Medial Side Patellofemoral Anatomy: Surgical Implications in Patellofemoral Instability

2010 ◽  
pp. 149-152 ◽  
Author(s):  
Elizabeth A. Arendt
Keyword(s):  
Patellofemoral Instability ◽  
Medial Side

Effect of Isolated Medial Patellofemoral Ligament Reconstruction in Patellofemoral Instability Regardless of Predisposing Factors

2020 ◽  
Author(s):  
Jae Ik Lee ◽  
Mohd Shahrul Azuan Jaffar ◽  
Han Gyeol Choi ◽  
Tae Woo Kim ◽  
Yong Seuk Lee
Keyword(s):  
Medial Patellofemoral Ligament ◽  
Trochlear Dysplasia ◽  
Case Series ◽  
Patellofemoral Instability ◽  
International Knee Documentation Committee ◽  
Predisposing Factors ◽  
Mpfl Reconstruction ◽  
Patellar Tilt ◽  
Case Series Study

AbstractThe purpose of this study was to evaluate the outcomes of isolated medial patellofemoral ligament (MPFL) reconstruction, regardless of the presence of predisposing factors. A total of 21 knees that underwent isolated MPFL reconstruction from March 2014 to August 2017 were included in this retrospective series. Radiographs of the series of the knee at flexion angles of 20, 40, and 60 degrees were acquired. The patellar position was evaluated using the patellar tilt angle, sulcus angle, congruence angle (CA), and Caton-Deschamps and Blackburne-Peel ratios. To evaluate the clinical outcome, the preoperative and postoperative International Knee Documentation Committee (IKDC) and Lysholm knee scoring scales were analyzed. To evaluate the postoperative outcomes based on the predisposing factors, the results were separately analyzed for each group. Regarding radiologic outcomes, 20-degree CA was significantly reduced from 10.37 ± 5.96° preoperatively to −0.94 ± 4.11° postoperatively (p = 0.001). In addition, regardless of the predisposing factors, delta values of pre- and postoperation of 20-degree CA were not significantly different in both groups. The IKDC score improved from 53.71 (range: 18–74) preoperatively to 94.71 (range: 86–100) at the last follow-up (p = 0.004), and the Lysholm score improved from 54.28 (range: 10–81) preoperatively to 94.14 (range: 86–100) at the last follow-up (p = 0.010). Isolated MPFL reconstruction provides a safe and effective treatment for patellofemoral instability, even in the presence of mild predisposing factors, such as trochlear dysplasia, increased patella height, increased TT–TG distance, or valgus alignment. This is a Level 4, case series study.

scholarly journals OP0177 PROPERTIES AND LOCATIONS OF COLOR-CODED DUAL ENERGY CT LESIONS IN GOUT PATIENTS – A SYSTEMATIC EVALUATION

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 110.1-110
Author(s):  
S. Nysom Christiansen ◽  
F. C. Müller ◽  
M. Ǿstergaard ◽  
O. Slot ◽  
J. Møllenbach Møller ◽  
...  
Keyword(s):  
Weight Bearing ◽  
Dual Energy ◽  
Joint Fluid ◽  
Knee Joints ◽  
Systematic Evaluation ◽  
Tibialis Posterior ◽  
Dual Energy Ct ◽  
Medial Side ◽  
Diagnostic Potential ◽  
Subgroup Analyses

