface cavities (14 percent) in primary teeth. However, ART was said to be rarely taught as a definitive treatment in permanent teeth (2 percent). Attitude was a major predictor, for clinical training provided and using professional guidelines in treatment decisions were associated with a positive attitude towards ART. These predoctoral pediatric dentistry programs used ART mainly in primary, anterior, and single-surface cavities and as interim treatment. As ART increases access of children to dental care, the incorporation of the ART approach into the curricula of U.S. dental schools should be facilitated by professional organizations.

  9. A field-trial of two restorative materials used with atraumatic restorative treatment in rural Turkey: 24-month results

    Directory of Open Access Journals (Sweden)

    Ertugrul Ercan

    2009-08-01

    Full Text Available OBJECTIVE: The purpose of this study was to investigate the clinical performance of high-strength glass ionomer cement (HSGIC and resin-modified glass ionomer (RMGIC in single and multiple surface carious cavities in the field conditions. MATERIAL AND METHODS: A split-mouth design, including ninety-one fillings placed on contra lateral molar pairs of 37 children, was used in permanent dentition. As filling materials, a HSGIC (Ketac Molar/3M ESPE and a RMGIC (Vitremer/ 3M ESPE were used with the Atraumatic Restorative Treatment (ART. Baseline and 6, 12 and 24-month evaluations of the fillings were made with standard-ART and USPHS criteria by two examiners with kappa values of 0.92 and 0.87 for both criteria. RESULTS: According to the USPHS criteria, the retention rates of RMGIC and HSGIC restorations were 100% and 80.9% for single surface, and 100% and 41.2% for multiple surface restorations after 24 months, respectively. Irrespective of surface number, RMGIC was significantly superior to HSGIC (p= 0.004, according to both standard-ART and USPHS criteria. CONCLUSION: The results indicate that RMGIC may be an alternative restorative technique in comparison to high-strength GIC applications in ART-field-trials. However, further clinical and field trials are needed to support this conclusion.

  10. Atraumatic restorative treatment (ART): a three-year clinical study in Malawi--comparison of conventional amalgam and ART restorations.

    Science.gov (United States)

    Kalf-Scholte, Sonja M; van Amerongen, Willem E; Smith, Albert J E; van Haastrecht, Harry J A

    2003-01-01

    This study compares the quality of class I restorations made with the atraumatic restorative treatment (ART) technique and conventional class I amalgam restorations. The study was carried out among secondary school students in Mzuzu, Malawi. First-year students in 1987 who needed at least two class I restorations were selected. Based on a split-mouth design, each participant received both ART and conventional restorations. The 89 pairs of class I cavities were divided randomly into two groups, since two different cermet ionomer cement (CIC) filling materials were used. Impressions of the restorations and subsequent models were made shortly after restoration, after six months, one year, two years, and three years. The quality of the restorations was determined on the models following the US Public Health Service criteria. Bulk fracture, contour, marginal integrity, and surface texture of the restorations were recorded and evaluated separately. Survival rates were determined by the resultant score of all criteria. Though conventional amalgam restorations performed better on all criteria, this difference was significant only for the contour criterion. The survival rates of ART restorations after three years (81.0%) were lower than those of amalgam restorations (90.4%) (P=.067). The quality of ART class I restorations is competitive with that of conventional amalgam restorations.

  11. Compromised Cardiopulmonary Exercise Capacity in Patients Early After Endoscopic Atraumatic Coronary Artery Bypass Graft: Implications for Rehabilitation.

    Science.gov (United States)

    Hansen, Dominique; Roijakkers, Ruben; Jackmaert, Lore; Robic, Boris; Hendrikx, Marc; Yilmaz, Alaaddin; Frederix, Ines; Rosseel, Michael; Dendale, Paul

    2017-02-01

    The purpose of this work was to test the hypothesis that cardiopulmonary exercise tolerance is better preserved early after endoscopic atraumatic coronary artery bypass graft (endo-ACAB) surgery versus coronary artery bypass graft (CABG) surgery. Twenty endo-ACAB surgery patients, 20 CABG surgery patients, and 15 healthy subjects executed a maximal cardiopulmonary exercise test, with assessment and comparison of cycling power output, O2 uptake, CO2 output, respiratory gas exchange ratio, end-tidal O2 and CO2 pressures, equivalents for O2 uptake and CO2 output, heart rate, O2 pulse, expiratory volume, tidal volume, respiratory rate, at peak exercise and ventilatory threshold. In patients, forced expiratory volume and forced vital capacity were measured. Oxygen uptake, CO2 output, expiratory and tidal volume, equivalents for O2 uptake and CO2 output, end-tidal O2 and CO2 pressures at peak exercise (matched peak respiratory gas exchange ratio between patient groups), and ventilatory threshold were significantly worse in patients versus healthy controls (P power, >0.80). All these parameters, and lung function, were, however, comparable between CABG and endo-ACAB surgery patients (P > 0.10). Exercise tolerance and ventilatory function during exercise seems, in contrast to expectation, equally compromised early after endo-ACAB surgery as opposed to after CABG surgery. These data may signify the need for exercise-based rehabilitation intervention early after endo-ACAB surgery.

  12. Cost-effectiveness analysis of the atraumatic restorative treatment-based approach to managing early childhood caries.

    Science.gov (United States)

    Tonmukayakul, Utsana; Arrow, Peter

    2016-11-14

    Paediatric dental care under general anaesthesia among preschool children in Western Australia is increasing and costly. This study assessed cost-effectiveness of the atraumatic restorative treatment-based (ART-based) approach against the standard care (SC) approach to managing early childhood caries in a primary care setting based on a 1-year pragmatic randomized controlled trial. Cost-effectiveness analysis, from the service provider perspective, was conducted. Outcomes include number of referral to specialists and dental treatments. One-way and probabilistic sensitivity analyses were undertaken to test the robustness of the cost-effectiveness estimates. Six children in the ART-based group and 62 children in the SC group (n = 127 each group) were referred for paediatric dental specialist care. Children in the ART-based group received more dental services than those allocated to the SC group (mean = 3.8, SD 2.0 and mean = 1.8, SD 1.8, respectively, Wilcoxon rank-sum test, P dental treatment. The probability that the ART-based approach is cost-saving was 63%. Specialist dental treatment fees had a big impact on the cost-effectiveness estimates. The ART-based approach appears to be a worthwhile intervention because it resulted in fewer referred cases and enabled more treatments to be provided with cost-savings. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  13. Proposal of e-learning strategy to teach Atraumatic Restorative Treatment (ART) to undergraduate and graduate students.

    Science.gov (United States)

    Camargo, Lucila Basto; Raggio, Daniela Prócida; Bonacina, Carlos Felipe; Wen, Chao Lung; Mendes, Fausto Medeiros; Bönecker, Marcelo José Strazzeri; Haddad, Ana Estela

    2014-07-17

    The aim of this study was to evaluate e-learning strategy in teaching Atraumatic Restorative Treatment (ART) to undergraduate and graduate students. The sample comprised 76 participants-38 dental students and 38 pediatric dentistry students-in a specialization course. To evaluate knowledge improvement, participants were subjected to a test performed before and after the course. A single researcher corrected the tests and intraexaminer reproducibility was calculated (CCI = 0.991; 95% IC = 0.975-0.996). All students improved their performances after the e-learning course (Paired t-tests p < 0.001). The means of undergraduate students were 4.7 (initial) and 6.4 (final) and those of graduate students were 6.8 (initial) and 8.2 (final). The comparison of the final evaluation means showed a statistically significant difference (t-tests p < 0.0001). The e-learning strategy has the potential of improving students' knowledge in ART. Mature students perform better in this teaching modality when it is applied exclusively via distance learning.

  14. Physiotherapy treatment for atraumatic recurrent shoulder instability: early results of a specific exercise protocol using pathology-specific outcome measures.

    Science.gov (United States)

    Bateman, Marcus; Smith, Benjamin E; Osborne, Sally E; Wilkes, Sally R

    2015-10-01

    Recurrent shoulder instability is usually caused by a traumatic event resulting in structural pathology, although a small subgroup of patients experience symptomatic recurrent shoulder instability without trauma. These patients are usually treated non-operatively but limited evidence exists regarding effective conservative management. In particular, there is a lack of reproducible exercise regimes and none that have been tested with condition-specific outcome measures. A service evaluation was conducted over a 15-month period to assess our current treatment protocol used in the management of patients with atraumatic recurrent shoulder instability. The regime is reproducible with target-led progression milestones. Oxford Instability Shoulder Scores (OISS) and Western Ontario Shoulder Index (WOSI) scores were compared between baseline and final follow-up. Eighteen consecutive patients were included with mean follow-up of 4.5 months (range 1.35 months to 11.77 months). A statistically significant improvement was seen in both outcome measures. Mean OISS improved by 16.67 points (confidence interval: 12.34 to 20.99; p shoulder instability, the Derby Shoulder Instability Programme produced significant improvements over the short term, with a high level of patient compliance. This is the first study to include pathology-specific patient-reported outcome measures to assess outcomes from a specific and reproducible exercise regime in this group of patients. The findings support further research to evaluate the exercise protocol in a larger group of patients over the longer term.

  15. A FIELD-TRIAL OF TWO RESTORATIVE MATERIALS USED WITH ATRAUMATIC RESTORATIVE TREATMENT IN RURAL TURKEY: 24-MONTH RESULTS

    Science.gov (United States)

    Ercan, Ertugrul; Dülgergil, Ç. Türksel; Soyman, Mübin; Dalli, Mehmet; Yildirim, Isil

    2009-01-01

    Objective: The purpose of this study was to investigate the clinical performance of high-strength glass ionomer cement (HSGIC) and resin-modified glass ionomer (RMGIC) in single and multiple surface carious cavities in the field conditions. Material and Methods: A split-mouth design, including ninety-one fillings placed on contra lateral molar pairs of 37 children, was used in permanent dentition. As filling materials, a HSGIC (Ketac Molar/3M ESPE) and a RMGIC (Vitremer/ 3M ESPE) were used with the Atraumatic Restorative Treatment (ART). Baseline and 6, 12 and 24-month evaluations of the fillings were made with standard-ART and USPHS criteria by two examiners with kappa values of 0.92 and 0.87 for both criteria. Results: According to the USPHS criteria, the retention rates of RMGIC and HSGIC restorations were 100% and 80.9% for single surface, and 100% and 41.2% for multiple surface restorations after 24 months, respectively. Irrespective of surface number, RMGIC was significantly superior to HSGIC (p= 0.004), according to both standard-ART and USPHS criteria. Conclusion: The results indicate that RMGIC may be an alternative restorative technique in comparison to high-strength GIC applications in ART-field-trials. However, further clinical and field trials are needed to support this conclusion. PMID:19668990

  16. Removable dental prosthesis as periodontal treatment method

    Directory of Open Access Journals (Sweden)

    Aprilia Adenan

    2007-11-01

    Full Text Available The objectives of prostheses are to restore mastication force, improve esthetics and maintain gingival health. The construction and function of prosthesis restoration are mutually interdependent with condition of periodontal tissues. A properly constructed prosthesis is an integral phase of complete treatment of periodontal disease in order to maintain periodontal tissues health. This paper reports case of a man aged 47 years who came to Dental Specialist Clinic in Oral and Dental Hospital Faculty of Dentistry Universitas Padjadjaran with chief complaint of mobility in almost all his teeth and they seems to look longer. The patient has no systemic disease and did not want his teeth to be extracted. Clinical and panoramic radiographic and laboratoris examinations has been done. During treatment, oclusal adjustment and splinting had been done on tooth 33,34,35 and tooth 44,43 also tooth 43,42 splinting with composite. The following treatment was the acrylic removable partial denture for upper jaw while mandible was fitted a frame denture which functioned as a semi permanent splint. One month post treatment, patien felt comfort and the denture was well functioning.

  17. [Prosthesis replacement in periprosthetic humeral fractures].

    Science.gov (United States)

    Jaeger, M; Maier, D; Izadpanah, K; Südkamp, N P

    2017-12-01

    Stabilization of the humerus with preservation or restoration of the shoulder function. Always in the presence of a loose prosthesis. It may become necessary in conditions of poor bone stock and if osteosynthesis is not possible. Noncompliant patients due to alcohol or drugs. Local infections. The loose implant is removed using an extended anterior deltopectoral approach. After exploration of the fracture and extended soft tissue release, the glenoidal components are implanted with visualization and protection of the axillary nerve. A long stemmed implant is typically needed on the humeral side. It is anchored in the distal fragment over a length of about 6 cm. Soft tissue tension is crucial, especially with reverse shoulder arthroplasty. Postoperatively, the affected limb is immobilized for 6 weeks on a 15° shoulder abduction pillow with active assisted movement therapy up to the horizontal plane. This is followed by gradual pain-adapted increases of movement, muscle coordination, and strength. In 17 patients with periprosthetic fractures of the humerus surgically treated in our institution, 4 underwent revision arthroplasty because of a loose prosthesis. No intra- or postoperative complications were observed. All fractures healed except one.

  18. Immediate effects of whole body vibration on patellar tendon properties and knee extension torque.

    Science.gov (United States)

    Rieder, F; Wiesinger, H-P; Kösters, A; Müller, E; Seynnes, O R

    2016-03-01

    Reports about the immediate effects of whole body vibration (WBV) exposure upon torque production capacity are inconsistent. However, the changes in the torque-angle relationship observed by some authors after WBV may hinder the measurement of torque changes at a given angle. Acute changes in tendon mechanical properties do occur after certain types of exercise but this hypothesis has never been tested after a bout of WBV. The purpose of the present study was to investigate whether tendon compliance is altered immediately after WBV, effectively shifting the optimal angle of peak torque towards longer muscle length. Twenty-eight subjects were randomly assigned to either a WBV (n = 14) or a squatting control group (n = 14). Patellar tendon CSA, stiffness and Young's modulus and knee extension torque-angle relationship were measured using ultrasonography and dynamometry 1 day before and directly after the intervention. Tendon CSA was additionally measured 24 h after the intervention to check for possible delayed onset of swelling. The vibration intervention had no effects on patellar tendon CSA, stiffness and Young's modulus or the torque-angle relationship. Peak torque was produced at ~70° knee angle in both groups at pre- and post-test. Additionally, the knee extension torque globally remained unaffected with the exception of a small (-6%) reduction in isometric torque at a joint angle of 60°. The present results indicate that a single bout of vibration exposure does not substantially alter patellar tendon properties or the torque-angle relationship of knee extensors.

  19. Landing limb posture in volleyball athletes with patellar tendinopathy: a pilot study.

    Science.gov (United States)

    Kulig, K; Joiner, D G; Chang, Y-J

    2015-05-01

    The aims of this pilot study were to investigate how a novel sagittal plane kinematic measurement - the lower extremity contact angle (LECA) - relates to the landing dynamics of elite male volleyball athletes with and without patellar tendinopathy. The LECA was defined as the angle between the ground and the line connecting the center of pressure to the L5S1 marker. 18 athletes (9 with patellar tendinopathy and 9 with asymptomatic tendons) completed simulated spike jumps while instrumented for kinetic and kinematic analysis using a force platform and 3D motion analysis system. The patellar tendinopathic group demonstrated a significantly more acute LECA compared to the asymptomatic group (65.3°±2.2° vs. 69.1°±4.5°) and was the only kinematic or kinetic variable measured to discriminate between the 2 groups. The LECA further demonstrated less variability between trials than sagittal plane hip, knee, and ankle kinematics. Additionally, the LECA's - and not individual joints' - high correlation with the braking impulse ensures its predictive value for landing dynamics (r=- 0.890). The LECA has the potential to be a valuable tool to help assess jumping athletes in both injury prevention screening and as a variable that, if modified, could help alter the maladaptive behavior observed in symptomatic athletes. © Georg Thieme Verlag KG Stuttgart · New York.

  20. Plateau-patella angle in evaluation of patellar height after total knee arthroplasty.

    Science.gov (United States)

    Robin, Brett N; Ellington, Matthew D; Jupiter, Daniel C; Allen, Bryce C

    2014-07-01

    The plateau-patella angle (PPA) has been proposed as a new and simpler method to describe patellar height. This method has not been used or validated in knees following total knee arthroplasty (TKA). A modified PPA (mPPA) was developed for use in this population. The method was validated by determining the interobserver and intraobserver reliability of the technique in 50 consecutive patients compared to three well-described methods of describing patellar height after TKA. Three observers then evaluated the mPPA of 297 post-operative radiographs to describe a normal range after TKA for a given technique and implant. The interobserver reliability was the highest for the mPPA compared to the other methods. The mean mPPA for the entire cohort was 21.06, 20.49, and 19.94 for the three observers. The modified plateau-patella angle is a reliable way to evaluate patellar height in patients who have undergone total knee arthroplasty. Copyright © 2014 Elsevier Inc. All rights reserved.

  1. Rehabilitation protocol for patellar tendinopathy applied among 16- to 19-year old volleyball players.

    Science.gov (United States)

    Biernat, Ryszard; Trzaskoma, Zbigniew; Trzaskoma, Lukasz; Czaprowski, Dariusz

    2014-01-01

    The aim of the study was to investigate the efficacy of rehabilitation protocol applied during competitive period for the treatment of patellar tendinopathy. A total of 28 male volleyball players were divided into two groups. Fifteen from experimental group (E) and 13 from control group (C) fulfilled the same tests 3 times: before the training program started (first measurement), after 12 weeks (second measurement) and after 24 weeks (third measurement). The above-mentioned protocol included the following: USG imagining with color Doppler function, clinical testing, pain intensity evaluation with VISA-P questionnaire, leg muscle strength and power and jumping ability measurements. The key element of the rehabilitation program was eccentric squat on decline board with additional unstable surface. The essential factor of the protocol was a set of preventive functional exercises, with focus on eccentric exercises of hamstrings. Patellar tendinopathy was observed in 18% of the tested young volleyball players. Implementation of the presented rehabilitation protocol with eccentric squat on decline board applied during sports season lowered the pain level of the young volleyball players. Presented rehabilitation protocol applied without interrupting the competitive period among young volleyball players together with functional exercises could be an effective method for the treatment of patellar tendinopathy.

  2. PATELLAR REALIGNMENT AND FUNCTIONAL PERFORMANCE IN PATIENTS WITH PATELLOFEMORAL PAIN SYNDROME

    Directory of Open Access Journals (Sweden)

    Abeer Farag Hanafy

    2016-02-01

    Full Text Available Background: Patellar taping is used for pain relief in patients with patello-femoral pain syndrome (PFPS. Yet, there is lack of knowledge regarding its effect on the functional performance. The purpose of the study was to examine the effects of therapeutic patellar taping on the Visual Analogue Scale (VAS pain scores, number of bilateral squats, and stair climbing time in patients with PFPS. Methods: 30 female patients with PFPS with mean age 20.3± 1.46 years, weight 66.1± 9.68 kg, height 165.83 ± 3.89 cm and BMI 23.91 ± 3.50kg/m2 participated in the study. The subjects were tested randomly under three taping conditions;namely therapeutic, placebo and no-tape. The tested limb was determined to be the affected limb in patients with unilateral affection, and the symptomatic limb in patients with bilateral affection. Data was collected using the Visual Analogue Scale (VAS, Bilateral Squat Test and Timed Stair Ambulation Test. Results: Repeated measures Multivariate Analysis of Variance (MANOVA revealed that the number of bilateral squats increased significantly (p0.05 in between for the number of bilateral squats and stair climbing time. Conclusion: The findings indicated that therapeutic patellar taping is effective in improving functional performance and reducing pain in patients with patellofemoral pain syndrome (PFPS.

  3. Sonographic appearances of medial retinacular complex injury in transient patellar dislocation

    Energy Technology Data Exchange (ETDEWEB)

    O' Reilly, M.A.R.; O' Reilly, P.M.R.; Bell, J

    2003-08-01

    AIM: To describe the sonographic appearances of the medial retinacular (MPFR) complex of the knee in patients with acute and recurrent patellar dislocation. MATERIALS AND METHODS: Thirty patients were scanned within 2-4 weeks of an acute episode of lateral patellar dislocation. Eleven gave a history of recurrent patellar dislocation. Ten patients had examination under anaesthesia with arthroscopy and repair of the injury. The sonographic and operative results were compared. RESULTS: The normal sonographic appearance of the MPFR is described. Of the 10 patients who underwent examination under anaesthesia, four patients had complete avulsion of the MPFR from the patella, two patients had avulsion of the MPFR from the adductor tubercle and four patients had avulsion of the MPFR from both the patella and adductor tubercle. There was complete correlation between the sonographic and operative findings for injuries of the MPFR. Other findings included partial retinacular tears, injury to the medial collateral ligament, haematoma within vastus medialis obliquus (VMO) and bony avulsions from the patella and adductor tubercle. CONCLUSION: Sonography gives reliable information regarding the site of the injury and its extent thus helping to decide whether conservative or operative treatment is the most appropriate approach to management of the injury.

  4. Malfunctioned and Fractured Penile Prosthesis Caused by Cross Placement: Case Report

    Directory of Open Access Journals (Sweden)

    Nihat Karakoyunlu

    2015-05-01

    Full Text Available Penile prosthesis is a functional option for patients who have erectile dysfunction after failed medical and intracavernosal treatments. Malleable penile prosthesis is a good alternative. Penile prosthesis implantation is a surgical process. Seldomly complications occur. In this study we presented a 61 y old man who has malfunctioned and broken penile prosthesis due to cross implantation.

  5. Effects of patellar taping on brain activity during knee joint proprioception tests using functional magnetic resonance imaging.

    Science.gov (United States)

    Callaghan, Michael J; McKie, Shane; Richardson, Paul; Oldham, Jacqueline A

    2012-06-01

    Patellar taping is a common treatment modality for physical therapists managing patellofemoral pain. However, the mechanisms of action remain unclear, with much debate as to whether its efficacy is due to a change in patellar alignment or an alteration in sensory input. The purpose of this study was to investigate the sensory input hypothesis using functional magnetic resonance imaging when taping was applied to the knee joint during a proprioception task. This was an observational study with patellar taping intervention. Eight male volunteers who were healthy and right-leg dominant participated in a motor block design study. Each participant performed 2 right knee extension repetitive movement tasks: one simple and one proprioceptive. These tasks were performed with and without patellar taping and were auditorally paced for 400 seconds at 72 beats/min (1.2 Hz). The proprioception task without patellar taping caused a positive blood oxygenation level-dependant (BOLD) response bilaterally in the medial supplementary motor area, the cingulate motor area, the basal ganglion, and the thalamus and medial primary sensory motor cortex. For the proprioception task with patellar taping, there was a decreased BOLD response in these regions. In the lateral primary sensory cortex, there was a negative BOLD response with less activity for the proprioception task with taping. Limitations This study may have been limited by the small sample size, a possible learning effect due to a nonrandom order of tasks, and use of a single-joint knee extension task. This study demonstrated that patellar taping modulates brain activity in several areas of the brain during a proprioception knee movement task.

  6. Effects of In-Season Inertial Resistance Training With Eccentric Overload in a Sports Population at Risk for Patellar Tendinopathy.

    Science.gov (United States)

    Gual, Gabriel; Fort-Vanmeerhaeghe, Azahara; Romero-Rodríguez, Daniel; Tesch, Per A

    2016-07-01

    Gual, G, Fort-Vanmeerhaeghe, A, Romero-Rodríguez, D, and Tesch, PA. Effects of in-season inertial resistance training with eccentric overload in a sports population at risk for patellar tendinopathy. J Strength Cond Res 30(7): 1834-1842, 2016-Volleyball and basketball players can be considered as a population at risk for patellar tendinopathy. Given the paradox that eccentric training elicits therapeutic benefits yet might provoke such injury, we investigated the influence of a weekly bout of inertial squat resistance exercise offering eccentric overload on lower limb muscle power and patellar tendon complaints. Players of 8 (4 basketball and 4 volleyball) teams (38 women and 43 men) were randomly assigned to either the intervention (IG) or control (CG) group. Although IG and CG maintained scheduled in-season training routines over 24 weeks, IG, in addition, performed 1 weekly session of eccentric overload by 4 sets of 8 repetitions of the squat using flywheel inertial resistance. Victorian Institute of Sports Assessment patellar tendinopathy questionnaire (VISA-p), vertical countermovement jump, and squat power, both concentric (Squat-Con) and eccentric (Squat-Ecc), tests were performed before (T1), during (T2), and after (T3) the 24 weeks of intervention. Neither group suffered from patellar tendinopathy during the study period. VISA-p displayed no differences across groups at any measurement period. Countermovement jump scores significantly (p ≤ 0.05) differed between groups in favor of the IG. Both Squat-Con and Squat-Ecc mean scores from the IG were significantly (p exercise routine enhances lower limb muscle power without triggering patellar tendon complaints. Future studies, using the current exercise paradigm, aim to explore its efficacy to prevent or combat patellar tendinopathy in sports calling for frequent explosive jumps.

