Investigation for Lesional Onset Site and Patellofemoral Joint Anatomy in Juvenile Femoral Trochlear Osteochondritis Dissecans : A Case Control Study

2021 ◽  
Author(s):  
Mitsuhiro Kimura ◽  
Junsuke Nakase ◽  
Yoshinori Ohashi ◽  
Kazuki Asai ◽  
Rikuto Yoshimizu ◽  
...  
Keyword(s):  
Osteochondritis Dissecans ◽  
Patellofemoral Joint ◽  
Femoral Condyle ◽  
Lateral View ◽  
Tibial Tubercle ◽  
Trochlear Groove ◽  
Return To Sports ◽  
Patellar Tilt ◽  
The Mean

Abstract Background: Femoral trochlear osteochondritis dissecans is an uncommon disease, and its cause remains unknown. We investigated the site of osteochondritis dissecans lesions and the patellofemoral joint anatomy of femoral trochlear osteochondritis dissecans in 15 knees, and assessed the clinical outcomes of the surgical treatments. Methods: We conducted a retrospective study of 15 knees in 14 patients who underwent surgery. The mean age was 13.2 ± 1.0 years at the time of surgery. All patients played athletic sports and experienced no traumatic events. We determined the site of osteochondritis dissecans lesions using the modified Cahill and Berg classification on magnetic resonance imaging scans. We also evaluated the patellofemoral structures with sulcus angle, facet ratio, patellar tilt, patellar height, and tibial tubercle-trochlear groove distance. Results: We performed osteochondral autograft transplantation surgery in nine knees, internal fixation in four knees, and drilling in two knees. The mean follow-up period was 34.5 ± 14.0 months, and the period of return to sports was 6.1 ± 1 months. At the final follow-up, the mean Tegner activity scale was 7.2 ± 1.4 (preoperative score was 7.7 ± 1.0), and the Lysholm knee score was 98.5 (range, 89-100). The area of most preponderance was in the medial portion of the lateral femoral condyle in the frontal view, and in the segment superior two-thirds of the anterior region in the lateral view. There were no anatomical abnormalities in the patellofemoral structures. Conclusions: Femoral trochlear osteochondritis dissecans lesions occurred in virtually identical sites, and there were no anatomical abnormalities. This disease seemed to be related to the repetitive and persistent loading from the patella at slight knee flexion. In almost all cases, satisfactory postoperative results were obtained for osteochondritis dissecans regardless of the stage or surgical method.

scholarly journals Good Operative Effects of Patellofemoral Arthroplasty Combined With the Tibial Tubercle Transfer for Isolated Patellofemoral Arthritis Patients With an Increased Tibial Tuberosity-Trochlear Groove Distance

2021 ◽  
Author(s):  
Conglei Dong ◽  
Chao Zhao ◽  
Ming Li ◽  
Huijun Kang ◽  
Kang Piao ◽  
...  
Keyword(s):  
Patellofemoral Joint ◽  
Tibial Tuberosity ◽  
Tibial Tubercle ◽  
Trochlear Groove ◽  
Patellofemoral Arthritis ◽  
Patellofemoral Arthroplasty ◽  
Group I ◽  
Tibial Tubercle Transfer ◽  
Group Ii

Abstract BackgroundThe objective of present study was to investigate the operative effect of patellofemoral arthroplasty combined with the tibial tubercle transfer for isolated patellofemoral arthritis patients with an increased tibial tuberosity-trochlear groove distance (>20mm). MethodsA prospective study was performed between November 2012 and December 2017. Finally, thirty-six cases, with a mean age of 61.1 ± 7.3 years, were admitted to our study. A total of 17 patients underwent patellofemoral arthroplasty combined with tibial tubercle transfer, and 19 patients underwent patellofemoral arthroplasty only. All eligible patients had CT scans preoperatively and at 12 months follow-up, to assess the stability of the patellofemoral joint on axial slices. In addition, the demographic and clinical features of all the patients were asked. Knee balance was assessed with the single leg stance test and timed get up and go, and functionality was evaluated with stair climbing test and the Western Ontario and McMaster Universities Osteoarthritis Index score. (P>0.05) ResultsPreoperatively, the data regarding the knee balance and functionality were not significantly different between the two Groups (P>0.05). Many measurements showed significant differences between the two groups at the last follow-up. Significant differences were seen in well-known measurements such as the SLST (Group I, 28.9 s (SD 7.5); Group II, 20.3 s (SD 5.9); p < 0.001), TGUG (Group I, 13.4 s (SD 3.2); Group II, 16.8 s (SD 3.1); p < 0.001), and SCT (Group I, 18.6 s (SD 6.8); Group II, 24.5 s (SD 8.7); p < 0.001). Additionally, the median WOMAC score was improved from 62.7 (SD 11.2) preoperatively to 25.7 (SD 8.2) one year postoperatively in Group I and from 64.1 (SD 10.7) to 36.2 (SD 9.7) in Group II, which were also significantly different between the groups. ConclusionsFor such special IPA patients with an increased TT-TG (>20mm), the combined operation of PFA combined with TTT can better restore the involutional relationship of patellofemoral joint and further improve the balance and function of knee joint.

