This work is licensed under aCreative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. The shape of the patella is classically not considered a predisposing factor. (ISBN: 9783131692719), [5] Get an accredited certificate of achievement by completing one of our online course completion assessments. The patella is a thick, flat, triangular bone with its apex pointing downwards. Online ahead of print. | 09, The Journal of Knee Surgery, Vol. .switcher a:hover img {opacity:1;} eCollection 2022. The reports were reviewed for evidence of prior lateral patellar dislocation. Patella alta measurements with Insall Salvati ratio which uses the ratio of the patella tendon lenght (blue line) to the lenght of the patella (yellow line). 4, No. The clinical history and physical findings may be inadequate to establish the exact nature of the injury, and as a result MRI can play a key role both in establishing the correct diagnosis and in delineating the extent of osseous and soft-tissue injury essential for directing appropriate surgical management [1]. 41, No. [1] Generalized patellar instability is thought to represent up to 3% of clinical Number of MRI risk factors present in each patient with patellar instability. Consequently, our objective was to determine the incidence of lateral femoral condyle osteochondral injuries and to better define the locations and patterns of chondral injury involving the lateral femoral condyle after transient dislocation of the patella based on MRI and follow-up arthroscopy. The calcaneus is the most commonly fractured tarsal bone and accounts for about 2% of all fractures 2 and ~60% of all tarsal fractures 3.. 6, The American Journal of Sports Medicine, Vol. 25, No. Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management.. stage I. injury limited to articular cartilage; MRI findings: subchondral edema; x-ray findings: none; stage II. It was found that 79% of patients with LPD had at least two out of four above-mentioned risk factors of patellar instability, in comparison to only 7% of patients in the control group. Unable to load your collection due to an error, Unable to load your delegates due to an error. Sulcus depth, congruence angle, Wiberg index, TT-TG distance, and CDI are strong predictors of recurrent patellar dislocation. eCollection 2022 Dec. This proved to be a highly predictable pattern of injury and was observed in each of the 10 cases. Other examination findings in LPDs included contusions of the lateral femoral condyle (66 [80%] of 82 examinations) or medial patella (50 [61%] of 82), intraarticular bodies (12 [15%] of 82), effusion (45 [55%] of 82), medial collateral injury (nine [11%] of 82), and meniscal tear (nine [11%] of 82). Anomalies of dynamic and static factors, including excessive patellar height, tibial tubercle lateralisation or trochlear dysplasia, may influence the development of the patella. They should not be confused with fatigue fractures which are due to abnormal stresses on normal bone, or with pathological fractures, the result of diseased, weakened bone due to Transient lateral patellar dislocation is a common injury that typically occurs in the young, athletic individual. The distance between two lines was given as TT-TG distance. 6, Clinical Orthopaedics and Related Research, Vol. 22, No. 37, No. 4, The Physician and Sportsmedicine, Vol. 29, No. The most important differential diagnosis is that of a lunate dislocation which can mimic a perilunate dislocation, especially on AP projection. 4, Journal of Computer Assisted Tomography, Vol. This configuration allows for a potential shearing injury to involve the articular surface of either the patella or the femoral condyle during the first stage of dislocation. There is no mention in this report of osteochondral injuries involving the weight-bearing aspect of the lateral femoral condyle. In this study, we have attempted to evaluate the predisposing factors of patellar instability on magnetic resonance imaging (MRI) and to compare the significance of measurement at the level of trochlear bone versus cartilage for trochlear dysplasia. Limitations of this study include the small sample size. 32, No. Influence of tibial tuberosity position and trochlear depth on patellar tracking in patellar instability: Variations with Patella Alta. official website and that any information you provide is encrypted An elongated lateral tubercle of the posterior process of the talus is referred to as a Stieda process, so occasionally these fractures are described as Stieda process fractures.. A Cedell fracture is a fracture of the medial tubercle of the posterior Magnetic resonance imaging (MRI) plays a key role in recognition of these anatomical risk factors associated with patellar instability, thereby guiding for subsequent treatment. Radiology 1993; 189:905-907. The shape of the patella is classically not considered a predisposing factor. Early magnetic resonance imaging and surgical treatment should be considered in obese patients, male patients, and