Partial Patellectomy Research Articles

Primary total knee arthroplasty after extensor mechanism reconstruction with structural allograft (case report)

Introduction. Total knee arthroplasty (TKA) in patients with the extensor mechanism insufficiency is traditionally considered as a complex case. Purpose. To demonstrate the specific features of primary TKA in a patient with a history of the extensor mechanism reconstruction using a structural allograft. Case description. A 32-years-old male was admitted to the hospital due to severe pain and decreased range of motion of the left knee 6 month ago. In 2014, due to a road traffic accident, he experienced an open comminuted fracture of the left patella, complicated by infection. During debridement, the partial patellectomy was performed followed by elimination of surgical site infection. One year after the injury, due to significant extension lag and knee instability during walking, an extensor mechanism reconstruction was performed using a structural allograft including the quadriceps tendon-patella-patellar ligament-tibial tubercle. The screws that were fixing the allograft in the tibial crest were removed one year after the reconstruction. The patient resumed an active lifestyle and practiced martial arts. In 2023, he began experiencing increasing pain, limited range of motion (0°–20°–110°), varus deformity (8°), and extensor lag of 20°. Oxford Knee Score (OKS) was 29 points. Due to the low efficacy of conservative treatment TKA was performed in February 2024. Results. After performing standard medial parapatellar approach, the fusion both of the tendon and bone parts of the structural allograft to the surrounding tissues was confirmed. Surprisingly, disintegration of the distal third of the anterior surface of the patella from the retinaculum was identified. To preserve the integrity of the extensor mechanism, the refixation of the patella to the retinaculum was performed with two anchors and non-absorbable sutures. At the 6-month follow-up, the patient reported no pain, full range of motion and walked without additional support or distance limitations. The OKS was 42 points but extensor lag of 5° persisted. Conclusion. After transplantation of structural allograft of the extensor mechanism, the fusion with the native tissues occurs only in the zones of proximal and distal fixation. Despite the reliable long-term mechanical properties, the whole graft did not go through complete revascularization by host tissue and full remodeling. Therefore, during subsequent surgical interventions, including TKA, it is necessary to be technically prepared for augmentation of the extensor mechanism or its secondary reconstruction

Management of severely comminuted fracture patella: a case report

Fracture patella is a breach in the extensor mechanism of the knee and needs to be fixed. Comminuted fractures of patella are a challenge given the difficulty in restoring the extensor mechanism. Introduction: Treatment options have evolved over the years from sacrifice to salvage i.e., from total or partial patellectomy to patellar preserving surgery. The challenge remains to fix the fragments optimally and also to have a tailor-made physiotherapy and rehabilitation program for the patient to provide a satisfactory functional outcome. A 14-year-old female presented to the casualty with a history of domestic fall, injuring her right knee. X-ray was done which revealed a comminuted fracture of right patella, classified as 34C3 OA/OTA classification. Salvage procedure for severely comminuted patella fracture has a successful functional outcome following a stable fixation of fragment.

Patellar Groove Replacement in a Cat

AbstractThe aim of this study was to report patellar groove replacement in a 6-year-old domestic short hair cat with chronic unilateral pelvic limb lameness and severe femoro-patellar osteoarthritis due to medial patellar luxation. This study is a case report. Computed tomographic scan of the affected limb revealed marked periarticular osteophytosis, medial trochlear ridge erosion, marked flattening of femoral trochlea, ectopic pseudo-trochlear groove, and medial patellar luxation. Femoral trochlear ostectomy with patellar groove replacement, release of the medial fibrocartilage, partial parasagittal patellectomy, and lateral tibial tuberosity were performed. Clinical review and radiographs performed 53 days post-surgery revealed no complications and substantial decrease in lameness. Thirteen months postoperatively the cat scored 2/72 on the Feline Musculoskeletal Pain Index questionnaire by the owner, indicating good mobility, minimal discomfort, and good quality of life. As far as the authors are aware, this is the first report of the use of patellar groove replacement in the management of feline medial patellar luxation. Patellar groove replacement, in combination with adjunctive procedures, resulted in a substantial improvement in lameness in this cat with chronic medial patellar luxation and severe femoro-patellar osteoarthritis.

Patellar Fractures: Anatomy, Mechanics, and Surgical Management.

