Medial Patellar Instability: A Little Known Cause of Anterior Knee Pain

Sanchis-Alfonso, Vicente; Ramírez-Fuentes, Cristina; Martı́nez-Soriano, Francisco; Monllau, Joan Carles; Merchant, Alan C.

doi:10.1007/978-3-642-54965-6_12

Cited by 4 publications

(11 citation statements)

References 27 publications

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“…[6][7][8][10][11][12][13] Some individuals have a lateral epicondylopatellar ligament, to a varying degree of frequency, but the superficial oblique and deep transverse retinacular layers are found more consistently. 1 The superficial oblique retinaculum is quite thin. However, the deep 3.…”

Section: Discussionmentioning

confidence: 99%

“…transverse retinaculum is stout, oriented in an optimal direction to restrain the patella, and attached to the lateral border of the patella and the deep surface of the iliotibial band. 1 We have chosen to try to reconstruct what appears to be the layer most suited to restrain the patella, that is, the deep transverse lateral retinaculum. Therefore the objective of our technique is to reconstruct the deep transverse layer of the lateral retinaculum and not the lateral patellofemoral ligament.…”

Section: Discussionmentioning

confidence: 99%

“…Our goal is to make the strip transversely oriented and attach it to the remaining iliotibial band at the level of the lateral femoral epicondyle, approximating the orientation of the native deep transverse retinacular ligament (Video 1). 1 To adjust and establish adequate tension, we begin placement of a series of sutures with No. 0 Vicryl (Ethicon), reattaching the posterior border of the transferred tendon to the anterior border of the remaining intact iliotibial band (Fig 3B).…”

Section: Ligament Reconstructionmentioning

confidence: 99%

“…1,2 All too frequently, the pain and disability from IMPI are much worse than the preoperative symptoms for which the operation was performed.…”

mentioning

confidence: 99%

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Deep Transverse Lateral Retinaculum Reconstruction for Medial Patellar Instability

Sanchis-Alfonso¹,

Montesinos-Berry²,

Monllau

et al. 2015

Arthroscopy Techniques

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Medial patellar instability can be a disabling complication of an extensive lateral retinaculum release. It is often overlooked, and for the diagnosis, it is necessary to have a high index of suspicion. Typically, the patient feels a new pain and new instability after the lateral retinaculum release that are distinct from, and much worse than, those before surgery. All of our patients had significant relief from their pain with "reverse" McConnell taping. If there is a significant improvement in symptoms after this taping and stress radiographs or stress axial computed tomography scans show an objective pathologic medial patellar displacement, reconstruction of the lateral retinaculum should be considered. This article details our technique for reconstruction of the deep transverse layer of the lateral retinaculum using an anterior strip of the iliotibial band. This strip is detached from its insertion onto the Gerdy tubercle and then reflected proximally beyond the level of the lateral femoral epicondyle. Finally, it is attached either by direct suture to the remaining prepatellar and peripatellar retinaculum if there is adequate tissue present or by a suture anchor.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Ligament Reconstructionmentioning

confidence: 99%

“…1,2 All too frequently, the pain and disability from IMPI are much worse than the preoperative symptoms for which the operation was performed.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Deep Transverse Lateral Retinaculum Reconstruction for Medial Patellar Instability

Sanchis-Alfonso¹,

Montesinos-Berry²,

Monllau

et al. 2015

Arthroscopy Techniques

Self Cite

View full text Add to dashboard Cite

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“…Iatrogenic medial patellar instability (IMPI) is an objective condition with its own characteristics that frequently causes incapacitating AKP and should be included in the differential diagnosis of AKP in patients who have undergone any prior extensor mechanism realignment surgery. 1 Certainly, IMPI is a rare condition in the totality of orthopaedic problems, but its clinical importance far exceeds its numbers. IMPI frequently causes severe pain and disability that are difficult to treat successfully.…”

mentioning

confidence: 99%

Iatrogenic Medial Patellar Instability: An Avoidable Injury

Sanchis-Alfonso¹,

Merchant

2015

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Holistic approach to understanding anterior knee pain. Clinical implications

Sanchis-Alfonso

2014

Knee Surg Sports Traumatol Arthrosc

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Anterior knee pain is one of the most frequent reasons for consultation within knee conditions. The aetiology is not well known, which explains the sometimes unpredictable results of its treatment. Normally, when we see a patient in the office with anterior knee pain, we only study and focus on the knee. If we do this, we are making a big mistake. We must not forget to evaluate the pelvis and proximal femur, as well as the psychological factors that modulate the course of the illness. Both the pelvifemoral dysfunction as well as the psychological factors (anxiety, depression, catastrophization and kinesiophobia) must be included in our therapeutic targets of the multidisciplinary treatment of anterior knee pain. We must not only focus on the knee, we must remember to "look up" to fully understand what is happening and be able to solve this difficult problem. The aetiology of anterior knee pain is multifactorial. Therefore, diagnosis and treatment of patellofemoral disorders must be individualized. Our findings stress the importance of tailoring physiotherapy, surgery and psycho-educational interventions to each patient.

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Medial Patellar Instability: A Little Known Cause of Anterior Knee Pain

Cited by 4 publications

References 27 publications

Deep Transverse Lateral Retinaculum Reconstruction for Medial Patellar Instability

Deep Transverse Lateral Retinaculum Reconstruction for Medial Patellar Instability

Iatrogenic Medial Patellar Instability: An Avoidable Injury

Holistic approach to understanding anterior knee pain. Clinical implications

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