scholarly journals A Knee Size-Independent Parameter for Malalignment of the Distal Patellofemoral Joint in Children

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Ferdinand Wagner ◽  
Günther Maderbacher ◽  
Jan Matussek ◽  
Boris M. Holzapfel ◽  
Birgit Kammer ◽  
...  
Keyword(s):  
Patellar Tendon ◽  
Patellofemoral Joint ◽  
Cruciate Ligament ◽  
Independent Parameter ◽  
Common Finding ◽  
Tibial Tubercle ◽  
Control Group ◽  
Study Cohort ◽  
Tendon Insertion ◽  
Knee Size

Introduction. Patellar instability (PI) is a common finding in children. Current parameters describing patellofemoral joint alignment do not account for knee size. Additionally, most parameters utilize joint-crossing tibiofemoral landmarks and are prone to errors. The aim of the present study was to develop a knee size-independent parameter that is suitable for pediatric or small knees and determines the malpositioning of the distal patellar tendon insertion solely utilizing tibial landmarks. Methods. Sixty-one pediatric knees were included in the study. The tibial tubercle posterior cruciate ligament distance (TTPCL) was measured via magnetic resonance imaging (MRI). The tibial head diameter (THD) was utilized as a parameter for knee size. An index was calculated for the TTPCL and THD (TTPCL/THD). One-hundred adult knees were analyzed to correlate the data with a normalized cohort. Results. The THD was significantly lower in healthy females than in males (69.3 mm ± 0.8 mm vs. 79.1 mm ± 0.7 mm; p<0.001) and therefore was chosen to serve as a knee size parameter. However, no gender differences were found for the TTPCL/THD index in the healthy adult study cohort. The TTPCL/THD was significantly higher in adult PI patients than in the control group (0.301 ± 0.007 vs. 0.270 ± 0.007; p=0.005). This finding was repeated in the PI group when the pediatric cohort was analyzed (0.316 ± 0.008 vs. 0.288 ± 0.010; p=0.033). Conclusion. The TTPCL/THD index represents a novel knee size-independent measure describing malpositioning of the distal patellar tendon insertion determined solely by tibial landmarks.

scholarly journals Patellar Tendon Thickness and Failure After Anterior Cruciate Ligament Reconstructions with Bone-Patella Tendon-Bone Autograft

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0014
Author(s):  
Ryan Roach ◽  
Mark Kramarchuk ◽  
Hien Pham ◽  
Michele Mastio ◽  
Amos Dai ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Patellar Tendon ◽  
Cruciate Ligament ◽  
Tibial Tubercle ◽  
Control Group ◽  
Font Size ◽  
Patella Tendon ◽  
Inferior Pole ◽  
Anterior Cruciate

Objectives: The purpose of this study was to determine if patellar tendon (PT) thickness measured on pre-operative magnetic resonance imaging (MRI) is a risk factor for failure after anterior cruciate ligament reconstruction (ACLR) using bone-patella tendon-bone (BTB) autograft. Methods: 18 patients [age (mean 96 Normal 0 false false false EN-US X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:”Table Normal”; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow: yes; mso-style-priority:99; mso-style-parent:”“; mso-padding-alt:0in 5.4 pt 0in 5.4 pt; mso-para-margin:0in; mso-para-margin-bottom:.0001 pt; mso-pagination: widow-orphan; font-size:11.0 pt; mso-bidi-font-size:12.0 pt; font-family: Helvetica;} ± standard deviation) 21.5 ± 4.99years] that underwent an ACLR with BTB autograft and returned for revision ACLR between July 2005-January 2017 at our institution were included in the study. Failures were age-, sex-, height-, and weight-matched to 36 control (age 21.5 ± 4.99years) BTB-ACLR patients that have not required revision at a minimum of 2-years follow-up. Demographic data and mechanism of injury were recorded from patients’ medical records. PT thickness was measured at 3 points (5 mm lateral to the center, center, and 5 mm medial to the center) each at the level of the inferior pole of the patella (IPP), midpoint (MP), and insertion to tibial tubercle (ITT) on pre-operative axial-cut MRI. Results: All ACLR failures occurred after a non-contact pivot-shift type injury. Mean time between primary ACLR and revision was 2.4 ± 2.4 years and mean follow-up time was 3.1 ± 0.9 years in the control group. Patients with a failed ACLR had significantly thicker PTs at the IPP (lateral: 4.66 ± 1.47 vs 3.96 ± 0.66 mm; central: 5.39 ± 1.49 vs 4.51 ± 1.04 mm; medial: 5.51 ± 1.52 vs 4.59 ± 1.05 mm) and MP (lateral: 4.50 ± 0.83 vs 4.12 ± 0.54 mm; central: 4.83 ± 0.80 vs 4.43 ± 0.59 mm; medial: 4.57 ± 0.88 vs 4.13 ± 0.59 mm). There were no significant differences in PT thickness at the ITT. PT width tended to be larger in the failure cohort but this was not statistically significant (IPP: 32.2 ± 4.6 vs 29.8 ± 4.3 mm; MP: 31.3 ± 4.9 vs 29.5 ± 3.8 mm; ITT: 27.7 ± 3.7 vs 26.2 ± 2.9 mm). Conclusion: Contrary to conventional wisdom, we found that BTB autograft ACLR failures had significantly thicker patellar tendons at the inferior pole of the patella and midpoint. Further studies are need to investigate possible causes for this inverse correlation, such as poor histological tendon quality or mechanical impingement due to increased tendon size.

