We performed intra-osseous venography in 16 patients with chondromalacia patellae or patellofemoral osteoarthritis. Of 16 patients, eight patients had chondromalacia patellae and 6 patellofemoral osteoarthritis. Two patients with normal patellae who underwent meniscectomy were used as controls. The results obtained were as follows: 1. Dye congested in the normal patella was disappeared within 2 minutes after injection and extra-osseous drainage pattern disappeared within 1 minute. 2. in chondromaiacia patellae, large amount of dye was spread throughout the entire patella and remained till 10 minutes, while extra-osseous drainage pattern disappeared at about 5 minutes. 3. In patellefemoral osteoarthritis, venous engorgment in patella was similar to that of chondromalacia patellae and extra-osseous drainage pattern disappeared at about 10 minutes. Conclusively, authors thought the patella I.O.V. was one of the significant clinical methods to define the etiological factors of the various patellofemoral disorders such as patellofemoral osteoarthritis and chondromalacia patellae.
Chondromalacia Patellae ; Drainage ; Estrogens, Conjugated (USP) ; Humans ; Osteoarthritis ; Patella ; Phlebography

Early chondromalacia patellae is initiated by malalignment in the extensor machaniam and abno-rmal patellofemoral tracking. It is well known that chondromalacia often occurs in recurrent pateIlar subluxation. In the 50 normal and 60 pathologic knees, the following five parameters were studied; 1) Q angle 2) PT ratio by Insall & Salvati method 3) AB ratio dy Blackburne & Peel method 4) sulcus angle 5) congruence angle. The following conclusions were made. l. In 50 normal asymptomatic knees, the average Q angle was 14°. The patellar length was equal to the patellar ligament length and the average congruence angle was −8°. In 40 knees with “Chondromalacia”, the Q angle was increaed (19.5°), and the average congruence angle was −2°. 3. In 20 knees with recurrent subaxation, the patellar was high riding (PT ratio, 0.89), the sulcus angle was shallow (145.1°), and the average congruence angle was +4.35°.
Cartilage Diseases ; Chondromalacia Patellae ; Knee ; Methods ; Patella ; Patellar Ligament

The patella is one of the most important components of the knee extension mechanism, and position of patella relates to some diseases of the knee, especially recurrent dislocation of the patella and Osgood-Schlatter s diseases. We checked the patella to patella tendon ratio in normal persons as well as in cases with recurrent dislocation of patella, chondromalacia of patella, degenerative arthritis of the knee and Osgood Schlatter s disease by means of Insall and Salvati method. The following results were obtained: 1) The ratio was 1.048 in normal persons. 2) The ratio was 0. 845 in recurrent dislocations. 3) The ratio was the same as normal in cases of the acute stage of Osgood-Schlatter's disease but chenged to 1. 236 in the late healing stage after 18 years of age. 4) The ratio in chondromalacia of the patella and degenerative arthritis of the knee was not significantly different from the normal.
Cartilage Diseases ; Chondromalacia Patellae ; Clinical Study ; Dislocations ; Humans ; Knee ; Methods ; Osteoarthritis ; Patella ; Patellar Ligament

