Objective To explore the surgical method and cl inical short-term outcomes of internal fixation combined closed reduction with arthroscope aid in treating patellar fracture. Methods From June 2004 to July 2008, 42 patients with fresh simple patellar fracture underwent internal fixation combined closed reduction with arthroscope aid, included28 males and 14 females, aged 16-59 years (35 years on average). The locations were 19 left knees and 23 right knees. Injury was by traffic accident in 21 cases, by fall ing in 11 cases, by sports in 7 cases and by crush in 3 cases. All the patients had fresh closed fracture, including 38 cases of transverse fracture and 4 cases of stellate fracture. The Lysholm score was 68.60 ± 15.20; the proprioceptive function of the knee joints was (3.72 ± 0.12)°. The time from injury to operation was 3-42 hours (12 hours on average). After the treatment of affil iated injury under the arthroscope, patellar fracture was reduced with manipulation method, fracture was fixed with tensile force screw or modified tension band. Results All incisions obtained heal ing by first intention after operation, 42 patients were followed up for 12-39 months (16 months on average). The X-ray films showed callus at the fracture and the smooth cartilage surface 6-9 weeks (7 weeks on average) after operation. The flexed motion range of knee joint at last follow-up was at normal range in 38 cases, was l imited in 4 cases. Circumference of suffered l imbs 15 cm above the patella was the same as normal ones in 23 cases, atrophied 0.7 cm in 19 cases. There were no breakage of internal fixation and shift of fracture and patellofemoral arthritis at last follow-up. The proprioceptive function of the knee joints was (2.06 ± 0.11)° and the Lysholm score was 95.10 ± 3.92; all showing statistically significant differences when compared with preoperation (P lt; 0.05). Conclusion This treatment method has advantages as follows: mini-wound, early exercises and few compl ications, which can rinse articular cavity and repair the affil iated injury at the same time.
Objective To investigate the management of extention apparatus and cl inical results of total knee arthroplasty (TKA) of osteoarthritis. Methods Between June 2007 and June 2009, 386 patients (460 knees) with osteoarthritis received TKA, including 216 left knees and 244 right knees. There were 125 males (145 knees) and 261 females (315 knees) with an average age of 60.3 years (range, 58-85 years). The disease duration was 4-12 years (mean, 6.7 years). The X-ray films and CT scanning showed that all patients had femur-tibia joint degeneration and osteophyte formation at the edgeof joint. According to modified Burnett patellar resurfacing indication, whether or not to replace the patellar was determined, and the patellar track was determined by combining no thumb test and towel clamp traction test. Patella resurfacing was performed in 53 cases (56 knees, resurfacing group), no patella resurfacing in 333 cases (404 knees, non-resurfacing group), and lateral retinacular releasing 68 cases (72 knees). The postoperative imaging and knee society score (KSS), patellofemoral compl ications were analyzed. Results All wounds healed by first intention. All the patients were followed up 1-3 years (mean, 26 months). Deep infection occurred in 3 cases (1 case of resurfacing group and 2 cases of non-resurfacing group) at 3-7 months and they were cured after two-stage reversion. Patellofemoral compl ications occurred in 2 cases of resurfacing group (2/56, 3.57%) and in 9 cases of non-resurfacing group (9/404, 2.23%), showing no significant difference (χ2=0.38, P=0.54). There were significant differences in KSS and visual analogue scale (VAS) at 2 and 3 year after operation when compared with before operation (P lt; 0.05). No significant difference in KSS and VAS of resurfacing group and non-resurfacing group were observed at 3 years after operation (P gt; 0.05). Conclusion It is benefit for selective patellar resurfacing and the patellar tract improvement to select patellar resurfacing indication according to the multi-factor assessment and to determine the patellar tract by combining no thumb test and towel clamp traction test, which can reduce the patellofemoral compl ication rate after TKA.