  7. Comparison of ultrasonographic patellar tendon evaluation methods in elite junior female volleyball players: thickness versus cross-sectional area.

    Science.gov (United States)

    Toprak, Uğur; Ustüner, Evren; Uyanık, Sadık; Aktaş, Gülcan; Kınıklı, Gizem Irem; Baltacı, Gül; Karademir, Mehmet Alp

    2012-01-01

    The goal of the present study was to compare the patellar tendon cross-sectional area with the patellar tendon thickness and to determine the intra-observer compliance level in the cross-sectional area and thickness measurements. This comparison was used to describe the effects of playing volleyball on the patellar tendon. The patellar tendons of 60 volleyball players and 60 non-player female students, who were 11-16 years of age with similar physical characteristics, were examined using Doppler ultrasonography (US). Cross-sectional area and thickness measurements were conducted. The proximal and distal thicknesses of the patellar tendon were similar, but the area was smaller for the distal portion. A correlation was observed between age and tendon thickness and between the thickness and area of the tendon. All of the measurements in the subjects with tendinosis were larger than those in the healthy controls. There were no pathological findings in the non-players. The intra-observer compliance was high. The transverse plane area measurement was as reliable as the thickness measurement and exhibited a high level of intraobserver compliance. This measurement can be conducted during routine examinations. The patellar tendons in the athletes were observed to be widened and thickened, most likely because of overuse. Patellar tendinosis and Osgood-Schlatter Syndrome may be asymptomatic and incidentally detected. Therefore, routine US examinations may help prevent further injuries. Although the tendon thicknesses were observed to be the same in both extremities, any observed difference in the tendon areas may alert the physician to a risk factor for the development of tendinosis.

  8. Bone bruise in acute traumatic patellar dislocation: volumetric magnetic resonance imaging analysis with follow-up mean of 12 months

    Energy Technology Data Exchange (ETDEWEB)

    Paakkala, Antti; Paakkala, Timo [Tampere University Hospital, Department of Radiology, Tampere (Finland); Sillanpaeae, Petri; Maeenpaeae, Heikki [Tampere University Hospital, Department of Orthopaedics and Traumatology, Tampere (Finland); Huhtala, Heini [University of Tampere, School of Public Health, Tampere (Finland)

    2010-07-15

    The aim of the study was to assess volumetric analysis of bone bruises in acute primary traumatic patellar dislocation by magnetic resonance imaging (MRI) and resolving resolution of bruises in follow-up MRI. MRI was performed in 23 cases. A follow-up examination was done at a mean of 12 months after dislocation. Volumes of patellar and femur bruises for every patient were evaluated separately by two musculoskeletal radiologists, and mean values of the bruises were assessed. Other MRI findings were evaluated, together with agreement by consensus. Bone bruise volumes were compared with other MR findings. In the acute study 100% of patients showed bruising of the lateral femoral condyle and 96% bruising of the patella. The bruise was located at the medial femoral condyle in 30% and at the patellar median ridge in 74% of patients. The median volume of the femoral bruise was 25,831 mm{sup 3} and of the patellar bruise 2,832 mm{sup 3}. At the follow-up study 22% of patients showed bruising of the lateral femoral condyle and 39% bruising of the patella, the median volumes of the bruises being 5,062 mm{sup 3} and 1,380 mm{sup 3}, respectively. Larger patellar bruise volume correlated with larger femur bruise volume in the acute (r=0.389, P=0.074) and the follow-up (r=1.000, P<0.01) studies. Other MRI findings did not correlate significantly with bone bruise volumes. Bone bruising is the commonest finding in cases of acute patellar dislocation, being seen even 1 year after trauma and indicating significant bone trabecular injury in the patellofemoral joint. A large bruise volume may be associated with subsequent chondral lesion progression at the patella. We concluded that the measurement of bone bruise volume in patients with acute patellar dislocation is a reproducible method but requires further studies to evaluate its clinical use. (orig.)

  9. Effects of Patellar Taping on Brain Activity During Knee Joint Proprioception Tests Using Functional Magnetic Resonance Imaging

    Science.gov (United States)

    McKie, Shane; Richardson, Paul; Oldham, Jacqueline A.

    2012-01-01

    Background Patellar taping is a common treatment modality for physical therapists managing patellofemoral pain. However, the mechanisms of action remain unclear, with much debate as to whether its efficacy is due to a change in patellar alignment or an alteration in sensory input. Objective The purpose of this study was to investigate the sensory input hypothesis using functional magnetic resonance imaging when taping was applied to the knee joint during a proprioception task. Design This was an observational study with patellar taping intervention. Methods Eight male volunteers who were healthy and right-leg dominant participated in a motor block design study. Each participant performed 2 right knee extension repetitive movement tasks: one simple and one proprioceptive. These tasks were performed with and without patellar taping and were auditorally paced for 400 seconds at 72 beats/min (1.2 Hz). Results The proprioception task without patellar taping caused a positive blood oxygenation level–dependant (BOLD) response bilaterally in the medial supplementary motor area, the cingulate motor area, the basal ganglion, and the thalamus and medial primary sensory motor cortex. For the proprioception task with patellar taping, there was a decreased BOLD response in these regions. In the lateral primary sensory cortex, there was a negative BOLD response with less activity for the proprioception task with taping. Limitations This study may have been limited by the small sample size, a possible learning effect due to a nonrandom order of tasks, and use of a single-joint knee extension task. Conclusions This study demonstrated that patellar taping modulates brain activity in several areas of the brain during a proprioception knee movement task. PMID:22282771

  10. Categorization of compensatory motions in transradial myoelectric prosthesis users.

    Science.gov (United States)

    Hussaini, Ali; Zinck, Arthur; Kyberd, Peter

    2017-06-01

    Prosthesis users perform various compensatory motions to accommodate for the loss of the hand and wrist as well as the reduced functionality of a prosthetic hand. Investigate different compensation strategies that are performed by prosthesis users. Comparative analysis. A total of 20 able-bodied subjects and 4 prosthesis users performed a set of bimanual activities. Movements of the trunk and head were recorded using a motion capture system and a digital video recorder. Clinical motion angles were calculated to assess the compensatory motions made by the prosthesis users. The video recording also assisted in visually identifying the compensations. Compensatory motions by the prosthesis users were evident in the tasks performed (slicing and stirring activities) as compared to the benchmark of able-bodied subjects. Compensations took the form of a measured increase in range of motion, an observed adoption of a new posture during task execution, and prepositioning of items in the workspace prior to initiating a given task. Compensatory motions were performed by prosthesis users during the selected tasks. These can be categorized into three different types of compensations. Clinical relevance Proper identification and classification of compensatory motions performed by prosthesis users into three distinct forms allows clinicians and researchers to accurately identify and quantify movement. It will assist in evaluating new prosthetic interventions by providing distinct terminology that is easily understood and can be shared between research institutions.

  11. Disassembly and Dislocation of a Bipolar Hip Prosthesis

    Directory of Open Access Journals (Sweden)

    Hsieh-Hsing Lee

    2008-01-01

    Full Text Available Dislocation of a hip prosthesis is a common complication. In usual cases of hip prosthesis dislocation, the prosthetic femoral head comes out from either the natural acetabular cavity in a bipolar hemiarthroplasty or the prosthetic acetabulum in a total hip arthroplasty. Only a few cases of bipolar hip prosthesis dislocation due to dissociation between the polyethylene and inner head of the prosthesis have been reported. We describe a rare case of disassembly of the inner head from the bipolar outer prosthesis in an osteoarthritic acetabulum. A 72-year-old woman had undergone bipolar hemiarthroplasty due to fracture of the left femoral neck about 10 years previously. Recently, she sustained an injury after falling from a chair, and examinations revealed an unusual disassembly−dislocation of the bipolar hip prosthesis. We classified this failure in our patient as a type II failure, representing extreme varus position of the outer head in the acetabulum, dislocation of the inner head from the outer head, and a detached locking ring around the stem neck. This mechanism of failure as shown in our patient rarely occurs in the bipolar prosthesis of the self-centering system. Osteoarthritic change of the acetabulum would place the outer head in the varus position, increasing wear on the beveled rim by impinging the femoral stem neck and causing dislodgment of the inner locking ring and consequent disassembly−dislocation of the inner head.

  12. Factors affecting the outcomes of modified tension band wiring techniques in transverse patellar fractures.

    Science.gov (United States)

    Hsu, Kai-Lan; Chang, Wei-Lun; Yang, Chyun-Yu; Yeh, Ming-Long; Chang, Chih-Wei

    2017-12-01

    Modified tension band wiring has been widely used to treat transverse patellar fractures. However, few studies have evaluated the clinical outcomes using different methods of Kirschner wire bending, location of the tension band, and depths of Kirschner wires. Thus, we tried to clarify these factors according to our clinical outcomes. This retrospective cohort study recruited consecutive patients underwent surgical fixation for patellar fractures using modified tension band technique between January 2010 and December 2015. Different factors in this procedure, including the bending manner of the Kirschner wires, their depth, and location of the tension band with respect to the superior and inferior border of the patella were recorded and analysed. The primary outcome was early loss of fixation. The secondary outcomes were minor loss of reduction, implant breakage, deep infection, and the need for implant removal. This study included 170 patients with patellar fractures. Regarding the bending method, similar results were obtained with bilaterally or proximally bent Kirschner wires. Regarding length, the tension band was placed closely (within 25% of the patella length) in 124 patients and distantly in 46 patients. The rates of loss of reduction and implant breakage were significantly higher in the distantly placed tension bands. Regarding depth, 37 patellar fractures were fixed with the Kirschner wires at the superficial one third of the patellae while the K- wires at the middle layer of patella were used in the remaining 133 patellar fractures. A significantly higher rate of minor loss of reduction was obtained using the superficial Kirschner wires. The modified tension band technique for transverse patella fractures provides favourable clinical outcomes, with low failure (5%) and infection (2%) rates. Implant irritation is the major complication, and almost half of cases require implant removal. The location of the tension band with respect to the superior and

  13. Knee extensor dynamics in the volleyball approach jump: the influence of patellar tendinopathy.

    Science.gov (United States)

    Sorenson, Shawn C; Arya, Shruti; Souza, Richard B; Pollard, Christine D; Salem, George J; Kulig, Kornelia

    2010-09-01

    Controlled laboratory study using a cross-sectional design. To evaluate knee joint dynamics in elite volleyball players with and without a history of patellar tendinopathy, focusing on mechanical energy absorption and generation. We hypothesized that tendinopathy would be associated withreduced net joint work and net joint power. Patellar tendinopathy is a common, debilitating injury affecting competitive volleyball players. Thirteen elite male players with and without a history of patellar tendinopathy (mean ± SD age, 27 ± 7 years) performed maximum-effort volleyball approach jumps. Sagittal plane knee joint kinematics, kinetics, and energetics were quantified in the lead limb, using data obtained from a force platform and an 8-camera motion analysis system. Vertical ground reaction forces and pelvis vertical velocity at takeoff were examined. Independent sample t tests were used to evaluate group differences (α = .05). The tendinopathy group, compared to controls, demonstrated significant reductions (approximately 30%) in net joint work and net joint power during the eccentric phase of the jump, with no differences in the concentric phase. Positive to-negative net joint work and net joint power ratios were significantly higher in the tendinopathy group, which had a net joint work ratio of 1.00 (95% CI: 0.77, 1.24) versus 0.76 (95% CI: 0.64, 0.88) for controls, and a net joint power ratio of 1.62 (95% CI: 1.15, 2.10) versus 1.00 (95% CI: 0.80, 1.21) for controls. There were no significant differences in net joint moment, angular velocity, or range of motion. Peak vertical ground reaction forces were lower for the tendinopathy group, while average vertical ground reaction forces and pelvis vertical velocity were similar. Patellar tendinopathy is associated with differences in sagittal plane mechanical energy absorption at the knee during maximum-effort volleyball approach jumps. Net joint work and net joint power may help define underlying mechanisms, adaptive

  14. A new approach towards hip-prosthesis design.

    Science.gov (United States)

    Huggler, A H; Jacob, H A

    1980-01-01

    A new femoral prosthesis with a stemless design, different from conventional types, has been conceived in an effort to preserve the physiological stress distribution in magnitude and direction within the living bone as far as possible. The most important feature is that the hip joint forces are transmitted directly to the cortical bone of the resected femoral neck by means of a thrust plate, which maintains the physiological stress an the proximal end of the femur. The prosthesis, the instruments required for its implantation and the surgical technique are described in detail. Up to now, 3 patients have received this new prosthesis.

  15. The bionic eye (electronic visual prosthesis): a review.

    Science.gov (United States)

    Suaning, G J; Lovell, N H; Schindhelm, K; Coroneo, M T

    1998-08-01

    The concept of a visual prosthesis for the blind or partially sighted is not a new one. Indeed, for more than three decades this technology based treatment for blindness has appeared imminent. Despite the concerted efforts of numerous physicians, scientists and engineers, the successful application of a useful visual prosthesis remains elusive. The present review will endeavour to describe past efforts, investigate the present state of the art and indicate the obstacles that must be overcome in order to bring an electronic visual prosthesis to fruition.

  16. A modified technique for retention of orbital prosthesis

    Directory of Open Access Journals (Sweden)

    Sameera R Shaikh

    2011-01-01

    Full Text Available An orbital defect (congenital or acquired causes severe facial asymmetry and disfigurement, which results in psychological and social disturbances to the patient. It becomes a challenging task for a maxillofacial prosthodontist to fabricate a prosthesis that replicates the healthy side of the face. Success of the prosthesis depends primarily on satisfactory retention of the same. This clinical report illustrates rehabilitation of a patient with an orbital defect by fabricating a hollow orbital prosthesis, utilizing anatomical undercuts for retention using an acrylic resin template relined by a resilient denture liner.

  17. Medial Patellofemoral Ligament Injuries in Children With First-Time Lateral Patellar Dislocations: A Magnetic Resonance Imaging and Arthroscopic Study.

    Science.gov (United States)

    Askenberger, Marie; Arendt, Elizabeth A; Ekström, Wilhelmina; Voss, Ulrika; Finnbogason, Throstur; Janarv, Per-Mats

    2016-01-01

    A lateral patellar dislocation (LPD) is the most common knee injury in children with traumatic knee hemarthrosis. The medial patellofemoral ligament (MPFL), the important passive stabilizer against LPDs, is injured in more than 90% of cases. The MPFL injury pattern is most often defined in adults or in mixed-age populations. The injury pattern in the skeletally immature patient may be different. To describe MPFL injuries in the skeletally immature patient by magnetic resonance imaging (MRI), and to compare the results with the injury pattern found at arthroscopic surgery. Case series; Level of evidence, 4. This was a prospective series of patients aged 9 to 14 years with acute, first-time traumatic LPDs in whom clinical examinations, radiographs, MRI, and arthroscopic surgery were performed within 2 weeks from the index injury. The MPFL injury was divided into 3 different groups according to the location: patellar site, femoral site, or multifocal. The MPFL injury site was confirmed on MRI by soft tissue edema. The length of the MPFL injury at the patellar site was measured at arthroscopic surgery, and those ≥2 cm were defined as total ruptures. A total of 74 patients (40 girls and 34 boys; mean age, 13.1 years) were included; 73 patients (99%) had an MPFL injury according to MRI and arthroscopic surgery. The MRI scans showed an isolated MPFL injury at the patellar attachment site in 44 of 74 patients (60%), a multifocal injury in 26 patients (35%), an injury at the femoral site in 3 patients (4%), and no injury in 1 patient (1%). Arthroscopic surgery disclosed an isolated MPFL injury at the patellar site in 60 of 74 patients (81%) and a multifocal injury in 13 patients (18%); the MPFL injury at the patellar site was a total rupture in 49 patients (66%). Edema at the patellar attachment site on MRI was proven to be an MPFL rupture at the same site at arthroscopic surgery in 99% of the patients. A patellar-based injury, isolated or as part of a multifocal injury

  18. [Reconstruction of medial patellofemoral ligament with transposition of great adductor muscular tendon for the treatment of teenagers' recurrent patellar dislocation].

    Science.gov (United States)

    Shao, Chuan-Qiang; Chen, Chang-Chun; Zhao, Chun-Cheng; Yang, Hong-Mei; Kang, Yan-Zhong

    2017-06-25

    To investigate surgical method and clinical curative effects of medial patellofemoral ligament (MPFL) reconstruction with great adductor muscular tendon in treating teenagers' recurrent patellar dislocation. From May 2012 to September 2014, 19 patients with recurrent dislocation of patellar, including 6 males and 13 females with an average of 16 years old (ranged from 13 to 17 years), the courses of disease ranged from 3 to 18 months(averaged 6 months). All patients were underwent great adductor muscular tendon transposition to reconstruct medial patellofemoral ligament. The curative effects were evaluated by preoperative and postoperative with Lysholm scores and Patellofemoral angle and Q angle. All patients were followed up from 12 to 18 months with an average of 16.5 months. Primary healing was achieved at stage I. No pain, swelling and patellar dislocation or subluxation occurred. Patellofemoral angle increased from preoperative (-3.8±4.9)° to (10.3±4.1)° postoperatively. Q angle decreased from preoperative(16.4±3.1)° to(10.5±1.2)° postoperatively; Lysholm scores were improved from preoperative (68.6±8.5) to (93.7±6.5) final follow-up (Pgood, and 1 fair. Reconstruction of medial patellofemoral ligament with transposition of great adductor muscular tendon could obviously recover stability of patellar, and it is one of the effective methods for the treatment of teenagers' recurrent patellar dislocation.

  19. Surgical versus non-surgical management for primary patellar dislocations: an up-to-date meta-analysis.

    Science.gov (United States)

    Zheng, Xiaozuo; Kang, Kai; Li, Tong; Lu, Bo; Dong, Jiangtao; Gao, Shijun

    2014-12-01

    The aim of this up-to-date meta-analysis was to compare the effects of surgical versus non-surgical treatment of patients following primary patellar dislocation and to provide the best evidence currently available. A comprehensive literature search was conducted using multiple databases, including Medline, Embase, and Cochrane Registry of Clinical Trials. All databases were searched from the earliest records to May 2013. Eligible studies were selected, and data were extracted by two independent investigators. The primary outcome variable was the frequency of recurrent patellar dislocation. The other outcomes included knee function scores, patient-rated outcomes, and radiographic examination. If appropriate, meta-analysis of these variables was performed. Nine independent trials were found to match the inclusion criteria. The pooled results demonstrated that the incidence of recurrent patellar dislocation and Hughston visual analog scale was significantly lower in the surgical treatment group than that in the non-surgical treatment group (P 0.05). This up-to-date meta-analysis indicates that surgical treatment was associated with a lower risk of recurrent patellar dislocation, but a lower Hughston VAS than non-surgical treatment for primary patellar dislocation. More large high-quality trials and further studies are needed to overcome the limitations of small sample sizes, and varieties of different surgical procedures or non-surgical management strategies adopted in the included trials.

  20. Development of a micromachined epiretinal vision prosthesis

    Science.gov (United States)

    Stieglitz, Thomas

    2009-12-01

    Microsystems engineering offers the tools to develop highly sophisticated miniaturized implants to interface with the nervous system. One challenging application field is the development of neural prostheses to restore vision in persons that have become blind by photoreceptor degeneration due to retinitis pigmentosa. The fundamental work that has been done in one approach is presented here. An epiretinal vision prosthesis has been developed that allows hybrid integration of electronics on one part of a thin and flexible substrate. Polyimide as a substrate material is proven to be non-cytotoxic. Non-hermetic encapsulation with parylene C was stable for at least 3 months in vivo. Chronic animal experiments proved spatially selective cortical activation after epiretinal stimulation with a 25-channel implant. Research results have been transferred successfully to companies that currently work on the medical device approval of these retinal vision prostheses in Europe and in the USA.

  1. Natural tooth as an interim prosthesis.

    Science.gov (United States)

    Dhariwal, Neha S; Gokhale, Niraj S; Patel, Punit; Hugar, Shivayogi M

    2016-01-01

    A traumatic injury to primary maxillary anterior tooth is one of the common causes for problems with the succedaneous tooth leading to it noneruption. A missing anterior tooth can be psychologically and socially damaging to the patient. Despite a wide range of treatment options available, sometimes, it is inevitable to save the natural tooth. This paper describes the immediate replacement of a right central incisor using a fiber-composite resin splint with the natural tooth crown as a pontic following surgical extraction of the dilacerated impacted permanent maxillary central incisor. The abutment teeth can be conserved with minimal or no preparation, thus keeping the technique reversible and can be completed at chair side thereby avoiding laboratory costs. It can be used as an interim measure until a definitive prosthesis can be fabricated as the growth is still incomplete.

  2. [Nocardia farcinica infection of a vascular prosthesis].

    Science.gov (United States)

    Babilas, P; Scherer, K; Landthaler, M; Ehrenstein, B; Szeimies, R-M

    2007-04-01

    A 61-year-old woman presented with purple-red subcutaneous nodules on her right leg. She had experienced fever up to 40 degrees C for the past 10 days and felt generally weak over the last two months. Four months earlier, a vascular graft had been implanted in her right femoral artery. Based on the diagnosis of skin infection due to implantation of an infected prosthesis, she was hospitalized and treated with an antibiotic regime. During the initial antibiotic treatment, the symptoms deteriorated, and she developed joint, hepatic and CNS abscesses. Finally, a microbiologic culture with an extended incubation time revealed the diagnosis of an infection with the slowly growing bacterium Nocardia ssp. Hereupon the patient was treated purposefully with Meropenem over six months. This treatment resulted in complete recovery.

  3. Comparison of reliability of five patellar position indices at various stifle joint angles in pelvic limbs obtained from cadavers of red foxes (Vulpes vulpes)

    DEFF Research Database (Denmark)

    Miles, James E; Nielsen, Dorte H; Jensen, Bente Rona

    2012-01-01

    To compare 5 patellar position indices at various stifle joint angles in cadavers of red foxes, determine measurement reliability, and assess the suitability of these indices for clinical use.......To compare 5 patellar position indices at various stifle joint angles in cadavers of red foxes, determine measurement reliability, and assess the suitability of these indices for clinical use....

  4. [Results after replacement of femoral neck prostheses - thrust plate prosthesis (TPP) versus ESKA cut prosthesis].

