Diagnosis and treatment of stress fracture of the patella in atheletes

Orava, Sakari; Taimela, Simo; Kvist, M; Karpakka, Jarmo; Hulkko, A; Kujala, Urho M.

doi:10.1007/bf01567964

Cited by 33 publications

(23 citation statements)

References 30 publications

(58 reference statements)

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“…Nuclear scintigraphy could be used after the first patellar fracture, and should show an increased activity in the unfractured bone (Orava and others 1996). In the cats with bilateral fractures there was a median gap of three months between fractures, and owners need to be warned of the likelihood of this occurring, especially when there is radiographic evidence of sclerosis in the unfractured patella.…”

Section: Discussionmentioning

confidence: 99%

Survey of 52 fractures of the patella in 34 cats

Langley‐Hobbs

2009

Veterinary Record

102

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Stress fractures of the patella were diagnosed in 34 cats with a mean age of two years and five months. Eighteen of the cats had bilateral fractures with a median interval of three months between fractures. All the fractures were transverse and occurred in the proximal aspect or base of the patella with no evidence of trauma. In 43 of the patellae there was radiographic evidence of sclerosis. Repairs with a pin and tension band in 18 cats resulted in a further fracture or failure of fixation in 86 per cent of the cases that were followed up. Ten of the cats had suffered fractures of other bones at different times to the patellae fractures. In the majority of the cats the fracture formed a functional non-union but some cats remained stiff and lame.

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Section: Discussionmentioning

confidence: 99%

Survey of 52 fractures of the patella in 34 cats

Langley‐Hobbs

2009

Veterinary Record

102

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“…Furthermore, stress fractures that are linked to altered stress patterns can occur in non‐osteoporotic bones in young adults active in sport. These include navicular fractures and stress fractures of the patella (Orava et al. 1996; Saxena et al.…”

Section: Discussionmentioning

confidence: 99%

“…These include navicular fractures and stress fractures of the patella (Orava et al 1996;Saxena et al 2001).…”

Section: Discussionmentioning

confidence: 99%

Regional variations in human patellar trabecular architecture and the structure of the proximal patellar tendon enthesis

et al. 2006

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Proximal patellar tendinopathy occurs as an overuse injury in sport and is also characteristic of ankylosing spondylitis patients. It particularly affects the posteromedial part of the patellar tendon enthesis, although the reason for this is unclear. We investigated whether there are regional differences in the trabecular architecture of the patella or in the histology of the patellar tendon enthesis that could suggest unequal force transmission from bone to tendon. Trabecular architecture was analysed from X-rays taken with a Faxitron radiography system of the patellae of dissecting room cadavers and in magnetic resonance images of the knees of living volunteers. Structural and fractal analyses were performed on the Faxitron digital images using MatLab software. Regional differences at the enthesis in the thickness of the uncalcified fibrocartilage and the subchondral plate were evaluated histologically in cadaveric material. The radiological studies showed that the quantity of bone and the apparent trabecular thickness in the patella were greatest medially, and that in the lateral part of the patella there were fewer trabeculae which were orientated either antero-posteriorly or superiorly inferiorly. The histological study showed that the uncalcified fibrocartilage was most prominent medially and that the subchondral plate was thinner laterally. Overall, the results indicate that mechanical stress at the proximal patellar tendon enthesis is asymmetrically distributed and greater on the medial than on the lateral side. Thus, we suggest that the functional anatomy of the knee is closely related to regional variations in force transmission, which in turn relates to the posteromedial site of pathology in proximal patellar tendinopathy.

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“…They are reported primarily in young athletes [41]. Orava et al [42] reported a 3:2 female‐to‐male ratio (5 cases), average age of 21.2 years, and average symptom duration of 4 months before diagnosis. As the quadriceps and patellar tendons attach to the superior and inferior poles of the anterior patella, respectively, high tensile forces occur during flexion and impact activities, especially running and jumping [43,44].…”

Section: High‐risk Stress Fracturesmentioning

confidence: 99%

High‐Risk Stress Fractures: Diagnosis and Management

McInnis

Ramey

2016

PM&R

103

101

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Stress fractures are common overuse injuries in athletes. They occur during periods of increased training without adequate rest, disrupting normal bone reparative mechanisms. There are a host of intrinsic and extrinsic factors, including biochemical and biomechanical, that put athletes at risk. In most stress fractures, the diagnosis is primarily clinical, with imaging indicated at times, and management focused on symptom-free relative rest with advancement of activity as tolerated. Overall, stress fractures in athletes have an excellent prognosis for return to sport, with little risk of complication. There is a subset of injuries that have a greater risk of fracture progression, delayed healing, and nonunion and are generally more challenging to treat with nonoperative care. Specific locations of high-risk stress fracture include the femoral neck (tension side), patella, anterior tibia, medial malleolus, talus, tarsal navicular, proximal fifth metatarsal, and great toe sesamoids. These sites share a characteristic region of high tensile load and low blood flow. High-risk stress fractures require a more aggressive approach to evaluation, with imaging often necessary, to confirm early and accurate diagnosis and initiate immediate treatment. Treatment consists of nonweight-bearing immobilization, often with a prolonged period away from sport, and a more methodic and careful reintroduction to athletic activity. These stress fractures may require surgical intervention. A high index of suspicion is essential to avoid delayed diagnosis and optimize outcomes in this subset of stress fractures.

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Diagnosis and treatment of stress fracture of the patella in atheletes

Cited by 33 publications

References 30 publications

Survey of 52 fractures of the patella in 34 cats

Survey of 52 fractures of the patella in 34 cats

Regional variations in human patellar trabecular architecture and the structure of the proximal patellar tendon enthesis

High‐Risk Stress Fractures: Diagnosis and Management

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