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Search on : Patellar and Dislocation [Words]
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[PMID]: 26148808
[Au] Autor:Kühle J; Südkamp NP; Niemeyer P
[Ad] Address:Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79098, Freiburg, Deutschland, jan.kuehle@uniklinik-freiburg.de.
[Ti] Title:Osteochondrale Frakturen am Kniegelenk. [Osteochondral fractures at the knee joint].
[So] Source:Unfallchirurg;118(7):621-34, 2015 Jul.
[Is] ISSN:1433-044X
[Cp] Country of publication:Germany
[La] Language:ger
[Ab] Abstract:Osteochondral fractures are traumatic shearing injuries to the cartilage and the subchondral bone which lead to defects in the articular surface and potentially lead to further degeneration and arthritis. Early diagnosis and therapy are therefore very important. As the resolving power of conventional X-rays is limited for this situation, magnetic resonance imaging (MRI) is regarded as the gold standard for diagnostics. Concomitant injuries often occur, such as tearing of the anterior cruciate ligament (ACL) or patellar dislocation resulting in instability of the patella. Concerning treatment options for osteochondral fractures, there are two potential strategies that can be applied: the first is removal of small osteochondral fragments with subsequent formation of regeneration tissue and the second is refixation of the dislocated fragment and therefore a 1-stage reconstruction of the joint surface. It is important to also address concomitant injuries. Even though there is no consensus for a standardized or evidence-based therapy in literature, this article gives an overview of the diagnostics and available therapeutic options.
[Pt] Publication type:ENGLISH ABSTRACT; JOURNAL ARTICLE
[Em] Entry month:1507
[Js] Journal subset:IM
[St] Status:In-Data-Review
[do] DOI:10.1007/s00113-015-0033-8

  2 / 1397 MEDLINE  
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[PMID]: 24217708
[Au] Autor:Rutherford L; Arthurs GI
[Ad] Address:Royal Veterinary College, Queen Mother Hospital for Animals, Hatfield, UK lrutherford@rvc.ac.uk.
[Ti] Title:Partial parasagittal patellectomy: a novel method for augmenting surgical correction of patellar luxation in four cats.
[So] Source:J Feline Med Surg;16(8):689-94, 2014 Aug.
[Is] ISSN:1532-2750
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:We describe a novel surgical technique used to correct feline patellar luxation (PL) where abnormal patellar tracking persists despite conventional corrective surgery. An anatomical difference between feline and canine stifles is that the feline patella is wider relative to the trochlear sulcus. This results in less constrained patellar tracking. Therefore, patellar subluxation is common in normal cats. It was noticed that in some feline cases with clinically significant PL, PL persisted intraoperatively despite performing the standard corrective procedures. We report a novel surgical technique - partial parasagittal patellectomy - to address the wide shape of the feline patella relative to the sulcus. This technique has been successfully performed in four cats with good outcomes. However, the immediate risks and long-term effects of partial parasaggital patellectomy are not known. We reserve this technique for surgical cases where PL cannot be controlled by conventional means.
[Mh] MeSH terms primary: Cat Diseases/surgery
Orthopedic Procedures/veterinary
Patella/surgery
Patellar Dislocation/veterinary
[Mh] MeSH terms secundary: Animals
Cat Diseases/radiography
Cats
Dogs
Orthopedic Procedures/methods
Patellar Dislocation/surgery
Stifle/surgery
[Pt] Publication type:CASE REPORTS; JOURNAL ARTICLE
[Em] Entry month:1507
[Js] Journal subset:IM
[Da] Date of entry for processing:141121
[St] Status:MEDLINE
[do] DOI:10.1177/1098612X13509996

