Why Do Patellofemoral Stabilization Procedures Fail? Keys to Success

Caplan, Nick; Nassar, Islam; Anand, Bobby; Kader, Deiary F.

doi:10.1097/jsa.0000000000000135

Cited by 15 publications

(22 citation statements)

References 66 publications

(66 reference statements)

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“…Because genu valgum has been regarded as one of negative factors to increase the forced displacement of patella laterally and cause a J-sign during the nal extension of the knee [9,25]. The MPFL serves as restricting lateral translation of the patella yet it does not pull the patella into the trochlear groove, hence isolated MPFLR shouldn't be recommended in the patients of genu valgum [26].…”

Section: Discussionmentioning

confidence: 99%

Closing-wedge Distal Femoral Osteotomy Combined with Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Dislocation with Genu Valgum

Jing¹,

Wang²,

Liu³

et al. 2020

Preprint

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Background: Medial patellofemoral ligament reconstruction (MPFLR) is a well-established procedure for addressing recurrent patellar dislocation (RPD) in young patients. However, for RPD with genu valgum, simultaneous MPFLR and closing-wedge distal femoral osteotomy (CWDFO) may be a promising procedure yet rarely reported. This study’s purpose was to observe and analyse the clinical and imaging findings of CWDFO combined with MPFLR for RPD with genu valgum.Methods: From May 2015 to Apirl 2018, 25 patients with RPD and genu valgum were surgically treated in our department. Anteroposterior long-leg, weight-bearing, lower-extremity radiographs, lateral radiographs and computed tomography (CT) scans of the patellofemoral joint were obtained, and the femorotibial angle (FTA), mechanical lateral distal femoral angle (mLDFA), weight-bearing line rate (WBLR), patellar height, patellar lateral shift (PLS) and tibial tubercle–trochlear groove (TT-TG) distance were analysed. Validated knee scores, such as the Kujala, Lysholm, visual analogue scale (VAS) scores and Tegner socres, were evaluated preoperatively and 2 years postoperatively.Results: 25 patients, with an average age of 19.8 years (14–27), were evaluated. All patients had been able to achieve a better sports level without any problems during the 2-year follow-up period. There has been no recurrence of patellar instability. Compared with preoperation, the FTA, mLDFA, WBLR and PLS showed statistically significant improvement following the procedure (p < 0.001). Meanwhile, no significant differences in the Insall index and TT-TG distance was found. The mean Kujala score, average Lysholm score, VAS score and Tegner socres showed significant improvement postoperatively.Conclusions: CWDFO combined with MPFLR is a suitable treatment for RPD with genu valgum, as it leads to significant improvement in the clinical and imaging findings of the knee in the short term.

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Section: Discussionmentioning

confidence: 99%

Closing-wedge Distal Femoral Osteotomy Combined with Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Dislocation with Genu Valgum

Jing¹,

Wang²,

Liu³

et al. 2020

Preprint

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“…patellofemoral ligament (MPFL) reconstruction, lateral retinacular release, tibial tubercle osteotomy and trochleoplasty are the most commonly discussed techniques in the contemporary literature. [3,5] In patients with a lateralized tibial tubercle where TT-TG distance is greater than 20 mm, anteromedial tibial tubercle transfer has been shown to be effective addressing much pathology by providing an opportunity to balance tracking forces and restore soft tissue restraints to a normal configuration. However, skeletal immaturity is a contraindication for this procedure as described by several others.…”

Section: Medialmentioning

confidence: 99%

“…in the etiology. [3] Owing to this varying etiology, myriad surgical techniques have been described in the last 100 years. It is recommended to individualize the treatment for each patient with a thorough preoperative planning considering all aforementioned factors.…”

mentioning

confidence: 99%

Treatment of a combined deformity following tibial tubercle ventromedialization with single proximal tibial closing wedge osteotomy

