Additionally, complex injuries to bone, cartilage, and ligaments may occur. AJR Am J Roentgenol 1997; 168:117-122. Normal TD > 5.2mm. Complete dislocation of the knee: spectrum of associated soft-tissue injuries depicted by MR imaging. Courtesy of Daniel Bodor, MD, Radsource. Acute lateral patellar dislocation at MR imaging: injury patterns of medial patellar soft-tissue restraints and osteochondral injuries of the inferomedial patella. It is a ratio between the patellar tendon length (along the inner surface of the tendon) and the diagonal patellar height [27]. 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. As a common knee injury, patellar dislocation has a mean annual incidence of 5.8 in 100,000 people and is more prevalent in women. Other structures that blend in this region include the medial patellotibial ligament, the medial patellomeniscal ligament, the investing fascia, and the medial joint capsule. Clipboard, Search History, and several other advanced features are temporarily unavailable. 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 MCL is composed of the superficial layer (layer 2 of the medial supporting structures) and the deep layer (layer 3 of the medial . Epub 2011 Nov 9. The transverse stabilizers include the medial and lateral retinaculum, the vastus medialis and lateralis muscles, the ilio-tibial band, and the medial patellofemoral ligament (MPFL). High resolution magnetic resonance imaging of the patellar retinaculum: normal anatomy, common injury patterns, and pathologies. Bone bruise in acute traumatic patellardislocation: volumetric magnetic resonance imaging analysis with follow-up mean of 12 months. The superficial layer originates from the lowest fibers of the iliotibial band and from an extension of vastus lateralis fascia. Edema and thickening compatible with tears of the MPFL and medial retinaculum (red arrows) are apparent both anteriorly and posteriorly. In general realignment surgery such as tibial tubercle transfer should be strongly considered in patients with TT-TG > 15mm (borderline) and typically should be performed in patients with TT-TG > 20mm. Failure to identify or treat injury to the patellar retinaculum is associated with recurrent patellar instability and contributes to significant morbidity. In one MRI study, 76% of cases of prior lateral patellar dislocation showed medial retinacular injury at its patellar insertion and 30% at its midsubstance, and injury of the femoral origin of the MPFL was identified in 49% of the cases [49]. 2012;40(4):837-844. 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. Injury of the superior peroneal retinaculum (SPR) occurs with peroneal dislocation through forceful ankle dorsiflexion and concomitant reflex peroneal muscle contraction. The average annual incidence for patellar dislocation injuries ranged between 5.8 and 7.0 per 100,000 person-years in the civilian population, and up to 29 per 100,000 person-years in the 10-17 year age . 8,12,18,28 In knees from cadavers, repair of the medial patellofemoral ligament is not only sufficient, but necessary to restore lateral patellar mobility to within a normal range. Treatment is nonoperative with physical therapy focusing on quadriceps stretching and strengthening. Because the diagnosis of lateral patellar dislocation is often unsuspected, MR provides valuable diagnostic information in such cases. Knee 10:215220, Terry GC, Hughston JC, Norwood LA (1986) The anatomy of the iliopatellar band and iliotibial tract. Patellar maltracking is a disorder that often affects the young active individuals. 4 Sanders TG, Morrison WB, Singleton BA, Miller MD, Cornum KG. The medial patellofemoral ligament is composed of a transverse (T) component arising between the adductor tubercle and medial epicondyle and an oblique decussation that originates from the medial collateral ligament (MCL). J Knee Surg 28:303309, Hevesi M, Heidenreich MJ, Camp CL et al (2019) The recurrent instability of the patella score: a statistically based model for prediction of long-term recurrence risk after first-time dislocation. Thawait SK, Soldatos T, Thawait GK, Cosgarea AJ, Carrino JA, Chhabra A. Skeletal Radiol. Axial PDFS MR image showing MPFL disruption (open arrow) and trochlear dysplasia (arrowheads). AJR Am J Roentgenol. Patellofemoral Pain Syndrome Exercises - sports injury rehabilitation In these patients, a triad of findings that included focal impaction injuries involving the lateral femoral condyle, osteochondral injuries of the medial patellar facet, and injuries of the medial retinacular ligament were seen. Yu JS, Goodwin D, Salonen D, Pathria MN, Resnick D, Dardani M, Schweitzer M. AJR Am J Roentgenol. The contralateral side may serve as an internal control or may also have anatomic factors predisposing to maltracking. Characterization of the type of medial restraint injury is crucial for surgical planning. Despite this, there remains considerable variation in surgical technique including graft choice, position, and tension making the literature difficult to compare [8, 15, 79,80,81,82,83,84,85,86].
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