Medial Patellar Instability: Treatment and Outcomes

Moatshe, Gilbert; Cram, Tyler R.; Chahla, Jorge; Cinque, Mark E.; Godin, Jonathan A.; LaPrade, Robert F.

doi:10.1177/2325967117699816

Cited by 13 publications

(12 citation statements)

References 28 publications

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“…Multiple techniques for reconstruction of the lateral patellar stabilizers have been described, illustrating the need for a thorough anatomy study. 19,24,25 Reports on clinical outcomes after LPFL reconstruction have had a recent surge in the literature and are often described in the setting of previous lateral retinaculum release complicated by iatrogenic medial patellar instability. Multiple case series have included beneficial outcomes after LPFL reconstruction in this setting.…”

Section: Discussionmentioning

confidence: 99%

A Comprehensive Description of the Lateral Patellofemoral Complex: Anatomy and Anisometry

et al. 2022

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Background: The lateral patellofemoral complex (LPFC) is an important stabilizer of the patella composed of the lateral retinacular structures including the lateral patellofemoral ligament (LPFL), the lateral patellomeniscal ligament (LPML), and the lateral patellotibial ligament (LPTL). While the isolated anatomy of the LPFL has been previously described, no previous study has investigated the entirety of the LPFC structure, length changes, and radiographic landmarks. An understanding of LPFC anatomy is important in the setting of LPFL injury or previous lateral release resulting in iatrogenic medial instability requiring LPFC reconstruction. Purpose: To both qualitatively and quantitatively describe the anatomy and length changes of the LPFC on gross anatomic dissections and standard radiographic views. Study Design: Descriptive laboratory study. Methods: Ten nonpaired cadaveric specimens were utilized in this study. Specimens were dissected to identify distinct attachments of the LPFL, LPML, and LPTL. Ligament lengths, footprints, and centers of each attachment were described with respect to osseous landmarks using a 3-dimensional coordinate measuring device. Ligament length changes were also assessed from 0° to 90° of flexion. Radiopaque markers were subsequently utilized to describe attachments on standard anteroposterior and lateral radiographic views. Results: The individual elements of the LPFC were identified in all specimens. The LPFL patellar attachment had an average total length of 22.5 mm (range, 18.3-27.5 mm), involving a mean of 59% (range, 50%-75%) of the sagittal patella. Based on the average patellar size, a mean of 63% of the LPFL attached to the patella, and the remainder (11.1 ± 1.4 mm) inserted into the patellar tendon. The femoral attachment of the LPFL had a mean maximum length of 24.4 ± 4.3 mm. The center of the LPFL femoral attachment was a mean distance of 13.5 ± 3.2 mm anterior and distal to the lateral epicondyle. The LPFL demonstrated significant shortening, especially in the first 45° of flexion (7.5 ± 5.1 mm). In contrast, the LPTL (5.5 ± 3.0 mm) and LPML (10.0 ± 3.3 mm) demonstrated significant shortening from 45° to 90°. On lateral radiographs, the center of the femoral attachment of the LPFL was a mean total distance of 19.2 ± 7.2 mm from the lateral epicondyle. Conclusion: The most important findings of this study were the correlative anatomy of 3 distinct lateral patellar ligaments (LPFL, LPML, and LPTL) and their anisometry through flexion. All 3 components demonstrated significant shortening during flexion. The quantitative and radiographic measurements detailed the LPFL osseous attachment on the patella; soft tissue attachment on the patellar tendon; and finally, the osseous insertion on the femur distal and anterior to the lateral epicondyle. Similarly, the authors documented the meniscal insertion of the LPML and defined a patellar insertion of the LPTL and LPML as a single attachment. These data allow for reproducible landmarks to aid in the understanding and reconstruction of the lateral patellar restraints. Clinical Relevance: The data produced from this investigation provide a comprehensive description of these 3 lateral patellar stabilizers (LPFL, LPML, LPTL). These data can be used intraoperatively to facilitate anatomic reconstructions of the lateral patellar stabilizers.

