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General Concepts for Patellofemoral Instability

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Knee Arthroscopy
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Abstract

Patellofemoral instability is a generic term that indicates subluxation/dislocation of the patella, and general symptomatic patellar instability. Patellofemoral instability is one of the most prevalent knee disorders in adolescent and young adult patients and can cause significant functional limitations in daily living activities. The pathophysiology is often multifactorial and complex. The exact understanding of this complex pathophysiology is a top priority in the management of patellofemoral instability.

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References

  1. Redziniak DE, Diduch DR, Mihalko WM, Fulkerson JP, Novicoff WM, Sheibani-Rad S, et al. Patellar instability. J Bone Joint Surg Am. 2009;91(9):2264–75.

    PubMed  Google Scholar 

  2. Hiemstra LA, Page JL, Kerslake S. Patient-reported outcome measures for patellofemoral instability: a critical review. Curr Rev Musculoskelet Med. 2019.

    Google Scholar 

  3. Koh JL, Stewart C. Patellar instability. Orthop Clin North Am. 2015;46(1):147–57.

    Article  PubMed  Google Scholar 

  4. Smith TO, Donell S, Song FJ, Hing CB. Surgical versus non-surgical interventions for treating patellar dislocation. Cochrane Db Syst Rev. 2015(2).

    Google Scholar 

  5. Fithian DC, Paxton EW, Stone ML, Silva P, Davis DK, Elias DA, et al. Epidemiology and natural history of acute patellar dislocation. Am J Sports Med. 2004;32(5):1114–21.

    Article  PubMed  Google Scholar 

  6. Hsiao M, Owens BD, Burks R, Sturdivant RX, Cameron KL. Incidence of acute traumatic patellar dislocation among active-duty United States military service members. Am J Sports Med. 2010;38(10):1997–2004.

    Article  PubMed  Google Scholar 

  7. Atkin DM, Fithian DC, Marangi KS, Stone ML, Dobson BE, 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.

    Article  CAS  PubMed  Google Scholar 

  8. Sillanpaa P, Mattila VM, Iivonen T, Visuri T, Pihlajamaki H. Incidence and risk factors of acute traumatic primary patellar dislocation. Med Sci Sports Exerc. 2008;40(4):606–11.

    Article  PubMed  Google Scholar 

  9. Tan SHS, Hui SJ, Doshi C, Wong KL, Lim AKS, Hui JH. The outcomes of distal femoral varus osteotomy in patellofemoral instability: a systematic review and meta-analysis. J Knee Surg. 2019.

    Google Scholar 

  10. Tan SHS, Ibrahim MM, Lee ZJ, Chee YKM, Hui JH. Patellar tracking should be taken into account when measuring radiographic parameters for recurrent patellar instability. Knee Surg Sports Traumatol Arthrosc. 2018;26(12):3593–600.

    Article  PubMed  Google Scholar 

  11. Post WR, Fithian DC. Patellofemoral instability: a consensus statement from the AOSSM/PFF patellofemoral instability workshop. Orthop J Sports Med. 2018;6(1):2325967117750352.

    Article  PubMed  PubMed Central  Google Scholar 

  12. White BJ, Sherman OH. Patellofemoral instability. Bull NYU Hosp Jt Dis. 2009;67(1):22–9.

    PubMed  Google Scholar 

  13. Berruto M, Ferrua P, Carimati G, Uboldi F, Gala L. Patellofemoral instability: classification and imaging. Joints. 2013;1(2):7–14.

    PubMed  PubMed Central  Google Scholar 

  14. Dejour H, Walch G, Nove-Josserand L, Guier C. Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc. 1994;2(1):19–26.

    Article  CAS  PubMed  Google Scholar 

  15. Samuels ME, Regnault S, Hutchinson JR. Evolution of the patellar sesamoid bone in mammals. PeerJ. 2017;5:e3103.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Loudon JK. Biomechanics and pathomechanics of the patellofemoral joint. Int J Sports Phys Ther. 2016;11(6):820–30.

    PubMed  PubMed Central  Google Scholar 

  17. Amis AA, Oguz C, Bull AM, Senavongse W, Dejour D. The effect of trochleoplasty on patellar stability and kinematics: a biomechanical study in vitro. J Bone Joint Surg Br. 2008;90(7):864–9.

