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Bin Zainuddin MA, Mishra N, Lim KBL, Razak HRBA, Lobenhoffer P, Chan CX. Good short-term results following arthroscopic deepening trochleoplasty combined with medial patellofemoral ligament reconstruction: surgical technique and outcomes. J ISAKOS 2024; 9:326-333. [PMID: 38428820 DOI: 10.1016/j.jisako.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 02/26/2024] [Accepted: 02/26/2024] [Indexed: 03/03/2024]
Abstract
PURPOSE To report short-term results and clinical outcomes of arthroscopic deepening trochleoplasty combined with medial patellofemoral ligament (MPFL) reconstruction utilizing standard arthroscopic instruments in patients of recurrent patellar dislocation and trochlear dysplasia. METHODS This is a case series of 13 patients between the ages of 14 and 20 years who presented with recurrent patellar dislocation and severe trochlear dysplasia (Dejour grade D). They were treated surgically using an arthroscopic technique from February 2017 to January 2019 and were followed for 18 months. Patients were assessed preoperatively and postoperatively (at 6, 12, and 18 months) with clinical scores (Tegner Activity Score, Lysholm Knee Score, and Kujala Score). RESULTS There were 69.2% females, and the mean age was 16.4 ± 2.0 years. There were statistically significant improvements in the mean Lysholm and Kujala scores when comparing pre-operative and post-operative scores at every follow-up landmark (p < 0.05). Comparing the preoperative and 18-month postoperative scores-the Lysholm score improved from 68.2 ± 10.3 to 98.7 ± 2.1 (p < 0.001), and the Kujala score improved from 50.3 ± 12.0 to 95.4 ± 4.8 (p < 0.001). Five patients were able to achieve premorbid Tegner activity levels at 12 months, with an additional 5 patients achieving the same premorbid Tegner activity at the 18-month mark. The remaining 3 patients were able to attain >90% of their activity level at 18 months' follow-up. No complications were observed during the follow-up period. CONCLUSIONS This proposed arthroscopic deepening trochleoplasty technique combined with MPFL reconstruction has demonstrated excellent and reproducible early clinical outcomes. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | - Neeraj Mishra
- Department of Orthopaedic Surgery, K K Women's and Children's Hospital, 229899, Singapore.
| | - Kevin Boon Leong Lim
- Department of Orthopaedic Surgery, K K Women's and Children's Hospital, 229899, Singapore.
| | | | - Phillip Lobenhoffer
- Department of Orthopaedic Surgery, Gelenkchirugie Orthopädie Hannover, 30159, Germany.
| | - Chloe Xiaoyun Chan
- Department of Orthopaedic Surgery, National University Hospital, 119074, Singapore.
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Park DY, Chung JY, Jin YJ, Yoon HS, Min BH, Park JY, Lim S. Lateral Retinacular Release During Medial Unicompartmental Knee Arthroplasty in the Presence of Patello-Femoral Joint Arthritis Relieves Patello-Femoral Joint Pressure and Improves Associated Symptoms. J Arthroplasty 2023; 38:2288-2294. [PMID: 37271229 DOI: 10.1016/j.arth.2023.05.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 05/15/2023] [Accepted: 05/20/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND This study evaluated the effects of concomitant lateral patellar retinacular release (LPRR) during medial unicompartmental knee arthroplasty (UKA). METHODS We retrospectively analyzed 100 patients who had patello-femoral joint (PFJ) arthritis who underwent medial UKA with (n = 50) and without (n = 50) LPRR who had ≥2 years follow-up. Radiological parameters associated with lateral retinacular tightness, including patellar tilt angle (PTA), lateral patello-femoral angle (LPFA), and congruence angle, were measured. Functional evaluation was performed using the Knee Society Pain Score, Knee Society Function Score (KSFS), Kujala Score, and the Western Ontario McMaster Universities Osteoarthritis Index score. Intraoperative patello-femoral pressure evaluation was performed on 10 knees to evaluate the pressure changes before and after LPRR. Mann-Whitney U-tests were used for statistical analyses. RESULTS Demographic data did not differ between the LPRR(+) and LPRR(-) groups. A decrease in PTA and an increase in LPFA were observed in the LPRR(+) group compared to those in the LPRR(-) group (PTA; -0.54 versus -1.74, P = .002, LPFA; 0.51 versus 2.01, P = .010). The LPRR(+) group showed significantly better KSFS and Kujala scores than the LPRR(-) group (KSFS: 90 versus 80, P = .017; Kujala score: 86 versus 79, P = .009). Intraoperative patello-femoral pressure analysis showed a 22.6% reduction in the PFJ contact pressure and an 18.7% reduction in PFJ peak pressure after LPRR. (P = .0015, P < .0001, respectively) CONCLUSION: A LPRR during UKA may be a simple and useful adjunct procedure to relieve PFJ symptoms with concomitant PFJOA.
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Affiliation(s)
- Do Young Park
- Department of Orthopedic Surgery, School of Medicine, Ajou University, Suwon, Korea; Cell Therapy Center, Ajou University Medical Center, Suwon, Korea
| | - Jun Young Chung
- Department of Orthopedic Surgery, School of Medicine, Ajou University, Suwon, Korea
| | - Yong Jun Jin
- Cell Therapy Center, Ajou University Medical Center, Suwon, Korea
| | - Ha Seung Yoon
- Department of Orthopedic Surgery, School of Medicine, Ajou University, Suwon, Korea
| | - Byoung-Hyun Min
- Department of Orthopedic Surgery, School of Medicine, Ajou University, Suwon, Korea; Cell Therapy Center, Ajou University Medical Center, Suwon, Korea; Department of Molecular Science and Technology, Ajou University, Suwon, Korea
| | - Jae-Young Park
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, Korea
| | - Sumin Lim
- Department of Orthopedic Surgery, School of Medicine, Ajou University, Suwon, Korea
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Yu Z, Cai H, Liu Z. Factors that impact the patellofemoral contact stress in the TKA: a review. ARTHROPLASTY 2023; 5:44. [PMID: 37542328 PMCID: PMC10403927 DOI: 10.1186/s42836-023-00197-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/06/2023] [Indexed: 08/06/2023] Open
Abstract
Abnormal retro patellar stress is believed to contribute to patellofemoral complications after total knee arthroplasty (TKA), but the causal link between TKA and patellofemoral contact stress remains unclear. By reviewing the relevant studies, we found that both TKA implantation and additional patellar resurfacing increase retro patellar pressure. The rotation and size of the femoral component, thickness and position of the patellar component, installation of the tibial component, prosthesis design and soft tissue balance further influence patellofemoral stress. Specific measures can be applied to reduce stress, including the installation of the femoral prosthesis with an appropriate external rotation angle, placing the tibial component at a more posterior position and the patellar button at a more medial position, avoiding over-sized femoral and patellar components, selecting posterior-stabilized design rather than cruciate-retaining design, using gender-specific prosthesis or mobile-bearing TKA system, and releasing the lateral retinaculum or performing partial lateral facetectomy. Despite these measures, the principle of individualization should be followed to optimize the patellofemoral biomechanics.
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Affiliation(s)
- Zhenguo Yu
- Department of Orthopedics II, Beijing Rehabilitation Hospital, Capital Medical University, Xixiazhuang, Shijingshan District, Beijing, 100144, China
| | - Hong Cai
- Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road, Haidian District, Beijing, 100191, China.
| | - Zhongjun Liu
- Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road, Haidian District, Beijing, 100191, China
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Huddleston HP, Shewman EF, Knapik D, Yanke AB. Lateral Patellofemoral Ligament Reconstruction: A Biomechanical Comparison of 2 Techniques. Am J Sports Med 2023; 51:446-452. [PMID: 36645040 DOI: 10.1177/03635465221145017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND The importance of maintaining lateral patellar stabilizing structures has been demonstrated by the presence of iatrogenic medial patellar instability after lateral retinacular release (LRR) procedures. In patients with medial patellar instability, lateral patellofemoral ligament (LPFL) reconstruction has been clinically shown to restore patellar stability while improving patient-reported outcomes. However, the biomechanics associated with different LPFL reconstruction techniques remain largely unknown. PURPOSE To (1) investigate whether LPFL reconstruction restores medial patellar translation compared with the intact state after LRR and (2) evaluate for any biomechanical differences between soft tissue and osseous LPFL reconstruction techniques. STUDY DESIGN Controlled laboratory study. METHODS A total of 7 knees were included in the final analysis. The knees were dissected, and the tibia and femur were potted. An eye screw was then placed at the midpoint of the patella perpendicular to the medial surface. A custom jig was constructed to allow for a 1-kg load to be applied to the quadriceps muscle. Medial patellar displacement was investigated at 0°, 10°, 20°, 30°, 45°, 60°, and 90° of knee flexion using a tensile testing machine with a 20-N medial force applied to the patella. Medial patellar displacement was assessed in 4 states: intact, LRR, soft tissue LPFL reconstruction (inserted through incisions in the iliotibial band, quadriceps tendon, and patellar tendon), and osseous LPFL reconstruction. RESULTS The LRR group had significantly greater medial patellar translation compared with the intact group throughout flexion (P < .01 to P = .029). The soft tissue LPFL reconstruction group demonstrated significantly greater medial patellar translation at 30° (P = .020) and 45° (P = .025) compared with the intact group, with less translation compared with the LRR group at all degrees of knee flexion except for 45° (P = .065). The osseous LPFL reconstruction group demonstrated significantly greater medial patellar translation compared with the intact group at 30° of flexion (P = .036), with significantly less translation compared with the LRR group from 0° to 30° (P < .01 to P = .013). The soft tissue LPFL reconstruction group (15.94 ± 2.55 mm) demonstrated significantly greater medial patellar translation at 10° of flexion compared with the osseous LPFL reconstruction group (14.16 ± 2.34 mm) (P = .033). CONCLUSION Soft tissue LPFL reconstruction led to significantly greater medial patellar translation at 30° and 45° compared with the intact state, while osseous LPFL reconstruction produced significantly greater translation only at 30°. Both the soft tissue and the osseous reconstruction techniques resulted in comparable medial patellar translation at all degrees of knee flexion except for 10°, in which osseous reconstruction was more similar to the intact state. CLINICAL RELEVANCE Compared with LRR, soft tissue LPFL reconstruction was able to restore stability against medial patellar translation at most degrees of knee flexion, while osseous LPFL reconstruction did not provide adequate stabilization beyond 30° of flexion. While the LPFL does appear to have osseous insertions, soft tissue reconstruction functioned more similarly to the intact state after LRR.
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Affiliation(s)
| | | | | | - Adam B Yanke
- Rush University Medical Center, Chicago, Illinois, USA
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The effect of quadriceps anatomical factors on patellar stability: A systematic review. Knee 2023; 41:29-37. [PMID: 36610240 DOI: 10.1016/j.knee.2022.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/21/2022] [Accepted: 12/14/2022] [Indexed: 01/06/2023]
Abstract
PURPOSE The aim of this systematic review was to analyse the effect of quadriceps anatomical factors on patellar stability. METHODS The protocol for this review was registered on PROSPERO with registration number CRD42022334265. A systematic PRISMA compliant database search was conducted. Electronic databases (MEDLINE, Global Health, MIDIRS, Embase, PsycARTICLES and APA PsycInfo), currently registered studies, conference proceedings and the reference lists of included studies were searched. A narrative synthesis provided a summary of current evidence pertaining to the effect of quadriceps anatomical factors on patellar stability. RESULTS A total of 9168 records were screened in the initial search. Of these, 20 articles satisfied the inclusion criteria, assessing 754 knees of 689 patients, and 69 cadaveric knees. Vastus medialis obliquus strength (VMO) affected patellar stability up to 15° of knee flexion, whereas medial retinaculum integrity did so up to 30° of knee flexion. Studies disagreed as to whether this applied to the rest of knee flexion. There is conflicting evidence regarding the effect of VMO elevation, cross-sectional area and angulation on patellar stability. The lateral retinaculum contributed to patellar stability throughout the entirety of knee flexion. Quadriceps angle altered patellar orientation during knee flexion, but not extension. CONCLUSION Whilst vastus medialis obliquus strength was found to be a determinant of patellar stability, there is conflicting evidence regarding the effect of VMO morphological parameters on patellar stability. The lateral retinaculum provided stability throughout the entirety of knee flexion, and the medial retinaculum did so up to 30° of flexion.
