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The research problem was identified by comparing several for knee joint injuries between players' outdoor playgrounds and futsal players. Research to: identify knee joint injuries suffered by players football outdoor playgrounds, And identify knee joint injuries that futsal players are exposed to, and a comparison several form of knee joint injuries between outdoor playgrounds and futsal players. The researchers assumed no that there was a significant difference in the percentage of knee joint injuries between outdoor playgrounds and futsal players. researchers used the descriptive method in the survey method for its suitability and the nature of the research. The research sample consisted of (121) outdoor playgrounds players (27.3%) and (60) Indoor football (23.44%) from the research community. They were chosen intentionally from those with injuries for the knee joint, researchers used Arab and foreign sources and references and an open questionnaire as methods and tools for research. And data was processed statistically using percentages, and the following conclusions were reached: I futsal players are more susceptible to or suffer from cruciate ligament tear, joint cartilage tear, and medial ligament tear of the knee joint compared to outdoor playgrounds soccer players. and outdoor playgrounds players are also more susceptible to or suffering from a lateral ligament tear and a fracture of the patella of The knee joint compared to futsal players several recommendations that serve The purpose of conducting the research. [ABSTRACT FROM AUTHOR]

Patellar sleeve fractures, though relatively rare, present unique challenges in diagnosis and management. This review aims to provide a comprehensive overview of the current understanding of patellar sleeve fractures, focusing on their epidemiology, clinical presentation, imaging, and management strategies. Epidemiologically, these fractures are uncommon, representing approximately 1% of all fractures in pediatric patients, yet they account for 50% of all patella fractures in this population. They predominantly affect adolescents, with a peak incidence around 12.7 years of age, and are more common in boys, occurring at a ratio of 3 to 5:1. Understanding these demographic patterns is crucial for early recognition and appropriate management. Clinically, patellar sleeve fractures typically present with the sudden onset of severe pain, often associated with explosive activities such as jumping. However, diagnosis can be challenging, particularly in cases with minimal displacement or where alternative muscle groups compensate for the injury. Differential diagnosis is essential, and clinicians should be vigilant for signs such as palpable gaps at the lower pole of the patella and patella alta. Imaging modalities play a vital role in diagnosis, with plain X-rays often revealing no bony damage. Ultrasonography may offer a cost-effective alternative, especially in cases where radiographic findings are inconclusive. Advanced imaging techniques such as MRI can assist in characterizing the extent of the injury and assessing for associated complications. Management strategies encompass a spectrum of approaches, ranging from conservative measures such as immobilization and physical therapy to surgical interventions, including open reduction and internal fixation or arthroscopic surgery. The choice of treatment depends on various factors, including the fracture pattern, displacement, patient age, activity level, and associated injuries. Despite advancements in diagnosis and treatment, the optimal management of patellar sleeve fractures remains a clinical challenge. Further research is warranted to elucidate optimal algorithms for diagnosis and treatment, with the ultimate goal of improving outcomes and reducing the risk of long-term complications associated with this rare but clinically significant knee injury. [ABSTRACT FROM AUTHOR]

Aim: Patellar fractures, which account for approximately 1% of all fractures, frequently require surgical intervention for significant displacement. Traditional anesthesia methods pose various risks and complications, especially for patients with comorbidities. This study aims to evaluate the safety and feasibility of wide-awake local anesthesia no tourniquet (WALANT) for patellar fracture fixation. Materials and Methods: A retrospective evaluation was conducted on a total of 8 patients who underwent patellar fracture fixation using the WALANT technique between 2020 and 2022. Patient demographics, clinical findings, and postoperative outcomes were collected. Peroperative pain was assessed using the Numerical Pain Rating Score (NPRS) and Visual Analogue Scale (VAS). Outcomes, including bleeding, complications, and the Lysholm Knee Score at 12 months postoperatively, were evaluated. Results: The median age at surgery for a total of 8 patients, 6 males and 2 females, was 56 years (range: 38-73). The median surgery duration was 52 minutes (range, 38-73), and postoperative pain onset was 160 minutes (range, 130-220). Minimal intraoperative bleeding was observed in most cases. Patient satisfaction with WALANT was high, with median VAS scores of 1 (range, 0-3) at 2 hours and 3 (range, 1-5) at 24 hours postsurgery. The median hospital stay was 2 (range, 1-7) days. One patient experienced a superficial skin infection. At 12 months postoperatively, the Lysholm Knee Score indicated satisfactory functional outcomes. Conclusion: This study is the first to explore WALANT for patellar fracture fixation. WALANT provides safe, effective anesthesia, high patient satisfaction, effective pain management, and shorter hospital stays. It benefits patients with comorbidities and offers an alternative to traditional anesthesia. Further research is needed to validate these findings and support wider use. [ABSTRACT FROM AUTHOR]

Purpose: The study aims to investigate the influence of patient- and fracture-specific factors on the occurrence of complications after osteosynthesis of patella fractures and to compare knee joint function, activity, and subjective pain levels after a regular postoperative course and after complications in the medium term. Methods: This retrospective, multicenter cohort study examined patients who received surgery for patella fracture at level 1 trauma centers between 2013 and 2018. Patient demographics and fracture-specific variables were evaluated. Final follow-up assessments included patient-reported pain scores (NRS), subjective activity and knee function scores (Tegner Activity Scale, Lysholm score, IKDC score), complications, and revisions. Results: A total of 243 patients with a mean follow-up of 63.4 ± 21.3 months were included. Among them, 66.9% of patients underwent tension band wiring (TBW), 19.0% received locking plate osteosynthesis (LPO), and 14.1% underwent screw osteosynthesis (SO). A total of 38 patients (15.6%) experienced complications (TBW: 16.7%; LPO: 15.2%; SO: 11.8%). Implant-related complications of atraumatic fragment dislocation and material insufficiency/dislocation, accounted for 50% of all complications, were significantly more common after TBW than LPO (p = 0.015). No patient-specific factor was identified as a general cause for increased complications. Overall, particularly following complications such as limited range of motion or traumatic refracture, functional knee scores were significantly lower and pain levels were significantly higher at the final follow-up when a complication occurred. Implant-related complications, however, achieved functional scores comparable to a regular postoperative course without complications after revision surgery. Conclusion: The present study demonstrated that implant-related complications occurred significantly more often after TBW compared to LPO. The complication rates were similar in all groups. [ABSTRACT FROM AUTHOR]

The International Lower Limb Collaborative (INTELLECT) study analyzed pediatric open fractures in the lower limbs, involving 163 patients from 43 centers in 13 countries. The study found that road traffic accidents were the most common cause of injury, followed by high-energy falls. The majority of injuries were open tibial/fibula fractures. The study examined outcomes such as soft tissue infection, deep infection, non-union, and amputation. It found that patients with Gustilo-Anderson IIIB and IIIC injuries had a higher risk of wound infection and deep infection. Delay in achieving soft tissue closure beyond 72 hours after injury was associated with a greater likelihood of infection. The study also emphasized the importance of a combined ortho-plastic approach for managing soft tissue injuries in pediatric trauma cases. However, the study has limitations due to its retrospective design and limited applicability to middle- and low-income settings. [Extracted from the article]

Background: The displacement and rotation of the Kirschner wire (K-wire) in the traditional tension band wiring (TBW) led to a high rate of postoperative complications. The anti-rotation tension band wiring (ARTBW) could address these issues and achieve satisfactory clinical outcomes. This study aimed to investigate the biomechanical performance of the ARTBW in treating transverse patellar fracture compared to traditional TBW using finite element analysis (FEA) and mechanical testing. Methods: We conducted a FEA to evaluate the biomechanical performance of traditional TBW and ARTBW at knee flexion angles of 20°, 45°, and 90°. Furthermore, we compared the mechanical properties under a 45° knee flexion through static tensile tests and dynamic fatigue testing. The K-wire pull-out test was also conducted to evaluate the bonding strength between K-wires and cancellous bone of two surgical approaches. Results: The outcome of FEA demonstrated the compression force on the articular surface of ARTBW was 28.11%, 27.32%, and 52.86% higher than traditional TBW at knee flexion angles of 20°, 45°, and 90°, respectively. In mechanical testing, the mechanical properties of ARTBW were similar to the traditional TBW. In the K-wire pull-out test, the pull-out strength of ARTBW was significantly greater than the traditional TBW (111.58 ± 2.38 N vs. 64.71 ± 4.22 N, P < 0.001). Conclusions: The ARTBW retained the advantages of traditional TBW, and achieved greater compression force of articular surface, and greater pull-out strength of K-wires. Moreover, ARTBW effectively avoided the rotation of the K-wires. Therefore, ARTBW demonstrates potential as a promising technique for treating patellar fractures. [ABSTRACT FROM AUTHOR]

