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https://www.readbyqxmd.com/read/29886008/medial-patellofemoral-ligament-repair-restores-stability-in-pediatric-patients-when-compared-to-reconstruction
#1
Jessica Bryant, Nirav Pandya
BACKGROUND: Pediatric patellar instability has a high recurrence rate with non-operative care, and medial patellofemoral ligament (MPFL) reconstruction has known complications. MPFL repair offers an alternative method to restore patellar stability. This study's purpose was to assess the outcomes of MPFL repair in a pediatric cohort, and to compare these outcomes to a cohort of pediatric patients who underwent MPFL reconstruction. METHODS: One surgeon performed 16 MPFL repairs on pediatric patients for traumatic patellar instability, with an average follow-up of 1...
June 6, 2018: Knee
https://www.readbyqxmd.com/read/29847145/operative-repair-of-medial-patellofemoral-ligament-injury-versus-knee-brace-in-children-with-an-acute-first-time-traumatic-patellar-dislocation-a-randomized-controlled-trial
#2
Marie Askenberger, Eva Bengtsson Moström, Wilhelmina Ekström, Elizabeth A Arendt, Anna Hellsten, Christina Mikkelsen, Per-Mats Janarv
BACKGROUND: A lateral patellar dislocation (LPD) is the most common traumatic knee injury with hemarthrosis in children. The redislocation rate is high. Varying operative and nonoperative treatments have been advocated with no consensus on the best treatment. PURPOSE: (1) To evaluate if arthroscopic-assisted repair of the medial patellofemoral ligament (MPFL) in patients with an acute first-time traumatic LPD would reduce the recurrence rate and offer better objective/subjective knee function compared with a knee brace without repair...
May 1, 2018: American Journal of Sports Medicine
https://www.readbyqxmd.com/read/29804612/editorial-commentary-which-came-first-the-patella-or-the-trochlea-morphological-relationships-in-patients-with-patellar-instability
#3
EDITORIAL
Miho J Tanaka
Trochlear dysplasia and patella alta are known risk factors for patellar instability, yet the relation between the two has not been well understood. Morphologic abnormalities such as trochlear dysplasia and patella alta are known to alter patellofemoral kinematics, whereas altered contact pressures, in turn, have been associated with the development of trochlear dysplasia. As our current treatments aim to correct these deformities through increasingly complex procedures such as trochleoplasty and tuberosity distalization, we should consider this relation and the potential for changing the course of developing such morphologic abnormalities earlier in life...
June 2018: Arthroscopy: the Journal of Arthroscopic & related Surgery
https://www.readbyqxmd.com/read/29789255/combined-tibial-tubercle-osteotomy-and-medial-patellofemoral-ligament-reconstruction-for-recurrent-lateral-patellar-instability-in-patients-with-multiple-anatomic-risk-factors
#4
Melissa M Allen, Aaron J Krych, Nick R Johnson, Rohith Mohan, Michael J Stuart, Diane L Dahm
PURPOSE: To report the outcomes for combined tibial tubercle osteotomy (TTO) and medial patellofemoral ligament (MPFL) reconstruction and assess for potential risk factors for recurrent instability and/or poor outcomes. METHODS: The medical record at our institution was reviewed for patients treated with MPFL reconstruction and TTO for recurrent lateral patellar instability from 1998 to 2014. Preoperative imaging was assessed for trochlear dysplasia according to the Dejour classification (high grade = B, C, D) and the presence of patella alta using the Caton-Deschamps ratio (>1...
May 19, 2018: Arthroscopy: the Journal of Arthroscopic & related Surgery
https://www.readbyqxmd.com/read/29787463/lateral-patellar-instability-in-the-skeletally-mature-patient-evaluation-and-surgical-management
#5
David R Diduch, Abdurrahman Kandil, M Tyrrell Burrus
Lateral patellar instability is a common disease process that affects all types of patients. Depending on the patient's anatomy and the results of preoperative imaging, surgical management options include medial patellofemoral ligament reconstruction, tibial tubercle osteotomy, and sulcus-deepening trochleoplasty. Medial patellofemoral ligament reconstruction or repair is useful for almost all patients, whereas tibial tubercle osteotomy is helpful to correct a lateralized tibial tubercle and the associated elevated lateral pull of the extensor mechanism...
