Patellofemoral Instability Symposium

Sachin Tapasvi, Parag Sancheti, Ashok K. Shyam

Volume 3 | Issue 1 | Jan – Apr 2018 | Page 1-2


Author: Sachin Tapasvi [1], Parag Sancheti [2] , Ashok K Shyam [2,3]

[2] Orthopaedic Speciality Clinic, Pune Mahatrahtra.
[1] Sancheti Institute for Orthopaedics &Rehabilitation, Pune, India
[3] Indian Orthopaedic Research Group, Thane, India

Address of Correspondence
Dr Sachin Tapasvi
AJA Editorial Office, A-203, Manthan Apts, Shreesh CHS, Hajuri Road, Thane [w], Maharashtra, India.
Email: asian.arthroscopy@gmail.com


Patellofemoral Instability Symposium

It gives us immense satisfaction and pride in presenting the Asian Journal of Arthroscopy’s Special issue on Patellofemoral Instability to our readers. The symposium unfolds the recent advances on all aspects of this Clinical condition, the management of which has undergone myriads of changes in this century. The problem of recurrent lateral dislocation of the patella has been traditionally treated with a combination of conservative and surgical methods with uneven outcomes for the patient. These extensive surgical procedures involved a bony re-alignment, either distal or proximal to the knee joint along with a soft tissue release or tightening as deemed appropriate by the operating surgeon. These were followed by long recoveries and rehabilitation periods which were not necessarily popular with the subjects. Continuous expansion of our understanding of the biomechanics of the Patello-Femoral articulation and the underlying pathologies leading to its instability has resulted in a paradigm shift in its management which has benefitted from technological advances in minimally invasive and arthroscopic surgery.
In this issue, we aim to demystify the current concept of patellofemoral instability and help the reader in taking more informed decisions in diagnosing and treating this vexing problem. The papers deal with understanding the pathology of primary lateral patellar dislocation, techniques, and review of medial patellofemoral ligament reconstruction, management of patellar chondral defect, technique of tibial tubercle transfer and its indications, and rehabilitation after surgery of patellofemoral instability. Each paper has plenty of figures and tables to vividly describe the details of the topic in question.
We are extremely fortunate that Prof. Elizabeth Arendt, the “Queen” of patellofemoral joint, agreed to be the guest editor for this special issue. All the papers have been designed and written under her able guidance. This in itself certifies the quality of the papers in this issue of Asian Journal of Arthroscopy (AJA).We are deeply indebted to Prof. Arendt and her team of associates and researchers from University of Minnesota, who have taken time off their busy schedules to contribute their scientific work for this issue.
The issue also contains original articles, reviews and case reports which are selected following a rigorous peer review process. We do hope that the wealth of knowledge contained in this issue of AJA will benefit all the readers and help improve patient care in the Indian subcontinent. We also urge the authors from the Asian Subcontinent and specially India to contribute to the journal and help us in providing an international platform to them.


How to Cite this article: Tapasvi S, Sancheti PK, Shyam AK. Editorial: Patellofemoral Instability Symposium. Asian Journal of Arthroscopy Jan-April 2018;3(1):1-2.


(Abstract)      (Full Text HTML)      (Download PDF)


Functional Outcome after Reconstruction in Patients with Anterior Cruciate Ligament Injuries after Roadside Accident in Non-athlete Population

Pawan Kamal, Shekhar Singhal, Akshdeep Bawa, Rajnish Garg

Volume 3 | Issue 1 | Jan – Apr 2018 | Page 47-51


Author: Pawan Kamal [1], Shekhar Singhal [2], Akshdeep Bawa [3], Rajnish Garg [2]

[1] Navnoor Hospital and trauma centre, Balachaur, Punjab
[2] Dept of Orthoapedics, Dayanand Medical College, Ludhiana, Punjab
[3] King’s College Hospital, London.

Address of Correspondence
Dr Akshdeep Bawa, Fellow Trauma and Orthopaedics,King’s College Hospital,London.
Email: bawa.akshdeep@gmail.com


Abstract

Rupture of the ACL is one of the most common sports injuries in active young people. The exact incidence of anterior cruciate ligament injuries is unknown. Other than sports injuries, road side accidents are the second most common cause of ACL injury. There are no studies where the results after ACL reconstruction done for an acutely injured knee as a result of road side accident have been documented. Our study aimed to determine if the functional outcome was satisfactory if it was done in a patient of road side accident irrespective of any associated meniscal injuries and to evaluate the complications.
Methods: This prospective study was conducted in the Department of Orthopaedics of Dayanand Medical College and Hospital, Ludhiana, Punjab. The patients presenting with knee injury at indoor/ outdoor patient Department of Orthopaedics for period starting from Jan 2007 to Dec 2011 were taken up for study. The diagnosis was confirmed clinically as well as radiographically. Patients with multiligamentous injuries were excluded from the study.Reconstruction was done arthroscopically using ipsilateral Quadrupled hamstring or patellar tendon autograft. Standard operative technique of transtibial ACL reconstruction was followed. The patients were followed at 6 months and one year postoperatively from 2007 to 2011 for assessment of functional results. A total of 107 patient met the inclusion criteria out of which 102 patient could be examined clinically while 5 patients were lost to follow up and one patient died due to some natural cause. After completion of study observations were tabulated & were analyzed qualitatively as well as quantitatively using proper statistical methods.
Results: Post operatively, instability disappeared in 100(98.04%) patients post ACL reconstruction. Only 2(1.96%) patients had occasional episode of instability the operated knee. One patient had instability due to missed postero-medial instability. The mean preoperative subjective IKDC score was 37.9513.88 and post-operative subjective IKDC score changed to 87.9010.07 after ACL reconstruction. After comparing the two scores the P value came out to be <0.001 which was highly significant.
Conclusion: Road traffic accidents and Sports injuries are the commonest cause for anterior cruciate ligament injuries in our country. Arthroscopic ACL reconstruction provides a stable knee with minimal complications. Arthroscopic anterior cruciate ligament reconstruction with BPTB and ST/G grafts is an excellent treatment option for anterior cruciate ligament deficient knees after road side accidents.
Keywords: ACL injury, road side accident, non athletes, functional outcome.


References

1. Eriksson E. Reconstruction of the anterior cruciate ligament. Orthop Clin North Am 1976;7:167-79.
2. Bartlett RJ Clatworthy MG, Nguyen TN. Graft selection in reconstruction of the anterior cruciate ligament. J Bone Joint Surg Br 2001;83:625-34.
3. Canale ST, Beaty JH. Campbell’ Operative Orthopaedics. 11th ed. Philadelphia: Elsevier; 2008. p. 2811-922.
4. Uhorchak JM, Scoville CR, Williams GN, Arciero RA, St Pierre P, Taylor DC. Risk factors associated with noncontact injury of the anterior cruciate ligament: A prospective four-year evaluation of 859 West Point cadets. Am J Sports Med 2003;31:831-42.
5. Jomha NM, Pinczewski LA, Clingelffer AJ, Otto DD. Arthroscopic reconstruction of the anterior cruciate ligament with patellar-tendon autograft and interference screw fixation. J Bone Joint Surg 1999;81:775-9.
6. Levy AS, Meier SW. Approach to cartilage injury in the anterior cruciate ligament-deficient knee. Orthop Clin North Am 2003;34:149-67.
7. Veltri DM. Arthroscopic anterior cruciate ligament reconstruction. Clin Sports Med 1997;16:123-44.
8. Tegner Y, Lysolm JL. Rating systems in the evaluation of knee ligament injuries. ClinOrthopRel Res 1985;198:43-9.
9. Ellenbecker TS. Clinical examination. In: Ellenbecker T, editor. Knee Ligament Rehabilitation. Philadelphia: Churchill Livingstone; 2000. p. 38.
10. Scoring Instructions for the 2000 IKDC Subjective Knee Evaluation. Available from: http://www.sportsmed.org/research/index.asp. [cited 2011 August 22]
11. Keays SL, Anthony JE, Peter K, NewcombeA, Bullock MI. A 6-year follow-up of the effect of graft site on strength, stability, range of motion, function, and joint degeneration after anterior cruciate ligament reconstruction patellar tendon versus Semitendinosus and Gracilis tendon graft. Am J Sports Med2007;35:729-39.
12. Barenius B, Nordlander M, Ponzer S, Tidermark J, Eriksson K. Anterior cruciate ligament reconstruction with Semitendinosus graft provided similar stability and knee function and fewer problems with kneeling compared with the bone-patellar tendon-bone graft. J Bone Joint Surg Am 2011;May 18;93(10):969
13. Svensson M, Sernert N, Ejerhed L, Karlsson J, Kartus T. A prospective comparison of bone-patellar tendon-bone and hamstring grafts for anterior cruciate ligament reconstruction in female patients. Knee Surg Sports Traumatol Arthrosc 2006;14:278-86.
14. Lee S, Seong SC, Hyunchul JC, Han HS, An JH, Lee MC. Anterior cruciate ligament reconstruction with use of autologous quadriceps tendon graft. J Bone Joint Surg Am 2007;89:116-26.
15. Webb JM, Corry IS, Clingeleffer AJ, Pinczewski LA. Endoscopic reconstruction for isolated anterior cruciate ligament rupture. J Bone Joint Surg 1998;80-B:288-94.
16. Drogset JO, Strand T, Uppheim G, Boe A, Grontvedt T. Autologous patellar tendon and quadrupled hamstring grafts in anterior cruciate ligament reconstruction: A prospective randomized multicentre review of different fixation methods. Knee Surg Sports Traumatol Arthrosc 2010;18:1085-93.
17. Sadoghi P, Müller PE, Jansson V, Griensven M, Kröpfl A, Fischmeister M. Reconstruction of the anterior cruciate ligament: A clinical comparison of bone-patellar tendon-bone single bundle versus Semitendinosus and Gracilis double bundle technique. IntOrthop (SICOT) 2011;35:127-33.
18. Gifstad T, Foss OA, Engebretsen L, Lind M, Forssblad M, Albrektsen G, et al. Lower risk of revision with patellar tendon autografts compared with hamstring autografts: a registry study based on 45,998 primary ACL reconstructions in Scandinavia. Am J Sports Med. 2014 Oct;42(10):2319-28
19. Bourke HE, Gordon DJ, Salmon LJ, Waller A, Linklater J, Pinczewski LA. The outcome at 15 years of endoscopic anterior cruciate ligament reconstruction using hamstring tendon autograft for ‘isolated’ anterior cruciate ligament rupture. J Bone Joint Surg Br 2012;94:630-7.
20. Corry IS, Webb JM, Clingeleffer AJ. Arthroscopic reconstruction of the anterior cruciate ligament: A comparison of patellar tendon autograft and four-strand hamstring tendon autograft. Am J Sports Med 1999;27:444-54.
21. O’Brien SJ, Warren RF, Pavlov H. Reconstruction of the chronically insufficient anterior cruciate ligament with the central third of the patellar ligament. J Bone Joint Surg 1991;73A:278-86.
22. Aune AK, Holm I, Risberg MA, Jensen HK, Steen H. Four-strand hamstring tendon autograft compared with patellar tendon-bone autograft for anterior cruciate ligament reconstruction. Am J Sports Med 2001;29:722-8.


