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1.
Artigo em Inglês | MEDLINE | ID: mdl-38713870

RESUMO

PURPOSE: The aim of this systematic review was to identify the surgical indications of tibial derotational osteotomy (TDO) in patients with idiopathic external tibial torsion (ETT) and identify common measurement thresholds for surgical correction. METHODS: A systematic search of MEDLINE and Embase via Ovid, Cochrane Library via Wiley, Web of Science, Scopus, SPORTDiscus via EBSCOhost, ClinicalTrials.gov, WHO ICTRP and Global Index Medicus databases was performed with search terms reflecting the concepts of idiopathic tibial torsion, TDOs, and surgical indications. Studies reporting surgical indications and measurement methods of idiopathic tibial torsion in patients who underwent TDO were included. Two authors independently screened articles and extracted data that was characterized with descriptive statistics. RESULTS: Seventeen studies were identified for inclusion, with 460 tibias and 351 patients. Nearly all patients who underwent surgery had either anterior knee pain or patellar instability, even if other indications were present. Of all included patients, the most common surgical indications for TDO were anterior knee pain (88%), patellar instability (59%), gait dysfunction (41%) and cosmetic deformity (12%). Twelve studies (71%) cited multiple of these indications as reasons for surgery. On physical exam, tibial torsion was measured most commonly by thigh-foot angle (59%) (TFA) and transmalleolar axis (24%) (TMA). In terms of TFA, the most frequently reported cut-off for ETT was >30° (35%). Computerized tomography (CT) was used by nine studies (53%). The most common CT axes used to measure ETT were the TMA with respect to the posterior tibia condylar axis or the bicondylar tibia axis. CONCLUSION: Anterior knee pain and/or patellar instability are common indications for TDO in patients with idiopathic tibial torsion. Standardized TFA thresholds (>30°) and CT measurement methods (TMA and posterior tibia condylar or bicondylar tibial axis) may help further establish objective surgical indications. LEVEL OF EVIDENCE: IV.

2.
Instr Course Lect ; 69: 671-692, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017760

RESUMO

Patellar instability is a common problem seen by the orthopedic surgeon. Surgery is indicated in recurrent dislocation to improve patellar tracking and ligamentous restraint in order to decrease risk of recurrence, osteochondral injury, and eventual progression to arthritis. Preoperative imaging studies identify anatomic risk factors that increase risk of patellar dislocation to inform surgical decision making. Surgical management starts with medial patellofemoral ligament reconstruction, which is effective in many cases. Tibial tubercle osteotomy realigns the extensor mechanism and is useful in cases of lateralized tibial tubercle or patella alta. For patients with trochlear dysplasia, both tibial tubercle osteotomy and trochleoplasty are options to prevent recurrent dislocation. Chondral lesions are common and, depending upon symptomology and size, can be addressed with débridement, structural grafting, or cell-based treatment. To maximize outcomes, comprehensive preoperative diagnosis and planning must be combined with meticulous surgical technique. Unfortunately, there is minimal evidence to guide when a soft-tissue ligament reconstruction is sufficient versus when is it necessary to correct and alter the bony anatomy. This chapter covers the individualized decision making and surgical pearls for these techniques to improve outcomes and minimize perioperative complications.


Assuntos
Instabilidade Articular/cirurgia , Luxação Patelar/cirurgia , Humanos , Articulação do Joelho , Ligamentos Articulares , Articulação Patelofemoral , Tíbia
3.
J Pediatr Orthop ; 40(2): e96-e102, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31107711

