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Kim DK, Lee KC, Yoon DW, Kim T. Medial Patellar Plica Thickness as a Morphologic Predictor of the Medial Patellar Plica Syndrome. J Comput Assist Tomogr 2024; 48:443-448. [PMID: 38271534 DOI: 10.1097/rct.0000000000001581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
OBJECTIVE The aim of this study was to evaluate the association between medial patellar plica (MPP) syndrome and the morphological features of the MPP, including length, width, and thickness, on knee magnetic resonance imaging (MRI). MATERIALS AND METHODS From 2018 to 2022, 167 patients diagnosed with isolated MPP syndrome based on both MRI and arthroscopic findings were included in the "study group" and 226 patients without knee pathology on both MRI and physical examination were included in the "control group." Finally, 393 patients (mean age, 38.9 ± 5.7 years) with 405 knee MRI examinations were included. Morphological MR features of MPP were assessed, including width, length, and thickness. Multivariate regression and receiver operating characteristic analyses were performed to identify the factors associated with MPP syndrome. RESULTS The mean thickness of MPP was significantly higher in the study group than control group (2.3 ± 0.5 mm vs 1.0 ± 0.8 mm, P < 0.001). Moreover, on multivariate analysis, MPP thickness was the only significant factor associated with MPP syndrome (odds ratio, 6.452; 95% confidence interval, 0.816-15.073; P = 0.002). On receiver operating characteristic analysis, thickness ≥1.8 mm was estimated as the optimal cutoff for predicting MPP syndrome with sensitivity of 75.9%, specificity of 65.4%, and area under the curve of 0.727 (95% confidence interval, 0.667-0.788; P < 0.001). CONCLUSIONS Measurement of MPP thickness on MRI could be a morphological predictor of MPP syndrome.
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Affiliation(s)
| | | | - Do Won Yoon
- From the Department of Radiology, the Armed Forces Capital Hospital, Seongnam
| | - Taeho Kim
- From the Department of Radiology, the Armed Forces Capital Hospital, Seongnam
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Chen Z, Li A, Shi R, Wang L, Cao Z, Mao N, Luo Z, Tan H. Reconstruction of medial meniscus posterior portion deficiency in pigs with an autologous patellar tendon graft: an experimental study. J Orthop Surg Res 2024; 19:225. [PMID: 38576008 PMCID: PMC10996223 DOI: 10.1186/s13018-024-04684-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 03/16/2024] [Indexed: 04/06/2024] Open
Abstract
OBJECTIVE This study was performed to investigate the effectiveness of two surgical procedures, autologous patellar tendon graft reconstruction and trans-tibial plateau pull-out repair, using a pig model. The primary focus was to assess the repair capability of medial meniscus posterior portion (MMPP) deficiency, the overall structural integrity of the meniscus, and protection of the femoral and tibial cartilage between the two surgical groups. The overall aim was to provide experimental guidelines for clinical research using these findings. METHODS Twelve pigs were selected to establish a model of injury to the MMPP 10 mm from the insertion point of the tibial plateau. They were randomly divided into three groups of four animals each: reconstruction (autologous tendon graft reconstruction of the MMPP), pull-out repair (suture repair of the MMPP via a trans-tibial plateau bone tunnel), and control (use of a normal medial meniscus as the negative control). The animals were euthanized 12 weeks postoperatively for evaluation of the meniscus, assessment of tendon bone healing, and gross observation of knee joint cartilage. The tibial and femoral cartilage injuries were evaluated using the International Society for Cartilage Repair (ICRS) grade and Mankin score. Histological and immunohistochemical staining was conducted on the meniscus-tendon junction area, primary meniscus, and tendons. The Ishida score was used to evaluate the regenerated meniscus in the reconstruction group. Magnetic resonance imaging (MRI) was used to evaluate meniscal healing. RESULTS All 12 pigs recovered well after surgery; all incisions healed without infection, and no obvious complications occurred. Gross observation revealed superior results in the reconstruction and pull-out repair groups compared with the control group. In the tibial cartilage, the reconstruction group had ICRS grade I injury whereas the pull-out repair and control groups had ICRS grade II and III injury, respectively. The Mankin score was significantly different between the reconstruction and control groups; histological staining showed that the structure of the regenerated meniscus in the reconstruction group was similar to that of the original meniscus. Immunohistochemical staining showed that the degree of type I and II collagen staining was similar between the regenerated meniscus and the original meniscus in the reconstruction group. The Ishida score was not significantly different between the regenerated meniscus and the normal primary meniscus in the reconstruction group. MRI showed that the MMPP in the reconstruction and pull-out repair groups had fully healed, whereas that in the control group had not healed. CONCLUSION Autologous patellar tendon graft reconstruction of the MMPP can generate a fibrocartilage-like regenerative meniscus. Both reconstruction and pull-out repair can preserve the structural integrity of the meniscus, promote healing of the MMPP, delay meniscal degeneration, and protect the knee cartilage.
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Affiliation(s)
- Zhian Chen
- Graduate School, Kunming Medical University, Kunming City, Yunnan Province, China
| | - Anxu Li
- Department of Orthopaedics, People's Liberation Army Joint Logistic Support Force 920th Hospital, Kunming City, Yunnan Province, China
| | - Rongmao Shi
- Department of Orthopaedics, People's Liberation Army Joint Logistic Support Force 920th Hospital, Kunming City, Yunnan Province, China
| | - Ling Wang
- Graduate School, Kunming Medical University, Kunming City, Yunnan Province, China
| | - Zijian Cao
- Graduate School, Kunming Medical University, Kunming City, Yunnan Province, China
| | - Neng Mao
- Graduate School, Kunming Medical University, Kunming City, Yunnan Province, China
| | - Zhihong Luo
- Department of Orthopaedics, People's Liberation Army Joint Logistic Support Force 920th Hospital, Kunming City, Yunnan Province, China
| | - Hongbo Tan
- Department of Orthopaedics, People's Liberation Army Joint Logistic Support Force 920th Hospital, Kunming City, Yunnan Province, China.
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Oğuzdoğan GY, Arslan FZ. Evaluation of Anatomical Variations with Morphological Measurements and Their Relationship to Meniscal Injury and Ligament Damage. J Knee Surg 2023; 36:1357-1364. [PMID: 36041483 DOI: 10.1055/a-1933-3592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The purpose of this study was to reveal the anatomical risk factors for anterior and posterior cruciate ligament (ACL and PCL) injuries and menisci injury. We aim to investigate whether there are significant relationships between tibial tubercle-trochlear groove (TT-TG) distance, patella angle, trochlear sulcus angle (TSA), trochlear groove depth (TGD), medial and lateral trochlea length (MT and LT), MT/LT ratio, lateral patellar tilt angle (LPTA), patella-patellar tendon angle (P-PTA), quadriceps-patellar tendon angle (QPA), Insall-Salvati index (ISI), medial and lateral trochlear inclination (MTI and LTI) measurements and important common pathologies such as ACL, PCL, medial and lateral meniscal injuries (MM and LM), peripatellar fat pad edema, chondromalacia, and effusion. Thus, the mechanisms of injury will be better understood by revealing important anatomical variations for meniscus and ligament damage. Three hundred eighty patients with knee magnetic resonance imaging examination were included in this study. Our patients who underwent knee magnetic resonance imaging were divided into groups according to the presence of MM tear, LM tear, ACL tear, PCL tear, peripatellar fat pad edema, chondromalacia and effusion. TT-TG distance, patella angle, TSA, TGD, MT, LT, MT/LT ratio, LPTA, P-PTA, QPA, ISI, MTI, and LTI were measured. In patients with ACL tear, age, LT, ML/LT ratio, and QPA measurements were found to be significantly higher. There was no significant difference between the participants' LPTA value and the presence of ACL tear, MM and LM injury. MT and ML/LT ratio were found to be significantly lower in the group with MM tear (p <0.001). The TT-TG distance was found to be significantly lower in the group with LM tear. Increased age, LT, ML/LT ratio, and QPA are predisposed risk for ACL tear. Decreased MT and ML/LT ratio are among the risk factors for MM tear. The anatomical variations are associated with ligament and meniscal injury.
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Affiliation(s)
| | - Fatma Zeynep Arslan
- Department of Radiology, Basaksehir Cam and Sakura City Hospital, İstanbul, Turkey
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Feyrer M, Sesselmann S, Koehl P, Schuh A. AN INTRATENDINOUS GANGLION CYST OF THE PATELLAR TENDON: A RARE CAUSE OF ANTERIOR KNEE PAIN. Georgian Med News 2023:204-205. [PMID: 38096541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Ganglion cysts in the knee region can manifest as anterior knee pain. Unlike synovial cysts, these lesions lack synovial epithelial lining and occur secondary to mucoid degeneration of connective tissue because, often in response to chronic irritation and repetitive traumas. However, an intratendinous location is a rare finding. In the knee region, infrapatellar fat pad, the alar folds, and the anterior cruciate ligament are recognized to degenerate into ganglion. There are few case reports describing an involvement of the patellar tendon. We present the clinical case of a 72 years old male patient suffering from anterior knee pain attributed to an intratendinous ganglion cyst of the patellar tendon, obviously after a single traumatic event. After aspiration of the ganglion cyst the patient reported no complaints, and there has been no recurrence during the latest follow-up examination.
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Affiliation(s)
- M Feyrer
- 1Department of Industrial Engineering and Health, Institute of Medical Engineering, Technical University of Applied Sciences Amberg-Weiden, Weiden, Germany
| | - S Sesselmann
- 2Technical University of Applied Sciences Würzburg-Schweinfurt, Würzburg, Germany
| | - Ph Koehl
- 3Hospital of Trauma Surgery, Department of Orthopedics, Marktredwitz Hospital, Germany
| | - A Schuh
- 4Hospital of Trauma Surgery, Department of Musculoskeletal Research, Marktredwitz Hospital, Germany
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Grol MW, Haelterman NA, Lim J, Munivez EM, Archer M, Hudson DM, Tufa SF, Keene DR, Lei K, Park D, Kuzawa CD, Ambrose CG, Eyre DR, Lee BH. Tendon and motor phenotypes in the Crtap-/- mouse model of recessive osteogenesis imperfecta. eLife 2021; 10:e63488. [PMID: 34036937 PMCID: PMC8186905 DOI: 10.7554/elife.63488] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 05/24/2021] [Indexed: 01/22/2023] Open
Abstract
Osteogenesis imperfecta (OI) is characterized by short stature, skeletal deformities, low bone mass, and motor deficits. A subset of OI patients also present with joint hypermobility; however, the role of tendon dysfunction in OI pathogenesis is largely unknown. Using the Crtap-/- mouse model of severe, recessive OI, we found that mutant Achilles and patellar tendons were thinner and weaker with increased collagen cross-links and reduced collagen fibril size at 1- and 4-months compared to wildtype. Patellar tendons from Crtap-/- mice also had altered numbers of CD146+CD200+ and CD146-CD200+ progenitor-like cells at skeletal maturity. RNA-seq analysis of Achilles and patellar tendons from 1-month Crtap-/- mice revealed dysregulation in matrix and tendon marker gene expression concomitant with predicted alterations in TGF-β, inflammatory, and metabolic signaling. At 4-months, Crtap-/- mice showed increased αSMA, MMP2, and phospho-NFκB staining in the patellar tendon consistent with excess matrix remodeling and tissue inflammation. Finally, a series of behavioral tests showed severe motor impairments and reduced grip strength in 4-month Crtap-/- mice - a phenotype that correlates with the tendon pathology.
