Patellofemoral Pain, Instability, and Arthritis: Clinical Presentation, Imaging, and Treatment

324 Pages·2010·12.48 MB·English

by  Vicente Sanchis-Alfonso MD

Patellofemoral Pain,
Instability, and Arthritis
Stefano Zaffagnini
David Dejour
Elizabeth A. Arendt (Eds.)
Patellofemoral Pain,
Instability, and Arthritis
Clinical Presentation,
Imaging, and Treatment
Stefano Zaffagnini, MD David Dejour, MD
Orthopaedic Surgeon Lyon-Ortho-Clinic
Assistant Professor (Lecturer) Knee Surgery Orthopaedic Department
Istituti Ortopedici Rizzoli 8 Avenue Ben Gourion
Laboratorio di Biomeccanica 69009 Lyon
(Biomechanics Lab) France
via di Barbiano, 1/10 [email protected]
40136 Bologna
Italy
[email protected]
Elizabeth A. Arendt, MD
University of Minnesota
Department of Orthopaedics
2450 Riverside Avenue S.
Suite R 200
Minneapolis, MN 55454
USA
[email protected]
Project Coordinator
Julie Agel
Department of Orthopaedic Surgery
University of Minnesota
2450 Riverside Avenue South, Suite # 200
Minneapolis, MN 55454, USA
[email protected]
ISBN: 978-3-642-05423-5 e-ISBN: 978-3-642-05424-2
DOI: 10.1007/978-3-642-05424-2
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Foreword
A new look at the patellofemoral joint and a new book by ESSKA members!
The patellofemoral joint (p-f joint) has been called “the spine for the sports medi-
cine physician” presumably due to the difficulty in finding the etiology of pain from
the p-f joint. Every third youth suffers from anterior knee pain showing the scope of
the clinical problem. The rationale for treatment is to correct unbalanced tracking of
the patella. The most commonly recommended treatment is strengthening of the quad-
riceps along with avoidance of painful activities. Recently, the focus in orthopedic
sports medicine has been on patella instability as the cause of the pain and many new
procedures have been published over the last few years. With the arrival of new, young
sports physicians and surgeons and not the least physiotherapists with profound
interest in the field, old dogmas are being torn apart and new algorithms are being
proposed.
This book was initiated by Stefano Zaffagnini and David Dejour with major input
from Elizabeth Arendt and originates from an ESSKA supported meeting in May 09
where the authors reviewed current concepts in this important field. Chapters were
assigned and more than 35 authors have contributed significantly to this book which
covers the p-f joint from the young child to the old athlete. The book will be handed
out to all the participants at the biannual ESSKA meeting in Oslo (June 2010) and
should thus set the standard for standard terminology, evidenced based analysis,
examination, and treatment of problems in the p-f joint. We, as ESSKA leadership,
are extremely grateful to the initiators as well as to the authors who with this book
will heighten the standards for p-f analysis and treatment.
Lars Engebretsen, MD PhD
Professor
Orthopaedic Center
Ullevål University Hospital and Faculty of Medicine
University of Oslo and
Oslo Sports Trauma Research Center
C. Niek van Diek, MD PhD
Professor
Department of Orthopaedic Surgery
Academic Medical Centre Amsterdam
v
Preface
ESSKA has given the arthroscopy committee a fantastic opportunity: to compile an
international reflection on patellofemoral (PF) disorders.
In creating this book we invited orthopedic surgeons, physiotherapists, and
researchers from Europe and the USA to provide their personal point of view on vari-
ous topics of interest and concern related to patellofemoral disorders. This was fol-
lowed by group discussions and debate at a consensus meeting where all authors
discussed each chapter of this book. This work is a collection of information and dif-
fering points of view resulting in what we hope is a homogenous product to the
reader. Its goal was to construct a global overview of the pathology and treatment
options for patellofemoral disorders for the young child to the old athlete.
Patellofemoral pathology is a frequent reason for consulting a knee physician; it is
also a leading cause of iatrogenic surgery.