scholarly journals THE RELATIONSHIP BETWEEN PATELLAR MORPHOLOGY AND LATERAL PATELLAR INSTABILITY

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0025
Author(s):  
SM. Andelman ◽  
J. Hedgecock ◽  
M. Solomito ◽  
R. Kostyun ◽  
JL. Pace
Keyword(s):  
Patellar Instability ◽  
Trochlear Dysplasia ◽  
Cruciate Ligament ◽  
Tibial Tubercle ◽  
Control Group ◽  
Data Points ◽  
The Relationship ◽  
Patellar Morphology ◽  
Lateral Facet ◽  
And Cartilage

Background: Lateral patellar instability (LPI) is a substantial cause of morbidity in the pediatric population. Previously identified risk factors for LPI include trochlear dysplasia, a lateralized tibial tubercle, genu valgum, femoral anteversion, and external tibial torsion. Less is known regarding the relationship between patellar morphology and LPI. Purpose: The goal of this study is to determine whether there exists a relationship between patellar morphology and LPI. Methods: Magnetic resonance imaging (MRI) evaluation was performed for patients under 18 years of age with LPI and compared to a control group of MRIs of patients with anterior cruciate ligament (ACL) rupture. Using T2 axial MRI images, the lateral and medial facet angle of both the bone and cartilage of the patella was measured at three locations: the most proximal and distal aspects of the patella where the cartilage of the facets could be identified and the widest point of the patella. The width of the patella at each point was also recorded, resulting in 15 total data points per subject (5 at each of the three locations on the patella). Results were analyzed and compared between the instability group and the control group to determine any relationship between facet angle and LPI. Results: 196 MRIs were reviewed, 97 in the instability group and 96 in the control group. The LPI group was noted to have a less steep angle at the proximal medial patellar facet of both the bone (LPI 27.2° ± 9.3° ; control 32.7° ± 8.8°, p < 0.001) and cartilage (LPI 26.5° ± 8.8°, control 32.7° ± 8.4°, p < 0.001) as well as a less steep angle of the cartilage at the distal lateral facet (LPI 23.4° ± 7.2°, control 25.6° ± 6.6°, p = 0.033). No other differences were noted for the remaining 12 data points. Conclusion: The are very few differences in patellar morphology between patients with and without LPI. Patients were LPI have a less steep angle of the bone of the proximal medial facet, the cartilage of the proximal medial facet, and the cartilage of the distal lateral facet when compared to a control group. [Figure: see text]

scholarly journals Open knee dislocation with a patellar tendon rupture: Result of staged surgical repair

2019 ◽  
Vol 7 ◽  
pp. 2050313X1882310
Author(s):  
Tsuneari Takahashi ◽  
Tomohiro Matsumura ◽  
Kazuaki Ishihara ◽  
Shuhei Hiyama ◽  
Katsushi Takeshita
Keyword(s):  
Posterior Cruciate Ligament ◽  
Surgical Management ◽  
Patellar Tendon ◽  
Tendon Rupture ◽  
Cruciate Ligament ◽  
Knee Dislocation ◽  
Patellar Tendon Rupture ◽  
Collateral Ligament ◽  
Range Of Movement ◽  
Multiligament Injury

Knee dislocation with concomitant multiligament injury is a rare and devastating injury. We report the successful repair of a rare case of open knee dislocation with concomitant multiligament injury and patellar tendon rupture of an 18-year-old male due to a motorcycle accident. The patient presented with an open wound running parallel to the knee joint line and patellar tendon rupture with full exposure of the cartilage of the distal femur. Staged surgical management including the application of a ring-type external fixator with a hinged joint, lateral collateral ligament repair, medial collateral ligament reconstruction using autogenous hamstring tendon, and joint release was performed. Range of movement was recovered to 0 degrees of knee extension and 80 degrees of knee flexion, and extension lag was negative. The Lysholm score of the patient was recovered to 92. The patient was able to return to work in the construction field 2 years after sustaining the injury. The patient had no complaint of pain and was able to resume construction work, even though reconstruction of the anterior cruciate ligament and posterior cruciate ligament was not performed. The application of a hinged ring-type external fixation device might play a key role in early range of movement restoration and to maintain the reduced position and acceptable recovery of the posterior cruciate ligament injury without the need for reconstructive surgery. This report is the first to describe the safety and effectiveness of staged surgical management for the repair of open knee dislocation with concomitant multiligament injury and patellar tendon rupture. However, further studies with longer follow-up periods will be needed to observe the development of osteoarthritis or weakness of the knee. Staged surgical management is a safe and effective procedure for repairing an open knee dislocation with concomitant multiligament injury and patellar tendon rupture.

