There are a number of MRI features of trochlear dysplasia including reduction in the trochlear depth, lateral trochlear inclination, and facet asymmetry. Imaging plays a vital role in detecting not only the secondary damage but also subtle early features that can raise the suspicion for the presence of this entity. Lateral Retinaculum - an overview | ScienceDirect Topics A ratio of >1.3 is considered indicative of patella alta [34] (Fig. Diagnosis is made clinically with pain with compression of the patella and moderate lateral facet tenderness and sunrise knee radiographs will often show patellar tilt in the lateral direction. The Anterolateral Ligament of the Knee: MRI Appearance, Association AJR Am J Roentgenol 195:13671373, Jarraya M, Diaz LE, Roemer FW, Arndt WF, Goud AR, Guermazi A (2018) MRI findings consistent with peripatellar fat pad impingement: how much related to patellofemoral maltracking? Stretching exercises for Patellofemoral pain. There is agreement, however, that the MPFL is almost always injured with lateral patellar dislocations4. 4. 1Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, 149 Sangil-dong, Gangdong-gu, Seoul 134-727, Korea. Direct impact to the front of the knee from a fall or other blow is a common cause of tears. (8a) A more posterior coronal T1-weighted image also demonstrates the intimate relationship of the VMO and MPFL. FOIA Distances between 15 and 20 mm are borderline, and distances of more than 20 mm indicate significant lateralization of the tuberosity.5. (23a) In this patient with recurrent patellofemoral dislocations, there are findings of subchondral degeneration (arrow) from recurrent impaction and chondral shearing injuries to the inferolateral femoral condyle. 2000; 216:858-864. 1. A thorough examination of the knee is then performed including presence of effusion, localization of pain, assessment of patellar translation, patellar apprehension, presence of a J sign (visual lateralization of the patella as it disengages from the trochlea when extending the knee), and a measurement of the Q angle along with ligamentous and meniscal testing. High resolution magnetic resonance imaging of the patellar retinaculum (1a) A single fat-suppressed proton density-weighted coronal image. The TT-TG distance can be influenced by the degree of knee flexion (reduces with flexion), and it is also smaller upon weight bearing [41]. Prior lateral patellar dislocation: MR imaging findings. Sports Med Arthrosc Rev 25:7277, Gillespie H (2012) Update on the management of patellar instability. More recently, the TT-TG index was developed, which takes knee size into account by assessing the proximaldistal distance between the entrance of the chondral trochlear groove (TE) and the tibial tuberosity (TT). The medial patellar retinaculum and MPFL are best seen on MRI on the axial fluid-sensitive sequences. Despite non-operative management, recurrent patellar instability occurs in between 15 and 45% of patients [17,18,19,20]. Less common predisposing factors to be aware of include laterally tilted patella, VMO dysplasia and generalized joint laxity. AIM: To describe the sonographic appearances of the medial retinacular (MPFR) complex of the knee in patients with acute and recurrent patellar dislocation.MATERIALS AND METHODS: Thirty patients were scanned within 2-4 weeks of an acute episode of lateral patellar dislocation. The pages that follow contain general guidance on the diagnosis and treatment of chronic nontraumatic knee pain. Military Health System Europe > Clinics > Grafenwoehr Army - TRICARE (24a) Scarring of the medial stabilizers (asterisk) often leads to healing in a more superior and lateral location (long arrow) leading to persistent medial instability, laxity and malalignment even after the patella has been repositioned. Radiology 216:858864, Biedert RM, Tscholl PM (2017) Patella alta: a comprehensive review of current knowledge. Eur Radiol 10:10511055, Stefanik JJ, Zumwalt AC, Segal NA, Lynch JA, Powers CM (2013) Association between measures of patella height, morphologic features of the trochlea, and patellofemoral joint alignment: the MOST study. The contralateral side may serve as an internal control or may also have anatomic factors predisposing to maltracking. The lateral patellar retinaculum presents a superficial layer attached medially to the patella and patellar ligament, and extending laterally to the iliotibial band and vastus lateralis muscle fascia (Fig. This distance is the trochlear sulcus depth (TD). The ensuing loss of medial restraint favors future patellar dislocations, especially if additional risk factors are present. Therefore, the management of patellar maltracking remains controversial and decisions need to be made on