Skip to main content
Top
Published in: Pediatric Radiology 11/2006

01-11-2006 | Original Article

MRI of traumatic patellar dislocation in children

Authors: Ali Zaidi, Paul Babyn, Ivan Astori, Lawrence White, Andrea Doria, William Cole

Published in: Pediatric Radiology | Issue 11/2006

Login to get access

Abstract

Background

Traumatic patellar dislocations (TPD) are common injuries in children, and MRI is useful in evaluation of pediatric musculoskeletal injuries. However, no pediatric studies on the MR features of TPD have been reported.

Objective

To review the injuries after TPD in children.

Materials and methods

Patients with clinical or radiological recognition of TPD and those with suggestive MR findings were selected. Bone, cartilage and soft-tissue injuries and patellofemoral relationships were assessed.

Results

A total of 26 patients (age range 10–18 years) were identified. The following injuries were seen: bone bruising of the inferomedial patella (81% of patients) and the lateral femoral condyle (81% of patients), cartilage injuries of the inferomedial patella (38% of patients) and the lateral femoral condyle (38% of patients), osteochondral fragments (42% of patients) and injuries of the medial patellar restraints (81% of patients).

Conclusion

Pediatric manifestations of TPD seen on MRI are similar to those in adults. TPD is often occult in children. Early recognition of bone bruising of the patella and lateral femoral condyle, associated osteochondral injuries, and medial patellar stabilizer injury is important for timely diagnosis.
Literature
1.
go back to reference Kirsch MD, Fitzgerald SW, Friedman H, et al (1993) Transient lateral patellar dislocation: diagnosis with MR imaging. AJR 161:109–113PubMed Kirsch MD, Fitzgerald SW, Friedman H, et al (1993) Transient lateral patellar dislocation: diagnosis with MR imaging. AJR 161:109–113PubMed
2.
go back to reference Pope TL Jr (2001) MR imaging of patellar dislocation and relocation. Semin Ultrasound CT MR 22:371–382PubMedCrossRef Pope TL Jr (2001) MR imaging of patellar dislocation and relocation. Semin Ultrasound CT MR 22:371–382PubMedCrossRef
3.
go back to reference Quinn SF, Brown TR, Demlow TA (1993) MR imaging of patellar retinacular ligament injuries. J Magn Reson Imaging 3:843–847PubMedCrossRef Quinn SF, Brown TR, Demlow TA (1993) MR imaging of patellar retinacular ligament injuries. J Magn Reson Imaging 3:843–847PubMedCrossRef
4.
go back to reference Spritzer CE (2000) Slip-sliding away: patellofemoral dislocation and tracking. Magn Reson Imaging Clin N Am 8:299–320PubMed Spritzer CE (2000) Slip-sliding away: patellofemoral dislocation and tracking. Magn Reson Imaging Clin N Am 8:299–320PubMed
5.
go back to reference Beasley LS, Vidal AF (2004) Traumatic patellar dislocation in children and adolescents: treatment update and literature review. Curr Opin Pediatr 16:29–36PubMedCrossRef Beasley LS, Vidal AF (2004) Traumatic patellar dislocation in children and adolescents: treatment update and literature review. Curr Opin Pediatr 16:29–36PubMedCrossRef
6.
7.
go back to reference Lance E, Deutsch AL, Mink JH (1993) Prior lateral patellar dislocation: MR imaging findings. Radiology 189:905–907PubMed Lance E, Deutsch AL, Mink JH (1993) Prior lateral patellar dislocation: MR imaging findings. Radiology 189:905–907PubMed
8.
go back to reference Apostolaki E, Cassar-Pullicino VN, Tyrrell PN, et al (1999) MRI appearances of the infrapatellar fat pad in occult traumatic patellar dislocation. Clin Radiol 54:743–747PubMedCrossRef Apostolaki E, Cassar-Pullicino VN, Tyrrell PN, et al (1999) MRI appearances of the infrapatellar fat pad in occult traumatic patellar dislocation. Clin Radiol 54:743–747PubMedCrossRef
9.
