Assessment and management of chronic patellofemoral instability

Mulford, Jonathan; Wakeley, C.J.; Eldridge, Jonathan

doi:10.1302/0301-620x.89b6.19064

Cited by 80 publications

(69 citation statements)

References 94 publications

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“…Most recently, Culvenor et al reviewed the increased incidence of PF arthritis with ACL reconstruction and recommended prevention and treatment strategies with attention to rehabilitation protocols and quadriceps and hamstring muscles coordination in order to minimize this complication [50]. Trochlear dysplasia has been found to be a strong associating factor for future PF arthritis [12,[52][53][54]. Many authors document the increased incidence of PF arthritis after high-grade dysplasia that may lead to patellar dislocation.…”

Section: Discussionmentioning

confidence: 99%

The incidence of trochlear dysplasia in anterior cruciate ligament tears

Ntagiopoulos¹,

Bonin²,

Sonnery‐Cottet

et al. 2014

International Orthopaedics (SICOT)

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Purpose The purpose of the present epidemiologic study is to record the radiographic presence of trochlear dysplasia and patella alta in patients who undergo anterior cruciate ligament (ACL) reconstruction as a potential underlying factor for postoperative anterior knee pain (AKP). Methods All consecutive cases of skeletally-mature ACLdeficient knees that would undergo ACL reconstruction in three different hospitals were prospectively included during a six-month period. Inclusion criteria were acute and subacute ACL injury with no previous ipsilateral knee operation. Patients with chronic ACL tears, prior-to-ACL-injury history of patellar instability or other PF disorders were excluded from the study. Results A total of 299 knees were included (mean age 32± ten years). Forty-four (14.7 %) knees had a positive 'crossing sign' in the lateral X-rays and 255 (85.3 %) had no sign of trochlear dysplasia (p<0.01). Among the cases with trochlear dysplasia, 41 (93 %) had type A trochlear dysplasia with the presence only of the 'crossing sign' and three (7 %) had type C trochlear dysplasia. Patellar height results included a mean Caton-Deschamps index of 1.0± 0.14 (0.5-1.4). Twenty (6.6 %) knees had an index of less than 0.8, and two (0.6 %) knees had an index less than 0.6. In contrast, 15 (5.0 %) knees had an abnormal value of more than 1.2, indicating patella alta. ConclusionsThe most important finding of the study is the increased prevalence of trochlear dysplasia and patella alta in patients with ACL injury, when compared to the incidence of trochlear dysplasia and patella alta in the general population in the literature. This finding could sound as an alert of a possible additional risk factor for post-operative anterior knee pain after ACL reconstruction.

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Section: Discussionmentioning

confidence: 99%

The incidence of trochlear dysplasia in anterior cruciate ligament tears

Ntagiopoulos¹,

Bonin²,

Sonnery‐Cottet

et al. 2014

International Orthopaedics (SICOT)

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“…However, the relationship between clinical pain and objective measures of patellar malalignment/maltracking is unclear. Clinical measures can provide static (eg, Q-angle [9,13,16,17,27,32,35,45]) and dynamic (eg, lateral hypermobility, J-sign [10,19,30]) indicators of patellar malalignment/maltracking. Yet, clinical presentation is often subtle and inconsistent and these measures have yet to be correlated to specific three-dimensional (3D), objectively quantifiable displacement and rotations.…”

Section: Introductionmentioning

confidence: 99%

Q-angle and J-sign: Indicative of Maltracking Subgroups in Patellofemoral Pain

Sheehan

Derasari

Fine

et al. 2010

Clinical Orthopaedics &Amp; Related Research

105

103

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Mechanical factors related to patellofemoral pain syndrome and maltracking are poorly understood. Clinically, the Q-angle, J-sign, and lateral hypermobility commonly are used to evaluate patellar maltracking. However, these measures have yet to be correlated to specific three-dimensional patellofemoral displacements and rotations. Thus, we tested the hypotheses that increased Q-angle, lateral hypermobility, and J-sign correlate with three-dimensional patellofemoral displacements and rotations. We also determined whether multiple maltracking patterns can be discriminated, based on patellofemoral displacements and rotations. Three-dimensional patellofemoral motion data were acquired during active extensionflexion using dynamic MRI in 30 knees diagnosed with patellofemoral pain and at least one clinical sign of patellar maltracking (Q-angle, lateral hypermobility, or J-sign) and in 37 asymptomatic knees. Although the Q-angle is assumed to indicate lateral patellar subluxation, our data supported a correlation between the Q-angle and medial, not lateral, patellar displacement. We identified two distinct maltracking groups based on patellofemoral lateral-medial displacement, but the same groups could not be discriminated based on standard clinical measures (eg, Q-angle, lateral hypermobility, and J-sign). A more precise definition of abnormal three-dimensional patellofemoral motion, including identifying subgroups in the patellofemoral pain population, may allow more targeted and effective treatments.

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“…The option between fixing and excising the fragment related to the fragment size (24x18mm, amenable to fixation). An otherwise small OCF, if symptomatic, would have been excised [7]. Despite representing a last resort procedure, excision combined with microfractures grants satisfactory results, according to some studies [10].…”

Section: Discussionmentioning

confidence: 99%

“…In fact, osteochondral patella fractures can be easily missed on plain knee radiograms [1,4], making neglected OCF of the patella a possible reason for claims for financial compensation against attending doctors [5]. Although APD can occur even in the context of a stable knee, patient-related predisposing factors may contribute to dislocation [6,7]. The goal of this article is to document and debate the surgical treatment performed to a patient with an OCF of the patella, in the context of the first episode of an APD, in a previously stable patellofemoral joint.…”

Section: Introductionmentioning

confidence: 99%

Open Reduction and Internal Fixation of an Osteochondral Patellar Fracture in an Eleven Year-Old Girl

Correia¹

2016

MOJOR

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Osteochondral patellar fractures in pediatric age can result from acute patellar dislocations (APDs). The purpose of this article is to document and discuss the surgical treatment performed to a young female patient diagnosed with an osteochondral fracture (OCF) of the patella in the first episode of an APD.We state the first episode of an APD in a 12 year-old girl, who presented with pain, edema and limited extension of the right knee, after a direct knee trauma. She had no predisposing factors regarding patellofemoral instability. This patient was treated at our Orthopaedic Surgery Department and then clinically (Kujala score) and radiographically evaluated, at 12 months of follow-up.The knee radiograms gave rise to the suspicion of a large inferior osteochondral patellar fragment. Operative treatment was decided and open reduction and internal fixation (ORIF) of the fragment was performed, through a medial parapatellar approach. The fragment dimensions were 24x18mm. The medial structures were addressed and repaired. The patient went through a rehabilitation programme and returned to full activities three months postoperatively. After 12 months of follow-up, there was full range of motion, no redislocation episodes and the Kujala score was 96.Open reduction and anatomic in situ internal fixation of the osteochondral fragment was mandatory in this case, due to its dimensions and location. We consider this a safe and efficient technique that allows osteosynthesis of the osteochondral fragment; the approach used makes possible the acute repair of the medial structures. There is still no general consensus about whether or not to reconstruct the medial patellofemoral ligament (MPFL) in the context of a primary APD.

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Assessment and management of chronic patellofemoral instability

Cited by 80 publications

References 94 publications

The incidence of trochlear dysplasia in anterior cruciate ligament tears

The incidence of trochlear dysplasia in anterior cruciate ligament tears

Q-angle and J-sign: Indicative of Maltracking Subgroups in Patellofemoral Pain

Open Reduction and Internal Fixation of an Osteochondral Patellar Fracture in an Eleven Year-Old Girl

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