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[PMID]: 23681410
[Au] Autor:Hartmann F; Dietz SO; Rommens PM; Gercek E
[Ad] Address:Department of Trauma Surgery, Center for Musculoskeletal Surgery, University Medical Centre Mainz, Mainz, Germany.
[Ti] Title:Long-term outcome after operative treatment of traumatic patellar dislocation in adolescents.
[So] Source:J Orthop Trauma;28(3):173-80, 2014 Mar.
[Is] ISSN:1531-2291
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVES: Retrospective evaluation of the long-term outcomes after surgical treatment of traumatic patellar dislocations in adolescents and identification of possible predictive factors of poor outcomes. DESIGN: Retrospective clinical study. SETTING: University Clinic, Level I Trauma Center. PATIENTS: All 33 adolescents, with a mean age of 14.8 years, who were treated surgically after traumatic patellar dislocation between 1994 and 2006, were involved in this study. INTERVENTION: Mini-open medial reefing and arthroscopic lateral release. MAIN OUTCOME MEASUREMENTS: The clinical outcome was evaluated with the visual analogue scale, the Lysholm score, the Kujala score, and the Tegner activity level scale. On preoperative radiographs and magnetic resonance imaging scans, trochlear dysplasia and patella alta were assessed. The variables analyzed were sex, associated osteochondral injuries, the number of redislocations before surgery, and the number of redislocations after surgery. RESULTS: At the mean follow-up of 9.8 years, the mean Lysholm score was 82.6, the mean Kujala score was 84.4, the mean Tegner activity level was 4.8, and the mean visual analogue scale was 0.2. We found no significant differences in the subgroups regarding functional outcomes. Fifteen patients with patella alta and 4 patients with trochlear dysplasia were assessed radiologically. Redislocations after surgery were observed in 4 patients, 2 of them were female patients who exhibited quadriceps angles requiring tibial tubercle osteotomy to be performed after maturation. CONCLUSIONS: The techniques of mini-open medial reefing and lateral release demonstrate a good functional long-term outcome and effectively prevent recurrent instability. The major predictive factor for poor outcomes and redislocations is an inadequately addressed pathology. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
[Mh] MeSH terms primary: Patella/surgery
Patellar Dislocation/surgery
[Mh] MeSH terms secundary: Adolescent
Child
Female
Humans
Male
Patella/injuries
Prognosis
Recovery of Function
Retrospective Studies
Risk Factors
Surgical Procedures, Minimally Invasive
Treatment Outcome
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1409
[Js] Journal subset:IM
[Da] Date of entry for processing:140224
[St] Status:MEDLINE
[do] DOI:10.1097/BOT.0b013e318299cb50

  2 / 1299 MEDLINE  
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[PMID]: 24268843
[Au] Autor:Guilbert S; Chassaing V; Radier C; Hulet C; Rémy F; Chouteau J; Chotel F; Boisrenoult P; Sebilo A; Ferrua P; Ehkirch FP; Bertin D; Dejour D; French Arthroscopy Society (SFA)
[Ad] Address:Pôle Santé Oréliance, Maison des consultations, 551, avenue Jacqueline-Auriol, 45770 Saran, Orléans, France. Electronic address: docteur.guilbert@gmail.com.
[Ti] Title:Axial MRI index of patellar engagement: a new method to assess patellar instability.
[So] Source:Orthop Traumatol Surg Res;99(8 Suppl):S399-405, 2013 Dec.
