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https://www.readbyqxmd.com/read/27904790/current-concepts-in-the-treatment-of-gross-patellofemoral-instability
#1
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...
December 2016: International Journal of Sports Physical Therapy
https://www.readbyqxmd.com/read/27900510/does-a-positioning-rod-or-a-patient-specific-guide-result-in-more-natural-femoral-flexion-in-the-concept-of-kinematically-aligned-total-knee-arthroplasty
#2
Max Ettinger, Tilman Calliess, Stephen M Howell
PURPOSE: Flexion of the femoral component in 5° increments downsizes the femoral component, decreases the proximal reach and surface area of the trochlea, delays the engagement of the patella during flexion, and is associated with a higher risk of patellar-femoral instability after kinematically aligned TKA. The present study evaluated flexion of the femoral component after use of two kinematic alignment instrumentation systems. We determined whether a distal cutting block attached to a positioning rod inserted perpendicular to the distal femoral joint line in the axial plane and 8-10 cm into the distal femur anterior and posterior to the distal cortex of the femur in the sagittal plane or a femoral patient-specific cutting guide sets the femoral component in more natural flexion...
November 29, 2016: Archives of Orthopaedic and Trauma Surgery
https://www.readbyqxmd.com/read/27894178/comparison-of-radiological-parameters-between-normal-and-patellar-dislocation-groups-in-korean-population-a-rotational-profile-ct-based-study
#3
Jatin Prakash, Jong-Keun Seon, Seong-Hwan Woo, Cheng Jin, Eun-Kyoo Song
Purpose: Patellofemoral instability is a common cause of anterior knee pain in adolescents and young adults. Most normal and pathological values for diagnosing patellofemoral instability are based on Western literature. We conducted this radiological study to determine normal values for different patellofemoral parameters in a Korean population and to evaluate their usefulness in diagnosis. Materials and Methods: We retrospectively reviewed the rotational profile computerized tomography (CT) scans of the patellar dislocation and control groups...
December 1, 2016: Knee Surgery & related Research
https://www.readbyqxmd.com/read/27826907/the-unstable-knee-in-congenital-limb-deficiency
#4
REVIEW
Gabriel T Mindler, Christof Radler, Rudolf Ganger
PURPOSE: Instability of the knee is a common finding in patients with congenital limb deficiency. The instability can be attributed to soft tissue abnormalities, frontal, sagittal or rotational deformity of the lower limb and bony dysplasia of the patella or of the femoral condyles. In most of the cases, these pathomorphologic changes stay asymptomatic in daily activity. However, instability can appear during deformity correction and bone-lengthening procedures, leading to flexion contracture or subluxation of the knee...
November 8, 2016: Journal of Children's Orthopaedics
https://www.readbyqxmd.com/read/27810431/clinical-results-after-treatment-for-bidirectional-patellar-subluxation-minimum-2-years-follow-up
#5
Michael Saper, Candice Brady, Robert Zondervan, David Shneider
BACKGROUND: We describe the preliminary clinical results of a patellar stabilization technique to treat bidirectional patellar subluxation (BPS). METHODS: Patients: six patients (one male, five females; mean age 30.2years) underwent this procedure with a minimum of 24months follow-up. Patients were assessed for clinical instability, patellar complications, and need for revision surgery. Patient functional outcomes were evaluated using the criteria of Crosby and Insall and the Kujala Anterior Knee Pain Scale at the time of final follow-up...