How to Cite this article:. Kamal P, Singhal S, Bawa A, Garg R. Functional Outcome after Reconstruction in Patients with Anterior Cruciate Ligament Injuries after Roadside Accident in Non-athlete Population. Asian Journal of Arthroscopy Jan – April 2018;3(1):47-51.


(Abstract)      (Full Text HTML)      (Download PDF)


Advances in Kienbock’s Disease: Imaging and Arthroscopy

Simon Bruce Murdoch MacLean, Gregory Ian Bain

Volume 3 | Issue 1 | Jan – Apr 2018 | Page 42-46


Author: Simon Bruce Murdoch MacLean [1], Gregory Ian Bain [1]

[1] Department of Orthopaedic Surgery, Flinders University, Adelaide, South Australia.

Address of Correspondence
Dr. Simon MacLean,
Department of Orthopaedic Surgery, Flinders University, Adelaide, South Australia.
E-mail: simonmaclean81@gmail.com


Abstract

The treatment of Kienbock’s disease has remained a clinical challenge since its original description over 100 years ago. We present our concepts on pathoanatomy and the role of new imaging modalities. Arthroscopic assessment remains the “gold standard” for the assessment of the lunate and wrist. We present our classification and algorithm as a management aid to the treating surgeon. In addition, we outline the indications and techniques of a number of arthroscopic procedures used to treat the Kienbock’s wrist.
Keywords: Kienbock’s disease; arthroscopy; Imaging.


References

1. Kienbock R. Concerning traumatic malacia of the lunate and its consequences: Joint degeneration and compression. FortschGeb Roentgen 1910;16:77-103.
2. Lichtman DM, Mack GR, MacDonald RI, Gunther SF, Wilson JN. Kienböck’s disease: The role of silicone replacement arthroplasty. J Bone Joint Surg Am 1977;59:899-908.
3. Bain G, MacLean S, Yeo C, Perilli E, Lichtman D. The etiology and pathogenesis of kienböck disease. J Wrist Surg 2016;5:248-54.
4. Lichtman DM, Pientka WF, Bain GI. Kienböck disease: A new algorithm for the 21st century. J Wrist Surg 2017;6:2-10.
5. Lichtman DM, Pientka WF, Bain GI. Kienböck disease: Moving forward. J Hand Surg Am 2016;41:630-8.
6. Lichtman DM, Bain GI. Kienbock’s Disease: Advances in Diagnosis and Treatment. 1st ed. Tokyo: Spinger; 2016.
7. Bain GI, MacLean SB, Tse WL, Ho PC, Lichtman DM. Kienböck disease and arthroscopy: Assessment, classification, and treatment. J Wrist Surg 2016;5:255-60.
8. MacLean SBM, Kantar K, Bain GI, Lichtman DM. The role of wrist arthroscopy in kienbock disease. Hand Clin 2017;33:727-34.
9. Bain GI, Durrant A. An articular-based approach to kienbock avascular necrosis of the lunate. Tech Hand Up ExtremSurg 2011;15:41-7.
10. Corre AL, Huynh KP, Dhaliwal RS, Bain GI. Development of a protocol for SPECT/CT in the assessment of wrist disorders. J Wrist Surg 2016;5:297-305.
11. Cerezal L, Abascal F, Canga A, García-Valtuille R, Bustamante M, del Piñal F, et al. Usefulness of gadolinium-enhanced MR imaging in the evaluation of the vascularity of scaphoid nonunions. AJR Am J Roentgenol 2000;174:141-9.
12. Schmitt R, Heinze A, Fellner F, Obletter N, Strühn R, Bautz W, et al. Imaging and staging of avascular osteonecroses at the wrist and hand. Eur J Radiol 1997;25:92-103.
13. Wassilew GI, Janz V, Heller MO, Tohtz S, Rogalla P, Hein P, et al.Real time visualization of femoroacetabular impingement and subluxation using 320-slice computed tomography. J Orthop Res 2013;31:275-81.
14. Wijeratna MD, Troupis JM, Bell SN. The use of four-dimensional computed tomography to diagnose costoclavicular impingement causing thoracic outlet syndrome. Shoulder Elbow 2014;6:273-5.
15. Garcia-Elias M, Alomar Serrallach X, Monill Serra J. Dart-throwing motion in patients with scapholunate instability: A dynamic four-dimensional computed tomography study. J Hand SurgEurVol 2014;39:346-52.
16. Demehri S, Hafezi-Nejad N, Morelli JN, Thakur U, Lifchez SD, Means KR, et al.Scapholunate kinematics of asymptomatic wrists in comparison with symptomatic contralateral wrists using four-dimensional CT examinations: Initial clinical experience. Skeletal Radiol 2016;45:437-46.
17. Demehri S, Wadhwa V, Thawait GK, Fattahi N, Means KR, Carrino JA, et al. Dynamic evaluation of pisotriquetral instability using 4-dimensional computed tomography. J Comput Assist Tomogr 2014;38:507-12.
18. Bell SN, Troupis JM, Miller D, Alta TD, Coghlan JA, Wijeratna MD, et al. Four-dimensional computed tomography scans facilitate preoperative planning in snapping scapula syndrome. J Shoulder Elbow Surg 2015;24:e83-90.
19. Bain GI, Begg M. Arthroscopic assessment and classification of kienbock’s disease. Tech Hand Up ExtremSurg 2006;10:8-13.
20. McGuire DT, Bain GI. Radioscapholunate fusions. J Wrist Surg 2012;1:135-40.
21. Bain GI, Ondimu P, Hallam P, Ashwood N. Radioscapholunate arthrodesis-a prospective study. Hand Surg 2009;14:73-82.


How to Cite this article:. MacLean S B M, Bain G I.Advances in Kienbock’s Disease: Imaging and Arthroscopy. Asian Journal of Arthroscopy Jan – April 2017;2(1):42-46.


(Abstract)      (Full Text HTML)      (Download PDF)


Post-operative Rehabilitation for Select Patellar-stabilizing Procedures

Jill Monson, Elizabeth Niemuth

Volume 3 | Issue 1 | Jan – Apr 2018 | Page 36-41


Author: Jill Monson [1], Elizabeth Niemuth [2]

[1] Department of Physical Therapy, TRIA Woodbury, 155 Radio Drive, Woodbury, MN 55125, USA,
[2] Department of Physical Therapy, Institute for Athletic Medicine, M Health Clinics and Surgery Center, Minneapolis, MN 55455, USA

Address of Correspondence
Dr. Elizabeth Niemuth,
Institute for Athletic Medicine, M Health Clinics and Surgery Center, 909 Fulton Street SE, Minneapolis, MN 55455, USA.
Email: eniemut1@fairview.org


Abstract

The rehabilitation process after surgical intervention for patellar instability warrants special consideration of the anatomy, biomechanics, and surgical procedure to facilitate the best outcomes for the patient. There is a paucity of evidence-based literature regarding post-operative rehabilitation protocols for the patellofemoral (PF) compartment. Recommendations for early rehabilitation (0–6 weeks) after lateral retinacular lengthening, medial PF ligament reconstruction, tibial tubercle osteotomy, and trochleoplastyare reviewed in this article. For each procedure, the following common post-operative rehabilitation focus points are reviewed: Weight-bearing status and brace use, joint range of motion, and strengthening.
Keywords: Patellofemoral, Rehabilitation, Patellar instability.