    Science.gov (United States)

    Ishaque, B A; Gils, J; Wienbeck, S; Donle, E; Basad, E; Stürz, H

    2009-01-01

    The aim of this study was to analyse and evaluate comparatively loosening mechanisms, failure frequency, surgical changing strategies and results after replacement of thrust plate prostheses (TPP) and ESKA Cut prostheses. Between 1993 und 2007, 465 TPP and in the years 2000 and 2001 82 ESKA Cut prostheses were performed and evaluated prospectively. Until 2007 46 change interventions of the TPP and 35 of the CUT prosthesis became necessary. All patients who received a stem revision procedure in our hospital were included within this study. Besides the evaluation of clinical results according to the criteria of the Harris Hip Score on the average at 15.6 months (+/- 14.4) postoperatively, radiological loosening processes and surgical difficulties were registered. Furthermore, an analysis of perioperative data was performed according to some criteria of the German Federal Office of Quality Assurance (BQS), such as duration of the surgery, intraoperative blood loss and complications. Statistical investigations for comparative analysis as well as survival analysis of both groups were calculated using SPSS for Windows 13.0. The mean age of the 46 patients who had to undergo revision surgery after TPP was 60.1 years, that of 35 patients in whom revision surgery was necessary after receiving an ESKA Cut femoral neck stem was 56.6 years. The survival rate analysis according to Kaplan-Meier at 13 years was 89.4 % (TPP) and 53.6 % at 66 months (ESKA Cut). In all cases the partial osteointegration of the tripod surface of the loosened Cut prosthesis complicated the explantation. It led on the one hand to a significant difference of the surgery duration and on the other hand to an increased frequency of fractures of the trochanteric region. The conversion of the TPP on standard type stems was usually free of problems. The HHS increased significantly to the averages of 86.6 (TPP) or, respectively, 91.69 (ESKA Cut) after revision. In comparison with the usually problem

  5. Energy dispersive X-ray microanalysis, fluoride release, and antimicrobial properties of glass ionomer cements indicated for atraumatic restorative treatment

    Science.gov (United States)

    Saxena, Sudhanshu; Tiwari, Sonia

    2016-01-01

    Aim: The aim of this study was to compare constituents of glass powder, fluoride release, and antimicrobial properties of new atraumatic restorative treatment material with zirconia fillers and conventional glass ionomer cement (GIC) type IX. Materials and Methods: Thisin vitro study comparing Zirconomer and Fuji IX was executed in three parts: (1) energy dispersive X-ray microanalysis of glass powders (2) analysis of fluoride release at 1st, 3rd, 7th, 15th, and 30th day, and (3) antimicrobial activity against Streptococcus mutans, Lactobacillus casei, and Candida albicans at 48 hours. Data was analyzed using unpaired t-test and two way analysis of variance followed by least significant difference post hoc test. A P value of glass powders, mean atomic percentage of oxygen was more than 50%. According to the weight percentage, zirconium in Zirconomer and silica in Fuji IX were the second main elements. Calcium, zinc, and zirconium were observed only in Zirconomer. At all the time intervals, statistically significant higher amount of fluoride release was observed with Zirconomer than Fuji IX. At 48 hours, mean ± standard deviation (SD) of zone of inhibition against Streptococcus mutans was 11.14 ± 0.77 mm and 8.51 ± 0.43 mm for Zirconomer and Fuji IX, respectively. Against Lactobacillus casei, it was 14.06 ± 0.71 mm for Zirconomer and 11.70 ± 0.39 mm for Fuji IX. No antifungal activity was observed against Candida albicans by Zirconomer and Fuji IX. Conclusion: Zirconomer had higher antibacterial activity against Streptococcus mutans and Lactobacillus casei, which may be attributed to its composition and higher fluoride release. However, it failed to show antifungal effect againstCandida albicans. PMID:27583226

  6. The atraumatic restorative treatment (ART) strategy in Mexico: two-years follow up of ART sealants and restorations.

    Science.gov (United States)

    Luengas-Quintero, Elisa; Frencken, Jo E; Muñúzuri-Hernández, Jorge Alejandro; Mulder, Jan

    2013-09-08

    The massive use of preventive measures in Mexico has resulted in a large decline in dental caries over the past two decades. There does however remain a largely unmet need for restorative treatment. This paper describes the steps leading up to the adoption of a strategy, as part of general health policy, to use Atraumatic Restorative Treatment (ART) within the Mexican public health service as a means of addressing this. The objective was to evaluate ART restorations and sealants placed in primary and permanent teeth in schoolchildren from deprived areas over a period of 2 years. 18 Dentists from 13 municipalities in 6 states with the lowest human development index treated 304, 6- to 13-year-old schoolchildren with ART sealants and ART restorations (single-surfaces) on the school compounds. Ketac Molar Easymix was the filling material used. ART procedures were evaluated according to the ART assessment criteria after 1 and 2 years, by 7 calibrated evaluators. Survival rates were estimated, using the PHREG Model with frailty correction. The 2-year cumulative survival rates of fully and partially retained ART sealants were 73.1% (primary teeth) and 48.8% (permanent teeth). The dentine carious lesion failure rates of ART sealants in primary and permanent teeth over the 2-year period were 0% and 2.5%, respectively. The 2-year cumulative survival rates of single-surface ART restorations in primary and permanent teeth were 74% and 80.9%, respectively. Secondary carious lesion development occurred in 6 restored primary teeth (2.1%) and in one restored permanent tooth (1.3%). All restorations placed in primary teeth in one state survived, whilst those in one of the 5 remaining states failed statistically significantly more than those in the other 4. The ART procedures were of substantial quality and had prevented to a large extent the development of new dentine carious lesions in these children from socio-economically deprived areas.

  7. Non-Necrotizing Streptococcal Cellulitis as a Cause of Acute, Atraumatic Compartment Syndrome of the Foot: A Case Report.

    Science.gov (United States)

    Toney, James; Donovan, Stephanie; Adelman, Vanessa; Adelman, Ronald

    2016-01-01

    Acute compartment syndrome is widely accepted as a surgical emergency. Most cases of acute compartment syndrome occur after high-energy trauma, especially crush injuries. We present a unique case of acute, atraumatic compartment syndrome of the foot associated with infectious cellulitis. A 53-year-old male, with a medical history significant for human immunodeficiency virus, presented to the emergency department secondary to an insidious onset of intense foot pain, swelling, and an inability to bear weight on the affected extremity. He had no history of recent trauma. He was admitted to the hospital because of a suspected infection and subsequently was given intravenous antibiotics. During the admission, he developed a severe infection, and blood cultures demonstrated growth of group A streptococcus. No abscess or hematoma was identified on magnetic resonance imaging or during exploratory surgery. The findings from intraoperative cultures were negative. Despite proper medical care for his infection, the lower extremity pain worsened; therefore, compartmental pressures were obtained at the bedside. Multiple compartment pressures were measured and were >40 mm Hg. Compartment syndrome was diagnosed, and the patient was taken to the operating room for emergent fasciotomies. Surgical release of the medial, lateral, interosseous, and adductor compartments revealed copious amounts of serosanguinous drainage. Again, no definitive hematoma or purulence was identified. The patient's symptoms resolved after the fasciotomies, and he healed uneventfully. Our case highlights the need to consider acute compartment syndrome in the differential diagnosis for pain out of proportion to the clinical situation, even when a traditional etiology is absent. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  8. A 2-year clinical study of two glass ionomer cements used in the atraumatic restorative treatment (ART) technique.

    Science.gov (United States)

    Ho, T F; Smales, R J; Fang, D T

    1999-06-01

    The purpose of the study was to evaluate, in a clinical study over 2 years, the deterioration of two glass ionomer cements used with the atraumatic restorative treatment (ART) technique or approach. Fifty-five Fuji IX and 45 ChemFil Superior restorations were placed randomly in 23 adult patients, mainly in small occlusal preparations in molar teeth. The restorations were placed in a dental hospital by one dentist using the ART technique. Photographs, radiographs and replicas were obtained at baseline and subsequent recalls. Both cements were easy to mix and place, but the radiolucency of ChemFil Superior was a disadvantage. Both cements also showed early high losses of sealant and restorative material. After 2 years, 34.5% of the sealants appeared to be completely lost, with caries recorded in 5.3% of the exposed fissures. In some instances, these small lesions may have been present, but not detected clinically, at the time of sealing. Restoration failures of 7.0% were from wear and fracture of the cements and recurrent caries. Mean cumulative wear was 83.1 microm for Fuji IX and 104.0 microm for ChemFil Superior, which was not statistically significant. The cements became darker after their placement to more closely match the restored teeth, but there were few exact matches. There was no surface staining and only minor marginal discrepancies and staining associated with the restorations. Although the short-term clinical performance of the two glass ionomer cements was reasonable, the materials require further improvements in their mechanical properties, to reduce sealant losses and wear. The cements evaluated appear suitable for restricted use only, in posterior teeth.

  9. The willingness of US pediatric dentists to use atraumatic restorative treatment (ART) with their patients: a conjoint analysis

    Science.gov (United States)

    Kateeb, Elham Talib; Warren, John; Gaeth, Gary; Damiano, Peter; Momany, Elizabeth; Kanellis, Michael J.; Weber-Gasparoni, Karin; Ansley, Timothy

    2014-01-01

    Objectives The atraumatic restorative treatment (ART) was developed as an affordable, patient-friendly dental caries management procedure that does not need extensive operator training or special skills. The aim of this study was to determine factors that influence the decision to use ART using an innovative marketing research technique known as conjoint analysis. Methods A conjoint survey was completed by 723 members of the American Academy of Pediatric Dentistry. Three factors (age of the child, level of cooperation, type of insurance) were varied across three levels to create nine patient scenarios. The weights that practitioners placed on these factors in decisions to use ART in treating carious lesions were determined by conjoint analysis. Factors such as lesion location, depth, and extension were fixed in the nine clinical scenarios. Results Seven-hundred twenty-three pediatric dentists completed the survey (32 percent). Age of the child was the most important factor in pediatric dentists’ decisions to use ART (46 percent) compared with level of cooperation (41 percent) and type of insurance coverage (11 percent). For the age factor, the age of 2 years had the greatest utility (0.55) compared with age 4 (−0.09) and age 6 (−0.46). For types of insurance coverage, having no insurance (0.124) had the greatest utility compared with having public insurance (−0.119). Conclusions Although insurance coverage was the least important among the factors, being without insurance, being very young, and being uncooperative was the scenario where pediatric dentists most favored ART when making trade offs between different factors using the conjoint design. PMID:24635596

  10. Acceptability, feasibility and perceived satisfaction of the use of the Atraumatic Restorative Treatment approach for people with disability

    Directory of Open Access Journals (Sweden)

    Gustavo Fabián MOLINA

    2015-01-01

    Full Text Available Unmet caries treatment need is prevalent among people with disability, partly due to difficulties cooperating with conventional dental treatment. This study compared Atraumatic Restorative Treatment (ART with conventional restorative treatment (CRT in the clinic and under general anaesthesia (GA, in terms of feasibility, acceptability and respondent satisfaction in patients referred for special care dentistry. Patients referred for dental restorative care were treated using either ART or CRT approach. Acceptance, feasibility and level of satisfaction with the treatment provided were assessed. ANOVA with Bonferroni correction and Chi-square tests investigated differences in age, gender and Visual Analogue Scale satisfaction scores. A total of 66 patients (mean 13.6 ± 7.8 years were included and 43 respondents chose ART. ART was feasible for 47 patients, with optimal placement of restorations for 79% of all patients receiving ART. CRT in the clinic was chosen by 15 respondents and was feasible for 5 (33%. Local anaesthesia was required for 4 of the 47 patients receiving ART and for 3 of the 5 patients receiving CRT in the clinic. Neither ART nor CRT could be performed in the clinic for 14 patients who were treated under GA (21%. Respondent satisfaction was higher for those receiving ART than CRT (in the clinic and under GA. It was concluded that ART is a satisfactory, feasible, acceptable and effective approach to restorative dental treatment in patients with disability who have difficulty coping with conventional treatment. More research is now required to confirm these results in a larger study population.

  11. The willingness of US pediatric dentists to use atraumatic restorative treatment (ART) with their patients: a conjoint analysis.

    Science.gov (United States)

    Kateeb, Elham Talib; Warren, John; Gaeth, Gary; Damiano, Peter; Momany, Elizabeth; Kanellis, Michael J; Weber-Gasparoni, Karin; Ansley, Timothy

    2014-01-01

    The atraumatic restorative treatment (ART) was developed as an affordable, patient-friendly dental caries management procedure that does not need extensive operator training or special skills. The aim of this study was to determine factors that influence the decision to use ART using an innovative marketing research technique known as conjoint analysis. A conjoint survey was completed by 723 members of the American Academy of Pediatric Dentistry. Three factors (age of the child, level of cooperation, type of insurance) were varied across three levels to create nine patient scenarios. The weights that practitioners placed on these factors in decisions to use ART in treating carious lesions were determined by conjoint analysis. Factors such as lesion location, depth, and extension were fixed in the nine clinical scenarios. Seven-hundred twenty-three pediatric dentists completed the survey (32 percent). Age of the child was the most important factor in pediatric dentists' decisions to use ART (46 percent) compared with level of cooperation (41 percent) and type of insurance coverage (11 percent). For the age factor, the age of 2 years had the greatest utility (0.55) compared with age 4 (-0.09) and age 6 (-0.46). For types of insurance coverage, having no insurance (0.124) had the greatest utility compared with having public insurance (-0.119). Although insurance coverage was the least important among the factors, being without insurance, being very young, and being uncooperative was the scenario where pediatric dentists most favored ART when making trade offs between different factors using the conjoint design. © 2014 American Association of Public Health Dentistry.

  12. Microperforation prolotherapy: a novel method for successful nonsurgical treatment of atraumatic spontaneous anterior sternoclavicular subluxation, with an illustrative case

    Directory of Open Access Journals (Sweden)

    Stein A

    2011-06-01

    Full Text Available Alvin Stein1, Scott McAleer2, Marty Hinz31Stein Orthopedic Associates, PA, Plantation, FL, USA; 2University of Central Florida, Orlando, FL, USA; 3Clinical Research, Neuroresearch Clinics, Inc, Cape Coral, FL, USABackground: Surgical repair of an atraumatic spontaneous anterior subluxation of the sternoclavicular joint (herein referred to as the “SCJ” is often associated with poor outcome expectations. With traditional treatment, successful conservative therapy usually incorporates major lifestyle alterations. This manuscript discusses a novel approach known as “microperforation prolotherapy”. To illustrate the technique, the care of a patient who benefitted from this treatment is reviewed.Purpose: To present a novel form of treatment with an illustrative case that demonstrates the potential efficacy of microperforation prolotherapy of the SCJ.Patient and methods: A novel approach to treatment of bilateral subluxation of the sternoclavicular joint with microperforation prolotherapy is discussed. The clinical course of a 21-year-old male with bilateral subluxation of the SCJ, which seriously hampered the patient's athletic and daily living activities, is used as a backdrop to the discussion.Results: Following microperforation prolotherapy, the instability of the SCJ was replaced by full stability, complete range of motion, and the opportunity to engage in all of the athletic endeavors previously pursued. There is no scar or other cosmetic defect resulting from the treatment received.Conclusion: Anterior sternoclavicular joint subluxation has a poor record of complete recovery with surgical procedures or conservative measures with regard to providing restoration of full lifestyle function. This manuscript documents a novel microperforation prolotherapy treatment that induced healing and restored full stability to the ligament structures responsible for the condition in a completely safe and effective fashion, allowing the patient to resume

  13. EVALUTION OF EFFECTIVENESS OF BALANCE TRAINING IN CONVENTIONAL PROSTHESIS VERSUS ULTRAMODERN PROSTHESIS IN UNILATERAL TRANSTIBIAL AMPUTEE BY USING FLAMINGO BALANCE TEST

    OpenAIRE

    Suresh; Vinod Kumar; Bharath Raju; Raja; Ravish; Mandeep; Hari Krishna; Rajeeva

    2014-01-01

    AIM: To estimate the effectiveness of balance training on unilateral transtibal amputee with conventional prosthesis and ultramodern prosthesis. To compare the Effectiveness of balance training in conventional prosthesis versus ultramodern prosthesis in unilateral transtibial amputee by using Flamingo balance test. MATERIALS AND METHODS: After obtaining informed consent from the patients, we studied a total of 40 patients, aged between 30- 60 yrs, where they were randomly ...

  14. 21 CFR 888.3025 - Passive tendon prosthesis.

    Science.gov (United States)

    2010-04-01

    ...) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3025 Passive tendon prosthesis. (a... flexor tendon of the hand. The device is implanted for a period of 2 to 6 months to aid growth of a new...

  15. Towards a Completely Implantable, Light-Sensitive Intraocular Retinal Prosthesis

    National Research Council Canada - National Science Library

    Humayun, M

    2001-01-01

    An electronic retinal prosthesis is under development to treat retinitis pigmentosa and age-related macular degeneration, two presently incurable diseases of the outer retina that afflict millions world-wide...

  16. Characterization of an eye prosthesis using monopoly syrup.

    Science.gov (United States)

    Bankoti, Pinki; Singhal, M K; Nair, Chandana; Chandra, Praveen

    2016-01-01

    The eye is a vital organ and an important component of facial expression. Loss of an eye has a crippling effect on the psychology of the patient. Maxillofacial prostheses restore and replace stomatognathic and associated facial structures with artificial substitutes. The objectives of eye prosthesis is to improve the patient esthetics, restore and maintain the health of the remaining associated structures, consequently provide physical and mental well-being. The primary purpose of an ocular prosthesis is to maintain the volume of eye socket and create the illusion of a healthy eye and surrounding tissue. A custom ocular prosthesis is a good option when reconstruction is done by plastic surgery, and osseointegrated implants are either not possible or not desired. A case of a custom-made ocular acrylic prosthesis is presented with acceptable fit, good retention, and esthetics.

  17. Metabolics of stair ascent with a powered transfemoral prosthesis.

    Science.gov (United States)

    Ledoux, E D; Lawson, B E; Shultz, A H; Bartlett, H L; Goldfarb, M

    2015-01-01

    This paper evaluates the effectiveness of a powered knee and ankle prosthesis for stair ascent through a metabolic assessment comparing energy expenditure of a single transfemoral amputee subject while ascending stairs with the powered prosthesis relative to his passive daily use device, as well as comparing the kinematics and kinetics obtained with the passive prosthesis to healthy biomechanics. The subject wore a portable system that measured pulmonary gaseous exchange rates of oxygen and carbon dioxide while he ascended stairs with each of the prostheses in alternating tests. The results indicated that the amputee's energy expenditure decreased by 32 percent while climbing with the powered prosthesis as compared to his passive one, and the kinematics and kinetics achieved were representative of healthy biomechanics.

  18. Komposit Laminate Rami Epoksi Sebagai Bahan Alternatif Socket Prosthesis

    OpenAIRE

    Irawan, Agustinus P; Soemardi, Tresna P.; Widjajalaksmi K. Widjajalaksmi K.; Agus H.S. Reksoprodjo

    2009-01-01

    pure plant oil, biofuel, coconut oil, palm oil, jatropha oilSocket is the most important component in a prosthesis making. Performance criteria for prosthetic socket material include strength, durability, minimal weight, comfort, and minimal fabrication cost. This research attempts to analyze the strength of ramie fiber reinforced epoxy laminate composite as an alternative of socket prosthesis. The research based on ASTM D 3039/D 3039M for tensile strength and ASTM D 695 for compressive stren...

  19. Komposit Laminate Rami Epoksi Sebagai Bahan Alternatif Socket Prosthesis

    OpenAIRE

    Irawan, Agustinus P; Soemardi, Tresna P.; Widjajalaksmi K., Widjajalaksmi K; Agus H.S. Reksoprodjo

    2009-01-01

    Pure plant oil, biofuel, coconut oil, palm oil, jatropha oilSocket is the most important component in a prosthesis making. Performance criteria for prosthetic socket material include strength, durability, minimal weight, comfort, and minimal fabrication cost. This research attempts to analyze the strength of ramie fiber reinforced epoxy laminate composite as an alternative of socket prosthesis. The research based on ASTM D 3039/D 3039M for tensile strength and ASTM D 695 for compressive stre...

  20. Energy exchange between knee and ankle in a transfemoral prosthesis

    OpenAIRE

    Koopman, Hubertus F.J.M.; Behrens, Sebastiaan Maria; Hekman, Edsko E. G.; Ünal, Ramazan

    2013-01-01

    In order to make an energy efficient transfemoral prosthesis, there should be energy exchange between knee and ankle of the prosthesis. A concept containing various spring elements is designed and tested for a single subject. It is shown that the concept of energy exchange can be realized; in this specific situation up to 76 % of the mechanical energy is restored to support ankle plantar flexion during push-off.

  1. Ethical issues in the development of a vestibular prosthesis

    OpenAIRE

    Poppendieck, Wigand; Hoffmann, Klaus-Peter; Merfeld, Daniel; Guyot, Jean-Philippe; Micera, Silvestro

    2011-01-01

    During the development of a neural prosthesis, various ethical aspects have to be considered. These range from the basic design of the prosthesis and manufacturing of the various components and the system using biocompatible materials to extensive in vitro and in vivo testing and investigations in the animal model, before taking the final step and going to human trials. As medical systems, neural prostheses have to be proven absolutely safe before considering any clinical study. In this work,...

  2. Treatment Using Functionally Fixed Prosthesis: A Case Report

    OpenAIRE

    Chandra, Sumi; Singh, Ajay; Gupta, Himanshu; Chandra, Chetan

    2013-01-01

    Most dental practitioners as well as their patients prefer to have fixed rather than removable prosthesis. However, there are many clinical situations that prohibit the use of the fixed treatment modality. These clinical cases can vary from, simply not having the proper number of healthy teeth and/or implants to, the esthetically challenging cases of high smile lines and severe loss of alveolar support. The approach of using a traditional removable prosthesis in these situations has always be...

  3. Split-Framework in Mandibular Implant-Supported Prosthesis

    OpenAIRE

    Danny Omar Mendoza Marin; Kássia de Carvalho Dias; André Gustavo Paleari; Ana Carolina Pero; João Neudenir Arioli Filho; Marco Antonio Compagnoni

    2015-01-01

    During oral rehabilitation of an edentulous patient with an implant-supported prosthesis, mandibular flexure must be considered an important biomechanical factor when planning the metal framework design, especially if implants are installed posterior to the interforaminal region. When an edentulous mandible is restored with a fixed implant-supported prosthesis connected by a fixed full-arch framework, mandibular flexure may cause needless stress in the overall restorative system and lead to s...

  4. Septic complication following porous hydroxyapatite cranioplasty: prosthesis retention management.

    Science.gov (United States)

    Iaccarino, Corrado; Mattogno, Pier P; Zanotti, Bruno; Bellocchi, Silvio; Verlicchi, Angela; Viaroli, Edoardo; Pastorello, Giulia; SGULò, Francesco; Ghadirpour, Reza; Servadei, Franco

    2016-05-13

    After failing of autologous cranioplasty or when the bone flap is unavailable, the alloplastic (heterologous) materials are the choice for cranial reconstruction. No agreement has been reported about the material with a significant lower risk of septic complications. This is due to extremely heterogeneous prognostic factors related not only to the material used but also to the surgical procedures and/or to the timing of the procedure. More attention should be focused on the material whose characteristic could enable a delay in bacterial colonization, where an antibiotic therapy could be effective, without need of prosthesis removal. Four cases of severe septic complication following cranioplasty with porous hydroxyapatite (HA) prosthesis are presented. Patients were conservatively treated, without heterologous bone flap removal. All of our patients presented reasons for delaying HA cranioplasty removal: Patients 1, 3 and 4 had an associated shunted hydrocephalus and the need for non- removing the prosthesis was related to the predictable recurrence of overshunting and/or sinking skin flap syndrome. In case 4 the revision surgery would have also damaged the microvascular flap with latissimus dorsi muscle used by plastic surgeon for skin reconstruction. In case 2 the patient refused revision surgery. In all cases systemic and/or radiological signs of infection were observed. In Case 2 the infective process surrounded completely the HA prosthesis, while it was located in the epidural region in Case 1 and 4. In Case 3 a surgical curettage of the infected wound was performed over the HA prosthesis. Following prosthesis retention management with antibiotic therapy, all patients revealed systemic and/or radiological signs of sepsis resolution at follow-up. The possibility to avoid a prosthesis removal with effective antibiotic treatment is mainly due to the combination of three factors: targeted antibiotic therapy, good anatomical area revascularization (resulting of an

  5. Kinematic Analysis of a Posterior-stabilized Knee Prosthesis

    Directory of Open Access Journals (Sweden)

    Zhi-Xin Zhao

    2015-01-01

    Full Text Available Background: The goal of total knee arthroplasty (TKA is to restore knee kinematics. Knee prosthesis design plays a very important role in successful restoration. Here, kinematics models of normal and prosthetic knees were created and validated using previously published data. Methods: Computed tomography and magnetic resonance imaging scans of a healthy, anticorrosive female cadaver were used to establish a model of the entire lower limbs, including the femur, tibia, patella, fibula, distal femur cartilage, and medial and lateral menisci, as well as the anterior cruciate, posterior cruciate, medial collateral, and lateral collateral ligaments. The data from the three-dimensional models of the normal knee joint and a posterior-stabilized (PS knee prosthesis were imported into finite element analysis software to create the final kinematic model of the TKA prosthesis, which was then validated by comparison with a previous study. The displacement of the medial/lateral femur and the internal rotation angle of the tibia were analyzed during 0-135° flexion. Results: Both the output data trends and the measured values derived from the normal knee′s kinematics model were very close to the results reported in a previous in vivo study, suggesting that this model can be used for further analyses. The PS knee prosthesis underwent an abnormal forward displacement compared with the normal knee and has insufficient, or insufficiently aggressive, "rollback" compared with the lateral femur of the normal knee. In addition, a certain degree of reverse rotation occurs during flexion of the PS knee prosthesis. Conclusions: There were still several differences between the kinematics of the PS knee prosthesis and a normal knee, suggesting room for improving the design of the PS knee prosthesis. The abnormal kinematics during early flexion shows that the design of the articular surface played a vital role in improving the kinematics of the PS knee prosthesis.