Current literature is difficult to interpret due to confusion over terminology and
definitions associated with this pathology, a plethora of surgical procedures for the
same pathology, and a paucity of well-executed outcome studies to help define treat-
ment algorithms. It is sometimes difficult to define what is normal and what is patho-
logical in a given patient. Precise definitions and clear terminology are needed in
order to ensure everyone is interpreting what is being discussed in the same manner;
this is a necessary first step for comparing and compiling global clinical results.
The phylogenesis of the human gait evolved from a quadruped mammal to bipedal
locomotion, making the constraint of the extensor mechanism increasingly more
important. The shape of the patellofemoral joint changed over the years to support
this necessary constraint and yet allow upright bipedal ambulation. The patella,
housed within the extensor mechanism, is the lower limb restraint mechanism. In
each phase of evolution the development of a specific problem could occur. The fam-
ily genetic influence is strong within this joint; the difference between pain and insta-
bility or dislocation has to be strongly individualized. The link is strong from the
child to the elderly because all the factors which lead to dislocation and pain are the
same factors which can lead to degenerative disease and osteoarthritis.
In the evaluation of PF disorders, there are elements that are objective others that
are subjective. Clinical history and examination is important and should be standard-
ized. The use of objective data to quantify findings on x-rays, CT scan, and MRI are
necessary to allow orthopedic surgeons, sport-medicine doctors, and physiotherapists
to speak the same language.
This was the goal of our team; this was the goal of ESSKA: to promote a unique,
but open point of view on this controversial topic.
vii
viii Preface
We hope this book has utility for all clinicians interested in the patellofemoral
joint and its disorders. We hope this book will be a reference in the future for our
youngest to our oldest colleagues.
Bologna, Italy Stefano Zaffagnini
Lyon, France David Dejour
Minneapolis, Minnesota, USA Elizabeth A. Arendt
Acknowledgement
The editors acknowledge Silvia Bassini for her contribution of iconographic material
and for the logo appearing on the cover page.
Contents
1 Pathophysiology of Anterior Knee Pain ................................................... 1
Vicente Sanchis-Alfonso
2 Pathophysiology of Lateral Patellar Dislocation ..................................... 17
Stefano Zaffagnini, Giovanni Giordano, Danilo Bruni,
Giulio Maria Marcheggiani Muccioli, and Maurilio Marcacci
3 Natural History of Patellofemoral Dislocations ...................................... 29
Justin J. Gent and Donald C. Fithian
4 Clinical Presentation of Patellofemoral Disorders .................................. 35
Ricardo Varatojo
5 Clinical Examination of the Patellofemoral Patient ............................... 41
Jacques Vallotton and Santiago Echeverri
6 Standard X-Ray Examination: Patellofemoral Disorders ..................... 51
David Dejour, P. R. Saggin, X. Meyer, and T. Tavernier
7 Patellar Height: Which Index? ................................................................. 61
J. Bruderer, E. Servien, and P. Neyret
8 Stress Radiographs in the Diagnosis
of Patellofemoral Instability ...................................................................... 69
Robert Teitge
9 Computed Tomography and Arthro-CT Scan
in Patellofemoral Disorders ...................................................................... 73
P. R. Saggin, David Dejour, X. Meyer, and T. Tavernier
10 MRI Analysis of Patellla Instability Factors ........................................... 79
Massimo Berruto, Enzo Marinoni, Giuseppe Chirico,
Angelo Vanzulli, Eva Usellini, and Bruno Marelli
11 MRI of the Patellofemoral Articular Cartilage ....................................... 91
Constance R. Chu, Ashley Williams, and Verena M. Schreiber
ix
x Contents
12 Patellofemoral Pain Syndrome: The Value of Pinhole