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Affiliation(s)
- Matthew William Grol
- Department of Molecular and Human Genetics, Baylor College of MedicineHoustonUnited States
| | - Nele A Haelterman
- Department of Molecular and Human Genetics, Baylor College of MedicineHoustonUnited States
| | - Joohyun Lim
- Department of Molecular and Human Genetics, Baylor College of MedicineHoustonUnited States
| | - Elda M Munivez
- Department of Molecular and Human Genetics, Baylor College of MedicineHoustonUnited States
| | - Marilyn Archer
- Department of Orthopaedics and Sports Medicine, University of WashingtonSeattleUnited States
| | - David M Hudson
- Department of Orthopaedics and Sports Medicine, University of WashingtonSeattleUnited States
| | - Sara F Tufa
- Shriners Hospital for ChildrenPortlandUnited States
| | | | - Kevin Lei
- Department of Molecular and Human Genetics, Baylor College of MedicineHoustonUnited States
| | - Dongsu Park
- Department of Molecular and Human Genetics, Baylor College of MedicineHoustonUnited States
| | - Cole D Kuzawa
- Department of Orthopaedic Surgery, UT Health Sciences CenterHoustonUnited States
| | - Catherine G Ambrose
- Department of Orthopaedic Surgery, UT Health Sciences CenterHoustonUnited States
| | - David R Eyre
- Department of Orthopaedics and Sports Medicine, University of WashingtonSeattleUnited States
| | - Brendan H Lee
- Department of Molecular and Human Genetics, Baylor College of MedicineHoustonUnited States
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Longo UG, Berton A, Stelitano G, Madaudo C, Perna M, Ciuffreda M, Guarnieri A, Papalia R, Maffulli N, Denaro V. 2017 Marathon of Rome: Anthropometry and Sport Profile in 350 Runners and Association With Achilles and Patellar Tendinopathy. Clin J Sport Med 2021; 31:e15-e20. [PMID: 30365471 DOI: 10.1097/jsm.0000000000000695] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Achilles and patellar tendinopathy are common in runners. Despite the relevance of the problem, causative factors remain poorly understood. This cross-sectional study evaluated the association between Achilles and patellar tendinopathy and age, sex, weight, height, number of marathons, and impact profile in runners who participated in the 2017 Marathon of Rome. METHODS At the 2017 Marathon of Rome, 350 athletes (256 men and 94 women; mean age: 44.8 years, range 12-80 years) filled in the VISA-A and VISA-P questionnaires. A fully trained orthopedic surgeon made a diagnosis of Achilles and patellar tendinopathy according to clinical criteria. RESULTS Ninety-five participants were diagnosed with Achilles tendinopathy and 96 with patellar tendinopathy. There was evidence of a statistically significant positive association between age and Achilles and patellar tendinopathy, with no effect of sex, weight, and height on the presence of Achilles tendinopathy. There was no evidence of a statistically significant positive association between the number of marathons and impact profile and VISA-A score. There was a statistically significant association between VISA-P score and impact profile. Finally, there was evidence of a statistically significant positive association between VISA-A score and VISA-P score (P = 0.007). CONCLUSIONS In marathon runners, there was no evidence of a statistically significant association between sex, weight, height, number of marathons, and Achilles and patellar tendinopathy. However, age was associated with Achilles and patellar tendinopathy, and impact profile was associated with patellar tendinopathy.
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Affiliation(s)
- Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Alessandra Berton
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Giovanna Stelitano
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Cristina Madaudo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Massiliano Perna
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Mauro Ciuffreda
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Andrea Guarnieri
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, University of Salerno School of Medicine and Surgery, Salerno, Italy ; and
- Department of Musculoskeletal Disorders, Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London, United Kingdom
| | - Vincenzo Denaro
- Department of Musculoskeletal Disorders, University of Salerno School of Medicine and Surgery, Salerno, Italy ; and
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Docking SI, Girdwood MA, Cook J, Fortington LV, Rio E. Reduced Levels of Aligned Fibrillar Structure Are Not Associated With Achilles and Patellar Tendon Symptoms. Clin J Sport Med 2020; 30:550-555. [PMID: 30067515 DOI: 10.1097/jsm.0000000000000644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate whether the mean cross-sectional area (mCSA) of aligned fibrillar structure (AFS) was associated with the presence and severity of symptoms. DESIGN Prospective cohort study. PARTICIPANTS One hundred seventy-five elite male Australian football players completed monthly Oslo Sports Trauma Research Center overuse injury questionnaires for both the Achilles and patellar tendon over the season to ascertain the presence and severity of symptoms. At the start of the preseason, participants underwent ultrasound tissue characterization (UTC) imaging of the Achilles and patellar tendon. MAIN OUTCOME MEASURES Images were classified as normal or abnormal based on gray-scale ultrasound. Based on UTC quantification, the mCSA of AFS was compared between those with and without current symptoms. RESULTS No difference in the mCSA of AFS was observed between those with or without tendon symptoms (P < 0.05). Similar to previous findings, 80% to 92% of abnormal tendons had similar amounts of mCSA of AFS compared with normal tendon. If reduced mCSA of AFS was present, it was not associated with the presence or severity of symptoms. CONCLUSIONS The prevalence, development, or severity of symptoms was not associated with decreased levels of AFS in the Achilles or patellar tendon. This suggests that a lack of structural integrity is not linked to symptoms and questions the rationale behind regenerative medicine. Most tendons are able to compensate for areas of disorganization and maintain tissue homeostasis.
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Affiliation(s)
- Sean I Docking
- La Trobe Sport and Exercise Medicine Research Center, College of Science, Health and Engineering; La Trobe University; Australia; and
- Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University, Ballarat, Australia
| | - Michael A Girdwood
- La Trobe Sport and Exercise Medicine Research Center, College of Science, Health and Engineering; La Trobe University; Australia; and
- Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University, Ballarat, Australia
| | - Jill Cook
- La Trobe Sport and Exercise Medicine Research Center, College of Science, Health and Engineering; La Trobe University; Australia; and
- Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University, Ballarat, Australia
| | - Lauren V Fortington
- Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University, Ballarat, Australia
| | - Ebonie Rio
- La Trobe Sport and Exercise Medicine Research Center, College of Science, Health and Engineering; La Trobe University; Australia; and
- Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University, Ballarat, Australia
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Ceyhan E, İnci F, Yavuz İA, Gürhan U, Yıldırım AÖ, Öken ÖF. Effects of morphological changes in the patellar tendon on the development of anterior knee pain after intramedullary nailing for tibial shaft fractures: A retrospective comparative study. Acta Orthop Traumatol Turc 2020; 54:634-638. [PMID: 33423998 DOI: 10.5152/j.aott.2020.20232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aimed to investigate the effects of morphological changes of the patellar tendon (length, width, and thickness) on the development of anterior knee pain (AKP) after intramedullary nailing (IMN) of tibial shaft fractures. METHODS A total of 39 patients, treated by IMN using the transpatellar approach for tibial shaft fractures, were retrospectively reviewed and included in the study. The patients were then divided into 2 groups based on the presence of AKP: group A, patients who developed AKP (9 men, 9 women; mean age=35.39±9.32 years), and group B, patients without AKP (13 men, 8 women; mean age=41.38±14.78 years). To assess the morphological changes in the patellar tendon, magnetic resonance imaging was performed on the operated and unoperated, contralateral knees of the patients. The patellar tendon index (PTI) was calculated using the length, width, and thickness of the patellar tendon, and a set of variables was established to be a proportion of the measurements of the operated knees to those of the unoperated ones (operated/healthy PTI ratio). PTI ratios were compared between both the groups. Furthermore, the morphological features of the patellar tendon, including the length, width, and thickness, were examined within the groups as independent variables. To assess pain intensity in group A, a 10-cm visual analogue scale (VAS) was used. To evaluate functional status, the Lysholm knee scoring system was used. RESULTS The PTI ratio was significantly higher in group A (1.37±0.12) than in group B (1.03±0.08) (p<0.001). In group A, the mean VAS score was 5.35±1.11, and a moderate linear correlation was found between PTI ratios and VAS scores (r=0.494, p=0.044). The mean Lysholm score was significantly lower in group A (80.17±3.05) than in group B (89.76±3.05) (p<0.001). In group A, the width and thickness of the patellar tendon were found to be significantly different between the operated and unoperated knees (p=0.024 and p=0.002, respectively). In group B, there was no difference between the operated and unoperated knees in terms of the 3 measurements (length, width, and thickness) (p=0.762, p=0.753, and p=0.118, respectively). CONCLUSION Evidence from this study revealed that morphological changes occurring in the patellar tendon after IMN for tibial shaft fractures using a transpatellar approach may have a significant role in the development of AKP. The increase in the tendon width and thickness may be the cause of pain and insufficient knee function in such patients. LEVEL OF EVIDENCE Level III, Therapeutic study.
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Affiliation(s)
- Erman Ceyhan
- Clinic of Orthopaedics and Traumatology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Fatih İnci
- Clinic of Orthopaedics and Traumatology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - İbrahim Alper Yavuz
- Clinic of Orthopaedics and Traumatology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Utku Gürhan
- Clinic of Orthopaedics and Traumatology, Silopi State Hospital, Şırnak, Turkey
| | - Ahmet Özgür Yıldırım
- Clinic of Orthopaedics and Traumatology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Özdamar Fuad Öken
- Clinic of Orthopaedics and Traumatology, Ankara Bilkent City Hospital, Ankara, Turkey
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Rabello LM, van den Akker-Scheek I, Kuipers IF, Diercks RL, Brink MS, Zwerver J. Bilateral changes in tendon structure of patients diagnosed with unilateral insertional or midportion achilles tendinopathy or patellar tendinopathy. Knee Surg Sports Traumatol Arthrosc 2020; 28:1631-1638. [PMID: 30937472 PMCID: PMC7176591 DOI: 10.1007/s00167-019-05495-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 03/25/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE Changes in tendon structure are commonly seen in patients with unilateral achilles (AT) or patellar (PT) tendinopathy but might also be present on the asymptomatic side, indicating a higher risk for developing symptoms. The aim of this study is to compare tendon structure of the symptomatic side with the asymptomatic side in AT and PT patients and control subjects. METHODS A total of 46 patients with unilateral AT (16 insertional and 30 midportion) and 38 with unilateral PT were included. For the control group, a total of 18 Achilles tendons and 25 patellar tendons were scanned. Tendon structure was assessed using ultrasound tissue characterisation (UTC), which quantifies tendon organisation dividing the structure into four different echo types (I-IV). RESULTS There were significant differences in echo types I, III, and IV between symptomatic and asymptomatic sides and controls. Additionally, there was a significant difference between the symptomatic and the asymptomatic side for all tendinopathy locations. In the insertional AT tendon portion, the symptomatic side showed a higher percentage of echo type III. For the midportion AT, the symptomatic side showed a lower percentage of echo type I and a higher percentage of echo types III and IV. For the patellar tendon, the symptomatic side showed a higher percentage of echo types III and IV. All differences were higher than the minimal detectable changes. CONCLUSION Although patients have symptoms unilaterally, the tendon structures are compromised on both sides. These results stress the importance of monitoring both symptomatic and asymptomatic tendon structures and in addition highlight that the asymptomatic side should not be used as reference in clinical practice. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Lucas Maciel Rabello
- Department of Sports and Exercise Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - I van den Akker-Scheek
- Department of Sports and Exercise Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Ireen F Kuipers
- Department of Sports and Exercise Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - R L Diercks
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Michel S Brink
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands
| | - J Zwerver
- Department of Sports and Exercise Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
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Kloen P, Hamdy RC, Bech NH. Plethora of Traumatic Lesions of Bilateral Knee Extensor Mechanism in Osteogenesis Imperfecta. Front Endocrinol (Lausanne) 2020; 11:603638. [PMID: 33551996 PMCID: PMC7859265 DOI: 10.3389/fendo.2020.603638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 11/23/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Injuries to the quadriceps extensor mechanism are rare in patients with Osteogenesis Imperfecta (OI). To the best of our knowledge, non-union of the patella in OI, either as an isolated problem or in combination with an acute fracture, has not been previously reported. CASE REPORT We describe how we surgically approached both the fracture and the non-union simultaneously. The surgical technique and steps are described in detail. Post-operative course was uneventful and the outcome was favorable, with full return of function for the patient. CONCLUSION A review of various knee extensor mechanism injuries in OI is described as illustrated in a single patient. The unusual simultaneous surgical treatment of a non-union and an acute fracture in the same patella shows that despite the severely compromised bone in this rare bone disease the bone still has a capacity to heal with a functional outcome.