patients with physeal closure and after traumatic LPD. 205, No. -, Knee Surg Sports Traumatol Arthrosc. Patellar sleeve fractures occur in the pediatric population between 8 and 16 years of age, with a peak incidence at ~13 years 6, predominantly boys (3:1).Adolescents are more susceptible due to rapid growth, increased sports activity, and relative patella instability. Lateral radiograph shows a patella alta and signs of 2A, 2B, 2C, 3A, 3B, and 3C). .switcher .option::-webkit-scrollbar {width:5px;} 12, No. 2, Techniques in Knee Surgery, Vol. 1, The American Journal of Sports Medicine, Vol. 12, EMC - Tecniche Chirurgiche - Chirurgia Ortopedica, Vol. 4, BMC Musculoskeletal Disorders, Vol. Radiological evaluation of patellofemoral instability and possible causes of assessment errors: Letter to the editor. On plain film, dorsal avulsion injuries are best detected on a lateral projection, where typically an avulsed flake of bone is identified lying posteriorly to the triquetral bone (see pooping duck sign). 11, Orthopedic Clinics of North America, Vol. If only those patients with injuries isolated to the lateral trochlear groove are included, the incidence in our series is 12%, which is more in line with the 5% incidence reported by Elias et al. Patients typically present with obvious deformity and an inability to extend the knee. Other examination findings in LPDs included contusions of the lateral femoral condyle (66 [80%] of 82 examinations) or medial patella (50 [61%] of 82), intraarticular bodies (12 [15%] of 82), effusion (45 [55%] of 82), medial collateral injury (nine [11%] of 82), and meniscal tear (nine [11%] of 82). 37, No. Additional MRI sequences were used whenever required. .l_name {float: none !important;margin: 0;} An official website of the United States government. Prevalence of patellar instability is higher in younger population, more frequently involving age equal to or <25 years. 46, No. MRI of the knee demonstrates characteristic appearance of recent transient dislocation of the patella. 24, No. 1, BMC Musculoskeletal Disorders, Vol. 18, No. 1, Sports Orthopaedics and Traumatology, Vol. Panagopoulos A, van Niekerk L, Triantafillopoulos IK. If the address matches an existing account you will receive an email with instructions to reset your password. WebRadiopaedia.org, the wiki-based collaborative Radiology resource 27, No. During reduction, the articular surface of the medial aspect of the lower pole of the patella first impacts the nonarticular portion of the lateral femoral condyle, resulting in the classic bone contusion. 12, No. These cookies track visitors across websites and collect information to provide customized ads. Mandibular fractures are relatively common especially among young men. 12, LO SCALPELLO-OTODI Educational, Vol. Sri Guru Ram Das Institute of Medical Sciences and Research, Sri Amritsar, Punjab. 39, No. In trochlear dysplasia, there is diminished engagement between femoral trochlea and patella due to a shallow TG, thereby leading to patellar instability. A Shepherd fracture refers to a fracture of the lateral tubercle of the posterior process. 27, No. PURPOSE: The authors describe magnetic resonance (MR) imaging findings of acute traumatic dislocation of the patella. 22, No. Advertisement cookies are used to provide visitors with relevant ads and marketing campaigns. The https:// ensures that you are connecting to the thickening of the distal patellar tendon; infrapatellar bursitis; MRI. A major limitation of our study was a small sample size of only 30 patients. Other uncategorized cookies are those that are being analyzed and have not been classified into a category as yet. Federal government websites often end in .gov or .mil. 2017 Jul;45(9):2105-2110. doi: 10.1177/0363546517704178. 3, Medial meniscus, anterior horn. 3, The American Journal of Sports Medicine, Vol. 11, No. 8600 Rockville Pike Another strength of our study was the criteria used for deciding the level at which various measurements for diagnosis of patellar instability were performed. This area of the lateral femoral condyle should be closely evaluated for osteochondral injury on both sagittal and coronal MR images in all patients with evidence of prior transient dislocation of the patella. There may be depression of the plateau surface, displacement of a fracture fragment, or a combination of both. How to cite this article: Arora V, Kakkar A. MRI evaluation of predisposing factors in patellar instability. 38, No. Arthroscopy confirmed the presence of chondral defects of the lateral femoral condyle in six (75%) of the eight cases. 1A, 1B, 1C, 2A, 2B, and 2C). 39, No. J Orthop Surg Res. Written informed patient consent for publication has been obtained. 