References

1. Ward SR, Powers CM. The influence of patella alta on patellofemoral joint stress during normal and fast walking. ClinBiomech (Bristol, Avon) 2004;19:1040-7.
2. Powers CM. Patellar kinematics, part I: The influence of vastus muscle activity in subjects with and without patellofemoral pain. PhysTher 2000;80:956-64.
3. Kaya D, Citaker S, Kerimoglu U, Atay OA, Nyland J, Callaghan M, et al. Women with patellofemoral pain syndrome have quadriceps femoris volume and strength deficiency. Knee Surg Sports Traumatol Arthrosc 2011;19:242-7.
4. Grenholm A, Stensdotter AK, Häger-Ross C. Kinematic analyses during stair descent in young women with patellofemoral pain. Clin Biomech (Bristol, Avon) 2009;24:88-94.
5. HeinoBrechter J, Powers CM. Patellofemoral stress during walking in persons with and without patellofemoral pain. Med Sci Sports Exerc 2002;34:1582-93.
6. Brechter JH, Powers CM. Patellofemoral joint stress during stair ascent and descent in persons with and without patellofemoral pain. Gait Posture 2002;16:115-23.
7. Spencer JD, Hayes KC, Alexander IJ. Knee joint effusion and quadriceps reflex inhibition in man. Arch Phys Med Rehabil 1984;65:171-7.
8. Pietrosimone B, Lepley AS, Murray AM, Thomas AC, Bahhur NO, Schwartz TA, et al. Changes in voluntary quadriceps activation predict changes in muscle strength and gait biomechanics following knee joint effusion. Clin Biomech (Bristol, Avon) 2014;29:923-9.
9. Senavongse W, Farahmand F, Jones J, Andersen H, Bull AM, Amis AA, et al. Quantitative measurement of patellofemoral joint stability: Force-displacement behavior of the human patella in vitro. J Orthop Res 2003;21:780-6.
10. Amis AA. Current conceptson anatomy and biomechanics of patellar stability. Sports Med Arthrosc Rev 2007;15:48-56.
11. Desio SM, Burks RT, Bachus KN. Soft tissue restraints to lateral patellar translation in the human knee. Am J Sports Med 1998;26:59-65.
12. Conlan T, Garth WP Jr., Lemons JE. Evaluation of the medial soft-tissue restraints of the extensor mechanism of the knee. J Bone Joint Surg Am1993;75:682-93.
13. Hautamaa PV, Fithian DC, Kaufman KR, Daniel DM, Pohlmeyer AM. Medial soft tissue restraints in lateral patellar instability and repair. ClinOrthopRelat Res 1998;349:174-82.
14. Mountney J, Senavongse W, Amis AA, Thomas NP. Tensile strength of the medial patellofemoral ligament before and after repair or reconstruction. J Bone Joint Surg Br2005;87:36-40.
15. Duchman KR, DeVries NA, McCarthy MA, Kuiper JJ, Grosland NM, Bollier MJ, et al. Biomechanical evaluation of medial patellofemoral ligament reconstruction. Iowa Orthop J 2013;33:64-9.
16. Woo SL, Gomez MA, Sites TJ, Newton PO, Orlando CA, Akeson WH, et al. The biomechanical and morphological changes in the medial collateral ligament of the rabbit after immobilization and remobilization. J Bone Joint Surg Am 1987;69:1200-11.
17. Newton PO, Woo SL, Kitabayashi LR, Lyon RM, Anderson DR, Akeson WH, et al.Ultrastructural changes in knee ligaments following immobilization. Matrix 1990;10:314-9.
18. Smith TO, Russell N, Walker J. A systematic review investigating the early rehabilitation of patients following medial patellofemoral ligament reconstruction for patellar instability. Crit Rev PhysRehabil Med2007;19:79-95.
19. Doucette SA, Child DD. The effect of open and closed chain exercise and knee joint position on patellar tracking in lateral patellar compression syndrome. J Orthop Sports Phys Ther 1996;23:104-10.
20. Steinkamp LA, Dillingham MF, Markel MD, Hill JA, Kaufman KR. Biomechanical considerations in patellofemoral joint rehabilitation. Am J Sports Med 1993;21:438-44.
21. Powers CM, Ward SR, Fredericson M, Guillet M, Shellock FG. Patellofemoral kinematics during weight-bearing and non-weight-bearing knee extension in persons with lateral subluxation of the patella: A preliminary study. J Orthop Sports Phys Ther 2003;33:677-85.
22. Powers CM, Ho KY, Chen YJ, Souza RB, Farrokhi S. Patellofemoral joint stress during weight-bearing and non-weight-bearing quadriceps exercises. J Orthop Sports PhysTher 2014;44:320-7.
23. Escamilla RF, Zheng N, Macleod TD, Edwards WB, Imamura R, Hreljac A, et al. Patellofemoral joint force and stress during the wall squat and one-leg squat. Med Sci Sports Exerc 2009;41:879-88.
24. Lee TQ, Morris G, Csintalan RP. The influence of tibial and femoral rotation on patellofemoral contact area and pressure. J Orthop Sports Phys Ther 2003;33:686-93.
25. Huberti HH, Hayes WC. Patellofemoral contact pressures. The influence of Q-angle and tendofemoral contact. J Bone Joint Surg [Am] 1984;66:715-24.
26. Li G, DeFrate LE, Zayontz S, Park SE, Gill TJ. The effect of tibiofemoral joint kinematics on patellofemoral contact pressures under simulated muscle loads. J Orthop Res 2004;22:801-6.
27. Davis K, Caldwell P, Wayne J, Jiranek WA. Mechanical comparison of fixation techniques for the tibial tubercle osteotomy. ClinOrthopRelat Res 2000;380:241-9.
28. Caldwell PE, Bohlen BA, Owen JR, Brown MH, Harris B, Wayne JS, et al. Dynamic confirmation of fixation techniques of the tibial tubercle osteotomy. Clin Orthop Relat Res 2004;424:173-9.
29. Powers CM, Lilley JC, Lee TQ. The effects of axial and multi-plane loading of the extensor mechanism on the patellofemoral joint. Clin Biomech (Bristol, Avon) 1998;13:616-24.
30. Rathleff MS, Rathleff CR, Crossley KM, Barton CJ. Is hip strength a risk factor for patellofemoral pain? A systematic review and meta-analysis. Br J Sports Med 2014;48:1088.
31. Van Cant J, Pineux C, Pitance L, Feipel V. Hip muscle strength and endurance in females with patellofemoral pain: A systematic review with meta-analysis. Int J Sports Phys Ther 2014;9:564-82.
32. Crossley KM, van Middelkoop M, Callaghan MJ, Collins NJ, Rathleff MS, Barton CJ, et al. 2016 patellofemoral pain consensus statement from the 4th international patellofemoral pain research retreat, manchester. Part 2: Recommended physical interventions (exercise, taping, bracing, foot orthoses and combined interventions). Br J Sports Med 2016;50:844-52.


How to Cite this article:. Monson J, Niemuth E. Post-operative Rehabilitation for Select Patellar-stabilizing Procedures. Asian Journal of Arthroscopy Jan – April 2018;3(1):36-41.


(Abstract)      (Full Text HTML)      (Download PDF)


Management of Patellar Chondral Defects

Kelsey L. Wise, Jeffrey A. Macalena

Volume 3 | Issue 1 | Jan – Apr 2018 | Page 30-35


Author: Kelsey L Wise [1], Jeffrey A Macalena [1]

[1] Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN 55454.

Address of Correspondence
Dr. Jeffrey A. Macalena,
Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN 55454.
E-mail: maca0049@umn.edu


Abstract

Patellar cartilage has a poor capacity for healing because of the avascular and hypocellular nature of articular cartilage. Surgical options for cartilage defects are varied and include repair, regeneration, and reconstruction. Open reduction internal fixation of chondral defects should be attempted when a large chondral fragment with bone is present. This is frequently seen following patellar dislocation, patellar fracture, or in the setting of osteochondritis dissecans lesions. Cartilage regeneration options include microfracture and a bone marrow-stimulating technique that involves penetration of the subchondral bone. This technique is best for small, isolated defects. Augmentation to microfracture with biologically active adjuncts is becoming more widely available and is thought to enhance stem cell production and tissue regeneration. Cartilage reconstruction options such as autologous chondrocyte implantation area cell-based therapy that develops hyaline-like cartilage, as opposed to the fibrocartilage of microfracture, and has the added advantage of ease in contouring to patellar anatomy. Short-term data suggest improvement of clinical outcomes for most patellar cartilage techniques; however, long-term studies are needed to assess the durability and clinical outcomes of these evolving procedures.
Keywords: Patellar, Chondral, Cartilage.