A preoperative computed tomography scan may be considered to improve surgical planning, as secondary fracture lines are poorly visualized on radiographs. Oblique internal and external rotation fluoroscopic views may be used intraoperatively to fully evaluate the medial and lateral facet articular reduction if direct assessment by visualization or palpation is not completed. Partial patellectomy for inferior pole fractures should be avoided, and bone-preserving procedures are recommended. A lateral arthrotomy may be used for direct visualization of the articular reduction for multifragmentary fractures. An inferomedial arthrotomy should be avoided to protect the dominant blood supply of the patella. Tension band fixation with cannulated screws yields a lower reoperation rate, improved functional outcome scores, and better performance in biomechanical studies than Kirschner wire-based tension band fixation. Preliminary studies of novel plate and screw constructs for osteosynthesis have shown promising results.

Suture Anchor Versus Transosseous Tunnel Repair for Inferior Pole Patellar Fractures Treated With Partial Patellectomy and Tendon Advancement: A Biomechanical Study.

Background:Comminuted inferior pole patellar fractures can be treated in numerous ways. To date, there have been no studies comparing the biomechanical properties of transosseous tunnels versus suture anchor fixation for partial patellectomy and tendon advancement of inferior pole patellar fractures.Hypothesis:Suture anchor repair will result in less gapping at the repair site. We also hypothesize no difference in load to failure between the groups.Study Design:Controlled laboratory study.Methods:Ten cadaveric knee extensor mechanisms (5 matched pairs; patella and patellar tendon) were used to simulate a fracture of the extra-articular distal pole of the patella. The distal simulated fracture fragment was excised, and the patellar tendon was advanced and repaired with either transosseous bone tunnels through the patella or 2 single-loaded suture anchors preloaded with 1 suture per anchor. Load to failure and elongation from cycles 1 to 250 between 20 and 100 N of force were measured, and modes of failure were recorded. Statistical analysis was performed using a paired 2-tailed Student t test.Results:The suture anchor group had less gapping during cyclic loading as compared with the transosseous tunnel group (mean ± SD, 6.83 ± 2.23 vs 13.30 ± 5.74 mm; P = .047). There was no statistical difference in the load to failure between the groups. The most common mode of failure was at the suture-anchor interface in the suture anchor group (4 of 5) and at the knot proximally on the patella in the transosseous tunnel group (4 of 5).Conclusion:Suture anchors yielded similar strength profiles and less tendon gapping with cyclic loading when compared with transosseous tunnels in the treatment of comminuted distal pole of the patellar fractures managed with partial patellectomy and patellar tendon advancement.Clinical Relevance:Suture anchors may offer robust repair and earlier range of motion in the treatment of fractures of the distal pole of the patella. Clinical randomized controlled trials would help clinicians better understand the difference in repair techniques and confirm the translational efficacy in clinical practice.

English

BACKGROUND Patella is the largest sesamoid bone in the human body, which plays important role in biomechanics of the knee. It is one of the few bones without periosteal surrounding. Fracture of patella constitute almost 1 % of all skeletal injuries with high prevalence in age group of 20 - 50 years. Fracture of patella may be due to direct/indirect force. Direct force often results in displaced or comminuted fractures. Fracture caused by indirect mechanisms result from a violent contraction of quadriceps muscle with knee flexion. Most of the patella fractures are combination of direct and indirect forces. Most significant effects of fracture patella are loss of continuity of the extensor mechanism of the knee and potential incongruity of the patellofemoral articulation. Treatment option includes reconstruction of entire patella or partial patellectomy and tendon repair or total patellectomy with extensor mechanism repair. Advancement in surgical techniques treatment option being shifted from patellectomy to reconstruction, preservation, and restoration of extensor mechanism. The purpose of this study was to evaluate the functional outcome of transverse fracture of patella treated with tension band wiring. METHODS This prospective study was done among 35 patients, who sustained transverse patellar fractures and were admitted in Department of Orthopaedics, Government Medical College, Thrissur from 01 October 2019 to 01 October 2020. Functional and clinical outcome was assessed at 2 weeks, 4 weeks, 3 months, and 6 months using Goodfellow’s scoring system. RESULTS The mean age was found to be 43 years, males were predominant. In 62.86 % of study population, right side was involved. In 63 % of study population, fracture occurred due to road traffic accidents (RTA). Average union was achieved in 11 - 13 weeks. Functional outcome was excellent to good in 85.71 % of study population. CONCLUSIONS Transverse fracture of patella can be treated with modified tension band wiring without much complications and early weight bearing is possible with good functional outcome. KEYWORDS Transverse Fracture Patella, Prospective Study, Tension Band Wiring, Good Fellows Score

