Patellofemoral Center

Patellofemoral Center Research Program

Patellofemoral disorders, also known as kneecap disorders, refer to pain and instability issues arising from a variety of sources in the patellofemoral joint. Some common examples include anterior knee pain, osteoarthritis and recurrent dislocations or subluxations. These disorders are multifactorial in etiology and can greatly inhibit patients from maintaining their active lifestyles. Furthermore, these conditions affect patients of a wide range of ages and activity, although this population is predominantly female. Patients, physicians and physical therapists find the diagnosis and treatment of these conditions extremely challenging. Currently, patients with anterior knee pain, instability and arthritis have great difficulty understanding their problem and finding the correct clinician to treat their pathology. Many orthopaedic caregivers see these conditions frequently in their offices, though treatment is extremely variable.

Our group addresses the current lack of formalized research into patellofemoral disorders, treatments and outcomes. Our Patellofemoral Center focuses on clinical outcome studies in order to evaluate current surgical techniques as well as develop new ones and improve patient outcomes. The Center has taken a comprehensive approach to investigating patient outcomes in a variety of patellofemoral disorders and treatment procedures. By utilizing a combination of prospective, retrospective, and biomechanical projects our group assesses the efficacy of current procedures and improves upon them to develop even better treatment options. The Patellofemoral Center is also focused on conducting collaborative research efforts with other institutions in the form of multi-center studies in order to maximize the quality and power of the patellofemoral patient data available. The comprehensive research efforts of the Patellofemoral Center play a critical role in improving the quality of life of the many patients suffering from knee pain and instability.

The specific areas of investigation include:

Analysis of factors that may help predict failure of patella stabilizing surgery

Comparison of surgical versus non-surgical treatment in first time dislocators with open growth plates

Evaluation of isolated medial patellofemoral ligament reconstruction to treat instability in the knee

Evaluation of the effect of current surgical techniques on contact mechanics and pressures of different trochlear and patellar morphologies

Evaluation of juvenile particulated cartilage to improve severe cartilage defects in the patella.

Determining the effect of patellofemoral surgery on patella vascularity

Measuring outcomes and quality of life in patients undergoing PFJ arthroplasty

Determining outcomes including return to sport after MPFL reconstruction

Evaluating tibial tubercle transfers in the management of patellar pain and arthritis

Support for our center helps us carry out our research program. Specific areas that can be supported include:

Clinical research personnel including research assistants, coordinators, and biostatisticians

Engineering support including biomechanical analysis, robotic testing, TekScan sensors, 3D printing, and cadaveric specimens

Imaging such as MRI, ultrasound and x-rays and histology

Advanced technologies including registry platforms and software programs that streamline data entry, storage, and analysis

Research staff and technologies required to facilitate large multi-institution studies