scholarly journals Retroarticular Drilling with Supplemental Bone Marrow Aspirate Concentrate for the Treatment of Osteochondritis Dissecans of the Knee

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0013 ◽  
Author(s):  
Kelsey Davidson ◽  
Nathan L. Grimm ◽  
Melissa A. Christino ◽  
S. Clifton Willimon ◽  
Michael T. Busch
Keyword(s):  
Bone Marrow ◽  
Osteochondritis Dissecans ◽  
Bone Marrow Aspirate ◽  
Femoral Condyle ◽  
Lesion Size ◽  
Autogenous Bone ◽  
Bone Marrow Aspirate Concentrate ◽  
The Mean ◽  
Back Filling

Objectives: Osteochondritis dissecans (OCD) is an idiopathic alteration of the subchondral bone which may lead to early osteoarthritis. This condition is commonly seen in the knee and is more common in young, athletic individuals. Several techniques have been developed to address the variable presentation of OCD in the knee, each with varying results. To our knowledge the use of autogenous bone marrow supplementation to an OCD lesion has not been described. The purpose of this study was to determine the radiographic healing of OCD lesions of the knee in a cohort of young, active patients who underwent retroarticular drilling of an OCD lesion with supplemental back-filling with bone marrow aspirate concentrate as an adjuvant to facilitate healing. Methods: We evaluated adolescent patients who were diagnosed with OCD of the knee who had previously failed non-operative, conservative treatment. All subjects underwent retroarticular drilling of the knee with supplemental back-filling of the lesion with bone marrow aspirate concentrate (BMAC®), harvested from the ilium, by two Orthopaedic Surgeons from a single institution. Based off previously published definitions, lesions were assigned as small if < 320 mm2 or large >320 mm2. All lesions were then followed radiographically for evidence of healing. Healing was graded based off the ROCK (Research in OsteoChondritis of the Knee) group radiographic healing criteria, which has shown excellent reliability. The healing was rated by two independent reviewers and when disagreements were noted a third reviewer was brought in to facilitate group consensus on healing. Results: 52 lesions in 49 patients were included in the study. 26 right knees, 26 left knees with 41 lesions located on the medial femoral condyle and 11 lesions located on the lateral femoral condyle. The mean age of the subjects was 12.5 (10 - 17) years old. 30 subjects were male, 19 were female. All lesions were categorized as immobile lesions based off the ROCK Arthroscopy Classification. The average OCD lesion size was 407 mm2 (132 - 899 mm2), respectively. The mean amount of BMAC® used per OCD lesion was 60 mL (45 - 120 mL). 40 lesions (76.9%) were rated as healed at a mean of 10.6 (2 - 32) months. 10 lesions (18.9%) were rated as 25-75% healed and 3.8% were rated at 0 - 25% healed at latest follow-up. 76.5% of large lesions were rated as healed at final follow-up. Whereas 77.8% of small lesions were rated as healed at final follow-up. There were three complications (1 rash from skin glue, 1 suture abscess, and 1 contact dermatitis from surgical cleansing prep) however no complications were noted from the surgical intervention or BMAC®. Conclusion: Overall healing rates with surgical treatment of OCD lesions that have failed non-operative interventions are variable. For immobile lesions, mainstay treatment options include retroarticular and transarticular drilling. Based off previous definitions of lesion size, the mean lesion size in our cohort would be categorized as “large” with 65% of our lesions falling into this category. Previously published series have shown that large lesions are significantly less likely to heal. Despite this we showed a 76.5% healing rate for large lesions. Overall, the adjuvant supplementation of BMAC® as back-fill for retrograde drilling of large OCD lesions of the knee has shown excellent results with no serious complications associated with its use. Future randomized trials are necessary to evaluate the comparative effectiveness of this treatment method.