December 2016: Knee
https://www.readbyqxmd.com/read/27796419/results-of-medial-patellofemoral-ligament-reconstruction-compared-with-trochleoplasty-plus-individual-extensor-apparatus-balancing-in-patellar-instability-caused-by-severe-trochlear-dysplasia-a-systematic-review-and-meta-analysis
#6
REVIEW
Peter Balcarek, Stephan Rehn, Nick R Howells, Jonathan D Eldridge, Keisuke Kita, David Dejour, Manfred Nelitz, Ingo J Banke, Delphine Lambrecht, Markus Harden, Tim Friede
PURPOSE: Many studies have reported satisfactory clinical outcomes and low redislocation rates after reconstruction of the medial patellofemoral ligament (MPFL) for the treatment of lateral patellar instability. Despite uncorrected severe trochlear dysplasia (Dejour type B to D) being acknowledged as a major reason for less favourable clinical outcomes and a higher incidence of patellar redislocations after an isolated MPFL reconstruction, the evidence for a deepening trochleoplasty procedure remains scarce in the current literature...
October 27, 2016: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
https://www.readbyqxmd.com/read/27717976/coexisting-sarcoidal-granulomatous-inflammation-and-diffuse-tenosynovial-giant-cell-tumor-of-the-knee-after-a-total-knee-replacement-a-case-report
#7
Yaxia Zhang, Michael Joyce, Jean Schils, Thomas W Bauer
Sarcoidosis is a systemic inflammatory disorder characterized by non-caseating granulomas, predominantly involving lung, mediastinal lymph nodes and other organs. Synovium involvement is infrequent, and as far as we know, involvement of a periprosthetic membrane has not been reported in the English literature. Intra-articular diffuse tenosynovial giant cell tumor ("conventional diffuse pigmented villonodular synovitis") is an uncommon, locally aggressive neoplasm with few previous case reports in which it arose in periprosthetic tissues after knee arthroplasty...
October 7, 2016: Skeletal Radiology
https://www.readbyqxmd.com/read/27717972/assessment-of-demographic-and-pathoanatomic-risk-factors-in-recurrent-patellofemoral-instability
#8
Laurie Anne Hiemstra, Sarah Kerslake, Mark Lafave
PURPOSE: The WARPS/STAID classification employs clinical assessment of presenting features and anatomic characteristics to identify two distinct subsets of patients within the patellofemoral instability population. The purpose of this study was to further define the specific demographics and the prevalence of risky pathoanatomies in patients classified as either WARPS or STAID presenting with recurrent patellofemoral instability. A secondary purpose was to further validate the WARPS/STAID classification with the Banff Patella Instability Instrument (BPII), the Marx activity scale and the Patellar Instability Severity Score (ISS)...
October 7, 2016: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
https://www.readbyqxmd.com/read/27709116/dynamic-simulation-of-the-effects-of-graft-fixation-errors-during-medial-patellofemoral-ligament-reconstruction
#9
John J Elias, Michael J Kelly, Kathryn E Smith, Kenneth A Gall, Jack Farr
BACKGROUND: Medial patellofemoral ligament (MPFL) reconstruction is performed to prevent recurrent instability, but errors in femoral fixation can elevate graft tension. HYPOTHESIS: Errors related to femoral fixation will overconstrain the patella and increase medial patellofemoral pressures. STUDY DESIGN: Controlled laboratory study. METHODS: Five knees with patellar instability were represented with computational models...
September 2016: Orthopaedic Journal of Sports Medicine
https://www.readbyqxmd.com/read/27703948/recurrent-patellar-instabilty-culminating-in-a-vertically-rotated-and-a-locked-patellar-dislocation-a-rare-entity
#10
Devgan A, Rohilla R, Jain A, Mehta H, Singh S
INTRODUCTION: Locked vertical patellar dislocations are rare and pose a therapeutic challenge. This case is more unusual, as the patient was a known case of recurrent patellar dislocation and presented with an atraumatic locked and vertically rotated patellar dislocation. This type of presentation has never been reported in literature to the best of our knowledge. CASE PRESENTATION: A 14-year-old healthy male child with previous history of recurrent lateral dislocation of patella presented to accident & emergency department with complaints of inability to walk or bear weight on his left lower limb after he spontaneously dislocated his patella while running on uneven ground...
