Operative Techniques in Sports Medicine最新文献

Medial patellofemoral ligament (MPFL) reconstruction is the most commonly performed surgery for treatment of lateral patellar instability. It may be used in isolation or in conjunction with a variety of different procedures depending on the individual patient's specific risk factors for instability. Indicating the correct patient involves a thorough history, physical examination, and proper imaging. Careful surgical technique and a detailed understanding of both topographic and radiographic anatomy is critical to successful reconstruction. MPFL reconstruction has been shown to be a safe and effective technique for treatment for lateral patellar instability.

The patellofemoral joint experiences substantial physiologic loads with normal daily activity. Anatomic risk factors can place certain patients at risk for patellofemoral pathology including patellar instability. Stability and load capacity of the joint are a result of numerous factors including the unique configuration of osseous and cartilaginous structures, static and dynamic soft tissue stabilizers, and global lower limb alignment. A thorough understanding of the anatomy and biomechanics of the patellofemoral joint is required to identify patient-specific sources of dysfunction and to tailor individualized treatment specific to a given patient's anatomy. Identification and correction of patient specific risk factors must form the basis for successful treatment strategies. Using novel imaging techniques, dissection methods, and technology for biomechanical evaluation, our understanding of the patellofemoral joint has continued to evolve and in turn help improve patient specific treatment and outcomes for patellar instability.

Medial patellofemoral ligament (MPFL) repair is a historically relevant treatment option for patellar instability, though it has been increasingly supplanted by MPFL reconstruction. Although several comparative studies report superior functional outcomes and a lower risk of recurrent patellar dislocation after MPFL reconstruction, MPFL repair may still be a viable treatment for a select group of patients. Patients with normal trochlear morphology, a normal TT-TG distance, lack of patella alta, and older age may be the best candidates for MPFL repair. MPFL repair also appears to be most effective when performed in the acute setting for avulsion-type tears. In an effort to improve repair outcomes, suture tape augmentation of MPFL repair has emerged recently and has shown promising early results. While our practice is typically to perform MPFL reconstruction for patellar instability, MPFL repair in appropriately selected patients may provide good clinical outcomes while avoiding some of the risks associated with reconstruction.

Medial patellar instability is less common than lateral instability and is almost always iatrogenic in nature. The lateral patellofemoral complex, and in particular the lateral patellofemoral ligament, is a major restraint to medial displacement of the patella. When considering surgical intervention, a comprehensive evaluation including understanding of previous procedures and presence of additional risk factors for instability, such as trochlear dysplasia, malalignment, or patella alta must be ruled out. This paper highlights recent anatomic and biomechanical evidence for the treatment of medial patellar instability as well as the pearls and pitfalls for a successful lateral patellofemoral ligament reconstruction.

The lateral retinaculum is a complex, layered structure that is the primary constraint to medial translation of the patella. Patients can develop patellar hypercompression syndrome and arthritis of the lateral patellofemoral joint from an overly tight lateral retinaculum. Conservative treatments include physical therapy and bracing but if relief is not achieved, surgical treatment in the form of lateral retinacular lengthening or release may alleviate symptoms. This chapter provides a thorough background of the risks, indications, outcomes, and techniques regarding treatment of the lateral retinaculum.