Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Patellar Dislocation”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 73 records · Page 4Linked to original sources
PubMed2006

Trochleaplasty for recurrent patellar dislocation in association with trochlear dysplasia. A 4- to 14-year follow-up study.

We investigated the clinical and radiological outcome of trochleaplasty for recurrent patellar dislocation in association with trochlear dysplasia in 38 consecutive patients (45 knees) with a mean follow-up of 8.3 years (4 to 14). None had recurrence of dislocation after trochleaplasty. Post-operatively, patellofemoral pain, present pre-operatively in only 35 knees, became worse in 15 (33.4%), remained unchanged in four (8.8%) and improved in 22 (49%). Four knees which had no pain pre-operatively (8.8%) continued to have no pain. A total of 33 knees were available for radiological assessment. Post-operatively, all but two knees (93.9%) had correction of trochlear dysplasia radiologically but degenerative changes of the patellofemoral joint developed in 30% (10) of the knees. We conclude that recurrent patellar dislocation associated with trochlear dysplasia can be treated successfully by trochleaplasty, but the impact on patellofemoral pain and the development of patellofemoral osteoarthritis is less predictable. Overall, subjective patient satisfaction with restored patellofemoral stability after trochleaplasty appeared to outweigh its possible sequelae.

Adolescent↗
PubMedDate not supplied

[Current aspects of surgical management of patellar dislocation in the growth period with special reference to Goldthwait surgery].

RESEARCH QUESTION: The Goldthwait procedure is an operative treatment method for patellar dislocation in children which respects the growth plate. The aim of the study was to analyse the long term results of this procedure. METHODS: The results of 36 knees (26 children) operated on because of patellar dislocation according to the Goldthwait technique alone or in combination with other procedures (Krogius, patellar fixation) between 1941-1991 at Balgrist Clinic were analysed. Therefore, we used an own score. RESULTS: After a mean follow-up of 16 years (1.5 to 51 years) we found in 77.8% of the cases good and very good subjective results, and in 63.9% good and very good objective results. A recurrence of dislocation occurred in 36.1% of the cases. In 76.9% of these cases a reoperation was performed, of which only one case led to an acceptable final result. The operation results were unsatisfactory in the presence of condylar dysplasia with an angle of more than 160 degrees. The age at the time of surgery and the degree of patellar dysplasia had no effect on the outcome. The success was increased through the use of the Goldthwait procedure in conjunction with other techniques. Pathologic leg axis or severe arthrosis did not occur. CONCLUSION: In absence of significant condylar dysplasia the Goldthwait procedure combined with other techniques provides acceptable results. The technique alone is less efficient.

Adolescent↗
PubMed2006

High-resolution MRI using a microscopy coil for the diagnosis of recurrent lateral patellar dislocation.

PURPOSE: Magnetic resonance imaging (MRI) has been commonly used for the preoperative evaluation of recurrent lateral patellar dislocation (RLPD). The purpose of this study was to determine the usefulness of high-resolution MRI (HR-MRI) with a microscopy coil for diagnosing RLPD. MATERIALS AND METHODS: The study group consisted of 15 patients with clinically diagnosed RLPD and 10 normal volunteers. All studies were performed on a 1.5-T MR system. First, conventional MRIs of the whole knee joint were obtained using the knee coil. Then HR-MRI scans using a microscopy coil in the medial aspect of the patella were obtained at the level of the superior pole of the patella, targeting the medial patellofemoral ligament (MPFL). The acquired HR-MRIs with RLPD were reviewed concerning the MPFL injury and the patellar injury. RESULTS: The MPFL was distinguished as a separate ligament, and the layer structure of the patellar cartilage was visualized clearly in all volunteers. The MPFL injury was visualized in 12 cases (87%); it included discontinuity, thickening, and loosening. The patellar injury was visualized in 11 cases (73%), which included dissecans of the medial margin and cartilage injuries. CONCLUSION: HR-MRI with a microscopy coil provides precise information of the MPFL and patellar cartilage injury for the diagnosis of RLPD.

Adolescent↗
PubMed1992

Patellofemoral relationships and distal insertion of the vastus medialis muscle: a magnetic resonance imaging study in nonsymptomatic subjects and in patients with patellar dislocation.