  3 / 1397 MEDLINE  
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[PMID]: 26161756
[Au] Autor:Ding DY; Egol KA
[Ad] Address:Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY.
[Ti] Title:Closed Reduction of Subacute Patellar Dislocation Using Saline Joint Insufflation: A Technical Trick.
[So] Source:Am J Orthop (Belle Mead NJ);44(7):299-301, 2015 Jul.
[Is] ISSN:1934-3418
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Patellar dislocations often spontaneously reduce or are reduced easily by experienced professionals. However, some dislocations can prove difficult to reduce and may require sedation or operative management. Our case report suggests an alternative method to facilitate reduction of patellar dislocations. Our technical trick involves insufflation of the knee joint with sterile normal saline, resulting in improved clearance of the patella over the femoral condyles. This low-risk technique can aid in the reduction of a dislocated patella and save the patient from unnecessary sedation or a surgical operation.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1507
[Js] Journal subset:IM
[St] Status:In-Data-Review

  4 / 1397 MEDLINE  
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[PMID]: 25970358
[Au] Autor:Metzler AV; Lattermann C; Johnson DL
[Ti] Title:Cartilage lesions of the patella: management after acute patellar dislocation.
[So] Source:Orthopedics;38(5):310-4, 2015 May.
[Is] ISSN:1938-2367
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Articular cartilage injuries to the patella are frequent after patellar dislocation. The management of these acute cartilage injuries in the acute setting can be challenging. It is well documented that acute fixation is the optimal choice for treatment of osteochondral injuries. This article discusses the challenges and potential treatment options for acute chondral/osteochondral injuries to the patella after acute patellar dislocation.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1505
[Js] Journal subset:IM
[St] Status:In-Process
[do] DOI:10.3928/01477447-20150504-05

  5 / 1397 MEDLINE  
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[PMID]: 26143551
[Au] Autor:Lubowitz JH
[Ti] Title:Editorial Commentary: Operative Treatment of Patellar Dislocation.
[So] Source:Arthroscopy;31(7):1381, 2015 Jul.
[Is] ISSN:1526-3231
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Modern medial patellofemoral ligament reconstruction results in improved outcomes for patients with patellar instability.
[Pt] Publication type:EDITORIAL
[Em] Entry month:1507
[Js] Journal subset:IM
[St] Status:In-Data-Review

  6 / 1397 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.
[Mh] MeSH terms primary: Knee Dislocation/epidemiology
Patellar Ligament/pathology
Patellofemoral Joint/pathology
[Mh] MeSH terms secundary: Adult
Case-Control Studies
Causality
Female
Humans
Joint Instability/complications
Joint Instability/etiology
Magnetic Resonance Imaging
Male
Middle Aged
Risk Factors
[Pt] Publication type:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Entry month:1507
[Js] Journal subset:IM
[Da] Date of entry for processing:140730
[St] Status:MEDLINE
[do] DOI:10.1007/s00264-014-2357-3

