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Search on : Patellar and Dislocation [Words]
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[PMID]: 27354953
[Au] Autor:Miswan MF; Al-Fayyadh MZ; Seow Hui T; Mohamed Ali MR; Ng WM
[Ad] Address:Discipline of Orthopaedic, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia....
[Ti] Title:Soft-Tissue Loop for Medial Patellofemoral Ligament Reconstruction.
[So] Source:Arthrosc Tech;5(2):e321-7, 2016 Apr.
[Is] ISSN:2212-6287
[Cp] Country of publication:Netherlands
[La] Language:eng
[Ab] Abstract:A patient with patellar instability frequently presents with anterior knee pain, patellar subluxation, or dislocation. Medial patellofemoral ligament (MPFL) has a key role for normal patella tracking and stability. Reconstruction of the MPFL using a hamstring graft is a commonly used procedure for the treatment of chronic lateral subluxation of patella. Anchor sutures and bony tunnels are used for the patellar attachment of the graft. This can be associated with complications such as patella fracture; besides, it does not produce an anatomical reconstruction for the native MPFL that can alter the direction of tension applied on the patella. To overcome these problems, a soft-tissue loop technique is used for MPFL reconstruction. During this procedure, a semitendinosus graft was passed through the prepatellar extensor retinaculum and secured with sutures. The free ends of the graft were then passed between the second and third layers of the medial patellofemoral retinaculum and fixed to a femoral tunnel on the medial femoral condyle with an interference screw. The desired amount of tension on the graft is achieved under direct vision of patella tracking arthroscopically. We found this method to be relatively safe and fast. It is more anatomical and can avoid the complications during the conventional bony procedures.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1606
[Cu] Class update date: 160701
[Lr] Last revision date:160701
[Da] Date of entry for processing:160629
[St] Status:PubMed-not-MEDLINE
[do] DOI:10.1016/j.eats.2016.01.003

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[PMID]: 26935465
[Au] Autor:Weber AE; Nathani A; Dines JS; Allen AA; Shubin-Stein BE; Arendt EA; Bedi A
[Ad] Address:Sports Medicine and Shoulder Service, MedSport, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan....
[Ti] Title:An Algorithmic Approach to the Management of Recurrent Lateral Patellar Dislocation.
[So] Source:J Bone Joint Surg Am;98(5):417-27, 2016 Mar 2.
[Is] ISSN:1535-1386
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:High-level evidence supports nonoperative treatment for first-time lateral acute patellar dislocations. Surgical intervention is often indicated for recurrent dislocations. Recurrent instability is often multifactorial and can be the result of a combination of coronal limb malalignment, patella alta, malrotation secondary to internal femoral or external tibial torsion, a dysplastic trochlea, or disrupted and weakened medial soft tissue, including the medial patellofemoral ligament (MPFL) and the vastus medialis obliquus. MPFL reconstruction requires precise graft placement for restoration of anatomy and minimal graft tension. MPFL reconstruction is safe to perform in skeletally immature patients and in revision surgical settings. Distal realignment procedures should be implemented in recurrent instability associated with patella alta, increased tibial tubercle-trochlear groove distances, and lateral and distal patellar chondrosis. Groove-deepening trochleoplasty for Dejour type-B and type-D dysplasia or a lateral elevation or proximal recession trochleoplasty for Dejour type-C dysplasia may be a component of the treatment algorithm; however, clinical outcome data are lacking. In addition, trochleoplasty is technically challenging and has a risk of substantial complications.
[Pt] Publication type:JOURNAL ARTICLE; REVIEW
[Em] Entry month:1603
[Js] Journal subset:AIM; IM
[St] Status:In-Process
[do] DOI:10.2106/JBJS.O.00354