Purpose: Extensor mechanism injuries, which comprise patella fractures, patella tendon tears and quadriceps tendon tears, are severely debilitating injuries and a common cause of traumatic knee pathology that requires surgical intervention. Risk factors for short‐term surgical complications and venous thromboembolism (VTE) in this population have not been well characterised. The aim of this study was to identify perioperative risk factors associated with these short‐term complications. Methods: The National Surgical Quality Improvement Program database was used to identify patients who underwent an isolated, primary extensor mechanism repair from 2015 to 2020. Patients were stratified by injury type. Demographic data were collected and compared. A multivariate logistic regression was used to control for demographic and comorbid factors while assessing risk factors for developing short‐term complications. Results: A total of 8355 patients were identified for inclusion in this study. Overall, 3% of patients sustained short‐term surgical complications and 1% were diagnosed with VTE within 30 days of surgery. Patella fracture fixation had a nearly twofold higher risk for surgical complications compared to quadriceps tendon repair (p = 0.004). Patella tendon repair had a twofold higher risk for VTE (p = 0.045), specifically deep vein thrombosis (p = 0.020), compared to patella fracture fixation. Increasing age, smoking and American Society of Anesthesiologists Classifications 3 and 4 were also found to be risk factors for surgical complications (p = 0.012, p = 0.004, p = 0.011 and p = 0.032, respectively). Conclusion: This study used a nationally representative, widely validated, peer‐reviewed database to provide valuable insights into risk factors for short‐term postoperative complications associated with extensor mechanism repair procedures, revealing notable differences in risk profiles among distinct surgical procedures. The results of this study will inform surgeons and patients in enhancing risk assessment, guiding procedure‐specific decision‐making, optimising preoperative care, improving postoperative monitoring and contributing to future research of extensor mechanism injuries. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]

Purpose: This paper investigates the biomechanical benefits of using hybrid constructs that combine cannulated screws with tension band wiring (TBW) cerclage compared to cannulated screws with anterior Variable Angle locking neutralisation plates (VA LNP). These enhancements can bear heavier loads and maintain the repaired patella's integrity, in contrast to traditional methods. Method: Eighteen fresh‐frozen human cadaver patellae were carefully fractured transversely at their midpoints using a saw. They were then divided into two groups of nine for subsequent utilisation. Fixation methods included Cannulated Screw Fixation added with either TBW or VA LNP Fixation Technique. Cyclic loading simulations (500 cycles) were conducted to mimic knee motion, tracking fracture displacement with Optotrak. After that, the constructs were secured over a servo‐hydraulic testing machine to determine the load‐to‐failure on axial mode. Results: The average fracture displacement for the anterior neutralisation plate group was 0.09 ± 0.12 mm, compared to 0.77 ± 0.54 mm for the tension band wiring with cannulated screw group after 500 cyclic loading. This result is statistically significant (p = 0.004). The anterior neutralisation plate group exhibited a mean load‐to‐failure of 1359 ± $\pm \,$21.53 N, whereas the tension band wiring group showed 780.1 ± 22.62 N, resulting in a significant difference between the groups (p = 0.007). Conclusion: This research highlights the superior biomechanical advantage of VA LNP over TBW for treating simple transverse patella fractures with two cannulated screws. It also highlights how the TBW is still a valuable option considering the load‐to‐failure limit. Level of Evidence: Not Applicable. [ABSTRACT FROM AUTHOR]

Patellar fractures represent approximately 1% of all fractures and the pattern is influenced by the quality of the bone and the energy of the trauma. Transverse fractures are associated with extensor mechanism failure and interruption of joint congruence. Patellar fractures are generally fixed using tension band principles, through K-wires and metal cerclage. The tension band was conceived to transform the considerable tensile force applied to the patella into a compressive one to obtain a stable fixation. The use of metal implants might be associated with a significant discomfort, mostly related to the irritating action of K-wires and cerclage on the surrounding soft tissues, often leading to the need for implant removal. Therefore, we introduced an original technique for fix patellar fractures by using only a non-adsorbable braided polyblend suture. Postoperative care included progressive range of motion recovery using an articulated knee brace and a specific protocol. The suture-only tension band technique seems to be a useful technique in terms of complications and reoperation rate while allowing secure and early mobilization. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to assess clinical and functional outcomes in separate cohorts of operatively and nonoperatively managed pediatric patella fractures. Methods: A retrospective review was completed for patients aged 5–19 years treated for a unilateral patella fracture at a single pediatric level-1 trauma center. Patients were excluded for osteochondral fracture associated with patellar dislocation, polytrauma presentation with additional fractures, or <3 months of clinical follow-up. Functional outcomes were assessed via the Pediatric International Knee Documentation Committee form and the Marx Knee Activity Scale. Results: A total of 53 patients met inclusion criteria; 30 patients were treated operatively and 23 patients were treated nonoperatively. Patients with patellar sleeve/pole fractures were significantly younger by 5.2 years (p < 0.01) and presented with greater variability in mechanism of injury (p < 0.01). The nonoperative cohort achieved bony healing and returned to sports at a median (interquartile range) of 1.7 (1.2–2.3) months and 2.8 (2.3–3.3) months, respectively, post-injury. The operative group achieved bony healing and returned to sports at 2.8 (2.1–3.5) months and 5.9 (4.0–7.1) months, respectively, following surgery. Median (interquartile range) Pediatric International Knee Documentation Committee and Marx scores were 98 (89–100) and 14 (10–16), respectively, for the nonoperative group, and 92 (84–99) and 13 (12–16), respectively, for the operative group. No significant differences in patient-reported outcomes were observed between fracture patterns or treatment cohorts. Conclusion: Pediatric and adolescent patients sustaining patella fractures reported long-term functional outcomes comparable to normative values, across multiple fracture patterns and with appropriate operative and nonoperative treatment. Fractures requiring surgery were expectedly associated with slower healing and return to sport timelines. Level of evidence: Therapeutic Level III. [ABSTRACT FROM AUTHOR]

Introduction: Patella fracture fixations were traditionally done using metal tension band wiring techniques. However, complications associated with metallic implants causing soft tissue irritation are not infrequent. Since 1998, there have been emerging case reports and series reporting the use of non-metallic implants, such as braided sutures, in the fixation of patella fractures 3. However, there is a limited clinical study on a direct comparison between metal and suture fixation in patella fractures. The aim of this study is to evaluate the outcome of all-suture fixation in patella fractures and to compare all-suture and metal fixation in mid-pole fractures. Materials and method: A total number of 50 patients with operated fracture patella were retrospectively reviewed in a 2.5-year period. Primary outcomes included operation time, time for fracture union and postoperative knee function. Secondary outcomes include complications, need for secondary operations due to prominent implants, infection or loss of fixation. Results: There was no statistically significant difference concerning time for fracture union, operation time and postoperative functional knee score between the three fixation methods. The rate of secondary operations was higher in the hybrid group (7 out of 11, 63.6%) and metal group (7 out of 13, 53.8%), and was lowest in an all-suture group (0 out of 28, 0%). Metal implant breakage and soft tissue irritation were the main reasons for secondary operations, which was significantly lower in the all-suture group (p < 0.0003). Subgroup analysis for mid-pole patella fractures showed similar results in which all primary outcomes showed no statistically significant difference, while the need for secondary operations was higher in the metal group (p < 0.003). Conclusion: All-suture fixation for patella fractures is a feasible option not limited to distal pole fractures. In our series, this technique achieved similar outcomes when compared with traditional metal implants, with lower rates of secondary operations, and could be safely employed in mid-pole fractures as well. [ABSTRACT FROM AUTHOR]