Among previously proposed etiological factors of chondromalacia patellae, abnormality in the extensor mechanism of the knee joint has been attributed as a cause of chondromalacia patellae by many authors Malalignment in the extensor mechanism of the knee joint is supposed to cause the positional change of patella. This positional change of patella can be measured by Q angle and P/PT ratio. Hereby we intened to classify the relationahip between the above measurement lenoting the positional change of patella and chondromalacia patellae. These values were obtained from 60 patients found to have chondromalacia patellae in Han Gang Sacred Heart Hospital, from Jan. 1977 to Sep. 1978. Values were also obtained from 60 normal persons as a control group. Thus a statistical analysis was made for the possible relationship between extensor mechanism of the knee joint and chondromalacia patellae. The following conclusion were made, 1. The sex ratio was 1:1.3 with female preponderance. There was 26 male and 34 female patients, common age group of chondromalacia patellae was age 20-40 years. 2. The average value of Q angle was 11 in control group, while 18 in chondromalacia patellae, having the difference of 7. 3. The average values of Q angle among different sexes were reviewed. The male control group had 9 of average value of Q angle, while male chondromalacia patellae had 16. The female control group had 12 of average value of Q angle, while female chondromalacia patellae had 20. 4. The average value of P/PT ratio was 1.03 in control group, while 0.9 in chondromalacia patellae, having the difference 0.13. For P/PT ratio in different sexes, the average value was 1.01 in male control group. while 0.9 in male chondromalacia patellae. The average value of P/PT ratio was 1.04 in female control group, while 0.89 in female chondromalacia patellae, 5. For statistical survey for these differences, P value was examined by t-test methods. The statistical diffrences of Q angle in male control group and chondromalacia patellae was 3.4 and it was 2.06 in he female. The difference between control group and the chondromalacia patellae in the overall seves was 2.61, thus having statistical significance.
Cartilage Diseases ; Chondromalacia Patellae ; Female ; Heart ; Humans ; Knee Joint ; Knee ; Male ; Patella ; Sex Ratio

OBJECTIVETo compare the clinical efficacy differences between fire needling technique of filiform needle at high stress points and regular acupuncture on chrondromalacia patellae so as to provide the better therapy for the treatment of this disease.

METHODSSixty cases of chrondromalacia patellae were randomized into a fire needling group (28 cases) and a routine acupuncture group (32 cases). In the fire needling group, 5 to 6 high stress points were localized according to the symptoms, palpation and imaging condition and were stimulated with fire needling technique of filiform needle. The treatment was given once every two days, 5 treatments made one session. In the routine acupuncture group, the regular acupuncture was applied at Dubi (ST 35), Xiguan (LR 7), Yanglingquan (GB 34), Yinlingquan (SP 9), Zusanli (ST 36), etc. The treatment was given once every day, 5 treatments made one session. Lysholm score, VSA score, patella title angle (PTA) and lateral patella angle (LPA) of the affected knees before and after treatment, as well as the clinical efficacy after treatment were observed in the two groups.

RESULTSAfter treatment, Lysholm score, VSA score, PTA and LPA were all improved apparently in the two groups (all P < 0.01). After the treatments, the improvements in Lysholm score, VSA score, PTA and LPA in the fire needling group were more obvious than those in the routine acupuncture group (all P < 0.05). The effective rate was 92.9% (26/28) in the fire needling group, better than 87.5% (28/32) in the routine acupuncture group (P < 0.01).

CONCLUSIONThe fire needling technique of filiform needle at the high stress points relieves the clinical symptoms of chrondromalacia patellae and recovers the biodynamical structure of patellae.

Acupuncture Points ; Acupuncture Therapy ; instrumentation ; methods ; Adult ; Chondromalacia Patellae ; therapy ; Female ; Humans ; Male ; Middle Aged ; Treatment Outcome ; Young Adult

OBJECTIVE: We wanted to compare the two-dimensional (2D) fast spin echo (FSE) techniques and the three-dimensional (3D) fast field echo techniques for the evaluation of the chondromalacia patella using a microscopy coil. MATERIALS AND METHODS: Twenty five patients who underwent total knee arthroplasty were included in this study. Preoperative MRI evaluation of the patella was performed using a microscopy coil (47 mm). The proton density-weighted fast spin echo images (PD), the fat-suppressed PD images (FS-PD), the intermediate weighted-fat suppressed fast spin echo images (iw-FS-FSE), the 3D balanced-fast field echo images (B-FFE), the 3D water selective cartilage scan (WATS-c) and the 3D water selective fluid scan (WATS-f) were obtained on a 1.5T MRI scanner. The patellar cartilage was evaluated in nine areas: the superior, middle and the inferior portions that were subdivided into the medial, central and lateral facets in a total of 215 areas. Employing the Noyes grading system, the MRI grade 0-I, II and III lesions were compared using the gross and microscopic findings. The sensitivity, specificity and accuracy were evaluated for each sequence. The significance of the differences for the individual sequences was calculated using the McNemar test. RESULTS: The gross and microscopic findings demonstrated 167 grade 0-I lesions, 40 grade II lesions and eight grade III lesions. Iw-FS-FSE had the highest accuracy (sensitivity/specificity/accuracy = 88%/98%/96%), followed by FS-PD (78%/98%/93%, respectively), PD (76%/98%/93%, respectively), B-FFE (71%/100%/93%, respectively), WATS-c (67%/100%/92%, respectively) and WATS-f (58%/99%/89%, respectively). There were statistically significant differences for the iw-FS-FSE and WATS-f and for the PD-FS and WATS-f (p < 0.01). CONCLUSION: The iw-FS-FSE images obtained with a microscopy coil show best diagnostic performance among the 2D and 3D GRE images for evaluating the chondromalacia patella.
Aged ; Chondromalacia Patellae/*diagnosis/pathology ; Female ; Humans ; *Imaging, Three-Dimensional ; Magnetic Resonance Imaging/instrumentation/*methods ; Male ; Middle Aged ; Patella/pathology ; Sensitivity and Specificity