The correlation between the insertion level of the vastus medialis muscle and lateral patellofemoral angle (LPA), lateral patellar displacement (LPD) and tilt (LPT), and the height of the patella (LT/LP) was analyzed by magnetic resonance imaging (MRI) in patients with patellar dislocation (n = 10) and in control subjects (n = 10). Images were produced in 0 degrees and 20 degrees of knee flexion. The insertion level to the patella was also analyzed with the knee in extension. No significant correlation was noted between the insertion level and different patellofemoral indexes, but multiple-regression analysis showed that the best predictor for the insertion level was the LPA with the knee in extension. The insertion level was significantly more proximal in patients with patellar dislocations than in normal subjects.

Adolescent↗
PubMed1992

Locked patellar dislocation with vertical axis rotation. A case report.

Whereas traumatic lateral dislocation of the patella is a well-described clinical entity, other types of patellar dislocations, specifically those that involve patellar rotation, are unusual. These rare types also present a therapeutic problem in which reduction often requires a general anesthetic and, possibly, an open procedure. A 16-year-old boy sustained a laterally directed blow to his knee, resulting in dislocation of the patella. The patella had rotated 90 degrees in the vertical plane and became wedged against the lateral femoral condyle. Initial attempts at closed reduction in the emergency room and under general anesthesia in the operating room were unsuccessful, and the patient required open reduction. A similar type of dislocation has been described; however, the patella is usually intercondylar. The tear along the medial side was extensive enough to allow the patella to dislocate lateral to the lateral femoral condyle, making this a unique case. In these instances of rare patellar dislocation, the surgeon should be prepared to perform an open reduction, because attempts at closed reduction even with a general anesthetic may be unsuccessful.

Adolescent↗
PubMed1990

[Patellar dislocation as a cause of osteochondral fracture of the femoro-patellar joint].

Acute traumatic dislocation of the patella may be associated with osteochondral fractures. Clinical examination invariably shows a tense effusion. A detailed radiographic examination including antero-posterior, lateral and skyline views of the patella is usually necessary to establish an exact diagnosis. Once diagnosis is made open reduction and fixation of the osteochondral fracture should be carried out if it is possible. Out of 78 patients of our own with patella dislocation 24 cases suffered an osteochondral fracture. In ten cases refixation of the osteochondral fragment was achieved. Intraoperatively the alignment of the patella was controlled in any case. In cases of lateral subluxation lateral release and medial reconstruction was performed. In two cases medial transfer of the tibial tuberosity was carried out. Osteochondral fractures of the femoro-patellar groove represent an important injury in the course of acute patellar dislocation. With exact diagnosis and correct treatment congruity of the femoro-patellar joint can be restored in many cases.

Bone Transplantation↗
PubMed2006

Vertical axis patellar dislocation with ipsilateral femoral fracture: use of a closed percutaneous technique for reduction of the dislocation.

Intra-articular vertical axis dislocations are rare injuries, which mostly occur after blunt trauma. In this type of dislocation, the patella rotates along its vertical axis, bringing the articular surface to face medially or laterally. A 13-year-old boy sustained an intra-articular lateral patellar dislocation with a 90 degrees vertical axis medial rotation, which resulted in the articular surface facing laterally, the medial edge of the patella pointing posteriorly, and the lateral edge of the patella pointing anteriorly. As a result, the patella was wedged between the medial and lateral femoral condyles. He also sustained an ipsilateral closed distal femoral shaft fracture. Closed reduction of the dislocation was not successful. Subsequently an A-O reduction clamp was used percutaneously to reduce the patellar dislocation. The femoral fracture was then stabilized by internal fixation using a dynamic compression plate. Isolated vertical and horizontal dislocations have been previously described, but the presence of an ipsilateral femoral shaft fracture makes this a unique case. The percutaneous method used for reduction of the patella has not been previously described. A focused review of the literature, pathoanatomy, and methods of treatment of this condition are presented.

Adolescent↗
PubMed1997

[Osteochondral fractures of the external femoral condyle after traumatic patellar dislocation during physical exercise in children].

