Anterior Knee Pain and Patellar Instability

Foreword to the Third Edition
Foreword to the Second Edition
Foreword to the First Edition
Preface
Acknowledgments
Contents
Contributors
Etiopathogenic Bases, Prevention and Therapeutic Implications
1 Patellofemoral Pain: An Overview
1 Anterior Knee Pain—So Common a Symptom, so Misunderstood
2 The Problem. Anterior Knee Pain—A Paradigm of Aversion Towards a Diagnosis
3 Patellofemoral Pain—A Pathologic Condition with Many Clichés and False Beliefs
4 Chondromalacia Patellae. A Symbol of Our Helplessness in Regards to a Diagnosis and Our Ignorance on AKP
5 Patellar Malalignment Versus Skeletal Lower Limb Malalignment
6 Tissue Homeostasis Theory. An Alternative to the Structural/Biomechanic Paradigm
7 Creation of Study Groups: An Inflection Point in the Knowledge of Patellofemoral Pain
8 The “Proximal Control” Concept—A Turning Point
9 Take Home Message
References
2 Pathophysiology of Anterior Knee Pain
1 Introduction
2 Theories on the Genesis of AKP
3 A Critical Analysis of Realignment Surgery for PM
4 The Key Question: Is There a Mechanical Overload of the PFJ Behind AKP and What is the Role of Patellofemoral Imbalance in the Genesis of AKP?
5 Neuroanatomical Bases for AKP in the Young Patient: Neural Model
5.1 Morphologic Neural Changes in the Lateral Retinaculum
5.2 Hyperinnervation into the Lateral Retinaculum and AKP
5.3 Role of Ischemia in the Genesis of AKP: Loss of Vascular Homeostasis
5.3.1 Basic Science
5.3.2 Clinical Studies
6 The Role of the Peripheral and/or Central Nervous System in the Pathophysiology of AKP—“Central Sensitization”—“The Neuromatrix Model”
7 Authors’ Proposed AKP Pathophysiology
8 Take Home Messagess
9 Key Message
References
3 Femoral and Tibial Rotational Abnormalities Are the Most Ignored Factors in the Diagnosis and Treatment of Anterior Knee Pain Patients. A Critical Analysis Review
1 Introduction
2 There is no Agreement on How to Measure Torsion
3 Not All Torsional Abnormalities are Symptomatic
4 Lack of Agreement Regarding Surgical Technique. Fear of Internal Fixation Failure and Other Complications
5 “Orthopedics is All About Anatomy … Plus A Little Bit of Common Sense”
6 The Keys to Increasing Adherence to Rotational Osteotomy by a Knee Surgeon. Future Studies
7 Take Home Messages
References
4 Why is Torsion Important in the Genesis of Anterior Knee Pain?
References
5 Clinical and Radiological Assessment of the Anterior Knee Pain Patient
1 Introduction
2 Clinical History—“Listen to the Patient”
3 Physical Examination
3.1 Tests to Locate the Painful Zone and Reproduce the Pain
3.2 Pressure Algometry
3.3 Range of Motion and Muscle Length Testing
3.4 Assessment of Muscle Strength
3.5 It is Mandatory to Look Beyond the Patellofemoral Joint
3.6 Functional Tests
4 Imaging Studies
4.1 Standard Radiography
4.2 Computed Tomography
4.3 Magnetic Resonance Imaging
4.4 Technetium Scintigraphy and Single-Photon Emission Computed Tomography (SPECT)—CT
5 Take Home Messages
References
6 Evaluation of Psychological Factors Affecting Anterior Knee Pain Patients: The Implications for Clinicians Who Treat These Patients
