Combined medial patellofemoral ligament and medial patellotibial ligament reconstruction in recurrent patellar instability:A systematic review and meta-analysis

BACKGROUND The medial patellofemoral ligament(MPFL),along with the medial patellotibial ligament(MPTL)and medial patellomeniscal ligament,aid in the stabilization of the patellofemoral joint.Although the MPFL is the primary stabilizer and the MPTL is a secondary limiter,this ligament is critical in maintaining joint stability.There have been few studies on the combined MPFL and MPTL reconstruction and its benefits.AIM To look into the outcomes of combined MPFL and MPTL reconstruction in frequent patellar instability.METHODS By May 8,2022,four electronic databases were searched:Medline(PubMed),Scopus,Web of Science,and Google Scholar.General keywords such as"patellar instability,""patellar dislocation,""MPFL,""medial patellofemoral ligament,""MPTL,"and"medial patellotibial ligament"were co-searched to increase the sensitivity of the search.RESULTS The pooled effects of combined MPFL and MPTL reconstruction for Kujala score(12-mo followup)and Kujala score(24-mo follow-up)were positive and incremental,according to the findings of this meta-analysis.The mean difference between the Cincinnati scores was also positive,but not statistically significant.The combination of the two surgeries reduces pain.According to cumulative meta-analysis,the trend of pain reduction in various studies is declining over time.CONCLUSION The combined MPFL and MPTL reconstruction has good clinical results in knee function and,in addition to providing good control to maintain patellofemoral joint balance,the patient's pain level decreases over time,making it a valid surgical method for patella stabilization.

Horizontal Inferior Patellar Dislocation in an Elderly Patient: A Case Report and Review of Literature

Intra-articular patellar dislocation due to acute trauma is considered a rare presentation and is less commonly encountered in practice than extra-articular patellar dislocation. This case study presents a rare type 2 inferior dislocation of the patella in an elderly patient which was successfully reduced and managed non-operatively.

Evaluation of the Surgical Treatment of Patella Fractures in 17 Cases in the Orthopedic-Traumatology Department of the University Hospital Center of Donka, Republic of Guinea

Objectives: To determine the epidemiological, therapeutic and evolutionary aspects. Methodology: This was a retrospective study, from January 1, 2016 to December 31, 2018, on the files of patients aged 16 and over, admitted for patella fractures, treated surgically and followed up in our service. Results: The study involved 17 patients including 15 men (88.24%) and 02 women (11.76%) with an average age of 36.65 years. Workers were the most represented (29.42%);AVP were the leading cause of these fractures (52.94%). The fractures were open in 70.58% of cases. Associated lesions were dominated by femur fractures in 29.42%. Duparc type II was the most encountered bone lesion with 47.06% of cases. All our patients benefited from regional anesthesia. Bracing was the most used surgical treatment in 58.83%;the anterior approach was performed in all our patients. Four (04) cases of knee stiffness, two (02) postoperative infections and skin necrosis complicated the short and medium term consequences. After a two-year follow-up, radiologically one case of pseudarthrosis and one case of patellofemoral osteoarthritis were noted. According to the Bosman score, we found 17.65% excellent, 47.06% good and 35.29% poor functional results. Conclusion: Patella fractures are relatively rare. Treatment is primarily surgical for transverse and/or displaced fractures;Bracing is the osteosynthesis technique of choice. However, knee stiffness, pseudarthrosis and patellofemoral osteoarthritis are not uncommon.

Autogenous iliotibial band enhancement combined with tendon lengthening plasty to treat patella baja:A case report

BACKGROUND Patella baja is a severe complication after knee injury or surgery,resulting in pain and impaired movement.This disorder is also a substantial challenge for orthopaedic surgeons.Currently,no consensus exists regarding the gold standard management of patella baja.If not appropriately treated,significant dysfunction of the knee joint will occur.CASE SUMMARY A 46-year-old man with a left patellar fracture was treated with tension band fixation at a local hospital.He had undergone a second operation at the same hospital because of limited knee flexion 6 mo after surgery.Unfortunately,the patellar tendon was ruptured.The patellar tendon was subsequently repaired using an ipsilateral semitendinosus tendon.Two years later,the patient presented to our department with knee pain and loss of range of motion.Autogenous iliotibial band(ITB)enhancement combined with sagittal tendon lengthening plasty was used to improve the symptoms of the knee joint.The patient was followed up for 2 years.The knee joint function of the patient returned to the normal level.CONCLUSION We successfully treated patella baja using autogenous ITB enhancement combined with sagittal tendon lengthening plasty.