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Berton A, Salvatore G, Orsi A, Egan J, DeAngelis J, Ramappa A, Longo UG, Nazarian A, Denaro V. Lateral retinacular release in concordance with medial patellofemoral ligament reconstruction in patients with recurrent patellar instability: A computational model. Knee 2022; 39:308-318. [PMID: 36345056 DOI: 10.1016/j.knee.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 03/21/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The aim of this study was to develop and validate a finite element (FE) model of the patellofemoral joint to analyze the biomechanics of lateral retinacular release after medial patellofemoral ligament (MPFL) reconstruction in patellar malalignment (increased tibial tubercle-trochlear groove distance (TT-TG)). We hypothesized that lateral retinacular release is not appropriate in patellar instability addressed by MPFL reconstruction due to decreased lateral stability and inappropriate adjustment in patellofemoral contact pressures. METHODS A FE in-silico model of the patellofemoral joint was developed and validated. The model was used analyze the effect of lateral retinacular release in association with MPFL reconstruction on patellofemoral contact pressures, contact area, and lateral patellar displacement during knee flexion. RESULTS MPFL reconstruction alone results in restoration of patellofemoral contact pressures throughout the entire range of motion (0-90°), mimicking the results from healthy condition. The addition of the lateral retinacular release to the MPFL reconstruction resulted in significant reductions in both patellofemoral contact pressure and contact area. Lateral retinacular release resulted in more lateral patellar displacement during the mid-flexion knee range of motion. CONCLUSIONS Combination of lateral retinacular release with MPFL reconstruction in patients with increased TT-TG is not recommended as MPFL reconstruction alone for first-line management of recurrent patellar instability offers a greater biomechanical advantage and restoration of contact forces to resemble that of the healthy knee. The presented biomechanical data outlines the effect of concomitant MPFL reconstruction and lateral retinacular release to help guide surgical planning for patients with recurrent patellar instability due to malalignment.
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Affiliation(s)
- Alessandra Berton
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
| | - Giuseppe Salvatore
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
| | | | - Jonathan Egan
- Center for Advanced Orthopaedic Studies, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Joseph DeAngelis
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Arun Ramappa
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Umile Giuseppe Longo
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy; Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy.
| | - Ara Nazarian
- Center for Advanced Orthopaedic Studies, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Vincenzo Denaro
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy; Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
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Saylik M, Bilgin Y, Atıcı T. Comparison of Clinical and Radiological Results of Lateral Retinacular Release or Lateral Retinacular Lengthening Methods Combined With Medial Retinaculum Plication in Patellofemoral Instability. Cureus 2022; 14:e29684. [PMID: 36321008 PMCID: PMC9615342 DOI: 10.7759/cureus.29684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction In this study, we aimed to compare the clinical and radiological results of patients who underwent medial retinaculum plication (MRP) combined with lateral retinacular release (LRR) or lateral retinacular lengthening (LRL) with the diagnosis of patellofemoral (PF) instability. Methods In our study, we retrospectively analyzed 75 knees of 75 adult patients (43 females and 32 males) who underwent MRP+LRR or MRP+LRL due to PF instability without osseous pathologies. Patients were divided into two groups (MRP+LRR and MRP+LRL) according to the surgical method. The clinical and radiological results of the two groups were compared. Results MRP+LRL surgery was performed on 45 knees and MRP+LRR surgery on 30 knees. The mean age was 26.5 (18-43) years. There was no significant difference between the two groups in the change in patellar lateral shift (PLS) (p=0.429) and congruence angle (CA) (p=0.218) values. However, there was a significant difference between the two groups in the change in patellar tilt angle (PTA) (p=0.009) and lateral patellofemoral angle (LPFA) (p<0.001) values. The change in PTA and LPFA values was higher in the MRP+LRL group. There was no significant difference between the two groups in terms of pre-operative and post-operative Lysholm knee scoring scale (p=0.205, p=0.228), Kujala pain scale (p=0.393, p=0.596), and Tegner activity level scale values (p=0.121, p=0.899). Conclusions MRP+LRR or MRP+LRL provided successful results for correcting the instability in PF instability without osseous pathologies such as patella alta, tibial tubercle-trochlear groove (TT-TG) dysplasia, trochlea dysplasia, genu valgus, and tibial-femoral torsion. While PTA and LPFA values improved more with the MRP-LRL method, clinical results were similar in both methods.
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Huang W, Zeng X, Man GCW, Yang L, Zhang Y. Simultaneous Measurement of Patellofemoral Joint Kinematics and Contact Mechanics in Intact Knees: A Cadaveric Study. Orthop Surg 2022; 14:2317-2329. [PMID: 35946420 PMCID: PMC9483075 DOI: 10.1111/os.13394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 06/05/2022] [Accepted: 06/13/2022] [Indexed: 12/03/2022] Open
Abstract
Objective Patellofemoral kinematics and contact mechanics are important measurements for the assessment of patellofemoral joint (PFJ) problems. Simultaneously measuring PFJ contact pressures and kinematics is a challenging task. The purpose of this study was to simultaneously measure the kinematics and mean/peak contact pressures in the PFJs of cadaveric knees. Methods This was a comparative study performed on fresh cadaveric knees. The kinematic data was acquired for nine cadaveric knees using an optical tracking system. Data about the contact pressure and contact area in the PFJ was obtained at knee flexion angles of 0°, 30°, 60°, 90°, and 120° using a pressure sensor. Intraclass correlation coefficients (ICCs) and minimal detectable differences (MDDs) of six degrees of freedom (6 DOF) in the PFJs were calculated. ICCs and the MDDs of contact pressure, peak pressure, and contact area in the PFJs were also analyzed. We also compared the kinematics of the cadaveric knees before and after the insertion of the pressure sensor. Results All ICC values of 6 DOF in the PFJs were found to be greater than or equal to 0.924. Regarding medial–lateral rotation, the patellar showed a simplified movement pattern that demonstrated progressive lateral rotation of 4.8° ± 3.4° at 120° of knee flexion. While for patellar tilting, the patella showed medial tilting that peaked at 7.2 ± 2.5° at 30° of knee flexion. Whereas no significant differences in PFJ kinematics were found between with and without the placement of the pressure sensor at all knee flexions (P > 0.05). Most of the ICC values for contact pressure, peak contact pressure, and contact area ranged from 0.8 to 0.9. The MDDs for rotational displacement were 0.9° and 0.6 mm for translational displacement. No statistical differences in patellar kinematics were found before and after the insertion of the pressure sensor. Conclusions The setup in the present study enables researchers to simultaneously and synchronously collect real‐time PFJ kinematics and tibiofemoral joint (TFJ) biomechanical kinematic data with high reliability. The low MDDs enabled the researchers to obtain an accurate interpretation of the kinematic and contact mechanics measurement using the experimental setting used in the present study.
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Affiliation(s)
- Wenhan Huang
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Department of Orthopaedics & Traumatology, Faculty of Medicine, Shatin, Hong Kong
| | - Xiaolong Zeng
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Gene Chi-Wai Man
- Department of Orthopaedics & Traumatology, Faculty of Medicine, Shatin, Hong Kong
| | - Liu Yang
- Department of Orthopaedics & Traumatology, Faculty of Medicine, Shatin, Hong Kong.,Department of Bone and Joint Surgery, Shenzhen People's Hospital, Shenzhen, China
| | - Yu Zhang
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Kerzner B, Hevesi M, Fortier LM, Haynes MS, Gursoy S, Dasari SP, Khan ZA, Yanke AB, Chahla J. Lateral Patellofemoral Ligament Reconstruction With Semitendinosus Allograft in the Setting of Previous Lateral Release. Arthrosc Tech 2022; 11:e1097-e1103. [PMID: 35782849 PMCID: PMC9244735 DOI: 10.1016/j.eats.2022.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 02/08/2022] [Indexed: 02/03/2023] Open
Abstract
The lateral patellofemoral ligament acts to resist medial displacement of the patella. When medial subluxation occurs, it usually has an iatrogenic cause such as prior lateral release, an over-tightened medial patellofemoral ligament reconstruction, or detachment of the vastus lateralis from the patella. The justification for lateral retinacular release has historically been to address extensor mechanism issues such as imbalance of the mechanism due to increased retinacular tension. We present a Technical Note on the treatment of chronic medial patellar instability due to a previous lateral retinacular release using a soft-tissue reconstruction approach with a semitendinosus allograft.
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Affiliation(s)
| | - Mario Hevesi
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
| | | | | | - Safa Gursoy
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
| | | | | | - Adam B. Yanke
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A,Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Jorge Chahla
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A,Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A,Address correspondence to Jorge Chahla, M.D., Ph.D., Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St, Ste 300, Chicago, IL 60612, U.S.A.
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Salvatore G, Berton A, Orsi A, Egan J, Walley KC, Johns WL, Kheir N, Ramappa AJ, DeAngelis JP, Longo UG, Denaro V, Nazarian A. Lateral Release With Tibial Tuberosity Transfer Alters Patellofemoral Biomechanics Promoting Multidirectional Patellar Instability. Arthroscopy 2022; 38:953-964. [PMID: 34411682 DOI: 10.1016/j.arthro.2021.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 07/29/2021] [Accepted: 08/03/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to develop and validate a finite element (FE) model of the patellofemoral (PF) joint to characterize patellofemoral instability, and to highlight the effect of lateral retinacular release in combination with tibial tuberosity transfer with respect to contact pressures (CP), contact area (CA), and kinematics during knee flexion. METHODS A comprehensive, dynamic FE model of the knee joint was developed and validated through parametric comparison of PF kinematics, CP, and CA between FE simulations and in vitro, cadaveric experiments. Using this FE model, we characterized the effect of patellar instability, lateral retinacular release (LR), and tibial tuberosity transfer (TTT) in the setting of medial patellofemoral ligament injury during knee flexion. RESULTS There was a high level of agreement in CP, CA, lateral patellar displacement, anterior patellar displacement, and superior patellar displacement between the FE model and the in vitro data (P values 0.19, 0.16, 0.81, 0.10, and 0.36, respectively). Instability conditions demonstrated the greatest CP compared to all of the other conditions. During all degrees of flexion, TTT and concomitant lateral release (TTT + LR) decreased CP significantly. TTT alone shows a consistently lower CA compared to nonrelease conditions with subsequent lateral release further decreasing CA. CONCLUSIONS The results of this study demonstrate that the FE model described reliably simulates PF kinematics and CP within 1 SD in uncomplicated cadaveric specimens. The FE model is able to show that tibial tubercle transfer in combination with lateral retinacular release markedly decreases patellofemoral CP and CA and increases lateral patellar displacement that may decrease bony stabilization of the patella within the trochlear groove and promote lateral patellar instability. CLINICAL RELEVANCE The goal of surgical correction for patellar instability focuses on reestablishing normal PF kinematics. By developing an FE model that can demonstrate patient PF kinematics and the results of different surgical approaches, surgeons may tailor their treatment to the best possible outcome. Of the surgical approaches that have been described, the biomechanical effects of the combination of TTT with lateral retinacular release have not been studied. Thus, the FE analysis will help shed light on the effect of the combination of TTT with lateral retinacular release on PF kinematics.
