Patellar maltracking: an update on the diagnosis and treatment strategies

Jibri, Zaid; Jamieson, Paul; Rakhra, Kawan; Sampaio, Marcos Loreto; Dervin, Geoffrey F.

doi:10.1186/s13244-019-0755-1

Cited by 63 publications

(52 citation statements)

References 84 publications

(96 reference statements)

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“…It is known from literature that values for the TT-TG distance over 20 mm recommend tibial osteotomy and medialization [1,18]. Many studies have shown good results using this only criterion but other disagreed because these results tend to deteriorate in time as Nakagawa et al showed in their study [19,20]. The reason is not fully known at this moment, but our hypothesis is that the reason for a high TT-TG does not lie solely in the tubercle lateralization but also in the knee rotation angle, as the result of our study suggested.…”

Section: Discussionmentioning

confidence: 98%

Correlations between intra and extraarticular factors measured by computed tomography in patients with recurrent patellar dislocation

Iacobescu

Cursaru

Anghelescu

et al. 2020

Romanian Journal of Orthopaedic Surgery and Traumatology

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Introduction: Lateral patellar dislocation (LPD) is a common injury of the knee, most frequent in young patients. It has a multifactorial etiology with several underlying risk factors. In most cases, patellar dislocation occurs on the lateral side, with the rupture of the medial patellofemoral ligament (MPFL), appearing in more than 80% of the cases. The tibial tuberosity-trochlear groove (TT-TG) distance of 20 mm or more in patients with lateral patellar dislocation is a gold standard for the surgical indication of tibial tubercle osteotomy (TTO).Hypothesis: Our investigation aimed to establish whether there is a correlation between the TT-TG distance and other bony landmarks, like trochlear groove medialization, tibial tuberosity lateralization, and knee rotation angle, in the surgical algorithm for the patient with patellar dislocation.Methods: We conducted a prospective study, analyzing and comparing data from two groups, 33 patients with a diagnosis of patellar dislocation, and a control group of 30 patients, with meniscal injury, but healthy contralateral limb. Using computed tomography, we measured the TT-TG distance, femoral anteversion, tibial torsion, knee rotation angle, tuberosity lateralization, and trochlear groove medialization of all the patients in our study. The measurements were conducted by two independent orthopedic surgeons in a randomized manner. Using an unpaired t test, we compared and analyzed each parameters value from the study and the control group.Results: Comparing the two groups, we observed a significant difference for TT-TG distance, knee rotation angle and tibial tuberosity lateralization with higher values in the study group compared to the control group (CI 95% 6.44-9.72, CI 95% 8.64-10.39, CI 95% 3.77-5.46, respectively), with a p value < 0.0001 in all cases. Also, the TT-TG distance positively correlated with knee rotation angle (r=.97, p=0.01) and tibial tuberosity lateralization (r=.86, p=0.0001) in the study group.Conclusions: The TT-TG distance measurement usually defines the lateralization of the tibial tuberosity; yet, in some cases, it can be caused by the trochlear groove medialization, or high rotation between the femur and tibia. Our study revealed that knee rotation and tuberosity lateralization were factors implicated in patellar dislocation and they should be taken into account when making the decision of tibial tubercle osteotomy.

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Section: Discussionmentioning

confidence: 98%

Correlations between intra and extraarticular factors measured by computed tomography in patients with recurrent patellar dislocation

Iacobescu

Cursaru

Anghelescu

et al. 2020

Romanian Journal of Orthopaedic Surgery and Traumatology

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“…Patellar height was characterized via the Caton-Deschamps ratio in strict lateral radiographs, and >1.2 was recorded as patella alta. Patellar tilt was measured on transverse sections of computed tomography images according to previously published methods, 16 and 20 was marked as excessive tilt.…”

Section: Clinical Assessment and Follow-upmentioning

confidence: 99%

“…This may not comprehensively represent the actual characteristics of the majority of patients with recurrent patellar dislocation because these are common characteristics with PFI. 16 For example, Dejour et al 5 demonstrated that >90% of patients with PFI had femoral trochlear dysplasia. It is thus important to investigate the clinical outcomes of MPFLR in these populations with patellar instability.…”

mentioning

confidence: 99%

Clinical Outcomes and Prognostic Factors in Patients With Recurrent Patellar Lateral Dislocation Treated With Isolated Medial Patellofemoral Ligament Reconstruction: A Retrospective Single-Center Analysis

