Patellofemoral Pain, Instability, and Arthritis (eBook)

Foreword 5
Preface 6
Contents 8
Pathophysiology of Anterior Knee Pain 12
1.1 Introduction 12
1.2 Background: Chondromalacia Patellae, Patellofemoral Malalignment Tissue Homeostasis Theory 12
1.3 Overload in the Genesis of Anterior Knee Pain. Posterior Knee Pain in Patellofemoral Disorders. Kinetic and Kinematic Analysis Help to Improve Understanding 14
1.4 Critical Analysis of Realignment Surgery, What Have We Learned? In Criticism of PFM Concept. Is PFM Crucial for the Genesis of Anterior Knee Pain? 15
1.5 Neuroanatomical Bases for Anterior Knee Pain in the Young Patient: “ Neural Model” 16
1.6 Which is the Basic Cause of the Disease? Role of Ischemia in the Genesis of Anterior Knee Pain. “ Loss of Vascular Homeostasis” 21
1.7 Author’s Proposed Anterior Knee Pain Pathophysiology ( See Fig. 1.9) 23
1.8 Clinical Relevance 24
1.9 Conclusions 25
1.10 Summary 25
References 25
Pathophysiology of Lateral Patellar Dislocation 28
2.1 Introduction 28
2.2 Soft Tissue Abnormalities 29
2.3 Bone Abnormalities 30
2.4 Summary 36
References 36
Natural History of Patellofemoral Dislocations 39
3.1 Introduction 39
3.2 Etiology 39
3.3 Family History 41
3.4 Recurrence Rate 41
3.5 Treatment 42
3.6 Development of Arthritis 42
3.7 Conclusion 43
References 43
Clinical Presentation of Patellofemoral Disorders 45
4.1 Anterior Knee Pain 45
4.2 Patellar Instability 46
4.3 Patellofemoral Arthritis 47
4.4 Previous Treatments 48
4.5 Past Medical History 48
4.6 Differential Diagnosis 48
4.7 Summary Statement 48
References 49
Clinical Examination of the Patellofemoral Patient 50
5.1 Introduction 50
5.2 Muscle Flexibility 54
5.3 Flexion-Extension Crepitus 54
5.4 Apprehension Test 55
5.5 Conclusions 57
5.6 Summary 57
References 57
Standard X-Ray Examination: Patellofemoral Disorders 59
6.1 Introduction 59
6.2 Basic Standard X-Rays 59
6.3 Sagittal View 60
6.4 Axial View 64
6.5 Conclusion 66
6.6 Summary 67
References 67
Patellar Height: Which Index? 68
7.1 Introduction 68
7.2 Definition [1–5] 68
7.3 Indices 69
7.4 Conclusion 72
7.5 Summary 73
References 73
Stress Radiographs in the Diagnosis of Patellofemoral Instability 75
8.1 Technique of Obtaining Patellofemoral Stress Radiographs 76
8.2 Measurements of Patellar Displacement 77
References 78
Computed Tomography and Arthro-CT Scan in Patellofemoral Disorders 79
9.1 Introduction 79
9.2 The Protocol (Lyon’s Protocol) 79
9.3 Tibial Tubercle-Trochlear Groove Distance 81
9.4 Patellar Tilt 81
9.5 Femoral Anteversion 82
9.6 External Tibial Torsion 82
9.7 Other Features of CT Imaging 82
References 84
MRI Analysis of Patellla Instability Factors 85
10.1 Static Analysis of Instability Factors 85
10.2 MRI Operative Protocol to Analyze Instability Factors 86
10.3 Dynamic Evaluation of Patellofemoral Joint 90
10.4 Summary Statements 93
References 94
MRI of the Patellofemoral Articular Cartilage 96
11.1 Introduction 96
11.2 Magnetic Resonance Imaging of the Patellofemoral Joint 97
11.3 Summary 101
11.4 Conflicts of Interest 101
References 101
Patellofemoral Pain Syndrome: The Value of Pinhole and SPECT Scintigraphic Imaging and Quantitative Measurements of Bone Mineral Equivalent Density with Quantitative Computed Tomography 104
12.1 Introduction 104
12.2 Methods 105
12.3 Conclusion 105
References 107
Gait Analysis in Patients with Patellofemoral Disorders 109
13.1 Introduction 109
13.2 Biomechanics in Patella Femoral Disorders 110
13.3 Conclusion and Future Directions References 113
Iatrogenic Anterior Knee Pain with Special Emphasis on the Clinical, Radiographical, Histological, Ultrastructural and Biochemical Aspects After Anterior Cruciate Ligament Reconstruction Using Ipsilateral Autografts 115
14.1 Introduction 115
14.2 Postoperative Restriction in Range of Motion and Loss of Strength 115
14.3 Dissection Studies in the Knee Region 116
