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Surgery of the Knee
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Alexander D Liddle, Lee A David, Timothy WR Briggs
It is almost always necessary to perform some degree of lateral parapatellar release to allow eversion of the patella. It is usually beneficial to perform the lateral release early on. The release should be performed from deep to superficial and from distal to proximal, alongside the lateral border of the patellar tendon and lateral retinaculum. To reduce subsequent blood loss, it can be performed using diathermy. Full-thickness lateral release should be avoided if possible, but if this is necessary to gain exposure the superior lateral geniculate artery should be left intact and the lateral parapatellar retinaculum should be closed later.
Patellar fractures
Published in Charles M Court-Brown, Margaret M McQueen, Marc F Swiontkowski, David Ring, Susan M Friedman, Andrew D Duckworth, Musculoskeletal Trauma in the Elderly, 2016
The patient should be evaluated with a complete history and physical examination. A history of direct trauma to the knee or eccentric load and subsequent knee pain should alert the clinician to a possible extensor mechanism injury. A large hemarthrosis may be present depending on the injury to the retinaculum. Removal of the hemarthrosis and injection of local anesthetic can help facilitate further physical examination testing, although the literature to support this is limited. Patients can often retain a portion of their active extension in the setting of a patella fracture if the medial and/or lateral retinaculum is intact. In this setting, an extension lag is often seen. With a patellar fracture and complete rupture of the retinaculum, the patient will have no ability to actively extend the knee and perform a straight leg raise.
Recurrent and habitual dislocation of the patella
Published in Benjamin Joseph, Selvadurai Nayagam, Randall Loder, Ian Torode, Paediatric Orthopaedics, 2016
If the problem appears to be simple subluxation rather than complete dislocation, then a rehabilitation programme designed to strengthen the vastus medialis and improve lateral retinacular flexibility should be prescribed.1,5 Passive mobilisation exercises of the lateral retinaculum along with progressive resistance short arc quadriceps exercises are initially prescribed, typically for eight weeks.
A novel clinical test for assessing patellar cartilage changes and its correlation with magnetic resonance imaging and arthroscopy
Published in Physiotherapy Theory and Practice, 2019
Paul Khoo, Abhijeet Ghoshal, Damien Byrne, Ramesh Subramaniam, Raymond Moran
Chondromalacia patellae (CMP) is a common cause of anterior knee pain (Cook, Mabry, Reiman, and Hegedus, 2012). However, the etiology of the disorder still remains unclear (Earl and Vetter, 2007). Suggested causes have included: dynamic alignment disorders (Earl and Vetter, 2007), malalignment of the lower extremity, muscular imbalance, cartilage disruption (Fulkerson, 2002), lateral retinaculum tightness, increased Q angle, overuse (Loudon et al., 2002), and abnormal hip mechanics (Powers, 2010). Patients presenting with patellofemoral pain may have normal cartilage findings at the time of arthroscopy (Leslie and Bentley, 1978). Conversely, patellar cartilage changes may be observed in patients without any patellofemoral symptoms (Royle, Noble, Davies, and Kay, 1991). Studies have also shown that there is no correlation between the severity of CMP and the severity of anterior knee pain (Pihlajamaki et al., 2010). Consequently, there is still much controversy surrounding assessment of the signs and symptoms of this condition.
Particulated juvenile articular cartilage allograft transplantation for osteochondral lesions of the knee and ankle
Published in Expert Review of Medical Devices, 2020
Colleen M. Wixted, Travis J. Dekker, Samuel B. Adams
Although an all-arthroscopic approach has been described in the talus, an open technique is preferred for lesions in the knee. A diagnostic arthroscopy is performed first to look for pathology or certain lesion characteristics that may preclude the use of PJCAT. A lateral parapatellar arthrotomy is then used for lesions of the patella, trochlea, and lateral femoral condyle. A vastus-sparing medial parapatellar arthrotomy is used for defects of the medial femoral condyle [57,60]. If a tibial tubercle osteotomy or meniscal allograft transplantation is part of the surgical plan, a single midline longitudinal incision can be used with full-thickness skin flaps elevated if necessary to expose the medial or lateral retinaculum.
Ersatz ultrasonographic measurements for the knee joint
Published in The Physician and Sportsmedicine, 2019
Vincenzo Ricci, Lèvent Ozçakar
For the same reason, the medial and lateral sagittal views performed during the US examination might be misleading as well. In other words, the vastus medialis obliquus muscle (on the medial side) and the lateral retinaculum (on the lateral side) apply a ‘squeeze effect’ on the supra-patellar recess with an eventual displacement of the intra-articular effusion to the para-patellar recesses (Figure 1) [3]. Moreover, the lack of posterior US imaging, whereby quantification of the joint fluid is an important parameter, is again an important drawback of this study since the gastrocnemius-semimembranosus bursa is often an important reservoir of intra-articular effusion in the painful knee [4].