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Sample records for spontaneous medial patellar

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

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    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.)

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

    International Nuclear Information System (INIS)

    Jerabek, Seth A.; Asnis, Peter D.; Poon, Steven K.; Gill, Thomas J.; Bredella, Miriam A.; Ouellette, Hugue A.

    2009-01-01

    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.)

  3. Proximo-distal patellar position in three small dog breeds with medial patellar luxation.

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    Wangdee, C; Theyse, L F H; Hazewinkel, H A W

    2015-01-01

    Medial patellar luxation is thought to be associated with a high proximal position of the patella in the trochlear groove. To determine whether the ratio of patellar ligament length and patellar length (L:P) is influenced by the stifle angle (75°, 96°, 113°, 130°, and 148°) in small dog breeds and to compare the L:P ratio in dogs of three small dog breeds with and without medial patellar luxation. A mediolateral radiograph of the stifle joint was used to measure the L:P ratio in the stifle joints of dogs of three small breeds with and without medial patellar luxation. The L:P ratio was evaluated at five stifle angles (75°, 96°, 113°, 130°, and 148°) in 14 cadavers (26 stifle joints) of small dog breeds in order to identify the best stifle angle to measure the L:P ratio. Then the mean ± SD L:P ratio was calculated for normal stifles and stifles with medial patellar luxation grades 1, 2, and 3 in 194 Pomeranians, 74 Chihuahuas, and 41 Toy or Standard Poodles. The L:P ratio was the same for all five stifle angles in the cadavers (p = 0.195). It was also not significantly different in the three breeds (p = 0.135), in normal and medial patellar luxation-affected stifles overall (p = 0.354), and in normal and medial patellar luxation-affected joints within each breed (p = 0.19). We conclude that a proximo-distal patellar position is not associated with medial patellar luxation in Pomeranians, Chihuahuas, and Toy or Standard Poodles. Thus a longer patellar ligament length does not play a role in the pathophysiology of medial patellar luxation in these small dog breeds.

  4. Trochleoplasty and medial patellofemoral ligament reconstruction for recurrent patellar dislocation

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    K Raghuveer Reddy

    2012-01-01

    Full Text Available We report a case of recurrent patellar dislocation with high-grade trochlear dysplasia which persisted despite two previous operations. We did a Dejour′s sulcus deepening trochleoplasty, medial patellofemoral ligament reconstruction, and lateral retinacular release. Trochleoplasty and medial patellofemoral ligament reconstruction is required in patients with high grade trochlear dysplasia.

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

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    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.

  6. Role of pathophysiology of patellofemoral instability in the treatment of spontaneous medial patellofemoral subluxation: a case report

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    Doğruyol Dağhan

    2010-05-01

    Full Text Available Abstract Introduction Medial patellar subluxation is usually seen after lateral retinacular release. Spontaneous medial subluxation of the patella is a very rare condition. There are few reports in the literature on the pathophysiology of iatrogenic medial patellar subluxation. To our knowledge, there are no reports of the pathophysiology of non-iatrogenic medial patellar subluxation in the English literature. In this study we present a case of spontaneous medial patellar instability that is more prominent in extension during weight bearing. We also try to define the treatment protocol based on pathophsiology. Case presentation We report the case of a 21-year-old Turkish man with spontaneous medial patellar instability. He had suffered right knee pain, clicking and popping sensation in the affected knee for three months prior to presentation. Clinical examination demonstrated medial patellar subluxation that is more prominent in extension during the weight bearing phase of gait and while standing. Increased medial tilt was observed when the patella was stressed medially. Conventional anterior to posterior, lateral and Merchant radiographs did not reveal any abnormalities. After three months of physical therapy, our patient was still suffering from right knee pain which disturbed his gait pattern. Throughout the surgery, medial patellar translation was tested following the imbrication of lateral structures. He still had a medial patellar translation that was more than 50% of his patellar width. Patellotibial ligament augmentation using an iliotibial band flap was added. When examined after surgery, the alignment of the patella was effectively corrected. Conclusions Chronic imbalance between the strengths of vastus lateralis and vastus medialis results in secondary changes in passive ligamentous structures and causes additional instability. Physical therapy modalities that aim to strengthen the vastus lateralis might be sufficient for the

  7. Repair of Medial Patellofemoral, Ligament Improves Patellar, Tracking in Total Knee Replacement.

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    Meneghini, R Michael; Ziemba-Davis, Mary; Smits, Shelly; Bicos, James

    2015-11-01

    The medial patellofemoral ligament (MPFL) is essential to maintain patella stability; however, its role in total knee replacement (TKR) has not been studied. Forty-six consecutive TKRs in 40 patients were reviewed. Standard closure was performed in 29 TKRs. The MPFL was isolated and anatomically re-approximated in 17 subsequent TKRs. Blinded radiographic evaluation of patellar tilt and subluxation was performed preoperatively and 4 months postoperatively. Despite greater preoperative lateral tilt, the MPFL repair group demonstrated greater correction in patellar tilt compared with the standard closure group (p = 0.02). Patellar tracking also was optimized in the MPFL group, despite equivalent preoperative lateral patellar subluxation in the two groups. Simple repair of the MPFL at arthrotomy closure appears to optimize patellar stability radiographically and may improve long-term results by minimizing patellar complications and wear.

  8. Simultaneous MPFL and LPFL reconstruction for recurrent lateral patellar dislocation with medial patellofemoral instability

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    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.

  9. Reconstruction of medial patellofemoral ligament using quadriceps tendon combined with reconstruction of medial patellotibial ligament using patellar tendon: initial experience

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    Betina Bremer Hinckel

    2016-02-01

    Full Text Available ABSTRACT OBJECTIVE: To describe a surgical technique for anatomical reconstruction of the medial patellofemoral ligament using the quadriceps tendon, combined with reconstruction of the medial patellotibial ligament using the patellar tendon; and to present the initial results from a case series. METHOD: The proposed technique was used on a series of cases of patients with diagnoses of patellofemoral instability and indications for surgical treatment, who were attended by the Knee Group of HC-IOT, University of São Paulo. The following were evaluated before and after the operation: range of motion (ROM, apprehension test, lateral translation test, patellar inclination test, inverted J sign, subluxation upon extension, pain from compression of the patella and pain from contraction of the quadriceps. After the operation, the patients were asked whether any new episode of dislocation had occurred, what their degree of satisfaction with the surgery was (on a scale from 0 to 10 and whether they would be prepared to go through this operation again. RESULTS: Seven knees were operated, in seven patients, with a mean follow-up of 5.46 months (±2.07. Four patients who presented apprehension before the operation did not show this after the operation. The lateral translation test became normal for all the patients, while the patellar inclination test remained positive for two patients. The patients with an inverted J sign continued to be positive for this sign. Five patients were positive for subluxation upon extension before the operation, but all patients were negative for this after the operation. None of the patients presented any new episode of dislocation of the patella. All of them stated that they were satisfied: five gave a satisfaction score of 9 and two, a score of 10. All of them said that they would undergo the operation again. Only one patient presented a postoperative complication: dehiscence of the wound. CONCLUSION: Reconstruction of the

  10. Lesions in canine stifle joints due to trochleoplasties as treatment for medial patellar luxation

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    Johannes Hans van der Zee

    2015-07-01

    Full Text Available Lesions in canine stifle joints after previous trochleoplasty surgery were documented. Infour clinical cases arthrotomies were performed due to stifle pain after previous trochleardeepening procedures. A small area of hyaline cartilage remained in the groove of the stiflesin cases where previous wedge trochleoplasties had been performed. All of the stifles hadsignificant areas of eburnation on the axial aspect of the medial trochlear ridge. The stifle jointsof a dog that was euthanased due to severe irreversible osteo-arthritis were photographed.The dog had undergone previous surgery for patellar luxation and cranial cruciate ligamentruptures. The trochlear grooves in this dog had almost no visible articular cartilage left.

  11. Clinical Outcomes After Isolated Medial Patellofemoral Ligament Reconstruction for Patellar Instability Among Patients With Trochlear Dysplasia.

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    Liu, Joseph N; Brady, Jacqueline M; Kalbian, Irene L; Strickland, Sabrina M; Ryan, Claire Berdelle; Nguyen, Joseph T; Shubin Stein, Beth E

    2018-03-01

    Medial patellofemoral ligament (MPFL) reconstruction has become one of the most common and widely used procedures to regain stability among patients with recurrent lateral patellar dislocation. While recent studies demonstrated low recurrence rates, improved patient-reported outcome measures, and a high rate of return to sports, limited literature explored its effectiveness as an isolated intervention in the context of trochlear dysplasia. To determine the efficacy of isolated MPFL reconstruction in treating patellar instability in the setting of trochlear dysplasia. Case series; Level of evidence, 4. This was a retrospective review of consecutive patients who underwent uni- or bilateral medial patellofemoral ligament reconstruction for patellofemoral instability with a minimum 2-year follow-up. No osteotomies were included. Pre- and postoperative assessment included ligamentous laxity, patellar crepitus, tilt, translation, apprehension, and radiographic features, including tibial tubercle-trochlear groove (TT-TG) distance, Dejour classification, and Caton-Deschamps index. A total of 121 MPFL reconstructions were included. Mean age at surgery was 23.8 years, and 4.4 dislocation events occurred before surgery. Mean follow-up was 44 months; 76% of patients were female. Mean preoperative TT-TG ratio was 13.5, and mean Caton-Deschamps ratio was 1.2; 92% of patients had Dejour B, C, or D trochlear dysplasia. Kujala score improved from 55.0 preoperatively to 90.0 ( P patellofemoral instability, despite the presence of trochlear dysplasia. Most patients are able to return to sports by 1 year postoperatively at the same or higher level of play.

  12. Results of isolated lateral retinacular reconstruction for iatrogenic medial patellar instability.

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    Sanchis-Alfonso, Vicente; Montesinos-Berry, Erik; Monllau, Joan Carles; Merchant, Alan C

    2015-03-01

    The aim of this study was to assess the outcomes of an isolated lateral retinaculum reconstruction for iatrogenic medial patellar instability (IMPI) in patients with continued pain after failed lateral retinacular release (LRR), including associated psychometric analysis. Pain was assessed using the visual analog scale (VAS) and disability was determined with the Lysholm scale. Psychological variables such as anxiety, depression, catastrophizing, and fear-of-movement beliefs were studied by using self-administered psychometric questionnaires. All 17 patients (13 women and 4 men) in this retrospective study had undergone LRR previously for anterior knee pain or lateral patellar instability. Four patients had undergone LRR plus proximal (Insall) realignment, and one had undergone LRR plus a medial tibial tubercle transfer. After their procedures, all had disabling symptoms. All patients underwent reconstructive surgery for IMPI. At a minimum follow-up of 2 years (range, 2 to 8 years), the mean preoperative VAS score was 7.6 (range, 5 to 9) and improved to 1.9 (range, 0 to 8) at the time of final follow-up (P surgery, 4 patients (24%) had the clinical criteria for depression, 10 (59%) had anxiety, 7 (41%) had "catastrophizing" ideas concerning pain, and all (100%) had kinesiophobia (fear of movement). After surgery, none of the patients had depression or anxiety, none had catastrophizing ideation, and only 53% had kinesiophobia. Reconstruction of the deep transverse layer of the lateral retinaculum (LR) using a central strip of the iliotibial band for IMPI in patients with continued pain after failed LRR can successfully treat these severely disabled patients. Level IV, therapeutic case series. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  13. [Reconstruction of medial patellofemoral ligament with transposition of great adductor muscular tendon for the treatment of teenagers' recurrent patellar dislocation].

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    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 ( P teenagers' recurrent patellar dislocation.

  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

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    Zhang, Guang-ying; Ding, Hong-yu; Zheng, Lei; Ji, Bing-jun; Shi, Hao; Feng, Yan

    2017-01-01

    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. 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

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    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.)

  16. MID-VASTUS VS MEDIAL PARA-PATELLAR APPROACH IN TOTAL KNEE REPLACEMENT—TIME TO DISCHARGE

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    Mukherjee, P.; Press, J.; Hockings, M.

    2009-01-01

    Background It has been shown before that when compared with the medial para-patellar approach, the mid-vastus approach for TKR results in less post-operative pain for patients and more rapid recovery of straight leg raise. As far as we are aware the post-operative length of stay of the two groups of patients has not been compared. We postulated that the reduced pain and more rapid recovery of straight leg raise would translate into an earlier, safe, discharge home for the mid-vastus patients compared with those who underwent a traditional medial para-patellar approach. Methods Twenty patients operated on by each of five established knee arthroplasty surgeons were evaluated prospectively with regard to their pre and post-operative range of movement, time to achieve straight leg raise post-operatively and length of post-operative hospital stay. Only one of the surgeons performed the mid-vastus approach, and the measurements were recorded by physiotherapists who were blinded as to the approach used on each patient. Results The results were analysed using a standard statistical software package, and although the mean length of stay was lower for the mid-vastus patients, the difference did not reach a level of significance (p = 0.13). The time taken to achieve straight leg raise post-operatively was significantly less in the mid-vastus group (p<0.001). Conclusion Although this study confirms previous findings that the mid-vastus approach reduces the time taken for patients to achieve straight leg raise, when compared with the medial para-patellar approach, on its own it does not translate into a significantly shorter length of hospital stay. In order to reduce the length of post-operative hospital stay with an accelerated rehabilitation program for TKR, a multi-disciplinary approach is required. Patient expectations, GP support, physiotherapists and nursing staff all have a role to play and the mid-vastus approach, in permitting earlier straight leg raising

  17. Patellar dislocations in children, adolescents and adults: A comparative MRI study of medial patellofemoral ligament injury patterns and trochlear groove anatomy

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    Balcarek, Peter; Walde, Tim Alexander; Frosch, Stephan; Schuettrumpf, Jan P.; Wachowski, Martin M.; Stuermer, Klaus M.; Frosch, Karl-Heinz

    2011-01-01

    Purpose: The first aim was to compare medial patellofemoral ligament injury patterns in children and adolescents after first-time lateral patellar dislocations with the injury patterns in adults. The second aim was to evaluate the trochlear groove anatomy at different developmental stages of the growing knee joint. Materials and methods: Knee magnetic resonance (MR) images were collected from 22 patients after first-time patellar dislocations. The patients were aged 14.2 years (a range of 11-15 years). The injury pattern of the medial patellofemoral ligament was analysed, and trochlear dysplasia was evaluated with regard to sulcus angle, trochlear depth and trochlear asymmetry. The control data consisted of MR images from 21 adult patients who were treated for first-time lateral patellar dislocation. Results: After patellar dislocation, injury to the medial patellofemoral ligament was found in 90.2% of the children and in 100% of the adult patients. Injury patterns of the medial patellofemoral ligament were similar between the study group and the control group with regard to injury at the patellar attachment site (Type I), to the midsubstance (Type II) and to injury at the femoral origin (Type III) (all p > 0.05). Combined lesions (Type IV) were significantly less frequently observed in adults when compared to the study group (p = 0.02). The magnitude of trochlear dysplasia was similar in children, adolescents and adults with regard to all three of the measured parameter-values (all p > 0.05). In addition, the articular cartilage had a significant effect on the distal femur geometry in both paediatrics and adults. Conclusion: First, the data from our study indicated that the paediatric medial patellofemoral ligament injury patterns, as seen on MR images, were similar to those in adults. Second, the trochlear groove anatomy and the magnitude of trochlear dysplasia, respectively, did not differ between adults and paediatrics with patellar instability. Thus

  18. Patellar dislocations in children, adolescents and adults: A comparative MRI study of medial patellofemoral ligament injury patterns and trochlear groove anatomy

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    Balcarek, Peter, E-mail: peter.balcarek@med.uni-goettingen.de [Department of Trauma Surgery, Plastic and Reconstructive Surgery, University Medicine, 37075 Goettingen (Germany); Walde, Tim Alexander; Frosch, Stephan; Schuettrumpf, Jan P.; Wachowski, Martin M.; Stuermer, Klaus M. [Department of Trauma Surgery, Plastic and Reconstructive Surgery, University Medicine, 37075 Goettingen (Germany); Frosch, Karl-Heinz [Department of Trauma and Reconstructive Surgery, Asklepios Clinic St. Georg, Hamburg (Germany)

    2011-09-15

    Purpose: The first aim was to compare medial patellofemoral ligament injury patterns in children and adolescents after first-time lateral patellar dislocations with the injury patterns in adults. The second aim was to evaluate the trochlear groove anatomy at different developmental stages of the growing knee joint. Materials and methods: Knee magnetic resonance (MR) images were collected from 22 patients after first-time patellar dislocations. The patients were aged 14.2 years (a range of 11-15 years). The injury pattern of the medial patellofemoral ligament was analysed, and trochlear dysplasia was evaluated with regard to sulcus angle, trochlear depth and trochlear asymmetry. The control data consisted of MR images from 21 adult patients who were treated for first-time lateral patellar dislocation. Results: After patellar dislocation, injury to the medial patellofemoral ligament was found in 90.2% of the children and in 100% of the adult patients. Injury patterns of the medial patellofemoral ligament were similar between the study group and the control group with regard to injury at the patellar attachment site (Type I), to the midsubstance (Type II) and to injury at the femoral origin (Type III) (all p > 0.05). Combined lesions (Type IV) were significantly less frequently observed in adults when compared to the study group (p = 0.02). The magnitude of trochlear dysplasia was similar in children, adolescents and adults with regard to all three of the measured parameter-values (all p > 0.05). In addition, the articular cartilage had a significant effect on the distal femur geometry in both paediatrics and adults. Conclusion: First, the data from our study indicated that the paediatric medial patellofemoral ligament injury patterns, as seen on MR images, were similar to those in adults. Second, the trochlear groove anatomy and the magnitude of trochlear dysplasia, respectively, did not differ between adults and paediatrics with patellar instability. Thus

  19. Case report - curved femoral osteotomy for management of medial patellar luxation

    DEFF Research Database (Denmark)

    Allpass, Maja; Miles, James Edward

    2015-01-01

    Medial patellaluxation kan forårsages af femoral varus hos hund. Førhen har patienter med excessiv femoralvarus været korrigeret ved en lateralt placeret femoral kile-ostektomi. Her præsenteres en case, hvor en buet osteotomi blev anvendt til behandling af medial patellaluxation.......Medial patellaluxation kan forårsages af femoral varus hos hund. Førhen har patienter med excessiv femoralvarus været korrigeret ved en lateralt placeret femoral kile-ostektomi. Her præsenteres en case, hvor en buet osteotomi blev anvendt til behandling af medial patellaluxation....

  20. Evaluation of medial patellofemoral ligament tears after acute lateral patellar dislocation: comparison of high-frequency ultrasound and MR

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    Zhang, Guang-Ying; Ding, Hong-Yu [Shandong University, Department of Ultrasonography, Qianfoshan Hospital, Jinan (China); Zheng, Lei; Sun, Bai-Sheng [Chinese People' s Armed Police Force, Department of Radiology, Shandong Provincial Corps Hospital, Jinan (China); Li, En-Miao [Jinan Third People' s Hospital, Department of Ultrasonography, Jinan (China); Shi, Hao [Shandong University, Department of Radiology, Qianfoshan Hospital, Jinan (China)

    2015-01-15

    The purpose of this study was to compare the diagnostic performance of high-frequency ultrasound with MR in the evaluation of medial patellofemoral ligament (MPFL) lesions after acute lateral patellar dislocation (LPD). High-frequency ultrasound and MR images were prospectively obtained in 97 consecutive patients with acute LPD. Images were acquired using standardised protocols and were independently evaluated by two radiologists. The MPFL was assessed at three sites (patellar insertion, femoral attachment, and mid-substance) for signs of injury. Of a total of 291 sites in 97 MPFLs, 127 showed proven MPFL tear at surgery, including 51 sites of complete tear and 76 sites of partial tear. In a site-based analysis, the sensitivity, specificity, and accuracy of high-frequency ultrasound was 90.8 %, 96.3 %, and 94.6 %, respectively, for partial MPFL tear and 86.3 %, 96.3 %, and 94 %, respectively, for complete tear. For MR, the sensitivity, specificity, and accuracy was 81.6 %, 95.7 %, and 91.3 %, respectively, for partial MPFL tear and 80.4 %, 95.7 %, and 92.1 %, respectively, for complete tear. There was no statistical difference between high-frequency ultrasound and MR in the assessment of partial (P = 0.1, 0.777, 0.155) or complete (P = 0.425, 0.777, 0.449) MPFL lesions. Interobserver agreement was very good for high-frequency ultrasound and good for MR. Data suggest that high-frequency ultrasound and MR have similar diagnostic performance in the evaluation of MPFL lesions after acute LPD. (orig.)

  1. Evaluation of medial patellofemoral ligament tears after acute lateral patellar dislocation: comparison of high-frequency ultrasound and MR

    International Nuclear Information System (INIS)

    Zhang, Guang-Ying; Ding, Hong-Yu; Zheng, Lei; Sun, Bai-Sheng; Li, En-Miao; Shi, Hao

    2015-01-01

    The purpose of this study was to compare the diagnostic performance of high-frequency ultrasound with MR in the evaluation of medial patellofemoral ligament (MPFL) lesions after acute lateral patellar dislocation (LPD). High-frequency ultrasound and MR images were prospectively obtained in 97 consecutive patients with acute LPD. Images were acquired using standardised protocols and were independently evaluated by two radiologists. The MPFL was assessed at three sites (patellar insertion, femoral attachment, and mid-substance) for signs of injury. Of a total of 291 sites in 97 MPFLs, 127 showed proven MPFL tear at surgery, including 51 sites of complete tear and 76 sites of partial tear. In a site-based analysis, the sensitivity, specificity, and accuracy of high-frequency ultrasound was 90.8 %, 96.3 %, and 94.6 %, respectively, for partial MPFL tear and 86.3 %, 96.3 %, and 94 %, respectively, for complete tear. For MR, the sensitivity, specificity, and accuracy was 81.6 %, 95.7 %, and 91.3 %, respectively, for partial MPFL tear and 80.4 %, 95.7 %, and 92.1 %, respectively, for complete tear. There was no statistical difference between high-frequency ultrasound and MR in the assessment of partial (P = 0.1, 0.777, 0.155) or complete (P = 0.425, 0.777, 0.449) MPFL lesions. Interobserver agreement was very good for high-frequency ultrasound and good for MR. Data suggest that high-frequency ultrasound and MR have similar diagnostic performance in the evaluation of MPFL lesions after acute LPD. (orig.)

  2. Treatment of recurrent patellar dislocation via knee arthroscopy combined with C-arm fluoroscopy and reconstruction of the medial patellofemoral ligament.

    Science.gov (United States)

    Li, Li; Wang, Hongbo; He, Yun; Si, Yu; Zhou, Hongyu; Wang, Xin

    2018-06-01

    Recurrent patellar dislocations were treated via knee arthroscopy combined with C-arm fluoroscopy, and reconstruction of the medial patellofemoral ligaments. Between October 2013 and March 2017, 52 cases of recurrent patellar dislocation [27 males and 25 females; age, 16-47 years (mean, 21.90 years)] were treated. Arthroscopic exploration was performed and patellofemoral joint cartilage injuries were repaired. It was subsequently determined whether it was necessary to release the lateral patellofemoral support belt. Pre-operative measurements were used to decide whether tibial tubercle osteotomy was required. Medial patellofemoral ligaments were reconstructed using autologous semitendinosus tendons. Smith and Nephew model 3.5 line anchors were used to double-anchor the medial patellofemoral margin. On the femoral side, the medial patellofemoral ligament was fixed using 7-cm, absorbable, interfacial compression screws. All cases were followed for 1-40 months (average, 21 months). The Q angle, tibial tuberosity trochlear groove distance, Insall-Salvati index, patellofemoral angle, lateral patellofemoral angle and lateral shift were evaluated on X-Ray images using the picture archiving and communication system. Subjective International Knee Documentation Committee (IKDC) knee joint functional scores and Lysholm scores were recorded. Post-operative fear was absent, and no patellar re-dislocation or re-fracture was noted during follow-up. At the end of follow-up, the patellofemoral angle (0.22±4.23°), lateral patellofemoral angle (3.44±1.30°), and lateral shift (0.36+0.14°) differed significantly from the pre-operative values (all, Ppatellofemoral ligament was effective.

  3. Short-term results of medial patellofemoral ligament reconstruction for patellar dislocation

    International Nuclear Information System (INIS)

    Sakuraba, Koji; Miura, Hiromasa; Matsuda, Shuichi; Okazaki, Ken; Iwamoto, Yukihide; Fukuoka, Shinji

    2009-01-01

    The short-term results of medial patellofemoral ligament (MPFL) reconstruction were reviewed. MPFL reconstruction surgery was performed on 13 patients (13 knees, three male, five female, mean age 24.1 years) with recurrent and habitual dislocation of the patella. After average 18.5 month follow-up, there has been no recurrence of dislocation and limitation of range of motion except for one case. The mean Kujula score was 60±20.2 preoperatively and 91±15 postoperatively. According to the Crosby and Insall grading system, six ceses were excellent, six cases were good, and one case was fair to poor. On axial radiographs, the mean congruence angle was 31.3±21.4deg preoperatively and -3.65±20.72deg postoperatively. The mean tilting angle was 32.1±7.9deg preoperatively and 21.9±8.39deg postoperatively. The mean lateral shift was 41.6±9.7% preoperatively and 24.5±9.9% postoperatively. These results demonstrate the short-term effectiveness of MPFL reconstruction. (author)

  4. Spontaneous Relocation of a Posterior Dislocation of Mobile Bearing in a Medial Unicompartmental Knee Replacement

    Science.gov (United States)

    Noureddine, Hussein; Aird, Jaimes; Latimer, Paul

    2012-01-01

    We describe a case of spontaneous relocation of a posterior dislocation of the mobile bearing in a medial unicompartmental knee replacement, prior to surgical intervention. We are unaware of any similar cases in the published literature. This paper highlights some clinical issues around this type of dislocation. PMID:23259116

  5. Spontaneous Relocation of a Posterior Dislocation of Mobile Bearing in a Medial Unicompartmental Knee Replacement

    Directory of Open Access Journals (Sweden)

    Hussein Noureddine

    2012-01-01

    Full Text Available We describe a case of spontaneous relocation of a posterior dislocation of the mobile bearing in a medial unicompartmental knee replacement, prior to surgical intervention. We are unaware of any similar cases in the published literature. This paper highlights some clinical issues around this type of dislocation.

  6. SPHENOID SINUS (SS ANTERIOR MEDIAL TEMPORAL LOBE ENCEPHALOCELE (AMTLE WITH SPONTANEOUS CSF RHINORRHOEA : A CASE REPORT

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    Laveena

    2015-09-01

    Full Text Available Cranial encephaloceles are the herniation of intracranial meninges and brain tissue through a defect in the cranium or skull base. These are rare conditions with an incidence of approximately 1 in 35,000 people, and are more common in the anterior cranial fossa than those in the middle one . 1,2 Temporal lobe herniation through a mid dle fossa defect into the lateral recess of the Sphenoid Sinus is even rarer than its medial representation. Intrasphenoidal encephaloceles are extremely rare findings 3 . Spontaneous, or primary, CSF fistula is a separate entity with no underlying cause of the CSF leak. Spontaneous CSF leaks are usually associated with a co - existing encephalocele of variable size 4 . We present a case of spontaneous CSF rhinorrhoea in a sphenoid sinus Anterior Medial Temporal lobe encephalocele herniating through a clinically silent lateral Craniopharyngeal canal.

  7. 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.)

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

    International Nuclear Information System (INIS)

    Meyers, Arthur B.; Sharafinski, Mark; Laor, Tal; Zbojniewicz, Andrew M.

    2016-01-01

    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.)

  9. A Comparison of Angular Values of the Pelvic Limb with Normal and Medial Patellar Luxation Stifles in Chihuahua Dogs Using Radiography and Computed Tomography.

    Science.gov (United States)

    Phetkaew, Thitaporn; Kalpravidh, Marissak; Penchome, Rampaipat; Wangdee, Chalika

    2018-02-01

     This article aimed to determine and compare the angular values of the pelvic limb in normal and medial patellar luxation (MPL) stifles in Chihuahuas using radiography and computed tomographic (CT) scan, to identify the relationship between pelvic limb angles and severity of MPL. In addition, radiographic and CT images were compared to determine the more suitable method of limb deformity assessment.  Sixty hindlimbs of Chihuahuas were divided into normal and grade 1, 2, 3 and 4 MPL groups. The pelvic limb angles in frontal and sagittal planes were evaluated on radiography and CT scan. Femoral and tibial torsion angles (FTA and TTA) were evaluated only by CT scan. All angles were compared among normal and MPL stifles and between radiography and CT scan.  Based on the CT scan, the mechanical lateral distal femoral angle (mLDFA), anatomical caudal proximal femoral angle (aCdPFA), and TTA were related to the severity of MPL. The mLDFA and TTA were significantly increased ( p  Chihuahuas are aLDFA, mLDFA, aCdPFA and TTA. Radiography had some limitations for evaluating pelvic limb angles. The caudocranial radiograph is recommended for the assessment of the distal femoral angles, while the craniocaudal radiograph is for the tibial angles. Schattauer GmbH Stuttgart.

  10. Clinical and Functional Outcomes following Primary Repair versus Reconstruction of the Medial Patellofemoral Ligament for Recurrent Patellar Instability

    Directory of Open Access Journals (Sweden)

    Marc Tompkins

    2014-01-01

    Full Text Available Background. The purpose of this study was to compare outcomes of medial patellofemoral ligament (MPFL repair or reconstruction. Methods. Fourteen knees that underwent MPFL repair and nine (F5, M4 knees that underwent reconstruction at our institution were evaluated for objective and subjective outcomes. The mean age at operation was 20.1 years for repair and 19.8 years for reconstruction. All patients had a minimum of 2 years of follow-up (range: 24–75 months. Patient subjective outcomes were obtained using the International Knee Documentation Committee (IKDC and Kujala patellofemoral subjective evaluations, as well as Visual Analog (VAS and Tegner Activity Scales. Bilateral isometric quadriceps strength and vastus medialis obliquus (VMO and vastus lateralis (VL surface EMG were measured during maximal isometric quadriceps contractions at 30° and 60° of flexion. Results. There were no redislocations in either group. There was no difference in IKDC (P=0.16, Kujala (P=0.43, Tegner (P=0.12, or VAS (P=0.05 scores at follow-up. There were no differences between repair and reconstruction in torque generation of the involved side at 30° (P=0.96 and 60° (P=0.99. In addition, there was no side to side difference in torque generation or surface EMG activation of VL or VMO. Conclusions. There were minimal differences found between patients undergoing MPFL repair and MPFL reconstruction for the objective and subjective evaluations in this study.

  11. Differential effects of unilateral lesions in the medial amygdala on spontaneous and induced ovulation.

    Science.gov (United States)

    Sanchez, M A; Dominguez, R

    1995-01-01

    The possible existence of asymmetry in the control of ovulation by the medial amygdala was explored. Unilateral lesions of the medial amygdala were performed on each day of the estrous cycle. The estral index diminished in almost all animals with a lesion in the right side of medial amygdala. Lesions of the right medial amygdala, when performed on diestrus-1, resulted in a significant decrease in the number of rats ovulating compared to controls (4/8 vs. 8/8, p rats with lesions of the right medial amygdala. However, sequential injections of PMSG-hCG did result in ovulation by all members of a group of lesioned animals. In this last condition a significant decrease in the number of ova shed by the right ovary was found compared to animals in the lesion-only condition (1.5 +/- 0.5 vs. 6.0 +/- 1.5, p cycle.

  12. Computed tomographic evaluation of realignment surgery for patellar subluxation

    International Nuclear Information System (INIS)

    Inoue, Masahiro; Shino, Konsei; Maeda, Akira; Nakata, Ken; Ono, Hiroo.

    1994-01-01

    Forty-two patients with patellar subluxation underwent realignment surgery of the knee extensor mechanism. The surgery included, lateral release, advancement and reefing of the vastus medialis and the medial capsule and tibial tubercle transfer (Elmslie-Trillat procedure). The effect of surgery was evaluated using computed tomograms of the pre- and post-operative knees at 0, 15, 30 and 45 degrees of knee flexion. The degree of patellofemoral incongruence on CT was expressed using two parameters of patellar tilt and patellar shift. Thirty-three volunteers without any patello-femoral symptoms served as controls. Postoperatively both the patellar tilt and the patellar shift improved significantly. The average patellar tilt and the patellar shift of the patient group at 45 degrees were comparable with those of controls. However, it was found by CT that the realignment surgery was less effective between 0 and 30 degrees of knee flexion. (author)

  13. Computed tomographic evaluation of realignment surgery for patellar subluxation

    Energy Technology Data Exchange (ETDEWEB)

    Inoue, Masahiro (Kansai Rosai Hospital, Amagasaki (Japan)); Shino, Konsei; Maeda, Akira; Nakata, Ken; Ono, Hiroo

    1994-01-01

    Forty-two patients with patellar subluxation underwent realignment surgery of the knee extensor mechanism. The surgery included, lateral release, advancement and reefing of the vastus medialis and the medial capsule and tibial tubercle transfer (Elmslie-Trillat procedure). The effect of surgery was evaluated using computed tomograms of the pre- and post-operative knees at 0, 15, 30 and 45 degrees of knee flexion. The degree of patellofemoral incongruence on CT was expressed using two parameters of patellar tilt and patellar shift. Thirty-three volunteers without any patello-femoral symptoms served as controls. Postoperatively both the patellar tilt and the patellar shift improved significantly. The average patellar tilt and the patellar shift of the patient group at 45 degrees were comparable with those of controls. However, it was found by CT that the realignment surgery was less effective between 0 and 30 degrees of knee flexion. (author).

  14. Patellar Tendinopathy

    OpenAIRE

    Schwartz, Aaron; Watson, Jonathan N.; Hutchinson, Mark R.

    2015-01-01

    Context: Patellar tendinopathy is a common condition. There are a wide variety of treatment options available, the majority of which are nonoperative. No consensus exists on the optimal method of treatment. Evidence Acquisition: PubMed spanning 1962-2014. Study Design: Clinical review. Level of Evidence: Level 4. Results: The majority of cases resolve with nonoperative therapy: rest, physical therapy with eccentric exercises, cryotherapy, anti-inflammatories, corticosteroid injections, extrac...

  15. Patellar Tendinopathy.

    Science.gov (United States)

    Schwartz, Aaron; Watson, Jonathan N; Hutchinson, Mark R

    2015-01-01

    Patellar tendinopathy is a common condition. There are a wide variety of treatment options available, the majority of which are nonoperative. No consensus exists on the optimal method of treatment. PubMed spanning 1962-2014. Clinical review. Level 4. The majority of cases resolve with nonoperative therapy: rest, physical therapy with eccentric exercises, cryotherapy, anti-inflammatories, corticosteroid injections, extracorporeal shockwave therapy, glyceryl trinitrate, platelet-rich plasma injections, and ultrasound-guided sclerosis. Refractory cases may require either open or arthroscopic debridement of the patellar tendon. Corticosteroid injections provide short-term pain relief but increase risk of tendon rupture. Anti-inflammatories and injectable agents have shown mixed results. Surgical treatment is effective in many refractory cases unresponsive to nonoperative modalities. Physical therapy with an eccentric exercise program is the mainstay of treatment for patellar tendinopathy. Platelet-rich plasma has demonstrated mixed results; evidence-based recommendations on its efficacy cannot be made. In the event that nonoperative treatment fails, surgical intervention has produced good to excellent outcomes in the majority of patients. © 2015 The Author(s).

  16. Estudo prospectivo randomizado sobre a luxação traumática de patela: tratamento conservador versus reconstrução do ligamento femoropatelar medial com tendão patelar - mínimo de dois anos de seguimento Randomized prospective study on traumatic patellar dislocation: conservative treatment versus reconstruction of the medial patellofemoral ligament using the patellar tendon, with a minimum of two years of follow-up

    Directory of Open Access Journals (Sweden)

    Alexandre Carneiro Bitar

    2011-01-01

    Full Text Available OBJETIVO: O objetivo deste estudo foi comparar os resultados da cirurgia (reconstrução do ligamento femoropatelar medial; LFPM com os resultados do tratamento conservador da luxação primária de patela. MÉTODOS: Trinta e nove pacientes (41 joelhos com luxação de patela foram randomizados em dois grupos (um grupo foi tratado conservadoramente - imobilização e fisioterapia - e o outro cirurgicamente com a reconstrução do LFPM e foram avaliados com um seguimento mínimo de dois anos. O questionário de Kujala foi aplicado para avaliar dor e qualidade de vida e as recidivas foram avaliadas. Os testes do Qui-quadrado de Pearson e exato de Fisher foram utilizados na avaliação estatística. RESULTADOS: A análise estatística mostrou que a média do escore de Kujala foi significativamente mais baixa no grupo conservador (70,8 quando comparada à média do grupo cirúrgico (88,9, com p = 0,001. O grupo cirúrgico apresentou maior porcentagem de resultados bom/excelente (71,43% no escore de Kujala quando comparados ao grupo conservador (25% com p = 0,003. O grupo conservador apresentou um número maior de recorrências (35% dos casos, enquanto que no grupo cirúrgico não houve relatos de recorrências e/ou subluxações. CONCLUSÕES: O tratamento com a reconstrução do ligamento femoropatelar medial com o tendão patelar produziu melhores resultados, com base na análise das recorrências pós-tratamento e nos resultados finais melhores no questionário de Kujala após um seguimento mínimo de dois anos.OBJECTIVE: The aim of this study was to compare the surgical results from reconstruction of the medial patellofemoral ligament (MPFL with non-operative treatment of primary patellar dislocation. METHODS: Thirty-nine patients (41 knees with patellar dislocation were randomized into two groups. One group was treated conservatively (immobilization and physiotherapy and other was treated surgically with reconstruction of the MPFL, and the

  17. 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.

  18. [Patellar instability : diagnosis and treatment].

    Science.gov (United States)

    Ngo, Trieu Hoai Nam; Martin, Robin

    2017-12-13

    The aim of this paper is to present recent advances in surgical management of patellar instability. Several anatomical factors were reported to promote instability. We propose to classify them in two groups. Extra articular factors are valgus and torsion deformity. Articular factors include trochlea and patella dysplasia, tibial tubercle lateralization and medial patellofemoral ligament (MPFL) insufficiency. Acute patellar dislocations are treated conservatively, with exception for osteochondral and MPFL avulsion fractures that require acute reinsertion. Surgery is considered for recurrent instability. As we aim for a correction of all contributing elements, we prefer a two stages approach. Extra articular factors are treated first by osteotomy, followed by articular factors after 4-6 months. This allows separate rehabilitation protocols.

  19. Patellar SPECT and planar imaging in orthopedic patients with knee pain

    International Nuclear Information System (INIS)

    Dehdashti, F.; Collier, B.D.; Johnson, R.P.; Isitman, A.T.; Hellman, R.S.; Carrera, G.F.; Krasnow, A.Z.

    1987-01-01

    Eighty-five painful knees in 56 patients were independently evaluated clinically, radiographically, and scintigraphically. All patients had an established final diagnosis of osteoarthritis or other predisposing conditions. Results of patellar bone scintigraphy were abnormal in 66 of 85 knees; there were ten isolated findings and 12 cases of medial, nine of lateral, and 35 of triple compartment involvement. Four-quadrant patellar analysis identified nine instances of isolated lateal patellar facet syndrome. Single-photon emission CT was of significant value in localizing patellar abnormalities. Radiographic evaluation disclosed osteoarthritis in 27 of 66 scintigraphically abnormal knees. Patellar bone scintigraphy is more valuable than radiography for evaluating adult orthopedic patients with knee pain

  20. 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.

  1. Does patellar rim electrocautery have deleterious effects on patellar cartilage?

    Science.gov (United States)

    Namazi, Niloofar; Jaberi, Fereidoon Mojtahed; Pakbaz, Sara; Vosoughi, Amir Reza; Jaberi, Mahrad Mojtahed

    2014-03-01

    Circumpatellar electrocauterization to destroy pain receptors during total knee arthroplasty without patellar resurfacing is commonly used to decrease postoperative knee pain. We aimed to evaluate the effect of denervation with electrocauterization on patellar cartilage. Twenty rabbits were randomly assigned to two equally sized case and control groups. The rabbits in the case group underwent surgery via the anterior midline skin incision and medial parapatellar arthrotomy, followed by denervation electrocauterization at a depth of 1 mm and a distance of 3 mm from the outer border of the patella. In the control group, surgery was identical to that performed in the case group, but without patellar denervation. Twelve weeks after surgery, all rabbits were sacrificed. Range of motion, macroscopic evaluation of cartilage using modified Outerbridge scoring, and histopathological assessment using a modified histologic scoring system for cartilage were evaluated. Three rabbits died during the study. Nine cases and eight animals from the control group were included in the final evaluation. All rabbits had passive full range of motion. Mean Outerbridge score was 2.0 in the case group and 0.37 in the control group (p=0.002). There were statistically significant differences in cellularity (p=0.016), loss of matrix (p=0.004), and clustering of chondrocytes (p=0.008) between the two groups. Microscopic variables as a whole were statistically significant (p=0.001). Circumpatellar electrocauterization may result in cartilage destruction. So, we encourage caution in using routine electrocauterization in patients undergoing total knee arthroplasty. level II. Copyright © 2014 Elsevier B.V. All rights reserved.

  2. Spontaneous Activity Associated with Delusions of Schizophrenia in the Left Medial Superior Frontal Gyrus: A Resting-State fMRI Study.

    Directory of Open Access Journals (Sweden)

    Bin Gao

    Full Text Available Delusions of schizophrenia have been found to be associated with alterations of some brain regions in structure and task-induced activation. However, the relationship between spontaneously occurring symptoms and spontaneous brain activity remains unclear. In the current study, 14 schizophrenic patients with delusions and 14 healthy controls underwent a resting-state functional magnetic resonance imaging (RS-fMRI scan. Patients with delusions of schizophrenia patients were rated with Positive and Negative Syndrome Scale (PANSS and Characteristics of Delusional Rating Scale (CDRS. Regional homogeneity (ReHo was calculated to measure the local synchronization of the spontaneous activity in a voxel-wise way. A two-sample t-test showed that ReHo of the right anterior cingulate gyrus and left medial superior frontal gyrus were higher in patients, and ReHo of the left superior occipital gyrus was lower, compared to healthy controls. Further, among patients, correlation analysis showed a significant difference between delusion scores of CRDS and ReHo of brain regions. ReHo of the left medial superior frontal gyrus was negatively correlated with patients' CDRS scores but not with delusional PANSS scores. These results suggested that altered local synchronization of spontaneous brain activity may be related to the pathophysiology of delusion in schizophrenia.

  3. Spontaneous Activity Associated with Delusions of Schizophrenia in the Left Medial Superior Frontal Gyrus: A Resting-State fMRI Study.

    Science.gov (United States)

    Gao, Bin; Wang, Yiquan; Liu, Weibo; Chen, Zhiyu; Zhou, Heshan; Yang, Jinyu; Cohen, Zachary; Zhu, Yihong; Zang, Yufeng

    2015-01-01

    Delusions of schizophrenia have been found to be associated with alterations of some brain regions in structure and task-induced activation. However, the relationship between spontaneously occurring symptoms and spontaneous brain activity remains unclear. In the current study, 14 schizophrenic patients with delusions and 14 healthy controls underwent a resting-state functional magnetic resonance imaging (RS-fMRI) scan. Patients with delusions of schizophrenia patients were rated with Positive and Negative Syndrome Scale (PANSS) and Characteristics of Delusional Rating Scale (CDRS). Regional homogeneity (ReHo) was calculated to measure the local synchronization of the spontaneous activity in a voxel-wise way. A two-sample t-test showed that ReHo of the right anterior cingulate gyrus and left medial superior frontal gyrus were higher in patients, and ReHo of the left superior occipital gyrus was lower, compared to healthy controls. Further, among patients, correlation analysis showed a significant difference between delusion scores of CRDS and ReHo of brain regions. ReHo of the left medial superior frontal gyrus was negatively correlated with patients' CDRS scores but not with delusional PANSS scores. These results suggested that altered local synchronization of spontaneous brain activity may be related to the pathophysiology of delusion in schizophrenia.

  4. Patellar subluxation syndrome

    International Nuclear Information System (INIS)

    Yagi, Tomonori; Sasaki, Tetsuto; Susuda, Koichi; Moji, Junichi

    1983-01-01

    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. (Ueda, J.)

  5. Proximal patellar tendinosis and abnormalities of patellar tracking

    International Nuclear Information System (INIS)

    Allen, G.M.; Tauro, P.G.; Ostlere, S.J.

    1999-01-01

    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.)

  6. The medial patellofemoral complex.

    Science.gov (United States)

    Loeb, Alexander E; Tanaka, Miho J

    2018-06-01

    The purpose of this review is to describe the current understanding of the medial patellofemoral complex, including recent anatomic advances, evaluation of indications for reconstruction with concomitant pathology, and surgical reconstruction techniques. Recent advances in our understanding of MPFC anatomy have found that there are fibers that insert onto the deep quadriceps tendon as well as the patella, thus earning the name "medial patellofemoral complex" to allow for the variability in its anatomy. In MPFC reconstruction, anatomic origin and insertion points and appropriate graft length are critical to prevent overconstraint of the patellofemoral joint. The MPFC is a crucial soft tissue checkrein to lateral patellar translation, and its repair or reconstruction results in good restoration of patellofemoral stability. As our understanding of MPFC anatomy evolves, further studies are needed to apply its relevance in kinematics and surgical applications to its role in maintaining patellar stability.

  7. MRI of traumatic patellar dislocation in children

    Energy Technology Data Exchange (ETDEWEB)

    Zaidi, A.; Cole, W. [Hospital for Sick Children, Toronto (Canada). Diagnostic Imaging; Babyn, P. [Mater Children' s, Brisbane (Australia). Paediatric Orthopaedic Surgery; Astori, I. [Univ. of Toronto (Canada). Diagnostic Imaging; White, L. [Hospital for Sick Children, Toronto (Canada). Orthopaedic Surgery; Doria, A.

    2006-11-15

    Traumatic patellar dislocations (TPD) are common injuries in children, and MRI is useful in evaluation of pediatric musculoskeletal injuries. However, no pediatric studies on the MR features of TPD have been reported. To review the injuries after TPD in children. Patients with clinical or radiological recognition of TPD and those with suggestive MR findings were selected. Bone, cartilage and soft-tissue injuries and patellofemoral relationships were assessed. Results A total of 26 patients (age range 10-18 years) were identified. The following injuries were seen: bone bruising of the inferomedial patella (81% of patients) and the lateral femoral condyle (81% of patients), cartilage injuries of the inferomedial patella (38% of patients) and the lateral femoral condyle (38% of patients), osteochondral fragments (42% of patients) and injuries of the medial patellar restraints (81% of patients). Pediatric manifestations of TPD seen on MRI are similar to those in adults. TPD is often occult in children. Early recognition of bone bruising of the patella and lateral femoral condyle, associated osteochondral injuries, and medial patellar stabilizer injury is important for timely diagnosis.

  8. MRI of traumatic patellar dislocation in children

    International Nuclear Information System (INIS)

    Zaidi, A.; Cole, W.; Babyn, P.; Astori, I.; White, L.; Doria, A.

    2006-01-01

    Traumatic patellar dislocations (TPD) are common injuries in children, and MRI is useful in evaluation of pediatric musculoskeletal injuries. However, no pediatric studies on the MR features of TPD have been reported. To review the injuries after TPD in children. Patients with clinical or radiological recognition of TPD and those with suggestive MR findings were selected. Bone, cartilage and soft-tissue injuries and patellofemoral relationships were assessed. Results A total of 26 patients (age range 10-18 years) were identified. The following injuries were seen: bone bruising of the inferomedial patella (81% of patients) and the lateral femoral condyle (81% of patients), cartilage injuries of the inferomedial patella (38% of patients) and the lateral femoral condyle (38% of patients), osteochondral fragments (42% of patients) and injuries of the medial patellar restraints (81% of patients). Pediatric manifestations of TPD seen on MRI are similar to those in adults. TPD is often occult in children. Early recognition of bone bruising of the patella and lateral femoral condyle, associated osteochondral injuries, and medial patellar stabilizer injury is important for timely diagnosis

  9. T2 mapping in patellar chondromalacia

    International Nuclear Information System (INIS)

    Ruiz Santiago, Fernando; Pozuelo Calvo, Rocío; Almansa López, Julio; Guzmán Álvarez, Luis; Castellano García, María del Mar

    2014-01-01

    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

  10. 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

  11. T2 mapping in patellar chondromalacia.

    Science.gov (United States)

    Ruiz Santiago, Fernando; Pozuelo Calvo, Rocío; Almansa López, Julio; Guzmán Álvarez, Luis; Castellano García, María Del Mar

    2014-06-01

    To study the correlation between the T2 relaxation times of the patellar cartilage and morphological MRI findings of chondromalacia. 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 1.5T 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). T2 values showed a significant increase in mild chondromalacia regarding normal cartilage in most of the cartilage areas (pchondromalacia 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 (pchondromalacia 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 central area of the middle section, where T2 values remain increased. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  12. Kinematic MR imaging of the knee for evaluating patellar tracking

    International Nuclear Information System (INIS)

    Shellock, F.G.; Mink, J.H.; Fox, J.

    1988-01-01

    A new technique to evaluate patellar tracking uses MR imaging and a specially designed positioning device (MEDRAD). T1-weighted, axial plane imaging was performed on both knees at the following joint angles: 0 0 , 5 0 , 10 0 , 15 0 , 20 0 , 25 0 , and 30 0 . The total examination time was approximately 12 minutes. Images were viewed in a cine loop to produce a kinematic study that depicted the relationship of the patella to the trochlear groove during the different angles of knee flexion. To date, 102 subjects (204 knees) have been examined. Dislocation, subluxatino, lateral tilt, lateral and medial displacement of the patella, and normal patellar tracking could all be identified with this technique. Abnormal configurations of the patella and/or trochlear groove were also clearly demonstrated. In conclusion, kinematic MR imaging of the knee provided important clinical information concerning patellar tracking and other related abnormalities of the patellofemoral joint

  13. Simultaneous bilateral patellar tendon rupture ?

    OpenAIRE

    Moura, Diogo Lino; Marques, Jos? Pedro; Lucas, Francisco Manuel; Fonseca, Fernando Pereira

    2016-01-01

    Bilateral patellar tendon rupture is a rare entity, often associated with systemic diseases and patellar tendinopathy. The authors report a rare case of a 34-year-old man with simultaneous bilateral rupture of the patellar tendon caused by minor trauma. The patient is a retired basketball player with no past complaints of chronic knee pain and a history of steroid use. Surgical management consisted in primary end-to-end tendon repair protected temporarily with cerclage wiring, followed by a s...

  14. 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.

  15. 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.

  16. 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, Ppatellofemoral joint (patella and trochlea) were significantly worse than those pre-ACLR. Neither lateral nor medial patellar mobility, 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.

  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. Concurrent patellar fracture and lateral collateral ligament avulsion as a result of trauma in three horses.

    Science.gov (United States)

    McLellan, Jonathan; Plevin, Sarah; Taylor, Elizabeth

    2012-05-15

    3 horses were evaluated because of lameness and swelling of the stifle joint subsequent to trauma. All horses had characteristic clinical signs of stifle joint pain and effusion. A medial patellar fracture and lateral collateral ligament avulsion fracture were visible ultrasonographically in each. Radiography, including standard as well as flexed lateromedial, cranioproximal-craniodistal oblique (skyline patellar), and laterally stressed caudocranial views, revealed similar findings. Arthroscopic surgery to remove the patellar fracture was attempted in 1 horse with severe desmitis of the lateral collateral ligament; it remained lame afterward. The other 2 horses, with less severe collateral ligament damage, were managed conservatively and returned to athletic use, despite the lack of surgical intervention to repair the patellar fractures. Special radiographic views were necessary for diagnosis of medial patellar fracture and lateral collateral ligament avulsion fracture in the 3 horses. Ultrasonographic findings pertaining to the collateral ligament may be prognostically important in such situations. The severity of a fracture involving ligament avulsion may be the limiting factor in horses with this combined injury, and this factor should be considered prior to attempting surgical correction of patellar fractures.

  19. Failed medial patellofemoral ligament reconstruction: Causes and surgical strategies

    OpenAIRE

    Sanchis-Alfonso, Vicente; Montesinos-Berry, Erik; Ramirez-Fuentes, Cristina; Leal Blanquet, Joan; Gelber, Pablo-Eduardo; Monllau García, Juan Carlos

    2017-01-01

    Patellar instability is a common clinical problem encountered by orthopedic surgeons specializing in the knee. For patients with chronic lateral patellar instability, the standard surgical approach is to stabilize the patella through a medial patellofemoral ligament (MPFL) reconstruction. Foreseeably, an increasing number of revision surgeries of the reconstructed MPFL will be seen in upcoming years. In this paper, the causes of failed MPFL reconstruction are analyzed: (1) incorrect surgical ...

  20. Adolescent patellar instability: current concepts review.

    Science.gov (United States)

    Clark, D; Metcalfe, A; Wogan, C; Mandalia, V; Eldridge, J

    2017-02-01

    Patellar instability most frequently presents during adolescence. Congenital and infantile dislocation of the patella is a distinct entity from adolescent instability and measurable abnormalities may be present at birth. In the normal patellofemoral joint an increase in quadriceps angle and patellar height are matched by an increase in trochlear depth as the joint matures. Adolescent instability may herald a lifelong condition leading to chronic disability and arthritis. Restoring normal anatomy by trochleoplasty, tibial tubercle transfer or medial patellofemoral ligament (MPFL) reconstruction in the young adult prevents further instability. Although these techniques are proven in the young adult, they may cause growth arrest and deformity where the physis is open. A vigorous non-operative strategy may permit delay of surgery until growth is complete. Where non-operative treatment has failed a modified MPFL reconstruction may be performed to maintain stability until physeal closure permits anatomical reconstruction. If significant growth remains an extraosseous reconstruction of the MPFL may impart the lowest risk to the physis. If minor growth remains image intensifier guided placement of femoral intraosseous fixation may impart a small, but acceptable, risk to the physis. This paper presents and discusses the literature relating to adolescent instability and provides a framework for management of these patients. Cite this article: Bone Joint J 2017;99-B:159-70. ©2017 The British Editorial Society of Bone & Joint Surgery.

  1. High-resolution MRI using a microscopy coil for the diagnosis of recurrent lateral patellar dislocation

    International Nuclear Information System (INIS)

    Iwata, Yuki; Fujii, Masahiko; Muratsu, Hirotsugu; Kurosaka, Masahiro; Kawamitsu, Hideaki; Sugimura, Kazuro; Shibanuma, Hitoshi

    2006-01-01

    Magnetic resonance imaging (MRI) has been commonly used for the preoperative evaluation of recurrent lateral patellar dislocation (RLPD). The purpose of this study was to determine the usefulness of high-resolution MRI (HR-MRI) with a microscopy coil for diagnosing RLPD. The study group consisted of 15 patients with clinically diagnosed RLPD and 10 normal volunteers. All studies were performed on a 1.5-T MR system. First, conventional MRIs of the whole knee joint were obtained using the knee coil. Then HR-MRI scans using a microscopy coil in the medial aspect of the patella were obtained at the level of the superior pole of the patella, targeting the medial patellofemoral ligament (MPFL). The acquired HR-MRIs with RLPD were reviewed concerning the MPFL injury and the patellar injury. The MPFL was distinguished as a separate ligament, and the layer structure of the patellar cartilage was visualized clearly in all volunteers. The MPFL injury was visualized in 12 cases (87%); it included discontinuity, thickening, and loosening. The patellar injury was visualized in 11 cases (73%), which included dissecans of the medial margin and cartilage injuries. HR-MRI with a microscopy coil provides precise information of the MPFL and patellar cartilage injury for the diagnosis of RLPD. (author)

  2. Simultaneous bilateral patellar tendon rupture.

    Science.gov (United States)

    Moura, Diogo Lino; Marques, José Pedro; Lucas, Francisco Manuel; Fonseca, Fernando Pereira

    2017-01-01

    Bilateral patellar tendon rupture is a rare entity, often associated with systemic diseases and patellar tendinopathy. The authors report a rare case of a 34-year-old man with simultaneous bilateral rupture of the patellar tendon caused by minor trauma. The patient is a retired basketball player with no past complaints of chronic knee pain and a history of steroid use. Surgical management consisted in primary end-to-end tendon repair protected temporarily with cerclage wiring, followed by a short immobilization period and intensive rehabilitation program. Five months after surgery, the patient was able to fully participate in sport activities.

  3. Simultaneous bilateral patellar tendon rupture

    Directory of Open Access Journals (Sweden)

    Diogo Lino Moura

    Full Text Available ABSTRACT Bilateral patellar tendon rupture is a rare entity, often associated with systemic diseases and patellar tendinopathy. The authors report a rare case of a 34-year-old man with simultaneous bilateral rupture of the patellar tendon caused by minor trauma. The patient is a retired basketball player with no past complaints of chronic knee pain and a history of steroid use. Surgical management consisted in primary end-to-end tendon repair protected temporarily with cerclage wiring, followed by a short immobilization period and intensive rehabilitation program. Five months after surgery, the patient was able to fully participate in sport activities.

  4. Neglected locked vertical patellar dislocation

    Science.gov (United States)

    Gupta, Rakesh Kumar; Gupta, Vinay; Sangwan, Sukhbir Singh; Kamboj, Pradeep

    2012-01-01

    Patellar dislocations occurring about the vertical and horizontal axis are rare and irreducible. The neglected patellar dislocation is still rarer. We describe the clinical presentation and management of a case of neglected vertical patellar dislocation in a 6 year-old boy who sustained an external rotational strain with a laterally directed force to his knee. Initially the diagnosis was missed and 2 months later open reduction was done. The increased tension generated by the rotation of the lateral extensor retinaculum kept the patella locked in the lateral gutter even with the knee in full extension. Traumatic patellar dislocation with rotation around a vertical axis has been described earlier, but no such neglected case has been reported to the best of our knowledge. PMID:23162154

  5. Neglected locked vertical patellar dislocation

    Directory of Open Access Journals (Sweden)

    Rakesh Kumar Gupta

    2012-01-01

    Full Text Available Patellar dislocations occurring about the vertical and horizontal axis are rare and irreducible. The neglected patellar dislocation is still rarer. We describe the clinical presentation and management of a case of neglected vertical patellar dislocation in a 6 year-old boy who sustained an external rotational strain with a laterally directed force to his knee. Initially the diagnosis was missed and 2 months later open reduction was done. The increased tension generated by the rotation of the lateral extensor retinaculum kept the patella locked in the lateral gutter even with the knee in full extension. Traumatic patellar dislocation with rotation around a vertical axis has been described earlier, but no such neglected case has been reported to the best of our knowledge.

