Patellar Tilt and Patellar Tendon-Trochlear Groove Angle Present the Optimum Magnetic Resonance Imaging Diagnostic Reliability for Patients With Patellar Instability.

PURPOSE: To describe, in controls and in a population with patellar instability, magnetic resonance imaging values of measurements representing major associated factors for patellar instability (patellar height, trochlear dysplasia, and extensor mechanism alignment), as well as their cutoff values. METHODS: In total, 323 knee magnetic resonance imaging scans, 142 with patellar instability and 181 controls without patellofemoral complaints (anterior cruciate, medial collateral ligament, meniscus ruptures or normal) were evaluated. Means, normality values in the control population, ideal cutoff values through receiver operating characteristic curves analysis, and interobserver reliability (intraclass correlation coefficient) were described for a series of measurements. RESULTS: All measurements were statistically different in control and instability patients, except for the patellotrochlear index and tibial tuberosity to posterior cruciate ligament distance. The interobserver intraclass correlation coefficient was good or excellent (above 0.75) only for the patellotrochlear index, patellar tendon-trochlear groove (PTTG) angle, and patellar tilt. The optimal cutoff value for each measurement was: PTTG angle ≥25.3o with sensitivity (S) of 70% and specificity (E) of 89%, patellar tilt ≥16o (S: 69% and E: 84%), trochlear sulcus angle ≥153o (S: 75% and E: 76%), Carrillon ≤12.8o (S: 62% and E: 87%), PTTG distance ≥11mm (S: 71% and E: 78%), Caton-Deschamps index ≥1.23 (S: 72% and E: 76%) and trochlear bump ≥3.95 mm (S: 76% and E: 65%). CONCLUSIONS: Caton-Deschamps index (≥1.23), trochlear sulcus angle (≥153o), ventral prominence of the trochlea (≥3.95 mm), PTTG distance (≥11 mm), PTTG angle (≥25.3o), Carrillon angle (≤12.8o), and patellar tilt (≥16o) presented better diagnostic performance for patellar instability. Patellotrochlear index and tibial tuberosity to posterior cruciate ligament distance were not related to patellar instability. The interobserver reliability of the factors related to patellar instability was excellent only for the PTTG angle and lateral patellar tilt. LEVEL OF EVIDENCE: Level III, retrospective case-control study.

Medial patellofemoral ligament reconstruction in skeletally immature patients without correction of bony risk factors leads to acceptable outcomes but higher failure rates.

OBJECTIVES: To report outcomes and re-dislocation rates of medial patellar stabilizers reconstruction without bone procedures for correction of anatomical risk factors for patellar instability in skeletally immature patients; to compare isolated medial patellofemoral ligament (MPFL) reconstruction to combined MPFL and medial patellotibial ligament (MPTL) reconstruction in this population. METHODS: Patients with open physis and bone abnormalities including patella alta and/or increased tibial tubercle-trochlear groove (TT-TG) distance and/or trochlear dysplasia underwent MPFL reconstruction, either isolated or associated with MPTL reconstruction. Preoperative, 1-year follow-up and the latest follow-up (5 years minimum) data were collected. Radiological and clinical evaluations were conducted, with special attention to failure rate. Comparison of results from isolated MPFL and combined MPFL/MPTL reconstructions was performed. RESULTS: Twenty-nine patients were included, 19 in the isolated MPFL group (median 14 years old; follow-up 5.8 â€‹± â€‹1.7 years) and 10 in the combined MPFL/MPTL group (median 13.5 years old; follow-up 5.2 â€‹± â€‹1.4 years). Kujala and Tegner scores increased over time, although without statistically significant differences between the two groups at the latest follow-up (p â€‹= â€‹0.840 and p â€‹> â€‹0.999, respectively). During follow-up, 5 of 19 (26.3%) isolated MPFL and 2 of 10 (20%) MPFL/MPTL reconstructions experienced recurrence of patellar dislocation (p â€‹> â€‹0.999). Trochlear dysplasia type D (p â€‹= â€‹0.028), knee rotation (p â€‹= â€‹0.009) and lateral patellar tilt angle (p â€‹= â€‹0.003) were associated with patellar instability recurrence. The isolated MPFL group showed increased laxity on physical exam at the latest follow-up compared to the 1-year follow-up (patellar glide test (p â€‹= â€‹0.002), patellar tilt test (p â€‹= â€‹0.042) and subluxation in extension (p â€‹= â€‹0.019). This increased laxity was not observed in the MPFL/MPTL group (p â€‹> â€‹0.999). Comparing both groups, the glide test was significantly better in the combined MPFL/MPTL group in comparison to the isolated MPFL reconstruction group at the latest follow-up (p â€‹= â€‹0.021). CONCLUSION: MPFL reconstruction in isolation or combined with MPTL reconstruction in skeletally immature patients with additional uncorrected anatomical patellofemoral abnormalities leads to acceptable clinical outcomes within a minimum of 5 years follow-up, although has a high failure rate of 24.1%. Addition of a MPTL reconstruction to the MPFL may result in decreased patellar laxity on physical exams, as demonstrated by better patellar glide test, patellar tilt test and subluxation in extension. LEVEL OF EVIDENCE: Level III; retrospective cohort study.