Comparison of Clinical and Radiographic Outcomes Between Central and Lateral Lesions After Osteochondral Autograft Transplantation for Osteochondritis Dissecans of the Humeral Capitellum

2017 ◽  
Vol 45 (14) ◽  
pp. 3331-3339 ◽  
Author(s):  
Takeshi Matsuura ◽  
Yusuke Hashimoto ◽  
Kazuya Nishino ◽  
Yohei Nishida ◽  
Shinji Takahashi ◽  
...  
Keyword(s):  
Osteochondritis Dissecans ◽  
Rate Of Return ◽  
Return To Sports ◽  
Central Group ◽  
Osteochondral Autograft ◽  
Radiographic Outcomes ◽  
Lateral Group ◽  
The Mean ◽  
Central Lesions

Background: Clinical studies have reported satisfactory results after osteochondral autograft transplantation (OAT) for central lesions of unstable osteochondritis dissecans (OCD) of the elbow. However, the outcomes after OAT for lateral lesions remain unclear. Hypothesis: The clinical outcomes of OAT would be better for central lesions than for lateral lesions. Study Design: Cohort study; Level of evidence, 3. Methods: The authors retrospectively evaluated 103 juvenile athletes (mean age, 13.2 years; range, 11-16 years) who underwent OAT for symptomatic OCD of the humeral capitellum from 2003 to 2014. Sixteen patients were excluded because they did not fit the inclusion criteria. The final cohort of 87 patients was divided by lesion type into central lesion (n = 43) and lateral lesion (n = 44) groups. When possible, a single large plug was created for grafting and trimmed to reconstruct the rounded joint surface. The clinical, radiographic, and magnetic resonance imaging outcomes were evaluated for each group at a mean follow-up of 43 months (range, 24-100 months). Results: There were no significant differences in the age, sex, height, weight, duration of symptoms, follow-up time, preoperative range of motion, or Timmerman and Andrews score between the 2 groups. The preoperative osteoarthritic changes (0 of 43 for central vs 5 of 44 cases for lateral; P = .023), mean lesion size (12.2 ± 2.9 vs 18.2 ± 7.0 mm; P < .001), and graft number (1.6 vs 2.8; P < .001) were significantly greater in the lateral group versus the central group. The mean range of extension (2.3° ± 5.4° vs −3.2° ± 8.7°; P < .001) and Timmerman and Andrews score (194 vs 185; P = .006) at the final follow-up were significantly better for patients in the central group. More patients in the lateral group had postoperative radial head subluxation (0 of 43 vs 6 of 44; P = .012) and osteoarthritic changes (1 of 43 vs 9 of 44; P = .008). The mean MOCART score showed no significant differences between the groups (78.0 ± 15.7 vs 72.6 ± 20.9; P = .181). The rate of return to sports at the previous level was 100% in the central group and 86% in the lateral group ( P = .012). Conclusion: The clinical and radiographic outcomes after OAT associated with unstable OCD of the humeral capitellum were better for central lesions than for lateral lesions. However, satisfactory outcomes and a high rate of return to sports were obtained for unstable lateral lesions after OAT.

Clinical Outcome After Arthroscopic Debridement and Microfracture for Osteochondritis Dissecans of the Capitellum

2017 ◽  
Vol 45 (10) ◽  
pp. 2312-2318 ◽  
Author(s):  
Rens Bexkens ◽  
Kim I.M. van den Ende ◽  
Paul T. Ogink ◽  
Christiaan J.A. van Bergen ◽  
Michel P.J. van den Bekerom ◽  
...  
Keyword(s):  
Osteochondritis Dissecans ◽  
Linear Regression Analysis ◽  
Case Series ◽  
Loose Body ◽  
Return To Sports ◽  
Arthroscopic Debridement ◽  
Duration Of Symptoms ◽  
Point Increase ◽  
The Mean

