Anterior Fat Pad Research Articles

Accuracy of needle placement into the intra-articular space of the knee.

To achieve their potential therapeutic benefit, hyaluronic acid derivatives should be injected directly into the knee joint space and not into the anterior fat pad or the subsynovial tissues. In the absence of a knee effusion, reproducible needle placement into the intra-articular space presents a challenge to the clinician. The accuracy of needle placement was assessed in a prospective series of 240 consecutive injections in patients without clinical knee effusion. The injections were performed by one orthopaedic surgeon using a 2.0-in (5.1-cm) 21-gauge needle through three commonly employed knee joint portals: anteromedial, anterolateral, and lateral midpatellar. Accuracy rates for needle placement were confirmed with fluoroscopic imaging to document the dispersion pattern of injected contrast material. Of eighty injections performed through an anterolateral portal, fifty-seven were confirmed to have been placed in the intra-articular space on the first attempt (an accuracy rate of 71%). Sixty of eighty injections performed through an anteromedial approach were intra-articular on the first attempt (75% accuracy rate), as were seventy-four of eighty injections performed through a lateral midpatellar portal (93% accuracy rate). Using real-time fluoroscopic imaging with contrast material, we demonstrated the difficulty of accurately placing a needle into the intra-articular space of the knee when an effusion is not present. This study revealed that a lateral midpatellar injection (an injection into the patellofemoral joint) was intra-articular 93% of the time and was more accurate than injections performed by the same orthopaedic surgeon using either of the other two portals. This study highlights the need for clinicians to refine injection techniques for delivering intra-articular therapeutic substances that are intended to coat the articular surfaces of the knee joint.

A true intra-articular lipoma of the knee in a girl

A 16-year-old girl presented with a soft-tissue mass in the anterolateral aspect of her right knee. Magnetic resonance imaging revealed an intra-articular tumor arising from the anterior fat pad of the knee. The tumor showed low signal intensity on T1-weighted images and high signal intensity on T2-weighted images. It was resected under arthroscopic guidance. Grossly, the tumor was composed of soft, yellowish adipose tissue. Pathologic examination revealed a collection of mature adipocytes with marked myxoid changes in the matrix. A diagnosis of lipoma was made. True intra-articular lipomas should be distinguished from lipoma arborescens, which is considered to be a reactive process. In the English language literature, we found only 7 cases of true intra-articular lipoma reported previously. The present case is the youngest patient with such a tumor, and all the previous reports are of the tumor in adult patients. Intra-articular lipoma should be considered in the differential diagnosis of intra-articular masses in adolescents.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 18, No 5 (May-June), 2002: E24

Arthroscopic treatment for localized pigmented villonodular synovitis of the knee.

This study investigated 11 patients with localized pigmented villonodular synovitis of the knee that was diagnosed and treated by arthroscopic technique. There were six male and five female patients between the ages of 15 and 59 years (mean, 34.6 years). Seven patients reported extension limitation without joint line tenderness. Four of the 11 patients had a history of trauma before the onset of knee symptoms. All patients were treated by arthroscopic resection with partial synovectomy. The most common involved site was the anteromedial synovium near the anterior horn of the medial meniscus (five patients). The remaining cases were located in the anterior fat pad (two patients), suprapatellar pouch, posteromedial compartment, medial gutter, and the anterior horn of the lateral meniscus. Nine patients had one mass, and the remaining patients each had two or three masses. There was no evidence of recurrence at followup for an average of 29.9 months (range, 24-48 months). Arthroscopy is effective in the diagnosis of localized pigmented villonodular synovitis with minimal morbidity, and complete arthroscopic excision can be considered the definitive treatment for localized pigmented villonodular synovitis.

Conscious neurosensory mapping of the internal structures of the human knee without intraarticular anesthesia.