1 Introduction
2 Biopsychosocial Model in Anterior Knee Pain—An Alternative to the Classic Biomedical Disease Model
3 Fear-Avoidance Model in Anterior Knee Pain. Kinesiophobia
4 Relationship Between Cognitions and Anterior Knee Pain. Catastrophizing
4.1 Coping Strategies
4.2 The Role of Catastrophizing
5 Psychological Involvement in AKP Patients. Depression and Anxiety
5.1 Relationship Between Anxiety and Anterior Knee Pain
5.2 Relationship Between Depression and Anterior Knee Pain
6 The Experience of Living with Anterior Knee Pain
6.1 Pain-Related Fear
6.2 Distress from Joint Noises
6.3 Responding to Treatment
7 Implications of Psychological Factors for Clinicians Who Are Treating AKP Patients
8 Take Home Messages
9 Key Message
References
7 Management of Anterior Knee Pain from the Physical Therapist’s Perspective
1 Sources of Pain
2 Effect of Pain
3 Anatomy and Biomechanics
4 Load and Frequency
5 History
6 Symptoms of Patellofemoral Pain
7 Physical Examination
8 Treatment
8.1 Unloading Pain
8.2 Improving Dynamic Lower Limb Loading
8.3 Treatment Progression
9 Conclusion
10 Take-Home Messages
11 Key-Message
References
8 Targeted Treatment in Anterior Knee Pain Patients According to Subgroups Versus Multimodal Treatment
1 Introduction and Background
2 Complex PFP Stratification Frameworks
3 Simple PFP Stratification Frameworks
4 Targeted Intervention for Patellofemoral Pains (TIPPs)
5 Verification of TIPPs Subgroups
6 Future Directions
6.1 Psychosocial Domain
6.2 Physiological Domain
7 Conclusion
8 Take-Home Messages
9 Key-Message
References
9 Surgical Treatment of Anterior Knee Pain. When is Surgery Needed?
1 Introduction
2 General Principles in the Surgical Management of AKP Patients
2.1 A Right Diagnosis is Paramount—Listen to the Patient
2.2 Treat Patients, Not Images
2.3 Identify if AKP is Related to Focal Overload of the PFJ
2.4 If You Repair Failed Tissue (Bone, Ligament or Cartilage) and Ignore the Mechanics Which Caused the Tissue Failure, You Will Usually Have a Failed Result
2.5 Identify if There Are Associatted Psychological Factors and Central Sensitization
2.6 In Short …
3 Minimally Invasive Surgical Procedures
3.1 Lateral Retinaculum Release
3.2 Arthroscopic Focal Synovectomy. Patellar Decompression
4 Major Surgical Procedures—Osteotomies
4.1 Derotational Osteotomies (Transverse Plane)
4.1.1 Rationale
4.1.2 Clinical Evaluation
4.1.3 Measuring Torsion
4.1.4 Surgical Considerations
4.2 Coronal Plane Osteotomy for Genu Valgum
4.3 Osteotomies in the Sagittal Plane—Genu Recurvatum
5 Take Home Messages
6 Key Message
References
10 The Failed Patella. What Can We Do?
1 Introduction
2 General Principles in the Management of Failed Patella
2.1 Correct Diagnosis—Listen to the Patient
2.2 Rule Out Inappropriate Physical Therapy
2.3 Rule Out Central Sensitization
2.4 Do Not Forget the Psychological Evaluation
2.5 Do Not Ignore the Mechanics Which Caused the Tissue Failure, if so, Another Failed Result Ensues
2.6 In Short …
3 Iatrogenic Medial Patellar Instability and Multidirectional Patellar Instability
4 Iatrogenic Patella Infera
5 The Failed Cartilage Surgery
6 Rotational Osteotomy. A Game Changer in the Treatment of “Failed Patella”
7 Take Home Messages
References
11 Risk Factors for Patellofemoral Pain: Prevention Programs
1 Epidemiology of PFP
2 Risk Factors
3 Intrinsic Risk Factors
4 Extrinsic Risk Factors
5 Prevention of PFP
6 Conclusions
7 Take-Home Messages
8 Key-Message
References
12 Anterior Knee Pain After Arthroscopic Meniscectomy: Risk Factors, Prevention and Treatment
1 General Considerations
2 Risk Factors for Patellofemoral Pain After Knee Arthroscopy
2.1 Postoperative Quadriceps Muscle Atrophy
2.2 Delayed Quadriceps Activation
2.3 Postoperative Quadriceps Muscle Weakness
