scholarly journals Characteristics of Osteochondral Fractures Caused by Patellar Dislocation

2021 ◽  
Vol 9 (1) ◽  
pp. 232596712097464
Author(s):  
Mikko Uimonen ◽  
Ville Ponkilainen ◽  
Juha Paloneva ◽  
Ville M. Mattila ◽  
Heikki Nurmi ◽  
...  
Keyword(s):  
Knee Joint ◽  
Patellar Dislocation ◽  
Femoral Condyle ◽  
Case Series ◽  
Recurrent Dislocation ◽  
Lateral Femoral Condyle ◽  
Recurrent Patellar Dislocation ◽  
Significant Difference ◽  
Mri Scans ◽  
Osteochondral Fractures

Background: Literature describing the anatomic characteristics of osteochondral fractures (OCFs) in the knee joint after patellar dislocation is scarce. Purpose: To describe the patterns of OCFs in the knee joint after acute or recurrent patellar dislocation in a sample of patients from 2 orthopaedic trauma centers. Study Design: Case series; Level of evidence, 4. Methods: In this multicenter study, all patients who had International Classification of Diseases, 10th Revision, diagnostic codes S83.0 and M22.0 between 2012 and 2018 were screened. Of the 2181 patients with clinically diagnosed patellar dislocation, 1189 had undergone magnetic resonance imaging (MRI). Patients with diagnosed patellar dislocation and osteochondral fragment verified on MRI scans were included. Demographic and clinical data were collected from electronic patient records. OCF location and size were assessed from MRI scans. Results were further compared in subgroups by sex, skeletal maturity, and primary versus recurrent patellar dislocation. Results: An OCF was detected in 134 patients with injured knees, all of whom were included in the final analysis. It occurred in the patella in 63% of patients, in the lateral femoral condyle in 34%, and in both locations in 3%. The median OCF size was 146 mm2 (interquartile range, 105-262 mm2). There was no statistically significant difference in OCF size between patellar and lateral femoral condyle fractures. Patellar OCFs were more frequent in female than male patients ( P = .009) and were larger after primary than recurrent dislocation ( P = .040). Conclusion: OCFs were mainly located in the medial facet of the patella and in the lateral femoral condyle, with these locations accounting for approximately two-thirds and one-third of all OCFs, respectively. Proportion of patellar OCF was higher in female than in male. Patellar OCFs may be larger after primary than recurrent dislocation.

Influence of posterior lateral femoral condyle geometry on patellar dislocation

2015 ◽  
Vol 135 (11) ◽  
pp. 1503-1509 ◽  
Author(s):  
Dominic Gillespie ◽  
Daniel Mandziak ◽  
Colin Howie
Keyword(s):  
Patellar Dislocation ◽  
Femoral Condyle ◽  
Lateral Femoral Condyle

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.

The 3-in-1 Procedure for Recurrent Dislocation of the Patella in Skeletally Immature Children and Adolescents

2009 ◽  
Vol 37 (9) ◽  
pp. 1814-1820 ◽  
Author(s):  
Francesco Oliva ◽  
Mario Ronga ◽  
Umile Giuseppe Longo ◽  
Vittorino Testa ◽  
Giovanni Capasso ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Patellar Dislocation ◽  
Case Series ◽  
Skeletal Maturation ◽  
Isokinetic Strength ◽  
Skeletally Immature ◽  
Recurrent Patellar Dislocation ◽  
Level Of Evidence ◽  
The Mean