RESUMO

BACKGROUND: Despite the critical role the trochlea plays in patellofemoral (PF) pathology, the development of the trochlea is poorly understood. The purpose of this study was 2-fold: (1) Describe quantitative osseous and soft tissue anatomy of the patella and trochlea in skeletally immature cadaveric specimens utilizing known measurements used in PF instability, and (2) evaluate additional measurement techniques in the sagittal plane as they relate to PF morphologic development. METHODS: Thirty-one skeletally immature fresh frozen cadaveric knees between the ages of 2 and 11 years old were evaluated using 0.625 mm computed tomography scans. In the axial plane, measurements included condylar height asymmetry, trochlear facet asymmetry, trochlear depth, osseous sulcus angle, cartilaginous sulcus angle, patella sulcus angle, and tibial tubercle-trochlear groove distance. In the sagittal plane, measurements included previously undescribed measurements of trochlear length and condylar height asymmetry which are based on the anterior femoral cortex. RESULTS: Analysis of trochlear morphology using condylar height asymmetry (both axial and sagittal), trochlear facet asymmetry, and trochlear depth and length demonstrated an increase in the size of the medial and lateral trochlea as age increased. There was more variability in the change of size of the medial trochlea (height, length, and facet length) than the lateral trochlea. The osseous sulcus angle, cartilaginous sulcus angle, and patella sulcus angle decreased (became deeper) with age until after 8 years and then plateaued. CONCLUSIONS: This cadaveric analysis demonstrated that there is an increase in the medial and lateral trochlear height as age increased by all measurements analyzed. The findings also demonstrate that the shape of the patella and trochlea change concurrently, which suggests that there may be interplay between the 2 during development. These new sagittal measurement techniques evaluating the medial, central, and lateral trochlear height and length with respect to age may help guide clinicians when investigating patellar instability in skeletally immature patients. LEVELS OF EVIDENCE: Level IV.


Assuntos
Fêmur/anatomia & histologia , Patela/anatomia & histologia , Articulação Patelofemoral/anatomia & histologia , Cadáver , Criança , Pré-Escolar , Epífises/anatomia & histologia , Epífises/diagnóstico por imagem , Epífises/crescimento & desenvolvimento , Feminino , Fêmur/diagnóstico por imagem , Fêmur/crescimento & desenvolvimento , Humanos , Masculino , Patela/diagnóstico por imagem , Patela/crescimento & desenvolvimento , Articulação Patelofemoral/diagnóstico por imagem , Articulação Patelofemoral/crescimento & desenvolvimento , Tíbia/anatomia & histologia , Tíbia/diagnóstico por imagem , Tomografia Computadorizada por Raios X
4.
Knee Surg Sports Traumatol Arthrosc ; 27(8): 2551, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30470849

RESUMO

Unfortunately, the middle name of author was incorrectly published as Jorge A. Chahla instead of Jorge Chahla in the original article.

5.
Knee Surg Sports Traumatol Arthrosc ; 27(4): 1280-1290, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30552468

RESUMO

PURPOSE: Various implant materials have been used in medial, opening-wedge high tibial osteotomy (HTO) including traditional metal and modern polyetheretherketone (PEEK) implants. The purpose of this study was to compare metal and PEEK implants and determine safety, varus deformity correction, as well as short- to mid-term hardware removal and arthroplasty rates. METHODS: HTO performed with metal and PEEK implants were reviewed between 2000 and 2015 at two institutions with a minimum of 2 years follow-up. Postoperative complications, radiographic measures, and osteotomy union were compared between groups using Kruskal-Wallis and Fisher's exact testing. Survival free of hardware removal and arthroplasty was compared between groups using Kaplan-Meier testing. Risk factors for HTO conversion to arthroplasty were examined using Cox proportional hazards regression. RESULTS: Ninety-five HTOs were performed in 90 patients (59 M, 31 F) using 50 metal and 45 PEEK implants. Mean follow-up was 4.2 years (range 2.0-16.5). Two metal and two PEEK HTO patients experienced nonunions, resulting in revision HTO at a mean of 1.0 years postoperatively (range 0.4-1.4 years). Both implant groups demonstrated similar, significant improvements in coronal deformity, with mean angulation improving from 6.0° and 5.4° varus preoperatively to 1.1° and 1.0° valgus postoperatively for the metal (p < 0.01) and PEEK groups (p < 0.01), respectively. 2- and 5-year hardware removal-free survival was 94% and 94% for PEEK, which was significantly superior to 80% and 73% observed for metal (p = 0.02). 2- and 5-year arthroplasty-free survival was similar for the metal (98% and 94%) and PEEK groups (100% and 78%) (n.s.). HTO performed for focal cartilage defects was observed to demonstrate decreased arthroplasty risk (HR 0.36, p = 0.03) when compared to HTO performed for osteoarthritis. CONCLUSIONS: Both metal and PEEK implants were found to be effective in obtaining and maintaining coronal varus deformity correction, with 88% overall arthroplasty-free survival at 5 years. Metal fixation demonstrated a higher rate of hardware removal while HTO performed for medial compartment osteoarthritis predicted conversation to arthroplasty. LEVEL OF EVIDENCE: III.