Background: Various surgical treatment techniques have been developed to treat capitellar osteochondritis dissecans; however, the optimal technique remains the subject of ongoing debate. Purpose: To evaluate clinical outcomes after arthroscopic debridement and microfracture for advanced capitellar osteochondritis dissecans. Study Design: Case series; Level of evidence, 4. Methods: Between 2008 and 2015, the authors followed 77 consecutive patients (81 elbows) who underwent arthroscopic debridement and microfracture, and loose body removal if needed, for advanced capitellar osteochondritis dissecans. Seventy-one patients (75 elbows) with a minimum follow-up of 1 year were included. The mean age was 16 years (SD, ±3.3 years; range, 11-26 years) and the mean follow-up length was 3.5 years (SD, ±1.9 years; range, 1-8.2 years). Based on CT and/or MRI results, 71 lesions were classified as unstable and 4 as stable. Clinical elbow outcome (pain, function, and social-psychological effect) was assessed using the Oxford Elbow Score (OES) at final follow-up (OES range, 0-48). Range of motion and return to sports were recorded. Multivariable linear regression analysis was performed to determine predictors of postoperative OES. Results: Intraoperatively, there were 3 grade 1 lesions, 2 grade 2 lesions, 10 grade 3 lesions, 1 grade 4 lesion, and 59 grade 5 lesions. The mean postoperative OES was 40.8 (SD, ±8.0). An open capitellar physis was a predictor of better elbow outcome (5.8-point increase; P = .025), as well as loose body removal/grade 4-5 lesions (6.9-point increase; P = .0020) and shorter duration of preoperative symptoms (1.4-point increase per year; P = .029). Flexion slightly improved from 134° to 139° ( P < .001); extension deficit slightly improved from 8° to 3° ( P < .001). Pronation ( P = .47) and supination did not improve ( P = .065). Thirty-seven patients (55%) returned to their primary sport at the same level, and 5 patients (7%) returned to a lower level. Seventeen patients (25%) did not return to sport due to elbow-related symptoms, and 10 patients (13%) did not return due to non–elbow-related reasons. No complications were recorded. Conclusion: Arthroscopic debridement and microfracture for advanced capitellar osteochondritis dissecans provide good clinical results, especially in patients with open growth plate, loose body removal, and shorter duration of symptoms. However, only 62% of patients in this study returned to sports.

Clinical Outcomes and Predictive Factors for Failure With Isolated MPFL Reconstruction for Recurrent Patellar Instability: A Series of 211 Reconstructions With a Minimum Follow-up of 3 Years

2019 ◽  
Vol 47 (6) ◽  
pp. 1323-1330 ◽  
Author(s):  
Elliot Sappey-Marinier ◽  
Bertrand Sonnery-Cottet ◽  
Padhraig O’Loughlin ◽  
Herve Ouanezar ◽  
Levi Reina Fernandes ◽  
...  
Keyword(s):  
Patellar Instability ◽  
Trochlear Dysplasia ◽  
Patella Alta ◽  
Mpfl Reconstruction ◽  
Tibial Tubercle ◽  
Trochlear Groove ◽  
Kujala Score ◽  
The Mean ◽  
Recurrent Patellar Instability

Background: Reconstruction of the medial patellofemoral ligament (MPFL) is widely acknowledged as an integral part of the current therapeutic armamentarium for recurrent patellar instability. The procedure is often performed with concomitant bony procedures, such as distalization of the tibial tuberosity or trochleoplasty in the case of patella alta or high-grade trochlear dysplasia, respectively. At the present time, few studies have evaluated the clinical effectiveness of MPFL reconstruction as an isolated intervention. Purpose: To report the clinical outcomes of isolated MPFL reconstruction in cases of patellar instability and to identify predictive factors for failure. Study Design: Case series; Level of evidence, 4. Methods: A retrospective analysis of prospectively collected data was performed, including all patients who had undergone isolated MPFL reconstruction between January 2008 and January 2014. Preoperative assessment included the Kujala score, assessment of patellar tracking (“J-sign”), and radiographic features, such as trochlear dysplasia according to Dejour classification, patellar height with the Caton-Deschamps index (CDI), tibial tubercle–trochlear groove distance, and patellar tilt. The Kujala score was assessed postoperatively. Failure was defined by a postoperative patellar dislocation or surgical revision for recurrent patellar instability. Results: A total of 239 MPFL reconstructions were included; 28 patients (11.7%) were uncontactable and considered lost to follow-up. Thus, 211 reconstructions were analyzed with a mean follow-up of 5.8 years (range, 3-9.3 years). The mean age at surgery was 20.6 years (range, 12-48 years), and 55% of patients were male. Twenty-seven percent of patients had a preoperative positive J-sign, and 93% of patients had trochlear dysplasia (A, 47%; B, 25%; C, 15%; D, 6%). The mean CDI was 1.2 (range, 1.0-1.7); mean tibial tubercle–trochlear groove distance, 15 mm (range, 5-30 mm); and mean patellar tilt, 23° (range, 9°-47°). The mean Kujala score improved from 56.1 preoperatively to 88.8 ( P < .001). Ten failures were reported that required surgical revision for recurrent patellar instability (4.7%). Uni- and multivariate analyses highlighted 2 preoperative risk factors for failure: patella alta (CDI ≥1.3; odds ratio, 4.9; P = .02) and preoperative positive J-sign (odds ratio, 3.9; P = .04). Conclusion: In cases of recurrent patellar instability, isolated MPFL reconstruction would appear to be a safe and efficient surgical procedure with a low failure rate. Preoperative failure risk factors identified in this study were patella alta with a CDI ≥1.3 and a preoperative positive J-sign.

