الفهرس 
Anatomy of Patellofemoral JointOnly 14 pages are availabe for public view
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Abstract
Patellofemoral malalignment and maltracking refers to conditions in which there is an imbalance on the forces on patella that produce abnormalities of alignment and tracking.
Patellofemoral instability presents in many ways and its etiology often is multifactorial these factors can be classified as:
• External (trauma) or
• Internal: The internal factors can be additionally subdivided into
Skeletal abnormalities (genu valgum, femoral or tibial torsional abnormalities, patella dysplasia, and trochlea dysplasia).
Soft tissue abnormalities (deficient medial structures, increased quadriceps angle, tight lateral structures, generalized ligamentous laxity, patella alta).
Each patient may have one or any combination of these predisposing factors.
Patellofemoral joint evaluation is directed to:
1. Evaluate the skeleton.
2. Evaluate patellofemoral ligaments.
3. Evaluate articular cartilage.
4. Evaluate the muscle and tendon.
This evaluation is done through: history, physical examination, radiological evaluation.
The first diagnostic step is thorough history and this is the main clue for an exact diagnosis and used to concentrate the physical examination to specific areas of the lower extremity these symptoms and include pain and instability, Catching, locking ,Giving-way episodes, Crepitus.
Physical examination should include examination of the whole lower lips and gait analysis to determine any skeletal abnormalities associated with patellofemoral maltracking then attention should be paid for patellofemoral joint.
Radiological Assessment includes:
• Structural imaging (radiographs ,computed tomography[CT], and magnetic resonance imaging [MRI])
• Metabolic imaging (technetium scintigraphy).
Treatment is divided into two phases:
1. Treatment directed at malalignment and other abnormalities of the extensor mechanism and patellofemoral joint
2. Treatment of the diseased cartilage.
The treatment protocols must be adjusted not only to each patient’s abnormal extensor mechanism factors but also to each patient’s age, weight, height, sex, conditioning, activity level and general health. For these reason, it is not appropriate to list a treatment protocol or algorithm for each diagnosis but rather to list the various treatment modalities.
Treatment modalities include:
A. Non-operative treatment:
Pharmacological treatment
Non-pharmacological treatment: Patient education, physical therapy, orthosis, braces, walking aids, weight reduction (if overweight) and patellar tapping.
Most cases of patellofemoral instability can be managed by conservative treatment.
B. Operative treatment:
Surgical modalities include:
Proximal Realignment Procedures (Indicated in maltracking secondary to medial laxity with normal Q angle and in skeletally immature patients):
o Medial patellofemoral ligament reconstruction
o Lateral retinacular release
o Proximal quadriceps plasty
Distal Realignment Procedures (Indicated in maltracking secondary to malalignment indicated by high Q angle and patellar instability with inferior and lateral chondromalacia):
o Tibial tubercle transfer:
o Elmslie-Trillat – medial
o Maquet – anterior
o Fulkerson – anterior/medial
Others :
o Autologous Cartilage Transplantation
o Minimally invasive patellar realignment
o Patellectomy
o Patellofemoral Joint Replacement(Resurfacing)
Some parameters are impossible to correct (generalized ligamentous laxity) or require complex surgical procedures that usually are considered inappropriate.