Assuntos
Artroplastia do Joelho/métodos , Remoção de Dispositivo/tendências , Cetonas , Osteoartrite do Joelho/cirurgia , Osteotomia/métodos , Polietilenoglicóis , Complicações Pós-Operatórias/epidemiologia , Tíbia/cirurgia , Adulto , Benzofenonas , Feminino , Seguimentos , Previsões , Humanos , Incidência , Masculino , Osteoartrite do Joelho/diagnóstico , Polímeros , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Radiografia , Reoperação/estatística & dados numéricos , Resultado do Tratamento , Estados Unidos/epidemiologia
6.
Knee Surg Sports Traumatol Arthrosc ; 27(8): 2537-2550, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30370440

RESUMO

PURPOSE: The scientific literature concerning the anatomy of medial soft-tissue stabilizers of the patella is growing exponentially. Much of the surgical literature has focused on the role of the medial patellofemoral ligament (MPFL) and techniques to reconstruct it, yet our understanding of its anatomy has evolved during the past several years. Given this, we report on the current understanding of medial patellofemoral anatomy and implications for reconstruction. METHODS: Current and historical studies of medial patellar anatomy were reviewed, which include the MPFL and medial quadriceps tendon femoral ligament (MQTFL), as well as that of the distal medial patellar restraints, the medial patellotibial ligament (MPTL) and medial patellomeniscal ligament (MPML). In addition to the reported findings, the authors' anatomic descriptions of each ligament during their dissections were identified and recorded. RESULTS: Despite the name of the MPFL, which implies that the ligament courses between the femur and patella, recent studies have highlighted the proximal MPFL fibers that attach to the quadriceps tendon, known as the MQTFL. The MPFL and MQTFL have also been referred to as the medial patellofemoral complex, reflecting the variability in anatomical attachment sites. The MPFL accounts for only half of the total restraint to lateral patellar displacement, and the remaining contributions to patellar stability are derived from the combination of the MPTL and MPML, which function primarily in greater degrees of knee flexion. CONCLUSION: The understanding of the complexity of the medial patellar stabilizers continues to evolve. Although MPFL reconstruction is gaining wide acceptance as a procedure to treat patellar instability, it is important to recognize the complex and changing understanding of the anatomy of the medial soft-tissue stabilizers and the implications for reconstruction. LEVEL OF EVIDENCE: V.


Assuntos
Ligamentos Articulares/anatomia & histologia , Luxação Patelar/cirurgia , Articulação Patelofemoral/anatomia & histologia , Fenômenos Biomecânicos , Humanos , Instabilidade Articular/cirurgia , Músculo Quadríceps/anatomia & histologia , Tendões/anatomia & histologia
7.
J Orthop Traumatol ; 20(1): 17, 2019 03 26.
Artigo em Inglês | MEDLINE | ID: mdl-30915690

RESUMO

Reconstruction of the medial patellofemoral ligament (MPFL) has been increasing as a surgical solution for treatment of recurrent lateral patellofemoral dislocation. Recent attention has been given to fibers extending from the femur to the quadriceps tendon, proximal to the MPFL, termed the medial quadriceps tendon-femoral ligament. This article briefly reviews the proximal medial patellar restraints and surgical procedures for their reconstruction.


Assuntos
Articulação do Joelho/cirurgia , Procedimentos Ortopédicos/métodos , Patela/cirurgia , Luxação Patelar/cirurgia , Ligamento Patelar/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Humanos , Articulação do Joelho/fisiopatologia
8.
Arthroscopy ; 34(8): 2427-2428, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30077265

RESUMO

A recent study suggests that aggressive correction of the tibial tuberosity-trochlear groove (TT-TG) distance by tibial tubercle osteotomy and medialization during patellar stabilization surgery can result in diminished outcomes. The mechanism may be overmedialization resulting in excessive medial patellofemoral and tibial-femoral pressure. Measurement of TT-TG may be inaccurate, and medialization of the tibial tubercle may not be required in cases of lateral patellar instability with TT-TG >20 mm (which is a current algorithm). My indication for tibial tubercle osteotomy, generally anteromedialization, is lateral patellofemoral chondrosis, and my goal is to create an intraoperative tubercle-sulcus angle of 0, which can be readily visualized with the knee at 90°. This is true regardless of the preoperative TT-TG measurement, and this intraoperative measurement mitigates against an excessive tubercle-sulcus angle of 0, which can be readily visualized with the knee at 90° and is true regardless of the preoperative TT-TG medialization.


