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Radiographics : a Review Publication of... Jun 2023Patellofemoral pain and instability are common indications for imaging that are encountered in everyday practice. The authors comprehensively review key aspects of...
Patellofemoral pain and instability are common indications for imaging that are encountered in everyday practice. The authors comprehensively review key aspects of patellofemoral instability pertinent to radiologists that can be seen before the onset of osteoarthritis, highlighting the anatomy, clinical evaluation, diagnostic imaging, and treatment. Regarding the anatomy, the medial patellofemoral ligament (MPFL) is the primary static soft-tissue restraint to lateral patellar displacement and is commonly reconstructed surgically in patients with MPFL dysfunction and patellar instability. Osteoarticular abnormalities that predispose individuals to patellar instability include patellar malalignment, trochlear dysplasia, and tibial tubercle lateralization. Clinically, patients with patellar instability may be divided into two broad groups with imaging findings that sometimes overlap: patients with a history of overt patellar instability after a traumatic event (eg, dislocation, subluxation) and patients without such a history. In terms of imaging, radiography is generally the initial examination of choice, and MRI is the most common cross-sectional examination performed preoperatively. For all imaging techniques, there has been a proliferation of published radiologic measurement methods. The authors summarize the most common validated measurements for patellar malalignment, trochlear dysplasia, and tibial tubercle lateralization. Given that static imaging is inherently limited in the evaluation of patellar motion, dynamic imaging with US, CT, or MRI may be requested by some surgeons. The primary treatment strategy for patellofemoral pain is conservative. Surgical treatment options include MPFL reconstruction with or without osseous corrections such as trochleoplasty and tibial tubercle osteotomy. Postoperative complications evaluated at imaging include patellar fracture, graft failure, graft malposition, and medial patellar subluxation. RSNA, 2023 Quiz questions for this article are available in the supplemental material.
Topics: Humans; Patellar Dislocation; Patellofemoral Joint; Joint Instability; Cross-Sectional Studies; Patellofemoral Pain Syndrome; Joint Dislocations; Ligaments, Articular
PubMed: 37261964
DOI: 10.1148/rg.220177 -
Medicine Jan 2022Reconstruction of the medial patellofemoral ligament (MPFL) is an effective surgical method for the treatment of lateral patellar instability. At present, there is not... (Review)
Review
INTRODUCTION
Reconstruction of the medial patellofemoral ligament (MPFL) is an effective surgical method for the treatment of lateral patellar instability. At present, there is not much controversies regarding the femoral attachment, however, the controversies regarding patellar attachment versus attachment, number of graft strands, tension, isometry and so on. The following electronic databases will be searched: PubMed, the Cochrane Library, Embase, Web of Science, Medline. We will consider articles published between database initiation and March 2021. MPFL in the subject heading will be included in the study. Language is limited to English. Research selection, data extraction, and research quality assessment were independently completed by 2 researchers.
CONCLUSIONS
MPFL reconstruction is a reliable technique for the treatment of patellofemoral instability. The Schöttle point is still the mainstream method for locating the femoral attachment, the patellar attachment for single-bundle is located at the junction of the proximal one third and the distal two third of the longitudinal axis of the patella. For double-bundles, one is located in the proximal one third of the medial patellar edge and another is in the center of the patellar edge. Meanwhile, the adjustment of graft tension during operation is very important.
Topics: Humans; Joint Instability; Knee Joint; Ligaments, Articular; Patella; Patellar Dislocation; Patellofemoral Joint
PubMed: 35029909
DOI: 10.1097/MD.0000000000028511 -
Knee Surgery & Related Research Jun 2023This study sought to clarify treatment evidence to treat patellar dislocation by evaluating which treatment could yield better improvement of clinical outcomes for acute... (Review)
Review
PURPOSE
This study sought to clarify treatment evidence to treat patellar dislocation by evaluating which treatment could yield better improvement of clinical outcomes for acute patellar dislocation in children and adolescents 18 years of age or younger.
MATERIALS AND METHODS
MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials electronic databases were searched for relevant articles comparing clinical outcomes of conservative and surgical treatments for acute patellar dislocation in children and adolescents published from March 2008 to August 2022. Data searching, extraction, analysis, and quality assessment were performed on the basis of the Cochrane Collaboration guidelines. The quality assessment of each study was investigated using the Physiotherapy Evidence Database (PEDro) critical appraisal scoring system and Newcastle-Ottawa Quality Assessment Scale scores. To calculate the overall combined effect size for each outcome, Review Manager Version 5.3 (The Cochrane Collaboration, Software Update, Oxford) was employed.