The conscious neurosensory characteristics of the internal components of the human knee were documented by instrumented arthroscopic palpation without intraarticular anesthesia. With only local anesthesia injected at the portal sites, the first author (SFD) had both knees inspected arthroscopically. Subjectively, he graded the sensation from no sensation (0) to severe pain (4), with a modifier of either accurate spatial localization (A) or poor spatial localization (B). The nature of the intraarticular sensation was variable, ranging from 0 on the patellar articular cartilage to 4A on the anterior synovium, fat pad, and joint capsule. The sensation arising from the cruciate ligaments ranged from 1 to 2B in the midportion, and from 3 to 4B at the insertion sites. The sensation from the meniscal cartilages ranged from 1B on the inner rim to 3B near the capsular margin. Innervation of most intraarticular components of the knee is probably crucial for tissue homeostasis. Failure of current intraarticular soft tissue reconstructions of the knee may be due, in part, to the lack of neurosensory restoration. Research studies of the knee designed to delineate factors that restore neurosensory characteristics of the musculoskeletal system may lead to techniques that result in true restoration of joint homeostasis and function.

Anterior abdominal fat pad - interventional gateway to high abdominal lesions

Anterior abdominal fat pad - interventional gateway to high abdominal lesions

Diagnosis of intestinal ischemia by MRI: Intraperitoneal presence of enteral gadolinium in a rat model

3-7 Diagnosis of Intestinal Ischemia by MRh Intraperitoneal Presence of Enteral Gadolinium in a Rat Model Fred Lee, Jr., M.D., Joseph M. Montalbano, B.S., Thomas M. Grist, M.D., John W. Weiss, M.D., Fred Kelcz, Ph.D., M.D. University of Wisconsin. 3-8 Anterior Abdominal Fat Pad Interventional Gateway to High Abdominal Lesions Wayne A. Wivell, M.D., Abhijit Roychowdhury, M.D., Susan A. Afonso, M.D., Jay M. Colby, M.D., Ashley Davidoff, M.D. University of Massachusetts Medical Center.

Graft impingement after anterior cruciate ligament reconstruction. Presentation as an active extension "thunk".

Twelve of 215 patients with an anterior cruciate ligament reconstruction developed a "thunk," a low-pitched sound, on active extension of the operative knee at an average of 5 months after surgery. In 4 of the patients the thunk resolved without surgical treatment at an average of 4 months after onset (range, 2 to 6). In 3 of the patients an increase in anterior knee laxity was associated with resolution of the thunk. Seven of the patients were treated with arthroscopic examination. Six of the patients had graft impingement on the lateral wall or the roof of the notch with knee extension. The thunk was eliminated with an adequate notchplasty that corrected the impingement. In the other patient the thunk was secondary to fibrosis of the anterior fat pad. One patient with a persistent thunk declined surgery and was lost to followup.

気管食道再建術 肺癌に対する右肺全摘，気管分岐部切除，気管・左主気管支端々吻合術を施行した一例

The patient was 51-year-old male with squamous cell carcinoma located around the orifice of the right upper-lobe bronchus invading the trachea and the bronchus intermedius. Pneumonectomy and concomitant resection of the carina were performed, followed by end-to-end anastomosis of the trachea and the left main bronchus.Anastomosis was completed with interrupted sutures using 3-0 nylon. Ventilation was maintained through a flexible endotracheal tube inserted into the left main bronchus via the operating field. The site of the anastomosis was covered with an anterior mediastinal fat pad pedunculated with the internal thoracic artery and vein. The post-operative course was uneventful, and no abnormal granulation or stenosis was found endoscopically.

Fat pad signs and supinator fat line in cubital trauma

The fat pad sign and the supinator fat line (SFL) are valuable diagnostic aids in the evaluation of bony cubital injuries. A total of 377 lateral X-rays of the elbow joint-including 121 fractures--were investigated. The supinator fat line exhibited bar-like and bird-like configurations in 55.9% and 41.8% of healthy test subjects, respectively. In the presence of a fracture, a wavy configuration, directed downwards from, or running parallel to, the upper edge of the radius, was seen in 95% of the cases. If in the event of an injury to the elbow a wavy configuration is seen in association with a positive anterior and/or posterior fat pad sign, bony involvement of the joint-forming elements may justifiably be suspected.

