lateral patellar retinaculum injury radiology

Jumping. Open Orthop J 9:463474, Article Eleven gave a history of recurrent patellar dislocation. Analysis with magnetic resonance imaging. Trochlear geometry, including slope of the lateral wall and depth, is an important factor. The authors declare that they have no competing interests. Areas of scarring and osteochondral lesions become more common as the frequency of patellar dislocation increases. There are a number of MRI features of trochlear dysplasia including reduction in the trochlear depth, lateral trochlear inclination, and facet asymmetry. (5a) An axial T1-weighted image demonstrates the low blending fibers of the VMO and transverse MPFL at their attachment along the upper patella. Osteochondral injuries to the inferomedial patella may be the result of impaction during dislocation or shearing with reduction. Surgical realignment procedures include medialization of the tibial tubercle particularly in patients with a TT-TG distance greater than 20mm. The lateral patellar retinaculum presents a superficial layer attached medially to the patella and patellar ligament, and extending laterally to the iliotibial band and vastus lateralis muscle fascia (Fig. Because as noted above, the femoral bone bruise occurs as the patella moves forward during reduction, bone bruises at the lateral femoral condyle always course anteriorly from the site of any femoral chondral injury that may be present. 3 Dirim B, Haghighi P, Trudell D et al. 2012;40(4):837-844. The Insall-Salvati index is the most widely accepted measurement and is easily performed on radiographs and MRI examinations. The most obvious presentation of patellar maltracking is that of the first time lateral patellar instability or recurrent instability thereafter. This site needs JavaScript to work properly. Romero J, Hodler J. Radiology. J Orthop Sports Phys Ther 2017;47(10):815. doi:10.2519/ jospt.2017.6616 . However, in the setting of osseous malalignment, MPFL reconstruction alone leads to higher rates of recurrent instability. Clin J Sport Med 15:6266, Colvin AC, West RV (2008) Patellar instability. (24a) Scarring of the medial stabilizers (asterisk) often leads to healing in a more superior and lateral location (long arrow) leading to persistent medial instability, laxity and malalignment even after the patella has been repositioned. It is a recognized cause of anterior pain and in extreme cases presents as acute and often recurrent patellar dislocation, which is usually transient. Cochrane Database Syst Rev 2:CD008106, Woo R, Busch MT (1998) Management of patellar instability in children. Usually, young individuals, particularly women, suffer the consequences of this disorder [2]. 7). It is therefore recommended that radiologists include measurement of TT-TG in reports on patients who undergo MRI for patellar instability. Division of Sports Trauma, Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark. Lateral dislocation may also occur, less commonly, as the result of a direct blow to the medial aspect of the knee. Imaging, particularly MRI, plays a vital role in the assessment of patellar maltracking. With knee extension and subsequent reduction, the patella bounces back into position and in doing so, the medial patella impacts against the non-weightbearing anterolateral aspect of the lateral femoral condyle, resulting in the characteristic marrow edema pattern. PFA of 0 or if it opens medially (negative value) is considered abnormal indicating lateral patellar tilt [27, 48]. Another method is the CatonDeschamps index. The lateral patellar retinaculum can also be assessed in this position. Operative lateral retinaculum release is indicated in refractory cases. Patellar tracking refers to the dynamic relationship between the patella and trochlea during knee motion [1]. Such patients are generally treated with immobilization for 3 to 6 weeks. All authors (ZJ, PJ, KSR, MLS, GD) contributed to the study design, drafted the work, and revised it critically for final submission. 3). In our experience, injuries to the transverse band most often involve the femoral attachment, whereas injuries to the oblique decussation and associated medial retinacular structures are more common at the patellar attachment. Lateral patellar tilt is a sensitive marker for patellar instability [45]. 