Background: Patellar fracture, femoral physis injury, and recurrent instability are concerning complications in medial patellofemoral ligament (MPFL) reconstruction (MPFLR) techniques for recurrent patellar dislocation in children and adolescents. Purpose: To evaluate the outcomes of an anatomic all–soft tissue fixation technique for reconstruction of the medial patellofemoral complex (MPFC) using a double-bundle quadriceps tendon (QT) autograft for recurrent patellar dislocation in skeletally immature patients. Study Design: Case series; Level of evidence, 4. Methods: This retrospective study involved 24 skeletally immature patients (24 knees; 16 women and 8 men; age range, 9.5-15 years) with recurrent patellar dislocation who underwent MPFC reconstruction using a double-bundle QT autograft between September 2018 and January 2021. Only soft tissue suture fixation was used on the femoral and patellar sides of the 2 bundles of the QT. Radiographs, computed tomography, and magnetic resonance imaging were used to evaluate physeal status, lower limb alignment, patellar height and tilt, trochlear morphology, tibial tubercle-trochlear groove distance, and any associated knee pathology. Functional outcomes were assessed with the Kujala score, the visual analog scale (VAS) for pain, and the grading system of Insall et al.22 Results: The mean follow-up time was 40 ± 9.6 months (range, 28-56 months). At the final follow-up, the Kujala and VAS pain scores showed a significant improvement versus preoperative scores (P <.001), and the passive lateral patellar glide showed a significant reduction (P <.001). All patients had negative apprehension and J signs. Of the 24 patients, 23 regained full range of motion, while 1 patient had a knee flexion deficit. The patellar tilt angle improved significantly at the final follow-up (P <.001). There was no patellar fracture, femoral physis injury, or recurrence of patellar dislocation. According to the grading system of Insall et al, the results were excellent in 15 knees (62.5%), good in 8 knees (33.3%), fair in 1 knee (4.2%), and no knees showed poor results. Conclusion: Reconstruction of the MPFC using a double-bundle QT autograft with an all–soft tissue fixation technique was an effective method for treating patellar instability in skeletally immature patients. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate the incidence of early and late complications following treatment of patella fractures. Secondary aims were to investigate the association between early and late complications and the patient-reported outcome measurement, the Knee Injury and Osteoarthritis outcome score (KOOS). Methods: Cross-sectional study including all patients recorded with a patella fracture residing in the Northern Region of Denmark between 2010 and 2020. Early (before 3 months) and late complications were investigated by retrospective review of charts and x-rays. All patients were invited to participate in the study by reporting current knee-specific symptoms. The KOOS was used to investigate patient-reported knee-specific symptoms. Results: Seven hundred ninety-eight patients were included in the study. A total of 532 (67%) patients were treated conservatively, and 266 (33%) patients underwent surgery. The mean age at the time of fracture was 66.8, ranging from 6 to 103 years of age. The mean follow-up time was 6.4 years, ranging from 1.1 to 12.3 years follow-up. Overall, the rate of complications was 26%. Overall, the rate of complication for the surgical group was 57% and for the conservative group 4%. The most common early complication was the loss of reduction followed by the removal of symptomatic hardware. The most common late complication was the removal of symptomatic hardware and knee arthroscopy. In all the five KOOS subscales (Pain, Symptoms, ADL, Sport/Rec, and QOL), patients presenting with early and late complications reported statistically significantly worse scores than those without complications. Conclusion: The overall incidence of complications in patients presenting with a patella fracture was 26%, with a mean follow-up time of 6.4 years. In the surgical group, 57% of patients experience at least one complication during the follow-up period. Early and late complications were significantly associated with worse KOOS subscale scores. [ABSTRACT FROM AUTHOR]

Background: People with achondroplasia exhibit distinct physical characteristics, but their cognitive abilities remain within the normal range. The challenges encountered during surgical procedures and perioperative care for achondroplastic individuals, are underrepresented in the existing literature. Case presentation: In this report, the management of a 26-year-old North-African achondroplastic male is highlighted. The patient suffered a complete intra-articular distal femur fracture (AO/OTA 33-C1) and an ipsilateral patella fracture (AO/OTA 34-C1). The patient's unusual anatomical variations and the lack of suitable orthopedic implants posed significant surgical challenges, particularly in the context of a resource-limited developing country. Facial and spinal deformities, which are common in patients with achondroplasia, further complicated the anesthetic approach. Conclusions: The limited information on operative management of fractures in achondroplastic patients necessitated independent decision-making and diverging from the convenient approach where clear guidance is available in the literature. [ABSTRACT FROM AUTHOR]

Introduction: Treatment of both simple and complex patella fractures is a challenging clinical problem. Although tension band wiring has been the standard of care, it can be associated with high complication rates. The aim of this study was to investigate the biomechanical performance of recently developed lateral rim variable angle locking plates versus tension band wiring used for fixation of simple and complex patella fractures. Materials and methods: Sixteen pairs of human anatomical knees were used to simulate either two-part transverse simple AO/OTA 34-C1 or five-part complex AO/OTA 34-C3 patella fractures by means of osteotomies, with each fracture model created in eight pairs. The complex fracture pattern was characterized by a medial and a lateral proximal fragment, together with an inferomedial, an inferolateral, and an inferior (central distal) fragment mimicking comminution around the distal patellar pole. The specimens with simple fractures were pairwise assigned for fixation with either tension band wiring through two parallel cannulated screws or a lateral rim variable angle locking plate. The knees with complex fractures were pairwise treated with either tension band wiring through two parallel cannulated screws plus circumferential cerclage wiring or a lateral rim variable angle locking plate. Each specimen was tested over 5000 cycles by pulling on the quadriceps tendon, simulating active knee extension and passive knee flexion within the range of 90° flexion to full extension. Interfragmentary movements were captured via motion tracking. Results: For both fracture types, the articular displacements measured between the proximal and distal fragments at the central patella aspect between 1000 and 5000 cycles, together with the relative rotations of these fragments around the mediolateral axis were all significantly smaller following the lateral rim variable angle locked plating compared with tension band wiring, p ≤ 0.01. Conclusions: From a biomechanical perspective, lateral rim variable angle locked plating of both simple and complex patella fractures provides superior construct stability versus tension band wiring under dynamic loading. [ABSTRACT FROM AUTHOR]

Background: Traditionally, patellar fractures (PFs) have been managed using metallic tension band fixation, a method often associated with a notable rate of complications. Considering these challenges, this study explores the potential of nonmetallic fixation as a treatment option for PFs. This research aims to provide robust evidence supporting the use of the nonmetallic tension band fixation technique as an effective alternative to conventional metallic tension band fixation, thereby advancing the standard of care in treating these fractures. Methods: This retrospective study analyzed a consecutive patient series presenting with PFs from 2008 to 2021, treated with a nonmetallic tension band fixation technique. Inclusion criteria were strictly defined to include individuals over 18 years of age with isolated PFs requiring surgical intervention. The study focused on evaluating postoperative complications and clinical outcomes, as measured by standardized scoring systems, at the final follow-up point to assess the efficacy and safety of the employed surgical technique. Results: In this study, with a mean follow-up of 64 ± 7 months, a total of 64 patients who received open reduction and internal fixation (ORIF) for PFs were enrolled. Among these, five cases required additional surgical interventions. Specifically, two cases were due to knee stiffness, while the remaining three involved complications such as superficial infection, skin irritation, or delayed wound healing. The mean postoperative values recorded for the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, Oxford knee score (OKS), and visual analog scale (VAS) were 20.4 ± 2.3, 35.5 ± 5.3, and 1.6 ± 0.4, respectively. There were no complications related to the nonmetallic fixation technique or instances of loss of reduction. Conclusion: This study substantiates that nonmetallic tension band fixation is a safe and effective alternative to traditional metallic tension band fixation for patellar fractures. The study's low-complication rate and reoperation frequency underscore the value of nonmetallic implants in mitigating adverse effects and enhancing clinical outcomes. Level of evidence: IV. [ABSTRACT FROM AUTHOR]

Objective: The risk of osteochondral fracture (OCF) after patellar dislocation has been shown to be related to patellofemoral anatomy, but its relationship to patellar morphology remains unknown. The aim of this study was to investigate the associations between patellar morphology and the risk of OCF after patellar dislocation. Methods: A total of 140 patients with patellar dislocation between January 2018 and June 2023 were enrolled in this study and divided into two groups. Sixty‐five patellar dislocation patients with OCF were included in the OCF group, while 75 patellar dislocation patients without OCF were included in the non‐OCF group. Computed tomography was used to compare measurements of patellar morphology including Wiberg classification, patellar width and thickness, Wiberg angle, Wiberg index, facet ratio, lateral patellar facet angle, and patellar tilt angle. A logistic regression model was performed to evaluate the correlations between patellar morphology and the risk of OCF after patellar dislocation. Receiver operating characteristic curves were used to calculate the area under the curve (AUC) and determine the diagnostic values of patellar morphology for OCF after patellar dislocation. Subgroup analyses for gender and age were conducted to compare the differences in patellar morphology of PD patients. Results: Wiberg angle was significantly lower in the OCF group (p = 0.017), while Wiberg index (p = 0.002) and facet ratio (p = 0.023) were significantly higher in the OCF group. According to the results of logistic regression analysis, Wiberg angle (odds ratio [OR] = 0.96, p = 0.022) and Wiberg index (OR = 1.105, p = 0.032) were the final relevant factors for the occurrence of OCF after patellar dislocation. The AUC was 0.622 (95% confidence interval [CI]: 0.529–0.714) for Wiberg angle, 0.65 (95% CI: 0.558–0.742) for Wiberg index, and 0.702 (95% CI: 0.615–0.788) for the combination of Wiberg angle plus Wiberg index. Conclusion: Wiberg angle and Wiberg index were independent risk factors for the occurrence of osteochondral fracture after patellar dislocation. Moreover, Wiberg angle, Wiberg index, and the combination of Wiberg angle plus Wiberg index had good predictive diagnostic value for the occurrence of OCF after patellar dislocation. [ABSTRACT FROM AUTHOR]

