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patellar dislocation following distal femoral replacement after extraarticular knee resection for bone sarcoma:A case report

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World Journal of Clinical Cases 2022年第11期10卷 3561-3572页

作者： Yuta Kubota Kazuhiro Tanaka Masashi Hirakawa Tatsuya Iwasaki Masanori Kawano Ichiro Itonaga Hiroshi Tsumura Orthopaedic Surgery Oita UniversityYufu City 879-5593OitaJapan

BACKGROUND For the treatment of bone sarcoma in the distal femur,wide-margin resection and knee reconstruction with tumor endoprosthesis are standard therapies.Extraarticular knee resection is required in cases of tumor invasion of the knee joint;however,the incidence of complications,such as aseptic loosening,prosthesis infection,and implant failure,is higher than that following intra-articular knee resection.To the best of our knowledge,there are three reports of patellar dislocations after replacement of a tumor endoprosthesis.CASE SUMMARY A 36-year-old man with no significant past medical history was admitted to our institution with continuous pain in his left knee for 4 mo.An open biopsy was performed,and the patient was diagnosed with a left distal femoral malignant bone tumor.Extra-articular knee resection and knee reconstruction with a tumor endoprosthesis were performed.Although the alignment of the tumor prosthesis was acceptable,knee instability was noticed postoperatively.The axial radiographic view of the patellar and computed tomography showed lateral patellar dislocation at 4 wk postoperatively.The patient had to undergo a lateral release and proximal realignment.He could perform his daily activities at 9 mo postoperatively.Radiography revealed no patellar re-dislocation.CONCLUSION Proximal realignment may be considered during primary surgery if there is an imbalance in the forces controlling the patellar tracking.

关键词： Bone tumor Distal femoral replacement Lateral release patellar dislocation Proximal realignment Case report

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Combination of medial patellofemoral ligament reconstruction with vastus medialis advancement for chronic patellar dislocation

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Chinese Medical Journal 2010年第21期123卷 3024-3029页

作者： WANG Fei KANG Hui-jun CHEN Bai-cheng CHEN Wei SU Yah-ling ZHANG Ying-ze Department of Joint Surgery Third Hospital of Hebei Medical University Shijiazhuang Hebei 050051 China Orthopedic Institute Third Hospital of Hebei Medical University Shijiazhuang Hebei 050051 China Center of Trauma Third Hospital of Hebei Medical University Shijiazhuang Hebei 050051 China

Background The medial patellofemoral ligament （MPFL） reconstruction is popular in clinical practice for chronic patellar dislocation; however, the combination with vastus medialis advancement is rare. The aim of this study was to evaluate the clinical outcome of the combination of MPFL reconstruction with vastus medialis advancement.Methods We retrospectively analyzed 69 patients with chronic patellar dislocation between July 2004 and October 2008： twenty eight cases with isolated MPFL reconstruction （group Ⅰ）, forty one cases with the combination of MPFL reconstruction with vastus medialis advancement （group C）. All patients had CT scans available for review with knee flexion at 30 degree, on which the congruence angle, patellar tilt angle and patellar lateral shift were measured. Physical apprehension tests were examined and the redislocation was recorded. In addition, knee function was evaluated using the Kujala score and subjective questionnaires.Results Patients were followed up for a mean of 42 months （12-65 months） without a recurrent dislocation reported.Postoperatively, all indexes on CT scan were within the normal range without a statistical difference between the two groups. Results from the apprehension test showed eight patients in group Ⅰ and three in group Chad patellar lateral shift exceeding 1.5 cm with a hard end point （P 〈0.05）. The Kujala score improved significantly from 51.3±4.5 to 79.9±6.2 in group Ⅰ and from 53.7±5.2 to 83.9±6.5 in group C （P 〉0.05）. However, the subjective questionnaire revealed a significant difference （P 〈0.05）, including 12 excellent, seven good and nine fair in group Ⅰ and 30 excellent, six good and five fair in group C.Conclusion The combination of MPFL reconstruction with vastus medialis advancement is better than isolated reconstruction to improve the subjective effects and decrease the patellar instability rate for chronic patellar dislocation.