Type II Collagen Sponges Facilitate Tendon Stem/Progenitor Cells to Adopt More Chondrogenic Phenotypes and Promote the Regeneration of Fibrocartilage-Like Tissues in a Rabbit Partial Patellectomy Model.

ObjectiveFibrocartilage transition zone (FC) is difficult to regenerate after surgical re-attachment of tendon to bone. Here, we investigated whether type II collagen-sponges (CII-sponges) facilitated tendon stem/progenitor cells (TSPCs) to adopt chondrogenic phenotypes and further observed if this material could increase the FC areas in bone-tendon junction (BTJ) injury model.MethodsCII-sponges were made as we previously described. The appearance and pore structure of CII-sponges were photographed by camera and microscopies. The viability, proliferation, and differentiation of TSPCs were examined by LIVE/DEAD assay, alamarBlue, and PKH67 in vitro tracking. Subsequently, TSPCs were seeded in CII-sponges, Matrigel or monolayer, and induced under chondrogenic medium for 7 or 14 days before being harvested for qPCR or being transplanted into nude mice to examine the chondrogenesis of TSPCs. Lastly, partial patellectomy (PP) was applied to establish the BTJ injury model. CII-sponges were interposed between the patellar fragment and tendon, and histological examination was used to assess the FC regeneration at BTJ after surgery at 8 weeks.ResultsCII-sponges were like sponges with interconnected pores. TSPCs could adhere, proliferate, and differentiate in this CII-sponge up to 14 days at least. Both qPCR and immunostaining data showed that compared with TSPCs cultured in monolayer or Matrigel, cells in CII-sponges group adopted more chondrogenic phenotypes with an overall increase of chondrocyte-related genes and proteins. Furthermore, in PP injured model, much more new formed cartilage-like tissues could be observed in CII-sponges group, evidenced by a large amount of positive proteoglycan expression and typical oval or round chondrocytes in this area.ConclusionOur study showed that CII-sponges facilitated the TSPCs to differentiate toward chondrocytes and increased the area of FCs, which suggests that CII-sponges are meaningful for the reconstruction of FC at bone tendon junction. However, the link between the two phenomena requires further research and validation.

Long-term outcomes after partial patellectomy in comminuted fractures - a clinical study.

The purpose of this study was to evaluate the long-term clinical and radiographic outcomes of partial patellectomy (PP) in patients with patella comminuted distal pole fractures. Seventeen patients who were diagnosed with patella comminuted distal pole fractures and underwent PP procedures were retrospectively included between January 1995 and January 2005. We collected patient demographics and data on the mechanism of injury, time to surgery, fracture type, follow-up time, and post-operative complications (infection, patellofemoral arthritis, and stiffness). At the final follow-up, functional outcome was evaluated by the range of motion (ROM) and the Bostman Scoring System. Quadriceps strength was evaluated by using an isokinetic dynamometer to measure peak torque, and patellar height was evaluated by the Insall-Salvati (IS) ratio in lateral knee radiographs. The average follow-up period was 14.6years (range, 11-19years). We analyzed 17 patients (AO/OTA 34-A1), with an average age of 59.8years (range, 43-76years). According to the Bostman grading scales, final functional outcomes were excellent in 11 (64.7%) and good in six (35.3%) patients. All patients had full knee extension, and the average ROM was 125.1° (range, 121.4-129.3°). The average peak torque of the injured knee was 103.2 ± 9.7 Nm, and that of the uninjured opposite side was 108.3 ± 7.6 Nm, with no significant difference (p > 0.05). Furthermore, no postoperative complications, such as infection, posttraumatic osteoarthritis, or stiffness, were observed. Compared to the uninjured knee, the IS ratio of the injured knee was 0.76 ± 0.13, indicating that the patellar height was decreased, which meant patella baja. The PP procedure for patella comminuted distal pole fractures is a safe, simple, and reliable technique that can provide good long-term clinical outcomes even with decreased patellar height and could be a satisfactory alternative treatment option when anatomical reduction is difficult.

