scholarly journals Patellar Instability in Pediatric Patients: Review of the Literature

Osteology ◽  
2021 ◽  
Vol 1 (4) ◽  
pp. 197-208
Author(s):  
Filippo Familiari ◽  
Riza Mert Cetik ◽  
Gazi Huri
Keyword(s):  
Patellar Instability ◽  
Pediatric Patients ◽  
Treatment Plan ◽  
Surgical Techniques ◽  
Patellar Height ◽  
Review Of The Literature ◽  
Comprehensive Understanding ◽  
Recurrent Instability ◽  
Open Physes ◽  
First Time

Patellar instability is a common pathology of the knee in pediatric patients. The management of this condition can be a challenge for the orthopedic surgeon, and a comprehensive understanding of the anatomy and biomechanics of the structures around the knee is of utmost importance in formulating a treatment plan. Predisposing factors can be related to: trochlear and patellar morphological abnormalities, ligamentous stabilizers, limb geometries in the axial plane, and patellar height abnormalities. Traditionally, first-time dislocators have been treated non-operatively; however, recent evidence suggests that certain factors are related to recurrent instability, and surgical treatment may be considered even after the first dislocation. It is important to keep in mind that younger children with open physes are not suitable candidates for certain surgical techniques. In this comprehensive review, we aimed to focus on the most up-to-date information on this topic and emphasize the importance of individualizing the treatment of pediatric patients.

scholarly journals Outcomes of Arthroscopic Loose Body Management in Patella Instability: Medial Patellofemoral Ligament Neglect or Repair Versus Reconstruction

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0047
Author(s):  
Alyssa Carroll ◽  
Kristina Johnson Andrew Pennock
Keyword(s):  
Patellar Instability ◽  
Ligament Reconstruction ◽  
Medial Patellofemoral Ligament ◽  
Loose Body ◽  
Recurrent Instability ◽  
Kujala Score ◽  
Second Surgery ◽  
First Time ◽  
Reconstruction Group

Objectives: Patellar instability is common in adolescents during their growth. Management of the actual patellar instability at the time of arthroscopic treatment for concomitant intra-articular loose body has been debated since many surgeons will manage first-time dislocations without surgery. To demonstrate that medial patellofemoral joint reconstruction, rather than neglect or repair of the ligament, should be performed at the time of arthroscopic loose body removal for first-time patellar instability events in children. Methods: Retrospective study design was performed on all patients who sustained a patellar instability event that resulted in an intra-articular loose body between 2011 and 2017 at our institution. Data was collected using ICD-9/10 and/or CPT codes. Patients included in the analysis were required to have a minimum of 24 month follow-up documented. We then performed chart review and radiographic review (XR and MRI). Variables collected included: demographics, weight, BMI, pain score, SANE score, Kujala score, subsequent recurrent instability, need for second surgery, growth plate status, trochlear dysplasia, TT-TG, Insall-Salvati ratio, and Blackburne-Peel ratio. Data analysis pooled the “neglect” and “repair” groups together and compared it to the “reconstruction” group. Continuous variables were examined for normal distribution and homogeneity and analyzed with ANOVA or Mann Whitney. Chi square was utilized for categorical variables. Results: 64 patients (34 males, 30 females) with a mean age at surgery of 14 years (range 9 to 18) met criteria. These participants had a reported mean weight (kg) and BMI of 67.6 kg and 23.9, respectively. In our two-cohort analysis, the reconstruction cohort demonstrated significantly less subsequent instability, with the rate of recurrence being 58.7% in the neglect/repair compared to 16.7% in the reconstruction group (p=0.002). In addition, the reconstruction group demonstrated significantly less patients that required second surgery (p=0.024). The only continuous variable that showed any statistically significant difference was the Insall-Salvati ratio (p=0.048) with the reconstruction group being a mean 1.3 versus a mean 1.4 in the neglect/ repair group. There was no difference was found for age, weight, BMI, Blackburn ratio, TDI, TT-TG, Pain, SANE, Kujala score, satisfaction, or length of follow-up. Conclusion: Medial patellofemoral ligament reconstruction in the setting of adolescent patellar instability with an intra-articular loose body results in significantly less recurrent instability and reduced need for subsequent surgery compared to those who do not undergo a concomitant ligament reconstruction.

