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Anterior knee pain diagnosis

Jan Dauwe, Olivier Van Kerkhove, Ines Unterfrauner, Dirk Dauwe
Introduction: Avulsion fractures of the tibial intercondylar eminence are rare and occur mostly in children. The purpose of this paper is to present a case of this rare pathology and to underline the importance of early diagnosis. Case Report: A male 8-year-old child presented with pain in his left knee and difficulties to walk after a combined injury of falling and contact trauma. Radiographic studies with conventional X-ray and computed tomography (CT) scan depicted a fracture of the intercondylar eminence...
September 2018: Journal of Orthopaedic Case Reports
Steven Baker, Jacob Seales, Scotty Newcomer, Jeremy Bruce
Introduction: The overuse and repetitive loading of a bone cause a stress fracture, commonly occurring in the weight-bearing structures of the lower extremities of athletes, but rarely the patella. Patella stress fractures are an extremely rare occurrence. Müller first described a patella stress fracture in 1943; however, we could find <15 reported cases in literature since that time. Thus, some uncertainty exists as to the proper treatment of this very rare condition. Case Report: A female collegiate gymnast presented with 2-months of anterior knee pain, and initial radiographs revealed a non-displaced patella stress fracture...
July 2018: Journal of Orthopaedic Case Reports
David Y Gaitonde, Alex Ericksen, Rachel C Robbins
Patellofemoral pain syndrome (PFPS) is one of the most common causes of anterior knee pain encountered in the outpatient setting in adolescents and adults younger than 60 years. The incidence in the United States is between 3% and 6%. The cardinal feature of PFPS is pain in or around the anterior knee that intensifies when the knee is flexed during weight-bearing activities. The pain of PFPS often worsens with prolonged sitting or descending stairs. The most sensitive physical examination finding is pain with squatting...
January 15, 2019: American Family Physician
Zhu Dai, Zhou Li, Yun-Liang Lei, De-Hong Fu
Popliteal meniscal fiber bundle injury is relatively infrequent in clinic, which can be either isolated or associated with anterior cruciate ligament rupture, lateral meniscus injury and so on. Popliteal meniscal fiber bundle injury often leads to instability of lateral meniscus. Because of the lack of specific symptoms and signs of injury, the imaging changes are subtle, and it is easy to miss diagnosis and misdiagnosis in clinical. Timely diagnosis and treatment are essential to prevent the chronic pain and instability of the knee joint...
December 25, 2018: Zhongguo Gu Shang, China Journal of Orthopaedics and Traumatology
Christopher A Iobst, Ahmed Ansari
When persistent rotation of the femur remains into adolescence, it can cause functional limitations such as fatigue, anterior knee pain, and frequent tripping. In these cases, derotation of the femur via osteotomy is often performed. We report preliminary results of bilateral derotational osteotomy for excessive femoral anteversion or retroversion using the modified intramedullary nail technique. A retrospective review of 8 patients was performed. Patients were excluded if additional procedures were performed or if the femoral osteotomy included any deformity correction other than rotation...
December 2018: Techniques in Orthopaedics: TIO
Julia F Funk, Susanne Lebek
This manuscript evaluates the recent standard concept for clubfoot treatment. With regard to the history of clubfoot therapy and the return to conservative methods, the focus is laid on Ponseti's treatment concept. Due to its development according to the precise analysis of the pathoanatomy, the practical principle is simple and easy to learn and consists basically of two redression maneuvers, percutaneous achillotenotomy, and boots and bar abduction treatment. Therefore, about 60 years after its implementation in Iowa it can be said to be the worldwide golden standard...
November 27, 2018: Zeitschrift Für Orthopädie und Unfallchirurgie
Alberto Gobbi, Graeme P Whyte
BACKGROUND: Surgical treatment to repair partial anterior cruciate ligament (ACL) injury without reconstruction has demonstrated inconsistent clinical success. PURPOSE: To examine the long-term clinical outcomes of primary ACL repair combined with biologic healing augmentation in patients with symptomatic partial ACL tears. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: 50 patients (mean age, 29.5 years) with a partial ACL tear and symptomatic knee instability were treated with primary ligament repair in conjunction with marrow stimulation and followed prospectively for a mean duration of 10...