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Affiliation(s)
- Peter Kloen
- Department of Orthopedic Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands
- *Correspondence: Peter Kloen,
| | - Reggie Charles Hamdy
- Division of Orthopaedic Surgery, McGill University Health Centre, Shriners Hospital for Children, Montreal, QC, Canada
| | - Niels Hendrik Bech
- Department of Orthopedic Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands
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Xu T, Bai J, Xu M, Yu B, Lin J, Guo X, Liu Y, Zhang D, Yan K, Hu D, Hao Y, Geng D. Relaxin inhibits patellar tendon healing in rats: a histological and biochemical evaluation. BMC Musculoskelet Disord 2019; 20:349. [PMID: 31351472 PMCID: PMC6661089 DOI: 10.1186/s12891-019-2729-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 07/18/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Female patients are more likely to have tendon injuries than males, especially those who has a higher concentration of relaxin. Previous studies have demonstrated that relaxin attenuates extracellular matrix (ECM) formation. However, the mechanism of relaxin on tendon repair remains unclear. We hypothesize that relaxin inhibits tendon healing by disrupting collagen synthesis. METHODS A patellar tendon window defect model was established using Sprague-Dawley rats. The center of the patellar tendon was removed from the patella distal apex and inserted to the tibia tuberosity in width of 1 mm. Then, the rats were injected with saline (0.2 μg/kg/day) or relaxin (0.2 μg/kg/day) for two and four weeks, which was followed by biomechanical analysis and histological and histochemical examination. RESULTS Mechanical results indicated that relaxin induces a significant decrease in tear resistance, stiffness, and Young's modulus compared to those rats without relaxin treatment. In addition, it was shown that relaxin activates relaxin family peptide receptor 1(RXFP1), disturbs the balance between matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteases (TIMPs), and reduces the deposition of collagen in injury areas. CONCLUSIONS Relaxin impairs tendon healing in rats. Also, relaxin might lead to tendon injury more commonly for females than males.
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Affiliation(s)
- Tianpeng Xu
- Orthopedics and Sports Medicine Center, The Affiliated Suzhou Hospital of Nanjing Medical University, 242, Guangji Road, Suzhou, 215006 People’s Republic of China
| | - Jiaxiang Bai
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 188, shi zi Road, Suzhou, 215006 People’s Republic of China
| | - Menglei Xu
- Orthopedics and Sports Medicine Center, The Affiliated Suzhou Hospital of Nanjing Medical University, 242, Guangji Road, Suzhou, 215006 People’s Republic of China
| | - Binqing Yu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 188, shi zi Road, Suzhou, 215006 People’s Republic of China
| | - Jiayi Lin
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 188, shi zi Road, Suzhou, 215006 People’s Republic of China
| | - Xiaobin Guo
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 188, shi zi Road, Suzhou, 215006 People’s Republic of China
| | - Yu Liu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 188, shi zi Road, Suzhou, 215006 People’s Republic of China
| | - Di Zhang
- Orthopedics and Sports Medicine Center, The Affiliated Suzhou Hospital of Nanjing Medical University, 242, Guangji Road, Suzhou, 215006 People’s Republic of China
| | - Kai Yan
- Orthopedics and Sports Medicine Center, The Affiliated Suzhou Hospital of Nanjing Medical University, 242, Guangji Road, Suzhou, 215006 People’s Republic of China
| | - Dan Hu
- Orthopedics and Sports Medicine Center, The Affiliated Suzhou Hospital of Nanjing Medical University, 242, Guangji Road, Suzhou, 215006 People’s Republic of China
| | - Yuefeng Hao
- Orthopedics and Sports Medicine Center, The Affiliated Suzhou Hospital of Nanjing Medical University, 242, Guangji Road, Suzhou, 215006 People’s Republic of China
| | - Dechun Geng
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 188, shi zi Road, Suzhou, 215006 People’s Republic of China
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Wang B, Lang Y, Zhang L. Histopathological changes in the infrapatellar fat pad in an experimental rabbit model of early patellofemoral osteoarthritis. Knee 2019; 26:2-13. [PMID: 30415972 DOI: 10.1016/j.knee.2018.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 05/20/2018] [Accepted: 06/08/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose of this study was to characterise the histopathological changes in the infrapatellar fat pad (IPFP) in the early stage of patellofemoral osteoarthritis (PFOA). METHODS Sixty-four New Zealand white rabbits were randomly divided into experimental (n = 24), sham (n = 16), and control groups (n = 24). In the experimental group, denoted as the patellar ligament uneven shortening group (US group), the patellar ligament (PL) was folded eight millimetres and sutured. After eight weeks, all animals were euthanised, and magnetic resonance imaging (MRI) evaluation, wet IPFP weight measurement, and histopathological and immunohistochemistry analysis were performed to analyse the histopathological changes in the IPFPs. RESULTS The maximum cross-sectional area (CSA) of the IPFPs in the sagittal position of MRI in the control group, sham group, and US group were 45.50 ± 7.19 mm2, 45.88 ± 6.60 mm2 (vs. control group, P = 0.907), and 53.83 ± 8.24 mm2 (vs. control group, P = 0.015; vs. sham group, P = 0.035), respectively. The MRI intensity of the IPFPs in the control group, sham group, and US group were 115.53 ± 28.85, 108.53 ± 26.73 (vs. control group, P = 0.589), and 154.52 ± 18.48 (vs. control group, P = 0.002; vs. sham group, P = 0.002), respectively. The wet weight of the IPFPs in the control group, sham group, and US group were 0.32 ± 0.05 g, 0.32 ± 0.04 g (vs. control group, P = 0.895), and 0.38 ± 0.06 g (vs. control group, P = 0.017; vs. sham group, P = 0.033), respectively. The Osteoarthritis Research Society International (OARSI) scores of the IPFPs in the US group were 6.00 ± 1.91, which was higher than the scores of 2.50 ± 2.02 (P < 0.001) in the control group and of 2.75 ± 1.67 (P = 0.001) in the sham group. CONCLUSIONS The histopathological changes of the IPFPs as determined via MRI and microscopic structure appeared to occur much earlier than cartilage damage in PFOA. Furthermore, detecting and treating the IPFP changes may offer aid in the diagnosis and treatment of PFOA.
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Affiliation(s)
- Binggang Wang
- Department of Orthopedic Surgery, Hebei Medical University, Shijiazhuang, China
| | - Yanfei Lang
- Department of Orthopedic Surgery, The Affiliated Hospital of North China University of Science and Technology, Tangshan, China
| | - Liu Zhang
- Department of Orthopedic Surgery, Hebei Medical University, Shijiazhuang, China; Department of Orthopedic Surgery, The Affiliated Hospital of North China University of Science and Technology, Tangshan, China.
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Erinç S, Esenkaya İ, Poyanlı OŞ, Özturan B, Ayaz M, Öztürk AT. Ultrasonographic comparison of bilateral patellar tendon dimensions in patients treated via intramedullary tibial nailing using a transpatellar approach. Acta Orthop Traumatol Turc 2018; 52:423-427. [PMID: 30177451 PMCID: PMC6318500 DOI: 10.1016/j.aott.2018.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 07/20/2018] [Accepted: 07/30/2018] [Indexed: 12/03/2022]
Abstract
Objective One of the most common complications following intramedullary nailing of a tibial shaft fracture is anterior knee pain. The etiology of pain remains unclear. Patellar tendon entry point is the most suspected reason for anterior knee pain. This study, sonographically examined the patellar tendons of patients treated via intramedullary nailing. Methods Thirty-two patients with a tibial shaft fracture requiring intramedullary nailing via a transpatellar approach were included in the study. After all patients were grouped by reference to the presence of anterior knee pain, bilateral patellar tendon ultrasonography was performed. Results Thirty-two patients were included in the study. Patients were measured postop average in 38.3 months (10th months - 84th months). It was determined that 10 patients of total 32 (31.3%) had anterior knee pain. There were no statistically differences between study groups in the length of patellar tendon. In the painless group; patellar tendon was wider and thicker in the operated side than the non operated side. The mean differences in the thickness between operated side versus non – operated side of the painless group were 5.3 ± 1.8 in the operated side and 3.9 ± 1.4 in the non – operated side (p = 0.007 < 0.05). The corresponding values for width of the patellar tendon was 29.6 ± 3.3 in the operated side and 27.6 ± 3.8 in the non – operated side (p = 0.007 ˂ 0.05). As a result, there were no statistically significant differences between width and thickness of the patellar tendons in the painful group, on the contrary, in the painless group; patellar tendons were wider and thicker in the operated side than those in the non - operated side. Mean values for thickness of the operated and non-operated side were 5.9 ± 2.3 and 4.2 ± 2.0, respectively (p = 0.059 > 0.05). Mean values for width of the operated and non-operated side were 30.2 ± 4.5 and 28.5 ± 4.0, respectively (p = 0.103 > 0,05). Conclusion Based on the ultrasonographic investigation of their patellar tendons after intramedullary nailing of a tibial shaft fracture, in the painless patients group; the patellar tendon was wider and thicker in the operated side than the non – operated side, however, in the painful patients there were no statistically significant differences between this parameters. Although the number of patients was not sufficient to conclude precise relation between patellar tendon entry point and anterior knee pain, we determined that thicker and wider tendon might be less related to anterior knee pain. Level of evidence Level IV, therapeutic study.
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Affiliation(s)
- Samet Erinç
- Department of Orthopedics and Traumatology Service, Şişli Hamidiye Etfal Research and Training Hospital, Istanbul, Turkey.
| | - İrfan Esenkaya
- Istanbul Medeniyet University, Faculty of Medicine, Department of Orthopaedics and Traumatology, Istanbul, Turkey.
| | - Oğuz Şükrü Poyanlı
- Istanbul Medeniyet University, Faculty of Medicine, Department of Orthopaedics and Traumatology, Istanbul, Turkey.
| | - Burak Özturan
- Department of Orthopedics and Traumatology Service, Nizip State Hospital, Gaziantep, Turkey.
| | - Muzaffer Ayaz
- Istanbul Medeniyet University, Göztepe Training and Research Hospital, Department of Radiology, Istanbul, Turkey.
| | - Afşar Timuçin Öztürk
- Istanbul Medeniyet University, Göztepe Training and Research Hospital, Department of Orthopedics and Traumatology, Istanbul, Turkey.
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Pozzi G, Al-Mnayyis A, Almolla J, Albano D, Messina C, Merli I, Mesquita RD, Sconfienza LM. Middle patellar tendon to posterior cruciate ligament (PT-PCL) and normalized PT-PCL: New magnetic resonance indices for tibial tubercle position in patients with patellar instability. Knee 2018; 25:799-806. [PMID: 29933931 DOI: 10.1016/j.knee.2018.05.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 03/28/2018] [Accepted: 05/31/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND To demonstrate whether the distance between the middle point of the patellar tendon and posterior cruciate ligament (PT-PCL) calculated on a single axial MR image could be an alternative measure to tibial tubercle-PCL (TT-PCL) distance for TT lateralization without the need of imaging processing. To show that normalization of PT-PCL (nPT-PCL) against the maximum diameter of the tibial plateau may help to identify patients with patellar instability (PI). METHODS MR scans of 30 patients (13 females, age 32 ± 13 years) with known PI and 60 patients (31 females, age 39 ± 19 years) with no history of PI were reviewed. Two operators calculated TT-PCL, and PT-PCL nPT-PCL. Intraclass correlation coefficient, Student's t-test, Receiver Operator Characteristic curves, Spearman's Rho and McNemar's test were used. RESULTS Interobserver reproducibility was 0.894 for PT-PCL for TT-PCL (95% CI = 0.839-0.930) and 0.866 for TT-PCL (95% CI = 0.796-0.912). The PT-PCL was 23.5 ± 3.8 mm in patients and 20.0 ± 2.7 mm in controls (P < 0.001). The TT-PCL was 22.9 ± 3.9 mm in patients and 20.5 ± 2.7 mm in controls (P = 0.002). Correlation between the PT-PCL and TT-PCL was R = 0.838, P < 0.001. The PT-PCL had 66.6% (95% CI = 0.542-0.790) diagnostic yield. The nPT-PCL was significantly higher in patients (0.302 ± 0.03) than controls (0.271 ± 0.03; P < 0.001) with 73.9% (95% CI = 0.628-0.851) diagnostic yield. CONCLUSION The PT-PCL correlated with TT-PCL, with 66.6% diagnostic yield. The nPT-PCL may represent an additional index, with 73.9% diagnostic yield.
