Rotating dome trochleoplasty: An experimental technique for correction of patellar luxation using a feline model

2007 ◽  
Vol 20 (03) ◽  
pp. 180-184 ◽  
Author(s):  
K. Linn ◽  
M. Gillick
Keyword(s):  
Surface Area ◽  
Articular Surface ◽  
Patellar Tilt ◽  
Ridge Height ◽  
Study Support ◽  
Biomechanical Evaluation ◽  
Feline Model ◽  
Trochlear Height ◽  
Patellar Tilt Angle ◽  
Flexion And Extension

SummaryThe purpose of this study was to compare a trochlear block recession to a rotating dome trochleoplasty, a novel technique for the correction of patellar luxation in small animals. Twenty-eight limbs were used from 14 feline cadavers. With the stifles in flexion and extension, computed tomography was utilized to compare width and depth of the trochlea, medial trochlear ridge height, trochlear articular surface area preserved, patellar contact articular surface area, patellar area covered by the trochlear ridges and patellar tilt angle. The results of this study demonstrated that a rotating dome trochleoplasty is superior to a trochlear block recession with regard to medial trochlear height, trochlear width, trochlear depth and trochlear surface area preservation. The results of this study support further biomechanical evaluation of this technique which eventually may lead to clinical trials.

scholarly journals Evaluating the Subtalar Joint in Tibiotalocalcaneal Nail

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0040
Author(s):  
Megan Reilly ◽  
Kurosh Darvish ◽  
Soroush Assari ◽  
John Cole ◽  
Tyler Wilps ◽  
...  
Keyword(s):  
Surface Area ◽  
Subtalar Joint ◽  
Articular Surface ◽  
Joint Surface ◽  
Central Dome ◽  
Below The Knee ◽  
Joint Surfaces ◽  
Circular Surface ◽  
The Mean ◽  
Pass Through

Category: Hindfoot Introduction/Purpose: In tibiotalocalcaneal nails for arthrodesis, the path of the nail through the subtalar joint has not been well documented. Ideally, the defect caused by reaming and the nail does not pass through the joint surface so that the amount of bony contact between the talus and calcaneus is maintained in order to optimize fusion. Our hypothesis is that the TTC nail does not destroy a significant amount contact area between the talus and calcaneus. However, using larger diameter nails (which are inherently stronger) will have more of an effect on the contact surface. Methods: Five cadaveric below the knee specimens were obtained. The ankle was disarticulated on each specimen. Subsequently, a guidepin was drilled from the central dome of the talus down to the calcaneus. The 11 mm reamer was then passed over the guidepin through the calcaneus to simulate retrograde reaming of a TTC nail. Then, the subtalar joint was dissected open and the articular surface was documented in comparison with the area that was reamed out. Measurements were then made, using software that calculated two dimensional surface area to determine the percentage of actual subtalar joint area that was reamed out. The mean percentage of articular area that was removed with the reamer was then calculated. Results: Among the five specimens, in the calcaneus, the mean total articular area was 599mm2±113 and the mean drilled articular area was 21mm2±16. The percentage of the calcaneal articular surface that was removed with the reamer was 3.4%±1.9. In the talus, the mean total articular area was 782mm2±130 and the mean drilled articular area was 39mm2±18. The percentage of the talar articular surface that was removed with the reamer was 5.0%±2.3. Additionally, an 11 mm reamer makes a circular surface area of 95mm2, and the statistics above indicate that a significant portion of the reamed area is nonarticular, within the calcaneal sulcus or the talar sulcus. Conclusion: In a tibiotalocalcaneal nail the subtalar joint is typically incompletely visualized, however this anatomic study demonstrates that the 11 mm reamer eliminates about 3.4% of the calcaneal articular surface and about 5% of the talar articular surface. Therefore, the majority of the articular surface is left intact, which is ideal in optimizing arthrodesis outcomes. Furthermore, this study could extrapolate the effects of a larger nail on the availability of joint surface. It could also be used to argue for cartilage stripping of the affected joint surfaces in arthrodesis preparation, because the majority of the articular surface is, in fact, left intact.

scholarly journals Clinical Outcomes After Medial Patellofemoral Ligament Reconstruction With Suture Fixation of the Gracilis Tendon via Transosseous Tunnels