Calcitonin Gene-Related Peptide Influences Bone-Tendon Interface Healing Through Osteogenesis: Investigation in a Rabbit Partial Patellectomy Model.

Background:Calcitonin gene-related peptide (CGRP), which has been shown to play an important role in osteogenesis during fracture repair, is also widely distributed throughout the tendon and ligament. Few studies have focused on the role of CGRP in repair of the bone-tendon interface (BTI).Purpose:To explore the effect of CGRP expression on BTI healing in a rabbit partial patellectomy model.Study Design:Controlled laboratory study.Methods:A total of 60 mature rabbits were subjected to a partial patellectomy and then randomly assigned to CGRP, CGRP-antagonist, and control groups. In the CGRP-antagonist group, the CGRP receptor antagonist BIBN4096BS was administered to block CGRP receptors. The patella–patellar tendon complex was harvested at 8 and 16 weeks postoperatively and subjected to radiographic, microlaser Raman spectroscopy, histologic, and biomechanical evaluation.Results:Radiographic data showed that local CGRP expression improved the growth parameters of newly formed bone, including area and volumetric bone mineral density (P < .05 for both). Raman spectroscopy revealed that the relative bone mineral composition increased in the CGRP group compared with in the control group and the CGRP-antagonist group (P < .05 for both). Histologic testing revealed that the CGRP group demonstrated better integration, characterized by well-developed trabecular bone expansion from the residual patella and marrow cavity formation, at the 8- and 16-week time points. Mechanical testing demonstrated that the failure load, ultimate strength, and stiffness in the CGRP group were significantly higher than those in the control group (P < .05 for all), whereas these parameters in the CGRP-antagonist group were significantly lower compared with those in the control group at 16 weeks after surgery (P < .05 for all).Conclusion:Increasing the local concentration of CGRP in the early stages of BTI healing enhanced osteogenesis in a rabbit partial patellectomy model and promoted healing of the BTI injury, whereas treatment using a CGRP antagonist had the opposite effect. However, exogenous CGRP expression did not induce novel bone remolding.Clinical Relevance:CGRP may have potential as a new therapy for BTI injuries or may be added to postoperative regimens to facilitate healing.

Functional outcome of surgical management in cases of fracture patella in a tertiary care hospital in Salem

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Fractures of the patella are serious injuries with a broad range of subtypes. These injuries account for about 1% of all skeletal injuries and are most prevalent within the age group of 20-50 years. The underlying mechanisms of open fractures are mostly high-velocity accidents. To assess the functional outcome of various surgical procedures done for fracture patella.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A longitudinal study was conducted from the department of orthopedics, Vinayaka missions Kirupananda Variyar medical college and hospital, Salem for one year in August 2019 and July 2020. All the adult patients admitted with the diagnosis of patellar fracture were included in the study. A complete local examination was conducted and an X-ray of AP and the lateral view was taken for all the patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Transverse patella fracture is being the most common fracture and for that modified tension band wiring (TBW) was the most common procedure performed and for comminuted fracture partial patellectomy was the most common procedure and for 1 patient total patellectomy was performed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt;&lt;strong&gt; &lt;/strong&gt;The study shows that the treatment of patella fractures with modified tension band wiring is a definitive treatment with minimal complications and excellent functional outcomes.&lt;/p&gt;

Sustained release of collagen-affinity SDF-1α from book-shaped acellular fibrocartilage scaffold enhanced bone-tendon healing in a rabbit model.