1-31. The convex articular surface of the patella places it at risk for chondral injury in either the dislocation or the reduction phases of injury. Med Sci Sports Exerc 35:20432047, Steiner T, Parker RD (2009) Patella: subluxation and dislocation. Am J Sports Med 33:220230, Nikku R, Nietosvaara Y, Aalto K, Kallio PE (2005) Operative treatment of primary patellar dislocation does not improve medium-term outcome: a 7-year follow-up report and risk analysis of 127 randomized patients. Medial retinacular complex injury in acute patellar dislocation: MR findings and surgical implications. The MPFL is also stripped from the femoral attachment (long arrow). Methods MRI studies taken at one imaging site between January, 2007 to January, 2008 with the final diagnosis of patella . AJR Am J Roentgenol 179:11591166, Zhang GY, Zheng L, Ding HY, Li EM, Sun BS, Shi H (2015) Evaluation of medial patellofemoral ligament tears after acute lateral patellar dislocation: comparison of high-frequency ultrasound and MR. Eur Radiol 25:274281, Tecklenburg K, Dejour D, Hoser C, Fink C (2006) Bony and cartilaginous anatomy of the patellofemoral joint. the patellar retinaculum at the dynamic examination (Fig. A trochlear depth of < 3mm indicates dysplasia. Curr Sports Med Rep 11:226231, Jain NP, Khan N, Fithian DC (2011) A treatment algorithm for primary patellar dislocations. Radiology 216:858864, Biedert RM, Tscholl PM (2017) Patella alta: a comprehensive review of current knowledge. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 2011;39(8):1756-1761. From 10 to 20 of flexion, the patella engages the trochlear groove with the contact area being the inferior most portion of the medial and lateral facets. PubMed 28 In fact, most patellar maltracking occurs between extension and the first 30 of flexion. Patellar fractures are the most common cause of disruption of the extensor mechanism, six times as frequent as soft tissue injuries such as quadriceps or patellar tendon rupture [ 3 ]. Imaging plays a vital role in detecting not only the secondary damage but also subtle early features that can raise the suspicion for the presence of this entity. In addition, symptomatic knees may demonstrate normal engagement between the patella and trochlea beyond 30 of flexion. Radiology. A ratio > 1.3 indicates patella alta. Normal TD > 5.2mm. This procedure involves removal of cancellous bone beneath the trochlea followed by fixation of the articular surface [88, 89]. Google Scholar, Fithian DC, Paxton EW, Stone ML et al (2004) Epidemiology and natural history of acute patellar dislocation. The lateral retinaculum provides significant additive support to the medial stabilizers. {"url":"/signup-modal-props.json?lang=us"}, Moodaley P, Hng J, Hacking C, et al. J Comput Assist Tomogr 2001; 25:957-962. PubMed Magn Reson Med Sci 17:195202, Elias DA, White LM (2004) Imaging of patellofemoral disorders. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. 1993;161(1):109-13. Epub 2023 Feb 7. In type A, the trochlear preserves its concave shape but has shallow trochlear groove; type B is flattened or convex trochlea; in type C, the medial facet is hypoplastic (facet asymmetry) with high lateral facet, resulting in flattened joint surface in an oblique plane; and type D shows a cliff pattern with type C features and a vertical link between the medial and lateral facets. Materials and methods: Twenty-two male patients (age range 20-45 years) with posttraumatic knee stiffness following distal femoral fractures underwent Thompson's quadricepsplasty where knee flexion range was less than 45. 30 Correctly diagnosing APD can be difficult as the displaced patella usually relocates spontaneously, with fewer than 10% of patients presenting with fixed lateral dislocation. Diagnosis is made clinically with pain with compression of the patella and moderate lateral facet tenderness and sunrise knee radiographs will often show patellar tilt in the lateral direction. Am J Sports Med 38:181188, Ali S, Bhatti A (2007) Arthroscopic proximal realignment of the patella for recurrent instability: report of a new surgical technique with 1 to 7 years of follow-up. 2023 BioMed Central Ltd unless otherwise stated. Pathology The stifle joint of the pampas deer . Eur J Trauma Emerg Surg. Some controversy exists regarding whether female gender is a definite risk factor for patellar instability with certain studies identifying a 33% increased likelihood of first-time dislocation as well as three times high re-dislocation rates than males, whereas others have found roughly equal rates [2, 12,13,14]. 