These are most often found at the inferomedial patella or the lateral femoral condyle [49, 61, 62]. Methods MRI studies taken at one imaging site between January, 2007 to January, 2008 with the final diagnosis of patella . There are numerous techniques reported in literature and commonly used to reconstruct the medial sided soft tissue constraints. Privacy The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Duke Radiology Case Review. 2015 Sep 30;9:463-74. doi: 10.2174/1874325001509010463. Radiology 2000; 216: 582-585. Knee Surg Sports Traumatol Arthrosc 13:522528, Farr J, Schepsis AA (2006) Reconstruction of the medial patellofemoral ligament for recurrent patellar instability. FOIA 7). Structures such as the iliotibial band, fibular collateral ligament, and biceps femoris tendon are readily apparent on MRI and are easy to identify. 2). A ratio equal or more than 1.2 indicates patella alta [35] (Fig. The objective of this paper was to describe the anatomy of the stifle joint (Articulatio genus) of the pampas deer (Ozotoceros bezoarticus, Linnaeus, 1758) by dissection and imaging studies. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Medial retinacular complex injury in acute patellar dislocation: MR findings and surgical implications. (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. A ratio of >1.3 is considered indicative of patella alta [34] (Fig. Patellar fractures are the most common cause of disruption of the extensor mechanism, six times as frequent as soft tissue injuries such as quadriceps or patellar tendon rupture [ 3 ]. https://doi.org/10.1186/s13244-019-0755-1, DOI: https://doi.org/10.1186/s13244-019-0755-1. 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. There is edema of the medial patella and of the lateral femoral condyle (arrow), consistent with bone contusion due to recent lateral patellar dislocation. The lateral patellar retinaculum is less commonly injured than the medial patellar retinaculum, however it is often disrupted during surgery to correct abnormal lateral patellar tracking or dislocation 3. In this section, we will emphasize the role of MRI and discuss how CT can also have value when assessing patellar maltracking. The pattern of bone bruising seen in a transient lateral patellar dislocation is easy to understand if one considers the mechanism of injury. PubMed 30 Correctly diagnosing APD can be difficult as the displaced patella usually relocates spontaneously, with fewer than 10% of patients presenting with fixed lateral dislocation. J Bone Joint Surg Am 61:5662, Jerabek SA, Asnis PD, Bredella MA, Ouellette HA, Poon SK, Gill TJ 4th (2009) Medial patellar ossification after patellar instability: a radiographic finding indicative of prior patella subluxation/dislocation. Lateral patellar compression syndrome is the improper tracking of the patella in the trochlear groove generally caused by a tight lateral retinaculum. no financial relationships to ineligible companies to disclose. Burks RT, Desio SM, Bachus KN, Tyson L, Springer K. Spritzer CE, Courneya DL, Burk DL Jr, Garrett WE, Strong JA. 4). and transmitted securely. Less common predisposing factors to be aware of include laterally tilted patella, VMO dysplasia and generalized joint laxity. 2002 Dec;225(3):736-43. doi: 10.1148/radiol.2253011578. 25a) Axial proton density-weighted images at initial injury (left) and 5 months later demonstrate progression of medial retinacular and MPFL scarring (arrows) in this patient with trochlear dysplasia and chronic patellofemoral instability with a history of multiple prior dislocations. Rev Chir Orthop Reparatrice Appar Mot 76:4554, CAS Knee Surg Sports Traumatol Arthrosc 26:27332742, Hingelbaum S, Best R, Huth J, Wagner D, Bauer G, Mauch F (2014) The TT-TG Index: a new knee size adjusted measure method to determine the TT-TG distance. 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]. Other indicated structures: gracilis (G), semitendinosus (ST), and adductor magnus (AM) tendons. Patients who experience multiple patellar dislocations are more likely to have anatomical variants of the trochlea, patellar alta, or tibial tubercle lateralization. Am J Sports Med 40:11191125, Boutris N, Delgado DA, Labis JS, McCulloch PC, Lintner DM, Harris JD (2018) Current evidence advocates use of a new pathologic tibial tubercle-posterior cruciate ligament distance threshold in patients with patellar instability. 1997 Jan;168(1):117-22. doi: 10.2214/ajr.168.1.8976933. The https:// ensures that you are connecting to the Anatomically, the transverse band of the MPFL is also a component of the medial retinaculum, but for purposes of MRI interpretation, the general convention is to describe abnormalities of the transverse band as being MPFL injuries, whereas more distal injuries which involve multiple layers are generally referred to as abnormalities of the medial retinaculum. The convex articular surface of the patella places it at risk for chondral injury in either the dislocation or the reduction phases of injury. The stability of the patella is dependent on both osseous anatomy and the integrity of longitudinal and transverse soft tissue stabilizers. Google Scholar, Amis AA, Firer P, Mountney J, Senavongse W, Thomas NP (2003) Anatomy and biomechanics of the medial patellofemoral ligament. 