【Abstract】 Objective To make the young patients with osteoarthritis and genu varum of knee delay total knee arthroplasty,to observe the cl inical effect of mosaicplasty of femoral medial condyle, patellar-plasty and high tibial osteotomy inthe treatment of osteoarthritis of knee with varum. Methods From June 2004 to February 2006, 8 patients with osteoarthritisof knee with varum(10 knees) were treated with combined operation such as mosaicplasty of femoral medial condyle, patellarplastyand high tibial osteotomy. There were 2 males with 3 knees, and 6 females with 7 knees,with an average age of 50 years(42-56 years). The left knees and right knees were involved in 3 cases respectively and bilateral knees in 2 cases. All patients hadknee ache after walk or long-time standing. The X-ray showed hyperosteogeny at peri-patella and circum ferential femur-tibialjoint，especially in the medial. The gap between patella and femur narrowed or disappeared，especially in the medial femurtibialjoint. The femoral tibial angel (FTA) was 185-200°(mean 190°). The HSS score of knee was 55-75(mean 60). The history ofknee ache was 1-12 years(mean 5 years). Results All patients were followed up for 7-24 months (mean 15 months). All theincisions healed by first intention, no early compl ication occurred. The cl inical bone heal ing time was 8-11 weeks(mean 9 weeks).Rectification of FTA was 15-30°(mean 20°). Normal weight-loading al ignment was recovered. The valgus angle of knee was 10°.The range of motion of knee was 100-120° after operation, increasing by 5-20° (mean 10°) when compared with preoperation.The X-ray of postoperation showed that genu varum was corrected obviously and that no displacement, loosening and breakageoccurred. The mean score of HSS was 80 (75-88), increasing by 20 when compared with preoperation. Conclusion Mosaicplastyof femoral medial condyle can make articular cartilage repair in certain degrees, patellar-plasty can rel ieve ache of fore region of knee effectively, and high tibial osteotomy can recover normal weight-loading al ignment. The curative effect is good withthe combined methods.
Objective To explore the cl inical effectiveness of arthroscopic reconstruction of medial patellofemoral l igament (MPFL) with trabs of medial soft tissues in the treatment of patellar instabil ity of adolescence. Methods From January 2005 to December 2006, 23 cases of patellar instabil ity were treated, including 10 males and 13 females with an average age of 16 years old (13 to 20 years old). The locations were left knee in 11 cases, right knee in 12 cases. The disease course was 1-28 weeks (mean 15 weeks). All patients had patellar instabil ity sense and knee arthralgia during strenuous exercise. Preoperative, the International Knee Documentation Committee (IKDC) score and Lysholm score were 48.30 ± 5.77 and 50.80 ± 7.61. The congruence angle, lateral patellar angle, and Q angle were (9.00 ± 2.46), (2.94 ± 2.55) and (19.10 ± 4.16)°. All of the patients experienced the operation of reconstruction of MPFL with trabs of medial soft tissues (medial patellar retinaculum, joint capsule and vastus medial is obl ique muscle fiber) through arthroscope. Results All the wounds healed by first intention, and no postoperative early compl ication occurred. All cases were followed up 19 months on average (12 to 24 months). Apprehensive test and patella tilt test were negative. The range of motion returned to normal. There was no recurrence of dislocation after operation. At 12 months after operation, the congruence angle, lateral patellar angle, and Q angle were (—7.03 ± 0.60), (11.00 ± 3.47) and (11.30 ± 1.90)°; the IKDC score and Lysholm score were 93.20 ± 3.51 and 94.10 ± 4.26. There were statistically significant differences between preoperation and postoperation (P lt; 0.05). Conclusion Arthroscopic reconstruction of MPFL with trabs of medial soft tissues can improved obviously the affected limb function in treatment of patellar instabil ity of adolescence.
Objective To review the influencing factors of medial patellofemoral ligament (MPFL) reconstruction for patellar dislocation. Methods The literature of MPFL reconstruction for patellar dislocation at home and abroad in recent years were summarized and analyzed. Results The influencing factors such as the location of the femoral insertion point, the tension and the fixed angle of the grafts, the dysplasia of the femoral trochlear before operation, the abnormal tuberositas tibiae-trochlear groove value, the high position of the patellar, and the tilting angle of the patellar, are all the factors affecting the effectiveness of MPLF reconstruction. Conclusion During MPFL reconstruction, the surgical techniques and elimination of other factors that caused patellar instability need to be focused in order to reduce the complications and operation failure.