New treatment of patellar instability after total knee arthroplasty: A case report and review of literature

BACKGROUND Patellar instability is an uncommon complication after total knee arthroplasty(TKA).Partial lateral patella facetectomy(LPF)with lateral retinaculum release treatment of patellar instability is rarely reported.CASE SUMMARY We present a case of patellar instability 8 mo after primary TKA.Treatment of this complication was adapted to address the cause of the dislocation.To eliminate patellar instability,we restored the vastus medialis and performed LPF with lateral retinaculum release.We achieved normal patellar tracking.Clinical and radiographic evaluations at the 1-year postoperative follow-up were satisfactory.CONCLUSION LPF with lateral retinaculum release represents a promising option to restore central patellar tracking in patients with patellar instability after TKA in cases without component malposition.

A Case of Simultaneous Total Knee Arthroplasty in Congenital Dislocation of the Patella

The gonarthrosis with congenital dislocation of the patella is rare condition. This paper will report about total knee arthroplasty (TKA) for the valgus knee with bilateral congenital dislocation of the patella. A 52-year-old woman presented to our hospital with progressive pain in bilateral knees. Both knee showed severe valgus deformity and lateral dislocation of the patella. Anteroposterior weight-bearing radiographs showed osteoarthritic changes in the lateral compartment with 7 valgus deformity at the right and 15 at the left. A bilateral TKA with cruciate retained components (NAKASHIMA FINE) was performed. Good tracking of the patella was achieved by using a lateral parapatellar approach and vastus medialis plication. There are no normative guidelines of operative procedure about TKA for osteoarthritis of valgus knee with congenital dislocation of the patella. With some referencing to current literature, strategies to good patella tracking are discussed.

Systematic review of the etiology behind patellar clunk syndrome

BACKGROUND Total knee arthroplasty is one of the most successful operations performed worldwide today.Patellar clunk syndrome(PCS)is a postoperative complication that arises due to the development of a fibrous nodule along the undersurface of the quadriceps tendon.The current literature on PCS has not yet come to a consensus regarding its etiology.To date,this is the first study that analyzes the existing literature on PCS in order to generate a conclusion regarding its etiology.It is hypothesized that prosthesis design is the main component behind the development of PCS.AIM To determine the etiology of PCS and its association with pre and post-operative characteristics of the prosthesis and native knee.METHODS We conducted a systematic review according to the PRISMA guidelines by searching through PubMed,Cochrane,and Google Scholar from May-July 2018 for cases of PCS using search MeSH terms“patella OR patellar”AND“clunk”OR“catch”OR“crepitus”.The search included case series and clinical trials and excluded review articles,yielding 30 articles from the original search and 3 additional articles from reference lists.We extracted data upon the outcomes in patients afflicted with PCS to determine the etiology of PCS.We performed additional bias assessments to validate our search algorithm and results.RESULTS Prosthesis design was the metric most frequently implicated in the incidence of PCS,though several other metrics were contributory toward its pathogenesis.Later prosthetic designs incorporate a reduced intercondylar box ratio and box width to reduce contact between the proximal patellar pole and the intercondylar box,thereby reducing incidence of PCS.CONCLUSION The etiology of PCS is multifactorial,owing to the growing metrics that have associations with its incidence.This conclusion is validated by the significance of prosthesis design as the most likely parameter involved in developing PCS since different prosthesis designs are often the result of different parameters.Future studies should be directed at isolating individual prosthetic parameters of prosthesis designs in order to determine what permutation of parameters is most closely associated with the development of PCS.

