Top

Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-03-2018 | Knee

Correlation analysis between injury patterns of medial patellofemoral ligament and vastus medialis obliquus after acute first-time lateral patellar dislocation

Authors: Guang-ying Zhang, Lei Zheng, Hao Shi, Wei Liu, Li Zhang, Su-hui Qu, Zheng-wu Bai, Hong-yu Ding

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 3/2018

Abstract

Purpose

To evaluate the correlation between injury patterns of the medial patellofemoral ligament (MPFL) and vastus medialis obliquus (VMO) after acute first-time lateral patellar dislocation (LPD) in adults.

Methods

Magnetic resonance imaging (MRI) was prospectively performed in 132 consecutive adults with acute first-time LPD. Images were acquired and evaluated using standardized protocols. Injury patterns of MPFL were grouped by location and severity for analysis of the prevalence of VMO injury.

Results

MRI demonstrated VMO injury in 63 (47.7%) patients. Twenty (38.5%) and 43 cases (56.6%) were present in partial and complete MPFL tear subgroups, respectively. Compared with partial MPFL tears, complete tears showed a higher prevalence of VMO injury (P = 0.044). The mean coronal (28.5 mm) and mean sagittal VMO elevations (20.7 mm) were higher in the complete MPFL tear subgroup than in the partial tear subgroup (19.8 mm, P = 0.005; 11.9 mm, P < 0.001). No correlations were identified between the prevalence of VMO injury and location subgroups of MPFL injury (n.s.). Mean VMO elevations were higher in isolated femoral-side (FEM) and combined MPFL tear (COM) subgroups (mean coronal VMO elevation of 29 mm and mean sagittal VMO elevation of 20.8 mm in the FEM subgroup; mean coronal VMO elevation of 29.6 mm and mean sagittal VMO elevation of 23.1 mm in the COM subgroup) than in the isolated patellar-side MPFL tear (PAT) subgroup (P = 0.022, P < 0.001) (mean coronal VMO elevation of 20.7 mm and mean sagittal VMO elevation of 10.6 mm).

Conclusions

Complete MPFL tear predisposes to VMO injury and has a higher elevation of torn VMO after acute first-time LPD in adults. Isolated femoral-side and combined MPFL tears predispose to higher elevation of torn VMO.

Level of evidence

IV.

Ahmad CS, Stein BE, Matuz D, Henry JH (2000) Immediate surgical repair of the medial patellar stabilizers for acute patellar dislocation. A review of eight cases. Am J Sports Med 28:804–810CrossRefPubMed

Aragão JA, Reis FP, de Vasconcelos DP, Feitosa VL, Nunes MA (2008) Metric measurements and attachment levels of the medial patellofemoral ligament: an anatomical study in cadaver. Clinics 63:541–544CrossRefPubMedPubMedCentral

Balcarek P, Ammon J, Frosch S, Walde TA, Schüttrumpf JP, Ferlemann KG et al (2010) Magnetic resonance imaging characteristics of the medial patellofemoral ligament lesion in acute lateral patellar dislocations considering trochlear dysplasia, patella alta, and tibial tuberosity-trochlear groove distance. Arthroscopy 26:926–935CrossRefPubMed

Balcarek P, Jung K, Ammon J, Walde TA, Frosch S, Schüttrumpf JP et al (2010) Anatomy of lateral patellar instability: trochlear dysplasia and tibial tubercle-trochlear groove distance is more pronounced in women who dislocate the patella. Am J Sports Med 38:2320–2327CrossRefPubMed

Balcarek P, Walde TA, Frosch S, Schüttrumpf JP, Wachowski MM, Stürmer KM (2012) MRI but not arthroscopy accurately diagnoses femoral MPFL injury in first-time patellar dislocations. Knee Surg Sports Traumatol Arthrosc 20:1575–1580CrossRefPubMed

Balcarek P, Walde TA, Frosch S, Schüttrumpf JP, Wachowski MM, Stürmer KM et al (2011) Patellar dislocations in children, adolescents and adults: a comparative MRI study of medial patellofemoral ligament injury patterns and trochlear groove anatomy. Eur J Radiol 79:415–420CrossRefPubMed

Brown GD, Ahmad CS (2008) Combined medial patellofemoral ligament and patellotibial ligament reconstruction in skeletally immature patients. J Knee Surg 21:328–332CrossRefPubMed

Buckens CF, Salis DB (2010) Reconstruction of the medial patellofemoral ligament for treatment of patellofemoral instability. A systematic review. Am J Sports Med 38:181–188CrossRefPubMed

Camanho GL, Viegas Ade C, Bitar AC, Demange MK, Hernandez AJ (2009) Conservative versus surgical treatment for repair of the medial patellofemoral ligament in acute dislocations of the patella. Arthroscopy 25:620–625CrossRefPubMed

10.

