Correction of Patellar Height in Patellofemoral Instability

Abstract

The management of patellofemoral instability is based on a thorough evaluation of predisposing anatomical factors. Patella alta is one of the utmost causes of objective instability. The resulting biomechanical changes can lead to recurrent patellar instability, pain, and focal degenerative alterations. Physical examination is paramount in the decision-making process. Imaging evaluation has evolved from X-ray-based methods to magnetic resonance imaging measurements, which enable a more accurate assessment of the patellotrochlear relationship. Treatment is based on selective correction of the risk factors, while tibial tubercle distalization osteotomy as well as medial patellofemoral ligament reconstruction are tools that must be rationally considered. The present article reviews the surgical rationale for the treatment of patella alta in patellofemoral instability.

Keywords

patellar height - patellofemoral instability - tibial tubercle distalization osteotomy - tibial tubercle osteotomy - patella alta - distal realignment

Publikationsverlauf

Eingereicht: 28. September 2019

Angenommen: 16. November 2020

Artikel online veröffentlicht:
02. Juni 2021

• Referencias

• 1 Hevesi M, Heidenreich MJ, Camp CL. et al. The Recurrent Instability of the Patella Score: A Statistically Based Model for Prediction of Long-Term Recurrence Risk After First-Time Dislocation. Arthroscopy 2019; 35 (02) 537-543 DOI: 10.1016/j.arthro.2018.09.017.
• 2 Desio SM, Burks RT, Bachus KN. Soft tissue restraints to lateral patellar translation in the human knee. Am J Sports Med 1998; 26 (01) 59-65 DOI: 10.1177/03635465980260012701.
• 3 Hautamaa PV, Fithian DC, Kaufman KR, Daniel DM, Pohlmeyer AM. Medial soft tissue restraints in lateral patellar instability and repair. Clin Orthop Relat Res 1998; 349 (349) 174-182 DOI: 10.1097/00003086-199804000-00021.
• 4 Sallay PI, Poggi J, Speer KP, Garrett WE. Acute dislocation of the patella. A correlative pathoanatomic study. Am J Sports Med 1996; 24 (01) 52-60 DOI: 10.1177/036354659602400110.
• 5 Nomura E. Classification of lesions of the medial patello-femoral ligament in patellar dislocation. Int Orthop 1999; 23 (05) 260-263 DOI: 10.1007/s002640050366.
• 6 Dejour H, Walch G, Nove-Josserand L, Guier C. Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 1994; 2 (01) 19-26 DOI: 10.1007/BF01552649.
• 7 Huntington LS, Webster KE, Devitt BM, Scanlon JP, Feller JA. Factors Associated With an Increased Risk of Recurrence After a First-Time Patellar Dislocation: A Systematic Review and Meta-analysis. Am J Sports Med. 2020; 48 (10) 2552-2562 DOI: 10.1177/0363546519888467.
• 8 Dejour D, Le Coultre B. Osteotomies in Patello-Femoral Instabilities. Sports Med Arthrosc Rev 2018; 26 (01) 8-15 DOI: 10.1097/JSA.0000000000000183.
• 9 Biedert RM, Tscholl PM. Patella Alta: A Comprehensive Review of Current Knowledge. Am J Orthop 2017; 46 (06) 290-300
• 10 Neyret P, Robinson AHN, Le Coultre B, Lapra C, Chambat P. Patellar tendon length–the factor in patellar instability?. Knee 2002; 9 (01) 3-6 DOI: 10.1016/S0968-0160(01)00136-3.
• 11 Baumann CA, Hinckel BB, Tanaka MJ. Update on Patellofemoral Anatomy and Biomechanics. Oper Tech Sports Med 2019; 27 (04) 150683 DOI: 10.1016/j.otsm.2019.150683.
• 12 Singerman R, Davy DT, Goldberg VM. Effects of patella alta and patella infera on patellofemoral contact forces. J Biomech 1994; 27 (08) 1059-1065 DOI: 10.1016/0021-9290(94)90222-4.
• 13 Stefanik JJ, Zhu Y, Zumwalt AC. et al. Association between patella alta and the prevalence and worsening of structural features of patellofemoral joint osteoarthritis: the multicenter osteoarthritis study. Arthritis Care Res (Hoboken) 2010; 62 (09) 1258-1265 DOI: 10.1002/acr.20214.
