heterotopic ossification of patellar tendon

In children, avulsion fractures of the patella are observed more frequently than ruptures of the quadriceps tendon. In cases of suspected lesions of the quadriceps tendon, conventional x-ray imaging and ultrasound comparison of both patellae is recommended. Arthroscopy is helpful for diagnosing concomitant intra-articular knee lesions and permits evacuation of the hemarthrosis.

We present a simultaneous patella tendon avulsion fracture from both sides of its attachment in an ectopic ossified patellar tendon. Medially two thirds of the patellar tendon was detached from the inferior patella, and laterally one third of that from anterior tibial tuberosity with the patellar tendon split. Osteosynthesis was used to restore the extensor mechanism of the knee. The result at 46 months was good, even though there were some remaining ectopic ossifications in the patellar tendon.

Reconstruction of the anterior cruciate ligament (ACL) is currently a common procedure. We report a case of ACL reconstruction using an autologous patellar tendon graft, where great infrapatellar heterotopic ossification occurred post-operatively. We found no similar cases in the literature. We discuss about the probable origin.

We reviewed the records of 107 consecutive patients who had undergone surgery for disruption of the knee extensor mechanism to test whether an association existed between rupture of the quadriceps tendon and the presence of a patellar spur. The available standard pre-operative lateral radiographs were examined to see if a patellar spur was an indicator for rupture of the quadriceps tendon in this group of patients. Of the 107 patients, 12 underwent repair of a ruptured patellar tendon, 59 had an open reduction and internal fixation of a patellar fracture and 36 repair of a ruptured quadriceps tendon...

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No abstract text is available yet for this article.

The evolution of osteoarthritis (OA) was compared in male and female STR/ORT mice and in male CBA mice with particular emphasis on the changes in para-articular structures which occur before the classical degenerative phenomena in the articular cartilage of the knee. In male STR but not female STR mice or male CBA mice, chondro-osseous metaplasia was found in the tendinous structures which surround the joint and in the major ligamentous entheses such as the patellar ligament. This change was detectable from the age of three months...

Prospectively, 119 patients were pursued clinically and by follow-up-arthroscopy for the occurrence of a "cyclops syndrome" after ACL reconstruction with a patellar tendon autograft, augmented by LAD. Twenty-one patients showed nodular formations. Ten of these (group 1) developed early clinical evidence of a "cyclops syndrome" with a mean extension deficit of 19 degrees before follow-up-arthroscopy, on average 5.9 months after the index operation. The nodular formations found and excised during débridement had a hard consistency...

Two men, aged 21 and 50 years, were seen with ossification of the patellar tendon after injury to the knee in adolescence. They complained of pain and had patella alta. Large bony masses were excised from below the affected patellae. The patellar tendon was then reconstructed using a Leeds-Keio ligament. The results at six and ten years, respectively, were good, with neither patient having pain or an extension lag.

Patellar tendinitis is a condition that occurs in patients who are involved in repetitive use of the extension mechanism. The most common symptoms are pain at the inferior pole of the patella, and radiographic changes may also occur. This case report demonstrates an extreme example of elongation of the inferior pole of the patellar tendon. The ossification caused the patient pain, which was resolved with surgical removal of the bone.

Heterotopic ossification (HO) of the patellar tendon following intramedullary nailing of the tibia for fracture, which has not been previously documented, occurred in 2 of 31 patients reviewed who had adequate follow-up after this procedure. One suffered grade IV HO and the other grade II HO using a modification of the Brooker classification. The patient with grade IV HO had serious disability from pain and decreased range of motion. Risk factors previously suggested were associated with the formation of heterotopic bone in our two patients...

Two patients with sleeve fractures of the patella and tibial tuberosity respectively are described. Our two cases demonstrate that the diagnosis can be difficult; patella alta and ossification in the patellar tendon are complications of conservative treatment. Early diagnosis and operative reduction and fixation are mandatory.

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First described by A. Trillat, the double patella is an uncommon clinical feature following repetitive injuries of the extensor mechanism of the knee. The first injury is a tendo-periosteal avulsion of the suprapatellar or, less frequently, infrapatellar tendon from the corresponding patellar pole. Often these avulsions are misdiagnosed and therefore treated only with a cast or no immobilization at all. Subsequent giving-way episodes lead to extensive ossification which is adjacent to or separated from the patella...

Ossification in the quadriceps mechanism after total patellectomy is a common finding. The relationship of knee symptoms and the extent of postpatellectomy ossifications is debatable. Reported is the case of a 74-year-old woman with extensive ossification in the patellar tendon following patellectomy and knee arthroplasty. The ossification was associated with only minimal discomfort. Functional results following patellectomy were not affected in patients previously observed by the authors.

In the total examination of the knee, degenerative changes and ossification in the quadriceps tendon easily recognized on the lateral roentgenogram may cause confusion in diagnosis when seen on the axial view. Vertical ridging of the osteophytes at the patellar insertion of the quadriceps tendon can resemble dentate structure ("tooth" sign). Two hundred and fifty examinations of the knee in different age groups were reviewed and several anatomical sections of the quadriceps-patella insertion were studied. The "tooth" sign represents the relief of severe osteophyte formation in the bundle of the quadriceps tendon at its insertion into the patella...