Aims. The aim of this study was to establish consensus statements on medial patellofemoral ligament (MPFL) reconstruction, anteromedialization tibial tubercle osteotomy, trochleoplasty, and rehabilitation and return to sporting activity in patients with
Aims. The aim of this study was to establish consensus statements on the diagnosis, nonoperative management, and indications, if any, for medial patellofemoral complex (MPFC) repair in patients with
Introduction. Genu valgum is a common presentation in paediatric patients with congenital limb deformities. The aim of this study is to assess the outcome of guided growth surgery in paediatric patients referred via our physiotherapy pathway with isolated genu valgum and associated
Recurrent
The purpose of this study was to evaluate the reasons for
Hypermobility is an acknowledged risk factor
for
Introduction. Current problem – Multiple surgical interventions for
Purpose Of The Study: Description of a new operative technique of trochleoplasty for
Statement of purpose. To determine whether the Q-angle, measured in a defined and reproducible manner, correlates with the TT-TG distance in patients with
The management of osteoarthritis of the knee associated with
Aim: To systematically review the present evidence-base, assessing the clinical and radiological outcomes following trochleoplasty for trochlear dysplasia. Methods: An electronic literature search was performed using the AMED, British Nursing Index, CINAHL, Cochrane, EMBASE, ovid Medline, Physiotherapy Evidence Database, PsycINFO, Pubmed and Zetoc databases from their inception to August 2007. Reference lists of identified papers and a hand search of specialist knee journals was also undertaken. All English language, human subject clinical studies, detailing the clinical and/or radiological outcomes of
A prospective study was done to assess the outcome of MPFL reconstruction for
Aims. The purpose of this study was to explore the correlation between femoral torsion and morphology of the distal femoral condyle in patients with trochlear dysplasia and lateral
Background.
Recurrent
Minor degrees of malalignment of the patella and anatomical abnormalities including a flattened sulcus angle and an increased ratio between patellar tendon length and patellar length (PT:P) have been suggested as predisposing factors in the causation of chondromalacia patellae, as well as
Purpose:
AIMS. The aim of this study was to assess the knee function after MPFL reconstruction with single hamstring autograft. METHODS-RESULTS. In this case series 68 patients (69 knees) were treated in total. Clinical and radiological evidence of
The aim of the study was to assess the knee function after MPFL reconstruction with single hamstring autograft. In this case series 86 patients (87 knees) were treated in total, from July 2002 till December 2008. Clinical and radiological evidence of
Background: The medial patellofemoral ligament (MPFL) is the primary stabilizer of the patellofemoral joint. Its reconstruction has been recommended in adults over the past decade after recurrent
Purpose of study: To evaluate the clinical outcome of operative intervention for chronic
Lateralisation of the tuberosity tibia causes distal malalignment of the extensor mechanism of the knee and can lead to lateral tracking patella (LTP), resulting in anterior knee pain, or objective
Medial instability of the patella is most often an iatrogenic condition following surgery for patellofemoral pain or instability. Most often the instability is associated with a previous extensive lateral retinacular release for anterior knee pain without instability. The symptoms usually involve pain and a sense of medial subluxation at unpredictable times. The clinical diagnosis is based on increased medial laxity of the patella and apprehension with medial translation. A positive gravity subluxation test is often present. If symptomatic treatment, bracing, and other conservative measures fail, surgery may be helpful. Repair of the vastus lateralis tendon near the proximal patella is usually necessary. The lateral retinaculum should also be reconstituted. At times this can be done with direct repair of the retinacular edges. More frequently the scar tissue filling the defect must be imbricated. Medial retinacular release has also been reported to be a successful intervention.
A simple procedure of using a Smillie knife to release the lateral patellar retinaculum and the capsule in the unstable patella syndrome is described. The syndrome includes recurrent dislocation, recurrent subluxation and acute dislocation of the patella. Arthroscopy, to exclude any other pathology such as chondromalacia patellae, is performed before proceeding to closed lateral release. The results of this procedure are as good as those after more major surgical procedures. In a small percentage of patients a second operation such as tibial tubercle transfer or patellectomy may be necessary, especially in patients with an underlying congenital abnormality; but in many patients this type of major surgery has proved unnecessary.
This paper describes a simple new MRI measurement of the axial patellar tendon angle (APTA), and compares this angle in patients with and without patello-femoral instability.
In PFI, the patella is commonly tilted laterally. This is matched by the orientation of the patellar tendon. The increased tilt of the tendon is only partially corrected at its distal insertion with an abnormal angle of tibial attachment. When performing distal realignment procedures, angular correction as well as displacement may be appropriate.
