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Sportverletzung Sportschaden : Organ... Dec 2021Anterior knee pain is a frequent symptom in young athletes. Symptomatic patellofemoral cartilage defects can occur after trauma, especially after patellar dislocation.... (Review)
Review
Anterior knee pain is a frequent symptom in young athletes. Symptomatic patellofemoral cartilage defects can occur after trauma, especially after patellar dislocation. Numerous cartilage repair methods are currently available. Due to co-pathologies, the outcome after patellofemoral cartilage repair is inferior to the treatment of cartilage defects of the tibiofemoral joint. Adequate addressing of coexisting pathologies is essential for treatment success. This review provides an overview of the different techniques of patellofemoral cartilage repair.
Topics: Cartilage; Cartilage, Articular; Humans; Knee Joint; Magnetic Resonance Imaging; Patellar Dislocation; Patellofemoral Joint; Treatment Outcome
PubMed: 34474494
DOI: 10.1055/a-1491-2622 -
The Bone & Joint Journal Jan 2020Trochlear dysplasia is a significant risk factor for patellofemoral instability. The Dejour classification is currently considered the standard for classifying trochlear... (Comparative Study)
Comparative Study
AIMS
Trochlear dysplasia is a significant risk factor for patellofemoral instability. The Dejour classification is currently considered the standard for classifying trochlear dysplasia, but numerous studies have reported poor reliability on both plain radiography and MRI. The severity of trochlear dysplasia is important to establish in order to guide surgical management. We have developed an MRI-specific classification system to assess the severity of trochlear dysplasia, the Oswestry-Bristol Classification (OBC). This is a four-part classification system comprising normal, mild, moderate, and severe to represent a normal, shallow, flat, and convex trochlear, respectively. The purpose of this study was to assess the inter- and intraobserver reliability of the OBC and compare it with that of the Dejour classification.
METHODS
Four observers (two senior and two junior orthopaedic surgeons) independently assessed 32 CT and axial MRI scans for trochlear dysplasia and classified each according to the OBC and the Dejour classification systems. Assessments were repeated following a four-week interval. The inter- and intraobserver agreement was determined by using Fleiss' generalization of Cohen's kappa statistic and S-statistic nominal and linear weights.
RESULTS
The OBC showed fair-to-good interobserver agreement and good-to-excellent intraobserver agreement (mean kappa 0.68). The Dejour classification showed poor interobserver agreement and fair-to-good intraobserver agreement (mean kappa 0.52).
CONCLUSION
The OBC can be used to assess the severity of trochlear dysplasia. It can be applied in clinical practice to simplify and standardize surgical decision-making in patients with recurrent patella instability. Cite this article: 2020;102-B(1):102-107.
Topics: Adolescent; Adult; Child; Female; Humans; Injury Severity Score; Joint Instability; Male; Middle Aged; Observer Variation; Patellar Dislocation; Patellofemoral Joint; Recurrence; Retrospective Studies; Young Adult
PubMed: 31888364
DOI: 10.1302/0301-620X.102B1.BJJ-2019-0366.R3 -
Injury Oct 2023Acute patellar dislocation is a common knee injury in adolescents and adults that is associated with a high incidence of medial patellofemoral ligament (MPFL) injuries.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Acute patellar dislocation is a common knee injury in adolescents and adults that is associated with a high incidence of medial patellofemoral ligament (MPFL) injuries. The aim of this network meta-analysis was to compare the different operative and non-operative protocols for the management of primary patellar dislocation (PPD).
METHODS
We searched Medline, Embase, and CENTRAL databases. We included randomized controlled trials (RCTs) that compared operative and non-operative protocols for adolescent or adult patients with acute traumatic PPD. We sought to evaluate the clinical and functional outcomes of each management protocol by considering the results of Kujala score, Tegner activity score, redislocation rate, and subluxation rate. The effectiveness of the different management protocols was measured through frequentist network meta-analysis, using the Netmeta statistical package in R software. All treatment protocols were ranked using the netrank function, yielding P scores.
