Stress Radiographs in the Diagnosis of Patellofemoral Instability

2010 ◽  
pp. 69-72 ◽  
Author(s):  
Robert Teitge
Keyword(s):  
Patellofemoral Instability ◽  
Stress Radiographs

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 Consistency and Reliability of Ankle Stress Radiography in Patients With Chronic Lateral Ankle Instability

2021 ◽  
Vol 9 (5) ◽  
pp. 232596712110040
Author(s):  
Ji Hye Choi ◽  
Kug Jin Choi ◽  
Chin Youb Chung ◽  
Moon Seok Park ◽  
Ki Hyuk Sung ◽  
...  
Keyword(s):  
Standard Deviation ◽  
Tilt Angle ◽  
Ankle Instability ◽  
Interobserver Reliability ◽  
Initial Presentation ◽  
Lateral Ankle ◽  
Chronic Lateral Ankle Instability ◽  
Stress Radiographs ◽  
Lateral Ankle Instability

Background: Ankle stress radiographs are important tools for evaluating chronic lateral ankle instability. The consistency of a patient’s ankle condition as it affects the reliability of ankle stress radiographs has never been evaluated. Purpose: To investigate the consistency and reliability of ankle stress radiographs in patients with chronic lateral ankle instability without an ankle injury during the study period. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Included were patients with chronic lateral ankle instability who underwent 2 repeated ankle stress radiographs between January 2014 and July 2019; those with an ankle injury during the study period were excluded. The tibiotalar tilt angle on varus stress radiographs and anterior translation of the talus on anterior drawer stress radiographs were measured at initial presentation and final follow-up examination. Interobserver reliability and consistency of ankle stress radiographs were analyzed using the intraclass correlation coefficient (ICC). Results: A total of 45 patients (mean ± standard deviation age, 36.4 ± 13.4 years; 18 men and 27 women; follow-up duration, 9.1 ± 3.2 months) were included. The mean ± standard deviation tibiotalar tilt angle and anterior talar translation at initial presentation were 10.8° ± 5.2° and 6.9 ± 2.7 mm, respectively. The interobserver reliabilities of the tibiotalar tilt angle and anterior talar translation were excellent (ICC = 0.926 [95% CI, 0.874-0.959] and 0.911 [95% CI, 0.766-0.961], respectively). The consistency between the initial and final radiographs was good for tibiotalar tilt angle (ICC = 0.763 [95% CI, 0.607-0.862]) and poor for anterior talar translation (ICC = 0.456 [95% CI, 0.187-0.660]). Conclusion: Although the interobserver reliability of the radiographic measurements was excellent, the consistency of the ankle stress radiographs was not as acceptable. Surgeons need to be cautious when deciding whether to operate on a patient with chronic lateral ankle instability based on a single ankle stress radiograph.

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.

Patellofemoral Instability: Distal Realignment

2019 ◽  
pp. 101-108
Author(s):  
Suroosh Madhanipour ◽  
Kostas Michail ◽  
Sam Oussedik
Keyword(s):  
Patellofemoral Instability ◽  
Distal Realignment

Magnetic Resonance Imaging Analysis of Rotational Alignment in Patients With Patellar Dislocations

2012 ◽  
Vol 41 (1) ◽  
pp. 51-57 ◽  
Author(s):  
Gerd Diederichs ◽  
Torsten Köhlitz ◽  
Evgenios Kornaropoulos ◽  
Markus O. Heller ◽  
Bernd Vollnberg ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Risk Factors ◽  
Magnetic Resonance ◽  
Patellar Dislocation ◽  
Patellofemoral Instability ◽  
Resonance Imaging ◽  
Tibial Torsion ◽  
Limb Alignment ◽  
Femoral Antetorsion ◽  
Rotational Limb Alignment

Background: The role of anatomic risk factors in patellofemoral instability is not yet fully understood, as they have been observed in patients either alone or in combination and in different degrees of severity. Purpose: To prospectively analyze rotational limb alignment in patients with patellofemoral instability and in controls using magnetic resonance imaging (MRI). Study Design: Cross-sectional study; Level of evidence, 3. Methods: Thirty patients (mean age, 22.9 y; range, 12-41 y) with a history of patellar dislocation and 30 age- and sex-matched controls (mean age, 25.2 y; range, 16-37 y) were investigated. The patients underwent MRI of the leg at 1.5 T using a peripheral angiography coil and a T2-weighted half-Fourier acquisition single-shot turbo spin echo (HASTE) sequence for measuring femoral antetorsion, tibial torsion, knee rotation, and mechanical axis deviation (MAD). The mean values of these parameters were compared between patients and controls. In addition, the patients underwent an assessment to determine the influence of rotational limb alignment on lateral trochlear inclination, trochlear facet asymmetry, trochlear depth, Insall-Salvati index, and tibial tuberosity–trochlear groove distance. Results: Patients had 1.56-fold higher mean femoral antetorsion (20.3° ± 10.4° vs 13.0° ± 8.4°; P < .01) and 1.6-fold higher knee rotation (9.4° ± 5.0° vs 5.7° ± 4.3°; P < .01) compared with controls. Moreover, patients had 2.9 times higher MAD (0.81 ± 0.75 mm vs −0.28 ± 0.87 mm; P < .01). Differences in tibial torsion were not significant. Also, there were no significant correlations between parameters of rotational alignment and standard anatomic risk factors. Conclusion: Our results suggest that some patients with nontraumatic patellar instability have greater internal femoral rotation, greater knee rotation, and a tendency for genu valgum compared with healthy controls. Rotational malalignment may be a primary risk factor in patellar dislocation that has so far been underestimated.

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