What are the symptoms and causes of suprapatellar spurs. How are quadriceps tendon ruptures related to patella spurs. What is the association between patella spurs and quadriceps tendon ruptures. What are the risk factors for quadriceps tendon ruptures. How are quadriceps tendon ruptures diagnosed and treated.

Understanding Suprapatellar Spurs and Quadriceps Tendon Ruptures

Suprapatellar spurs, also known as patella spurs, are bony prominences that develop at the quadriceps tendon insertion point on the proximal pole of the patella. These spurs have been associated with quadriceps tendon (QT) ruptures, a significant but relatively uncommon injury that predominantly affects middle-aged men. To better understand this association and its implications for diagnosis and treatment, a comprehensive study was conducted to examine the relationship between patella spurs and QT ruptures.

What are Quadriceps Tendon Ruptures?

Quadriceps tendon ruptures are injuries that occur when the tendon connecting the quadriceps muscle to the patella tears. These ruptures can be partial or complete and often result from a powerful, eccentric contraction of the quadriceps muscle when the knee is partially flexed and the foot is planted on the floor. Common causes include falls, direct trauma, lacerations, and in some cases, iatrogenic factors.

Prevalence and Demographics of Quadriceps Tendon Ruptures

A study conducted over a six-year period from 2008 to 2014 examined 20 patients with 21 QT ruptures. The findings revealed:

• Mean age of patients: 68.9 years (range: 44.9-82.1 years)
• Gender distribution: 85% male (17 out of 20 patients)
• Bilateral ruptures: 1 case (asynchronous ruptures approximately one year apart)
• Side distribution: 57% left knee, 43% right knee

These demographics highlight the prevalence of QT ruptures among older male populations, which aligns with previous research on the subject.

Mechanisms and Risk Factors for Quadriceps Tendon Ruptures

Understanding the mechanisms and risk factors associated with QT ruptures is crucial for prevention and early diagnosis. The study identified several key factors:

Mechanisms of Injury

• Indirect trauma: 76% of cases
• Direct trauma: 19% of cases
• Unknown: 5% of cases

Indirect trauma, such as falls or sudden movements, was the most common cause of QT ruptures in this study.

Risk Factors and Predisposing Conditions

Several predisposing conditions have been associated with an increased risk of QT ruptures:

1. Degenerative changes associated with aging
2. Calcific tendinopathy
3. Diabetes
4. Chronic renal failure
5. Gout
6. Quinolone antibiotic use

These factors may contribute to the weakening of the quadriceps tendon, making it more susceptible to rupture.

The Association Between Patella Spurs and Quadriceps Tendon Ruptures

One of the key findings of the study was the significant association between patella spurs and QT ruptures. The research revealed:

• 62% of patients with QT ruptures had patella spurs
• Only 19% of patients without QT ruptures had patella spurs
• The difference was statistically significant (P≤0.05)

This higher incidence of patella spurs in patients with QT ruptures suggests a potential connection between the two conditions. While the exact nature of this relationship is not fully understood, it highlights the importance of considering QT ruptures in patients presenting with knee injuries and patella spurs on radiographs.

Diagnosis and Imaging of Quadriceps Tendon Ruptures

Accurate and timely diagnosis of QT ruptures is crucial for proper treatment and recovery. The study emphasized the importance of clinical examination and imaging techniques in diagnosing these injuries:

Clinical Diagnosis

90.5% of QT ruptures in the study were identified clinically, with patients presenting a loss of the normal extensor mechanism of the knee. This highlights the importance of a thorough physical examination in suspected cases.

Radiographic Findings

Lateral knee radiographs play a crucial role in diagnosing QT ruptures and identifying associated patella spurs. Key radiographic features include:

• Presence of a patella spur at the proximal pole
• Insall-Salvati index of <0.8 (when no other radiographic features of a QT rupture are present)
• Other signs of tendon disruption or patella alta

The study emphasizes the importance of carefully examining knee radiographs for these features, especially in patients with a history of trauma or predisposing conditions.

