We reviewed 13 patients with end stage jumper's knee, 10 with patellar tendon ruptures, and 3 with ruptures of the quadriceps tendon to evaluate our long-term results in treating these tendon ruptures in an athletic population. The focus was on the natural history, the time until return, and the level of return, to athletic activity. Jumper's knee affected all patients to a varying degree prior to rupture. Basketball was the most common sport involved. At followup, averaging 4 1/2 years, patients underwent functional and clinical, as well as Cybex and roentgenographic, evaluations. Results indicated patellar tendon ruptures, where the ruptures are complete, have a more favorable prognosis than those of the quadriceps tendon which are incomplete. All of the latter patients continued to have quadriceps tendinitis following repair. In both groups, the poor results were obtained in patients with chondromalacia and/or patella alta. Cybex testing yielded results of greater than 100% strength in three patients with patellar tendon ruptures, but no patient with quadriceps rupture had comparable test results. There was no apparent relationship between ruptures and cortisone injections. Patellar and quadriceps tendon ruptures from indirect injury in athletes represent the end stage of jumper's knee and result from repetitive microtrauma. Excellent function usually follows repair of patellar tendon ruptures when surgery is performed early and care is taken to restore normal patellar tendon length. Results of quadriceps ruptures are less satisfactory since these ruptures are usually incomplete and all degenerative tissue may not be involved in the healing response.

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IntroductionMost elderly hip fractures are the result of a ground level fall. Defining high risk falls and fracture mechanisms are important to develop successful hip fracture prevention programs. This case series presents a previously unreported diagnostic sign and for the first time documents a hip fracture mechanism for a knee impact injury from a ground level fall in two elderly patients.Case presentationCase 1 was a 65-year-old Caucasian woman who fell forward with initial contact to her left knee, sustaining an impacted femoral neck fracture of her ipsilateral left hip. Case 2 was a 92-year-old Caucasian woman who fell bending forward, impacting her left knee and sustaining a comminuted intertrochanteric fracture of her ipsilateral left hip. The fractures occurred as a result of unprotected ground level falls in a forward direction with initial impact to the knee. The knee contusions were located near Gerdy’s tubercle and appear characteristic of a direct impact injury.ConclusionThe physical finding of a small localized site of impact and/or contusion in the anterior aspect of the knee in both of these patients with radiographic evidence of an ipsilateral hip fracture would strongly suggest that a knee impact injury can transmit enough energy to the proximal femur by axial loading to result in the hip fracture. The physical finding described is a reliable indicator of this hip fracture mechanism.

Introduction: Localized pigmented villonodular synovitis (LPVNS) (LPVNS) of the shoulder joint is an extremely rare disorder. It is most often associated with a nonspecific clinical presentation resulting in both delays in diagnosis and in treatment. The growth characteristics and natural history of LPVNS are poorly understood.Case report: This article describes an unusual case of a 53 -year-old woman whose treatment delay allowed us to more closely study the natural history of LPVNS. Our patient first presented with poorly localized posterior shoulder pain. Her symptoms slowly progressed. An initial MRI study more than 2 years after the onset of symptoms demonstrated a soft tissue tumor in a subscapularis recess location. Treatment with corticosteroid injections and physical therapy failed. A second MRI study, nearly 2 years later, found no change in signal characteristics, location, and size measurements of the soft tissue tumor, all important distinctions. Arthroscopic resection produced a definitive diagnosis of an intra-articular localized pigmented villonodular synovitis of the shoulder. At her final 18 mos. follow-up the patient demonstrated pain relief and no clinical recurrence of disease. Conclusion:To our knowledge, this is the first case report of a nodular appearing LPVNS arising from an intraarticular shoulder location in a patient with no prior shoulder surgery or trauma. It is also unique in that the tumor originated in a subscapularis recess location. This case documents for the first time a LPVNS with limited growth potential and emphasizes the importance of careful direct study and clinical correlation of MRI findings to avoid delays in treatment.

Improperly executed karate thrusts result in an unusually high incidence of this uncommon injury.