scholarly journals OUTCOMES OF ARTHROSCOPIC LOOSE BODY MANAGEMENT IN PATELLA INSTABILITY: MEDIAL PATELLOFEMORAL LIGAMENT NEGLECT OR REPAIR VERSUS RECONSTRUCTION

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0025
Author(s):  
Kristina P. Johnson ◽  
Alyssa N. Carroll ◽  
Andrew T. Pennock
Keyword(s):  
Patellar Instability ◽  
Ligament Reconstruction ◽  
Medial Patellofemoral Ligament ◽  
Loose Body ◽  
Recurrent Instability ◽  
Kujala Score ◽  
Second Surgery ◽  
First Time ◽  
Reconstruction Group

Background: Patellar instability is common in adolescents during their growth. Management of the actual patellar instability at the time of arthroscopic treatment for concomitant intra-articular loose body has been debated since many surgeons will manage first-time dislocations without surgery. Hypothesis/Purpose: To demonstrate that medial patellofemoral joint reconstruction, rather than neglect or repair of the ligament, should be performed at the time of arthroscopic loose body removal for first-time patellar instability events in children. Methods: Retrospective study design was performed on all patients who sustained a patellar instability event that resulted in an intra-articular loose body between 2011 and 2017 at our institution. Data was collected using ICD-9/10 and/or CPT codes. Patients included in the analysis were required to have a minimum of 24 month follow-up documented. We then performed chart review and radiographic review (XR and MRI). Variables collected included: demographics, weight, BMI, pain score, SANE score, Kujala score, subsequent recurrent instability, need for second surgery, growth plate status, trochlear dysplasia, TT-TG, Insall-Salvati ratio, and Blackburne-Peel ratio. Data analysis pooled the “neglect” and “repair” groups together and compared it to the “reconstruction” group. Continuous variables were examined for normal distribution and homogeneity and analyzed with ANOVA or Mann Whitney. Chi square was utilized for categorical variables. Results: 64 patients (34 males, 30 females) with a mean age at surgery of 14 years (range 9 to 18) met criteria. These participants had a reported mean weight (kg) and BMI of 67.6 kg and 23.9, respectively. In our two-cohort analysis, the reconstruction cohort demonstrated significantly less subsequent instability, with the rate of recurrence being 58.7% in the neglect/repair compared to 16.7% in the reconstruction group (p=0.002). In addition, the reconstruction group demonstrated significantly less patients that required second surgery (p=0.024). The only continuous variable that showed any statistically significant difference was the Insall-Salvati ratio (p=0.048) with the reconstruction group being a mean 1.3 versus a mean 1.4 in the neglect/ repair group. There was no difference was found for age, weight, BMI, Blackburn ratio, TDI, TT-TG, Pain, SANE, Kujala score, satisfaction, or length of follow-up. Conclusion: Medial patellofemoral ligament reconstruction in the setting of adolescent patellar instability with an intra-articular loose body results in significantly less recurrent instability and reduced need for subsequent surgery compared to those who do not undergo a concomitant ligament reconstruction.

scholarly journals Novel MRI Measurements of Extensor Mechanism Containment Can Predict Recurrent Patellar Instability

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0034
Author(s):  
Calvin Chan ◽  
Justin Mistovich ◽  
John Urwin ◽  
Christopher Gajewski ◽  
Peter Fabricant ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Patellar Instability ◽  
Tibial Tubercle ◽  
Trochlear Groove ◽  
Recurrent Instability ◽  
Relationship Of ◽  
First Time ◽  
The Relationship ◽  
Recurrent Patellar Instability ◽  
Mri Measurements

