Unstable osteochondral fragment of the lateral femoral condyle containing the popliteus tendon origin. Report of three cases

Objectives: Aim of this article is to present a pediatric patient with patellar osteochondral fracture treated by arthroscopical fixation and discuss through the literature. Patellar osteochondral fractures are kind of injuries mostly seen in adolescents and young adults, generally occur after trauma causing dislocation of patella and frequently accompanied by chondral damage in the lateral femoral condyle. Surgical intervention is indicated for the displaced and intraarticular fragments. Methods: Thirteen-year-old male patient referred our clinic with a swollen knee, limitation in knee movements, after he had fallen on his right knee while skating 2 weeks previously and was also unable to stand on his right leg. Plain radiogram, computerized tomography and magnetic resonance images of the right knee evaluated in our clinic and a chondral defect (17x10mm in size) in distal of medial marge of patella and an intraarticular osteochondral fragment just inferomedial to patella and anterior to lateral femoral condyle was determined. Results: In the arthroscopical evaluation osteochondral defect and intraarticular fragment were observed. In addition there was chondral lesion on the chondral surface of lateral femoral condyle. Osteochondral fragment was replaced to the distal part of medial marge of patella as arthroscopically, then retrograde fixed using 2 compressive screws (24x2.7 mm and 26x2.7 mm) from patella to the fragment. Conclusion: As patellar osteochondral fractures usually occur following acute dislocation of patella, rarely may occur without dislocation. We could find 2 cases in the literature which aren't accompanied by dislocation of patella. One of them is a non-displaced fracture and the other one is an osteochondral fragment with 15x20 mm in size which was resected due to inconformity. Eighty percent of acute dislocations of patella are accompanied by contusions on lateral femoral condyle and intraarticular fragments are present in 11 to 74 percent of cases. In this article we present 13 year-old male patient with an osteochondral fracture in the inferior of medial marge of patella without dislocation of patella, which was displaced into joint space and accompanied by a chondral lesion on the lateral femoral condyle, and then treated by artroscopical reduction and fixation. Our case seems to be original due to occuring without dislocation of patella and being the first case treated by arthroscopical intervention. Displaced and intraarticular patellar osteochondral fractures should be replaced and fixed by surgically. We consider that when compared with open joint surgery, arthroscopical replacement and fixation of osteochondral fractures causes lower morbidity and helps to improve rehabilitation of the patient.

Download Full-text

The evaluation of the distance between the popliteus tendon and the lateral collateral ligament footprint and the implant in Total Knee Arthroplasty using a 3-dimensional template.

10.21203/rs.2.22354/v3 ◽

2020 ◽

Author(s):

Akihito Takubo ◽

Keinosuke Ryu ◽

Takanori Iriuchishima ◽

Masahiro Nagaoka ◽

Yasuaki Tokuhashi ◽

...

Keyword(s):

Femoral Condyle ◽

Lateral Collateral Ligament ◽

Lower Limbs ◽

Lateral Femoral Condyle ◽

Popliteus Tendon ◽

Femoral Bone ◽

Collateral Ligament ◽

Bone Resection ◽

Total Knee ◽

Resection Area

Abstract Background The popliteus tendon (PT) or lateral collateral ligament (LCL) stabilizes the postero-lateral aspects of the knees. When surgeons perform total knee arthroplasty (TKA), PT and LCL iatrogenic injuries are a risk because the femoral attachments are relatively close to the femoral bone resection area. The purpose of this study was to evaluate the distance between the PT or LCL footprint and the TKA implant using a 3D template system and to evaluate any significant differences according to the implant model.Methods Eighteen non-paired formalin fixed cadaveric lower limbs were used (average age: 80.3). Whole length lower limbs were resected from the pelvis. All the surrounding soft tissue except the PT, knee ligaments and meniscus were removed from the limb. Careful dissection of the PT and LCL was performed, and the femoral footprints were detected. Each footprint periphery was marked with a 1.5 mm K-wire. Computed tomography (CT) scanning of the whole lower limb was then performed. The CT data was analyzed with a 3D template system. This simulation models for TKA were the Journey II BCS and the Persona PS. The area of each footprint, and the length between the most distal and posterior point of the lateral femoral condyle and the edge of each footprint were measured. Matching the implant model to the CT image of the femur, the shortest length between each footprint and the bone resection area were calculated.Results PT and LCL footprint were detected in all knees. The area of the PT and LCL footprints was 38.7±17.7mm2 and 58.0±24.6mm2, respectively. The length between the most distal and posterior point of the lateral femoral condyle and the edge of the PT footprint was 10.3±2.4mm and 14.2±2.8mm, respectively. The length between most distal and most posterior point of the lateral femoral condyle and the edge of the LCL footprint was 16.3±2.3mm and 15.5±3.3mm, respectively. Under TKA simulation, the shortest length between the PT footprint and the femoral bone resection area for the Journey II BCS and the Persona PS was 4.3±2.5mm and 3.2±2.9mm, respectively. The shortest length between the LCL footprint and the femoral bone resection area for the Journey II BCS and the Persona PS was 7.2±2.3mm and 5.6±2.1mm, respectively. The PT attachment was damaged by the bone resection of the Journey II BCS and the Persona PS TKA in 3 and 9 knees, respectively.Conclusion The PT and LCL femoral attachments existed close to the femoral bone resection area of the TKA. To prevent postero-lateral instability in TKA, careful attention is needed to avoid damage to the PT and LCL during surgical procedures.

