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PubMed2005

Reconstruction of the medial patellofemoral ligament for painful patellar subluxation in distal torsional malalignment: a case report.

Complex two-level rotational malalignment of the lower extremity can cause maltracking of the patella with anterior knee pain. Double derotation osteotomy would correct the underlying pathology. However, it carries a high risk of complications such as nerve and vessel damage. We report a case of rotational malalignment in the femur and the tibia associated with trochlear dysplasia, which causes painful patellar instability. The patient was successfully treated with reconstruction of the medial patellofemoral ligament and lateral release. Although the malrotation was not addressed, the position of the patella was corrected, and no dislocation occurred during a follow-up of 10 months.

Adolescent↗
PubMed2002

Dissecting popliteal cyst resulting from a fragmented, dislodged metal part of the patellar component after total knee arthroplasty.

Dissecting popliteal cyst is an uncommon complication after total knee arthroplasty, occurring mainly as a result of either rheumatoid arthritis or a malfunctioning knee prosthesis. Its association with a failed metal-backed patellar component has not been reported since the introduction of the resurfacing of the patella with this kind of design in 1980. We present a case of a late fracture-dislocation of the metal part of the patellar component that migrated to the posterior popliteal fossa, resulting in a cystic mass formation caused by a foreign body granuloma. The patient was treated successfully with a 2-stage operation: first, revision of the total knee arthroplasty and, second, excision of the cyst. The patient had a pain-free functional knee 7 years after surgery, with no recurrence of the symptoms or the popliteal cyst.

Aged↗
PubMed1977

[Knee arthroplasty. Our experiences with 22 cases].

In spite of continuing progress, total knee arthroplasty still presents many problems. In this clinic 25 arthroplasties have been performed in 22 patients over the last 4 1/2 years. Guépar hinges were used in 21 knees and Marmor modular knees in 4. Acrylic cement was used in all cases. The mean age of the patients was 69 years. 13 had osteoarthritis, 5 rheumatoid disease and 4 other conditions. There were no serious general complications or infections in the early postoperative period. The commonest local complication was malalignment of the patella (17 cases); 2 of these were complete but reducible dislocations. In only 3 knees did patellar subluxation produce sufficient pain to spoil an otherwise good result. Prostheses have loosened in 2 knees, one of which has been fused with success. Striking features of the early results have been reliable pain relief, improvement of joint movement, and generally an increased walking capacity. In spite of its present problems, arthroplasty remains the procedure of choice in knees where the amount of articular damage contraindicates conservative surgery.

Aged↗
PubMed2005

Long-term evaluation of the Roux-Elmslie-Trillat procedure for patellar instability: a 26-year follow-up.

BACKGROUND: Few published articles exist reporting the long-term evaluation of the Roux-Elmslie-Trillat procedure. PURPOSE: To assess the long-term effect of the Roux-Elmslie-Trillat procedure in preventing recurrent subluxation and dislocation of the patella. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Eighteen patients who underwent the Roux-Elmslie-Trillat procedure for dislocation or subluxation of the patella were identified from a group previously evaluated at a mean follow-up of 3 years. The prevalence of recurrent subluxation or dislocation at a mean follow-up of 26 years was compared with the prevalence reported at the mean follow-up of 3 years. Although not the focus of this study, Cox functional scores were obtained from the smaller group and compared with the results at the 3-year follow-up. RESULTS: Seven percent (95% confidence interval, 0.00-0.32) of the patients had recurrent subluxation at 26 years compared with 7% (95% confidence interval, 0.03-0.13) of the study population reported at 3 years (P = 1.00). Fifty-four percent (95% confidence interval, 0.27-0.79) rated their affected knee as good or excellent at 26 years compared with 73% (95% confidence interval, 0.64-0.81) of the larger study population reported at 3 years (P = .14). CONCLUSION: The prevalence of recurrent subluxation and dislocation in patients with patellofemoral malalignment who underwent the Roux-Elmslie-Trillat procedure for dislocation or subluxation of the patella is similar at 3 and 26 years after the procedure. The long-term functional status of the affected knee in patients who underwent the Roux-Elmslie-Trillat procedure declined.

Adolescent↗
PubMed1996

MR imaging in congenital lower limb deformities.

