Dr. Shubin Stein and Dr. Shital Parikh (Cincinnati Children’s Hospital), established the JUPITER Group in 2017 as the first multicenter patellar instability study. Twenty-six surgeons representing 12 sites across the country have prospectively enrolled over 1,500 subjects. All patients enrolled in JUPITER will be followed for 10 years after either operative or non-operative treatment to gain insight into treatment protocol modifications to help optimize outcomes.

Read about the historic grant at Sportsmed.org.

Dr. Green stated, “With an average follow-up of 2.5 years, this study demonstrated that restoration of patellofemoral chondral defects in these young patients with particulated juvenile allograft results in satisfactory short-term outcomes and postoperative MRI appearance, along with high rates of return to sport and low rate of complications and graft failure.” He continued, “This series of patients appears to be the largest single cohort of pediatric and adolescent patients who received particulated juvenile allograft cartilage for defects of the patellofemoral joint.”

Read the full article at Healio.com/news/orthopedics.

Dr. Shubin Stein’s research revealed important findings about the role of isolated medial patellofemoral ligament (MPFL) reconstruction for patellar instability and discussed in the context of malalignment such as trochlear dysplasia. The findings underscored the need for a full cohort with longer-term follow-up to determine who might benefit from bony realignment in addition to soft tissue reconstruction.

Dr. Green and colleagues presented “Spontaneous correction of external tibiofemoral rotation and tibial tuberosity -Trochlear groove distance occurs after medial patellofemoral ligament reconstruction in fixed or obligator dislocators.” The study found tibiofemoral rotation (TFR) is an important anatomic factor in pediatric patellar instability, and the first to show MPFL reconstruction can change intraarticular tibiofemoral rotation in severe cases.

Read the full article at Healio.com.

Drs. Shubin Stein and Fragomen wrote, “We read the article by ZhiJun Zhang, MD, and colleagues with great enthusiasm as it revealed clinical insights into a surgical approach that has dominated our practices: combined distal femoral osteotomy and tibial tubercle osteotomy/MPFL reconstruction for patients with complex patellofemoral instability. Dedicated to patellofemoral pathology-surgical sports medicine and limb deformity surgery, we have brought our separate skills together to deliver comprehensive surgical plans where osteotomies for valgus and femoral anteversion often accompany surgery to address coronal plane malalignment through tibial tubercle transfer, address incompetent medial structures via MPFL reconstruction and address cartilage defects with cartilage restoration. Historically, femoral anteversion was corrected through a mid-diaphyseal osteotomy fixed with an antegrade intramedullary nail with minimal impact on the extensor mechanism tracking.”

They added, “We have been performing transverse distal femoral rotational osteotomy to externally rotate the femoral condyles toward the patella while addressing varus or valgus malalignment. This is done with simultaneous MPFL reconstruction, tibial tubercle osteotomy, knee arthroscopy and cartilage restoration work if indicated. Femoral plate position and screw lengths are modified to accommodate the MPFL graft tunnel on the medial femur.”

Drs. Shubin Stein and Fragomen concluded, “Zhang and colleagues provide a sound clinical comparison that echoes the amazing clinical results we have witnessed in our collaborative practice.”

Read the full article at Healio.com/news/orthopedics.

"I would suggest seeing a physical therapist, a physiatrist, or your primary care physician if you are experiencing knee pain at night," advised Rogers, as there are different conditions that can cause that pain, and only a trained expert can make that call. "Osteoarthritis is the musculoskeletal condition I see most often in my clinical practice that can present with worsening pain at night," noted Rogers. "However, any knee condition that is associated with increased inflammation can present with increased pain at night. Some examples could be patella femoral pain syndrome, patella tendonitis, quadriceps tendonitis, and medial or lateral meniscus tears,” he continued.

Another reason that knee pain can feel more uncomfortable at night is due to increased activity levels during the day that are outside the person's exercise or functional capacity. "This can be seen when someone is accustomed to running one mile per day for exercise but then one day that person decides to run three or four miles without proper training or gradually building up to this distance,” explained Rogers.

