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Medial patellofemoral ligament physical therapy

Marie Askenberger, Eva Bengtsson Moström, Wilhelmina Ekström, Elizabeth A Arendt, Anna Hellsten, Christina Mikkelsen, Per-Mats Janarv
BACKGROUND: A lateral patellar dislocation (LPD) is the most common traumatic knee injury with hemarthrosis in children. The redislocation rate is high. Varying operative and nonoperative treatments have been advocated with no consensus on the best treatment. PURPOSE: (1) To evaluate if arthroscopic-assisted repair of the medial patellofemoral ligament (MPFL) in patients with an acute first-time traumatic LPD would reduce the recurrence rate and offer better objective/subjective knee function compared with a knee brace without repair...
May 1, 2018: American Journal of Sports Medicine
Sven Höhne, Kristina Gerlach, Lars Irlenbusch, Mathias Schulz, Christian Kunze, Rainer Finke
Introduction Patellar dislocation is one of the commonest knee injuries in adolescents. Although treatment usually leads to good results, the influence of anatomical and functional factors on therapeutic strategy has been underestimated, especially in cases of recurrence. Patients and Methods The course of treatment has been analysed in 88 patients with 136 patellar dislocations. The importance of anatomical conditions was studied using X-ray and MRI findings. The treatment results were critically evaluated in comparison with current recommendations...
April 2017: Zeitschrift Für Orthopädie und Unfallchirurgie
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
Eric Hohn, Nirav K Pandya
BACKGROUND: Medial patellofemoral ligament (MPFL) reconstruction is one of several surgical procedures used to treat patellofemoral instability. Use of allograft tissue can preserve autogenous tissue and may be preferable in patients with connective tissue disorders or ligamentous laxity. Although there are successful reports in adults, it is unclear if the use of allograft tissue in MPFL reconstruction can restore patellofemoral stability in children and adolescents. QUESTIONS/PURPOSES: (1) Does allograft tissue in MPFL reconstruction in pediatric and adolescent patients restore patellar stability? (2) What complications were associated with allograft MPFL reconstructions in children and adolescents? METHODS: Between June 2012 and August 2015, one surgeon (NKP) performed 26 MPFL reconstructions in 23 patients with gracilis allograft for traumatic patellar instability...
June 2017: Clinical Orthopaedics and related Research
Teresa Errigo Vitale, Brianne Mooney, Ashley Vitale, Demitra Apergis, Stephen Wirth, Mark G Grossman
BACKGROUND: The incidence of patellar subluxation or dislocation has been documented up to 43/100,000 with females more prevalent then males. There are many contributing factors involving the hip, knee, and ankle that lead to patellar subluxation. A patellar position of lateral tilt with lateral glide may indicate weakness of the vastus medialis oblique (VMO) and adductors, increased tightness in the iliotibial band, and overpowering of the vastus lateralis. Patella alta can predispose an individual to lateral dislocation due to the patella placement outside of the femoral trochlear groove with a disadvantage of boney stability...
June 2016: International Journal of Sports Physical Therapy
Denise Ramponi
Acute patellar dislocations are a common injury occurring in adolescents involved in sports and dancing activities. This injury usually occurs when the knee is in full extension and sustains a valgus stress on the knee. The medial patellofemoral ligament is the medial restraint that assists in stabilizing the patella from lateral dislocations. The patella usually dislocates laterally and is usually not difficult to reduce after patient evaluation and prereduction radiographs. After postreduction radiographs confirm proper position of the patella postreduction and the absence of fractures, the patient is usually treated conservatively with initial immobilization, orthopedic referral, and physical therapy...
April 2016: Advanced Emergency Nursing Journal
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
Zachary Ries, Matthew Bollier
Patellofemoral instability is a common problem in the adolescent population. Patellar stability depends on a dynamic interplay between bony and soft tissue restraints. Several pathoanatomical factors increase the likelihood of patellar instability: patella alta, trochlear dysplasia, malalignment, and deficient proximal medial restraints. Treatment for first-time patella dislocations is typically nonoperative and includes bracing, early range of motion, and physical therapy. The only absolute indication for early surgery is a large osteochondral fragment that can be fixed...
