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.
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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.

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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.

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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.

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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

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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.

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Wrist Arthroscopy– Setup, Indications and Complications

Satish Mane, Marwan Hardan, Anup Bansode, Abhijeet L Wahegaonkar

Volume 2 | Issue 2 | Sep-Dec 2017 |

Author: Satish Mane [1], Marwan Hardan [1], Anup Bansode [2],
Abhijeet L Wahegaonkar [1]

[1] Department of Upper Extremity, Hand and Microvascular Reconstructive
Surgery, Sancheti Institute for Orthopedics and Rehabilitation, Pune,
Maharashtra, India,
[2] Department of Hand Surgery, Jehangir Hospital, Pune, Maharashtra, India.

Address of Correspondence
Dr. Satish Mane,
Department of Upper Extremity, Hand and Microvascular Reconstructive Surgery,
Sancheti Institute for Orthopedics and Rehabilitation, Pune, Maharashtra, India.
E-mail: drsatishmane@gmail.com

Abstract

Wrist Arthroscopy, a minimally invasive, outpatient procedure, is a valuable tool in the diagnosis and treatment of most disorders of the wrist. In this article Arthroscopy set up, equipments are described, and operative indications and complications are discussed. Anatomy of Portal is described in details. Portals allow direct visualization of articular surfaces of radio-carpal and mid-carpal joints, triangular fibrocartilage, interosseous and extrinsic ligaments. It offers direct visualization of the structures of the joint anatomy and existing disease processes while causing minimal damage to surrounding soft tissue.
Keywords: Wrist arthroscopy, indications, portals, complications.

How to Cite this article: Mane S, Hardan M, Bansode A, Wahegaonkar AL. Wrist Arthroscopy – Setup, Indications, and Complications. Asian Journal Arthroscopy Sep-Dec 2017; 2(2): 11-14.

 

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Chronic Instability of the Distal Radioulnar Joint: Diagnosis and Management

Abhijeet L Wahegaonkar, Steve Rocha

Volume 2 | Issue 2 | Sep – Dec 2017 | Page 2-7

Author: Abhijeet L Wahegaonkar [1], Steve Rocha [1]

[1]  Department of Orthopaedics, Upper Extremity, Hand and Microvascular Reconstructive Surgery Service, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, India.
[2] Orthopaedic Speciality Clinic, Pune Mahatrahtra.

Address of Correspondence
Dr. Abhijeet L. Wahegaonkar
Department of Orthopaedics, Upper Extremity, Hand and
Microvascular Reconstructive Surgery Service, Sancheti Institute
for Orthopaedics and Rehabilitation, Pune, Maharashtra, India.
Email: abhiwahe@gmail.com

Abstract

Chronic Instability of the distal radioulnar joint is not uncommon but often misdiagnosed and mistreated. This review focusses on chronic wrist instability and provides an insight into this uncommon disorder.
Keywords: Distal Radioulnar Joint.

References

1. Albert SM, Wohl MA, Rechtman AM. Treatment of the disrupted radio-ulnar joint. J Bone Joint Surg Am 1963;45:1373-1381.
2. Alexander AH. Bilateral traumatic dislocation of the distal radioulnar joint, ulna dorsal: Case report and review of the literature. Clin Orthop Relat Res 1977;129:238-244.
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25. Adams BD, Samani JE, Holley KA. Triangular fibrocartilage injury: A laboratory model. J Hand Surg Am 1996;21(2):189-193.
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How to Cite this article:. Wahegaonkar AL, Rocha S. Chronic instability of the distal radioulnar joint: diagnosis and management. Asian Journal Arthroscopy Sep-Dec 2017;2(2):2-7.

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Wrist Symposium in Asian Journal of Arthroscopy

Abhijeet Wahegaonkar, Sachin Tapasvi

Volume 2 | Issue 2 | Sep – Dec 2017 | Page 1

Author: Abhijeet Wahegaonkar [1], Sachin Tapasvi [2]

[1] Department of Orthopaedics, Upper Extremity, Hand and Microvascular Reconstructive Surgery Service, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, India.
[2] Orthopaedic Speciality Clinic, Pune Mahatrahtra.