Background:Dual energy CT (DECT) has diagnostic potential in gout patients. DECT can automatically colour-code presumed urate deposits based on radiodensity (Hounsfield Units, HU) and DECT ratio (difference in attenuation between high and low kV series) of lesions. However, other materials may imitate properties of urate deposits, most importantly calcium-containing material, dense tendons and artefacts, which may lead to misinterpretations. The characteristics of DECT lesions in gout patients have not yet been systematically investigated.Objectives:To evaluate the properties and locations of colour-coded DECT lesions in gout patients.Methods:DECT were performed in patients with suspected gout. Patients were separated into gout and non-gout patients based on joint fluid microscopy findings. DECT of the hands, knees and feet were performed using default gout settings and colour-coded lesions were registered. Only location-relevant lesions were analysed (e.g. nail bed artefacts excluded). Mean density (mean of HU at 80 kV and Sn150 kV), mean DECT ratio, size and location of each lesion was determined.Subgroup analysis was performed post-hoc evaluating potential differences in properties and locations of lesions. Lesions were separated into groups according to properties (Figure 1, grey box): 1)Size—to separate artefacts characterised by small volume (possible artefacts). 2)DECT ratios—to separate calcium-containing material characterised by high DECT ratio (possible calcium-containing material). 3)Density—to separate dense tendons characterised by low DECT ratio and low HU values (possible dense tendons). Lesion fulfilling all urate characteristics (large volume, low DECT ratio, high density) were labelleddefinite urate deposits. Finally, for non-gout patients, properties ofnon-gout urate-imitation lesions(properties asdefinite urate deposits) were analysed.Results:In total, 3918 lesions (all lesions) were registered in gout patients (n=23), with mean DECT ratio 1.06 (SD 0.13), median density 160.6 HU and median size 6 voxels (Figure 1, blue box). Lesions were seen in all analysed joints, most frequently MTP1 joints (medial side), knee joints and midtarsal joints (Figure 2a). Tendon affections were also common, especially in the knee tendons (patella and quadriceps), malleolus-related tendons (e.g. peroneus and tibialis posterior) and the Achilles tendons (Figure 2a).Subgroup analyses showed thatdefinite urate deposits(figure 2b) were found at the same locations asall lesionin gout patients (figure 2a), with the four most common sites being MTP1 joints, midtarsal joints, and quadriceps and patella tendons (Figure 2b).Possible dense tendonlesions had a mean HU value of 156.5 HU—markedly higher than expected for dense tendons (<100HU)—and lesion-locations were similar todefinite urate deposits(data not shown), indicating that they primarily consisted of true urate deposits. In contrast,possible calcium-containing materialandnon-gout urate-imitating lesionshad distinctly different properties (ratios 1.33 and 1.20, respectively) (Figure 1, yellow and orange box). Furthermore, the locations of these lesions were different fromdefinite urate depositssince they were primarily found in a few weight-bearing joints (knee, midtarsal and talocrural including malleolus regions) and tendons (Achilles and quadriceps), whereas no lesions were found in either MTP1 joints or patella tendons (figure 2c).Conclusion:DECT color-coded lesions in gout patients are heterogeneous in properties and locations. Subgroup analyses found that locations such as MTP1 joints and patella tendons were characterised by almost only showingdefinite urate deposits. A sole focus on these regions in the evaluation of gout patients may therefore improve specificity of DECT scans.Disclosure of Interests:Sara Nysom Christiansen Speakers bureau: SNC has received speaker fees from Bristol Myers Squibb (BMS) and General Electric (GE)., Felix C Müller Employee of: Siemens Healthineers., Mikkel Ǿstergaard Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Merck, and Novartis, Consultant of: AbbVie, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo Nordisk, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi, and UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo Nordisk, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi, and UCB, Ole Slot: None declared, Jakob Møllenbach Møller: None declared, Henrik F Børgesen: None declared, Kasper K Gosvig: None declared, Lene Terslev Speakers bureau: LT declares speakers fees from Roche, MSD, BMS, Pfizer, AbbVie, Novartis, and Janssen.

A New Modified Labiaplasty Combined with Wedge De-Epithelialization on the Medial Side and Edge Resection

2021 ◽  
Author(s):  
Xudong Jiang ◽  
Sen Chen ◽  
Siwei Qu ◽  
Ning Ma ◽  
Weixin Wang ◽  
...  
Keyword(s):  
Medial Side

scholarly journals Comparable outcome for autografts and allografts in primary medial patellofemoral ligament reconstruction for patellofemoral instability: systematic review and meta-analysis

2021 ◽  
Author(s):  
Filippo Migliorini ◽  
Andromahi Trivellas ◽  
Jörg Eschweiler ◽  
Matthias Knobe ◽  
Markus Tingart ◽  
...  
Keyword(s):  
Medial Patellofemoral Ligament ◽  
Meta Analysis ◽  
Patellofemoral Instability ◽  
Mpfl Reconstruction ◽  
Current Evidence ◽  
Level Of Evidence ◽  
Feasible Alternative ◽  
The Mean ◽  
Persistent Instability