Objective To compare the treatment effect of patellar resurfacing versus patellar non-resurfacing in total knee arthroplasty. Methods We identified eligible studies in PubMed (1950 to 2008.6), OVID MEDLINE (1950 to 2008.6), OVID CINAHL (1950 to 2008.6), OVID EBM (2nd Quarter 2008), CBMdisk (1978 to 2008.6), and CNKI (1981 to 2008.6), and handsearched some Chinese orthopedic journals to identified randomize controlled trials (RCTs) comparing patellar resurfacing versus patellar non-resurfacing in total knee arthroplasty. Data were extracted and methodological quality was critically assessed by two reviewers independently. Meta-analyses were performed using Stata 10.0 software. Outcomes of interest included the number of reoperations for patellofemoral problems, the prevalence of postoperative anterior knee pain, and the improvement in HSS knee score. Results Thirteen RCTs involving 1 566 patients were included. The scores of methodological quality respectively were more than 13. The results of meta-analyses showed that patellar resurfacing could decrease the re-operation rate for patellofemoral problems (RR=0.30, 95%CI 0.14 to 0.62, Plt;0.01). The rate of postoperative anterior knee pain and the improvement in HSS knee score were comparable between patellar resurfacing and patellar non-resurfacing. Conclusion The outcome identified is re-operations for patellofemoral problems. The resurfaced patella performs better, and we find an increased relative risk for re-operation when the patella is left un-resurfaced. No differences are observed between the two groups for the prevalence of postoperative anterior knee pain, and the improvement in HSS knee score. Further well-designed and large-scale RCTs are required to determine the effects of patellar resurfacing and non-resurfacing on these outcomes.
Objective To investigate the treatment and effectiveness of inferior polar comminuted fractures of patella and patellar tendon injury. Methods Between January 2003 and December 2008, 5 patients with inferior polar comminuted fractures of patella and patellar tendon injury were treated with Nitinol Patellar Concentrator and fascia lata allograft. There were 3 males and 2 females with a mean age of 33.7 years (range, 20-48 years). The interval of injury and operation was 1-5 days. Fracture degree: 3 cases had 3 fractures of patella, 2 cases had 4 fractures; patellar tendon injury degree: 3cases had horizontal rupture of middle l igament, 1 case had obl ique rupture of tibial tubercle, and 1 case had longitudinal partial rupture. Results Heal ing of incision by first intention was achieved in all patients, and no compl ication of infection or deep venous thrombosis occurred. The X-ray films at 2 days after surgery showed that patella recovered to normal height, which meaned ratio of patella height to patellar tendon length recovered to 1 : 1. Five cases were followed up 18 months on average (range, 10-22 months). At 3-12 weeks after surgery, the knee function of the injury side almost reached that of the normal side in 4 patients, and the knee range of motion was about 100° in 1 patient. The fracture heal ing time was 3-5 months. At 12-15 months after surgery, patella holder was taken out and no lost of reduction or refracture occurred. During follow-up, there was no fracture displacement, loosening and breakage of implant, or rerupture of patellar tendon. According to ZHANG Chuncai’ s criterion for knee joint function, the results were excellent in 3 cases, good in 1 cases, and fair in 1 case with an excellent and good rate of 80%. According to XU Shaoting’s criterion for knee joint function, the results were excellent in 2 cases, good in 2 cases, and fair in 1 case with an excellent and good rate of 80%. Conclusion Nitinol Patellar Concentrator and fascia lata allograft is a new method to treat inferior polar comminuted fractures of patella and patellar tendon injury, and it can ensure the knee joint stabil ity in early motion after surgery.