• 14 Luyckx T, Didden K, Vandenneucker H, Labey L, Innocenti B, Bellemans J. Is there a biomechanical explanation for anterior knee pain in patients with patella alta?: influence of patellar height on patellofemoral contact force, contact area and contact pressure. J Bone Joint Surg Br 2009; 91 (03) 344-350 DOI: 10.1302/0301-620X.91B3.21592.
• 15 Ward SR, Terk MR, Powers CM. Patella alta: association with patellofemoral alignment and changes in contact area during weight-bearing. J Bone Joint Surg Am 2007; 89 (08) 1749-1755 DOI: 10.2106/JBJS.F.00508.
• 16 Feller JA. Distal realignment (tibial tuberosity transfer). Sports Med Arthrosc Rev 2012; 20 (03) 152-161 DOI: 10.1097/JSA.0b013e318262e8e7.
• 17 Rush J, Diduch D. When is Trochleoplasty a Rational Addition?. Sports Med Arthrosc Rev 2019; 27 (04) 161-168 DOI: 10.1097/JSA.0000000000000254.
• 18 Magnussen RA. Patella Alta Sees You, Do You See It?. Am J Orthop (Belle Mead NJ) 2017; 46 (05) 229-231
• 19 Ferlic PW, Runer A, Dammerer D, Wansch J, Hackl W, Liebensteiner MC. Patella height correlates with trochlear dysplasia: a computed tomography image analysis. Arthroscopy 2018; 34 (06) 1921-1928 DOI: 10.1016/j.arthro.2018.01.051.
• 20 Zhang Z, Zhang H, Song G, Zheng T, Feng H. A pre-operative grade 3 J-sign adversely affects short-term clinical outcome and is more likely to yield MPFL residual graft laxity in recurrent patellar dislocation. Knee Surg Sports Traumatol Arthrosc 2020; 28 (07) 2147-2156
• 21 Ahmad CS, McCarthy M, Gomez JA, Shubin Stein BE. The moving patellar apprehension test for lateral patellar instability. Am J Sports Med 2009; 37 (04) 791-796 DOI: 10.1177/0363546508328113.
• 22 Zimmermann F, Liebensteiner MC, Balcarek P. The reversed dynamic patellar apprehension test mimics anatomical complexity in lateral patellar instability. Knee Surg Sports Traumatol Arthrosc 2019; 27 (02) 604-610 DOI: 10.1007/s00167-018-5198-6.
• 23 Phillips CL, Silver DAT, Schranz PJ, Mandalia V. The measurement of patellar height: a review of the methods of imaging. J Bone Joint Surg Br 2010; 92 (08) 1045-1053 DOI: 10.1302/0301-620X.92B8.23794.
• 24 Caton J. [Method of measuring the height of the patella]. Acta Orthop Belg 1989; 55 (03) 385-386
• 25 D'Amore T, Tanaka MJ, Cosgarea AJ. When and How Far to Move the Tibial Tuberosity in Patients With Patellar Instability. Sports Med Arthrosc Rev 2017; 25 (02) 78-84 DOI: 10.1097/JSA.0000000000000146.
• 26 Seil R, Müller B, Georg T, Kohn D, Rupp S. Reliability and interobserver variability in radiological patellar height ratios. Knee Surg Sports Traumatol Arthrosc 2000; 8 (04) 231-236 DOI: 10.1007/s001670000121.
• 27 Berg. Patellar Height ratios: a comparation of 4 methods. Am J Sports Med 1996; 24: 218-221 DOI: 10.1177/036354659602400218.
• 28 Dejour DH. The patellofemoral joint and its historical roots: the Lyon School of Knee Surgery. Knee Surg Sports Traumatol Arthrosc 2013; 21 (07) 1482-1494
• 29 Narkbunnam R, Chareancholvanich K. Effect of patient position on measurement of patellar height ratio. Arch Orthop Trauma Surg 2015; 135 (08) 1151-1156 DOI: 10.1007/s00402-015-2268-9.
• 30 Thévenin-Lemoine C, Ferrand M, Courvoisier A, Damsin JP, Ducou le Pointe H, Vialle R. Is the Caton-Deschamps index a valuable ratio to investigate patellar height in children?. J Bone Joint Surg Am 2011; 93 (08) e35
• 31 Yue RA, Arendt EA, Tompkins MA. Patellar Height Measurements on Radiograph and Magnetic Resonance Imaging in Patellar Instability and Control Patients. J Knee Surg 2017; 30 (09) 943-950 DOI: 10.1055/s-0037-1599249.
• 32 Yiannakopoulos CK, Mataragas E, Antonogiannakis E. The effect of quadriceps contraction during weight-bearing on four patellar height indices. J Bone Joint Surg Br 2008; 90 (07) 870-873 DOI: 10.1302/0301-620X.90B7.20111.
