2, The American Journal of Sports Medicine, Vol. 4, Singapore Medical Journal, Vol. 36, No. 1, Egyptian Journal of Radiology and Nuclear Medicine, Vol. Because of the transient and brief nature of lateral patellar dislocations, the diagnosis is frequently unrecognized by both patients and clinicians. 9.9. The medial patellofemoral ligament has intrinsic signal and is disrupted at the anterior patella . Patellar translation can be measured using the tibial tuberosity to trochlear groove distance (TT-TG distance) by calculating the transverse length between the trochlear groove on the femur and tibial tuberosity on axial images. Dynamic mediolateral patellar translation (dMPT) and dynamic patellar tilt (dPT) were measured on two occasions by two independent examiners. 66.1 ). ( a) Right lower extremity CT showing a supratrochlear spur, patellar ossicle, and abnormal femoral rotation. 9, No. Which radiographic measurement is used to indicate when a lateral retinacular release may be helpful? Tibial tuberosity-trochlear groove (TT-TG) distance, bisecting the trochlear groove sulcus (TG), measure the distance between TT and TG = TT-TG distance. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username. 11, Clinics in Sports Medicine, Vol. Clipboard, Search History, and several other advanced features are temporarily unavailable. 4, Korean Journal of Radiology, Vol. Operative management is indicated for chronic and recurrent patellar instability. Unable to process the form. Volume 12, Indian Journal of Musculoskeletal Radiology, Vol. To provide normal values for physiological patellofemoral tracking in a representative group of healthy individuals, as well as sex differences, using real-time 3T-magnetic resonance imaging (MRI) and to test for the reliability of the presented technique. 205, No. There is also a bone contusion of the inferomedial patella. The ensuing loss of medial restraint favors future patellar dislocations, especially if additional risk factors are present. Epub 2019 Dec 13. 2010;30(4):961-81. 6. 2, American Journal of Roentgenology, Vol. Enter your email address below and we will send you the reset instructions. This is her third dislocation in the last 6 months. 1. Song E, Seon J, Kim M, Seol Y, Lee S. Radiologic Measurement of Tibial Tuberosity-Trochlear Groove (TT-TG) Distance by Lower Extremity Rotational Profile Computed Tomography in Koreans. Knee Surg Sports Traumatol Arthrosc. Patients with primary patellar dislocation without severe internal derangement who lack major risk factors can be treated conservatively. 22, No. 3, World Journal of Methodology, Vol. Prevalence of Lateral Patellofemoral Maltracking and Associated Complications in Patients with Osgood Schlatter Disease. . 2011;40(4):375-87. Background: Tibial tubercle-trochlear groove distance (TT-TG) is a commonly used measurement for surgical decision making in patients with patellofemoral malalignment and instability. 04, Archives of Orthopaedic and Trauma Surgery, Vol. 8. Patellar instability is a condition characterized by patellar subluxation or dislocation episodes as a result of injury, ligamentous laxity or increased Q angle of the knee. 25, No. 27, No. 56, No. The typical injury pattern is a tear of the medial patellofemoral ligament (MPFL) and bone bruises of the patella and the lateral femoral condyle. 9, Orthopaedic Journal of Sports Medicine, Vol. Please enable it to take advantage of the complete set of features! 44, No. 24, No. tight ITB and vastus lateralis), acute dislocation usually associated with a large hemarthrosis, absence of swelling supports ligamentous laxity and habitual dislocation mechanism, measured in quadrants of translation (midline of patella is considered "0"), and also should be compared to contralateral side, normal motion is <2 quadrants of patellar translation, lateral translation of medial border of patella to lateral edge of trochlear groove is considered "2" quadrants and is considered abnormal amount of translation, passive lateral translation results in guarding and a sense of apprehension, excessive lateral translation in extension which "pops" into groove as the patella engages the trochlea early in flexion, trochlear groove lies in same plane as anterior border of lateral condyle, anterior border of lateral condyle lies anterior to anterior border of medial condyle, represents convex trochlear groove/hypoplastic medial condyle, Blumensaat's line should extend to inferior pole of the patella at 30 degrees of knee flexion, angle between line along subchondral bone of lateral trochlear