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Veterinary and Comparative Orthopaedics... May 2022
Topics: Animals; Dog Diseases; Dogs; Patellar Dislocation; Posture; Stifle
PubMed: 35760073
DOI: 10.1055/s-0042-1749082 -
Archives of Orthopaedic and Trauma... Jun 2023A 'inwardly pointing knee' syndrome is a combined torsional deformity with increased femoral internal and tibial external torsion. After clinical and radiological...
INTRODUCTION
A 'inwardly pointing knee' syndrome is a combined torsional deformity with increased femoral internal and tibial external torsion. After clinical and radiological verification of the torsional deformity and unsuccessful conservative therapy approach, a combined (double level) torsional osteotomy of femur and tibia might be the appropriate treatment. Here, we present the diagnostic algorithms, treatment, and outcome of combined torsional osteotomies of femur and tibia. The aim of the study is to show that patients treated with the procedure achieve patellofemoral stability and pain relief or reduction.
MATERIAL AND METHODS
Twenty torsional osteotomies performed on 18 patients were included. Nine patients had experienced patellar dislocation in 11 joints before. All patients were suffering from anterior knee pain. All patients underwent a clinical and radiographical evaluation, including a torsion angle CT scan. Pre- and post-operatively multiple commonly approved scores (Lysholm Score, Tegner Activity score, Kujala Score, VAS and Japanese Knee Society score) were acquired.
RESULTS
In 18 patients we performed 20 double-level torsional osteotomies. 9 patients suffered from patellar dislocations in 11 knee joints prior to surgery. All patients were suffering from anterior knee pain. Of these 7 patients achieved a stable joint after surgery without further patellar dislocations. All achieved more knee stability and experienced less patellar luxation then before surgery. The mean duration of follow-up was 59 months (range 9-173 months). The mean VAS was significantly reduced by 3.75 points (SD 2.09, p value 0.0002) from 5.50 points (SD 2.73, range 0-9) before surgery to 1.75 points (SD 1.67, range 0-5) after surgery. The Lysholm score increased significantly by mean of 27.6 (SD 17.55, p value 0.0001) from mean 62.45 (SD 22.71, range 22-100) before surgery to mean 90.05 (SD 10.18, range 66-100) after surgery. The Kujala Score did improve significantly in average by 25.20 points (SD 13.61, p value 0.00012) from mean 62.9 (SD 16.24, range 35-95) to mean 93.2 (SD 9.20, range 66-100). The Tegner activity score did increase significantly by 1.2 points (SD 1.47, p value 0.004) in average from mean 2.65 (SD 1.11, range 1-5) to mean 3.85 (SD 1.42, range 1-6). The Japanese knee score did increase significantly by 19.15 in average (SD 11.95, p value 0.0001) from mean 74.05 (SD 14.63, range 33-95) to mean 93.05 (SD 10.18, range 68-100).
CONCLUSION
This is the first publication reporting about simultaneous double-level torsional osteotomies in a comparatively high number of patients. In addition, this is the first publication assessing the patient collective afterwards with objectifying clinical outcome scores. The results show that double-level torsional osteotomy is an effective treatment for patients with patellar dislocation or subluxation associated to torsional deformities of femur and tibia. Furthermore, we introduce a diagnostic algorithm for 'inwardly pointing knee' syndrome.
LEVEL OF EVIDENCE
Level IV.
Topics: Humans; Patellar Dislocation; Knee Joint; Tibia; Treatment Outcome; Osteotomy; Torsion Abnormality; Syndrome; Patellofemoral Joint
PubMed: 35551448
DOI: 10.1007/s00402-022-04446-w -
Orthopaedic Journal of Sports Medicine Aug 2023Increased femoral anteversion (FA) is reportedly associated with patellar dislocation (PD) and trochlear dysplasia (TD), and the increase in FA may occur at different...
BACKGROUND
Increased femoral anteversion (FA) is reportedly associated with patellar dislocation (PD) and trochlear dysplasia (TD), and the increase in FA may occur at different segments of the femur. In addition, TD is associated with dysplasia of the posterior femoral condyle. Among patients with PD, whether FA is greater with or without TD remains unclear.
PURPOSE
To explore differences in FA and torsion distribution at different femoral sections among patients with PD and TD, patients with PD and no TD, and sex- and age-matched controls and to investigate the association between FA and distal femoral morphology.
STUDY DESIGN
Cross-sectional study; Level of evidence, 3.
