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Zein A, Hassan AZM, Soliman AM, Mohamed MMA. Outcomes of surgical treatment of patellar instability in children with Down syndrome. J Orthop Surg Res 2024; 19:263. [PMID: 38664709 PMCID: PMC11044411 DOI: 10.1186/s13018-024-04730-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/07/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND patellar instability is a relatively frequent musculoskeletal disorder in children with Down syndrome (DS). However, such a condition has seldom been studied in the literature, even less its surgical treatment. Different techniques have been offered for this condition; the evidence for surgical options is scarce and primarily based on case reports or case series with few patients and heterogeneous techniques. Given this background, we aimed to evaluate the outcomes of a uniform kind of surgical procedure for such a condition that combined lateral soft tissue release, medial patellofemoral ligament (MPFL) reconstruction (using a partial-thickness quadriceps tendon autograft), the Roux-Goldthwait procedure, and V-Y quadricepsplasty (if needed). MATERIALS AND METHODS This retrospective study involved 11 skeletally immature patients (12 knees; 9 males and 2 females), 5.5 to 14.1 years of age, with DS who had patellofemoral instability (PFI) and were managed by this technique between October 2018 and March 2020. Preoperative radiography, CT scan, and MRI were performed to evaluate the physis status, lower limb alignment, patellar height, trochlear morphology, and any associated knee pathology. A functional knee assessment was done by using the Kujala score and the modified Lysholm score. RESULTS The mean time of follow-up (± SD) was 47.7 ± 5.8 months (range: 39-56). Pre-operatively, the Kujala score (± SD) was 52.6 ± 14.3 (range: (31-74), and at final follow-up, it was 92.2 ± 4.4 (range: (88-98), showing a significant improvement (P < 0.001). The preoperative modified Lysholm score (± SD) was 54.3 ± 8.1 (range: 39-62), and at final follow-up it was 92.4 ± 5.3 (range: 82-96), showing a significant improvement (P < 0.001). All patients had a stable patella without a recurrence of instability and regained full ROM. There was no incidence of a patellar fracture or femoral physis injury. CONCLUSIONS Our proposed technique of combined soft tissue procedures, including lateral soft tissue release, MPFL reconstruction (using a partial-thickness quadriceps tendon autograft), the Roux-Goldthwait procedure, and V-Y quadricepsplasty, was an effective method for treating patellar instability in children with DS while avoiding physeal injury and patellar fracture. Functional scores and radiological outcomes were improved. LEVEL OF EVIDENCE IV; retrospective case series.
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Affiliation(s)
- Assem Zein
- Department of Orthopaedics and Trauma Surgery, Minia University, Minia, Egypt.
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Ohko H, Ota S. Sex-based differences and relationship with the restricted knee flexion angle due to aging: a comparative study. BMC Musculoskelet Disord 2023; 24:348. [PMID: 37142997 PMCID: PMC10157923 DOI: 10.1186/s12891-023-06367-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/24/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND The relationship between inferior patellar mobility (IPM) and knee flexion angle has yet to be elucidated. This study aimed to develop quantitative IPM measurement methods and clarify the relationship between IPM and knee flexion angle in community-dwelling older females. METHODS This was a cross-sectional study. Overall, 128 healthy older women (age 65-79 years) were recruited from the community to evaluate the relationship between IPM and knee flexion angle. This study was performed between May 2015 and December 2017. The reference value of and sex differences in IPM were evaluated in 205 healthy young adults aged between 19 and 21 years. IPM was compared between healthy older and young women and was objectively measured using our specially designed patellofemoral arthrometer (PFA). Patellar mobility was calculated by normalization to body height. IPM reliability was assessed before all measurements. RESULTS Intraclass correlation coefficients for intratester and intertester reliabilities varied from 0.87 to 0.99. The normal range based on two standard deviations of inferior patellar displacement/body height was 5.9-13.5% (young men), 5.1-14.3% (young women), and 1.2-8.8% (older women). IPM was significantly lower in older than young women (P < 0.001). There was a significant positive correlation (r = 0.72 and P < 0.01) between IPM and knee flexion angle in healthy older women unable to flex the knee joint fully. CONCLUSIONS Our PFA has good intratester and intertester reliability. The results suggest that IPM decreases with aging in women. IPM and knee flexion angle are correlated among older women unable to flex the knee joint fully. CLINICAL TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Hiroshi Ohko
- Department of Rehabilitation and Care, Seijoh University, 2-172 Fukinodai, Tokai, 476-8588, Aichi, Japan.
| | - Susumu Ota
- Department of Rehabilitation and Care, Seijoh University, 2-172 Fukinodai, Tokai, 476-8588, Aichi, Japan
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Lachowski K, Hammermeister F, Halenz B, Lieckefett F, Götze T, Prill R, Becker R. The Patellostabilometer: A New Device for Quantification of Mediolateral Patella Displacement. SENSORS (BASEL, SWITZERLAND) 2023; 23:1274. [PMID: 36772314 PMCID: PMC9920919 DOI: 10.3390/s23031274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 06/18/2023]
Abstract
Mediolateral patella displacement is of interest for diagnostics and clinically relevant research questions. Apart from manual testing, no standardized method is currently available. Proper quantification of patella mobility is necessary to better understand pathologies at the patellofemoral joint. Patella mobility was assessed in 25 healthy individuals using a Patellostabilometer, a new prototype instrument for quantification of the mediolateral patella displacement. The participants underwent measurements of the mediolateral displacement three times using the Patellostabilometer. A maximal force of 10 N was applied for patella movement. Additionally, leg length and circumference of the knee, upper- and lower-leg were measured. Lateral patella displacement of 18.27 ± 3.76 mm (range 15.85-20.64 mm, interquartile range (IQR) of 4.79) was measured. The medial patella displacement showed 24.47 ± 6.59 mm (range 19.29-29.76 mm, IQR of 10.47). The test-retest measurement error was 2.32 ± 1.76 mm (IQR of 2.38 mm), with five outliers. There was greater test-retest variability between the measurements of the medial displacement compared to the lateral one. The test-retest variability reached 7% of the patella displacement. Other parameters provided no significant correlations. Based on the natural patellofemoral mobility, a precise and clinically relevant quantification of patella mobility is allowed.
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Affiliation(s)
- Krzysztof Lachowski
- Center of Orthopaedics and Traumatology, Brandenburg Medical School Theodor Fontane, University Hospital Brandenburg/Havel, 14770 Brandenburg a.d.H., Germany
| | - Florian Hammermeister
- Technical Faculty, Brandenburg University of Applied Sciences, 14770 Brandenburg a.d.H., Germany
| | - Bastian Halenz
- Technical Faculty, Brandenburg University of Applied Sciences, 14770 Brandenburg a.d.H., Germany
| | - Florian Lieckefett
- Technical Faculty, Brandenburg University of Applied Sciences, 14770 Brandenburg a.d.H., Germany
| | - Thomas Götze
- Technical Faculty, Brandenburg University of Applied Sciences, 14770 Brandenburg a.d.H., Germany
| | - Robert Prill
- Center of Orthopaedics and Traumatology, Brandenburg Medical School Theodor Fontane, University Hospital Brandenburg/Havel, 14770 Brandenburg a.d.H., Germany
- Faculty of Health Science Brandenburg, Brandenburg Medical School Theodor Fontane, 14770 Brandenburg a.d.H., Germany
| | - Roland Becker
- Center of Orthopaedics and Traumatology, Brandenburg Medical School Theodor Fontane, University Hospital Brandenburg/Havel, 14770 Brandenburg a.d.H., Germany
- Faculty of Health Science Brandenburg, Brandenburg Medical School Theodor Fontane, 14770 Brandenburg a.d.H., Germany
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Kolb A, Willegger M, Chiari C, Windhager R. Behandlung der Patellainstabilität. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2022; 160:463-475. [PMID: 33851401 DOI: 10.1055/a-1295-0533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Schmiesing A, Engelking M, Agel J, Arendt EA. Distalization of the Tibial Tubercle for Patellar Stabilization Combined With Medial Patellofemoral Ligament Reconstruction: Length of Distalization or Residual Patella Alta and its Affect on Outcome. Am J Sports Med 2022; 50:1627-1634. [PMID: 35438591 DOI: 10.1177/03635465221089979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Previous research supports that distal translation of the tibial tubercle osteotomy (dTTO) for patients with recurrent lateral patellar dislocation (R-LPD) and patella alta is effective for surgical patellar stabilization. HYPOTHESIS/PURPOSE The main purpose of this article is to evaluate (1) the results of modifying the surgical threshold and postoperative goal of patellar height measurements for surgical stabilization originated in the "menu à la carte" approach to patellar surgical stabilization and (2) the relationship between the distance distalized in millimeters and postoperative complications. Our hypothesis was that dTTO with medial patellofemoral ligament reconstruction (MPFL-R) will successfully stabilize the patella with improvement in outcome scores and few complications, using a modification of the original menu à la carte as our surgical algorithm. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 68 consecutive patients with R-LPD underwent dTTO and MPFL-R for surgical patellar stabilization by a single surgeon between May 2009 and September 2015. Surgical indications were R-LPD combined with patella alta. The surgical threshold for dTTO was Caton-Deschamps index (CDI) or Insall-Salvati ratio ≥1.4 and/or a patellar trochlear index <0.15. The postoperative surgical goal for patellar height was a CDI of 1.1 to 1.2. Length of the distalization was computed by using the CDI measurement as the primary intraoperative guide and measured intraoperatively with a ruler. Clinical, radiographic, and patient outcome measures were reviewed. RESULTS The mean CDI preoperatively was 1.40 and postoperatively it was 1.09. The mean distalization was 9.9 mm (range, 4-15 mm). Three patients (4.4%) had frank R-LPD postoperatively. Ten patients had residual patella alta (CDI >1.2), with 1 redislocation. Mean postoperative CDI in the recurrent dislocation group was 1.13 (range, 1.06-1.25) as compared with 1.09 (range, 0.92-1.35) in the nonrecurrent group (P = 0.65). Complications included 3 tibial fractures (4.4%) and postoperative knee arthrofibrosis in 6 patients (8.8%), with mean distalization greater in the arthrofibrosis group (P = .04). Knee injury and Osteoarthritis Outcome Score (KOOS) values improved in all domains, including a 31-point increase in Quality of Life. CONCLUSION dTTO with MPFL-R for patients with patella alta leads to a high rate of normalization of patellar height measurements (87%) and patellar stabilization (95.6%). Residual patella alta is not associated with an increased risk of recurrence. The length of dTTO up to 15 mm is not associated with an increase in postoperative complications, except for an increased prevalence of arthrofibrosis (8.8%).
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Affiliation(s)
- Andrew Schmiesing
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Marta Engelking
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Julie Agel
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Elizabeth A Arendt
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
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Fong J, Zeng GJ, Lee KH. Treatment of Chronic Dislocated Patella in a Skeletally Mature Down Syndrome Patient: A Case Report. JBJS Case Connect 2022; 12:01709767-202206000-00042. [PMID: 36099521 DOI: 10.2106/jbjs.cc.21.00710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CASE A 55-year-old man with Down syndrome (DS) suffered from chronic irreducible right patellar dislocation. Imaging studies showed an attenuated appearance of the medial patellar retinaculum, and the tibial tubercle to trochlear groove distance measured 1.6 cm. Right medial patellofemoral ligament reconstruction (MPFLR) and lateral lengthening (LL) with proximalization of the tibial tubercle (PTT) were performed with good surgical outcomes. CONCLUSION The combination of MPFLR, LL, and PTT is a viable option for treating a skeletally mature DS patient with patellofemoral instability causing recurrent patellar dislocation.
