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Annals of Agricultural and... Mar 2024Patella dislocation represents 3.3% of all knee injuries often leading to persistent instability. Medial patello-femoral ligament(MPFL) reconstruction is the standard...
INTRODUCTION AND OBJECTIVE
Patella dislocation represents 3.3% of all knee injuries often leading to persistent instability. Medial patello-femoral ligament(MPFL) reconstruction is the standard method of treatment in the patellar instability. Rehabilitation after MPFL-R is a long and demanding procedure. The hypothesis presented reflects the idea that despite relatively good access to hospital care and surgical options, the post-operative rehabilitation care system is still inferior in rural areas versus the one offered in major cities and towns.
MATERIAL AND METHODS
Between January 2015 - January 2018, 47 patients met the study inclusion criteria, diagnosed and operated on due to patellar instability. 8 patients were lost for full follow-up. Finally, 39 patients were included, divided into two groups - group A (19 from cities), group B (20 from rural area). Prospective KOOS and Kujala scales assessments were conducted: preoperative, 6 and 12 months after surgery. Knee isokinetic muscle strength was measured at 3 stages; prior to surgery, 6 and 12 months after reconstruction.
RESULTS
All patients showed significant improvement measured in the KOOS and Kujala scales after the procedure, compared to the pre-operational results. Despite equal clinical improvement, patients from Group A(city) achieved better functional outcomes as presented in the results of knee extensor functional tests using a Biodex dynamometer.
CONCLUSIONS
Rehabilitation after MPFL reconstruction improves muscle strength and clinical outcome. Patients from rural areas had inferior functional results in comparison to the patients from major cities, even 12 months after surgical patella stabilization. Despite the development of roads and transport according to the EU cohesion policy, there are still differences in rehabilitation results between rural and city areas.
Topics: Humans; Patella; Patellofemoral Joint; Joint Instability; Prospective Studies; Urban Population
PubMed: 38549487
DOI: 10.26444/aaem/178137 -
Cureus Feb 2024This case report details the clinical evaluation, imaging findings, and surgical management of a 17-year-old female with a two-year history of persistent knee pain and...
This case report details the clinical evaluation, imaging findings, and surgical management of a 17-year-old female with a two-year history of persistent knee pain and recurrent patellar dislocations. Despite the absence of traumatic injury, the patient exhibited significant anatomical abnormalities, including a laterally dislocated patella, shallow trochlear groove, increased tibial tuberosity to trochlear groove (TT-TG) distance, and patella alta by calculating Insall-Salvati ratio. The Insall-Salvati ratio is a radiographic measurement used to assess the position of the patella within the knee joint. It is calculated by dividing the length of the patellar tendon (from the lower pole of the patella to its insertion on the tibial tubercle) by the length of the patella itself (from its superior to inferior pole). This ratio is commonly used in the evaluation of patellar tracking disorders and patellar instability. Typically, a ratio greater than 1.2 is considered indicative of patella alta (high-riding patella), while a ratio less than 0.8 suggests patella baja (low-riding patella). The surgical intervention involved a tibial tuberosity osteotomy (TTO), distalization, and medial patellofemoral ligament (MPFL) reconstruction using the gracilis tendon, resulting in successful realignment as confirmed by postoperative imaging. A postoperative rehabilitation program, including physical therapy and pain management, was initiated to optimize recovery and enhance quadriceps strength and proprioception. This case underscores the importance of a comprehensive surgical approach in addressing recurrent patellar dislocation associated with complex anatomical variations, providing insights into effective management strategies for similar cases.
PubMed: 38544587
DOI: 10.7759/cureus.54891 -
The International Journal of Medical... Feb 2024The aim of the study was to validate a software-based planning method for the Schoettle Point and to evaluate precision and time efficiency of its live overlay on the...
BACKGROUND
The aim of the study was to validate a software-based planning method for the Schoettle Point and to evaluate precision and time efficiency of its live overlay on the intraoperative X-ray.
METHODS
A software-based method was compared with surgeons' manual planning in an inter- and intrarater study. Subsequently, K-wire placement was performed with and without an overlay of the planning. The time used and the precision achieved were statistically compared.
RESULTS
The average deviation between the surgeons (1.68 mm; 2.26 mm) was greater than the discrepancy between the surgeons and the software-based planning (1.30 mm; 1.38 mm). In the intrarater comparison, software-based planning provided consistent results. Live overlay showed a significantly lower positioning error (0.9 ± 0.5 mm) compared with that without overlay (3.0 ± 1.4 mm, p = 0.000; 3.1 ± 1.4 mm, p = 0.001). Live overlay did not achieve a significant time gain (p = 0.393; p = 0.678).
CONCLUSION
The software-based planning and live overlay of the Schoettle Point improves surgical precision without negatively affecting time efficiency.
