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Patellofemoral Disorders

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Patients presenting with patellofemoral pain represent a challenging population in any orthopaedic practice. Most patients can be successfully managed with a systematic nonoperative program. Patient selection is the key to achieving successful surgical outcomes. A thorough understanding of patellofemoral anatomy coupled with a complete patient history and physical will increase the chances of success with arthroscopic intervention. A variety of pathologic conditions exist in the patellofemoral joint, including cartilage disease, malalignment, instability, arthritis, and soft tissue disorders. Arthroscopy may be the first line of surgical treatment for a complicated problem or the definitive solution to a complex issue. A clear preoperative understanding of the potential pathology that might be encountered at the time of arthroscopy will assist in correctly applying one of several arthroscopic surgical procedures.

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References

  1. Fulkerson JP, Tennant R, Jaivin JS, Grunnet M. Histologic evidence of retinacular nerve injury associated with patellofemoral malalignment. Clin Orthop Relat Res 1985;197: 196–205.

    PubMed  Google Scholar 

  2. Biedert RM, Stauffer E, Friederich NF. Occurrence of free nerve endings in the soft tissue of the knee joint. A histologic investigation. Am J Sports Med 1992;20:430–433.

    Article  PubMed  CAS  Google Scholar 

  3. Post WR. Anterior knee pain: diagnosis and treatment. J Am Acad Orthop Surg 2005;13:534–543.

    PubMed  Google Scholar 

  4. Farahmand F, Senavongse W, Amis AA. Quantitative study of the quadriceps muscles and trochlear groove geometry related to instability of the patellofemoral joint. J Orthop Res 1998;16: 136–143.

    Article  PubMed  CAS  Google Scholar 

  5. Fulkerson JP, Gossling HR. Anatomy of the knee joint lateral retinaculum. Clin Orthop Relat Res 1980;153:183–188.

    PubMed  Google Scholar 

  6. Nomura E, Horiuchi Y, Kihara M. Medial patellofemoral ligament restraint in lateral patellar translation and reconstruction. The Knee 2000;7:121–127.

    Article  PubMed  Google Scholar 

  7. Arendt EA, Fithian DC, Cohen E. Current concepts of lateral patella dislocation. Clin Sports Med 2002;21:499–519.

    Article  PubMed  Google Scholar 

  8. Amis AA, Firer P, Mountney J, Senavongse W, Thomas NP. Anatomy and biomechanics of the medial patellofemoral ligament. The Knee 2003;10:215–220.

    Article  PubMed  CAS  Google Scholar 

  9. Senavongse W, Amis AA. The effects of articular, retinacular, or muscular deficiencies on patellofemoral joint stability. J Bone Joint Surg Br 2005;87:577–582.

    PubMed  CAS  Google Scholar 

  10. Bicos J, Fulkerson JP, Amis A. Current concepts review: the medial patellofemoral ligament. Am J Sports Med 2007;35:484–492.

    Article  PubMed  Google Scholar 

  11. Fulkerson JP. Diagnosis and treatment of patients with patellofemoral pain. Am J Sports Med 2002;30:447–456.

    PubMed  Google Scholar 

  12. Post WR. Clinical evaluation of patients with patellofemoral disorders. Arthroscopy 1999;15:841–851.

    Article  PubMed  CAS  Google Scholar 

  13. Post WR, Fulkerson J. Knee pain diagrams: correlation with physical examination findings in patients with anterior knee pain. Arthroscopy 1994;10:618–623.

    Article  PubMed  CAS  Google Scholar 

  14. Tiberio D. The effect of excessive subtalar joint pronation on patellofemoral mechanics. J Orthop Sports Phys Ther 1987;9:160–165.

    PubMed  CAS  Google Scholar 

  15. Ireland ML, Willson JD, Ballantyne BT, Davis IM. Hip strength in females with and without patellofemoral pain. J Orthop Sports Phys Ther 2003;33:671–676.

    PubMed  Google Scholar 

  16. Dupont JY. Synovial plicae of the knee. Controversies and review. Clin Sports Med 1997;16:87–122.

    Article  PubMed  CAS  Google Scholar 

  17. Fulkerson JP. Patellofemoral pain disorders: evaluation and management. J Am Acad Orthop Surg 1994;2:124–132.

    PubMed  Google Scholar 

  18. Fulkerson JP. Office evaluation of patients with anterior knee pain. Am J Knee Surg 1997;10:181–183.

    PubMed  CAS  Google Scholar 

  19. Goutallier D, Bernageau J, Lecudonnec B. [The measurement of the tibial tuberosity. Patella groove distanced technique and results (author’s transl.).] Revue de chirurgie orthopedique et reparatrice de l’appareil moteur 1978;64:423–428.