Anatomical Risk Factors for Anterior Cruciate Ligament Injury Are Not Important As Patellar Instability Risk Factors in Patients with Acute Knee Injury.

To compare in magnetic resonance imaging the anatomical risk factors for anterior cruciate ligament (ACL) injury and patellar dislocation among patients who suffered acute knee injury, 105 patients with acute knee injury resulting in 38 patellar dislocations (patella group), 35 ACL injuries (ACL group), and 32 meniscus or medial collateral ligament injuries (control group) were included. These groups were compared for risk factors for patellar dislocation (patellar height, trochlear dysplasia, and quadriceps angle of action) and for ACL injury (intercondylar width, posterior inclination of tibial plateaus, and depth of the medial plateau). Univariate analysis found statistically significant differences (p < 0.05) between the patella and ACL groups in patellar height (Caton-Deschamps [CD] 1.23 vs. 1.07), trochlear facet asymmetry (55 vs. 68%), PTTG (13.08 vs. 8.01 mm), and the patellar tip and trochlear groove (PTTG) angle (29.5 vs. 13.71 degrees). The patella group also differed from control in medial plateau inclination (4.8 vs. 1.87 degrees), patellar height (CD 1.23 vs 1.08), trochlear facet asymmetry (55 vs. 69%), lateral trochlear inclination (17.11 vs. 20.65 degrees), trochlear depth (4.1 vs. 6.05 mm), PTTG (13.08 vs. 9.85 mm), and the PTTG angle (29.5 vs. 17.88 degrees). The ACL and control groups were similar in all measures. Multivariate analysis found the following significant determinants between the Patella and Control groups: patellar height (CD index, odds ratio [OR]: 80.13, p = 0.015), trochlear anatomy (asymmetry of facets M/L, OR: 1.06, p = 0.031) and quadriceps action angle (PTTG angle, OR: 1.09, p = 0.016); between the ACL and control groups: PTTG angle (OR: 0.936, p = 0.04) and female gender (OR: 3.876, p = 0.032); and between the patella and ACL groups, the CD index (OR: 67.62, p = 0.026), asymmetry of the M/L facets (OR: 1.07, p = 0.011) and PTTG angle (OR: 1.16, p < 0.001). In conclusion, in patients with acute knee injury, the anatomical factors patellar height, trochlear dysplasia, and quadriceps angle of action were related to the occurrence of patellar dislocation. None of the anatomical factors studied was related to the occurrence of anterior cruciate ligament injury.

The Vastus Medialis Insertion Is More Proximal and Medial in Patients With Patellar Instability: A Magnetic Resonance Imaging Case-Control Study.

