patella

Background

Definition

Dislocated Patella

 

Repeated dislocation of patella with minimal trauma

- 15-20% of paediatric acute patella dislocations

- more common girls 

- often bilateral

 

Dislocation occurs unexpectedly when quadriceps contracted with knee in flexion 

 

Direction

 

Anatomical Approach to Biopsy

Region specific approaches

 

Theory

- want to traverse one muscle / one compartment

- keep away from NV bundle

- as a rule perform open biopsy through compartment the tumour is in

- this is the compartment that will require surgical removal in wide excision

- direct approach without going through muscle if possible i.e. tibia, distal ulna

 

Lower Limb

 

Thigh

 

Bipartite Patella

Ossification

 

Patella may develop from one or multiple ossification centres at 3 years

 

Failure of centres to fuse may produce bipartite or tripartite patella

- usually bilateral and painless

 

Classically superolateral

 

Classification Saupe

 

I   Inferior Pole 5%

II  Lateral 20%

Sinding - Larson - Johanssen

Epidemiology

 

Active pre teen boy

- activity related pain

- common in high jumpers

 

Diagnosis

 

Fragmentation / calcification of inferior pole

- repetitive traction injury where PT inserts

- tender at this point

 

Stages 

 

I     Normal

II    Ca inferior pole irregularity

III   Coalesce Ca inferior pole

Patellar tendonitis

Definition

 

Patellar Tendinitis

 

Epidemiology

 

Most common in athletes

- especially if involved in running, jumping and kicking

- over use injury

 

Basketball players

 

Aetiology

 

Chronic overload v inferior patella impingement

 

Schmidt et al Am J Sports Med

- dynamic MRI in patients with jumper's knee v controls

- no evidence of impingemnt

Management

Non-operativePatella Instability MPFL and TTT AP

 

Results

 

90% respond 

- very important

- 6 - 12 months minimum before offering surgery

 

Physiotherapy

 

1.  Stretches

- quads stretches

- ITB

- lateral retinaculum