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Jud L, Hartmann M, Vlachopoulos L, Zimmermann SM, Ackermann J, Fucentese SF. Increased tibial tuberosity torsion has the greatest predictive value in patients with patellofemoral instability compared to other commonly assessed parameters. Knee Surg Sports Traumatol Arthrosc 2024; 32:1179-1186. [PMID: 38504510 DOI: 10.1002/ksa.12151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 03/21/2024]
Abstract
PURPOSE The multifactorial nature of patellofemoral instability requires a comprehensive assessment of the affected patients. While an association between tibial tuberosity (TT) torsion and patellofemoral instability is known, its specific effect has not yet been investigated. This study investigated the effect of TT torsion on patellofemoral instability. METHODS This retrospective cohort study compared patients who underwent surgical intervention for patellofemoral instability and asymptomatic controls. TT torsion was measured in addition to other commonly assessed risk factors for patellofemoral instability using standardised computed tomography (CT) data of the lower extremities. The diagnostic performances of the assessed parameters were evaluated using receiver operating characteristic curve analysis and odds ratios (ORs) were calculated. RESULTS The patellofemoral instability group consisted of 79 knees, compared to 72 knees in the asymptomatic control group. Both groups differed significantly in all assessed parameters (p < 0.001), except for tibial torsion (n.s.). Among all parameters, TT torsion presented the best diagnostic performance for predicting patellar instability with an area under the curve of 0.95 (95% confidence interval [CI], 0.91-0.98; p < 0.001). A cut-off value of 17.7° yielded a 0.87 sensitivity and 0.89 specificity to predict patellar instability (OR, 55.2; 95% CI, 20.5-148.6; p < 0.001). CONCLUSION Among the evaluated risk factors, TT torsion had the highest predictive value for patellofemoral instability. Patients with TT torsions ≥ 17.7° showed a 55-fold increased probability of patellofemoral instability. Therefore, TT torsion should be included in the assessment of patients with patellofemoral instability. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Lukas Jud
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Martin Hartmann
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Lazaros Vlachopoulos
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Stefan M Zimmermann
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jakob Ackermann
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Sandro F Fucentese
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Figueroa F, Guiloff R, Bolton S, Figueroa D, Tapasvi S, Stocker E. Specific considerations in female patients with patellar instability: current concepts. J ISAKOS 2024:S2059-7754(24)00068-3. [PMID: 38580053 DOI: 10.1016/j.jisako.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 03/26/2024] [Accepted: 03/29/2024] [Indexed: 04/07/2024]
Abstract
Prior literature suggests that patellofemoral instability (PFI) is significantly more prevalent in women than in men. This higher prevalence is commonly attributed to anatomical differences between sexes, particularly with patellofemoral alignment. These differences encompass a higher rate of trochlear dysplasia (TD), patella alta, an increased Q angle, and soft tissue imbalances. In recent years worse outcomes have been reported in female patients after patellofemoral stabilization surgery using medial patellofemoral ligament reconstruction (MPFLr) alone or in combination with a tibial tubercle osteotomy (TTO), for this reason an "à la carte" plan (addressing the individuals anatomical risk factors) could be more appropriate for female patients.
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Affiliation(s)
- Francisco Figueroa
- Clinica Alemana-Universidad del Desarrollo, Chile; Hospital Sotero del Rio, Chile.
| | - Rodrigo Guiloff
- Clinica Alemana-Universidad del Desarrollo, Chile; Hospital Sotero del Rio, Chile.
| | - Sarah Bolton
- Fortius Clinic, UK; Chelsea & Westminster Hospital, UK.
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Jadidi S, Lee AD, Pierko EJ, Choi H, Jones NS. Non-operative Management of Acute Knee Injuries. Curr Rev Musculoskelet Med 2024; 17:1-13. [PMID: 38095838 PMCID: PMC10767052 DOI: 10.1007/s12178-023-09875-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/26/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE OF REVIEW Acute knee injuries are commonly encountered in both the clinical and sideline setting and may be treated operatively or non-operatively. This article describes an evidence-based approach to non-operative acute knee injury. This includes history, physical exam, imaging, and initial management. In addition, the non-operative management of three such injuries-ligament injury, meniscus injury, and patellar dislocation injury-will be discussed via a case-based practical approach. RECENT FINDINGS Aside from grade III ACL tears, most acute knee ligament injuries, especially in the absence of other concurrent injuries, can be treated non-operatively. There is new evidence that acute traumatic meniscus tears in those younger than 40 can be successfully treated non-operatively and can do equally, as well as those that undergo surgery, at 1 year out from injury. Based on the current literature, a short period of knee bracing in extension with progression to weightbearing to tolerance is recommended after initial patellar dislocation. Many of the most common acute knee injuries, including MCL tears, meniscus tears, and patellar dislocations, can be managed non-operatively. A detailed systemic approach to initial evaluation, including pertinent history, physical exam, and appropriate imaging, is essential and complementary to the subsequent non-operative treatment algorithm.
