Die Therapie der Patellaluxation: eine systematische Literaturanalyse

Zusammenfassung

Studienziel: Die Diagnostik und Therapie der Patellaluxation wird immer differenzierter und komplexer. Ziel der vorliegenden Arbeit ist es, einen Überblick über biomechanische Grundlagen des Femoropatellargelenks sowie über aktuelle Trends in der Diagnostik und Therapie der Patellaluxation zu geben. Methode: Wir führten eine systematische Literaturrecherche in den elektronischen Datenbanken Medline, Cochrane und Embase durch. Dabei wurde nach Studien über die Biomechanik des Patellofemoralgelenks sowie über konservative und operative Therapieverfahren bei Patellaluxation gesucht. Ergebnisse: In der Studie werden zunächst demografische Daten sowie die Biomechanik des Femoropatellargelenks vorgestellt. Ein konservatives Vorgehen wird im Allgemeinen bei primärer Patellaluxation ohne begleitende osteochondrale Läsion und ohne wesentliche Risikofaktoren für eine Reluxation empfohlen. In der operativen Therapie werden die niedrigsten Reluxationsraten derzeit für die Augmentation des medialen patellofemoralen Ligaments (MPFL) beschrieben. Auch bei Trochleadysplasie kann eine MPFL-Augmentation erfolgreich durchgeführt werden. Die mediale Dopplung zeigt in der Literatur sehr inhomogene Ergebnisse. Möglicherweise wird dieses Verfahren nicht allen Pathologien, die zu einer Patellaluxation führen, gerecht. Eine entsprechend der Rupturlokalisation adressierte Naht des MPFLs, insbesondere bei Erstluxation mit begleitenden Risikofaktoren für eine Reluxation, scheint sinnvoller zu sein. Ein Lateral Release kann die Instabilität aggravieren, sodass die Indikation sehr zurückhaltend gestellt werden sollte. Bei Gonarthrose im höheren Lebensalter kann das Lateral Release zu einer Beschwerdelinderung führen, bei chronisch-persistierender Patellaluxation ist es unter Umständen notwendig. Bei einer Medialisierung der Tuberositas tibiae sollte der TTTG-(tibial tuberosity trochlear groove-)Abstand gemessen werden und bei pathologischen Werten für eine verbesserte Patellaführung die Tuberositas entsprechend medialisiert werden. Bei Knorpelschäden an der medialen Patellafacette ist eine Medialisierung der Tuberositas kontraindiziert. Bei Knorpelschäden an der lateralen Facette kann neben knorpelchirurgischen Maßnahmen auch eine Anteromedialisierung der Tuberositas Erfolg versprechend sein. Die Osteotomien der Tuberositas können auch mit einer MPFL-Augmentation erfolgreich kombiniert werden. Im Wachstumsalter ist aus unserer Sicht nach wie vor die mediale Dopplung das Standardverfahren. Zusätzlich kann bei Patellamaltracking ein subperiostales Weichteilrelease mit Medialisierung des Patellasehnenansatzes an der Tuberositas tibiae durchgeführt werden. Schlussfolgerung: Die Biomechanik des Femoropatellargelenks stellt die Grundlage für das Verständnis pathologischer Vorgänge der Patellaluxation dar und ist somit entscheidend bei der Wahl eines adäquaten Therapieverfahrens. Für die patellofemorale Instabilität ist ein Zusammenspiel heterogener, morphologischer Risikofaktoren in Verbindung mit individuellen, prädisponierenden Faktoren in der Anamnese des Patienten ursächlich. Patellaerstluxationen ohne wesentliche Risikofaktoren sollten konservativ behandelt werden. In der operativen Therapie lässt sich ein Trend dahingehend feststellen, die essenzielle Pathomorphologie zu identifizieren und diese gezielt operativ anzugehen.