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[PMID]: 26435448
[Au] Autor:Kita K; Tanaka Y; Toritsuka Y; Amano H; Uchida R; Takao R; Horibe S
[Ad] Address:Department of Sports Orthopaedics, Osaka Rosai Hospital, Sakai, Japan keikita@hera.eonet.ne.jp....
[Ti] Title:Factors Affecting the Outcomes of Double-Bundle Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Dislocations Evaluated by Multivariate Analysis.
[So] Source:Am J Sports Med;43(12):2988-96, 2015 Dec.
[Is] ISSN:1552-3365
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Many factors are involved in causing patellar instability or recurrent patellar dislocations. However, factors affecting the outcomes of anatomic medial patellofemoral ligament (MPFL) reconstruction have not been fully documented. PURPOSE: To evaluate the rate of recurrent patellar instability after isolated MPFL reconstruction and to elucidate factors affecting the outcomes of isolated MPFL reconstruction using multivariable statistics. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: A total of 42 patients (44 knees) who underwent isolated, anatomic MPFL reconstruction using a semitendinosus autograft without any additional patellar stabilization procedures for treating recurrent patellar dislocations were included in this study. All patients were followed for more than 2 years; the mean follow-up period was 3.2 years (range, 2-9 years). Postoperative patellofemoral instability was diagnosed when the patient complained of recurrent patellar subluxations or dislocations or had a positive apprehension sign during follow-up. Preoperative radiographic findings were obtained using plain radiography and computed tomography. Femoral tunnel positions were assessed on postoperative radiographs. The strength of the relationship between postoperative patellofemoral instability and potential risk factors such as preoperative age, sex, body mass index, patellar type, sulcus angle, congruence angle, lateral tilt angle, patellar height, tibial tubercle-trochlear groove (TT-TG) distance, degree of trochlear dysplasia, and femoral bone tunnel position were evaluated by univariate and multivariate logistic regression analyses. RESULTS: At follow-up, 2 knees had experienced a redislocation (4.5%). A positive apprehension sign was still evident in 8 knees (18.2%). Three factors, including the sulcus angle, the congruence angle, and trochlear dysplasia, were extracted by single linear regression analysis. Univariate logistic regression analysis showed that the sulcus angle (odds ratio [OR], 1.11; 95% CI, 1.01-1.22; P = .04) and trochlear dysplasia (OR, 3.04; 95% CI, 1.39-6.63; P = .01) were associated with postoperative patellofemoral instability. Trochlear dysplasia was independently associated with postoperative patellofemoral instability by multivariable logistic regression analysis (P < .05). An increased TT-TG distance exerted a significant effect on the outcomes of MPFL reconstruction, particularly in patients with type D trochlea. CONCLUSION: Severe trochlear dysplasia is the most important predictor of residual patellofemoral instability after isolated MPFL reconstruction. In addition, an increased TT-TG distance affected the outcomes in patients with type D trochlea. Additional patellar stabilization procedures should be considered for patients with severe trochlear dysplasia and an increased TT-TG distance.
[Mh] MeSH terms primary: Ligaments, Articular/surgery
Patellar Dislocation/surgery
Patellar Ligament/surgery
[Mh] MeSH terms secundary: Adolescent
Adult
Case-Control Studies
Female
Femur/surgery
Humans
Joint Instability/etiology
Knee Joint/surgery
Male
Multivariate Analysis
Patellar Dislocation/complications
Recurrence
Tendons/transplantation
Tibia/surgery
Transplantation, Autologous
Young Adult
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1607
[Js] Journal subset:IM
[Da] Date of entry for processing:151201
[St] Status:MEDLINE
[do] DOI:10.1177/0363546515606102

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[PMID]: 26456287
[Au] Autor:Choufani C; Barbier O; Versier G
[Ad] Address:Service de chirurgie orthopédique et traumatologique, hôpital d'instruction des Armées-Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France. Electronic address: camchouf@hotmail.com.
[Ti] Title:Patellar lateral closing-wedge osteotomy in habitual patellar dislocation with severe dysplasia.
[So] Source:Orthop Traumatol Surg Res;101(7):879-82, 2015 Nov.
[Is] ISSN:1877-0568
[Cp] Country of publication:France
[La] Language:eng
[Ab] Abstract:The "à la carte" surgical strategy for treating patellar instability developed in Lyon, France, is well known. The corrective procedures are planned based on a preoperative analysis of the morphological abnormalities. Among factors responsible for patellofemoral incongruity, patellar dysplasia is among the most challenging to correct. We report a case of habitual patellar dislocation with severe patellar dysplasia that required a complex surgical strategy including patellar lateral closing-wedge osteotomy to improve patellofemoral congruity. This treatment was effective in ensuring stability and function. This complementary technical procedure can be useful in some patients with major patellofemoral instability.
[Mh] MeSH terms primary: Bone Diseases, Developmental/surgery
Joint Instability/surgery
Osteotomy/methods
Patellar Dislocation/surgery
[Mh] MeSH terms secundary: Adult
Bone Diseases, Developmental/complications
Female
Femur/surgery
Humans
Joint Instability/complications
Patella/surgery
Patellar Dislocation/complications
Recurrence
Tibia/surgery
[Pt] Publication type:CASE REPORTS; JOURNAL ARTICLE
[Em] Entry month:1606
[Js] Journal subset:IM
[Da] Date of entry for processing:151123
[St] Status:MEDLINE

