lateral patellar retinaculum injury radiology

Frequently underdiagnosed, the patellofemoral friction syndrome, also called Hoffa's fat cushion compression syndrome, is mainly represented by 2 characteristic symptoms, which are mainly found in women (especially if they present obesity or rapid weight gain, as in pregnancy): patellofemoral pain and instability in the patellar . Diederichs G, Issever A, Scheffler S. MR Imaging of Patellar Instability: Injury Patterns and Assessment of Risk Factors. The patella remains laterally shifted (blue arrow) and an osteochondral injury of the medial patella (arrowheads) is apparent. Prior lateral patellar dislocation: MR imaging findings. At the time the article was last revised Mohamed Saber had The radiograph can also be useful in detecting osseous morphologic features associated with patellar maltracking such as patella alta and trochlear dysplasia [24, 25]. 2010. 2011;39(8):1756-1761. Knee Surg Sports Traumatol Arthrosc 14:235240, Article (6a) A more distal T1-weighted image reveals fibers of the oblique decussation of the MPFL which blend with the medial collateral ligament (MCL). From the inside of the knee the lateral retinaculum is incised, from the inside, allowing the kneecap to untilit itself. It is measured at the mid-point of the patella on the axial slices [48]. The typical injury pattern is a tear of the medial patellofemoral ligament (MPFL) and bone bruises of the patella and the lateral femoral condyle. . Femoral condylar chondral injuries occur during the dislocation phase due to impaction shearing forces of the patella upon the flexed femur, typically occurring at the weightbearing surface. The two features are associated with patellar maltracking. 4). TT-TG assessment has its own limitations. The lateral trochlear articular surface is usually more prominent than its medial portion. AIM: To describe the sonographic appearances of the medial retinacular (MPFR) complex of the knee in patients with acute and recurrent patellar dislocation.MATERIALS AND METHODS: Thirty patients were scanned within 2-4 weeks of an acute episode of lateral patellar dislocation. Medial patellofemoral ligament injury following acute transient dislocation of the patella: MR findings with surgical correlation in 14 patients. The adductor magnus tendon (AT) attaches to the adductor tubercle, which lies posterior and superior to the femoral attachment of the MPFL. The anatomic relationship between the resultant force from the quadriceps and the line of pull of the patellar tendon is termed the Q angle and is normally 1015 of valgus [11]. Dejour et al. Patients who experience multiple patellar dislocations are more likely to have anatomical variants of the trochlea, patellar alta, or tibial tubercle lateralization. 1-B).Determine the possibility of a difficult knee revelation (following the medial parapatellar arthrotomy) owed to limited knee flexion, a lack of patellar mass, and patella baja when view on a lateral knee radiograph. (28a) A sagittal proton density-weighted image demonstrates the typical hardware location in a patient status post medialization of the tibial tuberosity (arrow). It can be divided into nonoperative and operative management. 9). The Medial Patellofemoral Ligament (MPFL) is an hour-glass shaped ligament made of bands of retinacular tissue. Retinaculum - Differential Diagnosis of the Knee Infrapatellar (Hoffas) fat pad impingement is recognized as a cause of anterior knee pain. Patellofemoral Pain Syndrome - OrthoInfo - AAOS The patella remains laterally subluxed and tilted, and the patient has an abnormally shallow trochlear groove (line). Physical therapy is directed to increasing range of motion and to strengthening the VMO and quadriceps muscles. Skeletal Radiol 38:785790, Campagna R, Pessis E, Biau DJ et al (2012) Is superolateral Hoffa fat pad edema a consequence of impingement between lateral femoral condyle and patellar ligament? In full extension, the patella has little to no contact with the trochlear groove and, therefore, is in a position of higher risk for instability. CAS 1. Inferiorly, components of the medial retinaculum blend with the patellar tendon. . The most important soft tissue passive stabilizers involved in patellofemoral dislocation injuries have traditionally been referred to as the MPFL and the medial retinaculum. Hemarthrosis is rare in lateral patellar sleeve