Altered Knee Laxity and Stiffness in Response to a Soccer Match Simulation in Players Returning to Sport Within 12 Months After Anterior Cruciate Ligament Reconstruction

2021 ◽  
pp. 036354652110130
Author(s):  
Stefano Nuccio ◽  
Luciana Labanca ◽  
Jacopo Emanuele Rocchi ◽  
Pier Paolo Mariani ◽  
Paola Sbriccoli ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Knee Laxity ◽  
Activity Level ◽  
Soccer Players ◽  
Control Group ◽  
Soccer Match ◽  
Anterior Cruciate ◽  
Anterior Knee

Background: The acute effects of exercise on anterior knee laxity (AKL) and anterior knee stiffness (AKS) have been documented in healthy participants, but only limited evidence has been provided for athletes cleared to return to sports after anterior cruciate ligament (ACL) reconstruction (ACLR). Purpose/Hypothesis: The purpose was to determine if 45 minutes of a soccer match simulation lead to acute changes in AKL and AKS in soccer players returning to sport within 12 months after ACLR. We hypothesized that the reconstructed knee of the ACLR group would exhibit an altered response to sport-specific exercise. Study Design: Controlled laboratory study. Methods: A total of 13 soccer players cleared to return to sport after ACLR and 13 healthy control soccer players matched for age, physical activity level, limb dominance, and anthropometric characteristics were recruited. To assess the effects of a standardized soccer match simulation (Soccer Aerobic Field Test [SAFT45]) on AKL and AKS, an arthrometric evaluation was carried out bilaterally before and immediately after SAFT45. To conduct a comprehensive examination of the force-displacement curve, the absolute and side-to-side difference (SSD) values of both AKL and AKS were extracted at 67, 134, and 200 N. Results: The ACLR and control groups showed similar AKL and AKS at baseline ( P > .05). In response to SAFT45, laxity increased bilaterally at all force levels by 14% to 17% only in the control group ( P < .025). Similarly, AKS at 134 and 200 N decreased in response to SAFT45 only in the control group (10.5% and 20.5%, respectively; P < .025). After SAFT45, the ACLR group had 1.9 and 2.5 times higher SSDs of AKS at 67 and 134 N compared with the control group, respectively ( P < .025), as well as a 1.9 times higher SSD of AKS at 134 N compared with baseline ( P = .014). Conclusion: Soccer players at the time of return to sport after ACLR showed an altered mechanical response to a sport-specific match simulation consisting of bilaterally unchanged AKL and AKS. Clinical Relevance: Soccer players showing altered AKL and AKS in response to exercise after ACLR may not be ready to sustain their preinjury levels of sport, thus potentially increasing the risk of second ACL injuries.

Effect of Medialization of the Trochlear Groove and Lateralization of the Tibial Tubercle on TT-TG Distance: A Cross-sectional Study of Dysplastic and Nondysplastic Knees

2021 ◽  
pp. 036354652098781
Author(s):  
Mathias Paiva ◽  
Lars Blønd ◽  
Per Hölmich ◽  
Kristoffer Weisskirchner Barfod
Keyword(s):  
Trochlear Dysplasia ◽  
Cross Sectional Study ◽  
Magnetic Resonance Images ◽  
Tibial Tubercle ◽  
Control Group ◽  
Trochlear Groove ◽  
Sectional Study ◽  
Cross Sectional ◽  
Mean Values ◽  
The Mean

Background: Tibial tubercle–trochlear groove (TT-TG) distance is often used as a measure of lateralization of the TT and is important for surgical planning. Purpose: To investigate if increased TT-TG distance measured on axial magnetic resonance images is due to lateralization of the TT or medialization of the TG. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 84 knees (28 normal [NK], 28 with trochlear dysplasia [TD], and 28 with patellar dislocation without TD [PD]) were examined. The medial border of the posterior cruciate ligament (PCL) was chosen as the central anatomic landmark. The distance from the TT to PCL (TT-PCL) was measured to examine the lateralization of the TT. The distance from the TG to the PCL (TG-PCL) was measured to examine the medialization of the TG. Between-group differences were investigated by use of 1-way analysis of variance. Results: The mean values for TT-TG distance were 8.7 ± 3.6 mm for NK, 12.1 ± 6.0 mm for PD, and 16.7 ± 4.3 mm in the TD group ( P < .01). The mean values for TT-PCL distance were 18.5 ± 3.6 mm for NK, 18.5 ± 4.5 mm for PD, and 21.2 ± 4.2 mm in the TD group ( P = .03). The mean values for TG-PCL distance were 9.6 ± 3.0 mm for NK, 7.1 ± 3.4 mm for PD, and 5.1 ± 3.3 mm in the dysplastic group ( P < .01). Conclusion: The present results indicate that increased TT-TG distance is due to medialization of the TG and not lateralization of the TT. Knees with TD had increased TT-TG distance compared with the knees of the control group and the knees with PD. The TT-PCL distance did not differ significantly between groups, whereas the TG-PCL distance declined with increased TT-TG.

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