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Query: UMLS:C0003864 (arthritis)
 69,039 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The incidence of chondromalacia of the pattella and degenerative arthritis of the knee is based on conjectural rather than objective autopsy observations. The notion that chondromalacia is a disabling, troublesome and almost universal disease affecting most older individuals is chiefly derived from clinical impressions of physicians who treat arthritis plus a few reports of European authors published some 50 years ago. The present investigation of 300 cadaver knees, whose average age was 70 years, demonstrates a much lower incidence of degenerative lesions of the articular cartilage than might be expected. There was minimal or no damage to the patella in 62% of the cases and an even lower incidence of 23% in the weight-bearing areas of the joint. Eighty-two per cent of the menisci were essentially normal, as were 96% of the cruciates. In patients in the U.S.A., articular cartilage of the knee resists the wear and tear of a normal lifespan remarkably well and infrequently undergoes progressive degradation.
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PMID:Gross pathological changes in the knee joint of the aged individual: a study of 300 cases. 67 45

The frequency, nature and tissue distribution of localized amyloid deposits in articular cartilage of young and elderly patients, with and without evidence of arthritic disease, was determined. Localized amyloid deposits in articular cartilage were not found in young patients with osteoarthritis of the hip or chondromalacia/osteoarthritis of the patella. However, in elderly patients with osteoarthritis of the hip, amyloid deposits were commonly found, although at no greater frequency than in elderly patients with no evidence of arthritis. Amyloid deposits were commonly present (in 95% of cases) in osteoarthritis of the knee joint and in the articular cartilage of all joints containing pyrophosphate deposits. Similar deposits of amyloid were also found in the articular cartilage of 40-45% of rheumatoid joints. These findings indicate that localized amyloid deposits in the articular cartilage are largely age-related and not due to specific pathological alterations affecting articular cartilage.
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PMID:Localized deposition of amyloid in articular cartilage. 173 25

To investigate the role of PGE2 in the development of bone and joint pathology in rat adjuvant arthritis, hindlimb paws were evaluated by calcified tissue histologic techniques focusing on histochemical visualization of cartilage and bone lesions. Case studies of hindlimbs from normal, adjuvant arthritic, and etodolac-treated arthritic rats demonstrated the association of disease severity with inflammation, chondromalacia, replacement of adipose bone marrow with a fibroid marrow, osteoclastic bone resorption, synovial cysts, and pannus formation within the joints. Extensive periosteal intramembranous bone formation was temporally associated with joint destruction and medullary tissue pathology. In vivo data were correlated with in vitro effects of inflammatory mediators (IL-1, PGE2) on bone resorption. Etodolac blocked bone explant PGE2 accumulation at concentrations of 10(-7) M and higher, and inhibited bone resorption at concentrations of 10(-5) M and higher. The data indicate that in vitro and in vivo models of bone metabolism are well correlated regarding prostaglandin synthesis; that the inflammatory mediator PGE2 is largely responsible for the involvement of skeletal tissue in the adjuvant arthritis model; and that the effects of etodolac are specifically mediated by its ability to inhibit PGE2 accumulation in vivo.
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PMID:Prostaglandins in inflammatory bone pathology: mechanism and therapeutic benefit of etodolac. 252 14

Fifty-nine fresh osteochondral allografts were consecutively transplanted into the knees of fifty-eight patients. The preoperative diagnoses were chondromalacia or degenerative arthritis of the patella, osteochondritis dissecans, a traumatic defect or osteonecrosis of the femoral condyle, a painful healed depressed fracture or traumatic defect of the tibial plateau, and unicompartmental traumatic arthritis of the knee. All of the patients had disabling pain after the failure of previous attempts to correct the problem surgically. Thirty-nine patients (forty knees) were available for follow-up at two to ten years after the allograft was transplanted. Nine transplants (22.5 per cent) failed and thirty-one (77.5 per cent) were successful. The result was rated excellent after thirteen of the successful transplants, good after fourteen, and fair after four. Transplantation of a fresh osteochondral allograft proved to be a satisfactory intermediate procedure for the treatment of the disabling conditions, except unicompartmental traumatic arthritis, in the young patients in this series. For the patients who had unicompartmental traumatic arthritis, the rate of success was only 30 per cent.
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PMID:Resurfacing of the knee with fresh osteochondral allograft. 265 99