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[PMID]: 26920960
[Au] Autor:Akiyama K; Nakata K; Kitada M; Yamamura M; Ohori T; Owaki H; Fuji T
[Ti] Title:Changes in axial alignment of the ipsilateral hip and knee after total hip arthroplasty.
[So] Source:Bone Joint J;98-B(3):349-58, 2016 Mar.
[Is] ISSN:2049-4408
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:AIMS: We investigated changes in the axial alignment of the ipsilateral hip and knee after total hip arthroplasty (THA). PATIENTS AND METHODS: We reviewed 152 patients undergoing primary THA (163 hips; 22 hips in men, 141 hips in women) without a pre-operative flexion contracture. The mean age was 64 years (30 to 88). The diagnosis was osteoarthritis (OA) in 151 hips (primary in 18 hips, and secondary to dysplasia in 133) and non-OA in 12 hips. A posterolateral approach with repair of the external rotators was used in 134 hips and an anterior approach in 29 hips. We measured changes in leg length and offset on radiographs, and femoral anteversion, internal rotation of the hip and lateral patellar tilt on CT scans, pre- and post-operatively. RESULTS: The mean internal rotation increased by 11° (-15° to 46°) and was associated with underlying disease (OA), pre-operative range of internal rotation, gender, surgical approach, leg lengthening, and change of femoral anteversion (adjusted R(2) : 0.253, p < 0.001). The mean lateral patellar tilt increased by 4° (-5° to 14°) and was associated with age, leg lengthening, and increment of hip internal rotation (adjusted R(2): 0.193, p < 0.001). CONCLUSION: Both internal rotation of the hip at rest and lateral patellar tilt are increased after THA. Changes in rotation after THA may affect gait, daily activities, the rate of dislocation of the hip, and ipsilateral knee pain. TAKE HOME MESSAGE: Internal rotation of the hip at rest and lateral patellar tilt increase after THA.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1602
[Js] Journal subset:AIM; IM
[St] Status:In-Process
[do] DOI:10.1302/0301-620X.98B3.35468

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[PMID]: 26704809
[Au] Autor:Nwachukwu BU; So C; Schairer WW; Green DW; Dodwell ER
[Ad] Address:Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA. nwachukwub@hss.edu....
[Ti] Title:Surgical versus conservative management of acute patellar dislocation in children and adolescents: a systematic review.
[So] Source:Knee Surg Sports Traumatol Arthrosc;24(3):760-7, 2016 Mar.
[Is] ISSN:1433-7347
[Cp] Country of publication:Germany
[La] Language:eng
[Ab] Abstract:PURPOSE: The goal of this study was to perform a comparative review to determine whether there is a significant difference in the rate of repeat dislocation and clinical outcome between surgical and conservative management of acute patellar dislocation in children and adolescents. METHODS: A systematic review of the MEDLINE database was performed. English-language clinical outcome studies with a primary outcome/treatment specific to acute patella dislocation in a paediatric population were included. Eleven studies met inclusion criteria; Chi-square analysis, independent t tests and weighted mean pooled cohort statistics were performed where appropriate. RESULTS: A total of 470 conservatively managed and 157 operatively treated knees were included. Conservatively managed patients were on average 17.0 years and had a mean follow-up of 3.9 years; surgically managed patients were on average 16.1 years and had a mean follow-up of 4.7 years. Conservatively managed knees had a 31% rate of recurrent dislocation rate compared to 22% in surgical knees (p = 0.04). Trochlear dysplasia and skeletal immaturity confer greater risk for recurrent instability. Surgical treatment may provide clinically important quality of life and sporting benefit. CONCLUSIONS: Surgical treatment of first time patella dislocation in children and adolescents is associated with a lower risk of recurrent dislocation and higher health-related quality of life and sporting function. There is a paucity of evidence on MPFL reconstruction for first time traumatic patella dislocation in this population. LEVEL OF EVIDENCE: IV.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1602
[Js] Journal subset:IM
[St] Status:In-Process
[do] DOI:10.1007/s00167-015-3948-2

