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PubMedDate not supplied

Functional treatment of patellar dislocation in an athletic population.

Fifty-eight athletically active study participants with 69 knees that had experienced patellar dislocations were available for followup after being selected for a functional rehabilitation program without antecedent immobilization. Follow-up evaluation was at a minimum of 24 months after onset of treatment and averaged 46.2 months. Good or excellent results occurred in 39 (66%) knees treated after an initial patellar dislocation and in 15 (50%) knees with a chronic history of patellar instability. Twenty-six percent of the 69 knees had experienced recurrent patellar instability at followup. Overall, 42 patients (73%) were satisfied with their knees after this nonsurgical management. Anatomic predisposition and onset of bilateral instability at an early age were found to be significant factors associated with a less favorable outcome.

Adolescent↗

PubMed1996

External tibial torsion: an underrecognized cause of recurrent patellar dislocation.

Seventeen patients (18 knees) with recurrent patellar dislocation were identified with increased quadriceps angles secondary to excessive isolated external tibial torsion. Traditional realignment procedures attempted in these knees were unsuccessful because of failure to align the biomechanical axis of the extensor mechanism. Derotational osteotomies of the tibia just proximal to the patella tendon insertion were used to reduce the quadriceps angle to within normal limits to improve the biomechanics of the extensor mechanism. Seventeen (94%) knees were available for clinical and subjective followup at an average of 25 months (range, 1-3.2 years). Overall, 13 of the 17 knees were graded as good to excellent (76%). Five of the 17 patients also had well established anterior knee pain in addition to recurrent dislocation and were treated with a combined derotational and Maquet type osteotomy, with 4 patients obtaining a good to excellent result. Knees that subjectively and functionally demonstrated less painful symptoms preoperatively were associated with excellent results. Poor outcomes were associated with knees that were operated on multiple times.

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↗

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↗

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↗

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↗

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↗

PubMed1990

The Hauser operation for patellar dislocation. 3-32-year results in 63 knees.

The Hauser operation for patellar dislocation was performed in 34 women and 20 men, median age 18 (3-55) years; one leg was amputated because of wound infection with chronic septic arthritis. At the time of follow-up, 8 (3-32) years after the operation 57 knees had normal or almost normal patellar stability, but only 26 knees were free from pain. Only 16 knees had both normal patellar stability and were without pain. Patellar arthrosis had developed in 16 knees and femorotibial arthrosis in 23 knees. Eleven patients operated on before the age of 15 years showed varying grades of axial deformity of the proximal tibia.

Adolescent↗

PubMed1986

Patellar dislocation and osteochondral fractures.

Follow-up study of nine patients with patellar dislocation in combination with osteochondral fractures. Three of these patients with special problems in relation to knee pathology are discussed in detail. This group of knee injuries is often overlooked because of frequent spontaneous reposition. Etiology, diagnosis and treatment are discussed. Arthroscopy is recommended to visualize chondral defects. Results are presented in combination with follow-up. Four patients still complain of instability of the knee after surgery. Reconstruction is the treatment of choice. The kind of fixation depends on the size of the osteochondral fragment, and consists of either screws or fibrin, in future possibly resorbable pins. Continuous passive motion is to be recommended after operation. Factors predisposing to recurrence are an indication for correction.

Adolescent↗

PubMed1997

Recurrence after patellar dislocation. Redislocation in 37/75 patients followed for 6-24 years.

75 patients had closed treatment for a primary unilateral acute patellar dislocation. All patients were studied clinically, radiographically and for isokinetic thigh muscle performance a median of 11 (6-24) years later. During the follow-up, 37 patients had experienced recurrent dislocations. The functional outcomes were similar in patients with or without recurrence. Radiographically unstable patellar morphology, spontaneous reduction of the dislocation and low volume of hemarthrosis predisposed to recurrence.

Adolescent↗