an individual patient basis with surgical management being reserved for those patients with documented recurrent lateral patellar instability. (18a) A 13-year-old female following acute patellar dislocation. {"url":"/signup-modal-props.json?lang=us"}, Shetty A, Saber M, Rasuli B, et al. Because the diagnosis of lateral patellar dislocation is often unsuspected, MR provides valuable diagnostic information in such cases. Sports Med Arthrosc Rev 15:7277, Mikashima Y, Kimura M, Kobayashi Y, Miyawaki M, Tomatsu T (2006) Clinical results of isolated reconstruction of the medial patellofemoral ligament for recurrent dislocation and subluxation of the patella. The latter distinction is important to recognize among both radiologists and surgeons. Radiographics 30:961981, Tscholl PM, Wanivenhaus F, Fucentese SF (2017) Conventional radiographs and magnetic resonance imaging for the analysis of trochlear dysplasia: the influence of selected levels on magnetic resonance imaging. Structures such as the iliotibial band, fibular collateral ligament, and biceps femoris tendon are readily apparent on MRI and are easy to identify. This protocol can help in evaluating for osseous integrity, morphology, and patellofemoral alignment [63] (Fig. There is a degree of variability in the literature about what is considered an abnormally high TT-TG. Clinical History: A 23 year-old female presents with medial knee pain following a twisting injury. Lateral Patellar Retinaculum Tension in Patellar Instability Quinn described the MRI findings following acute patellar dislocation as contusion or impaction of the medial patellar facet and lateral femoral condyle, along with injury of the medial retinaculum and/or medial patellofemoral ligament (MPFL) (Quinn, 1993). Axial PDFS left knee MR image, demonstrating the method used for the measurement of trochlear depth. 2012 Feb;41(2):137-48. doi: 10.1007/s00256-011-1291-3. In acute traumatic lateral patellar dislocation, it is not only the patella that dislocates. Other indicated structures: gracilis (G), semitendinosus (ST), and adductor magnus (AM) tendons. MRI can provide valuable information regarding the status of such repairs in patients who experience recurrent dislocation following surgery. These parameters can be evaluated using dynamic MRI [29]. An imbalance of forces acting on the patellofemoral joint due to abnormal bony geometry or altered function of the active and passive soft tissue restraints may result in abnormalities of alignment and tracking of the patella. A tear of the reconstructed MPFL is indicated by fluid interrupting the fibers (27a, long arrow) (27b, arrowheads). This injury has been described in conjunction with numerous sports activities, particularly snow skiing. A focused history of the mechanism, number, and circumstances of instability to date is essential. J Bone Joint Surg Am 61:5662, Jerabek SA, Asnis PD, Bredella MA, Ouellette HA, Poon SK, Gill TJ 4th (2009) Medial patellar ossification after patellar instability: a radiographic finding indicative of prior patella subluxation/dislocation. Traumatic dislocations are commonly associated with other injuries including that of the MPFL, meniscal pathology, and osteochondral fractures of the femur or patella [15, 16]. Recent literature does not encourage the use of lateral release, since this can increase patellar instability. {"url":"/signup-modal-props.json?lang=us"}, Moodaley P, Hng J, Hacking C, et al. PubMed Materials and methods: Two radiologists independently reviewed 99 knee MR images for the presence of a focal defect at the lateral patellar retinaculum and . (2a) In this case, it is the bone bruise within the anterolateral aspect of the lateral femoral condyle (long arrow) and the edema adjacent to the medial femoral condyle (arrowhead) that are the key to the diagnosis. b Trochlear dysplasia (9 inclination), Facet asymmetry assessment for trochlear dysplasia on axial MRI. Eur Radiol 22:418428, Sonin AH, Pensy RA, Mulligan ME, Hatem S (2002) Grading articular cartilage of the knee using fast spin-echo proton density-weighted MR imaging without fat suppression. This results in a slightly superolateral direction of pull on the patella by the quadriceps. (21a) A corresponding anterior coronal slice reveals the large displaced osteochondral fragment (arrow) that occurred as a result of this injury. Acute Osteochondral Fractures in the Lower Extremities - Approach to Identification and Treatment. (12a) At an axial image 3 cm proximal to the femoral-tibial joint space, the lengths of the medial and lateral trochlear facets are obtained. Accessibility Google Scholar, Amis AA, Firer P, Mountney J, Senavongse W, Thomas NP (2003) Anatomy and biomechanics of the medial patellofemoral