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Affiliation(s)
- Giuseppe Salvatore
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Alessandra Berton
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | | | - Jonathan Egan
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Kempland C Walley
- Department of Orthopaedic Surgery, University of Michigan
- Michigan Medicine, Ann Arbor, Michigan, U.S.A
| | - William L Johns
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, U.S.A
| | - Nadim Kheir
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Arun J Ramappa
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Joseph P DeAngelis
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Ara Nazarian
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A.; Department of Orthopaedic Surgery, Yerevan State Medical University, Yerevan, Armenia.
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Arthroscopic lateral retinacular release improves patello-femoral and femoro-tibial kinematics in patients with isolated lateral retinacular tightness. Knee Surg Sports Traumatol Arthrosc 2022; 30:791-799. [PMID: 33496826 PMCID: PMC8901473 DOI: 10.1007/s00167-021-06434-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 01/05/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE Arthroscopic lateral retinacular release (LRR) has long been considered the gold standard for the treatment for anterior knee pain caused by lateral retinacular tightness (LRT). However, one-third of patients experience continuous pain postoperatively, which is thought to be related to persistent maltracking of the patella and altered femoro-tibial kinematics. Therefore, the aim of the present study was to simultaneously assess femoro-tibial and patello-femoral kinematics and identify the influence of arthroscopic LRR. METHODS Sixteen healthy volunteers and 12 patients with unilateral, isolated LRT were prospectively included. Open MRI scans with and without isometric quadriceps contraction were performed in 0°, 30° and 90° of knee flexion preoperatively and at 12 months after surgery. Patellar shift, tilt angle, patello-femoral contact area and magnitude of femoro-tibial rotation were calculated by digital image processing. RESULTS Postoperatively, patellar shift was significantly reduced at 90° of knee flexion compared to preoperative values. The postoperative patellar tilt angle was found to be significantly smaller at 30° of knee flexion compared to that preoperatively. Isometric muscle contractions did not considerably influence patellar shift or tilt in either group. The patello-femoral contact area increased after LRR over the full range of motion (ROM), with significant changes at 0° and 90°. Regarding femoro-tibial kinematics, significantly increased femoral internal rotation at 0° was observed in the patient group preoperatively, whereas the magnitude of rotation at 90° of knee flexion was comparable to that of healthy individuals. The pathologically increased femoral internal rotation at 30° without muscular activity could be significantly decreased by LRR. With isometric quadriceps contraction no considerable improvement of femoral internal rotation could be achieved by LRR at 30° of knee flexion. CONCLUSIONS Patello-femoral and femoro-tibial joint kinematics could be improved, making LRR a viable surgical option in carefully selected patients with isolated LRT. However, pathologically increased femoral internal rotation during early knee flexion remained unaffected by LRR and thus potentially accounts for persistent pain. LEVEL OF EVIDENCE II.
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Hamawandi SA, Amin HI, Al-Humairi AK. Open versus arthroscopic release for lateral patellar compression syndrome: a randomized-controlled trial. Arch Orthop Trauma Surg 2022; 142:1-7. [PMID: 33829300 PMCID: PMC9474395 DOI: 10.1007/s00402-021-03878-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 03/24/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Lateral patellar compression syndrome is one of the causes of anterior knee pain in young adults and resulted from tight lateral patellar retinaculum. The aim of our study is to compare between open and arthroscopic release of lateral patellar compression syndrome in relation of functional outcome, time of surgical procedure, length of hospital stays, intraoperative and postoperative complications as bleeding, infection, recurrence, and patellar instability with 2 years of follow-up. MATERIALS AND METHODS 80 patients, age (21-49 years), were divided randomly into 2 groups (A and B). Group A (40 patients) were treated with open release. Group B (40 patients) were treated by arthroscopic release. All these patients are diagnosed as lateral patellar compression syndrome depending on clinical features and MRI. All patients were assessed by Lysholm knee scoring scale before surgery and at periods of 2, 6 weeks, 6, 12, and 24 months after surgery. RESULTS There is significant difference in functional outcome, measured by Lysholm knee scoring scale, between preoperative and postoperative assessment periods in both groups (P < 0.001). There is significantly better functional outcome at 2 years of follow-up with arthroscopic release (P = 0.018). There is no recurrence in both groups, but there were 4 patients develop medial patellar instability in the group of open release. CONCLUSION Both open and arthroscopic lateral release for patients with isolated lateral patellar compression syndrome can be effective surgical procedures, but arthroscopic release can achieve better functional outcome. TRIAL REGISTRATION NCT, NCT04130412. Retrospectively registered on 3rd of June, 2020 at ClinicalTrials.gov.
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Affiliation(s)
- Sherwan A. Hamawandi
- FIBMS Orthopedic Surgery, Head of Orthopaedic Department, College of Medicine, Hawler Medical University, Erbil, Iraq
| | - Hazhar I. Amin
- Orthopedic Department, Erbil Teaching Hospital, Erbil, Iraq
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Lee DW, Lee JK, Cho YC, Yang SJ, Cho SI, Kim JG. Internal Fixation of Lateral Trochlear Groove Osteochondritis Dissecans With Simultaneous Lateral Retinacular Lengthening in Adolescent Athletes. Am J Sports Med 2021; 49:3867-3875. [PMID: 34757816 DOI: 10.1177/03635465211047851] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The goals of operative treatment for the adolescent athlete with unstable osteochondritis dissecans (OCD) lesion are rigid fixation and prevention of recurrence. PURPOSE To evaluate clinical and radiological outcomes of internal fixation of lateral trochlear groove OCD with simultaneous lateral retinacular lengthening. STUDY DESIGN Case series; Level of evidence, 4. METHODS Adolescent athletes who had undergone internal fixation and simultaneous lateral retinacular lengthening for an unstable OCD lesion of the lateral trochlear groove were retrospectively reviewed. Subjective assessments included the Lysholm score, International Knee Documentation Committee (IKDC) subjective score, Tegner activity scale, and an athletic questionnaire. Functional tests included isokinetic muscle strength, single-leg hop for distance, single-leg vertical jump, and Y-balance. Pre- and postoperative radiographs and magnetic resonance images were reviewed. RESULTS The mean ± SD age of the 17 patients included in this study was 15.9 ± 0.9 years; last clinical follow-up duration was 37.7 ± 8.1 months. At the last follow-up, the Lysholm score improved from 68.7 ± 15.3 to 93.4 ± 12.4 and the IKDC subjective score from 60.2 ± 14.7 to 88.7 ± 12.7 (P < .001). The mean Tegner activity scale score was 9.4 ± 0.5 before injury and 8.9 ± 1.2 at the last follow-up (P = .059). The limb symmetry indices of isokinetic muscle strength, single-leg hop for distance, single-leg vertical jump, and Y-balance improved at the last follow-up; the mean limb symmetry index was ≥85% in each functional test. Regarding the athletic questionnaire, 16 (94.1%) patients were satisfied with the surgery. At the last follow-up, 2 patients had higher ability after returning to sports, 11 had the same ability, and 3 had lower ability than the preinjury level. Postoperative magnetic resonance imaging at 12-month follow-up showed that the OCD lesion appeared healed in 7 (41.2%) patients and partially healed in 9 (52.9%). CONCLUSION Internal fixation of lateral trochlear groove OCD with simultaneous lateral retinacular lengthening in adolescent athletes achieved satisfactory clinical and radiological outcomes. Therefore, this combined surgical technique could be considered an effective treatment for lateral trochlear groove OCD, with a high rate of return to sport.
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Affiliation(s)
- Dhong Won Lee
- Department of Orthopaedic Surgery, KonKuk University Medical Center, School of Medicine, Konkuk University, Seoul, Korea
| | - Joon Kyu Lee
- Department of Orthopaedic Surgery, KonKuk University Medical Center, School of Medicine, Konkuk University, Seoul, Korea
| | - Young Chang Cho
- Department of Orthopaedic Surgery, KonKuk University Medical Center, School of Medicine, Konkuk University, Seoul, Korea
| | - Sang Jin Yang
- Department of Health and Exercise Management, TongWon University, Gwangju, Korea
| | - Seung Ik Cho
- Sports Medical Center, KonKuk University Medical Center, Seoul, Korea
| | - Jin Goo Kim
- Department of Orthopedic Surgery, Myongji Hospital, Goyang-si, Korea
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A Prospective Cohort Study on Quality of Life among the Pediatric Population after Surgery for Recurrent Patellar Dislocation. CHILDREN-BASEL 2021; 8:children8100830. [PMID: 34682094 PMCID: PMC8535121 DOI: 10.3390/children8100830] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/15/2021] [Accepted: 09/18/2021] [Indexed: 11/17/2022]
Abstract
Patellofemoral instability is a frequent cause of knee pathology affecting quality of life among the pediatric population. Here, we present a prospective cohort study which included patients who had undergone surgical management using the lateral release and medial imbrication approach (LRMI) or medial patellofemoral ligament reconstruction (MPFL-R). The object of this study was to assess the quality of life among children that have undergone surgical treatment for patellar dislocation. Quality of life was assessed before and after surgery using the Pediatric International Knee Documentation Committee form (Pedi-IKDC), a questionnaire that aims to quantify knee functionality. Postoperative scarring was evaluated using The Stony Brook Scar Evaluation Scale. One hundred and eight patients were selected and grouped according to the type of procedure. Before surgery, the two groups had similar mean Pedi-IKDC scores (41,4 MPFL-R vs. 39,4 LRMI p = 0.314). Improvements were observed in the postoperative scores. The MPFL-R technique showed promising outcomes. When comparing the two surgical groups, there was a significant difference in favor of MPFL-R group (MPFL-R 77.71 points vs. LRMI 59.74 points, p < 0.0001-95% CI (11.22-24.72)). Using the Stony Brook Scar Evaluation Scale, a significant difference in scar quality in favor of MPFL-R was observed (4,5 MPFL-R vs. 2,77 LRMI p = 0.002). In conclusion, this study provides objective evidence-based outcome assessments that support the medial patellofemoral ligament reconstruction technique as the gold standard for patellofemoral instability.
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Surgical Technique for Obligate Flexion Patellar Dislocation: Medial Patellofemoral Ligament Reconstruction, Distal Femoral Osteotomy, Quadricepsplasty, and Lateral Retinacular Reconstruction with Dermal Allograft. Arthrosc Tech 2021; 10:e1845-e1852. [PMID: 34336584 PMCID: PMC8322671 DOI: 10.1016/j.eats.2021.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 04/01/2021] [Indexed: 02/03/2023] Open
Abstract
Lateral patellar dislocation is a relatively common pathology that can be surgically treated with a medial patellofemoral ligament reconstruction. In rare occurrences patients can present with patellar maltracking that results in obligate patellar instability in flexion but central tracking in extension. This presentation can be much more complicated to treat surgically and may require a combination of multiple patellofemoral procedures. In this technique we describe a four-pronged treatment approach for improving patellar tracking in a patient with obligate flexion patellar dislocation and valgus malalignment including VY quadricepsplasty, distal femoral osteotomy, medial patellofemoral ligament reconstruction, and lateral retinacular and capsular reconstruction with a dermal allograft.
