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Arthroscopic Examination and Treatment of the Patellofemoral Joint

  • Chapter
The Patella

Abstract

The patella is the largest sesamoid bone in the body and serves the following six basic functions1:

  1. 1.

    Increases the moment arm of the quadriceps mechanism, improving the force of extension 25% to 30%.

  2. 2.

    By cartilage-to-cartilage articulation, a low coefficient of friction is established, improving quadriceps efficiency.

  3. 3.

    The divergent forces of the four heads of the quadriceps are centralized and there-fore are transmitted to the patellar tendon.

  4. 4.

    Protects the quadriceps and patellar tendon from friction.

  5. 5.

    Shields the articular cartilage on the anterior tibia as well as the anterior femur.

  6. 6.

    Serves a cosmetic function.

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References

  1. Greenfield MA, Scott WN: Arthroscopic evaluation and treatment of the patellofemoral joint. Orthop Clin North Am 1992; 23 (4): 587–599.

    PubMed  CAS  Google Scholar 

  2. Casscells SW: The arthroscope in the diagnosis of disorders of the patellofemoral joint. Clin Orthop 1979; 144: 45–50.

    PubMed  Google Scholar 

  3. Metcalf RW: An arthroscopic method for lat-eral release of the subluxating or dislocating patella. Clin Orthop 1982; 167: 9.

    PubMed  Google Scholar 

  4. Sojbjerg JO, Lauritzen J, Havid I, et al.: Arthroscopic determination of patellofemoral malalignment. Clin Orthop 1987; 215: 243–247.

    PubMed  Google Scholar 

  5. Mayeda P. Ueber das strangartige gebilde in der kniegel-enkhoehle (chordi cavi articularis genu). Mitt Med Fak Kaisert University Tokyo 1918; 21: 507–553.

    Google Scholar 

  6. Aoki T: A case of internal derangement of the knee due to so called shelf. Nippon Seikeigeka Gakka Zasshi 1965; 39: 933.

    Google Scholar 

  7. Jackson RW, Marshall DJ, Fujisawa Y: The pathological medical shelf. Orthop Clin North Am 1982; 13: 307.

    PubMed  CAS  Google Scholar 

  8. Byoung-Hyoun M, Sung-Jae K, Byeong-Mun P, et al.: Arthroscopic anatomy of the infrapatellar plica. American Academy of Orthopaedic Surgeons 61st Annual Meeting Poster Presentation, New Orleans, February 1994.

    Google Scholar 

  9. Broom MJ, Fulkerson JP: The plica syndrome: A new perspective. Orthop Clin North Am 1986; 17 (2): 279–288.

    PubMed  CAS  Google Scholar 

  10. Aprin H, Shapiro J, Gershwind M: Arthrography (plica views). Clin Orthop 1984; 183: 90–95.

    PubMed  Google Scholar 

  11. Pipkin G: Lesions of the suprapatellar plica. J Bone Joint Surg Am 1950; 32A: 363–369.

    Google Scholar 

  12. Tasker T, Waugh W: Articular changes associated with internal derangement of the knee. J Bone Joint Surg Br 1982; 64B: 486–488.

    PubMed  CAS  Google Scholar 

  13. Patel D: Plica as a cause of anterior knee pain. Orthop Clin North Am 1986; 17 (2): 273–277.

    PubMed  CAS  Google Scholar 

  14. Denks WMT, DeMooge P, Van Linje B: Ultrasonographic detection of the patellar plica in the knee. JCU 1986; 14: 355–360.

    Google Scholar 

  15. Tindel NL, Nisonson B: The plica syndrome. Orthop Clin North Am 1992; 23 (4): 613–618.

    PubMed  CAS  Google Scholar 

  16. Patel D: Arthroscopy of the plicae—Synovial folds and their significance. Am J Sports Med 1978; 6: 217–225.

    Article  PubMed  CAS  Google Scholar 

  17. Nottage WM, Sprague NF, Auerback BJ, et al.: The medial patellar plica syndrome. Am J Sports Med 1983; 11: 211–214.

    Article  PubMed  CAS  Google Scholar 

  18. Hardaker WT, Whipple TL, Bassett FH III: Diagnosis and treatment of the plica syndrome of the knee. J Bone Joint Surg Am 1980; 62A: 221–225.

    PubMed  CAS  Google Scholar 

  19. Rovere GD, Adair DM: The medial synovial shelf plica syndrome. Treatment by intraplical steroid injection Am J Sports Med 1985; 13: 382–386.

