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PURPOSE: Trochlear dysplasia is one of the main risk factors for recurrent patellar dislocation. The Dejour classification identifies four categories that can be used to classify trochlear dysplasia. The purpose of this study is to evaluate the inter- and intraobserver reliability of the Dejour classification for trochlear dysplasia. The hypothesis was that both intra- and interobserver reliability would be at least moderate. METHODS: This is a cross-sectional, reliability study. Twenty-eight examiners from the International Patellofemoral Study Group 2022 meeting evaluated lateral radiographs of the knee and axial magnetic resonance images from 15 cases of patellofemoral instability with trochlear dysplasia. They classified each case according to Dejour's classification for trochlear dysplasia (A-D). There were three rounds: one with only computed radiograph (CR), one with only magnetic resonance imaging (MRI) and one with both. Inter- and intraobserver reliability were calculated using κ coefficient (0-1). RESULTS: The mean age of patients was: 14.6 years; 60% were female and 53% had open physis. The interobserver reliability κ probabilities were 0.2 (CR), 0.13 (MRI) and 0.12 (CR and MRI). The intraobserver reliability κ probabilities were 0.45 (CR), 0.44 (MRI) and 0.65 (CR and MRI). CONCLUSION: The Dejour classification for trochlear dysplasia has slight interobserver reliability and substantial intraobserver reliability. LEVEL OF EVIDENCE: Level I.

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Abstract BACKGROUND: The relationships between the morphometric structure of the patellofemoral joint, patella type and chondromalacia patella are still a matter of debate. OBJECTIVE: To identify the prevalence of chondromalacia patella by determining the patella type and making patellofemoral morphometric measurements. DESIGN AND SETTING: Retrospective cohort study in an orthopedics and traumatology clinic in Turkey, conducted between June 2017 and November 2019. METHODS: This study involved 562 knees of 522 patients with anterior knee pain (246 males and 316 females; mean age 46.59 years). The patients were grouped according to presence of chondromalacia patella (group I) or absence of chondromalacia patella (group II). The patella type, lateral trochlear inclination, medial trochlear inclination, trochlear angle, sulcus angle, patellar tilt and Insall-Salvati index were assessed. Group comparisons were made using chi-square tests or Student t tests. The r value was used to determine the magnitude of relationships between pairs of variables. RESULTS: Among the 562 knees evaluated, 265 (50.71%) presented type I patella, 195 (36.7%) type II, 100 (12.3%) type III and 2 (0.3%) type IV. Group I consisted of 448 knees and group II consisted of 114 knees. Significant differences were found between the groups in terms of age, gender, patella type and lateral inclination angles (P < 0.05). CONCLUSION: Detecting the patella type and making lateral inclination measurements in patients with anterior knee pain are of great importance for diagnosing suspected chondromalacia patella, particularly in the early degenerative period.

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BACKGROUND: Elevated patellofemoral joint stress has been associated with patellofemoral osteoarthritis (PFOA). Changes in lower limb kinematics, such as excessive femoral adduction and internal rotation and excessive rearfoot eversion during the stance phase of functional activities, may increase patellofemoral stress. There is a lack of studies that assess the effects of interventions for controlling femur and subtalar joint movements during functional activities on self-reported measures in individuals with PFOA. Thus, the primary aim of the study is to determine the immediate effects of the hip strap and foot orthoses during level-ground walking and the single-leg squat test on self-reported outcomes. The secondary aim is to investigate whether the hip strap and foot orthoses result in the kinematic changes that these devices are purported to cause. METHODS: Twenty-nine individuals with PFOA aged 50 years or older will take part in the study. The main outcome is pain intensity. The secondary outcomes are other self-reported measures (global rating of change, acceptable state of symptoms, ease of performance, and confidence) and lower limb kinematics (peak femoral adduction and internal rotation, and peak rearfoot eversion). These outcomes will be assessed during functional tasks performed under three conditions: (i) control condition, (ii) hip strap intervention, and (iii) foot orthoses intervention. To investigate whether these interventions result in the lower limb kinematic changes that they are purported to cause, three-dimensional kinematics of the femur and rearfoot will be captured during each task. Linear mixed models with two fixed factors will be used to test associations between the interventions (control, hip strap, and foot orthoses) and conditions (level-ground walking and single-leg squat test) as well as interactions between the interventions and conditions. DISCUSSION: To the best of the authors' knowledge, this is the first study to evaluate the immediate effects of the hip strap and foot orthoses on self-reported measures and lower limb kinematics during functional tasks in individuals with PFOA. The findings of this study will enable future trials to investigate the effects of these interventions in rehabilitation programmes. TRIAL REGISTRATION: ClinicalTrials.gov NCT04332900 . Registered on 3 April 2020.

