Surgical treatment of chronic proximal patellar tendon tears grades 3 and 4 using augmentation with quadriceps tendon-bone graft.

Background: Chronic proximal patellar tendinosis with partial tendon tears represents a multifactorial overuse injury. Several surgical techniques have been described with various outcomes and the return to sports may fail.

Hypothesis: Reconstruction of the proximal patellar tendon with augmentation using a quadriceps tendon-bone (QTB) graft improves knee function in patients presenting with proximal patellar tendinosis and partial tendon tears.

Patellar tendon lengthening and augmentation with quadriceps tendon graft for treatment of severe patella infera.

Background: Patella infera represents a permanent abnormally low position of the patella with three characteristics: distal position of the patella in the femoral trochlea, permanent shortening of the patellar tendon, and decreased distance between the inferior pole of the patella and the articular surface of the tibia. Several surgical techniques have been described to resolve this disabling condition with varying outcomes.

Hypothesis: Lengthening of the shortened patellar tendon with augmentation using a quadriceps tendon graft in combination with excessive intra-articular release improve knee function in patients presenting with severe and permanent patella infera.

Patella Alta: When to Correct and Impact on Other Anatomic Risk Factors for Patellofemoral Instability.

Patella alta is described as abnormally high-riding patella in relation to the femur, the trochlear groove, or the tibia with decreased bony stability. Patella alta represents an important predisposing factor for patellofemoral instability. Different measurement methods are used to define patella alta.

Reflections on Rotational Osteotomies around the Patellofemoral Joint.

Torsional abnormalities of the femur represent a significant risk factor for patellar instability or patellofemoral complaints. Although their clinical implication has been demonstrated, there is still a debate going on about different aspects. These include, especially, the various methods of measurements with a wide range of physiologic values, the indication or clear recommendation for surgical correction, and the site of the rotational osteotomy.

Combined deepening trochleoplasty and supracondylar external rotation osteotomy for recurrent patellar instability in patients with trochlear dysplasia and increased femoral antetorsion.

Background: Deepening trochleoplasty has become a part of surgical management in patients with patellar instability and severe trochlear dysplasia. In addition, increased femoral antetorsion is treated most commonly by proximal femoral external rotation osteotomy.

Hypothesis: Deepening trochleoplasty and supracondylar femoral external rotation osteotomy in combination improve patellar stability and function in patients presenting with recurrent patellar instability due to trochlear dysplasia and increased femoral antetorsion.

Patella Alta: A Comprehensive Review of Current Knowledge.

We systematically reviewed patella alta with respect to type of measurements, reported cutoff values, cutoff values for surgical correction, and proposed surgical techniques. Using the term patella alta, we performed a systematic literature search on PubMed. Inclusion criteria were original study or review articles, publication in peer-reviewed English-language journals between 2000 and 2017, and narrative description or measurement of human patellar height on plain radiographs or magnetic resonance imaging (MRI).

Cortical desmoids in adolescent top-level athletes.

Two adolescent, highly active athletes are presented with unspecific symptoms of anterior knee pain. Conventional radiographs and magnetic resonance imaging (MRI) showed a suspicious but pathognomonic cortical irregularity of the dorsal, medial femoral condyle. Cortical desmoid is one of the most common incidental osseous findings on conventional radiographs and MRI of the knee.

Surgical management of traumatic avulsion of the ischial tuberosity in young athletes.

Objective: Complete traumatic avulsion of the ischial tuberosity in young athletes is rare, and the optimal treatment is unclear. The purpose of this article is to present our experience and the efficacy of surgical repair of avulsions of the ischial tuberosity with bony dislocation of more than 2 cm and to discuss the complex postoperative rehabilitation.

Methods: Three young athletes sustained complete avulsion of the ischial tuberosity with bony dislocation during different sport activities (long jump, soccer, sprinting).

Radiological evaluation for conflict of the femoral tunnel entrance area prior to anterior cruciate ligament revision surgery.

Purpose: Anterior cruciate ligament (ACL) revision surgery is a demanding procedure and requires meticulous pre-operative clinical and radiological assessment. In clinical practice the position of the femoral tunnel is identified mainly using plain radiographs (XR). Two-dimensional computed tomography (2D-CT) and magnetic resonance imaging (MRI) are not yet routine imaging methods and are only performed in specific clinical indications or in the scientific setting.

Patellar instability with increased knee flexion due to lateral femoral condyle distal dysplasia: a report of two cases.

We present two case reports with clinical and radiological assessment of the anatomical features at the distal lateral end of trochlea and femur in patients with patellar instability in higher knee flexion and how these findings could possibly be involved in the genesis of this rare type of patellar instability. Both patients underwent several (nine and seven) surgical procedures, but the patellar instability could not be successfully eliminated. Our hypothesis was that a short and flattened lateral distal condyle/trochlea may cause lateral patellar instability in higher flexion.

The lateral condyle index: a new index for assessing the length of the lateral articular trochlea as predisposing factor for patellar instability.

The central trochlea has been considered as the major location of dysplasia. The purpose of this study was to investigate the influence of the lateral trochlea on patellar stability and to establish a new method for measuring the lateral trochlea on sagittal magnetic resonance (MR) images. Twenty-eight knees of 23 patients suffering from lateral patellar subluxation (12 knees with radiological signs of central trochlear dysplasia) and of 46 patients without patellofemoral complaints (without central trochlear dysplasia) were analysed.

Anterior-posterior trochlear measurements of normal and dysplastic trochlea by axial magnetic resonance imaging.

Different surgical techniques have been described to correct trochlear dysplasia, without clear descriptions of the various types of trochlear dysplasia. In describing trochlear dysplasia, there exist no clear criteria to distinguish between decreased trochlear depth (heightened trochlea floor) and flattened lateral and/or medial condylar height. The current study aims to build a database of axial MRI measurements of normal and abnormal trochlear shape to create a foundation for the selection of the necessary surgical correction to more normal trochlear anatomy.

The patellotrochlear index: a new index for assessing patellar height.

The radiological methods to determine patellar height described in the literature are variable, not reliable and depend on the chosen ratio. The purpose of this paper is to describe another method of measuring patellar height on sagittal MRI using the true articular cartilage patellotrochlear relationship. An analysis of magnetic resonance (MR) examinations of 66 consecutive patients was performed.

Surgical treatment for persistent complaints following rupture of the fascia of the plantaris longus muscle: a case report.

We report an unusual injury of the plantaris longus muscle with failed conservative treatment but successful surgical intervention. A simple surgical technique offers a minimally-invasive solution for treating persistent complaints.

Symphysis syndrome in athletes: surgical treatment for chronic lower abdominal, groin, and adductor pain in athletes.

Objective: To investigate the results of surgical treatment on athletes presenting with chronic symphysis syndrome (lower abdominal, groin, and adductor pain).

Design: Retrospective nonrandomized study.

Setting: Swiss Olympic Medical Center associated with Institute of Sports Sciences.

Overuse injuries of the extensor mechanism in athletes.

This article reviews the functional anatomy, pathophysiology, and overall management of overuse injuries of the extensor mechanism in athletes.

Sources of anterior knee pain.

The anterior part of the knee consists mainly of structures belonging to the patellofemoral joint, which includes a variety of tissues, such as cartilage, subchondral bone, synovial plicae, infrapatellar fat pad, retinacula, capsule, and tendons. Each of these structures, alone or in combination, can be a source of anterior knee pain. Unphysiologic load or changed metabolic activities can lead to structural failure with loss of homeostatic conditions.