scholarly journals PRESENTING FEATURES, CLINICAL COURSE, SURGICAL TECHNIQUES, AND OUTCOMES ASSOCIATED WITH OPERATIVE TREATMENT OF BIPARTITE PATELLA IN PEDIATRIC AND ADOLESCENT ATHLETES: A RETROSPECTIVE COMPARISON TO A NON-OPERATIVELY TREATED COHORT

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0024
Author(s):  
Jennifer Kallini ◽  
Lyle J. Micheli ◽  
Dennis E. Kramer ◽  
Mininder S. Kocher ◽  
Benton E. Heyworth
Keyword(s):  
Operative Treatment ◽  
Knee Pain ◽  
Clinical Course ◽  
Surgical Techniques ◽  
Lateral Release ◽  
Minor Trauma ◽  
Adolescent Athletes ◽  
Bipartite Patella ◽  
Competitive Athletes ◽  
Fragment Excision

Background: The bipartite patella is a developmental variant in which incomplete ossification leads to a fibrocartilaginous synchondrosis between ossification centers; repetitive traction on the synchondrosis in young athletes may lead to pain. Few series of surgical cases exist to guide treatment approaches to refractory pain. Hypothesis/Purpose: To investigate the presenting features, clinical course, surgical techniques, and outcomes associated with operative treatment of symptomatic bipartite patella in pediatric and adolescent athletes, with comparison to a control group of symptomatic, non-operative patients. Methods: A retrospective medical record review of patients ≤20 years-old diagnosed with symptomatic, radiographically-confirmed bipartite patellae between 2003 and 2018 at a single tertiary-care pediatric hospital was conducted. Patients for whom knee pain could not be attributed to bipartite patella were excluded. Additional clinical and operative variables were collected for the subset that underwent surgical treatment. Outcomes analyzed included time to return to sport (RTS) and re-operation. Results: 278 patients (37.8% females; mean age: 12.7 years, range 7-20 years) were included, 27 (mean age: 15.3 years, range 10-20 years) of whom were treated operatively (9.7%). Compared to the 251 patients who underwent non-operative treatment (consisting of physical therapy, activity modification, non-steroidal anti-inflammatory medicines, and cryotherapy), the operatively treated patients were more likely to be older (mean age 12.4 years vs. 15.3 years, p<0.001), female (35.5% vs. 59.3%, p=0.02) and competitive athletes (83.6% vs. 100%, p=0.10). Of the operative patients, 16 (59%) had Saupe III (superolateral) ossicles, 8 (30%) had Saupe II (lateral) ossicles, and 3 (11%) had Saupe I (inferior) ossicles. Most operative patients (79%) reported insidious onset of pain, with minor trauma precipitating symptom onset in the remainder (21%). Symptom duration prior to surgery was 2.2 years (range 1.7 mo-10.1yrs). Procedures were categorized as isolated fragment excision (n=10), fragment excision with lateral release (n=9), isolated lateral release (n=4), ORIF (n=3), and arthroscopic drilling (n=1). Operative outcomes are found in Table 1. Conclusions: Bipartite patella may be an underappreciated cause of knee pain in adolescent athletes. Patients who underwent surgery displayed symptoms lasting >2 years, representing ˜10% of cases, and were most likely to have superolateral bipartite fragments with a mean size of ˜1cm2. Surgery was more common amongst females, competitive athletes, and older adolescents. There was an overall 11% risk of persistent or recurrent symptoms warranting re-operation. Prospective multi-center investigations may be warranted to identify optimal candidates for earlier interventions, as well as optimal non-operative and operative treatment techniques. [Table: see text]

scholarly journals Operative Treatment of Bipartite Patella in Pediatric and Adolescent Athletes: A Retrospective Comparison With a Nonoperatively Treated Cohort

2020 ◽  
Vol 8 (12) ◽  
pp. 232596712096712
Author(s):  
Jennifer Kallini ◽  
Lyle J. Micheli ◽  
Patricia E. Miller ◽  
Dennis E. Kramer ◽  
Mininder S. Kocher ◽  
...  
Keyword(s):  
Operative Treatment ◽  
Knee Pain ◽  
Surgical Techniques ◽  
Lateral Release ◽  
Return To Sports ◽  
Treatment Technique ◽  
Adolescent Athletes ◽  
Bipartite Patella ◽  
Competitive Athletes ◽  
Fragment Excision