Abstract

Aim: The diagnosis and treatment of patellar dislocation is very complex. The aim of this study is to give an overview of the biomechanics of the patellofemoral joint and to point out the latest developments in diagnosis and treatment of patellar dislocation. Method: The authors electronically searched Medline, Cochrane and Embase for studies on the biomechanics of the patellofemoral joint and for conservative and surgical treatments after patellar dislocation. We extracted baseline demographics, biomechanical, conservation and surgical details. Results: Understanding the biomechanics of the patellofemoral joint is necessary to understand the pathology of patellar dislocation. The patellofemoral joint consists of a complex system of static, active and passive stabilising factors. Patellar instability can result from osseous and soft-tissue abnormalities, such as trochlear dysplasia, patella alta, a high tibial tuberosity trochlear groove (TTTG) distance, weaknesses of the vastus medialis obliquus or a lesion of the medial retinaculum. Recent studies have focused on the medial patellofemoral ligament (MPFL) and have shown that the MPFL is the most significant passive stabiliser of the patella. Following patellar dislocation, an MRI should be standard practice to detect an MPFL rupture, osteochondral lesions or other risk factors for redislocation. An acute first-time patellar dislocation without osteochondral lesions and without severe risk factors for a redislocation should follow a conservative treatment plan. If surgical treatment is required, the best postoperative results occur when the MPFL is reconstructed, leading to a redislocation rate of 5 %, this includes cases that have a dysplastic trochlea. Duplication of the medial retinaculum show very inconsistent results in the literature, possibly due to the fact that the essential pathomorphology of patellar dislocation is not addressed. Addressing the exact location of the rupture of the MPFL with a suture is possibly more convenient, especially after first-time dislocation with associated risk factors for a redislocation. Recent literature does not encourage the use of lateral release, since this can increase patellar instability. Indications for lateral release include persistent patellar instability or pain reduction in an older arthritic subject. For correcting a patellofemoral malalignment, the TTTG distance should be measured and a medial transposition of the anterior tibial tubercle hinged on a distal periosteal attachment should be considered. Cartilage lesions on the medial facet of the patella are a contra-indication for medial tubercle transposition. For cartilage lesions of the lateral facet, antero-medialization of the tibial tubercle can be successful. A tubercle osteotomy can be efficiently combined with MPFL reconstruction. We believe that patients with open epiphyseal plates should be treated with duplication of the medial retinaculum. In the presence of patellar maltracking, an additional subperiostal soft tissue release with medialisation of the distal part of the patellar tendon can be performed. Conclusion: It seems that the predominating factors for patellar dislocation are heterogenic morphology in combination with individual predisposition. Non-surgical treatment is typically recommended for primary patellar dislocation without any osteochondral lesions and in the absence of significant risk factors for redislocation. If surgical treatment is deemed necessary, addressing the essential pathomorphology has become the primary focus.

Schlüsselwörter

Patellaluxation - patellare Instabilität - Therapie - Biomechanik - Literaturanalyse

Key words

patellar dislocation - patellar instability - therapy - biomechanics - literature analysis

Literatur

• 1 Atkin D M, Fithian D C, Marangi K S et al. Characteristics of patients with primary acute lateral patellar dislocation and their recovery within the first 6 months of injury.  Am J Sports Med. 2000;  28 472-479
• 2 Aglietti P, Buzzi R, Insall J. Disorders of the patellofemoral Joint. In: Insall J, Scott W, eds. Surgery of the Knee. 3rd ed. New York, NY: Churchill Livingstone; 2001: 913-1042
• 3 Stefancin J J, Parker R D. First-time traumatic patellar dislocation: a systematic review.  Clin Orthop Relat Res. 2007;  455 93-101
• 4 Cofield R H, Bryan R S. Acute dislocation of the patella: results of conservative treatment.  J Trauma. 1977;  17 526-531
• 5 Larsen E, Lauridsen F. Conservative treatment of patellar dislocations: influence of evident factors on the tendency to redislocation and the therapeutic result.  Clin Orthop Relat Res. 1982;  171 131-136
• 6 Cash J D, Hughston J C. Treatment of acute patellar dislocation.  Am J Sports Med. 1988;  16 244-249