Objectives: Identifying risk factors for recurrent patellar dislocation (PD) following the first dislocation may help guide treatment. Tools for assessing the relationship of the extensor mechanism can distinguish dislocators from regular patients, but their usefulness in predicting the risk of re-dislocation has not been assessed. The purpose of this study was to determine the association of several novel MRI measures of patellar containment with recurrence in patients presenting with a first-time PD. Methods: An IRB approved query was conducted at a tertiary care children’s hospital (2005-2014) for patients (aged 8-19 years) diagnosed with a first-time PD. Patients were classified as either non-recurrent or recurrent-dislocators based on the review of the medical record. Next, MRI measurements were made by two independent raters. Interobserver reliability was assessed for all measurements via an intraclass correlation coefficient (ICC). Only measurements with ICC > 0.8 were included for further analysis. Univariate and multivariate regression analysis was used to evaluate variables associated with recurrence. Results: One hundred sixty-five patients were identified with a median follow up the length of 12.2 months. Median patients age was 14 years, and 57.6% were females. A second instability event or significant subluxation episode was documented in 98 (59.4%) patients. MRI measurements with excellent correlation (ICC>0.8) were Tibial tuberosity to trochlear groove distance (TT-TG), Tangential axial width of the patella (TAWP), Tangential axial trochlear width (TATW), Axial width of patellar tendon beyond lateral trochlear ridge (PT-LTR), and Lateral trochlear ridge to tibial tuberosity distance (LTR-TT). In univariate analysis, all mentioned MRI measurements had significant differences when comparing the group of RD to those that did not have a recurrent instability event. However, following both backward and forward stepwise regression analysis, LTR-TT was the only independent predictor of RD (p=0.003 in both). Patients with an LTR-TT value greater than -1 had a significantly higher rate of recurrent dislocation (72%) with Odds Ratio 2.4 (95% C.I. 1.2-4.7); p=0.011). Conclusion: Assessment of the relationship of the lateral trochlear ridge to the tibial tubercle had greater predictive value for recurrent instability than the relationship of the tibial tubercle to the trochlear groove. Patients with a tibial tubercle even with or outside of the lateral trochlear ridge have a significantly increased risk of re-dislocation compared with patients with a tibial tubercle inside the lateral trochlear ridge. This novel measurement (LTR-TT) can help predict recurrent patellar instability and may thus aid surgeons and patients when deciding on a treatment strategy. [Table: see text]

Managing the Transition to Edentulousness Using Partial Transitional Dentures for First Time Prosthodontic Patients: Addressing Unrealistic Expectations – A Case Report

2017 ◽  
Vol 1 (1) ◽  
Keyword(s):  
Case Report ◽  
Treatment Outcomes ◽  
Treatment Planning ◽  
Clinical Relevance ◽  
Treatment Plan ◽  
Sequential Treatment ◽  
Aesthetic Result ◽  
Abutment Teeth ◽  
First Time ◽  
Unrealistic Expectations

Aim: The aim of this report is to describe the management of a prosthodontic patient expressing unrealistic expectations with respect to the transition to edentulousness. Objectives: To outline (1) the diagnosis and explicit expectations of the patient on presentation (2) considerations made during treatment planning to address the wishes of the first time prosthodontic patient (3) a sequential treatment plan utilizing transitional partial removable dentures to manage the change to edentulousness (4) functional and aesthetic result achieved. Results: Delivery of immediate removable partial dentures retaining key abutment teeth in upper and lower arches was a viable prosthodontic solution in the transition to edentulousness of a patient expecting unrealistic treatment outcomes. Conclusions: Addressing impractical expectations and devising a treatment plan amenable to both clinician and patient is difficult. Strategies to manage these wishes in prosthodontic dentistry can include transitional partial dentures. Clinical relevance: Practitioners who encounter similar situations may consider this report valuable.

scholarly journals Masses of the Sternoclavicular Area: Case Series and Review of the Literature

2021 ◽  
Vol 15 ◽  
pp. 117955652110216
Author(s):  
Parisa Oviedo ◽  
Morgan Bliss
Keyword(s):  
English Language ◽  
Pediatric Patients ◽  
Tertiary Care ◽  
Case Series ◽  
Review Of The Literature ◽  
Incision And Drainage ◽  
Surgical Interventions ◽  
Ganglion Cysts ◽  
Icd 10 ◽  
Bronchogenic Cysts