facet + posterior femoral condyles, values > 140 degrees indicate flattening of the trochlea concerning for dysplasia, measures the distance between 2 perpendicular lines from the posterior cortex to the tibial tubercle and the trochlear groove, help further rule out suspected loose bodies, osteochondral lesion and/or bone bruising, tear usually at medial femoral epicondyle, NSAIDS, activity modification, and physical therapy, mainstay of treatment for first time patellar dislocator, without any loose bodies or intraarticular damage, short-term immobilization for comfort followed by 6 weeks of controlled motion, closed chain short arc quadriceps exercises, core and hip strengthening to improve limb positioning and balance (hip abductors, gluteals, and abdominals), displaced osteochondral fractures or loose bodies, may be an indication for operative treatment in a first-time dislocator, arthroscopic vs open removal versus repair of the osteochondral fragment, primary repair with screws or pins if sufficient bone available for fixation, first time dislocation with bony fragment, direct repair when surgery can be done within first few days, no clinical studies support this over nonoperative treatment, MPFL reconstruction with autograft vs allograft, gracilis or semitendinosus commonly used (stronger than native MPFL), femoral origin can be reliably found radiographically (Schottle point), a femoral tunnel positoined too proximally results in graft that is too tight ("high and tight"), severe trochlear dysplasia is the most important predictor of residual patellofemoral instability after isolated MPFL reconstruction, Fulkerson-type osteotomy (anterior and med, may be used in addition to MPFL or in isolation for significant malalignment, anteromedialized displacement of osteotomy and fixation, correct TT-TG to 10-15mm (never less than 10mm), distal displacement of osteotomy and fixation, isolated release no longer indicated for instability, only indicated if there is excessive lateral tilt or tightness after medialization, rarely addressed (in the USA) even if trochlear dysplasia present, arthroscopic or open trochlear deepening procedure, do not do tibial tubercle osteotomy (will harm growth plate of proximal tibia), redislocation rates with nonoperative treatment may be high (15-50%) at 2-5 years, recurrence rate is highest in those patients who sustain a primary dislocation, almost exclusively iatrogenic as a result of prior patellar stabilization surgery. Midsubstance oblique retinacular ligament rupture, Soft-tissue avulsion of medial patellofemoral ligament, Midsubstance medial patellofemoral ligament rupture, Bony avulsion of medial patellofemoral ligament. 5, Journal of Orthopaedic Science, Vol. Keywords: 3. Kamel S, Kanesa-Thasan R, Dave J et al. 20 Acutely, osteochondral and chondral fractures of the medial facet of the patella and/or the lateral femoral condyle can be a common finding on radiographs, MRI, ultrasound, arthroscopy, and open procedures (). HHS Vulnerability Disclosure, Help 34, No. 5, BMC Musculoskeletal Disorders, Vol. 22, No. -. The above video demonstrates the mechanism of injury in patellar dislocation. Dynamic mediolateral patellar translation is a size- and sex-independent parameter for proximal patellar tracking. Which of the following is the most likely site of origin for the loose fragment? (OBQ10.188) A Systematised MRI Approach to Evaluating the Patellofemoral Joint. 2022;41(1):77-88. Treatment is nonoperative with bracing for first time dislocation without bony avulsion or presence of articular loose bodies. Conclusion: This treatment is a new form of regenerative medicine currently being used to enhance the healing of various musculoskeletal system injuries, involving cartilages, tendons, muscles, ligaments, and bones. 2022, The American Journal of Sports Medicine, Vol. lateral patellar motion, with one, two, and three quadrants corresponding to 75-99, 100-125, and >125 %, respectively. Acute patellar dislocation accounts for 2% to 3% of all knee injuries 1 and is the second most common cause of traumatic knee hemarthrosis. Frings J, Dust T, Krause M, Ohlmeier M, Frosch KH, Adam G, Warncke M, Maas KJ, Henes FO. The site is secure. Radiological parameters for patellar maltracking were within the normal range. Clin Orthop Surg. 142, No. 09, The Journal of Knee Surgery, Vol. Magnetic resonance (MR) imaging is reliable in identifying risk factors for chronic patellar instability and in assessing knee joint damage associated with patellar dislocation. Check for errors and try again. The "crossing sign"represents an abnormally elevated floor of the trochlear groove rising above the top of the wall of one of the femoral condyles, assessed on lateral radiographs. 