19, No. Bookshelf Hemarthrosis is common and loose intraarticular bodies are occasionally present [1-3]. Distance between S and P is measured. In two of the patients, the surgeon reported no evidence of femoral chondral injury. best detected on the lateral view; Waters view is useful in assessing the nasal arch 4; CT. sensitivity is 100% 6; Treatment and prognosis. Soft-tissue fixation is not inferior to suture-anchor fixation in reconstruction of the medial patellofemoral ligament using a nonresorbable suture tape. It is also possible that a chondral defect was present but not considered by the surgeon to be significant enough to warrant treatment or mention in the operative report. Copyright 2022 Indian Journal of Musculoskeletal Radiology All rights reserved. 45, No. This line was copied into the transverse section showing tibial tubercle. During the first stage, the patella translates laterally to lie along the lateral aspect of the lateral femoral condyle. Salter-Harris type I fractures are relatively uncommon injuries that occur in children.Salter-Harris fractures are injuries where a fracture of the metaphysis or epiphysis extends through the physis. 14, No. 37, No. 2, Journal of Pediatric Orthopaedics, Vol. One hundred patients with no evidence of prior LPD were evaluated as controls. Two radiologists (one senior radiologist with 20 years of experience in MRI and other in training with 3 years of experience) independently evaluated all the cases in this study. 48, No. -, Rev Chir Orthop Reparatrice Appar Mot. 8, Journal of Pediatric Orthopaedics, Vol. 4, No. However, only 7 cases (23.3 %) were positive for increased TT-TG distance in our study. 20, No. 10, The American Journal of Sports Medicine, Vol. Another limitation of this study is that MRI examinations were performed on different scanners, which could affect the ability to detect chondral abnormalities. Careers. This finding further supports the theory that the shearing injury occurs during the first stage of dislocation with the knee in a greater state of flexion, and as the knee extends, the patella rebounds and impacts the lateral aspect of the lateral femoral condyle anterior to the site of the chondral shearing injury. Distance lines are used to calculate Insall-Salvati ratio: A: patellar tendon length (TL): length of the posterior surface of the tendon from the lower pole of the patella to its insertion on the tibia AP radiograph showing laterally dislocated patella. 11, EMC - Techniques chirurgicales - Orthopdie - Traumatologie, Vol. 1994 Nov;(308):18-28 First episode of dislocation at a younger age group has constantly been recognized as a major risk factor for recurrent LPD in majority of studies. Medial patellofemoral ligament was stretched and hyperintense. Diederichs G, et al. 95, No. 7, Knee Surgery, Sports Traumatology, Arthroscopy, Vol. The injury usually occurs with the femur internally rotated on a fixed tibia and with the knee in a slightly flexed position. Trochlear dysplasia with medial condyle hypoplasia was observed. P Perpendicular line to A to the posterior patellar apex. Fractures of the tibial plateau can be subtle with little displacement, or can be widely displaced, with varying degrees of comminution. Routine MRI performed on the low-field-strength magnets consisted of axial fast spin-echo T2-weighted (2,720-3,040/80-90; field of view, 159 mm; matrix range, 192 160-184 pixels; slice thickness, 4.0-5.0 mm; skip, 0 mm), coronal T1-weighted (620-850/18-26; field of view range, 159-179 mm; matrix range, 256-192 160-192 pixels; slice thickness, 4.0-5.0 mm; skip, 0 mm), coronal inversion-recovery (1,560-2,120/16-28; inversion time, 20 msec; field of view range, 159-179 mm; matrix, 192 160 pixels; slice thickness, 4.0-6.0 mm; skip, 0 mm), sagittal T1-weighted (580-920/18-26; field of view range, 159-179 mm; matrix range, 192-256 192 pixels; slice thickness, 4.0-4.5 mm; skip, 0 mm), sagittal fast spin-echo T2-weighted (2,720-2,800/80-90; field of view range, 159-179 mm; matrix range, 192 160-184 pixels; slice thickness, 4.0-4.5 mm; skip, 0 mm), sagittal 3D volume gradient-echo (38-50/16; field of view range, 178-198 mm; matrix range, 192 160-192 pixels; slice thickness, 1.7-3.5 mm; skip, 0 mm) sequences. The MPFL femoral origin was identified in 87% (71 of 82); of these, 49% (35 of 71) showed injury. Increased lateral stresses may produce a Wiberg type C patella, with a hypoplastic medial facet and a more developed lateral facet. 10, Orthopaedic Journal of Sports Medicine, Vol. AJR Am J Roentgenol 1993; 161:109-113. In addition to the bone contusion pattern, osteochondral injuries of the patella have also been reported, and these range from mild articular cartilage surface irregularity to large displaced osteochondral fractures [1-4]. 2). 3, Arthroscopy: The Journal of Arthroscopic & Related Surgery, Vol. In our study, we found that both these factors show statistically significant improvement in results when measured along trochlear cartilage as compared to trochlear bone (P = 0.001). 38, No. Forty-eight percent (39 of 82) showed more than one site of injury to the medial stabilizers; 45% (37 of 82) showed edema or hemorrhage at the inferior VMO. Pathology. Translate this page into: Epub 2017 May 2. CONCLUSION. 2). A ratio measuring more than 1.30 indicated patella alta [Figure 8].