May 18, 2018: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/29752638/avoiding-complications-with-mpfl-reconstruction
#6
REVIEW
Marvin K Smith, Brian C Werner, David R Diduch
PURPOSE OF REVIEW: To discuss the potentially significant complications associated with medial patellofemoral ligament (MPFL) reconstruction. Additionally, to review the most current and relevant literature with an emphasis on avoiding these potential complications. RECENT FINDINGS: Multiple cadaveric studies have characterized the anatomy of the MPFL and the related morphologic abnormalities that contribute to recurrent lateral patellar instability. Such abnormalities include patella alta, excessive tibial tubercle to trochlear grove (TT-TG) distance, trochlear dysplasia, and malalignment...
May 12, 2018: Current Reviews in Musculoskeletal Medicine
https://www.readbyqxmd.com/read/29744697/trochleoplasty-indications-and-technique
#7
EDITORIAL
John E Nolan, Patrick C Schottel, Nathan K Endres
PURPOSE OF REVIEW: Trochlear dysplasia is a well-described risk factor for patellar instability. Trochleoplasty has emerged as a procedure within the surgical armamentarium for patellar instability, yet its role is unclear. A variety of trochleoplasty procedures have emerged. The purpose of this review is to clarify indications for trochleoplasty, outline the technical steps involved in performing common trochleoplasties and report the published outcomes and potential complications of these procedures...
May 9, 2018: Current Reviews in Musculoskeletal Medicine
https://www.readbyqxmd.com/read/29742532/osteoarticular-allograft-transplantation-of-the-trochlear-groove-for-trochlear-dysplasia-a-case-report
#8
Nicholas N DePhillipo, Mitchell I Kennedy, Zachary S Aman, Gilbert Moatshe, Robert F LaPrade
CASE: A 21-year-old woman with recurrent lateral patellar instability caused by severe trochlear dysplasia and concomitant grade-IV trochlear chondromalacia was treated successfully with osteoarticular allograft transplantation of the entire trochlear groove. CONCLUSION: The treatment of chronic lateral patellar instability caused by trochlear dysplasia can be challenging. When nonoperative treatment is unsuccessful, a sulcus-deepening trochleoplasty may be indicated...
May 9, 2018: JBJS Case Connector
https://www.readbyqxmd.com/read/29736871/predicting-risk-of-recurrent-patellar-dislocation
#9
REVIEW
Shital N Parikh, Marios G Lykissas, Ioannis Gkiatas
PURPOSE OF REVIEW: Lateral patellar dislocation (LPD) is one of the most common injuries of the knee, especially in a young patient. It is multifactorial with several underlying risk factors. The purpose of this review is to present the most recent data concerning risk factors and their predictive value to estimate recurrent LPD risk. RECENT FINDINGS: Several demographic risk factors (age, skeletal immaturity, sex, bilaterality), mechanism of injury, and anatomic risk factors (trochlear dysplasia, patella alta, excessive tibial tubercle lateralization, increased patellar tilt) have been recognized...
May 7, 2018: Current Reviews in Musculoskeletal Medicine
https://www.readbyqxmd.com/read/29730214/patella-height-correlates-with-trochlear-dysplasia-a-computed-tomography-image-analysis
#10
Peter Wilhelm Ferlic, Armin Runer, Dietmar Dammerer, Jürgen Wansch, Wolfgang Hackl, Michael Christian Liebensteiner
PURPOSE: The aim of this study was to investigate the position of the patella relative to the trochlea for a possible correlation with radiologic parameters characterizing the form of the trochlea. METHODS: The computed tomography scans of 36 cases with patellofemoral instability and 30 without (mean age, 24.7 ± 6.8 years) were studied. The height of the patella relative to the trochlea was evaluated as the distance between the axial slice where the patella (P) showed its widest diameter, as the patella at this level has the greatest potential to form the trochlea, and the proximal entrance of the femoral trochlea (TE)...
