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Patellar instability

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https://www.readbyqxmd.com/read/28630757/the-patellofemoral-joint-from-dysplasia-to-dislocation
#1
Stefano Zaffagnini, Alberto Grassi, Gianluca Zocco, Michele Attilo Rosa, Cecilia Signorelli, Giulio Maria Marcheggiani Muccioli
Patellofemoral dysplasia is a major predisposing factor for instability of the patellofemoral joint. However, there is no consensus as to whether patellofemoral dysplasia is genetic in origin, caused by imbalanced forces producing maltracking and remodelling of the trochlea during infancy and growth, or due to other unknown and unexplored factors.The biomechanical effects of patellofemoral dysplasia on patellar stability and on surgical procedures have not been fully investigated. Also, different anatomical and demographic risk factors have been suggested, in an attempt to identify the recurrent dislocators...
May 2017: EFORT open reviews
https://www.readbyqxmd.com/read/28628800/increased-internal-femoral-torsion-can-be-regarded-as-a-risk-factor-for-patellar-instability-a-biomechanical-study
#2
Peter Kaiser, Werner Schmoelz, Philip Schoettle, Marit Zwierzina, Christian Heinrichs, Rene Attal
BACKGROUND: Increased internal femoral torsion is regarded as a risk factor for patellar instability. Biomechanical investigations confirming this hypothesis are missing. METHODS: Eight fresh-frozen cadaver knees were tested on a specially designed simulator. Patellar motion and patellofemoral pressure were evaluated for 0°, 10°, and 20° of increased internal and external femoral torsion with native and with transected medial patellofemoral ligaments used to simulate patellar instability...
June 10, 2017: Clinical Biomechanics
https://www.readbyqxmd.com/read/28623415/a-stand-alone-lateral-condyle-elevating-trochlear-osteotomy-leads-to-high-residual-instability-but-no-excessive-increase-in-patellofemoral-osteoarthritis-at-12-year-follow-up
#3
S Tigchelaar, J van Sambeeck, S Koeter, A van Kampen
PURPOSE AND HYPOTHESIS: Trochlear osteotomy is a rarely performed procedure, only indicated in selected cases. Due to its nature, it can potentially lead to cartilage damage and subsequent early osteoarthritis. Satisfactory short-term results from lateral condyle-elevating osteotomy have previously been reported. The long-term effects of this procedure on clinical outcomes, patellar stability and radiological osteoarthritis are reported here. METHODS: Sixteen patients (19 knees) with patellar instability due to trochlear dysplasia were included...
June 16, 2017: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
https://www.readbyqxmd.com/read/28614288/evaluation-of-the-tibial-tubercle-to-posterior-cruciate-ligament-distance-in-a-pediatric-patient-population
#4
Blake Clifton, Dustin L Richter, Dan Tandberg, Matthew Ferguson, Gehron Treme
BACKGROUND: Evaluation of distal extensor mechanism alignment continues to evolve in children with patella instability. Prior studies support the use of the tibial tubercle to trochlear groove (TT-TG) distance but limitations exist for this measurement including: changes in the TT-TG distance with knee flexion, difficulty with finding the deepest part of a dysplastic trochlea, and limitations regarding identification of the site of the anatomic abnormality. The tibial tubercle-posterior cruciate ligament (TT-PCL) distance has been introduced as an alternative measure to address the shortcomings in the TT-TG distance by quantifying the position of the TT independent of the trochlea and with respect to the tibia only...
June 13, 2017: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/28614283/recurrent-patellar-instability-implications-of-preoperative-patellar-crepitation-on-the-status-of-the-patellofemoral-articular-cartilage
#5
Scott J Luhmann, June C Smith, Mario Schootman, Nandan Prasad
BACKGROUND: The purpose of the study was to quantify the frequency, severity, and location of patellofemoral (PF) articular cartilage changes recurrent patellar instability treated surgically in patients with preoperative clinical patellar crepitation. METHODS: A single-surgeon database was queried for all knees with recurrent patellar instability between 3/2000 and 6/2012 (n=214). Only knees which underwent knee arthroscopy during the surgical treatment were included (n=148)...