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Objective: To assess clinical results of patients who underwent medial patellofemoral ligament (MPFL) reconstruction after a minimum of two years of follow-up. Methods: Patients' medical records were assessed for residual instability, patient satisfaction, and post-operative functional outcomes. Results: Fifty-one patients were analyzed, out of which 56.87% were women. Patients' mean age was 30.8 years (16 to 57 years). The mean follow-up time was 68.7 months (37 to 120 months). Length between first dislocation and surgery was less than 1 year for 58.82% of patients, between 1 and 5 years for 37.25%, and over 5 years for 3.93%. Patients showed a high degree of satisfaction (96.08% would undergo surgery again), with recurrence rate of 11.76%. Twenty-two patients reported knee symptoms, including pain from movements (72.72%), weakness (18.18%), constant pain (13.63%), and crepitus (4.54%). Considering dissatisfied patients, patients with dislocation recurrence, and patients with symptoms, five cannot practice physical activity, out of which only three blame their knee. Conclusion: MPFL reconstruction showed a recurrence rate of 11.7%, with high patient satisfaction, good functional results, and high rate of return to sports, after a minimum of two years of follow-up. Level of Evidence IV, Case Series.

Objetivo: Avaliar o resultado clínico de pacientes submetidos à reconstrução do ligamento patelofemoral medial (LPFM), acompanhados por mínimo de dois anos. Métodos: Avaliação de prontuários para informações sobre instabilidade residual, satisfação do paciente e resultado funcional pós-operatório. Resultados: Foram analisados 51 pacientes. 56,87% do sexo feminino e média etária 30,8 anos (16 a 57). Tempo médio de acompanhamento de 68,7 meses (37 a 120). Intervalo entre primeira luxação e cirurgia foi menos de 1 ano em 58,82%, entre 1 e 5 anos em 37,25% e mais de 5 anos para 3,93%. Os pacientes apresentaram alto grau de satisfação (96,08% fariam a cirurgia novamente), com 11,76% de recidiva. Houve persistência de sintomas em 22 pacientes, sendo dor ao movimento o principal (72,72%), seguido de fraqueza (18,18%), dor constante (13,63%) e crepitações (4,54%). Somando os pacientes insatisfeitos aos que tiveram recidiva da instabilidade e os sintomáticos, 5 não conseguem praticar atividade física, mas apenas 3 por causa do joelho. Conclusão: A reconstrução isolada do LPFM demonstrou índice de recidiva de 11,7%, com alto nível de satisfação dos pacientes, ótimos resultados funcionais e alta taxa de retorno ao esporte, em acompanhamento mínimo de 2 anos. Nível de Evidência IV, Série de Casos.

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PURPOSE: To evaluate the inter-observer and inter-method reliability for patellar height measurements between conventional radiographs (CR) and magnetic resonance imaging (MRI) using one or two slices. METHODS: This was a reliability study, with 60 patients divided in two groups: 30 patients with patellar instability (patella group) and 30 patients with anterior cruciate ligament or meniscus injury (control group). CR and MRI were evaluated by two independent observers. Insall-Salvati index (IS) and Caton-Deschamps index (CD) were measured using three different methods: CR, one-slice MRI or two-slice MRI. Intra-class correlation coefficients (ICC) were calculated for inter-observer reliability and inter-method reliability. Bland-Altman agreement was also calculated. RESULTS: The inter-observer reliability was very good for the IS with ICCs of 0.93, 0.84 and 0.82, for the CR, one-slice MRI and two-slice MRI, respectively. Similarly, for the CD the ICCs were good, 0.76, 0.80 and 0.75 for the CR, one-slice MRI and two-slice MRI, respectively. No differences were found between the patella and the control group. The inter-method analysis results were: ICCs for IS (0.83, 0.86, 0.93) and CD (0.72, 0.82, 0.83), for the comparisons of CR/one-slice MR, CR/two-slice MRI and one-slice MRI/two-slice MRI, respectively. The Bland-Altman mean differences showed an 8% and a 7% increase on IS values with one-slice MRI and two-slice MRI compared to CR results, while the increase was of 9% and 1% in CD for the respective comparisons with CR. CONCLUSION: MRI can overestimate patellar height compared to CR, as much as an 8% increase in Insall-Salvati values when using one- or two-slice MRI measurements, and up to a 9% increase in Caton-Deschamps value when using the one-slice MRI method. It is recommended to use the CR as the preferred method when measuring patellar height. LEVEL OF EVIDENCE: III.

