Database : MEDLINE
Search on : Patellar and Dislocation [Words]
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[PMID]: 23392290
[Au] Autor:Magnussen RA; De Simone V; Lustig S; Neyret P; Flanigan DC
[Ad] Address:Department of Orthopaedic Surgery, Sports Health and Performance Institute, The Ohio State University, Columbus, OH, USA, robert.magnussen@gmail.com.
[Ti] Title:Treatment of patella alta in patients with episodic patellar dislocation: a systematic review.
[So] Source:Knee Surg Sports Traumatol Arthrosc;22(10):2545-50, 2014 Oct.
[Is] ISSN:1433-7347
[Cp] Country of publication:Germany
[La] Language:eng
[Ab] Abstract:PURPOSE: While there are numerous anatomic contributors to patellar instability, the role of patella alta has been traditionally under-appreciated. The goal of this systematic review is to identify the described techniques for treating patella alta in skeletally mature patients with episodic patellar dislocation (EPD) and review their published results. METHODS: A comprehensive literature review was performed to identify published surgical techniques and their results. Tibial tubercle distalization is the primary described treatment for patellar alta in patients with EPD, and five studies reporting results of this procedure were reviewed. RESULTS: Tibial tubercle distalization was generally successful in normalizing patellar height and preventing recurrent patellar dislocation. Physical examination tests for instability such as patellar apprehension remained positive in 15 to 33 % of patients. Patient-reported outcomes were rarely reported and difficult to interpret given the lack of pre-operative values or comparison groups. CONCLUSION: Tibial tubercle distalization is an effective technique for correction of patellar height and preventing recurrent patellar dislocations. More comparative studies are required to evaluate patient-reported outcomes of this technique, the effect of an associated tubercle medialization, and the results of supplementing distalization with procedures such as MPFL reconstruction. LEVEL OF EVIDENCE: Systematic review of case series, Level IV.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1409
[Js] Journal subset:IM
[St] Status:In-Data-Review
[do] DOI:10.1007/s00167-013-2445-8

  2 / 1319 MEDLINE  
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[PMID]: 25059336
[Au] Autor:Sillanpää PJ; Salonen E; Pihlajamäki H; Mäenpää HM
[Ad] Address:Department of Orthopaedic Surgery and Trauma, Tampere University Hospital, Teiskontie 35, 33521, Tampere, Finland, petri.sillanpaa@uta.fi.
[Ti] Title:Medial patellofemoral ligament avulsion injury at the patella: classification and clinical outcome.
[So] Source:Knee Surg Sports Traumatol Arthrosc;22(10):2414-8, 2014 Oct.
[Is] ISSN:1433-7347
[Cp] Country of publication:Germany
[La] Language:eng
[Ab] Abstract:PURPOSE: To define medial patellofemoral ligament (MPFL) injury characteristics at the patellar attachment and clinical outcome in patients with primary traumatic patellar dislocation and MPFL avulsion injury at the patella. METHODS: Magnetic resonance imaging (MRI) was used to assess patients with primary (first-time) patellar dislocation and MPFL injury at the medial margin of the patella. Fifty-six patients with patellar attachment MPFL injury were enrolled in the study. Thirteen patients underwent surgical fixation of the avulsed MPFL and patellar medial margin osteochondral fracture, and the remaining patellar MPFL injures were treated nonoperatively. Forty-four patients were evaluated clinically at median four (range 1-10) years after patellar dislocation. The follow-up included evaluation of recurrent patellar instability, subjective symptoms, and functional limitations. RESULTS: Three types of patellar MPFL injuries were found; type P0 with ligamentous disruption at the patellar attachment, type P1 with bony avulsion fracture from the medial margin of the patella, and type P2 with bony avulsion involving articular cartilage from the medial facet of the patella. Of the patellar MPFL avulsion injuries that underwent initial surgical fixation, two patients (2/13) reported an unstable patella at follow-up. Fifty-five per cent (17/31) of patellar MPFL avulsion injuries that were treated nonoperatively had recurrent patellar instability (n.s.). The median Kujala score was 90 for patellar avulsion with surgical fixation and 86 for patellar avulsion without surgical fixation (n.s.). CONCLUSION: Patellar attachment MPFL injury showed three different patterns, classified as types P0, P1, and P2. MRI can be used to assess the injury pattern. Patellar MPFL avulsion injuries do not benefit from acute surgical repair compared with nonsurgical treatment. Type P2 patellar MPFL avulsion includes an osteochondral fracture that may require surgical fixation. LEVEL OF EVIDENCE: Prognostic study, Level III.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1409
[Js] Journal subset:IM
[St] Status:In-Data-Review
[do] DOI:10.1007/s00167-014-3174-3

