Patellofemoral instability: Current status and future perspectives

Migliorini, Filippo; Maffulli, Nicola; Vaishya, Raju

doi:10.1016/j.jor.2022.12.010

Cited by 3 publications

(5 citation statements)

References 10 publications

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“…FE analysis, supported by clinical studies, can lead to a better disease-management approach in terms of time, results, and improved healthcare costs [55]. Effective treatment options are important to improve patient outcomes and prevent further deterioration; thus, conservative treatment through gradual muscle-strengthening and improvement of joint proprioception plays a fundamental role in the management of the pathology [7]. Prevention is also essential in patients with anatomical and biomechanical predispositions, and in those with a history of dislocation [25]; however, the best treatment for patellar instability remains controversial, with differing opinions regarding surgical versus non-surgical approaches and the most effective surgical techniques [27].…”

Section: Discussionmentioning

confidence: 99%

“…These two bony ends are covered by a strong fibrous capsule which holds them together in synergy with the action of the ligaments, which, combined with the geometry, restrict movement [5,6]. On the other hand, the patellofemoral joint is composed of the patella and the trochlear surface, which are morphologically related, i.e., the patella has an optimised surface for sliding over the femur, which in turn forms a groove that acts as a track for the patella [7].…”

Section: Introductionmentioning

confidence: 99%

“…The most significant patellar movement occurs in the sagittal plane, but significant horizontal sliding is possible in the frontal plane [7]. In order to provide an anatomical description, as has been done previously by other authors [14], Figure 1 shows a 3D volume rendering of the knee from the TC images.…”

Section: Introductionmentioning

confidence: 99%

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Quadriceps Muscle and Medial Retinaculum Combinate Effects on Patellar Instability during Knee Flexion

2023

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Background: Patellar instability can cause pain and disability. A finite element model of a healthy human knee was performed to analyze the role of quadriceps and medial retinaculum imbalance in patellar instability. Methods: The model was created by matching magnetic resonance and computed tomography images of a normal adult patient’s knee. Muscle force intensities were calculated by static optimization, considering the lower limb muscles, knee movement and the ground reaction during walking. Patellar instability was experimentally generated by progressively uncoupling muscular forces, (90 N versus 110 N), while at the same time, the load derived from the quadriceps was gradually reduced by 20%. Results: This loss in force symmetry of 10 N on the retinaculum may produce a displacement of approximately 7 mm, with an increase in patellar contact forces of approximately 44%. When the quadriceps force is reduced by 10% and the unbalanced medial retinaculum acts together, the displacements are in the order of 14 mm, and the patellar contact forces increase by 84%. Conclusion: A reduced quadriceps force alone is not able to cause significant patellar instability, while an imbalance of forces at the level of the retinaculum could lead to patellar instability, especially when the two effects are combined. A better understanding of joint relationships and muscle synergies can help to improve clinical approaches to patella instability

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Quadriceps Muscle and Medial Retinaculum Combinate Effects on Patellar Instability during Knee Flexion

2023

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“…Over the last few years, there has been an increased scientific and clinical interest in MPFL reconstruction concerning the refinement of its technique and clinical outcomes [32]. In the current literature, MPFL reconstruction was associated with a significant improvement in PROMs, a low rate of progression to recurrent PFI and complications [12,33,34]. However, when other anatomical factors in PFI are also present, such as an increased tibial tuberosity to trochlear groove distance, lower limb malalignment or patellar/trochlear dysplasia, isolated MPFL reconstruction may not be sufficient [35].…”