Casteleyn PP, Handelberg F (1989) Arthroscopy in the diagnosis of occult dislocation of the patella. Acta Orthop Belg 55:381–383PubMed

11.

Christiansen SE, Jakobsen BW, Lund B, Lind M (2008) Isolated repair of the medial patellofemoral ligament in primary dislocation of the patella: a prospective randomized study. Arthroscopy 24:881–887CrossRefPubMed

12.

Conlan T, Garth WP Jr, Lemons JE (1993) Evaluation of the medial soft-tissue restraints of the extensor mechanism of the knee. J Bone Joint Surg Am 75:682–693CrossRefPubMed

13.

Dejour D, Saggin P (2010) The sulcus deepening trochleoplasty: the Lyon’s procedure. Int Orthop 34:311–316CrossRefPubMedPubMedCentral

14.

Desio SM, Burks RT, Bachus KN (1998) Soft tissue restraints to lateral patellar translation in the human knee. Am J Sports Med 26:59–65CrossRefPubMed

15.

Duthon VB (2015) Acute traumatic patellar dislocation. Orthop Traumatol Surg Res 101(1 Suppl):S59–S67CrossRefPubMed

16.

Elias DA, White LM, Fithian DC (2002) Acute lateral patellar dislocation at MR imaging: injury patterns of medial patellar soft-tissue restraints and osteochondral injuries of the inferomedial patella. Radiology 225:736–743CrossRefPubMed

17.

Feller JA, Feagin JA Jr, Garrett WE Jr (1993) The medial patellofemoral ligament revisited: an anatomical study. Knee Surg Sports Traumatol Arthrosc 1:184–186CrossRefPubMed

18.

Giordano M, Falciglia F, Aulisa AG, Guzzanti V (2012) Patellar dislocation in skeletally immature patients: semitendinosous and gracilis augmentation for combined medial patellofemoral and medial patellotibial ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 20:1594–1598CrossRefPubMed

19.

Goh JC, Lee PY, Bose K (1995) A cadaver study of the function of the oblique part of vastus medialis. J Bone Joint Surg Br 77:225–231CrossRefPubMed

20.

Hautamaa PV, Fithian DC, Kaufman KR, Daniel DM, Pohlmeyer AM (1998) Medial soft tissue restraints in lateral patellar instability and repair. Clin Orthop Relat Res 349:174–182CrossRef

21.

Hinton RY, Sharma KM (2003) Acute and recurrent patellar instability in the young athlete. Orthop Clin North Am 34:385–396CrossRefPubMed

22.

Kramer DE, Simoni MK (2013) Horizontal intra-articular patellar dislocation resulting in quadriceps avulsion and medial patellofemoral ligament tear: a case report. J Pediatr Orthop B 22:329–332CrossRefPubMed

23.

Lippacher S, Dejour D, Elsharkawi M, Dornacher D, Ring C, Dreyhaupt J et al (2012) Observer agreement on the Dejour trochlear dysplasia classification: a comparison of true lateral radiographs and axial magnetic resonance images. Am J Sports Med 40:837–843CrossRefPubMed

24.

Nomura E, Horiuchi Y, Inoue M (2002) Correlation of MR imaging findings and open exploration of medial patellofemoral ligament injuries in acute patellar dislocations. Knee 9:139–143CrossRefPubMed

25.

Panagiotopoulos E, Strzelczyk P, Herrmann M, Scuderi G (2006) Cadaveric study on static medial patellar stabilizers: the dynamizing role of the vastus medialis obliquus on medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc 14:7–12CrossRefPubMed

26.

Petri M, Liodakis E, Hofmeister M, Despang FJ, Maier M, Balcarek P et al (2013) Operative vs conservative treatment of traumatic patellar dislocation: results of a prospective randomized controlled clinical trial. Arch Orthop Trauma Surg 133:209–213CrossRefPubMed

27.

Philippot R, Boyer B, Testa R, Farizon F, Moyen B (2012) The role of the medial ligamentous structures on patellar tracking during knee flexion. Knee Surg Sports Traumatol Arthrosc 20:331–336CrossRefPubMed

28.

