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Patella alta

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https://www.readbyqxmd.com/read/29300223/osteotomies-in-patello-femoral-instabilities
#1
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
#2
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
#3
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...
January 1, 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
#4
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...
December 5, 2017: Gait & Posture
https://www.readbyqxmd.com/read/29149666/relationship-between-radiographic-patella-alta-pathology-and-walking-dysfunction-in-children-with-bilateral-spastic-cerebral-palsy
#5
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...
November 10, 2017: 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
#6
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...
October 31, 2017: Arthroscopy: the Journal of Arthroscopic & related Surgery
https://www.readbyqxmd.com/read/29099881/patella-alta-sees-you-do-you-see-it
#7
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
#8
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
https://www.readbyqxmd.com/read/29079908/patellofemoral-dysbalance-and-genua-valga-outcome-after-femoral-varisation-osteotomies
#9
Jörg Dickschas, Felix Ferner, Christoph Lutter, Kolja Gelse, Jörg Harrer, Wolf Strecker
INTRODUCTION: Patellofemoral dysbalance may be caused by trochlear dysplasia, an elevated TTTG distance, femoral or tibial torsional deformities, patella alta, or a genu valgum. The surgical procedure for the treatment of a genu valgum is varisation osteotomy, usually in the femoral aspect. Several authors believe that a genu valgum is one cause of patellofemoral dysbalance, but studies about the outcome of the treatment with a varisation osteotomy are rare. MATERIALS AND METHODS: Nineteen knees in 18 patients, aged on average 28 (16-52) years were investigated in a retrospective study...
October 27, 2017: Archives of Orthopaedic and Trauma Surgery
https://www.readbyqxmd.com/read/28918784/-treatment-of-patellar-instability
#10
Martin Lind, Peter Faunø, Ole Gade Sørensen, Bjarne Mygind-Klavsen
First-time patellar luxation appears typically in teenagers and young adults below the age of 16 years, with a prevalence of 45/100,000/year. This luxation is treated with brief limited mobility in a bandage, and with a complementary physiotherapy if the mobility is influenced afterwards. Risk factors for patellar instability are patellofemoral dysplasia, hyperlaxity, patella alta and valgus malalignment in the knee joint. In case of repeated luxation the treatment is surgical, i.e. reconstruction of the medial patellofemoral ligament recreating the medial patella-stabilizing structures...
September 18, 2017: Ugeskrift for Laeger
https://www.readbyqxmd.com/read/28914334/the-clinical-and-radiological-results-of-individualized-surgical-treatment-depending-on-pathologic-abnormalities-in-recurrent-patellar-dislocation-low-recurrence-rate-but-unintended-patella-baja
#11
Do Kyung Lee, Joon Ho Wang, Seung Hoon Kang, Jun Ho Kim, Russel Haque, Byung Hoon Lee
PURPOSE: To evaluate the clinical and radiological outcomes and chondral lesion change using individualized surgery for recurrent patellar dislocation. METHODS: A total of 31 knees with recurrent patellar dislocation underwent surgery depending on individual pathologic abnormalities. Pathologic abnormalities including medial laxity, lateral tightness, increased tibial tuberosity (TT)-to-trochlear groove distance (>20 mm), and patella alta (Caton-Deschamps ratio >1...
September 15, 2017: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
https://www.readbyqxmd.com/read/28867290/modified-adductor-sling-technique-a-surgical-therapy-for-patellar-instability-in-skeletally-immature-patients
#12
Lena Alm, Matthias Krause, Carolin Mull, Karl-Heinz Frosch, Ralph Akoto
BACKGROUND: Due to open femoral physis the therapy of patellar instability in skeletally immature patients is challenging. We developed a modified surgical technique of the 'Adductor-Sling-Approach' by Sillanpää. The purpose of this study was to evaluate the clinical outcome of the operative technique and to analyse the reasons for failure. METHODS: Thirty 'modified adductor sling' reconstructions in 28 patients were included in the study. From 2010 to 2016 modified adductor sling reconstruction was performed by looping the gracilis or semitendinosus tendon around the adductor magnus tendon and attaching it at the medial facet of the patella...
August 31, 2017: Knee
https://www.readbyqxmd.com/read/28852343/finite-element-analysis-of-patella-alta-a-patellofemoral-instability-model
#13
Nicole A Watson, Kyle R Duchman, Nicole M Grosland, Matthew J Bollier
BACKGROUND: This study aims to provide biomechanical data on the effect of patella height in the setting of medial patellofemoral ligament (MPFL) reconstruction using finite element analysis. The study will also examine patellofemoral joint biomechanics using variable femoral insertion sites for MPFL reconstruction. METHODS: A previously validated finite element knee model was modified to study patella alta and baja by translating the patella a given distance to achieve each patella height ratio...
2017: Iowa Orthopaedic Journal
https://www.readbyqxmd.com/read/28744079/evaluation-of-patella-alta-using-mri-measurements-in-adolescents
#14
Barış Yılmaz, Guzelali Ozdemir, Evrim Sirin, Esin D Cicek, Burcu S Anıl, Goncagul Bulbun
PURPOSE: To determine whether or not there were any differences in the measurement techniques used by orthopedic and radiology specialists in the evaluation of magnetic resonance (MR) images for the diagnosis of patella alta in adolescents. MATERIALS AND METHODS: Evaluations were performed by three orthopedic specialists (Group I) and three radiology specialists (Group II) regarding the presence of patella alta in 40 adolescents cases using the Insall-Salvati, Caton-Deschamps, Blackburne-Peel, and modified Insall-Salvati indices on MR images obtained to diagnose patellar instability...