PURPOSE OF THE STUDY: Nineteen osteochondral fractures of the lateral femoral condyle associated with acute traumatic patellar dislocation resulting from sport injury in children were studied. The purpose of this study was to specify clinical and radiological features. MATERIAL AND METHOD: This study was led with special care to injury circumstances, fracture visibility on X-rays, size and location of the fracture, treatment delay, presence of femoro-patellar dysplasia signs. Treatment results were evaluated on knee pain, bone consolidation and recurrent dislocation. RESULT: Thirteen boys and six girls aged 8 to 16 years (average 14 years) were included. The injury resulted from a rotatory-compression stress in 75 per cent cases. The patella was always in place at the time of examination. Thirteen fractures were diagnosed within 24 hours and 5 fractures were diagnosed within 1 week after injury. One fracture was not visible on X-rays and was diagnosed 6 weeks after injury. Only the lateral view showed the fracture in more than one case out of two. Seven patients whose fracture was less than 5 mm, or involving a non-weight-bearing portion, or diagnosed within more than ten days after injury, were treated by knee arthroscopy and removal of the osteochondral fragment. Twelve patients were treated by arthrotomy and excision (one case) or replacement of the osteochondral fragment (11 cases). The replaced fracture was fixed with biological glue ten times, and screwed once. The knee was immobilised in a cylinder cast and weight-bearing prohibited for six weeks. Bone consolidation was obtained in 9 cases out of 11, in an average of 8 weeks. Knee pain occurred 5 times. Recurrence of the dislocation occurred 3 times within 6 months. Eighty per cent of these children showed patello-femoral dysplasia. DISCUSSION: This fracture complicated 31.6 per cent of traumatic patellar dislocation resulting from sport injury in children which we observed during the last ten years. It may be overlooked if it is suspected and carefully looked for by radiographic examination including antero-posterior, lateral, oblique and true skyline views of the patella. The presence of fat in the hemarthrosis may help. Early surgery is recommended. Arthroscopy may be performed to evaluate fracture location and size. After ten days, host area begins to fill in and free fragment will not fit back well. Fragments less than 5 mm, or involving a non-weight-bearing portion, or diagnosed within more than ten days after injury, may be removed. CONCLUSION: Lateral femoral condyle osteochondral fractures are associated with nearly one third of traumatic patellar dislocation resulting from sport injury in children. A detailed radiographic examination can help diagnosis. Treatment depends on the delay after injury, the size and location of the fracture.

Adolescent↗
PubMedDate not supplied

Immediate surgical repair of the medial patellar stabilizers for acute patellar dislocation. A review of eight cases.

An open surgical repair of the injured medial patellar stabilizers, including the vastus medialis obliquus muscle and the medial patellofemoral ligament, after acute patellar dislocation was studied in eight patients. At initial examination, all patients had tenderness over the adductor tubercle and a positive patellar apprehension sign. Four of eight patients had obvious ecchymosis over the adductor tubercle. Magnetic resonance imaging, diagnostic arthroscopy, and open surgical exploration documented injury to both the medial patellofemoral ligament and the origin of the vastus medialis obliquus muscle. In all patients, the torn muscle was retracted in an anterior and superior direction and an arthroscopic lateral release was performed followed by open primary repair of the medial patellofemoral ligament to the adductor tubercle and repair of the vastus medialis obliquus muscle to the adductor magnus tendon. Patients were evaluated postoperatively with the Kujala scoring questionnaire. The average follow-up was 3.0 years, with a minimum of 1.5 years. No patients experienced a recurrent dislocation. The average Kujala score was 91.9. Patients rated their return to athletic activity at an average 86% of their pre-injury level. The average subjective satisfaction was 96%. In appropriate cases of acute patellar dislocation, we recommend primary repair of the medial patellofemoral ligament and the vastus medialis obliquus muscle to avoid recurrent dislocation, chronic subluxation, pain, and disability.

Adolescent↗
PubMed2006

A laterally positioned concave trochlear groove prevents patellar dislocation.

