The Patellofemoral Joint: A Case-Based Approach

Description

This practical case-based book assists clinicians in the evaluation and treatment of patellofemoral patients by reviewing critical elements for assessment and presenting clinical scenarios in which different experts provide their recommendations for treatment. Subdivided in 6 parts it explores the joint’s anatomy and mechanics, as well as case-based evaluation and treatment of patellofemoral instability, arthritis and chondrosis, traumatic injuries and degenerative tendinopathies. Moreover, the closing part offers an overview of the latest advances and future developments. Written in collaboration with ISAKOS, this book offers a valuable guide for orthopedists and sports medicine treating common and complex injuries of this joint. Foreword Contents Introduction Part I: Patellofemoral Anatomy, Mechanics and Evaluation 1: Patellofemoral Biomechanics 1.1 Introduction 1.2 Epidemiology 1.3 Anatomy 1.4 Osseous Anatomy 1.4.1 Patella 1.4.2 Trochlea 1.4.3 Cartilage 1.5 Soft Tissue Anatomy 1.5.1 Quadriceps/Extensor Mechanism 1.5.2 Medial Restraints 1.5.3 Lateral Restraints 1.5.4 Neurovascular 1.6 Biomechanics/Kinematics 1.7 Kinematics 1.7.1 Tracking 1.7.2 Abnormal Tracking 1.7.3 Sagittal Plane 1.8 Mechanics 1.8.1 Contact Area 1.8.2 Contact Stresses 1.8.3 Modeling Techniques of Patellofemoral Joint 1.9 Summary References 2: Patellofemoral Anatomy, Mechanics, and Evaluation: Patient and Family History in the Evaluation of Patellofemoral Patients 2.1 Event History 2.2 Previous Instability 2.3 Age 2.4 Gender 2.5 Activity 2.6 Personal History 2.7 Previous Treatment History 2.7.1 Conservative Management 2.7.2 Surgical Treatment 2.8 Importance and Implications References 3: Examination of the Patients with Patellofemoral Symptoms 3.1 Examination 3.1.1 Clinical History 3.1.2 Physical Examination 3.1.2.1 Static Evaluation 3.1.2.1.1 The Quadriceps Angle (Q Angle) 3.1.2.1.2 Limb Discrepancy 3.1.2.1.3 Supine Position 3.1.2.1.4 Sitting Position 3.1.2.1.5 Foot Posture 3.1.2.2 Dynamic Evaluation 3.1.2.2.1 Patellar Tracking 3.1.2.2.2 Step-Down Test 3.1.2.2.3 Single-Leg Squat 3.1.2.2.4 Two-Leg Jump Test 3.1.2.2.5 Single-Leg Hop Test 3.1.2.3 Special Tests 3.1.2.3.1 Patella Glide 3.1.2.3.2 Apprehension or Fairbank Test 3.1.2.3.3 Patellar Tilt Test 3.1.2.3.4 Compression Test 3.1.2.3.5 Clarke’s Test or Patellar Grind 3.1.2.3.6 The Gravity Subluxation Test 3.1.2.3.7 Flexibility Tests 3.1.2.4 Instrumented Assessment References 4: Imaging Evaluation in the Patient with Patellofemoral Symptoms 4.1 Introduction 4.2 Radiographs 4.3 Computed Tomography 4.4 Magnetic Resonance Imaging 4.5 Dynamic Imaging References 5: Principles of Prevention and Rehabilitation for the Patellofemoral Joint 5.1 Introduction 5.2 Anatomy 5.3 Biomechanics 5.4 Evaluation of the Knee 5.5 Rehabilitation Principles 5.6 Conclusion References 6: Newest Surgical Treatments for Patellofemoral Osteochondral Lesions 6.1 Introduction 6.2 Two Step Procedures: (ACI-MACI) 6.3 One Step Procedures 6.3.1 Cell-based Scaffold Implant (HA-BMAC) 6.3.1.1 The HA-BMAC Technique 6.3.2 Allograft Cell-based Scaffold Implant (DeNovo—Cartiform—BioCartilage—IMPACT) 6.3.3 Cell-free Scaffolds (MaioRegen) 6.3.4 Scaffold-free Tissue-Engineered Construct (TEC) 6.4 Concomitant Surgical Procedures References Part II: Patellofemoral Instability: Case-Based Evaluation and Treatment 7: Patellofemoral Instability in the Pediatric Patient with Open Physes: A 11-Year-Old Girl with Trochlear Dysplasia 7.1 Case Presentation 7.2 Evaluation and Treatment by Presenting Physician (Daniel Green) 7.3 Commentary and Treatment Recommendation from US Surgeon (Jack Andrish) 7.3.1 General Comments 7.3.2 Treatment Recommendation 7.4 Recommendation from EU (Marie Askenberger) 7.5 Preferred Graft and Method for MPFL Reconstruction 7.6 Recommendation from APKAS Country (Ryosuke Kuroda) 7.6.1 Our Preferred Surgical Technique 7.6.1.1 Graft Choice 7.6.1.2 Surgical Procedure 7.6.1.3 Postoperative Rehabilitation 7.6.1.4 MPFL Reconstruction with Suture Anchors 7.7 Recommendation from SLARD Country (Geraldo Schuck De Freitas) 7.7.1 General Comments 7.7.2 Case Discussion 7.7.3 General Rules 7.8 Postoperative Course and Outcomes (Daniel Green) References 8: A 12-Year-Old Girl with Recurrent Patellar Dislocation and Multiple Risk Factors Including Genu Valgum 8.1 Case Presentation 8.2 Treatment (SNP, JRC) 8.3 Post-operative Course and Outcome 8.4 Perspective and Treatment Recommendation from USA (Pennock) 8.5 Perspective and Treatment Recommendation from Argentina (Masquijo) 8.6 Perspective and Treatment Recommendation from France (Chotel) 8.7 Discussion 8.8 Summary References 9: Patellofemoral Instability in the Young Male Soccer Player with First-Time Dislocation, Closed Physes, Normal Trochlea: 17-Year-Old 9.1 Case 9.1.1 History 9.1.2 Physical Examination 9.1.3 Radiographic Examination 9.1.4 Proposed Treatment 9.2 Rehabilitation and Outcome 9.3 Perspective 9.3.1 First-Time Dislocation with OC Fragment 9.4 Perspective References 10: The Patellofemoral Joint: A Case-Based Approach 10.1 Introduction 10.2 History and Examination 10.3 Imaging 10.4 Diagnostic Arthroscopy 10.5 Options for Management 10.6 Summary of Above Finding 10.7 Definitive Management “1”: Abdelkafy and Fulkerson 10.8 Definitive management “2”: Kuroda 10.9 Discussion of definitive management “1”: Abdelkafy and Fulkerson 10.10 Discussion of definitive management “2”: Kuroda References 11: Patellofemoral Case Study: Patella Instability, High TT-TG, Patella Alta + Trochlear Dysplasia in a Skeletally Mature Female 11.1 Case Presentation by Jason L. Koh 11.2 Commentary by Andrew Cosgarea 11.3 Commentary by Phillippe Neyret 11.4 Commentary by Elizabeth Arendt References 12: Patellofemoral Instability in a Young Patient with a Chondral Defect, Patella Alta and a Lateralized Tuberosity 12.1 Clinical Vignette 12.1.1 Case 12.2 Commentary 12.2.1 Julian Feller 12.2.2 Christian Lattermann 12.2.2.1 Subsequent Follow-Up Visit 12.2.3 Jason Koh References Part III: Patellofemoral Pain. Chondrosis, and Arthritis: Case-Based Evaluation and Treatment 13: Patellofemoral Instability in the Adult Female with Recurrent Instability, Chondrosis of Patella and Trochlea 13.1 Case Presentation 13.2 Evaluation and Treatment by a Presenting Surgeon (Ryosuke Kuroda) 13.3 Commentary and Treatment Recommendation from Dr. Stefano Zaffagnini 13.3.1 