OBJECTIVE: To investigate the clinical effect of double pulley combined with suture bridge in the treatment of comminuted fracture of the lower pole of the patella. METHODS: From January 2018 to June 2020, 15 patients with comminuted fracture of the lower pole of the patella were treated with double pulley and suture bridge technology, including 9 males and 6 females, aged 28 to 68 years old with an average of (42.4±9.6) years old. All patients had obvious knee joint pain and limited movement after injury. All knee joints were examined by X-ray and CT, which confirmed that they were all comminuted fractures at the lower level of the patella. After operation, X-ray films of the knee joint were taken regularly to understand the fracture healing, the Insall Salvati index was measure, the range of motion of the joint was recorded, and the function of the knee joint was evaluateed by the Bostman scoring system. RESULTS: All the 15 patients were followed up for 7 to 24 months with an average of (11.4±4.2) months, and there was no obvious anterior knee pain. At the last follow-up, the knee joint range of motion of the affected limb was 105° to 140° with an average of (128.5±12.8) °, and the Insall Salvati index was 0.79 to 1.12 with an average of (0.92±0.18). The X-ray film showed that the patella was bone healing, and no anchor fell off, broken, or displaced fracture block was found. Bostman patellar fracture function score was 27.85±2.06, 13 cases were excellent, 2 cases were good. CONCLUSION Double pulley technique combined with suture bridge technique is reliable for reduction and fixation of comminuted fracture of the lower pole of patella, and patients can start functional exercise early after operation.
Male ; Female ; Humans ; Adult ; Middle Aged ; Aged ; Fractures, Comminuted/surgery* ; Fracture Fixation, Internal/methods* ; Patella/injuries* ; Bone Wires ; Fractures, Bone/surgery* ; Sutures ; Treatment Outcome

OBJECTIVE: To investigate effectiveness of suture anchor fixation combined with Nice knot strapping via longitudinal patellar drilling in the treatment of patellar inferior pole fractures. METHODS: A clinical data of 37 patients with unilateral patellar inferior pole fracture who met the selection criteria between June 2017 and June 2021 was retrospectively analyzed. Among them, 17 cases were treated with the suture anchor fixation combined with Nice knot strapping via longitudinal patellar drilling (group A), and 20 cases were treated with the traditional Kirschner wire tension band technique (group B). There was no significant difference in terms of gender, age, body mass index, fracture side, combined medical disease, and preoperative hemoglobin between the two groups ( P>0.05). Operation time, intraoperative blood loss, postoperative complications, fracture healing time, knee range of motion, and knee function Bostman score (range of motion, pain, daily work, muscle atrophy, walking aids, knee effusion, soft leg, and stair climbing) and grading were recorded in both groups at last follow-up. RESULTS: There was no significant difference in operation time and intraoperative blood loss between the two groups ( P>0.05). All incisions healed by first intention. All patients were followed up 1-2 years, with an average of 1.7 years. X-ray films reexamination showed that all fractures in group A healed, while 2 cases in group B did not heal. There was no significant difference in bone healing time between the two groups ( P>0.05). At last follow-up, the knee range of motion, the range of motion score of Bostman score, total score and effectiveness grading in group A were significantly better than those in group B ( P<0.05). There was no significant difference in the other items of Bostman scores between the two groups ( P>0.05). During follow-up, 2 cases of internal fixation failure and 1 case of internal fixator irritation occurred in group B, and no complication related to internal fixation occurred in group A. The occurrence of complications was significantly lower in group A than in group B ( P<0.05). CONCLUSION Compared with the traditional Kirschner wire tension band technique, the suture anchor combined with Nice knot strapping via longitudinal patellar drilling for the patellar inferior pole fractures has the advantages of simple operation, reliable fixation, early flexion and extension activity, and better functional recovery of knee joint.
Humans ; Blood Loss, Surgical ; Bone Wires ; Fracture Fixation, Internal/methods* ; Fractures, Bone/surgery* ; Knee Injuries ; Patella/surgery* ; Retrospective Studies ; Suture Anchors ; Treatment Outcome ; Male ; Female