• 33 Bonadio MB, Helito CP, do Prado Torres JA. et al. Plateau-patella angle: An option for the evaluation of patellar height in patients with patellar instability. Knee 2017; 24 (02) 340-344 DOI: 10.1016/j.knee.2017.01.006.
• 34 Portner O, Pakzad H. The evaluation of patellar height: a simple method. J Bone Joint Surg Am 2011; 93 (01) 73-80
• 35 Dejour D, Ferrua P, Ntagiopoulos PG. et al; French Arthroscopy Society (SFA). The introduction of a new MRI index to evaluate sagittal patellofemoral engagement. Orthop Traumatol Surg Res 2013; 99 (8, Suppl) S391-S398 DOI: 10.1016/j.otsr.2013.10.008.
• 36 Biedert RM, Albrecht S. The patellotrochlear index: a new index for assessing patellar height. Knee Surg Sports Traumatol Arthrosc 2006; 14 (08) 707-712 DOI: 10.1007/s00167-005-0015-4.
• 37 Barnett AJ, Prentice M, Mandalia V, Wakeley CJ, Eldridge JDJ. Patellar height measurement in trochlear dysplasia. Knee Surg Sports Traumatol Arthrosc 2009; 17 (12) 1412-1415 DOI: 10.1007/s00167-009-0801-5.
• 38 Ali SA, Helmer R, Terk MR. Patella alta: lack of correlation between patellotrochlear cartilage congruence and commonly used patellar height ratios. AJR Am J Roentgenol 2009; 193 (05) 1361-1366 DOI: 10.2214/AJR.09.2729.
• 39 Tompkins MA, Arendt EA. Patellar instability factors in isolated medial patellofemoral ligament reconstructions–what does the literature tell us? A systematic review. Am J Sports Med 2015; 43 (09) 2318-2327 DOI: 10.1177/0363546515571544.
• 40 Reider B. À la carte. Am J Sports Med 2015; 43 (09) 2099-2101 DOI: 10.1177/0363546515601076.
• 41 Martin RK, Leland DP, Krych AJ, Dahm DL. Treatment of First-time Patellar Dislocations and Evaluation of Risk Factors for Recurrent Patellar Instability. Sports Med Arthrosc Rev 2019; 27 (04) 130-135 DOI: 10.1097/JSA.0000000000000239.
• 42 Weber AE, Nathani A, Dines JS. et al. An Algorithmic Approach to the Management of Recurrent Lateral Patellar Dislocation. J Bone Joint Surg Am 2016; 98 (05) 417-427 DOI: 10.2106/JBJS.O.00354.
• 43 Magnussen RA, De Simone V, Lustig S, Neyret P, Flanigan DC. Treatment of patella alta in patients with episodic patellar dislocation: a systematic review. Knee Surg Sports Traumatol Arthrosc 2014; 22 (10) 2545-2550 DOI: 10.1007/s00167-013-2445-8.
• 44 Sappey-Marinier E, Sonnery-Cottet B, O'Loughlin P. et al. Clinical Outcomes and Predictive Factors for Failure With Isolated MPFL Reconstruction for Recurrent Patellar Instability: A Series of 211 Reconstructions With a Minimum Follow-up of 3 Years. Am J Sports Med 2019; 47 (06) 1323-1330 DOI: 10.1177/0363546519838405.
• 45 Luceri F, Roger J, Randelli PS, Lustig S, Servien E. How Does Isolated Medial Patellofemoral Ligament Reconstruction Influence Patellar Height?. Am J Sports Med 2020; 48 (04) 895-900 DOI: 10.1177/0363546520902132.
• 46 Burnham JM, Howard JS, Hayes CB, Lattermann C. Medial Patellofemoral Ligament Reconstruction With Concomitant Tibial Tubercle Transfer: A Systematic Review of Outcomes and Complications. Arthroscopy 2016; 32 (06) 1185-1195 DOI: 10.1016/j.arthro.2015.11.039.
• 47 Tscholl PM, Wanivenhaus F, Centmaier-Molnar V, Camenzind RS, Fucentese SF. Clinical and radiological results after one hundred fifteen MPFL reconstructions with or without tibial tubercle transfer in patients with recurrent patellar dislocation-a mean follow-up of 5.4 years. Int Orthop 2020; 44 (02) 301-308 DOI: 10.1007/s00264-019-04441-8.
• 48 Duchman K, Bollier M. Distal realignment: indications, technique, and results. Clin Sports Med 2014; 33 (03) 517-530 DOI: 10.1016/j.csm.2014.03.001.