December 2018: American Journal of Sports Medicine
Christine Becks Mansfield, Mitchell Selhorst
OBJECTIVES: 1) Report levels of fear-avoidance beliefs in adolescents with anterior knee pain, 2) determine if fear-avoidance beliefs predict the number of therapy visits used to treat anterior knee pain, and 3) determine if initial fear-avoidance beliefs predict functional ability at discharge. DESIGN: A retrospective review. SETTING: Pediatric outpatient hospital. PARTICIPANTS: Patients ages 10-21 years with a diagnosis of anterior knee pain between 2009 and 2016...
November 2018: Physical Therapy in Sport
Tomoki Nakamura, Tomohito Hagi, Kunihiro Asanuma, Akihiro Sudo
Intra-articular primary soft tissue sarcomas are extremely rare. The present case report describes a case of intra-articular synovial sarcoma of the ankle joint. A 51-year-old man presented with complaints of swelling and progressive pain in the right ankle. Lateral radiographs of the ankle revealed lytic invasion of the anterior and posterior parts of the talus. Computed tomography imaging revealed a low-density lesion with calcifications around the ankle joint. Magnetic resonance imaging revealed that the diffuse lesion was isointense on T1-weighted images and hypointense to hyperintense on T2-weighted images...
October 2018: Molecular and Clinical Oncology
Jan Fritz, Shivani Ahlawat, Benjamin Fritz, Gaurav K Thawait, Steven E Stern, Esther Raithel, Walter Klyce, Rushyuan J Lee
BACKGROUND: Ten-minute MRI of the pediatric knee can add value through increased cost-effectiveness and decreased sedation needs but requires validation of its clinical efficacy. PURPOSE: To determine the arthroscopy-based diagnostic accuracy and interreader reliability of 10-min 3D Controlled Aliasing In Parallel Imaging Results In Higher Acceleration (CAIPIRINHA) turbo spin echo (TSE) MRI with two isotropic pulse sequences for the diagnosis of internal derangement in children with painful knee conditions...
August 24, 2018: Journal of Magnetic Resonance Imaging: JMRI
Enrico Vaienti, Paolo Schiavi, Francesco Ceccarelli, Francesco Pogliacomi
PURPOSE: The aim of this study is to compare clinical and radiological outcome of intramedullary nailing (IMN) and locked plate (LP) in patients affected by fracture of the distal tibia (DTF). We performed also an analysis to identify predictive factors of unfavourable outcome. METHODS: Data about patients with DTF treated at our first level trauma centre between 2008 and 2017 were collected. Patients were divided in group 1 (IMN) and group 2 (LP). The inclusion criteria were age at least 18 years at the time of diagnosis and unilateral DTF (closed or Gustilo 1)...
August 22, 2018: International Orthopaedics
Ramya Srinivasan, Jennifer Wan, Christina R Allen, Lynne S Steinbach
Anterior cruciate ligament (ACL) tears are common injuries that if left untreated can result in chronic instability, cartilage damage, meniscal tears, and ligamentous injuries, eventually leading to early osteoarthritis. ACL reconstruction surgeries are therefore increasingly being performed. Despite the fact that most patients achieve excellent postoperative results, patients can present with recurrent instability and pain. These patients often undergo imaging with radiographs, magnetic resonance imaging, and/or computed tomography...
September 2018: Seminars in Musculoskeletal Radiology
Ryan T Galloway, Yingying Xu, Timothy E Hewett, Kim Barber Foss, Adam W Kiefer, Christopher A DiCesare, Robert A Magnussen, Jane Khoury, Kevin R Ford, Jed A Diekfuss, Dustin Grooms, Gregory D Myer, Alicia M Montalvo
BACKGROUND: Female athletes are at an increased risk of developing patellofemoral pain (PFP) relative to male athletes. The unique effects of maturation may compound that risk. Hypothesis/Purpose: The purpose was to evaluate the neuromuscular control mechanisms that are adaptive to pubertal maturation and determine their relative contribution to PFP development. It was hypothesized that aberrant landing mechanics (reduced sagittal-plane and increased frontal- and transverse-plane kinematics and kinetics) would be associated with an increased risk for PFP...
September 2018: American Journal of Sports Medicine
Alexander Franz, Laura Joseph, Constantin Mayer, Jan-Frieder Harmsen, Holger Schrumpf, Julia Fröbel, Martin S Ostapczuk, Rüdiger Krauspe, Christoph Zilkens
Osteoarthritis (OA) is the most frequently diagnosed joint disorder worldwide with increasing prevalence and crucial impact on the quality of life of affected patients through chronic pain, decreasing mobility and invalidity. Although some risk factors, such as age, obesity and previous joint injury are well established, the exact pathogenesis of OA on a cellular and molecular level remains less understood. Today, the role of nitrosative and oxidative stress has not been investigated conclusively in the pathogenesis of OA yet...