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

    Directory of Open Access Journals (Sweden)

    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.

  7. In Vivo Patellar Tracking and Patellofemoral Cartilage Contacts during Dynamic Stair Ascending

    Science.gov (United States)

    Suzuki, Takashi; Hosseini, Ali; Li, Jing-Sheng; Gill, Thomas J; Li, Guoan

    2012-01-01

    The knowledge of normal patellar tracking is essential for understanding of the knee joint function and for diagnosis of patellar instabilities. This paper investigated the patellar tracking and patellofemoral joint contact locations during a stair ascending activity using a validated dual-fluoroscopic imaging system. The results showed that the patellar flexion angle decreased from 41.9° to 7.5° with the knee extension during stair ascending. During first 80% of the activity, the patella shifted medially about 3.9 mm and then slightly shifted laterally during the last 20% of the ascending activity. Anterior translation of 13 mm of the patella was measured at the early 80% of the activity and then slightly moved posteriorly by about 2 mm at the last 20% of the activity. The path of the cartilage contact points was slightly lateral on the cartilage surfaces of patella and femur. On the patellar cartilage surface, the cartilage contact locations were about 2 mm laterally from heel strike to 60% of the stair ascending activity and moved laterally and reached 5.3 mm at full extension. However, the cartilage contact locations were relatively constant on the femoral cartilage surface (~5 mm lateral). The patellar tracking pattern was consistent with the patellofemoral cartilage contact location pattern. These data could provide baseline knowledge for understanding of normal physiology of the patellofemoral joint and can be used as a reference for clinical evaluation of patellofemoral disorder symptoms. PMID:22840488

  8. 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 ...

  9. Keblish's lateral surgical approach enhances patellar tilt in valgus knee arthroplasty

    Directory of Open Access Journals (Sweden)

    José Roberto Tonelli Filho

    Full Text Available ABSTRACT OBJECTIVE: To compare the clinical and radiological outcomes of conventional medial and lateral approaches for total knee replacement in the valgus osteoarthritic knee. METHODS: In this randomized controlled trial, 21 patients with valgus knee osteoarthritis were randomized to total knee replacement through medial or lateral approach. The primary outcome was radiographic patellar tilt. Secondary outcomes were visual analog scale of pain, postoperative levels of hemoglobin, and clinical aspect of the operative wound. RESULTS: There were no differences between the groups regarding other clinical variables. Mean lateral tilt of the patella was 3.1 degrees (SD ± 5.3 in the lateral approach group and 18 degrees (SD ± 10.2 in the medial approach group (p = 0.02. There were no differences regarding the secondary outcomes. CONCLUSION: Lateral approach provided better patellar tilt following total knee replacement in valgus osteoarthritic knee.

  10. 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.

  11. Lateral patellar retinacular release: changes over the last ten years

    Directory of Open Access Journals (Sweden)

    Leonardo Pini Rosalem Marciano da Fonseca

    Full Text Available ABSTRACT Lateral retinacular release is a useful resource in knee surgery that can be used for disorders of the extensor mechanism. For many years, it was indiscriminately used in the treatment of the various patellofemoral joint alterations, with conflicting functional results. This study aimed to analyze the changes that have occurred in the indications and clinical effectiveness of lateral retinacular release by reviewing the relevant literature of the past ten years, comparing it to the classic literature on the subject. It was found that less extensive releases decompress the lateral patellar facet, helping with pain control, while decreasing the risks of medial subluxation. Nowadays, there is clear evidence for its indication in the lateral patellar hypercompression syndrome associated with anterior knee pain, as long as there is no related instability; furthermore, it will normally play an adjuvant role in extensor mechanism alignment surgeries for cases of recurrent patellar instability. The initial results for symptomatic patellofemoral osteoarthritis are promising when lateral release is combined with cartilage debridement; in total knee replacement, it is more commonly used for the correction of valgus deformity in order to improve the components’ congruency. Finally, distinguishing the different patellofemoral joint pathologies is seen as crucial in order to indicate this procedure. Further randomized control trials that compare surgical techniques with long-term results are still needed.

  12. 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

  13. 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 ( r 2 = 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.

  14. Arginine vasopressin antagonizes the effects of prostaglandin E2 on the spontaneous activity of warm-sensitive and temperature-insensitive neurons in the medial preoptic area in rats.

    Science.gov (United States)

    Xu, Jian-Hui; Hou, Xiao-Yu; Tang, Yu; Luo, Rong; Zhang, Jie; Liu, Chang; Yang, Yong-Lu

    2018-01-01

    Arginine vasopressin (AVP) plays an important role in thermoregulation and antipyresis. We have demonstrated that AVP could change the spontaneous activity of thermosensitive and temperature insensitive neurons in the preoptic area. However, whether AVP influences the effects of prostaglandin E 2 (PGE 2 ) on the spontaneous activity of neurons in the medial preoptic area (MPO) remains unclear. Our experiment showed that PGE 2 decreased the spontaneous activity of warm-sensitive neurons, and increased that of low-slope temperature-insensitive neurons in the MPO. AVP attenuated the inhibitory effect of PGE 2 on warm-sensitive neurons, and reversed the excitatory effect of PGE 2 on low-slope temperature-insensitive neurons, demonstrating that AVP antagonized the effects of PGE 2 on the spontaneous activity of these neurons. The effect of AVP was suppressed by an AVP V 1a receptor antagonist, suggesting that V 1a receptor mediated the action of AVP. We also demonstrated that AVP attenuated the PGE 2 -induced decrease in the prepotential's rate of rise in warm-sensitive neurons and the PGE 2 -induced increase in that in low-slope temperature-insensitive neurons through the V 1a receptor. Together, these data indicated that AVP antagonized the PGE 2 -induced change in the spontaneous activity of warm-sensitive and low-slope temperature-insensitive neurons in the MPO partly by reducing the PGE 2 -induced change in the prepotential of these neurons in a V 1a receptor-dependent manner. Copyright © 2017 Elsevier B.V. All rights reserved.

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

    NARCIS (Netherlands)

    de Vries, 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

  16. 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

  17. Corrective surgery for canine patellar luxation in 75 cases (107 limbs): landmark for block recession

    OpenAIRE

    Mitsuhiro Isaka; Masahiko Befu; Nami Matsubara; Mayuko Ishikawa; Yurie Arase; Toshiyuki Tsuyama; Akiko Doi; Shinichi Namba

    2014-01-01

    Canine medial patellar luxation (MPL) is a very common orthopedic disease in small animals. Because the pathophysiology of this disease involves various pathways, the surgical techniques and results vary according to the veterinarian. Further, the landmark for block recession is not completely clear. We retrospectively evaluated 75 dogs (107 limbs) with MPL in whom our landmark for block recession was used from July 2008 to May 2013. Information regarding the breed, age, sex, body weight, bod...

  18. Superolateral Hoffa's fat pad (SHFP) oedema and patellar cartilage volume loss: quantitative analysis using longitudinal data from the Foundation for the National Institute of Health (FNIH) Osteoarthritis Biomarkers Consortium.

    Science.gov (United States)

    Haj-Mirzaian, Arya; Guermazi, Ali; Hafezi-Nejad, Nima; Sereni, Christopher; Hakky, Michael; Hunter, David J; Zikria, Bashir; Roemer, Frank W; Demehri, Shadpour

    2018-04-12

    To determine the association of superolateral Hoffa's fat pad (SHFP) oedema and patellofemoral joint structural damage in participants of Foundation for the National Institute of Health Osteoarthritis Biomarkers Consortium study. Baseline and 24-month MRIs of 600 subjects were assessed. The presence of SHFP oedema (using 0-3 grading scale) and patellar morphology metrics were determined using baseline MRI. Quantitative patellar cartilage volume and semi-quantitative MRI osteoarthritis knee score (MOAKS) variables were extracted. The associations between SHFP oedema and patellar cartilage damage, bone marrow lesion (BML), osteophyte and morphology were evaluated in cross-sectional model. In longitudinal analysis, the associations between oedema and cartilage volume loss (defined using reliable change index) and MOAKS worsening were evaluated. In cross-sectional evaluations, the presence of SHFP oedema was associated with simultaneous lateral patellar cartilage/BML defects and inferior-medial patellar osteophyte size. A significant positive correlation between the degree of patella alta and SHFP oedema was detected (r = 0.259, p < 0.001). The presence of oedema was associated with 24-month cartilage volume loss (odds ratio (OR) 2.11, 95% confidence interval 1.46-3.06) and medial patellar BML size (OR 1.92 (1.15-3.21)) and number (OR 2.50 (1.29-4.88)) worsening. The optimal cut-off value for the grade of baseline SHFP oedema regarding both presence and worsening of patellar structural damage was ≥ 1 (presence of any SHFP hyperintensity). The presence of SHFP oedema could be considered as a predictor of future patellar cartilage loss and BML worsening, and an indicator of simultaneous cartilage, BML and osteophyte defects. • SHFP oedema was associated with simultaneous lateral patellar OA-related structural damage. • SHFP oedema was associated with longitudinal patellar cartilage loss over 24 months. • SHFP oedema could be considered as indicator and predictor

  19. 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

  20. 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.

  1. [Treatment options for patellar tendinopathy].

    Science.gov (United States)

    Duthon, V B; Borloz, S; Ziltener, J-L

    2012-07-25

    Patellar tendinopathy is also called jumper's knee because of its high incidence in athletes with jumping or cutting activities as soccer, basketball, volleyball. Many different treatment methods have been described. However, no consensus exists regarding the optimal treatment for this condition. According to the literature, eccentric exercise-based physical therapy should be proposed first because of its strong scientific evidence. Shockwave therapy and injections may be useful but their real efficacy still has to be proven by randomized controlled study. For patients recalcitrant to more conservative options, operative management may be indicated.

  2. Patellar tendinopathy: physical therapy and injection treatments

    OpenAIRE

    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 participation. The development of jumper’s knee and the best treatment for it are still unclear. The general aim of this thesis was to investigate the development and management of patellar tendinop...

  3. 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.)

  4. Bone bruise in acute traumatic patellar dislocation: volumetric magnetic resonance imaging analysis with follow-up mean of 12 months

    International Nuclear Information System (INIS)

    Paakkala, Antti; Paakkala, Timo; Sillanpaeae, Petri; Maeenpaeae, Heikki; Huhtala, Heini

    2010-01-01

    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 3 and of the patellar bruise 2,832 mm 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 3 and 1,380 mm 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.)

  5. Medial patellofemoral ligament reconstruction: patient selection and perspectives

    Directory of Open Access Journals (Sweden)

    Baer MR

    2017-09-01

    Full Text Available Michael R. Baer, Jeffrey A. Macalena Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA Abstract: Patellofemoral instability is a painful and often recurring disorder with many negative long-term consequences. After a period of failed nonoperative management, surgical intervention has been used to reduce the incidence of patellar subluxation and dislocations. Medial patellofemoral ligament (MPFL reconstruction successfully addresses patellofemoral instability by restoring the deficient primary medial patellar soft tissue restraint. When planning MPFL reconstruction for instability, it is imperative to consider the patient’s unique anatomy including the tibial tuberosity–trochlear groove (TT–TG distance, trochlear dysplasia, and patella alta. Additionally, it is important to individualize surgical treatment in the skeletally immature, hypermobile, and athletic populations. Keywords: MPFL, indications, considerations, contraindications

  6. Imaging patellar complications after knee arthroplasty

    International Nuclear Information System (INIS)

    Melloni, Pietro; Valls, Rafael; Veintemillas, Maite

    2008-01-01

    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

  7. 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.

  8. Axial loaded stress views and kinematic MR imaging evaluation of patellar alignment and tracking

    International Nuclear Information System (INIS)

    Shellock, F.G.; Mink, J.H.; Deutsch, A.; Meeks, T.; Fox, J.; Molnar, T.

    1990-01-01

    This paper evaluates patellar alignment and tracking in patients with suspected abnormalities by obtaining axial loaded stress views to assess dynamic stabilizers and kinematic MR images to assess static stabilizers of the patellofemoral joint. Ninety-eight symptomatic joints were studied; 21 joints had prior realignment surgery. Axial loaded stress views were achieved with a device that simulated weight bearing. Images were obtained with knees flexed at 20 degrees ± 5 degrees while the patient resisted with an isometric contraction. Kinematic MR imaging was performed according to previously described methods. Kinematic MR imaging showed normal findings in six joints, lateral subluxation in 22, medial subluxation in 58, lateral tilt in two, and lateral to medial subluxation in 10. Axial stress views showed normal findings in 30, lateral subluxation in 18, and medial subluxation in 50. Both tests agreed on abnormalities for 63% of the joints, while kinematic MR imaging showed abnormalities for an additional 32%

  9. Reliability of McConnell's classification of patellar orientation in symptomatic and asymptomatic subjects.

    Science.gov (United States)

    Watson, C J; Propps, M; Galt, W; Redding, A; Dobbs, D

    1999-07-01

    Test-retest reliability study with blinded testers. To determine the intratester reliability of the McConnell classification system and to determine whether the intertester reliability of this system would be improved by one-on-one training of the testers, increasing the variability and numbers of subjects, blinding the testers to the absence or presence of patellofemoral pain syndrome, and adhering to the McConnell classification system as it is taught in the "McConnell Patellofemoral Treatment Plan" continuing education course. The McConnell classification system is currently used by physical therapy clinicians to quantify static patellar orientation. The measurements generated from this system purportedly guide the therapist in the application of patellofemoral tape and in assessment of the efficacy of treatment interventions on changing patellar orientation. Fifty-six subjects (age range, 21-65 years) provided a total of 101 knees for assessment. Seventy-six knees did not produce symptoms. A researcher who did not participate in the measuring process determined that 17 subjects had patellofemoral pain syndrome in 25 knees. Two testers concurrently measured static patellar orientation (anterior/posterior and medial/lateral tilt, medial/lateral glide, and patellar rotation) on subjects, using the McConnell classification system. Repeat measures were performed 3-7 days later. A kappa (kappa) statistic was used to assess the degree of agreement within each tester and between testers. The kappa coefficients for intratester reliability varied from -0.06 to 0.35. Intertester reliability ranged from -0.03 to 0.19. The McConnell classification system, in its current form, does not appear to be very reliable. Intratester reliability ranged from poor to fair, and intertester reliability was poor to slight. This system should not be used as a measurement tool or as a basis for treatment decisions.

  10. Medial patellofemoral ligament: Research progress in anatomy and injury imaging

    International Nuclear Information System (INIS)

    Zheng Lei; Zhao Bin

    2013-01-01

    The medial patellofemoral ligament (MPFL) is considered as the most important soft tissue restraint providing medial stability of the patellofemoral joint. During patellar dislocation, the MPFL is subjected to severe stretching forces, resulting in injuries of the ligament in the most patients. With the development of medical imaging technology, a variety of non-invasive diagnostic imaging methods have been becoming important means in diagnosis of MPFL injury. In this paper, MPFL anatomy, the applications of medical imaging technology in diagnosis of MPFL injury and the distributions of MPFL injury site were reviewed. (authors)

  11. Radiographic Features of Acute Patellar Tendon Rupture.

    Science.gov (United States)

    Fazal, Muhammad Ali; Moonot, Pradeep; Haddad, Fares

    2015-11-01

    The purpose of our study was to assess soft tissue features of acute patellar tendon rupture on lateral knee radiograph that would facilitate early diagnosis. The participants were divided into two groups of 35 patients each. There were 28 men and seven women with a mean age of 46 years in the control group and 26 men and nine women with a mean age of 47 years in the rupture group. The lateral knee radiograph of each patient was evaluated for Insall-Salvati ratio for patella alta, increased density of the infrapatellar fat pad, appearance of the soft tissue margin of the patellar tendon and bony avulsions. In the rupture group there were three consistent soft tissue radiographic features in addition to patellar alta. These were increased density of infrapatellar fat pad; loss of sharp, well-defined linear margins of the patellar tendon and angulated wavy margin of the patellar tendon while in the control group these features were not observed. The soft tissue radiographic features described in the rupture group are consistent and reliable. When coupled with careful clinical assessment, these will aid in early diagnosis and further imaging will be seldom required. © 2015 Chinese Orthopaedic Association and Wiley Publishing Asia Pty Ltd.

  12. Comparison of patellar distraction with patellar glides in female patients with patellofemoral pain syndrom

    International Nuclear Information System (INIS)

    Syed, S.; Chaudhary, M.A.; Noor, R.; Bashir, M.S.; Manzoor, B.

    2017-01-01

    To analyse effectiveness of patellar glides and patellar distraction in the patients with patellofemoral pain syndrome (PFPS). Methodology: This longitudinal interventional comparative study was conducted at Physiotherapy Department, Mayo Hospital Lahore, Pakistan from September 2015 to March 2016. A total of 70 patients were divided into 2 groups randomly; group A received hot pack, quadriceps strengthening exercises and patellar distraction whereas group B received hot pack, quadriceps strengthening exercises and patellar glides. Age of the female patients was 18-40 years. Visual Analogue Scale (VAS) and Knee Injury and osteoarthritis outcome score (KOOS) questionnaire were used to compare the effectiveness of both treatments. The data were analysed using SPSS v. 21.0. Results: There was reduction in pain at VAS and KOOS showed improvement in function as well as the range of motion also increased in both groups. Both treatment techniques were effective in reducing pain in PFPS (P <0.005). Pre-treatment KOOS score in patellar glides group was 34.77+10.84 and post-treatment KOOS score was 62.155+15.75 and for patellar distraction group pre-treatment KOOS score was 35.42+10.07 that increased to 55.77+14.66 after treatment which showed that patellar glides had better effect on PFPS. Conclusion: Both treatments were effective in managing PFPS in terms of decreasing pain and increasing ROM as there was no significant difference between two techniques, however patellar glides were superior as compared to patellar distraction in decreasing pain and increasing ROM. (author)

  13. CT patellar cortex tilt angle: A radiological method to measure patellar tilt

    International Nuclear Information System (INIS)

    Mirza Toluei, F.; Afshar, A.; Salarilak, S.; Sina, A.

    2005-01-01

    Background/Objectives: the role of patellar tilt in the anterior knee pain is indisputable. Traditionally. the lateral patello-femoral angle of Laurin has been defined in both the axial view and CT images for measuring the tilt of patella. We present a new angle. which is independent of the morphology of patella and directly relates to clinical assessment of the tilt. which is appreciated from palpation of the edges of the patella. Patients and Methods: 38 patients with anterior knee pain and forty normal control subjects were examined using CT scan of patello-femoral joint in 15 degrees of knee flexion. The amount of lateral patellar tilt was quantitatively assessed using the lateral patello-femoral angle, as described by Laurin et al, and the newly defined patellar cortex tilt angle. This angle is subtended by the line drawn along the posterior femoral condyles and the one parallel to the subchondral bone of patellar cortex. The fifteen-degree tilt was taken as normal cut-off point for patellar cortex tilt angle in the control group. Results: in patients, the average tilt of patella. using the patellar cortex tilt angle was 15.26 versus 7.05 in the control group. Using Student's t test, the difference between the two means was significant (P<0.001). The sensitivity and specificity of patellar cortex tilt angle were 40 and 90 percent, respectively There was a moderate agreement between our presented test and the lateral tilt angle test (kappa=0.40. P<0.001). Conclusion: our results indicate that patellar tilt can also be detected using patellar cortex tilt angle. We need more specific studies ta determine the validity of the test

  14. Axial linear patellar displacement: a new measurement of patellofemoral congruence.

    Science.gov (United States)

    Urch, Scott E; Tritle, Benjamin A; Shelbourne, K Donald; Gray, Tinker

    2009-05-01

    The tools for measuring the congruence angle with digital radiography software can be difficult to use; therefore, the authors sought to develop a new, easy, and reliable method for measuring patellofemoral congruence. The abstract goes here and covers two columns. The abstract goes The linear displacement measurement will correlate well with the congruence angle measurement. here and covers two columns. Cohort study (diagnosis); Level of evidence, 2. On Merchant view radiographs obtained digitally, the authors measured the congruence angle and a new linear displacement measurement on preoperative and postoperative radiographs of 31 patients who suffered unilateral patellar dislocations and 100 uninjured subjects. The linear displacement measurement was obtained by drawing a reference line across the medial and lateral trochlear facets. Perpendicular lines were drawn from the depth of the sulcus through the reference line and from the apex of the posterior tip of the patella through the reference line. The distance between the perpendicular lines was the linear displacement measurement. The measurements were obtained twice at different sittings. The observer was blinded as to the previous measurements to establish reliability. Measurements were compared to determine whether the linear displacement measurement correlated with congruence angle. Intraobserver reliability was above r(2) = .90 for all measurements. In patients with patellar dislocations, the mean congruence angle preoperatively was 33.5 degrees , compared with 12.1 mm for linear displacement (r(2) = .92). The mean congruence angle postoperatively was 11.2 degrees, compared with 4.0 mm for linear displacement (r(2) = .89). For normal subjects, the mean congruence angle was -3 degrees and the mean linear displacement was 0.2 mm. The linear displacement measurement was found to correlate with congruence angle measurements and may be an easy and useful tool for clinicians to evaluate patellofemoral

  15. 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.

  16. Lateral patellar luxation: magnetic resonance findings

    International Nuclear Information System (INIS)

    Armesto, V.; Pulpeiro, J.R.

    1995-01-01

    The objective of this article is to present the magnetic resonance (MR) findings associated with lateral patellar luxation. The series consisted of eight patients, all of whom presented joint effusion, damage to the medical retinaculum and cortical contusion or fracture of medical aspect of the patella or of anterolateral surface of the outer condyle. Five patients also presented patellar sub luxation. Diagnosis depends on the technique employed, with axial planes being very useful. Thus, it is recommended that they be used as the standard plane, especially in pathologies that are clinically unsuspicious as in this case. MR can also provide information that leads to surgical treatment rather than the standard conservative treatment. (Author)

  17. MRI after patellar dislocation. Assessment of risk factors and injury to the joint

    International Nuclear Information System (INIS)

    Diederichs, G.

    2013-01-01

    Patellar dislocation is the lateral displacement of the patella from the femoral trochlea. Affected individuals typically have underlying anatomic risk factors of variable magnitude, which, in conjunction with leg rotation, cause the event. Magnetic resonance imaging (MRI) permits straightforward diagnosis of the typical features of recent patellar dislocation: contusion edema of the inferomedial patella and the lateral femoral condyle as well as rupture of the medial patellofemoral ligament. In case of concomitant osteochondral injury, early surgical refixation may be indicated, depending on the size. After a first dislocation, which can damage the capsuloligamentous stabilizers, subjects may sustain further dislocations or even develop chronic patellofemoral instability, depending on the presence and severity of anatomic variants. A wide range of conservative and surgical treatments are available. While a first patellar dislocation is often treated conservatively, surgical strategies after a second dislocation depend on the pattern of injury and the severity of underlying anatomic risk factors. The most relevant predisposing variants are trochlear dysplasia, patella alta, and an abnormal tibial tubercle to trochlear groove distance (TT-TG). The radiologist's report should give a quantitative estimate of both the injuries resulting from dislocation and the underlying anatomic risk factors. An accurate characterization of the individual pathomechanism is crucial for tailoring treatment. (orig.)

  18. Anchor proximal migration in the medial patellofemoral ligament reconstruction in skeletally immature patients

    Directory of Open Access Journals (Sweden)

    Fabiano Kupczik

    2013-09-01

    Full Text Available The medial patellofemoral ligament (MPFL injury has been considered instrumental in lateral patellar instability after patellar dislocation. Consequently, the focus on the study of this ligament reconstruction has increased in recent years. The MPFL femoral anatomical origin point has great importance at the moment of reconstruction surgery, because a graft fixation in a non anatomical position may result in medial overload, medial subluxation of the patella or excessive tensioning of the graft with subsequent failure. In the pediatric population, the location of this point is highlighted by the presence of femoral physis. The literature is still controversial regarding the best placement of the graft. We describe two cases of skeletally immature patients in whom LPFM reconstruction was performed. The femoral fixation was through anchors that were placed above the physis. With the growth and development of the patients, the femoral origin point of the graft moved proximally, resulting in failure in these two cases.

  19. Medial release and lateral imbrication for intractable anterior knee pain: diagnostic process, technique, and results

    Directory of Open Access Journals (Sweden)

    Meldrum AR

    2015-01-01

    Full Text Available Alexander R Meldrum,1 Jeremy R Reed,2 Megan D Dash3 1Department of Surgery, Section of Orthopedic Surgery, University of Calgary, Calgary, AB, Canada; 2Department of Surgery, University of Saskatchewan College of Medicine, Regina, SK, Canada; 3Department of Family Medicine, College of Medicine, University of Saskatchewan, Regina, SK, Canada Purpose: To present two cases of intractable patellofemoral pain syndrome treated with a novel procedure, arthroscopic medial release, and lateral imbrication of the patellar retinaculum. Patients and methods: This case series presents the treatment of three knees in two patients (one bilateral in whom an all-inside arthroscopic medial release and lateral imbrication of the patellar retinaculum was performed. Subjective measurement of pain was the primary outcome measurement, and subjective patellofemoral instability was the secondary outcome measurement. Results: Subjectively the two patients had full resolution of their pain, without any patellofemoral instability. Conclusion: Medial release and lateral imbrication of the patellar retinaculum is a new surgical procedure that has been used in the treatment of intractable patellofemoral pain syndrome. This is the first report of its kind in the literature. While outcome measurements were less than ideal, the patients had positive outcomes, both functionally and in terms of pain. Keywords: anterior knee pain syndrome, chondromalacia patellae, runners knee, patellar chondropathy, patellofemoral dysfunction, patellofemoral tracking disorder

  20. Excessive lateral patellar translation on axial computed tomography indicates positive patellar J sign.

    Science.gov (United States)

    Xue, Zhe; Song, Guan-Yang; Liu, Xin; Zhang, Hui; Wu, Guan; Qian, Yi; Feng, Hua

    2018-03-20

    The purpose of the study was to quantify the patellar J sign using traditional computed tomography (CT) scans. Fifty-three patients (fifty-three knees) who suffered from recurrent patellar instability were included and analyzed. The patellar J sign was evaluated pre-operatively during active knee flexion and extension. It was defined as positive when there was obvious lateral patellar translation, and negative when there was not. The CT scans were performed in all patients with full knee extension; and the parameters including bisect offset index (BOI), patellar-trochlear-groove (PTG) distance, and patellar lateral tilt angle (PLTA) were measured on the axial slices. All the three parameters were compared between the J sign-positive group (study group) and the J sign-negative group (control group). In addition, the optimal thresholds of the three CT scan parameters for predicting the positive patellar J sign were determined with receiver operating characteristic (ROC) curves, and the diagnostic values were assessed by the area under the curve (AUC). Among the fifty-three patients (fifty-three knees), thirty-seven (70%) showed obvious lateral patellar translation, which were defined as positive J sign (study group), and the remaining sixteen (30%) who showed no lateral translation were defined as negative J sign (control group). The mean values of the three CT parameters in the study group were all significantly larger compared to the control group, including BOI (121 ± 28% vs 88 ± 12%, P = 0.038), PTG distance (5.2 ± 6.6 mm vs - 4.4 ± 5.2 mm, P J sign was 97.5% (Sensitivity = 83.3%, Specificity = 87.5%). In this study, the prevalence of positive patellar J sign was 70%. The BOI measured from the axial CT scans of the knee joint can be used as an appropriate predictor to differentiate the positive J sign from the negative J sign, highlighting that the excessive lateral patellar translation on axial CT scan indicates positive

  1. Failed medial patellofemoral ligament reconstruction: Causes and surgical strategies

    Science.gov (United States)

    Sanchis-Alfonso, Vicente; Montesinos-Berry, Erik; Ramirez-Fuentes, Cristina; Leal-Blanquet, Joan; Gelber, Pablo E; Monllau, Joan Carles

    2017-01-01

    Patellar instability is a common clinical problem encountered by orthopedic surgeons specializing in the knee. For patients with chronic lateral patellar instability, the standard surgical approach is to stabilize the patella through a medial patellofemoral ligament (MPFL) reconstruction. Foreseeably, an increasing number of revision surgeries of the reconstructed MPFL will be seen in upcoming years. In this paper, the causes of failed MPFL reconstruction are analyzed: (1) incorrect surgical indication or inappropriate surgical technique/patient selection; (2) a technical error; and (3) an incorrect assessment of the concomitant risk factors for instability. An understanding of the anatomy and biomechanics of the MPFL and cautiousness with the imaging techniques while favoring clinical over radiological findings and the use of common sense to determine the adequate surgical technique for each particular case, are critical to minimizing MPFL surgery failure. Additionally, our approach to dealing with failure after primary MPFL reconstruction is also presented. PMID:28251062

  2. Preoperative Patellofemoral Chondromalacia is Not a Contraindication for Fixed-Bearing Medial Unicompartmental Knee Arthroplasty.

    Science.gov (United States)

    Adams, Alexander J; Kazarian, Gregory S; Lonner, Jess H

    2017-06-01

    Patellofemoral chondromalacia (PFCM) has historically been considered a contraindication for unicompartmental knee arthroplasty (UKA), but there is limited data assessing PFCM's impact on the results of fixed-bearing UKA. Our objective was to assess the impact of medial patellar and/or medial trochlear PFCM on overall and patellofemoral-specific 2-year outcomes after fixed-bearing medial UKA. Intraoperative notes defined the presence and location of PFCM during fixed bearing medial UKA. Outcome measures included the New Knee Society Score (NKSS), Kneeling Ability Score (KAS) and Forgotten Joint Score (FJS-12). Thirty-one knees with PFCM (PFCM group), and 52 knees without PFCM (N-PFCM group) were included for analysis. Mann-Whitney U tests assessed the statistical significance of observed differences, and a Bonferroni correction was applied, adjusting threshold for significance to P = .005. At minimum follow-up of 2 years, no statistical differences were detected between the N-PFCM and PFCM groups in the postoperative NKSS (159 vs 157, P = .731), preoperative to postoperative NKSS change (P = .447), FJS-12 (70.5 vs 67.6, P = .471), or KAS (71% vs 65%, P = .217). Patients with isolated patellar chondromalacia (n = 13) demonstrated trends toward worse outcomes according to NKSS (147, P = .198), FJS-12 (58, P = .094), and KAS (46%, P = .018), but were statistically insignificant. No failures occurred in either group. Functional outcomes of fixed-bearing medial UKA are not adversely impacted by the presence of PFCM involving the medial patellar facet and/or medial or central trochlea. Further follow-up is needed to determine longer-term implications of fixed-bearing medial UKA in patients with PFCM. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Patellofemoral instability in children: T2 relaxation times of the patellar cartilage in patients with and without patellofemoral instability and correlation with morphological grading of cartilage damage.

    Science.gov (United States)

    Kang, Chang Ho; Kim, Hee Kyung; Shiraj, Sahar; Anton, Christopher; Kim, Dong Hoon; Horn, Paul S

    2016-07-01

    Patellofemoral instability is one of the most common causes of cartilage damage in teenagers. To quantitatively evaluate the patellar cartilage in patients with patellofemoral instability using T2 relaxation time maps (T2 maps), compare the values to those in patients without patellofemoral instability and correlate them with morphological grades in patients with patellofemoral instability. Fifty-three patients with patellofemoral instability (mean age: 15.9 ± 2.4 years) and 53 age- and gender-matched patients without patellofemoral instability were included. Knee MR with axial T2 map was performed. Mean T2 relaxation times were obtained at the medial, central and lateral zones of the patellar cartilage and compared between the two groups. In the patellofemoral instability group, morphological grading of the patellar cartilage (0-4) was performed and correlated with T2 relaxation times. Mean T2 relaxation times were significantly longer in the group with patellofemoral instability as compared to those of the control group across the patellar cartilage (Student's t-test, Ppatellofemoral instability, patellar cartilage damage occurs across the entire cartilage with the highest T2 values at the apex. T2 relaxation times directly reflect the severity in low-grade cartilage damage, which implies an important role for T2 maps in differentiating between normal and low-grade cartilage damage.

  4. 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.

  5. Achilles and Patellar Tendinopathy Loading Programmes

    DEFF Research Database (Denmark)

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

    2013-01-01

    . Eccentric-concentric progressing to eccentric (Silbernagel combined) and eccentric-concentric isotonic (heavy-slow resistance; HSR) loading have also been investigated. In order for clinicians to make informed decisions, they need to be aware of the loading options and comparative evidence. The mechanisms...... 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...... isolated eccentric loading. In the Achilles tendon, a majority of studies did not find an association between improved imaging (e.g. reduced anteroposterior diameter, proportion of tendons with Doppler signal) and clinical outcomes, including all high-quality studies. In contrast, HSR loading...

  6. The Anatomic Midpoint of the Attachment of the Medial Patellofemoral Complex.

    Science.gov (United States)

    Tanaka, Miho J; Voss, Andreas; Fulkerson, John P

    2016-07-20

    The medial patellofemoral ligament varies in attachment of its fibers to the patella and vastus intermedius tendon. Our aim was to identify and describe its anatomic midpoint. To account for the variability of the attachment site, we refer to it as the medial patellofemoral complex. Using AutoCAD software, we identified the midpoint of the medial patellofemoral complex attachment on photographs of 31 cadaveric knee dissections. The midpoint was referenced relative to the superior articular surface of the patella (P1) and was described in terms of the percentage of the patellar articular length distal to this point. A second point, at the junction of the medial border of the vastus intermedius tendon with the superior articular border of the patella, was identified (P2). The distances of the midpoint to P1 and P2 were calculated and were compared using paired t tests. Twenty-five images had appropriate quality and landmarks for digital analysis. The midpoint of the medial patellofemoral complex was located a mean (and standard deviation) of 2.3% ± 15.8% of the patellar articular length distal to the superior pole and was at or proximal to P1 in 12 knees. In all knees, the midpoint was at or proximal to P2. After exclusion of 2 knees with vastus intermedius tendon attachments only, the medial patellofemoral complex midpoint was closer to P2 (5.3% ± 8.6% of the patellar articular length) than to P1 (9.3% ± 8.5% of the patellar articular length) (p = 0.06). The midpoint of the medial patellofemoral complex was 2.3% of the articular length distal to the superior pole of the patella. Additionally, we describe an anatomic landmark at the junction of the medial border of the vastus intermedius tendon and the articular border of the patella that approximates the midpoint of this complex. Our study shows that the anatomic midpoint of the attachment of the medial patellofemoral complex is proximal to the junction of the medial vastus intermedius tendon and the articular

  7. [SPECIFIC DIAGNOSTIC SIGNIFICANCE OF "RIPPLE SIGN" OF MEDIAL FEMORAL CONDYLE UNDER ARTHROSCOPE IN MEDIAL LONGITUDINAL MENISCAL TEARS].

    Science.gov (United States)

    Ren Shiyou; Sun, Limang; Chen, Guofei; Jiang, Changqing; Zhang, Xintao; Zhang Wentao

    2015-01-01

    To investigate the reliability of the "ripple sign" on the upper surface of the medial femoral condyle in the diagnosis of medial longitudinal meniscal tears under arthroscope. Between June 2013 and June 2014, 56 patients with knee injuries were included. There were 35 males and 21 females with an average age of 22.2 years (range, 12-38 years). The causes of injury were sports in 40 cases, falling in 10 cases, and traffic accident in 6 cases. The injury was located at the left knee in 22 cases and at the right knee in 34 cases. The disease duration was 10-40 days (mean, 20.2 days). Of 56 patients, 15 cases had simple medial meniscal injury; 41 cases had combined injuries, including anterior cruciate ligament injury in 38 cases, posterior cruciate ligament injury in 2 cases, and patellar dislocation in 1 case. The "ripple sign" was observed under arthroscope before operation. Repair of medial meniscal injury and reconstruction of cruciate ligament were performed. The positive "ripple sign" was seen under arthroscope in all patients, who were diagnosed to have longitudinal meniscal tears, including 23 cases of mild "ripple sign" , 28 cases of moderate "ripple sign", and 5 cases of severe "ripple sign". The "ripple sign" on the upper surface of the medial femoral condyle is a reliable diagnostic evidence of medial longitudinal meniscal tears.

  8. Clinical and radiographic features, treatment and outcome in 15 horses with fracture of the medial aspect of the patella

    International Nuclear Information System (INIS)

    Dyson, S.; Wright, I.; Kold, S.; Vatistas, N.

    1992-01-01

    A sagittal fracture of the medial aspect of the patella was identified in 15 horses, 2 of which had been kicked and 12 of which had hit a fixed fence while jumping. Eight horses showed concurrent fragmentation of the base of the patella, and 2 had sustained a concurrent fracture of the distal end of the lateral trochlear ridge of the femur. A cranioproximal-craniodistal oblique radiographic view was essential to identify the site of the medial patellar fracture and to determine its configuration. Fourteen horses were treated by surgical removal of the medial patellar fracture fragment(s). Of 12 horses (83%) without evidence of pre-existing degenerative joint disease, 10 were treated successfully with return to full athletic function

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

    International Nuclear Information System (INIS)

    Collins, Mark S.; Tiegs-Heiden, Christin A.; Stuart, Michael J.

    2014-01-01

    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 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.)

  10. 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

  11. 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

  12. 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

  13. Extracorporeal shockwave for chronic patellar tendinopathy.

    Science.gov (United States)

    Wang, Ching-Jen; Ko, Jih-Yang; Chan, Yi-Sheng; Weng, Lin-Hsiu; Hsu, Shan-Lin

    2007-06-01

    Chronic patellar tendinopathy is an overuse syndrome with pathologic changes similar to tendinopathies of the shoulder, elbow, and heel. Extracorporeal shockwave was shown effective in many tendinopathies. Extracorporeal shockwave therapy may be more effective than conservative treatment for chronic patellar tendinopathy. Randomized controlled clinical trial; Level of evidence, 2. This study consisted of 27 patients (30 knees) in the study group and 23 patients (24 knees) in the control group. In the study group, patients were treated with 1500 impulses of extracorporeal shockwave at 14 KV (equivalent to 0.18 mJ/mm(2) energy flux density) to the affected knee at a single session. Patients in the control group were treated with conservative treatments including nonsteroidal anti-inflammatory drugs, physiotherapy, exercise program, and the use of a knee strap. The evaluation parameters included pain score, Victorian Institute of Sports Assessment score, and ultrasonographic examination at 1, 3, 6, and 12 months and then once a year. At the 2- to 3-year follow-up, the overall results for the study group were 43% excellent, 47% good, 10% fair, and none poor. For the control group, the results were none excellent, 50% good, 25% fair, and 25% poor. The mean Victorian Institute of Sports Assessment scores were 42.57 +/- 10.22 and 39.25 +/- 10.85, respectively, before treatment (P = .129) and 92.0 +/- 10.17 and 41.04 +/- 10.96, respectively, after treatment (P Extracorporeal shockwave therapy appeared to be more effective and safer than traditional conservative treatments in the management of patients with chronic patellar tendinopathy.

  14. [Current status and expectations in the surgical treatment of recurrent lateral patellar dislocation].

    Science.gov (United States)

    Zhao, Zhi-Dong; Li, Peng-Cui; Wei, Xiao-Chun

    2017-11-25

    Up to now, surgical treatment of recurrent lateral patellar dislocation mainly includes: medial patellofemoral ligament reconstruction, tibial tubercle osteotomy, trochleoplasty, lateral retinacular release, derotation osteotomy and so on . Clinical reports show that: the use of a single or combined with several methods have achieved ideal short to mid-term clinical outcomes. However, there is no consolidate criterion concerning the choices of different kinds of surgical ways for the treatment of individual recurrent lateral patellar dislocation. Meanwhile, with the wide use of MPFL reconstruction and other surgical options, there are more and more complications and failures that are worthy and necessary for us to pay attention to, even though its high success rate. The aim of this article is to make a systematic review of the application status of different surgical methods, collecting the positive results we have achieved, illuminating application keys of surgical techniques, guiding patient-specific therapy more precisely. Copyright© 2017 by the China Journal of Orthopaedics and Traumatology Press.

  15. Floating knee injury associated with patellar tendon rupture: a case report and review of literature.

    Science.gov (United States)

    Vaidyanathan, Singaravadivelu; Panchanathan Ganesan, Jagannath; Moongilpatti Sengodan, Mugundhan

    2012-01-01

    Floating knee injuries are frequently associated with other concomitant injuries to the ipsilateral limb or other parts of body of which injury to the ipsilateral knee ligaments carries significance for various reasons. A middle-aged man sustained a floating knee injury following RTA. DCS fixation by bridge plating technique for the distal femur and lateral buttress plating by MIPO technique for proximal tibia were planned and executed under spinal anesthesia with image intensifier. In addition, there were patellar tendon rupture along with avulsion of VMO from the medial border of patella and torn MPFL, which we have missed initially. To the best of our knowledge no similar case has been reported in English literature so far. We have reviewed the literature and proposed a different interpretation of Blake and McBride classification.

  16. Floating Knee Injury Associated with Patellar Tendon Rupture: A Case Report and Review of Literature

    Directory of Open Access Journals (Sweden)

    Singaravadivelu Vaidyanathan

    2012-01-01

    Full Text Available Floating knee injuries are frequently associated with other concomitant injuries to the ipsilateral limb or other parts of body of which injury to the ipsilateral knee ligaments carries significance for various reasons. A middle-aged man sustained a floating knee injury following RTA. DCS fixation by bridge plating technique for the distal femur and lateral buttress plating by MIPO technique for proximal tibia were planned and executed under spinal anesthesia with image intensifier. In addition, there were patellar tendon rupture along with avulsion of VMO from the medial border of patella and torn MPFL, which we have missed initially. To the best of our knowledge no similar case has been reported in English literature so far. We have reviewed the literature and proposed a different interpretation of Blake and McBride classification.

  17. Analysis of failed surgery for patellar instability in children with open growth plates.

    Science.gov (United States)

    Nelitz, Manfred; Theile, Michael; Dornacher, Daniel; Wölfle, Julia; Reichel, Heiko; Lippacher, Sabine

    2012-05-01

    Many surgical procedures have been proposed to treat recurrent patellar dislocation in children. In recent years, a more tailored approach considering the underlying pathology has been advocated. The aim of the study was to analyze a group of patients with recurrent patellofemoral instability after unsuccessful operative stabilization (Roux-Goldthwait procedure, lateral release, medial reefing or in combination) in childhood and adolescence. A total of 37 children and adolescents with recurrent patellofemoral instability despite previous surgery were analyzed retrospectively. Radiographic examination included AP and lateral views to assess patella alta and limb alignment. MRI was performed to evaluate trochlear dysplasia and tibial tubercle-trochlear groove (TTTG) distance. As a control group, 23 age- and sex-matched adolescents that were treated with a favorable outcome after medial reefing alone or combined with a Roux-Goldthwait procedure were analyzed. Severe trochlear dysplasia (type B-D according to Dejour) as detected on MRI scans was found significantly more often in the study group (89%) than in the control group (21%). No statistical difference of patellar height ratio (Insall-Salvati index) and TTTG distance between the two groups could be found. Of the measured parameters, only the incidence of trochlear dysplasia was increased. Trochlear dysplasia therefore seems to be a major risk factor for failure of operative stabilization of recurrent patellofemoral instability in children and adolescents. The results in children are in consensus with the literature in adults that a more tailored operative therapy including reconstruction of the MPFL and trochleaplasty has to be considered. Retrospective study, Level III.

  18. Evaluation of patellar chondromalacia with MR: comparison between T2-weighted FSE SPIR and GE MTC.

    Science.gov (United States)

    Macarini, Luca; Perrone, Alessandra; Murrone, Mario; Marini, Stefania; Stefanelli, Michele

    2004-09-01

    To compare two different MR sequences to tissue signal suppression in the study of patellar cartilage abnormalities. We examined 26 patients with magnetic resonance (MR) imaging: sequences included spectral presaturation with inversion recovery (SPIR), with fat suppression and T2-weighted images, magnetization transfer contrast (MTC) sequences, T1-weighted and T2-weighted spin-echo sequences. All patients underwent conventional knee arthroscopy and in all patients a hyaline cartilage lesion was assessed in three articular zones: the patellar medial facet, the lateral facet and the patellar crista. Was assessed 78 articular facets. The lesions were classified using a standard arthroscopic grading system adapted to MR imaging: normal cartilage that corresponds to the grade 0 according to the Noyes grading system, low grade lesions that correspond to the grade I e IIa and high grade lesions that correspond to grades IIb and III. The arthroscopic results were compared with MR images. We assessed the MR diagnostic accuracy, sensitivity, specificity and MR positive predictive value and negative predictive value of the two sequences taking into consideration total lesions, and high-grade and low grade lesions separately. Twenty-four low grade lesions (16 grade I e 8 grade IIa) and 18 high grade lesions (10 grade IIb e 8 grade III) were diagnosed by arthroscopy. Regarding low grade and high-grade lesions together, the accuracy was 77% for MTC sequences and 90% for SPIR sequences. In identifying low-grade lesions, the sensitivity was 88% for SPIR sequence and 42% for MTC sequences. Specificity for the detection of all lesions was 89% for the SPIR sequences and 94% for the MTC sequences. The SPIR sequence visualised water content abnormalities in degenerating cartilage, which are representative of low-grade lesions. The sensitivity of the sequence enabled us to obtain improved contrast for detecting cartilage surface irregularities. The MTC sequences allowed us to grade high

  19. Effect of Medial Patellofemoral Ligament Reconstruction Method on Patellofemoral Contact Pressures and Kinematics.

    Science.gov (United States)

    Stephen, Joanna M; Kittl, Christoph; Williams, Andy; Zaffagnini, Stefano; Marcheggiani Muccioli, Giulio Maria; Fink, Christian; Amis, Andrew A

    2016-05-01

    There remains a lack of evidence regarding the optimal method when reconstructing the medial patellofemoral ligament (MPFL) and whether some graft constructs can be more forgiving to surgical errors, such as overtensioning or tunnel malpositioning, than others. The null hypothesis was that there would not be a significant difference between reconstruction methods (eg, graft type and fixation) in the adverse biomechanical effects (eg, patellar maltracking or elevated articular contact pressure) resulting from surgical errors such as tunnel malpositioning or graft overtensioning. Controlled laboratory study. Nine fresh-frozen cadaveric knees were placed on a customized testing rig, where the femur was fixed but the tibia could be moved freely from 0° to 90° of flexion. Individual quadriceps heads and the iliotibial tract were separated and loaded to 205 N of tension using a weighted pulley system. Patellofemoral contact pressures and patellar tracking were measured at 0°, 10°, 20°, 30°, 60°, and 90° of flexion using pressure-sensitive film inserted between the patella and trochlea, in conjunction with an optical tracking system. The MPFL was transected and then reconstructed in a randomized order using a (1) double-strand gracilis tendon, (2) quadriceps tendon, and (3) tensor fasciae latae allograft. Pressure maps and tracking measurements were recorded for each reconstruction method in 2 N and 10 N of tension and with the graft positioned in the anatomic, proximal, and distal femoral tunnel positions. Statistical analysis was undertaken using repeated-measures analyses of variance, Bonferroni post hoc analyses, and paired t tests. Anatomically placed grafts during MPFL reconstruction tensioned to 2 N resulted in the restoration of intact medial joint contact pressures and patellar tracking for all 3 graft types investigated (P > .050). However, femoral tunnels positioned proximal or distal to the anatomic origin resulted in significant increases in the mean

  20. Bilateral patellar tuberculosis masquerading as infected infrapatellar bursitis.

    Science.gov (United States)

    Sreenivasan, Ravi; Haq, Rehan Ul

    2017-04-01

    A 30-year-old woman presented to our outpatient department with complaints of pain and swelling in bilateral infrapatellar regions and a discharging sinus in the right knee over the duration of one year. Radiographs showed lytic regions in bilateral patellae. Samples sent from material curetted from sinus yielded no organism but histopathology reported granulomatous inflammation. Following a fresh magnetic resonance imaging (MRI) scan that revealed the infrapatellar pad of fat communicating with the patellar lesions, an exploration and evacuation was done. Material sent revealed epithelioid cell granulomas with caseous necrosis consistent with tuberculosis (TB). The patient was put on first line anti-tubercular treatment (ATT) and has responded favourably with healing of sinus and patellar lesions. Bilateral infrapatellar bursitis is not rare. However patellar TB as a cause for OMIT is not a common diagnosis. A bilateral patellar involvement has not been reported in literature to the best of our knowledge.

  1. 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.)

  2. Patellofemoral instability in children: T2 relaxation times of the patellar cartilage in patients with and without patellofemoral instability and correlation with morphological grading of cartilage damage

    International Nuclear Information System (INIS)

    Kang, Chang Ho; Kim, Hee Kyung; Shiraj, Sahar; Anton, Christopher; Kim, Dong Hoon; Horn, Paul S.

    2016-01-01

    Patellofemoral instability is one of the most common causes of cartilage damage in teenagers. To quantitatively evaluate the patellar cartilage in patients with patellofemoral instability using T2 relaxation time maps (T2 maps), compare the values to those in patients without patellofemoral instability and correlate them with morphological grades in patients with patellofemoral instability. Fifty-three patients with patellofemoral instability (mean age: 15.9 ± 2.4 years) and 53 age- and gender-matched patients without patellofemoral instability were included. Knee MR with axial T2 map was performed. Mean T2 relaxation times were obtained at the medial, central and lateral zones of the patellar cartilage and compared between the two groups. In the patellofemoral instability group, morphological grading of the patellar cartilage (0-4) was performed and correlated with T2 relaxation times. Mean T2 relaxation times were significantly longer in the group with patellofemoral instability as compared to those of the control group across the patellar cartilage (Student's t-test, P<0.05) with the longest time at the central area. Positive correlation was seen between mean T2 relaxation time and morphological grading (Pearson correlation coefficiency, P<0.001). T2 increased with severity of morphological grading from 0 to 3 (mixed model, P<0.001), but no statistical difference was seen between grades 3 and 4. In patellofemoral instability, patellar cartilage damage occurs across the entire cartilage with the highest T2 values at the apex. T2 relaxation times directly reflect the severity in low-grade cartilage damage, which implies an important role for T2 maps in differentiating between normal and low-grade cartilage damage. (orig.)

  3. 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...

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

    NARCIS (Netherlands)

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

  5. 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...

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

    DEFF Research Database (Denmark)

    Couppé, Christian; Kongsgaard, M; Aagaard, Per

    2013-01-01

    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...

  7. Ipsilateral Medial and Lateral Discoid Meniscus with Medial Meniscus Tear

    OpenAIRE

    Shimozaki, Kengo; Nakase, Junsuke; Ohashi, Yoshinori; Numata, Hitoaki; Oshima, Takeshi; Takata, Yasushi; Tsuchiya, Hiroyuki

    2016-01-01

    Introduction: Discoid meniscus is a well-documented knee pathology, and there are many cases of medial or lateral discoid meniscus reported in the literature. However, ipsilateral concurrent medial and lateral discoid meniscus is very rare, and only a few cases have been reported. Herein, we report a case of concurrent medial and lateral discoid meniscus. Case Report: A 27-year-old Japanese man complained of pain on medial joint space in his right knee that was diagnosed as a complete medial ...

  8. [Significance of lateral release in the therapy of patellar chondromalacia].

    Science.gov (United States)

    Krüger, T; Göbel, F; Huschenbett, A; Hein, W

    2002-10-01

    A retrospective study was performed in 26 patients who underwent an operation for femoro-patellar pain due to a patellar chondromalacia with or without minor patellar dislocation/lateral pressure syndrome. The average age of the patients was 28.5 (15-39) years. 22 of the 26 patients revealed minor chondral damages of the stages 1 and 2 according to Outerbridge. In 12 patients ("lavage" group), an arthroscopic joint debridement only was carried out, while an additional open, lateral retinaculum release was made in 14 patients ("lateral release" group). The patella's distance of dislocation according to Hepp was reduced on an average of 3.0 (0-7) mm (p = 0.0019). The results of Bentley's score obtained during the follow-up interval on an average of 30.1 (9 to 60) months were almost identical for both groups. "Good" and "very good" results were achieved in the "lavage" group (83.3 %) and "lateral release" group (78.6 % of the patients). Lateral release should be used in cases of patellar decentration between 5 and 10 mm and adequate pain symptoms. The post-operative distance of dislocation should be less than 5 mm. Under such conditions and with minor chondral damage, a combined approach by using an arthroscopic joint debridement and open lateral release is promising to treat a patellar dislocation/lateral pressure syndrome.

  9. Patellar denervation with electrocautery in total knee arthroplasty without patellar resurfacing: a meta-analysis.

    Science.gov (United States)

    Cheng, Tao; Zhu, Chen; Guo, Yongyuan; Shi, Sifeng; Chen, Desheng; Zhang, Xianlong

    2014-11-01

    The impact of patellar denervation with electrocautery in total knee arthroplasty (TKA) on post-operative outcomes has been under debate. This study aims to conduct a meta-analysis and systematic review to compare the benefits and risks of circumpatellar electrocautery with those of non-electrocautery in primary TKAs. Comparative and randomized clinical studies were identified by conducting an electronic search of articles dated up to September 2012 in PubMed, EMBASE, Scopus, and the Cochrane databases. Six studies that focus on a total of 849 knees were analysed. A random-effects model was conducted using the inverse-variance method for continuous variables and the Mantel-Haenszel method for dichotomous variables. There was no significant difference in the incidence of anterior knee pain between the electrocautery and non-electrocautery groups. In term of patellar score and Knee Society Score, circumpatellar electrocautery improved clinical outcomes compared with non-electrocautery in TKAs. The statistical differences were in favour of the electrocautery group but have minimal clinical significance. In addition, the overall complications indicate no statistical significance between the two groups. This study shows no strong evidence either for or against electrocautery compared with non-electrocautery in TKAs. Therapeutic study (systematic review and meta-analysis), Level III.

  10. Patellar Instability Management: A Survey of the International Patellofemoral Study Group.

    Science.gov (United States)

    Liu, Joseph N; Steinhaus, Michael E; Kalbian, Irene L; Post, William R; Green, Daniel W; Strickland, Sabrina M; Shubin Stein, Beth E

    2017-10-01

    Although patellofemoral instability is among the most prevalent knee disorders, the management of patients with this condition is complex and remains variable, given the lack of long-term, high-level clinical outcome studies to compare various operative and nonoperative modalities. To discover a consensus within treatment controversies in patellofemoral instability among experienced knee surgeons with a specific interest in the patellofemoral joint. Expert opinion; Level of evidence, 5. A 3-step modified Delphi technique was used to establish a consensus. A 34-question, case-based online survey regarding patellofemoral instability was distributed to all active members of the International Patellofemoral Study Group. Consensus statements were generated if at least 66% of the respondents agreed and then redistributed to the same panel. Modifications to the consensus statements were made based on the iterative feedback process until no discordance was encountered in the third stage. Eight consensus statements were achieved. Nonoperative management is the current standard of care for a first-time dislocation in the absence of an osteochondral fragment or loose body requiring excision (100% agreement). In patients with a first-time dislocation with an operative osteochondral fracture requiring excision or repair, patellar instability should be addressed concurrently (89% agreement). Recurrent instability should be treated surgically, with most surgeons favoring medial reconstruction (77%-86% agreement). While there is general agreement that bony procedures should be performed to correct underlying bony deformities, there is no consensus regarding the most appropriate type of procedure performed. Lateral release should not be performed in isolation for the treatment of patellar instability (89% agreement). Despite the consensus generated in this study, our current understanding remains limited by a lack of high-level evidence as well as the numerous complex variables

  11. 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.

  12. Treatment of the lateral patellar luxation in toy poodles Tratamento da luxação lateral da patela em poodles toy

    Directory of Open Access Journals (Sweden)

    João Guilherme Padilha Filho

    2005-08-01

    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.O objetivo deste estudo retrospectivo foi relatar a ocorrência de luxação lateral em poodles. Os animais foram encaminhados ao Serviço de Ortopedia do Hospital Veterinário da Faculdade de Ciências Agrárias e Veterinárias, Campus de Jaboticabal, SP/Brasil, doze poodles, sete fêmeas e cinco machos, com idades variando entre três a nove meses. Ao exame clínico, notaram-se sinais de dor, claudicação e deformidades físicas dos membros afetados. Realizaram-se procedimentos cirúrgicos de condroplastia com sobreposição medial de retalho do retináculo e a transposição medial da crista tibial. O retorno à função do membro afetado ocorreu em um período de uma a duas semanas de pós-cirúrgico. Apesar de ser condição patológica rara em poodles, a reconstituição cirúrgica foi de fácil execução pela similaridade desta com a correção para luxação medial de patela. A luxação lateral de patela é rara em cães de ra

  13. 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.)

  14. The Effects of Patellar Taping on Dynamic Balance and Reduction of Pain in Athletic Women with Patellofemoral Pain Syndrome(PFPS

    Directory of Open Access Journals (Sweden)

    N Khoshraftare Yazdi

    2012-08-01

    Full Text Available Introduction: Patellofemoral pain syndrome(PFPS is the most common overuse syndrome in athletes. It is one of the causes of anterior knee pain in athletic population who attend to the sport medical clinics. Patellofemoral is more common among female athletes especially adolescents and young adults. Patellar taping provides an effective treatment in alleviating the symptoms of a high proportion of subjects who suffer from PFPS, though the mechanisms of pain reduction have not completely been established following its application. The purpose of this study was to investigate the effects of taping on dynamic balance and reduction of pain in athletic women with patellofemoral pain syndrome. Methods: Fifteen female athletes with patellofemoral pain syndrome participated in the study. Therefore, dynamic balance was assessed using a SEBT(Star Excursion Balance Test before and after application of patellar taping. The severity of pain was measured by VAS(Visual Analog Scale. Results: The results of variance analysis by VAS(p<0/008 in repeated measure indicated a statistically significant improvement in pain and in knee function in anterior, anteromedial, medial, posteromedial and anterolateral directions(p<0/05. Conclusion: The study results confirmed a significant improvement in reducing pain and increasing function (dynamic balance of female athletes with patellofemoral pain syndrome after patellar taping.

