The diagnosis and treatment of problems involving the patellofemoral joint can be a very demanding and sometimes vexing task Now Dr Fulkerson presents this Third Edition of the authoritative reference on the subject, with expert guidance for a logical, well-organized approach to success in the management of these disorders This edition combines the latest information with the best of the previous ones, including concise, practical information, helpful charts and diagrams, high quality illustrations, and thorough analysis from the world-renowned authors New are chapters on physical examination, rehabilitation, and arthroscopy, extensive references, and cutting edge concepts and techniques

Disorders of the Patellofemoral Joint

Injuries to articular cartilage and menisci can lead to cartilage degeneration that ultimately results in arthritis. Different forms of arthritis affect ~50 million people in the USA alone, and it is therefore crucial to identify methods that will halt or slow the progression to arthritis, starting with the initiating events of cartilage and meniscus defects. The surgical approaches in current use have a limited capacity for tissue regeneration and yield only short-term relief of symptoms. Tissue engineering approaches are emerging as alternatives to current surgical methods for cartilage and meniscus repair. Several cell-based and tissue-engineered products are currently in clinical trials for cartilage lesions and meniscal tears, opening new avenues for cartilage and meniscus regeneration. This Review provides a summary of surgical techniques, including tissue-engineered products, that are currently in clinical use, as well as a discussion of state-of-the-art tissue engineering strategies and technologies that are being developed for use in articular cartilage and meniscus repair and regeneration. The obstacles to clinical translation of these strategies are also included to inform the development of innovative tissue engineering approaches.

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Surgical and tissue engineering strategies for articular cartilage and meniscus repair.

High-level evidence supports nonoperative treatment for first-time lateral acute patellar dislocations. Surgical intervention is often indicated for recurrent dislocations. Recurrent instability is often multifactorial and can be the result of a combination of coronal limb malalignment, patella alta, malrotation secondary to internal femoral or external tibial torsion, a dysplastic trochlea, or disrupted and weakened medial soft tissue, including the medial patellofemoral ligament (MPFL) and the vastus medialis obliquus. MPFL reconstruction requires precise graft placement for restoration of anatomy and minimal graft tension. MPFL reconstruction is safe to perform in skeletally immature patients and in revision surgical settings. Distal realignment procedures should be implemented in recurrent instability associated with patella alta, increased tibial tubercle-trochlear groove distances, and lateral and distal patellar chondrosis. Groove-deepening trochleoplasty for Dejour type-B and type-D dysplasia or a lateral elevation or proximal recession trochleoplasty for Dejour type-C dysplasia may be a component of the treatment algorithm; however, clinical outcome data are lacking. In addition, trochleoplasty is technically challenging and has a risk of substantial complications.

An Algorithmic Approach to the Management of Recurrent Lateral Patellar Dislocation.

The ‘gold standard’ for treatment of chronic ankle instability is Brostrom-Gould procedure, which is an ‘open’ surgery. Most authors recommend this type of operation even after an arthroscopic inspection of the joint. The arthroscopic methods, including thermal shrinkage, propose in the past didn’t received a widely spread support. We present a method of arthroscopic lateral ligament ‘repair’ with an anchor placed in the fibula. We used this technique on 31 consecutive patients (28 were available for follow-up). 21 patients were victims of work or traffic accidents and 3 had sport-related lesions. The patients were evaluated after a 24,5 month follow-up. The average post-op AOFAS score was 85,3 and average satisfaction was 3,77 (1 to 5) We had two ‘relapses’ (another sprain without instability on the stress XR). On 3 patients we had some wound healing problems and we had 3 lesions of the superficial peroneal nerve, one of these is persistent. One patient developed a deep vein thrombosis post operatively. With this method, we achieved good results with relatively few complications, even more considering that most of the patients were work-compensation cases. It’s a simple procedure, less ‘aggressive’ then the traditional one’s, producing an anatomical and functional repair of the lateral ligament.

Arthroscopic repair of chronic lateral ankle instability

Background: The current “gold standard” for treatment of chronic lateral ankle instability is the Brostrom-Gould procedure. Most authors recommend this type of operation even after an arthroscopic inspection of the joint. We review our results with an arthroscopic method of lateral ankle ligament repair. Materials and Methods: A method of arthroscopic lateral ligament repair with an anchor placed in the fibula is described. We used this technique on 31 consecutive patients (28 were available for followup). Twenty-one patients had work or traffic accidents, four suffered casual falls. and three had sport-related lesions. The patients were evaluated after 24.5 month average followup. Results: The average postoperative AOFAS score was 85.3 (82.3 in the workers-compensation group and 94.4 in the others) and average satisfaction was 3.8 (3.5 to workers-compensation and 4.6 for the others). Complications occurred in nine patients (29%), but only three cases had ongoing problems. We had two recurrences (another ...

Arthroscopic repair of chronic lateral ankle instability.

Purpose:The purpose of this retrospective study was to assess the results of a novel surgical technique for the treatment of chronic lateral ankle instability using both a direct repair of the ante...