This paper describes a simple new MRI measurement of the axial patellar tendon angle (APTA), and compares this angle in patients with and without patello-femoral instability.
In PFI, the patella is commonly tilted laterally. This is matched by the orientation of the patellar tendon. The increased tilt of the tendon is only partially normalized at its distal insertion with an abnormal angle of tibial attachment. When performing distal realignment procedures, angular correction as well as displacement may be appropriate.
Patello-femoral instability (PFI) and pain may be caused by anatomical abnormality. Many radiographic measurements have been used to describe the shape and position of the patella and femoral trochlea. This paper describes a simple new MRI measurement of the axial patellar tendon angle (APTA), and compares this angle in patients with and without patello-femoral instability.
In PFI, the patella is commonly tilted laterally. This is matched by the orientation of the patellar tendon. The increased tilt of the tendon is only partially normalized at its distal insertion with an abnormal angle of tibial attachment. When performing distal realignment procedures, angular correction as well as displacement may be appropriate.
The isolated arthroscopic lateral release has been already presented in the literature as an effective alternative for surgical treatment of different degrees of patellofemoral instability. This paper is to evaluate the long term results of this procedure in patients with recurrent dislocation of the patella (RDP). Material of this study is a group of patients who underwent isolated arthroscopic lateral release for RDP with a minimum 10 years follow-up. All the patients included presented 1) clear clinical history of RDP 2) positive apprehension test 3) patella able to be dislocated under anesthesia. Were excluded from this study patients who presented 1) generalised ligamentous laxity 2) habitual dislocations of the patella 3) avulsion fracture of the patella 4) marked malalignment 5) age over 40 years. 42 patients met these criteria and 27 (28 knees) were available for follow-up. There were 13 females and 14 males with an average age of 20, 1 years and an average follow-up of 13, 4 years. All the patients were evaluated for patellar stability and functional outcomes with both Miller and Bartlett and Crosby and Insall scores. According to the evaluation scores above mentioned 16 knees (57%) were rated as excellent /good results. The isolated lateral release can be considered as the first approach for the treatment of RDP. The outcomes are adversely affected by long term-follow-up, however, it does not compromise any further treatment.
We report on a case of bilateral medial patellar dislocation, studied with hip/knee/ankle TC for evaluation of torsional defects and treated four times with distal derotative femoral osteotomy and cuneiform subtractive osteotomy of the lateral part of the femoral trochlea. The patient, a woman 18 years of age at the beginning of treatment, presented with femoral neck anteversion of 30° dx and 25° sx referred to the plane passing posteriorly to the distal femoral condyles; the trochlear angle was 140° dx and 144° sx with medial inclination of trochlea due to medial hypoplasia. The patellae were facing medially, and clinically the patient had suffered medial dislocation of the patella several times. The treatment lasted 4 years: the femoral derotation of 10° was executed by Orthofix monoassial external fixator; the lateral bone wedge removed from the trochlea was about 10 mm and we used reabsorbable nails for fixation. Current values are 17° of femoral neck anteversion bilaterally, and the trochlear angle is 151° dx and 150° sx. The patient, now 26 years old, has not had any more dislocations and her knees have complete mobility with no pain. The good result demonstrates the importance of femoral neck anteversion in the genesis of knee disorders. In this case the absence of specific abnormalities of the extensor mechanism (valgus knee, lateralisation of tibial apophyisis) probably caused the hypoplasia of the medial part of the trochlea and the resulting, rare medial patellar dislocation.
We present 10–15 year follow-up of 33 patients who underwent Elmslie-Trillat osteotomy for severe patellar subluxation or dislocation. In the literature it has been reported that tibial tubercle osteotomy predisposes to subsequent patella-femoral arthritis, however it has never been documented if pre existent knee chondral damage has any role in this development. In our group all patients had pre-op knee arthroscopy performed and extant of chondral damage was documented. We pre-formed an evaluation by long-term follow-up to determined weather pre-op chondral damage was the cause of subsequent osteoarthritis of patella-femoral joint. All patients were invited to attend outpatient clinic for clinical examination and knee radiographs and assessed by an independent research surgeon. Mean age at follow-up was 43 years and average follow-up was 10.5 years (range 10–15 years). 90% follow-up was achieved. Knee function was assessed by clinical scores (Lysholm knee score, American Knee Score, Oxford Knee score, Tegner and Insall knee scores) and three radiographs (AP, Lateral and Merchant views) were performed. Four patients had developed significant arthritis and underwent joint arthroplasty. Majority of patients reported good results with no further dislocation. However we noticed that extant of pre-op chondral damage was a significant factor in subsequent development of patella-femoral arthritis. We will present our data which is unique as no previous such long-term results have been reported for tibial tubercle transfers followed-up for more than 10 years and have pre-op arthroscopic documented chondral damage.
