Tumor like swellings arising from Hoffa's fat pad: A report of three patients

We report three rare cases of tumor-like conditions arising from Hoffa''s fat pad (HFP). Patients were having persistent knee pain, the cause of which was not diagnosed by the general physician, and then were referred to us for knee pain. Magnetic resonance imaging revealed the lesions to be arising from HFP (ganglion cysts and hemangioma), as was suggested by clinical findings. Anatomy, pathology, and radiological features of the Hoffa''s disease are described here to increase awareness in orthopedic community of this rare but interesting disease which is often misdiagnosed as meniscal pathology. These cases illustrate that increased cognizance can facilitate timely intervention which will prevent morbidity of the patient.     

COMP in the Infrapatellar Fat Pad—Results of a Prospective Histological,Immunohistological, and Biochemical Case–Control Study

Knee osteoarthritis (OA) involves several structures and molecules in the joint, which interact in a pathophysiological process. One of these molecules is the cartilage oligomeric matrix protein (COMP). Elevated COMP levels in the synovial fluid as well as in the serum have been described in OA patients. However, this has not been described in the infrapatellar fat pad (IPFP) tissue before. In this prospective trial, we collected 14 IPFPs from patients with high-grade OA (mean age 63.8 ± 17.6 years) who underwent total knee replacement (OA group) and from 11 healthy patients (mean age 33.7 ± 14.8 years) who underwent anterior cruciate ligament reconstruction (control group). The presence of macrophages (CD68 and CD206) and proinflammatory cytokines (interleukin 1β [IL-1β] and IL-6) was analyzed. Histological and immunohistological examinations as well as immunoblotting analysis for COMP, leptin, and matrix-metalloproteinase-3 were performed. The IPFPs of both the OA and control group consisted of adipose tissue and fibrous tissue, and the fibrous tissue showed higher score values than the adipose tissue for COMP staining (intensity as well as stained area) in both groups. Although COMP could be detected in most samples, leptin expression was found only in single specimens. COMP could be detected mostly in the fibrous tissue portion of the IPFP. We speculate that it is involved in a remodeling process taking place in the IPFP during OA. Presence of leptin was irregular in immunohistology, and the control group showed higher scores in case of presence. Interestingly, immunoblotting could detect leptin in all analyzed samples. © 2019 The Authors. Journal of Orthopaedic Research® published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society J Orthop Res 38:747-758, 2020     

The nature of anterior knee pain following injection of hypertonic saline into the infrapatellar fat pad.

The infrapatellar fat pad has been implicated as a possible source of anterior knee pain. This study examined the nature, distribution and time-course of experimentally induced pain in the infrapatellar fat pad. Hypertonic saline (5%) was injected into the medial fat pad of 11 healthy individuals with no history of knee pain. Severity of pain was assessed at rest and during activity using an 11 point numerical rating scale (NRS) at regular intervals over 15-30 min following injection. Participants described the size of the pain region from a series of different sized circles while the area and type of pain was established from a body chart and the McGill pain questionnaire. The effect of pain on temperature-pain threshold and sensory thresholds of the anterior knee was assessed. Participants generally reported a deep aching pain that peaked in severity around 3 min and gradually declined over 15 min. Pain levels were not altered by clinical manoeuvres designed to impinge the fat pad. The size of the pain region was related to pain intensity. Pain was most commonly felt in the region of the fat pad medial to the patella, although some individuals reported proximal referred pain as far as the groin region. Thermal and sensory thresholds were not altered at a region close to the injection site during the experimental pain. These results suggest that nociceptive stimulation of the infrapatellar fat pad may cause anterior knee pain that is not necessarily confined locally particularly if pain is severe. This has implications for the investigation of pathological structures in patients presenting clinically with anterior knee pain and provides an experimental model of anterior knee pain.     

Influence of an infrapatellar fat pad edema on patellofemoral biomechanics and knee kinematics: a possible relation to the anterior knee pain syndrome