2.4 Preoperative Quadriceps Muscle Thickness
3 Prevention
4 Treatment
5 Summary
References
13 Anterior Knee Pain Prevalence After Anterior Cruciate Ligament Reconstruction: Risk Factors and Prevention
1 Introduction
2 Prevalence
3 Risk Factors for AKP After ACL Reconstruction
3.1 Range of Motion (ROM) Deficits
3.2 Type of Graft
3.3 Intraoperative Technical Errors
4 Prevention of AKP After ACL Reconstruction
5 Take Home Messages
References
14 Patellar Tendinopathy: Risk Factors, Prevention, and Treatment
1 Introduction
2 Clinical Presentation
3 Risk and Associated Factors
4 Physical Examination/Differential Diagnosis
5 Differential Diagnosis
6 Outcome Measures
7 Role of Imaging
8 Management
9 In-Season Rehabilitation
10 Adjuncts
11 Prevention
12 Take Home Messages
13 Key Message
References
15 Pathophysiology of Patellar Instability
1 Using Pathophysiology to Understand Different Types of Patellofemoral Instability
2 Conclusion
References
16 Evaluation of the Patient with Patellar Instability: Clinical and Radiological Assessment
1 Introduction
2 History
3 Physical Examination
4 Evaluation of Failed Prior Stabilization Surgery
5 Evaluation of Medial Patellar Instability
6 Imaging Studies
7 Radiographs
8 Magnetic Resonance Imaging (MRI)
9 Computed Tomography (CT)
10 Ultrasound
11 Summary
12 Take Home Messages
13 Key Message
References
17 Evolving Management of Acute Dislocations of the Patella
1 Background
2 Who Needs Early Surgery?–Factors Affecting Decision-Making
2.1 First-Time Patellar Dislocation with an Associated Loose Body
2.2 Pathoanatomy−Risk Factors for Recurrence After an FTLPD−Predictive Models Analysis
2.3 Patient’s Goals–Return to Sports at a Pre-Injury Level
2.4 Economic Decision Model
3 Take Home Messages
References
18 How to Deal with Chronic Patellar Instability
1 Introduction
2 Lateral Patellar Instability During the Early Arc of Knee Flexion
2.1 What to Do–Rationale
2.2 The Treatment of Associated Chondral Lesions
3 Lateral Patellar Instability Persisting Beyond 30° of Knee Flexion
3.1 The Medial and Anteromedial Tibial Tuberosity Transfer
3.2 Patellar Distalization by Osteotomy or Patellar Tendon Imbrication
3.3 Trochleoplasty
3.4 The Rotational Femoral Osteotomy And The Femoral Varization Osteotomy Versus Growth Modulation
3.5 Additional Surgery on the Lateral Retinaculum
4 Fixed Lateral Patellar Instability in Knee Flexion
5 Medial Patellar Instability and Multidirectional Patellar Instability
6 Take Home Messages
References
19 Limitations of Patellofemoral Surgery in Children
1 Rehabilitation Challenges in Children with Patellofemoral Instability
2 Anatomic Considerations
3 Surgical Techniques
3.1 Medial Patellofemoral Ligament Reconstruction
4 Risk of Recurrence and Return to Activity
5 Summary
References
20 The Failed Medial Patellofemoral Ligament Reconstruction. What Can We Do?
1 Introduction
2 Causes of Revision Surgery—MPFLr Failure Etiology
2.1 Incorrect Surgical Indication
2.2 Technical Mistakes and Surgical Technique Issues
2.2.1 Incorrect Femoral Attachment Point
2.2.2 Excessive Graft Tension
2.2.3 Single Versus Double-Bundle Patellar Graft Insertion
2.3 Failure to Recognize and Correct Concomitant Risk Factors for Instability
2.4 Intrinsic Risk Factors Such as Collagen Disorders
2.5 Patellar Fracture. How to Avoid It
3 Reasons for Consultation in a Patient with Failed MPFLr
3.1 Re-dislocation or Persistence of Apprehension Without Dislocation
3.2 Knee Pain and Limitation of the Range of Motion
4 Revision Surgery After Failed MPFLr
4.1 How Should We Plan It?
4.2 General Principles in the Management of Failed MPFLr
4.2.1 Confirm Diagnosis
4.2.2 Define the Deficient Restraints Which Caused the Instability—Reconstruction of the Deficient Restraints and Limb Realignment When It is Grossly Abnormal
