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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
#1
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/29789249/the-relationship-of-femoral-tunnel-positioning-in-medial-patellofemoral-ligament-reconstruction-on-clinical-outcome-and-postoperative-complications
#2
Philippe M Tscholl, Lukas Ernstbrunner, Linda Pedrazzoli, Sandro F Fucentese
PURPOSE: To analyze the relation of the femoral tunnel (FT) positioning on clinical outcome. METHODS: Patients with recurrent patellar dislocation who underwent medial patellofemoral ligament (MPFL) reconstruction with or without tibial tubercle osteotomy between 1998 and 2012 were included in this retrospective study. Strict postoperative lateral radiographs were mandatory. Knees with previous osseous stabilization surgery, fixed lateral patellar dislocation, valgus knee (>5°), or open growth plates were excluded...
May 19, 2018: Arthroscopy: the Journal of Arthroscopic & related Surgery
https://www.readbyqxmd.com/read/29752638/avoiding-complications-with-mpfl-reconstruction
#3
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/29752499/intraoperative-fluoroscopy-during-mpfl-reconstruction-improves-the-accuracy-of-the-femoral-tunnel-position
#4
P Koenen, S Shafizadeh, T R Pfeiffer, A Wafaisade, B Bouillon, A C Kanakamedala, V Jaecker
PURPOSE: Reconstruction of the medial patellofemoral ligament (MPFL) has been established as standard of care for patellofemoral instability. An anatomic femoral tunnel position has been shown to be a prerequisite for restoration of patellofemoral stability and biomechanics. However, the incidence of malpositioning of the femoral tunnel during MPFL reconstruction continues to be notable. Palpation of anatomic landmarks and intraoperative fluoroscopy are the two primary techniques for tunnel placement...
May 11, 2018: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
https://www.readbyqxmd.com/read/29724252/synthetic-versus-autologous-reconstruction-syn-var-of-the-medial-patellofemoral-ligament-a-study-protocol-for-a-randomised-controlled-trial
#5
Adam Tucker, Sam McMahon, Bronwyn McArdle, Bridgeen Rutherford, Danny Acton
BACKGROUND: Recurrent patellar instability incidence is 5.8/100,000 population, and recurrent dislocations are reported in the range of 15-80%. Recurrent instability is multifactorial and can be associated with disorder of limb alignment, osseous development, congruity of the patella in the trochlea and soft tissue static and dynamic constraints. The multifactorial aetiology makes management challenging, and a lack studies in a heterogeneous population with robust clinical outcomes compounds this further...
May 3, 2018: Trials
https://www.readbyqxmd.com/read/29723036/patellar-redislocation-rates-and-clinical-outcomes-after-medial-patellofemoral-ligament-reconstruction-suture-anchor-versus-double-transpatellar-tunnel-fixation
#6
Jae-Won Heo, Kyung-Han Ro, Dae-Hee Lee
BACKGROUND: Few studies to date have compared clinical outcomes in patients who have undergone medial patellofemoral ligament (MPFL) reconstruction using the suture anchor and double transpatellar tunnel fixation methods. This meta-analysis therefore compared the clinical results, including the patellar redislocation rate and improvement in functional scores, of suture anchor and double transpatellar tunnel fixation. HYPOTHESIS: The recurrence rate and improvement in functional outcomes after surgery would be similar using the suture anchor and double transpatellar tunnel fixation methods...
May 1, 2018: American Journal of Sports Medicine
https://www.readbyqxmd.com/read/29682680/mpfl-in-first-time-dislocators
#7
REVIEW
Beth E Shubin Stein, Simone Gruber, Jacqueline M Brady
PURPOSE OF REVIEW: Historically, the standard of care for patients with an acute patella dislocation has been non-operative with the exception being those with a loose body or osteochondral fracture requiring fixation or removal. RECENT FINDINGS: Recent literature has brought into question this standard of care approach and defined a higher risk subset of first-time dislocators who may benefit from early operative treatment. In addition, these studies suggest that operative treatment not only reduces the risk of recurrence but may improve outcomes overall and specifically in the pediatric population...