References

1. Brattstroem H. Shape of the intercondylar groove normally and in recurrent dislocation of patella. A clinical and x-ray-anatomical investigation. Acta Orthop ScandSuppl 1964;68Suppl 68:1-148.
2. Goldthwait JE. V. Permanent dislocation of the patella. The report of a case of twenty years’ duration, successfully treated by transplantation of the patella tendons with the tubercle of the tibia. Ann Surg 1899;29:62-8.
3. Hauser ED. Total tendon transplant for slipping patella: A new operation for recurrent dislocation of the patella 1938. ClinOrthopRelat Res 2006;452:7-16.
4. Roux C. Luxation habituelle de la rotule. Traitementopératoire/[Recurrent dislocation of the patella. Operative treatment]. Rev Chir 1888;8:682-9.
5. Dejour D, Byn P, Ntagiopoulos PG. The lyon’s sulcus-deepening trochleoplasty in previous unsuccessful patellofemoral surgery. IntOrthop 2013;37:433-9.
6. Dejour H, Walch G, Nove-Josserand L, Guier C. Factors of patellar instability: An anatomic radiographic study. Knee Surg Sports TraumatolArthrosc 1994;2:19-26.
7. Trillat A, Dejour H, Couette A. Diagnostic et traitement des subluxation récidivantes de la rotule/[Diagnosis and treatment of recurrent dislocations of the patella]. Rev ChirOrthopReparatriceAppar Mot 1964;50:813-24.
8. Campbell WC, Edmonson AS, Crenshaw AH. Campbell’s Operative Orthopaedics. 6th ed. St. Louis: Mosby; 1980.
9. Hawkins RJ, Bell RH, Anisette G. Acute patellar dislocations. The natural history. Am J Sports Med 1986;14:117-20.
10. Macnab I. Recurrent dislocation of the patella. J Bone Joint Surg [Am] 1952;34:957-67.
11. Arendt EA, Donell ST, Sillanpää PJ, Feller JA. The management of lateral patellar dislocation: State of the art. J ISAKOS 2017;2:205-12.
12. Tensho K, Akaoka Y, Shimodaira H, Takanashi S, Ikegami S, Kato H, et al. What components comprise the measurement of the tibial tuberosity-trochlear groove distance in a patellar dislocation population? J Bone Joint Surg Am 2015;97:1441-8.
13. Seitlinger G, Scheurecker G, Högler R, Labey L, Innocenti B, Hofmann S, et al. Tibial tubercle-posterior cruciate ligament distance: A new measurement to define the position of the tibial tubercle in patients with patellar dislocation. Am J Sports Med 2012;40:1119-25.
14. Heidenreich MJ, Camp CL, Dahm DL, Stuart MJ, Levy BA, Krych AJ, et al. The contribution of the tibial tubercle to patellar instability: Analysis of tibial tubercle-trochlear groove (TT-TG) and tibial tubercle-posterior cruciate ligament (TT-PCL) distances. Knee Surg Sports TraumatolArthrosc 2017;25:2347-51.
15. Arendt EA, England K, Agel J, Tompkins MA. An analysis of knee anatomic imaging factors associated with primary lateral patellar dislocations. Knee Surg Sports TraumatolArthrosc 2017;25:3099-107.
16. Askenberger M, Janarv PM, Finnbogason T, Arendt EA. Morphology and anatomic patellar instability risk factors in first-time traumatic lateral patellar dislocations: A Prospective magnetic resonance imaging study in skeletally immature children. Am J Sports Med 2017;45:50-8.
17. Matsushita T, Kuroda R, Oka S, Matsumoto T, Takayama K, Kurosaka M, et al. Clinical outcomes of medial patellofemoral ligament reconstruction in patients with an increased tibial tuberosity-trochlear groove distance. Knee Surg Sports TraumatolArthrosc 2014;22:2438-44.
18. Fulkerson JP. Anteromedialization of the tibial tuberosity for patellofemoral malalignment. ClinOrthopRelat Res 1983;177:176-81.
19. Blumensaat C. Die lageabweichungen und verrenkungen der kniescheibe/[The positional deviation and dislocation of the kneecap]. In: Payr E, Kirschner M, editors. Ergebnisse der Chirurgie und Orthopädie. Einunddreissigster Band. Berlin: Springer-Verlag; 1938. p. 149-223.
20. Brattström H. Patella alta in non-dislocating knee joints. ActaOrthopScand 1970;41:578-88.
21. Geenen E, Molenaers G, Martens M. Patella alta in patellofemoral instability. ActaOrthopBelg 1989;55:387-93.
22. Lancourt JE, Cristini JA. Patella alta and patella infera. Their etiological role in patellar dislocation, chondromalacia, and apophysitis of the tibial tubercle. J Bone Joint Surg Am 1975;57:1112-5.
23. Insall J, Salvati E. Patella position in the normal knee joint. Radiology 1971;101:101-4.
24. Grelsamer RP, Meadows S. The modified insall-salvati ratio for assessment of patellar height. ClinOrthopRelat Res 1992;282:170-6.
25. Caton J, Deschamps G, Chambat P, Lerat JL, Dejour H. Patella infera. Apropos of 128 cases. Rev ChirOrthopReparatriceAppar Mot 1982;68:317-25.
26. Caton J. Method of measuring the height of the patella. ActaOrthopBelg 1989;55:385-6.
27. Blackburne JS, Peel TE. A new method of measuring patellar height. J Bone Joint Surg Br 1977;59:241-2.
28. Biedert RM, Albrecht S. The patellotrochlear index: A new index for assessing patellar height. Knee Surg Sports TraumatolArthrosc 2006;14:707-12.
29. Bernageau J, Goutallier D, Debeyre J, Ferrané J. Nouvelle technique d’exploration de l’articulationfémoro-patellaire: Incidences axiales quadriceps décontractés et quadriceps contractés. [New exploration technique of the patellofemoral joint. Relaxed axial quadriceps and contracted quadriceps]. Rev ChirOrthopReparatriceAppar Mot 1975;61Suppl 2:286-90.
30. Charles MD, Haloman S, Chen L, Ward SR, Fithian D, Afra R, et al. Magnetic resonance imaging-based topographical differences between control and recurrent patellofemoral instability patients. Am J Sports Med 2013;41:374-84.
31. Caton JH, Dejour D. Tibial tubercle osteotomy in patello-femoral instability and in patellar height abnormality. IntOrthop 2010;34:305-9.
32. Amis AA, Firer P, Mountney J, Senavongse W, Thomas NP. Anatomy and biomechanics of the medial patellofemoral ligament. Knee 2003;10:215-20.
33. Ellera Gomes JL. Medial patellofemoral ligament reconstruction for recurrent dislocation of the patella: A preliminary report. Arthroscopy 1992;8:335-40.


How to Cite this article:. Wise KL, Macalena JA. Management of Patellar Chondral Defects. Asian Journal of Arthroscopy Jan – April 2018;3(1):30-35 .


(Abstract)      (Full Text HTML)      (Download PDF)


Tibial Tubercle Osteotomy for Patellar Instability: Where are we in 2018?

Marta Engelking, Andrew Schmiesing, Elizabeth A Arendt

Volume 3 | Issue 1 | Jan – Apr 2018 | Page 24-29


Author: Marta Engelking [1], Andrew Schmiesing [1], Elizabeth A Arendt [1]

[1] Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN 55454, USA.

Address of Correspondence
Dr. Elizabeth A Arendt,
Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN 55454, USA.
E-mail: arend001@umn.edu


Abstract

Management of recurrent lateral patellar dislocation (LPD) remains difficult and controversial, despite an expansion of knowledge. With the advancement of medicine, an understanding of known anatomical risk factors of LPD, including patella alta and increased tibial tubercle (TT)–trochlear groove distance, now guide present-day management. However, this is not without drawbacks. Current measurements of anatomical risk factors cannot be considered universal, and it is, therefore,important to consider each case individually. The focus of this article is to highlight the history of patellar instability risk factors associated with TT osteotomy, as well as present-day operative management, which aims to restore normal biomechanics. Our goal is to provide a clinical framework to help clinicians approach surgical management of LPD. Operative versus non-operative management will be discussed in another article. The included case studies will aid in the understanding of patients with patellofemoral instability, presentation, and the clinician’s approach to management, in addition to showcasing the ongoing challenges in treating patellar instability.
Keywords: Patellofemoral joint; patellar instability; lateral patellar dislocation; patella alta; tibial tubercle distalization; tibial
tubercle osteotomy.


