2016;8(1):45-8. government site. This is an AAOS Self Assessment Exam (SAE) question. Pa-tellar orientation has been defined as the triplanar position of the patella within the femoral sulcus.94 Physical therapists are usually concerned with the 4 compo-nents of patellar orientation as described 4, BMC Musculoskeletal Disorders, Vol. Patella alta: association with patellofemoral alignment and changes in contact area during weight-bearing, Reliability and interobserver variability in radiological patellar height ratios, Patellar height measurement in trochlear dysplasia, MR imaging of Baker cysts: association with internal derangement, effusion, and degenerative arthropathy, The patellotrochlear index: a new index for assessing patellar height, Radiographic and computed tomographic analysis of the position of the tibial tubercle in recurrent dislocation and subluxation of the patella, The tibial tuberosity-trochlear groove distance: a comparative study between CT and MRI scanning, Femoral avulsion of the medial patellofemoral ligament after primary traumatic patellar dislocation predicts subsequent instability in men: a mean 7-year nonoperative follow-up study, The abnormal lateral patellofemoral angle: a diagnostic roentgenographic sign of recurrent patellar subluxation, Arthroscopic treatment of acute patellar dislocations, Fat-suppressed three-dimensional spoiled gradient-echo MR imaging of hyaline cartilage defects in the knee: comparison with standard MR imaging and arthroscopy, Accuracy of fat-suppressed three-dimensional spoiled gradient-echo FLASH MR imaging in the detection of patellofemoral articular cartilage abnormalities, MRI of patellar articular cartilage: evaluation of an optimized gradient echo sequence (3D-DESS), Clinical magnetic resonance imaging of articular cartilage, Imaging of patellar cartilage with a 2D multiple-echo data image combination sequence, Medial patellar ossification after patellar instability: a radiographic finding indicative of prior patella subluxation/dislocation, Medial retinacular complex injury in acute patellar dislocation: MR findings and surgical implications, Knee effusion: normal distribution of fluid, Acute dislocation of the patella: a correlative pathoanatomic study, Current concepts of lateral patella dislocation, Isolated repair of the medial patellofemoral ligament in primary dislocation of the patella: a prospective randomized study, Arthroscopic surgery for primary traumatic patellar dislocation: a prospective, nonrandomized study comparing patients treated with and without acute arthroscopic stabilization with a median 7-year follow-up, Arthroscopic medial retinacular repair after patellar dislocation with and without underlying trochlear dysplasia: a preliminary report, Fully arthroscopic stabilization of the patella, Effects of lateral retinacular release on the lateral stability of the patella, A prospective evaluation of trochleoplasty for the treatment of patellofemoral dislocation and instability, Trochleaplasty for recurrent patellar dislocation in association with trochlear dysplasia: a 4- to 14-year follow-up study, CT changes after trochleoplasty for symptomatic trochlear dysplasia, Trochleaplasty for patellar instability due to trochlear dysplasia: a minimum 2-year clinical and radiological follow-up of 19 knees, Elmslie-Trillat procedure for the treatment of recurrent patellar instability, Tibial tuberosity transfer for episodic patellar dislocation, To read the full-text, please use one of the options below to sign in or purchase access, Purchase this article as pay-per-view (unlimited access for 24 hours), Layered Approach to the Anterior Knee: Normal Anatomy and Disorders Associated with Anterior Knee Pain, Imaging of Sports-related Injuries of the Lower Extremity in Pediatric Patients, Patelofemoralinio skausmo sindromo vaizdinimas. Where should your femoral tunnel be located when looking at Figure A? Measurement Superimpose axial images of: femoral condyles In addition, surgical correction of anatomic variants will help reduce the potential for chronic instability. Palpation is important in detecting areas of retinacular tenderness and soft tissue injury. The typical MR imaging findings after patellar dislocation, the assessment of predisposing anatomic factors, and current surgical procedures are discussed and illustrated. 