ligament. The patella has 4 different planes of motion: flexionextension, mediallateral rotation, mediallateral patellar tilt, and mediallateral patellar shift. Medial patellar chondral injuries may occur during either the dislocation or reduction phases of injury. The superficial layer originates from the lowest fibers of the iliotibial band and from an extension of vastus lateralis fascia. . Become a Gold Supporter and see no third-party ads. It runs obliquely and transversely and inserts on the patella and the patellar tendon, and is composed of two layers. Am J Sports Med 16:244249, Hawkins RJ, Bell RH, Anisette G (1986) Acute patellar dislocations. Knee Surg Sports Traumatol Arthrosc 13:522528, Farr J, Schepsis AA (2006) Reconstruction of the medial patellofemoral ligament for recurrent patellar instability. The pattern of bone bruising seen in a transient lateral patellar dislocation is easy to understand if one considers the mechanism of injury. Between 15 and 45% of patients will develop recurrent patellar instability after acute dislocation, which is both functionally limiting and painful [17,18,19,20]. 2012;40(4):837-844. Magnetic Resonance Imaging Characteristics of the Medial Patellofemoral Ligament Lesion in Acute Lateral Patellar Dislocations Considering Trochlear Dysplasia, Patella Alta, and Tibial Tuberosity-Trochlear Groove Distance These are most often found at the inferomedial patella or the lateral femoral condyle [49, 61, 62]. Acute traumatic instability most commonly occurs in young athletes in their second and third decade at an incidence rate of 29 per 100,000. Clin Radiol 59:543557, Ali SA, Helmer R, Terk MR (2010) Analysis of the patellofemoral region on MRI: association of abnormal trochlear morphology with severe cartilage defects. The patella articulates with the trochlear groove of the anterior femur, which has corresponding lateral and medial patellar articular surfaces [6]. 1 Lance E, Deutsch AL, Mink JH. However, the patella starts to engage with the trochlea by 30 and is typically completely engaged by 45. Identifying edema at the superolateral aspect of Hoffas fat pad on MRI should prompt the reporting radiologist to look for features of patellar maltracking. The posterior articulating surface of the patella is composed of two facets, a medial and lateral facet, separated by a vertical ridge, and in 30% of the population, there is a third facet, the odd facet, most medially. 35 Dislocation typically occurs in the setting of internal rotation of the femur on a fixed, externally rotated tibia. The deep layer is comprised of the lateral patellofemoral ligament, patellotibial band and transverse ligament. Knee 10:215220, Terry GC, Hughston JC, Norwood LA (1986) The anatomy of the iliopatellar band and iliotibial tract. Dejour et al. MR findings were correlated with clinical, surgical, and arthroscopic findings. Current Concepts Regarding Patellofemoral Trochlear Dysplasia. MR imaging can help define patellar retinacular and associated osteochondral injuries, which may be clinically useful information. 2023 BioMed Central Ltd unless otherwise stated. In: West RV, Colvin AC (eds) The patellofemoral joint in the athlete. 6 Cone R. Patella Alta and Baja. Knee Surg Sports Traumatol Arthrosc 26:27332742, Hingelbaum S, Best R, Huth J, Wagner D, Bauer G, Mauch F (2014) The TT-TG Index: a new knee size adjusted measure method to determine the TT-TG distance. There is edema of the medial patella and of the lateral femoral condyle (arrow), consistent with bone contusion due to recent lateral patellar dislocation. The adductor magnus tendon (AT) attaches to the adductor tubercle, which lies posterior and superior to the femoral attachment of the MPFL. Chronic fat impingement can result in chronic inflammation and fat pad hypertrophy. 3 Dirim B, Haghighi P, Trudell D et al. A ratio > 1.3 indicates patella alta. ity. The MPFL plays a significant role in the stabilization of the medial aspect of the patella.Especially during the early stages of knee flexion, the MPFL is a critical component in patellar tracking and stability within the trochlear groove. Acta Orthop Belg 72:6571, Panagopoulos A, van Niekerk L, Triantafillopoulos IK (2008) MPFL reconstruction for recurrent patella dislocation: a new surgical technique and review of the literature. Transient medial patellar dislocation: injury patterns at US and MR Over 100 different procedures have been described for the treatment of patellar instability, and this reflects the various causes for instability and lack of current gold standard [66, 69, 72]. The lateral patellar retinaculum is a fibrous expansion comprising of superficial and deep layers. As the knee joint ranges from extension to flexion, the articular