Periprosthetic joint infection(PJI)following total knee arthroplasty is one of the most catastrophic and costly complications that carries significant patient wellness as well as economic burdens.The road to efficient...Periprosthetic joint infection(PJI)following total knee arthroplasty is one of the most catastrophic and costly complications that carries significant patient wellness as well as economic burdens.The road to efficiently diagnosing and treating PJI is challenging,as there is still no gold standard method to reach the diagnosis as early as desired.There are also international controversies with respect to the best approach to manage PJI cases.In this review,we highlight recent advances in managing PJI following knee arthroplasty surgery and discuss in depth the two-stage revision method.展开更多
Background: Jumper’s knee is relatively common among rugby players, and treatment of this condition is known to be difficult. Intratendinous revision surgery has shown poor results. New research on innervation patter...Background: Jumper’s knee is relatively common among rugby players, and treatment of this condition is known to be difficult. Intratendinous revision surgery has shown poor results. New research on innervation patterns, and a new US+DP-guided treatment method targeting the regions with vessels and nerves outside the tendon has shown promising results in patients with Jumper’s knee. Material: This study includes 12 patellar tendons from 9 professional rugby players (mean age 26 years) with a long duration (range 12 - 72 months) of pain from the proximal patellar tendon. For 3 tendons there was previously intratendinous revision surgery with a poor result. Method: Treatment with Ultrasound (US) and Doppler (DP)-guided arthroscopic shaving + open scraping, followed by immediate weight bearing and gradually increased loading up to full loading after 6 - 8 weeks, was performed. Results: For 9 tendons there was a good clinical result, and all returned to full professional rugby within 4 - 6 months. The mean VISA score increased from 49 to 78 (p < 0.05). Follow-ups (range 10 - 30 months) show remaining good results. For 3 tendons, all have had previous intratendinous revision surgery, the clinical results were poor and they couldn’t return to rugby. Conclusions: The short-term results in this relatively small material indicate that US+DP-guided arthroscopic shaving + open scraping is a good treatment method for professional rugby players with chronic painful Jumper’s knee.展开更多
Benign symmetric lipomatosis（BSL） is a rare disease characterized by the presence of multiple, symmetric and nonencapsulated fat masses in the face. neck and other areas. It is commonly seen in middle-aged Caucasian...Benign symmetric lipomatosis（BSL） is a rare disease characterized by the presence of multiple, symmetric and nonencapsulated fat masses in the face. neck and other areas. It is commonly seen in middle-aged Caucasian Mediterranean males, while its etiology is still not clear. The majority of the patients with BSL have a history of alcohol abuse and hepatopathy. BSL of the limbs is very rare. This article reports a unique case of a 60-year-old Chinese woman with involvement of the knees confirmed by the results of magnetic resonance imaging（MR1） and histopathology, which was not described previously in published literatures.展开更多
AIM To determine the functional outcomes, complications and revision rates following total knee arthroplasty(TKA) in patients with Paget's disease of bone(PDB). METHODS A systematic review of the literature was pe...AIM To determine the functional outcomes, complications and revision rates following total knee arthroplasty(TKA) in patients with Paget's disease of bone(PDB). METHODS A systematic review of the literature was performed. Four studies with a total of 54 TKAs were included for analysis. Functional outcomes, pain scores, complications and revision rates were assessed. The mean age was 72.0 years and the mean follow-up was 7.5 years.RESULTS All studies reported significant improvement in knee function and pain scores following TKA. There were 2 cases of aseptic loosening, with one patient requiring revision of the femoral component 10 years after the index procedure. Malalignment, bone loss, soft tissue contractures were the most commonly reported intraoperative challenges. There were five cases(9%) that were complicated by intra-operative patellar tendon avulsion.CONCLUSION The findings support the use of TKA in patients with PDB. The post-operative functional outcomes are largely similar to other patients, however there are specific perioperative challenges that have been highlighted, in particular the high risk for patellar tendon avulsion.展开更多
Osteonecrosis is a very rare complication of Crohn's disease(CD).It is not clear if it is related to corticosteroid therapy or if it occurs as an extraintestinal manifestation of inflammatory bowel disease.We pres...Osteonecrosis is a very rare complication of Crohn's disease(CD).It is not clear if it is related to corticosteroid therapy or if it occurs as an extraintestinal manifestation of inflammatory bowel disease.We present the case of a patient with CD who presented with osteonecrosis of both knees.A 22 years old woman was diagnosed with CD in April 2012(Montreal Classification A2L1 + L4B3p).She was started on prednisolone(40 mg/d),azathioprine(100 mg/d) and messalazine(3 g/d).In July 2012,due to active perianal disease,infliximab therapy was initiated.In September 2012,she had a pelvic abscess complicated by peritonitis and an ileal segmental resection and right hemicolectomy were performed.In December 2012 she was diagnosed with bilateral septic arthritis of both knees with walking impairment.She was treated with amoxicillin-clavulanic acid,started a physical rehabilitation program and progressively improved.However,then,bilateral knee pain exacerbated by movement developed.Magnetic resonance imaging showed multiple osseous medullary infarcts in the distal extremity of the femurs,proximal extremity of the tibiae and patellas and no signs of subchondral collapse,which is consistent with osteonecrosis.The patient recovered completely and maintains therapy with azathioprine and messalazine.A review of the literature is also done.展开更多