Background Recurrent patellar dislocations are common injuries in children and adolescents. The subjective and functional results of soft tissue surgical management in a population that was skeletally immature at the time of surgery have not been reported. Hypothesis The 3-in-1 procedure is an effective treatment for recurrent patellar dislocation in skeletally immature patients. Study Design Case series; Level of evidence, 4. Methods Twenty-five skeletally immature patients (age at operation, 13.5 ± 3.8 years) who were practicing sports and suffering from recurrent unilateral patellar dislocation were included in the study and followed until skeletal maturation. Clinical evaluation included the modified Cincinnati rating system and the Kujala score, anthropometry, plain radiography, and isokinetic dynamometry. Results The average follow-up was 3.8 years (range, 2.5-6 years). The mean modified Cincinnati score increased from 51.7 ± 12.6 preoperatively to 94.3 ± 10.8 (P < .02), while the mean Kujala scores increased from 52.4 ± 12.7 preoperatively to 93.8 ± 14.2 (P < .02). The Insall-Salvati index remained essentially unchanged, being 1.04 ± 0.2 preoperatively and 1.02 ± 0.3 at latest follow-up. Significant differences were found between the operated and the contralateral limb in the various isokinetic strength variables at all angular velocities measured at the latest follow-up (.05 < P < .0042). Conclusion The 3-in-1 procedure is a safe, reliable management option for recurrent patellar dislocation in skeletally immature patients. Side-to-side differences in isokinetic strength and in anthropometric indices persist despite subjective success of the procedure.

scholarly journals Tratamiento quirúrgico de la luxación recidivante de rótula en el niño asociada a displasia patello-femoral./ Surgical treatment of recurrent patellar dislocation in children associated with patello-femoral dysplasia

2014 ◽  
Vol 14 (1) ◽  
pp. 117-128
Author(s):  
Enrique Vergara- amador ◽  
Ricardo Castro
Keyword(s):  
Down Syndrome ◽  
Patellar Dislocation ◽  
Trochlear Dysplasia ◽  
Recurrent Dislocation ◽  
Recurrent Patellar Dislocation ◽  
Femoral Trochlea ◽  
Small Series ◽  
Q Angle ◽  
Proximal Realignment

Objetivo:El objetivo del presente trabajo es mostrar los resultados en una serie cortade pacientes con inestabilidad patelo-femoral o luxación recurrente de rótula en niñosoperados con la técnica de realineamiento proximal. La inestabilidad patelo-femoralse define como una enfermedad en la cual no hay suficiente acople de la rótula con latróclea femoral durante el rango de movimiento de la rodilla. En niños esta inestabilidadpuede deberse a diversos factores anatómicos conduciendo a luxación recurrente dela rótula. Hay cirugías sobre la parte proximal o distal de la rótula.Materiales y mé-todos:tratamos una serie de 10 rodillas en 7 niños, con un realineamiento proximalde la rótula según la técnica de Insall.Resultados:se obtuvieron buenos resultadosen 8 rodillas, sin dolor, sin luxación ni inestabilidad residual, presentando buenaestabilidad y seguridad durante la marcha. Un paciente presento reluxación y otrocon Síndrome de Down, presento con el tiempo una subluxación.Conclusiones:Elrealineamiento proximal en esta serie muestra buenos resultados en pacientes quetenían poca displasia troclear y sin mucha alteración del ángulo Q. Es una técnicano muy usada, que tiene indicación en casos escogidos. Hoy en día con el conceptode la reconstrucción del ligamento patelo- femoral medial, este puede ser usado encombinación con las técnicas de realineamiento proximal. Hay que estar alerta conlos pacientes con síndromes que se acompañan de hiperlaxitud como el S. de Down. Objective: The aim of this paper is to show the results in a small series of patients withpatellofemoral instability or recurrent patellar dislocation in children operated with theproximal realignment technique. Materials and methods: It is a series of 10 knees in7 children, with proximal patela realignment patela using the Insall technique. The mostimportant role of the patela is to increase the quadriceps efficiency. The patelo -femoralinstability is defined as a condition in which there is insufficient coupling of the patelawith the femoral trochlea during the knee range of motion. In children this instabilitymay be due to various anatomical factors leading to recurrent dislocation of the patela.There are surgeries proximal o distal to the patela level. Results: Good results wereobtained on 8 knees, without pain, neither dislocation nor residual instability and havinggood stability and safety during the gait. One patient showed redislocation and anotherpatient with Down syndrome had a subluxation. Conclusions: proximal realignment inthis series shows good results in patients who had little trochlear dysplasia with mildalteration of the Q angle. It is a technique not widely used but has indicated in selectedcases. Today, the patelo - femoral medial ligament reconstruction, can be used incombination with proximal realignment techniques. Patients with collagen problemslike Marfan and Down syndrome usually have redislocation and require some otherprocedures for patelar stabilization.