go back to reference Ecklund K (2002) Magnetic resonance imaging of pediatric musculoskeletal trauma. Top Magn Reson Imaging 13:203–217PubMedCrossRef Ecklund K (2002) Magnetic resonance imaging of pediatric musculoskeletal trauma. Top Magn Reson Imaging 13:203–217PubMedCrossRef
10.
11.
12.
go back to reference Oeppen RS, Connolly SA, Bencardino JT, et al (2004) Acute injury of the articular cartilage and subchondral bone: a common but unrecognized lesion in the immature knee. AJR 182:111–117PubMed Oeppen RS, Connolly SA, Bencardino JT, et al (2004) Acute injury of the articular cartilage and subchondral bone: a common but unrecognized lesion in the immature knee. AJR 182:111–117PubMed
13.
go back to reference 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 9:139–143PubMedCrossRef 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 9:139–143PubMedCrossRef
14.
go back to reference Swischuk LE, Hernandez JA, Hendrick EP, et al (2003) Lateral femoral condylar shearing fractures. Emerg Radiol 10:19–22PubMed Swischuk LE, Hernandez JA, Hendrick EP, et al (2003) Lateral femoral condylar shearing fractures. Emerg Radiol 10:19–22PubMed
15.
go back to reference 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 225:736–743PubMedCrossRef 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 225:736–743PubMedCrossRef
16.
go back to reference Sanders TG, Morrison WB, Singleton BA, et al (2001) Medial patellofemoral ligament injury following acute transient dislocation of the patella: MR findings with surgical correlation in 14 patients. J Comput Assist Tomogr 25:957–962PubMedCrossRef Sanders TG, Morrison WB, Singleton BA, et al (2001) Medial patellofemoral ligament injury following acute transient dislocation of the patella: MR findings with surgical correlation in 14 patients. J Comput Assist Tomogr 25:957–962PubMedCrossRef
17.
go back to reference Sanders TG, Medynski MA, Feller JF, et al (2000) Bone contusion patterns of the knee at MR imaging: footprint of the mechanism of injury. Radiographics 20:135–151 Sanders TG, Medynski MA, Feller JF, et al (2000) Bone contusion patterns of the knee at MR imaging: footprint of the mechanism of injury. Radiographics 20:135–151
18.
go back to reference Sallay PI, Poggi J, Speer KP, et al (1996) Acute dislocation of the patella. A correlative pathoanatomic study. Am J Sports Med 24:52–60PubMedCrossRef Sallay PI, Poggi J, Speer KP, et al (1996) Acute dislocation of the patella. A correlative pathoanatomic study. Am J Sports Med 24:52–60PubMedCrossRef
19.
go back to reference Wessel LM, Scholz S, Rusch M (2001) Characteristic pattern and management of intraarticular knee lesions in different pediatric age groups. J Pediatr Orthop 21:14–19PubMedCrossRef Wessel LM, Scholz S, Rusch M (2001) Characteristic pattern and management of intraarticular knee lesions in different pediatric age groups. J Pediatr Orthop 21:14–19PubMedCrossRef
20.
go back to reference Strouse PJ, Koujok K (2002) Magnetic resonance imaging of the pediatric knee. Top Magn Reson Imaging 13:277–294PubMedCrossRef Strouse PJ, Koujok K (2002) Magnetic resonance imaging of the pediatric knee. Top Magn Reson Imaging 13:277–294PubMedCrossRef
21.
go back to reference McCauley TR (2002) MR imaging of chondral and osteochondral injuries of the knee. Radiol Clin North Am 40:1095–1107PubMedCrossRef McCauley TR (2002) MR imaging of chondral and osteochondral injuries of the knee. Radiol Clin North Am 40:1095–1107PubMedCrossRef
22.
23.
24.
go back to reference Spritzer CE, Courneya DL, Burk DL Jr, et al (1997) Medial retinacular complex injury in acute patellar dislocation: MR findings and surgical implications. AJR 168:117–122PubMed Spritzer CE, Courneya DL, Burk DL Jr, et al (1997) Medial retinacular complex injury in acute patellar dislocation: MR findings and surgical implications. AJR 168:117–122PubMed
25.