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. Am J Sports Med 28:472479, Lewallen L, McIntosh A, Dahm D (2015) First-time patellofemoral dislocation: risk factors for recurrent instability. Evaluate the TCO of your PACS download >, 750 Old Hickory Blvd, Suite 1-260Brentwood, TN 37027, Focus on Musculoskeletal and Neurological MRI, https://radsource.us/patella-alta-and-baja/, The Anterior Meniscofemoral Ligament of the Medial Meniscus. 10 Diederichs G, Issever Ahi S, Scheffler S. MR Imaging of Patellar Instability: Injury Patterns and Assessment of Risk Factors. Springer Nature. A bone bruise of the lateral femoral condyle (asterisk) and an abnormally shallow trochlear groove (red line) are also indicated. PubMed Jumping. Osteochondral fractures are common in acute or recurrent transient lateral patellar dislocation, seen in up to 70% of cases. As with the anatomy, there is considerable variability in both the surgical and radiology literature regarding the location of soft tissue injuries in patients following patellar dislocation. Patella alta assessment. In eight of 17 patients, the mechanism of injury was a patellar tendon tear (n = 1) or valgus hyperextension (n = 7). The radiograph can also be useful in detecting osseous morphologic features associated with patellar maltracking such as patella alta and trochlear dysplasia [24, 25]. The medial patellar retinaculum is part of the anterior third of the medial joint capsule. Knee 10:215220, Terry GC, Hughston JC, Norwood LA (1986) The anatomy of the iliopatellar band and iliotibial tract. 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. Disclaimer. In patients without osseous malalignment, MPFL reconstruction and plication of the medial restraints is reported to decrease re-dislocation rates to 5%. A distance between the tibial tubercle and the trochlear groove of less than 15 mm is considered normal. Patellar tilt can also be assessed using the patellofemoral angle (PFA). MRI can provide valuable information regarding the status of such repairs in patients who experience recurrent dislocation following surgery. Terms and Conditions, The most obvious presentation of patellar maltracking is that of the first time lateral patellar instability or recurrent instability thereafter. This is an arthroscopic surgery ( a knee "scope" which is performed through 3 small incisions ( about inch each) around the knee. California Privacy Statement, b The patella tilt angle is measured between the posterior condylar line (dashed line) and the maximal patella width (solid line). Materials and methods: Two radiologists independently reviewed 99 knee MR images for the presence of a focal defect at the lateral patellar retinaculum and . Imaging, particularly MRI, can detect subtle features that could lead to the diagnosis, probably even more importantly when there is no clear history of patellar dislocation or before its development. The lateral patellar retinaculum is a fibrous expansion comprising of superficial and deep layers. 3. J Bone Joint Surg Am 89:17491755, PubMed Manage cookies/Do not sell my data we use in the preference centre. A tight lateral retinaculum can tilt the patella leading to increased pressure on the lateral facet causing pain (Ficat). Magn Reson Med Sci 17:195202, Elias DA, White LM (2004) Imaging of patellofemoral disorders. For first-time dislocators without intra-articular loose bodies or chondral injury, a trial of nonoperative therapy is indicated. It is the percentage of the medial (a) to the lateral (b) trochlear facet length (a/b100%). The authors would like to sincerely thank Cheryl Kreviazuk for all her efforts in the submission process. The pages that follow contain general guidance on the diagnosis and treatment of chronic nontraumatic knee pain. Complete dislocation of the knee: spectrum of associated soft-tissue injuries depicted by MR imaging. Large tears may require surgical suturing repair. In the seven patients with hyperextension injuries, three had associated meniscal and cruciate ligament tears. Google Scholar, Nakagawa S, Kadoya Y, Kobayashi A, Tatsumi I, Nishida N, Yamano Y (2003) Kinematics of the patella in deep flexion. Facet asymmetry is determined by calculating the percentage of the medial to the lateral femoral facet length (Fig. In the setting of osseous patellar malalignment, an osseous procedure such as tibial tubercle transfer osteotomy can be performed (Fig. Int Orthop. J Pediatr Orthop 37:484490, Parikh SN, Lykissas MG, Gkiatas I (2018) Predicting risk of recurrent patellar dislocation. Materials and methods: Twenty-two male patients (age range 20-45 years) with posttraumatic knee stiffness following distal femoral fractures underwent Thompson's quadricepsplasty where knee flexion range was less than 45. However, in the setting of osseous malalignment, MPFL reconstruction alone leads to higher rates of recurrent instability. A small osseous avulsion (arrowhead) is seen in this region. 