• 7 Henry J, Crosland J. Conservative treatment of patellofemoral subluxation.  Am J Sports Med. 1979;  7 12-14
• 8 Hawkins R J, Bell R H, Anisette G. Acute patellar dislocations: the natural history.  Am J Sports Med. 1986;  14 117-120
• 9 Fithian D C, Paxton E W, Stone M L et al. Epidemiology and natural history of acute patellar dislocation.  Am J Sports Med. 2004;  32 1114-1121
• 10 Nietosvaara Y, Aalto K, Kallio P E. Acute patellar dislocation in children: incidence and associated osteochondral fractures.  J Pediatr Orthop. 1994;  14 513-515
• 11 Beasley L S, Vidal A F. Traumatic patellar dislocation in children and adolescents: treatment update and literature review.  Curr Opin Pediatr. 2004;  16 29-36
• 12 Hinton R Y, Sharma K M. Acute and recurrent patellar instability in the young athlete.  Orthop Clin North Am. 2003;  34 385-396
• 13 Nakagawa K, Wada Y, Minamide M et al. Deterioration of long-term clinical results after the Elmslie-Trillat procedure for dislocation of the patella.  J Bone Joint Surg [Br]. 2003;  85 933
• 14 Mäenpää H, Lehto M U. Patellofemoral osteoarthritis after patellar dislocation.  Clin Orthop Relat Res. 1997;  339 156-162
• 182 Crosby E B, Insall J. Recurrent dislocation of the patella. Relation of treatment to osteoarthritis.  J Bone Joint Surg [Am]. 1976;  58 9-13
• 15 MacNab I. Recurrent dislocation of the patella.  J Bone Joint Surg [Am]. 1952;  34 957-967
• 16 Mäenpää H, Lehto M U. Patellar dislocation has predisposing factors.  Knee Surg Sports Traumatol Arthrosc. 1996;  4 212-216
• 17 Mäenpää H, Huhtala H, Lehto M U. Recurrence after patellar dislocation: redislocation in 37/75 patients followed for 6–24 years.  Acta Orthop Scand. 1997;  68 424-426
• 18 Fithian D C, Paxton E W, Cohen A B. Indications in the treatment of patellar instability.  J Knee Surg. 2004;  17 47-56
• 19 Mäenpää H, Lehto M U. Surgery in acute patellar dislocation – evaluation of the effect of injury mechanism and family occurrence on the outcome of treatment.  Br J Sports Med. 1995;  29 239-241
• 20 Senavongse W, Farahmand F, Jones J et al. Quantitative measurement of patellofemoral joint stability: force-displacement behavior of the human patella in vitro.  J Orthop Res. 2003;  21 780-786
• 21 Farahmand F, Senavongse W, Amis A A. Quantitative study of the quadriceps muscles and trochlear groove geometry related to instability of the patellofemoral joint.  J Orthop Res. 1998;  16 136-143
• 22 Nomura E, Inoue M. Surgical technique and rationale for medial patellofemoral ligament reconstruction for recurrent patellar dislocation.  Arthroscopy. 2003;  19 E47
• 23 Panagiotopoulos E, Strzelczyk P, Herrmann M et al. Cadaveric study on static medial patellar stabilizers: the dynamizing role of the vastus medialis obliquus on medial patellofemoral ligament.  Knee Surg Sports Traumatol Arthrosc. 2006;  14 7-12
• 24 Reider B, Marshall J L, Koslin B et al. The anterior aspect of the knee joint.  J Bone Joint Surg [Am]. 1981;  63 351-356
• 25 Colvin A C, West R V. Patellar instability.  J Bone Joint Surg [Am]. 2008;  90 2751-2762
• 26 Farahmand F, Tahmasbi M N, Amis A A. Lateral force-displacement behaviour of the human patella and its variation with knee flexion – a biomechanical study in vitro.  J Biomech. 1998;  31 1147-1152
• 27 Hautamaa P V, Fithian D C, Kaufman K R et al. Medial soft tissue restraints in lateral patellar instability and repair.  Clin Orthop Relat Res. 1998;  349 174-182
• 28 Powers C M, Lilley J C, Lee T Q. The effects of axial and multi-plane loading of the extensor mechanism on the patellofemoral joint.  Clin Biomech (Bristol, Avon). 1998;  13 616-624
• 29 Stokes M, Young A. Investigations of quadriceps inhibition: implications for clinical practice.  Physiotherapy. 1984;  70 425-428
• 30 Warren L F, Marshall J L. The supporting structures and layers on the medial side of the knee: an anatomical analysis.  J Bone Joint Surg [Am]. 1979;  61 56-62
• 31 Warren L A, Marshall J L, Girgis F. The prime static stabilizer of the medical side of the knee.  J Bone Joint Surg [Am]. 1974;  56 665-674
• 32 Terry G C. The anatomy of the extensor mechanism.  Clin Sports Medicine. 1995;  8 63-77
• 33 Desio S M, Burks R T, Bachus K N. Soft tissue restraints to lateral patellar translation in the human knee.  Am J Sports Med. 1998;  26 59-65
• 34 Smirk C, Morris H. The anatomy and reconstruction of the medial patellofemoral ligament.  Knee. 2003;  3 221-227
• 35 Sandmeier R H, Burks R T, Bachus K N et al. The effect of reconstruction of the medial patellofemoral ligament on patellar tracking.  Am J Sports Med. 2000;  28 345-349
• 36 Conlan T, Garth Jr W P, Lemons J E. Evaluation of the medial soft-tissue restraints of the extensor mechanism of the knee.  J Bone Joint Surg [Am]. 1993;  75 682-693
