3. Magnetic Resonance Imaging Findings After Acute Patellar Dislocation in Macroscopic Anatomy of the Stifle Joint in the Pampa's Deer It thickens as it inserts onto the lateral border of the patella, quadriceps tendon and patellar ligament. (20a) A fat-suppressed proton density-weighted sagittal image in a patient following patellar dislocation reveals an osteochondral injury with a chondral defect (arrows) at the lateral weightbearing surface of the lateral femoral condyle, a finding seen in only 5% of patients. https://doi.org/10.1186/s13244-019-0755-1, DOI: https://doi.org/10.1186/s13244-019-0755-1. Google Scholar, Amis AA, Firer P, Mountney J, Senavongse W, Thomas NP (2003) Anatomy and biomechanics of the medial patellofemoral ligament. Other indicated structures: gracilis (G), semitendinosus (ST), and adductor magnus (AM) tendons. Knee Surg Sports Traumatol Arthrosc 15:13011314, Tom A, Fulkerson JP (2007) Restoration of native medial patellofemoral ligament support after patella dislocation. {"url":"/signup-modal-props.json?lang=us"}, Moodaley P, Hng J, Hacking C, et al. Epidemiology Patellar dislocation accounts for ~3% of all knee injuries and is commonly seen in those individuals who participate in sports activities. The primary aim of surgery is to repair the knee damage and to correct the anomalies that are predisposing to chronic instability. The degree of patellar tilt can be evaluated by measuring the patella tilt angle, which is the angle between the posterior condylar line and the maximal patella width line [47] (Fig. Bookshelf 9). 3. Patellar maltracking: an update on the diagnosis and treatment strategies, https://doi.org/10.1186/s13244-019-0755-1, http://creativecommons.org/licenses/by/4.0/. Knee Surg Sports Traumatol Arthrosc 22:26552661, Seitlinger G, Scheurecker G, Hgler R, Labey L, Innocenti B, Hofmann S (2012) Tibial tubercle-posterior cruciate ligament distance: a new measurement to define the position of the tibial tubercle in patients with patellar dislocation. Concave impaction deformity of the inferomedial patella is a specific sign of prior LPD. Analysis with magnetic resonance imaging. This can provide a road map of developing a treatment strategy that would be primarily aimed at stabilizing the patellofemoral joint and halt the progression of cartilage loss. Surgical repair is most commonly directed to MPFL reconstruction and to distal realignment in the subset of patients who have significant osseous malalignment. Am J Sports Med 33:220230, Nikku R, Nietosvaara Y, Aalto K, Kallio PE (2005) Operative treatment of primary patellar dislocation does not improve medium-term outcome: a 7-year follow-up report and risk analysis of 127 randomized patients. PubMedGoogle Scholar. Post WR, Teitge R, Amis A (2002) Patellofemoral malalignment: looking beyond the viewbox. the patellar retinaculum at the dynamic examination (Fig. Long term follow up studies in patients who have undergone a lateral release have shown an increased incidence of patellofemoral arthritis. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. 5 Carrillon Y, Abidi H, Dejour D, et al. The pattern of bone bruising seen in a transient lateral patellar dislocation is easy to understand if one considers the mechanism of injury. Clin Orthop Relat Res 471:26412648, Laurin CA, Dussault R, Levesque HP (1979) The tangential x-ray investigation of the patellofemoral joint: x-ray technique, diagnostic criteria and their interpretation. Patellar tracking refers to the dynamic relationship between the patella and trochlea during knee motion [1]. Unable to load your collection due to an error, Unable to load your delegates due to an error. a Normal trochlea. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Terms and Conditions, Axial PDFS MR image showing MPFL disruption (open arrow) and trochlear dysplasia (arrowheads). quadricepsplasty rehab protocol Usually, young individuals, particularly women, suffer the consequences of this disorder [2]. (23a) In this patient with recurrent patellofemoral dislocations, there are findings of subchondral degeneration (arrow) from recurrent impaction and chondral shearing injuries to the inferolateral femoral condyle. The transverse stabilizers include the medial and lateral retinaculum, the vastus medialis and lateralis muscles, the ilio-tibial band, and the medial patellofemoral ligament (MPFL). Traumatic lateral patellar dislocation is a common injury among young, athletic individuals and is generally transient in nature. This is often secondary to an underlying structural abnormality. The conditions are presented anatomicallyanterior, lateral, medial, or posteriorwith common etiologies, history and physical exam findings, and diagnosis and treatment options for each (see Table, page 28). Radiology 189:905907, Warren LF, Marshall JL (1979) The supporting structures and layers on the medial side of the knee: an anatomical analysis. b Axial MRI at the level of the tibial tuberosity. The main morphological features associated with patellar maltracking are trochlear dysplasia, lateralization of the tibial tuberosity, patella alta, and lateral patellar tilt. Of course, if medial soft tissue restraints are disrupted at the first dislocation, the loss of such restraints makes future dislocations more likely. J Comput Assist Tomogr 2001; 25:957-962. 