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Sports Medicine and Arthroscopy Review Jun 2017Trochleoplasty is a very effective procedure for correcting trochlear dysplasia and addressing instability of the patella. With an increasing knowledge about the anatomy... (Review)
Review
Trochleoplasty is a very effective procedure for correcting trochlear dysplasia and addressing instability of the patella. With an increasing knowledge about the anatomy and biomechanics of the anterior distal femur, a wider array of surgical techniques may be applied to address specific conditions. Patients must be carefully selected to undergo trochleoplasty by use of a thorough history and physical examination as well as basic and advanced imaging. The presence of a "J sign" on physical examination, a history of recurrent instability, patella alta, trochlear dysplasia, and elevated tibial tubercle to trochlear groove are signs and symptoms for which the patient should be evaluated. We attempt to elucidate when trochleoplasty is indicated by means of addressing all aspects of evaluation.
Topics: Humans; Joint Instability; Knee Joint; Patella; Patellar Dislocation; Tibia
PubMed: 28459752
DOI: 10.1097/JSA.0000000000000150 -
The Orthopedic Clinics of North America Oct 2021Complications related to the extensor mechanism and patellofemoral joint continue to be the most common cause of pain and indication for surgical revision following... (Review)
Review
Complications related to the extensor mechanism and patellofemoral joint continue to be the most common cause of pain and indication for surgical revision following total knee arthroplasty. Numerous risk factors related to the patient, implant, and technical performance of the procedure have been identified. The Ortiguera and Berry classification system is widely used for the systematic classification and management of these fractures. Because of the difficult nature of revision surgery for fracture and the high risk of complication, a careful assessment of the fracture and implants is vital to determining the best course of treatment.
Topics: Arthroplasty, Replacement, Knee; Fracture Fixation, Internal; Humans; Open Fracture Reduction; Patella; Periprosthetic Fractures; Reoperation
PubMed: 34538347
DOI: 10.1016/j.ocl.2021.05.003 -
BMJ Case Reports Mar 2022Acute patella dislocations account for approximately 2%-3% of knee injuries and are therefore a relatively common presentation in the accident and emergency department....
Acute patella dislocations account for approximately 2%-3% of knee injuries and are therefore a relatively common presentation in the accident and emergency department. The majority of patella dislocations can be reduced with simple manoeuvres or even spontaneously and can be managed conservatively by bracing and rehabilitation. The aim of this study is to identify and review the main causes of the unique and unexpected event of irreducible patella dislocation and their characteristic presentations. Irreducible patella dislocations can happen but are very rare. Currently, a limited number of case reports are available, prompting for a need for research on this topic. This case study can shed light on the possible pathogenesis and pathognomonic features of irreducible patella dislocations and provide insight on the available therapeutic approaches.
Topics: Humans; Joint Dislocations; Knee Injuries; Patella; Patellar Dislocation
PubMed: 35264391
DOI: 10.1136/bcr-2021-248398 -
Seminars in Musculoskeletal Radiology Apr 2017We present an overview of imaging and intervention of the extensor mechanism of the knee. Particular focus is placed on the evaluation of patellofemoral tracking... (Review)
Review
We present an overview of imaging and intervention of the extensor mechanism of the knee. Particular focus is placed on the evaluation of patellofemoral tracking disorders, patellar and quadriceps tendinosis and tears, patellar fracture, lateral patellar condyle patellar friction syndrome, and prepatellar bursitis. Anatomical and biomechanical factors contributing to these disorders are considered. Imaging evaluation is presented in a clinical context, and therapeutic options for these disorders are discussed. Image-guided therapy options for symptomatic patellar tendinosis are also described and illustrated.
Topics: Biomechanical Phenomena; Diagnostic Imaging; Fractures, Bone; Humans; Joint Diseases; Ligaments, Articular; Patella; Patellofemoral Joint
PubMed: 28355673
DOI: 10.1055/s-0037-1599207 -
Current Opinion in Pediatrics Feb 2022The incidence of patellar instability in pediatric patients ranges is 50-100 in 100,000 patients per year. Risk of recurrent dislocations however has been cited from... (Review)
Review
PURPOSE OF REVIEW
The incidence of patellar instability in pediatric patients ranges is 50-100 in 100,000 patients per year. Risk of recurrent dislocations however has been cited from 8.6% to 88% depending on individual patient factors. This manuscript highlights the demographical, historical, and anatomic factors associated with recurrent patellar instability following a first-time patella dislocation in the pediatric population.
RECENT FINDINGS
In recent years, various studies have focused on identifying risk factors for recurrent patellar instability following a primary patellar dislocation. A mix of patient factors, including age of first dislocation, patella alta, elevated tibial tubercle to trochlear groove and trochlear dysplasia have all been noted in the literature, which have helped to develop various scoring tools to predict recurrent dislocation following nonoperative treatment.
