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Patellar luxation: pathogenesis and surgical correction.
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[Arthroscopic management of traumatic luxation of the patella].
AIM: The authors present a restrospective assessment of acute traumatic patellar luxation. MATERIAL: From 1999 to 2003, the authors treated 57 patients with acute traumatic patellar luxations, including 36 females and 21 males, the age range was 16-40 years. In cases of marked lateralization of the patella, the injured medial retinaculum was sutured under arthroscopic control. Furthermore, should the lateralization persist, lateral release of the patella was conducted. Early patellar cartillage injuries were detected in 34 subjects (59%), injuries of the lateral femoral condyle in 19 subjects (33 %). Patellar chondromalacia, grade 1-2 was diagnosed in 16 subjects. Free cartillagenous particles within the joint were detected in 18 subjects. Reconstruction of the cartillage was conducted in extensive injuries in 13 subjects. RESULTS: The subjects were assessed 1-4 years after the injuries and surgery. In one case (2%), a relaps of the patellar luxation, due to a new contact sport injury (a direct impact), was recorded. Assessment results, using the Lysholm score, were defined as follows: 93%-excellent and good, 7% fair. CONCLUSION: Sparing surgical techniques, followed by appropriate rehabilitation care, may optimalize the healing process of the injured tissue and prevent relapses of patellar luxations, as well as further wearing of femoropatellar cartillages.
Dovetail patellar tendon transfer for recurrent dislocating patella.
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Patellofemoral Instability: Evaluation and Management.
Patellofemoral disorders are a common cause of knee pain and disability. A thorough history and a careful physical examination are essential to accurate diagnosis, and imaging modalities play an important role. Magnetic resonance imaging can provide information on malalignment and soft-tissue injuries. Although there is a continuum of diagnoses, most patellofemoral disorders can be divided into three distinct categories: soft-tissue abnormalities, patellar instability due to subluxation and dislocation, and patellofemoral arthritis. Many patellofemoral disorders respond to nonoperative therapy. When surgical intervention is necessary, patellar tilt can be successfully treated by a lateral release. Lateral patellar subluxation associated with malalignment can be corrected by a distal realignment procedure such as the anteromedial tibial tubercle transfer. Repair of the medial patellofemoral ligament in cases of patellar dislocation has considerably lowered the incidence of recurrent instability. Although no ideal treatment exists for patellofemoral arthritis, mechanical symptoms may be alleviated by arthroscopic debridement of delamination lesions. Articular cartilage-wear disorders may be stabilized by addressing the primary causative disorder.
[The final stage of untreated congenital bilateral patellar luxation].
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[Indication for, technic and results of reconstruction of the extensor apparatus in the treatment of patellar instability and patellar chondropathy].
Patella dislocation or subluxation is a common cause of internal derangement of the knee. Frequently they lead to lesions of the articular cartilage of the patella. More than one-hundred operative methods have been described for surgical correction of this condition and for treatment of the chondral damage, suggesting that none has been consistently successful. Long-term results of extensor mechanism reconstruction have been published by Turba et al. (26) advocating a numerical rating system with subjective and objective criteria for the follow-up control. We present our operative technique and results with extensor mechanism reconstruction in 54 cases by applying the above mentioned rating system. With a follow-up period from more than one year 39 patients were available for control. The results of proximal reconstruction (24 cases) were good and excellent in 20 cases by subjective and in 23 cases by objective evaluation. The proximal and distal reconstructions (15 cases) showed subjective 13 and objective 14 patients with good and excellent results.
[On the therapy of habitual patellar luxation].
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[On the therapy of so-called habitual patellar luxation].
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[Etiology and therapy of habitual congenital patellar luxation].
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[Surgical treatment of patellar luxation].
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[Some problems of pathogenesis and therapy of so-called habitual patellar luxation].
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[Horizontal patellar luxation].
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Periprosthetic patellar fracture after an open knee dislocation.
We present a patient who sustained an open knee dislocation with a periprosthetic fracture of the patella and who was treated satisfactorily with tension band wiring and a conservative rehabilitation program. In addition to describing this unique combination of injuries, we review the literature on the treatment of periprosthetic patellar fractures. Although internal fixation of these fractures historically has provided unpredictable results, we think that it is warranted if the patella has adequate bone stock.
Unicortical transverse osteochondral fracture of the patella: a case report.
Chondral lesions are relatively common and they usually occur as a result of high energy trauma. Chondral fractures of the patella ordinarily occur during an acute dislocation of the patella. Patellar chondral fractures without either a dislocation or a patella fracture are extremely rare. We have treated a 25-year-old male who had a unicortical transverse osteochondral fracture of the patella without a dislocation which was produced by high energy trauma. Chondral fractures of the patella are often overlooked because they are difficult to detect on plain radiographs. A persistent cartilaginous irregularity from either a chondral or osteochondral fracture may lead to the development of secondary osteoarthrosis. In this case, restoration of the articular surface was achieved by elevation of the compressed osteochondral fragment. This case demonstrates that understanding the mechanism of injury can be helpful in the treatment of osteochondral lesions.
Evaluation of patellar tracking in patients with suspected patellar malalignment: cine MR imaging vs arthroscopy.
OBJECTIVE: The purpose of this study was to compare results of motion-triggered cine MR imaging of active extension of the knee with arthroscopic findings in cases of suspected femoropatellar malalignment. SUBJECTS AND METHODS: Twenty patients with clinically proved or suspected patellar subluxation or dislocation were examined prospectively with motion-triggered cine MR imaging to analyze patellar tracking from 30 degrees of flexion to full extension during active extension of the knee. The patellar tracking pattern was evaluated by measuring the following: bisect offset and lateral patellar displacement to assess lateralization of the patella and the patellar tilt angle to assess tilting of patella. The slopes of the linear regression lines of the MR findings vs the knee angle position, representing the patellar tracking, and the position of the patella at 30 degrees and 0 degrees of flexion were correlated with a semiquantitative arthroscopic classification of patellar tracking that had four categories ranging from normal to highly abnormal. RESULTS: The results showed a significant correlation between the semiquantitative arthroscopic findings of patellar tracking and the slopes of the linear regression lines of the bisect offset, lateral patellar displacement, and patellar tilt angle, as measured with cine MR imaging (p < .01). The arthroscopic findings also correlated significantly with the position of the patella when the knee was extended (p < .01), but not with the knee flexed 30 degrees. CONCLUSION: We conclude that motion-triggered cine MR imaging of active extension of the knee enables the dynamic evaluation of patellar bracing and is therefore suitable for noninvasive analysis of patellar tracking.
[Capsuloligamentous plasty à capot and crossed transplantation of patellar semitendon as treatment of habitual dislocation of patella in infancy].
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Patellar realignment in recurrent subluxations and dislocations: long-term results.
A total of 41 patients affected with recurrent subluxations or dislocations of the patella treated with different surgical methods between 1972 and 1981 were examined. Radiographic and clinical monitoring according to Crosby-Insall in 35 patients ranges from 10 to 20 years, with the following results: excellent: 17%; good: 69%; fair: 14%; poor: 0; recurrent dislocations or subluxations: 0.