  7 / 1397 MEDLINE  
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[PMID]: 25716704
[Au] Autor:Smith TO; Donell S; Song F; Hing CB
[Ad] Address:Faculty of Medicine and Health Sciences, University of East Anglia, Queen's Building, Norwich, Norfolk, UK, NR4 7TJ. toby.smith@uea.ac.uk.
[Ti] Title:Surgical versus non-surgical interventions for treating patellar dislocation.
[So] Source:Cochrane Database Syst Rev;2:CD008106, 2015.
[Is] ISSN:1469-493X
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:BACKGROUND: Patellar dislocation occurs when the patella disengages completely from the trochlear (femoral) groove. Following reduction of the dislocation, conservative (non-surgical) rehabilitation with physiotherapy may be used. Since recurrence of dislocation is common, some surgeons have advocated surgical intervention rather than non-surgical interventions. This is an update of a Cochrane review first published in 2011. OBJECTIVES: To assess the effects (benefits and harms) of surgical versus non-surgical interventions for treating people with primary or recurrent patellar dislocation. SEARCH METHODS: We searched the Cochrane Bone, Joint and Muscle Trauma Group's Specialised Register, the Cochrane Central Register of Controlled Trials (The Cochrane Library), MEDLINE, EMBASE, AMED, CINAHL, ZETOC, Physiotherapy Evidence Database (PEDro) and a variety of other literature databases and trial registries. Corresponding authors were contacted to identify additional studies. The last search was carried out in October 2014. SELECTION CRITERIA: We included randomised and quasi-randomised controlled clinical trials evaluating surgical versus non-surgical interventions for treating lateral patellar dislocation. DATA COLLECTION AND ANALYSIS: Two review authors independently examined titles and abstracts of each identified study to assess study eligibility, extract data and assess risk of bias. The primary outcomes we assessed were the frequency of recurrent dislocation, and validated patient-rated knee or physical function scores. We calculated risk ratios (RR) for dichotomous outcomes and mean differences MD) for continuous outcomes. When appropriate, we pooled data. MAIN RESULTS: We included five randomised studies and one quasi-randomised study. These recruited a total of 344 people with primary (first-time) patellar dislocation. The mean ages in the individual studies ranged from 19.3 to 25.7 years, with four studies including children, mainly adolescents, as well as adults. Follow-up for the full study populations ranged from two to nine years across the six studies. The quality of the evidence is very low as assessed by GRADE (Grading of Recommendations Assessment, Development and Evaluation Working Group) criteria, with all studies being at high risk of performance and detection biases, relating to the lack of blinding.There was very low quality but consistent evidence that participants managed surgically had a significantly lower risk of recurrent dislocation following primary patellar dislocation at two to five years follow-up (21/162 versus 32/136; RR 0.53 favouring surgery, 95% confidence interval (CI) 0.33 to 0.87; five studies, 294 participants). Based on an illustrative risk of recurrent dislocation in 222 people per 1000 in the non-surgical group, these data equate to 104 fewer (95% CI 149 fewer to 28 fewer) people per 1000 having recurrent dislocation after surgery. Similarly, there is evidence of a lower risk of recurrent dislocation after surgery at six to nine years (RR 0.67 favouring surgery, 95% CI 0.42 to 1.08; two studies, 165 participants), but a small increase cannot be ruled out. Based on an illustrative risk of recurrent dislocation in 336 people per 1000 in the non-surgical group, these data equate to 110 fewer (95% CI 195 fewer to 27 more) people per 1000 having recurrent dislocation after surgery.The very low quality evidence available from single trials only for four validated patient-rated knee and physical function scores (the Tegner activity scale, KOOS, Lysholm and Hughston VAS (visual analogue scale) score) did not show significant differences between the two treatment groups.The results for the Kujala patellofemoral disorders score (0 to 100: best outcome) differed in direction of effect at two to five years follow-up, which favoured the surgery group (MD 13.93 points higher, 95% CI 5.33 points higher to 22.53 points higher; four studies, 171 participants) and the six to nine years follow-up, which favoured the non-surgical treatment group (MD 3.25 points lower, 95% CI 10.61 points lower to 4.11 points higher; two studies, 167 participants). However, only the two to five years follow-up included the clear possibility of a clinically important effect (putative minimal clinically important difference for this outcome is 10 points).Adverse effects of treatment were reported in one trial only; all four major complications were attributed to the surgical treatment group. Slightly more people in the surgery group had subsequent surgery six to nine years after their primary dislocation (20/87 versus 16/78; RR 1.06, 95% CI 0.59 to 1.89, two studies, 165 participants). Based on an illustrative risk of subsequent surgery in 186 people per 1000 in the non-surgical group, these data equate to 11 more (95% CI 76 fewer to 171 more) people per 1000 having subsequent surgery after primary surgery. AUTHORS' CONCLUSIONS: Although there is some evidence to support surgical over non-surgical management of primary patellar dislocation in the short term, the quality of this evidence is very low because of the high risk of bias and the imprecision in the effect estimates. We are therefore very uncertain about the estimate of effect. No trials examined people with recurrent patellar dislocation. Adequately powered, multi-centre, randomised controlled trials, conducted and reported to contemporary standards, are needed. To inform the design and conduct of these trials, expert consensus should be achieved on the minimal description of both surgical and non-surgical interventions, and the anatomical or pathological variations that may be relevant to both choice of these interventions and the natural history of patellar instability. Furthermore, well-designed studies recording adverse events and long-term outcomes are needed.
[Mh] MeSH terms primary: Patellar Dislocation/therapy
[Mh] MeSH terms secundary: Adolescent
Adult
Child
Humans
Patellar Dislocation/surgery
Randomized Controlled Trials as Topic
Young Adult
[Pt] Publication type:COMPARATIVE STUDY; JOURNAL ARTICLE; META-ANALYSIS; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Em] Entry month:1506
[Js] Journal subset:IM
[Da] Date of entry for processing:150302
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD008106.pub3