Sezgin

Szerb

Tóth

et al. 2019

Eklem Hastalik Cerrahisi

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Incidence of patellar dislocation is highest in adolescents; almost 10 times higher than in adults. [1] It is known that 69% of first time patellar dislocations are seen between 10-19 years. [2] There are dynamic factors (weak hip abductors and vastus medialis, tight lateral retinaculum and iliotibial band) and static factors (increased Q-angle, valgus malalignment, patella alta, trochlear dysplasia, lateralization of tibial tuberosity) ÖZİskelet gelişimi tamamlanmamış hastalarda patellar instabiliteye yaklaşırken olası fizis hasarı göz önünde bulundurulmalıdır. Bu yazıda, pediatrik tibial tüberkül ventromedializasyonunu takiben gelişen; genu rekurvatum, genu valgum ve patella baja'dan oluşan bir kombine diz deformitesi olgusu sunuldu. Hasta ilk başvurusunda 22 yaşında olan bir kadın idi. Kıkırdağın sağlıklı olduğu doğrulandıktan sonra deformite tek bir supratüberküler posteriyor ve medial temelli proksimal tibial kapalı kama osteotomisi ile düzeltildi. Yedinci yıl kontrolünde hastanın ağrısı yoktu, fonksiyonel açıdan memnundu ve radyografik değerlendirme düzgün dizilim gösterdi. Bu olgu patellar instabilite tedavisi sırasında fizis hasarı gelişirse karşılaşılacak zorlukları ve kombine genu rekurvatum, genu valgum ve patella baja deformitelerini tedavi eden tek bir iyi planlanmış supratüberküler proksimal tibial osteotominin etkililiğini, kullanımının yaygınlaşması için anatomik ve klinik çalışmalara gerek olsa da göstermektedir. ABSTRACTPatellar instability in skeletally immature patients must be approached with concern of potential damage to physes. In this article, we present a case of combined knee deformity consisting of genu recurvatum, genu valgum and patella baja which arose subsequent to a pediatric tibial tubercle ventromedialization. Patient was a female who was 22 years old upon first admission. After confirming cartilage to be in good health, the deformity was corrected with a single supratubercular posteriorly and medially based proximal tibial closing wedge osteotomy. At the seventh year follow-up, patient was pain free, functionally satisfied and radiographic evaluation showed correct alignment. This case illustrates the consequent difficulties faced if physeal damage occurs during treatment of patellar instability as well as effectiveness of a single well-planned supratubercular proximal tibial osteotomy treating combined genu recurvatum, genu valgum and patella baja deformities; although anatomic and clinical studies are required to generalize its use. Citation:Sezgin EA, Szerb I, TÓTH Z, Hangody L. Treatment of a combined deformity following tibial tubercle ventromedialization with single proximal tibial closing wedge osteotomy. Eklem Hastalik Cerrahisi 2019;30(3):316-321.

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“…68 Nonunion of the osteotomy is relatively rare. 69 Overcorrection may lead to medial patellar subluxation and increased stress on the medial patellofemoral joint, or less commonly to patella infera. 56,70 When combined with MPFL Fig.…”

Section: Distal Patellar Tendon Realignmentmentioning

confidence: 99%

Postoperative Imaging of the Knee Extensor Mechanism

Long

Rubin

2018

Semin Musculoskelet Radiol

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The extensor mechanism of the knee plays an important role in many movements of the lower extremity. Although its main function is to extend the knee, it also stabilizes the patellofemoral joint and resists passive flexion of the knee when landing from jumping. Pathologic conditions of the extensor mechanism can be acute or chronic, and they can negatively affect daily activities. Fortunately, many surgical treatments are available aimed at restoring function to the injured extensor mechanism. Understanding the surgical techniques and common complications of these procedures enables the radiologist to recognize expected and unexpected postoperative imaging appearances.

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Why Do Patellofemoral Stabilization Procedures Fail? Keys to Success

Cited by 15 publications

References 66 publications

Closing-wedge Distal Femoral Osteotomy Combined with Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Dislocation with Genu Valgum

Closing-wedge Distal Femoral Osteotomy Combined with Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Dislocation with Genu Valgum

Treatment of a combined deformity following tibial tubercle ventromedialization with single proximal tibial closing wedge osteotomy

Postoperative Imaging of the Knee Extensor Mechanism

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