2, Knee Surgery, Sports Traumatology, Arthroscopy, Vol. Diederichs G, Issever A, Scheffler S. MR Imaging of Patellar Instability: Injury Patterns and Assessment of Risk Factors. 19, No. 211, No. Accessibility 2002; 225:736-743. doi . 3, Knee Surgery, Sports Traumatology, Arthroscopy, Vol. Before 1, 11 October 2016 | RadioGraphics, Vol. 1, Open Access Journal of Sports Medicine, Vol. 2. Sci Rep. 2020 Oct 8;10(1):16770. doi: 10.1038/s41598-020-72332-9. 12, Topics in Magnetic Resonance Imaging, Vol. 3, AMEI's Current Trends in Diagnosis & Treatment, Vol. First-time patellar dislocation typically occurs with twisting knee motions, during which the medial ligamentous stabilizers rupture, and the patella strikes against the lateral femoral condyle. ( c) 3D reconstruction of CT scan for visualization of trochlear dysplasia. Transient Patellar Dislocation - MSK Radiology Imaging Findings: Hyperintense marrow edema of the anterolateral femoral condyle consistent with bone contusion. They are produced by passing a small, highly controlled amount of radiation through the human body, and capturing the resulting image on an image recording device. You recommend reconstruction of her medial patellofemoral ligament (MPFL) given her recurrent instability. 1, Orthopaedic Journal of Sports Medicine, Vol. In addition, surgical correction of anatomic variants will help reduce the potential for chronic instability. A Platelet-Rich Plasma (PRP) injection is a solution containing concentrated levels of platelets in plasma. Am J Sports Med. 3, The Physician and Sportsmedicine, Vol. 6, American Journal of Roentgenology, Vol. Increased Patellar Volume/Width and Decreased Femoral Trochlear Width Are Associated With Adolescent Patellofemoral Pain. 3, Revista Brasileira de Ortopedia, Vol. 24, No. 4, Journal of Medical Imaging and Radiation Sciences, Vol. Patellar tendon length: the factor in patellar instability? Is Superolateral Hoffa Fat Pad Edema a Consequence of Impingement between Lateral Femoral Condyle and Patellar Ligament? Published by Elsevier Inc. All rights reserved. First-time patellar dislocation typically occurs with twisting knee motions, during which the medial ligamentous stabilizers rupture, and the patella strikes against the lateral femoral condyle. 213, No. (SAE08AN.85) Hinckel B, Gobbi R, Filho E et al. This site needs JavaScript to work properly. 2, Knee Surgery, Sports Traumatology, Arthroscopy, Vol. Patellofemoral instability. Level of evidence: results: grades of patellar abnormality, based on findings in the enthesial region at mr imaging, correlated with signs of increasing fibrovascular repair: grade 1 (n = 4), enhancing area adjacent to patellar apex, with marginal zone of intermediate signal intensity, and a patellar apical chondral-bone avulsion; grade 2 (n = 5), same signs as Anish Choudhary Ankle joint radiography Nikhil Murkey Habitual dislocation of patella Link, Google Scholar; 12 Tung GA, Davis LM, Wiggins ME, Fadale PD. 24, No. 23, No. 8, Clinics in Sports Medicine, Vol. In healthy individuals without patellofemoral abnormalities normal dMPT proximal to the trochlea groove was 1.7 2.5 (1.2-2.2) mm, independent of size or sex. 2, International Orthopaedics, Vol. Dickens A, Morrell N, Doering A, Tandberg D, Treme G. Tibial Tubercle-Trochlear Groove Distance: Defining Normal in a Pediatric Population. official website and that any information you provide is encrypted Most patients with patellar instability are young and active individuals, especially females in the second decade. Primarily, CT is useful to assess the anterior tibial tubercle-trochlear groove distance, of which an abnormal measurement is an indication of patellar instability. Dr. Mah joined EXR Medical Imaging in 1985 and has been a partner since 1986. She completed 6 weeks of physical therapy following her first dislocation. 2018 Dec;476(12):2334-2343. doi: 10.1097/CORR.0000000000000499. 1, American Journal of Roentgenology, Vol. All of the following are predisposing factors for lateral patellar dislocation in a native knee EXCEPT? 5, Sports Medicine and Arthroscopy Review, Vol. and transmitted securely. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Jha P, Feger J, Knipe H, et al. Am J Sports Med. 3, Scandinavian Journal of Medicine & Science in Sports, Vol. 1 Pain is often described as medial because of soft tissue injuries that occur to the medial retinaculum and/or MPFL. 2016. 