Rapid and functional bone-tendon (B-T) healing remains a difficulty in clinical practice. Tissue engineering has emerged as a promising strategy to address this problem. However, the majority of tissue engineering scaffolds are loaded with stem cells to enhance the regenerability in B-T healing, which is complicated and inconvenient for clinical application. Accordingly, developing a cell-free scaffold with chemotactic function and chondrogenic inducibility may be an effective approach. In this study, a collagen affinity peptidederived from the A3 domain of von Willebrand factor (a hemostasis factor) was fused into the C-terminal of a stromal cell-derived factor-1α (SDF-1α) to synthesize a recombinant SDF-1α capable of binding collagen and chemotactic activity. The recombinant SDF-1α was then tethered on the collagen fibers of a book-shaped acellular fibrocartilage scaffold (BAFS), thus fabricating a novel scaffold (C-SDF-1α/BAFS) with chemotactic function and chondrogenic inducibility. In vitro tests determined that this scaffold was noncytotoxic and biomimetic, could attract stem cells migrating to the scaffold using sustainably released C-SDF-1α, and inducedthe interacting stem cells down the chondrogenic lineage. In vivo, the C-SDF-1α/BAFS significantly enhanced the B-T healing in a rabbit partial patellectomy model, as shown by the larger cartilaginous metaplasia region, better fibrocartilage regeneration, additional bone formation, and improved biomechanical properties. Therefore, the findings of the study demonstrate that the C-SDF-1α/BAFS could potentially be applied for B-T healing.

Результаты хирургического лечения переломов надколенника

Introduction Patella fractures account for one percent of all fractures. Arthritis, non-union and other complications which affect the function of the lower limb may develop in the long term. The aim was to develop the most optimal osteosynthesis techniques for patella fractures. Methods We analyzed longterm treatment results of 78 patients with patella fractures treated from 2017 to 2018 using the KOOS (The Knee Injury and Osteoarthritis Outcome Score) scale, clinical examinations and knee joint X-rays. Based on the methods of surgical treatment for patella fractures, we divided the patients into 5 groups: Weber tension band wiring for two-fragment fractures; cross-like osteosynthesis and other methods of patella osteosynthesis using K-wires and wire loops for multifragmental fractures of the patella; combined osteosynthesis (tension band wiring with an additional screw or cerclage around patella); partial patellectomy and the inferior pole osteosynthesis. Results A comparative analysis of patients’ groups after surgical treatment of patella fractures using the KOOS scale showed the best results after Weber tension band wiring for transversal fractures (72 %). The results of patients with multifragmental fractures of the patella using K-wires and wire loops were positive in 64 %; after the restoration of the inferior pole in 68 %, after partial patellectomy in 57 %. Conclusion For transversal fractures of the patella, tension band wiring is the method of choice. With multifragmental patella fractures, good results are achieved by cross-like osteosynthesis and other methods using K-wires and wire bands. The use of patellectomy followed by wire loop locking should be avoided for all types of patella fractures. In fractures of the inferior pole of the patella, it is preferable to fix it to the main patella fragment.

Comparison of bone surface and trough fixation on bone–tendon healing in a rabbit patella–patellar tendon injury model

BackgroundMany orthopedic surgical procedures involve reattachment between tendon and bone. Whether bone–tendon healing is better facilitated by tendon fixation on a bone surface or within a tunnel is unknown. The purpose of this study was to comparatively evaluate the effects of bone surface versus bone trough fixation on bone–tendon healing in a rabbit patella–patellar tendon (PPT) injury model. MethodsThe rabbits underwent partial patellectomy with patellar-tendon fixation on the osteotomy surface (bone surface fixation, BSF group) (n = 28) or within a bone trough (bone trough fixation, BTF group) (n = 28). The PPT interface was evaluated by macroscopic observation, micro-computed tomography scanning, histological analysis, and biomechanical testing at postoperative week 8 or week 16. ResultsMacroscopically, no signs of infection or osteoarthritis were observed, and the regenerated tissue bridging the residual patella and patellar tendon showed no obvious difference between the two groups. There were significantly higher bone mineral density ​and trabecular thickness ​in BSF group compared with BTF group at week 8 (p ​< ​0.05 for both). However, the bone volume fraction (BVF), bone mineral density and trabecular thickness in BSF group were significantly lower than those in BTF group (p ​< ​0.05 for all) at week 16. Histological analysis demonstrated that new bone was formed at the proximal patella and reattached to the residual patellar tendon through a regenerated fibrocartilage-like tissue in both groups. There was more formation and better remodelling of fibrocartilage-like tissue in BTF group than BSF group at week 8 and week 16 (p ​< ​0.05 for both). Biomechanical testing revealed that there was higher failure load and stiffness at the PPT interface in BTF group than BSF group at week 16 (p ​< ​0.05 for both). ConclusionsThese results suggested that raptured tendon fixation in a bone trough resulted in superior bone–tendon healing in comparison with tendon fixation on bone surface in a rabbit PPT injury model. The translational potential of this articleAlthough the structural and functional difference of knee joint between human and rabbit limit the results to be directly used in clinical, our research does offer a valuable reference for the improvement of reattachment between bone and tendon.

