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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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La inestabilidad patelofemoral es una entidad que afecta principalmente a adolescentes y adultos jóvenes. En su diagnóstico se consideran elementos clínicos e imagenológicos, en especial para medir la distancia entre la tuberosidad anterior de la tibia y el surco intercondíleo, que permite la selección de la técnica quirúrgica en cada paciente, en específico la transferencia de la tuberosidad anterior de la tibia. En este artículo se exponen brevemente algunos aspectos de interés sobre el tema: métodos imagenológicos empleados en estos pacientes (radiografía simple, tomografía axial computarizada, imagen por resonancia magnética) y valores de referencia considerados como normales; también se describe por pasos cómo medir la distancia entre la tuberosidad anterior de la tibia y el surco intercondíleo.

The patellofemoral instability is an entity that mainly affects adolescents and young adults. In its diagnosis clinical and imaging elements are considered, especially to measure the tibial-tuberosity to trochlear groove distance that allows the selection of the surgical technique in each patient, in specific the transfer of the tibial-tuberosity. In this work some aspects of interest on the topic are shortly exposed: the imaging methods used in these patients (simple x-rays, computerized axial tomography, magnetic resonance imaging) and the reference values considered as normal; it is also described step by step how to measure the tibial-tuberosity to trochlear groove distance.

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INTRODUCTION: It is our understanding that there is no consensual solution for the treatment of post-traumatic patellar ankylosis; therefore, the purpose of this work is to present two cases of patellofemoral retinacular interposition arthroplasty, and its corresponding technical note. CASE 1: Female, 24, patellar ankylosis secondary to supratranscondylar fracture, associated with comminuted diaphyseal tibia fracture. CASE 2: Female, 48, patellar ankylosis secondary to femoral diaphysis and lateral femoral condyle fracture. RESULTS: After going through a patellofemoral retinacular interposition release, both patients were satisfied with the results, presenting with significantly improved knee range of motion. CONCLUSION: Using our surgical technique, we were not able to restore normal function to our patients, but their improvement was certainly impressive relative to their initial clinical situation.

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BACKGROUND: Focal cartilage lesions in the patellofemoral (PF) joint are common. Several studies correlated PF risk factors with PF instability, anterior knee pain, and PF arthritis; however, there is a lack of evidence correlating those factors to PF focal cartilage lesions. PURPOSE: To evaluate the influence of the anatomic PF risk factors in patients with isolated focal PF cartilage lesions. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Patients with isolated PF focal cartilage lesions were included in the cartilage lesion group, and patients with other pathologies and normal PF cartilage were included in the control group. Multiple PF risk factors were accessed on magnetic resonance imaging scans: patellar morphology (patellar width, patellar thickness, and patellar angle), trochlear morphology (trochlear sulcus angle, lateral condyle index, and trochlear sulcus depth), patellar height (Insall-Salvati ratio and Caton-Deschamps index), axial patellar positioning (patellar tilt, angle of Fulkerson), and quadriceps vector (tibial tuberosity-trochlear groove distance). RESULTS: A total of 135 patients were included in the cartilage lesion group and 100 in the control group. As compared with the control group, the cartilage lesion group had a higher sulcus angle (P = .0007), lower trochlear sulcus depth (P < .0001), lower angle of Fulkerson (P < .0001), lower patellar width (P = .0003), and higher Insall-Salvati ratio (P < .0001). From the patients in the cartilage lesion group, 36% had trochlear dysplasia; 27.6%, patella alta; and 24.7%, abnormal patellar tilt. These parameters were more frequent in the cartilage lesion group (P < .0001). Trochlear lesions were more frequent in men, presented at an older age, and had fewer associated anatomic risk factors. Patellar lesions, conversely, were more frequent in women, presented at younger age, and were more closely associated with anatomic risk factors. CONCLUSION: PF anatomic abnormalities are significantly more common in patients with full-thickness PF cartilage lesions. Trochlear dysplasia, patella alta, and excessive lateral patellar tilt are the most common correlated factors, especially in patellar lesions.

