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PubMed2002

Correlation of MR imaging findings and open exploration of medial patellofemoral ligament injuries in acute patellar dislocations.

The purpose of this investigation was to correlate magnetic resonance (MR) images of medial patellofemoral ligament (MPFL) injuries with gross macroscopic findings. Twenty-seven knees with MPFL injury following an initial patellar dislocation were examined using axial proton-density and T2-weighted fast spin-echo MR imaging. MR findings were subsequently correlated with open exploration. MPFL injury was observed in 26 (96%) of the 27 knees. From the MR images, discontinuity, irregularity and/or high-signal intensity changes anterior to the femoral attachment were seen in 13 (82%) of the 16 knees with substantial-tear type injuries of the MPFL. In 8 (80%) of the 10 knees with avulsion-tear type injuries, detachment of the MPFL from the femoral attachment, accompanied with or without high-signal intensity changes, was confirmed. MPFL injury types could be accurately diagnosed on 21 (81%) out of 26 knees using MR imaging. MR imaging was an acceptable method in diagnosing MPFL injury types.

Acute Disease↗
PubMed1989

Diagnosis of undetected knee injuries. Interpreting subtle clinical and radiologic findings.

The vast majority of knee problems can be diagnosed by taking a complete history, performing a comprehensive physical examination, and obtaining appropriate x-ray films. However, diagnosis of anterior and posterior cruciate ligament tears, patellofemoral subluxation, tibial tubercle fracture, and fibular head dislocation is challenging because they often present like common, less serious knee disorders. Accurate assessment of these five injuries depends upon the examiner's knowledge of the specific presenting complaints and the subtle clinical and radiologic findings associated with these conditions.

Adolescent↗
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↗
PubMed2002

Posterior femoral impingement causing polyethylene failure in total knee arthroplasty.

Several reports in the literature describe dislocation and fractures of the meniscal bearings as a result of polyethylene failure after total knee arthroplasty. In this case of an asymptomatic patient with a clinically uneventful 7-year follow-up, who died a year later of an unrelated cause, we found impressive damage of the polyethylene components. This damage, at the posterior corner of the meniscal bearing elements, was caused by regrowth of the posterior femoral osteophytes. The primary osteophytes had been resected adequately during the arthroplasty. These osteophytes are related to a bone-polyethylene impingement that occurs at >110 degrees of knee flexion. The possible range of motion of an artificial joint, owing to its design, is less than the range of flexion sometimes reached clinically by the patient. This is a problem that should be solved by the industry in the near future.

Aged↗
PubMed1981

Superior dislocation of the fibular head associated with a tibia fracture.

Superior dislocation of the fibular head associated with a fractured tibia occurred in four cases with a direct, severe trauma to the tibia. In one case there was permanent peroneal nerve damage. This injury is somewhat analogous to the fracture-dislocation of the Monteggia type in the forearm. To diagnose secondary dislocations of the fibula and treat the condition early, the knee joint should be carefully examined before and after X-ray of all fractures of the tibia.

Adolescent↗
PubMed1993

Arthroscopy of the acute traumatic knee in children. Prospective study of 138 cases.

We performed diagnostic arthroscopy for acute knee trauma in 138 children and adolescents aged 13 (1-15) years. The compatibility between the clinical examination and the arthroscopic findings was 59 percent. Ligament injuries were found in 32 cases, 14 of which had rupture of the anterior cruciate ligament. The compatibility in the case of ligament injuries was 31 percent. 48 patients had dislocation of the patella, and a displaced osteochondral fragment was seen in 19, 14 of which were radiographically silent. In 37 cases of distortion of the knee a correct diagnosis would have been missed unless arthroscopy had been performed. Arthroscopy is therefore indicated in children with severe distortion of the knee, hemarthrosis and with dislocation of the patella.

Adolescent↗
PubMed1994

Patellar thickness in total knee replacement.

The question of patellar thickness after total knee replacement (TKR) is an important issue. From November 1989 to June 1993, a total of 294 TKR were performed on 219 patients (34 males, 185 females) with an average age of 67 years. Tricon-M prostheses were used in TKRs performed before October 1992, and PCA prostheses were used after that date. In each TKR, all polyethylene patellar components used on patellar resurfacing were cemented in place. The average preoperative patellar thickness was 21.2 +/- 1.8 mm. The thickness was preserved in 106 knees, while for 53 knees, a slight increase in thickness (mean, 1.5 +/- 0.9 mm) was recorded, and for 120 knees, a slight decrease in thickness (mean, 1.5 +/- 0.8 mm) was recorded. Lateral retinacular release was performed in 96 knees (40%) of the 238 TKR with a Tricon-M prosthesis, but in only seven knees (17%) among the 41 TKR using the PCA prosthesis. Patellar subluxation and dislocation after TKR occurred in 13 knees of 11 patients (10 females, one male, mean body weight 63.5 kg) with the Tricon-M prosthesis. The mean time from arthroplasty to occurrence of patellar instability was eight months. Six knees were treated by proximal realignment procedure while seven knees were given conservative treatment, with good results and no recurrence reported. The use of a patellar cutting jig allows better control of patellar thickness when performing patellar resurfacing for small patella. No complications such as patellar fracture, infection or patellar component-loosening were encountered in the 294 TKRs performed.

