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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
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
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
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
Eric C Hans, Sharon C Kerwin, Alan C Elliott, Ryan Butler, W Brian Saunders, Don A Hulse
Grade 4/4 medial patellar luxation (MPL) is a complex disease of the canine stifle that often requires surgical realignment of the patella to resolve clinical lameness. Outcome following surgery remains poorly described. Medical records were retrospectively reviewed for surgical correction of grade 4 MPL. Signalment and exam findings, surgical procedures performed, complications, and clinical outcome were reported. Data was statistically analyzed for association with major complication occurrence and unacceptable function following surgery...
May 2016: Journal of the American Animal Hospital Association
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
J Chouteau
Various treatments for patellofemoral instability have been proposed, such as lowering or medialization of the tibial tubercle, division of the lateral retinaculum, plication of the medial retinaculum, lowering of the vastus medialis, and trochleoplasty. However, it has been difficult to analyze the outcomes of each technique because they are often performed in combination. Recent anatomical and biomechanical studies have shown that the medial patellofemoral ligament (MPFL) is the primary stabilizer of the patella between full extension and 30° flexion...
February 2016: Orthopaedics & Traumatology, Surgery & Research: OTSR
Masaaki Katayama, Hikaru Ogaya, Shimamura Shunsuke, Yuji Uzuka
OBJECTIVE: To document the trochlear depth (TD) and clinical outcome after kite shield-shaped wedge (K-wedge) recession trochleoplasty in toy-breed dogs with medial patellar luxation (MPL). STUDY DESIGN: Case series. ANIMALS: Seven toy-breed dogs (<5 kg) with uni- or bilateral grades II-IV MPL (10 stifles). METHODS: A K-wedge recession trochleoplasty was performed in all dogs in combination with other surgical procedures as treatment for MPL...
January 2016: Veterinary Surgery: VS
M Nelitz, S R M Williams
OBJECTIVE: Combined anatomical reconstruction of the MPFL and deepening trochleoplasty to improve the stability of the patellofemoral joint in patients with severe trochlear dysplasia. INDICATIONS: Confirmed patellofemoral instability with recurrent dislocations and high-grade trochlear dysplasia. CONTRAINDICATIONS: Open distal femoral physis, degenerative changes of the patellofemoral joint grade ICRS III-IV. SURGICAL TECHNIQUE: Diagnostic arthroscopy, exposure of the femoral trochlea through a lateral parapatellar arthrotomy and preparation of an osteochondral flake were carried out...
December 2015: Operative Orthopädie und Traumatologie
Iain McNamara, Nelson Bua, Toby O Smith, Khameinei Ali, Simon T Donell
BACKGROUND: In patients with patellar instability and severe trochlear dysplasia, trochleoplasty has become increasingly used as part of its surgical management. HYPOTHESIS: Deepening trochleoplasty for severe dysplasia in patellofemoral instability improves function and increases sports participation. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Between 1995 and 2010, deepening trochleoplasty with a thick flap was performed in 90 patients (107 knees) with severe trochlear dysplasia...
November 2015: American Journal of Sports Medicine
Johannes Hans van der Zee
Lesions in canine stifle joints after previous trochleoplasty surgery were documented. In four clinical cases arthrotomies were performed due to stifle pain after previous trochlear deepening procedures. A small area of hyaline cartilage remained in the groove of the stifles in cases where previous wedge trochleoplasties had been performed. All of the stifles had significant areas of eburnation on the axial aspect of the medial trochlear ridge. The stifle joints of a dog that was euthanased due to severe irreversible osteoarthritis were photographed...
2015: Journal of the South African Veterinary Association
Enrique Adrian Testa, Carlo Camathias, Felix Amsler, Philipp Henle, Niklaus F Friederich, Michael Tobias Hirschmann
PURPOSE: Trochleoplasty and reconstruction of the medial patellofemoral ligament (MPFL) are among the most commonly performed surgical treatments in patients with patellofemoral instability. The primary purpose of the study was to perform a systematic literature review on trochleoplasty in the treatment of patients with patellofemoral instability. The secondary purpose was to compare the outcomes with those seen in patients treated after reconstruction of the MPFL. METHODS: A standardised search on search engines was performed...