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OBJECTIVE: To assess the differences in morphology and alignment of the knee between patients with proximal patellar tendinopathy (PPT) and a control group, using MRI and focusing on the patellofemoral joint. METHODS: We retrospectively included 35 patients with clinically diagnosed and unequivocal findings of PPT on knee MRI, the case group. For the control group, we included 70 patients who underwent knee MRI for other reasons, with no clinical or MRI evidence of PPT. Patients and controls were matched for age and gender, with all subjects reporting frequent physical activity. MRIs were evaluated by two musculoskeletal radiologists, who assessed parameters of patellar morphology, trochlear morphology, patellofemoral alignment, and tibiofemoral alignment. The differences in parameters between cases and controls were assessed using Student's t test. Logistic regression was applied to assess the associations between the MRI parameters and the presence of PPT. RESULTS: The patellar height Insall-Salvati ratio was different between cases and controls (1.37 ± 0.21 vs. 1.24 ± 0.19; p = 0.003). The subchondral Wiberg angle was higher in cases than controls (136.8 ± 7.4 vs. 131.7 ± 8.8; p = 0.004). After applying logistic regression, significant associations with PPT were found [odds ratios (95% CI)] for patellar morphology [1.1 (1.0, 1.2)] and patellar height [1.3 (1.0, 1.7)]. CONCLUSIONS: Patellar height and the subchondral patellar Wiberg angle were greater in patients with PPT and significantly associated with PPT.

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OBJECTIVE: Compare pressure pain thresholds (PPTs) at the knee and a site remote to the knee in female adults with patellofemoral pain (PFP) to pain-free controls before and after a patellofemoral joint (PFJ) loading protocol designed to aggravate symptoms. DESIGN: Cross-sectional study SETTING: Participants were recruited via advertisements in fitness centers, public places for physical activity and universities. SUBJECTS: Thirty-eight females with patellofemoral pain, and 33 female pain-free controls. METHODS: All participant performed a novel PFJ loading protocol involving stair negotiation with an extra load equivalent 35% of body mass. PPTs and current knee pain (measured on a visual analogue scale) was assessed before and after the loading protocol. PPTs were measured at four sites around the knee and one remote site on the upper contralateral limb. RESULTS: Females with PFP demonstrated significantly lower PPTs locally and remote to the knee, both before and after the PFJ loading protocol when compared to control group. Following the loading protocol, PPTs at knee were significantly reduced by 0.54 kgf (95%CI = 0.33; 0.74) for quadriceps tendon, 0.38 kgf (95%CI = 0.14; 0.63) for medial patella, and 0.44 kgf (95%CI = 0.18; 0.69) for lateral patella. No significant change in PPT remote to the knee was observed - 0.10 kgf (95%CI = -0.04; 0.24). CONCLUSIONS: Female adults with PFP have local and widespread hyperalgesia compared to pain free controls. A novel loading protocol designed to aggravate symptoms, lowers the PPTs locally at the knee but has no effect on PPT on the upper contralateral limb. This suggests widespread hyperalgesia is not affected by acute symptom aggravation.

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La eficacia antiinflamatoria de meloxicam tablet* fue evaluada por medio de la synovitis reversible inducida experimentalmente por el modelo de inyección intrasinovial (articulación femorotibiopatelar) de cristal de urato de sódio em 16 Beagles. El produto meloxicam fue administrado por via oral em forma de tabletas (0,2mg/kg de peso corporal) em 8 animales 15 min depués de la inducción de la sinovitis. El examen clínico y ortopédico, como también los parâmetros hematológicos y bioquímicos, y el análisis dei líquido sinovial, fueron realizados durante el estúdio. La eficácia clínica fue evaluada mediante el uso de um sistema de puntuación de la claudicación. La recuparación de la claudicación fue observada a partir de 4 horas después de lainducción y 24 horas después retornó a su estado normal. Las evaluaciones demonstraron diferenças significativas (p<0,05) em los signos clínicos de los animales del grupo tratado em comparación com el grupo control. El estúdio demuestra la eficácia antiinflamatoria de meloxicam tableta em la dosis recomendada.(AU)