Aged↗
PubMed1988

Patellofemoral problems following total knee arthroplasty.

We reviewed 350 knee arthroplasties performed between 1977 and 1984 for patellar problems. Seventeen knees with four types of patellofemoral complications were found. The diagnosis in both the group of 350 and the study group of 17 knees was evenly distributed between rheumatoid arthritis and osteoarthritis. The complication rate was 4.9%. Follow-up ranged from one to nine years post-complication. Two knees had two different complications, providing a total of 19 complications with five loosenings, three fractures of the patella, one fracture of the patellar component, and ten subluxations or dislocations. Sixteen revision surgical procedures were performed on 11 knees. Six knees were managed nonoperatively. In the four knees with multiple surgeries, one of the complications was patellar subluxation or dislocation. Only one patient was dissatisfied with his result; however, this included both knees. Patellar complications continue to be recognized as a frequent cause of problems after total knee arthroplasty. We recommend nonoperative management of patellar fractures, revision of implant with loosening or component fracture, and careful selection of realignment procedures.

Aged↗
PubMed2005

Trochleoplasty in dysplastic knee trochlea.

In patients complaining of recurrent patellar dislocations or persistent retropatellar pain due to a dysplastic femoral trochlea, we perform a Henri Dejour trochleoplasty. In this technique the femoral trochlea is deepened by removing the subchondral trochlear bone followed by incision, impaction and fixation of the cartilage flange along the trochlear groove. Between 1996 and 1999, 13 procedures were performed in 12 patients. Strictly lateral X-rays showed dysplasia of the trochlea, as defined by the "crossing sign", whether or not in combination with patella alta. Patients were assessed using the Larsen-Lauridsen score considering pain, stiffness, osteopatellar crepitus, flexion and loss of function. Although the majority of patients scored fair and poor on an objective scoring system, we achieved 77% good to very good subjective results. Although the result was not perfect, the patients were satisfied with the procedure. This technique might be a valuable alternative in cases of frank trochlear dysplasia associated with persistent retropatellar pain or recurrent patellar dislocations.

Adolescent↗
PubMed1979

The natural history of congenital disease of the hip.

Fifty-four adults with eighty hips affected by congenital disease which had not been treated have been reviewed. Fifty-nine per cent of forty-two dislocated hips had fair or poor grading scores. The incidence of osteoarthritis was markedly increased in the presence of a well-developed false acetabulum. Unilateral dislocation led to valgus deformity and degenerative changes in the ipsilateral knee in seven of twenty-two patients. Dislocation did not increase the incidence of symptomatic lumbar spondylosis. The height of the dislocated head on the ilium was not found to be related to the prognosis for the hip, the knee or the lumbar spine and did not correlate with the development of the false acetabulum. Frank congenital subluxation eventually led to osteoarthritis of the hip.

Acetabulum↗
PubMed2004

Epidemiology and natural history of acute patellar dislocation.

BACKGROUND: The goals of this study were to (1) define the epidemiology of acute patellar dislocation, (2) determine the risk of subsequent patellar instability episodes (subluxation and/or redislocation) during the study period, and (3) identify risk factors for subsequent instability episodes. STUDY DESIGN: Prospective cohort study. METHODS: The authors prospectively followed 189 patients for a period of 2 to 5 years. Historical data, injury mechanisms, and physical and radiographic measurements were recorded to identify potential risk factors for poor outcomes. RESULTS: Risk was highest among females 10 to 17 years old. Patients presenting with a prior history of instability were more likely to be female (P < .05) and were older than first-time dislocation patients (P < .05). Fewer first-time dislocators (17%) had episodes of instability during follow-up than patients with a previous history of instability (49%) (P < .01). After adjusting for demographics, patients with a prior history had 7 times higher odds of subsequent instability episodes during follow-up than first time dislocators (adjusted odds ratio = 6.6, P < .001). CONCLUSIONS: Patellar dislocators who present with a history of patellofemoral instability are more likely to be female, are older, and have greater risk of subsequent patellar instability episodes than first-time patellar dislocators. Risk of recurrent patellar instability episodes in either knee is much higher in this group than in first-time dislocators.

Acute Disease↗
PubMed2003

Sonographic appearances of medial retinacular complex injury in transient patellar dislocation.