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Isolated Arthroscopic Lateral Retinacular Release for Lateral Patellar Compression Syndrome. Life (Basel) 2021; 11:life11040295. [PMID: 33808422 PMCID: PMC8066445 DOI: 10.3390/life11040295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/28/2021] [Accepted: 03/29/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction: Evidence concerning the role of isolated lateral retinacular release (LRR) for lateral patellar compression syndrome (LPCS) dates back at least three decades. Appropriate indications, execution and outcomes still remain unclear and controversial. The present investigation analyzed the midterm result of isolated and arthroscopic LRR for LPCS in a cohort of patients who underwent such procedure at our institution. Material and methods: Patients undergoing isolated arthroscopic LRR for LPCS were identified retrospectively from our electronic database. All procedures were performed by two experienced surgeons. Patients with bony and/or soft tissues abnormalities, patellofemoral instability, moderate to severe chondral damage were not included. Patients with previous surgeries were not included, as were those who underwent combined interventions. Clinical scores and complications were recorded. Results: 31 patients were recruited in the present investigation. The mean follow-up was 86.0 ± 22.8 months. The mean age of the patients at the index operation was 34.2 ± 13.1 years. A total 55% (17 of 31) were women, and 58% (18 of 31) had involved the right knee. The mean hospitalization length was 3.5 ± 1.4 days. At a mean follow-up of 86.0 ± 22.8 months, the numeric rating scale (NRS) was 1.2 ± 0.8, the Kujala score was 91.3 ± 11.3, the Lysholm score was 93.1 ± 15.0, and the Tegner score was 5.0 ± 1.8. At the latest follow-up, 9 of 31 (29.0%) of patients experienced compilations. One patient (3.2%) had a post-operative hemarthrosis which was managed conservatively. Six patients (19.4%) reported a persistent sensation of instability, without signs of patellar dislocation or subluxation. One patient underwent an arthroscopic meniscectomy, and another patient an anterior cruciate ligament (ACL) reconstruction. Conclusion: isolated arthroscopic lateral retinacular release for lateral patellar compression syndrome is feasible and effective, achieving satisfying results at more than seven years following the procedure.
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Management of Patellar Chondral Defects with Autologous Matrix Induced Chondrogenesis (AMIC) Compared to Microfractures: A Four Years Follow-Up Clinical Trial. Life (Basel) 2021; 11:life11020141. [PMID: 33668454 PMCID: PMC7918926 DOI: 10.3390/life11020141] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/08/2021] [Accepted: 02/10/2021] [Indexed: 02/06/2023] Open
Abstract
Introduction: Evidence on the management of chondral defects of the patella arises from studies in which the patellofemoral joint was treated together with the femorotibial joint and primary and revision settings. Furthermore, the superiority of Autologous Matrix Induced Chondrogenesis (AMIC) over microfractures (MFx) for patellar chondral defects is uncertain. Therefore, the present study compared primary isolated AMIC versus MFx for focal unipolar chondral defects of the patellar facet joints at midterm follow-up. Methods: Patients undergoing AMIC or isolated MFx surgery for borderline-sized focal unipolar chondral defects of the patellar facet joints were followed at our institution. All surgeries were performed in the same fashion by experienced surgeons. A parapatellar arthrotomy was adopted in all surgeries. The outcomes of interest were: Visual Analogic Scale (VAS), Tegner Activity Scale, International Knee Documentation Committee (IKDC), and the Lysholm scores. The Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) was assessed by a blinded radiologist, who had not been involved in the clinical management of the patients. Results: 38 patients were enrolled in the present study: 27 underwent AMIC, and 11 MFx. The mean follow-up was 45.1 months. The mean age of the patients at baseline was 34.5 years. The mean size of the defect was 2.6 cm2. The MFx cohort experienced a shorter length of the hospitalization (P = 0.008). There was no difference in terms of follow-up and previous symptoms duration, mean age, sex, side, defect size, and BMI. At last follow-up, the AMIC cohort reported greater IKDC (P = 0.01), Lysholm (P = 0.009), and Tegner (P = 0.02), along with a low rate of failure (P = 0.02). VAS was lower in the AMIC group (P = 0.002). No difference was found in the MOCART score (P = 0.09), rates of revision (P = 0.06), and arthroplasty (P = 0.2). Conclusion: The AMIC procedure achieves greater IKDC and Lysholm score, and a significant reduction of the VAS score in the management of patellar chondral defects. The Tegner scale demonstrated greater activity after AMIC procedure. Finally, the AMIC group evidenced a lower rate of failure. Similarity was found on MOCART score, rates of revision, and arthroplasty between the two procedures.
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18
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Park D, Kang J, Kim N, Heo S. Patellofemoral contact mechanics after transposition of tibial tuberosity in dogs. J Vet Sci 2020; 21:e67. [PMID: 32735102 PMCID: PMC7402942 DOI: 10.4142/jvs.2020.21.e67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 04/14/2020] [Accepted: 05/17/2020] [Indexed: 11/20/2022] Open
Abstract
Background Tibial tuberosity transposition (TTT) causes caudalization of the patellar ligament insertion in canine medial patellar luxation, which can lead to increases in patellofemoral contact pressure. Objectives The purpose of this study is to confirm the effect of patellofemoral contact mechanics after craniolateral and caudolateral transposition of tibial tuberosity in normal canine hindlimbs. Methods Craniolateral and caudolateral transposition of tibial tuberosity was performed in 5 specimens, respectively. The pressure was measured in the specimen before TTT, and then in the same specimen after TTT. In this process, data was obtained in 10 specimens. The measurement results were output as visualization data through the manufacturer's software and numerical data through spreadsheet. Based on these 2 data and the anatomical structure of the patellofemoral joint (PFJ) surface, whole measurement area was analysed by dividing into medial, lateral and central area. Results In craniolateralization of tibial tuberosity, total, medial, central contact pressure was decreased and lateral contact pressure was not statistically changed lateral contact pressure than normal PFJ. In caudolateralization of tibial tuberosity, total, lateral contact pressure was increased and medial contact pressure was not statistically changed than normal PFJ. Although not statistically significant changed, central contact pressure in caudolateralization of tibial tuberosity was increased in all 5 specimens. Conclusions These results imply that traditional TTT, prone to caudal shift of patellar tendon, can increase retropatellar pressure may lead to various complications and diseases of the stifle joint.
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Affiliation(s)
- Donghee Park
- Department of Veterinary Surgery, College of Veterinary Medicine, Jeonbuk National University, Iksan 54596, Korea
| | - Jinsu Kang
- Department of Veterinary Surgery, College of Veterinary Medicine, Jeonbuk National University, Iksan 54596, Korea
| | - Namsoo Kim
- Department of Veterinary Surgery, College of Veterinary Medicine, Jeonbuk National University, Iksan 54596, Korea
| | - Suyoung Heo
- Department of Veterinary Surgery, College of Veterinary Medicine, Jeonbuk National University, Iksan 54596, Korea.
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T2 mapping on magnetic resonance imaging to diagnose lateral patellar compression syndrome: a report of two cases. CURRENT ORTHOPAEDIC PRACTICE 2020. [DOI: 10.1097/bco.0000000000000919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
PURPOSE OF REVIEW The patellofemoral joint is a complicated articulation of the patella and femur that is prone to pathologies. The purpose of this review is to report on the current methods of investigating patellofemoral mechanics, factors that affect joint function, and future directions in patellofemoral joint research with emerging technologies and techniques. RECENT FINDINGS While previous hypotheses have suggested that the patella is only a moment arm extender, recent literature has suggested that the patella influences the control of knee moments and forces acting on the tibia as well as contributes to various aspects of patellar function with minimal neural input. With advancements in simulating a six-degrees-of-freedom patellofemoral joint, we have gained a better understanding of patella motion and have shown that geometry and muscle activations impact patella mechanics. Research into influences on patella mechanics from other joints such as the hip and foot has become more prevalent. In this review, we report current in vivo, in vitro, and in silico approaches to studying the patellofemoral joint. Kinematic and anatomical factors that affect patellofemoral joint function such as patella alta and tilt or bone morphology and ligaments are discussed. Moving forward, we suggest that advanced in vivo dynamic imaging methods coupled to musculoskeletal simulation will provide further understanding of patellofemoral pathomechanics and allow engineers and clinicians to design interventions to mitigate or prevent patellofemoral pathologies.
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Lu K, Wang HZ, Li C, Dong QR. Semiextended approach for intramedullary nailing via a patellar eversion technique for tibial-shaft fractures: Evaluation of the patellofemoral joint. Injury 2019; 50:2142. [PMID: 31471073 DOI: 10.1016/j.injury.2019.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 08/17/2019] [Indexed: 02/02/2023]
Affiliation(s)
- Ke Lu
- Department of Orthopaedics, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215004, China; Department of Joint Surgery, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, Jiangsu, 215300, China.
| | - Hong-Zhen Wang
- Department of Joint Surgery, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, Jiangsu, 215300, China.
| | - Chong Li
- Department of Orthopaedics, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, Jiangsu, 215300, China.
| | - Qi-Rong Dong
- Department of Orthopaedics, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215004, China.
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Felli L, Capello AG, Lovisolo S, Chiarlone F, Alessio-Mazzola M. Goldthwait technique for patellar instability: surgery of the past or here to stay procedure? A systematic review of the literature. Musculoskelet Surg 2019; 103:107-113. [PMID: 30270400 DOI: 10.1007/s12306-018-0566-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 09/20/2018] [Indexed: 06/08/2023]
Abstract
Patellar instability is the pathologic condition where the patella is prone to recurrent lateral dislocation. The clinical results on large series of patients and long-term outcome of Goldthwait techniques have not been described in the literature. The aim of this systematic review is: (1) to analyze and summarize the available literature focused on Goldthwait procedure in the treatment of recurrent patellar dislocation and (2) to evaluate the clinical and functional outcomes of patients treated with this surgical procedure. A systematic review of the literature was performed to investigate the results of Goldthwait procedure according to the PRISMA 2009 guidelines. A total of 7 articles published were systematically reviewed. A total of 197 knees (182 patients: 86 males and 96 females) have been treated with Goldthwait procedure. The mean reported follow-up was 6.8 years. The mean age at surgery was 18 years old. The Goldthwait procedure was associated with open lateral retinacular release in 127 (64.5%) knees to arthroscopic lateral retinacular release in 20 (10.1%) knees, and with retinacular plasty and a vastus medialis advancement in 33 (16.7%) knees. Only in 17 (8.6%) knees the Goldthwait procedure was performed as an isolated procedure. Poor standardization of methodological assessment has been observed. Despite the limitations of the available literature, the Goldthwait technique provides satisfying results for the treatment of patellar instability even in pediatric population. More high-quality studies are necessary to evaluate the long-term complications and the real incidence of long-term PF osteoarthritis.
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Affiliation(s)
- L Felli
- Orthopaedic Clinic, Department of Surgical Sciences (DISC), Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genova, Italy
| | - A G Capello
- Orthopaedic Clinic, Department of Surgical Sciences (DISC), Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genova, Italy
| | - S Lovisolo
- Orthopaedic Clinic, Department of Surgical Sciences (DISC), Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genova, Italy
| | - F Chiarlone
- Orthopaedic Clinic, Department of Surgical Sciences (DISC), Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genova, Italy
| | - M Alessio-Mazzola
- Orthopaedic Clinic, Department of Surgical Sciences (DISC), Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genova, Italy.