14.4 Knee Surgery and Sensory Nerve Complications 117
14.5 Local Discomfort in the Donor- Site Region 118
14.6 Radiographic Assessments 119
14.7 Histological Examinations 120
14.8 Ultrastructural Examinations 121
14.9 Biochemical Investigations 121
14.10 Summary Statement 123
References 123
Non-operative Treatment of Patellofemoral Pain: Role of Physical Therapy 127
15.1 Patellar Bracing and Taping 128
15.2 Foot Orthoses for Treatment 132
15.3 Exercise Therapy/ Physical Therapy 133
15.4 Guidelines When Rehabilitation Is Completed 138
References 138
Lateral Release of the Lateral Patellar Retinaculum: Literature Review for Select Patellofemoral Disorders 142
16.1 Introduction 142
16.2 Materials and Methods 143
16.3 Physical Examination 143
16.4 Surgical Options 144
16.5 Summary Statement 149
References 149
Medial Side Patellofemoral Anatomy: Surgical Implications in Patellofemoral Instability 151
17.1 Surgical Implications 153
References 154
Arthroscopic Medial Reefing in Acute Patellar Dislocation 155
18.1 Introduction 155
18.2 Clinical Results of Conservative Versus Operative Treatment: A Literature Review 156
18.3 Indications and Contraindications for Arthroscopic Medial Soft Tissue Reefing 158
18.4 Surgical Technique of Arthroscopic Medial Soft Tissue Reefing 158
18.5 Conclusion 159
References 159
Medial Reefing in Chronic Potential Patellar Instability 161
19.1 Introduction 161
19.2 Materials and Methods 162
19.3 Surgical Technique 162
19.4 Results 163
19.5 Discussion 163
19.6 Conclusion 165
19.7 Summary Statement 165
References 165
Medial Patellofemoral Ligament Reconstruction Indications and Surgical Technique 166
20.1 Historical Background 166
20.2 Indications for Medial Patellofemoral Ligament Reconstruction 168
20.3 Authors’ Preferred Technique 169
20.4 Postoperative Care 173
20.5 Results 173
20.6 Summary 174
References 174
MPFL Reconstruction: The Adductor Sling Approach 176
21.1 Indications for Medial Patellofemoral Ligament Reconstruction 176
21.2 Contraindications for MPFL Reconstruction 176
21.3 MPFL Reconstruction Adductor Sling Approach: Surgical Technique 177
21.4 Discussion 178
21.5 The Minnesota Experience 179
21.6 Conclusion References 180
Importance and Radiographic Identification of the Femoral Insertion in Medial Patellofemoral Ligament Reconstruction 181
References 183
MPTL (Medial Patellotibial Ligament) Reconstruction 184
23.1 Background 184
23.2 Anatomical Description 185
23.3 Biomechanical Consideration 185
23.4 Technique 186
23.5 Postoperative Rehabilitation Protocol 189
23.6 Results 189
23.7 Discussion 189
23.8 Summary Statements 191
References 191
Distal Realignment: Medialization of Tibial Tuberosity: The Elmslie- Trillat Technique 192
24.1 Introduction 192
24.2 Indications 193
24.3 Surgical Technique 193
24.4 Postoperative Treatment 196
24.5 Discussion 196
24.6 Conclusions 199
References 199
Bony Surgery Distal Realignment Surgery for Episodic Patellar Dislocations 201
25.1 Introduction 201
25.2 Indication 201
25.3 Surgical Technique: The Anterior Tibial Tubercle Osteotomy 202
25.4 Discussion 204
25.5 Summary 205
References 205
Trochlear Lengthening Osteotomy with or Without Elevation of the Lateral Trochlear Facet 207
26.1 Introduction 207
26.2 Physical Examination 208
26.3 Imaging 209
26.4 Surgery 210
26.5 Postoperative Care 212
26.6 Conclusions 212
References 212
Proximal Open Trochleoplasty ( Grooveplasty) 214
27.1 Introduction (Stability of the Patellofemoral Joint: Passive and Active Stability) 214
27.2 Trochlear Dysplasia 214
27.3 Proximal Open Trochleoplasty 215
27.4 Other Surgeries 218
27.5 Rehabilitation 221
27.6 Complications 221
27.7 Summary Statement 221
References 221
Deepening Trochleoplasty for Patellar Instability 222
28.1 Introduction 222
28.2 Indications 222
28.3 Contraindications 223
28.4 Techniques 223
28.5 Results 226
28.6 Discussion 229
28.7 Conclusion 229