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ABSTRACT Objective: To assess clinical results of patients who underwent medial patellofemoral ligament (MPFL) reconstruction after a minimum of two years of follow-up. Methods: Patients' medical records were assessed for residual instability, patient satisfaction, and post-operative functional outcomes. Results: Fifty-one patients were analyzed, out of which 56.87% were women. Patients' mean age was 30.8 years (16 to 57 years). The mean follow-up time was 68.7 months (37 to 120 months). Length between first dislocation and surgery was less than 1 year for 58.82% of patients, between 1 and 5 years for 37.25%, and over 5 years for 3.93%. Patients showed a high degree of satisfaction (96.08% would undergo surgery again), with recurrence rate of 11.76%. Twenty-two patients reported knee symptoms, including pain from movements (72.72%), weakness (18.18%), constant pain (13.63%), and crepitus (4.54%). Considering dissatisfied patients, patients with dislocation recurrence, and patients with symptoms, five cannot practice physical activity, out of which only three blame their knee. Conclusion: MPFL reconstruction showed a recurrence rate of 11.7%, with high patient satisfaction, good functional results, and high rate of return to sports, after a minimum of two years of follow-up. Level of Evidence IV, Case Series.

RESUMO Objetivo: Avaliar o resultado clínico de pacientes submetidos à reconstrução do ligamento patelofemoral medial (LPFM), acompanhados por mínimo de dois anos. Métodos: Avaliação de prontuários para informações sobre instabilidade residual, satisfação do paciente e resultado funcional pós-operatório. Resultados: Foram analisados 51 pacientes. 56,87% do sexo feminino e média etária 30,8 anos (16 a 57). Tempo médio de acompanhamento de 68,7 meses (37 a 120). Intervalo entre primeira luxação e cirurgia foi menos de 1 ano em 58,82%, entre 1 e 5 anos em 37,25% e mais de 5 anos para 3,93%. Os pacientes apresentaram alto grau de satisfação (96,08% fariam a cirurgia novamente), com 11,76% de recidiva. Houve persistência de sintomas em 22 pacientes, sendo dor ao movimento o principal (72,72%), seguido de fraqueza (18,18%), dor constante (13,63%) e crepitações (4,54%). Somando os pacientes insatisfeitos aos que tiveram recidiva da instabilidade e os sintomáticos, 5 não conseguem praticar atividade física, mas apenas 3 por causa do joelho. Conclusão: A reconstrução isolada do LPFM demonstrou índice de recidiva de 11,7%, com alto nível de satisfação dos pacientes, ótimos resultados funcionais e alta taxa de retorno ao esporte, em acompanhamento mínimo de 2 anos. Nível de Evidência IV, Série de Casos.

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OBJECTIVE: To determine the relationship between cartilage lesion etiology and clinical outcomes after second-generation autologous chondrocyte implantation (ACI) in the patellofemoral joint (PFJ) with a minimum of 2 years' follow-up. METHODS: A retrospective review of all patients that underwent ACI in the PFJ by a single surgeon was performed. Seventy-two patients with a mean follow-up of 4.2 ± 2.0 years were enrolled in this study and were stratified into 3 groups based on the etiology of PFJ cartilage lesions: patellar dislocation (group 1; n = 23); nontraumatic lesions, including chondromalacia, osteochondritis dissecans, and degenerative defects (group 2; n = 28); and other posttraumatic lesions besides patellar dislocations (group 3; n = 21). Patient's mean age was 29.6 ± 8.7 years. Patients in group 1 were significantly younger (25.4 ± 7.9 years) than group 2 (31.7 ± 9.6 years; P = 0.025) and group 3 (31.5 ± 6.6 years; P = 0.05). Body mass index averaged 26.2 ± 4.3 kg/m2, with a significant difference between group 1 (24.4 ± 3.2 kg/m2) and group 3 (28.7 ± 4.5 kg/m2; P = 0.005). A clinical comparison was established between groups based on patient-reported outcome measures (PROMs) and failure rates. RESULTS: Neither pre- nor postoperative PROMs differed between groups (P > 0.05). No difference was seen in survivorship between groups (95.7% vs. 82.2% vs. 90.5%, P > 0.05). CONCLUSION: Cartilage lesion etiology did not influence clinical outcome in this retrospective study after second generation ACI in the PFJ. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

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Patellar instability is a multifactorial clinical condition that affects a significant number of patients and occurs due to morphological variations of the joint and patellofemoral alignment. The present literature review study aimed to identify and summarize current concepts on patellar instability, in relation to associated risk factors, diagnostic criteria, and the benefits and risks of conservative and surgical treatments. For this purpose, a search was conducted in the following electronic databases: MEDLINE (via Pubmed), LILACS and Cochrane Library. It is concluded that the accurate diagnosis depends on the detailed clinical evaluation, including the history and possible individual risk factors, as well as imaging exams. The initial treatment of patellar instability is still controversial, and requires the combination of conservative and surgical interventions, taking into consideration both soft tissues and bone structures, the latter being the most common reason for choosing surgical treatment, especially lateral patellar instability.

