[Patellar Dislocation : Causes and Treatment]

Overview

Journal Unfallchirurg

Date 2020 Nov 17

PMID 33201266

Citations 5

Authors

A Schmeling

J Frings

R Akoto

K H Frosch

Affiliations

Soon will be listed here.

Abstract

The causes of patellofemoral instability (PFI) are complex. In accordance with the current literature a classification was developed which clearly weights all entities and derives diagnostic and therapeutic consequences. It considers patellar instability and patellar maltracking or the complete loss of patellar tracking and differentiates into 5 types. Type 1: patellar dislocation without maltracking or instability with a low risk of redislocation. Type 2: high risk of redislocation, no maltracking. Type 3: instability and maltracking; reasons for maltracking are a) soft tissue contracture, b) patella alta, c) pathological tibial tuberosity trochlear groove (TTTG) distance, c) valgus deformities and e) torsional deformities. Type 4: massively unstable floating patella, which is based on a high-grade trochlear dysplasia. Type 5: maltracking without instability.

Citing Articles

Intraoperative control by Schanz-screws is inaccurate to achieve the exact amount of correction in de-rotational osteotomies.

Ferner F, Klinder A, Woerner M, Morris P, Harrer J, Dickschas J Knee Surg Sports Traumatol Arthrosc. 2023; 31(10):4319-4326.

PMID: 37329368 DOI: 10.1007/s00167-023-07485-x.

The Impact of Anatomical Predisposition and Mechanism of Trauma on Dislocation of the Patella: A Retrospective Analysis of 104 Cases.

Schubert I, Morris P, Dickschas J, Strohm P J Pers Med. 2023; 13(1).

PMID: 36675745 PMC: 9863944. DOI: 10.3390/jpm13010084.

Correction of tibial tubercle trochlea groove distance is related to torsional correction in high tibial derotational osteotomy.

Ferner F, Dickschas J, Jasinski M, Huettner F, Harrer J, Lutter C Knee Surg Sports Traumatol Arthrosc. 2022; 31(3):1176-1182.

PMID: 36198835 DOI: 10.1007/s00167-022-07190-1.

Distalization of tibial tubercle osteotomy is not necessary for patients with recurrent patellar dislocation accompanied by patella alta and increased TT-TG distance.

Zhou K, Bai P, Sun Z, Jia Y, Wang F, Wang X BMC Musculoskelet Disord. 2022; 23(1):838.

PMID: 36057569 PMC: 9440549. DOI: 10.1186/s12891-022-05779-8.

[Mid-term effectiveness analysis of combined knee extensor mechanism realignment with bone anchor for recurrent patella dislocation].

Cai G, Li Y, Ning Z, Han R, Jia D, Li S Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2022; 36(8):963-968.

PMID: 35979787 PMC: 9379466. DOI: 10.7507/1002-1892.202201087.

References

Frosch S, Balcarek P, Walde T, Schuttrumpf J, Wachowski M, Ferleman K . [The treatment of patellar dislocation: a systematic review]. Z Orthop Unfall. 2011; 149(6):630-45. DOI: 10.1055/s-0030-1250691. View

Christiansen S, Jakobsen B, Lund B, Lind M . Isolated repair of the medial patellofemoral ligament in primary dislocation of the patella: a prospective randomized study. Arthroscopy. 2008; 24(8):881-7. DOI: 10.1016/j.arthro.2008.03.012. View

Paiva M, Blond L, Holmich P, Steensen R, Diederichs G, Feller J . Quality assessment of radiological measurements of trochlear dysplasia; a literature review. Knee Surg Sports Traumatol Arthrosc. 2017; 26(3):746-755. DOI: 10.1007/s00167-017-4520-z. View

Palmu S, Kallio P, Donell S, Helenius I, Nietosvaara Y . Acute patellar dislocation in children and adolescents: a randomized clinical trial. J Bone Joint Surg Am. 2008; 90(3):463-70. DOI: 10.2106/JBJS.G.00072. View

Frings J, Balcarek P, Tscholl P, Liebensteiner M, Dirisamer F, Koenen P . Conservative Versus Surgical Treatment for Primary Patellar Dislocation. Dtsch Arztebl Int. 2020; 117(16):279-286. PMC: 7370958. DOI: 10.3238/arztebl.2020.0279. View

