Increased Femoral Anteversion Influence Over Surgically Treated Recurrent Patellar Instability Patients

2017 ◽  
Vol 33 (3) ◽  
pp. 633-640 ◽  
Author(s):  
Carlos Eduardo Franciozi ◽  
Luiz Felipe Ambra ◽  
Leonardo José Bernardes Albertoni ◽  
Pedro Debieux ◽  
Fernando Cury Rezende ◽  
...  
Keyword(s):  
Patellar Instability ◽  
Femoral Anteversion ◽  
Recurrent Patellar Instability

scholarly journals Increased Femoral Anteversion Influence Over Surgically Treated Recurrent Patellar Instability Patients

2017 ◽  
Vol 33 (10) ◽  
pp. e68
Author(s):  
Carlos Eduardo Da Silveira Franciozi ◽  
Felipe Ambra ◽  
Leonardo José Bernardes Albertoni ◽  
Pedro Debieux ◽  
Fernando Cury Rezende ◽  
...  
Keyword(s):  
Patellar Instability ◽  
Femoral Anteversion ◽  
Recurrent Patellar Instability

Clinical Comparison of Medial Patellofemoral Ligament Reconstruction With or Without Tibial Tuberosity Transfer for Recurrent Patellar Instability

2021 ◽  
pp. 036354652110377
Author(s):  
Jong-Min Kim ◽  
Jae-Ang Sim ◽  
HongYeol Yang ◽  
Young-Mo Kim ◽  
Joon-Ho Wang ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Patellar Instability ◽  
Medial Patellofemoral Ligament ◽  
Tibial Tuberosity ◽  
Mpfl Reconstruction ◽  
Trochlear Groove ◽  
Functional Failure ◽  
Radiological Parameters ◽  
Recurrent Patellar Instability

Background: No clear guidelines or widespread consensus has defined a threshold value of tibial tuberosity–trochlear groove (TT-TG) distance for choosing the appropriate surgical procedures when additional tibial tuberosity osteotomy (TTO) should be added to augment medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability. Purpose: To compare the clinical outcomes between MPFL reconstruction and MPFL reconstruction with TTO for patients who have patellar instability with a TT-TG distance of 15 to 25 mm. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively analyzed 81 patients who underwent surgical treatment using either MPFL reconstruction or MPFL reconstruction with TTO for recurrent patellar instability with a TT-TG distance of 15 to 25 mm; the mean follow-up was 25.2 months (range, 12.0-53.0 months). The patients were divided into 2 groups: isolated MPFL reconstruction (iMPFL group; n = 36) performed by 2 surgeons and MPFL reconstruction with TTO (TTO group; n = 45) performed by another 2 surgeons. Clinical outcomes were assessed using the Kujala score, Knee injury and Osteoarthritis Outcome Score, and Tegner activity score. Radiological parameters, including patellar height, TT-TG distance, patellar tilt, and congruence angle were compared between the 2 groups. Functional failure based on clinical apprehension sign, repeat subluxation or dislocation, and subjective instability and complications was assessed at the final follow-up. We also compared clinical outcomes based on subgroups of preoperative TT-TG distance (15 mm ≤ TT-TG ≤ 20 mm vs 20 mm < TT-TG ≤ 25 mm). Results: All of the clinical outcome parameters significantly improved in both groups at the final follow-up ( P < .001), with no significant differences between groups. The radiological parameters also showed no significant differences between the 2 groups. The incidence of functional failure was similar between the 2 groups (3 failures in the TTO group and 2 failures in the iMPFL group; P = .42). In the TTO group, 1 patient experienced a repeat dislocation postoperatively and 2 patients had subjective instability; in the iMPFL group, 2 patients had subjective instability. The prevalence of complications did not differ between the 2 groups ( P = .410). In the subgroup analysis based on TT-TG distance, we did not note any differences in clinical outcomes between iMPFL and TTO groups in subgroups of 15 mm ≤ TT-TG ≤ 20 mm and 20 mm < TT-TG ≤ 25 mm. Conclusion: MPFL reconstruction with and without TTO provided similar, satisfactory clinical outcomes and low redislocation rates for patients who had patellar instability with a TT-TG distance of 15 to 25 mm, without statistical difference. Thus, our findings suggest that iMPFL reconstruction is a safe and reliable treatment for patients with recurrent patellar dislocation with a TT-TG distance of 15 to 25 mm, without the disadvantages derived from TTO.