METHODS
This study involved 132 knees: 44 knees with PD and TD, 44 knees with PD but no TD, and 44 control knees. FA, proximal torsion (PT), middle torsion (MT), distal torsion (DT), and distal femoral morphology were measured. Differences were investigated by 1-way analysis of variance. Pearson correlation analysis was conducted to explore the association between FA and each parameter.
RESULTS
FA was significantly larger in the PD with TD group (25.4° ± 4.7°) than in the other groups (controls: 18.9° ± 5.6°; PD without TD: 19.9° ± 4.8°) ( < .01). DT was significantly larger in the PD with TD group (15.8° ± 2.9°) than in the other groups (controls: 9.0° ± 4.3°; PD without TD: 8.8° ± 3.9°) ( < .01). In all 3 groups, FA was strongly positively correlated with DT (control, PD without TD, and PD with TD, respectively: = 0.76, 0.80, and 0.88; < .01), strongly positively correlated with the posteromedial condylar length ( = 0.48, 0.48, and 0.70; < .01) and negatively correlated with the posterolateral condylar length ( = -0.30, -0.35, and -0.78, respectively; < .05).
CONCLUSION
The increased FA in knees with TD was due mainly to DT rather than PT or MT, which may provide a reference for choosing the optimal position for femoral derotation osteotomy.
PubMed: 37576457
DOI: 10.1177/23259671231181937 -
Arthroscopy Techniques Mar 2021Although patellar dislocation is a knee disorder prevalent in adolescence and young adults, the evaluation and treatment of patients are complex and even enigmatic. Much...
Although patellar dislocation is a knee disorder prevalent in adolescence and young adults, the evaluation and treatment of patients are complex and even enigmatic. Much of the literature fails to provide a detailed description of patient management. The purpose of this study is to introduce a method for the evaluation and treatment of patellar dislocation. This Technical Note will help guide clinicians in the clinical evaluation of patients and formulation of treatment plans.
PubMed: 33738207
DOI: 10.1016/j.eats.2020.10.064 -
Journal of Clinical Orthopaedics and... Feb 2022Treatment of congenital and habitual dislocation of the patella in syndromic adolescents can be difficult due to accompanying soft-tissue and/or osseous abnormalities...
BACKGROUND
Treatment of congenital and habitual dislocation of the patella in syndromic adolescents can be difficult due to accompanying soft-tissue and/or osseous abnormalities often present in the knee. The aim of this study was to report the results of surgical treatment of congenital and habitual patellar dislocation with medial patellofemoral ligament (MPFL) reconstruction and tibial tubercle osteotomy (TTO) in adolescents with an underlying syndrome.
METHODS
Syndromic adolescent patients with congenital or habitual patellar dislocation treated with MPFL reconstruction and TTO between 2005 and 2019 with a minimum of one year of follow-up were identified. Demographic, clinical, radiographic, and surgical data were recorded, and any complications were noted. Kujala and Lysholm scores were used to quantitate knee function.
RESULTS
Seventeen knees in 11 patients met the criteria for inclusion. The mean age at operation was 14.8 years (range, 13.3-18.3 years). Patients were identified as having Ehlers-Danlos (four), Down (two), trichorhinophalangeal (one), McCune-Albright (one), Klippel-Feil (one), and generalized joint hypermobility (two) syndromes. The mean follow-up was 2.2 years for each individual knee (range, 1-5.9 years). The mean Kujala score increased from 56 ± 10 preoperatively to 86 ± 6 at the most recent postoperative visit (p < 0.001). The mean Lysholm score increased from 53 ± 10 preoperatively to 85 ± 7 at the most recent postoperative visit (p < 0.001). Knee flexion increased significantly from 117° ± 15° preoperatively to 154° ± 13° postoperatively (p < 0.001). However, knee extension was no different pre- and postoperatively (4° ± 8° vs. 1° ± 4°, respectively, p = 0.2).
CONCLUSIONS
Congenital and habitual patellar dislocation in adolescent-aged patients with an underlying syndromic diagnosis can be successfully treated with MPFL reconstruction combined with TTO.
PubMed: 35127438
DOI: 10.1016/j.jcot.2022.101770 -
Frontiers in Surgery 2022Patellar instability is a common multifactorial disease in orthopedics, which seriously affects the quality of life. Because of the unified pathogeny, diagnosis and...
BACKGROUND
Patellar instability is a common multifactorial disease in orthopedics, which seriously affects the quality of life. Because of the unified pathogeny, diagnosis and treatment, patellar instability has gradually attracted the interest of more scholars these years, resulting in an explosive growth in the research output. This study aims to summarize the knowledge structure and development trend in the field from the perspective of bibliometrics.