Abstract Purpose This study updates the current evidence on the role of allografts versus autografts for medial patellofemoral ligament (MPFL) reconstruction in patients with patellofemoral instability. Methods The study was performed according to the PRISMA guidelines. In March 2021, a literature search in the main online databases was performed. Studies reporting quantitative data concerning primary MPFL reconstruction using an allograft were considered for inclusion. The Coleman Methodology Score was used to assess the methodological quality of the selected articles. Results Data from 12 studies (474 procedures) were retrieved. The mean follow-up was 42.2 (15–78.5) months. The mean age was 21.1 ± 6.2 years. 64.9% (285 of 439) of patients were female. At the last follow-up, the Tegner (p < 0.0001), Kujala (p = 0.002) and the Lysholm (p < 0.0001) scores were minimally greater in the autografts. The similarity was found in the rate of persistent instability sensation and revision. The allograft group evidenced a lower rate of re-dislocations (p = 0.003). Conclusion Allografts may represent a feasible alternative to traditional autograft for MPFL reconstruction in selected patients with patellofemoral instability. Allograft tendons yielded similar PROMs, rates of persistent instability, and revision. Allograft reconstructions tended to have modestly lower re-dislocation rates. Level of evidence IV.

Dynamic KINE-MRI in patellofemoral instability in adolescents

2013 ◽  
Vol 22 (11) ◽  
pp. 2795-2802 ◽  
Author(s):  
Gideon Regalado ◽  
Hannu Lintula ◽  
Matti Eskelinen ◽  
Hannu Kokki ◽  
Heikki Kröger ◽  
...  
Keyword(s):  
Patellofemoral Instability

scholarly journals Isolated medial patellofemoral ligament reconstruction for recurrent patellofemoral instability: analysis of outcomes and risk factors

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Filippo Migliorini ◽  
Francesco Oliva ◽  
Gayle D. Maffulli ◽  
Jörg Eschweiler ◽  
Matthias Knobe ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Outcomes ◽  
Ligament Reconstruction ◽  
Medial Patellofemoral Ligament ◽  
Patellofemoral Instability ◽  
Mpfl Reconstruction ◽  
Medial Patellofemoral Ligament Reconstruction ◽  
The Mean ◽  
Tegner Score

Abstract Background The medial patellofemoral ligament (MPFL) is always damaged after patellar dislocation. In selected patients, MPFL reconstruction is necessary to restore a correct patellar tracking. Despite the large number of different techniques reported to reconstruct the MPFL, there is no consensus concerning the optimal procedure, and debates is still ongoing. The present study analysed the results after isolated MPFL reconstruction in patients with patellofemoral instability. Furthermore, a subgroup analysis of patients presenting pathoanatomical risk factors was made. Methods In November 2020, the main electronic databases were accessed. All articles reporting the results of primary isolated MPFL reconstruction for recurrent patellofemoral instability were considered for inclusion. Only articles reporting a minimum 12-month follow-up were eligible. Results Data from a total of 1777 knees were collected. The mean age of the patients involved was 22.8 ± 3.4 years. The mean follow-up was 40.7 ± 25.8 months. Overall, the range of motion (+ 27.74; P < 0.0001) and all the other scores of interests improved at last follow-up: Kujala (+ 12.76; P = 0.0003), Lysholm (+ 15.69; P < 0.0001), Tegner score (+ 2.86; P = 0.006). Seventy-three of 1780 patients (4.1%) showed a positive apprehension test. Thirty of 1765 patients (1.7%) experienced re-dislocations, while 56 of 1778 patients (3.2%) showed persisting joint instability. Twenty-five of 1786 patients (1.4%) underwent revision surgeries. Conclusion Isolated MPFL reconstruction for recurrent patellofemoral instability provides reliable surgical outcomes. Patients with pathoanatomical predisposing factors reported worse surgical outcomes.

scholarly journals Differential Contribution of the Medial and the Lateral Side of the Joint to Symptoms in Knee Osteoarthritis: A Radiographic and Laboratory Analysis in the Nagahama Study

Cartilage ◽  
2021 ◽  
pp. 194760352110258
Author(s):  
Kazuya Nigoro ◽  
Hiromu Ito ◽  
Tomotoshi Kawata ◽  
Shinichiro Ishie ◽  
Yugo Morita ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Clinical Outcomes ◽  
Knee Pain ◽  
High Sensitivity ◽  
Analysis Of Covariance ◽  
Radiographic Evaluation ◽  
Radiographic Feature ◽  
Lateral Side ◽  
Cross Sectional ◽  
Medial Side