• 37 Senavongse W, Amis A A. The effects of articular, retinacular, or muscular deficiencies on patellofemoral joint stability.  J Bone Joint Surg [Br]. 2005;  87 577-582
• 38 Avikainen V J, Nikku R K, Seppanen-Lehmonen T K. Adductor magnus tenodesis for patellar dislocation. Technique and preliminary results.  Clin Orthop Relat Res. 1993;  297 12-16
• 39 Nomura E, Inoue M, Osada N. Anatomical analysis of the medial patellofemoral ligament of the knee, especially the femoral attachment.  Knee Surg Sports Traumatol Arthrosc. 2005;  13 510-515
• 40 Sallay P I, Poggi J, Speer K P et al. Acute dislocation of the patella. A correlative pathoanatomic study.  Am J Sports Med. 1996;  24 52-60
• 41 Nomura E. Classification of lesions of the medial patello-femoral ligament in patellar dislocation.  Int Orthop. 1999;  23 260-263
• 42 Merican A M, Kondo E, Amis A A. The effect on patellofemoral joint stability of selective cutting of lateral retinacular and capsular structures.  J Biomech. 2009;  42 291-296
• 43 Sherman O H, Fox J M, Sperling H et al. Patellar instability: treatment by arthroscopic electrosurgical lateral release.  Arthroscopy. 1987;  3 152-160
• 44 Christoforakis J, Bull A M, Strachan R K et al. Effects of lateral retinacular release on the lateral stability of the patella.  Knee Surg Sports Traumatol Arthrosc. 2006;  14 273-277
• 45 Dejour H, Walch G, Neyret P et al. [Dysplasia of the femoral trochlea].  Rev Chir Orthop. 1990;  76 45-54
• 46 Dejour D, Reynaud P, Lecoultre B. Douleurs et instabilité rotulienne. Essai de classification.  Med Hyg. 1998;  56 1466-1471
• 47 Hing C B, Shepstone L, Marshall T et al. A laterally positioned concave trochlear groove prevents patellar dislocation.  Clin Orthop Relat Res. 2006;  447 187-194
• 48 Dejour D, Le Coultre B. Osteotomies in patello-femoral instabilities.  Sports Med Arthrosc. 2007;  15 39-46
• 49 Frosch K H, Floerkemeier T, Abicht C et al. [A novel knee endoprosthesis with a physiological joint shape. Part 1: Biomechanical basics and tribological studies].  Unfallchirurg. 2009;  112 168-175
• 50 Runow A. The dislocating patella. Etiology and prognosis in relation to generalized joint laxity and anatomy of the patellar articulation.  Acta Orthop Scand Suppl. 1983;  201 1-53
• 51 Blackburne J S, Peel T E. A new method of measuring patellar height.  J Bone Joint Surg [Br]. 1977;  59 241-242
• 52 Aglietti P, Insall J N, Cerulli G. Patellar pain and incongruence. I: Measurements of incongruence.  Clin Orthop Relat Res. 1983;  176 217-224
• 53 Insall J, Goldberg V, Salvati E. Recurrent dislocation and the high-riding patella.  Clin Orthop Relat Res. 1972;  88 67-69
• 54 Simmons E, Cameron J C. Patella alta and recurrent dislocation of the patella.  Clin Orthop Relat Res. 1992;  274 265-269
• 55 Caton J. [Method of measuring the height of the patella].  Acta Orthop Belg. 1989;  55 385-386
• 56 Laurin C A, Dussault R, Levesque H P. The tangential x-ray investigation of the patellofemoral joint: x-ray technique, diagnostic criteria and their interpretation.  Clin Orthop Relat Res. 1979;  144 16-26
• 57 Berg E E, Mason S L, Lucas M J. Patellar height ratios. A comparison of four measurement methods.  Am J Sports Med. 1996;  24 218-221
• 58 Seil R, Muller B, Georg T et al. Reliability and interobserver variability in radiological patellar height ratios.  Knee Surg Sports Traumatol Arthrosc. 2000;  8 231-236
• 59 Dejour H, Walch G, Nove-Josserand L et al. Factors of patellar instability: an anatomic radiographic study.  Knee Surg Sports Traumatol Arthrosc. 1994;  2 19-26
• 60 Arendt E A, Fithian D C, Cohen E. Current concepts of lateral patella dislocation.  Clin Sports Med. 2002;  21 499-519
• 61 Feller J A, Amis A A, Andrisch J T et al. Current concepts: surgical biomechanics of the patellofemoral joint.  Arthroscopy. 2007;  5 542-553
• 62 Grana W A, Kriegshauser L A. Scientific basis of extensor mechanism disorders.  Clin Sports Med. 1985;  4 247-257
• 63 Hughston J C, Walsh M W, Puddu G. Patellar Subluxation and Dislocation. Saunders Monographs in Clinical Orthopaedics. Vol. 5 Philadelphia: W.B. Saunders; 1984
• 64 Jafaril A, Farahmand F, Meghdari A. The effects of trochlear groove geometry on patellofemoral joint stability – a computer model study.  Proc Inst Mech Eng [H]. 2008;  222 75-88
• 65 Ward S R, Terk M R, Powers C M. Patella alta: association with patellofemoral alignment and changes in contact area during weight-bearing.  J Bone Joint Surg [Am]. 2007;  89 1749-1755
• 66 Stanitski C L. Articular hypermobility and chondral injury in patients with acute patellar dislocation.  Am J Sports Med. 1995;  23 146-150
• 67 Vainionpää S, Laasonen E, Silvennoinen T et al. Acute dislocation of the patella: a prospective review of operative treatment.  J Bone Joint Surg [Br]. 1990;  72 366-369