2020 ◽  
Vol 8 (2) ◽  
pp. 232596711990037
Author(s):  
Hangzhou Zhang ◽  
Mao Ye ◽  
Qingwei Liang
Keyword(s):  
Patellar Dislocation ◽  
Medial Patellofemoral Ligament ◽  
Case Series ◽  
Mpfl Reconstruction ◽  
Suture Fixation ◽  
Recurrent Patellar Dislocation ◽  
Patellar Tilt ◽  
Transosseous Suture ◽  
Patellar Tilt Angle

Background: Several fixation methods have been introduced in medial patellofemoral ligament (MPFL) reconstruction. However, the optimal management of patients with recurrent patellar dislocation remains controversial. Purpose: To present a case series with a minimum 2-year follow-up of 29 patients with recurrent patellar dislocation who underwent a new transosseous suture fixation technique for MPFL reconstruction. Study Design: Case series; Level of evidence, 4. Methods: From January 2014 through February 2016, a total of 29 patients with recurrent patellar dislocation for which the MPFL was reconstructed with transosseous suture patellar fixation were studied. All patients were available for follow-up (mean, 37.52 months; range, 26-48 months). The patellar attachment was fixed by transosseous patellar sutures. The International Knee Documentation Committee (IKDC) subjective knee score, Kujala score, Tegner score, range of motion, congruence angle, patellar tilt angle, and complications were assessed both pre- and postoperatively. Results: No recurrent dislocation was observed in any of the 29 patients for a minimum of 2 years. All outcome scores improved significantly from preoperatively to postoperatively: the average IKDC subjective knee evaluation score from 53 to 87, Kujala from 54 to 90, Lysholm from 50 to 89, and Tegner from 3 to 5 ( P < .001 for all). The congruence angle significantly decreased from 22° preoperatively to –3° postoperatively, and the patellar tilt angle (Merchant) decreased from 23° preoperatively to 5° postoperatively ( P < .001 for both). In total, 25 patients (25/29; 86.21%) were completely pain-free when performing activities of daily living at the last follow-up, and 27 patients (93.1%) rated themselves as very satisfied or satisfied with the results. Conclusion: In patients with chronic recurrent patellar dislocation, transosseous patellar suture fixation for MPFL reconstruction can significantly improve patellar stability and achieve good results at short-term follow-up.

Evidence of Abnormal Anteroposterior Patellar Tilt in Patients with Patellar Tendinitis with Use of a New Radiographic Measurement

2002 ◽  
Vol 30 (3) ◽  
pp. 396-401 ◽  
Author(s):  
Timothy F. Tyler ◽  
Elliott B. Hershman ◽  
Stephen J. Nicholas ◽  
Jeffery H. Berg ◽  
Malachy P. McHugh
Keyword(s):  
Tilt Angle ◽  
Sagittal Plane ◽  
High Reliability ◽  
Normal Population ◽  
Normal Subjects ◽  
Patellofemoral Pain ◽  
Radiographic Measurement ◽  
Patellar Tilt ◽  
Radiographic Measurements ◽  
Patellar Tilt Angle

Background A number of clinical conditions of the patellofemoral joint have been correlated with abnormal patellofemoral radiographic measurements. Hypothesis An abnormal anteroposterior patellar-tilt angle may be a contributing factor to pathologic conditions of the knee. Study Design Prospective nonrandomized clinical trial. Methods The anteroposterior patellar-tilt angle was measured in cadaveric knees to determine the best knee position. The radiographs of normal subjects and patients with patellar tendinitis or patellofemoral pain syndrome were examined for differences in patellar-tilt angle. Results Cadaveric measurements demonstrated highest intertester and intratester reliability at 30° of knee flexion and neutral femoral rotation. Intratester measurements on normal subjects exhibited high reliability, with a mean anteroposterior tilt angle of 30.8° ± 6.7°. In the patellofemoral pain group the mean anteroposterior tilt angle was 29.1° ± 8.5°; however, for patients with patellar tendinitis, it was 25.6° ± 7.0°, significantly lower than in the normal population. Furthermore, there was no difference between the angles of involved and uninvolved knees of patients with unilateral patellar tendinitis. Conclusion The anteroposterior patellar-tilt angle is a clinically reliable measurement of patellar tilt in the sagittal plane that can be used to study patellofemoral tilt in a variety of clinical situations. The results of this study demonstrate that patients with patellar tendinitis have abnormal patellar tilt in the sagittal plane.

