An unusual case of extraarticular lipoma of the knee joint

Lipoma of the knee joint is a rare disease and most cases are lipoma arborescens within the joint. Here we report a case of true extraarticular lipoma of the knee.     

创伤性膝关节脱位的治疗体会

对13例膝关节脱位采用膝关节韧带修补重建术.平均随访16个月,治疗结果评定优4例,良6例,差3例.作者认为急诊复位、手术修复、重建韧带及功能锻炼可取得满意的效果.     

Intra-articular lipoma with osteochondroid metaplasia in the knee joint

We describe a case of lipoma with osteochondroid metaplasia in the knee joint. Although the location of the lesion and radiographic findings were unusual, computed tomography and magnetic resonance imaging were useful in characterizing adipose, cartilaginous and osseous tissue components within the lesion. Received: 12 October 2000 Revision requested: 3 November 2000 Revision received: 23 December 2000 Accepted: 28 December 2000     

An unusual cause for anterior knee pain: strangulated intra-articular lipoma

Lipoma is the most frequently encountered benign soft tissue tumor. However, intra-articular lipomas are rarely seen. Anterior knee pain is a frequent complaint of adults and is of diverse etiology. This 42-year-old female patient had severe anterior knee pain, unresponsive to medical treatment. Magnetic resonance imaging revealed an intra-articular tumor of the knee joint. Arthroscopic intervention and subsequent histological examination resulted in the diagnosis of strangulated lipoma originating from infrapatellar fat pad. We present clinical, radiological and operative features of this rare case of intra-articular lipoma.     

Locked lateral patellar dislocation: a rare case of irreducible patellar dislocation requiring open reduction

Irreducible patellar dislocations are rare injuries, but those that do occur are mainly directed intra-articularly. In this case, a 53-year-old woman sustained a locked lateral patellar dislocation when falling from a chair. A preoperative CT-scan revealed bony avulsions at the insertion of the vastus medialis muscle, the medial retinaculum, and partial disruption of the ligamentum patellae from the apex patellae. Open reduction was necessary and the torn structures were reattached with anchor systems and sutures. Postoperative management included intensive physiotherapy. At 1 year after surgery, the patient was without swelling or pain and had a normal gait, but flexion was restricted to 120°. All postoperative radiographs showed the patella correctly placed in the femoral groove. Received: 21 December 1998 Accepted: 15 April 1999     

膝关节滑膜树枝状脂肪瘤1例

患者 男,42岁,主诉右膝关节肿痛2年余,曾于2012-10在当地医院就诊,诊断为滑膜炎。给予抽液,冲洗,抗生素等治疗,症状得到缓解。本次由于胀痛症状再次出现,来院就诊。入院查体：中等体型,无膝关节外伤史。右膝关节较对侧明显肿胀,有压痛,局部皮温高,浮髌实验阳性,关节活动受限。实验室检查：血、尿、便常规及血尿酸正常,血沉、类风湿3项、C反应蛋白均在正常值范围。MRI 检查显示：膝关节腔及髌上囊内可见大量积液,积液内可见多发 T1 WI 序列呈高信号,脂肪抑制 T2 WI 序列呈低信号,树枝状、绒毛状结节(图1~4)。行右膝关节关节镜滑膜切除,术后病理诊断为：滑膜树枝状脂肪瘤。     

Magnetic resonance imaging comparison of intra-articular cavernous synovial hemangioma and cystic synovial hyperplasia of the knee

Purpose: To identify and compare magnetic resonance imaging (MRI) characteristics, with and without intravenous contrast medium, of cavernous synovial hemangiomas and cystic synovial hyperplasia.

Material and Methods: Four cases of cavernous synovial hemangioma and five of cystic synovial hyperplasia of the knee were studied retrospectively. The patients (5 F and 4 M; 15-25 years of age) all had long-standing knee pain. At clinical examination we observed elastic swelling and pain without significant joint effusion. The patients underwent conventional radiography and MRI without and following intravenous contrast medium before arthroscopic biopsy.

Results: The radiographs were interpreted as negative in all patients. MRI examination without contrast medium revealed a similar multicystic appearance for both lesions. Following intravenous contrast agent administration, cavernous synovial hemangiomas demonstrated avid, rather homogenous enhancement, whereas cystic synovial hyperplasia demonstrated less intense, peripheral enhancement only. Arthroscopy with histological examination of the lesions confirmed the MRI diagnosis in every case.