[Is] ISSN:1877-0568
[Cp] Country of publication:France
[La] Language:eng
[Ab] Abstract:INTRODUCTION: The aim of this study was to define a new index to measure lateral patellar displacement (LPD) using nuclear magnetic resonance imaging (MRI), an axial index of engagement of the patella (AEI) obtained from two different axial MRI views then to validate its use in a prospective series of patients presenting an objective patellar instability (OPI). MATERIALS AND METHODS: One hundred and thirty-five patients with OPI and no history of surgery of the patella were included in a prospective study organized by the French Society of Arthroscopy performed between June 2010 and August 2012. All patients underwent axial and sagittal MRI. The AEI was obtained by projecting predefined patellar and trochlear landmarks (cartilaginous landmarks) on 2 different axial MRI views (one trochlear and one patellar). The results were compared with a series of controls (n=45). RESULTS: The preoperative AEI of the patella was 0.94 ± 0.09 for the control group and 0.84 ± 0.16 for OPI group (P=0.000016). The AEI could be obtained in 100% of the cases if it was measured on 2 MRI views while it could not be measured in 38.5% of the cases if the measurement was only obtained from one MRI view or whenever the widest part of the patella was not across from the femoral trochlea. The AEI did not significantly depend on dysplasia or the presence of a supratrochlear spur. The lowest AIE values were associated with trochlear dysplasia with a supratrochlear spur (P=0.0023) and a more prominent trochlea (P=0.0016). The AEI was correlated with patellar tilt (P<0.000001) and TT-TG on MRI (P<0.000001). DISCUSSION: AEI is a new index to measure LPD. It can be obtained in all cases because it is obtained from two different MRI views. The normal value is close to 1. It can be used to measure patellar instability on the axial plane in patients with OPI, especially in the most severe cases.
[Mh] MeSH terms primary: Joint Instability/diagnosis
Magnetic Resonance Imaging/methods
Patellar Dislocation/diagnosis
[Mh] MeSH terms secundary: Adult
Arthroscopy/methods
Case-Control Studies
Female
Humans
Joint Instability/surgery
Male
Patellar Dislocation/surgery
Postoperative Care/methods
Preoperative Care/methods
Prognosis
Prospective Studies
Reference Values
Reproducibility of Results
Severity of Illness Index
Treatment Outcome
[Pt] Publication type:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Entry month:1408
[Js] Journal subset:IM
[Da] Date of entry for processing:131209
[St] Status:MEDLINE

  3 / 1299 MEDLINE  
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[PMID]: 24246663
[Au] Autor:Dejour D; Ferrua P; Ntagiopoulos PG; Radier C; Hulet C; Rémy F; Chouteau J; Chotel F; Boisrenoult P; Sebilo A; Guilbert S; Bertin D; Ehkirch FP; Chassaing V; French Arthroscopy Society (SFA)
[Ad] Address:Clinique de la Sauvegarde, bâtiment Trait-d'union allée B, 29, avenue des Sources, 69009 Lyon, France. Electronic address: corolyon@wanadoo.fr.
[Ti] Title:The introduction of a new MRI index to evaluate sagittal patellofemoral engagement.
[So] Source:Orthop Traumatol Surg Res;99(8 Suppl):S391-8, 2013 Dec.
[Is] ISSN:1877-0568
[Cp] Country of publication:France
[La] Language:eng
[Ab] Abstract:INTRODUCTION: Patella alta is one of the primary factors of patellofemoral instability and its importance lies in the reduced engagement between patella and trochlea during the early degrees of flexion. The evaluation of patellar height is based on conventional x-rays, CT scan and, more recently, MRI. The objective of this multicentric prospective study is to describe a novel index to assess in the sagittal plane the functional engagement between patella and trochlea. MATERIALS AND METHODS: One hundred and thirty-five patients with objective patellar dislocation were prospectively enrolled between April 2010 and September 2011 and were compared with a second group of 45 controls. All patients underwent a standard MRI and a complete radiographic study. Sagittal engagement was measured as the ratio between the articular cartilage of the patella and the trochlear cartilage length measured on two different MRI slices. RESULTS: The mean Sagittal Patellofemoral Engagement (SPE) index was 0.43 ± 0.18 and ranged from 0.02 to 0.913 in the Objective Patellar Dislocation group versus 0.42 ± 0.11 range 0.22 to 0.55 in controls. In the Patellar Dislocation group the mean Caton-Deschamps index was 1.18 ± 0.21 (range 0.71 to 1.91). There were 58 patients with patella alta, in whom the mean SPE was 0.39 ± 0.18 (range 0.02 to 0.87). Sagittal engagement was significantly higher when compared with patients in the Patellar Dislocation group who had no patella alta (mean 0.46 ± 0.16, range 0.1-0.913). DISCUSSION: The present study introduces a new method to measure the SPE with the use of MRI. The evaluation of the functional engagement of the patella with the femoral trochlea in the sagittal plane can serve as a supplementary tool to the existing methods of evaluating patellar height, and may help to better identify the cases where inadequate engagement is recorded despite the absence of patella alta, so that the need for tibial tuberosity osteotomy may be re-assessed.
