lateral patellar retinaculum injury radiology

J Bone Joint Surg Am 89:17491755, PubMed From the inside of the knee the lateral retinaculum is incised, from the inside, allowing the kneecap to untilit itself. Lateral dislocation may also occur, less commonly, as the result of a direct blow to the medial aspect of the knee. Despite the presence of numerous detailed anatomical dissection and MRI based studies of the anatomy2,3, there is much variability in the description of these structures within the literature. 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. In: Miller M, Thompson S (ed) DeLee and Drezs orthopaedic sports medicine. These are most often found at the inferomedial patella or the lateral femoral condyle [49, 61, 62]. {"url":"/signup-modal-props.json?lang=us"}, Shetty A, Saber M, Rasuli B, et al. It acts as a powerful extensor of the knee. 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. A commonly used one is the InsallSalvati ratio of patellar tendon length: patellar length. In eight of 17 patients, the mechanism of injury was a patellar tendon tear (n = 1) or valgus hyperextension (n = 7). 2). 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. Methods MRI studies taken at one imaging site between January, 2007 to January, 2008 with the final diagnosis of patella . 11 Lind M, Jakobsen B, Lund B, et al. Femoral avulsion of the MPFL is a predictor of chronic instability and may be a surgical indication in some patients with acute injury. Intervention: Taping the knee to promote medial glide . MeSH 5). Insights into Imaging Patellar dislocation most commonly results from a twisting motion, with the knee in flexion and the femur rotating internally on a fixed foot (valgus-flexion-external rotation) 1. Unable to process the form. On the other hand, the PTI is significantly altered with knee flexion [37]. The Medial Patellofemoral Ligament (MPFL) is an hour-glass shaped ligament made of bands of retinacular tissue. Significantly greater lateral patellar displacement and tilt was found in osteoarthritis patients compared to a control group [3]. These prevailing anatomic indices feature prominently into the probability of recurrence, and understanding their variability and pathophysiology is critical to successful management of these patients. Clin Sports Med 21:521546 x, Article Accessibility Migliorini F, Marsilio E, Cuozzo F, Oliva F, Eschweiler J, Hildebrand F, Maffulli N. Life (Basel). (1a) A single fat-suppressed proton density-weighted coronal image is provided. (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. 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. The patients are then J-braced for 3 to 6 months for all sports activities. MR imaging can help define patellar retinacular and associated osteochondral injuries, which may be clinically useful information. 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. (20a) A fat-suppressed proton density-weighted sagittal image in a patient following patellar dislocation reveals an osteochondral injury with a chondral defect (arrows) at the lateral weightbearing surface of the lateral femoral condyle, a finding seen in only 5% of patients. Most commonly the patella tracks outwards (laterally) so the muscles on the inside of the thigh need strengthening. Do a thorough work-up of the patient at the clinic to determine the need for a redesign total knees arthroplasty (Figs. A bone bruise of the lateral femoral condyle (asterisk) and an abnormally shallow trochlear groove (red line) are also indicated. Soft tissue procedures are designed to repair or tighten stretched and injured soft tissues contributing to patellar stability. ANTERIOR KNEE PAIN Jibri, Z., Jamieson, P., Rakhra, K.S. 1. The MPFL plays a significant role in the stabilization of the medial aspect of the patella.Especially during the early stages of knee flexion, the MPFL is a critical component in patellar tracking and stability within the trochlear groove. (26a) An axial proton density-weighted image reveals trochlear dysplasia (line, indicating facet asymmetry and a shallow trochlear groove), ossification in the medial retinaculum and MPFL attachment anteriorly (short arrow) and diffuse scarring of the medial retinaculum (arrowheads)--these findings indicate chronic patellofemoral instability. Lateral trochlear inclination is another quantitative method to diagnose trochlear dysplasia. Radiology 189:905907, Warren LF, Marshall JL (1979) The supporting structures and layers on the medial side of the knee: an anatomical analysis. A newer method to assess for patella alta is the patellotrochlear index (PTI), which is measured in the midsagital MRI as the ratio of the length of trochlear cartilage engaged with the patella to the patellar cartilage length [36]. Oper Tech Sports Med 6:247258, Dejour H, Walch G, Nove-Josserand L, Guier C (1994) Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 14:235240, Article This can provide a road map for formulating a treatment strategy that would be primarily aimed at stabilizing the patellofemoral joint to halt or slow the progression of articular cartilage loss. They include: pain with compression of patella and moderate lateral facet tenderness, inability to evert the lateral edge of the patella, mainstay of treatment and should be done for extensive period of time, closed chain short arc quadriceps exercises, pain refractory to extensive rehabilitation, ideal candidate has no symptoms of instability, medial patellar glide of less than one quadrant, lateral patellar glide of less than three quadrants, only elevate 1 cm or else risk of skin necrosis, indicated only for instability with lateral translation (not isolated lateral tilt), viewing through superior portal will show medial facet does not articulate with trochlea at 40 degrees of knee flexion, postoperatively the patella should be able to be, patellar instability with medial translation, Spontaneous Osteonecrosis of the Knee (SONK), Osgood Schlatter's Disease (Tibial Tubercle Apophysitis), Anterior Superior Iliac Spine (ASIS) Avulsion, Anterior Inferior Iliac Spine Avulsion (AIIS), Proximal Tibiofibular Joint Ganglion Cysts, Pre-Participation Physical Exam in Athlete, Concussions (Mild Traumatic Brain Injury). Zaid Jibri. At the time the article was last revised Joel Hng had The medial patellar retinaculum (MPR) and the lateral patellar retinaculum (LPR) are vital structures for the stability of the patella. Clin Radiol 59:543557, Ali SA, Helmer R, Terk MR (2010) Analysis of the patellofemoral region on MRI: association of abnormal trochlear morphology with severe cartilage defects. A patient with acute first-time transient patellar dislocation without osteochondral lesions and severe risk factors for redislocation is generally treated conservatively. Before Nonoperative treatment is generally recommended in first time dislocators unless there are MRI findings of severe predisposing dysplasia and the presence of a chondral or osteochondral body. Abnormalities of the medial retinaculum and MPFL are seen in 82-100% of MRI examinations following patellar dislocation. The transverse stabilizers include the medial and lateral retinaculum, the vastus medialis and lateralis muscles, the ilio-tibial band, and the medial patellofemoral ligament (MPFL). 