Additionally, there are some things you can do at home to help relieve your knee pain. "When dealing with knee pain at night, I recommend applying an ice pack to the knee before bed for 15-20 minutes to help soothe the pain," said Rogers. "A lot of times ice before bed will be sufficient to help reduce the knee pain at night." Alternating between a heating pad and an ice pack could also be helpful if ice alone isn't doing the trick. "One can use a heating pad on the knee for 15-20 minutes about an hour before bed and then use an ice pack on the knee for 15-20 minutes right before bed. Sometimes the alternating combination of heat and ice before bed can be helpful to soothe knee pain at night,” he added. Gentle stretching of the quadriceps, hamstrings, and calves may also help in reducing knee pain at night, concluded Rogers.

Read the full article at Popsugar.com.

“We know that approximately 10 percent of cases with acute patella dislocation and a relatively significant osteochondral fracture that early surgical stabilization is often necessary,” said Dr. Green. “For the past many years, we’ve done this simultaneously with an MPFL reconstruction with an attempt to try and preserve cartilage going forward.”

Dr. Green and colleagues analyzed data from a retrospective review of 321 MPFL reconstructions performed by a single surgeon between 2011 and 2019. Of the surgeries performed, 38 knees underwent MPFL reconstruction with osteochondral fixation. Patients had an average age of 14.8 years at surgery and average follow-up of 2.1 years. The surgeon used an average of 4.4 biodegradable fixation nails.

Read the full article at Healio.com/news/orthopedics.

From March 2014 to July 2018, Dr. Nguyen and colleagues analyzed 107 patients (25 skeletally immature patients and 82 skeletally mature patients) who underwent isolated MPFL reconstruction. Researchers compared return-to-sport rates and re-dislocation episodes. They also compared outcomes between standard, adult graft placement and graft placement distal to the physis, which avoids the growth plate, in a strictly pediatric cohort.

“Over 90 percent of patients were able to return to sport in both groups, with a high percentage of patients in both groups returning at the same or an even higher level of activity,” said Dr. Nguyen. “In the sub-analysis of skeletally immature patients, no differences were found in any outcomes between patients with standard graft placement vs. those with distal graft placement,” he added.

Dr. Nguyen noted, “Successful outcomes can be achieved in skeletally immature patients following MPFL reconstruction, or over these outcomes are aligned with outcomes in the skeletally mature patients,” concluding, “Future studies with larger populations are needed to further investigate if any morphological differences impact patient outcomes, and additional studies are needed to study the impact of graft placement on the younger population.”

Read the full article at Healio.com/news/orthopedics.

Dr. Shubin Stein explains that her group has a prospective study underway with the goal to perform isolated medial patellofemoral ligament reconstructions on all patients with recurrent instability regardless of bony measurements.

“We look forward to being able to identify a scoring algorithm that will help all of us treat these patients in a more standardized fashion and hopefully see fewer recurrences and complications as a result,” she writes.

Read the full article at Healio.com.

Dr. Green wrote, “Specifically, the investigators measured patellofemoral morphology comparing MRIs with 20 controls vs. 20 adolescents with idiopathic patellofemoral pain that was not associated clinically with patella instability. Interestingly, the idiopathic patellofemoral (PF) pain group had a deeper sulcus and they speculate that there may be two groups of PF pain patients — one with PF instability and one group without instability. In addition to deeper femoral sulci, adolescents with PF pain were noted to have increased lateral patellar width and patellotrochlear width ratio.”

Dr. Green concluded, “It is my opinion that these radiographic findings probably will not directly change or modify clinicians’ current approach to adolescent idiopathic PF pain. However, hopefully this study will stimulate further research and potentially new treatment approaches to this common form of adolescent knee pain and disability.”

Read the article at Healio.com.

Dr. Green and colleagues assessed the physeal safety in 54 knees in 49 pediatric patients who underwent physeal-sparing MPFL reconstruction performed by one surgeon between 2007 and 2016. The researchers found no evidence of physeal arrest and the median distance from the physis to the socket at the aperture and distal end of the femoral socket were 5.9 mm (range, 1.9-12) and 7.1 mm (1.3-12.4), respectively.

Dr. Green cited, “The results in the paper demonstrate that patella stabilization surgery with MPFL reconstruction can be performed safely and effectively in young patients with open growth plates.” He added, “We are proud at Hospital for Special Surgery to be one of the FIRST hospitals in the country to perform MPFL surgery in children and adolescents who suffer from patella dislocations. The results in the paper demonstrate that the surgery can be performed safely and effectively in patients who are growing.”

Read the article at ryothro.com.