go back to reference Carrillon Y, Abidi H, Dejour D, et al (2000) Patellar instability: assessment on MR images by measuring the lateral trochlear inclination – initial experience. Radiology 216:582–585PubMed Carrillon Y, Abidi H, Dejour D, et al (2000) Patellar instability: assessment on MR images by measuring the lateral trochlear inclination – initial experience. Radiology 216:582–585PubMed
26.
go back to reference Miller TT, Staron RB, Feldman F (1996) Patellar height on sagittal MR imaging of the knee. AJR 167:339–341PubMed Miller TT, Staron RB, Feldman F (1996) Patellar height on sagittal MR imaging of the knee. AJR 167:339–341PubMed
27.
go back to reference Atkin DM, Fithian DC, Marangi KS, et al (2000) Characteristics of patients with primary acute lateral patellar dislocation and their recovery within the first 6 months of injury. Am J Sports Med 28:472–479PubMed Atkin DM, Fithian DC, Marangi KS, et al (2000) Characteristics of patients with primary acute lateral patellar dislocation and their recovery within the first 6 months of injury. Am J Sports Med 28:472–479PubMed
28.
go back to reference Nietosvaara Y, Aalto K, Kallio PE (1994) Acute patellar dislocation in children: incidence and associated osteochondral fractures. J Pediatr Orthop 14:513–515PubMed Nietosvaara Y, Aalto K, Kallio PE (1994) Acute patellar dislocation in children: incidence and associated osteochondral fractures. J Pediatr Orthop 14:513–515PubMed
29.
go back to reference Mashoof AA, Scholl MD, Lahav A, et al (2005) Osteochondral injury to the mid-lateral weight-bearing portion of the lateral femoral condyle associated with patella dislocation. Arthroscopy 21:228–232PubMedCrossRef Mashoof AA, Scholl MD, Lahav A, et al (2005) Osteochondral injury to the mid-lateral weight-bearing portion of the lateral femoral condyle associated with patella dislocation. Arthroscopy 21:228–232PubMedCrossRef
30.
go back to reference Nomura E, Inoue M, Kurimura M (2003) Chondral and osteochondral injuries associated with acute patellar dislocation. Arthroscopy 19:717–721PubMedCrossRef Nomura E, Inoue M, Kurimura M (2003) Chondral and osteochondral injuries associated with acute patellar dislocation. Arthroscopy 19:717–721PubMedCrossRef
31.
go back to reference Ahmad CS, Stein BE, Matuz D, et al (2000) Immediate surgical repair of the medial patellar stabilizers for acute patellar dislocation. A review of eight cases. Am J Sports Med 28:804–810PubMed Ahmad CS, Stein BE, Matuz D, et al (2000) Immediate surgical repair of the medial patellar stabilizers for acute patellar dislocation. A review of eight cases. Am J Sports Med 28:804–810PubMed
32.
go back to reference Nomura E, Inoue M (2003) Surgical technique and rationale for medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Arthroscopy 19:E47PubMedCrossRef Nomura E, Inoue M (2003) Surgical technique and rationale for medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Arthroscopy 19:E47PubMedCrossRef
33.
go back to reference Nomura E (1999) Classification of lesions of the medial patellofemoral ligament in patellar dislocation. Int Orthop 23:260–263PubMedCrossRef Nomura E (1999) Classification of lesions of the medial patellofemoral ligament in patellar dislocation. Int Orthop 23:260–263PubMedCrossRef
34.
go back to reference Virolainen H, Visuri T, Kuusela T (1993) Acute dislocation of the patella: MR findings. Radiology 189:243–246PubMed Virolainen H, Visuri T, Kuusela T (1993) Acute dislocation of the patella: MR findings. Radiology 189:243–246PubMed
Metadata
Title
MRI of traumatic patellar dislocation in children
Authors
Ali Zaidi
Paul Babyn
Ivan Astori
Lawrence White
Andrea Doria
William Cole
Publication date
01-11-2006
Publisher
Springer-Verlag
Published in
Pediatric Radiology / Issue 11/2006
Print ISSN: 0301-0449
Electronic ISSN: 1432-1998
DOI
https://doi.org/10.1007/s00247-006-0293-0

Other articles of this Issue 11/2006

Pediatric Radiology 11/2006 Go to the issue