Recurrent patellar dislocation in combination with cartilage injures are difficult injuries to treat with confounding pathways of treatment. The aim of this study is to compare the clinical and functional outcomes of patients operated for patellofemoral instability with and without cartilage defects. 82 patients (mean age-28.8 years) with recurrent patellar dislocations, who underwent soft-tissue or bony procedures, were divided into 2 matched groups (age, sex, follow-up and type of procedure) of 41 each based on the presence or absence of cartilage defects in patella. Chondroplasty, microfracture, osteochondral fixation or Autologous Matrix-Induced Chondrogenesis(AMIC)-type procedures were done depending on the nature of cartilage injury. Lysholm, Kujala, Tegner and Subjective Knee scores of both groups were compared and analysed. Complications and return to theatre were noted.Background
Methods
Abnormal patella height has been found to be one of the main reasons for abnormal contact between patella and trochlear groove leading to
Aims. The Oswestry-Bristol Classification (OBC) is an MRI-specific assessment tool to grade trochlear dysplasia. The aim of this study is to validate clinically the OBC by demonstrating its use in selecting treatments that are safe and effective. Methods. The OBC and the patellotrochlear index were used as part of the Oswestry Patellotrochlear Algorithm (OPTA) to guide the surgical treatment of patients with
Abstract. Introduction. The Syn-VAR RCT is the first of its kind comparing hamstrings autograft v synthetic neoligament for MPFL reconstruction. Our aim is to evaluate short and long term patient related outcomes measures (PROMs) following synthetic / autologous MPFL reconstruction in a heterogenous cohort of patients with recurrent
The February 2023 Children’s orthopaedics Roundup. 360. looks at: Trends in management of paediatric distal radius buckle fractures; Pelvic osteotomy in patients with previous sacral-alar-iliac fixation; Sacral-alar-iliac fixation in patients with previous pelvic osteotomy; Idiopathic toe walking: an update on natural history, diagnosis, and treatment; A prediction model for treatment decisions in distal radial physeal injuries: a multicentre retrospective study; Angular deformities after percutaneous epiphysiodesis for leg length discrepancy; MRI assessment of anterior coverage is predictive of future radiological coverage; Predictive scoring for recurrent
Recognized anatomic variations that lead to patella instability include patella alta and trochlea dysplasia. Lateralization of the extensor mechanism relative to the trochlea is often considered to be a contributing factor; however, controversy remains as to the degree this contributes to instability and how this should be measured. As the tibial tuberosity-trochlear groove (TT-TG) is one of most common imaging measurements to assess lateralization of the extensor mechanism, it is important to understand its strengths and weaknesses. Care needs to be taken while interpreting the TT-TG value as it is affected by many factors. Medializing tibial tubercle osteotomy is sometimes used to correct the TT-TG, but may not truly address the underlying anatomical problem. This review set out to determine whether the TT-TG distance sufficiently summarizes the pathoanatomy, and if this assists with planning of surgery in
The February 2024 Knee Roundup. 360. looks at: Do patients with hypoallergenic total knee arthroplasty implants for metal allergy do worse? An analysis of healthcare utilizations and patient-reported outcome measures; Defining a successful total knee arthroplasty; Incidence, microbiological studies, and factors associated with periprosthetic joint infection after total knee arthroplasty; A modified Delphi consensus statement on
Evaluating musculoskeletal conditions of the lower limb and understanding the pathophysiology of complex bone kinematics is challenging. Static images do not take into account the dynamic component of relative bone motion and muscle activation. Fluoroscopy and dynamic MRI have important limitations. Dynamic CT (4D-CT) is an emerging alternative that combines high spatial and temporal resolution, with an increased availability in clinical practice. 4D-CT allows simultaneous visualization of bone morphology and joint kinematics. This unique combination makes it an ideal tool to evaluate functional disorders of the musculoskeletal system. In the lower limb, 4D-CT has been used to diagnose femoroacetabular impingement, patellofemoral, ankle and subtalar joint instability, or reduced range of motion. 4D-CT has also been used to demonstrate the effect of surgery, mainly on