Introduction  An edema of the infrapatellar fat pad following knee arthroscopy or in case of chronic anterior knee pain syndrome is suspected to increase the patellofemoral pressure by a modification of the patellofemoral glide mechanism. The study was performed to evaluate this hypothesis. Materials and methods  Isokinetic knee extension from 120° of flexion to full extension was simulated on 10 human knee cadaver specimens (six males, four females, average age at death 42 years) using a knee kinemator. Joint kinematics was evaluated by ultrasound sensors (CMS 100^TM, Zebris, Isny, Germany), and retro-patellar contact pressure was measured using a thin-film resistive ink pressure system (K-Scan^TM 4000, Tekscan, Boston). Infrapatellar tissue pressure was analyzed using a closed sensor cell which was implanted inside the fat pad (GISMA, Buggingen, Germany). An inflatable fluid cell was implanted by ultrasound control in the center of the infrapatellar fat pad and filled subsequently with water to simulate a fat pad edema. All parameters were recorded and analyzed from 0 to 5 ml volume of the fluid cell. Results  Simulating a fat pad edema resulted in a significant (P < 0.01) increase of the infrapatellar fat pad pressure (247 mbar at 0 ml to 615 mbar at 5 ml volume). In knee extension and flexion the patella flexion (sagittal plane) was decreased while we did not find any other significant influence of the edema on knee kinematics. During the analysis of the patellofemoral biomechanics, a simulated fat pad edema resulted in a significant (P < 0.05) decrease of the patellofemoral force between 120° of knee flexion and full extension. The contact area was reduced significantly near extension (0°–30°) by an average of 10% while the contact pressure was reduced at the entire range of motion up to 20%. Conclusion  An edema of the infrapatellar fat pad does not cause an increase of the patellofemoral pressure or a significant alteration of the patellofemoral glide mechanism. Anterior knee pain in case of a fat pad edema may be related to a significant increase of the tissue pressure and possible histochemical reactions. The study was funded by the German Speaking Association of Artroscopy (AGA).     

Case report. An unusual cause of a patient presenting with an acutely locked knee: multiple benign fat pad cysts

Benign ganglion (synovial) cysts within the knee are uncommon and especially so when located in the infrapatellar fad pad. They cause many non-specific symptoms but usually present as a swelling. We report the case of a young gentleman with multiple benign synovial cysts within the fat pad causing a locked knee, which was treated with arthroscopically assisted open excision. We can find no previous reports of isolated multiple fat pad cysts causing acute locking of the knee.     

Infrapatellar fat pad volume and Hoffa-synovitis after ACL reconstruction: Association with early osteoarthritis features and pain over 5 years

Infrapatellar fat pad (IPFP) morphology and Hoffa-synovitis may be relevant to the development and progression of post-traumatic osteoarthritis (OA). We aimed to compare IPFP volume and Hoffa-synovitis in participants with anterior cruciate ligament reconstruction (ACLR) and uninjured controls, and to determine their association with prevalent and worsening early knee OA features and pain in participants post-ACLR. We assessed IPFP volume and Hoffa-synovitis from magnetic resonance imaging (MRI) in 111 participants 1-year post-ACLR and 20 uninjured controls. Patellofemoral and tibiofemoral cartilage and bone marrow lesions (BMLs) were assessed from MRIs at 1 and 5 years post-ACLR, and worsening defined as any longitudinal increase in lesion size/severity. IPFP volume and Hoffa-synovitis prevalence were compared between groups with analysis of covariance and χ ² tests, respectively. Generalized linear models assessed the relation of IPFP volume and Hoffa-synovitis to prevalent and worsening features of OA and knee pain (Knee injury and Osteoarthritis Outcome Score—Pain Subscale, Anterior Knee Pain Scale). No significant between-group differences were observed in IPFP volume (ACLR 34.39 ± 7.29cm³, Control 34.27 ± 7.56cm³) and Hoffa-synovitis (ACLR 61%, Control 80%). Greater IPFP volume at 1-year post-ACLR was associated with greater odds of patellofemoral BMLs at 1-year (odds ratio [OR] [95% confidence intervals]: 1.104 [1.016, 1.200]) and worsening tibiofemoral cartilage lesions at 5-year post-ACLR (OR: 1.234 [1.026, 1.483]). Hoffa-synovitis at 1-year post-ACLR was associated with greater odds of worsening patellofemoral BMLs at 5-year post-ACLR (OR: 7.465 [1.291, 43.169]). In conclusion, IPFP volume and Hoffa-synovitis prevalence are similar between individuals 1-year post-ACLR and controls. Greater IPFP volume and Hoffa-synovitis appear to be associated with the presence and worsening of some early OA features in those post-ACLR, but not pain.     