scholarly journals Comparison of Weightbearing and Nonweightbearing Juvenile Osteochondritis Dissecans Lesions of the Lateral Femoral Condyle

2021 ◽  
Vol 9 (8) ◽  
pp. 232596712110269
Author(s):  
Liang Zhou ◽  
Shawn M. Gee ◽  
Philip L. Wilson ◽  
Sharon Huang ◽  
K. John Wagner ◽  
...  
Keyword(s):  
Osteochondritis Dissecans ◽  
Femoral Condyle ◽  
International Knee Documentation Committee ◽  
Lateral Femoral Condyle ◽  
Consecutive Series ◽  
Level Of Evidence ◽  
Juvenile Osteochondritis Dissecans ◽  
Patient Reported ◽  
Mri Scans

Background: Repetitive microtrauma may contribute to osteochondritis dissecans (OCD) lesions of the femoral condyle. The effect of differential loading between OCD weightbearing (WB) zones has not been studied. Purpose: To determine whether clinical and radiographic variables differ by WB zone in lateral femoral condyle OCD lesions. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively reviewed a consecutive series of patients aged <18 years with lateral femoral condyle OCD lesions presenting at a single institution between 2004 and 2018. Patients with OCD lesions outside of the lateral femoral condyle were excluded. Lesions were localized on radiographs using the Cahill and Berg classification, referencing the Blumensaat line and an extension of the posterior femoral cortex. Progeny bone characteristics evaluated at baseline and 24-month follow-up included ossification, distinct borders from parent bone, and displacement. Baseline lesion dimensions were measured on magnetic resonance imaging (MRI) scans. We evaluated posttreatment pain level, return-to-activity rate, and patient-reported outcome measures (PROMs) including the Pediatric International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, and Pediatric Functional Activity Brief Scale. Results: A total of 62 lateral femoral condyle OCD lesions (mean follow-up, 24.1 months) presented within the study period: 26 WB lesions and 36 nonweightbearing (NWB) lesions. At presentation, no differences between the lesion types were observed in symptom chronicity or symptomatology. NWB lesions were deeper on MRI scans (sagittal depth, 7.11 vs 5.96 mm; P = .046; coronal depth ratio, 0.05 vs 0.01 mm; P = .003), were more likely to develop progeny bone (69.4% vs 44%; P = .047), and demonstrated higher radiographic healing rates (52.8% vs 24%; P = .025) compared with WB lesions. PROMs at follow-up were available for 25 of 62 patients (40.3%), with no statistically significant differences between cohorts at any time. Return to full activity was observed in 72% of WB and 82.1% of NWB lesions ( P = .378). Conclusion: Lateral femoral condyle OCD lesions of the knee in WB and NWB zones presented similarly at initial evaluation; however, NWB lesions demonstrated higher rates of progeny bone formation and radiographic healing at mean 2-year follow-up.

Anatomical Characteristics and Potential Gene Mutation Sites of a Familial Recurrent Patellar Dislocation

2021 ◽  
Author(s):  
Qi-hao Zhang ◽  
Yan Zhang ◽  
Rui-xuan He ◽  
Xin-guang Wang
Keyword(s):  
Knee Joint ◽  
High Frequency ◽  
Patellar Dislocation ◽  
Family Members ◽  
Patella Dislocation ◽  
Recurrent Patellar Dislocation ◽  
Anatomical Characteristics ◽  
Synonymous Mutations ◽  
Pathogenic Genes ◽  
Pathogenic Gene

