Leading article of March 2018

Anatomic patellar instability risk factors in primary lateral patellar dislocations do not predict injury patterns: an MRI-based study


Marc A. Tompkins, Sara R. Rohr, Julie Agel and Elizabeth A. Arendt

The leading article, “Anatomic patellar instability risk factors in primary lateral patellar dislocations do not predict injury patterns: an MRI-based study”, is a review of a large cohort of patients experiencing a primary lateral patella dislocation.  An analysis of a large number of injury factors revealed that many commonly held clinical assumptions were not validated by this study (eg.) chondral damage and the injury pattern of the MPFL have no relationship to the degree of anatomic dysplastic factors.This paper also led to an understanding of the frequency of injury to the MPTL in lateral patellar dislocations. This prompted a more thorough review of the role of the MPTL including its anatomy, biomechanics, and current clinical use in patella stabilizing procedures (“Medial patellotibial ligament and medial patellomeniscal ligament: anatomy, imaging, biomechanics, and clinical review”).The article, “Q-vector measurements: physical examination versus magnetic resonance imaging measurements and their relationship with tibial tubercle–trochlear groove distance”), is an attempt to merge the more objective imaging parameters of TT-TG with our common physical exam measurements. One particular physical exam measurement, the tubercle- sulcus angle (TSA), is easy to perform in the operating room. Depending on imaging alone for the degree of correction has a high-risk of over medialization of the tibial tubercle, which can lead to overload in both the medial patellofemoral joint as well as medial tibial-femoral compartments.It is hoped that the patellofemoral clinician will find these papers interesting and useful.

Elizabeth A. Arendt

Leading article of February 2018

ACL-reconstructed and ACL-deficient individuals show
differentiated trunk, hip, and knee kinematics during vertical hops
more than 20 years post-injury


Markström JL, Tengman E, Häger CK

Rupture of the anterior cruciate ligament (ACL) is very common in sports and often occurs in non-contact situations with full weight-bearing on one leg and with multi-plane knee loadings. It is important to determine the consequences of ACL injury and in particular the influence on movement strategies in the longer term to fully understand the impact of an injury. However, the few studies that have investigated kinematics in the long term so far present contradictory results.

Using a 3D motion capture system, we recorded the one-leg vertical hop performed by 66 persons tested on average 23 years after unilateral ACL injury, and 33 age- and sex-matched healthy-knee controls. The patients consisted of two cohorts treated with either, 1) surgery and physiotherapy, or 2) solely physiotherapy. Trunk, hip, and knee kinematics were investigated using multivariate methods to provide comprehensive information of movement strategies.

Our results showed that both ACL-injured groups presented different kinematics when compared to controls, although persons treated only with physiotherapy presented larger deviations. We also found different kinematics between treatment groups, and asymmetry between legs for both treatment groups which was not found for controls. In our article, we discuss the possibility of different protective strategies for the injured groups, and the importance of looking beyond the knee joint for this population. This study therefore adds knowledge about long-term consequences on movement patterns following ACL injury which crucially combines the trunk, hip, and knee. Consideration is also given to the two commonly used types of treatment i.e., reconstructive surgery in combination with physiotherapy or solely physiotherapy, as at present there is no concrete evidence as to which is best in the long term.


Editors Choice Paper Award 2016

Winner of the KSSTA Best Paper Award 2014-2016

Microfracture technique versus osteochondral autologous transplantation mosaicplasty in patients with articular chondral lesions of the knee: a prospective randomized trial with long-term follow-up


Svend Ulstein, Asbjørn Arøen, Jan Harald Røtterud, Sverre Løken, Lars Engebretsen and Stig Heir

Despite considerable research efforts and advances in surgical techniques, chondral and osteochondral lesions remain a challenge for the orthopaedic surgeon. None of the surgical strategies, ranging from debridement to advanced cell-based treatment, is established as the “golden standard“.

Osteochondral autologous transplantation (mosaicplasty) and the microfracture technique have both shown promising result at short- to midterm follow-up. However, high quality studies of long-term results have been sparse.

In this prospective randomized trial our aim was to compare the long-term results after osteochondral autologous transplantation and microfracture. As in many knee cartilage surgery studies, inclusion of patients was challenging. Even though the duration of the inclusion period was extended up to five years, only 25 patients were included. However, a follow-up of 100% for the main outcome (Lysholm score) was accomplished. Moreover, a broad spectrum of outcome measures (KOOS, isokinetic muscle strength, reoperations/failures and radiographic OA evaluation) were assessed and compared between the two groups.

We believe that the result from the current study provides some important knowledge regarding the long-term outcome following these two “old”, but still relevant surgical techniques. Enjoy!

Svend Ulstein