[Mh] MeSH terms primary: Joint Instability/diagnosis
Magnetic Resonance Imaging/methods
Patellar Dislocation/diagnosis
Patellofemoral Joint/pathology
Range of Motion, Articular/physiology
[Mh] MeSH terms secundary: Adolescent
Adult
Age Factors
Arthroscopy/methods
Child
Cohort Studies
Female
Follow-Up Studies
Humans
Injury Severity Score
Joint Instability/surgery
Male
Middle Aged
Patellar Dislocation/surgery
Patellofemoral Joint/surgery
Prospective Studies
Recovery of Function
Risk Assessment
Sex Factors
Treatment Outcome
Young Adult
[Pt] Publication type:COMPARATIVE STUDY; JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Entry month:1408
[Js] Journal subset:IM
[Da] Date of entry for processing:131209
[St] Status:MEDLINE

  4 / 1299 MEDLINE  
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[PMID]: 24362407
[Au] Autor:Hensler D; Sillanpaa PJ; Schoettle PB
[Ad] Address:aDepartment of Trauma Surgery, Trauma Center Murnau, Murnau, Germany bTampere University Hospital, Tampere, Finland cMedical Director of Orthopedics and Sports Medicine, Isar Medical Centre, Munich, Germany.
[Ti] Title:Medial patellofemoral ligament: anatomy, injury and treatment in the adolescent knee.
[So] Source:Curr Opin Pediatr;26(1):70-8, 2014 Feb.
[Is] ISSN:1531-698X
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:PURPOSE OF REVIEW: Traumatic and nontraumatic patellofemoral instability (PFI) in children and adolescents is a complex problem. It is determined by a large number of mechanical and pathomorphologic conditions, mainly seen in nontraumatic dislocations. RECENT FINDINGS: Although conservative treatment with a short immobilization, followed by early passive motion and isometric quadriceps strengthening, can be considered in real traumatic dislocations without any cartilaginous injury, a surgical intervention should be considered in atraumatic cases. As 90% of PFI are nontraumatic and correlated with skeletal deformities, the redislocation rate is reported to be up to 80% after initial conservative treatment. To optimize the results, the causing disorder for PFI has to be considered imperatively. In addition to bony disorder, further risk factors have to be taken into consideration for determining the optimal time for surgery. As biomechanical and clinical studies have shown the importance of the medial patellofemoral complex, especially the medial patellofemoral ligament (MPFL), against patellar lateralization, the reconstruction or minimally invasive double-bundle reconstruction of the MPFL is the main surgical technique to treat PFI in children, as it can be used even in open epiphysial cartilage. Further surgical interventions correcting bone deformities, such as trochleoplasty or tibial tubercle osteotomies addressing lower limb deformities, should be performed after closure of the epiphysial cartilage. SUMMARY: It is the goal of this overview to explain the pathoanatomy of PFI, the demanding clinical and radiological examinations and treatment options.