and SPECT Scintigraphic Imaging and Quantitative
Measurements of Bone Mineral Equivalent Density
with Quantitative Computed Tomography .............................................. 99
Ahmet Turan Aydin, Haluk Özcanlı,
Akın Yıldız, and Can Özkaynak
13 Gait Analysis in Patients with Patellofemoral Disorders ....................... 105
Anastasios D. Georgoulis, Constantina Od. Moraiti,
Sofia A. Xergia, and Nicholas Stergiou
14 Iatrogenic Anterior Knee Pain with Special Emphasis
on the Clinical, Radiographical, Histological, Ultrastructural
and Biochemical Aspects After Anterior Cruciate Ligament
Reconstruction Using Ipsilateral Autografts ........................................... 111
Jüri Kartus, Lars Ejerhed, and Tomas Movin
15 Non-operative Treatment of Patellofemoral Pain:
Role of Physical Therapy ........................................................................... 123
Andrew D. Lynch, Suzanne Werner, and Lynn Snyder-Mackler
16 Lateral Release of the Lateral Patellar Retinaculum:
Literature Review for Select Patellofemoral Disorders .......................... 139
Peter C. Verdonk, Francis Bonte,
Fredrik Almqvist, and René Verdonk
17 Medial Side Patellofemoral Anatomy:
Surgical Implications in Patellofemoral Instability ................................ 149
Elizabeth A. Arendt
18 Arthroscopic Medial Reefing in Acute Patellar Dislocation .................. 153
Rainer Siebold and Nico Sartory
19 Medial Reefing in Chronic Potential Patellar Instability ....................... 159
Alfredo Schiavone Panni, Simone Cerciello, Michele Vasso,
and Andrea Palombi
20 Medial Patellofemoral Ligament Reconstruction
Indications and Surgical Technique ......................................................... 165
Justin J. Gent, Brian D. Johnson, and Donald C. Fithian
21 MPFL Reconstruction: The Adductor Sling Approach ......................... 175
Elizabeth A. Arendt
22 Importance and Radiographic Identification of the Femoral
Insertion in Medial Patellofemoral Ligament Reconstruction .............. 181
Philip B. Schöttle
Contents xi
23 MPTL (Medial Patellotibial Ligament) Reconstruction ........................ 185
Maurilio Marcacci, Stefano Zaffagnini, Danilo Bruni,
Giulio Maria Marcheggiani Muccioli, Giovanni Giordano,
and Pau Golano Alvarez
24 Distal Realignment: Medialization of Tibial
Tuberosity: The Elmslie-Trillat Technique .............................................. 193
Claudio Zorzi and Vincenzo Condello
25 Bony Surgery Distal Realignment Surgery
for Episodic Patellar Dislocations ............................................................. 203
E. Servien, S. Lustig, and P. Neyret
26 Trochlear Lengthening Osteotomy with or Without
Elevation of the Lateral Trochlear Facet ................................................. 209
Roland M. Biedert
27 Proximal Open Trochleoplasty (Grooveplasty) ....................................... 217
Lars Peterson and Haris S. Vasiliadis
28 Deepening trochleoplasty for Patellar Instability ................................... 225
David Dejour, Peter Byn, and Paulo R. Saggin
29 Arthroscopic Deepening Trochleoplasty for Patella Instability ............. 233
Lars Blønd and Philip Schöttle
30 The Role of Limb Rotational Osteotomy
in the Treatment of Patellofemoral Dysfunction ..................................... 237
Robert A. Teitge
31 Long-Term Results After Autologous Chondrocyte Implantation
in Cartilage Lesions of the Patellofemoral Joint ..................................... 245
Lars Peterson and Haris S. Vasiliadis
32 Novel Nano-composite Multilayered Biomaterial
for the Treatment of Patellofemoral Cartilage Lesions .......................... 255
Giuseppe Filardo, Elizaveta Kon, Marco Delcogliano,
Giovanni Giordano, Tommaso Bonanzinga,
Maurilio Marcacci, and Stefano Zaffagnini
33 Isolated Patellofemoral Osteoarthritis:
Natural History and Clinical Presentation .............................................. 263
David Dejour, J. Allain, and SOFCOT
34 The Nonoperative Treatment of Patellofemoral Arthritis ..................... 271
Ronald Grelsamer and Jenny McConnell