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Which of the following structures attaches between the medial epicondyle and adductor tubercle of the femur?
Medial head of gastrocnemius
Medial collateral ligament
Medial patellofemoral ligament
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A 27-year-old football player sustains an acute lateral patellar dislocation. Which of the following is the most likely site of injury seen on MRI?
Midsubstance oblique retinacular ligament rupture
Soft-tissue avulsion of medial patellofemoral ligament
Midsubstance medial patellofemoral ligament rupture
Partial quadriceps tendon rupture
Bony avulsion of medial patellofemoral ligament
You see a patient in the emergency room with an acute lateral patellar dislocation. Which of the following factors is associated with the highest risk of persistent patellar instability?
Previous patellar instability event
Amount of lateral patellar tilt
Which of the following best describes the radiographic landmarks on a lateral radiograph for locating the femoral attachment of the medial patellofemoral ligament (MPFL) during reconstruction?
The intersection of a line extended from the middle of the shaft and Blumensaat's line
Anterior to a line extended from the middle of the shaft and Blumensaat's line
Posterior to a line extended from the posterior cortex of the shaft and distal to Blumensaat's line
Anterior to a line extended from the posterior cortex of the shaft and distal to Blumensaat's line
Anterior to a line extended from the posterior cortex of the shaft and proximal to Blumensaat's line
An athlete sustains a traumatic patellar dislocation. The MRI shows a hemarthrosis with a floating osteochondral fragment. Which of the following is the most likely site of origin for the loose fragment?
The lateral patellar facet
The medial patellar facet
The odd patellar facet
The medial trochlea
The central trochlea
All of the following are predisposing factors for lateral patellar dislocation in a native knee EXCEPT?
Excess femoral internal rotation
Excess external tibial rotation
Lateral femoral condylar hypoplasia
Insufficiency of the vastus lateralis
A high school softball player has chronic activity-related anterior knee pain without a history of instability. Which radiographic measurement is used to indicate when a lateral retinacular release may be helpful?
Lateral patello-femoral angle
Patellar height index
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HPI - 14 year old playing soccer and sustained twisting injury. Fell to the ground. Presented to me with swollen knee. Place in KI and MRI obtained.
MRI shows significant lateral patellar subluxation with some tilt.
Trochlear dysplasia (flat trochlea)
Large medial facet chondral deficiency with loose fragment in suprapatellar pouch.
Medial patellar facet fx.
MPFL seems to be attached to medial fx fragment.
I measured TTTG to be 19-20
I did not appreciate patella alta.
What are your guys thoughts?
Scope and see if cartilage piece can be fixated?
Or let medial facet fx heal then go back and do tibial tubercle transfer with lateral release, medial plication / mpfl and denovo for chondral defect?
What would be your next step in treatment of this patient?
HPI - 25 yo laborer that was dancing at his bachelor party with first-time patella dislocation. evidence of large (approx 2cm)chondral loose body from medial facet with small amount of bone attached to small portion of loose body. TT-TG ratio is normal. In addition to MPFL repair/recon how would you treat the largely chondral fragment with small amounts of bony attachment.
would your treatment include attempted fixation of segments with attached bone, debridement, OATS, microfracture?
would you use bioscrews or acutrax metal screws for any attempted refixation??
deNovo is not available due to insurance restriction.
what would your treatment be for the largely chondral defect with small areas of bony attachment?
HPI - 27 yr F. Multiple knee instability episodes. Many patellar dislocations when teenager. Was a dancer. Has generalized ligamentous laxity.
Had MPFL repair and lateral release 12 years ago. Did not do well after surgery.
Main complaint is instablity.
On exam very lax patella. + apprehension. 4 quadrant excursion.
Failed conservative tx.
+ patella alta
Caton deshamps 1.3
Trochlear dysplasia Dejour type C
+ acl tear
What to do now?
Tibial tubercle tx with distalization and revision mpfl reconstruction
When to reconstruct ACL? Do all one surgery or stage?