References

1. Brattstroem H. Shape of the intercondylar groove normally and in recurrent dislocation of patella. A clinical and x-ray-anatomical investigation. Acta Orthop ScandSuppl 1964;68Suppl 68:1-148.
2. Goldthwait JE. V. Permanent dislocation of the patella. The report of a case of twenty years’ duration, successfully treated by transplantation of the patella tendons with the tubercle of the tibia. Ann Surg 1899;29:62-8.
3. Hauser ED. Total tendon transplant for slipping patella: A new operation for recurrent dislocation of the patella 1938. ClinOrthopRelat Res 2006;452:7-16.
4. Roux C. Luxation habituelle de la rotule. Traitementopératoire/[Recurrent dislocation of the patella. Operative treatment]. Rev Chir 1888;8:682-9.
5. Dejour D, Byn P, Ntagiopoulos PG. The lyon’s sulcus-deepening trochleoplasty in previous unsuccessful patellofemoral surgery. IntOrthop 2013;37:433-9.
6. Dejour H, Walch G, Nove-Josserand L, Guier C. Factors of patellar instability: An anatomic radiographic study. Knee Surg Sports TraumatolArthrosc 1994;2:19-26.
7. Trillat A, Dejour H, Couette A. Diagnostic et traitement des subluxation récidivantes de la rotule/[Diagnosis and treatment of recurrent dislocations of the patella]. Rev ChirOrthopReparatriceAppar Mot 1964;50:813-24.
8. Campbell WC, Edmonson AS, Crenshaw AH. Campbell’s Operative Orthopaedics. 6th ed. St. Louis: Mosby; 1980.
9. Hawkins RJ, Bell RH, Anisette G. Acute patellar dislocations. The natural history. Am J Sports Med 1986;14:117-20.
10. Macnab I. Recurrent dislocation of the patella. J Bone Joint Surg [Am] 1952;34:957-67.
11. Arendt EA, Donell ST, Sillanpää PJ, Feller JA. The management of lateral patellar dislocation: State of the art. J ISAKOS 2017;2:205-12.
12. Tensho K, Akaoka Y, Shimodaira H, Takanashi S, Ikegami S, Kato H, et al. What components comprise the measurement of the tibial tuberosity-trochlear groove distance in a patellar dislocation population? J Bone Joint Surg Am 2015;97:1441-8.
13. Seitlinger G, Scheurecker G, Högler R, Labey L, Innocenti B, Hofmann S, et al. Tibial tubercle-posterior cruciate ligament distance: A new measurement to define the position of the tibial tubercle in patients with patellar dislocation. Am J Sports Med 2012;40:1119-25.
14. Heidenreich MJ, Camp CL, Dahm DL, Stuart MJ, Levy BA, Krych AJ, et al. The contribution of the tibial tubercle to patellar instability: Analysis of tibial tubercle-trochlear groove (TT-TG) and tibial tubercle-posterior cruciate ligament (TT-PCL) distances. Knee Surg Sports TraumatolArthrosc 2017;25:2347-51.
15. Arendt EA, England K, Agel J, Tompkins MA. An analysis of knee anatomic imaging factors associated with primary lateral patellar dislocations. Knee Surg Sports TraumatolArthrosc 2017;25:3099-107.
16. Askenberger M, Janarv PM, Finnbogason T, Arendt EA. Morphology and anatomic patellar instability risk factors in first-time traumatic lateral patellar dislocations: A Prospective magnetic resonance imaging study in skeletally immature children. Am J Sports Med 2017;45:50-8.
17. Matsushita T, Kuroda R, Oka S, Matsumoto T, Takayama K, Kurosaka M, et al. Clinical outcomes of medial patellofemoral ligament reconstruction in patients with an increased tibial tuberosity-trochlear groove distance. Knee Surg Sports TraumatolArthrosc 2014;22:2438-44.
18. Fulkerson JP. Anteromedialization of the tibial tuberosity for patellofemoral malalignment. ClinOrthopRelat Res 1983;177:176-81.
19. Blumensaat C. Die lageabweichungen und verrenkungen der kniescheibe/[The positional deviation and dislocation of the kneecap]. In: Payr E, Kirschner M, editors. Ergebnisse der Chirurgie und Orthopädie. Einunddreissigster Band. Berlin: Springer-Verlag; 1938. p. 149-223.
20. Brattström H. Patella alta in non-dislocating knee joints. ActaOrthopScand 1970;41:578-88.
21. Geenen E, Molenaers G, Martens M. Patella alta in patellofemoral instability. ActaOrthopBelg 1989;55:387-93.
22. Lancourt JE, Cristini JA. Patella alta and patella infera. Their etiological role in patellar dislocation, chondromalacia, and apophysitis of the tibial tubercle. J Bone Joint Surg Am 1975;57:1112-5.
23. Insall J, Salvati E. Patella position in the normal knee joint. Radiology 1971;101:101-4.
24. Grelsamer RP, Meadows S. The modified insall-salvati ratio for assessment of patellar height. ClinOrthopRelat Res 1992;282:170-6.
25. Caton J, Deschamps G, Chambat P, Lerat JL, Dejour H. Patella infera. Apropos of 128 cases. Rev ChirOrthopReparatriceAppar Mot 1982;68:317-25.
26. Caton J. Method of measuring the height of the patella. ActaOrthopBelg 1989;55:385-6.
27. Blackburne JS, Peel TE. A new method of measuring patellar height. J Bone Joint Surg Br 1977;59:241-2.
28. Biedert RM, Albrecht S. The patellotrochlear index: A new index for assessing patellar height. Knee Surg Sports TraumatolArthrosc 2006;14:707-12.
29. Bernageau J, Goutallier D, Debeyre J, Ferrané J. Nouvelle technique d’exploration de l’articulationfémoro-patellaire: Incidences axiales quadriceps décontractés et quadriceps contractés. [New exploration technique of the patellofemoral joint. Relaxed axial quadriceps and contracted quadriceps]. Rev ChirOrthopReparatriceAppar Mot 1975;61Suppl 2:286-90.
30. Charles MD, Haloman S, Chen L, Ward SR, Fithian D, Afra R, et al. Magnetic resonance imaging-based topographical differences between control and recurrent patellofemoral instability patients. Am J Sports Med 2013;41:374-84.
31. Caton JH, Dejour D. Tibial tubercle osteotomy in patello-femoral instability and in patellar height abnormality. IntOrthop 2010;34:305-9.
32. Amis AA, Firer P, Mountney J, Senavongse W, Thomas NP. Anatomy and biomechanics of the medial patellofemoral ligament. Knee 2003;10:215-20.
33. Ellera Gomes JL. Medial patellofemoral ligament reconstruction for recurrent dislocation of the patella: A preliminary report. Arthroscopy 1992;8:335-40.


How to Cite this article:. Engelking M, Schmiesing A, Arendt EA. Tibial Tubercle Osteotomy for Patellar Instability: Where are we in 2018?. Asian Journal of Arthroscopy Jan – April 2018; 3(1):24-29.


(Abstract)      (Full Text HTML)      (Download PDF)


Medial Patellofemoral Ligament Reconstruction- State of the Art

Benjamin F Sandberg, Marc A Tompkins

Volume 3 | Issue 1 | Jan – Apr 2018 | Page 17-23


Author: Benjamin F Sandberg [1], Marc A Tompkins [1,2]

[1] The Orthopaedic Speciality Clinic, Wrangler Paranjpe Road, Pune
[2] Head, Translational Medicine & Research, SRM University, Kattankulathur, Tamil Nadu

Address of Correspondence
Dr. Sachin Ramchandra Tapasvi,
The Orthopaedic Speciality Clinic, Wrangler Paranjpe Road, Pune
Email: stapasvi@gmail.com


Abstract

The management of recurrent patellar instability has undergone progressive changes over the past few decades with improved optimal and predictable outcomes for the patients. Open surgical realignment procedures with bony osteotomies either proximal or distal to the Patella, designed to correct the imbalance of the extensor mechanism such that the patella tracks smoothly over the trochlea were commonly advocated. These procedures aimed to restore normal chondral loading of the patellofemoral joint and modify or delay progression of arthritic changes at an early age. With enhanced knowledge on the biomechanics of the anatomical structures providing medial and lateral restraints around the knee, the role of the Medial Patello-Femoral Ligament has been shown to be a vital one. This has refined the surgical options available to minimally invasive arthroscopic approaches with satisfying calculable results. This review article outlines the evolution of the surgical management of patellar instability and the prominent role of the MPFL reconstruction in achieving it. The biomechanics, surgical principles, anatomic landmarks, types of grafts and fixation methods, along with the senior surgeon’s preferred surgical technique are described in detail.
Keywords: Recurrent patellar instability, Medial Patello-Femoral Ligament, reconstruction.


