Patellar clunk crepitation is a well-known complication following knee replacement surgery and is associated with posterior stabilized knee replacement surgery and surgical technique. Currently, patellar clunk or crepitation management following knee replacement surgery with preserved patella remains unclear. The purpose of this case report is to discuss whether patellar clunk or crepitation management should include debridement with patellar resurfacing or debridement alone. This case describes a patellar crepitation after knee replacement surgery with the preserved patella. The surgery went uneventfully using the standard medial parapatellar approach. However, the patient was still unsatisfied with the chronic left knee pain (>3 months) and crepitation that developed following the surgery, and the patient was diagnosed with patellar clunk and crepitation (PCC). A patellar resurfacing procedure was performed with a satisfactory clinical outcome. Replicating the original joint line level and placing the tibial component posteriorly play a pivotal role in preventing PCC. Debridement and patellar resurfacing procedures are recommended in this type of case to overcome the valgus knee alignment and the placement of the tibial component.
Calcific tendinitis is not an uncommon condition, although many patients may experience no symptoms, and calcification was found accidentally through imaging studies. Even so, in some cases, calcific tendinitis may arise with bothersome symptoms that can lead to diminished function of the affected joint. Calcific tendinitis is usually a self-limiting disease, where in its course, it may resolve on its own, may not need further interventions. In symptomatic cases, conservative treatment is the main option. More aggressive treatment such as percutaneous lavage may be needed in acute or unresponsive chronic pain. Surgical intervention may be needed to help resolve the symptoms, but it is rarely indicated.
AbstrakLatar belakang: Injeksi intra-artikular merupakan prosedur terapi osteoartritis (OA) yang memerlukan tingkat akurasi tinggi. Penelitian ini bertujuan menentukan rerata jarak antara kulit dan rongga intra-artikular yang dapat digunakan sebagai panduan untuk memilih panjang jarum ketika melakukan injeksi intra-artikular pada pasien osteoartritis lutut.Metode: Dua puluh satu MRI lutut diambil dari 16 pasien wanita dengan osteoartritis lutut. Panjang jarum yang dibutuhkan untuk mencapai ruang intra-artikular didapatkan melalui rekonstruksi gambaran garis lurus dari kulit ke ruang intraartikular. Uji t berpasangan dipakai untuk melihat perbedaan mean hasil pengukuran bagian kiri dengan bagian kanan, dengan tingkat kemaknaan nilai p < 0,05.Hasil: Hasil menunjukkan tempat masuk dari parapatela pada medial dan lateral lebih kranial dari garis mid-patellar. Pada portal medial, jarak terdekat antara kulit dan cairan intra-artikular adalah 27,81 mm ± 7,58 mm. Jarak rerata titik portal adalah 4,46 ± 2,16 mm kranial dari garis mid-patellar, dan 14,20 ± 4,45 mm posterior dari permukaan medial patela. Pada portal lateral, jarak terdekat dari kulit dan cairan intra-artikular adalah 16,84 ± 6,79 mm. Jarak rata-rata titik injeksi adalah 11,10 ± 5,95 mm kranial dari garis mid-patellar, dan 8,91 ± 3,83 mm posterior dari permukaan lateral patela.Kesimpulan: Studi MRI lutut menunjukkan bahwa rerata jarak antara kulit dan rongga intra-artikular lutut pada portal medial 27,81 ± 7,58 mm sedangkan pada portal lateral 16,84 ± 6,79 mm. Portal tersebut terletak kranial dari garis tengah patela dimana portal lateral lebih kranial dibandingkan medial, sehingga panjang jarum dan lokasi injeksi harus disesuaikan untuk meningkatkan akurasi injeksi intra-artikular. (Med J Indones. 2013;22:83-7) Abstract Background: Intra-articular injection is a common therapeutic procedure in osteoarthritis (OA) that need high accuracy.This study was aimed to measure the distance between parapatellar skin and intra-articular space as a guidance to choose the length of needle needed to perform intra-articular injection.Methods: Twenty one knees MRI were taken from 16 females with knee osteoarthritis. The length of the needle needed to reach intra-articular space was reconstructed by drawing straight line from skin to intra-articular fluid. Paired t-test was using to analyze the mean difference of measurement of left side compare with right side with significant indicator if p-value < 0.05. Results:The entry point on both medial and lateral parapatellar were more cranial than transverse mid-patellar line. On medial portal, the closest distance from skin to intra-articular space is 27.81 ± 7.58 mm. Mean point of entry is 4.46 ± 2.16 mm cranial to mid-patellar line, and 14.20 ± 4.45 mm posterior to the prominence of medial border of patella. On lateral portal, the closest distance from skin to intra-articular space is 16.84 ± 6.79 mm. Mean point of entry is 11.10 ± 5.94 mm cranial to mid-patellar line, and 8.91 ± 3.83 mm posterior to the prominence of lateral ...
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