Injury patterns of medial patellofemoral ligament and correlation analysis with articular cartilage lesions of the lateral femoral condyle after acute lateral patellar dislocation in adults: An MRI evaluation

Zhang, Guangying; Zheng, Lei; Feng, Yanqiu; Shi, Hao; Liu, Wei; Bing-jun, JI; Sun, Bei; Ding, Haiyan

doi:10.1016/j.injury.2015.09.025

Cited by 36 publications

(65 citation statements)

References 52 publications

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“…Specifically, the patella is affected in 11.0–37.5%, while the trochlea is involved in only 6.0–15.5% of the patients . Patellofemoral joint biomechanics have been considered having an important role in cartilage pathology . Indeed, the incidence of patellar chondral lesions with recurrent patellar dislocations is exceedingly high, ranging from 73.5% to 95.7% in MRI and arthroscopic studies .…”

Section: Incidence Of Chondral Defects On the Different Topographies mentioning

confidence: 99%

Functional properties of native and tissue‐engineered cartilage toward understanding the pathogenesis of chondral lesions at the knee: A bovine cadaveric study

Paschos

Lim

et al. 2017

Journal Orthopaedic Research

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Chondral lesions frequently occur in different topographic locations of the knee. This study evaluated the functional properties among the articulating surfaces of the tibiofemoral and patellofemoral joints, and whether neo-cartilage engineered using chondrocytes from different knee locations would reflect these differences. The biomechanical properties of bovine cartilage isolated from eight locations within the tibiofemoral (medial and lateral condyle, medial and lateral tibial plateau) and patellofemoral joints (medial and lateral trochlea, medial and lateral patella) were examined. Tensile Young's moduli (tensile moduli) and aggregate moduli of the medial condyle were lower than those of the medial tibial plateau (6.11 ± 0.89 MPa vs. 7.19 ± 1.05 MPa, p = 0.04 and 354.4 ± 38.3 kPa vs. 419.4 ± 31.3 kPa, p = 0.002, respectively). Patella tensile and compressive moduli were lower than the trochlea (4.79 ± 2.01 MPa vs. 6.91 ± 2.46 MPa, p = 0.01 and 337.4 ± 37.2 kPa vs. 389.1 ± 38.3 kPa, p = 0.0005, respectively). Furthermore, chondrocytes from the above locations were used to engineer neo-cartilage, and its respective properties were evaluated. In neo-cartilage, medial condyle tensile and aggregate moduli were lower than in the medial tibial plateau (0.96 ± 0.23 MPa vs. 1.31 ± 0.31 MPa, p = 0.02, and 115.8 ± 26.0 kPa vs. 160.8 ± 18.8 kPa, p = 0.001, respectively). Compared to trochlear chondrocytes, neo-cartilage formed from patellar chondrocytes exhibited lower tensile and compressive moduli (1.16 ± 0.27 MPa vs. 0.74 ± 0.25 MPa, p < 0.001, and 109.1 ± 24.0 kPa vs. 82.5 ± 18.1 kPa, p < 0.001). A significant degree of disparity in biomechanical properties of the opposing articular surfaces was detected; the medial condyle and patella exhibited inferior properties compared to the opposing medial tibial plateau and trochlea, respectively. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2452-2464, 2017.

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Section: Incidence Of Chondral Defects On the Different Topographies mentioning

confidence: 99%

Functional properties of native and tissue‐engineered cartilage toward understanding the pathogenesis of chondral lesions at the knee: A bovine cadaveric study

Paschos

Lim

et al. 2017

Journal Orthopaedic Research

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“…Key areas of injury include the medial patellofemoral ligament (MPFL), as well as cartilage and bone on the patella and/or trochlea [19,37,42]. Dysfunction of the knee can result from injury to these structures [39].…”

Section: Introductionmentioning

confidence: 99%

Anatomic patellar instability risk factors in primary lateral patellar dislocations do not predict injury patterns: an MRI-based study

