Therapeutic study, Level III.

Patellofemoral instability is a severe problem in young and active patients. This pathology is influenced by ligamentous, bony, and neuromuscular parameters. The reconstruction of the medial patellofemoral ligament (MPFL) evolved to a primary procedure, but combined procedures were more frequently performed in the past years. However, additional operative procedures are associated with increased morbidity and no absolute indication can be identified in the literature. This study is intended to clarify whether addressing only ligamentous influence factors (MPFL) in chronic patellofemoral instability is sufficient to produce good clinical outcomes, or whether other risk factors influence the results negatively and should also be treated at some point. In 52 patients with chronic patellofemoral instability patellar height according to Caton-Deschamps, trochlear dysplasia according to Dejour, the leg axis, the femoral antetorsion, tibial tubercle (TT)–trochlear groove, and TT–posterior cruciate ligament distance were evaluated. All patients were treated with isolated MPFL reconstruction. After a minimum follow-up period of 24 months (24–36 months), the clinical outcome results were calculated using the scoring system according to Lysholm and Tegner. Correlation between clinical outcome scores and anatomic risk factors were calculated. The analysis was performed using a standard statistical software package (JMP version 12, SAS Institute, Cary, NC). The average postoperative Lysholm score increased significantly from 57.23 ± 19.9 to 85.9 ± 17.2 points (p < 0.0001) after isolated MPFL reconstruction. Moreover, the Tegner and Lysholm scores significantly improved both in patients without and with different risk factors postoperative. There were no significant differences in the outcome sores between the groups. Even the degree of trochlear dysplasia (types I–III) did not influence the results. Finally, there was no significant correlation found between all collected risk factors and the postoperative outcome scores. Isolated MPFL reconstruction can be an effective procedure in patients with patellofemoral instability and mild to moderate risk factors.

the time of follow up MRI after six months. The ttest was used to determine statistical differences. Results: four of ten patients (40%) showed decrease of meniscal lesion in follow up MRI after six months. Nine of ten patients (90%) complained about short episodes of heavy pain after the injections with average NRS-Score of 7.9 at daily loads after the last injection. Six of ten patients (60%) showed Improvement of NRS-Score at final follow up. Average NRS-Score improved significantly (p=0.027) from 6.9 before injections to 4.5 six month after treatment. Six of ten patients (60%) reported increase of sports activity compared to the situation before injections. In four patients (40%) additional surgical treatment was necessary because of persistent knee pain or progression of meniscal lesion. Conclusions: percutaneous injections of PRP have the ability to achieve pain relief and halt of progression on MRI over 6 months in patients with grade 2 meniscal lesions. Therefore it could be considered as a treatment option in patients with persisting pain. Level of evidence: IV.

No abstract

Despite differences between sexes in knee anatomy and the injury risk, the sagittal and coronal slopes (LTS, MTS, CTS), as well as the concavity of the medial tibial plateau (MTD), were not associated with the risk of an ACL tear during a noncontact injury among recreational alpine skiers.