Background:The Victorian Institute of Sport Assessment–Patella(VISA-P) scale is the most condition-specific patient-reported outcome measure used to assess symptom severity in athletes with patellar tendinopathy.Prev...Background:The Victorian Institute of Sport Assessment–Patella(VISA-P) scale is the most condition-specific patient-reported outcome measure used to assess symptom severity in athletes with patellar tendinopathy.Previous exploratory factor analyses have been conducted to evaluate the scale's dimensionality,with inconsistent results,and the factor structure of the scale remains unclear.The aims of the present study were to determine the factorial structure of the VISA-P scale using confirmatory factor analysis(CFA) and test measurement invariance across sexes.Methods:The study included a convenience sample of 249 Spanish athletes with patellar tendinopathy.CFA was performed to assess factorial validity.Hypothesized 1-and 2-factor models were tested.Measurement invariance across sexes was evaluated via multi-group CFA with several fit indices using EQS 6.1 software.Results:The internal consistency coefficient was 0.74.Several CFA models were examined and the 1-factor model in which errors for Items 7 and8 were correlated showed acceptable fit in terms of comparative fit index(CFI) and goodness-of-fit index(GFI) statistics(CFI = 0.93;GFI = 0.94;standardized root mean square residual = 0.06;root mean square error of approximation = 0.10;90% confidence interval:0.08–0.13).This model was invariant across sexes.Conclusion:The 1-factor model of the Spanish version of the VISA-P scale(VISA-P-Sp) in which errors for Items 7 and 8 were correlated demonstrated relative fit in CFA.Scores obtained via VISA-P-Sp can be compared between men and women without sexes bias.Further studies should examine the VISA-P scale and other single-score patient-reported outcome measures concurrently.展开更多
The pathology of patellar tendinopathy and the mechanisms of pain are poorly understood. The most popular treatment modality is the Eccentric overload Exercise. However, there is insufficient evidence to recommend a s...The pathology of patellar tendinopathy and the mechanisms of pain are poorly understood. The most popular treatment modality is the Eccentric overload Exercise. However, there is insufficient evidence to recommend a specific protocol and yet it is the most commonly used treatment modality. The aim of this case study is to present the possible mechanisms of pain and a treatment approach on a patient who was diagnosed as having patellar tendinopathy. It is suggested that hyper extension of the knee might be the source of patellar tendon pain in this patient. Following a course of pulsed short wave diathermy the patient was symptom free and remained so at 6 month review. Further studies to evaluate effectiveness of pulsed short wave diathermy is suggested.展开更多
文摘Periprosthetic joint infection(PJI)following total knee arthroplasty is one of the most catastrophic and costly complications that carries significant patient wellness as well as economic burdens.The road to efficiently diagnosing and treating PJI is challenging,as there is still no gold standard method to reach the diagnosis as early as desired.There are also international controversies with respect to the best approach to manage PJI cases.In this review,we highlight recent advances in managing PJI following knee arthroplasty surgery and discuss in depth the two-stage revision method.
文摘Background: Jumper’s knee is relatively common among rugby players, and treatment of this condition is known to be difficult. Intratendinous revision surgery has shown poor results. New research on innervation patterns, and a new US+DP-guided treatment method targeting the regions with vessels and nerves outside the tendon has shown promising results in patients with Jumper’s knee. Material: This study includes 12 patellar tendons from 9 professional rugby players (mean age 26 years) with a long duration (range 12 - 72 months) of pain from the proximal patellar tendon. For 3 tendons there was previously intratendinous revision surgery with a poor result. Method: Treatment with Ultrasound (US) and Doppler (DP)-guided arthroscopic shaving + open scraping, followed by immediate weight bearing and gradually increased loading up to full loading after 6 - 8 weeks, was performed. Results: For 9 tendons there was a good clinical result, and all returned to full professional rugby within 4 - 6 months. The mean VISA score increased from 49 to 78 (p < 0.05). Follow-ups (range 10 - 30 months) show remaining good results. For 3 tendons, all have had previous intratendinous revision surgery, the clinical results were poor and they couldn’t return to rugby. Conclusions: The short-term results in this relatively small material indicate that US+DP-guided arthroscopic shaving + open scraping is a good treatment method for professional rugby players with chronic painful Jumper’s knee.