1835 31 - 40 27 30.0 41 - 50 22 24.4 50 + 4 4.4 Total 90 100.0 Age Distribution Number Percent Sex Female 19 21.1 Male 71 78.9 The axial proton density-weighted image reveals a large osteochondral shearing injury involving the mid to medial patella (arrowheads). It is not until beyond 90 of flexion that the odd facet engages the medial femoral condyle and plays a role in load sharing along with lateral facet [6, 7]. Trochlear depth assessment. Kim et al. This allows for greater detailed evaluation of the patellar and trochlear morphology, patellofemoral relationship, and status of the joint. Open Orthop J. (7a) A coronal T1-weighted image at the level of the patella demonstrates blending of fibers of the VMO with the MPFL superiorly. 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. The ensuing loss of medial restraint favors future patellar dislocations, especially if additional risk factors are present. Figure 1: ligaments (Gray's illustrations), View Pereshin Moodaley's current disclosures, see full revision history and disclosures, posterior suprapatellar (prefemoral or supratrochlear) fat pad, anterior suprapatellar (quadriceps) fat pad, accessory anterior inferior tibiofibular ligament, superficial posterior tibiotalar ligament, superficial posterior compartment of the leg (calf), accessory extensor digiti secundus muscle, descending branch of the lateral circumflex. The literature in this field has been extremely heterogeneous, and this has made clinical guidelines difficult to produce. Chronic fat impingement can result in chronic inflammation and fat pad hypertrophy. A 2015 Cochrane Review concluded that there is no significant increase in functional scores between nonoperative and operative management; however, surgical management does result in a significantly lower risk of recurrent dislocation at the cost of surgical complications [19]. MRI, given its superior soft tissue contrast and multi-planar capability, has emerged as the modality of choice in evaluating articular cartilage abnormalities. The most accepted indication for surgical management of patellar instability is the presence of a large displaced osteochondral fracture or loose body. The latter distinction is important to recognize among both radiologists and surgeons. It may occur without patellar lateralization. and transmitted securely. 2015 Sep 30;9:463-74. doi: 10.2174/1874325001509010463. J Bone Joint Surg Am Volume 90:27512762, Dixit S, Deu RS (2017) Nonoperative treatment of patellar instability. Current Concepts Regarding Patellofemoral Trochlear Dysplasia. 3). Skeletal Radiology 39:7, 675-682. For first-time dislocators without intra-articular loose bodies or chondral injury, a trial of nonoperative therapy is indicated. (24a) Scarring of the medial stabilizers (asterisk) often leads to healing in a more superior and lateral location (long arrow) leading to persistent medial instability, laxity and malalignment even after the patella has been repositioned. California Privacy Statement, It is reported in surgical literature that 50-75% of recurrent dislocators, have some form of dysplasia, malalignment or generalized joint laxity. The marrow edema and medial patellofemoral ligament (MPFL) injury pattern above are virtually pathognomonic of a transient lateral patellar dislocation, as little else will cause such an appearance. Epub 2010 Mar 8. Given the lack of history of direct trauma, a reliable diagnosis can be made. 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. VMO dysplasia may play a role in patellofemoral instability. 2. It should be noted that these procedures are mostly contraindicated in the patient with open physes due to growth arrest of the tibial tubercle apophysis. Bethesda, MD 20894, Web Policies Osteochondral injuries to the inferomedial patella may be the result of impaction during dislocation or shearing with reduction. Frequently underdiagnosed, the patellofemoral friction syndrome, also called Hoffa's fat cushion compression syndrome, is mainly represented by 2 characteristic symptoms, which are mainly found in women (especially if they present obesity or rapid weight gain, as in pregnancy): patellofemoral pain and instability in the patellar . 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. A ratio equal or more than 1.2 indicates patella alta [35] (Fig. 2. Int Orthop 34:311316, Donell ST, Joseph G, Hing CB, Marshall TJ (2006) Modified Dejour trochleoplasty for severe dysplasia: operative technique and early clinical results. Fluid extending into the VMO myotendinous junction is generally seen in the setting of coexisting MPFL/retinacular tears. Anatomy of the lateral aspect of the knee is complex, with numerous structures providing stability. Google Scholar, Diederichs G, Issever AS, Scheffler S (2010) MR imaging of patellar instability: injury patterns and assessment of risk factors. The incidence rates of primary patellar dislocation in a population-based setting among adults were revealed in some reports [ 3 - 5, 9 ]. Methods: We compared 361 treated cases of aneurysm occlusion after subarachnoid hemorrhage from 1997 to 2003 with 281 cases from 2006 to 2014. Inferiorly, components of the medial retinaculum blend with the patellar tendon. Google Scholar, Fithian DC, Paxton EW, Stone ML et al (2004) Epidemiology and natural history of acute patellar dislocation. Note the edema in the superolateral aspect of Hoffas fat pad (arrow). Patellar maltracking: an update on the diagnosis and treatment strategies. (8a) A more posterior coronal T1-weighted image also demonstrates the intimate relationship of the VMO and MPFL.

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