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  1. Article ; Online: Medial Patellofemoral Reconstruction Techniques for Patellar Instability.

    Velasquez Hammerle, Maria V / Tanaka, Miho J

    Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association

    2023  Volume 39, Issue 6, Page(s) 1373–1375

    Abstract: The medial patellofemoral complex (MPFC) is the term used to describe the primary soft tissue stabilizer of the patella, which consists of fibers that attach to the patella (medial patellofemoral ligament, or MPFL), and the quadriceps tendon (medial ... ...

    Abstract The medial patellofemoral complex (MPFC) is the term used to describe the primary soft tissue stabilizer of the patella, which consists of fibers that attach to the patella (medial patellofemoral ligament, or MPFL), and the quadriceps tendon (medial quadriceps tendon femoral ligament, or MQTFL). Despite the variability of its attachment on the extensor mechanism, the midpoint of this complex is consistently at the junction of the medial quadriceps tendon with the articular surface of the patella, indicating that either patellar or quadriceps tendon fixation can be used for anatomic reconstruction. Multiple techniques exist to reconstruct the MPFC, including graft fixation on the patella, quadriceps tendon, or both structures. Various techniques using several graft types and fixation devices have all reported good outcomes. Regardless of the location of fixation on the extensor mechanism, elements critical to the success of the procedure include anatomic femoral tunnel placement, avoiding placing undue tension on the graft, and addressing concurrent morphological risk factors when present. This infographic reviews the anatomy and techniques for the reconstruction of the MPFC, including graft configuration, type, and fixation, while addressing common pearls and pitfalls in the surgical treatment of patellar instability.
    MeSH term(s) Humans ; Patellofemoral Joint/surgery ; Patellofemoral Joint/anatomy & histology ; Joint Instability/surgery ; Ligaments, Articular/surgery ; Ligaments, Articular/anatomy & histology ; Patella/surgery ; Patella/anatomy & histology ; Tendons/transplantation
    Language English
    Publishing date 2023-05-03
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 632528-2
    ISSN 1526-3231 ; 0749-8063
    ISSN (online) 1526-3231
    ISSN 0749-8063
    DOI 10.1016/j.arthro.2023.01.006
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Redefining Trochlear Dysplasia: Normal Thresholds Vary by Measurement Technique, Landmarks, and Sex.

    Tanaka, Miho J / Sodhi, Alisha / Wadhavkar, Isha / Kane, Kylynn / Velasquez Hammerle, Maria V / Mangudi Varadarajan, Kartik / Tornetta, Paul

    The American journal of sports medicine

    2023  Volume 51, Issue 5, Page(s) 1202–1210

    Abstract: Background: Trochlear dysplasia is a known risk factor for patellar instability. Multiple radiographic measurements exist to assess trochlear morphology, but the optimal measurement technique and threshold for instability are unknown.: Purpose: To ... ...