SUMMARY
Risk of recurrent patellar instability in patients who have previously suffered a patellar dislocation can be due to many factors. These risk factors should be used and applied to a variety of risk scores in order to provide physicians and healthcare providers with a tool to counsel patients and families on their patellar redislocation risk and help guide further management.
Topics: Child; Humans; Joint Instability; Patella; Patellar Dislocation; Patellofemoral Joint; Tibia
PubMed: 34693936
DOI: 10.1097/MOP.0000000000001080 -
American Journal of Orthopedics (Belle... 2017We systematically reviewed patella alta with respect to type of measurements, reported cutoff values, cutoff values for surgical correction, and proposed surgical... (Review)
Review
We systematically reviewed patella alta with respect to type of measurements, reported cutoff values, cutoff values for surgical correction, and proposed surgical techniques. Using the term patella alta, we performed a systematic literature search on PubMed. Inclusion criteria were original study or review articles, publication in peer-reviewed English-language journals between 2000 and 2017, and narrative description or measurement of human patellar height on plain radiographs or magnetic resonance imaging (MRI). All evidence levels were included. Of 211 articles identified, 92 met the inclusion criteria for original study, and 28 for review. The 92 original study articles defined patella alta mostly with imaging-based measurements (81.5%) and more rarely by description only (18.5%). Eighteen types of measurement methods with 27 different cutoff values were used to assess patella alta; these methods included lateral radiographs, sagittal MRI, radiographic ratios measured on MRI, and patellar tendon length. The Insall-Salvati index (ISI) was used more than the Caton-Deschamps index (CDI); cutoff values for patella alta varied from >1.2 to >1.5 for ISI and from >1.2 to >1.3 for CDI. Both indices were seldom used on MRI; cutoff values were similar to those for conventional radiographs. On sagittal MRI, the patellotrochlear index was used most; cutoff values ranged from <0.125 to 0.28. Eleven studies used patellar tendon length and found it was increased (>52 mm to >56 mm). The 28 reviews described patella alta mostly with ISI (75%) or CDI (64%). However, 12 (57%) of the 21 review studies that used ISI and 7 (39%) of the 18 review studies that used CDI did not report cutoff values. Only 2 review studies suggested an ideal patellar height after surgery. Different procedures were used to treat patella alta: tibial tubercle distalization with and without patellar tendon tenodesis, tibial tubercle distalization and medialization, and distal advancement of the patellar tendon. Only 11 original studies proposed a critical patellar height as an indication for surgery; however, these studies mainly used CDI, and only 4 mentioned a desired postoperative patellar height after correction. Our review revealed many variations in patella alta definitions and descriptions, measurement methods, cutoff values, and treatment options. Presence of patella alta depends on the measurement method used. Unfortunately, there is no generally accepted consensus on patella alta. Given its influence on patellofemoral loading/stress and patellar stability, however, we must strive to establish a consensus in the near future.
Topics: Humans; Magnetic Resonance Imaging; Orthopedic Procedures; Patella; Patellar Ligament; Tibia
PubMed: 29309446
DOI: No ID Found -
Scientific Reports May 2022The relationship between the morphological characteristics of the infrapatellar fat pad (IFP) and joint deformity has yet to be fully elucidated. Therefore, the purpose...
The relationship between the morphological characteristics of the infrapatellar fat pad (IFP) and joint deformity has yet to be fully elucidated. Therefore, the purpose of this study was to clarify the morphological characteristics of the IFP and to identify the relationships between morphological characteristics of the IFP and degenerative grade of the articular surface of the patella. This investigation examined 41 legs from 25 Japanese cadavers. The IFP length, width, and volume were measured. It was categorized into three types: Type I, IFP proximal located on medial and lateral sides of the patella; Type II, the IFP proximal only located medially; and Type III, absence of the IFP proximal. Articular surfaces were graded as macroscopically intact or mildly altered (Grade I), moderately (Grade II), or severely (Grade III). Grade III was significantly more frequent than Grades I or II in Type III. IFP volume was significantly larger in Type I than in Types II or III. A negative correlation was found between the degenerative grade of the articular surface of the patella and IFP volume. It was suggested that a relationship between the degenerative grade of the articular surface of the patella and the IFP volume.