References

1. Fulkerson JP. Anteromedialization of the tibial tuberosity for patellofemoral malalignment. ClinOrthopRelat Res 1983;???:176-81.
2. Roux C. The classic. Recurrent dislocation of the patella: Operative treatment. ClinOrthopRelat Res 1979;???:4-8.
3. Hauser ED. Total tendon transplant for slipping patella: A new operation for recurrent dislocation of the patella 1938. ClinOrthopRelat Res 2006;452:7-16.
4. Trillat A, Dejour H, Couette A. Diagnosis and treatment of recurrent dislocations of the patella. Rev ChirOrthopReparatriceAppar Mot 1964;50:813-24.
5. Maquet P. Advancement of the tibial tuberosity. ClinOrthopRelat Res 1976;???:225-30.
6. Marcacci M, Zaffagnini S, Iacono F, Visani A, Petitto A, Neri NP, et al. Results in the treatment of recurrent dislocation of the patella after 30 years’ follow-up. Knee Surg Sports TraumatolArthrosc 1995;3:163-6.
7. Hinckel BB, Arendt EA. Lateral retinaculum lengthening or release. Oper Tech Sports Med 2015;23:100-6.
8. Chen SC, Ramanathan EB. The treatment of patellar instability by lateral release. J Bone Joint Surg Br 1984;66:344-8.
9. Cosgarea AJ, Freedman JA, McFarland EG. Nonunion of the tibial tubercle shingle following fulkerson osteotomy. Am J Knee Surg 2001;14:51-4.
10. Luhmann SJ, Fuhrhop S, O’Donnell JC, Gordon JE. Tibial fractures after tibial tubercle osteotomies for patellar instability: A comparison of three osteotomy configurations. J Child Orthop 2011;5:19-26.
11. Payne J, Rimmke N, Schmitt LC, Flanigan DC, Magnussen RA. The incidence of complications of tibial tubercle osteotomy: A Systematic review. Arthroscopy 2015;31:1819-25.
12. Dejour H, Walch G, Nove-Josserand L, Guier C. Factors of patellar instability: An anatomic radiographic study. Knee Surg Sports TraumatolArthrosc 1994;2:19-26.
13. Cerciello S, Lustig S, Costanzo G, Neyret P. Medial retinaculum reefing for the treatment for patellar instability. Knee Surg Sports TraumatolArthrosc 2014;22:2505-12.
14. Coons DA, Barber FA. Thermal medial retinaculum shrinkage and lateral release for the treatment of recurrent patellar instability. Arthroscopy 2006;22:166-71.
15. Zhao J, Huangfu X, He Y. The role of medial retinaculum plication versus medial patellofemoral ligament reconstruction in combined procedures for recurrent patellar instability in adults. Am J Sports Med 2012;40:1355-64.
16. Warren LF, Marshall JL. The supporting structures and layers on the medial side of the knee: An anatomical analysis. J Bone Joint Surg Am 1979;61:56-62.
17. Feller JA, Feagin JA Jr., Garrett WE Jr. The medial patellofemoral ligament revisited: An anatomical study. Knee Surg Sports TraumatolArthrosc 1993;1:184-6.
18. Zaffagnini S, Grassi A, MarcheggianiMuccioli GM, Luetzow WF, Vaccari V, Benzi A, et al. Medial patellotibial ligament (MPTL) reconstruction for patellar instability. Knee Surg Sports TraumatolArthrosc 2014;22:2491-8.
19. Schöttle PB, Schmeling A, Rosenstiel N, Weiler A. Radiographic landmarks for femoral tunnel placement in medial patellofemoral ligament reconstruction. Am J Sports Med 2007;35:801-4.
20. Stephen JM, Lumpaopong P, Deehan DJ, Kader D, Amis AA. The medial patellofemoral ligament: Location of femoral attachment and length change patterns resulting from anatomic and nonanatomic attachments. Am J Sports Med 2012;40:1871-9.
21. Tanaka MJ, Voss A, Fulkerson JP. The anatomic midpoint of the attachment of the medial patellofemoral complex. J Bone Joint Surg Am 2016;98:1199-205.
22. Conlan T, Garth WP Jr., Lemons JE. Evaluation of the medial soft-tissue restraints of the extensor mechanism of the knee. J Bone Joint Surg Am 1993;75:682-93.
23. Hautamaa PV, Fithian DC, Kaufman KR, Daniel DM, Pohlmeyer AM. Medial soft tissue restraints in lateral patellar instability and repair. ClinOrthopRelat Res 1998;???:174-82.
24. Sillanpää P, Mattila VM, Iivonen T, Visuri T, Pihlajamäki H. Incidence and risk factors of acute traumatic primary patellar dislocation. Med Sci Sports Exerc 2008;40:606-11.
25. Amis AA, Firer P, Mountney J, Senavongse W, Thomas NP. Anatomy and biomechanics of the medial patellofemoral ligament. Knee 2003;10:215-20.
26. Mountney J, Senavongse W, Amis AA, Thomas NP. Tensile strength of the medial patellofemoral ligament before and after repair or reconstruction. J Bone Joint Surg Br 2005;87:36-40.
27. Hinckel BB, Gobbi RG, Demange MK, Pereira CAM, Pécora JR, Natalino RJM, et al. Medial patellofemoral ligament, medial patellotibial ligament, and medial patellomeniscal ligament: Anatomic, histologic, radiographic, and biomechanical study. Arthroscopy 2017;33:1862-73.
28. Weber AE, Nathani A, Dines JS, Allen AA, Shubin-Stein BE, Arendt EA, et al. An algorithmic approach to the management of recurrent lateral patellar dislocation. J Bone Joint Surg Am 2016;98:417-27.
29. McNeilan RJ, Everhart JS, Mescher PK, Abouljoud M, Magnussen RA, Flanigan DC. Graft choice in isolated medial patellofemoral ligament reconstruction: a systematic review with meta-analysis of rates of recurrent instability and patient-reported outcomes for autograft, allograft, and synthetic options. Arthroscopy 2018;???:???.
30. Elias JJ, Cosgarea AJ. Technical errors during medial patellofemoral ligament reconstruction could overload medial patellofemoral cartilage: A computational analysis. Am J Sports Med 2006;34:1478-85.
31. Smirk C, Morris H. The anatomy and reconstruction of the medial patellofemoral ligament. Knee 2003;10:221-7.
32. Redler LH, Meyers KN, Brady JM, Dennis ER, Nguyen JT, Stein BE. Anisometry of medial patellofemoral ligament reconstruction in the setting of increased tibial tubercle–trochlear groove distance and patella alta. Arthroscopy 2018;34:502-10.
33. Tuxøe JI, Teir M, Winge S, Nielsen PL. The medial patellofemoral ligament: A dissection study. Knee Surg Sports TraumatolArthrosc 2002;10:138-40.
34. LaPrade RF, Engebretsen AH, Ly TV, Johansen S, Wentorf FA, Engebretsen L, et al. The anatomy of the medial part of the knee. J Bone Joint Surg Am 2007;89:2000-10.
35. Philippot R, Chouteau J, Wegrzyn J, Testa R, Fessy MH, Moyen B, et al. Medial patellofemoral ligament anatomy: Implications for its surgical reconstruction. Knee Surg Sports TraumatolArthrosc 2009;17:475-9.
36. Baldwin JL. The anatomy of the medial patellofemoral ligament. Am J Sports Med 2009;37:2355-61.
37. Steensen RN, Dopirak RM, McDonald WG. The anatomy and isometry of themedialpatellofemoral ligament. Am J Sports Med 2004;32:1509-13.
38. Barnett AJ, Howells NR, Burston BJ, Ansari A, Clark D, Eldridge JD, et al. Radiographic landmarks for tunnel placement in reconstruction of the medial patellofemoral ligament. Knee Surg Sports TraumatolArthrosc 2012;20:2380-4.
39. Balcarek P, Walde TA. Accuracy of femoral tunnel placement in medial patellofemoral ligament reconstruction: The effect of a nearly true-lateral fluoroscopic view. Am J Sports Med 2015;43:2228-32.
40. Huston KL, Okoroafor UC, Kaar SG, Wentt CL, Saluan P, Farrow LD. Evaluation of the schottle technique in the pediatric knee. Orthop J Sports Med 2017;5:2325967117740078.
41. Hiemstra LA, Kerslake S, Lafave M. Medial patellofemoral ligament reconstruction femoral tunnel accuracy: Relationship to disease-specific quality of life. Orthop J Sports Med 2017;5:2325967116687749.
42. Sanchis-Alfonso V, Ramirez-Fuentes C, Montesinos-Berry E, Aparisi-Rodriguez F, Martí-Bonmatí L. Does radiographic location ensure precise anatomic location of the femoral fixation site in medial patellofemoral ligament surgery? Knee Surg Sports TraumatolArthrosc 2016;24:2838-44.
43. Ziegler CG, Fulkerson JP, Edgar C. Radiographic reference points are inaccurate with and without a true lateral radiograph: The importance of anatomy in medial patellofemoral ligament reconstruction. Am J Sports Med 2016;44:133-42.
44. Weinberger JM, Fabricant PD, Taylor SA, Mei JY, Jones KJ. Influence of graft source and configuration on revision rate and patient-reported outcomes after MPFL reconstruction: A systematic review and meta-analysis. Knee Surg Sports TraumatolArthrosc 2017;25:2511-9.
45. Lee PYF, Golding D, Rozewicz S, Chandratreya A. Modern synthetic material is a safe and effective alternative for medial patellofemoral ligament reconstruction. Knee Surg Sports TraumatolArthrosc 2017;???:???.
46. Sillanpää PJ, Mäenpää HM, Arendt EA. Treatment of lateral patella dislocation in the skeletally immature athlete. Oper Tech Sports Med 2010;18:83-92.
47. Lind M, Enderlein D, Nielsen T, Christiansen SE, Faunø P. Clinical outcome after reconstruction of the medial patellofemoral ligament in paediatric patients with recurrent patella instability. Knee Surg Sports TraumatolArthrosc 2016;24:666-71.
48. Nelitz M, Dreyhaupt J, Williams SR. Anatomic reconstruction of the medial patellofemoral ligament in children and adolescents using a pedicled quadriceps tendon graft shows favourable results at a minimum of 2-year follow-up. Knee Surg Sports TraumatolArthrosc 2017;???:???.
49. Hohn E, Pandya NK. Does the utilization of allograft tissue in medial patellofemoral ligament reconstruction in pediatric and adolescent patients restore patellar stability? ClinOrthop Related Res 2016;475:1563-9.
50. vonEngelhardt LV, Fuchs T, Weskamp P, Jerosch J. Effective patellofemoral joint stabilization and low complication rates using a hardware-free MPFL reconstruction technique with an intra-operative adjustment of the graft tension. Knee Surg Sports TraumatolArthrosc 2017;???:???.
51. Joyner PW, Bruce J, Roth TS, Mills FB 4th, Winnier S, Hess R, et al. Biomechanical tensile strength analysis for medial patellofemoral ligament reconstruction. Knee 2017;24:965-76.


How to Cite this article:. Shekhar A, Patil S, Tapasvi S. Medial Patellofemoral Ligament Reconstruction- State of the Art. Asian Journal of Arthroscopy Jan-April 2018;3(2):17-23.


(Abstract)      (Full Text HTML)      (Download PDF)


The Role of Imaging in the Evaluation of Patellar Instability

Benjamin F Sandberg, Marc A Tompkins

Volume 3 | Issue 1 | Jan – Apr 2018 | Page 10-16


Author: Benjamin F Sandberg [1], Marc A Tompkins [1,2]

[1] Department of, TRIAOrthopaedic Center, 8100 Northland Drive, Bloomington, MN 55431,
[2] Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN 55454

Address of Correspondence
Dr. Bradley J Nelson,
Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200,Minneapolis, MN 55454.
E-mail: ???


Abstract

Patellar instability is a complex problem that requires a thorough evaluation and work up. A critical part of this work up is appropriate imaging. This article reviews key imaging techniques and important imaging findings in patellar instability patients. This includes the evaluation of patella alta, trochlear dysplasia, lateral patellar tilt, extensor mechanism alignment, valgus alignment, rotational alignment, and soft tissue injury. Effective management for patellar instability relies on a comprehensive approach where any of these elements are evaluated when necessary.
Keywords: Patellofemoral Instability, Patellar Instability, Patellar Dislocation, Imaging.