    Article  CAS  PubMed  Google Scholar 

  18. Senavongse W, Amis AA. The effects of articular, retinacular, or muscular deficiencies on patellofemoral joint stability: a biomechanical study in vitro. J Bone Joint Surg Br. 2005;87(4):577–82.

    Article  CAS  PubMed  Google Scholar 

  19. Andrish J. The biomechanics of patellofemoral stability. J Knee Surg. 2004;17(1):35–9.

    Article  PubMed  Google Scholar 

  20. Dierks TA, Manal KT, Hamill J, Davis IS. Proximal and distal influences on hip and knee kinematics in runners with patellofemoral pain during a prolonged run. J Orthop Sport Phys. 2008;38(8):448–56.

    Article  Google Scholar 

  21. Parikh S, Noyes FR. Patellofemoral disorders: role of computed tomography and magnetic resonance imaging in defining abnormal rotational lower limb alignment. Sports Health. 2011;3(2):158–69.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Redziniak DE, Diduch DR, Mihalko WM, Fulkerson JP, Novicoff WM, Sheibani-Rad S, et al. Patellar instability. Instr Course Lect. 2010;59:195–206.

    PubMed  Google Scholar 

  23. Warren LF, Marshall JL. The supporting structures and layers on the medial side of the knee: an anatomical analysis. J Bone Joint Surg Am. 1979;61(1):56–62.

    Article  CAS  PubMed  Google Scholar 

  24. Tuxoe JI, Teir M, Winge S, Nielsen PL. The medial patellofemoral ligament: a dissection study. Knee Surg Sports Traumatol Arthrosc. 2002;10(3):138–40.

    Article  PubMed  Google Scholar 

  25. Conlan T, Garth WP Jr, Lemons JE. Evaluation of the medial soft-tissue restraints of the extensor mechanism of the knee. J Bone Joint Surg Am. 1993;75(5):682–93.

    Article  CAS  PubMed  Google Scholar 

  26. Steensen RN, Dopirak RM, McDonald WG 3rd. The anatomy and isometry of the medial patellofemoral ligament: implications for reconstruction. Am J Sports Med. 2004;32(6):1509–13.

    Article  PubMed  Google Scholar 

  27. Panagiotopoulos E, Strzelczyk P, Herrmann M, Scuderi G. Cadaveric study on static medial patellar stabilizers: the dynamizing role of the vastus medialis obliquus on medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc. 2006;14(1):7–12.

    Article  PubMed  Google Scholar 

  28. Feller JA, Amis AA, Andrish JT, Arendt EA, Erasmus PJ, Powers CM. Surgical biomechanics of the patellofemoral joint. Arthroscopy. 2007;23(5):542–53.

    Article  PubMed  Google Scholar 

  29. Desio SM, Burks RT, Bachus KN. Soft tissue restraints to lateral patellar translation in the human knee. Am J Sports Med. 1998;26(1):59–65.

    Article  CAS  PubMed  Google Scholar 

  30. Hautamaa PV, Fithian DC, Kaufman KR, Daniel DM, Pohlmeyer AM. Medial soft tissue restraints in lateral patellar instability and repair. Clin Orthop Relat Res. 1998;349:174–82.

    Article  Google Scholar 

  31. Philippot R, Chouteau J, Wegrzyn J, Testa R, Fessy MH, Moyen B. Medial patellofemoral ligament anatomy: implications for its surgical reconstruction. Knee Surg Sports Traumatol Arthrosc. 2009;17(5):475–9.

    Article  PubMed  Google Scholar 

  32. Smirk C, Morris H. The anatomy and reconstruction of the medial patellofemoral ligament. Knee. 2003;10(3):221–7.

    Article  PubMed  Google Scholar 

  33. Nomura E, Inoue M, Osada N. Anatomical analysis of the medial patellofemoral ligament of the knee, especially the femoral attachment. Knee Surg Sport Tr a. 2005;13(7):510–5.