Background: Bipartite patella (BPP) is a developmental anomaly that forms when incomplete patellar ossification leaves a residual fibrocartilaginous synchondrosis between ossification centers. Repetitive traction forces across the synchondrosis can cause knee pain, most commonly presenting in adolescence. Symptoms frequently resolve with nonoperative management. Few surgical case series exist to guide treatment approaches for refractory pain. Purpose: To investigate the clinical features, surgical techniques, and outcomes associated with operative treatment of symptomatic BPP in pediatric and adolescent athletes and to compare features of the series with a large control group managed nonoperatively. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective medical record review was conducted of all patients aged ≤20 years who were diagnosed with symptomatic, radiologically confirmed BPP between 2003 and 2018 at a single tertiary-care pediatric hospital (N = 266). Demographic and clinical variables were analyzed, and additional radiologic and perioperative variables were collected for the surgical subcohort. Results: Of the 266 patients included, 27 were treated operatively (10.2%). When compared with those treated nonoperatively (with rest, physical therapy, cryotherapy, and anti-inflammatory medications), the operatively managed group experienced a longer duration of symptoms before first presentation (21.5 vs 7.6 months; P < .001) and were more likely to be older (mean age, 15.4 vs 12.4 years; P < .001), female (59.3% vs 35.6%; P = .03), and competitive athletes (100% vs 84.5%; P = .02). In the 27 patients treated operatively, procedures were categorized as isolated fragment excision (n = 9), fragment excision with lateral release (n = 8), isolated lateral release (n = 5), fragment screw fixation (n = 4), and synchondrosis drilling (n = 1). The mean time between surgery and return to sports was 2.2 months. Four patients (14.8%) reported residual symptoms requiring secondary surgery, including lateral release (n = 1), excision of residual fragment (n = 1), and fixation screw removal (n = 2). Conclusion: BPP can cause knee pain in adolescent athletes and is generally responsive to nonoperative treatment. Patients undergoing surgical treatment—most commonly female competitive athletes with prolonged symptoms—represented 10% of cases. A variety of surgical techniques may be effective, with a 15% risk of persistent or recurrent symptoms warranting reoperation. Prospective multicenter investigations are needed to identify optimal candidates for earlier interventions and the optimal operative treatment technique.

Spontaneous Resolution of a Ruptured Dissecting PICA Aneurysm

1998 ◽  
Vol 4 (4) ◽  
pp. 287-292 ◽  
Author(s):  
R.L. Piske ◽  
R. Darwich ◽  
C.M.S. Campos ◽  
N.C. Fonseca ◽  
E. Oliveira ◽  
...  
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Arterial Wall ◽  
Similar Case ◽  
Clinical Course ◽  
Dissecting Aneurysm ◽  
Occipital Artery ◽  
Minor Trauma ◽  
Vessel Occlusion ◽  
Dissecting Aneurysms

Spontaneous dissecting aneurysms (SDAs) seldom involve the intradural vertebral artery VA, the posterior cerebral, basilar or postero inferior cerebellar arteries (PICAs), where they produce subarachnoid haemorrhage and/or ischaemia. These lesions may develop spontaneously or occasionally after minor trauma and occur in young people in whom there is no underlying abnormality to explain the appearance of the dissection in most cases. Spontaneous dissecting aneurysm of the PICA is rare and its natural history is not well understood. Surgery or endovascular treatment for PICA dissection remain controversial because they suggest vessel occlusion. Only in a few cases is the bypass between the occipital artery and the PICA possible with trapping of the dissected segment. Reinforcement of the arterial wall does not seem efficient and the surgical approach per se with sole exclusion of the aneurysm may be disastrous. We describe two cases of SDA of PICA that presented with subarachnoid haemorrhage (SAH), treated conservatively, with spontaneous cure of the lesions, angiographically confirmed at mid-time follow-up of five and four months. These favourable spontaneous thromboses, like 11 other similar case reported in the literature, did not show any rebleed. The possibility of a benign clinical course of this lesion exists; clinical and angiographic management of the patient before a decision for a aggressive treatment is proposed.