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Affiliation(s)
- Grazia Pozzi
- Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy
| | - Asma'a Al-Mnayyis
- Department of Radiology, College of Medicine, Yarmouk University, Shafiq Irshidat St, Irbid 21163, Jordan
| | - Joan Almolla
- Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy
| | - Domenico Albano
- Department of Radiology, Di. Bi. Med., University of Palermo, Via del Vespro 127, 90127 Palermo, Italy.
| | - Carmelo Messina
- Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy; Department of Biomedical Sciences for Health, University of Milano, Via Festa del Perdono 7, 20122 Milano, Italy
| | - Ilaria Merli
- School of Specialization in Radiodiagnostics, University of Milano, Via Festa del Perdono 7, 20122 Milano, Italy
| | - Romeu Duarte Mesquita
- Radiology Department, Centro Hospitalar de Entre o Douro e Vouga, R. Dr. Cândido Pinho, 4520-211 Santa Maria da Feira, Portugal
| | - Luca Maria Sconfienza
- Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy; Department of Biomedical Sciences for Health, University of Milano, Via Festa del Perdono 7, 20122 Milano, Italy
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Abstract
BACKGROUND Osgood-Schlatter disease (OSD) is a self-limiting condition which occurs commonly in adolescence. PURPOSE The objective of this article is to review published literature regarding pathophysiology, diagnosis and treatment of OSD. METHODS A search of the literature was performed on the electronic databases PubMed, Cochrane and SCOPUS databases between 1962 and 2016 for pathophysiology, diagnosis and treatment of Osgood-Schlatter disease. RESULTS OSD, also known as apophysitis of the tibial tubercle, is a common disease with most cases resolving spontaneously with skeletal maturity. In pathophysiology, the most accepted theory is repetitive knee extensor mechanism contraction. The pain is localized to the anterior aspect of the proximal tibia over the tibial tuberosity. They may describe a dull ache exacerbated by jumping or stair climbing. Radiological evaluation may indicate superficial ossicle in the patellar tendon. Osgood-Schlatter is a self-limited disease and generally ceases with skeletal maturity. Treatment is usually symptomatic. Adults with continued symptoms may need surgical treatment if they fail to respond to conservative treatment. Surgical procedures include open, bursoscopic and arthroscopic technique. Arthroscopic surgery is beneficial over an open procedure due to early postoperative recovery, no incisional scar in front of the tuberosity that usually causes discomfort in kneeling with a better cosmetic result and the ability to address concomitant intra-articular pathology. CONCLUSION Osgood-Schlatter syndrome runs a self-limiting course, and usually complete recovery is expected with closure of the tibial growth plate. Overall prognosis for Osgood-Schlatter syndrome is good, except for some discomfort in kneeling and activity restriction in a few cases. Arthroscopic techniques seem to be the best choice of treatment of unresolved Osgood-Schlatter lesions.
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Affiliation(s)
- E Circi
- Department of Orthopaedics and Traumatology, Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Y Atalay
- Department of Orthopaedics and Traumatology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - T Beyzadeoglu
- Department of Orthopaedics and Traumatology, Beyzadeoglu Clinic, Bagdat Cad. Cubukcu Apt. No:333/8, 34738, Erenkoy, Istanbul, Turkey.
- Department of Physiotherapy and Rehabilitation, School of Health Sciences, Halic University, Istanbul, Turkey.
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Unlu MC, Kivrak A, Kayaalp ME, Birsel O, Akgun I. Peritendinous injection of platelet-rich plasma to treat tendinopathy: A retrospective review. Acta Orthop Traumatol Turc 2017; 51:482-487. [PMID: 29108884 PMCID: PMC6197157 DOI: 10.1016/j.aott.2017.10.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/18/2017] [Accepted: 10/12/2017] [Indexed: 12/29/2022]
Abstract
Objective The aim of this study was to determine factors associated with the likelihood of a better clinical outcome after the peritendinous injection of PRP for the treatment of chronic tendinopathy and identify whether PRP represents an effective treatment option for chronic tendinopathies. Methods The study included 214 patients (86 males and 128 females; mean age: 39.3 (18–75) years) who received PRP injections for tendinopathy refractory to conventional treatments. The mean duration of symptoms at the moment of the PRP treatment was 8.3 months. Primary outcome measurement was perceived improvement in symptoms for each anatomic compartment for upper and lower limbs at 6 months after treatment. Also, a visual analog scale (VAS) score (pain intensity on a 0–10 scale) was used for pain scoring questionnaire before treatment, 6 weeks and 6 months following the PRP injection(s). To identify factors associated with the likelihood of a better clinical outcome, patients were categorized on the basis of their perceived improvement in symptoms 6 months after the PRP injection(s)—that is, as lower (less than 50% global improvement) or higher (more than 50% global improvement). Results A visual analogue scale score and perceived improvement in symptoms were significantly lower after peritendinous injection in 6-week and 6-month follow-ups compared with the baseline (P < 0.001) except for peroneal and Achilles tendons. Overall, 83% of patients indicated moderate to complete improvement in symptoms. The most common injection sites were the lateral epicondyle, Achilles, and patellar tendons. Furthermore, 30% of patients received only 1 injection, 30% received 2 injections, and 40% received 3 or more injections. A total of 85% of patients were satisfied (more than 50% global improvement) with the procedure. In addition, upper limb tendons, increase in the age, and female gender were associated with a higher likelihood of perceived improvement in symptoms. Conclusions In the present retrospective study assessing PRP injections in the treatment of chronic tendinopathy, a moderate improvement (>50%) in pain symptoms was observed in most of the patients. Our research found that results were most promising with patellar and lateral epicondylar tendinopathy in the short to medium term. Female patients, patients with upper extremity tendinopathy and older patients appeared to benefit more from PRP injection. Level of evidence Level IV, Therapeutic study.
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Affiliation(s)
- Mehmet Can Unlu
- Istanbul University, Cerrahpasa Medical Faculty, Department of Orthopedics and Traumatology, Istanbul, Turkey.
| | - Aybars Kivrak
- Istanbul University, Cerrahpasa Medical Faculty, Department of Orthopedics and Traumatology, Istanbul, Turkey.
| | - Mahmut Enes Kayaalp
- Istanbul University, Cerrahpasa Medical Faculty, Department of Orthopedics and Traumatology, Istanbul, Turkey.
| | - Olgar Birsel
- Koc University Hospital, Department of Orthopedics and Traumatology, Istanbul, Turkey.
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Tan L, Wang T, Li YH, Yang T, Hao B, Zhu D, Sun DH. Patellar tendon ossification after retrograde intramedullary nailing for distal femoral shaft fracture: A case report and review of the literature. Medicine (Baltimore) 2017; 96:e8875. [PMID: 29382009 PMCID: PMC5709008 DOI: 10.1097/md.0000000000008875] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Retrograde femoral nailing was one of the most important treatment means for distal femoral shaft fracture. However, studies regarding heterotopic ossification of the patellar tendon after retrograde intramedullary nailing for distal femoral shaft fracture are limited. We herein present a rare complication, namely heterotopic ossification of the patellar tendon, after retrograde intramedullary nailing for displaced femoral shaft fracture. PATIENT CONCERNS We present a case of 25-year-old male with displaced femoral shaft fracture who was treated by retrograde intramedullary nailing. DIAGNOSES During the period of follow-up, the patient developed symptomatic heterotopic ossification of the patellar tendon with extensively hard ossification area. INTERVENTIONS Open surgery was recommended, but the patient has refused further treatment. OUTCOMES The patient resulted in pain and restricted the range of motion of the affected knee. LESSONS This case stresses the importance of longer-term follow-up and further attention into the possibility of heterotopic ossification of the patellar tendon.
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Affiliation(s)
- Lei Tan
- Department of Orthopedic Traumatology
| | | | - Yan-Hui Li
- Department of Cardiology and Echocardiography
| | - Tianye Yang
- Department of Plastic and Cosmetic Surgery, The First Hospital of Jilin University. Changchun, China
| | | | - Dong Zhu
- Department of Orthopedic Traumatology
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Hinckel BB, Gobbi RG, Kihara Filho EN, Demange MK, Pécora JR, Rodrigues MB, Camanho GL. Why are bone and soft tissue measurements of the TT-TG distance on MRI different in patients with patellar instability? Knee Surg Sports Traumatol Arthrosc 2017; 25:3053-3060. [PMID: 27034087 DOI: 10.1007/s00167-016-4095-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 03/15/2016] [Indexed: 01/16/2023]
Abstract
PURPOSE To determine whether the tibial tuberosity-to-trochlear groove distance (TT-TG) and patellar tendon-to-trochlear groove distance (PT-TG) are equal, whether the bony and cartilaginous points coincide in the trochlea, and whether the insertion of the PT coincides with the most anterior point of the TT in patients with patellar instability. METHODS Fifty-three MRI scans of patients with patellar instability were examined. TT-TG and PT-TG were measured by three examiners in 31 knees. Additionally, the bone-cartilage distance in the trochlea [trochlear cartilage to trochlear bone (TC-TB)] and the distance between the mid-point of the PT insertion and the most anterior point of the TT (PT-TT) were measured by one examiner. The intraclass correlation coefficient was used to evaluate the reliability of the measurements between the three examiners. The relationships between the measurements were determined, the means of the measurements were calculated, and the correlations between PT-TG and TT-TG, PT-TT, and TC-TB were assessed. RESULTS The ICC was above 0.8. PT-TG was 3.7 mm greater than TT-TG. The TC and TB coincided in 73 % of cases, and the mean TC-TB was 0.3 mm. The PT was lateral to the TT in 94 % of the cases, and the mean PT-TT was 3.4 mm. The Pearson's correlation coefficients between PT-TG and TT-TG, PT-TT, and TC-TB were 0.946, 0.679, and 0.199, respectively. CONCLUSION TT-TG underestimated PT-TG, primarily due to the lateralization of the PT insertion relative to the most anterior point of the TT. CLINICAL RELEVANCE our study shows that in patients with patellar instability, there are differences in the absolute values of TT-TG and PT-TG, as previously reported for patients without patellar instability. Hence, normal cut-off values based on case-control studies of TT-TG cannot be equivalently used when measuring PT-TG to indicate TT medialization in patients with patellar instability. It is also important to note that the clinical outcomes cannot be directly compared between patients evaluated using TT-TG versus PT-TG measurements. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Betina B Hinckel
- Department of Orthopaedics and Traumatology, Institute of Orthopaedics and Traumatology, University of São Paulo, Ovídio Pires de Campos St, 333, 2nd Floor, Cerqueira César, São Paulo, SP, 5403-010, Brazil
| | - Riccardo G Gobbi
- Department of Orthopaedics and Traumatology, Institute of Orthopaedics and Traumatology, University of São Paulo, Ovídio Pires de Campos St, 333, 2nd Floor, Cerqueira César, São Paulo, SP, 5403-010, Brazil.
| | - Eduardo N Kihara Filho
- Department of Musculoskeletal Radiology, University of São Paulo, São Paulo, SP, 55403-010, Brazil
| | - Marco K Demange
- Department of Orthopaedics and Traumatology, Institute of Orthopaedics and Traumatology, University of São Paulo, Ovídio Pires de Campos St, 333, 2nd Floor, Cerqueira César, São Paulo, SP, 5403-010, Brazil
| | - José Ricardo Pécora
- Department of Orthopaedics and Traumatology, Institute of Orthopaedics and Traumatology, University of São Paulo, Ovídio Pires de Campos St, 333, 2nd Floor, Cerqueira César, São Paulo, SP, 5403-010, Brazil
| | - Marcelo B Rodrigues
- Department of Musculoskeletal Radiology, University of São Paulo, São Paulo, SP, 55403-010, Brazil
| | - Gilberto Luis Camanho
- Department of Orthopaedics and Traumatology, Institute of Orthopaedics and Traumatology, University of São Paulo, Ovídio Pires de Campos St, 333, 2nd Floor, Cerqueira César, São Paulo, SP, 5403-010, Brazil
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Cullum CK, Tran PHT, Døssing S. [Running and causes of running-related injuries]. Ugeskr Laeger 2017; 179:V06170438. [PMID: 28918787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Running is one of the most popular sports among the adult Danish population. Overuse injuries of the knee, such as runners knee, jumpers knee, patello-femoral pain syndrome and patello-femoral pre-arthrosis, are common and cause reduction of the health beneficial physical activity. Treatment should primarily focus on adjustment of training habits and physiotherapeutic guided rehabilitation. Other treatment options include changing landing pattern during running, corticosteroid injections, non-steroid anti-inflammatory drugs and ultimately surgery.