BACKGROUND: The anatomy and function of the quadriceps muscle play a role in patellofemoral stability. Few studies have evaluated anatomic differences in the vastus medialis between patients with and without patellar instability. PURPOSE: To compare the anatomy of the vastus medialis using magnetic resonance imaging in patients with patellar instability to a control group. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: A group of patients with patellar instability were sex-matched with a control group with anterior cruciate ligament tears, meniscal injuries, or sprains; patients younger than 15 years were excluded. The anatomy of the vastus medialis was examined by the distance between the distal origin of the vastus medialis in the femur and the medial femoral condyle, the distance from the proximal pole of the patella to the most distal insertion of the muscle and its ratio to the length of the articular surface of the patella, and a qualitative description of the insertion position of the muscle fibers (directly in the patella or the medial retinaculum). RESULTS: Both groups comprised 78 knees (48 female; 61.5%). The mean age in the control and patellar instability groups was 30.2 ± 7.8 years and 25.6 ± 7.5 years, respectively (P = .001). The distance from the vastus origin to the condyle was 27.52 ± 3.49 mm and 26.59 ± 3.43 mm, respectively (P = .041); the distance from the proximal pole of the patella to the most distal muscle insertion was 17.59 ± 5.54 mm and 15.02 ± 4.18 mm, respectively (P < .001); and the ratio of this distance to the joint surface was 0.586 ± 0.180 and 0.481 ± 0.130, respectively (P < .001). In 75.6% of knees in the patellar instability group, the insertion of the vastus was into the medial retinaculum and not into the patella compared with 52.6% in the control group (P = .003; odds ratio, 2.8). CONCLUSION: The distal insertion of the vastus medialis differed in knees with patellar instability, with a more proximal insertion and less patellar coverage relative to controls, and was more frequently found in the retinaculum instead of directly in the patella.

Femoral condyle osteochondral fracture treated with bone suture after acute patellar dislocation: a case report / Lesão condral do fêmur tratada com sutura óssea após luxação aguda de patela: um relato de caso

ABSTRACT Osteochondral fracture after acute patellar dislocation in teenagers is relatively common (up to 60% of cases of patellar dislocation), but poorly diagnosed. There are several treatments proposed for this type of injury, but none well defined in the literature.A male patient, 13 years old, with a diagnosis of osteochondral fracture of the lateral femoral condyle after acute dislocation of the right patella. He underwent surgical treatment of the chondral injury, which consisted of suturing of the chondral fragment to the cartilage defect and, in a second approach, reconstruction of the medial patellotibial ligament and medial patellofemoral ligament with autologous flexor graft. Currently, the patient has been followed up for 16 months postoperatively for the suture of the chondral fragment and for 8 months for the ligament reconstruction. He has been evaluated through functional scores and T2 weighted magnetic resonance imaging. Acute fixation through direct bone suturing of a purely chondral fragment can be considered in special situations.

RESUMO A fratura osteocondral após luxação aguda de patela em adolescentes é relativamente comum (até 60% dos casos de luxação patelar), porém pouco diagnosticada. Existem diversos tratamentos propostos para esse tipo de lesão, mas nenhum está bem definido na literatura. Paciente do sexo masculino, 13 anos, com diagnóstico de fratura osteocondral do côndilo femoral lateral, após luxação aguda da patela direita. Foi submetido a tratamento cirúrgico da lesão condral, que consistiu em sutura do fragmento condral ao defeito da cartilagem e, em um segundo tempo, a reconstrução do ligamento patelotibial medial (LPTM) e reconstrução do ligamento patelofemoral medial (LPFM) com enxerto autólogo de flexores. Atualmente o paciente encontra-se com o seguimento de 16 meses de pós-operatório da sutura do fragmento condral e oito meses da reconstrução ligamentar, foi avaliado através de escores funcionais e ressonância magnética com mapeamento de T2. Em casos especiais, pode-se considerar o uso de fixação aguda por sutura óssea direta de um fragmento puramente condral.

Femoral condyle osteochondral fracture treated with bone suture after acute patellar dislocation: a case report.