RESULTS
Three randomized controlled trials (RCTs) and one prospective study were investigated. In terms of pain [mean difference (MD) 6.59, 95% confidence interval (CI) 1.73-11.45, I 0%], there were significantly better outcomes in conservative group. Nevertheless, there were no significant differences in any evaluated outcomes such as redislocation [risk ratio (RR) 1.36, 95% CI 0.72-2.54, I 65%], Kujala score (MD 3.92, 95% CI -0.17 to 8.01, I 0%), Tegner score (MD 1.04, 95% CI -0.04 to 2.11, I 71%), or subjective results (RR 0.99, 95% CI 0.74-1.34, I 33%) between conservative and surgical treatment groups.
CONCLUSIONS
Despite better pain outcomes with conservative group, the present study revealed no significant differences in clinical outcomes between conservative treatment and surgical treatment in children and adolescents with acute patellar dislocation. Since there are no significant differences in clinical outcomes between the two groups, routine surgical treatment is not advocated for treating acute patellar dislocation in children and adolescents.
PubMed: 37349852
DOI: 10.1186/s43019-023-00189-z -
Bulletin of the Hospital For Joint... 2014Patellar instability is a complex pathoanatomical phenomenon that requires an intricate understanding in order to properly treat patients. Often, the etiology of this... (Review)
Review
Patellar instability is a complex pathoanatomical phenomenon that requires an intricate understanding in order to properly treat patients. Often, the etiology of this entity is multifactorial, combining a series of physiologic and anatomic variables. A thorough history and physical as well as correct radiographic examinations are critical in both establishing the diagnosis and instituting the correct treatment. Non-operative management of recurrent instability has a high failure rate. Current operative techniques have been shown to be instrumental in correcting anatomic abnormalities, reducing symptoms of instability, and giving patients an appropriate chance of returning to their previous level of activity.
Topics: Biomechanical Phenomena; Humans; Joint Instability; Knee Joint; Orthopedic Procedures; Patella; Patellar Dislocation; Patellar Ligament; Radiography; Recovery of Function; Recurrence; Treatment Outcome
PubMed: 25150323
DOI: No ID Found -
Archives of Trauma Research Sep 2015Patellar dislocation usually occurs to the lateral side, leading to ruptures of the Medial Patellofemoral Ligament (MPFL) in about 90% of the cases. Even though several... (Review)
Review
CONTEXT
Patellar dislocation usually occurs to the lateral side, leading to ruptures of the Medial Patellofemoral Ligament (MPFL) in about 90% of the cases. Even though several prognostic factors are identified for patellofemoral instability after patellar dislocation so far, the appropriate therapy remains a controversial issue.
EVIDENCE ACQUISITION
Authors searched the Medline library for studies on both surgical and conservative treatment for patellar dislocation and patellofemoral instability. Additionally, the reference list of each article was searched for additional studies.
RESULTS
A thorough analysis of the anatomical risk factors with a particular focus on patella alta, increased Tibial Tuberosity-Trochlear Groove (TT-TG) distance, trochlear dysplasia as well as torsional abnormalities should be performed early after the first dislocation to allow adequate patient counseling. Summarizing the results of all published randomized clinical trials and comparing surgical and conservative treatment after the first-time patellar dislocation until today indicated no significant evident difference for children, adolescents, and adults. Therefore, nonoperative treatment was indicated after a first-time patellar dislocation in the vast majority of patients.
CONCLUSIONS
Surgical treatment for patellar dislocation is indicated primarily in case of relevant concomitant injuries such as osteochondral fractures, and secondarily for recurrent dislocations.
PubMed: 26566512
DOI: 10.5812/atr.29301 -
Bulletin of the NYU Hospital For Joint... 2009This review describes the normal patellofemoral joint and detail the mechanism and anatomic elements that predispose patients to patellar instability. The treatment... (Review)
Review
This review describes the normal patellofemoral joint and detail the mechanism and anatomic elements that predispose patients to patellar instability. The treatment options for both acute and chronic injuries are described and the rationale behind their approach to this problem is explained. In general, most acute dislocations should be treated nonoperatively unless the instability is associated with an osteochondral injury. Chronic dislocators should be treated based on an understanding of the patient's individual reason for recurrent instability. This is achieved with a thorough history, physical examination, and imaging studies. This information can help the clinician select the most appropriate proximal and or distal procedure.
