The Patellofemoral Foundation (PFF) Board of Directors met in San Francisco at the American Academy of Orthopedic Surgeons meeting on March 6, 2008. Representatives from our major benefactor, Smith and Nephew Endoscopy, attended as well as Lieve Van den Berghe, Vice Preident of DJO International and organizer of the Patellofemoral Consensus Group. The AAOS meeting was a great opportunity for Patellofemoral Board Members to fulfill part of our mission to enhance awareness of patellofemoral problems and provide focused educational opportunities for health care professionals about prevention and proper care of patients and athletes with patellofemoral pain and instability.
News & Activities
Ongoing & Focused
John Elias and Andrew Cosgarea have reported new and exciting results from their PFF funded research. In a computer model of knees with dysplastic trochleas, they have established that proximal realignment (MPFL reconstruction) creates greater patellofemoral articular loads than tibial tubercle transfer. This important work helps to further clarify the need for distal alignment in controlling patellar instability when the trochlea is flat and there is lateral tracking of the patella. Read More
Purpose: The purpose of this study was to evaluate the effect of surgical reinsertion of the medial patellofemoral ligament (MPFL) to the adductor tubercle compared with conservative treatment in patients with primary dislocation of the patella. Methods: Eighty patients with primary patella dislocation were included in the study. Delayed arthroscopy (mean, 50 days after injury) was performed to assess cartilage injury and status. During arthroscopy, patients were randomized to surgical reinsertion of the MPFL or to conservative treatment. Conservative treatment was use of a brace with 0° to 20° motion for the first 2 weeks after dislocation. Patients were followed up for 2 years. The incidence of recurrent patella dislocation was recorded along with the clinical Kujala scores and Knee Injury and Osteoarthritis Outcome Scores. Results: The redislocation rates were 17% and 20% in the operative and conservative treatment groups, respectively (P= not significant). Kujala scores were 85 and 78 in the operative and conservative treatment groups, respectively (P = .07). The patella stability subscore was significantly higher in the operative group. No difference in Knee Injury and Osteoarthritis Outcome Scores was found. Conclusions: Delayed primary repair of the MPFL by use of an anchor-based reattachment to the adductor tubercle without vastus medialis obliquus repair after primary patella dislocation does not reduce the risk of redislocation nor does it produce any significantly better subjective functional outcome based on the Kujala knee score. Only the specific subjective patella stability score was improved by MPFL repair compared with conservative treatment. Level of Evidence: Level I, therapeutic randomized controlled trial. Read More
Patellofemoral General Agreement Statement from the PFF/ IPSG Consensus meeting sponsored by DJO International on March 6, 2008
- Focal loading can be a cause of PF pain.
- Overuse or at times cyclical overload of soft tissue or bone areas may explain the unusual and sometimes ill defined nature of anterior knee pain in some patients (Dye theory of envelope of load acceptance) Treatment should establish load reduction.
- Patellofemoral imbalance (including but not limited to malalignment) may cause pain by virtue of cyclical soft tissue and/or bone overload.
- Focal supraphysiological loading can, in some patients, be a cause of PF pain.
- Structural damage of articular cartilage does not always result in anterior knee pain. However, there is growing evidence that a subset of patients with chondral lesions may have a component of their pain related to that lesion.
There are many alternatives for non-operative PF pain treatment that should be considered some of which may include medications that affect neural pain transmission.
History, exam, imaging and response to treatment (differential injection, specific unloading, medication and multidisciplinary evaluation) should correlate well and be consistent in order to localize pathology and to make a precise diagnosis. Treatment should be developed based on the most precise diagnosis possible. Persistence of pain may be related to inaccurate appraisal of the cause of pain and/or inappropriate treatment decisions, patient non-compliance or complications of surgical treatment.
A patient’s active participation and understanding in his/her treatment is necessary for optimal results.
At the PFF Board meeting on March 6, 2008, members of the Board welcomed Philippe Neyret, M.D., of Lyon France to the Board of Directors.
Dr. Neyret is Professor and Chief of Orthopedics Department in Lyon (France), after the famous Alfred Trillat and Henri Dejour. The Lyon school is known for its expertise in the field of knee surgery and particularly patellofemoral disorders. The Lyon team has published results of many clinical investigations and books. Dr. Neyret serves many prestigious international societies such as ISAKOS, ESSKA, EFORT... He has particular interest in sport and soccer injuries.
For a full list of Patellofemoral Foundation Board of Directors click here.