Introduction Improper tracking of patella in trochlear groove Caused by tight lateral retinaculum leads to excessive lateral tilt without excessive patellar mobility Miserable Triad is a term coined for anatomic characteristics that lead to an increased Q angle and an exacerbation of patellofemoral dysplasia. They include: femoral anteversion genu valgum external tibial torsion / pronated feet Presentation Presentation pain with stair climbing theatre sign (pain with sitting for long periods of time) Physical exam pain with compression of patella and moderate lateral facet tenderness inability to evert the lateral edge of the patella Imaging Radiographs patellar tilt in lateral direction Treatment Nonoperative NSAIDS, activity modification, and therapy indications mainstay of treatment and should be done for extensive period of time technique therapy should emphasize vastus medialis strengthening and closed chain short arc quadriceps exercises Operative arthroscopic lateral release indications objective evidence of lateral tilting (neutral or negative tilt) pain refractory to extensive rehabilitation inability to evert the lateral edge of the patella ideal candidate has no symptoms of instability medial patellar glide of less than one quadrant lateral patellar glide of less than three quadrants patellar realignment surgery Maquet (tubercle anteriorization) indicated only for distal pole lesions only elevate 1 cm or else risk of skin necrosis Elmslie-Trillat (medialization) indicated only for instability with lateral translation (not isolated lateral tilt) avoid if medial patellar facet arthrosis Fulkerson alignment surgery (tubercle anteriorization and medialization) indications (controversial) lateral and distal pole lesions increased Q angle contraindications superior medial arthrosis (scope before you perform the surgery) skeletal immaturity Techniques Arthroscopic lateral release technique viewing through superior portal will show medial facet does not articulate with trochlea at 40 degrees of knee flexion be sure adequate hemostasis is obtained postoperatively the patella should be able to be passively tilted 80° complications persistent or worsened pain patellar instability with medial translation
QUESTIONS 1 of 3 1 2 3 Previous Next (OBQ11.34) An 18-year-old female has 9 months of anterior knee pain recalcitrant to physical therapy that includes VMO strengthening, NSAIDS, and lifestyle modification. On physical examination she has no effusion in the knee and her Q angle is measured at 15 degrees. She has less than one quadrant of medial patella translation and less than two quadrants of lateral patella translation. The lateral edge of the patella is unable to be everted. A merchant view radiograph is shown in Figure A. The tibia tubercle-trochlear groove distance is measured as 14mm on a CT scan. Which of the following procedures is MOST appropriate? Review Topic QID: 3457 FIGURES: A 1 Lateral retinacular release 77% (1750/2266) 2 Anterolateral tibial tubercle osteotomy 5% (114/2266) 3 Anterior tibial tubercle osteotomy (Maquet) 5% (116/2266) 4 Medial tibial tubercle osteotomy (Elmslie-Trillat) 8% (183/2266) 5 Medial plica resection 4% (84/2266) ML 2 Select Answer to see Preferred Response PREFERRED RESPONSE 1 Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ05.184) A 21-year-old female presents with left knee pain for six months. The symptoms are worse climbing stairs and sitting for long periods of time. On physical exam she has a stable knee with no effusion and pain with compression of the patella. Her Q angle is 21 degrees. What is the first step in management? Review Topic QID: 1070 1 arthroscopic lateral retinacular release 1% (11/1531) 2 tubercle elevation and medialization 1% (13/1531) 3 strict immobilization and non-weight bearing for four weeks 1% (10/1531) 4 open chain exercises and a focus on seated leg extensions 8% (123/1531) 5 closed chain exercises with focus on quadriceps and hamstring strengthening 89% (1370/1531) ML 1 Select Answer to see Preferred Response PREFERRED RESPONSE 5
Login to View Community Videos Login to View Community Videos 2018 Winter SKS Meeting: Shoulder, Knee, & Sports Medicine Is Lateral Release EVER indicated? - Robin West, MD (2.34, 2018 Winter SKS) Robin West Knee & Sports - Lateral Patellar Compression Syndrome 7/16/2018 229 views Upgrade to View Premium Videos Upgrade to View Premium Videos Arthroscopic lateral retinacular release Michael Hughes Knee & Sports - Lateral Patellar Compression Syndrome 1/26/2012 3306 views Upgrade to View Premium Videos Upgrade to View Premium Videos Fulkerson tibial tubercle osteotomy Michael Hughes Knee & Sports - Lateral Patellar Compression Syndrome 1/24/2012 11972 views
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