June 13, 2017: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/28601942/anatomic-reconstruction-of-the-medial-patellofemoral-ligament-in-children-and-adolescents-using-a-pedicled-quadriceps-tendon-graft-shows-favourable-results-at-a-minimum-of-2-year-follow-up
#6
Manfred Nelitz, Jens Dreyhaupt, Sean Robert March Williams
PURPOSE: In adults, reconstruction of the medial patellofemoral ligament (MPFL) has shown good results. Treatment for recurrent patellar instability in children and adolescents with open growth plates, however, requires alternative MPFL reconstruction techniques. This study presents the outcomes of a minimally invasive technique for anatomic reconstruction of the MPFL in children using a pedicled superficial quadriceps tendon graft, hardware-free patellar graft attachment, and anatomic femoral fixation that spares the distal femoral physis...
June 10, 2017: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
https://www.readbyqxmd.com/read/28594500/patellofemoral-arthroplasty-an-evolving-science
#7
Jess H Lonner
Patellofemoral arthroplasty (PFA) has long been a clinical option for patients with isolated patellofemoral arthritis. However, a high rate of failure as a result of patellar instability related to component malposition, soft-tissue imbalance, errant surgical techniques, and poor trochlear implant designs contributed to the underutilization of PFA. The evolution of surgical indications, trochlear implant design, component positioning, and soft-tissue balance has led to improved patellar tracking, fewer failures related to patellar instability, and improved functional outcomes...
February 15, 2017: Instructional Course Lectures
https://www.readbyqxmd.com/read/28593102/rehabilitation-following-medial-patellofemoral-ligament-reconstruction-for-patellar-instability
#8
Robert C Manske, Daniel Prohaska
Patellar instability is a common problem seen by physical therapists, athletic trainers and orthopedic surgeons. Although following an acute dislocation, conservative rehabilitation is usually the first line of defense; refractory cases exist that may require surgical intervention. Substantial progress has been made in the understanding of the medial patellofemoral ligament (MPFL) and its role as the primary stabilizer to lateral patellar displacement. Medial patellofemoral ligament disruption is now considered to be the essential lesion following acute patellar dislocation due to significantly high numbers of ruptures following this injury...
June 2017: International Journal of Sports Physical Therapy
https://www.readbyqxmd.com/read/28585997/diagnosis-and-management-of-traumatic-patellar-instability-in-the-pediatric-patient
#9
Steven F DeFroda, Joseph A Gil, Alex Boulos, Aristides I Cruz
Instability of the patella is a common cause of knee pain and dysfunction in pediatric and adolescent patients and can be due to several factors. Although some patients will recall a specific traumatic event others may not, requiring the diagnosis to be made on the basis of physical examination and imaging. Congenital dislocation and connective tissue disorders should also be considered, even in the setting of trauma. There are radiographic parameters that may identify causes of instability such as trochlear and patellar abnormalities, and magnetic resonance imaging can identify signs of trauma such as bony edema, loose osteochondral fragments, and increased tibial tubercle-trochlear groove distance...
June 6, 2017: Orthopedics
https://www.readbyqxmd.com/read/28580253/arthroscopic-patellar-lateral-facetectomy
#10
Marcio B Ferrari, George Sanchez, Jorge Chahla, Gilbert Moatshe, Robert F LaPrade
Isolated patellofemoral osteoarthritis is relatively prevalent, with the lateral facet of the patella being the most commonly affected portion. This pathology can be a result of a patellar maltracking syndrome, patella instability, or idiopathic degenerative changes. A thorough diagnostic work-up with a physical examination and imaging studies are mandatory for a proper diagnosis and to rule out other causes of patellofemoral knee pain. These patients are often treated nonoperatively with exercises for patella mobility, intra-articular injections, braces, patellar tracking, quadriceps balance and strength, and activity modification...
April 2017: Arthroscopy Techniques
https://www.readbyqxmd.com/read/28577210/-distal-femoral-osteotomy-using-a-lateral-opening-wedge-technique
#11
M J Feucht, J Mehl, P Forkel, A B Imhoff, S Hinterwimmer
OBJECTIVE: To shift the weight-bearing axis of the lower limb medially by opening a lateral-based metaphyseal osteotomy at the distal femur. INDICATIONS: Femoral-based valgus malalignment and symptomatic lateral unicompartimental osteoarthritis, lateral hyperpression syndrome, cartilage therapy of the lateral compartment, lateral meniscal replacement/transplantation, medial instability with valgus thrust, reconstruction of the medial collateral ligament, patellar instability and/or maltracking...
