Traumatic dislocations are commonly associated with other injuries including that of the MPFL, meniscal pathology, and osteochondral fractures of the femur or patella [15, 16]. All authors (ZJ, PJ, KSR, MLS, GD) contributed to the study design, drafted the work, and revised it critically for final submission. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. J Comput Assist Tomogr 2001; 25:957-962. (16a) An axial fat-suppressed T2-weighted image reveals numerous typical findings of recent lateral patellar dislocation. In the past two decades dissection studies have shown that it extends from the superomedial border of the patella to the femoral epicondyle, at or immediately above the adductor tubercle. J Orthop Sports Phys Ther 2017;47(10):815. doi:10.2519/ jospt.2017.6616 . Radiology 216:858864, Biedert RM, Tscholl PM (2017) Patella alta: a comprehensive review of current knowledge. Structures such as the iliotibial band, fibular collateral ligament, and biceps femoris tendon are readily apparent on MRI and are easy to identify. It can be difficult to determine the deepest part of the trochlear groove when assessing the TT-TTG in the presence of trochlear dysplasia; therefore, an alternative method for assessing tibial tubercle position was proposed measuring the distance in reference to the posterior cruciate ligament and not to the trochlea (tibial tubercle-posterior cruciate ligament distance [TT-PCL]), with proposed pathologic threshold of 21mm [42, 43]. 1-31. By altering the insertion point of the patellar tendon, these procedures affect the timing and position of patellar engagement in the trochlea and have the ability to biomechanically offload damaged distal articular cartilage, thereby reducing pain and increasing stability simultaneously. Traumatic lateral patellar dislocation is a common injury among young, athletic individuals and is generally transient in nature. 7 Balcarek P, Jung K, Frosch KH, Sturmer KM. There is agreement, however, that the MPFL is almost always injured with lateral patellar dislocations4. Kamel S, Kanesa-Thasan R, Dave J et al. AJR Am J Roentgenol 195:13671373, Jarraya M, Diaz LE, Roemer FW, Arndt WF, Goud AR, Guermazi A (2018) MRI findings consistent with peripatellar fat pad impingement: how much related to patellofemoral maltracking? 8). In the seven patients with hyperextension injuries, three had associated meniscal and cruciate ligament tears. Surgical management of patellar instability should be guided on an individual patient basis depending on history, physical examination, and radiologic findings as outlined above. Knee Surg Sports Traumatol Arthrosc 14:264272, McNally EG, Ostlere SJ, Pal C, Phillips A, Reid H, Dodd C (2000) Assessment of patellar maltracking using combined static and dynamic MRI. Knee 13:2631, McNally EG (2001) Imaging assessment of anterior knee pain and patellar maltracking. Acute Osteochondral Fractures in the Lower Extremities - Approach to Identification and Treatment. Patellar maltracking: an update on the diagnosis and treatment strategies, https://doi.org/10.1186/s13244-019-0755-1, http://creativecommons.org/licenses/by/4.0/. 2. MRI has been found to be 85%-92% sensitive for diagnosing MPFL injury (Seeley, 2013). (8a) A more posterior coronal T1-weighted image also demonstrates the intimate relationship of the VMO and MPFL. The lateral retinaculum is a ligament that helps hold your patella, or kneecap, in place. 2011;39(8):1756-1761. Chondral and Soft Tissue Injuries Associated to Acute Patellar Dislocation: A Systematic Review. Discussion. [Crossref] Harvinder Bedi, John Marzo. Both knees are scanned simultaneously. Bone bruises at the anterolateral aspect of the lateral femoral condyle and at the inferomedial patella are the most constant findings in patients who have sustained a recent patellar dislocation. The MPFL plays a significant role in the stabilization of the medial aspect of the patella.Especially during the early stages of knee flexion, the MPFL is a critical component in patellar tracking and stability within the trochlear groove. AJR Am J Roentgenol 194:721727, Kalichman L, Zhang Y, Niu J et al (2007) The association between patellar alignment and patellofemoral joint osteoarthritis features--an MRI study. Anatomical and radiology atlas of the abdomen and pelvis based on anatomical diagrams and cross-sectional CT and MRI imaging. However, the use of this method is not widespread. 1 Lance E, Deutsch AL, Mink JH. Acta Orthop Scand 68:419423, Deie M, Ochi M, Sumen Y, Adachi N, Kobayashi K, Yasumoto M (2005) A long-term follow-up study after medial patellofemoral ligament reconstruction using the transferred semitendinosus tendon for patellar dislocation. The literature in this field has been extremely heterogeneous, and this has made clinical guidelines difficult to produce. The distance from the tibial tubercle to the trochlear groove (TT-TG) provides a quantitative evaluation of excessive lateralization of the tibial tuberosity.7, (10a) Axial image of the knee with superimposition of the tibial tubercle from another slice (yellow outline). 2002 Dec;225(3):736-43. doi: 10.1148/radiol.2253011578. (13a) A line is drawn between the cortex of the lateral trochlear facet on the most superior axial image showing cartilage. 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. Patellar sleeve avulsion (PSA) fractures are rare injuries that occur in in skeletally immature patients. Radiology 263:469474, Subhawong TK, Eng J, Carrino JA, Chhabra A (2010) Superolateral Hoffas fat pad edema: association with patellofemoral maltracking and impingement. However, in the case of acute, focal, lateral patellar pain, a lateral patel - lar sleeve avulsion should be considered and may necessitate advanced imaging for optimal evaluation. 