Focal lesions of the patella

Hedayati, Bijan; Saifuddin, Asif

doi:10.1007/s00256-009-0699-5

Cited by 9 publications

(5 citation statements)

References 44 publications

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“…Patellofemoral joint disorders represent a common cause of anterior knee pain [1, 2]. As the largest sesamoid bone of the body, the patella functions to magnify the moment arm of the patellar tendon; thereby increasing the effectiveness of extensor musculature [3].…”

Section: Introductionmentioning

confidence: 99%

Association of trochlear dysplasia with degenerative abnormalities in the knee: data from the Osteoarthritis Initiative

et al. 2013

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Objective To evaluate trochlear morphology as a potential risk factor for patellofemoral osteoarthritis, determined by morphological and quantitative measurements of cartilage degeneration using 3T magnetic resonance imaging (MRI) of the knee. Materials and Methods MR images of right knees of 304 randomly selected subjects, aged 45–60 years, from the Osteoarthritis Initiative (OAI) progression cohort were screened for trochlear dysplasia, defined by an abnormal trochlear depth. Out of 304 subjects, n=85 demonstrated a shallow trochlea (depth ≤3mm; 28%). In these, and also in a random sample of controls with normal trochlear depth (n=50), the facetal ratio and the sulcus angle were calculated and knee structural abnormalities were assessed by using a modified Whole-Organ-MR-Imaging Score (WORMS). Cartilage segmentation was performed and T2 relaxation times and patellar cartilage volume were determined. ANOVA and multivariate regression models were used for statistical analysis of the association of MRI structural measures and trochlear morphology. Results Knees with a shallow trochlea showed higher patellofemoral degeneration (WORMS mean ±standard deviation, 11.2±0.5 versus 5.7±0.6; Multivariate regression, P<0.001) and lower patellar cartilage volume than controls (900±664mm3 versus 1671±671mm3; P<0.001). Knees with an abnormal medial-to-lateral facetal ratio (<0.4) showed increased patellofemoral WORMS scores (12.3±0.9 versus 8.3±0.5; P<0.001). Knees with an abnormal sulcus angle (>170°) also showed increased WORMS scores (12.2±1.1 versus 8.6±0.6; P=0.003). T2 values at the patella were significantly lower in the dysplasia group with a shallow trochlea. However, significance was lost after adjustment for cartilage volume (P=0.673). Conclusion Trochlear dysplasia, defined by a shallow trochlea, was associated with higher WORMS scores and lower cartilage volume, indicating more advanced osteoarthritis at the patellofemoral joint.

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Section: Introductionmentioning

confidence: 99%

Association of trochlear dysplasia with degenerative abnormalities in the knee: data from the Osteoarthritis Initiative

et al. 2013

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“…8 Its characteristic location in the superolateral aspect of the patella allows for accurate diagnosis. The etiology of the patellar dorsal defect is not defi nitely known, although proposed etiologies include incomplete fusion of multiple patellar ossifi cation centers in the general spectrum of multipartite and bipartite patellae, or perhaps an acquired lesion owing to stress-related traction from the vastus lateralis muscle.…”

Section: Mimicker: Femoral Condyle Secondary Ossifi Cationmentioning

confidence: 99%

Osteochondritis Dissecans

2013

Contemporary Diagnostic Radiology

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After participating in this activity, the diagnostic radiologist should be better able to diagnose the various imaging appearances of osteochondritis dissecans and to identify differential diagnoses.Osteochondritis dissecans (OCD) is a common cause of joint pain in skeletally immature and young adult patients. Various pathologic conditions can mimic OCD in large and small joints. This article is a review of the pathophysiology, common imaging fi ndings, and treatment options of OCD. Several common mimickers of OCD, organized by joint, also are presented. PathophysiologyThe exact etiology of osteochondritis dissecans (OCD) is unclear, although several proposed pathologic mechanisms have been described in the literature. OCD is subdivided into juvenile and adult forms.The juvenile form of OCD occurs in skeletally immature patients. These patients are typically 5 to 15 years of age, and their physes are open. Several proposed etiologies for juvenile OCD include genetic predisposition, acute trauma, ischemia, and ossifi cation center abnormalities. 1 The authors favor the pathophysiologic process in which osteochondritis represents a normal variant ossifi cation center adjacent to a region of abnormal physis. Repetitive microtrauma may injure the articular cartilage, subchondral bone plate, and subchondral bone about the variant ossifi cation center. Given the adjacent region of abnormal physis, there is altered ability to lay down normal reparative bone.The adult form of OCD occurs in the skeletally mature patients. The physes are closed in these patients. Adult OCD may form de novo or result from the sequelae of juvenile OCD. 2 Imaging FindingsA report of the imaging fi ndings of OCD should contain a description of the integrity of the articular cartilage, subchondral bone plate, and subjacent subchondral bone. The stability of OCD is an important factor infl uencing treatment options and management. Stable OCD may be treated conservatively, whereas unstable OCD requires surgical intervention. The majority of adult OCD is unstable, whereas approximately 50% of juvenile OCD is stable and will heal with conservative therapy. V o l u m e 3 6 • N u m b e r 2 4 N o v e m b e r 3 0 , 2 0 1 3Lippincott Continuing Medical Education Institute, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Lippincott Continuing Medical Education Institute, Inc., designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity. To earn CME credit, you must read the CME article and complete the quiz and evaluation on the enclosed answer form, answering at least seven of the 10 quiz questions correctly. This continuing medical education activity expires on January

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“…Dear Editors, Many books and articles, including the recent review article in Skeletal Radiology [1], have referred to, and even purportedly shown [2], periosteum of the patella and periosteal reaction of the patella. However, the nature of growth of the patella (as well as carpal bones and tarsal bones, for example) implies that any fibers adjacent to the patella and similar bones are not periosteum.…”

mentioning

confidence: 99%

“…Hedayati and Saifuddin [1] refer to the patellar sleeve fracture as rapid muscle contraction resulting in a "sleeve" of periosteum being pulled off the patella. However, The magnetic resonance (MR) imaging study by Bates et al [4] clearly demonstrates in three children that the sleeve is of cartilage, not periosteum.…”

mentioning

confidence: 99%