Correction of Patellofemoral Instability 13.3.2 Treatment of Chondral Lesion 13.4 Commentary and Treatment Recommendation from Dr. Mauro Nunez 13.5 Postoperative Course and Outcomes (Ryosuke Kuroda) References 14: Patellofemoral Pain, Chondrosis, and Arthritis in the Young to Middle-Aged Patient: A 32-Year-Old Woman with Lateral Patella and Trochlear Chondrosis 14.1 Case 14.1.1 History 14.1.2 Physical Examination 14.2 Imaging Findings (Figs. 14.1, 14.2, and 14.3) 14.3 Proposed Plan of Treatment 14.4 Intra-operative Photos (Figs. 14.4 and 14.5) 14.5 Results 14.6 Perspective: Francesca De Caro 14.7 Perspective: Robert Magnussen References 15: Patellofemoral Pain, Chondrosis, and Arthritis: A 18-Year-Old with Anterior Knee Pain and Normal Articular Cartilage 15.1 Case Summary 15.2 Discussion 15.3 Biomechanical Factors 15.4 Extrinsic Factors References 16: A 24-Year-Old Female with Anterior Knee Pain, Normal Looking Cartilage, and Mild Malalignment 16.1 Introduction 16.2 Case Presentation 16.3 Evaluation and Treatment by Presenting Physician (Dr. John Fulkerson) 16.4 Commentary and Treatment Recommendation from Dr. Marc Tompkins 16.5 Commentary and Treatment Recommendation from Dr. Daniel Green References 17: Patellofemoral Pain, Chondrosis, and Arthritis: A 23-Year-Old with Patellofemoral Pain and Maltorsion of the Lower Limbs: The Place of Torsional Osteotomies 17.1 Chapter Outline 17.2 Case Presentation 17.2.1 Clinical Assessment 17.3 Radiologic Study 17.4 Introduction 17.5 Clinical Presentation 17.6 Normal Development of Torsional Profile 17.7 Radiologic Study in Torsional Abnormalities 17.7.1 Femoral Torsion 17.7.2 Tibial Torsion 17.7.3 Torsional Problems Related to Patellofemoral (PF) Pain, Chondropathy, & Osteoarthritis (OA) 17.8 Biomechanical Evidence 17.8.1 The Concept of Horizontal Morphotype 17.9 Surgical Indications 17.10 Surgical Technique 17.10.1 Femoral Derotational Osteotomy 17.10.2 Tibial Derotational Osteotomy 17.10.3 Commentary on Torsional Case by Sheanna Maine 17.10.4 Commentary on Torsional Chapter by Shital Parikh References 18: Anterior Knee Pain in a Patient with a Central Trochlea Defect: A 32-Year-Old Man with a Central Trochlear Defect 18.1 Case 1 18.1.1 History 18.1.2 Physical Examination 18.1.3 Imaging 18.1.4 Treatment 18.1.5 Rehabilitation 18.1.6 Results 18.1.7 Discussion 18.2 Commentary by Jack Farr, OrthoIndy 18.3 Patellofemoral Pain in the Patient with a Trochlear Lesion: Proposed Case 39-Year-Old Male, Basketball, with a Central Trochlear Lesion 18.3.1 Introduction 18.3.2 History and Examination 18.3.3 Imaging 18.3.4 Treatment 18.4 Rehabilitation 18.5 Results 18.6 Discussion References 19: A 35-Year-Old Woman with Painful Early Lateral Patellofemoral Degenerative Arthrosis 19.1 Fulkerson Perspective 19.2 Magnussen Perspective References 20: Patellofemoral Chondrosis and Instability in the Middle Aged Patient 20.1 Case Vignette 20.2 Expert Opinions 20.2.1 Stefano Zaffagini, MD 20.2.1.1 Lateral Patellar Retinaculum Tightness 20.2.1.2 Abnormal Axial Alignment 20.2.1.3 Incompetent Medial Soft Tissue Restraints 20.2.1.4 Patella Cartilage Lesion 20.2.2 Mauro Nunez, MD 20.2.3 Julian Feller, MD 20.2.4 Author’s Treatment Plan 20.2.4.1 Lateral