  15. MRI after patellar dislocation. Assessment of risk factors and injury to the joint; MRT nach Patellaluxation. Quantifizierung der Risikofaktoren und Beschreibung der Folgeschaeden

    Energy Technology Data Exchange (ETDEWEB)

    Diederichs, G. [Charite Universitaetsmedizin, Berlin (Germany). Radiologie; Scheffler, S. [Charite Universitaetsmedizin, Berlin (Germany). Zentrum fuer Muskuloskeletale Chirurgie; Chirurgisch Orthopaedischer PraxisVerbund, Berlin (Germany)

    2013-07-15

    Patellar dislocation is the lateral displacement of the patella from the femoral trochlea. Affected individuals typically have underlying anatomic risk factors of variable magnitude, which, in conjunction with leg rotation, cause the event. Magnetic resonance imaging (MRI) permits straightforward diagnosis of the typical features of recent patellar dislocation: contusion edema of the inferomedial patella and the lateral femoral condyle as well as rupture of the medial patellofemoral ligament. In case of concomitant osteochondral injury, early surgical refixation may be indicated, depending on the size. After a first dislocation, which can damage the capsuloligamentous stabilizers, subjects may sustain further dislocations or even develop chronic patellofemoral instability, depending on the presence and severity of anatomic variants. A wide range of conservative and surgical treatments are available. While a first patellar dislocation is often treated conservatively, surgical strategies after a second dislocation depend on the pattern of injury and the severity of underlying anatomic risk factors. The most relevant predisposing variants are trochlear dysplasia, patella alta, and an abnormal tibial tubercle to trochlear groove distance (TT-TG). The radiologist's report should give a quantitative estimate of both the injuries resulting from dislocation and the underlying anatomic risk factors. An accurate characterization of the individual pathomechanism is crucial for tailoring treatment. (orig.)

  16. Arthroscopic partial medial meniscectomy

    Directory of Open Access Journals (Sweden)

    Dašić Žarko

    2011-01-01

    Full Text Available Background/Aim. Meniscal injuries are common in professional or recreational sports as well as in daily activities. If meniscal lesions lead to physical impairment they usually require surgical treatment. Arthroscopic treatment of meniscal injuries is one of the most often performed orthopedic operative procedures. Methods. The study analyzed the results of arthroscopic partial medial meniscectomy in 213 patients in a 24-month period, from 2006, to 2008. Results. In our series of arthroscopically treated medial meniscus tears we noted 78 (36.62% vertical complete bucket handle lesions, 19 (8.92% vertical incomplete lesions, 18 (8.45% longitudinal tears, 35 (16.43% oblique tears, 18 (8.45% complex degenerative lesions, 17 (7.98% radial lesions and 28 (13.14% horisontal lesions. Mean preoperative International Knee Documentation Committee (IKDC score was 49.81%, 1 month after the arthroscopic partial medial meniscectomy the mean IKDC score was 84.08%, and 6 months after mean IKDC score was 90.36%. Six months after the procedure 197 (92.49% of patients had good or excellent subjective postoperative clinical outcomes, while 14 (6.57% patients subjectively did not notice a significant improvement after the intervention, and 2 (0.93% patients had no subjective improvement after the partial medial meniscectomy at all. Conclusion. Arthroscopic partial medial meniscetomy is minimally invasive diagnostic and therapeutic procedure and in well selected cases is a method of choice for treatment of medial meniscus injuries when repair techniques are not a viable option. It has small rate of complications, low morbidity and fast rehabilitation.

  17. Signs of patellar chondromalacia on sagittal T2-weighted magnetic resonance imaging

    International Nuclear Information System (INIS)

    De Smet, A.A.; Monu, J.U.; Fisher, D.R.; Keene, J.S.; Graf, B.K.

    1992-01-01

    We incidentally noted distinctive high signal defects or fissures in the patellar articular cartilage on sagittal T2-weighted magnetic resonance (MR) images in 4 patients. At subsequent arthroscopy all 4 patients were found to have patellar chondromalacia. To determine the reliabilty of these signs, we retrospectively evaluated, in a blinded manner, sagittal T2-weighted MR images of the knee in 75 patients who were undergoing arthroscopic assessment of their patellar articular cartilage. We indentified high signal defects of fissures in the patellar cartilage of 5 patients. Patellar chondromalacia was noted at arthroscopy in all 5 patients. Arthroscopy demonstrated patellar chondromalacia in an additional 21 patients with normal MR images. We conclude that high signal defects or fissures on sagittal T2-weighted images are usefull signs of patellar chondromalacia. This single imaging sequence will, however, detect only a small number of the cartilage lesions that may be present. (orig.)

  18. Signs of patellar chondromalacia on sagittal T2-weighted magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    De Smet, A.A.; Monu, J.U.; Fisher, D.R. (Univ. of Wisconsin Hospital and Clinics, Dept. of Radiology, Madison, WI (United States)); Keene, J.S.; Graf, B.K. (Univ. of Wisconsin Hospital and Clinics, Div. of Orthopedic Surgery, Madison, WI (United States))

    1992-02-01

    We incidentally noted distinctive high signal defects or fissures in the patellar articular cartilage on sagittal T2-weighted magnetic resonance (MR) images in 4 patients. At subsequent arthroscopy all 4 patients were found to have patellar chondromalacia. To determine the reliabilty of these signs, we retrospectively evaluated, in a blinded manner, sagittal T2-weighted MR images of the knee in 75 patients who were undergoing arthroscopic assessment of their patellar articular cartilage. We indentified high signal defects of fissures in the patellar cartilage of 5 patients. Patellar chondromalacia was noted at arthroscopy in all 5 patients. Arthroscopy demonstrated patellar chondromalacia in an additional 21 patients with normal MR images. We conclude that high signal defects or fissures on sagittal T2-weighted images are usefull signs of patellar chondromalacia. This single imaging sequence will, however, detect only a small number of the cartilage lesions that may be present. (orig.).

  19. Medial Patellofemoral Ligament Reconstruction Using the Hamstring Tendon for Patellofemoral Joint Instability in an 81-Year-Old Female.

    Science.gov (United States)

    Takahashi, Tsuneari; Takeshita, Katsushi

    2017-01-01

    Chronic patellofemoral instability occurs mainly in adolescent females and can also be induced by medial patellofemoral ligament (MPFL) injury. There are no case reports of MPFL reconstruction for chronic patellofemoral instability due to MPFL injury in aged populations. 81-year-old female presented with left knee pain, giving way, and patellar instability while climbing stairs, which continued for 18 months. Patellar apprehension test was positive, and roentgenogram showed lateral patellar subluxation. Conservative therapy was not successful; hence, we performed a lateral release and MPFL reconstruction surgery. After arthroscopic lateral release, the hamstring tendon was harvested, and a graft composite made of doubled hamstring tendon and polyester tape with a suspensory fixation device was prepared. Then, a femoral bone tunnel was constructed in a socket shape at the anatomical footprint of the MPFL. The graft was passed through the femoral tunnel, and free ends of the graft composite were sutured to the periosteum of the patella, using two suture anchors at 60° of knee flexion with patellar reduction. Physiotherapy was gradually started using a patella-stabilizing orthosis on the first postoperative day. Her Kujala score improved from 66 to 97 points, and Barthel index score improved from 70 to 100 points at 1 year after surgery. She neither developed patellofemoral joint OA nor had any recurrence of symptoms at the 5-year postoperative follow up. MPFL reconstruction using the hamstring tendon is an effective procedure for patients with chronic patellofemoral instability even after the age of 80 years.

  20. Effects of Patellar Taping on the Patella Position in Presence of Quadriceps Contraction in 20-40 Year-Old Women With Patellofemoral Pain Syndrome Using MRI

    Directory of Open Access Journals (Sweden)

    Mahboobeh Banejad

    2016-06-01

    Discussion: Kinesio taping plus quadriceps contraction reduced the PFCA and LPFA. Patellar taping is effective in the correction of the patellar position in contracted quadriceps. Therefore, both neuromuscular and mechanical effects of patellar taping affect the patellar position over a long period. The combination of patellar taping and exercise reduced pain and improved activity faster than either of the treatment alone.

  1. 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.

  2. 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. Ea...

  3. 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

  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. Comparative diagnostic imaging of a partial patellar ligament tear in ...

    African Journals Online (AJOL)

    Ibrahim Eldaghayes

    2018-04-27

    Apr 27, 2018 ... of the patellar or tibial insertion, and soft tissue opacity at the cranial aspect of the joint. ... the exclusion of microfracture and distal PL avulsion, but did not add information ..... angles and under stress (Hodgson et al., 2012).

  6. 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

  7. 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 ...... produces changes resembling chondromalacia patellae and early arthrotic changes suggesting the importance of malalignment in the development of patellofemoral cartilage degeneration....

  8. 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 ...

  9. 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...

  10. Patellar tendon load in different types of eccentric squats.

    Science.gov (United States)

    Frohm, A; Halvorsen, K; Thorstensson, A

    2007-07-01

    Differences in mechanical loading of the patellar tendon have been suggested as a reason for varying effects in rehabilitation of patellar tendinopathy using different eccentric squat exercises and devices. The aim was to characterize the magnitude and pattern of mechanical load at the knee and on the patellar tendon during four types of eccentric squat. Subjects performed squats with a submaximal free weight and with maximal effort in a device for eccentric overloading (Bromsman), on a decline board and horizontal surface. Kinematics was recorded with a motion-capture system, reaction forces with force plates, and electromyography from three leg muscles with surface electrodes. Inverse dynamics was used to calculate knee joint kinetics. Eccentric work, mean and peak patellar tendon force, and angle at peak force were greater (25-30%) for squats on decline board compared to horizontal surface with free weight, but not in Bromsman. Higher knee load forces (60-80%), but not work, were observed with Bromsman than free weight. Angular excursions at the knee and ankle were larger with decline board, particularly with free weight, and smaller in Bromsman than with free weight. Mean electromyography was greater on a decline board for gastrocnemius (13%) and vastus medialis (6%) with free weight, but in Bromsman only for gastrocnemius (7%). The results demonstrated clear differences in the biomechanical loading on the knee during different squat exercises. Quantification of such differences provides information that could be used to explain differences in rehabilitation effects as well as in designing more optimal rehabilitation exercises for patellar tendinopathy.

  11. 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

  12. Chronic Allium sativum administration alters spontaneous ...

    African Journals Online (AJOL)

    The whole brains were removed and the medial prefrontal cortex excised and processed for histomorphologic studies by haematoxylin and eosin, and cresyl fast violet techniques. Neurobehavioural test revealed less spontaneous alternation in 156 mg/kg Allium sativum group, while the prefrontal cortices of the test groups ...

  13. Outcome and clinical signs of arthroscopically graded patellar chondromalacia with or without lateral release.

    Science.gov (United States)

    Korkala, O L; Isotalo, T M; Lavonius, M I; Niskanen, R O

    1995-01-01

    In a follow-up study of 67 patients with an arthroscopically diagnosed patellar chondromalacia, we compared the results of plain conservative treatment with those after an open lateral retinacular release. The mean follow-up was 35 months. In Grade I chondromalacia the lateral release did not affect the result, which was in all cases good or excellent. In Grade II to IV chondromalacia the lateral release appeared beneficial, although the difference did not reach statistical significance. We also examined the validity of three clinical signs in arthroscopically verified patellar chondromalacia. Patellar inhibition and tracking tests were clearly more sensitive than the lateral apprehension test, which often gave a false negative result. If the patellar inhibition test is positive and a Grade II to IV chondromalacia of the patella is found at arthroscopy, lateral release should be considered among other procedures, like patellar shaving or patellar resurfacing.

  14. Cine MR imaging before and after realignment surgery for patellar maltracking - comparison with axial radiographs

    Energy Technology Data Exchange (ETDEWEB)

    Brossmann, J. [Klinik fuer Radiologische Diagnostik der Univ. Kiel (Germany); Muhle, C. [Klinik fuer Radiologische Diagnostik der Univ. Kiel (Germany); Buell, C.C. [Rheumaklinik, Bad Bramstedt (Germany); Zieplies, J. [Lubinus Klinik, Kiel (Germany); Melchert, U.H. [Klinik fuer Radiologische Diagnostik der Univ. Kiel (Germany); Brinkmann, G. [Klinik fuer Radiologische Diagnostik der Univ. Kiel (Germany); Schroeder, C. [Klinik fuer Radiologische Diagnostik der Univ. Kiel (Germany); Heller, M. [Klinik fuer Radiologische Diagnostik der Univ. Kiel (Germany)

    1995-04-01

    Comparison of motion-triggered cine magnetic resonance (MR) imaging and conventional radiographs for the assessment of operative results of patellar realignment. Fifteen patients with recurrent patellar dislocation or patellar subluxation were evaluated with conventional axial radiographs before and after realignment surgery by measuring the congruence angle (CA), lateral patellofemoral angle (LPFA), and lateral displacement (d). In eight patients the patellofemoral joint was additionally evaluated pre- and postoperatively with motion-triggered cine MR imaging by determining the bisect offset (BSO), lateral patellar displacement (LPD), and patellar tilt angle (PTA). Significant differences between the pre- and postoperative measurements were found for all MR imaging parameters (BSO, LPD, PTA: p<0.01) but not for the conventional X-ray parameters (CA: p=0.70, LPFA: p=0.56; d: p=0.04). Motion-triggered cine MR imaging was superior to conventional tangential radiographs for assessing the effectiveness of patellar realignment surgery. (orig.)

  15. Cine MR imaging before and after realignment surgery for patellar maltracking - comparison with axial radiographs

    International Nuclear Information System (INIS)

    Brossmann, J.; Muhle, C.; Buell, C.C.; Zieplies, J.; Melchert, U.H.; Brinkmann, G.; Schroeder, C.; Heller, M.

    1995-01-01

    Comparison of motion-triggered cine magnetic resonance (MR) imaging and conventional radiographs for the assessment of operative results of patellar realignment. Fifteen patients with recurrent patellar dislocation or patellar subluxation were evaluated with conventional axial radiographs before and after realignment surgery by measuring the congruence angle (CA), lateral patellofemoral angle (LPFA), and lateral displacement (d). In eight patients the patellofemoral joint was additionally evaluated pre- and postoperatively with motion-triggered cine MR imaging by determining the bisect offset (BSO), lateral patellar displacement (LPD), and patellar tilt angle (PTA). Significant differences between the pre- and postoperative measurements were found for all MR imaging parameters (BSO, LPD, PTA: p<0.01) but not for the conventional X-ray parameters (CA: p=0.70, LPFA: p=0.56; d: p=0.04). Motion-triggered cine MR imaging was superior to conventional tangential radiographs for assessing the effectiveness of patellar realignment surgery. (orig.)

  16. Incarceration of the medial collateral ligament in the intercondylar notch following proximal avulsion

    Energy Technology Data Exchange (ETDEWEB)

    Walton, Edward [Fiona Stanley Hospital, Department of Radiology, Perth, Western Australia (Australia); Williams, Martin [North Bristol NHS Trust, Department of Radiology, Bristol (United Kingdom); Robinson, James R. [Bristol Knee Group, Avon Orthopaedic Centre, Bristol (United Kingdom)

    2017-11-15

    Intra-articular entrapment of the medial collateral ligament (MCL) is a rare but recognised complication of traumatic injury to the posteromedial corner (PMC) of the knee. Considering the MCL is the most commonly injured ligament of the knee this complication is extremely rare with only a handful of cases describing MCL entrapment following distal avulsion of the MCL. We present the first known case of MCL entrapment following proximal avulsion of the MCL and posterior oblique ligament (POL) with the mid-substance of the MCL becoming entrapped in the joint, lying on the superior surface of the medial meniscus and extending up into the intercondylar notch. In addition, the medial patellar retinaculum was also entrapped in the medial aspect of the medial patellofemoral joint. MCL entrapment is best treated with expeditious surgical intervention and it is therefore crucial that the MRI findings are not overlooked. Details of the clinical assessment, MRI and operative findings are presented with a literature review of MCL entrapment. (orig.)

  17. Incarceration of the medial collateral ligament in the intercondylar notch following proximal avulsion

    International Nuclear Information System (INIS)

    Walton, Edward; Williams, Martin; Robinson, James R.

    2017-01-01

    Intra-articular entrapment of the medial collateral ligament (MCL) is a rare but recognised complication of traumatic injury to the posteromedial corner (PMC) of the knee. Considering the MCL is the most commonly injured ligament of the knee this complication is extremely rare with only a handful of cases describing MCL entrapment following distal avulsion of the MCL. We present the first known case of MCL entrapment following proximal avulsion of the MCL and posterior oblique ligament (POL) with the mid-substance of the MCL becoming entrapped in the joint, lying on the superior surface of the medial meniscus and extending up into the intercondylar notch. In addition, the medial patellar retinaculum was also entrapped in the medial aspect of the medial patellofemoral joint. MCL entrapment is best treated with expeditious surgical intervention and it is therefore crucial that the MRI findings are not overlooked. Details of the clinical assessment, MRI and operative findings are presented with a literature review of MCL entrapment. (orig.)

  18. Influence of patellar type and localization on chondromaliacia of patella, magnetic resonanse diagnostics

    OpenAIRE

    Žukauskas, Tomas

    2017-01-01

    Tomas Žukauskas Master’s thesis – influence of patellar type and localization on chondromaliacia of patella, magnetic resonanse diagnostics. Academic supervisor Prof. Eglė Monastyreckienė. Place of study was Lithuanian University of Health Sciences, Radiology department. The aim of study: to investigate the link between patellar type and localization with chondromaliacia of the patella using magnetic resonanse imaging. The objectives were: to investigate patellar type’s influence on its ch...

  19. Fibrocartilage in the attachment zones of the quadriceps tendon and patellar ligament of man.

    OpenAIRE

    Evans, E J; Benjamin, M; Pemberton, D J

    1990-01-01

    Differences are reported in the quantities and distribution of uncalcified fibrocartilage at the attachment sites of the quadriceps tendon and the patellar ligament. The largest quantity of fibrocartilage was characteristic of the quadriceps tendon. A prominent wedge of fibrocartilage was seen in the proximal part of the tibial attachment of the patellar ligament, though there was no fibrocartilage in the most superficial fibres. Little fibrocartilage was seen at the patellar attachment of th...

  20. [The initial (I and II) and advanced (III and IV) stages of juvenile patellar chondromalacia. Its diagnosis by magnetic resonance using a 1.5-T magnet with FLASH sequences].

    Science.gov (United States)

    Macarini, L; Rizzo, A; Martino, F; Zaccheo, N; Angelelli, G; Rotondo, A

    1998-06-01

    Juvenile patellar chondromalacia is a common orthopedic disorder which can mimic other conditions; early diagnosis is mandatory to prevent its evolution into osteoarthrosis. In the early stages of patellar chondromalacia (I and II), the lesions originate in the deep cartilage layer and the joint surface is not affected. Arthroscopy can demonstrate joint surface changes only and give indirect information about deeper lesions. We investigated the yield of 2D FLASH MRI with 30 degrees flip angle and a dedicated coil in the diagnosis of patellar chondromalacia, especially in its early stages. Eighteen patients (mean age: 21 years) with clinically suspected patellar chondromalacia were examined with MRI; 13 of them were also submitted to arthroscopy. A 1.5 T unit with a transmit-and-receive extremity coil was used. We acquired T1 SE sequences (TR/TE: 500-700/15/20) and 2D T2* FLASH sequence (TR/TE/FA: 500-800/18/30 degrees). The field of view was 160-180 mm and the matrix 192 x 256, with 2-3 NEX. The images were obtained on the axial plane. The lesions were classified in 4 stages according to Shahriaree classification. Agreement between MR and arthroscopic findings was good in both early and advanced lesions in 12/13 cases. Early lesions appeared as hyperintense focal thickening of the hyaline cartilage (stage I) or as small cystic lesions within the cartilage and no articular surface involvement (stage II). The medial patellar facet was the most frequent site. Advanced lesions appeared as articular surface ulcerations, thinning and cartilage hypointensity (stage III); stage IV lesions presented as complete erosions of the hyaline cartilage and hypointense underlying bone. 2D FLASH MRI with 30 degrees flip angle can show the differences in water content in the cartilage and thus permit to detect early chondromalacia lesions in the deep cartilage.

  1. Patellar tendon properties distinguish elite from non-elite soccer players and are related to peak horizontal but not vertical power.

    Science.gov (United States)

    Murtagh, Conall F; Stubbs, Michael; Vanrenterghem, Jos; O'Boyle, Andrew; Morgans, Ryland; Drust, Barry; Erskine, Robert M

    2018-06-02

    To investigate potential differences in patellar tendon properties between elite and non-elite soccer players, and to establish whether tendon properties were related to power assessed during unilateral jumps performed in different directions. Elite (n = 16; age 18.1 ± 1.0 years) and non-elite (n = 13; age 22.3 ± 2.7 years) soccer players performed vertical, horizontal-forward and medial unilateral countermovement jumps (CMJs) on a force plate. Patellar tendon (PT) cross-sectional area, elongation, strain, stiffness, and Young's modulus (measured at the highest common force interval) were assessed with ultrasonography and isokinetic dynamometry. Elite demonstrated greater PT elongation (6.83 ± 1.87 vs. 4.92 ± 1.88 mm, P = 0.011) and strain (11.73 ± 3.25 vs. 8.38 ± 3.06%, P = 0.009) than non-elite soccer players. Projectile range and peak horizontal power during horizontal-forward CMJ correlated positively with tendon elongation (r = 0.657 and 0.693, P < 0.001) but inversely with Young's modulus (r = - 0.376 and - 0.402; P = 0.044 and 0.031). Peak medial power during medial CMJ correlated positively with tendon elongation (r = 0.658, P < 0.001) but inversely with tendon stiffness (r = - 0.368, P = 0.050). Not only does a more compliant patellar tendon appear to be an indicator of elite soccer playing status but it may also facilitate unilateral horizontal-forward and medial, but not vertical CMJ performance. These findings should be considered when prescribing talent selection and development protocols related to direction-specific power in elite soccer players.

  2. Monoplanar versus biplanar medial open-wedge proximal tibial osteotomy for varus gonarthrosis: a comparison of clinical and radiological outcomes.

    Science.gov (United States)

    Elmalı, Nurzat; Esenkaya, Irfan; Can, Murat; Karakaplan, Mustafa

    2013-12-01

    We compared clinical and radiological results of two proximal tibial osteotomy (PTO) techniques: monoplanar medial open-wedge osteotomy and biplanar retrotubercle medial open-wedge osteotomy, stabilised by a wedged plate. We evaluated 88 knees in 78 patients. Monoplanar medial open-wedge PTO was performed on 56 knees in 50 patients with a mean age of 55 ± 9 years. Biplanar retrotubercle medial open-wedge PTO was performed on 32 knees in 28 patients with a mean age of 57 ± 7 years. Mean follow-up periods were 40.6 ± 7 months for the monoplanar PTO group and 38 ± 5 months for the biplanar retrotubercle PTO group. Clinical outcome was evaluated using the hospital for special surgery scoring system, and radiological outcome was evaluated by the measurements of femorotibial angle (FTA), patellar height and tibial slope changes. In both groups, post-operative HSS scores increased significantly. No significant difference was found between groups in FTA alteration, but the FTA decreased significantly in both groups. Patellar index ratios decreased significantly in the monoplanar PTO group (Insall-Salvati Index by 0.07, Blackburne-Peel Index by 0.07), but not in the biplanar retrotubercle PTO group. Tibial slopes were increased significantly in the monoplanar PTO group, but not in the retrotubercle PTO group. Biplanar retrotubercle medial open-wedge osteotomy and monoplanar medial open-wedge osteotomy are both clinically effective for the treatment for varus gonarthrosis. Retrotubercle osteotomy also prevents patella infera and tibial slope changes radiologically.

  3. Imaging assessment of anterior knee pain and patellar maltracking

    International Nuclear Information System (INIS)

    McNally, E.G.

    2001-01-01

    Anterior knee pain is a common complaint in the orthopaedic clinic. The differential diagnosis is wide and the principal goal of initial assessment is to detect remediable causes. The majority of patients do not have a specific disease and increasingly interest has focused on the role of patello-femoro-tibial morphology and of patellar maltracking in the aetiology of anterior knee pain. Classification in this group of patients is poor and there is no uniform agreement on which patient groups benefit from treatment and which treatment is best. Much of the literature involves relatively small numbers of patients, is poorly controlled and there is little agreement on outcome measures [1, 2]. The purpose of this review is to outline the current status of the imaging assessment of recalcitrant anterior knee pain with particular reference to patellar maltracking. (orig.)

  4. Open versus closed kinetic chain exercises for patellar chondromalacia.

    Science.gov (United States)

    Bakhtiary, A H; Fatemi, E

    2008-02-01

    Conservative treatment of patellar chondromalacia has been the subject of several studies. One recommended treatment is a strengthening exercise of the quadriceps muscle, which may be performed in closed or open kinetic chains. This study was designed to compare the effect of straight leg raise (SLR) and semi-squat exercises on the treatment of patellar chondromalacia, which has not been done to date. 32 female university students with a diagnosis of patellar chondromalacia were randomly assigned to two experimental groups: SLR and semi-squat exercise. Before starting exercise protocols, Q angle, maximal isometric voluntary contraction force (MIVCF) of quadriceps, crepitation, circumference of thigh 5 and 10 cm above the patella and patellofemoral pain according to the visual analogue scale (VAS) were assessed. Both groups then followed a 3-week programme of quadriceps muscle strengthening exercises (SLR or semi-squat) starting with 20 exercises twice a day and increasing each session by 5 exercises every 2 days. All measurements were repeated at the end of each week and then again 2 weeks after the 3-week exercise programme. Reduced Q angle (mean differences (SD) 0.8 (0.3), p = 0.016) and crepitation (19.9 (8.5), p = 0.04), and an increase in the MIVCF of the quadriceps (15.8 (5.6), p = 0.01) and thigh circumference (1.5 (0.3), p = 0.001) were found in semi-squat group compared with SLR group. However, patellofemoral pain was decreased significantly in both groups. The results of this study indicate that semi-squat exercises (closed kinetic chain) are more effective than SLR exercise (open kinetic chain) in the treatment of patellar chondromalacia. More studies are needed to investigate the long-term effect of these types of exercise.

  5. Medial temporal lobe

    International Nuclear Information System (INIS)

    Silver, A.J.; Cross, D.T.; Friedman, D.P.; Bello, J.A.; Hilal, S.K.

    1989-01-01

    To better define the MR appearance of hippocampal sclerosis, the authors have reviewed over 500 MR coronal images of the temporal lobes. Many cysts were noted that analysis showed were of choroid-fissure (arachnoid) origin. Their association with seizures was low. A few nontumorous, static, medial temporal lesions, noted on T2-weighted coronal images, were poorly visualized on T1-weighted images and did not enhance with gadolinium. The margins were irregular, involved the hippocampus, and were often associated with focal atrophy. The lesions usually were associated with seizure disorders and specific electroencephalographic changes, and the authors believe they represented hippocampal sclerosis

  6. Análise funcional dos estabilizadores patelares Functional analysis of the patellar stabilizers

    Directory of Open Access Journals (Sweden)

    Débora Bevilaqua Grossi

    2004-06-01

    Full Text Available O músculo vasto medial obliquo (VMO desempenha importante papel na estabilização medial da patela. No entanto, o padrão de recrutamento dos componentes laterais, o músculo vasto lateral longo (VLL e vasto lateral obliquo (VLO não está estabelecido. O objetivo deste trabalho foi analisar a atividade eletromiográfica dos músculos VMO, VLL e VLO de 21 indivíduos saudáveis (X=23,3 e DP=2,9, sendo 10 mulheres e 11 homens, sem história clínica de dor ou lesão osteomioarticular. Para tanto foi utilizado um eletromiógrafo NICOLET VIKING II de 8 canais (NICOLET Biomedical Instruments e eletrodos bipolares de superfície para registrar a atividade elétrica dos músculos VMO, VLL e VLO durante a realização de exercícios isométricos de extensão do joelho a 15º e 90º de flexão. Os dados eletromiográficos foram normalizados pela contração isométrica voluntária máxima de extensão do joelho a 50º de flexão e revelaram que os músculos VLL e VLO apresentam diferença significativa no padrão de recrutamento podendo ser considerados fisiologicamente distintos. O músculo VMO desempenhou juntamente com o VLO um papel recíproco e sincrônico na estabilização patelar e apresentou maior ativação em relação ao músculo VLL nos exercícios isométricos de extensão do joelho a 90º.The vastus medialis obliquus muscle (VMO performs an important role in the medial patellar stability . However , the recruitment of the lateral components, the vastus lateralis longus (VLL and vastus laterallis oblique (VLO is not established. The main purpose of this work was to investigate the electromyographic (EMG activity of the VMO, VLL and VLO muscles of twenty one health volunteers (X= 23,3 ± DP 2,9, 10 female and eleven males, without clinical pain symptoms or osteomioarticular injuries EMG NICOLET VIKING II was used with eight channels (NICOLET Biomedical Instruments, and bipolar electrodes surface in order to record the electrical activity

  7. A mini-invasive adductor magnus tendon transfer technique for medial patellofemoral ligament reconstruction: a technical note.

    Science.gov (United States)

    Sillanpää, Petri J; Mäenpää, Heikki M; Mattila, Ville M; Visuri, Tuomo; Pihlajamäki, Harri

    2009-05-01

    Patellar dislocations are associated with injuries to the medial patellofemoral ligament (MPFL). Several techniques for MPFL reconstruction have been recently published with some disadvantages involved, including large skin incisions and donor site morbidity. Arthroscopic stabilizing techniques carry the potential of inadequate restoration of MPFL function. We present a minimally invasive technique for MPFL reconstruction using adductor magnus tendon autograft. This technique is easily performed, safe, and provides a stabilizing effect equal to current MPFL reconstructions. Skin incision of only 3-4 cm is located at the level of the proximal half of the patella. After identifying the distal insertion of the adductor magnus tendon, a tendon harvester is introduced to harvest the medial two-thirds of the tendon, while the distal insertion is left intact. The adductor magnus tendon is cut at 12-14 cm from its distal insertion and transferred into the patellar medial margin. Two suture anchors are inserted through the same incision at the superomedial aspect of the patella in the anatomic MPFL origin. The graft is tightened at 30 degrees knee flexion. Aftercare includes 4 weeks of brace treatment with restricted range of motion.

  8. Treatment of Patellar Lower Pole Fracture with Modified Titanium Cable Tension Band Plus Patellar Tibial Tunnel Steel "8" Reduction Band.

    Science.gov (United States)

    Li, Jiaming; Wang, Decheng; He, Zhiliang; Shi, Hao

    2018-01-08

    To determine the efficacy of modified titanium tension band plus patellar tendon tunnel steel 8 "reduction band" versus titanium cable tension band fixation for the treatment of patellar lower pole fracture. 58 patients with lower patella fracture were enrolled in this study, including 30 patients treated with modified titanium cable tension band plus patellar tibial tunnel wire "8" tension band internal fixation (modified group), and 28 patients with titanium cable tension band fixation. All patients were followed up for 9∼15 months with an average of 11.6 months. Knee flexion was significantly improved in the modified group than in the titanium cable tension band group (111.33 ± 13 degrees versus 98.21 ± 21.70 degrees, P = 0.004). The fracture healing time showed no significant difference. At the end of the follow-up, the improvement excellent rate was 93.33% in the modified group, and 82.14% in the titanium cable tension band group. Titanium cable tension band internal fixation loosening was found in 2 cases, including 1 case of treatment by two surgeries without loose internal fixation. The modified titanium cable tension band with "8" tension band fixation showed better efficacy for lower patella fractures than titanium cable tension band fixation.

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

    International Nuclear Information System (INIS)

    Bergin, D.; Keogh, C.; O'Connell, M.; Zoga, A.; Rowe, D.; Shah, B.; Eustace, S.

    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.)

  10. Spontaneous deregulation

    NARCIS (Netherlands)

    Edelman, Benjamin; Geradin, Damien

    Platform businesses such as Airbnb and Uber have risen to success partly by sidestepping laws and regulations that encumber their traditional competitors. Such rule flouting is what the authors call “spontaneous private deregulation,” and it’s happening in a growing number of industries. The authors

  11. Extracorporeal shockwave therapy for patellar tendinopathy : a review of the literature

    NARCIS (Netherlands)

    van Leeuwen, M. T.; Zwerver, J.; van den Akker-Scheek, I.

    Background and purpose: Extracorporeal shockwave therapy (EWST) has become a popular treatment for patellar tendinopathy. The purpose of this review was to study the effectiveness of ESWT treatment for patellar tendinopathy; to draft guidelines for an effective treatment protocol of ESWT treatment;

  12. Fragmented medial coronoid process

    International Nuclear Information System (INIS)

    Juhasz, Cs.; Juhasz, T.

    1997-01-01

    Fragmented medial coronoid process: (FCP) is often considered to be part of the osteochondrosis dissecans complex, but trauma and growth discrepancies between the radius and ulna are proposed as causes. There is little to clinically differentiate FCP, from osteochondrosis dissecans (OCD) of the elbow. Pain on, flexion-extension of the elbow and lateral rotation of the paw is a little more consistent in FCP. Radiographic examination of the elbow is important despite the, fact that radiographic signs of the FCP are often nonspecific. Excessive osteoarthrosis and superimposition of the radial head and coronoid process make identification of the FCP difficult. Craniocaudal, flexed mediolateral and 25 degree craniocaudal-lateromedial views are necessary for diagnosis. Osteophyte production is more dramatic with FCP than with OCD and suggests therefore the occurrence of OCP in many cases. Although the detached process may be seen on any view, the oblique projection offers the least obstructed view. Exposure of the joint is identical to that for OCD, that means a medial approach with osteotomy of the epicondyle. In most cases the process is loose enough to be readily apparent, but in some it is necessary to exert force on the process in order to find the cleavage plane. It is necessary to remove the osteophytes as well and to inspect and irrigate the joint carefully to remove cartilage fragments before closure. Confinement is advisable for 4 weeks before returning the dog to normal activity. The outlook for function is good if the FCP is removed before secondary degenerative joint disease is well established

  13. 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.

  14. 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.

  15. Isolated and combined medial patellofemoral ligament reconstruction in revision surgery for patellofemoral instability: a prospective study.

    Science.gov (United States)

    Kohn, Ludwig M; Meidinger, Gebhart; Beitzel, Knut; Banke, Ingo J; Hensler, Daniel; Imhoff, Andreas B; Schöttle, Philip B

    2013-09-01

    Persistent pain and redislocations after surgical treatment of patellofemoral instability are described in up to 40% of patients. However, prospective outcome data about revision surgery are missing. To evaluate the clinical outcome after revision medial patellofemoral ligament (MPFL) reconstruction using isolated and combined procedures, with a follow-up of 24 months. Case series; Level of evidence, 4. Study participants were 42 patients (median age, 22 years; range, 13-46 years) who underwent revision surgery between January 2007 and December 2009 because of persistent patellofemoral instability after a mean of 1.8 previous failed surgical interventions (lateral release, medial imbrication/vastus medialis obliquus distalization, medialization of the tuberosity). An isolated MPFL reconstruction was performed in 15 cases, while a combination procedure was performed in 27 cases. The clinical results were evaluated preoperatively and 24 months postoperatively using the International Knee Documentation Committee (IKDC), Kujala, and Tegner scores as well as a subjective questionnaire. Patellar shift, tilt, and height, as well as level of degeneration, were defined preoperatively and at the latest follow-up on plain radiographs and magnetic resonance imaging. At 24-month follow-up, 87% of the patients were satisfied or very satisfied with the treatment. No apprehension or redislocation was reported at follow-up, and there was a significant decrease in pain during daily activities. There were significant improvements (P instability is a multifactorial problem, revision surgery should be indicated only after a comprehensive examination. The results of this study show that MPFL reconstruction, alone or in combination, seems to be an effective treatment for recurrent patellar dislocations after a failed previous surgery, leading to significant increases in stability and functionality as well as a reduction in pain.

  16. Patellar tendinopathy in junior basketball players: a controlled clinical and ultrasonographic study of 268 patellar tendons in players aged 14-18 years.

    Science.gov (United States)

    Cook, J L; Khan, K M; Kiss, Z S; Griffiths, L

    2000-08-01

    Anterior knee pain is a common presenting complaint amongst adolescent athletes. We hypothesised that patellar tendinopathy may occur at a younger age than is generally recognised. Thus, we studied the patellar tendons in 134 elite 14- to 18-year-old female (n=64) and male (n=70) basketball players and 29 control swimmers (17 female, 12 male) clinically and with ultrasonography. We found that of 268 tendons, 19 (7%) had current patellar tendinopathy on clinical grounds (11% in males, 2% in females). Twenty-six percent of the basketball players' patellar tendons contained an ultrasonographic hypoechoic region. Ultrasonographic abnormality was more prevalent in the oldest tertile of players (17-18 years) than the youngest tertile (14-15.9 years). Of tendons categorised clinically as 'Never patellar tendinopathy', 22% had an ultrasonographic hypoechoic region nevertheless. This study indicates that patellar tendinopathy can occur in 14- to 18-year-old basketball players. Ultrasonographic tendon abnormality is 3 times as common as clinical symptoms.

  17. Clinical and radiological outcomes after a quasi-anatomical reconstruction of medial patellofemoral ligament with gracilis tendon autograft.

    Science.gov (United States)

    Monllau, Joan C; Masferrer-Pino, Àngel; Ginovart, Gerard; Pérez-Prieto, Daniel; Gelber, Pablo E; Sanchis-Alfonso, Vicente

    2017-08-01

    To analyse the clinical and radiological outcomes of a quasi-anatomical reconstruction of the medial patellofemoral ligament (MPFL) with a gracilis tendon autograft. Patients with objective recurrent patellar instability that were operated on from 2006 to 2012 were included. A quasi-anatomical surgical technique was performed using a gracilis tendon autograft. It was anatomically attached at the patella, and the adductor magnus tendon was also used as a pulley for femoral fixation (non-anatomical reconstruction). The IKDC, Kujala and Lysholm scores as well as Tegner and VAS for pain were collected preoperatively and at final follow-up. Radiographic measurements of patellar position tilt and signs of osteoarthritis (OA) as well as trochlear dysplasia were also recorded. Thirty-six patients were included. The mean age at surgery was 25.6 years. After a minimum 27 months of follow-up, all functional scores significantly improved (p patellofemoral surfaces at the short term, as shown by the absence of radiological signs of OA in the CT scan. The procedure has been shown to be safe and suitable for the treatment of chronic patellar instability, including in adolescents with open physis. A new effective, inexpensive and easy-to-perform technique is described to reconstruct MPFL in the daily clinical practice. Therapeutic case series, Level IV.

  18. 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...

  19. Spontaneous osteonecrosis of the knee associated with tibial plateau and femoral condyle insufficiency stress fracture

    Energy Technology Data Exchange (ETDEWEB)

    Narvaez, J.A.; Narvaez, J.; Lama, E.De; Sanchez, A. [Department of Magnetic Resonance Imaging, IDI Hospital Duran i Reynals, Ciutat Sanitaria i Universitaria de Bellvitge, Gran Via s/n, 08907, L' Hospitalet de Llobregat (Barcelona) (Spain)

    2003-08-01

    The purpose of this article is to describe the association between spontaneous osteonecrosis and insufficiency stress fractures of the knee. To determine whether insufficiency stress fracture is associated with spontaneous osteonecrosis of the knee, we retrospectively reviewed the medical charts and imaging studies of all patients with spontaneous osteonecrosis of the knee, studied by MR imaging, seen in a tertiary hospital over an 8-year period. Four women (age range 66-84 years) presented spontaneous osteonecrosis of the knee associated with insufficiency stress fracture of the medial tibial plateau. One of these patients also presented a concomitant insufficiency stress fracture of the medial femoral condyle. Radiographs were diagnostic of spontaneous osteonecrosis of the medial femoral condyle in three cases, and insufficiency stress fracture of the medial tibial plateau was detected in one case. Magnetic resonance imaging allows the diagnosis of both conditions in all four cases. Spontaneous osteonecrosis of the knee may be associated with insufficiency stress fracture of the medial femoral condyle and the medial tibial plateau. This association provides additional arguments in favor of the traumatic etiology of spontaneous osteonecrosis of knee. (orig.)

  20. Spontaneous osteonecrosis of the knee associated with tibial plateau and femoral condyle insufficiency stress fracture

    International Nuclear Information System (INIS)

    Narvaez, J.A.; Narvaez, J.; Lama, E.De; Sanchez, A.

    2003-01-01

    The purpose of this article is to describe the association between spontaneous osteonecrosis and insufficiency stress fractures of the knee. To determine whether insufficiency stress fracture is associated with spontaneous osteonecrosis of the knee, we retrospectively reviewed the medical charts and imaging studies of all patients with spontaneous osteonecrosis of the knee, studied by MR imaging, seen in a tertiary hospital over an 8-year period. Four women (age range 66-84 years) presented spontaneous osteonecrosis of the knee associated with insufficiency stress fracture of the medial tibial plateau. One of these patients also presented a concomitant insufficiency stress fracture of the medial femoral condyle. Radiographs were diagnostic of spontaneous osteonecrosis of the medial femoral condyle in three cases, and insufficiency stress fracture of the medial tibial plateau was detected in one case. Magnetic resonance imaging allows the diagnosis of both conditions in all four cases. Spontaneous osteonecrosis of the knee may be associated with insufficiency stress fracture of the medial femoral condyle and the medial tibial plateau. This association provides additional arguments in favor of the traumatic etiology of spontaneous osteonecrosis of knee. (orig.)

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

    Science.gov (United States)

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

    2017-11-01

    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 of effectiveness could be found. Randomised cross-over pilot study. 24 athletes with PT (age 27.3±9.0, VISA-P 50.6±11.2) performed a joint position sense test with and without a patellar strap. The difference between both conditions was analysed using linear mixed-model analysis. No improvement in the joint position sense using the strap for the whole group was found, while those classified as having low proprioceptive acuity did improve using the strap (p=0.015, 17.2%). A larger knee girth, longer duration of symptoms and more tendon abnormalities were negatively associated with the strap's effectiveness. The use of a patellar strap improves the knee joint proprioception - measured with joint position sense - of the symptomatic leg in athletes with poor proprioceptive acuity. Especially athletes with relatively small knee girth, short duration of symptoms and small tendon abnormalities might benefit from the strap. As proprioception plays an important role in motor control, and deficits in proprioception may put an athlete at risk for (re-)injury, these findings may be relevant for prevention as well as rehabilitation purposes in those PT athletes with low proprioceptive acuity. Copyright © 2017 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  2. 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 (Psquat position on the decline surface compared to the standard surface. The stop angles of the ankle and hip joints were significantly smaller during the decline compared to the standard squats (Psquats (Psquats. 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.

  3. Management of displaced comminuted patellar fracture with titanium cable cerclage.

    Science.gov (United States)

    Yang, Li; Yueping, Ouyang; Wen, Yuan

    2010-08-01

    Management of a displaced comminuted patellar fracture is challenging. Tension band wiring and lag screw fixation are not suitable for such a fracture pattern. Stainless steel wiring with various configurations has been the mainstay of treatment. However, issues of loss of fixation and breakage of wire have not been resolved yet. Partial or total patellectomy is the last resort with a detrimental effect on quadriceps power. Braided titanium cable is stronger in tensile strength and better in fatigue resistance than the stainless steel monofilament wire, and the tension of fixation could be controlled by a graded instrument in its application. We used titanium cable to treat 21 consecutive patients with displaced comminuted patellar fracture. Patients were followed up for a mean period of 24 months (12 to 32 months). The mean score at the final follow-up was 27 points (25 to 30) using the Böstman method. There was no complication except breakage of one cable at the sixth week after the operation and the fracture had united despite the breakage. This technique is simple and effective for these difficult fractures and avoided prolonged immobilisation of the knee. Copyright 2010 Elsevier B.V. All rights reserved.

  4. The reliability of four widely used patellar height ratios.

    Science.gov (United States)

    van Duijvenbode, Dennis; Stavenuiter, Michel; Burger, Bart; van Dijke, Cees; Spermon, Jacco; Hoozemans, Marco

    2016-03-01

    The objective of this study was to evaluate the inter-observer reliability and the intra-observer reliability of four patellar height ratios: Insall-Salvati (IS), modified Insall-Salvati (MIS), Blackburne-Peel (BP) and Caton-Deschamps (CD). The patellar height ratios were assessed by four independent examiners using weight-bearing lateral knee radiographs in 30° flexion. Intra-class correlation coefficients and Fleiss' kappa's were determined. The inter-observer reliability was excellent for the IS and moderate for the other ratios. When the ratio values were categorized, the inter-observer reliability was strong for the IS, moderate for the MIS and BP, and poor for the CD. The intra-observer reliability was excellent for the IS, MIS and CD, and strong for the BP. When the ratio values were categorized, the intra-observer reliability was strong for the IS and MIS, and moderate for the other ratios. Although the IS showed best reliability, we advise to use the MIS as it showed the second best reliability but is, according to the literature, associated with better validity.

  5. Prediction of medial tibiofemoral compartment joint space loss progression using volumetric cartilage measurements: Data from the FNIH OA biomarkers consortium

    Energy Technology Data Exchange (ETDEWEB)

    Hafezi-Nejad, Nima; Demehri, Shadpour [Johns Hopkins University School of Medicine, Musculoskeletal Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD (United States); Guermazi, Ali [Boston University School of Medicine, Quantitative Imaging Center, Department of Radiology, Boston, MA (United States); Roemer, Frank W. [University of Erlangen-Nuremberg, Department of Radiology, Erlangen (Germany); Hunter, David J. [Royal North Shore Hospital Sydney, Institute of Bone and Joint Research, Kolling Institute, University of Sydney, and Rheumatology Department, Sydney (Australia); Dam, Erik B. [Biomediq, Copenhagen (Denmark); Zikria, Bashir [Johns Hopkins University, Department of Orthopaedic Surgery, Baltimore, MD (United States); Kwoh, C.K. [University of Arizona, Division of Rheumatology and Clinical Immunology, Tucson, AZ (United States)

    2017-02-15

    Investigating the association between baseline cartilage volume measurements (and initial 24th month volume loss) with medial compartment Joint-Space-Loss (JSL) progression (>0.7 mm) during 24-48th months of study. Case and control cohorts (Biomarkers Consortium subset from the Osteoarthritis Initiative (OAI)) were defined as participants with (n=297) and without (n=303) medial JSL progression (during 24-48th months). Cartilage volume measurements (baseline and 24th month loss) were obtained at five knee plates (medial-tibial, lateral-tibial, medial-femoral, lateral-femoral and patellar), and standardized values were analysed. Multivariate logistic regression was used with adjustment for known confounders. Artificial-Neural-Network analysis was conducted by Multi-Layer-Perceptrons (MLPs) including baseline determinants, and baseline (1) and interval changes (2) in cartilage volumes. Larger baseline lateral-femoral cartilage volume was predictive of medial JSL (OR: 1.29 (1.01-1.64)). Greater initial 24th month lateral-femoral cartilage volume-loss (OR: 0.48 (0.27-0.84)) had protective effect on medial JSL during 24-48th months of study. Baseline and interval changes in lateral-femoral cartilage volume, were the most important estimators for medial JSL progression (importance values: 0.191(0.177-0.204), 0.218(0.207-0.228)) in the ANN analyses. Cartilage volumes (both at baseline and their change during the initial 24 months) in the lateral femoral plate were predictive of medial JSL progression. (orig.)

  6. Vocal fold injection medialization laryngoplasty.

    Science.gov (United States)

    Modi, Vikash K

    2012-01-01

    Unilateral vocal fold paralysis (UVFP) can cause glottic insufficiency that can result in hoarseness, chronic cough, dysphagia, and/or aspiration. In rare circumstances, UVFP can cause airway obstruction necessitating a tracheostomy. The treatment options for UVFP include observation, speech therapy, vocal fold injection medialization laryngoplasty, thyroplasty, and laryngeal reinnervation. In this chapter, the author will discuss the technique of vocal fold injection for medialization of a UVFP. Copyright © 2012 S. Karger AG, Basel.

  7. Medial Unicondylar Knee Arthroplasty Improves Patellofemoral Congruence: a Possible Mechanistic Explanation for Poor Association Between Patellofemoral Degeneration and Clinical Outcome.

    Science.gov (United States)

    Thein, Ran; Zuiderbaan, Hendrik A; Khamaisy, Saker; Nawabi, Danyal H; Poultsides, Lazaros A; Pearle, Andrew D

    2015-11-01

    The purpose was to determine the effect of medial fixed bearing unicondylar knee arthroplasty (UKA) on postoperative patellofemoral joint (PFJ) congruence and analyze the relationship of preoperative PFJ degeneration on clinical outcome. We retrospectively reviewed 110 patients (113 knees) who underwent medial UKA. Radiographs were evaluated to ascertain PFJ degenerative changes and congruence. Clinical outcomes were assessed preoperatively and postoperatively. The postoperative absolute patellar congruence angle (10.05 ± 10.28) was significantly improved compared with the preoperative value (14.23 ± 11.22) (P = 0.0038). No correlation was found between preoperative PFJ congruence or degeneration severity, and WOMAC scores at two-year follow up. Pre-operative PFJ congruence and degenerative changes do not affect UKA clinical outcomes. This finding may be explained by the post-op PFJ congruence improvement. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Overuse tendinosis, not tendinitis part 2: applying the new approach to patellar tendinopathy.

    Science.gov (United States)

    Cook, J L; Khan, K M; Maffulli, N; Purdam, C

    2000-06-01

    Patellar tendinopathy causes substantial morbidity in both professional and recreational athletes. The condition is most common in athletes of jumping sports such as basketball and volleyball, but it also occurs in soccer, track, and tennis athletes. The disorder arises most often from collagen breakdown rather than inflammation, a tendinosis rather than a tendinitis. Physicians must address the degenerative pathology underlying patellar tendinopathy because regimens that seek to minimize (nonexistent) inflammation would appear illogical. Suggestions for applying the 'tendinosis paradigm' to patellar tendinopathy management include conservative measures such as load reduction, strengthening exercises, and massage. Surgery should be considered only after a long-term and appropriate conservative regimen has failed.

  9. High volume ultrasound guided injections at the interface between the patellar tendon and Hoffa's body are effective in chronic patellar tendinopathy: A pilot study.

    Science.gov (United States)

    Crisp, Tom; Khan, Faisal; Padhiar, Nat; Morrissey, Dylan; King, John; Jalan, Rosy; Maffulli, Nicola; Frcr, Otto Chan

    2008-01-01

    To evaluate a novel conservative management modality for patellar tendinopathy. We recruited nine patients with patellar tendinopathy who had failed conservative management and showed evidence of neovascularisation on power Doppler scanning. A high volume ultrasound guided injection at the interface between the patellar tendon and Hoffa's body. The injection contained 10 ml 0.5% Bupivacaine, 25 mg Hydrocortisone, and between 12 and 40 ml normosaline. 100 mm visual analogue scales (VAS) for pain and for function, and Victorian Institute of Sport Assessment - Patellar tendon (VISA-P) questionnaires at an average of 9 months from the injection. All but one patient (whose pain was unchanged) improved (p = 0.028). The mean improvement in function 2 weeks after injection was 58 mm on VAS (interquartile range 27 - 88, p = 0.018). The mean improvement in pain 2 weeks after injection was 56 mm on a VAS scale (interquartile range 32 - 80, p = 0.018). At a mean follow up of 9 months, an improvement of 22 points from a baseline score of 46 on the VISA-P questionnaire (100 being normal) was established. High volume injections to mechanically disrupt the neovascularisation in patellar tendinopathy are helpful in the management of this condition. Controlled trials would be warranted to investigate in a more conclusive fashion this management modality.

  10. Regional strain variations in the human patellar tendon.

    Science.gov (United States)

    Pearson, Stephen J; Ritchings, Tim; Mohamed, Azlan S A

    2014-07-01

    Characteristics of localized tendon strain in vivo are largely unknown. The present study examines local tendon strain between the deep, middle, and surface structures at the proximal and distal aspects of the patellar tendon during ramped isometric contractions. Male subjects (age 28.0 ± 6.3 yr) were examined for patellar tendon excursion (anterior, midsection, and posterior) during ramped isometric voluntary contractions using real-time B-mode ultrasonography and dynamometry. Regional tendon excursion measurements were compared using an automated pixel tracking method. Strain was determined from the tendon delta length normalized to initial/resting segment length. Strain increased from 10% to 100% of force for all regions. Significantly greater mean strain was seen for the anterior proximal region compared to the posterior and mid layer of the tendon (7.5% ± 1.1% vs 3.7% ± 0.5% vs 5.5% ± 1.0%; P < 0.05). Similarly, the distal posterior region showed greater mean strain compared to the mid and anterior regions (7.9% ± 0.6% vs 5.0% ± 0.6% vs 5.4% ± 0.6%; P < 0.05). Relative changes in strain differences from 50% to 100% of force for the proximal region were greatest for the anterior to midline regions (4.6% ± 0.6% and 5.6% ± 0.6%, respectively) and those for the distal region were also greatest for the anterior to midline regions (4.4% ± 0.2% and 5.3% ± 0.2%, respectively). The largest mean strain for the proximal region was at the anterior layer (7.5% ± 1.1%) and that for the distal tendon region was at the posterior layer (7.9% ± 0.9%). This study shows significant regional differences in strain during ramped isometric contractions for the patellar tendon. Lower proximal strains in the posterior tendon compared to the anterior region may be associated with the suggestion of "stress shielding" as an etiological factor in insertional tendinopathy.

  11. Medial stabilized and posterior stabilized TKA affect patellofemoral kinematics and retropatellar pressure distribution differently.

    Science.gov (United States)

    Glogaza, Alexander; Schröder, Christian; Woiczinski, Matthias; Müller, Peter; Jansson, Volkmar; Steinbrück, Arnd

    2018-06-01

    Patellofemoral kinematics and retropatellar pressure distribution change after total knee arthroplasty (TKA). It was hypothesized that different TKA designs will show altered retropatellar pressure distribution patterns and different patellofemoral kinematics according to their design characteristics. Twelve fresh-frozen knee specimens were tested dynamically in a knee rig. Each specimen was measured native, after TKA with a posterior stabilized design (PS) and after TKA with a medial stabilized design (MS). Retropatellar pressure distribution was measured using a pressure sensitive foil which was subdivided into three areas (lateral and medial facet and patellar ridge). Patellofemoral kinematics were measured by an ultrasonic-based three-dimensional motion system (Zebris CMS20, Isny Germany). Significant changes in patellofemoral kinematics and retropatellar pressure distribution were found in both TKA types when compared to the native situation. Mean retropatellar contact areas were significantly smaller after TKA (native: 241.1 ± 75.6 mm 2 , MS: 197.7 ± 74.5 mm 2 , PS: 181.2 ± 56.7 mm 2 , native vs. MS p patellofemoral kinematics were found in both TKA designs when compared to the native knee during flexion and extension with a more medial patella tracking. Patellofemoral kinematics and retropatellar pressure change after TKA in different manner depending on the type of TKA used. Surgeons should be aware of influencing the risks of patellofermoral complications by the choice of the prosthesis design.

  12. 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.

  13. 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

  14. Femoral neuropathy due to patellar dislocation in a theatrical and jazz dancer: a case report.

    Science.gov (United States)

    Shin, Chris S; Davis, Brian A

    2005-06-01

    This case report describes a teenage female, high-level modern dancer who suffered multiple left patellar dislocations. Her history is atypical in that after her fifth dislocation, her recovery was hindered secondary to persistent weakness and atrophy of her quadriceps out of proportion to disuse alone. Electrodiagnostic studies and magnetic resonance imaging showed evidence of a subacute femoral neuropathy correlating chronologically with her most recent patellar dislocation. This case suggests that further diagnostic study may be warranted in patients with persistent quadriceps weakness or atrophy after a patellar dislocation, because this may suggest the presence of a femoral neuropathy. This is important because the strength training goals and precautions differ in disuse atrophy and a neuropathy. We believe this is the first reported case of a femoral neuropathy associated with the mechanism of a patellar dislocation.

  15. Factors associated with the presence of patellar tendon abnormalities in male athletes.

    Science.gov (United States)

    Mendonça, Luciana D; Verhagen, Evert; Bittencourt, Natália F N; Gonçalves, Gabriela G P; Ocarino, Juliana M; Fonseca, Sérgio T

    2016-05-01

    To investigate the association between lower limb alignment, range of motion/flexibility and muscle strength with the presence of patellar tendon abnormalities in male athletes. This was a cross-sectional study. Thirty-one male basketball and volleyball athletes were assessed for ankle dorsiflexion range of motion, shank-forefoot alignment, iliotibial band flexibility, hip external rotators and abductors isometric torque, passive hip internal rotation range of motion and frontal plane knee and patellar alignment (McConnell and Arno angles). Ultrasonographic evaluations of hypoechoic areas of the patellar tendons were performed in longitudinal and transverse planes. A receiver operating characteristic curve was used to determine clinically relevant cut-off point for each variable. When the area under the curve was statistically significant, Prevalence Ratio (PR) and 95% confidence intervals were calculated to indicate the strength of the association between the independent variable and the presence of patellar tendon abnormalities. Receiver operating characteristic curve showed that iliotibial band flexibility (p=0.006), shank-forefoot alignment (p=0.013) and Arno angle (p=0.046) were associated with patellar tendon abnormalities. Cut-off points were established and only the Prevalence Ratio of iliotibial band flexibility (cut-off point=-0.02°/kg; PR=5.26) and shank-forefoot alignment (cut-off point=24°; PR=4.42) were statistically significant. Athletes with iliotibial band or shank-forefoot alignment above the clinically relevant cut-off point had more chance to have patellar tendon abnormalities compared to athletes under the cut-off point values. These results suggest that such factors could contribute to patellar tendon overload, since patellar tendon abnormalities indicate some level of tissue damage. Both factors might be considered in future prospective studies. Copyright © 2015 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  16. Total knee arthroplasty in a pseudoachondroplastic dwarfism patient with bilateral patellar dislocation.

    Science.gov (United States)

    Oh, Kwang-Jun; Yoon, Jung-Ro; Yang, Jae-Hyuk

    2013-01-01

    Late presentation of congenital patellar dislocation with advanced osteoarthritis is rare. This article presents a case of a 59-year-old man with underlying pseudoachondroplastic dwarfism. Advanced osteoarthritis due to bilateral neglected congenital patellar dislocation was treated with total knee arthroplasty without patella relocation surgery. Two years later, the patient had an improvement in Knee Society scores, painless function, and stability. Copyright © 2012 Elsevier B.V. All rights reserved.

