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Patellar instability

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https://www.readbyqxmd.com/read/28510474/increased-magnetic-resonance-imaging-signal-of-the-lateral-patellar-facet-cartilage-a-functional-marker-for-patellar-instability
#1
Anna L Falkowski, Carlo Camathias, Jon A Jacobson, Olaf Magerkurth
BACKGROUND: In the knee joint, predisposition for patellar instability can be assessed by an abnormal Insall-Salvati index, tibial tuberosity-trochlear groove (TTTG) distance, and abnormal shape of patella and trochlea. Given the complex anatomic features of the knee joint with varying positions of the patella during motion, the presence of a single or even a combination of these factors does not inevitably result in patellar instability. After trocheoplasty in patients with trochlear dysplasia, assessment of trochlear cartilage and subchondral bone is limited due to postoperative artifacts...
May 1, 2017: American Journal of Sports Medicine
https://www.readbyqxmd.com/read/28508959/surgical-treatment-of-patellar-instability-clinical-and-radiological-outcome-after-medial-patellofemoral-ligament-reconstruction-and-tibial-tuberosity-medialisation
#2
Stefan Lobner, Christine Krauss, Frank Reichwein, Thilo Patzer, Wolfgang Nebelung, Arne J Venjakob
INTRODUCTION: The aim of this retrospective study was to analyse clinical and radiological outcome after medial patellofemoral ligament reconstruction (MPFLR) and tibial tuberosity medialisation (TTM) in patients with recurrent patellar instability. MATERIALS AND METHODS: Thirty-five patients were included between 2008 and 2012. According to defined criteria such as tibial tuberosity-trochlear groove (TTTG) distance, hyperpression on the lateral patella facet and lateral retropatellar cartilage damage either MPFLR (group A) or TTM (group B) was performed: 18 patients underwent TTM, the other 17 patients underwent MPFLR...
May 16, 2017: Archives of Orthopaedic and Trauma Surgery
https://www.readbyqxmd.com/read/28501222/medial-patellar-instability-a-systematic-review-of-the-literature-of-outcomes-after-surgical-treatment
#3
REVIEW
Gilbert Moatshe, Mark E Cinque, Bradley M Kruckeberg, Jorge Chahla, Robert F LaPrade
PURPOSE: To perform a systematic review of literature reporting on outcomes after surgical treatment of medial patellar instability. METHODS: A systematic review was performed according to PRISMA guidelines. Inclusion criteria were as follows: the outcomes and complications of medial patellar instability repair with a follow-up greater than 12 months, English language, and human studies. We excluded cadaveric studies, animal studies, basic science articles, editorial articles, review articles, and surveys...
May 10, 2017: Arthroscopy: the Journal of Arthroscopic & related Surgery
https://www.readbyqxmd.com/read/28463535/risk-factors-and-time-to-recurrent-ipsilateral-and-contralateral-patellar-dislocations
#4
Tyson C Christensen, Thomas L Sanders, Ayoosh Pareek, Rohith Mahan, Diane L Dahm, Aaron J Krych
BACKGROUND: Previous studies have reported variable rates of recurrent lateral patellar instability mainly because of limited cohort sizes. In addition, there is currently a lack of information on contralateral patellar instability. PURPOSE: To evaluate the rate of recurrent ipsilateral patellar dislocations and contralateral patellar dislocations after a first-time lateral patellar dislocation. Additionally, risk factors associated with recurrent dislocations (ipsilateral or contralateral) and time to recurrence were investigated...
May 1, 2017: American Journal of Sports Medicine
https://www.readbyqxmd.com/read/28459754/rehabilitation-after-medial-patellofemoral-ligament-reconstruction
#5
Terrence G McGee, Andrew J Cosgarea, Kevin McLaughlin, Miho Tanaka, Ken Johnson
Patellar instability resulting from subluxation or dislocation is a painful and commonly recurring condition. Retinacular restraints control patellar tracking, limiting the movement of the patella in the trochlear groove. The medial patellofemoral ligament (MPFL) is considered the main soft tissue stabilizer against lateral displacement. Few studies of patellar instability discuss rehabilitation after MPFL reconstruction. In this review, we discuss the phases of rehabilitation after MPFL reconstruction, typical interventions by rehabilitation specialists, and patient-specific guidelines for return to prior level of function...