New Classification and Visual Analysis of the Patella Cartilage during Total Knee Replacement

Objective: The aim of this prospective study is to evaluate how much damage the patellar cartilage presents during a total knee replacement. Methods: The damage of the articular patellar surface was analysed by visual inspection and photographs in 354 primary total knee replacements. The authors graded the degree of cartilage lesion in five groups. The cartilage status was analyzed and correlated with age, gender, side, body mass index (BMI), Kellgren-Lawrence radiographic scale and axial deviation. Results: After statistical analysis, we concluded: there was no evidence of an association between patellar arthrosis and age gender, side, weight and deformity. Conclusions: Articular cartilage was damaged in all 354 knees. Important subchondral bone exposure occurred in 274 knees (77.4%). Obese patients had more severe patellar osteoarthritis.

Cable Pin System versus K-wire Tension Band Fixation for Patella Fractures in Chinese Han Population: A Meta-analysis

This meta-analysis compared the therapeutic effect of cable pin system(CPS) with K-wire tension band(KTB) in the treatment of patella fractures among Chinese Han population. The databases of PubM ed, Cochrane library, China National Knowledge Infrastructure(CNKI), Chinese Wan Fang and Chinese VIP were searched for studies on CPS versus KTB in the treatment of patella fractures among Chinese Han population. Literatures were screened according to the inclusion and exclusion criteria. The quality of the studies was assessed, and meta-analysis was performed using the Cochrane Collaboration's REVMAN 5.3 software. A total of 932 patients from 15 studies were included in this meta-analysis(426 fractures treated with CPS and 506 fractures treated with KTB). There were significant differences in duration of hospital stay [mean difference(MD)=–1.07; 95% confidence interval(CI): –1.71 to –0.43], fracture healing time(MD=–1.23; 95% CI: –1.68 to –0.77), flexion degree of knee joint at 6 th month after operation(MD=14.82; 95% CI: 10.93 to 18.71), incidence of postoperative complication [risk ratio(RR)=0.16; 95% CI: 0.09 to 0.27] and excellent-good rate of B?stman score(RR=1.09; 95% CI: 1.03 to 1.16) between the CPS group and KTB group, while no significant difference was found in operative time between the two groups(MD=–4.52; 95% CI: –11.70 to 2.67). For the treatment of patella fractures among Chinese Han population, limited evidence suggests that the CPS is more suitable than the KTB when considering the hospital stay, fracture healing time, flexion degree of knee at 6 th month after operation, incidence of postoperative complication and excellent-good rate of B?stman joint score. Due to the limitation of high quality evidence and sample size, more large-scale randomized controlled trials are needed to validate the findings in the future.

从石鳖(Chiton sp.)和帽贝(Patella sp.)中提取海藻解壁酶的初步研究

本研究尝试从两种海洋贝类──石鳖和帽贝的消化腺中提取混合消化酶，以获得对海藻原生质体分离更有效的工具酶。通过对１９种青岛海滨常见藻类酶解效果的比较发现；（ｌ）该酶对各种藻类均有一定的解离作用，尤其对红藻效果好，对绿藻次之；（２）解离时间相对较短，一般在１ｈ左右，对甘紫菜１０ｍｉｎ即可见效。石鳖和帽贝混合消化酶由于综合两种贝的食性特征，具有比单一动物消化酶更广泛的消化作用．同时还对这一混合工具酶的酶解条件进行了研究。

New Technique for Medial Patellar Desmotomy in Cattle and Donkeys

The present technique is designed to transect the medial patellar ligament indicated for treatment of upward fixation of patella in cattle and donkeys. A medial patellar desmotomy was performed first on cadavers and then on 21 live cattle or donkeys. In live animals under local anesthesia, a sterile silk strand (USP 1) mounted on a curved needle is inserted through skin at the medial aspect of the medial patellar ligament to the subcutaneous fascia and directed beneath the ligament to emerge at opposite side. The silk is then sawed to cut the ligament. In contrast to other procedures, the desmotomy is less invasive as skin at the surgical site is not incised, pericapsular fat and joint capsules not invaded, and the ligament is fully transected in a one-step procedure. Minimal tissue invasiveness limited infection of surgical site, minimized bleeding, and decreased related postoperative consequences.