  6. A Simplified Technique for Fabrication of Orbital Prosthesis

    OpenAIRE

    Sharma, Neeraj; Thakral, G.K.; Mohapatra, Abhilash; Seth, Jyotsna; Vashisht, Pallavi

    2014-01-01

    Eye is a vital organ not only for vision, but also an important component of facial expression, and over-all personality of a person. Loss of eye, apart from leading to impaired vision has a crippling effect on the psychology of the patient. Prosthodontic rehabilitation of such cases includes fabrication of prosthesis by acrylic resin, silicone and implants. However, not all patients are willing to use implants for maxillofacial rehabilitation. Therefore, a custom made orbital prosthesis serv...

  7. Successful conservative management of symptomatic bilateral dorsal patellar defects presenting with cartilage involvement and bone marrow edema: MRI findings

    Energy Technology Data Exchange (ETDEWEB)

    Kwee, Thomas C. [University Medical Center Utrecht, Department of Radiology and Nuclear Medicine, Utrecht (Netherlands); Meander Medical Center, Department of Radiology, Amersfoort (Netherlands); Sonneveld, Heleen [Meander Medical Center, Department of Orthopaedics, Amersfoort (Netherlands); Nix, Maarten [Meander Medical Center, Department of Radiology, Amersfoort (Netherlands)

    2016-05-15

    The dorsal patellar defect is a relatively rare entity that involves the superolateral quadrant of the patella. It is usually considered to represent a delayed ossification process, although its exact origin remains unclear. Because of its usually innocuous nature and clinical course, invasive interventions are generally deemed unnecessary, although curretage has been successfully performed on symptomatic cases. This case report presents a rather unusual case of symptomatic bilateral dorsal patellar defects with cartilage involvement and widespread surrounding bone marrow edema as demonstrated by magnetic resonance imaging (MRI). Both cartilage involvement and bone marrow edema should be considered part of the spectrum of associated MRI findings that can be encountered in this entity. Furthermore, the presented case shows that symptomatic dorsal patellar defects can be treated conservatively with success and that (decrease of) pain symptoms are likely related to (decrease of) bone marrow edema. (orig.)

  8. Surgical Treatment for Failure of Repair of Patellar and Quadriceps Tendon Rupture With Ipsilateral Hamstring Tendon Graft.

    Science.gov (United States)

    Maffulli, Nicola; Papalia, Rocco; Torre, Guglielmo; Denaro, Vincenzo

    2017-03-01

    Tears of the patellar and quadriceps tendon are common in the active population, especially in athletes. At present, several techniques for surgical repair and reconstruction are available. When reruptures occur, a reconstruction is mandatory. In the present paper, we describe a surgical technique for patellar and quadriceps tendon reconstruction using ipsilateral hamstring autograft. After routine hamstring tendon harvesting, the tendon ends are prepared using a whip stitch. A transverse tunnel is drilled in the midportion of the patella, the hamstring graft is passed through the patella, and firmly secured to the patellar tunnel openings with sutures. The details of the technique are fully described. Autologous ipsilateral hamstring tendon grafts provide a secure sound means to manage these challenging injuries.

  9. Design and Optimization of Sinusoidal Formed Femur Prosthesis

    Directory of Open Access Journals (Sweden)

    Ahmet Zafer ŞENALP

    2015-01-01

    Full Text Available One of the major problems in hip replacement surgery is the hip replacement loosening. Hip replacement loosening occurs over time after the surgery and it is related to the discretization between the bone cement and prosthesis. The underlying factors of this situation are the stress occurring in the bone cement and the shape of the prosthesis. In this study, cortical and trabecular layers of the femur, bone cement and prosthesis were modeled. The models of bone cement and prosthesis were constructed parametrically and two different sinusoidal formed prostheses were developed unlike the former prostheses shapes. Analyses were conducted for these two different sinusoidal forms by using finite element method and optimization was conducted to obtain the appropriate prosthesis stem shape and bone cement thickness by using parametric modeling in finite element analyses. For finite element analyses and optimization, Ansys Workbench software was used and analyses were conducted for 316LS stainless steel material. Finally, the optimum prosthesis stem shape and bone cement thickness was determined by using the results of the analyses in the first stage

  10. Failed total carpometacarpal joint prosthesis of the thumb

    DEFF Research Database (Denmark)

    Hansen, Torben Bæk; Homilius, Morten

    2010-01-01

    Total joint prosthesis in carpometacarpal joint arthritis of the thumb often fails. Loosening of the implant is often treated by resection arthroplasty, and we reviewed 10 patients, mean age 54 years (range 47-63) who were treated by resection arthroplasty after a failed total joint prosthesis. T...... in eight of 10 patients, but the mean Disabilities of the arm, shoulder, and hand (DASH) scores, self-reported pinch-grip-related function, and pain were comparable with our earlier published results with the Elektra carpometacarpal total joint prosthesis.......Total joint prosthesis in carpometacarpal joint arthritis of the thumb often fails. Loosening of the implant is often treated by resection arthroplasty, and we reviewed 10 patients, mean age 54 years (range 47-63) who were treated by resection arthroplasty after a failed total joint prosthesis....... The male:female ratio was 1:4 and the mean duration of observation 32 months (range 6-52). In three patients the revised implant was a MOJE uncemented carpometacarpal joint prosthesis and in seven patients an Elektra uncemented one. At follow-up grip strength was reduced to less than 90% of the other hand...

  11. The reliability and validity of radiological assessment for patellar instability. A systematic review and meta-analysis

    Energy Technology Data Exchange (ETDEWEB)

    Smith, Toby O. [University of East Anglia, Faculty of Health, Norwich (United Kingdom); Davies, Leigh [Norfolk and Norwich University Hospital, Norwich (United Kingdom); Toms, Andoni P.; Donell, Simon T. [University of East Anglia, Faculty of Health, Norwich (United Kingdom); Norfolk and Norwich University Hospital, Norwich (United Kingdom); Hing, Caroline B. [St George' s Hospital, London (United Kingdom)

    2011-04-15

    To determine the discriminative validity and reliability of the evidence base using meta-analysis. A review of published sources using the databases AMED, CINHAL, EMBASE, MEDLINE, Scopus and the Cochrane Library, and for unpublished material was conducted. All studies assessing the reliability, validity, sensitivity or specificity of magnetic resonance imaging (MRI), computed tomography (CT) or ultrasound (US) of the patellofemoral joint of patients following patellar dislocation, subluxation or instability, were included. A meta-analysis was performed to assess the difference in radiological measurements between healthy controls and subjects with patellar instability in order to assess discrimination validity. A narrative assessment was used to evaluate the inter- and intra-observer reliability as well as the sensitivity and specificity of specific radiological measurements. A total of 27 studies were reviewed. The findings indicated that there was acceptable inter-observer and intra-observer reliability and validity for different methods of assessing patellar height and the sulcus angle with X-ray, MRI and CT methods, and the tibial tubercle-trochlear groove (TT-TG) assessed using CT. There was poor reliability or validity for the assessment of severity of trochlear dysplasia and the sulcus angle using US. There is insufficient evidence to determine the reliability, validity, sensitivity or specificity of tests such as the congruence angle, lateral patellar displacement, lateral patellar tilt, trochlear depth, boss height, the crossing sign or Wiberg patellar classification. A critical appraisal of the literature identified a number of recurrent methodological limitations. Further study is recommended to evaluate the reliability and validity of these radiological outcomes using well-designed radiological trials. (orig.)

  12. Are the take-off and landing phase dynamics of the volleyball spike jump related to patellar tendinopathy?

    Science.gov (United States)

    Bisseling, R W; Hof, A L; Bredeweg, S W; Zwerver, J; Mulder, T

    2008-06-01

    The causal mechanism of the chronic sports injury patellar tendinopathy is not well understood. The aim of the present study was to compare ankle and knee joint dynamics during the performance of the volleyball spike jump between healthy volleyball players (n = 8) and asymptomatic volleyball players with previous patellar tendinopathy (n = 7). Cross-sectional. Inverse dynamics were used to estimate ankle and knee joint dynamics. From these multiple biomechanical variables, a logistic regression was performed to estimate the probability of the presence or absence of previous patellar tendinopathy among the volleyball players studied. Several biomechanical variables improved the prediction of the presence or absence of previous patellar tendinopathy. For landing, ankle plantar flexion at the time of touch-down, and knee range of motion during the first part of impact, and for take-off, loading rate of the knee extensor moment during the eccentric countermovement phase of take-off were predictive. As interaction effects, the presence or absence of previous patellar tendinopathy were correctly predicted by ankle and knee range of motion during the first part of impact, by loading rate of the knee extensor moment during the eccentric phases of take-off and landing, and by knee angular velocity during the eccentric phases of take-off and landing. Smaller joint flexion during the first part of landing impact , and higher rate of knee moment development during the eccentric phases of the spike-jump landing sequence, together with higher knee angular velocities, might be risk factors in the development of patellar tendinopathy in volleyball players.

  13. Patellar taping alters knee kinematics during step descent in individuals with a meniscal injury: An exploratory study.

    Science.gov (United States)

    Roy, Nicolas; Gaudreault, Nathaly; Tousignant, Michel; Vézina, François; Boudreau, Nicolas

    2016-01-01

    Meniscus lesions are common musculoskeletal knee injuries which often lead to pain, limitation and compensations during functional tasks, such as descending stairs. This study investigated the effect of patellar taping with tension and without tension on three-dimensional (3D) kinematics of the knee during a slow step descent task in patients with meniscal lesions. Ten patients diagnosed with a meniscal lesion, confirmed by magnetic resonance imaging, underwent five, step descent movements at slow speed under three different conditions: 1) no taping; 2) tension-free taping; and 3) patellar taping with medial tension. 3D kinematic data were recorded from the injured knee using an eight-camera infrared Vicon motion analysis system. Maximum and minimum angle values and total range of motion (maximum/minimum value) in three movement planes during single-limb stance were compared using a repeated measure ANOVA. Results showed a significant increase in the maximum and minimum angle value in the sagittal plane (mean differences=2.4° and 4.2°, respectively) and a decrease in the transverse plane (-6.3° and -2.2°, respectively) for the patellar taping condition compared to the no taping condition. A decreased rotational angle range when comparing the patellar taping to the no taping (-4.1°) and tension-free taping (-3.1°) conditions was also observed. These changes remained significant when pain was considered as a covariate in the analysis. The tension applied to the patellar tape played a role in controlling the sagittal and transverse plane step-down movement among patients in our study. These results support the use of patellar taping with a medially oriented tension to help to reduce the transversal plane movement of the knee in this population and they bring new light to the taping effect. Copyright © 2015 Elsevier Ltd. All rights reserved.

  14. Association between dental prosthesis need, nutritional status and quality of life of elderly subjects

    DEFF Research Database (Denmark)

    Pillai, Rajath; Mathur, Vijay Prakash; Jain, Veena

    2015-01-01

    To determine the effect of prosthesis need on nutritional status and oral health-related quality of life (OHrQoL) in elderly and to check the disparity between prosthesis need and prosthesis want in the Indian elderly. METHODS: A total of 946 geriatric participants reporting to a geriatric medicine...... need (r = -0.460). Participants with some prosthesis need had significantly lower MNA and GOHAI scores as compared to those with no prosthesis need. Though prosthesis need was high (79.7 %), demand was low (39.3 %). CONCLUSION: Prosthesis need affects nutritional status and OHrQoL in elderly...... clinic were recruited in the study. Mini-nutritional assessment (MNA), geriatric oral health assessment (GOHAI) indices, prosthesis need according to WHO criteria, and prosthesis want was recorded along with age, gender, socioeconomic status and posterior occluding pair. RESULTS: Significant associations...

  15. The epidemiology of patellar luxation in dogs attending primary-care veterinary practices in England.

    Science.gov (United States)

    O'Neill, Dan G; Meeson, Richard L; Sheridan, Adam; Church, David B; Brodbelt, Dave C

    2016-01-01

    Canine patellar luxation is one of the most common orthopaedic disorders of dogs and is a potential welfare concern because it can lead to lameness, osteoarthritis and pain. However, there are limited epidemiological data on the disorder relating to the general population of dogs in England. This study aimed to investigate the VetCompass Programme database of dogs attending primary-care veterinary practices in England to report on the prevalence, risk factors and clinical management of diagnosed patellar luxation cases. The study included all dogs with at least one electronic patient record in the VetCompass database from September 1(st), 2009 to August 31(st), 2014. Candidate patellar luxation cases were identified using free-text word searching of the clinical notes and VeNom diagnosis term fields. Univariable and multivariable binary logistic regression modelling was used for risk factor analysis. The overall dataset comprised 210,824 dogs attending 119 clinics in England. The prevalence of patellar luxation diagnosis in dogs was 1.30 % (95 % confidence interval (CI) 1.21-1.39). Of the 751 incident cases, 293 (39.0 %) received medical management, 99 (13.2 %) received surgical intervention and 28 (3.7 %) were referred for further management. Multivariable modelling documented 11 breeds with increased odds of patellar luxation compared with crossbred dogs, including the Pomeranian (odds ratio [OR]: 6.5, 95 % CI 4.0-10.7, P < 0.001), Chihuahua (OR: 5.9, 95 % CI 4.4-7.9, P < 0.001), Yorkshire Terrier (OR: 5.5, 95 % CI 4.3-7.1, P < 0.001) and French Bulldog (OR: 5.4, 95 % CI 3.1-9.3, P < 0.001). Dogs with bodyweight below their mean for breed and sex had a 1.4 times odds of diagnosis (95 % CI 1.2-1.6, P < 0.001). Dogs aged ≥ 12.0 years showed 0.4 times the odds (95 % CI 0.3-0.5, P < 0.001) compared with dogs aged < 3.0 years. Females had 1.3 times the odds (95 % CI 1.1-1.5, P < 0.001), neutered dogs had 2.4 times

  16. Heated lidocaine/tetracaine patch for treatment of patellar tendinopathy pain

    Directory of Open Access Journals (Sweden)

    Gammaitoni AR

    2013-07-01

    Full Text Available Arnold R Gammaitoni,1 Henry T Goitz,2 Stephanie Marsh,2 Thomas B Marriott,3 Bradley S Galer1 1Pain Group, Nuvo Research US, West Chester, PA, USA; 2Sports Medicine, Detroit Medical Center, Warren, MI, USA; 3Pain Group, Nuvo Research US, Salt Lake City, UT, USA Introduction: The pain of patellar tendinopathy (PT may be mediated by neuronal glutamate and sodium channels. Lidocaine and tetracaine block both of these channels. This study tested the self-heated lidocaine-tetracaine patch (HLT patch in patients with PT confirmed by physical examination to determine if the HLT patch might relieve pain and improve function. Methods: Thirteen patients with PT pain of ≥14 days' duration and baseline average pain scores ≥4 (on a 0–10 scale enrolled in and completed this prospective, single-center pilot study. Patients applied one HLT patch to the affected knee twice daily for 2–4 hours for a total of 14 days. Change in average pain intensity and interference (Victorian Institute of Sport Assessment [VISA] scores from baseline to day 14 were assessed. No statistical inference testing was performed. Results: Average pain scores declined from 5.5 ± 1.3 (mean ± standard deviation at baseline to 3.8 ± 2.5 on day 14. Similarly, VISA scores improved from 45.2 ± 14.4 at baseline to 54.3 ± 24.5 on day 14. A clinically important reduction in pain score (≥30% was demonstrated by 54% of patients. Conclusion: The results of this pilot study suggest that topical treatment that targets neuronal sodium and glutamate channels may be useful in the treatment of PT. Keywords: patellar tendinopathy, patellar tendinosis, heated lidocaine/tetracaine patch, topical analgesic patch, knee pain

  17. Comparison of the Suture Anchor and Transosseous Techniques for Patellar Tendon Repair: A Biomechanical Study.

    Science.gov (United States)

    Lanzi, Joseph T; Felix, Justin; Tucker, Christopher J; Cameron, Kenneth L; Rogers, John; Owens, Brett D; Svoboda, Steven J

    2016-08-01

    Minimizing gap formation and maximizing the strength of patellar tendon repairs are 2 critical factors for successful healing of these injuries. The purpose of this study was to compare transosseous and screw-in anchor repair techniques to determine if there is a difference in gap formation and load to failure of the 2 constructs. The research hypotheses were that the anchor construct would have significantly less gap formation and would also have significantly greater load-to-failure strength. Controlled laboratory study. A total of 24 porcine specimens were randomly assigned into transosseous and 4.75-mm polyetheretherketone (PEEK) screw-in anchor repair groups. The repairs were then completed using 2 No. 2 FiberWire sutures, and each specimen was cyclically loaded on a tensile test machine to 250 N for a total of 1000 cycles. Gap formation was measured at 1, 10, 250, 500, and 1000 cycles. Each specimen was loaded to failure after 1000 cycles. Independent t tests were conducted. Statistically significant gap formation and load-to-failure differences were found between the 2 repair techniques. The mean gap in the anchor group (2.16 ± 1.81 mm) was significantly less than that seen in the transosseous group (5.71 ± 1.58 mm) (P anchor group (669.9 ± 91.8 N) was significantly higher than that of the transosseous group (582.8 ± 92.6 N) (P = .03). The results support the 2 study hypotheses. These findings suggest that the 4.75-mm PEEK screw-in anchor construct may be superior to the transosseous technique for minimizing gap formation and improving load-to-failure strength after surgical repair of the patellar tendon. The use of the suture anchor technique in patellar tendon repair may support early load-bearing rehabilitation. © 2016 The Author(s).

  18. Non-metallic implant for patellar fracture fixation: A systematic review.

    Science.gov (United States)

    Camarda, Lawrence; Morello, Salvatore; Balistreri, Francesco; D'Arienzo, Antonio; D'Arienzo, Michele

    2016-08-01

    Despite good clinical outcome proposals, there has been relatively little published regarding the use of non-metallic implant for patellar fracture fixation. The purpose of the study was to perform a systematic literature review to summarize and evaluate the clinical studies that described techniques for treating patella fractures using non-metallic implants. A comprehensive literature search was systematically performed to evaluate all studies included in the literature until November 2015. The following search terms were used: patellar fracture, patella suture, patella absorbable, patella screw, patella cerclage. Two investigators independently reviewed all abstracts and the selection of these abstracts was then performed based on inclusion and/or exclusion criteria. A total of 9 studies involving 123 patients were included. Patients had a mean age of 33.7 years and were followed up for a mean of 18.9 months. The most common method for fracture fixations included the use of suture material. Good clinical outcomes were reported among all studies. Thirteen patients (10.5%) presented complications, while 4 patients (3.2%) required additional surgery for implant removal. There is a paucity of literature focused on the use of non-metallic implant for patellar fracture fixation. However, this systematic review showed that non-metallic implants are able to deliver good clinical outcomes reducing the rate of surgical complications and re-operation. These results may assist surgeons in choosing to use alternative material such as sutures to incorporate into their routine practice or to consider it, in order to reduce the rate of re-operation. Copyright © 2016 Elsevier Ltd. All rights reserved.

  19. Lumbar Radiculopathy Confounded: Total Knee Arthroplasty Diminishes the Patellar Tendon Reflex.

    Science.gov (United States)

    McNabb, David Clinton; Olcott, Christopher W; Del Gaizo, Daniel J; Vaughn, Bradley K; Lim, Moe R

    2015-12-01

    Patellar tendon reflexes were elicited among patients who had had a unilateral total knee replacement, those planned for unilateral total knee replacement, and a cohort of controlled patients. Patellar tendon reflex (PTR) response was measured with surface electromyography. The aim of this study was to determine if total knee arthroplasty significantly alters the PTR. As part of the clinical evaluation of the spine, extremity reflexes are provoked. Reflex variation between right and left extremities can be a pathological finding in disease of the spine. It has been noted that in patients who have undergone total knee arthroplasty (TKA), the PTR is diminished on the operative side compared with the contralateral nonoperative side. PTR is part of the clinical exam when evaluating a patient for lumbar radiculopathy. The right and left patellar tendon reflex intensities were measured by quadriceps surface electromyography in 3 groups of patients. Group 1 consisted of 21 patients with unilateral TKA who were at least 6 months postoperative. Group 2 consisted of 18 patients with unilateral severe knee arthritis indicated for TKA. Group 3, serving as the control group, included 20 patients with no evidence of knee arthritis in either knee. The average reflex response for each group was recorded and comparisons were then made between each group. Patients who have undergone unilateral TKA have a PTR on average of 55.1% of their contralateral uninvolved side. This is statistically significant when compared with reflexes in patients who are planned for unilateral total knee arthroplasty, 96.03% (P = 0.001) and when compared with patients without evidence for knee arthritis, 102.2% (P < 0.001). The results of this case control study show that TKAs do significantly diminish PTRs when compared with a contralateral uninvolved knee in the same patient. 3.

  20. Multimodality correlations of patellar height measurement on X-ray, CT, and MRI

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Pearlene P.; Chalian, Majid; Carrino, John A.; Eng, John; Chhabra, Avneesh [Johns Hopkins University School of Medicine, Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD (United States)

    2012-10-15

    To investigate whether the universally accepted range of normal patellar height ratios derived from radiography for the Insall-Salvati (IS) and Blackburne-Peel (BP) methods could be similarly applied to both CT and MRI. Institutional review board approval was obtained with waiver of informed consent for this HIPPA-compliant study. A total of 45 knees in 42 patients (15 men, 27 women; age range 11 to 75 years, mean age 39 {+-} 20 years) who underwent tri-modality (radiograph, CT, and MRI) examinations were selected. All patients had knee imaging obtained for a variety of reasons and measurements were performed by two independent readers who were blinded to each other's measurements or the respective measurements derived from each of the methods. Paired t test was used to compare the mean values among the modalities. Inter-observer and inter-method agreements were assessed using intra-class correlation coefficients. Statistically significant, but small quantitative differences are noted between tri-modality patellar height ratios. For comparable results, the small addition of 0.13 and 0.10 are needed for the Insall-Salvati measurements on MRI and CT respectively, compared with radiographs. For the Blackburne-Peel ratio, an additional adjustment of 0.09 is needed between radiographs and MRI, but not between radiographs and CT. These adjustments are independent of gender. The interobserver reproducibility was excellent (ICC {>=} 0.94) for both the Insall-Salvati and Blackburne-Peel methods for all modalities. The results indicate that cut-off values for patella alta and baja derived from radiographs should not be directly transposed to CT and MRI; however, the adjustments are relatively minor. These measurements show excellent reproducibility for all modalities currently used for patellar height measurements. (orig.)

  1. Assessment of the lateral patellar facet in varus arthritis of the knee.

    Science.gov (United States)

    Waldstein, Wenzel; Jawetz, Shari T; Farshad-Amacker, Nadja A; Merle, Christian; Schmidt-Braekling, Tom; Boettner, Friedrich

    2014-10-01

    Lateral patellar arthritis has been associated with poor outcomes in unicompartmental knee arthroplasty. The current study correlates intraoperative findings with MRI imaging, skyline radiographs and the presence of anterior knee pain. In 92 consecutive knees with varus arthritis, the patellofemoral compartment was assessed during surgery, on skyline radiographs and on MRI. Anterior knee pain was recorded on a visual-analog-scale. Intraoperative assessment was based on the Outerbridge grading scale. Skyline radiographs were evaluated according to the Ahlbäck grading scale; MRIs were assessed according to a modified Outerbridge grading scale. There was an excellent correlation (rs=0.833; p<0.001) in the cartilage assessment of the lateral patellar facet between MRI and surgery. A good correlation (rs=0.664; p<0.001) was seen between Ahlbäck Grades and macroscopic Outerbridge Grades of the lateral patella. Ahlbäck Grades and MRI modified Outerbridge Grades showed a good correlation (rs=0.643; p<0.001) for the lateral patella. Twelve percent of knees (seven out of 60) with Ahlbäck Grade 0 or 1 and mild to moderate anterior knee pain had a macroscopic Outerbridge Grade of 3 on the lateral patella. None of these 60 knees had a full-thickness cartilage defect on MRI. Normal skyline radiographs in patients with mild to moderate anterior knee pain can rule out full-thickness cartilage defects of the lateral patellar facet as observed during surgery and on MRI. The MRI allows for the most accurate assessment of the patellofemoral joint and is warranted in all patients with radiographic abnormalities or severe anterior knee pain. Diagnostic study, Level II. Copyright © 2014 Elsevier B.V. All rights reserved.

