no financial relationships to ineligible companies to disclose. Large tears may require surgical suturing repair. provided a morphologic classification system for trochlear dysplasia describing four types [26,27,28]. Unable to load your collection due to an error, Unable to load your delegates due to an error. The medial patellofemoral ligament is composed of a transverse (T) component arising between the adductor tubercle and medial epicondyle and an oblique decussation that originates from the medial collateral ligament (MCL). Google Scholar, Diederichs G, Issever AS, Scheffler S (2010) MR imaging of patellar instability: injury patterns and assessment of risk factors. A small osseous avulsion (arrowhead) is seen in this region. 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 vastus medialis oblique (VMO) provides active stability of the patella. In acute traumatic lateral patellar dislocation, it is not only the patella that dislocates. Chronic fat impingement can result in chronic inflammation and fat pad hypertrophy. J Knee Surg 28:303309, Hevesi M, Heidenreich MJ, Camp CL et al (2019) The recurrent instability of the patella score: a statistically based model for prediction of long-term recurrence risk after first-time dislocation. 3. Sports Med Arthrosc 15:5760, Nam EK, Karzel RP (2005) Mini-open medial reefing and arthroscopic lateral release for the treatment of recurrent patellar dislocation: a medium-term follow-up. and transmitted securely. A facet ratio of < 40% indicates dysplasia. Medial Collateral Ligament (MCL) and Medial Supporting - Radiology Key a The posterior condylar line is drawn on the slice where the posterior femoral condyles are largest (dashed line). A ratio of >1.3 is considered indicative of patella alta [34] (Fig. If the lateral retinaculum tendon is tight enough to pull the patella out of the trochlear groove, a lateral release procedure can loosen the tissue and correct the patellar malalignment. Patella instability in children and adolescents. Patellar instability: Assessment on MR images by measuring the lateral trochlear inclination-initial experience. The TT-TG index is the TTTG/TT-TE ratio [44]. 2000; 216:858-864. Usually, young individuals, particularly women, suffer the consequences of this disorder [2]. Clinical History: A 23 year-old female presents with medial knee pain following a twisting injury. AJR Am J Roentgenol 161:109113, Lance E, Deutsch AL, Mink JH (1993) Prior lateral patellar dislocation: MR imaging findings. Patellar Fat Pad Abnormalities - Radsource Knee Surg Sports Traumatol Arthrosc 15:13011314, Tom A, Fulkerson JP (2007) Restoration of native medial patellofemoral ligament support after patella dislocation. Courtesy of Daniel Bodor, MD, Radsource. 2). Kim et al. A ratio equal or more than 1.2 indicates patella alta [35] (Fig. Lateral Retinacular Release - Surgery Information A study has found that the femoral groove tends to be shallower in osteoarthritis patients compared to those with normal cartilage, regardless of age. Clin Orthop Relat Res 144:1626, Elias DA, White LM, Fithian DC (2002) Acute lateral patellar dislocation at MR imaging: injury patterns of medial patellar soft-tissue restraints and osteochondral injuries of the inferomedial patella. TT-TG assessment has its own limitations. The injured retinaculum had an indistinct, irregular appearance associated with edema and hemorrhage. (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. Imaging of patellar fractures | Insights into Imaging | Full Text Dejour et al. Accessibility Inferiorly, components of the medial retinaculum blend with the patellar tendon. Patellar sleeve avulsion (PSA) fractures are rare injuries that occur in in skeletally immature patients. The trochlear depth is calculated by measuring the mean of the maximum anteroposterior (AP) distance of the medial and lateral femoral condyles minus the distance between the deepest point of the trochlear groove and the line paralleling the posterior femoral condyles surfaces (Fig. 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. The medial patellar retinaculum is part of the anterior third of the medial joint capsule. The knee is a complex synovial joint that can be affected by a range of pathologies: Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. The most obvious presentation of patellar maltracking is that of the first time lateral patellar instability or recurrent instability thereafter. Patellofemoral Pain Syndrome - OrthoInfo - AAOS 2012;40(4):837-844. 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. 