  17. THE EFFECTS OF EXTRACORPOREAL SHOCKWAVE THERAPY (ESWT) AND CRYOTHERAPY IN TREATING PATELLAR TENDINOPATHIES IN PROFESSIONAL ATHLETES

    OpenAIRE

    Dobreci Iulian

    2014-01-01

    Aim: this paper tries to optimize the existent classical treatments for patellar tendinopathies that are resistant to classical forms of therapy, in professional athletes. Hypotheses: this research wants to highlight the effectiveness of the ESWT and cryotherapy in treating patellar tendinopathies in professional athletes who previously underwent classical treatments that had no positive results. Material: the research was conducted at the Bacau Spinal Care Rehabilitation Clinic, where the sy...

  18. Extracorporeal shockwave therapy for patellar tendinopathy: a review of the literature

    OpenAIRE

    van Leeuwen, M. T.; Zwerver, J.; van den Akker-Scheek, I.

    2009-01-01

    Background and purpose: Extracorporeal shockwave therapy (EWST) has become a popular treatment for patellar tendinopathy. The purpose of this review was to study the effectiveness of ESWT treatment for patellar tendinopathy; to draft guidelines for an effective treatment protocol of ESWT treatment; and to identify topics for further research. Methods: A computerised search of the Medline and Embase databases was conducted on 1 August 2007, to identify studies dealing with the effectiveness of...

  19. The effect of eccentric exercise on injured patellar tendon healing in rats: a gene expression study

    OpenAIRE

    Yagishita, Masafumi

    2011-01-01

    Recently, clinical studies have suggested that eccentric exercise can be beneficial for patellar tendinopathy. It is known that loading induces collagen synthesis in tendon, but the mechanisms responsible for mediating this effect are still unclear. We hypothesized that loading-induced expression of collagen depends on a specific contraction type. Eccentric exercise induces a more beneficial healing response than concentric exercise. Two longitudinal incisions were made in rat patellar tendon...

  20. 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.

  1. Assessment of rotatory instability after anterior cruciate ligament reconstruction with a bone-patellar tendon-bone graft

    International Nuclear Information System (INIS)

    Tashiro, Yasutaka; Okazaki, Ken; Miura, Hiromasa

    2010-01-01

    Anatomically oriented anterior cruciate ligament (ACL) reconstruction has been advocated recently, but its effect on rotatory instability remains to be cleared objectively. The purpose of this study was to quantitatively evaluate rotatory instability in ACL reconstructed knees with a bone-patellar tendon-bone (BTB) graft using an open MRI system. Eighteen subjects underwent arthroscopic ACL reconstruction with a BTB graft. The tibial tunnel was placed in the center of the ACL footprint. The femoral tunnel was drilled transtibially at the 10:00 to 10:30-o'clock position for the right knees. Subjects were examined using a Slocum anterolateral rotatory instability test in open MRI. Anterior tibial translation was measured at the medial and lateral compartments by evaluating sagittal images. Anterior knee stability was evaluated using the KT-2000 arthrometer. The clinical knee function was assessed with the Lysholm and Tegner scoring scales before and after the surgery. Side-to-side differences of anterolateral tibial translation was 0.1 mm. Side-to-side difference on KT-2000 arthrometer measurement was 1.8 mm. The Lysholm score improved to 96 and the latest Tegner score reached substantially the preinjury level. ACL reconstruction with a BTB graft was successful in restoring rotatory stability as well as anterior stability and knee function. (author)

  2. 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.

  3. Extracorporeal shockwave therapy for patellar tendinopathy: a review of the literature.

    Science.gov (United States)

    van Leeuwen, M T; Zwerver, J; van den Akker-Scheek, I

    2009-03-01

    Extracorporeal shockwave therapy (EWST) has become a popular treatment for patellar tendinopathy. The purpose of this review was to study the effectiveness of ESWT treatment for patellar tendinopathy; to draft guidelines for an effective treatment protocol of ESWT treatment; and to identify topics for further research. A computerised search of the Medline and Embase databases was conducted on 1 August 2007, to identify studies dealing with the effectiveness of ESWT for patellar tendinopathy. Seven articles describing the effectiveness of ESWT on patellar tendinopathy, all published after 2000, were included. These studies included a total of 283 patients (298 tendons), 204 of whom (215 tendons) were assigned to ESWT treatment. The treatment results were positive but most studies had methodological deficiencies, small numbers and/or short follow-up periods. Method of application and shockwave generation, energy level, number and frequency of treatments, use of (local) anaesthesia and method of localisation were variable. ESWT seems to be a safe and promising treatment for patellar tendinopathy with a positive effect on pain and function. Based on current knowledge it is impossible to recommend a specific treatment protocol. Further basic and clinical research into the working mechanism and effectiveness of ESWT for patellar tendinopathy are necessary.

  4. [Spontaneous hypoglycemia].

    Science.gov (United States)

    Ellorhaoui, M; Schultze, W

    1977-01-15

    On the basis of a survey is attempted to describe mode of development, symptomatology, individual forms and the different possibilities of therapy of the spontaneous hypoglycaemias. A particularly broad range was devoted to the cerebral sequelae, since in these cases--according to our experience--on account of simulation of neurologico-psychiatric symptoms at the soonest wrong diagnoses are to be expected. Furthermore, it is attempted to classify the hypoglycemias according to their development, in which cases their incompleteness was evident from the very beginning. The individual forms of appearance are treated according their to significance. Out of the inducible hypoglycaemias a particular attention is devoted to the forms caused by insulin and oral antidiabetics, since these most frequently participate in the development. Finally the author inquires into diagnostic measures for recognition of special forms of hypoglycaemia. In this place the diagnostics of hyperinsulinism conditioned by adenomatosis or tumours of other kinds is of particular importance. Finally conservative and operative possibilities of the therapy of these tumours are discussed,whereby the only recently tested treatment with streptotocin is mentioned.

  5. The relationship between chondromalacia patella, medial meniscal tear and medial periarticular bursitis in patients with osteoarthritis

    Directory of Open Access Journals (Sweden)

    Resorlu Mustafa

    2017-11-01

    Full Text Available This study investigated the presence of bursitis in the medial compartment of the knee (pes anserine, semimembranosus-tibial collateral ligament, and medial collateral ligament bursa in osteoarthritis, chondromalacia patella and medial meniscal tears.

  6. Injerto libre braquial medial Free medial arm graft

    Directory of Open Access Journals (Sweden)

    P. Martos Díaz

    2007-12-01

    Full Text Available Introducción. Entre las reconstrucciones de defectos titulares de cabeza y cuello, el injerto libre microvascularizado braquial medial no ha adquirido mucha popularidad debido a las variaciones anatómicas que se reflejan en la vascularización de éste. Nuestro objetivo es realizar una descripción de la anatomía y técnica quirúrgica, así como una revisión de la literatura describiendo las ventajas y desventajas de este tipo de injerto. Material y método. Presentamos el caso de una paciente con carcinoma epidermoide de mucosa yugal izquierda con afectación ganglionar ipsilateral. Se procedió a su resección con márgenes más disección cervical funcional. La reconstrucción del defecto se llevó a cabo mediante un injerto libre microvascularizado braquial medial de brazo izquierdo. Discusión. Pensamos que el injerto libre braquial medial de brazo se trata de una opción más segura a la hora de la reconstrucción de defectos cervicofaciales, aportando una serie de ventajas entre las que destacan: no sacrificio de una arteria terminal, cierre primario de la zona donante, mínimo defecto estético, y poseer una piel fina, elástica y sin vello.Introduction. Free medial microvascularized arm grafts have not become very popular for the reconstruction of head and neck defects due to anatomic variations in their vascularization. Our objective was to describe the anatomy and surgical technique and to review the literature on the advantages and disadvantages of free medial arm grafts. Material and methods. We report the case of a patient with squamous cell carcinoma of the left jugal mucosa with same-side lymph node involvement. The tumor was resected with margins and a functional cervical dissection was performed. The defect was reconstructed using a free medial microvascularized graft from the left arm. Discussion. We believe that free medial arm grafts are a safer option for the reconstruction of cervicofacial defects and that they offer

  7. Characteristics and prognosis of medial epicondylar fragmentation of the humerus in male junior tennis players.

    Science.gov (United States)

    Harada, Mikio; Takahara, Masatoshi; Maruyama, Masahiro; Takagi, Michiaki

    2014-10-01

    Although medial epicondylar fragmentation of the humerus is a reported elbow injury in junior tennis players, there have been only a few studies on this entity, and none have investigated the characteristics and prognosis of medial epicondylar fragmentation. Forty-one male junior tennis players, aged 11 to 14 years (mean, 13 years), underwent elbow examination by ultrasonography. Elbow re-examination was performed in subjects with medial epicondylar fragmentation at an average of 20 months (12-30 months) after the initial examination. On examination, 9 subjects (22%) had elbow pain. Ultrasonography showed that 6 subjects (15%) had medial epicondylar fragmentation, all of whom had elbow pain. Medial epicondylar fragmentation was present in 5 (38%) of 13 subjects aged 11 to 12 years and in 1 (4%) of 28 aged 13 to 14 years. More subjects aged 11 to 12 years had medial epicondylar fragmentation (P = .0084). All 6 subjects with medial epicondylar fragmentation continued to play tennis between the initial elbow examination and the re-examination. At re-examination, although ultrasonography showed that 5 developed bone union and 1 had nonunion, 3 subjects (50%) reported elbow pain. Our results demonstrated that subjects aged 11 to 12 years had a high frequency (38%) of medial epicondylar fragmentation. Although medial epicondylar fragmentation was the main cause of elbow pain (67%) at the initial elbow examination, all 6 players with medial epicondylar fragmentation continued to play tennis between the initial elbow examination and the re-examination. At re-examination, 5 subjects presented spontaneous bone union (83%), but 3 subjects (50%) reported elbow pain. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  8. A lower limb assessment tool for athletes at risk of developing patellar tendinopathy.

    Science.gov (United States)

    Mann, Kerry J; Edwards, Suzi; Drinkwater, Eric J; Bird, Stephen P

    2013-03-01

    Patellar tendon abnormality (PTA) on diagnostic imaging is part of the diagnostic criteria for patellar tendinopathy. PTA and altered landing strategies are primary risk factors that increase the likelihood of asymptomatic athletes developing patellar tendinopathy. Therefore, the aim of this study was to examine the risk factors that are predictors of the presence and severity of a PTA in junior pre-elite athletes. Ten junior pre-elite male basketball athletes with a PTA were matched with 10 athletes with normal patellar tendons. Participants had patellar tendon morphology, Victorian Institute of Sport Assessment (VISA) score, body composition, lower limb flexibility, and maximum vertical jump height measured before performing five successful stop-jump tasks. During each stop-jump task, both two-dimensional and three-dimensional kinematics and ground reaction forces were recorded. Multiple regression analyses were used to identify factors for estimating PTA presence and severity, and discriminate analysis was used to classify PTA presence. Sixty-eight percent of variance for presence of a PTA was accounted for by hip joint range of motion (ROM) and knee joint angle at initial foot-ground contact (IC) during stop-jump task and quadriceps flexibility, whereas hip joint ROM during stop-jump task and VISA score accounted for 62% of variance for PTA severity. Prediction of the presence of a PTA was achieved with 95% accuracy and 95% cross-validation. An easily implemented, reliable, and valid movement screening tool composed of three criteria enables coaches and/or clinicians to predict the presence and severity of a PTA in asymptomatic athletes. This enables identification of asymptomatic athletes at higher risk of developing patellar tendinopathy, which allows the development of effective preventative measures to aid in the reduction of patellar tendinopathy injury prevalence.

  9. Achilles and patellar tendinopathy display opposite changes in elastic properties: A shear wave elastography study.

    Science.gov (United States)

    Coombes, B K; Tucker, K; Vicenzino, B; Vuvan, V; Mellor, R; Heales, L; Nordez, A; Hug, F

    2018-03-01

    To compare tendon elastic and structural properties of healthy individuals with those with Achilles or patellar tendinopathy. Sixty-seven participants (22 Achilles tendinopathy, 17 patellar tendinopathy, and 28 healthy controls) were recruited between March 2015 and March 2016. Shear wave velocity (SWV), an index of tissue elastic modulus, and tendon thickness were measured bilaterally at mid-tendon and insertional regions of Achilles and patellar tendons by an examiner blinded to group. Analysis of covariance, adjusted for age, body mass index, and sex was used to compare differences in tendon thickness and SWV between the two tendinopathy groups (relative to controls) and regions. Tendon thickness was included as a covariate for analysis of SWV. Compared to controls, participants with Achilles tendinopathy had lower SWV at the distal insertion (Mean difference MD; 95% CI: -1.56; -2.49 to -0.62 m/s; P < .001) and greater thickness at the mid-tendon (MD 0.19; 0.05-0.33 cm; P = .007). Compared to controls, participants with patellar tendinopathy had higher SWV at both regions (MD 1.25; 0.40-2.10 m/s; P = .005) and greater thickness proximally (MD 0.17; 0.06-0.29 cm; P = .003). Compared to controls, participants with Achilles and patellar tendinopathy displayed lower Achilles tendon elastic modulus and higher patellar tendon elastic modulus, respectively. More research is needed to explore whether maturation, aging, or chronic load underlie these findings and whether current management programs for Achilles and patellar tendinopathy need to be tailored to the tendon. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  10. Corrective surgery for canine patellar luxation in 75 cases (107 limbs: landmark for block recession

    Directory of Open Access Journals (Sweden)

    Mitsuhiro Isaka

    2014-05-01

    Full Text Available Canine medial patellar luxation (MPL is a very common orthopedic disease in small animals. Because the pathophysiology of this disease involves various pathways, the surgical techniques and results vary according to the veterinarian. Further, the landmark for block recession is not completely clear. We retrospectively evaluated 75 dogs (107 limbs with MPL in whom our landmark for block recession was used from July 2008 to May 2013. Information regarding the breed, age, sex, body weight, body condition score (BCS, lateral vs bilateral, pre-operative grading, surgical techniques, removal of implants, concomitance with anterior cruciate ligament (ACL rupture, re-luxation, re-operation, and rehabilitation was obtained from the medical records. The breeds were as follows: Chihuahua (n=23, Pomeranian (n=12, Yorkshire Terrier (n=9, and so on. The study group consisted of 33 males (castrated n=13 and 42 females (spayed n=21. The median age was 53.3±35.9 months (32-146 months; 13 cases were less than 12 months of age (17.3%. The pre-surgical BCSs were as follows: 1 (n=0, 2 (n=20, 3 (n=24, 4 (n=24 and 5 (n=7. The body weight was 4.51±3.48 kg (1.34-23.0 kg; 71 cases (94.7% were less than 10 kg. The MPL grades (each limb were G1 (n=1, G2 (n=18, G3 (n=78, and G4 (n=10; 32 cases were bilateral and 43 cases were unilateral (right n=27; left n=16. The specific surgical procedure (distal femoral osteotomy was 3 stifles in Chihuahuas. Concurrent with ACL rupture was 16/107 stifles (15.0% corrected with the over-the-top method or the extracapsular method in Papillons (5/6, Chihuahuas (5/23, and so on. The occurrences of re-luxation and re-operation were 3 out of 107 stifles (2.8% and 0%, respectively. In this retrospective study, we present a potentially good surgical landmark for block recession of MPL in dogs.

  11. Association between patellar cartilage defects and patellofemoral geometry: a matched-pair MRI comparison of patients with and without isolated patellar cartilage defects.

    Science.gov (United States)

    Mehl, Julian; Feucht, Matthias J; Bode, Gerrit; Dovi-Akue, David; Südkamp, Norbert P; Niemeyer, Philipp

    2016-03-01

    To compare the geometry of the patellofemoral joint on magnetic resonance images (MRI) between patients with isolated cartilage defects of the patella and a gender- and age-matched control group of patients without patellar cartilage defects. A total of 43 patients (17 female, 26 male) with arthroscopically verified grade III and IV patellar cartilage defects (defect group) were compared with a matched-pair control group of patients with isolated traumatic rupture of the anterior cruciate ligament without cartilage defects of the patellofemoral joint. Preoperative MRI images were analysed retrospectively with regard to patellar geometry (width, thickness, facet angle), trochlear geometry (dysplasia according to Dejour, sulcus angle, sulcus depth, lateral condyle index, trochlea facet asymmetry, lateral trochlea inclination) and patellofemoral alignment (tibial tuberosity-trochlear groove distance, patella height, lateral patella displacement, lateral patellofemoral angle, patella tilt, congruence angle). In addition to the comparison of group values, the measured values were compared to normal values reported in the literature, and the frequency of patients with pathologic findings was compared between both groups. The defect group demonstrated a significantly higher proximal chondral sulcus angle (p patellofemoral joint. In particular, a flat and shallow trochlea, trochlea dysplasia and patella alta seem to contribute to the development of patellar cartilage defects, which must be taken into consideration when planning to do surgical cartilage repair at the patella. III.

  12. Spontaneous Pneumothorax

    Directory of Open Access Journals (Sweden)

    John Costumbrado

    2017-09-01

    Full Text Available History of present illness: A 16-year-old male with asthma was brought to the emergency department by his parents for increasing right-sided chest pain associated with cough and mild dyspnea over the past week. Albuterol inhaler did not provide relief. He denied recent trauma, fever, sweats, and chills. The patient’s vitals and oxygen saturations were stable. Physical exam revealed a tall, slender body habitus with no signs of chest wall injuries. Bilateral breath sounds were present, but slightly diminished on the right. A chest radiograph was ordered to determine the etiology of the patient’s symptoms. Significant findings: Initial chest radiograph showed a 50% right-sided pneumothorax with no mediastinal shift, which can be identified by the sharp line representing the pleural lung edge (see arrows and lack of peripheral lung markings extending to the chest wall. While difficult to accurately estimate volume from a two-dimensional image, a 2 cm pneumothorax seen on chest radiograph correlates to approximately 50% volume.1 The patient underwent insertion of a pigtail pleural drain on the right and repeat chest radiograph showed resolution of previously seen pneumothorax. Ultimately the pigtail drain was removed and chest radiograph showed clear lung fields without evidence of residual pneumothorax or pleural effusion. Discussion: Pneumothorax is characterized by air between the lungs and the chest wall.2 Spontaneous pneumothorax (SP occurs when the pneumothorax is not due to trauma or any discernable etiology. 3 SP is multifactorial and may be associated with subpleural blebs, bullae, and other connective tissue changes that predispose the lungs to leak air into the pleural space.4 SP can be further subdivided into primary (no history of underlying lung disease or secondary (history of chronic obstructive pulmonary disease, tuberculosis, cystic fibrosis, lung malignancy, etc..2 It is estimated that the incidence of SP among US pediatric

  13. Fresh osteochondral allograft transplantation for isolated patellar cartilage injury.

    Science.gov (United States)

    Gracitelli, Guilherme C; Meric, Gokhan; Pulido, Pamela A; Görtz, Simon; De Young, Allison J; Bugbee, William D

    2015-04-01

    The treatment of patellofemoral cartilage injuries can be challenging. Osteochondral allograft (OCA) transplantation has been used as a treatment option for a range of cartilage disorders. To evaluate functional outcomes and survivorship of the grafts among patients who underwent OCA for patellar cartilage injuries. Case series; Level of evidence, 4. An institutional review board-approved OCA database was used to identify 27 patients (28 knees) who underwent isolated OCA transplantation of the patella between 1983 and 2010. All patients had a minimum 2-year follow-up. The mean age of the patients was 33.7 years (range, 14-64 years); 54% were female. Twenty-six (92.9%) knees had previous surgery (mean, 3.2 procedures; range, 1-10 procedures). The mean allograft area was 10.1 cm(2) (range, 4.0-18.0 cm(2)). Patients returned for clinical evaluation or were contacted via telephone for follow-up. The number and type of reoperations were assessed. Any reoperation resulting in removal of the allograft was considered a failure of the OCA transplantation. Patients were evaluated pre- and postoperatively using the modified Merle d'Aubigné-Postel (18-point) scale, the International Knee Documentation Committee (IKDC) pain, function, and total scores, and the Knee Society function (KS-F) score. Patient satisfaction was assessed at latest follow-up. Seventeen of the 28 knees (60.7%) had further surgery after the OCA transplantation; 8 of the 28 knees (28.6%) were considered OCA failures (4 conversions to total knee arthroplasty, 2 conversions to patellofemoral knee arthroplasty, 1 revision OCA, 1 patellectomy). Patellar allografting survivorship was 78.1% at 5 and 10 years and 55.8% at 15 years. Among the 20 knees (71.4%) with grafts in situ, the mean follow-up duration was 9.7 years (range, 1.8-30.1 years). Pain and function improved from the preoperative visit to latest follow-up, and 89% of patients were extremely satisfied or satisfied with the results of the OCA

  14. Medial Canthoplasty Combined with Conjunctivodacryocystorhinostomy for the Treatment of Delayed Medial Telecanthal Deformity

    Directory of Open Access Journals (Sweden)

    Hua Sun

    2017-01-01

    Conclusions: Medial canthoplasty combined with CDCR is an effective surgical method for treatment of patients with medial telecanthal deformity and lacrimal drainage system obstruction. The study indicates that medial canthoplasty combined with CDCR surgery rebuilds normal appearance of eyelid and contour of the medial canthus and successfully repairs the function of the lacrimal drainage system.

  15. Medial tibial “spackling” to lessen chronic medial tibial soft tissue irritation

    Directory of Open Access Journals (Sweden)

    J. Ryan Martin, MD

    2016-09-01

    Full Text Available We describe a unique, utilitarian reconstructive treatment option known as tibial “spackling” for chronic, localized medial joint line pain corresponding with progressive radiographic peripheral medial tibial bone loss beneath a well-fixed revision total knee arthroplasty tibial baseplate. It is believed that this localized pain is due to chronic irritation of the medial capsule and collateral ligament from the prominent medial edge of the tibial component. In the setting of failed nonoperative treatment, our experience with utilizing bone cement to reconstruct the medial tibial bone defect and create a smooth medial tibial surface has been successful in eliminating chronic medial soft tissue irritation.

  16. 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.

    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

  17. 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

  18. Reproducibility and clinical utility of tendon palpation to detect patellar tendinopathy in young basketball players

    Science.gov (United States)

    Cook, J; Khan, K; Kiss, Z; Purdam, C; Griffiths, L

    2001-01-01

    Background—Palpation is an important clinical test for jumper's knee. Objectives—To (a) test the reproducibility of palpation tenderness, (b) evaluate the sensitivity and specificity of palpation in subjects with clinical symptoms of jumper's knee, and (c) determine whether tenderness to palpation may serve as a useful screening test for patellar tendinopathy. The yardstick for diagnosis of patellar tendinopathy was ultrasonographic abnormality. Methods—In 326 junior symptomatic and asymptomatic athletes' tendons, palpation was performed by a single examiner before ultrasonographic examination by a certified ultrasound radiologist. In 58 tendons, palpation was performed twice to test reliability. Tenderness to palpation was scored on a scale from 0 to 3 where 0 represented no pain, and 1, 2, and 3 represented mild, moderate, and severe tenderness respectively. Results—Patellar tendon palpation was a reliable examination for a single examiner (Pearson r = 0.82). In symptomatic tendons, the positive predictive value of palpation was 68%. As a screening examination in asymptomatic subjects, the positive predictive value of tendon palpation was 36–38%. Moderate and severe palpation tenderness were better predictors of ultrasonographic tendon pathology than absent or mild tenderness (ppatellar tendinopathy in a preparticipation examination. In symptomatic tendons, palpation is a moderately sensitive but not specific test. Mild tenderness in the patellar tendons in asymptomatic jumping athletes should be considered normal. Key Words: patellar tendon; ultrasound; palpation; reliability; athletes PMID:11157466

  19. Patellar tendon-lateral femoral condyle friction syndrome: MR imaging in 42 patients

    International Nuclear Information System (INIS)

    Chung, C.B.; Skaf, A.; Campos, J.; Stump, X.; Resnick, D.; Roger, B.

    2001-01-01

    Objective: To demonstrate the MR imaging findings that occur between the posterior inferolateral patellar tendon and the lateral femoral condyle in patients with chronic anterior and or lateral knee pain. Patients and design: A retrospective review of the MR images in 42 patients who presented with chronic anterior or lateral knee pain was performed by two musculoskeletal radiologists. In 15 patients, post-contrast images were available. Results: Sagittal and axial imaging planes best demonstrated the patellar tendon and its relationship with the lateral femoral condyle. In 40 patients, there was obliteration of the fat planes and abnormal signal intensity in the lateral soft tissues of the inferior patellofemoral joint. Enhancement after administration of gadolinium was noted in all cases in which contrast was administered. Eighteen patients showed cystic changes in the soft tissues adjacent to the lateral femoral condyle in addition to fat plane obliteration. In two patients, only cystic changes were noted in the lateral soft tissues. Abnormal patellar alignment was noted in 37 patients. Patellar tendon pathology was seen in nine patients. Conclusion: In evaluating anterior knee symptoms, MR imaging allows identification of changes that may be related to patellar tendon-lateral femoral condyle friction syndrome and that should be distinguished from other causes of anterior or lateral knee pain. (orig.)

  20. Patellar tendon-lateral femoral condyle friction syndrome: MR imaging in 42 patients

    Energy Technology Data Exchange (ETDEWEB)

    Chung, C.B.; Skaf, A.; Campos, J.; Stump, X.; Resnick, D. [Dept. of Radiology, University of California, San Diego (United States); Roger, B. [Service de Radiologie Polyvalente, Groupe Hospitalier Pitie-Salpetriere, Paris (France)

    2001-12-01

    Objective: To demonstrate the MR imaging findings that occur between the posterior inferolateral patellar tendon and the lateral femoral condyle in patients with chronic anterior and or lateral knee pain. Patients and design: A retrospective review of the MR images in 42 patients who presented with chronic anterior or lateral knee pain was performed by two musculoskeletal radiologists. In 15 patients, post-contrast images were available. Results: Sagittal and axial imaging planes best demonstrated the patellar tendon and its relationship with the lateral femoral condyle. In 40 patients, there was obliteration of the fat planes and abnormal signal intensity in the lateral soft tissues of the inferior patellofemoral joint. Enhancement after administration of gadolinium was noted in all cases in which contrast was administered. Eighteen patients showed cystic changes in the soft tissues adjacent to the lateral femoral condyle in addition to fat plane obliteration. In two patients, only cystic changes were noted in the lateral soft tissues. Abnormal patellar alignment was noted in 37 patients. Patellar tendon pathology was seen in nine patients. Conclusion: In evaluating anterior knee symptoms, MR imaging allows identification of changes that may be related to patellar tendon-lateral femoral condyle friction syndrome and that should be distinguished from other causes of anterior or lateral knee pain. (orig.)

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

    International Nuclear Information System (INIS)

    Berlin, R.C.; Levinsohn, E.M.; Chrisman, H.

    1991-01-01

    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.)

  2. Assessment of patellar maltracking using combined static and dynamic MRI

    International Nuclear Information System (INIS)

    McNally, E.G.; Ostlere, S.J.; Pal, C.; Phillips, A.; Reid, H.; Dodd, C.

    2000-01-01

    Between January 1995 and Jul 1997, 474 patients with anterior knee pain resistant to conservative treatment were referred for MR of the knee. The MR examination consisted of routine sequences with an additional patellofemoral dynamic examination using a technique that has been developed at this institution. The dynamic study examines both knees simultaneously, with the patient supine and the quadriceps loaded. No gating or restraint apparatus is needed. Patellar subluxation or tilt was present in 188(40%) of cases, bilateral in 104 and unilateral in 84 cases (right 39, left 45). It was classified as mild in 51%, moderate in 39% and severe in 10%. Subluxation was more prevalent in females than males (42% vs. 37%) and this was most obvious in the severe group where 68% were female. In 90 knees selected at random, four measurements of patellofemoral morphology were obtained using reconstructed images from a volume gradient echo sequence. These measurements were correlated with the degree of subluxation or tilt. A tibial tubercle distance greater than 20 mm, a femoral sulcus angle greater than 150 degrees, sulcus depth less than 4 mm were specific for subluxation but no measurement proved to be sufficiently sensitive to preclude a tracking study. MRI can be used to define more precisely the anatomy of the extensor mechanism and its relationship to the femur and tibia, in both a static and dynamic setting. In this way, patients with anterior knee pain can be classified more accurately and the outcomes of treatment more reliably assessed. (orig.)

  3. Assessment of patellar maltracking using combined static and dynamic MRI

    Energy Technology Data Exchange (ETDEWEB)

    McNally, E.G.; Ostlere, S.J.; Pal, C.; Phillips, A.; Reid, H. [Department of Radiology, Nuffield Orthopaedic Centre, Headington, Oxford OX3 9JW (United Kingdom); Dodd, C. [Department of Orthopaedic Surgery, Nuffield Orthopaedic Centre, Headington, Oxford OX3 9JW (United Kingdom)

    2000-07-01

    Between January 1995 and Jul 1997, 474 patients with anterior knee pain resistant to conservative treatment were referred for MR of the knee. The MR examination consisted of routine sequences with an additional patellofemoral dynamic examination using a technique that has been developed at this institution. The dynamic study examines both knees simultaneously, with the patient supine and the quadriceps loaded. No gating or restraint apparatus is needed. Patellar subluxation or tilt was present in 188(40%) of cases, bilateral in 104 and unilateral in 84 cases (right 39, left 45). It was classified as mild in 51%, moderate in 39% and severe in 10%. Subluxation was more prevalent in females than males (42% vs. 37%) and this was most obvious in the severe group where 68% were female. In 90 knees selected at random, four measurements of patellofemoral morphology were obtained using reconstructed images from a volume gradient echo sequence. These measurements were correlated with the degree of subluxation or tilt. A tibial tubercle distance greater than 20 mm, a femoral sulcus angle greater than 150 degrees, sulcus depth less than 4 mm were specific for subluxation but no measurement proved to be sufficiently sensitive to preclude a tracking study. MRI can be used to define more precisely the anatomy of the extensor mechanism and its relationship to the femur and tibia, in both a static and dynamic setting. In this way, patients with anterior knee pain can be classified more accurately and the outcomes of treatment more reliably assessed. (orig.)

  4. Anthropometry, physical performance, and ultrasound patellar tendon abnormality in elite junior basketball players: a cross-sectional study

    OpenAIRE

    Cook, J; Kiss, Z; Khan, K; Purdam, C; Webster, K

    2004-01-01

    Objective: Patellar tendinopathy has been reported to be associated with many intrinsic risk factors. Few have been fully investigated. This cross-sectional study examined the anthropometric and physical performance results of elite junior basketball players with normal or abnormal patellar tendons to see if any measures were associated with changes in tendon morphology.

  5. 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

  6. 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

  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. 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

  9. Medial prefrontal cortex role in recognition memory in rodents.

    Science.gov (United States)

    Morici, Juan Facundo; Bekinschtein, Pedro; Weisstaub, Noelia V

    2015-10-01

    The study of the neurobiology of recognition memory, defined by the integration of the different components of experiences that support recollection of past experiences have been a challenge for memory researches for many years. In the last twenty years, with the development of the spontaneous novel object recognition task and all its variants this has started to change. The features of recognition memory include a particular object or person ("what"), the context in which the experience took place, which can be the arena itself or the location within a particular arena ("where") and the particular time at which the event occurred ("when"). This definition instead of the historical anthropocentric one allows the study of this type of episodic memory in animal models. Some forms of recognition memory that require integration of different features recruit the medial prefrontal cortex. Focusing on findings from spontaneous recognition memory tasks performed by rodents, this review concentrates on the description of previous works that have examined the role that the medial prefrontal cortex has on the different steps of recognition memory. We conclude that this structure, independently of the task used, is required at different memory stages when the task cannot be solved by a single item strategy. Copyright © 2015 Elsevier B.V. All rights reserved.

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

    Science.gov (United States)

    Zwerver, Johannes; Dekker, Femke; Pepping, Gert-Jan

    2010-01-01

    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 ascertained. Aim of this pilot study was to investigate if patient guided Piezo-electric, focused ESWT, without local anesthesia is a safe and well tolerated treatment which improves pain and function in patients with patellar tendinopathy. Nineteen male athletes with severe chronic patellar tendinopathy received 3 patient guided focused medium to high energy ESWT treatments at a weekly interval. Before and after 3 months VISA-P and VAS (pain) scores were recorded. Data on side effects and complications of treatment were also collected. No serious complications were reported and patients tolerated the treatment well. Mean VISA-P score improved from 36.1 to 50.1 (p patellar tendinopathy.

  11. In vivo Evaluation of Patellar Tendon Stiffness in Individuals with Patellofemoral Pain Syndrome

    Directory of Open Access Journals (Sweden)

    Hsin-Yi Liu

    2008-01-01

    Full Text Available The objective of this study was to utilise an ultrasonic technique to assess the effect of patellofemoral pain syndrome (PFPS on the mechanical properties of the patellar tendon. Seven subjects with PFPS and seven matched control subjects volunteered to participate in this study. Subjects were asked to perform isometric maximal voluntary contractions of the knee extensors while their knee extension torque was monitored and the displacement of the patellar tendon was recorded with an ultrasonic system. Our results showed significantly lower tendon stiffness (by ∼30% in the PFPS subjects. Although tendon secant modulus was lower by 34% in the PFPS subjects, the difference was not statistically significant. Therefore, we conclude that the ultrasonic technique was able to detect a decrease in the structural stiffness of the patellar tendon associated with PFPS. The decrease in tendon stiffness was moderately correlated with the length of symptoms in these individuals.

  12. Bone scan features in spontaneous knee pain.

    Science.gov (United States)

    Vattimo, A; Merlo, F; Bertelli, P; Burroni, L

    1992-01-01

    In 21 patients with "spontaneous" knee pain, 99mTc-MDP bone scan was found to be more sensitive than clinical and radiographic examination in detecting alterations of the joint components. These alterations were shown by increased radionuclide uptake in the compartments where pain was present, which was most commonly the medial femorotibial compartment, although the femoropatellar compartment was also frequently affected. The authors conclude that bone scan should be the first imaging study performed on the knee in order to establish if further tests are necessary.

  13. MR imaging of patellar cartilage degeneration at 0.02 T

    International Nuclear Information System (INIS)

    Koskinen, S.K.; Komu, M.; Aho, H.J.; Kormano, M.; Turku University Hospital

    1991-01-01

    MR imaging with a 0.02 T resistive magnet was used to establish the correlation between the histologic grading of patellar cartilage degeneration and fat water separation images or T1- and T2-relaxation times. We examined 23 cadaveric patellae. There was a positive correlation between histologically graded cartilage degeneration and T1-relaxation time. Patellar cartilage was well differentiated from surrounding structures on chemical shift water proton images, and an evaluation of cartilage degeneration was possible. No correlation was found between cartilage degeneration damage and T2-relaxation time. Chemical shift imaging at 0.02 T is easy to perform and gives further information of cartilage disorders. (orig.)

  14. Radial tear of posterior horn of the medial meniscus and osteonecrosis of the knee

    International Nuclear Information System (INIS)

    Motoyama, Tatsuo; Ihara, Hidetoshi; Kawashima, Mahito

    2003-01-01

    We studied the relation between a radial tear of the posterior horn of the medial meniscus and osteonecrosis of the knee. Thirty-eight knees of 37 patients were diagnosed as medial meniscus tear and received arthroscopic knee surgery. We divided them into two groups: knees having radial tear of the posterior horn of the medial meniscus (posterior horn group) and knees containing radial tear except for posterior horn, horizontal tear, degenerative tear, and flap tear of the medial meniscus (non-posterior horn group). The posterior horn group consisted of 14 knees (average age: 65.1 years old) and the non-posterior horn group consisted of 24 knees (average age: 59.6 years old). All cases underwent MRI before arthroscopy. MRI findings were classified into three types (typical osteonecrosis, small osteonecrosis, and non-osteonecrosis). In the posterior horn group, typical osteonecrosis were five knees and small osteonecrosis were five knees, while in the non-posterior horn group only three knees were small osteonecrosis. These findings suggest the relevance between radial tear of the posterior horn of the medial meniscus and osteonecrosis of the knee (Mann-Whitney test p<0.01). The etiology of spontaneous osteonecrosis of the knee joint is unknown, however one etiology could be the radial tear of the posterior horn of the medial meniscus. (author)

  15. Patellar Skin Surface Temperature by Thermography Reflects Knee Osteoarthritis Severity

    Directory of Open Access Journals (Sweden)

    Anna E. Denoble

    2010-01-01

    Full Text Available Background Digital infrared thermal imaging is a means of measuring the heat radiated from the skin surface. Our goal was to develop and assess the reproducibility of serial infrared measurements of the knee and to assess the association of knee temperature by region of interest with radiographic severity of knee Osteoarthritis (rOA. Methods A total of 30 women (15 Cases with symptomatic knee OA and 15 age-matched Controls without knee pain or knee OA participated in this study. Infrared imaging was performed with a Meditherm Med2000™ Pro infrared camera. The reproducibility of infrared imaging of the knee was evaluated through determination of intraclass correlation coefficients (ICCs for temperature measurements from two images performed 6 months apart in Controls whose knee status was not expected to change. The average cutaneous temperature for each of five knee regions of interest was extracted using WinTes software. Knee x-rays were scored for severity of rOA based on the global Kellgren-Lawrence grading scale. Results The knee infrared thermal imaging procedure used here demonstrated long-term reproducibility with high ICCs (0.50–0.72 for the various regions of interest in Controls. Cutaneous temperature of the patella (knee cap yielded a significant correlation with severity of knee rOA (R = 0.594, P = 0.02. Conclusion The skin temperature of the patellar region correlated with x-ray severity of knee OA. This method of infrared knee imaging is reliable and as an objective measure of a sign of inflammation, temperature, indicates an interrelationship of inflammation and structural knee rOA damage.

  16. Patellar skin surface temperature by thermography reflects knee osteoarthritis severity.

    Science.gov (United States)

    Denoble, Anna E; Hall, Norine; Pieper, Carl F; Kraus, Virginia B

    2010-10-15

    Digital infrared thermal imaging is a means of measuring the heat radiated from the skin surface. Our goal was to develop and assess the reproducibility of serial infrared measurements of the knee and to assess the association of knee temperature by region of interest with radiographic severity of knee Osteoarthritis (rOA). A total of 30 women (15 Cases with symptomatic knee OA and 15 age-matched Controls without knee pain or knee OA) participated in this study. Infrared imaging was performed with a Meditherm Med2000™ Pro infrared camera. The reproducibility of infrared imaging of the knee was evaluated through determination of intraclass correlation coefficients (ICCs) for temperature measurements from two images performed 6 months apart in Controls whose knee status was not expected to change. The average cutaneous temperature for each of five knee regions of interest was extracted using WinTes software. Knee x-rays were scored for severity of rOA based on the global Kellgren-Lawrence grading scale. The knee infrared thermal imaging procedure used here demonstrated long-term reproducibility with high ICCs (0.50-0.72 for the various regions of interest) in Controls. Cutaneous temperature of the patella (knee cap) yielded a significant correlation with severity of knee rOA (R = 0.594, P = 0.02). The skin temperature of the patellar region correlated with x-ray severity of knee OA. This method of infrared knee imaging is reliable and as an objective measure of a sign of inflammation, temperature, indicates an interrelationship of inflammation and structural knee rOA damage.

  17. Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy.

    Science.gov (United States)

    Rio, Ebonie; Kidgell, Dawson; Purdam, Craig; Gaida, Jamie; Moseley, G Lorimer; Pearce, Alan J; Cook, Jill

    2015-10-01

    Few interventions reduce patellar tendinopathy (PT) pain in the short term. Eccentric exercises are painful and have limited effectiveness during the competitive season. Isometric and isotonic muscle contractions may have an immediate effect on PT pain. This single-blinded, randomised cross-over study compared immediate and 45 min effects following a bout of isometric and isotonic muscle contractions. Outcome measures were PT pain during the single-leg decline squat (SLDS, 0-10), quadriceps strength on maximal voluntary isometric contraction (MVIC), and measures of corticospinal excitability and inhibition. Data were analysed using a split-plot in time-repeated measures analysis of variance (ANOVA). 6 volleyball players with PT participated. Condition effects were detected with greater pain relief immediately from isometric contractions: isometric contractions reduced SLDS (mean±SD) from 7.0±2.04 to 0.17±0.41, and isotonic contractions reduced SLDS (mean±SD) from 6.33±2.80 to 3.75±3.28 (peffect on inhibition (pre 30.26±3.89, post 31.92±4.67; p=0.004). Condition by time analysis showed pain reduction was sustained at 45 min postisometric but not isotonic condition (ptendon pain immediately for at least 45 min postintervention and increased MVIC. The reduction in pain was paralleled by a reduction in cortical inhibition, providing insight into potential mechanisms. Isometric contractions can be completed without pain for people with PT. The clinical implications are that isometric muscle contractions may be used to reduce pain in people with PT without a reduction in muscle strength. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  18. Acute Medial Plantar Fascia Tear.

    Science.gov (United States)

    Pascoe, Stephanie C; Mazzola, Timothy J

    2016-06-01

    A 32-year-old man who participated in competitive soccer came to physical therapy via direct access for a chief complaint of plantar foot pain. The clinical examination findings and mechanism of injury raised a concern for a plantar fascia tear, so the patient was referred to the physician and magnetic resonance imaging was obtained. The magnetic resonance image confirmed a high-grade, partial-thickness, proximal plantar fascia tear with localized edema at the location of the medial band. J Orthop Sports Phys Ther 2016;46(6):495. doi:10.2519/jospt.2016.0409.

  19. The anatomy and isometry of a quasi-anatomical reconstruction of the medial patellofemoral ligament.

    Science.gov (United States)

    Pérez-Prieto, Daniel; Capurro, Bruno; Gelber, Pablo E; Ginovart, Gerard; Reina, Francisco; Sanchis-Alfonso, Vicente; Monllau, Joan C

    2017-08-01

    To describe the anatomy of the medial patellofemoral ligament (MPFL) and its relationship to the Adductor Magnus (AM) tendon as well as the behaviour exhibited in length changes during knee flexion. Ten cadaveric knees were dissected. The length from the superior and inferior patellar origin of the MPFL to its femoral insertion was measured at different degrees of knee flexion (0°, 30°, 60°, 90° and 120°). The same measures were made from both patellar origins of the MPFL up to the femoral insertion of the AM. The distance between the insertion of the AM and the Hunter canal was also measured. In general, isometry up to 90° was seen in all measures of the MPFL and those of the AM. The most isometric behaviour was seen in 2 measures: the length of the AM femoral insertion up to the inferior origin of the MPFL on the patella and the length of the femoral insertion of the MPFL up to the inferior origin of the MPFL on the patella. Similar behaviour was seen regardless of the anatomical or quasi-anatomical femoral point of attachment (n.s.). The distance from the AM tendon to the Hunter canal had a mean value of 78.6 mm (SD 9.4 mm). The behaviour exhibited during the changes in the length of the anatomical femoral footprint of the MPFL and the AM is similar. Neurovascular structures were not seen at risk. This is relevant in the daily clinical practice since the AM tendon might be a suitable point of insertion for MPFL reconstruction.

  20. Do Changes in Patellofemoral Joint Offset Lead to Adverse Outcomes in Total Knee Arthroplasty With Patellar Resurfacing? A Radiographic Review.

    Science.gov (United States)

    Matz, Jacob; Howard, James L; Morden, David J; MacDonald, Steven J; Teeter, Matthew G; Lanting, Brent A

    2017-03-01

    Patellofemoral joint biomechanics contribute to anterior knee pain, instability, and dysfunction following total knee arthroplasty (TKA). Information about specific factors leading to anterior knee pain and dysfunction is currently limited. Changes in patellofemoral joint offset (PFO) refers to a mismatch between the preoperative and postoperative anteroposterior geometry of the patellofemoral joint. It remains unclear whether these changes lead to adverse outcomes in TKA. A retrospective radiographic review of 970 knees pre-TKA and post-TKA was completed to correlate the radiographic and clinical outcomes of changing the PFO using a posterior-stabilized single knee design with patellar resurfacing. A total of 970 patients were reviewed. Postoperatively, the anterior femoral offset, anteroposterior femoral size, and anterior patellar offset were changed in 40%, 60%, and 71% of knees, respectively, compared to preoperative values. The Western Ontario and McMasters Osteoarthritis Index total score as well as subscale scores for pain and function were not significantly affected by an increase or decrease in PFO. Similarly, Knee Society Scores and range of motion were not significantly affected. Increased anterior patellar offset was, however, associated with increased postoperative patellar tilt. Postoperative patellar tilt was not correlated with adverse patient satisfaction scores or loss of range of motion. Changes in PFO (decreased, maintained, or increased) are common post-TKA and are not associated with a difference in clinical outcomes. Increases in anterior patellar offset led to increased patellar tilt, which was not associated with adverse patient satisfaction scores. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Snapping Knee Caused by Medial Meniscal Cyst

    Directory of Open Access Journals (Sweden)

    Tsuyoshi Ohishi

    2014-01-01

    Full Text Available Snapping phenomenon around the medial aspect of the knee is rare. We present this case of snapping knee caused by the sartorius muscle over a large medial meniscal cyst in a 66-year-old female. Magnetic resonance images demonstrated a large medial meniscal cyst with a horizontal tear of the medial meniscus. Arthroscopic cyst decompression with limited meniscectomy resulted in the disappearance of snapping, and no recurrence of the cyst was observed during a 2-year follow-up period.

  2. Lower limb strength and flexibility in athletes with and without patellar tendinopathy.

    Science.gov (United States)

    Scattone Silva, Rodrigo; Nakagawa, Theresa H; Ferreira, Ana Luisa G; Garcia, Luccas C; Santos, José E M; Serrão, Fábio V

    2016-07-01

    To compare the hip, knee and ankle torques, as well as knee and ankle flexibility between athletes with patellar tendinopathy and asymptomatic controls. Cross-sectional study. Laboratory setting. Fourteen male volleyball, basketball or handball athletes, divided into 2 groups, patellar tendinopathy group (TG; n = 7) and asymptomatic control group (CG; n = 7). Hip, knee and ankle isometric torques were measured with a handheld dynamometer. Weight-bearing ankle dorsiflexion, hamstring and quadriceps flexibility were measured with a gravity inclinometer. The TG had 27% lower hip extensor torque when compared to the CG (P = 0.031), with no group differences in knee and ankle torques (P > 0.05). Also, the TG had smaller weight-bearing ankle dorsiflexion (P = 0.038) and hamstring flexibility (P = 0.006) when compared to the CG. Regarding quadriceps flexibility, no group differences were found (P = 0.828). Strength and flexibility deficits might contribute to a greater overload on the knee extensor mechanism, possibly contributing to the origin/perpetuation of patellar tendinopathy. Interventions aiming at increasing hip extensors strength as well as ankle and knee flexibility might be important for the rehabilitation of athletes with patellar tendinopathy. Copyright © 2015 Elsevier Ltd. All rights reserved.

  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. 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

  5. Metabolic and cytoprotective effects of in vivo peri-patellar hyaluronic acid injections in cultured tenocytes.

    Science.gov (United States)

    Salamanna, F; Frizziero, A; Pagani, S; Giavaresi, G; Curzi, D; Falcieri, E; Marini, M; Abruzzo, P M; Martini, L; Fini, M

    2015-02-01

    The purpose of this study was to investigate tenocyte mechanobiology after sudden-detraining and to examine the hypothesis that repeated peri-patellar injections of hyaluronic acid (HA) on detrained patellar tendon (PT) may reduce and limit detrained-associated damage in tenocytes. Twenty-four male Sprague-Dawley rats were divided into three groups: Untrained, Trained and Detrained. In the Detrained rats, the left tendon was untreated while the right tendon received repeated peri-patellar injections of either HA or saline (NaCl). Tenocyte morphology, metabolism and synthesis of C-terminal-propeptide of type I collagen, collagen-III, fibronectin, aggrecan, tenascin-c, interleukin-1β, matrix-metalloproteinase-1 and-3 were evaluated after 1, 3, 7 and 10 days of culture. Transmission-electronic-microscopy showed a significant increase in mitochondria and rough endoplasmic reticulum in cultured tenocytes from Detrained-HA with respect to those from Detrained-NaCl. Additionally, Detrained-HA cultures showed a significantly higher proliferation rate and viability, and increased synthesis of C-terminal-Propeptide of type I collagen, fibronectin, aggrecan, tenascin-c and matrix-metalloproteinase-3 with respect to Detrained-NaCl ones, whereas synthesis of matrix-metalloproteinase-1 and interleukin-1β was decreased. Our study demonstrates that discontinuing training activity in the short-term alters tenocyte synthetic and metabolic activity and that repeated peri-patellar infiltrations of HA during detraining allow the maintenance of tenocyte anabolic activity.

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

    NARCIS (Netherlands)

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

    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

  7. 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;

  8. Treatment of transverse patellar fractures : a comparison between metallic and non-metallic implants

    NARCIS (Netherlands)

    Heusinkveld, M.H.G.; Hamer, den A.; Traa, W.A.; Oomen, P.J.A.; Maffulli, N.

    2013-01-01

    Introduction: Several methods of transverse patellar fixation have been described. This study compares the clinical outcome and the occurrence of complications of various fixation methods. Sources of data: The databases PubMed, Web of Science, Science Direct, Google Scholar and Google were searched.

  9. Influence of Total Knee Arthroplasty on Patellar Kinematics and Patellofemoral Pressure.

    Science.gov (United States)

    Tanikawa, Hidenori; Tada, Mitsunori; Harato, Kengo; Okuma, Kazunari; Nagura, Takeo

    2017-01-01

    Patellofemoral complications are one of the main problems after total knee arthroplasty (TKA). The design of the TKA component may affect the patellar biomechanics, which may be associated with this postoperative complication. The purpose of this study was to assess the influence of TKA and prosthesis designs on the patellar kinematics and patellofemoral pressure. Using fresh-frozen cadavers, we measured the patellofemoral pressure, patella offset, and patella tilt in the following 4 conditions: normal knee (patella replacement only), cruciate-retaining TKA, condylar-stabilizing TKA, and posterior-stabilized TKA. The patellofemoral pressure increased significantly after the cruciate-retaining TKA and condylar-stabilizing TKA compared with the normal knee. The patella offset in the normal knee decreased with increasing knee flexion angles, while the patella offset in the TKA knees did not change significantly through the full range of motion. The amount of lateral patella tilt in the normal knee was significantly larger than the TKA knees in the full range of motion. Although the femoral components are designed to reproduce an anatomical patellar tracking, the physiological patellar kinematics were not observed. Relatively high patellofemoral pressure and kinematic change after TKA may be associated with postoperative complications such as the anterior knee pain. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. 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.

  11. 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.

  12. Anterior Cruciate Ligament Reconstruction using Bone Patellar Tendon Bone autograft in ACL deficient Knee

    Directory of Open Access Journals (Sweden)

    Navin Kumar Karn

    2015-12-01

    Full Text Available Background & Objectives: Injury to Anterior Cruciate Ligament (ACL reconstruction has increased because of increased interest in sports. There are various grafts used for reconstruction of ACL, for example, Bone Patellar Tendon Bone, Hamstring etc. The study was conducted to evaluate the results of Bone Patellar Tendon Bone graft used for reconstruction of Anterior Cruciate Ligament.Materials & Methods: 40 patients with chronic ACL deficient knee presenting to Neuro Hospital from July 2011 to June 2013 were included in the study. The patients with intraarticular fracture of knee, severe OA knee, local active or suspected infection and systemic disease that might influence the study results were excluded from the study. Bone patellar tendon bone graft was harvested from ipsilateral knee in all the cases. The patient was followed till 2 year with specified programme of rehabilitation. The pain was assessed using VAS and the function of the knee was assessed using Modified WOMAC knee index.Results: The long term satisfactory results in terms of functional stability, symptom relief and return to preinjury level of activity was seen in 32 cases (80%. Two knees got infected out of which one required arthroscopic debridement. Mean visual analogue scale was 8 and modified WOMAC knee score was 3 at 2 year follow up.Conclusion: Bone patellar tendon bone graft is useful in high demand patients and cost effective option with high patient satisfaction rate for reconstruction of ACL.JCMS Nepal. 2015;11(3:12-15.

  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. 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.

  15. Evolution of the patellar sesamoid bone in mammals

    Directory of Open Access Journals (Sweden)

    Mark E. Samuels

    2017-03-01

    Full Text Available 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

  16. Structural and in vivo mechanical characterization of canine patellar cartilage: a closed chondromalacia patellae model.

    Science.gov (United States)

    LaBerge, M; Audet, J; Drouin, G; Rivard, C H

    1993-01-01

    The purpose of this project was to study the relationship between the structure of the patellar cartilage and its response to static compressive loading with a closed chondromalacia patellae model. An animal model was used to induce degeneration of the patella that was monitored quantitatively and qualitatively as a function of time. Ten adult mongrel dogs had their left patellofemoral groove replaced by a customized metallic implant covered with a thin film of polyethylene for periods of 3 months (five dogs) and 6 months (five dogs). An indenter was designed to perform mechanical indentation testing on the patellar cartilage in situ. The animals were anesthetized and the response of patellar cartilage to a static compressive load of 4.5 MPa was monitored for 20 min and its relaxation after load removal for 20 min. Indentation tests were performed every 3 months of the implantation period. At the end of the implantation period, the patellae were processed for histology, and sections were stained with Safranin-O indicative of the proteoglycans content. Macroscopically, no apparent degeneration or fibrillation of the patellar surfaces was observed after 3 or 6 months of implantation. However, the patellar surface showed a change in coloration after 6 months. A 17 +/- 3% and 37 +/- 8% deformation of the cartilage were calculated for the 3-month and 6-month specimens, respectively. Histologically, a progressive loss of proteoglycans was observed in the matrix as a function of implantation time. These results indicated that an increase in cartilage compliance is associated with an intrinsic remodeling of the cartilage matrix and that these changes might occur without external signs of degeneration and can be quantified.

  17. 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

    2018-04-01

    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 augmented repairs (mean yield 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.

  18. Diagnostic Accuracy of a Self-Report Measure of Patellar Tendinopathy in Youth Basketball.

    Science.gov (United States)

    Owoeye, Oluwatoyosi B A; Wiley, J Preston; Walker, Richard E A; Palacios-Derflingher, Luz; Emery, Carolyn A

    2018-04-27

    Study Design Prospective diagnostic accuracy validation study. Background Engaging clinicians for diagnosis of patellar tendinopathy in large surveillance studies is often impracticable. A self-report measure, the Oslo Sports Research Trauma Centre patellar tendinopathy (OSTRC-P) Questionnaire, an adaptation of the OSTRC Questionnaire may provide a viable alternative. Objectives To evaluate the diagnostic accuracy of the OSTRC-P Questionnaire in detecting patellar tendinopathy in youth basketball players when compared to clinical evaluation. Methods Following the Standards for Reporting of Diagnostic Accuracy Studies guidelines, 208 youth basketball players (aged 13-18 years) were recruited. Participants completed the OSTRC-P Questionnaire (index test) prior to a clinical evaluation (reference standard) by a physiotherapist blinded to OSTRC-P Questionnaire results. Sensitivity, specificity, predictive values (PVs), likelihood ratios (LRs) and posttest probabilities were calculated. Linear regression was used to examine the association between OSTRC-P Questionnaire severity score and patellar tendinopathy severity rating during single leg decline squat (SLDS). Results The final analysis included 169 players. The OSTRC-P Questionnaire had a sensitivity of 79% (95%CI: 65%, 90%), specificity of 98% (95%CI: 94%, 100%), positive PV of 95%, negative PV of 92%, positive LR of 48 and negative LR of 0.21. The posttest probabilities were 95% and 8% given positive and negative results, respectively. A positive association was found between OSTRC-P Questionnaire and SLDS rating [(β = .08 (95%CI: .03, .12) (p = .001)]. Conclusions The OSTRC-P Questionnaire is an acceptable alternative to clinical evaluation for self-reporting patellar tendinopathy and grading its severity in settings involving youth basketball players. Level of Evidence Diagnosis, level 1b. J Orthop Sports Phys Ther, Epub 27 Apr 2018. doi:10.2519/jospt.2018.8088.

  19. Medial subtalar dislocation: Case report

    Directory of Open Access Journals (Sweden)

    Manojlović Radovan

    2010-01-01

    Full Text Available Introduction. Subtalar dislocation (SI is a term that refers to an injury in which there is dislocation of the talonavicular and talocalcanear joint, although the tibiotalar joint is intact. Case Outline. A case of medial subtalar dislocation as a result of basketball injury, so-called 'basketball foot', is presented. Closed reposition in i.v. anaesthesia was performed with the patient in supine position and a knee flexed at 90 degrees. Longitudinal manual traction in line of deformity was carried out in plantar flexion. The reposition continued with abduction and eversion simultaneously increasing dorsiflexion. It was made in the first attempt and completed instantly. Rehabilitation was initiated after 5 weeks of immobilization. One year after the injury, the functional outcome was excellent with full range of motion and the patient was symptom-free. For better interpretation of roentgenogram, bone model of subtalar dislocation was made using the cadaver bone. Conclusion. Although the treatment of such injury is usually successful, diagnosis can be difficult because it is a rare injury, and moreover, X-ray of the injury can be confusing due to superposition of bones. Radiograms revealed superposition of the calcaneus, tarsal and metatarsal bones which was radiographically visualized in the anterior-posterior projection as one osseous block inward from the talus, and on the lateral view as in an osteal block below the tibial bone. Prompt recognition of these injuries followed by proper, delicately closed reduction under anaesthesia is crucial for achieving a good functional result in case of medial subtalar dislocation.

  20. 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.

  1. Outside-In Deep Medial Collateral Ligament Release During Arthroscopic Medial Meniscus Surgery.

    Science.gov (United States)

    Todor, Adrian; Caterev, Sergiu; Nistor, Dan Viorel

    2016-08-01

    Arthroscopic partial medial meniscectomy is a very common orthopaedic procedure performed for symptomatic, irreparable meniscus tears. It is usually associated with a very good outcome and minimal complications. In some patients with tight medial compartment, the posterior horn of the medial meniscus can be difficult to visualize, and access in this area with instruments may be challenging. To increase the opening of the medial compartment, after valgus-extension stress position of the knee, different techniques of deep medial collateral ligament release have been described. The outside-in pie-crusting technique shown in this technical note has documented effectiveness and good outcomes with minimal or no morbidity.