Treatment Approaches for Quadriceps Tendon Ruptures

While the study primarily focused on the association between patella spurs and QT ruptures, it’s important to discuss treatment options for these injuries:

Surgical Repair

Most complete QT ruptures require surgical repair to restore the extensor mechanism of the knee. The procedure typically involves:

1. Reattachment of the torn tendon to the superior pole of the patella
2. Use of suture anchors or transosseous sutures
3. Reinforcement with additional sutures or augmentation techniques in some cases

Rehabilitation

Post-operative rehabilitation is crucial for optimal recovery and return to function. A typical rehabilitation program may include:

• Initial period of immobilization to protect the repair
• Gradual range of motion exercises
• Progressive strengthening of the quadriceps muscle
• Functional exercises and sport-specific training (if applicable)

The duration and intensity of rehabilitation may vary depending on the severity of the injury and individual patient factors.

Implications for Clinical Practice and Future Research

The findings of this study have several important implications for clinical practice and future research in the field of orthopedics and sports medicine:

Clinical Vigilance

Healthcare providers should maintain a high index of suspicion for QT ruptures in patients presenting with knee injuries, especially those with risk factors or radiographic evidence of patella spurs. Early diagnosis can lead to better outcomes and prevent complications associated with missed or delayed treatment.

Radiographic Assessment

The presence of a patella spur on knee radiographs should prompt a thorough evaluation for potential QT ruptures, even in the absence of obvious clinical signs. This may include additional imaging studies such as ultrasound or MRI to confirm the diagnosis.

Preventive Strategies

Further research is needed to determine whether interventions targeting patella spurs or associated risk factors could help prevent QT ruptures. This may include conservative treatments for calcific tendinopathy or modifications to training programs for at-risk individuals.

Long-term Outcomes

Future studies should investigate the long-term outcomes of patients with QT ruptures and patella spurs, including the risk of re-rupture, functional limitations, and the development of osteoarthritis.

Conclusion and Future Directions

The study’s findings highlight a significant association between patella spurs and quadriceps tendon ruptures. This relationship underscores the importance of careful radiographic assessment and clinical vigilance in diagnosing and treating these injuries. As our understanding of this association grows, it may lead to improved diagnostic protocols, preventive strategies, and treatment approaches for patients at risk of QT ruptures.

Future research should focus on:

1. Elucidating the exact mechanism by which patella spurs contribute to QT ruptures
2. Developing predictive models to identify patients at highest risk for QT ruptures
3. Investigating potential preventive interventions for patients with patella spurs
4. Evaluating long-term outcomes and quality of life in patients with QT ruptures and patella spurs
5. Exploring novel imaging techniques for early detection of tendon degeneration and impending ruptures

By continuing to investigate the relationship between patella spurs and QT ruptures, researchers and clinicians can work towards improving patient care and outcomes in this challenging area of orthopedic medicine.

Association between patella spurs and quadriceps tendon ruptures

Muscles Ligaments Tendons J. 2015 Apr-Jun; 5(2): 88–91.

Published online 2015 Jul 3.

Author information Copyright and License information Disclaimer

Background

quadriceps tendon (QT) ruptures are significant injuries that are relatively uncommon. The diagnosis of QT ruptures is frequently missed or delayed. An association between the presence of a patella spur and QT ruptures has been suggested in the literature.

Patients and methods

the Hospital Inpatient Enquiry system was used to gather data on all patients who sustained a QT rupture over a six year period from 2008 to 2014. A retrospective review of the medical notes as well as radiographs was undertaken. We reviewed 200 knee radiographs of patients without QT ruptures to establish the incidence of patella spurs in our normal population. Statistical analysis was performed using SPSS version 11.5 for Windows^®.

Results

the records of 20 consecutive patients with 21 QT ruptures were reviewed. The mean age was 60.9 yrs (range 44.9–82.1 yrs) and the majority were male (n=17; 85%). There was one bilateral QT ruptures. Patella spurs were noted in 13 cases (62%) which were significantly higher than in patients without QT rupture 19% (P≤0.05).

Conclusion

we noted a significantly higher incidence of patella spurs in patients with QT ruptures compared to those without. The presence of a QT rupture should be ruled out in patients with a knee injury and a patella spur on the knee radiographs.