Balcarek P, Oberthur S, Hopfensitz S, Frosch S, Walde T, Wachowski M . Which patellae are likely to redislocate?. Knee Surg Sports Traumatol Arthrosc. 2013; 22(10):2308-14. DOI: 10.1007/s00167-013-2650-5. View

Amis A, Senavongse W, Bull A . Patellofemoral kinematics during knee flexion-extension: an in vitro study. J Orthop Res. 2006; 24(12):2201-11. DOI: 10.1002/jor.20268. View

Feller J, Amis A, Andrish J, Arendt E, Erasmus P, Powers C . Surgical biomechanics of the patellofemoral joint. Arthroscopy. 2007; 23(5):542-53. DOI: 10.1016/j.arthro.2007.03.006. View

Dejour H, Walch G, Neyret P, Adeleine P . [Dysplasia of the femoral trochlea]. Rev Chir Orthop Reparatrice Appar Mot. 1990; 76(1):45-54. View

10.

Lippacher S, Dejour D, Elsharkawi M, Dornacher D, Ring C, Dreyhaupt J . Observer agreement on the Dejour trochlear dysplasia classification: a comparison of true lateral radiographs and axial magnetic resonance images. Am J Sports Med. 2012; 40(4):837-43. DOI: 10.1177/0363546511433028. View

11.

Biedert R . Patellar instability with increased knee flexion due to lateral femoral condyle distal dysplasia: a report of two cases. Knee. 2011; 19(2):140-3. DOI: 10.1016/j.knee.2010.12.003. View

12.

Carrillon Y, Abidi H, Dejour D, Fantino O, Moyen B, Tran-Minh V . Patellar instability: assessment on MR images by measuring the lateral trochlear inclination-initial experience. Radiology. 2000; 216(2):582-5. DOI: 10.1148/radiology.216.2.r00au07582. View

13.

Frosch K, Akoto R, Schmeling A . [Patella dislocation in athletes]. Chirurg. 2014; 85(10):879-87. DOI: 10.1007/s00104-014-2772-4. View

14.

Atkin D, Fithian D, Marangi K, Stone M, Dobson B, Mendelsohn C . Characteristics of patients with primary acute lateral patellar dislocation and their recovery within the first 6 months of injury. Am J Sports Med. 2000; 28(4):472-9. DOI: 10.1177/03635465000280040601. View

15.

Ma L, Wang F, Chen B, Wang C, Zhou J, Wang H . Medial retinaculum plasty versus medial patellofemoral ligament reconstruction for recurrent patellar instability in adults: a randomized controlled trial. Arthroscopy. 2013; 29(5):891-7. DOI: 10.1016/j.arthro.2013.01.030. View

16.

Smith T, Walker J, Russell N . Outcomes of medial patellofemoral ligament reconstruction for patellar instability: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2007; 15(11):1301-14. DOI: 10.1007/s00167-007-0390-0. View

17.

Lorenz A, Muller O, Kohler P, Wunschel M, Wulker N, Leichtle U . The influence of asymmetric quadriceps loading on patellar tracking--an in vitro study. Knee. 2012; 19(6):818-22. DOI: 10.1016/j.knee.2012.04.011. View

18.

Wunschel M, Leichtle U, Obloh C, Wulker N, Muller O . The effect of different quadriceps loading patterns on tibiofemoral joint kinematics and patellofemoral contact pressure during simulated partial weight-bearing knee flexion. Knee Surg Sports Traumatol Arthrosc. 2011; 19(7):1099-106. DOI: 10.1007/s00167-010-1359-y. View

19.

Nelitz M, Dreyhaupt J, Lippacher S . Combined trochleoplasty and medial patellofemoral ligament reconstruction for recurrent patellar dislocations in severe trochlear dysplasia: a minimum 2-year follow-up study. Am J Sports Med. 2013; 41(5):1005-12. DOI: 10.1177/0363546513478579. View

20.

Pagenstert G, Wolf N, Bachmann M, Gravius S, Barg A, Hintermann B . Open lateral patellar retinacular lengthening versus open retinacular release in lateral patellar hypercompression syndrome: a prospective double-blinded comparative study on complications and outcome. Arthroscopy. 2012; 28(6):788-97. DOI: 10.1016/j.arthro.2011.11.004. View