Hip problems form about 10% (7.0 to 14.2%) of most published series of ballet injuries. The abnormally large range of external rotation needed for a perfect turnout is primarily due to soft tissue adaptation, more readily achieved in the young dancer. Insufficient range of motion at the hip throws considerable stress on the other lower limb segments. The snapping hip syndrome is common (43.8% of hip problems), with about one-third associated with pain. A tight iliotibial band may contribute to this, and balanced flexibility requires special attention to abductor stretching. The external clicking hip must be distinguished from the internal clicking hip, which is associated with the joint and psoas tendon. Stress fractures of the hip are easily overlooked and, if undetected, they may progress to a complete fracture. Knee problems account for 14.0 to 20% of complaints, and over 50% of these are peri- or retropatellar problems. This includes synovial plica, medial chondromalacia, lateral patella facet syndrome, subluxing patella and the fat pad syndrome. Specific diagnosis leads to specific treatment and the best chance of cure. Mild hyperextension of the knee may be aesthetically desirable, but excessive range leads to symptoms in the posterior capsule and poor control. Young dancers with a tendency to very lax joint structures should be identified early and protected from overstretching. In the author's series, meniscal lesions did not appear to be as big a problem as reported elsewhere in the literature. Ballerinas appear to have less leg strength than other groups of athletes, having only 77% of the weight-predicted norms. The introduction of strength training for male and female dancers may reduce injuries and improve balance, but it requires an intensive educational programme to dispense with the many myths. There are several references to the development of early arthritis but, while relatively common in the foot, symptomatic arthrosis in ballet dancers' hips and knees is not more prevalent than in the general population. The young age at which serious dance training begins, the long and rigorous hours of practice, the thin ballet slipper, dancing en pointe and unusual dietary regimens may all contribute to injury patterns in varying degrees.
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PMID:Prevention of hip and knee injuries in ballet dancers. 306 38

One hundred seven patients were examined who had undergone patellectomies between 1965 and 1983 (113 patellectomies). The mean follow-up time was 10.5 years (3-17.5 years) and the average age of the patients 42.6 years. There were three distinct groups of operative techniques: (1) the purse-string technique in 40 patellectomies; (2) the vastus medialis technique in 24 patellectomies; (3) other techniques in 49 patellectomies. The indications for patellectomy were: chondromalacia, 56 cases; comminuted patellar fractures, 32 cases; arthritis, 17 cases; recurrent patellar dislocations, 8 cases. The patients were examined for pain, rage of motion, giving way, swelling, quadriceps strength, activity and cosmetic results (interview, physical examination, Cybex and radiographic study). In the purse-string technique group, 81% of the cases ended up with good or excellent results; in the vastus medialis group there were 79% and in the third group only 73% good or excellent results. Among the patellectomies for comminuted fractures, 75% had excellent results. The clinical outcome of patelletomy for arthritis is fair, for recurrent dislocation favorable, and for chondromalacia variable and not predictable.
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PMID:[Patellectomy as a salvage operation]. 330 92

The authors report 19 operations according to the Maquet technique for patellofemoral arthritis or chondromalacia between 1977 and 1984. The same procedure and technique were used in all cases but the results were better in chondromalacia which were good in 64% of the cases compared with 38% in arthritis. After discussing the problems of clinical and radiographic evaluation, the authors conclude that after a long period of rehabilitation satisfactory results are obtained in chondromalacia, while only limited success is achieved in arthritis.
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PMID:Tibial tubercle advancement by the Maquet technique for patellofemoral arthritis or chondromalacia. 331 55