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). Incidence and concomitant chondral injuries in a consecutive cohort of primary traumatic patellar dislocations examined with sub-acute MRI. Observer Agreement on the Dejour Trochlear Dysplasia Classification: A comparison of true lateral radiographs and axial magnetic resonance images. Ten patients had examination under anaesthesia with . Created for people with ongoing healthcare needs but benefits everyone. Knee Surg Sports Traumatol Arthrosc 22:23882395, Escala JS, Mellado JM, Olona M, Gin J, Sauri A, Neyret P (2006) Objective patellar instability: MR-based quantitative assessment of potentially associated anatomical features. There is agreement, however, that the MPFL is almost always injured with lateral patellar dislocations4. Traumatic lateral patellar dislocation is a common injury among young, athletic individuals and is generally transient in nature. It is therefore recommended that radiologists include measurement of TT-TG in reports on patients who undergo MRI for patellar instability. Diagnosis is made clinically with pain with compression of the patella and moderate lateral facet tenderness and sunrise knee radiographs will often show patellar tilt in the lateral direction. Eur Radiol 10:10511055, Stefanik JJ, Zumwalt AC, Segal NA, Lynch JA, Powers CM (2013) Association between measures of patella height, morphologic features of the trochlea, and patellofemoral joint alignment: the MOST study. Stretching exercises for Patellofemoral pain. Pathology (22a) In this patient with an acute first time patellar dislocation injury, typical bone bruises were not apparent. The clinical evaluation of patellar maltracking is often challenging, Imaging can detect subtle features that could lead to early diagnosis, Imaging can detect predisposing factors for patellar maltracking and associated structural changes, Management decisions are made on individual basis with imaging playing a vital role. This results in a slightly superolateral direction of pull on the patella by the quadriceps. (12a) At an axial image 3 cm proximal to the femoral-tibial joint space, the lengths of the medial and lateral trochlear facets are obtained. The MCL is composed of the superficial layer (layer 2 of the medial supporting structures) and the deep layer (layer 3 of the medial . (2a) In this case, it is the bone bruise within the anterolateral aspect of the lateral femoral condyle (long arrow) and the edema adjacent to the medial femoral condyle (arrowhead) that are the key to the diagnosis. Ellas et al. 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. Imaging assessment can start with the radiograph including anteroposterior and lateral views of the knee and skyline view of the patella. The patients are then J-braced for 3 to 6 months for all sports activities. Analysis with magnetic resonance imaging. Starok M, Lenchik L, Trudell D, Resnick D. Normal patellar retinaculum: MR and sonographic imaging with cadaveric correlation. Please enable it to take advantage of the complete set of features! Acute patellar dislocation (APD) is a common injury in children, accounting for up to 16% of acute knee hemarthroses. Most commonly the patella tracks outwards (laterally) so the muscles on the inside of the thigh need strengthening. Radiology 225:736743, Kirsch MD, Fitzgerald SW, Friedman H, Rogers LF (1993) Transient lateral patellar dislocation: diagnosis with MR imaging. Patellar maltracking is a disorder that often affects the young active individuals. The patellar usually relocates, and the typical bone contusions are the key MRI features to diagnose transient lateral patellar dislocation (Fig. Significantly greater lateral patellar displacement and tilt was found in osteoarthritis patients compared to a control group [3]. 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? AJR Am J Roentgenol 1997; 168:117-122. J Bone Joint Surg Am 85-A:12381242, Article The common peroneal nerve can be localized in the popliteal fossa or identified posterior to the biceps femoris tendon and followed as it courses around the fibular neck. 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. Sports Health 3:170174, Stensdotter AK, Hodges PW, Mellor R, Sundelin G, Hger-Ross C (2003) Quadriceps activation in closed and in open kinetic chain exercise. et al. MR imaging can help define patellar retinacular and associated osteochondral injuries, which may be clinically useful information. Cookies policy. 35 Dislocation typically occurs in the setting of internal rotation of the femur on a fixed, externally rotated tibia. lateral patellar retinacular sleeve, mak-ing this particular avulsion a rare oc-currence. This treatment generally consists of the use of anti-inflammatory medications, a short period of immobilization (36weeks) followed by a progressive physiotherapy regimen with focus on range of motion, closed chain exercises, and vastus medialis obliquus strengthening [16, 65,66,67,68,69,70]. More recently, the TT-TG index was developed, which takes knee size into account by assessing the proximaldistal distance between the entrance of the chondral trochlear groove (TE) and the tibial tuberosity (TT).
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