Purposes: Fractures of the inferior patellar pole, unlike other patellar fractures, present challenges for traditional surgical fixation methods. This article introduces the clinical technique and outcomes of using Kirschner wire tension band combined with anchor screw cross-stitch fixation for comminuted inferior patellar pole fractures. Methods: This retrospective case series study included 14 patients with comminuted inferior patellar pole fractures treated at our institution from September 1, 2020, to April 30, 2022. All patients underwent surgery using the Kirschner wire tension band with anchor screw cross-stitch technique. Follow-up assessments involved postoperative X-rays to evaluate fracture healing, as well as clinical parameters such as healing time, Visual Analog Scale (VAS) scores, range of motion (ROM), and Bostman scores. Results: All patients were followed for an average of over 12 months, with no cases of internal fixation failure. Knee joint stability and function were excellent. X-rays revealed an average healing time of approximately 10.79 ± 1.53 weeks, hospitalization lasted 5.64 ± 1.15 days, surgery took approximately 37.86 ± 5.32 minutes, and intraoperative blood loss was 33.29 ± 8.15 ml. One patient experienced irritation from the internal fixation material. At the final follow-up, the Bostman score averaged 28.29 ± 0.83, knee joint flexion reached 131.07° ± 4.88°, all patients achieved full knee extension, and the VAS score was 0.36 ± 0.63. Conclusion: Kirschner wire tension band with anchor screw cross-stitch fixation for comminuted inferior patellar pole fractures delivered satisfactory clinical outcomes. This surgical method, characterized by its simplicity and reliability, is a valuable addition to clinical practice. [ABSTRACT FROM AUTHOR]

Background and Objectives: Patella baja is a common complication after operative treatment for patellar fracture. This study aimed to investigate (1) the serial changes in patellar height and (2) the potential predictive factors for patellar height changes after tension band wiring (TBW) for patellar fractures. Materials and Methods: Forty-one patients who underwent TBW for patellar fracture between March 2019 and September 2022 were enrolled. To identify serial changes in patellar height, modified Blackburne–Peel index (mBPI) was assessed at just after surgery, at 3 months, at 6 months, at 1 year and at the final follow-up. Multiple regression analysis was conducted to identify factors correlated with mBPI difference between the contralateral side (considered as preoperative status) and injured side. Results: The postoperative mBPI exhibited a decline over time (mean mBPI immediately post operation/3 months/6 months/1 year/final follow-up: 0.69/0.63/0.63/0.62/0.61) Specifically, mBPI showed a significant reduction immediately post operation to 3 months (p < 0.001), although comparisons at other time points did not reveal significant differences. A lower position of the fracture was associated with a decrease in patellar height after surgery. Conclusions: Patellar height was mainly decreased from immediately post operation to 3 months. A fracture in a lower position of associated with decreased patellar height after the TBW of the transverse patellar fracture. [ABSTRACT FROM AUTHOR]

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Background: patellar instability is a relatively frequent musculoskeletal disorder in children with Down syndrome (DS). However, such a condition has seldom been studied in the literature, even less its surgical treatment. Different techniques have been offered for this condition; the evidence for surgical options is scarce and primarily based on case reports or case series with few patients and heterogeneous techniques. Given this background, we aimed to evaluate the outcomes of a uniform kind of surgical procedure for such a condition that combined lateral soft tissue release, medial patellofemoral ligament (MPFL) reconstruction (using a partial-thickness quadriceps tendon autograft), the Roux-Goldthwait procedure, and V-Y quadricepsplasty (if needed). Materials and methods: This retrospective study involved 11 skeletally immature patients (12 knees; 9 males and 2 females), 5.5 to 14.1 years of age, with DS who had patellofemoral instability (PFI) and were managed by this technique between October 2018 and March 2020. Preoperative radiography, CT scan, and MRI were performed to evaluate the physis status, lower limb alignment, patellar height, trochlear morphology, and any associated knee pathology. A functional knee assessment was done by using the Kujala score and the modified Lysholm score. Results: The mean time of follow-up (± SD) was 47.7 ± 5.8 months (range: 39–56). Pre-operatively, the Kujala score (± SD) was 52.6 ± 14.3 (range: (31–74), and at final follow-up, it was 92.2 ± 4.4 (range: (88–98), showing a significant improvement (P < 0.001). The preoperative modified Lysholm score (± SD) was 54.3 ± 8.1 (range: 39–62), and at final follow-up it was 92.4 ± 5.3 (range: 82–96), showing a significant improvement (P < 0.001). All patients had a stable patella without a recurrence of instability and regained full ROM. There was no incidence of a patellar fracture or femoral physis injury. Conclusions: Our proposed technique of combined soft tissue procedures, including lateral soft tissue release, MPFL reconstruction (using a partial-thickness quadriceps tendon autograft), the Roux-Goldthwait procedure, and V-Y quadricepsplasty, was an effective method for treating patellar instability in children with DS while avoiding physeal injury and patellar fracture. Functional scores and radiological outcomes were improved. Level of evidence: IV; retrospective case series. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to report the epidemiology of patellar sleeve injuries, describe diagnostic findings and treatment, and assess functional outcomes following different treatments. Methods: A medical database was queried from 1990 to 2016 to identify patients ≤18 years presenting to a single pediatric institution with a patellar sleeve injury. Patients with significant comorbidities or previously operatively treated for ipsilateral knee injuries were excluded. Standard demographic data, mechanism of injury, skeletal maturity, injury-related radiographic parameters, along with treatment paradigms, post-treatment clinical and radiographic findings, and patient-reported outcomes were collected. Results: A total of 90 patients, mean age of 10.7 years (range: 7–17) was included, of which 69 (77%) were male. Seventy-three percent of all injuries occurred while playing sports (particularly football/basketball/soccer), with "direct blow" or "landing" being the most prevalent mechanisms of injury. Twenty-six (29%) underwent operative treatment, with transosseous suture fixation being the most popular surgical technique (73%). Of the 64 (71%) non-operatively treated patients, 18 (39%) were placed in a hinged knee brace locked in extension with the remainder split between casting and standard knee immobilizer. Compared to the non-operative cohort, a higher percentage of the operative group had a pre-treatment extensor lag (p < 0.001) and greater fragment displacement (p < 0.001) with patella alta (p < 0.001) on imaging. There was no difference in outcome scores (Pedi-IKDC/Lysholm) or patella alta on radiographs between groups. Post-treatment surveys indicated no difference in residual pain or ability to return to sport. Conclusion: This large case series provides valuable epidemiologic, clinical, and radiographic data describing patellar sleeve fractures, along with outcomes following non-operative and operative treatments. Level of evidence: IV. [ABSTRACT FROM AUTHOR]

Objective: TKR followed by patellar resurfacing has been shown of great advantage in literature. This study is done To review post-operative complications among patients, after being treated with patellar resurfacing in total knee repair Method: Prospective continuous study at Orthopaedic Surgery PAEC General Hospital, Islamabad for 6 months Selected sample size is n=58 by simple random sampling( non-probability) Inclusion criteria: Patients under the age group of 18-70 years old of both genders undergone TKR followed by patellar resurfacing, arthritis undergone TKR followed by patellar resurfacing & patellar resurfacing after trauma. Exclusion criteria: Patients undergone TKR with comorbid; diabetes, congestive heart disease, hypertension, neuropathological diseases & renal disorders.& unwilling to participate. Results: The mean age of participants was 44.32 (S.D=3.5) Mean BMI was 29.4 (S.D=3.2). males were 16 while 42 females went under surgery. There was no association seen between BMI and post-op complications Average follow-up was 98 days (58-144). Co-relation between TKR and patellar resurfacing, there was no variation. Among fifty-eight patients patellar fracture, patellar matlracking, aseptic loosening,. Patellar osteonecrosis, polythene wear, Dislocation following total knee arthroplasty, and other hardware mal-function, Overstuffing of the PFJ in postoperative TKA was seen among three people 5.2% of individuals Conclusion: To reduce the danger of additional difficulties, patellar resurfacing must be performed with a high level of accuracy and precision since it is just as crucial as tibiofemoral replacement. [ABSTRACT FROM AUTHOR]

Background: To better understand the pathophysiological mechanisms of patellar fractures, MRI was utilized to identify the imaging signs of various types of patellar fractures. Methods: A retrospective study was performed using MRI images of 52 patients with patellar fractures. Observing the development of patellar and femoral morphology and the imaging manifestations of different fracture types, such as fracture displacement, and damage to accessory ligaments, tendons, and meniscus, type of joint cavity effusion, and damage to surrounding accessory bones were identified. Results: There were 21 tangential fractures (40.4%), 8 transverse fractures (15.4%), 8 longitudinal fractures (15.4%), 4 oblique fractures (7.7%), and 11 comminuted fractures (21.2%) among the 52 patients with patellar fracture. Tangential fractures begin at a younger age than the other four forms of fractures. When tangential fractures were compared to other types of fractures, medial patellar retinaculum and anterior and posterior cruciate ligament injuries were statistically significant (P< 0.05). The detection rate of trochlear dysplasia, type II and type III patellar was higher in patients with tangential fractures than in other fractures. Conclusions: Tangential fractures are less common to cause anterior and posterior cruciate ligament injuries than other types of fractures, but they are more likely to cause medial patellar retinaculum injuries. [ABSTRACT FROM AUTHOR]

