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https://www.readbyqxmd.com/read/28437493/the-role-of-medial-patellofemoral-ligament-repair-and-imbrication
#1
Kyle R Duchman, Matthew J Bollier
Repair, reefing, and advancement of the medial patellofemoral ligament (MPFL) and medial retinacular structures can be performed as an isolated procedure or in conjunction with distal realignment procedures for patients with patellar instability. Although various operative techniques have been described, understanding the appropriate clinical indications and MPFL injury patterns ultimately determines the success or failure of the procedure. MPFL repair is best indicated in the acute setting, particularly if there is a patella- or femoral-based avulsion...
March 2017: American Journal of Orthopedics
https://www.readbyqxmd.com/read/28396049/acquired-femoral-flexion-deformity-due-to-physeal-injury-during-medial-patellofemoral-ligament-reconstruction
#2
Gerd Seitlinger, Philipp Moroder, Christian Fink, Guido Wierer
BACKGROUND: Reconstruction of the medial patellofemoral ligament (MPFL) is the most frequent surgical procedure performed in patients with patellar instability. Recently, concerns regarding physeal injury during femoral tunnel placement for anatomical MPFL reconstruction in children have been discussed. METHODS: This is the first case to report partial posterior physeal growth arrest and subsequent flexion deformity of the distal femur after MPFL reconstruction in a skeletally immature patient...
April 7, 2017: Knee
https://www.readbyqxmd.com/read/28249974/trochleoplasty-with-a-flexible-osteochondral-flap-results-from-an-11-year-series-of-214-cases
#3
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/28178962/the-outcomes-of-the-modified-fulkerson-osteotomy-procedure-to-treat-habitual-patellar-dislocation-associated-with-high-grade-trochlear-dysplasia
#4
Hong Chen, Daohong Zhao, Jingming Xie, Qihui Duan, Jun Zhang, Zhidan Wu, Jia Jiang
BACKGROUND: Habitual patellar dislocation is not common in clinical practice, but it has a deep impact on the patient's lifestyle and movement. There has been no large case-control study on habitual patellar dislocation, and the management of it is still controversial. The aim of this study was to observe the efficacy of the modified Fulkerson procedure on patients with habitual patellar dislocation with high-grade trochlear dysplasia without trochleoplasty and to evaluate the results of this procedure...
February 8, 2017: BMC Musculoskeletal Disorders
https://www.readbyqxmd.com/read/28148656/adolescent-patellar-instability-current-concepts-review
#5
REVIEW
D Clark, A Metcalfe, C Wogan, V Mandalia, J Eldridge
Patellar instability most frequently presents during adolescence. Congenital and infantile dislocation of the patella is a distinct entity from adolescent instability and measurable abnormalities may be present at birth. In the normal patellofemoral joint an increase in quadriceps angle and patellar height are matched by an increase in trochlear depth as the joint matures. Adolescent instability may herald a lifelong condition leading to chronic disability and arthritis. Restoring normal anatomy by trochleoplasty, tibial tubercle transfer or medial patellofemoral ligament (MPFL) reconstruction in the young adult prevents further instability...
February 2017: Bone & Joint Journal
https://www.readbyqxmd.com/read/28094422/predicting-the-need-for-trochleoplasty-in-canine-patellar-luxation-using-pre-and-intra-operative-assessments-of-trochlear-depth
#6
Julie Skovgaard Orthmand Hansen, Ken Lindeblad, Lene Buelund, James Miles
OBJECTIVES: To evaluate the repeatability and reproducibility of ultrasonographic femoral trochlear depth measurements and to compare ultrasonographic and intra-operative evaluations of femoral trochlear depth for predictive value in selecting trochleoplasty. METHODS: Repeatability and reproducibility of an ultrasonographic protocol were tested in a preclinical cadaveric study. Clinical patients undergoing corrective surgery for patellar luxation were evaluated preoperatively with ultrasound and intra-operatively using a depth gauge...
March 20, 2017: Veterinary and Comparative Orthopaedics and Traumatology: V.C.O.T
https://www.readbyqxmd.com/read/28045869/why-do-patellofemoral-stabilization-procedures-fail-keys-to-success
#7
Nick Caplan, Islam Nassar, Bobby Anand, Deiary F Kader
In recent years, surgical interventions for patellofemoral joint instability have gained popularity, possibly revitalized by the recent advances in our understanding of patellofemoral joint instability and the introduction of a number of new surgical procedures. This rise in surgical intervention has brought about various complications. In this review article, we present the complications that are associated with 5 main surgical procedures to stabilize the patella-medial patellofemoral ligament reconstruction, tibial tubercle osteotomy, trochleoplasty, lateral release/lateral retinacular lengthening, and derotation osteotomies...
March 2017: Sports Medicine and Arthroscopy Review
https://www.readbyqxmd.com/read/27904790/current-concepts-in-the-treatment-of-gross-patellofemoral-instability
#8
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. Following an initial patellar dislocation, nonoperative management with bracing and physical therapy is an acceptable option, despite limited evidence that operative management may improve functional outcome and reduce recurrent dislocations...
December 2016: International Journal of Sports Physical Therapy
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
#9
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
#10
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/27436719/trochleoplasty-as-a-solitary-treatment-for-recurrent-patellar-dislocation-results-in-good-clinical-outcome-in-adolescents
#11
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...
November 2016: American Journal of Sports Medicine
https://www.readbyqxmd.com/read/27274449/patellofemoral-joint-reconstruction-for-patellar-instability-medial-patellofemoral-ligament-reconstruction-trochleoplasty-and-tibial-tubercle-osteotomy
#12
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
https://www.readbyqxmd.com/read/27077588/imaging-of-individual-anatomical-risk-factors-for-patellar-instability
#13
REVIEW
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
https://www.readbyqxmd.com/read/27032603/medial-patellofemoral-ligament-reconstruction-combined-with-bony-procedures-for-patellar-instability-current-indications-outcomes-and-complications
#14
REVIEW
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
https://www.readbyqxmd.com/read/27008322/outcome-following-surgical-correction-of-grade-4-medial-patellar-luxation-in-dogs-47-stifles-2001-2012
#15
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
https://www.readbyqxmd.com/read/26935465/an-algorithmic-approach-to-the-management-of-recurrent-lateral-patellar-dislocation
#16
REVIEW
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
https://www.readbyqxmd.com/read/26797001/surgical-reconstruction-of-the-medial-patellofemoral-ligament
#17
REVIEW
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
https://www.readbyqxmd.com/read/26638125/kite-shield-shaped-wedge-recession-for-treatment-of-medial-patellar-luxation-in-seven-small-breed-dogs
#18
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
https://www.readbyqxmd.com/read/26407998/-combined-trochleoplasty-and-medial-patellofemoral-ligament-reconstruction-for-patellofemoral-instability
#19
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
https://www.readbyqxmd.com/read/26337419/deepening-trochleoplasty-with-a-thick-osteochondral-flap-for-patellar-instability-clinical-and-functional-outcomes-at-a-mean-6-year-follow-up
#20
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
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