    PubMed  CAS  Google Scholar 

  20. Aglietti P, Insall JN, Cerulli G. Patellar pain and incongruence. I: measurements of incongruence. Clin Orthop Relat Res 1983;176:217–224.

    PubMed  Google Scholar 

  21. Laurin CA, Dussault R, Levesque HP. The tangential x-ray investigation of the patellofemoral joint: x-ray technique, diagnostic criteria and their interpretation. Clin Orthop Relat Res 1979;144: 16–26.

    PubMed  Google Scholar 

  22. Merchant AC, Mercer RL, Jacobsen RH, Cool CR. Roentgenographic analysis of patellofemoral congruence. J Bone Joint Surg Am 1974;56:1391–1396.

    PubMed  CAS  Google Scholar 

  23. Dejour H, Walch G, Nove-Josserand L, Guier C. Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 1994;2:19–26.

    Article  PubMed  CAS  Google Scholar 

  24. Dejour H, Walch G, Neyret P, Adeleine P. [Dysplasia of the femoral trochlea.] Revue de chirurgie orthopedique et reparatrice de l’appareil moteur 1990;76:45–54.

    PubMed  CAS  Google Scholar 

  25. Malghem J, Maldague B. [Profile of the knee. Differential radiologic anatomy of the articular surfaces.] J Radiol 1986;67: 725–735.

    PubMed  CAS  Google Scholar 

  26. Williams JS, Jambor C. Role of lateral release in patellofemoral instability. Tech Knee Surg 2006;5:187–192.

    Article  Google Scholar 

  27. Fithian DC, Paxton EW, Post WR, Panni AS. Lateral retinacular release: a survey of the International Patellofemoral Study Group. Arthroscopy 2004;20:463–468.

    Article  PubMed  Google Scholar 

  28. Lattermann C, Toth J, Bach BR Jr. The role of lateral retinacular release in the treatment of patellar instability. Sports Med Arthrosc Rev 2007;15:57–60.

    Article  Google Scholar 

  29. Ficat P. [The syndrome of lateral hyperpressure of the patella.] Acta Orthop Belg 1978;44:65–76.

    PubMed  CAS  Google Scholar 

  30. Shea KP, Fulkerson JP. Preoperative computed tomography scanning and arthroscopy in predicting outcome after lateral retinacular release. Arthroscopy 1992;8:327–334.

    Article  PubMed  CAS  Google Scholar 

  31. Christensen F, Soballe K, Snerum L. Treatment of chondromalacia patellae by lateral retinacular release of the patella. Clin Orthop Relat Res 1988;234:145–147.

    PubMed  Google Scholar 

  32. Aderinto J, Cobb AG. Lateral release for patellofemoral arthritis. Arthroscopy 2002;18:399–403.

    Article  PubMed  Google Scholar 

  33. Ford DH, Post WR. Open or arthroscopic lateral release. Indications, techniques, and rehabilitation. Clin Sports Med 1997;16: 29–49.

    Article  PubMed  CAS  Google Scholar 

  34. Fulkerson JP, Schutzer SF, Ramsby GR, Bernstein RA. Computerized tomography of the patellofemoral joint before and after lateral release or realignment. Arthroscopy 1987;3:19–24.

    Article  PubMed  CAS  Google Scholar 

  35. Elias DA, White LM. Imaging of patellofemoral disorders. Clin Radiol 2004;59:543–557.

    Article  PubMed  CAS  Google Scholar 

  36. Panni AS, Tartarone M, Patricola A, Paxton EW, Fithian DC. Long-term results of lateral retinacular release. Arthroscopy 2005;21:526–531.

    Article  PubMed  Google Scholar 

  37. Aglietti P, Pisaneschi A, De Biase P. Recurrent dislocation of patella: three kinds of surgical treatment. Ital J Orthop Traumatol 1992;18:25–36.

    PubMed  CAS  Google Scholar 

  38. Dainer RD, Barrack RL, Buckley SL, Alexander AH. Arthroscopic treatment of acute patellar dislocations. Arthroscopy 1988;4: 267–271.

    Article  PubMed  CAS  Google Scholar 

  39. Ricchetti ET, Mehta S, Sennett BJ, Huffman GR. Comparison of lateral release versus lateral release with medial soft-tissue realignment for the treatment of recurrent patellar instability: a systematic review. Arthroscopy 2007;23:463–468.

    Article  PubMed  Google Scholar 

  40. Gecha SR, Torg JS. Clinical prognosticators for the efficacy of retinacular release surgery to treat patellofemoral pain. Clin Orthop Relat Res 1990;253:203–208.

