Anatomie et tendinopathie patellaire : un malentendu

The anatomical structure linking the patella and the tibia is called the “patellar ligament” in the international nomenclature. This term is well accepted yet can be a source of confusion for non-specialists. This is because the priority role of this structure is not to maintain joint stability, the primary role of the cruciate ligaments and the collateral ligaments, but rather to prolong the mechanical action of the quadriceps muscle onto the leg skeleton beyond the “patellar sesmoid”. Patellar tendon injuries are a common observation in sports medicine. The proximal third of the tendon below the patella is most generally involved. This highly frequent tendinopathy sometimes termed an “insertion” tendiopathy. Based on 100 consecutive magnetic resonance imaging studies and cadaveric dissection, we confirm that the insertion of the patellar tendon is situated on the anterior aspect of the patella and not the tip. We describe two anatomical variants of the healthy patellar tendon (type 1 and 2) that should not be confused with a site of tendinopathy. The anatomical limits between tendinous tissue and infrapatellar adipose body (the Hoffa adipose ligament), notably on the upper third is still debated and merits further work.     

Landing on Your Own Two Feet: A Case Report of Bilateral Calcaneus and Open Pilon Fractures

High energy fractures of the distal tibial plafond and calcaneus have been associated with high functional morbidity and wound complications. Although both of these fractures result from a similar mechanism, they have rarely been reported to occur on an ipsilateral extremity. The combination of these 2 injuries on the same extremity would increase the likelihood of an adverse surgical or functional outcome. We present the case and management strategy of a 43-year-old male with bilateral open pilon fractures and closed calcaneal fractures after falling from a height. A staged protocol was used for the bilateral pilon fractures, with external fixation until operative fixation on day 9. Nonoperative management of the calcaneal fractures resulted in a successful functional outcome at 10 months of follow-up. Treatment of this fracture pattern must incorporate the condition of the soft tissues, an understanding of the fractures, and minimize patient risk factors to optimize the functional and surgical outcomes.     

哈尔滨市中小学生身材比例变化情况

目的 分析1999和2010年哈尔滨7 ～18岁儿童青少年身材比例的变化特点,为及时识别或发现身体的生长异常提供基础数据.方法 1999,2010年分别对分层整群抽取的哈尔滨市城区7～18岁3 162名,3 971名学生进行身高、坐高、腓骨点高等指标的测量,并统计分析.结果 哈尔滨城市男女学生身高、坐高、小腿长随着年龄增加而增长,2010年各指标值高于1999年.1999,2010年哈尔滨城市男女学生坐高/腿长变化随年龄增长逐渐下降,15岁以后基本稳定,但1999年多于半数的年龄组此值大于2010年.1999和2010年,1O岁之后女生坐高/腿长均高于男生.1999年与2010年哈尔滨城市男女学生小腿长/腿长集中在0.52 ～0.54之间；男、女生差异不明显.结论 近11 a来,哈尔滨7～ 18岁城市男女学生身高、坐高、小腿长均有所增长；坐高/腿长在青春期前性别和年份差异不明显,青春期后女性略高于男性；小腿长/腿长不存在明显的年份和性别差异.     

Guidebook for Nutrition Counselors

Background: Because accurate measures of recumbent length are essential to assess growth and energy requirements of mobility-impaired individuals with cerebral palsy (CP), a reliable and simple method of estimating recumbent length is required. Prediction of recumbent length from knee height in this population has not yet been investigated.

Objectives: i) To correlate direct measures of recumbent length in mobility-impaired individuals having lower leg extremity cerebral palsy (LECP) involvement with indirect measures of recumbent length calculated using knee-height prediction equations and ii) to determine if knee height is a reliable predictor of recumbent length in this population.

Methods: Subjects (n=34; 15F, 19M), aged 6 to 30 years, were participants in a six-month nutrition rehabilitation program. All subjects had varying degrees of LECP involvement. Recumbent length to the nearest 0.5 cm was measured by standardised techniques. Knee height was measured to the nearest 0.5 centimetre using sliding callipers. Equations based on normal, healthy individuals with application to mobility-impaired or handicapped individuals were used to predict recumbent length from knee height.

Results: Direct measures of recumbent length of subjects significantly correlated with indirect measures calculated using knee height prediction equations (R=0.88, p≤0.0001). In addition, knee height of these subjects was a reliable predictor of recumbent length (R²=0.78, p<0.0001).

Conclusions: Results suggest that knee height may be a reliable predictor for recumbent length in this population.     

Anthropometric characteristics and comorbidities in Japanese patients with neurofibromatosis type 1: A single institutional case–control study

Neurofibromatosis type 1 (NF1) is a well‐known genetic disorder characterized by café‐au‐lait spots and neurofibromas, but many other clinical characteristics and associated comorbidities also have been reported. This study aimed to characterize NF1 further by investigating its association with anthropometric characteristics and other diseases. We performed a case–control study of 227 NF1 patients (101 male, 126 female) and a randomly selected age‐ and sex‐matched control group of 681 non‐NF1 patients (303 male, 378 female) who visited our institution in Japan. We examined adult (≥20 years) height and body mass index (BMI), and, in the total sample, allergic diseases (bronchial asthma [BA], atopic dermatitis [AD] and allergic rhinitis) and other respiratory cardiovascular and psychiatric disorders. In adults, the mean BMI was lower in the NF1 group than in the control group, and was significantly statistically different among men (P = 0.0238). In the whole sample, the prevalences of BA (P = 0.0184), AD (P = 0.0144) and valvular heart disease (P = 0.0166) were significantly greater in the NF1 group than in the control group. To date, no similar research on the BMI or the prevalence of allergic disease in NF1 patients has been reported. Our results suggest that NF1 patients tend to have lower BMI and may have alterations in specific metabolic pathways and altered allergic immunity.     