2, American Journal of Roentgenology, Vol. (OBQ07.30) This measurement has historically been performed utilizing axial computed tomography (CT). 2. Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. A 27-year-old football player sustains an acute lateral patellar dislocation. anterior cruciate ligament avulsion fracture, posterior cruciate ligament avulsion fracture, Ahlback classification system in assessing osteoarthritis of the knee joint, Kellgren and Lawrence system for classification of osteoarthritis, anterior cruciate ligament mucoid degeneration, MRI grading system for meniscal signal intensity. Copyright 2021 Arthroscopy Association of North America. 1, The American Journal of Sports Medicine, Vol. 49, No. 3.2, European Journal of Radiology, Vol. J Bone Joint Surg Am. MR imaging can thus provide important information for individually tailored treatment. 5, No. 52, No. Development of Real-Time Kinematic Magnetic Resonance Imaging (kMRI) Techniques for Studying the Kinematics of the Spine and Joints in Dogs-Preliminary Study on Cadavers. Prevalence is 6-77 per 100,000 population 2. 3. 4, BMC Musculoskeletal Disorders, Vol. Editorial Commentary: Real-Time Dynamic Magnetic Resonance Imaging of the Patellofemoral Joint: Ready for Prime Time? 10, American Journal of Roentgenology, Vol. 84, No. Giovannetti de Sanctis E, Mesnard G, Dejour D. Trochlear Dysplasia: When and How to Correct. The intersection of a line extended from the middle of the shaft and Blumensaat's line, Anterior to a line extended from the middle of the shaft and Blumensaat's line, Posterior to a line extended from the posterior cortex of the shaft and distal to Blumensaat's line, Anterior to a line extended from the posterior cortex of the shaft and distal to Blumensaat's line, Anterior to a line extended from the posterior cortex of the shaft and proximal to Blumensaat's line. 7, Journal of Orthopaedic Surgery and Research, Vol. 2, Trauma und Berufskrankheit, Vol. Patients with pronounced ligamentous tears or large osteochondral lesions require prompt surgery. Neither dMPT nor dPT was correlated with height, BMI, or patellar diameter. Patellofemoral instability or maltracking is the clinical syndrome due to morphologic abnormalities in the patellofemoral joint where the patella is prone to recurrent lateral dislocation. Purpose: 38, No. Subscribe now (individual subscription: $237.00), (This functionality works only for purchases made as a guest), Knee Surgery, Sports Traumatology, Arthroscopy, European Journal of Orthopaedic Surgery & Traumatology, Vol. The MRI shows a hemarthrosis with a floating osteochondral fragment. Patellar translation can be measured using the tibial-tuberosity to trochlear groove distance (TT-TG distance) by calculating the transverse length between the trochlear groove on the femur and tibial tuberosity on axial images. 10, Current Physical Medicine and Rehabilitation Reports, Vol. The definition of maltracking refers to the dynamic malpositioning of the patella within the trochlear groove that occurs during active range of motion of the knee. 10, International Orthopaedics, Vol. Since 1985, he has also been on staff at Scarborough Grace Hospital (now The . 97, No. In the acute and subacute setting MRI displays features of lateral patellar dislocation as: Moreover, MRI can indicate risk factors such as trochlear dysplasia, patella alta and patellar translation for which all different measurements exist, such as: Nearly half of the patients with first-time dislocation will sustain recurrent dislocation after conservative management. 2022 Sep 18. During the range of motion, mean dMPT was 1.7 2.4 (95% CI .9-2.5) mm in females and 1.8 2.7 (95% CI 1.1-2.6) mm in males (P = .766). 1, Knee Surgery, Sports Traumatology, Arthroscopy, Vol. 22, No. 8600 Rockville Pike Are the Osseous and Tendinous-Cartilaginous Tibial Tuberosity-Trochlear Groove Distances the Same on CT and MRI? 4, Osteoarthritis and Cartilage, Vol. 2013;41(1):51-7. 87, No. 12, Canadian Association of Radiologists Journal, Vol. What is the most likely diagnosis? 2, International Orthopaedics, Vol. 203, No. 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Medial Retinacular Plication (Modified Insall ), MPFL Reconstruction - Pediatric and Adolescent, Type in at least one full word to see suggestions list, Orthopaedic Summit Evolving Techniques 2021, Correcting Femoral Torsion & Version With A Femoral Osteotomy: Not So Hard, Let Me Share My Experience - Robert Buly, MD, MS, Commentary: Let My Experience Speak - David R. Diduch, MD, Pro: MPFL Reconstruction Nothing More, Keep It Simple, Safe & Effective - Jason Koh, MD, MBA, Patellar Dislocation with Loose Chondral Fragment and Medial Facet Fx, Patella dislocation with large loosebody in 25M. The typical injury pattern is a tear of the medial patellofemoral ligament (MPFL) and bone bruises of the patella and the lateral femoral condyle. 