The anti-inflammatory efficacy of meloxicam tablet* was evaluated by reversible experimental synovitis model induced by intrasynovial (femoral-tibio-patellar joint) injection of sodium urate crystal in 16 Beagles. The product meloxicam was administered orally in tablet form (0.2 mg/kg body weight) in 8 animais 15 min after synovitis induction. Clinical and orthopedic examination, as well as hematological and biochemical parameters, and synovial fluid analysis were performed during the study period. Clinical efficacy was assessed by the use of a lameness scoring system. The lameness recovering was observed from 4 hours post-induction, and 24 hours after they returned to normal status. Evaluations have shown significant differences (p<0.05) in the clinical signs of the animais in the test group compared to the control group showing the efficacy of meloxicam in the recommended dose.(AU)

A eficácia anti-inflamatória do meloxicam comprimido* foi investigada através da indução experimental da sinovite reversível pela injeção de cristais de urato de sódio na articulação fêmoro-tibiopatelar em 16 Beagles. O produto meloxicam foi administrado via oral na forma de comprimido (0,2 mg/ kg de peso corpóreo) em 8 animais, 15 minutos após a indução da sinovite. Exames clínicos, laboratoriais, ortopédicos e colheita de líquido sinovial foram realizados durante o período do estudo. A eficácia clínica foi avaliada pelo uso de sistema de escores de claudicação. A diminuição da claudicação foi observada a partir de 4 horas pós-indução e 24 horas após todos retornaram a condição normal. As avaliações demonstraram diferenças significativas (p<0,05) nos sinais clínicos dos animais do grupo teste em comparação ao grupo controle demonstrando a eficácia do meloxicam na dose preconizada.(AU)

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La eficacia antiinflamatoria de meloxicam tablet* fue evaluada por medio de la synovitis reversible inducida experimentalmente por el modelo de inyección intrasinovial (articulación femorotibiopatelar) de cristal de urato de sódio em 16 Beagles. El produto meloxicam fue administrado por via oral em forma de tabletas (0,2mg/kg de peso corporal) em 8 animales 15 min depués de la inducción de la sinovitis. El examen clínico y ortopédico, como también los parâmetros hematológicos y bioquímicos, y el análisis dei líquido sinovial, fueron realizados durante el estúdio. La eficácia clínica fue evaluada mediante el uso de um sistema de puntuación de la claudicación. La recuparación de la claudicación fue observada a partir de 4 horas después de lainducción y 24 horas después retornó a su estado normal. Las evaluaciones demonstraron diferenças significativas (p<0,05) em los signos clínicos de los animales del grupo tratado em comparación com el grupo control. El estúdio demuestra la eficácia antiinflamatoria de meloxicam tableta em la dosis recomendada.

The anti-inflammatory efficacy of meloxicam tablet* was evaluated by reversible experimental synovitis model induced by intrasynovial (femoral-tibio-patellar joint) injection of sodium urate crystal in 16 Beagles. The product meloxicam was administered orally in tablet form (0.2 mg/kg body weight) in 8 animais 15 min after synovitis induction. Clinical and orthopedic examination, as well as hematological and biochemical parameters, and synovial fluid analysis were performed during the study period. Clinical efficacy was assessed by the use of a lameness scoring system. The lameness recovering was observed from 4 hours post-induction, and 24 hours after they returned to normal status. Evaluations have shown significant differences (p<0.05) in the clinical signs of the animais in the test group compared to the control group showing the efficacy of meloxicam in the recommended dose.

A eficácia anti-inflamatória do meloxicam comprimido* foi investigada através da indução experimental da sinovite reversível pela injeção de cristais de urato de sódio na articulação fêmoro-tibiopatelar em 16 Beagles. O produto meloxicam foi administrado via oral na forma de comprimido (0,2 mg/ kg de peso corpóreo) em 8 animais, 15 minutos após a indução da sinovite. Exames clínicos, laboratoriais, ortopédicos e colheita de líquido sinovial foram realizados durante o período do estudo. A eficácia clínica foi avaliada pelo uso de sistema de escores de claudicação. A diminuição da claudicação foi observada a partir de 4 horas pós-indução e 24 horas após todos retornaram a condição normal. As avaliações demonstraram diferenças significativas (p<0,05) nos sinais clínicos dos animais do grupo teste em comparação ao grupo controle demonstrando a eficácia do meloxicam na dose preconizada.

