Iranian Journal of Orthopedic Surgery

Abstract Abstract
Introduction: The patella has an important role in knee extension and shock absorption. This retrospective study assessed factors influencing surgical outcomes of patellar fractures over ten years at a single center.
Methods: A descriptive-correlational design was applied to patellar fracture cases treated at a university center over a decade. Patients were stratified into follow-ups of <5 or ≥5 years. Data included demographics, medical history, functional outcomes (Koo’s and WOMAC indices), pain, range of motion, and osteoarthritis severity (Kallgren/Lawrence classification). Census sampling was used. Analyses were performed in SPSS, with visualizations in Excel and GraphPad Prism.
Results: Among 53 patients (mean age 60.45 ± 16.00; 90.6% male), 62.3% had <5-year and 37.7% had ≥5-years follow-up. Follow-up duration did not correlate with outcomes. Treatment complications significantly correlated with degenerative arthritis. Functional scores were higher (p < 0.05) and pain scores lower (p < 0.05) in patients without complications.
Conclusion: Patellar fracture surgery yielded favorable mid-term outcomes, with complications linked to poorer function and higher pain. Reoperation rates were low, supporting surgical efficacy.

Abstract One of the common complications after total knee replacement surgery is pain and instability in the patellofemoral joint, which significantly impacts patients' quality of life. Statistics show that 8–12% of revision knee replacement surgeries are due to issues related to the patellofemoral joint. A critical concern during surgery is patellar maltracking, which is frequently observed. This condition occurs when the patella does not move along its proper path, leading to functional problems and pain. Various methods have been introduced to evaluate and correct patellar maltracking. This review article addresses different aspects of this issue, including: Definition of patellofemoral maltracking, factors affecting patellar tracking, intraoperative evaluation of patellar tracking, the concept of Perfect Patellar Tracking, Surgical methods to correct patellar maltracking. This article aims to provide a comprehensive perspective on the importance of proper correction of patellar tracking to improve surgical outcomes and patients’ satisfaction.

Abstract Background: Destruction of pain receptors around patella by electrocauterization is commonly used during total knee arthroplasty. Its effect on cartilage was the goal of this survey.Methods: In a clinical trail study, 20 rabbits, divided into two equality sized groups (experimental-control) and experimental group underwent surgery via medial parapatellar arthrotomy of the knee joint. Electrocauterization denervation at a depth of 1 mm and a distance of 3 mm from border of patella performed in the cases animals. No patellar denervation was done in the control group. Range of motion of joint, macroscopic evaluation using modified outerbridge score, and histopathologic scoring were assessed after twelve weeks. Results: Finally, nine cases and eight control animals were included due to death of three animals. Full range of motion was seen in all rabbits. Statistically significant difference in outerbridge score (p < /em>=.002), cellularity (p < /em>=.016), loss of matrix (p < /em>=.004), and clustering of chondrocytes (p < /em>=.008) were obtained.Conclusions: Cartilage destruction may be the result of electrocauterization of patellar rim. So, routine electrocauterization should be discouraged.

Abstract True duplication of the patella is extremely rare. We describe a case of duplication of the patella in an eight-year-old boy with the history of progressive deformity of his left knee.

Abstract Background: Change in the position of the patella in relation to the tibiofemoral joint (PB/PPB) is an important but often neglected complication of total knee arthroplasty. Such change may result in pain and decreased knee range of motion after surgery. The aim of this study is to measure the incidence of patella baja and pseudo-patella baja after total knee arthroplasty.  Methods: In a retrospective study, 60 patients (49 women, 11 men) who had knee arthroplasty between 1992 and 2002 at Akhtar teaching Hospital in Tehran were studied for patellar problem. At the time of the study, patients were at least one year and at most eleven years from their operation. All measurements were made by a single person. All the patients received posterior cruciate ligament retaining prosthesis knees through a medial parapatellar arthrotomy. The average age at the time of the study was 62.5 years and the average follow-up was 27.5 months. The Knee Society Scoring System was used to score the knees. Patients' radiographs were examined using the Insall Salvati and Blackburne Peel methods.     Results: Pseudo-patella baja was found in 15 (25%) patients while simultaneous baja and Pseudo-patella baja in 2 (3%) patients. While patella baja or Pseudo-patella baja were associated with more incidence of knee pain or limitation of motion, no relation was seen with final knee society scores.Conclusion: Patella baja or Pseudo-patella baja after knee arthroplasty may cause pain or limitation in knee range of motion. Attention to proper bone cuts and patellar tracking during surgery is suggested.

Abstract Ipsilateral fractures of patella and femur are occasionally seen in multiple trauma cases. In such cases duration of surgery, amount of bleeding and treatment modality have effect on rehabilitation of the patient and return of joint motion. In this article we present 2 patients, 18 and 52 years of age that were treated by internal fixation of femur and arthroscopically-assisted percutaneous fixation of patella.

Abstract Background: Recurrent patellar subluxation is clinically manifested by slippage of patella and positive apprehension test. Fulkerson osteotomy of tibial tubercle is a well-known surgery for this type of patellar malalignment. Little data is available for changes of apprehension test after Fulkerson operation. The goal of this survey was assessment of Fulkerson surgery for patellar instability and its effect on apprehension test.Methods: In a clinical trial study, 12 patients (9 females, 3 males) with mean age of 38.3 years (28-60 years) underwent tibial tubercle osteotomy for symptomatic patellar subluxation. Mean follow-up time was 10 months (6-18 months). The pre and post operative assessment of change in “apprehension test”, knee function and radiographic changes were respectively evaluated by visual analog scale (VAS) and with Bristol pain score, Fulkerson scoring and lateral pattelo-femoral angle or Merchant view.Results: The results in 8 patients were excellent or good, 3 fair and one poor. Eight cases believed the surgery had been effective. The Fulkerson score of 48.75 improved to 71.6, while Bristol pain score of 7.3 decreased to 4.1 and VAS for apprehension test of 7.5 decreased to 5.16. The “Apprehension test” did not change in 3 patients, and one case developed significant limitation of motion.Conclusions: Fulkerson tibial tubercle osteotomy in selected patients improves knee function and decreases pain in short-term, but does not improve patellar alignment.