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Musculoskeletal trauma
Published in Ian Greaves, Keith Porter, Chris Wright, Trauma Care Pre-Hospital Manual, 2018
Ian Greaves, Keith Porter, Chris Wright
Patellar dislocation usually occurs as a result of sudden twisting of the knee or occasionally a result of a direct blow. Some patients will be able to reduce the patella themselves, particularly if dislocation has occurred before. The patient experiences pain and an inability to weight-bear and the leg is held flexed. The trick to reduction is to gradually extend the knee with gentle pressure on the patella in a lateral to medial direction, whilst offering reassurance. Entonox® is useful for analgesia and as a distraction. The patient should be advised to attend hospital, as these injuries may be associated with bony fractures and may require specific imaging. All will require physiotherapy to reduce the risk of recurrent dislocation.
Patellar dislocation
Published in Alisa McQueen, S. Margaret Paik, Pediatric Emergency Medicine: Illustrated Clinical Cases, 2018
This patient is presenting with an acute patellar dislocation. This classically occurs with either direct trauma to the patella or a sudden twisting movement of the lower leg, and is more common in children due to the increased ligamentous laxity. This is a clinical diagnosis and requires rapid reduction, and many practitioners perform this reduction without radiographic confirmation. After discharge, patients should be referred to an orthopedic surgeon or sports medicine specialist for follow-up.
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
Transient patellar dislocation is the dislocation of the patella laterally and subsequent relocation. Trochlear dysplasia, patella alta (increase in the ratio of the patella tendon to the patella length) and an increase in the tibial tuberosity–trochlear groove (TT-TG) distance are associated factors. TT-TG >20 mm is abnormal and 15–20 mm is considered borderline change. TT-TG less than 15 mm is within normal limits.
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
As seen in OLTs, acute traumatic injury often precedes the development of an osteochondral lesion in the knee joint. In the active pediatric and adolescent patient population specifically, acute lateral patellar dislocation is one of the most common injuries that may result in osteochondral lesions of the medial aspect of the patella and lateral femoral condyle[33]. Other soft tissue injuries, including those of the anterior cruciate ligament, can also present with concomitant articular cartilage injury[34]. Any type of impaction injury or significant increase in force, either due to malalignment or meniscal deficiency, can damage the chondrocytes and eventually lead to a clinically significant lesion. Other etiologies include repetitive jumping or squatting activities, chronic maltracking, and, in some cases, lesions may be idiopathic[35]. For symptomatic, focal lesions with an International Cartilage Repair Society (ICRS) grade III or IV, surgical treatment is indicated[36].
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
Rehabilitation following lateral patellar dislocation has been the subject of research for several decades [5,6]. For those patients suffering from recurrent patellar instability after non-operative management, MPFL reconstruction has become an increasingly employed surgical option. However, concomitant studies devoted to understanding MPFL postoperative rehabilitation are lacking. Presently, most MPFL physical therapy protocols are extrapolated from ACL reconstruction protocols and are heavily influenced by variable surgeon preferences [12]. Within the past several years, a combined research effort by physicians and physical therapists has pushed for a validated standard of care protocol [3,11,12]. Interestingly, recent studies in this effort have reached varying conclusions regarding the fundamental components of rehabilitation, including knee immobilization, early ROM, and weight-bearing. With this in mind, the authors felt it important to evaluate accredited online protocols in an effort to examine this variability and to encourage outcome-based studies through which clinically beneficial modalities can be identified and recommended. In this way, an evidence-based, standardized protocol could be proposed to serve as both a guide to the clinical surgeon as well as a patient-directed resource.