Topics: Humans; Patellar Dislocation; Knee Joint; Ligaments, Articular; Plastic Surgery Procedures; Radiography; Joint Instability
PubMed: 38536717
DOI: 10.1002/rcs.2607 -
Operative Orthopadie Und Traumatologie Apr 2024A rotational osteotomy requires a complete cut of the bone in order to correct maltorsion. An additional correction of the frontal axis can be achieved via an oblique... (Review)
Review
OBJECTIVE
A rotational osteotomy requires a complete cut of the bone in order to correct maltorsion. An additional correction of the frontal axis can be achieved via an oblique cut of the bone. The osteotomy with bone to bone contact is fixed with an angle stable plate.
INDICATIONS
Symptoms such as anterior knee pain, inwardly pointing knee syndrome, lateral patellar subluxation or dislocation, lateral patellar hypercompression syndrome are a common indication for derivational osteotomy if clinically increased femoral internal rotation and radiologically increased femoral antetorsion is detected.
CONTRAINDICATIONS
Increased hip external rotation versus internal rotation, increased femoral torsion but no increased internal hip rotation, malcompliance, inability for partial weight bearing, risk of delayed union (nicotine abuse and obesity) as well as patellofemoral arthritis and systematic glucocorticoids, immunosuppressants are (relative) contra-indications.
SURGICAL TECHNIQUE
A lateral or optionally medial approach to the distal femur and exposure of the bone with Eva hooks for the osteotomy is done. The use of patient-specific cutting blocks accurately specify the planned extent of derotation and level of incision. A defined oblique cutting plane of the single-cut osteotomy and derotation will additionally correct/change frontal axis. An additional biplanar osteotomy with an anterior wedge increases intraoperative stability and generates a larger bone contact area for consolidation.
POSTOPERATIVE MANAGEMENT
With the use of an extra medullary fixation device partial weight bearing with 15-20 kg with crutches up to 6 weeks is required, but no restriction on knee movement is given.
RESULTS
The literature shows significantly improved patient satisfaction regarding patellofemoral stability and knee function. With the use of patient-specific cutting guides, high accuracy of the osteotomy and 3‑dimensional correction can be achieved, while delayed union rate is up to 10%.
Topics: Humans; Treatment Outcome; Femur; Knee Joint; Patella; Osteotomy; Joint Dislocations
PubMed: 38536427
DOI: 10.1007/s00064-024-00844-y -
Knee Surgery, Sports Traumatology,... Jun 2024Trochlear dysplasia is one of the main risk factors for recurrent patellar dislocation. The Dejour classification identifies four categories that can be used to classify...
PURPOSE
Trochlear dysplasia is one of the main risk factors for recurrent patellar dislocation. The Dejour classification identifies four categories that can be used to classify trochlear dysplasia. The purpose of this study is to evaluate the inter- and intraobserver reliability of the Dejour classification for trochlear dysplasia. The hypothesis was that both intra- and interobserver reliability would be at least moderate.
METHODS
This is a cross-sectional, reliability study. Twenty-eight examiners from the International Patellofemoral Study Group 2022 meeting evaluated lateral radiographs of the knee and axial magnetic resonance images from 15 cases of patellofemoral instability with trochlear dysplasia. They classified each case according to Dejour's classification for trochlear dysplasia (A-D). There were three rounds: one with only computed radiograph (CR), one with only magnetic resonance imaging (MRI) and one with both. Inter- and intraobserver reliability were calculated using κ coefficient (0-1).
RESULTS
The mean age of patients was: 14.6 years; 60% were female and 53% had open physis. The interobserver reliability κ probabilities were 0.2 (CR), 0.13 (MRI) and 0.12 (CR and MRI). The intraobserver reliability κ probabilities were 0.45 (CR), 0.44 (MRI) and 0.65 (CR and MRI).
CONCLUSION
The Dejour classification for trochlear dysplasia has slight interobserver reliability and substantial intraobserver reliability.
LEVEL OF EVIDENCE
Level I.
Topics: Humans; Cross-Sectional Studies; Female; Magnetic Resonance Imaging; Reproducibility of Results; Adolescent; Observer Variation; Male; Patellofemoral Joint; Patellar Dislocation; Joint Instability; Tomography, X-Ray Computed; Femur; Child
PubMed: 38532466
DOI: 10.1002/ksa.12158 -
Knee Surgery, Sports Traumatology,... May 2024Numerous methods have been proposed to characterise tubercle lateralisation. However, their normal values and related changes remain unclear. Accordingly, it was aimed...
PURPOSE
Numerous methods have been proposed to characterise tubercle lateralisation. However, their normal values and related changes remain unclear. Accordingly, it was aimed to determine the potential sex and age effects and determined the optimal individualised method of diagnosing lateralisation of the tibial tubercle in patients with recurrent patellar dislocation (RPD).