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[PMID]: 25416671
[Au] Autor:Dickschas J; Harrer J; Bayer T; Schwitulla J; Strecker W
[Ad] Address:Klinik für Orthopädie und Unfallchirurgie, Klinikum Bamberg, Buger Strasse 80, 96049, Bamberg, Germany. Joerg.dickschas@sozialstiftung-bamberg.de....
[Ti] Title:Correlation of the tibial tuberosity-trochlear groove distance with the Q-angle.
[So] Source:Knee Surg Sports Traumatol Arthrosc;24(3):915-20, 2016 Mar.
[Is] ISSN:1433-7347
[Cp] Country of publication:Germany
[La] Language:eng
[Ab] Abstract:PURPOSE: The Q-angle has been used for years to quantify lateralization of the patella. The tibial tuberosity-trochlea groove distance (TT-TG distance) was introduced to analyse patellar tracking. Does a significant correlation exist between these two parameters? Do other significant interrelations exist between the Q-angle/TT-TG distance, torsion of the femur and tibia, the frontal axis, overall leg length, gender, former patellar dislocation, BMI? METHODS: One hundred knees in 55 patients with patellofemoral symptoms were included in a prospective study. All patients underwent clinical examination, including measurement of the Q-angle. A torsional CT was obtained from all patients. RESULTS: The correlation coefficient was 0.33/0.34 (left/right leg), showing that the TT-TG distance tends to rise in direct ratio to a rising Q-angle. Thus, a significant correlation was found (p = 0.017). Femoral and tibial torsion had a positive effect on the TT-TG distance, but showed no significant correlation. Leg length had a significant effect on the TT-TG distance (p = 0.04). The frontal axis had a nonsignificant influence on the Q-angle or TT-TG distance. On average, the Q-angle in women was 2.38° greater than it was in men, but the difference was not significant. CONCLUSION: A significant correlation was noted between the Q-angle and the TT-TG distance. Both depend on various parameters and must be assessed for the analysis of patellofemoral maltracking. The Q-angle did not differ significantly between men and women; thus, the conclusion is that no different ranges need not be used. LEVEL OF EVIDENCE: Diagnostic study, Level III.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1602
[Js] Journal subset:IM
[St] Status:In-Process
[do] DOI:10.1007/s00167-014-3426-2

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[PMID]: 25358690
[Au] Autor:Neumann MV; Stalder M; Schuster AJ
[Ad] Address:Department of Orthopaedic Surgery and Traumatology, University of Freiburg, Freiburg, Germany. mirjam.victoria.neumann@uniklinik-freiburg.de.
[Ti] Title:Reconstructive surgery for patellofemoral joint incongruency.
[So] Source:Knee Surg Sports Traumatol Arthrosc;24(3):873-8, 2016 Mar.
[Is] ISSN:1433-7347
[Cp] Country of publication:Germany
[La] Language:eng
[Ab] Abstract:PURPOSE: A retrospective analysis of a heterogeneous patient cohort was performed to determine the outcome and eligibility of a combined trochleaplasty and soft tissue-balancing technique for repair of patellofemoral joint disorders. METHODS: A strict surgical treatment algorithm including trochleaplasty and reconstruction of the medial patellofemoral ligament and vastus medialis oblique muscle was implemented to restore the patellofemoral joint. A heterogeneous patient cohort including 46 consecutively treated symptomatic knees was reviewed. The median follow-up period was 4.7 years (range 24-109 months). RESULTS: No patellar redislocation occurred post-operatively, and the median Kujala score improved from 62 (9-96) to 88 (47-100) points (p < 0.001) at follow-up. Radiological signs of trochlear dysplasia were corrected, and both patellar height and trochlear depth were significantly restored after surgery. In total, 16% of affected patients with pre-existing patellofemoral degenerative changes showed progression of osteoarthrosis according to the Kellgren and Lawrence classification. CONCLUSION: The surgical combination of trochleaplasty and reconstruction of the medial patellofemoral ligament and vastus medialis oblique muscle offers excellent clinical and radiological results. The overall results of the present study showed significant improvement of the Kujala score in patients with Dejour grades C and D dysplasia. These results outline the clinical relevance of trochleaplasty with additional soft tissue balancing as an effective joint-preserving method with satisfying results in patients with pre-existing degenerative changes. LEVEL OF EVIDENCE: IV.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1602
[Js] Journal subset:IM
[St] Status:In-Process
[do] DOI:10.1007/s00167-014-3397-3

