Periosteal Sleeve Avulsion Fracture of the Quadriceps Tendon

Sleeve fractures at the superior pole of the patella have been previously described in the literature. We present the case of a 15-year-old girl who sustained a patellar sleeve avulsion of the quadriceps tendon 1 month following patellar dislocation without surgical treatment. Open repair of quadriceps tendon was performed with subsequent union. Arthrofibrosis of the knee was noted; two subsequent manipulations and adhesiolysis were performed. At 18-month postinjury, normal motion and strength were present. Special attention to postoperative recovery of range of motion is imperative for good clinical outcome after periosteal sleeve avulsion fractures of the patella.

Novel Operation of Snapping Biceps Femoris Tendon

Snapping biceps femoris tendon (BFT) over the fibular head is an uncommon cause of lateral knee pain. This study reports a case of nontraumatic painful snapping of the BFT due to a prominent fibular head that was persistent intraoperatively after fibular head resection. We describe a novel surgical technique of release of the anterior arm of the biceps tendon followed by soft tissue tenodesis to the popliteofibular ligament, as opposed to the remaining fibular head, to prevent iatrogenic fracture.

“Baker's Cyst”–Induced Above-Knee Amputation

We report a 65-year-old man who presented with a necrotic fifth toe, incipient phlegmon and hypesthesia of the right foot, a swollen lower leg, and a palpable popliteal mass. An occlusion of the popliteal artery secondary to a Baker's cyst was found to have caused protracted ischemia and the abovementioned symptoms. Despite several endovascular and open-surgery procedures to restore perfusion of the limb, the patient eventually had to undergo above-knee amputation.It might be speculated whether earlier surgery would have preserved the patient's limb. Whereas the traditional procedure of open resection of the Baker's cyst has been associated with high recurrence rates, the condition can be treated effectively and safely today by means of arthroscopic surgery. We believe that arthroscopic interventions should at least be performed in the following instances: (1) in patients with recurrent symptoms of a Baker's cyst after previous treatment of the intra-articular pathology and previous aspiration of the cyst and (2) in patients with incipient sequelae that indicate relevant compression of neurovascular structures of the popliteal fossa (pseudothrombophlebitis, intermittent claudication, neuropathy).

Medial Patellofemoral Ligament Reconstruction Following Total Knee Arthroplasty: A Case Report

Patella instability is a rare but serious complication seen following total knee arthroplasty. The typical cause of patella instability in this setting is malpositioned components. While the mainstay of treatment is recognizing and correcting any malpositioning of the components, continued instability can remain and be a difficult problem to treat. Medial patellofemoral ligament (MPFL) reconstruction can be a helpful adjunct for the surgeon when faced with cases of continued instability. In this case report, we describe the successful use of MPFL reconstruction in conjunction with component revision for the treatment of postarthroplasty patella instability.