Background: Lower-extremity fractures (LEFs) account for >30% of all skeletal injuries, contributing to the global health and economic burden. Fracture epidemiology in the Middle East and North Africa (MENA) region has been studied little. Health factors and disease epidemiology differ greatly among populations in MENA despite cultural, political, and economic similarities among the region's countries. This study examined the epidemiology of LEFs and the need for rehabilitation in MENA from 1990 to 2019. Methods: We examined the epidemiology of fractures of the pelvis, hip, femur, patella, tibia, fibula, ankle, and foot bones using Global Burden of Disease (GBD) data. Fracture incidence, counts, and rates were measured for males and females across age groups in the 21 MENA countries as identified by the GBD data set. Associations between years of healthy life lost due to disability (YLD) resulting from fracture and the Socio-demographic Index (SDI) were analyzed. Results: In contrast to the global trend, the age-standardized incidence rate (ASIR) of LEFs in the MENA region increased by 4.57% from 1990 to 2019. In 2019, the highest ASIR among fractures was attributed to fractures of the patella, fibula, tibia, or ankle (434.36 per 100,000), most frequently occurring among those 20 to 24 years of age. In 2019, the highest ASIR of all fractures was noted in Saudi Arabia (2,010.56 per 100,000) and the lowest, in Sudan (523.29 per 100,000). The greatest increases from 1990 to 2019 in the ASIR of LEFs were noted in Yemen (132.39%), Syria (107.27%), and Afghanistan (94.47%), while the largest decreases were found in Kuwait (262.72%), Sudan (248.72%), and Iran (245.37%). In 2019, the YLD rate of LEFs had increased to 277.65 per 100,000, up from 235.55 per 100,000 in 1990. Conclusions: Between 1990 and 2019, LEFs increased in the MENA region. Violence, war, and road traffic accidents increased, leading to a high rate of fractures, especially among youth. Low bone-mineral density related to vitamin D deficiency has also been reported as a risk factor for fracture in the region. Regional health authorities should be informed of fracture patterns by this study. [ABSTRACT FROM AUTHOR]

Patella fractures usually occur as a result of direct trauma to the anterior knee joint, indirect injury as a result of eccentric muscle contraction, or rapid knee flexion against a contracted quadriceps muscle. The patella functions as part of the extensor mechanism of the knee, where large forces are transmitted, and its subcutaneous nature has made treatment of patella fractures a challenge. In this review article, we evaluate how the management of these fractures has evolved over time and the advantages associated with the various treatment techniques. There are few comparative studies looking at the different treatment types for fractures of the patella, with the goal of achieving a functional extensor mechanism with low rates of post-traumatic arthritis and metal-work irritation. [ABSTRACT FROM AUTHOR]

Introduction: We present a new surgical technique of Krackow suture combined with vertical Nice knot for the treatment of inferior patellar fractures and report the clinical results. Patients and Methods: Seventeen consecutive patients admitted with inferior patellar fractures over a 2-year period from June 2019 to February 2022 were prospectively enrolled. The AO classification was 34-A1. All patients underwent open reduction and fixation with Krackow sutures in combination with vertical Nice knot. Postoperative follow-up was performed for at least 1 year to evaluate knee function. Results: The mean age of seventeen patients was 53.2 ± 9.5 years (39–68 years), and all patients were followed up for more than 12 months. The operation time was 54.6 ± 7.7 min (42–68 min). No patients had nonunion, joint stiffness, and joint pain. All cases achieved bony union at an average of 9.9 ± 1.5 weeks (8–13 weeks) after surgery. At the last follow-up, there was no significant difference in range of motion between the injured knee (129.7 ± 3.3°, range 125–135°) and the unaffected knee (130.8 ± 3.8°, range 126–137°) (t = 0.28, P > 0.05). The mean Bostman score of the knee joint was 29.6 ± 0.7, including 15 excellent cases (88.2%) and two good case (11.8%). Conclusion: Krackow sutures combined with vertical Nice knots are stable and reliable in the treatment of inferior patellar fractures. Knee rehabilitation can be performed immediately after surgery and satisfactory knee function can be achieved. It is a safe, simple, and reliable alternative surgical method, and patients do not need to bear the secondary surgical injury of removing the internal fixation material. Therefore, it is suitable for the application of clinical promotion. [ABSTRACT FROM AUTHOR]

Background and Objectives: Complications arising from transverse fractures of the patella, olecranon, and medial malleolus are a leading cause of disability. Among the available therapeutic options, tension band wiring is the most helpful for patient mobilisation at an early stage. Materials and Methods: In our study, which involved 50 patients requiring surgery at the Department of Orthopedics, Siddhartha Medical College, Vijayawada, Andhra Pradesh, India for fractures of the patella, olecranon, and medial malleolus, tension band wiring was used. This study was conducted between the January 2023 to December 2023. Various metrics were used to assess the functional outcome of the patients. Patients had radiological evaluation as well. Results: Among the top ratings given to the surgery, our research shows that it was 85% successful for patella. "Reduction" is the medical term most often used to describe the procedures performed to set broken bones. Manual techniques are used for less severe fracture reduction, while open reduction internal fixation is used for more severe fractures. Following this treatment, the motion of the broken bones is limited by means of a cast. For accurate and lawful healing to occur, the resting period is absolutely necessary. Conclusion: It is critical to have trials that show the operation is beneficial because of the frequency of knee fractures and the length of time it takes for the patella to recover. In order to successfully cure any fracture, early mobilization is essential. [ABSTRACT FROM AUTHOR]

Patella fractures in the pediatric age group often have a dilemma in their ease of diagnosis and treatment required. Indications for conservative management or surgical intervention in the pediatric population during growth phase are not clearly defined. The current systematic review aims to provide a consensus on the morphological types, treatment options, indications, the outcomes expected and complications and their management. The review was conducted as per the PRISMA guidelines. Inclusion criteria were (a). Articles published in English, (b) Age <18 years, (c) Patellar fractures including osteochondral fractures. Exclusion criteria includes articles with incomplete data, case reports, biomechanical studies, case series with sample size <2, biomechanical studies, reviews, letter to the editor, or editorials and Non-English language. The review search yielded a total of 18 articles. A total of 288 patients with patellar fractures were included in the review. The average age ranged from 9.6 years to 16 years. The follow-up period ranged from 3 months to 20 years. In total, 49 individuals underwent immobilization with cast or brace application, 4 with spica cast application and 48 with cylindrical cast in extension. Overall, 83 patients in 13 studies underwent surgical fixation most of which underwent wiring. Pediatric patella fracture/dislocations or Osteochondral fractures (OCF) although being a rare event, may be associated with a child with knee injury and swelling. Conservative management in terms of casting and immobilization may be an alternative but surgical intervention should be the primary mode of treatment in such cases. [ABSTRACT FROM AUTHOR]

Background: Hyponatremia and hypokalemia are common electrolyte imbalances in trauma patients and have been identified to be risk factors for a fall. In addition, hyponatremia was reported to be related to osteoporosis and fragility fractures, while the association between hypokalemia and osteoporosis has only been reported in rare case reports. This study investigated the impact of hyponatremia and hypokalemia on the incidence of fractures in various body regions of adult trauma patients, using the propensity score-matched patient cohort to reduce the influence of patients' baseline characteristics. Methods: The study analyzed data from 11,173 hospitalized adult trauma patients treated from 1 January 1998, to 31 December 2022. The study included 1968 patients with hyponatremia and 9205 without, and 1986 with hypokalemia and 9187 without. Different 1:1 propensity score-matched cohorts were generated to create the 1903 pairings of patients with or without hyponatremia, 1977 pairings of patients with or without hypokalemia, and 380 pairing of patients with both hyponatremia and hypokalemia vs. normal control patients. Analysis was conducted on the incidence of fracture in various anatomic regions. Results: Hyponatremic patients had increased odds of thoracic vertebral fracture [odds ratio (95% confidence interval) 1.63 (1.10–2.42), p = 0.014], pelvic fracture [2.29 (1.12–4.67), p = 0.019], and femoral fracture [1.28 (1.13–1.45), p < 0.001] but decreased odds of radial and patella fractures. Hypokalemic patients showed no significant differences in fracture risk except for a decreased likelihood of radial fractures. The patients with both hyponatremia and hypokalemia showed a decreased likelihood of radial fractures and patella fractures. Conclusion: Hyponatremia may have a greater impact on the occurrence of bone fractures than hypokalemia in trauma patients who have suffered a fall. Electrolyte abnormalities should be taken into account while assessing the risk of fractures in trauma patients. [ABSTRACT FROM AUTHOR]