84, No. 6. 22-year-old female with multiple previous dislocations, the MRI findings in Figure A, and a tibial tubercle-trochlear groove (TT-TG) distance of 26 mm, 22-year-old female with the MRI findings in Figure B and a TT-TG distance of 18 mm, 13-year-old female with no prior history of knee injury and the MRI findings in Figure A, 13-year-old female with no prior history of knee injury and the MRI findings in Figure B, 13-year-old female with multiple previous dislocations despite PT and the MRI findings in Figure A. 44, No. (OBQ19.184) 10, American Journal of Roentgenology, Vol. 2002; 225:736-743. doi . Is Superolateral Hoffa Fat Pad Edema a Consequence of Impingement between Lateral Femoral Condyle and Patellar Ligament? Bookshelf Subluxation of 5 mm or more had 58% sensitivity, 93% specificity, and 69% accuracy for an ACL tear. PRP is obtained from your blood by . 48, No. Results: 9.9. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username. 7, No. helmet to knee collision in football), Pathology is usually proximal (e.g. Additionally, complex injuries to bone, cartilage, and ligaments may occur. Mean height was 170.1 7.7 cm in women and 181.8 6.4 cm in men. RSNA members have free access to all RadioGraphics content. 30, No. Plateau-patella angle normal between 20 and 30 degrees Sunrise/Merchant views best to assess for lateral patellar tilt lateral patellofemoral angle (normal is an angle that opens laterally) angle between line along subchondral bone of lateral trochlear facet + posterior femoral condyles normal > 11 congruence angle (normal is -6 degrees) Which of the following structures attaches between the medial epicondyle and adductor tubercle of the femur? 97, No. Giovannetti de Sanctis E, Mesnard G, Dejour D. Trochlear Dysplasia: When and How to Correct. Operative management is indicated for chronic and recurrent patellar instability. Unable to load your collection due to an error, Unable to load your delegates due to an error. Normal dPT showed a dependency on sex and was 1.3 2.9 (.4-2.1) in women and -0.2 3.8 (-1.2-0.9) in men. 44, No. Arthroscopy. They are produced by passing a small, highly controlled amount of radiation through the human body, and capturing the resulting image on an image recording device. 6, Knee Surgery, Sports Traumatology, Arthroscopy, Vol. He is a graduate of the University of Toronto - Hon Bsc (physics) 1977 and MD 1981. What is the most likely diagnosis? 41, No. 11, Clinics in Sports Medicine, Vol. Clipboard, Search History, and several other advanced features are temporarily unavailable. 236, No. 2, Knee Surgery, Sports Traumatology, Arthroscopy, Vol. For which of the following clinical scenarios is nonoperative management with bracing and physical therapy (PT) best indicated? 50, No. Treasure Island (FL): StatPearls Publishing; 2022 Jan. 2, Knee Surgery, Sports Traumatology, Arthroscopy, Vol. 3, World Journal of Methodology, Vol. 9, No. 4, Medicinos teorija ir praktika, Vol. 2, American Journal of Roentgenology, Vol. 206, No. Purpose: injury patterns of medial patellar soft-tissue restraints and osteochondral injuries of the inferomedial patella. Copyright 2021 Arthroscopy Association of North America. 2, Trauma und Berufskrankheit, Vol. 6, Knee Surgery & Related Research, Vol. Chhabra A, Subhawong T, Carrino J. 2022 Radiological Society of North America, Epidemiology and natural history of acute patellar dislocation, Incidence and risk factors of acute traumatic primary patellar dislocation, Acute patellar dislocations: the natural history, Characteristics of patients with primary acute lateral patellar dislocation and their recovery within the first 6 months of injury, Acute lateral patellar dislocation at MR imaging: injury patterns of medial patellar soft-tissue restraints and osteochondral injuries of the inferomedial patella, Medial patellofemoral ligament injury patterns and associated pathology in lateral patella dislocation: an MRI study, Transient lateral patellar dislocation: diagnosis with MR imaging, Prior lateral patellar dislocation: MR imaging findings, Correlation of MR imaging findings and open exploration of medial patellofemoral ligament