Assuntos
Patela , Tíbia , Humanos , Articulação do Joelho , Osteotomia , Fatores de Risco
9.
Knee Surg Sports Traumatol Arthrosc ; 26(3): 697-704, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28378138

RESUMO

PURPOSE: An increased lateral quadriceps vector has been associated with lateral patellar dislocation. Surgical correction of this increased vector through tibial tubercle medialization is often recommended when the quadriceps vector is "excessive". This can be evaluated by physical examination measurements of Q-angle and/or tubercle sulcus angle (TSA), as well as the magnetic resonance imaging (MRI) measurement of tibial tubercle-trochlear groove (TT-TG) distance. This study examined the relationship between three objective measurements of lateral quadriceps vector (TT-TG, Q-angle, TSA). A secondary goal was to relate lateral patellar tilt to these measurements. METHODS: Consecutive patients undergoing patellofemoral stabilization surgery from 9/2010 to 6/2011 were included. The Q-angle and TSA were measured on intra-operative physical examination. The TT-TG and patellar tilt were measured on MRI. TSA, Q-angle, and patellar tilt were compared to TT-TG using Pearson correlation coefficient. RESULTS: The study cohort included 49 patients, ages 12-37 (mean 23.2); 62% female. The Pearson correlation coefficients showed (+) significance (p < 0.01) between the TT-TG and both TSA and Q-angle. Tilt and TT-TG were (+) non-significantly correlated. Despite positive correlations of each measurement with TT-TG, there is not uniform intra-patient correlation. In other words, if TT-TG is elevated for a patient, it does not guarantee that all other measurements, including tilt, are elevated in that individual patient. CONCLUSION: The TT-TG distance has significant positive correlation with the measurements of TSA and Q-angle in patients undergoing surgery for patellofemoral instability. The clinical relevance is that the variability within individual patients demonstrates the need for considering both TSA and TT-TG before and during surgical intervention to avoid overcorrection with a medial tibial tubercle osteotomy. LEVEL OF EVIDENCE: Diagnostic study, Level III.


Assuntos
Imageamento por Ressonância Magnética/métodos , Patela/patologia , Luxação Patelar/diagnóstico , Articulação Patelofemoral/diagnóstico por imagem , Exame Físico/métodos , Tíbia/diagnóstico por imagem , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Procedimentos Ortopédicos/métodos , Patela/cirurgia , Luxação Patelar/cirurgia , Articulação Patelofemoral/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Tíbia/cirurgia , Adulto Jovem
10.
Knee Surg Sports Traumatol Arthrosc ; 26(3): 677-684, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28246877

RESUMO

PURPOSE: The primary goal was to describe the injury patterns in a population of primary (first time) lateral patellar dislocators (LPD) to lend clarity to commonly held notions about injury patterns in this population. METHODS: A prospective study identifying patients presenting with LPD between 2008 and 2012. Inclusion criteria were a history and physical exam consistent with primary LPD, and an MRI consistent with the diagnosis without other significant ligamentous injury. On MRI, location of cartilage, medial patellofemoral ligament (MPFL) injury, and bone bruising were noted. Severity was categorized as partial or complete for MPFL and cartilage lesions. Anatomic patellar instability risk factors (patella alta, trochlear dysplasia, increased TT-TG, and lateral patella tilt) were recorded and compared to the injury patterns. RESULTS: This study involved 157 patients; 107 patients were skeletally mature. Of the 157 patients, 26 had surgery for this injury due to clinician-perceived need for cartilage debridement. MPFL injury severity was complete rupture (N = 69, 44%), partial (N = 67, 43%), and none (N = 19, 13%). MPFL injury location was isolated femoral (N = 16, 10%), isolated patella (N = 26, 17%), isolated mid-substance (0%), multiple locations (N = 95, 61%), and none (N = 20, 13%). Chondral injury location was patella (N = 67, 43%), lateral femoral condyle (N = 11, 7%), multiple locations (N = 53, 34%), and none (N = 26, 17%). A majority (61%) of patellar chondral lesions were at its inferomedial aspect; all medial patellar retinacular partial injuries involved the inferomedial aspect of the patella, consistent with the insertion of the medial patellotibial ligament (MPTL). Skeletally immature patients had a greater risk of isolated patellar MPFL and chondral injury. No clear relationship was found between/across the location and/or severity of bone bruising, MPFL, or chondral injury. CLINICAL RELEVANCE: Underlying anatomic patellar instability risk factors defined by MRI, do not predict injury patterns. MPFL and chondral injury, as well as bone bruising, are common following LPD. The medial patellotibial ligament is torn in patellar-based medial retinacular injuries, based on MRI injury location. Skeletal immaturity plays a role in the location of the injury pattern with isolated patellar-based MPFL/chondral injury being more common in the skeletally immature patient. Sex does not appear to be a factor in injury patterns after primary LPD. Knowledge of these injury trends will help focus the clinician in injury evaluation when managing primary patellar dislocations. LEVEL OF EVIDENCE: Case series, Level IV.