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Abstract Patellar instability is a multifactorial clinical condition that affects a significant number of patients and occurs due to morphological variations of the joint and patellofemoral alignment. The present literature review study aimed to identify and summarize current concepts on patellar instability, in relation to associated risk factors, diagnostic criteria, and the benefits and risks of conservative and surgical treatments. For this purpose, a search was conducted in the following electronic databases: MEDLINE (via Pubmed), LILACS and Cochrane Library. It is concluded that the accurate diagnosis depends on the detailed clinical evaluation, including the history and possible individual risk factors, as well as imaging exams. The initial treatment of patellar instability is still controversial, and requires the combination of conservative and surgical interventions, taking into consideration both soft tissues and bone structures, the latter being the most common reason for choosing surgical treatment, especially lateral patellar instability.

Resumo A instabilidade patelar é uma condição clínica multifatorial, que acomete um número expressivo de pacientes, ocorrendo devido a variações anatómicas, morfológicas da articulação e do alinhamento patelofemoral. O presente estudo de revisão e atualização da literatura teve como objetivos identificar e sumarizar os conceitos atuais sobre instabilidade patelar em relação aos fatores de risco associados, os critérios diagnósticos e os benefícios e riscos dos tratamentos conservador e cirúrgico. Para tanto, foi realizado um levantamento nas bases de dados eletrónicas MEDLINE (via Pubmed), LILACS e Cochrane Library. Conclui-se que o diagnóstico preciso depende da avaliação clínica detalhada, incluindo o histórico e possíveis fatores de risco individuais, além de exames de imagem. O tratamento inicial da instabilidade patelar é ainda controverso, e requer a combinação de intervenções conservadoras e cirúrgicas, levando em consideração tanto os tecidos moles quanto as estruturas ósseas, sendo estas últimas a razão mais comum para a escolha do tratamento cirúrgico, principalmente instabilidade patelar lateral.

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BACKGROUND: Tibial tubercle osteotomy with concomitant distalization for the treatment of patellar instability remains controversial, as it may cause anterior knee pain and chondral degeneration. PURPOSE: To evaluate radiographic, clinical, and functional outcomes in patients who had patellar instability with patella alta and underwent tibial tubercle osteotomy with distalization (TTO-d) as well as medial patellofemoral ligament reconstruction. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Included in this study were 25 patients (31 cases) (mean age at surgery, 28.7 years; range, 14-33 years) with patellar instability and patella alta who underwent TTO-d with minimum 1-year follow-up. The Caton-Deschamps index (CDI), tibial tubercle-trochlear groove (TT-TG) distance, and amount of distalization were assessed. Clinical and functional variables included J-sign, anterior knee pain, apprehension test, Tegner activity level, and Kujala score. RESULTS: The mean follow-up period was 2.62 years. The mean TT-TG was 16.15 mm (range, 7-24 mm); the mean CDI changed from 1.37 (1.25-1.7) preoperatively to 1.02 (0.9-1.12) postoperatively (P = .001); and the mean amount of tibial tubercle distalization was 8.80 mm (range, 4-16 mm). Lateral release (22 cases; 71.0%), medialization of tibial tubercle (17 cases; 54.8%), and autologous chondrocyte implantation (4 cases; 12.9%) were other associated procedures. The J-sign improved in 30 cases (96.8%; P = .001), and there was a complete resolution of anterior knee pain in 22 cases (71.0%; P = .001). An exploratory analysis showed that patellar cartilage defect severity was correlated with persistent pain (P = .005). The apprehension test became negative in all cases (P = .001). The median Kujala score increased from 52 to 77 (P = .001), and the median Tegner activity level improved from 3 to 4 (P = .001). No cases of osteotomy nonunion were reported. One case (3.2%) of patellar instability recurrence and 3 cases (6.5%) with painful hardware were observed. CONCLUSION: TTO-d resulted in good radiographic, clinical, and functional outcomes providing proper patellar stability to patients with patella alta. TTO-d appears to be a safe and efficient procedure with low complication rates, providing an additional tool for the personalized treatment of patellar instability.