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Thangarajah T, Shahbazi S, Pendegrass CJ, Lambert S, Alexander S, Blunn GW. Tendon Reattachment to Bone in an Ovine Tendon Defect Model of Retraction Using Allogenic and Xenogenic Demineralised Bone Matrix Incorporated with Mesenchymal Stem Cells. PLoS One 2016; 11:e0161473. [PMID: 27606597 PMCID: PMC5015825 DOI: 10.1371/journal.pone.0161473] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 08/06/2016] [Indexed: 01/12/2023] Open
Abstract
Background Tendon-bone healing following rotator cuff repairs is mainly impaired by poor tissue quality. Demineralised bone matrix promotes healing of the tendon-bone interface but its role in the treatment of tendon tears with retraction has not been investigated. We hypothesized that cortical demineralised bone matrix used with minimally manipulated mesenchymal stem cells will result in improved function and restoration of the tendon-bone interface with no difference between xenogenic and allogenic scaffolds. Materials and Methods In an ovine model, the patellar tendon was detached from the tibial tuberosity and a complete distal tendon transverse defect measuring 1 cm was created. Suture anchors were used to reattach the tendon and xenogenic demineralised bone matrix + minimally manipulated mesenchymal stem cells (n = 5), or allogenic demineralised bone matrix + minimally manipulated mesenchymal stem cells (n = 5) were used to bridge the defect. Graft incorporation into the tendon and its effect on regeneration of the enthesis was assessed using histomorphometry. Force plate analysis was used to assess functional recovery. Results Compared to the xenograft, the allograft was associated with significantly higher functional weight bearing at 6 (P = 0.047), 9 (P = 0.028), and 12 weeks (P = 0.009). In the allogenic group this was accompanied by greater remodeling of the demineralised bone matrix into tendon-like tissue in the region of the defect (p = 0.015), and a more direct type of enthesis characterized by significantly more fibrocartilage (p = 0.039). No failures of tendon-bone healing were noted in either group. Conclusion Demineralised bone matrix used with minimally manipulated mesenchymal stem cells promotes healing of the tendon-bone interface in an ovine model of acute tendon retraction, with superior mechanical and histological results associated with use of an allograft.
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Affiliation(s)
- Tanujan Thangarajah
- The John Scales Centre for Biomedical Engineering, Institute of Orthopaedics and Musculoskeletal Science, Division of Surgery and Interventional Science, University College London, The Royal National Orthopaedic Hospital Trust, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom
- * E-mail:
| | - Shirin Shahbazi
- The John Scales Centre for Biomedical Engineering, Institute of Orthopaedics and Musculoskeletal Science, Division of Surgery and Interventional Science, University College London, The Royal National Orthopaedic Hospital Trust, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom
| | - Catherine J. Pendegrass
- The John Scales Centre for Biomedical Engineering, Institute of Orthopaedics and Musculoskeletal Science, Division of Surgery and Interventional Science, University College London, The Royal National Orthopaedic Hospital Trust, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom
| | - Simon Lambert
- The Shoulder and Elbow Service, The Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, United Kingdom
| | - Susan Alexander
- The Shoulder and Elbow Service, The Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, United Kingdom
| | - Gordon W. Blunn
- The John Scales Centre for Biomedical Engineering, Institute of Orthopaedics and Musculoskeletal Science, Division of Surgery and Interventional Science, University College London, The Royal National Orthopaedic Hospital Trust, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom
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Wu Y, Wang Z, Fuh JYH, Wong YS, Wang W, Thian ES. Mechanically-enhanced three-dimensional scaffold with anisotropic morphology for tendon regeneration. J Mater Sci Mater Med 2016; 27:115. [PMID: 27215211 DOI: 10.1007/s10856-016-5728-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 05/14/2016] [Indexed: 06/05/2023]
Abstract
Tissue engineering has showed promising results in restoring diseased tendon tissue functions. Herein, a hybrid three-dimensional (3D) porous scaffold comprising an outer portion rolled from an electrohydrodynamic jet printed poly(ɛ-caprolactone) (PCL) fiber mesh, and an inner portion fabricated from uniaxial stretching of a heat-sealed PCL tube, was developed for tendon tissue engineering (TE) application. The outer portion included three layers of micrometer-scale fibrous bundles (fiber diameter: ~25 µm), with an interconnected spacing and geometric anisotropy along the scaffold length. The inner portion showed orientated micro-ridges/grooves in a parallel direction to that of the outer portion. Owning to the addition of the inner portion, the as-fabricated scaffold exhibited comparable mechanical properties to those of the human patellar tendon in terms of Young's modulus (~227 MPa) and ultimate tensile stress (~50 MPa). Compared to the rolled electrospun fibers, human tenocytes cultured in the tendon scaffolds showed increased cellular metabolism. Furthermore, the 3D tendon scaffold resulted in up-regulated cell alignment, cell elongation and formation of collagen type I. These results demonstrated the potential of mechanically-enhanced 3D fibrous scaffold for applications in tendon TE, with desired cell alignment and functional differentiation.
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Affiliation(s)
- Yang Wu
- Department of Mechanical Engineering, National University of Singapore, 9 Engineering Drive 1, Singapore, 117576, Singapore
| | - Zuyong Wang
- Department of Mechanical Engineering, National University of Singapore, 9 Engineering Drive 1, Singapore, 117576, Singapore
| | - Jerry Ying Hsi Fuh
- Department of Mechanical Engineering, National University of Singapore, 9 Engineering Drive 1, Singapore, 117576, Singapore
- National University of Singapore (Suzhou) Research Institute, Suzhou Industrial Park, Suzhou, 215123, China
| | - Yoke San Wong
- Department of Mechanical Engineering, National University of Singapore, 9 Engineering Drive 1, Singapore, 117576, Singapore
| | - Wilson Wang
- Department of Orthopaedic Surgery, National University of Singapore, Singapore, 119074, Singapore
| | - Eng San Thian
- Department of Mechanical Engineering, National University of Singapore, 9 Engineering Drive 1, Singapore, 117576, Singapore.
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Yin Z, Guo J, Wu TY, Chen X, Xu LL, Lin SE, Sun YX, Chan KM, Ouyang H, Li G. Stepwise Differentiation of Mesenchymal Stem Cells Augments Tendon-Like Tissue Formation and Defect Repair In Vivo. Stem Cells Transl Med 2016; 5:1106-16. [PMID: 27280798 DOI: 10.5966/sctm.2015-0215] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 03/07/2016] [Indexed: 02/06/2023] Open
Abstract
UNLABELLED : Tendon injuries are common and present a clinical challenge, as they often respond poorly to treatment and result in long-term functional impairment. Inferior tendon healing responses are mainly attributed to insufficient or failed tenogenesis. The main objective of this study was to establish an efficient approach to induce tenogenesis of bone marrow-derived mesenchymal stem cells (BMSCs), which are the most common seed cells in tendon tissue engineering. First, representative reported tenogenic growth factors were used as media supplementation to induce BMSC differentiation, and the expression of teno-lineage transcription factors and matrix proteins was compared. We found that transforming growth factor (TGF)-β1 significantly induced teno-lineage-specific gene scleraxis expression and collagen production. TGF-β1 combined with connective tissue growth factor (CTGF) elevated tenomodulin and Egr1 expression at day 7. Hence, a stepwise tenogenic differentiation approach was established by first using TGF-β1 stimulation, followed by combination with CTGF for another 7 days. Gene expression analysis showed that this stepwise protocol initiated and maintained highly efficient tenogenesis of BMSCs. Finally, regarding in situ rat patellar tendon repair, tendons treated with induced tenogenic BMSCs had better structural and mechanical properties than those of the control group, as evidenced by histological scoring, collagen I and tenomodulin immunohistochemical staining, and tendon mechanical testing. Collectively, these findings demonstrate a reliable and practical strategy of inducing tenogenesis of BMSCs for tendon regeneration and may enhance the effectiveness of cell therapy in treating tendon disorders. SIGNIFICANCE The present study investigated the efficiency of representative tenogenic factors on mesenchymal stem cells' tenogenic differentiation and established an optimized stepwise tenogenic differentiation approach to commit tendon lineage differentiation for functional tissue regeneration. The reliable tenogenic differentiation approach for stem cells not only serves as a platform for further studies of underlying molecular mechanisms but also can be used to enhance cell therapy outcome in treating tendon disorders and develop novel therapeutics for tendon injury.
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Affiliation(s)
- Zi Yin
- Dr. Li Dak Sum and Yip Yio Chin Center for Stem Cells and Regenerative Medicine, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, People's Republic of China China Orthopedic Regenerative Medicine Group, Hangzhou, People's Republic of China
| | - Jia Guo
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, People's Republic of China
| | - Tian-Yi Wu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, People's Republic of China
| | - Xiao Chen
- Dr. Li Dak Sum and Yip Yio Chin Center for Stem Cells and Regenerative Medicine, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China China Orthopedic Regenerative Medicine Group, Hangzhou, People's Republic of China
| | - Liang-Liang Xu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, People's Republic of China
| | - Si-En Lin
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, People's Republic of China
| | - Yun-Xin Sun
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, People's Republic of China
| | - Kai-Ming Chan
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, People's Republic of China
| | - Hongwei Ouyang
- Dr. Li Dak Sum and Yip Yio Chin Center for Stem Cells and Regenerative Medicine, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China China Orthopedic Regenerative Medicine Group, Hangzhou, People's Republic of China
| | - Gang Li
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, People's Republic of China China Orthopedic Regenerative Medicine Group, Hangzhou, People's Republic of China Key Laboratory for Regenerative Medicine, Ministry of Education, School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, People's Republic of China Stem Cells and Regenerative Medicine Laboratory, Lui Che Woo Institute of Innovative Medicine, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, People's Republic of China The Chinese University of Hong Kong-China Astronaut Research and Training Center Space Medicine Centre on Health Maintenance of Musculoskeletal System, The Chinese University of Hong Kong Shenzhen Research Institute, Shenzhen, People's Republic of China
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Abstract
OBJECTIVES Substance P (SP) is known to be involved in neuropathic pain, chronic inflammation, and tendinopathy. The present study evaluated the effects of different doses of SP on tendon-derived stem cells (TDSCs) in vitro and tendons in vivo. METHODS For the in vitro study, TDSCs cultured in growth medium with different concentrations of SP (negative control, 0.1 nM, and 1.0 nM). The effects of SP on TDSCs were examined with respect to their ability to proliferate and differentiate. For the in vivo study, we injected different doses of SP (saline control, 0.5 nmol, and 5.0 nmol) into rat patella tendons to investigate the effects of SP on tendons. RESULTS Low and high doses SP significantly enhanced the proliferation ability of TDSCs. Low-dose of SP induced the expression of tenocyte-related genes; however, high-dose of SP induced the expression of non-tenocyte genes, which was evident by the high expression of PPARγ and collagen type II. In the in vivo study, only high-doses of SP (5.0 nmol) induced the tendinosis-like changes in the patella tendon injection model. Low doses of SP (0.5 nmol) enhanced the tenogenesis compared with saline injection and the high-dose SP group. CONCLUSIONS SP enhances the proliferation of TDSCs in vitro and the effects of SP on tendinopathy are dose-dependent in vivo.
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Affiliation(s)
- Y Zhou
- Kanglai Tang, Department of Orthopedic Surgery, Third Military Medical University Affiliated Southwest Hospital, Gaotanyan Str. 30, Chongqing 400038, People's Republic of China, Telephone number: 86-23-68765289; Fax number: 86-23-65656500. E-mail:
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Teber MA, Oğur T, Bozkurt A, Er B, Turan A, Gülbay M, Akdağ İ. Real-time sonoelastography of the quadriceps tendon in patients undergoing chronic hemodialysis. J Ultrasound Med 2015; 34:671-677. [PMID: 25792583 DOI: 10.7863/ultra.34.4.671] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES This study aimed to compare sonoelastographic findings for the quadriceps tendon in patients with chronic renal failure who were in a dialysis program to findings in a control group. METHODS Fifty-three randomly allocated patients (mean age, 54.3 years; range, 27-86 years) with chronic renal failure who were in a dialysis program 3 days a week between January and May 2012 were included. The measurements were performed in both knees of 53 patients undergoing dialysis and 25 individuals in the control group. The tendons were classified as follows: type 1, very stiff tissue (blue); type 2, stiff tissue (blue-green); and type 3, intermediate tissue (green-yellow) according to color mapping. RESULTS The mean quadriceps tendon thicknesses in the patient group were 4.9 mm (range, 1.9-6.5 mm) for the right knee and 4.9 mm (1.4-6.5 mm) for the left knee; the values in the control group were 5.4 mm (3.6-7.0 mm) for the right knee and 5.4 mm (3.4-7.0 mm) for the left knee. The mean elasticity scores in the patient group were 3.14 (1.03-5.23) for the right knee and 3.33 (1.29-5.00) for the left knee; in the control group, the values were 3.79 (1.73-5.23) and 3.69 (1.23-5.53) for the right and left knees, respectively (right knee, P = .025; left knee, P = .018; Mann-Whitney U test). The quadriceps tendons were significantly thinner in the patient group (right knee, P = .054; left knee, P = .015; Mann-Whitney U test). CONCLUSIONS Quadriceps tendons in patients with chronic renal failure are thinner and have lower elasticity scores compared to controls.