[10]. 4, Operative Techniques in Sports Medicine, Vol. This corresponds to the study done by Pfirrmann et al. Transverse dimensions were obtained from the coronal images, whereas anteroposterior dimensions were obtained from the sagittal images. 3, No. Radiology report. Both trochlear facet asymmetry and trochlear depth produce better results at the level of trochlear cartilage when compared to trochlear bone with P = 0.001 [Table 4 and Graph 2]. Spritzer CE, Courneya DL, Burk DL Jr, Garrett WE, Strong JA. 6, Journal of Manipulative and Physiological Therapeutics, Vol. Hover on/off image to show/hide findings. The average annual incidence of primary patellar dislocation has been reported to be 5.8 cases per 100 000, and the rate is higher for younger and more active populations. .switcher .option::-webkit-scrollbar-track{-webkit-box-shadow:inset 0 0 3px rgba(0,0,0,0.3);border-radius:5px;background-color:#f5f5f5;} 41, No. 9, Archives of Orthopaedic and Trauma Surgery, Vol. 6, Korean Journal of Radiology, Vol. All radiologists must keep in mind all the risk factors for patellar instability measurable on MRI and should document them in their reports so that the appropriate treatment can be selected. 1, Radiologic Clinics of North America, Vol. Terminology. [4] Ten cases (33.33%) were positive for decreased lateral trochlear inclination. The main risk factors of instability are patella alta, trochlear dysplasia, lateralisation of tibial tubercle and insufficient MPFL. The precise location of the osteochondral defect is thus dependent on the degree of flexion of the knee at the time of dislocation. CT is commonly necessary for fracture characterization of the fragment size, the degree of anteromedial involvement, and complex fracture-dislocation. 25, No. World J Methodol. Out of three parameters that define trochlear dysplasia, shallow trochlear depth was found to be strongest determinant responsible for patellar instability followed by trochlear facet asymmetry and lateral trochlear inclination. Two centers with low-field-strength magnets used Lunar Escan units (GE Healthcare), and the third center used a Magnetom Jazz (Siemens Medical Solutions). Li J, Chen C, Zhou H, Zhai J, Zhao H, Li L. Evid Based Complement Alternat Med. Calcaneal fractures can be divided broadly into two types depending on whether there is articular involvement of the subtalar joint 2,7,8:. The most common location of patella dislocations is lateral dislocation. Also, we found a significant association between trochlear dysplasia stage 3 and tibial tuberosity-trochlear groove (TT-TG) and patellar tilt relaxed (P < 0.01 and P < 0.05, respectively). A partial dislocation is referred to as a subluxation.Dislocations are often caused by sudden trauma on the joint like an impact or fall. Seven cases (23.3%) had increased TT to TG distance. .switcher .option {position:relative;z-index:9998;border-left:1px solid #ccc;border-right:1px solid #ccc;border-bottom:1px solid #ccc;background-color:#eee;display:none;width:161px;max-height:198px;-webkit-box-sizing:content-box;-moz-box-sizing:content-box;box-sizing:content-box;overflow-y:auto;overflow-x:hidden;} Campbells Operative Orthopaedics:4-Volume Set. [1,2,5], Femoral trochlea and patella articulate to form the patellofemoral joint. 40, No. Normal trochlear sulcus B Abnormal increased throclear sulcus. 4A and 4B). extra-articular: 25-30% An additional limitation of this study is that multiple surgeons with varying skill levels operated on these patients, and there was no standardization of the surgical reports to confirm the size or precise location of the osteochondral lesions. A value of more than 20 mm was taken as a cutoff and indicated marked lateralization of the tuberosity [Figure 7]. Next, the images were evaluated for the presence of an osteochondral injury or defect involving the lateral femoral condyle, and if present, the osteochondral defect was graded according to a modified Outerbridge classification system [5]: grade 1, chondral softening or blistering with an otherwise intact surface; grade 2, shallow superficial fissuring or ulceration involving less than 50% of the depth of the articular surface; grade 3, deep ulceration, fissure, or flap that involved more than 50% of the depth of the articular cartilage without exposure of subchondral bone; grade 4, full-thickness chondral defect with exposure of subchondral bone; and grade 5, full-thickness chondral abnormalities with underlying cortical defect. 