Address of Correspondence
Dr. Abhijeet L. Wahegaonkar
Department of Orthopaedics, Upper Extremity, Hand and Microvascular Reconstructive Surgery Service, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, India.
Email: abhiwahe@gmail.com

Wrist Symposium in Asian Journal of Arthroscopy

It is perhaps for the first time that a special issue dedicated to wrist arthroscopy is being published in the Asia-Pacific region.
The advent of wrist arthroscopy has facilitated the diagnosis; improved the understanding of the etiopathogenesis and helped in the development of new therapies for several wrist injuries and pathologies with promising results. Therapeutic wrist arthroscopy has been established as the “Gold Standard” in the management of TFCC injuries and the indications are ever evolving, with contributions from brilliant authors and clinicians from around the world.
Arthroscopy of the wrist was once primarily performed for diagnostic applications. With rapid development of this art and science, the indications have expanded to reparative and reconstructive procedures.
This issue of the Asian Journal of Arthroscopy exposes just the tip of the iceberg of the exciting times ahead in the field of wrist surgery. I sincerely hope that the readers will gain some insight into the most commonly performed arthroscopic procedures such as ganglion excision, TFCC repair and scapholunate ligament repair. This is like a sensitization of what is a potentially “complicated” area even for experienced arthroscopists with the intention to drive away a lot of mental blocks towards wrist arthroscopy. The realm of possibility is ever expanding for anyone who wishes to explore this field.
I am grateful to the authors, each a master of wrist arthroscopy, for taking time off their busy practice and schedule to contribute to advancing science and knowledge.
I would like to take this opportunity to thank the Editors of the Asian Journal of Arthroscopy for entrusting me with the responsibility of compiling this special issue on Wrist Arthroscopy. I do hope our efforts satiates the readers’ appetite for information and knowledge.
Happy reading!

Dr. Abhijeet L. Wahegaonkar | Dr Sachin Tapasvi

How to Cite this article:. Wahegaonkar AL, Tapasvi SR. Wrist Symposium in Asian Journal of Arthroscopy. Asian Journal of Arthroscopy Sep-Dec 2017;2(2):1.

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Rehabilitation Postsurgical Stabilization for Shoulder Instability

Shyam Sundar, David V Rajan

Volume 2 | Issue 1 | Jan – Apr 2017 | Page 40 – 48

Author: Shyam Sundar [1], David V Rajan [1].

[1] Ortho OneOrthopaedic Speciality Centre, Coimbatore, Tamil Nadu, India

Address of Correspondence

Dr. Shyam Sundar,
MS Orthopaedics, Ortho One Orthopaedic Speciality Centre, Coimbatore – 641 005, Tamil Nadu, India.
Email: drshyam.msortho@gmail.com

Abstract

The shoulder joint is a polyaxial joint with the advantage of increased mobility at the cost of stability. The incidence of subluxation/dislocation is on the increase considering the fact that children are more actively involved in sporting activities at a very young age. This has necessitated the orthopedic surgeons to identify those at risk of injuries as well as to treat those with injuries to restore normality without compromising the function. Over the recent past, surgical management for shoulder instability has evolved to a more precise level giving importance to the minutest details in respecting and repairing the injured structures. As a result of which the patient’s recovery and functional outcome has been better than how it was earlier. Nonetheless, the success of surgery depends not only on the surgeon or the patient factors but also in the implementation of a tailored rehabilitation protocol focusing on getting the patient back to normalcy at the earliest with minimal discomfort. The aim of this article is to kindle the various aspects of an ideal rehabilitation following surgical stabilization of shoulder instability and to guide in the optimizing treatment protocol.
Keywords: Shoulder instability, Rehabilitation, Proprioception, Kinetic chain.

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How to Cite this article:. Sundar S, Rajan DV. Rehabilitation Postsurgical Stabilization for Shoulder Instability Asian Journal of Arthroscopy Jan – April 2017;1(2):40-48.

 

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