surface area of the patella is in contact with the femur changes. Less commonly, a direct laterally or medially orientated blow to the patella can precipitate dislocation. . Femoral condylar chondral injuries occur during the dislocation phase due to impaction shearing forces of the patella upon the flexed femur, typically occurring at the weightbearing surface. The injured retinaculum had an indistinct, irregular appearance associated with edema and hemorrhage. A commonly used one is the InsallSalvati ratio of patellar tendon length: patellar length. As the knee joint ranges from extension to flexion, the articular surface area of the patella is in contact with the femur changes. Transient lateral patellar dislocation. Sports Health 3:170174, Stensdotter AK, Hodges PW, Mellor R, Sundelin G, Hger-Ross C (2003) Quadriceps activation in closed and in open kinetic chain exercise. Please enable it to take advantage of the complete set of features! The lateral patellar retinaculum is less commonly injured than the medial patellar retinaculum, however it is often disrupted during surgery to correct abnormal lateral patellar tracking or dislocation 3. The lateral patellar retinaculum can also be assessed in this position. Bone bruise in acute traumatic patellardislocation: volumetric magnetic resonance imaging analysis with follow-up mean of 12 months. Google Scholar, Nakagawa S, Kadoya Y, Kobayashi A, Tatsumi I, Nishida N, Yamano Y (2003) Kinematics of the patella in deep flexion. Value of the tibial tuberosity-trochlear groove distance in patellar instability in the young athlete. Biomechanical evaluation of lateral patellar dislocations. Additionally, in this degree of flexion, the quadriceps tendon itself engages the proximal trochlear groove and participates in force distribution [8,9,10]. 5). PubMed Correspondence ML: [emailprotected] Submitted 07-19-2011. Skeletal Radiol 38:785790, Campagna R, Pessis E, Biau DJ et al (2012) Is superolateral Hoffa fat pad edema a consequence of impingement between lateral femoral condyle and patellar ligament? The patellar dislocations were clinically unsuspected in the initial evaluation of eight of these nine patients. A typical bone bruise is seen within the anterolateral aspect of the lateral femoral condyle (asterisk). The decreased patellar contact area decreases stability particularly in shallow degrees of flexion and thus predisposes to lateral patellar subluxation. Incidence and concomitant chondral injuries in a consecutive cohort of primary traumatic patellar dislocations examined with sub-acute MRI. Lateral patellar tilt is a sensitive marker for patellar instability [45]. Patellofemoral Pain Syndrome - OrthoInfo - AAOS The medial patellar retinaculum is part of the anterior third of the medial joint capsule. Surgical realignment procedures include medialization of the tibial tubercle particularly in patients with a TT-TG distance greater than 20mm. MRI Web Clinic, August 2010. https://radsource.us/patella-alta-and-baja/. Findings typically associated with acute lateral patellar dislocation were also assessed and recorded (present or absent) including characteristic bone bruises and osteochondral injuries involving the patella, lateral trochlear facet, and lateral femoral condyle. The distance (double-headed arrow) from the deepest point of the trochlea (line B) to the middle of the tibial tubercle (line A) is measured, again by using the posterior plane of the condyles as the reference line (line C). Stretching a Lateral Retinaculum of the Knee | livestrong The patellar retinaculum and the MPFL are seen on MRI as well-defined low-signal-intensity bands. It has been shown that ossification in the medial patellar stabilizers correlates with prior injury to these structures [53]. Twenty-six pelvic limbs were used for gross dissection, and four stifle regions from two animals were used for radiography and magnetic resonance imaging (MRI). Lateral trochlear inclination is another quantitative method to diagnose trochlear dysplasia. Open Orthop J. By using this website, you agree to our The MCL is beneath the deep crural fascia (layer 1), from which it is separated by a variable amount of fat (Fig. Orthopedic Surgery 22 years experience. Features that may predispose to patellar dislocation and/or patellar maltracking and can be evaluated with CT include patellar and trochlear morphology and the alignment between the two structures. The common peroneal nerve can be localized in the popliteal fossa or identified posterior to the biceps femoris tendon and followed as it courses around the fibular neck. Knee Surg Sports Traumatol Arthrosc 14:707712, Ahmad M, Janardhan S, Amerasekera S, Nightingale P, Ashraf T, Choudhary S (2019) Reliability of patellotrochlear index in patellar height assessment on MRI-correction for variation due to change in knee flexion. 