PURPOSE OF THE STUDY Patellofemoral stability and congruency are influenced by different parameters. Their contribution to anterior knee pain and instability is not fully understood. We investigated, if isolated femoral antetorsion of more than 25° leads to patellofemoral instability. MATERIAL AND METHODS We analyzed 90 knees in patients with patellofemoral complaints and correlated clinical and radiological characteristics. Patients presenting at our center between January 2018 and December 2020 because of patellofemoral pain or instability were included, provided that there was no previous surgical intervention done. RESULTS The severity of trochlea dysplasia classified using the Oswestry-Bristol classification significantly correlated with events of patellofemoral dislocations. (χ=8.152, p=0.043, φ=0.288). All males with a history of patella dislocation had at least a mild trochlea dysplasia. The majority of females complaining about patellofemoral symptoms in general had a dysplastic trochlea. Patella alta is more frequently found in patients with trochlea dysplasia than in patients with a normal femoral trochlea anatomy. DISCUSSION The majority of unstable patellofemoral joints showed a dysplastic trochlea. A high femoral antetorsion was found to be an additional minor factor contributing to instability. Isolated high femoral antetorsion without trochlea dysplasia rather leads to anterior knee pain without patella dislocation. Furthermore, no direct significant correlation between patella alta and patellofemoral instability was found. Patella alta can therefore rather be seen as a result of a dysplastic trochlea than a primary major risk factor for patellofemoral instability. CONCLUSIONS Trochlea dysplasia is the major risk factor for patellofemoral instability. Patella alta can rather be seen as a result of a dysplastic trochlea than as a primary risk factor for patella instability or pain. Isolated high femoral antetorsion often leads to patellofemoral pain syndrome but not to patella dislocations. Key words: MPFL, patella instability, patellofemoral instability.

• MeSH
• bolest komplikace   MeSH
• femur diagnostické zobrazování   chirurgie   MeSH
• kolenní kloub diagnostické zobrazování   chirurgie   MeSH
• lidé MeSH
• luxace pately * komplikace   diagnostické zobrazování   MeSH
• nestabilita kloubu * diagnostické zobrazování   etiologie   MeSH
• patela chirurgie   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE OF THE STUDY The study retrospectively reviews the outcomes of patella stabilisation surgeries performed at our department in the period 2010-2020. It aimed to provide a more thorough evaluation, to compare the respective types of MPFL reconstruction and to confirm the beneficial effect of tibial tubercle ventromedialization on patella height. MATERIAL AND METHODS In the period 2010-2020, a total of 72 stabilisation surgeries of patellofemoral joint in 60 patients with objective patellar instability (OPI) were performed at our department. The surgical treatment outcomes were evaluated retrospectively using a questionnaire, including the postoperative Kujala score. A comprehensive examination was carried out in 42 patients (70%) who had completed the questionnaire. In case of distal realignment, the TT-TG distance and a change in the InsallSalvati index which serve as an indication for surgery, were assessed. RESULTS Altogether 42 patients (70%) and 46 surgical interventions (64%) were evaluated. The follow-up period was 1-11 years, with the mean follow-up of 6.9 years. In the studied group of patients, only 1 case (2%) of new dislocation was seen, in 2 cases (4%) the patients reported a subluxation episode. The mean score using the school grades was 1.76. Thirty-eight patients (90%) were satisfied with the surgical outcome, 39 patients would undergo a surgery in case of identical problems with the other limb. The mean postoperative Kujala score was 76.8 points, range 28-100 points. The mean TT-TG distance in the studied group with the preoperative CT scan (33x) was 15.4 mm (12-30 mm). The mean TT-TG distance in the cases indicated for tibial tubercle transposition was 22.2 mm (15-30 mm). The mean Insall-Salvati index prior to the performance of tibial tubercle ventromedialization was 1.33 (1-1.74). Postoperatively, the index decreased by 0.11 on average (-0.00 to -0.26) to 1.22 (0.92-1.63). No infectious complications were presented in the studied group. DISCUSSION In patients with recurrent patellar dislocation, the instability is often times caused by pathomorphologic anomalies of the patellofemoral joint. In patients with clinically expressed patellar instability and physiological values of the TT-TG distance, an isolated proximal realignment is performed by medial patellofemoral ligament (MPFL) reconstruction. In the case of pathological values of the TT-TG distance, distal realignment is performed by tibial tubercle ventromedialization to achieve physiological values of the TT-TG distance. In the studied group, tibial tubercle ventromedialization helped decrease the Insall-Salvati index by 0.11 points on average. This has a positive side effect on the patella height, thus on increasing its stability in the femoral groove. In patients with both proximal and distal malalignment, a two-stage surgery is performed. In the isolated cases of severe instability or if symptoms of lateral patellar hyperpressure are present, musculus vastus medialis transfer or arthroscopic lateral release are performed as well. CONCLUSIONS When correctly indicated, proximal, distal realignment or their combination can bring very good functional outcomes with a low risk of recurrent dislocation and postoperative complications. The importance of MPFL reconstruction is confirmed by low incidence of recurrent dislocation in the group investigated in this study, namely when compared with studies referred to in this paper, in which the patients underwent patellar stabilisation using the Elmslie-Trillat procedure. Conversely, leaving the bone malalignment untreated during the isolated MPFL reconstruction increases the risk of its failure. Judging from the obtained results, tibial tubercle ventromedialization also has a positive effect on the patella height through its distalization. Provided the stabilisation procedure is correctly indicated and performed, the patients can get back to their normal activities, often even sports activities. Key words: objective patellar instability, patellar stabilisation, MPFL, tibial tubercle transposition.