Introduction. The most challenging aspect in rotational deformity correction is translating the pre-operative plan to an accurate intra-operative correction. Landmarks away from the osteotomy site are typically employed at pre-operative planning and this can render inadequate correction. Our proposed technique of pre-operative planning using CT scan and leg length radiographs can translate to accurate intra-operative correction. Materials and Methods. A circle was superimposed at osteotomy site with its centre serving as the centre of correction of rotation. Medio-lateral distance at osteotomy site measured and used as diameter of the circle. Circumference of the circle was calculated by multiplying diameter with Pi and used in the below formula to obtain accurate de-rotation distance;. Derotation distance = (Circumference/360) × correction value for desired ante-version. The exact site of osteotomy was measured in theatre under C-arm and exposed. Derotation distance was marked on the surface of bone as point A and point B with a flexible ruler. Osteotomy performed with saw and derotation was done till point A and point B were co-linear. Derotation distance obtained using this technique is specific for the site of chosen osteotomy and implies a specific degree of correction for every millimeter derotated. Distal femur was the chosen site of osteotomy if there was associated
Aims. The Bereiter trochleoplasty has been used in our unit for 12
years to manage recurrent
Abstract. Background. The primary objective of the study is to determine the function outcome and survivorship of patellofemoral replacement. The secondary aim is to find the determinants of successful/poor outcome. Methods. This retrospective study involved 45 patients who underwent AVON patellofemoral replacement between January 2015 to December 2020 with the minimal follow-up off for 12 months. The functional outcome was measured using Oxford Knee score (OKS), EuroQol five dimension (EQ-5D). IWANO and Kellgren-Lawrence classification was used to analyse radiographs. To identify determinants of outcome, the following subgroups the presence or absence of normal alignment, tibiofemoral arthritis, trochlear dysplasia and previous surgery. Complications and revision rates were also recorded. Results. The mean follow-up period was 41.7 +/− 8.3 months with no patients lost in follow-up. Patellofemoral replacement significantly improved the Oxford Knee score (OKS), EuroQol five dimension (EQ-5D) (p<0.001). Four out of 45(8.9%) patients underwent revision surgery. Patients with normal alignment preoperatively did worse than those with abnormal alignment with
Introduction. Patellofemoral instability is one of the most common presentations to a children's orthopaedic clinic. Recurrent patellar dislocations and instability episodes are painful, disabling and increase the risk of irreversible chondral damage. The medial patellofemoral ligament is the primary static stabiliser to prevent lateral dislocation of the patella and is almost always torn or attenuated in these cases. Reconstruction of this ligament is commonly performed using autologous hamstring tendon however there has been some interest recently in use of quadriceps tendon as a graft. Children with
An abnormal lateral position of the tibial tuberosity causes distal malalignment of the extensor mechanism of the knee and can lead to lateral tracking of the patella causing anterior knee pain or objective
Objective
Purpose: The purpose of this work was to analyse functional results in patients with objective
The August 2015 Children’s orthopaedics Roundup. 360 . looks at: Learning the Pavlik; MRI and
Purpose: Even with modern ancillary and good surgical experience, rotational implant positioning is sometimes sub-optimal, leading to poor results. Except for obvious cases with
Background: No studies exist about the long-term correlation of patellofemoral osteoarthrosis to poor outcome after traditional realignment surgery for chronic patellofemoral instability. The objective of this study was to evaluate the recurrent instability and symptomatic osteoarthrosis over a long follow-up period. Methods: Fifty-two patients underwent distal realignment surgery for chronic
Malreduction of the syndesmosis is a poor prognosticator following ankle fracture and has been documented in as many as 52% of patients following fracture fixation. The current standard for assessment of reduction of the syndesmosis is bilateral computed tomography (CT) scan of the ankle. Multiple radiographic parameters are utilized to define malreduction, however, there has been limited investigation into the accuracy of these measurements to differentiate malreduction from inherent anatomical asymmetry. The purpose of this study was to identify the prevalence of positive malreduction standards within the syndesmosis of native, uninjured ankles. Bilateral lower extremity CT scans including ankles were screened. Studies were excluded if the patient was skeletally immature, had pathology below the knee or if they had congenital neuromuscular syndromes. The resulting cohort consisted of 207 patients. The indication for bilateral CT scan was femoral acetabular impingement in 110 patients (53%), rotation assessment following arthroplasty in 32 patients (15%), rotation assessment following femoral fracture in 30 patients (14%), rotational assessment for