  2. Spontaneous external gallbladder perforation

    International Nuclear Information System (INIS)

    Noeldge, G.; Wimmer, B.; Kirchner, R.

    1981-01-01

    Spontaneous perforation of the gallbladder is one complication of cholelithiasis. There is a greater occurence of free perforation in the peritoneal cavity with bilary pertonitis, followed by the perforation into the stomach, small intestine and colon. A single case of the nowadays rare spontaneous perforation in and through the abdominal wall will be reported. Spontaneous gallbladder perforation appears nearly asymptomatic in its clinical course because of absent biliary peritonitis. (orig.) [de

  3. Effectiveness of Shockwave Treatment Combined With Eccentric Training for Patellar Tendinopathy : A Double-Blinded Randomized Study

    NARCIS (Netherlands)

    Thijs, Karin M; Zwerver, Johannes; Backx, Frank J G; Steeneken, Victor; Rayer, Stephan; Groenenboom, Petra; Moen, Maarten H

    OBJECTIVE: To evaluate the effectiveness of a combined treatment of focused shockwave therapy (ESWT) and eccentric training compared with sham-shockwave therapy (placebo) and eccentric training in participants with patellar tendinopathy (PT) after 24 weeks. DESIGN: Randomized controlled trial.

  4. Effectiveness of Shockwave Treatment Combined With Eccentric Training for Patellar Tendinopathy : A Double-Blinded Randomized Study

    NARCIS (Netherlands)

    Thijs, Karin M.; Zwerver, Johannes; Backx, Frank J. G.; Steeneken, Victor; Rayer, Stephan; Groenenboom, Petra; Moen, Maarten H.

    2017-01-01

    OBJECTIVE: To evaluate the effectiveness of a combined treatment of focused shockwave therapy (ESWT) and eccentric training compared with sham-shockwave therapy (placebo) and eccentric training in participants with patellar tendinopathy (PT) after 24 weeks. DESIGN: Randomized controlled trial.

  5. Peritonitis - spontaneous bacterial

    Science.gov (United States)

    Spontaneous bacterial peritonitis (SBP); Ascites - peritonitis; Cirrhosis - peritonitis ... who are on peritoneal dialysis for kidney failure. Peritonitis may have other causes . These include infection from ...

  6. 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 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 = 0.00). The

  7. 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.

  8. In-vivo patellar tracking in individuals with patellofemoral pain and healthy individuals.

    Science.gov (United States)

    Esfandiarpour, Fateme; Lebrun, Constance M; Dhillon, Sukhvinder; Boulanger, Pierre

    2018-02-28

    Understanding of the exact cause of patellofemoral pain has been limited by methodological challenges to evaluate in-vivo joint motion. This study compared six degree-of-freedom patellar motion during a dynamic lunge task between individuals with patellofemoral pain and healthy individuals. Knee joints of eight females with patellofemoral pain and ten healthy females were imaged using a CT scanner in supine lying position, then by a dual-orthogonal fluoroscope while they performed a lunge. To quantify patellar motion, the three-dimensional models of the knee bones, reconstructed from CT scans, were registered on the fluoroscopy images using the Fluomotion registration software. At full knee extension, the patella was in a significantly laterally tilted (PFP: 11.77° ± 7.58° vs. healthy: 0.86° ± 4.90°; p = 0.002) and superiorly shifted (PFP: 17.49 ± 8.44 mm vs. healthy: 9.47 ± 6.16 mm, p = 0. 033) position in the patellofemoral pain group compared with the healthy group. There were also significant differences between the groups for patellar tilt at 45°, 60°, and 75° of knee flexion, and for superior-inferior shift of the patella at 30° flexion (p ≤ 0.031). In the non-weight-bearing knee extended position, the patella was in a significantly laterally tilted position in the patellofemoral pain group (7.44° ± 6.53°) compared with the healthy group (0.71° ± 4.99°). These findings suggest the critical role of passive and active patellar stabilizers as potential causative factors for patellar malalignment/maltracking. Future studies should investigate the associations between patellar kinematics with joint morphology, muscle activity, and tendon function in a same sample for a thorough understanding of the causes of patellofemoral pain. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  9. Spontaneous intracranial hypotension.

    LENUS (Irish Health Repository)

    Fullam, L

    2012-01-31

    INTRODUCTION: Spontaneous\\/primary intracranial hypotension is characterised by orthostatic headache and is associated with characteristic magnetic resonance imaging findings. CASE REPORT: We present a case report of a patient with typical symptoms and classical radiological images. DISCUSSION: Spontaneous intracranial hypotension is an under-recognised cause of headache and can be diagnosed by history of typical orthostatic headache and findings on MRI brain.

  10. Are unilateral and bilateral patellar tendinopathy distinguished by differences in anthropometry, body composition, or muscle strength in elite female basketball players?

    OpenAIRE

    Gaida, J; Cook, J; Bass, S; Austen, S; Kiss, Z

    2004-01-01

    Background: Overuse injury to the patellar tendon (patellar tendinopathy) is a major reason for interrupted training and competition for elite athletes. In both sexes, the prevalence of unilateral and bilateral tendinopathy has been shown to differ. It has been proposed that bilateral pathology may have a different aetiology from unilateral pathology. Investigation of risk factors that may be unique to unilateral and bilateral patellar tendinopathy in female athletes may reveal insights into ...

  11. The TOPSHOCK study: Effectiveness of radial shockwave therapy compared to focused shockwave therapy for treating patellar tendinopath - design of a randomised controlled trial

    OpenAIRE

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

    2011-01-01

    Abstract Background Patellar tendinopathy is a chronic overuse injury of the patellar tendon that is especially prevalent in people who are involved in jumping activities. Extracorporeal Shockwave Therapy is a relatively new treatment modality for tendinopathies. It seems to be a safe and promising part of the rehabilitation program for patellar tendinopathy. Extracorporeal Shockwave Therapy originally used focused shockwaves. Several years ago a new kind of shockwave therapy was introduced: ...

  12. Endoscopic medial maxillectomy breaking new frontiers.

    Science.gov (United States)

    Mohanty, Sanjeev; Gopinath, M

    2013-07-01

    Endoscopy has changed the perspective of rhinologist towards the nose. It has revolutionised the surgical management of sinonasal disorders. Sinus surgeries were the first to get the benefit of endoscope. Gradually the domain of endoscopic surgery extended to the management of sino nasal tumours. Traditionally medial maxillectomy was performed through lateral rhinotomy or mid facial degloving approach. Endoscopic medial maxillectomy has been advocated by a number of authors in the management of benign sino-nasal tumours. We present our experience of endoscopic medial maxillectomy in the management of sinonasal pathologies.

  13. Complex Medial Meniscus Tears Are Associated With a Biconcave Medial Tibial Plateau.

    Science.gov (United States)

    Barber, F Alan; Getelman, Mark H; Berry, Kathy L

    2017-04-01

    To determine whether an association exists between a biconcave medial tibial plateau and complex medial meniscus tears. A consecutive series of stable knees undergoing arthroscopy were evaluated retrospectively with the use of preoperative magnetic resonance imaging (MRI), radiographs, and arthroscopy documented by intraoperative videos. Investigators independently performed blinded reviews of the MRI or videos. Based on the arthroscopy findings, medial tibial plateaus were classified as either biconcave or not biconcave. A transverse coronal plane ridge, separating the front of the tibial plateau from the back near the inner margin of the posterior body of the medial meniscus, was defined as biconcave. The medial plateau slope was calculated with MRI sagittal views. General demographic information, body mass index, and arthroscopically confirmed knee pathology were recorded. A total of 179 consecutive knees were studied from July 2014 through August 2015; 49 (27.2%) biconcave medial tibial plateaus and 130 (72.8%) controls were identified at arthroscopy. Complex medial meniscus tears were found in 103. Patients with a biconcave medial tibial plateau were found to have more complex medial meniscus tears (69.4%) than those without a biconcavity (53.1%) (P = .049) despite having lower body mass index (P = .020). No difference in medial tibial plateau slope was observed for biconcavities involving both cartilage and bone, bone only, or an indeterminate group (P = .47). Biconcave medial tibial plateaus were present in 27.4% of a consecutive series of patients undergoing knee arthroscopy. A biconcave medial tibial plateau was more frequently associated with a complex medial meniscus tear. Level III, case-control study. Copyright © 2016 Arthroscopy Association of North America. All rights reserved.

  14. Chondromalacia induced by patellar subluxation: morphological and morphometrical aspects in rabbits.

    Science.gov (United States)

    Sant'Anna, M M S; Apfel, M I R

    2002-01-01

    The purpose of this study was to describe morphologically and quantify the changes of the articular cartilage in chondromalacia, concerning both the chondrocytes and extracellular matrix. Eight rabbits were submitted daily to patellar subluxation, causing chondromalacia after two weeks. The knee fragments obtained were processed by the standard methods. These experimental conditions caused degenerative alterations of the articular cartilage, varying from a slight decrease of proteoglycans, to fibrillations, clefts, and horizontal splitting. The results showed a significantly increase number of chondrocytes (p < 0,000139), although smaller in size (p < 0,000109). The immobilization for 2 weeks and the intermittent passive daily motion afterwards for a period of 2 weeks, was effective to cause patellar chrondomalacia in rabbits.

  15. Tibial Tubercle Osteotomies: a Review of a Treatment for Recurrent Patellar Instability.

    Science.gov (United States)

    Grimm, Nathan L; Lazarides, Alexander L; Amendola, Annunziato

    2018-06-01

    The goal of this review is to provide an overview of current surgical treatment options for tibial tubercle osteotomies as a treatment for recurrent patellofemoral instability. As such we sought to provide the reader with the most current answers to why treatment practices have changed and how this has affected the outcome of surgical treatment for patellar instability. As our understanding of patellofemoral biomechanics have grown, appropriate surgical and non-surgical treatment options have followed suit to address these findings. A clear understanding of the pathomechanics causing the patient's patellar instability is germane to choosing the most appropriate surgical intervention to address this instability. Likewise, understanding the goal of the intervention chosen-e.g., unloading, realignment-is paramount. These surgical techniques may be technically challenging and surgical specialists with experience in these techniques are recommended for optimal outcomes.

  16. Prospective imaging study of asymptomatic patellar tendinopathy in elite junior basketball players.

    Science.gov (United States)

    Cook, J L; Khan, K M; Kiss, Z S; Purdam, C R; Griffiths, L

    2000-07-01

    To evaluate the ability of ultrasonography to predict eventual symptoms in an at-risk population, 52 elite junior basketball players' patellar tendons were studied at baseline and again 16 months later. The group consisted of 10 study tendons (ultrasonographically hypoechoic at baseline) and 42 control tendons (ultrasonographically normal at baseline). By design, all tendons were asymptomatic at baseline. No differences were noted between subjects and controls at baseline for age, height, weight, training hours, and vertical jump. Functional (P patellar tendon changes may resolve, but this is not necessary for an athlete to become asymptomatic. Qualitative or quantitative analysis of baseline ultrasonographic images revealed it was not possible to predict which tendons would develop symptoms or resolve ultrasonographically.

  17. 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

    were higher in OM than in YM (73 +/- 13 vs. 11 +/- 2 mmol/mol; P appreciably influence the dimensions or mechanical properties of the human patellar tendon in vivo. Collagen concentration was reduced, whereas both enzymatic......Age-related loss in muscle mass and strength impairs daily life function in the elderly. However, it remains unknown whether tendon properties also deteriorate with age. Cross-linking of collagen molecules provides structural integrity to the tendon fibrils and has been shown to change with age...... 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...

  18. 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 properties...... assessed symptoms/function and maximal tendon pain during activity. Tendon biopsy samples were analyzed for fibril density, volume fraction, and mean fibril area. Tendon mechanical properties were assessed using force and ultrasonography samplings. RESULTS: Patients improved in symptoms/function (P = .02...... area decreased (-26% +/- 21%, P = .04) in tendinopathic tendons after HSR. CONCLUSION: Fibril morphology is abnormal in tendinopathy, but tendon mechanical properties are not. Clinical improvements after HSR were associated with changes in fibril morphology toward normal fibril density and mean fibril...

  19. Mechanical Properties of Human Patellar Tendon at the Hierarchical levels of Tendon and Fibril

    DEFF Research Database (Denmark)

    Svensson, Rene Brüggebusch; Hansen, Philip; Hassenkam, Tue

    2012-01-01

    Tendons are strong hierarchical structures, but how tensile forces are transmitted between different levels remains incompletely understood. Collagen fibrils are thought to be primary determinants of whole tendon properties, and therefore we hypothesized that the whole human patellar tendon and its...... distinct collagen fibrils would display similar mechanical properties. Human patellar tendons (n=5) were mechanically tested in vivo by ultrasonography. Biopsies were obtained from each tendon and individual collagen fibrils were dissected and tested mechanically by atomic force microscopy. The Young...... that of tendon supports that fibrillar rather than interfibrillar properties govern sub-failure tendon response, making the fibrillar level a meaningful target of intervention. The lower modulus found in vitro suggests a possible adverse effect of removing the tissue from its natural environment. In addition...

  20. 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.

  1. [Tibial periostitis ("medial tibial stress syndrome")].

    Science.gov (United States)

    Fournier, Pierre-Etienne

    2003-06-01

    Medial tibial stress syndrome is characterised by complaints along the posteromedial tibia. Runners and athletes involved in jumping activities may develop this syndrome. Increased stress to stabilize the foot especially when excessive pronation is present explain the occurrence this lesion.

  2. Eccentric Exercise in Treatment of Patellar Tendinopathy in High Level Basketball Players. A Randomized Clinical Trial.

    OpenAIRE

    Sosa, Carlos; Lorenzo Calvo, Alberto; Jiménez, Sergio L.; Bonfanti, Noelia

    2014-01-01

    Chronic patellar tendinopathy is a common pathology in sporting population. To date, there is no agreed upon protocol as election treatment. Eccentric exercises have been used with satisfactory outcomes. The purpose of this trial is compare the effects of two eccentric exercise protocols. 0.146 SJR (2014) Q4, 199/231 Health (social science), 131/169 Physical therapy, sports therapy and rehabilitation, 119/128 Sports sciences UEM

  3. Psychometric properties of a Swedish translation of the VISA-P outcome score for patellar tendinopathy

    OpenAIRE

    Frohm, Anna; Saartok, Tönu; Edman, Gunnar; Renström, Per

    2004-01-01

    Abstract Background Self-administrated patient outcome scores are increasingly recommended for evaluation of primary outcome in clinical studies. The VISA-P score, developed at the Victorian Institute of Sport Assessment in Melbourne, Australia, is a questionnaire developed for patients with patellar tendinopathy and the patients assess severity of symptoms, function and ability to participate in sport. The aim of this study was to translate the questionnaire into Swedish and to study the rel...

  4. The patellar tendon in junior elite volleyball players and an Olympic elite weightlifter

    OpenAIRE

    Gisslén, Karl

    2006-01-01

    The principal aim of the present thesis was to prospectively follow (clinical status and ultrasound + Doppler findings) the patellar tendons in the young elite volleyball players at the Swedish National Centre for high school volleyball in Falköping. In an Olympic weightlifter with chronic painful jumper´s knee, the effects of treatment with sclerosing injections followed by early instituted very heavy weightlifting training, was also evaluated. First, in a prevalence study, we demonstrated t...

  5. Effect of eccentric exercise on the healing process of injured patellar tendon in rats

    OpenAIRE

    Nakamura, Kenichi; Kitaoka, Katsuhiko; Tomita, Katsuro

    2008-01-01

    Background. Earlier studies have reported positive results from eccentric training in patients with tendon disorders. The reasons for the beneficial clinical effects of eccentric training are not known. Vascularization followed by regression of the vasculature enhances the healing response of injured tendons. Eccentric exercise induces a more beneficial healing response than concentric exercise. Methods. Sixty rats with patellar tendon injuries were divided into three groups: nonexercise cont...

  6. Evaluation and Management of Patellar Instability in Pediatric and Adolescent Athletes

    OpenAIRE

    Khormaee, Sariah; Kramer, Dennis E.; Yen, Yi-Meng; Heyworth, Benton E.

    2015-01-01

    Context: The rising popularity and intensity of youth sports has increased the incidence of patellar dislocation. These sports-related injuries may be associated with significant morbidity in the pediatric population. Treatment requires understanding and attention to the unique challenges in the skeletally immature patient. Evidence Acquisition: PubMed searches spanning 1970-2013. Study Design: Clinical review. Level of Evidence: Level 5. Results: Although nonoperative approaches are most oft...

  7. MRI evaluation of the patellar articular cartilage in patients with subluxation of the patella

    Energy Technology Data Exchange (ETDEWEB)

    Nakanishi, Katsuyuki; Inoue, Masahiro; Harada, Koushi; Murakami, Takamichi; Kim, Shougen; Fujita, Norihiko; Sakurai, Kousuke; Kozuka, Takahiro (Osaka Univ. (Japan). Faculty of Medicine)

    1991-04-01

    In patients with subluxation of the patella, injury of the patellar articular cartilage is frequently observed and correct evaluation is important to manage these patients. We examined 11 patients with subluxation of the patella and five normal volunteers. In 12 patellofemoral joints of seven patients with subluxation of the patella, the abnormalities observed on MRI were compared with those on arthroscopy and/or at operation. MRI was performed with a Magnetom 1.5 T (Siemens) using the round surface coil. Pulse sequences were SE (TR 400 ms/TE 19 ms), FLASH(TR 320 ms/TE 15 ms FA 90deg and 40deg), and SE (TR 2000 ms/TE 26, 70 ms). We analysed MR findings of the 12 abnormal joints and 10 normal joints according to the following classification of abnormalities observed on arthroscopy; normal appearance (n=3 joints), softening and fibrillation (n=6), fragmentation (n=3), and erosion to bone (n=0). In only one of the six cases with softening and fibrillation observed on arthroscopy, MRI could visualize the thickening of patellar articular cartilage, but in all three cases with fragmentation observed on arthroscopy, MRI could visualize the thin inhomogeneous cartilage with irregular surface. The combination of SE (TR 400 ms/TE 19 ms) and FLASH (TR 320 ms/TE 15 ms FA 90deg) are extremely effective pulse sequence to detect the abnormalities of patellar articular cartilage. We conclude that MRI is a useful noninvasive method of detecting advanced changes in patellar articular cartilage. (author).

  8. MRI evaluation of the patellar articular cartilage in patients with subluxation of the patella

    International Nuclear Information System (INIS)

    Nakanishi, Katsuyuki; Inoue, Masahiro; Harada, Koushi; Murakami, Takamichi; Kim, Shougen; Fujita, Norihiko; Sakurai, Kousuke; Kozuka, Takahiro

    1991-01-01

    In patients with subluxation of the patella, injury of the patellar articular cartilage is frequently observed and correct evaluation is important to manage these patients. We examined 11 patients with subluxation of the patella and five normal volunteers. In 12 patellofemoral joints of seven patients with subluxation of the patella, the abnormalities observed on MRI were compared with those on arthroscopy and/or at operation. MRI was performed with a Magnetom 1.5 T (Siemens) using the round surface coil. Pulse sequences were SE (TR 400 ms/TE 19 ms), FLASH(TR 320 ms/TE 15 ms FA 90deg and 40deg), and SE (TR 2000 ms/TE 26, 70 ms). We analysed MR findings of the 12 abnormal joints and 10 normal joints according to the following classification of abnormalities observed on arthroscopy; normal appearance (n=3 joints), softening and fibrillation (n=6), fragmentation (n=3), and erosion to bone (n=0). In only one of the six cases with softening and fibrillation observed on arthroscopy, MRI could visualize the thickening of patellar articular cartilage, but in all three cases with fragmentation observed on arthroscopy, MRI could visualize the thin inhomogeneous cartilage with irregular surface. The combination of SE (TR 400 ms/TE 19 ms) and FLASH (TR 320 ms/TE 15 ms FA 90deg) are extremely effective pulse sequence to detect the abnormalities of patellar articular cartilage. We conclude that MRI is a useful noninvasive method of detecting advanced changes in patellar articular cartilage. (author)

  9. Endoscopic Medial Maxillectomy Breaking New Frontiers

    OpenAIRE

    Mohanty, Sanjeev; Gopinath, M.

    2011-01-01

    Endoscopy has changed the perspective of rhinologist towards the nose. It has revolutionised the surgical management of sinonasal disorders. Sinus surgeries were the first to get the benefit of endoscope. Gradually the domain of endoscopic surgery extended to the management of sino nasal tumours. Traditionally medial maxillectomy was performed through lateral rhinotomy or mid facial degloving approach. Endoscopic medial maxillectomy has been advocated by a number of authors in the management ...

  10. The relationship between chondromalacia patella, medial meniscal tear and medial periarticular bursitis in patients with osteoarthritis

    OpenAIRE

    Resorlu Mustafa; Doner Davut; Karatag Ozan; Toprak Canan Akgun

    2017-01-01

    Abstract Background This study investigated the presence of bursitis in the medial compartment of the knee (pes anserine, semimembranosus-tibial collateral ligament, and medial collateral ligament bursa) in osteoarthritis, chondromalacia patella and medial meniscal tears. Patients and methods Radiological findings of 100 patients undergoing magnetic resonance imaging with a preliminary diagnosis of knee pain were retrospectively evaluated by two radiologists. The first radiologist assessed al...

  11. Ultrasound-guided sclerosis of neovessels in painful chronic patellar tendinopathy: a randomized controlled trial.

    Science.gov (United States)

    Hoksrud, Aasne; Ohberg, Lars; Alfredson, Håkan; Bahr, Roald

    2006-11-01

    Color Doppler ultrasound examination frequently reveals neovascularization in chronic painful Achilles and patellar tendinopathy. Sclerosing the area with vascular ingrowth using polidocanol has shown promising clinical results in patients with Achilles tendinopathy. To investigate sclerosing treatment using polidocanol on a group of elite athletes with patellar tendinopathy. Randomized controlled trial/cross-over study; Level of evidence, 1. The authors recruited 33 patients (42 tendons), mainly from the Norwegian elite divisions in basketball, team handball, and volleyball. Seventeen patients (23 knees) were randomized to the treatment group (polidocanol injections in the area of neovascularization) and 16 patients (20 knees) to the control group (similar injections with lidocaine/epinephrine). After 4 months of treatment, the control group was crossed over to active treatment. Pain and function were recorded using the Victorian Institute of Sport Assessment score before the start of treatment and 4, 8, and 12 months after the first injection. Victorian Institute of Sport Assessment scores between groups were compared using multivariate analysis of variance for repeated measures. The treatment group reported a significant improvement in Victorian Institute of Sport Assessment score from 51 to 62 after 4 months; there was no change for the control group (group by time interaction, P = .052). After 8 months, when the control group had also received active treatment with polidocanol, they had a greater improvement in Victorian Institute of Sport Assessment score (58-79) than did the treatment group (54-70; group by time interaction, P = .022; time effect, P patellar tendinopathy.

  12. 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.

  13. 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.

  14. 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.

  15. Description of patellar movement by 3D parameters obtained from dynamic CT acquisition

    Science.gov (United States)

    de Sá Rebelo, Marina; Moreno, Ramon Alfredo; Gobbi, Riccardo Gomes; Camanho, Gilberto Luis; de Ávila, Luiz Francisco Rodrigues; Demange, Marco Kawamura; Pecora, Jose Ricardo; Gutierrez, Marco Antonio

    2014-03-01

    The patellofemoral joint is critical in the biomechanics of the knee. The patellofemoral instability is one condition that generates pain, functional impairment and often requires surgery as part of orthopedic treatment. The analysis of the patellofemoral dynamics has been performed by several medical image modalities. The clinical parameters assessed are mainly based on 2D measurements, such as the patellar tilt angle and the lateral shift among others. Besides, the acquisition protocols are mostly performed with the leg laid static at fixed angles. The use of helical multi slice CT scanner can allow the capture and display of the joint's movement performed actively by the patient. However, the orthopedic applications of this scanner have not yet been standardized or widespread. In this work we present a method to evaluate the biomechanics of the patellofemoral joint during active contraction using multi slice CT images. This approach can greatly improve the analysis of patellar instability by displaying the physiology during muscle contraction. The movement was evaluated by computing its 3D displacements and rotations from different knee angles. The first processing step registered the images in both angles based on the femuŕs position. The transformation matrix of the patella from the images was then calculated, which provided the rotations and translations performed by the patella from its position in the first image to its position in the second image. Analysis of these parameters for all frames provided real 3D information about the patellar displacement.

  16. [Simultaneous Traumatic Rupture of Patellar Ligament and Contralateral Rupture of Quadriceps Femoris Muscle].

    Science.gov (United States)

    Hladký, V; Havlas, V

    2017-01-01

    Our paper presents a unique case of a 64-year-old patient after a fall, treated with oral antidiabetic drugs for type II diabetes mellitus. Following a series of examinations, a bilateral injury was diagnosed - patellar ligament tear on the right side and rupture of quadriceps femoris muscle on the left side. It is a rare injury, complicated by simultaneous involvement of both knee joints. The used therapy consisted of a bilateral surgery followed by gradual verticalisation, first with the support of a walking frame and later with the use of forearm crutches. During the final examination, the patient demonstrated full flexion at both knees, while an extension deficit of approx. 5 degrees was still present on the left side. The right knee X-ray showed a proper position of the patella after the removal of temporary tension band wire. Although the clinical results of operative treatment of both the patellar ligament rupture and rupture of quadriceps femoris muscle are in most cases good, early operative treatment, proper technique and post-operative rehabilitation are a prerequisite for success. Key words: knee injuries, patellar ligament, quadriceps muscle, rupture.

  17. Endoscopic bursectomy for the treatment of septic pre-patellar bursitis: a case series.

    Science.gov (United States)

    Dillon, John P; Freedman, Ilan; Tan, James S M; Mitchell, David; English, Shaun

    2012-07-01

    Operative treatment for septic pre-patellar bursitis generally involves open debridement in addition to an extended course of intravenous antibiotics. Skin necrosis and wound breakdown are potential complications of this procedure in addition to scar sensitivity and a prolonged recovery. We report endoscopic bursectomy for the treatment of septic pre-patellar bursitis in eight patients over a 3-year period. All patients had microbiological confirmation of an infective process. The average age was 36 years (23-68 years). The average hospital stay was 6 days (4-9 days). No patient had a recurrence or complained of tenderness or hypoaesthesia around their wound. No patient experienced wound complications or skin necrosis. The average return to work time was 18 days (7-22 days). We conclude that endoscopic bursectomy is a safe and effective treatment for septic pre-patellar bursitis with a shortened hospital stay and a quicker return to work than conventional open debridement.

  18. Comparison of surface coil and knee coil for evaluation of the patellar cartilage by MR imaging

    International Nuclear Information System (INIS)

    Steen, M. van den; Maeseneer, M. de; Hoste, M.; Vanderdood, K.; Ridder, F. de; Osteaux, M.

    2003-01-01

    Purpose: The aim of this work was to compare the knee coil and the surface coil for the visualisation of the patellar cartilage. Materials and methods: In 28 patients (17 women, 11 men) with an average age of 40 years (range 14-76) with knee pain MR was performed. Transverse images were obtained using a fast spin echo proton density weighted sequence on a Philips Gyroscan Intera 1.5 T clinical system. Transverse images were obtained at the level of the patellar cartilage using both the surface and the knee coil. All images were evaluated by consensus of two radiologists. They evaluated a number of quality criteria on a 4-point scale. Criteria for artefacts were also graded on a 4-point scale. Results: For the visualisation of fluid there was no significant difference between the knee coil and the surface coil (P=0.021). For all other criteria regarding image quality and presence of imaging artefacts there was a significant difference between both coils (P<0.001) with the surface coil obtaining the better result. Conclusion: The use of the surface coil in the visualisation of the patellar cartilage can be recommended at knee MR

  19. UMAPRM: Uniformly sampling the medial axis

    KAUST Repository

    Yeh, Hsin-Yi Cindy

    2014-05-01

    © 2014 IEEE. Maintaining clearance, or distance from obstacles, is a vital component of successful motion planning algorithms. Maintaining high clearance often creates safer paths for robots. Contemporary sampling-based planning algorithms That utilize The medial axis, or The set of all points equidistant To Two or more obstacles, produce higher clearance paths. However, They are biased heavily Toward certain portions of The medial axis, sometimes ignoring parts critical To planning, e.g., specific Types of narrow passages. We introduce Uniform Medial Axis Probabilistic RoadMap (UMAPRM), a novel planning variant That generates samples uniformly on The medial axis of The free portion of Cspace. We Theoretically analyze The distribution generated by UMAPRM and show its uniformity. Our results show That UMAPRM\\'s distribution of samples along The medial axis is not only uniform but also preferable To other medial axis samplers in certain planning problems. We demonstrate That UMAPRM has negligible computational overhead over other sampling Techniques and can solve problems The others could not, e.g., a bug Trap. Finally, we demonstrate UMAPRM successfully generates higher clearance paths in The examples.

  20. Locoregional deformation pattern of the patellar cartilage after different loading types. High-resolution 3D-MRI volumetry at 3 T in-vivo

    International Nuclear Information System (INIS)

    Horng, Annie; Raya, J.; Klinikum der Ludwig-Maximilians-Universitaet Muenchen, Grosshadern; Zscharn, M.

    2011-01-01

    Purpose: To analyze locoregional deformation patterns indicative of contact areas in patellar cartilage after different loading exercises. Materials and Methods: 7 healthy patellae were examined in-vivo before and immediately after standardized loading (kneeling, squatting or knee bends) and after 90 minutes of rest using a sagittal 3D-T1-w FLASH WE sequence (22 msec/ 9.8msec/ 15 / 0.3 x 0.3 x 1.5 mm 3 ) at 3 T. After cartilage segmentation and 3D reconstruction, voxel-based and global precision errors (PR) were calculated. The former were used to determine significant differences in local cartilage thickness. Voxel-based 2σ-thickness difference maps were calculated to visualize locoregional deformation patterns. Global changes in volume (Vol), mean thickness (mTh) and cartilage-bone-interface area (CBIA) were calculated. Results: The voxel-based PR depended on cartilage thickness (D) ranging from 0.12 - 0.35 mm. For D ≥ 1 mm the RF was 3 (2.4 %) for Vol, 0.06 mm (2.0 %) for mTh and 16 mm 2 (1.4 %) for CBIA. The focal cartilage deformation equaled 14 % of the local thickness reduction. The deformation areas were oval and located in the peripheral medial (more vertically oriented, all exercises) and caudo-lateral (more horizontally oriented, kneeling and knee bends) aspects of the patella and were least pronounced in knee bends. Significant changes for Vol/mTh ranged from 2.1 to 3.7 %. Conclusion: This MRI-based study is the first to identify in-vivo voxel-based patellar cartilage deformation patterns indicating contact and loading zones after kneeling and squatting. These zones are anatomically and functionally plausible and may represent areas where stress induced degeneration and subsequent OA can originate. The data may facilitate understanding of individual knee loading properties and help to improve and validate biomechanical models for the knee. (orig.)

  1. Fear Expression Suppresses Medial Prefrontal Cortical Firing in Rats.

    Directory of Open Access Journals (Sweden)

    Thomas F Giustino

    Full Text Available The medial prefrontal cortex (mPFC plays a crucial role in emotional learning and memory in rodents and humans. While many studies suggest a differential role for the prelimbic (PL and infralimbic (IL subdivisions of mPFC, few have considered the relationship between neural activity in these two brain regions recorded simultaneously in behaving animals. Importantly, how concurrent PL and IL activity relate to conditioned freezing behavior is largely unknown. Here we used single-unit recordings targeting PL and IL in awake, behaving rats during the acquisition and expression of conditioned fear. On Day 1, rats received either signaled or unsignaled footshocks in the recording chamber; an auditory conditioned stimulus (CS preceded signaled footshocks. Twenty-four hours later, animals were returned to the recording chamber (modified to create a novel context where they received 5 CS-alone trials. After fear conditioning, both signaled and unsignaled rats exhibited high levels of post-shock freezing that was associated with an enduring suppression of mPFC spontaneous firing, particularly in the IL of signaled rats. Twenty-four hours later, CS presentation produced differential conditioned freezing in signaled and unsignaled rats: freezing increased in rats that had received signaled shocks, but decreased in animals in the unsignaled condition (i.e., external inhibition. This group difference in CS-evoked freezing was mirrored in the spontaneous firing rate of neurons in both PL and IL. Interestingly, differences in PL and IL firing rate highly correlated with freezing levels. In other words, in the signaled group IL spontaneous rates were suppressed relative to PL, perhaps limiting IL-mediated suppression of fear and allowing PL activity to dominate performance, resulting in high levels of freezing. This was not observed in the unsignaled group, which exhibited low freezing. These data reveal that the activity of mPFC neurons is modulated by both

  2. Magnetic resonance imaging-based morphological and alignment assessment of the patellofemoral joint and its relationship to proximal patellar tendinopathy

    Energy Technology Data Exchange (ETDEWEB)

    Crema, Michel D. [Hospital do Coracao (HCor) and Teleimagem, Department of Radiology, Sao Paulo, SP (Brazil); University Paris VI, Department of Radiology, Hopital Saint-Antoine, Paris (France); Boston University School of Medicine, Department of Radiology, Quantitative Imaging Center, Boston, MA (United States); Cortinas, Larissa G.; Lima, Giovanni B.P.; Skaf, Abdalla Y. [Hospital do Coracao (HCor) and Teleimagem, Department of Radiology, Sao Paulo, SP (Brazil); Abdalla, Rene Jorge; McNeill Ingham, Sheila Jean [Federal University of Sao Paulo, Department of Orthopaedic Surgery, School of Medicine, Sao Paulo (Brazil); Hospital do Coracao (HCor), Knee Institute, Sao Paulo, SP (Brazil)

    2018-03-15

    To assess the differences in morphology and alignment of the knee between patients with proximal patellar tendinopathy (PPT) and a control group, using MRI and focusing on the patellofemoral joint. We retrospectively included 35 patients with clinically diagnosed and unequivocal findings of PPT on knee MRI, the case group. For the control group, we included 70 patients who underwent knee MRI for other reasons, with no clinical or MRI evidence of PPT. Patients and controls were matched for age and gender, with all subjects reporting frequent physical activity. MRIs were evaluated by two musculoskeletal radiologists, who assessed parameters of patellar morphology, trochlear morphology, patellofemoral alignment, and tibiofemoral alignment. The differences in parameters between cases and controls were assessed using Student's t test. Logistic regression was applied to assess the associations between the MRI parameters and the presence of PPT. The patellar height Insall-Salvati ratio was different between cases and controls (1.37 ± 0.21 vs. 1.24 ± 0.19; p = 0.003). The subchondral Wiberg angle was higher in cases than controls (136.8 ± 7.4 vs. 131.7 ± 8.8; p = 0.004). After applying logistic regression, significant associations with PPT were found [odds ratios (95% CI)] for patellar morphology [1.1 (1.0, 1.2)] and patellar height [1.3 (1.0, 1.7)]. Patellar height and the subchondral patellar Wiberg angle were greater in patients with PPT and significantly associated with PPT. (orig.)

  3. Magnetic resonance imaging-based morphological and alignment assessment of the patellofemoral joint and its relationship to proximal patellar tendinopathy

    International Nuclear Information System (INIS)

    Crema, Michel D.; Cortinas, Larissa G.; Lima, Giovanni B.P.; Skaf, Abdalla Y.; Abdalla, Rene Jorge; McNeill Ingham, Sheila Jean

    2018-01-01

    To assess the differences in morphology and alignment of the knee between patients with proximal patellar tendinopathy (PPT) and a control group, using MRI and focusing on the patellofemoral joint. We retrospectively included 35 patients with clinically diagnosed and unequivocal findings of PPT on knee MRI, the case group. For the control group, we included 70 patients who underwent knee MRI for other reasons, with no clinical or MRI evidence of PPT. Patients and controls were matched for age and gender, with all subjects reporting frequent physical activity. MRIs were evaluated by two musculoskeletal radiologists, who assessed parameters of patellar morphology, trochlear morphology, patellofemoral alignment, and tibiofemoral alignment. The differences in parameters between cases and controls were assessed using Student's t test. Logistic regression was applied to assess the associations between the MRI parameters and the presence of PPT. The patellar height Insall-Salvati ratio was different between cases and controls (1.37 ± 0.21 vs. 1.24 ± 0.19; p = 0.003). The subchondral Wiberg angle was higher in cases than controls (136.8 ± 7.4 vs. 131.7 ± 8.8; p = 0.004). After applying logistic regression, significant associations with PPT were found [odds ratios (95% CI)] for patellar morphology [1.1 (1.0, 1.2)] and patellar height [1.3 (1.0, 1.7)]. Patellar height and the subchondral patellar Wiberg angle were greater in patients with PPT and significantly associated with PPT. (orig.)

  4. 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 training bout to a regular basketball and volleyball 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.

  5. T2 relaxation time in patellar cartilage - global and regional reproducibility at 1.5 Tesla and 3 Tesla

    International Nuclear Information System (INIS)

    Glaser, C.; Horng, A.; Mendlik, T.; Weckbach, S.; Hoffmann, R.T.; Wagner, S.; Raya, J.G.; Reiser, M.; Horger, W.

    2007-01-01

    Purpose: Evaluation of the global and regional reproducibility of T2 relaxation time in patellar cartilage at 1.5 T and 3 T. Materials and Methods: 6 left patellae of 6 healthy volunteers (aged 25-30, 3 female, 3 male) were examined using a fat-saturated multiecho sequence and a T1-w 3D-FLASH sequence with water excitation at 1.5 Tesla and 3 Tesla. Three consecutive data sets were acquired within one MRI session with the examined knee being repositioned in the coil and scanner between each data set. The segmented cartilage (FLASH sequence) was overlaid on the multiecho data and T2 values were calculated for the total cartilage, 3 horizontal layers consisting of a superficial, intermedial and deep layer, 3 facets consisting of a medial, median (ridge) and lateral facet (global T2 values) and 27 ROIs/MRI slices (regional T2 value). The reproducibility (precision error) was calculated as the root mean square average of the individual standard deviations [ms] and coefficients of variation (COV) [%]. Results: The mean global reproducibility error for T2 was 3.53% (±0.38%) at 1.5 Tesla and 3.25% (±0.61%) at 3 Tesla. The mean regional reproducibility error for T2 was 8.62% (±2.61%) at 1.5 Tesla and 9.66% (±3.37%) at 3 Tesla. There was no significant difference with respect to absolute reproducibility errors between 1.5 Tesla and 3 Tesla at a constant spatial resolution. However, different reproducibility errors were found between the cartilage layers. One third of the data variability could be attributed to the influence of the different cartilage layers, and another 10% to the influence of the separate MRI slices. Conclusion: Our data provides an estimation of the global and regional reproducibility errors of T2 in healthy cartilage. In the analysis of small subregions, an increase in the regional reproducibility error must be accepted. The data may serve as a basis for sample size calculations of study populations and may contribute to the decision regarding the

  6. COMPARISON OF FUNCTIONAL ACTIVITIES ON STRUCTURAL CHANGES OF THE INFERIOR PATELLAR POLE

    Science.gov (United States)

    Wallmann, Harvey; Stalcup, Patrick; DiTommaso, Katie

    2017-01-01

    Background It is well known that eccentric and concentric exercise produce varied amounts of stress on the connective tissues. Diagnostic ultrasound has been used to measure these structural changes by observing fascicle length, angle, and thickness; however, there is a lack of evidence comparing the structural changes as it relates to eccentric, concentric, and stretching protocols. Purpose The purpose of this study was to compare the acute effects of static stretching, eccentric, concentric, and a combination of eccentric/concentric exercises on structural changes of the muscle tendon unit at the inferior patellar pole utilizing the diagnostic ultrasound. Study Design A repeated measures 2 × 4 within factorial study design with repeated measures on both factors was used to determine the differences in patellar tendon thickness within and between groups. Methods Forty-seven healthy subjects were screened for any lower extremity deficits or orthopaedic pathology. Forty-four (N=44) subjects completed all four protocols; the attrition was due to injuries to the lower extremity, occurring unrelated to the study. A baseline measurement of the anterior inferior patellar tendon was performed with the diagnostic ultrasound prior to each participant completing one of the four interventions per week over a four-week period. Interventions completed by each participant included static stretching, concentric, eccentric, and combined concentric and eccentric exercises. Immediately following each intervention, a post-intervention inferior patellar tendon measurement was recorded using the diagnostic ultrasound. Results Significant differences in anterior to posterior tendon thickness of the inferior patellar tendon were observed between pre (4.983 ± 0.041mm) and post (5.198 ± 0.055mm) measurements (peffect of time. However, no differences in tendon thickness were noted comparing each intervention to one another (p=0.351). Conclusion Differences in tendon thickness

  7. Spontaneous mutation by mutagenic repair of spontaneous lesions in DNA

    International Nuclear Information System (INIS)

    Hastings, P.J.; Quah, S.-K.; Borstel, R.C. von

    1976-01-01

    It is stated that strains of yeast carrying mutations in many of the steps in pathways repairing radiation-induced damage to DNA have enhanced spontaneous mutation rates. Most strains isolated because they have enhanced spontaneous mutation carry mutations in DNA repair systems. This suggests that much spontaneous mutation arises by mutagenic repair of spontaneous lesions. (author)

  8. Clinical improvements are not explained by changes in tendon structure on UTC following an exercise program for patellar tendinopathy.

    Science.gov (United States)

    van Ark, Mathijs; Rio, Ebonie; Cook, Jill; van den Akker-Scheek, Inge; Gaida, James E; Zwerver, Johannes; Docking, Sean

    2018-04-11

    The aim of this study was to investigate the effects of a 4-week in-season exercise program of isometric or isotonic exercises on tendon structure and dimensions as quantified by Ultrasound Tissue Characterization (UTC). Randomized clinical trial. Volleyball and basketball players (16-31 years, n=29) with clinically diagnosed patellar tendinopathy were randomized to a 4-week isometric or isotonic exercise program. The programs were designed to decrease patellar tendon pain. A baseline and 4-week UTC scan was used to evaluate change in tendon structure. No significant change in tendon structure or dimensions on UTC was detected after the exercise program, despite patellar tendinopathy symptoms improving. The percentage and mean cross-sectional area (mCSA) of aligned fibrillar structure (echo-types I+II) (Z=-0.414,p=0.679) as well as disorganized structure (echo-types III + IV) (Z=-0.370,p=0.711) did not change over the 4-week exercise program. Change in tendon structure and dimensions on UTC did not differ significantly between the groups. Structural properties and dimensions of the patellar tendon on UTC did not change after a 4-week isometric or isotonic exercise program for athletes with patellar tendinopathy in-season, despite an improvement of symptoms. It seems that structural improvements are not required for a positive clinical outcome.

  9. Vertical Patellar Dislocation: Reduction by the Push Up and Rotate Method, A Case Report and Literature Review.

    Science.gov (United States)

    Ahmad Khan, Hayat; Bashir Shah, Adil; Kamal, Younis

    2016-11-01

    Patellar dislocation is an emergency. Vertical patellar dislocation is rare, often seen in adolescents and mostly due to sports injuries or high-velocity trauma. Few cases have been reported in the literature. Closed or open reduction under general anesthesia is often needed. We report a case of vertical locked patellar dislocation in a 26-year-old male, which was reduced by a simple closed method under spinal anaesthesia. A literature review regarding the various methods of treatment is also discussed. A 26-year-old male experienced a trivial accident while descending stairs, sustaining patellar dislocation. The closed method of reduction was attempted, using a simple technique. Reduction was confirmed and postoperative rehabilitation was started. Follow-up was uneventful. Vertical patellar dislocations are encountered rarely in the emergency department. Adolescents are not the only victims, and high-velocity trauma is not the essential cause. Unnecessary manipulation should be avoided. The closed reduction method is simple, but the surgeon should be prepared for open reduction.

  10. 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....

  11. The TOPSHOCK study : Effectiveness of radial shockwave therapy compared to focused shockwave therapy for treating patellar tendinopath - Design of a randomised controlled trial

    NARCIS (Netherlands)

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

    2011-01-01

    Background: Patellar tendinopathy is a chronic overuse injury of the patellar tendon that is especially prevalent in people who are involved in jumping activities. Extracorporeal Shockwave Therapy is a relatively new treatment modality for tendinopathies. It seems to be a safe and promising part of

  12. Definition of spontaneous reconnection

    International Nuclear Information System (INIS)

    Schindler, K.

    1984-01-01

    The author discusses his view of driven versus spontaneous. There is a close link between ''spontaneous'' and ''instability.'' One of the prominent examples for instability is the thermal convection instability. Just to remind you, if you heat a fluid layer from below, it takes a certain Rayleigh number to make it unstable. Beyond the onset point you find qualitatively new features. That is called ''spontaneous,'' and this is a bit more than semantics. It's a new qualitative property that appears and it is spontaneous although we have an energy flux through the system. It's a misconception, to call this ''driven'' pointing at the energy flux through it. Of course, the convection would not exist without this energy flux. But what makes it ''spontaneous'' is that without any particular external signal, a new qualitative feature appears. And this is what is called an ''instability'' and ''spontaneous.'' From these considerations the author got a little reassured of what distinction should be made in the field of the magnetosphere. If we have a smooth energy transport into the magnetosphere and suddenly we have this qualitatively new feature (change of B-topology) coming up; then, using this terminology we don't have a choice other than calling this spontaneous or unstable, if you like. If we ''tell'' the system where it should make its neutral line and where it should make its plasmoids, then, it is driven. And this provides a very clear-cut observational distinction. The author emphasizes the difference he sees is a qualitative difference, not only a quantitative one

  13. Case of spontaneous ventriculocisternostomy

    Energy Technology Data Exchange (ETDEWEB)

    Yamane, Kanji; Yoshimoto, Hisanori; Harada, Kiyoshi; Uozumi, Tohru [Hiroshima Univ. (Japan). School of Medicine; Kuwabara, Satoshi

    1983-05-01

    The authors experienced a case of spontaneous ventriculocisternostomy diagnosed by CT scan with metrizamide and Conray. Patient was 23-year-old male who had been in good health until one month before admission, when he began to have headache and tinnitus. He noticed bilateral visual acuity was decreased about one week before admission and vomiting appeared two days before admission. He was admitted to our hospital because of bilateral papilledema and remarkable hydrocephalus diagnosed by CT scan. On admission, no abnormal neurological signs except for bilateral papilledema were noted. Immediately, right ventricular drainage was performed. Pressure of the ventricle was over 300mmH/sub 2/O and CSF was clear. PVG and PEG disclosed an another cavity behind the third ventricle, which was communicated with the third ventricle, and occlusion of aqueduct of Sylvius. Metrizamide CT scan and Conray CT scan showed a communication between this cavity and quadrigeminal and supracerebellar cisterns. On these neuroradiological findings, the diagnosis of obstructive hydrocephalus due to benign aqueduct stenosis accompanied with spontaneous ventriculocisternostomy was obtained. Spontaneous ventriculocisternostomy was noticed to produce arrest of hydrocephalus, but with our case, spontaneous regression of such symptoms did not appeared. By surgical ventriculocisternostomy (method by Torkildsen, Dandy, or Scarff), arrest of hydrocephalus was seen in about 50 to 70 per cent, which was the same results as those of spontaneous ventriculocisternostomy. It is concluded that VP shunt or VA shunt is thought to be better treatment of obstructive hydrocephalus than the various kinds of surgical ventriculocisternostomy.

  14. 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......Millions of older individuals consume acetaminophen or ibuprofen daily and these same individuals are encouraged to participate in resistance training. Several in vitro studies suggest that cyclooxygenase-inhibiting drugs can alter tendon metabolism and may influence adaptations to resistance...... tendon properties were assessed with MRI [cross-sectional area (CSA) and signal intensity] and ultrasonography of patellar tendon deformation coupled with force measurements to obtain stiffness, modulus, stress, and strain. Mean patellar tendon CSA was unchanged (P > 0.05) with training in the placebo...

  15. Neovascularity in patellar tendinopathy and the response to eccentric training: a case report using Power Doppler ultrasound.

    Science.gov (United States)

    McCreesh, Karen M; Riley, Sara J; Crotty, James M

    2013-12-01

    This report describes the case of an amateur soccer player with chronic patellar tendinopathy who underwent ultrasound imaging before and after engaging in an 8-week programme of eccentric exercise. On initial assessment, greyscale ultrasound imaging demonstrated tendon thickening and reduced echogenicity, while Power Doppler imaging demonstrated a large amount of neovascularity. After 8 weeks of an eccentric loading programme, the patient reported significantly improved symptoms and functional scores, while follow-up imaging demonstrated improvement in the echo appearance of the tendon and complete resolution of the neovascularity. The association between neovascularity and symptoms in tendinopathy research is conflicting, with a paucity of research in the area of patellar tendinopathy. While further research is needed to clarify the significance of greyscale and Power Doppler ultrasound changes in relation to symptoms in patellar tendinopathy, ultrasound imaging was shown to be a useful adjunct to diagnosis and outcome assessment in this case. Copyright © 2012 Elsevier Ltd. All rights reserved.

  16. Successful conservative management of symptomatic bilateral dorsal patellar defects presenting with cartilage involvement and bone marrow edema: MRI findings

    International Nuclear Information System (INIS)

    Kwee, Thomas C.; Sonneveld, Heleen; Nix, Maarten

    2016-01-01

    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.)

  17. Successful conservative management of symptomatic bilateral dorsal patellar defects presenting with cartilage involvement and bone marrow edema: MRI findings.

    Science.gov (United States)

    Kwee, Thomas C; Sonneveld, Heleen; Nix, Maarten

    2016-05-01

    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.

  18. 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.)

  19. 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.)

  20. The reliability and validity of radiological assessment for patellar instability. A systematic review and meta-analysis

    International Nuclear Information System (INIS)

    Smith, Toby O.; Davies, Leigh; Toms, Andoni P.; Donell, Simon T.; Hing, Caroline B.

    2011-01-01

    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.)

  1. The Relationship between Chondromalacia Patella, Medial Meniscal Tear and Medial Periarticular Bursitis in Patients with Osteoarthritis.

    Science.gov (United States)

    Resorlu, Mustafa; Doner, Davut; Karatag, Ozan; Toprak, Canan Akgun

    2017-12-01

    This study investigated the presence of bursitis in the medial compartment of the knee (pes anserine, semimembranosus-tibial collateral ligament, and medial collateral ligament bursa) in osteoarthritis, chondromalacia patella and medial meniscal tears. Radiological findings of 100 patients undergoing magnetic resonance imaging with a preliminary diagnosis of knee pain were retrospectively evaluated by two radiologists. The first radiologist assessed all patients in terms of osteoarthritis, chondromalacia patella and medial meniscal tear. The second radiologist was blinded to these results and assessed the presence of bursitis in all patients. Mild osteoarthritis (grade I and II) was determined in 55 patients and severe osteoarthritis (grade III and IV) in 45 cases. At retropatellar cartilage evaluation, 25 patients were assessed as normal, while 29 patients were diagnosed with mild chondromalacia patella (grade I and II) and 46 with severe chondromalacia patella (grade III and IV). Medial meniscus tear was determined in 51 patients. Severe osteoarthritis and chondromalacia patella were positively correlated with meniscal tear (p chondromalacia patella (p = 0.023 and p = 0.479, respectively). Evaluation of lateral compartment bursae revealed lateral collateral ligament bursitis in 2 patients and iliotibial bursitis in 5 patients. We observed a greater prevalence of bursitis in the medial compartment of the knee in patients with severe osteoarthritis and medial meniscus tear.

  2. The Relationship between Chondromalacia Patella, Medial Meniscal Tear and Medial Periarticular Bursitis in Patients with Osteoarthritis

    Science.gov (United States)

    Doner, Davut; Karatag, Ozan; Toprak, Canan Akgun

    2017-01-01

    Abstract Background This study investigated the presence of bursitis in the medial compartment of the knee (pes anserine, semimembranosus-tibial collateral ligament, and medial collateral ligament bursa) in osteoarthritis, chondromalacia patella and medial meniscal tears. Patients and methods Radiological findings of 100 patients undergoing magnetic resonance imaging with a preliminary diagnosis of knee pain were retrospectively evaluated by two radiologists. The first radiologist assessed all patients in terms of osteoarthritis, chondromalacia patella and medial meniscal tear. The second radiologist was blinded to these results and assessed the presence of bursitis in all patients. Results Mild osteoarthritis (grade I and II) was determined in 55 patients and severe osteoarthritis (grade III and IV) in 45 cases. At retropatellar cartilage evaluation, 25 patients were assessed as normal, while 29 patients were diagnosed with mild chondromalacia patella (grade I and II) and 46 with severe chondromalacia patella (grade III and IV). Medial meniscus tear was determined in 51 patients. Severe osteoarthritis and chondromalacia patella were positively correlated with meniscal tear (p chondromalacia patella (p = 0.023 and p = 0.479, respectively). Evaluation of lateral compartment bursae revealed lateral collateral ligament bursitis in 2 patients and iliotibial bursitis in 5 patients. Conclusions We observed a greater prevalence of bursitis in the medial compartment of the knee in patients with severe osteoarthritis and medial meniscus tear. PMID:29333118

  3. Spontaneous tension haemopneumothorax.

    Science.gov (United States)

    Patterson, Benjamin Oliver; Itam, Sarah; Probst, Fey

    2008-10-31

    We present a patient with sudden onset progressive shortness of breath and no history of trauma, who rapidly became haemodynamically compromised with a pneumothorax and pleural effusion seen on chest radiograph. He was treated for spontaneous tension pneumothorax but this was soon revealed to be a tension haemopneumothorax. He underwent urgent thoracotomy after persistent bleeding to explore an apical vascular abnormality seen on CT scanning. To our knowledge this is the first such case reported.Aetiology and current approach to spontaneous haemothorax are discussed briefly.

  4. Spontaneous Atraumatic Mediastinal Hemorrhage

    Directory of Open Access Journals (Sweden)

    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.

  5. Spontaneous tension haemopneumothorax

    Directory of Open Access Journals (Sweden)

    Itam Sarah

    2008-10-01

    Full Text Available Abstract We present a patient with sudden onset progressive shortness of breath and no history of trauma, who rapidly became haemodynamically compromised with a pneumothorax and pleural effusion seen on chest radiograph. He was treated for spontaneous tension pneumothorax but this was soon revealed to be a tension haemopneumothorax. He underwent urgent thoracotomy after persistent bleeding to explore an apical vascular abnormality seen on CT scanning. To our knowledge this is the first such case reported. Aetiology and current approach to spontaneous haemothorax are discussed briefly.

  6. Trochleoplasty as a Solitary Treatment for Recurrent Patellar Dislocation Results in Good Clinical Outcome in Adolescents.

    Science.gov (United States)

    Camathias, Carlo; Studer, Katrin; Kiapour, Ata; Rutz, Erich; Vavken, Patrick

    2016-11-01

    The essential static patellar stabilizer is a normal-shaped trochlear groove. A dysplastic groove destabilizes the patella. Trochleoplasty approaches this underlying condition and reshapes the trochlea. However, studies have reported on trochleoplasty for revision cases or as accompanied by other interventions. The effect of trochleoplasty alone remains unexplained. To introduce trochleoplasty as a stand-alone treatment for recurrent patellar dislocation and to compare its pre- to postoperative functional and clinical variables. Case series; Level of evidence, 4. A trochleoplasty was performed in 50 knees (27 right) in 44 patients (30 females; mean ± SD age, 15.6 ± 2.0 years). The indication for surgery was recurrent patellar dislocation not responding to nonoperative treatment (>6 months), with types B through D dysplasia and closed or closing physes in adolescents aged 10 to 20 years. Assessment included J-sign and apprehension test, Kujala and Lysholm scores, patients' subjective assessment and activity level according to the International Knee Documentation Committee questionnaire, and patients' overall satisfaction. The Caton-Deschamps ratio and the lateral condyle index were measured. Pre- versus postoperative values were compared with a paired Wilcoxon signed-rank test. The minimum follow-up was 24 months (33 ± 10.6 months). The Kujala score improved from 71 preoperatively to 92 postoperatively (P debridement. In this study, trochleoplasty as a solitary treatment for recurrent patellofemoral dislocations in patients with trochlear dysplasia resulted in good clinical outcomes if severe torsional and axial malalignment was excluded. Kujala and Lysholm scores increased postoperatively, as well as subjective International Knee Documentation Committee assessment of outcomes, activity level, and overall satisfaction. © 2016 The Author(s).

  7. 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.

  8. [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.

  9. Medial structure generation for registration of anatomical structures

    DEFF Research Database (Denmark)

    Vera, Sergio; Gil, Debora; Kjer, Hans Martin

    2017-01-01

    structures. Methods for generation of medial structures, however, are prone to the generation of medial artifacts (spurious branches) that traditionally need to be pruned before the medial structure can be used for further computations. The act of pruning can affect main sections of the medial surface......Medial structures (skeletons and medial manifolds) have shown capacity to describe shape in a compact way. In the field of medical imaging, they have been employed to enrich the description of organ anatomy, to improve segmentation, or to describe the organ position in relation to surrounding...

  10. Chondropathia patellae - preoperative and postoperative demonstration of the patellar structure in plain roentgenography

    International Nuclear Information System (INIS)

    Schumacher, K.A.; Mutschler, W.; Bargon, G.

    1982-01-01

    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. (orig.) [de

  11. Effect of prostaglandin E2 injection on the structural properties of the rat patellar tendon

    Directory of Open Access Journals (Sweden)

    Ferry Scott T

    2012-01-01

    Full Text Available Abstract Background Increased tendon production of the inflammatory mediator prostaglandin E2 (PGE2 has been suggested to be a potential etiologic agent in the development of tendinopathy. Repeated injection of PGE2 into tendon has been proposed as a potential animal model for studying treatments for tendinopathy. In contrast, nonsteroidal anti-inflammatory drugs (NSAIDs which inhibit PGE2 production and are commonly prescribed in treating tendinopathy have been shown to impair the healing of tendon after acute injury in animal models. The contradictory literature suggests the need to better define the functional effects of PGE2 on tendon. Our objective was to characterize the effects of PGE2 injection on the biomechanical and biochemical properties of tendon and the activity of the animals. Our hypothesis was that weekly PGE2 injection to the rat patellar tendon would lead to inferior biomechanical properties. Methods Forty rats were divided equally into four groups. Three groups were followed for 4 weeks with the following peritendinous injection procedures: No injection (control, 4 weekly injections of saline (saline, 4 weekly injections of 800 ng PGE2 (PGE2-4 wks. The fourth group received 4 weekly injections of 800 ng PGE2 initially and was followed for a total of 8 weeks. All animals were injected bilaterally. The main outcome measurements included: the structural and material properties of the patellar tendon under tensile loading to failure, tendon collagen content, and weekly animal activity scores. Results The ultimate load of PGE2-4 wks tendons at 4 weeks was significantly greater than control or saline group tendons. The stiffness and elastic modulus of the PGE2 injected tendons at 8 weeks was significantly greater than the control or saline tendons. No differences in animal activity, collagen content, or mean fibril diameter were observed between groups. Conclusions Four weekly peritendinous injections of PGE2 to the rat patellar

  12. 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...