4.3 Steps In Revision MPFLr Surgery
4.3.1 Correction of Patellofemoral Tracking
4.3.2 Stabilization of the Patella
4.3.3 Patellar Chondropathy. What Can We Do?
4.4 Complex Revision Cases—MPFLr Without Bone Tunnels
4.5 Outcomes After Revision Surgery
5 Take Home Messages
6 Key Message
References
21 Surgical Treatment of Recurrent Patellar Instability: History and Current Concepts
1 Introduction: Background and History
2 Putting It All Together: What Does Fulkerson Do Now?
References
22 Chondral and Osteochondral Lesions in the Patellofemoral Joint
1 Introduction to Focal Cartilage Defects
2 Modified Outerbridge Classification / International Cartilage Repair Society (ICRS) Classification
3 General Isolated Cartilage Lesion Evaluation
4 Evaluation of the Patient with Patellofemoral Specific Lesions
5 General Indications for Cartilage Restoration Procedures
6 Debridement/Chondroplasty
7 Bone Marrow Stimulation
8 Osteochondral Autograft Transplant (OAT)/Mosiacplasty
9 Osteochondral Allograft Transplantation (OCA)
10 Matrix Induced Autologous Chondrocyte Implantation (MACI) / Autologous Chondrocyte Implantation (ACI)
11 Particulated Juvenile Allograft Cartilage
12 Post-operative Rehabilitation
13 Conclusion
14 Key Message
15 Seven Take Home Messages
References
23 Patellofemoral Arthritis
1 Background
2 Anatomy
3 Pathophysiology and Risk Factors
4 Presentation
5 Examination
6 Imaging
7 Conservative Treatment
8 Surgical Management of Patellofemoral Arthritis
9 Osteotomy
10 Cartilage Surgery
11 Arthroplasty
12 Conclusion
References
24 Fresh Osteochondral Allografts in Patellofemoral Surgery
1 Introduction
2 Anatomical and Biomechanical Considerations
3 Pathophysiology
4 Treatment Modalities
5 Osteochondral Allografts (OCA)
6 Osteochondral Allograft Storage and Preparation
7 Indications and Contraindications
8 Pre-Operative Planning
8.1 Imaging
8.2 Concomitant Procedures
8.3 Graft-Matching
9 Surgical Technique and Case Presentation
9.1 Patient Positioning and Anesthesia
9.2 Surgical Exposure
9.3 Dowel-Plug OCA Technique
9.4 Shell Technique for the Patella
9.5 Shell Technique for the Trochlea
10 Rehabilitation
11 Patient Outcomes
11.1 Clinical Outcomes
11.2 Imaging Outcomes
11.3 Survivorship
11.4 Complications
11.5 Reoperation Rates
12 Conclusion and Key Message
References
25 Extensor Mechanism Complications After Total Knee Arthroplasty
1 Introduction
2 Avascular Necrosis of the Patella
2.1 Definition and Epidemiology
2.2 Anatomical Considerations
2.3 Risk Factors
2.3.1 Surgical Approach
2.4 Surgical Management
2.4.1 Allograft
2.4.2 Muscle Transfer
2.4.3 Patellectomy
2.5 Extensor Mechanism Allograft Replacement
3 Patella Clunk Syndrome
3.1 Definition and Epidemiology
3.2 Anatomical Considerations
3.3 Risk Factors
3.3.1 Prosthesis Type
3.3.2 Prosthesis Design
3.3.3 Prosthesis Placement
3.3.4 Elevation of the Joint Line
3.3.5 Surgical Technique
3.4 Surgical Management
4 Patella Tendon Rupture in Total Knee Arthroplasty
4.1 Definition and Epidemiology
4.2 Anatomical Considerations
4.3 Risk Factors
4.3.1 Difficult Exposure
4.3.2 Previous Tibial Tubercle Osteotomy
4.3.3 Joint Line Elevation
4.4 Surgical Management
4.4.1 Achilles Tendon Allograft
4.4.2 Partial Extensor Mechanism Allograft Using the ‘Hour-Glass Technique’
4.4.3 Whole Extensor Mechanism Allograft
4.4.4 Surgical Technique—Acute Patellar Tendon Rupture—Repair with Semitendinosus Augmentation
4.4.5 Surgical Technique for Chronic Patellar Tendon Rupture—Reconstruction with a PartialExtensor Mechanism Allograft—The “Hour-Glass” Technique (Fig. 9)
5 Quadriceps Tendon Rupture
5.1 Definition and Epidemiology
5.2 Risk Factors
5.3 Surgical Management
6 Periprosthetic Patella Fracture
6.1 Definition and Epidemiology
6.2 Anatomical Considerations
6.3 Risk Factors
6.4 Surgical Management
6.5 Case Example
7 Patellar Instability in Total Knee Arthroplasty
7.1 Definition and Epidemiology
7.2 Risk Factors
7.2.1 Femoral Component Rotation
