IC 307-2023: Patellar Instability: When is an MPFL Reconstruction Just Not Enough! A Case-Based Discussion-IC 307 - Patellar Instability: When is an MPFL Reconstruction Just Not Enough! A Case-Based Discussion (3/4)

IC 307 - Patellar Instability: When is an MPFL Reconstruction Just Not Enough! A Case-Based Discussion (3/4)

Video Transcription

Video Summary

In the video, the presenter discusses the use of a test called the moving apprehension test to assess instability and pain-related buckling in the patella. The test involves translating the patella laterally while slowly flexing the knee to determine at what degree of flexion the patella locks in. The greater the degree of flexion at which the locking occurs, the more instability is present. The test is particularly useful for differentiating between true instability and pain-related buckling.<br /><br />The presenter also discusses a case of a skeletally immature patient with multiple subluxations and effusion. The patient had a high PTLTR (patellar tendon-tibial tubercle ratio) but a normal TTTG (tibial tubercle to trochlear groove distance). The presenter highlights the importance of considering the vector of forces on the patella when assessing anatomic risk factors. They also mention the potential benefits of guided growth for patients with valgus alignment.<br /><br />Trochleoplasty is another topic discussed in the video. The presenter emphasizes the need to consider both dysplasia and alta (abnormally high patella) when deciding whether to perform a trochleoplasty. They caution that trochleoplasty alone may not be sufficient to address all risk factors for patella instability, particularly if there are other anatomic risk factors present. They also discuss the importance of balancing the patella track with distal realignment procedures like tubercle osteotomies and MPFL (medial patellofemoral ligament) reconstruction.<br /><br />No credits are granted in the video transcript.

Asset Caption

David Diduch, MD

Keywords

moving apprehension test

instability

patella

flexion

skeletally immature patient

trochleoplasty

anatomic risk factors