Assuntos
Instabilidade Articular/diagnóstico , Imageamento por Ressonância Magnética/métodos , Patela/patologia , Luxação Patelar/diagnóstico , Adolescente , Adulto , Criança , Feminino , Humanos , Instabilidade Articular/etiologia , Instabilidade Articular/cirurgia , Articulação do Joelho/patologia , Masculino , Pessoa de Meia-Idade , Patela/lesões , Luxação Patelar/complicações , Luxação Patelar/cirurgia , Estudos Prospectivos , Fatores de Risco , Adulto Jovem
11.
Knee Surg Sports Traumatol Arthrosc ; 26(3): 685-696, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28289819

RESUMO

PURPOSE: The purpose of this article is to review anatomical, biomechanical, and clinical data of the medial patellotibial ligament (MPTL) and medial patellomeniscal ligament (MPML), as well as studies focusing on the medial patellofemoral ligament (MPFL) but with relevant data about the MPTL and MPML. METHODS: A literature search of articles specifically addressing the MPTL and/or MPML was included along with studies focusing on the MPFL but with relevant data about the MPTL and MPML. RESULTS: The medial patellar ligaments responsible for maintaining the stability of the patellofemoral (PF) joint include the MPFL, the MPTL, and the MPML. The MPFL is considered the primary restraint to lateral patellar translation, while the latter two are considered secondary restraints. There is robust literature on the anatomical, imaging, and biomechanical characteristics of the MPFL, and also the clinical outcome of its injury and surgical reconstruction; much less is known about the MPTL and MPML. Isolated MPFL reconstruction has good clinical and functional outcomes, with a low failure rate when defined as frank re-dislocation. Complications, including continued episodes of patellar apprehension and subluxation, remain present in most series. In addition, the current literature primarily includes a homogeneous population with few excessive anatomic dysplastic factors. There is lack of knowledge on the role of MPTL and MPML in (potentially) aiding patella stabilization and improving clinical outcomes. Understanding the role of the medial-sided patellar ligaments, in particular the role of the secondary stabilizers, in PF function and injury will aid in this goal. CONCLUSION: MPTL and MPML have consistent basic science literature, as well as favorable clinical outcomes of surgical patellar stabilization with reconstruction of the MPTL. However, there is much heterogeneity among clinical case series and lack of comparative studies to allow clear indication for the role of isolated or combined surgical reconstruction in patellar stabilization. Therefore, this comprehensive review helps understand the current knowledge and the possible applications in the orthopedic clinical practice. LEVEL OF EVIDENCE: V.


Assuntos
Diagnóstico por Imagem , Instabilidade Articular/diagnóstico , Ligamentos Articulares/patologia , Patela/diagnóstico por imagem , Luxação Patelar/diagnóstico , Articulação Patelofemoral/diagnóstico por imagem , Fenômenos Biomecânicos , Humanos , Instabilidade Articular/fisiopatologia , Instabilidade Articular/cirurgia , Procedimentos Ortopédicos , Patela/fisiopatologia , Luxação Patelar/fisiopatologia , Luxação Patelar/cirurgia , Articulação Patelofemoral/fisiopatologia , Articulação Patelofemoral/cirurgia
12.
Knee Surg Sports Traumatol Arthrosc ; 26(10): 2920-2933, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29344696