2021;50(7):1399-409. MR imaging of patellar retinacular ligament injuries - PubMed Radiology 189:905907, Warren LF, Marshall JL (1979) The supporting structures and layers on the medial side of the knee: an anatomical analysis. a Sagittal PD knee MRI showing the method of assessing the InsallSalvati index, calculated as the ratio of the patellar tendon length at its inner aspect (white dashed line) to the greatest diagonal length of the patella (white line). Am J Sports Med 28:472479, Lewallen L, McIntosh A, Dahm D (2015) First-time patellofemoral dislocation: risk factors for recurrent instability. Observer Agreement on the Dejour Trochlear Dysplasia Classification: A comparison of true lateral radiographs and axial magnetic resonance images. J Bone Joint Surg Am 85-A:12381242, Article As a common knee injury, patellar dislocation has a mean annual incidence of 5.8 in 100,000 people and is more prevalent in women. This short surgical video demonstrates an arthroscopic lateral release as seen from inside the knee. Int Orthop. Despite this, there remains considerable variation in surgical technique including graft choice, position, and tension making the literature difficult to compare [8, 15, 79,80,81,82,83,84,85,86]. Lateral patellar retinaculum. Radiographics. The patellar dislocations were clinically unsuspected in the initial evaluation of eight of these nine patients. Post WR, Teitge R, Amis A (2002) Patellofemoral malalignment: looking beyond the viewbox. With knee extension and subsequent reduction, the patella bounces back into position and in doing so, the medial patella impacts against the non-weightbearing anterolateral aspect of the lateral femoral condyle, resulting in the characteristic marrow edema pattern. (1a) A single fat-suppressed proton density-weighted coronal image is provided. RadioGraphics 2010; 30: 961-981. Patellar maltracking occurs as a result of imbalance of this relationship often secondary to anatomic morphologic abnormality. Prevalence of Lateral Patellofemoral Maltracking and Associated Complications in Patients with Osgood Schlatter Disease. 9 Lippacher S, Dejour S, Elsharkawi M, et al. The .gov means its official. 4). CT of both knees in 20 flexion demonstrating bilateral shallow trochlear groove (arrows) compatible with dysplasia and bilateral lateral patellar subluxation and lateral tilt. The patellofemoral joint has two primary functions; firstly, it acts as an anatomic pulley to provide mechanical advantage for the extensor mechanism and, secondly, to reduce friction between the extensor mechanism and the femur. From the inside of the knee the lateral retinaculum is incised, from the inside, allowing the kneecap to untilit itself. 5 a-d). Although edema can be seen in other peripatellar fad pads on MRI, there is no clear association between patellar maltracking and prefemoral fat pad edema or with that at the suprapatellar fat pad [56]. Part of 1995 Jan;164(1):135-9. doi: 10.2214/ajr.164.1.7998526. The femoral attachment of the transverse band of the MPFL is not always discretely visible, and therefore secondary signs on MRI such as fluid, edema, and soft tissue thickening at the attachment indicate MPFL injury. When the knee moves slightly out of place or becomes tilted in the joint, it can cause tension and pain in the lateral retinaculum. Although you may feel that being asked to make the specific diagnosis of lateral patellar dislocation from a single image is unrealistic, the coronal view in fact reveals a classic and highly characteristic appearance, allowing the diagnosis to be made with confidence. Kirsch M, Fitzgerald S, Friedman H, Rogers L. Transient Lateral Patellar Dislocation: Diagnosis with MR Imaging. Eleven gave a history of recurrent patellar dislocation. Patellar maltracking: an update on the diagnosis and treatment strategies, https://doi.org/10.1186/s13244-019-0755-1, http://creativecommons.org/licenses/by/4.0/. A distance between the tibial tubercle and the trochlear groove of less than 15 mm is considered normal. (4a) This 3D graphic view of the medial knee with the crural fascia and sartorius (S) muscle incised and reflected demonstrates the main medial contributors to patellar stability. (13a) A line is drawn between the cortex of the lateral trochlear facet on the most superior axial image showing cartilage. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Unable to process the form. 20,61 This is attributable to a medial retinacular injury, specifically, avulsion or tearing of the medial patellofemoral ligament. b Axial CT image showing tibial tuberosity transfer surgery with screw placement (arrow). Unauthorized use of these marks is strictly prohibited. 