• MeSH
• dislokace kloubu * MeSH
• kloubní ligamenta chirurgie   MeSH
• lidé MeSH
• luxace pately * chirurgie   MeSH
• nestabilita kloubu * chirurgie   MeSH
• patela chirurgie   MeSH
• patelofemorální kloub * chirurgie   MeSH
• retrospektivní studie MeSH
• tibie chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

Introduction: The plica is a residual septum that divides the knee into three compartments: supra, medial, and lateral. Although anatomically suprapatellar plica of the knee is common, it rarely causes symptoms. Thickening of suprapatellar plica may present as anterior knee pain with or without mechanical symptoms. The suprapatellar plica may be a cause to be missed as a cause to look for anterior knee pain. Case Presentation: 33-years-old woman presented with recurring anterior knee pain. A non-specific patellofemoral pain was concluded as initial diagnosis, but conservative treatment failed to relieve the pain. During exploratory arthroscopic examination, a shallow suprapatellar cavity with folded synovium with central perforation was found. Plica excision was done with no complication. After 10 days, the patient has significant improvement and after one month the patient walked uneventfully. Conclusion: Suprapatellar plica is the most common arthroscopic findings compared to other type of plica. Because the presence of suprapatellar plica does not always depict suprapatellar plica syndrome, it is a cause to be looked for during arthroscopy on anterior knee pain. The complete type of it, especially without perforation, appears only as shallow suprapatellar cavity, that the surgeon should be aware of.

• MeSH
• artroskopie metody   MeSH
• dospělí MeSH
• koleno patologie   MeSH
• lidé MeSH
• muskuloskeletální bolest etiologie   MeSH
• neúspěšná terapie MeSH
• patela patologie   MeSH
• patelofemorální syndrom * diagnóza   patologie   MeSH
• synovitida * chirurgie   diagnostické zobrazování   patofyziologie   patologie   terapie   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH
• přehledy MeSH

• Klíčová slova
• osteosutura,
• MeSH
• fraktury kostí * chirurgie   MeSH
• lidé MeSH
• ortopedické výkony dějiny   metody   přístrojové vybavení   MeSH
• patela * chirurgie   zranění   MeSH
• vnitřní fixace fraktury dějiny   metody   přístrojové vybavení   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• historické články MeSH
• práce podpořená grantem MeSH

PURPOSE OF THE STUDY Treatment of patella fractures has always been difficult; especially in older patients. The aim of this study was to investigate the XS nail in the treatment of patella fractures. MATERIAL AND METHODS 49 fractures could be registered and reevaluated with a standardized questionnaire. RESULTS Mean follow-up time was 38.67 months, mean age 71.48 years. The mean OKS was 16.26 points, the Kujala Score was 81.56 points. No wound healing or revision could be detected. CONCLUSIONS The XS nail is a good treatment option with a low risk of complications also for the age-related trauma patient and for more complex patella fractures. Key words: patella, patella fracture, XS nail, locking nail, intramedullary nail, nail osteosynthesis.