June 2, 2017: Operative Orthopädie und Traumatologie
https://www.readbyqxmd.com/read/28567511/trochleoplasty-techniques-provide-good-clinical-results-in-patients-with-trochlear-dysplasia
#12
REVIEW
Umile Giuseppe Longo, Candela Vincenzo, Nicholas Mannering, Mauro Ciuffreda, Giuseppe Salvatore, Alessandra Berton, Vincenzo Denaro
PURPOSE: The aim of this systematic review is to compare the clinical outcomes of patients treated with different trochleoplasty procedures, the rate of complications and recurrence of patellar dislocation. METHODS: A systematic review of the literature was performed, in accord with the PRISMA guidelines. PubMed, MEDLINE, CINAHL, Cochrane, EMBASE and Google Scholar databases were comprehensively searched using the keyword combinations, "Dejour trochleoplasty", "Bereiter Trochleoplasty", "Albee Trochleoplasty", "Recession Trochleoplasty", "Trochlear Dysplasia", "Instability", "Adult", "Clinical Outcome" and "Surgery"...
May 31, 2017: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
https://www.readbyqxmd.com/read/28566788/patellar-tendon-re-rupture-on-the-opposite-end-of-the-previous-site-of-surgical-repair
#13
Bryan Thean Howe Koh, Andrew A Sayampanathan, Keng Thiam Lee
We describe a rare case of a patellar tendon "re-rupture" at the opposite end of a previous proximal tendon repair. A 32-year-old male with a history of surgically repaired right proximal patellar tendon rupture presented with an acute non-traumatic right knee pain and instability during sports. Magnetic resonance imaging confirmed a complete rupture of his distal patellar tendon at the tibial tuberosity. The patellar tendon was repaired using two 5.5 mm BioCorkscrews (Arthrex) inserted into the tibial tuberosity; the tendon was stitched with the No...
May 2017: Indian Journal of Orthopaedics
https://www.readbyqxmd.com/read/28541005/a-combined-closing-wedge-distal-femoral-osteotomy-and-medial-reefing-procedure-for-recurrent-patellar-dislocation-with-genu-valgum
#14
Chong Bum Chang, Gautam M Shetty, Jong Seong Lee, Young Chan Kim, Jae Ho Kwon, Kyung Wook Nha
PURPOSE: Recurrent patellar dislocation is often associated with genu valgum. The purpose of this study was to analyze the short-term results of single-incision, closing-wedge distal femoral osteotomy (CWDFO) combined with medial reefing and lateral release for recurrent patellar instability with genu valgum. MATERIALS AND METHODS: Combined CWDFO/medial reefing/lateral release was performed on 10 knees. Clinical evaluation was based on pre- and postoperative Knee Society Score (KSS) and Kujala patellofemoral score...
July 2017: Yonsei Medical Journal
https://www.readbyqxmd.com/read/28532997/the-influence-of-varus-and-valgus-deviation-on-patellar-kinematics-in-healthy-knees-an-exploratory-cadaver-study
#15
Michael Worlicek, Benedikt Moser, Günther Maderbacher, Raphael Zentner, Florian Zeman, Joachim Grifka, Armin Keshmiri
BACKGROUND: Patellofemoral instability may lead to osteoarthritis, anterior knee pain, and patellar luxation. The purpose of this study was to conduct an exploratory investigation into the difference of patellar kinematics of healthy knees during extension/flexion cycles in neutral, varus and valgus alignment. METHODS: The three-dimensional patellar kinematics of 10 lower extremities of whole body cadavers were examined during passive motion, in neutral position, and under valgus and varus stress...
May 19, 2017: Knee
https://www.readbyqxmd.com/read/28510474/increased-magnetic-resonance-imaging-signal-of-the-lateral-patellar-facet-cartilage-a-functional-marker-for-patellar-instability
#16
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
#17
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
#18
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
#19
Tyson C Christensen, Thomas L Sanders, Ayoosh Pareek, Rohith Mohan, 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
#20
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
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