fractures, as the lateral pole is not as vascularized as the inferior pole of the patella that has the most important blood supply of patella [5 ]. Open Orthop J. Patella alta is related to a long patellar tendon and is considered a major factor associated with reduced contact area at the patellofemoral joint and a major contributor to patellar instability [33]. Division of Sports Trauma, Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark. Clinical History: A 23 year-old female presents with medial knee pain following a twisting injury. Observer Agreement on the Dejour Trochlear Dysplasia Classification: A comparison of true lateral radiographs and axial magnetic resonance images. It was shown that certain features of patellar maltracking (increased sulcus angle, lateral patellar tilt, and a higher patellar tendon to patellar length ratio) are associated with cartilage loss and bone marrow lesions [59]. What is the treatment for a patellar retinaculum tear? 2000; 216:858-864. Lateral patellar retinaculum. The authors declare that they have no competing interests. (9a) The Insall-Salvati Index is determined by dividing the length of the patellar tendon (PT) by the length of the patella (PL). Pedersen ME, DaCambra MP, Jibri Z, Dhillon S, Jen H, Jomha NM. Value of the tibial tuberosity-trochlear groove distance in patellar instability in the young athlete. 1). Analysis with magnetic resonance imaging. PFA of 0 or if it opens medially (negative value) is considered abnormal indicating lateral patellar tilt [27, 48]. These measurements are not routinely recorded in the MRI report, but in select situations may be helpful in quantifying low-grade versus high-grade dysplasia. Kirsch M, Fitzgerald S, Friedman H, Rogers L. Transient Lateral Patellar Dislocation: Diagnosis with MR Imaging. Zaid Jibri. The angle between the two lines is the lateral trochlear inclination (LTI). On the other hand, frank patellar dislocation is a significant risk factor in the development of patellofemoral osteoarthritis with an incidence of 49% at 25years after the patellar dislocation incident in comparison with 8% in a control group without a dislocation history [60]. 2 Baldwin JL. This is measured on the sagittal MRI images at the point where the patella is at its greatest length. Features that may predispose to patellar dislocation and/or patellar maltracking and can be evaluated with CT include patellar and trochlear morphology and the alignment between the two structures. The distance (double-headed arrow) from the deepest point of the trochlea (line B) to the middle of the tibial tubercle (line A) is measured, again by using the posterior plane of the condyles as the reference line (line C). Acute lateral patellar dislocation at MR imaging: injury patterns of medial patellar soft-tissue restraints and osteochondral injuries of the inferomedial patella. Complete disruption and avulsion are seen as discontinuity of ligament fibers with associated edema [50]. The ensuing loss of medial restraint favors future patellar dislocations, especially if additional risk factors are present. In order for the patella to engage with the femoral trochlea, a higher degree of flexion than normal is needed. In this section, we will emphasize the role of MRI and discuss how CT can also have value when assessing patellar maltracking. Osteochondral injuries of the inferomedial patella are seen in up to 70% of patellofemoral dislocations. Stress and shear forces that follow can result in cartilage damage and the development and evolution of osteoarthritis [57]. Focal Defect at the LPR on Clinical Knee MRI and a Cadaveric Study Musculoskeletal Imaging Original Research. It is therefore recommended that radiologists include measurement of TT-TG in reports on patients who undergo MRI for patellar instability. Patellar maltracking: an update on the diagnosis and treatment strategies, https://doi.org/10.1186/s13244-019-0755-1, http://creativecommons.org/licenses/by/4.0/. Tears of the medial retinaculum and the MPFL are commonly present at both the patellar and femoral attachments, though tears of the transverse band of the MPFL are more likely at the femoral attachment. This can provide a road map of developing a treatment strategy that would be primarily aimed at stabilizing the patellofemoral joint and halt the progression of cartilage loss. Epub 2010 Mar 8. The MPFL is also stripped