RESUMO

PURPOSE: The medial patellotibial ligament (MPTL), the medial patellofemoral ligament (MPFL), and the medial patellomeniscal ligament (MPML) support the stability of the patellofemoral joint. The purpose of this systematic review was to report the surgical techniques and clinical outcomes of the repair or reconstruction of the MPTL in isolation or concomitant with the MPFL and/or other procedures. METHODS: A systematic review of the literature was conducted. Inclusion criteria were articles in the English language that reported clinical outcomes of the reconstruction of the MPTL in isolation or in combination with the MPFL and/or other procedures. Included articles were then cross-referenced to find additional journal articles not found in the initial search. The methodological quality of the articles was determined using the Coleman Methodology Score. RESULTS: Nineteen articles were included detailing the clinical outcomes of 403 knees. The surgical procedures described included hamstrings tenodesis with or without other major procedures, medial transfer of the medial patellar tendon with or without other major procedures and the reconstruction of the MPTL in association with the MPFL. Overall, good and excellent outcomes were achieved in > 75% of cohorts in most studies and redislocations were < 10%, with or without the association of the MPFL. An exception was one study that reported a high failure rate of 82%. Results were consistent across different techniques. The median CMS for the articles was 66 out of 100 (range 30-85). CONCLUSION: Across different techniques, the outcomes are good with low rates of recurrence, with one article reporting a high rate of recurrence. Quality of the articles is variable, from low to high. Randomized control trials are needed for a better understanding of the indications, surgical techniques, and clinical outcomes. This systematic review suggests that the reconstruction of the MPTL leads to favorable clinical outcomes and supports the role of the procedure as a valid surgical patellar stabilization procedure. LEVEL OF EVIDENCE: IV: systematic review of level I-IV studies.


Assuntos
Luxação Patelar/cirurgia , Ligamento Patelar/cirurgia , Articulação Patelofemoral/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Humanos , Instabilidade Articular/cirurgia , Recidiva , Tenodese
13.
Arthroscopy ; 33(8): 1558-1559, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28779800

RESUMO

A novel surgical technique to reduce the tibial tubercle prominence in painful Osgood-Schlatter disease was piloted in a small cohort of patients with chronic anterior knee pain. Midterm results judged by patient-reported outcomes of pain and function show promise for this technique.


Assuntos
Osteocondrose , Humanos , Articulação do Joelho , Osteotomia , Dor , Tíbia
14.
Instr Course Lect ; 66: 531-542, 2017 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-28594527

RESUMO

The management of patellofemoral cartilage lesions is controversial and should begin with a comprehensive nonsurgical treatment plan. Patients with patellofemoral cartilage lesions in whom nonsurgical treatment fails may be candidates for surgical treatment. Surgical treatment strategies for the management of patellofemoral cartilage lesions are guided by the size, quality, and location of the defect. Recent advancements in cartilage restoration and arthroplasty techniques as well as appropriate patient selection and meticulous surgical technique have resulted in promising outcomes for patients with patellofemoral cartilage lesions who undergo surgical treatment.


Assuntos
Artrite , Artroplastia do Joelho , Artroplastia , Cartilagem Articular , Articulação Patelofemoral , Cartilagem Articular/cirurgia , Humanos
15.
Knee Surg Sports Traumatol Arthrosc ; 25(10): 3099-3107, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27145773

RESUMO

PURPOSE: Various knee anatomic imaging factors have been historically associated with lateral patellar dislocation. The characterization of these anatomic factors in a primary lateral patellar dislocation population has not been well described. Our purpose was to characterize the spectrum of anatomic factors from slice imaging measurements specific to a population of primary lateral patellar dislocation. A secondary purpose was to stratify these data by sex/skeletal maturity to better detail potential dimorphic characteristics. METHODS: Patients with a history of primary lateral patellar dislocation between 2008 and 2012 were prospectively identified. Ten MRI measurements were analysed with results stratified by sex/skeletal maturity. A '4-factor' analysis was performed to detail the number of 'excessive' anatomic factors within a single individual. RESULTS: This study involved 157 knees (79 M/78 F), and 107 patients were skeletally mature. The measurements demonstrate more anatomic risk factors in this population than historical controls. Patella height and trochlear measurements are the most common 'dysplastic' anatomic factors in this population. There were differences based on sex for some patellar height measurements and for TT-TG; there were no differences based on skeletal maturity. CONCLUSION: Primary lateral patellar dislocation patients have MRI measurements of knee anatomic factors that are generally more dysplastic than the normal population; however, there is a broad spectrum of anatomic features with no pattern predominating. Characterizing knee anatomic imaging factors in the patient with a primary lateral patellar dislocation is a necessary first step in characterizing the (potential) differences between the primary and recurrent patellar dislocation patient. LEVEL OF EVIDENCE: IV.