Objective: Masses of the sternoclavicular area are rare, and are not well described in the literature. We aim to present a series of patients with masses in this location and to review all reported English language cases of sternoclavicular masses in pediatric patients. Methods: This is a case series of pediatric patients with masses of the sternoclavicular area presenting to a tertiary care pediatric hospital from 2010 through 2017. Data was collected by using ICD-9 and ICD-10 codes to query the electronic medical record. Chart review included age at presentation, mass characteristics, medical and surgical interventions, and pathology results. A review of the literature was then performed. Results: Ten patients with masses overlying the sternoclavicular area were identified. Four patients presented with abscess and were treated with incision and drainage. Three of these patients were then treated with staged excision once infection cleared. Two additional patients were treated with primary excision. Four patients were treated with observation. The most common histopathologic finding was epidermoid. One patient was found to have a dermoid cyst, and 1 had a congenital cartilaginous rest. Conclusion: Epidermoids and dermoids are the most common masses overlying the sternoclavicular area. Controversy remains regarding the embryologic origin of sternoclavicular masses. The differential for masses in this area also includes branchial remnants, bronchogenic cysts, ganglion cysts, or septic arthritis.

scholarly journals A Review of the Major Prosthetic Factors Influencing the Prognosis of Implant Prosthodontics

2021 ◽  
Vol 10 (4) ◽  
pp. 816
Author(s):  
Javier Montero
Keyword(s):  
Animal Studies ◽  
Treatment Approach ◽  
Treatment Plan ◽  
Meta Analysis ◽  
Good Prognosis ◽  
Cochrane Library ◽  
Review Of The Literature ◽  
Hand Search ◽  
Related Risk

Background: The treatment plan of prosthetic restorations supported by dental implants requires comprehensive scientific knowledge to deliver prostheses with good prognosis, even before the implant insertion. This review aims to analyze the main prosthetic determinants of the prognosis of implant-supported prostheses. Methods: A comprehensive review of the literature was conducted with a PICO (Patient Intervention Comparison Outcomes) question: “For partially or complete edentulous subjects treated with implant-supported prostheses, which prosthetic factors could affect clinical outcomes?”. A literature search was performed electronically in PubMed (MEDLINE), Scopus and Cochrane Library with the following equation [PROGNOS * OR RISK] FACTOR IMPLANT DENTAL, and by hand search in relevant journals and throughout the selected papers. Results: This revision was carried out based on 50 papers focused on several prosthodontics-related risk factors that were grouped as follows: implant-connection, loading protocol, transmucosal abutments, prosthetic fit, provisionalization, type of retention, impression technique, fabrication technique, and occlusion. More than a half of the studies were systematic reviews (30%), meta-analysis (16%), or prospective evaluations of prosthesis with various kinds of events (18%). However, narrative reviews of literature (14%) and in vitro/animal studies (16%) were also found. Conclusions: The current literature provides insufficient evidence for most of the investigated topics. However, based on the accumulated data, it seems reasonable to defend that the best treatment approach is the use of morse taper implants with transmucosal abutments, recorded by means of rigidly splinted copings through the pick-up technique, and screwed by milled prosthesis occlusally adjusted to minimize functional overloading.

Subtotal Pedal Amputations

2001 ◽  
Vol 91 (1) ◽  
pp. 6-12 ◽  
Author(s):  
Christopher Funk ◽  
Gregg Young
Keyword(s):  
Functional Outcome ◽  
Diabetic Foot ◽  
Surgical Techniques ◽  
Surgical Correction ◽  
Proper Treatment ◽  
Review Of The Literature ◽  
Human Foot