Abstract Background Recurrent patellar dislocation is the result of anatomical alignment and imbalance of restraint of bone and soft tissue. To investigate the anatomical characteristics of the knee joint in a family of patients with recurrent patella dislocation, and to screen the possible pathogenic genes in this family by whole exon sequencing in 4 patients and 4 healthy subjects, so as to provide theoretical basis for the pathogenesis of this disease. Methods The data related to patella dislocation were measured by imaging data. The peripheral blood DNA of related family members was extracted for full exon sequencing, and then the sequencing results were compared with the human database. By filtering out synonymous mutations and high-frequency mutations, and then integrating single nucleotide non-synonymous mutations of family members, disease-causing genes were found. Results All patients in this family have different degree of abnormal knee anatomy, which is closely related to patella dislocation. The sequencing results of patients and normal persons in this patella dislocation family were compared and analyzed, and the data were filtered through multiple biological databases. Find HOXB9(NM_024017.4:p.Glu135Gly/c.404A>G),COL1A1(NM_000088.3:p.Ala1256 Thr/c.3766G>A),GNPAT(NM_014236.3:p.Asp519Gly/c1556A>G),NANS(NM_018946.3:p.Glu68Asp/c.204G>C),SLC26A2(NM_000112.3:p.Thr689Ser/c.2065A>T) are not synonymous mutations (MISSENSE). Through Sanger sequencing, HOXB9 and SLC26A2 genes were found to be the pathogenic genes of this family with recurrent patella dislocation. Conclusions The anatomical structure of the knee joint of patients with recurrent patellar dislocation in this family is obviously abnormal. HOXB9 mutation may be the high frequency pathogenic gene of recurrent patella dislocation in this family, while COL1A1, GNPAT, NAans, SLC26A2 gene may be the sporadical pathogenic gene.

scholarly journals Arthroscopical Fixation of Patellar Osteochondral Fracture in a Pediatric Patient

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0020
Author(s):  
Ahmet Güney ◽  
Ali Saltuk Argün ◽  
Murat Kahraman ◽  
İbrahim Karaman ◽  
Ökkeş Bilal
Keyword(s):  
Pediatric Patient ◽  
Male Patient ◽  
Femoral Condyle ◽  
Magnetic Resonance Images ◽  
Chondral Lesion ◽  
Lateral Femoral Condyle ◽  
Osteochondral Fracture ◽  
First Case ◽  
Osteochondral Fragment ◽  
Osteochondral Fractures

Objectives: Aim of this article is to present a pediatric patient with patellar osteochondral fracture treated by arthroscopical fixation and discuss through the literature. Patellar osteochondral fractures are kind of injuries mostly seen in adolescents and young adults, generally occur after trauma causing dislocation of patella and frequently accompanied by chondral damage in the lateral femoral condyle. Surgical intervention is indicated for the displaced and intraarticular fragments. Methods: Thirteen-year-old male patient referred our clinic with a swollen knee, limitation in knee movements, after he had fallen on his right knee while skating 2 weeks previously and was also unable to stand on his right leg. Plain radiogram, computerized tomography and magnetic resonance images of the right knee evaluated in our clinic and a chondral defect (17x10mm in size) in distal of medial marge of patella and an intraarticular osteochondral fragment just inferomedial to patella and anterior to lateral femoral condyle was determined. Results: In the arthroscopical evaluation osteochondral defect and intraarticular fragment were observed. In addition there was chondral lesion on the chondral surface of lateral femoral condyle. Osteochondral fragment was replaced to the distal part of medial marge of patella as arthroscopically, then retrograde fixed using 2 compressive screws (24x2.7 mm and 26x2.7 mm) from patella to the fragment. Conclusion: As patellar osteochondral fractures usually occur following acute dislocation of patella, rarely may occur without dislocation. We could find 2 cases in the literature which aren't accompanied by dislocation of patella. One of them is a non-displaced fracture and the other one is an osteochondral fragment with 15x20 mm in size which was resected due to inconformity. Eighty percent of acute dislocations of patella are accompanied by contusions on lateral femoral condyle and intraarticular fragments are present in 11 to 74 percent of cases. In this article we present 13 year-old male patient with an osteochondral fracture in the inferior of medial marge of patella without dislocation of patella, which was displaced into joint space and accompanied by a chondral lesion on the lateral femoral condyle, and then treated by artroscopical reduction and fixation. Our case seems to be original due to occuring without dislocation of patella and being the first case treated by arthroscopical intervention. Displaced and intraarticular patellar osteochondral fractures should be replaced and fixed by surgically. We consider that when compared with open joint surgery, arthroscopical replacement and fixation of osteochondral fractures causes lower morbidity and helps to improve rehabilitation of the patient.