  3 / 1319 MEDLINE  
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[PMID]: 25059335
[Au] Autor:Cerciello S; Lustig S; Costanzo G; Neyret P
[Ad] Address:Albert Trillat Center, Lyon North University Hospital, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France, simo.red@tiscali.it.
[Ti] Title:Medial retinaculum reefing for the treatment for patellar instability.
[So] Source:Knee Surg Sports Traumatol Arthrosc;22(10):2505-12, 2014 Oct.
[Is] ISSN:1433-7347
[Cp] Country of publication:Germany
[La] Language:eng
[Ab] Abstract:PURPOSE: Medial structures repair is a well-established approach in the treatment for patellar instability. However, the literature is confusing concerning the indications for surgery, the different surgical techniques and outcomes. The goal of this systematic review was to clarify the indications for medial structures repair and to analyse the results of both arthroscopic and open techniques. METHODS: A comprehensive literature review was performed using the keywords 'patellar instability', 'medial capsule reefing' and 'medial capsule plication' with no limit regarding the year of publication. All the selected articles in Anglo-Saxon language were evaluated with the Coleman methodology score. RESULTS: Seventeen full-text articles were evaluated. Initial cohort included 617 patients. About 569 patients were reviewed at an average FU of 54.6 months (range 2-165 months) after medial structures repair. Average age at the time of surgery was 21.2 years (range 9-65 years). The indications for surgery included both patellar subluxation and dislocation (acute or chronic). Average Kujala score increased from 55 to 84 at the last FU, and in the same way average Lysholm score increased from 41.2 to 80.5, whereas average Tegner score increased from 3 to 5.3 and IKDC score from 47.8 to 75.1. Re-dislocation rate among the series was 6.1 %. Average Coleman methodology score was 61.6 (range 17-92). CONCLUSION: From this review, it emerges that medial capsule reefing is a reliable option in the treatment for patellar instability. It can be proposed with good expectations, since the outcomes are positive and stable even at longer FU and complications rates are low. Re-dislocation rate is variable and can occur in up to one-third of patients. However, most of the available studies are case series, and comparison of the series is hard since they widely differ in inclusion criteria and indications, surgical technique and additional procedures, and outcome measures.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1409
[Js] Journal subset:IM
[St] Status:In-Data-Review
[do] DOI:10.1007/s00167-014-3171-6

  4 / 1319 MEDLINE  
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[PMID]: 25047793
[Au] Autor:Ménétrey J; Putman S; Gard S
[Ad] Address:Centre de medicine de l'appareil locomoteur et du sport, Unité d'Orthopédie et Traumatologie du Sport (UOTS), Swiss Olympic Medical Center, Service de chirurgie orthopédique et traumatologie de l'appareil moteur, University Hospital of Geneva (HUG) and Faculty of Medicine, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland, Jacques.menetrey@hcuge.ch.
[Ti] Title:Return to sport after patellar dislocation or following surgery for patellofemoral instability.
[So] Source:Knee Surg Sports Traumatol Arthrosc;22(10):2320-6, 2014 Oct.
[Is] ISSN:1433-7347
[Cp] Country of publication:Germany
[La] Language:eng
[Ab] Abstract:Patellofemoral instability may occur in a young population as a result of injury during sporting activities. This review focuses on return to sport after one episode of dislocation treated no operatively and as well after surgery for chronic patellofemoral instability. With or without surgery, only two-thirds of patients return to sports at the same level as prior to injury. A high-quality rehabilitation programme using specific exercises is the key for a safe return to sporting activities. To achieve this goal, recovery of muscle strength and dynamic stability of the lower limbs is crucial. The focus should be directed to strengthen the quadriceps muscle and pelvic stabilizers, as well as lateral trunk muscle training. Patient education and regularly performed home exercises are other key factors that can lead to a successful return to sports. The criteria for a safe return to sports include the absence of pain, no effusion, a complete range of motion, almost symmetrical strength, and excellent dynamic stability. Level of evidence IV.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1409
[Js] Journal subset:IM
[St] Status:In-Data-Review
[do] DOI:10.1007/s00167-014-3172-5