Treatment for children with congenital deformities of the lower extremities may vary, depending on the state of the unossified skeletal structures and surrounding soft tissues. The purpose of our study was to demonstrate the spectrum of the osteochondral and extrasosseous abnormalities as depicted with MR imaging. We retrospectively reviewed MR examinations of 13 limbs of ten children (aged 1 month-9 years, mean 2.1 years) with longitudinal and transverse deformities of the lower extremities. The lesions imaged were fibular hemimelia (n = 5), tibial hemimelia (n = 5), and congenital constriction bands (n = 3). Each examination was assessed for abnormalities in the osteocartilaginous and extraosseous (articular or periarticular components such as ligaments, tendons, and menisci; the muscles and the arteries) structures. Abnormalities were seen in all patients. Osteocartilaginous abnormalities in the patients with longitudinal deformities included abnormal distal femoral epiphyses, abnormal proximal tibial physes, hypertrophied and dislocated proximal fibular epiphyses, unsuspected fibular and tibial remnants, and absence or coalition of the tarsal bones. No osteocartilaginous abnormalities were seen in the patients with congenital constriction bands. Articular abnormalities about the knee in patients with either form of hemimelia included absent cruciate ligaments and menisci, dislocated or absent cartilaginous patellae, absent patellar tendons, and abnormal collateral ligaments. All but one limb imaged had absent or attenuated muscle groups. Of the nine MR arteriograms performed at the level of the knee, eight were abnormal. The normal popliteal trifurcation was absent or in an abnormal location. We conclude that MR imaging of children with congenital lower extremity deformities shows many osteochondral and extraosseous abnormalities that are not depicted by conventional radiography. This information can help to plan early surgical intervention and prosthetic rehabilitation.

Child↗
PubMedDate not supplied

Failure of heat shrinkage for treatment of a posterior cruciate ligament tear.

Incomplete tears or traumatic elongations of either the native cruciate ligaments or cruciate ligament reconstructions represent a therapeutic dilemma for orthopaedic surgeons. We report a case of a partially torn posterior cruciate ligament that was treated unsuccessfully with an electrothermal shrinkage procedure. Although the use of thermal energy to selectively shrink tissues may ultimately prove to be an invaluable tool, the lack of well-designed, randomized controlled studies to firmly establish its efficacy in the treatment of partial cruciate injuries mandates cautious use of this technique at this time.

Adult↗
PubMedDate not supplied

Current status of a hinge prosthesis (GUEPAR).

Although a great many GUEPAR hinge knee prostheses have been successful, the early complications have been numerous. Also, long-term follow up studies have been hampered owing to the patients' advanced age. Many of the patients died of causes unrelated to their knee. The use of this prosthesis is limited to very old patients or individuals with grossly dislocated knees. Previous problems such as patellar pain have been resolved. Because the femoral and tibial stems have been reinforced, they are much stronger and cement is no longer necessary for fixation. The part that articulates with the patella has been changed so that it is now more shallow and better adapted to the shape of the patella.

Adult↗
PubMed1984

The isolated lateral retinacular release in the treatment of patellofemoral disorders.

Isolated lateral retinacular release was performed on 102 knees in 76 patients. Diagnoses included chondromalacia patellae, patellar compression syndrome, and subluxation and dislocation of the patella. Patients reported that their symptoms improved after isolated lateral retinacular release in 95 of 102 knees. At follow-up evaluation (mean, 14.5 months after surgery), independent observers found no recurrence of dislocation in the 23 knees having had frank dislocations before surgery. In 71% of the knees with limitation of activity before surgery, unlimited activity was tolerated after isolated lateral retinacular release. Quadriceps exercise tolerance improved from 51% before surgery to 100% after surgery. This improvement in exercise tolerance can provide a significant length of time in which quadriceps rehabilitation can be conducted. Hypothetically, the effect of that lateral retinacular release is a decrease in the work load of an overpowered or weakened vastus medialis obliquus muscle, the major provider of dynamic stability required by the patellofemoral joint.

Adolescent↗
PubMed1993

[Experimental study of tangential osteochondral and chondral fracture of the patella].

It has been reported that trauma is not an only responsible factor for tangential osteochondral fracture (OF) in the patellofemoral joint, but other factors predisposing to OF are also involved in many clinical cases. The present investigator manually dislocated the patella of 25 young rabbits without anesthesia (group 1). In other 25 young rabbits (group 2), dislocation of the patella followed the experimental production of the patellar subluxation which was considered as an etiology of OF. The resulting patellar cartilage changes were compared between these groups of rabbits to clarify the relation between the preceding cartilage change and the development of OF. As a result, the present study confirmed that OF was not caused by mere dislocation of the patella but was induced only when dislocation was superimposed on an existing cartilage change resulting from the patellar subluxation. In treating clinical cases of OF, it is, therefore, important to evaluate cartilageous degeneration thoroughly and clarify its pathologic process.

Animals↗
PubMed1999

A technique for reconstruction of the medial patellofemoral ligament.