OBJECTIVE: To investigate the correlation between the quadriceps cross-sectional area (CSA) and quadriceps muscle volume (QMV) at different horizontal levels from the upper edge of the patella, and to determine the best observation position. METHODS: Thigh magnetic resonance imaging (MRI) images of 22 Chinese young men [age: (29±6) years] with anterior cruciate ligament (ACL) rupture were examined. The CSA was measured at 18, 15, and 12 cm above the upper edge of the pate-lla (denoted by CSA-18, CSA-15 and CSA-12 respectively), and the QMV and CSA were determined by semiautomatic segmentation. A curve model was established to estimate QMV. Bland-Altman analysis was performed to determine the confidence limits of the volumes. RESULTS: On the unaffected side, the mean QMV was (1 944.45±323.77) cm³. The quadriceps CSA at the upper edge of the patella at 18, 15, and 12 cm was (80.80±12.16) cm², (77.53±12.03) cm², and (72.68±10.51) cm², respectively. The coefficients of determination (R²), ascertained using curve estimation models, for the 3 positions were 0.819, 0.755, and 0.684 (P < 0.001), and the standard deviations of the volume estimated value (SEE) were 7.4%, 8.7%, and 9.8%. The fitting equations of the three horizontal positions were all good, but the fitting degree of CSA-18 was the highest. The Bland-Altman scatter plot showed that the arithmetic means of the QMV at 18, 15 and 12 cm from the upper edge of the patella 0.8 cm³, -1.1 cm³, and 0.9 cm³ and 95% limits of agreement (LoA) were (-268.8, 270.5), (-315.2, 313.1), and (-355.7, 357.5), respectively. The estimated QMV was in good agreement with the measured value. The difference between the estimated CSA-18 and measured values was the smallest. The results on the affected side were consistent. CONCLUSION The correlation between QMV and CSA in the young men with the upper edge of patella as baseline was reliable and consistent. Among them, CSA-18 had the highest correlation with the QMV. However, different observation sites could be selected for different injuries of the quadriceps.
Adult ; Anterior Cruciate Ligament Injuries/surgery* ; Anterior Cruciate Ligament Reconstruction ; Humans ; Magnetic Resonance Imaging ; Male ; Patella ; Quadriceps Muscle/diagnostic imaging* ; Young Adult

OBJECTIVE: To determine the optimal stimulation and recording site for infrapatellar branch of saphenous nerve (IPBSN) conduction studies by a cadaveric study, and to confirm that obtained location is practically applicable to healthy adults. METHODS: Twelve lower limbs from six cadavers were studied. We defined the optimal stimulation site as the point IPBSN exits the sartorius muscle and the distance or ratio were measured on the X- and Y-axis based on the line connecting the medial and lateral poles of the patella. We defined the optimal recording site as the point where the terminal branch met the line connecting inferior pole of patella and tibial tuberosity, and measured the distance from the inferior pole. Also, nerve conduction studies were performed with obtained location in healthy adults. RESULTS: In optimal stimulation site, the mean value of X-coordinate was 55.50±6.10 mm, and the ratio of the Y-coordinate to the thigh length was 25.53%±5.40%. The optimal recording site was located 15.92±1.83 mm below the inferior pole of patella. In our sensory nerve conduction studies through this location, mean peak latency was 4.11±0.30 ms and mean amplitude was 4.16±1.49 µV. CONCLUSION: The optimal stimulation site was located 5.0–6.0 cm medial to medial pole of the patella and 25% of thigh length proximal to the X-axis. The optimal recording site was located 1.5–2.0 cm below inferior pole of patella. We have also confirmed that this location is clinically applicable.
Adult ; Cadaver* ; Clinical Study* ; Electromyography ; Humans ; Knee Injuries ; Lower Extremity ; Neural Conduction* ; Patella ; Reference Values* ; Thigh

A 20-year-old National Serviceman presented with left knee pain and swelling after training for his physical fitness test. Lateral knee radiography and magnetic resonance (MR) imaging showed patellar tendon-lateral femoral condyle friction syndrome (PT-LFCFS), on a background of patella alta and patellar malalignment. The patient was treated non-operatively with a course of physiotherapy and given advice on rest and activity modification. PT-LFCFS is a less well-recognised but important cause of anterior knee pain and represents an entity in a spectrum of disorders related to patellofemoral instability. We herein discuss the MR imaging findings specific to and associated with this condition, as well as briefly describing treatment options. In addition, we showcase a range of commonly encountered abnormalities that affect the infrapatellar fat pad and briefly discuss their specific MR imaging findings.
Adult ; Arthralgia ; diagnostic imaging ; Female ; Femur ; diagnostic imaging ; Humans ; Knee ; diagnostic imaging ; Knee Injuries ; diagnostic imaging ; therapy ; Knee Joint ; diagnostic imaging ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pain ; diagnostic imaging ; Patella ; diagnostic imaging ; Patellar Ligament ; diagnostic imaging ; Physical Therapy Modalities ; Radiography ; Young Adult

PURPOSETension band wiring is commonly used for fixation of simple transverse fractures. The popular configuration is parallel Kirschner wires (K-wires) and a stainless steel wire loop placed in a vertically oriented figure-of-8.

METHODSWe used a wooden model of a patella with a midway transverse fracture and compared four different types of fixation. The first construct had a vertical figure-of-8 with one twist of wire. The second contained a vertical figure-of-8 with two twists of wire. The third was a vertical figure-of-8 with two twists of wire placed at adjacent corners while the last one had a horizontal figure-of-8 with two twists of wire placed at adjacent corners. Interfragmentary compression at the point of wire breakage was measured for each construct as well as permanent displacement on cyclic loading.