April 2016: Journal of Orthopaedic Case Reports
https://www.readbyqxmd.com/read/27619673/what-clinical-characteristics-and-radiographic-one-parameters-are-associated-with-patellofemoral-instability-after-kinematically-aligned-total-knee-arthroplasty
#11
Alexander J Nedopil, Stephen M Howell, Maury L Hull
INTRODUCTION: Thirteen patients presented with patellofemoral instability out of 3212 knees treated with kinematically aligned total knee arthroplasty (KA TKA) during a nine year period. We determined the clinical characteristics and post-operative radiographic parameters associated with patellofemoral instability, and whether re-operation and patient reported outcome measures are different between patients with and without patellofemoral instability. METHODS: Patients with patellofemoral instability were matched 1:3 to a control cohort based on date of surgery (±3 months), age (±10 years), sex, pre-operative knee deformity (varus or valgus), and implant brand...
September 12, 2016: International Orthopaedics
https://www.readbyqxmd.com/read/27613760/morphology-and-anatomic-patellar-instability-risk-factors-in-first-time-traumatic-lateral-patellar-dislocations-a-prospective-magnetic-resonance-imaging-study-in-skeletally-immature-children
#12
Marie Askenberger, Per-Mats Janarv, Throstur Finnbogason, Elizabeth A Arendt
BACKGROUND: The incidence of primary lateral patellar dislocation (LPD) in children aged 9 to 14 years is 0.6 to 1.2 per 1000. Causation is assumed to be multifactorial, including anatomic variants of the patellofemoral (PF) joint that result in a higher risk of LPD. No publication has compared the morphology of the PF joint and anatomic patellar instability risk factors (APIFs) in a primary LPD population versus controls, defining children by skeletal maturity. PURPOSE: To characterize the PF morphology and APIFs (trochlear dysplasia, abnormal lateral patellar tilt, elevated tibial tubercle-trochlear groove [TT-TG] distance, patella alta) through magnetic resonance imaging (MRI) measurements in skeletally immature children with and without a primary LPD and to identify (potential) distinctive differences between these 2 groups...
September 9, 2016: American Journal of Sports Medicine
https://www.readbyqxmd.com/read/27590642/does-the-utilization-of-allograft-tissue-in-medial-patellofemoral-ligament-reconstruction-in-pediatric-and-adolescent-patients-restore-patellar-stability
#13
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...
September 2, 2016: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/27574606/lateral-patellofemoral-ligament-reconstruction-to-restore-functional-capacity-in-patients-previously-undergoing-lateral-retinacular-release
#14
Mitch Beckert, Dylan Crebs, Michael Nieto, Yubo Gao, John Albright
AIM: To study patient outcomes after surgical correction for iatrogenic patellar instability. METHODS: This retrospective study looked at 17 patients (19 knees) suffering from disabling medial patellar instability following lateral release surgery. All patients underwent lateral patellofemoral ligament (LPFL) reconstruction by a single surgeon. Assessments in all 19 cases included functional outcome scores, range of motion, and assessment for the presence of apprehension sign of the patella to determine if LPFL reconstruction surgery was successful at restoring patellofemoral stability...
August 16, 2016: World Journal of Clinical Cases
https://www.readbyqxmd.com/read/27565481/an-evaluation-of-the-effectiveness-of-medial-patellofemoral-ligament-reconstruction-using-an-anatomical-tunnel-site
#15
Kars P Valkering, Aysha Rajeev, Nick Caplan, Wim E Tuinebreijer, Deiary F Kader
PURPOSE: Medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability has gained popularity, and anatomical and biomechanical studies have recently altered our operative techniques. The aim of this study was to report the clinical outcome of this new anatomical MPFL reconstructive technique and investigate whether correlating factors could be identified. METHODS: Between 2009 and 2012, a total of 31 consecutive patients underwent MPFL reconstruction using an autologous gracilis graft and anatomical tunnel placement...