Keywords: quadriceps tendon, ruptures, patella spur, knee, injury

Quadriceps tendon (QT) ruptures are uncommon injuries that predominantly affect middle-aged men1. Ruptures most commonly occur from a powerful, eccentric contraction of the quadriceps muscle, when the knee is partially flexed and the foot is planted on the floor. This injury is most frequently caused by falls, however other mechanisms include direct trauma, lacerations and iatrogenic causes2. Degenerative changes associated with ageing and calcific tendinopathy have also been shown to be a factor with QT ruptures3,4. Spontaneous QT ruptures have been shown to be associated with predisposing conditions such as diabetes, chronic renal failure5, gout6, and quinolone antibiotic use7 amongst others. It has also been suggested that the presence of a patella spur, a bony prominence at the QT tendon insertion point of the proximal pole may be associated with ruptures ()8. We examined a series of QT ruptures to see if such an association existed among our patients.

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Lateral radiograph of a knee demonstrating a proximal patellar pole spur (white arrow).

All patients with a QT rupture who had undergone repair over a six year period (from July 2008 to July 2014) were reviewed. Data were collected retrospectively using the Hospital In-Patient Enquiry (HIPE) system and patient’s medical notes. The study meets the ethical standards of the Muscle, Ligaments and Tendons Journal9. Details include patient demographics, surgical details, mechanism and side of injury and knee radiographs. Twenty-four patients were identified. We excluded one patient who had under-gone exploration of an open muscolotendinous tear from a penetrating injury and two patients with patella tendon ruptures who had been miscoded. The patient’s radiographs were reviewed to confirm the presence or absence of a patella spur. The Insall-Salvati index of <0.8 was used on preoperative radiographs when no other radiographic features of a QT rupture were present. The lateral radiographs of 200 consecutive non-injured knees were collected from the emergency department and examined to ascertain the incidence of patella spurs in the population without QT ruptures. Statistical analysis was performed with the Chi-Squared test using SPSS version 11.5 for Windows®, with a P value ≤0.05 considered significant.

Of the 20 patients identified, 19 had unilateral ruptures while one patient had asynchronous ruptures to both QT’s approximately one year apart. The QT ruptures were predominantly in males (85%) with a mean age of 68.6 years. Indirect trauma was the most frequent mechanism of injury in our series (). A lateral radiograph was included for review in all patients in the series ().

Table 1

Patient characteristics comparing the patient’s with QT-ruptures to those without.

	Non-QT rupture	QT rupture
Total = n	200	21
Age = years (range)	67.1 (45.1–80. 7)	68.9 (44.9–82.1)
Gender = n (%)	Male = 166 (83%)	Male = 17 (85%) Female = 3 (15%)
Side = n (%)	Left = 95 (47.5%) Right = 105 (52.5%)	Left = 12 (57%) Right = 9 (43%)
Mechanism = n (%)	N/A	Direct = 4 (19%) Indirect = 16 (76%) Unknown = 1 (5%)
Spur Present = n (%)	Yes = 38 (19%) No = 162 (81%)	Yes = 13 (62%) No = 8 (38%)

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The majority of QT ruptures (90. 5%) were identified clinically with having a loss of the normal extensor mechanism of the knee and a palpable suprapatellar gap. The remaining two patients had large haemarthroses making clinical examination equivocal: the diagnosis was in these cases confirmed by ultrasonography. One patient had rupture both QT’s about 1 year apart. While six patients had mild renal impairment at the time of admission none had a history of chronic renal failure, gout, steroid or quinolone use. Analysis of the 200 lateral radiographs of normal, non-QT ruptured knees had an incidental finding of 38 (19%) patellar spurs. The patient characteristics of both cohorts were similar for age and gender and shown in . Statistical analysis demonstrated a significant correlation between the presence of patella tendon spurs and QT ruptures (P ≤0.05).

QT ruptures are infrequent injuries and relatively rare when all types of knee injuries are factored1. They most often occur in men over 40 years of age and are more common than patellar tendon ruptures10. Unilateral ruptures are more common than bilateral. Early diagnosis and prompt surgical repair have been shown to have good outcomes in QT ruptures, aided in part by the technical simplicity of the operation11,12. Patellar tendinopathy and ruptures have been studied in more detail and it is believed that eccentric exercises and even surgical interventions may be beneficial in tendinopathies which may avoid their progression and subsequent tendon ruptures13–15. Clinical features of QT ruptures include the triad of pain, loss of extension and a suprapatellar gap. However, clinical examination may be limited by both pain and swelling leading to a high rate of misdiagnosis, estimated between 10–50%16,17. Radiographic features include the obliteration of the quadriceps shadow, a visible suprapatellar soft tissue mass (due to the retracted tendon), an osseous avulsion fragment (from the proximal pole) and patella baja (low riding patella)18. The Insall-Salvati index which is a ratio of the patella tendon length to the patella length on the lateral radiograph is useful in detecting a low riding patella or patella baja when the index is <0. 8 ()19. Ultrasonography (US) has proven to be a better modality than radiographs for the diagnosis of QT ruptures and can further differentiate between partial and complete tears as well as the tear location10,20. Magnetic resonance has greater sensitivity and specificity than US, however it is more expensive, time consuming and limited by its availability ()21.