• 49 Dempsey IJ, Southworth TM, Huddleston HP, Yanke A, Farr J. Tibial Tubercle Osteotomy: Anterior, Medial, and Distal Correction. Oper Tech Sports Med 2019; 27 (04) 150686 DOI: 10.1016/j.otsm.2019.150686.
• 50 Malghem J, Maldague B. Depth insufficiency of the proximal trochlear groove on lateral radiographs of the knee: relation to patellar dislocation. Radiology 1989; 170 (02) 507-510 DOI: 10.1148/radiology.170.2.2911676.
• 51 Mayer C, Magnussen RA, Servien E. et al. Patellar tendon tenodesis in association with tibial tubercle distalization for the treatment of episodic patellar dislocation with patella alta. Am J Sports Med 2012; 40 (02) 346-351 DOI: 10.1177/0363546511427117.
• 52 Yin L, Liao TC, Yang L, Powers CM. Does Patella Tendon Tenodesis Improve Tibial Tubercle Distalization in Treating Patella Alta? A Computational Study. Clin Orthop Relat Res 2016; 474 (11) 2451-2461 DOI: 10.1007/s11999-016-5027-5.
• 53 Caton JH, Dejour D. Tibial tubercle osteotomy in patello-femoral instability and in patellar height abnormality. Int Orthop 2010; 34 (02) 305-309
• 54 Servien E, Ait Si Selmi T, Neyret P. Le Genou du Sportif. Montpellier: Sauramps Medical; 2002
• 55 Servien E, Verdonk PC, Neyret P. Tibial tuberosity transfer for episodic patellar dislocation. Sports Med Arthrosc Rev 2007; 15 (02) 61-67 DOI: 10.1097/JSA.0b013e3180479464.
• 56 Colmenares O, Sandoval A, Díaz P, Figueroa F, Prado T, Carrasco E. La altura patelar disminuye con la reconstrucción del ligamento patelofemoral medial. ¿Aumenta este efecto al combinar una osteotomía de medialización de la tuberosidad tibial? 56° Congr Chil Ortop y Traumatol 2020
• 57 Franciozi CE, Ambra LF, Albertoni LJB. et al. Anteromedial Tibial Tubercle Osteotomy Improves Results of Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Instability in Patients With Tibial Tuberosity-Trochlear Groove Distance of 17 to 20 mm. Arthroscopy 2019; 35 (02) 566-574 DOI: 10.1016/j.arthro.2018.10.109.
• 58 Stephen JM, Dodds AL, Lumpaopong P, Kader D, Williams A, Amis AA. The ability of medial patellofemoral ligament reconstruction to correct patellar kinematics and contact mechanics in the presence of a lateralized tibial tubercle. Am J Sports Med 2015; 43 (09) 2198-2207 DOI: 10.1177/0363546515597906.
• 59 Warner BT, Kamath GV, Spang JT, Weinhold PS, Creighton RA. Comparison of fixation methods after anteromedialization osteotomy of the tibial tubercle for patellar instability. Arthroscopy 2013; 29 (10) 1628-1634 DOI: 10.1016/j.arthro.2013.06.020.
• 60 Chang C-W, Chen Y-N, Li C-T, Chung C-R, Chang C-H, Peng Y-T. Finite element study of the effects of fragment shape and screw configuration on the mechanical behavior of tibial tubercle osteotomy. J Orthop Surg (Hong Kong) 2019; 27 (03) 2309499019861145 DOI: 10.1177/2309499019861145.
• 61 Luhmann SJ, Fuhrhop S, O'Donnell JC, Gordon JE. Tibial fractures after tibial tubercle osteotomies for patellar instability: a comparison of three osteotomy configurations. J Child Orthop 2011; 5 (01) 19-26 DOI: 10.1007/s11832-010-0311-5.
• 62 Stetson WB, Friedman MJ, Fulkerson JP, Cheng M, Buuck D. Fracture of the proximal tibia with immediate weightbearing after a Fulkerson osteotomy. Am J Sports Med 1997; 25 (04) 570-574 DOI: 10.1177/036354659702500422.
• 63 Bernhoff K, Björck M. Iatrogenic popliteal artery injury in non arthroplasty knee surgery. Bone Joint J 2015; 97-B [phone] DOI: 10.1302/0301-620X.97B2.34353.
• 64 Hernigou J, Chahidi E, Kashi M. et al. Risk of vascular injury when screw drilling for tibial tuberosity transfer. Int Orthop 2018; 42 (05) 1165-1174 DOI: 10.1007/s00264-017-3554-7.
• 65 Sherman SL, Erickson BJ, Cvetanovich GL. et al. Tibial tuberosity osteotomy: Indications, techniques, and outcomes. Am J Sports Med 2014; 42 (08) 2006-2017 DOI: 10.1177/0363546513507423.