Tompkins

Rohr

Agel

et al. 2017

Knee Surg Sports Traumatol Arthrosc

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for this injury due to clinician-perceived need for cartilage debridement. MPFL injury severity was complete rupture (N = 69, 44%), partial (N = 67, 43%), and none (N = 19, 13%). MPFL injury location was isolated femoral (N = 16, 10%), isolated patella (N = 26, 17%), isolated mid-substance (0%), multiple locations (N = 95, 61%), and none (N = 20, 13%). Chondral injury location was patella (N = 67, 43%), lateral femoral condyle (N = 11, 7%), multiple locations (N = 53, 34%), and none (N = 26, 17%). A majority (61%) of patellar chondral lesions were at its inferomedial aspect; all medial patellar retinacular partial injuries involved the inferomedial aspect of the patella, consistent with the insertion of the medial patellotibial ligament (MPTL). Skeletally immature patients had a greater risk of isolated patellar MPFL and chondral injury. No clear relationship was found between/across the location and/or severity of bone bruising, MPFL, or chondral injury. Clinical relevance Underlying anatomic patellar instability risk factors defined by MRI, do not predict injury patterns. MPFL and chondral injury, as well as bone bruising, are common following LPD. The medial patellotibial ligament is torn in patellar-based medial retinacular injuries, based on MRI injury location. Skeletal immaturity plays a role in the location of the injury pattern with isolated patellar-based MPFL/chondral injury being more common in the skeletally immature patient. Sex does not appear to be a factor in injury patterns after primary LPD. Knowledge of these injury trends will help focus the clinician in injury evaluation when managing primary patellar dislocations. Level of evidence Case series, Level IV. AbstractPurpose The primary goal was to describe the injury patterns in a population of primary (first time) lateral patellar dislocators (LPD) to lend clarity to commonly held notions about injury patterns in this population. Methods A prospective study identifying patients presenting with LPD between 2008 and 2012. Inclusion criteria were a history and physical exam consistent with primary LPD, and an MRI consistent with the diagnosis without other significant ligamentous injury. On MRI, location of cartilage, medial patellofemoral ligament (MPFL) injury, and bone bruising were noted. Severity was categorized as partial or complete for MPFL and cartilage lesions. Anatomic patellar instability risk factors (patella alta, trochlear dysplasia, increased TT-TG, and lateral patella tilt) were recorded and compared to the injury patterns. Results This study involved 157 patients; 107 patients were skeletally mature. Of the 157 patients, 26 had surgery

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“…The literature reports chondral lesions on MRI in 13 to 44% of patients. [9][10][11][12][13] In a prospective MRI analysis of adults with an acute lateral patellar dislocation, Zhang et al found the MPFL to be injured in 98% (119/121) of patients. Partial or incomplete tears were found in 40% of patients.…”

Section: Discussionmentioning

confidence: 99%

“…Injury of the lateral femoral condyle was seen in 22.3% (27/121) with osteochondral and chondral lesions comprising 13.2% (16/121) and 9.1% (11/121), respectively. 13 If the dislocation is subacute, the edema within the MPFL and chondral injury will be absent, but predisposing factors for dislocation, such as trochlear dysplasia, patella alta, or increased tibial tubercle (TT)-trochlear groove (TG) or TT-posterior cruciate ligament distance can be seen.…”

Section: Discussionmentioning

confidence: 99%

Empty Sunrise Sign: An Arthroscopic Finding in Recurrent Patellar Dislocation

2018

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Patellar dislocation is a relatively common knee injury and can be challenging to diagnose. We describe an arthroscopic finding we noted in recurrent patellar dislocation. Arthroscopic photos were evaluated from 50 knees with a history patellar dislocation and 100 control patients. We quantified the amount of patellar subluxation seen on a single arthroscopic view and coined it Empty Sunrise Sign if the patella did not overlap the trochlea. Empty Sunrise Sign was found in 82% of 50 cases with recurrent patellar dislocation and none of the 100 control cases. The finding was 100% specific for identifying a recurrent patellar dislocator. High interobserver agreement was noted. Empty Sunrise Sign suggests significant capsular laxity. This may need to be considered in the surgical treatment of recurrent patellar dislocation.

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Injury patterns of medial patellofemoral ligament and correlation analysis with articular cartilage lesions of the lateral femoral condyle after acute lateral patellar dislocation in adults: An MRI evaluation

Cited by 36 publications

References 52 publications

Functional properties of native and tissue‐engineered cartilage toward understanding the pathogenesis of chondral lesions at the knee: A bovine cadaveric study

Functional properties of native and tissue‐engineered cartilage toward understanding the pathogenesis of chondral lesions at the knee: A bovine cadaveric study

Anatomic patellar instability risk factors in primary lateral patellar dislocations do not predict injury patterns: an MRI-based study

Empty Sunrise Sign: An Arthroscopic Finding in Recurrent Patellar Dislocation

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