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La artrosis patelofemoral es una entidad clínica frecuente y muy incapacitante. Numerosos tratamientos han sido propuestos para el tratamiento quirúrgico de esta patología cuando fracasa el tratamiento ortopédico. Los hemos dividido en tratamientos quirúrgicos menores (liberación retináculo lateral- resección osteofito lateral y resección de la faceta lateral) y mayores (osteotomía de la TAT-cultivo de condrocitos- remplazos articulares). El objetivo de este trabajo es realizar una actualización de esta entidad clínica, y presentar una serie de casos mostrando la experiencia personal en el manejo de esta patología. Nivel de Evidencia: V (AU)

Patellofemoral osteoarthritis is a common and very disabling clinical entity. Several treatments have been proposed for the surgical treatment of this disease when the orthopedic one fails WeÆve divided these treatments into minor surgery (lateral retinaculum release- laterally osteophyte resection and resection of the lateral facet) and major (osteotomy TAT-ACI- joint replacements). The aim of this work is an update of this clinical entity, and presents a series of cases showing personal experience in the management of this condition. Evidence Level: V (AU)

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La artrosis patelofemoral es una entidad clínica frecuente y muy incapacitante. Numerosos tratamientos han sido propuestos para el tratamiento quirúrgico de esta patología cuando fracasa el tratamiento ortopédico. Los hemos dividido en tratamientos quirúrgicos menores (liberación retináculo lateral- resección osteofito lateral y resección de la faceta lateral) y mayores (osteotomía de la TAT-cultivo de condrocitos- remplazos articulares). El objetivo de este trabajo es realizar una actualización de esta entidad clínica, y presentar una serie de casos mostrando la experiencia personal en el manejo de esta patología. Nivel de Evidencia: V

Patellofemoral osteoarthritis is a common and very disabling clinical entity. Several treatments have been proposed for the surgical treatment of this disease when the orthopedic one fails We’ve divided these treatments into minor surgery (lateral retinaculum release- laterally osteophyte resection and resection of the lateral facet) and major (osteotomy TAT-ACI- joint replacements). The aim of this work is an update of this clinical entity, and presents a series of cases showing personal experience in the management of this condition. Evidence Level: V

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PURPOSE: Because the medial patellofemoral ligament (MPFL) is the primary restraint to lateral dislocation of the patella, we aimed, in this controlled study, to verify whether the MPFL with different measurements could be considered another predisposing factor for patellar dislocation. METHODS: A group of 100 consecutive individuals without the criteria for patellar dislocation (trochlear dysplasia, patella alta and lateral patellar tilt) was recruited as a control group and underwent magnetic resonance imaging (MRI) study and another group of 50 patients with patellar instability. Femoral condyles, interepicondylar distance, length and thickness of the MPFL were measured. RESULTS: In the control group, the MPFL was 38-60 mm long. Individuals with patellar instability who had no episode of patellar dislocation had a 4.11-mm longer ligament than controls (p = 0.032), while patients with instability with a previous history of dislocation had a 13.54-mm longer MPFL than controls (p < 0.001). Thickness of the MPFL at the patellar insertion was lower in individuals with patellar instability with a history of dislocation (p < 0.001). An instability coefficient (IC) less than 1.3 indicates that the MPFL is insufficient. CONCLUSIONS: Individuals with patellar instability and previous patellar dislocation present with longer MPFL when compared to controls, and an associated IC less than 1.3 can be considered a predisposing factor for patellar dislocation. Treatment of patellar instability is a challenge, and it is difficult to identify what is the predisposing factor. This study has verified the measurements of the MPFL for the first time and presents values of thickness and length that can be considered as indications for surgical reconstruction. LEVEL OF EVIDENCE: III.