4. (14a) A fat-suppressed proton density-weighted coronal image following patellar dislocation reveals the classic lateral condylar bone bruise (arrow). It runs obliquely and transversely and inserts on the patella and the patellar tendon, and is composed of two layers. (22a) In this patient with an acute first time patellar dislocation injury, typical bone bruises were not apparent. MRI Web Clinic, August 2010. https://radsource.us/patella-alta-and-baja/. Correspondence to Advantages of CT over MRI include the reduced cost, larger gantry diameter allowing to fit larger patients, faster acquisition with less potential for claustrophobia, fewer absolute and relative contraindications related to implanted devices, and better cortical bone definition. It is not until beyond 90 of flexion that the odd facet engages the medial femoral condyle and plays a role in load sharing along with lateral facet [6, 7]. 2012;40(4):837-844. Arthroscopy 32:929943, Dejour D, Saggin P (2010) The sulcus deepening trochleoplastythe Lyons procedure. Knee Surg Sports Traumatol Arthrosc 22:23882395, Escala JS, Mellado JM, Olona M, Gin J, Sauri A, Neyret P (2006) Objective patellar instability: MR-based quantitative assessment of potentially associated anatomical features. Physical Therapy. Guidelines and Gamuts in Musculoskeletal Ultrasound. MRI has been found to be 85%-92% sensitive for diagnosing MPFL injury (Seeley, 2013). Because the diagnosis of lateral patellar dislocation is often unsuspected, MR provides valuable diagnostic information in such cases. Am J Sports Med 14:117120, Smith TO, Donell S, Song F, Hing CB (2015) Surgical versus non-surgical interventions for treating patellar dislocation. The patellar dislocations were clinically unsuspected in the initial evaluation of eight of these nine patients. A sliver of fluid undermines a moderately thickened and scarred MPFL at the medial femoral condyle attachment consistent with a chronic partial stripping tear (arrowheads). The pattern of bone bruising seen in a transient lateral patellar dislocation is easy to understand if one considers the mechanism of injury. It has been shown that ossification in the medial patellar stabilizers correlates with prior injury to these structures [53]. Magnetic Resonance Cholangiopancreatography MRI PREMIUM Digestive system Illustrations PREMIUM CT axial male abdomen and pelvis CT PREMIUM CT peritoneal cavity CT PREMIUM MRI female pelvis MRI PREMIUM Female pelvis Femoral condylar chondral injuries occur during the dislocation phase due to impaction shearing forces of the patella upon the flexed femur, typically occurring at the weightbearing surface. Am J Sports Med. Springer Nature. The purpose of this article is to discuss the clinical and radiologic evaluation of patellar maltracking providing an update on the cross-sectional imaging assessment and also a synopsis of the management options. At the time the article was last revised Joel Hng had It has been shown that damage to the medial patellar stabilizers including medial patellar retinaculum and the medial patellofemoral ligament (MPFL) injuries are prevalent in 70100% of cases of lateral patellar dislocation [5, 27, 49,50,51]. Because of the transient and brief nature of lateral patellar dislocations, the diagnosis is frequently unrecognized by both patients and clinicians.1 Pain is often described as medial because of soft tissue injuries that occur to the medial retinaculum and/or MPFL. At the time the article was created Pereshin Moodaley had no recorded disclosures. Large tears may require surgical suturing repair. (17a) An axial T2 fat-suppressed image in another patient reveals a fluid filled gap (short arrow) at the site of attachment of the medial retinaculum. Failure to identify or treat injury to the patellar retinaculum is associated with recurrent patellar instability and contributes to significant morbidity. Ellas et al. 2. As an example, although the InsallSalvati ratio is one of the most commonly used methods and does not depend on the degree of knee flexion, it is affected by the patellar shape particularly its inferior point and measurement does not change after tibial tubercle distalization procedure [25]. Facet asymmetry is determined by calculating the percentage of the medial to the lateral femoral facet length (Fig. (12a) At an axial image 3 cm proximal to the femoral-tibial joint space, the lengths of the medial and lateral trochlear facets are obtained.
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