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Introducción El síndrome de dolor patelofemoral (SDPF) es una posible causa de dolor anterior en la rodilla que afecta predominantemente a mujeres jóvenes. No existe hasta el momento un consenso en cuanto a la etiología, pero la evidencia sugiere que el malalineamiento patelofemoral probablemente desempeña un papel en la patogénesis del dolor y particularmente en la condromalacia. Las osteotomías clásicamente utilizadas y descritas en la literatura reportan resultados funcionales variables, sin embargo los buenos resultados descritos en la literatura se encuentran en un rango entre el 50%-80%, lo que indica alguna dificultad con la reproducibilidad de la técnica o su eficacia, por lo que queremos evaluar los resultados de una técnica diferente. Materiales y Métodos Estudio de serie de casos prospectivo de pacientes con síndrome de dolor patelofemoral tratados con una nueva técnica de osteotomía de la tuberosidad tibial anterior anteromedializadora en V. Resultados Se evaluaron 19 rodillas, los promedios de intensidad de dolor fueron de 9 en el preoperatorio, 4 y 3 en el seguimiento a tres y seis meses, en la escala de Kujala se obtuvo un promedio de 33 puntos en el preoperatorio, de 75 a los 3 meses y de 87 a los seis meses. Discusión En nuestro estudio consideramos un porcentaje de 94,7% de buenos o excelentes resultados y 5% de malos resultados. La técnica descrita y utilizada en nuestro estudio presenta una tasa de buenos resultados similar a las descritas en la literatura con otras técnicas quirúrgicas y con diferentes escalas funcionales.

Background Patellofemoral pain syndrome (PFPS) is a possible cause of anterior knee pain that predominantly affects young women. To date, there is no consensus regarding the aetiology, but the evidence suggests that patellofemoral misalignment probably plays a role in the pathogenesis of pain and particularly in chondromalacia. Osteotomies classically used and described in the literature report variable functional results. As the good results described in the literature are in a range between 50%-80%, this indicates some difficulty with the reproducibility of the technique, or its effectiveness, we wish to evaluate the results of a different technique. Materials and Methods Prospective case series study of patients with patellofemoral pain syndrome treated with a new osteotomy technique of the anterior tibial tuberosity, anterior-medialized, in V. Results A total of 19 knees were evaluated. The mean pain intensity was 9 in the preoperative period, and 4 and 3 in the follow-up at three and six months, respectively. A mean of 33 points on the Kujala scale was obtained in the pre-operative period, and 75 at 3 months and 87 at six months follow-up. Discussion A percentage of 94.7% was considered good or excellent results, and 5% of considered as bad. The technique described and used in our study presents a rate of good results similar to those described in the literature with other surgical techniques and with different functional scales.

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Objective To evaluate different femoral fixation devices for medial patellofemoral ligament reconstruction and compare their effectiveness regarding fixation strength up to failure in porcine knees. Methods Thirty porcine knees were used, divided into three groups of 10 knees. The removed grafts were dissected from the extensor tendons of porcine feet. In each group, the graft was fixed to the femur with an interference screw, an anchor, or adductor tenodesis. The three methods were subjected to biomechanical tests using a universal Tensile testing machine at a speed of 20 mm/minute. Results The highest average linear resistance under lateral traction occurred in group 1, "screw fixation" (185.45 ± 41.22 N), followed by group 2, "anchor fixation" (152.97 ± 49, 43 N); the lower average was observed in group 3, "tenodesis fixation" (76.69 ± 18.90 N). According to the fixed error margin (5%), there was a significant difference between groups ( p < 0.001); in addition, multiple comparison tests (between group pairs) also showed significant differences. Variability was small, since the variance coefficient was lower than 33.3%. Conclusion Interference screws in bone tunnels and mountable anchors fixation with high resistance wire are strong enough for femoral fixation in porcine medial patellofemoral ligament reconstruction. Adductor tenodesis, however, was deemed fragile for such purpose.

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Abstract Objective To evaluate different femoral fixation devices for medial patellofemoral ligament reconstruction and compare their effectiveness regarding fixation strength up to failure in porcine knees. Methods Thirty porcine knees were used, divided into three groups of 10 knees. The removed grafts were dissected from the extensor tendons of porcine feet. In each group, the graft was fixed to the femur with an interference screw, an anchor, or adductor tenodesis. The three methods were subjected to biomechanical tests using a universal Tensile testing machine at a speed of 20 mm/minute. Results The highest average linear resistance under lateral traction occurred in group 1, "screw fixation" (185.45 ± 41.22 N), followed by group 2, "anchor fixation" (152.97 ± 49, 43 N); the lower average was observed in group 3, "tenodesis fixation" (76.69 ± 18.90 N). According to the fixed error margin (5%), there was a significant difference between groups (p < 0.001); in addition, multiple comparison tests (between group pairs) also showed significant differences. Variability was small, since the variance coefficient was lower than 33.3%. Conclusion Interference screws in bone tunnels and mountable anchors fixation with high resistance wire are strong enough for femoral fixation in porcine medial patellofemoral ligament reconstruction. Adductor tenodesis, however, was deemed fragile for such purpose.