7.2.2 Tibial Rotation
7.2.3 Femoral-Tibial Rotation
7.3 Surgical Management
7.3.1 Technique
7.3.2 Medial Patellofemoral Ligament Reconstruction
8 Summary
References
Surgical Techniques: Why, When and How I Do It
26 Sonosurgery Ultrasound-Guided Arthroscopic Shaving for the Treatment of Patellar Tendinopathy When Conservative Treatment Fails
1 Background
2 Classification and Preoperative Evaluation
3 Indications
4 Contraindications
5 Surgical Technique Using Ultrasound-Guided Arthroscopy
6 Rehabilitation Protocol
7 Complications
8 Conclusions (Take Home Message)
References
27 Medial Patellofemoral Ligament Reconstruction: Anatomical Versus Quasi-anatomical Femoral Fixation
1 Introduction
2 Aim
3 Indications
4 The Bases for a Successful MPFLr
4.1 The Femoral Attachment Point
4.2 Graft Tensioning
4.3 Role of Lateral Retinacular Release
5 Surgical Technique Step-By-Step. Pearls and Tips
5.1 Static and Anatomic MPFLr
5.2 Quasi-Anatonical (Elastic) MPFLr
6 Addressing the Associated Predisposing Factors to Patellar Dislocation
7 Postoperative Management
8 Clinical Outcomes. Scientific Evidence
9 Anatomical MPFLr Versus Quasi-anatomical MPFLr
10 Take Home Messages
References
28 Minimal Invasive MPFL Reconstruction Using Quadriceps Tendon
1 Historical Perspective
2 Anatomy and Considerations for QT Graft Harvest
3 Biomechanics
4 Surgical Technique
4.1 Patient Positioning and Arthroscopy
4.2 Graft Harvest
4.3 Patella Preparation
4.4 Femoral Preparation
5 Pearls and Pitfalls
5.1 Pearls
5.2 Pitfalls
6 Postoperative Treatment
7 Clinical Outcome
8 Discussion
References
29 Combined Medial Patellofemoral Ligament and Medial Patellotibial Ligament Reconstruction
1 Introduction
2 Anatomy and Biomechanics
3 Diagnosis
3.1 Presentation and Physical Exam
3.2 Imaging
4 Treatment Options
5 Isolated Procedures
5.1 Hamstrings Tenodesis
5.2 Isolated MPTL Reconstruction
5.3 Combined “3 or 4 in 1” Procedures
5.4 Combined MPFL and MPTL Reconstruction
5.5 MPML Repair
5.6 Post-operative Protocol
6 Outcomes
6.1 MPTL Repair/Reconstruction Without MPFL
6.2 MPTL with MPFL Reconstruction
6.3 MPTL with Concomitant Realignment Procedures
6.4 Systematic Reviews
7 Conclusions
8 Key Message
References
30 Warning: Lateral Retinacular Release Can Cause Medial Patellar Dislocation—Lateral Patellofemoral Ligament Reconstruction
1 Historic Evolution of Diagnosis and Treatment
2 Stress Radiographs
3 Lateral Patellofemoral Ligament Reconstruction
References
31 Reconstruction of the Lateral Patellofemoral Ligament
1 Introduction
2 Indications (Table 1)
3 Contraindications (Table 2)
4 Procedure
5 Pearls and Pitfalls
6 Postoperative Rehabilitation
7 Outcomes
References
32 Patellar Tendon Imbrication
1 Introduction
2 Surgical Indications
3 Surgical Technique
4 Postoperative Care
5 Discussion
References
33 Quadricepsplasty
1 Introduction
2 Evaluation
3 Indications
4 Contraindications
5 Surgical Technique
5.1 Preoperatively
5.2 Incision and Exposure
5.3 Lateral Side Releases
5.4 Quadriceps Lengthening
6 Associated Procedures and Order of Correction
7 Postoperative Management
8 Results of Quadricepsplasty
9 Complications
10 Take Home Message
References
34 Sulcus Deepening Trochleoplasty
1 Introduction
2 Radiologic Features and Classification
3 Function and Biomechanics
4 Goals
5 Indications
6 Surgical Technique
7 Post-Operative Care
8 Results
9 Conclusion
Acknowledgements
References
35 Arthroscopic Deepening Trochleoplasty
1 Introduction
2 Indication
3 Technique
3.1 Preparation and Portal Placement
3.2 Creation of the Cartilage Flap
3.3 Formation and Shaping of a Deeper Trochlear Groove
3.4 Fixation of the Cartilage Flap
4 Video
4.1 Postoperative Regime
5 Results
6 Complications
7 Discussion
8 Conclusion
9 Take Home Message
10 Key Message
References
36 Lengthening Trochleoplasty
1 Introduction
2 Physical Examination
3 Imaging
3.1 Radiographs
3.2 MR Measurements
4 Differential Diagnosis
4.1 Patella Alta
4.2 J-Sign
4.3 Lateral Pull Sign
4.4 Hyperlaxity
