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[Femoro-tibial torsion in patellar instability. A contribution to the pathogenesis of recurrent and habitual patellar dislocations].

Examination of femoro-tibial torsion in patellar instability. A contribution to pathogenesis of recurrent and habitual dislocation of patella. In a CT-study are examined the angle of tibial torsion, femoral antetorsion, femoro-tibial rotation and tibio-femoral index as well as the habitual step angle by direct measurement in 40 patients with recurrent in habitual dislocation of the patella and in 10 normal persons. In comparison to the control group the femoral antetorsion and the femoro-tibial rotation in the pathological group were significantly increased. Results are discussed in regard of pathogenesis and operative treatment of patella dislocation.

Adolescent↗

Adductor magnus tenodesis for patellar dislocation. Technique and preliminary results.

Fourteen patients with acute or chronic patellar instability had treatment with a new reconstructive procedure. It consists of isokinetic augmentation of the medial patellofemoral ligament (PFL) by making a tenodesis of the distal adductor magnus tendon to the medial border of patella. The patients were reviewed at a mean of 6.9 +/- 0.5 years after operation. In 12 patients, the subjective result was good. One patient had redislocation.

Adolescent↗

Vertical patellar dislocation: a case report.

Dislocation of the patella around the vertical axis is rare. Previous reports suggest reduction requires general anaesthesia and occasionally open reduction is necessary. We describe a case of dislocation of the patella around its vertical axis with impaction in the intercondylar notch of the femur following minor trauma. Successful reduction was achieved without the need for general anaesthesia.

Adult↗

Recurrent inferior patellar dislocation in an osteo-arthritic knee.

A case of inferior dislocation of the patella in an 80-year-old woman with an osteo-arthritic knee is presented. This is a rare injury in the degenerate knee and the first case in which recurrence, the need for operative reduction and intra-articular damage has been demonstrated.

Aged↗

Arthroscopic medial retinacular repair after patellar dislocation with and without underlying trochlear dysplasia: a preliminary report.

PURPOSE: This study was undertaken to evaluate the influence of underlying trochlear dysplasia (TD) on clinical outcomes of arthroscopic medial retinacular repair. METHODS: Between January 2000 and October 2004, a total of 91 patients underwent arthroscopic medial retinacular repair. Inclusion criteria for this study included an arthroscopic medial retinacular repair, a follow-up time of 12 months, and trochlear grading based on axial computed tomography (CT) scans (n = 48). TD, if present, was graded as types A through D, and patients were separated into group I (no or low-grade type A TD) and group II (types B through D TD). Redislocation was recorded, and Tegner, Lysholm, and International Knee Documentation Committee (IKDC) scores were determined. RESULTS: No or grade A TD was detected in 26 knees (group I), and TD of grade B or C was found in 22 knees (group II). Type D TD was not observed. At a follow-up time of 12 months, 4 redislocations had been noted, all belonging to group II. Neither the Tegner nor the Lysholm score reached preinjury levels, but in a comparison with preoperative status, we could find a significant increase in all scores in both groups. Group I reached a significantly better postoperative outcome than was attained by group II. CONCLUSIONS: Arthroscopic repair of the medial retinaculum is an effective technique by which patellofemoral instability can be addressed when normal or nearly normal trochlear geometry is present. In patients with underlying TD, patellofemoral stability cannot be completely restored, and clinical results are less successful. Precise preoperative radiologic determination of trochlear geometry may help the clinician to predict short-term outcomes in patients with patellofemoral instability. LEVEL OF EVIDENCE: Level III, retrospective comparative therapeutic study.

Adult↗

Depth insufficiency of the proximal trochlear groove on lateral radiographs of the knee: relation to patellar dislocation.

The depth of the trochlear groove was frequently noted to be insufficient in knees with patellar instability, particularly in the proximal portion of the trochlea. To confirm this observation, the depth of the trochlear groove of the femur was measured on lateral radiographs of 218 knees: 40 knees in 20 asymptomatic subjects, 116 knees in 69 patients undergoing radiography for various symptoms (96 without and 20 with patellar subluxation, determined on axial radiographs), and 62 knees in 34 patients who underwent surgery for recurrent dislocation or subluxation of one or both patellae (40 treated and 22 contralateral knees). In the 40 knees that had been operated on, the proximal trochlear depth (measured 1 cm below the upper limit of the trochlear groove) was 2.74 mm +/- 1.35, in contrast to 5.94 mm +/- 1.74 in the asymptomatic subjects and 5.84 mm +/- 1.53 in the patients with symptoms but no patellar instability. Recognition of depth insufficiency in the proximal portion of the trochlea should prompt a search for patellar instability. Axial views made with 30 degrees of knee flexion and lateral rotation of the leg are particularly helpful.

Adult↗