June 2017: Sports Medicine and Arthroscopy Review
https://www.readbyqxmd.com/read/28459753/surgical-options-for-patellar-stabilization-in-the-skeletally-immature-patient
#6
Jack Andrish
The surgical management of children and youth with patellar instability can be a challenging exercise. It is possible to identify the various pathoanatomies that coexist with and predispose to patellar instability and in so doing, it is possible to address some, but not all, of these pathoanatomies as part of the surgical management. Although reconstruction of the medial patellofemoral ligament has become a mainstay of treatment, it is not without potential complications. Understanding the importance of surgical technique as it relates to the unique anatomies involved is crucial...
June 2017: Sports Medicine and Arthroscopy Review
https://www.readbyqxmd.com/read/28459752/patellar-instability-when-is-trochleoplasty-necessary
#7
S Evan Carstensen, Heather M Menzer, David R Diduch
Trochleoplasty is a very effective procedure for correcting trochlear dysplasia and addressing instability of the patella. With an increasing knowledge about the anatomy and biomechanics of the anterior distal femur, a wider array of surgical techniques may be applied to address specific conditions. Patients must be carefully selected to undergo trochleoplasty by use of a thorough history and physical examination as well as basic and advanced imaging. The presence of a "J sign" on physical examination, a history of recurrent instability, patella alta, trochlear dysplasia, and elevated tibial tubercle to trochlear groove are signs and symptoms for which the patient should be evaluated...
June 2017: Sports Medicine and Arthroscopy Review
https://www.readbyqxmd.com/read/28459750/when-and-how-far-to-move-the-tibial-tuberosity-in-patients-with-patellar-instability
#8
Taylor D'Amore, Miho J Tanaka, Andrew J Cosgarea
The many factors contributing to patellar instability have led to various surgical techniques that are used commonly today. When surgery is deemed necessary, the operation should be tailored to the patient's specific pathoanatomy. Patients with malalignment can often be stabilized by moving the tibial tuberosity to a more medial, anteromedial, or distal position. Subsequent changes in the forces acting on the patellofemoral joint will depend on the direction and distance of the tuberosity repositioning. When planning tuberosity osteotomies, it is crucial to understand how to use clinical and imaging modalities to measure and quantify tuberosity position accurately to achieve the desired degree of realignment...
June 2017: Sports Medicine and Arthroscopy Review
https://www.readbyqxmd.com/read/28459749/nonoperative-treatment-of-patellar-instability
#9
Sameer Dixit, Rajwinder S Deu
The treatment of patellar instability is challenging and typically begins with nonoperative methods. Clinical decisions are made on an individual basis and may vary according to a number of factors. First-time patellar dislocations most commonly occur during sports participation. Initial evaluation, including patient history, physical examination, and appropriate imaging, determines care. Although nonoperative treatment consists primarily of regressive immobilization and physical therapy, there is little evidence to support particular protocols for either...
June 2017: Sports Medicine and Arthroscopy Review
https://www.readbyqxmd.com/read/28459748/diagnosis-and-characterization-of-patellofemoral-instability-review-of-available-imaging-modalities
#10
Arya Haj-Mirzaian, Gaurav K Thawait, Miho J Tanaka, Shadpour Demehri
Patellofemoral instability (PI) is defined as single or multiple episodes of patellar dislocation. Imaging modalities are useful for characterization of patellar malalignment, maltracking, underlying morphologic abnormalities, and stabilizing soft-tissue injuries. Using these findings, orthopedic surgeons can decide when to operate, determine the best operation, and measure degree of correction postoperatively in PI patients. Also, these methods assist with PI diagnosis in some suspicious cases. Magnetic resonance imaging is the preferred method especially in the setting of acute dislocations...