Neglected segmental patella fracture: A case report and review of literature

Introduction: Fractures of patella constitute only 1% of all skeletal injuries. Mechanism of injury can be either by a direct impact or by indirect eccentric extensor contraction. Management depends on the personality of fracture, displacement, articular surface involvement, and the status of the patient’s extensor mechanism. Several techniques have been described for patellar fracture fixation.Case Report: We present a case of a 35 year old male who had a 3 months old segmental fracture of the patella. After dissecting all the fibrous tissue in-between the fracture fragments, the 3-piece patella was fixed using principle of tension band construct.Discussion: There have been several techniques described in literature for the treatment of patella fractures depending upon the personality of fracture like tension band wiring, cerclage wiring, cannulated screw fixation, trans-osseous suture, partial patellectomy, etc.Conclusion: This stable fixation allowed us to start immediate physiotherapy program and has resulted in a good functional result at one-year follow-up.

Patellar Fixation Following Fracture: A Retrospective Review of Outcomes Following Varying Surgical Interventions

Purpose: Patella fractures are a common injury in trauma patients and can be treated with a multitude of different fixation methods. With so many fixation techniques available, no current consensus exists on best practices for patients presenting with this injury. The purpose of this analysis is to review the multiple different patella fixation strategies and to evaluate the outcomes and complications associated with each. Methods: One hundred and fifteen patients who underwent patellar fracture fixation at an urban Level I-Trauma center were retrospectively reviewed. Operative treatment included open reduction and internal fixation with plate and screw devices, tension band wiring (TBW), cannulated screw tension band wiring (CS-TBW), isolated interfragmentary screw fixation, or partial patellectomy with soft tissue repair and tendon advancement. Patient demographics, fracture and injury characteristics, operative variables, radiographic information, and post-operative outcome measurements were recorded for each patient assessed in the study. Results: Results demonstrated that plating techniques had the highest overall rate of union. Furthermore, a significant decrease in implant removal with utilization of isolated suture/wire was appreciated compared to other fixation groups (p < 0.01). Conclusion: We conclude that plate utilization achieves high radiographic union compared with other fixation methods.

Autologous Freeze-Dried, Platelet-Rich Plasma Carrying Icariin Enhances Bone-Tendon Healing in a Rabbit Model

Background: Tendon-bone interface (TBI) injuries are common in sports activities. Owing to the limited regenerative ability of the TBI, its functional healing remains a difficulty in clinical practice. Icariin (ICA) provides strong stimulation for osteogenesis. Platelet-rich plasma (PRP) can be used as a carrier for bioactive molecules, although its ability to provide sustained release for such molecules needs improvement. Hypothesis: Freeze-dried PRP (FD-PRP) as a carrier for ICA can provide sustained release of ICA into the tendon-bone (T-B) healing site, thus accelerating T-B healing. Study Design: Controlled laboratory study. Methods: A total of 84 New Zealand rabbits with partial patellectomy in the hindlimb were randomly allocated into 3 different treatments: ICA incorporated with FD-PRP (ICA/FD-PRP), FD-PRP alone (FD-PRP), or saline control (CTL). The rabbit patella–patellar tendon (PP) interfaces were postoperatively harvested at postoperative week 8 or 16 for gross, radiological, histological, and mechanical evaluations. Results: Our results showed that FD-PRP can act as a carrier for sustained release of ICA into the T-B healing site. Macroscopically, no signs of infection or osteoarthritis were shown in the regenerated PP interfaces, and the area of cartilaginous metaplasia in the FD-PRP and ICA/FD-PRP groups at postoperative week 16 was significantly larger than that of the CTL group (P < .05 for all). Radiologically, micro–computed tomography showed that new bone which formed at the healing site in the ICA/FD-PRP group was significantly increased, remodeled, and mineralized in comparison with the CTL group (P < .05 for all). Histologically, the ICA/FD-PRP group exhibited a significant native PP interface, as shown by the enlargement and remodeling of new bone, well-organized collagen fibers, and robust production of proteoglycans in the regenerated fibrocartilage. The mechanical strength of the regenerated PP interface was significantly improved in the ICA/FD-PRP group. Significantly higher failure load and stiffness were shown in the ICA/FD-PRP group compared with the CTL and FD-PRP groups, respectively (P < .05 for all). Conclusion: FD-PRP is a suitable sustained-release carrier for ICA, and ICA/FD-PRP can provide sustained release of ICA into the T-B healing site, thus effectively accelerating T-B healing. Clinical Relevance: Findings of this study demonstrate the feasibility of using FD-PRP as a carrier for ICA to improve T-B healing and provide a foundation for future clinical application.

