Hook plating in patella fractures

PurposeTension band wiring is considered the standard treatment for patella fractures. However, it is limited for fractures with marginal involvement, comminution, and osteoporotic bone. Our experience indicates that these limitations can be overcome with the hook plate. We evaluated the radiographic and clinical outcomes in patients with patella fracture treated with hook plating.MethodsWe enrolled 30 patients who underwent hook plating for patella fracture at two institutions between 2013 and 2017. Fracture classification and surgical options were reviewed. Postoperative fracture gap and time to union as radiographic measurements, and complications, range of motion, and functional outcome with the Lysholm score as clinical outcomes, were evaluated retrospectively.ResultsNine fractures were AO/OTA 34A1, three B1, one B2, two C1, nine C2, and six C3. All were closed fractures. There were 3 cases of revision, 4 with lateral or medial marginal fracture, 9 with isolated inferior pole fracture, and 14 with comminuted fracture. The average postoperative fracture gap was 0.4 (range, 0–2.0) mm, and bone union was achieved without additional intervention. The average time to union was 11.6 (range, 7–24) weeks. There were no complications, and no extension lag except in one case (10°). The average flexion was 138.5° (range, 110–145°). For functional outcomes, the average Lysholm score was 89.5 (range, 74–95), with 13 excellent, 14 good, 3 fair, and no poor cases.ConclusionThis study suggests that hook plating can result in good bone union and restored knee function in marginal or comminuted fractures of the patella.     

经皮微创钛缆内固定治疗髌骨骨折的效果及对患者应激反应、骨代谢指标的影响

目的探讨经皮微创钛缆内固定治疗髌骨骨折的效果及对患者应激反应、骨代谢指标的影响。方法选取我院自2018年1月至2020年1月收治的77例髌骨骨折患者,按照术式的不同分为对照组38例、观察组39例。对照组给予传统切开复位术治疗,观察组给予经皮微创钛缆内固定术治疗,比较两组一般手术指标、并发症、应激反应指标、骨代谢指标。结果观察组手术时间、出血量、术后住院时间、骨折愈合时间少于对照组(P0.05);观察组并发症总发生率为12.82%,低于对照组的34.21%(P0.05);观察组膝关节功能评分在术后15 d[(65.21±5.97)分vs (56.47±6.23)分]、术后1个月[(70.28±4.96)分vs (61.65±5.17)分]、术后3个月[(82.68±3.25)分vs(77.62±4.02)分]时高于对照组(P 0.05);术后24 h,观察组血清Cor [(13.82±2.02)ng/mL vs (21.36±3.79)ng/mL]、PGE2[(131.25±17.64)pg/mL vs (162.49±21.05)pg/mL]、E [(35.02±6.37)ng/mL vs (60.63±7.59)ng/mL]、NE[(45.65±5.22)ng/mL vs (76.94±7.06)ng/mL]水平低于对照组(P0.05);术后24 h,观察组血清OC[(6.30±0.74)μg/L vs (5.28±0.71)μg/L]、PⅠNP[(38.52±6.09)ng/mL vs(23.19±3.57)ng/mL]水平高于对照组(P0.05),CTX-Ⅰ[(312.07±50.36)pg/mL vs(558.39±62.98)pg/mL]、CTX-Ⅱ[(211.45±32.18)pg/mL vs (342.62±40.92)pg/mL]水平低于对照组(P0.05)。结论经皮微创钛缆内固定治疗髌骨骨折创伤小,术后并发症少,可明显改善膝关节功能,减轻应激反应,改善术后骨代谢。     

