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Patellar instability is a multifactorial clinical condition that affects a significant number of patients and occurs due to morphological variations of the joint and patellofemoral alignment. The present literature review study aimed to identify and summarize current concepts on patellar instability, in relation to associated risk factors, diagnostic criteria, and the benefits and risks of conservative and surgical treatments. For this purpose, a search was conducted in the following electronic databases: MEDLINE (via Pubmed), LILACS and Cochrane Library. It is concluded that the accurate diagnosis depends on the detailed clinical evaluation, including the history and possible individual risk factors, as well as imaging exams. The initial treatment of patellar instability is still controversial, and requires the combination of conservative and surgical interventions, taking into consideration both soft tissues and bone structures, the latter being the most common reason for choosing surgical treatment, especially lateral patellar instability., Competing Interests: Conflito de Interesses Os autores declaram não haver conflito de interesses., (Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

Objective: To compare clinical, functional, and quality of life outcomes between patients with tibial plateau fractures operated with locked or conventional plates, and to compare the costs of these implants., Methods: This was a comparative cross-sectional study of a consecutive series of patients with tibial plateau fractures treated surgically from August 2015 to June 2016. Patients < 18 years old, those unable to answer the questionnaires or to attend the outpatient reassessment, polytrauma patients, those with associated injuries on the ipsilateral limb, and patients who had not undergone treatment with bone plates were excluded. The present study compared the costs of the implants for the hospital, quality of life (with the 12-Item Short Form Health Survey [SF-12]), Lysholm score, pain scale, and clinical and radiological parameters., Results: A total of 45 patients with tibial plateau fractures were admitted, and 11 cases were excluded. Two cases were lost to follow-up; therefore, 32 remained for the analysis (94%). The mean follow-up time was of 15.1 months (standard deviation [SD] = 4.8 months). In group A (locked plates), there were 22 patients (69%), at an average hospital cost of BRL 4,125.39/patient (SD = 1,634.79/patient) for the implants. In group B (conventional plates) there were 10 patients (31%), at an average cost of BRL 438.53 (SD = 161.8/patient) ( p  < 0.00001). For the other parameters, no differences were observed, except for a greater articular depression in group A (2.7 mm ± 3.3 mm versus 0.5 mm ± 1.6 mm; p  = 0.02; TE = 0.90)., Conclusion: The costs of locked implants for the treatment of tibial plateau fractures are significantly higher than those of conventional implants, without any clinical, quality of life, radiological, or functional advantages of the locked implants demonstrated in the present series.

Objectives: To ascertain thickness measurements on the anterior cruciate ligament (ACL) in its middle third on magnetic resonance imaging (MRI) scans and to assess whether there is any association between variations in ligament thickness and patients' heights and ages, along with variations in the anatomical measurements on the knee., Methods: MRI scans on 48 knees were evaluated. The anteroposterior size of the femoral condyles, interepicondylar distance, intercondylar distance and anteroposterior and mediolateral thicknesses of the ACL were measured. It was assessed whether there was any statistical relationship between ACL thickness and the patients' age, height or other measurements evaluated., Results: The mean thickness of the middle third of the ACL was 4.5 mm in the sagittal plane and 4.3 mm in the frontal plane. The anteroposterior thickness of the ACL in its middle third had a positive relationship with the size of the lateral condyle. The mediolateral thickness of the ACL in its middle third had a positive relationship with the size of the lateral condyle and with the intercondylar distance in the axial plane. There was no relationship between the thickness of the ACL and the patients' age or height., Conclusion: The thickness of the ACL presented positive associations with the size of the lateral femoral condyle and the intercondylar distance.

To create a rehabilitation protocol following reconstruction of the posterior cruciate ligament (PCL), through a literature review. The literature review was conducted in the Medline and Embase databases, to search for data on biomechanical concepts and analyses relating to the posterior cruciate ligament of the knee. The search strategy was set up using the following rules: problem or injury in association with anatomical location terms; or surgical intervention procedure in association with rehabilitation terms. We began the process in this manner and subsequently introduced restrictions on certain terms to improve the search specificity. To design the protocol, a table was created for better data assessment, based on the time that elapsed between surgery and the start of physiotherapy. A rehabilitation protocol was created to improve weight-bearing control in the initial weeks after surgery, with the aid of a knee brace. Our aim was to achieve gains in total range of motion of the knee, which should be attained by the third month, thereby avoiding contractures resulting from the tissue healing process. Strengthening exercises and sensory-motor training were guided accordingly, thus avoiding overload on the graft and respecting the healing phases. The protocol proposed through this review was based on the current evidence relating to this subject.

