upture of the anterior cruciate ligament is a common injury (incidence: 68.6 per 100 000 patient years) that mostly affects young, physically active patients and can lead to chronic instability (1). The lateral tibial plateau in particular is prone to anterior subluxation (anteroposterior instability), as the ligament no longer restricts movement and the axis of rotation can shift medially. Isolated injury to the posterior cruciate ligament is rarer (incidence: 1.8 per 100 000 patient years) (2). Chronic anteroposterior instability, which manifests in 8 to 50% of cases after surgical treatment and 75 to 87% after conservative treatment (3-7), is associated with increased risk of posttraumatic osteoarthritis of the knee (prevalence: 24.5 to 51.2%) (8), restricted knee function with reduced activity level (17% of competitive athletes do not return to competitive level) (9), and reduced quality of life (score of 54 to 77 on the KOOS QOL [Knee injury and Osteoarthritis Outcome Score: Quality of Life] versus 81 to 92 points in the uninjured population) (10). Despite intensive research into anterior cruciate ligament rupture, there is a lack of high-quality studies to determine clear treatment strategies for anterior cruciate ligament-deficient adults. According to the current S1 Guideline of the Association of Scientific Medical Societies in Germany (AWMF, Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften), anterior cruciate ligament reconstruction with autologous tendon graft is indicated for associated injuries to the collateral ligaments, meniscal injuries suitable for reconstruction, or a marked feeling of instability or subjective loading requirement. It is the first-line treatment for symptomatically unstable patients, in order to restore passive stability of the knee joint. According to meta-analyses and cohort studies, anterior cruciate ligament reconstruction can prevent secondary meniscal and cartilage injuries and restore previous activity levels (11-13). Until recently there was only one randomized controlled trial, though this was widely recognized, comparing outcomes following early surgery and following conservative treatment with optional delayed surgery. The findings of this trial indicate that nonsurgical treatment with possible delayed surgery leads to comparable subjective knee function and quality of life (14, 15). On the basis of these findings, coverage Summary Background: Anterior cruciate ligament (ACL) rupture is a serious injury in patients who are typically young and athletically active, with potential long-term complications including functional limitation, posttraumatic osteo arthritis of the knee, and impaired quality of life. ACL reconstruction is now considered the gold standard of treatment for regaining stability and improving knee function. Conservative treatment is an alternative. Methods: To compare operative and conservative treatment, we reviewed pertinent publications retrieved by a systematic search in Ovid MEDLINE, the Cochrane Database of Systematic...
A bstract Background Patellofemoral maltracking is caused by different anatomical factors. Most of them are associated with a proximal maltracking, which alters the patella's engagement into the trochlear groove and predisposes the patellofemoral joint for instability. Different surgical techniques have been described to realign patellar tracking, however, most of which address proximal patellar maltracking. Aim The aim of this article is to demonstrate the influence of patella-related deformities on patellar tracking and to present a novel surgical technique for the treatment of distal patellar maltracking, caused by a severe patellar dyplasia. Case Description We report the case of a 23-year-old patient with a severe patellar dysplasia, presenting a distal patellar maltracking with recurring dislocations in deep flexion. Due to her instability, the patient was immobilised and dependent on the constant use of walking aids. Radiological images showed a concavely shaped patellar, which articulated exclusively with the lateral epicondyle and caused the patella to dislocate laterally, starting at a flexion angle of 60°. An anterior closing-wedge osteotomy was used to reshape and recenter the patella, which was complemented by a medial patellofemoral ligament reconstruction. At the 18-month follow-up, the patient presented pain free and fully remobilised, without the use of walking aids. Patellar tracking was reestablished, with a possible knee flexion until 140°. No redislocation of the patella had occurred. Conclusion Distal patellofemoral maltracking, caused by a severe patellar dysplasia, can successfully be treated with an anterior closed-wedge osteotomy of the patella. In combination with a medial patellofemoral ligament reconstruction, patellofemoral stability can be reestablished, to prevent further dislocations. Clinical Significance There are multiple factors, which may cause patellar maltracking. A thorough clinical and radiological preoperative analysis is mandatory, in order to clearly identify the underlying pathologies, as these may affect patellar tracking proximally or distally. How to cite this article Frings J, Freudenthaler F, Krause M, et al. Closed-wedge Patelloplasty for the Treatment of Distal Patellofemoral Maltracking and Instability due to Severe Patellar Dysplasia: Case Report and Surgical Technique. Strategies Trauma Limb Reconstr 2020;15(3):184-192.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.