1. Patellar instability might display the following different clinical presentations 3: The normal patellofemoral joint has two kinds of stabilizers - active stabilizers (extensor muscles) and passive stabilizers (bones and ligaments): Three major morphologic abnormalities that predispose to patellar instability: Other factors contributing to patellar instability include 3,4: The most common mechanism of first-time patellar dislocation is internal rotation of the femur relative to the knee (i.e. Recurrent patellar dislocations usually occur in individuals with anatomic variants of the patellar stabilizers, such as trochlear dysplasia, patella alta, and lateralization of the tibial tuberosity. 2014;96(4):318-24. 5, Knee Surgery, Sports Traumatology, Arthroscopy, Vol. 2022 Radiological Society of North America, Epidemiology and natural history of acute patellar dislocation, Incidence and risk factors of acute traumatic primary patellar dislocation, Acute patellar dislocations: the natural history, Characteristics of patients with primary acute lateral patellar dislocation and their recovery within the first 6 months of injury, Acute lateral patellar dislocation at MR imaging: injury patterns of medial patellar soft-tissue restraints and osteochondral injuries of the inferomedial patella, Medial patellofemoral ligament injury patterns and associated pathology in lateral patella dislocation: an MRI study, Transient lateral patellar dislocation: diagnosis with MR imaging, Prior lateral patellar dislocation: MR imaging findings, Correlation of MR imaging findings and open exploration of medial patellofemoral ligament injuries in acute patellar dislocations, MRI of osteochondral defects of the lateral femoral condyle: incidence and pattern of injury after transient lateral dislocation of the patella, Acute dislocation of the patella: MR findings, Patellar instability: assessment on MR images by measuring the lateral trochlear inclinationinitial experience, Objective patellar instability: MR-based quantitative assessment of potentially associated anatomical features, Patellar height on sagittal MR imaging of the knee, Imaging the femoral sulcus with ultrasound, CT, and MRI: reliability and generalizability in patients with patellar instability, The supporting structures and layers on the medial side of the knee: an anatomical analysis, Factors of patellar instability: an anatomic radiographic study, Dysplasia of the femoral trochlea [in French], Minimal rotation aberrations cause radiographic misdiagnosis of trochlear dysplasia, Comparison of native axial radiographs with axial MR imaging for determination of the trochlear morphology in patients with trochlear dysplasia. (OBQ18.157) In: StatPearls [Internet]. Average patella diameter was 37.9 2.7 (95% CI 37.1-38.7) mm in women and 42.4 3.2 (95% CI 41.5-43.3) mm in men. The most common procedures, in addition to MPFL reconstruction, include trochleoplasty, medialization of the tibial tuberosity, and medial capsular plication. 7, The American Journal of Sports Medicine, Vol. FOIA 37, No. 1From the Department of Radiology (G.D., A.S.I.) Spontaneous Osteonecrosis of the Knee (SONK), Osgood Schlatter's Disease (Tibial Tubercle Apophysitis), Anterior Superior Iliac Spine (ASIS) Avulsion, Anterior Inferior Iliac Spine Avulsion (AIIS), Concussions (Mild Traumatic Brain Injury). 14, No. Surgical replacement of the knee, also called total knee arthroplasty (TKA), is one of the most successful and cost-effective interventions in modern medicine [], but TKA is not without risk or complication.As a major surgical procedure typically performed on older patients, who often have comorbid conditions, TKA is subject to both immediate and delayed complications and failures. ( b) Left lower extremity CT showing a more severe rotational abnormality of the femur, with chronic patellar subluxation and trochlear dysplasia. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Within a 30-seconds time-frame, three simultaneous, transverse slices were acquired. 28, No. 215, No. RSNA members have free access to all RadioGraphics content. 50, No. 3, Knee Surgery, Sports Traumatology, Arthroscopy, Vol. Radiology 1994;193(3):829-834. 