关键词： patellar dislocation medial patellofemoral ligament isometric reconstruction combined reconstruction vastus medialis advancement

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Significance of Diffusion Tensor Imaging of Vastus Medialis Oblique in Recurrent patellar dislocation

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Chinese Medical Journal 2017年第6期130卷 642-646页

作者： Li-Si Liu Zhuo-Zhao Zheng Hui-Shu Yuan Department of Radiology Peking University Third Hospital Beijing 100191 China Department of Radiology Tsinghua Changgung Hospital Beijing 102218 China

Background： Numerous studies have investigated the influence of osseous factors on patellofemoral joint instability, but research on the influence of dynamic muscle factors in vivo is still in the exploratory stage. This study aimed to use magnetic resonance imaging （MRI） and diffusion tensor imaging （DTI） to evaluate vastus medialis oblique （VMO） fiber bundles in patients with recurrent patellar dislocation to explore the changes in muscle morphology and function. Methods： This prospective study involved 30 patients （7 males and 23 females; average age, 21.4 ± 3.8 years） clinically diagnosed with recurrent patellar dislocation in Peking University Third Hospital and 30 healthy volunteers matched for age, sex, and body mass index in our medical school between January 2014 and October 2014. None of the patients had a recent history of traumatic patellar dislocation or transient patellar dislocation. All patients underwent conventional MRI and DTI of the knee. The cross-sectional area of the VMO on MRI and the fractional anisotropy （FA）, apparent diffusion coefficient （ADC）, and primary （λ1）, secondary （λ2）, and three-level characteristic （λ3） values on DTI were measured. The independent-samples t-test was used to compare these parameters between the two groups. Results： Compared with the control group, the patient group showed significantly higher FA values （0.39 ± 0.05 vs. 0.33 ± 0.03） and significantly lower ADC （1.51 ± 0.13 vs. 1.58± 0.07）, λ2 （4.96 ±0.13 vs. 5.04 ± 0.07）, and λ3 values （4.44 ± 0.14 vs. 4.58 ± 0.07; t = 5.99, t = -2.58, t = 3.02, and t = -4.88, respectively： all P 〈 0.05）. Cross-sectional VMO area and λ1 values did not differ between the two groups （t = 1.82 and t = 0.22, respectively; both P 〉 0.05）. Conclusions： The functional status of the VMO is closely associated with recurrent patellar dislocation. MRI, especially DTI （FA, ADC, λ2, and ,λ3）, can detect early changes in VMO function and might lhcilitate the noninvasive monitoring of the functional status of the VMO in patients with recurre

关键词： Diffusion Tensor lmaging Magnetic Resonance Imaging patellar dislocation Vastus Medialis Oblique

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Horizontal Inferior patellar dislocation in an Elderly Patient: A Case Report and Review of Literature

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Open Journal of Orthopedics 2023年第6期13卷 224-232页

作者： Ramy Shehata Shuchi Kohli Akshdeep Bawa Sandeep Kohli Norfolk and Norwich University Hospital Norfolk UK Whiston Hospital St Helens and Knowsley NHS Trust Merseyside UK Princess Royal University Hospital—Kings College NHS Trust Orpington UK

Intra-articular patellar dislocation due to acute trauma is considered a rare presentation and is less commonly encountered in practice than extra-articular patellar dislocation. This case study presents a rare type 2 inferior dislocation of the patella in an elderly patient which was successfully reduced and managed non-operatively.