Open Patellar Fracture in a 2-Year-Old Child: A Rare Case Report

We present this unusual fracture in order to stress the importance of being aware of the existence of open fractures of patella in 2-year-old child. Fractures of the patella are rare in children, as the patella is largely cartilaginous and has great mobility. Normally in this age closed patellar fractures cannot be diagnosed radiologically as the ossification starts only after 3 years of age. Our case is an open transverse patellar fracture in a two-year-old girl which is treated with transcartilagenous absorbable sutures, which is not found reported in the literature.

Medial Patella Subluxation after Minor Trauma

Most cases of medial patella subluxation occur under iatrogenic conditions that are often associated with a prior excessive lateral retinacular release procedure. We report a case of medial subluxation following minor trauma with no history of previous lateral release. The abnormality was identified on magnetic resonance imaging and was successfully treated by direct repair of the lateral retinaculum. The recognition and treatment of medial subluxation of the patella without retinacular release can be difficult. Therefore, consideration of multiple causes through careful medical history taking, physical examination, and radiologic examination is needed for accurate diagnosis.

A Double Tension Band Technique for Patellar Fractures—A New Concept

Amongst the many known techniques used for the management of fractures of the patella, the tension band wire fixation is a reliable treatment modality and has given consistently good results. In transverse patellar fractures, a combination of cerclage wiring and tension band fixation gives a good mechanical stability and an environment conducive to healing. The fracture described herein is classified as 45-C1 (based on Orthopaedic Trauma Association classification) of the right knee of a forty three years old male patient. It was fixed with three vertical 1.5 mm K wires and double cerclage wire looped proximally through the quadriceps tendon and distally through the patellar ligament in a double figure-of-eight configuration. The average follow-up period was 7 months. The Activity of Daily Living Scale (ADLS) of the Knee Outcome Survey was used to assess symptoms and functional capability of the knee. The fracture union was achieved at an average of 10 weeks. Full range of knee motion was achieved by end of the third postoperative month. No complications, such as infection and implant failure were noted. The technique aims to stress the advantage of giving a balanced fixation addressing the bony elements (the fractured ends) as well as the soft tissue (the extensor apparatus).

Femoro Patella Vialla patellofemoral arthroplasty: An independent assessment of outcomes at minimum 2-year follow-up

AIM: To determine outcomes using the Femoro-Patella Vialla(FPV) arthroplasty and if there is an ideal patient for this implant. METHODS: A total of 41 FPV patellofemoral joint replacements were performed in 31 patients(22 females, 9 males, mean age 65 years). Mean followup was 3.2 years(minimum 2 years). Radiographs were reviewed preoperatively and postoperatively. We assessed whether gender, age, previous surgery, patella atla or trochlear dysplasia influenced patient satisfaction or patient functional outcome.RESULTS: The median Oxford Knee Score was 40 and the median Melbourne Patellofemoral Score was 21 postoperatively. Seventy-six percent of patients were satisfied, 10% unsure and 14% dissatisfied postoperatively. There was no radiological progression of tibiofemoral joint arthritis, using the Ahlback grading,in any patient. One patient, who was diagnosed with rheumatoid arthritis postoperatively, underwent revision to total knee replacement. There were no intraoperative lateral releases and no implant failures. Gender, age, the presence of trochlear dysplasia, patella alta or bilateral surgery did not influence patient outcome. Previous surgery did not correlate with outcome. CONCLUSION: In contrast to the current literature, the FPV shows promising early results. However, we cannot identify a subgroup of patients with superior outcomes.

Nail—patella综合症1例报道并文献复习

目的探讨指甲-髌骨综合症(nail-patella syndrome NPS)影像学表现。方法分析临床诊断NPS一例影像学表现并结合已报道病例文献进行复习。结果 NPS典型临床表现为:指甲发育障碍、髂骨角、膝和肘部发育不良四联征;髂骨角、髌骨发育不良并半脱位及肘关节发育不良是典型的X线表现。结论 NPS具有典型X线表现,结合临床症状及体征能明确诊断。

Impact of Surgical Treatment of Patella Tendon Rupture Regarding Return to Sports in Yaounde