  2. Arthroscopically assisted fixation is a reliable option for patellar fractures: A literature review.

    Science.gov (United States)

    Cerciello, S; Cote, M; Lustig, S; Dyrna, F; Pauzenberger, L; Neyret, P; Mazzocca, A D

    2017-11-01

    Proper reduction and stable fixation of articular fractures is essential for an early recovery and to avoid late complications. Arthroscopically assisted techniques for minimally invasive fixation have been introduced to reduce local morbidity and improve anatomic reduction of the fragments. However up to date no clear indications for surgery have been given. In addition, the precise rates of functional outcomes and complications are controversial. The hypothesis was the systematic analysis of the available literature would provide precise indications, outcomes and complications of arthroscopically assisted techniques for patellar fracture fixation. A comprehensive literature review was performed using the keywords "patellar fracture", "arthroscopy" with no limit regarding the year of publication. All the selected articles were in English language and were evaluated with the Coleman score by three independent surgeons. The interclass correlation coefficient between the three examiners was calculated. Six full text articles were retrieved. The initial cohort included 60 patients with a displaced transverse fracture in the majority of the cases. At an average FU of 27.2 months the Lysholm score was 91.3. The rate of complication was 7%; Average Coleman score for the three observers was 55.8±6.5 with an ICC of 0.89, indicating adequate inter-rater agreement. Arthroscopically assisted techniques for minimally invasive fixation of patellar fractures represent a reliable option. The positive clinical outcomes and low rates of complications must be confirmed with further studies including larger series and longer FU. Level IV, systematic review of retrospective series. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  3. Geometrical changes of knee ligaments and patellar tendon during passive flexion.

    Science.gov (United States)

    Belvedere, C; Ensini, A; Feliciangeli, A; Cenni, F; D'Angeli, V; Giannini, S; Leardini, A

    2012-07-26

    Patterns of fibre elongation and orientation for the cruciate and collateral ligaments of the human knee joint and for the patellar tendon have not yet been established in three-dimensions. These patterns are essential for understanding thoroughly the contribution of these soft tissues to joint function and of value in surgical treatments for a more conscious assessment of the knee status. Measurements from 10 normal cadaver knees are here reported using an accurate surgical navigation system and consistent anatomical references, over a large flexion arc, and according to current recommended conventions. The contours of relevant sub-bundles were digitised over the corresponding origins and insertions on the bones. Representative fibres were calculated as the straight line segments joining the centroids of these attachment areas. The most isometric fibre was also taken as that whose attachment points were at the minimum change in length over the flexion arc. Changes in length and orientation of these fibres were reported versus the flexion angle. A good general repeatability of intra- and inter-specimens was found. Isometric fibres were found in the locations reported in the literature. During knee flexion, ligament sub-bundles slacken in the anterior cruciate ligament, and in the medial and lateral collateral ligaments, whereas they tighten in the posterior cruciate ligament. In each cruciate ligament the two compounding sub-bundles have different extents for the change in fibre length, and also bend differently from each other on both tibial planes. In the collateral ligaments and patellar tendon all fibres bend posteriorly. Patellar tendon underwent complex changes in length and orientation, on both the tibial sagittal and frontal planes. For the first time thorough and consistent patterns of geometrical changes are provided for the main knee ligaments and tendons after careful fibre mapping. Copyright © 2012 Elsevier Ltd. All rights reserved.

  4. [Treatment of septic olecranon and patellar bursitis by excision and vacuum-assisted closure therapy].

    Science.gov (United States)

    Walter, G; Kemmerer, M; Hoffmann, R

    2013-08-01

    Treatment of septic olecranon and patellar bursitis differs considerably and is currently under discussion. We therefore performed a retrospective study of our patients with septic bursitis in the past 5 years. Between March 2007 and February 2012 we treated 79 patients with septic olecranon (n = 43) and patellar (n = 36) bursitis surgically: 61-males, 18 females, age 51 (range: 11-91) years. Four patients had not been treated before, 25 had suffered recurrences after 1-10 previous procedures, and 9 patients had not improved after conservative therapy. 34 patients presented with traumatic rupture or fistula of their bursae. In all cases we performed a radical bursectomy and vacuum-assisted therapy for 4 to 5 days. In addition, patients received systemic antibiotics. We phoned all patients and were successful in 57 cases (72 %). We questioned these patients for range of movement, limitations at work, pain, sensibility disorder, satisfaction with the result and further surgical procedures. In all cases we took tissue specimens for cultures, in 48 preparations histological examination was performed. Microbiological and histological results are discussed in detail. 40 patients were free of complaints, 15 complained of mild pain, 54 of 57 had unlimited range of motion. Minor discomforts at desk work were reported by 5 of 43 patients, 12 out of 36 patient reported discomfort when performing on their knees. There was no recurrence in the period of investigation. We recommend our treatment concept for septic olecranon and patellar bursitis because patient satisfaction is high and recurrences are reliably avoided. The soft tissue is spared, so that plastic covering procedures are seldom necessary. Georg Thieme Verlag KG Stuttgart · New York.

  5. Ultrasound Detection of Patellar Fracture and Evaluation of the Knee Extensor Mechanism in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Kiersten Carter

    2016-11-01

    Full Text Available Traumatic injuries to the knee are common in emergency medicine. Bedside ultrasound (US has benefits in the rapid initial detection of injuries to the patella. In addition, US can also quickly detect injuries to the entire knee extensor mechanism, including the quadriceps tendon and inferior patellar ligament, which may be difficult to diagnose with plain radiographs. While magnetic resonance imaging remains the gold standard for diagnostic evaluation of the knee extensor mechanism, this can be difficult to obtain from the emergency department. Clinicians caring for patients with orthopedic injuries of the knee would benefit from incorporating bedside musculoskeletal US into their clinical skills set.

  6. PHYSICAL THERAPY INTERVENTION FOR MEDIAL PATELLOFEMORAL LIGAMENT RECONSTRUCTION AFTER REPEATED LATERAL PATELLAR SUBLUXATION/DISLOCATION.

    Science.gov (United States)

    Vitale, Teresa Errigo; Mooney, Brianne; Vitale, Ashley; Apergis, Demitra; Wirth, Stephen; Grossman, Mark G

    2016-06-01

    The incidence of patellar subluxation or dislocation has been documented up to 43/100,000 with females more prevalent then males. There are many contributing factors involving the hip, knee, and ankle that lead to patellar subluxation. A patellar position of lateral tilt with lateral glide may indicate weakness of the vastus medialis oblique (VMO) and adductors, increased tightness in the iliotibial band, and overpowering of the vastus lateralis. Patella alta can predispose an individual to lateral dislocation due to the patella placement outside of the femoral trochlear groove with a disadvantage of boney stability. Other factors that may cause the patella to laterally sublux or dislocate during a functional activity or sporting activity include a position of femoral external rotation, tibial internal rotation, and excessive contraction of the vastus lateralis. The medial patellofemoral ligament (MPFL) aids in the prevention of a lateral patellar subluxation or dislocation. In cases where there is recurrent subluxation/dislocation and Magnetic Resonance Imaging confirms a MPFL tear, a reconstruction may be the treatment of choice. The purpose of this case series is to describe the post-surgical physical therapy management of MPFL reconstructions, outcomes using the Modified Cincinnati Knee Outcome Measure (MCKOM) and to propose staged physical therapy interventions for this pathology in the form of a treatment progression. Post-operative management data and outcomes were retrospectively collected using a detailed chart review methodology from seven subjects who underwent MPFL reconstruction. The Modified Cincinnati Knee Outcome Measure (MCKOM) was analyzed for each participant in four sections that were most important to the return and maintenance of participation in sport. At follow-up the mean scores for the seven subjects in Section 3 (instability) was 19.3/20, Section 4 (overall activity level) was 17.3/20, Section 7 (running activity) was 4.5/5, and Section 8

  7. Mechanical properties and collagen cross-linking of the patellar tendon in old and young men

    DEFF Research Database (Denmark)

    Couppé, C; Hansen, P; Kongsgaard, M

    2009-01-01

    in animals but has never been examined in humans in vivo. In this study, we examined the mechanical properties and pyridinoline and pentosidine cross-link and collagen concentrations of the patellar tendon in vivo in old (OM) and young men (YM). Seven OM (67 +/- 3 years, 86 +/- 10 kg) and 10 YM (27 +/- 2...... lower in OM than in YM (0.49 +/- 0.27 vs. 0.73 +/- 0.14 mg/mg dry wt; P P P ... were higher in OM than in YM (73 +/- 13 vs. 11 +/- 2 mmol/mol; P

  8. Finding and defining the ideal patellar resection plane in total knee arthroplasty.

    Science.gov (United States)

    Anglin, C; Fu, C; Hodgson, A J; Helmy, N; Greidanus, N V; Masri, B A

    2009-10-16

    Asymmetric resection of the patella during total knee arthroplasty (TKA) correlates with anterior knee pain, bony impingement and patellar maltracking. Despite this, there is no consensus regarding the desired landmarks; the cut is often done freehand; and there has been no quantitative comparison of proposed resection planes. The objectives of this study were to: determine the intra- and inter-surgeon repeatability of two radiographic resection definitions (medial-divot, MD, and medial-lateral extents, MLE); calculate two additional definitions from the radiographic patellar circumferences (parallel to the anterior surface, ANT, and perpendicular to the anteroposterior tangent points, PERP); compare the clinical resection line to the previous four definitions before and after introducing the MD method clinically; and identify distinguishing features of patellae with better vs. worse resection angles. We hypothesized that the MD method would improve repeatability both radiographically and clinically, that the different radiographic definitions would produce comparable angles, and that we could identify distinguishing features. For the radiographic study, three surgeons drew lines on 40 preoperative X-rays plus 9 interspersed repetitions of 3 of these X-rays. For the clinical study, we compared the patellar resection angle for 20 patients immediately before and after implementing the new method. Given that the clinical goal is to have equal distances from the resection surface to the anterior surface, we compared all results to the ANT definition as the theoretically ideal definition. Confirming the first hypothesis, intra-surgeon repeatability (10 repetitions of 3 X-rays) and inter-surgeon repeatability (3 surgeons x 40 X-rays) were both significantly better using the new MD method compared to the MLE method (phypothesis, clinical use of the MD method did not improve resection symmetry. Contrary to the third hypothesis, the PERP definition was significantly

  9. Tratamento cirúrgico da tendinite distal da patela Surgical treatment of the distal patellar tendinitis

    Directory of Open Access Journals (Sweden)

    Marco Martins Amatuzzi

    2005-01-01

    Full Text Available A tendinite distal da patela é uma doença que acomete principalmente jovens esportistas e caracteriza-se por dor referida na extremidade distal da patela junto à inserção do ligamento patelar. O tratamento inicial preconizado é sempre conservador com fisioterapia. A grande maioria tem boa resposta a este tipo de conduta, mas em alguns raros casos os sintomas não regridem exigindo uma mudança de conduta. Para este grupo usamos o tratamento cirúrgico com técnica derivada de Trillat que se baseia na utilização de um enxerto de parte do tendão do músculo Grácil implantado dentro do ligamento patelar, inserido intra-ósseo na patela e fixado na tuberosidade anterior da tíbia. Foram operados seis pacientes, sendo que em dois casos a operação foi bilateral, totalizando oito joelhos. O seguimento mínimo foi de três anos, com avaliação final dentro do índice considerado como EXCELENTE, conforme a cotação ARPÉGE, para todos os joelhos.Distal patellar tendinitis is a young athlete's disease characterized by pain at the distal patellar pole, near the patellar ligament insertion. Early treatment recommended is generally conservative, with physical therapy. The great majority of patients present favorable responses to this approach, but, in some cases, the remission of symptoms does not occur, requiring a different approach. For this group, surgical treatment with a technique derived from that of Trillat was used, which is based on the use of a graft removed from a portion of gracillis muscle tendon into patellar ligament, intraosseously inserted in the patella and fixed at the tibial anterior tuberosity. Six patients were operated, bilaterally in two cases, totaling eight knees. The minimum follow-up time was three years, with all knees presenting an EXCELLENT score, according to ARPÉGE evaluation.

  10. SURGICAL CORRECTION OF BILATERAL PATELLAR LUXATION IN AN AMERICAN BLACK BEAR CUB (URSUS AMERICANUS).

    Science.gov (United States)

    Bennett, Katarina R; Desmarchelier, Marion R; Bailey, Trina R

    2015-06-01

    A wild orphaned male American black bear cub ( Ursus americanus ) presented with hind limb gait abnormalities and was found to have bilateral grade 3 laterally luxating patellas. There were no other significant abnormalities detected on neurologic, radiographic, or hematologic examinations. The trochlear grooves were deepened with a chondroplasty, and the redundant soft tissues imbricated. There was a marked improvement in the bear's gait postoperatively, with an apparent full return to function. To the authors' knowledge, patellar luxation has not been reported in the Ursidae family, and the success in this case suggests that this technique may be used in large wild or captive carnivore cubs.

  11. Simultaneous MPFL and LPFL reconstruction for recurrent lateral patellar dislocation with medial patellofemoral instability

    Directory of Open Access Journals (Sweden)

    Masashi Kusano

    2014-01-01

    Full Text Available We report an extremely rare case of both recurrent lateral patella dislocation and medial patellofemoral instability, following prior operations to correct patella maltracking. Manual translation of the patella revealed medial and lateral instability with a positive apprehension sign. 3-D computer modelling of kinematics based on MRI data demonstrated that the patella deviated laterally at full extension and translated medially with knee flexion. The medial and lateral patellofemoral ligaments were reconstructed simultaneously with hamstring tendons, alleviating peripatellar pain and patellar instability in both directions.

  12. Chondropathia patellae - preoperative and postoperative demonstration of the patellar structure in plain roentgenography

    Energy Technology Data Exchange (ETDEWEB)

    Schumacher, K.A.; Mutschler, W.; Bargon, G.

    1982-07-01

    The study is based on 86 patients surgically treated for chondromalacia patellae, who in a 2 year follow-up were controlled by defile-radiographs and clinical examination. While there was an improvement of all clinical symptoms examined, no significant change in the radiologic appearance of the patellar structure was observed as compared with the pre-operative status. This includes that neither significant changes indicating development of arthrosis nor aggravation of pre-existing arthrotic lesions could be found. However, it is commonly suggested from roentgenographic findings with type 3 lesions, that severe chondromalacia patellae may be a precursor of osteoarthrosis.

  13. Equivalence of online and clinician administration of a patellar tendinopathy risk factor and severity questionnaire

    DEFF Research Database (Denmark)

    Morton, S; Morrissey, D; Valle, X

    2015-01-01

    The VISA-P is a questionnaire for assessing the severity of patellar tendinopathy (PT). Our study aim was to evaluate the equivalence of self-administration of the VISA-P online with the addition of risk factor questions to develop a tool suitable for high-volume remote use. A crossover study...... design with 107 subjects was used to determine equivalence between online and clinician administration. Three population groups were used to ensure construct validity. Online vs clinician administration revealed an intraclass correlation (ICC) of 0.79 [confidence interval (CI): 0.68-0.86] for the VISA...

  14. The impact of patellar tendinopathy on sports and work performance in active athletes

    OpenAIRE

    de Vries, Astrid J; Koolhaas, Wendy; Zwerver, Johannes; Diercks, Ron L.; Nieuwenhuis, Kari; van der Worp, Henk; Brouwer, Sandra; van den Akker-Scheek, Inge

    2017-01-01

    Greater insight into sports and work performance of athletes with patellar tendinopathy (PT) will help establish the severity of this common overuse injury. Primary aim of this study is to investigate the impact of PT on sports and work performance. Seventy seven active athletes with PT (50 males; age 28.1 +/- 8.2years; Victorian Institute of Sports Assessment Patella 56.4 +/- 12.3) participated in this survey. Sports performance, work ability and work productivity were assessed using the Osl...

  15. An Atraumatic Symphysiolysis with a Unilateral Injured Sacroiliac Joint in a Patient with Cushing's Disease: A Loss of Pelvic Stability Related to Ligamentous Insufficiency?

    Science.gov (United States)

    Höch, Andreas; Pieroh, Philipp; Dehghani, Faramarz; Josten, Christoph; Böhme, Jörg

    2016-01-01

    Glucocorticoids are well known for altering bone structure and elevating fracture risk. Nevertheless, there are very few reports on pelvic ring fractures, compared to other bones, especially with a predominantly ligamentous insufficiency, resulting in a rotationally unstable pelvic girdle. We report a 39-year-old premenopausal woman suffering from an atraumatic symphysiolysis and disruption of the left sacroiliac joint. She presented with external rotational pelvic instability and immobilization. Prior to the injury, she received high-dose glucocorticoids for a tentative diagnosis of rheumatoid arthritis over two months. This diagnosis was not confirmed. Other causes leading to the unstable pelvic girdle were excluded by several laboratory and radiological examinations. Elevated basal cortisol and adrenocorticotropic hormone levels were measured and subsequent corticotropin-releasing hormone stimulation, dexamethasone suppression test, and petrosal sinus sampling verified the diagnosis of adrenocorticotropic hormone-dependent Cushing's disease. The combination of adrenocorticotropic hormone-dependent Cushing's disease and the additional application of exogenous glucocorticoids is the most probable cause of a rare atraumatic rotational pelvic instability in a premenopausal patient. To the authors' knowledge, this case presents the first description of a rotationally unstable pelvic ring fracture involving a predominantly ligamentous insufficiency in the context of combined exogenous and endogenous glucocorticoid elevation.

  16. An Atraumatic Symphysiolysis with a Unilateral Injured Sacroiliac Joint in a Patient with Cushing’s Disease: A Loss of Pelvic Stability Related to Ligamentous Insufficiency?

    Directory of Open Access Journals (Sweden)

    Andreas Höch

    2016-01-01

    Full Text Available Glucocorticoids are well known for altering bone structure and elevating fracture risk. Nevertheless, there are very few reports on pelvic ring fractures, compared to other bones, especially with a predominantly ligamentous insufficiency, resulting in a rotationally unstable pelvic girdle. We report a 39-year-old premenopausal woman suffering from an atraumatic symphysiolysis and disruption of the left sacroiliac joint. She presented with external rotational pelvic instability and immobilization. Prior to the injury, she received high-dose glucocorticoids for a tentative diagnosis of rheumatoid arthritis over two months. This diagnosis was not confirmed. Other causes leading to the unstable pelvic girdle were excluded by several laboratory and radiological examinations. Elevated basal cortisol and adrenocorticotropic hormone levels were measured and subsequent corticotropin-releasing hormone stimulation, dexamethasone suppression test, and petrosal sinus sampling verified the diagnosis of adrenocorticotropic hormone-dependent Cushing’s disease. The combination of adrenocorticotropic hormone-dependent Cushing’s disease and the additional application of exogenous glucocorticoids is the most probable cause of a rare atraumatic rotational pelvic instability in a premenopausal patient. To the authors’ knowledge, this case presents the first description of a rotationally unstable pelvic ring fracture involving a predominantly ligamentous insufficiency in the context of combined exogenous and endogenous glucocorticoid elevation.

  17. Atraumatic Occult Odontoid Fracture in Patients with Osteoporosis-Associated Thoracic Kyphotic Deformity: Report of a Case and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Kanji Mori

    2015-01-01

    Full Text Available Anderson type II odontoid fractures are reported to be the most common injury of the odontoid process in patients over the age of 65. However, atraumatic occult Anderson type III odontoid fractures have been rarely described and remain a diagnostic challenge. In the present report, we illustrate a 78-year-old female with osteoporosis-associated marked thoracic kyphotic deformity who developed atraumatic Anderson type III occult odontoid fracture and raise awareness of this condition. Anteroposterior and lateral standard radiographs of cervical spine failed to disclose odontoid fracture. Magnetic resonance imaging demonstrated intensity changes of the axis. Subsequent computed tomography clearly demonstrated Anderson type III odontoid fracture. Conservative treatment achieved complete bone union without neurological deteriorations. At 3-year follow-up, the patient was doing well without neurological and radiological deteriorations. Even if the patients have no traumatic event, we have to keep odontoid fractures in our mind as one of the differential diagnoses when we encounter elderly patients with neck pain, especially in patients with osteoporosis-associated marked thoracic kyphotic deformity.

  18. Is Atraumatic restorative treatment an option for restoring occlusoproximal caries lesions in primary teeth? A systematic review and meta-analysis.

    Science.gov (United States)

    Raggio, Daniela P; Hesse, Daniela; Lenzi, Tathiane L; Guglielmi, Camila A B; Braga, Mariana M

    2013-11-01

    Atraumatic restorative treatment (ART) has demonstrated good longevity when used for single-surface restorations, but lower success rates are reported for occlusoproximal surfaces. This systematic review and meta-analysis aimed to verify the pooled success rate of occlusoproximal ART restorations in primary teeth considering the outcomes: longevity, pulp damage, or caries lesion progression. Literature searching was carried out on the studies reporting clinical trials indexed in PubMed and in English language, comprising the outcomes. A meta-analysis was undertaken considering the results from reviewed studies. An initial search resulted in 126 articles, and three of them were finally selected. The main reasons for excluding articles were the absence of control group, as amalgam, composite resin, or compomer restorations to be compared with ART (hand excavation + high-viscous GIC). The pooled estimate (odds ratio; 95% confidence interval) for ART approach success was 1.04 (0.65-1.66). Atraumatic restorative treatment restorations performed with high-viscous GIC present similar survival/success rates to conventional approach using composite resin or amalgam for occlusoproximal restorations in primary teeth and can be suggested as a good option for occlusoproximal cavities in primary molars. In addition, further randomized controlled clinical investigations concerning occlusoproximal restorations in primary teeth are still necessary. © 2012 John Wiley & Sons Ltd, BSPD and IAPD.

  19. Prediction model for penile prosthesis implantation for erectile dysfunction management.

    Science.gov (United States)

    Segal, Robert L; Camper, Stephen B; Ma, Larry; Burnett, Arthur L

    2014-10-01

    Penile prosthesis surgery is indicated based on undesirability, contraindication or ineffectiveness of non-surgical options for erectile dysfunction. This definitive treatment is often delayed after initial diagnosis. Our objective was to develop a prediction tool based on a patient's clinical history to determine likelihood of ultimately receiving a penile prosthesis. This retrospective analysis used claims data from Commercial and Medicare supplemental databases. Inclusion criteria were 18 years of age with 1 year of continuous enrollment at the first diagnosis of erectile dysfunction. Patients' demographics, co-morbidities and erectile dysfunction therapy were derived based on enrollment, medical and prescription histories. The Cox proportional hazards model with stepwise selection was used to identify and quantify (using relative risk) factors associated with a future penile prosthesis implant. Co-morbidities and therapies present prior to the index erectile dysfunction diagnosis were analyzed as fixed covariates. Approximately 1% of the dataset's population (N = 310,303 Commercial, N = 74,315 Medicare, respectively) underwent penile prosthesis implantation during the study period (3928 patients in the overall population: 2405 patients [0.78%] in the Commercial and 1523 patients [2.05%] in the Medicare population). Factors with the greatest predictive strength of penile prosthesis implantation included prostate cancer diagnosis (relative risk: 3.93, 2.29; 95% CI, 3.57-4.34, 2.03-2.6), diabetes mellitus (2.31, 1.23; 2.12-2.52, 1.1-1.37) and previous treatment with first-line therapy (1.39, 1.33; 1.28-1.5, 1.2-1.47) (all P prosthesis. Calculating the likelihood of penile prosthesis implantation based on the weight of these factors may assist clinicians with the definition of a care plan and patient counseling. The precision of the model may be limited by factors beyond medical history information that possibly influence the decision to proceed to

  20. Automated estimation of hip prosthesis migration: a feasibility study

    Science.gov (United States)

    Vandemeulebroucke, Jef; Deklerck, Rudi; Temmermans, Frederik; Van Gompel, Gert; Buls, Nico; Scheerlinck, Thierry; de Mey, Johan

    2013-09-01

    A common complication associated with hip arthoplasty is prosthesis migration, and for most cemented components a migration greater than 0.85 mm within the first six months after surgery, are an indicator for prosthesis failure. Currently, prosthesis migration is evaluated using X-ray images, which can only reliably estimate migrations larger than 5 mm. We propose an automated method for estimating prosthesis migration more accurately, using CT images and image registration techniques. We report on the results obtained using an experimental set-up, in which a metal prosthesis can be translated and rotated with respect to a cadaver femur, over distances and angles applied using a combination of positioning stages. Images are first preprocessed to reduce artefacts. Bone and prosthesis are extracted using consecutive thresholding and morphological operations. Two registrations are performed, one aligning the bones and the other aligning the prostheses. The migration is estimated as the difference between the found transformations. We use a robust, multi-resolution, stochastic optimization approach, and compare the mean squared intensity differences (MS) to mutual information (MI). 30 high-resolution helical CT scans were acquired for prosthesis translations ranging from 0.05 mm to 4 mm, and rotations ranging from 0.3° to 3° . For the translations, the mean 3D registration error was found to be 0.22 mm for MS, and 0.15 mm for MI. For the rotations, the standard deviation of the estimation error was 0.18° for MS, and 0.08° for MI. The results show that the proposed approach is feasible and that clinically acceptable accuracies can be obtained. Clinical validation studies on patient images will now be undertaken.