Assuntos
Traumatismos do Joelho/diagnóstico por imagem , Articulação do Joelho/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Luxação Patelar/diagnóstico por imagem , Adolescente , Adulto , Criança , Feminino , Humanos , Instabilidade Articular/etiologia , Articulação do Joelho/anatomia & histologia , Masculino , Pessoa de Meia-Idade , Luxação Patelar/etiologia , Estudos Prospectivos , Recidiva , Fatores de Risco , Adulto Jovem
16.
Knee Surg Sports Traumatol Arthrosc ; 25(8): 2352-2356, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26215775

RESUMO

PURPOSE: While a significant research has gone into identifying patients at highest risk of recurrence following primary patellar dislocation, there has been little work exploring the outcomes of patients who do not have a recurrent patellar dislocation. We hypothesize that patients without recurrent dislocation episodes will exhibit significantly higher KOOSs than those who suffer recurrent dislocations, but lower scores than published age-matched normative data. METHODS: A retrospective review of patients with nonoperatively treated primary lateral patellar dislocations was carried out, and patients were contacted at a mean of 3.4 years (range 1.3-5.5 years) post-injury. Information regarding subsequent treatment and recurrent dislocations along with patient-reported outcome scores and activity level was collected. RESULTS: One hundred and eleven patients (29.8 %) of 373 eligible patients agreed to study participation, seven of whom were excluded because they underwent subsequent patellar stabilization surgery on the index knee. Seventy-six patients (73.1 %) reported no further dislocation events, and the mean KOOS subscales at follow-up were: symptoms-80.2 ± 18.8, pain-81.8 ± 16.2, ADL-88.7 ± 15.9, sport/recreation-72.1 ± 24.4, and QOL-63.9 ± 23.8 at a mean follow-up of 3.3 years (range 1.3-5.5 years). No significant differences in any of the KOOS subscales were noted between these patients and the group that reported recurrent patellar dislocations. Only 26.4 % of the patients without further dislocations reported they were able to return to desired sport activities without limitations following their dislocation. CONCLUSION: Patients who do not report recurrent patellar dislocations following nonoperative treatment of primary patellar dislocations are in many cases limited by this injury 3 years following the initial dislocation event. LEVEL OF EVIDENCE: Retrospective cohort study, Level III.


Assuntos
Luxação Patelar/terapia , Adolescente , Adulto , Criança , Tratamento Conservador , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Luxação Patelar/cirurgia , Medidas de Resultados Relatados pelo Paciente , Recuperação de Função Fisiológica , Recidiva , Estudos Retrospectivos , Volta ao Esporte , Adulto Jovem
17.
Knee Surg Sports Traumatol Arthrosc ; 24(6): 1836-44, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27120193

RESUMO

Patellofemoral joint cartilage lesions are associated with a variety of clinical situations including blunt trauma, lateral patella dislocations, or as a secondary development in the setting of abnormal joint loading. There is a need for more clarity on how to best address these lesions. Most specifically, when is it necessary to surgically treat these lesions of the patella and trochlea and which technique to use? This review will focus on the spectrum of patellofemoral disease/injury and their treatment strategies, with special emphasis on cartilage damage and early osteoarthritis. Chapter sections will review the most common scenarios of cartilage damage in the patellofemoral joint, with an attempt to summarize current treatment, their outcomes, remaining challenges and unanswered questions.


Assuntos
Cartilagem Articular/fisiopatologia , Instabilidade Articular/fisiopatologia , Osteoartrite do Joelho/fisiopatologia , Luxação Patelar/fisiopatologia , Articulação Patelofemoral/fisiopatologia , Cartilagem Articular/lesões , Cartilagem Articular/cirurgia , Humanos , Instabilidade Articular/cirurgia , Articulação do Joelho/fisiopatologia , Patela , Articulação Patelofemoral/lesões , Articulação Patelofemoral/cirurgia
18.
Clin Orthop Relat Res ; 473(12): 3700-4, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26197951

