Index [link.springer.com]978-0-85729-507-1/1.pdf · High school personality questionnaire (HSPQ), 130 Hoffa’s fat pad extraskeletal osteosarcoma, 148 localized pigmented villonodular

533

AAcetylcholine (ACh), 231Achilles tendinosis, 367, 368Acupuncture, 30Adductor magnus, 452–453Adductor tubercle, 452Allodynia, 25, 26Anatomical patella abnormalities, 171Anisometry, 391Anterior cruciate ligament (ACL), 3–4, 74, 106, 383

debridement, 245definition, 241graft-donor knee, 242hyperextension, 243intraoperative prevention, 246–247meniscus lesions, 244muscle imbalance, 242patellofemoral chondromalacia, 244physical therapy programs, 243postoperative prevention, 247–248preoperative prevention, 245–246quadriceps angle, 242range of motion, 242retained tibia hardware, 245treatment, 248–249

Anteromedial tibial tubercle osteotomyanteromedialization outcomes, 461arthroscopic evaluation, 457break-away pins, 458, 459complications, 461contraindications, 455–456cutting guide, 459incision and exposure, 457–458indications, 455–456Maquet procedure, 455patient positioning, 457pearls and pitfalls, 460postoperative management, 461preoperative assessment and planning, 457reference pin guide, 458screw positioning and fixation, 459–460small osteotome, 459Tracker system, 458T3 system, 458–459

Antithrombotic prophylaxis, 375Apoptosis, 25

Arbeitsgemainshaftfür Osteosynthesefragen (AO) technique, 441

Arthrofibrosis, 248Arthroscopic mosaicplasty

defect preparation, 486–487graft harvest, 487–488graft implantation, 488portal selection, 486

Arthroscopic patellar denervationadvantage of, 377–378anatomic dissection, right knee, 373–374antithrombotic prophylaxis, 375avascular osteonecrosis, 377clinical outcomes, 376–377clinical results of, 377flexion–extension of knee, 375indications/contraindications, 374patellofemoral osteoarthritis, 377pearls and pitfalls, 375–376quadriceps atrophy, 377quadriceps exercises, 375selective neurotomy, 373sensory innervation, 373surgical technique, 374–375thermal lesion, electrocoagulator, 375

Arthroscopy, 120–121Articular cartilage, 191Atherosclerotic calcification, 27Athletes, non-operative treatment of

balance and coordination training, 180bracing and taping, 180–182closed and open kinetic chain training, 179differential diagnosis, 172–173extensor mechanism, 177flexibility, 175functional knee scores, 176–177hamstring/quadriceps ratio, 174history, 172isokinetic training, 178–179isometric training, 178knee-related functional performance tests, 175–176lower extremity, 173patellar mobility, 173–174patellar pain vs. patellar instability problems, 171patellar position, 173psychological factors, 172

Index

V. Sanchis-Alfonso (ed.), Anterior Knee Pain and Patellar Instability, DOI: 10.1007/978-0-85729-507-1, © Springer-Verlag London Limited 2011

534 Index

quadriceps angle, 173quadriceps muscle strength, 174risk factors, 172sport-specific exercises, 180stretching, 179symptoms, 171vastus medialis vs. vastus lateralis, 174–175VMO training, 177–178

Autografts, ACLbiochemical investigations, 259–260dissection study, 252–253donor-site morbidity, 255histological examinations, 258–259knee surgery and sensory nerve complications,

253–254radiographic abnormalities, 256–257ROM and loss of strength, 251–252ultrastructural examinations, 259

Autologous chondrocyte implantation (ACI)indications/contraindications, 474patch preparation and fixation, 476–477patch sealing, 477postoperative management, 478–479recipient site preparation, 476skin incision, 476surgical outcomes, 479

Autologous osteochondral mosaicplastyarthroscopic mosaicplasty, 486–488cartilage stiffness measurement, 491–492clinical outcomes, 489, 491–493complications, 493contraindications, 485donor-site morbidity, 491femoral condylar implantation, 492full-thickness cartilage damages, 492–493hyaline or hyaline-like repair tissue, 483indications, 484–485kissing lesions, 485multiple small-sized grafts, 483–484open mosaicplasty, 488–489operative technique, 486osteochondral autograft transfer, 483patient positioning, 485pearls and pitfalls, 489postoperative complications, 492postoperative management, 489preoperative preparations, 485–486rehabilitation protocol, 489–491