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Lateral radiograph of a knee with a quadriceps tendon rupture demonstrating a low lying patella (patella baja), suprapatella calcific density (dashed arrow) and obliteration of the quadriceps tendon shadow and haematoma (solid arrow).

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Magnetic resonance imaging (T1 and T2 weighted sagittal views) of the knee illustrating a ruptured QT (solid arrows) and a large haematoma (dashed arrow).

Bony spurs are most commonly caused by osteoarthritis, with a higher incidence found in the elderly population. The presence of a patellar spur has been associated with anterior knee pain22. Studies have hypothesized an association between patella spurs found on lateral knee radiographs and QT ruptures8. To date we have found one study that looked at the presence of patella spurs and extensor mechanism ruptures in patients with patella fractures, patella tendon ruptures and QT ruptures8. They noted the presence of patella spurs in 27% of the patella tendon group, and 15% of the patella fracture group. In the QT rupture group 23 of 29 (79%) had a patella spur, however they did not have radiographs available for 7 (19%) patients and therefore were excluded from analysis. They did not examine the incidence of patella spurs within the non-QT rupture population. Our study confirms the high incidence of patella spurs amongst those with QT ruptures (62%), however less than the previously reported 79% incidence of patella spurs. We excluded patients with partial tears who were treated conservatively and discharged.

The study is limited mainly by its retrospective nature and the small sample size of 20 patients with QT ruptures due to the relative infrequency of the injury. Another limitation of the study was that our cohort only included patients who underwent surgical intervention and had complete tears. Patients with partial tears or those who were managed non-operatively were not analyzed. The study accounted for the most common patient risk factors associated with QT ruptures however this was limited to the patient’s medical notes and there may be non-documented risk factors present.

This retrospective study identified a significantly higher incidence of patella spurs amongst patients with QT ruptures compared to those without. Based on our findings, we would recommend in the clinical setting of a knee injury with a patellar spur on the lateral radiograph, the clinician should consider the presence of a QT rupture.

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Patellofemoral Arthritis of the Knee: An Overview

Introduction of Arthritis in the Knee

Knee arthritis is a condition that affects more than four million Americans annually, occurs when degenerative changes develop in the cartilage that lines the knee joint.

The knee joint is a complex structure with three main compartments that have individual functions and structures: the inner (medial) compartment and the outer (lateral) compartments are formed by the articulation (or joining) of the lowest part of the thighbone (femur) and the highest part of the shinbone (tibia). The third compartment of the knee is formed by the kneecap (patella) and the front part of the femur and is called the “patello-femoral joint.”

Figure 1: Diagram of knee anatomy, including the patello-femoral compartment, which is located behind the kneecap (patella). Click on image to enlarge.

While the first two compartments are the most important for the patient to walk on flat terrain, the third compartment (patello-femoral joint) is involved in activities like walking on inclined terrain, going up and down stairs, kneeling, squatting, and rising from the sitting position.

Knee arthritis frequently affects two or more compartments of the knee. However, in rare cases, arthritis may be isolated to the patellofemoral compartment. This condition, which is more commonly seen in women, is characterized by pain in the front part of the knee (behind the patella, or kneecap) that typically worsens when the patient walks on inclined terrain, goes up and down stairs, knees, squats, and rises from the sitting position (while walking on level ground is often unaffected).

Diagnosis of Arthritis in the Knee

“Patellofemoral arthritis is diagnosed when loss of cartilage is seen in the joint on x-rays or MRI and no other compartment of the knee is affected,” explains Friedrich Boettner, MD. (Please Note: Many patients with osteoarthritis of the knee first develop the disease in the medial compartment of the knee and subsequently develop patellofemoral arthritis; however, this article focuses on patients who develop arthritis limited to the patellofemoral joint.)