Conclusion: In our experience, cavernous synovial hemangioma and cystic synovial hyperplasia have a similar appearance on unenhanced MRI, but can be reliably differentiated on the basis of enhancement characteristics following intravenous contrast administration.     

Spontaneous recurrent hemarthrosis of the knee joint in elderly patients with osteoarthritis: an infrequent presentation of synovial lipoma arborescens

Synovial lipoma arborescens (SLA) is a rare, benign, fat-containing synovial proliferative lesion that is typically known to affect the knee joint in adults, although it has also been described in other joints. SLA usually presents as a painless swelling and recurrent joint effusion, and the laboratory test results, including aspirated synovial fluid, are usually normal. We present here two cases of SLA of the knee, which presented as spontaneous recurrent hemarthroses in elderly patients with osteoarthritis (OA) with bloody aspirated synovial fluid. Magnetic resonance imaging (MRI) and arthroscopic synovectomy suggested the diagnosis of SLA; the histopathologic examination confirmed the diagnosis. One year later, both patients remain symptom-free and report no new episodes of hemarthrosis. We postulate that SLA should be included in the differential diagnosis of patients with recurrent joint effusions with hemarthrosis in elderly patients with OA. The clinical presentation, MRI findings, and treatment of SLA are described, and the entity is briefly reviewed.     

A case of intra-articular fracture of the knee joint with three layers within lipohemarthrosis by ultrasonography and computed tomography

We report a case of intra-articular fracture of the knee joint showing three layers within lipohemarthrosis. Sagittal ultrasonography showed three layers (double fluid-fluid level): a superior hyperechoic layer of fat, an intermediate anechoic layer of serum, and an inferior hypoechoic layer of red blood cells. Horizontal computed tomography imaging demonstrated the same three layers. This is the first case of lipohemarthrosis in which three layers of joint effusion were confirmed by both ultrasonography and computed tomography.     

阴式超声在剖宫产瘢痕处妊娠检查中的临床应用

剖宫产术后子宫瘢痕处妊娠是一种特殊类型的宫内异位妊娠,临床上比较少见,近年来其发病率随着剖宫产术的不断增加而上升。对剖宫产术后子宫瘢痕处妊娠的早期诊断,选择治疗的方法及对保守治疗疗效的评价已越来越受到妇产科医生的重视。本文总结2004年10月～2008年12月收治我院妇产科住院的子宫瘢痕处妊娠7例患者进行回顾性分析,旨在探讨彩色多普勒超声在剖宫产子宫瘢痕处妊娠检查中的临床应用价值。     

Arthroscopic synovectomy of synovial tuberculosis of the knee joint

Synovial tuberculosis is a rare, but important differential diagnosis of synovial diseases. Three cases of arthroscopic synovectomy of tubercular monarthritis affecting the knee joint are reported. The Lysholm scoring scale modified by Klein and Kloos was excellent in two cases, but poor in one. In all three cases there was an excellent improvement in the range of motion compared to the preoperative period and no deterioration of the Larsen score in the follow-up period (25–56 months postoperatively). Considering these results arthroscopic synovectomy can be recommeded as an alternative to the open procedure of synovectomy.     

急性膝关节脱位的手术治疗

创伤性膝关节脱位少见，对这些损伤的错误治疗可能会引起灾难性的后果，特别是并发的血管损伤引起的筋膜间隔综合征和肢体坏死。     

The influence of patellar dislocation on the femoro-tibial loading during total knee arthroplasty

Purpose  

Balancing the gap is essential in total knee arthroplasty (TKA). The purpose of this study was to quantify the influence of patellar position on femoro-tibial joint load in TKA. We hypothesized that resetting of the patella increased medial joint load and decreased lateral joint load.     

Iatrogenic medial patellar instability following lateral retinacular release of the knee joint

Purpose

Iatrogenic medial patellar instability (IMPI) is a disabling but easily missed condition that is most often seen as a late complication of lateral retinacular release (LRR) procedures. The purposes of this study were (1) to summarize the available diagnostic methods and (2) to explore the contributing factors of IMPI following LRR procedures.

