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Trochlear dysplasia

Laurie Anne Hiemstra, Sarah Kerslake, Mark Lafave
PURPOSE: The WARPS/STAID classification employs clinical assessment of presenting features and anatomic characteristics to identify two distinct subsets of patients within the patellofemoral instability population. The purpose of this study was to further define the specific demographics and the prevalence of risky pathoanatomies in patients classified as either WARPS or STAID presenting with recurrent patellofemoral instability. A secondary purpose was to further validate the WARPS/STAID classification with the Banff Patella Instability Instrument (BPII), the Marx activity scale and the Patellar Instability Severity Score (ISS)...
October 7, 2016: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Hülya Kurtul Yildiz, Elif Evrim Ekin
PURPOSE: The medial patellofemoral ligament (MPFLL)/lateral patellar retinaculum (LPR) ratio were assessed in knees as a means to detect patellar malalignment. We also aimed to evaluate the prevalence of the various types of trochlear dysplasia in patients with patellar malalignment. MATERIALS AND METHODS: After approval of our institutional ethics committee, we conducted a retrospective study that included 450 consecutive patients to evaluate them for the presence of patellar malalignment...
2016: SpringerPlus
Mansur Halai, Andrew Ker, Iain Anthony, Graeme Holt, Bryn Jones, Mark Blyth
AIM: To determine outcomes using the Femoro-Patella Vialla (FPV) arthroplasty and if there is an ideal patient for this implant. METHODS: A total of 41 FPV patellofemoral joint replacements were performed in 31 patients (22 females, 9 males, mean age 65 years). Mean follow-up was 3.2 years (minimum 2 years). Radiographs were reviewed preoperatively and postoperatively. We assessed whether gender, age, previous surgery, patella atla or trochlear dysplasia influenced patient satisfaction or patient functional outcome...
August 18, 2016: World Journal of Orthopedics
Marie Askenberger, Per-Mats Janarv, Throstur Finnbogason, Elizabeth A Arendt
BACKGROUND: The incidence of primary lateral patellar dislocation (LPD) in children aged 9 to 14 years is 0.6 to 1.2 per 1000. Causation is assumed to be multifactorial, including anatomic variants of the patellofemoral (PF) joint that result in a higher risk of LPD. No publication has compared the morphology of the PF joint and anatomic patellar instability risk factors (APIFs) in a primary LPD population versus controls, defining children by skeletal maturity. PURPOSE: To characterize the PF morphology and APIFs (trochlear dysplasia, abnormal lateral patellar tilt, elevated tibial tubercle-trochlear groove [TT-TG] distance, patella alta) through magnetic resonance imaging (MRI) measurements in skeletally immature children with and without a primary LPD and to identify (potential) distinctive differences between these 2 groups...
September 9, 2016: American Journal of Sports Medicine
Eric Hohn, Nirav K Pandya
BACKGROUND: Medial patellofemoral ligament (MPFL) reconstruction is one of several surgical procedures used to treat patellofemoral instability. Use of allograft tissue can preserve autogenous tissue and may be preferable in patients with connective tissue disorders or ligamentous laxity. Although there are successful reports in adults, it is unclear if the use of allograft tissue in MPFL reconstruction can restore patellofemoral stability in children and adolescents. QUESTIONS/PURPOSES: (1) Does allograft tissue in MPFL reconstruction in pediatric and adolescent patients restore patellar stability? (2) What complications were associated with allograft MPFL reconstructions in children and adolescents? METHODS: Between June 2012 and August 2015, one surgeon (NKP) performed 26 MPFL reconstructions in 23 patients with gracilis allograft for traumatic patellar instability...
September 2, 2016: Clinical Orthopaedics and related Research
Carlo Camathias, Katrin Studer, Ata Kiapour, Erich Rutz, Patrick Vavken
BACKGROUND: The essential static patellar stabilizer is a normal-shaped trochlear groove. A dysplastic groove destabilizes the patella. Trochleoplasty approaches this underlying condition and reshapes the trochlea. However, studies have reported on trochleoplasty for revision cases or as accompanied by other interventions. The effect of trochleoplasty alone remains unexplained. PURPOSE: To introduce trochleoplasty as a stand-alone treatment for recurrent patellar dislocation and to compare its pre- to postoperative functional and clinical variables...