METHODS
Measurements included the tibial tubercle-trochlear groove (TT-TG) distance, tibial tubercle-posterior cruciate ligament (TT-PCL) distance and tibial tubercle lateralisation (TTL); and the proximal tibial width (PTW), trochlear width (TW) and trochlear dysplasia index (TDI), for adjustment. A two-way analysis of variance was used to determine the effect of age, sex and their interaction within the normal group. When the age effect was statistically significant, a nonlinear regression was created. Areas under the receiver-operating characteristic curve (AUCs) were calculated to assess diagnostic accuracy.
RESULTS
A total of 277 normal participants (mean [SD] age, 13.5 [2.6] years; 125 [45.1%] female) and 227 patients with RPD (mean [SD] age, 13.5 [2.6] years; 161 [58.1%] female) were analysed. It was found that in the normal group, in patients aged 7-10, TT-PCL distance (p = 0.006), TTL (p = 0.007) and TT-PCL/PTW (p < 0.001) were significantly larger in females than in males. A significant sex effect was also detected on TT-TG/TW (p = 0.014). TT-TG distance, TT-PCL distance, TTL and TT-PCL/PTW (in male patients) approached an established normal adult value of 12.3 mm, 20.9 mm, 0.64 and 0.28, respectively, with increasing age (p < 0.001). The AUC was greater for TT-TG/TDI and TT-TG/TW (p ≤ 0.01) and TT-TG/TDI outperformed TT-TG/TW in patients aged 15-18 (p = 0.004).
CONCLUSIONS
Tubercle lateralisation increased with age and was affected by sex, with the exception of TT-TG distance and TT-TG/TDI. TT-TG/TDI is the optimal method of diagnosing a lateralized tibial tubercle in patients with RPD. These findings assist with the evaluation of tubercle lateralisation in that they provide a proper protocol for paediatric and adolescent populations with RPD; and thus, will help determine whether medial tubercle transfer should be included among the tailored surgical procedures considered for the treatment of patients with RPD.
LEVEL OF EVIDENCE
Level III.
Topics: Humans; Female; Male; Adolescent; Child; Tibia; Sex Factors; Age Factors; Patellar Dislocation; Posterior Cruciate Ligament; Reference Values; ROC Curve; Recurrence
PubMed: 38529701
DOI: 10.1002/ksa.12146 -
The American Journal of Sports Medicine Apr 2024Tibial tubercle osteotomy (TTO) is a well-established surgical treatment option for patellofemoral instability and pain. TTO with distalization (TTO-D) is indicated for...
BACKGROUND
Tibial tubercle osteotomy (TTO) is a well-established surgical treatment option for patellofemoral instability and pain. TTO with distalization (TTO-D) is indicated for patients with patellofemoral instability, patellar malalignment, and patella alta. The current literature demonstrates several complications that may be associated with TTO, with reportedly higher rates of complications associated with TTO-D.
PURPOSE
To analyze and compare complication rates after TTO without distalization (TTO-ND) and TTO-D and assess risk factors associated with complications.
STUDY DESIGN
Cohort study; Level of evidence, 3.
METHODS
All skeletally mature patients who underwent TTO with or without distalization by a single surgeon between September 2014 and May 2023 with a minimum of 6 months of clinical follow-up were retrospectively reviewed. Patient factors, surgical indications, perioperative data, and complications were collected via a retrospective review of electronic medical records. Concomitant procedures were categorized as intra-articular, extra-articular, and osteotomies.
RESULTS
A total of 251 TTOs (117 TTO-D, 134 TTO-ND) were included in the study group. Postoperative complications were observed in 15 operations (6%), with arthrofibrosis as the most common complication (10 operations [4%]). TTO-D and TTO-ND had similar rates of complication (5% vs 7%; = .793). Clinical nonunion was observed in 3 operations (3%) in the TTO-D cohort and 1 operation (1%) in the TTO-ND cohort. In the TTO-D cohort, concomitant intra-articular procedures were significantly associated with an increased likelihood of complications in a univariate model. In the TTO-ND cohort, an increased tourniquet time was significantly associated with an increased likelihood of complications in a univariate model. For all TTOs as well as the TTO-D and TTO-ND cohorts, there were no significant associations between patient or surgical variables in a multivariate model.
CONCLUSION
TTO with and without distalization is a safe procedure with low rates of complication. TTO-D was not associated with a higher rate of complications compared with TTO-ND. There was no association between complications and surgical variables for TTO procedures.
Topics: Humans; Retrospective Studies; Cohort Studies; Incidence; Osteotomy; Patellar Dislocation; Tibia; Joint Instability; Patellofemoral Joint
PubMed: 38516864
DOI: 10.1177/03635465241235883 -
Orthopaedic Journal of Sports Medicine Mar 2024Recent studies have reported conflicting results as to whether isolated medial patellofemoral ligament reconstruction (MPFLr) leads to decreased patellar height.