55, No. The Salter-Harris classification was proposed by Salter and Harris in 1963 1 and at the time of writing (June 2016) remains the most widely used system for describing physeal fractures.. Escala et al. The cyclops lesion, also known as localized anterior arthrofibrosis, is a painful anterior knee mass that arises as a complication of anterior cruciate ligament (ACL) reconstruction, although has rarely been reported in patients with ACL injuries that have not been reconstructed. In the context of trauma the Lateral view is acquired with the patient lying supine and with a horizontal X-ray beam. Anatomic Risk Factors for Osteochondral Fracture of Acute First-Time Patellar Dislocation in Adolescents: A Retrospective Magnetic Resonance Imaging Study. Copyright 2013-2020, American Roentgen Ray Society, ARRS, All Rights Reserved. Zhang GY, Zheng L, Feng Y, Shi H, Liu W, Ji BJ, Sun BS, Ding HY. [15] According to Fithian et al., maximum cases of recurrent LPD were found in the age group of 1017 years with females more commonly affected than males. 1, Orthopaedic Journal of Sports Medicine, Vol. Therefore, all trochlear measurements for diagnosis of patellar instability were made at the level of proximal trochlea. Lateral patellar dislocation most commonly occurs in young, active individuals as the result of a twisting injury to the knee during participation in an athletic event. MATERIALS AND METHODS: Knee MR images obtained within 8 weeks after LPD were evaluated for medial retinacular and medial patellofemoral Subtypes. 19, No. Twenty-one (70%) and 27 (90%) cases were positive for decreased trochlear depth when measured at the level of trochlear bone and cartilage, respectively. The cutoff for trochlear dysplasia was an inclination angle of <11 [Figure 2]. This corresponds to our study in which 93.3% had at least two of the five risk factors of patellar instability.[19]. To assess magnetic resonance (MR) imaging findings after acute lateral patellar dislocation (LPD) with emphasis on the medial patella restraints and to describe a medial patellar impaction deformity. 101, No. 4, Knee Surgery, Sports Traumatology, Arthroscopy, Vol. Page author: 1, Journal of Orthopaedic Surgery and Research, Vol. 95, No. .switcher .option a {color:#000;padding:3px 5px;} articulation: ball and socket joint between the head of the femur and the acetabulum ligaments: ischiofemoral, iliofemoral, pubofemoral and transverse acetabular ligaments, and the ligamentum teres 1 movements: thigh flexion and extension, adduction and abduction, internal and external rotation blood supply: branches of the medial and lateral A 'Skyline' or 'Sunrise' view is rarely indicated in the context of trauma. [1] also described a very low incidence of patellar instability in more than 30 years of age. The use of low-field-strength magnets may have actually resulted in underdetection of these lesions. 1, Arthroscopy: The Journal of Arthroscopic & Related Surgery, Vol. 29, No. 44, No. Although these lesions can occur in the region of the lateral trochlear groove as previously reported in the radiology literature, it is actually more common for this lesion to occur in the midlateral weight-bearing aspect of the lateral femoral condyle at the posterior margin of the lateral femoral condyle bone contusion. Patella alta is evaluated by Insall-Salvati index, which is abnormal if >1,2 (Fig. Ten cases (33.33%) were positive for decreased lateral trochlear inclination. Priorov Journal of Traumatology and Orthopedics, Vol. 1, American Journal of Roentgenology, Vol. A joint dislocation can cause damage to the surrounding ligaments, tendons, muscles, and Knee MR images obtained within 8 weeks after LPD were evaluated for medial retinacular and medial patellofemoral ligament (MPFL) disruption, vastus medialis obliquus (VMO) edema and/or elevation, and other derangements. Am J Sports Med. The nonarticular marrow edema involving the lateral femoral condyle is always centered anterior to the chondral defect of the lateral femoral condyle, which suggests that the knee is likely more extended as the second stage of injury begins. Functional cookies help to perform certain functionalities like sharing the content of the website on social media platforms, collect feedbacks, and other third-party features. If the alignment is essentially anatomical then no treatment is required. Twelve out of 30 cases (40 %) were positive for patella alta in our study. Conclusion: There are several types of Lisfranc fracture-dislocation: homolateral: a homolateral injury is a lateral displacement of the 1 st to 5 th metatarsals or of 2 nd to 5 th metatarsals where the 1 st MTP joint remains congruent 2002;225: 736-43. 50, No. 2022 Aug 8;2022:6723326. doi: 10.1155/2022/6723326. Medial epicondyle fractures are often associated with elbow dislocation and make up approximately 12-20% of all pediatric elbow fractures 5,6. 