Topics: Acute Disease; Biomechanical Phenomena; Chronic Disease; Femur; Humans; Joint Instability; Knee Joint; Magnetic Resonance Imaging; Orthopedic Procedures; Patella; Patellar Dislocation; Physical Examination; Recovery of Function; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 19302054
DOI: No ID Found -
Archives of Orthopaedic and Trauma... Oct 2021The purpose of this study was to describe the indications and technical aspects as well as evaluate the clinical and functional outcome of lengthening osteotomy of the...
INTRODUCTION
The purpose of this study was to describe the indications and technical aspects as well as evaluate the clinical and functional outcome of lengthening osteotomy of the lateral trochlear ridge in patients with patellofemoral pain and/or patella instability and presence of trochlear dysplasia Dejour type A or lack of Dejour type dysplasia and short lateral articular trochlea.
MATERIALS AND METHODS
Six consecutive adult patients were treated with a lateral trochlear lengthening osteotomy. Five patients received a concomitant medial patellofemoral ligament reconstruction. Three patients had prior patella stabilization surgeries. Trochlea dysplasia (Dejour classification), Caton-Dechamps index, tibial tubercle trochlear groove (TT-TG) distance, patellar tilt and lateral condylar index were measured in preoperative MRIs. Clinical and functional evaluation included the Kujala Anterior Knee Pain Scale, the Lysholm Knee Score, the Tegner Activity Score, a subjective evaluation form and isokinetic muscle strength.
RESULTS
Four patients had a Dejour type A dysplasia, two patients had no dysplasia. The mean (range) Caton-Dechamps index was 1.09 (0.95-1.16), TT-TG distance 10.9 mm (9.2-15.6 mm), patellar tilt 15° (4-32°) and lateral condylar index 82.0% (74-90%). One patient was lost to follow up, all others were followed for 2-5 years. All patients were satisfied with the clinical outcome. The Lysholm score increased from 55 (37-79) to 89 (76-100), the Tegner activity score from 3.6 (2-6) to 5.6 (5-7). The Kujala score postoperative was 90 (75-96). Some but not all patients had full strength recovery compared to the contralateral leg.
CONCLUSION
We recommend measuring the lateral condylar index and considering the indication of a lateral trochlear lengthening osteotomy as an additional or isolated procedure in selected patients with trochlear dysplasia Dejour type A or lack of dysplasia and short lateral articular trochlea depending on the extent of the patellar instability.
LEVEL OF EVIDENCE
Level IV, Case Series.
TRIAL REGISTRATION NUMBER
NCT04378491, clinicaltrials.gov, May 7, 2020.
Topics: Adult; Humans; Joint Instability; Knee Joint; Ligaments, Articular; Osteotomy; Patella; Patellar Dislocation; Patellofemoral Joint
PubMed: 33625541
DOI: 10.1007/s00402-020-03736-5 -
Orthopaedics & Traumatology, Surgery &... Feb 2014Paediatric patellar instability encompasses many anatomic entities located along a continuum of knee extensor mechanism abnormalities. Major or minor clinical... (Review)
Review
Paediatric patellar instability encompasses many anatomic entities located along a continuum of knee extensor mechanism abnormalities. Major or minor clinical manifestations may occur at a variable age. In major forms with irreducible patellar dislocation or habitual patellar dislocation during knee flexion, shortness of the quadriceps is a consistent feature. A comprehensive aetiological work-up is in order, as syndromic conditions are common. Early surgical treatment is mandatory and should be performed by an experienced paediatric orthopaedic surgeon, as the procedure is technically challenging. Minor forms are more common; they are characterised by patellar dislocation or subluxation near terminal knee extension. The diagnosis may be difficult, particularly at the acute phase. Surgery is needed in patients with recurrent dislocation or functional impairments. The semiology of patellar instability has undergone considerable development in recent years, and a three-dimensional evaluation of patellar position can now be obtained using magnetic resonance imaging. Individually tailored surgical treatment "à la carte" remains a valid approach in 2013. However, new techniques for medial patello-femoral ligament reconstruction have modified the management strategies for adults and superseded many stabilisation procedures. Adapting these new techniques to paediatric patients and developing new procedures constitute major challenges.