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Section: Discussionmentioning

confidence: 99%

A Comprehensive Description of the Lateral Patellofemoral Complex: Anatomy and Anisometry

et al. 2022

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“…Moatshe et al. 10 published a case series of 13 knees using a technique combining autograft lateral patellar tendon and ITB, showing improvement in Lysholm and Western Ontario and McMaster Universities Arthritis Index scores at 2 years postoperatively with a mean satisfaction of 8.2/10. Sanchis-Alfonso et al.…”

Section: Discussionmentioning

confidence: 99%

“…A few retrospective studies have looked at outcomes in LPFL reconstruction. Moatshe et al 10 published a case series of 13 knees using a technique combining autograft lateral patellar tendon and ITB, showing improvement in Lysholm and Western Ontario and McMaster Universities Arthritis Index scores at 2 years postoperatively with a mean satisfaction of 8.2/10. Sanchis-Alfonso et al 8 reported on 17 knees at 18 to 48 months postoperatively using ITB autograft and found similarly improved Lysholm scores and improved psychometrics postoperatively.…”

Section: Discussionmentioning

confidence: 99%

“…While a range of techniques have been described resulting in good outcomes, our preference is to perform a soft tissue–based LPFL reconstruction. 8 , 9 , 10 Due to the paucity of literature as well as the varied anatomical descriptions, for the purposes of discussion in this manuscript, the term LPFL reconstruction will refer to any augmentation technique of the lateral retinaculum to treat medial patellar instability.…”

Section: Introductionmentioning

confidence: 99%

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Medial Patellofemoral Ligament Reconstruction With Concomitant Lateral Patellofemoral Reconstruction for Patellar Instability

Parvaresh¹,

Huddleston²,

Yanke³

2021

Arthroscopy Techniques

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Patients with bidirectional patellar instability who are unresponsive to conservative management may benefit from a medial patellofemoral ligament (MPFL) reconstruction and lateral patellofemoral ligament (LPFL) reconstruction. If an isolated MPFL reconstruction does not provide adequate stabilization intraoperatively, combined MPFL and LPFL reconstruction allows independent reconstruction, which can be performed with a facile, reproducible technique. The purpose of this report was to describe our technique for performing an MPFL reconstruction with a concurrent soft-tissue LPFL reconstruction combined with a distalizing tibial tubercle osteotomy to correct patella alta.

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“…It is also important to recognize pediatric patients with congenital (fixed) or obligatory (habitual) patellar dislocations as these patients often require extensive bony realignment and soft tissue tensioning procedures with better outcomes when performed at a younger age [80]. Furthermore, in rare cases, patients may suffer from medial patellar instability in the setting of an acute traumatic dislocation or secondary to iatrogenic damage to lateral sided structures (i.e., isolated lateral release) necessitating alternative forms of surgical intervention [81,82].…”

Section: Additional Considerationsmentioning

confidence: 99%

Recurrent Patellofemoral Instability in the Pediatric Patient: Management and Pitfalls

Vellios

Trivellas

Arshi

et al. 2020

Curr Rev Musculoskelet Med

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Purpose of Review The purpose of the review is to discuss the relevant pathoanatomy, management, complications, and technical considerations for recurrent patellofemoral instability (PFI) in the pediatric population. Special consideration is given to recent literature and management of the patient with repeat instability following surgery. Recent Findings Patellar stabilization surgery is in principle dependent upon restoration of normal patellofemoral anatomy and dynamic alignment. Historically, treatment options have been numerous and include extensor mechanism realignment, trochleoplasty, and more recently repair and/or reconstruction of the medial patellofemoral ligament (MPFL) as a dynamic check rein during initial knee flexion. In skeletally immature patients, preference is given to physeal-sparing soft tissue procedures. While medial patellofemoral ligament reconstruction has become a popular option, postoperative failure is a persistent issue with rates ranging from 5 to 30% for PFI surgery in general without any single procedure (e.g., distal realignment, MPFL reconstruction) demonstrating clear superiority. Failure of surgical patellar stabilization is broadly believed to occur for three main reasons: (1) technical failure of the primary stabilization method, (2) unaddressed static and dynamic pathoanatomy during the primary stabilization, and (3) intrinsic risk factors (e.g., collagen disorders, ligamentous laxity). Summary PFI is a common orthopedic condition affecting the pediatric and adolescent population. Treatment of repeat instability following surgery in the PFI patient requires understanding and addressing underlying pathoanatomic risk factors as well as risks and reasons for failure.

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Medial Patellar Instability: Treatment and Outcomes

Cited by 13 publications

References 28 publications

A Comprehensive Description of the Lateral Patellofemoral Complex: Anatomy and Anisometry

A Comprehensive Description of the Lateral Patellofemoral Complex: Anatomy and Anisometry

Medial Patellofemoral Ligament Reconstruction With Concomitant Lateral Patellofemoral Reconstruction for Patellar Instability

Recurrent Patellofemoral Instability in the Pediatric Patient: Management and Pitfalls

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