Flashcards in 04 Patellofemoral 2 Deck (55):
What does LAACS stand for?
- Laxity, generalized and Lower aged at initial dislocation
- Atraumatic in nature
- Abnormal PF architecture and abnormal ligamentous laxity
- Chronic in nature, Contralateral involvement
- Sex dependent with greater # of females
What does TONES stand for?
- Traumatic, sports related MOI
- Older at initial dislocation, OCD fx more common
- Normal PF architecture, Normal alignment
- Equal sex distribution
- Single occurrence, Single leg involvement
What are LAACS and TONES?
ways to classify patients
What are the general PF surgical procedures?
- release tight lateral retinaculum
- reposition VMO attachment
- tighten, advance, or repair medial soft tissues
- reposition tibial tuberosity
What are the terms to indicate surgical shortening?
- "vest over pants"
What are the 4 proximal realignments?
- femoral trochleoplasty (osteotomy)
- lateral release
- VMO advancement (reefing)
What will they do if they do something for the lateral side of the knee?
- use a balancing approach
- make adjustments medially as well
Which trochlea is higher?
What does the lateral trochlea do?
helps create a bony buttress to prevent the patella from moving due to the valgus vector
Are lateral releases performed?
not often done on its own now because it doesn't resolve the problem
What is performed in a lateral release?
fibers of the lateral retinaculum are cut to release the patella and restore normal tilt
What is a major complication that arises from doing a lateral release?
- superior lateral genicular artery is embedded in the tissue
- must cut it, creating a huge hemarthrosis
What is being done now instead of lateral release?
lengthening of the lateral retinaculum
- put sutures in it so it doesn't spread further apart
- VERY new procedure (within the last 2 months)
What is VMO advancement also called?
Why do a reefing procedure?
- balance the soft tissue
- with a lateral release, need to tighten the medial side
Why is VMO advancement such a challenging surgery?
can't see whether or not it's actually balanced
Which is the most important stabilizer of the knee?
medial patello-femoral ligament
When would a MPFL reconstruction be done?
if it ruptures and is macerated and unable to repair it
What is used for MPFL repair?
allograft or autograft (gracilis)
How is an MPFL repair performed?
- tunnel through superior lateral patella
- pull the patella medially
What is the benefit to using suture anchors over drilling through in an MPFL reconstruction?
fewer fractures when anchors put in the patella instead of drilling through it
medial and lateral trochlea are level
What is a trochleoplasty?
- used to correct trochlear dysplasia
- make sulcus deeper and bias it more on the medial side
What are the 4 distal realignments?
- Hauser procedure
- Elmslie Trillat procedure
- Fulkerson's Anteromedialization
- Maquet procedure
Which of the distal realignments is not used anymore?
What are other names for the Maquet procedure?
- tib tub elevation
- salvage procedure
What did the Hauser procedure do?
moved the tibia medially
What is the Elmslie-Trillat procedure?
tibial tuberosity osteotomized and translated medially
What is a potential problem with the Elmslie-Trillat procedure?
may create a patella baja
Which distal realignment procedure is the gold standard?
What occurs in Fulkerson's anteromedialization?
- tibial tuberosity is medialized AND elevated
- decreased PF pressure
What is different about the direction of the cuts in Elmslie-Trillat vs. Fulkerson's anteromedialization?
Fulkerson's is on a diagonal, where Elmslie-Trillat is cut straight across
What type of patient will need the Maquet procedure?
- someone who has a lot of OA/DJD
- trying to take some of the pressure off
- salvage procedure
What happens in the maquet procedure?
- wedge bone in to push the patella anteriorly
- decreases pressure of the patella on the trochlear groove
Atrophy of this muscle is a contributing factor in PFPS
What is the function of the MPFL?
80% of the restraining force on the patella
Where does the MPFL originate?
superior 2/3 of the medial patellar border
Where does the MPFL insert?
- runs posteriorly toward medial femoral epicondyle
- inserts close to the origin of the superficial MCL and slightly distal to the adductor tubercle
What is the limiting factor of an MPFL surgery?
soft tissue healing
What are the types of repairs for MPFL?
- primary repair OR
- allograft reconstruction
Which tendon will be used for an allograft reconstruction for MPFL repair?
2 MPFL rehab protocols
0-90˚ day 1
progressive increase in ROM weekly
rehab protocol for MPFL
- progressive increase in ROM
Week 1: 0
Week 2: 0-30˚
Week 3: 0-45˚
Week 4: 0-60˚
Week 5: 0-75˚
Week 6: 0-90˚
What determines the rehab protocol for MPFL surgery?
When is it safe to begin exercises after a MPFL-R?
depends on the status of the joint
- if PF chondrosis - NO NO NO!
- if no PF chondrosis - okay
increase in PFJR forces during CKC exercises (flexion)
OKC exercise - what movement causes a linear increase in PFJR forces?
from flexion to extension
For OKC exercises, you should exercise within this range to minimize PFJR forces
For CKC exercises, you should exercise within this range to minimize PFJR forces
Draw the PFJR force chart
Draw the PFJR force chart if there are more significant issues in the knee
With more issues in the knee, what is the range for CKC exercises?
With more issues in the knee, what is the range for OKC exercises?