  13. 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.

  14. 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.

  15. Medial branch neurotomy in low back pain

    Energy Technology Data Exchange (ETDEWEB)

    Masala, Salvatore; Mammucari, Matteo; Simonetti, Giovanni [Interventional Radiology and Radiotherapy University ' ' Tor Vergata' ' , Department of Diagnostic and Molecular Imaging, Rome (Italy); Nano, Giovanni [Interventional Radiology and Radiotherapy University ' ' Tor Vergata' ' , Department of Diagnostic and Molecular Imaging, Rome (Italy); University ' ' Tor Vergata' ' , Department of Radiology, Rome (Italy); Marcia, Stefano [S. Giovanni di Dio Hospital, Department of Diagnostic and Molecular Imaging, Cagliari (Italy)

    2012-07-15

    This study aimed to assess the effectiveness of pulsed radiofrequency medial branch dorsal ramus neurotomy in patients with facet joint syndrome. From January 2008 to April 2010, 92 patients with facet joint syndrome diagnosed by strict inclusion criteria and controlled diagnostic blocks undergone medial branch neurotomy. We did not exclude patients with failed back surgery syndrome (FBSS). Electrodes (20G) with 5-mm active tip were placed under fluoroscopy guide parallel to medial branch. Patients were followed up by physical examination and by Visual Analog Scale and Oswestry Disability Index at 1, 6, and 12 months. In all cases, pain improvement was statistically significant and so quality of life. Three non-FBSS patients had to undergo a second neurotomy because of non-satisfactory pain decrease. Complications were reported in no case. Medial branch radiofrequency neurotomy has confirmed its well-established effectiveness in pain and quality of life improvement as long as strict inclusion criteria be fulfilled and nerve ablation be accomplished by parallel electrode positioning. This statement can be extended also to FBSS patients. (orig.)

  16. Medial branch neurotomy in low back pain

    International Nuclear Information System (INIS)

    Masala, Salvatore; Mammucari, Matteo; Simonetti, Giovanni; Nano, Giovanni; Marcia, Stefano

    2012-01-01

    This study aimed to assess the effectiveness of pulsed radiofrequency medial branch dorsal ramus neurotomy in patients with facet joint syndrome. From January 2008 to April 2010, 92 patients with facet joint syndrome diagnosed by strict inclusion criteria and controlled diagnostic blocks undergone medial branch neurotomy. We did not exclude patients with failed back surgery syndrome (FBSS). Electrodes (20G) with 5-mm active tip were placed under fluoroscopy guide parallel to medial branch. Patients were followed up by physical examination and by Visual Analog Scale and Oswestry Disability Index at 1, 6, and 12 months. In all cases, pain improvement was statistically significant and so quality of life. Three non-FBSS patients had to undergo a second neurotomy because of non-satisfactory pain decrease. Complications were reported in no case. Medial branch radiofrequency neurotomy has confirmed its well-established effectiveness in pain and quality of life improvement as long as strict inclusion criteria be fulfilled and nerve ablation be accomplished by parallel electrode positioning. This statement can be extended also to FBSS patients. (orig.)

  17. Medial tibial stress syndrome: a critical review

    NARCIS (Netherlands)

    Moen, Maarten H.; Tol, Johannes L.; Weir, Adam; Steunebrink, Miriam; de Winter, Theodorus C.

    2009-01-01

    Medial tibial stress syndrome (MTSS) is one of the most common leg injuries in athletes and soldiers. The incidence of MTSS is reported as being between 4% and 35% in military personnel and athletes. The name given to this condition refers to pain on the posteromedial tibial border during exercise,

  18. Acute compartment syndrome after medial gastrocnemius tear.

    Science.gov (United States)

    Sit, Yan Kit; Lui, Tun Hing

    2015-02-01

    Acute compartment syndrome after medial gastrocnemius tear is very rare. It can involve the superficial posterior compartment alone or progress to involve all the 4 compartments of the lower legs. Those patients with high pain tolerance and minor trauma can lead to delayed presentation. Immediate fasciotomy is the treatment of choice. Therapeutic Level IV, Case Study. © 2014 The Author(s).

  19. Rheo: Japanese Sound Art Interrogating Digital Mediality

    DEFF Research Database (Denmark)

    Vandsø, Anette

    2014-01-01

    THe article asks in what way the Japanese sound artist Ryoichi Kurokawa's audiovisual installation Rheo 5 Horisonz (2010) is 'digital'. Using Professor Lars Elleströms concept of 'mediality, the main claim in this article is that Rheo no only uses digital tehcnology, but also interrogates digital...

  20. Spontaneous rib fractures.

    Science.gov (United States)

    Katrancioglu, Ozgur; Akkas, Yucel; Arslan, Sulhattin; Sahin, Ekber

    2015-07-01

    Other than trauma, rib fracture can occur spontaneously due to a severe cough or sneeze. In this study, patients with spontaneous rib fractures were analyzed according to age, sex, underlying pathology, treatment, and complications. Twelve patients who presented between February 2009 and February 2011 with spontaneous rib fracture were reviewed retrospectively. The patients' data were evaluated according to anamnesis, physical examination, and chest radiographs. The ages of the patients ranged from 34 to 77 years (mean 55.91 ± 12.20 years), and 7 (58.4%) were male. All patients had severe cough and chest pain. The fractures were most frequently between 4th and 9th ribs; multiple rib fractures were detected in 5 (41.7%) patients. Eight (66.7%) patients had chronic obstructive pulmonary disease, 2 (16.7%) had bronchial asthma, and 2 (16.7%) had osteoporosis. Bone densitometry revealed a high risk of bone fracture in all patients. Patients with chronic obstructive pulmonary disease or bronchial asthma had been treated with high-dose steroids for over a year. Spontaneous rib fracture due to severe cough may occur in patients with osteoporosis, chronic obstructive pulmonary disease, or bronchial asthma, receiving long-term steroid therapy. If these patients have severe chest pain, chest radiography should be performed to check for bone lesions. © The Author(s) 2015.

  1. [Spontaneous bacterial peritonitis].

    Science.gov (United States)

    Velkey, Bálint; Vitális, Eszter; Vitális, Zsuzsanna

    2017-01-01

    Spontaneous bacterial peritonitis occurs most commonly in cirrhotic patients with ascites. Pathogens get into the circulation by intestinal translocation and colonize in peritoneal fluid. Diagnosis of spontaneous bacterial peritonitis is based on elevated polymorphonuclear leukocyte count in the ascites (>0,25 G/L). Ascites culture is often negative but aids to get information about antibiotic sensitivity in positive cases. Treatment in stable patient can be intravenous then orally administrated ciprofloxacin or amoxicillin/clavulanic acid, while in severe cases intravenous III. generation cephalosporin. Nosocomial spontaneous bacterial peritonitis often caused by Gram-positive bacteria and multi-resistant pathogens can also be expected thus carbapenem should be the choice of the empiric treatment. Antibiotic prophylaxis should be considered. Norfloxacin is used most commonly, but changes are expected due to increase in quinolone resistance. As a primary prophylaxis, a short-term antibiotic treatment is recommended after gastrointestinal bleeding for 5 days, while long-term prophylaxis is for patients with low ascites protein, and advanced disease (400 mg/day). Secondary prophylaxis is recommended for all patients recovered from spontaneous bacterial peritonitis. Due to increasing antibiotic use of antibiotics prophylaxis is debated to some degree. Orv. Hetil., 2017, 158(2), 50-57.

  2. Medial frontal cortex and response conflict: Evidence from human intracranial EEG and medial frontal cortex lesion

    NARCIS (Netherlands)

    Cohen, M.X.; Ridderinkhof, K.R.; Haupt, S.; Elger, C.E.; Fell, J.

    2008-01-01

    The medial frontal cortex (MFC) has been implicated in the monitoring and selection of actions in the face of competing alternatives, but much remains unknown about its functional properties, including electrophysiological oscillations, during response conflict tasks. Here, we recorded intracranial

  3. Stimulation of the medial amygdala enhances medial preoptic dopamine release: implications for male rat sexual behavior.

    Science.gov (United States)

    Dominguez, J M; Hull, E M

    2001-11-02

    Increased dopamine (DA) in the medial preoptic area (MPOA) facilitates male sexual behavior. A major source of innervation to the MPOA is the medial amygdala (MeA). We now report that chemical stimulation of the MeA enhanced levels of extracellular MPOA DA in anesthetized male rats. These results suggest that DA activity in the MPOA can be regulated by input from the MeA to the MPOA.

  4. Representing Representation: Integration between the Temporal Lobe and the Posterior Cingulate Influences the Content and Form of Spontaneous Thought.

    Directory of Open Access Journals (Sweden)

    Jonathan Smallwood

    Full Text Available When not engaged in the moment, we often spontaneously represent people, places and events that are not present in the environment. Although this capacity has been linked to the default mode network (DMN, it remains unclear how interactions between the nodes of this network give rise to particular mental experiences during spontaneous thought. One hypothesis is that the core of the DMN integrates information from medial and lateral temporal lobe memory systems, which represent different aspects of knowledge. Individual differences in the connectivity between temporal lobe regions and the default mode network core would then predict differences in the content and form of people's spontaneous thoughts. This study tested this hypothesis by examining the relationship between seed-based functional connectivity and the contents of spontaneous thought recorded in a laboratory study several days later. Variations in connectivity from both medial and lateral temporal lobe regions was associated with different patterns of spontaneous thought and these effects converged on an overlapping region in the posterior cingulate cortex. We propose that the posterior core of the DMN acts as a representational hub that integrates information represented in medial and lateral temporal lobe and this process is important in determining the content and form of spontaneous thought.

  5. [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.

  6. Open reduction and internal fixation of patellar fractures with tension band wiring through cannulated screws.

    Science.gov (United States)

    Malik, Mudasir; Halwai, Manzoor Ahmad

    2014-10-01

    The purpose of this study was to evaluate effectiveness and safety of a relatively new technique of open reduction and internal fixation of displaced transverse patellar fractures with tension band wiring (TBW) through parallel cannulated compression screws. A total of 30 patients with displaced transverse patellar fracture were enrolled in this prospective study. Of the 30 patients, 20 patients had trauma due to fall, 5 due to road traffic accident, 2 due to fall of heavy object on the knee, 2 due to forced flexion of knee, and 1 had fracture due to being beaten. All 30 patients were treated with vertical skin exposure, fracture open reduction, and internal fixation by anterior TBW through 4.0 mm cannulated screws. The postoperative rehabilitation protocol was standardized. The patients were followed postsurgery to evaluate time required for radiographic bone union, knee joint range of motion (ROM), loss of fracture reduction, material failure, and the overall functional result of knee using Bostman scoring. All the fractures healed radiologically, at an average time of 10.7 weeks (range, 8-12 weeks). The average ROM arc was 129.7 degrees (range, 115-140 degrees). No patient had loss of fracture reduction, implant migration, or material failure. The average Bostman score was 28.6 out of 30. Anterior TBW through cannulated screws for displaced transverse fractures is safe and effective alternative treatment. Good functional results and recovery can be expected. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  7. 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.

  8. Effect of eccentric exercise on the healing process of injured patellar tendon in rats.

    Science.gov (United States)

    Nakamura, Kenichi; Kitaoka, Katsuhiko; Tomita, Katsuro

    2008-07-01

    Earlier studies have reported positive results from eccentric training in patients with tendon disorders. The reasons for the beneficial clinical effects of eccentric training are not known. Vascularization followed by regression of the vasculature enhances the healing response of injured tendons. Eccentric exercise induces a more beneficial healing response than concentric exercise. Sixty rats with patellar tendon injuries were divided into three groups: nonexercise controls (group N; n = 20); concentric exercise group (group C; n = 20); eccentric exercise group (group E; n = 20). Each rat was taught to run uphill or downhill for 14 days. Patellar tendons were removed 1, 4, 7, 10, and 14 days following injury. Vascular endothelial growth factor (VEGF), angiopoietin-1, and angiopoietin-2 were measured by reverse transcription polymerase chain reaction. In group C, VEGF mRNA was increased 1 and 4 days following injury but was decreased on days 7, 10, and 14. In group E, VEGF mRNA was elevated only on day 1. In group N, VEGF mRNA remained at a low level throughout all 14 days. The angiopoietin-2/angiopoietin-1 ratio was higher for group C than for group E. In the presence of VEGF, angiopoietin-1 promotes vessel stability, whereas angiopoietin-2 has the opposite effect. Eccentric exercise contributes to stabilized angiogenesis during the early phase of tendon injury. Conversely, concentric exercise, which induces destabilized angiogenesis, leads to a delayed healing response. Initiation of eccentric exercise immediately after tendon injury may help improve healing by reducing vascularity.

  9. Comparative diagnostic imaging of a partial patellar ligament tear in a dog

    Directory of Open Access Journals (Sweden)

    Mario Ricciardi

    2018-05-01

    Full Text Available Traumatic lesions of the patellar ligament (PL are rare in dogs. The resulting injury can be a complete or partial laceration, depending on the quantity of torn collagen fibres. Information obtained from imaging evaluation is of great value to the clinical approach towards PL injuries, because subsequent treatment options are affected by the distinction between complete or partial tears. Imaging diagnosis of PL damage in veterinary practice commonly relies on radiographic examination through the recognition of indirect signs, such as “patella alta”, bone fragments at the level of the patellar or tibial insertion, and soft tissue opacity at the cranial aspect of the joint. Although ultrasound (US and magnetic resonance imaging (MRI have been described as useful diagnostic tools for the assessment of PL tears in human patients, specific comparative data regarding the evaluation of PL rupture in dogs using different imaging modalities is lacking in the veterinary literature. This paper describes the radiographic, ultrasonographic, CT and MRI imaging findings of a partial PL tear in a dog and discusses the utility of these techniques in diagnosing this condition. CT provided more detailed information than X-ray examination in the assessment of the osteoligamentous junction, the exclusion of microfracture and distal PL avulsion, but did not add information regarding PL integrity. MRI and US provided the most useful information regarding intra-ligamentous damage and as such their combined use may be considered for the assessment of PL injuries after clinical examination and survey radiographs.

  10. The effects of test environment and cyclic stretching on the failure properties of human patellar tendons

    International Nuclear Information System (INIS)

    Haut, R.C.; Powlison, A.C.

    1990-01-01

    There is a need to document the mechanical properties of patellar tendon allografts used for reconstructive surgery of the damaged anterior cruciate ligament, especially the effects of irradiation sterilization. The purpose of this study was to investigate the influences of in vitro test environment and low-level cyclic stretching prior to failure tests on nonirradiated and irradiated human graft tissues. Bilateral patellar tendons were split and each half processed accordingly. Some graft tissues were stretched cyclically at 2.5 mm deformation before failure. Experiments were performed in a 37 degrees C saline bath or with tissues moistened with a drip of the same. The irradiated grafts relaxed less and generated less slack length in the drip environment than the nonirradiated controls. Cyclic stretching did not alter failure characteristics of either graft tissue. While no significant differences in the tensile responses or failure characteristics were noted for irradiated and nonirradiated grafts in the drip, in the bath environment the nonirradiated tissues had greater strength and modulus. This resulted in there being a significant difference between irradiated and nonirradiated tissue responses in a heated saline bath environment. These experimental results exemplify the need to control in vitro test environments in the evaluation of various sterilization and preservation protocols for soft tissue allografts

  11. Natural history of medial clavicle fractures.

    Science.gov (United States)

    Salipas, Andrew; Kimmel, Lara A; Edwards, Elton R; Rakhra, Sandeep; Moaveni, Afshin Kamali

    2016-10-01

    Fractures of the medial third of the clavicle comprise less than 3% of all clavicle fractures. The natural history and optimal management of these rare injuries are unknown. The aim of our study is to describe the demographics, management and outcomes of patients with medial clavicle fractures treated at a Level 1 Trauma Centre. A retrospective review was conducted of patients presenting to our institution between January 2008 and March 2013 with a medial third clavicle fracture. Clinical and radiographic data were recorded including mechanism of injury, fracture pattern and displacement, associated injuries, management and complications. Functional outcomes were assessed using the Glasgow Outcome Scale Extended (GOS-E) scores from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR). Shoulder outcomes were assessed using two patient reported outcomes scores, the American Shoulder and Elbow Society Score (ASES) and the Subjective Shoulder Value (SSV). Sixty eight medial clavicle fractures in 68 patients were evaluated. The majority of patients were male (n=53), with a median age of 53.5 years (interquartile range (IQR) 37.5-74.5 years). The most common mechanism of injury was motor vehicle accident (n=28). The in-hospital mortality rate was 4.4%. The fracture pattern was almost equally distributed between extra articular (n=35) and intra-articular (n=33). Fifty-five fractures (80.9%) had minimal or no displacement. Associated injuries were predominantly thoracic (n=31). All fractures were initially managed non-operatively, with a broad arm sling. Delayed operative fixation was performed for painful atrophic delayed union in two patients (2.9%). Both patients were under 65 years of age and had a severely displaced fracture of the medial clavicle. One intra-operative vascular complication was seen, with no adverse long-term outcome. Follow-up was obtained in 85.0% of the surviving cohort at an average of three years post injury (range 1-6 years). The mean ASES

  12. Does the grading of chondromalacia patellae influence anterior knee pain following total knee arthroplasty without patellar resurfacing?

    Science.gov (United States)

    Zha, Guo-Chun; Feng, Shuo; Chen, Xiang-Yang; Guo, Kai-Jin

    2018-03-01

    The influence of chondromalacia patellae (CMP) on post-operative anterior knee pain (AKP) following total knee arthroplasty (TKA) remains controversial, and few studies have focused on the relationship between them. The purpose of this study was to determine whether different CMP grades affect the incidence of AKP after TKA without patellar resurfacing. We performed a retrospective analysis of prospectively collected data on 290 TKAs with the use of the low contact stress mobile-bearing prosthesis, without patellar resurfacing in 290 patients from February 2009 to January 2013. Patients were assessed by the Outerbridge classification for CMP, visual analog scale for AKP, the Knee Society clinical scoring system of knee score (KS), function score (FS), the patellar score (PS) for clinical function, and patients' satisfaction. The intra-operative grading of CMP: grade I in 30 patients, grade II in 68 patients, grade III in 97 patients, and grade IV in 95 patients. The incidence of AKP at 36-month follow-up was 10.3% (30/290). No statistical difference was detected among the different CMP grades in terms of the incidence of AKP (p = 0.995), patients' satisfaction (p = 0.832), KS (p = 0.228), FS (p = 0.713), and PS (p = 0.119) at 36-month follow-up. The findings may suggest no relevant influence of CMP grading on the incidence of AKP after TKA without patellar resurfacing.

  13. Lower strength of the human posterior patellar tendon seems unrelated to mature collagen cross-linking and fibril morphology

    DEFF Research Database (Denmark)

    Hansen, Philip; Haraldsson, Bjarki Thor; Aagaard, Per

    2010-01-01

    The human patellar tendon is frequently affected by tendinopathy, but the etiology of the condition is not established, although differential loading of the anterior and posterior tendon may be associated with the condition. We hypothesized that changes in fibril morphology and collagen cross-lin...

  14. Anthropometry, physical performance, and ultrasound patellar tendon abnormality in elite junior basketball players: a cross-sectional study.

    Science.gov (United States)

    Cook, J L; Kiss, Z S; Khan, K M; Purdam, C R; Webster, K E

    2004-04-01

    Patellar tendinopathy has been reported to be associated with many intrinsic risk factors. Few have been fully investigated. This cross-sectional study examined the anthropometric and physical performance results of elite junior basketball players with normal or abnormal patellar tendons to see if any measures were associated with changes in tendon morphology. Agility, leg strength, endurance, and flexibility were measured in 71 male and 64 female players. A blinded radiologist ultrasonographically examined their patellar tendons and athletes were grouped as having normal or abnormal tendons. One-way ANOVA was used to test for differences in anthropometric and physical performance data for athletes whose tendons were normal or abnormal (unilateral or bilateral tendinopathy) on ultrasound. Results show that females with abnormalities in their tendons had a significantly better vertical jump (50.9+/-6.8 cm) than those with normal tendons (46.1+/-5.4 cm) (p = 0.02). This was not found in males. In males, the mean sit and reach in those with normal tendons (13.2+/-6.7 cm) was greater (ptendinopathy (10.3+/-6.2 cm) or in bilateral tendinopathy (7.8+/-8.3 cm). In females, those with normal tendons (13.3+/-4.8 cm) and bilateral tendinopathy (15.8+/-6.2 cm) were distinctly different from those with unilateral tendinopathy (7.9+/-6.6 cm). Flexibility and vertical jump ability are associated with patellar tendinopathy and the findings warrant consideration when managing young, jumping athletes.

  15. Isometric Contractions Are More Analgesic Than Isotonic Contractions for Patellar Tendon Pain : An In-Season Randomized Clinical Trial

    NARCIS (Netherlands)

    Rio, Ebonie; van Ark, Mathijs; Docking, Sean; Moseley, G. Lorimer; Kidgell, Dawson; Gaida, Jamie E.; van den Akker-Scheek, Inge; Zwerver, Johannes; Cook, Jill

    Objective: This study aimed to compare the immediate analgesic effects of 2 resistance programs in in-season athletes with patellar tendinopathy (PT). Resistance training is noninvasive, a principle stimulus for corticospinal and neuromuscular adaptation, and may be analgesic. Design: Within-season

  16. 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.

  17. 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

  18. Topical glyceryl trinitrate treatment of chronic patellar tendinopathy : a randomised, double-blind, placebo-controlled clinical trial

    NARCIS (Netherlands)

    Steunebrink, Mirjam; Zwerver, Johannes; Brandsema, Ruben; Groenenboom, Petra; van den Akker-Scheek, Inge; Weir, Adam

    Objectives To assess if continuous topical glyceryl trinitrate (GTN) treatment improves outcome in patients with chronic patellar tendinopathy when compared with eccentric training alone. Methods Randomised double-blind, placebo-controlled clinical trial comparing a 12-week programme of using a GTN

  19. The computed tomographic evaluation of patellofemoral joint in patellar fractures treated with open reduction and internal fixation

    International Nuclear Information System (INIS)

    Benli, I.T.; Akalin, S.; Mumcu, E.F.; Citak, M.; Kilic, M.; Pasaoglu, E.

    1992-01-01

    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)

  20. 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).

  1. Do peak torque angles of muscles change following anterior cruciate ligament reconstruction using hamstring or patellar tendon graft?

    Science.gov (United States)

    Yosmaoğlu, Hayri Baran; Baltacı, Gül; Sönmezer, Emel; Özer, Hamza; Doğan, Deha

    2017-12-01

    This study aims to compare the effects of anterior cruciate ligament (ACL) reconstruction using autogenous hamstring or patellar tendon graft on the peak torque angle. The study included 132 patients (103 males, 29 females; mean age 29±9 year) who were performed ACL reconstruction with autogenous hamstring or patellar tendon graft. The peak torque angles in the quadriceps and hamstring muscles were recorded using an isokinetic dynamometer. Angle of peak knee flexion torque occurred significantly earlier within the range of motion on the operated side than nonoperated side at 180°/second in the hamstring tendon group. Angle of peak knee extension torque occurred significantly earlier within the range of motion on the operated side than nonoperated side at 180°/second in the patellar tendon group. There were no statistically significant differences in the flexion and extension peak torque angles between the operated and nonoperated knees at 60°/second in both groups. The angle of peak torque at relatively high angular velocities is affected after ACL reconstruction in patients with hamstring or patellar tendon grafts. The graft donor site directly influences this parameter. This finding may be important for clinicians in terms of preventing re-injury.

  2. Successful conservative management of symptomatic bilateral dorsal patellar defects presenting with cartilage involvement and bone marrow edema : MRI findings

    NARCIS (Netherlands)

    Kwee, Thomas C.; Sonneveld, Heleen; Nix, Maarten

    2016-01-01

    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

  3. Spontaneous tension haemopneumothorax

    OpenAIRE

    Patterson, Benjamin Oliver; Itam, Sarah; Probst, Fey

    2008-01-01

    Abstract We present a patient with sudden onset progressive shortness of breath and no history of trauma, who rapidly became haemodynamically compromised with a pneumothorax and pleural effusion seen on chest radiograph. He was treated for spontaneous tension pneumothorax but this was soon revealed to be a tension haemopneumothorax. He underwent urgent thoracotomy after persistent bleeding to explore an apical vascular abnormality seen on CT scanning. To our knowledge this is the first such c...

  4. Spontaneous spinal epidural abscess.

    LENUS (Irish Health Repository)

    Ellanti, P

    2011-10-01

    Spinal epidural abscess is an uncommon entity, the frequency of which is increasing. They occur spontaneously or as a complication of intervention. The classical triad of fever, back pain and neurological symptoms are not always present. High index of suspicion is key to diagnosis. Any delay in diagnosis and treatment can have significant neurological consequences. We present the case of a previously well man with a one month history of back pain resulting from an epidural abscess.

  5. Spontaneous polyploidization in cucumber.

    Science.gov (United States)

    Ramírez-Madera, Axel O; Miller, Nathan D; Spalding, Edgar P; Weng, Yiqun; Havey, Michael J

    2017-07-01

    This is the first quantitative estimation of spontaneous polyploidy in cucumber and we detected 2.2% polyploids in a greenhouse study. We provide evidence that polyploidization is consistent with endoreduplication and is an on-going process during plant growth. Cucumber occasionally produces polyploid plants, which are problematic for growers because these plants produce misshaped fruits with non-viable seeds. In this study, we undertook the first quantitative study to estimate the relative frequency of spontaneous polyploids in cucumber. Seeds of recombinant inbred lines were produced in different environments, plants were grown in the field and greenhouse, and flow cytometry was used to establish ploidies. From 1422 greenhouse-grown plants, the overall relative frequency of spontaneous polyploidy was 2.2%. Plants possessed nuclei of different ploidies in the same leaves (mosaic) and on different parts of the same plant (chimeric). Our results provide evidence of endoreduplication and polysomaty in cucumber, and that it is an on-going and dynamic process. There was a significant effect (p = 0.018) of seed production environment on the occurrence of polyploid plants. Seed and seedling traits were not accurate predictors of eventual polyploids, and we recommend that cucumber producers rogue plants based on stature and leaf serration to remove potential polyploids.

  6. Pediatric Glial Heterotopia in the Medial Canthus.

    Science.gov (United States)

    Kim, Soung Min; Amponsah, Emmanuel Kofi; Eo, Mi Young; Cho, Yun Ju; Lee, Suk Keun

    2017-11-01

    Glial heterotopias are rare, benign, congenital, midline, and nonteratomatous extracranial glial tissue. They may be confused as encephalocele or dermoid cysts and are mostly present in the nose.An 8-month-old African female child presented with a slow growing paranasal mass. The mass had been present at the left upper medial canthus since birth and had slowly and progressively enlarged. There was no communication between the mass and the cranial cavity during the operational procedure. The mass was immunohistochemically positive for S-100 protein as well as for glial fibrillary acidic protein, but negative for proliferating cell nuclear antigen. This suggested that the mass was composed of benign glial tissues with many astrocytes.The purpose of this report is to demonstrate the first patient with pediatric glial heterotopic tissue in the medial canthus and to report the clinical importance of its immunohistochemical findings.

  7. Neuromuscular Exercise Post Partial Medial Meniscectomy

    DEFF Research Database (Denmark)

    Hall, Michelle; Hinman, Rana S; Wrigley, Tim V

    2015-01-01

    PURPOSE: To evaluate the effects of a 12-week, home-based, physiotherapist-guided neuromuscular exercise program on the knee adduction moment (an indicator of mediolateral knee load distribution) in people with a medial arthroscopic partial meniscectomy within the past 3-12 months. METHODS......: An assessor-blinded, randomised controlled trial including people aged 30-50 years with no to mild pain following medial arthroscopic partial meniscectomy was conducted. Participants were randomly allocated to either a 12-week neuromuscular exercise program that targeted neutral lower limb alignment...... or a control group with no exercise. The exercise program included eight individual sessions with one of seven physiotherapists in private clinics, together with home exercises. Primary outcomes were the peak external knee adduction moment during normal pace walking and during a one-leg sit-to-stand. Secondary...

  8. [SECOT consensus on medial femorotibial osteoarthritis].

    Science.gov (United States)

    Moreno, A; Silvestre, A; Carpintero, P

    2013-01-01

    A consensus, prepared by SECOT, is presented on the management of medial knee compartment osteoarthritis, in order to establish clinical criteria and recommendations directed at unifying the criteria in its management, dealing with the factors involved in the pathogenesis of medial femorotibial knee osteoarthritis, the usefulness of diagnostic imaging techniques, and the usefulness of arthroscopy. Conservative and surgical treatments are also analysed. The experts consulted showed a consensus (agreed or disagreed) in 65.8% of the items considered, leaving 14items where no consensus was found, which included the aetiopathogenesis of the osteoarthritis, the value of NMR in degenerative disease, the usefulness of COX-2 and the chondroprotective drugs, as well as on the ideal valgus tibial osteotomy technique. © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

  9. Foot medial longitudinal-arch deformation during quiet standing and gait in subjects with medial tibial stress syndrome

    DEFF Research Database (Denmark)

    Bandholm, Thomas Quaade; Boysen, Lisbeth; Haugaard, Stine

    2008-01-01

    The objective of this study was to investigate (1) if subjects with medial tibial stress syndrome demonstrate increased navicular drop and medial longitudinal-arch deformation during quiet standing and gait compared with healthy subjects, and (2) the relationship between medial longitudinal-arch ...

  10. The prevalence of Achilles and patellar tendon injuries in Australian football players beyond a time-loss definition.

    Science.gov (United States)

    Docking, S I; Rio, E; Cook, J; Orchard, J W; Fortington, L V

    2018-03-23

    Little is known about the prevalence and associated of morbidity of tendon problems. With only severe cases of tendon problems missing games, players that have their training and performance impacted are not captured by traditional injury surveillance. The aim of this study was to report the prevalence of Achilles and patellar tendon problems in elite male Australian football players using the Oslo Sports Trauma Research Centre (OSTRC) overuse questionnaire, compared to a time-loss definition. Male athletes from 12 professional Australian football teams were invited to complete a monthly questionnaire over a 9-month period in the 2016 pre- and competitive season. The OSTRC overuse injury questionnaire was used to measure the prevalence and severity of Achilles and patellar tendon symptoms and was compared to traditional match-loss statistics. A total of 441 participants were included. Of all participants, 21.5% (95% CI: 17.9-25.6) and 25.2% (95% CI 21.3-29.4) reported Achilles or patellar tendon problems during the season, respectively. Based on the traditional match-loss definition, a combined 4.1% of participants missed games due to either Achilles or patellar tendon injury. A greater average monthly prevalence was observed during the pre-season compared to the competitive season. Achilles and patellar tendon problems are prevalent in elite male Australian football players. These injuries are not adequately captured using a traditional match-loss definition. Prevention of these injuries may be best targeted during the off- and pre-season due to higher prevalence of symptoms during the pre-season compared to during the competitive season. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  11. Recession wedge trochleoplasty as an additional procedure in the surgical treatment of patellar instability with major trochlear dysplasia: early results.

    Science.gov (United States)

    Thaunat, M; Bessiere, C; Pujol, N; Boisrenoult, P; Beaufils, P

    2011-12-01

    The importance of a dysplastic trochlea as a component of patellar instability has long been recognized. An original trochleoplasty technique consisting in retro-trochlear recession wedge osteotomy was described by Goutallier et al. The aim is not to fashion a groove but to reduce the bump without modifying patellofemoral congruence. This retrospective study reports the operative technique and short-term outcomes of a consecutive case series of 17 patients (19 knees) who underwent recession wedge trochleoplasty for patellofemoral instability associated with severe trochlear dysplasia. Other contributing factors of patellar instability were also corrected as part of the surgical procedure: tibial tuberosity transfer (n=18), MPFL reconstruction (n=8). Minimum follow-up was 12 months (mean, 34 months; range, 12 to 71 months). The trochlear prominence was reduced from a mean 4.8mm (range, 0 to 8mm) to -0.8mm (range, -8 to 6mm). Patellar tilt was reduced from a mean 14° (range, 6° to 26°) to 6° (range, -1° to 24°). Two cases showed recurrent patellofemoral instability. Mean Kujala, KOOS and IKDC score were respectively 80 (± 17), 70 (± 18) and 67 (± 17) at last follow-up. Three patients required further operations, apart from removal of metal screws: arthroscopic arthrolysis for stiffness (n=1), revision for tibial tuberosity non-union (n=1), and supratrochlear exostosectomy (n=1). Recession wedge trochleoplasty is a feasible additional procedure addressing bony trochlear abnormality in the surgical treatment of patellar instability. Our attitude is to perform it never in isolation but associated to realignment of the extensor apparatus according to the à la carte surgery concept. It seems to be effective in preventing future patellar dislocation and reducing anterior knee pain in case of painful patellofemoral instability with a major dysplastic trochlea, or in revision cases when other realignment procedures have failed. Copyright © 2011 Elsevier Masson SAS

  12. Unicameral Bone Cyst of the Medial Cuneiform.

    Science.gov (United States)

    Schick, Faith A; Daniel, Joseph N; Miller, Juliane S

    2016-09-02

    A unicameral bone cyst is a relatively uncommon, benign bone tumor found in the metaphysis of long bones, such as the humerus and the femur, in skeletally immature persons. In the foot, these benign, fluid-filled cavities are most commonly found within the os calcis. We present a case report of a 10-year-old female with a unicameral bone cyst of the medial cuneiform.

  13. Osteoligamentous injuries of the medial ankle joint.

    Science.gov (United States)

    Lötscher, P; Lang, T H; Zwicky, L; Hintermann, B; Knupp, M

    2015-12-01

    Injuries of the ankle joint have a high incidence in daily life and sports, thus, playing an important socioeconomic role. Therefore, proper diagnosis and adequate treatment are mandatory. While most of the ligament injuries around the ankle joint are treated conservatively, great controversy exists on how to treat deltoid ligament injuries in ankle fractures. Missed injuries and inadequate treatment of the medial ankle lead to inferior outcome with instability, progressive deformity, and ankle joint osteoarthritis.

  14. “Basket weave technique” for medial patellofemoral ligament reconstruction: Clinical outcome of a prospective study

    Science.gov (United States)

    Kodkani, Pranjal S

    2016-01-01

    Background: Bone tunneling and implants with rigid fixations for medial patellofemoral ligament (MPFL) reconstruction are known to compromise results and are avoidable, especially in skeletally immature subjects. This study was to assess if these deficiencies were overcome with the technique devised by the author which avoids implants and bone tunnels. Results were assessed for complication rate and outcome. Materials and Methods: Fifty six knees of recurrent lateral patellar dislocation were treated in the past 49 months by MPFL reconstruction. Thirty nine were female and 17 male knees. The mean age was 20.6 years (range 9-48 years). Mean followup was 26 months. Five knees had previously failed stabilization procedures. Thirty one cases had Dejours Type A or B and 12 had Type C trochlear dysplasia. Arthroscopy was performed for associated injuries and loose bodies. Seven knees required loose body removal. Five knees underwent lateral retinacular release. Four knees had tibial tuberosity transfer. One knee had an associated anterior cruciate ligament reconstruction. An anatomical MPFL reconstruction was performed using hamstring autograft without the need for intraoperative fluoroscopy. Only soft tissue fixation was necessary with this newly devised technique and suturing. A rapid rehabilitation protocol was implemented with monthly followup until normalcy and 6 monthly thereafter. Results: All achieved full range of motion and normal mediolateral stability. There was no recurrence of dislocation. No major surgery related complications. One patella fracture at 8 months was due to a fall developed terminal restriction of flexion. Those in sports could return to their sporting activities (Tegner 1–9). Cases with osteochondral fractures had occasional pain that subsided in 1 year. Mean Kujala score improved from 64.3 to 99.69 with KOOS score near normal in all. Conclusion: This new method of MPFL reconstruction gives excellent results. It avoids complications

  15. Biomechanical cadaveric comparison of patellar ligament suture protected by a steel cable versus a synthetic cable.

    Science.gov (United States)

    Bouget, P; Breque, C; Beranger, J S; Faure, J P; Khiami, F; Vendeuvre, T

    2017-12-01

    Purpose and hypothesis: Patellar ligament rupture is a rare disabling pathology requiring a surgical ligament suture protected by a frame. The gold standard is the steel cable, but its rigidity and the necessity of a surgical re-intervention for its removal render it unsatisfactory. The objective of this paper is to quantify the mechanical protection provided by the terylene® in comparison with steel. Twenty-four knees of 12 fresh frozen cadaveric subjects were divided into 2 homogeneous groups (terylene and steel) of 12 knees (mean age = 69.3 years). Proximal ligament repair was performed according to a three-tunnel transosseous reinsertion technique. Mechanical tests were performed in flexion to simulate movement of the knee. The interligament gap and the amplitude angulation of the knee were measured by a system of extensometer and optical goniometer. Mechanical analysis permitted calculation of flexion amplitude for a ligament gap of 1 and 2 mm taking as initial angle the adjusting angle of pretension of the protection frame. Study of deformations of frames was performed. Statistical analysis was performed with a Wilcoxon Mann Whitney test. There is no significant difference in protection of the ligament suture between the "terylene" and "steel" groups. Mean flexion amplitudes (mΔF) show no significant differences between the 2 groups for a distension of the suture of 1 mm (m ΔF terylene1 = 4.74 °; mΔF steel1 = 5.91°; p = 0.198) and 2 mm (mΔF terylene2 = 8.71°; mΔF steel2 = 10.41°; p = 0.114). Elastic deformation of terylene was significantly greater than that of steel (p = 0.0004). Suture protection of the patellar ligament by a terylene wire is not significantly different from that provided by steel frame. The elastic properties of terylene and absence of a need for re intervention to secure its removal lead us towards its use in acute ruptures of the patellar ligament. The main limits involve the properties of

  16. Results of Lateral Retinacular Release Plus Circumpatellar Electrocautery in Total Knee Arthroplasty without Patellar Resurfacing.

    Science.gov (United States)

    Wang, Yong; Sun, Jun-Ying; Zha, Guo-Chun

    2017-03-01

    Anterior knee pain (AKP) is integral to the overall success of total knee arthroplasty (TKA) without patellar resurfacing. Numerous studies have evaluated various factors that may contribute to AKP, including patellofemoral design, surgical technique, characteristics of the patient, and degree of chondromalacia. This study aims to explore whether patients who received lateral retinacular release (LRR) plus circumpatellar electrocautery (CE) in TKA attain a low incidence of AKP and whether the LRR plus CE increases postoperative complications. Between February 2001 and February 2009, all patients undergoing TKA without patellar resurfacing and LRR plus CE were evaluated. In total, 286 TKAs in 259 (88.7%) patients were available for assessment, with a mean of 9.3 ± 2.5 years (range: 6-14 years) after the index TKA. The patients were evaluated with a VAS and the Kujala patellofemoral score (KPS) for AKP and the Knee Society's clinical scoring system (KSS) for the clinical function. Satisfaction and LRR-related complications were also assessed. The mean KPS and KSS improved from 45.2 ± 12.9 and 75.4 ± 26.8 points preoperatively to 82.8 ± 10.0 and 151.6 ± 17.3 points at the final follow-up ( p  < 0.001), respectively. Subjectively, 5.6% (16 of 286) of patients suffered from AKP and 88.1% (252 of 286) were satisfied or very satisfied. Postoperative complications occurred in 15 (5.2%) patients, but these complications were mild and did not require reoperation. None of patients exhibited aseptic and septic prosthesis loosening and required revision surgery in the final follow-up. LRR plus CE appears to be a reasonable option in TKA without patellar resurfacing. It may achieve adequate mid-term results, with a low incidence of AKP and postoperative complications.The level of evidence of the study is therapeutic level IV. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  17. Radiographic evaluation of the canine elbow joint with special reference to the medial humeral condyle and the medial coronoid process

    International Nuclear Information System (INIS)

    Voorhout, G.; Hazewinkel, H.A.W.

    1987-01-01

    The results of radiographic examination of clinically affected elbow joints in 14 young, large-breed dogs, including standard and oblique projections and linear tomography, were compared with the findings of medial arthrotomy. Radiographs revealed arthrosis (13 dogs), osteochondrosis of the medial humeral condyle (2 dogs), fragmentation of the medial coronoid process (5 dogs), and a combination of osteochondrosis of the medial humeral condyle and fragmentation of the medial coronoid process (2 dogs). In one dog fissures in the medial coronoid process and in another dog a linear radiopacity along the articular surface of the medial coronoid process were found. In three dogs both medial humeral condyle and medial coronoid process appeared normal. The radiographic findings were confirmed during surgery in 11 dogs. Cartilage erosion of the medial humeral condyle in two dogs and of the medial coronoid process in one dog had not resulted in radiographically visible abnormalities. Radiographic examination of the elbow joints in young, large-breed dogs should include standard mediolateral and craniocaudal projections, a mediolateral projection with the joint maximally extended and the leg supinated 15°, and a craniolateral-to-caudomedial projection

  18. Spontaneously broken mass

    International Nuclear Information System (INIS)

    Endlich, Solomon; Nicolis, Alberto; Penco, Riccardo

    2015-01-01

    The Galilei group involves mass as a central charge. We show that the associated superselection rule is incompatible with the observed phenomenology of superfluid helium 4: this is recovered only under the assumption that mass is spontaneously broken. This remark is somewhat immaterial for the real world, where the correct space-time symmetries are encoded by the Poincaré group, which has no central charge. Yet it provides an explicit example of how superselection rules can be experimentally tested. We elaborate on what conditions must be met for our ideas to be generalizable to the relativistic case of the integer/half-integer angular momentum superselection rule.

  19. Comparative study of two protocols of eccentric exercise on knee pain and function in athletes with patellar tendinopathy: randomized controlled study

    OpenAIRE

    Cunha, Ronaldo Alves da; Dias, Andreia Natacha; Santos, Marcelo Bannwart; Lopes, Alexandre Dias

    2012-01-01

    INTRODUCTION: The eccentric squat on a slope has been proved effective in conservative treatment of patellar tendinopathy, especially in the athletic population. However, several aspects such as intensity and pain during therapy still differ among authors. OBJECTIVES: To compare the effectiveness of two protocols of eccentric exercise (performed with and without pain), in the improvement of knee function and pain intensity in athletes with patellar tendinopathy. METHODS: 7 athletes of both ge...

  20. Histological comparison of patellar cartilage degeneration between chondromalacia in youth and osteoarthritis in aging.

    Science.gov (United States)

    Mori, Y; Kubo, M; Okumo, H; Kuroki, Y

    1995-01-01

    The histological findings of the patellar cartilage were compared between cases of chondromalacia, which occurs predominantly in young persons (22 patients, average age 19.8 years) and cases of osteoarthritis, which is common among the elderly (21 patients, average age 65.4 years). The histological findings of cartilage in the chondromalacia were characterized by increased density and vigorous fibrous metaplasia of chondrocytes. These findings may be considered to represent a reactive change in the chondrocyte. Cartilage degeneration in osteoarthritis, by contrast, is regressive and presents a clearly different histological picture from that of chondromalacia patellae. We conclude that chondromalacia does not easily lead to osteoarthritis. On the other hand, the cartilage was characteristically softened, as observed by gross inspection, and showed rarefaction of the cartilage matrix. It should be noted that the change was not observed in aging, but showed a pattern of cartilage degeneration peculiar to young patients with chondromalacia patellae.

  1. Magnetic resonance evaluation of anterior cruciate ligament repair using the patellar tendon double bone block technique

    International Nuclear Information System (INIS)

    Autz, G.; Singson, R.D.; Goodwin, C.

    1991-01-01

    The magnetic resonance (MR) appearance of the anterior cruciate ligament reconstruction was determined in 20 clinically stable and 2 clinically unstable knees for a total of 22 examinations. All patients studied had undergone knee reconstruction using the patellar tendon as graft material. The reconstructed anterior cruciate ligament varies in appearance. It appeared as a thick, well-defined, low signal band on T1- and T2-weighted sagittal and coronal images in 14 of 22 examinations. The remaining 8 knees showed a graft having one or more thin and attenuated, low signal intensity bands in the sagittal and/or coronal plane. Arthroscopy confirmed an intact but lax graft in the clinically unstable knees. (orig.)

  2. X-ray computed tomography of the anterior cruciate ligament and patellar tendon

    Science.gov (United States)

    Shearer, Tom; Rawson, Shelley; Castro, Simon Joseph; Balint, Richard; Bradley, Robert Stephen; Lowe, Tristan; Vila-Comamala, Joan; Lee, Peter David; Cartmell, Sarah Harriet

    2014-01-01

    Summary The effect of phosphotungstic acid (PTA) and iodine solution (IKI) staining was investigated as a method of enhancing contrast in the X-ray computed tomography of porcine anterior cruciate ligaments (ACL) and patellar tendons (PT). We show that PTA enhanced surface contrast, but was ineffective at penetrating samples, whereas IKI penetrated more effectively and enhanced contrast after 70 hours of staining. Contrast enhancement was compared when using laboratory and synchrotron based X-ray sources. Using the laboratory source, PT fascicles were tracked and their alignment was measured. Individual ACL fascicles could not be identified, but identifiable features were evident that were tracked. Higher resolution scans of fascicle bundles from the PT and ACL were obtained using synchrotron imaging techniques. These scans exhibited greater contrast between the fascicles and matrix in the PT sample, facilitating the identification of the fascicle edges; however, it was still not possible to detect individual fascicles in the ACL. PMID:25332942

  3. Treatment of transverse patellar fractures: a comparison between metallic and non-metallic implants.

    Science.gov (United States)

    Heusinkveld, Maarten H G; den Hamer, Anniek; Traa, Willeke A; Oomen, Pim J A; Maffulli, Nicola

    2013-01-01

    Several methods of transverse patellar fixation have been described. This study compares the clinical outcome and the occurrence of complications of various fixation methods. The databases PubMed, Web of Science, Science Direct, Google Scholar and Google were searched. A direct comparison between fixation techniques using mixed or non-metallic implants and metallic K-wire and tension band fixation shows no significant difference in clinical outcome between both groups. Additionally, studies reporting novel operation techniques show good clinical results. Studies describing the treatment of patients using non-metallic or mixed implants are fewer compared with those using metallic fixation. A large variety of clinical scoring systems were used for assessing the results of treatment, which makes direct comparison difficult. More data of fracture treatment using non-metallic or mixed implants is needed to achieve a more balanced comparison.

  4. 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...... for risk factor questions was excellent at 0.89 (CI: 0.84-0.93) with no mean difference (P = 1.00). The online questionnaire enables equivalent collection of VISA-P data and risk factor information and may well improve further with the suggested modifications to the instructions for questions 7 and 8....... There is potential to use this questionnaire electronically to generate large databases in future research....

  5. Magnetization transfer and spin lock MR imaging of patellar cartilage degeneration at 0.1 T

    International Nuclear Information System (INIS)

    Koskinen, S.K.; Ylae-Outinen, H.; Komu, M.E.S.; Aho, H.J.

    1997-01-01

    Purpose: To investigate magnetization transfer (MT) parameters and rotating frame relaxation time T1ρ in patellar cartilage at different levels of degeneration. Material and Methods: Thirty cadaveric patellae were examined at 0.1 T using the time-dependent saturation-transfer MT technique and the spin lock (SL) technique. In an SL experiment, nuclear spins are locked with a radiofrequency (RF) field, and the locked nuclear magnetization relaxes along the magnetic component of the locking RF field. The specimens were divided into three groups according to the level of cartilage degeneration. MT parameters and T1ρ were measured. Results: The MT effect was greater in degenerated cartilage than in normal cartilage. T1ρ was longer in advanced cartilage degeneration than in intermediate cartilage degeneration. Conculsion: The results suggest that more studies are needed to fully establish the value of SL imaging in cartilage degeneration. (orig.)

  6. 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

    suggested that the proteoglycan-associated glycosaminoglycans (GAGs) found on the surface of the collagen fibrils may be an important transmitter of load, but existing results are ambiguous and have not investigated human tendons. We have used a small-scale mechanical testing system to measure...... change the tendon modulus, relative energy dissipation, peak stress, or peak strain. The effect of deformation rate was not modulated by the treatment either, indicating no effect on viscosity. These results suggest that GAGs cannot be considered mediators of tensile force transmission in the human...... patellar tendon, and as such, force transmission must either take place through other matrix components or the fibrils must be mechanically continuous at least to the tested length of 7 mm....

  7. Magnetic resonance evaluation of anterior cruciate ligament repair using the patellar tendon double bone block technique

    Energy Technology Data Exchange (ETDEWEB)

    Autz, G.; Singson, R.D. (St. Luke' s Roosevelt Hospital Center, New York, NY (United States). Dept. of Radiology); Goodwin, C. (St. Luke' s Roosevelt Hospital Center, New York, NY (United States). Dept. of Orthopedics)

    1991-11-01

    The magnetic resonance (MR) appearance of the anterior cruciate ligament reconstruction was determined in 20 clinically stable and 2 clinically unstable knees for a total of 22 examinations. All patients studied had undergone knee reconstruction using the patellar tendon as graft material. The reconstructed anterior cruciate ligament varies in appearance. It appeared as a thick, well-defined, low signal band on T1- and T2-weighted sagittal and coronal images in 14 of 22 examinations. The remaining 8 knees showed a graft having one or more thin and attenuated, low signal intensity bands in the sagittal and/or coronal plane. Arthroscopy confirmed an intact but lax graft in the clinically unstable knees. (orig.).

  8. Psychometric properties of a Swedish translation of the VISA-P outcome score for patellar tendinopathy.

    Science.gov (United States)

    Frohm, Anna; Saartok, Tönu; Edman, Gunnar; Renström, Per

    2004-12-18

    Self-administrated patient outcome scores are increasingly recommended for evaluation of primary outcome in clinical studies. The VISA-P score, developed at the Victorian Institute of Sport Assessment in Melbourne, Australia, is a questionnaire developed for patients with patellar tendinopathy and the patients assess severity of symptoms, function and ability to participate in sport. The aim of this study was to translate the questionnaire into Swedish and to study the reliability and validity of the translated questionnaire and resultant scores. The questionnaire was translated into Swedish according to internationally recommended guidelines for cross-cultural adaptation of self-report measures. The reliability and validity were tested in three different populations. The populations used were healthy students (n = 17), members of the Swedish male national basketball team (n = 17), considered as a population at risk, and a group of non-surgically treated patients (n = 17) with clinically diagnosed patellar tendinopathy. The questionnaire was completed by 51 subjects altogether. The translated VISA-P questionnaire showed very good test-retest reliability (ICC = 0.97).The mean (+/- SD) of the VISA-P score, at both the first and second test occasions was highest in the healthy student group 83 (+/- 13) and 81 (+/- 15), respectively. The score of the basketball players was 79 (+/- 24) and 80 (+/- 23), while the patient group scored significantly (p < 0.05) lower, 48 (+/- 20) and 52 (+/- 19). The translated version of the VISA-P questionnaire was linguistically and culturally equivalent to the original version. The translated score showed good reliability.

  9. Psychometric properties of a Swedish translation of the VISA-P outcome score for patellar tendinopathy

    Directory of Open Access Journals (Sweden)

    Edman Gunnar

    2004-12-01

    Full Text Available Abstract Background Self-administrated patient outcome scores are increasingly recommended for evaluation of primary outcome in clinical studies. The VISA-P score, developed at the Victorian Institute of Sport Assessment in Melbourne, Australia, is a questionnaire developed for patients with patellar tendinopathy and the patients assess severity of symptoms, function and ability to participate in sport. The aim of this study was to translate the questionnaire into Swedish and to study the reliability and validity of the translated questionnaire and resultant scores. Methods The questionnaire was translated into Swedish according to internationally recommended guidelines for cross-cultural adaptation of self-report measures. The reliability and validity were tested in three different populations. The populations used were healthy students (n = 17, members of the Swedish male national basketball team (n = 17, considered as a population at risk, and a group of non-surgically treated patients (n = 17 with clinically diagnosed patellar tendinopathy. The questionnaire was completed by 51 subjects altogether. Results The translated VISA-P questionnaire showed very good test-retest reliability (ICC = 0.97. The mean (± SD of the VISA-P score, at both the first and second test occasions was highest in the healthy student group 83 (± 13 and 81 (± 15, respectively. The score of the basketball players was 79 (± 24 and 80 (± 23, while the patient group scored significantly (p Conclusions The translated version of the VISA-P questionnaire was linguistically and culturally equivalent to the original version. The translated score showed good reliability.

  10. Effects of habitual loading on patellar tendon mechanical and morphological properties in basketball and volleyball players.

    Science.gov (United States)

    Zhang, Z J; Ng, G Y F; Fu, S N

    2015-11-01

    Tendon mechanical properties are linked to sports performance and tendon-related injuries, such as tendinopathy. Whether habitual loading, such as participation in regular jumping activities, would induce adaptation on tendon mechanical properties remains unclear. Forty healthy subjects (10 sedentary, 15 volleyball players, and 15 basketball players) aged between 18 and 35 years were recruited. Supersonic shearwave imaging was used to measure the shear elastic modulus and thickness and cross-sectional area (CSA) of the proximal patellar tendons of both knees at 30° of flexion. Significant group differences in tendon shear elastic modulus were found among the three groups. In the dominant leg, reduction in tendon shear elastic modulus by 18.9 % (p = 0.018) and 48.7 % (p = 0.000) were observed in the basketball and volleyball players, respectively, when compared with sedentary subjects. In the non-dominant leg, reduction in tendon shear elastic modulus were 27.3 % (p = 0.034) and 47.1 % (p = 0.02) in the basketball and volleyball players, respectively. The athlete groups were found to have larger CSA but with similar tendon thickness than sedentary group. The CSA were larger by 24-29 % and by 22-24 % in the basketball players and volleyball players, for the dominant and non-dominant legs, respectively (all p < 0.05). Age and body mass are related to tendon stiffness and CSA, particularly in the sedentary subjects. The proximal patellar tendon can undergo substantial adaptation on tendon mechanical and morphological properties when exposed in jumping sports. Intrinsic factors such as age and body mass could influence tendon properties.

  11. A pilot study of the eccentric decline squat in the management of painful chronic patellar tendinopathy.

    Science.gov (United States)

    Purdam, C R; Jonsson, P; Alfredson, H; Lorentzon, R; Cook, J L; Khan, K M

    2004-08-01

    This non-randomised pilot study investigated the effect of eccentric quadriceps training on 17 patients (22 tendons) with painful chronic patellar tendinopathy. Two different eccentric exercise regimens were used by subjects with a long duration of pain with activity (more than six months). (a) Nine consecutive patients (10 tendons; eight men, one woman; mean age 22 years) performed eccentric exercise with the ankle joint in a standard (foot flat) position. (b) Eight patients (12 tendons; five men, three women; mean age 28 years) performed eccentric training standing on a 25 degrees decline board, designed to increase load on the knee extensor mechanism. The eccentric training was performed twice daily, with three sets of 15 repetitions, for 12 weeks. Primary outcome measures were (a) 100 mm visual analogue scale (VAS), where the subject recorded the amount of pain during activity, and (b) return to previous activity. Follow up was at 12 weeks, with a further limited follow up at 15 months. Good clinical results were obtained in the group who trained on the decline board, with six patients (nine tendons) returning to sport and showing a significantly reduced amount of pain over the 12 week period. Mean VAS scores fell from 74.2 to 28.5 (p = 0.004). At 15 months, four patients (five tendons) reported satisfactory results (mean VAS 26.2). In the standard squat group the results were poor, with only one athlete returning to previous activity. Mean VAS scores in this group were 79.0 at baseline and 72.3 at 12 weeks (p = 0.144). In a small group of patients with patellar tendinopathy, eccentric squats on a decline board produced encouraging results in terms of pain reduction and return to function in the short term. Eccentric exercise using standard single leg squats in a similar sized group appeared to be a less effective form of rehabilitation in reducing pain and returning subjects to previous levels of activity.

  12. A randomised, controlled trial of circumpatellar electrocautery in total knee replacement without patellar resurfacing.

    Science.gov (United States)

    van Jonbergen, H P W; Scholtes, V A B; van Kampen, A; Poolman, R W

    2011-08-01

    The efficacy of circumpatellar electrocautery in reducing the incidence of post-operative anterior knee pain is unknown. We conducted a single-centre, outcome-assessor and patient-blinded, parallel-group, randomised, controlled trial to compare circumpatellar electrocautery with no electrocautery in total knee replacement in the absence of patellar resurfacing. Patients requiring knee replacement for primary osteoarthritis were randomly assigned circumpatellar electrocautery (intervention group) or no electrocautery (control group). The primary outcome measure was the incidence of anterior knee pain. A secondary measure was the standardised clinical and patient-reported outcomes determined by the American Knee Society scores and the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index. A total of 131 knees received circumpatellar electrocautery and 131 had no electrocautery. The overall incidence of anterior knee pain at follow-up at one year was 26% (20% to 31%), with 19% (12% to 26%) in the intervention group and 32% (24% to 40%) in the control group (p = 0.02). The relative risk reduction from electrocautery was 40% (9% to 61%) and the number needed to treat was 7.7 (4.3 to 41.4). The intervention group had a better mean total WOMAC score at follow-up at one year compared with the control group (16.3 (0 to 77.7) versus 21.6 (0 to 76.7), p = 0.04). The mean post-operative American Knee Society knee scores and function scores were similar in the intervention and control groups (knee score: 92.4 (55 to 100) versus 90.4 (51 to 100), respectively (p = 0.14); function score: 86.5 (15 to 100) versus 84.5 (30 to 100), respectively (p = 0.49)). Our study suggests that in the absence of patellar resurfacing electrocautery around the margin of the patella improves the outcome of total knee replacement.

