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Patellar instability

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https://www.readbyqxmd.com/read/29653442/examination-under-anesthesia-in-patients-with-recurrent-patellar-dislocation-prognostic-study
#1
Ismail Fathalla, James Holton, Tanweer Ashraf
Surgical management of patellar instability is a matter of wide debate. While some authors believe that isolated medial patellofemoral ligament (MPFL) reconstruction is sufficient, others advocate procedures to treat the underlying pathology, namely, patella alta and trochlear dysplasia. Radiological studies have been traditionally used as a determinant of these pathologies and to determine the need for an additional procedure. The value of examination under anesthesia (EUA) in formulating a treatment plan remains unknown...
April 13, 2018: Journal of Knee Surgery
https://www.readbyqxmd.com/read/29622246/editorial-commentary-knee-medial-patellofemoral-ligament-reconstruction-does-not-always-result-in-the-bee-s-knees
#2
EDITORIAL
Aman Dhawan
Reconstruction of the medial patellofemoral ligament has gained in popularity as a surgical technique to reconcile recurrent lateral patellar instability. This technique has shown success in a variety of settings including with concomitant osseous abnormalities. Despite the general good to excellent results with medial patellofemoral ligament reconstruction, a number of technical errors are still commonly made and may result in decreased range of motion, pain, chondrosis, and arthrofibrosis. In a recent study, the importance of knee flexion angle during final fixation of the graft is emphasized...
April 2018: Arthroscopy: the Journal of Arthroscopic & related Surgery
https://www.readbyqxmd.com/read/29611848/special-considerations-for-pediatric-patellar-instability
#3
Sean Keyes, Meghan Price, Daniel W Green, Shital N Parikh
Patellar instability in children and adolescents is a challenging subset to treat. Varied forms of instability, ranging from episodic dislocation to fixed dislocation, have been recognized. It is of utmost importance for the treating physician to recognize these different patterns of instability and their associated risk factors, as more complex patterns of instability would require more extensive surgical procedures. Medial patellofemoral ligament (MPFL) reconstruction, by itself, may not suffice or may not be appropriate for the more complex instability patterns...
March 2018: American Journal of Orthopedics
https://www.readbyqxmd.com/read/29569702/an-anatomical-study-of-the-origin-structure-and-insertion-of-the-medial-patellofemoral-ligament
#4
Chang-Hui Li, David Ricketts, Xi-Shan Wang, Teng-Bo Yu, Chao Qi, Yong-Le Zhu
BACKGROUND: Repair and reconstruction of the medial patellofemoral ligament (MPFL) has been undertaken for the treatment of patellar instability. For successful surgery detailed knowledge of the anatomy of the ligament is required. The aim of this study was to describe the origin, structure and insertion of the MPFL. MATERIALS AND METHODS: We studied cadaveric knees from 30 Chinese adults. We studied the origin, course and insertion of the MPFL. RESULTS: We found that the MPFL was composed of two main strands, superficial and deep...
March 23, 2018: Folia Morphologica (Warsz)
https://www.readbyqxmd.com/read/29560511/excessive-lateral-patellar-translation-on-axial-computed-tomography-indicates-positive-patellar-j-sign
#5
Zhe Xue, Guan-Yang Song, Xin Liu, Hui Zhang, Guan Wu, Yi Qian, Hua Feng
PURPOSE: The purpose of the study was to quantify the patellar J sign using traditional computed tomography (CT) scans. METHODS: Fifty-three patients (fifty-three knees) who suffered from recurrent patellar instability were included and analyzed. The patellar J sign was evaluated pre-operatively during active knee flexion and extension. It was defined as positive when there was obvious lateral patellar translation, and negative when there was not. The CT scans were performed in all patients with full knee extension; and the parameters including bisect offset index (BOI), patellar-trochlear-groove (PTG) distance, and patellar lateral tilt angle (PLTA) were measured on the axial slices...
