الفهرس 
Anatomy of patellofemoral jointOnly 14 pages are availabe for public view
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Abstract
Summary
The patello-femoral joint refers to a specific part of the knee joint. It is the joint space between the patella and the distal femur which consists of the medial and lateral condyles with the trochlear grove in-between. The patella is attached to the quadriceps tendon at its upper pole and attached to the patellar tendon at its lower pole which is inserted into the tibial tuberosity.
The centering of the patella in the trochlear groove is related to the strength of the vastus medialis obliquus and the medial patello-femoral ligaments which pull the patella medially while the vastus lateralis and the lateral patello-femoral ligaments pull the knee towards the lateral aspect of the knee joint. When all of these factors are in proper alignment, the patella is centered in the trochlear groove of the femur. An understanding of the normal function of the patello-femoral joint is essential for any evaluation involving patella-femoral dysfunction, such understanding results from integration of the anatomy and biomechanics.
Patellar maltracking is a mechanical problem and occurs usually laterally. One must consider, as an aetiological factor, either abnormal tightness of the lateral capsule or abnormal weakness of the medial capsule.
Diagnosis of patellar maltracking starts with taking history of the problem during which specific complaints are identified and the physician attempts to identify any contributing factors to the knee problem.
The next step is to start physical examination which includes tracking of the patella, strength of the muscles around the knee, tightness of the tissues and ligaments around the knee , areas of tenderness in the soft tissues, areas of tenderness on the underside of the patella, the
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location of the patella, the presence of abnormal grinding of the patella as it moves and the liability of the patella to be subluxed or dislocated.
Standard radiographic evaluation including anteroposterior, lateral and axial views should be obtained in each patient with patello-femoral disorders. CT scan has been widely used to study the patello-femoral joint in the first 20 degrees of flexion where it cannot be investigated using traditional radiographic techniques.
The role of arthroscopy in the evaluation of the patello-femoral joint has been recognized for a long time. It allows direct visualization of both patellar tracking and cartilage abnormalities.
Nonoperative treatment was long considered the standard of care for patellar dislocations.Currently, surgical treatment is recommended for recurrent patellar instability, osteochondral fractures with loose bodies, and failed nonoperative measures of functional rehabilitation.
The operative treatment options in skeletally immature patients are different than those available in adults because of concerns about potential physeal injury to the distal femoral or proximal tibial physis or apophysis.
Procedures that violate these structures or the surrounding perichondral ring can produce complications of altered growth, including coronal plane angular deformity, leg length discrepancy, and recurvatum. For these reasons, soft-tissue Procedures are more likely to be appropriate in children, and these procedures range from those with extensive exposure to mini open procedures. The selection of appropriate surgical procedures is dependent on the underlying pathophysiology of patellar instability, which is often anatomic in nature. There is a clear association
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between lateral patellar dislocations and medial soft tissue injuries.
So we focus here on the correction of the soft tissue abnormities lead to maltracking of patella including medial retinaculum plication and medial patello-femoral ligament reconstruction with its’ different techniques and Roux-Goldthwait procedure.
Through the search we found that good results were achieved after reconstruction of the medial patella-femoral ligament.
Different graft methods had been described including hamstring graft, fascia lata graft, quadriceps tendon graft, and synthetic grafts. Whatever the type of graft, optimal graft fixation is the key step for proper restoration of MPFL function.
One of those techniques was the anatomical reconstruction of the MPFL. This technique allows reconstruction of the MPFL in skeletally immature patients with ligament laxity avoiding any potential risks of growth disturbances or chondral damage as compared to other techniques, allows more anatomic and more secure form of reconstruction and is cost-effective without the need for hardware.
In skeletally immature patients who are about to reach the age of maturity with bony causes of maltracking of patella (patella Alta, increased TT-TG distance and trochlear dysplasia) who will need bony operations (medialization /distalization of tibial tuberosity or trochleoplasty) surgical interference can be postponed until the age of maturity to gain the best results.