- Email: [email protected]
Ossification of infrapatellar bursae and fat pad
NEW SERIES VOL. LI, No.
+
RobiIIard-Ossification
orI; I’, the fat pad partiaIIy fiIIs the surfaces bet ween the condyIes of the femur and the hea d of the tibia. The posterior surfaceof the
FIG. 3. Knee joint at operation;
articuIar surface of femur; osseous tumor mass indicated by pointer.
FIG. 5. Microphotograph
American
Journal
of Surgery
443
reIated to the fat pad The superficia1 I.>ursa the is situated inferiorIy, just above tuberosity of the tibia. The deep bur -sa IS
FIG. 4. Osseous mass after mova1.
re-
of tumor showing bone trabeculae.
fat pad is attached to the anterior intercondyIoid eminence of the tibia by the ligamentum mucosum. The anterior surface is continuous with synovia1 fringes of the edges of the pateIIa, known as the Iigaments or plicae aIares. The infrapatelIar fat as a pressure reducing pad functions mechanism to the joint. The cavity of the joint is at its greatest capacity when the knee is flexed to 45 degrees, the fat pad pushing in to prevent a IocaI vacuum. When the knee is extended, the fat pad is puIIed forward free from opposing surfaces (Cravener). The infrapateIIar bursae are cIoseIy
situated between the posterior surface of the pateIIar ligament, and the proxima1 end of the tibia. Both bursae are anterior to the fat pad. CASE
REPORT
E. C. H., 34 year white female, was admitted to the hospital June 6, 1939. Two years before, she had injured her Ieft hand and knee in a faI1. Roentgenographic study at that time reveaIed a fracture of the distal phaIanx of the Ieft thumb and osteoarthritic changes in the joints of the hand. It was then noted that crepitus was present in both knee joints, but the knee was not x-rayed. The patient had since compIained of pain in the Ieft knee, and
American
444
Journal
of Surgery
Robillard-Ossification
was treated for osteoarthritis. In March, 1939 she feII again, and pain, tenderness, sweIIing, and immobihty of the left knee resulted, persisting to the date of admission to the hospita1.
SUMMARY
A case of ossification of the infrapatellar bursae and fat pad is reported in which good functiona resuIt was obtained foIIowing surgica1 excision. The Iesion may be Iooked upon as an osteoma. REFERENCES
FIG.
6.
Postoperative
roentgenogram joint.
of
knee
Examination reveaIed a sweIIing of the left knee, reaching a maximum between the pateIIa and the tuberosity of the tibia, with diffuse tenderness and marked restriction of motion. Roentgenographic studies reveaIed a large in the anterior caIcified mass, apparently chamber of the knee joint. A utility incision was empIoyed and the pateIIa dispIaced IateraIIy. The joint cavity was opened and expIored. The mass was exposed, dissected free, and excised. It measured 5.5 by the infrapateIIar 4 by 2 cm., and invoIved bursae and fat pad. The synovia1 Iining of the joint cavity was normaI. The postoperative course was uneventfu1. A posterior mouIded spIint was appIied for ten days, foIIowing which active and passive motion, supplemented with short wave therapy, was instituted. Motion at the knee joint improved, until 60 degrees of ffexion were present and the patient was free of pain.
AIEVOLI, E. Proliferation of fat tissue of knee. Recent literature. Rijororma med., 35: 318, 1919. BASSETT, A. Unusual case. Foreign body in knee. Rev. de cbir., 58: 144, 1920. BONNET, IDRAC and TOULEMONDE. Sot. de mkd. mil. jranq., Bull. mew., 32: 534, 1938. BRISTOW, W. R. InternaI derangement of knee joint. J. Bone @ Joint Surg., 17: 605, 1935. CAMPBELL, W. C. Internal derangement of knee joint. Surg., Gynec. @ Obst., 52: 568, 193 I. CASSOU. CaIcified pretibial bursitis. Bulk et m6m. Sot. radiol. m&d. de France, vo1. 24, 1936. COTTON, F. J. Knee Iesions and operation; IOO cases. S. Clin. Nortb America, p. 1021, 1922. CRAVENER, E. K. Extra-articuIar disorders of knee joint. C/i&on M. J., 16: 96, 1930. DARROCK, W. Internal derangement of knee joint. Ann. Surg., 102: 129, 1935. DUBS, J. Proliferation of fat tissue of knee. Car. bl. f. scbweiz. Aerzte, 49: 289, 1919. FISHER, A. G. T. InternaI Derangement of the Knee Joint. New York, 1933. MacmiIIan. GUILLAUME, L. P. Foreign bodies of knee. Arch. mtd.-cbir. de Provence, 26: 247, 1936. HARBIN, M. A consideration of certain derangements of knee joint. Surg., Gynec. ti Obst., 47: 55, 1928. HENDERSON, M. S. Surgical conditions of knee joint. Am. J. Surg., 26: 499, 1934. MOUCHET, A., and LAIGLE, L. CaIcified hygroma of knee. Rev. d’ortbop., 23: 615, 1936. REDI. Une complication rare de Ia fracture de Ia rotuIe: I’ossification de Ia bourse pr&otuIienne profonde. Rev. d’ ortbop., 15: 497, 1928. STEINDLER, A. Synovectomy and fat pad remova in knee. J. A. M. A., 84: 16, 1925. STEWART, H. A. Internal derangements of knee. West Virginia M. J., 33: 304, 1937. SURLS, J. K., and OSGOOD. R. B. InternaI derangements of knee. Review of 181 cases. J. Bone H Joint Surg., ‘923. WHITELOCKE. Loose bodies in knee, with specia1 reference to etioIogy and growth. Brit. J. Surg., ApriI, 1914.
