04 Patellofemoral 2 Flashcards Preview

7212 Pathophysiology > 04 Patellofemoral 2 > Flashcards

Flashcards in 04 Patellofemoral 2 Deck (55):
1

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

2

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

3

What are LAACS and TONES?

ways to classify patients

4

What are the general PF surgical procedures?

- release tight lateral retinaculum
- reposition VMO attachment
- tighten, advance, or repair medial soft tissues
- reposition tibial tuberosity

5

What are the terms to indicate surgical shortening?

- plication
- imbrication
- reefing
- "vest over pants"
- capsulorraphy

6

What are the 4 proximal realignments?

- femoral trochleoplasty (osteotomy)
- lateral release
- VMO advancement (reefing)
- MPFL-R

7

What will they do if they do something for the lateral side of the knee?

- use a balancing approach
- make adjustments medially as well

8

Which trochlea is higher?

lateral

9

What does the lateral trochlea do?

helps create a bony buttress to prevent the patella from moving due to the valgus vector

10

Are lateral releases performed?

not often done on its own now because it doesn't resolve the problem

11

What is performed in a lateral release?

fibers of the lateral retinaculum are cut to release the patella and restore normal tilt

12

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

13

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)

14

What is VMO advancement also called?

reefing

15

Why do a reefing procedure?

- balance the soft tissue
- with a lateral release, need to tighten the medial side

16

Why is VMO advancement such a challenging surgery?

can't see whether or not it's actually balanced

17

Which is the most important stabilizer of the knee?

MPFL

18

MPFL

medial patello-femoral ligament

19

When would a MPFL reconstruction be done?

if it ruptures and is macerated and unable to repair it

20

What is used for MPFL repair?

allograft or autograft (gracilis)

21

How is an MPFL repair performed?

- tunnel through superior lateral patella
- pull the patella medially

22

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

23

trochlear dysplasia

medial and lateral trochlea are level

24

What is a trochleoplasty?

- osteotomy
- used to correct trochlear dysplasia
- make sulcus deeper and bias it more on the medial side

25

What are the 4 distal realignments?

- Hauser procedure
- Elmslie Trillat procedure
- Fulkerson's Anteromedialization
- Maquet procedure

26

Which of the distal realignments is not used anymore?

Hauser procedure

27

What are other names for the Maquet procedure?

- tib tub elevation
- salvage procedure

28

What did the Hauser procedure do?

moved the tibia medially

29

What is the Elmslie-Trillat procedure?

tibial tuberosity osteotomized and translated medially

30

What is a potential problem with the Elmslie-Trillat procedure?

may create a patella baja

31

Which distal realignment procedure is the gold standard?

Fulkerson's anteromedialization

32

What occurs in Fulkerson's anteromedialization?

- tibial tuberosity is medialized AND elevated
- decreased PF pressure

33

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

34

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

35

What happens in the maquet procedure?

- wedge bone in to push the patella anteriorly
- decreases pressure of the patella on the trochlear groove

36

Atrophy of this muscle is a contributing factor in PFPS

VMO

37

What is the function of the MPFL?

80% of the restraining force on the patella

38

Where does the MPFL originate?

superior 2/3 of the medial patellar border

39

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

40

What is the limiting factor of an MPFL surgery?

soft tissue healing

41

What are the types of repairs for MPFL?

- primary repair OR
- allograft reconstruction

42

Which tendon will be used for an allograft reconstruction for MPFL repair?

semitendinosus

43

2 MPFL rehab protocols

0-90˚ day 1

OR

progressive increase in ROM weekly

44

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˚

45

What determines the rehab protocol for MPFL surgery?

surgeon dependent

46

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

47

increase in PFJR forces during CKC exercises (flexion)

almost linear

48

OKC exercise - what movement causes a linear increase in PFJR forces?

from flexion to extension

49

For OKC exercises, you should exercise within this range to minimize PFJR forces

45-90˚

50

For CKC exercises, you should exercise within this range to minimize PFJR forces

0-45˚

51

Draw the PFJR force chart

:)

52

Draw the PFJR force chart if there are more significant issues in the knee

:p

53

With more issues in the knee, what is the range for CKC exercises?

0-30˚

54

With more issues in the knee, what is the range for OKC exercises?

60-90˚

55

Why is the Hauser procedure no longer used?

- medial translation of the tubercle also moves it posteriorly
- causes increased PF contact
- leads to more DJD problems