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Affiliation(s)
- Jiawen Fong
- Lee Kong Chian School of Medicine, Singapore
| | - Gerald Joseph Zeng
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Kong Hwee Lee
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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Hamawandi SA, Amin HI, Al-Humairi AK. Open versus arthroscopic release for lateral patellar compression syndrome: a randomized-controlled trial. Arch Orthop Trauma Surg 2022; 142:1-7. [PMID: 33829300 PMCID: PMC9474395 DOI: 10.1007/s00402-021-03878-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 03/24/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Lateral patellar compression syndrome is one of the causes of anterior knee pain in young adults and resulted from tight lateral patellar retinaculum. The aim of our study is to compare between open and arthroscopic release of lateral patellar compression syndrome in relation of functional outcome, time of surgical procedure, length of hospital stays, intraoperative and postoperative complications as bleeding, infection, recurrence, and patellar instability with 2 years of follow-up. MATERIALS AND METHODS 80 patients, age (21-49 years), were divided randomly into 2 groups (A and B). Group A (40 patients) were treated with open release. Group B (40 patients) were treated by arthroscopic release. All these patients are diagnosed as lateral patellar compression syndrome depending on clinical features and MRI. All patients were assessed by Lysholm knee scoring scale before surgery and at periods of 2, 6 weeks, 6, 12, and 24 months after surgery. RESULTS There is significant difference in functional outcome, measured by Lysholm knee scoring scale, between preoperative and postoperative assessment periods in both groups (P < 0.001). There is significantly better functional outcome at 2 years of follow-up with arthroscopic release (P = 0.018). There is no recurrence in both groups, but there were 4 patients develop medial patellar instability in the group of open release. CONCLUSION Both open and arthroscopic lateral release for patients with isolated lateral patellar compression syndrome can be effective surgical procedures, but arthroscopic release can achieve better functional outcome. TRIAL REGISTRATION NCT, NCT04130412. Retrospectively registered on 3rd of June, 2020 at ClinicalTrials.gov.
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Affiliation(s)
- Sherwan A. Hamawandi
- FIBMS Orthopedic Surgery, Head of Orthopaedic Department, College of Medicine, Hawler Medical University, Erbil, Iraq
| | - Hazhar I. Amin
- Orthopedic Department, Erbil Teaching Hospital, Erbil, Iraq
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Dandu N, Trasolini NA, DeFroda SF, Darwish RY, Yanke AB. The Lateral Side: When and How to Release, Lengthen, and Reconstruct. Clin Sports Med 2021; 41:171-183. [PMID: 34782073 DOI: 10.1016/j.csm.2021.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The lateral patellofemoral complex is an important stabilizer to medial and lateral displacement of the patella. Soft tissue abnormalities can range from pathologic tightness to laxity, presenting with symptoms related to patellar instability, anterior knee pain, or arthritis. Clinical evaluation should be performed to confirm patellar dislocation, assess the integrity of the lateral and medial soft tissues, and explore other pathoanatomic factors that may need to be addressed. Lateral retinacular lengthening is recommended over lateral release owing to the potential of iatrogenic medial instability with release, and a lateral patellofemoral ligament reconstruction can be performed to effectively treat medial instability.
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Affiliation(s)
- Navya Dandu
- Rush University Medical Center, 1611 West Harrison Street, Suite 300, Chicago, IL 60612, USA
| | - Nicholas A Trasolini
- Rush University Medical Center, 1611 West Harrison Street, Suite 300, Chicago, IL 60612, USA
| | - Steven F DeFroda
- Rush University Medical Center, 1611 West Harrison Street, Suite 300, Chicago, IL 60612, USA
| | - Reem Y Darwish
- Rush University Medical Center, 1611 West Harrison Street, Suite 300, Chicago, IL 60612, USA
| | - Adam B Yanke
- Rush University Medical Center, 1611 West Harrison Street, Suite 300, Chicago, IL 60612, USA.
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Wang XL, Peng C, Tu YW, Liu YP, Zhang W, Zhang Y, Hua GJ. Effects of Lateral Patellar Retinaculum Release for Recurrent Patella Dislocation: A Prospective Study. Int J Gen Med 2021; 14:5527-5535. [PMID: 34531678 PMCID: PMC8439663 DOI: 10.2147/ijgm.s329026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/01/2021] [Indexed: 02/02/2023] Open
Abstract
Purpose Recurrent patellar dislocation (RPD) is the most common complication of patellar instability and the medial patellofemoral ligament (MPFL) reconstruction has become its reference treatment. Lateral patellar retinaculum (LPR) release used to be performed in association with MPFL reconstruction. The aim of this study was to investigate the added values of MPFL reconstruction plus LPR release for RPD. Methods After Institutional Review Board approval, RPD patients from October 2014 to April 2019 were randomly assigned into two groups (isolated MPFL reconstruction [Group I] and MPFL reconstruction plus LPR release [Group II]) and prospectively assessed until 12 months after surgery. Knee joints with flexion of 20° were scanned by a 64-row CT scanner. Congruence angle (CA), patella tilt angle (PTA), lateral patellofemoral angle (LPFA), tibial tuberosity-trochlear groove distance and patellar tilt with the quadriceps relaxed and contracted were measured. Knee function was assessed by Lysholm knee score and International Knee Documentation Committee (IKDC) score. Patients were followed up for at least 12 months. Results A total of 87 RPD patients (45 for Group I and 42 for Group II) were selected in this study. Preoperative clinical characteristics were not significantly different across groups. No serious complications were noted in either group. It was statistically insignificant between the two group patients in terms of postoperative patella associated measurements (P > 0.05 for all). The Lysholm score and IKDC score of Group I (84.5 ± 7.1 and 87.9 ± 7.2) were significantly less than that of Group II (89.7 ± 8.7 and 93.1 ± 7.7), which indicated the better knee function of Group II. Conclusion LPR release plus MPFL reconstruction provides additional benefits compared with isolated MPFL reconstruction in knee function. A combination of surgical treatments for RPD should be recommended.
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Affiliation(s)
- Xing-Liang Wang
- Department of Orthopedics, Wuxi Second People's Hospital, Wuxi, 214000, People's Republic of China
| | - Chao Peng
- Department of Orthopedic Surgery, The No.904 Hospital of People's Liberation Army, Wuxi214000, People's Republic of China
| | - You-Wei Tu
- Department of Orthopedic Surgery, The No.904 Hospital of People's Liberation Army, Wuxi214000, People's Republic of China
| | - Yun-Peng Liu
- Department of Orthopedic Surgery, The No.904 Hospital of People's Liberation Army, Wuxi214000, People's Republic of China
| | - Wei Zhang
- Department of Orthopedic Surgery, The No.904 Hospital of People's Liberation Army, Wuxi214000, People's Republic of China
| | - Yan Zhang
- Department of Orthopedic Surgery, The No.904 Hospital of People's Liberation Army, Wuxi214000, People's Republic of China
| | - Guo-Jun Hua
- Department of Orthopedic Surgery, Wuxi No.2 Chinese Medicine Hospital, Wuxi, 214000, People's Republic of China
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Stokey PJ, Kennedy HV, Cross JM, Sohn DH. Medial and Lateral Patellar Instability Leading to Medial Patellofemoral Ligament and Lateral Retinaculum Reconstruction: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00107. [PMID: 34473661 DOI: 10.2106/jbjs.cc.21.00083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE Combined medial and lateral patellar instability is exceptionally rare with only 3 reported cases to date. Here, we present the case of a 37-year-old White woman with multiple recurrent medial and lateral patellar instability. After failure of conservative care with bracing and therapy, she underwent surgical stabilization with medial and lateral allograft reconstruction. CONCLUSION This case provides an example of the condition and successful surgical follow-up.
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Affiliation(s)
- Phillip J Stokey
- Department of Orthopaedic Surgery, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
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Dynamic Q-angle is increased in patients with chronic patellofemoral instability and correlates positively with femoral torsion. Knee Surg Sports Traumatol Arthrosc 2021; 29:1224-1231. [PMID: 32683477 DOI: 10.1007/s00167-020-06163-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/14/2020] [Indexed: 01/26/2023]
Abstract
PURPOSE The purpose of the study was to evaluate the frontal gait patterns in patients with chronic patellofemoral instability compared to healthy controls. The hypothesis was that internal-rotation-adduction moment of the knee as altered dynamic Q-angle is evident in patients and correlates positively with increased femoral torsion. METHODS Thirty-five patients with symptomatic recurrent patellofemoral instability requiring surgical treatment were matched for average age, sex, and body mass index with 15 healthy controls (30 knees). Several clinical and radiographic measurements were taken from each participant: internal and external rotation (hipIR, hipER), Q-angle, tubercle sulcus angle (TS-angle), femoral antetorsion (femAT), tibial tubercle-trochlear groove (TT-TG) distance, and frontal leg axis. Additionally, three frontal gait patterns were defined and recorded: (1) internal-rotation-adduction moment of the knee during normal walking, (2) dynamic valgus of the knee, and (3) Trendelenburg's sign in a single-leg squat. Randomized videography was evaluated by three independent blinded observers. Statistical analysis was performed using regression models and comparisons of gait patterns and clinical and radiological measurements. Furthermore, observer reliability was correlated to gradings of radiological parameters. RESULTS Patients showed altered dynamic Q-angle gait pattern during normal walking (p < 0.001) compared to healthy controls (interrater kappa = 0.61), whereas highest observer agreement was reported if femAT was greater than 20° (kappa = 0.85). Logistic regression model revealed higher femAT (18.2° ± 12.5 versus 11.9° ± 7.0 (p = 0.004) as a significant variable, as well as lower TT-TG distance (23.6 mm ± 2.8 vs. 16.6 mm ± 4.9, p = 0.004) on evident dynamic Q-angle gait pattern. Dynamic valgus in a single-leg squat was observed significantly more often in patients (p < 0.001) compared to controls (interrater kappa = 0.7). However, besides the static measured Q-angle as the only significant variable on evident dynamic valgus pattern (13.6° ± 4.6 vs. 10.3° ± 5.2, p = 0.003), no radiological parameter was detected to correlate significantly with dynamic valgus and Trendelenburg's sign (n.s.). CONCLUSIONS Clinical detection of pathologic torsion and bony alignment may be difficult in patients with patellofemoral instability. The present study demonstrated that dynamic Q-angle gait pattern is significantly altered in patients with chronic patellofemoral instability compared to healthy controls. Moreover, dynamic Q-angle correlates positively with higher femoral torsion and negatively with higher TT-TG distance. Therefore, clinical and radiological assessment of maltorsion should be added to the standard diagnostic workup in cases of patellofemoral instability. LEVEL OF EVIDENCE Level II.