Resumo Objetivo Avaliar diferentes dispositivos de fixação femoral na reconstrução do ligamento patelofemoral medial para comparar sua eficácia quanto à força de fixação até a falha em joelhos suínos. Métodos Foram ensaiados 30 joelhos de suínos subdivididos em 3 grupos de 10 joelhos. Os enxertos retirados foram dissecados de tendões extensores das patas dos suínos. Cada grupo teve o enxerto fixado ao fêmur com parafuso de interferência, âncora, ou tenodese no tendão adutor. Os 3 métodos foram submetidos à testes biomecânicos utilizando uma máquina universal de ensaio de tração com uma velocidade de 20 mm/min. Resultados Verificamos que a média mais elevada da resistência linear sob tração lateral (185,45 ± 41,22 N) ocorreu no grupo 1: "fixação por parafuso," seguido do grupo 2: "fixação por âncora" (152,97 ± 49,43 N), e a média foi menor no grupo 3: "fixação por tenodese" (76,69 ± 18,90 N). Para a margem de erro fixada (5%), comprovou-se a diferença significativa entre os grupos (p < 0,001) e também através dos testes de comparações múltiplas (entre os pares de grupos) verificou-se a ocorrência de diferenças significativas. A variabilidade expressada por meio do coeficiente de variação mostrou-se reduzida, já que a referida medida foi inferior a 33,3%. Conclusão O uso de parafusos de interferência no túnel ósseo de joelhos porcinos é suficientemente forte para fixação femoral na reconstrução do ligamento patelofemoral medial, assim como a fixação com âncoras montáveis com fio de alta resistência. Entretanto, a tenodese no tendão adutor mostrou-se frágil para essa finalidade.

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Objective The aim of the present study was to evaluate the clinical results, functional outcomes, and risk factors after anatomic reconstructions using knee flexor grafts in athletes. Methods The authors followed-up 32 patients and 34 knees for 1 year in a prospective design case series evaluating pre- and postoperative functional scores (Kujala and Lysholm) and associated risk factors. Results All of the 32 patients had a significant increase of the Lysholm and Kujala scores. Patients with < 5 preoperative dislocations had a better score on the Lysholm and Kujala scales. The mean preoperative Lysholm score was 62.8, and the mean postoperative score was 94.3. The mean preoperative Kujala score was 63.0, and the mean postoperative score was 94.0. Conclusion Medial patellofemoral ligament reconstruction with hamstring graft in athletes with patellar instability improved clinical and functional scores. The bone drilling through the patella and the positioning of the femoral tunnel should be judiciously performed.

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Abstract Objective The aim of the present study was to evaluate the clinical results, functional outcomes, and risk factors after anatomic reconstructions using knee flexor grafts in athletes. Methods The authors followed-up 32 patients and 34 knees for 1 year in a prospective design case series evaluating pre- and postoperative functional scores (Kujala and Lysholm) and associated risk factors. Results All of the 32 patients had a significant increase of the Lysholm and Kujala scores. Patients with < 5 preoperative dislocations had a better score on the Lysholm and Kujala scales. The mean preoperative Lysholm score was 62.8, and the mean postoperative score was 94.3. The mean preoperative Kujala score was 63.0, and the mean postoperative score was 94.0. Conclusion Medial patellofemoral ligament reconstruction with hamstring graft in athletes with patellar instability improved clinical and functional scores. The bone drilling through the patella and the positioning of the femoral tunnel should be judiciously performed.

Resumo Objetivo Avaliar os resultados clínicos e funcionais da reconstrução anatômica do ligamento patelofemoral medial com tendões flexores em atletas. Métodos Estudo tipo série de casos, prospectivo, que analisou a reconstrução do ligamento patelofemoralmedial em32 pacientes (34 joelhos). A avaliação funcional foi feita pelos escores Lysholm e Kujala nos períodos pré e pós-operatórios e os fatores de risco envolvidos foram avaliados. Resultados Dos 32 pacientes analisados, todos obtiveram melhoria dos escores funcionais comparativamente ao período pré-operatório. Pacientes com menos de cinco episódios de luxação prévios obtiveram melhores resultados funcionais. O valor médio de Lysholm no pré-operatório foi de 62,8 e no pós-operatório de 94,3, quanto ao escore de Kujala a média pré-operatório foi de 63,0 e pós-operatória de 94,0. Conclusão A reconstrução do ligamento patelofemoral medial com enxerto de tendão flexor do joelho em atletas propiciou melhoria dos escores clínicos e funcionais nos pacientes com instabilidade patelofemoral. A perfuração óssea da patela e o posicionamento do túnel femoral devem ocorrer de forma judiciosa.

