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Patellar instability

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https://www.readbyqxmd.com/read/28330756/femoral-articular-geometry-and-patellofemoral-stability
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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
#8
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
#9
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
#10
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
#11
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
#12
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
#13
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
https://www.readbyqxmd.com/read/28241086/the-anatomy-of-the-medial-patellofemoral-ligament
#14
Thai Q Trinh, Jason R Ferrel, Jared C Bentley, Robert N Steensen
Recurrent patellar dislocation is observed in many patients treated nonoperatively following primary dislocation. Injury to the medial patellofemoral ligament (MPFL) is reported in the majority of patients following dislocation. There is an increased interest in repair or reconstruction of the MPFL for patients experiencing recurrent instability. The femoral attachment of the MPFL is critical in determining graft behavior following reconstruction. The femoral attachment can be determined by referencing local anatomy, fluoroscopic imaging or on the basis of desired graft-length changes...
February 27, 2017: Orthopedics
https://www.readbyqxmd.com/read/28228051/patellar-complications-in-single-versus-double-tunnel-medial-patellofemoral-ligament-reconstruction
#15
Riazuddin Mohammed, Neil Hunt, A J Gibbon
PURPOSE: Hamstring graft fixation on the patellar side during medial patellofemoral ligament (MPFL) reconstruction is usually with transosseous tunnels and can frequently lead to further problems. The aim of our study was to compare and analyse patellar complications in single patellar tunnel versus double tunnel hamstring graft fixation. METHODS: Twenty-nine knees with MPFL reconstructions (group S) in which the hamstring tendon graft was transfixed using a suspensory fixation method in a single tunnel drilled across the patella were analysed in comparison with 29 knees (group D) with interference fixation of the graft through two tunnels drilled up to a predetermined depth in the patella...
January 2017: Journal of Orthopaedic Surgery
https://www.readbyqxmd.com/read/28224070/combined-particulated-juvenile-cartilage-allograft-transplantation-and-medial-patellofemoral-ligament-reconstruction-for-symptomatic-chondral-defects-in-the-setting-of-recurrent-patellar-instability
#16
Armin Arshi, Dean Wang, Kristofer J Jones
Successful management of patellar osteochondral lesions has proved difficult, with unreliable outcomes reported using traditional cartilage repair and restoration procedures. Unique considerations for this type of defect include the multiplanar contours of the articular surface of the patella, high compressive and shear forces with knee range of motion that may disrupt graft healing, and the potential need for concomitant surgery to address patellar malalignment and instability. We describe our preferred method for treatment of a symptomatic chondral defect in the setting of recurrent patellar instability using particulated juvenile articular cartilage allograft transplantation and medial patellofemoral ligament reconstruction with semitendinosus allograft...
October 2016: Arthroscopy Techniques
https://www.readbyqxmd.com/read/28219090/quality-of-life-outcomes-of-patients-following-patellofemoral-stabilization-surgery-the-influence-of-trochlear-dysplasia
#17
Laurie Anne Hiemstra, Sarah Kerslake, Mark R Lafave
Trochlear dysplasia is a well-described risk factor for recurrent patellofemoral instability. Despite its clear association with the incidence of patellofemoral instability, it is unclear whether the presence of high-grade trochlear dysplasia influences clinical outcome after patellofemoral stabilization. The purpose of this study was to assess whether trochlear dysplasia influenced patient-reported, disease-specific outcomes in surgically treated patellar instability patients, when risk factors were addressed in accordance with the à la carte surgical approach to the treatment of patellofemoral instability...
February 20, 2017: Journal of Knee Surgery
https://www.readbyqxmd.com/read/28217302/patellofemoral-joint-is-an-under-reported-joint-in-mri-knee-a-retrospective-cross-sectional-study
#18
Arun Khajuria, Amit Shah, Ankur Khajuria, Rajesh Botchu
BACKGROUND: Patellofemoral joint (PFJ) pathology accounts for upto 40% of cases of knee pain. It has been suggested that PFJ pathology may be underreported in Magnetic Resonance Imaging (MRI) Knee reports. The objective of this study was to elucidate whether PFJ was reported in MRI knee reports at our institution. MATERIALS AND METHODS: A retrospective review of 103 consecutive Knee MRIs over a 2-month period was performed by an author, blinded to the reports, at our institution...
March 2017: Annals of Medicine and Surgery
https://www.readbyqxmd.com/read/28210789/medial-patellofemoral-ligament-mpfl-reconstruction-in-combination-with-a-modified-grammont-technique-leads-to-favorable-mid-term-results-in-adolescents-with-recurrent-patellofemoral-dislocations
#19
Helmut Wegmann, Christoph Würnschimmel, Tanja Kraus, Georg Singer, Robert Eberl, Holger Till, Matthias Sperl
PURPOSE: The aim of the present study is to present the outcome of a cohort of adolescent patients with trochlear dysplasia and elevated tibial tuberosity trochlear groove (TTTG) distance suffering from recurrent patellar dislocation. Treatment consisted of medial patellofemoral ligament (MPFL) reconstruction and a modified Grammont procedure. METHODS: MRI examinations were obtained pre- and postoperatively. Trochlear dysplasia was classified according to Déjour, and TTTG was measured on MRI...
February 16, 2017: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
https://www.readbyqxmd.com/read/28210659/medial-patellofemoral-ligament-reconstruction-femoral-tunnel-accuracy-relationship-to-disease-specific-quality-of-life
#20
Laurie A Hiemstra, Sarah Kerslake, Mark Lafave
BACKGROUND: Medial patellofemoral ligament (MPFL) reconstruction is a procedure aimed to reestablish the checkrein to lateral patellar translation in patients with symptomatic patellofemoral instability. Correct femoral tunnel position is thought to be crucial to successful MPFL reconstruction, but the accuracy of this statement in terms of patient outcomes has not been tested. PURPOSE: To assess the accuracy of femoral tunnel placement in an MPFL reconstruction cohort and to determine the correlation between tunnel accuracy and a validated disease-specific, patient-reported quality-of-life outcome measure...
February 2017: Orthopaedic Journal of Sports Medicine
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