  5 / 1319 MEDLINE  
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[PMID]: 24781275
[Au] Autor:Becher C; Kley K; Lobenhoffer P; Ezechieli M; Smith T; Ostermeier S
[Ad] Address:Department of Orthopedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany, becher.chris@web.de.
[Ti] Title:Dynamic versus static reconstruction of the medial patellofemoral ligament for recurrent lateral patellar dislocation.
[So] Source:Knee Surg Sports Traumatol Arthrosc;22(10):2452-7, 2014 Oct.
[Is] ISSN:1433-7347
[Cp] Country of publication:Germany
[La] Language:eng
[Ab] Abstract:PURPOSE: To compare clinical and radiological outcomes of static and dynamic medial patellofemoral ligament (MPFL) reconstruction techniques. METHODS: In a retrospective, matched-paired, cohort analysis, 30 patients surgically treated for recurrent lateral patellar dislocation were divided into two groups of 15 patients matched for inclusion and exclusion criteria. The static technique group underwent rigid fixation of the gracilis tendon at the anatomic femoral MPFL insertion and the superomedial border of the patella; the dynamic technique group underwent detachment of the gracilis tendon at the pes anserinus with fixation to the proximal medial patellar margin via tunnel transfer obliquely through the patella. Kujala, Lysholm, and Tegner scores; pain level; and pre- and postoperative radiographic changes of patellar height, patellar tilt, and bisect offset were compared. RESULTS: No significant between-group differences were found in mean Kujala, Tegner, Lysholm, or visual analogue scale scores or radiographic parameters. One case of resubluxation was observed in the dynamic group. All but one patient in each group would have been willing to undergo the procedure again. CONCLUSIONS: Both techniques provided satisfactory short-term outcomes. LEVEL OF EVIDENCE: III.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1409
[Js] Journal subset:IM
[St] Status:In-Data-Review
[do] DOI:10.1007/s00167-014-3020-7

  6 / 1319 MEDLINE  
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[PMID]: 24760161
[Au] Autor:Kang HJ; Cao JH; Pan S; Wang XJ; Yu da H; Zheng ZM
[Ad] Address:Department of Orthopaedic Surgery, Shijiazhuang No. 1 Hospital, Shijiazhuang, 050011, Hebei, China.
[Ti] Title:The horizontal Y-shaped graft with respective graft tension angles in anatomical two-bundle medial patellofemoral ligament reconstruction.
[So] Source:Knee Surg Sports Traumatol Arthrosc;22(10):2445-51, 2014 Oct.
[Is] ISSN:1433-7347
[Cp] Country of publication:Germany
[La] Language:eng
[Ab] Abstract:PURPOSE: Various techniques for medial patellofemoral ligament (MPFL) reconstruction have been described with two bundles of graft tensioned simultaneously. The present study was to introduce an anatomical reconstruction procedure using a horizontal Y-shaped graft with respective graft tension angles and report the preliminary results. METHODS: A surgical technique for MPFL reconstruction using a horizontal Y-shaped semitendinosus tendon autograft with two bundles tensioned at 0° and 30° of knee flexion was described in detail. The patellar stability was evaluated with the apprehension test and an axial computed tomography (CT) scan at 30° of knee flexion. The knee function was evaluated using the Lysholm and Kujala scores. RESULTS: No recurrent dislocation or subluxation was reported for 45 patients at a mean of 33.7-month follow-up. On CT images, congruence angle, patellar tilt angle, lateral patellar angle and lateral displacement were restored to the normal range. At the last follow-up, the mean Lysholm score improved from 51.8 ± 6.2 to 91.7 ± 4.1 and mean Kujala score was from 53.4 ± 5.3 to 90.9 ± 6.6 (P < 0.01). CONCLUSIONS: The present anatomical MPFL reconstruction technique with a horizontal Y-shaped two-bundle graft tensioned at respective knee flexion angles could not only recreate the fan-shape of MPFL but also mimic the function bundles of native ligament. Clinical follow-up confirms the good restoration of the patellar stability and significant improvement of knee function without special complications. LEVEL OF EVIDENCE: Therapeutic, Level IV.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1409
[Js] Journal subset:IM
[St] Status:In-Data-Review
[do] DOI:10.1007/s00167-014-3005-6