[Mh] MeSH terms primary: Joint Instability/surgery
Knee Injuries/surgery
Ligaments, Articular/surgery
Patellofemoral Joint/surgery
[Mh] MeSH terms secundary: Adolescent
Biomechanical Phenomena
Humans
Joint Instability/diagnosis
Joint Instability/etiology
Joint Instability/pathology
Knee Injuries/diagnosis
Knee Injuries/pathology
Ligaments, Articular/injuries
Ligaments, Articular/pathology
Magnetic Resonance Imaging
Patellar Dislocation/diagnosis
Patellar Dislocation/etiology
Patellar Dislocation/pathology
Patellar Dislocation/surgery
Patellofemoral Joint/injuries
Patellofemoral Joint/pathology
Patellofemoral Joint/physiopathology
Risk Factors
[Pt] Publication type:JOURNAL ARTICLE; REVIEW
[Em] Entry month:1408
[Js] Journal subset:IM
[Da] Date of entry for processing:140108
[St] Status:MEDLINE
[do] DOI:10.1097/MOP.0000000000000055

  5 / 1299 MEDLINE  
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[PMID]: 24902510
[Au] Autor:Mansour R; Yoong P; McKean D; Teh JL
[Ad] Address:Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Windmill Road, Headington, Oxford, UK.
[Ti] Title:The iliotibial band in acute knee trauma: patterns of injury on MR imaging.
[So] Source:Skeletal Radiol;43(10):1369-75, 2014 Oct.
[Is] ISSN:1432-2161
[Cp] Country of publication:Germany
[La] Language:eng
[Ab] Abstract:OBJECTIVE: To delineate the spectrum of knee injuries associated with sprains and tears of the distal iliotibial band (ITB). MATERIALS AND METHODS: A retrospective review of 200 random MRI scans undertaken for acute knee trauma was performed. Scans were excluded if there was a history of injury over 4 weeks from the time of the scan, septic arthritis, inflammatory arthropathy, previous knee surgery, or significant artefact. In each scan, the ITB was scored as normal, minor sprain (grade 1), severe sprain (grade 2), and torn (grade 3). The menisci, ligaments, and tendons of each knee were also assessed. RESULTS: The mean age was 27.4 years (range, 9-69 years) and 71.5 % (n = 143) of the patients were male. The ITB was injured in 115 cases (57.5 %). The next most common soft tissue structure injured was the anterior cruciate ligament (ACL) in 53.5 % of cases (n = 107). Grade 1 ITB injury was seen in 90 of these 115 cases (45 %), grade 2 injury in 20 cases, and grade 3 injury in only five cases. There is a significant association between ITB injury and ACL rupture (p < 0.05), as well as acute patellar dislocation (p < 0.05). There were ten cases of significant posterolateral corner injury, and all were associated with ITB injury, including four ITB tears. Only two cases of isolated ITB injury were seen (1 %). CONCLUSIONS: ITB injury is common in acute knee trauma and is associated with significant internal derangement of the knee, especially cruciate ligament rupture, posterolateral corner injury, and patellar dislocation.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1408
[Js] Journal subset:IM
[St] Status:In-Data-Review
[do] DOI:10.1007/s00256-014-1918-2

  6 / 1299 MEDLINE  
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[PMID]: 24144621
[Au] Autor:Berenger V; Pesenti S; Ollivier M; Buord JM; Pinelli PO
[Ad] Address:Hôpital de la Conception, 147, boulevard Baille, 13005 Marseille, France.
[Ti] Title:Traumatic inter-condylar dislocation of the patella: report of two cases.
[So] Source:Orthop Traumatol Surg Res;99(8):979-81, 2013 Dec.
[Is] ISSN:1877-0568
[Cp] Country of publication:France
[La] Language:eng
[Ab] Abstract:Traumatic patellar dislocation usually occurs in the lateral direction. In a few cases, however, the patella rotates around its horizontal axis and becomes wedged between the femoral condyles. We report two cases of traumatic inter-condylar patellar dislocation that required surgical management.