Sallay PI, Poggi J, Speer KP, Garrett WE (1996) Acute dislocation of the patella. A correlative pathoanatomic study. Am J Sports Med 24:52–60CrossRefPubMed

29.

Sanders TG, Morrison WB, Singleton BA, Miller MD, Cornum KG (2001) Medial patellofemoral ligament injury following acute transient dislocation of the patella: MR findings with surgical correlation in 14 patients. J Comput Assist Tomogr 25:957–962CrossRefPubMed

30.

Seeley M, Bowman KF, Walsh C, Sabb BJ, Vanderhave KL (2012) Magnetic resonance imaging of acute patellar dislocation in children: patterns of injury and risk factors for recurrence. J Pediatr Orthop 32:145–155CrossRefPubMed

31.

Sillanpää PJ, Mäenpää HM, Mattila VM, Visuri T, Pihlajamäki H (2008) Arthroscopic surgery for primary traumatic patellar dislocation: a prospective, nonrandomized study comparing patients treated with and without acute arthroscopic stabilization with a median 7-year follow-up. Am J Sports Med 36:2301–2309CrossRefPubMed

32.

Sillanpää PJ, Peltola E, Mattila VM, Kiuru M, Visuri T, Pihlajamäki H (2009) Femoral avulsion of the medial patellofemoral ligament after primary traumatic patellar dislocation predicts subsequent instability in men: a mean 7-year nonoperative follow-up study. Am J Sports Med 37:1513–1521CrossRefPubMed

33.

Sillanpää PJ, Salonen E, Pihlajamäki H, Mäenpää HM (2014) Medial patellofemoral ligament avulsion injury at the patella: classification and clinical outcome. Knee Surg Sports Traumatol Arthrosc 22:2414–2418CrossRefPubMed

34.

Smirk C, Morris H (2003) The anatomy and reconstruction of the medial patellofemoral ligament. Knee 10:221–227CrossRefPubMed

35.

Wissman RD, Verma S, Kreeger M, Robertson M (2009) Extensor mechanism injuries in tibiofemoral dislocations. J Comput Assist Tomogr 33:145–149CrossRefPubMed

36.

Zhang GY, Zheng L, Ding HY, Li EM, Sun BS, Shi H (2015) Evaluation of medial patellofemoral ligament tears after acute lateral patellar dislocation: comparison of high-frequency ultrasound and MR. Eur Radiol 25:274–281CrossRefPubMed

37.

Zhang GY, Zheng L, Feng Y, Shi H, Liu W, Ji BJ et al (2015) Injury patterns of medial patellofemoral ligament and correlation analysis with articular cartilage lesions of the lateral femoral condyle after acute lateral patellar dislocation in adults: an MRI evaluation. Injury 46:2413–2421CrossRefPubMed

38.

Zheng L, Shi H, Feng Y, Sun BS, Ding HY, Zhang GY (2015) Injury patterns of medial patellofemoral ligament and correlation analysis with articular cartilage lesions of the lateral femoral condyle after acute lateral patellar dislocation in children and adolescents: an MRI evaluation. Injury 46:1137–1144CrossRefPubMed

Title: Correlation analysis between injury patterns of medial patellofemoral ligament and vastus medialis obliquus after acute first-time lateral patellar dislocation
Authors: Guang-ying Zhang
Lei Zheng
Hao Shi
Wei Liu
Li Zhang
Su-hui Qu
Zheng-wu Bai
Hong-yu Ding
Publication date: 01-03-2018
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 3/2018
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-016-4408-3

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Correlation analysis between injury patterns of medial patellofemoral ligament and vastus medialis obliquus after acute first-time lateral patellar dislocation

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Please log in to get access to this content

Other articles of this Issue 3/2018

Return to sport activities after medial displacement calcaneal osteotomy and flexor digitorum longus transfer

Development of an accelerated functional rehabilitation protocol following minimal invasive Achilles tendon repair

Functional testing and return to sport following stabilization surgery for recurrent lateral patellar instability in competitive athletes

Arthroscopic meniscus repair for recurrent subluxation of the lateral meniscus

Gluteus maximus contraction velocity assessed by tensiomyography improves following arthroscopic treatment of femoroacetabular impingement

The interaction between the vastus medialis and vastus intermedius and its influence on the extensor apparatus of the knee joint