August 2015: Journal of Knee Surgery
Scott Cheatham, Morey J Kolber, William J Hanney
BACKGROUND: Patellar dislocations are traumatic injuries that occur most often in individuals under the age of twenty and are related to sports and physical activity. Currently, there are no published reports describing the rehabilitation of younger males after arthroscopy and open reconstruction of the medial patellofemoral ligament (MPFL) using a tibialis anterior allograft. CASE DESCRIPTION: The subject of this case report was a 23 year-old recreational male athlete who underwent right knee arthroscopic patellar chondroplasty, lateral retinacular release, partial lateral menisectomy, and an open MPFL reconstruction with a tibialis anterior allograft after sustaining a second patellar dislocation...
April 2014: International Journal of Sports Physical Therapy
James D Wylie, Robert T Burks
Patellar instability is a common complaint after traumatic dislocation of the patella. Traumatic dislocation always leads to tearing of the medial patellofemoral ligament (MPFL). Treatment consists of recovery from the traumatic injury, followed by reconditioning and physical therapy to strengthen the dynamic stabilizers of the patella. In patients with recurrent instability, detailed evaluation of the cause is required to determine the needed interventions. In patients with an incompetent MPFL and recurrent instability, reconstruction is indicated, along with other procedures to address other contributing factors...
2013: Arthroscopy Techniques
Manfred Nelitz, Jens Dreyhaupt, Heiko Reichel, Julia Woelfle, Sabine Lippacher
BACKGROUND: Recurrent lateral patellar dislocation is a common knee injury in the skeletally immature adolescent. Because of the open physis, operative therapy in children is challenging. This study presents the outcomes of a minimally invasive technique for anatomic reconstruction of the medial patellofemoral ligament (MPFL) in children that respects the distal femoral physis. HYPOTHESIS: Anatomic reconstruction of the MPFL in children that maintains the distal femoral physis will prevent redislocation, preserve the distal femoral physis, and improve knee function...
January 2013: American Journal of Sports Medicine
Heather Gillespie
Patellar instability is a complex topic that must be treated at the individual level. The majority of first-time patellar dislocations occur in sport, and there is a high rate of recurrence and ongoing symptoms. Physical examination and imaging studies can aid in treatment decisions. Patient symptoms, degree of trauma, compliance with therapy, anatomical factors, and desired activity levels influence management strategies (both operative and nonoperative). There is recent emphasis on the medial patellofemoral ligament and its involvement in patellar stability, and various surgical techniques have been studied; however there is no clear consensus...
September 2012: Current Sports Medicine Reports
Rainer Siebold, Carlo Angelo V Borbon
The standard approach to reconstruct the medial patellofemoral ligament (MPFL) is by mini-open incision at its patellar insertion and femoral origin. At the medial patella rim, the MPFL insertion may be visualized in most cases by dissection during surgery. On the femur, it is more difficult to localize the MPFL remnants by a mini-open incision due to soft tissue covering the anatomical origin. Therefore, the femoral MPFL origin is usually identified by intraoperative lateral fluoroscopy. However, the insertion and origin of the MPFL at the patella and femur might be directly visualized using an arthroscopic extraarticular approach from the knee joint through a window of the synovial layer...
July 2012: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Alexandre Carneiro Bitar, Marco Kawamura Demange, Caio Oliveira D'Elia, Gilberto Luis Camanho
BACKGROUND: Over the long term, acute patellar dislocations can result in patellar instability, with high recurrence rates after nonoperative treatment. PURPOSE: To compare the results of operative (reconstruction of the medial patellofemoral ligament [MPFL]) versus nonoperative treatment of primary patellar dislocation. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: Thirty-nine patients (41 knees) (mean age, 24...