4.5 Apprehension Test
5 Surgery
5.1 Preoperative Planning
5.2 Lengthening
5.3 Postoperative Care
5.4 Complications
6 Results
7 Conclusions
8 Take Home Messages
References
37 Tibial Tubercle Osteotomy in Patients with Patella Supera or Infera
1 Historical Introduction
2 Indications and Contraindications
2.1 Patella Alta
2.2 Patella Baja
3 Surgical Technique, Tips and Tricks
3.1 Patella Alta
3.2 Patella Baja
4 Results
5 Scientific Evidence
6 Complications
7 Take Home Message
References
38 Tibial Tubercle Anteromedialization Osteotomy (Fulkerson Osteotomy)
1 Introduction
2 Indications
3 Contraindications
4 Surgical Technique
4.1 Pre-operative Assessment and Planning
4.2 Set up and Positioning of the Patient
4.3 Arthroscopic Evaluation
4.4 Incision and Exposure
4.5 Performing the Osteotomy
4.6 Positioning and Fixation
5 Pearls and Pitfalls
5.1 Pearls
5.2 Pitfalls
6 Complications
7 Post-Operative Management
8 Key Message and Take-Home Points
References
39 Rotational Osteotomy. Principles, Surgical Technique, Outcomes and Complications
1 Introduction
2 Principles of Rotational Osteotomy Surgery
3 Rotational Osteotomy. Surgical Techniques Step-by-Step. Pearls and Tips
3.1 Rotational Osteotomy of the Tibia
3.1.1 Positioning
3.1.2 Surgical Approach
3.1.3 Fibular Osteotomy and Peroneal Nerve Release
3.1.4 Tibial Osteotomy
3.1.5 Fixation of the Osteotomy
Correction Loss After Fixation—“Incongruity” is the Problem
How to Avoid the Correction Loss
3.1.6 Closure
3.1.7 Postoperative Management
3.2 Rotational Osteotomy of the Proximal Fermur
3.2.1 Positioning
3.2.2 Lateral Approach to the Proximal Femur
3.2.3 Femoral Osteotomy
Danger
3.2.4 Fixation of the Osteotomy, Closure and Postoperative Management
3.3 Rotational Supracondylar Femoral Osteotomy
3.3.1 Positioning
3.3.2 Surgical Approach
3.3.3 Femoral Osteotomy
Technical Considerations when an MPFLr is Associated
3.3.4 Fixation of the Osteotomy, Closure and Postoperative Management
4 Case Examples
5 Clinical Outcomes. Scientific Evidence
6 Complications. Scientific Evidence (See Tables 1, 2, 3 and 4)
7 The Patient Experience Before and After Rotational Femoral and/or Tibial Osteotomy. A Qualitative Analysis
7.1 Patient Observations Before Surgery Include the Following
7.1.1 Uncertainty, Confusion and Sense Making
7.1.2 Impact on Self and Loss of Self-identity
7.1.3 Coping Strategies and Activity Beliefs
7.1.4 Expectation of the Future
7.2 Patient Observations After Surgery Include the Following
8 Take Home Message
References
40 Bipolar Fresh Osteochondral Allograft Transplantation of the Patellofemoral Joint
1 Introduction
2 Indications and Contraindications
3 The Keys for a Successful Osteochondral Allograft Transplantation of the Patellofemoral Joint
4 Surgical Thecnique
5 What Can We Expect from a Fresh Osteochondral Allograft? Literature Review. Scientific Evidence
6 Conclusion
References
41 Patellofemoral Arthroplasty. Pearls and Pitfalls
1 Introduction
2 History of Patellofemoral Arthroplasty (PFA)
3 Types of PFA Implants
4 Indications (Table 1)
5 Contraindications (Table 2)
6 Diagnosis of PF-OA: Patient Selection
6.1 Anamnesis
6.2 Physical Examination
6.3 Preoperative Radiology
6.4 Other Examinations
7 Treatment Alternatives
7.1 Conservative Treatment
7.2 Medialization and Anteriorization Osteotomy of the Tibial Tuberosity
7.3 Patellectomy
7.4 Partial Lateral Patella Facetectomy
7.5 Total Knee Arthroplasty (TKA)
8 Advantages of PFAs
9 Surgical Technique
10 Postoperative Treatment and Rehabilitation
11 PFAs Results
12 Complications of PFAs
12.1 Early Complications
12.2 Late Complications
13 PFA Revision
14 Take-Home Messages
15 Key Message
References
Clinical Cases—Primary and Revision Patellofemoral Surgery Patellofemoral Joint Preservation Surgery A Case-Based Approach
42 Case # 1: Disabling Anterior Knee Pain After Failed MPFL Reconstruction in a Patient with Patellar Chondropathy, Femoral Anteversion and External Tibial Torsion
