News & Activities
Ongoing & Focused
By Drs Jacqueline Munch Brady and Nicholas Paschos
We began our journey in beautiful Lyon, France with Dr David Dejour. We focused on instability, discussing the principles of clinical and radiographic evaluation of the patellofemoral joint, and indications for procedures such as distalizing tibial tubercle osteotomy and trochleoplasty. Dr. Dejour explained the thought process behind identifying patella alta and/or trochlear dysplasia as the major contributing factor to instability, and correcting each accordingly.
Dr. Philippe Neyret was our next host, across the city in Lyon. With him, we shifted our focus to the extensor mechanism of the knee, discussing considerations for surgical intervention in chronic quadriceps or patellar tendon insufficiency. He demonstrated a technique for complex reconstruction of a deficient patellar tendon using mesh augmentation, for instances where the native tendon is insufficient for repair.
Next, we stopped in London to visit Dr. Andrew Amis. His lab at the Imperial College is equipped to study everything from soft tissue anatomy to complex joint kinematics. We discussed the difficulties in studying the patellofemoral joint biomechanically: for instance, a dearth of trochlear dysplasia in cadaveric material, and the complexity of the soft tissue envelope surrounding the joint. We toured his laboratory and the neighboring robotics laboratory, and then had a great discussion with Dr. Amis and his colleague Dr Jo Stephen regarding their recent interest in the anatomy of the infrapatellar fat pad and its contributions to symptoms in the patellofemoral joint.
We departed London, inspired to continue our studies. In Tampere, Finland, we shifted our research discussion to the clinical world with Dr. Petri Sillanpaa and his partner, Dr. Frederick Weitz. They collaborate on the majority of their trochleoplasty cases, in order to increase their respective experience and ensure close examination of their outcomes. Among other excellent cases, we observed the technique of thin-flap trochleoplasty, and discussed the surgical indications for the procedure.
At the end of our visit, providers from across Finland gathered in Tampere for a conference focusing on all aspects of the patellofemoral joint, and we had an excellent discussion on the latest developments in PF joint disorders. True to the Finnish tradition, we concluded our conference with a visit to the conference’s sauna!
For our second week, we returned to the United States, landing first in Hartford, Connecticut for a visit with UConn surgeons Dr. John Fulkerson and Dr. Cory Edgar. We shifted gears slightly to discuss chondral lesions and implications for patellofemoral surgery. Dr. Edgar filled us in on his latest biomechanical undertakings, explaining the effects of distalization of the tibial tubercle in early knee flexion. Dr. Fulkerson reviewed the anatomy of the medial patellofemoral complex, and demonstrated his MQTFL technique in addition to the anteromedializing tibial tubercle osteotomy. The UConn residents filled us in on some of their research surrounding patellofemoral anatomy and cartilage restoration techniques, and we were able to see one more case with Dr. Fulkerson, illustrating the treatment of iatrogenic medial instability, before departing for Minnesota.
Our next stop was the Mayo Clinic with Dr. Diane Dahm. After observing an MPFL reconstruction, we focused on patellofemoral arthritis in particular with Dr. Dahm. We discussed indications for unloading procedures versus patellofemoral arthroplasty. She demonstrated a lateral facetectomy in a patient who was too high-risk for arthroplasty. Afterward, we reviewed various patellofemoral implants, and discussed the fact that they vary significantly in design and considerations for technique.
From Rochester, we journeyed to neighboring Minneapolis, MN, where Dr. Elizabeth Arendt hosted us at the University of Minnesota. Dr. Arendt demonstrated her MPFL reconstruction technique of wrapping a graft around the adductor magnus tendon rather than creating a bony socket in the medial femur. We discussed the lateral retinacular complex, and she demonstrated the technique of lateral retinacular lengthening. Dr. Arendt also performed a thick-flap trochleoplasty technique in a severely dysplastic patient, demonstrating the ability of trochleoplasty to significantly improve the level of trochlear dysplasia on direct inspection and lateral fluoroscopic examination. We ended the visit with a morning in the laboratory, reviewing the complex anatomy of the patellofemoral joint and its soft tissue envelope, and trying our hand at tibial tubercle osteotomy and trochleoplasty procedures.
