Overview of Patellofemoral Joint Instability: Difference between revisions
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Introduction | == Introduction == | ||
Patellofemoral instability is a complex orthopaedic condition that frequently affects children and adolescents. | Patellofemoral instability is a complex orthopaedic condition that frequently affects children and adolescents.<ref>Bailey MEA, Metcalfe A, Hing CB, Eldridge J; BASK Patellofemoral Working Group. [https://linkinghub.elsevier.com/retrieve/pii/S0968-0160(21)00065-X Consensus guidelines for management of patellofemoral instability]. Knee. 2021;29:305-12. </ref><ref name=":0">Vellios EE, Trivellas M, Arshi A, Beck JJ. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7083998/ Recurrent Patellofemoral Instability in the Pediatric Patient: Management and Pitfalls]. Curr Rev Musculoskelet Med. 2020;13(1):58-68. </ref> It is estimated that the incidence of patellofemoral instability in paediatric patients ranges from 23 to 43 per 100,000 person-years. The highest rates are in teenagers aged between 14 and 18 years.<ref name=":0" /> | ||
The management of patellofemoral instability is complex ( | |||
The management of patellofemoral instability is complex.<ref>Jaquith BP, Parikh SN. [https://journals.lww.com/pedorthopaedics/Abstract/2017/10000/Predictors_of_Recurrent_Patellar_Instability_in.13.aspx Predictors of recurrent patellar instability in children and adolescents after first-time dislocation]. J Pediatr Orthop. 2017;37(7):484-90. </ref> Vellios et al.<ref name=":0" /> note that first-time dislocation may be managed conservatively (i.e. through rehabilitation, bracing, activity modification), but as many as 36 percent of patients will have recurrent instability on the same leg. | |||
== Definitions == | |||
'''Patellofemoral stability''' is defined as “constraint by passive soft tissue tethers and chondral/bony geometry that, with muscular forces, guide the patella into the trochlear groove and keep it engaged within the trochlear groove as the knee flexes and extends.” <ref name=":1">Post WR, Fithian DC. [https://journals.sagepub.com/doi/full/10.1177/2325967117750352 Patellofemoral instability: a consensus statement from the AOSSM/PFF Patellofemoral Instability Workshop]. Orthop J Sports Med. 2018;6(1):2325967117750352. </ref> | |||
Conversely, '''patellofemoral instability''' is defined as “symptomatic deficiency of the aforementioned passive constraint (patholaxity) such that the patella may escape partially or completely from its asymptomatic position with respect to the femoral trochlea under the influence of displacing force.”<ref name=":1" /> | |||
'''Dislocation''' - patella comes completely out of the trochlea. Dislocation might be caused by a:<ref name=":2">Robertson C. Patellofemoral Joint Instability Course. Physioplus. 2022.</ref> | |||
* Trauamatic event (e.g. rugby tackle) | |||
** In these cases, the knee has been structurally intact prior to injury<ref>Duthon VB. [https://www.sciencedirect.com/science/article/pii/S1877056814003302 Acute traumatic patellar dislocation]. Orthop Traumatol Surg Res. 2015;101(1 Suppl):S59-67. </ref> | |||
** These individuals tend to have a better prognosis as there are no underlying structural morphological elements to predispose them to instability | |||
* Minor trauma - a slight tap / knock to the knee causes dislocation | |||
** These individuals tend to have a structural element which predisposes them to instability | |||
'''Subluxation''' - a “halfway" point between dislocation and an in situ patella.<ref name=":2" /> Patients with a subluxing patella may complain of a painful knee / anterior knee pain.<ref name=":2" /><ref>Monk AP, Doll HA, Gibbons CL, Ostlere S, Beard DJ, Gill HS, Murray DW. [https://online.boneandjoint.org.uk/doi/full/10.1302/0301-620X.93B10.27205 The patho-anatomy of patellofemoral subluxation]. J Bone Joint Surg Br. 2011;93(10):1341-7.</ref> | |||
== References == | |||
[[Category:Knee]] | |||
[[Category:Course Pages]] | |||
[[Category:Physioplus Content]] | |||
Revision as of 12:00, 13 June 2022
This article or area is currently under construction and may only be partially complete. Please come back soon to see the finished work! (13/06/2022)
Original Editor - Jess Bell based on the course by Claire Robertson
Top Contributors - Jess Bell, Kim Jackson, Wanda van Niekerk and Ewa Jaraczewska
Top Contributors - Jess Bell, Kim Jackson, Wanda van Niekerk and Ewa Jaraczewska
Introduction[edit | edit source]
Patellofemoral instability is a complex orthopaedic condition that frequently affects children and adolescents.[1][2] It is estimated that the incidence of patellofemoral instability in paediatric patients ranges from 23 to 43 per 100,000 person-years. The highest rates are in teenagers aged between 14 and 18 years.[2]
The management of patellofemoral instability is complex.[3] Vellios et al.[2] note that first-time dislocation may be managed conservatively (i.e. through rehabilitation, bracing, activity modification), but as many as 36 percent of patients will have recurrent instability on the same leg.
Definitions[edit | edit source]
Patellofemoral stability is defined as “constraint by passive soft tissue tethers and chondral/bony geometry that, with muscular forces, guide the patella into the trochlear groove and keep it engaged within the trochlear groove as the knee flexes and extends.” [4]
Conversely, patellofemoral instability is defined as “symptomatic deficiency of the aforementioned passive constraint (patholaxity) such that the patella may escape partially or completely from its asymptomatic position with respect to the femoral trochlea under the influence of displacing force.”[4]
Dislocation - patella comes completely out of the trochlea. Dislocation might be caused by a:[5]
- Trauamatic event (e.g. rugby tackle)
- In these cases, the knee has been structurally intact prior to injury[6]
- These individuals tend to have a better prognosis as there are no underlying structural morphological elements to predispose them to instability
- Minor trauma - a slight tap / knock to the knee causes dislocation
- These individuals tend to have a structural element which predisposes them to instability
Subluxation - a “halfway" point between dislocation and an in situ patella.[5] Patients with a subluxing patella may complain of a painful knee / anterior knee pain.[5][7]
References[edit | edit source]
- ↑ Bailey MEA, Metcalfe A, Hing CB, Eldridge J; BASK Patellofemoral Working Group. Consensus guidelines for management of patellofemoral instability. Knee. 2021;29:305-12.
- ↑ 2.0 2.1 2.2 Vellios EE, Trivellas M, Arshi A, Beck JJ. Recurrent Patellofemoral Instability in the Pediatric Patient: Management and Pitfalls. Curr Rev Musculoskelet Med. 2020;13(1):58-68.
- ↑ Jaquith BP, Parikh SN. Predictors of recurrent patellar instability in children and adolescents after first-time dislocation. J Pediatr Orthop. 2017;37(7):484-90.
- ↑ 4.0 4.1 Post WR, Fithian DC. Patellofemoral instability: a consensus statement from the AOSSM/PFF Patellofemoral Instability Workshop. Orthop J Sports Med. 2018;6(1):2325967117750352.
- ↑ 5.0 5.1 5.2 Robertson C. Patellofemoral Joint Instability Course. Physioplus. 2022.
- ↑ Duthon VB. Acute traumatic patellar dislocation. Orthop Traumatol Surg Res. 2015;101(1 Suppl):S59-67.
- ↑ Monk AP, Doll HA, Gibbons CL, Ostlere S, Beard DJ, Gill HS, Murray DW. The patho-anatomy of patellofemoral subluxation. J Bone Joint Surg Br. 2011;93(10):1341-7.