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Affiliation(s)
- Shaheen Jadidi
- Department of Orthopedics, Edward-Elmhurst Health, Naperville, IL, USA
| | - Aaron D Lee
- Department of Orthopedics and Family Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Eliza J Pierko
- Department of Orthopedics and Family Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Haemi Choi
- Department of Orthopedics and Family Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Nathaniel S Jones
- Department of Orthopedics and Family Medicine, Loyola University Medical Center, Maywood, IL, USA.
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Monaco E, Criseo N, Annibaldi A, Carrozzo A, Pagnotta SM, Cantagalli MR, Orlandi P, Daggett M. Medial Patellofemoral Ligament Reconstruction Using Gracilis Tendon Graft and "All Suture" Knotless Anchors for Patellar Fixation. Arthrosc Tech 2023; 12:e2329-e2334. [PMID: 38196870 PMCID: PMC10773230 DOI: 10.1016/j.eats.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/03/2023] [Indexed: 01/11/2024] Open
Abstract
Patellar dislocation is a frequent sports-related knee injury. The primary restraint to lateral translation of patella is medial patellofemoral ligament. Several treatments for patella dislocation have been described in the literature. The purpose of this Technical Note is to describe the surgical technique for medial patellofemoral ligament reconstruction using gracilis tendon and 2 knotless soft anchors, avoiding patella tunneling.
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Affiliation(s)
- Edoardo Monaco
- Department of Orthopaedic Surgery, S. Andrea Hospital, "Sapienza" University of Rome, Italy
| | - Natale Criseo
- Department of Orthopaedic Surgery, S. Andrea Hospital, "Sapienza" University of Rome, Italy
| | - Alessandro Annibaldi
- Department of Orthopaedic Surgery, S. Andrea Hospital, "Sapienza" University of Rome, Italy
| | - Alessandro Carrozzo
- Department of Orthopaedic Surgery, S. Andrea Hospital, "Sapienza" University of Rome, Italy
| | - Susanna M Pagnotta
- Department of Orthopaedic Surgery, S. Andrea Hospital, "Sapienza" University of Rome, Italy
| | | | - Pierfrancesco Orlandi
- Department of Orthopaedic Surgery, S. Andrea Hospital, "Sapienza" University of Rome, Italy
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Xu C, Chen X, Li K, Ji G, Chen Z, Wang X, Yan L, Kang H, Wang F. Predicting the Probability of Recurrence Based on Individualized Risk Factors After Primary Lateral Patellar Dislocation Treated Nonoperatively. Arthroscopy 2023:S0749-8063(23)00872-1. [PMID: 37918700 DOI: 10.1016/j.arthro.2023.10.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/15/2023] [Accepted: 10/20/2023] [Indexed: 11/04/2023]
Abstract
PURPOSE To develop a comprehensive and effective personalized scoring system on the basis of demographic and clinical characteristics for predicting recurrence probability in patients with primary lateral patellar dislocation (LPD). METHODS Participants included 261 primary patients with LPD with 2-year minimum follow-up from our hospital across 2013 to 2020. Demographic and clinical characteristics were collected retrospectively. The backward stepwise method was performed to identify independent predictors and construct a nomogram to predict the probability of recurrence. The predictive performance was assessed by receiver operating characteristic curves, calibration plots, and decision curve analysis. RESULTS After variables selection, 6 independent predictors of recurrence (skeletal maturity, trochlear dysplasia, tibial tuberosity-trochlear groove distance, mechanical axis deviation, Insall-Salvati index, and patellar tilt) were enrolled in our model. Validation of this nomogram in both training and validation cohort revealed powerful predictive ability, with an area under the curve of 0.962 and 0.977, respectively. The nomogram also showed great calibration and good clinical practicability. CONCLUSIONS Our study presented a nomogram that incorporates 6 independent risk factors (skeletal maturity, trochlear dysplasia, tibial tuberosity-trochlear groove distance, mechanical axis deviation, Insall-Salvati index, and patellar tilt), which can be conveniently used to accurately predicts the risk of recurrence after primary LPD in individual cases. LEVEL OF EVIDENCE Level III, retrospective comparative prognostic study.
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Affiliation(s)
- Chenyue Xu
- Hebei Medical University Third Affiliated Hospital, Hebei, China
| | - Xiaobo Chen
- Hebei Medical University Third Affiliated Hospital, Hebei, China
| | - Kehan Li
- Hebei Medical University Third Affiliated Hospital, Hebei, China
| | - Gang Ji
- Hebei Medical University Third Affiliated Hospital, Hebei, China
| | | | - Xiaomeng Wang
- Hebei Medical University Third Affiliated Hospital, Hebei, China
| | - Lirong Yan
- Hebei Medical University Third Affiliated Hospital, Hebei, China
| | - Huijun Kang
- Hebei Medical University Third Affiliated Hospital, Hebei, China
| | - Fei Wang
- Hebei Medical University Third Affiliated Hospital, Hebei, China.