  8 / 1397 MEDLINE  
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[PMID]: 26114563
[Au] Autor:von Roth P; Pfitzner T; Fuchs M; Perka C
[Ad] Address:Centrum für Muskuloskeletale Chirurgie, Klinik für Orthopädie, Charité - Universitätsmedizin Berlin....
[Ti] Title:Intraoperative Analyse der Anatomie und Kinematik in der Knieendoprothetik. [Intraoperative Evaluation of Total Knee Arthroplasty: Anatomic and Kinematic Assessment with Trial Components].
[So] Source:Z Orthop Unfall;153(3):317-20, 2015 Jun.
[Is] ISSN:1864-6743
[Cp] Country of publication:Germany
[La] Language:ger
[Ab] Abstract:The intraoperative use of trial components in total knee arthroplasty (TKA) is of paramount importance to prevent inadequate ligament balance and to achieve optimal position of the definitive components. This review demonstrates an 8-step algorithm to assess the anatomy of the femoral, tibial and patellar component as well as the kinematics of the tibiofemoral and patellofemoral joints. Trial components allow an easy assessment of the anatomic fit of the final implants. Upon the trials insertion, bone coverage and the component overhang should be evaluated. The femoral rotation should be assessed using the transepicondylar axis and for the tibial component rotation assessment, the tibial tuberosity would be the most reliable bony landmark. Addressing the patella, sizing and bone coverage should be thoroughly evaluated. In order to restore physiological kinematics the remnants of the meniscus rim can be used to determine the correct reconstruction of the joint line. A tight extension gap results in limited extension, whereas a tight or unbalanced flexion gap leads to "booking" or "spin-out" of the inlay. The POLO test (pull-out, lift- off) allows an easy assessment of the posterior cruciate ligament tension and the size of the flexion gap as well. To prevent postoperative dislocation and overstuffing, specific tests for correct patellar positioning and tracking support should be performed. The anatomy and kinematics of total knee arthroplasty have to be evaluated by trial components on a routine basis before inserting the final implants in order to identify implant positioning errors and inadequate ligament balance.
[Pt] Publication type:ENGLISH ABSTRACT; JOURNAL ARTICLE
[Em] Entry month:1506
[Js] Journal subset:IM
[St] Status:In-Data-Review
[do] DOI:10.1055/s-0035-1545968

  9 / 1397 MEDLINE  
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[PMID]: 25757696
[Au] Autor:Abouelsoud MM; Abdelhady A; Elshazly O
[Ad] Address:Department of Orthopedic Surgery, Ain Shams University Hospitals, 11 Latif Mansour St., P.O. box: 11341, Heliopolis, Cairo, Egypt, magedmsamy2000@yahoo.com.
[Ti] Title:Anatomic physeal-sparing technique for medial patellofemoral ligament reconstruction in skeletally immature patients with ligamentous laxity.
[So] Source:Eur J Orthop Surg Traumatol;25(5):921-6, 2015 Jul.
[Is] ISSN:1633-8065
[Cp] Country of publication:France
[La] Language:eng
[Ab] Abstract:PURPOSE: To evaluate the clinical outcome of this modified physeal-sparing technique for MPFL reconstruction in skeletally immature patients with ligament laxity. PATIENTS AND METHODS: This study was conducted on 16 patients (11 females and 5 males) with an average age of 11.5 years (8-15). They all had recurrent patellar dislocation with generalized ligament laxity (mean Beighton's score of 7) and no patellar tilt on X-ray. We modified the Frank Noyes' non-anatomic technique for MPFL reconstruction to become anatomic without hardware fixation for the graft. RESULTS: The mean follow-up period was 29.25 months (SD 4.3) ranged from 24 to 34 months. Preoperative Kujala score had ranged from 49 to 61 points (mean of 56, SD 4.72), improved to be ranged from 90 to 99 points (mean 94, SD 2.73), which is considered highly significant (p value < 0.005). Till the latest follow-up, there were no definite re-dislocation episodes in any of our patients. CONCLUSION: The described technique allows reconstruction of the MPFL in skeletally immature patients with ligament laxity avoiding any potential risks of growth disturbances or chondral damage as compared to other techniques. The modification of two-point femoral fixation allows both a more anatomic and more secure form of reconstruction and is cost-effective without the need for hardware.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1506
[Js] Journal subset:IM
[St] Status:In-Data-Review
[do] DOI:10.1007/s00590-015-1618-1