According to Beth Shubin Stein MD patellofemoral joint arthritis is more common in women than in men. Based on the radiographs and MRI studies, your physician can determine if you carry anatomical factors that further predispose you to this condition: a radiographic parameter that is frequently found to be abnormal in patients with isolated patellofemoral arthritis is the “Q angle.”

The Q angle is determined between the quadriceps muscle running down the front of the thigh and its attachment through the patellar tendon below the knee joint. The patella is imbedded in this “musculotendinous complex” that allows the patient to straighten the knee. It tracks on a perfectly matched “rail” provided by the femur, much like a train on a track.

A Q angle exceeding normal range indicates that the patella is being pulled laterally (to the side), and the joint is no longer congruent. This places abnormal stress on the patellofemoral joint, leading to progressive wear and tear of the soft cushion of the joint (cartilage). Dr. Shubin Stein notes, “Women tend to have higher Q angles than men, predisposing them to this condition that typically manifests during the third and fourth decades of life. ”

Another factor predisposing patients to patellofemoral arthritis is excessive hip anteversion, a condition in which the neck of the femur rotates too far forward in the hip socket, resulting in additional lateral (sideways) pull on the patella.

In addition, patellofemoral arthritis is more common in patients with patellofemoral dysplasia. In these patients the trochlea groove (femoral side) is misshapen and no longer matches the patella surface, increasing contact stresses and therefore resulting in early cartilage deterioration.

Some patients with loose patellar ligaments and the previously mentioned anatomical abnormalities resulting in severe “maltracking” of the patella can suffer episodes of complete “derailment” (dislocation) of the patella. “This condition – known as patellar instability – also predisposes patients to early patellofemoral arthritis, as each dislocation episode further damages the cartilage coating on the patella and/or trochlea,” explains Dr Shubin Stein.

The anatomical phenomena that lead to patellofemoral arthritis usually affect both legs. Therefore, patients may develop a similar problem in both knees. The orthopedic surgeon will judge if studying both knees is necessary, even though the patient may be experiencing pain in only one knee.

Treatment of Arthritis in the Knee

Nonsurgical Treatment

According to Alejandro Gonzalez Della Valle, MD, “In the early stages, patellofemoral arthritis does not cause significant pain or disability. Many affected individuals may be able to walk on level ground for miles – although uneven terrain may cause discomfort – and maintain good flexibility and range of motion in the knee. As a result, the condition may become relatively advanced before the patient seeks treatment.”

When patellofemoral arthritis is detected, depending on the degree of cartilage damage, the orthopedist may recommend adaptive measures such as avoiding stairs and low seating or placing a pillow on a chair to make rising more comfortable. Physical therapy may also be prescribed to strengthen and stretch the quadriceps muscle and to compensate for the loss of cartilage while improving patella tracking during motion.

Most patients can initially achieve good pain relief by taking acetaminophen (Tylenol) or non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil and Motrin) or naproxen (Aleve). Patients may also experience pain relief with some oral nutritional supplements like glucosamine and chondroitin sulfate, fish oil or vitamin E. However, there is little data on the latter over-the-counter supplements.

An intraarticular steroid injection (cortisone shot) is often a useful alternative to reduce pain and intraarticular inflammation and is almost always performed before considering surgery. Another option may be injection of viscosupplements, which help to lubricate the joint and might extend the effect of the steroid injection. Non-operative treatment can be successful for quite some time, especially in patients that do not need to climb stairs. However, Dr. Boettner cautions that “once the patellofemoral arthritis results in increasing patella bone loss, surgery may be recommended to avoid excessive bone loss and difficulties with implant fixation.”

“If the surgeon feels that surgery is not yet warranted in patients with bone on bone patellofemoral arthritis,” Dr. Boettner adds, “he/she may recommend regular follow up examinations, including x-rays, to make sure the patient does not develop bone loss of the patella and notching of the anterior femur.”

Surgical Treatment

Dr. Shubin Stein points out that “the age of the patient and the amount of cartilage damage often dictates the surgical treatment options.” For example, in younger patients with mild cartilage changes, the orthopedist may suggest a lateral release, a procedure in which the tight ligaments on the outer side of the kneecap are cut to achieve better alignment and tracking of the kneecap and allow a smoother, less painful motion in the joint. Most surgeons agree that a lateral release is rarely indicated in isolation and should not be performed if more advanced cartilage damage is encountered.