RESULTS
A total of 10 RCTs were deemed eligible. As per P-scores, open MPFL repair yielded the highest effectiveness with respect to Kujala score (P=0.81) and lowest odds for redislocation (P=0.14) whereas arthroscopic MPFL repair yielded the highest effectiveness with respect to Tegner activity score (P=0.85) and lowest odds for subluxation (P=0.21). Arthroscopic MPFL repair showed a significant reduction in redislocation and subluxation rate.
CONCLUSION
This network meta-analysis demonstrated arthroscopic MPFL repair is the most effective treatment protocol for the management of acute primary patellar dislocation.
Topics: Adult; Adolescent; Humans; Patellar Dislocation; Patellofemoral Joint; Network Meta-Analysis; Knee Joint; Patella; Joint Dislocations; Ligaments, Articular; Joint Instability
PubMed: 37473507
DOI: 10.1016/j.injury.2023.110926 -
The Orthopedic Clinics of North America Oct 2020Patellar instability and associated patellar dislocation can result in significant pain, disability, and associated injuries in young athletes. The patellofemoral joint... (Review)
Review
Patellar instability and associated patellar dislocation can result in significant pain, disability, and associated injuries in young athletes. The patellofemoral joint is a complex articulation with stabilizing restraints, both medially and laterally, that help guide the patella into the corresponding trochlear groove as the knee cycles through an extension-to-flexion arc. In addition to soft tissue injuries, many osseous aberrancies can contribute to patellar instability in young athletes, including trochlear dysplasia, patella alta, and axial and coronal plane abnormalities. There is a role for nonoperative treatment in these young athletes; however, if recurrent or associated injuries are identified surgical intervention is warranted. Correct diagnosis of the underlying cause of the patellar instability is paramount to developing a surgical plan that will yield the most favorable outcome for these young athletes.
Topics: Adolescent; Child; Humans; Joint Instability; Orthopedic Procedures; Patellar Dislocation
PubMed: 32950217
DOI: 10.1016/j.ocl.2020.06.005 -
RoFo : Fortschritte Auf Dem Gebiete Der... Sep 2021Throughout the literature, patellofemoral instability (PI) is defined as an increased risk of re-/luxation of the patella within the patellofemoral joint (PFJ). In... (Review)
Review
BACKGROUND
Throughout the literature, patellofemoral instability (PI) is defined as an increased risk of re-/luxation of the patella within the patellofemoral joint (PFJ). In most patients it is caused by traumatic patella luxation or the existence of a range of predisposing anatomic risk factors leading to an unphysiological movement sequence within the PFJ also known as patellofemoral maltracking. In order to provide an individualized therapy approach, clinical and radiological evaluation of those risk factors of variable magnitude becomes essential. Diagnostic imaging such as magnetic resonance imaging (MRI), plain radiography, and computed tomography (CT) are straightforward diagnostic tools in terms of evaluation and treatment of PI.
METHOD
In this review we performed a precise analysis of today's literature concerning the radiological evaluation of anatomic risk factors leading to PI. The purpose of the review is to present a logical compilation of the different anatomical risk factors causing PI and provide a straight overview of valuable radiological imaging techniques.
RESULTS AND CONCLUSION
PI is frequently based on a multifactorial disposition. The most relevant predisposing risk factors are trochlea dysplasia, rupture of the medial patellofemoral ligament (MPFL), patella alta, abnormal tibial tubercle to trochlea groove distance (TT-TG), femoral torsion deformities, and genu valgum. Although plain X-rays may provide basic diagnostic value, cross-sectional imaging (MRI, CT) is the standard radiological tool in terms of evaluation and detection of severity of predisposing anatomic variants leading to PI.
KEY POINTS
· Based on today's literature, PI is characterized as an increased risk of patella re-/luxation within the PFJ.. · Underlying anatomic risk factors of variable magnitude mark the pathological cause of PI.. · Modern diagnostic imaging (MRI and CT) permits straightforward diagnosis of the typical features in terms of PI.. · To provide an individualized therapy approach, precise radiological evaluation and determination of the severity of predisposing anatomic anomalies are essential..