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Affiliation(s)
- Mehmet A Teber
- Departments of Radiology (M.A.T., T.O., A.B., A.T., M.G.) and Nephrology (B.E., İ.A.), Etlik Ihtisas Training and Research Hospital, Etlik, Ankara, Turkey.
| | - Törel Oğur
- Departments of Radiology (M.A.T., T.O., A.B., A.T., M.G.) and Nephrology (B.E., İ.A.), Etlik Ihtisas Training and Research Hospital, Etlik, Ankara, Turkey
| | - Alper Bozkurt
- Departments of Radiology (M.A.T., T.O., A.B., A.T., M.G.) and Nephrology (B.E., İ.A.), Etlik Ihtisas Training and Research Hospital, Etlik, Ankara, Turkey
| | - Bülent Er
- Departments of Radiology (M.A.T., T.O., A.B., A.T., M.G.) and Nephrology (B.E., İ.A.), Etlik Ihtisas Training and Research Hospital, Etlik, Ankara, Turkey
| | - Aynur Turan
- Departments of Radiology (M.A.T., T.O., A.B., A.T., M.G.) and Nephrology (B.E., İ.A.), Etlik Ihtisas Training and Research Hospital, Etlik, Ankara, Turkey
| | - Mutlu Gülbay
- Departments of Radiology (M.A.T., T.O., A.B., A.T., M.G.) and Nephrology (B.E., İ.A.), Etlik Ihtisas Training and Research Hospital, Etlik, Ankara, Turkey
| | - İbrahim Akdağ
- Departments of Radiology (M.A.T., T.O., A.B., A.T., M.G.) and Nephrology (B.E., İ.A.), Etlik Ihtisas Training and Research Hospital, Etlik, Ankara, Turkey
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25
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Abstract
Patellar instability is a common problem, and medial patellofemoral ligament (MPFL) injury is inherent with traumatic patellar dislocations. Initial nonoperative management is focused on reconditioning and strengthening the dynamic stabilizers of the patella. For those patients who progress to recurrent instability, further investigation into the predisposing factors is required. MPFL reconstruction is indicated in patients with recurrent instability and insufficient medial restraint due to MPFL injury. A technique of MPFL reconstruction is outlined. This procedure may also be performed in combination with other realignment procedures.
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Affiliation(s)
- Jeffrey Reagan
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Raj Kullar
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Robert Burks
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA.
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Pawelec KM, Wardale RJ, Best SM, Cameron RE. The effects of scaffold architecture and fibrin gel addition on tendon cell phenotype. J Mater Sci Mater Med 2015; 26:5349. [PMID: 25578703 DOI: 10.1007/s10856-014-5349-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 08/03/2014] [Indexed: 06/04/2023]
Abstract
Development of tissue engineering scaffolds relies on careful selection of pore architecture and chemistry of the cellular environment. Repair of skeletal soft tissue, such as tendon, is particularly challenging, since these tissues have a relatively poor healing response. When removed from their native environment, tendon cells (tenocytes) lose their characteristic morphology and the expression of phenotypic markers. To stimulate tendon cells to recreate a healthy extracellular matrix, both architectural cues and fibrin gels have been used in the past, however, their relative effects have not been studied systematically. Within this study, a combination of collagen scaffold architecture, axial and isotropic, and fibrin gel addition was assessed, using ovine tendon-derived cells to determine the optimal strategy for controlling the proliferation and protein expression. Scaffold architecture and fibrin gel addition influenced tendon cell behavior independently in vitro. Addition of fibrin gel within a scaffold doubled cell number and increased matrix production for all architectures studied. However, scaffold architecture dictated the type of matrix produced by cells, regardless of fibrin addition. Axial scaffolds, mimicking native tendon, promoted a mature matrix, with increased tenomodulin, a marker for mature tendon cells, and decreased scleraxis, an early transcription factor for connective tissue. This study demonstrated that both architectural cues and fibrin gel addition alter cell behavior and that the combination of these signals could improve clinical performance of current tissue engineering constructs.
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Affiliation(s)
- K M Pawelec
- Cambridge Centre for Medical Materials, Materials Science and Metallurgy Department, University of Cambridge, Cambridge, CB3 0FS, UK
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27
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Abstract
OBJECTIVES To examine Achilles and patellar tendon morphology in dancers with and without tendon pain. METHODS Fifty-three dancers with and without Achilles and/or patellar tendon pain participated. Eleven age-matched non-dancers served as controls. Longitudinal ultrasound images of the middle and distal Achilles and proximal and distal patellar tendons were acquired. To assess macromorphology, the thickness of the middle and distal Achilles and proximal and distal patellar tendons were measured. Micromorphology was analyzed by selecting 2 x 2-mm2 regions of interest in the tendons; spectral analysis using the fast Fourier transform was run for several kernels (2 x 2-mm2 subimages) within each image, and the peak spatial frequency (PSF) was extracted. A one-way ANOVA compared asymptomatic, symptomatic, and control tendon thickness and PSF. RESULTS Macromorphology: There was no significant difference between asymptomatic and symptomatic dancers in middle or distal Achilles tendon thickness and distal patellar tendon thickness. Proximal patellar tendons in control subjects were thinner than those in asymptomatic (p=0.036) and symptomatic (p=0.003) dancers. Micromorphology: There was no significant difference in PSF between asymptomatic and symptomatic dancers and controls in the Achilles or patellar tendon. CONCLUSION Increased proximal patellar tendon thickness without changes in tendon micromorphology suggests that tendon adaptations are more likely activity-related and less likely influenced by degeneration.
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Affiliation(s)
- Kornelia Kulig
- Musculoskeletal Biomechanics Research Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 East Alcazar Street, CHP-155, Los Angeles, CA 90089, USA. Tel 323-442-2911, fax 323-442-1515.
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28
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Zhang ZJ, Ng GYF, Lee WC, Fu SN. Changes in morphological and elastic properties of patellar tendon in athletes with unilateral patellar tendinopathy and their relationships with pain and functional disability. PLoS One 2014; 9:e108337. [PMID: 25303466 PMCID: PMC4193737 DOI: 10.1371/journal.pone.0108337] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 08/05/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Patellar tendinopathy (PT) is one of the most common knee disorders among athletes. Changes in morphology and elasticity of the painful tendon and how these relate to the self-perceived pain and dysfunction remain unclear. OBJECTIVES To compare the morphology and elastic properties of patellar tendons between athlete with and without unilateral PT and to examine its association with self-perceived pain and dysfunction. METHODS In this cross-sectional study, 33 male athletes (20 healthy and 13 with unilateral PT) were enrolled. The morphology and elastic properties of the patellar tendon were assessed by the grey and elastography mode of supersonic shear imaging (SSI) technique while the intensity of pressure pain, self-perceived pain and dysfunction were quantified with a 10-lb force to the most painful site and the Victorian Institute of Sport Assessment-patella (VISA-P) questionnaire, respectively. RESULTS In athletes with unilateral PT, the painful tendons had higher shear elastic modulus (SEM) and larger tendon than the non-painful side (p<0.05) or the dominant side of the healthy athletes (p<0.05). Significant correlations were found between tendon SEM ratio (SEM of painful over non-painful tendon) and the intensity of pressure pain (rho = 0.62; p = 0.024), VISA-P scores (rho = -0.61; p = 0.026), and the sub-scores of the VISA-P scores on going down stairs, lunge, single leg hopping and squatting (rho ranged from -0.63 to -0.67; p<0.05). CONCLUSIONS Athletes with unilateral PT had stiffer and larger tendon on the painful side than the non-painful side and the dominant side of healthy athletes. No significant differences on the patellar tendon morphology and elastic properties were detected between the dominant and non-dominant knees of the healthy control. The ratio of the SEM of painful to non-painful sides was associated with pain and dysfunction among athletes with unilateral PT.
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Affiliation(s)
- Zhi Jie Zhang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
- Guangdong-Hongkong Joint Sports Rehabilitation and Research Center, Guangdong Provincial Work Injury Rehabilitation Hospital, Guangzhou, China
| | - Gabriel Yin-fat Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Wai Chun Lee
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Siu Ngor Fu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
- * E-mail:
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Chagou A, Rhanim A, Berrady MA, Lamrani MO, Oudghiri M, Berrada MS, El Yaacoubi M. [Bilateral rupture of patellar tendons in young patients with no notion of systemic disease or corticosteroid therapy: report of a case and review of the literature]. Pan Afr Med J 2014; 19:49. [PMID: 25667711 PMCID: PMC4315478 DOI: 10.11604/pamj.2014.19.49.5268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 08/20/2014] [Indexed: 11/11/2022] Open
Abstract
Les lésions du tendon rotulien sont moins communes que celles du tendon quadricipital. Les lésions bilatérales sont encore plus rares et sont souvent associées à une notion de tendinopathie, d'injection de corticoïdes ou de maladies systémiques tels que le lupus érythémateux, l'ostéomalacie ou l'insuffisance rénale chronique. Nous rapportons le cas d'un patient de 26 ans victime d'une rupture bilatérale du tendon rotulien suite à une réception de saut. Le patient n'avait pas d'antécédents de tendinopathie ni de maladies systémiques. Le diagnostic a été suspecté devant une position anormalement haute des deux rotules avec une impossibilité d'extension active des deux jambes. L’échographie a confirmé le diagnostic. Le patient a été traité par la technique de laçage selon Judet protégée par un cadrage. La rupture bilatérale du tendon rotulien est rare. La plupart des patients rapportent une notion de maladie systémique ou un antécédents de chirurgie du genou. Nous rapportons le cas d'une lésion rare dans la littérature, une rupture bilatérale des tendons rotuliens sans notions de maladies auto-immunes ni de traitement avec des corticostéroïdes. Les lésions bilatérales présentent certaines particularités diagnostiques et thérapeutiques. En effet l'objectivation d'une rotule haute peut être rendu difficile par un aspect controlatéral semblable. Concernant le volet thérapeutique, deux difficultés sont à noter la première réside dans l'absence de référence comparative pour la hauteur patellaire. La deuxième difficulté est l'obligation de différer l'appui à 45 jours. Ce qui est contraignant pour le patient. La technique de laçage décrite par judet couplée à un cadrage provisoire protégeant la suture nous a donné des résultats satisfaisants.
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Affiliation(s)
- Aniss Chagou
- Service de Traumatologie-Orthopédie, Centre Hospitalier Universitaire Avicenne, Rabat, Maroc, Université Mohammed V, Rabat, Maroc
| | - Abdelkarim Rhanim
- Service de Traumatologie-Orthopédie, Centre Hospitalier Universitaire Avicenne, Rabat, Maroc, Université Mohammed V, Rabat, Maroc
| | - Mohammed Ali Berrady
- Service de Traumatologie-Orthopédie, Centre Hospitalier Universitaire Avicenne, Rabat, Maroc, Université Mohammed V, Rabat, Maroc
| | - Moulay Omar Lamrani
- Service de Traumatologie-Orthopédie, Centre Hospitalier Universitaire Avicenne, Rabat, Maroc, Université Mohammed V, Rabat, Maroc
| | - Mohammed Oudghiri
- Service de Traumatologie-Orthopédie, Centre Hospitalier Universitaire Avicenne, Rabat, Maroc, Université Mohammed V, Rabat, Maroc
| | - Mohammed Saleh Berrada
- Service de Traumatologie-Orthopédie, Centre Hospitalier Universitaire Avicenne, Rabat, Maroc, Université Mohammed V, Rabat, Maroc
| | - Moradh El Yaacoubi
- Service de Traumatologie-Orthopédie, Centre Hospitalier Universitaire Avicenne, Rabat, Maroc, Université Mohammed V, Rabat, Maroc
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Tan C, Lui PPY, Lee YW, Wong YM. Scx-transduced tendon-derived stem cells (tdscs) promoted better tendon repair compared to mock-transduced cells in a rat patellar tendon window injury model. PLoS One 2014; 9:e97453. [PMID: 24831949 PMCID: PMC4022525 DOI: 10.1371/journal.pone.0097453] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 04/21/2014] [Indexed: 02/06/2023] Open
Abstract
We hypothesized that the transplantation of Scx-transduced tendon-derived stem cells (TDSCs) promoted better tendon repair compared to the transplantation of mock-transduced cells. This study thus aimed to investigate the effect of Scx transduction on the expression of lineage markers in TDSCs and the effect of the resulting cell line in the promotion of tendon repair. Rat non-GFP or GFP-TDSCs were transduced with Scx or empty lentiviral vector (Mock) and selected by blasticidin. The mRNA expressions of Scx and different lineage markers were examined by qRT-PCR. The effect of the transplantation of GFP-TDSC-Scx on tendon repair was then tested in a rat unilateral patellar tendon window injury model. The transplantation of GFP-TDSC-Mock and scaffold-only served as controls. At week 2, 4 and 8 post-transplantation, the repaired patellar tendon was harvested for ex vivo fluorescent imaging, vivaCT imaging, histology, immunohistochemistry and biomechanical test. GFP-TDSC-Scx consistently showed higher expressions of most of tendon- and cartilage- related markers compared to the GFP-TDSC-Mock. However, the effect of Scx transduction on the expressions of bone-related markers was inconclusive. The transplanted GFP-TDSCs could be detected in the window wound at week 2 but not at week 4. Ectopic mineralization was detected in some samples at week 8 but there was no difference among different groups. The GFP-TDSC-Scx group only statistically significantly improved tendon repair histologically and biomechanically compared to the Scaffold-only group and the GFP-TDSC-Mock group at the early stage of tendon repair. There was significant higher expression of collagen type I in the window wound in the GFP-TDSC-Scx group compared to the other two groups at week 2. The transplantation of GFP-TDSC-Scx promoted healing at the early stage of tendon repair in a rat patellar tendon window injury model.
