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Patellar instability

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https://www.readbyqxmd.com/read/28089467/the-evolution-of-implant-design-decreases-the-incidence-of-lateral-release-in-primary-total-knee-arthroplasty
#1
Jonathan E Webb, Heidi Y Yang, Jamie E Collins, Elena Losina, Thomas S Thornhill, Jeffrey N Katz
BACKGROUND: Appropriate balancing of the patellofemoral joint (PFJ) using a lateral release can help to prevent patellar instability in total knee arthroplasty (TKA). Contemporary total knee implant designs are characterized by enhanced trochlear geometry more similar to native knee anatomy to minimize instability and reduce utilization of a lateral release. METHODS: We retrospectively reviewed consecutive TKA cases from a single senior surgeon's practice with 3 successive total knee designs: the Press-Fit Condylar (PFC), the Sigma, and the ATTUNE (DePuy, Warsaw, IN)...
December 14, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28056523/the-tibial-tubercle-trochlear-groove-distance-is-greater-in-patients-with-patellofemoral-pain
#2
Victor R Carlson, Barry P Boden, Aricia Shen, Jennifer N Jackson, Lawrence Yao, Frances T Sheehan
BACKGROUND: The distance between the tibial tubercle (TT) and trochlear groove (TT-TG distance) is known to be greater in patients with patellar instability. However, the potential role and prevalence of pathological TT-TG distances in a large cohort of skeletally mature patients with isolated patellofemoral pain (PFP) are not clear. PURPOSE: To determine if the mean TT-TG distance is greater in patients with PFP, who lack a history of patellar dislocations, knee trauma, or osteoarthritis, relative to healthy controls...
December 1, 2016: American Journal of Sports Medicine
https://www.readbyqxmd.com/read/28050572/comparison-of-a-novel-weightbearing-cone-beam-computed-tomography-scanner-versus-a-conventional-computed-tomography-scanner-for-measuring-patellar-instability
#3
John Marzo, Melissa Kluczynski, Anthony Notino, Leslie Bisson
BACKGROUND: Conventional computed tomography (CT) images are routinely used for diagnosing patellofemoral instability and are obtained with the patient in a supine position, nonweightbearing, with the knee in full extension, and with leg muscles relaxed. A new portable extremity cone beam CT (CBCT) scanner has been developed that may allow for more accurate diagnosis, as imaging can be performed with the patient standing, the knee flexed, and with leg muscles active. PURPOSE/HYPOTHESIS: The purpose of this study was to compare CT measurements of patellar alignment on a prototype scanner versus conventional scanner in patients with known patellar instability...
December 2016: Orthopaedic Journal of Sports Medicine
https://www.readbyqxmd.com/read/28029579/patellar-inversion-180-degree-rotation-of-the-patella-around-its-vertical-axis-within-the-intercondylar-notch
#4
Samarth Mittal, Arkesh M, Vivek Shankar, Swapnil Singh, Pankaj Sharma, Ravi Mittal
BACKGROUND: Dislocation of the patella can occur around its vertical as well as horizontal axis. However, near 180 degree rotation of the patella around its vertical axis within the intercondylar notch without its complete dislocation has never been previously reported to the best of our knowledge. We report one such neglected case along with its management. METHODS: The patient underwent open reduction and de-rotation of patella with repair of the medial and lateral patellar retinacula...
October 28, 2016: Knee
https://www.readbyqxmd.com/read/28028569/functional-testing-and-return-to-sport-following-stabilization-surgery-for-recurrent-lateral-patellar-instability-in-competitive-athletes
#5
Aaron J Krych, Michael P O'Malley, Nick R Johnson, Rohith Mohan, Timothy E Hewett, Michael J Stuart, Diane L Dahm
PURPOSE: Medial patellofemoral ligament (MPFL) reconstruction and tibial tubercle osteotomy are commonly used to treat recurrent lateral patellar instability, yet there are limited available data on return to sport (RTS) following these procedures. The purpose of this study is to evaluate patient factors associated with excellent functional outcomes, including successful RTS, following surgical stabilization including MPFL reconstruction in competitive athletes with recurrent lateral patellar instability...
