Elizabeth A. Arendt Professor & Vice Chair University of Minnesota Department of Orthopaedic Surgery. Restore patella stability.

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1 Page 1 of 5 Elizabeth A. Arendt Professor & Vice Chair University of Minnesota Department of Orthopaedic Surgery Restore patella stability. Restore / improve function. I have no conflicts to declare H. Dejour, G. Walch (n= 190) (n= 147) TT- TG > 20 mm 1 % Recurrence Trochlear dysplasia 14 Without % Residual an Pain Serie de 216 Patients Reconstruction Service H. DEJOUR Tilt >20 French J. Orthop Knee Surg. Trauma 1994 Patella Alta > 1.2 Compliments of David Dejour The essential stabilizer against Lateral Patella Dislocations

2 Page 2 of 5 Patella Height Trochlear Dysplasia Q Vector Patella Height Recurrent LPD with little or no pain between episodes of patella dislocation May report functional impairment when asked but It is the unpredictable patella dislocations and / or the lack of knee confidence that brings them to the doctor s office Trochlear dysplasia Increased Q- angle Increased TT-TG Patella Alta Increased lateral patella tilt Increased Q Angle: Ellera Gomes (1992) Q angle < 20 TF Valgus < 10 Christiansen et al. (2008) if Q angle : med. TTT When should we add a bony procedure? Increased Q Angle: Excluded if TT-TG > Wang et al > 15mm Howell et al > 18mm Kang et al > 20mm TT-TG 21 mm Patella alta: Distal tibial tubercle transfer Steiner et al. (2006) significant alta excluded M I/S 1.16 Nomura et al. (2006) I/S : M 1.08 Range ( )

3 Page 3 of 5 Patella alta: excluded if >1.2 (I/S) Ronga et al Kang et al Goyal 2013 Wang et al Variable Number Variable Result Studied of Articles Reported Reported MRI available 44% (11 / 24) abnormalities 36% (4 / 11) Patellar height 76% (19 / 24) Insall-Salvati 53% of studies Trochlear 88% (21 / 24) Sulcus angle 52% (11 / 21) dysplasia Dejour classification 43% (9 / 21) Trochlear depth 9% (2 / 21) Extensor 88% (21 / 24) TT-TG 52% (11 /21) mechanism Q-angle 38% (8 / 21) alignment Valgus 38% (8 / 21) 16/24 papers (66%): a homogenous population was reported the author s surgical indications for isolated R had no excessive anatomic instability factors In 8 studies, a heterogenous population was reported. (ie) patients with excessive anatomic imaging factors were included, (e.g.) patella alta, TT-TG, and TD. Only 2 studies related any outcome metric to pre-operative variables, in particular, anatomic imaging risk factors. Anatomic Reconstruction of the in Children & Adolescents With Open Growth Plates N= 21 M age 12.2 yrs. F/U 2+ yrs. Kujala / Tegner outcome High grade dysplasia ~ (+) apprehension sign High-grade trochlear dysplasia possible risk factor for inferior results of reconstruction in skeletally immature children & adolescents. The Influence of Risk factors on Clinical Outcomes following Reconstructions N= 50 M age: 19 +/- 6 yr. F/U 12 mo. Kujala outcome Higher grade T.D. Kujala score TT-TG : no difference in Kujala score Alta : no difference in Kujala score 29 pts. > pts. > 1.5 I/S Wagner et al., KSST 2013 Outcomes Reporting n=24 Rate of re-dislocation 88% commented Kujala score (pain scale) 75% pre / 96% post VAS (pain) 4% Return to sport 67% commented Tegner 33% pre / 54% post QOL scale 21% (KOS, IKDC, Cinncinati) Instability scale none Nelitz et al., AJSM 2012

4 Page 4 of 5 Increased Lateral Tilt Lateral retinacular release / lengthening Lateral tilt measured: 42% LRL / LRR: all or none in most reported series Redislocation? Quality of life? Activity level? T P PTI = T / P * Charles et al., AJSM 2012 ** Biedert, Albrecht. KSST 2006

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