Osteochondral fracture after acute patellar dislocation in teenagers is relatively common (up to 60% of cases of patellar dislocation), but poorly diagnosed. There are several treatments proposed for this type of injury, but none well defined in the literature. A male patient, 13 years old, with a diagnosis of osteochondral fracture of the lateral femoral condyle after acute dislocation of the right patella. He underwent surgical treatment of the chondral injury, which consisted of suturing of the chondral fragment to the cartilage defect and, in a second approach, reconstruction of the medial patellotibial ligament and medial patellofemoral ligament with autologous flexor graft. Currently, the patient has been followed up for 16 months postoperatively for the suture of the chondral fragment and for 8 months for the ligament reconstruction. He has been evaluated through functional scores and T2 weighted magnetic resonance imaging. Acute fixation through direct bone suturing of a purely chondral fragment can be considered in special situations.

A fratura osteocondral após luxação aguda de patela em adolescentes é relativamente comum (até 60% dos casos de luxação patelar), porém pouco diagnosticada. Existem diversos tratamentos propostos para esse tipo de lesão, mas nenhum está bem definido na literatura. Paciente do sexo masculino, 13 anos, com diagnóstico de fratura osteocondral do côndilo femoral lateral, após luxação aguda da patela direita. Foi submetido a tratamento cirúrgico da lesão condral, que consistiu em sutura do fragmento condral ao defeito da cartilagem e, em um segundo tempo, a reconstrução do ligamento patelotibial medial (LPTM) e reconstrução do ligamento patelofemoral medial (LPFM) com enxerto autólogo de flexores. Atualmente o paciente encontra-se com o seguimento de 16 meses de pós-operatório da sutura do fragmento condral e oito meses da reconstrução ligamentar, foi avaliado através de escores funcionais e ressonância magnética com mapeamento de T2. Em casos especiais, pode-se considerar o uso de fixação aguda por sutura óssea direta de um fragmento puramente condral.

Medial patellotibial ligament and medial patellomeniscal ligament: anatomy, imaging, biomechanics, and clinical review.

PURPOSE: The purpose of this article is to review anatomical, biomechanical, and clinical data of the medial patellotibial ligament (MPTL) and medial patellomeniscal ligament (MPML), as well as studies focusing on the medial patellofemoral ligament (MPFL) but with relevant data about the MPTL and MPML. METHODS: A literature search of articles specifically addressing the MPTL and/or MPML was included along with studies focusing on the MPFL but with relevant data about the MPTL and MPML. RESULTS: The medial patellar ligaments responsible for maintaining the stability of the patellofemoral (PF) joint include the MPFL, the MPTL, and the MPML. The MPFL is considered the primary restraint to lateral patellar translation, while the latter two are considered secondary restraints. There is robust literature on the anatomical, imaging, and biomechanical characteristics of the MPFL, and also the clinical outcome of its injury and surgical reconstruction; much less is known about the MPTL and MPML. Isolated MPFL reconstruction has good clinical and functional outcomes, with a low failure rate when defined as frank re-dislocation. Complications, including continued episodes of patellar apprehension and subluxation, remain present in most series. In addition, the current literature primarily includes a homogeneous population with few excessive anatomic dysplastic factors. There is lack of knowledge on the role of MPTL and MPML in (potentially) aiding patella stabilization and improving clinical outcomes. Understanding the role of the medial-sided patellar ligaments, in particular the role of the secondary stabilizers, in PF function and injury will aid in this goal. CONCLUSION: MPTL and MPML have consistent basic science literature, as well as favorable clinical outcomes of surgical patellar stabilization with reconstruction of the MPTL. However, there is much heterogeneity among clinical case series and lack of comparative studies to allow clear indication for the role of isolated or combined surgical reconstruction in patellar stabilization. Therefore, this comprehensive review helps understand the current knowledge and the possible applications in the orthopedic clinical practice. LEVEL OF EVIDENCE: V.

Translation and validation of the new version of the Knee Society Score - The 2011 KS Score - into Brazilian Portuguese.