  1. Evaluation of the relationship between the cost and properties of glass ionomer cements indicated for atraumatic restorative treatment.

    Science.gov (United States)

    Calvo, Ana Flávia Bissoto; Kicuti, Ariane; Tedesco, Tamara Kerber; Braga, Mariana Minatel; Raggio, Daniela Prócida

    2016-01-01

    The aim of this study was to evaluate microshear bond strength (μSBS), water sorption and solubility of glass ionomer cements (GIC) indicated for atraumatic restorative treatment (ART). Cylindrical specimens (6 x 2.4 mm) were used to test the sorption and solubility of each GIC (n = 5). The specimens were weighed before and after immersion in water and desiccation. For the μSBS test, 60 primary molars were ground to obtain flat surfaces from both enamel and dentin. The teeth were then assigned to the tested GIC (n = 10) groups, namely Fuji IX - FIX, Ketac Molar - KM and Maxxion R - MX. The exposed surfaces were pre-treated with GIC liquid. Polyethylene tubes were placed on the pre-treated surface and filled with one of the GIC. After 24 h, the specimens were submitted to the μSBS test. The failure mode was assessed using a stereomicroscope (400 x magnification). The powder to liquid ratio and cost of material were also determined (n = 3). The data were analyzed by ANOVA and Tukey's post hoc test. Linear regression was used to determine the relation between cost and the other variables. Overall, MX showed lower μSBS values (enamel: 3.93 ± 0.38; dentin: 5.04 ± 0.70) than FIX (enamel: 5.95 ± 0.85; dentin: 7.01 ± 1.06) and KM (enamel: 5.91 ± 0.78; dentin: 6.88 ± 1.35), as well as higher sorption and solubility. The regression analyses showed a significant and positive correlation between cost and μSBS in enamel (R2 = 0.62; p dentin (R2 = 0.43; p < 0.001); and a negative correlation between cost and water sorption (R2 = 0.93; p < 0.001) and solubility (R2 = 0.79; p < 0.001). In conclusion, the materials indicated for ART exhibit distinct physical and mechanical properties; in addition, low-priced materials may interfere with GIC properties.

  2. Evaluation of the relationship between the cost and properties of glass ionomer cements indicated for atraumatic restorative treatment

    Directory of Open Access Journals (Sweden)

    Ana Flávia Bissoto CALVO

    2016-01-01

    Full Text Available The aim of this study was to evaluate microshear bond strength (μSBS, water sorption and solubility of glass ionomer cements (GIC indicated for atraumatic restorative treatment (ART. Cylindrical specimens (6x2.4 mm were used to test the sorption and solubility of each GIC (n = 5. The specimens were weighed before and after immersion in water and desiccation. For the μSBS test, 60 primary molars were ground to obtain flat surfaces from both enamel and dentin. The teeth were then assigned to the tested GIC (n = 10 groups, namely Fuji IX - FIX, Ketac Molar - KM and Maxxion R – MX. The exposed surfaces were pre-treated with GIC liquid. Polyethylene tubes were placed on the pre-treated surface and filled with one of the GIC. After 24 h, the specimens were submitted to the μSBS test. The failure mode was assessed using a stereomicroscope (400x magnification. The powder to liquid ratio and cost of material were also determined (n = 3. The data were analyzed by ANOVA and Tukey's post hoc test. Linear regression was used to determine the relation between cost and the other variables. Overall, MX showed lower μSBS values (enamel: 3.93 ± 0.38; dentin: 5.04 ± 0.70 than FIX (enamel: 5.95 ± 0.85; dentin: 7.01 ± 1.06 and KM (enamel: 5.91 ± 0.78; dentin: 6.88 ± 1.35, as well as higher sorption and solubility. The regression analyses showed a significant and positive correlation between cost and μSBS in enamel (R2 = 0.62; p < 0.001 and dentin (R2 = 0.43; p < 0.001; and a negative correlation between cost and water sorption (R2 = 0.93; p < 0.001 and solubility (R2 = 0.79; p < 0.001. In conclusion, the materials indicated for ART exhibit distinct physical and mechanical properties; in addition, low-priced materials may interfere with GIC properties.

  3. The atraumatic restorative treatment (ART) strategy in Mexico: two-years follow up of ART sealants and restorations

    Science.gov (United States)

    2013-01-01

    Background The massive use of preventive measures in Mexico has resulted in a large decline in dental caries over the past two decades. There does however remain a largely unmet need for restorative treatment. This paper describes the steps leading up to the adoption of a strategy, as part of general health policy, to use Atraumatic Restorative Treatment (ART) within the Mexican public health service as a means of addressing this. The objective was to evaluate ART restorations and sealants placed in primary and permanent teeth in schoolchildren from deprived areas over a period of 2 years. Methods 18 Dentists from 13 municipalities in 6 states with the lowest human development index treated 304, 6- to 13-year-old schoolchildren with ART sealants and ART restorations (single-surfaces) on the school compounds. Ketac Molar Easymix was the filling material used. ART procedures were evaluated according to the ART assessment criteria after 1 and 2 years, by 7 calibrated evaluators. Survival rates were estimated, using the PHREG Model with frailty correction. Results The 2-year cumulative survival rates of fully and partially retained ART sealants were 73.1% (primary teeth) and 48.8% (permanent teeth). The dentine carious lesion failure rates of ART sealants in primary and permanent teeth over the 2-year period were 0% and 2.5%, respectively. The 2-year cumulative survival rates of single-surface ART restorations in primary and permanent teeth were 74% and 80.9%, respectively. Secondary carious lesion development occurred in 6 restored primary teeth (2.1%) and in one restored permanent tooth (1.3%). All restorations placed in primary teeth in one state survived, whilst those in one of the 5 remaining states failed statistically significantly more than those in the other 4. Conclusions The ART procedures were of substantial quality and had prevented to a large extent the development of new dentine carious lesions in these children from socio-economically deprived areas

  4. Spatiotemporal interactions in retinal prosthesis subjects.

    Science.gov (United States)

    Horsager, Alan; Greenberg, Robert J; Fine, Ione

    2010-02-01

    Vision loss due to retinitis pigmentosa affects an estimated 15 million people worldwide. Through collaboration between Second Sight Medical Products, Inc., and the Doheny Eye Institute, six blind human subjects underwent implantation with epiretinal 4 x 4 electrode arrays designed to directly stimulate the remaining cells of the retina, with the goal of restoring functional vision by applying spatiotemporal patterns of stimulation. To better understand spatiotemporal interactions between electrodes during synchronous and asynchronous stimulation, the authors investigated how percepts changed as a function of pulse timing across the electrodes. Pulse trains (20, 40, 80, and 160 Hz) were presented on groups of electrodes with 800, 1600, or 2400 microm center-to-center separation. Stimulation was either synchronous (pulses were presented simultaneously across electrodes) or asynchronous (pulses were phase shifted). Using a same-different discrimination task, the authors were able to evaluate how the perceptual quality of the stimuli changed as a function of phase shifts across multiple electrodes. Even after controlling for electric field interactions, subjects could discriminate between spatiotemporal pulse train patterns based on differences of phase across electrodes as small as 3 ms. These findings suggest that the quality of the percept is affected not only by electric field interactions but also by spatiotemporal interactions at the neural level. During multielectrode stimulation, interactions between electrodes have a significant influence on the quality of the percept. Understanding how these spatiotemporal interactions at the neural level influence percepts during multielectrode stimulation is fundamental to the successful design of a retinal prosthesis.

  5. Zirconia in fixed prosthesis. A literature review

    Science.gov (United States)

    Román-Rodríguez, Juan L.; Ferreiroa, Alberto; Solá-Ruíz, María F.; Fons-Font, Antonio

    2014-01-01

    Statement of problem: Evidence is limited on the efficacy of zirconia-based fixed dental prostheses. Objective: To carry out a literature review of the behavior of zirconium oxide dental restorations. Material and Methods: This literature review searched the Pubmed, Scopus, Medline and Cochrane Library databases using key search words “zirconium oxide,” “zirconia,” “non-metal restorations,” “ceramic oxides,” “veneering ceramic,” “zirconia-based fixed dental prostheses”. Both in vivo and in vitro studies into zirconia-based prosthodontic restoration behavior were included. Results: Clinical studies have revealed a high rate of fracture for porcelain-veneered zirconia-based restorations that varies between 6% and 15% over a 3- to 5-year period, while for ceramo-metallic restorations the fracture rate ranges between 4 and 10% over ten years. These results provoke uncertainty as to the long-term prognosis for this material in the oral medium. The cause of veneering porcelain fractures is unknown but hypothetically they could be associated with bond failure between the veneer material and the zirconia sub-structure. Key words:Veneering ceramic, zirconia-based ceramic restoration, crown, zirconia, tooth-supported fixed prosthesis. PMID:24596638

  6. Golf hand prosthesis performance of transradial amputees.

    Science.gov (United States)

    Carey, Stephanie L; Wernke, Matthew M; Lura, Derek J; Kahle, Jason T; Dubey, Rajiv V; Highsmith, M Jason

    2015-06-01

    Typical upper limb prostheses may limit sports participation; therefore, specialized terminal devices are often needed. The purpose of this study was to evaluate the ability of transradial amputees to play golf using a specialized terminal device. Club head speed, X-factor, and elbow motion of two individuals with transradial amputations using an Eagle Golf terminal device were compared to a non-amputee during a golf swing. Measurements were collected pre/post training with various stances and grips. Both prosthesis users preferred a right-handed stance initially; however, after training, one preferred a left-handed stance. The amputees had slower club head speeds and a lower X-factor compared to the non-amputee golfer, but increased their individual elbow motion on the prosthetic side after training. Amputees enjoyed using the device, and it may provide kinematic benefits indicated by the increase in elbow flexion on the prosthetic side. The transradial amputees were able to swing a golf club with sufficient repetition, form, and velocity to play golf recreationally. Increased elbow flexion on the prosthetic side suggests a potential benefit from using the Eagle Golf terminal device. Participating in recreational sports can increase amputees' health and quality of life. © The International Society for Prosthetics and Orthotics 2014.

  7. Metabolic Prosthesis for Oxygenation of Ischemic Tissue

    Energy Technology Data Exchange (ETDEWEB)

    Greenbaum, Elias [ORNL

    2009-01-01

    This communication discloses new ideas and preliminary results on the development of a "metabolic prosthesis" for local oxygenation of ischemic tissue under physiological neutral conditions. We report for the first time the selective electrolysis of physiological saline by repetitively pulsed charge-limited electrolysis for the production of oxygen and suppression of free chlorine. For example, using 800 A amplitude current pulses and <200 sec pulse durations, we demonstrated prompt oxygen production and delayed chlorine production at the surface of a shiny 0.85 mm diameter spherical platinum electrode. The data, interpreted in terms of the ionic structure of the electric double layer, suggest a strategy for in situ production of metabolic oxygen via a new class of "smart" prosthetic implants for dealing with ischemic disease such as diabetic retinopathy. We also present data indicating that drift of the local pH of the oxygenated environment can be held constant using a feedback-controlled three electrode electrolysis system that chooses anode and cathode pair based on pH data provided by local microsensors. The work is discussed in the context of diabetic retinopathy since surgical techniques for multielectrode prosthetic implants aimed at retinal degenerative diseases have been developed.

  8. Biomedical and psychosocial factors influencing transtibial prosthesis fit: a Delphi survey among health care professionals.

    Science.gov (United States)

    Baars, Erwin C; Schrier, Ernst; Geertzen, Jan H; Dijkstra, Pieter U

    2015-01-01

    We aimed to reach consensus among professionals caring for prosthesis users, on definitions of biomedical and psychosocial factors, to assess their influence on fit of transtibial prosthesis and to identify new factors. A three-round, internet-based, Delphi survey was conducted among experts recruited via the Dutch National Amputee and Prosthesis Work Group. The main outcome measure was consensus among care professionals on statements concerning new and presented biomechanical and psychosocial factors that influence transtibial prosthesis fit. Fifty-four experts participated in the survey, and consensus was reached on 67% (46/69) of all statements. Consensus on statements relevant for good prosthesis fit was reached in most of the statements concerning psychosocial factors and on statements concerning the biomedical factors "prosthesis support and suspension". Least consensus was reached on statements concerning the biomedical factor "skin problems and pain in the residual limb". Biomedical and psychosocial factors influence transtibial prosthesis fit. Consensus was reached among care professionals in a majority of the presented statements concerning these factors. Implications for Rehabilitation Prosthesis fit and comfort is suboptimal in many prosthesis users. Both biomedical and psychosocial factors influence fit. Biomedical and psychosocial factors should be checked during transtibial prosthesis prescription to achieve and maintain an optimal fit. Consensus on many factors influencing prosthesis fit is achieved among care professionals. Consensus was largest regarding prosthesis support and suspension and least regarding skin problems and pain in the residual limb. This consensus contributes to systematic assessment of prosthesis fit.

  9. Association between dental prosthesis need, nutritional status and quality of life of elderly subjects.

    Science.gov (United States)

    Pillai, Rajath Sasidharan; Mathur, Vijay Prakash; Jain, Veena; Shah, Naseem; Kalra, Sandeep; Kumar, Pravesh; Dey, A B

    2015-12-01

    To determine the effect of prosthesis need on nutritional status and oral health-related quality of life (OHrQoL) in elderly and to check the disparity between prosthesis need and prosthesis want in the Indian elderly. A total of 946 geriatric participants reporting to a geriatric medicine clinic were recruited in the study. Mini-nutritional assessment (MNA), geriatric oral health assessment (GOHAI) indices, prosthesis need according to WHO criteria, and prosthesis want was recorded along with age, gender, socioeconomic status and posterior occluding pair. Significant associations exist between prosthesis need and age (p = 0.005), MNA (p = 0.006) and GOHAI (p = 0.000). Prosthesis demand too was influenced by age (p = 0.004), posterior occluding pairs (p = 0.000), MNA (p = 0.012) and GOHAI (p = 0.000). GOHAI was negatively correlated with upper (r = -0.445) and lower prosthesis need (r = -0.460). Participants with some prosthesis need had significantly lower MNA and GOHAI scores as compared to those with no prosthesis need. Though prosthesis need was high (79.7 %), demand was low (39.3 %). Prosthesis need affects nutritional status and OHrQoL in elderly, and a wide gap exists between need and want of prosthesis.

  10. Gait assessment in patients with thrust plate prosthesis and intramedullary stemmed prosthesis implanted to each hip.

    Science.gov (United States)

    Angin, Salih; Karatosun, Vasfi; Unver, Bayram; Gunal, Izge

    2007-02-01

    There has not been any study regarding comparative gait analysis in patients with intramedullary stemmed prosthesis (ISP) and thrust plate prosthesis (TPP) implanted to each hip. Four patients (three females and one male) who had undergone operation due to coxarthrosis were selected. The mean age was 60.5 (37-78) years. TPP and ISP had been implanted to the left and right hip, respectively, in three patients, and one patient received TPP to the right and ISP to the left hip. Gait was analyzed with a BTS Elite System consisting six cameras and two Kistler force plates using Helen Hayes marker set to assess the gait parameters. The clinical outcome was also evaluated according to Harris hip score (HHS). The average HHS was 95.0 (82-100) points after a mean follow-up of 45.0 (30-50) months for TPP and 94.5 (80-100) points after a follow-up of 60.0 (14-122) months for ISP. Neither of the HHS scores and follow-up time nor gait parameters obtained from the TPP-implanted side were statistically different when compared to those of the ISP-implanted side. TPP and ISP as the implants with their own biomechanical specifications did not produce any remarkable difference in gait.

  11. Recurrent locked knee caused by an impaction fracture following inferior patellar dislocation: a case report

    Directory of Open Access Journals (Sweden)

    Sutcliffe William

    2011-08-01

    Full Text Available Abstract Introduction Locked knee caused by inferior patellar dislocation is considered rare in elderly patients. It was originally thought that, in the osteoarthritic knee, osteophytes on the pole of the patella become entrapped in the inter-condylar notch, which is managed by performing closed reduction and immobilization in a knee splint for three to four weeks. We present an unusual case of a locked knee with an impaction fracture. To the best of our knowledge, there have been no previous reports of such impaction fractures managed with arthroscopy. Case presentation We present an unusual case of an 88-year-old Caucasian woman with moderate arthritis who had a locked knee caused by an impaction fracture of the patella into the lateral femoral condyle. In this case report, we describe the need for arthroscopic surgery to prevent relocking of the knee in these patients. Conclusions This case report emphasizes the need for careful assessment of locked knees in elderly patients. Impaction fractures should be considered in all rare cases of patellar dislocation, and we advocate arthroscopic assessment of the articular cartilage in these patients. This is an important consideration, as the population demographics change and such impaction fractures may become more common in patients with degeneration in the knees.

  12. Fixation of Comminuted Patellar Fracture with Combined Cerclage and Tension Band Wiring Technique

    Directory of Open Access Journals (Sweden)

    T K Ong

    2008-11-01

    Full Text Available In comminuted patellar fractures, a combination of cerclage wiring and tension band fixation is said to provide good mechanical stability. This is a retrospective review of four patients treated with this method. All fractures described herein were classified as 45-C3 (based on Orthopaedic Trauma Association classification and were fixed with a 1.25mm cerclage wire and tension band wire proximally looped through the quadriceps tendon and distally through the patellar ligament in a figure-of-eight configuration. The average follow-up period was 10 months. The Activity of Daily Living Scale (ADLS of the Knee Outcome Survey was used to assess symptoms and functional capability of the knee. In all the cases, fracture union was achieved at an average of 11 weeks. The average ADLS score was good (92.5 %. Full range of knee motion was achieved by end of the third postoperative month. None of the patients had complications, such as infection and implant failure.

  13. Patellar tendon rerupture in a footballer: our personal surgical technique and review of the literature.

    Science.gov (United States)

    Moretti, L; Vicenti, G; Abate, A; Pesce, V; Moretti, B

    2014-02-01

    Patellar tendon rerupture is a relatively uncommon condition that severely compromises the function of the extensor mechanism of the knee. Few cases described in the literature does not show a unique mode of treatment for this type of lesion. We report the case of a young athlete with traumatic patellar tendon rerupture. The first rupture was treated with the use of Statak anchors. Following a second rerupture incident as a result of a sporting accodent, the tendon was reconstructed with the use of an autologous graft tendon of semitendinosus and biological augmentation with gracilis tendon. For both tendons the distal insertion part was preserved to facilitate the healing process. The treatment was completed with the application of a neutralization cerclage wire and with local injection of plateket reach plasma (PRP). At 12 months follow up, a full recovery of the structure and function of the extensor mechanism was observed and the patient was able to resume normal sports competitive activity. Copyright © 2013 Elsevier Ltd. All rights reserved.

  14. [Successive ruptures of patellar and Achilles tendons. Anabolic steroids in competitive sports].

    Science.gov (United States)

    Isenberg, J; Prokop, A; Skouras, E

    2008-01-01

    Derivatives of testosterone or of 19-nor-testosterone are used as anabolics for the purpose of improving performance although the effect of anabolics is known still to be under discussion. The use of anabolic steroids continues among competitive athletes despite increased controls and increasingly frequent dramatic incidents connected with them. Whereas metabolic dysfunction during anabolic use is well documented, ruptures of the large tendons are rarely reported. Within 18 months, a 29-year-old professional footballer needed surgery for rupture of the patellar tendon and of both Achilles tendons. Carefully directed questioning elicited confirmation that he had taken different anabolic steroids regularly for 3 years with the intention of improving his strength. After each operation anabolic steroids were taken again at a high dosage during early convalescence and training. Minimally invasive surgery and open suturing techniques led to complete union of the Achilles tendons in good time. Training and anabolic use (metenolon 300 mg per week) started early after suturing of the patellar tendon including bone tunnels culminated in histologically confirmed rerupture after 8 weeks. After a ligament reconstruction with a semitendinosus tendon graft with subsequent infection, the tendon and reserve traction apparatus were lost. Repeated warnings of impaired healing if anabolic use was continued had been given without success. In view of the high number of unrecorded cases in competitive and athletic sports, we can assume that the use of anabolic steroids is also of quantitative relevance in the operative treatment of tendon ruptures.

  15. Press-fit Femoral Fixation in ACL Reconstruction using Bone-Patellar Tendon-Bone Graft

    Directory of Open Access Journals (Sweden)

    Kaseb Mohammad Hasan

    2009-05-01

    Full Text Available Bone-patellar tendon auto graft is probably the most widely used graft for ACL reconstruction. Several methods for graft fixation have been described. To avoid intra-articular hardware we adopt biological fixation with a femoral trapezoidal press-fit fixation. A prospective study was performed on 30 consecutive active people who underwent ACL reconstruction with this technique by two surgeons between september2004 and march2007 (mean follow-up 15.2 months. Results were evaluated by an independent examiner using radiography, subjective and objective evaluation. Assessment using the IKDC knee scoring revealed 92% of the patients with a normal or nearly normal knee joint. Lysholm's score was 63.6(40- 86 preoperatively and 91.88(73-100 at the latest follow up (P < 0.005. No patient complained of instability at latest follow up. The quadriceps muscle showed mild atrophy at 3 and 6 months and at final follow-up. Five Patients complained of anterior knee pain and had a positive kneeling test. We found no graft displacement on follow up radiographs. All cases showed radiological evidence of graft osteointegration at last follow up. Our results show that press-fit fixation of trapezoidal bone graft in femoral tunnel is a simple, reliable, and cost-effective alternative for ACL recon-struction using bone-patellar tendon-bone graft.

  16. Patellar maltracking is prevalent among patellofemoral pain subjects with patella alta: an upright, weightbearing MRI study

    Science.gov (United States)

    Pal, Saikat; Besier, Thor F.; Beaupre, Gary S.; Fredericson, Michael; Delp, Scott L.; Gold, Garry E.