scholarly journals Increased tibial tubercle-trochlear groove and patellar height indicate a higher risk of recurrent patellar dislocation following medial reefing

2021 ◽  
Author(s):  
Marc-Daniel Ahrend ◽  
Tobias Eisenmann ◽  
Moritz Herbst ◽  
Boyko Gueorguiev ◽  
Gabriel Keller ◽  
...  
Keyword(s):  
Patellar Dislocation ◽  
Recurrent Dislocation ◽  
Patellar Height ◽  
Tibial Tubercle ◽  
Trochlear Groove ◽  
Recurrent Patellar Dislocation ◽  
Patellar Tilt ◽  
Level Of Evidence ◽  
Sulcus Angle ◽  
Patellar Shift

Abstract Purpose Identifying anatomical risk factors on recurrent dislocation after medial reefing is important for deciding surgical treatment. The present study aimed to retrospectively analyze the preoperative magnetic resonance imaging (MRI)-based parameters of patients treated with medial reefing and whether these parameters lead to a higher risk of recurrent dislocation. Methods Fifty-five patients (18.6 ± 6.6 years) who underwent medial reefing after primary traumatic patellar dislocation (84% with medial patellofemoral ligament [MPFL] rupture) were included. Patients were followed up for at least 24 months postoperatively (3.8 ± 1.2 years) to assess the incidence of recurrent patellar dislocation. In patients without recurrent dislocation, the Kujala and subjective IKDC scores were assessed. Moreover, the tibial tubercle-trochlear groove (TT-TG), sulcus angle, patellar tilt, patellar shift, and lateral trochlea index (LTI) were measured. The patellar height was measured using the Caton-Dechamps (CDI), Blackburne-Peel (BPI), and Insall-Salvati index (ISI). The cohort was subclassified into two groups with and without recurrent dislocation. Differences between groups were analyzed with respect to the MRI parameters. Results Forty percent had a pathological sulcus angle of > 145°, 7.2% had an LTI of < 11°, 47.3% had a patellar tilt of > 20°, and 36.4% had a TT-TG of ≥ 16 mm. Increased patellar height was observed in 34.5, 65.5, and 34.5% of the patients as per CDI, BPI, and ISI, respectively. Nineteen (34.5%) patients suffered from recurrent dislocation. Compared with patients without recurrent dislocation, those with recurrent dislocation had a significantly lower LTI (p = 0.0467). All other parameters were not significantly different between the groups. Risk factor analysis showed higher odds ratios (OR > 2), although not statistically significant, for MPFL rupture (OR 2.05 [95% confidence interval 0.38–11.03], LTI (6.6 [0.6–68.1]), TT-TG (2.9 [0.9–9.2]), and patellar height according to ISI (2.3 [0.7–7.5]) and CDI (2.3 [0.7–7.5])). Patients without recurrent dislocation had a Kujala score of 93.7 ± 12.1 (42–100) points and an IKDC score of 90.6 ± 11.7 (55.2–100) points. Conclusion Anatomical, MRI-based parameters should be considered before indicating medial reefing. A ruptured MPFL, an LTI < 11°, a TT-TG ≥ 16 mm, a patellar tilt > 20 mm, and an increased patellar height according to ISI and CDI were found to be associated, although not significantly, with a higher risk (OR > 2) of recurrent patellar dislocation after medial reefing. Thorough preoperative analysis is crucial to reduce the risk of recurrent dislocation in young patient cohorts. Level of evidence Level IV

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