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Abstract Objective To evaluate the classification proposed by David Dejour to describe trochlear dysplasia of the knee through inter- and intraobserver reproducibility measurements. Methods Ten patients with trochlear dysplasia were studied. Three physicians, members of the Sociedade Brasileira de Cirurgia do Joelho (Brazilian Society of Knee Surgery), were invited to evaluate the images. Intra- and interobserver analyses were performed at one-week intervals. Reproducibility was evaluated in four scenarios: using only radiography; using radiography and tomography; using radiography and consulting the classification; and using radiography and tomography, consulting the classification. Results The intraobserver evaluation presented discordant results. In the interobserver analysis, the degree of agreement was low for the analyses that used only radiography and excellent for those in which both radiography and tomography were used. Conclusion The Dejour classification presented a low intra- and interobserver reproducibilitywhenonly the profile radiography was used. It was demonstrated that the use of the radiography alone for classificationmay generate lack of uniformity even among experienced observers. However, when radiography and tomography were combined, reproducibility improved.

Resumo Objetivo Avaliar, pela reprodutibilidade interobservador e intraobservador, a classificação proposta por David Dejour para descrever a displasia troclear do joelho. Métodos Foram estudados dez pacientes com diagnóstico de displasia troclear. Três médicos membros da Sociedade Brasileira de Cirurgia do Joelho foram convidados para avaliar as imagens. Análises intra- e interobservador foram feitas com intervalo de uma semana. A reprodutibilidade foi avaliada em quatro cenários: uso de radiografia; uso de radiografia e tomografia; uso de radiografia, consultando-se a classificação no momento; e uso de radiografia e tomografia, consultando-se a classificação no momento. Resultados A avaliação intraobservador apresentou resultados discordantes. Na análise interobservador, o grau de concordância foi baixo para as análises que usavam apenas a radiografia e excelente para aquelas que associavamradiografia e tomografia. Conclusão A classificação de Dejour apresentou uma baixa reprodutibilidade intra e interobservador quando usada somente a radiografia em perfil. Demonstrou-se que o uso apenas da radiografia para classificar pode gerar falta de uniformidade até mesmo entre observadores experientes. Contudo, quando radiografia e tomografia foram associadas, a reprodutibilidade melhorou.

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ABSTRACT Objective: To compare the clinical outcomes and the results of knee functional scores in patients with normal patellar height and patella alta who underwent isolated medial patellofemoral ligament reconstruction. Methods: A total of 37 knees from 33 patients with recurrent patellar dislocation who underwent isolated medial patellofemoral ligament reconstruction were included. Retrospectively, the postoperative clinical results were compared using the Kujala and Lysholm scores in the group of patients with normal patellar height and in those with patella alta. Results: The sample consisted of 37 patients; 16 knees of 14 patients in the group with normal patellar height, 21 knees of 19 patients in the group with patella alta. In the first group, the mean Kujala score was 85.8 and the mean Lysholm score was 85.6. In the second, the mean Kujala score was 78.1 and the mean Lysholm score was 79.7. No significant differences were observed between the groups in relation to the Lysholm (p = 0.296) and Kujala scores (p = 0.181). Conclusion: Isolated medial patellofemoral ligament reconstruction presented similar results in patients with normal patellar height and patella alta.

RESUMO Objetivo: Comparar os resultados clínicos e escores funcionais do joelho em pacientes com altura patelar normal e patela alta submetidos a reconstrução isolada do ligamento patelofemoral medial. Métodos: Foram incluídos 37 joelhos de 33 pacientes com quadro de luxação recidivante da patela submetidos a reconstrução isolada do ligamento patelofemoral medial. Retrospectivamente, foi comparado o resultado clínico pós-operatório pelas escalas de Kujala e Lysholm entre o grupo de pacientes com altura patelar dentro da normalidade e aqueles com patela alta. Resultados: A amostra foi constituída por 37 pacientes; 16 joelhos de 14 pacientes pertenciam ao grupo da patela com altura normal e 21 joelhos de 19 pacientes compuseram o grupo com patela alta. No primeiro grupo, a pontuação média pela escala de Kujala foi de 85,8 e pela de Lysholm, 85,6. No segundo, a pontuação média pela escala de Kujala foi de 78,1 e pela de Lysholm, 79,7. Não foi observada diferença significativa entre os grupos em relação aos escores das escalas de Lysholm (p = 0,296) e de Kujala (p = 0,181). Conclusão: A reconstrução isolada do ligamento patelofemoral medial apresentou resultados semelhantes em pacientes com altura patelar normal e elevada.

Assuntos

RESUMO

OBJECTIVE: To compare the clinical outcomes and the results of knee functional scores in patients with normal patellar height and patella alta who underwent isolated medial patellofemoral ligament reconstruction. METHODS: A total of 37 knees from 33 patients with recurrent patellar dislocation who underwent isolated medial patellofemoral ligament reconstruction were included. Retrospectively, the postoperative clinical results were compared using the Kujala and Lysholm scores in the group of patients with normal patellar height and in those with patella alta. RESULTS: The sample consisted of 37 patients; 16 knees of 14 patients in the group with normal patellar height, 21 knees of 19 patients in the group with patella alta. In the first group, the mean Kujala score was 85.8 and the mean Lysholm score was 85.6. In the second, the mean Kujala score was 78.1 and the mean Lysholm score was 79.7. No significant differences were observed between the groups in relation to the Lysholm (p = 0.296) and Kujala scores (p = 0.181). CONCLUSION: Isolated medial patellofemoral ligament reconstruction presented similar results in patients with normal patellar height and patella alta.