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Yoo JD, Huh MH, Lee CW, Roh YH, D’Lima DD, Shin YS. Medial patellofemoral ligament reconstruction appears to be a better treatment than repair, proximal realignment, or conservative management for primary patellar dislocation: A network meta-analysis. Medicine (Baltimore) 2023; 102:e35251. [PMID: 37773862 PMCID: PMC10545352 DOI: 10.1097/md.0000000000035251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/25/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND The purpose of this study was to compare the functional outcomes and re-dislocation rates of medial patellofemoral ligament (MPFL) reconstruction, MPFL repair, combined proximal realignment (CPR), and conservative management for primary patellar dislocation by conducting a systematic literature search of the available studies. The hypothesis was that MPFL repair and MPFL reconstruction would be better options for treating primary patellar dislocation. METHODS Randomized controlled trials or prospective studies of primary patellar dislocation treated with MPFL reconstruction, MPFL repair, CPR, or conservative management were identified from the MEDLINE, EMBASE, and the Cochrane Library databases through December 31, 2021. A total of 626 patients met the prespecified inclusion criteria. The methodological quality of each study was assessed using a risk of bias table, Detsky quality index, and Newcastle-Ottawa Scale. The end-point data collected included comparisons of the mean in functional scores on knee outcomes scales and the number of patients who experienced re-dislocation. A network meta-analysis of the relevant literature was performed to investigate which treatment showed better outcomes. RESULTS In total, 10 trials were included in this study. There was no statistically significant difference in the subgroup analysis in terms of the functional outcomes among MPFL reconstruction, MPFL repair, CPR, and conservative management. However, MPFL reconstruction showed statistically significantly better outcomes than MPFL repair, CPR, or conservative management in terms of the re-dislocation rate. Additionally, surface under the cumulative ranking curve percentage showed that MPFL reconstruction had a lower probability of re-dislocation than MPFL repair even though there was no significant difference (0.24, 95% confidence interval: 0.02-2.91). CONCLUSION Using a network meta-analysis, this meta-analysis showed that there was no significant difference in functional outcomes in a subgroup analysis. In re-dislocation subgroup analysis, MPFL repair and MPFL reconstruction produced significantly better results than other treatments. Also, surface under the cumulative ranking curve percentage showed that MPFL reconstruction had a lower probability of re-dislocation than MPFL repair.
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Affiliation(s)
- Jae-Doo Yoo
- Department of Orthopedic Surgery, Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Min-Hwan Huh
- Department of Orthopedic Surgery, Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Chan-Woo Lee
- Department of Orthopedic Surgery, Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Young-Hak Roh
- Department of Orthopedic Surgery, Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Darryl D. D’Lima
- Shiley Center for Orthopaedic Research and Education, Scripps Health, LA Jolla, CA
| | - Young-Soo Shin
- Department of Orthopedic Surgery, Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Republic of Korea
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Sannasi R, Rajashekar A, Hegde NS. Association of patellofemoral pain syndrome (PFPS) with quadratus lumborum and lower limb muscle tightness a cross-sectional study. J Orthop 2023; 42:1-5. [PMID: 37416861 PMCID: PMC10319640 DOI: 10.1016/j.jor.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 06/09/2023] [Accepted: 06/17/2023] [Indexed: 07/08/2023] Open
Abstract
Background Patellofemoral pain syndrome (PFPS) is characterized by peripatellar or retro patellar pain, as a result of changes in the physical and biochemical components of the patellofemoral joint. The main contributory factor is being the excessive load on the patellofemoral joint. The change in the flexibility of lower limb muscles is one of the factors for developing PFPS. Objective To find the association of quadratus lumborum (QL) and lower limb muscles tightness in patients with unilateral PFPS. Materials and methods 50 PFPS participants (21 male and 29 female) were included and assessed for muscle tightness on both affected and unaffected side. The QL, rectus femoris, hamstring, iliotibial band (ITB) and gastrocnemius tightness were measured using inch tape and mobile inclinometer. A Chi Square test and phi crammer's v criteria were used to check the association and the strength of it. Results A significant association was found between tightness of rectus femoris (PFPS-right Chi 19.99 p < 0.001; Phi-0.632, PFPS-left Chi-5.52 p = 0.019 and Phi- 0.332), gastrocnemius (PFPS-right Chi 8.78 p = 0.003; Phi-0.419, PFPS-left Chi- 11.41 p = 0.001; Phi- 0.478), iliotibial band (PFPS-right Chi 7.83 p = 0.005; Phi-0.396, PFPS left Chi-3.68 p = 0.055; Phi- 0.27). There was no significant association of hamstring tightness (PFPS-right Chi - 3.68 p = 0.055; Phi-0.055, PFPS left Chi-1.11 p = 0.291; Phi- 0.019) and QL (PFPS right Chi - 1.10 p = 0.293; Phi-0.293, PFPS left Chi-0.79 p = 0.372; Phi- 0.372). Conclusion PFPS was associated with tightness of rectus femoris, gastrocnemius, ITB and no association found between hamstring and QL muscle tightness and PFPS.
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