Additional medial patellofemoral ligament reconstruction was performed successfully on six consecutive patients with recurrent dislocation of the patella because of residual patellar instability after medial transfer of the tibial tubercle. A technique for medial patellofemoral ligament reconstruction is described, and complications and postoperative management are discussed. The reconstruction was performed using a double strand hamstring tendon graft in five patients and iliotibial allograft in one. Good stabilization of the patella was achieved in all six patients, resulting in improved confidence in higher levels of activity. The satisfactory outcome of additional medial patellofemoral ligament reconstruction suggests the possibility that the procedure may be part of the optional procedure in proximal realignment for recurrent dislocation of the patella.

Adolescent↗
PubMed1991

Quadriceps dislocation medial approach for intraarticular and medial structures of the knee.

To minimize possible complications such as patellar subluxation, quadriceps atrophy and skin tightness and slough which interfere with successful rehabilitation following knee surgery, the author employed a quadriceps dislocation medial approach for total knee arthroplasty and ligament (medial and both cruciates) surgery. The results of this approach (99 knees) were compared with a medial capsular incision approach (111 knees), a lateral capsular incision approach (114 knees), and Hughston's medial hockey stick incision approach (122 knees). The skin slough, patellar subluxation, and sense of tightness during rehabilitation occurred least with the quadriceps dislocation medial approach (P less than .05). The quadriceps dislocation medial approach was also the most convenient approach of the four.

Adult↗
PubMed2005

In vivo contact areas of the knee in patients with patellar subluxation.

OBJECTIVE: Ex vivo studies have suggested that cartilage contact areas and pressure are of high clinical relevance in the etiology of osteoarthritis in patients with patellar subluxation. The aims of this study were therefore to validate in vivo measurements of contact areas with 3D open magnetic resonance imaging (MRI), and to study knee joint contact areas in patients with patellar subluxation at different angles of knee flexion in comparison with healthy subjects. METHODS: 3D-MRI data sets of 12 healthy volunteers and eight patients with patellar subluxation were acquired using a standard clinical (1.5 T) and an open (0.2 T) MRI scanner. We compared femoro-patellar and femoro-tibial contact areas obtained with two different sequences from open MRI [dual-echo-steady-state (DESS) and fast-low-angle-shot (FLASH) sequences] with those derived from standard clinical 1.5 T MRI. We then analyzed differences in joint contact areas between healthy subjects and patients with patellar subluxation at 0 degree, 30 degrees, and 90 degrees of knee flexion using open MRI. RESULTS: The correlation of the size of contact areas from open MRI with standard clinical MRI data ranged from r = 0.52 to 0.92. Open-MRI DESS displayed a smaller overestimation of joint contact areas (+21% in the femoro-patellar, +12% in the medial femoro-tibial, and +19% in the lateral femoro-tibial compartment) than FLASH (+40%, +37%, +30%, respectively). The femoro-patellar contact areas in patients were significantly reduced in comparison with healthy subjects (-47% at 0 degree, -56% at 30 degrees, and -42% at 90 degrees of flexion; all p < 0.01), whereas no significant difference was observed in femoro-tibial contact areas. CONCLUSIONS: Open MRI allows one to quantify joint contact areas of the knee with reasonable accuracy, if an adequate pulse sequence is applied. The technique permits one to clearly identify differences between patients with patellar subluxation and healthy subjects at different flexion angles, demonstrating a significant reduction and lateralization of contact areas in patients. In the future, application of this in vivo technique is of particular interest for monitoring the efficacy of different types of surgical and conservative treatment options for patellar subluxation.

Adult↗
PubMed2006

Trochlear osteotomy for patellar instability: satisfactory minimum 2-year results in patients with dysplasia of the trochlea.

Trochlear dysplasia is a predisposing factor for recurrent patellar instability. We evaluated the results of an anterior lateral femoral condyle open wedge osteotomy for treating patellar instability. A total of 16 consecutive patients (19 knees) with symptoms of recurrent patellar instability and trochlear dysplasia identified using a true lateral radiograph of the knee underwent an anterior lateral femoral osteotomy. Outcomes were documented at 2 years minimum follow-up using the Lysholm scale, the patellofemoral score, WOMAC score and standard conventional radiographs. In 17 knees, patients reported good improvement in stability (no dislocations) and most patients had a marked improvement in pain and functional scores at follow-up (mean follow-up 51 months). No serious complications occurred. Anterior femoral osteotomy of the lateral condyle appears to be a satisfactory and safe method for treating patients with patellofemoral joint instability caused by trochlea dysplasia. In selected cases this procedure can be used to correct trochlea dysplasia. In our opinion, the key to a successful treatment of patellofemoral instability is to successfully distinguish the anatomic deficiencies and to correct the anatomical abnormality.