[Mh] MeSH terms primary: Knee Joint/surgery
Patellar Dislocation/surgery
[Mh] MeSH terms secundary: Adolescent
Biomechanical Phenomena
Humans
Knee Joint/physiopathology
Ligaments, Articular/radiography
Male
Patellar Dislocation/physiopathology
Patellar Dislocation/radiography
Range of Motion, Articular
Rotation
Young Adult
[Pt] Publication type:CASE REPORTS; JOURNAL ARTICLE
[Em] Entry month:1408
[Js] Journal subset:IM
[Da] Date of entry for processing:131203
[St] Status:MEDLINE

  7 / 1299 MEDLINE  
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[PMID]: 24817023
[Au] Autor:de Oliveira V; de Souza V; Cury R; Camargo OP; Avanzi O; Severino N; Fucs P
[Ad] Address:Orthopaedic and Traumatology, Santa Casa Medical School and Hospitals, São Paulo, Brazil.
[Ti] Title:Medial patellofemoral ligament anatomy: is it a predisposing factor for lateral patellar dislocation?
[So] Source:Int Orthop;38(8):1633-9, 2014 Aug.
[Is] ISSN:1432-5195
[Cp] Country of publication:Germany
[La] Language:eng
[Ab] Abstract:PURPOSE: Because the medial patellofemoral ligament (MPFL) is the primary restraint to lateral dislocation of the patella, we aimed, in this controlled study, to verify whether the MPFL with different measurements could be considered another predisposing factor for patellar dislocation. METHODS: A group of 100 consecutive individuals without the criteria for patellar dislocation (trochlear dysplasia, patella alta and lateral patellar tilt) was recruited as a control group and underwent magnetic resonance imaging (MRI) study and another group of 50 patients with patellar instability. Femoral condyles, interepicondylar distance, length and thickness of the MPFL were measured. RESULTS: In the control group, the MPFL was 38-60 mm long. Individuals with patellar instability who had no episode of patellar dislocation had a 4.11-mm longer ligament than controls (p = 0.032), while patients with instability with a previous history of dislocation had a 13.54-mm longer MPFL than controls (p < 0.001). Thickness of the MPFL at the patellar insertion was lower in individuals with patellar instability with a history of dislocation (p < 0.001). An instability coefficient (IC) less than 1.3 indicates that the MPFL is insufficient. CONCLUSIONS: Individuals with patellar instability and previous patellar dislocation present with longer MPFL when compared to controls, and an associated IC less than 1.3 can be considered a predisposing factor for patellar dislocation. Treatment of patellar instability is a challenge, and it is difficult to identify what is the predisposing factor. This study has verified the measurements of the MPFL for the first time and presents values of thickness and length that can be considered as indications for surgical reconstruction. LEVEL OF EVIDENCE: III.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1407
[Js] Journal subset:IM
[St] Status:In-Data-Review
[do] DOI:10.1007/s00264-014-2357-3

  8 / 1299 MEDLINE  
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[PMID]: 24992066
[Au] Autor:Borbas P; Koch PP; Fucentese SF
[Ti] Title:Lateral patellofemoral ligament reconstruction using a free gracilis autograft.
[So] Source:Orthopedics;37(7):e665-8, 2014 Jul.