References

1. Dejour D, Saggin PR, Meyer X, Tavernier T. Standard X-ray Examination: Patellofemoral Disorders. In: Zaffagnini S, Dejour D, Arendt EA, editors. Patellofemoral Pain, Instability, and Arthritis: Clinical Presentation, Imaging, and Treatment. New York: Springer; 2010. p. 51-60.
2. Dejour H, Walch G, Nove-Josserand L, Guier C. Factors of patellar instability: An anatomic radiographic study. Knee Surg Sports TraumatolArthrosc 1994;2:19-26.
3. Arendt EA, England K, Agel J, Tompkins MA. An analysis of knee anatomic imaging factors associated with primary lateral patellar dislocations. Knee Surg Sports TraumatolArthrosc 2017;25:3099-107.
4. Charles MD, Haloman S, Chen L, Ward SR, Fithian D, Afra R, et al. Magnetic resonance imaging-based topographical differences between control and recurrent patellofemoral instability patients. Am J Sports Med 2013;41:374-84.
5. Phillips CL, Silver DA, Schranz PJ, Mandalia V. The measurement of patellar height: A review of the methods of imaging. J Bone Joint Surg Br 2010;92:1045-53.
6. Bruderer J, Servien E, Neyret P. Patellar Height: Which Index? In: Zaffagnini S, Dejour D, Arendt EA, editors. Patellofemoral Pain, Instability, and Arthritis: Clinical Presentation, Imaging, and Treatment. Berlin, Heidelberg: Springer Berlin Heidelberg; 2010. p. 61-7.
7. Biedert RM, Albrecht S. The patellotrochlear index: A new index for assessing patellar height. Knee Surg Sports TraumatolArthrosc 2006;14:707-12.
8. Dejour D, Le Coultre B. Osteotomies in patello-femoral instabilities. Sports Med Arthrosc Rev 2007;15:39-46.
9. Yue RA, Arendt EA, Tompkins MA. Patellar height measurements on radiograph and magnetic resonance imaging in patellar instability and control patients. J Knee Surg 2017;30:943-50.
10. Ridley TJ, Hinckel BB, Kruckeberg BM, Agel J, Arendt EA. Anatomical patella instability risk factors on MRI show sensitivity without specificity in patients with patellofemoral instability: A systematic review. J ISAKOS 2016;1:141-52.
11. Galland O, Walch G, Dejour H, Carret JP. An anatomical and radiological study of the femoropatellar articulation. SurgRadiolAnat 1990;12:119-25.
12. Dejour D, Reynaud P, Lecoultre B. Douleursetinstabilitérotulienne: Essai de classification [Pains and patelar instability: Trial classification]. MédHyg (Geneve) 1998;56:1466-71.
13. Thomas S, Rupiper D, Stacy GS. Imaging of the patellofemoral joint. Clin Sports Med 2014;33:413-36.
14. Pfirrmann CW, Zanetti M, Romero J, Hodler J. Femoral trochlear dysplasia: MR findings. Radiology 2000;216:858-64.
15. Askenberger M, Janarv PM, Finnbogason T, Arendt EA. Morphology and anatomic patellar instability risk factors in first-time traumatic lateral patellar dislocations: A Prospective magnetic resonance imaging study in skeletally immature children. Am J Sports Med 2017;45:50-8.
16. Bollier M, Fulkerson JP. The role of trochlear dysplasia in patellofemoral instability. J Am Acad Orthop Surg 2011;19:8-16.
17. Carrillon Y, Abidi H, Dejour D, Fantino O, Moyen B, Tran-Minh VA, et al. Patellar instability: Assessment on MR images by measuring the lateral trochlear inclination-initial experience. Radiology 2000;216:582-5.
18. Biedert RM, Bachmann M. Anterior-posterior trochlear measurements of normal and dysplastic trochlea by axial magnetic resonance imaging. Knee Surg Sports TraumatolArthrosc 2009;17:1225-30.
19. Merchant AC, Mercer RL, Jacobsen RH, Cool CR. Roentgenographic analysis of patellofemoral congruence. J Bone Joint Surg Am 1974;56:1391-6.
20. Saggin PR, Saggin JI, Dejour D. Imaging in patellofemoral instability: An abnormality-based approach. Sports Med Arthrosc Rev 2012;20:145-51.
21. Laurin CA, Lévesque HP, Dussault R, Labelle H, Peides JP. The abnormal lateral patellofemoral angle: A diagnostic roentgenographic sign of recurrent patellar subluxation. J Bone Joint Surg Am 1978;60:55-60.
22. Fithian DC, Neyret P, Servien E. Patellar instability: The Lyon experience. CurrOrthopPract 2008;19:328-38.
23. Graf KH, Tompkins MA, Agel J, Arendt EA. Q-vector measurements: Physical examination versus magnetic resonance imaging measurements and their relationship with tibial tubercle-trochlear groove distance. Knee Surg Sports TraumatolArthrosc 2018;26:697-704.
24. Seitlinger G, Scheurecker G, Högler R, Labey L, Innocenti B, Hofmann S, et al. Tibial tubercle-posterior cruciate ligament distance: A new measurement to define the position of the tibial tubercle in patients with patellar dislocation. Am J Sports Med 2012;40:1119-25.
25. Heidenreich MJ, Camp CL, Dahm DL, Stuart MJ, Levy BA, Krych AJ, et al. The contribution of the tibial tubercle to patellar instability: Analysis of tibial tubercle-trochlear groove (TT-TG) and tibial tubercle-posterior cruciate ligament (TT-PCL) distances. Knee Surg Sports TraumatolArthrosc 2017;25:2347-51.
26. Saggin PR, Dejour D, Meyer X, Tavernier T. Computed Tomography and Arthro-CT Scan in Patellofemoral Disorders. In: Zaffagnini S, Dejour D, Arendt EA, editors. Patellofemoral Pain, Instability, and Arthritis. Berlin: Springer-Verlag; 2010. p. 73-8.
27. Feller JA, Amis AA, Andrish JT, Arendt EA, Erasmus PJ, Powers CM, et al. Surgical biomechanics of the patellofemoral joint. Arthroscopy 2007;23:542-53.
28. Seitlinger G, Moroder P, Scheurecker G, Hofmann S, Grelsamer RP. The contribution of different femur segments to overall femoral torsion. Am J Sports Med 2016;44:1796-800.
29. Diederichs G, Issever AS, Scheffler S. MR imaging of patellar instability: Injury patterns and assessment of risk factors. Radiographics 2010;30:961-81.
30. Tompkins MA, Rohr SR, Agel J, Arendt EA. Anatomic patellar instability risk factors in primary lateral patellar dislocations do not predict injury patterns: An MRI-based study. Knee Surg Sports Traumatol Arthrosc 2018;26:677-84..


How to Cite this article:. Sandberg BF, Tompkins MA. The Role of Imaging in the Evaluation of Patellar Instability. Asian Journal Arthroscopy. Jan-April 2018;3(1):10-16.


(Abstract)      (Full Text HTML)      (Download PDF)


First-time Lateral Patellar Dislocation: Evaluation and Management

Jarred K Holt, Bradley J Nelson

Volume 3 | Issue 1 | Jan – Apr 2018 | Page 3-9


Author: Jarred K Holt [1], Bradley J Nelson [1,2]

[1] Department of, TRIAOrthopaedic Center, 8100 Northland Drive, Bloomington, MN 55431,
[2] Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN 55454

Address of Correspondence
Dr. Bradley J Nelson,
Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200,Minneapolis, MN 55454.
E-mail: ???


Abstract

Lateral patellar dislocation is a common injury affecting a young, athletically active population. These injuries occur as a direct trauma to the knee or as a result of a twisting mechanism on a planted foot. They are typically accompanied by an audible “pop,” acute pain, and substantial swelling. The nature of the injury results in a variety of bony and soft tissue disruptions including medial patellofemoral ligament tears and osteochondral lesions of the femoral trochlea and inferomedial patella. In the acute setting, initial treatment is directed toward obtaining a concentric reduction, though oftentimes, this has already occurred spontaneously following the injury. Further, management decisions are based on a multitude of factors including concomitant injuries and patient anatomic considerations. Historically, the first-time patella dislocations were treated conservatively; however, more recent literature supports operative care in an effort to prevent recurrent instability events. Given an overall lack of compelling evidence to support either treatment option, it is felt that a thorough risk assessment and shared decision-making model should be employed to guide care of the first-time patella dislocation.
Key words: lateral patellar dislocation, evaluation, surgical management


