Anatomy and Biomechanics of Patellar Instability

Greiwe, R. Michael; Saifi, Comron; Ahmad, Christopher S.; Gardner, Thomas R.

doi:10.1053/j.otsm.2009.12.014

Cited by 36 publications

(32 citation statements)

References 45 publications

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“…Most LPDs are thought to occur when changing direction with the knee relatively extended, and the femur internally rotated and adducted on an externally rotated tibia (20). This view is supported by studies which demonstrated increased lateral patellar displacement in early knee exion (21) and with tibial external rotation (22).…”

Section: Interventionmentioning

confidence: 96%

Is an Individually Tailored Programme of Intense Leg Resistance and Dynamic Exercise Acceptable to Adults with an Acute Lateral Patellar Dislocation? A Feasibility Study

Forde

Haddad

Hirani

et al. 2020

Preprint

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Background: lateral patellar dislocations mainly affect active teenagers and young adults. To help people recover, non-surgical exercise-based treatment is often recommended but the optimal exercise-based treatment is unknown. Currently, treatment outcomes after this injury are variable. Common problems include recurrent dislocation, reduced activity levels, and later surgery. A programme of intense leg resistance exercises, and dynamic exercises related to participants’ activity-related goals, has rationale, but has not been previously reported. In line with Medical Research Council guidance, this study aimed to assess the acceptability of a novel evidence-based exercise programme for adults after acute lateral patellar dislocation and the feasibility of future research evaluating this treatment.Methods: a single-group prospective study was conducted at the John Radcliffe Hospital, Oxford, UK. Participants were 16 years or older with an acute first-time or recurrent lateral patellar dislocation. Participants received up to six face-to-face, one-to-one, physiotherapy sessions, over maximum three months, and performed intensive home exercises independently at least three times per week. Strategies to increase exercise adherence were used. Primary objectives were to determine the number of eligible patients, the recruitment rate (proportion of eligible patients that provided written informed consent), participant adherence to scheduled physiotherapy sessions and self-reported adherence to prescribed exercise, and intervention acceptability to participants measured by attrition and a study-specific questionnaire. Data were analysed using descriptive statistics.Results: 15/22 (68%) patients with a lateral patellar dislocation were eligible. All eligible (100%) were recruited. 2/15 (13%) participants provided no outcome data, 2/15 (13%) provided partial outcome data, and 11/15 (73%) provided all outcome data. Questionnaire responses demonstrated high intervention acceptability to participants. Participants attended 56/66 (85%) physiotherapy sessions and 10/11 (91%) participants reported they ‘always’ or ‘often’ completed prescribed exercise. One participant redislocated their patella; another experienced knee pain or swelling lasting more than one week after home exercise on three occasions.Conclusion: the intervention appeared acceptable to adults after acute lateral patellar dislocation and future larger-scale research appears feasible. Future research should estimate feasibility outcomes with increased precision and assess participants’ willingness to be randomised to different treatments across multiple centres.Trial registration: ClinicalTrials.gov NCT03798483, registered January 10, 2019 https://clinicaltrials.gov/ct2/show/NCT03798483?term=INDEX-KD&draw=2&rank=1

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Section: Interventionmentioning

confidence: 96%

Is an Individually Tailored Programme of Intense Leg Resistance and Dynamic Exercise Acceptable to Adults with an Acute Lateral Patellar Dislocation? A Feasibility Study

Forde

Haddad

Hirani

et al. 2020

Preprint

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“…Lateral dislocation of the patella frequently occurs during the initial moment of the knee flexion movement, since the patella is less stable in the first degrees of flexion before it is accommodated more congruently in the trochlea. 3 Given the importance of this condition, there are reports of over 100 procedures that aimed to treat and/or prevent PFI. 3 , 4 …”

Section: Introductionmentioning

confidence: 99%

Patellar position in patients with patellofemoral syndrome as characterized by anatomo-radiographic study

Franco¹,

Sadigursky²,

Daltro³

2018

Revista Brasileira de Ortopedia (English Edition)

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ObjectivesTo determine the prevalence of high patella in adult patients with knee pain, and to correlate patellar height with symptoms of patellar instability, episode of patellofemoral dislocation and anterior pain in the knee; and also verify the concordance correlation between the Insall-Salvati and Caton-Deschamps indices.MethodCross-sectional study analyzing the medical records of patients with knee pain, using lateral view knee radiographs with 30° degrees of flexion and computed tomography. The values of the Insall-Salvati index and the Caton-Deschamps index were used to determine the patellar height.ResultsA total of 756 records were analyzed, resulting in 140 knees studied, 39% men and 61% women. Both indices produced statistically significant associations for the occurrence of high patella and signs of instability and episodes of dislocation, but there was no significant association for anterior knee pain. The Kappa index obtained when analyzing the concordance correlation between the Insall-Salvati index and Caton-Deschamps index points to a regular association between them.ConclusionPatients with high patella present a higher prevalence of instability. Having a high patella has no significant relationship with the presence of anterior knee pain. The Insall-Salvati and Caton-Deschamps indices demonstrate a regular agreement on the presentation of patellar heights results.

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“…Risk factors for patellar instability include increased Tibial Tubercle-Trochlear Groove (TT-TG) distance, trochlear dysplasia, patellar alta, patellar tilt, etc3. Currently, medial patellofemoral ligament (MPFL) is considered as the most important structure for static stabilization, providing 50–60% of the restraint strength to prevent lateral patellar dislocation45. For this reason, MPFL reconstruction is broadly used to treat patellar dislocation.…”

mentioning

confidence: 99%

Relationship between bony tunnel and knee function in patients after patellar dislocation triple surgeries—a CT-based study

Qin

Yao

et al. 2017

Sci Rep

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We aimed to assess the CT-based bony tunnel valuations and their correlation with knee function after patellar dislocation triple surgeries. A retrospective study was performed on 66 patients (70 knees) who underwent patellar dislocation triple surgeries. The surgery was MPFL reconstruction primarily, combined with lateral retinaculum release and tibial tubercle osteotomy. CT examinations were performed to determine the femoral tunnel position, along with the patellar and femoral tunnel width 3 days and more than 1 year after operation for follow-up. Functional evaluation based on Kujala and Lysholm scores was also implemented. We compared tunnel width of the first and last examinations and correlated femoral tunnel position of the last examination with knee function. At the last follow-up, femoral tunnel position in the anterior-posterior direction was moderately correlated with knee function. Femoral tunnel position in the proximal-distal direction was not associated with postoperative knee function. Patellar and femoral tunnel width increased significantly at the last follow-up. However, no significant functional difference was found between patients with and without femoral tunnel enlargement. Our results suggested that the tunnel malposition in anterior-posterior position based on CT was related to impaired knee function during the follow-ups.

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Anatomy and Biomechanics of Patellar Instability

Cited by 36 publications

References 45 publications

Is an Individually Tailored Programme of Intense Leg Resistance and Dynamic Exercise Acceptable to Adults with an Acute Lateral Patellar Dislocation? A Feasibility Study

Is an Individually Tailored Programme of Intense Leg Resistance and Dynamic Exercise Acceptable to Adults with an Acute Lateral Patellar Dislocation? A Feasibility Study

Patellar position in patients with patellofemoral syndrome as characterized by anatomo-radiographic study

Relationship between bony tunnel and knee function in patients after patellar dislocation triple surgeries—a CT-based study

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