METHODS
The data of articles and reviews on patellar instability was extracted from the Web of Science database. The Microsoft Excel, R-bibliometrix, CiteSpace, VOSviewer, Pajek software are comprehensively used to scientifically analyze the data quantitatively and qualitatively.
RESULTS
Totally, 2,155 papers were identified, mainly from North America, Western Europe and East Asia. Until December 31, 2021, the United States has contributed the most articles (1,828) and the highest total citations (17,931). Hospital for Special Surgery and professor Andrew A Amis are the most prolific institutions and the most influential authors respectively. Through the analysis of citations and keywords based on a large number of literatures, "medial patellofemoral ligament construction", "tibial tubercle-trochlear groove (TT-TG) distance", "epidemiological prevalence", "multifactor analysis of etiology, clinical outcome and radiographic landmarks " were identified to be the most promising research directions.
CONCLUSIONS
This is the first bibliometric study to comprehensively summarize the research trend and development of patellar instability. The result of our research provides the updated perspective for scholars to understand the key information in this field, and promote future research to a great extent.
PubMed: 35651685
DOI: 10.3389/fsurg.2022.870781 -
Orthopaedic Journal of Sports Medicine Jul 2022Osteochondral fractures (OCFs) are common injuries during acute patellar dislocation (APD), carrying a high risk of early joint deterioration if left untreated. The...
BACKGROUND
Osteochondral fractures (OCFs) are common injuries during acute patellar dislocation (APD), carrying a high risk of early joint deterioration if left untreated. The recommended approach is reduction and stable fixation; however, data on the results of such treatment are limited.
PURPOSE
To evaluate midterm results of fixation of APD-related OCFs in adolescents and to identify predictive factors for poor outcomes.
STUDY DESIGN
Case series; Level of evidence, 4.
METHODS
This was a retrospective analysis of adolescent patients who underwent internal fixation of APD-related OCFs between 2004 and 2015 at a single tertiary pediatric trauma center. The primary outcome variables included Knee injury and Osteoarthritis Outcome Score (KOOS), patient satisfaction (0-10 scale), and sports participation compared with preoperative level. Secondary outcome variables included relationship between final results and OCF location (patellofemoral vs tibiofemoral), surgical delay (>6 weeks), and patellar instability after OCF fixation. OCF healing was evaluated using magnetic resonance imaging (MRI).
RESULTS
Included were 40 patients (19 female, 21 male) with 42 OCFs (29 patellar OCFs, 13 lateral femoral condyle OCFs). The median patient age at surgery was 14.5 years (interquartile range [IQR], 13-15.5 years), and median follow-up was 76 months (IQR, 52.5-95 months). Recurrence of patellar instability occurred in 27.5% of patients. Median overall KOOS was 93.8 (IQR, 90.8-97.6); KOOS-Symptoms, 92.9 (IQR, 85.7-96.4); KOOS-Pain, 97.2 (IQR, 91.7-100); KOOS-Activities of Daily Living, 100 (IQR, 97.1-100); KOOS-Sports, 90 (IQR, 80-100); and KOOS-Quality of Life, 78.1 (IQR, 56.2-87.5). Median satisfaction score was 8 (IQR, 8-9), and 16 patients (40%) returned to sports participation at their preinjury level. MRI scans revealed a 100% rate of bone healing. Abnormalities exceeding the fracture area were evident on MRI scans in 86.5% of patients. Recurrence of patellar instability (even after surgical fixation) and unstable patella at final follow-up were independent predictors of worse results after OCF fixation.
CONCLUSION
In the current study, reduction and internal fixation for APD-related OCF in adolescents yielded favorable midterm outcomes. Recurrence of dislocation and persistent patellar instability jeopardized clinical results.
PubMed: 35859644
DOI: 10.1177/23259671221107608 -
Cureus Feb 2022Background Pediatric patients often present with vague complaints involving the anterolateral foot and ankle, the medial knee, the lower back, and the hip. In our...