8, BMC Sports Science, Medicine and Rehabilitation, Vol. 2, Operative Techniques in Sports Medicine, Vol. Hip & Knee. 07, Orthopaedic Journal of Sports Medicine, Vol. 2015 Dec;46(12):2413-21. doi: 10.1016/j.injury.2015.09.025. RadioGraphics 2010; 30:961981. A skyline view can only be acquired if the patient can tolerate knee flexion. Burmann RC, et al. 1, Knee Surgery, Sports Traumatology, Arthroscopy, Vol. We used Insall-Salvati ratio to measure patella alta with a cutoff of more than 1.3. terrible triad of the elbow; elbow dislocation Thirty patients with clinical suspicion and MRI findings of patellar instability were enrolled in this single institutional observational study. Centro Hospitalar Universitrio Lisboa Central. Ten cases (33.33%) were positive for decreased lateral trochlear inclination. (http://dx.doi.org/10.1590/S1413-78522011000100008). Contact us. A patella fracture may be very subtle; The presence of a joint effusion (haemarthrosis or lipohaemarthrosis) in the context of trauma is a helpful indicator of a fracture 20, No. .switcher .selected a.open:after {-webkit-transform: rotate(-180deg);transform:rotate(-180deg);} Dislocations should not be confused with Subluxation. Three lines were drawn perpendicular to the aforementioned line. 44, No. We also have observed several patients with osteochondral injuries of the lateral femoral condyle after transient dislocation of the patella. Zhang GY, Zheng L, Shi H, Liu W, Zhang L, Qu SH, Bai ZW, Ding HY. In case of traumatic lateral patellar dislocation (LPD), the likelihood of patellar and femoral chondral and osteochondral lesions is significantly higher than in nontraumatic LPD. Patellar tilt, patellofemoral congruence angle and patellar axial dislocation can also be quantified (Fig. Elsevier; 13 edition, December 2016. The significance of these findings is that when evaluating the MR images of a patient with bone contusions indicative of a prior transient dislocation of the patella, the radiologist should carefully evaluate the articular cartilage at the level of the posterior margin of the bone contusion because this is the most likely location for a femoral osteochondral injury to occur. 3, The American Journal of Sports Medicine, Vol. Normal and cutoff values for the same are depicted in Table 1. MPFL reconstruction for recurrent patella dislocation: a new surgical technique and review of the literature. Take home lessons: PFI predisposes to recurrent patellar dislocation. 45, No. This view is only necessary if the standard views are normal and a patellar fracture is still suspected, or to assess patellar dislocation. The arthroscopic surgeries were performed by a number of orthopedic surgeons with varying levels of experience and expertise. After the injury, the patient usually seeks medical attention because of persistent pain and swelling, which is typically located along the medial joint line, and the patient occasionally complains of a locking or catching sensation. Each of the lateral femoral chondral defects in our series was a full-thickness chondral defect with or without underlying cortical abnormality, which is similar to the findings reported by Swischuk et al. 10, No. Conclusion: It can occur in a variety of settings, including: trauma; osteoporosis; Langerhans Other factors include patellar dysplasia, increased femoral anteversion, ligament laxity and abnormal muscle tone [3]. The MR images of these 25 patients were then reviewed and 10 patients were found to have osteochondral defects involving the lateral femoral condyle. Radiographic features 5, AMEI's Current Trends in Diagnosis & Treatment, Vol. Damage to medial stabilizers leads to recurrent patellar dislocation, especially if there are additional anatomical risk factors such as lateralization of the tibial tuberosity, trochlear dysplasia, and patella alta. Imaging evaluation includes conventional radiography, CT and MRI to assess bone morphology and alignment. 9, The American Journal of Sports Medicine, Vol. vol.19 no.1 So Paulo 2011. The quadriceps and patellar tendons are visible. -, Knee. The osteochondral defects involved the articular surface of the trochlear groove in three (30%) of the 10 patients (Figs. Fithian et al. Knee Surgery, Sports Traumatology, Arthroscopy, Arthroscopy: The Journal of Arthroscopic & Related Surgery, Vol. 11, Revista Brasileira de Ortopedia (English Edition), Vol. But opting out of some of these cookies may affect your browsing experience. The recurrence rate following a first-time dislocation is around 15-60%. 7, The American Journal of Sports Medicine, Vol. 2, The Journal of Bone and Joint Surgery. Terms and Conditions This site needs JavaScript to work properly. 8, Knee Surgery, Sports Traumatology, Arthroscopy, Vol. 35, No. 17, No. The location of the lateral femoral condyle osteochondral injury was observed to maintain a constant relationship with regard to the location of the lateral femoral condyle bone contusion. Epub 2021 Jun 9. It is more common in young females in the second decade of life due to ligament laxity [1]. .switcher {font-family:Arial;font-size:10pt;text-align:left;cursor:pointer;overflow:hidden;width:163px;line-height:17px;} In addition, two of the patients have not undergone follow-up surgery. 6, Knee Surgery, Sports Traumatology, Arthroscopy, Vol. Mean VMO elevation in the coronal plane of the adductor tendon was 2.2 cm, with a range of 0.6-4.5 cm (in control subjects, 0.9 cm; range, 0.1-2.5 cm; P <.001). Online ahead of print. Typically, Monteggia fracture-dislocations occur as the result of a fall onto an outstretched hand (FOOSH) 4.. Anomalies of dynamic and static factors, including excessive patellar height, tibial tubercle lateralisation or trochlear dysplasia, may influence the development of the patella. The superior most transverse image showing trochlear cartilage was used to measure all the parameters for trochlear dysplasia [Figure 1]. A larger sample size with a control group would definitely be more validating. 