Suturing and wiring a novel technique for Osteosynthesis of inferior pole patella fracture: A prospective comparative study

Background: Osteosynthesis and partial patellectomy with patellar tendon repair are accepted procedures for inferior pole fracture of patella. Fractures of lower end of patella are usually avulsion injuries due to forceful flexion of knee against contracted quadriceps muscle. Multiple small fragments attached to patellar tendon make the management difficult. We conducted a prospective study of clinical and radiological outcome of inferior pole of patellar fractures treated with patellar tendon repair with non absorbable Ethibond and circumferential wiring. We compared the results with those of mid patellar fractures treated with modified tension band wiring technique. Materials: We included all patients with lower pole patella fractures, presented to our department from 2012 to 2015. We included patients with fracture 34 A1 (b) (extra articular lower pole) and 34C1.3 (complete articular distal 3rd fracture). These fractures were fixed with Ethibond 5 by making transosseous longitudinal drill holes and supplemented with circumferential stainless steel wires. Bostman scoring system was used to analyze and assess clinical results. We compared the results with midpatellar fractures treated by tension band wiring at the end of follow up period. Results: We recruited 21 patients with inferior pole patella fractures. Independent T Test was used to compare the means of Bostman scoring, flexion and loss of extension of knee joint between two groups of patients. Anterior knee pain and implant loosening was found more prevalent in midpatellar fracture treated by tension band wiring technique and required implant removal. There was no significant difference between two groups of patients. Conclusion: Lower pole patella fracture can be successfully treated by this novel technique of fixation with less number of complications. Comminuted lower pole fractures which otherwise needed excision may be preserved with this technique.

Surgical treatment and rehabilitation capabilities of patients with patellar fractures

Relevance. Fractures of the patella represent about 1% of all fractures of the bones. Among surgeons there is no a single approach to the treatment of patients with many fragmentary patellar fractures. After surgical treatmerit of patients with patellar fractures, various complications could be observed. Aside from that, there is no consensus on the treatment of complex fractures of the patella, and in practice, trauma physicians use a variety of methods of osteosynthesis of the patella. In the light of the foregoing, the study of long-term results of patients after patellar fractures is of particular relevance. Purpose of study: to examine the results of patients after surgical treatment of patellar fractures with a view to devising best practices for its osteosynthesis. Patients and methods. A study of the results of treatment of 78 patients with patellar fractures was conducted. The following groups were identified depending on the type of surgery and the nature of the fracture: Weber osteosynthesis in fragmentary fractures; cruciform osteosynthesis and other identical options of osteosynthesis with spokes and wires at three or more fragmented fractures of the patella; combination osteosynthesis. A comparative analysis of the results of treatment of patients after partial patellectomy and osteosynthesis of the patella with spokes and tightening wire loops was conducted. We evaluated the results on the KOOS scale with clinical examination and x-ray examination of patients. Beyond that, we have supplemented this scale with the patients own opinion on the evaluation of the results of their treatment. Results. The average follow-up period was 22 months. A comparative analysis of the groups of patients after surgical treatment of patellar fractures on the KOOS scale showed the best results in osteosynthesis of transverse two-fragment patellar fractures by Webery 72%. The results of treatment of patients with many fragmentary patellar fractures using 35 spokes and 23 wires was 64%); after the rehabilitation of the lower pole was 68%) and after partial patellectomy 51%. Conclusion. If a patient has three-fragmented patellar fractures, reasonable results could be achieved by using 3 spokes and 2 tightening wire loops. With four or more fragmentary fractures of the patella, the optimal method for its osteosynthesis is the use of a cruciform method with 4 or more spokes in combination with two or three wire loops. The use of patellectomy with subsequent fixation of the blocking wire loop should be avoided in all types of patellar fractures.