RESULTSPlacement of the figure-of-eight in a horizontal orientation with two wire twists at the corner improved interfragmentary compression by 63% (p < 0.05, Tukey post hoc test). On cyclic loading, all the constructs with vertical figure-of-eight but none with a horizontal construct failed (p=0.01; Fisher's exact test). Permanent fracture displacement after cyclic loading was 67% lower with horizontal figure- of-eight constructs (p < 0.05; t test).

CONCLUSIONPlacing wire twists at the corner and a horizontal placement of figure-of-8 improves stability of the construct.

Biomechanical Phenomena ; Bone Wires ; Fracture Fixation, Internal ; methods ; Fractures, Bone ; physiopathology ; surgery ; Humans ; Patella ; injuries ; Stainless Steel

A 14-year-old girl presented with left knee pain and swelling after an injury. Magnetic resonance (MR) imaging showed a transient lateral patellar dislocation with patellar osteochondral fracture, medial patellofemoral ligament tear and underlying femoral trochlear dysplasia. Open reduction and internal fixation of the osteochondral fracture, plication of the medial patellar retinaculum and lateral release were performed. As lateral patellar dislocation is often clinically unsuspected, an understanding of its characteristic imaging features is important in making the diagnosis. Knowledge of the various predisposing factors for patellar instability may also influence the choice of surgical management. We also discuss signs of acute injury and chronic instability observed on MR imaging, and the imaging features of anatomical variants that predispose an individual to lateral patellar dislocation. Treatment options and postsurgical imaging appearances are also briefly described.
Adolescent ; Arthralgia ; diagnosis ; Female ; Fracture Fixation, Internal ; Fractures, Bone ; diagnostic imaging ; pathology ; Humans ; Joint Instability ; Knee Joint ; diagnostic imaging ; Ligaments, Articular ; injuries ; Magnetic Resonance Imaging ; Patella ; diagnostic imaging ; pathology ; Patellar Dislocation ; diagnosis

Acupuncture Points ; Adolescent ; Adult ; Child ; Combined Modality Therapy ; Electroacupuncture ; Exercise Therapy ; Female ; Humans ; Male ; Middle Aged ; Patella ; injuries ; Rheumatic Diseases ; therapy ; Young Adult

Adolescent ; Diagnosis, Differential ; Humans ; Hyperoxaluria, Primary ; diagnosis ; Knee ; diagnostic imaging ; Lumbar Vertebrae ; diagnostic imaging ; Male ; Patella ; diagnostic imaging ; injuries ; Radiography

BACKGROUND: Several tendon graft and fixation methods have been introduced in medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar dislocation. The purpose of this study was to evaluate the results of MPFL reconstruction using a gracilis autograft fixation without bone tunnel in patients with recurrent patellar instability. METHODS: Nine patients (four males and five females) diagnosed with recurrent patellar instability from July 2009 to January 2013 and had MPFL reconstruction using a gracilis autograft were included. The average age of the patients was 24.6 years (range, 13 to 48 years), and the average follow-up period was 19.3 months (range, 12 to 30 months). For every patient, femoral attachment was fixed using suture anchors securing the patella by suturing the periosteum and surrounding soft tissue. Clinical evaluation included the Kujala, Lysholm, and Tegner scores; in addition, patients were examined for any complication including recurrent dislocation. The congruence angle and patella alta were assessed radiologically before and after surgery. RESULTS: The Kujala score improved from an average of 42.7 ± 8.4 before surgery to 79.6 ± 13.6 (p = 0.008) at final follow-up; the Lysholm score improved from 45.8 ± 5.7 to 82.0 ± 10.5 (p = 0.008); and the Tegner score improved from 2.8 ± 0.8 to 5.6 ± 1.5 (p = 0.007). The Insall-Salvati ratio changed from 1.16 ± 0.1 (range, 0.94 to 1.35) before surgery to 1.14 ± 0.1 (range, 0.96 to 1.29; p = 0.233) at the final follow-up without significance. The congruence angle significantly improved from 26.5°± 10.6° (range, 12° to 43°) before surgery to -4.0°± 4.3° (range, -12° to 5°; p = 0.008) at final follow-up. Subluxation was observed in one patient and hemarthrosis occurred in another patient 2 years after surgery, but these patients were asymptomatic. CONCLUSIONS: We achieved good results with a patellar fixation technique in MPFL reconstruction using a gracilis autograft employing soft tissue suturing in patients with recurrent patellar dislocation.
Adolescent ; Adult ; *Autografts ; Female ; Humans ; Knee Injuries/radiography/*surgery ; Ligaments, Articular/radiography/*surgery ; Male ; Middle Aged ; Muscle, Skeletal/surgery/transplantation ; Patella/radiography/*surgery ; Patellofemoral Joint/radiography/*surgery ; Reconstructive Surgical Procedures/adverse effects/instrumentation/*methods ; Retrospective Studies ; Thigh/surgery ; Young Adult