June 2017: Sports Medicine and Arthroscopy Review
https://www.readbyqxmd.com/read/28459747/biomechanical-analysis-of-tibial-tuberosity-medialization-and-medial-patellofemoral-ligament-reconstruction
#11
John J Elias, Bradley W Smith, Blake T Daney
Biomechanical studies are commonly performed to evaluate the influence of medial patellofemoral ligament (MPFL) reconstruction and tibial tuberosity medialization on patellar tracking and patellofemoral contact pressures. The most common method is in vitro simulation of knee function, but computational simulation of knee function and computational reconstruction of in vivo motion can also be utilized. The current review of the biomechanical literature indicates that MPFL reconstruction and tibial tuberosity medialization reduce lateral patellar tracking...
June 2017: Sports Medicine and Arthroscopy Review
https://www.readbyqxmd.com/read/28455474/contemporary-failure-aetiologies-of-the-primary-posterior-stabilised-total-knee-arthroplasty
#12
M P Abdel, C K Ledford, A Kobic, M J Taunton, A D Hanssen
AIMS: The number of revision total knee arthroplasties (TKA) that are performed is expected to increase. However, previous reports of the causes of failure after TKA are limited in that they report the causes at specific institutions, which are often dependent on referral patterns. Our aim was to report the most common indications for re-operations and revisions in a large series of posterior-stabilised TKAs undertaken at a single institution, excluding referrals from elsewhere, which may bias the causes of failure...
May 2017: Bone & Joint Journal
https://www.readbyqxmd.com/read/28451613/medial-patellar-instability-treatment-and-outcomes
#13
Gilbert Moatshe, Tyler R Cram, Jorge Chahla, Mark E Cinque, Jonathan A Godin, Robert F LaPrade
BACKGROUND: Historically, a lateral retinacular release was one of the primary surgical interventions used to treat lateral patellar instability. However, disruption of the lateral structures during this procedure has been associated with medial instability of the patella. HYPOTHESIS: We hypothesize that good to excellent outcomes can be achieved at midterm follow-up after lateral patellotibial ligament reconstruction. STUDY DESIGN: Case series; Level of evidence, 4...
April 2017: Orthopaedic Journal of Sports Medicine
https://www.readbyqxmd.com/read/28451595/medial-patellofemoral-ligament-repair-versus-reconstruction-for-recurrent-patellar-instability-two-year-results-of-an-algorithm-based-approach
#14
Jason L Dragoo, Michael Nguyen, Corey T Gatewood, Jacob D Taunton, Simon Young
BACKGROUND: Patellar instability remains a challenging problem for both the patient and surgeon. Medial patellofemoral ligament (MPFL) repair has historically had poor results, and due to this, there is currently a trend toward reconstruction. PURPOSE/HYPOTHESIS: This study was undertaken to investigate experience with repair versus reconstruction of the MPFL using a multifactorial treatment algorithm approach. Our hypothesis was that there will be no significant difference in outcome scores between patients in the MPFL repair and reconstruction groups...
March 2017: Orthopaedic Journal of Sports Medicine
https://www.readbyqxmd.com/read/28437493/the-role-of-medial-patellofemoral-ligament-repair-and-imbrication
#15
Kyle R Duchman, Matthew J Bollier
Repair, reefing, and advancement of the medial patellofemoral ligament (MPFL) and medial retinacular structures can be performed as an isolated procedure or in conjunction with distal realignment procedures for patients with patellar instability. Although various operative techniques have been described, understanding the appropriate clinical indications and MPFL injury patterns ultimately determines the success or failure of the procedure. MPFL repair is best indicated in the acute setting, particularly if there is a patella- or femoral-based avulsion...