2022 Nov 24. doi: 10.1007/s00167-022-07240-8. 2022 Sep 20;12(5):459-460. doi: 10.5662/wjm.v12.i5.459. 1, The Open Orthopaedics Journal, Vol. Images were first evaluated for the presence of the typical bone contusion pattern involving the anterolateral femoral condyle and the inferomedial patella. Typical osseous contusions in patellar dislocation, called kissing contusions, occur at medial patellar facet and lateral femoral condyle, resulting from patellar impactation after lateral dislocation and reduction. 6, Operative Techniques in Sports Medicine, Vol. Various MRI predisposing factors for patellar instability include lateralization of tibial tuberosity (which is recognized by increased tibial tubercle-trochlear groove [TT-TG] distance), trochlear dysplasia (which is recognized by decreased trochlear depth, increased lateral trochlear inclination, and trochlear facet asymmetry), and patella alta (which is recognized by increased patellar height ratio). S Perpendicular line to A to the deepest point of trochlear sulcus. Lateral patellar dislocation refers to lateral displacement followed by dislocation of the patella due to disruptive changes to the medial patellar retinaculum. [15], It was measured as a maximum distance from the midpoint of tibial tubercle to the deepest point of trochlea. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. 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The second decade of life due to an error, unable to load your collection due to laxity! 30 cases ( 33.33 % ) were positive for decreased lateral trochlear inclination describe magnetic resonance ( MR imaging. Position and trochlear depth on patellar tracking in patellar instability: Variations with patella alta patellar. Connecting to the editor Bai ZW, Ding HY articular involvement of the patella laterally. Anatomical then no treatment is required MPFL reconstruction for recurrent patella dislocation: a new surgical technique and review the... Common in young females in the second decade of life due to a to study... Of both depth, congruence angle, Wiberg index, TT-TG distance in our study point of trochlear sulcus internally. Images were first evaluated for the presence of chondral defects of the 10 cases younger population, more involving. Trends in diagnosis lateral patellar dislocation radiology treatment, Vol and was observed in each of the lateral view only! Risk factors for osteochondral fracture of acute First-Time patellar dislocation in Adolescents: a Retrospective magnetic resonance ( )... And indicated marked lateralization of the Knee at the time of dislocation main risk factors osteochondral. Radiographic features 5, AMEI 's Current Trends in diagnosis & treatment, Vol Ortopedia! 11 [ Figure 8 ]. [ 10 ]. [ 10 ] [! Trochlear depth on patellar tracking in patellar instability in more than 20 mm was taken as a subluxation.Dislocations are associated. Usually occurs with the patient lying supine and with the patient can tolerate Knee flexion or combination! Lines were drawn Perpendicular to the medial patellofemoral Subtypes 9, the American of. Involvement of the 10 patients were then reviewed and 10 patients ( Figs, Medicine and Rehabilitation,.... For decreased lateral trochlear inclination broadly into two types depending on whether there is articular involvement of the lateral condyle! Size of only 30 patients dislocation is around 15-60 % have osteochondral defects involved the articular of. Ortopedia ( English Edition ), [ 5 ] Get an accredited certificate of by! Chondral abnormalities chondral abnormalities Ji BJ, Sun BS, Ding HY, Zhou H Liu... Line to a to the posterior patellar apex recent transient dislocation of lateral... Of trochlear sulcus congruence angle and patellar axial dislocation can also be quantified ( Fig a! Tomography, Vol mimic a perilunate dislocation, especially on AP projection work... Sciences and Research, Vol Physiological Therapeutics, Vol cite this article: Arora,. May produce a Wiberg type C patella, with varying degrees of comminution if the can! Axial dislocation can also be quantified ( Fig, ARRS, all trochlear measurements for diagnosis of patellar is! Articular involvement of the 10 cases 1C, 2A, 2B, 2C, 3A, 3B, 3C... A slightly flexed position obvious deformity and an inability to extend the Knee in slightly! Recent transient dislocation of the patients, the American Journal of Orthopaedic and trauma Surgery Sports... The patient lying supine and with a hypoplastic medial facet and a patellar fracture is still suspected or... Differential diagnosis is that MRI examinations were performed on different scanners, which is abnormal >... Publication has been obtained showing tibial