9). 2. Injury. The purpose of this article is to discuss the evaluation of patellar maltracking providing an update on the imaging assessment and also a synopsis on the management options. (15a) A fat-suppressed proton density-weighted axial image at the level of the upper patella in the same patient demonstrates avulsion of the transverse band of the MPFL at the femoral attachment (arrow) with edema primarily anterior to the adductor magnus tendon (AM). 2015 Sep 30;9:463-74. doi: 10.2174/1874325001509010463. The conditions are presented anatomicallyanterior, lateral, medial, or posteriorwith common etiologies, history and physical exam findings, and diagnosis and treatment options for each (see Table, page 28). Clin Orthop Relat Res 471:26412648, Laurin CA, Dussault R, Levesque HP (1979) The tangential x-ray investigation of the patellofemoral joint: x-ray technique, diagnostic criteria and their interpretation. official website and that any information you provide is encrypted Am J Sports Med 18:359365, Lattermann C, Toth J, Bach BR Jr (2007) The role of lateral retinacular release in the treatment of patellar instability. 7). From the inside of the knee the lateral retinaculum is incised, from the inside, allowing the kneecap to untilit itself. MeSH Long term follow up studies in patients who have undergone a lateral release have shown an increased incidence of patellofemoral arthritis. Acute lateral patellar dislocation at MR imaging: injury patterns of medial patellar soft-tissue restraints and osteochondral injuries of the inferomedial patella Injury to the medial retinaculum, MPFL, and VMO may be identified at MR imaging after acute LPD. 2023 BioMed Central Ltd unless otherwise stated. Soft tissue changes may include effusion, thickening or disruption of the MPFL, and retinacular complex and regional edema. The two features are associated with patellar maltracking. Am J Sports Med 14:117120, Smith TO, Donell S, Song F, Hing CB (2015) Surgical versus non-surgical interventions for treating patellar dislocation. Materials and methods: Two radiologists independently reviewed 99 knee MR images for the presence of a focal defect at the lateral patellar retinaculum and . 8 Lippacher S, Dejour S, Elsharkawi M, et al. Physical therapy is directed to increasing range of motion and to strengthening the VMO and quadriceps muscles. The oblique decussation of the MPFL blends with fibers of the superficial MCL. The osteocartilaginous anatomy of the patellofemoral joint provides additional static stabilization to the joint. Knee CT images in the early post-operative period in a 19-year-old male with history of patellar maltracking. Clin Radiol 59:543557, Ali SA, Helmer R, Terk MR (2010) Analysis of the patellofemoral region on MRI: association of abnormal trochlear morphology with severe cartilage defects. Osteochondral fractures are common in acute or recurrent transient lateral patellar dislocation, seen in up to 70% of cases. Unable to process the form. A ratio equal or more than 1.2 indicates patella alta [35] (Fig. Fractures may be caused either by excessive force through the extensor mechanism or by a direct blow. Deep lacerations are often associated with this type of injury. MRI and operative studies have revealed that it is almost . Google Scholar, Amis AA, Firer P, Mountney J, Senavongse W, Thomas NP (2003) Anatomy and biomechanics of the medial patellofemoral ligament. The clinical evaluation can provide useful clues for the presence of such entity; however, the diagnosis can often be challenging especially in the absence of a documented history of patellar dislocation. (28a) A sagittal proton density-weighted image demonstrates the typical hardware location in a patient status post medialization of the tibial tuberosity (arrow). Patellar tendon lateral femoral condyle friction syndrome is one of several entities that result in anterior knee pain and in which abnormalities of the patellar fat pads are found on MR imaging. Chronic fat impingement can result in chronic inflammation and fat pad hypertrophy. Radiology 187:205212, Jibri Z, Martin D, Mansour R, Kamath S (2012) The association of infrapatellar fat pad oedema with patellar maltracking: a case-control study. Twenty-seven knees in 21 patients were studied and the mean age of the patients at surgery was 19 years. In patients without osseous malalignment, MPFL reconstruction and plication of the medial restraints is reported to decrease re-dislocation rates to 5%. Evaluate the TCO of your PACS download >, 750 Old Hickory Blvd, Suite 1-260Brentwood, TN 37027, Focus on Musculoskeletal and Neurological MRI, https://radsource.us/patella-alta-and-baja/, The Anterior Meniscofemoral Ligament of the Medial Meniscus. Rethy Chhem, Etienne Cardinal. Thus, imaging at positions both less than and greater than 30 can be used to avoid missing maltracking that might be captured at only certain degrees of flexion [64]. J Bone Joint Surg Am 89:17491755, PubMed 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]. Both MRI and ultrasound are accurate imaging modalities in the detection of MPFL injuries [5, 50, 51]. 2012;40(4):837-844. Am J Sports Med. A ratio > 1.3 indicates patella alta. Migliorini F, Marsilio E, Cuozzo F, Oliva F, Eschweiler J, Hildebrand F, Maffulli N. Life (Basel). Less than 3-mm trochlear depth is indicative of trochlear dysplasia [24]. For CT evaluation of the patellofemoral joint, patients are positioned supine, with mild external rotation of up to 15 with padding as needed to facilitate a relaxed state of the quadriceps musculature.
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