    Article  Google Scholar 

  34. Amis AA, Firer P, Mountney J, Senavongse W, Thomas NP. Anatomy and biomechanics of the medial patellofemoral ligament. Knee. 2003;10(3):215–20.

    Article  CAS  PubMed  Google Scholar 

  35. Schottle PB, Schmeling A, Rosenstiel N, Weiler A. Radiographic landmarks for femoral tunnel placement in medial patellofemoral ligament reconstruction. Am J Sports Med. 2007;35(5):801–4.

    Article  PubMed  Google Scholar 

  36. McCarthy M, Ridley TJ, Bollier M, Wolf B, Albright J, Amendola A. Femoral tunnel placement in medial patellofemoral ligament reconstruction. Iowa Orthop J. 2013;33:58–63.

    PubMed  PubMed Central  Google Scholar 

  37. Nomura E, Inoue M, Kobayashi S. Generalized joint laxity and contralateral patellar hypermobility in unilateral recurrent patellar dislocators. Arthroscopy. 2006;22(8):861–5.

    Article  PubMed  Google Scholar 

  38. Steensen RN, Bentley JC, Trinh TQ, Backes JR, Wiltfong RE. The prevalence and combined prevalences of anatomic factors associated with recurrent patellar dislocation: a magnetic resonance imaging study. Am J Sports Med. 2015;43(4):921–7.

    Article  PubMed  Google Scholar 

  39. Petersen W, Ellermann A, Gosele-Koppenburg A, Best R, Rembitzki IV, Bruggemann GP, et al. Patellofemoral pain syndrome. Knee Surg Sports Traumatol Arthrosc. 2014;22(10):2264–74.

    Article  PubMed  Google Scholar 

  40. Carson WG, Jr., James SL, Larson RL, Singer KM, Winternitz WW. Patellofemoral disorders: physical and radiographic evaluation. Part I: Physical examination. Clin Orthop Relat Res. 1984(185):165–77.

    Google Scholar 

  41. Sanchez HM, Sanchez EGD, Barauna MA, Canto RSD. Evaluation of Q angle in differents static postures. Acta Ortopedica Brasileira. 2014;22(6).

    Google Scholar 

  42. Insall J, Salvati E. Patella position in the normal knee joint. Radiology. 1971;101(1):101–4.

    Article  CAS  PubMed  Google Scholar 

  43. Caton J, Deschamps G, Chambat P, Lerat JL, Dejour H. [Patella infera. Apropos of 128 cases]. Rev Chir Orthop Reparatrice Appar Mot. 1982;68(5):317–25.

    Google Scholar 

  44. Blackburne JS, Peel TE. A new method of measuring patellar height. J Bone Joint Surg Br. 1977;59(2):241–2.

    Article  CAS  PubMed  Google Scholar 

  45. Grelsamer RP, Meadows S. The modified Insall-Salvati ratio for assessment of patellar height. Clin Orthop Relat Res. 1992;282:170–6.

    Google Scholar 

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

    CAS  PubMed  Google Scholar 

  47. Davies-Tuck M, Teichtahl AJ, Wluka AE, Wang Y, Urquhart DM, Cui J, et al. Femoral sulcus angle and increased patella facet cartilage volume in an osteoarthritic population. Osteoarthritis Cartilage. 2008;16(1):131–5.

    Article  CAS  PubMed  Google Scholar 

  48. Minkoff J, Fein L. The role of radiography in the evaluation and treatment of common anarthrotic disorders of the patellofemoral joint. Clin Sport Med. 1989;8(2):203–60.

    Article  CAS  Google Scholar 

  49. Alemparte J, Ekdahl M, Burnier L, Hernandez R, Cardemil A, Cielo R, et al. Patellofemoral evaluation with radiographs and computed tomography scans in 60 knees of asymptomatic subjects. Arthroscopy J Arthros Related Surg. 2007;23(2):170–7.

    Article  Google Scholar 

  50. Song EK, Seon JK, Kim MC, Seol YJ, Lee SH. Radiologic measurement of tibial tuberosity-trochlear groove (TT-TG) distance by lower extremity rotational profile computed tomography in Koreans. Clin Orthop Surg. 2016;8(1):45–8.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Quinn SF, Brown TR, Demlow TA. MR imaging of patellar retinacular ligament injuries. J Magn Reson Imaging. 1993;3(6):843–7.