Avascular osteonecrosis, 377Avoidance behavior

lateral patellar instability, 306medial patellar instability, 360–362

BBereiter trochleoplasty, 431Bilateral anterior knee pain, 338–340Biochemical mediators

blood vessel walls, 233chronic tendon pain, 231–232clinical implications, 233–234nonneuronal cells, signal substances, 231

sensory nerves, 230sympathetic neurons and SMP, 230tendinopathy pain, 229–230tendinosis tissue changes, 233tenocytes, 231

Biomechanics, patellofemoral disorders, 287–288Bipolar transplants, 505Blackburn–Peel technique, 523Bone-patellar tendon-bone (B-PT-B), 4

CCartilage and bone stresses

bone density assignment, 284hydrostatic stresses, 283metabolic activity, 282PET image intensity, 284

Cartilage morphology, 271–272Cartilage restoration, patellofemoral joint. See also Autologous

chondrocyte implantation; Microfracture; Osteochon-dral allograft transplantation; Osteochondral autograft transplantation

anterior knee pain, 470arthroscopic chondral debridement, 473arthroscopic evaluation, 471bone scans, 472chondral defects, 469, 470clinical history, 470–471co-morbidities, 469crepitus, 471CT scan, 472dislocation episodes, 470–471fibrocartilage, 473gait evaluation, 471hyaline cartilage, 473indications/contraindications, 473–474knee trauma, 470magnetic resonance imaging, 472muscle weakness evaluation, 471patellar glide/apprehension test, 471–472patellar instability, 470–471patellofemoral chondrosis, 473physical examination, 471–472plain radiographs, 472postoperative management, 478–479quadriceps tightness, 472retinacular tightness evaluation, 471surgical technique, 474–478treatment outcomes, 479–480

Central bumpCT evaluation, 416MR measurements, 416physical examination, 415, 416postoperative rehabilitation, 418radiographs, 416trochleoplasty, 417

Choline acetyltransferase (ChAT), 231Chondromalacia patellae, 6, 172, 191. See also Patella alta

kinetic and kinematic study, 510–512lateral retinacular release, 512lateral retinaculum lengthening, 513–515medial patellar instability, 512, 513

535Index

patellofemoral joint replacement, 513patient history, 509physical examination, 509–510stress axial radiography, 509–510

Chronic tendinopathy, 43Cincinnati knee rating system (CKRS), 123Cognitive behavior therapy, 28Complete extensor mechanism allograft

bipolar transplants, 505indication and contraindication, 508older patient, 504patellar tendon chronic rupture, 508recommendation, 508–509risk factor, 505

Complex regional pain syndrome (CRPS), 500Computational model, patellofemoral joint

accuracy, 289clinical relevance, 289CT images and MRI, 292EMG measurements, 293enhanced display, patellofemoral kinematics,

289–291vs. experimental validation, 289finite element analysis, 292–293flexed knee, 294intact cartilage and cartilage with lateral lesion, 294limitations, 295–296MPFL reconstruction, 295predictive models, 293three-dimensional representations, 289tibial tuberosity anteriorization, 295validation, 293–294VMO force, 295

Computed tomography (CT), 95, 116arthrosis, 340extension and quadriceps contraction,

354, 355, 356lateral stress, 358medial stress, 358trochlear dysplasia type D, 308–309

Conservative management, PFPSabnormal patellar tracking, 191altered foot biomechanics, 193biomechanical faults, 192, 194calcaneum, 195dynamic examination, 195foot problems, 204–205hip muscle weakness, 193internal femoral rotation, 194McConnell program, 205prone, 197quadriceps, 192–193retinacular tissue, 197side lying, 197soft tissue tightness, 192supine lying examination, 195–197

Continuous passive motion (CPM) machine, 247Coping strategies questionnaire (CSQ), 127Coronal thinning osteotomy, 463Cryo/Cuff, 247Cybex dynamometer, 66

DDelayed onset muscle soreness (DOMS), 26Donor-site morbidity, 255Drill-Dilate-Deliver grafting, 488Dual-plane fluoroscopy, 290–291

EEffector cells, 23–24Ehlers–Danlos syndrome, 112Electromyography (EMG), 174, 281Enhanced display, patellofemoral kinematics

limitations, 291low resolution and high-resolution scans, 290–291muscle loading, 289–290validation, 291

