(17a) An axial T2 fat-suppressed image in another patient reveals a fluid filled gap (short arrow) at the site of attachment of the medial retinaculum. Am J Knee Surg 13:8388, Izadpanah K, Weitzel E, Vicari M et al (2014) Influence of knee flexion angle and weight bearing on the Tibial Tuberosity-Trochlear Groove (TTTG) distance for evaluation of patellofemoral alignment. The VMO blends distally with the MPFL to attach to the medial border of the patella along its upper two thirds. Nine of 17 patients showed MR evidence of a patellar dislocation. Pediatric Lateral Patellar Retinacular Sleeve Avulsion - JOSPT 2021 Dec 8;11(12):1360. doi: 10.3390/life11121360. The goal of patellar instability treatment is to achieve a stable, functional, and pain-free knee and ultimately to halt or slow the development of osteoarthritis. Radiology 1993; 189:905-907. 5 Carrillon Y, Abidi H, Dejour D, et al. Additional passive stabilizers include the medial patellotibial ligament (MPTL) and the medial patellomeniscal ligament (MPML). The stifle joint of the pampas deer . Eur Radiol 22:418428, Sonin AH, Pensy RA, Mulligan ME, Hatem S (2002) Grading articular cartilage of the knee using fast spin-echo proton density-weighted MR imaging without fat suppression. PDF Painful patellar swelling - dipot.ulb.ac.be The natural history. 4. (3a) Graphical depictions of the mechanism of patellar dislocation: With the knee in flexion, the patella dislocated laterally. 2010 Aug;36(4):353-60. doi: 10.1007/s00068-010-9165-2. Edema is also present medially in the region of the MPFL and medial retinaculum (arrowheads). It is a geometric abnormality of the trochlear groove that affects its shape and depth mainly at its superior part, which can result in abnormal tracking of the patella along the trochlea. The transverse band attaches to the upper pole of the patella, and this component originates on a bony groove that lies between the adductor tubercle and the medial epicondyle, slightly posterior to the epicondyle. PMC In our experience, injuries to the transverse band most often involve the femoral attachment, whereas injuries to the oblique decussation and associated medial retinacular structures are more common at the patellar attachment. Other indicated structures: gracilis (G), semitendinosus (ST), and adductor magnus (AM) tendons. Although you may feel that being asked to make the specific diagnosis of lateral patellar dislocation from a single image is unrealistic, the coronal view in fact reveals a classic and highly characteristic appearance, allowing the diagnosis to be made with confidence. In a series of 474 patients with anterior knee pain, patellar tilt or subluxation was present in 40% of the cases on axial MRI [46]. Magnetic Resonance Cholangiopancreatography MRI PREMIUM Digestive system Illustrations PREMIUM CT axial male abdomen and pelvis CT PREMIUM CT peritoneal cavity CT PREMIUM MRI female pelvis MRI PREMIUM Female pelvis 2012;40(4):837-844. Intervention: Taping the knee to promote medial glide . An association has been demonstrated between patellofemoral cartilage damage and patellar maltracking. Epub 2010 Mar 8. The Insall-Salvati index is the most widely accepted measurement and is easily performed on radiographs and MRI examinations. Insights Imaging 10, 65 (2019). On the other hand, the PTI is significantly altered with knee flexion [37]. Patellar tendon lateral femoral condyle friction syndrome is one of several entities that result in anterior knee pain and in which abnormalities of the patellar fat pads are found on MR imaging. MRI, given its superior soft tissue contrast and multi-planar capability, has emerged as the modality of choice in evaluating articular cartilage abnormalities. Yu JS, Goodwin D, Salonen D, Pathria MN, Resnick D, Dardani M, Schweitzer M. AJR Am J Roentgenol. J Comput Assist Tomogr 2001; 25:957-962. quadricepsplasty rehab protocol In eight of 17 patients, the mechanism of injury was a patellar tendon tear (n = 1) or valgus hyperextension (n = 7). Patellar maltracking: an update on the diagnosis and treatment strategies. Osteochondral fractures are common in acute or recurrent transient lateral patellar dislocation, seen in up to 70% of cases. Am J Sports Med 18:359365, Lattermann C, Toth J, Bach BR Jr (2007) The role of lateral retinacular release in the treatment of patellar instability. On the other hand, frank patellar dislocation is a significant risk factor in the development of patellofemoral osteoarthritis with an incidence of 49% at 25years after the patellar dislocation incident in comparison with 8% in a control group without a dislocation history [60]. MR findings were correlated with clinical, surgical, and arthroscopic findings. Physical Therapy. In these patients, a triad of findings that included focal impaction injuries involving the lateral femoral condyle, osteochondral injuries of the medial patellar facet, and injuries of the medial retinacular ligament were seen. The lateral trochlear articular surface is usually more prominent than its medial portion. Discussion. It acts as a powerful extensor of the knee. J Pediatr Orthop 37:484490, Parikh SN, Lykissas MG, Gkiatas I (2018) Predicting risk of recurrent patellar dislocation. Although edema can be seen in other peripatellar fad pads on MRI, there is no clear association between patellar maltracking and prefemoral fat pad edema or with that at the suprapatellar fat pad [56]. By altering the insertion point of the patellar tendon, these procedures affect the timing and position of patellar engagement in the trochlea