December 27, 2016: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
https://www.readbyqxmd.com/read/28005409/safe-drilling-paths-in-the-distal-femoral-epiphysis-for-pediatric-medial-patellofemoral-ligament-reconstruction
#6
Cynthia V Nguyen, Lutul D Farrow, Raymond W Liu, Allison Gilmore
BACKGROUND: Anatomic surgical reconstruction of the medial patellofemoral ligament (MPFL) has been popularized for the treatment of recurrent patellar instability in the skeletally immature population. Previous anatomic studies have found that the femoral attachment point of the MPFL is very close to the distal femoral physis. PURPOSE: To establish the safe angles for drilling the distal femoral epiphysis for MPFL graft placement. STUDY DESIGN: Descriptive laboratory study...
December 1, 2016: American Journal of Sports Medicine
https://www.readbyqxmd.com/read/28005405/patellofemoral-arthritis-after-lateral-patellar-dislocation
#7
Thomas L Sanders, Ayoosh Pareek, Nicholas R Johnson, Michael J Stuart, Diane L Dahm, Aaron J Krych
BACKGROUND: The rate of patellofemoral arthritis after lateral patellar dislocation is unknown. Purpose/Hypothesis: The purpose of this study was to compare the risk of patellofemoral arthritis and knee arthroplasty between patients who experienced a lateral patellar dislocation and matched individuals without a patellar dislocation. Additionally, factors predictive of arthritis after patellar dislocation were examined. The hypothesis was that the rate of arthritis is likely higher among patients who experience a patellar dislocation compared with those who do not...
December 1, 2016: American Journal of Sports Medicine
https://www.readbyqxmd.com/read/27999505/osteochondral-allograft-transplantation-for-femoral-trochlear-dysplasia
#8
Dharmpal V Vansadia, James R Heltsley, Scott Montgomery, Misty Suri, Deryk G Jones
BACKGROUND: The risk factors for patellofemoral joint instability include laxity of medial patellar restraints, abnormal limb geometry, femoral and tibial malrotation, patella alta, and trochlear dysplasia. Femoral trochlear dysplasia is characterized by a hypoplastic or shallow trochlear groove. CASE REPORT: We report the case of a 31-year-old female with trochlear dysplasia and recurrent patella dislocations, laxity of the medial patellofemoral ligament (MPFL), and high-grade chondromalacia of the trochlea and the patella...
2016: Ochsner Journal
https://www.readbyqxmd.com/read/27988165/increased-femoral-anteversion-influence-over-surgically-treated-recurrent-patellar-instability-patients
#9
Carlos Eduardo Franciozi, Luiz Felipe Ambra, Leonardo José Bernardes Albertoni, Pedro Debieux, Fernando Cury Rezende, Mauricio Ayres de Oliveira, Marcio de Castro Ferreira, Marcus Vinícius Malheiros Luzo
PURPOSE: To verify the influence that increased femoral anteversion (FA) has on patients with recurrent patellar instability (RPI) treated by anteromedialization tibial tubercle osteotomy (TTO) combined with medial patellofemoral ligament reconstruction (MPFLR) and to present the midterm outcomes of these patients. METHODS: From January 2008 to August 2013, skeletally mature patients with RPI and tibial tubercle (TT)-trochlear groove (TG) ≥ 17 mm who underwent anteromedialization TTO combined with MPFLR were evaluated for J sign, patellar glide, apprehension test, increased FA, Caton index, trochlea dysplasia, TT-TG, Kujala, International Knee Documentation Committee subjective knee evaluation form, and Tegner...
December 14, 2016: Arthroscopy: the Journal of Arthroscopic & related Surgery
https://www.readbyqxmd.com/read/27957592/-lateral-unicompartmental-knee-arthroplasty-a-challenge
#10
T Walker, P R Aldinger, M R Streit, T Gotterbarm
OBJECTIVE: Joint surface replacement in the lateral compartment by unicondylar knee arthroplasty. INDICATIONS: Lateral unicompartmental osteoarthritis of the knee joint, avascular necrosis of the lateral femoral condyle. CONTRAINDICATIONS: Full thickness cartilage defect in the central part of the medial compartment or in the medial aspect of the patellofemoral joint. Instability/contracture of cruciate and collateral ligaments, valgus deformity >15°, valgus deformity not passively correctable, flexion deformity >15°, an intraoperative flexion <100°, failed upper tibial osteotomy, rheumatoid arthritis...