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Use of hyaluronic acid injection after arthroscopic release in lateral patellar compression syndrome with degenerative cartilage changes: randomized control trial. BMC Musculoskelet Disord 2021; 22:24. [PMID: 33407337 PMCID: PMC7786499 DOI: 10.1186/s12891-020-03876-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 12/14/2020] [Indexed: 11/30/2022] Open
Abstract
Background Degenerative cartilage changes can be seen, in cases of lateral patellar compression syndrome, involving the patellofemoral joint. Hyaluronic acid is a natural component of the synovial fluid and responsible for its elastic features and function of articular surfaces. The aim of this study is to show the effect of intra-articular injection of Hyaluronic acid, after arthroscopic lateral release in lateral patellar compression syndrome, on the functional outcome and knee pain in those patients with degenerative cartilage changes. Method Ninety patients age (30–50) years with lateral patellar compression syndrome and degenerative cartilage changes were divided randomly into 2 groups. Group A was treated by arthroscopic lateral release and received intraarticular injection of Hyaluronic acid 2 weeks after surgery. Group B was treated by arthroscopic lateral release only. Both groups were assessed by Kujala score and visual analogue scale for knee pain preoperatively and re-assessed postoperatively at 3 months, 6 months, 12 months and 24 months. Results There was significant improvement in Kujala score and Visual analogue scale post-operatively in both groups (P-value< 0.001) with better improvement in Kujala score in group A after intra-articular injection of Hyaluronic acid up to 2 year of follow up (P-value = 0.006) as well as better improvement in visual analogue score at 6 months post-operatively (P-value = 0.035). Conclusion Intra-articular injection of Hyaluronic acid after arthroscopic release, in patients with lateral patellar compression syndrome and degenerative cartilage changes, can result in better improvement of knee pain and functional outcome up to 2 years of follow up. Trial registration NCT, NCT04134611. Registered 18 October 2019 -Retrospectively registered.
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Femoral derotation osteotomy for recurrent patellar dislocation. Arch Orthop Trauma Surg 2020; 140:2077-2084. [PMID: 32948916 DOI: 10.1007/s00402-020-03598-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 09/09/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE Excessive femoral internal torsion is an important risk factor for patellar dislocation. The aim of the present study was to estimate the effect of derotational osteotomy of the femur on the tibial tubercle trochlear groove (TTTG) distance or patellar tilt angle (PTA) and to report our clinical outcomes of recurrent patellar dislocation after femoral derotation osteotomy. METHODS A retrospective analysis of 16 patients (17 knees) with recurrent patellar dislocation treated by femoral derotation osteotomy in our department from January 2016 to February 2019 was carried out. The procedure was performed with supracondylar femoral derotation. A few procedures were combined with soft tissue procedures. Knee function was evaluated by using the International Knee Documentation Committee (IKDC) score, Kujala score, Lysholm score, visual analog scale (VAS) score and patient satisfaction. Additionally, CT was used to assess the influence of femoral derotational osteotomy on TTTG distance and PTA. RESULTS The average femoral antetorsion angle before surgery was 33° (SD ± 5°), and the intraoperative correction angle was 23° (SD ± 4°). A total of 17 femoral derotation osteotomies in 16 patients with patellar instability [11 females, 5 males, aged 20.8 (range 15-41) years] were included in the study. No dislocation occurred within 26.5 months after follow-up (range 12-49 months). The IKDC score, Kujala score, Lysholm score and VAS score significantly improved. The preoperative TTTG distance was 15.63 mm (SD ± 2.07 mm), and it was 14.69 mm (SD ± 1.78 mm) at the follow-up. The PTA decreased from 26.35° (SD ± 6.86°) to 11.65° (SD ± 2.85°). The powers of TTTG and PTA measurements are 0.78 and 1.00, respectively and all of these differences were statistically significant. CONCLUSIONS Derotational osteotomy of the femur for the treatment of recurrent patellar dislocation can achieve good clinical results, including improved TTTG distance and PTA and improved knee function.
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Manilov R, Chahla J, Maldonado S, Altintas B, Manilov M, Zampogna B. High tibial derotation osteotomy for distal extensor mechanism alignment in patients with squinting patella due to increased external tibial torsion. Knee 2020; 27:1931-1941. [PMID: 33221691 DOI: 10.1016/j.knee.2020.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 09/28/2020] [Accepted: 10/07/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The patellofemoral joint is often affected by torsionaldisorders of the lower limb, causing pain, instability and knee degeneration. The aims of this study were to determine functional outcomes of patients who underwent a high tibial derotation osteotomy (HTDO) for symptomatic squinting patella due to increased external tibial torsion. Moreover, factors associated with inferior clinical outcomes were investigated. METHODS Patients with symptomatic squinting patella, increased external tibial torsion (>30°) treated with this technique, and with 2 years of follow up were included. Fulkerson and Kujala patellofemoral joint scores were assessed. Age, body mass index, history of prior surgery, increased femoral anteversion, association of lateral retinaculum release and patellar cartilage lesions were analysed. RESULTS Sixty HTDOs were included in this retrospective study with an average of 66 months of follow up. The mean Kujala score improved from 47.5 preoperatively to 93 postoperatively. The mean Fulkerson score improved from 40.6 to 91.6. Kujala subscores for pain improved from 8.6 to 30.4, for instability improved from 6.4 to 17.9, and their ability to climb stairs increased from 6.9 to 17.9 (all P < 0.0001). Multivariate logistic regression model identified that patient age (P < 0.005) and advanced chondral damage (P < 0.001) were the dominant factors predicting inferior clinical outcomes using Kujala's score. CONCLUSION HTDO provided good results regarding the pain symptoms, instability and the ability to climb stairs. Advanced chondral damage and advanced age had negative effects on outcomes.
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Affiliation(s)
| | - Jorge Chahla
- Cedars Sinai Kerlan Jobe Institute, Santa Monica, CA, USA
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15
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Xue Z, Pei Z, Zhang H, Tang C, Jia J, Zhang K, Zhang K, Guan Z. Development of an innovative measurement method for patellar tracking disorder. Aging (Albany NY) 2020; 13:516-524. [PMID: 33260153 PMCID: PMC7835065 DOI: 10.18632/aging.202161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 10/09/2020] [Indexed: 11/25/2022]
Abstract
In this study, we investigated whether the measurement of patellar tracking can be used as a diagnostic parameter of patellofemoral joint disease. Patellar tracking is defined as the movement of the patella in relation to the femorotibial joint within the full range of flexion and extension of the knee joint. The PubMed, EMBASE, Medline, PsychINFO, and AMED databases were used to find relevant articles. Analyzed were the patellar tracking coordinate system and the measurement objects, precision, methods used in those studies, as well as the results obtained. Origin points for coordinate systems varied across the studies. The research object and methods of patellar tracking varied in the studies. Most studies focused on a static description of the internal and external displacement and the internal and external inclination. The in vivo, noninvasive, and six degrees of freedom evaluation of patellar tracking reflect patellar motion more comprehensively, though each of these methods does so in different ways. Dynamic and quantitative evaluation of patellar tracking is still lacking in clinical work. Accurate and quantitative patellar tracking measurement could provide clinicians with a comprehensive evaluation of the stability of the knee joint.
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Affiliation(s)
- Zhe Xue
- Department of Orthopedics, Peking University Shougang Hospital, ShiJingshan 100144, Beijing, P.R. China
| | - Zheng Pei
- Department of Orthopedics, Peking University Shougang Hospital, ShiJingshan 100144, Beijing, P.R. China
| | - Hui Zhang
- Department of Orthopedics, Peking University Shougang Hospital, ShiJingshan 100144, Beijing, P.R. China
| | - Chong Tang
- Department of Orthopedics, Peking University Shougang Hospital, ShiJingshan 100144, Beijing, P.R. China
| | - Junxiu Jia
- Department of Orthopedics, Peking University Shougang Hospital, ShiJingshan 100144, Beijing, P.R. China
| | - Kun Zhang
- Department of Orthopedics, Peking University Shougang Hospital, ShiJingshan 100144, Beijing, P.R. China
| | - Keshi Zhang
- Department of Orthopedics, Peking University Shougang Hospital, ShiJingshan 100144, Beijing, P.R. China
| | - Zhenpeng Guan
- Department of Orthopedics, Peking University Shougang Hospital, ShiJingshan 100144, Beijing, P.R. China
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16
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Patellofemorale Arthrose. ARTHROSKOPIE 2020. [DOI: 10.1007/s00142-020-00379-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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A new device for patellofemoral instrumented stress-testing provides good reliability and validity. Knee Surg Sports Traumatol Arthrosc 2020; 28:389-397. [PMID: 31250058 DOI: 10.1007/s00167-019-05601-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/24/2019] [Indexed: 12/26/2022]
Abstract
PURPOSE To evaluate the reliability of an instrumented patellofemoral (PF) stress-testing-the Porto Patellofemoral Testing Device (PPTD)-and validate the instrumented assessment method comparing to manual physical examination. METHODS Eight asymptomatic volunteers underwent bilateral PF-instrumented examination with the PPTD and magnetic resonance imaging (MRI) to assess intra-rater reliability of the instrumented assessment methodology. Six patients with unilateral PF instability underwent physical examination and PPTD concomitantly with MRI. Manual examination was performed by two blinded surgeons and compared with PPTD test. Ligament stiffness was calculated and compared between injured and non-injured lower limbs. RESULTS PPTD showed a pre-determined and reproducible stress-force application with excellent intra-rater agreement (intra-class correlation coefficient 0.83-0.98). The manual exam was imprecise with variable examiner-dependent stress-force application. The PPTD resulted in greater lateral patellar translation (converted in quadrants) than manual exam for patients that have reached maximum translation force. Measurement of patellar position and displacement using PPTD was more accurate and precise than the visual estimation of translated quadrants by manual exam. Ligament stiffness curves showed no relevant changes in patellar displacement after 62 N. CONCLUSION The PPTD instrumented stress-testing is a valid device to quantify PF position and displacement with high intra-rater reliability, showing more accuracy, more precision and less variability than physical examination. This device provides an accurate and objective measure to quantify the patellar movement which can augment the physical examination procedures and assist clinicians in the management of decision-making and in the assessment of post-treatment outcomes of PF pathological conditions.