Topics: Adipose Tissue; Cadaver; Humans; Knee Joint; Patella
PubMed: 35624138
DOI: 10.1038/s41598-022-12859-1 -
Injury Mar 2020The aim of this article is to discuss the diagnosis, management and pitfalls of bony injuries around the skeletally immature knee. Each within their own right is a... (Review)
Review
The aim of this article is to discuss the diagnosis, management and pitfalls of bony injuries around the skeletally immature knee. Each within their own right is a relatively uncommon injury but associated with potential complications. Distal femoral physeal fractures can result in growth arrest and vascular injury. Tibial spine avulsions can result in an unstable knee. Tibial tubercle fractures can be associated with compartment syndrome and pose a risk to the extensor mechanism of the knee. Fixation can be complicated by growth arrest and subsequent recurvatum deformity. Finally, patella sleeve injuries are often missed and this can also threaten the extensor mechanism. We discuss the approach to clinical and radiological assessment of these injuries, and evidence based recommendations as to how they are best managed to avoid complications.
Topics: Adolescent; Child; Child, Preschool; Femoral Fractures; Fracture Fixation; Humans; Infant; Infant, Newborn; Knee Injuries; Knee Joint; Patella; Tibial Fractures
PubMed: 32067766
DOI: 10.1016/j.injury.2019.12.033 -
Knee Surgery, Sports Traumatology,... Aug 2020The aim of the present study was to evaluate the effect of patellofemoral joint morphology and patellar alignment (lateral patellar tilt and sagittal patellar tilt) on...
PURPOSE
The aim of the present study was to evaluate the effect of patellofemoral joint morphology and patellar alignment (lateral patellar tilt and sagittal patellar tilt) on the presence and stage of CP, and identify the differences between sexes.
METHODS
MRI of 243 patients [146 men (60.1%)] were evaluated retrospectively. Patients were grouped as normal group without chondromalacia, group with mild chondromalacia (grades 1-2) and group with severe chondromalacia (grades 3-4). Sagittal patellofemoral alignment was assessed by the angle between the patella and patellar tendon (P-PTA), and the angle between the quadriceps tendon and patella (Q-PA). Patellar tilt was assessed by lateral patellar tilt angle (LPTA). In addition, patellofemoral joint morphology was evaluated by measuring trochlear depth (TD), trochlear sulcus angle (TSA) and patella angle (PA).
RESULTS
P-PTA, Q-PA, LPTA and TD values were significantly lower in patients with severe chondromalacia than in patients with both normal and mild chondromalacia (P < 0.001). TSA values were significantly higher in patients with severe chondromalacia than those with both normal and mild chondromalacia (P < 0.001). TSA was higher and TD was lower in women compared to men (P < 0.001). LPTA and P-PTA were lower in women compared to men, and the difference was significant. There was no difference in PA between the two sexes.
CONCLUSIONS
Patellar cartilage degeneration increases with trochlear dysplasia. There is a strong correlation between patellar malalignment (lateral patellar tilt and sagittal patellar tilt) and chondromalacia patella. Women are more prone to developing CP than men.
Topics: Adult; Cartilage Diseases; Chondromalacia Patellae; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Patella; Patellar Ligament; Patellofemoral Joint; Quadriceps Muscle; Retrospective Studies; Sex Factors; Tendons
PubMed: 32451620
DOI: 10.1007/s00167-020-06065-7 -
Sao Paulo Medical Journal = Revista... 2022The relationships between the morphometric structure of the patellofemoral joint, patella type and chondromalacia patella are still a matter of debate.
BACKGROUND
The relationships between the morphometric structure of the patellofemoral joint, patella type and chondromalacia patella are still a matter of debate.
OBJECTIVE
To identify the prevalence of chondromalacia patella by determining the patella type and making patellofemoral morphometric measurements.
DESIGN AND SETTING
Retrospective cohort study in an orthopedics and traumatology clinic in Turkey, conducted between June 2017 and November 2019.
METHODS
This study involved 562 knees of 522 patients with anterior knee pain (246 males and 316 females; mean age 46.59 years). The patients were grouped according to presence of chondromalacia patella (group I) or absence of chondromalacia patella (group II). The patella type, lateral trochlear inclination, medial trochlear inclination, trochlear angle, sulcus angle, patellar tilt and Insall-Salvati index were assessed. Group comparisons were made using chi-square tests or Student t tests. The r value was used to determine the magnitude of relationships between pairs of variables.
RESULTS
Among the 562 knees evaluated, 265 (50.71%) presented type I patella, 195 (36.7%) type II, 100 (12.3%) type III and 2 (0.3%) type IV. Group I consisted of 448 knees and group II consisted of 114 knees. Significant differences were found between the groups in terms of age, gender, patella type and lateral inclination angles (P < 0.05).
CONCLUSION
Detecting the patella type and making lateral inclination measurements in patients with anterior knee pain are of great importance for diagnosing suspected chondromalacia patella, particularly in the early degenerative period.
Topics: Male; Female; Humans; Middle Aged; Patella; Retrospective Studies; Prevalence; Magnetic Resonance Imaging; Chondromalacia Patellae; Pain
PubMed: 36102448
DOI: 10.1590/1516-3180.2021.0206.R2.10012022