Anatomical and clinical significance of the Cyrano long-nosed patella in combination with patellofemoral instability: a case report and review of literature.

IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL
Kunpeng Yang, Andreas Prescher, Frank Hildebrand, Christian David Weber
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Abstract

Background: The combination of a long-nosed patella and patella alta can lead to symptoms such as anterior knee pain and patellofemoral instability.

Purpose: Our objective was to address this uncommon, multifactorial cause of patellar pain and instability by a single-stage combined surgical approach.

Case presentation: A 14-year-old German female presented to our hospital for recurrent patellar dislocations and exacerbated infrapatellar pain during kneeling. Following physical examination and imaging, the patient was diagnosed with patellar instability combined with the rare "Cyrano"-type patella. The patient underwent a single-stage procedure that included knee arthroscopic exploration, inferior pole osteotomy of the patella, tibial tuberosity osteotomy, and dynamic medial patellofemoral ligament reconstruction. Following the surgical procedure, the symptoms of knee pain and instability were entirely alleviated, accompanied by notable enhancements in the Knee Injury and Osteoarthritis Outcome Score , Kujala Score, and Lysholm Score. Notably, no recurrence was observed throughout the 2-year follow-up period.

Conclusion: The entity of a symptomatic Cyrano patella may be combined with patellofemoral instability. Osteotomy and surgical excision of the long-nosed aspect of the inferior pole, coupled with the realignment of the patellofemoral joint in both coronal and sagittal planes, alleviated pain and enhanced knee joint stability, ultimately contributing to the resolution of this uncommon condition. A sagittal plane deformity of the patellar shape may significantly affect the measurement of the patella height, as the Insall-Salvati index may not correctly determine the height of a patella owing to the elongated nose.

Level of evidence iv:

Cyrano型长鼻髌骨合并髌股不稳的解剖及临床意义:1例报告及文献复习。
背景:长鼻髌骨和上髌骨合并可导致膝关节前侧疼痛和髌股不稳定等症状。目的:我们的目的是通过单阶段联合手术方法来解决这种罕见的、多因素的髌骨疼痛和不稳定。病例介绍:一名14岁的德国女性因复发性髌骨脱位和膝跪时髌骨下疼痛加重而来到我院。经体格检查和影像学检查,患者被诊断为髌骨不稳合并罕见的“Cyrano”型髌骨。患者接受了一期手术,包括膝关节镜探查、髌骨下极截骨、胫骨结节截骨和动态髌股内侧韧带重建。手术后,膝关节疼痛和不稳定症状完全缓解,膝关节损伤和骨关节炎结局评分、Kujala评分和Lysholm评分均显著提高。值得注意的是,在2年的随访期间没有观察到复发。结论:有症状的Cyrano型髌骨可能合并髌股不稳。截骨术和手术切除下极长鼻部,结合髌股关节在冠状面和矢状面重新定位,减轻了疼痛,增强了膝关节的稳定性,最终有助于解决这种罕见的疾病。髌骨形状矢状面畸形可能会显著影响髌骨高度的测量,因为由于鼻长,install - salvati指数可能无法正确确定髌骨高度。证据等级iv:
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Medical Case Reports
Journal of Medical Case Reports Medicine-Medicine (all)
CiteScore
1.50
自引率
0.00%
发文量
436
期刊介绍: JMCR is an open access, peer-reviewed online journal that will consider any original case report that expands the field of general medical knowledge. Reports should show one of the following: 1. Unreported or unusual side effects or adverse interactions involving medications 2. Unexpected or unusual presentations of a disease 3. New associations or variations in disease processes 4. Presentations, diagnoses and/or management of new and emerging diseases 5. An unexpected association between diseases or symptoms 6. An unexpected event in the course of observing or treating a patient 7. Findings that shed new light on the possible pathogenesis of a disease or an adverse effect
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