and have the ability to biomechanically offload damaged distal articular cartilage, thereby reducing pain and increasing stability simultaneously. Less commonly, patients can also present after chronic patellar instability secondary to generalized ligamentous laxity with or without anterior knee pain. a Sagittal PD knee MRI showing the method of assessing the InsallSalvati index, calculated as the ratio of the patellar tendon length at its inner aspect (white dashed line) to the greatest diagonal length of the patella (white line). A bone bruise occurs anterior to this site of impaction as the patella reduces with knee extension. All authors (ZJ, PJ, KSR, MLS, GD) contributed to the study design, drafted the work, and revised it critically for final submission. b Patellar alta evaluation using the CatonDeschamps index, which is the ratio between a line measured between the inferior margin of the patellar articular surface and the anterior aspect of the tibial plateau (black line) and the greatest length of the patellar articular surface (white line). AJR Am J Roentgenol 194:721727, Kalichman L, Zhang Y, Niu J et al (2007) The association between patellar alignment and patellofemoral joint osteoarthritis features--an MRI study. Guidelines and Gamuts in Musculoskeletal Ultrasound. A bone bruise at the anterolateral aspect of the lateral femoral condyle is also apparent (arrowheads). The lateral patellar retinaculum (LPR) is located on the anterolateral aspect of the knee joint and extends to the femur transversely and obliquely from the lateral margin of the patella [].It plays an important role in patellar stability, and patellar instability can be caused by abnormal tension or tightness in the LPR [].The LPR is a complex structure composed of various merging fascial layers. The lateral patellar retinaculum is a fibrous expansion comprising of superficial and deep layers. Would you like email updates of new search results? Am J Sports Med. Because as noted above, the femoral bone bruise occurs as the patella moves forward during reduction, bone bruises at the lateral femoral condyle always course anteriorly from the site of any femoral chondral injury that may be present. Over 100 different procedures have been described for the treatment of patellar instability, and this reflects the various causes for instability and lack of current gold standard [66, 69, 72]. With knee extension and subsequent reduction, the patella bounces back into position and in doing so, the medial patella impacts against the non-weightbearing anterolateral aspect of the lateral femoral condyle, resulting in the characteristic marrow edema pattern. Pathology Additionally, return to sport can be as low as 45%, leaving many patients searching for further management options [12]. Skeletal Radiol 38:785790, Campagna R, Pessis E, Biau DJ et al (2012) Is superolateral Hoffa fat pad edema a consequence of impingement between lateral femoral condyle and patellar ligament? Tears of the medial retinaculum and the MPFL are commonly present at both the patellar and femoral attachments, though tears of the transverse band of the MPFL are more likely at the femoral attachment. Twenty-seven knees in 21 patients were studied and the mean age of the patients at surgery was 19 years. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. As the knee progresses through greater flexion, the contact surface becomes more proximal on the patella. In either case, careful search for possible displaced osteochondral fragments is necessary, as surgery is often indicated in such patients. Patellar dislocation accounts for ~3% of all knee injuries and is commonly seen in those individuals who participate in sports activities. Eur J Trauma Emerg Surg. This distance is the trochlear sulcus depth (TD). The injury typically occurs from a twisting event with the knee in mild flexion (less than 30). Patients who experience multiple patellar dislocations are more likely to have anatomical variants of the trochlea, patellar alta, or tibial tubercle lateralization. Diederichs G, Issever A, Scheffler S. MR Imaging of Patellar Instability: Injury Patterns and Assessment of Risk Factors. VMO dysplasia may play a role in patellofemoral instability. Clinical History: A 23 year-old female presents with medial knee pain following a twisting injury. Falls. Hemarthrosis is rare in lateral patellar sleeve fractures, as the lateral pole is not as vascularized as the inferior pole of the patella that has the most important blood supply of patella [5 ]. PubMed The medial patellar retinaculum is part of the anterior third of the medial joint capsule. The adductor magnus tendon (AT) attaches to the adductor tubercle, which lies posterior and superior to the femoral attachment of the MPFL. Cochrane Database Syst Rev 2:CD008106, Woo R, Busch MT (1998) Management of patellar instability in children. It can not only detect any underlying morphological risk factors but also look for structural damage associated with maltracking including patellofemoral articular cartilage loss, osteochondral defects, or damage to the medial patellar stabilizers [4, 5]. Am J Sports Med. Twenty-six pelvic limbs were used for gross dissection, and four stifle regions from two animals were used for radiography and magnetic resonance imaging (MRI). Google Scholar, Fithian DC, Paxton EW, Stone ML et al (2004) Epidemiology and natural history of acute patellar dislocation. Correspondence to a Axial CT image demonstrating MPFL reconstruction (arrow heads).
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