  13. Spontaneous Tumor Lysis Syndrome

    Directory of Open Access Journals (Sweden)

    Alicia C. Weeks MD

    2015-08-01

    Full Text Available Tumor lysis syndrome (TLS is a known complication of malignancy and its treatment. The incidence varies on malignancy type, but is most common with hematologic neoplasms during cytotoxic treatment. Spontaneous TLS is thought to be rare. This case study is of a 62-year-old female admitted with multisystem organ failure, with subsequent diagnosis of aggressive B cell lymphoma. On admission, laboratory abnormalities included renal failure, elevated uric acid (20.7 mg/dL, and 3+ amorphous urates on urinalysis. Oliguric renal failure persisted despite aggressive hydration and diuretic use, requiring initiation of hemodialysis prior to chemotherapy. Antihyperuricemic therapy and hemodialysis were used to resolve hyperuricemia. However, due to multisystem organ dysfunction syndrome with extremely poor prognosis, the patient ultimately expired in the setting of a terminal ventilator wean. Although our patient did not meet current TLS criteria, she required hemodialysis due to uric acid nephropathy, a complication of TLS. This poses the clinical question of whether adequate diagnostic criteria exist for spontaneous TLS and if the lack of currently accepted guidelines has resulted in the underestimation of its incidence. Allopurinol and rasburicase are commonly used for prevention and treatment of TLS. Although both drugs decrease uric acid levels, allopurinol mechanistically prevents formation of the substrate rasburicase acts to solubilize. These drugs were administered together in our patient, although no established guidelines recommend combined use. This raises the clinical question of whether combined therapy is truly beneficial or, conversely, detrimental to patient outcomes.

  14. Spontaneous intracranial hypotension

    International Nuclear Information System (INIS)

    Cardwell, C.; Cox, I.; Baldey, A.

    2002-01-01

    Full text: A 49-year old female presented with severe postural headache with no history of trauma. A Computed Tomography (CT) study of the brain demonstrated abnormal meningeal enhancement raising the possibility of leptomeningeal metastases. The patient was then referred to Magnetic Resonance Imaging (MRI) which demonstrated diffuse smooth dural enhancement with ancillary findings characteristic of spontaneous intracranial hypotension. The patient was then referred to Nuclear Medicine to confirm the diagnosis and localise the presumed leak 400MBq of 99mTc DTPA was injected via lumbar puncture into the L3-L4 subarachnoid space Posterior images of the spine were taken with a GE XRT single head gamma camera at 1 and 4 hours post administration of radionuclide. Images demonstrated abnormal early arrival of radionuclide in the kidneys and bladder at 1 hour and abnormal leak of tracer was demonstrate at the level of the first thoracic vertebra on the right side at 4 hours. This confirmed CSF leak at this level. Consequently the patient underwent a blood patch and her symptoms resolved. Spontaneous Intracranial Hypotension is a syndrome often unrecognised presenting with symptoms including severe postural headache neck stiffness nausea vomiting tinnitus and vertigo. The diagnosis is frequently suspected from findings on MRI, but Nuclear Medicine CSF imaging provides a readily available and cost effective method for confirming the diagnosis, and for making the diagnosis in patients who are unsuitable for or do not have access to MRI. Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc

  15. Spontaneous intracranial hypotension

    Energy Technology Data Exchange (ETDEWEB)

    Cardwell, C; Cox, I; Baldey, A [St. F.X. Cabrini Hospital, VIC (Australia). Departments of Nuclear Medicine and Magnetic Resonance Imaging

    2002-07-01

    Full text: A 49-year old female presented with severe postural headache with no history of trauma. A Computed Tomography (CT) study of the brain demonstrated abnormal meningeal enhancement raising the possibility of leptomeningeal metastases. The patient was then referred to Magnetic Resonance Imaging (MRI) which demonstrated diffuse smooth dural enhancement with ancillary findings characteristic of spontaneous intracranial hypotension. The patient was then referred to Nuclear Medicine to confirm the diagnosis and localise the presumed leak 400MBq of 99mTc DTPA was injected via lumbar puncture into the L3-L4 subarachnoid space Posterior images of the spine were taken with a GE XRT single head gamma camera at 1 and 4 hours post administration of radionuclide. Images demonstrated abnormal early arrival of radionuclide in the kidneys and bladder at 1 hour and abnormal leak of tracer was demonstrate at the level of the first thoracic vertebra on the right side at 4 hours. This confirmed CSF leak at this level. Consequently the patient underwent a blood patch and her symptoms resolved. Spontaneous Intracranial Hypotension is a syndrome often unrecognised presenting with symptoms including severe postural headache neck stiffness nausea vomiting tinnitus and vertigo. The diagnosis is frequently suspected from findings on MRI, but Nuclear Medicine CSF imaging provides a readily available and cost effective method for confirming the diagnosis, and for making the diagnosis in patients who are unsuitable for or do not have access to MRI. Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc.

  16. Are unilateral and bilateral patellar tendinopathy distinguished by differences in anthropometry, body composition, or muscle strength in elite female basketball players?

    Science.gov (United States)

    Gaida, J E; Cook, J L; Bass, S L; Austen, S; Kiss, Z S

    2004-10-01

    Overuse injury to the patellar tendon (patellar tendinopathy) is a major reason for interrupted training and competition for elite athletes. In both sexes, the prevalence of unilateral and bilateral tendinopathy has been shown to differ. It has been proposed that bilateral pathology may have a different aetiology from unilateral pathology. Investigation of risk factors that may be unique to unilateral and bilateral patellar tendinopathy in female athletes may reveal insights into the aetiology of this condition. To examine whether anthropometry, body composition, or muscle strength distinguished elite female basketball players with unilateral or bilateral patellar tendinopathy. Body composition, anthropometry, and muscle strength were compared in elite female basketball players with unilateral (n = 8), bilateral (n = 7), or no (n = 24) patellar tendinopathy. Body composition was analysed using a dual energy x ray absorptiometer. Anthropometric measures were assessed using standard techniques. Knee extensor strength was measured at 180 degrees /s using an isokinetic dynamometer. z scores were calculated for the unilateral and bilateral groups (using the no tendinopathy group as controls). z scores were tested against zero. The tibia length to stature ratio was approximately 1.3 (1.3) SDs above zero in both the affected and non-affected legs in the unilateral group (ppatellar tendinopathy has identifiable risk factors whereas bilateral patellar tendinopathy may not. This suggests that the aetiology of these conditions may be different. However, interpretation must respect the limitation of small subject numbers.

  17. Patellar resurfacing versus nonresurfacing in total knee arthroplasty for osteoarthritis: experience at a tertiary care institution in Pakistan

    Directory of Open Access Journals (Sweden)

    Lakdawala RH

    2012-02-01

    Full Text Available Akil Fazal1, Riaz H Lakdawala21Clinical Fellow, NYU Hospital for Joint Disease, New York, US; 2Associate Professor and Chief, Section of Orthopedics, Department of Surgery, The Aga Khan University Hospital, Karachi, PakistanObjective: To determine the effect of patellar resurfacing in patients offered total knee arthroplasty for osteoarthritis.Design: Randomized control study.Place and duration of study: The Aga Khan University Hospital, Karachi, Pakistan from January 3, 2005 to January 9, 2010.Patients and methods: Patients undergoing primary total knee arthroplasty for osteoarthritis were assigned to either the patellar resurfacing or nonresurfacing arm using systematic sampling. This consisted of patients undergoing unilateral and bilateral knee arthroplasty. Preoperatively, Knee Society Knee and Function Scores were calculated. After a minimum of 3 years postoperatively Knee Society Knee and Function Scores as well as the Clinical Anterior Knee Pain Rating were calculated and analysis done to check for differences.Results: Seventy-five patients were recruited in each arm; 135 patients had bilateral and 15 had unilateral knee arthroplasty. The mean preoperative knee score was 40.4 for the resurfacing group and 40.60 for the nonresurfacing group (P = 0.45. This improved postoperatively to 93.67 and 94.23 respectively, with no difference between the two groups (P = 0.67. The mean preoperative function score was 45.50 for resurfaced patellae and 45.83 for nonresurfaced. This improved to 89.67 and 90.50, respectively, again with no difference (P = 0.51. Postoperative Clinical Anterior Knee Pain Rating was a mean of 0.1 for resurfaced and 0.13 for nonresurfaced patellas, with no difference on analysis (P = 0.06. However, patients who had bilateral knee arthroplasty had a slightly higher Clinical Anterior Knee Pain Rating than those who had single knee surgery (P = 0.046 irrespective of whether the patellar was resurfaced or not.Conclusion: In

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

    Science.gov (United States)

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

    2011-06-01

    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 symptoms for 3 to 12 months and are still playing. The TOPGAME study was created to determine the effectiveness of ESWT on pain, symptoms, and function in athletes with early symptomatic patellar tendinopathy who are still in training and competition. Randomized controlled trial; Level of evidence, 1. Athletes playing volleyball, basketball, or handball with patellar tendinopathy for 3 to 12 months were randomized into the ESWT or placebo group during the first half of the season. The ESWT group received 3 ESWT treatments while the placebo group received sham ESWT. In-season follow-up measurements were 1, 12, and 22 weeks after treatment. The primary outcome was severity of patellar tendinopathy determined with the Victorian Institute of Sport Assessment-Patella (VISA-P) questionnaire. Secondary outcome measures were pain during activities of daily living and sports and after functional knee-loading tests rated on a visual analog scale and subjective improvement. Multilevel analyses were performed to determine differences between groups over time. Of the 127 symptomatic athletes invited to participate, 62 were eligible, gave consent, and were randomized into the ESWT (n = 31) or placebo group (n = 31). Mean VISA-P scores before and 1, 12, and 22 weeks after treatment were 59.4 (±11.7), 66.8 (±16.2), 66.7 (±17.5), and 70.5 (±18.9) for the ESWT group and 62.4 (±13.4), 66.3 (±19.0), 68.9 (±20.3), and 72.7 (±18.0) for the placebo group. For the VISA-P, there was a significant effect for time (P Extracorporeal shockwave therapy as a solitary treatment during the competitive season has no benefit over placebo treatment in the management of actively competing jumping athletes with

  19. Subchondral Bone Plate Thickening Precedes Chondrocyte Apoptosis and Cartilage Degradation in Spontaneous Animal Models of Osteoarthritis

    OpenAIRE

    Zamli, Zaitunnatakhin; Robson Brown, Kate; Tarlton, John F.; Adams, Mike A.; Torlot, Georgina E.; Cartwright, Charlie; Cook, William A.; Vassilevskaja, Kristiina; Sharif, Mohammed

    2014-01-01

    Osteoarthritis (OA) is the most common joint disorder characterised by bone remodelling and cartilage degradation and associated with chondrocyte apoptosis. These processes were investigated at 10, 16, 24, and 30 weeks in Dunkin Hartley (DH) and Bristol Strain 2 (BS2) guinea pigs that develop OA spontaneously. Both strains had a more pronounced chondrocyte apoptosis, cartilage degradation, and subchondral bone changes in the medial than the lateral side of the tibia, and between strains, the ...

  20. Neural activation and memory for natural scenes: Explicit and spontaneous retrieval.

    Science.gov (United States)

    Weymar, Mathias; Bradley, Margaret M; Sege, Christopher T; Lang, Peter J

    2018-05-06

    Stimulus repetition elicits either enhancement or suppression in neural activity, and a recent fMRI meta-analysis of repetition effects for visual stimuli (Kim, 2017) reported cross-stimulus repetition enhancement in medial and lateral parietal cortex, as well as regions of prefrontal, temporal, and posterior cingulate cortex. Repetition enhancement was assessed here for repeated and novel scenes presented in the context of either an explicit episodic recognition task or an implicit judgment task, in order to study the role of spontaneous retrieval of episodic memories. Regardless of whether episodic memory was explicitly probed or not, repetition enhancement was found in medial posterior parietal (precuneus/cuneus), lateral parietal cortex (angular gyrus), as well as in medial prefrontal cortex (frontopolar), which did not differ by task. Enhancement effects in the posterior cingulate cortex were significantly larger during explicit compared to implicit task, primarily due to a lack of functional activity for new scenes. Taken together, the data are consistent with an interpretation that medial and (ventral) lateral parietal cortex are associated with spontaneous episodic retrieval, whereas posterior cingulate cortical regions may reflect task or decision processes. © 2018 Society for Psychophysiological Research.

  1. Chronic Allium sativum administration alters spontaneous ...

    African Journals Online (AJOL)

    Arun Kumar Agnihotri

    investigate the effects of Allium sativum extract on the medial prefrontal cortex and neurobehaviour of adult ... KEY WORDS: Allium sativum; Medial prefrontal cortex; Neurobehaviour;. Histomorphology ..... brain atrophy mouse model. Clin Exp.

  2. Rheo: Japanese sound art interrogating digital mediality

    Directory of Open Access Journals (Sweden)

    Vandsø Anette

    2014-12-01

    Full Text Available The article asks in what way the Japanese sound artist, Ryoichi Kurokawa’s audiovisual installation, Rheo: 5 Horisonz (2010, is “digital.” Using professor Lars Elleström’s concept of “mediality,” the main claim in this article is that Rheo not only uses digital technology but also interrogates digital mediality as such. This argument is pursued in an analysis of Rheo that draws in various descriptions of digital media by N. Catherine Hayles, Lev Manovic, Bolter, and Grusin among other. The article will show how the critical potential in Rheo is directed both towards digital media as a language (Meyrowitz (or a place for representation and towards the digital as a milieu (Meyrowitz or as our culture (Gere. The overall goal of the article is not just analyse this singular art work, but also to show how such a sound art work can contribute to our understanding of our own contemporary culture as a digital culture.

  3. Spontaneous Intracranial Hypotension

    International Nuclear Information System (INIS)

    Joash, Dr.

    2015-01-01

    Epidemiology is not only rare but an important cause of new daily persistent headaches among young & middle age individuals. The Etiology & Pathogenesis is generally caused by spinal CSF leak. Precise cause remains largely unknown, underlying structural weakness of spinal meninges is suspected. There are several MR Signs of Intracranial Hypotension that include:- diffuse pachymeningeal (dural) enhancement; bilateral subdural, effusion/hematomas; Downward displacement of brain; enlargement of pituitary gland; Engorgement of dural venous sinuses; prominence of spinal epidural venous plexus and Venous sinus thrombosis & isolated cortical vein thrombosis. The sum of volumes of intracranial blood, CSF & cerebral tissue must remain constant in an intact cranium. Treatment in Many cases can be resolved spontaneously or by use Conservative approach that include bed rest, oral hydration, caffeine intake and use of abdominal binder. Imaging Modalities for Detection of CSF leakage include CT myelography, Radioisotope cisternography, MR myelography, MR imaging and Intrathecal Gd-enhanced MR

  4. Spontaneous soft tissue hematomas.

    Science.gov (United States)

    Dohan, A; Darnige, L; Sapoval, M; Pellerin, O

    2015-01-01

    Spontaneous muscle hematomas are a common and serious complication of anticoagulant treatment. The incidence of this event has increased along with the rise in the number of patients receiving anticoagulants. Radiological management is both diagnostic and interventional. Computed tomography angiography (CTA) is the main tool for the detection of hemorrhage to obtain a positive, topographic diagnosis and determine the severity. Detection of an active leak of contrast material during the arterial or venous phase is an indication for the use of arterial embolization. In addition, the interventional radiological procedure can be planned with CTA. Arterial embolization of the pedicles that are the source of the bleeding is an effective technique. The rate of technical and clinical success is 90% and 86%, respectively. Copyright © 2015 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.

  5. Spontaneous wave packet reduction

    International Nuclear Information System (INIS)

    Ghirardi, G.C.

    1994-06-01

    There are taken into account the main conceptual difficulties met by standard quantum mechanics in dealing with physical processes involving macroscopic system. It is stressed how J.A.Wheeler's remarks and lucid analysis have been relevant to pinpoint and to bring to its extreme consequences the puzzling aspects of quantum phenomena. It is shown how the recently proposed models of spontaneous dynamical reduction represent a consistent way to overcome the conceptual difficulties of the standard theory. Obviously, many nontrivial problems remain open, the first and more relevant one being that of generalizing the model theories considered to the relativistic case. This is the challenge of the dynamical reduction program. 43 refs, 2 figs

  6. Arthroscopic treatment of symptomatic type D medial plica

    OpenAIRE

    Uysal, Mustafa; Asik, Mehmet; Akpinar, Sercan; Ciftci, Feyyaz; Cesur, Necip; Tandogan, Reha N.

    2007-01-01

    We aimed to review the results of subtotal arthroscopic resection of symptomatic type D medial plica. We retrospectively evaluated 23 knees with symptomatic type D medial plica in 22 patients without other intra-articular pathology. All patients complained of chronic knee pain that had not been alleviated by medical treatment or physical therapy. In only three (13%) of the patients studied was the plica diagnosed pre-operatively with magnetic resonance imaging. The type D medial plicae in our...

  7. The medial tibial stress syndrome. A cause of shin splints.

    Science.gov (United States)

    Mubarak, S J; Gould, R N; Lee, Y F; Schmidt, D A; Hargens, A R

    1982-01-01

    The medial tibial stress syndrome is a symptom complex seen in athletes who complain of exercise-induced pain along the distal posterior-medial aspect of the tibia. Intramuscular pressures within the posterior compartments of the leg were measured in 12 patients with this disorder. These pressures were not elevated and therefore this syndrome is a not a compartment syndrome. Available information suggests that the medial tibial stress syndrome most likely represents a periostitis at this location of the leg.

  8. Acute traumatic rupture of the patellar tendon in pediatric population: Case series and review of the literature.

    Science.gov (United States)

    Ali Yousef, Mohamed Abdelhamid; Rosenfeld, Scott

    2017-11-01

    Intact knee extensor mechanism is required for the normal function of the lower extremity. Patellar tendon rupture is a relatively rare injury with peak age incidence around 40 years and usually occurs midsubstance. The occurrence of pure patellar tendon rupture without bony avulsion is an extremely rare injury in the pediatric population with few cases reported in the literature with limited information regarding frequency, complications, and outcomes in children. However, due to increased participation in sports and high-energy recreational activities during childhood, the frequency of such injuries has progressively increased. To evaluate the frequency of pediatric patellar tendon rupture injuries and describe the radiological findings, treatment modalities, and outcome of such injuries. Demographic and clinical data on a series of patients who sustained patellar tendon rupture were reviewed. These data included age at time of injury, sex, laterality, mechanism of injury, associated injuries, complications, presence or absence of Osgood-Schlatter disease, diagnostic imaging such as plain radiographs and magnetic resonance images (MRI), surgical technique, method of fixation, period of postoperative immobilization, total duration of physiotherapy, time to return to sports activities and follow-up duration. Insall-Salvati ratio was calculated on the preoperative lateral x-ray. The functional outcome was evaluated with regard to final knee active range of motion (AROM), manual quadriceps muscle testing, and presence or the absence of terminal extension lag. Clinical outcome rating using knee society score (KSS) was performed and functional outcome was further classified according to the calculated score. Five male patients with patellar tendon rupture (7%) were identified among 71 pediatric patients who sustained acute traumatic injury of the knee extensor mechanism. The mean age at the time of injury was 13.6 years (range: 12-15 years). The injury occurred in

  9. Semiextended approach for intramedullary nailing via a patellar eversion technique for tibial-shaft fractures: Evaluation of the patellofemoral joint.

    Science.gov (United States)

    Yasuda, Tomohiro; Obara, Shu; Hayashi, Junji; Arai, Masayuki; Sato, Kaoru

    2017-06-01

    Intramedullary nail fixation is a common treatment for tibial-shaft fractures, and it offers a better functional prognosis than other conservative treatments. Currently, the primary approach employed during intramedullary nail insertion is the semiextended position is the suprapatellar approach, which involves a vertical incision of the quadriceps tendon Damage to the patellofemoral joint cartilage has been highlighted as a drawback associated with this approach. To avoid this issue, we perform surgery using the patellar eversion technique and a soft sleeve. This method allows the articular surface to be monitored during intramedullary nail insertion. We arthroscopically assessed the effect of this technique on patellofemoral joint cartilage. The patellar eversion technique allows a direct view and protection of the patellofemoral joint without affecting the patella. Thus, damage to the patellofemoral joint cartilage can be avoided. Copyright © 2017 Elsevier Ltd. All rights reserved.

  10. Functional results after external vocal fold medialization thyroplasty with the titanium vocal fold medialization implant.

    Science.gov (United States)

    Schneider, Berit; Denk, Doris-Maria; Bigenzahn, Wolfgang

    2003-04-01

    A persistent insufficiency of glottal closure is mostly a consequence of a unilateral vocal fold movement impairment. It can also be caused by vocal fold atrophy or scarring processes with regular bilateral respiratory vocal fold function. Because of consequential voice, breathing, and swallowing impairments, a functional surgical treatment is required. The goal of the study was to outline the functional results after medialization thyroplasty with the titanium vocal fold medialization implant according to Friedrich. In the period of 1999 to 2001, an external vocal fold medialization using the titanium implant was performed on 28 patients (12 women and 16 men). The patients were in the age range of 19 to 84 years. Twenty-two patients had a paralysis of the left-side vocal fold, and six patients, of the right-side vocal fold. Detailed functional examinations were executed on all patients before and after the surgery: perceptive voice sound analysis according to the "roughness, breathiness, and hoarseness" method, judgment of the s/z ratio and voice dysfunction index, voice range profile measurements, videostroboscopy, and pulmonary function tests. In case of dysphagia/aspiration, videofluoroscopy of swallowing was also performed. The respective data were statistically analyzed (paired t test, Wilcoxon-test). All patients reported on improvement of voice, swallowing, and breathing functions postoperatively. Videostroboscopy revealed an almost complete glottal closure after surgery in all of the patients. All voice-related parameters showed a significant improvement. An increase of the laryngeal resistance by the medialization procedure could be excluded by analysis of the pulmonary function test. The results confirm the external medialization of the vocal folds as an adequate method in the therapy of voice, swallowing, and breathing impairment attributable to an insufficient glottal closure. The titanium implant offers, apart from good tissue tolerability, the

  11. Extracorporeal Shock Wave Therapy for Achilles and Patellar Tendinopathy: Meta-Analysis and a Systematic Review of the Literature

    OpenAIRE

    Punnoose, Anuj; Norrish, Alan; Pak, Katie

    2017-01-01

    Background: Sports related injuries such as lower limb tendinopathies can result in long-standing impairment of athletic performance. In recent years, treatment interventions like eccentric exercises, Platelet Rich Plasma (PRP) injections and Extracorporeal Shockwave Therapy (ESWT) have gained popularity among Physiotherapists and sports clinicians, but the evidence of their effectiveness is very limited. Purpose: To investigate the effectiveness of ESWT on Achilles and Patellar tendinopathy....

  12. Effectiveness of Shockwave Treatment Combined With Eccentric Training for Patellar Tendinopathy: A Double-Blinded Randomized Study

    OpenAIRE

    Thijs, Karin M.; Zwerver, Johannes; Backx, Frank J. G.; Steeneken, Victor; Rayer, Stephan; Groenenboom, Petra; Moen, Maarten H.

    2017-01-01

    OBJECTIVE: To evaluate the effectiveness of a combined treatment of focused shockwave therapy (ESWT) and eccentric training compared with sham-shockwave therapy (placebo) and eccentric training in participants with patellar tendinopathy (PT) after 24 weeks. DESIGN: Randomized controlled trial. SETTING: Sports medicine departments of a university hospital and a general hospital in the Netherlands. PARTICIPANTS: Fifty-two physically active male and female participants with a clinical diagnosis ...

  13. 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...... was accomplished, and 4-month follow-up demonstrated a good outcome. © 2015, European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA)....

  14. Cross-cultural adaptation and validation of the VISA-P questionnaire for German-speaking patients with patellar tendinopathy.

    Science.gov (United States)

    Lohrer, Heinz; Nauck, Tanja

    2011-03-01

    Clinical measurement study. To cross-culturally adapt and validate the Victorian Institute of Sports Assessment Patellar Tendinopathy Questionnaire (VISA-P) for German-speaking patients. Like most questionnaires, the VISA-P was developed for English-speaking patients. There is a need to adapt the scale for German-speaking patients and thereby add to the total body of psychometric evidence relating to this instrument. The VISA-P questionnaire was translated and cross-culturally adapted into German (VISA-P-G) in 6 steps: translation, synthesis, back translation, expert committee review, pretesting, and advisory committee appraisal. The psychometric properties of the VISA-P-G were determined using 23 patients with patellar tendinopathy and 57 active healthy persons (32 sport students and 25 basketball players). Reliability was evaluated by applying the questionnaire twice within a week to all 80 participants. Known group validity was calculated using a 1-way analysis of variance. Additionally, VISA-P-G results were correlated with the Blazina classification system for patellar tendinopathy, using the Spearman rank correlation coefficient. VISA-P-G ratings from the present study groups were further compared with respective data published in the original English, Dutch, and Swedish versions by a 2-sample t test. Internal consistency for the individual items of the questionnaire was determined within the patient group using a Cronbach alpha. Test-retest revealed excellent reliability for the patient and the asymptomatic control group (ICC = 0.88 and 0.87, respectively). Internal consistency for the patients was 0.88. Concurrent validity was almost perfect (ρ = -0.81; Pspeaking patients with patellar tendinopathy. Its psychometric properties are comparable with the original English and international adaptations (Swedish, Dutch, and Italian).

  15. Increased serum cartilage oligomeric matrix protein levels and decreased patellar bone mineral density in patients with chondromalacia patellae.

    Science.gov (United States)

    Murphy, E; FitzGerald, O; Saxne, T; Bresnihan, B

    2002-11-01

    Chondromalacia patellae is a potentially disabling disorder characterised by features of patellar cartilage degradation. To evaluate markers of cartilage and bone turnover in patients with chondromalacia patellae. 18 patients with chondromalacia patellae were studied. Serum cartilage oligomeric matrix protein (s-COMP) and bone sialoprotein (s-BSP) levels were measured by enzyme linked immunosorbent assay (ELISA) and compared with those of age and sex matched healthy control subjects. Periarticular bone mineral density (BMD) of both knee joints was assessed by dual energy x ray absorptiometry (DXA). s-COMP levels were significantly raised in all patients with chondromalacia patellae compared with healthy control subjects (p=0.0001). s-BSP levels did not differ significantly between the groups (p=0.41). BMD of the patella was significantly reduced in patients with chondromalacia patellae compared with the control subjects (p=0.016). In patients with bilateral chondromalacia patellae, BMD of the patella was lower in the more symptomatic knee joint (p=0.005). Changes in periarticular BMD were localised to the patella and were not present in femoral regions. Neither s-COMP (p=0.18) nor s-BSP (p=0.40) levels correlated with patellar BMD. Increased s-COMP levels, reflecting cartilage degradation, and reduced BMD localised to the patella may represent clinically useful markers in the diagnosis and monitoring of patients with chondromalacia patellae. Measures of cartilage degradation did not correlate with loss of patellar bone density, suggesting dissociated pathophysiological mechanisms.

  16. Long-Term Follow-Up of Nonoperatively and Operatively Treated Acute Primary Patellar Dislocation in Skeletally Immature Patients

    Directory of Open Access Journals (Sweden)

    Eva Bengtsson Moström

    2014-01-01

    Full Text Available Purpose. The present study reports a long-term follow-up of acute primary patellar dislocation in patients with open physes. The purpose of the study was to evaluate knee function and recurrence rates after surgical and nonsurgical treatment of patellar dislocation. Methods. A total of 51 patients, including 29 girls and 22 boys, who were 9–14 years of age at the time of injury, were retrospectively evaluated. The minimum follow-up time was 5 years. Thigh muscle torque, range of motion, the squat test, the knee injury and osteoarthritis outcome score (KOOS, the Kujala score, and the recurrence rate were registered. Radiological predisposing factors at the time of injury were determined. Results. Quality of life and sports/recreation were the most affected subscales, according to KOOS, and a reduced Kujala score was also observed in all treatment groups. The surgically treated patients had a significantly lower recurrence rate. Those patients also exhibited reduced muscle performance, with a hamstring to quadriceps ratio (H/Q of 1.03. The recurrence rate was not correlated with knee function. Conclusions. Patellar dislocation in children influences subjective knee function in the long term. Surgery appears to reduce the recurrence rate, but subjective knee function was not restored.

  17. Circumferential electrocautery of the patella in primary total knee replacement without patellar replacement: a meta-analysis and systematic review

    Science.gov (United States)

    Fan, Lihong; Ge, Zhaogang; Zhang, Chen; Li, Jia; Yu, Zefeng; Dang, Xiaoqian; Wang, Kunzheng

    2015-03-01

    The purpose of this meta-analysis and systematic review was to identify and assess whether circumferential electrocautery is useful for improving outcomes after primary total knee replacement(TKR). We searched MEDLINE, EMBASE, PubMed, SpringerLink, Web of Knowledge, OVID CINAHL, OVID EBM and Google Scholar and included articles published through January 2014. A total of 6 articles met the inclusion criteria. Of the 776 cases included in the analysis, 388 cases involved patellar denervation, and 388 cases were designated as the control group. The meta-analysis revealed no significant difference in the incidence of anterior knee pain (AKP, p = 0.18) or in the visual analogue scale score (VAS, p = 0.23) between the two groups. In addition, AKSS Function Score indicated no significant difference between the two groups (p = 0.28). However, the OKS (p = 0.02), patellar score (p = 0.01), AKSS-Knee Score (p = 0.004), range of motion (ROM, p electrocautery. The results indicate that circumferential electrocautery of the patella does not significantly improve AKP compared with non-electrocautery techniques but that circumferential electrocautery significantly improves patients' knee function after surgery. Therefore, we believe that circumferential electrocautery is beneficial to the outcome of primary TKR surgery without patellar replacement.

  18. Spontaneous compactification to homogeneous spaces

    International Nuclear Information System (INIS)

    Mourao, J.M.

    1988-01-01

    The spontaneous compactification of extra dimensions to compact homogeneous spaces is studied. The methods developed within the framework of coset space dimensional reduction scheme and the most general form of invariant metrics are used to find solutions of spontaneous compactification equations

  19. Screening for spontaneous preterm birth

    NARCIS (Netherlands)

    van Os, M.A.; van Dam, A.J.E.M.

    2015-01-01

    Preterm birth is the most important cause of perinatal morbidity and mortality worldwide. In this thesis studies on spontaneous preterm birth are presented. The main objective was to investigate the predictive capacity of mid-trimester cervical length measurement for spontaneous preterm birth in a

  20. Spontaneous Pneumomediastinum: Hamman Syndrome

    Directory of Open Access Journals (Sweden)

    Tushank Chadha, BS

    2018-04-01

    significant fat stranding. The image also showed an intraluminal stent traversing the gastric antrum and gastric pylorus with no indication of obstruction. Circumferential mural thickening of the gastric antrum and body were consistent with the patient’s history of gastric adenocarcinoma. The shotty perigastric lymph nodes with associated fat stranding, along the greater curvature of the distal gastric body suggested local regional nodal metastases and possible peritoneal carcinomatosis. The thoracic CT scans showed extensive pneumomediastinum that tracked into the soft tissues of the neck, which given the history of vomiting also raised concern for esophageal perforation. There was still no evidence of mediastinal abscess or fat stranding. Additionally, a left subclavian vein port catheter, which terminates with tip at the cavoatrial junction of the superior vena cava can also be seen on the image. Discussion: Spontaneous Pneumomediastinum, also known as Hamman syndrome, is defined by the uncommon incidence of free air in the mediastinum due to the bursting of alveoli, as a result of extended spells of shouting, coughing, or vomiting.1,2 The condition is diagnosed when a clear cause (aerodigestive rupture, barotrauma, infection secondary to gas-forming organisms3 for pneumomediastinum cannot be clearly identified on diagnostic studies. Macklin and Macklin were the first to note the pathogenesis of the syndrome and explained that the common denominator to spontaneous pneumomediastinum was that increased alveolar pressure leads to alveolar rupture.3 Common clinical findings for spontaneous pneumomediastinum include: chest pain, dyspnea, cough, and emesis.4 The condition is not always readily recognized on initial presentation in part for its rare incidence, estimated to be approximately 1 in every 44,500 ED patients3and also because of the non-specific presenting symptoms. For this patient, there was no clear singular cause, and therefore she received care for spontaneous

  1. Medialized repair for retracted rotator cuff tears.

    Science.gov (United States)

    Kim, Young-Kyu; Jung, Kyu-Hak; Won, Jun-Sung; Cho, Seung-Hyun

    2017-08-01

    The purpose of this study was to evaluate the functional outcomes of medialized rotator cuff repair and the continuity of repaired tendon in chronic retracted rotator cuff tears. Thirty-five consecutive patients were selected from 153 cases that underwent arthroscopic rotator cuff repair for more than medium-sized posterosuperior rotator cuff tears between July 2009 and July 2012 performed with the medialized repair. All cases were available for at least 2 years of postoperative follow-up. The visual analog scale of pain, muscle strength, Constant score, American Shoulder and Elbow Surgeons (ASES) score, and University of California-Los Angeles score were evaluated. At the final follow-up, all clinical outcomes were significantly improved. The visual analog scale score for pain improved from 6 ± 1 preoperatively to 2 ± 1 postoperatively. The range of motion increased from preoperatively to postoperatively: active forward elevation, from 134° ± 49° to 150° ± 16°; active external rotation at the side, from 47° ± 15° to 55° ± 10°; and active internal rotation, from L3 to L1. The shoulder score also improved: Constant score, from 53.5 ± 16.7 to 79 ± 10; American Shoulder and Elbow Surgeons score, from 51 ± 15 to 82 ± 8; and University of California-Los Angeles score, from 14 ± 4 to 28 ± 4. The retear cases at the final follow-up were 6 (17%). Medialized repair may be useful in cases in which anatomic bone-to-tendon repair would be difficult because of the excessive tension of the repaired tendon and a torn tendon that does not reach the anatomic insertion. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  2. Nonsurgical Treatments of Patellar Tendinopathy: Multiple Injections of Platelet-Rich Plasma Are a Suitable Option: A Systematic Review and Meta-analysis.

    Science.gov (United States)

    Andriolo, Luca; Altamura, Sante Alessandro; Reale, Davide; Candrian, Christian; Zaffagnini, Stefano; Filardo, Giuseppe

    2018-03-01

    Patellar tendinopathy is a condition characterized by anterior knee activity-related pain. It has a high incidence among athletes engaged in jumping sports and may become a chronic condition. Nonoperative management is the first choice in these patients, and several nonsurgical treatment options have been proposed. Nonetheless, clear indications on the most effective approach to address patellar tendinopathy are still lacking. To analyze the evidence on nonoperative options to treat chronic patellar tendinopathy through a systematic review of the literature and to perform a meta-analysis to identify the most effective nonsurgical option. Systematic review and meta-analysis. The search was conducted with the PubMed and Cochrane databases on January 4, 2017. All clinical English-language reports of any level of evidence on nonsurgical treatment of patellar tendinopathy were included. The quality of each article was assessed by use of the Coleman score. A meta-analysis was performed on all articles reporting the Victorian Institute of Sport Assessment scale for patellar tendinopathy to evaluate the results of the most described treatments. A total of 70 studies involving 2530 patients were included in the qualitative data synthesis. The Coleman score showed an overall poor study quality. The most described treatment groups that could be included in the meta-analysis were reported in 22 studies on eccentric exercise, extracorporeal shockwave therapy (ESWT), and platelet-rich plasma (PRP). Single and multiple PRP injections were evaluated separately. Eccentric exercise therapies obtained the best results ( P patellar tendinopathy with important limitations in terms of study quality. The available evidence showed an overall positive outcome, but some differences have been highlighted. Eccentric exercises may seem the strategy of choice in the short-term, but multiple PRP injections may offer more satisfactory results at long-term follow-up and can be therefore considered

  3. The TOPSHOCK study: effectiveness of radial shockwave therapy compared to focused shockwave therapy for treating patellar tendinopath - design of a randomised controlled trial.

    Science.gov (United States)

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

    2011-10-11

    Patellar tendinopathy is a chronic overuse injury of the patellar tendon that is especially prevalent in people who are involved in jumping activities. Extracorporeal Shockwave Therapy is a relatively new treatment modality for tendinopathies. It seems to be a safe and promising part of the rehabilitation program for patellar tendinopathy. Extracorporeal Shockwave Therapy originally used focused shockwaves. Several years ago a new kind of shockwave therapy was introduced: radial shockwave therapy. Studies that investigate the effectiveness of radial shockwave therapy as treatment for patellar tendinopathy are scarce. Therefore the aim of this study is to compare the effectiveness of focussed shockwave therapy and radial shockwave therapy as treatments for patellar tendinopathy. The TOPSHOCK study (Tendinopathy Of Patella SHOCKwave) is a two-armed randomised controlled trial in which the effectiveness of focussed shockwave therapy and radial shockwave therapy are directly compared. Outcome assessors and patients are blinded as to which treatment is given. Patients undergo three sessions of either focused shockwave therapy or radial shockwave therapy at 1-week intervals, both in combination with eccentric decline squat training. Follow-up measurements are scheduled just before treatments 2 and 3, and 1, 4, 7 and 12 weeks after the final treatment. The main outcome measure is the Dutch VISA-P questionnaire, which asks for pain, function and sports participation in subjects with patellar tendinopathy. Secondary outcome measures are pain determined with a VAS during ADL, sports and decline squats, rating of subjective improvement and overall satisfaction with the treatment. Patients will also record their sports activities, pain during and after these activities, and concurrent medical treatment on a weekly basis in a web-based diary. Results will be analysed according to the intention-to-treat principle. The TOPSHOCK study is the first randomised controlled trial that

  4. Quadriceps Tendon Autograft Medial Patellofemoral Ligament Reconstruction.

    Science.gov (United States)

    Fink, Christian; Steensen, Robert; Gföller, Peter; Lawton, Robert

    2018-06-01

    Critically evaluate the published literature related to quadriceps tendon (QT) medial patellofemoral ligament (MPFL) reconstruction. Hamstring tendon (HT) MPFL reconstruction techniques have been shown to successfully restore patella stability, but complications including patella fracture are reported. Quadriceps tendon (QT) reconstruction techniques with an intact graft pedicle on the patella side have the advantage that patella bone tunnel drilling and fixation are no longer needed, reducing risk of patella fracture. Several QT MPFL reconstruction techniques, including minimally invasive surgical (MIS) approaches, have been published with promising clinical results and fewer complications than with HT techniques. Parallel laboratory studies have shown macroscopic anatomy and biomechanical properties of QT are more similar to native MPFL than hamstring (HS) HT, suggesting QT may more accurately restore native joint kinematics. Quadriceps tendon MPFL reconstruction, via both open and MIS techniques, have promising clinical results and offer valuable alternatives to HS grafts for primary and revision MPFL reconstruction in both children and adults.

  5. Lower Extremity Kinematics During a Drop Jump in Individuals With Patellar Tendinopathy

    Science.gov (United States)

    Rosen, Adam B.; Ko, Jupil; Simpson, Kathy J.; Kim, Seock-Ho; Brown, Cathleen N.

    2015-01-01

    Background: Patellar tendinopathy (PT) is a common degenerative condition in physically active populations. Knowledge regarding the biomechanics of landing in populations with symptomatic PT is limited, but altered mechanics may play a role in the development or perpetuation of PT. Purpose: To identify whether study participants with PT exhibited different landing kinematics compared with healthy controls. Study Design: Controlled laboratory study. Methods: Sixty recreationally active participants took part in this study; 30 had current signs and symptoms of PT, including self-reported pain within the patellar tendon during loading activities for at least 3 months and ≤80 on the Victorian Institute of Sport Assessment Scale–Patella (VISA-P). Thirty healthy participants with no history of PT or other knee joint pathology were matched by sex, age, height, and weight. Participants completed 5 trials of a 40-cm, 2-legged drop jump followed immediately by a 50% maximum vertical jump. Dependent variables of interest included hip, knee, and ankle joint angles at initial ground contact, peak angles, and maximum angular displacements during the landing phase in 3 planes. Independent-samples t tests (P ≤ .05) were utilized to compare the joint angles and angular displacements between PT and control participants. Results: Individuals with PT displayed significantly decreased peak hip (PT, 59.2° ± 14.6°; control, 67.2° ± 13.9°; P = .03) and knee flexion angles (PT, 74.8° ± 13.2°; control, 82.5° ± 9.0°; P = .01) compared with control subjects. The PT group displayed decreased maximum angular displacement in the sagittal plane at the hip (PT, 49.3° ± 10.8°; control, 55.2° ± 11.4°; P = .04) and knee (PT, 71.6° ± 8.4°; control, 79.7° ± 8.3°; P plane, at both the knee and the hip. The altered movement patterns in those with PT may be perpetuating symptoms associated with PT and could be due to the contributions of the rectus femoris during dynamic

  6. Spontaneous mentalizing during an interactive real world task: an fMRI study.

    Science.gov (United States)

    Spiers, Hugo J; Maguire, Eleanor A

    2006-01-01

    There are moments in everyday life when we need to consider the thoughts and intentions of other individuals in order to act in a socially appropriate manner. Most of this mentalizing occurs spontaneously as we go about our business in the complexity of the real world. As such, studying the neural basis of spontaneous mentalizing has been virtually impossible. Here we devised a means to achieve this by employing a unique combination of functional magnetic resonance imaging (fMRI), a detailed and interactive virtual reality simulation of a bustling familiar city, and a retrospective verbal report protocol. We were able to provide insights into the content of spontaneous mentalizing events and identify the brain regions that underlie them. We found increased activity in a number of regions, namely the right posterior superior temporal sulcus, the medial prefrontal cortex and the right temporal pole associated with spontaneous mentalizing. Furthermore, we observed the right posterior superior temporal sulcus to be consistently active during several different subtypes of mentalizing events. By contrast, medial prefrontal cortex seemed to be particularly involved in thinking about agents that were visible in the environment. Our findings show that it is possible to investigate the neural basis of mentalizing in a manner closer to its true context, the real world, opening up intriguing possibilities for making comparisons with those who have mentalizing problems.

  7. Spontaneous lateral temporal encephalocele.

    Science.gov (United States)

    Tuncbilek, Gokhan; Calis, Mert; Akalan, Nejat

    2013-01-01

    A spontaneous encephalocele is one that develops either because of embryological maldevelopment or from a poorly understood postnatal process that permits brain herniation to occur. We here report a rare case of lateral temporal encephalocele extending to the infratemporal fossa under the zygomatic arch. At birth, the infant was noted to have a large cystic mass in the right side of the face. After being operated on initially in another center in the newborn period, the patient was referred to our clinic with a diagnosis of temporal encephalocele. He was 6 months old at the time of admission. Computerized tomography scan and magnetic resonance imaging studies revealed a 8 × 9 cm fluid-filled, multiloculated cystic mass at the right infratemporal fossa. No intracranial pathology or connection is seen. The patient was operated on to reduce the distortion effect of the growing mass. The histopathological examination of the sac revealed well-differentiated mature glial tissue stained with glial fibrillary acid protein. This rare clinical presentation of encephaloceles should be taken into consideration during the evaluation of the lateral facial masses in the infancy period, and possible intracranial connection should be ruled out before surgery to avoid complications.

  8. Spontaneous intracranial hypotension

    International Nuclear Information System (INIS)

    Haritanti, A.; Karacostas, D.; Drevelengas, A.; Kanellopoulos, V.; Paraskevopoulou, E.; Lefkopoulos, A.; Economou, I.; Dimitriadis, A.S.

    2009-01-01

    Spontaneous intracranial hypotension (SIH) is an uncommon but increasingly recognized syndrome. Orthostatic headache with typical findings on magnetic resonance imaging (MRI) are the key to diagnosis. Delayed diagnosis of this condition may subject patients to unnecessary procedures and prolong morbidity. We describe six patients with SIH and outline the important clinical and neuroimaging findings. They were all relatively young, 20-54 years old, with clearly orthostatic headache, minimal neurological signs (only abducent nerve paresis in two) and diffuse pachymeningeal gadolinium enhancement on brain MRI, while two of them presented subdural hygromas. Spinal MRI was helpful in detecting a cervical cerebrospinal fluid leak in three patients and dilatation of the vertebral venous plexus with extradural fluid collection in another. Conservative management resulted in rapid resolution of symptoms in five patients (10 days-3 weeks) and in one who developed cerebral venous sinus thrombosis, the condition resolved in 2 months. However, this rapid clinical improvement was not accompanied by an analogous regression of the brain MR findings that persisted on a longer follow-up. Along with recent literature data, our patients further point out that SIH, to be correctly diagnosed, necessitates increased alertness by the attending physician, in the evaluation of headaches

  9. Stress fracture of the medial clavicle secondary to nervous tic

    International Nuclear Information System (INIS)

    Yamada, K.; Sugiura, H.; Suzuki, Y.

    2004-01-01

    The clinical and radiological characteristics of swelling in the region of the medial clavicle may suggest the presence of a neoplastic or inflammatory lesion. This report describes a 27-year-old man with a painful tumor-like lesion over the medial clavicle, which was found to be a stress fracture caused by a nervous tic resulting from mental stress. (orig.)

  10. Anatomical and magnetic resonance imaging study of the medial ...

    African Journals Online (AJOL)

    Introduction: The medial collateral ligament of the ankle joint also known as the deltoid ligament, is a multifascicular group of ligaments. It can be divided into a superficial and deep group of fibers originating from the medial malleolus to insert in the talus, calcaneus, and navicular bones. Wide variations have been noted in ...

  11. Medial shoe-ground pressure and specific running injuries

    DEFF Research Database (Denmark)

    Brund, René B K; Rasmussen, Sten; Nielsen, Rasmus O

    2017-01-01

    pressure. Foot balance was categorized into those which presented a higher lateral shod pressure (LP) than medial pressure, and those which presented a higher medial shod pressure (MP) than lateral pressure during the stance phase. A time-to-event model was used to compare differences in incidence between...

  12. Low implant migration of the SIGMA® medial unicompartmental knee arthroplasty

    DEFF Research Database (Denmark)

    Koppens, Daan; Stilling, Maiken; Munk, Stig

    2017-01-01

    The purpose of this study was to evaluate implant migration of the fixed-bearing Sigma® medial unicompartmental knee arthroplasty (UKA). UKA is a regularly used treatment for patients with medial osteoarthritis (OA) of the knee. UKA has a higher revision rate than total knee arthroplasty. Implant...

  13. Intrinsic factors associated with medial tibial stress syndrome in ...

    African Journals Online (AJOL)

    Intrinsic factors associated with medial tibial stress syndrome in athletes: A large case-control study. ... Medial tibial stress syndrome (MTSS) is the most common lower-leg injury in athletes, and is thought to be caused by ... from 32 Countries:.

  14. Medial Amygdala and Aggressive Behavior : Interaction Between Testosterone and Vasopressin

    NARCIS (Netherlands)

    Koolhaas, J.M.; Roozendaal, B.; Boorsma, F.; Van Den Brink, T.H.C.

    1990-01-01

    This paper considers the functional significance of the testosterone-dependent vasopressinergic neurons of the medial amygdala (Ame) in intermale aggressive behavior of rats. Local microinfusion of vasopressin into the medial amygdala causes an increase in offensive behavior both in gonadally intact

  15. Genetics Home Reference: primary spontaneous pneumothorax

    Science.gov (United States)

    ... Home Health Conditions Primary spontaneous pneumothorax Primary spontaneous pneumothorax Printable PDF Open All Close All Enable Javascript ... view the expand/collapse boxes. Description Primary spontaneous pneumothorax is an abnormal accumulation of air in the ...

  16. Traumatic posterior root tear of the medial meniscus in patients with severe medial instability of the knee.

    Science.gov (United States)

    Ra, Ho Jong; Ha, Jeong Ku; Jang, Ho Su; Kim, Jin Goo

    2015-10-01

    To examine the incidence and diagnostic rate of traumatic medial meniscus posterior root tear associated with severe medial instability and to evaluate the effectiveness of pullout repair. From 2007 to 2011, 51 patients who underwent operation due to multiple ligament injuries including medial collateral ligament rupture were reviewed retrospectively. The International Knee Documentation Committee (IKDC) subjective and Lysholm score were evaluated pre- and postoperatively. Postoperative magnetic resonance imaging (MRI) was performed, and if indicated, a second-look arthroscopic examination was conducted. Fourteen out of 51 patients were associated with severe medial instability. Seven patients were diagnosed with traumatic medial meniscus posterior root tear and underwent arthroscopic pullout repair. Five of them were missed at initial diagnosis using MRI. In seven patients, the mean Lysholm and IKDC subjective scores improved from 74.6 ± 10.3 and 47.6 ± 7.3 to 93.0 ± 3.7 and 91.6 ± 2.6, respectively. All showed complete healing of meniscus root on follow-up MRI and second-look arthroscopy. Medial meniscus posterior root tear may occur in severe medial instability from trauma. It is a common mistake that surgeons may not notice on the diagnosis of those injuries using MRI. Therefore, a high index of suspicion is required for the diagnosis of medial meniscus posterior root tear in this type of injuries. The traumatic medial meniscus posterior root tear could be healed successfully using arthroscopic pullout repair technique. The possibility of the medial meniscus posterior root tear should be considered in severe medial instability and arthroscopic pullout repair can be an effective option for treatment. Case series with no comparison group, Level IV.

  17. Ziprasidone-induced spontaneous orgasm.

    Science.gov (United States)

    Boora, K; Chiappone, K; Dubovsky, S; Xu, J

    2010-06-01

    Neuroleptic treatment in schizophrenic patients has been associated with sexual dysfunction, including impotence and decreased libido. Spontaneous ejaculation without sexual arousal during typical antipsychotic treatment is a rare condition that has been described with zuclopentixol, trifluoperazine, and thiothixene. Here, we are reporting a case of spontaneous orgasm with ziprasidone in a bipolar patient. This patient began to repeatedly experience spontaneous sexual arousal and orgasm, which she had never experienced in the past. Ziprasidone might be causing an increase in sexual orgasm by 5-HT2 receptor antagonism, which preclinical evidence suggests that it facilitates dopamine release in the cortex.

  18. Centralization of extruded medial meniscus delays cartilage degeneration in rats.

    Science.gov (United States)

    Ozeki, Nobutake; Muneta, Takeshi; Kawabata, Kenichi; Koga, Hideyuki; Nakagawa, Yusuke; Saito, Ryusuke; Udo, Mio; Yanagisawa, Katsuaki; Ohara, Toshiyuki; Mochizuki, Tomoyuki; Tsuji, Kunikazu; Saito, Tomoyuki; Sekiya, Ichiro

    2017-05-01

    Meniscus extrusion often observed in knee osteoarthritis has a strong correlation with the progression of cartilage degeneration and symptom in the patients. We recently reported a novel procedure "arthroscopic centralization" in which the capsule was sutured to the edge of the tibial plateau to reduce meniscus extrusion in the human knee. However, there is no animal model to study the efficacy of this procedure. The purposes of this study were [1] to establish a model of centralization for the extruded medial meniscus in a rat model; and [2] to investigate the chondroprotective effect of this procedure. Medial meniscus extrusion was induced by the release of the anterior synovial capsule and the transection of the meniscotibial ligament. Centralization was performed by the pulled-out suture technique. Alternatively, control rats had only the medial meniscus extrusion surgery. Medial meniscus extrusion was evaluated by micro-CT and macroscopic findings. Cartilage degeneration of the medial tibial plateau was evaluated macroscopically and histologically. By micro-CT analysis, the medial meniscus extrusion was significantly improved in the centralization group in comparison to the extrusion group throughout the study. Both macroscopically and histologically, the cartilage lesion of the medial tibial plateau was prevented in the centralization group but was apparent in the control group. We developed medial meniscus extrusion in a rat model, and centralization of the extruded medial meniscus by the pull-out suture technique improved the medial meniscus extrusion and delayed cartilage degeneration, though the effect was limited. Centralization is a promising treatment to prevent the progression of osteoarthritis. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  19. A Study on the Effects of Patellar Taping on Pain, Quality of Life, and Radiographic Findings in Patients with Patellofemoral Pain Syndrome

    Directory of Open Access Journals (Sweden)

    M Banan

    2016-01-01

    Full Text Available BACKGROUND AND OBJECTIVE: Patellofemoral pain syndrome (PFPS is the most common cause of anterior knee pain in adults. Patellar taping is used to correct patellar position and rehabilitate patients with PFPS. However, the effectiveness and clinical efficiency of this technique in the treatment of these patients are not fully determined. Therefore, this study aimed to evaluate the effects of knee taping on patellar alignment, quality of life, and pain in patients with PFPS. METHODS: This cross-sectional study was conducted on 25 PFPS patients within the age range of 20-50 years. McConnell taping technique was applied for patients during four weeks. Before and immediately after the treatment, quality of life (via KOOS questionnaire, patellar alignment (via skyline radiography of the knee, and pain intensity were measured. FINDINGS: After four weeks, McConnell taping technique caused a decline in pain intensity from 50.13±21.60 to 26.67±10.14 mm in patients with PFPS (P=0.001. However, this technique had no positive effects on quality of life (score on KOOS questionnaire or patellar angle/position (P<0.05. CONCLUSION: Based on the findings, independent use of McConnell taping technique is not sufficient for improving the quality of life in patients with PFPS or correcting the abnormal alignment of patella however, it can help reduce the induced pain.

  20. Comparing the effects of eccentric training with eccentric training and static stretching exercises in the treatment of patellar tendinopathy. A controlled clinical trial.

    Science.gov (United States)

    Dimitrios, Stasinopoulos; Pantelis, Manias; Kalliopi, Stasinopoulou

    2012-05-01

    The aim of the present study was to investigate the effectiveness of eccentric training and eccentric training with static stretching exercises in the management of patellar tendinopathy. Controlled clinical trial. Rheumatology and rehabilitation centre. Forty-three patients who had patellar tendinopathy for at least three months. They were allocated to two groups by alternative allocation. Group A (n = 22) was treated with eccentric training of patellar tendon and static stretching exercises of quadriceps and hamstrings and Group B (n = 21) received eccentric training of patellar tendon. All patients received five treatments per week for four weeks. Pain and function were evaluated using the VISA-P score at baseline, at the end of treatment (week 4), and six months (week 24) after the end of treatment. At the end of treatment, there was a rise in VISA-P score in both groups compared with baseline (Peccentric training and static stretching exercises produced the largest effect (PEccentric training and static stretching exercises is superior to eccentric training alone to reduce pain and improve function in patients with patellar tendinopathy at the end of the treatment and at follow-up.

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

    Science.gov (United States)

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

    2012-12-01

    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 large representative sample of basketball and volleyball players. Separate risk factors for men and women, basketball and volleyball players, and athletes with unilateral and bilateral PT were identified. All basketball and volleyball players between ages 18 and 35 from the Dutch Basketball Association and the Dutch Volleyball Association were invited to complete an online questionnaire on knee complaints and risk factors for PT. The logistic regression analyses included 2224 subjects. The risk factors for PT were age, playing at the national level, being male and playing volleyball (compared with playing basketball). The risk factors for men and women were comparable. Among volleyball players, outside hitters and middle blockers/hitters had an increased risk compared with setters. For basketball players, no risk factors could be identified. No differences in the risk factors were found between athletes with unilateral and bilateral PT. These findings should be taken into account for prevention and rehabilitation purposes. © 2011 John Wiley & Sons A/S.

  2. MRI of anterior cruciate ligament repair with patellar and hamstring tendon autografts

    International Nuclear Information System (INIS)

    Jansson, K.A.; Karjalainen, P.T.; Harilainen, A.; Sandelin, J.; Tallroth, K.; Soila, K.; Aronen, H.J.

    2001-01-01

    Objective. Several MRI sequences were used to evaluate the 2-year postoperative appearance of asymptomatic knee with a torn anterior cruciate ligament (ACL) reconstructed with bone-patellar tendon-bone (BTB) and semitendinosus and gracilis (STG) tendon autografts.Design and patients. Two groups with successful repair of ACL tear with BTB (n=10) or STG (n=10) autografts were imaged at 1.5 T with sagittal and oblique coronal proton density-, T2-weighted and sagittal STIR sequences and plain and contrast-enhanced oblique coronal T1-weighted sequences. The appearance of the graft and periligamentous tissues was evaluated.Results. In all 20 cases, the ACL graft showed homogeneous, low signal intensity with periligamentous streaks of intermediate signal intensity on T2-weighted images. In 10 cases, localised areas of intermediate signal intensity were seen in the intra-articular segment of the graft on proton density- and T1-weighted images. The graft itself did not show enhancement in either of the two groups, but mild to moderate periligamentous enhancement was detected in 10 cases.Conclusion. The MRI appearance of ACL autograft is variable on proton density- and T1-weighted images. Periligamentous tissue showing contrast enhancement is a typical MRI finding after clinically successful ACL reconstruction. (orig.)

  3. The informative value of radionative diagnostics in cases of patellar chondropathy

    International Nuclear Information System (INIS)

    Gloeckler, T.W.

    1979-01-01

    The present study of 64 patients analyzes the diagnosticability of patellar chondropathy on the basis of X-ray native images. The results were confirmed intraoperatively or arthroscopically. We evaluated images of both knees in a.p. and lateral projection and walking images with 30, 60, and 90 0 of joint bending. In all cases of chondropathy of third degree, radiomorphologic changes could be delineated; in stage I this was possible in 66% of the cases. The summarizing assessment of structural irregularities as discontinued contours of the subchondral osseous lamella, spot-like or diffuse demineralisation, osteophyteous peripheral serration, disintegration in the insertion area of the quadriceps tendo, soft-tissue swelling and hemarthrosis is significant for establishing the diagnosis. Whereas there is a causal relationship between defective axial positions of the patella or particularly posttraumatic defect and the development of a chrondropathy, we could not detect in the investigated patient-group a significantly higher incidence of chondropathy in cases of dysplasia of the patella or of the femoral condyles. A simple scheme - applicable in arthroscopy and radiology - is introduced: it shall help to record chondromalacious regions and considers the most frequently affected areas. (orig.) [de

  4. Patellar instability in Indian population: relevance of tibial tuberosity and trochlear groove distance

    Directory of Open Access Journals (Sweden)

    Kulkarni Sourabh

    2016-01-01

    Full Text Available Introduction: The tibial tuberosity to trochlear groove (TTTG distance in the western population is extensively studied through various modalities such as X-rays, computerised tomography and magnetic resonance imaging. However, to our knowledge there is very little or no literature support to indicate that TTTG distance has been studied in the Indian population. Methods: We therefore undertook a study to measure the TTTG distance in 100 MRI scans of normal Indian knees. Patients with the following co-morbidities were excluded from the study; ligamentous laxity, patellofemoral instability, mal-alignment and osteoarthritis. We measured TTTG distance on the axial MRI slices using OsiriX software. Results: The mean value for females was found to be 14.07 mm and that for male was found to be 13.34 mm. Our study indicates that the TTTG distance, using MRI scans as measurement modality, in the Indian population is significantly different when compared to the published western data. Discussion: We believe that this study can form the basis for future studies on the relationship between TTTG distance and patellar instability in Indian population.