• MeSH
• fraktury kostí * diagnostické zobrazování   chirurgie   MeSH
• hojení fraktur MeSH
• intramedulární fixace fraktury * MeSH
• kostní hřeby MeSH
• lidé MeSH
• patela diagnostické zobrazování   chirurgie   MeSH
• senioři MeSH
• vnitřní fixace fraktury MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH

A 49-year-old female fell from standing. Her right knee extended into the air. She had acute right knee pain preventing weight-bearing. Her knee was most comfortable fully-extended. She could not flex it due to pain, nor extend it against resistance. Tenderness and a horizontal defect were noted over the anterior knee. Bedside ultrasound demonstrated a horizontally-fractured patella (confirmed on X-ray) with intact femoral and patellar tendons. She was put in a knee immobilizer and underwent surgery, with return to full function and activities. Ultrasound can identify patella fractures and help with early evaluation, management, and specialty referral, as well as ordering more-focused imaging. In one study, POCUS (point-of-care ultrasound) for patella fracture had 95% sensitivity, 63% specificity, 86% positive predictive value, and 83% negative predictive value. The dynamic nature of ultrasound allows a ruptured patella (87% sensitivity) or quadriceps tendon (100% sensitivity) to be excluded with high certainty.

• MeSH
• lidé středního věku MeSH
• lidé MeSH
• patela * diagnostické zobrazování   MeSH
• vyšetření u lůžka * MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Predstavujeme prípad pacientky s akútnou ischémiou na hornej aj dolnej končatine v dôsledku paradoxnej embolizácie. 67-ročná žena bez anamnézy venózneho tromboembolizmu utrpela v novembri 2017 dislokovanú fraktúru pately s potrebou operačného riešenia. Dva mesiace po operácii bola rehospitalizovaná pre obojstrannú embóliu do arteria pulmonalis, oklúziu ľavej arteria subclavia, ľavej arteria femoralis communis a arteria mesenterica superior. Transezofageálna echokardiografia zistila prítomnosť foramen ovale patens. Cievny chirurg neindikoval embolektómiu a intervenčný rádiológ neindikoval farmakomechanickú trombolýzu z dôvodu veľkého rozsahu oklúzie. Následne bola úspešne podaná systémová trombolýza (altepláza) s rozpustením embolov v ľavej arteria subclavia, v ľavej arteria femoralis communis a v arteria mesenterica supeior.

We present a case report of a patient with acute upper and lower limb ischemia due to paradoxical embolism. A 67-year old woman without history of venous thromboembolism suffered dislocated patellar fracture requiring surgery in November 2017. Two months after surgery she presented to the emergency room with bilateral pulmonary embolism, occlusion of the left subclavian artery, left common femoral artery and superior mesenteric artery. Transesophageal echocardiography detected patent foramen ovale. Vascular surgeon decided against embolectomy, interventional radiologist against pharmacomechanical thrombolysis due to the extent of the occlusions. Systemic thrombolysis (alteplase) was administered successfully with resolution of the emboli in the left subclavian artery, left common femoral artery and superior mesenteric artery.

• MeSH
• foramen ovale apertum MeSH
• lidé MeSH
• mechanická trombolýza MeSH
• ortopedické výkony * MeSH
• paradoxní embolie * diagnóza   terapie   MeSH
• patela zranění   MeSH
• pooperační komplikace MeSH
• senioři MeSH
• výsledek terapie MeSH
• žilní tromboembolie * diagnóza   etiologie   terapie   MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

Patellar sleeve fracture is a form of injury in which small osseous fragments avulsed with periosteum and cartilage. 15-year-old male patient, playing in school football team, apllied to our clinic with a history of previously missed patellar superior pole sleeve avulsion fracture. Care must be taken in order not to miss the patellar superior pole sleeve fractures, which are very rare in children. Extra care must be taken in patients, whose X-ray imaging is clean but there is a problem in the extensor mechanism of the knee. INTRODUCTION Since the patella has high mobility and large cartilage surfaces, it's fracture is very rare in children (9). Growing patella is more prone to osteochondral or avulsion fractures (8). Patellar sleeve fracture is a form of injury in which small osseous fragments fractured with periosteum and cartilage (5). Avulsion or sleeve fractures of patella can be seen in inferior and superior patellar poles. Fractures in superior pole is very rare and only a few cases have been described in the literature (2).