March 20, 2018: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
https://www.readbyqxmd.com/read/29552477/sulcus-deepening-trochleoplasty-and-medial-patellofemoral-ligament-reconstruction-for-recurrent-patellar-instability
#6
Michael S Laidlaw, Scott M Feeley, Jeffrey R Ruland, David R Diduch
There are multiple etiologies for recurrent patellar instability. While patella alta, an elevated tibial tubercle trochlear groove distance, and prior lateral patellar dislocations with medial patellofemoral ligament (MPFL) insufficiency have been shown to be risk factors for recurrent patellar instability, trochlear dysplasia can result in a significant impediment to normal patellar tracking. With the adequate identification of risk factors, appropriate surgical treatments can be individually tailored to the patient...
February 2018: Arthroscopy Techniques
https://www.readbyqxmd.com/read/29546510/the-quadriceps-active-ratio-a-dynamic-mri-based-assessment-of-patellar-height
#7
Sergio Barroso Rosa, Zaid Bahho, Kenji Doma, Kaushik Hazratwala, Peter McEwen, Varaguna Manoharan, Brent Matthews, Matthew Wilkinson
INTRODUCTION: Patella alta (PA) is one of the primary correctable risk factors for patellofemoral instability (PFI). Both an accurate diagnosis of PA and a clinically relevant target for correction are necessary for optimal treatment. An ideal test for PA should relate the position of the patella to the femur rather than tibia, should do so with the quadriceps contracted and the patellar tendon under tension and should have good sensitivity and specificity. None of the currently used radiographic tests PA meet these criteria, most of which are based on the position of the patella relative to the tibia with diagnostic cutoffs based on 2 standard deviations from the mean rather than optimal sensitivity and specificity...
March 15, 2018: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
https://www.readbyqxmd.com/read/29544985/dynamic-tracking-influenced-by-anatomy-following-medial-patellofemoral-ligament-reconstruction-computational-simulation
#8
John J Elias, Kerwyn C Jones, S Cyrus Rezvanifar, Joseph N Gabra, Melanie A Morscher, Andrew J Cosgarea
BACKGROUND: Continued patellar instability can occur following medial patellofemoral ligament (MPFL) reconstruction. Computational simulation of function was used to investigate the influence of the lateral position of the tibial tuberosity, trochlear dysplasia and patella alta on lateral patellar tracking following MPFL reconstruction. METHODS: Multibody dynamic simulation models were developed to represent nine knees being treated for recurrent patellar instability...
March 12, 2018: Knee
https://www.readbyqxmd.com/read/29521938/the-growth-of-trochlear-dysplasia-during-adolescence
#9
Shital N Parikh, Neil Rajdev, Qin Sun
BACKGROUND: Femoral trochlear dysplasia is a known risk factor for patellar instability. The growth pattern of the normal trochlea is known, but there have been no studies investigating the growth and development of the dysplastic trochlea. The purpose of this study was to assess the growth pattern of trochlear dysplasia in adolescents. METHODS: In a retrospective analysis, magnetic resonance images of adolescents with patellar instability and trochlear dysplasia were evaluated...
March 8, 2018: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/29514373/long-term-clinical-results-of-double-bundle-reconstruction-of-the-medial-patellofemoral-ligament-for-patellar-instability
#10
Lei Zhang, Zhiyao Li
Medial patellofemoral ligament (MPFL) reconstruction is a satisfactory technique for patellar instability, and the anatomical double bundle variant is recommended for better clinical results. However, long-term outcomes are still uncharacterized. This study aimed to assess the effectiveness of double bundle reconstruction of the MPFL for patellar instability by means of established scores. A total of 68 patients with chronic patellar instability who underwent surgery from May 2005 to February 2010 were included prospectively...
March 7, 2018: Journal of Knee Surgery
https://www.readbyqxmd.com/read/29502693/editorial-commentary-is-magnetic-resonance-imaging-imaged-knee-patellar-tracking-relevant-in-assessing-the-patient-with-patellar-instability
#11
EDITORIAL
Jack Farr
Patellar pain and instability are common presentations to surgeons, yet assessment is more a static art than a dynamic science. In addition to resource-intensive gait laboratory, computed tomography (CT) and magnetic resonance imaging (MRI) have been used to measure patellar tracking. CT has the limitation of radiation and MRI has the limitation of software processing times. With an updated MRI protocol and software, it is now possible to dynamically view patellar tracking. Determining how this will be used to help in the diagnosis and treatment of patients will be the next goal...