CITATION FORMAT
· Maas KJ, Warncke ML, Leiderer M et al. Diagnostic Imaging of Patellofemoral Instability. Fortschr Röntgenstr 2021; 193: 1019 - 1033.
Topics: Humans; Ligaments, Articular; Magnetic Resonance Imaging; Patella; Patellar Dislocation; Patellofemoral Joint; Tibia
PubMed: 33773517
DOI: 10.1055/a-1348-2122 -
Der Unfallchirurg Dec 2020The causes of patellofemoral instability (PFI) are complex. In accordance with the current literature a classification was developed which clearly weights all entities...
The causes of patellofemoral instability (PFI) are complex. In accordance with the current literature a classification was developed which clearly weights all entities and derives diagnostic and therapeutic consequences. It considers patellar instability and patellar maltracking or the complete loss of patellar tracking and differentiates into 5 types. Type 1: patellar dislocation without maltracking or instability with a low risk of redislocation. Type 2: high risk of redislocation, no maltracking. Type 3: instability and maltracking; reasons for maltracking are a) soft tissue contracture, b) patella alta, c) pathological tibial tuberosity trochlear groove (TTTG) distance, c) valgus deformities and e) torsional deformities. Type 4: massively unstable floating patella, which is based on a high-grade trochlear dysplasia. Type 5: maltracking without instability.
Topics: Humans; Joint Instability; Osteotomy; Patella; Patellar Dislocation; Patellofemoral Joint; Tibia
PubMed: 33201266
DOI: 10.1007/s00113-020-00912-5 -
Orthopaedics & Traumatology, Surgery &... Feb 2022Trochlear dysplasia consists in deficient trochlear concavity, giving rise to a flat or convex trochlea, and is the main risk factor for patellar dislocation. Surgical... (Review)
Review
Trochlear dysplasia consists in deficient trochlear concavity, giving rise to a flat or convex trochlea, and is the main risk factor for patellar dislocation. Surgical indications depend on familiarity with trochlear dysplasias, and especially those of high grade, identified on clinical examination and standard and cross-sectional imaging, and on quantification of associated instability factors. Treatment strategy is accordingly determined "à la carte" to correct these factors one by one. Sulcus deepening trochleoplasty corrects the morphology and is the appropriate etiological treatment. It gives good results in terms of recurrence of dislocation, but tends to cause knee stiffness and patellofemoral osteoarthritis. Indications are based on objective patellar instability associated to high-grade B or D dysplasia. Medial patellofemoral ligament reconstruction should be systematically associated. The lateral retinaculum is systematically sectioned, as patellar tilt is never reducible in such high-grade dysplasia. Trochleoplasty corrects the sulcus defect, resolves protrusion and enables proximal realignment. The main complications are stiffness and pain due to persistence or onset of cartilage lesions. Trochleoplasty is indicated: 1) in first line for objective patellar instability associated with high-grade dysplasia; or 2) for recurrence in high-grade dysplasia previously managed by other surgery. The aim of the present study was to review the literature on trochleoplasty and address the following questions: how to define high-grade dysplasia? What are the key clinical and radiologic points? What are the risk factors for patellar dislocation? What trochleoplasty techniques are available? What results can be expected? Level of evidence: V; expert opinion.
Topics: Femur; Humans; Joint Instability; Ligaments, Articular; Patellar Dislocation; Patellofemoral Joint
PubMed: 34863959
DOI: 10.1016/j.otsr.2021.103160 -
Arthroscopy : the Journal of... Nov 2019The medial patellofemoral ligament is the primary static restraint to lateral patellar translation. It is injured in 96% to 100% of patellar dislocations that affect... (Review)
Review
The medial patellofemoral ligament is the primary static restraint to lateral patellar translation. It is injured in 96% to 100% of patellar dislocations that affect approximately 6 to 29 of 100,000 patients and is more common in patients younger than 20 years of age. Risk factors for patellar dislocation include patella alta, trochlear dysplasia, genu valgus, increased Q angle, and hyperlaxity. The treatment for patellar instability depends on the clinical and radiographic findings and can be nonoperative for first-time dislocations (bracing, proximal strengthening, and progressive return to sport) or operative for recurrent dislocations. It is critical for medial patellofemoral ligament reconstruction to reproduce the anatomy and isometry of the native ligament. Graft choice and methods of fixation are less critical to achieve successful outcomes. Studies have reported successful outcomes and improved Kujala scores, with recurrent instability ranging from 1% to 5%. Careful surgical technique can avoid complications, including fracture, graft failure, loss of range of motion, persistent anterior knee pain, medial instability, and recurrent instability. The role of the medial quadriceps tendon femoral ligament also should be considered more in future research.