    2012-01-01

    The purpose of this study is to determine if patellar maltracking is more prevalent among patellofemoral (PF) pain subjects with patella alta compared to subjects with normal patella height. We imaged 37 PF pain and 15 pain free subjects in an open-configuration magnetic resonance imaging scanner while they stood in a weightbearing posture. We measured patella height using the Caton-Deschamps, Blackburne-Peel, Insall-Salvati, Modified Insall-Salvati, and Patellotrochlear indices, and classified the subjects into patella alta and normal patella height groups. We measured patella tilt and bisect offset from oblique-axial plane images, and classified the subjects into maltracking and normal tracking groups. Patellar maltracking was more prevalent among PF pain subjects with patella alta compared to PF pain subjects with normal patella height (two-tailed Fisher’s exact test, p patella alta were maltrackers, whereas only 16% (4/25) of PF pain subjects with normal patella height were maltrackers. Patellofemoral pain subjects classified as maltrackers displayed a greater patella height compared to the pain free and PF pain subjects classified as normal trackers (two-tailed unpaired t-tests with Bonferroni correction, p patella alta compared to subjects with normal patella height; and 2) we show greater patella height in PF pain subjects compared to pain free subjects using four indices commonly used in clinics. PMID:23165335

  17. Reduced Patellar Tendon Elasticity with Aging: In Vivo Assessment by Shear Wave Elastography.

    Science.gov (United States)

    Hsiao, Ming-Yen; Chen, Yi-Ching; Lin, Che-Yu; Chen, Wen-Shian; Wang, Tyng-Guey

    2015-11-01

    How aging affects the elasticity of tendons has long been debated, partly because of the limited methods for in vivo evaluation, which differ vastly from those for in vitro animal studies. In this study, we tested the reliability of shear wave elastography (SWE) in the evaluation of patellar tendons and their change in elasticity with age. We recruited 62 healthy participants in three age groups: 20-30 years (group 1), 40-50 years (group 2) and 60-70 years (group 3). Shear wave velocity and elastic modulus were measured at the proximal, middle and distal areas of the patellar tendon. Reliability was excellent at the middle area and fair to good at both ends. Compared with the other groups, group 3 had significantly decreased elastic modulus and shear wave velocity values (p ≤ 0.001 vs. group 1 or 2), with significant increased side-to-side differences. SWE may be valuable in detecting aging tendons before visible abnormalities are observed on B-mode ultrasonography. Copyright © 2015 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

  18. [ISOLATION OF RAT PATELLAR TENDON STEM CELLS AND EFFECT OF MECHANICAL STRETCHING ON Sox-9 EXPRESSION].

    Science.gov (United States)

    Qin, Shengnan; Wang, Wen; Fu, Shiquan; Cheng, Yushan; Chen, Honghui; Dong, Fei; Chen, Qiming; Li, Aiguo

    2015-07-01

    To isolate the tendon stem cells (TSCs) from rat patellar tendon and to investigate the effect of mechanical stretching on the expression of Sox-9. TSCs were isolated from Sprague Dawley rat (12 weeks old) patellar tendon by collagenase digestion and low density culture. The cell colony morphology and number were observed by crystal violet staining; the cell morphology was observed by inverted phase contrast microscope, and the immunophenotypes of mesenchymal stem cells (MSCs) were determined by flow cytometry. The TSCs at passage 3 was given the mechanical stretching at 4%, 0.17 Hz for 4 hours and 24 hours in the experimental group, and cells without stretching was used as control. The Sox-9 gene and protein expressions were detected by real-time fluorescence quantitative PCR and Western blot. Primary cells showed clonal growth and star shape; after subculture, cells at passage 1 showed fibroblast-like shape. The cells formed cell colonies after 7 days; the expressions were positive for CD29, CD44, and CD90 and negative for CD45. The result of real-time fluorescence quantitative PCR showed that Sox-9 gene was down-regulated at 4 hours after mechanical stretching compared with control (P Sox-9 protein expression was lower at 4 hours after stretching, but higher at 24 hours after mechanical stretching than that in control group (P Sox-9 expression, but the inhibited effect might stimulate the Sox-9 expression after the mechanical stretching effect disappears.

  19. Vastus Medialis Obliquus Muscle Morphology in Primary and Recurrent Lateral Patellar Instability

    Directory of Open Access Journals (Sweden)

    Peter Balcarek

    2014-01-01

    Full Text Available The morphology of the vastus medialis obliquus (VMO muscle in the anatomical setting of an unstable patella has not been described. Therefore, the purpose of this study was to investigate the morphological parameters of the VMO muscle that delineate its importance in the maintenance of patellofemoral joint stability. Eighty-two consecutive subjects were prospectively enrolled in this study. The groups were composed of thirty patients with an acute primary patellar dislocation, thirty patients with recurrent patellar dislocation, and twenty-two controls. Groups were adjusted according to sex, age, body mass index, and physical activity. Magnetic resonance imaging was used to measure the VMO cross-sectional area, muscle-fiber angulation, and the craniocaudal extent of the muscle in relation to the patella. No significant difference was found with respect to all measured VMO parameters between primary dislocation, recurrent dislocation, and control subjects with a trend noted for only the VMO cross-sectional area and the VMO muscle-fiber angulation. This finding is notable in that atrophy of the VMO has often been suggested to play an important role in the pathophysiology of an unstable patellofemoral joint.

  20. Infrapatellar Straps Decrease Patellar Tendon Strain at the Site of the Jumper's Knee Lesion: A Computational Analysis Based on Radiographic Measurements.

    Science.gov (United States)

    Lavagnino, Michael; Arnoczky, Steven P; Dodds, Julie; Elvin, Niell

    2011-05-01

    The impetus for the use of patellar straps in the treatment of patellar tendinopathy has largely been based on empirical evidence and not on any mechanistic rationale. A computational model suggests that patellar tendinopathy may be a result of high localized tendon strains that occur at smaller patella-patellar tendon angles (PPTAs). Infrapatellar straps will decrease the mean localized computational strain in the area of the patellar tendon commonly involved in jumper's knee by increasing the PPTA. Controlled laboratory study. Twenty adult males had lateral weightbearing and nonweightbearing radiographs of their knees taken with and without 1 of 2 infrapatellar straps at 60° of knee flexion. Morphologic measurements of PPTA and patellar tendon length with and without the straps were used as input data into a previously described computational model to calculate average and maximum strain at the common location of the jumper's knee lesion during a simulated jump landing. The infrapatellar bands decreased the predicted localized strain (average and maximum) in the majority of participants by increasing PPTA and/or decreasing patellar tendon length. When both PPTA and patellar tendon length were altered by the straps, there was a strong and significant correlation with the change in predicted average localized strain with both straps. Infrapatellar straps may limit excessive patella tendon strain at the site of the jumper's knee lesion by increasing PPTA and decreasing patellar tendon length rather than by correcting some inherent anatomic or functional abnormality in the extensor apparatus. The use of infrapatellar straps may help prevent excessive localized tendon strains at the site of the jumper's knee lesion during a jump landing.

  1. Prognostic value of MRI in arthroscopic treatment of chronic patellar tendinopathy: a prospective cohort study.

    Science.gov (United States)

    Ogon, Peter; Izadpanah, Kaywan; Eberbach, Helge; Lang, Gernot; Südkamp, Norbert P; Maier, Dirk

    2017-04-04

    To date, prognostic outcome factors for patients undergoing arthroscopic treatment due to chronic patellar tendinopathy (PT) are lacking. The purpose of this study was to investigate whether preoperatively assessed MRI parameters might be of prognostic value for prediction of functional outcome and return to sports in arthroscopic treatment of chronic PT. A prospective cohort study was conducted including 30 cases (4 female and 24 male competitive athletes) undergoing arthroscopic patellar release (APR) due to chronic PT. The mean age was 28.2 years (range, 18-49 years) at the time of surgery, and the mean follow-up period was 4.2 years (range, 2.2-10.4 years). Preoperatively assessed MRI parameters included bone marrow edema (BME) of the inferior patellar pole, patellar tendon thickening, infrapatellar fat pad (IFP) edema, and infrapatellar bursitis. Prevalences of preoperative MRI findings were correlated to functional outcome scores in order to determine statistically significant predictors. All athletes regained their preinjury sports levels. Athletes featuring preoperative IFP edema showed significantly inferior modified Blazina score (0.6 ± 0.7 vs. 0.2 ± 0.5), single assessment numeric evaluation (SANE; 86.0 ± 8.8 vs. 94.3 ± 7.5), and Visual Analogue Scale (VAS; 1.0 ± 1.2 vs. 0.3 ± 0.8) compared to subjects without IFP edema (p < 0.05). Return to sports required a mean of 4 ± 3.2 months. On average, patients with IFP edema needed significantly more time to return to sports than subjects without IFP edema (6.5 vs 2.8 months; p < 0.05). The simultaneous presence of BME and IFP edema was associated with significantly inferior outcomes by means of the Victorian Institute of Sport Assessment questionnaire for patients with patellar tendinopathy (VISA-P; 88.1 ± 11.9 vs. 98.6 ± 4.2), SANE (84.3 ± 10.2 vs. 93.1 ± 8.3), and VAS (1.3 ± 1.4 vs. 0.3 ± 0.9) compared to an isolated BME or

  2. Increased versican content is associated with tendinosis pathology in the patellar tendon of athletes with jumper’s knee

    Science.gov (United States)

    Scott, A; Lian, Ø; Roberts, CR; Cook, JL; Handley, CJ; Bahr, R; Samiric, T; Ilic, MZ; Parkinson, J; Hart, DA; Duronio, V; Khan, KM

    2014-01-01

    Expansion of the extracellular matrix is a prominent but poorly characterized feature of tendinosis. The present study aimed to characterize the extent and distribution of the large aggregating proteoglycan versican in patients with patellar tendinosis. We obtained tendon from tendinopathy patients undergoing debridement of the patellar tendon and from controls undergoing intramedullary tibial nailing. Versican content was investigated by Western blotting and immunohistochemistry. Microvessel thickness and density were determined using computer-assisted image analysis. Markers for smooth muscle (α-SMA), endothelial cells (CD31) and proliferating cells (Ki67) were examined immunohistochemically. Western blot analysis and immunohistochemical staining revealed elevated versican content in the proximal patellar tendon of tendinosis patients (p=0.042). Versican content was enriched in regions of fibrocartilage metaplasia and fibroblast proliferation, as well as in the perivascular matrix of proliferating microvessels and within the media and intima of arterioles. Microvessel density was higher in tendinosis tissue compared to control tissue. Versican deposition is a prominent feature of patellar tendinosis. Because this molecule is not only a component of normal fibrocartilagenous matrices, but is also implicated in a variety of soft tissue pathologies, future studies should further detail both pathological and adaptive roles of versican in tendons. PMID:18067512

  3. Biomechanical properties of suture anchor repair compared with transosseous sutures in patellar tendon ruptures: a cadaveric study.

    Science.gov (United States)

    Ettinger, Max; Dratzidis, Antonios; Hurschler, Christof; Brand, Stephan; Calliess, Tilman; Krettek, Christian; Jagodzinski, Michael; Petri, Maximilian

    2013-11-01

    Ruptures of the patellar tendon are debilitating injuries requiring surgical repair. Reliable data about the most appropriate suture technique and suture material are missing. The standard procedure consists of refixing the tendon with sutures in transpatellar tunnels, sometimes combined with augmentation. Suture anchors provide at least equal results concerning gap formation during cyclic loading and ultimate failure load compared with transosseous suture repair. Controlled laboratory study. A total of 30 human cadaveric patellar tendons underwent tenotomy followed by repair with 5.5-mm titanium suture anchors, 5.5-mm resorbable hydroxyapatite suture anchors, or transpatellar suture tunnels with No. 2 Ultrabraid and the Krackow whipstitch technique. Biomechanical analysis included pretensioning the constructs at 20 N for 30 seconds and then cyclic loading of 250 cycles between 20 and 100 N at 1 Hz in a servohydraulic testing machine with measurement of elongation. After this, ultimate failure load and failure mode analysis was performed. Compared with transosseous sutures, tendon repairs with suture anchors yielded significantly less gap formation during cyclic loading (P suture anchor in the hydroxyapatite anchor group and rupture of the suture in the titanium anchor group and-at lower load to failure-in the transosseous group. Patellar tendon repair with suture anchors yields significantly better biomechanical results than repair with the commonly applied transosseous sutures. These findings may be of relevance for future clinical treatment of patellar tendon ruptures. Randomized controlled clinical trials comparing suture anchors to transosseous suture repair are desirable.

  4. Patella fracture during rehabilitation after bone-patellar tendon-bone anterior cruciate ligament reconstruction: 2 case reports.

    Science.gov (United States)

    Piva, Sara R; Childs, John D; Klucinec, Brian M; Irrgang, James J; Almeida, Gustavo J M; Fitzgerald, G Kelley

    2009-04-01

    Case report. Patellar fracture is a rare but significant complication following anterior cruciate ligament (ACL) reconstruction when using a bone-patellar tendon-bone (BPTB) autograft. The purpose of these case reports is to describe 2 cases in which patellar fracture occurred during rehabilitation after ACL reconstruction using a BPTB. Both patients were 23-year-old males referred for rehabilitation after ACL reconstruction using a BPTB autograft. They were both progressing satisfactorily in rehabilitation until sustaining a fracture of the patella. One fracture occurred during the performance of the eccentric phase of a knee extension exercise during the sixth week of rehabilitation (7 weeks postsurgery), whereas the other fracture occurred during testing of the patient is quadriceps maximum voluntary isometric contraction in the ninth week of rehabilitation (10 weeks postsurgery). Both patients were subsequently treated with open reduction and internal fixation of the patella. During rehabilitation following ACL reconstruction using BPTB autograft, clinicians should consider the need to balance the sometimes-competing goals of improving quadriceps strength while providing protection to the healing graft, minimization of patellofemoral pain, and protection of the patellar donor site.

  5. The computed tomographic evaluation of patellofemoral joint in patellar fractures treated with open reduction and internal fixation

    Energy Technology Data Exchange (ETDEWEB)

    Benli, I.T.; Akalin, S.; Mumcu, E.F.; Citak, M.; Kilic, M.; Pasaoglu, E. (Ankara Social Security Hospital (Turkey))

    1992-08-01

    In this study, we examined 97 patella fractures in which open reduction and internal fixation had been performed at the 1st Orthopaedics and Trauma Clinic of Social Security Ankara Hospital between January 1983 and December 1988. After 24 to 96 months, on an average of 48.4 months follow-up period, the cases were evaluated clinically for knee function complaints and by CT and roentgenography for patellofemoral articulation. In 11 of the patients (11.5%) there was patellar displacement, 2 of the patients had patellar tilt (2.1%) and in 14 patients (14.5%) there was malalignment in which 1 patient (1.1%) had both patellar tilt and displacement. This data was obtained by measuring femoral trochlear angle (FTA) and patellar tilt angle (PTA) by CT at various degrees of knee flexion. Thirty three patients (34%) had slight and 19 patients (19.6%) had severe degenerative changes in the patellofemoral articulation. It is found that there is close relation between the variability of the pain complaints of the patients and the type of the fracture and the time of management and the postoperative rehabilitation. (author).

  6. An exercise-based physical therapy program for patients with patellar tendinopathy after platelet-rich plasma injection

    NARCIS (Netherlands)

    van Ark, Mathijs; van den Akker-Scheek, Inge; Meijer, L.T.B.; Zwerver, Hans

    Objectives: To describe a post platelet-rich plasma (PRP) injection, exercise-based physical therapy program, investigate feasibility and report the first results of patellar tendinopathy patients treated with PRP injection combined with the physical therapy program. Study Design: Case-series.

  7. Increased versican content is associated with tendinosis pathology in the patellar tendon of athletes with jumper's knee.

    Science.gov (United States)

    Scott, A; Lian, Ø; Roberts, C R; Cook, J L; Handley, C J; Bahr, R; Samiric, T; Ilic, M Z; Parkinson, J; Hart, D A; Duronio, V; Khan, K M

    2008-08-01

    Expansion of the extracellular matrix is a prominent but poorly characterized feature of tendinosis. The present study aimed to characterize the extent and distribution of the large aggregating proteoglycan versican in patients with patellar tendinosis. We obtained tendon from tendinopathy patients undergoing debridement of the patellar tendon and from controls undergoing intramedullary tibial nailing. Versican content was investigated by Western blotting and immunohistochemistry. Microvessel thickness and density were determined using computer-assisted image analysis. Markers for smooth muscle actin, endothelial cells (CD31) and proliferating cells (Ki67) were examined immunohistochemically. Western blot analysis and immunohistochemical staining revealed elevated versican content in the proximal patellar tendon of tendinosis patients (P=0.042). Versican content was enriched in regions of fibrocartilage metaplasia and fibroblast proliferation, as well as in the perivascular matrix of proliferating microvessels and within the media and intima of arterioles. Microvessel density was higher in tendinosis tissue compared with control tissue. Versican deposition is a prominent feature of patellar tendinosis. Because this molecule is not only a component of normal fibrocartilagenous matrices but also implicated in a variety of soft tissue pathologies, future studies should further detail both pathological and adaptive roles of versican in tendons.

  8. Influence of acetaminophen and ibuprofen on in vivo patellar tendon adaptations to knee extensor resistance exercise in older adults

    DEFF Research Database (Denmark)

    Carroll, C C; Dickinson, J M; LeMoine, J K

    2011-01-01

    adults induces modest changes in the mechanical properties of the patellar tendon. Over-the-counter doses of acetaminophen, but not ibuprofen, have a strong influence on tendon mechanical and material property adaptations to resistance training. These findings add to a growing body of evidence...

  9. Bifocal osseous avulsion of the patellar tendon from the distal patella and tibial tuberosity in a child.

    Science.gov (United States)

    Hermansen, Lars L; Freund, Knud G

    2016-03-01

    This case report describes a 12-year-old boy, who suffered an injury to the right knee in a skateboard accident. Radiographs and surgery confirmed the extremely rare bifocal avulsion fracture including the distal patellar pole and tibial tuberosity. Open reduction and internal fixation was accomplished, and 4-month follow-up demonstrated a good outcome.

  10. Bifocal osseous avulsion of the patellar tendon from the distal patella and tibial tuberosity in a child

    DEFF Research Database (Denmark)

    Lykke Hermansen, Lars; Gade Freund, Knud

    2016-01-01

    This case report describes a 12-year-old boy, who suffered an injury to the right knee in a skateboard accident. Radiographs and surgery confirmed the extremely rare bifocal avulsion fracture including the distal patellar pole and tibial tuberosity. Open reduction and internal fixation was accomp...

  11. Do isometric and isotonic exercise programs reduce pain in athletes with patellar tendinopathy in-season? : A randomised clinical trial

    NARCIS (Netherlands)

    van Ark, Mathijs; Cook, Jill L; Docking, Sean I; Zwerver, Hans; Gaida, James E; van den Akker-Scheek, Inge; Rio, Ebonie

    Objectives: Many athletes with patellar tendinopathy participate in sports with symptoms during or after activities. Current treatments do not decrease pain in-season; eccentric exercises in-season result in an increase in pain. This study examined if isometric and isotonic exercises relieved pain

  12. Are the take-off and landing phase dynamics of the volleyball spike jump related to patellar tendinopathy?

    NARCIS (Netherlands)

    Bisseling, R.W.; Hof, A.L.; Bredeweg, S.W.; Zwerver, J.; Mulder, T.

    Objective: The causal mechanism of the chronic sports injury patellar tendinopathy is not well understood. The aim of the present study was to compare ankle and knee joint dynamics during the performance of the volleyball spike jump between healthy volleyball players (n = 8) and asymptomatic

  13. Population genetic analysis and genome-wide association study of patellar luxation in a Thai population of Pomeranian dogs

    NARCIS (Netherlands)

    Wangdee, C.; Leegwater, P.A.J.; Heuven, H.C.M.; Steenbeek, van F.G.; Techakumphu, M.; Hazewinkel, H.A.W.

    2017-01-01

    The genetics of patellar luxation (PL) were investigated in Pomeranian dogs presented at the Small Animal Hospital, Faculty of Veterinary Science, Chulalongkorn University. A cohort of 339 Pomeranian dogs, part of a four-generation pedigree of 842 Pomeranians, was screened for PL from 2006 to

  14. Population genetic analysis and genome-wide association study of patellar luxation in a Thai population of Pomeranian dogs

    NARCIS (Netherlands)

    Wangdee, C; Leegwater, P A J|info:eu-repo/dai/nl/074236539; Heuven, H C M|info:eu-repo/dai/nl/314417818; van Steenbeek, F G|info:eu-repo/dai/nl/314417958; Techakumphu, M; Hazewinkel, H A W|info:eu-repo/dai/nl/070975760

    The genetics of patellar luxation (PL) were investigated in Pomeranian dogs presented at the Small Animal Hospital, Faculty of Veterinary Science, Chulalongkorn University. A cohort of 339 Pomeranian dogs, part of a four-generation pedigree of 842 Pomeranians, was screened for PL from 2006 to 2013.

  15. No difference in effectiveness between focused and radial shockwave therapy for treating patellar tendinopathy : A randomized controlled trial

    NARCIS (Netherlands)

    van der Worp, H.; Zwerver, J.; Hamstra, M.; van den Akker-Scheek, I.; Diercks, R. L.

    The aim of the study was to compare the effectiveness of focused shockwave therapy (FSWT) and radial shockwave therapy (RSWT) for treating patellar tendinopathy. Patients were randomized into two groups. One group received three sessions of FSWT, and the other group received three sessions of RSWT.

  16. The patellar shift index: a reliable and valid measure for patellofemoral congruence following total knee arthroplasty with unresurfaced patella.

    Science.gov (United States)

    Metsna, Vahur; Sarap, Pirja; Vorobjov, Sigrid; Tootsi, Kaspar; Märtson, Aare

    2013-01-01

    The aim of this study was to develop a new radiographic measure, the patellar shift index (PSI), for the precise estimation of patellar position relative to the trochlea after a total knee replacement with an unresurfaced patella. This study included radiographs of 51 patients suffering from anterior knee pain following total knee arthroplasty. Patellofemoral axial radiographs were analyzed to compare the reliability of the PSI to the classical measures of patellofemoral congruence, the lateral patellar tilt (LPT) and patellar displacement (PD). Intra-rater reliability of the PSI, LPT and PD was estimated using the intraclass correlation coefficient (ICC) and the inter-rater reliability using Krippendorff's alpha (Kα). Agreement proportion of was calculated for the PD. Face validity of the PSI was also tested. The PSI had excellent intra (mean ICC=0.91) and inter-rater (Kα=0.92) reliability, as did LPT (mean ICC=0.96; Kα=0.89). The calculation of PD caused a low level of agreement (47.1%) between evaluators in terms of which images could be measured. The exclusion of these radiographs resulted in a high PD intra (ICC=0.96) and inter-rater (Kα=0.97) reliability. The PSI appears to be a reliable and valid measure for patellofemoral congruence in a replaced knee joint with an unresurfaced patella. The superiority of the PSI is the result of its consideration of the geometry and size of the replaced knee joint and independence from radiographic magnification.

  17. Design and Testing of a Bionic Dancing Prosthesis.

    Science.gov (United States)

    Rouse, Elliott J; Villagaray-Carski, Nathan C; Emerson, Robert W; Herr, Hugh M

    2015-01-01

    Traditionally, prosthetic leg research has focused on improving mobility for activities of daily living. Artistic expression such as dance, however, is not a common research topic and consequently prosthetic technology for dance has been severely limited for the disabled. This work focuses on investigating the ankle joint kinetics and kinematics during a Latin-American dance to provide unique motor options for disabled individuals beyond those of daily living. The objective of this study was to develop a control system for a bionic ankle prosthesis that outperforms conventional prostheses when dancing the rumba. The biomechanics of the ankle joint of a non-amputee, professional dancer were acquired for the development of the bionic control system. Subsequently, a professional dancer who received a traumatic transtibial amputation in April 2013 tested the bionic dance prosthesis and a conventional, passive prosthesis for comparison. The ability to provide similar torque-angle behavior of the biological ankle was assessed to quantify the biological realism of the prostheses. The bionic dancing prosthesis overlapped with 37 ± 6% of the non-amputee ankle torque and ankle angle data, compared to 26 ± 2% for the conventional, passive prosthesis, a statistically greater overlap (p = 0.01). This study lays the foundation for quantifying unique, expressive activity modes currently unavailable to individuals with disabilities. Future work will focus on an expansion of the methods and types of dance investigated in this work.

  18. Design and Testing of a Bionic Dancing Prosthesis.

    Directory of Open Access Journals (Sweden)

    Elliott J Rouse

    Full Text Available Traditionally, prosthetic leg research has focused on improving mobility for activities of daily living. Artistic expression such as dance, however, is not a common research topic and consequently prosthetic technology for dance has been severely limited for the disabled. This work focuses on investigating the ankle joint kinetics and kinematics during a Latin-American dance to provide unique motor options for disabled individuals beyond those of daily living. The objective of this study was to develop a control system for a bionic ankle prosthesis that outperforms conventional prostheses when dancing the rumba. The biomechanics of the ankle joint of a non-amputee, professional dancer were acquired for the development of the bionic control system. Subsequently, a professional dancer who received a traumatic transtibial amputation in April 2013 tested the bionic dance prosthesis and a conventional, passive prosthesis for comparison. The ability to provide similar torque-angle behavior of the biological ankle was assessed to quantify the biological realism of the prostheses. The bionic dancing prosthesis overlapped with 37 ± 6% of the non-amputee ankle torque and ankle angle data, compared to 26 ± 2% for the conventional, passive prosthesis, a statistically greater overlap (p = 0.01. This study lays the foundation for quantifying unique, expressive activity modes currently unavailable to individuals with disabilities. Future work will focus on an expansion of the methods and types of dance investigated in this work.