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Introducción: Los síntomas patelofemorales como dolor y/o inestabilidad son causados por múltiples factores etiológicos, uno de los principales es el componente rotacional, que produce intrarrotación de la rodilla durante la marcha con el consiguiente desgaste prematuro, dolor y/o inestabilidad patelofemoral. Material y Método: Entre 2001 y 2010 se efectuaron 25 osteotomías desrotadoras supratuberositaria tibial, se logró evaluar en forma retrospectiva 17 casos operados por dolor y/o inestabilidad patelofemoral en pacientes con extrarrotación tibial aumentada donde fracaso el tratamiento conservador, la cantidad de corrección de rotación se verificó bajo control artroscópico. Los resultados se evaluaron con scores de Kujala y Fulkerson. El score preoperatorio de Kujala fue de 41,4 y el de Fulkerson fue 36,6; el score post-op de Kujala 94,9 y Fulkerson 93,6. El seguimiento fue de 37,4 meses. Se describe indicación, técnica quirúrgica, algoritmo para tratamiento de trastorno patelofemoral. Conclusión: La osteotomía desrotadora supratuberositaria logra excelentes resultados en casos de extrarrotación tibial aumentada y aumento de ángulo Q, logrando corregir el dolor, la inestabilidad y la capacidad para subir escaleras. La artroscopia es útil para tratar lesiones asociadas y evitar hipo e hipercorrecciones.

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Introducción: Los síntomas patelofemorales como dolor y/o inestabilidad son causados por múltiples factores etiológicos, uno de los principales es el componente rotacional, que produce intrarrotación de la rodilla durante la marcha con el consiguiente desgaste prematuro, dolor y/o inestabilidad patelofemoral. Material y Método: Entre 2001 y 2010 se efectuaron 25 osteotomías desrotadoras supratuberositaria tibial, se logró evaluar en forma retrospectiva 17 casos operados por dolor y/o inestabilidad patelofemoral en pacientes con extrarrotación tibial aumentada donde fracaso el tratamiento conservador, la cantidad de corrección de rotación se verificó bajo control artroscópico. Los resultados se evaluaron con scores de Kujala y Fulkerson. El score preoperatorio de Kujala fue de 41,4 y el de Fulkerson fue 36,6; el score post-op de Kujala 94,9 y Fulkerson 93,6. El seguimiento fue de 37,4 meses. Se describe indicación, técnica quirúrgica, algoritmo para tratamiento de trastorno patelofemoral. Conclusión: La osteotomía desrotadora supratuberositaria logra excelentes resultados en casos de extrarrotación tibial aumentada y aumento de ángulo Q, logrando corregir el dolor, la inestabilidad y la capacidad para subir escaleras. La artroscopia es útil para tratar lesiones asociadas y evitar hipo e hipercorrecciones (AU)

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Isolated degenerative patellofemoral chondropathy is a prevalent disease. There is still controversy regarding its ideal type of management. A retrospective study was performed to assess the outcomes of 28 patients with a minimum of 10-year follow-up, in whom the Bandi tibial tubercle osteotomy was performed. The Bentley score was applied pre and postoperatively to evaluate the clinical results. Preoperatively, 21 (67%) patients were rated as fair and seven (33%) as poor according to the Bentley functional scale for patellofemoral osteoarthritis. At 5 years of follow-up, one case was rated as excellent, 23 (81%) cases as good, three as fair and one as poor. At 10 years of follow-up no cases were rated as excellent, 17 (61%) cases as good, four (14%) as fair and seven (25%) as poor. The difference in terms of poor results evaluated at five and 10 years after the surgery was statistically significant (p<0.05). We concluded that excellent and good short-term results can be expected with the use of the Bandi tibial tubercle osteotomy in patients with isolated degenerative patellofemoral chondropathy; however, such outcomes tend to deteriorate over the time, especially in patients with advanced chondromalacia, making its indication controversial.

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