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Affiliation(s)
- Chunlai Tan
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- The Hong Kong Jockey Club Sports Medicine and Health Sciences Centre, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | | | - Yuk Wa Lee
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- The Hong Kong Jockey Club Sports Medicine and Health Sciences Centre, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yin Mei Wong
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- The Hong Kong Jockey Club Sports Medicine and Health Sciences Centre, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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Namazi N, Jaberi FM, Pakbaz S, Vosoughi AR, Jaberi MM. Does patellar rim electrocautery have deleterious effects on patellar cartilage? Knee 2014; 21:524-8. [PMID: 24503227 DOI: 10.1016/j.knee.2014.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 12/17/2013] [Accepted: 01/06/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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). CONCLUSIONS Circumpatellar electrocauterization may result in cartilage destruction. So, we encourage caution in using routine electrocauterization in patients undergoing total knee arthroplasty. LEVEL OF EVIDENCE level II.
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Affiliation(s)
- Niloofar Namazi
- Bone and Joint Disease Research Center, Department of Orthopedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fereidoon Mojtahed Jaberi
- Bone and Joint Disease Research Center, Department of Orthopedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sara Pakbaz
- Department of Pathology, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Reza Vosoughi
- Bone and Joint Disease Research Center, Department of Orthopedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
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Sutera R, Contiguglia A, Iovane A, Midiri M. A rare case of enchondromatosis of the knees and hands with involvement of Hoffa's fat pad and peri-articular soft-tissues. J Radiol Case Rep 2014; 7:22-30. [PMID: 24421940 DOI: 10.3941/jrcr.v7i6.1307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We report a case of a 56-year old man with chronic pain in both knees for several years. This patient had already undergone surgery on his left knee in 2002 after an x-ray showed multiple lytic and well margined lesions in the distal femur and proximal tibia with ground-glass matrix, involving Hoffa's fat pad and the patellar ligament. Histology was consistent with an enchondroma. The most recent MRI examination showed enchondromatosis involving both knees with bilateral extension into Hoffa's fat pad and the patellar ligament. Subsequently, we performed an additional radiographic examination of the hands and feet, as well as an MRI of both hands to identify other possible enchondromas in the most common sites for this disease. Enchondromatosis with soft tissue involvement is extremely rare, and involvement of Hoffa's fat pad has not been reported in the scientific literature. The clinical presentation of this case and the general aspects of Enchondromatosis are discussed.
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Affiliation(s)
| | | | - Angelo Iovane
- Department of Legal Sciences of Society and Sport, University of Palermo, Italy
| | - Massimo Midiri
- Department of Diagnostic Imaging, University of Palermo, Italy
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33
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Christian RA, Rossy WH, Sherman OH. Patellar tendinopathy - recent developments toward treatment. Bull Hosp Jt Dis (2013) 2014; 72:217-224. [PMID: 25429390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
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.
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Ishii Y, Noguchi H, Takeda M, Sato J, Ishii H, Toyabe SI. Impact of knee flexion on patella length in osteoarthritic patients undergoing total knee arthroplasty. J Orthop Sci 2013; 18:547-51. [PMID: 23512017 DOI: 10.1007/s00776-013-0377-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 03/04/2013] [Indexed: 12/22/2022]
Abstract
PURPOSE This study used magnetic resonance imaging (MRI) to evaluate in vivo preoperative changes in the length of the patellar tendon (LPT) in patients undergoing total knee arthroplasty (TKA). We sought to answer two questions: first, does the LPT change with flexion? Second, does the LPT show a gender-specific pattern? METHODS Eighty-five knees in 76 consecutive osteoarthritic patients were evaluated. The age range was 56-90 years (mean 70). The study included 62 females and 14 males. MRI was performed at full extension and at 30°, 60°, 90°, and full flexion. RESULTS There were significantly different patterns between genders (p < 0.001). The main shortenings occurred earlier, at 30°, in females and later, at 60°, in males. In females, LPT values in full extension were significantly longer than those measured at other flexion angles. In male subjects, significant differences in LPT values were found between full extension versus 90° (p < 0.001) and full flexion (p < 0.001), and between 60° versus 90°(p = 0.030) and full flexion (p = 0.030). CONCLUSION These differences might influence the gender-specific complications related to the extensor mechanism after TKA. These data provide useful information for surgeons attempting to achieve a satisfactory balance between joint gaps in the patellar reduced position intraoperatively.
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Affiliation(s)
- Yoshinori Ishii
- Ishii Orthopaedic and Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama 361-0037, Japan.
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Jabour P, Masrouha K, Gailey M, El-Khoury GY. Masses in the extensor mechanism of the knee: an unusual presentation of gout. J Med Liban 2013; 61:183-186. [PMID: 24422370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Tophaceous gout presenting as a soft tissue mass in an unusual location can pose a diagnostic challenge for radiologists. Tophi sometimes occur in a variety of unusual anatomic locations making them difficult to distinguish from tumors such as sarcomas. We report two cases of gout in the extensor mechanism of the knee, with imaging findings that were initially concerning for a neoplasm. One mass occurred in the patellar tendon and the other mass involved the quadriceps tendon. Both lesions had enigmatic imaging findings and to arrive at a definitive diagnosis, incisional biopsies were performed.
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Affiliation(s)
- Paul Jabour
- Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Karim Masrouha
- Division of Orthopaedic Surgery, Dept of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Michael Gailey
- Dept of Pathology ,University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Georges Y El-Khoury
- Musculoskeletal Radiology Section-Dept of Radiology, University of Iowa Hospitals and Clinics, Iowa City, USA
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Abstract
The incidence of open bicondylar Hoffa fractures is extremely rare. We report one such case of a 42-year-old woman who presented to the emergency department with an open injury over the knee. Imaging revealed bicondylar Hoffa fracture. The patient was taken up for debridement and internal fixation. Intraoperative findings included an entrapped patella between the fracture fragments and extensor mechanism disruption. Hoffas fracture was fixed with lag screws and patellar tendon repaired on to the inferior patella. The patient was started on early postoperative range of motion exercises. The fracture united at 12 weeks with 120° knee flexion at 2 year follow-up.
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37
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Kaux JF, Crielaard JM. Platelet-rich plasma application in the management of chronic tendinopathies. Acta Orthop Belg 2013; 79:10-15. [PMID: 23547508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Platelet-rich plasma (PRP) may represent a new therapeutic option for chronic tendinopathies. Platelets release various cytokines and growth factors which promote angiogenesis, tissue remodeling, and wound healing. We made an extended literature review of the use of PRP in chronic tendinopathies: epicondylitis, rotator cuff, patellar and calcaneal tendinopathies, and plantar fasciitis. Medline, Embase and Google Scholar were used (until July 31, 2012). Clinical studies on PRP and tendinopathies published in English and French language peer-reviewed journals were included. Articles with a high level of evidence were given special consideration. Despite the proven efficacy of PRP on tissue regeneration in experimental studies, there is currently scanty tangible clinical evidence with respect to its efficacy in chronic tendon disorders. The few studies that have been performed appear unlikely to be comparable. Randomized controlled studies with appropriate placebo groups are needed to determine the real effectiveness of PRP for treating chronic musculoskeletal injuries.
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Affiliation(s)
- Jean-François Kaux
- Department of Motricity Sciences, Service of Physical Medicine and Sports Traumatology, University and University Hospital of Liège, Belgium.
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38
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Akagi M, Asada S, Mori S, Matsushita T, Hashimoto K, Hamanishi C. Estimation of frontal alignment error of the extramedullary tibial guide on the bi-malleolar technique: a simulation study with magnetic resonance imaging. Knee 2012; 19:836-42. [PMID: 22507073 DOI: 10.1016/j.knee.2012.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 03/06/2012] [Accepted: 03/14/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE The bi-malleolar technique for the extramedullary tibial guide is a representative method for determining the ankle center in total knee arthroplasty (TKA). The purpose of this study is to estimate three-dimensionally the lateral errors (difference between the real ankle center and the bi-malleolar center) and the varus angular errors of this technique under the condition that the malleolar prominences were correctly identified. METHODS Magnetic resonance images of 51 lower limbs from 51 healthy volunteers were analyzed. The lateral errors were measured, including or excluding the subcutaneous thickness, along the line perpendicular to the transmalleolar axis (TMA) or along the tibial anteroposterior (AP) axis. Furthermore, we evaluated the effects of the tibial torsion and the difference between the subcutaneous thicknesses on the malleoli on the lateral error. RESULTS When including the skin, the mean lateral errors of the ankle center observed along the line perpendicular to the TMA and along the tibial AP axis were 3.7 ± 1.4mm and 1.2 ± 1.5mm, respectively. The mean angular errors were 0.6 ± 0.2° and 0.2 ± 0.3°, respectively. A significant correlation between the tibial torsion and the lateral error was noted when observed along the tibial AP axis. The difference between the subcutaneous thicknesses on the malleoli affected the lateral error. CONCLUSION The errors were small enough to determine the mechanical axis of the tibia if the tibial guide could catch the bi-malleolar prominences of the ankle accurately and align along the tibial AP axis.
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Affiliation(s)
- Masao Akagi
- Department of Orthopaedic Surgery, Kinki University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama City, Osaka, 589-8511, Japan.
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Yee PK, Poon KC, Chiu SY. Simultaneous bilateral patellar tendon avulsion in an adolescent. Hong Kong Med J 2012; 18:530-532. [PMID: 23223656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
A 13-year-old boy sustained an injury to both knees upon landing after a forceful jump in a soccer game. Plain radiography and magnetic resonance imaging demonstrated bilateral distal patellar tendon avulsions without fracture of the tibial tuberosities and the physes. To our knowledge, this particular injury has not been previously described in the literature. Open surgeries and internal fixation were performed with excellent functional outcome. This type of injury was similar to the well-recognised acute tibial tuberosity avulsion fracture in terms of the pathogenesis and treatment. We propose a further subtype of this injury pattern.
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Affiliation(s)
- P K Yee
- Department of Orthopaedics and Traumatology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong.
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40
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Kwon OS, Kelly J. Arthroscopic repair of medial patellofemoral ligament avulsion in acute patellar dislocation in skeletally immature patient--a case report. Knee 2012; 19:713-5. [PMID: 22424690 DOI: 10.1016/j.knee.2012.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 12/18/2011] [Accepted: 02/21/2012] [Indexed: 02/02/2023]
Abstract
Acute patellar dislocation is a severe injury to the knee and usually manifests with symptoms such as giving way, a sensation of lateral displacement of the patella accompanied by hemarthrosis and tenderness over the medial epicondylar region to palpation. Spontaneous reduction of the patella makes the diagnosis more difficult in initial evaluation. Radiographs often show a small bony avulsion at the medial border of the patella, which may represent an injury to the medial restraints. Magnetic resonance imaging may show a bone bruise on the medial patella, and/or on the lateral femoral condyle. The medial patellofemoral ligament (MPFL) may be avulsed distally, proximally or sustain in interstitial tear. Arthroscopic findings include hematoma and chondral or osteochondral lesions located on the central or medial facet of the patella or on the anterior lateral femoral condyle. We report a case of a patellar avulsion of medial patellofemoral ligament in a skeletally immature patient.