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. At 0 extension, the patellar may lie completely above the level of the trochlea, without direct apposition between the two articular surfaces. AJR Am J Roentgenol 169:211215, Buchner M, Baudendistel B, Sabo D, Schmitt H (2005) Acute traumatic primary patellar dislocation: long-term results comparing conservative and surgical treatment. Clin Sports Med 21:521546 x, Article Deep lacerations are often associated with this type of injury. Radiology 263:469474, Subhawong TK, Eng J, Carrino JA, Chhabra A (2010) Superolateral Hoffas fat pad edema: association with patellofemoral maltracking and impingement. U.S. Army Health Clinic Grafenwoehr U.S. Army Health Clinic Grafenwhr is located on Tower Barracks and provides quality ambulatory care for more than 15,000 Soldiers and their families, while coordinating and facilitating inpatient and specialty care with nearby German host nation medical facilities and DoD partners. Prevalence of Lateral Patellofemoral Maltracking and Associated Complications in Patients with Osgood Schlatter Disease. In acute patellar dislocation, CT may demonstrate osseous impaction or fractures of the medial margin of the patella (with or without involvement of the articular surface) and/or the lateral surface of the lateral femoral condyle and intraarticular fragments. Patients with patella alta may also benefit from tibial tuberosity advancement. Medial retinacular complex injury in acute patellar dislocation: MR findings and surgical implications. (PDF) Magnetic Resonance Imaging Characteristics of the Medial Radiology 2000; 216: 582-585. An imbalance of forces acting on the patellofemoral joint due to abnormal bony geometry or altered function of the active and passive soft tissue restraints may result in abnormalities of alignment and tracking of the patella. The superficial layer originates from the lowest fibers of the iliotibial band and from an extension of vastus lateralis fascia. 8 Lippacher S, Dejour S, Elsharkawi M, et al. (1a) A single fat-suppressed proton density-weighted coronal image is provided. 6). When the knee moves slightly out of place or becomes tilted in the joint, it can cause tension and pain in the lateral retinaculum. The literature in this field has been extremely heterogeneous, and this has made clinical guidelines difficult to produce. However, subtle sprains are seen at the anterior medial retinaculum (arrowhead) and posterior MPFL (arrow) along with a large joint effusion. A commonly used one is the InsallSalvati ratio of patellar tendon length: patellar length. Focal Defect at the LPR on Clinical Knee MRI and a Cadaveric Study Musculoskeletal Imaging Original Research. 2. Arthroscopy 35:537543, Mountney J, Senavongse W, Amis AA, Thomas NP (2005) Tensile strength of the medial patellofemoral ligament before and after repair or reconstruction. :: KJR :: Korean Journal of Radiology Medial patellofemoral ligament injury patterns and associated pathology The knee then was flexed 30, 60, 90, and 120, and the transducer recorded changes in tension within the lateral patellofemoral . Arthroscopy 22:643649, Carrillon Y, Abidi H, Dejour D, Fantino O, Moyen B, Tran-Minh VA (2000) Patellar instability: assessment on MR images by measuring the lateral trochlear inclination-initial experience. Infrapatellar (Hoffas) fat pad impingement is recognized as a cause of anterior knee pain. (5a) An axial T1-weighted image demonstrates the low blending fibers of the VMO and transverse MPFL at their attachment along the upper patella. 3). Google Scholar, Sanders TG, Paruchuri NB, Zlatkin MB (2006) MRI of osteochondral defects of the lateral femoral condyle: incidence and pattern of injury after transient lateral dislocation of the patella. Such patients are generally treated with immobilization for 3 to 6 weeks. Perpendicular to this baseline, trochlear depth is calculated by measuring the mean of the maximum AP distance of the medial (a) and lateral (b) femoral condyles minus the distance between the deepest point of the trochlear groove and the line paralleling the posterior condylar surfaces (c). 3.1 ). J Pediatr Orthop 37:484490, Parikh SN, Lykissas MG, Gkiatas I (2018) Predicting risk of recurrent patellar dislocation. 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 ]. In general realignment surgery such as tibial tubercle transfer should be strongly considered in patients with TT-TG > 15mm (borderline) and typically should be performed in patients with TT-TG > 20mm.
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