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https://www.readbyqxmd.com/read/29752638/avoiding-complications-with-mpfl-reconstruction
#1
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/29748692/clinics-in-diagnostic-imaging-185
#2
Ying Xin Candice Leong, Poh Lye Paul See
A 20-year-old National Serviceman presented with left knee pain and swelling after training for his physical fitness test. Lateral knee radiography and magnetic resonance (MR) imaging showed patellar tendon-lateral femoral condyle friction syndrome (PT-LFCFS), on a background of patella alta and patellar malalignment. The patient was treated non-operatively with a course of physiotherapy and given advice on rest and activity modification. PT-LFCFS is a less well-recognised but important cause of anterior knee pain and represents an entity in a spectrum of disorders related to patellofemoral instability...
April 2018: Singapore Medical Journal
https://www.readbyqxmd.com/read/29736871/predicting-risk-of-recurrent-patellar-dislocation
#3
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/29653442/examination-under-anesthesia-in-patients-with-recurrent-patellar-dislocation-prognostic-study
#4
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/29651769/superolateral-hoffa-s-fat-pad-shfp-oedema-and-patellar-cartilage-volume-loss-quantitative-analysis-using-longitudinal-data-from-the-foundation-for-the-national-institute-of-health-fnih-osteoarthritis-biomarkers-consortium
#5
Arya Haj-Mirzaian, Ali Guermazi, Nima Hafezi-Nejad, Christopher Sereni, Michael Hakky, David J Hunter, Bashir Zikria, Frank W Roemer, Shadpour Demehri
OBJECTIVES: To determine the association of superolateral Hoffa's fat pad (SHFP) oedema and patellofemoral joint structural damage in participants of Foundation for the National Institute of Health Osteoarthritis Biomarkers Consortium study. METHODS: Baseline and 24-month MRIs of 600 subjects were assessed. The presence of SHFP oedema (using 0-3 grading scale) and patellar morphology metrics were determined using baseline MRI. Quantitative patellar cartilage volume and semi-quantitative MRI osteoarthritis knee score (MOAKS) variables were extracted...
April 12, 2018: European Radiology
https://www.readbyqxmd.com/read/29552477/sulcus-deepening-trochleoplasty-and-medial-patellofemoral-ligament-reconstruction-for-recurrent-patellar-instability
#6
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/29546510/the-quadriceps-active-ratio-a-dynamic-mri-based-assessment-of-patellar-height
#7
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
#8
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 12, 2018: Knee
https://www.readbyqxmd.com/read/29413194/editorial-commentary-medial-patellofemoral-ligament-reconstruction-for-knee-patellar-instability-when-are-soft-tissue-procedures-not-enough
#9
EDITORIAL
Miho J Tanaka
Medial patellofemoral ligament reconstruction is commonly performed to treat patellofemoral instability by recreating the static soft tissue restraint to lateral patellar translation. Concurrent tibial tuberosity osteotomy can be indicated in the setting of bony malalignment, such as a lateralized tuberosity or patella alta; however, the exact indications for this have been difficult to define due to the multifactorial nature of this problem. Understanding the role of tuberosity lateralization and patella alta on the function of medial patellofemoral ligament grafts can help to identify the interplay of some factors that contribute to patellar stability and improve our understanding of when and how concurrent tibial tuberosity osteotomy may be indicated...
February 2018: Arthroscopy: the Journal of Arthroscopic & related Surgery
https://www.readbyqxmd.com/read/29410197/patellofemoral-reconstruction-for-patellar-instability-with-patella-alta-in-middle-aged-patients-clinical-outcomes
#10
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/29399590/medial-patellofemoral-ligament-reconstruction-reduces-radiographic-measures-of-patella-alta-in-adults
#11
Jarret M Woodmass, Nick R Johnson, Robert A Cates, Aaron J Krych, Michael J Stuart, Diane L Dahm
Background: Patellar height has long been considered a risk factor for patellofemoral instability. However, recent pediatric literature demonstrated a reduction in patellar height measurements following medial patellofemoral ligament (MPFL) reconstruction. Purpose: To assess the mean change in patellar height and the percentage of skeletally mature patients with patellar height ratios reduced to within-normal limits following MPFL reconstruction. Study Design: Case series; Level of evidence, 4...
January 2018: Orthopaedic Journal of Sports Medicine
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
#12
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/29300223/osteotomies-in-patello-femoral-instabilities
#13
David Dejour, Bertrand Le Coultre
Patellar instability is defined by clinical and radiologic criteria. The surgical treatment is aimed at restoring the congruence of the patellofemoral articulation and correcting extensor mechanism malalignment, to prevent recurrence of dislocation. The standard soft-tissue procedures are lateral release and vastus medialis advancement and medial patello femoral ligament plasty. Bony procedures are frequently performed in addition to soft-tissue surgery, to realign the extensor mechanism by means of tibial tubercle medialization, or to correct the patellar index in patella alta...
March 2018: Sports Medicine and Arthroscopy Review
https://www.readbyqxmd.com/read/29299655/medial-patellofemoral-ligament-reconstruction-in-children-do-osseous-abnormalities-matter
#14
Sebastien Pesenti, Matthieu Ollivier, Jean-Charles Escudier, Mathieu Cermolacce, Alexandre Baud, Franck Launay, Jean-Luc Jouve, Elie Choufani
PURPOSE: Management of post-traumatic patellar instability in children with osseous abnormalities is challenging because of the presence of an open physis. The aim of our study was to compare the rate of recurrence after isolated reconstruction of the medial patellofemoral ligament (MPFL) in children with or without osseous abnormalities. METHODS: The medical records of 25 children (27 knees) with recurrent patellar dislocation were reviewed. Each child underwent an isolated reconstruction of the MPFL using a hamstring graft...