Staphylococcus aureus-induced blistering distal dactylitis in an adult immunosuppressed patient

Blistering distal dactylitis (BDD) is a superficial infection of the anterior fat pad of the distal portion of the finger. [-4 BDD has the distinctive clinical appearance of large tense superficial blisters on a tender, erythematous base. The blister may involve the distal and medial phalanges, extend to the dorsal nailfolds, and involve more than one finger. Two cases have been reported involving toes.f 5 BDD occurs most commonly between 2 and 16 years of age. Only three cases have been reported in adults. I, 6, 7 BDD is generally caused by group A ,a-hemolytic streptococci. However, in one instance group B streptococci caused BDD.6 In one study of 13 children with BDD, f3-hemolytic streptococci were cultured from the lesions of all children; in addition, three cultures grew hemolytic staphylococci. We report the first case of BDD in an adult immunocompromised patient from whom hemolytic Staphylococcus aureus was the only organism isolated.

Proximal superomedial portal in arthroscopy of the knee

The proximal superomedial portal is placed 4 cm proximal to and in line with the medial edge of the patella. From this position, a 30° arthroscope approaches the midline at a 30° angle providing a “straight on” view of the patellofemoral joint. Passing the scope down the patellofemoral joint allows visualization of the anterior horns of both menisci, the tibial attachment of the anterior cruciate ligament, and the anterior fat pad, but the view on the monitor is upside down. To correct the orientation, the television camera is turned upside down. Both anterior portals are available for instrumentation. Both gutters, including the periphery of both menisci, can be fully viewed from the proximal protal. The menisci appear vertically oriented on the monitor, and the television camera is rotated 90° to provide the usual horizontal orientation. The routine use of this portal is facilitated by using a cannula system, so that the cannula used initially for inflow-outflow irrigation remains in place and the scope is passed through it for viewing.

Ultrasonic demonstration of the elbow fat pads

Elevation of the fat pads around the elbow joint is a well recognised radiological sign of a joint effusion which may be due to trauma or other inflammatory process. There are occasions when plain radiographs fail to demonstrate this sign. A case is reported in which elevation of the posterior fat pad and an elbow joint effusion were demonstrated ultrasonically. Comparative ultrasound examination of the normal elbow in this patient and examination of 40 normal elbows, in adults and children, consistently demonstrated the normal anterior and posterior fat pads except in one patient aged 4 days where the fat pads could not be clearly seen. The normal ultrasonic appearances are described. Ultrasound examination may be useful in patients where plain radiographs have failed to demonstrate the position of the fat pads.

Induction of glutamine synthetase and transient co-expression with carbamoylphosphate synthetase in hepatocytes transplanted into fat pads of syngeneic hosts

Isolated rat hepatocytes were transplanted into the interscapular and both anterior lateral fat pads of hepatectomized syngeneic rats. At various time points following transplantation, the fat pads were removed, fixed and embedded in paraffin. Serial sections were stained for glutamine synthetase (GS) and carbamoylphosphate synthetase (CPS) using specific antisera and the PAP technique. The initially low fraction of GS+-heptatocytes remained low up to the fourth day, then increased strikingly up to almost 100% and declined gradually after the 14th day. In contrast, the number of CPS+-cells declined continuously to about 30% after 28 days. If the animals were exposed to CCl4 prior to the isolation of the hepatocytes in order to reduce the number of GS+-cells in the initial cell suspension similar results were obtained and no difference in the probability of the colony formation was noted between this and the normal hepatocyte suspensions indicating that the appearance of the GS+-phenotype was not due to a selective survival of these cells. Analysis of the staining intensity of the transplanted hepatocytes revealed the appearance of two populations of GS+-hepatocytes, one with a strong and one with a weak staining, during the course of formation of larger nodules, while only a single weakly stained population could be discerned with respect to the staining for CPS. These results demonstrate that all hepatocytes or at least their descendents can be induced to express GS by the environmental conditions of the fat pads, and that GS and CPS can be co-expressed with an apparently reciprocal relationship.

Blistering Distal Dactylitis in an Adult

To the Editor.— Blistering distal dactylitis is a superficial infection of the anterior fat pad of the distal portion of the fingers, caused by group A β-hemolytic streptococci.1The disease has been described in children but, to our knowledge, no case in adults has been previously reported.1-5We herein report a case of blistering distal dactylitis in an adult fishmonger. Report of a Case.— A 35-year-old male fishmonger was referred to our office because of persistent purulent bullous lesions with an erythematous and edematous base. The locations of the lesions on the right hand were the volar fat pads (Fig 1) of the first, second, and third fingers and the dorsum of the fourth finger proximal interphalangeal joint (Fig 2). He complained of pain and functional disability without systemic symptoms. A thin, pale, purulent exudate was aspirated from these lesions. Group A β-hemolytic streptococci were isolated in culture.