April 23, 2018: Current Reviews in Musculoskeletal Medicine
https://www.readbyqxmd.com/read/29679209/quadriceps-tendon-autograft-medial-patellofemoral-ligament-reconstruction
#8
REVIEW
Christian Fink, Robert Steensen, Peter Gföller, Robert Lawton
PURPOSE: Critically evaluate the published literature related to quadriceps tendon (QT) medial patellofemoral ligament (MPFL) reconstruction. RECENT FINDINGS: Hamstring tendon (HT) MPFL reconstruction techniques have been shown to successfully restore patella stability, but complications including patella fracture are reported. Quadriceps tendon (QT) reconstruction techniques with an intact graft pedicle on the patella side have the advantage that patella bone tunnel drilling and fixation are no longer needed, reducing risk of patella fracture...
April 20, 2018: Current Reviews in Musculoskeletal Medicine
https://www.readbyqxmd.com/read/29653442/examination-under-anesthesia-in-patients-with-recurrent-patellar-dislocation-prognostic-study
#9
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/29644317/a-rare-case-of-hoffa-fracture-combined-with-lateral-patellar-dislocation
#10
Martin C Jordan, Leonie A Bittrich, Kai Fehske, Rainer H Meffert, Hendrik Jansen
The coronal unicondylar fracture of the distal femur (AO 33-B3) is a rare intraarticular injury within the weight bearing area of the knee, initially described by Albert Hoffa in 1904. We report an unusual combination of a Hoffa fracture with lateral patellar dislocation in a young adult. Our patient sustained the injury by a sudden twist of his leg during sports. He presented clinically with knee swelling, dislocation of the patella, and localized tenderness; unable to bare weight. After plane radiograph confirmed the injury, manual reduction of the patella was done by hyperextension of the knee and medialward pressure...
June 2017: Trauma Case Reports
https://www.readbyqxmd.com/read/29611848/special-considerations-for-pediatric-patellar-instability
#11
Sean Keyes, Meghan Price, Daniel W Green, Shital N Parikh
Patellar instability in children and adolescents is a challenging subset to treat. Varied forms of instability, ranging from episodic dislocation to fixed dislocation, have been recognized. It is of utmost importance for the treating physician to recognize these different patterns of instability and their associated risk factors, as more complex patterns of instability would require more extensive surgical procedures. Medial patellofemoral ligament (MPFL) reconstruction, by itself, may not suffice or may not be appropriate for the more complex instability patterns...
March 2018: American Journal of Orthopedics
https://www.readbyqxmd.com/read/29611007/femoral-tunnel-widening-is-associated-with-tunnel-malposition-but-not-with-clinical-failure-after-medial-patellofemoral-ligament-reconstruction-with-a-free-gracilis-tendon-graft
#12
Karl-Friedrich Schüttler, A Hoeger, T J Heyse, J Figiel, N Timmesfeld, T Stein, E Ziring, T Efe
INTRODUCTION: MPFL reconstruction is widely and successfully used for treating patella instability, either as a standalone procedure or in combination. Although different techniques allow for MPFL reconstruction, the use of a free tendon graft is one of the most commonly used. The phenomenon of tunnel widening or tunnel enlargement is well described in ACL reconstruction, but so far only little effort has been put into evaluating this phenomenon after MPFL reconstruction. MATERIALS AND METHODS: Patients who received an MPFL reconstruction with a free gracilis tendon graft were identified by review of patient files...
April 2, 2018: Archives of Orthopaedic and Trauma Surgery
https://www.readbyqxmd.com/read/29569702/an-anatomical-study-of-the-origin-structure-and-insertion-of-the-medial-patellofemoral-ligament
#13
Chang-Hui Li, David Ricketts, Xi-Shan Wang, Teng-Bo Yu, Chao Qi, Yong-Le Zhu
BACKGROUND: Repair and reconstruction of the medial patellofemoral ligament (MPFL) has been undertaken for the treatment of patellar instability. For successful surgery detailed knowledge of the anatomy of the ligament is required. The aim of this study was to describe the origin, structure and insertion of the MPFL. MATERIALS AND METHODS: We studied cadaveric knees from 30 Chinese adults. We studied the origin, course and insertion of the MPFL. RESULTS: We found that the MPFL was composed of two main strands, superficial and deep...
