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https://www.readbyqxmd.com/read/28437493/the-role-of-medial-patellofemoral-ligament-repair-and-imbrication
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
https://www.readbyqxmd.com/read/28341281/uncemented-metal-backed-tantalum-patellar-components-in-total-knee-arthroplasty-have-a-high-fracture-rate-at-midterm-follow-up
#7
Jeremy Y Chan, Nicholas J Giori
BACKGROUND: There is interest in uncemented total knee arthroplasty due to the hope for long-term biologic fixation, but limited data are available regarding uncemented tantalum patellar components. The purpose of this study was to evaluate the radiographic outcomes of uncemented tantalum patellar implants at midterm follow-up. METHODS: We retrospectively reviewed a consecutive series of 30 knees in 29 patients who underwent cementless total knee arthroplasty with an uncemented metal-backed tantalum patella between September 2006 and April 2009...
March 2, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28330756/femoral-articular-geometry-and-patellofemoral-stability
#8
Farhad Iranpour, Azhar M Merican, Seow Hui Teo, Justin P Cobb, Andrew A Amis
BACKGROUND: Patellofemoral instability is a major cause of anterior knee pain. The aim of this study was to examine how the medial and lateral stability of the patellofemoral joint in the normal knee changes with knee flexion and measure its relationship to differences in femoral trochlear geometry. METHODS: Twelve fresh-frozen cadaveric knees were used. Five components of the quadriceps and the iliotibial band were loaded physiologically with 175N and 30N, respectively...
March 19, 2017: Knee
https://www.readbyqxmd.com/read/28318932/patellar-instability-treated-with-distal-femoral-osteotomy
#9
Ishaan Swarup, Osama Elattar, S Robert Rozbruch
BACKGROUND: Patellar instability can cause significant disability in both pediatric and adult patients, and it is associated with several factors including genu valgum. In this study, we describe the role of a lateral opening wedge distal femoral osteotomy (DFO) combined with lateral retinacular release in addressing genu valgum with associated patellar instability. The rationale for this approach is to medialize the patellar tendon insertion and decrease the Q angle with DFO. METHODS: A consecutive series of patients were studied, and our outcomes of interest included improvements in radiographic measures and patient outcomes...
March 17, 2017: Knee
https://www.readbyqxmd.com/read/28315921/quality-assessment-of-radiological-measurements-of-trochlear-dysplasia-a-literature-review
#10
REVIEW
Mathias Paiva, Lars Blønd, Per Hölmich, Robert N Steensen, Gerd Diederichs, Julian A Feller, Kristoffer Weisskirchner Barfod
PURPOSE: To make a systematic review with quality assessments of the known measurements used to describe trochlear dysplasia. METHODS: A systematic literature search was conducted in the databases PubMed and Embase using the search string "trochlea dysplasia OR trochlear dysplasia". Papers were screened for their relevance based on predefined parameters, and all measurements showing a statistical association between trochlear dysplasia and patellar instability were presented...
March 18, 2017: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
https://www.readbyqxmd.com/read/28303844/significance-of-diffusion-tensor-imaging-of-vastus-medialis-oblique-in-recurrent-patellar-dislocation
#11
Li-Si Liu, Zhuo-Zhao Zheng, Hui-Shu Yuan
BACKGROUND: Numerous studies have investigated the influence of osseous factors on patellofemoral joint instability, but research on the influence of dynamic muscle factors in vivo is still in the exploratory stage. This study aimed to use magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) to evaluate vastus medialis oblique (VMO) fiber bundles in patients with recurrent patellar dislocation to explore the changes in muscle morphology and function. METHODS: This prospective study involved 30 patients (7 males and 23 females; average age, 21...
March 20, 2017: Chinese Medical Journal
https://www.readbyqxmd.com/read/28299386/high-rate-of-recurrent-patellar-dislocation-in-skeletally-immature-patients-a-long-term-population-based-study
#12
Thomas L Sanders, Ayoosh Pareek, Timothy E Hewett, Michael J Stuart, Diane L Dahm, Aaron J Krych
PURPOSE: Patellar dislocation can occur in isolation or be associated with chronic instability. The goals of this study are to describe the rate and factors associated with additional patellar instability events (ipsilateral recurrence and contralateral dislocation), as well as the development of patellofemoral arthritis in patients who are skeletally immature at the time of first patellar dislocation. METHODS: The study included a population-based cohort of 232 skeletally immature patients who experienced a first-time lateral patellar dislocation between 1990 and 2010...
March 15, 2017: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
https://www.readbyqxmd.com/read/28298062/traumatic-patellar-dislocation-and-cartilage-injury
#13
Essi E Salonen, Teemu Magga, Petri J Sillanpää, Tommi Kiekara, Heikki Mäenpää, Ville M Mattila
BACKGROUND: Patellofemoral cartilage deterioration and osteoarthritis are reported to be associated with recurrent patellar dislocation. However, the association between first-time traumatic patellar dislocation and cartilage deterioration is unknown. PURPOSE: The aim of this study was to assess long-term cartilage deterioration in the patellofemoral and tibiofemoral joint after conservatively treated traumatic lateral patellar dislocation. STUDY DESIGN: Case series; Level of evidence, 4...