OBJECTIVE: Translation, cultural adaptation, and validation of the new version of the Knee Society Score - The 2011 KS Score - into Brazilian Portuguese and verification of its measurement properties, reproducibility, and validity. In 2012, the new version of the Knee Society Score was developed and validated. This scale comprises four separate subscales: (a) objective knee score (seven items: 100 points); (b) patient satisfaction score (five items: 40 points); (c) patient expectations score (three items: 15 points); and (d) functional activity score (19 items: 100 points). METHOD: A total of 90 patients aged 55-85 years were evaluated in a clinical cross-sectional study. The pre-operative translated version was applied to patients with TKA referral, and the post-operative translated version was applied to patients who underwent TKA. Each patient answered the same questionnaire twice and was evaluated by two experts in orthopedic knee surgery. Evaluations were performed pre-operatively and three, six, or 12 months post-operatively. The reliability of the questionnaire was evaluated using the intraclass correlation coefficient (ICC) between the two applications. Internal consistency was evaluated using Cronbach's alpha. RESULTS: The ICC found no difference between the means of the pre-operative, three-month, and six-month post-operative evaluations between sub-scale items. CONCLUSION: The Brazilian Portuguese version of The 2011 KS Score is a valid and reliable instrument for objective and subjective evaluation of the functionality of Brazilian patients who undergo TKA and revision TKA.

OBJETIVO: Traduzir, adaptar culturalmente e validar a nova versão da escala Knee Society Score ­ The 2011 KS Score ­ para a língua portuguesa e verificar suas propriedades de medida, reprodutibilidade e validade. Em 2012, a nova versão do Knee Society Score foi desenvolvida e validada, com quatro subescalas: a) avaliação objetiva do joelho (sete itens: 100 pontos); b) satisfação do paciente (cinco itens: 40 pontos); c) expectativa do paciente (três itens: 15 pontos); e d) atividade funcional (19 itens: 100 pontos). MÉTODO: Foram avaliados 90 pacientes entre 55 e 85 anos em estudo clínico transversal. A versão traduzida pré-operatória foi aplicada em pacientes com indicação de ATJ e a versão traduzida pós-operatória foi aplicada em pacientes submetidos a ATJ. Cada paciente respondeu o mesmo questionário duas vezes, foram avaliados por dois ortopedistas especialistas em cirurgia do joelho. Foram feitas avaliações pré-operatórias com três, seis ou 12 meses de pós-operatório. A confiabilidade do questionário foi avaliada através do coeficiente de correlação intraclasse (CCI) entre as duas aplicações. A consistência interna foi avaliada através do alfa de Cronbach. RESULTADOS: O índice do coeficiente de correlação intraclasse não detectou diferença entre as médias das avaliações no pré-operatório, com três meses e seis meses de pós-operatório entre os subitens da escala. CONCLUSÃO: A versão brasileira do The 2011 KS Score mostrou-se um instrumento válido e confiável para avaliação objetiva e subjetiva da função de pacientes brasileiros submetidos a ATJ e revisão de ATJ.

Translation and validation of the new version of the Knee Society Score - The 2011 KS Score - into Brazilian Portuguese / Tradução e validação da nova versão da escala Knee Society Score - The 2011 KS Score - para a língua portuguesa

ABSTRACT OBJECTIVE: Translation, cultural adaptation, and validation of the new version of the Knee Society Score - The 2011 KS Score - into Brazilian Portuguese and verification of its measurement properties, reproducibility, and validity. In 2012, the new version of the Knee Society Score was developed and validated. This scale comprises four separate subscales: (a) objective knee score (seven items: 100 points); (b) patient satisfaction score (five items: 40 points); (c) patient expectations score (three items: 15 points); and (d) functional activity score (19 items: 100 points). METHOD: A total of 90 patients aged 55-85 years were evaluated in a clinical cross-sectional study. The pre-operative translated version was applied to patients with TKA referral, and the post-operative translated version was applied to patients who underwent TKA. Each patient answered the same questionnaire twice and was evaluated by two experts in orthopedic knee surgery. Evaluations were performed pre-operatively and three, six, or 12 months post-operatively. The reliability of the questionnaire was evaluated using the intraclass correlation coefficient (ICC) between the two applications. Internal consistency was evaluated using Cronbach's alpha. RESULTS: The ICC found no difference between the means of the pre-operative, three-month, and six-month post-operative evaluations between sub-scale items. CONCLUSION: The Brazilian Portuguese version of The 2011 KS Score is a valid and reliable instrument for objective and subjective evaluation of the functionality of Brazilian patients who undergo TKA and revision TKA.

