lateral patellar retinaculum injury radiology

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. A buckle transducer was clamped on the lateral patellofemoral ligament and the transducer was calibrated to zero with the knee at full extension. The angle between the two lines is the lateral trochlear inclination (LTI). 3. It can be divided into nonoperative and operative management. {"url":"/signup-modal-props.json?lang=us"}, Moodaley P, Hng J, Hacking C, et al. Bookshelf Patients with patella alta may also benefit from tibial tuberosity advancement. In eight of 17 patients, the mechanism of injury was a patellar tendon tear (n = 1) or valgus hyperextension (n = 7). Background Lateral Patella dislocations are common injuries seen in the active and young adult populations. Dr. Frederick Buechel, Jr. MD answered. Excessive lateralization of the tibial tuberosity allows the patella to be pulled laterally in flexion and is considered to be a risk factor for instability. Why Do Orthopaedic Surgeons Ignore the Medial - ScienceDirect One of the more common MPFL reconstruction procedures uses a single hamstring tendon graft passed through the medial intermuscular septum at the adductor magnus insertion fixed by an anchor in the femoral condyle and sutured or anchored to the superomedial pole of the patella11. A ratio of >1.3 is considered indicative of patella alta [34] (Fig. Knee Surg Sports Traumatol Arthrosc 13:522528, Farr J, Schepsis AA (2006) Reconstruction of the medial patellofemoral ligament for recurrent patellar instability. Skeletal Radiology 39:7, 675-682. Axial PDFS left knee MR image, demonstrating the method used for the measurement of trochlear depth. Diederichs G, Issever A, Scheffler S. MR Imaging of Patellar Instability: Injury Patterns and Assessment of Risk Factors. Epidemiology Patellar dislocation accounts for ~3% of all knee injuries and is commonly seen in those individuals who participate in sports activities. The discrimination between low-grade and high-grade dysplasia is important because prognosis and treatment may depend upon the severity of trochlear dysplasia. eCollection 2015. Alimorad Farshchian M. D.. Farshchian's Orthopedic Regenerative Series. Tibial tubercletrochlear groove distance (TT-TG) assessment. It is measured at the mid-point of the patella on the axial slices [48]. Springer Nature. It has proven to be both sensitive and specific in the detection of hyaline cartilage abnormalities [4]. Rethy Chhem, Etienne Cardinal. The Medial Patellofemoral Ligament (MPFL) is an hour-glass shaped ligament made of bands of retinacular tissue. The most accepted indication for surgical management of patellar instability is the presence of a large displaced osteochondral fracture or loose body. (14a) A fat-suppressed proton density-weighted coronal image following patellar dislocation reveals the classic lateral condylar bone bruise (arrow). Oper Tech Sports Med 6:247258, Dejour H, Walch G, Nove-Josserand L, Guier C (1994) Factors of patellar instability: an anatomic radiographic study. In: Miller M, Thompson S (ed) DeLee and Drezs orthopaedic sports medicine. It is a ratio between the patellar tendon length (along the inner surface of the tendon) and the diagonal patellar height [27]. b Trochlear dysplasia (9 inclination), Facet asymmetry assessment for trochlear dysplasia on axial MRI. 4. A lateral patellar sleeve fracture can be misdiagnosed 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. Google Scholar, Amis AA, Firer P, Mountney J, Senavongse W, Thomas NP (2003) Anatomy and biomechanics of the medial patellofemoral ligament. In addition, symptomatic knees may demonstrate normal engagement between the patella and trochlea beyond 30 of flexion. Dejour et al. Complete dislocation of the knee: spectrum of associated soft-tissue injuries depicted by MR imaging. 2023 BioMed Central Ltd unless otherwise stated. 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. Normal TD > 5.2mm. Division of Sports Trauma, Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark. Medial patellofemoral ligament MRI abnormalities in the - Springer Unable to process the form. Lateral patellar retinaculum. The two features are associated with patellar maltracking. Specialists of neuroradiology and vascular neurosurgery decided over the modality assignment. Nearly 50% of all first-time dislocators will sustain further dislocations. AJR Am J Roentgenol. no financial relationships to ineligible companies to disclose. Osteochondral injuries of the inferomedial patella are seen in up to 70% of patellofemoral dislocations. Please enable it to take advantage of the complete set of features! Medial patellofemoral ligament injury patterns and associated pathology 6. There is edema of the medial patella and of the lateral femoral condyle (arrow), consistent with bone contusion due to recent lateral patellar dislocation. Traumatic lateral patellar dislocation is a common injury among young, athletic individuals and is generally transient in nature. Twenty-seven knees in 21 patients were studied and the mean age of the patients at surgery was 19 years. Methods MRI studies taken at one imaging site between January, 2007 to January, 2008 with the final diagnosis of patella . The authors declare that they have no competing interests. Pediatric Lateral Patellar Retinacular Sleeve Avulsion - JOSPT 5. Lateral