Download Full-text

The evaluation of the distance between the popliteus tendon and the lateral collateral ligament footprint and the implant in Total Knee Arthroplasty using a 3-dimensional template.

10.21203/rs.2.22354/v2 ◽

2020 ◽

Author(s):

Akihito Takubo ◽

Keinosuke Ryu ◽

Takanori Iriuchishima ◽

Masahiro Nagaoka ◽

Yasuaki Tokuhashi ◽

...

Keyword(s):

Femoral Condyle ◽

Lateral Collateral Ligament ◽

Simulation Models ◽

Ct Scanning ◽

Lower Limbs ◽

Lateral Femoral Condyle ◽

Popliteus Tendon ◽

Collateral Ligament ◽

Bone Resection ◽

Resection Area

Abstract Background When surgeons perform TKA, popliteus tendon (PT) and lateral collateral ligament (LCL) iatrogenic injuries are a risk because the femoral attachments are relatively close to the bone resection area. The purpose of this study was to evaluate the distance between the PT or LCL footprint and the TKA implant using a 3D template system and to evaluate any significant differences according to the implant model. Methods Eighteen non-paired formalin fixed cadaveric lower limbs were used. All the surrounding soft tissue except the PT, ligaments and meniscus were removed from the knee. Careful dissection of the PT and LCL was performed, and the femoral footprints were detected. Each footprint periphery was marked with a K-wire. CT scanning was then performed. The data was analyzed with a 3D template system. This simulation models for TKA were the Journey II BCS and the Persona PS. The area of each footprint, and the length between the most distal and posterior point of the lateral femoral condyle and the edge of each footprint were measured. Matching the implant model to the CT image, the shortest length between each footprint and the osteotomy area were calculated. Results The area of the PT and LCL footprints was 38.7±17.7mm 2 and 58.0±24.6mm 2 . The length between the most distal and posterior point of the lateral femoral condyle and the edge of the PT footprint was 10.3±2.4mm and 14.2±2.8mm. The length between these same points and the edge of the LCL footprint was 16.3±2.3mm and 15.5±3.3mm. Under TKA simulation, for the Journey II BCS and the Persona PS, the shortest length between the PT footprint and the osteotomy area was 4.3±2.5mm and 3.2±2.9mm, and the shortest length between the LCL footprint and the osteotomy area was 7.2±2.3mm and 5.6±2.1mm. The PT attachment was damaged by the bone resection of the Journey II BCS and the Persona PS TKA in 3 and 9 knee. Conclusion The PT and LCL femoral attachments existed close to the femoral bone resection area of the TKA. Careful attention is needed to avoid damage to the PT and LCL during surgical procedures.

Download Full-text

Two Patients with Osteochondral Injury of the Weight-Bearing Portion of the Lateral Femoral Condyle Associated with Lateral Dislocation of the Patella

Case Reports in Orthopedics ◽

10.1155/2014/876410 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Shuji Nakagawa ◽

Yuji Arai ◽

Hiroaki Inoue ◽

Satoru Atsumi ◽

Shohei Ichimaru ◽

...

Keyword(s):

Patellar Dislocation ◽

Femoral Condyle ◽

Weight Bearing ◽

Lateral Femoral Condyle ◽

Bearing Surface ◽

Lateral Dislocation ◽

Osteochondral Injury ◽

Osteochondral Fragment ◽

Femoral Groove ◽

Dislocation Of The Patella

Complications of patellar dislocation include osteochondral injury of the lateral femoral condyle and patella. Most cases of osteochondral injury occur in the anterior region, which is the non-weight-bearing portion of the lateral femoral condyle. We describe two patients with osteochondral injury of the weight-bearing surface of the lateral femoral condyle associated with lateral dislocation of the patella. The patients were 18- and 11-year-old females. Osteochondral injury occurred on the weight-bearing surface distal to the lateral femoral condyle. The presence of a free osteochondral fragment and osteochondral injury of the lateral femoral condyle was confirmed on MRI and reconstruction CT scan. Treatment consisted of osteochondral fragment fixation or microfracture, as well as patellar stabilization. Osteochondral injury was present in the weight-bearing portion of the lateral femoral condyle in both patients, suggesting that the injury was caused by friction between the patella and lateral femoral condyle when the patella was dislocated or reduced at about 90° flexion of the knee joint. These findings indicate that patellar dislocation may occur and osteochondral injury may extend to the weight-bearing portion of the femur even in deep flexion, when the patella is stabilized on the bones of the femoral groove.

Download Full-text

Two cases of chronic knee pain caused by unusual injuries to the popliteus tendon

Joints ◽

10.11138/jts/2016.4.1.062 ◽

2016 ◽

Vol 04 (01) ◽

pp. 062-064

Author(s):

Eric Davalos ◽

David Barank ◽

Rajeev Varma

Keyword(s):

Knee Pain ◽

Femoral Condyle ◽

Insertion Site ◽

Joint Space ◽

Lateral Femoral Condyle ◽

Popliteus Tendon ◽

Musculotendinous Junction ◽

Chronic Knee Pain

Injuries to the popliteus tendon are less frequent than injuries to the menisci or ligamentous structures of the knee. When they do occur, injuries to the popliteus tendon tend to be the result of trauma and associated with injuries to other components of the knee. The most commonly seen injuries include tears at the musculotendinous junction and avulsion tears at the lateral femoral condyle insertion site. This report presents two unusual injuries of the popliteus tendon in pa tients with chronic knee pain: an isolated split tear of the tendon and a subluxed tendon residing within the lateral joint space.

Download Full-text