2002 Dec;225(3):736-43. doi: 10.1148/radiol.2253011578. Medial patellofemoral ligament injury patterns and associated pathology Patellar maltracking: an update on the diagnosis and treatment strategies. Hemarthrosis is rare in lateral patellar sleeve fractures, as the lateral pole is not as vascularized as the inferior pole of the patella that has the most important blood supply of patella [5 ]. AJR Am J Roentgenol 167:339341, Caton JH, Dejour D (2010) Tibial tubercle osteotomy in patello-femoral instability and in patellar height abnormality. AJR Am J Roentgenol. Methods: We compared 361 treated cases of aneurysm occlusion after subarachnoid hemorrhage from 1997 to 2003 with 281 cases from 2006 to 2014. The most obvious presentation of patellar maltracking is that of the first time lateral patellar instability or recurrent instability thereafter. Terms and Conditions, The lateral retinaculum appears as a hyperechoic band originating from the iliotibial band and the vastus lateralis muscle. All authors (ZJ, PJ, KSR, MLS, GD) contributed to the study design, drafted the work, and revised it critically for final submission. Jumping. In fact, most patellar maltracking occurs between extension and the first 30 of flexion. The most accepted indication for surgical management of patellar instability is the presence of a large displaced osteochondral fracture or loose body. The knee is a complex synovial joint that can be affected by a range of pathologies: Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Check for errors and try again. J Bone Joint Surg Am 89:17491755, PubMed Insights Imaging 10, 65 (2019). It can be difficult to determine the deepest part of the trochlear groove when assessing the TT-TTG in the presence of trochlear dysplasia; therefore, an alternative method for assessing tibial tubercle position was proposed measuring the distance in reference to the posterior cruciate ligament and not to the trochlea (tibial tubercle-posterior cruciate ligament distance [TT-PCL]), with proposed pathologic threshold of 21mm [42, 43]. Google Scholar, Sanders TG, Paruchuri NB, Zlatkin MB (2006) MRI of osteochondral defects of the lateral femoral condyle: incidence and pattern of injury after transient lateral dislocation of the patella. The medial patellar retinaculum (MPR) and the lateral patellar retinaculum (LPR) are vital structures for the stability of the patella. It is the angle between a line tangential to the subchondral bone of the posterior aspect of the femoral condyles and a line along the lateral trochlear facet subchondral bone (Fig. is a term coined for anatomic characteristics that lead to an increased Q angle and an exacerbation of patellofemoral dysplasia. Skeletal Radiol 30:484495, Tsujimoto K, Kurosaka M, Yoshiya S, Mizuno K (2000) Radiographic and computed tomographic analysis of the position of the tibial tubercle in recurrent dislocation and subluxation of the patella. Stress and shear forces that follow can result in cartilage damage and the development and evolution of osteoarthritis [57]. Arthroscopy 35:537543, Mountney J, Senavongse W, Amis AA, Thomas NP (2005) Tensile strength of the medial patellofemoral ligament before and after repair or reconstruction. Manage cookies/Do not sell my data we use in the preference centre. 9). Because as noted above, the femoral bone bruise occurs as the patella moves forward during reduction, bone bruises at the lateral femoral condyle always course anteriorly from the site of any femoral chondral injury that may be present. b Patellar alta evaluation using the CatonDeschamps index, which is the ratio between a line measured between the inferior margin of the patellar articular surface and the anterior aspect of the tibial plateau (black line) and the greatest length of the patellar articular surface (white line). The radiograph can also be useful in detecting osseous morphologic features associated with patellar maltracking such as patella alta and trochlear dysplasia [24, 25]. On the other hand, there are static MRI measurements that are routinely used as indicators of patellofemoral alignment during knee movement [30, 31]. Depends on how bad: Small tears are observed and heal. Flattening or developmental dysplasia of the trochlea leads to loss of normal patellar tracking and can predispose to lateral patellar dislocation with flexion. ADVERTISEMENT: Supporters see fewer/no ads. Bone bruises at the anterolateral aspect of the lateral femoral condyle and at the inferomedial patella are the most constant findings in patients who have sustained a recent patellar dislocation.
Us Soldat Rente,
Dreams About Yelling At Your Dad,
Oxford Magistrates Court Email,
Articles L