ULTRASONOGRAPHY OF THE CARTILAGINOUS PATELLA IN PEDIATRIC PATIENTS: A CASE SERIES

Tenório, Leila Pereira; Volpon, José Batista; Nogueira-Barbosa, Marcello Henrique

doi:10.1590/1413-785220253305e291176

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Original Article/Pediatric Orthopedic • Acta Ortop Bras 33 (5) • 2025 • https://doi.org/10.1590/1413-785220253305e291176 linkcopy

ULTRASONOGRAPHY OF THE CARTILAGINOUS PATELLA IN PEDIATRIC PATIENTS: A CASE SERIES

ULTRASSONOGRAFIA DA PATELA CARTILAGINOSA EM PACIENTES PEDIÁTRICOS: UMA SÉRIE DE CASOS

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective: To analyze cases with clinical suspicion of patellar abnormalities, before ossification of the patella and to characterize the spectrum of abnormalities of the cartilaginous infantile patella by ultrasonography.

Methods: Retrospective study using the keyword "patella" in ultrasonography reports in the Radiology Information System (RIS). The main researcher performed patellar measurements in the group of patients and in a control group (9 patients) without clinical or ultrasonography abnormalities.

Results: Twelve patients with suspected patellar abnormalities were identified, with a mean age of 9 months and 4 days (±1.9 years), 75% male.

Findings: dislocation or subluxation associated with patellar hypoplasia (7 knees), low lying patella and patellar hypoplasia (2), unilateral patellar agenesis (1), bilateral patellar agenesis (1), patellar instability in dynamic assessment and absence of patellar morphological changes (1). In two patients, ultrasonography was negative. The craniocaudal diameter of the hypoplastic patellas measured 0.94 cm ± 0.24 cm and in the control group 1.24 cm and ±0.12 cm (p<0.01). The Insall-Salvati index adapted for ultrasonography measured 0.63±0.07 for the low lying patella and 0.93±0.16 in the control group (p=0.004).

Conclusions: Ultrasonography was useful to characterize abnormalities of the cartilaginous patella, and the most frequent findings were instability and hypoplasia. Level of Evidence IV; Case Series.

Keywords:
Patella; Patellar Dislocation; Nail-Patella Syndrome; Ultrasonography; Congenital Abnormalities

Age and gender	Physical findings	Main clinical suspicion	Ultrasound findings
2 months 8 days Male	Congenital hip dislocation and bilateral cryptorchidism	Nail-patella syndrome	Hypoplasia and lateral dislocation of the right patella
6 days Women	Bone dysplasia, hip and knee dislocation	Arthrogryposis Larsen syndrome	Patellas without morphological alterations, but unstable during dynamic maneuvers.
12 days Women	Breech presentation, congenital hip dysplasia, congenital clubfoot	Congenital malformation	Hypoplasia and low lying patellas
4 months and 15 days Male	Total hemimelia of the tibia and dislocation of the right knee	Congenital malformation	Right patella agenesis and distal femur dysplasia
2 months and 14 days Male	Myelomeningocele and congenital clubfoot	Chiari type II and hydrocephalus	Patellae with no echographic changes
6 years and 9 months Male	Proximal femur deficiency and right fibular hemimelia	Congenital malformation	Right lateralized patella with trochlear dysplasia
27 days Male	Left genu recurvatum, contracture in hip adduction and elbow flexion, clinodactyly	VACTERL	Hypoplasia and lateral dislocation of the left patella
3 months and 10 days Male	Meromelia, deformity in flexion of the hips and knees. Absence of both arms and forearms	Arthrogryposis Fuhrmann syndrome	Patella agenesis
2 months and 23 days Male	Imperforate anus, acetabular dysplasia, and cryptorchidism	Intrauterine disruptive syndrome	Hypoplastic patellas and lateral subluxation on the right
1 year Male	Proximal focal deficiency of the femur with fibular hemimelia on the left	Femur-fibula-ulna syndrome Fuhrmann syndrome	Hypoplastic left patella and lateral dislocation associated with femoral trochlear dysplasia
25 days Male	Partial tibial hemimelia and focal proximal deficiency of the right femur, left hip dislocation	Malformations secondary to uncontrolled maternal diabetes	Hypoplastic right patella and medial dislocation associated with femoral trochlear dysplasia
1 month and 3 days Women	Contraction of the hips and genu recurvatum	Larsen syndrome	Anterior dislocation of the tibiae, hypoplastic patellae, and low position

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