Articular Surface Area of the Coronoid Process and Radial Head in Elbow Extension: Surface Ratio in Cadavers and a Computed Tomography Study In Vivo

2010 ◽  
Vol 35 (7) ◽  
pp. 1120-1125 ◽  
Author(s):  
Seong-Ho Shin ◽  
In-Ho Jeon ◽  
Hyo-Jin Kim ◽  
Matthew McCullough ◽  
Jae-Hyuck Yi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Surface Area ◽  
Radial Head ◽  
Articular Surface ◽  
Coronoid Process ◽  
Elbow Extension

Anatomical Medial Patellofemoral Ligament Reconstruction for Recurrent Patella Dislocation: Two-Strand Grafts versus Four-Strand Grafts

2019 ◽  
Author(s):  
Jinghui Niu ◽  
Wei Lin ◽  
Qi Qi ◽  
Jiangfeng Lu ◽  
Yike Dai ◽  
...  
Keyword(s):  
Tilt Angle ◽  
Medial Patellofemoral Ligament ◽  
Lysholm Score ◽  
Mpfl Reconstruction ◽  
Patella Dislocation ◽  
Reconstruction Method ◽  
Patellar Tilt ◽  
Kujala Score ◽  
Patellar Tilt Angle

AbstractThe purpose of this study was to describe two anatomical medial patellofemoral ligament (MPFL) reconstruction methods: reconstruction with two-strand grafts and reconstruction with four-strand grafts and to evaluate the clinical and radiological results. From January 2010 to January 2013, patients who sustained recurrent patella dislocation and met inclusion criteria were included in the study and divided into two groups randomly to undergo MPFL reconstruction either by two-strand grafts (T group) or four-strand grafts (F group). Patients were followed up 1 month, 1 year, 2 years, and 3 years postoperatively. The apprehension test was applied to test patella stability. The Kujala score, Lysholm score, and Crosby–Insall grading were used to evaluate the function of the affected knee. The patellar congruence and patellar tilt angle were used to measure the morphology of the patellofemoral joint. In addition, patients' subjective assessments and complications were recorded. Thirty-eight patients in T group and 38 patients in F group were followed for at least 36 months. The apprehension test was positive in all patients preoperatively but was negative at follow-up. The Kujala score, Lysholm score, patellar congruence angle, and the patellar tilt angle of patients in both groups improved significantly at 36-month follow-up when compared with those assessed preoperatively. However, patients in the F group achieved better clinical results in terms of Kujala score, patellar congruence angle, patellar tilt angle, and Crosby–Insall grading when compared with those in the T group 3 years after the operation. Most patients (92% of patients in the T group and 97% of patients in the F group) were satisfied with the surgery. The anatomical MPFL reconstruction with two-strand grafts or four-strand grafts were both safe techniques for recurrent patella dislocation with satisfactory clinical outcomes. The anatomical fixation with four-strand grafts achieved better clinical and radiographic results in the follow-up, which may be a better reconstruction method.

scholarly journals A Retrospective Study on the Morphology of Posterior Malleolar Fractures Based on a CT Scan: Whether We Ignore the Importance of Fracture Height

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Zhifeng Wang ◽  
Chengjie Yuan ◽  
Genrui Zhu ◽  
Xiang Geng ◽  
Chao Zhang ◽  
...  
Keyword(s):  
Ct Scan ◽  
Surface Area ◽  
Articular Surface ◽  
Area Ratio ◽  
Ankle Injury ◽  
Average Height ◽  
Malleolar Fracture ◽  
Malleolar Fractures ◽  
Posterior Malleolar Fracture ◽  
Fracture Area

Objective. The aim of this study was to investigate the respective correlation between the height (H) of a posterior malleolar fracture (PMF) and the involved area (S) of an articular surface and the presence of “die-punch.” Methods. Patients with closed posterior malleolar fractures admitted to our hospital from January 2015 to December 2017 were selected, with complete X-ray and 3D reconstruction CT imaging data. The gender, age, injured side, and surgical fixation methods of the patients were recorded. A preoperative ankle CT scan was performed, and the images were viewed through the PACS (Picture Archiving and Communication Systems). Simultaneously, the involved joint surface area (S) by the posterior malleolar fracture was measured, as well as the proportion of the fracture area to the total ankle joint area. On the sagittal reconstruction CT images, the height (H) of the posterior malleolar fracture was measured to compare the correlation between the height of the fracture and the area of the fracture, as well as the area ratio. Besides, according to the presence or absence of “die-punch,” patients were divided into two groups: A and B. And each group was further divided into three subgroups according to age (16-39 years old, 40-59 years old, and ≥60 years old). The statistical differences in the height of fracture between the subgroups were compared. Results. A total of 48 patients, aged 16-82 years, with an average age of 48.9 years, were included in this study, including 13 males and 35 females. There were 20 cases of left ankle injury and 28 cases of right ankle injury. The average height of the posterior malleolar fractures was 18.19 mm, the average area of the fracture was 202.28 mm2, and the average ratio of the fracture area to the total articular surface area was 17.84%. Besides, die-punch was seen in 27 cases and not in 21 cases. The average height of fractures was 21.33±5.38 mm in group A1, 14.38±9.01 mm in group B1, 18.30±7.95 mm in group A2, 14.48±5.37 mm in group B2, 26.26±6.73 mm in group A3, and 12.77±3.07 mm in group B3. Conclusion. The height (H) of the posterior malleolar fractures is positively correlated with the fracture area (S) and the fracture area ratio (FAR). The posterior malleolar fractures with “die-punch” tend to have a greater average height than that without “die-punch.” In clinical work, orthopedic surgeons should not only pay attention to the size of the posterior malleolus fracture but also value its height, which hopefully could provide insight into the treatment and prognosis of PMF patients.