Epidemiological studies, 21Exam under anesthesia (EUA), 379Extensor mechanism pathology, 76–77Extrinsic risk factors

conservative treatment, 160excessive loading, 160patellofemoral joint, 159

FFear avoidance beliefs questionnaire (FABQ), 125Feller’s Patellar Score, 465, 466Femoral anteversion, 434, 435

conservative approach, 409hyperpronation, 409imaging, 408–409physical examination, 407, 408postoperative rehabilitation, 410supracondylar rotation osteotomy, 409–410

Femoral osteotomy, rotationalclinical data, 442surgical technique, 441–442

Femoral trochlea allograft, 507–509Fibrosis, 24Finite element model, 292–293Foot alignment, 164–165Foot progression angle (FPA), 434Footwear, 70–71Fractures

central patella, 394MPFL reconstruction, redislocation, 393transverse patella, 394

Fulkerson osteotomy. See Anteromedial tibial tubercle osteotomy

Functional pain, 28

GGait analysis

NedAMH/IBV software, 354postoperative, 355preoperative, 355, 356, 360

Gastrocnemius, 175Genu recurvatum, 76Glycosaminoglycans (GAGs), 259Goniometer, 66Gracilis tendon (GT), 452Gray-scale ultrasonography, 368

536 Index

Ground reaction force (GRF), 321, 357, 358, 360Ground surface, 70–71

HHamstring and quadriceps muscles, 174Hamstring tendon autografts, 254Heel contact abduction–adduction moment, 321Heel contact flexion–extension moment, 321Heel contact ground reaction force, 321High school personality questionnaire (HSPQ), 130Hoffa’s fat pad

extraskeletal osteosarcoma, 148localized pigmented villonodular synovitis, 139, 140sagittal plane FSE T1W, 154

Homeostasis theory, 363Hospital anxiety and depression (HAD) questionnaire, 128Hyperalgesia, 25–26Hyperextension device, 246Hyperinnervation

immunoblotting detection, 39microneuromas, 36nerve ingrowth, 37neural growth factor, 38nociceptive fibers, 37nociceptive signals, 36osteoid osteoma, 37periadventitial innervation, 38vascular innervation, 37

Hyperpronation, 409Hypervascularization, 43Hypoxia, 25, 26, 39–40Hypoxia-inducible factors (HIFs), 26

IIatrogenic medial patellar instability

abduction–adduction moment, 358, 361avoidance behavior, patients, 360–362chondral lesion, 362computed tomography, 354, 355, 356conventional radiology, 356, 357flexion and extension moment, 358, 361gait analysis, 354–355ground reaction force, 357, 358, 360knee flexion–extension angle, 356, 357, 360manual pressure, 354PFM theory vs. homeostasis theory, 363retinacular structures vs. muscle coordination, 362–363Tc 99 m, bone scan, 356, 359

Iliotibial band (ITB), 110, 398, 399Inflammation and immune reactions

acute inflammation, 22cardinal signs, 22cells, 23–24chronic inflammation, 22injury and homestatic disturbances, 22–24mediators, 23–24neuronal cholinergic pathway, 24neuropeptides, 23–24pain perception, 25stimulus types, 22tissue remodeling, 25

Inflammatory arthritis, 239, 500Infrapatellar fat pad, 45Infrapatellar nerve, 252Insall’s proximal realignment (IPR), 10, 51International Knee Documentation Committee

(IKDC), 66International Patellofemoral Study Group

(IPSG), 4, 79Intrinsic risk factors

extensor muscle, 162lower leg alignment characteristics, 161muscular parameters, 162overactivity, 161

Ischemiaclinical studies, 42–43neural sprouting, 40NGF synthesis, 40tissue homeostasis and hypoxia, 39–40VEGF, 42

JJumper’s knee. See Patellar tendinopathy

KKinetic and kinematic analysis

clinical relevance, 322–327dynamometric platforms, 318–319iatrogenic medial patellar instability (See Iatrogenic

medial patellar instability)instruments, 318–319laboratory procedures, 319–321motion analysis system, 318–319objective measurement, 317variables, 321–326

Knee abduction moment, 326Knee braces, 30Kneecap symptoms, 241Knee flexion/extension moment, 322–324Knee Society Score (KSS), 465, 466Knee-walking test, 253

LLateral facet elevating trochleoplasty, 431Lateral patellar instability, kinetic analysis

ACL deficient knee, 307–308avoidance behavior, 306diagnostic clinical tests, 299Dinascan/IBV platform, 300dominant vs. nondominant limb, 304–306dynamometric platforms, 300–301evidence-based practice, 299false negative, 308–310force and moment, 300healthy knee vs. injured contralateral knee, 305isolated lateral patellar instability, 307–308kinetic variables, 303–305laboratory procedures, 302limitations, 314monopodal jumping, external tibial rotation test,