Objective: The most common technique for fixing patella fractures is tension band wiring (TBW). The current study aimed to assess the functional and radiological outcomes of the patellar fractures treated by TBW. Patients and Methods: This retrospective cohort study was performed on 78 patients who underwent TBW of patellar fracture in Akhtar Orthopedic Hospital, Tehran, Iran, from September 2015 to April 2018 and had completed a two-year follow-up. A surgical intervention consisting of open reduction and internal fixation was performed on all patients using TBW. Patients were evaluated two years postoperatively by clinical examination, radiographic investigation, and three scales (Tegner activity score [TAS], Lysholm knee score [LKS], and lower extremity functional scale [LEFS]). Result: Of the 78 patients, 48 (61.5%) were male, with a mean age of 36.7±13.1 years. Postoperatively, 41 (52.6%) patients had anterior knee pain, and four (5%) patients had an infection. Knee range of motion was limited in 20 (25.6%) patients. The mean postoperative TAS, LKS, and LEFS mean scores were 4.3±1.34, 85.97±9.21, and 69.62±6.68, respectively. Age was inversely correlated with LKS and LEFS, as both scores decreased with increasing age (p<0.001, r:-0.4). Younger patients (under 30 years old) were more likely to reach their pre-injury TAS score than older patients (p<0.001). In addition, patellofemoral osteoarthritis and patella baja were significantly higher in patients with comminuted fractures than in those with simple fracture patterns (p<0.001). Conclusion: We found acceptable outcomes after fixation with TBW, especially in younger patients; LKS and LEFS scores were lower in the elderly, and younger patients were more likely to reach closer to their pre-injury TAS score. Furthermore, patellofemoral osteoarthritis and patella baja were associated with comminuted patella fractures. [ABSTRACT FROM AUTHOR]

The patella is the largest sesamoid bone in the body and an important structure of the extensor apparatus which is under undue stress during flexion and extension of the knee. Bilateral fracture of the patella without trauma is a very rare event and may be multifactorial without a single cause. A repetitive stress reaction in a previously predisposed bone can be an important cause. We report a case of a 45-year-old female with a nontraumatic bilateral transverse patella fracture with loss of extensor mechanism. A stable surgical fixation for such a displaced fracture with a good rehabilitation program can lead to a good functional outcome. [ABSTRACT FROM AUTHOR]

Background: Longitudinal patellar fractures are uncommon in veterinary orthopedics routine. These fractures directly affect pelvic limb movements and can result in joint incongruity and potentially degenerative joint disease. Surgical repair is necessary to preserve the quadriceps extensor mechanism and reduce possible complications. This paper describes the clinical status of a cat suffering from a longitudinal patellar fracture, the surgical procedure used to repair and stabilize the bone, and the postoperative outcomes during the animal's different healing phases. Case: One cat with a longitudinal patellar fracture of the left pelvic limb was treated at the Veterinary Hospital of the Federal University of Santa Maria (UFSM), in the state of Rio Grande do Sul, Brazil. The patient was diagnosed based on physical and radiographic examinations of the affected pelvic limb. Under anesthesia, the patella was subjected to osteosynthesis using cerclage wire and to trochlear sulcoplasty to prevent luxation. The veterinarian recommended postoperative rest and basic care involving hygiene of the surgical wound. After 60 days, the cat was brought back to the hospital for radiographic reassessment to verify the osseous consolidation of the patella. The X-ray exam revealed non-consolidation of the bone fragments, despite the cemented implant and the proper joining of the fragments. However, although the fracture did not consolidate, the animal exhibited clinical improvement of its lameness. Discussion: Longitudinal fractures are rare and the literature contains few reports about them. It is believed that cats are more likely to present longitudinal fractures after direct blows that cause compression of the patella over the trochlear groove, since the patella in this species is relatively wider and smoother than that of dogs. The literature still lacks a clear description of the causal mechanism of longitudinal fractures; however, but the main causes may vary according to the clinical presentation. The choice of the best method to treat patellar fractures still poses a challenge, since several methods have been described, depending on how the fracture presents. Regardless of the choice of treatment, the techniques for surgical repair of patellar fractures must involve the following steps: the fracture must be reduced, the fragments kept in apposition until the fracture closes, the soft tissues are healed, and the knee function restored. The cat's patellar fracture was repaired with cerclage wire to restore its anatomical normality, reducing the fracture and stabilizing the bone fragments in order to immobilize them and ensure proper better bone healing. Maintenance and approximation of the lateral fragment of the longitudinal fracture, in conjunction with sulcoplasty, were proposed to ensure greater contact between the patella and the trochlear groove, thereby reducing the possibility of luxation. Despite the non-consolidation of the fracture, the fragment remained intact and immobile, and no post-surgical complications were reported. This confirmed the success of the technique employed to bring together the patellar fragments of the lateral longitudinal fracture, even in the absence of bone callus formation. Moreover, the technique proved to be simple and resulted in complete joint stability after 60 days. This is therefore an important tool for patellar fractures, whose lateral longitudinal fragment was retained, allowing for correct approximation and fragment immobilization, without the need for excision by partial patellectomy. [ABSTRACT FROM AUTHOR]

Background: Patellar instability is a common condition that affects many young, active patients and can lead to long-term disability. This video aims to provide insights in the treatment of acute osteochondral fractures in skeletally immature patients after acute patellar dislocation. Indications: Patients who present with acute patellar dislocation and evidence of osteochondral fracture or osteochondral fracture with a loose body are potential candidates for medial patellofemoral ligament reconstruction (MPFLR) with osteochondral fragment fixation. Technique Description: In case 1, arthroscopy revealed a medial patellar facet defect. A medial patellar incision was made with dissection down to the vastus medialis oblique fascia and medial retinaculum. Before continuing to capsulotomy, the dissection for the MPFLR is completed by dissecting down to create a plane between layers 2 and 3. Capsulotomy is then performed with retrieval of the loose body, preparation of the patellar defect, and fixation of the osteochondral fragment. The MPFLR is then performed. An allograft is fixed to the patella with 2 pushlock anchors, and to a distally directed femoral tunnel using a 7-mm pitchfork SwiveLock tenodesis anchor, with care to avoid the medial femoral physis. The capsulotomy is then closed underneath the graft, with layer 2 closed above it. In case 2, a large osteochondral fracture of the lateral femoral condyle with loose cartilage flaps was arthroscopically identified. An anterior incision was made and a lateral lengthening was completed to perform a laterally based arthrotomy to expose the defect on the lateral femoral condyle. The defect site was prepared and the loose body was secured and fixated into the donor site lesion using bioabsorbable screws. The MPFLR was completed as in case 1, and the wound was closed in standard fashion. Results: Acute patellar dislocation with osteochondral fracture has been shown to lower both subjective and functional patient outcome measures. A recent study suggests that in large osteochondral fractures after patella dislocation, internal fixation improves mid- and long-term outcomes when compared with debridement alone. Conclusion: The MPFLR with concurrent osteochondral fracture fixation in patients with open physes is a reliable option for improving patellar stability and protecting articular cartilage from further injury. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form. [ABSTRACT FROM AUTHOR]

Background: We have applied primarily multiple locking compression miniplates in treating multifragmentary, comminuted patellar fracture in combination with conventional fixation methods. Methods: Medical and radiologic data were retrospectively reviewed for the patients surgically fixated with locking compression miniplates in patellar fracture of AO/OTA 34-C3. The primary outcome was bone union at the final follow-up, and the secondary outcomes were functional outcomes and postoperative complications associated with the procedure. For the functional assessment, the Lysholm score, Tegner scores, and the knee range of motion was compared. Results: A total of twenty patients with AO/OTA 34-C3 patellar fracture were included in the study with an average follow-up period of 15 months (range:11 ~ 18 months) between June 2018 and November 2021. Eleven male and nine female patients presented an average age of 57.15 years. The primary fracture union was seen in all twenty patients, and the average time to the union was 15.6 weeks on serial radiograph follow-up. All patients did not show any postoperative complications, such as fixation failure, infection, or revision operations. Postoperatively, all patients achieved an average range of motion of 130 degrees, and the Lysholm and Tegners scores showed an average of 90.4 and 5.0 at the final follow-up, retrospectively. Conclusion: Fixations with miniplates in comminuted patellar fractures can be a useful option for effective osteosynthesis due to their versatile, efficient, and low-profile nature. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to investigate whether increased patellar thickness after resurfacing decreased knee flexion angle and had any effect on functional outcomes comparing with patellar thickness restoration (patelloplasty) in patients undergoing primary total knee arthroplasty (TKA) or not. Methods: We retrospectively reviewed 220 patients undergoing primary TKA: 110 patients undergoing patelloplasty and 110 patients received overstuffed patellar resurfacing using subchondral bone cut at lateral facet technique were recruited. The mean increase in patellar thickness after resurfacing equal to 2 ± 1.2 mm. The outcomes were postoperative knee flexion angle and modified Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score at minimum 2 year after surgery. Results: The mean postoperative knee flexion angles were similar between overstuffed resurfacing group and patelloplasty group (132 ± 7° vs. 134 ± 8°, 95% confidence interval [CI] − 6.9–1.8°, p = 0.1). The mean increase in postoperative knee flexion was 13° in both groups (p = 0.94). The mean change of overall modified WOMAC score was also similar between the two groups (42 ± 12 vs. 39 ± 9 points, 95% CI − 1.7–9.4 points, p = 0.17). Conclusion: This study demonstrated that increased patellar thickness has no effect on postoperative knee flexion angle and functional outcomes in TKA. The finding clarified the misunderstanding principle of native patellar thickness restoration after resurfacing which had made many surgeons to refrain from resurfacing especially in patient who had thin patella. [ABSTRACT FROM AUTHOR]

