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Patellofemoral reconstruction

Samuel Pitcairn, Bryson Lesniak, William Anderst
BACKGROUND: The patellofemoral (PF) joint is a common site for non-specific anterior knee pain. The pathophysiology of patellofemoral pain may be related to abnormal motion of the patella relative to the femur, leading to increased stress at the patellofemoral joint. Patellofemoral motion cannot be accurately measured using conventional motion capture. RESEARCH QUESTION: The aim of this study was to determine the accuracy of a biplane radiography system for measuring in vivo PF motion during walking and stair ascent...
June 18, 2018: Gait & Posture
Harry M Lightsey, Margaret L Wright, David P Trofa, Charles A Popkin, Lauren H Redler
BACKGROUND: Medial patellofemoral ligament (MPFL) reconstruction is an increasingly utilized surgical option for recurrent patellar instability. Recent studies have highlighted the potential benefits of accelerated functional rehabilitation; however, no validated MPFL rehabilitation guidelines currently exist. OBJECTIVE: To assess the variability of MPFL reconstruction rehabilitation protocols published online by academic orthopaedic programs. METHODS: Online MPFL rehabilitation protocols from U...
June 9, 2018: Physician and Sportsmedicine
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
Justin L Makovicka, David E Hartigan, Karan A Patel, Sailesh V Tummala, Anikar Chhabra
The medial patellofemoral ligament (MPFL), which is critical for both patellar stability and normal kinematics of the patellofemoral joint, is disrupted in most patellar dislocations. Consequently, MPFL reconstruction is advocated in recurrent dislocations to restore native patellar constraints. Fixation of the MPFL graft to the medial border of the patella can be achieved through various methods, each with its own benefits and drawbacks. We present a technique for MPFL fixation to the patella using all-soft suture anchors, theoretically decreasing the risk of patellar fracture and articular surface violation...
March 2018: Arthroscopy Techniques
Jeffrey Kay, Muzammil Memon, Ajay Shah, Yi-Meng Yen, Kristian Samuelsson, Devin Peterson, Nicole Simunovic, Helene Flageole, Olufemi R Ayeni
PURPOSE: To evaluate the association between surgical timing and the incidence of secondary meniscal or chondral damage in children and adolescents with anterior cruciate ligament (ACL) ruptures. METHODS: Three electronic databases, PubMed, MEDLINE, and EMBASE, were systematically searched from database inception until October 16, 2017 by two reviewers independently and in duplicate. The inclusion criteria were English language studies that reported the incidence of meniscal and articular cartilage damage in children or adolescent athletes with ACL injuries as well as the timing of their ACL reconstruction (ACLR)...
June 6, 2018: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Jannik Frings, Matthias Krause, Ralph Akoto, Peter Wohlmuth, Karl-Heinz Frosch
PURPOSE: Valgus deformities of the lower extremity influence patellofemoral joint kinematics. However, studies examining the clinical outcome after treatment of patellar instability and maltracking due to valgus deformity are rare in recent literature. This study's purpose is to analyze the clinical results after combined distal femoral osteotomy (DFO) for treatment of patellar instability. METHODS: From 2010 to 2016, 406 cases of patellofemoral instability and maltracking were treated...
June 4, 2018: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Ricardo Hideki Yanasse, Guilherme Aravechia, Tiago Rocha Ramos, Luiz Gustavo Lucena Augusto Lima, Danilo Zanutto de Oliveira Medeiros, Marcos Henrique Ferreira Laraya, Roberto Ryuiti Mizobuchi
The medial patellofemoral ligament (MPFL) and the MPFL/vastus medialis obliquus complex are essential for patellar stability. Insufficiency of the MPFL can lead to altered biomechanics and patellofemoral joint contact pressure, high recurrence rate, osteochondral lesions, compromised knee function, and patellofemoral osteoarthritis. Most frequently surgical reconstruction of the MPFL is performed to address patellar instability; however, open physis and donor site morbidity can be a concern. This Technical Note presents a surgical technique to identify the insufficient MPFL and describes in detail an anatomical retensioning repair of the MPFL to restore patellar stability...
May 2018: Arthroscopy Techniques
Michael Saper
Isolated medial patellar subluxation (MPS), in the absence of a previous lateral retinacular release, is a poorly recognized clinical condition characterized by chronic anterior knee pain that is exacerbated with knee flexion. This type of patellar instability is often overlooked, and a high index of suspicion is needed for appropriate diagnosis and treatment. The purpose of this Technical Note is to describe a surgical technique to reconstruct the lateral patellofemoral ligament with an allograft gracilis tendon...
April 2018: Arthroscopy Techniques
Xiaojian Li, Zhanli Fu, Changwei Lü
Objective: To investigate the effectiveness of the arthroscopic lateral retinacular release combined with medial patellofemoral ligament (MPFL) reconstruction for patellar dislocation. Methods: Between January 2016 and March 2017, 28 cases (32 knees) with patellar dislocation were treated by arthroscopic lateral retinacular release and MPFL reconstruction. There were 6 males (6 knees) and 22 females (26 knees) with an average age of 21 years (range, 17-29 years)...
February 1, 2018: Chinese Journal of Reparative and Reconstructive Surgery
Gouzhong Wu
Objective: To investigate effectiveness of a improved technique for perforation of patella combined with suture anchor and non-tourniquet for repairing acute rupture of the bone tendon junction of quadriceps tendon. Methods: Between June 2010 and June 2016, 15 patients with acute rupture of the bone tendon junction of quadriceps tendon were treated with the improved technique for perforation of patella combined with suture anchor and non-tourniquet. Of them, 14 were male and 1 was female, aged from 19 to 74 years (mean, 44 years)...
December 1, 2017: Chinese Journal of Reparative and Reconstructive Surgery
Li Li, Hongbo Wang, Yun He, Yu Si, Hongyu Zhou, Xin Wang
Recurrent patellar dislocations were treated via knee arthroscopy combined with C-arm fluoroscopy, and reconstruction of the medial patellofemoral ligaments. Between October 2013 and March 2017, 52 cases of recurrent patellar dislocation [27 males and 25 females; age, 16-47 years (mean, 21.90 years)] were treated. Arthroscopic exploration was performed and patellofemoral joint cartilage injuries were repaired. It was subsequently determined whether it was necessary to release the lateral patellofemoral support belt...
June 2018: Experimental and Therapeutic Medicine
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
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
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
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
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
Matjaz Sajovic, Domen Stropnik, Katja Skaza
BACKGROUND: Short-term and mid-term differences between hamstring and patellar tendon autografts for anterior cruciate ligament (ACL) reconstruction are well documented. Systematic reviews highlight the lack of long-term results between the two grafts. HYPOTHESIS: Seventeen years after ACL reconstruction, no difference will be found in functional outcome, quality of life, and graft failure between patients with patellar tendon (PT) or semitendinosus and gracilis tendon (STG) autografts; however, a significant difference will be seen in the prevalence of osteoarthritis...
May 1, 2018: American Journal of Sports Medicine
Alexander E Loeb, Miho J Tanaka
PURPOSE OF REVIEW: The purpose of this review is to describe the current understanding of the medial patellofemoral complex, including recent anatomic advances, evaluation of indications for reconstruction with concomitant pathology, and surgical reconstruction techniques. RECENT FINDINGS: Recent advances in our understanding of MPFC anatomy have found that there are fibers that insert onto the deep quadriceps tendon as well as the patella, thus earning the name "medial patellofemoral complex" to allow for the variability in its anatomy...
May 4, 2018: Current Reviews in Musculoskeletal Medicine
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
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
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