injuries in acute patellar dislocations, MRI of osteochondral defects of the lateral femoral condyle: incidence and pattern of injury after transient lateral dislocation of the patella, Acute dislocation of the patella: MR findings, Patellar instability: assessment on MR images by measuring the lateral trochlear inclinationinitial experience, Objective patellar instability: MR-based quantitative assessment of potentially associated anatomical features, Patellar height on sagittal MR imaging of the knee, Imaging the femoral sulcus with ultrasound, CT, and MRI: reliability and generalizability in patients with patellar instability, The supporting structures and layers on the medial side of the knee: an anatomical analysis, Factors of patellar instability: an anatomic radiographic study, Dysplasia of the femoral trochlea [in French], Minimal rotation aberrations cause radiographic misdiagnosis of trochlear dysplasia, Comparison of native axial radiographs with axial MR imaging for determination of the trochlear morphology in patients with trochlear dysplasia. Reference article, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-44662, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":44662,"questionManager":null,"mcqUrl":"https://radiopaedia.org/articles/patellar-translation-tt-tg-distance/questions/2392?lang=us"}. Fithian D, Paxton E, Stone M et al. Within a 30-seconds time-frame, three simultaneous, transverse slices were acquired. 2, Revista Brasileira de Ortopedia (English Edition), Vol. To diagnose a patellar subluxation, your doctor will bend and straighten the injured knee and feel the area around the kneecap. Conclusion: 1, Knee Surgery, Sports Traumatology, Arthroscopy, Vol. Check for errors and try again. Kamel S, Kanesa-Thasan R, Dave J et al. 4, Arthroscopy: The Journal of Arthroscopic & Related Surgery, Vol. 1, Acta Orthopaedica Belgica, Vol. 37, No. 23, No. 50, No. had normal tracking patterns; 41 (82 %) had increased lateral translation in extension, which we . If the address matches an existing account you will receive an email with instructions to reset your password. First-time patellar dislocation typically occurs with twisting knee motions, during which the medial ligamentous stabilizers rupture, and the patella strikes against the lateral femoral condyle. The "crossing sign"represents an abnormally elevated floor of the trochlear groove rising above the top of the wall of one of the femoral condyles, assessed on lateral radiographs. 10, International Orthopaedics, Vol. The above video demonstrates the mechanism of injury in patellar dislocation. 41, No. . Midsubstance oblique retinacular ligament rupture, Soft-tissue avulsion of medial patellofemoral ligament, Midsubstance medial patellofemoral ligament rupture, Bony avulsion of medial patellofemoral ligament. An athlete sustains a traumatic patellar dislocation. 07, The American Journal of Sports Medicine, Vol. The authors thank the artist, Mrs. Stephanie Kreutzer, Charit Campus Mitte, Universittsmedizin Berlin, Berlin, Germany, for the drawings. 32, No. The intersection of a line extended from the middle of the shaft and Blumensaat's line, Anterior to a line extended from the middle of the shaft and Blumensaat's line, Posterior to a line extended from the posterior cortex of the shaft and distal to Blumensaat's line, Anterior to a line extended from the posterior cortex of the shaft and distal to Blumensaat's line, Anterior to a line extended from the posterior cortex of the shaft and proximal to Blumensaat's line. The anteroposterior AP radiograph rarely provides any information regarding patellofemoral problems. S1, Sports Medicine and Arthroscopy Review, Vol. 3, Knee Surgery, Sports Traumatology, Arthroscopy, Vol. 2015;44(8):1085-93. Characterization of patellar maltracking using dynamic kinematic CT imaging in patients with patellar instability. Link, Google Scholar; 12 Tung GA, Davis LM, Wiggins ME, Fadale PD. First-time patellar dislocation typically occurs with twisting knee motions, during which the medial ligamentous stabilizers rupture, and the patella strikes against the lateral femoral condyle. 7, Knee Surgery, Sports Traumatology, Arthroscopy, Vol. 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), Concussions (Mild Traumatic Brain Injury). 