Topics: Humans; Ligaments, Articular; Patellar Dislocation; Patellofemoral Joint; Range of Motion, Articular; Plastic Surgery Procedures; Tendons
PubMed: 31699243
DOI: 10.1016/j.arthro.2019.09.008 -
The Knee Dec 2019Little guidance exists on the management of the first-time patellar dislocation. The aim of this article was to review current guidance for management of this condition. (Review)
Review
BACKGROUND
Little guidance exists on the management of the first-time patellar dislocation. The aim of this article was to review current guidance for management of this condition.
METHODS
Recent meta-analyses, systematic reviews and current consensus documents relating to first-time patellar dislocation were sourced. An instructional lecture was then created and delivered at the acute knee injuries session at the British Orthopaedic Association 2019 annual conference, which was presented on behalf of the British Association for Surgery of the Knee. This article has been written based on this lecture.
RESULTS
There is a paucity of literature relating to management of the first-time patellar dislocation. Many studies are of poor design, with inadequate follow-up, making it difficult to draw conclusions from them. However, based upon available information and consensus from working groups it is recommended that patients presenting with first-time dislocation should be assessed to ensure they have not sustained an alternative or associated injury that may require surgical intervention, be assessed and counselled for the risk of recurrent dislocation, and be referred for initial conservative treatment. Surgical stabilisation should be reserved for patients with recurrent instability.
CONCLUSIONS
Most patients with a first-time patellar dislocation can be managed conservatively, having excluded associated injuries. Due to the poor quality of the literature, care must be taken interpreting the results of studies. It is clear that further research is required in this field.
Topics: Consensus; Conservative Treatment; Female; Humans; Joint Instability; Male; Orthopedics; Patellar Dislocation; Recurrence
PubMed: 31727430
DOI: 10.1016/j.knee.2019.10.015 -
Instructional Course Lectures 2020Patellar instability is a common problem seen by the orthopedic surgeon. Surgery is indicated in recurrent dislocation to improve patellar tracking and ligamentous...
Patellar instability is a common problem seen by the orthopedic surgeon. Surgery is indicated in recurrent dislocation to improve patellar tracking and ligamentous restraint in order to decrease risk of recurrence, osteochondral injury, and eventual progression to arthritis. Preoperative imaging studies identify anatomic risk factors that increase risk of patellar dislocation to inform surgical decision making. Surgical management starts with medial patellofemoral ligament reconstruction, which is effective in many cases. Tibial tubercle osteotomy realigns the extensor mechanism and is useful in cases of lateralized tibial tubercle or patella alta. For patients with trochlear dysplasia, both tibial tubercle osteotomy and trochleoplasty are options to prevent recurrent dislocation. Chondral lesions are common and, depending upon symptomology and size, can be addressed with débridement, structural grafting, or cell-based treatment. To maximize outcomes, comprehensive preoperative diagnosis and planning must be combined with meticulous surgical technique. Unfortunately, there is minimal evidence to guide when a soft-tissue ligament reconstruction is sufficient versus when is it necessary to correct and alter the bony anatomy. This chapter covers the individualized decision making and surgical pearls for these techniques to improve outcomes and minimize perioperative complications.
Topics: Humans; Joint Instability; Knee Joint; Ligaments, Articular; Patellar Dislocation; Patellofemoral Joint; Tibia
PubMed: 32017760
DOI: No ID Found