As an end-of-year thank-you to the orthopaedic community, we’re offering limited-time full-text access to the five most-read JBJS articles of 2016. The fact that several of these most-read articles were published prior to 2016 is testament to the durable utility of orthopaedic research published in The Journal of Bone & Joint Surgery.
- Bariatric Orthopaedics: Total Hip Arthroplasty in Super-Obese Patients
- Antibiotic-Impregnated Cement Spacers for the Treatment of Infection Associated with Total Hip or Knee Arthroplasty
- The Surgical Management of Chronic Tophaceous Gout
- Rotator Cuff Tear Arthropathy: Evaluation, Diagnosis, and Treatment
- An Algorithmic Approach to the Management of Recurrent Lateral Patellar Dislocation
This month’s Image Quiz from the JBJS Journal of Orthopaedics for Physician Assistants(JOPA) presents the case of a teenage girl who dislocated her patella while playing volleyball. The quiz provides four postreduction images, two radiographs and two fat-suppressed MRI scans, and then readers are presented with two questions:
- What is the next best step in this patient’s treatment?
- Which concomitant condition does NOT cause an increased risk of patellar instability?
In many orthopaedic contexts, post-procedure stiffness is a complication to be avoided. But when it comes to reconstructing the medial patellofemoral ligament (MPFL) to treat recurrent patellar dislocation, stiffness of the patella is, to borrow Hamlet’s phrasing, “a consummation devoutly to be wished.”
In the April 6, 2016 edition of The Journal of Bone & Joint Surgery, Kumahashi et al. report on 17 knees with recurrent patellar dislocation that underwent MPFL reconstruction using an autograft semitendinosus tendon and an interference screw for precise graft tensioning. Medial patellar stiffness was significantly improved three months after surgery, and the reconstructions achieved the normal stiffness levels found in reference knees (n=64) after six months. Moreover, medial and lateral patellar stiffness was found to be well balanced by six months and for up to two years postoperatively.
The authors describe their intraoperative graft-tensioning technique in detail. They measured patellar stiffness (in N/mm) using a Patella Stability Tester (Kishi Engineering, Izumo, Japan) preoperatively and every three months after surgery up to two years. In addition, postoperative radiographic findings and Kujala and Lysholm scores were significantly improved at the time of the latest follow-up relative to preoperative radiographic and clinical evaluations.