References 229
Arthroscopic Deepening Trochleoplasty for Patella Instability 230
29.1 Background 230
29.2 Surgical Technique 231
29.3 Discussion 232
29.4 Summary 233
References 233
The Role of Limb Rotational Osteotomy in the Treatment of Patellofemoral Dysfunction 234
30.1 Importance 234
30.2 Intrinsic and Extrinsic Limb Factors 234
30.3 Conclusions 240
References 240
Long-Term Results After Autologous Chondrocyte Implantation in Cartilage Lesions of the Patellofemoral Joint 242
31.1 Introduction 242
31.2 Autologous Chondrocyte Implantation: Surgical Procedure and Rehabilitation 243
31.3 Long-Term Follow-Up of ACI Patients 246
References 251
Novel Nano-composite Multilayered Biomaterial for the Treatment of Patellofemoral Cartilage Lesions 252
32.1 Introduction 252
32.2 Scaffold 253
32.3 Surgical Procedure and Postoperative Treatment 254
32.4 Clinical Experience 255
32.5 Discussion 256
32.6 Conclusion 258
References 258
Isolated Patellofemoral Osteoarthritis: Natural History and Clinical Presentation 260
33.1 Introduction 260
33.2 Etiologies of PF Arthritis 260
33.3 Radiographic Analysis of Isolated Patellofemoral Arthritis ( Fig. 33.4) 262
33.4 CT Arthrography 262
33.5 Differential Diagnosis: Patella Infera 263
33.6 Predisposing Factors to Patellofemoral Arthritis 263
33.7 Natural History and Treatment Implications 265
33.8 Therapeutic Consequences 265
33.9 Conclusion 267
References 267
The Nonoperative Treatment of Patellofemoral Arthritis 268
34.1 Activity Modification 268
34.2 Weight Control 268
34.3 Water Exercise 268
34.4 Medications 268
34.5 Nutritional Supplements 269
34.6 Knee Supports 269
34.7 Orthotics 269
34.8 Physical Therapy 269
References 270
Current Concepts Regarding Tibial Tubercle Osteotomy 272
35.1 Decision Making Regarding Alternatives to Tibial Tubercle Transfer 273
35.2 Pearls and Principles of Tibial Tubercle Transfer 273
35.3 Conclusions 273
References 274
Isolated Patellofemoral Osteoarthritis: Prosthetic Indications 275
36.1 Introduction 275
36.2 Isolated Patellofemoral Arthroplasty 275
36.3 Total Knee Arthroplasty 279
36.4 Summary 280
References 280
Post-operative Management of Surgeries Aimed at Correcting Patellofemoral Instability: Results of an International Surgeon Survey 282
37.1 Introduction and Justification of the Survey 282
37.2 Immobilization, Bracing, and Weight- Bearing Status 283
37.3 Range of Motion 285
37.4 Open and Closed Kinetic Chain Quadriceps Exercise 286
37.5 Conclusion 291
Appendix 291
Errors and Complications in Patellofemoral Surgery 292
38.1 Bony Surgery 292
38.2 Soft Tissue 296
38.3 Autologous Cartilage Transplantation 297
38.4 Patellofemoral Arthroplasty 297
38.5 Summary 299
References 299
Trochleoplasty for Symptomatic Trochlear Dysplasia in the Skeletally Immature Patient with Review of Fetal Anatomy 302
39.1 Surgical Procedure 303
39.2 Guidelines for Physicians 304
References 305
Patellofemoral Disorders in the Skeletally Immature Patients 306
40.1 Overuse Conditions of Patella 306
40.2 Patello-femoral Instability in Immature Patients 308
40.3 Patellar Fractures in Pediatric Patients 312
40.4 Chapter Summary 313
References 313
Dictionary 315
Abnormal Tracking 315
Apprehension Sign 315
Arthritis (Isolated Patellofemoral Arthritis) 315
Chondromalacia 315
Episodic Patellar Dislocation 315
Excessive Lateral Hyperpressure Syndrome 315
Hyperlaxity 315
J Sign 315
J Tracking 316
Lateral Retinaculum 316
Lateral Retinacular Tightness 316
Malalignment of the Patellofemoral Joint 316
Medial Retinaculum 316
Objective Patellar Instability 316
Patella Alta/Infera 316
Patellofemoral Disorders Classification 316
Patellar Dysplasia 317
Patella Glide Test 317
Patellar Instability 317
Patella Tilt Test 317
Potential Patellar Instability 317
Q Angle 317
Patella Subluxation 317
Tibial Tubercle Trochlear Groove Distance ( TT/ TG) 317
Trochlear Dysplasia 317
Index 318