June 14, 2018: Orthopedic Reviews
Josie Acuna, Elaine Situ-LaCasse, Robert P Jamplis, Richard Amini, Srikar Adhikari
It can be difficult to diagnose a tibial avulsion fracture based on physical examination alone as findings are often non-specific. Emergency physicians will usually opt for radiography as their initial imaging modality, which has several disadvantages in evaluating tibial avulsion fractures. The objective of this case series is to describe the utility of point-of-care ultrasound (POCUS) in the evaluation of tibial avulsion injuries. A 15-year-old male presented to the emergency department (ED) after sustaining a left knee injury while playing soccer...
May 23, 2018: Curēus
Garrett L Chapman, Nirav H Amin
We report a patient who developed persistent knee pain with mechanical symptoms after an uncomplicated patellofemoral arthroplasty. The etiology of his knee pain remained inconclusive following magnetic resonance imaging due to metallic artifact image distortion. With the use of an in-office needle arthroscopy, an immediate and definitive diagnosis was obtained, preventing an unnecessary surgery for a diagnostic arthroscopy. We discovered a lateral meniscus tear, an anterior cruciate ligament tear, and a medial femoral condyle chondral defect for which the patient underwent arthroscopic partial meniscectomy, ligament reconstruction, and osteochondral allograft transplantation, with resolution of his knee pain...
2018: Case Reports in Orthopedics
Romain Chevallier, Shahnaz Klouche, Antoine Gerometta, Yoann Bohu, Serge Herman, Nicolas Lefevre
PURPOSE: To describe the clinical results of patients who underwent surgical treatment for a intra-osseous tibial tunnel cyst on a bioabsorbable interference screw following anterior cruciate ligament reconstruction (ACL). METHODS: This retrospective study included all patients who underwent surgery between 2004 and 2016 for an intra-osseous tibial tunnel cyst on bioabsorbable interference screw following ACL reconstruction. The diagnosis was suggested clinically by pretibial pain at the incision site, sometimes associated with a palpable subcutaneous nodule and then confirmed on MRI...
June 30, 2018: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Thomas Victor Smallman, Oliver Torben Portner, Amos Race, Kris Shekitka, Ken Mann
Anterior knee pain (AKP), a multifactorial symptom complex, can be successfully treated surgically. A specific diagnosis often cannot be made, but the pain is linked to an unrecognized common factor in most patients: the mechanical behavior of the non-isometric contents of the anterior compartment of the knee-the fat pad (FP) and infrapatellar plica (IPP). The objective of this presentation is to describe an effective arthroscopic technique that treats AKP by addressing this common factor. The operation consists of release or resection of the IPP, or ligamentum mucosum, which tethers the FP...
May 2018: Arthroscopy Techniques
Seong-Eun Byun, Hyun-Chul Shon, Jai Hyung Park, Hyoung Keun Oh, Young-Ho Cho, Ji Wan Kim, Jae-Ang Sim
A femoral shaft fracture is usually a high-energy injury and, thus, is likely to be accompanied by an injury of adjacent joints such as a knee ligament injury. However, these associated injuries are often neglected because of severe pain and deformity. The purpose of the current study is to evaluate the incidence, type and risk factors of ipsilateral knee injuries associated with femoral shaft fractures. A total of 429 femoral shaft fractures were included in this study from January 2010 to September 2015. There were 320 males and 109 females, with mean age of 40...
August 2018: Injury
William R VanWye, Harvey W Wallmann, Elizabeth S Norris, Karen E Furgal
BACKGROUND AND PURPOSE: Knee joint biomechanics requires an understanding of lower extremity (LE) segmental interactions. In some cases, knee pain may arise as a result of altered LE biomechanics; while in other cases, knee pain may stem from other causes, such as a peripheral nerve injury. CASE DESCRIPTION: A 33-year-old woman presented via direct access for physical therapist (PT) examination with a chief complaint of left knee pain. The day after undergoing a dilation and curettage (D&C) procedure the patient had an acute onset of gait dysfunction...
June 7, 2018: Physiotherapy Theory and Practice
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