May 2, 2018: Arthroscopy: the Journal of Arthroscopic & related Surgery
https://www.readbyqxmd.com/read/29727413/3d-knee-trochlear-morphology-assessment-by-magnetic-resonance-imaging-in-patients-with-normal-and-dysplastic-trochleae
#11
Andrew T Pennock, Aileen Chang, Joshua Doan, James D Bomar, Eric W Edmonds
BACKGROUND: Trochlear dysplasia is recognized as a significant risk factor for patellar instability, but current imaging modalities fail to allow full visualization and classification of the complex 3-dimensional (3D) anatomy of the trochlea. The purpose of this study was to elucidate primary differences in trochlear morphology between patients with and without patellar instability by utilizing 3D magnetic resonance imaging (MRI) reconstructions of the trochlea. METHODS: An institutional review board-approved retrospective review included 24 patients with a diagnosis of patellar instability and an age-matched and sex-matched control population of 12 patients...
April 30, 2018: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/29653442/examination-under-anesthesia-in-patients-with-recurrent-patellar-dislocation-prognostic-study
#12
Ismail Fathalla, James Holton, Tanweer Ashraf
Surgical management of patellar instability is a matter of wide debate. While some authors believe that isolated medial patellofemoral ligament (MPFL) reconstruction is sufficient, others advocate procedures to treat the underlying pathology, namely, patella alta and trochlear dysplasia. Radiological studies have been traditionally used as a determinant of these pathologies and to determine the need for an additional procedure. The value of examination under anesthesia (EUA) in formulating a treatment plan remains unknown...
April 13, 2018: Journal of Knee Surgery
https://www.readbyqxmd.com/read/29552477/sulcus-deepening-trochleoplasty-and-medial-patellofemoral-ligament-reconstruction-for-recurrent-patellar-instability
#13
Michael S Laidlaw, Scott M Feeley, Jeffrey R Ruland, David R Diduch
There are multiple etiologies for recurrent patellar instability. While patella alta, an elevated tibial tubercle trochlear groove distance, and prior lateral patellar dislocations with medial patellofemoral ligament (MPFL) insufficiency have been shown to be risk factors for recurrent patellar instability, trochlear dysplasia can result in a significant impediment to normal patellar tracking. With the adequate identification of risk factors, appropriate surgical treatments can be individually tailored to the patient...
February 2018: Arthroscopy Techniques
https://www.readbyqxmd.com/read/29551276/femoral-component-rotation-in-patellofemoral-joint-replacement
#14
Hans-Peter W van Jonbergen, Robin E Westerbeek
BACKGROUND: Clinical outcomes in patellofemoral joint replacement may be related to femoral component rotation. Assessment of rotational alignment is however difficult as patients with isolated patellofemoral osteoarthritis often have trochlear dysplasia. The use of the medial malleolus as a landmark to guide rotation has been suggested. The purpose of our study was to evaluate this technique with regard to femoral component rotation, and to correlate rotation with clinical outcomes at one-year follow-up...
March 15, 2018: Knee
https://www.readbyqxmd.com/read/29546510/the-quadriceps-active-ratio-a-dynamic-mri-based-assessment-of-patellar-height
#15
Sergio Barroso Rosa, Zaid Bahho, Kenji Doma, Kaushik Hazratwala, Peter McEwen, Varaguna Manoharan, Brent Matthews, Matthew Wilkinson
INTRODUCTION: Patella alta (PA) is one of the primary correctable risk factors for patellofemoral instability (PFI). Both an accurate diagnosis of PA and a clinically relevant target for correction are necessary for optimal treatment. An ideal test for PA should relate the position of the patella to the femur rather than tibia, should do so with the quadriceps contracted and the patellar tendon under tension and should have good sensitivity and specificity. None of the currently used radiographic tests PA meet these criteria, most of which are based on the position of the patella relative to the tibia with diagnostic cutoffs based on 2 standard deviations from the mean rather than optimal sensitivity and specificity...