OBJECTIVE: To assess the therapeutic effect of hyaluronate acid (HA) injection through the subpatellar route for treatment of chondromalacia patellae (CP). METHODS: Eighty-eight patients with the diagnosis of CP were enrolled in this prospective study, including 38 with early CP (CP group) and 50 with advanced CP (patellofemoral arthritis group) diagnosed based on image presentations. All the patients received intra-articular HA injections through a subpatellar route once a week for 5 consecutive weeks. The primary outcome measures included WOMAC index scores and Lequesne scores before and at 4, 12, 26 and 52 weeks after the injections. The secondary outcome measures included the 30-m walking time and stair ascending and descending time (one floor) before and at 1, 2, 3, and 4 weeks after the injections. RESULTS: In both groups the patients showed significantly decreased WOMAC scores and Lequesne scores at 4, 12, 26 and 52 weeks after HA injections as compared with the baseline scores (all < 0.01). No significant difference was found between the two groups in WOMAC scores and Lequesne scores at 4 or 12 weeks after the injections (both >0.05). The WOMAC scores and Lequesne scores at 26 and 52 weeks after the injections were significantly higher in patellofemoral arthritis group than in CP group (both < 0.05). In both groups, the 30-m walking time and the stair ascending and descending time decreased significantly at 1, 2, 3, and 4 weeks after HA injections (all < 0.05) without significant differences between the two groups (all >0.05). CONCLUSIONS HA injection through the subpatellar route is effective for treatment of CP. HA injection produces better long-term efficacy for treatment of early CP than for advanced CP where patellofemoral arthritis occurs.
Chondromalacia Patellae ; Follow-Up Studies ; Humans ; Hyaluronic Acid ; Injections, Intra-Articular ; Osteoarthritis, Knee ; Pain Measurement ; Prospective Studies ; Severity of Illness Index ; Treatment Outcome

OBJECTIVE: To explore the operation method in treating patellar instability guided by arthroscopy and to evaluate its therapeutic effects. METHODS: Thirty-two patients (34 knees) with patellar instability including 2 patellar tilt (2 knees), 26 (27 knees) patellar subluxation, and 4 (5 knees) patellar dislocation, diagnosed by clinical and arthroscopical standard, were treated with anterior transfer of the gracilis or medial transfer of the tibial tuberosity based on the lateral retinacular release and medial tightening. RESULTS: Twenty-eight patients were followed up for 5-87 (mean 36.6) months. The excellence rates was 92.8%. CONCLUSION The patellofemoral alignment can be seen directly and dynamically under the arthroscopy. The combinational treatment including anterior transfer of the gracilis in repairing patellar instability can avoid the recurrence effectively and get satisfactory results.
Adolescent ; Adult ; Arthroscopy ; Child ; Chondromalacia Patellae ; complications ; Female ; Humans ; Joint Instability ; etiology ; surgery ; Knee Injuries ; surgery ; Male ; Middle Aged ; Patella ; injuries ; Patellar Dislocation ; complications