  10 / 1397 MEDLINE  
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[PMID]: 25187383
[Au] Autor:Zhang GY; Zheng L; Ding HY; Li EM; Sun BS; Shi H
[Ad] Address:Department of Ultrasonography, Qianfoshan Hospital, Shandong University, Jinan, 250014, China.
[Ti] Title:Evaluation of medial patellofemoral ligament tears after acute lateral patellar dislocation: comparison of high-frequency ultrasound and MR.
[So] Source:Eur Radiol;25(1):274-81, 2015 Jan.
[Is] ISSN:1432-1084
[Cp] Country of publication:Germany
[La] Language:eng
[Ab] Abstract:OBJECTIVES: The purpose of this study was to compare the diagnostic performance of high-frequency ultrasound with MR in the evaluation of medial patellofemoral ligament (MPFL) lesions after acute lateral patellar dislocation (LPD). METHODS: High-frequency ultrasound and MR images were prospectively obtained in 97 consecutive patients with acute LPD. Images were acquired using standardised protocols and were independently evaluated by two radiologists. The MPFL was assessed at three sites (patellar insertion, femoral attachment, and mid-substance) for signs of injury. RESULTS: Of a total of 291 sites in 97 MPFLs, 127 showed proven MPFL tear at surgery, including 51 sites of complete tear and 76 sites of partial tear. In a site-based analysis, the sensitivity, specificity, and accuracy of high-frequency ultrasound was 90.8%, 96.3%, and 94.6%, respectively, for partial MPFL tear and 86.3%, 96.3%, and 94%, respectively, for complete tear. For MR, the sensitivity, specificity, and accuracy was 81.6%, 95.7%, and 91.3%, respectively, for partial MPFL tear and 80.4%, 95.7%, and 92.1%, respectively, for complete tear. There was no statistical difference between high-frequency ultrasound and MR in the assessment of partial (P = 0.1, 0.777, 0.155) or complete (P = 0.425, 0.777, 0.449) MPFL lesions. Interobserver agreement was very good for high-frequency ultrasound and good for MR. CONCLUSIONS: Data suggest that high-frequency ultrasound and MR have similar diagnostic performance in the evaluation of MPFL lesions after acute LPD. KEY POINTS: • High-frequency ultrasound and MR were able to detect MPFL lesions after acute lateral patellar dislocation. • High-frequency ultrasound and MR showed similarly high accuracy in diagnosing MPFL lesions. • Interobserver agreement was very good for high-frequency ultrasound and good for MR.
[Mh] MeSH terms primary: Knee Injuries/diagnosis
Ligaments, Articular/injuries
Magnetic Resonance Imaging/methods
Patella/injuries
Patellar Dislocation/diagnosis
[Mh] MeSH terms secundary: Acute Disease
Adolescent
Adult
Child
Female
Humans
Knee Injuries/complications
Ligaments, Articular/pathology
Ligaments, Articular/ultrasonography
Male
Patella/pathology
Patella/ultrasonography
Patellar Dislocation/etiology
Prospective Studies
Reproducibility of Results
Rupture
Young Adult
[Pt] Publication type:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Entry month:1506
[Js] Journal subset:IM
[Da] Date of entry for processing:141129
[St] Status:MEDLINE
[do] DOI:10.1007/s00330-014-3407-3


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