patellar compression syndrome is the improper tracking of the patella in the trochlear groove generally caused by a tight lateral retinaculum. Tibial Tubercle Osteotomy to Aid Exposure for Revision Total Knee The most obvious presentation of patellar maltracking is that of the first time lateral patellar instability or recurrent instability thereafter. The adductor magnus tendon (AT) attaches to the adductor tubercle, which lies posterior and superior to the femoral attachment of the MPFL. . Starok M, Lenchik L, Trudell D, Resnick D. Normal patellar retinaculum: MR and sonographic imaging with cadaveric correlation. Prevalence of Lateral Patellofemoral Maltracking and Associated Complications in Patients with Osgood Schlatter Disease. Seventeen patients with patellar retinacular ligament injuries were evaluated with magnetic resonance (MR) imaging. Value of the tibial tuberosity-trochlear groove distance in patellar instability in the young athlete. A study has found that the femoral groove tends to be shallower in osteoarthritis patients compared to those with normal cartilage, regardless of age. 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 Frequently underdiagnosed, the patellofemoral friction syndrome, also called Hoffa's fat cushion compression syndrome, is mainly represented by 2 characteristic symptoms, which are mainly found in women (especially if they present obesity or rapid weight gain, as in pregnancy): patellofemoral pain and instability in the patellar . (18a) A 13-year-old female following acute patellar dislocation. 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. PubMed A perpendicular line is measured to the most posterior cortex of the central trochlea. It takes a very strong force to tear the patellar tendon. 8 Lippacher S, Dejour S, Elsharkawi M, et al. There are numerous techniques reported in literature and commonly used to reconstruct the medial sided soft tissue constraints. Patellar maltracking: an update on the diagnosis and treatment Peroneal Tendon Dislocation and Superior Peroneal Retinaculum Injury Radiology 216:582585, Ward SR, Terk MR, Powers CM (2007) Patella alta: association with patellofemoral alignment and changes in contact area during weight-bearing. Patellar dislocation; Knee; Medial patellofemoral ligament; Recurrence; MRI Go to: INTRODUCTION Lateral patellar dislocation (LPD) is a common injury that typically occurs in young, active patients as a result of a variety of activities and accounts for approximately 2-3% of all knee injuries ( 1 ). The lateral patellar retinaculum is a fibrous expansion comprising of superficial and deep layers. The lateral patellar retinaculum can also be assessed in this position. On T2-weighted MR images, sprain is depicted as thickening of retinaculum with signal intensity signifying edema and hemorrhage (Fig. Migliorini F, Marsilio E, Cuozzo F, Oliva F, Eschweiler J, Hildebrand F, Maffulli N. Life (Basel). Reconstruction of the MPFL has recently become an increasingly popular procedure for recurrent lateral patellar instability. Patellar dislocation most commonly results from a twisting motion, with the knee in flexion and the femur rotating internally on a fixed foot (valgus-flexion-external rotation) 1. Edema is also present medially in the region of the MPFL and medial retinaculum (arrowheads). Additionally, in this degree of flexion, the quadriceps tendon itself engages the proximal trochlear groove and participates in force distribution [8,9,10]. Patellar Tendon Tear - OrthoInfo - AAOS The most important active stabilizer of the patella is the vastus medialis oblique (VMO). This protocol can help in evaluating for osseous integrity, morphology, and patellofemoral alignment [63] (Fig. Insights Imaging 10, 65 (2019). Lateral patellar compression syndrome is the improper tracking of the patella in the trochlear groove generally caused by a tight lateral retinaculum. Falls. Stretching this ligament keeps the patella in place and the ligament healthy. CAS A typical bone bruise is seen within the anterolateral aspect of the lateral femoral condyle (asterisk). Because of the transient and brief nature of lateral patellar dislocations, the diagnosis is frequently unrecognized by both patients and clinicians. MRI can provide valuable information regarding the status of such repairs in patients who experience recurrent dislocation following surgery. The femoral attachment of the transverse band of the MPFL is not always discretely visible, and therefore secondary signs on MRI such as fluid, edema, and soft tissue thickening at the attachment indicate MPFL injury. Several osteotomies have been described including the medializing ElmslieTrillat procedure, the anteromedializing Fulkerson osteotomy, and distalization osteotomy [87]. 