Non-metallic implant for patellar fracture fixation: A systematic review

IntroductionDespite good clinical outcome proposals, there has been relatively little published regarding the use of non-metallic implant for patellar fracture fixation. The purpose of the study was to perform a systematic literature review to summarize and evaluate the clinical studies that described techniques for treating patella fractures using non-metallic implants.MethodsA comprehensive literature search was systematically performed to evaluate all studies included in the literature until November 2015. The following search terms were used: patellar fracture, patella suture, patella absorbable, patella screw, patella cerclage. Two investigators independently reviewed all abstracts and the selection of these abstracts was then performed based on inclusion and/or exclusion criteria.ResultsA total of 9 studies involving 123 patients were included. Patients had a mean age of 33.7 years and were followed up for a mean of 18.9 months. The most common method for fracture fixations included the use of suture material. Good clinical outcomes were reported among all studies. Thirteen patients (10.5%) presented complications, while 4 patients (3.2%) required additional surgery for implant removal.ConclusionThere is a paucity of literature focused on the use of non-metallic implant for patellar fracture fixation. However, this systematic review showed that non-metallic implants are able to deliver good clinical outcomes reducing the rate of surgical complications and re-operation. These results may assist surgeons in choosing to use alternative material such as sutures to incorporate into their routine practice or to consider it, in order to reduce the rate of re-operation.     

Austrian height and body proportion references for children aged 4 to under 19 years

Abstract

Background: Previous studies have demonstrated differences between national and the WHO reference curves in children older than 5 years. Moreover, reference curves for body proportions (sitting height, subischial leg length and their ratio) based on state-of-the-art statistics are not available.

Aim: To develop reference curves for height and body proportions for use in Austria and compare the curves with WHO reference curves. To estimate and statistically investigate extreme percentiles.

Subjects and methods: A sample of ～14?500 children between 4–19 years of age was drawn via schooling institutions, stratified by provinces according to age- and sex-specific population proportions. GAMLSS models were used for a flexible estimation of percentile curves.

Results and conclusions: After the age of 5 years national reference curves are more suitable than the WHO reference curves for clinical use in Austria. These height curves are very similar to the German reference curves published recently. Therefore, these reference curves for criteria of body proportions are recommended for use in other populations. Further validation studies are needed to establish whether the recently recommended ?2.5 and ?3.0 SD for height are a sensitive and specific cut-off in the diagnostic work-up for children with a suspected growth disorder using this new Austrian height chart.     

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??Objective??To evaluate the clinical effect of maxillary sinus lifting??bone graft??and simultaneously placement of implants in severely atrophic maxillae and the stability of cylindrical implants. Methods??Totally 20 patients with 30 Straumann tissue-level implants were included. After osteotome sinus floor elevation and grafting??implants were inserted. Patients were recalled at 1 and 3-years follow-up. Implant success??resonance frequency analysis??clinical and radiographic outcomes were recorded. Results??At 3-year examination??the implant success rate was 96.7%. The ISQ value was 71.1±4.15??69.6 ± 5.01??68.4 ± 4.34 and 72.8 ± 6.42 at implant insertion??2??4 and 12 weeks after surgery. Modified bleeding index was 0.53 ± 0.40 and 0.61 ± 0.31 at 1 and 3-year examination. Probing depth was??3.21 ± 0.67??mm and??3.45 ± 0.71??mm at 1 and 3-year examination. Modified plaque index was 0.48 ± 0.44 and 0.52 ± 0.51 at 1 and 3-year examination. No significant difference was found between two examinations. Marginal bone loss increased from ??1.16 ± 0.27??mm at 1-year follow-up to ??1.45 ± 0.39?? mm at 3-year follow-up??the difference reached statistically significant??P < 0.05??. Implant apex height decreased from ??2.05 ± 0.43??mm at baseline to ??1.85 ± 0.75??mm at 1-year and ??1.42 ± 0.69??mm at 3-year follow-up??the difference reached statistically significant??P < 0.05??. Conclusion??Maxillary sinus lifting??bone graft??and simultaneously placement of implants could be a predicable treatment option in severely atrophic maxilla. In addition??cylindrical implants could achieve enough stability during the healing phrase. High success rate could be achieved in the short term.     

Association of varus thrust with prevalent patellofemoral osteoarthritis: A cross-sectional study

This cross-sectional study investigated (i) the association of varus thrust during gait with the presence of patellofemoral osteoarthritis (PFOA) in patients with medial knee osteoarthritis (OA) and (ii) patellar alignment in the knees with varus thrust. Participants from orthopedic clinics (n = 171; mean age, 73.4 years; 71.9% female) diagnosed with radiographic medial knee OA (Kellgren/Lawrence [K/L] grade ≥1) were included in this study, and underwent gait observation for varus thrust assessment using 2D video analysis. A radiographic skyline view was used to assess the presence of medial PFOA using the grading system from the Osteoarthritis Research Society International Atlas. The tibiofemoral joint K/L grade, patellar alignment (i.e., lateral shift and tilting angle), and knee pain intensity were also evaluated as covariates. Thirty-two (18.7%) of 171 patients exhibited varus thrust and they presented significantly higher knee pain (46.0 ± 3.04 mm vs. 32.4 ± 2.73 mm; P = 0.024), a lower patellar tilting angle (P = 0.024), and a higher prevalence of PFOA compared with those without varus thrust. A logistic regression analysis with adjustment of covariates showed that varus thrust was significantly associated with higher odds of the presence of mixed and medial PFOA, and trended to significantly associate with any PFOA, including lateral PFOA. This indicates that varus thrust was associated with PFOA in a compartment-nonspecific manner in patients with medial knee OA. Varus thrust may represent a clinical disease feature of more advanced and multicompartmental disease.