March 2018: Arthroscopy: the Journal of Arthroscopic & related Surgery
https://www.readbyqxmd.com/read/29502142/knee-size-chart-nomogram-for-evaluation-of-tibial-tuberosity-trochlear-groove-distance-in-knees-with-or-without-history-of-patellofemoral-instability
#12
Jacques Hernigou, Esfandiar Chahidi, Medhi Bouaboula, Eric Moest, Antoine Callewier, Theofylaktos Kyriakydis, Dimitrios Koulalis, Olivier Bath
PURPOSE: Lateralized tibial tubercle is a cause of patellar instability. Before proceeding with reduction of the tibial tubercle-trochlear groove (TT-TG) distance, surgeons prefer to know whether this distance is pathologic. However, the pathological value remains discussed and may vary with the size of the knee. METHODS: We sought to determine variability in the traditional TT-TG distance versus the anthropometric knee size, using dimensions of the distal part of the femur and proximal part of the tibia of 85 CT scans of the knees in two groups of knees, one normal group without history of patellofemoral instability and one pathologic group with history of instability...
March 3, 2018: International Orthopaedics
https://www.readbyqxmd.com/read/29500485/mri-findings-associated-with-medial-patellofemoral-capsuloligamentous-plication
#13
William R Walter, Hien Pham, Robert J Meislin, Laith M Jazrawi, Christopher J Burke
OBJECTIVE: To review the MRI appearance of medial patellofemoral capsuloligamentous plication (also known as reefing or imbrication) for proximal patellar realignment in patients with patellofemoral instability. MATERIALS AND METHODS: Retrospective analysis of our surgical and PACS databases identified cases of medial plication performed between June 2011 and July 2016. Pre- and postoperative MRI characteristics were reviewed. Correlation was made with operative reports and clinical records to define postoperative appearances on MRI...
March 2, 2018: Skeletal Radiology
https://www.readbyqxmd.com/read/29492253/case-report-of-a-ruptured-endobutton-used-in-medial-patellofemoral-ligament-reconstruction-causing-patellofemoral-impingement
#14
Raashad Hasan, Wiqqas Jamil
The medial patellofemoral ligament (MPFL) is a key soft tissue stabilizer of the medial patella, with deficiency proven to be a key contributor to patellar dislocation. Reconstruction of this ligament has become a widely employed procedure in managing patients with recurrent patellar dislocation, and is also gaining popularity in the setting of primary dislocation. A wide variety of techniques have been described, differing in the type of graft used, sites for fixation and fixation technique. A number of complications have also been reported in the literature, including post-operative stiffness, apprehension, patellar fracture and recurrence of instability and dislocation...
February 2018: Journal of Surgical Case Reports
https://www.readbyqxmd.com/read/29490405/anterior-knee-pain-in-children-and-adolescents-overview-and-management
#15
Steven Slotkin, Andrew Thome, Cassandra Ricketts, Andrew Georgiadis, Aristides Cruz, Mark Seeley
Anterior knee pain (AKP) is a common presenting complaint for pediatricians and orthopaedic surgeons and is often seen in young athletes. AKP is multifactorial and has a broad differential diagnosis. The growth changes, biomechanics, and anatomy around the knee add to the complexity of diagnosis and treatment of AKP. Common causes of AKP include Osgood-Schlatter's disease, patellar tendinitis, and patellofemoral instability. In the diagnosis of AKP, it is important to rule out serious and morbid causes of pain, including infection and tumor...
February 28, 2018: Journal of Knee Surgery
https://www.readbyqxmd.com/read/29457387/-multi-point-fixation-with-absorbable-cartilage-screws-for-the-treatment-of-osteochondral-fracture-caused-by-patellar-instability
#16
Xu-Hui Zhang, Lei Xia, Gang-Tao Wang, Tan Li
OBJECTIVE: To study clinical effects of multi-point fixation with bioabsorbable cartilage screws for the treatment of osteochondral fracture caused by patellar instability. METHODS: During the period from August 2014 to Steptember 2016, there were 21 patients with osteochondral fracture caused by patellar dislocation, including 7 males and 14 females, ranging in age from 12 to 42 years old, with an average of 27 years old. During the operation, free fractures fragments of cartilage were found with a open surgery, and the patients were treated with fixation by absorbable cartilage screws combined with lateral retinaculum release and medial retinaculum shrinkage...