Purpose: Poor outcomes and high complication and reoperation rates have been reported with tension-band wiring (TBW) in the management of patellar fractures and particularly the comminuted ones. The purpose of this study was to investigate the functional outcomes and complication rates of patellar fractures managed with open reduction and internal fixation (ORIF) with a plate. Methods: MEDLINE, EMCare, CINAHL, AMED and HMIC were searched, and the PRISMA guidelines were followed. Two independent reviewers extracted the data from the included studies and assessed them for the risk of bias. Results: Plating of patellar fractures is associated with satisfactory range of movement (ROM) and postoperative function and low pain levels. We found a 10.44% complication rate and a low reoperation rate. Reoperations were mainly performed for metalwork removal. Conclusion: ORIF with plating of patellar fractures is a safe alternative in the management of patellar fractures and may be associated with a lower complication and reoperation rate compared to TBW. Future randomized prospective studies are needed to validated the results of the present systematic review. [ABSTRACT FROM AUTHOR]

Background: Fibrodysplasia ossificans progressiva (FOP) is an ultrarare genetic disorder with episodic and progressive heterotopic ossification. Tissue trauma is a major risk factor for flareups, heterotopic ossification (HO), and loss of mobility in patients with FOP. The International Clinical Council on FOP generally recommends avoiding surgery in patients with FOP unless the situation is life-threatening, because soft tissue injury can trigger an FOP flareup. Surprisingly little is known about flareups, HO formation, and loss of mobility after fractures of the normotopic (occurring in the normal place, distinct from heterotopic) skeleton when treated nonoperatively in patients with FOP. Questions/purposes: (1) What proportion of fractures had radiographic evidence of union (defined as radiographic evidence of healing at 6 weeks) or nonunion (defined as the radiographic absence of a bridging callus at 3 years after the fracture)? (2) What proportion of patients had clinical symptoms of an FOP flareup because of the fracture (defined by increased pain or swelling at the fracture site within several days after closed immobilization)? (3) What proportion of patients with fractures had radiographic evidence of HO? (4) What proportion of patients lost movement after a fracture. Methods: We retrospectively identified 36 patients with FOP from five continents who sustained 48 fractures of the normotopic skeleton from January 2001 to February 2021, who were treated nonoperatively, and who were followed for a minimum of 18 months after the fracture and for as long as 20 years, depending on when they sustained their fracture during the study period. Five patients (seven fractures) were excluded from the analysis to minimize cotreatment bias because these patients were enrolled in palovarotene clinical trials (NCT02190747 and NCT03312634) at the time of their fractures. Thus, we analyzed 31 patients (13 male, 18 female, median age 22 years, range 5 to 57 years) who sustained 41 fractures of the normotopic skeleton that were treated nonoperatively. Patients were analyzed at a median follow-up of 6 years (range 18 months to 20 years), and none was lost to follow-up. Clinical records for each patient were reviewed by the referring physician-author and the following data for each fracture were recorded: biological sex, ACVR1 gene pathogenic variant, age at the time of fracture, fracture mechanism, fracture location, initial treatment modality, prednisone use at the time of the fracture as indicated in the FOP Treatment Guidelines for flare prevention (2 mg/kg once daily for 4 days), patient-reported flareups (episodic inflammatory lesions of muscle and deep soft connective tissue characterized variably by swelling, escalating pain, stiffness, and immobility) after the fracture, follow-up radiographs of the fracture if available, HO formation (yes or no) as a result of the fracture determined at a minimum of 6 weeks after the fracture, and patient-reported loss of motion at least 6 months after and as long as 20 years after the fracture. Postfracture radiographs were available in 76% (31 of 41) of fractures in 25 patients and were independently reviewed by the referring physician-author and senior author for radiographic criteria of fracture healing and HO. Results: Radiographic healing was noted in 97% (30 of 31) of fractures at 6 weeks after the incident fracture. Painless nonunion was noted in one patient who sustained a displaced patellar fracture and HO. In seven percent (three of 41) of fractures, patients reported increased pain or swelling at or near the fracture site within several days after fracture immobilization that likely indicated a site-specific FOP flareup. The same three patients reported a residual loss of motion 1 year after the fracture compared with their prefracture status. HO developed in 10% (three of 31) of the fractures for which follow-up radiographs were available. Patient-reported loss of motion occurred in 10% (four of 41) of fractures. Two of the four patients reported noticeable loss of motion and the other two patients reported that the joint was completely immobile (ankylosis). Conclusion: Most fractures treated nonoperatively in individuals with FOP healed with few flareups, little or no HO, and preservation of mobility, suggesting an uncoupling of fracture repair and HO, which are two inflammation-induced processes of endochondral ossification. These findings underscore the importance of considering nonoperative treatment for fractures in individuals with FOP. Physicians who treat fractures in patients with FOP should consult with a member of the International Clinical Council listed in the FOP Treatment Guidelines (https://www.iccfop.org). [ABSTRACT FROM AUTHOR]

Objective: We invented a new cannulated screw with holes on the tail, which called Ding's screw. The goal of this study was to evaluate the biomechanical outcomes of this new screw with tension band wiring for the treatment of inferior pole patellar fractures in a finite element model. Methods: We conducted a finite element biomechanical study using two fixation methods: Ding's screw and tension band wiring (DSTBW) and cannulated screws and tension band wiring (CSTBW). Two methods were simulated to fix the inferior pole patellar fracture in a finite element model. The relative displacement and stress distribution were analyzed and compared. Result: There were less displacement and stress distribution of DSTBW in different knee movement (30°, 60°, 90°, 120°) when compared to CSTBW. The highest value of displacement of the fracture and von Mises stress of the internal fixation happened in 120° knee movement in both groups. The highest displacement of the DSTBW was less than that of the CSTBW (1.92 mm to 2.12 mm). The highest value of the stress on the screws was 110.60 MPa in DSTBW group, and 132.90 MPa in CSTBW group. The highest value of the stress on the titanium cable was 38.51 MPa in DSTBW group, and 41.91 MPa in CSTBW group. Conclusion: DSTBW fixation provides more stability than CSTBW fixation model in a finite element study. [ABSTRACT FROM AUTHOR]

Despite the variety of treatment methods, comminuted inferior pole fractures of the patella remain difficult and technically demanding to achieve stable internal fixation. The purpose of this study is to evaluate the clinical outcomes of rim plate-augmented separate vertical wiring with supplementary fixation in the management of comminuted inferior pole fractures, AO/OTA 34-A1, C2, and C3, which has the secondary horizontal fracture line on lower articular boundary. From our study, bony union was achieved in all patients at an average of 3.1 ± 1.4 months after surgery. There was no patient with loss of reduction, fixation failure, or infection during follow-up. The average final range of motion was 131.6° ± 7.2°. Lysholm knee scores gradually increased over 3, 6, 9, and 12 months postoperatively by 58.7, 74.0, 82.9, and 89.4, respectively. Isokinetic peak torque deficit of the knee extensor muscles in 3, 6, 9, and 12 months postoperatively was 59.9%, 49.7%, 35.7%, and 28.1%, respectively. The rim plate-augmented separate vertical wiring with supplementary fixation for the treatment of patellar fracture associated comminuted inferior pole is effective and can be safely applied AO/OTA 34-C2 or C3 with favorable outcomes. [ABSTRACT FROM AUTHOR]

Background: Patellar fractures have a comparatively low incidence compared to all fracture frequencies of the musculoskeletal system. However, surgical management is crucial to prevent postoperative complications that affect the knee joint. The purpose of the present study was to evaluate the incidence of postoperative complications and onset of postoperative osteoarthritis related to the chosen technique of patellar fracture management. Methods: In a retrospective cohort study consecutive managed, isolated patella fractures were reviewed for demographic data, trauma mechanism, patella fracture type, fixation technique and postoperative complications. The results were documented radiographically and clinically and analysed statistically. The reporting followed the STROBE guidelines. Results: A total of 112 patients were eligible for data evaluation. Surgical management of comminuted patellar fractures with small fragment screws showed significant fewer postoperative complications compared to other fixation techniques (8%, p < 0.043). The incidence of posttraumatic infection was significantly higher following the hybrid fixation technique with cannulated screws and tension wire than following the other analysed techniques (p = 0.024). No postoperative wound infection was observed after screw fixation or locking plate fixation. Symptomatic hardware was most frequently seen after tension-band fixation. Onset of posttraumatic osteoarthritis was most often found after the hybrid fixation technique (55%). Conclusion: Surgical management of patellar fractures remains crucial but fracture fixation using plating systems or small fragment screws is least associated with postoperative complications. Trial registration: Trial registration number (DRKS):00027894. [ABSTRACT FROM AUTHOR]