Alternatively a tibial tuberosity osteotomy (which refers to the part of the shinbone that the patellar tendon is attached to), a procedure to improve the Q angle and reduce the pressure on the patellofemoral joint, can improve patellofemoral symptoms in patients with significantly enlarged Q angles and a relatively well preserved patellofemoral joint space. Joint preserving procedures are usually reserved for patients less than 50 years of age and are no longer indicated once significant cartilage loss or “bone on bone” disease is present.

Figure 2: MRI Images of a 47 year old patient considered for patellofemoral knee replacement. The images show well-preserved medial and lateral compartments and severe arthritis in the patellofemoral compartment, shown behind the patella (kneecap) at the end of the white arrow. (© F. Boettner, MD)  Click on image to enlarge. 

Total Knee Replacement

In general, patients with “bone on bone” arthritis or absence of cartilage in the joint and severe joint pain can be candidates for total knee replacement. However, “We learned that while total knee replacement is a very good treatment option for patients with osteoarthritis throughout the knee, it may not be the only option for patients who present with isolated patellofemoral arthritis,” says Dr. Della Valle. “Often patients with patellofemoral arthritis have excellent range of motion before surgery and might lose some motion after a total knee replacement. They can also walk relatively long distances before surgery, and major surgery like a total knee replacement with a rather long recovery time may not be appealing to these patients.”

Partial Knee Replacement

Patients frequently ask their surgeon why it is necessary to replace all the compartments of the knee when only one (the patellofemoral compartment) is affected by arthritis. In patients with advanced patellofemoral arthritis and no involvement of the medial and lateral compartment of the knee, the orthopedic surgeon may recommend a patellofemoral knee replacement, which is a type of partial knee replacement. In this procedure, arthritic surfaces on the femur and patella are removed and replaced with prosthetic components, somewhat like capping a tooth, while the remaining compartments of the joint and all the knee ligaments are preserved. The components are made of metal and plastic to create a bearing surface that glides smoothly and resists wear.

Figure 3: Image of the femoral component of a patellofemoral knee replacement implant. (© F. Boettner, MD)  Click on image to enlarge.

Figure 4: Radiographs of the patellofemoral joint before (L) and after (R) patellofemoral knee replacement. (© F. Boettner, MD) Click image to enlarge.

Over the past decade partial knee replacement for the medial compartment of the knee has become popular, according to Dr. Boettner. “In recent years, there has been an increased interest in the use of partial knee replacements of the patellofemoral joint as well.”

Dr. Boettner summarizes the consensus of the Hip and Knee Service at HSS:

A patellofemoral knee replacement is a treatment option for selected patients with advanced arthritis affecting only the patellofemoral compartment. In this group of patients, a partial knee replacement is a less invasive surgical option that can substantially relieve pain and improve knee function. The surgery preserves more bone, cartilage and, ligaments; and the recovery is generally faster than from a total knee replacement. For young patients any knee replacement is done with the understanding that revision surgery may be necessary later in life. Patellofemoral knee replacement has the advantage that later revision to a total knee replacement may be potentially easier than the revision of a total knee replacement.

However, the Hip and Knee Service also feels that it must be emphasized that only patients with degenerative changes in the patellofemoral joint and adequate patellar alignment are considered optimal candidates for this procedure. Arthritis involving the other compartments and those with poor patella alignment do not do well with a patellofemoral knee replacement.

“Based on an analysis of the literature, older patients are considered the ideal candidates for patellofemoral knee replacement.” explains Dr. Della Valle: “The decreased activity level in patients above age 75 makes loosening of the implants and progression of arthritis in the remaining compartments of the knee less likely and therefore reduces the most common reasons for revision surgery. Older patients also often have multiple health issues and are at increased risk for perioperative complication. Since patellofemoral knee replacement is less invasive and minimizes perioperative blood loss it seems reasonable to believe that it may involve less risk for older patients.

“A patellofemoral knee replacement is also especially appealing since revision to a total knee replacement usually does not pose a significant problem. However adherence to the indication criteria is key to avoid less optimal functional outcomes and early revisions,” states Dr. Della Valle.

