Patellofemoral Instability: Evaluation and Management

Chondral and osteochondral injuries. Diagnosis and management

Osteochondral lesions are relatively common and usually occur as a result of trauma. They often are unrecognized acutely and lead to osteochondral defects and eventually osteoarthritis. Detection of these lesions has been aided by bone scan, CT, and MR imaging. Acute osteochondral fragments can be replaced and internally fixed. Chronic osteochondral defects can be treated with several methods designed to stimulate healing by either fibrocartilage or healing by transplantation of bone and cartilage or cartilage alone. The goal of all treatment methods is to provide a stable, congruent joint surface, restore function, and prevent the evolution of osteoarthritis in the injured joint.

Results of medial patellofemoral ligament reconstruction in the treatment of patellar dislocation

PURPOSE: The purpose of this study is to describe the technique of medial patellofemoral ligament reconstruction using autogenous hamstrings or autogenous fascia lata and report the results at a minimum 2-year follow-up. Type of Study: This study represents a case series. Patients with patellofemoral instability following patellar dislocation were restrospectively reviewed after being treated with medial patellofemoral ligament reconstruction. No concurrent control group was used. METHODS: Nineteen consecutive patients underwent medial patellofemoral repair or reconstruction in the treatment of patellar instability after patellar dislocation. The reconstructions were performed using autogenous gracilis and/or semitendinosus tendons or a strip of autogenous fascia lata. Fifteen patients were available for interview, examination, and radiographic evaluation, with a mean follow-up of 31.5 months. RESULTS: Subjectively, 10 knees had excellent results, 3 knees obtained good results, 1 knee had a fair result, and 1 knee had a poor result, for a total of 93% improvement overall. Using Fulkerson's functional knee score, 93% had good or excellent results. The average postoperative result on Kujala's score for anterior knee symptoms was 88 (range, 80-100). The Tegner activity level averaged 6.8 preinjury and 6.7 postoperatively. Radiographic evaluation showed significant improvements in the congruence angle by an average of 20 degrees (P =.0006), and in the lateral patellofemoral angle by an average of 10 degrees (P =.0003). CONCLUSIONS: Surgical reconstruction or repair of the medial patellofemoral ligament provides favorable results for the treatment of recurrent patellofemoral dislocations with regard to radiographic findings, patient satisfaction, and functional outcome.

The effects of patellar taping on patellofemoral incongruence. A computed tomography study

Patellar taping for the purpose of patellar medialization is a nonoperative rehabilitation technique used in the treatment of patellofemoral pain. Despite early reports of excellent success rates, the indications for this treatment and its efficacy on patellofemoral pain are unclear. The present computed tomography study was undertaken to evaluate the effect of patellar taping on patellofemoral incongruence. Sixteen female patients (age range, 16 to 25 years) with anterior knee pain related to patellofemoral incongruence underwent computed tomography examination with their quadriceps muscles relaxed and contracted both before and after patellar taping. Patellar lateralization was measured as lateral patellar displacement, and patellar tilt was measured as lateral patellar angle. Patellar taping did not significantly affect patellofemoral lateralization or tilt. The results of this study do not support the use of this method for passive correction of patellofemoral incongruence. Although patellar taping may well be effective in controlling anterior knee pain during physical therapy, it does not do so by medializing the patella.

Identifying structural hip and knee problems. Patient age, history, and limited examination may be all that's needed

A likely identification of a given structural disorder of the hip or knee can be suggested by the patient's age. In the hip, developmental dysplasia is usually found in infants, Legg-Calvé-Perthes disease in children of 4 to 10 years, slipped capital femoral epiphysis in somewhat older children, osteonecrosis in young to middle-aged adults, and degenerative joint disease and hip fracture in older adults. In the knee, Blount's disease is usually found in children aged 3 to 8, patellofemoral disease during the teens and early 20s, meniscal tears from the early teens through the mid-50s, ligament injuries from the teens to the 40s, and osteoarthritis throughout adulthood. With relatively little additional information, a useful diagnosis can be made so appropriate therapy can be started or referral made.

Sports injuries of the knee

In spite of considerable research efforts, knee injuries continue to plague athletes. The rate of occurrence may actually be increasing. Particularly vulnerable to injury because of its anatomic location, the knee sustains a tremendous amount of force during sports. Physicians caring for these patients must be familiar with the mechanism of these injuries. This report aims to familiarize rheumatology physicians with an overview of the anatomy, function, physical examination, and treatment of the various anatomic structures that are commonly injured.

Adolescent and pediatric sports injuries

With the ever increasing number of boys and girls participating in organized sports, specific injury patterns, often dependent upon sport and gender, have been identified. This article identifies the most common sports injuries, focusing on mechanisms of injury, pathoanatomy, the history and physical findings, as well as recommendations, for the primary care physician, for initial diagnostic studies and treatment.