301–303, 309, 313MPFL reconstruction, 310–314

537Index

Lateral patellar motionextensor mechanism, 94knee extensor apparatus, 91knee flexion, 92ligamentous retinacular structures, 92muscle activity, 93passive laxity, 95patellofemoral articulation, 93trochlear topography, 91

Lateral patellofemoral ligament reconstructionclinical results and complications, 401, 402contraindications, 398graft selection, 403harvesting, 403iliotibial band detatchment, 398, 399impingement avoidance, 404–405indications, 397isometric location, 403–404kink/wrinkle, 399, 401lateral retinaculum exposure, 398orientation, 399patella attachment, 399, 400pearls and pitfalls, 401postoperative care, 405postoperative management, 400, 401range of motion, 400secure fixation, 404sutures, 399, 400tension, 404wound closure, 400

Lateral retinaculumhyperinnervation (See Hyperinnervation)morphologic neural changes (See Morphologic

neural changes)Lateral retinaculum lengthening, 513–515Lateral retinaculum (LR) tightness, 521Left knee instability

lateral retinaculum analysis, 334–335physical exam, 334radiographs, 334treatment, 335

Left medial infrapatellar knee pain, 349Ligamentous hyperlaxity, 96Linear elastic theory, 293

MMalingering syndrome, 137Maquet osteotomy, 336, 337Marrow stimulation technique. See MicrofractureMast cells, 35, 44Maximal voluntary contraction (MVC), 193McConnell program, PFPS, 205Mechanical theory

excessive adherence, 70lesions, 71microtraumatism, 69morphotype and extensor mechanism pathology, 76–77pain production mechanism, 80–81running and jumping, 69–70shock absorption, 70sport, 69

subchondral bone overload, 69swimming, 77–78

Medial collateral ligament (MCL), 90Medial patellar dislocation

clinical history, 335iatrogenic arthrosis, 335physical exam, 335radiographs, 335, 336treatment, 335

Medial patellar displacementlateral retinaculum, 363MPFL, 305

Medial patellar instability, 512–513Medial patellar retinaculum (MPR), 92Medial patellofemoral ligament (MPFL) reconstruction,

27, 76, 89, 521anisometry, 391biomechanics of, 389–390clinical results of, 387contraindications, 379, 451diagnostic arthroscopy, 380distalization, tibial tubercle, 392femoral tunnel, 381–382femur exposure, 381fractures, 393–394graft advancement, 387graft placement, 382–383graft selection and harvesting, 385–386impingement avoidance, 387incidence of, 391indications, 379, 385, 451isometric location, 386knee stiffness, 384localized tenderness, 395patella bone tunnels, 381patella exposure, 380–381patellar fracture, 384, 387patellar tension, 391–392patellofemoral degeneration, 395patient positioning and EUA, 379postoperative management, 383, 387, 453preoperative vs. post operative kinetic analysis, 310–312quadriceps inhibition, 393redislocations, 394secure fixation, 387semitendinosis tendon harvest, 380in sports, 310, 312–314surgical technique, 452–453tension, 386, 387

Medial patellomeniscal ligament (MPML), 92Medial patellotibial ligament (MPTL), 92Meniscal and patellar pathology, 16Microfracture

contraindications, 474indications, 474lesion preparation, 475marrow stimulation technique, 475postoperative management, 478surgical outcomes, 479

Minnesota multiphasic personality inventory (MMPI), 129Miserable malalignment syndrome, 76, 77

538 Index

Morphologic neural changeslateral retinaculum, 34mast cells, 35nerve damage, 34proprioception, 34

Mosaicplasty. See Autologous osteochondral mosaicplasty

Muscle activity and bone blood flow, 27–28Muscle exercises, 29–30Muscle imbalance

hip muscle weakness, 193quadriceps, 192–193

Muscle trainingEMG biofeedback, 202generalized quadriceps strengthening, 201limb alignment, 203muscle fatigue, 204neuromuscular system, 202VMO timing deficit, 202

Musculoskeletal modeling, PF jointcartilage and bone stresses, 282–284EMG-driven model, 280–282geometry and morphology, 277–278joint orientation/kinematics, 279–280material properties, 278–279simulation and validation, 282

NNecrosis, 25Nerve sprouting process, 45Neural growth factor (NGF), 38Neural model

immunohistochemical analysis, 36–39lateral retinaculum, 34morphologic neural changes, 34–35patellofemoral realignment surgery, 33