August 26, 2016: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
https://www.readbyqxmd.com/read/27544273/patellar-tracking-after-isolated-medial-patellofemoral-ligament-reconstruction-dynamic-evaluation-using-computed-tomography
#16
Riccardo G Gobbi, Marco K Demange, Luiz Francisco Rodrigues de Ávila, José de Arimatéia Batista Araújo Filho, Ramon Alfredo Moreno, Marco Antônio Gutierrez, Marina de Sá Rebelo, Luis Eduardo Passarelli Tírico, José Ricardo Pécora, Gilberto Luis Camanho
PURPOSE: Medial patellofemoral ligament (MPFL) reconstruction offers good clinical results with a very low rate of instability recurrence. However, its in vivo effect on patellar tracking is not clearly known. The aim of this study is to investigate the effects of MPFL reconstruction on patellar tracking using dynamic 320-detector-row CT. METHODS: Ten patients with patellofemoral instability referred to isolated MPFL reconstruction surgery were selected and subjected to dynamic CT before and ≥6 months after surgery...
August 20, 2016: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
https://www.readbyqxmd.com/read/27528843/clinical-accuracy-of-j-sign-measurement-compared-to-magnetic-resonance-imaging
#17
Mitch W Beckert, Jay C Albright, Jeff Zavala, Justin Chang, John P Albright
BACKGROUND: The J-sign is defined as lateral patellar translation over the anterolateral femur proximal to the trochlear groove during active leg extension. Dynamic magnetic resonance imaging (MRI) techniques allow for quantification of the J-sign using a variety of published indices. However, to date, clinical quantification of the J-sign has not been reliably described. The purpose of the present study is to assess the accuracy of clinically quantifying the J-sign compared with objective MRI data...
2016: Iowa Orthopaedic Journal
https://www.readbyqxmd.com/read/27385203/-ligamentous-knee-injuries-in-children-and-adolescents
#18
T C Drenck, R Akoto, N M Meenen, M Heitmann, A Preiss, K- H Frosch
Due to an increase in sporting activities, the number of injuries of the immature knee is continuously increasing. These injuries necessitate a special approach regarding the particular anatomical situation with open growth plates. Three of the most commonly occurring injuries are rupture of the anterior cruciate ligament, patella dislocation and meniscus injuries. The clinical results for conservative treatment of ruptures of the anterior cruciate ligament in the growth phase are inferior to operative treatment...
July 2016: Der Unfallchirurg
https://www.readbyqxmd.com/read/27358051/characterization-of-patellar-maltracking-using-dynamic-kinematic-ct-imaging-in-patients-with-patellar-instability
#19
Miho J Tanaka, John J Elias, Ariel A Williams, Shadpour Demehri, Andrew J Cosgarea
PURPOSE: Little has been reported on the relationship between patellar maltracking and instability. Patellar maltracking has been subjectively described with the "J sign" but is difficult to assess objectively using traditional imaging. Dynamic kinematic computed tomography (DKCT) allows dynamic assessment of the patellofemoral joint. DKCT was used to visualize and quantify patellar maltracking patterns, and severity of maltracking was correlated with the presence or absence of patellar instability symptoms...
June 29, 2016: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
https://www.readbyqxmd.com/read/27354953/soft-tissue-loop-for-medial-patellofemoral-ligament-reconstruction
#20
Mohd Fairudz Bin Mohd Miswan, Mohamed Zubair Mohamed Al-Fayyadh, Teo Seow Hui, Mohamed Razif Bin Mohamed Ali, Wuey Min Ng
A patient with patellar instability frequently presents with anterior knee pain, patellar subluxation, or dislocation. Medial patellofemoral ligament (MPFL) has a key role for normal patella tracking and stability. Reconstruction of the MPFL using a hamstring graft is a commonly used procedure for the treatment of chronic lateral subluxation of patella. Anchor sutures and bony tunnels are used for the patellar attachment of the graft. This can be associated with complications such as patella fracture; besides, it does not produce an anatomical reconstruction for the native MPFL that can alter the direction of tension applied on the patella...
April 2016: Arthroscopy Techniques
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