scholarly journals Good Operative Effects of Patellofemoral Arthroplasty Combined With the Tibial Tubercle Transfer for Isolated Patellofemoral Arthritis Patients With an Increased Tibial Tuberosity-trochlear Groove Distance

2021 ◽  
Author(s):  
Conglei Dong ◽  
Chao Zhao ◽  
Ming Li ◽  
Huijun Kang ◽  
Kang Piao ◽  
...  
Keyword(s):  
Patellofemoral Joint ◽  
Tibial Tuberosity ◽  
Tibial Tubercle ◽  
Trochlear Groove ◽  
Patellofemoral Arthritis ◽  
Patellofemoral Arthroplasty ◽  
Group I ◽  
Tibial Tubercle Transfer ◽  
Group Ii

Abstract Purpose: The objective of present study was to investigate the operative effect of patellofemoral arthroplasty combined with the tibial tubercle transfer for isolated patellofemoral arthritis patients with an increased tibial tuberosity-trochlear groove distance (>20mm).Methods: A prospective study was performed between November 2012 and December 2017. Finally, thirty-six cases, with a mean age of 61.1 ± 7.3 years, were admitted to our study. A total of 17 patients underwent patellofemoral arthroplasty combined with tibial tubercle transfer, and 19 patients underwent patellofemoral arthroplasty only. All eligible patients had CT scans preoperatively and at 12 months follow-up, to assess the stability of the patellofemoral joint on axial slices. In addition, the demographic and clinical features of all the patients were asked. Knee balance was assessed with the single leg stance test and timed get up and go, and functionality was evaluated with stair climbing test and the Western Ontario and McMaster Universities Osteoarthritis Index score. (P>0.05)Results: Preoperatively, the data regarding the knee balance and functionality were not significantly different between the two Groups (P>0.05). Many measurements showed significant differences between the two groups at the last follow-up. Significant differences were seen in well-known measurements such as the SLST (Group I, 28.9 s (SD 7.5); Group II, 20.3 s (SD 5.9); p < 0.001), TGUG (Group I, 13.4 s (SD 3.2); Group II, 16.8 s (SD 3.1); p < 0.001), and SCT (Group I, 18.6 s (SD 6.8); Group II, 24.5 s (SD 8.7); p < 0.001). Additionally, the median WOMAC score was improved from 62.7 (SD 11.2) preoperatively to 25.7 (SD 8.2) one year postoperatively in Group I and from 64.1 (SD 10.7) to 36.2 (SD 9.7) in Group II, which were also significantly different between the groups.Conclusion: For such special IPA patients with an increased TT-TG (>20mm), the combined operation of PFA combined with TTT can better restore the involutional relationship of patellofemoral joint and further improve the balance and function of knee joint.

Fresh Osteochondral Allografting in the Treatment of Osteochondritis Dissecans of the Femoral Condyle

2007 ◽  
Vol 35 (6) ◽  
pp. 907-914 ◽  
Author(s):  
Bryan C. Emmerson ◽  
Simon Görtz ◽  
Amir A. Jamali ◽  
Christine Chung ◽  
David Amiel ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Osteochondritis Dissecans ◽  
Femoral Condyle ◽  
Osteochondral Allograft ◽  
Patient Questionnaire ◽  
Comprehensive Treatment ◽  
Allograft Transplantation ◽  
Fresh Osteochondral Allograft ◽  
The Mean