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Shao X, Zeng J, Chen Y, Wu L, Wang X. In Vitro Biomechanical Study of Epidural Pressure during the Z-shape Elevating-Pulling Reduction Technique for Cervical Unilateral Locked Facets. J INVEST SURG 2019; 32:446-453. [PMID: 29537899 DOI: 10.1080/08941939.2018.1442533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 02/14/2018] [Indexed: 02/05/2023]
Abstract
Objective: To analyze the mechanism of the halo vest-assisted Z-shape elevating-pulling reduction technique for cervical unilateral locked facets, and confirm the safety of the spinal cord under the epidural pressure that occurs during the reduction process. Methods: Eleven osteoligamentous whole coronal and cervical spine specimens were established as skull-neck-thorax models of cervical unilateral locked facets at the C5/6 level. The halo vest-assisted Z-shape elevating-pulling reduction technique was then applied to reduce the locked facets. The changes in the epidural pressure in five cervical positions (cervical physiological curvature, cervical lateral bending, cervical unilateral locked facets, cervical unilateral perched facets, and reduction) were measured by a pressure sensor during the reduction procedure. The models simultaneously underwent multi-angle radiographic examination and CT scanning. Results: Successful closed reduction was achieved via the halo vest-assisted Z-shape elevating-pulling reduction technique in all 11 models. The epidural pressure in the cervical unilateral locked facets position was significantly higher than that in the other four cervical positions (P < 0.005). There was no significant difference in the epidural pressures measured during cervical lateral bending, cervical unilateral perched facets, and reduction. Conclusions: Maximum epidural pressures were measured in the position of cervical unilateral locked facets. The halo vest-assisted Z-shape elevating-pulling reduction technique achieved spinal decompression without causing secondary spinal cord injury. The halo vest-assisted Z-shape elevating-pulling reduction technique is safe and effective, and has a high success rate of reduction.
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Affiliation(s)
- Xinwei Shao
- a Department of Spine Surgery, The Second Affiliated Hospital, Shantou University Medical College , Shantou, Guangdong 515041 , P. R. China
| | - Jican Zeng
- a Department of Spine Surgery, The Second Affiliated Hospital, Shantou University Medical College , Shantou, Guangdong 515041 , P. R. China
| | - Yuchun Chen
- a Department of Spine Surgery, The Second Affiliated Hospital, Shantou University Medical College , Shantou, Guangdong 515041 , P. R. China
| | - Lixian Wu
- b Department of Human Anatomy, Shantou University Medical College , Shantou, Guangdong 515063 , P. R. China
| | - Xinjia Wang
- a Department of Spine Surgery, The Second Affiliated Hospital, Shantou University Medical College , Shantou, Guangdong 515041 , P. R. China
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Malatray M, Magnussen R, Lustig S, Servien E. Lateral retinacular release is not recommended in association to MPFL reconstruction in recurrent patellar dislocation. Knee Surg Sports Traumatol Arthrosc 2019; 27:2659-2664. [PMID: 30483832 DOI: 10.1007/s00167-018-5294-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 11/12/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Reconstruction of the medial patellofemoral ligament (MPFL) has become the gold standard for the treatment of the recurrent patellar dislocation (RPD). Lateral retinacular release can be performed in association with MPFL reconstruction, but the effect on outcomes is not clear. To evaluate the effect of lateral release on outcomes following MPFL reconstruction is the aim of this study. It is hypothesized that isolated MPFL reconstruction was not inferior to MPFL reconstruction and lateral retinacular release in terms of IKDC subjective score and patellar tilt (PT). METHODS Patients between ages 18 and 45 scheduled to undergo MPFL reconstruction without an associated bony procedure (tibial tubercle osteotomy or trochleoplasty) were randomized to isolated MPFL reconstruction or MPFL reconstruction (no LRR group) and arthroscopic LRR (LRR group). Evaluation criteria were subjective IKDC score as the primary outcome and PT evaluated with a CT-scan. PT was evaluated with the quadriceps relaxed (PTQR) and contracted (PTQC). RESULTS Of 43 patients included in the trial, 7 were lost of follow-up, 3 were not able to complete evaluation because of medical reasons, and 33 patients were evaluated with a minimum of 12 months and a median follow-up of 24 (12-60) months. The average subjective IKDC score was at 86 ± 20 (29-94) in the LRR group and 82 ± 15 (39-95) in the no LRR group (p = 0.45). The PTQR was at 22° ± 7° (13-37) in the LRR group and 21 ± 10 (4-37) in the no LRR group (n.s.). The PTQC was at 27° ± 9° (12-40) in the LRR group and 25 ± 12 (5-45) in the no LRR group (n.s.). No complications were noted in either group. CONCLUSIONS No significant differences were found in subjective IKDC score or patellar tilt based on the addition of an arthroscopic LRR to an MPFL reconstruction in patients with RPD not undergoing associated bony procedures. There is no indication to a systematic lateral retinacular release in association with MPFL reconstruction in the treatment of RPD. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Matthieu Malatray
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix Rousse Hospital, Civil Hospices of Lyon, 103 Boulevard de la Croix Rousse, 69004, Lyon, France.
| | - Robert Magnussen
- OSU Sports Medicine Research Institute, Department of Orthopaedics, The Ohio State University, Columbus, OH, USA
| | - Sebastien Lustig
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix Rousse Hospital, Civil Hospices of Lyon, 103 Boulevard de la Croix Rousse, 69004, Lyon, France.,LBMC UMR T 9406, Laboratory of Chock Mechanics and Biomechanics, Claude Bernard Lyon 1 University, Lyon, France
| | - Elvire Servien
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix Rousse Hospital, Civil Hospices of Lyon, 103 Boulevard de la Croix Rousse, 69004, Lyon, France.,LIBM, EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, Lyon, France
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Shamrock AG, Day MA, Duchman KR, Glass N, Westermann RW. Medial Patellofemoral Ligament Reconstruction in Skeletally Immature Patients: A Systematic Review and Meta-analysis. Orthop J Sports Med 2019; 7:2325967119855023. [PMID: 31384615 PMCID: PMC6664654 DOI: 10.1177/2325967119855023] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Given the proximity of the medial patellofemoral ligament (MPFL) femoral insertion to the distal femoral physis in skeletally immature patients, multiple techniques for femoral graft fixation have been described. PURPOSE To systematically review the literature and evaluate outcomes and complications following MPFL reconstruction in skeletally immature patients. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A comprehensive literature search was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines through use of the PubMed, Embase, and Cochrane Central databases. All original, English-language studies reporting outcomes or complications following MPFL reconstruction in skeletally immature patients were included. Skeletally mature patients were excluded. Data regarding demographics, surgical technique, graft type, outcomes, and complications were recorded. Study quality was assessed by use of the modified Coleman methodology score. Statistical analysis was performed through use of chi-square and weighted mean pooled cohort statistics, where appropriate, with significance set at P < .05. RESULTS 7 studies that entailed 132 MPFL reconstructions (126 patients) met the inclusion criteria. Females comprised 57.9% of the cohort (73 females), and the mean age was 13.2 years (range, 6-17 years). Mean postoperative follow-up was 4.8 years (range, 1.4-10 years). All of the grafts used were autograft, with gracilis tendon (n = 80; 60.6%) being the most common. Methods of femoral fixation included interference screw (n = 52; 39.4%), suture anchor (n = 51; 38.6%), and soft tissue pulley around the medial collateral ligament or adductor tendon (n = 29; 21.9%). Pooled Kujala scores improved from 59.1 to 84.6 after MPFL reconstruction. The total reported complication rate was 25.0% (n = 33) and included 5 redislocations (3.8%) and 15 subluxation events (11.4%). No cases of premature physeal closure were noted, and there were 3 reports of donor site pain (2.3%). Neither autograft choice (P > .804) nor method of femoral fixation (P > .416) influenced recurrent instability or overall complication rates. CONCLUSION These findings suggest that MPFL reconstruction in skeletally immature patients is a viable treatment option, with significant improvement in patient-reported outcomes and redislocation event rates of less than 5% at nearly 5-year follow-up. Further high-quality research is needed to determine optimal graft options and surgical technique while considering recurrent instability, donor site morbidity, and potential injury to the adjacent physis.
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Affiliation(s)
- Alan G. Shamrock
- Department of Orthopaedic Surgery, University of Iowa Hospitals and
Clinics, Iowa City, Iowa, USA
| | - Molly A. Day
- Department of Orthopaedic Surgery, University of Iowa Hospitals and
Clinics, Iowa City, Iowa, USA
| | - Kyle R. Duchman
- Department of Orthopaedic Surgery, University of Iowa Hospitals and
Clinics, Iowa City, Iowa, USA
| | - Natalie Glass
- Department of Orthopaedic Surgery, University of Iowa Hospitals and
Clinics, Iowa City, Iowa, USA
| | - Robert W. Westermann
- Department of Orthopaedic Surgery, University of Iowa Hospitals and
Clinics, Iowa City, Iowa, USA
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Liu C, Duan G, Niu Y, Cao P, Fu K, Niu J, Wang F. Lateral retinaculum plasty instead of lateral retinacular release with concomitant medial patellofemoral ligament reconstruction can achieve better results for patellar dislocation. Knee Surg Sports Traumatol Arthrosc 2018; 26:2899-2905. [PMID: 29138916 DOI: 10.1007/s00167-017-4798-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 11/08/2017] [Indexed: 01/16/2023]
Abstract
PURPOSE To elucidate the outcomes of lateral retinaculum plasty versus lateral retinacular release with concomitant medial patellofemoral ligament (MPFL) reconstruction. METHODS In a prospective study, 59 patients treated at our institution from 2012 to 2014 were included. The 59 patients were randomly divided into two groups. Group I included 27 patients who underwent lateral retinacular release and MPFL reconstruction. Group II included 32 patients who underwent lateral retinaculum plasty and MPFL reconstruction. All patients were followed up for at least 2 years and all assessments were performed both pre- and post-operation. Clinical evaluation consisted of the Kujala score, patellar medial glide test, and patellar tilt angle, patellar lateral shift, and congruence angle, measured on CT scan. RESULTS Significant improvement was seen after surgery in both groups. The group of lateral retinaculum plasty achieved better results than the group of lateral retinacular release. No statistically significant differences were found in lateral patellar shift (ns) or congruence angle (ns) between the groups. There were significant differences in Kujala score (P < 0.05) patellar tilt angle (P < 0.05), and patellar medial glide test (P < 0.05) between the groups. CONCLUSIONS MPFL reconstruction with lateral retinaculum plasty yielded better results than MPFL with lateral retinacular release. Postoperatively, medial and lateral function were restored, and patellar tracking was normal. Lateral retinaculum plasty is a new method that reduces the complications of lateral retinacular release for patellar dislocation. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Chang Liu
- Hebei Medical University Third Affiliated Hospital, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Guman Duan
- Hebei Medical University Third Affiliated Hospital, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Yingzhen Niu
- Hebei Medical University Third Affiliated Hospital, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Pengkai Cao
- Hebei Medical University Third Affiliated Hospital, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Kunpeng Fu
- Hebei Medical University Third Affiliated Hospital, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Jinghui Niu
- Hebei Medical University Third Affiliated Hospital, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Fei Wang
- Hebei Medical University Third Affiliated Hospital, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China.