4. 1, Diagnostic and Interventional Imaging, Vol. Unable to process the form. Surgical replacement of the knee, also called total knee arthroplasty (TKA), is one of the most successful and cost-effective interventions in modern medicine [], but TKA is not without risk or complication.As a major surgical procedure typically performed on older patients, who often have comorbid conditions, TKA is subject to both immediate and delayed complications and failures. 2. 1, 11 October 2016 | RadioGraphics, Vol. 97, No. 205, No. Since 1985, he has also been on staff at Scarborough Grace Hospital (now The . She completed 6 weeks of physical therapy following her first dislocation. Hinckel B, Gobbi R, Filho E et al. 32, No. 19, No. 98, No. A short presentation on the practical issues related to the patellofemoral joint (subluxation, dislocation and incongruence) and chondromalacia Bhavin Jankharia Follow Doctor Advertisement Recommended Patella dislocations Dr Gandhi Kota Patello femoral jt. Abstract. Patellar tendon length: the factor in patellar instability? Dejour H, Walch G, Neyret P, Adeleine P. [Dysplasia of the Femoral Trochlea]. All of the following are predisposing factors for lateral patellar dislocation in a native knee EXCEPT? 52, No. 2010;30(4):961-81. 2022;41(1):77-88. 12, Canadian Association of Radiologists Journal, Vol. Dynamic mediolateral patellar translation is a size- and sex-independent parameter for proximal patellar tracking. Are the Osseous and Tendinous-Cartilaginous Tibial Tuberosity-Trochlear Groove Distances the Same on CT and MRI? lateralization of the tibial tuberosity: femorotibial malrotation, abnormal muscle tone, vastus medialis atrophy, ligament or retinaculum injury or laxity (, edema/hemorrhage of vastus medialis muscle, medial patellofemoral ligament reconstruction. 1. (OBQ04.46) 12, Topics in Magnetic Resonance Imaging, Vol. official website and that any information you provide is encrypted 4, No. Patellar instability symptoms were correlated with maltracking severity. The measurements are used to quantify patellar instability. Unable to process the form. First-time patellar dislocation typically occurs with twisting knee motions, during which the medial ligamentous stabilizers rupture, and the patella strikes against the lateral femoral condyle. 7, The American Journal of Sports Medicine, Vol. Careers. 9, Diagnostic and Interventional Imaging, Vol. Canal S, Tamburro R, Falerno I, Signore FD, Simeoni F, De Pasquale F, De Bonis A, Maraone A, Paolini A, Bianchi A, Rosto M, Vignoli M. Animals (Basel). The site is secure. Which of the following best describes the radiographic landmarks on a lateral radiograph for locating the femoral attachment of the medial patellofemoral ligament (MPFL) during reconstruction? 2018 Dec;476(12):2334-2343. doi: 10.1097/CORR.0000000000000499. 3, Knee Surgery, Sports Traumatology, Arthroscopy, Vol. Increased Patellar Volume/Width and Decreased Femoral Trochlear Width Are Associated With Adolescent Patellofemoral Pain. Patellar translation can be measured using the tibial tuberosity to trochlear groove distance (TT-TG distance) by calculating the transverse length between the trochlear groove on the femur and tibial tuberosity on axial images. 2022, The American Journal of Sports Medicine, Vol. The most common procedures, in addition to MPFL reconstruction, include trochleoplasty, medialization of the tibial tuberosity, and medial capsular plication. 20 Acutely, osteochondral and chondral fractures of the medial facet of the patella and/or the lateral femoral condyle can be a common finding on radiographs, MRI, ultrasound, arthroscopy, and open procedures (). 3, Magnetic Resonance Imaging Clinics of North America, Vol. 66.1 ). A 27-year-old football player sustains an acute lateral patellar dislocation. 2016. Surgical modalities are: The knee is a complex synovial joint that can be affected by a range of pathologies: ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. X-rays may be used to. Copyright 2022 Lineage Medical, Inc. All rights reserved. A 22-year-old female sustained a lateral patellar dislocation while playing intramural soccer. 