• 68 Amis A A, Firer P, Mountney J et al. Anatomy and biomechanics of the medial patellofemoral ligament.  Knee. 2003;  10 215-220
• 69 Bicos J, Fulkerson J P, Amis A A. Current concepts review: the medial patellofemoral ligament.  Am J Sports Med. 2007;  35 484-492
• 70 Nomura E, Horiuchi Y, Kihara M. Medial patellofemoral ligament restraint in lateral patellar translation and reconstruction.  Knee. 2000;  7 121-127
• 71 Mizuno Y, Kumagai M, Mattessich S M et al. Q-angle influences tibiofemoral arid patellofemoral kinematics.  J Orthop Res. 2001;  19 834-840
• 72 Goh J C, Lee P Y, Bose K. A cadaver study of the function of the oblique part of vastus medialis.  J Bone Joint Surg [Br]. 1995;  77 666
• 73 Bennett W F, Doherty N, Hallisey M J et al. Insertion orientation of terminal vastus lateralis obliquus and vastus medialis obliquus muscle fibers in human knees.  Clin Anat. 1993;  6 129-134
• 74 Amis A A, Farahmand F. Biomechanics masterclass: extensor mechanism of the knee.  Curr Orthop. 1996;  10 102-109
• 75 Larson R L, Cabaud H E, Slocum D B et al. The patellar compression syndrome: surgical treatment by lateral retinacular release.  Clin Orthop Relat Res. 1978;  134 158-167
• 76 Shih Y F, Bull A M, Amis A A. The cartilaginous and osseous geometry of the femoral trochlear groove.  Knee Surg Sports Traumatol Arthrosc. 2004;  12 300-306
• 77 Salsich G B, Ward S R, Terk M R et al. In vivo assessment of patellofemoral joint contact area in individuals who are pain free.  Clin Orthop Relat Res. 2003;  417 277-284
• 78 Goodfellow J, Hungerford D S, Zindel M. Patello-femoral joint mechanics and pathology. 1. Functional anatomy of the patellofemoral joint.  J Bone Joint Surg [Br]. 1976;  58 287-290
• 79 Heino Brechter J, Powers C. Patellofemoral stress during stair ascent and descent in persons with and without patellofemoral pain.  Gait Posture. 2002;  16 115-123
• 80 Amis A A. Current concepts on anatomy and biomechanics of patellar stability.  Sports Med Arthrosc Rev. 2007;  15 48-56
• 81 Heino Brechter J, Powers C M. Patellofemoral stress during walking in persons with and without patellofemoral pain.  Med Sci Sports Exerc. 2002;  34 1582-1593
• 82 Ward S R, Powers C M. The influence of patella alta on patellofemoral joint stress during normal and fast walking.  Clin Biomech. 2004;  19 1040-1047
• 83 Nikku R, Nietosvaara Y, Aalto K et al. Operative treatment of primary patellar dislocation does not improve medium-term outcome: a 7-year follow-up report and risk analysis of 127 randomized patients.  Acta Orthop. 2005;  76 699-704
• 84 Sillanpää P J, Mattila V M, Mäenpää H et al. Treatment with and without initial stabilizing surgery for primary traumatic patellar dislocation. A prospective randomized study.  J Bone Joint Surg [Am]. 2009;  91 263-273
• 85 Christiansen S E, Jakobsen B W, Lund B et al. Isolated repair of the medial patellofemoral ligament in primary dislocation of the patella: a prospective randomized study.  Arthroscopy. 2008;  24 82-87
• 86 Buchner M, Baudendistel B, Sabo D et al. Acute traumatic primary patellar dislocation: long-term results comparing conservative and surgical treatment.  Clin J Sport Med. 2005;  15 62-66
• 87 Nikku R, Nietosvaara Y, Kallio P E et al. Operative versus closed treatment of primary dislocation of the patella: similar 2-year results in 125 randomized patients.  Acta Orthop Scand. 1997;  68 419-423
• 88 Lysholm J, Nordin M, Ekstrand J et al. The effect of a patella brace on performance in a knee extension strength test in patients with patellar pain.  Am J Sports Med. 1984;  12 110-112
• 89 Powers C M, Ward S R, Chan L D et al. The effect of bracing on patella alignment and patellofemoral joint contact area.  Med Sci Sports Exerc. 2004;  36 1226-1232
• 90 Powers C M, Shellock F G, Beering T V et al. Effect of bracing on patellar kinematics in patients with patellofemoral joint pain.  Med Sci Sports Exerc. 1999;  31 1714-1720
• 91 Muhle C, Brinkmann G, Skaf A et al. Effect of a patellar realignment brace on patients with patellar subluxation and dislocation. Evaluation with kinematic magnetic resonance imaging.  Am J Sports Med. 1999;  27 350-353
• 92 McConnell J. Rehabilitation and nonoperative treatment of patellar instability.  Sports Med Arthrosc. 2007;  15 95-104
• 93 Powers C M. Rehabilitation of patellofemoral joint disorders: a critical review.  J Orthop Sports Phys Ther. 1998;  28 345-354
• 94 Rivera J E. Open versus closed kinetic chain rehabilitation of the lower extremity: a functional and biomechanical analysis. J.  Sports Rehabil. 1994;  3 154-167
• 95 Snyder-Mackler L. Scientific rationale and physiological basis for the use of closed kinetic chain exercise in the lower extremity. J.  Sports Rehabil. 1996;  5 2-12
• 96 Stensdotter A K, Hodges P W, Mellor R et al. Quadriceps activation in closed and in open kinetic chain exercise.  Med Sci Sports Exerc. 2003;  35 2043-2047