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Lee DK, Wang JH, Kang SH, Kim JH, Haque R, Lee BH. The clinical and radiological results of individualized surgical treatment depending on pathologic abnormalities in recurrent patellar dislocation: low recurrence rate, but unintended patella baja. Knee Surg Sports Traumatol Arthrosc 2018; 26:2558-2567. [PMID: 28914334 DOI: 10.1007/s00167-017-4697-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 08/23/2017] [Indexed: 01/17/2023]
Abstract
PURPOSE To evaluate the clinical and radiological outcomes and chondral lesion change using individualized surgery for recurrent patellar dislocation. METHODS A total of 31 knees with recurrent patellar dislocation underwent surgery depending on individual pathologic abnormalities. Pathologic abnormalities including medial laxity, lateral tightness, increased tibial tuberosity (TT)-to-trochlear groove distance (>20 mm), and patella alta (Caton-Deschamps ratio >1.2) were evaluated in each patient. The abnormalities were corrected through medial patellofemoral ligament reconstruction, TT distalization, TT anteromedialization, and lateral retinacula release. The mean follow-up period was 33 months. RESULTS There was one recurrent case (3.2%), requiring additional surgery. The mean Kujala scores were significantly (P = 0.002) improved from 75.8 (SD 12.4) to 84.6 (SD 13.1). Tegner scores were significantly improved from 3.7 (range 1-9) to 5.4 (range 2-9) (P < 0.001), as were and visual analogue scale pain scores from 4.7 (SD 2.5) to 2.6 (SD 2.2) (P = 0.001). Caton-Deschamps ratio was significantly decreased from 1.1 (SD 0.2) to 0.9 (SD 0.1) (P < 0.001), regardless of TT distalization. Chondral lesions of the patella and trochlear groove were improved or maintained in 57.1 and 71.4% of patients, respectively. CONCLUSION Individualized surgery in recurrent patellar dislocation was effective and safe with a low recurrence rate. However, the possibility of unintended patella baja, which might be related to post-operative anterior knee pain, should be considered. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Do Kyung Lee
- Department of Orthopedic Surgery, Konyang University Hospital, Konyang University School of Medicine, Daejeon, Korea
| | - Joon Ho Wang
- Department of Orthopedic Surgery, Samsung Medical Center and Department of Health Sciences and Technology and Department of Medical Device Management and Research, SAIHST Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Seung Hoon Kang
- Department of Orthopedic Surgery, Samsung Changwon hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Jun Ho Kim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Russel Haque
- Department of Orthopedic Surgery, Konkuk University Hospital, Konkuk University School of Medicine, Seoul, Korea
| | - Byung Hoon Lee
- Department of Orthopedic Surgery, Kang-Dong Sacred Heart Hospital, Hallym University School of Medicine, Seoul, Korea
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Zhu Y, Li Y, Yan C, Du X, Xing Z, Chen P. [Influence of lateral retinacular release on anterior knee pain following total knee arthroplasty]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 31:541-546. [PMID: 29798542 DOI: 10.7507/1002-1892.201701052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the effect of lateral retinacular release on the clinical outcomes after total knee arthroplasty (TKA) without resurfacing of the patella. Methods A prospective randomized controlled study was performed on 132 patients with unilateral degenerative knee arthritis undergoing TKA bewteen October 2012 and October 2014, who met the selection criteria. During TKA, lateral retinacular release was used in 66 cases (trial group) and was not used in 66 cases (control group). Two patients were excluded from the study due to missing the follow-up in trial group. Four patients were excluded from the study due to lateral retinacular release in control group. Finally, 64 patients and 62 patients were included in the trial group and in the control group. There was no significant difference in gender, age, body mass index, side, disease duration, preoperative patellar morphology, grading of patellofemoral arthritis, grade of patellar cartilage degeneration, patellar malposition, patellar maltracking, patellar score, and Knee Society Score (KSS) between 2 groups ( P>0.05). The operation time, postoperative drainage volume, hospitalization time, postoperative complications, and patient satisfaction were recorded. Postoperative anterior knee pain was assessed by visual analogue scale (VAS), and the knee joint function was evaluated by KSS score and patellar score. The femoral angle, tibial angle, femoral flexion angle, and tibial posterior slope angle were measured on the X-ray film for postoperative prosthetic alignment. The postoperative patellar tracking and patellar position, as well as the presence of osteolysis, prosthesis loosening, patellar fracture and patellar necrosis were observed. Results All patients were followed up for 24 months. There was no significant difference in operation time, postoperative drainage volume, hospitalization time, and patient satisfaction between 2 groups ( P>0.05). The incidence of anterior knee pain in the trial group was better than that in the control group ( P=0.033). KSS score and patellar score were significantly improved in both groups at 24 months after operation when compared with preoperative scores ( P<0.05), but no significant difference was found between 2 groups ( P>0.05). Complications included hematoma (2 cases in the trial group, and 1 case in the control group), mild wound dehiscence (2 cases in each group respectively), skin-edge necrosis (1 case in the trial group), and superficial wound infection (1 case in each group respectively), which were cured by conservative treatment. No patellar necrosis, patella fracture, or knee lateral pain occurred in 2 groups. There was no significant difference in complication rate between groups ( P=0.392). Satisfactory implant alignment was observed in both groups during follow-up. There was no significant difference in femoral angle, tibial angle, femoral flexion angle, and tibial posterior slope angle between 2 groups ( P>0.05). No radiolucent line at the bone-implant interface was seen around the tibial components and femoral components in both groups. The patellar maltracking was observed in 3 patients of the trial group and 5 patients of the control group, showing no significant difference ( P=0.488). However, the incidence of patellar malposition in the trial group (18.8%) was significantly lower than that in the control group (35.5%) ( χ2=0.173, P=0.034). Conclusion Lateral retinacular release during primary TKA without resurfacing of the patella can reduce postoperative knee pain without increasing complications.
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Affiliation(s)
- Yongliang Zhu
- Department of Orthopaedics, Nanjing Center Hospital, Nanjing Jiangsu, 210018, P.R.China
| | - Yuming Li
- Department of Orthopaedics, Nanjing Center Hospital, Nanjing Jiangsu, 210018,
| | - Chao Yan
- Department of Orthopaedics, Nanjing Center Hospital, Nanjing Jiangsu, 210018, P.R.China
| | - Xiaotao Du
- Department of Orthopaedics, Nanjing Center Hospital, Nanjing Jiangsu, 210018, P.R.China
| | - Zhongjie Xing
- Department of Orthopaedics, Nanjing Center Hospital, Nanjing Jiangsu, 210018, P.R.China
| | - Peng Chen
- Department of Orthopaedics, Nanjing Center Hospital, Nanjing Jiangsu, 210018, P.R.China
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Popkin CA, Bayomy AF, Trupia EP, Chan CM, Redler LH. Patellar Instability in the Skeletally Immature. Curr Rev Musculoskelet Med 2018; 11:172-181. [PMID: 29682681 DOI: 10.1007/s12178-018-9472-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW This review will focus on the evaluation and management of patellar instability in the developing patient. RECENT FINDINGS A large number of surgical techniques have been described to prevent recurrent patellofemoral instability in the pediatric population, including both proximal and distal realignment procedures. The wide variety of treatment options highlights the lack of agreement as to the best surgical approach. However, when a comprehensive exam and workup are paired with a surgical plan to address each of the identified abnormalities, outcomes are predictably good. Patellar instability is a common knee disorder in the skeletally immature patient that presents a unique set of challenges. Rates of re-dislocation in pediatric and adolescent patients are higher than in their adult counterparts. Careful consideration of the physeal and apophyseal anatomy is essential in these patients. While the majority of primary patellar instability events can be treated conservatively, multiple events often require surgical intervention.
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Affiliation(s)
- Charles A Popkin
- Elbow and Sports Medicine and Morgan Stanley Children's Hospital, Columbia University Center for Shoulder, 622 W 168th Street 11th floor, New York, NY, 10032, USA.
| | - Ahmad F Bayomy
- Elbow and Sports Medicine and Morgan Stanley Children's Hospital, Columbia University Center for Shoulder, 622 W 168th Street 11th floor, New York, NY, 10032, USA
| | - Evan P Trupia
- Elbow and Sports Medicine and Morgan Stanley Children's Hospital, Columbia University Center for Shoulder, 622 W 168th Street 11th floor, New York, NY, 10032, USA
| | - Charles M Chan
- Department of Orthopaedic Surgery, Lucile Packard Children's Hospital, Stanford University, 450 Serra Mall, Stanford, CA, 94305, USA
| | - Lauren H Redler
- Elbow and Sports Medicine and Morgan Stanley Children's Hospital, Columbia University Center for Shoulder, 622 W 168th Street 11th floor, New York, NY, 10032, USA
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Steinbrück A, Schröder C, Woiczinski M, Glogaza A, Müller PE, Jansson V, Fottner A. A lateral retinacular release during total knee arthroplasty changes femorotibial kinematics: an in vitro study. Arch Orthop Trauma Surg 2018; 138:401-407. [PMID: 29188420 DOI: 10.1007/s00402-017-2843-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Lateral retinacular release (LRR) is a common procedure during total knee arthroplasty (TKA), especially if patellar maltracking is observed intraoperatively. The impact of LRR on patellofemoral kinematics is well-examined, but the influence on femorotibial kinematics requires more elucidation. Therefore, the aim of this study was to evaluate the effects of LRR on femorotibial kinematics in vitro. MATERIALS AND METHODS A fixed bearing TKA was implanted in six human knee specimens. Femorotibial kinematics were measured dynamically through the use of a custom-constructed knee rig which flexes the knee from 20° to 120° under weight bearing conditions. Measurements were performed before and after LRR. LRR was performed completely including transection of synovium, retinaculum and tractus fibers. For the registration of tibiofemoral kinematics a 3-dimensional-ultrasound-based motion analysis system was used. RESULTS LRR revealed a significant reduction of femoral rollback at the lateral compartment (9.4 ± 5.0 vs 7.8 ± 9.4 mm; p < 0.01), whereas the present decrease of femoral rollback at the medial compartment was not significant (3.4 ± 4.7 vs 2.3 ± 5.9 mm; p = 0.34). Accordingly, LRR significantly reduced internal rotation of the tibia (0.8°; p < 0.01). CONCLUSION The results suggest that LRR significantly decreases lateral femoral rollback as well as internal rotation of the tibia, probably by changing the tension of the iliotibial band. When performing a LRR in clinical routine, surgeons should be aware of altering not only patellofemoral kinematics but also the femorotibial kinematics.
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Affiliation(s)
- Arnd Steinbrück
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany.
| | - Christian Schröder
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Matthias Woiczinski
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Alexander Glogaza
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Peter E Müller
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Volkmar Jansson
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Andreas Fottner
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
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Kaiser P, Schmoelz W, Schoettle P, Zwierzina M, Heinrichs C, Attal R. Increased internal femoral torsion can be regarded as a risk factor for patellar instability - A biomechanical study. Clin Biomech (Bristol, Avon) 2017. [PMID: 28628800 DOI: 10.1016/j.clinbiomech.2017.06.007] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Increased internal femoral torsion is regarded as a risk factor for patellar instability. Biomechanical investigations confirming this hypothesis are missing. METHODS Eight fresh-frozen cadaver knees were tested on a specially designed simulator. Patellar motion and patellofemoral pressure were evaluated for 0°, 10°, and 20° of increased internal and external femoral torsion with native and with transected medial patellofemoral ligaments used to simulate patellar instability. A regression analysis was used for statistical analysis. FINDINGS In native medial patellofemoral ligaments, there were no significant changes in mean or peak pressures for any torsional states (P≥0.07). At 20° increased internal femoral torsion, there was a significant center of force shift towards the lateral side (P=0.01). Patellar shift was directed laterally at low knee flexion angles up to 30°. Lateral patellar tilt increased significantly at 10° and 20° of increased internal femoral torsion (P≤0.004). In transected medial patellofemoral ligaments, mean pressure (P≤0.005) and peak pressure (P≤0.02) decreased significantly for all torsional states. There was a significantly greater lateral center of force shift with increased internal femoral torsion (P≤0.04). Lateral patellar tilt increased significantly (P<0.001). Patellar shift did not change significantly with increased internal femoral torsion (P≥0.30). INTERPRETATION In a native medial patellofemoral ligament, 20° of increased internal femoral torsion can be regarded as a significant risk factor for patellar instability. With an insufficient medial patellofemoral ligament, 10° of increased internal femoral torsion already represents a significant risk factor.
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Affiliation(s)
- Peter Kaiser
- Department of Trauma Surgery, Medical University of Innsbruck, Innsbruck, Austria.
| | - Werner Schmoelz
- Department of Trauma Surgery, Medical University of Innsbruck, Innsbruck, Austria.
| | - Philip Schoettle
- Department of Orthopaedic and Trauma Surgery, Isar Medical Center, Munich, Germany.
| | - Marit Zwierzina
- Department of Anatomy, Embryology and Histology, Medical University of Innsbruck, Innsbruck, Austria.
| | - Christian Heinrichs
- Department of Trauma Surgery, Medical University of Innsbruck, Innsbruck, Austria.
| | - Rene Attal
- Department of Trauma Surgery, Medical University of Innsbruck, Innsbruck, Austria.