    Article  PubMed  CAS  Google Scholar 

  20. Broukhim B, Fox JM, Blazina ME, et al.: The synovial shelf syndrome. Clin Orthop 1979; 142: 135–138.

    PubMed  Google Scholar 

  21. Dandy DJ: Arthroscopy in the treatment of young patients with anterior knee pain. Orthop Clin North Am 1986; 17 (2): 221–229.

    PubMed  CAS  Google Scholar 

  22. Munzinger U, Ruckstuhl, J, Scherrer H, et al.: Internal derangement of the knee joint due to pathologic synovial folds: The mediopatellar plica syndrome. Clin Orthop 1981; 155: 59–64.

    PubMed  Google Scholar 

  23. Muse GL, Grana WA, Hollingsworth S: Arthroscopic treatment of medial shelf syndrome. Arthroscopy 1983; 102: 67.

    Google Scholar 

  24. Johnson DP, Eastwood DM, Witherow PJ: Symptomatic synovial plicae of the knee. J Bone Joint Surg Am 1993; 75A: 1485–1496.

    PubMed  CAS  Google Scholar 

  25. Lombardo SJ, Bradley JP: Arthroscopic diagnosis and treatment of patellofemoral disorders, in Scott, WN (ed.): Arthroscopy of the Knee. Philadelphia, WB Saunders Co., 1990, pp. 155–171.

    Google Scholar 

  26. Schonholtz GJ, Ling B: Arthroscopic chondro- plasty of the patella. Arthroscopy 1985; 1 (2): 92–96.

    Article  PubMed  CAS  Google Scholar 

  27. Wissinger HA: Chondromalacia patellae: A nonoperative program. Orthopedics 1982; 50: 315.

    Google Scholar 

  28. Outerbridge RE: The etiology of chondromalacia patellae. J Bone Joint Surg Br 1961; 43B.-752–757.

    Google Scholar 

  29. Insall JN: Current concepts review. Patellar pain. J Bone Joint Surg Am 1982; 64A: 147–152.

    PubMed  CAS  Google Scholar 

  30. DeHaven KE, Dolan WA, Mayer PJ: Chondromalacia patellae in athletes. Clinical presentation and conservative management. Am J Sports Med 1979; 7 (1): 5.

    Article  PubMed  CAS  Google Scholar 

  31. Leslie IJ, Bentley G: Arthroscopy in the diagnosis of chondromalacia patellae. Ann Rheum Dis 1978; 37: 540–547.

    Article  PubMed  CAS  Google Scholar 

  32. Fisher RL: Conservative treatment of patellofemoral pain. Orthop Clin North Am 1986; 17 (2): 269–272.

    PubMed  CAS  Google Scholar 

  33. Fulkerson JP, Schutzer SF: After failure of conservative treatment for painful patellofemoral malalignment: Lateral release or realignment? Orthop Clin North Am 1986; 17 (2): 283–288.

    PubMed  CAS  Google Scholar 

  34. Gecha SR, Torg JS: Clinical prognosticators for the efficacy of retinacular release surgery to treat patellofemoral pain. Clin Orthop 1990; 253: 203–208.

    PubMed  Google Scholar 

  35. Gruber M: The conservative treatment of chondromalacia patellae. Orthop Clin North Am 1979; 10: 105.

    PubMed  CAS  Google Scholar 

  36. Bentley G, Dowd G: Current concepts of etiology and treatment of chondromalacia patellae. Clin Orthop 1984; 189: 209–228.

    PubMed  Google Scholar 

  37. Fox J, Ferkel R, Del Pizzo W, et al.: Electro- surgery in orthopaedics. II. Applications to arthroscopy. Contemp Orthop 1984; 8: 37.

    Google Scholar 

  38. Grana WA, Hinkley B, Hollingsworth S: Arthroscopic evaluation and treatment of patellar malalignment. Clin Orthop 1984; 186: 122–128.

    PubMed  Google Scholar 

  39. Insall JN, Aglietti P, Tria AJ Jr: Patellar pain and incongruence. II: Clinical application. Clin Orthop 1983; 176: 225–232.

    PubMed  Google Scholar 

  40. McGinty JB, McCarthy JC: Endoscopic lateral retinacular release. A preliminary report. Clin Orthop 1981; 158: 120–125.

    PubMed  Google Scholar 

  41. Insall J, Falvo KA, Wise DW: Chondromalacia patellae. J Bone Joint Surg Am 1976; 58A: 1–8.

    PubMed  CAS  Google Scholar 

  42. Ogilvie-Harris DJ, Jackson RW: The arthroscopic treatment of chondromalacia patellae. J Bone Joint Surg Br 1984; 66B: 660.