• MeSH
• avulzní fraktury diagnóza   chirurgie   MeSH
• fraktury kostí diagnóza   chirurgie   MeSH
• lidé MeSH
• mladiství MeSH
• nepoznaná diagnóza MeSH
• patela zranění   chirurgie   MeSH
• poranění kolena diagnóza   chirurgie   MeSH
• Check Tag
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

PURPOSE OF THE STUDY The preoperative planning in habitual dislocation of the patella should take into account all pathologies and the procedure should address all abnormalities. One of them might be also the rotational deformity of the femur. The purpose of this prospective study was to confirm the hypothesis that the only correction of pathological femoral anteversion by derotational intertrochanteric osteotomy (in the absence of another pathology) or the correction of femoral anteversion with simultaneous reconstruction of the patellofemoral joint provide adequate stability for the patellofemoral joint, with respect to the elimination of the risk of recurrent dislocation of the patella. MATERIAL AND METHODS In the course of 15 years, 17 patients (20 knee joints) with habitual dislocation of the patella were included in the study, in whom the CT scan also confirmed the femoral anteversion of 35° and greater. The group was female-dominant, often with BMI > 30. The mean age was 26 years. In 4 cases only derotational intertrochanteric osteotomy was performed, in 16 patients the osteotomy was followed by the stabilization of the patella in the knee region (always individually in dependence on the diagnosed pathology), of whom in 2 cases as the second step procedure because of thrombophilic disorders detected earlier. Immediately after the surgery, or at 6 weeks postoperatively (depending on the knee procedure done), individual rehabilitation was commenced. Partial weight bearing was recommended for the period of 3 months after the surgery. The mean follow-up period was 39 months (minimum of 36 months). RESULTS In one case a failure of osteosynthesis was observed and revision osteosynthesis with an intramedullary nail was performed. In all the other cases, primary healing of the osteotomy was achieved. The other complications were less significant (1 case of asymptomatic deep vein thrombosis of the lower limb, evacuation of subcutaneous haematoma in 1 case, 3 cases of the knee stiffness solved by manipulation under general anaesthesia at 6 weeks after surgery). Recurrent patellar dislocation was not observed in any of the patients. No pain in the upper thigh was reported by patients during the last follow-up control (at least 3 years postoperatively). Three female patients reported an isolated feeling of patellar instability. DISCUSSION There are very few studies focusing on the femoral derotational osteotomy for habitual dislocation of the patella in world literature. If any at all, they concern supracondylar and not intertrochanteric femoral osteotomy and the groups of patients were smaller than the group evaluated by us. CONCLUSIONS Preoperative planning for habitual dislocation of the patella should definitely reflect all pathologies. Therefore, the femoral derotational osteotomy should certainly be mastered by the orthopaedic surgeon, though it is a larger and more exacting procedure than patellar stabilizations in the knee region. Indications for this type of osteotomy should include anteversion greater than 30°, or 35°. The derotational intertrochanteric osteotomy alone or its combination with the stabilization of the patella in the knee region brings reliable results with no risk of recurrent dislocation. Key words: patella, habitual dislocation, femur, anteversion, derotational osteotomy.

• MeSH
• dospělí MeSH
• femur diagnostické zobrazování   chirurgie   MeSH
• kolenní kloub MeSH
• lidé MeSH
• osteotomie MeSH
• patela * MeSH
• patelofemorální kloub * diagnostické zobrazování   chirurgie   MeSH
• prospektivní studie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• chirurgie operační metody   MeSH
• fraktury kostí * chirurgie   komplikace   patofyziologie   terapie   MeSH
• kosti a kostní tkáň patofyziologie   zranění   MeSH
• kosti dolní končetiny patofyziologie   zranění   MeSH
• ortopedické výkony metody   škodlivé účinky   MeSH
• patela * patofyziologie   zranění   MeSH
• poranění dolní končetiny chirurgie   komplikace   patofyziologie   terapie   MeSH
• poranění kolena chirurgie   komplikace   patofyziologie   terapie   MeSH
• vnitřní fixace fraktury metody   škodlivé účinky   MeSH