Methods

The MEDLINE, PubMed, EMBASE and Cochrane Library databases were searched for studies including diagnosed IMPI cases following LRR procedures. All patients were first divided into IMPI group and non-IMPI group based on the diagnostic methods of IMPI collected from studies. Univariate analysis was performed by comparing the two groups with regard to individual patient data (age at initial LRR, gender) and surgical details (type, releasing scope, combined surgeries and indication) of LRR procedures. Multivariate logistic regression was carried out to identify independent contributing factors for IMPI and to calculate odds ratios (ORs).

Results

Eight studies with 274 patients (300 knees) were finally included. Of those, 161 patients (171 knees, 57.0 %) had IMPI and 113 patients (129 knees, 43.0 %) had no IMPI. Univariate analysis revealed a statistically significant difference between both groups for releasing scope (P ₁ < 0.001) and indication of LRR procedures (P ₂ < 0.001), with releasing lateral retinaculum (LR) + vastus lateralis (VL) tendon and absence of tight LR during the initial LRR procedures being more common in patients with IMPI. The independent contributing factors for IMPI identified in the multivariate logistic regression analysis were releasing LR + VL (OR₁ = 16.49) and absence of tight LR (OR₂ = 14.37).

Conclusions

The IMPI was more common in patient with an over-released LRR and patient who was absent of tight LR during the initial LRR procedures. Aggressive surgical corrections and inappropriate indications of initial LRR were two contributing factors for the late complications of IMPI. This study suggests that the IMPI may occur as a major complication of LRR, especially when the VL tendon is extensively released or when there is no confirmative clinical evidence of a tight LR preoperatively.

Level of evidence

IV.

     

髋关节不典型滑膜软骨瘤病1例

患者女,52岁。左髋部进行性肿痛伴活动受限8月余加重2周。查体：左髋关节半屈位,髋关节周围肿胀饱满,腹部沟区压痛明显,有反跳痛。实验室检查：血、尿、粪、血沉、结核抗体、生化全项、类风湿因子、C-反应蛋白未见异常。     

Anatomy of patellar dislocation

Acute patellar dislocation is a common injury that can lead to disabling knee pain and/or recurrent instability. In the past 10 years, research has begun to focus on the injuries associated with acute patellar dislocation, and the specific contributions the injured structures make to patellar stability in intact knees. The implication is that injury to specific structures may have important consequences in converting a previously asymptomatic, although perhaps abnormal, patellofemoral joint into one that is painful and/or unstable. These studies have been intended to improve the precision of surgical treatment for patellar instability, and their results are driving refinements in our surgical indications as well as technique.     

跗跖关节脱位1例报告

跗跖关节脱位临床少见，现将近期遇见的1例报道如下。     

胸锁关节脱位合并胸骨柄体脱位1例

回顾性分析1例胸锁关节脱位合并胸骨柄体脱位的患者,经手术治疗,恢复良好。     

Treatment of acute patellar dislocation

To determine the effectiveness of nonoperative and operative treatment of initial acute patellar dislocation, we reviewed the charts of 399 patients with the diagnosis of an acute dislocation, seen during a 30 year period. One hundred patients (103 knees) met the criteria for inclusion in the study. The average age of the patient at injury was 21.7 years (range, 9 to 72 years). Length of followup averaged 8 years (range, 2 to 26 years). Retrospectively, we divided the patients into two groups, according to the examination of their unaffected knee. Group I (69 knees) showed evidence on examination of congenital abnormality of the extensor mechanism in the unaffected knee, indicating a predisposition to dislocate with less significant trauma. Group II (34 knees) showed no clinically perceptible congenital predisposition to dislocate based on examination of the unaffected knee. In the nonoperatively treated knees in Group I, there was a 52% (28/54) incidence of good or excellent results. The nonoperatively treated knees in Group II had a 75% (15/20) incidence of good or excellent results. Acute dislocation occurred more frequently in males than in females. Recurrence was rarer in patients whose initial dislocation had occurred when they were over 15 years old. Contrary to recently published reports, primary acute traumatic patellar dislocations can be treated with nonoperative therapy with good or excellent results. Initial evaluation should include examination of the uninvolved knee which, if found to have signs of congenital abnormality, would indicate a worse prognosis.