    PubMed  CAS  Google Scholar 

  43. Henry JH, Crosland JW: Conservative treatment of patellofemoral subluxation. Am J Sports Med 1979; 7: 12.

    Article  PubMed  CAS  Google Scholar 

  44. Sandow MJ, Goodfellow JW: The natural history of anterior knee pain in adolescents. J Bone Joint Surg Br 1985; 67B: 36–38.

    PubMed  CAS  Google Scholar 

  45. McCarroll JR, O’Donoghue DH, Grana WA: The surgical treatment of chondromalacia patella. Clin Orthop 1983; 175: 130–134.

    PubMed  Google Scholar 

  46. Hunter W: On the structure and diseases of articulating cartilage. Philos Trans R Soc Lond Biol 1743; 9: 267.

    Google Scholar 

  47. Leidy J: On the intimate structure and history of articular cartilage. Am J Med Sci 1849; 17: 277.

    Article  Google Scholar 

  48. Pridie KH: A method of resurfacing osteoarthritic knee joints. J Bone Joint Surg Br 1959; 41B: 618.

    Google Scholar 

  49. Childers JC Jr, Elwood SC: Partial chondrectomy and subchondral bone drilling for chondromalacia. Clin Orthop 1979; 144: 114–120.

    PubMed  Google Scholar 

  50. Roux C: Luxation habituelle de la rotule: Traitemente operatoire. Rev Chir Orthop 1888; 8: 682–689.

    Google Scholar 

  51. Willner P: Recurrent dislocation of the patella. Clin Orthop 1970; 69: 213.

    Google Scholar 

  52. Shim SS, Leung G: Blood supply of the knee joint. A microangiographic study in children and adults. Clin Orthop 1986; 208: 119–125.

    PubMed  Google Scholar 

  53. Ficat RP, Hungerford DS: Disorders of the Patello-Femoral Joint. Baltimore, Williams & Wilkins Co., 1977.

    Google Scholar 

  54. Scuderi GR: Surgical treatment for patellar instability. Orthop Clin North Am 1992; 23 (4): 619–630.

    PubMed  CAS  Google Scholar 

  55. Henry JH, Goletz TH, Williamson B: Lateral retinacular release in patellofemoral subluxation. Indications, results and comparison to open patellofemoral reconstruction. Am J Sports Med 1986; 14 (2): 121–129.

    Article  PubMed  CAS  Google Scholar 

  56. Fox TM, Ferkel RD: Use of electrosurgery and arthroscopic surgery, in Parisien J (ed.):Arthroscopic Surgery. New York, McGraw-Hill Book Co., 1988, pp. 315–330.

    Google Scholar 

  57. Dzioba RB: Diagnostic arthroscopy and longitudinal open lateral release: A four year follow-up study to determine predictors of surgical outcome. Am J Sports Med 1990; 18 (4): 343–348.

    Article  PubMed  CAS  Google Scholar 

  58. Simpson L, Barrett T: Factors associated with poor results following arthroscopic subcutaneous lateral release. Arthroscopy 1987; 3: 152.

    Article  Google Scholar 

  59. Hughston JC, Deese M: Medial subluxation of the patella as a complication of lateral retinacular release. Am J Sports Med 1988; 16 (4): 383–388.

    Article  PubMed  CAS  Google Scholar 

  60. Kolowich PA, Paulos LE, Rosenberg TO, et al.: Lateral release of the patella: Indications and contraindications. Am J Sports Med 1990; 18: 359.

    Article  PubMed  CAS  Google Scholar 

  61. Shellock FG, Mink JH, Deutsch A, et al.: Evaluation of patients with persistent symptoms after lateral release by kinematic magnetic resonance imaging of the patellofemoral joint. Arthroscopy 1990; 6: 226.

    Article  PubMed  CAS  Google Scholar 

  62. Bray RC, Roth JHT, Jacobsen RP: Arthroscopic lateral release for anterior knee pain: A study comparing patients who are claiming worker’s compensation with those who are not. Arthroscopy 1987; 3: 237–247.

    Article  PubMed  CAS  Google Scholar 

  63. Busch MT, DeHaven KE: Pitfalls of the lateral retinacular release. Clin Sports Med 1989; 8: 279.

    PubMed  CAS  Google Scholar 

  64. Lord M, Maltry J, Shall L: Thermal injury resulting from arthroscopic lateral retinacular release by electrocautery: Report of three cases and a review of the literature. Arthroscopy 1991; 7: 33.

    Article  PubMed  CAS  Google Scholar 

  65. Bigos, SJ, McBride GG: The isolated lateral retinacular release in the treatment of patellofemoral disorders. Clin Orthop 1984; 186: 75–80.