scholarly journals Automatic Segmentation and Measurement on Knee Computerized Tomography Images for Patellar Dislocation Diagnosis

2020 ◽  
Vol 2020 ◽  
pp. 1-13
Author(s):  
Limin Sun ◽  
Qi Kong ◽  
Yan Huang ◽  
Jiushan Yang ◽  
Shaoshan Wang ◽  
...  
Keyword(s):  
Computerized Tomography ◽  
Tilt Angle ◽  
Patellar Dislocation ◽  
Automatic Segmentation ◽  
Automatic Measurement ◽  
Ct Images ◽  
Lateral Shift ◽  
Patellar Tilt ◽  
Cad System ◽  
Patellar Tilt Angle

Traditionally, for diagnosing patellar dislocation, clinicians make manual geometric measurements on computerized tomography (CT) images taken in the knee area, which is often complex and error-prone. Therefore, we develop a prototype CAD system for automatic measurement and diagnosis. We firstly segment the patella and the femur regions on the CT images and then measure two geometric quantities, patellar tilt angle (PTA), and patellar lateral shift (PLS) automatically on the segmentation results, which are finally used to assist in diagnoses. The proposed quantities are proved valid and the proposed algorithms are proved effective by experiments.

scholarly journals Relationship of Patellofemoral Angles and Tibiofemoral Rotational Angles With Jumper’s Knee in Professional Dancers: An MRI Analysis

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712098522
Author(s):  
Neslihan Aksu ◽  
Vefa Atansay ◽  
Işık Karalök ◽  
Taner Aksu ◽  
Ayhan Nedim Kara ◽  
...  
Keyword(s):  
Patellar Tendon ◽  
Tilt Angle ◽  
Patella Alta ◽  
Jumper’S Knee ◽  
Patellar Tilt ◽  
Sulcus Angle ◽  
Significant Difference ◽  
Mri Scans ◽  
Professional Dancers ◽  
Patellar Tilt Angle

Background: Jumper’s knee is a type of tendinopathy affecting the distal insertion of the quadriceps tendon (25% of cases) or the patellar tendon. It has been shown that frontal-plane measurements, such as genu valgum, genu varum, an increased quadriceps angle, a protuberant tibial tuberosity, patella alta, and short hamstring muscles, may be related to jumper’s knee. Purpose: To investigate the effects of tibiofemoral rotational angles and patellofemoral (PF) angles on the development of jumper’s knee in professional folk dancers. Study Design: Case-control study; Level of evidence, 3. Methods: We examined 26 dancers (16 male, 10 female) with knee pain using magnetic resonance imaging (MRI), for a total of 32 knees. Of the knees, 21 with quadriceps tendinopathy (QT) and 7 with patellar tendinopathy (PT) were detected. Using MRI scans, we measured PF angles (PF sulcus angle, lateral PF angle, patellar tilt angle, lateral trochlear inclination angle, lateral patellar tilt angle, and PF congruence angle) and tibiofemoral rotational angles (condylar twist angle, posterior condylar angle, femoral Insall angle, tibial Insall angle, posterior tibiofemoral angle, and angle between the Whiteside line and posterior femoral condylar line) and noted specifics such as patella alta, patella baja, and the Wiberg classification of the patellar shape between the patients with versus without QT and between patients with versus without PT to understand if there was any relationship with tendinopathy. Results: No statistically significant difference was observed in age, sex, patella alta, or the Wiberg classification between the QT groups (with vs without) and between the PT groups (with vs without) ( P > .05). Having QT was found to be significantly associated with the PF sulcus angle ( P = .009), and having PT was found to be significantly associated with the femoral Insall angle ( P = .029). Conclusion: Jumper’s knee was found to be associated with anatomic variations of the PF sulcus angle and rotation of the patellar tendon in relation to the femur (femoral Insall angle) on axial MRI scans in professional dancers. Unlike those of other athletes, dancers’ knees are exposed more to external rotation forces because of turnout, and this can be the cause of jumper’s knee.