Unlabelled: To evaluate results obtained using the protection device technique for osteosintesis or suture of extensor mechanism lesions., Material and Methods: The authors reviewed 18 charts of patients submitted to protection device technique due to traumatic lesion of extensor mechanism that had occurred between the anterior tibial tuberosity and the apical portion of patella. Age ranged from 22 to 69 years, with a mean of 44 years. Male patients prevailed, with 67% of the cases. The most affected spot was, in 83% of the cases, the apical distal third. A protocol was created to collect data, listing the patients and the clinical history from their medical records., Results: The authors observed consolidation of the patella fracture in all 17 patients, and cicatrization of the patellar ligament in one patient. Pain was described in four patients. There were no complications related to the procedure., Conclusion: The protection device showed to be efficient when used in surgical treatment of lesions between the apical patella and the anterior tibial tuberosity, providing active and passive mobility in the early postoperative time.

Objectives: To study the measurements and anatomical relationships of the patellofemoral joint using magnetic resonance imaging, and to evaluate the variation in the morphology of the medial patellofemoral ligament (MPFL) according to patients' heights and ages and the variation in measurements on other structures that are known to be involved in predisposition to patellar instability., Method: Twenty-three knees (18 patients) underwent magnetic resonance imaging and their interepicondylar distance, patellar height, trochlear depth, ventral trochlear prominence, trochlear groove angle, lateral facet tilt, lateral patellar tilt and size of the lateral and medial facets and their ratio were measured. These measurements were compared with the length and thickness of the MPFL., Results: The average length of the MPFL was 46.4 mm, while the average thicknesses of its patellar insertion, middle third and femoral insertion were, respectively, 1.7 mm, 1.4 mm and 1.2 mm. The thickness of the MPFL correlated positively with the lateral condyle and interepicondylar distance measurements, and negatively with the patients' ages., Conclusion: The morphology of the MPFL varies with the interepicondylar distance and the lateral condyle distance, and with patients' ages.

Objective: To evaluate the surgical aspects that may offer good anatomic and functional results in posterior cruciate ligament (PCL) reconstruction using an autologous graft of the quadriceps tendon and double semitendinosus through a double femoral tunnel., Methods: Fourteen patients with isolated PCL lesions, instability and pain were operated on by arthroscopy and evaluated according to the International Knee Documentation Committee (IKDC) and Lysholm scales. Posterior knee laxity was examined with a KT1000 arthrometer., Results: The mean postoperative posterior side-to-side difference was between 0-2 mm in 57.1% of patients and between 3 and 5 mm in 35.7% of cases. The average Lysholm score was 93 points in the final follow-up. In the IKDC evaluation, 3 patients were graded A, 10 were graded B, and 1 patient was graded C., Conclusions: Double bundle arthroscopic PCL reconstruction based on the anatomical positioning of the tunnels, with double semitendinosus tendon and single quadriceps, provides a clinically evident reduction in symptoms and restores satisfactory stability, although no statistically significant difference was found due to the small sample.

Objective: To evaluate the medium and long term results from total knee arthroplasty with rotating tibial weight-bearing., Methods: Between January 2000 and July 2007, 162 patients underwent total knee arthroplasty with mobile tibial weight-bearing. Among these, 96 were evaluated in a previous study with a mean follow-up of 4 years. In the present study, the same group was invited back for reassessment and the results were analyzed. Sixty-nine patients responded to this call (79 knees), and they were evaluated in accordance with the Knee Society Rating System (KSRS), after a mean follow-up of 8 years and 8 months (ranging from 5.5 and 13 years)., Results: A mean KSRS score of 74.41 points was obtained, with good or excellent results., Conclusion: The medium and long-term results from total knee arthroplasty with mobile tibial weight-bearing were good, and a mean score of 74.41 points in the Knee Society Clinical Rating System was attained.