    PubMed  Google Scholar 

  41. Ostermeier S, Holst M, Hurschler C, Windhagen H, Stukenborg-Colsman C. Dynamic measurement of patellofemoral kinematics and contact pressure after lateral retinacular release: an in vitro study. Knee Surg Sports Traumatol Arthrosc 2007;15:547–554.

    Article  PubMed  Google Scholar 

  42. Simpson LA, Barrett JP Jr. Factors associated with poor results following arthroscopic subcutaneous lateral retinacular release. Clin Orthop Relat Res 1984;186:165–171.

    PubMed  Google Scholar 

  43. Bigos SJ, McBride GG. The isolated lateral retinacular release in the treatment of patellofemoral disorders. Clin Orthop Relat Res 1984;186:75–80.

    PubMed  Google Scholar 

  44. Henry JH, Goletz TH, Williamson B. Lateral retinacular release in patellofemoral subluxation. Indications, results, and comparison to open patellofemoral reconstruction. Am J Sports Med 1986;14:121–129.

    Article  PubMed  CAS  Google Scholar 

  45. DiGiulio M, Donaldson WR. Complications of patello-femoral joint surgery. Sports Med Arthrosc Rev 2004;12:172–184.

    Article  Google Scholar 

  46. Hughston JC, Deese M. Medial subluxation of the patella as a complication of lateral retinacular release. Am J Sports Med 1988;16:383–388.

    Article  PubMed  CAS  Google Scholar 

  47. Blasier RB, Ciullo JV. Rupture of the quadriceps tendon after arthroscopic lateral release. Arthroscopy 1986;2:262–263.

    Article  PubMed  CAS  Google Scholar 

  48. Lord MJ, Maltry JA, Shall LM. Thermal injury resulting from arthroscopic lateral retinacular release by electrocautery: report of three cases and a review of the literature. Arthroscopy 1991;7: 33–37.

    Article  PubMed  CAS  Google Scholar 

  49. Lee G, Kelly MA. Isolated patellofemoral arthritis without malalignment. In: Fulkerson J, ed. Common Patellofemoral Problems. Rosemont, IL: American Academy of Orthopaedic Surgeons, 2005, pp. 73–84.

    Google Scholar 

  50. Federico DJ, Reider B. Results of isolated patellar debridement for patellofemoral pain in patients with normal patellar alignment. Am J Sports Med 1997;25:663–669.

    Article  PubMed  CAS  Google Scholar 

  51. Peters TA, McLean ID. Osteochondritis dissecans of the patellofemoral joint. Am J Sports Med 2000;28:63–67.

    PubMed  CAS  Google Scholar 

  52. Owens BD, Stickles BJ, Balikian P, Busconi BD. Prospective analysis of radiofrequency versus mechanical debridement of isolated patellar chondral lesions. Arthroscopy 2002;18:151–155.

    Article  PubMed  Google Scholar 

  53. Barber FA, Iwasko NG. Treatment of grade III femoral chondral lesions: mechanical chondroplasty versus monopolar radiofrequency probe. Arthroscopy 2006;22:1312–1317.

    Article  PubMed  Google Scholar 

  54. Amiel D, Ball ST, Tasto JP. Chondrocyte viability and metabolic activity after treatment of bovine articular cartilage with bipolar radiofrequency: an in vitro study. Arthroscopy 2004;20: 503–510.

    Article  PubMed  Google Scholar 

  55. Yasura K, Nakagawa Y, Kobayashi M, Kuroki H, Nakamura T. Mechanical and biochemical effect of monopolar radiofrequency energy on human articular cartilage: an in vitro study. Am J Sports Med 2006;34:1322–1327.

    Article  PubMed  Google Scholar 

  56. Edwards RB 3rd, Lu Y, Uthamanthil RK, Bogdanske J, Muir P, Athanasiou K, Markel M. Comparison of mechanical debridement and radiofrequency energy for chondroplasty in an in vivo equine model of partial thickness cartilage injury. Osteoarthritis Cartilage 2007;15:169–178.

    Article  PubMed  Google Scholar 

  57. Saleh KJ, Arendt EA, Eldridge J, Fulkerson JP, Minas T, Mulhall KJ. Symposium. Operative treatment of patellofemoral arthritis. J Bone Joint Surg Am 2005;87:659–671.

    Article  PubMed  Google Scholar 

  58. Minas T. Autologous chondrocyte implantation for focal chondral defects of the knee. Clin Orthop Relat Res 2001;391(Suppl): S349–S361.