Topics: Adolescent; Child; Cooperative Behavior; Early Medical Intervention; Humans; Image Interpretation, Computer-Assisted; Imaging, Three-Dimensional; Interdisciplinary Communication; Joint Instability; Magnetic Resonance Imaging; Orthopedic Procedures; Patellar Dislocation; Risk Factors
PubMed: 24412258
DOI: 10.1016/j.otsr.2013.06.014 -
BMC Medical Genomics Aug 2022Recurrent patellar dislocation is the result of anatomical alignment and imbalance of restraint of bone and soft tissue. We investigate the anatomical characteristics of...
BACKGROUND
Recurrent patellar dislocation is the result of anatomical alignment and imbalance of restraint of bone and soft tissue. We investigate the anatomical characteristics of the knee joint in a family of patients with recurrent patella dislocation, and to screen the possible pathogenic genes in this family by whole exome sequencing in 4 patients and 4 healthy subjects, so as to provide theoretical basis for the pathogenesis of this disease.
METHODS
The data related to patella dislocation were measured by imaging data. The peripheral blood DNA of related family members was extracted for the whole exome sequencing, and then the sequencing results were compared with the human database. By filtering out synonymous variants and high-frequency variants in population databases, and then integrating single nucleotide non-synonymous variants of family members, disease-causing genes were found.
RESULTS
All patients in this family have different degrees of abnormal knee anatomy, which is closely related to patella dislocation. The sequencing results of patients and normal persons in this patella dislocation family were compared and analyzed, and the data were filtered through multiple biological databases. Find HOXB9 (NM_024017.4:c.404A>G:p.Glu135Gly),COL1A1(NM_000088.3:c.3766G>A:p.Ala1256Thr),GNPAT(NM_014236.3:c1556A>G:p.Asp519Gly),NANS(NM_018946.3:c.204G>C:p.Glu68Asp),SLC26A2(NM_000112.3:c.2065A>T:p.Thr689Ser) are nonsynonymous variants (MISSENSE). Through Sanger sequencing, the identified mutations in HOXB9 and SLC26A2 genes were only present in samples from patients with recurrent patellar dislocation.
CONCLUSIONS
The patients with recurrent patellar dislocation had markedly abnormal knee anatomy in this family. HOXB9 gene and SLC26A2 gene were found to be the possible pathogenic genes or related genes for patella dislocation.
Topics: Diagnostic Imaging; Homeodomain Proteins; Humans; Knee Joint; Mutation; Patella; Patellar Dislocation; Recurrence
PubMed: 35934709
DOI: 10.1186/s12920-022-01330-9 -
Cartilage 2022The study was performed to evaluate cartilage within the knee following a first-time patellar dislocation, using elevated MRI-based T1ρ relaxation times as an indicator...
OBJECTIVE
The study was performed to evaluate cartilage within the knee following a first-time patellar dislocation, using elevated MRI-based T1ρ relaxation times as an indicator of low proteoglycan concentration. The hypothesis is that MRI-based T1ρ relaxation times for patellofemoral and tibiofemoral cartilage are significantly longer for knees being treated for patellar dislocation than for healthy control knees.
DESIGN
Twenty-one subjects being treated for a first-time, unilateral dislocation of the patella and 16 healthy controls participated in MRI-based T1ρ relaxation time mapping. Mean relaxation times were quantified for patellofemoral and tibiofemoral regions for injured knees, the contralateral knees, and healthy controls. T1ρ values for each region were compared between the 3 groups with generalized estimating equations. Linear regressions were also performed to correlate T1ρ relaxation times with time from injury.
RESULTS
The knees with a disloction had longer T1ρ relaxation times than the contralateral knees and control group at the medial patella and longer relaxation times than the control group at the lateral tibia ( < 0.05). T1ρ relaxation times at the medial patella also decreased with time from injury (r = 0.21, = 0.037).
CONCLUSIONS
Compositional changes to cartilage on the medial patella are related to traumatic impact during a dislocation. Potential exists for cartilage properties at the medial patella to improve with time. Cartilage degradation at the lateral tibia is not directly related to traumatic impact. The current baseline data are a starting point to characterize the pathway from a first-time dislocation to progressive cartilage degradation and osteoarthritis.
Topics: Cartilage, Articular; Humans; Joint Dislocations; Knee Joint; Patella; Patellar Dislocation; Tibia
PubMed: 35676874
DOI: 10.1177/19476035221102570