17, No. Methods: Quadriceps and Patellar tendon Patellar dislocation Bone and Cartilage Normal and abnormal bone marrow Avascular Necrosis Insufficiency fracture Osteochondritis Dissecans Ligaments MR-signs of ligament tear Anterior Cruciate Ligament The ACL has interesting anatomy. Are the Osseous and Tendinous-Cartilaginous Tibial Tuberosity-Trochlear Groove Distances the Same on CT and MRI? Intercondylar distance correlated weakly with dPT (r = -.241; P = .041). For which of the following clinical scenarios is nonoperative management with bracing and physical therapy (PT) best indicated? 236, No. Diagnosis is made clinically in the acute setting with a patellar dislocation with a traumatic knee effusion and in chronic settings with passive patellar translation and a positive J sign. Fithian D, Paxton E, Stone M et al. . 205, No. In females, the patellar diameters and intercondylar distances were significantly smaller than in males (P < .001). Imaging findings Prior to reduction, the patient had one-view imaging of the right knee. Log-in above or renew your membership today. Rev Chir Orthop Reparatrice Appar Mot. PMC 2004;32(5):1114-21. 44, No. The typical injury pattern is a tear of the medial patellofemoral ligament (MPFL) and bone bruises of the patella and the lateral femoral condyle. Additionally, complex injuries to bone, cartilage, and ligaments may occur. Dr. Jonathan Chung has joined X-Ray Associates, January, 2021. 26, No. Which of the following best describes the radiographic landmarks on a lateral radiograph for locating the femoral attachment of the medial patellofemoral ligament (MPFL) during reconstruction? 215, No. Unable to load your collection due to an error, Unable to load your delegates due to an error. Canal S, Tamburro R, Falerno I, Signore FD, Simeoni F, De Pasquale F, De Bonis A, Maraone A, Paolini A, Bianchi A, Rosto M, Vignoli M. Animals (Basel). 33, No. The skyline view can show decreased trochlear depth and a large sulcus angle (>144). 4, Arthroscopy: The Journal of Arthroscopic & Related Surgery, Vol. Bookshelf Normal dPT showed a dependency on sex and was 1.3 2.9 (.4-2.1) in women and -0.2 3.8 (-1.2-0.9) in men. In healthy individuals . Reference article, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-16281, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":16281,"questionManager":null,"mcqUrl":"https://radiopaedia.org/articles/patellofemoral-instability/questions/1618?lang=us"}. 2022 May;38(5):1581-1583. doi: 10.1016/j.arthro.2021.11.034. "Double contour sign" is a double line at the anterior aspect of condyles and is seen if the medial condyle is hypoplastic. S1, Sports Medicine and Arthroscopy Review, Vol. 9, Clinics in Sports Medicine, Vol. The .gov means its official. 40, No. Knee Surg Sports Traumatol Arthrosc. Tanaka MJ, Elias JJ, Williams AA, Demehri S, Cosgarea AJ. Clin Sports Med. Link, Google Scholar 5, The American Journal of Sports Medicine, Vol. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. To diagnose a patellar subluxation, your doctor will bend and straighten the injured knee and feel the area around the kneecap. 2016 Nov;24(11):3634-3641. doi: 10.1007/s00167-016-4216-9. Abstract. Surgical modalities are: The knee is a complex synovial joint that can be affected by a range of pathologies: ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. 48, No. Treasure Island (FL): StatPearls Publishing; 2022 Jan. 24, No. Epidemiology and Natural History of Acute Patellar Dislocation. 2015;44(8):1085-93. 22-year-old female with multiple previous dislocations, the MRI findings in Figure A, and a tibial tubercle-trochlear groove (TT-TG) distance of 26 mm, 22-year-old female with the MRI findings in Figure B and a TT-TG distance of 18 mm, 13-year-old female with no prior history of knee injury and the MRI findings in Figure A, 13-year-old female with no prior history of knee injury and the MRI findings in Figure B, 13-year-old female with multiple previous dislocations despite PT and the MRI findings in Figure A. Where should your femoral tunnel be located when looking at Figure A? 3, Knee Surgery, Sports Traumatology, Arthroscopy, Vol. 22, No. 1, Acta Orthopaedica Belgica, Vol. MeSH 97, No. 47, No. A high school softball player has chronic activity-related anterior knee pain without a history of instability. Chronic patellar instability, if not treated, may lead to severe arthritis and chondromalacia patellae. The aim of the surgery is to repair the knee damage caused by patellar dislocation and to correct the primary anatomical anomaly. Which of the following factors is associated with the highest risk of persistent patellar instability? 