Neuromatous knee painanatomic location and paths, 344chronic joint pain, 343–344chronic knee pain, traumatic injury, 349, 350chronic right knee pain, total knee arthroplasty,

347–348, 350diagnostic evaluation, 346initial consultation, 345–346intractable knee pain, 343–344lateral retinacular excisions, 343left medial infrapatellar knee pain, 349, 350medial cutaneous nerve, 349vs. nonneuromatous knee pain, 345operative technique, 346–347predisposing factors, 350–351proximal tibial screws, 346

Neuronal cholinergic pathway, 24Nonsteroid anti-inflammatory drugs, 30

OObesity, 239Open mosaicplasty

arthroscopic approach, 488–489patella, 484trochlea, 484, 485

Osteoarthritis, 209Osteochondral allograft transplantation

donor plug preparation, 477graft insertion/fixation, 477–478indications/contraindications, 474postoperative management, 479recipient site preparation, 477surgical outcomes, 480

Osteochondral autograft transplantationgraft harvest, 475–476graft implantation, 476indications/contraindications, 474postoperative management, 478, 479recipient site preparation, 475skin incision, 475surgical outcomes, 479

Osteochondritis dissecans (OCD), 137Osteoporosis, 44Osteotomy, 217–219

central bump, 415–418femoral anteversion, 407–410patella alta, 418–419tibia, 419–421trochlea (See Trochlea)trochlear dysplasia, 410, 411

Overuse, 171

PPain and disability

anxiety and stress, 128–129catastrophization, 126–127coping strategies, 126depression, 127–128Fear-Avoidance Model, 124–125malingering, 130personality and mental disorder, 129–130psychogenic pain, 130–131somatization, 131

Pain Catastrophizing Scale (PCS), 127Pain classification, 21–22Patella alta, 95, 522–523. See also Chondromalacia patellae

aseptic loosening, femoral component, 507, 509Caton–Deschamps ratio, 460complete extensor mechanism allograft, 504–505diagnostic examination, 504, 505femoral shield loosening, patellofemoral prosthesis,

506–507femoral trochlea allograft, 507–509MPFL reconstruction, 385MR measurement, 418patellar tendon absence, 506–507patellar tendon chronic rupture, 507–509patellar tendon tenodesis, 449–450patient history, 503physical examination, 418, 503–504postoperative rehabilitation, 419quadriceps nonradiated cryopreserved allograft, 507radiographs, 418stair descent test, 504–506surgery, 418–419surgical risk, 505

539Index

surgical technique, 448–449therapeutic options, 504tibial tubercle transfers, 447, 448

Patella inferabone scan, 445clinical signs, 444functional signs, 444inflammatory etiology, 443mechanical etiology, 443MRI, 445operative treatment, 445–446patellar tendon lengthening, 446–447patient history, 443tibial tubercle transfer, 446x-ray analysis, 444–446

Patellar chondral injury, 5–6Patellar chondropathy, 374Patellar dislocation

anatomical predisposition, 99arthroscopic evaluation, 97extensor mechanism malalignment, 96femoral sulcus, 95medial collateral ligament, 90MPFL, 89MR imaging, 97nerve supply, 91patella alta, 95residual laxity, 98retinacular injury, 98soft tissue dysplasias, 96VMO tendon, 90

Patellar mobility, 173–174Patellar pain and instability

generalized ligamentous laxity, 80MPFL, 79patellar tilt and patella alta, 79trochlear dysplasia, 79VMO insufficiency, 78

Patellar tapingeffects, 201principles, 201unloading, 200–201

Patellar tendinopathy, 70Achilles tendon pain, 367, 368additional diagnoses, 370arthroscopic shaving, 368arthroscopy, ultrasound advantages, 369biopsy analysis, 367clinical results, 370collagen fiber disruption, 225color Doppler examination, 368–369complications, 370contraindications, 368gray-scale ultrasonography, 368inflammatory models, pain, 223–224morphology and perivascular innervation,

367–368neural and vascular sources, 226postoperative rehabilitation regimen, 370stress-shielding, 226surgical technique, 369

tendon pain and pathology, 224–225tissue impingement, 225treatment outcomes, 370

Patellar tendon autograft, 254Patellar tendon chronic rupture, 507–509Patellar tendon lengthening, 446–447Patellar tendon tenodesis, 449–450Patella thinning osteotomy, patellofemoral arthritis

complications, 467, 468contraindications, 463cutting high-speed burr, 464Feller’s patellar score, 465, 466femorotibial osteoarthritis progression, 466, 467indications, 463knee society score, 465, 466pearls and pitfalls, 464, 466postoperative management, 464radiological incidence, 463sagittal and coronal plane, 463skyline view, 466, 467surgical technique, 463–465total knee arthroplasty, 466, 467