髌下脂肪垫滑膜软骨瘤病1例报告

患者,女,38岁,主因右膝下渐肿胀3年入院,不伴有关节交锁,打软腿,无外伤病史。查体:右膝髌下膨隆肿大,象眼消失,触诊约有5 cm×5 cm大小肿物,表面欠光滑,质柔韧,无压痛,活动差,右膝关节活动度良好。辅助检查:CR拍片可见右膝髌下散在多个圆形高密度影。MRI扫描见,右膝髌骨下方,关     

Age‐associated increases in the size of the infrapatellar fat pad in knee osteoarthritis as measured by 3T MRI

Obesity, as a primary risk factor for osteoarthritis (OA), has been shown to alter joint loading, but may also result in metabolic changes characterized by chronic, low‐level inflammation due to increased circulating levels of adipose‐derived cytokines, or “adipokines.” The presence of the infrapatellar fat pad in the knee suggests that local changes in adipokine concentrations may influence knee OA. This study examined the hypotheses that the volume of the infrapatellar fat pad is correlated to the body mass index (BMI) of OA patients, and that fat pad volume is greater in subjects with OA. Fat pad volume was measured in sequential magnetic resonance (MR) images taken over one year in a cohort of 15 control and 15 knee OA subjects. No differences were observed in the fat pad volume between the two groups at baseline, 3, 6, or 12 months. In control subjects, no significant correlations were present between any parameters (age, BMI, weight, volume of fat pad at any time point). However, in the osteoarthritic group, fat pad volume was correlated with age at every time point. One possible explanation is that local factors related to knee OA may also induce enlargement of the fat pad with age. Alternatively, subjects who are prone to growth or enlargement of the fat pad may also be more prone to symptomatic OA. These findings provide intriguing preliminary data on the potential role of the infrapatellar fat pad in OA, although additional study is required to better understand the mechanisms of this relationship. © 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 28:1149–1154, 2010     

髌下脂肪垫对全膝关节置换术后患者膝关节功能恢复影响的meta分析

目的通过meta分析评价髌下脂肪垫对全膝关节置换患者术后功能恢复的影响。 方法检索Cochrane Library、Embase、PubMed英文数据库和万方数据库、维普数据库以及中国知网数据库有关于髌下脂肪垫对全膝关节置换术后影响的临床随机对照试验（RCTs）和回顾性队列研究实验（RCSs）,使用Revman5.3软件进行meta分析。 结果最终共纳入8篇文献,其中英文文献4篇,中文文献4篇,共纳入全膝关节置换术病例1 474例,其中髌下脂肪垫切除术696例,髌下脂肪垫保留组778例。与髌下脂肪垫切除相比,髌下脂肪垫保留组可降低术后髌韧挛缩（MD=-2.34,95% CI：-3.38~-1.31,P<0.05）,麦克马斯特骨关节炎指数（WOMAC）评分（MD=2.34,95% CI：2.04~2.65,P<0.05）;提高膝关节功能评分（MD=-0.77,95% CI：-1.02~-0.52,P<0.05）,降低术后膝关节前侧疼痛发生率（RR=12.58,95% CI：3.24~48.75,P<0.05）。两组患者在术后膝关节活动度（MD=-7.53,95% CI：-20.27~5.21,P>0.05）,髌腱长度与髌骨最大长轴比值（Insall-Savatict）评分法（MD=-0.04,95% CI：-0.09~0.01,P>0.05）;术后膝关节返修率：（RD=0.01,95% CI：-0.01~0.02,P>0.05）方面无明显差异。 结论与髌下脂肪垫去除组相比,全膝关节置换术后髌下脂肪垫保留可以降低髌韧带痉挛程度,提高膝关节功能评分,同时可降低膝关节前侧疼痛。     

腰椎Scheuermann病(附5例报告)

目的 探讨腰椎Scheuermann病的病因、发病机制和诊断与治疗。方法 共收治5例患者,全部表现为严重下腰痛,X线片示腰椎1-2个椎间隙上下终板不规则,Schmorl结节形成,椎间隙狭窄,对其进行椎间盘造影和腰椎前路植骨融合术。术中将椎体上下终板和其下的薄层松质骨一并切下,进行常规病理组织学检查。结果 Scheuermann病发生的椎间隙其椎间盘造影试验阳性。5例病人术后随访6～20个月,平均12月。4例术后腰痛症状消失,l例仍有腰痛,但较术前明显减轻。X线片上显示的终板不规则和Schmorl结节在组织学上实际上是终板和终板下松质骨的骨坏死。结论 腰椎Scheuermann病的发病机制实质上是椎体软骨终板下的骨坏死。腰椎Scheuermann病手术治疗具有良好临床效果,腰椎间盘造影术阳性是确保手术成功的关键。     

佩吉特骨病1例

<正>患者女,63岁,因"无诱因出现间断性头痛5年余,近1个月加重,咳嗽时双颞侧剧烈跳痛"就诊。查体:头部及四肢关节未见畸形、活动障碍等异常。实验室检查:碱性磷酸酶(alkaline phosphatase, ALP)1 668 U/L。骨密度检测提示骨量减少。头颅X线片:颅骨轮廓尚见,头皮软组织肿胀,骨质内多发混杂密度影,病灶形状不规则;提示颅骨多发病变。胸部、双侧肱骨、骨盆X线检查骨质均未见明显异常。全身骨显像:颅骨弥漫性摄取增强,放射性     