January 4, 2018: International Orthopaedics
https://www.readbyqxmd.com/read/29298083/clinical-outcomes-after-isolated-medial-patellofemoral-ligament-reconstruction-for-patellar-instability-among-patients-with-trochlear-dysplasia
#15
Joseph N Liu, Jacqueline M Brady, Irene L Kalbian, Sabrina M Strickland, Claire Berdelle Ryan, Joseph T Nguyen, Beth E Shubin Stein
BACKGROUND: Medial patellofemoral ligament (MPFL) reconstruction has become one of the most common and widely used procedures to regain stability among patients with recurrent lateral patellar dislocation. While recent studies demonstrated low recurrence rates, improved patient-reported outcome measures, and a high rate of return to sports, limited literature explored its effectiveness as an isolated intervention in the context of trochlear dysplasia. PURPOSE: To determine the efficacy of isolated MPFL reconstruction in treating patellar instability in the setting of trochlear dysplasia...
March 2018: American Journal of Sports Medicine
https://www.readbyqxmd.com/read/29248848/the-coupled-effects-of-crouch-gait-and-patella-alta-on-tibiofemoral-and-patellofemoral-cartilage-loading-in-children
#16
Scott C E Brandon, Darryl G Thelen, Colin R Smith, Tom F Novacheck, Michael H Schwartz, Rachel L Lenhart
BACKGROUND: Elevated tibiofemoral and patellofemoral loading in children who exhibit crouch gait may contribute to skeletal deformities, pain, and cessation of walking ability. Surgical procedures used to treat crouch frequently correct knee extensor insufficiency by advancing the patella. However, there is little quantitative understanding of how the magnitudes of crouch and patellofemoral correction affect cartilage loading in gait. METHODS: We used a computational musculoskeletal model to simulate the gait of twenty typically developing children and fifteen cerebral palsy patients who exhibited mild, moderate, and severe crouch...
February 2018: Gait & Posture
https://www.readbyqxmd.com/read/29149666/relationship-between-radiographic-patella-alta-pathology-and-walking-dysfunction-in-children-with-bilateral-spastic-cerebral-palsy
#17
Matthias Hösl, Harald Böhm, Michaela Seltmann, Chakravarthy Ugandhar Dussa, Leonhard Döderlein
BACKGROUND: Patella-alta is very common in patients with Cerebral Palsy (CP). While several diagnostic x-ray indices have been developed for patella-alta in general, the specific relationship with walking dysfunction in CP is only partly understood. METHODS: 33 participants with bilateral spastic CP between 4 and 20 years (GMFCS I-II without previous surgery) that underwent 3D gait analysis as well as a radiographic exam within 0.8 (SD 1.2) months were retrospectively included...
February 2018: Gait & Posture
https://www.readbyqxmd.com/read/29100777/anisometry-of-medial-patellofemoral-ligament-reconstruction-in-the-setting-of-increased-tibial-tubercle-trochlear-groove-distance-and-patella-alta
#18
Lauren H Redler, Kathleen N Meyers, Jacqueline M Brady, Elizabeth R Dennis, Joseph T Nguyen, Beth E Shubin Stein
PURPOSE: To assess the impact elevated tibial tubercle-trochlear groove (TT-TG) distance and patella height, as measured by the Caton-Deschamps Index (CDI), have on the isometry of a reconstructed medial patellofemoral ligament (MPFL). METHODS: Nine fresh-frozen cadaveric knees were placed on a custom testing fixture, with a fixed femur and a mobile tibia. A suture fixed to the MPFL origin on the patella and free to move at the Schöttle point on the femur represented a reconstructed MPFL...
February 2018: Arthroscopy: the Journal of Arthroscopic & related Surgery
https://www.readbyqxmd.com/read/29099881/patella-alta-sees-you-do-you-see-it
#19
Robert A Magnussen
Numerous anatomic factors have been shown to contribute to patellar instability. Patellar height remains a critical, yet underappreciated contributor to instability that is amenable to surgical correction through the performance of a tibial tubercle distalization osteotomy (TTDO). The indications for a distalizing tibial tubercle osteotomy are not completely clear and depend on multiple factors. One must consider patient factors and physical examination findings in addition to radiographic measures. In general, the addition of a TTDO to medial patellofemoral ligament reconstruction should be considered when the degree of patella alta exceeds a Caton-Deschamps Index (CDI) of 1...
September 2017: American Journal of Orthopedics
https://www.readbyqxmd.com/read/29095402/mri-and-arthroscopy-correlation-in-the-patellofemoral-joint
#20
Lisa G M Friedman, Melissa S White, Patrick F Carroll, Jeffrey A Macalena, Elizabeth A Arendt, Jutta M Ellermann, Marc Tompkins
The patellofemoral joint is an articulation between the patella and the femoral trochlea, which serves to increase the lever arm of the extensor mechanism. The stability of the patella within the trochlear groove is supported statically by the bony confines of the groove itself, as well as the medial patellofemoral ligament, and dynamically by the vastus musculature. Pathologic changes seen on magnetic resonance imaging (MRI) are frequently well correlated with findings found by arthroscopy at the time of surgery...
December 2017: Sports Medicine and Arthroscopy Review
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