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Fonseca LPRMD, Kawatake EH, Pochini ADC. Liberação retinacular lateral da patela: o que mudou nos últimos dez anos. Rev Bras Ortop 2017. [DOI: 10.1016/j.rbo.2016.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Fonseca LPRMD, Kawatake EH, Pochini ADC. Lateral patellar retinacular release: changes over the last ten years. Rev Bras Ortop 2017; 52:442-449. [PMID: 28884103 PMCID: PMC5582814 DOI: 10.1016/j.rboe.2017.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 06/30/2016] [Indexed: 11/19/2022] Open
Abstract
Lateral retinacular release is a useful resource in knee surgery that can be used for disorders of the extensor mechanism. For many years, it was indiscriminately used in the treatment of the various patellofemoral joint alterations, with conflicting functional results. This study aimed to analyze the changes that have occurred in the indications and clinical effectiveness of lateral retinacular release by reviewing the relevant literature of the past ten years, comparing it to the classic literature on the subject. It was found that less extensive releases decompress the lateral patellar facet, helping with pain control, while decreasing the risks of medial subluxation. Nowadays, there is clear evidence for its indication in the lateral patellar hypercompression syndrome associated with anterior knee pain, as long as there is no related instability; furthermore, it will normally play an adjuvant role in extensor mechanism alignment surgeries for cases of recurrent patellar instability. The initial results for symptomatic patellofemoral osteoarthritis are promising when lateral release is combined with cartilage debridement; in total knee replacement, it is more commonly used for the correction of valgus deformity in order to improve the components' congruency. Finally, distinguishing the different patellofemoral joint pathologies is seen as crucial in order to indicate this procedure. Further randomized control trials that compare surgical techniques with long-term results are still needed.
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Affiliation(s)
| | | | - Alberto de Castro Pochini
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Ortopedia e Traumatologia, São Paulo, SP, Brazil
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Erickson BJ, Campbell K, Cvetanovich GL, Harris JD, Bach BR, Sherman SL. Nonligamentous Soft Tissue Pathology About the Knee: A Review. Orthopedics 2016; 39:32-42. [PMID: 26709560 DOI: 10.3928/01477447-20151218-06] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 05/20/2015] [Indexed: 02/03/2023]
Abstract
Knee pain is one of the most frequent complaints evaluated by orthopedic surgeons. It encompasses a broad range of pathology and can present in a variety of ways. Most of this pain can be attributed to essential structures of the knee, including the menisci, cruciate or collateral ligaments, and articular cartilage. However, there are underrecognized structures in and around the knee that can frequently be a cause of knee pathology and pain. Knee pain stemming from these structures may be missed or incorrectly diagnosed, and these patients often present for second and third opinions because of failure to diagnose and treat the underlying pathology. The synovial plica, suprapatellar pouch, lateral retinaculum, infrapatellar fat pad, and infrapatellar branch of the saphenous nerve are less common but still significant causes of knee pain. Although initial treatment involves various nonoperative modalities, operative treatment is often warranted. Operative and nonoperative management of these soft tissue structures may occur in isolation or with concomitant procedures, including knee ligament reconstruction, total knee arthroplasty, tibial tuberosity osteotomy, or lysis of adhesions. With proper recognition of the role of these structures in knee pain, the orthopedic surgeon can offer a valuable primary or adjunctive treatment option for patients with knee pain, especially those without localizing signs of meniscal, ligamentous, or cartilage damage.
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Song GY, Hong L, Zhang H, Zhang J, Li Y, Feng H. Iatrogenic medial patellar instability following lateral retinacular release of the knee joint. Knee Surg Sports Traumatol Arthrosc 2016; 24:2825-2830. [PMID: 25618277 DOI: 10.1007/s00167-015-3522-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 01/20/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE Iatrogenic medial patellar instability (IMPI) is a disabling but easily missed condition that is most often seen as a late complication of lateral retinacular release (LRR) procedures. The purposes of this study were (1) to summarize the available diagnostic methods and (2) to explore the contributing factors of IMPI following LRR procedures. METHODS The MEDLINE, PubMed, EMBASE and Cochrane Library databases were searched for studies including diagnosed IMPI cases following LRR procedures. All patients were first divided into IMPI group and non-IMPI group based on the diagnostic methods of IMPI collected from studies. Univariate analysis was performed by comparing the two groups with regard to individual patient data (age at initial LRR, gender) and surgical details (type, releasing scope, combined surgeries and indication) of LRR procedures. Multivariate logistic regression was carried out to identify independent contributing factors for IMPI and to calculate odds ratios (ORs). RESULTS Eight studies with 274 patients (300 knees) were finally included. Of those, 161 patients (171 knees, 57.0 %) had IMPI and 113 patients (129 knees, 43.0 %) had no IMPI. Univariate analysis revealed a statistically significant difference between both groups for releasing scope (P 1 < 0.001) and indication of LRR procedures (P 2 < 0.001), with releasing lateral retinaculum (LR) + vastus lateralis (VL) tendon and absence of tight LR during the initial LRR procedures being more common in patients with IMPI. The independent contributing factors for IMPI identified in the multivariate logistic regression analysis were releasing LR + VL (OR1 = 16.49) and absence of tight LR (OR2 = 14.37). CONCLUSIONS The IMPI was more common in patient with an over-released LRR and patient who was absent of tight LR during the initial LRR procedures. Aggressive surgical corrections and inappropriate indications of initial LRR were two contributing factors for the late complications of IMPI. This study suggests that the IMPI may occur as a major complication of LRR, especially when the VL tendon is extensively released or when there is no confirmative clinical evidence of a tight LR preoperatively. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Guan-Yang Song
- Sports Medicine Service, Beijing Jishuitan Hospital, No. 31, Xin Jie Kou East Street, Xi Cheng District, Beijing, 100035, China
| | - Lei Hong
- Sports Medicine Service, Beijing Jishuitan Hospital, No. 31, Xin Jie Kou East Street, Xi Cheng District, Beijing, 100035, China
| | - Hui Zhang
- Sports Medicine Service, Beijing Jishuitan Hospital, No. 31, Xin Jie Kou East Street, Xi Cheng District, Beijing, 100035, China
| | - Jin Zhang
- Sports Medicine Service, Beijing Jishuitan Hospital, No. 31, Xin Jie Kou East Street, Xi Cheng District, Beijing, 100035, China
| | - Yue Li
- Sports Medicine Service, Beijing Jishuitan Hospital, No. 31, Xin Jie Kou East Street, Xi Cheng District, Beijing, 100035, China
| | - Hua Feng
- Sports Medicine Service, Beijing Jishuitan Hospital, No. 31, Xin Jie Kou East Street, Xi Cheng District, Beijing, 100035, China.
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Rosales-Varo A, Roda-Murillo O, Prados-Olleta N, García-Espona M. Coronal patellar osteotomy of the external facet combined with the release of the lateral retinaculum improves the clinical outcomes of isolated lateral release in lateral knee compartment syndrome. Rev Esp Cir Ortop Traumatol (Engl Ed) 2016. [DOI: 10.1016/j.recote.2016.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Rosales-Varo AP, Roda-Murillo O, Prados-Olleta N, García-Espona MA. Coronal patellar osteotomy of the external facet combined with the release of the lateral retinaculum improves the clinical outcomes of isolated lateral release in lateral knee compartment syndrome. Rev Esp Cir Ortop Traumatol (Engl Ed) 2016; 60:296-305. [PMID: 27435989 DOI: 10.1016/j.recot.2016.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 05/08/2016] [Accepted: 06/05/2016] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To describe a novel coronal osteotomy of the external facet of the patella, and to evaluate if the outcomes of the treatment of lateral knee compartment syndrome (LKCS) with this osteotomy, combined with the release of the external lateral retinaculum, are better than the isolated lateral retinacular release. MATERIAL AND METHODS A prospective study with a 2 year follow up that included 70 patients diagnosed with LKCS, distributed into 2 groups. The first group included 50 patients on whom the lateral retinacular release combined with osteotomy was performed, and a second group on whom an isolated retinacular release was performed. Measurements were made using the Werner functional scale before the surgery and at 3, 12, and 24 months follow-up. RESULTS There were significant differences in the overall functional state between the two groups after the surgery (better in the osteotomy group at all the intervals, P<.05). The improvement, which was progressive up to 12 months, was slightly less at 24 months, although the values were still better than the pre-surgical ones in both groups. Pain was the variable that showed most improvement. The patients with LKCS with degenerative signs showed a benefit in all cases. CONCLUSION The results demonstrate that the described patellar osteotomy technique, combined with lateral retinacular release, significantly improves the pain and the functional scale score of patients with LKCS after 2 years of follow-up, to a greater extent than isolated lateral retinacular release, including those in which there was evidence of degenerative signs.
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Affiliation(s)
| | - O Roda-Murillo
- Departamento de Anatomía, Facultad de Medicina, Universidad de Granada, Granada, España
| | - N Prados-Olleta
- Área de Traumatología, Hospital Universitario Virgen de las Nieves, Departamento de Traumatología y Ortopedia, Universidad de Granada, Granada, España
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Gausden EB, Fabricant PD, Taylor SA, McCarthy MM, Weeks KD, Potter H, Shubin Stein B, Green DW. Medial Patellofemoral Reconstruction in Children and Adolescents. JBJS Rev 2015; 3:01874474-201510000-00002. [DOI: 10.2106/jbjs.rvw.n.00091] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Lorenz A, Bobrowitsch E, Wünschel M, Walter C, Wülker N, Leichtle UG. Robot-aided in vitro measurement of patellar stability with consideration to the influence of muscle loading. Biomed Eng Online 2015. [PMID: 26201401 PMCID: PMC4511523 DOI: 10.1186/s12938-015-0068-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background Anterior knee pain is often associated with patellar maltracking and instability. However, objective measurement of patellar stability under clinical and experimental conditions is difficult, and muscular activity influences the results. In the present study, a new experimental setting for in vitro measurement of patellar stability was developed and the mediolateral force–displacement behavior of the native knee analyzed with special emphasis on patellar tilt and muscle loading. Methods In the new experimental setup, two established testing methods were combined: an upright knee simulator for positioning and loading of the knee specimens, and an industry robot for mediolateral patellar displacement. A minimally invasive coupling and force control mechanism enabled unconstrained motion of the patella as well as measurement of patellar motion in all six degrees of freedom via an external ultrasonic motion-tracking system. Lateral and medial patellar displacement were measured on seven fresh-frozen human knee specimens in six flexion angles with varying muscle force levels, muscle force distributions, and displacement forces. Results Substantial repeatability was achieved for patellar shift (ICC(3,1) = 0.67) and tilt (ICC(3,1) = 0.75). Patellar lateral and medial shift decreased slightly with increasing flexion angle. Additional measurement of patellar tilt provided interesting insights into the different displacement mechanisms in lateral and medial directions. For lateral displacement, the patella tilted in the same (lateral) direction, and tilted in the opposite direction (again laterally) for medial displacement. With regard to asymmetric muscle loading, a significant influence (p < 0.03, up to 5 mm shift and 8° tilt) was found for lateral displacement and a reasonable relationship between muscle and patellar force, whereas no effect was visible in the medial direction. Conclusion The developed experimental setup delivered reproducible results and was found to be an excellent testing method for the in vitro analysis of patellar stability and future investigation of surgical techniques for patellar stabilization and total knee arthroplasty. We demonstrated a significant influence of asymmetric quadriceps loading on patellar stability. In particular, increased force application on the vastus lateralis muscle led to a clear increase of lateral patellar displacement.