• 97 Escamilla R F, Fleisig G S, Zheng N et al. Biomechanics of the knee during closed kinetic chain and open kinetic chain exercises.  Med Sci Sports Exerc. 1998;  30 556-569
• 98 Cowan S M, Bennell K L, Hodges P W. Therapeutic patellar taping changes the timing of vasti muscle activation in people with patellofemoral pain syndrome.  Clin J Sport Med. 2002;  12 339-347
• 99 Harilainen A, Sandelin J. Prospective long-term results of operative treatment in primary dislocation of the patella.  Knee Surg Sports Traumatol Arthrosc. 1993;  1 100-103
• 100 Mäenpää H, Lehto M U. Patellar dislocation. The long-term results of nonoperative management in 100 patients.  Am J Sports Med. 1997;  25 213-217
• 101 Andrish J T. The Elmslie-Trillat procedure.  Tech Orthop. 1997;  12 170-177
• 102 Frosch K H, Nägerl H, Kubein-Meesenburg D et al. [A new total knee arthroplasty with physiologic ally shaped surfaces. Part 2: First clinical results].  Unfallchirurg. 2009;  112 176-184
• 103 Beaconsfield T, Pintore E, Maffulli N et al. Radiological measurements in patellofemoral disorders: a review.  Clin Orthop Relat Res. 1994;  308 18-28
• 104 Barber F A, McGarry J E. Elmslie-Trillat procedure for the treatment of recurrent patellar instability.  Arthroscopy. 2008;  24 77-81
• 105 Kuroda R, Kambic H, Valdevit A et al. Articular cartilage contact pressure after tibial tuberosity transfer. A cadaveric study.  Am J Sports Med. 2001;  29 403-409
• 106 Nakagawa K, Wada Y, Minamide M et al. Deterioration of long-term clinical results after the Elmslie-Trillat procedure for dislocation of the patella.  J Bone Joint Surg [Br]. 2002;  84 861-864
• 107 Krüger T, Birke A, Decker T et al. Results of the Elmslie-Trillat procedure in cases of patella(sub)luxation related to chondral pathology.  Unfallchirurg. 1999;  102 700-707
• 108 Cox J S. Evaluation of the Roux-Elmslie-Trillat procedure for knee extensor realignment.  Am J Sports Med. 1982;  10 303-310
• 109 Brown D E, Alexander A H, Lichtman D M. The Elmslie-Trillat procedure: evaluation in patellar dislocation and subluxation.  Am J Sports Med. 1984;  12 104-109
• 110 Conti C, Berruto M, Bianchi M. The Elmslie-Trillat procedure for recurrent subluxation of the patella: one to five year follow-up.  Ital J Orthop Traumatol. 1992;  18 341-349
• 111 Wootton J R, Cross M J, Wood D G. Patellofemoral malalignment: a report of 68 cases treated by proximal and distal patellofemoral reconstruction.  Injury. 1990;  21 169-173
• 112 Ramappa A J, Apreleva M, Harrold F R et al. The effects of medialization and anteromedialization of the tibial tubercle on patellofemoral mechanics and kinematics.  Am J Sports Med. 2006;  34 749-756
• 113 Farr J. Anteromedialization of the tibial tubercle for treatment of patellofemoral malpositioning and concomitant isolated patellofemoral arthrosis.  Tech Orthop. 1997;  12 151-164
• 114 Fulkerson J P. Anterolateralization of the tibial tubercle.  Tech Orthop. 1997;  12 165-169
• 115 Fulkerson J P. The effects of medialization and anteromedialization of the tibial tubercle on patellofemoral mechanics and kinematics.  Am J Sports Med. 2007;  35 147
• 116 Pritsch T, Haim A, Arbel R et al. Tailored tibial tubercle transfer for patellofemoral malalignment: analysis of clinical outcomes.  Knee Surg Sports Traumatol Arthrosc. 2007;  15 994-1002
• 117 Palmer S H, Servant C T, Maguire J et al. Surgical reconstruction of severe patellofemoral maltracking.  Clin Orthop Relat Res. 2004;  419 144-148
• 118 Buuck D A, Fulkerson J P. Anteromedialization of the tibial tubercle: a 4- to 12-year follow-up.  Op Tech Sports Med. 2000;  8 131-137
• 119 Pidoriano A J, Weinstein R N, Buuck D A et al. Correlation of patellar articular lesions with results from anteromedial tibial tubercle transfer.  Am J Sports Med. 1997;  25 533-537
• 120 Henry J H, Goletz T H, Williamson B. Lateral retinacular release in patellofemoral subluxation. Indications, results, and comparison to open patellofemoral reconstruction.  Am J Sports Med. 1986;  14 121-129
• 121 Krompinger W J, Fulkerson J P. Lateral retinacular release for intractable lateral retinacular pain.  Clin Orthop Relat Res. 1983;  179 183-188
• 122 Larson R L, Cabaud E, Slocum D B et al. The patellar compression syndrome. Surgical treatment by lateral retinacular release.  Clin Orthop Relat Res. 1978;  134 158-167
• 123 Schonholtz G J, Zahn M G, Magee C M. Lateral retinacular release of the patella.  Arthroscopy. 1987;  3 269-272
• 124 Teitge R A, Faerber W W, Des Madryl P et al. Stress radiographs of the patellofemoral joint.  J Bone Joint Surg [Am]. 1996;  78 193-203
• 125 Skalley T C, Terry G C, Teitge R A. The quantitative measurement of normal passive medial and lateral patellar motion limits.  Am J Sports Med. 1993;  21 728-732