关键词： patellar dislocation Elderly Patient Horizontal Inferior Patella dislocation

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Repair of a large patellar cartilage defect using human umbilical cord blood-derived mesenchymal stem cells:A case report

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World Journal of Clinical Cases 2022年第34期10卷 12665-12670页

作者： Jun-Seob Song Ki-Taek Hong Ki Jeon Song Seok Jung Kim Department of Orthopedic Surgery Gangnam JS HospitalSeoul 06053South Korea Department of Orthopedic Surgery Uijeongbu Street Mary’s HospitalCollege of MedicineThe Catholic University of KoreaUijeongbu 11765GyeonggidoSouth Korea

BACKGROUND patellar dislocation may cause cartilage defects of various sizes.Large defects commonly require surgical treatment;however,conventional treatments are problematic.CASE SUMMARY A 15-year-old male with a large patellar cartilage defect due to patellar dislocation was treated via human umbilical cord blood-derived mesenchymal stem cell(hUCB-MSC)implantation.To our knowledge,this is the first report of this treatment for this purpose.The patient recovered well as indicated by good visual analog scale,International Knee Documentation Committee and McMaster Universities Osteoarthritis Index scores.Magnetic resonance imaging showed cartilage regeneration 18 mo postoperatively.CONCLUSION Umbilical cord blood-derived hUCB-MSCs may be a useful treatment option for the repair of large patellar cartilage defects.

关键词： Cartilage defect Umbilical cord Mesenchymal stem cells patellar dislocation Magnetic resonance imaging Case report

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Fixation versus Excision of Osteochondral Fractures after patellar dislocations in Adolescent Patients： A Retrospective Cohort Study

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Chinese Medical Journal 2018年第11期131卷 1296-1301页

作者： Hui Kang Jian Li Xu-Xu Chen Tao Wang Shi-Chang Liu Hong-Chuan Li Department of Sports Medicine Hong-Hui Hospital Xi'an Jiaotong University Medical College Xi'an Shaanxi 710054 China Department of Spine Surgery Hong-Hui Hospital Xi'an Jiaotong University Medical College Xi'an Shaanxi 710054 China

Background： patellar dislocation is one of the most common knee injuries in the adolescent population. It is often combined with osteochondral fracture. The purpose of this study was to cornpare the outcomes between fixation and excision of osteochondral fractures not involving the bearing surface in adolescent patients with patellar dislocations. Methods： Patients who underwent surgery for osteochondral fracture following patellar dislocation in our institution from 2007 to 2014 were retrospectively evaluated. Visual analog scale （VAS） of pain and the International Knee Documentation Committee （IKI）C） form were used to assess knee pain and function at follow-up. Patient satisfaction was evaluated. Differences in the values of variables among groups were assessed using t-test if equal variance or Mann-Whitney U-test if not equal variance. The Pearson＇s Chi-square test was applied for dichotomous variables if expected frequency was 〉5 or Fisher＇s exact test was applied if not. A value of P 〈 0.05 was considered statistically significant. Results： Forty-three patients were included, with the average age of 14.1 ± 2.3 （range, 9.0-17.0） years. Nineteen underwent fixation of osteochondral fractures and 24 did not. The average follow-up time was 28 ± 10 months. There was no significant difference in age, gender, follow-up time, causes of injury, times of dislocation, and location of osteochondral fracture between fixation and excision groups. The fixation group had a significantly longer surgery time （82± 14 rain） and larger size of osteochondral fracture （2.30 ±0.70 cm2） than the excision group （43 ± 10 min, 1.88 ± 0.62 cm2, respectively, t = 10,77, P 〈 0.01 and t = 0.84, P 〈 0.05）. At the last follow-up, the average I KDC score in the fixation group （82.52 ± 8.71 ） was significantly lower than that in the excision group （89.51 ± 7.19, t 2.65, P 〈 0.01 ）. There was no significant difference in VAS of pain and patients＇ satisfaction. There were 7 （16%） patients with recurrent dislocation. Conclusion： Excision of osteoc

关键词： Adolescent Osteochondral Fracture patellar dislocation

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