    Abstract Background: Trochlear dysplasia is a known risk factor for patellar instability. Multiple radiographic measurements exist to assess trochlear morphology, but the optimal measurement technique and threshold for instability are unknown.
    Purpose: To describe the optimal measurements and thresholds for trochlear dysplasia on magnetic resonance imaging (MRI) that can identify knees with patellar instability in male and female patients.
    Study design: Cohort study (diagnosis); Level of evidence, 3.
    Methods: Knee MRI scans of patients with patellar instability were compared with those of age- and sex-matched controls. Measurements of the sulcus angle, lateral trochlear inclination (LTI), and trochlear depth were performed on axial images using bony and cartilaginous landmarks. Receiver operating characteristic curve analysis was performed, with the area under the curve (AUC) describing the accuracy of each diagnostic test. Optimal cutoff values were calculated to distinguish between knees with and without patellar instability. AUC and cutoff values were reported for each measurement as well as for male and female subgroups.
    Results: A total of 238 knee MRI scans were included in this study (138 female, 100 male; age range, 18-39 years). Trochlear depth measurements had the greatest diagnostic value, with AUCs of 0.79 and 0.82 on bone and cartilage, respectively. All measurements (sulcus angle, LTI, trochlear depth) on bone and cartilage had an AUC ≥0.7 (range, 0.70-0.86), with optimal cutoff values of 145° (bone) and 154° (cartilage) for the sulcus angle, 17° (bone) and 13° (cartilage) for LTI, and 4 mm (bone) and 3 mm (cartilage) for trochlear depth. Optimal cutoff values in female patients varied from those in male patients for all measurements except for cartilaginous trochlear depth.
    Conclusion: Normal thresholds for trochlear dysplasia varied based on the use of bony versus cartilaginous landmarks. Cartilaginous trochlear depth measurements had the greatest ability to identify knees with patellar instability. Furthermore, optimal cutoff values for all measurements except for cartilaginous trochlear depth differed between female and male patients. These findings suggest that sex-specific parameters of normal values may be needed in the assessment of risk factors for patellofemoral instability.
    MeSH term(s) Humans ; Male ; Female ; Adolescent ; Young Adult ; Adult ; Patellofemoral Joint/diagnostic imaging ; Patellofemoral Joint/pathology ; Femur/diagnostic imaging ; Femur/pathology ; Cohort Studies ; Joint Instability/etiology ; Knee Joint/diagnostic imaging ; Knee Joint/pathology ; Magnetic Resonance Imaging ; Patella/pathology
    Language English
    Publishing date 2023-03-21
    Publishing country United States
    Document type Journal Article
    ZDB-ID 197482-8
    ISSN 1552-3365 ; 0363-5465
    ISSN (online) 1552-3365
    ISSN 0363-5465
    DOI 10.1177/03635465231158099
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Association of Trochlear Length on Sagittal MRI to Trochlear Dysplasia in Knees With Patellar Instability.

    Tanaka, Miho J / LaPorte, Zachary L / Perry, Nicholas P J / Velasquez Hammerle, Maria V / Nukala, Varun / Liu, Fang

    Orthopaedic journal of sports medicine

    2023  Volume 11, Issue 6, Page(s) 23259671231169730

    Abstract: Background: Trochlear dysplasia is a primary risk factor for patellar instability and leads to loss of the osteochondral constraint of the patella. Trochleoplasty techniques include the Peterson grooveplasty, which alters the length of the trochlea; ... ...

    Abstract Background: Trochlear dysplasia is a primary risk factor for patellar instability and leads to loss of the osteochondral constraint of the patella. Trochleoplasty techniques include the Peterson grooveplasty, which alters the length of the trochlea; however, a radiographic measurement of trochlear length to support this has not been described.
    Purpose: To describe measurements to quantify trochlear length on sagittal magnetic resonance imaging in patients with and without patellar instability and to correlate trochlear length with measurements of trochlear dysplasia.
    Study design: Cross-sectional study; Level of evidence, 3.
    Methods: A total of 66 age- and sex-matched knees (36 female and 30 male; mean age, 20.8 ± 4.8 years) were included in this study, of which 33 had patellar instability. Trochlear extension length (TEL) and trochlear alpha angle (TAA) were measured on 3 sagittal magnetic resonance imaging scans (center of the knee, center of the medial condyle, and center of the lateral condyle), and measurements were compared between symptomatic and control knees. Receiver operating characteristic curve analysis was performed, and the area under the curve (AUC) was calculated to describe the accuracy of each measurement to distinguish between knees with and without patellar instability. Linear and multivariate regression analyses were performed to assess the relationship between sagittal measurements and axial measurements of trochlear dysplasia, including lateral trochlear inclination, sulcus angle, and trochlear depth, as well as patient size reflected by the epicondylar distance.
    Results: In symptomatic knees, the central trochlea extended more proximally than in control knees, as determined by the TEL (14.0 ± 3.0 vs 11.5 ± 2.3 mm, respectively;
    Conclusion: In knees with symptomatic patellar instability, the central trochlea was found to extend 2.5 mm more proximally than in control knees, and this increase in length correlated with severity of trochlear dysplasia. As radiographic examinations of the trochlea and grooveplasty procedures are often based on the proximal extent of the cartilaginous trochlea, further studies are needed to identify the role of trochlear length in the assessment and treatment of trochlear dysplasia in the setting of patellar instability.
    Language English
    Publishing date 2023-06-05
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2706251-X
    ISSN 2325-9671
    ISSN 2325-9671
    DOI 10.1177/23259671231169730
    Database MEDical Literature Analysis and Retrieval System OnLINE

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