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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 -
Why and Where to Move the Tibial Tubercle: Indications and Techniques for Tibial Tubercle Osteotomy.Sports Medicine and Arthroscopy Review Dec 2019Patellofemoral disorders including pain and instability are common orthopedic problems, particularly in the adolescent population. Patellofemoral pain is usually... (Review)
Review
Patellofemoral disorders including pain and instability are common orthopedic problems, particularly in the adolescent population. Patellofemoral pain is usually anterior, poorly localized, and diffuse. Because of its multifactorial etiology, patellofemoral pain can be clinically challenging to diagnose and manage. With regards to instability, predisposing factors include trochlear dysplasia, patella alta, patellar tilt, and an elevated tibial tuberosity and trochlea groove distance. Initially, nonoperative management is recommended to treat patellofemoral maladies such as overload, maltracking, and acute first-time dislocations. However, tibial tubercle transfer (TTT) is commonly used to address cases of symptomatic malalignment and overload and recurrent patellar instability. The tubercle can be translated in multiplanar directions to correct patellar height, maltracking associated with instability, and to offload chondral defects. A thorough understanding of the anatomy and biomechanics of the patellofemoral joint is essential for optimizing results after TTT. Individualizing the direction and degree of tubercle transfer on the basis of patient parameters is critical to producing successful long-term results after surgery. This article will review the indications for performing a TTT and highlight the various techniques.
Topics: Humans; Joint Instability; Osteotomy; Patella; Patellar Dislocation; Patellofemoral Joint; Plastic Surgery Procedures; Tibia
PubMed: 31688534
DOI: 10.1097/JSA.0000000000000270 -
The Surgeon : Journal of the Royal... Aug 2022Evidence concerning the influence gender, age, and the time elapsed from the first dislocation to surgery in the outcomes of Medial Patella Femoral Ligament (MPFL)... (Review)
Review
BACKGROUND
Evidence concerning the influence gender, age, and the time elapsed from the first dislocation to surgery in the outcomes of Medial Patella Femoral Ligament (MPFL) reconstruction are lacking. This systematic review was conducted to investigate whether patient characteristics have an influence in the clinical outcomes of MPFL reconstruction for patients with patellofemoral instability.
MATERIAL AND METHODS
This study followed the PRISMA guidelines. The main databases were accessed in February 2021. All the studies reporting outcomes of primary MPFL reconstruction in patients with recurrent patellofemoral instability were considered for inclusion. A multivariate analysis diagnostic tool was used to analyse the association between age, gender and time from injury to surgery and the surgical outcomes at last follow-up.
RESULTS
A total of 50 articles (2037 procedures) were included. The mean follow-up was 40.90 ± 24.8 months. The mean age was 23.6 ± 3.9 years. 64.3% (1309 of 2037 patients) were female. The mean time from injury to surgery was 64.5 ± 48.9 months. Women showed no statistically significant association with the Kujala score or complications. Older patients had a reduced risk to incur re-dislocations (P = 0.01) and revisions (P = 0.01). Longer time from injury to surgery was associated with greater risk to incur re-dislocations (P = 0.01), and with lower Kujala score (P < 0.0001). No other statistically significant association was evidenced.
CONCLUSION
The time span from the first patellar dislocation to the surgical reconstruction was a negative prognostic factor, while sex had no influence on surgical outcomes. The role of patients age on surgical outcomes remains unclear.
Topics: Adult; Female; Humans; Joint Dislocations; Joint Instability; Ligaments, Articular; Male; Patellar Dislocation; Patellofemoral Joint; Prognosis; Young Adult
PubMed: 33962891
DOI: 10.1016/j.surge.2021.03.003 -
Archives of Orthopaedic and Trauma... Dec 2020Excessive femoral internal torsion is an important risk factor for patellar dislocation. The aim of the present study was to estimate the effect of derotational...
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.
Topics: Adolescent; Adult; Female; Femur; Humans; Joint Instability; Knee Joint; Male; Osteotomy; Patella; Patellar Dislocation; Patient Satisfaction; Retrospective Studies; Tibia; Torsion Abnormality; Young Adult
PubMed: 32948916
DOI: 10.1007/s00402-020-03598-x -
Clinics in Sports Medicine Jan 2022The lateral patellofemoral complex is an important stabilizer to medial and lateral displacement of the patella. Soft tissue abnormalities can range from pathologic... (Review)
Review
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.
Topics: Humans; Joint Instability; Ligaments, Articular; Patella; Patellar Dislocation; Patellofemoral Joint
PubMed: 34782073
DOI: 10.1016/j.csm.2021.07.007 -
Journal of Orthopaedic Surgery and... Oct 2021The aim of this study was to evaluate patellar morphological changes following surgical correction of recurrent patellar dislocation in children.
BACKGROUND
The aim of this study was to evaluate patellar morphological changes following surgical correction of recurrent patellar dislocation in children.