RESUMO

BACKGROUND: In 2001, the Institute of Medicine released a report stating that sex must be considered in all aspects and at all levels of biomedical research. Knowledge of differences between males and females in responses to treatment serves to improve our ability to care for our patients. QUESTIONS/PURPOSES: The purpose of our study was to determine (1) if there is an increase in the proportion of sex-specific reporting from 2000 to 2005 and to 2010; and (2) whether there is a proportional difference in such reporting based on journal type: subspecialty versus general orthopaedics. We hypothesize that assessment of the role of sex in outcomes has improved during the past 15 years and that the proportion of studies with of sex-specific analyses has increased with awareness of the role of sex in clinical outcomes and disease states. We additionally hypothesized that the reporting of sex would be similar between subspecialty and general orthopaedic journals. METHODS: Five high-impact orthopaedic journals, consisting of two general and three subspecialty journals, were chosen for review. Issues from even-numbered months during three calendar years (2000, 2005, 2010) were critically assessed for the presence of sex-specific analyses and reporting by two separate reviewers. Retrospective and prospective clinical studies, with a minimum of 20 patients, were included for analysis. Cadaveric, biomechanical, and in vitro studies were excluded. Review articles and clinical studies with less than 20 patients were excluded. A total of 821 studies that met inclusion criteria were analyzed: 206 in 2000, 277 in 2005, and 338 in 2010. RESULTS: Overall, the proportion of sex-specific analyses increased during the three times studied (19%, 40/206, [95% CI, 0.14-0.25] of the studies in 2000; 27%, 77/277, [95% CI, 0.23-0.33] in 2005; and 30%, 102/338, [95% CI, 0.25-0.35] in 2010). The increase in the proportion of sex-specific analysis was significant between 2000 and 2005 (p = 0.033), but was not significant between 2005 and 2010 (p = 0.518). During each of the three specific years studied, general and subspecialty journals increased in the proportions that reported sex-based analyses, but specialty journals had significantly higher reporting rates only in 2000 (2000: 11.9%, 13/109, [95% CI, 0.06-0.18] and 27.8%, 27/97, [95% CI, 0.19-0.37], p = 0.004; 2005: 22.9%, 33/144, [95% CI, 0.16-0.30], and 33.1%, 44/133, [95% CI, 0.25-0.41], p = 0.059; 2010: 28.2%, 51/181, [95% CI, 0.22-0.35] and 32.5%, 51/157, [95% CI, 0.25-0.40], p = 0.390). CONCLUSIONS: Our findings indicate that inclusion of sex-specific analysis and reporting in the orthopaedic literature improved during our study period, but are present in less than 1/3 of the studies. Although subgroup analysis and reporting are required by NIH guidelines, it is important that such analyses be published in non-NIH-funded studies to generate hypotheses regarding sex differences for subsequent research. These data also are important as they can be used in systematic reviews where large independent studies may not be available in the literature. CLINICAL RELEVANCE: Where evaluating conditions that affect males and females, studies should be designed with sufficient sample size to allow for subgroup analysis by sex to be performed, and they should include sex-specific differences among the a priori research questions.


Assuntos
Pesquisa Biomédica/métodos , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde , Fator de Impacto de Revistas , Ortopedia/métodos , Publicações Periódicas como Assunto , Projetos de Pesquisa , Bibliometria , Feminino , Humanos , Masculino , Tamanho da Amostra , Fatores Sexuais
20.
J Arthroplasty ; 30(7): 1203-6, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25737384

RESUMO

This study aims to report the incidence of patellar fracture after patellofemoral arthroplasty (PFA) and to determine associated factors as well as outcomes of patients with and without this complication. 77 knees in 59 patients with minimum two-year follow-up were included. Seven (9.1%) patients experienced a patellar fracture at a mean of 34 (range 16-64) months postoperatively. All were treated nonoperatively. Lower BMI (P = 0.03), change in patellar thickness (P < 0.001), amount of bone resected (P = 0.001), and larger trochlear component size (P = 0.01) were associated with a greater incidence of fracture. Fewer fractures occurred when the postoperative patellar height exceeded the preoperatively measured height. No statistically significant differences were found in outcome scores between groups at mean four-year follow-up.


Assuntos
Artroplastia/efeitos adversos , Fraturas Ósseas/etiologia , Patela/lesões , Articulação Patelofemoral/cirurgia , Complicações Pós-Operatórias/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Fraturas Ósseas/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Minnesota/epidemiologia , Articulação Patelofemoral/lesões , Complicações Pós-Operatórias/epidemiologia , Período Pós-Operatório , Estudos Retrospectivos
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