Retinacular Tightness 20.2.4.2 Incompetent Medial Soft Tissue Restraints 20.2.4.3 Axial Malalignment, Trochlear Dysplasia, and Bipolar Grade IV Chondral Disease of the Patellofemoral Joint 20.3 Conclusion References 21: Patellofemoral Pain and Arthritis in Latter Middle-Aged Patient, with Marginal Osteophytes and General Patellofemoral Chondrosis 21.1 Case Presentation 21.2 Evaluation and Treatment by Presenting Physician (Stefano Zaffagnini) 21.2.1 Surgical Treatment 21.2.2 Post-operative Management 21.3 Commentary and Treatment Recommendation from Dr. Elizabeth Arendt 21.4 Post-operative Follow-Up 21.5 Patellofemoral Arthroplasty: Current Concepts and Evidence References Part IV: Traumatic Injuries to the Patellofemoral Joint: Case-Based Evaluation and Treatment 22: Stellate Patella Fracture Case 22.1 Case Presentation 22.1.1 History and Physical Examination 22.2 Imaging Findings 22.3 Proposed Treatment 22.3.1 Planning 22.3.2 Preparation 22.3.3 Approach 22.3.4 Postoperative Care 22.4 Discussion 22.4.1 Commentary by Dr. Rajeev Garapati 22.5 Patella Fracture 22.5.1 Introduction 22.5.2 Discussion 22.5.3 Alternative Treatment 22.5.4 Longer Term Consequences 22.5.5 Patellofemoral Arthroplasty 22.5.6 Arthroscopic Total Patellectomy 22.6 Conclusions References 23: Quadriceps Tendon Tear: Evaluation and Management in a 54-Year-Old Man 23.1 Case 23.2 Imaging Findings 23.3 Treatment 23.4 Rehabilitation 23.5 Discussion 23.6 Perspective: Roshan Wade, Chaitanya Waghchoure References 24: Chronic Patella Tendon Tear in a 24-Year-Old Man: Revision Procedure 24.1 Case Presentation (Jason L. Koh) 24.2 Physical Examination 24.3 Radiographic Examination 24.4 Proposed Treatment 24.5 Rehabilitation and Outcome 24.6 Discussion 24.7 Commentary by Sabrina Strickland 24.7.1 Proposed Treatment 24.7.2 Rehabilitation and Outcome 24.7.3 Discussion 24.8 Perspective: Petri Sillanpää References Part V: Tendinopathies of the Patellofemoral Joint: Case-Based Evaluation and Treatment 25: Tendinopathies of the Patellofemoral Joint: A Case-Based Approach: Osgood–Schlatter’s Disease in a 12-Year-Old 25.1 Case 1 25.1.1 Definition 25.1.2 Pathophysiology 25.1.3 Conservative Treatment 25.1.4 Operative Treatment 25.2 Case 2 25.3 2–3 Fact Boxes 25.4 Algorithm for the Treatment of Osood–Schlatter’s Disease References 26: Patellar Tendinopathy in a 21-Year-Old Long Jumper 26.1 Case Description: 26.2 Author 1 Comments and Proposed Treatment Plan 26.3 Author 2 Comments and Proposed Treatment: 26.4 Author 3 Comments and Proposed Treatment: 26.5 Author 4 Comments and Proposed Treatment 26.6 Key Points on Athletes with Patellar Tendinopathy References 27: Patellar Tendinitis at Osgood–Schlatter’s Lesion of a 32 Year Old 27.1 Case Vignette 27.2 Background 27.3 Evaluation 27.4 Nonsurgical Treatment 27.5 Surgical Treatment 27.6 Post-surgical Rehabilitation 27.7 Outcomes 27.8 Complications 27.9 Conclusion References Part VI: Advances and the Future Treatment of Patellofemoral Disorders 28: Advances in Patellofemoral Disorders 28.1 Instrumented Laxity Evaluation 28.2 Dynamic Computed Tomography (CT) 28.3 Finite Element Analysis 28.4 Suture Tape Augmentation of MPFL Stabilization Surgery 28.5 Conclusion References