High Rates of Damage to the Medial Patellofemoral Ligament, Lateral Trochlea, and Patellar Crest After Acute Patellar Dislocation: Magnetic Resonance Imaging Analysis

Migliorini, Filippo; Pilone, Marco; Eschweiler, Jörg; Marsilio, Emanuela; Hildebrand, Frank; Maffulli, Nicola

doi:10.1016/j.arthro.2022.01.044

Cited by 34 publications

(35 citation statements)

References 52 publications

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“…Most authors performed the procedures in patients with patellofemoral instability [21,22,[26][27][28][29][30]. Up to 96% of patients following a patellar dislocation demonstrated cartilage damage at the patellofemoral joint [50][51][52][53][54]. Approximately 85% of patients following a patellar dislocation demonstrated focal patellar chondropathy at MRI, while 47% evidenced chondral damage in the trochlea [55][56][57][58][59][60].…”

Section: Discussionmentioning

confidence: 99%

Surgical strategies for chondral defects of the patellofemoral joint: a systematic review

Migliorini

Baroncini

Bell³

et al. 2022

J Orthop Surg Res

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Background The management of chondral defects of the patellofemoral joint is debated, and definitive evidence is lacking. This study systematically updated and summarised the current literature on the surgical management of isolated chondral defects of the patellofemoral joint, discussing techniques, outcome, pitfalls, and new frontiers. Methods This systematic review was conducted according to the 2020 PRISMA statement. In August 2022, PubMed, Web of Science, Google Scholar, and Embase databases were accessed with no time constrain. All the clinical studies investigating the surgical management of chondral defects of the patellofemoral joint were retrieved. Articles which reported data on patients with advanced to severe osteoarthritis were not eligible. Only studies with a minimum 24 months follow-up were considered. Studies which mixed results of patellofemoral and tibiofemoral joints were not considered. Results Data from 10 studies (692 procedures) were retrieved. The mean follow-up was 46.9 ± 18.2 months. The mean age of the patients was 34.0 ± 6.1 years, and the mean BMI was 25.9 ± 0.8 kg/m2. The mean duration of symptoms before the index surgery was 81.0 ± 24.0 months. The mean defect size was 3.8 ± 0.8 cm2. All the PROMs improved from baseline to last follow-up: VAS 0–10 (P = 0.04), Tegner (P = 0.02), Lysholm (P = 0.03), and International Knee Documentation Committee (P = 0.03). The rate of hypertrophy was 5.6% (14 of 251), the rate of progression to total knee arthroplasty was 2.4% (2 of 83), the rate of revision was 16.9% (29 of 136), and the rate of failure was 13.0% (16 of 123). Conclusion Current surgical strategies may be effective to improve symptoms deriving from chondral defects of the patellofemoral joint. The limited and heterogeneous data included for analysis impact negatively the results of the present study. Further clinical studies are strongly required to define surgical indications and outcomes, and the most suitable technique.

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Section: Discussionmentioning

confidence: 99%

Surgical strategies for chondral defects of the patellofemoral joint: a systematic review

Migliorini

Baroncini

Bell³

et al. 2022

J Orthop Surg Res

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“…Patellofemoral joint instability is mainly manifested by poor balance and coordination ability, significantly decreased spatial position judgment ability, poor nerve reactivity, prolonged nerve response to sudden torsional stress and electrical stimulation, and weakened muscle strength [ 32 ]. After a first episode of patellar dislocation, most patients presented with soft tissue lesions [ 33 ]. Electrophysiological examination is an important means to monitor muscle balance.…”

Section: Discussionmentioning

confidence: 99%

Electrophysiological and pathological changes in the vastus medialis and vastus lateralis muscles after early patellar reduction and nerve growth factor injection in rabbits with patellar dislocation

Liu

Tang

et al. 2022

J Orthop Surg Res

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Background Patellar dislocation can cause a series of changes in the trochlear groove and patella. However, the influence of patellar dislocation on the medialis (VM) and vastus lateralis (VL) muscles and whether nerve growth factor (NGF) is beneficial to proprioceptive rehabilitation for patellar dislocation are unknown. The purpose of this study was to investigate the effects on VM and VL after the injection of NGF and early reduction in rabbits for patellar dislocation with electrophysiological and pathological analysis. Methods Sixty 2-month-old rabbits were randomly divided into four groups (15 rabbits in each group). Rabbits in Group 1, Group 2, and Group 3 underwent patellar dislocation surgery, and rabbits in Group 4 underwent sham surgery. One month later, patellar reduction was performed in Groups 1 and 2. NGF was injected into the rabbits of Group 1. The electrophysiological and pathological changes in VM and VL were analyzed at 1 month and 3 months after patellar reduction. Results The electrophysiological and pathological indices in Groups 1 and 2 were significantly different from those in Group 3 at 1 and 3 months after patellar reduction. There were significant differences between NGF injection Group 1 and Group 2 without NGF injection. There was no significant difference between Group 1 and Group 4 at 3 months after patellar reduction. Conclusions Patellar dislocation can cause abnormal electrophysiological and pathological effects on VM and VL. Patellar reduction should be performed as early as possible, and NGF injection may be beneficial to the rehabilitation of proprioception.