• 126 Nonweiler D E, DeLee J C. The diagnosis and treatment of medial subluxation of the patella after lateral retinacular release.  Am J Sports Med. 1994;  22 680-686
• 127 Hughston J C, Deese M. Medial subluxation of the patella as a complication of lateral retinacular release.  Am J Sports Med. 1988;  16 383-388
• 128 Miller P R, Klein R M, Teitge R A. Medial dislocation of the patella.  Skeletal Radiol. 1991;  20 429-431
• 129 Jackson R W, Kunkel S S, Taylor G J. Lateral retinacular release for patellofemoral pain in the older patient.  Arthroscopy. 1991;  7 283-286
• 130 Schöttle P B, Hensler D. Revisionseingriffe zur Patellastabilisierung nach erfolgloser Operation am Streckapparat.  Arthroskopie. 2008;  21 145-152
• 131 Chester R, Smith T O, Sweeting D et al. The relative timing of VMO and VL in the aetiology of anterior knee pain: a systematic review and meta-analysis.  BMC Musculoskelet Disord. 2008;  9 64
• 132 Balcarek P, Ammon J, Frosch S et al. 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. 2010;  26 926-935
• 133 Elias D A, White L M, Fithian D C. Acute lateral patellar dislocation at MR imaging: injury patterns of medial patellar soft-tissue restraints and osteochondral injuries of the inferomedial patella.  Radiology. 2002;  225 736-743
• 134 Nomura E, Inoue M, Kobayashi S. Generalized joint laxity and contralateral patellar hypermobility in unilateral recurrent patellar dislocators.  Arthroscopy. 2006;  22 861-865
• 135 Rehn B, Lidström J, Skoglund J et al. Effects on leg muscular performance from whole-body vibration exercise: a systematic review.  Scand J Med Sci Sports. 2007;  17 2-11
• 136 Słupik A, Dwornik M, Białoszewski D et al. Effect of Kinesio Taping on bioelectrical activity of vastus medialis muscle. Preliminary report.  Ortop Traumatol Rehabil. 2007;  9 644-651
• 137 Stanitski C L, Paletta Jr G A. Articular cartilage injury with acute patellar dislocation in adolescents: arthroscopic and radiographic correlation.  Am J Sports Med. 1998;  26 52-55
• 138 Andrish J. The management of recurrent patellar dislocation.  Orthop Clin North Am. 2008;  39 313-327
• 139 Drez Jr D, Edwards T B, Williams C S. Results of medial patellofemoral ligament reconstruction in the treatment of patellar dislocation.  Arthroscopy. 2001;  17 298-306
• 140 Muneta T, Sekiya I, Tsuchiya M et al. A technique for reconstruction of the medial patellofemoral ligament.  Clin Orthop Relat Res. 1999;  339 151-155
• 141 Deie M, Ochi M, Sumen Y et al. A long-term follow-up study after medial patellofemoral ligament reconstruction using the transferred semitendinosus tendon for patellar dislocation.  Knee Surg Sports Traumatol Arthrosc. 2005;  13 522-528
• 142 Schottle P B, Romero J, Schmeling A et al. Technical note: anatomical reconstruction of the medial patellofemoral ligament using a free gracilis autograft.  Arch Orthop Trauma Surg. 2008;  128 479-484
• 143 Burks R T, Luker M G. Medial patellofemoral ligament reconstruction.  Tech Orthop. 1997;  12 185-191
• 144 Steensen R N, Dopirak R M, Maurus P B. A simple technique for reconstruction of the medial patellofemoral ligament using a quadriceps tendon graft.  Arthroscopy. 2005;  21 365-370
• 145 Teitge R A, Torga-Spak R. Medial patellofemoral ligament reconstruction.  Orthopedics. 2004;  27 1037-1040
• 146 Davis D K, Fithian D C. Techniques of medial retinacular repair and reconstruction.  Clin Orthop Relat Res. 2002;  402 38-52
• 147 Nomura E, Inoue M. Hybrid medial patellofemoral ligament reconstruction using the semitendinosus tendon for recurrent patellar dislocation: minimum 3 years' follow-up.  Arthroscopy. 2006;  22 787-793
• 148 Steiner T M, Torga-Spak R, Teitge R A. Medial patellofemoral ligament reconstruction in patients with lateral patellar instability and trochlear dysplasia.  Am J Sports Med. 2006;  34 1254-1261
• 149 Gomes J. Medial patellofemoral ligament reconstruction for recurrent dislocation of the patella: a preliminary report.  Arthroscopy. 1992;  8 335-340
• 150 Mountney J, Senavongse W, Amis A A et al. Tensile strength of the medial patellofemoral ligament before and after repair or reconstruction.  J Bone Joint Surg [Br]. 2005;  87 36-40
• 151 Elias J J, Cosgarea A J. Technical errors during medial patellofemoral ligament reconstruction could overload medial patellofemoral cartilage: a computational analysis.  Am J Sports Med. 2006;  34 1478-1485
• 152 Smith T O, Walker J, Russell N. Outcomes of medial patellofemoral ligament reconstruction for patellar instability: a systematic review.  Knee Surg Sports Traumatol Arthrosc. 2007;  15 1301-1314
• 153 Panagopoulos A, van Niekerk L, Triantafillopoulos I K. MPFL reconstruction for recurrent patella dislocation: a new surgical technique and review of the literature.  Int J Sports Med. 2008;  29 359-365