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Affiliation(s)
- Oh Soo Kwon
- The Catholic University of Korea, Department of Orthopaedic Surgery, Daejeon, Republic of Korea.
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41
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Jibri Z, Martin D, Mansour R, Kamath S. The association of infrapatellar fat pad oedema with patellar maltracking: a case-control study. Skeletal Radiol 2012; 41:925-31. [PMID: 22012480 DOI: 10.1007/s00256-011-1299-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2011] [Revised: 08/21/2011] [Accepted: 09/23/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To look for any association between oedema in the superolateral portion of the infrapatellar fat pad and patellar maltracking. MATERIALS AND METHODS We compared two groups of knee MRI with regard to five patellar maltracking parameters. The first group included 100 knees with evidence of oedema in the superolateral aspect of the infrapatellar fat pad (the study group). The second group included another 100 knee MRI that had a normal infrapatellar fat pad (the control group). The five patellar maltracking parameters assessed were the trochlear depth, tibial tuberosity-trochlear groove distance (TTTG), patellar translation, patellofemoral angle (PFA) and the Insall-Salvati index. RESULTS There was a statistically significant difference in the Insall-Salvati index, patellar translation and PFA between the two groups (p value of <0.001, <0.001 and 0.004 respectively, Student's t test). There was a higher prevalence of patella alta, lateral patellar displacement (LPD) and lateral patellar tilt in the study group (p value of <0.001, <0.001 and 0.011 respectively, Fisher's exact test). Sixty out of 100 knees in the study group had at least one abnormal patellar maltracking parameter in comparison to 16 out of 100 knees in the control group (p < 0.001, Fisher's exact test). CONCLUSION Oedema in the superolateral portion of Hoffa's fat pad, the MRI feature of fat pad impingement, is associated with patellar maltracking.
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Affiliation(s)
- Zaid Jibri
- Department of Radiology, University Hospital of Wales, Cardiff, United Kingdom.
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Barbier-Brion B, Lerais JM, Aubry S, Lepage D, Vidal C, Delabrousse E, Runge M, Kastler B. Magnetic resonance imaging in patellar lateral femoral friction syndrome (PLFFS): prospective case-control study. Diagn Interv Imaging 2012; 93:e171-82. [PMID: 22421281 DOI: 10.1016/j.diii.2012.01.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To describe morphologic abnormalities and signs of patellar lateral femoral friction syndrome (PLFFS) detected by magnetic resonance imaging (MRI). MATERIALS AND METHODS Prospective study of 56 knees (21 patients and 30 controls) studied by 3Tesla MRI. Comparative analysis of clinical data, quantitative and qualitative imaging criteria in a population of patients with anterior knee pain associated with an abnormal MRI signal along the lateral alar folds of the infrapatellar fat pad, a characteristic sign of PLFFS, and a control population with no anterior knee pain or abnormal signal from the infrapatellar fat pad. RESULTS Patients with PLFFS have anterior and/or lateral knee pain. Their knee has anatomical predispositions for instability, primarily with patella alta (P<0.0001), patellar tilt more than 13.5° (P<0.0001), a patellar nose length less than 9 mm (P=0.0037), a patellar nose ratio less than 0.25 (P<0.0001), a TT-TG distance more than 10 mm (P<0.0001), and a trochlear prominence more than 4 mm (P=0.0056). In 35% of patients, patellar chondropathy is visible, and 48% of patients have patellar or trochlear subchondral abnormalities. CONCLUSION Anterior, lateral, and medial knee pain may be related to PLFFS. Anatomical predispositions contributing to instability are found in these patients. There may be associated chondropathies and osteochondropathies.
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Affiliation(s)
- B Barbier-Brion
- Osteoarticular Imaging Department, CHU Jean-Minjoz, Besançon, France.
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Abstract
BACKGROUND High levels of total cholesterol, triglycerides, and low-density lipoprotein are toxic to the vascular endothelium and thus have long been associated with atherosclerosis. Several clinical studies have suggested that elevated cholesterol also has a negative effect on tendon structure and function. Data from our preliminary studies show that the patellar tendons of hypercholesterolemic knockout mice exhibit reduced baseline elastic modulus and strength postinjury compared with controls. QUESTIONS/HYPOTHESES We therefore hypothesized elevated cholesterol would be associated with diminished tendon mechanical properties. METHOD OF STUDY Using hypercholesterolemic (B6.129P2-Apoetm1Unc/J) mice, patellar tendons from control (C57BL/6) and knockout mice will be injured surgically at two different times. Subsequently, mechanical testing will be performed and data evaluated for differences in baseline and in healing between cholesterol groups. For healing assessment, data from the injured limb of each animal will be normalized to that of the sham-operated contralateral limb. SIGNIFICANCE We anticipate that such studies eventually will enable us to elucidate the link between elevated cholesterol and tendon disease. If a mechanistic cause of hypercholesterolemia causing tendon disease is clarified, then potentially therapeutic interventions such as the use of pharmacotherapy may be used to help combat this. In the future, it may become worthwhile to consider the presentation of tendinopathy as a trigger to measure serum cholesterol just as one might consider measuring serum glucose in patients presenting with adhesive capsulitis.
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Affiliation(s)
- Joseph A Abboud
- Department of Orthopaedic Surgery, University of Pennsylvania Health System, 3B Orthopaedics, Pennsylvania Hospital, 800 Spruce Street, 8th Floor Preston, Philadelphia, PA 19107, USA.
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Abstract
Chronic patellar tendon rupture is a rare injury whose treatment poses technical difficulties. Surgical repair is mandatory to restore the extensor mechanism of the knee. Many different surgical methods of patellar tendon reconstruction have been described. We present the case of a 48-year-old male patient who sustained patellar tendon rupture 8 months before surgery. A semitendinosus tendon graft and the modified Ecker technique were used for the reconstruction of the patellar tendon. Full extension was achieved alongside high patient satisfaction. However, the patient required prolonged intensive rehabilitation.
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Panasiuk M, Groblewski M. [Spontaneous patellar tendon rupture as a result of morbid obesity]. Chir Narzadow Ruchu Ortop Pol 2011; 76:353-354. [PMID: 22708324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We present the case of spontaneous damage to the patellar tendon in a patient with pathologic obesity (BMI = 41), without comorbid conditions. Damage occurred during normal load combined with the movement of the knee extension when inserting a foot in flip-flops. Surgical treatment was performed in a matter of urgency and the patellar tendon was sutured in half the length of. Six weeks of immobilization was used and then rehabilitation. After four months efficient gait and a good range of motion was achieved. Please note that obesity is a disease of civilization and cause further disease. These include acute injuries resulting from a sudden overload.
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Affiliation(s)
- Michał Panasiuk
- Oddział Chirurgii Urazowo-Ortopedycznej i Nowotworów Narzqdu Ruchu, Wojewódzki Szpital Specjalistyczny im. Mikołaja Kopernika w Łodzi
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Abstract
To address recurrent patellar instability in children and young adolescents a variety of therapeutic options exist either as non-operative or operative treatment. Recent options, such as reconstruction of the medial patellofemoral ligament have evoked a new focus of attention on this topic. The intention of this article is to present diverse therapeutic options and to evaluate them by reference to the current literature.
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Affiliation(s)
- C Baier
- Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland.
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47
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Ehlinger M, Adam P, Bierry G, Dosch JC, Taglang G, Bonnomet F. Supra-patellar swelling and knee instability. Skeletal Radiol 2010; 39:1033-4, 1047-8. [PMID: 20217408 DOI: 10.1007/s00256-010-0877-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Revised: 01/04/2010] [Accepted: 01/07/2010] [Indexed: 02/02/2023]
Affiliation(s)
- M Ehlinger
- Hôpitaux Universitaires de Strasbourg, Strasbourg Cedex, France.
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48
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Pećina M, Bojanić I, Ivković A, Brčić L, Smoljanović T, Seiwerth S. Patellar tendinopathy: histopathological examination and follow-up of surgical treatment. Acta Chir Orthop Traumatol Cech 2010; 77:277-283. [PMID: 21059324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
PURPOSE OF THE STUDY The aim of this study was to determine the exact localization of the histopathological process (bone, bone-tendon junction or tendon), and to determine whether the underlying pathologic process is predominantly of inflammatory or degenerative nature, then to evaluate the outcome of the surgical treatment of patellar tendinopathy. MATERIALS A prospective cohort study was performed in order to analyze the outcome of surgical treatment of patellar tendinopathy, as well as to document histopathological changes in bone, bone-tendon junction, and in the patellar ligament in 34 professional athletes treated with patellar apicotomy. All the patients included in the study were classified as stage 3 according to Blazina and showed no improvement after at least 6 months of conservative treatment. The postoperative follow-up was from 1 to 8 years with a mean value of 4.7 years. METHODS The postoperative results were analyzed using a semiquantitative scoring system where the functional outcome was classified as very good if the athlete returned to his sporting activity without any negative side effects, good if the athlete resumed his sporting activities with modest painful sensations present only at the maximum level of physical exertion, and poor if any reduction of athletic activity was present. In twenty patients a histopathological examination of resected bone and tendon tissue was performed. The specimens were stained with hematoxylin-eosin and examined under a light microscope using polarization. Special stains used were Alcian blue, to detect any increase in ground substance, and Prussian blue which enhances conspicuity of hyaline degeneration and enables detection of hemosiderin. Immunohistochemistry was performed in order to analyze presence of blood vessels, leukocytes and histiocytes. RESULTS Very good results were achieved in 20 of operated knees, good results were achieved in 12 of knees and poor results were achieved in 2 of operated knees. Pathological changes in the bone were found in 35% of analyzed specimens, abnormality at the bone-tendon junction were found in 75% of the specimens, and changes in the patellar tendon were found in all extracted specimens. The histopatholological nature of the lesions found within the tendon tissue in all of the analyzed specimens belongs to the group of degenerative changes. DISCUSSION Currently a consenus has been established that the expression tendinitis is "out", and the term tendinopathy should be used instead. No inflammatory cells and no increase in prostaglandins can be detected in the tendons. Histopathological studies of the tissue fibrils affected by tendinosis characteristically demonstrate hypercellularity, hypervascularity, lack of inflammatory infiltrates, and disorganization and loosening of collagen fibers. CONCLUSION The clinical results and histopathological examination in our series justified our operative method. In the chronic stage these lesions are irreversible and constitute permanent intratendinous lesions. It thus seems logical to excise these lesions from their origin at the apex of the patella and entry into the adjacent tendon. It is also recommended on the basis of our and other authors' research that the term patellar tendinopathy should be used instead of tendonitis/tendinitis.
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Affiliation(s)
- M Pećina
- Department of Orthopaedic Surgery, University of Zagreb School of Medicine, University Hospital Center Zagreb, Croatia.
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Savarese E, Bisicchia S, Amendola A. Bilateral spontaneous concurrent rupture of the patellar tendon in a healthy man: case report and review of the literature. Musculoskelet Surg 2010; 94:81-8. [PMID: 20480273 DOI: 10.1007/s12306-010-0077-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Accepted: 04/06/2010] [Indexed: 11/26/2022]
Affiliation(s)
- Eugenio Savarese
- Department of Orthopaedic Surgery, University of Rome Tor Vergata, 81 Oxford Street, Rome, Italy.
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Epstein DM, Capeci CM, Rokito AS. Patella tendon rupture after arthroscopic resection of the prepatellar bursa--a case report. Bull NYU Hosp Jt Dis 2010; 68:307-310. [PMID: 21162710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The use of arthroscopic techniques for excision of the pre-patellar bursa has become more common in recent years for the treatment of prepatellar bursitis. The current literature includes several case series that report few complications with this technique. We report the case of a 73-year-old male who sustained a low-energy patella tendon rupture 2 months after arthroscopic resection of the prepatellar bursa. We hypothesize that during arthroscopic excision of the prepatellar bursa there was an iatrogenic injury to the patellar tendon, which contributed to the subsequent rupture. Surgical repair was successfully performed using an open technique with a 1-year follow-up. To our knowledge, this is the first case report of patella tendon rupture following arthroscopic excision of the prepatellar bursa.
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Affiliation(s)
- David M Epstein
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, NY, USA
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