Frequently, meniscal pathology accompanies degenerative changes affecting the articular surface of the knee. The attritional changes in the meniscus lead to fragmentation of the meniscus and a variety of tears, usually of the posterior horn of the medial meniscus. A prospective study of the results of arthroscopic partial meniscectomy in the presence of at least Outerbridge Grade III chondromalacia of the accompanying joint surface was performed between 1980 and 1984. Eighty-seven knees in 84 patients were studied. The mean age was 62 (29-84) years. The right knee was involved in 44 patients, and 47 were men. Preoperative radiographs demonstrated osteoarthritis in 53 patients. The medial meniscus was involved in 82, while the lateral meniscus was affected in nine knees. Four knees had involvement of both menisci. In 72 knees, the most frequent lesion was a tear of the posterior horn of the medial meniscus. The most frequent configuration of the tears was a flap in 42. The morbidity was small with the use of ambulatory aids being 10 +/- 13 (mean +/- SD) days. Subsequent surgery was performed on six knees consisting of two total knee arthroplasties, two upper-tibial osteotomies, one repeat arthroscopic meniscectomy, and one popliteal cyst excision. Two patients had poor results related to progression of their arthritis and one developed osteonecrosis. Five patients were unchanged from their preoperative status. Subchondral sclerosis or osteophytes on the preoperative radiographs correlated with 72% compared to 90% satisfactory results in the absence of these findings (p less than 0.03). Complications consisted of superficial thrombophlebitis in three, hemarthrosis in one, and superficial infection in one patient.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Arthroscopic management of degenerative meniscus tears in patients with degenerative arthritis. 384 40

We studied the results in forty-seven knees in thirty-seven patients - ten male and twenty-seven female - who had recurrent dislocation of the patella and were treated by a modified Roux-Goldthwait procedure (lateral retinacular release, medial transfer of the lateral patellar tendon without advancement, plication of the medial retinaculum, and advancement of the vastus medialis). Ten of the female patients had bilateral dislocation. The results were analyzed after follow-ups ranging from 3.0 to 16.3 years (average, 5.8 years). The study confirmed that a tangential radiograph of the patellofemoral joint, made with the knee in 20 degrees of flexion, is reliable in determining patellar displacement. The results were excellent in twelve knees, good in thirty-one, fair in one, and poor in three. The fair and poor ratings were due to pain caused by severe chondromalacia patellae. The patient with a fair result had had recurrent dislocations after the Roux-Goldthwait procedure due to a very lax synovial and capsular sac. Reoperation with tightening of the sac medially and laterally eliminated hypermobility of the patella in this patient and established straight patellar tracking. There was one serious complication, a large subcutaneous hematoma with necrosis of a skin flap. The patients with mild chondromalacia improved and showed no progressive patellofemoral arthritis after simple realignment, while those with severe chondromalacia were not improved by shaving, drilling, and realignment. Preliminary results indicated that a modified Maquet procedure, in addition to realignment, may be indicated for patients with severe chondromalacia. This study demonstrated that the modified Roux-Goldthwait procedure, without advancement of the tibial attachment of the patellar ligament, can stabilize the patella without increasing patellofemoral compression. The procedure does not relieve the symptoms of severe chondromalacia of the patella but realignment is the first step in treatment of any form of patellofemoral arthrosis.
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PMID:Recurrent dislocation of the patella treated by the modified Roux-Goldthwait procedure. A prospective study of forty-seven knees. 403 Aug 42

In an effort to evaluate the use of a transverse incision and a relatively small elevation (1.25 centimeters) of the tendinous insertion of the patellar ligament into the tibial tubercle, 184 patients were treated with a modified procedure using the Maquet principle. The indications for the procedure were patellofemoral pain and loss of active function. The patients were placed in five groups based on the cause of their symptoms: chondromalacia, patellofemoral arthritis, patellar dislocation, previous trauma, and previous patellectomy. The results were evaluated on the basis of whether or not primary wound-healing was satisfactory and whether or not the patient resumed the ability to ascend stairs and could engage in previously lost athletic function, Eighty-five per cent of the patients achieved these goals of treatment. The disadvantages of the procedure appeared to be the slow return of full function (averaging six months), prominence of the area of the tibial tubercle, and persistence of crepitus on patellofemoral motion.
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PMID:Elevation of the insertion of the patellar ligament for patellofemoral pain. 708 3


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