March 2017: American Journal of Orthopedics
https://www.readbyqxmd.com/read/28437491/correct-positioning-of-the-medial-patellofemoral-ligament-troubleshooting-in-the-operating-room
#16
M Tyrrell Burrus, Brian C Werner, Jourdan M Cancienne, David R Diduch
Medial patellofemoral ligament (MPFL) reconstruction is often required after failed nonoperative management of lateral patellar instability. It is important to properly re-create the native ligament to avoid altering patellofemoral biomechanics. Such alterations can cause knee stiffness, anterior knee pain, and patellofemoral chondrosis. Incorrect femoral location is the most common mistake that affects MPFL graft biomechanics. Authors have described multiple radiographic and anatomical landmarks that assist in determining the appropriate location, and time should be taken to accurately localize this position...
March 2017: American Journal of Orthopedics
https://www.readbyqxmd.com/read/28409075/bilateral-patella-dislocation-after-total-knee-arthroplasty-a-report-of-two-cases-and-a-review-of-the-literature
#17
Raju Vaishya, Amit Kumar Agarwal, Sagar Panthi, Vipul Vijay, Abhishek Vaish
Patellar instability is a known but catastrophic complication after total knee arthroplasty (TKA). The occurrence of bilateral dislocation of the patella after TKA is exceedingly rare. It may present as anterior knee pain, and diagnosis can easily be made clinically or by plain radiographs. Early diagnosis with surgical realignment and repair of the extensor mechanism can provide good outcomes after this complication.
March 4, 2017: Curēus
https://www.readbyqxmd.com/read/28396049/acquired-femoral-flexion-deformity-due-to-physeal-injury-during-medial-patellofemoral-ligament-reconstruction
#18
Gerd Seitlinger, Philipp Moroder, Christian Fink, Guido Wierer
BACKGROUND: Reconstruction of the medial patellofemoral ligament (MPFL) is the most frequent surgical procedure performed in patients with patellar instability. Recently, concerns regarding physeal injury during femoral tunnel placement for anatomical MPFL reconstruction in children have been discussed. METHODS: This is the first case to report partial posterior physeal growth arrest and subsequent flexion deformity of the distal femur after MPFL reconstruction in a skeletally immature patient...
April 7, 2017: Knee
https://www.readbyqxmd.com/read/28387435/collagen-v-haploinsufficiency-in-a-murine-model-of-classic-ehlers-danlos-syndrome-is-associated-with-deficient-structural-and-mechanical-healing-in-tendons
#19
Jessica M Johnston, Brianne K Connizzo, Snehal S Shetye, Kelsey A Robinson, Julianne Huegel, Ashley B Rodriguez, Mei Sun, Sheila M Adams, David E Birk, Louis J Soslowsky
Classic Ehlers-Danlos syndrome (EDS) patients suffer from connective tissue hyperelasticity, joint instability, skin hyperextensibility, tissue fragility, and poor wound healing due to heterozygous mutations in COL5a1 or COL5a2 genes. This study investigated the roles of collagen V in establishing structure and function in uninjured patellar tendons as well as in the injury response using a Col5a1(+/-) mouse, a model for classic EDS. These analyses were done comparing tendons from a classic EDS model (Col5a1(+/-) ) with wild-type controls...
April 7, 2017: Journal of Orthopaedic Research: Official Publication of the Orthopaedic Research Society
https://www.readbyqxmd.com/read/28378138/q-vector-measurements-physical-examination-versus-magnetic-resonance-imaging-measurements-and-their-relationship-with-tibial-tubercle-trochlear-groove-distance
#20
Kristin H Graf, Marc A Tompkins, Julie Agel, Elizabeth A Arendt
PURPOSE: An increased lateral quadriceps vector has been associated with lateral patellar dislocation. Surgical correction of this increased vector through tibial tubercle medialization is often recommended when the quadriceps vector is "excessive". This can be evaluated by physical examination measurements of Q-angle and/or tubercle sulcus angle (TSA), as well as the magnetic resonance imaging (MRI) measurement of tibial tubercle-trochlear groove (TT-TG) distance. This study examined the relationship between three objective measurements of lateral quadriceps vector (TT-TG, Q-angle, TSA)...
April 4, 2017: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
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