March 23, 2018: Folia Morphologica (Warsz)
https://www.readbyqxmd.com/read/29554436/biomechanical-evaluation-of-the-medial-stabilizers-of-the-patella
#14
Matthew D LaPrade, Samantha L Kallenbach, Zachary S Aman, Gilbert Moatshe, Hunter W Storaci, Travis Lee Turnbull, Elizabeth A Arendt, Jorge Chahla, Robert F LaPrade
BACKGROUND: Quantification of the biomechanical properties of each individual medial patellar ligament will facilitate an understanding of injury patterns and enhance anatomic reconstruction techniques by improving the selection of grafts possessing appropriate biomechanical properties for each ligament. PURPOSE: To determine the ultimate failure load, stiffness, and mechanism of failure of the medial patellofemoral ligament (MPFL), medial patellotibial ligament (MPTL), and medial patellomeniscal ligament (MPML) to assist with selection of graft tissue for anatomic reconstructions...
March 1, 2018: American Journal of Sports Medicine
https://www.readbyqxmd.com/read/29552477/sulcus-deepening-trochleoplasty-and-medial-patellofemoral-ligament-reconstruction-for-recurrent-patellar-instability
#15
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/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/29520187/the-correlation-between-the-injury-patterns-of-the-medial-patellofemoral-ligament-in-an-acute-first-time-lateral-patellar-dislocation-on-mr-imaging-and-the-incidence-of-a-second-time-lateral-patellar-dislocation
#17
Guang-Ying Zhang, Hong-Xia Zhu, En-Miao Li, Hao Shi, Wei Liu, Lei Zheng, Zheng-Wu Bai, Hong-Yu Ding
Objective: To evaluate the correlation between the injury patterns of the medial patellofemoral ligament (MPFL) on magnetic resonance imaging in an acute first-time lateral patellar dislocation (LPD) and incidence of a second-time LPD. Materials and Methods: Magnetic resonance images were prospectively analyzed in 147 patients after an acute first-time LPD with identical nonoperative management. The injury patterns of MPFL in acute first-time LPDs were grouped by location and severity for the analysis of the incidence of second-time LPD in a 5-year follow-up...
March 2018: Korean Journal of Radiology: Official Journal of the Korean Radiological Society
https://www.readbyqxmd.com/read/29514373/long-term-clinical-results-of-double-bundle-reconstruction-of-the-medial-patellofemoral-ligament-for-patellar-instability
#18
Lei Zhang, Zhiyao Li
Medial patellofemoral ligament (MPFL) reconstruction is a satisfactory technique for patellar instability, and the anatomical double bundle variant is recommended for better clinical results. However, long-term outcomes are still uncharacterized. This study aimed to assess the effectiveness of double bundle reconstruction of the MPFL for patellar instability by means of established scores. A total of 68 patients with chronic patellar instability who underwent surgery from May 2005 to February 2010 were included prospectively...
March 7, 2018: Journal of Knee Surgery
https://www.readbyqxmd.com/read/29492253/case-report-of-a-ruptured-endobutton-used-in-medial-patellofemoral-ligament-reconstruction-causing-patellofemoral-impingement
#19
Raashad Hasan, Wiqqas Jamil
The medial patellofemoral ligament (MPFL) is a key soft tissue stabilizer of the medial patella, with deficiency proven to be a key contributor to patellar dislocation. Reconstruction of this ligament has become a widely employed procedure in managing patients with recurrent patellar dislocation, and is also gaining popularity in the setting of primary dislocation. A wide variety of techniques have been described, differing in the type of graft used, sites for fixation and fixation technique. A number of complications have also been reported in the literature, including post-operative stiffness, apprehension, patellar fracture and recurrence of instability and dislocation...
February 2018: Journal of Surgical Case Reports
https://www.readbyqxmd.com/read/29466677/analysis-of-graft-length-change-patterns-in-medial-patellofemoral-ligament-reconstruction-via-a-fluoroscopic-guidance-method
#20
Takehiko Matsushita, Daisuke Araki, Yuichi Hoshino, Shinya Oka, Kyohei Nishida, Toshikazu Tanaka, Nobuaki Miyaji, Noriyuki Kanzaki, Kazuyuki Ibaraki, Tomoyuki Matsumoto, Masahiro Kurosaka, Ryosuke Kuroda
BACKGROUND: A fluoroscopic guidance method for medial patellofemoral ligament (MPFL) reconstruction has been widely used to determine the anatomic femoral attachment site. PURPOSE: To examine the graft length change patterns in MPFL reconstruction with a fluoroscopic guidance method. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Forty-four knees of 42 patients who underwent MPFL reconstruction for the treatment of recurrent patellar dislocation were examined prospectively...
April 2018: American Journal of Sports Medicine
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