Objective: This cross-sectional study aimed to explore the differences of the medial and lateral sides of the knee joint and precise radiographic abnormalities in contribution to the knee pain and clinical outcomes. Design: Participants 60 years or older who underwent radiographic evaluation were included. Knee radiography was assessed using grading systems of the Osteoarthritis Research Society International (OARSI) atlas. The Japanese Knee Osteoarthritis Measure (JKOM) was evaluated as clinical outcomes. Serum high-sensitivity C-reactive protein (hsCRP) was used to evaluate systemic inflammation. We divided the participants into normal, medial-, lateral-, and medial & lateral-OA types and compared their JKOM using an analysis of covariance. Furthermore, we analyzed the relationship between the knee pain and stiffness of JKOM and the grading of each radiographic feature using a multiple regression model. Results: Lateral- and medial & lateral-OA groups had a significantly worse symptoms in the total and the pain score, especially in movement subscales, in JKOM score. Lateral-OA groups had higher hsCRP than medial-OA group. Multivariate analysis showed that medial joint space narrowing (JSN), and lateral femoral and tibial osteophytes significantly affected knee pain (adjusted odds ratios: 1.73, 1.28, and 1.55, respectively). The radiographic changes are associated with pain more in JSN in the medial side and osteophytes in the lateral side. Conclusion: Lateral- and medial & lateral-OA groups showed worth symptom. In addition, medial JSN and lateral osteophytes have potent effects on the knee pain.

Sphincteroplasty with aponeurosis

1927 ◽  
Vol 23 (4) ◽  
pp. 467-467
Author(s):  
I. Tsimkhes
Keyword(s):  
Inguinal Hernia ◽  
Operative Treatment ◽  
Oblique Muscle ◽  
Medial Side ◽  
External Oblique Muscle ◽  
External Oblique

After the examination of sphincteroplasty as a method of operative treatment of inguinal hernia, Bleek, based on his own experience (12 cases), suggests that after exposing the aponeurosis of the external oblique muscle, it should be dissected in the usual way, making two parallel incisions immediately next to the pouparticular ligament and on the medial side.

Bone Ingrowth Around an Uncemented Femoral Implant Using Mechanoregulatory Algorithm: A Multiscale Finite Element Analysis

2021 ◽  
Author(s):  
Basil Mathai ◽  
Sanjay Gupta
Keyword(s):  
Finite Element ◽  
Bone Tissue ◽  
Bone Ingrowth ◽  
Progressive Increase ◽  
Stair Climbing ◽  
Porous Coating ◽  
Fe Model ◽  
Implant Surface ◽  
Element Analysis ◽  
Medial Side

Abstract The primary fixation and long-term stability of a cementless femoral implant depend on bone ingrowth within the porous coating. Although attempts were made to quantify the peri-implant bone ingrowth using the finite element (FE) analysis and mechanoregulatory principles, the tissue differentiation patterns on a porous-coated hip stem have scarcely been investigated. The objective of this study is to predict the spatial distribution of evolutionary bone ingrowth around an uncemented hip stem, using a 3D multiscale mechanobiology based numerical framework. Multiple load cases representing a variety of daily living activities, including walking, stair climbing, sitting down and standing up from a chair, were used as applied loading conditions. The study accounted for the local variations in host bone material properties and implant-bone relative displacements of the macroscale implanted FE model, in order to predict bone ingrowth in microscale representative volume elements (RVEs) of twelve interfacial regions. In majority RVEs, 20-70% bone tissue (immature and mature) was predicted after two months, contributing towards a progressive increase in average Young's modulus (1200-3000 MPa) of the inter-bead tissue layer. Higher bone ingrowth (mostly greater than 60%) was predicted in the antero-lateral regions of the implant, as compared to the postero-medial side (20-50%). New bone tissue was formed deeper inside the inter-bead spacing, adhering to the implant surface. The study helps to gain an insight into the degree of osseointegration of a porous-coated femoral implant.

Sign in / Sign up

Export Citation Format

Share Document