  7 / 1319 MEDLINE  
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[PMID]: 24752539
[Au] Autor:Ntagiopoulos PG; Dejour D
[Ad] Address:Lyon-Ortho-Clinic, Clinique de la Sauvegarde, Ave Ben Gourion, Lyon, France, ntagiopoulos@hotmail.com.
[Ti] Title:Current concepts on trochleoplasty procedures for the surgical treatment of trochlear dysplasia.
[So] Source:Knee Surg Sports Traumatol Arthrosc;22(10):2531-9, 2014 Oct.
[Is] ISSN:1433-7347
[Cp] Country of publication:Germany
[La] Language:eng
[Ab] Abstract:Trochleoplasty is a surgical procedure, whose goal is to change the abnormal shape of the femoral trochlea in patients with recurrent patellar dislocation. Such surgeries that aim to reshape the articular surface of a bone without damaging it are quite unique in orthopaedic surgery. Although in the beginning, trochleoplasty was reserved for the refractory cases where previous surgery has failed, the last years it became more and more popular because of a better knowledge of anatomy and biomechanics and a greater availability of instruments. The roots of the deepening trochleoplasty could be found in the previous century when the first surgeons tried to directly remove the dysplastic bone with pioneer interventions but with devastating consequences. Since then, multiple procedures have been described and are analysed in this review; each one with its unique features, advantages and pitfalls. Regardless of the technique used, the very recent bibliography presents very encouraging results from the application of trochleoplasty with other procedures in a selected population with severe trochlear dysplasia and recurrent patellar dislocation, in whom the benign neglect of dysplasia would lead to unfavourable results. Level of evidence IV.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1409
[Js] Journal subset:IM
[St] Status:In-Data-Review
[do] DOI:10.1007/s00167-014-3013-6

  8 / 1319 MEDLINE  
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[PMID]: 24744173
[Au] Autor:Kuroda Y; Matsushita T; Matsumoto T; Kawakami Y; Kurosaka M; Kuroda R
[Ad] Address:Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
[Ti] Title:Bilateral medial patellofemoral ligament reconstruction in high-level athletes.
[So] Source:Knee Surg Sports Traumatol Arthrosc;22(10):2465-9, 2014 Oct.
[Is] ISSN:1433-7347
[Cp] Country of publication:Germany
[La] Language:eng
[Ab] Abstract:This report presents two cases of high-level athletes with bilateral patellar dislocations who were able to return to their preinjury level of activity after bilateral medial patellofemoral ligament (MPFL) reconstruction, without any major complications. Patient 1 was a 19-year-old male volleyball player for a top-level college volleyball team, and patient 2 was a 24-year-old woman who was a member of a national-level adult softball team. MPFL reconstruction could be an effective treatment for bilateral patellar dislocation in high-level athletes. Level of evidence V.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1409
[Js] Journal subset:IM
[St] Status:In-Data-Review
[do] DOI:10.1007/s00167-014-2990-9