RESUMO OBJETIVO: Traduzir, adaptar culturalmente e validar a nova versão da escala Knee Society Score - The 2011 KS Score - para a língua portuguesa e verificar suas propriedades de medida, reprodutibilidade e validade. Em 2012, a nova versão do Knee Society Score foi desenvolvida e validada, com quatro subescalas: a) avaliação objetiva do joelho (sete itens: 100 pontos); b) satisfação do paciente (cinco itens: 40 pontos); c) expectativa do paciente (três itens: 15 pontos); e d) atividade funcional (19 itens: 100 pontos). MÉTODO: Foram avaliados 90 pacientes entre 55 e 85 anos em estudo clínico transversal. A versão traduzida pré-operatória foi aplicada em pacientes com indicação de ATJ e a versão traduzida pós-operatória foi aplicada em pacientes submetidos a ATJ. Cada paciente respondeu o mesmo questionário duas vezes, foram avaliados por dois ortopedistas especialistas em cirurgia do joelho. Foram feitas avaliações pré-operatórias com três, seis ou 12 meses de pós-operatório. A confiabilidade do questionário foi avaliada através do coeficiente de correlação intraclasse (CCI) entre as duas aplicações. A consistência interna foi avaliada através do alfa de Cronbach. RESULTADOS: O índice do coeficiente de correlação intraclasse não detectou diferença entre as médias das avaliações no pré-operatório, com três meses e seis meses de pós-operatório entre os subitens da escala. CONCLUSÃO: A versão brasileira do The 2011 KS Score mostrou-se um instrumento válido e confiável para avaliação objetiva e subjetiva da função de pacientes brasileiros submetidos a ATJ e revisão de ATJ.

Combined Reconstruction of the Medial Patellofemoral Ligament With Quadricipital Tendon and the Medial Patellotibial Ligament With Patellar Tendon.

Although the medial patellotibial ligament (MPTL) has been neglected regarding its function in patellar stability, recently, its importance in terminal extension and during flexion has been recognized. Indications for reconstruction of the medial patellofemoral ligament combined with the MPTL are extension subluxation, flexion instability, children with anatomic risk factors for patellar instability, and knee hyperextension associated with generalized laxity. We describe a combined reconstruction of the medial patellofemoral ligament with quadricipital tendon and reconstruction of the MPTL with patellar tendon autografts.

Reconstruction of medial patellofemoral ligament using quadriceps tendon combined with reconstruction of medial patellotibial ligament using patellar tendon: initial experience.

OBJECTIVE: To describe a surgical technique for anatomical reconstruction of the medial patellofemoral ligament using the quadriceps tendon, combined with reconstruction of the medial patellotibial ligament using the patellar tendon; and to present the initial results from a case series. METHOD: The proposed technique was used on a series of cases of patients with diagnoses of patellofemoral instability and indications for surgical treatment, who were attended by the Knee Group of HC-IOT, University of São Paulo. The following were evaluated before and after the operation: range of motion (ROM), apprehension test, lateral translation test, patellar inclination test, inverted J sign, subluxation upon extension, pain from compression of the patella and pain from contraction of the quadriceps. After the operation, the patients were asked whether any new episode of dislocation had occurred, what their degree of satisfaction with the surgery was (on a scale from 0 to 10) and whether they would be prepared to go through this operation again. RESULTS: Seven knees were operated, in seven patients, with a mean follow-up of 5.46 months (±2.07). Four patients who presented apprehension before the operation did not show this after the operation. The lateral translation test became normal for all the patients, while the patellar inclination test remained positive for two patients. The patients with an inverted J sign continued to be positive for this sign. Five patients were positive for subluxation upon extension before the operation, but all patients were negative for this after the operation. None of the patients presented any new episode of dislocation of the patella. All of them stated that they were satisfied: five gave a satisfaction score of 9 and two, a score of 10. All of them said that they would undergo the operation again. Only one patient presented a postoperative complication: dehiscence of the wound. CONCLUSION: Reconstruction of the medial patellofemoral ligament using the quadriceps tendon, combined with reconstruction of the medial patellotibial ligament using the patellar tendon, was technically safe and presented good objective and subjective clinical results in this case series with a short follow-up.