Background: Tension band wiring (TBW) has conventionally been used for the open reduction and internal fixation of the patella. However, it suffers from distinct disadvantages such as large incision, implant irritation, and need for subsequent implant removal. Here, we propose a novel technique using closed reduction and percutaneous fixation with three cannulated screws (TCS), which may be an alternative to this established conventional technique. Although some researchers have proposed alternative methods including closed reduction and cannulated screw fixation, with or without additional wires through the screws, and arthroscopic-assisted reduction and fixation, there are few studies that focus on the biomechanical stability of percutaneous fixation using only cannulated screws. Thus, the purpose of this study was to evaluate TCS versus TBW for simple transverse patellar fractures in cadaveric and patients' level, aiming to determine whether TCS show superiority over TBW in terms of biomechanical stability in a cadaveric study with benign clinical feasibility and outcomes in patients. Methods: We conducted a cadaveric study with 15 knee specimens that had simple transverse patellar fractures. We used two fixation techniques: TBW (group A, n = 6) and TCS (group B, n = 9). We applied sinusoidal forces (25 N–125 N) at 1/5 Hz and 90° knee flexion to simulate knee movement. We compared the displacements at the fracture site between the two groups. We also used the same technique in a total of 23 patients and followed up them for at least 1 year. Results: TCS demonstrated favourable biomechanical stability in the cadaveric study. The technique also performed excellently in terms of postoperative pain, knee function recovery, and complication rates during the follow-up period. Conclusions: The technique provides a surgical treatment option with small incisions, minimal soft tissue irritation, and possibly lower removal rate of bothersome material. [ABSTRACT FROM AUTHOR]

Background: The most recommended method for treating transverse patella fractures is modified tension band wiring (MTBW). However, the optimal instrument for use with MTBW is still undetermined. Hence, we aimed to design a novel screw-cable integrated system (SCIS) and compare its biomechanical characteristics with Kirschner-wire, SCIS, and Cable-Pin systems in treating transverse patellar fracture. Methods: A finite-element (FE) model of transverse patella fracture was created. The fracture model was fixed with either K-wire, SCIS, or Cable-pin. Different tension force loading (400 N and 800 N), direction(0° and 45°), and screw or K-wire depth(5 mm and 10 mm) were set. The maximum displacement of the fragment and maximum gap opening were measured by using FE analysis. Results: Compared with the K-wire and Cable-pin system, SCIS increased the stability of the fractured patella by reducing fragment displacement and gap opening. Under 400 N loading in the direction 45°, SCIS with screw placing at 5-mm depth reduced the maximum fragment displacement (0.43 mm) by 49.62% and 26%, respectively, compared with the K-wire (0.22 mm) and Cable-pin (0. 22 mm) group. Meanwhile, the gap opening in SCIS (0.05 mm) was reduced by 83% and 59.8% (0.05 to 0.18) compared with the K-wire (0.30 mm) and Cable-pin (0.18 mm) group. Conclusion: SCIS demonstrated improved biomechanical stability for treating transverse patellar fractures compared to MTBW with Kirschner wire and the Cable-Pin system. Finite element analysis showed SCIS substantially reduced fracture fragment displacement and gap opening under various loading conditions. [ABSTRACT FROM AUTHOR]

Background: Maintaining effective reduction and firm fixation in inferior pole patellar fractures is a highly challenging task. There are various treatment methods available; although tension-band wiring combined with cerclage wiring (TBWC) is the mainstream approach, its effectiveness is limited. Herein, we propose and evaluate a new technique called candy box (CB), based on separate vertical wiring (SVW), for the treatment of inferior pole patellar fractures. Specifically, we provide biomechanical evidence for its clinical application. Methods: Five fixation models were built: SVW combined with cerclage wiring (SVWC); TBWC; modified SVW with the middle (MSVW-A) or upper (MSVW-B) 1/3 of the steel wire reserved, and CB. A finite element analysis was performed to compare the displacement and stress under 100-N, 200-N, 300-N, 400-N and 500-N force loads. Three-dimensional printing technology was utilized to create fracture models, and the average displacement of each model group was compared under a 500-N force. Results: The results of the finite element analysis indicate that CB technology exhibits significantly lower maximum displacement, bone stress, and wire stress compared to that with other technologies under different loads. Additionally, in biomechanical experiments, the average force displacement in the CB group was significantly smaller than that with other methods under a 500-N force (P < 0.05). Conclusions: CB technology has the potential to overcome the limitations of current techniques due to its superior biomechanical characteristics. By incorporating early functional exercise and ensuring strong internal fixation, patient prognosis could be enhanced. However, further clinical trials are needed to fully evaluate the therapeutic effects of CB technology. [ABSTRACT FROM AUTHOR]

Purpose: Periprosthetic patella fractures (PPPFs) are infrequent but potentially devastating complications after total knee arthroplasty (TKA) and revision TKA (rTKA). These fractures may occur both in resurfaced and un-resurfaced patella. This review summarizes the current literature on PPPFs to help orthopedic surgeons diagnose and treat this uncommon but extremely challenging TKA complication. Methods: A comprehensive search was performed in three databases: PubMed, SCOPUS, and EMBASE. All relevant information was retrieved and summarized in this narrative review. Results: In the studies analyzed, there is a general trend in favor of nonsurgical treatment, except for implant loosening or extensor lag with extensor apparatus disruption, because surgery is often associated with poor clinical outcomes and high complication rates. Conclusion: PPPF is a rare but catastrophic event in TKA and rTKA, occurring mainly in a reconstructed patella. Patient-, implant-, and surgical technique-related factors contribute to its multifactorial etiopathogenesis. Prevention plays a crucial role in reducing the PPPFs rate. Conservative management is the treatment of choice due to high surgery complication rates unless implant loosening, or extensor apparatus disruption occurs. [ABSTRACT FROM AUTHOR]

Background: Patella fractures are relatively rare fractures and only little is known about the postoperative return to sports after patella fractures. Methods: This retrospective study presents information on functional outcome after operative treatment of patella fractures as well as time until return to sports and patients' complaints after open-reduction internal-fixation (ORIF) of patella fractures. Results: Overall, 39 patients after ORIF of patella fractures were evaluated at our Level-I trauma center with a mean follow-up of 42 months. The mean time until return to sports was 7 ± 3.9 months. No significant difference was found for functional outcome with respect to body mass index (BMI) or age. Fracture consolidation was accomplished after a mean of 6.9 ± 2.9 months besides a relatively low complication rate of 5.1% (n = 2). Conclusion: The results demonstrate a high return to sports rate of 90.3%. However, only 51.6% were able to perform sports on their pre-injury level or above. Trial Registration The study was retrospectively registered at DRKS (No: DRKS00031146). [ABSTRACT FROM AUTHOR]

Background. Lateral patellar dislocation is frequently observed among teenagers and young adults. There is no consensus on the best type of graft or fixation strategy for the femur and patella, and complications such as iatrogenic patella fracture, tunnel malposition, and grafting failure are common. The objective of our research is to find out the functional outcome of a new method of medial patellofemoral ligament (MPFL) reconstruction, which involves two key components: (1) patellar fixation is accomplished by suturing the two limbs of the looped doubled hamstring graft in a divergent fashion to the retinaculum at the medial border of the upper half of patella and (2) the placement of a suture anchor tied to the graft at the isometric point on the medial femur condyle. Methods. This study is a retrospective assessment of patients who underwent MPFL reconstruction at our hospital between September 2018 and August 2020. Patients were monitored for at least 2 years after the initial procedure until August 2022. Results. A total of 29 patients were recruited for the study, with 22 being females and the average age being 30.38 years. During the postoperative period, none of the participants experienced instability, redislocation, patellar/femoral fractures, or abnormal distal femur growth. The Tegner–Lysholm knee score was good to excellent for 17 (58.6%) participants, fair for 10 (34.5%) participants, and poor for 2 (6.9%) participants. The Kujala anterior knee pain score was more than 80 for 19 (65.5%) participants. Conclusion. This research presents a significant achievement rate of the surgical procedure, accompanied by the mean Tegner–Lysholm knee score of 82.68 and the mean Kujala anterior knee pain score of 82.71. Notably, there were no complications observed in the postoperative period. [ABSTRACT FROM AUTHOR]

The article focuses on patellar fractures in the pediatric patient population, particularly highlighting patellar sleeve fractures (PSFs). It discusses the challenges in diagnosing PSFs accurately, emphasizing the need for proper imaging techniques, such as MRI and ultrasound, due to the limitations of radiographs. It mentions Furthermore, it underlines the importance of early recognition and timely treatment to achieve a functional outcome and avoid long-term complications.