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MR imaging of patellar instability: injury patterns and assessment of risk factors.
[trochlear dysplasia]
First
-time
patellar
dislocation
typically
occurs
with
twisting
knee
motions
,
during
which
the
medial
ligamentous
stabilizers
rupture
,
and
the
patella
strikes
against
the
lateral
femoral
condyle
.
The
typical
injury
pattern
is
a
tear
of
the
medial
patellofemoral
ligament
(
MPFL
)
and
bone
bruises
of
the
patella
and
the
lateral
femoral
condyle
.
Additionally
,
complex
injuries
to
bone
,
cartilage
,
and
ligaments
may
occur
.
The
ensuing
loss
of
medial
restraint
favors
future
patellar
dislocations
,
especially
if
additional
risk
factors
are
present
.
Recurrent
patellar
dislocations
usually
occur
in
individuals
with
anatomic
variants
of
the
patellar
stabilizers
,
such
as
trochlear
dysplasia
,
patella
alta
,
and
lateralization
of
the
tibial
tuberosity
.
Magnetic
resonance
(
MR
)
imaging
is
reliable
in
identifying
risk
factors
for
chronic
patellar
instability
and
in
assessing
knee
joint
damage
associated
with
patellar
dislocation
.
MR
imaging
can
thus
provide
important
information
for
individually
tailored
treatment
.
Patients
with
primary
patellar
dislocation
without
severe
internal
derangement
who
lack
major
risk
factors
can
be
treated
conservatively
.
Patients
with
pronounced
ligamentous
tears
or
large
osteochondral
lesions
require
prompt
surgery
.
In
addition
,
surgical
correction
of
anatomic
variants
will
help
reduce
the
potential
for
chronic
instability
.
The
most
common
procedures
,
in
addition
to
MPFL
reconstruction
,
include
trochleoplasty
,
medialization
of
the
tibial
tuberosity
,
and
medial
capsular
plication
.
For
comprehensive
assessment
of
patellar
dislocation
,
a
radiologist
should
be
able
to
identify
typical
injury
patterns
,
know
standard
methods
to
assess
risk
factors
for
patellar
instability
,
and
be
familiar
with
surgical
options
.
Diseases
Validation
Diseases presenting
"a radiologist should be able to identify typical injury patterns"
symptom
trochlear dysplasia
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