BACKGROUND
Recent studies have reported conflicting results as to whether isolated medial patellofemoral ligament reconstruction (MPFLr) leads to decreased patellar height.
PURPOSE
To investigate if patellar stabilization surgery not intended to address patella alta influences patellar height.
STUDY DESIGN
Cohort study; Level of evidence, 3.
METHODS
A multicenter retrospective chart review was conducted, and patients who underwent MPFLr, medializing tibial tuberosity osteotomy (TTO), and/or trochleoplasty between 2016 and 2020 were included. The Caton-Deschamps index (CDI) was calculated from radiographs obtained preoperatively, 2 weeks postoperatively, and 3 months postoperatively. The preoperative CDI value was compared with the 2-week postoperative and 3-month postoperative values according to stabilization procedure (isolated MPFLr, isolated TTO, MPFLr + TTO, MPFLr + trochleoplasty, and MPFLr + trochleoplasty + TTO) using the paired test. Analyses of the 1-bundle versus 2-bundle MPFLr technique and the presence of lateral retinacular release or lateral retinacular lengthening were conducted on the isolated MPFLr and combined MPFLr + TTO cohorts.
RESULTS
A total of 356 knees were included. Statistically significant pre- to postoperative decreases in CDI were seen in all stabilization procedures analyzed (≤ .017 for all). Within the isolated MPFLr cohort, this significant decrease was seen at 2 weeks postoperatively with the 2-bundle technique (ΔCDI = -0.09; < .001) but not with the 1-bundle technique (ΔCDI = -0.01; = .621).
CONCLUSION
The different surgical techniques analyzed in the current study affected patellar height, even when a distalizing TTO was not performed. The decrease was dependent on surgical technique, with a 2-bundle MPFLr leading to a statistically significant decrease and a 1-bundle MPFLr effecting no change.
PubMed: 38515605
DOI: 10.1177/23259671241235597 -
Scientific Reports Mar 2024Osteochondral damage (OD) is a significant outcome following acute patellar dislocation (APD), yet the factors contributing to its susceptibility remain unclear. The...
Osteochondral damage (OD) is a significant outcome following acute patellar dislocation (APD), yet the factors contributing to its susceptibility remain unclear. The primary objective of this study was to assess the association between demographic characteristics, patellofemoral (PF) joint morphology, and the occurrence of OD. A retrospective analysis identified 74 patients with APD who underwent treatment in our unit between 2019 and 2022. All patients received MRI within a week of injury to assess OD, subsequently categorized according to the injury pattern. The Caton-Deschamps index (CDI), tibial tuberosity-trochlear groove distance (TT-TG), lateral trochlear inclination (LTI), sulcus angle (SA), patellar width (PW), patellar thickness (PT), and femoral condyle geometry were calculated from the MRI scans and compared between groups. The findings revealed that OD predominantly manifested in the lateral femoral condyle (LFC) region and the medial patella (MP) region. In our patient cohort, this study identified a significant association between sulcus angle and the incidence of OD in both MP and LFC regions. Additionally, a significant correlation was discerned between skeletal maturity and the incidence of OD in the LFC region within demographic characteristics.
Topics: Humans; Patella; Retrospective Studies; Patellar Dislocation; Patellofemoral Joint; Tibia; Intra-Articular Fractures; Risk Factors
PubMed: 38509137
DOI: 10.1038/s41598-024-57363-w -
The Knee Jun 2024Metallosis is a known yet rare late complication of unicompartmental and total knee arthroplasty (TKA), usually secondary to either metal-backed patellar component...
Metallosis is a known yet rare late complication of unicompartmental and total knee arthroplasty (TKA), usually secondary to either metal-backed patellar component failure, mobile-bearing polyethylene dislocation, or catastrophic polyethylene failure and wear through. The majority of literature surrounding metallosis has been published in relation to total hip arthroplasty (THA) metal on metal bearing wear or mechanically assisted crevice corrosion.This case report describes the development of metallosis in a 77-year-old male patient with advanced (Kellgren-Lawrence Grade 4) osteoarthritis with associated valgus deformity, who underwent index TKA with a semiconstrained revision knee system due to intraoperative medial collateral ligament laxity. The taper junction between the titanium alloy stem and cobalt chromium femoral component was the source of diffuse intra-articular metallosis.
Topics: Humans; Male; Aged; Arthroplasty, Replacement, Knee; Knee Prosthesis; Prosthesis Failure; Corrosion; Reoperation; Osteoarthritis, Knee; Prosthesis Design; Titanium
PubMed: 38507890
DOI: 10.1016/j.knee.2024.02.010