METHODS
A total of 35 immature children aged 5 to 10 years who suffered from bilateral recurrent patellar dislocation associated with abnormal patella morphology were enrolled in this study. The knees with the most frequent dislocations (treated with medial patellar retinacular plasty) were selected as the study group (SG), and those undergoing conservative treatment for the contralateral knee were selected as the control group (CG). Computed tomography (CT) scans were performed on all children preoperatively and at the last follow-up to evaluate morphological characteristics of the patella.
RESULTS
All the radiological parameters of the patella showed no significant difference between the two groups preoperatively. At the last follow-up for CT scans, no significant differences were found for the relative patellar width (SG, 54.61%; CG, 52.87%; P = 0.086) and the relative patellar thickness (SG, 26.07%; CG, 25.02%; P = 0.243). The radiological parameters including Wiberg angle (SG, 136.25°; CG, 122.65°; P < 0.001), modified Wiberg index (SG, 1.23; CG, 2.65; P < 0.001), and lateral patellar facet angle (SG, 23.35°; CG, 15.26°; P < 0.001) showed statistical differences between the two groups.
CONCLUSIONS
The patellar morphology can be improved by early surgical correction in children with recurrent patellar dislocation. Therefore, early intervention is of great importance for children diagnosed with recurrent patellar dislocation.
Topics: Child; Humans; Knee Joint; Patella; Patellar Dislocation; Radiography; Recurrence; Tomography, X-Ray Computed
PubMed: 34656140
DOI: 10.1186/s13018-021-02779-7 -
Knee Surgery, Sports Traumatology,... Jul 2022Patellar dislocation is associated with a range of anatomical abnormalities affecting the trochlea, extensor mechanism and the tibia. The relationship between...
PURPOSE
Patellar dislocation is associated with a range of anatomical abnormalities affecting the trochlea, extensor mechanism and the tibia. The relationship between patellofemoral instability and rotational abnormalities of the posterior condyles, trochlear groove and proximal tibia has not been adequately determined. This study aimed to identify the frequency and severity of anatomical risk factors to determine their relative contribution to patellofemoral instability.
METHODS
A retrospective morphological study was undertaken comparing multiple anatomical measurements with magnetic resonance imaging of 50 patients with patellofemoral instability to an age- and gender-matched Control group (n = 50). Several techniques were assessed measuring both femoral and tibial axial asymmetry. A new measurement, tibial rotational asymmetry, comparing a line between the midpoints of the collateral ligaments to the axis between the patellar tendon and posterior cruciate ligament, was assessed for its association with patellofemoral instability.
RESULTS
Compared to the controls, the patellofemoral instability group demonstrated a significant difference in tibial rotational asymmetry, with a mean of 2.9° (SD 3.2°) externally rotated vs - 1.6° (SD 2.2°) in the control group. Significant differences were also demonstrated regarding the sulcus angle, tibial tubercle-trochlear groove distance, tibial tubercle-posterior cruciate ligament distance, patellar size and the Insall-Salvati ratio. There were no differences between groups regarding the lengths of the posterior condyles, the heights of the trochlear ridges or lateralisation of the trochlear groove. Further analysis of the patellofemoral instability group revealed a subgroup of males with normal anatomy (7/50) and a subgroup of females with isolated patella alta (7/50).
CONCLUSION
Patellofemoral instability is associated with tibial rotational asymmetry due to lateralisation of the tibial tubercle. It is also associated with patella alta and reduced trochlear groove depth. The femoral axial shape is otherwise unchanged.
LEVEL OF EVIDENCE
III.
Topics: Female; Humans; Joint Instability; Magnetic Resonance Imaging; Male; Patella; Patellar Dislocation; Patellofemoral Joint; Recurrence; Retrospective Studies; Tibia
PubMed: 34850247
DOI: 10.1007/s00167-021-06813-3 -
Arthroscopy : the Journal of... Dec 2020Trochlear dysplasia may be asymptomatic and benign, or could engender patellar instability and degenerative arthritis. Autologous chondrocyte implantation is...
Trochlear dysplasia may be asymptomatic and benign, or could engender patellar instability and degenerative arthritis. Autologous chondrocyte implantation is demonstrating promising outcomes for the treatment of patellofemoral cartilage lesions, but may not suffice for knees with underlying mechanical anomalies as trochlear dysplasia, where adjuvant trochleoplasty or tibial tubercle osteotomy may be required to prevent patellofemoral instability and to protect the graft from wear and damage. Rigorous radiographic assessment is important to discern the type of dysplasia, notably the presence of a potentially pathogenic supra-trochlear spur. Trochleoplasty or other realignment procedures such as tibial tubercle osteotomy should be considered where necessary to correct underlying trochlear deformities and thereby avoid iatrogenic complications or failure.
Topics: Chondrocytes; Femur; Humans; Joint Instability; Patellar Dislocation; Prognosis
PubMed: 33276890
DOI: 10.1016/j.arthro.2020.09.011 -
BMC Musculoskeletal Disorders May 2021Few studies have reported the clinical outcomes of the medial reefing procedure and lateral release with arthroscopic control of medial retinacular tension in patients...