January 2012: American Journal of Sports Medicine
S Frosch, P Balcarek, T A Walde, J P Schüttrumpf, M M Wachowski, K-G Ferleman, K M Stürmer, K-H Frosch
AIM: The diagnosis and treatment of patellar dislocation is very complex. The aim of this study is to give an overview of the biomechanics of the patellofemoral joint and to point out the latest developments in diagnosis and treatment of patellar dislocation. METHOD: The authors electronically searched Medline, Cochrane and Embase for studies on the biomechanics of the patellofemoral joint and for conservative and surgical treatments after patellar dislocation. We extracted baseline demographics, biomechanical, conservation and surgical details...
December 2011: Zeitschrift Für Orthopädie und Unfallchirurgie
Joseph M Hart, Kimberly A Turman, David R Diduch, Jennifer A Hart, Mark D Miller
PURPOSE: Quadriceps strength and activation may play an important role in the recovery from ACL revision surgery. The purpose of this study was to describe quadriceps strength and central activation ratio (CAR) and correlate with radiographic findings in patients with ACL revision surgery. METHODS: Twenty-one patients who were on average 47.5 ± 21.1 months [range: 14-85 months] post-revision ACL reconstruction. We performed knee joint physical examination and radiographic evaluation...
April 2011: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Ertuğrul Akşahin, Feridun Yumrukçal, Halil Yalçın Yüksel, Dağhan Doğruyol, Levent Celebi
INTRODUCTION: Medial patellar subluxation is usually seen after lateral retinacular release. Spontaneous medial subluxation of the patella is a very rare condition. There are few reports in the literature on the pathophysiology of iatrogenic medial patellar subluxation. To our knowledge, there are no reports of the pathophysiology of non-iatrogenic medial patellar subluxation in the English literature. In this study we present a case of spontaneous medial patellar instability that is more prominent in extension during weight bearing...
May 22, 2010: Journal of Medical Case Reports
Michael O Harris-Love, Joseph A Shrader
STUDY DESIGN: Resident's case problem. BACKGROUND: Kaposi's sarcoma (KS) is the most common form of cancer in patients with human immunodeficiency virus (HIV) infection. Although KS is often initially asymptomatic, this neoplasm may progress to affect multiple organ systems, including structures of the musculoskeletal system, which can produce symptoms similar to those associated with common orthopaedic conditions. This resident's case problem describes the evaluation and differential diagnosis of a 45-year-old male with HIV and KS, referred to physical therapy with an initial diagnosis of radiographic osteoarthritis (OA) and patellofemoral pain syndrome (PFPS) of the left knee...
August 2009: Journal of Orthopaedic and Sports Physical Therapy
Gilberto Luis Camanho, Alexandre de Christo Viegas, Alexandre Carneiro Bitar, Marco Kawamura Demange, Arnaldo José Hernandez
PURPOSE: The objective of this study was to analyze and compare the results obtained after 2 types of treatment, surgical and conservative, for acute patellar dislocations. METHODS: We divided 33 patients with acute patellar dislocations into 2 groups. One group with 16 patients underwent conservative treatment (immobilization and subsequent physiotherapy), and the other group with 17 patients underwent surgical treatment. A radiographic examination was performed in the evaluation of the patients to verify predisposing factors for patellofemoral instability, and the Kujala questionnaire was applied with the intention of analyzing the improvement of pain and quality of life...
June 2009: Arthroscopy: the Journal of Arthroscopic & related Surgery
Alexis Chiang Colvin, Robin V West
Recurrent patellar instability can result from osseous abnormalities, such as patella alta, a distance of >20 mm between the tibial tubercle and the trochlear groove, and trochlear dysplasia, or it can result from soft-tissue abnormalities, such as a torn medial patellofemoral ligament or a weakened vastus medialis obliquus. Nonoperative treatment includes physical therapy, focusing on strengthening of the gluteal muscles and the vastus medialis obliquus, and patellar taping or bracing. Acute medial-sided repair may be indicated when there is an osteochondral fracture fragment or a retinacular injury...
December 2008: Journal of Bone and Joint Surgery. American Volume
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