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Surgery for patella malalignment

PainSci » bibliography » Iliadis et al 2012
updated
Tags: surgery, patellar pain, treatment, arthritis, aging, pain problems, knee, leg, limbs, overuse injury, injury, running, exercise, self-treatment

One article on PainSci cites Iliadis 2012: The Complete Guide to Patellofemoral Pain Syndrome

PainSci notes on Iliadis 2012:

This article surveyed the existing research on surgery for PFPS as of 2012.

The authors conclude that the evidence of efficacy is generally poor for most surgical techniques. This may be due to the research being poorly designed and populations studied being poorly described, but other evidence (e.g. Kettunen 2007 and Kettunen 2012) has shown that common surgeries don’t work.

Some techniques might be promising in very specific situations, but a good rationale needs to be developed to justify going ahead with surgery, and better research needs to be produced to support it.

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

Management of patellofemoral joint pathology is challenging as a result of the unique and complex organization of static forces and dynamic factors contributing to its functional capacity. Anterior knee pain is a common musculoskeletal complaint seen daily in the practices of primary care physicians, rheumatologists, and orthopedic surgeons. The key to successful treatment lies not only in the correct diagnosis of a chondral defect, but more importantly, in the accurate identification of associated pathomechanical factors. Appreciating the pathoanatomic basis of the disease and addressing imbalances and anatomical abnormalities should guide treatment.Despite the complexity of the interplay of various components it is essential to attempt to describe patellar malalignement as a clinical entity in order to proceed with appropriate surgical management and successful outcomes. The goals of patellofemoral re- alignment surgery should be to create both a stable environment for optimal extensor mechanism performance and an appropriate load transmission for optimal cartilage wear and joint loading. In the context of this article we will review the operative management of patellofemoral malalignment; the indications for surgery, the different techniques available and the evidence regarding their effectiveness.A large number of procedures have been employed and they have all undergone various modifications over the course of the years. The majority of publications are retrospective series in poorly defined population groups. There are significant methodological inconsistencies and as a result there is lack of strong evidence base for the majority of these procedures.

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