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18
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19
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Huddleston HP, Cancienne J, Farr J, Yanke A. Lateral Lengthening and Lateral Release. OPER TECHN SPORT MED 2019. [DOI: 10.1016/j.otsm.2019.150685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Malatray M, Magnussen R, Lustig S, Servien E. Lateral retinacular release is not recommended in association to MPFL reconstruction in recurrent patellar dislocation. Knee Surg Sports Traumatol Arthrosc 2019; 27:2659-2664. [PMID: 30483832 DOI: 10.1007/s00167-018-5294-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 11/12/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Reconstruction of the medial patellofemoral ligament (MPFL) has become the gold standard for the treatment of the recurrent patellar dislocation (RPD). Lateral retinacular release can be performed in association with MPFL reconstruction, but the effect on outcomes is not clear. To evaluate the effect of lateral release on outcomes following MPFL reconstruction is the aim of this study. It is hypothesized that isolated MPFL reconstruction was not inferior to MPFL reconstruction and lateral retinacular release in terms of IKDC subjective score and patellar tilt (PT). METHODS Patients between ages 18 and 45 scheduled to undergo MPFL reconstruction without an associated bony procedure (tibial tubercle osteotomy or trochleoplasty) were randomized to isolated MPFL reconstruction or MPFL reconstruction (no LRR group) and arthroscopic LRR (LRR group). Evaluation criteria were subjective IKDC score as the primary outcome and PT evaluated with a CT-scan. PT was evaluated with the quadriceps relaxed (PTQR) and contracted (PTQC). RESULTS Of 43 patients included in the trial, 7 were lost of follow-up, 3 were not able to complete evaluation because of medical reasons, and 33 patients were evaluated with a minimum of 12 months and a median follow-up of 24 (12-60) months. The average subjective IKDC score was at 86 ± 20 (29-94) in the LRR group and 82 ± 15 (39-95) in the no LRR group (p = 0.45). The PTQR was at 22° ± 7° (13-37) in the LRR group and 21 ± 10 (4-37) in the no LRR group (n.s.). The PTQC was at 27° ± 9° (12-40) in the LRR group and 25 ± 12 (5-45) in the no LRR group (n.s.). No complications were noted in either group. CONCLUSIONS No significant differences were found in subjective IKDC score or patellar tilt based on the addition of an arthroscopic LRR to an MPFL reconstruction in patients with RPD not undergoing associated bony procedures. There is no indication to a systematic lateral retinacular release in association with MPFL reconstruction in the treatment of RPD. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Matthieu Malatray
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix Rousse Hospital, Civil Hospices of Lyon, 103 Boulevard de la Croix Rousse, 69004, Lyon, France.
| | - Robert Magnussen
- OSU Sports Medicine Research Institute, Department of Orthopaedics, The Ohio State University, Columbus, OH, USA
| | - Sebastien Lustig
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix Rousse Hospital, Civil Hospices of Lyon, 103 Boulevard de la Croix Rousse, 69004, Lyon, France.,LBMC UMR T 9406, Laboratory of Chock Mechanics and Biomechanics, Claude Bernard Lyon 1 University, Lyon, France
| | - Elvire Servien
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix Rousse Hospital, Civil Hospices of Lyon, 103 Boulevard de la Croix Rousse, 69004, Lyon, France.,LIBM, EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, Lyon, France
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21
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Shubert DJ, McDonough EB. Bilateral Medial and Lateral Patellofemoral Ligament Reconstruction in a Patient with Hypermobility Type Ehlers-Danlos Syndrome: A Case Report. JBJS Case Connect 2019; 9:e0359. [PMID: 31390333 DOI: 10.2106/jbjs.cc.18.00359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
CASE Medial patellar instability (MPI) is a known sequela of previous lateral retinacular release. Literature on surgical intervention is scarce. We present a case of a 35-year-old woman with hypermobility type Ehlers-Danlos syndrome, with bilateral iatrogenic MPI (IMPI) and lateral patellar instability. This condition led to a marked decrease in quality of life, 10/10 persistent pain, and frequent dislocation events. She was successfully treated surgically, and at 2 years had 0/10 pain and no further dislocations. CONCLUSIONS Our technique for medial and lateral patellofemoral ligament reconstruction is a viable intervention for patients with IMPI, even in the setting of underlying collagen disorder.
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Affiliation(s)
- Daniel J Shubert
- Department of Orthopaedics, West Virginia University, Morgantown, West Virginia
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22
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Jibri Z, Jamieson P, Rakhra KS, Sampaio ML, Dervin G. Patellar maltracking: an update on the diagnosis and treatment strategies. Insights Imaging 2019; 10:65. [PMID: 31201575 PMCID: PMC6570735 DOI: 10.1186/s13244-019-0755-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 05/21/2019] [Indexed: 02/08/2023] Open
Abstract
Patellar maltracking occurs as a result of an imbalance in the dynamic relationship between the patella and trochlea. This is often secondary to an underlying structural abnormality. The clinical evaluation can provide useful clues for the presence of such entity; however, the diagnosis can often be challenging especially in the absence of a documented history of patellar dislocation. Imaging, particularly MRI, can detect subtle features that could lead to the diagnosis, probably even more importantly when there is no clear history of patellar dislocation or before its development. This can provide a road map for formulating a treatment strategy that would be primarily aimed at stabilizing the patellofemoral joint to halt or slow the progression of articular cartilage loss. The purpose of this article is to discuss the clinical and radiologic evaluation of patellar maltracking providing an update on the cross-sectional imaging assessment and also a synopsis of the management options.
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Affiliation(s)
- Zaid Jibri
- Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada. .,Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
| | - Paul Jamieson
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.,Division of Orthopaedic Surgery, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Kawan S Rakhra
- Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.,Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
| | - Marcos L Sampaio
- Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.,Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
| | - Geoffrey Dervin
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.,Division of Orthopaedic Surgery, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
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23
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Agarwalla A, Gowd AK, Liu JN, Puzzitiello RN, Yanke AB, Verma NN, Forsythe B. Concomitant Medial Patellofemoral Ligament Reconstruction and Tibial Tubercle Osteotomy Do Not Increase the Incidence of 30-Day Complications: An Analysis of the NSQIP Database. Orthop J Sports Med 2019; 7:2325967119837639. [PMID: 31019984 PMCID: PMC6463332 DOI: 10.1177/2325967119837639] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: Lateral patellar dislocations account for 2% to 3% of total knee injuries, especially in adolescents. Depending on the anatomic abnormality contributing to lateral patellar instability, medial patellofemoral ligament reconstruction (MPFLR) and/or tibial tubercle osteotomy (TTO) may be indicated. Purpose: To assess the risk of adverse events (AEs) after TTO, MPFLR, and concomitant MPFLR and TTO. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent MPFLR, TTO, and concomitant MPFLR and TTO between 2005 and 2016 were identified through the American College of Surgeons–National Surgical Quality Improvement Program (ACS-NSQIP) database. Medical complications (eg, surgical site infection and deep vein thrombosis), readmission rates, and extended hospital stay within 30 days of the procedure were recorded. Outcomes were compared with bivariate and multivariate Poisson regression. Results: Out of 882 patients, 617 (70.0%) underwent isolated MPFLR, 170 (19.3%) underwent TTO, and 95 (10.8%) underwent concomitant MPFLR and TTO. The operative time for concomitant MPFLR and TTO was significantly longer (122 ± 45 minutes) compared with isolated MPFLR (97 ± 55 minutes; P < .001) and isolated TTO (89 ± 51 minutes; P < .001). There were 32 AEs (3.6%), with 10 AEs in the isolated TTO group (5.9%), 18 AEs in the isolated MPFLR group (2.9%), and 4 AEs in the MPFLR + TTO group (4.2%). There was no significant difference in the rate of AEs between the isolated MPFLR and isolated TTO groups (P = .1), isolated MPFLR and MPFLR + TTO groups (P = .5), and isolated TTO and MPFLR + TTO groups (P = .8). Diabetes mellitus was associated with an increased risk of developing an AE (odds ratio, 4.0; P = .003), and hypertension resulted in an increased risk of an extended hospital stay (odds ratio, 4.0; P = .010). Conclusion: While concomitant MPFLR and TTO significantly increased operative time, there was no difference in the rate of AEs, extended hospital stay, and readmissions within 30 days after isolated MPFLR, isolated TTO, and concomitant MPFLR and TTO.
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Affiliation(s)
- Avinesh Agarwalla
- Department of Orthopaedic Surgery, Westchester Medical Center, Valhalla, New York, USA
| | - Anirudh K Gowd
- Department of Orthopaedic Surgery, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Joseph N Liu
- Department of Orthopedic Surgery, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Richard N Puzzitiello
- Department of Orthopaedic Surgery, Tufts University Medical Center, Boston, Massachusetts, USA
| | - Adam B Yanke
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Nikhil N Verma
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Brian Forsythe
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
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Anteromedial Tibial Tubercle Osteotomy Improves Results of Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Instability in Patients With Tibial Tuberosity-Trochlear Groove Distance of 17 to 20 mm. Arthroscopy 2019; 35:566-574. [PMID: 30612771 DOI: 10.1016/j.arthro.2018.10.109] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 10/14/2018] [Accepted: 10/21/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the midterm clinical outcomes of anteromedialization tibial tubercle osteotomy combined with medial patellofemoral ligament reconstruction (TTO+MPFLR) with MPFLR alone (MPFLRa) for the treatment of recurrent patellar instability (RPI) in patients with a tibial tuberosity-trochlear groove (TT-TG) of 17 to 20 mm. METHODS From January 2008 to August 2013, patients with RPI and a TT-TG of 17 to 20 mm were divided into 2 groups: TTO+MPFLR or MPFLRa. Subjects were evaluated for J sign classification (1-4+); patellar glide (1-4+); the apprehension test; increased femoral anteversion; the Caton index; trochlear dysplasia; TT-TG; and Kujala, Lysholm, International Knee Documentation Committee (IKDC), and Tegner scores. Kujala improvement was the primary outcome. RESULTS Forty-two subjects were evaluated, 18 in the TTO+MPFLR group and 24 in the MPFLRa group. Mean follow-up time was 40.86 months (range, 24-60 months). Demographics between the groups were not different. Preoperatively, there was no statistically significant difference between groups regarding J sign classification; patellar glide; the apprehension test; increased femoral anteversion; the Caton index; trochlear dysplasia; TT-TG; and Kujala, Lysholm, IKDC, and Tegner scores. Postoperative J sign classification mean results comparing TTO+MPFLR and MPFLRa, respectively, were 1 and 1.33 (P = .006). Improvement was significantly higher in the TTO+MPFLR group in all scores except for Tegner. Kujala improvement, 30.27 and 23.95, respectively (P = .003), was also clinically significant, favoring TTO+MPFLR. Lysholm improvement was 40.5 and 36.2, respectively (P = .02), and IKDC improvement was 38.59 and 31.6, respectively (P = .002). There were no reported recurrent subluxations or dislocations in either group. CONCLUSIONS TTO+MPFLR resulted in better functional outcome scores and patellar kinematics compared with MPFLRa in the surgical treatment of RPI in patients with a TT-TG distance of 17 to 20 mm. LEVEL OF EVIDENCE Level II, prospective comparative study.