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“…Research showed that MPFL was very vulnerable to injury in lateral patella dislocation [ 5 ]. At the same time, it was stated that the MPFL played an important role in maintaining the stability of patella [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

“…In anatomy, the occurrence of patellar dislocation is closely related to femoral trochlear dysplasia, patella alta, injury of the medial patellofemoral ligament (MPFL), lateralization of the tibial tubercle relative to femoral trochlear, abnormal torsion of the femur and tibia, and atrophy of vastus medialis oblique (VMO) [ 2 – 4 ]. 92% of MPFLs were damaged after the first acute patellar dislocation [ 5 ]. And MPFL reconstruction has become one of the basic operations for patellofemoral instability [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Change of the cross-sectional area of vastus medialis oblique in patients with recurrent patellar dislocation treated by tibial tubercle transfer combined with medial patellofemoral ligament reconstruction on axial CT

et al. 2022

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Purpose To investigate the change of the cross-sectional area (CSA) of vastus medialis oblique (VMO) in patients with recurrent patellar dislocation (RPD) treated by tibial tubercle transfer combined with medial patellofemoral ligament (MPFL) reconstruction by imaging methods, and to guide clinical treatment and rehabilitation. Methods From October 2015 to March 2022, 23 patients with RPD who underwent tibial tubercle transfer combined with MPFL reconstruction were retrospectively enrolled. All patients were assessed by CT in the supine position with the knee fully extended and the quadriceps relaxed. The CSA of VMO and the ratio of CSA of VMO to body weight (CSA/BW) were measured at the upper pole of the patella, 5 mm above the upper pole of the patella and 5 mm below the upper pole of patella. The differences of measured parameters were compared before surgery and at follow-up, including CSA of VMO and CSA/BW. Test level α = 0.05. Results The tibial tubercle-trochlear groove (TT-TG) distance was significantly reduced at follow-up compared with that before surgery (27.91 ± 1.95 mm vs 12.33 ± 1.07 mm, P < 0.001). The CSA of VMO was significantly increased at follow-up compared with that before surgery at 5 mm below the upper pole of the patella (473.06 ± 106.32 mm2 vs 562.97 ± 157.90 mm2, P < 0.001), at the upper pole of the patella (641.23 ± 188.45 mm2 vs 700.23 ± 177.55 mm2, P = 0.029), and at 5 mm above the upper pole of the patella (788.25 ± 238.62 mm2 vs 849.79 ± 180.84 mm2, P = 0.018). The CSA/BW was significantly increased at follow-up compared with that before surgery at 5 mm below the upper pole of the patella (7.83 ± 2.52 mm2/kg vs 9.22 ± 3.54 mm2/kg, P < 0.001), at the upper pole of the patella (10.48 ± 3.62 mm2/kg vs 11.42 ± 4.14 mm2/kg, P = 0.020), and at 5 mm above the upper pole of the patella (12.86 ± 4.65 mm2/kg vs 13.68 ± 3.86 mm2/kg, P = 0.017). Conclusion After tibial tubercle transfer combined with MPFL reconstruction, CSA of VMO increased in patients with RPD, which will help to enhance patellar stability and reduce recurrence.

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High Rates of Damage to the Medial Patellofemoral Ligament, Lateral Trochlea, and Patellar Crest After Acute Patellar Dislocation: Magnetic Resonance Imaging Analysis

Cited by 34 publications

References 52 publications

Surgical strategies for chondral defects of the patellofemoral joint: a systematic review

Surgical strategies for chondral defects of the patellofemoral joint: a systematic review

Electrophysiological and pathological changes in the vastus medialis and vastus lateralis muscles after early patellar reduction and nerve growth factor injection in rabbits with patellar dislocation

Change of the cross-sectional area of vastus medialis oblique in patients with recurrent patellar dislocation treated by tibial tubercle transfer combined with medial patellofemoral ligament reconstruction on axial CT

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