December 12, 2016: Operative Orthopädie und Traumatologie
https://www.readbyqxmd.com/read/27935008/distal-femoral-lateral-closing-wedge-osteotomy-as-a-component-of-comprehensive-treatment-of-medial-patellar-luxation-and-distal-femoral-varus-in-dogs
#11
Barry E Brower, Michael P Kowaleski, Ann M Peruski, Antonio Pozzi, Jonathan Dyce, Kenneth A Johnson, Randy J Boudrieau
OBJECTIVE: To describe a cohort of dogs with medial patellar luxation managed with a distal femoral lateral closing wedge ostectomy (DFO) as a component of comprehensive treatment, and to report radiographic and long-term clinical outcome of this technique. METHODS: Medical records of dogs that had a lateral closing wedge DFO as part of management of medial patellar luxation at three veterinary teaching hospitals were reviewed. Surgical reports as well as the preoperative, postoperative, and follow-up radiographs were reviewed...
January 16, 2017: Veterinary and Comparative Orthopaedics and Traumatology: V.C.O.T
https://www.readbyqxmd.com/read/27920260/how-to-deal-with-anterior-knee-pain-in-the-active-young-patient
#12
Vicente Sanchis-Alfonso, Scott F Dye
CONTEXT: Anterior knee pain (AKP) represents the most common reason to consult with a clinician who specializes in the knee. Despite the high incidence of the disorder, however, its etiology is still controversial. Many unnecessary surgeries that may damage the patient are done for this clinical entity. EVIDENCE ACQUISITION: A PubMed search from 1995 through June 2016. STUDY DESIGN: Clinical review. LEVEL OF EVIDENCE: Level 4...
December 5, 2016: Sports Health
https://www.readbyqxmd.com/read/27904790/current-concepts-in-the-treatment-of-gross-patellofemoral-instability
#13
Grant Buchanan, LeeAnne Torres, Brian Czarkowski, Charles E Giangarra
: Patellofemoral instability is a painful and commonly recurring condition, which often must be managed surgically. Diagnosis can be aided by the use of a variety of physical exam signs, such as the Q angle, Beighton hypermobility score, glide test, J sign, patellar tilt test, and apprehension test. Imaging modalities including x-ray, CT, and MRI guide both diagnosis and management by revealing trochlear dysplasia, bony malalignment, and ligamentous injury that contribute to instability...
December 2016: International Journal of Sports Physical Therapy
https://www.readbyqxmd.com/read/27900510/does-a-positioning-rod-or-a-patient-specific-guide-result-in-more-natural-femoral-flexion-in-the-concept-of-kinematically-aligned-total-knee-arthroplasty
#14
Max Ettinger, Tilman Calliess, Stephen M Howell
PURPOSE: Flexion of the femoral component in 5° increments downsizes the femoral component, decreases the proximal reach and surface area of the trochlea, delays the engagement of the patella during flexion, and is associated with a higher risk of patellar-femoral instability after kinematically aligned TKA. The present study evaluated flexion of the femoral component after use of two kinematic alignment instrumentation systems. We determined whether a distal cutting block attached to a positioning rod inserted perpendicular to the distal femoral joint line in the axial plane and 8-10 cm into the distal femur anterior and posterior to the distal cortex of the femur in the sagittal plane or a femoral patient-specific cutting guide sets the femoral component in more natural flexion...
January 2017: Archives of Orthopaedic and Trauma Surgery
https://www.readbyqxmd.com/read/27894178/comparison-of-radiological-parameters-between-normal-and-patellar-dislocation-groups-in-korean-population-a-rotational-profile-ct-based-study
#15
Jatin Prakash, Jong-Keun Seon, Seong-Hwan Woo, Cheng Jin, Eun-Kyoo Song
Purpose: Patellofemoral instability is a common cause of anterior knee pain in adolescents and young adults. Most normal and pathological values for diagnosing patellofemoral instability are based on Western literature. We conducted this radiological study to determine normal values for different patellofemoral parameters in a Korean population and to evaluate their usefulness in diagnosis. Materials and Methods: We retrospectively reviewed the rotational profile computerized tomography (CT) scans of the patellar dislocation and control groups...