Proper treatment for the compromised diabetic foot often requires surgical correction and subtotal pedal amputation. This article discusses various levels of amputation of the human foot, including digital, ray, transmetatarsal, midfoot, and Syme amputations. Surgical techniques and biomechanical considerations are presented in order to assist the surgeon in planning for the most functional outcome of the patient. A review of the literature and the experiences of the authors are presented. (J Am Podiatr Med Assoc 91(1): 6-12, 2001)

Nasal Dermoids in Children: Factors Influencing the Distant Result

2021 ◽  
Author(s):  
Michal Kotowski ◽  
Paulina Adamczyk ◽  
Jaroslaw Szydlowski
Keyword(s):  
Pediatric Patients ◽  
Surgical Techniques ◽  
Intracranial Extension ◽  
Recurrence Rates ◽  
Local Conditions ◽  
Aesthetic Result ◽  
Factors Influencing ◽  
Vertical Incision ◽  
External Rhinoplasty

AbstractThe aim of the study was to present a single institution’s treatment strategy for nasal dermoids and to identify factors influencing distant results. The study covered 24 surgically treated pediatric patients with nasal dermoids (NDs). The medical data concerning demographics, preoperative local inflammations and surgical procedures, form of the abnormality, imaging, surgical techniques, and a role of osteotomies and reconstructions were analyzed. The recurrence rates and distant aesthetic outcomes were assessed. The surgical approach included vertical incision in 21 patients, the external rhinoplasty approach in 2 cases, and bicoronal incision in 1 child. The intracranial extension was confirmed in 6 patients. Seven out of 8 cases with preoperative local inflammations and 3 out of 4 with secondary fistulization were < 4 years old. Nine patients required osteotomies. Three children required reconstruction of the nasal skeleton. None of the distant cosmetic results was described as hideous or unsatisfactory. The incidence of local inflammatory complications is unrelated to the age of the patients. The distant aesthetic result depends on both the initial extent of the disease and preoperative local conditions or interventions. Prompt surgical intervention is highly recommended.

scholarly journals Failed Latarjet procedure: a systematic review of surgery revision options

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Matteo Buda ◽  
Riccardo D’Ambrosi ◽  
Enrico Bellato ◽  
Davide Blonna ◽  
Alessandro Cappellari ◽  
...  
Keyword(s):  
Systematic Review ◽  
Case Series ◽  
Review Of The Literature ◽  
Inclusion Criteria ◽  
Latarjet Procedure ◽  
Shoulder Stabilization ◽  
Recurrent Instability ◽  
Level Of Evidence ◽  
Radiographic Outcomes

Abstract Background Revision surgery after the Latarjet procedure is a rare and challenging surgical problem, and various bony or capsular procedures have been proposed. This systematic review examines clinical and radiographic outcomes of different procedures for treating persistent pain or recurrent instability after a Latarjet procedure. Methods A systematic review of the literature was performed using the Medline, Cochrane, EMBASE, Google Scholar and Ovid databases with the combined keywords “failed”, “failure”, “revision”, “Latarjet”, “shoulder stabilization” and “shoulder instability” to identify articles published in English that deal with failed Latarjet procedures. Results A total of 11 studies (five retrospective and six case series investigations), all published between 2008 and 2020, fulfilled our inclusion criteria. For the study, 253 patients (254 shoulders, 79.8% male) with a mean age of 29.6 years (range: 16–54 years) were reviewed at an average follow-up of 51.5 months (range: 24–208 months). Conclusions Eden–Hybinette and arthroscopic capsuloplasty are the most popular and safe procedures to treat recurrent instability after a failed Latarjet procedure, and yield reasonable clinical outcomes. A bone graft procedure and capsuloplasty were proposed but there was no clear consensus on their efficacy and indication. Level of evidence Level IV Trial registration PROSPERO 2020 CRD42020185090—www.crd.york.ac.uk/prospero/

CARD14 ‐associated papulosquamous eruption (CAPE) in pediatric patients: Three additional cases and review of the literature

2021 ◽  
Author(s):  
Cindy P. Frare ◽  
Alli J. Blumstein ◽  
Amy S. Paller ◽  
Lia Pieretti ◽  
Keith A. Choate ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Review Of The Literature
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