July 19, 2016: American Journal of Sports Medicine
Shichang Chen, Zhe Du, Mengning Yan, Bing Yue, You Wang
PURPOSE: This study aimed to investigate the natural morphology of the femoral trochlear groove based on quantitative measurement. METHODS: Computed tomographic femur models of 50 male and 50 female healthy Chinese adults (30-60 years) were analysed using three-dimensional software. Coaxial cutting planes (15° increments) rotating about the trochlear groove axis from the proximal to distal point were created, followed by the deepest point of the trochlear groove marked at each cross section...
July 9, 2016: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Guang-Ying Zhang, Lei Zheng, Hao Shi, Bing-Jun Ji, Yan Feng, Hong-Yu Ding
OBJECTIVES: To assess the relationship between injury patterns of medial patellofemoral ligament (MPFL) and anatomical variants and patellar cartilage lesions after acute lateral patellar dislocation (LPD) in children. METHODS: MR images were obtained in 140 children with acute LPD. Images were acquired and evaluated using standardised protocols. RESULTS: Fifty-eight cases of partial MPFL tear and 75 cases of complete MPFL tear were identified...
June 28, 2016: European Radiology
Chase S Dean, Jorge Chahla, Raphael Serra Cruz, Tyler R Cram, Robert F LaPrade
Recurrent patellar instability can be very debilitating and may require surgical intervention. A thorough workup must be completed in this subset of patients. Risk factors for recurrent instability include patella alta, trochlear dysplasia, an increased tibial tubercle-trochlear groove distance, and insufficiencies in the medial retinacular structures. Necessary treatment of these risk factors, once identified, should be addressed surgically. Patellofemoral reconstruction must be individually tailored to each patient's anatomy and may necessitate medial patellofemoral ligament reconstruction, tibial tubercle osteotomy, or trochleoplasty in any combination or as a standalone procedure...
February 2016: Arthroscopy Techniques
Laurie A Hiemstra, Sarah Kerslake, Michael Loewen, Mark Lafave
BACKGROUND: Trochlear dysplasia is a well-described risk factor for patellofemoral instability. Despite its clear association with the incidence of patellar instability, it is unclear whether the presence of high-grade trochlear dysplasia influences clinical outcome after patellofemoral stabilization. PURPOSE: To determine whether isolated proximal soft tissue stabilization for patellofemoral instability is as successful in patients with high-grade dysplasia compared with low-grade or no dysplasia, as measured by disease-specific quality-of-life and pain scores...
June 2016: American Journal of Sports Medicine
Michael Christian Liebensteiner, Julia Ressler, Gerd Seitlinger, Tanja Djurdjevic, Rene El Attal, Peter Wilhelm Ferlic
PURPOSE: To investigate the possible relation between femoral anteversion (AV) and trochlear morphology. METHODS: Among 560 available lower-limb computed tomography (CT) scans, those with previous fracture, arthroplasty, or osteotomy were excluded and 40 cases were randomly selected. The following 4 lines were determined from the CT scans: 1 through the center of the femoral head and neck; 1 through the lesser trochanter and the center of the femoral shaft; 1 as a tangent to the dorsal part of the distal femur, just above the gastrocnemius insertion; and 1 as a tangent to the posterior condyles...
May 18, 2016: Arthroscopy: the Journal of Arthroscopic & related Surgery
Tobias J Dietrich, Sandro F Fucentese, Christian W A Pfirrmann
This review article presents several pitfalls and limitations of image interpretation of anatomical risk factors for patellar instability. The most important imaging examinations for the work-up of patients with patellar instability are the true lateral radiograph and transverse computed tomography (CT) or MR images of the knee. Primary anatomical risk factors are an insufficient medial patellofemoral ligament (MPFL), patella alta, trochlear dysplasia, increased distance from the tibial tuberosity to the trochlear groove (TTTG), and torsional limb parameters...
February 2016: Seminars in Musculoskeletal Radiology
Hee Kyung Kim, Sahar Shiraj, Chang Ho Kang, Christopher Anton, Dong Hoon Kim, Paul S Horn
OBJECTIVE: The purpose of this study was to compare MRI findings between groups with and without patellofemoral instability and to correlate the MRI findings with the severity of patellar cartilage damage. MATERIALS AND METHODS: Fifty-three children with patellofemoral instability and 53 age- and sex-matched children without patellofemoral instability (15.9 ± 2.4 years) were included. Knee MRI with T2-weighted mapping was performed. On MR images, femoral trochlear dysplasia, patellofemoral malalignment, medial retinaculum injury, and bone marrow edema were documented...
