Joseph Lowe

The Role of the Knee Brace in the Prevention of Anterior Knee Pain Syndrome

Our prospective study evaluates the use of a knee brace with a silicon patellar support ring as a method of preventing anterior knee pain from developing in young persons undergoing strenuous physical exercise. We studied 60 young athletes, who qualified for a strenu ous physical training course and who had not suffered from anterior knee pain previously. Twenty-seven sub jects were in the brace group and 33 were in the nonbrace control group. The incidence of anterior knee pain syndrome increased with the intensity of exertion as the study progressed; i.e., subjects ran 6 km in the 1 st week, gradually increasing each week up to 42 km/week at the 8th week. Yet, there was a significant reduction in the incidence of the syndrome at the end of the study in male athletes who had applied the braces before exercise sessions and in the brace group as a whole, compared with the control group. Prophylactic use of the brace, as described, did not reduce the ability of the athletes who wore braces to improve their physical fitness parameters in response to exercise. These data indicate that the use of a brace may be an effective way to prevent the development of anterior knee pain syndromes in persons participating in strenuous and intensive physical exercise.

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.

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.].

Migrating shrapnel: a rare cause of knee synovitis

UNLABELLED Shrapnel injuries in soft tissues often do not require surgical excision. Metals that remain embedded in the surrounding tissue are not thought to cause significant damage and the patients are generally asymptomatic. This case presentation describes a patient who sustained a penetrating shrapnel injury to his thigh, where the metal fragment was not removed. However, more than 20 years later, the patient developed knee synovitis. On X-ray the shrapnel was seen in the suprapatellar pouch. An arthroscopy was preformed and the shrapnel was removed with full healing of the patient. CONCLUSION although nonsurgical treatment of shrapnel in soft tissues is the treatment of choice in many cases, late migration is possible, causing distal symptoms and may require surgical excision.