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.

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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

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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.

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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

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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.
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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.
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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.

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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

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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.

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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.

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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 .

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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

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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

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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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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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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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