February 1, 2017: American Journal of Sports Medicine
https://www.readbyqxmd.com/read/28293511/de-novo-reconstruction-of-a-hybrid-patella-by-staged-fabrication-of-a-microvascular-bone-transplant-with-an-osteointegrated-prosthetic-socket
#14
Goetz A Giessler, Christian Hendrich
Total patellectomy is sometimes unavoidable but usually results in severely impaired function, pain, and instability in the affected knee. Any patellar prosthetic solutions rely on a certain amount of remaining bone and therefore are not applicable after total patellectomy. Traditionally, reconstruction of a neopatella by avascular or allogeneic bone grafts is hampered by mechanical failure, resorption, or infection. We developed a new, 3-stage approach to reconstruct a hybrid patella composed of a revascularized scapula tip transplant fabricated with a prosthetic socket...
December 2016: Plastic and Reconstructive Surgery. Global Open
https://www.readbyqxmd.com/read/28282674/patellar-height-measurements-on-radiograph-and-magnetic-resonance-imaging-in-patellar-instability-and-control-patients
#15
R Alexander Yue, Elizabeth A Arendt, Marc A Tompkins
Insall-Salvati (IS) ratio, modified IS ratio (mIS), Caton-Deschamps (CD) index, and Blackburne-Peel (BP) index are patellar height measurements commonly made on lateral radiographs (XRs) in patients with patellofemoral instability. More recently, magnetic resonance imaging (MRI) has been used as an additional imaging modality to measure patellar height. However, different imaging modalities have not been previously compared for all of these measurements. First, to compare the patellar height measurements of IS, mIS, CD, and BP on XR and MRI in first-time lateral patellar dislocation (LPD) patients and a control population and, second, to evaluate for the effect of sex and skeletal maturity...
March 10, 2017: Journal of Knee Surgery
https://www.readbyqxmd.com/read/28280905/clinical-outcomes-after-revision-surgery-for-medial-patellofemoral-ligament-reconstruction
#16
Andreas Chatterton, Torsten Grønbech Nielsen, Ole Gade Sørensen, Martin Lind
PURPOSE: Medial patellofemoral ligament reconstruction (MPFL-R) is the standard surgical intervention for patella instability. However, limited knowledge exists concerning the causes for failure, and outcome after revision MPFL-R. The purpose of this study is to evaluate the causes of primary MPFL-R failure and clinical outcomes after revision MPFL-R. METHODS: Twenty-three patients (6 males and 17 females) with failed primary MPFL-R underwent isolated revision MPFL-R or combined revision MPFL-R with tibial tuberosity osteotomy (TTO)...
March 9, 2017: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
https://www.readbyqxmd.com/read/28261427/causes-of-aseptic-persistent-pain-after-total-knee-arthroplasty
#17
Hong-An Lim, Eun-Kyoo Song, Jong-Keun Seon, Kyung-Soon Park, Young-Joo Shin, Hong-Yeol Yang
BACKGROUND: Persistent pain after total knee arthroplasty (TKA) is dissatisfying to the patient and frustrating to the surgeon. The purpose of this study is to evaluate the aseptic causes and clinical course of intractable pain following TKA. METHODS: Of the total 2,534 cases of primary TKA reviewed, 178 cases were classified as having aseptic persistent pain that was not resolved within 1 year after surgery. Except for the cases with periprosthetic fracture (56 knees), 122 cases of aseptic painful TKA were divided into two groups: intra-articular group (83 knees) and extra-articular group (39 knees)...
March 2017: Clinics in Orthopedic Surgery
https://www.readbyqxmd.com/read/28251062/failed-medial-patellofemoral-ligament-reconstruction-causes-and-surgical-strategies
#18
REVIEW
Vicente Sanchis-Alfonso, Erik Montesinos-Berry, Cristina Ramirez-Fuentes, Joan Leal-Blanquet, Pablo E Gelber, Joan Carles Monllau
Patellar instability is a common clinical problem encountered by orthopedic surgeons specializing in the knee. For patients with chronic lateral patellar instability, the standard surgical approach is to stabilize the patella through a medial patellofemoral ligament (MPFL) reconstruction. Foreseeably, an increasing number of revision surgeries of the reconstructed MPFL will be seen in upcoming years. In this paper, the causes of failed MPFL reconstruction are analyzed: (1) incorrect surgical indication or inappropriate surgical technique/patient selection; (2) a technical error; and (3) an incorrect assessment of the concomitant risk factors for instability...
February 18, 2017: World Journal of Orthopedics
https://www.readbyqxmd.com/read/28249974/trochleoplasty-with-a-flexible-osteochondral-flap-results-from-an-11-year-series-of-214-cases
#19
A J Metcalfe, D A Clark, M A Kemp, J D Eldridge
AIMS: The Bereiter trochleoplasty has been used in our unit for 12 years to manage recurrent patellar instability in patients with severe trochlea dysplasia. The aim of this study was to document the outcome of a large consecutive cohort of patients who have undergone this operation. PATIENTS AND METHODS: Between June 2002 and August 2013, 214 consecutive trochleoplasties were carried out in 185 patients. There were 133 women and 52 men with a mean age of 21.3 years (14 to 38)...
March 2017: Bone & Joint Journal
https://www.readbyqxmd.com/read/28246877/anatomic-patellar-instability-risk-factors-in-primary-lateral-patellar-dislocations-do-not-predict-injury-patterns-an-mri-based-study
#20
Marc A Tompkins, Sara R Rohr, Julie Agel, Elizabeth A Arendt
PURPOSE: The primary goal was to describe the injury patterns in a population of primary (first time) lateral patellar dislocators (LPD) to lend clarity to commonly held notions about injury patterns in this population. METHODS: A prospective study identifying patients presenting with LPD between 2008 and 2012. Inclusion criteria were a history and physical exam consistent with primary LPD, and an MRI consistent with the diagnosis without other significant ligamentous injury...
February 28, 2017: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
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