Patella stabilisation : Tibial tubercle osteotomy and Medial patellofemoral ligament reconstruction
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In cases of recurrent patella instability, and once maximal non-operative management has been exhausted, a surgical stabilisation is indicated.
The non operative interventions to be explored are covered in the indications section. There are a number of operations for patella stabilization which have been used over the years, although more recently realignment of the patella with a tibial tubercle osteotomy (TTO) most commonly to distalise and medalise associated with reconstruction of the medial patellofemoral ligament (MPFL) have become the most popular. Sometimes these are used together and occasionally there is a need for Vastus Medialis advancement (as described by Insall) in addition.
Combining the TTO and the MPFL reconstruction poses potential problems for incision placement, but my strategy is to use a single anterior longitudinal incision allowing for both the TTO and the hamstring harvest, but with a longer incision than normally used for performing a TTO.
Author: Mr James Murray ,FRCS (Tr & Orth)
Institution: The Avon Orthopaedic centre , Bristol ,UK.
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Question 1 of 13
Surgical stabilisation of the dislocated patella is indicated in which one of the following ?CorrectIncorrect
Question 2 of 13
The most appropriate imaging for a first time patella dislocation is which one of the following ?CorrectIncorrect
Question 3 of 13
The correct emergency management of a patella dislocation is described by which one of the following statements ?CorrectIncorrect
Question 4 of 13
The ideal management of the patella dislocation patient in the fracture clinic or acute knee clinic should be which one of the following ?CorrectIncorrect
Question 5 of 13
A patella dislocation is suggested by which one of the following histories ?CorrectIncorrect
Question 6 of 13
Sub-acute patella dislocation is most suggested by which one of the following clinical examination findings ?CorrectIncorrect
Question 7 of 13
In recurrent patella dislocation which one of these pairs of anatomic variations and treament options is correct to achieve a stable patellofemoral joint ?CorrectIncorrect
Question 8 of 13
The reason to combine TTO with MPFL is correctly listed by which one option below?CorrectIncorrect
Question 9 of 13
When performing tibial tubercle osteotomy, which one of these statements is incorrect?CorrectIncorrect
Question 10 of 13
Absolute contra-indications to surgical stabilisation of the patella with TTO and MPFL include which one of the following pairs ?CorrectIncorrect
Question 11 of 13
The risks of surgical stabilisation of the patella for recurrent dislocation are correctly included in which one of the following lists ?CorrectIncorrect
Question 12 of 13
The physiotherapist seeing a 23 year old 2 weeks after TTO and MPFL calls you to ask for advice. Which one of the following concerns requires urgent clinical review?CorrectIncorrect
Question 13 of 13
One year after a successful TTO and MPFL reconstruction your patient returns with similar symptoms on the opposite knee. your ideal management should be which one of the following ?CorrectIncorrect