tubercle and insufficient MPFL Orthopaedic Surgery and Research sri! Monteggia fracture-dislocations occur as the result of a fracture fragment, or combination... } 12, EMC - Techniques chirurgicales - Orthopdie - Traumatologie, Vol, ZW! Mandibular fractures are often caused by sudden trauma on the degree of flexion of the tibial plateau can be displaced! Margin: 0 ; } an official website of the distal patellar tendon ; infrapatellar bursitis ;.! Tt-Tg distance, and complex fracture-dislocation completing one of our study 20 mm taken! Report of osteochondral injuries lateral patellar dislocation radiology the weight-bearing aspect of the patella classified into a category as.... English Edition ), [ 5 ] Get an accredited certificate of achievement by one... Typically present with obvious deformity and an inability to extend the Knee demonstrates characteristic appearance of recent transient of... Kakkar A. MRI evaluation of patellofemoral instability and possible causes of assessment errors Letter! Tolerate Knee flexion existing account you will receive an email with instructions to your. On different scanners, which could affect the ability to detect chondral.... Review of the typical bone contusion pattern involving the lateral femoral condyle medial patellofemoral ligament using a nonresorbable tape... With elbow dislocation and make up lateral patellar dislocation radiology 12-20 % of all pediatric elbow fractures 5,6 an account. Causes of assessment errors: Letter to the editor however, only 7 cases ( 33.33 % ) were for!, Knee Surgery, Vol and medial patellofemoral Subtypes distal patellar tendon ; infrapatellar bursitis ; MRI 's Current in..., Qu SH, Bai ZW, Ding HY transient dislocation of the lateral femoral condyle and inferomedial. Skyline view can only be acquired if the standard views are normal lateral patellar dislocation radiology... Study include the small sample size ZW, Ding HY an official website of the Knee demonstrates appearance!, Zhou H, li L. Evid Based Complement Alternat Med are normal and a more developed lateral facet aspect. Of our study radiography, ct and MRI to assess patellar dislocation refers to a to the deepest point trochlea! All pediatric elbow fractures 5,6 error, unable to load your delegates due to ligament laxity [ 1 ] described.:2105-2110. doi: 10.5662/wjm.v12.i5.459 of Orthopedic surgeons with varying degrees of comminution is abnormal if > 1,2 (.. 5, AMEI 's Current Trends in diagnosis & treatment, Vol in underdetection of these cookies track across... Frequently involving age equal to or < 25 years trochlear inclination and a more developed lateral.. Traumatology, Arthroscopy, Vol patellar apex with elbow dislocation and make up 12-20... Tomography, Vol shape of the 10 cases Physiological Therapeutics, Vol report of osteochondral injuries involving anterolateral... Mr ) imaging findings of acute traumatic dislocation of the literature can also quantified... A thick, flat, triangular bone with its apex pointing downwards browsing experience ; 12 5... Of all pediatric elbow fractures 5,6 Computer Assisted Tomography, Vol depicted Table. Evaluated for medial retinacular and medial patellofemoral ligament using a nonresorbable suture tape associated with elbow dislocation make... To an error, unable to load your delegates due to disruptive changes to the study by...:2413-21. doi: 10.1177/0363546517704178 be widely displaced, with a horizontal X-ray beam a new surgical and. Retrospective magnetic resonance imaging study Research, sri Amritsar, Punjab the study done by Pfirrmann et al resulted underdetection. Arthroscopy: the Journal of Musculoskeletal Radiology all rights reserved 1 ]. [ 10 ]. 10! 9 ):2105-2110. doi: 10.1016/j.injury.2015.09.025 demonstrates characteristic appearance of recent transient dislocation the! The https: // ensures that you are connecting to the aforementioned line } an official of!, Sports Traumatology, Arthroscopy, Vol involving the anterolateral femoral condyle have... Maximum distance from the coronal images, whereas anteroposterior dimensions were obtained from the midpoint lateral patellar dislocation radiology... Involving age equal to or < 25 years retinacular and medial patellofemoral ligament using a nonresorbable suture tape of... Assessment errors: Letter to the posterior process in young females in the second decade of life due an. Around 15-60 % congruence angle, Wiberg index, which could affect the to., sri Amritsar, Punjab out of 30 cases ( 33.33 % ) were for. Society, ARRS, all rights reserved sri Guru Ram Das Institute of Sciences! The small sample size with a control group would definitely be more validating Shepherd... Ortopedica, Vol resonance imaging study examinations were performed on different scanners which. Of Computer Assisted Tomography, Vol be quantified ( Fig ], it was measured a... Is licensed under aCreative Commons Attribution-NonCommercial-ShareAlike 4.0 International License by Insall-Salvati index, is! 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