Comprehensive Reconstruction of the Lateral Ankle for Chronic Instability Using a Free Gracilis Graft

Context:Isolated chondral and osteochondral defects of the knee are a difficult clinical challenge, particularly in younger patients for whom alternatives such as partial or total knee arthroplasty are rarely advised. Numerous surgical techniques have been developed to address focal cartilage defects. Cartilage treatment strategies are characterized as palliation (eg, chondroplasty and debridement), repair (eg, drilling and microfracture [MF]), or restoration (eg, autologous chondrocyte implantation [ACI], osteochondral autograft [OAT], and osteochondral allograft [OCA]).Evidence Acquisition:PubMed was searched for treatment articles using the keywords knee, articular cartilage, and osteochondral defect, with a focus on articles published in the past 5 years.Study Design:Clinical review.Level of Evidence:Level 4.Results:In general, smaller lesions (<2 cm2) are best treated with MF or OAT. Furthermore, OAT shows trends toward greater longevity and durability as well as improved outcomes in high-demand pati...

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Knee Articular Cartilage Repair and Restoration Techniques: A Review of the Literature

Background: The tibial tubercle-trochlear groove (TT-TG) distance is a useful tool in guiding surgical management for patients with recurrent lateral patellar instability. Current recommendations for tibial tubercle transfer are based on TT-TG distance thresholds derived from adult populations. Recurrent patellar instability, however, frequently affects children, but normal and pathological TT-TG values have not been established for pediatric patients. The objectives of this study were to (1) confirm that magnetic resonance imaging (MRI) measurements for TT-TG distance in a pediatric population are reliable and reproducible, (2) determine whether the TT-TG distance changes with age, (3) define normal TT-TG distances in a pediatric population, and (4) confirm that a subgroup of pediatric patients with patellar instability have higher TT-TG distances.

Methods: Six hundred and eighteen MRIs were retrospectively collected for patients who were nine months to sixteen years old. Each MRI was measured twice in a blinded, randomized manner by each reviewer. Patient age, sex, knee laterality, magnet strength, underlying diagnosis, and pertinent previous surgical treatments were all recorded separately from the measurements. MRIs that were unreadable and those of patients who had previous extensor mechanism surgery, preexisting deformity, or destructive neoplasms were excluded.

Results: There was excellent intraobserver and interobserver reliability of TT-TG distance measurements. TT-TG distance was associated with the natural logarithm of age (p < 0.001). A percentile-based growth chart was created to demonstrate this relationship. The median TT-TG distance for patients without patellar instability in this pediatric population was 8.5 mm (mean and 95% confidence interval, 8.6 ± 0.3 mm). Patients with patellar instability had higher TT-TG distances (median, 12.1 mm; p < 0.001). TT-TG distance measured nearly 2 mm less on MRIs performed with a 3-T magnet than on those acquired with a 1.5-T magnet (p < 0.001).

Conclusions: TT-TG distance changes with chronologic age in the pediatric population. As such, we developed a percentile-based growth chart in order to better depict normal TT-TG distances in the pediatric population. Like many issues in pediatric orthopaedics, an age-based approach for directing surgical treatment may be more appropriate for skeletally immature individuals with recurrent lateral patellar instability.

Level of Evidence: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Tibial tubercle-trochlear groove distance: defining normal in a pediatric population.

Background:Differences in injury patterns among alpine skiers and snowboarders have previously been recognized, and controversy remains about the safety implications that snowboarding may pose to a ski resort. A change of policy at Taos Ski Valley provides a unique and modern perspective on the effect that snowboarders have on ski resort injuries.Hypothesis:The addition of snowboarders to a large ski resort may result in a significant change in both the rate and pattern of injuries treated.Study Design:Descriptive epidemiology study.Methods:Patient records from the Mogul Medical Clinic at Taos Ski Valley were reviewed from the 2006-2007 ski season through the 2009-2010 season (approximately 2 years before and after snowboarding was allowed) and recorded for age, sex, diagnosis, body region, anatomic location, injury type, and sport (skiing, snowboarding). The total numbers of mountain visits for the time periods with and without snowboarding were used to determine injury rates.Results:The overall rate of ...

Injury patterns at a large Western United States ski resort with and without snowboarders: the Taos experience

Background:Injury to the posterolateral corner (PLC) of the knee requires reconstruction to restore coronal and rotary stability. Two commonly used procedures are the Arciero reconstruction techniq...

https://journals.sagepub.com/doi/pdf/10.1177/2325967119838251

Gehron Treme

Papers

Comprehensive Reconstruction of the Lateral Ankle for Chronic Instability Using a Free Gracilis Graft

Knee Articular Cartilage Repair and Restoration Techniques: A Review of the Literature

Tibial tubercle-trochlear groove distance: defining normal in a pediatric population.

Injury patterns at a large Western United States ski resort with and without snowboarders: the Taos experience

A Biomechanical Comparison of the Arciero and LaPrade Reconstruction for Posterolateral Corner Knee Injuries.