    Article  PubMed  Google Scholar 

  59. Jones DG, Peterson L. Autologous chondrocyte implantation. J Bone Joint Surg Am 2006;88:2502–2520.

    Article  PubMed  Google Scholar 

  60. Knutsen G, Drogset JO, Engebretsen L, Grøntvedt T, Isaksen V, Ludvigsen TC, Roberts S, Solheim E, Strand T, Johansen O. A randomized trial comparing autologous chondrocyte implantation with microfracture. Findings at five years. J Bone Joint Surg Am 2007;89:2105–2112.

    Article  PubMed  Google Scholar 

  61. Knutsen G, Engebretsen L, Ludvigsen TC, Drogset JO, Grøntvedt T, Solheim E, Strand T, Roberts S, Isaksen V, Johansen O. Autologous chondrocyte implantation compared with microfracture in the knee. A randomized trial. J Bone Joint Surg Am 2004;86: 455–464.

    PubMed  Google Scholar 

  62. Steadman JR, Rodkey WG, Rodrigo JJ. Microfracture: surgical technique and rehabilitation to treat chondral defects. Clin Orthop Relat Res 2001;391:(Suppl):S362–S369.

    Article  PubMed  Google Scholar 

  63. Marder RA, Hopkins G Jr, Timmerman LA. Arthroscopic microfracture of chondral defects of the knee: a comparison of two postoperative treatments. Arthroscopy 2005;21:152–158.

    Article  PubMed  Google Scholar 

  64. Bert JM, Giannini D, Nace L. Antibiotic prophylaxis for arthroscopy of the knee: is it necessary? Arthroscopy 2007;23:4–6.

    Article  PubMed  Google Scholar 

  65. Lubowitz JH, Poehling GG. Arthroscopy and antibiotics. Arthroscopy 2007;23:1–3.

    PubMed  Google Scholar 

  66. Babcock HM, Carroll C, Matava M, L’Ecuyer P, Fraser V. Surgical site infections after arthroscopy: outbreak investigation and case control study. Arthroscopy 2003;19:172–181.

    Article  PubMed  Google Scholar 

  67. Ramos J, Perrotta C, Badariotti G, Berenstein G. Interventions for preventing venous thromboembolism in adults undergoing knee arthroscopy. Cochrane Database System Rev 2007(2): CD005259.

    Google Scholar 

  68. Galloway MT, Noyes FR. Cystic degeneration of the patella after arthroscopic chondroplasty and subchondral bone perforation. Arthroscopy 1992;8:366–369.

    Article  PubMed  CAS  Google Scholar 

  69. Elias JJ, Cosgarea AJ. Technical errors during medial patellofemoral ligament reconstruction could overload medial patellofemoral cartilage: a computational analysis. Am J Sports Med 2006;34:1478–1485.

    Article  PubMed  Google Scholar 

  70. Tom A, Fulkerson J. Restoration of native MPFL support after patella dislocation. Sports Med Arthrosc Rev 2007;15: 68–71.

    Article  Google Scholar 

  71. Ali S, Bhatti A. Arthroscopic proximal realignment of the patella for recurrent instability: report of a new surgical technique with 1 to 7 years of follow-up. Arthroscopy 2007;23:305–311.

    Article  PubMed  Google Scholar 

  72. Haspl M, Cicak N, Klobucar H, Pecina M. Fully arthroscopic stabilization of the patella. Arthroscopy 2002;18:E2.

    PubMed  Google Scholar 

  73. Small NC, Glogau AI, Berezin MA. Arthroscopically assisted proximal extensor mechanism realignment of the knee. Arthroscopy 1993;9:63–67.

    Article  PubMed  CAS  Google Scholar 

  74. Halbrecht JL. Arthroscopic patella realignment: an all-inside technique. Arthroscopy 2001;17:940–945.

    Article  PubMed  CAS  Google Scholar 

  75. Schoettle PB, Scheffler SU, Schwarck A, Weiler A. Arthroscopic medial retinacular repair after patellar dislocation with and without underlying trochlear dysplasia: a preliminary report. Arthroscopy 2006;22:1192–1198.

    Article  Google Scholar 

  76. Coons DA, Barber FA. Thermal medial retinaculum shrinkage and lateral release for the treatment of recurrent patellar instability. Arthroscopy 2006;22:166–171.

    Article  PubMed  Google Scholar 

  77. Fukushima K, Horaguchi T, Okano T, Yoshimatsu T, Saito A, Ryu J. Patellar dislocation: arthroscopic patellar stabilization with anchor sutures. Arthroscopy 2004;20:761–764.

    Article  PubMed  Google Scholar 

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Spang, J.T., Fulkerson, J.P. (2009). Patellofemoral Disorders. In: Richmond, J., Bono, J., McKeon, B. (eds) Knee Arthroscopy. Springer, New York, NY. https://doi.org/10.1007/978-0-387-89504-8_7

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