  9 / 1319 MEDLINE  
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[PMID]: 24696005
[Au] Autor:Saffarini M; Ntagiopoulos PG; Demey G; Le Negaret B; Dejour DH
[Ad] Address:Accelerate Innovation Management SA, 1 Rue de la Navigation, 1201, Geneva, Switzerland, saffarini@mac.com.
[Ti] Title:Evidence of trochlear dysplasia in patellofemoral arthroplasty designs.
[So] Source:Knee Surg Sports Traumatol Arthrosc;22(10):2574-81, 2014 Oct.
[Is] ISSN:1433-7347
[Cp] Country of publication:Germany
[La] Language:eng
[Ab] Abstract:PURPOSE: The design of the trochlear compartment is crucial in patellofemoral arthroplasty (PFA), because 78 % of patients with isolated patellofemoral arthritis present concomitant trochlear dysplasia with patellar maltracking and therefore remain predisposed to post-operative patellar subluxation and dislocation. The study investigated whether current PFA implants are designed with anatomic trochlear parameters such as the sulcus angle, lateral facet height and groove orientation. METHODS: Five trochlear components of commercially available PFA implants were scanned, and the generated three-dimensional surfaces were measured using engineering design software. The mediolateral trochlear profiles were plotted at various flexion angles (0°, 15°, 30° and 45°) to deduce the following variables: sulcus angle, height of lateral facet and trochlear groove orientation. RESULTS: Four specimens had sulcus angle >144° in the 45° of flexion, and all five specimens had sulcus angle >143° in 30° of flexion. Three specimens had a facet <5 mm high through the entire range of early flexion (0°-30°), and two specimens had a facet <5 mm high beyond early flexion (30°-45°). The trochlear groove was oriented laterally in all specimens (range 1.6°-13.5°). CONCLUSION: Current PFA trochlear components are not always designed with anatomic parameters, and some models exhibit characteristics of trochlear dysplasia. Surgeons are therefore advised to implant components with a deep sulcus, particularly in patients with history of patellofemoral disorders, and to adapt the surgical technique and extensor mechanism if the component implanted has a shallow sulcus, to ensure normal patellar tracking. LEVEL OF EVIDENCE: III.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1409
[Js] Journal subset:IM
[St] Status:In-Data-Review
[do] DOI:10.1007/s00167-014-2967-8

  10 / 1319 MEDLINE  
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[PMID]: 24647852
[Au] Autor:Niimoto T; Deie M; Adachi N; Usman MA; Ochi M
[Ad] Address:Department of Orthopaedic Surgery, Higashihiroshima Medical Center, 513 Jike, Saijyou-chou, Higashihiroshima, Hiroshima, Japan, takuniimoto@gmail.com.
[Ti] Title:Quantitative stress radiography of the patella and evaluation of patellar laxity before and after lateral release for recurrent dislocation patella.
[So] Source:Knee Surg Sports Traumatol Arthrosc;22(10):2408-13, 2014 Oct.
[Is] ISSN:1433-7347
[Cp] Country of publication:Germany
[La] Language:eng
[Ab] Abstract:PURPOSE: The aims of the present controlled clinical study were to (1) compare patella laxity determined in the outpatient clinic with that in anaesthetized patients and (2) evaluate patella laxity before and after lateral release. METHOD: The study evaluated data on 33 knees from 33 patients (average age 19.7 years) between 2007 and 2011. All patients were diagnosed with recurrent dislocation of the patella. Patellar stability was evaluated in each patient thrice: patellas were first imaged in the outpatient clinic prior to surgery at 45° knee flexion with 20 N stress from the medial to lateral side and from the lateral to medial side; then, at the time of surgery, patella stress images were obtained in the same manner before and after the lateral release procedure. Radiological assessments were performed using the medial stress shift ratio (MSSR) and lateral stress shift ratio (LSSR). RESULTS: There were no significant differences in the LSSR and MSSR before surgery (outpatient data) and in anaesthetized patients before the lateral release procedure. Furthermore, there was no significant difference in MSSR at the time of surgery before and after the lateral release procedure. However, LSSR increased significantly after the lateral release procedure. CONCLUSION: The results of the present study suggest that quantitative patella stress radiography in the outpatient clinic is useful when it comes to investigating laxity of the patella, and that lateral release significantly increases lateral, but not medial, laxity in patients with recurrent patellar dislocation. LEVEL OF EVIDENCE: IV.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1409
[Js] Journal subset:IM
[St] Status:In-Data-Review
[do] DOI:10.1007/s00167-014-2930-8


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