    PubMed  Google Scholar 

  66. Small NC: An analysis of complications in lateral retinacular release procedures. Arthroscopy 1989; 5: 282.

    Article  PubMed  CAS  Google Scholar 

  67. Scuderi G, Cuomo F, Scott WN: Lateral release and proximal realignment for patellar subluxation and dislocation. J Bone Joint Surg Am 1988; 70A: 856–861.

    PubMed  CAS  Google Scholar 

  68. Brief LP: Lateral patellar instability: Treatment with a combined open-arthroscopic approach. Arthroscopy 1993; 9 (6): 617–623.

    Article  PubMed  CAS  Google Scholar 

  69. Aglietti P, Pisaneschi A, Buzzi R, et al.: Arthroscopic lateral release for patellar pain or instability. Arthroscopy 1989; 5: 176–183.

    Article  PubMed  CAS  Google Scholar 

  70. Betz R, Lonergan R, Patterson R, et al.: The percutaneous lateral retinacular release. Orthopedics 1982; 5: 57.

    Google Scholar 

  71. Malek M: Arthroscopic lateral retinacular release: Functional results in series of 67 knees. Orthop Rev 1985; 14: 55.

    Google Scholar 

  72. Gallick GS, Bena TA, Fox TM: Electrosurgery in operative arthroscopy. Clin Sports Med 1987; 6: 607.

    PubMed  CAS  Google Scholar 

  73. Sherman OH, Fox JM, Sperling H, et al.: Patellar instability: Treatment by arthroscopic electrosurgical lateral release. Arthroscopy 1987; 3 (3): 152–160.

    Article  PubMed  CAS  Google Scholar 

  74. Krompinger WJ, Fulkerson JP: Lateral retinacular release for intractable lateral retinacular pain. Clin Orthop 1983; 179: 191.

    PubMed  Google Scholar 

  75. Larson RL, Cabaud HE, Slocum DB, et al.: The patellar compression syndrome: Surgical treat¬ment by lateral retinacular release. Clin Orthop 1978; 134: 158–167.

    PubMed  Google Scholar 

  76. Schonholtz GJ, Zahn MG, Magee CM: Lateral retinacular release of the patella. Arthroscopy 1987; 3: 269–272.

    Article  PubMed  CAS  Google Scholar 

  77. Christensen F, Soballe K, Snerum L: Treat-ment of chondromalacia patellae by lateral retinacular release of the patella. Clin Orthop 1988; 234: 145–147.

    PubMed  Google Scholar 

  78. Jackson RW, Kunkel SS, Taylor G: Lateral retinacular release for patellofemoral pain in the older patient. Arthroscopy 1991; 7: 283.

    Article  PubMed  CAS  Google Scholar 

  79. Cofield RH, Bryan RS: Acute dislocation of the patella: Results of conservative treatment. J Trauma 1977; 17 (7): 526.

    Article  PubMed  CAS  Google Scholar 

  80. Power MA: Natural history of recurring dislocation of the patella. J Bone Joint Surg Br 1977; 59B: 107.

    Google Scholar 

  81. Dainer RD, Barrack RL, Buckley SL, et at.: Arthroscopy treatment of acute patellar dislocations. Arthroscopy 1988; 4 (4): 267.

    Article  PubMed  CAS  Google Scholar 

  82. Detrisac DA, Austin MN, Johnson LL: Arthroscopic patellar realignment. Arthroscopy Association of North America Annual Meeting, Washington, DC., March 1988.

    Google Scholar 

  83. Small NC, Glogau, AI, Berezin MA: Arthroscopically assisted proximal extensor mechanism realignment of the knee. Arthroscopy 1993; 9 (1): 63–67.

    Article  PubMed  CAS  Google Scholar 

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Authors
  1. Fred D. Cushner
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  2. W. Norman Scott
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Editor information

Editors and Affiliations

  1. Beth Israel Medical Center-North Division, The Insall Scott Kelly Institute for Orthopaedics and Sports Medicine, New York, NY, 10128, USA

    Giles R. Scuderi M.D.

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Cushner, F.D., Scott, W.N. (1995). Arthroscopic Examination and Treatment of the Patellofemoral Joint. In: Scuderi, G.R. (eds) The Patella. Springer, New York, NY. https://doi.org/10.1007/978-1-4612-4188-1_10

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  • DOI: https://doi.org/10.1007/978-1-4612-4188-1_10

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4612-8691-2

  • Online ISBN: 978-1-4612-4188-1

  • eBook Packages: Springer Book Archive

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