[Is] ISSN:1938-2367
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Medial patellofemoral instability is a rare, disabling condition that is often associated with the wrong indication for lateral retinacular release or overcorrection with medializing tibial tubercle osteotomy. It is an even less common complication after total knee arthroplasty (TKA). The lateral patellofemoral ligament is an important lateral stabilizer of the patella against medial subluxation or dislocation. Until now, no report in the literature has described lateral patellofemoral ligament reconstruction with a free gracilis tendon autograft. Furthermore, there has not been a single case report of lateral patellofemoral ligament reconstruction after TKA. The authors describe a novel technique for reconstruction of the lateral patellofemoral ligament in a symptomatic medial subluxated patella resulting from TKA and extended lateral release in a 62-year-old patient. The result 1 year postoperatively was deemed successful. Clinically, the patella was stable, with correct tracking, and radiologically the patella was correctly positioned. With a technique similar to that used for the medial patellofemoral ligament, the lateral patellofemoral ligament can be reconstructed with a gracilis tendon autograft to permit stabilization independent of resting scar tissue of the lateral retinaculum. This operation can be performed in a minimally invasive way, without opening the joint, therefore decreasing the risk of joint infection. The authors showed a successful clinical and radiologic outcome 1 year after lateral patellofemoral ligament reconstruction in a patient with medial patellar instability after TKA and lateral release.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1407
[Js] Journal subset:IM
[St] Status:In-Process
[do] DOI:10.3928/01477447-20140626-66

  9 / 1299 MEDLINE  
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[PMID]: 24993410
[Au] Autor:Koh JL; Stewart C
[Ad] Address:Orthopaedic Surgery, NorthShore University HealthSystem, 2650 Ridge Avenue, Walgreen's 2505, Evanston, IL, USA; Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago Medicine & Biological Sciences, 5841 S. Maryland Avenue, Rm. P207, MC 3079, Chicago, IL 60637, USA. Electronic address: kohj1@hotmail.com.
[Ti] Title:Patellar instability.
[So] Source:Clin Sports Med;33(3):461-76, 2014 Jul.
[Is] ISSN:1556-228X
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Patella instability can cause significant pain and functional limitations. Several factors can predispose to patella instability, such as ligamentous laxity, increased anterior TT-TG distance, patella alta, and trochlear dysplasia. Acquired factors include MPFL injury or abnormal quadriceps function. In many cases, first-time dislocation can successfully be managed with physical therapy and other nonoperative management; however, more than one dislocation significantly increases the chance of recurrence. Surgical management can improve stability, but should be tailored to the injuries and anatomic risk factors for recurrent dislocation. Isolated lateral release is not supported by current literature and increases the risk of iatrogenic medial instability. Medial repair is usually reserved for patients with largely normal anatomy. MPFL reconstruction can successfully stabilize patients with medial soft tissue injury but is a technically demanding procedure with a high complication rate and risks of pain and arthrosis. Tibial tubercle osteotomy can address bony malalignment and also unload certain articular cartilage lesions while improving stability. Trochleoplasty may be indicated in individuals with a severely dysplastic trochlea that cannot otherwise be stabilized. A combination of procedures may be necessary to fully address the multiple factors involved in causing pain, loss of function, and risk of recurrence in patients with patellar instability.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1407
[Js] Journal subset:IM
[St] Status:In-Process

  10 / 1299 MEDLINE  
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[PMID]: 24993408
[Au] Autor:Thomas S; Rupiper D; Stacy GS
[Ad] Address:Department of Radiology, University of Chicago, 5841 South Maryland Avenue, MC 2026, Chicago, IL 60637, USA.
[Ti] Title:Imaging of the patellofemoral joint.
[So] Source:Clin Sports Med;33(3):413-36, 2014 Jul.
[Is] ISSN:1556-228X
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:The patellofemoral (PF) joint is a complex articulation, with interplay between the osseous and soft tissue structures to maintain the balance between knee mobility and stability. Disorders of the PF joint can be a source of anterior knee pain (AKP). In this article, radiographic and magnetic resonance imaging of the PF joint are reviewed, including normal anatomy, imaging techniques, and imaging-based measurements. Common imaging findings associated with AKP are reviewed, including symptomatic normal variants, tendinopathy, apophysitis, osteoarthritis, chondromalacia patella, trochlear dysplasia, excessive lateralization of tibial tuberosity, patellar maltracking, patellar dislocation and fractures, anterior bursitis, Morel-Lavallée effusions, and fat pad edema.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1407
[Js] Journal subset:IM
[St] Status:In-Process


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