AIM: To describe the sonographic appearances of the medial retinacular (MPFR) complex of the knee in patients with acute and recurrent patellar dislocation. MATERIALS AND METHODS: Thirty patients were scanned within 2-4 weeks of an acute episode of lateral patellar dislocation. Eleven gave a history of recurrent patellar dislocation. Ten patients had examination under anaesthesia with arthroscopy and repair of the injury. The sonographic and operative results were compared. RESULTS: The normal sonographic appearance of the MPFR is described. Of the 10 patients who underwent examination under anaesthesia, four patients had complete avulsion of the MPFR from the patella, two patients had avulsion of the MPFR from the adductor tubercle and four patients had avulsion of the MPFR from both the patella and adductor tubercle. There was complete correlation between the sonographic and operative findings for injuries of the MPFR. Other findings included partial retinacular tears, injury to the medial collateral ligament, haematoma within vastus medialis obliquus (VMO) and bony avulsions from the patella and adductor tubercle CONCLUSION: Sonography gives reliable information regarding the site of the injury and its extent thus helping to decide whether conservative or operative treatment is the most appropriate approach to management of the injury.

Acute Disease↗
PubMed1996

Paediatric sports injuries in Hong Kong: a seven year survey.

OBJECTIVE: To ascertain the epidemiological characteristics of sports injuries in children in Hong Kong. METHODS: Retrospective review of all cases seen in the Sports Injury Clinic of the Prince of Wales Hospital, Shatin, Hong Kong, in the period May 1984 to December 1990. The variables studied were age at presentation, gender, side of the body injured, anatomical location of the injury, type and severity of injury, sport played, level (school, recreational, amateur and professional) and frequency of sports participation, length in years of sports practice, and initial management of the injury. RESULTS: Of the 2293 patients seen, 238 were youngsters (54% boys) 16 years old or younger. Ball games accounted for the greatest number of injuries, with 37 children taking part in basketball, 28 in soccer, 12 in volleyball, and 31 children taking part in a variety of other ball games. Of the remaining children, the single largest group was practising track and field, with sprinting and middle distance running accounting for 42 injuries, and 28 children were injured while cycling. Most of the injuries (85%) were classified as non-serious, but 15% of children presented with a total of 21 fractures, two joint dislocations, five concussions, and seven torn knee ligaments. CONCLUSIONS: Children sports participation in Hong Kong, although not at high level and not as widespread as in the West, accounts for significant morbidity. These injuries should be carefully monitored to ascertain whether they result in any detrimental long term effects.

Adolescent↗
PubMedDate not supplied

Larsen's syndrome: review of the literature and analysis of thirty-eight cases.

Thirty-eight cases of Larsen's syndrome in patients living on Reunion Island were analyzed, with an average follow-up of 13 years. Fourteen of these patients died of early complications secondary to dislocation of the cervical spine, tracheomalacias, heart disease, and severe respiratory infection. These children pose a problem of planning early treatment. Clubfeet must be treated conservatively early, and operation should be postponed until after knee deformities are corrected by plaster cast and/or early operation. Unilateral hip dislocations should be treated surgically in the second year of life. Treatment of bilateral hip dislocations is best neglected. Finally, the spinal status of these children must be monitored throughout their life.

Abnormalities, Multiple↗
PubMed2002

Locked lateral patellar dislocation with impaction fracture of patella.

Irreducible lateral patellar dislocation is rare. It has previously been described with rotation around a vertical axis. We describe a case of irreducible lateral patellar dislocation in a 66-year-old lady with an impaction fracture of medial facet of patella locked on the lateral femoral condyle. Closed reduction was unsuccessful and the patient was treated by total knee replacement. Such a case has not been described previously in the literature.

Aged↗
PubMed2003

A modified system of stress radiography for patellofemoral instability.

Axial radiographs were obtained under valgus and external rotation stress at 45 degrees of knee flexion with and without contraction of the quadriceps muscle in order to assess the dynamics of patellar subluxation or dislocation. The radiography was performed on 82 knees in 61 patients with patellofemoral instability, and on 44 normal knees. The lateral patellofemoral angle and the congruence angle were measured and compared with the conventional Merchant views. Both parameters showed greater differences between symptomatic and normal knees on the stress radiographs obtained without quadriceps contraction. There was a major difference in the lateral patellofemoral angles between the groups, which clearly distinguished symptomatic knees from normal controls. Congruence angles on stress radiography had a significant correlation with the functional scores obtained after a period of conservative treatment and a positive correlation with the frequency of patellar subluxation. When the quadriceps contracted, two patterns of patellar shift were observed. While the patella reduced into the trochlear groove in all normal knees and about 70% of the symptomatic knees, contraction of the quadriceps caused further subluxation of the patella in the remaining symptomatic knees. All the knee joints which showed this displacement failed to respond to conservative treatment and eventually required surgical treatment. Thus, this technique of stress radiography is a simple, cost-effective and useful method of evaluating patellar instability and predicting the prognosis.

Adolescent↗