Alex Finsterbush

Symptomatic bipartite patella: treatment alternatives.

Abstract Bipartite patella is usually an asymptomatic, incidental finding. However, in adolescents, it may be a cause of anterior knee pain following trauma or a result of overuse or strenuous sports activity. Most patients improve with nonsurgical treatment. Surgery is considered when nonsurgical treatment fails. Excision of the fragment is the most popular surgical option, with good results. However, when the fragment is large and has an articular surface, excision may lead to patellofemoral incongruity. Lateral retinacular release and detachment of the vastus lateralis muscle insertion are other surgical options and are reported to produce good pain relief and union in some patients. These procedures reduce the traction force of the vastus lateralis on the loose fragment. Internal fixation of the separated fragment has limited support in the literature. Understanding the possible consequences of different treatment approaches to painful bipartite patella is necessary to preserve quadriceps muscle strength and patellofemoral joint function.

Stress Fractures: Overview

Fatigue microdamage is an essential element of bone biology. Under certain conditions this may lead to stress fractures. These fractures were first described in 1855 and in later years were diagnosed in almost every bone in the body. Concerning the individual soldier or sportsman, contributing factors are divided into internal and external factors, which are not always well defined or fully understood. Female gender is specifically at risk, which is far higher than that of male gender, both in military conditions and in sport. Diagnosis is based on clinical assessment and on imaging modalities, and though X-rays, bone scan and CT are widely used, MRI is today accepted as the more safe and accurate diagnostic tool. Treatment is essentially conservative, though surgical intervention should be considered in specific location or situations. Prevention can be practiced successfully using a logical approach and available interventions.

Sesamoid Stress Fractures

Stress fractures of the sesamoid occur in a wide variety of sports. They occur more frequently in the medial sesamoid though they may occur in either lateral or medial bone. They have a strong tendency for nonunion. Diagnosis would include imaging modalities as x-ray; Bone scan, and CT, as differential diagnosis, is often difficult. Treatment would be initially conservative with an orthosis preventing Hallux dorsiflexion and relative rest for 3–6 weeks, or cast for a similar period. Surgical treatment may eventually be needed to perform a bone graft or advance to partial or full excision of the injured bone.

Reduced Anterior Cruciate Ligament Vascularization Is Associated With Chondral Knee Lesions

This study tested the association between periligamentous vascularization of the anterior cruciate ligament (ACL) and the presence of chondral knee lesions via retrospective analysis of prospectively collected data from 702 consecutive knee arthroscopic procedures. In each case, the ACL periligamentous envelope was documented as follows: (1) vascular, where the ACL was covered with blood vessels along its entire length; (2) centrally avascular, where the central third of the ACL was not covered but peripheral vascularized coverage was present; and (3) avascular, where there was no blood vessel coverage of the ACL. Inclusion criteria for the study were as follows: (1) age older than 18 years and (2) normal knee ligament laxity. Univariate analysis and multiple logistic regression were used to test the association between chondral lesions and each of the variables: sex, age, meniscus tear, decreased ACL vascularity, and concomitant chondral lesion in another knee compartment. The cohort included 516 knees. In the univariate analysis, all variables were associated with a chondral lesion, but only older age and decreased ACL vascularity were associated with chondral lesions in each knee compartment. In the regression model, only decreased ACL vascularity was associated with chondral lesions in each knee compartment. For avascular knees, the odds ratio was 2.84 for medial femoral condyle lesions (95% confidence interval, 1.73-4.68; P=.000), 2.44 for lateral femoral condyle lesions (95% confidence interval, 1.19-5.03; P=.015), and 2.48 for patellofemoral lesions (95% confidence interval, 1.55-3.97; P=.000). The findings showed that decreased ACL periligamentous vascularization is associated with chondral lesions of the femoral condyles in knees with preserved ACL laxity. [Orthopedics. 2016; 39(4):e737-e743.].

Tarsal Navicular Stress Fractures

The navicular stress fracture presents clinically as deep located pain, insidious on onset, occurring after physical activity. Diagnosis would be assisted by bone scan and CT, which would usually show a fracture in the sagittal plane involving the dorsal part of the bone. Differential diagnosis may include a bipartite navicular, an accessory navicular, osteochondritis dissecans, avascular necrosis, or Kienboeck’s disease. Treatment could be conservative using a weight bearing or preferably a non-weight bearing cast for 6 weeks, and occasionally surgical intervention. In either treatment, protocol results are often unsatisfactory and the athlete should be advised of this prior to initiating treatment.