Patellofemoral allograftsarticular cartilage replacement, 495chondrocyte viability, 495complications, 497isolated patellofemoral joint osteoarthritis, 497long bone osteotomies, 497patellofemoral arthrosis and chondrosis, 496procedure, 495, 496shaving chondroplasty, 496surgical technique, 495treatment outcomes, 496–497

Patellofemoral arthritis, 500genetic factors, 239malalignment, 234–238medial–lateral displacement, 238–239obesity, 239osteoarthritis and inflammatory arthritis, 239patella thinning osteotomy (See Patella thinning osteotomy,

patellofemoral arthritis)patellofemoral dysplasia, 238trauma, 239

Patellofemoral arthroplastyclinical presentation, 499custom trochlear implant, 501–502implants, 500–501indication, 500medical history, 499off-the-shelf implant, 501patellofemoral prosthesis, 503 (See also Chondromalacia

patellae; Patella alta)resection/onlay design, 501resurfacing/inlay designs, 500–501technical principles, 501–502

Patellofemoral bracinghypermobile patella, 165increased sensory feedback, 166kneepads, 167On-Track brace, 166patellar tracking, 165

540 Index

Patellofemoral chondromalacia, 244Patellofemoral crepitation, 15Patellofemoral degeneration, 395Patellofemoral disease

extensor mechanism, 14lateral retinacular release, 15–16meniscal injury, 16minimalist surgical approach, 17overactivity, 13patellofemoral crepitation, 15patellofemoral osteoarthrosis, 14psychological problems, 14Q angle, 15VMO, 15

Patellofemoral dysplasia, 295vs. activity level, 520articular cartilage reaction, at macro level, 527articular cartilage stress, 527, 528clinical manifestation, 520clinical presentation, 519homeostasis, 527–528hydrostatic pressure, 528increased quadriceps (Q) angle, 521–522injury pain, 528lax medial patellofemoral ligament, 521logical surgical decisions, 526–527logical treatment decisions, 524–525microscopic neuropathy, 527patella alta, 522–523patellofemoral arthritis, 528–529repetitive overuse, sports or recreational activities, 528safe knee exercises, 525–526sheer stress, 528symptoms, 520theory, 520tight lateral retinaculum, 521trochlear dysplasia, 523–524vastus medialis obliquus deficiency, 520–521

Patellofemoral jointcartilage morphology, 271–272computational model (See Computational model,

patellofemoral joint)contact area measurements, 270–271patellofemoral biomechanics, 287–288PET–CT imaging, 276upright, weight-bearing posture, 270

Patellofemoral joint reaction forcebody weight force, 73complementary weights, 74extensor moment, 72flexor lever arm, 73hip flexion, 74knee flexion positions, 72obesity, 73patellar articular cartilage, 71patellar tendon pretibial adhesions, 75quadriceps muscle force, 71

Patellofemoral joint replacement, 513Patellofemoral malalignment (PFM)

ACL reconstruction, 145anterior cruciate ligament, 3–4

anteromedial aspect of the knee, 147arthroscopy, 145bipartite patella, 137, 139chondromalacia patellae, 6diagnostic errors, 4extraskeletal osteosarcoma, 148femoral interference screw, 144follow-up evaluation, 52–53Hoffa fat pad, 148hyperpression, 7image analyses, 55–56intra-articular lesion, 148intramuscular hemangioma, 139IPR, 8–10IPSG, 4isolated symptomatic PFM, 51Kaplan’s ligaments, 142lateral patellar compression syndrome, 6lateral retinacular release, 139localized osteonecrosis, 139, 143localized pigmented villonodular synovitis, 139, 140medial patellofemoral ligament, 57MRI tilt angle, 144musculoskeletal tumor, 140OCD, 137onset of symptoms, 52osteochondral lesion, 138overload/overuse, 7patellar instability patients, 54–55patellar pain patients, 53–54patellar subluxation, 144patellar symptoms, 56patellar tendinopathy, 143patellofemoral pathology, 142patient selection, IPR, 52posterior aspect of the knee, 147post-meniscectomy osteoarthritis, 150realignment surgery, 8, 58referred pain, 140SEMG analysis, 56statistical analysis, 53stress fracture, 139, 143subperiostial osteoid osteoma, 141superolateral fragment, 139surgical technique, 52tendinopathy, 3vs. tissue homeostasis, 13tissue homeostasis theory, 57vastus lateralis muscle, 53VMO, 59