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25
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Xue Z, Song GY, Liu X, Zhang H, Wu G, Qian Y, Feng H. Excessive lateral patellar translation on axial computed tomography indicates positive patellar J sign. Knee Surg Sports Traumatol Arthrosc 2018; 26:3620-3625. [PMID: 29560511 DOI: 10.1007/s00167-018-4897-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 03/12/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE The purpose of the study was to quantify the patellar J sign using traditional computed tomography (CT) scans. METHODS Fifty-three patients (fifty-three knees) who suffered from recurrent patellar instability were included and analyzed. The patellar J sign was evaluated pre-operatively during active knee flexion and extension. It was defined as positive when there was obvious lateral patellar translation, and negative when there was not. The CT scans were performed in all patients with full knee extension; and the parameters including bisect offset index (BOI), patellar-trochlear-groove (PTG) distance, and patellar lateral tilt angle (PLTA) were measured on the axial slices. All the three parameters were compared between the J sign-positive group (study group) and the J sign-negative group (control group). In addition, the optimal thresholds of the three CT scan parameters for predicting the positive patellar J sign were determined with receiver operating characteristic (ROC) curves, and the diagnostic values were assessed by the area under the curve (AUC). RESULT Among the fifty-three patients (fifty-three knees), thirty-seven (70%) showed obvious lateral patellar translation, which were defined as positive J sign (study group), and the remaining sixteen (30%) who showed no lateral translation were defined as negative J sign (control group). The mean values of the three CT parameters in the study group were all significantly larger compared to the control group, including BOI (121 ± 28% vs 88 ± 12%, P = 0.038), PTG distance (5.2 ± 6.6 mm vs - 4.4 ± 5.2 mm, P < 0.05), and PLTA (34.9 ± 10.5° vs 25.7 ± 3.4°, P = 0.001). Furthermore, the evaluation of ROC analysis showed that the AUC of BOI was the largest (AUC = 0.906) among the three parameters, and the optimal threshold of BOI to predict the positive patellar J sign was 97.5% (Sensitivity = 83.3%, Specificity = 87.5%). CONCLUSIONS In this study, the prevalence of positive patellar J sign was 70%. The BOI measured from the axial CT scans of the knee joint can be used as an appropriate predictor to differentiate the positive J sign from the negative J sign, highlighting that the excessive lateral patellar translation on axial CT scan indicates positive patellar J sign. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Zhe Xue
- Sports Medicine Service, Beijing Jishuitan Hospital, No. 31, Xin Jie Kou East Street, Xi Cheng District, Beijing, China
| | - Guan-Yang Song
- Sports Medicine Service, Beijing Jishuitan Hospital, No. 31, Xin Jie Kou East Street, Xi Cheng District, Beijing, China
| | - Xin Liu
- Sports Medicine Service, Beijing Jishuitan Hospital, No. 31, Xin Jie Kou East Street, Xi Cheng District, Beijing, China
| | - Hui Zhang
- Sports Medicine Service, Beijing Jishuitan Hospital, No. 31, Xin Jie Kou East Street, Xi Cheng District, Beijing, China
| | - Guan Wu
- Sports Medicine Service, Beijing Jishuitan Hospital, No. 31, Xin Jie Kou East Street, Xi Cheng District, Beijing, China
| | - Yi Qian
- Sports Medicine Service, Beijing Jishuitan Hospital, No. 31, Xin Jie Kou East Street, Xi Cheng District, Beijing, China
| | - Hua Feng
- Sports Medicine Service, Beijing Jishuitan Hospital, No. 31, Xin Jie Kou East Street, Xi Cheng District, Beijing, China.
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26
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Liu C, Duan G, Niu Y, Cao P, Fu K, Niu J, Wang F. Lateral retinaculum plasty instead of lateral retinacular release with concomitant medial patellofemoral ligament reconstruction can achieve better results for patellar dislocation. Knee Surg Sports Traumatol Arthrosc 2018; 26:2899-2905. [PMID: 29138916 DOI: 10.1007/s00167-017-4798-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 11/08/2017] [Indexed: 01/16/2023]
Abstract
PURPOSE To elucidate the outcomes of lateral retinaculum plasty versus lateral retinacular release with concomitant medial patellofemoral ligament (MPFL) reconstruction. METHODS In a prospective study, 59 patients treated at our institution from 2012 to 2014 were included. The 59 patients were randomly divided into two groups. Group I included 27 patients who underwent lateral retinacular release and MPFL reconstruction. Group II included 32 patients who underwent lateral retinaculum plasty and MPFL reconstruction. All patients were followed up for at least 2 years and all assessments were performed both pre- and post-operation. Clinical evaluation consisted of the Kujala score, patellar medial glide test, and patellar tilt angle, patellar lateral shift, and congruence angle, measured on CT scan. RESULTS Significant improvement was seen after surgery in both groups. The group of lateral retinaculum plasty achieved better results than the group of lateral retinacular release. No statistically significant differences were found in lateral patellar shift (ns) or congruence angle (ns) between the groups. There were significant differences in Kujala score (P < 0.05) patellar tilt angle (P < 0.05), and patellar medial glide test (P < 0.05) between the groups. CONCLUSIONS MPFL reconstruction with lateral retinaculum plasty yielded better results than MPFL with lateral retinacular release. Postoperatively, medial and lateral function were restored, and patellar tracking was normal. Lateral retinaculum plasty is a new method that reduces the complications of lateral retinacular release for patellar dislocation. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Chang Liu
- Hebei Medical University Third Affiliated Hospital, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Guman Duan
- Hebei Medical University Third Affiliated Hospital, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Yingzhen Niu
- Hebei Medical University Third Affiliated Hospital, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Pengkai Cao
- Hebei Medical University Third Affiliated Hospital, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Kunpeng Fu
- Hebei Medical University Third Affiliated Hospital, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Jinghui Niu
- Hebei Medical University Third Affiliated Hospital, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Fei Wang
- Hebei Medical University Third Affiliated Hospital, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China.
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Lee DK, Wang JH, Kang SH, Kim JH, Haque R, Lee BH. The clinical and radiological results of individualized surgical treatment depending on pathologic abnormalities in recurrent patellar dislocation: low recurrence rate, but unintended patella baja. Knee Surg Sports Traumatol Arthrosc 2018; 26:2558-2567. [PMID: 28914334 DOI: 10.1007/s00167-017-4697-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 08/23/2017] [Indexed: 01/17/2023]
Abstract
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 >1.2) were evaluated in each patient. The abnormalities were corrected through medial patellofemoral ligament reconstruction, TT distalization, TT anteromedialization, and lateral retinacula release. The mean follow-up period was 33 months. RESULTS There was one recurrent case (3.2%), requiring additional surgery. The mean Kujala scores were significantly (P = 0.002) improved from 75.8 (SD 12.4) to 84.6 (SD 13.1). Tegner scores were significantly improved from 3.7 (range 1-9) to 5.4 (range 2-9) (P < 0.001), as were and visual analogue scale pain scores from 4.7 (SD 2.5) to 2.6 (SD 2.2) (P = 0.001). Caton-Deschamps ratio was significantly decreased from 1.1 (SD 0.2) to 0.9 (SD 0.1) (P < 0.001), regardless of TT distalization. Chondral lesions of the patella and trochlear groove were improved or maintained in 57.1 and 71.4% of patients, respectively. CONCLUSION Individualized surgery in recurrent patellar dislocation was effective and safe with a low recurrence rate. However, the possibility of unintended patella baja, which might be related to post-operative anterior knee pain, should be considered. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Do Kyung Lee
- Department of Orthopedic Surgery, Konyang University Hospital, Konyang University School of Medicine, Daejeon, Korea
| | - Joon Ho Wang
- Department of Orthopedic Surgery, Samsung Medical Center and Department of Health Sciences and Technology and Department of Medical Device Management and Research, SAIHST Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Seung Hoon Kang
- Department of Orthopedic Surgery, Samsung Changwon hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Jun Ho Kim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Russel Haque
- Department of Orthopedic Surgery, Konkuk University Hospital, Konkuk University School of Medicine, Seoul, Korea
| | - Byung Hoon Lee
- Department of Orthopedic Surgery, Kang-Dong Sacred Heart Hospital, Hallym University School of Medicine, Seoul, Korea
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Arendt EA. Editorial Commentary: Reducing the Tibial Tuberosity-Trochlear Groove Distance in Patella Stabilization Procedure. Too Much of a (Good) Thing? Arthroscopy 2018; 34:2427-2428. [PMID: 30077265 DOI: 10.1016/j.arthro.2018.05.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 05/30/2018] [Indexed: 02/02/2023]
Abstract
A recent study suggests that aggressive correction of the tibial tuberosity-trochlear groove (TT-TG) distance by tibial tubercle osteotomy and medialization during patellar stabilization surgery can result in diminished outcomes. The mechanism may be overmedialization resulting in excessive medial patellofemoral and tibial-femoral pressure. Measurement of TT-TG may be inaccurate, and medialization of the tibial tubercle may not be required in cases of lateral patellar instability with TT-TG >20 mm (which is a current algorithm). My indication for tibial tubercle osteotomy, generally anteromedialization, is lateral patellofemoral chondrosis, and my goal is to create an intraoperative tubercle-sulcus angle of 0, which can be readily visualized with the knee at 90°. This is true regardless of the preoperative TT-TG measurement, and this intraoperative measurement mitigates against an excessive tubercle-sulcus angle of 0, which can be readily visualized with the knee at 90° and is true regardless of the preoperative TT-TG medialization.
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Graf KH, Tompkins MA, Agel J, Arendt EA. Q-vector measurements: physical examination versus magnetic resonance imaging measurements and their relationship with tibial tubercle-trochlear groove distance. Knee Surg Sports Traumatol Arthrosc 2018; 26:697-704. [PMID: 28378138 DOI: 10.1007/s00167-017-4527-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 03/20/2017] [Indexed: 01/03/2023]
Abstract
PURPOSE An increased lateral quadriceps vector has been associated with lateral patellar dislocation. Surgical correction of this increased vector through tibial tubercle medialization is often recommended when the quadriceps vector is "excessive". This can be evaluated by physical examination measurements of Q-angle and/or tubercle sulcus angle (TSA), as well as the magnetic resonance imaging (MRI) measurement of tibial tubercle-trochlear groove (TT-TG) distance. This study examined the relationship between three objective measurements of lateral quadriceps vector (TT-TG, Q-angle, TSA). A secondary goal was to relate lateral patellar tilt to these measurements. METHODS Consecutive patients undergoing patellofemoral stabilization surgery from 9/2010 to 6/2011 were included. The Q-angle and TSA were measured on intra-operative physical examination. The TT-TG and patellar tilt were measured on MRI. TSA, Q-angle, and patellar tilt were compared to TT-TG using Pearson correlation coefficient. RESULTS The study cohort included 49 patients, ages 12-37 (mean 23.2); 62% female. The Pearson correlation coefficients showed (+) significance (p < 0.01) between the TT-TG and both TSA and Q-angle. Tilt and TT-TG were (+) non-significantly correlated. Despite positive correlations of each measurement with TT-TG, there is not uniform intra-patient correlation. In other words, if TT-TG is elevated for a patient, it does not guarantee that all other measurements, including tilt, are elevated in that individual patient. CONCLUSION The TT-TG distance has significant positive correlation with the measurements of TSA and Q-angle in patients undergoing surgery for patellofemoral instability. The clinical relevance is that the variability within individual patients demonstrates the need for considering both TSA and TT-TG before and during surgical intervention to avoid overcorrection with a medial tibial tubercle osteotomy. LEVEL OF EVIDENCE Diagnostic study, Level III.
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Affiliation(s)
- Kristin H Graf
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - Marc A Tompkins
- Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R 200, Minneapolis, MN, 55454, USA.,TRIA Orthopaedic Center, Bloomington, MN, USA
| | - Julie Agel
- Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R 200, Minneapolis, MN, 55454, USA
| | - Elizabeth A Arendt
- Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R 200, Minneapolis, MN, 55454, USA.