OBJETIVO: Comparar os resultados clínicos e escores funcionais do joelho em pacientes com altura patelar normal e patela alta submetidos a reconstrução isolada do ligamento patelofemoral medial. MÉTODOS: Foram incluídos 37 joelhos de 33 pacientes com quadro de luxação recidivante da patela submetidos a reconstrução isolada do ligamento patelofemoral medial. Retrospectivamente, foi comparado o resultado clínico pós-operatório pelas escalas de Kujala e Lysholm entre o grupo de pacientes com altura patelar dentro da normalidade e aqueles com patela alta. RESULTADOS: A amostra foi constituída por 37 pacientes; 16 joelhos de 14 pacientes pertenciam ao grupo da patela com altura normal e 21 joelhos de 19 pacientes compuseram o grupo com patela alta. No primeiro grupo, a pontuação média pela escala de Kujala foi de 85,8 e pela de Lysholm, 85,6. No segundo, a pontuação média pela escala de Kujala foi de 78,1 e pela de Lysholm, 79,7. Não foi observada diferença significativa entre os grupos em relação aos escores das escalas de Lysholm (p = 0,296) e de Kujala (p = 0,181). CONCLUSÃO: A reconstrução isolada do ligamento patelofemoral medial apresentou resultados semelhantes em pacientes com altura patelar normal e elevada.

RESUMO

BACKGROUND: Tibial tubercle osteotomy (TTO) is a treatment option for patients with patellofemoral instability and chondrosis. Occasionally, these patients also present with patella alta, and distalization of the tibial tubercle is desirable. Free distal transfer of the tubercle, however, can compromise mechanical stability of the osteotomy construct, leading to loss of fixation. PURPOSE: To evaluate alternative TTO proximal cut geometries to investigate whether these can result in tubercle distalization while preserving the proximal buttress. STUDY DESIGN: Descriptive laboratory study. METHODS: Three variants of TTO cut geometry were evaluated on Sawbones as well as cadaveric knees. The proximal cut of the osteotomy was modified in 2 axes: anterior-posterior (AP) and medial-lateral (ML). Three variations were used: ML neutral/AP neutral, ML 30° proximal/AP neutral, and ML neutral/AP 30° proximal. The medial cut plane was 45° for all specimens. Tibial tubercle position was evaluated before and after osteotomy to calculate anteriorization, medialization, and distalization. RESULTS: Distalization was achieved with all variants. Increasing the inclination angle of the proximal cut in the AP and ML axes resulted in maximum distalization. A proximally directed cut yielded significantly more distalization when performed in the AP axis than in the ML axis (P < .05). Even the standard, neutral cut resulted in 5 mm of distalization. CONCLUSION: Fulkerson osteotomy allows 3-dimensional repositioning of the tibial tubercle and has historically been utilized to achieve anteriorization and medialization. Even the neutral cut of a standard TTO resulted in distalization, which is relevant for patients with preexisting patella baja. Modification of the proximal cut increased distalization of the tubercle while preserving the proximal buttress, a potential benefit for construct stability. CLINICAL RELEVANCE: These results provide a guideline for adjusting the proximal cut geometry in Fulkerson TTO to meet specific patient needs.

RESUMO

[Purpose] Neuromuscular activity has been evaluated in patellofemoral pain syndrome but movement velocity has not been considered. The aim was to determine differences in onset latency of hip and knee muscles between individuals with and without patellofemoral pain syndrome during a single leg squat, and whether any differences are dependent on movement velocity. [Subjects and Methods] Twenty-four females with patellofemoral pain syndrome and 24 healthy females participated. Onset latency of gluteus maximus, anterior and posterior gluteus medius, rectus femoris, vastus medialis, vastus lateralis and biceps femoris during a single leg squat at high and low velocity were evaluated. [Results] There was an interaction between velocity and diagnosis for posterior gluteus medius. Healthy subjects showed a later posterior gluteus medius onset latency at low velocity than high velocity; and also later than patellofemoral pain syndrome subjects at low velocity and high velocity. [Conclusion] Patellofemoral pain syndrome subjects presented an altered latency of posterior gluteus medius during a single leg squat and did not generate adaptations to velocity variation, while healthy subjects presented an earlier onset latency in response to velocity increase.