Adolescent↗
PubMed2001

Total knee arthroplasty in an adult with congenital dislocation of the patella.

This article reports the use of total knee arthroplasty with release of the lateral retinaculum, proximal extensor mechanism realignment, and patellar resurfacing as a valid treatment option for adult patients with congenital dislocation of the patella who have absence of the femoral sulcus and associated osteoarthritis. The patient presented in this case report had improvement of his Knee Society knee score and function score from preoperative levels of 8 and 45 to 77 and 80 postoperatively.

Arthroplasty, Replacement, Knee↗
PubMed2003

Ehlers-Danlos-like syndrome in 2 dogs: clinical, histologic, and ultrastructural findings.

BACKGROUND: Ehlers-Danlos syndrome comprises a group of rare inherited connective tissue diseases characterized by skin hyperextensibility, joint laxity, skin and vessel fragility, and poor wound healing. OBJECTIVE: The purpose of this report was to describe the clinical, histologic, and ultrastructural findings in 2 dogs with collagenopathies consistent with Ehlers-Danlos syndrome. METHODS: Two dogs were examined clinically; skin extensibility index was calculated. Skin biopsies obtained from the dorsum were examined by light and electron microscopy. RESULTS: Both dogs had clinical signs of skin hyperextensibility and fragility, lower skin elasticity, vessel fragility, and poor wound healing. One dog had a hip dislocation, and the other had bilateral medial patellar luxation (grade II), subcutaneous hematomas produced by minimal trauma, and generalized periodontitis. Histologic and ultrastructural examination confirmed abnormalities in the structure and arrangement of collagen fibrils. Fibroblasts were characterized by variable dilatation of the rough endoplasmic reticulum, and anomalous elastic fibers (elaunin fibers) were present in the dermis. CONCLUSION: Although the primary defects underlying collagenopathies in animals are still unknown, analysis of the ultrastructural changes in collagen fibrils and clinical findings could facilitate better characterization of these disorders in dogs.

Animals↗
PubMed1984

Patellofemoral disorders: physical and radiographic evaluation. Part II: Radiographic examination.

Evaluation of the patient with patellofemoral complaints requires a comprehensive physical and radiologic investigation. The tangential view is most helpful in the evaluation of such patellofemoral disorders as chondromalacia, lateral patellar compression syndrome, and recurrent subluxation or dislocation. Commonly utilized tangential views include those described by Hughston, Merchant, Laurin, and Ficat. Multiple calculations available for quantitation of abnormal tangential views include the sulcus angle, congruence angle, lateral patellofemoral angle, patella index, and patellofemoral index. Lateral radiographic views commonly utilized to evaluate the patellofemoral joint for patella alta or infera include those described by Blumensaat, Labelle and Laurin, and Insall and Salvati. Utilization of all of the available patellofemoral radiographic views and calculations is impractical and unnecessary. However, to ensure diagnostic accuracy, a routine consisting of a reproducible radiographic technique and various, easily performed calculations that aid in diagnosis must be adopted.

Femur↗
PubMed2006

Medial patellofemoral ligament reconstruction in patients with lateral patellar instability and trochlear dysplasia.

BACKGROUND: Reconstruction of the medial patellofemoral ligament has been proven to restore stability in patients with lateral patellar instability. No study to date has examined the results in a patient population with the predisposing factor of femoral trochlear dysplasia. HYPOTHESIS: Reconstruction of the medial patellofemoral ligament restores stability and provides pain relief in patients who have lateral patellar instability in association with trochlear dysplasia. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Thirty-four patients with chronic patellar instability and trochlear dysplasia were treated with medial patellofemoral ligament reconstruction using an adductor tendon autograft, bone-quadriceps tendon autograft, or bone-patellar tendon allograft. All patients were evaluated preoperatively and postoperatively with Kujala, Lysholm, and Tegner scores at a minimum of 24 months. RESULTS: Thirty-four patients were followed for a mean of 66.5 months (range, 24-130 months) after surgery. Kujala scores improved from 53.3 to 90.7, Lysholm scores improved from 52.4 to 92.1, and Tegner activity scores improved from 3.1 to 5.1. All improvements were highly statistically significant (P < .001). No statistical difference was found between the postoperative Lysholm, Kujala, and Tegner scores and the degree of dysplasia, graft type, or degree of symptoms. There were 85.3% and 91.1% good and excellent results based on Kujala and Lysholm scores, respectively. No recurrent dislocations have occurred. CONCLUSION: Medial patellofemoral ligament reconstruction provides excellent long-term pain relief and functional return in patients with patellar instability and femoral trochlear dysplasia. In addition, reconstruction prevents recurrent dislocation, despite the diminished bony constraint of a dysplastic trochlea.

Adult↗