June 2016: AJR. American Journal of Roentgenology
S Tigchelaar, J de Rooy, G Hannink, S Koëter, A van Kampen, E Bongers
AIM: Nail patella syndrome (NPS) is a skeletal dysplasia with patellofemoral dysfunction as a key symptom. We present the first in-depth radiological evaluation of the knee in a large series of NPS patients and describe the typical malformations. PATIENTS AND METHODS: Conventional radiological examination of 95 skeletally mature patients with NPS was performed. Patellar morphology was classified according to the Wiberg classification as modified by Baumgartl and Ficat criteria, and trochlear shape was classified according to the Dejour classification...
April 2016: Bone & Joint Journal
Umile Giuseppe Longo, Alessandra Berton, Giuseppe Salvatore, Filippo Migliorini, Mauro Ciuffreda, Ara Nazarian, Vincenzo Denaro
PURPOSE: The aim of this literature review is to analyze current indications, outcomes, and complication rates of medial patellofemoral ligament (MPFL) reconstruction associated with bony procedures in order to clarify efficacy and adoptability in selected patients with patellar instability. METHODS: A systematic review of the literature was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search on PubMed, Medline, CINAHL, Cochrane, Embase, and Google Scholar databases was performed, using various combinations of the keywords patellar instability, MPFL reconstruction, tibial tubercle osteotomy, and trochleoplasty...
July 2016: Arthroscopy: the Journal of Arthroscopic & related Surgery
Hyoung-Soo Kim, Jeong-Hyun Yoo, Noh-Hyuck Park, Jun-Hee Chang, Yun-Seong Ban, Sang-Heon Song
Small patella syndrome (SPS) is characterized by aplasia or hypoplasia of the patella and pelvic girdle abnormalities, including bilateral absence or delayed ossification of the ischiopubic junction and infra-acetabular axe-cut notches. Here, we report a case of SPS in a 26-year-old female. Magnetic resonance image (MRI) showed a small patella with thick eccentric non-ossified patellar cartilage and femoral trochlear dysplasia with hypoplastic patellar undersurface. To our knowledge, this is the first report of MRI findings in SPS...
March 2016: Knee Surgery & related Research
Pranjal S Kodkani
BACKGROUND: Bone tunneling and implants with rigid fixations for medial patellofemoral ligament (MPFL) reconstruction are known to compromise results and are avoidable, especially in skeletally immature subjects. This study was to assess if these deficiencies were overcome with the technique devised by the author which avoids implants and bone tunnels. Results were assessed for complication rate and outcome. MATERIALS AND METHODS: Fifty six knees of recurrent lateral patellar dislocation were treated in the past 49 months by MPFL reconstruction...
January 2016: Indian Journal of Orthopaedics
Alexander E Weber, Amit Nathani, Joshua S Dines, Answorth A Allen, Beth E Shubin-Stein, Elizabeth A Arendt, Asheesh Bedi
High-level evidence supports nonoperative treatment for first-time lateral acute patellar dislocations. Surgical intervention is often indicated for recurrent dislocations. Recurrent instability is often multifactorial and can be the result of a combination of coronal limb malalignment, patella alta, malrotation secondary to internal femoral or external tibial torsion, a dysplastic trochlea, or disrupted and weakened medial soft tissue, including the medial patellofemoral ligament (MPFL) and the vastus medialis obliquus...
March 2, 2016: Journal of Bone and Joint Surgery. American Volume
John J Elias, Neil T Soehnlen, Loredana M Guseila, Andrew J Cosgarea
BACKGROUND: The current study was performed to correlate anatomical parameters related to trochlear dysplasia, tibial tuberosity position, and patella alta with in vivo patellar tracking for subjects with recurrent patellar instability. METHODS: Eight subjects with recurrent patellar instability that failed conservative treatment were evaluated using computational reconstruction of in vivo knee motion. Computational models were created from dynamic CT scans of the knee during extension against gravity...
June 2016: Knee
Daniel Dornacher, Angela Trubrich, Joachim Guelke, Heiko Reichel, Thomas Kappe
PURPOSE: Regarding TT-TG in knee realignment surgery, two aspects have to be considered: first, there might be flaws in using absolute values for TT-TG, ignoring the knee size of the individual. Second, in high-grade trochlear dysplasia with a dome-shaped trochlea, measurement of TT-TG has proven to lack precision and reliability. The purpose of this examination was to establish a knee rotation angle, independent of the size of the individual knee and unaffected by a dysplastic trochlea...
February 12, 2016: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
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