July 18, 2015: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
J Richter, P Mayer, M Immendörfer, M Schulz, M Schlumberger, P Schuster
OBJECTIVE: Anatomic reconstruction of the medial patellofemoral ligament using autologous gracilis tendon in an implant-free technique on the patellar side to regain patellofemoral stability. INDICATIONS: Recurrent dislocations, primary dislocation with high risk of recurrence, and dislocations with (osteo-)chondral flake fractures. As combined approach together with other procedures (trochleoplasty, tibial tubercle osteotomy). Revisions. CONTRAINDICATIONS: As an isolated procedure in patients with high degrees of trochlear dysplasia, chronic dislocation of the patella, and patellofemoral maltracking without instability...
February 2016: Operative Orthopädie und Traumatologie
T Rouanet, F Gougeon, J M Fayard, F Rémy, H Migaud, G Pasquier
INTRODUCTION: Trochlear dysplasia is one of the main elements of patellofemoral instability. Although correction by trochleoplasty seems logical, the long-term outcome of this procedure is unknown and the progression to osteoarthritis has not been clarified. Thus, we performed a retrospective study of a series of sulcus deepening trochleoplasties with a 15-year follow-up whose goal was to (1) evaluate the long-term clinical outcome and radiological rate of osteoarthritis, and (2) define the results in relation to the type of instability and the grade of dysplasia...
June 2015: Orthopaedics & Traumatology, Surgery & Research: OTSR
Annemieke Van Haver, Karel De Roo, Matthieu De Beule, Luc Labey, Patrick De Baets, David Dejour, Tom Claessens, Peter Verdonk
BACKGROUND: Trochlear dysplasia appears in different geometrical variations. The Dejour classification is widely used to grade the severity of trochlear dysplasia and to decide on treatment. PURPOSE: To investigate the effect of trochlear dysplasia on patellofemoral biomechanics and to determine if different types of trochlear dysplasia have different effects on patellofemoral biomechanics. STUDY DESIGN: Controlled laboratory study. METHODS: Trochlear dysplasia was simulated in 4 cadaveric knees by replacing the native cadaveric trochlea with different types of custom-made trochlear implants, manufactured with 3-dimensional printing...
June 2015: American Journal of Sports Medicine
Don-Felix Ryzek, Philip Schöttle
Patellofemoral instability (PFI) is a pathological knee syndrome that frequently affects young patients. The patellofemoral joint's structural morphology is the determining factor in the extent of PFI. Structural factors that play leading roles in patellofemoral stability can be classified into static (bone morphology), passive (ligamentous), and active (muscular). The predominant static factor leading to patella dislocation and thus patellofemoral dysfunction is trochlear dysplasia, which we focus on in this review...
August 2015: Journal of Knee Surgery
Roland Biedert
No abstract text is available yet for this article.
December 2014: Knee
Jason L Koh, Cory Stewart
Patellar instability is a common injury that can result in significant limitations of activity and long-term arthritis. There is a high risk of recurrence in patients and operative management is often indicated. Advances in the understanding of patellofemoral anatomy, such as knowledge about the medial patellofemoral ligament, tibial tubercle-trochlear groove distance, and trochlear dysplasia may allow improved surgical management of patellar instability. However, techniques such as MPFL reconstruction are technically demanding and may result in significant complication...
January 2015: Orthopedic Clinics of North America
Kyung Jin Cho, Jacobus H Müller, Pieter J Erasmus, David DeJour, Cornie Scheffer
Segmentation and computer assisted design tools have the potential to test the validity of simulated surgical procedures, e.g., trochleoplasty. A repeatable measurement method for three dimensional femur models that enables quantification of knee parameters of the distal femur is presented. Fifteen healthy knees are analysed using the method to provide a training set for an artificial neural network. The aim is to use this artificial neural network for the prediction of parameter values that describe the shape of a normal trochlear groove geometry...
2014: Acta of Bioengineering and Biomechanics
C Wangdee, H A W Hazewinkel, J Temwichitr, L F H Theyse
Seven Pomeranians with bidirectional patellar luxation (BPL) were prospectively studied regarding aetiology and results of a new surgical technique. Radiographic evaluation of the ratio between patellar ligament length and patellar bone length revealed no differences between Pomeranians with bidirectional patellar luxation and healthy stifle joints. Functional rather than anatomic patella alta might be associated with bidirectional patellar luxation in Pomeranians. The surgical outcome of extended proximal trochleoplasty was good-to-excellent in 87·5% of the stifles and all dogs achieved functional recovery...
February 2015: Journal of Small Animal Practice
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