March 15, 2018: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
https://www.readbyqxmd.com/read/29544985/dynamic-tracking-influenced-by-anatomy-following-medial-patellofemoral-ligament-reconstruction-computational-simulation
#16
John J Elias, Kerwyn C Jones, S Cyrus Rezvanifar, Joseph N Gabra, Melanie A Morscher, Andrew J Cosgarea
BACKGROUND: Continued patellar instability can occur following medial patellofemoral ligament (MPFL) reconstruction. Computational simulation of function was used to investigate the influence of the lateral position of the tibial tuberosity, trochlear dysplasia and patella alta on lateral patellar tracking following MPFL reconstruction. METHODS: Multibody dynamic simulation models were developed to represent nine knees being treated for recurrent patellar instability...
March 2018: Knee
https://www.readbyqxmd.com/read/29521938/the-growth-of-trochlear-dysplasia-during-adolescence
#17
Shital N Parikh, Neil Rajdev, Qin Sun
BACKGROUND: Femoral trochlear dysplasia is a known risk factor for patellar instability. The growth pattern of the normal trochlea is known, but there have been no studies investigating the growth and development of the dysplastic trochlea. The purpose of this study was to assess the growth pattern of trochlear dysplasia in adolescents. METHODS: In a retrospective analysis, magnetic resonance images of adolescents with patellar instability and trochlear dysplasia were evaluated...
March 8, 2018: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/29410197/patellofemoral-reconstruction-for-patellar-instability-with-patella-alta-in-middle-aged-patients-clinical-outcomes
#18
S Otsuki, Y Okamoto, T Murakami, K Nakagawa, N Okuno, H Wakama, M Neo
INTRODUCTION: Although several surgical treatments for patellar instability with patella alta have been reported, the clinical outcomes and optimal surgical procedures for patellar instability with patella alta in middle-aged patients are still controversial. We hypothesized that optimal surgical procedures for patellar instability with patella alta in middle-aged patients may induce good clinical outcomes with better patellofemoral geometry. MATERIALS AND METHODS: Twelve middle-aged patients with a mean age of 44 years (range: 40-55 years), who presented with patellar instability and patella alta, were treated with a combination of several surgeries, such as medial patellofemoral ligament (MPFL) reconstruction, trochleoplasty, lateral release, and three-dimensional transfer of the tibial tuberosity, based on a surgical algorithm...
April 2018: Orthopaedics & Traumatology, Surgery & Research: OTSR
https://www.readbyqxmd.com/read/29395748/does-different-duration-of-non-operative-immobilization-have-an-effect-on-the-redislocation-rate-of-primary-patellar-dislocation-a-retrospective-multicenter-cohort-study
#19
Bo Kaewkongnok, Anders Bøvling, Nikolaj Milandt, Celia Møllenborg, Bjarke Viberg, Lars Blønd
BACKGROUND: Immobilization devices such as plaster splints, casts and braces have been used for first time patellar dislocation (FTPD) in order to prevent redislocation. This study evaluates different non-operative immobilization regimes upon rates of redislocation. METHODS: A retrospective cohort study with a study population of 1366 in which 601 subjects under 30years with FTPD were included from three hospitals. Exclusion criteria were osteochondral fracture, ligament injury and subluxation...
January 2018: Knee
https://www.readbyqxmd.com/read/29322270/recent-developments-in-evaluation-and-treatment-of-lateral-patellar-instability
#20
REVIEW
Alexander Zimmerer, Christian Sobau, Peter Balcarek
Recent years have been characterized by an ongoing increase in knowledge about the different conditions associated with lateral patellar instability. This increase in knowledge provides differentiated approaches to the various pathologies of the patellofemoral joint. Though current guidelines consider medial patellofemoral ligament (MPFL) reconstruction the basic treatment for the unstable patella, medial soft tissue-stabilizing procedures should not be interpreted as stand-alone procedures in every case. The influence of different anatomical factors leading to patellar instability, as well as their impact on clinical outcome measures, is becoming increasingly apparent and deserves further attention...
January 10, 2018: Journal of Experimental Orthopaedics
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