  5. Assessment of Patellar Tendon Reflex Responses Using Second-Order System Characteristics

    Directory of Open Access Journals (Sweden)

    Brett D. Steineman

    2016-01-01

    Full Text Available Deep tendon reflex tests, such as the patellar tendon reflex (PTR, are widely accepted as simple examinations for detecting neurological disorders. Despite common acceptance, the grading scales remain subjective, creating an opportunity for quantitative measures to improve the reliability and efficacy of these tests. Previous studies have demonstrated the usefulness of quantified measurement variables; however, little work has been done to correlate experimental data with theoretical models using entire PTR responses. In the present study, it is hypothesized that PTR responses may be described by the exponential decay rate and damped natural frequency of a theoretical second-order system. Kinematic data was recorded from both knees of 45 subjects using a motion capture system and correlation analysis found that the mean R2 value was 0.99. Exponential decay rate and damped natural frequency ranges determined from the sample population were −5.61 to −1.42 and 11.73 rad/s to 14.96 rad/s, respectively. This study confirmed that PTR responses strongly correlate to a second-order system and that exponential decay rate and undamped natural frequency are novel measurement variables to accurately measure PTR responses. Therefore, further investigation of these measurement variables and their usefulness in grading PTR responses is warranted.

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

    Science.gov (United States)

    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 ± 8.2 years; 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 Oslo Sports Trauma Research Center overuse injury questionnaire, the single-item Work Ability Index and the Quantity and Quality questionnaire, respectively. Reduced sports performance was reported by 55% of the participants; 16% reported reduced work ability and 36% decreased work productivity, with 23% and 58%, respectively, for physically demanding work. This study shows that the impact of PT on sports and work performance is substantial and stresses the importance of developing preventive measures.

  7. Quark potential of spontaneous strings

    International Nuclear Information System (INIS)

    German, G.; Kleinert, H.

    1989-01-01

    The authors present some recent developments in string models with an extrinsic curvature term in action. Particular emphasis is placed upon the static quark potential and on the thermal deconfinement properties of spontaneous strings

  8. Hematome Extra - Dural Rachidien Spontane

    Directory of Open Access Journals (Sweden)

    Cl. Gros

    1967-01-01

    Full Text Available Four personal cases of Spontaneous Spinal Epidurdl Hemerrhage are Reported. And 29 additional cases have been analysed by reviewing the literature. The clinical radiologcal and surgical aspects were discussed.

  9. Spontaneous intraorbital hematoma: case report

    Directory of Open Access Journals (Sweden)

    Vinodan Paramanathan

    2010-12-01

    Full Text Available Vinodan Paramanathan, Ardalan ZolnourianQueen's Hospital NHS Foundation Trust, Burton on Trent, Staffordshire DE13 0RB, UKAbstract: Spontaneous intraorbital hematoma is an uncommon clinical entity seen in ophthalmology practice. It is poorly represented in the literature. Current evidence attributes it to orbital trauma, neoplasm, vascular malformations, acute sinusitis, and systemic abnormalities. A 65-year-old female presented with spontaneous intraorbital hematoma manifesting as severe ocular pains, eyelid edema, proptosis, and diplopia, without a history of trauma. Computer tomography demonstrated a fairly well defined extraconal lesion with opacification of the paranasal sinuses. The principal differential based on all findings was that of a spreading sinus infection and an extraconal tumor. An unprecedented finding of a spontaneous orbital hematoma was discovered when the patient was taken to theater. We discuss the rarity of this condition and its management.Keywords: hemorrhage, ophthalmology, spontaneous, intra-orbital, hematoma

  10. Fragmentation of the medial malleolus of dogs with and without tarsal osteochondrosis

    International Nuclear Information System (INIS)

    Newell, S.M.; Mahaffey, M.B.; Aron, D.N.

    1994-01-01

    Fragmentation of the medial malleolus of the tibia was found radiographically in 5 canine tarsi which did not have evidence of osteochondrosis of the medial trochlear ridge. An additional 5 tarsi were found where both medial malleolar fragmentation and osteochondrosis of the medial trochlear ridge were present. Radiographic evidence of degenerative joint disease was present in 3 of 5 dogs with medial malleolar fragmentation alone, and 5 of 5 dogs with medial malleolar fragmentation and medial trochlear ridge osteochondrosis. Eight of the 9 dogs were Rottweilers. Considering the sites of occurrence of osteochondrosis in other species, the authors propose that medial malleolar fragmentation could be secondary to osteochondrosis of the medial malleolus. Osteochondrosis of the medial malleolus has not been previously reported in dogs. Histological examination of the medial malleolar fragmentation was unavailable because surgery was not performed, therefore the hypothesis that the medial malleolar fragmentation is due to osteochondrosis was not proven

  11. Spontaneity and international marketing performance

    OpenAIRE

    Souchon, Anne L.; Hughes, Paul; Farrell, Andrew M.; Nemkova, Ekaterina; Oliveira, Joao S.

    2016-01-01

    The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link. Purpose – The purpose of this paper is to ascertain how today’s international marketers can perform better on the global scene by harnessing spontaneity. Design/methodology/approach – The authors draw on contingency theory to develop a model of the spontaneity – international marketing performance relationship, and identify three potential m...

  12. Spontaneous ischaemic stroke in dogs

    DEFF Research Database (Denmark)

    Gredal, Hanne Birgit; Skerritt, G. C.; Gideon, P.

    2013-01-01

    Translation of experimental stroke research into the clinical setting is often unsuccessful. Novel approaches are therefore desirable. As humans, pet dogs suffer from spontaneous ischaemic stroke and may hence offer new ways of studying genuine stroke injury mechanisms.......Translation of experimental stroke research into the clinical setting is often unsuccessful. Novel approaches are therefore desirable. As humans, pet dogs suffer from spontaneous ischaemic stroke and may hence offer new ways of studying genuine stroke injury mechanisms....

  13. Spontaneous calf haematoma: case report.

    Science.gov (United States)

    Zubaidah, N H; Liew, N C

    2014-02-01

    Spontaneous calf haematoma is a rare condition and few case reports have been published in the English literature. Common conditions like deep vein thrombosis and traumatic gastrocnemius muscle tear need to be considered when a patient presents with unilateral calf swelling and tenderness. Ultrasound and Magnetic Resonance Imaging are essential for confirmation of diagnosis. The purpose of this paper is to report on a rare case of spontaneous calf hematoma and its diagnosis and management.

  14. Quantifying emissions from spontaneous combustion

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2013-09-01

    Spontaneous combustion can be a significant problem in the coal industry, not only due to the obvious safety hazard and the potential loss of valuable assets, but also with respect to the release of gaseous pollutants, especially CO2, from uncontrolled coal fires. This report reviews methodologies for measuring emissions from spontaneous combustion and discusses methods for quantifying, estimating and accounting for the purpose of preparing emission inventories.

  15. Medial cortex activity, self-reflection and depression.

    Science.gov (United States)

    Johnson, Marcia K; Nolen-Hoeksema, Susan; Mitchell, Karen J; Levin, Yael

    2009-12-01

    Using functional magnetic resonance imaging, we investigated neural activity associated with self-reflection in depressed [current major depressive episode (MDE)] and healthy control participants, focusing on medial cortex areas previously shown to be associated with self-reflection. Both the MDE and healthy control groups showed greater activity in anterior medial cortex (medial frontal gyrus, anterior cingulate gyrus) when cued to think about hopes and aspirations compared with duties and obligations, and greater activity in posterior medial cortex (precuneus, posterior cingulate) when cued to think about duties and obligations (Experiment 1). However, the MDE group showed less activity than controls in the same area of medial frontal cortex when self-referential cues were more ambiguous with respect to valence (Experiment 2), and less deactivation in a non-self-referential condition in both experiments. Furthermore, individual differences in rumination were positively correlated with activity in both anterior and posterior medial cortex during non-self-referential conditions. These results provide converging evidence for a dissociation of anterior and posterior medial cortex depending on the focus of self-relevant thought. They also provide neural evidence consistent with behavioral findings that depression is associated with disruption of positively valenced thoughts in response to ambiguous cues, and difficulty disengaging from self-reflection when it is appropriate to do so.

  16. Treatment of Patellar Tendinopathy Refractory to Surgical Management Using Percutaneous Ultrasonic Tenotomy and Platelet-Rich Plasma Injection: A Case Presentation.

    Science.gov (United States)

    Nanos, Katherine N; Malanga, Gerard A

    2015-12-01

    Chronic proximal patellar tendinopathy is a common condition in sports medicine that may be refractory to nonoperative treatments, including activity modification, medications, and comprehensive rehabilitation. Percutaneous ultrasonic tenotomy is a recently developed technique designed to cut and debride tendinopathic tissue, thus promoting pain relief and functional recovery. We present a case of a collegiate athlete with chronic proximal patellar tendinopathy who was effectively treated with percutaneous ultrasonic tenotomy after not responding to extensive nonoperative treatment, surgical debridement, and platelet-rich plasma injections. Percutaneous ultrasonic tenotomy can be considered as a treatment option in patients presenting with refractory proximal patellar tendinopathy, including those who do not respond to previous operative intervention. Copyright © 2015 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  17. Episodic reinstatement in the medial temporal lobe.

    Science.gov (United States)

    Staresina, Bernhard P; Henson, Richard N A; Kriegeskorte, Nikolaus; Alink, Arjen

    2012-12-12

    The essence of episodic memory is our ability to reexperience past events in great detail, even in the absence of external stimulus cues. Does the phenomenological reinstatement of past experiences go along with reinstating unique neural representations in the brain? And if so, how is this accomplished by the medial temporal lobe (MTL), a brain region intimately linked to episodic memory? Computational models suggest that such reinstatement (also termed "pattern completion") in cortical regions is mediated by the hippocampus, a key region of the MTL. Although recent functional magnetic resonance imaging studies demonstrated reinstatement of coarse item properties like stimulus category or task context across different brain regions, it has not yet been shown whether reinstatement can be observed at the level of individual, discrete events-arguably the defining feature of episodic memory-nor whether MTL structures like the hippocampus support this "true episodic" reinstatement. Here we show that neural activity patterns for unique word-scene combinations encountered during encoding are reinstated in human parahippocampal cortex (PhC) during retrieval. Critically, this reinstatement occurs when word-scene combinations are successfully recollected (even though the original scene is not visually presented) and does not encompass other stimulus domains (such as word-color associations). Finally, the degree of PhC reinstatement across retrieval events correlated with hippocampal activity, consistent with a role of the hippocampus in coordinating pattern completion in cortical regions.

  18. Appearance of medial plica of the knee on MR images

    International Nuclear Information System (INIS)

    Barton, J.; Pope, C.F.; Jokl, P.; Lynch, K.

    1989-01-01

    To assess the appearance of the abnormal plica, a rare but important cause of knee pain, the authors have reviewed 1.5-T MR images of 17 patients (mean age, 33 years) who had arthroscopically confirmed abnormal plicae involving the medial aspect of the patella pouch. Asymmetry in the medial wall of the patella pouch was seen in 17 of 17; 10 of 17 had a discernible edge, and four of 17 had sufficient fluid to surround the plica. When sufficient intraarticular fluid was present, the plica was easily detected. Asymmetry in the medial wall of the patella pouch was a helpful MR characteristic to account for unexplained knee pain

  19. Cartilage Delamination Flap Mimicking a Torn Medial Meniscus

    Directory of Open Access Journals (Sweden)

    Gan Zhi-Wei Jonathan

    2016-01-01

    Full Text Available We report a case of a chondral delamination lesion due to medial parapatellar plica friction syndrome involving the medial femoral condyle. This mimicked a torn medial meniscus in clinical and radiological presentation. Arthroscopy revealed a chondral delamination flap, which was debrided. Diagnosis of chondral lesions in the knee can be challenging. Clinical examination and MRI have good accuracy for diagnosis and should be used in tandem. Early diagnosis and treatment of chondral lesions are important to prevent progression to early osteoarthritis.

  20. Modified tension band wiring of medial malleolar ankle fractures.

    Science.gov (United States)

    Georgiadis, G M; White, D B

    1995-02-01

    Twenty-two displaced medial malleolar ankle fractures that were treated surgically using the modified tension band method of Cleak and Dawson were retrospectively reviewed at an average follow-up of 25 months. The technique involves the use of a screw to anchor a figure-of-eight wire. There were no malreductions and all fractures healed. Problems with the technique included technical errors with hardware placement, medial ankle pain, and asymptomatic wire migration. Despite this, modified tension band wiring remains an acceptable method for fixation of selected displaced medial malleolar fractures. It is especially suited for small fracture fragments and osteoporotic bone.

  1. Radiographic anatomy of the medial coronoid process of dogs

    International Nuclear Information System (INIS)

    Miyabayashi, T.; Takiguchi, M.; Schrader, S.C.; Biller, D.S.

    1995-01-01

    Mediolateral, flexed mediolateral, mediocaudal-laterocranial 15 degrees oblique (extended and supinated mediolateral), and craniolateral-caudomedial 20 degrees to 30 degrees oblique radiographs of 16 elbow-joint specimens were produced to study the radiographic anatomy of the medial coronoid process. On the mediolateral view, the cranial point of the coronoid process was at the level of the distal one-third of the radial epiphysis. Degree of superimposition of the proximal radius and ulna determined how the medial coronoid process was projected on the radiographs. Mediocaudal-laterocranial oblique radiographs best showed the cranial outline of the medial coronoid process with moderate superimposition of the proximal radius and ulna

  2. Changes on Tendon Stiffness and Clinical Outcomes in Athletes Are Associated With Patellar Tendinopathy After Eccentric Exercise.

    Science.gov (United States)

    Lee, Wai-Chun; Ng, Gabriel Yin-Fat; Zhang, Zhi-Jie; Malliaras, Peter; Masci, Lorenzo; Fu, Siu-Ngor

    2017-12-19

    Eccentric exercise is commonly used as a form of loading exercise for individuals with patellar tendinopathy. This study investigated the change of mechanical properties and clinical outcomes and their interrelationships after a 12-week single-legged decline-board exercise with and without extracorporeal shockwave therapy (ESWT). Randomized controlled trial. Outpatient clinic of a university. Thirty-four male in-season athletes with patellar tendinopathy for more than 3 months were randomized into exercise and combined groups. The exercise group received a 12-week single-legged decline-squat exercise, and the combined group performed an identical exercise program in addition to a weekly session of ESWT in the initial 6 weeks. Tendon stiffness and strain were examined using ultrasonography and dynamometry. Visual analog scale and Victoria Institute of Sports Assessment-patella (VISA-p) score were used to assess pain and dysfunction. These parameters were measured at preintervention and postintervention. Significant time effect but no significant group effect on the outcome measures; significant reduction in tendon stiffness (P = 0.02) and increase in tendon strain (P = 0.00); and reduction of intensity of pain (P = 0.00) and dysfunction (P = 0.00) were observed. Significant correlations between changes in tendon stiffness and VISA-p score (ρ = -0.58, P = 0.05); alteration in tendon strain, pain intensity (ρ = -0.63, P = 0.03); and VISA-p score (ρ = 0.60, P = 0.04) were detected after the exercise program. Eccentric exercise-induced modulation on tendon mechanical properties and clinical symptoms are associated in athletes with patellar tendinopathy.

  3. Imaging the femoral sulcus with ultrasound, CT, and MRI: reliability and generalizability in patients with patellar instability

    Energy Technology Data Exchange (ETDEWEB)

    Toms, Andoni P.; Cahir, John [Norfolk and Norwich University Hospital, Departments of Radiology, Norwich, Norfolk (United Kingdom); Swift, Louise [University of East Anglia, School of Medicine, Health Policy and Practice, Norwich, Norfolk (United Kingdom); Donell, Simon T. [Norfolk and Norwich University Hospital, Institute of Orthopedics, Norwich, Norfolk (United Kingdom)

    2009-04-15

    Recent advances in surgical intervention for patellar instability have led to a need for long-term radiological monitoring. The aim of this study is to determine whether or not magnetic resonance imaging (MRI) or ultrasound (US) can replace computed tomography (CT) as the standard of care for the evaluation of the femoral sulcus. This was a prospective study comparing the reliability of CT, magnetic resonance (MR), and US for measuring the femoral sulcus in patients with patellar instability. Twenty-four patients were recruited to undergo a CT, MR, and US examination of each knee. Two observers independently measured femoral sulcus angles from subchondral bone and hyaline cartilage on two occasions. Intraclass correlations and generalizability coefficients were calculated to measure the reliability of each of the techniques. Thereafter, two observers measured the femoral sulcus angle from ultrasound images recorded by two independent operators to estimate interobserver and interoperator reliability. Forty-seven knees were examined with CT and US and 44 with MRI. The sulcus angle was consistently smaller when measured from subchondral bone compared to cartilage (5-7 ). Interobserver reliability for CT, MR, and US measurements from subchondral bone were 0.87, 0.80, and 0.82 and from cartilage 0.80, 0.81, and 0.50. Generalizability coefficients of measurements from subchondral bone for CT, MR, and US were 0.87, 0.76, and 0.81 and for cartilage 0.76, 0.73, and 0.05. Most of the variability in the US occurred at image acquisition rather than measurement. In patients with patellar instability, CT and MR are reliable techniques for measuring the femoral sulcus angle but US, particularly of the articular cartilage, is not. MR is therefore the most suitable tool for longitudinal studies of the femoral sulcus. (orig.)

  4. The world according to me: Personal relevance and the medial prefrontal cortex

    Directory of Open Access Journals (Sweden)

    Anna eAbraham

    2013-07-01

    Full Text Available More than a decade of neuroimaging research has established that anterior and posterior cortical midline regions are consistently recruited during self-referential thinking. These regions are engaged under conditions of directed cognition, such as during explicit self-reference tasks, as well as during spontaneous cognition, such as under conditions of rest. One of the many issues that remain to be clarified regarding the relationship between self-referential thinking and cortical midline activity is the functional specificity of these regions with regard to the nature of self-representation and processing. The functional profile associated with the medial prefrontal cortex (mPFC is the focus of the current article. What is specifically explored is the idea that personal relevance or personal significance is a central factor that impacts how brain activity is modulated within this cortical midline region. The proactive, imaginative and predictive nature of function in the mPFC is examined by evaluating studies of spontaneously-directed cognition, which is triggered by stimulus associated personal relevance.

  5. Isolated partial tear and partial avulsion of the medial head of gastrocnemius tendon presenting as posterior medial knee pain

    OpenAIRE

    Watura, Christopher; Ward, Anthony; Harries, William

    2010-01-01

    We present a case of medial head of gastrocnemius tendon tear. The type of injury widely reported in the literature is tear of the medial head of gastrocnemius muscle or ‘tennis leg’. We previously reported an isolated partial tear and longitudinal split of the tendon to the medial head of gastrocnemius at its musculotendinous junction. The case we now present has notable differences; the tear was interstitial and at the proximal (femoral attachment) part of the tendon, the patient’s symptoms...

  6. A case of spontaneous ventriculocisternostomy

    International Nuclear Information System (INIS)

    Yamane, Kanji; Yoshimoto, Hisanori; Harada, Kiyoshi; Uozumi, Tohru; Kuwabara, Satoshi.

    1983-01-01

    The authors experienced a case of spontaneous ventriculocisternostomy diagnosed by CT scan with metrizamide and Conray. Patient was 23-year-old male who had been in good health until one month before admission, when he began to have headache and tinnitus. He noticed bilateral visual acuity was decreased about one week before admission and vomiting appeared two days before admission. He was admitted to our hospital because of bilateral papilledema and remarkable hydrocephalus diagnosed by CT scan. On admission, no abnormal neurological signs except for bilateral papilledema were noted. Immediately, right ventricular drainage was performed. Pressure of the ventricle was over 300mmH 2 O and CSF was clear. PVG and PEG disclosed an another cavity behind the third ventricle, which was communicated with the third ventricle, and occlusion of aqueduct of Sylvius. Metrizamide CT scan and Conray CT scan showed a communication between this cavity and quadrigeminal and supracerebellar cisterns. On these neuroradiological findings, the diagnosis of obstructive hydrocephalus due to benign aqueduct stenosis accompanied with spontaneous ventriculocisternostomy was obtained. Spontaneous ventriculocisternostomy was noticed to produce arrest of hydrocephalus, but with our case, spontaneous regression of such symptoms did not appeared. By surgical ventriculocisternostomy (method by Torkildsen, Dandy, or Scarff), arrest of hydrocephalus was seen in about 50 to 70 per cent, which was the same results as those of spontaneous ventriculocisternostomy. It is concluded that VP shunt or VA shunt is thought to be better treatment of obstructive hydrocephalus than the various kinds of surgical ventriculocisternostomy. (J.P.N.)

  7. Comparison of the Effect of 5 Different Treatment Options for Managing Patellar Tendinopathy: A Secondary Analysis.

    Science.gov (United States)

    van Rijn, Dafne; van den Akker-Scheek, Inge; Steunebrink, Mirjam; Diercks, Ron L; Zwerver, Johannes; van der Worp, Henk

    2017-10-10

    Currently, no treatments exist for patellar tendinopathy (PT) that guarantee quick and full recovery. Our objective was to assess which treatment option provides the best chance of clinical improvement and to assess the influence of patient and injury characteristics on the clinical effect of these treatments. A secondary analysis was performed on the combined databases of 3 previously performed double-blind randomized controlled trials. In total, 138 patients with PT were included in the analysis. Participants were divided into 5 groups, based on the treatment they received: Extracorporeal shockwave therapy (ESWT) (n = 31), ESWT plus eccentric training (n = 43), eccentric training (n = 17), topical glyceryl trinitrate patch plus eccentric training (n = 16), and placebo treatment (n = 31). Clinical improvement (increase of ≥13 points on the Victorian Institute of Sport Assessment-Patella score) after 3 months of treatment. Fifty-two patients (37.7%) improved clinically after 3 months of treatment. Odds ratios (ORs) for clinical improvement were significantly higher in the eccentric training group (OR 6.68, P = 0.009) and the ESWT plus eccentric training group (OR 5.42, P = 0.015) compared with the other groups. We found evidence that a high training volume, a longer duration of symptoms, and older age negatively influence a treatment's clinical outcome (trend toward significance). Our study confirmed the importance of exercise, and eccentric training in particular, in the management of PT. The role of ESWT remains uncertain. Further research focusing on the identified prognostic factors is needed to be able to design patient-specific treatment protocols for the management of PT.

  8. Isolated medial meniscal tear in a Border Collie.

    Science.gov (United States)

    Ridge, P A

    2006-01-01

    A three-year-old, female Border Collie was successfully treated for an isolated, torn, medial meniscus by arthroscopic meniscal tear resection. The dog returned to agility competition without recurrence of lameness.

  9. Medial tibial stress syndrome: a critical review.

    Science.gov (United States)

    Moen, Maarten H; Tol, Johannes L; Weir, Adam; Steunebrink, Miriam; De Winter, Theodorus C

    2009-01-01

    Medial tibial stress syndrome (MTSS) is one of the most common leg injuries in athletes and soldiers. The incidence of MTSS is reported as being between 4% and 35% in military personnel and athletes. The name given to this condition refers to pain on the posteromedial tibial border during exercise, with pain on palpation of the tibia over a length of at least 5 cm. Histological studies fail to provide evidence that MTSS is caused by periostitis as a result of traction. It is caused by bony resorption that outpaces bone formation of the tibial cortex. Evidence for this overloaded adaptation of the cortex is found in several studies describing MTSS findings on bone scan, magnetic resonance imaging (MRI), high-resolution computed tomography (CT) scan and dual energy x-ray absorptiometry. The diagnosis is made based on physical examination, although only one study has been conducted on this subject. Additional imaging such as bone, CT and MRI scans has been well studied but is of limited value. The prevalence of abnormal findings in asymptomatic subjects means that results should be interpreted with caution. Excessive pronation of the foot while standing and female sex were found to be intrinsic risk factors in multiple prospective studies. Other intrinsic risk factors found in single prospective studies are higher body mass index, greater internal and external ranges of hip motion, and calf girth. Previous history of MTSS was shown to be an extrinsic risk factor. The treatment of MTSS has been examined in three randomized controlled studies. In these studies rest is equal to any intervention. The use of neoprene or semi-rigid orthotics may help prevent MTSS, as evidenced by two large prospective studies.

  10. Hyperglycemia decreased medial amygdala projections to medial preoptic area in experimental model of Diabetes Mellitus.

    Directory of Open Access Journals (Sweden)

    Yousef Mohamadi

    2015-01-01

    Full Text Available In Wistar rats, reproductive behavior is controlled in a neural circuit of ventral forebrain including the medial amygdala (Me, bed nucleus of the stria terminalis (BNST and medial preoptic area (MPOA via perception of social odors. Diabetes Mellitus (DM is a widespread metabolic disease that affects many organs in a variety of levels. DM can cause central neuropathies such as neuronal apoptosis, dendritic atrophy, neurochemical alterations and also causes reproductive dysfunctions. So we hypothesized damage to the nuclei of this circuit can cause reproductive dysfunctions. Therefore in this project we assessed diabetic effect on these nuclei. For this purpose neuron tracing technique and TUNEL assay were used. We injected HRP in the MPOA and counted labeled cells in the Me and BNST to evaluate the reduction of neurons in diabetic animals. Also, coronal sections were analyzed with the TMB histochemistry method. Animals in this study were adult male Wistar rats (230 ± 8g divided to control and 10-week streptozotocin-induced diabetic groups. After data analysis by SPSS 16 software, a significant reduction of HRP-labeled neurons was shown in both Me and BNST nuclei in the diabetic group. Moreover, apoptotic cells were significantly observed in diabetic animals in contrast to control the group. In conclusion, these alterations of the circuit as a result of diabetes might be one of the reasons for reproductive dysfunctions.

  11. The medial collateral ligament of the elbow joint

    DEFF Research Database (Denmark)

    Floris, S; Olsen, Bo Sanderhoff; Dalstra, Michel

    1998-01-01

    Eighteen osteoligamentous elbow joint specimens were included in a study of the medial collateral ligament complex (MCL). The morphologic characteristics of the MCL were examined, and three-dimensional kinematic measurements were taken after selective ligament dissections were performed. On morph......Eighteen osteoligamentous elbow joint specimens were included in a study of the medial collateral ligament complex (MCL). The morphologic characteristics of the MCL were examined, and three-dimensional kinematic measurements were taken after selective ligament dissections were performed...

  12. Moore I postero-medial articular tibial fracture in alpine skiers: Surgical management and return to sports activity.

    Science.gov (United States)

    Morin, Vincent; Pailhé, Régis; Sharma, Akash; Rouchy, René-Christopher; Cognault, Jérémy; Rubens-Duval, Brice; Saragaglia, Dominique

    2016-06-01

    Over the past 10 years, like many authors, we observed an increasing number of Moore I tibial plateau fractures related to alpine skiing for which the surgeon may face difficult choices regarding surgical approach and fixation means. Some authors have recently been suggesting a posterior approach associated to open reduction and osteosynthesis by a buttress plate. But in our knowledge there is no specific study on sports activity recovery after Moore I tibial fractures. The aim of this work was to assess sports activities and clinical outcomes after surgically treated Moore I tibial plateau fractures in an athletic population of skiers. We conducted a prospective case series between 2012 and 2014. This included fifteen patients aged 39.6±7 years whom presented with a Moore I tibial plateau fracture during a skiing accident. 12 cases (80%) presented with an associated tibial spine fracture. Treatment consisted of a standard antero-medial approach, with a medial para patellar arthrotomy to allow direct visualisation of articular reduction and spinal fixation. Two or three 6.5mm long cancellous bone screws were placed antero-posteriorly so as to ensure perfect compression of the fracture site. Radiological and functional results were assessed by an independent observer (Lysholm-Tegner, UCLA, KOOS scores) at the longest follow-up. Mean follow-up was 18.2±6 months (12-28). An immediate postoperative anatomical reduction was achieved in all cases and remained stable in time. At last follow-up Lysholm mean score was 85±14 points (59-100), UCLA score was 7.3±1.6 (4-10) and Tegner score was 4.6±1.3 (3-6). Mean KOOS score was 77±15 (54-97). 87% of patients had resumed their skiing activity and 93% were satisfied or very satisfied from their post-operative surgical outcome. We observed no pseudarthrosis or secondary varus displacement. In our series 87% of patients had resumed back to their sporting activities. Surgical management of Moore I tibial plateau fractures by

  13. Flow Friction or Spontaneous Ignition?

    Science.gov (United States)

    Stoltzfus, Joel M.; Gallus, Timothy D.; Sparks, Kyle

    2012-01-01

    "Flow friction," a proposed ignition mechanism in oxygen systems, has proved elusive in attempts at experimental verification. In this paper, the literature regarding flow friction is reviewed and the experimental verification attempts are briefly discussed. Another ignition mechanism, a form of spontaneous combustion, is proposed as an explanation for at least some of the fire events that have been attributed to flow friction in the literature. In addition, the results of a failure analysis performed at NASA Johnson Space Center White Sands Test Facility are presented, and the observations indicate that spontaneous combustion was the most likely cause of the fire in this 2000 psig (14 MPa) oxygen-enriched system.

  14. Spontaneous rupture of vaginal enterocele

    DEFF Research Database (Denmark)

    Svendsen, J H; Galatius, H; Hansen, P K

    1985-01-01

    Spontaneous rupture of an enterocele is a rare complication. Only 24 cases including the present case have been reported in the literature. The patients were elderly and had had at least one vaginal operation. The patients were remarkably unaffected symptomatically on admission.......Spontaneous rupture of an enterocele is a rare complication. Only 24 cases including the present case have been reported in the literature. The patients were elderly and had had at least one vaginal operation. The patients were remarkably unaffected symptomatically on admission....

  15. Spontaneous baryogenesis from asymmetric inflaton

    International Nuclear Information System (INIS)

    Takahashi, Fuminobu

    2015-10-01

    We propose a variant scenario of spontaneous baryogenesis from asymmetric inflaton based on current-current interactions between the inflaton and matter fields with a non-zero B-L charge. When the inflaton starts to oscillate around the minimum after inflation, it may lead to excitation of a CP-odd component, which induces an effective chemical potential for the B-L number through the current-current interactions. We study concrete inflation models and show that the spontaneous baryogenesis scenario can be naturally implemented in the chaotic inflation in supergravity.

  16. Ultrasound evaluation of a spontaneous plantar fascia rupture.

    Science.gov (United States)

    Louwers, Michael J; Sabb, Brian; Pangilinan, Percival H

    2010-11-01

    Plantar fascia rupture is an occasional complication in patients with chronic plantar fasciitis or in patients with plantar fasciitis treated with steroid injection. Very few cases of spontaneous plantar fascia rupture have been reported in the literature (Herrick and Herrick, Am J Sports Med 1983;11:95; Lun et al, Clin J Sports Med 1999;9:48-9; Rolf et al, J Foot Ankle Surg 1997;36:112-4; Saxena and Fullem, Am J Sports Med 2004;32:662-5). Spontaneous medial plantar fascia rupture in a 37-yr-old man with no preceding symptoms or steroid injections was confirmed with diagnostic ultrasound, which revealed severe fasciitis at the calcaneal insertion with partial tearing. After conservative treatment, the patient returned to full activities. We discuss the anatomy, risk factors, examination findings, and treatment for this condition, as well as the unique benefits that ultrasound offers over magnetic resonance imaging. It is important to consider plantar fascia rupture in patients with hindfoot pain and medioplantar ecchymosis, particularly if an injury occurred during acceleration maneuvers. Ultrasound in these cases can be used to diagnose a plantar fascia tear quickly, accurately, and cost-effectively.

  17. Differential roles for medial prefrontal and medial temporal cortices in schema-dependent encoding: From congruent to incongruent

    OpenAIRE

    Kesteren, M.T.R. van; Beul, S.F.; Takashima, A.; Henson, R.N.; Ruiter, D.J.

    2013-01-01

    Information that is congruent with prior knowledge is generally remembered better than incongruent information. This effect of congruency on memory has been attributed to a facilitatory influence of activated schemas on memory encoding and consolidation processes, and hypothesised to reflect a shift between processing in medial temporal lobes (MTL) towards processing in medial prefrontal cortex (mPFC). To investigate this shift, we used functional magnetic resonance imaging (fMRI) to compare ...

  18. Evaluation of patellar cartilage surface lesions: comparison of CT arthrography and fat-suppressed FLASH 3D MR imaging

    International Nuclear Information System (INIS)

    Daenen, B.R.; Ferrara, M.A.; Marcelis, S.; Dondelinger, R.F.

    1998-01-01

    The aim of this study was to evaluate the sensitivity and specificity of fat-suppressed fast low-angle shot (FLASH) 3D MR imaging in the detection of patellar cartilage surface lesions in comparison with CT arthrography. Fifty patients, with or without symptoms of chondromalacia, were prospectively examined by CT arthrography and fat-suppressed 3D gradient-echo MR imaging. All MR examinations were evaluated by three observers, two of them reaching a consensus interpretation. The lesions were graded according to their morphology and their extent. The CT arthrography was considered as the reference examination. For both sets of observers, the final diagnosis of chondromalacia was obtained in 92.5 %. The specificity was 60 % on a patient-by-patient basis. Fissures were missed in 83 and 60 %, respectively, but were isolated findings only in 2.5 % of the cases. Considering ulcers involving more than 50 % of the cartilage thickness, 65 and 88 %, respectively, were recognized. Fat-suppressed FLASH 3D is an adequate pulse sequence for the detection of patellar cartilage ulcers. It can be applied on a routine clinical basis, but it does not show as many fissures as CT arthrography and is less precise for grading of lesions. (orig.)

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

    Science.gov (United States)

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

    2015-10-01

    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 causal relations. The primary aim of the current study is to investigate whether the factors identified in the previous 2008 study can also be prospectively recognized as predictors of symptomatic PT in 2011. Nine hundred twenty-six Dutch elite and non-elite basketball and volleyball players from the previous study were invited again to complete an online survey about knee complaints and risk factors for PT in 2011. The logistic regression included 385 athletes of which 51 (13%) developed PT since 2008. Male gender [odds ratio (OR) 2.0, 95% confidence interval (CI) 1.1-3.5] was found to be a risk factor for developing PT. No sports-related variables could be identified to increase the risk of developing PT, but some evidence was found for performing heavy physically demanding work, like being a nurse or a physical education teacher (OR 2.3, 95% CI 0.9-6.3). These findings indicate that, when considering preventive measures, it is important to take into account the total tendon load. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  20. A role for hedgehog signaling in the differentiation of the insertion site of the patellar tendon in the mouse.

    Directory of Open Access Journals (Sweden)

    Chia-Feng Liu

    Full Text Available Tendons are typically composed of two histologically different regions: the midsubstance and insertion site. We previously showed that Gli1, a downstream effector of the hedgehog (Hh signaling pathway, is expressed only in the insertion site of the mouse patellar tendon during its differentiation. To test for a functional role of Hh signaling, we targeted the Smoothened (Smo gene in vivo using a Cre/Lox system. Constitutive activation of the Hh pathway in the mid-substance caused molecular markers of the insertion site, e.g. type II collagen, to be ectopically expressed or up-regulated in the midsubstance. This was confirmed using a novel organ culture method in vitro. Conversely, when Smo was excised in the scleraxis-positive cell population, the development of the fibrocartilaginous insertion site was affected. Whole transcriptome analysis revealed that the expression of genes involved in chondrogenesis and mineralization was down-regulated in the insertion site, and expression of insertion site markers was decreased. Biomechanical testing of murine adult patellar tendon, which developed in the absence of Hh signaling, showed impairment of tendon structural properties (lower linear stiffness and greater displacement and material properties (greater strain, although the linear modulus of the mutant group was not significantly lower than controls. These studies provide new insights into the role of Hh signaling during tendon development.

  1. Effects of a peracetic acid disinfection protocol on the biocompatibility and biomechanical properties of human patellar tendon allografts.

    Science.gov (United States)

    Lomas, R J; Jennings, L M; Fisher, J; Kearney, J N

    2004-01-01

    Patellar tendon allografts, retrieved from cadaveric human donors, are widely used for replacement of damaged cruciate ligaments. In common with other tissue allografts originating from cadaveric donors, there are concerns regarding the potential for disease transmission from the donor to the recipient. Additionally, retrieval and subsequent processing protocols expose the graft to the risk of environmental contamination. For these reasons, disinfection or sterilisation protocols are necessary for these grafts before they are used clinically. A high-level disinfection protocol, utilising peracetic acid (PAA), has been developed and investigated for its effects on the biocompatibility and biomechanics of the patellar tendon allografts. PAA disinfection did not render the grafts either cytotoxic or liable to provoke an inflammatory response as assessed in vitro . However, the protocol was shown to increase the size of gaps between the tendon fibres in the matrix and render the grafts more susceptible to digestion with collagenase. Biomechanical studies of the tendons showed that PAA treatment had no effect on the ultimate tensile stress or Young's modulus of the tendons, and that ultimate strain was significantly higher in PAA treated tendons.

  2. Evaluation of patellar cartilage surface lesions: comparison of CT arthrography and fat-suppressed FLASH 3D MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Daenen, B.R.; Ferrara, M.A.; Marcelis, S.; Dondelinger, R.F. [Department of Medical Imaging, University Hospital Sart-Tilman, Liege (Belgium)

    1998-07-01

    The aim of this study was to evaluate the sensitivity and specificity of fat-suppressed fast low-angle shot (FLASH) 3D MR imaging in the detection of patellar cartilage surface lesions in comparison with CT arthrography. Fifty patients, with or without symptoms of chondromalacia, were prospectively examined by CT arthrography and fat-suppressed 3D gradient-echo MR imaging. All MR examinations were evaluated by three observers, two of them reaching a consensus interpretation. The lesions were graded according to their morphology and their extent. The CT arthrography was considered as the reference examination. For both sets of observers, the final diagnosis of chondromalacia was obtained in 92.5 %. The specificity was 60 % on a patient-by-patient basis. Fissures were missed in 83 and 60 %, respectively, but were isolated findings only in 2.5 % of the cases. Considering ulcers involving more than 50 % of the cartilage thickness, 65 and 88 %, respectively, were recognized. Fat-suppressed FLASH 3D is an adequate pulse sequence for the detection of patellar cartilage ulcers. It can be applied on a routine clinical basis, but it does not show as many fissures as CT arthrography and is less precise for grading of lesions. (orig.) With 4 figs., 3 tabs., 21 refs.

  3. Quantitative Analysis of Patellar Tendon Abnormality in Asymptomatic Professional “Pallapugno” Players: A Texture-Based Ultrasound Approach

    Directory of Open Access Journals (Sweden)

    Kristen M. Meiburger

    2018-04-01

    Full Text Available Abnormalities in B-mode ultrasound images of the patellar tendon often take place in asymptomatic athletes but it is still not clear if these modifications forego or can predict the development of tendinopathy. Subclinical tendinopathy can be arbitrarily defined as either (1 the presence of light structural changes in B-mode ultrasound images in association with mild neovascularization (determined with Power Doppler images or (2 the presence of moderate/severe structural changes with or without neovascularization. Up to now, the structural changes and neovascularization of the tendon are evaluated qualitatively by visual inspection of ultrasound images. The aim of this study is to investigate the capability of a quantitative texture-based approach to determine tendon abnormality of “pallapugno” players. B-mode ultrasound images of the patellar tendon were acquired in 14 players and quantitative texture parameters were calculated within a Region of Interest (ROI of both the non-dominant and the dominant tendon. A total of 90 features were calculated for each ROI, including 6 first-order descriptors, 24 Haralick features, and 60 higher-order spectra and entropy features. These features on the dominant and non-dominant side were used to perform a multivariate linear regression analysis (MANOVA and our results show that the descriptors can be effectively used to determine tendon abnormality and, more importantly, the occurrence of subclinical tendinopathy.

  4. Spontaneous Development of Moral Concepts

    Science.gov (United States)

    Siegal, M.

    1975-01-01

    Moral competence is more difficult to attain than scientific competence. Since language comprehension plays a central role in conceptual development, and moral language is difficult to learn, there is a common deficiency in moral conceptual development. This suggests a theory of non-spontaneous solutions to moral problems. (Author/MS)

  5. Spontaneous regression of pulmonary bullae

    International Nuclear Information System (INIS)

    Satoh, H.; Ishikawa, H.; Ohtsuka, M.; Sekizawa, K.

    2002-01-01

    The natural history of pulmonary bullae is often characterized by gradual, progressive enlargement. Spontaneous regression of bullae is, however, very rare. We report a case in which complete resolution of pulmonary bullae in the left upper lung occurred spontaneously. The management of pulmonary bullae is occasionally made difficult because of gradual progressive enlargement associated with abnormal pulmonary function. Some patients have multiple bulla in both lungs and/or have a history of pulmonary emphysema. Others have a giant bulla without emphysematous change in the lungs. Our present case had treated lung cancer with no evidence of local recurrence. He had no emphysematous change in lung function test and had no complaints, although the high resolution CT scan shows evidence of underlying minimal changes of emphysema. Ortin and Gurney presented three cases of spontaneous reduction in size of bulla. Interestingly, one of them had a marked decrease in the size of a bulla in association with thickening of the wall of the bulla, which was observed in our patient. This case we describe is of interest, not only because of the rarity with which regression of pulmonary bulla has been reported in the literature, but also because of the spontaneous improvements in the radiological picture in the absence of overt infection or tumor. Copyright (2002) Blackwell Science Pty Ltd

  6. Shell theorem for spontaneous emission

    DEFF Research Database (Denmark)

    Kristensen, Philip Trøst; Mortensen, Jakob Egeberg; Lodahl, Peter

    2013-01-01

    and therefore is given exactly by the dipole approximation theory. This surprising result is a spontaneous emission counterpart to the shell theorems of classical mechanics and electrostatics and provides insights into the physics of mesoscopic emitters as well as great simplifications in practical calculations....

  7. Silicosis with bilateral spontaneous pneumothorax

    Directory of Open Access Journals (Sweden)

    Fotedar Sanjay

    2010-01-01

    Full Text Available Presentation with simultaneous bilateral pneumothorax is uncommon and usually in the context of secondary spontaneous pneumothorax.The association of pneumothorax and silicosis is infrequent and most cases are unilateral. Bilateral pneumothorax in silicosis is very rare with just a few reports in medical literature.

  8. Spontaneous emission by moving atoms

    International Nuclear Information System (INIS)

    Meystre, P.; Wilkens, M.

    1994-01-01

    It is well known that spontaneous emission is not an intrinsic atomic property, but rather results from the coupling of the atom to the vacuum modes of the electromagnetic field. As such, it can be modified by tailoring the electromagnetic environment into which the atom can radiate. This was already realized by Purcell, who noted that the spontaneous emission rate can be enhanced if the atom placed inside a cavity is resonant with one of the cavity is resonant with one of the cavity modes, and by Kleppner, who discussed the opposite case of inhibited spontaneous emission. It has also been recognized that spontaneous emission need not be an irreversible process. Indeed, a system consisting of a single atom coupled to a single mode of the electromagnetic field undergoes a periodic exchange of excitation between the atom and the field. This periodic exchange remains dominant as long as the strength of the coupling between the atom and a cavity mode is itself dominant. 23 refs., 6 figs

  9. Prediction of Spontaneous Preterm Birth

    NARCIS (Netherlands)

    Dijkstra, Karolien

    2002-01-01

    Preterm birth is a leading cause of neonatal morbidity and mortality. It is a major goal in obstetrics to lower the incidence of spontaneous preterm birth (SPB) and related neonatal morbidity and mortality. One of the principal objectives is to discover early markers that would allow us to identify

  10. The TOPGAME-study : effectiveness of extracorporeal shockwave therapy in jumping athletes with patellar tendinopathy. Design of a randomised controlled trial

    NARCIS (Netherlands)

    Zwerver, Johannes; Verhagen, Evert; Hartgens, Fred; van den Akker-Scheek, Inge; Diercks, Ron L.

    2010-01-01

    Background: Patellar tendinopathy is a major problem for many athletes, especially those involved in jumping activities. Despite its frequency and negative impact on athletic careers, no evidence-based guidelines for management of this overuse injury exist. Since functional outcomes of conservative

  11. Reproducibility and clinical utility of tendon palpation to detect patellar tendinopathy in young basketball players. Victorian Institute of Sport tendon study group.

    Science.gov (United States)

    Cook, J L; Khan, K M; Kiss, Z S; Purdam, C R; Griffiths, L

    2001-02-01

    Palpation is an important clinical test for jumper's knee. To (a) test the reproducibility of palpation tenderness, (b) evaluate the sensitivity and specificity of palpation in subjects with clinical symptoms of jumper's knee, and (c) determine whether tenderness to palpation may serve as a useful screening test for patellar tendinopathy. The yardstick for diagnosis of patellar tendinopathy was ultrasonographic abnormality. In 326 junior symptomatic and asymptomatic athletes' tendons, palpation was performed by a single examiner before ultrasonographic examination by a certified ultrasound radiologist. In 58 tendons, palpation was performed twice to test reliability. Tenderness to palpation was scored on a scale from 0 to 3 where 0 represented no pain, and 1, 2, and 3 represented mild, moderate, and severe tenderness respectively. Patellar tendon palpation was a reliable examination for a single examiner (Pearson r = 0.82). In symptomatic tendons, the positive predictive value of palpation was 68%. As a screening examination in asymptomatic subjects, the positive predictive value of tendon palpation was 36-38%. Moderate and severe palpation tenderness were better predictors of ultrasonographic tendon pathology than absent or mild tenderness (ppatellar tendinopathy in a preparticipation examination. In symptomatic tendons, palpation is a moderately sensitive but not specific test. Mild tenderness in the patellar tendons in asymptomatic jumping athletes should be considered normal.

  12. The three-in-one proximal and distal soft tissue patellar realignment procedure. Results, and its place in the management of patellofemoral instability

    DEFF Research Database (Denmark)

    Myers, P; Williams, Andrew Richard; Dodds, R

    1999-01-01

    to affect outcome. Thirty patients (37 knees) were studied 2 years earlier as well (mean follow-up, 29 months). When comparing the results 2 years later, there was a significant deterioration in outcome over time. These results are comparable with the published results for other techniques of patellar...

  13. Knee extension and flexion muscle power after anterior cruciate ligament reconstruction with patellar tendon graft or hamstring tendons graft: a cross-sectional comparison 3 years post surgery

    DEFF Research Database (Denmark)

    Ageberg, Eva; Roos, Harald; Silbernagel, Karin

    2008-01-01

    Hamstring muscles play a major role in knee-joint stabilization after anterior cruciate ligament (ACL) injury. Weakness of the knee extensors after ACL reconstruction with patellar tendon (PT) graft, and in the knee flexors after reconstruction with hamstring tendons (HT) graft has been observed ...

  14. TCDD alters medial epithelial cell differentiation during palatogenesis

    International Nuclear Information System (INIS)

    Abbott, B.D.; Birnbaum, L.S.

    1989-01-01

    2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) is a widely distributed, persistent environmental contaminant that is teratogenic in mice, where it induces hydronephrosis and cleft palate. The incidence of clefting has been shown to be dose dependent after exposure on either gestation Day (GD) 10 or 12, although the embryo is more susceptible on GD 12. TCDD-exposed palatal shelves meet but do not fuse, and programmed cell death of the medial epithelial cells is inhibited. The mechanism of action through which TCDD alters the program of medial cell development has not been examined in earlier studies, and it is not known whether the mechanism is the same regardless of the dose or developmental stage of exposure. In this study, C57BL/6N mice, a strain sensitive to TCDD, were dosed orally on GD 10 or 12 with 0, 6, 12, 24, or 30 micrograms/kg body wt, in 10 ml corn oil/kg. Embryonic palatal shelves were examined on GD 14, 15, or 16. The degree of palatal closure, epithelial surface morphology, and cellular ultrastructure, the incorporation of [3H]TdR, the expression of EGF receptors, and the binding of 125I-EGF were assessed. After exposure on GD 10 or 12, TCDD altered the differentiation pathway of the medial epithelial cells. The palatal shelves were of normal size and overall morphology, but fusion of the medial epithelia of the opposing shelves did not occur. TCDD prevented programmed cell death of the medial peridermal cells. The expression of EGF receptors by medial cells continued through Day 16 and the receptors were able to bind ligand. The medial cells differentiated into a stratified, squamous, keratinizing epithelium. The shift in phenotype to an oral-like epithelium occurred after exposure on either GD 10 or 12. At the lower dose (6 micrograms/kg), fewer cleft palates were produced, but those shelves which did respond had a fully expressed shift in differentiation

  15. The TOPSHOCK study: Effectiveness of radial shockwave therapy compared to focused shockwave therapy for treating patellar tendinopath - design of a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Diercks Ron L

    2011-10-01

    Full Text Available Abstract Background Patellar tendinopathy is a chronic overuse injury of the patellar tendon that is especially prevalent in people who are involved in jumping activities. Extracorporeal Shockwave Therapy is a relatively new treatment modality for tendinopathies. It seems to be a safe and promising part of the rehabilitation program for patellar tendinopathy. Extracorporeal Shockwave Therapy originally used focused shockwaves. Several years ago a new kind of shockwave therapy was introduced: radial shockwave therapy. Studies that investigate the effectiveness of radial shockwave therapy as treatment for patellar tendinopathy are scarce. Therefore the aim of this study is to compare the effectiveness of focussed shockwave therapy and radial shockwave therapy as treatments for patellar tendinopathy. Methods/design The TOPSHOCK study (Tendinopathy Of Patella SHOCKwave is a two-armed randomised controlled trial in which the effectiveness of focussed shockwave therapy and radial shockwave therapy are directly compared. Outcome assessors and patients are blinded as to which treatment is given. Patients undergo three sessions of either focused shockwave therapy or radial shockwave therapy at 1-week intervals, both in combination with eccentric decline squat training. Follow-up measurements are scheduled just before treatments 2 and 3, and 1, 4, 7 and 12 weeks after the final treatment. The main outcome measure is the Dutch VISA-P questionnaire, which asks for pain, function and sports participation in subjects with patellar tendinopathy. Secondary outcome measures are pain determined with a VAS during ADL, sports and decline squats, rating of subjective improvement and overall satisfaction with the treatment. Patients will also record their sports activities, pain during and after these activities, and concurrent medical treatment on a weekly basis in a web-based diary. Results will be analysed according to the intention-to-treat principle. Discussion

  16. The TOPGAME-study: effectiveness of extracorporeal shockwave therapy in jumping athletes with patellar tendinopathy. Design of a randomised controlled trial.

    Science.gov (United States)

    Zwerver, Johannes; Verhagen, Evert; Hartgens, Fred; van den Akker-Scheek, Inge; Diercks, Ron L

    2010-02-08

    Patellar tendinopathy is a major problem for many athletes, especially those involved in jumping activities. Despite its frequency and negative impact on athletic careers, no evidence-based guidelines for management of this overuse injury exist. Since functional outcomes of conservative and surgical treatments remain suboptimal, new diagnostic and therapeutic strategies have to be developed and evaluated. Extracorporeal shockwave therapy (ESWT) appears to be a promising treatment in patients with chronic patellar tendinopathy. ESWT is most often applied after the known conservative treatments have failed. However, its effectiveness as primary therapy has not been studied in athletes who keep playing sports despite having patellar tendon pain. The aim of this study is to determine the effectiveness of ESWT in athletes with patellar tendinopathy who are still in training and competition. The TOPGAME-study (Tendinopathy of Patella Groningen Amsterdam Maastricht ESWT) is a multicentre two-armed randomised controlled trial with blinded participants and outcome assessors, in which the effectiveness of patient-guided focussed ESWT treatment (compared to placebo ESWT) on pain reduction and recovery of function in athletes with patellar tendinopathy will be investigated. Participants are volleyball, handball and basketball players with symptoms of patellar tendinopathy for a minimum of 3 to a maximum duration of 12 months who are still able to train and compete. The intervention group receives three patient-guided focussed medium-energy density ESWT treatments without local anaesthesia at a weekly interval in the first half of the competition. The control group receives placebo treatment. The follow-up measurements take place 1, 12 and 22 weeks after the final ESWT or placebo treatment, when athletes are still in competition. Primary outcome measure is the VISA-P (Victorian Institute of Sport Assessment - patella) score. Data with regard to pain during function tests (jump

  17. The TOPGAME-study: effectiveness of extracorporeal shockwave therapy in jumping athletes with patellar tendinopathy. Design of a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Diercks Ron L

    2010-02-01

    Full Text Available Abstract Background Patellar tendinopathy is a major problem for many athletes, especially those involved in jumping activities. Despite its frequency and negative impact on athletic careers, no evidence-based guidelines for management of this overuse injury exist. Since functional outcomes of conservative and surgical treatments remain suboptimal, new diagnostic and therapeutic strategies have to be developed and evaluated. Extracorporeal shockwave therapy (ESWT appears to be a promising treatment in patients with chronic patellar tendinopathy. ESWT is most often applied after the known conservative treatments have failed. However, its effectiveness as primary therapy has not been studied in athletes who keep playing sports despite having patellar tendon pain. The aim of this study is to determine the effectiveness of ESWT in athletes with patellar tendinopathy who are still in training and competition. Methods/design The TOPGAME-study (Tendinopathy of Patella Groningen Amsterdam Maastricht ESWT is a multicentre two-armed randomised controlled trial with blinded participants and outcome assessors, in which the effectiveness of patient-guided focussed ESWT treatment (compared to placebo ESWT on pain reduction and recovery of function in athletes with patellar tendinopathy will be investigated. Participants are volleyball, handball and basketball players with symptoms of patellar tendinopathy for a minimum of 3 to a maximum duration of 12 months who are still able to train and compete. The intervention group receives three patient-guided focussed medium-energy density ESWT treatments without local anaesthesia at a weekly interval in the first half of the competition. The control group receives placebo treatment. The follow-up measurements take place 1, 12 and 22 weeks after the final ESWT or placebo treatment, when athletes are still in competition. Primary outcome measure is the VISA-P (Victorian Institute of Sport Assessment - patella score

  18. ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: A COMPARISON BETWEEN BONE PATELLAR TENDON BONE GRAFT AND LIPSCOMB PROCEDURE - A FOLLOWUP STUDY OF 7 YEARS

    Directory of Open Access Journals (Sweden)

    Vijayamohan S

    2016-07-01

    Full Text Available BACKGROUND Anterior Cruciate Ligament injury has become more common and the demand by the patients to return to pre-injury level of activity has made reconstruction of the ligament very crucial. Though there are various techniques in reconstructing the anterior cruciate ligament, in this study, we compare two most commonly used techniques to see whether there is any significant difference in the outcome. METHODS Study included 25 patients in the age group of 19-36 years, of which 23 were males. The patients were divided randomly into 2 groups, and 15 patients underwent Anterior Cruciate Ligament reconstruction using Bone Patellar Tendon Bone Graft and 10 patients had Hamstring graft. RESULTS Patients were followed up at regular intervals monthly for the first six months and then at three monthly intervals. Patients were assessed using Knee Scoring Scale of Lysholm and Gillquist and International Knee Documentation Committee (IKDC scoring system. In addition, activity level, harvest site pain, thigh atrophy, kneeling pain and hamstring pain were assessed. All patients were followed up for a minimum period of 2 years. 20% of both groups were able to return to strenuous activity level, and 67% of Patellar tendon group and 50% of the Hamstring tendon group were able to return to moderate level of activity. 55% of patients in the patellar tendon group and 20% of patients in the hamstring tendon group had donor site pain in the first 6 months. 73% of patients in the hamstring group had at least 10 mm of thigh wasting. Pain on kneeling was seen only in the patellar tendon group (35% while hamstring pain was found only in the hamstring group (20%. CONCLUSIONS Patients in the patellar tendon group had increased anterior stability and were able to return to strenuous occupation. The difference in thigh atrophy between the two groups was not significant. The hamstring group had lower graft harvest site morbidity. Lachman test was the single most accurate

  19. A Case of Spontaneously Resolved Bilateral Primary Spontaneous Pneumothorax

    Directory of Open Access Journals (Sweden)

    Hasan Kahraman

    2014-03-01

    Full Text Available A condition of intrapleural air-space accumulation in individuals without any history of trauma or lung disease is called as primary spontaneous pneumothorax (PSP. Sixteen-years-old male patient admitted with complains of chest pain and dyspnea beginning 3 day ago. On physical examination, severity of breath sounds decreased on right side. Chest radiograph was taken and right-sided pneumothorax was detected and tube thoracostomy was inserted. Two months ago the patient referred to a doctor with similar complaints and physical examination and chest radiograph were reported as normal. The radiograph was retrospectively examined and bilateral PSP was detected. We presented the case duo to spontaneous recovery of bilateral PSP is seen very rarely and so contributes data to the literature. In patients admitted to the clinic with chest pain and shortness of breath, pneumothorax should be considered at differential diagnosis.

  20. Epidemiology of lateral and medial epicondylitis in a military population.

    Science.gov (United States)

    Wolf, Jennifer Moriatis; Mountcastle, Sally; Burks, Robert; Sturdivant, Rodney X; Owens, Brett D

    2010-05-01

    To determine the epidemiology of lateral and medial epicondylitis in the U.S. military. The Defense Medical Epidemiology Database was queried for ICD-9 codes 726.32 (lateral epicondylitis) and 726.33 (medial epicondylitis) for the years 1998-2006. Multivariate Poisson regression was used to calculate incidence rates (IR) and rate ratios (RR) among demographic groups. The IRs for lateral and medial epicondylitis were 2.98 and 0.81 per 1000 person-years. For lateral epicondylitis, women had a higher incidence (RR = 1.22, 95% CI 1.19-1.26). In both groups, analysis by age showed higher incidence in the > or = 40-year-old group. White compared with black race was a risk factor for both lateral (RR = 1.68, 95% CI, 1.63-1.74) and medial epicondylitis (RR = 1.11, 95% CI 1.05-1.17). Female gender was a risk factor for lateral but not medial epicondylitis. Age greater than 40 and white race were significant risk factors for both conditions.