手术治疗食道型颈椎病8例

目的:探讨手术治疗以吞咽困难为主诉的食道型颈椎病的临床疗效和手术方式。方法:对2005年6月至2012年5月采用颈椎前路手术方式治疗的8例食道型颈椎病患者进行回顾性分析,其中男6例,女2例;年龄65~83岁,平均73岁。3例行单纯骨赘切除,2例合并椎间盘摘除、植骨融合及内固定术,3例合并椎体次全切、植骨融合及内固定术。观察手术前后症状体征并用Bazaz吞咽困难评分进行评价。结果:8例患者均获得随访,时间12~40个月,平均18.5个月。末次随访结果为无症状7例,轻度症状1例,影像学示气管后、椎体前间隙较术前明显增大。结论:手术治疗以吞咽困难为主诉的食道型颈椎病效果良好,手术方式依据患者病变节段椎体的稳定性、是否合并神经症状而定。     

Castleman's disease in the pelvic retroperitoneum: A case report and review of the Japanese literature

INTRODUCTIONCastleman's disease is a fairly rare benign tumor of lymphoid origin. It can develop anywhere lymphoid tissue is found, but the expected origin is mediastinum and rarely pelvic retroperitoneum.PRESENTATION OF CASEA 22-year-old woman was admitted to our hospital for a mass in the pelvic retroperitoneum that was detected incidentally on an ultrasonography during a routine medical checkup with no signs of symptoms. After laboratory examination, ultrasonography, and magnetic resonance imaging (MRI), surgical resection was performed successfully through a lower midline incision. But the patient was needed transfusion because of massive bleeding. Postoperative histopathological diagnosis was hyaline-vascular type of Castleman's disease. The patient is leading an active social life without any signs of sequelae or recurrence.DISCUSSIONThrough the review of Japanese literature on Castleman's disease in the retroperitoneum, the characteristics of preoperative imaging findings are studied. Castleman's disease is easily misdiagnosed clinically because of its scarcity and no specific imaging findings. And the embolization via angiography should be considered in the hypervasular tumors such as in this case to prevent massive bleeding and transfusion.CONCLUSIONAlthough Castleman's disease is uncommon, it should always be included in the differential diagnosis of pelvic retroperitoneal tumors. A better knowledge of this disease would help surgeon to avoid unnecessarily extensive resection and massive bleeding for transfusion when dealing with retroperitoneal tumors.     

Severe stricturing Crohn's disease of the duodenum: A case report and review of surgical options

INTRODUCTIONDuodenal Crohn's disease is a rare clinical entity that occurs in 0.5–4.0% of patients with Crohn's disease. A unique case of Crohn's disease of the upper gastrointestinal tract characterized by multiple strictures within the duodenum and jejunum is described in our review.PRESENTATION OF CASEA 41-year-old male presented with a 2-month history of intermittent, crampy abdominal pain accompanied by nausea, bilious emesis, early satiety, anorexia and weight loss. Physical examination revealed fullness in the epigastric region. Imaging demonstrated strictures in the proximal and distal duodenum with dilatation of the intervening segments. There was also gross dilatation of the proximal jejunum, which was followed by a 9 cm strictured segment. There was no evidence of acute Crohn's disease. Although a Whipple's resection was initially considered as a form of operative intervention given the extent of disease within the duodenum, the discovery of unexpected disease intra-operatively presented a surgical dilemma. In this case, strictureplasty, surgical resection and bypass were used to treat the patient.DISCUSSIONDiffuse stricturing of the proximal gastrointestinal tract is a rare manifestation of Crohn's disease. Although imaging can aid in surgical planning, intra-operative decision-making to deal with unexpected findings will remain an important aspect of the management of this entity.CONCLUSIONThe fundamental goal of the surgical management of strictures secondary to Crohn's disease is to relieve obstruction while maximizing bowel conservation. A variety of operative techniques are currently described for the management of duodenal Crohn's disease and are reviewed in this case report.     

A histochemical study of the mucosubstances of the colon in cases of Hirschsprung's disease with and without enterocolitis

From the histochemical studies of the mucus factor in normal controls and 10 cases with Hirschsprung's disease including 5 with enterocolitis, using Alcian blue-PAS method, we concluded that ganglionosis had no effect on the secretion of mucus. The presence of qualitative changes in the type of mucopolysaccharides, demonstrated as an increase in the sulphated group especially in cases with enterocolitis, was secondary to the chronic obstruction. These nonspecific changes might diminish the protecting mechanism of the mucous membrane. Quantitative changes were seen to be related to the severity of the enterocolitis.