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. Radiographics 30:961981, Tscholl PM, Wanivenhaus F, Fucentese SF (2017) Conventional radiographs and magnetic resonance imaging for the analysis of trochlear dysplasia: the influence of selected levels on magnetic resonance imaging. Surgical realignment procedures include medialization of the tibial tubercle particularly in patients with a TT-TG distance greater than 20mm. official website and that any information you provide is encrypted Patellar maltracking occurs as a result of imbalance of this relationship often secondary to anatomic morphologic abnormality. The MCL is beneath the deep crural fascia (layer 1), from which it is separated by a variable amount of fat (Fig. Asymmetry of <40% suggests trochlear dysplasia [24]. Patients who experience multiple patellar dislocations are more likely to have anatomical variants of the trochlea, patellar alta, or tibial tubercle lateralization. The anatomic relationship between the resultant force from the quadriceps and the line of pull of the patellar tendon is termed the Q angle and is normally 1015 of valgus [11]. The patellar apprehension test is used to assess for lateral instability and is positive when pain or discomfort occurs with lateral translation of the patella. Google Scholar, Miller TT, Staron RB, Feldman F (1996) Patellar height on sagittal MR imaging of the knee. Radiographics. Patellar tilt assessment. Created for people with ongoing healthcare needs but benefits everyone. Isolated Avulsion Fracture of Patellar Attachment of Medial They include: pain with compression of patella and moderate lateral facet tenderness, inability to evert the lateral edge of the patella, mainstay of treatment and should be done for extensive period of time, closed chain short arc quadriceps exercises, pain refractory to extensive rehabilitation, ideal candidate has no symptoms of instability, medial patellar glide of less than one quadrant, lateral patellar glide of less than three quadrants, only elevate 1 cm or else risk of skin necrosis, indicated only for instability with lateral translation (not isolated lateral tilt), viewing through superior portal will show medial facet does not articulate with trochlea at 40 degrees of knee flexion, postoperatively the patella should be able to be, patellar instability with medial translation, 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), Proximal Tibiofibular Joint Ganglion Cysts, Pre-Participation Physical Exam in Athlete, Concussions (Mild Traumatic Brain Injury). All authors (ZJ, PJ, KSR, MLS, GD) contributed to the study design, drafted the work, and revised it critically for final submission. Chronic fat impingement can result in chronic inflammation and fat pad hypertrophy. High resolution magnetic resonance imaging of the patellar retinaculum Radiology 1993; 189:905-907. Objective: Must rule out a tight iliotibial band (ITB) and weak quadriceps muscles (Juhn). Romero J, Hodler J. Radiology. 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. AJR Am J Roentgenol 1997; 168:117-122. 1). The primary aim of surgery is to repair the knee damage and to correct the anomalies that are predisposing to chronic instability. Tears of the medial retinaculum and the MPFL are commonly present at both the patellar and femoral attachments, though tears of the transverse band of the MPFL are more likely at the femoral attachment. Patella alta persists in this patient. Bethesda, MD 20894, Web Policies Patella alta assessment. The trochlea, due to its large surface area and concave contour, is rarely subject to chondral injury in patellar dislocation. (22a) In this patient with an acute first time patellar dislocation injury, typical bone bruises were not apparent. The trochlear depth is calculated by measuring the mean of the maximum anteroposterior (AP) distance of the medial and lateral femoral condyles minus the distance between the deepest point of the trochlear groove and the line paralleling the posterior femoral condyles surfaces (Fig. The AIUM Practice Parameter for the Performance of the Musculoskeletal Sports Med Arthrosc Rev 15:7277, Mikashima Y, Kimura M, Kobayashi Y, Miyawaki M, Tomatsu T (2006) Clinical results of isolated reconstruction of the medial patellofemoral ligament for recurrent dislocation and subluxation of the patella. The MCL is composed of the superficial layer (layer 2 of the medial supporting structures) and the deep layer (layer 3 of the medial . This is measured on the sagittal MRI images at the point where the patella is at its greatest length. 10 Diederichs G, Issever Ahi S, Scheffler S. MR Imaging of Patellar Instability: Injury Patterns and Assessment of Risk Factors. 7). Findings typically associated with acute lateral patellar dislocation were also assessed and recorded (present or absent) including characteristic bone bruises and osteochondral injuries involving the patella, lateral trochlear facet, and lateral femoral condyle. Am J Sports Med 45:10591065, Brossmann J, Muhle C, Schrder C et al (1993) Patellar tracking patterns during active and passive knee extension: evaluation with motion-triggered cine MR imaging. Surgical management of patellar instability should be guided on an individual patient basis depending on history, physical examination, and radiologic findings as outlined above. The degree of patellar tilt can be evaluated by measuring the patella tilt angle, which is the angle between the posterior condylar line and the maximal patella width line [47] (Fig. 28 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. Patellar sleeve avulsion fracture in a patient with Sinding-Larsen Privacy Other structures combine to form the region referred to as the medial retinaculum (MR) more anteriorly. PDF Painful patellar swelling - dipot.ulb.ac.be Surgical repair is most commonly directed to MPFL reconstruction and to distal realignment in the subset of patients who have significant osseous malalignment.