Throughout the journey, we felt incredibly grateful and fortunate to have the opportunity to learn from some of the leaders in our field. We are eternally thankful to our hosts for their time and energy. The trip was challenging and enlightening in all the right ways, and we look forward to using our improved understanding to treat our patients and contribute to the literature.
Our travels in pictures:
The Board of Directors of the Patellofemoral Foundation were honored to present the 2017 Lifetime Achievement Award to Vicente Sanchis-Alfonso MD PhD. Dr. Sanchis-Alfonso works at the Hospital Arnau de Vilanova in Valencia, Spain. Prior recipients of the award, Drs. Elizabeth Arendt and Alan Merchant, attended the celebration luncheon to honor their peer.
Dr. Sanchis-Alfonso was introduced by PFF board president, John Fulkerson MD who summarized his career work and significant accomplishments. The attendees were then treated to a heartfelt and poignant speech that was highlighted by an incredible accounting of dates and events that defined his career passion for the patellofemoral joint. He mentioned that he still owns and cherishes his first communication from Dr. Fulkerson!
The 2017 Academy of Orthopaedic Surgeons annual meeting was held in beautiful San Diego this past week. The Board of Directors of the Patellofemoral Foundation recently held our board meeting and luncheon in San Diego concurrent with the 2017 AAOS meeting. This year we met at the Oceanaire Restaurant located a few blocks from the San Diego Convention Center.
Agenda items included updates on a number of ongoing projects and relationships with partners that include AANA, ISAKOS, and AOSSM. The upcoming September 8-9, 2017 PFF/AANA Orthopaedic Learning Center course was discussed and significant time was given to ideas for providing residents and fellows with a focused course directed to teaching current and optimized options for treatment.
The board was grateful and fortunate that corporate donations continue to support efforts to provide education. Dr. John Fulkerson reviewed the current list of sponsors noting especially the generous DJO Global commitment to donate $250,000 over 5 years. Continued support from Smith & Nephew, Kinamed was gratefully acknowledged as well as the first year of support from ZipLine Medical.
The board meeting was adjourned at noon and the invitation-only luncheon followed. In attendance were leaders of PFF partner organizations including AANA President Rob Hunter, MD of Salida, CO and AOSSM President Ned Amendola, MD of Duke University. Michael McBrayer, Sr. VP of DJO Global and Alain Tranchemontagne, Sr. VP of Smith & Nephew each took a few minutes to voice their commitment to the goals and efforts the Patellofemoral Foundation. Vineet Sarin, PhD, President of Kinamed, also attended this year’s luncheon.
Each year the PFF presents a very special award at the luncheon to honor significant contributions to patellofemoral science and treatment. The Patellofemoral Foundation Lifetime Achievement Award this year was awarded to Vicente Sanchis-Alfonso MD PhD of Valencia, Spain. Several previous recipients of the award, Dr. Alan Merchant and Dr. Liza Arendt, joined us for the celebration.
The Board of Directors of the Patellofemoral Foundation is pleased to announce that DJO Global has again committed to supporting the organization. Senior Vice President Michael McBrayer recently confirmed to the board that DJO Global will support the organization with a 5 year, $50,000 per year commitment.
With the announcement, Mr. McBrayer added that “DJO Global is proud to continue and further our support to the Patellofemoral Foundation. The Foundation’s worldwide efforts to improve the quality of life for individuals with knee pain falls directly in line with DJO Global and our efforts to keep people in motion. Truly Motion is Medicine.”
Dr. John Fulkerson, founder and President of the Patellofemoral Foundation responded that “the Foundation is grateful for all support offered to support or mission and goals, but we are extremely pleased with the relationship with DJO Global that has been generous and consistent since we formed the organization in 2003.”
The PFF has partnered with major organizations to continue with their effort to provide education and support research to help surgeons with the information and options needed to help patients suffering from anterior knee pain. These organizations include AANA (Arthroscopy Association of North America), AOSSM (American Orthopaedic Society for Sports Medicine) and ISAKOS (International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine).
“The board is looking forward to continuing with a number of successful and effective programs such as acknowledging and supporting research and traveling fellowships. Donations to the foundation also provide the opportunity to expand its reach into new areas such as developing programs to benefit residents”, said Eric Dahlinger, Executive Director of the PFF.