Background Pediatric patients often present with vague complaints involving the anterolateral foot and ankle, the medial knee, the lower back, and the hip. In our experience, closer examination of these patients reveals a constellation of symptoms that involve pathology in the ankle, knee, back, and hip. This study aimed to detail the identification and treatment of patients with the triad of flexible flat feet, tight Achilles complex, and altered gait, and their clinical course over time. Methods All patients of age 18 years or younger who presented to our urban academic center outpatient clinic with foot, ankle, patellar, low back, or hip pain or pathology were included. Patients with identified tarsal coalitions, accessory naviculars, malalignment syndrome, bone cysts or tumors, soft tissue tumors, arthropathy, neuropathy, infection, limb length inequality, patellar subluxation or dislocation, or spinal pathology were excluded. For each patient, demographic information, symptom description, treatment, and clinical course, including the Foot and Ankle Outcome Score (FAOS) was recorded. Results A total of 62 patients were included in our study. Patients mostly presented with low back pain (n=24, 38.7%), medial patellar pain (n=36, 58.1%), anterolateral ankle pain (n=35, 56.5%), and vague foot pain (n=13, 21.0%). Overall, 53.8% of patients with back pain at the initial visit, 35.0% of patients with knee pain, 44.4% of patients with ankle pain and 80.0% of patients with foot pain improved at final follow up. While patient-reported sports and recreation subscale scores demonstrated a significant improvement at the final follow-up compared to baseline scores (p=0.02), all other scores did not significantly differ compared to baseline scores. At final follow-up, 12 of 26 (46.2%) patients reported being able to return to play in their desired sport. Conclusion Complaints of back, hip, knee, ankle, or foot pain in the pediatric population can be early markers for a constellation of conditions that include low back pain, flexible flat feet, Achilles contracture, and altered gait due to increased lateral subluxation of the patella and hip flexion.
PubMed: 35282538
DOI: 10.7759/cureus.21983 -
Ochsner Journal 2022Patellar instability is a common orthopedic condition in the pediatric population. Many factors contribute to patellar instability, including trochlear dysplasia....
Patellar instability is a common orthopedic condition in the pediatric population. Many factors contribute to patellar instability, including trochlear dysplasia. However, patellar instability and its treatments are not well documented in the literature for patients with osteogenesis imperfecta. After medial patellofemoral ligament (MPFL) reconstruction, a 17-year-old male with osteogenesis imperfecta had a patellar dislocation that resulted in a patellar fracture. The patient subsequently had a revision of his MPFL reconstruction, and at 2½ years postoperation has had no episodes of recurrent patellar instability. The combination of bone fragility, trochlear dysplasia, and strength of the allograft used for MPFL reconstruction compared to the patient's bone strength led to dislocation and patellar fracture. Research into alternative methods for patellar fixation and postoperative physical therapy protocols for patients with osteogenesis imperfecta is needed. Special considerations must be made for this patient population.
PubMed: 35355651
DOI: 10.31486/toj.21.0025 -
Knee Surgery, Sports Traumatology,... Jun 2021In this study, the functional mid-term outcomes of the modified Grammont and Langenskiöld technique was assessed in skeletally immature patients with habitual patellar...
PURPOSE
In this study, the functional mid-term outcomes of the modified Grammont and Langenskiöld technique was assessed in skeletally immature patients with habitual patellar dislocation, with emphasis on knee function, pain, and other possible post-surgical complications. This is the first study concerning the application of the modified Grammont and Langenskiöld technique in habitual patellar dislocations.
METHODS
This retrospective cohort study considered 10 patients (15 knees), ranging from 7 to 11 years old, who underwent the modified Grammont and Langenskiold procedure between 2015 and 2018. History of dislocation, patellar stability and range of motion (ROM) were analysed. To assess functional improvement and knee pain, the Kujala Anterior Knee Pain Scale and KOOS-Child Knee Survey were used before and after surgical treatment.
RESULTS
No history of dislocation was noted after surgical treatment. All 15 knees showed full ROM. There were no signs of genu recurvatum and no length discrepancies were found. The subjective assessment revealed significant improvement in the scores of the KOOS-Child questionnaire in all five sections (p < 0.001), as well as in The Kujala Anterior Knee Pain Scale (p = 0.001).
CONCLUSION
The modified Grammont and Langenskiöld technique yields remarkable results in terms of knee stability and knee function, while decreasing recurrence risk and intensity of pain in patients with challenging cases of patellofemoral joint dislocation. This surgical technique is most effective in cases where the patella remains dislocated continuously; however, it may also be used in immature patients with recurrent instability.
LEVEL OF EVIDENCE
IV.
Topics: Arthralgia; Arthroplasty; Child; Female; Humans; Male; Patellar Dislocation; Patellofemoral Joint; Range of Motion, Articular; Recurrence; Retrospective Studies; Treatment Outcome
PubMed: 32980886
DOI: 10.1007/s00167-020-06284-y