For women between the ages of 60 and 75 with patellofemoral arthritis, determining optimal surgical treatment may be more difficult. Because these patients might be faced with the need for a revision of their patellofemoral knee replacement somewhere between the ages of 75 or 80 years old – depending on when the initial surgery is performed – they may elect to have a total knee replacement which is less likely to require revision surgery after 10 years. “Although a total knee replacement can be associated with more discomfort following surgery and the possibility of more restricted range of motion, it may [remove] the need for a revision surgery in this age group,” Dr. Boettner explains.

Surgical Outcomes of Arthritis in the Knee

Partial knee replacement has a low risk of perioperative complications. However, the procedure does have some of the same potential post-surgical complications as total knee replacement, including deep venous thrombosis (blood clot), delayed wound healing, and implant infection, as well as implant wear and loosening. Other complications are much less common than in total knee replacement, including nerve damage or the need for blood transfusions.

“While we today try to minimize the surgical trauma during total knee replacement with minimal invasive implantation techniques, partial knee replacements are truly minimally invasive since they spare large parts of the joint and do not alter the motion pattern (kinematic) by preserving the anterior and posterior cruciate ligaments, which are usually removed during total knee replacement,” explains Dr. Shubin Stein.

As compared to total knee replacement, partial knee replacement will speed the postoperative rehabilitation and offers the potential for excellent function. At Hospital for Special Surgery we have established a partial knee replacement rehabilitation pathway that will offer patients discharge from the hospital within 1-2 days compared to 3-4 days after total knee replacement surgery. The patient will require intensive physical therapy during a period that ranges from six weeks to three months to achieve the best possible outcome.

As with many complex orthopedic procedures, Dr. Della Valle notes, it’s in the best interest of the patient to select an institution and surgeon with a high volume of experience performing the surgery.

To find out more about partial knee replacement at HSS, please visit the Physician Referral Service or call 1 (877) 606-1555.

Updated: 3/26/2010

Authors

Friedrich Boettner, MD

Attending Orthopedic Surgeon, Hospital for Special Surgery
Professor of Orthopedic Surgery, Weill Cornell Medical College

Alejandro Gonzalez Della Valle, MD

Attending Orthopedic Surgeon, Hospital for Special Surgery
Professor, Clinical Orthopedic Surgery, Weill Cornell Medical College

Beth E. Shubin Stein, MD

Associate Attending Orthopedic Surgeon, Hospital for Special Surgery
Associate Professor of Orthopedic Surgery, Weill Cornell Medical College

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Treatment of Mediopatellar Fold Syndrome – Orthopedics Ruslana Sergienko

The mediopatellar fold is a thickening of the synovial membrane lining the inner surface of the knee joint and secreting a lubricating fluid. It is needed by a person only during fetal development, and after birth it gradually “resolves”.

What is “Mediopatellar Fold Syndrome”?

This is a pain syndrome in the knee joint caused by inflammation of this fold.

30% of people have a mediopatellar fold, but this does not guarantee that it will become inflamed.
The syndrome is manifested by the following symptoms: pain in the anterior part, especially when getting up from a sitting position, painful clicks during flexion-extensor movements.
The risk group for this disease includes people who regularly play sports and visit the gym. The main sports that can cause violations are running, cycling, jumping, which provide for an overload of the knee joint.

What can this disease lead to?

When inflammation occurs, the fold between the kneecap and the femur is pinched, this is the so-called patellofemoral joint. Her infringement is accompanied by aching pains, “clicks”, periodic swelling in the knee joint. But the great danger lies in the fact that with a long absence of adequate therapy, the articular cartilage of the patella and femur is destroyed, with the formation of patellofemoral arthrosis. At the same time, the thickened mediopatellar fold acts as sandpaper and mechanically “erases” the articular cartilage with each movement, which, unfortunately, is not restored to its original structure.

How is MPS syndrome diagnosed?

Careful collection of a medical history with clinical tests is performed by an orthopedic doctor in conjunction with an MRI study and is a necessary diagnostic manipulation. It is also worth noting that only disks with images, not films, have diagnostic value. Since they save up to 150 frames of your knee joint in different projections, while on films there are no more than 40. We independently evaluate MRI images, without relying on the conclusions of other specialists.

What is the treatment for mediopatellar fold syndrome?