Zhao

Wang

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Medial patellofemoral ligament reconstruction (MPFLR) is widely used to treat patellofemoral instability. However, it is still unclear when a concomitant bony procedure is needed. Purpose: To evaluate the therapeutic efficacy of isolated MPFLR for recurrent patellar lateral dislocation and to identify the prognostic factors for clinical outcomes. Study Design: Case series; Level of evidence, 4. Methods: A total of 237 patients who had undergone unilateral isolated MPFLR between January 2011 and December 2016 were included. Patellar tracking (J sign) and radiologic information including patellar height, trochlear dysplasia, tibial tubercle–trochlear groove distance, and patellar tilt was collected preoperatively, and the Kujala and International Knee Documentation Committee (IKDC) functional scores were used to assess postoperative recovery. Failure was defined as redislocation or patient-reported and clinically confirmed patellar instability. The influence of radiologic features and the J sign on knee functional scores was explored via subgroup analysis. Potential prognostic factors were explored using univariate and multivariate regression analyses, and risk factors for a positive J sign were evaluated using Spearman coefficient correlation analysis. Results: The mean ± SD follow-up period was 70.67 ± 18.05 months (range, 36-108 months). From preoperatively to final follow-up, all patients had statistically and clinically significant improvements in the Kujala score (from 51.43 ± 6.87 to 88.52 ± 4.83; P < .001) and IKDC score (from 49.78 ± 6.05 to 81.16 ± 4.20; P < .001). Subgroup analysis indicated no significant difference in functional score improvements based on radiologic features or the J sign. Overall, 20 knees (8.4%) experienced postoperative failure: 11 with redislocation and 9 with patellar instability. A preoperative positive J sign was shown to be an independent prognostic factor for postoperative failure via logistic regression analyses: univariate (odds ratio, 3.340; 95% CI, 1.316-8.480; P = .011) and multivariate (odds ratio, 3.038; 95% CI, 1.179-7.827; P = .021). In addition, the J sign was closely associated with patellar height ( r S, 0.159; P = .014) and trochlear dysplasia ( r S, 0.235; P < .001). Conclusion: Isolated MPFLR appears to be an effective strategy for recurrent patellar lateral dislocation, with significant functional improvement and a low failure rate. A preoperative positive J sign was identified as a potential prognostic risk factor for postoperative failure.

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“…Patellar maltracking is the disproportional relationship in the trochlea and the patella which is associated with an abnormal anatomical change. 73 The patellofemoral joint is high in complexity and involves the multidirectional (mostly cranial and caudal) articulations between the patellar and the femoral groove. It also consists of the muscles and ligaments which act on the patella for stability and tracking.…”

Section: Patellar Maltrackingmentioning

confidence: 99%

Literature review of the causes of pain following total knee replacement surgery: prosthesis, inflammation and arthrofibrosis

Chung

Ali

et al. 2020

EFORT Open Reviews

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Adverse knee pain occurs in 10–34% of all total knee replacements (TKR), and 20% of TKR patients experience more pain post-operatively than pre-operatively. Knee pain is amongst the top five reasons for knee replacement revision in the United Kingdom. The number of TKRs is predicted to continue increasing due to the ageing population. A narrative literature review was performed on the different causes of pain following TKR. A database search on Scopus, PubMed, and Google Scholar was conducted to look for articles related to TKR, pain, and cause. Articles were selected based on relevance, publication date, quality of research and validation. Relevant sections were added to the review. One hundred and fourteen articles were identified and potential causes of TKR pain included: arthrofibrosis, aseptic loosening, avascular necrosis, central sensitization, component malpositioning, infection, instability, nerve damage, overstuffing, patellar maltracking, polyethylene wear, psychological factors and unresurfaced patella. It is important to tailor our approach to address the individual causes of pain. Certain controllable risk factors can be managed pre-operatively to minimize post-operative pain. Risk factors help to predict adverse pain outcomes and identify specific causes. There are multiple causes of pain following TKR. Some factors will require further extensive studies, and as pain is a commonly attributed reason for TKR revision, its underlying aetiologies should be explored. Understanding these factors helps to develop effective methods for diagnosis, prevention and management of TKR pain, which help to improve patient outcomes. Cite this article: EFORT Open Rev 2020;5:534-543. DOI: 10.1302/2058-5241.5.200031

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Patellar maltracking: an update on the diagnosis and treatment strategies

Cited by 63 publications

References 84 publications

Correlations between intra and extraarticular factors measured by computed tomography in patients with recurrent patellar dislocation

Correlations between intra and extraarticular factors measured by computed tomography in patients with recurrent patellar dislocation

Clinical Outcomes and Prognostic Factors in Patients With Recurrent Patellar Lateral Dislocation Treated With Isolated Medial Patellofemoral Ligament Reconstruction: A Retrospective Single-Center Analysis

Literature review of the causes of pain following total knee replacement surgery: prosthesis, inflammation and arthrofibrosis

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