References

1. Stefancin JJ, Parker RD. First-time traumatic patellar dislocation: A systematic review. ClinOrthopRelat Res 2007;455:93-101.
2. Askenberger M, Ekström W, Finnbogason T, Janarv PM. Occult intra-articular knee injuries in children with hemarthrosis. Am J Sports Med 2014;42:1600-6.
3. Christensen TC, Sanders TL, Pareek A, Mohan R, Dahm DL, Krych AJ, et al. Risk factors and time to recurrent ipsilateral and contralateral patellar dislocations. Am J Sports Med 2017;45:2105-10.
4. Fithian DC, Paxton EW, Stone ML, Silva P, Davis DK, Elias DA, et al. Epidemiology and natural history of acute patellar dislocation. Am J Sports Med 2004;32:1114-21.
5. Gravesen KS, Kallemose T, Blond L, Troelsen A, Barfod KW. High incidence of acute and recurrent patellar dislocations: A retrospective nationwide epidemiological study involving 24.154 primary dislocations. Knee Surg Sports TraumatolArthrosc2017. DOI: 10.1007/s00167-017-4594-7.
6. Atkin DM, Fithian DC, Marangi KS, Stone ML, Dobson BE, Mendelsohn C, et al. Characteristics of patients with primary acute lateral patellar dislocation and their recovery within the first 6 months of injury. Am J Sports Med 2000;28:472-9.
7. Mitchell J, Magnussen RA, Collins CL, Currie DW, Best TM, Comstock RD, et al. Epidemiology of patellofemoral instability injuries among high school athletes in the united states. Am J Sports Med 2015;43:1676-82.
8. Elias DA, White LM, Fithian DC. Acute lateral patellar dislocation at MR imaging: Injury patterns of medial patellar soft-tissue restraints and osteochondral injuries of the inferomedial patella. Radiology 2002;225:736-43.
9. Tompkins MA, Rohr SR, Agel J, Arendt EA. Anatomic patellar instability risk factors in primary lateral patellar dislocations do not predict injury patterns: An MRI-based study. Knee Surg Sports TraumatolArthrosc 2018;26:677-84.
10. Askenberger M, Arendt EA, Ekström W, Voss U, Finnbogason T, Janarv PM, et al. Medial patellofemoral ligament injuries in children with first-time lateral patellar dislocations: A Magnetic resonance imaging and arthroscopic study. Am J Sports Med 2016;44:152-8.
11. Kepler CK, Bogner EA, Hammoud S, Malcolmson G, Potter HG, Green DW, et al. Zone of injury of the medial patellofemoral ligament after acute patellar dislocation in children and adolescents. Am J Sports Med 2011;39:1444-9.
12. Seeley M, Bowman KF, Walsh C, Sabb BJ, Vanderhave KL. Magnetic resonance imaging of acute patellar dislocation in children: Patterns of injury and risk factors for recurrence. J PediatrOrthop 2012;32:145-55.
13. Bassett FH3rd. Acute dislocation of the patella, osteochondral fractures, and injuries to the extensor mechanism of the knee. AAOSInstr Course Lect1976;25:40-9.
14. Sillanpää PJ, Peltola E, Mattila VM, Kiuru M, Visuri T, Pihlajamäki H, et al. Femoral avulsion of the medial patellofemoral ligament after primary traumatic patellar dislocation predicts subsequent instability in men: A mean 7-year nonoperative follow-up study. Am J Sports Med 2009;37:1513-21.
15. Nord A, Agel J, Arendt EA. Axial knee radiographs: Consistency across clinic sites. Knee Surg Sports TraumatolArthrosc 2014;22:2401-7.
16. Cash JD, Hughston JC. Treatment of acute patellar dislocation. Am J Sports Med 1988;16:244-9.
17. Cofield RH, Bryan RS. Acute dislocation of the patella: Results of conservative treatment. J Trauma 1977;17:526-31.
18. Henry JH, Crosland JW. Conservative treatment of patellofemoral subluxation. Am J Sports Med 1979;7:12-4.
19. Jensen CM, Roosen JU. Acute traumatic dislocations of the patella. J Trauma1985;25:160-2.
20. Mäenpää H, Lehto MU. Patellar dislocation. The long-term results of nonoperative management in 100 patients. Am J Sports Med 1997;25:213-7.
21. Hawkins RJ, Bell RH, Anisette G. Acute patellar dislocations. The natural history. Am J Sports Med 1986;14:117-20.
22. Macnab I. Recurrent dislocation of the patella. J Bone Joint Surg(Am)1952;34:957-67.
23. Magnussen RA, Verlage M, Stock E, Zurek L, Flanigan DC, Tompkins M, et al. Primary patellar dislocations without surgical stabilization or recurrence: How well are these patients really doing? Knee Surg Sports TraumatolArthrosc 2017;25:2352-6.
24. Smith TO, Song F, Donell ST, Hing CB. Operative versus non-operative management of patellar dislocation. A meta-analysis. Knee Surg Sports TraumatolArthrosc 2011;19:988-98.
25. Amis AA. Current conceptson anatomy and biomechanics of patellar stability. Sports Med Arthrosc Rev 2007;15:48-56.
26. Senavongse W, Farahmand F, Jones J, Andersen H, Bull AM, Amis AA, et al. Quantitative measurement of patellofemoral joint stability: Force-displacement behavior of the human patella in vitro. J Orthop Res 2003;21:780-6.
27. Magnussen RA, Schmitt LC, Arendt EA. Return to soccer following acute patellar dislocation. In: Musahl V, Karlsson J, Krutsch W, Mandelbaum BR, Espregueira-Mendes J, d’Hooghe PP, editors. Return to Play in Football: An Evidence-based Approach.???: Springer-Verlag; 2018.
28. Ménétrey J, Putman S, Gard S. Return to sport after patellar dislocation or following surgery for patellofemoral instability. Knee Surg Sports TraumatolArthrosc 2014;22:2320-6.
29. Monson J, Arendt EA. Rehabilitative protocols for select patellofemoral procedures and nonoperative management schemes. Sports Med Arthrosc Rev 2012;20:136-44.
30. Ahmad CS, Stein BE, Matuz D, Henry JH. Immediate surgical repair of the medial patellar stabilizers for acute patellar dislocation. A review of eight cases. Am J Sports Med 2000;28:804-10.
31. Buchner M, Baudendistel B, Sabo D, Schmitt H. Acute traumatic primary patellar dislocation: Long-term results comparing conservative and surgical treatment. Clin J Sport Med 2005;15:62-6.
32. Harilainen A, Sandelin J. Prospective long-term results of operative treatment in primary dislocation of the patella. Knee Surg Sports TraumatolArthrosc 1993;1:100-3.
33. Dainer RD, Barrack RL, Buckley SL, Alexander AH. Arthroscopic treatment of acute patellar dislocations. Arthroscopy 1988;4:267-71.
34. Fukushima K, Horaguchi T, Okano T, Yoshimatsu T, Saito A, Ryu J, et al. Patellar dislocation: Arthroscopic patellar stabilization with anchor sutures. Arthroscopy 2004;20:761-4.
35. Haspl M, cicak N, Klobucar H, Pecina M. Fully arthroscopic stabilization of the patella. Arthroscopy 2002;18:E2.
36. Nikku R, Nietosvaara Y, Kallio PE, Aalto K, Michelsson JE. Operative versus closed treatment of primary dislocation of the patella. Similar 2-year results in 125 randomized patients. ActaOrthopScand 1997;68:419-23.
37. Nomura E, Inoue M, Osada N. Augmented repair of avulsion-tear type medial patellofemoral ligament injury in acute patellar dislocation. Knee Surg Sports TraumatolArthrosc 2005;13:346-51.
38. Vainionpää S, Laasonen E, Silvennoinen T, Vasenius J, Rokkanen P. Acute dislocation of the patella. A prospective review of operative treatment. J Bone Joint Surg Br 1990;72:366-9.
39. Yamamoto RK. Arthroscopic repair of the medial retinaculum and capsule in acute patellar dislocations. Arthroscopy 1986;2:125-31.
40. Apostolovic M, Vukomanovic B, Slavkovic N, Vuckovic V, Vukcevic M, Djuricic G, et al. Acute patellar dislocation in adolescents: Operative versus nonoperative treatment. IntOrthop 2011;35:1483-7.
41. Askenberger M. Operative versus non-operative treatment of acute primary lateral patellar dislocation in children: A prospective randomized study. Am J Sports Med???;???:???.
42. Camanho GL, Viegas Ade C, Bitar AC, Demange MK, Hernandez AJ. Conservative versus surgical treatment for repair of the medial patellofemoral ligament in acute dislocations of the patella. Arthroscopy 2009;25:620-5.
43. Nwachukwu BU, So C, Schairer WW, Green DW, Dodwell ER. Surgical versus conservative management of acute patellar dislocation in children and adolescents: A systematic review. Knee Surg Sports TraumatolArthrosc 2016;24:760-7.
44. Palmu S, Kallio PE, Donell ST, Helenius I, Nietosvaara Y. Acute patellar dislocation in children and adolescents: A randomized clinical trial. J Bone Joint Surg Am 2008;90:463-70.
45. Regalado G, Lintula H, Kokki H, Kröger H, Väätäinen U, Eskelinen M, et al. Six-year outcome after non-surgical versus surgical treatment of acute primary patellar dislocation in adolescents: A prospective randomized trial. Knee Surg Sports TraumatolArthrosc 2016;24:6-11.
46. Bitar AC, Demange MK, D’EliaCO, Camanho GL. Traumatic patellar dislocation: Nonoperative treatment compared with MPFL reconstruction using patellar tendon. Am J Sports Med 2012;40:114-22.
47. Arnbjornsson A, Egund N, Rydling O. The natural history of recurrent dislocation of the patella: Long-term results of conservative and operative treatment. J Bone Joint Surg [Br] 1992;74:140-2.
48. Christiansen SE, Jakobsen BW, Lund B, Lind M. Isolated repair of the medial patellofemoral ligament in primary dislocation of the patella: A prospective randomized study. Arthroscopy 2008;24:881-7.
49. Petri M, von Falck C, Broese M, Liodakis E, Balcarek P, Niemeyer P, et al. Influence of rupture patterns of the medial patellofemoral ligament (MPFL) on the outcome after operative treatment of traumatic patellar dislocation. Knee Surg Sports TraumatolArthrosc 2013;21:683-9.
50. Sillanpää PJ, Mäenpää HM, Mattila VM, Visuri T, Pihlajamäki H. Arthroscopic surgery for primary traumatic patellar dislocation: A prospective, nonrandomized study comparing patients treated with and without acute arthroscopic stabilization with a median 7-year follow-up. Am J Sports Med 2008;36:2301-9.
51. Erickson BJ, Mascarenhas R, Sayegh ET, Saltzman B, Verma NN, Bush-Joseph CA, et al. Does operative treatment of first-time patellar dislocations lead to increased patellofemoral stability? A Systematic review of overlapping meta-analyses. Arthroscopy 2015;31:1207-15.
52. Hing CB, Smith TO, Donell S, Song F. Surgical versus non-surgical interventions for treating patellar dislocation. Cochrane Database Syst Rev 2011;11:CD008106.
53. Zheng X, Kang K, Li T, Lu B, Dong J, Gao S, et al. Surgical versus non-surgical management for primary patellar dislocations: An up-to-date meta-analysis. Eur J OrthopSurgTraumatol 2014;24:1513-23.
54. Arendt EA, England K, Agel J, Tompkins MA. An analysis of knee anatomic imaging factors associated with primary lateral patellar dislocations. Knee Surg Sports TraumatolArthrosc 2017;25:3099-107.
55. Askenberger M, Janarv PM, Finnbogason T, Arendt EA. Morphology and anatomic patellar instability risk factors in first-time traumatic lateral patellar dislocations: A Prospective magnetic resonance imaging study in skeletally immature children. Am J Sports Med 2017;45:50-8.
56. Arendt EA, Donell ST, Sillanpää PJ, Feller JA. The management of lateral patellar dislocation: State of the art. J ISAKOS2017;2:205-12.
57. Jaquith BP, Parikh SN. Predictors of recurrent patellar instability in children and adolescents after first-time dislocation. J PediatrOrthop 2017;37:484-90.
58. Lewallen L, McIntosh A, Dahm D. First-time patellofemoral dislocation: Risk factors for recurrent instability. J Knee Surg 2015;28:303-9.


How to Cite this article:. Holt J K, Nelson B J. First-time Lateral Patellar Dislocation: Evaluation and Management. Asian Journal of Arthroscopy Jan – April 2018; 3(1):3-9.


(Abstract)      (Full Text HTML)      (Download PDF)