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Affiliation(s)
- Andrea Lorenz
- Department of Orthopaedic Surgery, University Hospital Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany.
| | - Evgenij Bobrowitsch
- Department of Orthopaedic Surgery, University Hospital Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany.
| | - Markus Wünschel
- Department of Orthopaedic Surgery, University Hospital Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany.
| | - Christian Walter
- Department of Orthopaedic Surgery, University Hospital Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany.
| | - Nikolaus Wülker
- Department of Orthopaedic Surgery, University Hospital Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany.
| | - Ulf G Leichtle
- Department of Orthopaedic Surgery, University Hospital Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany.
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Does early operative treatment improve outcomes of primary patellar dislocation? A systematic review. CURRENT ORTHOPAEDIC PRACTICE 2015. [DOI: 10.1097/bco.0000000000000221] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kedgley AE, McWalter EJ, Wilson DR. The effect of coordinate system variation on in vivo patellofemoral kinematic measures. Knee 2015; 22:88-94. [PMID: 25656245 DOI: 10.1016/j.knee.2014.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 11/10/2014] [Accepted: 11/13/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND The use of different coordinate system definitions for the patella leads to difficulties in comparing kinematic results between studies. The purpose of this work was to establish the effect of using a range of coordinate system definitions to quantify patellar kinematics. Additionally, intra- and inter-investigator repeatabilities of the digitization of anatomic landmarks on the patella were determined. METHODS Four different patellar coordinate system definitions were applied using digitisations in two and three dimensions and a single femoral coordinate system was used for comparison. Intra-investigator variability was established by having one investigator digitize the patellar landmarks of three subjects on five separate occasions. Inter-investigator variability was quantified by having five participants digitize the same landmarks on the same three subjects. Patellofemoral kinematics were quantified for ten subjects, at six angles of tibiofemoral flexion, using MRI. RESULTS As a result of changes in the patellar coordinate system, differences of up to 11.5° in flexion, 5.0° in spin, and 27.3° in tilt were observed in the resultant rotations for the same motion, illustrating the importance of standardizing the coordinate system definition. CONCLUSIONS To minimize errors due to variability while still maintaining physiologically sensible kinematic angles, a coordinate system based upon an intermediate flexion axis between the most medial and lateral points on the patella, and a superiorly-directed long axis located between the most proximal and distal points on the patella, with an origin at the centre of the most proximal, distal, medial, and lateral points on the patella is recommended. CLINICAL RELEVANCE The recommended anatomic coordinate frame may be employed in the calculation of dynamic in vivo patellar kinematics when used in combination with any method that reliably quantifies patellar motion.
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Affiliation(s)
- Angela E Kedgley
- Department of Orthopaedics, University of British Columbia, 3114-910 West 10th Avenue, Vancouver, BC V5Z 1M9, Canada.
| | - Emily J McWalter
- Department of Mechanical Engineering, University of British Columbia, 2054-6250 Applied Science Lane, Vancouver, BC V6T 1Z4, Canada
| | - David R Wilson
- Department of Orthopaedics, University of British Columbia, 3114-910 West 10th Avenue, Vancouver, BC V5Z 1M9, Canada; Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Robert H.N. Ho Research Centre, 7/F, 2635 Laurel Street, Vancouver, BC V5Z 1M9, Canada
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Abstract
Patellar instability is a common problem, and medial patellofemoral ligament (MPFL) injury is inherent with traumatic patellar dislocations. Initial nonoperative management is focused on reconditioning and strengthening the dynamic stabilizers of the patella. For those patients who progress to recurrent instability, further investigation into the predisposing factors is required. MPFL reconstruction is indicated in patients with recurrent instability and insufficient medial restraint due to MPFL injury. A technique of MPFL reconstruction is outlined. This procedure may also be performed in combination with other realignment procedures.
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Affiliation(s)
- Jeffrey Reagan
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Raj Kullar
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Robert Burks
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA.
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Yao J, Yang B, Niu W, Zhou J, Wang Y, Gong H, Ma H, Tan R, Fan Y. In vivo measurements of patellar tracking and finite helical axis using a static magnetic resonance based methodology. Med Eng Phys 2014; 36:1611-7. [DOI: 10.1016/j.medengphy.2014.08.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Revised: 08/19/2014] [Accepted: 08/28/2014] [Indexed: 10/24/2022]
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Diagnosis and treatment of lateral patellar compression syndrome. Arthrosc Tech 2014; 3:e633-8. [PMID: 25473620 PMCID: PMC4246402 DOI: 10.1016/j.eats.2014.07.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 07/17/2014] [Indexed: 02/03/2023] Open
Abstract
Chronic anterior knee pain with a stable patella is often associated with overload and increased pressure on the lateral facet due to pathologic lateral soft-tissue restraints. "Lateral pressure in flexion" is a term describing the pathologic process of increasing contact pressure over the lateral patellar facet as knee flexion progresses. This report describes a surgical technique developed in response to lateral pressure in flexion and the shortcomings of traditional arthroscopic lateral release procedures. The technique is performed open with the knee in flexion, and the lateral release is repaired with a rotation flap of iliotibial band to close the defect and prevent patellar subluxation. The technique effectively decreases lateral patellar pressure and centers the patella correctly in the trochlear groove with minimal risk of iatrogenic patellar instability.
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Niimoto T, Deie M, Adachi N, Usman MA, Ochi M. Quantitative stress radiography of the patella and evaluation of patellar laxity before and after lateral release for recurrent dislocation patella. Knee Surg Sports Traumatol Arthrosc 2014; 22:2408-13. [PMID: 24647852 DOI: 10.1007/s00167-014-2930-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 03/03/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE The aims of the present controlled clinical study were to (1) compare patella laxity determined in the outpatient clinic with that in anaesthetized patients and (2) evaluate patella laxity before and after lateral release. METHOD The study evaluated data on 33 knees from 33 patients (average age 19.7 years) between 2007 and 2011. All patients were diagnosed with recurrent dislocation of the patella. Patellar stability was evaluated in each patient thrice: patellas were first imaged in the outpatient clinic prior to surgery at 45° knee flexion with 20 N stress from the medial to lateral side and from the lateral to medial side; then, at the time of surgery, patella stress images were obtained in the same manner before and after the lateral release procedure. Radiological assessments were performed using the medial stress shift ratio (MSSR) and lateral stress shift ratio (LSSR). RESULTS There were no significant differences in the LSSR and MSSR before surgery (outpatient data) and in anaesthetized patients before the lateral release procedure. Furthermore, there was no significant difference in MSSR at the time of surgery before and after the lateral release procedure. However, LSSR increased significantly after the lateral release procedure. CONCLUSION The results of the present study suggest that quantitative patella stress radiography in the outpatient clinic is useful when it comes to investigating laxity of the patella, and that lateral release significantly increases lateral, but not medial, laxity in patients with recurrent patellar dislocation. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Takuya Niimoto
- Department of Orthopaedic Surgery, Higashihiroshima Medical Center, 513 Jike, Saijyou-chou, Higashihiroshima, Hiroshima, Japan,
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Zha GC, Sun JY, Dong SJ. Less anterior knee pain with a routine lateral release in total knee arthroplasty without patellar resurfacing: a prospective, randomized study. Knee Surg Sports Traumatol Arthrosc 2014; 22:517-25. [PMID: 24288077 DOI: 10.1007/s00167-013-2789-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 11/17/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Anterior knee pain is a major cause of complaint in total knee arthroplasty (TKA) without patellar resurfacing. The concept of improved patellar tracking and decreased retropatellar contact pressure for lateral retinacular release theoretically suggests that patients with lateral retinacular release in TKA would achieve a lower incidence of anterior knee pain when compared without lateral retinacular release. We sought to determine (1) whether those patients who received a routine lateral retinacular release in TKA would attain lower incidence of anterior knee pain as compared to patients who received TKA without lateral retinacular release and (2) whether lateral retinacular release would increase the lateral retinacular release-related complications. METHODS A total of 148 patients who underwent TKA with the use of the Gemini MK II mobile bearing were randomized to receive either routine lateral retinacular release (intervention group) or not (control group). Patients were assessed by the visual analogue scale for anterior knee pain, the Knee Society clinical scoring system of knee score and function score, and patellar score for clinical function. Patients' satisfaction and lateral retinacular release-related complications were also evaluated. RESULTS The overall incidence of anterior knee pain in the intervention group at 18 months follow-up was 5.6%, while that of the control group was 20.6% (p = 0.009). No statistical difference was detected between the two groups in terms of lateral retinacular release-related complications (n.s.), patients' satisfaction (n.s.), knee score (n.s.), function score (n.s.), and patellar score (n.s.) at 18 months follow-up. CONCLUSION The present study suggests that routine lateral retinacular release can reduce anterior knee pain and does not increase lateral retinacular release-related complications, in TKA with the use of the Gemini MK II mobile bearing without patellar resurfacing. LEVEL OF EVIDENCE Therapeutic, Level I.
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Affiliation(s)
- Guo-Chun Zha
- Orthopaedic Department, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu, People's Republic of China,
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The effect of medial release of the distal patellar tendon insertion on lateral patella translation and residual insertion strength: a cadaveric study. J Arthroplasty 2014; 29:525-9. [PMID: 24011927 DOI: 10.1016/j.arth.2013.07.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 07/26/2013] [Accepted: 07/26/2013] [Indexed: 02/01/2023] Open
Abstract
Patellar tendon avulsion is a risk with difficult exposure in a stiff knee, patella baja or previous tibial osteotomy. We sought to define a safe amount of release of the patellar tendon insertion for such cases. Eleven pairs of fresh frozen cadaveric lower limb specimens were acquired and randomized to either intact or partial release of the distal tibial insertion. Partial release of the tibial insertion of the tendon increased lateral exposure a mean 29% ± 15% (P = 0.002) while reducing ultimate strength to a mean of 80% that of the intact contralateral tendon. Measured patella release increased lateral patella translation and can be performed without risk of catastrophic rupture with basic activities of daily living following TKA.
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Abstract
PURPOSE OF REVIEW Traumatic and nontraumatic patellofemoral instability (PFI) in children and adolescents is a complex problem. It is determined by a large number of mechanical and pathomorphologic conditions, mainly seen in nontraumatic dislocations. RECENT FINDINGS Although conservative treatment with a short immobilization, followed by early passive motion and isometric quadriceps strengthening, can be considered in real traumatic dislocations without any cartilaginous injury, a surgical intervention should be considered in atraumatic cases. As 90% of PFI are nontraumatic and correlated with skeletal deformities, the redislocation rate is reported to be up to 80% after initial conservative treatment. To optimize the results, the causing disorder for PFI has to be considered imperatively. In addition to bony disorder, further risk factors have to be taken into consideration for determining the optimal time for surgery. As biomechanical and clinical studies have shown the importance of the medial patellofemoral complex, especially the medial patellofemoral ligament (MPFL), against patellar lateralization, the reconstruction or minimally invasive double-bundle reconstruction of the MPFL is the main surgical technique to treat PFI in children, as it can be used even in open epiphysial cartilage. Further surgical interventions correcting bone deformities, such as trochleoplasty or tibial tubercle osteotomies addressing lower limb deformities, should be performed after closure of the epiphysial cartilage. SUMMARY It is the goal of this overview to explain the pathoanatomy of PFI, the demanding clinical and radiological examinations and treatment options.
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Variation in patellofemoral kinematics due to changes in quadriceps loading configuration during in vitro testing. J Biomech 2014; 47:130-6. [DOI: 10.1016/j.jbiomech.2013.09.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 09/25/2013] [Accepted: 09/26/2013] [Indexed: 11/23/2022]
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