ObjectiveTo explore the treatment methed of recurrent patellar dislocation associated with old osteochondral fracture and to evaluate its effectiveness. MethodsBetween August 2010 and August 2014, 12 cases of recurrent patellar dislocation with old osteochondral fracture were treated. There were 4 males and 8 females with an average age of 18.3 years (range, 15-24 years). The left knee was involved in 7 cases and the right knee in 5 cases. All the patients had a history of patellar dislocation, the average interval from injury to first hospitalization was 7.6 months (range, 6-13 months). At preoperation, the range of motion (ROM) of the injured knee was (89.17±13.11)°; the Lysholm score was 56.67±18.91; the Q-angle was (17.50±5.28)°; and tibial tuberosity-trochlear groove (TT-TG) distance was (18.33±4.03) mm. The Q-angle was more than 20° and TT-TG distance was more than 20 mm in 6 of 12 cases. There were 6 cases of patellar osteochondral fracture, 5 cases of lateral femoral condylar osteochondral fracture, and 1 case of patellar osteochondral fracture combined with lateral femoral condylar osteochondral fracture. After osteochondral fracture fragments were removed under arthroscope, lateral patellar retinaculum releasing and medial patellar retinaculum reefing was performed in 2 cases, medial patellofemoral ligament (MPFL) reconstruction combined with both lateral patellar retinaculum releasing and medial patellar retinaculum reefing in 4 cases, and MPFL reconstruction, lateral patellar retinaculum releasing, medial patellar retinaculum reefing, and tibial tubercle transfer in 6 cases. ResultsAll wounds healed by first intention with no complication of infection, haematoma, skin necrosis, or bone nonunion. All patients were followed up 12-60 months with an average of 24.2 months. At 3 months after operation, all patellar dislocations were corrected; the Q-angle was (13.33±1.37)° and the TT-TG distance was (12.17±1.17) mm in 6 patients undergoing tibial tubercle transfer, showing significant differences when compared with preoperative values[(22.50±2.17)° and (21.33±2.34) mm] (t=15.25, P=0.00; t=8.27, P=0.00). All patients achieved relief of knee pain and knee locking; the knee ROM and the Lysholm score at last follow-up were (120.42±11.57)° and 89.25±9.71, showing significant differences when compared with preoperative ones (t=-11.61, P=0.00; t=-8.66, P=0.00). ConclusionIt has satisfactory short-term effectiveness to remove old osteochondral fragments that can not be reset and to correct patellar dislocation for recurrent patellar dislocation with old osteochondral fracture.
Objective To investigate the advance in surgical treatment of inferior pole fracture of patella and to explore the existing problems and further research directions. Methods Domestic and foreign l iterature in recent years on patella fracture was extensively reviewed, the surgical treatment of inferior pole fracture of patella was summarized by combining the research findings with cl inical experience. Results The surgical treatment of inferior pole of patella fractures included retaining the integrity of the patella and partial patellectomy of inferior pole of patella and extending knee installationreconstruction. There were kinds of ways to retain the integrity of the patella, such as circular wire fixation, tension bandfixation, NiTi-patella concentrotor fixation, basket plate fixation, reforming McLaughl in way and polydioxanone suture netfixation; the latter category is partial patellectomy and extensor device reconstruction. Every surgical way had its advantages and l imitations. Conclusion Most studies tend to retain the integrity of the patella, but some researches have shown that partial resection of inferior pole of patella had no significant effect on knee function. It is important to obtain the security excisional range and elongation range postoperative by experiment for regulating the treatment of comminuted fractures of inferior pole of patella.
ObjectiveTo review research progress of surgical treatment of patellar fractures.MethodsThe domestic and foreign literature about patellar fracture treatment in recent years was extensively consulted, and the advantages, disadvantages, and indications of various surgical treatments were summarized.ResultsThe patella plays an important role in knee flexion and extension activities, and the fracture significantly affects the patient’s quality of life. At present, the surgical methods include open reduction and internal fixation and patella resection. The internal fixation methods include ring/binding patella fixation, tension band wiring and improved technology, tension band wiring combined with other methods, screw fixation (including absorbable screws), steel plate fixation, and patella fixator fixation. Each surgical method has different indications, advantages, and disadvantages. Choosing an appropriate treatment plan plays a crucial role in clinical prognosis.ConclusionThere are many surgical treatments for patellar fractures. In order to improve the effectiveness and reduce postoperative complications, it is necessary to choose the most appropriate treatment strategy for the type of fracture.