• 154 Mikashima Y, Kimura M, Kobayashi Y et al. Clinical results of isolated reconstruction of the medial patellofemoral ligament for recurrent dislocation and subluxation of the patella.  Acta Orthop Belg. 2006;  72 65-71
• 155 Nomura E, Horiuchi Y, Kihara M. A mid-term follow-up of medial patellofemoral ligament reconstruction using an artificial ligament for recurrent patellar dislocation.  Knee. 2000;  7 213-216
• 156 Deie M, Ochi M, Sumen Y et al. Reconstruction of the medial patellofemoral ligament for the treatment of habitual or recurrent dislocation of the patella in children.  J Bone Joint Surg [Br]. 2003;  85 887-890
• 157 Schöttle P B, Fucentese S F, Romero J. Clinical and radiological outcome of medial patellofemoral ligament reconstruction with a semitendinosus autograft for patella instability.  Knee Surg Sports Traumatol Arthrosc. 2005;  13 516-521
• 158 Cossey A J, Paterson R. A new technique for reconstructing the medial patellofemoral ligament.  Knee. 2005;  12 93-98
• 159 Albee F H. The bone graft wedge in the treatment of habitual dislocation of the patella.  Med Rec. 1915;  88 257-259
• 160 Weiker G, Black K P. The anterior femoral osteotomy for patellofemoral instability.  Am J Knee Surg. 1997;  10 221-227
• 161 Kuroda R, Kambic H, Valdevit A et al. Distribution of patellofemoral joint pressures after femoral trochlear osteotomy.  Knee Surg Sports Traumatol Arthrosc. 2002;  10 33-37
• 162 Verdonk R, Jansegers E, Stuyts B. Trochleoplasty in dysplastic knee trochlea.  Knee Surg Sports Traumatol Arthrosc. 2005;  13 529-533
• 163 von Knoch F, Bohm T, Burgi M L et al. Trochleaplasty for recurrent patellar dislocation in association with trochlear dysplasia. A 4- to 14-year follow-up study.  J Bone Joint Surg [Br]. 2006;  88 1331-1335
• 164 Koeter S, Diks M J, Anderson P G et al. A modified tibial tubercle osteotomy for patellar maltracking: results at two years.  J Bone Joint Surg [Br]. 2007;  89 180-185
• 165 Lattermann C, Toth J, Bach Jr B R. The role of lateral retinacular release in the treatment of patellar instability.  Sports Med Arthrosc. 2007;  15 57-60
• 166 Kolowich P A, Paulos L E, Rosenberg T D et al. Lateral release of the patella: indications and contraindications.  Am J Sports Med. 1990;  18 359-365
• 167 Alemdaroğlu K B, Cimen O, Aydoğan N H et al. Early results of arthroscopic lateral retinacular release in patellofemoral osteoarthritis.  Knee. 2008;  15 451-455
• 168 Biedert R M. Osteotomien.  Orthopäde. 2008;  37 872-883
• 169 Teitge R A. Osteotomy in the treatment of patellofemoral instability.  Tech Knee Surg. 2006;  5 2-18
• 170 Post W R, Teitge R, Amis A. Patellofemoral malalignment: looking beyond the viewbox.  Clin Sports Med. 2002;  21 521-546
• 171 Meister K, James S L. Proximal tibial derotation osteotomy for anterior knee pain in the miserably malaligned extremity.  Am J Orthop. 1995;  24 149-155
• 172 Aglietti P, Buzzi R, De Biase P et al. Surgical treatment of recurrent dislocation of the patella.  Clin Orthop Relat Res. 1994;  308 8-17
• 173 Nam E K, Karzel R P. Mini-open medial reefing and arthroscopic lateral release for the treatment of recurrent patellar dislocation: a medium-term follow-up.  Am J Sports Med. 2005;  33 220-230
• 174 Ali S, Bhatti A. Arthroscopic proximal realignment of the patella for recurrent instability: report of a new surgical technique with 1 to 7 years of follow-up.  Arthroscopy. 2007;  23 305-311
• 175 Vainionpää S, Laasonen E, Silvennoinen T et al. Acute dislocation of the patella. A prospective review of operative treatment.  J Bone Joint Surg [Br]. 1990;  72 366-369
• 176 Ostermeier S, Holst M, Bohnsack M et al. In vitro measurement of patellar kinematics following reconstruction of the medial patellofemoral ligament.  Knee Surg Sports Traumatol Arthrosc. 2007;  15 276-285
• 177 Davis D K, Fithian D C. Techniques of medial retinacular repair and reconstruction.  Clin Orthop Relat Res. 2002;  402 38-52
• 178 Iwano T, Kurosawa H, Tokuyama H et al. Roentgenographic and clinical findings of patellofemoral osteoarthrosis: with special reference to its relationship to femorotibial osteoarthrosis and etiologic factors.  Clin Orthop. 1990;  252 190-197
• 179 Harrison M H. The results of a realignment operation for recurrent dislocation of the patella.  J Bone Joint Surg [Br]. 1955;  37 559-567
• 180 Schneider F, Linhart W. Weichteilige Medialisierung des distalen Patellasehnenansatzes bei Patienten mit offenen Wachstumsfugen. Retrospektive Analyse von 36 Patienten; durchschnittliches Follow-up 4 Jahre. Köln; 24. Kongress der Deutschsprachigen Arbeitsgemeinschaft für Arthroskopie 2007
• 181 Masse Y. Trochleoplasty. Restoration of the intercondylar groove in subluxations and dislocations of the patella.  Rev Chir Orthop. 1978;  64 3-17