Patellofemoral instability is a disabling condition that occurs in adolescence. Recurrence after patellar dislocation has been reported in 2-50% of patients. We compared the distal femur in patients with patellofemoral instability with distal femura of a healthy cohort using mathematical quantification of two-dimensional shape variation at the same position in different knees. One hundred eight computed tomography scans from 54 patients with patellofemoral instability were compared with 197 computed tomography scans from 102 subjects with normal knees. We used principal components analysis to quantify variation in shape of the trochlear groove as it allows comparison of knees with patellofemoral instability to healthy knees. We found that subjects who had dislocated their patella had a flattened trochlear groove, whereas normal knees had a more concave groove. The position of the trochlear groove was more medial in patients with patellofemoral instability compared with normal knees. Groove position was more important than shape when predicting which patellae were likely to dislocate.

Adolescent↗
PubMed1996

Patellar dislocation has predisposing factors. A roentgenographic study on lateral and tangential views in patients and healthy controls.

One hundred patients with the diagnosis of an acute patellar dislocation treated conservatively and 30 healthy control subjects were studied roentgenographically by lateral and tangential views. The aim of the study was to determine the distribution and incidence of predisposing factors in different study groups. Three study groups were formed as follows: 67 patients (group A) without late problems or operative treatment of redislocation; 33 patients (group B) who underwent a surgical realignment procedure for redislocations or late problems; and 30 healthy control subjects (group C). A statistically significant difference was observed between the patient groups (A, B) and control group (C) when the means, medians and distributions of patellar tendon length (LT), patellar length (LP), tendon to patella length ratio (LT/LP), tendon to patellar articular surface ratio (LT/LAS), sulcus angle (SA), lateral patellar displacement (LPD), lateral patellofemoral angle (LPA) and morphological classification of the patella (1-5, Jägerhut) were compared. In group A, LPD was also significantly greater than in group B. This study demonstrates a considerably high rate of predisposing factors associated with patellar dislocation.

Adult↗
PubMed2004

Augmented repair of avulsion-tear type medial patellofemoral ligament injury in acute patellar dislocation.

This study investigated the results of augmented repair for avulsion-tear type medial patellofemoral ligament (MPFL) injury performed on a total of five knees with initial acute lateral patellar dislocation. Augmented repair was performed using a medial retinaculum slip on all five knees. The average follow-up was 5.9 years. The results were evaluated with the Insall, Aglietti, and Tria grading system. Three knees were classified as excellent, one knee as good, and one knee as fair. The mean Kujala score at follow-up was 97.6 points. Augmented repair of the injured MPFL for avulsion-type MPFL injury may be considered as one good option to prevent subsequent dislocation and subluxation.

Acute Disease↗
PubMed1989

Acute traumatic lateral patellar dislocation.

An unusual case of acute extra-articular patellar dislocation is described in which the patella dislocated laterally, rotated 90 degrees about its vertical axis, and wedged against the lateral femoral condyle. Closed reduction in the emergency department failed and operative intervention was required.

Adolescent↗
PubMed2001

Results of medial patellofemoral ligament reconstruction in the treatment of patellar dislocation.

PURPOSE: The purpose of this study is to describe the technique of medial patellofemoral ligament reconstruction using autogenous hamstrings or autogenous fascia lata and report the results at a minimum 2-year follow-up. Type of Study: This study represents a case series. Patients with patellofemoral instability following patellar dislocation were restrospectively reviewed after being treated with medial patellofemoral ligament reconstruction. No concurrent control group was used. METHODS: Nineteen consecutive patients underwent medial patellofemoral repair or reconstruction in the treatment of patellar instability after patellar dislocation. The reconstructions were performed using autogenous gracilis and/or semitendinosus tendons or a strip of autogenous fascia lata. Fifteen patients were available for interview, examination, and radiographic evaluation, with a mean follow-up of 31.5 months. RESULTS: Subjectively, 10 knees had excellent results, 3 knees obtained good results, 1 knee had a fair result, and 1 knee had a poor result, for a total of 93% improvement overall. Using Fulkerson's functional knee score, 93% had good or excellent results. The average postoperative result on Kujala's score for anterior knee symptoms was 88 (range, 80-100). The Tegner activity level averaged 6.8 preinjury and 6.7 postoperatively. Radiographic evaluation showed significant improvements in the congruence angle by an average of 20 degrees (P =.0006), and in the lateral patellofemoral angle by an average of 10 degrees (P =.0003). CONCLUSIONS: Surgical reconstruction or repair of the medial patellofemoral ligament provides favorable results for the treatment of recurrent patellofemoral dislocations with regard to radiographic findings, patient satisfaction, and functional outcome.