6, No. 213, No. Transient Patellar Dislocation - MSK Radiology Imaging Findings: Hyperintense marrow edema of the anterolateral femoral condyle consistent with bone contusion. This image shows a laterally displaced patella without apparent fracture ( Fig. 9, No. HHS Vulnerability Disclosure, Help 24, No. 9, Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine, Vol. Rev Chir Orthop Reparatrice Appar Mot. Dynamic mediolateral patellar translation is a size- and sex-independent parameter for proximal patellar tracking. sharing sensitive information, make sure youre on a federal In females, the patellar diameters and intercondylar distances were significantly smaller than in males (P < .001). MR imaging can thus provide important information for individually tailored treatment. 34, No. (OBQ10.188) Patellar translation can be measured using the tibial-tuberosity to trochlear groove distance (TT-TG distance) by calculating the transverse length between the trochlear groove on the femur and tibial tuberosity on axial images. 38, No. Courtesy of Daniel Bodor, MD, Radsource. 9, Orthopaedic Journal of Sports Medicine, Vol. 4, Korean Journal of Radiology, Vol. -. Published by Elsevier Inc. All rights reserved. Imaging findings Prior to reduction, the patient had one-view imaging of the right knee. 09, The Journal of Knee Surgery, Vol. 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Medial Retinacular Plication (Modified Insall ), MPFL Reconstruction - Pediatric and Adolescent, Type in at least one full word to see suggestions list, Orthopaedic Summit Evolving Techniques 2021, Correcting Femoral Torsion & Version With A Femoral Osteotomy: Not So Hard, Let Me Share My Experience - Robert Buly, MD, MS, Commentary: Let My Experience Speak - David R. Diduch, MD, Pro: MPFL Reconstruction Nothing More, Keep It Simple, Safe & Effective - Jason Koh, MD, MBA, Patellar Dislocation with Loose Chondral Fragment and Medial Facet Fx, Patella dislocation with large loosebody in 25M. In healthy individuals without patellofemoral abnormalities normal dMPT proximal to the trochlea groove was 1.7 2.5 (1.2-2.2) mm, independent of size or sex. Magnetic resonance (MR) imaging is reliable in identifying risk factors for chronic patellar instability and in assessing knee joint damage associated with patellar dislocation. This site needs JavaScript to work properly. 22, No. (SAE08AN.85) 24, No. The MRI shows a hemarthrosis with a floating osteochondral fragment. Mean dPT was 1.3 2.9 (95% CI .4-2.1) in females and -0.2 3.8 (95% CI -1.2-.9) in males (P = .036). MeSH The aim of the surgery is to repair the knee damage caused by patellar dislocation and to correct the primary anatomical anomaly. Epidemiology and Natural History of Acute Patellar Dislocation. 38, No. 1, American Journal of Roentgenology, Vol. PATELLAR ALIGNMENT Patellar Orientation T his is the aspect of patello-femoral alignment most commonly evaluated by physical therapists. Editorial Commentary: Real-Time Dynamic Magnetic Resonance Imaging of the Patellofemoral Joint: Ready for Prime Time? anterior cruciate ligament avulsion fracture, posterior cruciate ligament avulsion fracture, Ahlback classification system in assessing osteoarthritis of the knee joint, Kellgren and Lawrence system for classification of osteoarthritis, anterior cruciate ligament mucoid degeneration, MRI grading system for meniscal signal intensity. 7. 3.2, European Journal of Radiology, Vol. 2015;44(8):1085-93. A high school softball player has chronic activity-related anterior knee pain without a history of instability. 5 Athleticum, University Medical Center Hamburg-Eppendorf, . The typical injury pattern is a tear of the medial patellofemoral ligament (MPFL) and bone bruises of the patella and the lateral femoral condyle. Anish Choudhary Ankle joint radiography Nikhil Murkey Habitual dislocation of patella 26, No. 205, No. Patients with pronounced ligamentous tears or large osteochondral lesions require prompt surgery. 1. 2, Journal of Computer Assisted Tomography, Vol. The typical injury pattern is a tear of the medial patellofemoral ligament (MPFL) and bone bruises of the patella and the lateral femoral condyle. Clin Orthop Surg. Subscribe now (individual subscription: $237.00), (This functionality works only for purchases made as a guest), Knee Surgery, Sports Traumatology, Arthroscopy, European Journal of Orthopaedic Surgery & Traumatology, Vol. 22, No. Epub 2019 Dec 13. Dickens A, Morrell N, Doering A, Tandberg D, Treme G. Tibial Tubercle-Trochlear Groove Distance: Defining Normal in a Pediatric Population. 