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Soft Tissue Surgery of the Knee
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Stephen Key, Jonathan Miles, Richard Carrington
Associated conditions that may worsen the symptoms include chondromalacia patellae, patella alta, abnormal Q angle and trochlear hypoplasia, but these alone are not sufficient to perform a lateral release. In cases of malalignment, it may need to be combined with more advanced procedures, including osteotomy or tibial tubercle transfer. It can also be performed in conjunction with medial patellofemoral ligament reconstruction and vastus medialis advancement.
Biomechanics and Joint Replacement of the Knee
Published in Manoj Ramachandran, Tom Nunn, Basic Orthopaedic Sciences, 2018
Alister Hart, Joshua Lee, Richard Carrington, Paul Allen
In addition to the bony contours, soft tissues provide additional static restraints to the patella. Of particular interest in recent years is the function of the medial patellofemoral ligament (MPFL). It is a distinct condensation of capsular fibres within layer 2 of the medial structures of the knee, originating from the medial femoral epicondyle and part of the superficial medial collateral ligament, inserting into the superomedial aspect of the patella. It provides a medial check-rein to the patella and is commonly disrupted in acute patella dislocations. In recurrent dislocation of the patella, if the bony anatomy is within normal limits, then it may be appropriate to reconstruct the MPFL.
Test Paper 2
Published in Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike, Get Through, 2017
Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike
Contusional marrow oedema is often seen in the medial patellar facet and the lateral femoral condyle. The medial patellar retinaculum and/or medial patellofemoral ligament (MPFL) may be torn or show a pattern of strain injury.
The torsion of tibial tuberosity, a new factor of patellar instability
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2019
V. Chassaing, N. Courilleau, J. L. Blin, F. Khiami, J. M. Zeitoun, E. Decrette, T. Vendeuvre, C. Brèque
Every year in France, 18500 patients suffer from patellar instability. 17% of these are recurrences. Patellar instability is caused by excessive lateralization of the tibial tuberosity (TT) measured by a distance between femoral trochlear groove and the tibial tuberosity (> 17 mm +/– 4), dysplasia of the femoral trochlea, patella height anomaly (alta) and a rupture of the medial patellofemoral ligament (MPFL). In case of excessive lateralization, surgical management may be considered. It consists of medializing the anterior tibial tuberosity (TTA) to bring the patella to a stable position on the femoral trochlea. Recently, clinical observations based on MRI, have suggested that the inclination of the TT was also an aggravating factor in patellar instability. The purpose of our study was to quantify the effect of this new factor in patellar instability and to observe the effect of its correction on patellar dislocation. This surgical strategy has not yet been described in the literature, only the risk factors have been analyzed, by Chassaing.
Changes in knee extensor strengths before and after medial patellofemoral ligament reconstruction
Published in The Physician and Sportsmedicine, 2019
Takehiko Matsushita, Daisuke Araki, Tomoyuki Matsumoto, Takahiro Niikura, Ryosuke Kuroda
The incidence of patellar dislocation is approximately 5.6–7.0 per 100,000 in the general population [1]. After initial patellar dislocation, patients often experience persistent patellar instability and recurrent patellar dislocation [2]. Multiple radiographic findings have been suggested as risk factors for patellar instability, such as trochlear dysplasia, patella alta, lateralized tibial tuberosity relative to the femur, femoral torsion, and increased anteversion of the femoral neck [3,4,5,6]. Previous biomechanical studies have shown that the medial patellofemoral ligament (MPFL) is a primary passive restraint against the lateralization of the patella [7,8,9,10], and previous clinical studies have reported that the MPFL was damaged in most cases of patellar dislocation [11,12,13].
Rehabilitation variability following medial patellofemoral ligament reconstruction
Published in The Physician and Sportsmedicine, 2018
Harry M. Lightsey, Margaret L. Wright, David P. Trofa, Charles A. Popkin, Christopher S. Ahmad, Lauren H. Redler
Patellar instability is a common clinical problem affecting young female athletes [1–3] with an incidence of approximately 29:100,000 person-years in the 10–17 years age-group[4]. Whereas first-time, acute patellar dislocation is traditionally managed non-operatively [5], recurrent dislocation occurs in as many as 44% (range, 15–44%) of patients, with a higher frequency among athletes [6–8]. Recurrent patellar instability can have a significant negative impact on a patient’s quality of life in athletic, occupational, and social domains [2]. For these patients, reconstruction of the medial patellofemoral ligament (MPFL) restores the primary soft tissue stabilizer against lateral displacement of the patella and has been shown to return patellar tracking to near normal [9,10]. Following surgery, rehabilitation that is mindful of the soft tissue reconstruction yet progressive in promoting early functional recovery is critical in the effort to achieve pre-injury levels of activity [3,11,12].