Section: Discussionmentioning

confidence: 99%

Allografts for Medial Patellofemoral Ligament (MPFL) Reconstruction in Adolescent Patients with Recurrent Patellofemoral Instability: A Systematic Review

et al. 2023

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This systematic review updates the currently available evidence on medial patella-femoral ligament (MPFL) reconstruction using allografts. The outcomes were measured with patient-reported outcome measures (PROMs), redislocation and complication rates. This study was performed according to the 2020 PRISMA guidelines using the PubMed, Scopus, Web of Science databases, accessed in February 2023. Studies examining the clinical outcomes of MPFL reconstruction with allografts in adolescents and children with recurrent patellofemoral instability (PFI) were included. Data from three trials, including 113 surgical procedures in 121 children, were retrieved. 40% (48/121) of the included patients were girls. The mean age of the patients was 14.7 ± 0.8 years, and the mean follow-up length was 38.1 ± 16.5 months. With MPFL allograft reconstruction, the Kujala score improved by 14.7% (p < 0.0001) and the IKDC by 38.8% (p < 0.0001). The rate of dislocations was 5% (6 of 121), reoperation for instability was 11% (13 of 121), and subluxation was 2% (1 of 47). Conclusion: These results encourage the use of allografts for MPFL reconstruction in adolescent patients with recurrent patellofemoral instability. Though patellofemoral instability is common in clinical practice, the current literature lacks clinical evidence on allograft MPFL reconstruction. Additional high-quality investigations are required to properly establish the long-term advantages of allograft MPFL and its complication rate.

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“…Patients with patellofemoral instability exhibit abnormal patellar tracking over the femoral trochlea during motion [1,2] and report discomfort during prolonged knee flexion or during sports activities [3][4][5]. Several risk factors predispose to patellofemoral instability, including patella alta, trochlear dysplasia, muscle imbalance, increased distance between the tibial tubercle (TT) and trochlear groove (TG), valgus, and femoral deformity, especially anteversion [6][7][8][9]. Patellar dislocation accounts for 2-3% of all knee injuries [10].…”

Section: Introductionmentioning

confidence: 99%

Conservative management following patellar dislocation: a level I systematic review

et al. 2023

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Background Patellar instability is a common and disabling clinical condition. Treatment of acute primary patellar dislocation aims to reduce the risk of recurrence or painful subluxation and improve function. However, the actual clinical efficacy of any management modality following an acute dislocation has never been demonstrated in prospective or retrospective studies, and the optimal way in which the various management modalities should be used is at best unclear. Methods A search was conducted in PubMed, Bireme and Embase databases. Inclusion criteria followed the acronym PICOS, (P) subjects with patellar instability, (I) therapeutic interventions, (C) placebo or control or surgical treatments, (O) rate of dislocations and function, and (S) clinical trials. The Medical Subject Headings (MeSH) terms used were: ((“patellar instability”) OR (“patellar dislocation”)) AND ((physiotherapy) OR (rehabilitation) OR (“conservative treatment”) OR (therapy) OR (therapeutic)). The risk of bias was analysed using the PeDRO scale. Results Seven randomized controlled trials including 282 patients were considered. The quality of studies detailing the results of conservative treatment was higher than that of surgical procedures, but all studies have relatively low methodological quality. Four studies compared physiotherapeutic interventions with surgical procedures, and three studies compared conservative intervention techniques. Conclusion An unstructured lower limb physical therapy programme evidences similar outcomes to specific exercises. Surgical management is associated with a lower rate of re-dislocation; however, whether surgery produces greater functional outcomes than conservative management is still unclear. The use of a knee brace with a limited range of motion, stretching and neuromuscular exercises are the most commonly recommended physiotherapy methodologies.

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Patellofemoral instability: Current status and future perspectives

Cited by 3 publications

References 10 publications

Quadriceps Muscle and Medial Retinaculum Combinate Effects on Patellar Instability during Knee Flexion

Quadriceps Muscle and Medial Retinaculum Combinate Effects on Patellar Instability during Knee Flexion

Allografts for Medial Patellofemoral Ligament (MPFL) Reconstruction in Adolescent Patients with Recurrent Patellofemoral Instability: A Systematic Review

Conservative management following patellar dislocation: a level I systematic review

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