Understanding the Patellofemoral Joint: From Instability to Arthroplasty; An Issue of Clinics in Sports Medicine, E-Book

Opis

This issue of Clinics in Sports Medicine will focus on patellofemoral disorders and how they are among the most common clinical conditions managed in the orthopaedic and sports medicine setting. The correct diagnosis at an early stage is essential if subsequent treatment is to be successful and secondary complications are to be avoided. Nonoperative intervention is usually the first form of treatment; however, there is no consensus on the most effective method of treatment.

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Front Cover 2
Understanding the Patellofemoral Joint: From Instability to Arthroplasty 3
Copyright 4
Contributors 5
Contents 9
Clinics In Sports Medicine 12
Foreword 13
Preface 15
Patellofemoral Anatomy and Biomechanics 17
- Epidemiology 17
- Key points 17
- Introduction 17
- Spectrum of disease 18

Front Cover 2
Understanding the Patellofemoral Joint: From Instability to Arthroplasty 3
Copyright 4
Contributors 5
Contents 9
Clinics In Sports Medicine 12
Foreword 13
Preface 15
Patellofemoral Anatomy and Biomechanics 17
- Epidemiology 17
- Key points 17
- Introduction 17
- Spectrum of disease 18
- Anatomy 18
  - Osseous Anatomy of the Patella 18
  - Osseous Anatomy of the Trochlea 18
- Anatomy of patellofemoral soft tissue structures 21
  - Medial Soft Tissues 21
  - Quadriceps Mechanism 21
  - Patella Tendon 21
  - Lateral Soft Tissues 22
- Biomechanics 23
  - Normal Patella Tracking 23
- Measurements of osseous restraint 24
  - Coronal and Axial Planes 24
  - Sagittal Plane 25
  - Abnormal Patella Tracking 27
- Summary 27
- References 28
Physical Examination of the Patellofemoral Joint 31
- Key points 31
- Introduction 31
- Overview 32
- Standing 33
- Sitting 35
- Supine 36
- Summary 39
- References 39
Imaging of the Patellofemoral Joint 41
- Introduction 41
- Imaging of the knee 41
  - Radiographs 41
  - Magnetic Resonance Imaging 42
- Key points 41
- Anatomy 43
  - Patellar Cartilage 43
  - Bipartite Patella 43
  - Dorsal Defect of the Patella 43
  - Patellar Anatomy and Variants 43
  - Trochlea 44
  - Patellar Tendon 45
  - Medial Patellar Soft Tissue Restraints 45
  - Quadriceps Tendon 45
  - Patellar Tilt 46
    - Lateral radiograph 47
    - Axial radiograph 47
    - MRI 48
  - Synovial Plicae of the Knee 46
  - Patellar Displacement (Subluxation) 48
  - Patellar Height 49
    - MRI 50
  - Chondromalacia patella and osteoarthritis 50
  - Apophysitis 50
  - Trochlear dysplasia 52
  - Tibial tubercle to trochlear groove distance 55
  - Patellar sleeve fracture 56
  - Patellar fractures 56
  - Patellar dislocation 57
  - Tendon abnormalities 58
  - Anterior bursitis 60
    - Morel-Lavallée Effusion 61
  - Quadriceps fat pad edema 62
  - References 62
  - Superolateral Hoffa fat pad edema 62
- Anterior Knee Pain in the Athlete 65
  - Key points 65
  - Introduction 65
  - Symptoms 65
  - Diagnostic imaging 66
  - Treatment principles 67
    - Relative Rest and Activity Modification 68
    - Methods to Control Inflammation 69
      - Anti-inflammatories and analgesics 69
      - Cryotherapy 69
    - Methods to Stimulate Healing 69
      - Hyaluronic acid 69
      - Platelet-rich plasma 69
      - Other therapies 70
    - Improving Lower Extremity Biomechanics 70
      - Patellar taping 70
      - Patellofemoral bracing 70
      - Foot orthotics 71
      - Stretching 71
      - Strengthening 72
    - Pathology 73
      - Soft-Tissue Pathology 73
        
        Patellar tendinopathy 73
        
        Bursitis 73
        
        Pediatric patellar tendon abnormalities 74
        
        Iliotibial band syndrome 74
        
        Plica syndrome 75
        
        Infrapatellar fat pad syndrome 75
      - Patellar Tracking 73
      - Cartilage Pathology 75
      - Bone Pathology 76
        
        Osteochondritis dissecans 76
        
        Stress fractures 76
        
        Trauma 77
        
        Bipartite patella 77
      - Patellar Instability 77
      - Neuromuscular Pathology 78
        
        Hip muscles 78
        
        Muscle flexibility 78
        
        Quadriceps muscles 78
        
        Functional testing 78
      - References 79
    - Patellar Instability 89
      - Introduction 89
      - Key points 89
      - Anatomy and evaluation of the patellofemoral joint 90
        