The main group of drugs in the treatment are anti-inflammatory tablets and local ointments without a warming effect.
It is necessary to limit excessive physical activity for a period of 2 to 6 weeks, flexion at the knee joint up to 90 degrees, as well as rotational and impact loads on the joint.
At the same time, physical therapy is required, aimed at maintaining the tone of the thigh muscles, especially the quadriceps, which is one of the main stabilizers of the knee joint.

What if conservative treatment fails?

In such a situation, arthroscopic removal of the mediopatellar fold is necessary. You can read more about knee arthroscopy on our website.

Can the fold “grow back” after the operation?

No. With the necessary surgical instruments and the experience of an orthopedic surgeon, the fold is completely excised, which is very important. But if the removal of the fold is carried out partially, then the remnants of the fold are usually fibrosed, become even denser and cause additional damage.

Postoperative rehabilitation

The rehabilitation period is very important, the final result of the treatment largely depends on it. After the arthroscopy, massages, physiotherapy exercises, and exercises on an exercise bike are prescribed. The patient should be careful about physical activity and follow all the recommendations of the doctor.
In our clinic, it is possible to undergo a full cycle of treatment from consultation with an orthopedist to rehabilitation.

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Bursitis of the knee joint treatment in Zaporozhye

Among the many joints of the human body, the largest joint, the knee joint, most often suffers from injuries and various pathologies. This explains the fact that knee discomfort and pain is the most common reason patients seek medical attention. In inflammatory diseases of the knees, infectious and other inflammatory processes occur, among these are arthritis, tendonitis, synovitis and bursitis of the knee joint. The last one will be discussed.

What is knee bursitis?

Bursitis of the knee is a severe inflammation of the anatomical bags of the knee, located between the bones and tendon fibers. Anatomical bags are filled with a special organic fluid and serve as a kind of airbags. They also help to ensure proper gliding of the tendon along the bone, as well as to avoid damage to the tendon fibers.

Bursitis can occur in different types of bags, among which:

• suprapatellar;
• prepatellar;
• subpatellar superficial and deep;
• goose foot bag;
• medial ligament pouch;
• iliotibial tract bag;
• semimembranosus tendon bursa;
• medial gastrocnemius pouch;
• popliteal pouch;
• also distinguish bursitis of the lateral bursa of the knee joint.

Crow’s foot bursitis of the knee joint is an inflammatory process of the tendon bag, which is united by the sartorius, gracilis and semitendinosus muscles. The houndstooth pouch is a bladder filled with synovial fluid that helps reduce friction between tissues.

Symptoms of knee joint bursitis

There are acute and chronic inflammation of the anatomical bags. The disease is accompanied by pain and limited movement, sometimes there is swelling and redness.

The most common signs of bursitis in the knee joint:

• Pain in the joint
• Swelling of the joint
• Increased temperature of the skin over the joint
• Violation of the function of the limb

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Types of bursitis

There are several types of disease:

1. infrapatellar bursitis of the knee
2. calculous bursitis of the knee
3. lateral bursitis of the knee
4. Acute knee bursitis
5. Popliteal bursitis
6. Posttraumatic knee bursitis
7. Prepatellar knee bursitis
8. Reactive knee bursitis
9. Serous bursitis
10. suprapatellar bursitis of the knee
11. traumatic bursitis of the knee
12. chronic bursitis of the knee joint

Causes

Various processes occurring in the body contribute to the development of bursitis:

• Injuries
• Infectious processes
• Metabolic disorders
• Exposure to toxic substances
• Increased allergic mood of the body
• Damage by the immune system to its own tissues

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Treatment of knee bursitis

Patients with this diagnosis are prescribed medication. The treatment of bursitis of the knee joint is based on the following provisions:

• Applying a plaster splint;
• Prescribing non-steroidal anti-inflammatory drugs;
• In case of inflammation, intra-articular administration of anti-inflammatory hormonal drugs is indicated;

If a patient develops purulent bursitis of the knee joint, surgery should be performed to open and drain the inflamed synovial sac.

How to treat knee bursitis at home?

If the disease is non-infectious, you can use traditional methods:

1. Tinctures

(A teaspoon of propolis should be dissolved in 50 ml of vodka and infused for 5 days. Later, using the tincture, lotions can be made)

2. Vegetable therapy

(cut beets and potatoes thin slices, apply to a sore spot, wrap with gauze)

3. Mask

(Grate soap and onion, add a little honey.