Background The treatment of osteochondritis dissecans in the adult knee can be challenging. As part of our comprehensive treatment program, fresh osteochondral allografts have been used in the surgical management of osteochondritis dissecans of the femoral condyle. Hypothesis Fresh osteochondral allograft transplantation will provide a successful surgical treatment for osteochondritis dissecans of the femoral condyle. Study Design Case series; Level of evidence, 4. Methods Sixty-six knees in 64 patients underwent fresh osteochondral allografting for the treatment of osteochondritis dissecans. Each patient was evaluated both preoperatively and postoperatively using an 18-point modified D'Aubigné and Postel scale. Subjective assessment was performed using a patient questionnaire. Radiographs were evaluated preoperatively and postoperatively. Results Mean follow-up was 7.7 years (range, 2-22 years). There were 45 men and 19 women with a mean age of 28.6 years (range, 15-54 years). All patients had undergone previous surgery. Forty-one lesions involved the medial femoral condyle, and 25 involved the lateral femoral condyle. All were osteochondritis dissecans type 3 or 4. The mean allograft size was 7.5 cm2. One knee was lost to follow-up. Of the remaining 65 knees, 47 (72%) were rated good/excellent, 7 (11%) were rated fair, and 1 (2%) was rated poor. Ten patients (15%) underwent reoperation. The mean clinical score improved from 13.0 preoperatively to 16.4 postoperatively (P < .01). Fifty-nine of 64 patients completed questionnaires. Subjective knee function improved from a mean of 3.4 to 8.4 on a 10-point scale (P < .01). Conclusion With greater than 70% good or excellent results, fresh osteochondral allograft transplantation is a successful surgical treatment for osteochondritis dissecans of the femoral condyle.

scholarly journals FRI0418 SELECTIVE PATELLAR RESURFACING IN TOTAL KNEE ARTHROPLASTY FOR THE OSTEOARTHRITIC KNEE: A PROSPECTIVE STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 807.3-807
Author(s):  
I. Moriyama
Keyword(s):  
Total Knee Arthroplasty ◽  
Clinical Outcome ◽  
Knee Arthroplasty ◽  
Patellofemoral Joint ◽  
Osteoarthritis Of The Knee ◽  
Patellar Resurfacing ◽  
Criterion A ◽  
Total Knee ◽  
The Mean

Background:No widely accepted view or criteria currently exist concerning whether or not patellar replacement (resurfacing) should accompany total knee arthroplasty for osteoarthritis of the knee.1)2)3)Objectives:We recently devised our own criteria for application of patellar replacement and performed selective patellar replacement in accordance with this set of criteria. The clinical outcome was analyzed.Methods:The study involved 1150 knees on which total knee arthroplasty was performed between 2005 and 2019 because of osteoarthritis of the knee. The mean age at operation was 73, and the mean postoperative follow-up period was 91 months. Our criteria for application of patellar replacement are given below. Criterion A pertains to evaluation of preoperative clinical symptoms related to the patellofemoral joint: (a) interview regarding presence/absence of pain around the patella, (b) cracking or pain heard or felt when standing up from a low chair, (c) pain when going upstairs/downstairs. Because it is difficult for individual patients to identify the origin of pain (patellofemoral joint or femorotibial joint), the examiner advised each patient about the location of the patellofemoral joint when checking for these symptoms. Criterion B pertains to intense narrowing or disappearance of the patellofemoral joint space on preoperative X-ray of the knee. Criterion C pertains to the intraoperatively assessed extent of patellar cartilage degeneration corresponding to class 4 of the Outerbridge classification. Patellar replacement was applied to cases satisfying at least one of these sets of criteria (A-a,-b,-c, B and C). Postoperatively, pain of the patellofemoral joint was evaluated again at the time of the last observation, using Criterion A-a,-b,-c.Results:Patellar replacement was applied to 110 knees in accordance with the criteria mentioned above. There were 82 knees satisfying at least one of the Criterion sets A-a,-b,-c, 39 knees satisfying Criterion B and 70 knees satisfying Criterion C. (Some knees satisfied 2 or 3 of Criteria A, B and C).When the pain originating from patellofemoral joint (Criterion A) was clinically assessed at the time of last observation, pain was not seen in any knee of the replacement group and the non-replacement group.Conclusion:Whether or not patellar replacement is needed should be determined on the basis of the symptoms or findings related to the patellofemoral joint, and we see no necessity of patellar replacement in cases free of such symptoms/findings. When surgery was performed in accordance with the criteria on patellar replacement as devised by us, the clinical outcome of the operated patellofemoral joint was favorable, although the follow-up period was not long. Although further follow-up is needed, the results obtained indicate that selective patellar replacement yields favorable outcome if applied to cases judged indicated with appropriate criteria.References:[1]The Effect of Surgeon Preference for Selective Patellar Resurfacing on Revision Risk in Total Knee Replacement: An Instrumental Variable Analysis of 136,116 Procedures from the Australian Orthopaedic Association National Joint Replacement Registry.Vertullo CJ, Graves SE, Cuthbert AR, Lewis PL J Bone Joint Surg Am. 2019 Jul 17;101(14):1261-1270[2]Resurfaced versus Non-Resurfaced Patella in Total Knee Arthroplasty.Allen W1, Eichinger J, Friedman R. Indian J Orthop. 2018 Jul-Aug;52(4):393-398.[3]Is Selectively Not Resurfacing the Patella an Acceptable Practice in Primary Total Knee Arthroplasty?Maradit-Kremers H, Haque OJ, Kremers WK, Berry DJ, Lewallen DG, Trousdale RT, Sierra RJ. J Arthroplasty. 2017 Apr;32(4):1143-1147.Disclosure of Interests:None declared