scholarly journals Anterior knee pain and functional outcome following different surgical techniques for tibial nailing: a systematic review

2020 ◽  
Author(s):  
Mandala S. Leliveld ◽  
Michael H. J. Verhofstad ◽  
Eduard Van Bodegraven ◽  
Jules Van Haaren ◽  
Esther M. M. Van Lieshout
Keyword(s):  
Systematic Review ◽  
Functional Outcome ◽  
Knee Pain ◽  
Anterior Knee Pain ◽  
Surgical Techniques ◽  
Anterior Knee

scholarly journals Arthroscopic Lateral Retinacular Ligament Release in Patellofemoral Pain Syndrome

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0018
Author(s):  
Teoman Başaran ◽  
Ahmet Ozgur Atay ◽  
Mahmut Nedim Doral ◽  
Pınar Özge Başaran
Keyword(s):  
Knee Pain ◽  
Anterior Knee Pain ◽  
Bleeding Time ◽  
Pain Syndrome ◽  
Patellofemoral Pain Syndrome ◽  
Patellofemoral Pain ◽  
Lateral Release ◽  
Lateral Retinacular Release ◽  
Anterior Knee ◽  
Surgery Duration

Objectives: Arthroscopic lateral retinacular release in patellofemoral pain syndrome Comparing the amount of hemorrhage and times of release between electrocautery and a new techniques for arthroscopic lateral release with scissors Methods: 77 patients included in this prospective randomized controlled study. Inclusion Criteria: 1. Over the age of fourteen and have anterior knee pain syndrome 2. Tightness in lateral part of knee 3. Despite receiving conservative treatment for 6 months, patients who have anterior knee pain complaints Exclusion Criteria: 1. Diseases that prolong bleeding time 2. Drugs that prolong bleeding time 3. Abnormal APTT-INR levels 4. Patients underwent anterior cruciate reconstruction surgery 5. Patients underwent microfracture surgery 6. Patients underwent meniscus repair surgery 7. Patients underwent synovectomy -- Due to inflammatory diseases and synovial chondromatosis is excluded from the study. In this study 77 (25M 52W med age 50,14 ± 14,17 ) patients divided into three groups which was similar in age and sex. All patients underwent standard arthroscopic surgery for patellofemoral knee sydrome and meniscal debridement 1. Group 1 (Control) (n:10) LRL was preserved 2. Group 2 (Scissors) (n:33) LRL was released with Scissors 3. Group 3 (Electrocautery) (n:34) LRL was released with Electrocautery Results: There was no difference between the groups in terms of socio-demographic characteristics. All lateral ligaments releases were performed under tourniquet . The release is not considered to be complete unless the patella can be stood on its medial edge without difficulty . In all patients, surgery duration was recorded. To calculate the amount of bleeding the blood in the drainage tube was recorded for 24 hours after surgery. For 67 patients based on clinical examination at surgery and in the immediate postoperative period, all releases were felt to be adequate. For all groups total bleeding at 24 h postoperatively is the statistically same (p:0.850) . In first 8 hours the amount of bleeding is more in scissors group (p:0.002). Lateral release time is longer in electrocautery group (380 seconds) than in scissors group (24 seconds). In release with electrocautery sometimes we used additional techniques scissors and scalpel for enough release. There was no difference between groups in terms of complications such as deep vein thrombosis , hemarthrosis or severe complications. Conclusion: In this study the amount of bleeding was the same in the groups but surgery duration was longer in electrocautery group. Our new technique for intraarticular arthroscopy guided lateral retinacular release uses with scissors which is simple, effective, rapid, and have resulted a few surgical complications such as superficial skin infection which responds oral antibiotics. Electrocautery is difficult and needs experience.