膝関節脂肪組織の解剖学的並びに病理学的知見

Weston and Palmer (1978) recently described their radiological research on the fat pad tissues and their intraarticular location along with their diagnostic value in various disorders of the human knee joint.As early as 1938 Kling already drew attention to these fat pad tissue and explained their anatomy. The author, while performing knee joint synovectomy, observed clearly the existence of these fat tissues which cover the suprapatellar pouch in every instance.In spite of such uniformity of the fat tissue in their anatomical location, their nomenclature varies from one textbook to another. For example, some describe their location as being extrasynovial or subsynovial, and others as lying on the synovial capsule of the knee joint.In this study, the author, using human cadaver specimens, designates these fat pad tissues as being located in 5 different places which are named as follows: 1. infrapatellar fat pad; 2. anterior suprapatellar fat pad; 3. posterior suprapatellar fat pad; 4. fat pad surrounding the patellar margin; 5. popliteal fat pad.Then, the specimens from infrapatell ar fat pad and ant. and post. suprapatellar fat pads are sectioned, stained and examined using ordinary microscopic techniques so that the location of these fat pad tissues were identified in relation to the surrounding tissues and it was found that the infrapatellar fat pad is located right beneath the synovial lining whereas the ant. and post. suprapatellar fat pads are located in between the tendinous membrane of quadriceps muscle and the layers of collagen fiber bundles running in parallel with the synovia just on the o utside of the subsynovial tissue.From these findings the aut hor concludes that the suprapatellar pouch, having the tissue structure comprizing both Stratum fibrosum and Stratum synoviale, can be regarded as the joint capsule itself and therefore the suprapatellar fat pad can be interpreted as being extracapsular in nature.In the second part of the article, the fat pad specimens taken surgically from the rheumatoid arthritic knee joint were studied macroscopically and microscopically.In gross eye examination fat pads in rheumatoid knee joints were found to be more or less edematously swollen in comparison with the normal joint. In microscopic study, however, findings of various types of angitis and connective tissue inflammation were observed in the interlobular connective tissue of these fat pads.The connective tissue dividing these fat pad tissues into smaller lobuli is rich in fibers as well as in fibrocyt but is poorly supplied with capillary, and moderately supplied with small vessels which are arterioles and venules. Various kinds of infiltration or proliferation of immunocytes such as lymphocytes and plasma cells surrounding small vessels, capillaries and in the interstitial stroma tissue and also the proliferation of fibroblast, angioblast and collagen fibers in various degree were very common findings in the microscopic specimens in these studies.In addition, edematous swelling of the stroma and disintegration or segmentation of edematously swollen collagen fiber were seen in the interlobular connective tissue of these fat pads which findings could be interpreted as a tissue response to the recurrent rheumatoid inflammation of the knee joint.The findings of matured fibrosis formation in the interlobular connective tissue were very rarely seen in this study. The angitis and connective tissue inflammation of various kinds seen in this study can well be interpreted as allergic in nature as well as the evidence of the selfperpetuation mechanism of this disease.And since these obvious his tological findings of rheumatoid inflammation are abundantly demonstrated, we conclude that in almost every patient fat pad tissue removal in conjunction with knee joint synovectomy seems to be justified in the treatment of R. A.

Current Concepts of Thoracic Surgery in the Management of Lymphoma

Improved techniques of radiation therapy and chemotherapy have provided a substantial rate of cure or palliation for many patients with malignant lymphoma. A study of 1,036 patients with lymphoma seen during a ten-year period has identified the place of thoracic surgery in the total management of this disease. In 104 patients, thoracic procedures contributed to the diagnosis. A positive diagnosis was made from tissue obtained by scalenus anterior fat pad biopsy, mediastinoscopy, bronchoscopy, or thoracotomy. Because of the nature of lymphoma, crises develop that cause increased debility or that threaten life. When customary treatment is ineffective, several varieties of thoracic operations (including tube thoracostomy, pleurectomy, peri-cardiectomy, and tumor resection) can be employed. Twenty-five of 39 patients for whom a surgical procedure was carried out have had their life prolonged or have been cured.