100 knees (53 right, 47 left; age: 26.7 4.4 years; BMI: 22.5 3.1) of 57 individuals (27 females, 30 males) were included. This is an AAOS Self Assessment Exam (SAE) question. 2022 Oct 15;12(20):2790. doi: 10.3390/ani12202790. He is a graduate of the University of Toronto - Hon Bsc (physics) 1977 and MD 1981. The measurements are used to quantify patellar instability. A short presentation on the practical issues related to the patellofemoral joint (subluxation, dislocation and incongruence) and chondromalacia Bhavin Jankharia Follow Doctor Advertisement Recommended Patella dislocations Dr Gandhi Kota Patello femoral jt. 3, Magnetic Resonance Imaging Clinics of North America, Vol. 1, Diagnostic and Interventional Imaging, Vol. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Patellar translation (TT-TG distance). 11, Knee Surgery, Sports Traumatology, Arthroscopy, Vol. knee to knee collision in basketball, or football helmet to side of knee, between medial epicondyle and adductor tubercle, is primary restraint in first 20 degrees of knee flexion, patellar-femoral bony structures account for stability in deeper knee flexion, trochlear groove morphology, patella height, patellar tracking, May occur from a direct blow (ex. Radiological technology is the production of medical images, commonly called X-rays, of internal organs and structures. Patellar maltracking is typically Radiology. Radiographics. 27, No. 22, No. Results: The https:// ensures that you are connecting to the 25, No. Courtesy of Daniel Bodor, MD, Radsource. Objective assessment of patellar maltracking with 3T dynamic magnetic resonance imaging: feasibility of a robust and reliable measuring technique. Patellar Instability Radiology Radiographs: Radiographs are necessary to identify fracture, loose bodies, arthritis, malalignment and abnormal anatomy. Radiographs reveal a patellar dislocation. Hinckel B, Gobbi R, Filho E et al. 206, No. Would you like email updates of new search results? 4, American Journal of Roentgenology, Vol. 5, Indian Journal of Radiology and Imaging, Vol. 1, Chinese Journal of Traumatology, Vol. Wolfe S, Varacallo M, Thomas JD, Carroll JJ, Kahwaji CI. Figure 49 shows an acute axial MRI scan of a right knee. Which of the following structures attaches between the medial epicondyle and adductor tubercle of the femur? 48, No. 41, No. Chhabra A, Subhawong T, Carrino J. How is patellar subluxation diagnosed? 32, No. 28, No. 1, American Journal of Roentgenology, Vol. An athlete sustains a traumatic patellar dislocation. Dynamic mediolateral patellar translation is a size- and sex-independent parameter for proximal patellar tracking. Plateau-patella angle normal between 20 and 30 degrees Sunrise/Merchant views best to assess for lateral patellar tilt lateral patellofemoral angle (normal is an angle that opens laterally) angle between line along subchondral bone of lateral trochlear facet + posterior femoral condyles normal > 11 congruence angle (normal is -6 degrees) Measurement Superimpose axial images of: femoral condyles 2, Knee Surgery, Sports Traumatology, Arthroscopy, Vol. A 22-year-old female sustained a lateral patellar dislocation while playing intramural soccer. 26, No. The typical MR imaging findings after patellar dislocation, the assessment of predisposing anatomic factors, and current surgical procedures are discussed and illustrated. 4, Medicinos teorija ir praktika, Vol. 37, No. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Brown N, Foster T, Elena B, et al. 38, No. Radiology 1993;188(3):661-667. An official website of the United States government. 12, No. MIKE MAH, MD, FRCPC. 10, Knee Surgery, Sports Traumatology, Arthroscopy, Vol. dynamic MRI; maltracking; normal values; patella; patellofemoral; tracking. Clin Orthop Relat Res. Federal government websites often end in .gov or .mil. (OBQ11.188) 5. 2, Revista Brasileira de Ortopedia (English Edition), Vol. First-time patellar dislocation typically occurs with twisting knee motions, during which the medial ligamentous stabilizers rupture, and the patella strikes against the lateral femoral condyle. 4, No. 32, No. Intra- and interrater reliability were excellent for dMPT and dPT. 12, Journal de Radiologie Diagnostique et Interventionnelle, Vol. Measurement Superimpose axial images of: femoral condyles 21, No. PATELLAR ALIGNMENT Patellar Orientation T his is the aspect of patello-femoral alignment most commonly evaluated by physical therapists. 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