3, The American Journal of Sports Medicine, Vol. Anterior tibial translocation, when measured at the midsagittal plane of the lateral femoral condyle with regard to a plane parallel to the cephalocaudal axis of the image, was a relatively specific indicator of ACL disruption. 56, No. 48, No. Are the Osseous and Tendinous-Cartilaginous Tibial Tuberosity-Trochlear Groove Distances the Same on CT and MRI? A Platelet-Rich Plasma (PRP) injection is a solution containing concentrated levels of platelets in plasma. 1, Pilot and Feasibility Studies, Vol. 193, No. Development of Real-Time Kinematic Magnetic Resonance Imaging (kMRI) Techniques for Studying the Kinematics of the Spine and Joints in Dogs-Preliminary Study on Cadavers. 4 Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. This is her third dislocation in the last 6 months. 4, Journal of Medical Imaging and Radiation Sciences, Vol. 6, International Journal of Environmental Research and Public Health, Vol. Knee Surg Sports Traumatol Arthrosc. 2, The American Journal of Sports Medicine, Vol. 26, No. A Systematised MRI Approach to Evaluating the Patellofemoral Joint. Prevalence of Lateral Patellofemoral Maltracking and Associated Complications in Patients with Osgood Schlatter Disease. The medial patellofemoral ligament has intrinsic signal and is disrupted at the anterior patella . 9, No. Patellar maltracking is typically Tanaka MJ, Elias JJ, Williams AA, Demehri S, Cosgarea AJ. Figure 49 shows an acute axial MRI scan of a right knee. 12, No. 3. 215, No. 4 Department of Radiology, The Johns Hopkins . 4, American Journal of Roentgenology, Vol. Tears of the anterior cruciate ligament: primary and secondary signs at MR imaging. (OBQ08.49) 1, Evidence-Based Complementary and Alternative Medicine, Vol. Wolfe S, Varacallo M, Thomas JD, Carroll JJ, Kahwaji CI. The Insall-Salvati ratio is classically measured to determine patellar height, and is measured on the lateral view with the knee flexed to 30 degrees; it is the ratio measuring the length of the patellar tendon (LL; from the inferior patellar pole to the tibial tubercle) and the patellar length (LP; the longest diagonal length of the patella). 19, No. 04, Archives of Orthopaedic and Trauma Surgery, Vol. 3, AMEI's Current Trends in Diagnosis & Treatment, Vol. Patellar translation can be measured using the tibial tuberosity to trochlear groove distance (TT-TG distance) by calculating the transverse length between the trochlear groove on the femur and tibial tuberosity on axial images. 215, No. Skeletal Radiol. 211, No. 100 knees (53 right, 47 left; age: 26.7 4.4 years; BMI: 22.5 3.1) of 57 individuals (27 females, 30 males) were included. 6, Orthopaedic Journal of Sports Medicine, Vol. Bethesda, MD 20894, Web Policies (OBQ07.30) 22, No. 5, Sports Medicine and Arthroscopy Review, Vol. You see a patient in the emergency room with an acute lateral patellar dislocation. Draw a line along the posterior femoral condyles, and then draw the following lines perpendicular to this line: The distance has been shown to be slightly less when measured on MRI than CT 1. Song E, Seon J, Kim M, Seol Y, Lee S. Radiologic Measurement of Tibial Tuberosity-Trochlear Groove (TT-TG) Distance by Lower Extremity Rotational Profile Computed Tomography in Koreans. 2022 Oct 15;12(20):2790. doi: 10.3390/ani12202790. The measurements are used to quantify patellar instability. Dynamic mediolateral patellar translation (dMPT) and dynamic patellar tilt (dPT) were measured on two occasions by two independent examiners. 25, No. Diederichs G, Khlitz T, Kornaropoulos E, Heller M, Vollnberg B, Scheffler S. Magnetic Resonance Imaging Analysis of Rotational Alignment in Patients with Patellar Dislocations. J Bone Joint Surg Am. FOIA 2014;96(4):318-24. 