scholarly journals Leave it or fix it? How fixation of a small posterior malleolar fragment neutralizes rotational forces in trimalleolar fractures

2021 ◽  
Author(s):  
Julia Evers ◽  
Maren Fischer ◽  
Michael Raschke ◽  
Oliver Riesenbeck ◽  
Alexander Milstrey ◽  
...  
Keyword(s):  
Surface Area ◽  
Articular Surface ◽  
Plantar Flexion ◽  
Weight Bearing ◽  
Full Weight Bearing ◽  
Neutral Position ◽  
Screw Osteosynthesis ◽  
Trimalleolar Fractures ◽  
Group I ◽  
Group Ii

Abstract Introduction This study investigated the effects of a small posterior malleolar fragment (PMF), containing less than 25% articular surface area, on ankle joint stability via computed tomography (CT) scanning under full weight bearing in a human cadaveric ankle fracture model. Materials and methods A trimalleolar fracture with a PMF of less than 25% articular surface area was created in 6 pairs of fresh-frozen human cadaveric lower legs. The specimens were randomized into 2 groups stabilized by internal fixation including a positioning screw for syndesmotic reconstruction. In Group I the PMF was addressed by direct screw osteosynthesis, whereas in Group II the fragment was not fixed. Six predefined distances within the ankle were measured under axial loading. CT scans of each specimen were performed in intact and fixated states in neutral position, dorsiflexion and plantar-flexion of the ankle. Results In plantar-flexion, significant differences were detected between the groups with regard to rotational instability. Group II demonstrated a significantly increased inward rotation of the fibula compared with Group I. No significant differences were detected between the groups for each one of the measured distances in any of the three foot positions. Conclusions Additional reduction and fixation of a small PMF seems to neutralize rotational forces in the ankle more effectively than a sole syndesmotic screw. Clinically, this becomes relevant in certain phases of the gait cycle. Direct screw osteosynthesis of a small PMF stabilizes the ankle more effectively than a positioning screw.

1053 Comparing MRI Parameters in Quantifying Patellofemoral Instability

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Nagi ◽  
C Hing
Keyword(s):  
Soft Tissue ◽  
Tilt Angle ◽  
Patellofemoral Joint ◽  
Patellofemoral Instability ◽  
Trochlear Groove ◽  
Magnetic Resonance Imaging Measurement ◽  
Patellar Tilt ◽  
Significant Difference ◽  
Soft Tissue Changes ◽  
Patellar Tilt Angle

Abstract Aim Patellofemoral instability is where various stabilising factors of the patellofemoral joint undergo pathomorphological changes. It has an incidence rate of 5.8 per 100,000 in UK and has been associated with osteoarthritis[1]. Variations in the factors that stabilise the patellofemoral joint can be observed on MRI including measurements of the trochlea in relation to the patella, the femur and soft tissue changes. This study aims to compare different measures used to detect and quantify patellofemoral instability on MRIs and to look for any significant difference in their use both in isolation and together. Method 109 MRI reports of 78 patients diagnosed with patellofemoral instability were reviewed and all quantitative and qualitative parameters reported were inputted in a data table. Quantitative elements known as the Dejour protocol included the trochlear sulcus angle, patellar tilt angle, tibial tuberosity-trochlear groove distance and the Insall-Salvati ratio. Qualitative factors involved facet changes, patellar position, and any damage to soft tissue. Results It was found that the Insall-Salvati ratio greater than 1.2 and the patellar tilt angle of greater than 11 degrees irregular ranges had the greatest incidence in the MRI reports found 77.1% and 87.6% respectively in MRIs that reported them. Conclusions There is a discrepancy between quantitative parameters in their correlation with patellofemoral instability for the MRI reports observed. [1]: Ye Q, Yu T, Wu Y, Ding X, Gong X. Patellar instability: the reliability of magnetic resonance imaging measurement parameters. BMC Musculoskeletal Disorders. 2019;20(1).

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