Effect of Low-Intensity Pulsed Ultrasound After Autologous Adipose-Derived Stromal Cell Transplantation for Bone-Tendon Healing in a Rabbit Model

Background: Low-intensity pulsed ultrasound (LIPUS), as a safe biophysiotherapy, can enhance bone-tendon (B-T) healing in vivo and induce osteogenic or chondrogenic differentiation of mesenchymal stromal cells in vitro. This study aimed to determine whether LIPUS can improve the efficacy of transplanted mesenchymal stromal cells on B-T healing. Hypothesis: LIPUS can induce lineage-specific differentiation of transplanted adipose-derived stromal cells (ASCs) at the B-T healing site, thus resulting in superior healing quality when compared with LIPUS or ASCs alone. Study Design: Controlled laboratory study. Methods: A total of 112 mature rabbits with partial patellectomy in the hindlimb were randomly assigned into mock sonication without ASCs (control), ultrasonication without ASCs (LIPUS), mock sonication with ASCs (ASCs), and ultrasonication with ASCs (LIPUS + ASCs). The treatment time of the mock sonication or ultrasonication was 20 minutes per day. Autologous ASCs were transplanted to the healing site by fibrin glue during the operation, and LIPUS was delivered daily starting at postoperative day 3 until euthanasia. The patella–patellar tendon junctions were postoperatively harvested at 8 and 16 weeks for radiological, histological, and mechanical evaluations. Additionally, 9 animals were used for ASC tracking with mCherry protein. Results: Radiologically, there was more new bone formation and remodeling in the LIPUS + ASCs group as compared with the other groups. Synchrotron radiation micro–computed tomography showed that the LIPUS + ASCs group significantly increased bone volume fraction, trabecular thickness, and trabecular number at the healing site as compared with the other groups at postoperative 8 weeks (P < .05 for all). Histologically, immunohistochemical staining confirmed that the transplanted mCherry-ASCs can differentiate into osteoblasts and fibrochondrocytic-like cells. Meanwhile, as compared with the other groups, the LIPUS + ASCs group showed more formation and maturity of the fibrocartilage layer and new bone at postoperative weeks 8 and 16 (P < .05 for all). Biomechanically, the LIPUS + ASCs group showed significantly higher failure load and stiffness versus the other groups at postoperative weeks 8 and 16 (P < .05 for all). Conclusion: Autologous ASC transplantation stimulated with LIPUS can result in superior B-T healing quality when compared with LIPUS or ASCs alone. Clinical Relevance: This study demonstrates the effectiveness of using ASC transplantation stimulated with LIPUS for B-T healing and provides a foundation for future clinical studies.

A prospective study of 50 cases of patella fractures treated with different modalities

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Fractures of patella account for 1% of all skeletal injuries. There is no universal accepted treatment for patellar fractures. After a fracture of the patella, the best results are obtained by accurate reduction and stable internal fixation. Partial or total patellectomy is generally indicated when the patella is so severely comminuted that an accurate reduction and reconstruction of the retropatellar joint surface cannot be achieved.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The prospective study of 50 cases of patellar fractures was carried out at the department of orthopaedics for the period from May 2015 to December 2017. The maximum period of follow up was 18 months with a minimum period of follow up of 5 months (average 11.68 months). Operative treatment was done in patella fractures for more than 2 mm of articular displacement or 3 mm of fragment separation. Surgical options includes internal fixation with tension band wiring with k wire and partial patellectomy with extensor mechanism repair.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; We have studied 50 patients where 7 cases were treated conservatively. In the present series 22 patients were treated with internal fixation out of which 13 patients had excellent results. 6 patients had good results. 21 patients were treated with partial patellectomy where 6 patients had excellent results, 11 patients had good and 4 patients had fair results.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Patella should be preserved and Osteosynthesis whenever possible has better chance for excellent results. A good surgical technique, optimal operation room environment and judicious use of antibiotics will reduce the possibility of infection.&lt;/p&gt;