December 1, 2016: Knee Surgery & related Research
https://www.readbyqxmd.com/read/27826597/are-the-current-classifications-and-radiographic-measurements-for-trochlear-dysplasia-appropriate-in-the-skeletally-immature-patient
#16
Matthew Stepanovich, James D Bomar, Andrew T Pennock
BACKGROUND: The assessment and classification of trochlear dysplasia in pediatric patients has yet to be well documented or validated. PURPOSE: To examine several different measurements/classifications of trochlear dysplasia in skeletally immature patients to assess inter- and intraobserver reliability and to determine which best correlates with patellar instability. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 3. METHODS: Radiographs and magnetic resonance imaging (MRI) scans of 36 skeletally immature patients undergoing surgery for patellar instability were compared with 27 age-matched cohort patients who had similar imaging for an acute knee injury but no clinical evidence of patellar instability...
October 2016: Orthopaedic Journal of Sports Medicine
https://www.readbyqxmd.com/read/27810431/clinical-results-after-treatment-for-bidirectional-patellar-subluxation-minimum-2-years-follow-up
#17
Michael Saper, Candice Brady, Robert Zondervan, David Shneider
BACKGROUND: We describe the preliminary clinical results of a patellar stabilization technique to treat bidirectional patellar subluxation (BPS). METHODS: Patients: six patients (one male, five females; mean age 30.2years) underwent this procedure with a minimum of 24months follow-up. Patients were assessed for clinical instability, patellar complications, and need for revision surgery. Patient functional outcomes were evaluated using the criteria of Crosby and Insall and the Kujala Anterior Knee Pain Scale at the time of final follow-up...
December 2016: Knee
https://www.readbyqxmd.com/read/27796419/results-of-medial-patellofemoral-ligament-reconstruction-compared-with-trochleoplasty-plus-individual-extensor-apparatus-balancing-in-patellar-instability-caused-by-severe-trochlear-dysplasia-a-systematic-review-and-meta-analysis
#18
REVIEW
Peter Balcarek, Stephan Rehn, Nick R Howells, Jonathan D Eldridge, Keisuke Kita, David Dejour, Manfred Nelitz, Ingo J Banke, Delphine Lambrecht, Markus Harden, Tim Friede
PURPOSE: Many studies have reported satisfactory clinical outcomes and low redislocation rates after reconstruction of the medial patellofemoral ligament (MPFL) for the treatment of lateral patellar instability. Despite uncorrected severe trochlear dysplasia (Dejour type B to D) being acknowledged as a major reason for less favourable clinical outcomes and a higher incidence of patellar redislocations after an isolated MPFL reconstruction, the evidence for a deepening trochleoplasty procedure remains scarce in the current literature...
October 27, 2016: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
https://www.readbyqxmd.com/read/27782936/the-lateral-wedge-augmentation-trochleoplasty-in-a-pediatric-population-a-5-year-follow-up-study
#19
Sébastien Pesenti, Benjamin Blondel, Gregory Armaganian, Sébastien Parratte, Gérard Bollini, Franck Launay, Jean-Luc Jouve
Patellofemoral instability in children requires surgery when recurrent dislocation occurs. The aim of this study is to report the 5-year clinical and radiographic outcomes following lateral wedge augmentation trochleoplasty of the femoral trochlea. This is a review of 23 (mean age: 12.5 years) patients who underwent surgery for recurrent patellar dislocations related to a flat trochlea. In every case, a lateral wedge augmentation trochleoplasty was performed with preservation of the growth plate. This surgery was consistently associated with a soft tissue procedure...
October 25, 2016: Journal of Pediatric Orthopedics. Part B
https://www.readbyqxmd.com/read/27780349/early-experience-with-vitamin-e-antioxidant-infused-highly-cross-linked-polyethylene-inserts-in-primary-total-knee-arthroplasty
#20
Emilie M Flament, Keith R Berend, Jason M Hurst, Michael J Morris, Joanne B Adams, Adolph V Lombardi
BACKGROUND: In past decades, polyethylene wear was a major cause of failure in total knee arthroplasty (TKA). Polyethylene for use in arthroplasty has been vastly improved in recent years, with improved materials as well as manufacturing and sterilization processes. Testing has shown that infusion of vitamin E prevents oxidative degradation of polyethylene without remelting, allowing the material to maintain mechanical properties and wear resistance over time. The purpose of this study is to review the early result of patients undergoing primary TKA with vitamin E antioxidant-infused polyethylene inserts...
October 26, 2016: Surgical Technology International
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