文摘Benign symmetric lipomatosis（BSL） is a rare disease characterized by the presence of multiple, symmetric and nonencapsulated fat masses in the face. neck and other areas. It is commonly seen in middle-aged Caucasian Mediterranean males, while its etiology is still not clear. The majority of the patients with BSL have a history of alcohol abuse and hepatopathy. BSL of the limbs is very rare. This article reports a unique case of a 60-year-old Chinese woman with involvement of the knees confirmed by the results of magnetic resonance imaging（MR1） and histopathology, which was not described previously in published literatures.
文摘AIM To determine the functional outcomes, complications and revision rates following total knee arthroplasty(TKA) in patients with Paget's disease of bone(PDB). METHODS A systematic review of the literature was performed. Four studies with a total of 54 TKAs were included for analysis. Functional outcomes, pain scores, complications and revision rates were assessed. The mean age was 72.0 years and the mean follow-up was 7.5 years.RESULTS All studies reported significant improvement in knee function and pain scores following TKA. There were 2 cases of aseptic loosening, with one patient requiring revision of the femoral component 10 years after the index procedure. Malalignment, bone loss, soft tissue contractures were the most commonly reported intraoperative challenges. There were five cases(9%) that were complicated by intra-operative patellar tendon avulsion.CONCLUSION The findings support the use of TKA in patients with PDB. The post-operative functional outcomes are largely similar to other patients, however there are specific perioperative challenges that have been highlighted, in particular the high risk for patellar tendon avulsion.
文摘Osteonecrosis is a very rare complication of Crohn's disease(CD).It is not clear if it is related to corticosteroid therapy or if it occurs as an extraintestinal manifestation of inflammatory bowel disease.We present the case of a patient with CD who presented with osteonecrosis of both knees.A 22 years old woman was diagnosed with CD in April 2012(Montreal Classification A2L1 + L4B3p).She was started on prednisolone(40 mg/d),azathioprine(100 mg/d) and messalazine(3 g/d).In July 2012,due to active perianal disease,infliximab therapy was initiated.In September 2012,she had a pelvic abscess complicated by peritonitis and an ileal segmental resection and right hemicolectomy were performed.In December 2012 she was diagnosed with bilateral septic arthritis of both knees with walking impairment.She was treated with amoxicillin-clavulanic acid,started a physical rehabilitation program and progressively improved.However,then,bilateral knee pain exacerbated by movement developed.Magnetic resonance imaging showed multiple osseous medullary infarcts in the distal extremity of the femurs,proximal extremity of the tibiae and patellas and no signs of subchondral collapse,which is consistent with osteonecrosis.The patient recovered completely and maintains therapy with azathioprine and messalazine.A review of the literature is also done.
文摘Background:The Victorian Institute of Sport Assessment–Patella(VISA-P) scale is the most condition-specific patient-reported outcome measure used to assess symptom severity in athletes with patellar tendinopathy.Previous exploratory factor analyses have been conducted to evaluate the scale's dimensionality,with inconsistent results,and the factor structure of the scale remains unclear.The aims of the present study were to determine the factorial structure of the VISA-P scale using confirmatory factor analysis(CFA) and test measurement invariance across sexes.Methods:The study included a convenience sample of 249 Spanish athletes with patellar tendinopathy.CFA was performed to assess factorial validity.Hypothesized 1-and 2-factor models were tested.Measurement invariance across sexes was evaluated via multi-group CFA with several fit indices using EQS 6.1 software.Results:The internal consistency coefficient was 0.74.Several CFA models were examined and the 1-factor model in which errors for Items 7 and8 were correlated showed acceptable fit in terms of comparative fit index(CFI) and goodness-of-fit index(GFI) statistics(CFI = 0.93;GFI = 0.94;standardized root mean square residual = 0.06;root mean square error of approximation = 0.10;90% confidence interval:0.08–0.13).This model was invariant across sexes.Conclusion:The 1-factor model of the Spanish version of the VISA-P scale(VISA-P-Sp) in which errors for Items 7 and 8 were correlated demonstrated relative fit in CFA.Scores obtained via VISA-P-Sp can be compared between men and women without sexes bias.Further studies should examine the VISA-P scale and other single-score patient-reported outcome measures concurrently.
文摘The pathology of patellar tendinopathy and the mechanisms of pain are poorly understood. The most popular treatment modality is the Eccentric overload Exercise. However, there is insufficient evidence to recommend a specific protocol and yet it is the most commonly used treatment modality. The aim of this case study is to present the possible mechanisms of pain and a treatment approach on a patient who was diagnosed as having patellar tendinopathy. It is suggested that hyper extension of the knee might be the source of patellar tendon pain in this patient. Following a course of pulsed short wave diathermy the patient was symptom free and remained so at 6 month review. Further studies to evaluate effectiveness of pulsed short wave diathermy is suggested.