全膝关节置换术中髌骨置换与髌骨截骨疗效的病例对照研究

目的：比较人工全膝关节置换术髌骨截骨和髌骨置换的疗效,为临床治疗提供参考.方法：2004年4月至2011年4月行人工全膝关节置换术52例（54膝）,分为髌骨置换组和髌骨截骨组.髌骨置换组24例24膝,其中男13例,女11例,年龄53～78岁;髌骨截骨组28例30膝,男16例,女12例,年龄55～79岁.术后对其进行临床评价,包括膝关节评分（HSS评分系统）,髌骨评分（Feller评分标准）,膝关节活动度（ROM）,患者满意度,髌骨相关并发症.结果：术后随访20～80个月,平均56个月.髌骨置换组HSS评分由术前38.4±8.2提高为末次随访时的91.2±8.6,Feller评分由13.6±6.2提高为25.2±4.2,膝前痛分数由3.9±3.2提高为11.2±3.7,ROM由（78±26）°提高为（108±18）°.髌骨截骨组HSS评分由术前39.5±8.4提高为末次随访时的91.0±8.5,Feller评分由13.4±6.5提高为25.6±4.0,膝前痛分数由3.7±3.1提高为11.3±3.6,ROM由（76±27）°提高为（110±19）°.术后满意度髌骨置换组91％,髌骨截骨组89％;髌骨相关并发症髌骨置换组16.7％,髌骨截骨组10.0％.两组术后HSS评分、Feller评分、膝前痛分数及ROM比较差异无统计学意义,患者满意度比较差异无统计学意义,两组髌骨相关并发症比较差异有统计学意义,髌骨截骨组低于髌骨置换组.结论：全膝关节置换术中髌骨置换与髌骨截骨均能明显改善膝关节功能和减轻疼痛,髌骨相关并发症与髌骨的处理方式有关,但术后膝前痛及患者满意度与髌骨的处理方式无关.     

The incidence of trochlear dysplasia in anterior cruciate ligament tears

Purpose

The purpose of the present epidemiologic study is to record the radiographic presence of trochlear dysplasia and patella alta in patients who undergo anterior cruciate ligament (ACL) reconstruction as a potential underlying factor for post-operative anterior knee pain (AKP).

Methods

All consecutive cases of skeletally-mature ACL-deficient knees that would undergo ACL reconstruction in three different hospitals were prospectively included during a six-month period. Inclusion criteria were acute and sub-acute ACL injury with no previous ipsilateral knee operation. Patients with chronic ACL tears, prior-to-ACL-injury history of patellar instability or other PF disorders were excluded from the study.

Results

A total of 299 knees were included (mean age 32 ± ten years). Forty-four (14.7 %) knees had a positive ‘crossing sign’ in the lateral X-rays and 255 (85.3 %) had no sign of trochlear dysplasia (p < 0.01). Among the cases with trochlear dysplasia, 41 (93 %) had type A trochlear dysplasia with the presence only of the ‘crossing sign’ and three (7 %) had type C trochlear dysplasia. Patellar height results included a mean Caton-Deschamps index of 1.0 ± 0.14 (0.5–1.4). Twenty (6.6 %) knees had an index of less than 0.8, and two (0.6 %) knees had an index less than 0.6. In contrast, 15 (5.0 %) knees had an abnormal value of more than 1.2, indicating patella alta.

Conclusions

The most important finding of the study is the increased prevalence of trochlear dysplasia and patella alta in patients with ACL injury, when compared to the incidence of trochlear dysplasia and patella alta in the general population in the literature. This finding could sound as an alert of a possible additional risk factor for post-operative anterior knee pain after ACL reconstruction.     

Better results with patelloplasty compared to traditional total knee arthroplasty

Purpose

The aim of this study was to compare the results of primary total knee arthroplasty with or without patelloplasty.

Methods

We retrospectively reviewed 89 patients who had received total knee arthroplasty. In patelloplasty, the patellar cartilage was resected using a tangential saw cut, and in the traditional treatment, only the surrounding osteophytes were removed. The outcome was measured using radiographs, Knee Injury and Osteoarthritis Outcome Score, Oxford Knee Score, Knee Society Score, Knee Society Function Score and Knee Society Pain Score.

Results

Patelloplasty patients had a better outcome according to the Oxford Knee Score (P = 0.012), Knee Injury and Osteoarthritis Outcome Score (P = 0.003) and all of the Knee Injury and Osteoarthritis Outcome Score subscales (P < 0.05). The patella was significantly thinner (P = 0.001) post-operatively in the patelloplasty patients, but there was no statistically significant correlation between Oxford Knee Score or Knee Injury and Osteoarthritis Outcome Score and post-operative patellar thickness in the patelloplasty group.

Conclusions

In this follow-up, patelloplasty was better than traditional treatment in relieving pain and improving function and quality of life.