Journal Article↗
PubMed1991

[Patellar dislocation in athletes. Arthroscopic diagnosis and therapy].

Out of 270 arthroscopies performed in the Sports Clinic in Stuttgart-Bad Cannstatt in 1987 and 1988, 317 (11.5%) were done because of hemarthrosis of the knee after an acute trauma. Besides ruptures of the anterior cruciate ligament and synovial ruptures, in 53 cases (16.4%) acute patellar dislocation was found. These were only the first dislocations. Most, i.e., 44 (83%) occurred in sports, such as soccer (18) and skiing (9), which were the most frequent sports involved. Thirty-three (62.2%) were young men with an average age of 21.5 years. The clinical history, physical examination and plain X-rays failed in more than 50% to come up with a diagnosis. Arthroscopy showed the typical pattern of patellar dislocations with hemarthrosis, rupture and hematoma of the medial quadriceps retinaculum and a concomitant cartilage lesion, which was found in 39 cases (66%). During arthroscopy, operative treatment could also be performed, such as the extraction of splinter bone fragments and chondroplasties. Seven chondral and osteochondral fragments were refixated. Immobilization of the knee was guaranteed for 4 weeks by the application of a plaster splint. Only one recurrent dislocation was observed.

Adolescent↗
PubMed1998

Effect of Elmslie-Trillat and Roux-Goldthwait procedures on patellofemoral relationships and symptoms in patients with patellar dislocations.

Seventeen patients (18 knees) with a history of one or more patellar dislocations underwent Elmslie-Trillat (9 knees [group 1]) or Roux-Goldthwait (9 knees [group 2]) patellar realignment surgery. Anterior knee pain was evaluated with a questionnaire, and lateral patellar displacement and tilt were analyzed by magnetic resonance imaging both pre- and postoperatively. Postoperative evaluations were performed after 44 and 50 months (mean) in groups 1 and 2, respectively. The Elmslie-Trillat procedure provided better subjective relief of anterior knee pain and symptoms. One redislocation occurred in each group. Both procedures relieved excessive patellar lateralization, but the effect on patellar tilt was less marked. In patients who underwent the Roux-Goldthwait operation, a less pronounced correction of tilt and lateralization appeared to correlate with more satisfactory subjective results.

Adolescent↗
PubMed2000

A mid-term follow-up of medial patellofemoral ligament reconstruction using an artificial ligament for recurrent patellar dislocation.

A prospective study on medial patellofemoral ligament reconstruction for recurrent patellar dislocation was performed. At an average follow-up of 5.9 years, 27 MPFL reconstructions using a mesh-type artificial ligament and medial retinaculum slip coverage were reviewed using the Crosby and Insall grading system. Fifteen knees (55%) were classified as excellent, 11 knees (41%) as good, 1 knee (4%) as fair/poor and none as worse. At a mid-term follow-up, medial patellofemoral ligament reconstruction should be considered as a safe and effective operation.

Journal Article↗
PubMed1989

Patellofemoral relationships in recurrent patellar dislocation.

Magnetic resonance imaging was used to analyse the patellofemoral relationships during the first 30 degrees of knee flexion in women with recurrent patellar dislocation. The patellofemoral joints were imaged both sagittally and axially with the knee flexed 0 degrees, 10 degrees, 20 degrees, and 30 degrees. At the beginning of knee flexion the sulcus angle was greater than in unaffected women, the lateral patellofemoral angle was smaller, the patella displaced further laterally, tilted more laterally and the congruence angle was directed more laterally. At 30 degrees of knee flexion these differences were less marked than at 0 degree to 10 degrees. Logistic regression analysis showed that the sulcus angle at 10 degrees of knee flexion was the most diagnostic feature, indicating that there is an anatomical predisposition to recurrent dislocation and that pathological patellar tracking starts from the beginning of flexion. Traditional sunrise radiographic films taken at 25 degrees to 30 degrees knee flexion clearly miss diagnostically important information.

Adolescent↗