Introduction: Patella tendon rupture (PTR) is a cause of handicap in athletic patients. Surgery remains the actual therapeutic modality with a variety of techniques that permits a return to sport. Our objective was to evaluate the return to sporting activities after surgical repair of a PTR. Method: We conducted a retrospective cohort study over five years from January 2016 to April 2021. We included athletes from 18 to 65 years of operating for a PTR. We evaluated: the knee functional score, the level of satisfaction, Lysholm score, VISA-P questionnaire, and return to sports. Results: A total of twenty-one cases of PTR were identified. The median age was 36 years (18 - 63). After surgery, the median follow-up was 17 months (12 - 55). All patients were able to walk at 3 months. A total of 17 patients (85%) returned to sports. The median return to sports was 6 months (5 - 11). Patients who return to a similar sport with a similar initial level of sporting activity were 45% (9 patients). The median time to return to sports for patients at a similar level of sport was 7.5 months (6 - 13). Functional scores were satisfactory;with a VISA-P score of 90/100 (25 - 100) and a Lysholm score of 98/100 (40 - 100). Conclusion: Surgical repair of PTR in athletes offers good results regarding return to sports in terms of proportion and timing whatsoever the technique. The use of protection band wires is reserved for patients with relative satisfaction during suture repair.

浅析Patella粉碎性骨折术后的康复指导及护理

目的:针对Patella粉碎性骨折术后心理康复指导及患者术后功能恢复。方法:对25例Patella粉碎性骨折的患者在手术前进行评估,针对患者体质不同制定一套有效的术后康复护理计划及心理辅导。结果:半年内4例膝关节功能完全康复,2例大部分功能恢复,后6个月17例膝关节功能完全康复,1年后有2例患者膝关节未完全康复。结论:对于Patella粉碎性骨折术后医护人员要有针对性的进行护理方面的系统培训及指导,对患者今后的康复治疗打下基础,缩短患者康复治疗的时间。

Total Knee Arthroplasty:Patellar Replacement’s Influence in Patient Quality of Life Postoperatively

Objective: To study the influence of patellar resurfacing on quality of life under a standardised score. The chosen score was the Knee Society Score (KSS), which considers range of motion, pain, contractors, alignment and stability. Methods: Retrospective review of 60 patients submitted to total knee arthroplasty (TKA) was divided into two groups: with patellar resurfacing (PR) and without patellar resurfacing (NPR). We reviewed data from these patients containing the KSS, which are routinely used in our service. Data were analysed from 2013 to 2014, with a minimal patient follow-up of 18 months. Results: There were no unsatisfactory scores in our study. Total scores (KSS) were similar between the groups (mean KSS: PR = 88.36 ± 9.64;NPR = 84.26 ± 9.44 [p = 0.1]). While stratifying into groups (poor, fair, good, excellent), we found excellent results in 84.8% of PR versus 59.3% NPR (p = 0.056). These data did not reach statistical significance and can therefore be considered a coincidental result. Conclusion: Although these results did not show statistical significance (p = 0.056), patellar resurfacing patients tend to get more “excellent” results after 18 months of follow-up in quality of life when evaluated by KSS. Perhaps a larger amount of patients would suffice to acquire statistical significance in a future study.

Acute Traumatic Primary Patella Dislocation in Children and Adolescents:A Detailed Evaluation of the Impact upon the Results

Background and Aim: Through accurate assessment of the risk factors and structural characteristics of children presenting with acute patella dislocation, this study aimed to evaluate the probability of recurrence and the effects on treatment. Materials and Methods: Demographic and radiological evaluation was made of each case. Contributory factors to patellofemoral instability were investigated. Surgical treatment was applied to 4 (15.39%) patients and conservative treatment to 22 (84.61%). Functional status before and after treatment was evaluated using the Kujala patellofemoral scoring system. Results: The patients comprised 8 (30.77%) males and 18 (69.23%) females with a mean age of 13.46 years. In 15 (57.69%) cases, there were patellofemoral complaints before the dislocation. The Kujala score was determined as mean 54.27 pre-treatment and 84.81 post-treatment in the conservative treatment group and mean 48.00 preoperatively and 75.25 postoperatively in the surgically treated group. No recurrence of patella dislocation was observed in any patient during the follow-up of both groups. Conclusions: Although it seems to be simple surgical intervention, as patella dislocation surgery can involve several complications, the surgical program must be very well planned and only applied to cases where necessary. With case-by-case assessment, the probability of recurrence of patella dislocation will be removed.