Short-term Clinical Course of Knee Pain in Children and Adolescents: A Feasibility Study Using Electronic Methods of Data Collection

2016 ◽  
Vol 22 (4) ◽  
pp. e1669
Author(s):  
Michael S. Swain ◽  
Steven J. Kamper ◽  
Chris G. Maher ◽  
Jane Latimer ◽  
Carolyn Broderick ◽  
...  
Keyword(s):  
Data Collection ◽  
Children And Adolescents ◽  
Knee Pain ◽  
Feasibility Study ◽  
Clinical Course ◽  
Short Term

scholarly journals Successful Treatment of Painful Synchondrosis of Bipartite Patella after Direct Trauma by Operative Fixation: A Series of Six Cases

2017 ◽  
Vol 11 (1) ◽  
pp. 390-396 ◽  
Author(s):  
Sarkhell Radha ◽  
Michael Shenouda ◽  
Sujith Konan ◽  
Jonathon Lavelle ◽  
Samuel Church
Keyword(s):  
Knee Pain ◽  
Anterior Knee Pain ◽  
Case Series ◽  
Symptomatic Treatment ◽  
Operative Management ◽  
The Body ◽  
Direct Trauma ◽  
Bipartite Patella ◽  
Operative Fixation ◽  
Anterior Knee

Introduction: The patella is the largest sesamoid bone in the body and may have one (77%) or multiple (23%) ossification centres. Patellar and patellofemoral joint abnormalities are a common cause of anterior knee pain but symptomatic bipartite patella is an uncommon problem. Case Series: We report a series of six cases of painful synchondrosis in bipartite patellae, all in keen athletes following a direct blow to the anterior aspect of the knee. A complete rupture of the synchondrosis with evidence of retropatellar chondral separation was seen on MRI scan in all cases. Successful surgical fixation was undertaken with complete resolution of symptoms in all patients at an average of three months post-operatively. Conclusion: Painful synchondrosis of a bipartite patella in young and active individuals following direct trauma is a relatively rare cause of anterior knee pain, but may be associated with significant morbidity. In cases refractory to non-operative management, successful symptomatic treatment can be achieved by operative fixation.

scholarly journals Use of hyaluronic acid injection after arthroscopic release in lateral patellar compression syndrome with degenerative cartilage changes: randomized control trial

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Sherwan A. Hamawandi
Keyword(s):  
Hyaluronic Acid ◽  
Knee Pain ◽  
Lateral Release ◽  
Arthroscopic Release ◽  
Compression Syndrome ◽  
Kujala Score ◽  
Group A ◽  
Lateral Patellar Compression Syndrome ◽  
Degenerative Cartilage

Abstract Background Degenerative cartilage changes can be seen, in cases of lateral patellar compression syndrome, involving the patellofemoral joint. Hyaluronic acid is a natural component of the synovial fluid and responsible for its elastic features and function of articular surfaces. The aim of this study is to show the effect of intra-articular injection of Hyaluronic acid, after arthroscopic lateral release in lateral patellar compression syndrome, on the functional outcome and knee pain in those patients with degenerative cartilage changes. Method Ninety patients age (30–50) years with lateral patellar compression syndrome and degenerative cartilage changes were divided randomly into 2 groups. Group A was treated by arthroscopic lateral release and received intraarticular injection of Hyaluronic acid 2 weeks after surgery. Group B was treated by arthroscopic lateral release only. Both groups were assessed by Kujala score and visual analogue scale for knee pain preoperatively and re-assessed postoperatively at 3 months, 6 months, 12 months and 24 months. Results There was significant improvement in Kujala score and Visual analogue scale post-operatively in both groups (P-value< 0.001) with better improvement in Kujala score in group A after intra-articular injection of Hyaluronic acid up to 2 year of follow up (P-value = 0.006) as well as better improvement in visual analogue score at 6 months post-operatively (P-value = 0.035). Conclusion Intra-articular injection of Hyaluronic acid after arthroscopic release, in patients with lateral patellar compression syndrome and degenerative cartilage changes, can result in better improvement of knee pain and functional outcome up to 2 years of follow up. Trial registration NCT, NCT04134611. Registered 18 October 2019 -Retrospectively registered.

Plica Excision with and without Lateral Release in Adolescents with Anterior Knee Pain

PEDIATRICS ◽  
2016 ◽  
Vol 137 (Supplement 3) ◽  
pp. 553A-553A
Author(s):  
Dennis E. Kramer ◽  
Leslie Kalish ◽  
Matthew Abola ◽  
Elizabeth Kramer ◽  
Yi-Meng Yen ◽  
...  
Keyword(s):  
Knee Pain ◽  
Anterior Knee Pain ◽  
Lateral Release ◽  
Anterior Knee
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