  19. A digital patient for computer-aided prosthesis design.

    Science.gov (United States)

    Colombo, Giorgio; Facoetti, Giancarlo; Rizzi, Caterina

    2013-04-06

    This article concerns the design of lower limb prosthesis, both below and above knee. It describes a new computer-based design framework and a digital model of the patient around which the prosthesis is designed and tested in a completely virtual environment. The virtual model of the patient is the backbone of the whole system, and it is based on a biomechanical general-purpose model customized with the patient's characteristics (e.g. anthropometric measures). The software platform adopts computer-aided and knowledge-guided approaches with the goal of replacing the current development process, mainly hand made, with a virtual one. It provides the prosthetics with a set of tools to design, configure and test the prosthesis and comprehends two main environments: the prosthesis modelling laboratory and the virtual testing laboratory. The first permits the three-dimensional model of the prosthesis to be configured and generated, while the second allows the prosthetics to virtually set up the artificial leg and simulate the patient's postures and movements, validating its functionality and configuration. General architecture and modelling/simulation tools for the platform are described as well as main aspects and results of the experimentation.

  20. [Design and study of carbon fiber tracheal prosthesis].

    Science.gov (United States)

    Qi, L; Liu, D; Han, Z; Wang, F

    1998-12-01

    32 healty adult dogs were selected for this experiment. 10 of them were subjected to the tracheal biomechanics test using indices including the relation between stretcher ratio (lambda) and stress (T), the squeeze stress (delta jy) of medical silk thread on trachea, the side stress (Ts) inducing the tracheal collapse, the functional maximum angle (psi max) of tracheal, and the sever area torsion angle (theta max) of tracheal functional maximum curved. According to the indices measured, two types of tracheal prosthesis were designed, and were made of carbon fiber and silicon. They were the straight tube type tracheal prosthesis and the bifurcate type tracheal prosthesis. The straight tube type tracheal prosthesis was studied with a design of two groups comprising a total of 11 dogs. In the experiment group (n = 6), the outer surface of the tube was not coated with silicon, the average survival period was 379.8 days. In the control group (n = 5), the outer surface of the tube was coated with silicon, the average survival period was 90.4 days. The bifurcate type tracheal prosthesis was studied in 11 dogs, the average survival period was 4.32 days. The main causes of death in the experiment were infection and anastomotic dehiscent.

  1. Closed-eye orbital prosthesis: a clinical report.

    Science.gov (United States)

    Hatamleh, Muhanad M; Watson, Jason; Srinivasan, Dilip

    2015-03-01

    One of the most challenging prostheses to fabricate is an acceptable orbital prosthesis. Successful reconstruction of the complex missing tissues, the globe, muscle, skin, and bony elements requires time and high levels of practical skill. A good match to the contralateral nondefect side will help mask the underlying defect and give the patient confidence to return to normal, routine life. The contralateral eye opening will commonly dictate the eye opening of such a prosthesis, but because of the expressive nature of the eye and its high levels of mobility, this can be difficult to achieve. This clinical report presents a patient who had an extended orbital exenteration and right maxillectomy to remove a maxillary squamous cell carcinoma. An alternative approach to constructing an orbital prosthesis was undertaken with the eye closed. Compared to the normal method of fabrication, this process was less complex and quicker, made the prosthesis less "staring," camouflaged the defect, and reduced the detection of the prosthesis because of movements in the remaining eye. The patient engaged in his routine daily life, which reinforced his self-esteem, confidence, and reintegration into the community. Copyright © 2015 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

  2. Split-Framework in Mandibular Implant-Supported Prosthesis

    Directory of Open Access Journals (Sweden)

    Danny Omar Mendoza Marin

    2015-01-01

    Full Text Available During oral rehabilitation of an edentulous patient with an implant-supported prosthesis, mandibular flexure must be considered an important biomechanical factor when planning the metal framework design, especially if implants are installed posterior to the interforaminal region. When an edentulous mandible is restored with a fixed implant-supported prosthesis connected by a fixed full-arch framework, mandibular flexure may cause needless stress in the overall restorative system and lead to screw loosening, poor fit of prosthesis, loss of the posterior implant, and patient’s discomfort due to deformation properties of the mandible during functional movements. The use of a split-framework could decrease the stress with a precise and passive fit on the implants and restore a more natural functional condition of the mandible, helping in the longevity of the prosthesis. Therefore, the present clinical report describes the oral rehabilitation of an edentulous patient by a mandibular fixed implant-supported prosthesis with a split-framework to compensate for mandibular flexure. Clinical Significance. The present clinical report shows that the use of a split-framework reduced the risk of loss of the posterior implants or screws loosening with acceptable patient comfort over the period of a year. The split-framework might have compensated for the mandibular flexure during functional activities.

  3. [Tracheal reconstruction with memory alloy prosthesis coated with collagen].

    Science.gov (United States)

    Lin, Hai-ping; Cao, Zi-ang; Gu, Xu-dong; Pan, Wen-biao; Wu, Xue-jun; Zhang, Gu-lan

    2007-03-01

    To investigate the feasibility of tracheal reconstruction with a prosthesis made of memory alloy coated with collagen sponge in mongrel dogs. The basic skeleton of the prosthesis was knitted with Ni-Ti memory alloy wires. The tubular mesh was sealed with polyurethane membrane and then inner and external walls of the lumen were coated with collagen sponge. Cervical trachea segmental reconstruction was performed in 8 mongrel dogs with these prostheses. The efficacy of the implanted prostheses were periodically evaluated after operation using x-ray, tracheoscopy and specimen microscope examinations. One dog died of prosthesis dislocation 10 days after operation, another was killed 45 days later because of anastomotic stenosis. 6 dogs survived more than 90 days and the longest one lived for 150 days. Its implanted prosthesis was completely incorporated with the recipient tissue, where re-epithelialization occluded on anastomotic sites. The tracheal lumen was patent. This memory alloy tracheal prosthesis has been proved useful for reconstruction of large, circumferential tracheal defects, although its long-term safety and efficiency need to be confirmed.

  4. Estimation of crank angle for cycling with a powered prosthesis.

    Science.gov (United States)

    Lawson, B E; Shultz, A; Ledoux, E; Goldfarb, M

    2014-01-01

    In order for a prosthesis to restore power generation during cycling, it must supply torque in a manner that is coordinated with the motion of the bicycle crank. This paper outlines an algorithm for the real time estimation of the angular position of a bicycle crankshaft using only measurements internal to an intelligent knee and ankle prosthesis. The algorithm assumes that the rider/prosthesis/bicycle system can be modeled as a four-bar mechanism. Assuming that a prosthesis can generate two independent angular measurements of the mechanism (in this case the knee angle and the absolute orientation of the shank), Freudenstein's equation can be used to synthesize the mechanism continuously. A recursive least-squares algorithm is implemented to estimate the Freudenstein coefficients, and the resulting link lengths are used to reformulate the equation in terms of input-output relationships mapping both measured angles to the crank angle. Using two independent measurements allows the algorithm to uniquely determine the crank angle from multi-valued functions. In order to validate the algorithm, a bicycle was mounted on a trainer and configured with the prosthesis using an artificial hip joint attached to the seat post. Motion capture was used to monitor the mechanism for forward and backward pedaling and the results are compared to the output of the presented algorithm. Once the parameters have converged, the algorithm is shown to predict the crank angle within 15° of the externally measured value throughout the entire crank cycle during forward rotation.

  5. Design and Control of a Pneumatically Actuated Transtibial Prosthesis

    Science.gov (United States)

    Zheng, Hao; Shen, Xiangrong

    2015-01-01

    This paper presents the design and control of a pneumatically actuated transtibial prosthesis, which utilizes a pneumatic cylinder-type actuator to power the prosthetic ankle joint to support the user's locomotion. The pneumatic actuator has multiple advantages over the traditional electric motor, such as light weight, low cost, and high power-to-weight ratio. The objective of this work is to develop a compact and lightweight transtibial prosthesis, leveraging the multiple advantages provided by this highly competitive actuator. In this paper, the design details of the prosthesis are described, including the determination of performance specifications, the layout of the actuation mechanism, and the calculation of the torque capacity. Through the authors’ design calculation, the prosthesis is able to provide sufficient range of motion and torque capacity to support the locomotion of a 75 kg individual. The controller design is also described, including the underlying biomechanical analysis and the formulation of the finite-state impedance controller. Finally, the human subject testing results are presented, with the data indicating that the prosthesis is able to generate a natural walking gait and sufficient power output for its amputee user. PMID:26146497

  6. Intermanual Transfer Effects in Below-Elbow Myoelectric Prosthesis Users.

    Science.gov (United States)

    de Boer, Errit; Romkema, Sietske; Cutti, Andrea G; Brouwers, Michael A; Bongers, Raoul M; van der Sluis, Corry K

    2016-11-01

    To determine intermanual transfer effects in patients with a below-elbow amputation using a myoelectric prosthesis and to establish whether laterality affects these effects. Case-control. A standardized setting in a rehabilitation clinic. A convenience sample (N=44) of experienced myoelectric prosthesis users (n=22) and matched controls (n=22). Controls were matched on sex, age (±5y), and hand dominance. Both the experienced group and the control group performed several tasks using a prosthesis simulator attached to their nonaffected arm. Movement time, force control, Box and Block test (BBT) scores, and duration of hand opening. Movement times of myoelectric prosthesis users were shorter, and these users had significantly higher BBT scores and shorter hand opening durations than those of controls. No intermanual transfer effects on force control and no laterality effects were found. Intermanual transfer effects were present in experienced myoelectric prosthesis users with a below-elbow amputation, independent of laterality. These findings support the clinical relevance of intermanual transfer training, which may facilitate persons with an upper limb amputation to start training directly after the amputation. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  7. Functional improvement with digital prosthesis use after multiple digit amputations.

    Science.gov (United States)

    Lifchez, Scott D; Marchant-Hanson, Judith; Matloub, Hani S; Sanger, James R; Dzwierzynski, William W; Nguyen, Hanh H

    2005-07-01

    Patients who sustain traumatic amputation of multiple fingers suffer both a functional and psychologic loss. Previous studies of prosthesis use for finger amputees have focused primarily on the psychologic benefits. Clinically our group noticed a functional improvement on hand function tests when patients with multiple digit amputations used a prosthesis. Given the expense of multiple finger prostheses we sought to determine if they led to a consistent functional improvement in these patients. Ten consecutive patients performed a battery of hand function tests and rated their ability to perform a variety of activities of daily living both with and without their prosthesis using the Disabilities of the Arm, Shoulder, and Hand questionnaire. Our results show a significant improvement in 3-finger-pinch strength and grip strength and a trend of improvement of tip-pinch, lateral-pinch, and grip strength in dynamometer positions 1, 2, 3, and 4 in these patients when tested with and without their prostheses. Function in activities of daily living, as assessed by the Disabilities of the Arm, Shoulder, and Hand questionnaire, was improved globally with prosthesis use. In addition, significant improvement was noted in several specific activities including opening a jar, writing, and turning a key, among others. These results show that prosthesis use provides a functional benefit to these patients in multiple activities.

  8. The impact of joint line restoration on functional results after hinged knee prosthesis

    Directory of Open Access Journals (Sweden)

    Serdar Yilmaz

    2016-01-01

    Conclusion: RHKA is an effective salvage procedure for serious instability and large bone defects. Restoration of the joint line improves the patellar score although it had no effect on the clinical outcome.

  9. The making of indigenous vascular prosthesis

    Directory of Open Access Journals (Sweden)

    Madathipat Unnikrishnan

    2016-01-01

    Full Text Available Background & objectives: Vascular illnesses are on the rise in India, due to increase in lifestyle diseases and demographic transition, requiring intervention to save life, organ or limbs using vascular prosthesis. The aim of this study was to develop indigenous large diameter vascular graft for treatment of patients with vascular pathologies. Methods: The South India Textile Research Association, at Coimbatore, Tamil Nadu, India, developed seamless woven polyester (Polyethylene terephthalate graft at its research wing. Further characterization and testing followed by clinical trials were conducted at Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India. Fifteen in vivo experiments were carried out in 1992-1994 in pigs as animal model. Controlled (phase I clinical trial in ten patients was performed along with control graft. Thereafter, phase II trial involved 22 patients who underwent multi-centre clinical trial in four centres across India. Results: Laboratory testing showed that polyester graft was non-toxic, non-leeching and non-haemolytic with preserved long-term quality, further confirming in pigs by implanting in thoracic aorta, comparable to control Dacron grafts. Perigraft incorporation and smooth neointima formation which are prime features of excellent healing characteristics, were noted at explantation at planned intervals. Subsequently in the phase I and II clinical trials, all patients had excellent recovery without mortality or device-related adverse events. Patients receiving the test graft were followed up for 10 and 5 years, respectively. Serial clinical, duplex scans and CT angiograms performed periodically confirmed excellent graft performance. Interpretation & conclusions: Indigenously developed Chitra vascular graft was comparable to commercially available Dacron graft, ready for clinical use at affordable cost to patients as against costly imported grafts.

  10. Active Bone Conduction Prosthesis: BonebridgeTM

    Directory of Open Access Journals (Sweden)

    Zernotti, Mario E.

    2015-10-01

    Full Text Available Introduction Bone conduction implants are indicated for patients with conductive and mixed hearing loss, as well as for patients with single-sided deafness (SSD. The transcutaneous technology avoids several complications of the percutaneous bone conduction implants including skin reaction, skin growth over the abutment, and wound infection. The Bonebridge (MED-EL, Austria prosthesis is a semi-implantable hearing system: the BCI (Bone Conduction Implant is the implantable part that contains the Bone Conduction-Floating Mass Transducer (BC-FMT, which applies the vibrations directly to the bone; the external component is the audio processor Amadé BB (MED-EL, Austria, which digitally processes the sound and sends the information through the coil to the internal part. Bonebridge may be implanted through three different approaches: the transmastoid, the retrosigmoid, or the middle fossa approach. Objective This systematic review aims to describe the world́s first active bone conduction implant system, Bonebridge, as well as describe the surgical techniques in the three possible approaches, showing results from implant centers in the world in terms of functional gain, speech reception thresholds and word recognition scores. Data Synthesis The authors searched the MEDLINE database using the key term Bonebridge. They selected only five publications to include in this systematic review. The review analyzes 20 patients that received Bonebridge implants with different approaches and pathologies. Conclusion Bonebridge is a solution for patients with conductive/mixed hearing loss and SSD with different surgical approaches, depending on their anatomy. The system imparts fewer complications than percutaneous bone conduction implants and shows proven benefits in speech discrimination and functional gain.

  11. In vivo performance of photovoltaic subretinal prosthesis

    Science.gov (United States)

    Mandel, Yossi; Goetz, George; Lavinsky, Daniel; Huie, Phil; Mathieson, Keith; Wang, Lele; Kamins, Theodore; Manivanh, Richard; Harris, James; Palanker, Daniel

    2013-02-01

    We have developed a photovoltaic retinal prosthesis, in which camera-captured images are projected onto the retina using pulsed near-IR light. Each pixel in the subretinal implant directly converts pulsed light into local electric current to stimulate the nearby inner retinal neurons. 30 μm-thick implants with pixel sizes of 280, 140 and 70 μm were successfully implanted in the subretinal space of wild type (WT, Long-Evans) and degenerate (Royal College of Surgeons, RCS) rats. Optical Coherence Tomography and fluorescein angiography demonstrated normal retinal thickness and healthy vasculature above the implants upon 6 months follow-up. Stimulation with NIR pulses over the implant elicited robust visual evoked potentials (VEP) at safe irradiance levels. Thresholds increased with decreasing pulse duration and pixel size: with 10 ms pulses it went from 0.5 mW/mm2 on 280 μm pixels to 1.1 mW/mm2 on 140 μm pixels, to 2.1 mW/mm2 on 70 μm pixels. Latency of the implant-evoked VEP was at least 30 ms shorter than in response evoked by the visible light, due to lack of phototransduction. Like with the visible light stimulation in normal sighted animals, amplitude of the implant-induced VEP increased logarithmically with peak irradiance and pulse duration. It decreased with increasing frequency similar to the visible light response in the range of 2 - 10 Hz, but decreased slower than the visible light response at 20 - 40 Hz. Modular design of the photovoltaic arrays allows scalability to a large number of pixels, and combined with the ease of implantation, offers a promising approach to restoration of sight in patients blinded by retinal degenerative diseases.

  12. [Ideal total hip prosthesis in 1993].

    Science.gov (United States)

    Delagoutte, J P; Mainard, D

    Although it is a hazardous adventure to define what is an ideal in any field, it would appear that there is a certain consensus about total hip prostheses. The fundamental principle of the total hip replacement was based on the articulation of a spheric segment, a mobile head contained in a hemispheric non-retaining element. To date, the first material is a titanium in a alloy containing 6% aluminum and 4% vanadium. The second material facing the titanium is polyethylene or alumine. Thus the joint couple could be "polyethylene-metal", or "polyethylene-alumine" or even "alumine-alumine". The hemispheric element can be a massive piece of polyethylene or formed by a peripheral metal (an open hemisphere) filled with the joint surface, itself made of polyethylene. This solution offers the possibility of changing the prosthesis in case of wear without interrupting the implant-bone contact. The first type is cemented to the bone with methyl polymethacrylate. With the second, the metallic part need not to be cemented and can be fitted to the bone by simple pressing. Several points are essential in the femoral piece. It should include a removable head so the length of the neck can be adjusted. It must fill the medullary canal as closely as possible and fill the methaphyseal space. It is fixed by a self-fitting system leading to stable secondary long-term fixation-a porous covering, sometimes with hydroxy apatite can also be useful. In certain cases it must be cemented, although the cement must only play the role of adaptation.(ABSTRACT TRUNCATED AT 250 WORDS)

  13. Multimodal sensor controlled three Degree of Freedom transradial prosthesis.

    Science.gov (United States)

    Ohnishi, Kengo; Morio, Toshiyuki; Takagi, Tomoo; Kajitani, Isamu

    2013-06-01

    This paper describes the basic concept of our multimodal sensor control system for 3-Degree-of-Freedom transradial prosthesis. The target of developing the controller is to reduce the mental effort of planning operating multiple joints in the conventional multifunctional myoelectric controller and reduce the compensating motion of conventional myoelectric prosthesis. An accelerometer is installed in the socket and the angles of the gravitational force are computed to drive the pronation/spination joint and the palmar flexion/dorsifelxion joint of the prosthesis. A threshold On/Off control using the posture information is implemented with the triggering of a co-contraction EMG signal. Through experiment with able-body subjects, we confirmed that this controller has a potential of reducing compensating shoulder movements for pick-raise-place tasks, when compared to the task conducted with conventional locked-wrist prostheses. Yet modification is required for stability.

  14. Research, design and development project Myoelectric Prosthesis of Upper Limb

    Energy Technology Data Exchange (ETDEWEB)

    Galiano, L; Montaner, E; Flecha, A [Bioparx, J Hernandez 1101, Parana, ERios (Argentina)

    2007-11-15

    A Research Design and Development Project was developed of a myoelectric prosthesis for a pediatric patient presenting congenital amputation of the left forearm below the elbow. A multidisciplinary work-team was formed for this goal, in order to solve the several (/various) aspects regarding this project (mechanical, ergonomics, electronics, physical). The prosthesis as an electromechanical device was divided in several blocks, trying to achieve a focused development for each stage, acording to requisites. A mechanical prototype of the prothesis was designed and built along with the circuitry needed for EMG aquisition, control logic and drivers. Having acomplished the previuos stages, the project is now dealing with the definitions of the interface between the prosthesis and the patient, with promising perspectives.

  15. An electronic prosthesis mimicking the dynamic vestibular function

    Science.gov (United States)

    Shkel, Andrei M.

    2006-03-01

    This paper reports our progress toward development of a unilateral vestibular prosthesis. The sensing element of the prosthesis is a custom designed one-axis MEMS gyroscope. Similarly to the natural semicircular canal, the microscopic gyroscope senses angular motion of the head and generates voltages proportional to the corresponding angular accelerations. Then, voltages are sent to the pulse generating unit where angular motion is translated into voltage pulses. The voltage pulses are converted into current pulses and are delivered through specially designed electrodes, conditioned to stimulate the corresponding vestibular nerve branch. Our preliminary experimental evaluations of the prosthesis on a rate table indicate that the device's output matches the average firing rate of vestibular neurons to those in animal models reported in the literature. The proposed design is scalable; the sensing unit, pulse generator, and the current source can be potentially implemented on a single chip using integrated MEMS technology.

  16. Implant-retained finger prosthesis with modified retention system.

    Science.gov (United States)

    Goiato, Marcelo Coelho; dos Santos, Daniela Micheline; Amoroso, Andressa Paschoal; Gennari Filho, Humberto; Dekon, Stefan Fiuza de Carvalho

    2013-08-01

    Amputations affect both the physical and the psychological aspects of an individual, causing significant impact on self-esteem. The main causes of finger amputations are work-related accidents with dangerous machinery, road traffic accidents, and animal bites, as well as systemic diseases such as diabetes. This report aims to describe a simple technique for fabrication of implant-retained finger prosthesis with a modified base of the retention system. The O-Ring retention system was used with a modified hexagon-shaped base and a metallic capsule adapted to the acrylic resin to attach the prosthesis to the implant. The prosthesis was made with silicone, and after osseointegration, it was installed without complications, leading to a patient satisfied with the end result and encouraged to return to social life. Restoring self-esteem in the patient and static and functional rehabilitation.

  17. Mastication improvement after partial implant-supported prosthesis use.

    Science.gov (United States)

    Gonçalves, T M S V; Campos, C H; Gonçalves, G M; de Moraes, M; Rodrigues Garcia, R C M

    2013-12-01

    Partially edentulous patients may be rehabilitated by the placement of removable dental prostheses, implant-supported removable dental prostheses, or partial implant fixed dental prostheses. However, it is unclear the impact of each prosthesis type over the masticatory aspects, which represents the objective of this paired clinical trial. Twelve patients sequentially received and used each of these 3 prosthesis types for 2 months, after which maximum bite force was assessed by a strain sensor and food comminution index was determined with the sieving method. Masseter and temporal muscle thicknesses during rest and maximal clenching were also evaluated by ultrasonography. Each maxillary arch received a new complete denture that was used throughout the study. Data were analyzed by analysis of variance for repeated measures, followed by the Tukey test (p mastication, and the magnitude of this effect was related to prosthesis type.

  18. [Tests of hand functionality in upper limb amputation with prosthesis].

    Science.gov (United States)

    Bazzini, G; Orlandini, D; Moscato, T A; Nicita, D; Panigazzi, M

    2007-01-01

    The need for standardized instruments for clinical measurements has become pressing in the fields of occupational rehabilitation and ergonomics. This is particularly the case for instruments that allow a quantitative evaluation of upper limb function, and especially hand function in patients who have undergone an amputation and then application of an upper limb prosthesis. This study presents a review of the main tests used to evaluate hand function, with a critical analysis of their use in subjects with an upper limb prosthesis. The tests are divided into: tests to evaluate strength, tests to evaluate co-ordination and dexterity, tests of global or overall function, and tests proposed specifically for subjects with an upper limb prosthesis. Of the various tests presented, the authors give their preference to the Bimanual Functional Assessment, Abilhand and/or the ADL Questionnaire, because of the practical usefulness, clinimetric features, simplicity and ease of administration of these tests.

  19. 21 CFR 888.3810 - Wrist joint ulnar (hemi-wrist) polymer prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Wrist joint ulnar (hemi-wrist) polymer prosthesis... SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3810 Wrist joint ulnar (hemi-wrist) polymer prosthesis. (a) Identification. A wrist joint ulnar (hemi-wrist) polymer prosthesis...

  20. 21 CFR 888.3770 - Wrist joint carpal trapezium polymer prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Wrist joint carpal trapezium polymer prosthesis... SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3770 Wrist joint carpal trapezium polymer prosthesis. (a) Identification. A wrist joint carpal trapezium polymer prosthesis is a one...