5, The American Journal of Sports Medicine, Vol. Keywords: 27, No. results: grades of patellar abnormality, based on findings in the enthesial region at mr imaging, correlated with signs of increasing fibrovascular repair: grade 1 (n = 4), enhancing area adjacent to patellar apex, with marginal zone of intermediate signal intensity, and a patellar apical chondral-bone avulsion; grade 2 (n = 5), same signs as Clin Orthop Relat Res. 7-8, The Egyptian Journal of Radiology and Nuclear Medicine, Vol. 9, Clinics in Sports Medicine, Vol. Patellofemoral instability or maltracking is the clinical syndrome due to morphologic abnormalities in the patellofemoral joint where the patella is prone to recurrent lateral dislocation. 1. PMC Skeletal Radiol. In the acute and subacute setting MRI displays features of lateral patellar dislocation as: knee joint effusion medial patellofemoral ligament tear bone contusions or cartilage injuries of the medial patella facet and lateral femoral condyle edema/hemorrhage of vastus medialis muscle intra-articular fragments The skyline view can show decreased trochlear depth and a large sulcus angle (>144). Intercondylar distance correlated weakly with dPT (r = -.241; P = .041). 7, HSS Journal: The Musculoskeletal Journal of Hospital for Special Surgery, Journal of Orthopaedic Surgery, Vol. One hundred knees of healthy individuals with no history of patellofemoral symptoms were scanned with dynamic MRI sequences, during repetitive cycles of flexion (40) and full extension. 27, No. During the range of motion, mean dMPT was 1.7 2.4 (95% CI .9-2.5) mm in females and 1.8 2.7 (95% CI 1.1-2.6) mm in males (P = .766). ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. 21, No. 2011;40(4):375-87. Level of evidence: Radiology 1994;193(3):829-834. Diagnosis is made clinically in the acute setting with a patellar dislocation with a traumatic knee effusion and in chronic settings with passive patellar translation and a positive J sign. Most patients with patellar instability are young and active individuals, especially females in the second decade. 10, Current Physical Medicine and Rehabilitation Reports, Vol. Patellar instability is a condition characterized by patellar subluxation or dislocation episodes as a result of injury, ligamentous laxity or increased Q angle of the knee. Frings J, Dust T, Krause M, Ohlmeier M, Frosch KH, Adam G, Warncke M, Maas KJ, Henes FO. Before You recommend reconstruction of her medial patellofemoral ligament (MPFL) given her recurrent instability. 17, No. Patellofemoral Pain in Adolescents: Understanding Patellofemoral Morphology and Its Relationship to Maltracking. 1, Open Access Journal of Sports Medicine, Vol. and the Center for Musculoskeletal Surgery (S.S.), Charit-Universittsmedizin Berlin, Campus Charit Mitte, Charitplatz 1, 10117 Berlin, Germany. 2, International Orthopaedics, Vol. Recurrent patellar dislocations usually occur in individuals with anatomic variants of the patellar stabilizers, such as trochlear dysplasia, patella alta, and lateralization of the tibial tuberosity. 47, No. MATERIALS AND METHODS: The authors evaluated radiographs and MR images from . 3. In: StatPearls [Internet]. 1 Pain is often described as medial because of soft tissue injuries that occur to the medial retinaculum and/or MPFL. 15, No. 36, No. Treatment is nonoperative with bracing for first time dislocation without bony avulsion or presence of articular loose bodies. 2, American Journal of Roentgenology, Vol. Chronic patellar instability, if not treated, may lead to severe arthritis and chondromalacia patellae. 49, No. An official website of the United States government. Hinckel B, Gobbi R, Filho E et al. 4, Osteoarthritis and Cartilage, Vol. To provide normal values for physiological patellofemoral tracking in a representative group of healthy individuals, as well as sex differences, using real-time 3T-magnetic resonance imaging (MRI) and to test for the reliability of the presented technique. PURPOSE: To demonstrate the magnetic resonance (MR) imaging characteristics of patellar sleeve fracture, a cartilaginous avulsion from the lower pole of the patella occurring during forceful contraction of the quadriceps muscle against a partially flexed knee. 45, No. and transmitted securely. 