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Pathophysiology of Patellar Instability

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Anterior Knee Pain and Patellar Instability
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Abstract

Effective and rational treatment depends upon a clear understanding of all the factors that go into patellofemoral instability. How can you solve a problem without understanding the contributing factors? Some of these will be able to be modified surgically. Some cannot and depend on muscle strength and control. Some pertinent morphological features such as rotational deformities and trochlear dysplasia are well known to be familial.

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References

  1. Chan CJ, Chau YJ, Woo SB, Luk HM, Lo IF. Familial patellar dislocation associated with t(15;20) (q24;q13.1). J Orthop Surg (Hong Kong). 2018;26(2):2309499018777026.

    Google Scholar 

  2. Rebolledo BJ, Nam D, Cross MB, Green DW, Sculco TP. Familial association of femoral trochlear dysplasia with recurrent bilateral patellar dislocation. Orthopedics. 2012;35(4):e574-9.

    Article  PubMed  Google Scholar 

  3. 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 

  4. Hinckel BB, Gobbi RG, Demange MK, Pereira CAM, Pecora JR, Natalino RJM, et al. Medial patellofemoral ligament, medial patellotibial ligament, and medial patellomeniscal ligament: anatomic, histologic, radiographic, and biomechanical study. Arthroscopy. 2017;33(10):1862–73.

    Article  PubMed  Google Scholar 

  5. Tanaka MJ, Chahla J, Farr J 2nd, LaPrade RF, Arendt EA, Sanchis-Alfonso V, et al. Recognition of evolving medial patellofemoral anatomy provides insight for reconstruction. Knee Surg Sports Traumatol Arthrosc. 2019;27(8):2537–50.

    Article  PubMed  Google Scholar 

  6. Shah KN, DeFroda SF, Ware JK, Koruprolu SC, Owens BD. Lateral patellofemoral ligament: an anatomic study. Orthop J Sports Med. 2017;5(12):2325967117741439.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Capkin S, Zeybek G, Ergur I, Kosay C, Kiray A. An anatomic study of the lateral patellofemoral ligament. Acta Orthop Traumatol Turc. 2017;51(1):73–6.

    Article  PubMed  Google Scholar 

  8. Reider B, Marshall JL, Koslin B, Ring B, Girgis FG. The anterior aspect of the knee joint. J Bone Joint Surg Am. 1981;63(3):351–6.

    Article  CAS  PubMed  Google Scholar 

  9. 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 

  10. Betz RR, Magill JTd, Lonergan RP. The percutaneous lateral retinacular release. Am J Sports Med 1987;15(5):477–82.

    Google Scholar 

  11. Dandy DJ, Desai SS. The results of arthroscopic lateral release of the extensor mechanism for recurrent dislocation of the patella after 8 years. Arthroscopy. 1994;10(5):540–5.

    Article  CAS  PubMed  Google Scholar 

  12. Christensen F, Soballe K, Snerum L. Treatment of chondromalacia patellae by lateral retinacular release of the patella. Clin Orthop. 1988;234:145–7.

    Article  Google Scholar 

  13. Biedert RM, Albrecht S. The patellotrochlear index: a new index for assessing patellar height. Knee Surg Sports Traumatol Arthrosc. 2006;14(8):707–12.

    Article  PubMed  Google Scholar 

  14. Brady JM, Sullivan JP, Nguyen J, Mintz D, Green DW, Strickland S, et al. The tibial tubercle-to-trochlear groove distance is reliable in the setting of trochlear dysplasia, and superior to the tibial tubercle-to-posterior cruciate ligament distance when evaluating coronal malalignment in patellofemoral instability. Arthroscopy. 2017;33(11):2026–34.

    PubMed  Google Scholar 

  15. Post WR, Teitge R, Amis A. Patellofemoral malalignment: looking beyond the viewbox. Clin Sports Med. 2002;21(3):521–46, x.

    Google Scholar 

  16. Imhoff FB, Cotic M, Dyrna FGE, Cote M, Diermeier T, Achtnich A, et al. Dynamic Q-angle is increased in patients with chronic patellofemoral instability and correlates positively with femoral torsion. Knee Surg Sports Traumatol Arthrosc. 2021;29(4):1224–31.

    Article  PubMed  Google Scholar 

  17. Halder AM, Kuhl SG, Zobitz ME, Larson D, An KN. Effects of the glenoid labrum and glenohumeral abduction on stability of the shoulder joint through concavity-compression: an in vitro study. J Bone Joint Surg Am. 2001;83(7):1062–9.

    Article  CAS  PubMed  Google Scholar 

  18. Lippitt SB, Vanderhooft JE, Harris SL, Sidles JA, Harryman DT 2nd, Matsen FA 3rd. Glenohumeral stability from concavity-compression: a quantitative analysis. J Shoulder Elbow Surg. 1993;2(1):27–35.

    Article  CAS  PubMed  Google Scholar 

  19. Teitge RA, Faerber WW, Des Madryl P, Matelic TM. Stress radiographs of the patellofemoral joint. J Bone Joint Surg Am. 1996;78(2):193–203.

    Article  CAS  PubMed  Google Scholar 

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

    Google Scholar 

  21. Huntington LS, Webster KE, Devitt BM, Scanlon JP, Feller JA. Factors associated with an increased risk of recurrence after a first-time patellar dislocation: a systematic review and meta-analysis. Am J Sports Med. 2020;48(10):2552–62.

    Article  PubMed  Google Scholar 

  22. Jaquith BP, Parikh SN. Predictors of recurrent patellar instability in children and adolescents after first-time dislocation. J Pediatr Orthop. 2017;37(7):484–90.

    Article  PubMed  Google Scholar 

  23. Arendt EA, Askenberger M, Agel J, Tompkins MA. Risk of redislocation after primary patellar dislocation: a clinical prediction model based on magnetic resonance imaging variables. Am J Sports Med. 2018;46(14):3385–90.

    Article  PubMed  Google Scholar 

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Correspondence to William R. Post .

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Post, W.R. (2023). Pathophysiology of Patellar Instability. In: Sanchis-Alfonso, V. (eds) Anterior Knee Pain and Patellar Instability. Springer, Cham. https://doi.org/10.1007/978-3-031-09767-6_15

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  • DOI: https://doi.org/10.1007/978-3-031-09767-6_15

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-09766-9

  • Online ISBN: 978-3-031-09767-6

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