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Ota S, Ohko H. Sex differences in passive lateral and medial patellar mobility in healthy young adults. J Back Musculoskelet Rehabil 2018; 31:127-132. [PMID: 28946527 DOI: 10.3233/bmr-169704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Sex differences in passive patellar mobility have not been quantitatively evaluated. OBJECTIVE The present study aimed to: 1) investigate sex differences in absolute and normalized patellar mobility, and 2) verify the relationship between patellar mobility and knee joint laxity. METHODS Two hundred and five pain-free individuals (205 knees, 103 men, 102 women) participated. Passive lateral and medial patellar displacement was measured using a modified patellofemoral arthrometer and manual pushing method at 0∘ and 30∘ knee flexion angles. The absolute values of lateral and medial patellar displacement (LPD and MPD, respectively), and values normalized to patellar width (PW) and body height (HT) were used in the final analysis. RESULTS At a 30∘ knee flexion angle, LPD/PW and LPD/HT were greater in women than in men (LPD/PW: 27.0 ± 6.7% vs. 22.6 ± 6.7%, LPD/HT: 0.81 ± 0.19% vs. 0.70 ± 0.15%, respectively, P< 0.001, effect size > 0.50). Absolute and normalized lateral and medial patellar mobility correlated positively with the range of the knee extension angle. CONCLUSIONS Sex differences in LPD/PW and LPD/HT at a 30∘ knee flexion were detected in healthy subjects. Although the knee extension angle related to both the lateral and medial direction of the patellar mobility, the relations were only fairly correlated in asymptomatic young subjects.
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Arendt EA, Donell ST, Sillanpää PJ, Feller JA. The management of lateral patellar dislocation: state of the art. J ISAKOS 2017. [DOI: 10.1136/jisakos-2015-000011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Vetrano M, Oliva F, Bisicchia S, Bossa M, De Carli A, Di Lorenzo L, Erroi D, Forte A, Foti C, Frizziero A, Gasparre G, Via AG, Innocenti B, Longo UG, Mahmoud A, Masiero S, Mazza D, Natali S, Notarangelo C, Osti L, Padulo J, Pellicciari L, Perroni F, Piccirilli E, Ramponi C, Salvatore G, Panni AS, Suarez T, Tarantino U, Vittadini F, Vulpiani MC, Ferretti A, Maffulli N. I.S.Mu.L.T. first-time patellar dislocation guidelines. Muscles Ligaments Tendons J 2017; 7:1-10. [PMID: 28717605 DOI: 10.11138/mltj/2017.7.1.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Primary traumatic patellar dislocation is common, particularly in young active individuals. A consensus on its management is still lacking. The present work provides easily accessible guidelines to be considered as recommendations for a good clinical practice developed through a process of systematic review of the literature and expert opinion, to improve the quality of care and rationalize the use of resources. LEVEL OF EVIDENCE Ia.
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Affiliation(s)
- Mario Vetrano
- Physical Medicine and Rehabilitation Unit, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Francesco Oliva
- Department of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Rome, Italy
| | - Salvatore Bisicchia
- Department of Orthopaedic Surgery, San Pietro Fatebenefratelli Hospital, Rome, Italy
| | - Michela Bossa
- Department of Physical Medicine and Rehabilitation, University of Rome "Tor Vergata", Rome, Italy
| | - Angelo De Carli
- Orthopaedic Department and "Kirk Kilgour" Sports Injury Center, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Luigi Di Lorenzo
- Rehabilitation Unit, Neuroscience Department, "RUMMO" Hospital, Benevento, Italy.,Biomedical Research Centre, Gruppo Forte, Salerno, Italy
| | - Davide Erroi
- Physical Medicine and Rehabilitation Unit, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Alfonso Forte
- Biomedical Research Centre, Gruppo Forte, Salerno, Italy
| | - Calogero Foti
- Department of Physical Medicine and Rehabilitation, University of Rome "Tor Vergata", Rome, Italy
| | - Antonio Frizziero
- Department of Physical and Rehabilitation Medicine, University of Padova, Padova, Italy
| | - Giuseppe Gasparre
- Department of Physical and Rehabilitation Medicine, University of Padova, Padova, Italy
| | - Alessio Giai Via
- Department of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Rome, Italy
| | - Bernardo Innocenti
- BEAMS Department (Bio Electro and Mechanical Systems), École Polytechnique de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Umile Giuseppe Longo
- Department of Orthopedic and Traumatology, University Campus Bio-Medico of Rome, Rome, Italy
| | - Asmaa Mahmoud
- Department of Physical Medicine and Rehabilitation, University of Rome "Tor Vergata", Rome, Italy
| | - Stefano Masiero
- Department of Physical and Rehabilitation Medicine, University of Padova, Padova, Italy
| | - Daniele Mazza
- Orthopaedic Department and "Kirk Kilgour" Sports Injury Center, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Simone Natali
- Department of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Rome, Italy
| | - Christian Notarangelo
- Department of Physical and Rehabilitation Medicine, University of Padova, Padova, Italy
| | - Leonardo Osti
- Unit of Arthroscopy and Sports Trauma Surgery, Hesperia Hospital, Modena, Italy
| | - Johnny Padulo
- University eCampus, Novedrate, Italy; Tunisian Research Laboratory "Sports Performance Optimization", National Center of Medicine and Science in Sport, Tunis, Tunisia; Faculty of Kinesiology, University of Split, Split, Croatia
| | - Leonardo Pellicciari
- Department of Physical Medicine and Rehabilitation, University of Rome "Tor Vergata", Rome, Italy
| | - Fabrizio Perroni
- School of Exercise and Sport Sciences (SUISM), Department of Medical Sciences, University of Turin, Turin, Italy
| | - Eleonora Piccirilli
- Department of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Rome, Italy
| | - Carlo Ramponi
- Sport Physical Therapist, Kinè Physiotherapic Center, Conegliano, Italy
| | - Giuseppe Salvatore
- Department of Orthopedic and Traumatology, University Campus Bio-Medico of Rome, Rome, Italy
| | - Alfredo Schiavone Panni
- Multidisciplinary Department of Medical-Surgical and Dental Specialty, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Tania Suarez
- Physical Medicine and Rehabilitation Unit, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Umberto Tarantino
- Department of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Rome, Italy
| | - Filippo Vittadini
- Department of Physical and Rehabilitation Medicine, University of Padova, Padova, Italy
| | - Maria Chiara Vulpiani
- Physical Medicine and Rehabilitation Unit, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Andrea Ferretti
- Orthopaedic Department and "Kirk Kilgour" Sports Injury Center, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy; Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Abstract
The knee is one of the most commonly injured joints in the body. Its superficial anatomy enables diagnosis of the injury through a thorough history and physical examination. Examination techniques for the knee described decades ago are still useful, as are more recently developed tests. Proper use of these techniques requires understanding of the anatomy and biomechanical principles of the knee as well as the pathophysiology of the injuries, including tears to the menisci and extensor mechanism, patellofemoral conditions, and osteochondritis dissecans. Nevertheless, the clinical validity and accuracy of the diagnostic tests vary. Advanced imaging studies may be useful adjuncts.
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Franciozi CE, Ambra LF, Albertoni LJB, Debieux P, Rezende FC, Oliveira MAD, Ferreira MDC, Luzo MVM. Increased Femoral Anteversion Influence Over Surgically Treated Recurrent Patellar Instability Patients. Arthroscopy 2017; 33:633-640. [PMID: 27988165 DOI: 10.1016/j.arthro.2016.09.015] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 09/15/2016] [Accepted: 09/16/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To verify the influence that increased femoral anteversion (FA) has on patients with recurrent patellar instability (RPI) treated by anteromedialization tibial tubercle osteotomy (TTO) combined with medial patellofemoral ligament reconstruction (MPFLR) and to present the midterm outcomes of these patients. METHODS From January 2008 to August 2013, skeletally mature patients with RPI and tibial tubercle (TT)-trochlear groove (TG) ≥ 17 mm who underwent anteromedialization TTO combined with MPFLR were evaluated for J sign, patellar glide, apprehension test, increased FA, Caton index, trochlea dysplasia, TT-TG, Kujala, International Knee Documentation Committee subjective knee evaluation form, and Tegner. Increased FA was determined clinically by a difference of more than 30° between hip internal and external rotation, 70° or more of hip internal rotation, and 30° or more of femoral neck anteversion. A subgroup analysis involving increased FA was made. RESULTS Forty-eight patients composed the study group. Mean follow-up was 41.5 ± 11.05 months. The J-sign was present in 86% before surgery and none postoperatively (P < .001). All patients had a positive apprehension test or a patellar luxation at the patellar glide test rated as grade 4 before surgery. After surgery, the mean glide was 1.29 ± 0.45 with no apprehension (P < .001). Increased FA was present in 18.7%. Caton index before surgery was 1.11 ± 0.21 and 0.99 ± 0.11 postoperatively (P = .004). Trochlea dysplasia was present in all patients. TT-TG preoperatively was 20.77 ± 2.12 mm and 11.33 ± 1.24 mm postoperatively (P < .001). Functional scores improved preoperatively to postoperatively (P < .001) with Kujala and International Knee Documentation Committee means: 59.08 to 84.37; 52.6 to 85.5, respectively. Tegner preinjury score was 5.4 and postoperatively was 5.2 (P = .01). Increased FA group had worse Kujala compared with the normal FA group and worse Kujala improvement: 77.7 and 85.89 (P = .012), and 21.7 and 26.1, respectively (P < .001). CONCLUSIONS Increased FA in patients with RPI had a negative effect on the outcome of anteromedialization TTO combined with MPFLR. Combined anteromedialization TTO and MPFLR had good functional midterm outcomes in treating patients with RPI and TT-TG ≥ 17 mm. LEVEL OF EVIDENCE Level III, comparative study.
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Affiliation(s)
- Carlos Eduardo Franciozi
- Department of Orthopaedics and Traumatology, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, SP, Brazil.
| | - Luiz Felipe Ambra
- Department of Orthopaedics and Traumatology, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, SP, Brazil
| | | | - Pedro Debieux
- Department of Orthopaedics and Traumatology, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Fernando Cury Rezende
- Department of Orthopaedics and Traumatology, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, SP, Brazil
| | | | | | - Marcus Vinícius Malheiros Luzo
- Department of Orthopaedics and Traumatology, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, SP, Brazil
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Steinberg N, Tenenbaum S, Hershkovitz I, Zeev A, Siev-Ner I. Lower extremity and spine characteristics in young dancers with and without patellofemoral pain. Res Sports Med 2017; 25:166-180. [PMID: 28140673 DOI: 10.1080/15438627.2017.1282355] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Very little is known about patellofemoral pain syndrome (PPFS) among young dancers. Understanding the mechanism of the injury and implementing a preventative programme are important in order to minimize the risk of PFPS. The aim of the current study is to determine the extent to which factors such as lower extremity and back characteristics are common among dancers with PFPS. The study population included 271 dancers with PFPS and 271 non-injured dancers, aged 10-16 years. All dancers were screened for morphometric profile, dance discipline (h/week), anatomical anomalies (present/absent of scoliosis, genu valgus/varum, etc.), and joint range of motion (measured by goniometer at the hip, knee, ankle, foot, and spinal joints). The predicting factors for PFPS among young dancers (10-11 years old) were: hyper hip abduction (OR = 0.906) and lower back and hamstring flexibility (OR = 3.542); for adolescent dancers (12-14 years old): hyper ankle dorsiflexion (OR = 0.888), hind foot-varum (OR = 0.260), and mobility of patella (OR = 2.666); and, for pre-mature dancers (15-16 years old): scoliosis (OR = 5.209), limited ankle plantar-flexion (OR = 1.060), and limited hip internal rotation (OR = 1.063). In conclusion, extrinsic and intrinsic parameters predisposing the dancers to knee injuries should be identified by screening in early stages of dance classes.