5 a-d). Lateral patellar retinaculum. HHS Vulnerability Disclosure, Help First, a line is drawn paralleling the posterior femoral condyles surfaces. Careers. Tibial Tubercle Osteotomy to Aid Exposure for Revision Total Knee Peroneal Tendon Dislocation and Superior Peroneal Retinaculum Injury Patellar dislocation most commonly results from a twisting motion, with the knee in flexion and the femur rotating internally on a fixed foot (valgus-flexion-external rotation) 1. Patellar sleeve avulsion (PSA) fractures are rare injuries that occur in in skeletally immature patients. It takes a very strong force to tear the patellar tendon. Patellar dislocation accounts for ~3% of all knee injuries and is commonly seen in those individuals who participate in sports activities. Am J Sports Med 45:10591065, Brossmann J, Muhle C, Schrder C et al (1993) Patellar tracking patterns during active and passive knee extension: evaluation with motion-triggered cine MR imaging. Lateral patellar dislocation | Radiology Reference Article Abnormalities of the medial retinaculum and MPFL are seen in 82-100% of MRI examinations following patellar dislocation. The close association of the MR with the MCL is also apparent. 2021;50(7):1399-409. The medial patellar retinaculum is part of the anterior third of the medial joint capsule. Osteochondral fractures are common in acute or recurrent transient lateral patellar dislocation, seen in up to 70% of cases. Bone bruises at the anterolateral aspect of the lateral femoral condyle and at the inferomedial patella are the most constant findings in patients who have sustained a recent patellar dislocation. The lateral trochlear articular surface is usually more prominent than its medial portion. Manage cookies/Do not sell my data we use in the preference centre. These measurements are not routinely recorded in the MRI report, but in select situations may be helpful in quantifying low-grade versus high-grade dysplasia. Because the diagnosis of lateral patellar dislocation is often unsuspected, MR provides valuable diagnostic information in such cases. Asymmetry of <40% suggests trochlear dysplasia [24]. On MRI, impingement is usually manifested as high signal intensity within the superolateral aspect of the infrapatellar fat pad on fluid-sensitive sequences (edema) (Fig. J Orthop Sports Phys Ther 2017;47(10):815. doi:10.2519/ jospt.2017.6616 . All authors (ZJ, PJ, KSR, MLS, GD) contributed to the study design, drafted the work, and revised it critically for final submission. Created for people with ongoing healthcare needs but benefits everyone. From 10 to 20 of flexion, the patella engages the trochlear groove with the contact area being the inferior most portion of the medial and lateral facets. Kamel S, Kanesa-Thasan R, Dave J et al. From this insertion, it extends posteriorly to blend with the lateral margin of the knee capsule and inferior surface of the lateral tibial condyle 1,2. Cite this article. Additionally, MRs ability to delineate the extent of injury and predisposing factors is important in patient care and surgical planning. Medial patellofemoral ligament injury following acute transient dislocation of the patella: MR findings with surgical correlation in 14 patients. Because of the transient and brief nature of lateral patellar dislocations, the diagnosis is frequently unrecognized by both patients and clinicians. Knee Surg Sports Traumatol Arthrosc 14:264272, McNally EG, Ostlere SJ, Pal C, Phillips A, Reid H, Dodd C (2000) Assessment of patellar maltracking using combined static and dynamic MRI. Lateral Patellar Dislocation. Patellar maltracking: an update on the diagnosis and treatment strategies. MRI and operative studies have revealed that it is almost . The average annual incidence for patellar dislocation injuries ranged between 5.8 and 7.0 per 100,000 person-years in the civilian population, and up to 29 per 100,000 person-years in the 10-17 year age . Medial patellofemoral ligament: cadaveric investigation of anatomy with MRI, MR arthrography, and histologic correlation. In acute patellar dislocation, CT may demonstrate osseous impaction or fractures of the medial margin of the patella (with or without involvement of the articular surface) and/or the lateral surface of the lateral femoral condyle and intraarticular fragments. A thorough examination of the knee is then performed including presence of effusion, localization of pain, assessment of patellar translation, patellar apprehension, presence of a J sign (visual lateralization of the patella as it disengages from the trochlea when extending the knee), and a measurement of the Q angle along with ligamentous and meniscal testing. If the lateral retinaculum tendon is tight enough to pull the patella out of the trochlear groove, a lateral release procedure can loosen the tissue and correct the patellar malalignment. A distance between the tibial tubercle and the trochlear groove of less than 15 mm is considered normal. 0000070933 00000 n 0000192215 00000 n 0000212094 00000 n
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