OBJETIVO: Descrever técnica cirúrgica de reconstrução anatômica do LPFM com tendão quadricipital combinada com a reconstrução do LPTM com tendão patelar e apresentar os resultados iniciais em uma série de casos. MÉTODO: Foi aplicada a técnica proposta em uma série de casos de pacientes do Grupo de Joelho do HC-IOT diagnosticados com instabilidade patelofemoral e com indicação de tratamento cirúrgico. No pré e pós-operatório foram avaliados: amplitude de movimento (ADM), teste da apreensão, teste da translação lateral, teste da inclinação patelar, sinal do J invertido, subluxação em extensão, dor a compressão da patela e dor a contração do quadríceps. No pós-operatório também foi perguntado aos pacientes se houve novo episódio de luxação, qual o grau de satisfação com a cirurgia (escala de zero a 10) e se passariam pela cirurgia novamente. RESULTADOS: Foram operados sete joelhos em sete pacientes e a média de seguimento foi de 5,46 meses (±2,07). Tivemos quatro pacientes com apreensão no pré-operatório que não tinham apreensão no pós-operatório. O teste de translação lateral foi normalizado em todos os pacientes enquanto o teste da inclinação patelar permaneceu positivo em dois pacientes. Os pacientes com J invertido permaneceram com o sinal positivo. A subluxação em extensão, presente no pré-operatório em cinco pacientes, foi negativa em todos no pós-operatório. Nenhum paciente apresentou novo episódio de luxação da patela. Todos responderam estar satisfeitos. Cinco pacientes referiram satisfação 9 e dois referiram 10. Todas passariam novamente pela cirurgia. Apenas uma paciente apresentou complicação pós-operatória, deiscência de ferida. CONCLUSÃO: A reconstrução combinada do LPFM com tendão quadricipital com a reconstrução do LPTM com tendão patelar é tecnicamente segura e apresentou bons resultados clínicos objetivos e subjetivos nesta série de caso de curto seguimento.

Reconstruction of medial patellofemoral ligament using quadriceps tendon combined with reconstruction of medial patellotibial ligament using patellar tendon: initial experience / Reconstrução do ligamento patelofemoral medial com tendão quadricipital combinada com patelotibial medial com tendão patelar: experiência inicial

To describe a surgical technique for anatomical reconstruction of the medial patellofemoral ligament using the quadriceps tendon, combined with reconstruction of the medial patellotibial ligament using the patellar tendon; and to present the initial results from a case series. METHOD: The proposed technique was used on a series of cases of patients with diagnoses of patellofemoral instability and indications for surgical treatment, who were attended by the Knee Group of HC-IOT, University of São Paulo...

Descrever técnica cirúrgica de reconstrução anatômica do LPFM com tendão quadricipital combinada com a reconstrução do LPTM com tendão patelar e apresentar os resultados iniciais em uma série de casos. MÉTODO: Foi aplicada a técnica proposta em uma série de casos de pacientes do Grupo de Joelho do HC-IOT diagnosticados com instabilidade patelofemoral e com indicação de tratamento cirúrgico...

Tibial Tuberosity-Posterior Cruciate Ligament Distance.