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Affiliation(s)
- Nili Steinberg
- a Sackler Faculty of Medicine, Department of Anatomy and Anthropology , Tel-Aviv University , Tel-Aviv , Israel.,b The Wingate College of physical Education and Sports Sciences at the Wingate Institute , Netanya , Israel
| | - Shay Tenenbaum
- c Department of orthopedic surgery, Chaim Sheba medical center Tel-Hashomer, affiliated to the Sackler Faculty of Medicine , Tel Aviv University , Tel-Aviv , Israel
| | - Israel Hershkovitz
- a Sackler Faculty of Medicine, Department of Anatomy and Anthropology , Tel-Aviv University , Tel-Aviv , Israel
| | - Aviva Zeev
- b The Wingate College of physical Education and Sports Sciences at the Wingate Institute , Netanya , Israel
| | - Itzhak Siev-Ner
- d Orthopedic Rehabilitation Dept , Sheba Medical Center , Tel-Hashomer , Israel
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An anatomic study of the lateral patellofemoral ligament. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2017; 51:73-76. [PMID: 27516002 PMCID: PMC6197417 DOI: 10.1016/j.aott.2016.07.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 05/15/2016] [Accepted: 07/24/2016] [Indexed: 01/26/2023]
Abstract
Objective The lateral patellofemoral ligament (LPFL) is part of the lateral retinaculum cut during arthroscopic or open release. We investigated its anatomic and morphometric characteristics. Materials and methods We identified the LPFL insertion point on the condyle in vertical and sagittal planes in 32 adult cadaveric knees. We measured its length and width at the insertion point. We located the midpoint of this point and measured from it to the distal and posterior condylar ends. We measured anterior-posterior and proximal-distal lateral condylar lengths. We evaluated the insertion point shape on the lateral femoral condyle. Degree of relationship between variables was assessed using Pearson's correlation coefficient. p < 0.05 was considered statistically significant. Results The LPFL mean length was 23.2 mm, and mean width at the insertion point was 15.6 mm. Regarding its insertion into the lateral condyle, central insertions were more frequent (vertical plane: 53.1% central and sagittal plane: 75% central). A significant positive correlation was evident between the LPFL length and width at the insertion point (p = 0.05). Thus, the LPFL length was proportional to its width at the insertion point. A significant positive correlation was found between the anterior-posterior condylar length and width of the LPFL at the insertion point (p = 0.017). Therefore, greater anterior-posterior condylar length equates to a larger area of insertion on the condyle. Conclusion Greater width of the LPFL at the insertion point corresponds to greater LPFL and anterior-posterior lateral condylar lengths.
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Abstract
The management of patellofemoral cartilage lesions is controversial and should begin with a comprehensive nonsurgical treatment plan. Patients with patellofemoral cartilage lesions in whom nonsurgical treatment fails may be candidates for surgical treatment. Surgical treatment strategies for the management of patellofemoral cartilage lesions are guided by the size, quality, and location of the defect. Recent advancements in cartilage restoration and arthroplasty techniques as well as appropriate patient selection and meticulous surgical technique have resulted in promising outcomes in patients with patellofemoral cartilage lesions who undergo surgical treatment.
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Erickson BJ, Campbell K, Cvetanovich GL, Harris JD, Bach BR, Sherman SL. Nonligamentous Soft Tissue Pathology About the Knee: A Review. Orthopedics 2016; 39:32-42. [PMID: 26709560 DOI: 10.3928/01477447-20151218-06] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 05/20/2015] [Indexed: 02/03/2023]
Abstract
Knee pain is one of the most frequent complaints evaluated by orthopedic surgeons. It encompasses a broad range of pathology and can present in a variety of ways. Most of this pain can be attributed to essential structures of the knee, including the menisci, cruciate or collateral ligaments, and articular cartilage. However, there are underrecognized structures in and around the knee that can frequently be a cause of knee pathology and pain. Knee pain stemming from these structures may be missed or incorrectly diagnosed, and these patients often present for second and third opinions because of failure to diagnose and treat the underlying pathology. The synovial plica, suprapatellar pouch, lateral retinaculum, infrapatellar fat pad, and infrapatellar branch of the saphenous nerve are less common but still significant causes of knee pain. Although initial treatment involves various nonoperative modalities, operative treatment is often warranted. Operative and nonoperative management of these soft tissue structures may occur in isolation or with concomitant procedures, including knee ligament reconstruction, total knee arthroplasty, tibial tuberosity osteotomy, or lysis of adhesions. With proper recognition of the role of these structures in knee pain, the orthopedic surgeon can offer a valuable primary or adjunctive treatment option for patients with knee pain, especially those without localizing signs of meniscal, ligamentous, or cartilage damage.
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Kurtul Yildiz H, Ekin EE. Patellar malalignment: a new method on knee MRI. SPRINGERPLUS 2016; 5:1500. [PMID: 27652073 PMCID: PMC5014770 DOI: 10.1186/s40064-016-3195-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 09/01/2016] [Indexed: 01/11/2023]
Abstract
Purpose The medial patellofemoral ligament (MPFLL)/lateral patellar retinaculum (LPR) ratio were assessed in knees as a means to detect patellar malalignment. We also aimed to evaluate the prevalence of the various types of trochlear dysplasia in patients with patellar malalignment. Materials and methods After approval of our institutional ethics committee, we conducted a retrospective study that included 450 consecutive patients to evaluate them for the presence of patellar malalignment. Parameters investigated were the trochlear type, sulcus angle, presence of a supratrochlear spur, MPFLL, LPR, patella alta, and patella baja by means of 1.5T magnetic resonance imaging (MRI). Overall, 133 patients were excluded because of the presence of major trauma, multiple ligament injuries, bipartite patella, and/or previous knee surgery. The Dejour classification was used to assess trochlear dysplasia. Two experienced radiologists (HKY, EEE) evaluated the images. Their concordance was assessed using the kappa (κ) test. Results The frequencies of patellar malalignment and trochlear dysplasia were 34.7 and 63.7 %, respectively. The frequency of trochlear dysplasia associated with patellar malalignment was 97.2 %. An MPFLL/LPR ratio of 1.033–1.041 had high sensitivity and specificity for malalignment. The researchers’ concordance was good (κ = 0.89, SE = 0.034, P < 0.001). Conclusion Trochlear dysplasia is frequently associated with patellar malalignment. An increased MPFLL/LPR ratio is useful for detecting patellar malalignment on knee MRI, which is a novel quantitative method based on ligament length.
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Affiliation(s)
- Hülya Kurtul Yildiz
- Radiology Department, Gaziosmanpaşa Taksim Training and Research Hospital, Istanbul, Turkey
| | - Elif Evrim Ekin
- Radiology Department, Gaziosmanpaşa Taksim Training and Research Hospital, Istanbul, Turkey
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Duerr RA, Chauhan A, Frank DA, DeMeo PJ, Akhavan S. An Algorithm for Diagnosing and Treating Primary and Recurrent Patellar Instability. JBJS Rev 2016; 4:01874474-201609000-00002. [DOI: 10.2106/jbjs.rvw.15.00102] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Song GY, Hong L, Zhang H, Zhang J, Li Y, Feng H. Iatrogenic medial patellar instability following lateral retinacular release of the knee joint. Knee Surg Sports Traumatol Arthrosc 2016; 24:2825-2830. [PMID: 25618277 DOI: 10.1007/s00167-015-3522-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 01/20/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE Iatrogenic medial patellar instability (IMPI) is a disabling but easily missed condition that is most often seen as a late complication of lateral retinacular release (LRR) procedures. The purposes of this study were (1) to summarize the available diagnostic methods and (2) to explore the contributing factors of IMPI following LRR procedures. METHODS The MEDLINE, PubMed, EMBASE and Cochrane Library databases were searched for studies including diagnosed IMPI cases following LRR procedures. All patients were first divided into IMPI group and non-IMPI group based on the diagnostic methods of IMPI collected from studies. Univariate analysis was performed by comparing the two groups with regard to individual patient data (age at initial LRR, gender) and surgical details (type, releasing scope, combined surgeries and indication) of LRR procedures. Multivariate logistic regression was carried out to identify independent contributing factors for IMPI and to calculate odds ratios (ORs). RESULTS Eight studies with 274 patients (300 knees) were finally included. Of those, 161 patients (171 knees, 57.0 %) had IMPI and 113 patients (129 knees, 43.0 %) had no IMPI. Univariate analysis revealed a statistically significant difference between both groups for releasing scope (P 1 < 0.001) and indication of LRR procedures (P 2 < 0.001), with releasing lateral retinaculum (LR) + vastus lateralis (VL) tendon and absence of tight LR during the initial LRR procedures being more common in patients with IMPI. The independent contributing factors for IMPI identified in the multivariate logistic regression analysis were releasing LR + VL (OR1 = 16.49) and absence of tight LR (OR2 = 14.37). CONCLUSIONS The IMPI was more common in patient with an over-released LRR and patient who was absent of tight LR during the initial LRR procedures. Aggressive surgical corrections and inappropriate indications of initial LRR were two contributing factors for the late complications of IMPI. This study suggests that the IMPI may occur as a major complication of LRR, especially when the VL tendon is extensively released or when there is no confirmative clinical evidence of a tight LR preoperatively. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Guan-Yang Song
- Sports Medicine Service, Beijing Jishuitan Hospital, No. 31, Xin Jie Kou East Street, Xi Cheng District, Beijing, 100035, China
| | - Lei Hong
- Sports Medicine Service, Beijing Jishuitan Hospital, No. 31, Xin Jie Kou East Street, Xi Cheng District, Beijing, 100035, China
| | - Hui Zhang
- Sports Medicine Service, Beijing Jishuitan Hospital, No. 31, Xin Jie Kou East Street, Xi Cheng District, Beijing, 100035, China
| | - Jin Zhang
- Sports Medicine Service, Beijing Jishuitan Hospital, No. 31, Xin Jie Kou East Street, Xi Cheng District, Beijing, 100035, China
| | - Yue Li
- Sports Medicine Service, Beijing Jishuitan Hospital, No. 31, Xin Jie Kou East Street, Xi Cheng District, Beijing, 100035, China
| | - Hua Feng
- Sports Medicine Service, Beijing Jishuitan Hospital, No. 31, Xin Jie Kou East Street, Xi Cheng District, Beijing, 100035, China.