BACKGROUND
Few studies have reported the clinical outcomes of the medial reefing procedure and lateral release with arthroscopic control of medial retinacular tension in patients with recurrent patellar dislocation. The purpose of this study was to investigate the clinical, radiologic outcomes and complications of arthroscopy-controlled medial reefing and lateral release.
METHODS
Patients who underwent arthroscopy-controlled medial reefing and lateral release for recurrent patellar dislocation between November 2007 and June 2017 were retrospectively evaluated. The clinical outcome (Kujala score), radiologic outcome (congruence and patellar tilt angles), and complications were evaluated at final follow-up. The results were also compared with literature-reported outcomes of other surgical procedures for patellar dislocation.
RESULTS
Twenty-five patients (mean age, 18.3 ± 4.8 years) were included in the study. The mean clinical follow-up period was 7.0 ± 2.5 (range, 3.8-12.2) years. The mean Kujala score was significantly improved from 54.7 ± 14.0 (range, 37-86) preoperatively to 91.0 ± 7.6 (range, 63-99) at a mean follow-up period of 7 years (P < 0.001). The radiologic results also significantly improved from 17.8° ± 5.9° to 6.8° ± 2.4° (P < 0.001) in the congruence angle and from 17.5° ± 8.2° to 5.6° ± 3.1° (P < 0.001) in the patella tilt angle at a mean follow-up period of 3.6 years. One patient developed a redislocation after a traumatic event, and two patients showed patellofemoral osteoarthritis progression.
CONCLUSIONS
Arthroscopy-controlled medial reefing and lateral release significantly improved the clinical and radiologic outcomes of the patients with recurrent patellar dislocation at a mean follow-up period of 7 years. The results of this study are comparable with the literature-reported outcomes of other surgical procedures for patellar dislocation.
LEVEL OF EVIDENCE
Level IV, retrospective therapeutic case series.
Topics: Adolescent; Adult; Arthroscopy; Humans; Osteoarthritis, Knee; Patella; Patellar Dislocation; Retrospective Studies; Young Adult
PubMed: 33971864
DOI: 10.1186/s12891-021-04300-x -
Knee Surgery, Sports Traumatology,... May 2023To assess the imaging modalities used for diagnosis, as well as the management decisions of patients with osteochondral fractures (OCF) and loose bodies following... (Review)
Review
MRI as the optimal imaging modality for assessment and management of osteochondral fractures and loose bodies following traumatic patellar dislocation: a systematic review.
PURPOSE
To assess the imaging modalities used for diagnosis, as well as the management decisions of patients with osteochondral fractures (OCF) and loose bodies following traumatic patellar dislocation.
METHODS
According to the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA), MEDLINE, EMBASE, Web of Science, and PubMed were searched for results from January 1, 2000, to May 18, 2021, in two subsequent searches for English language studies that presented data on traumatic patellar dislocation. Quality of selected papers was assessed using the Methodological Index for Non-Randomised Studies (MINORS) and the Risk of Bias (RoB) 2.0 protocol. Results were qualitatively synthesised, and descriptive statistics were calculated.
RESULTS
Forty studies totalling 3074 patients (1407 females) were included for the analysis. The mean age was 18.9 years (range 0-69). The population included 2446 first-time dislocations. The imaging modalities used were: 71.1% MRI, 52.6% plain radiography, 12.1% CT, and 0.68% ultrasound. In the 25 studies that reported the number of OCF, a total of 38.3% of patients were found to have OCF. 43.3% of patients with a first-time dislocation, and 34.7% of patients with previous dislocations, had at least one OCF. In the included paediatric studies (maximum age ≤ 18), the presence of OCF was detected by plain radiography in 10.1% of patients, MRI in 76.6% of patients, and CT in 89.5% of patients. For management of an OCF, the surgical options include fixation for larger pieces, excision for smaller pieces, and conservative management on a case-by-case basis.
CONCLUSIONS
Based on the current available evidence, assessment and management of patellar dislocations and subsequent OCFs vary, with radiography and MRI as the main imaging modalities on presentation and particular benefit for MRI in the paediatric population. Findings from this study suggest the highest rate of OCF detection with MRI, and thus, surgeons should consider routinely ordering an MRI in patients with first-time patellar dislocation. Regarding management of OCFs, the main indication for fixation was large fragments, while smaller and poor-quality fragments are excised. Few studies choose conservative management of OCFs due to later requirements for surgical management. Future work should focus on large, high-quality studies, and implementation of randomised control trials to form guidelines for imaging patellar dislocations and management of OCFs.
LEVEL OF EVIDENCE
Level IV.
Topics: Female; Humans; Child; Infant, Newborn; Infant; Child, Preschool; Adolescent; Young Adult; Adult; Middle Aged; Aged; Patellar Dislocation; Joint Dislocations; Magnetic Resonance Imaging; Femoral Fractures; Radiography; Intra-Articular Fractures
PubMed: 35796753
DOI: 10.1007/s00167-022-07043-x