        Anatomy 90
        
        Radiographs 91
        
        Clinical History and Examination 91
        
        Imaging 91
        
        Bone Scan 93
        
        MRI 94
        
        CT Scan 94
      - Treatment 94
        
        Nonoperative Management 94
        
        Surgical Management 95
        
        Arthroscopic and Minimally Invasive Techniques 95
        
        MPFL Reconstruction 96
      - Tibial tubercle osteotomy 97
        
        Trochleoplasty 98
      - Summary 99
      - References 99
    - Management of Patellofemoral Chondral Injuries 105
      - Key points 105
      - Introduction: nature of the problem 105
      - History 106
      - Physical examination 106
      - Surgical technique/procedure 107
      - Indications/contraindications 107
      - Postoperative care 115
      - Complications and management 115
      - Outcomes 117
        
        ACI 117
        
        Microfracture 117
        
        Osteotomy 118
        
        Patellofemoral Arthroplasty 119
        
        Osteochondral Autograft/Allograft Transplantation 119
      - References 126
      - Summary 126
    - MPFL Reconstruction 129
      - Key points 129
      - Introduction 130
      - Indications 131
      - Contraindications 131
      - Surgical technique 132
        
        Preparation and Patient Positioning 132
        
        Surgical Approach 132
        
        Patellar preparation 132
        
        Graft harvest 132
        
        Femoral preparation 133
        
        Graft passage 134
        
        Preoperative Planning 132
        
        Outcomes 140
        
        Postoperative care 140
        
        Complications and management 140
        
        References 141
        
        Summary 141
        
        Supplementary data 141
      - Distal Realignment 145
        
        Introduction 145
        
        Key points 145
        
        Indications 146
        
        Contraindications 148
        
        Surgical technique 149
        
        History of Distal Realignment Procedures 149
        
        Medialization of the Tibial Tubercle 150
        
        Distalization of the Tibial Tubercle 150
        
        Anteriorization of the Tibial Tubercle 151
        
        Anteromedialization of the Tibial Tubercle 152
        
        Anteromedialization: A Detailed Surgical Technique 152
        
        Complications 154
        
        Postoperative management 154
        
        Outcomes 154
        
        Summary 155
        
        References 155
      - Trochlear Dysplasia and the Role of Trochleoplasty 159
        
        Key points 159
        
        Introduction 159
        
        Normal trochlear anatomy and biomechanics 160
        
        Anatomy 160
        
        Biomechanics 160
        
        The anatomy and biomechanics of trochlear dysplasia 161
        
        Anatomy 161
        
        Biomechanics 161
        
        Diagnosis of trochlear dysplasia 161
        
        History and Physical Examination 161
        
        Radiographic Evaluation 162
        
        Arthroscopy 164
        
        Magnetic Resonance Imaging 164
        
        TT-TG Distance 164
        
        Natural history 165
        
        Treatment options 165
        
        Indications for a trochleoplasty 166
        
        Sulcus-deepening trochleoplasty and MPFL reconstruction 166
        
        Surgical Procedure 166
        
        Postoperative Rehabilitation 170
        
        Complications 170
        
        Outcomes after trochleoplasty 170
        
        Summary 170
        
        References 171
      - Patellofemoral Arthroplasty in the Athlete 175
        
        Introduction 175
        
        Key points 175
        
        The patellofemoral preparation 176
        
        The patient 176
        
        The implant 176
        
        Why avoid certain sports 177
        
        Polyethylene Wear 177
        
        Catastrophic Failure 177
        
        Why allow sports 177
        
        Summary: sporting recommendations 179
        
        References 179
      - Rehabilitation of the Patellofemoral Joint 181
        
        Key points 181
        
        Introduction to rehabilitation approaches for patellofemoral pain syndrome 181
        
        Inflammation and swelling 182
        
        Clinical options for rehabilitation: acute phase 182
        
        Medications 182
        
        Activities 182
        
        General goals 182
        
        Injections 183
        
        Modalities 183
        
        Bracing 185
        
        Clinical options for rehabilitation: subacute phase 185
        
        Protection 185
        
        Physical therapy 186
        
        Manual Medicine 186
        
        Flexibility 187
        
        Strength 187
        
        Stability 188
        
        Activity Progression 189
        
        Taping 186
        
        Shoe type 189
        
        Reasons for Failure of Conservative Treatment 190
        
        Noncompliance 190
        
        Symptom Chronicity 190
        
        Undiagnosed Conditions 190
        
        Pain Severity 190
        
        Maintenance phase 190
        
        References 191
        
        Surgical referral 191
      - Index 195

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Alexander Meininger: Steamboat Orthopedic Assoc

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