Current Concepts in the Management of Patellar Instability

Laidlaw, Michael S.; Diduch, David R.

doi:10.4103/ortho.ijortho_164_17

Cited by 39 publications

(28 citation statements)

References 82 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Patellar instability is a common orthopedic complaint representing up to 3% of clinical presentations involving the knee [1][2][3]. In the absence of intraarticular pathology, patients presenting with first-time dislocations are primarily treated nonoperatively [4][5][6][7][8]. Recurrent instability ranges from 15 to 71% of patients initially treated nonoperatively and requires operative intervention [1,7,[9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Avoiding Complications with MPFL Reconstruction

Smith

Werner

Diduch

2018

Curr Rev Musculoskelet Med

Self Cite

View full text Add to dashboard Cite

Multiple cadaveric studies have characterized the anatomy of the MPFL and the related morphologic abnormalities that contribute to recurrent lateral patellar instability. Such abnormalities include patella alta, excessive tibial tubercle to trochlear grove (TT-TG) distance, trochlear dysplasia, and malalignment. Recent studies have evaluated the clinical outcomes associated with the treatment of concomitant pathology in combination with MPFL reconstruction, which is critical in avoiding recurrent instability and complications. Although there remains a lack of consensus regarding various critical aspects of MPFL reconstruction, certain concepts remain imperative. Our preferred methods and rationales for surgical techniques are described. These include appropriate work up, a combination of procedures to address abnormal morphology, anatomical femoral insertion, safe and secure patellar fixation, appropriate graft length fixation, and thoughtful knee flexion during fixation.

show abstract

Section: Introductionmentioning

confidence: 99%

Avoiding Complications with MPFL Reconstruction

Smith

Werner

Diduch

2018

Curr Rev Musculoskelet Med

Self Cite

View full text Add to dashboard Cite

show abstract

“… 9 Detailed history, physical exam, and radiographic evaluation are vital to identify the presence of primary anatomic risk factors of patellar instability, including trochlear dysplasia, coronal malalignment manifested as genu valgum or elevated tibial tubercle-trochlear groove (TT-TG) distance, femoral anteversion, and patella alta. 1 We acquire a standard 3-view radiographic series, including a standing flexion posteroanterior, lateral, and 45° flexed axial Merchant view of the knee as part of our initial imaging workup. We routinely acquire additional advanced imaging, usually consisting of magnetic resonance imaging for further evaluation of the patient’s anatomy.…”

Section: Surgical Techniquementioning

confidence: 99%

“…Identifying and addressing additional anatomic features that predispose patients to instability events with a combination of surgical interventions helps to ensure the best outcome. 1 …”

Section: Surgical Techniquementioning

confidence: 99%

“…Reconstruction of the medial patellofemoral ligament (MPFL), the main static stabilizer of the knee during early flexion, is the primary surgical intervention for recurrent patellar instability. 1 Current reconstruction techniques, which differ in their modality of patellar graft fixation, include the use of suture anchors, interference screws, and transpatellar bone tunnels. 2 To date, no single technique has been shown to have superior clinical outcomes.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Small (3.2-mm), Short, Oblique Patellar Tunnels for Patellar Fixation in MPFL Reconstruction

Moran

Burke

Diduch

2020

Arthroscopy Techniques

Self Cite

View full text Add to dashboard Cite

Multiple techniques exist for patellar graft fixation during medial patellofemoral ligament (MPFL) reconstruction, each with their respective advantages and disadvantages. In recent studies, the use of 2 small (3.2-mm), short, oblique patellar tunnels with looped graft has been shown to be effective for patellar fixation during MPFL reconstruction. This technique does not appear to be associated with the same risk of patellar fracture as the use of larger (4.5-mm) transpatellar tunnels. A recent retrospective study also reported decreased risk of recurrent patellar instability and decreased cost compared with the use of suture anchors for patellar fixation, which is currently the most common modality. Given these promising findings relative to existing techniques for patellar fixation, further description of the senior author’s technique for using these small (3.2-mm), short, oblique patellar tunnels is provided. This technique is safe, efficacious, and cost-conscious and should be considered a viable option for patellar fixation during MPFL reconstruction.

show abstract

“…Distal tibial realignment has been the treatment of choice for patients with failed conservative treatment for patellar instability due to patella alta of trochlear dysplasia [10,17]. There are two tibial tubercle osteotomies that are most commonly used, the medial tubercle transfer (Elmslie-Trillat) or an anteromedial transfer (Fulkerson) [18]. The Elmslie-Trillat osteotomy is a distal realignment procedure that controls instability and lateral maltracking of the patella by medializing the tibial tuberosity with a lateral soft-tissue and possibly reefing of medial structures [19,20].…”

Section: Introductionmentioning

confidence: 99%

Functional outcome and prognostic implications in patellofemoral instability using Elmslie-Trillat and MPFL reconstruction procedures

Iacobescu

Cîrstoiu

Cursaru

et al. 2019

Romanian Journal of Orthopaedic Surgery and Traumatology

View full text Add to dashboard Cite

Introduction. Patellofemoral instability is a troublesome condition that results in significant morbidity, frequently associated with persistent anterior knee pain, long-term osteoarthritis and reduced quality of life.Purpose. The purpose of this study was to describe functional outcomes following surgical treatment of patients who underwent Elmslie-Trillat procedure and reconstruction of medial patellofemoral ligament (MPFL) correlated with Elmslie-Trillat in the treatment of recurrent patellar dislocation and subluxation.Methods. We prospectively followed 23 patients (24 knees) with patellofemoral instability who underwent realignment surgery procedures between 2015 and 2017, 14 knees by the Elmslie-Trillat procedure (Group 1) and 10 knees by Elmslie-Trillat combined with MPFL reconstruction (Group 2). The patients were evaluated pre and postoperatively by clinical examination, knee radiographs, CT scans and functional outcome Kujala score.Results. At a follow up period of 2 years, the apprehension sign remained positive in 6 knees in Group 1, and only one in Group 2. On the skyline radiographs and axial CT scans, stability was significantly better in group 2 than in group 1. The mean Kujala score was 65.2+/ -9.39 points in group 1, and 87.1+/ -6.43 points in group 2, at 2 years evaluation, significantly higher than before surgery. No patient developed osteoarthritis while being followed up.Conclusion. Based on these findings, we were able to conclude that the reconstruction of the MPFL combined with the osteotomy of distal tuberosity is a useful treatment of recurrent patellar dislocation and subluxation. However, further studies are needed to assess the impact of the realignment procedures in the prevention of joint degeneration.

show abstract

Current Concepts in the Management of Patellar Instability

Cited by 39 publications

References 82 publications

Avoiding Complications with MPFL Reconstruction

Avoiding Complications with MPFL Reconstruction

Small (3.2-mm), Short, Oblique Patellar Tunnels for Patellar Fixation in MPFL Reconstruction

Functional outcome and prognostic implications in patellofemoral instability using Elmslie-Trillat and MPFL reconstruction procedures

Contact Info

Product

Resources

About