24, No. 2021;50(7):1399-409. Measurement Superimpose axial images of: femoral condyles 20, No. tight ITB and vastus lateralis), acute dislocation usually associated with a large hemarthrosis, absence of swelling supports ligamentous laxity and habitual dislocation mechanism, measured in quadrants of translation (midline of patella is considered "0"), and also should be compared to contralateral side, normal motion is <2 quadrants of patellar translation, lateral translation of medial border of patella to lateral edge of trochlear groove is considered "2" quadrants and is considered abnormal amount of translation, passive lateral translation results in guarding and a sense of apprehension, excessive lateral translation in extension which "pops" into groove as the patella engages the trochlea early in flexion, trochlear groove lies in same plane as anterior border of lateral condyle, anterior border of lateral condyle lies anterior to anterior border of medial condyle, represents convex trochlear groove/hypoplastic medial condyle, Blumensaat's line should extend to inferior pole of the patella at 30 degrees of knee flexion, angle between line along subchondral bone of lateral trochlear facet + posterior femoral condyles, values > 140 degrees indicate flattening of the trochlea concerning for dysplasia, measures the distance between 2 perpendicular lines from the posterior cortex to the tibial tubercle and the trochlear groove, help further rule out suspected loose bodies, osteochondral lesion and/or bone bruising, tear usually at medial femoral epicondyle, NSAIDS, activity modification, and physical therapy, mainstay of treatment for first time patellar dislocator, without any loose bodies or intraarticular damage, short-term immobilization for comfort followed by 6 weeks of controlled motion, closed chain short arc quadriceps exercises, core and hip strengthening to improve limb positioning and balance (hip abductors, gluteals, and abdominals), displaced osteochondral fractures or loose bodies, may be an indication for operative treatment in a first-time dislocator, arthroscopic vs open removal versus repair of the osteochondral fragment, primary repair with screws or pins if sufficient bone available for fixation, first time dislocation with bony fragment, direct repair when surgery can be done within first few days, no clinical studies support this over nonoperative treatment, MPFL reconstruction with autograft vs allograft, gracilis or semitendinosus commonly used (stronger than native MPFL), femoral origin can be reliably found radiographically (Schottle point), a femoral tunnel positoined too proximally results in graft that is too tight ("high and tight"), severe trochlear dysplasia is the most important predictor of residual patellofemoral instability after isolated MPFL reconstruction, Fulkerson-type osteotomy (anterior and med, may be used in addition to MPFL or in isolation for significant malalignment, anteromedialized displacement of osteotomy and fixation, correct TT-TG to 10-15mm (never less than 10mm), distal displacement of osteotomy and fixation, isolated release no longer indicated for instability, only indicated if there is excessive lateral tilt or tightness after medialization, rarely addressed (in the USA) even if trochlear dysplasia present, arthroscopic or open trochlear deepening procedure, do not do tibial tubercle osteotomy (will harm growth plate of proximal tibia), redislocation rates with nonoperative treatment may be high (15-50%) at 2-5 years, recurrence rate is highest in those patients who sustain a primary dislocation, almost exclusively iatrogenic as a result of prior patellar stabilization surgery. 2. Radiology 1993;188(3):661-667. Reference article, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-16281, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":16281,"questionManager":null,"mcqUrl":"https://radiopaedia.org/articles/patellofemoral-instability/questions/1618?lang=us"}. 5,12,16,18,23,38,46,49,52,55,56,64,65,67,68 . (OBQ18.157) This measurement has historically been performed utilizing axial computed tomography (CT). 5, BMC Musculoskeletal Disorders, Vol. Patellar apprehension and mobility should be assessed by medial and lateral patellar translation. 10, Knee Surgery, Sports Traumatology, Arthroscopy, Vol. lateral patellar motion, with one, two, and three quadrants corresponding to 75-99, 100-125, and >125 %, respectively. 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