+
RobiIIard-Ossification
orI; I’, the fat pad partiaIIy fiIIs the surfaces bet ween the condyIes of the femur and the hea d of the tibia. The posterior surfaceof the
FIG. 3. Knee joint at operation;
articuIar surface of femur; osseous tumor mass indicated by pointer.
FIG. 5. Microphotograph
American
Journal
of Surgery
443
reIated to the fat pad The superficia1 I.>ursa the is situated inferiorIy, just above tuberosity of the tibia. The deep bur -sa IS
FIG. 4. Osseous mass after mova1.
re-
of tumor showing bone trabeculae.
fat pad is attached to the anterior intercondyIoid eminence of the tibia by the ligamentum mucosum. The anterior surface is continuous with synovia1 fringes of the edges of the pateIIa, known as the Iigaments or plicae aIares. The infrapatelIar fat as a pressure reducing pad functions mechanism to the joint. The cavity of the joint is at its greatest capacity when the knee is flexed to 45 degrees, the fat pad pushing in to prevent a IocaI vacuum. When the knee is extended, the fat pad is puIIed forward free from opposing surfaces (Cravener). The infrapateIIar bursae are cIoseIy
situated between the posterior surface of the pateIIar ligament, and the proxima1 end of the tibia. Both bursae are anterior to the fat pad. CASE
REPORT
E. C. H., 34 year white female, was admitted to the hospital June 6, 1939. Two years before, she had injured her Ieft hand and knee in a faI1. Roentgenographic study at that time reveaIed a fracture of the distal phaIanx of the Ieft thumb and osteoarthritic changes in the joints of the hand. It was then noted that crepitus was present in both knee joints, but the knee was not x-rayed. The patient had since compIained of pain in the Ieft knee, and
American
444
Journal
of Surgery
Robillard-Ossification
was treated for osteoarthritis. In March, 1939 she feII again, and pain, tenderness, sweIIing, and immobihty of the left knee resulted, persisting to the date of admission to the hospita1.
SUMMARY
A case of ossification of the infrapatellar bursae and fat pad is reported in which good functiona resuIt was obtained foIIowing surgica1 excision. The Iesion may be Iooked upon as an osteoma. REFERENCES
FIG.
6.
Postoperative
roentgenogram joint.
of
knee
Examination reveaIed a sweIIing of the left knee, reaching a maximum between the pateIIa and the tuberosity of the tibia, with diffuse tenderness and marked restriction of motion. Roentgenographic studies reveaIed a large in the anterior caIcified mass, apparently chamber of the knee joint. A utility incision was empIoyed and the pateIIa dispIaced IateraIIy. The joint cavity was opened and expIored. The mass was exposed, dissected free, and excised. It measured 5.5 by the infrapateIIar 4 by 2 cm., and invoIved bursae and fat pad. The synovia1 Iining of the joint cavity was normaI. The postoperative course was uneventfu1. A posterior mouIded spIint was appIied for ten days, foIIowing which active and passive motion, supplemented with short wave therapy, was instituted. Motion at the knee joint improved, until 60 degrees of ffexion were present and the patient was free of pain.
AIEVOLI, E. Proliferation of fat tissue of knee. Recent literature. Rijororma med., 35: 318, 1919. BASSETT, A. Unusual case. Foreign body in knee. Rev. de cbir., 58: 144, 1920. BONNET, IDRAC and TOULEMONDE. Sot. de mkd. mil. jranq., Bull. mew., 32: 534, 1938. BRISTOW, W. R. InternaI derangement of knee joint. J. Bone @ Joint Surg., 17: 605, 1935. CAMPBELL, W. C. Internal derangement of knee joint. Surg., Gynec. @ Obst., 52: 568, 193 I. CASSOU. CaIcified pretibial bursitis. Bulk et m6m. Sot. radiol. m&d. de France, vo1. 24, 1936. COTTON, F. J. Knee Iesions and operation; IOO cases. S. Clin. Nortb America, p. 1021, 1922. CRAVENER, E. K. Extra-articuIar disorders of knee joint. C/i&on M. J., 16: 96, 1930. DARROCK, W. Internal derangement of knee joint. Ann. Surg., 102: 129, 1935. DUBS, J. Proliferation of fat tissue of knee. Car. bl. f. scbweiz. Aerzte, 49: 289, 1919. FISHER, A. G. T. InternaI Derangement of the Knee Joint. New York, 1933. MacmiIIan. GUILLAUME, L. P. Foreign bodies of knee. Arch. mtd.-cbir. de Provence, 26: 247, 1936. HARBIN, M. A consideration of certain derangements of knee joint. Surg., Gynec. ti Obst., 47: 55, 1928. HENDERSON, M. S. Surgical conditions of knee joint. Am. J. Surg., 26: 499, 1934. MOUCHET, A., and LAIGLE, L. CaIcified hygroma of knee. Rev. d’ortbop., 23: 615, 1936. REDI. Une complication rare de Ia fracture de Ia rotuIe: I’ossification de Ia bourse pr&otuIienne profonde. Rev. d’ ortbop., 15: 497, 1928. STEINDLER, A. Synovectomy and fat pad remova in knee. J. A. M. A., 84: 16, 1925. STEWART, H. A. Internal derangements of knee. West Virginia M. J., 33: 304, 1937. SURLS, J. K., and OSGOOD. R. B. InternaI derangements of knee. Review of 181 cases. J. Bone H Joint Surg., ‘923. WHITELOCKE. Loose bodies in knee, with specia1 reference to etioIogy and growth. Brit. J. Surg., ApriI, 1914.