November 25, 2017: Zhongguo Gu Shang, China Journal of Orthopaedics and Traumatology
https://www.readbyqxmd.com/read/29438635/twenty-year-follow-up-study-comparing-operative-versus-nonoperative-treatment-of-anterior-cruciate-ligament-ruptures-in-high-level-athletes
#17
Daan T van Yperen, Max Reijman, Eline M van Es, Sita M A Bierma-Zeinstra, Duncan E Meuffels
BACKGROUND: An anterior cruciate ligament (ACL) rupture has major consequences at midterm follow-up, with an increasing chance of developing an old knee in a young patient. The long-term (≥20 years) effects of the operative and nonoperative treatment of ACL ruptures are still unclear. PURPOSE: To compare the long-term treatment outcomes of operative versus nonoperative treatment of ACL ruptures in high-level athletes. STUDY DESIGN: Cohort study; Level of evidence, 2...
February 1, 2018: American Journal of Sports Medicine
https://www.readbyqxmd.com/read/29413194/editorial-commentary-medial-patellofemoral-ligament-reconstruction-for-knee-patellar-instability-when-are-soft-tissue-procedures-not-enough
#18
EDITORIAL
Miho J Tanaka
Medial patellofemoral ligament reconstruction is commonly performed to treat patellofemoral instability by recreating the static soft tissue restraint to lateral patellar translation. Concurrent tibial tuberosity osteotomy can be indicated in the setting of bony malalignment, such as a lateralized tuberosity or patella alta; however, the exact indications for this have been difficult to define due to the multifactorial nature of this problem. Understanding the role of tuberosity lateralization and patella alta on the function of medial patellofemoral ligament grafts can help to identify the interplay of some factors that contribute to patellar stability and improve our understanding of when and how concurrent tibial tuberosity osteotomy may be indicated...
February 2018: Arthroscopy: the Journal of Arthroscopic & related Surgery
https://www.readbyqxmd.com/read/29410197/patellofemoral-reconstruction-for-patellar-instability-with-patella-alta-in-middle-aged-patients-clinical-outcomes
#19
S Otsuki, Y Okamoto, T Murakami, K Nakagawa, N Okuno, H Wakama, M Neo
INTRODUCTION: Although several surgical treatments for patellar instability with patella alta have been reported, the clinical outcomes and optimal surgical procedures for patellar instability with patella alta in middle-aged patients are still controversial. We hypothesized that optimal surgical procedures for patellar instability with patella alta in middle-aged patients may induce good clinical outcomes with better patellofemoral geometry. MATERIALS AND METHODS: Twelve middle-aged patients with a mean age of 44 years (range: 40-55 years), who presented with patellar instability and patella alta, were treated with a combination of several surgeries, such as medial patellofemoral ligament (MPFL) reconstruction, trochleoplasty, lateral release, and three-dimensional transfer of the tibial tuberosity, based on a surgical algorithm...
February 1, 2018: Orthopaedics & Traumatology, Surgery & Research: OTSR
https://www.readbyqxmd.com/read/29409075/the-pediatric-patella-normal-development-anatomical-variants-and-malformations-stability-imaging-and-injury-patterns
#20
Ezekiel Maloney, A Luana Stanescu, Anh-Vu Ngo, Marguerite T Parisi, Ramesh S Iyer
We discuss the pediatric patella, with an emphasis on diagnostic imaging. Topics include normal patellar development, anatomical variants and their physiologic significance, genetic syndromes that alter the appearance of the patella, physiology of patellar tracking and stability, patellofemoral instability, and injury patterns and classification. Recognition of appropriate development on imaging prevents diagnostic error and unnecessary evaluation. Knowledge of the pertinent features of syndromes associated with morphological patellar abnormalities can aid in generating a succinct and relevant differential diagnosis...
February 2018: Seminars in Musculoskeletal Radiology
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