Arthroscopic Medial Retinacular Imbrication for the Treatment of Recurrent Patellar Instability: A Simple and All-Inside Technique

Orthopedics ◽  
2011 ◽  
Vol 34 (7) ◽  
pp. 524-529 ◽  
Author(s):  
Hu Xu ◽  
Chunli Zhang ◽  
Guoxian Pei ◽  
Qinsheng Zhu ◽  
Yisheng Han
Keyword(s):  
Patellar Instability ◽  
Recurrent Patellar Instability

Recurrent Patellar Instability

2018 ◽  
pp. 149-169
Author(s):  
Robin West ◽  
Ryan S. Murray ◽  
Daniel M. Dean
Keyword(s):  
Patellar Instability ◽  
Recurrent Patellar Instability

scholarly journals Isolated Medial Patellofemoral Ligament Reconstruction for Patellar Instability in Skeletally Immature versus Mature Patients

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0047
Author(s):  
Simone Gruber ◽  
Rhiannon Miller ◽  
Beth Shubin Stein ◽  
Joseph Nguyen
Keyword(s):  
Growth Plate ◽  
Patellar Instability ◽  
Medial Patellofemoral Ligament ◽  
Return To Sport ◽  
Mpfl Reconstruction ◽  
Skeletally Immature ◽  
Immature Group ◽  
Chi Square Analysis ◽  
Recurrent Patellar Instability ◽  
Mature Population

Objectives: Medial patellofemoral ligament (MPFL) reconstruction is the standard of care surgical treatment for recurrent patellar instability. Recurrent patellar instability is common after a first-time dislocation in the skeletally immature population. Adult-type reconstruction techniques are often avoided in skeletally immature patients due to the proximity of the femoral insertion of the MFPL to the distal femoral physis. It is currently unclear how outcomes of MPFL reconstruction in skeletally immature patients compare to those for skeletally mature patients. The objective of this study is to present the outcomes of isolated MPFL reconstruction in skeletally immature patients and compare their findings to a skeletally mature population. Methods: Patients were identified from an institutional patellofemoral registry who underwent isolated MPFL reconstruction from March 2014 to July 2018. Demographic, radiographic, and knee-specific patient-reported outcome measures (PROMs) were collected prior to surgery. Follow-up data collection included knee surveys collected at 1 and 2-years following MPFL reconstruction. Additionally, return to sport rates and episodes of re-dislocations were also collected. Comparisons of demographic and clinical data were made between skeletally immature and mature patients. Sub-analysis was performed on outcomes in skeletally immature patients who underwent MPFL reconstruction where the graft was placed distal to the physis to avoid the growth plate versus those who had standard placement of the graft. Baseline factors were analyzed using independent samples t-tests or chi-square analysis. Longitudinal analysis of knee PROMs was conducted using generalized estimating equation (GEE) modeling. Statistical significance was defined as p-values of 0.05 or less. Results: The study cohort included 107 patients (25 skeletally immature, 82 skeletally mature). Mean age of the study groups was 13.8 years in the immature group (range 11-15) and 21.3 in the mature group (range 14-34). No differences in sex (72% female in both groups) or obesity (0% vs. 8%) was observed between immature and mature patients. Radiographic measures of Caton-Deschamps Index (1.18 in both groups), TT-TG (14.9 vs. 14.8), and Dejour classification (P=0.328) also saw no differences between groups. Longitudinal outcomes in KOOS QoL, IKDC, KOOS PS, and Kujala surveys found no differences between immature versus mature patients over time. However, higher PediFABS was observed in the immature group versus mature at baseline (21.6 vs. 11.9, P<0.001), 1-year (18.1 vs. 11.5, P=0.006), and 2-years (22.4 vs. 11.5, P=0.003). Low incidence of post-operative dislocation and a high return to sport rate was observed in both skeletally immature and mature patients. No statistical differences were observed in all outcomes between immature patients who had standard graft placement and those where the graft was placed distal to the physis. Conclusion: Controversy exists in how best to treat the skeletally immature patient with recurrent lateral patellar instability. Due to the risk of injury to the growth plate, many believe it is best to wait to stabilize these patients until they have stopped growing. However, given the high risk of cartilage injury with each dislocation and the long term sequelae of such injuries in these young knees, the risk of waiting may be high. This study demonstrates similar outcomes and recurrence rates in skeletally immature patients with those seen in the mature population without disturbance or injury to the growth plates. [Figure: see text][Figure: see text]

scholarly journals Use of a Superolateral Portal and 70° Arthroscope to Optimize Visualization of Patellofemoral Tracking and Osteochondral Lesions in Patients With Recurrent Patellar Instability

2020 ◽  
Vol 9 (11) ◽  
pp. e1731-e1736
Author(s):  
Ryan Bell ◽  
Andrew E. Jimenez ◽  
Benjamin J. Levy ◽  
Robert Willson ◽  
Robert A. Arciero ◽  
...  
Keyword(s):  
Patellar Instability ◽  
Osteochondral Lesions ◽  
Recurrent Patellar Instability
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