    Article  CAS  PubMed  Google Scholar 

  52. Sanders TG, Loredo R, Grayson D. Computed tomography and magnetic resonance imaging evaluation of patellofemoral instability. Oper Techn Sport Med. 2001;9(3):152–63.

    Article  Google Scholar 

  53. Sallay PI, Poggi J, Speer KP, Garrett WE. Acute dislocation of the patella—a correlative pathoanatomic study. Am J Sport Med. 1996;24(1):52–60.

    Article  CAS  Google Scholar 

  54. Maenpaa H, Lehto MU. Patellar dislocation. The long-term results of nonoperative management in 100 patients. Am J Sports Med. 1997;25(2):213–7.

    Google Scholar 

  55. Buchner M, Baudendistel B, Sabo D, Schmitt H. Acute traumatic primary patellar dislocation: long-term results comparing conservative and surgical treatment. Clin J Sport Med. 2005;15(2):62–6.

    Article  PubMed  Google Scholar 

  56. Palmu S, Kallio PE, Donell ST, 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.

    Article  PubMed  Google Scholar 

  57. Arnbjornsson A, Egund N, Rydling O, Stockerup R, Ryd L. The natural history of recurrent dislocation of the patella. Long-term results of conservative and operative treatment. J Bone Joint Surg Br. 1992;74(1):140–2.

    Google Scholar 

  58. Stensdotter AK, Hodges PW, Mellor R, Sundelin G, Hager-Ross C. Quadriceps activation in closed and in open kinetic chain exercise. Med Sci Sports Exerc. 2003;35(12):2043–7.

    Article  PubMed  Google Scholar 

  59. Escamilla RF, Fleisig GS, Zheng N, Barrentine SW, Wilk KE, Andrews JR. Biomechanics of the knee during closed kinetic chain and open kinetic chain exercises. Med Sci Sports Exerc. 1998;30(4):556–69.

    Article  CAS  PubMed  Google Scholar 

  60. Dolak KL, Silkman C, Medina McKeon J, Hosey RG, Lattermann C, Uhl TL. Hip strengthening prior to functional exercises reduces pain sooner than quadriceps strengthening in females with patellofemoral pain syndrome: a randomized clinical trial. J Orthop Sports Phys Ther. 2011;41(8):560–70.

    Article  PubMed  Google Scholar 

  61. Mc CJ. The management of chondromalacia patellae: a long term solution. Aust J Physiother. 1986;32(4):215–23.

    Article  Google Scholar 

  62. Cowan SM, Bennell KL, Crossley KM, Hodges PW, McConnell J. Physical therapy alters recruitment of the vasti in patellofemoral pain syndrome. Med Sci Sports Exerc. 2002;34(12):1879–85.

    Article  PubMed  Google Scholar 

  63. Cowan SM, Bennell KL, Hodges PW. Therapeutic patellar taping changes the timing of vasti muscle activation in people with patellofemoral pain syndrome. Clin J Sport Med. 2002;12(6):339–47.

    Article  CAS  PubMed  Google Scholar 

  64. Becher C, Schumacher T, Fleischer B, Ettinger M, Smith T, Ostermeier S. The effects of a dynamic patellar realignment brace on disease determinants for patellofemoral instability in the upright weight-bearing condition. J Orthopaedic Surg Res. 2015;10.

    Google Scholar 

  65. Smith TO, Donell ST, Chester R, Clark A, Stephenson R. What activities do patients with patellar instability perceive makes their patella unstable? Knee. 2011;18(5):333–9.

    Article  PubMed  Google Scholar 

  66. Colvin AC, West RV. Patellar instability. J Bone Joint Surg Am Vol. 2008;90a(12):2751–62.

    Google Scholar 

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Jang, KM. (2021). General Concepts for Patellofemoral Instability. In: Kim, J.G. (eds) Knee Arthroscopy. Springer, Singapore. https://doi.org/10.1007/978-981-15-8191-5_27

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  • DOI: https://doi.org/10.1007/978-981-15-8191-5_27

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