1 Clinical Case
3 Imaging Studies
4 What to Do in Such a Situation?
5 Why not the Tibial Tubercle Osteotomy?
6 Why Rotational Osteotomy?
7 Special Considerations. Why Double Level Rotational Osteotomy?
8 Follow-Up
9 What Has This Case Taught Us? Key Points
10 Conclusion
References
43 Case # 2: Disabling Anterior Knee Pain Recalcitrant to Conservative Treatment in a Patient with Patellofemoral Osteoarthritis and Structural Femoral Retrotorsion and Genu Varum
1 Clinical Case
2 What to Do in Such a Situation?
3 The Conventional Thinking is ...
4 What Has This Case Taught Us? This Case Shows ...
5 Conclusion
References
44 Case # 3: Severe Anterior Knee Pain Recalcitrant to Conservative Treatment in a Patient with Functional Femoral Retrotorsion
1 Clinical Case
2 What to Do in Such a Situation? Our Surgical Treatment
3 Follow-Up
4 What Does the Medical Literature Tell Us About the Association Between External Rotational Femoral Deformity and AKP?
5 What Has This Case Taught Us? This Case Shows …
6 Conclusion
References
45 Case # 4: Disabling Anterior Knee Pain in a Multi-operated Young Patient with Severe Patellofemoral Osteoarthritis and Medial Patellar Instability
1 Clinical Case
2 Diagnosis
3 Our Surgical Treatment
4 Follow-Up
5 What Has This Case Taught Us? This Case Shows …
6 Conclusion
References
46 Case # 5: Multidirectional Patellar Instability After Over-Medialization of the Tibial Tubercle in a Patient with Severe Trochlear Dysplasia and Patella Alta
1 Clinical Case
2 Imaging Studies
3 What to Do in Such a Situation?
3.1 Surgical Approach
4 Follow-Up
5 Key Points
References
47 Case # 6: Failed MPFL Reconstruction in a Patient with Severe Trochlear Dysplasia and Malpositioning of the Femoral Attachment Point
1 Clinical Case
2 Physical Examination—Key Points
3 Imaging Studies
4 Questions Raised by This Case
5 What to Do in Such a Situation?
6 What Has This Case Taught Us? This Case Shows …
7 Conclusion
References
48 Case # 7: Lateral Patellar Instability in a Multi-operated Young Patient with Severe Patellofemoral Osteoarthritis and Severe Trochlear Dysplasia
1 Clinical Case
2 What to Do in Such a Situation?
3 Our Surgical Treatment
4 Follow-Up
5 The Conventional Thinking Is …
6 Is There an Indication for Patella Osteotomies?
7 What Has This Case Taught Us? This Case Shows
8 Conclusion
References
49 Case # 8: Extensor Mechanism Reconstruction After Resection of a Soft Tissue Sarcoma that Infiltrates the Patellar Tendon
1 Clinical Case
2 What to Do in Such a Situation?
2.1 First Step—Tumor Resection (Fig. 2)
2.2 Second Step—Reconstruction of the Extensor Mechanism (Fig. 3)
2.3 Third Step—Skin Coverage (Fig. 4)
3 Outcome—The Key for a Successful Reconstruction of the Extensor Mechanism of the Knee
References
50 Case # 9: Severe Patellofemoral Chondropathy in an Active 47-Year-Old Patient
1 Clinical Case
2 What to Do in Such a Situation?
3 Outcome
4 What Has This Case Taught Us? This Case Shows …
5 The Key for a Successful Fulkerson’s Osteotomy
6 Conclusions
References
51 Case # 10: Dislocated Patella After Revision Total Knee Arthroplasty. Case # 11: Patella Baja and Valgus Limb 56 Years After Tibial Tubercle Transfer