Patellofemoral osteoarthritis, 377Patellofemoral pain syndrome (PFPS), 191

anatomical structures, 44–46articular cartilage, 33chronic tendinopathy, 43pathophysiology, AKP, 43–44proprioceptive neuromuscular training, 46realignment surgery, 46

Patellofemoral surgery failurealignment, 331bilateral anterior knee pain, 338–340

541Index

cartilage damage, 332–333left knee instability, 334–335medial patellar dislocation, 335–336patella hypermobility, 339–341right Maquet osteotomy, 336, 337stability, 332tibial tubercle transfer, 336–338treatment failure, 333

Patient evaluationarthroscopy, 120–121axial compression test, 107bone geometry, 117bone scintigraphy, 120CT scans, 1173D-CT reconstruction, 119emotional and psychiatric evaluation, 114–116femoral anteversion, 113finger, 106Fulkerson’s relocation test, 109, 111gastrocnemius tightness, 110hamstring flexibility, 110, 111history, 105–106hypermobility, 112ITB flexibility, 110knee flexion test, 108knee ligaments, 114lateral retinaculum, 106leg-length measurement, 113medial patellar instability, 109moving patellar apprehension test, 108MRI, 118Ober’s test, 112painful zone, 106patellar glide test, 107, 110patellar tilt test, 107patellar tracking, 113psychological pain vs. pain due to reflex sympathetic

dystrophy, 116quadriceps atrophy, 113quadriceps flexibility, 109, 111SPECT, 120standard radiography, 116TT-TG, 117

Peripatellar synovitis, 45Peripheral and central sensitization, 25–26Plantaris tendon, 223Posterior cruciate ligament (PCL), 106

QQuadriceps angle (Q-angle), 75–76, 173Quadriceps exercises, 375Quadriceps muscle

articular moment, 83chondral lesion, 82closed and open kinetic chains, 83eccentric isotonic exercises, 82patellofemoral joint stress, 85patellofemoral pain, 81VMO, 82

Quadriceps nonradiated cryopreserved allograft, 507

RRange of motion (ROM), 252, 383Real-time magnetic resonance imaging

influence of bracing, 275malalignment, 272maltracking, 273patellar tilt angle, 274upright weight-bearing motion, 273

Redislocations, 394Reflex sympathetic dystrophy (RSD), 106, 500Rehabilitation

full extension, 66heel prop exercise, 67physical therapy, 66towel extension exercise, 67

Risk factorsexercises, 163extrinsic, 159–160foot alignment, 164–165foot orthoses, 165injury prevention, 159intrinsic, 160–162patellofemoral bracing, 165–167scientific prevention program, 162–163

Roentgen stereophotogrammetric analysis (RSA), 289Rotational malalignment

contact pressures, 214–215medial patellofemoral ligament strain, 215patellofemoral joint position, 215–216

Rotational plane alignmentbone torsion, 212–213TT-TG, 213

SSagittal plane alignment, 213–214Selective neurotomy, 373Sensory nerve complications, 253–254Single leg hop test, 163, 164Single-photon emission computed tomography

(SPECT), 43, 120Skeletal alignment

abnormal patellofemoral joint mechanics, 216bone torsion, 212–213chondromalacia patella, 209frontal plane alignment, 211–212mechanical overload, 217osteoarthritis, 209osteotomy, 217–219patellofemoral alignment, 210–211patellofemoral joint pathology, 209–210patellofemoral pathology, 217pathogenesis, anterior knee pain, 209Q-angle, 210rotational deformity, 219sagittal plane alignment, 213–214torsional malalignment, 219TT-TG, 213

Somatization, 131Stair descent test

chondromalacia patellae, 510–512dynamometric platforms, 318–319

542 Index

ground reaction force, 325, 357, 358, 360instruments, 318–319kinetic and kinematic variables, 321knee abduction/adduction moment,

326, 358, 361knee flexion-extension angle, 356, 357, 360knee flexion/extension moment, 322–324, 358, 361marker disposition, 319motion analysis system, 318–319patella alta, 504–506photographic sequence, 320