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.

scholarly journals SPONTANEOUS CORRECTION OF EXTERNAL TIBIOFEMORAL ROTATION AND TIBIAL TUBEROSITY-TROCHLEAR GROOVE DISTANCE OCCURS AFTER MEDIAL PATELLOFEMORAL LIGAMENT RECONSTRUCTION IN FIXED OR OBLIGATORY DISLOCATORS

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0013
Author(s):  
Alexandra H. Aitchison ◽  
Kenneth M. Lin ◽  
Daniel W. Green
Keyword(s):  
Patellar Instability ◽  
Ligament Reconstruction ◽  
Medial Patellofemoral Ligament ◽  
Extensor Mechanism ◽  
Tibial Tubercle ◽  
Trochlear Groove ◽  
Medial Patellofemoral Ligament Reconstruction ◽  
Force Vector ◽  
Tibiofemoral Rotation ◽  
The Mean

Background: Tibial tubercle to trochlear groove distance (TT-TG) and external tibiofemoral rotation (TFR) through the knee joint have been identified potential contributing factors to patellar instability. In patients with a fixed or obligatory lateral patella dislocation (FOD), the normal force vector of the extensor mechanism is altered, so instead of a direct axial pull to cause extension, it exerts a lateralizing and external rotatory force on the tibia via the tibial tubercle. Hypothesis/Purpose: The purpose of this study is to investigate postoperative changes in TT-TG and TFR after medial patellofemoral ligament reconstruction (MPFLR) in two clinical cohorts: standard traumatic patellar instability (SPI) patients and FOD patients. We hypothesized that by surgically relocating the patella in the trochlea, and re-establishing medial sided soft tissue tension, the increased medializing force vector on the patella may exert enough force to alter resting rotation of the tibia in relation to the femur in the FOD group. Methods: A retrospective study was performed from April 2009 to February 2019. FOD and SPI patients under 18 years with available magnetic resonance imaging (MRI) of the knee before and after MPFLR were eligible. All FOD patients in the time frame were analyzed and SPI patients were randomly selected. Exclusion criteria were outside institution MRI, concomitant alignment procedures done at the time of MPFLR, and prior MPFLR or tibial tubercle osteotomy. TT-TG and TFR (using the posterior femoral and tibial condylar lines) were measured blindly on initial axial MRI. Statistical analysis using a paired sample t-test was performed with significance set at p<0.05. Results: A total of 30 patients were included, 14 in the FOD group and 16 in the SPI group. The mean age at time of surgery was 13.9 years (range 10-17 years), 53% of the cohort was female, and the mean time from surgery to follow-up MRI was 2.0 years. Demographics by group are shown in Table 1. TT-TG and TFR were not significantly different preoperatively versus postoperatively in the SPI group (Table 2). In the FOD group, both TT-TG (17.7 vs 13.7, P=.019) and TFR (8.6 vs 3.1, P=.025) decreased significantly on postoperative MRI. Conclusion: The postoperative decrease in TT-TG and TFR in the FOD group suggests that MPFLR in fixed or obligatory dislocators can improve the external rotation deformity through the level of the joint, and thus may help normalize the forces acting through the extensor mechanism. Tables/ Figures [Table: see text][Table: see text]

Sign in / Sign up

Export Citation Format

Share Document