When trochlear dysplasia is present, it is difficult to measure the tibial tuberosity to trochlear groove (TT-TG) distance. A new measurement to assess tuberosity position was recently described by Seitlinger et al, which avoids the difficulty of identifying the TG as it references the posterior cruciate ligament (PCL). To evaluate the reproducibility of the Seitlinger et al findings, 42 knees in 41 patients with a documented history of recurrent patellar instability and 84 knees in patients with no history of patellar instability or patellofemoral symptoms were evaluated with magnetic resonance imaging. The TT-PCL distance was increased in the instability group (mean, 21.6 mm) compared with the control group (mean, 19.0 mm). The TT-PCL distance is an independent risk factor for patients with recurrent patellar instability. Its role in surgical planning remains to be determined.

Are the osseous and tendinous-cartilaginous tibial tuberosity-trochlear groove distances the same on CT and MRI?

OBJECTIVE: To verify whether the tibial tuberosity-trochlear groove distance (TT-TG) and the tendinous-cartilaginous TT-TG (the distance between the patellar tendon and trochlear groove: PT-TG) are identical using computed tomography (CT) and magnetic resonance imaging (MRI) techniques. SUBJECTS AND METHODS: The TT-TG and PT-TG distances were measured on the same knee samples by three observers (two measurements per observer) using CT and MRI scans collected retrospectively. The reproducibility of the measurements was assessed using the interclass correlation coefficient (ICC). The means and standard deviations of four measurements were calculated for each patient. A paired t-test was used to assess differences between measurements. RESULTS: Fifty knee samples (32 with patellar instability and 18 with other conditions) were evaluated. The inter- and intraobserver reliability was excellent for all four measurements (>0.8). On average, the TT-TG distance on MRI was 3.1-3.6 mm smaller than that on CT, and the PT-TG distance on MRI was 1.0-3.4 mm larger than the TT-TG distance on MRI. CONCLUSION: The osseous TT-TG and tendinous-cartilaginous PT-TG distances determined by CT and MRI were not identical.

Correlação inter-observador da classificação de falhas ósseas em artroplastia de joelho / Interobserver correlation in classification of bone loss in total knee arthroplasty

OBJETIVO: Considerando a dificuldade para classificar os defeitos ósseos foi feito estudo para avaliar se a classificação de falha óssea da AORI baseada na radiografia pré-operatória é fidedigna e reprodutível entre diferentes médicos. MÉTODOS: Seis ortopedistas com subespecialização em cirurgia do joelho foram treinados para o uso da classificação radiográfica. Esses cirurgiões avaliaram e classificaram isoladamente as falhas ósseas de 26 radiografias de próteses de joelho pré revisão. RESULTADOS: Constatou-se que houve coincidência de >50 por cento (correlação moderada) da classificação em 24 dos 26 casos no fêmur e em 22 dos 26 casos na tíbia; e correlação de >80 por cento (boa correlação) em 12 dos 26 casos no fêmur e em sete dos 26 casos na tíbia. CONCLUSÃO: Em relação à concordância da classificação, observamos que a classificação AORI apresenta moderada correlação inter-observadores. Nível de evidência III, Estudo de pacientes não consecutivos; sem padrão de referencia "ouro" aplicado uniformemente.

OBJECTIVE: Considering the difficulty for classifying bone losses the present study was designed to analyse if the AORI classification based on pre-operative radiographies is consistent and reproductible between different orthopaedic surgeons. METHODS: Six orthopedists specialized in knee surgery were trained for the use of the classification based on radiographic evaluation. All the surgeons individually classified 26 pre operative knee radiographs. RESULTS: There was a moderate (> 50 percent) matching of the classification in 24 of 26 cases in the femur and 22 of 26 in the tibia. A good matching (> 80 percent) was present in 12 of 26 cases in the femur and in 7 of 26 cases in the tibia. CONCLUSION: We observed that the AORI classification presented a moderate radiographic correlation between surgeons. Evidence of level III, Study of nonconsecutive patients; without consistently applied reference ''gold'' standard.