Stress-shielding theory, 226Subchondral patellar bone, 45Sulcus angle measurement, 523Sulcus deepening trochleoplasty

anesthesia, 426bereiter trochleoplasty, 431cancellous bone removal, 427complications, 430–431cortical bone removal, 427function and biomechanics, 424–425goals of, 425indications, 425–426K-wires, 428lateral facet elevating trochleoplasty, 431midline skin incision, 426postoperative care, 428–429radiologic features and classification, 423–425results, 430surgical exposure, 426trochlea exposure, 426

Superficial medial retinaculum (SMR), 89Supracondylar rotation osteotomy, 409–410Surface electromyographic (SEMG) analysis, 53Symmetric knees

anterior knee pain, 63asymmetry mechanism, 61–62crepitus, 64flexion contracture, 63Hamstring flexibility, 65knee hyperextension, 64knee soreness/pain, 61objective testing, 65–66patellar tracking, 64quadriceps muscle flexibility, 65radiographic evaluation, 65rehabilitation, 66–67

heel prop exercise, 67physical therapy, 66towel extension exercise, 67

subjective testing, 66uninvolved extremity, 63

Sympathetically maintained pain (SMP), 230Sympathetic blockades, 30

TTaping, 30Tendinitis, 24Tendinopathy. See also Patellar tendinopathy

cytokines, 224jumper’s knee, 225

longitudinal tenotomy, 225neurogenic inflammation, 224patellar tendon pain, 225stress-shielding theory, 226structural sources, 226tendon pain and pathology, 224–225

Thermal lesion, electrocoagulator, 375Tibia. See Tibial tubercle–trochlear groove (TT-TG)Tibial osteotomy

femoral anteversion, 434, 435FPA, 434post-op rehabilitation, 438sclerosis, 433, 434surgical technique, 437–438tibial torsion, 434–436

Tibial torsion. See also Tibial osteotomyanatomic measurements, 435CT measurements, 434goal of, 435–436morbidity of, 436Q-angle, 436results of, 438–439tibial reference line, 434

Tibial tubercle realignmentindications and contraindications, 451postoperative management, 453surgical technique, 452

Tibial tubercle–trochlear groove (TT-TG), 117axial CT evaluation, 419lateralization, 420MRI, 419physical examination, 419postoperative rehabilitation, 420–421radiographs, 419surgery, 420

Tight hamstrings, 175Tissue homeostasis, 39–40

covert osseous pathology, 10envelope function theory, 11vs. patellofemoral malalignment, 13peripatellar synovitis, 11symptom resolution, 12tissue healing processes, 12

Toe-off abduction–adduction moment, 321Toe-off flexion–extension moment, 321Toe-off ground reaction force, 321Traumatic osteochondral lesion, 486Treatment protocol, AKP

balance and coordination training, 183balance board training, 185cryotherapy, 182flexibility training, 182functional knee exercises, 184isokinetic quadriceps training, 186stationary bicycle training, 183transcutaneous electrical stimulation, 182

Trochleaaxial CT evaluation, 414elevation, 414, 415lengthening, 413, 415MR measurements, 412

543Index

physical examination, 411–413postoperative rehabilitation, 413, 415radiographs, 412, 414

Trochlear dysplasia, 95, 410, 411, 523–524. See Sulcus deepening trochleoplasty

bilateral anterior knee pain, 339lateral patellar instability, 308MPFL reconstruction, 385, 387patellar dislocation, 305type A, 308, 310type B, 308, 312, 313type D, 308–309

Trochlear/patellar defect, 478Trochleoplasty, 417Tyrosine hydroxylase (TH), 231

UUltrastructural examinations, 259Upright weight-bearing imaging, 271

VValgus knees (genu valgum), 76Vanderbilt Pain Management Inventory (VPMI), 126Vascular endothelial growth factor (VEGF), 40

Vascular homeostasis, 39Vastus lateralis (VL), 174–175Vastus medialis (VM), 174–175Vastus medialis longus (VML), 174Vastus medialis obliquus (VMO)

deficiency, 520fibers, 79lateral patellar motion, 93patellar stability, 15SEMG activity, 57tendon strain, 193transcutaneous electrical stimulation, 182

Vesicular glutamate transporter 2 (VGluT2), 231Visual analogue scale (VAS), 174

chronic knee pain, traumatic injury, 349chronic right knee pain, 347chronic right knee pain, total knee arthroplasty,

347, 348left medial infrapatellar knee pain, 349patellar tendinopathy/jumper’s knee, 370

ZZone of homeostasis, 11, 12Zone of supraphysiologic overload, 11, 12