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Examination of Knee Joint in a Child
Published in Nirmal Raj Gopinathan, Clinical Orthopedic Examination of a Child, 2021
The infrapatellar pad of fat forms a thin layer beneath and on either side of the patellar tendon. Surgery or infection in the region may restrict the mobility of this fat pad, which may get pinched during knee extension and become painful. The site of insertion of the patellar tendon and tibial tuberosity is also palpated for any tender lumps (e.g., Osgood–Schlatter’s disease).
Knee Pain
Published in Benjamin Apichai, Chinese Medicine for Lower Body Pain, 2021
The patella tendon is located inferior to the patella. The patellar tendon originates in the patellar apex and runs inferiorly to attach to the tibial tuberosity.49 Technically, the patellar tendon is not supposed to be called a tendon, because a tendon is connective tissue that connects a muscle to a bone, but the patellar tendon connects a bone (patellar) to a bone (tibial tuberosity). A ligament connects bones, so the patellar tendon should be called the patellar ligament.
Physiologically Based Treatments
Published in Verna Wright, Eric L. Radin, Mechanics of Human Joints, 2020
A 43-year-old male patient complained of a painful knee. The patella was high and slightly subluxated (Fig. 42A). A subchondral dome-shaped sclerosis inside the patella indicated exaggerated articular pressure. A 3 cm anterior and slightly medial displacement of the tibial tuberosity was carried out. Pain disappeared immediately, and the range of movement was preserved. At the 14 year follow-up, the clinical result remained excellent. An x-ray showed a sclerosis of even width throughout had replaced the dome-shaped subchondral sclerosis. This indicates an evenly distributed joint pressure (Fig. 42B).
Tibial Intraosseous Insertion in Pediatric Emergency Care: A Review Based upon Postmortem Computed Tomography
Published in Prehospital Emergency Care, 2020
H. Theodore Harcke, Riley N. Curtin, M. Patricia Harty, Sharon W. Gould, Jennie Vershvovsky, Gary L. Collins, Stephen Murphy
Intraosseous devices are an alternative to traditional venous access for rapid fluid delivery. During emergency situations, vascular access can be difficult to obtain for many reasons. Because bone marrow is highly vascularized, IO offers a quick, readily available method to deliver fluids when placed correctly in the intramedullary space (7,11–14). While several sites can be used, the most common preferred location for an IO placement in children is the proximal tibia (2–4,15,16). Recommended tibial placement in adults is into the flat medial portion of the proximal tibia, 2 cm below the anterior tibial tuberosity (5). In children, however, a recommended location is not as easily determined because of smaller and more variable bone size as well as nonossified epiphyses and anterior tibial tuberosities. The recommended insertion site is approximately 1 cm medial to the tibial tuberosity, or just inferior to the patella (approximately 1 cm or one finger width) and slightly medial (approximately 1 cm or one finger width), along the flat aspect of the tibia (10).
Treatment of Patellar Lower Pole Fracture with Modified Titanium Cable Tension Band Plus Patellar Tibial Tunnel Steel “8” Reduction Band
Published in Journal of Investigative Surgery, 2019
Jiaming Li, Decheng Wang, Zhiliang He, Hao Shi
Currently, treatment of comminuted fracture fragments relies on fixed suturation of the patellar ligament on the patella distal. However, this causes the long axis of patella shorter, which affects knee extensor function. Here we report a new titanium cable tension band fixation based on wire in the patella and the tibial tuberosity bone tunnel reinforcement body that tied to a “8” tension belt, which successfully lowered the patella fracture fixation and the implementation of the reduction, allowing patients to perform early functional exercises. This result has a positive significance for the smooth recovery of the articular surface of the patella and recovery of knee extensor device function.1 The postoperative follow-up showed good outcome and satisfactory functional recovery of knees.2
The torsion of tibial tuberosity, a new factor of patellar instability
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2019
V. Chassaing, N. Courilleau, J. L. Blin, F. Khiami, J. M. Zeitoun, E. Decrette, T. Vendeuvre, C. Brèque
Every year in France, 18500 patients suffer from patellar instability. 17% of these are recurrences. Patellar instability is caused by excessive lateralization of the tibial tuberosity (TT) measured by a distance between femoral trochlear groove and the tibial tuberosity (> 17 mm +/– 4), dysplasia of the femoral trochlea, patella height anomaly (alta) and a rupture of the medial patellofemoral ligament (MPFL). In case of excessive lateralization, surgical management may be considered. It consists of medializing the anterior tibial tuberosity (TTA) to bring the patella to a stable position on the femoral trochlea. Recently, clinical observations based on MRI, have suggested that the inclination of the TT was also an aggravating factor in patellar instability. The purpose of our study was to quantify the effect of this new factor in patellar instability and to observe the effect of its correction on patellar dislocation. This surgical strategy has not yet been described in the literature, only the risk factors have been analyzed, by Chassaing.