from the femoral attachment (long arrow). Trochlear depth=[(a+b)/2]c, Lateral trochlear inclination measurement on axial MRI. MRI and operative studies have revealed that it is almost . Knee Surg Sports Traumatol Arthrosc 15:13011314, Tom A, Fulkerson JP (2007) Restoration of native medial patellofemoral ligament support after patella dislocation. U.S. Army Health Clinic Grafenwoehr U.S. Army Health Clinic Grafenwhr is located on Tower Barracks and provides quality ambulatory care for more than 15,000 Soldiers and their families, while coordinating and facilitating inpatient and specialty care with nearby German host nation medical facilities and DoD partners. Medial patellar. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Patellar maltracking occurs as a result of imbalance of this relationship often secondary to anatomic morphologic abnormality. ADVERTISEMENT: Supporters see fewer/no ads. Sports Health 3:170174, Stensdotter AK, Hodges PW, Mellor R, Sundelin G, Hger-Ross C (2003) Quadriceps activation in closed and in open kinetic chain exercise. The MPFL plays a significant role in the stabilization of the medial aspect of the patella.Especially during the early stages of knee flexion, the MPFL is a critical component in patellar tracking and stability within the trochlear groove. Patella alta persists in this patient. Failure to identify or treat injury to the patellar retinaculum is associated with recurrent patellar instability and contributes to significant morbidity. Between 15 and 45% of patients will develop recurrent patellar instability after acute dislocation, which is both functionally limiting and painful [17,18,19,20]. Areas of scarring and osteochondral lesions become more common as the frequency of patellar dislocation increases. Fluid extending into the VMO myotendinous junction is generally seen in the setting of coexisting MPFL/retinacular tears. The literature in this field has been extremely heterogeneous, and this has made clinical guidelines difficult to produce. J Bone Joint Surg Br 87:3640, Wechter J, Macalena J, Arendt EA (1994) Lateral patella dislocations: history, physical exam, and imaging. 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. 1Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, 149 Sangil-dong, Gangdong-gu, Seoul 134-727, Korea. Disclaimer. There are a number of MRI features of trochlear dysplasia including reduction in the trochlear depth, lateral trochlear inclination, and facet asymmetry. Lateral patellar dislocation refers to lateral displacement followed by dislocation of the patelladue to disruptive changes to the medial patellar retinaculum. Laxity of the medial stabilizers will lead to increasing instability over time. Provided by the Springer Nature SharedIt content-sharing initiative. It is the angle between a line tangential to the subchondral bone of the posterior aspect of the femoral condyles and a line along the lateral trochlear facet. Guidelines and Gamuts in Musculoskeletal Ultrasound. The Anterolateral Ligament of the Knee: MRI Appearance, Association Prevalence of Lateral Patellofemoral Maltracking and Associated Complications in Patients with Osgood Schlatter Disease. Arthroscopy 32:929943, Dejour D, Saggin P (2010) The sulcus deepening trochleoplastythe Lyons procedure. Patellar dislocation accounts for ~3% of all knee injuries and is commonly seen in those individuals who participate in sports activities. Medial patellar chondral injuries may occur during either the dislocation or reduction phases of injury. Lateral patellar dislocation | Radiology Reference Article A ratio of >1.3 is considered indicative of patella alta [34] (Fig. MRI, given its superior soft tissue contrast and multi-planar capability, has emerged as the modality of choice in evaluating articular cartilage abnormalities. statement and In these patients, a triad of findings that included focal impaction injuries involving the lateral femoral condyle, osteochondral injuries of the medial patellar facet, and injuries of the medial retinacular ligament were seen. The TT-TG distance can be influenced by the degree of knee flexion (reduces with flexion), and it is also smaller upon weight bearing [41]. The AIUM Practice Parameter for the Performance of the Musculoskeletal Acute lateral patellar dislocation at MR imaging: injury patterns of

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