Patellar sleeve avulsion fracture in a patient with Sinding-Larsen Techniques for quantifying trochlear dysplasia with MRI have been standardized and shown to be accurate and reproducible in assessing lateral trochlear inclination, facet asymmetry, and trochlear depth8,9. (7a) A coronal T1-weighted image at the level of the patella demonstrates blending of fibers of the VMO with the MPFL superiorly. Lateral patellar dislocation refers to lateral displacement followed by dislocation of the patelladue to disruptive changes to the medial patellar retinaculum. Arthroscopy 35:537543, Mountney J, Senavongse W, Amis AA, Thomas NP (2005) Tensile strength of the medial patellofemoral ligament before and after repair or reconstruction. The above video demonstrates the mechanism of injury in patellar dislocation. A second line is drawn parallel to a line along the posterior femoral condyles. Transient medial patellar dislocation: injury patterns at US and MR The technique has been refined, and a better understanding of the anatomical features of both the origin and insertion of the ligament onto the patella has made the operation more reproducible (Fig. For first-time dislocators without intra-articular loose bodies or chondral injury, a trial of nonoperative therapy is indicated. There is agreement, however, that the MPFL is almost always injured with lateral patellar dislocations4. J Bone Joint Surg Am 85-A:12381242, Article Observer Agreement on the Dejour Trochlear Dysplasia Classification: A comparison of true lateral radiographs and axial magnetic resonance images. The deep layer is comprised of the lateral patellofemoral ligament, patellotibial band and transverse ligament. Figure 1: ligaments (Gray's illustrations), View Pereshin Moodaley's current disclosures, see full revision history and disclosures, posterior suprapatellar (prefemoral or supratrochlear) fat pad, anterior suprapatellar (quadriceps) fat pad, accessory anterior inferior tibiofibular ligament, superficial posterior tibiotalar ligament, superficial posterior compartment of the leg (calf), accessory extensor digiti secundus muscle, descending branch of the lateral circumflex. Perpendicular to this baseline, trochlear depth is calculated by measuring the mean of the maximum AP distance of the medial (a) and lateral (b) femoral condyles minus the distance between the deepest point of the trochlear groove and the line paralleling the posterior condylar surfaces (c). Concave impaction deformity of the inferomedial patella is a specific sign of prior LPD. MRI Web Clinic, August 2010. https://radsource.us/patella-alta-and-baja/. 2021;50(7):1399-409. Failure to identify or treat injury to the patellar retinaculum is associated with recurrent patellar instability and contributes to significant morbidity. Why Do Orthopaedic Surgeons Ignore the Medial - ScienceDirect It is not until beyond 90 of flexion that the odd facet engages the medial femoral condyle and plays a role in load sharing along with lateral facet [6, 7]. Imaging plays a vital role in detecting not only the secondary damage but also subtle early features that can raise the suspicion for the presence of this entity. 4. Epub 2023 Feb 7. The superficial layer originates from the lowest fibers of the iliotibial band and from an extension of vastus lateralis fascia. The injuries involved the medial retinacular ligament in 16 of 17 patients and the medial and lateral retinacular ligament in one patient. Anatomical and radiology atlas of the abdomen and pelvis based on anatomical diagrams and cross-sectional CT and MRI imaging. Less than 3-mm trochlear depth is indicative of trochlear dysplasia [24]. Int Orthop 34:305309, Biedert RM, Albrecht S (2006) The patellotrochlear index: a new index for assessing patellar height. It is a recognized cause of anterior pain and in extreme cases presents as acute and often recurrent patellar dislocation, which is usually transient. Quinn described the MRI findings following acute patellar dislocation as contusion or impaction of the medial patellar facet and lateral femoral condyle, along with injury of the medial retinaculum and/or medial patellofemoral ligament (MPFL) (Quinn, 1993). The patellar usually relocates, and the typical bone contusions are the key MRI features to diagnose transient lateral patellar dislocation (Fig. Orthopedic Surgery 22 years experience. This distance is the trochlear sulcus depth (TD). Patellofemoral friction syndrome: MRI findings of an - Eurorad Objective: Must rule out a tight iliotibial band (ITB) and weak quadriceps muscles (Juhn). 7,14 While plain radiography is an important tool to diagnose APD, magnetic resonance imaging (MRI . Tibial Tubercle Osteotomy to Aid Exposure for Revision Total Knee The lateral trochlear articular surface is usually more prominent than its medial portion. The lateral trochlear articular surface is usually more prominent than its medial portion. Trauma itself rarely causes patellofemoral dislocations without predisposing factors such as trochlear dysplasia, patella alta and lateralization of the tibial tuberosity. These are most often found at the inferomedial patella or the lateral femoral condyle [49, 61, 62]. PFA of 0 or if it opens medially (negative value) is considered abnormal indicating lateral patellar tilt [27, 48]. Other structures that blend in this region include the medial patellotibial ligament, the medial patellomeniscal ligament, the investing fascia, and the medial joint capsule.

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