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[PMID]: 27331033
[Au] Autor:Calanna F; Pulici L; Carimati G; Quaglia A; Volpi P
[Ad] Address:Department of knee Orthopedic and Sports Traumatology Unit, Humanitas Research Hospital, Rozzano, Italy....
[Ti] Title:Medial patello-femoral ligament (MPFL) reconstruction using suture anchors fixation: preliminary results.
[So] Source:Muscles Ligaments Tendons J;6(1):64-70, 2016 Jan-Mar.
[Is] ISSN:2240-4554
[Cp] Country of publication:Italy
[La] Language:eng
[Ab] Abstract:PURPOSE: several surgical techniques have been described for the MPFL reconstruction, using many femoral and patellar fixation techniques and different grafts (autograft, allograft, synthetic). The goal of our study is to evaluate the safety and efficacy of MPFL reconstruction using Juggerknot™ (BIOMET, Warsaw, Indiana) suture anchors fixation with a clinical evaluation pre/post surgery of our patients with objective patellofemoral (PF) instability. METHODS: from January 2013 to March 2015, 19 patients underwent isolated MPFL reconstruction using Juggerknot™ (BIOMET, Warsaw, Indiana) suture anchors fixation. All patients were operated by the same surgeon using the same technique. Patients were evaluated by the same operator during pre surgery phase and at least at 6 months of follow up, using clinical evaluation (apprehension sign, patellar glide test, ROM) and 4 different scores (Tegner, Vas, Lysholm, Kujala). The possible complications and dislocation following surgery were investigated. RESULTS: no patellar dislocation and complications were found at follow up. A clinical evaluation improvement was recorded at follow up: all patients achieved a full range of knee motion; apprehension sign from 89% positivity (17 cases) decreased up to 11% (2 cases); glide test from 100% (19 cases) positivity decreased up to 0% (0 cases). Median VAS score decreased significantly (p<0.05) from a median pre-operative value of 8 (min:5 max:10) to 2 (min:0 max:7). Mean Kujala score improved significantly (p<0.05) from 65.23 ± 18.64 pre-operatively to 94.69 ± 6.40. Mean Lysholm score improved significantly (p<0.05) from 64.30 ± 19.29 pre-operatively to 94.72 ± 4.02. Mean Tegner score decreased from 6.15 ± 1.06 pre-operatively to 5.69 ± 0.85. CONCLUSIONS: in this preliminary study, a clinical assessment of patients undergoing surgery with the Juggerknot ™ (BIOMET, Warsaw, Indiana) suture anchor fixation in MPFL reconstruction, has shown promising results, revealing easy to apply, effective and safe for patients.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1606
[Cu] Class update date: 160624
[Lr] Last revision date:160624
[Da] Date of entry for processing:160622
[St] Status:PubMed-not-MEDLINE
[do] DOI:10.11138/mltj/2016.6.1.064

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[PMID]: 27339584
[Au] Autor:Gormeli G; Gormeli CA; Karakaplan M; Gurbuz S; Ozdemir Z; Ozer M
[Ad] Address:Deprtment of Orthopaedic and Trauma Surgery, Medical Faculty of Inonu University, Malatya, Turkey....
[Ti] Title:Acute patellar dislocation with multiple ligament injuries after knee dislocation and single session reconstruction.
[So] Source:J Pak Med Assoc;66(6):757-60, 2016 Jun.
[Is] ISSN:0030-9982
[Cp] Country of publication:Pakistan
[La] Language:eng
[Ab] Abstract:Knee dislocation is a relatively rare condition of all orthopaedic injuries. Accompanying multiple ligament injuries are common after knee dislocations. A 41-year-old male presented to the emergency department suffering from right knee dislocation in June 2013. The patient had anterior cruciate ligament, medial collateral ligament (MCL), medial patellofemoral ligament (MPFL) rupture, and lateral meniscal tear. A single-bundle anatomic reconstruction, medial collateral ligament reconstruction, medial patellofemoral ligament reconstruction and meniscus repair were performed in single session. At twelve months follow-up; there was 160º flexion and 10° extension knee range of motion. Lysholm knee score was 90. Extensive forces can cause both MCL and MPFL injury due to overload and the anatomical relationship between these two structures. Therefore, patients with valgus instability should be evaluated for both MPFL and MCL tears to facilitate successful treatment.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1606
[Js] Journal subset:IM
[St] Status:In-Data-Review


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