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Fujita Y, Tsuda E, Yamamoto Y, Naraoka T, Kimura Y, Sasaki S, Ishibashi Y. Quantitative analysis of dynamic patellar tracking in patients with lateral patellar instability using a simple video system. Knee 2016; 23:604-9. [PMID: 27169720 DOI: 10.1016/j.knee.2015.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 11/21/2015] [Accepted: 12/05/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND As patellar dislocation occurs during activity, it is more important to assess the behavior of the patellofemoral joint under dynamic conditions. The aim of this study was to compare patellar tracking between knees with and without patellar dislocation in patients with an unstable patella and healthy controls using a simple video technique. METHODS Twenty-three knees with patellar dislocation (dislocated group), 23 contralateral knees without dislocation (non-dislocated group), and 23 healthy knees (control group) were examined. Those with skin markers on anatomical landmarks were made to extend their knees actively, and skin markers were attached to the examiner's fingertips and the patella was followed by pinching. The knee during active knee extension was recorded with digital video cameras. The patella was tracked on imaging software, and the mediolateral patellar position (% patellar position: %PP) was calculated in reference to the knee width consecutively. RESULTS %PP was significantly different between the dislocated and control groups, from 30° (mean±SD: 58.9±6.2%, 54.6±4.7%) to 5° (64.2±5.2%, 55.2±5.2%). It was also significantly different between the non-dislocated and control groups, from 25° (58.9±7.1%, 54.5±4.6%) to 5° (63.8±6.5%, 55.2±5.2%). No significant difference in %PP was found between the dislocated and non-dislocated groups. CONCLUSION With the new video system, patellar tracking during active knee extension was successfully quantified. The tracking patterns were the same in knees with and without patellar dislocation, and the tracking in patients significantly differed from that in the controls at lower knee flexion angles. CLINICAL RELEVANCE The development of a quantitative examination technique for dynamic patellar tracking, which is easy to use and repeatedly applicable in a clinical situation, could help to follow-up the time-dependent changes and analyze the treatment effect on an unstable patella.
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Affiliation(s)
- Yuki Fujita
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori 036-8562, Japan.
| | - Eiichi Tsuda
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori 036-8562, Japan
| | - Yuji Yamamoto
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori 036-8562, Japan
| | - Takuya Naraoka
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori 036-8562, Japan
| | - Yuka Kimura
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori 036-8562, Japan
| | - Shizuka Sasaki
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori 036-8562, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori 036-8562, Japan
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Kumahashi N, Kuwata S, Takuwa H, Egusa N, Uchio Y. Longitudinal Change of Medial and Lateral Patellar Stiffness After Reconstruction of the Medial Patellofemoral Ligament for Patients with Recurrent Patellar Dislocation. J Bone Joint Surg Am 2016; 98:576-83. [PMID: 27053586 DOI: 10.2106/jbjs.15.00605] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Longitudinal changes in patellar stiffness following reconstruction of the medial patellofemoral ligament for recurrent patellar dislocation at full extension are unknown. METHODS Fifteen consecutive patients (three men and twelve women, with a mean age of twenty-two years) with seventeen knees were matched by sex and age to thirty-two reference subjects in this prospective study. The follow-up period was a minimum of twenty-four months. The medial patellofemoral ligament reconstruction used an autograft semitendinosus tendon and an interference screw system with or without lateral release under 10 N of laterally directed force. The medial patellar stiffness and lateral patellar stiffness were measured in 0° of knee extension using the Patella Stability Tester preoperatively; postoperatively at three, six, twelve, and eighteen months; and at the time of the latest follow-up. Before and after the surgical procedure, patients were evaluated for apprehension and Kujala and Lysholm scores; radiographic examinations were performed to evaluate changes, including osteoarthritic changes. RESULTS The medial stiffness of the affected side before the surgical procedure was significantly lower than the lateral stiffness (p = 0.004) and the stiffness for healthy reference knees (p = 0.004). Medial stiffness three months after the surgical procedure was significantly elevated compared with lateral values (p = 0.027), preoperative values (p < 0.001), and reference group values (p = 0.002); reached the reference level by six months; and was maintained for up to two years. Furthermore, medial stiffness and lateral stiffness were well balanced after six months and this balance was sustained for up to two years postoperatively. No recurrent dislocation occurred during the follow-up period; one patient experienced apprehension. Postoperative radiographic findings and clinical scores were significantly improved at the time of the latest follow-up (p < 0.05). One knee progressed to patellofemoral osteoarthritis. CONCLUSIONS The value for medial stiffness was significantly improved three months after medial patellofemoral ligament reconstruction compared with the preoperative and lateral values and returned to the reference level by six months. Medial stiffness and lateral stiffness of the patella were well balanced by six months and retained that balance for up to two years, with good clinical results. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Nobuyuki Kumahashi
- Departments of Orthopaedic Surgery (N.K., S.K., H.T., and Y.U.) and Rehabilitation (N.E.), School of Medicine, Shimane University, Shimane, Japan
| | - Suguru Kuwata
- Departments of Orthopaedic Surgery (N.K., S.K., H.T., and Y.U.) and Rehabilitation (N.E.), School of Medicine, Shimane University, Shimane, Japan
| | - Hiroshi Takuwa
- Departments of Orthopaedic Surgery (N.K., S.K., H.T., and Y.U.) and Rehabilitation (N.E.), School of Medicine, Shimane University, Shimane, Japan
| | - Norimasa Egusa
- Departments of Orthopaedic Surgery (N.K., S.K., H.T., and Y.U.) and Rehabilitation (N.E.), School of Medicine, Shimane University, Shimane, Japan
| | - Yuji Uchio
- Departments of Orthopaedic Surgery (N.K., S.K., H.T., and Y.U.) and Rehabilitation (N.E.), School of Medicine, Shimane University, Shimane, Japan
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Revision Surgery in Permanent Patellar Dislocation in DiGeorge Syndrome. Case Rep Orthop 2016; 2015:752736. [PMID: 26783479 PMCID: PMC4691475 DOI: 10.1155/2015/752736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 11/26/2015] [Indexed: 11/17/2022] Open
Abstract
A 29-year-old patient, suffering from DiGeorge syndrome, came to our attention with a history of persistent pain and patellar instability in the left knee after failure of arthroscopic lateral release and Elmslie-Trillat procedure. The patient was unable to walk without crutches and severely limited in daily living activities. Because of arthritic changes of the patellofemoral joint and the failure of previous surgeries it was decided to perform only an open lateral release and medial patellofemoral ligament (MPFL) reconstruction using a biosynthetic ligament in order to obtain patellofemoral stability. At one year post-op range of motion (ROM) was 0-120 with a firm end point at medial patellar mobilization; patella was stable throughout the entire ROM. All the scores improved and she could be able to perform daily activity without sensation of instability. Bilateral patellar subluxation and systemic hyperlaxity are characteristics of syndromic patients and according to literature can be also present in DiGeorge syndrome. MPFL reconstruction with lateral release was demonstrated to be the correct solution in the treatment of patellar instability in this complex case. The choice of an artificial ligament to reconstruct the MPFL was useful in this specific patient with important tissue laxity due to her congenital syndrome.
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Isolierter patellofemoraler Gelenkersatz. ARTHROSKOPIE 2015. [DOI: 10.1007/s00142-015-0029-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Surgical versus conservative treatment of primary patellar dislocation. A systematic review and meta-analysis. INTERNATIONAL ORTHOPAEDICS 2015. [PMID: 26202017 DOI: 10.1007/s00264-015-2856-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of this study was to determine the efficacy of surgical and conservative treatment in the prevention of recurrence after primary patellar dislocation. METHODS Studies were searched on MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and CINHAL from their inception to April 2015. All randomized controlled clinical trials comparing surgical versus conservative treatment after first patellar dislocation were included. Primary outcomes were: recurrent dislocation, subluxation, overall instability and subsequent surgery. Secondary outcomes included imaging, and subjective and objective clinical assessment tools. Methodological quality of the studies was assessed using Cochrane Collaboration's "Risk of Bias" tool. Pooled analyses were reported as risk ratio (RR) using a random effects model. Continuous data were reported as standardized mean difference (SMD) and 95 % confidence intervals (CIs). Heterogeneity was assessed using I². RESULTS Nine studies were included in the meta-analyses. Methodological quality of the studies was moderate to low. Meta-analyses showed that surgical treatment significantly reduces the redislocation rate (RR = 0.62; 95% CI = 0.39, 0.98, p = 0.04) and provides better results on Hughston VAS score (SMD = -0.32; 95% CI = -0.61, -0.03; p = 0.03) and running (OR = -0.52; 95% CI = 0.31, 0.88; p = 0.01). Conservative treatment showed less occurrence of minor complications (OR = 3.46; 95% CI = 2.08, 5.77; p = 0.01) and better results in the figure-of-8 run test (SMD = 0.42; 95% CI = 0.06, 0.77; p = 0.02) and in the squat down test (SMD = -0.45; 95% CI = -0.81, -0.10; p < 0.00001). No other significant differences could be found. CONCLUSIONS Based on the available data, surgical treatment of primary patella dislocation significantly reduces the risk of patella redislocation.
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The results of adductor magnus tenodesis in adolescents with recurrent patellar dislocation. BIOMED RESEARCH INTERNATIONAL 2015; 2015:456858. [PMID: 25785271 PMCID: PMC4345238 DOI: 10.1155/2015/456858] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 01/25/2015] [Accepted: 01/29/2015] [Indexed: 01/17/2023]
Abstract
Recurrent dislocation of the patella is a common orthopaedic problem which occurs in about 44% of cases after first-time dislocation. In most cases of first-time patellar dislocation, the medial patellofemoral ligament (MPFL) becomes damaged. Between 2010 and 2012, 33 children and adolescents (39 knees) with recurrent patellar dislocation were treated with MPFL reconstruction using the adductor magnus tendon. The aim of our study is to assess the effectiveness of this surgical procedure. The outcomes were evaluated functionally (Lysholm knee scale, the Kujala Anterior Knee Pain Scale, and isokinetic examination) and radiographically (Caton index, sulcus angle, congruence angle, and patellofemoral angle). Four patients demonstrated redislocation with MPFL graft failure, despite the fact that patellar tracking was found to be normal before the injury, and the patients had not reported any symptoms. Statistically significant improvements in Lysholm and Kujala scales, in patellofemoral and congruence angle, were seen (P < 0.001). A statistically significant improvement in the peak torque of the quadriceps muscle and flexor was observed for 60°/sec and 180°/sec angular velocities (P = 0.01). Our results confirm the efficacy of MPFL reconstruction using the adductor magnus tendon in children and adolescents with recurrent patellar dislocation.
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Kearney SP, Mosca VS. Selective hemiepiphyseodesis for patellar instability with associated genu valgum. J Orthop 2015; 12:17-22. [PMID: 25829756 DOI: 10.1016/j.jor.2015.01.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 01/04/2015] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Patellar instability limits activity and promotes arthritis. Correcting genu valgum with selective hemiepiphyseodesis can treat patellar instability. METHODS We retrospectively reviewed 26 knees with patellar instability and associated genu valgum that underwent hemiepiphyseodesis. RESULTS Average anatomic lateral distal femoral angle (aLDFA) significantly corrected. Symptoms improved in all patients. All competitive athletes returned to sports. One complication occurred. CONCLUSIONS In genu valgum, the patella seeks an abnormal mechanical axis, resulting in patellar instability. By correcting the mechanical axis with hemiepiphyseodesis, patellar instability symptoms improve and patients return to sports. Complications are rare. Selective hemiepiphyseodesis is recommended when treating patellar instability with associated genu valgum.
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Affiliation(s)
- Sean P Kearney
- Womack Army Medical Center, Department of Orthopedics and Rehabilitation, Fort Bragg, NC 28310, United States
| | - Vincent S Mosca
- Seattle Children's Hospital, W-7706-Orthopaedics Administration, Seattle, WA 98105, United States
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