1 Clinical Case
2 What to Do in Such a Situation?
3 Outcome
5 Diagnoses
6 Options
7 Surgery
8 Outcome
New Frontiers in Anterior Knee Pain, Patellar Instability and Patellofemoral Osteoarthritis Evaluation and Treatment
52 Kinetic and Kinematic Analysis in Evaluating Anterior Knee Pain Patients
1 The Need for an Objective Measurement of Outcomes
2 What Provoking Activity is the Best to Evaluate AKP? The Rationale
3 Kinetic and Kinematic Analysis in Evaluating AKP
3.1 Instruments—Motion Analysis System—Dynamometric Platforms
3.2 Laboratory Protocol
3.3 Kinematic and Kinetic Variables
4 Clinical Relevance: Understand the Knee Osteoarthritis Mechanisms in the AKP Patient
5 Case Studies: A “Snapshot”
6 Take Home Messages
References
53 Patellofemoral Instrumented Stress Testing
1 Background
2 Instability Versus Laxity
3 Clinical and Imaging Assessment of Patellofemoral Joint Instability
4 Measurement of Joint Laxity
5 Porto Patella Testing Device (PPTD)
5.1 PPTD Operation Protocol
5.2 Measurement Protocol
5.3 PPTD Validity, Reliability and Outcomes
5.4 PPTD Possible Clinical and Research Applications
6 Conclusions
References
54 Anterior Knee Pain and Functional Femoral Maltorsion in Patients with Cam Femoroacetabular Impingement
1 Introduction
2 Proximal Causes of Anterior Knee Pain
3 Biomechanical Conflicts of the Hip
4 Anterior Knee Pain in Biomechanical Conflicts of the Hip
5 Take-Home Messages
6 Key-Message
References
55 Finite Element Technology in Evaluating Medial Patellofemoral Ligament Reconstruction
1 Introduction
2 Parametric Model of the PFJ—Our Protocol (See Video)
3 The Clinical Problem—What is Going to Happen with the PFJ in the Long-Term After a MPFLr?
4 Native MPFL Evaluation Using FEM Technology. The Ideal MPFLr from a Biomechanical Standpoint
5 Analysis of the Types of MPFLr Using FEM Technology
5.1 Static and Anatomic MPFLr—The Type of Graft Does Matter
5.2 Dynamic MPFLr
5.3 Static Versus Dynamic MPFLr. Clinical Relevance
6 Examples Demonstrating the Good Correlation Between Computational Predictions and Clinical Evaluation
7 Clinical Relevance of FE Technology—Discussion
8 Take Home Messages
References
56 Biomechanical Analysis of the Influence of Trochlear Dysplasia on Patellar Tracking and Pressure Applied to Cartilage
1 Trochlear Dysplasia
2 Biomechanical Analysis
2.1 In Vitro Simulation of Knee Function
2.2 Functional Imaging
2.3 Dynamic Simulation of Knee Function
3 Discussion
References
57 Brain Network Functional Connectivity Clinical Relevance and Predictive Diagnostic Models in Anterior Knee Pain Patients
1 Background
1.1 Functional Magnetic Resonance Imaging
1.2 Pain Neuromatrix
1.3 Clinical Decision Support System (CDSS)
2 Our Clinical Results
2.1 Participants and Clinical Assessments
2.2 Resting State MRI Data Acquisition
2.3 Image Processing
2.4 Image Analysis
2.5 Classification Model
2.6 Results
3 Discusion
4 Future Oportunities
References
58 Robotic-Assisted Patellofemoral Arthroplasty
1 Introduction
2 Indications and Contraindications
3 Preoperative Planning
4 Surgical Technique
4.1 Patient Positioning
4.2 Operative Technique
5 Postoperative Course
6 Discussion
7 Conclusion
8 Take Home Messages
9 Key Message
Acknowledgements
References
59 Modern Patellofemoral Inlay Arthroplasty—A Silver Lining in the Treatment of Isolated Patellofemoral Arthritis
1 Key Notes
2 Introduction
3 Indication
4 Contraindication
5 Surgical Technique
6 Rehabilitation
7 Clinical Outcome
References
60 Virtual Orthopaedic Examination in Patellofemoral Disorders
1 Introduction
2 Preparation for the Telemedicine Visit
3 Inspection
4 Lower Extremity Alignment
5 Gait
6 Palpation
7 Range of Motion
8 Muscle Strength and Functional Testing
9 Patellar Tracking
10 Patellar Apprehension
11 Limitations to the Virtual Examination
12 Conclusion
13 Take Home Points
14 Key Message
References
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