April 2017: Indian Journal of Radiology & Imaging
https://www.readbyqxmd.com/read/28706804/tibial-tuberosity-transfer-in-combination-with-medial-patellofemoral-ligament-reconstruction-surgical-technique
#15
Damian Clark, Katie Walmsley, Peter Schranz, Vipul Mandalia
The stability of the patellofemoral joint relies on the tenuous interplay of soft tissue and bony factors. Anatomic risk factors for instability include a shallow trochlea, an abnormally lateral tibial tubercle position, patella alta, hypermobility, or a secondary injury to the medial patellofemoral ligament (MPFL). There is an increasing interest in restoring normal anatomy to achieve stability, and at times more than 1 abnormality exists. This article describes the technique for combining a tibial tuberosity transfer and an MPFL reconstruction...
June 2017: Arthroscopy Techniques
https://www.readbyqxmd.com/read/28629941/does-patella-lowering-improve-crouch-gait-in-cerebral-palsy-comparative-retrospective-study
#16
E Desailly, C Thévenin-Lemoine, N Khouri
BACKGROUND: Patella lowering aims to improve quadriceps function as a means of correcting crouch gait in patients with cerebral palsy. Few studies have assessed the effects of patella lowering as a component of multilevel surgery. HYPOTHESIS: Including patella lowering into the components of multilevel surgery is beneficial in patients with crouch gait and patella alta. MATERIAL AND METHODS: In 12 lower limbs with patella alta (Caton-Deschamps index>1...
June 16, 2017: Orthopaedics & Traumatology, Surgery & Research: OTSR
https://www.readbyqxmd.com/read/28601942/anatomic-reconstruction-of-the-medial-patellofemoral-ligament-in-children-and-adolescents-using-a-pedicled-quadriceps-tendon-graft-shows-favourable-results-at-a-minimum-of-2-year-follow-up
#17
Manfred Nelitz, Jens Dreyhaupt, Sean Robert March Williams
PURPOSE: In adults, reconstruction of the medial patellofemoral ligament (MPFL) has shown good results. Treatment for recurrent patellar instability in children and adolescents with open growth plates, however, requires alternative MPFL reconstruction techniques. This study presents the outcomes of a minimally invasive technique for anatomic reconstruction of the MPFL in children using a pedicled superficial quadriceps tendon graft, hardware-free patellar graft attachment, and anatomic femoral fixation that spares the distal femoral physis...
June 10, 2017: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
https://www.readbyqxmd.com/read/28569198/determination-of-reference-values-and-frequency-of-occurrence-of-patella-alta-in-german-shepherd-dogs-a-retrospective-study
#18
Anna Łojszczyk-Szczepaniak, Piotr Silmanowicz, Renata Komsta, Zbigniew Osiński
BACKGROUND: Patella alta and patella baja are important conditions underlying a predisposition to many joint diseases, including patellar luxation and patellar chondromalacia of the articular cartilage. The frequencies of patella alta and patella baja have not yet been determined. The objectives of this study were to determine the frequency of patella alta and to determine reference values to the position of the vertical patella according to two modified techniques of the Insall-Salvati method in a group of 65 German shepherd dogs (115 stifle joints)...
May 31, 2017: Acta Veterinaria Scandinavica
https://www.readbyqxmd.com/read/28463535/risk-factors-and-time-to-recurrent-ipsilateral-and-contralateral-patellar-dislocations
#19
Tyson C Christensen, Thomas L Sanders, Ayoosh Pareek, Rohith Mohan, Diane L Dahm, Aaron J Krych
BACKGROUND: Previous studies have reported variable rates of recurrent lateral patellar instability mainly because of limited cohort sizes. In addition, there is currently a lack of information on contralateral patellar instability. PURPOSE: To evaluate the rate of recurrent ipsilateral patellar dislocations and contralateral patellar dislocations after a first-time lateral patellar dislocation. Additionally, risk factors associated with recurrent dislocations (ipsilateral or contralateral) and time to recurrence were investigated...
July 2017: American Journal of Sports Medicine
https://www.readbyqxmd.com/read/28459752/patellar-instability-when-is-trochleoplasty-necessary
#20
S Evan Carstensen, Heather M Menzer, David R Diduch
Trochleoplasty is a very effective procedure for correcting trochlear dysplasia and addressing instability of the patella. With an increasing knowledge about the anatomy and biomechanics of the anterior distal femur, a wider array of surgical techniques may be applied to address specific conditions. Patients must be carefully selected to undergo trochleoplasty by use of a thorough history and physical examination as well as basic and advanced imaging. The presence of a "J sign" on physical examination, a history of recurrent instability, patella alta, trochlear dysplasia, and elevated tibial tubercle to trochlear groove are signs and symptoms for which the patient should be evaluated...
June 2017: Sports Medicine and Arthroscopy Review
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