Papers and Presentations

Green DW, Arendt EA, Wixted C, Price M. Quadriceplasty Techniques for Patellar Stabilization. In: Patellar Instability: Management Principles and Operative Techniques, 1st ed. USA: Wolters Kluwer; 2019: 123-133. [ISBN: 978-1496380821].
Green DW, Price MJ, Quadricepsplasty Operative Techniques. In: Patellar Instability: Management Principles and Operative Techniques, 1st ed. USA: Wolters Kluwer; 2019: [ISBN: 978-1496380821].
Green DW, Wixted C, Price M, Parikh SN. Pediatric Distal Stabilization Procedures. In Patellar Instability: Management Principles and Operative Techniques, 1st ed. USA: Wolters Kluwer; 2019: 323-336. [ISBN: 978-1496380821].
Green DW, Price MJ, Moloney J. Patellofemoral Pain in the Skeletally Immature Patient: Diagnosis and Treatment. In: Patellofemoral Pain and Instability: Etiology, Diagnosis and Management. Switzerland: Springer; 2019: 3-25. [978-3319976396].
Uppstrom, TJ, Price M, Black S, Gausden E, Haskel J, Green DW. Medial Patellofemoral Ligament (MPFL) Reconstruction Technique Using an Epiphyseal Femoral Socket with Fluoroscopic Guidance Helps Avoid Physeal Injury in Skeletally Immature Patients. Knee Sur Sports Traumatology Arthroscopy. 2019 Mar. 9. doi: 10.1007/s00167-019-05412-7. [Epub ahead of print]. PMID: 30852626
Gruskay J, Strickland S, Casey E, Chiaia T, Green D, Gomoll A. Team Approach: Patellofemoral Instability in the Skeletally Immature. JBJS Reviews. 2019: 1-32. doi: 10.2106/JBJS.RVW.18.00159.
Richmond CG, Green DW, Cannamela PC, Martinson D, Shea KG. The Distance Between the Hamstring Grafts and the Physis and Apophysis of the Proximal Tibia – Implications for Pediatric ACL Reconstruction and Physeal Arrest. J of ISAKOS. 2018 Sep 3. DOI: 10.1136/jisakos-2018-000222.
Price MJ, Tuca M, Nguyen J, Silberman J, Luderowski E, Uppstrom TJ, Green DW. Juvenile Osteochondritis Dissecans of the Trochlea: A Cohort Study of 34 Trochlear Lesions Associated With Sporting Activities that Load the Patellofemoral Joint. J Ped Ortho. 2018 Apr. 16. DOI: 10.1097/BPO.0000000000001174. [Epub ahead of print]; PMID: 29664877.
Keyes S, Price M, Green DW, Parikh SN. Special Considerations for Pediatric Patellar Instability. Am J of Ortho. 2018 Mar. 27; 2018;47(3). DOI: 10.12788/ajo.2018.0017; PMID: 29611848.
Strickland S, Bird Mackenzie, Christ A. “Advances in Patellofemoral Arthroplasty,” Curr Rev Musculoskelet Med. June 2018; 11(2): 221-230.
Wang D, Shubin Stein B, Strickland S. (2018). Patellofemoral Issues. Farr J & Gomoll A (Eds.), Cartilage Restoration: Practical Clinical Applications 2nd Edition. 103-117. Springer Science.
Christ AB, Koch C, Shubin Stein BE, Gonzalez Della Valle A, Strickland SM. “Patellofemoral arthroplasty conversion to total knee arthroplasty: Retrieval analysis and clinical correlation” The Knee. October 2017; 24(5): 1233-1239.
Liu JN, Steinhaus ME, Kalbian IL, Post WR, Green DW, Strickland SM, Shubin Stein BE. Patellar Instability Management: A Survey of the International Patellofemoral Study Group. Am J Sports Med. 2017 Oct. 1:363546517732045. DOI: 10.1177/0363546517732045. [Epub ahead of print]; PMID: 28985094.
Liu J, Steinhaus M, Kalbian I, Post W, Green D, Strickland S, Shubin Stein, B. “Patellar Instability Management: A Survey of the International Patellofemoral Study Group.” American Journal of Sports Medicine. October 2017; 46(13): 3299-3306.
Grawe B, Burge A, Nguyen J, Strickland S, Warren R, Rodeo S, Shubin Stein B. “Cartilage Regeneration in Full-Thickness Patellar Chondral Defects Treated with Particulated Juvenile Articular Allograft Cartilage: An MRI Analysis” Cartilage. October 2017; 8(4): 374-383.
Brady JM, Sullivan JP, Nguyen J, Mintz D, Green DW, Strickland S, Shubin Stein BE. The Tibial Tubercle-to-Trochlear Groove (TT-TG) Distance is Reliable in the Setting of Trochlear Dysplasia and Superior to the Tibial Tubercle-to-Posterior Cruciate (TT-PCL) Distance When Evaluating Coronal Malalignment in Patellofemoral Instability. Arthroscopy. 2017 Aug. 25. DOI: 10.1016/j.arthro.2017.06.020. [Epub ahead of print]; PMID: 28847574.
Nwachukwu B, So C, Schairer W, Shubin Stein B, Strickland S, Green D, Dodwell E. “Economic Decision Model for First-Time Traumatic Patellar Dislocations in Adolescents.” American Journal of Sports Medicine. August 2017; 45(10): 2267-2275.
Liu J, Strickland S, Shubin Stein B. “Patellar Instability Management: A Survey of the International Patellofemoral Study Group.” American Journal of Sports Medicine. July 2017.
Liu J, Mintz D, Nguyen J, Munch J, Strickland S, Shubin Stein B. “MRI Validation of Tibial Tubercle Transfer Distance: A Clinical and Cadaveric Study” July 2017.
Benedict Nwachukwa, Conan So, William Schairer, Beth Shubin-Stein, Sabrina Strickland, Daniel Green, Emily Dodwell. Economic Decision Model for First-Time Traumatic Patellar Dislocations in Adolescents. Am J Sports Med. 2017.
Grawe B, Rodeo S, Burge A, Strickland S, Warren R, Nguyen J, Shubin Stein B. “Patellar Chondral Defects Treated with Particulated Juvenile Articular Allograft Cartilage: An MRI Analysis.” Podium presentation at: 2016 International Cartilage Repair Societ. 2016 September 24-27; Naples, Italy.
Munch J, Sullivan J, Nguyen J, Mintz D, Green D, Shubin Stein B, Strickland S. “Patellar Articular Overlap is a Simple Alternative to Conventional Measurements of Patellar Height.” Orthopaedic Journal of Sports Medicine. July 2016.
Uppstrom TJ, Haskel JD, Gausden EB, Meyer R, Shin YW, Nguyen JT, Green DW. Reliability of Predictive Models for Non-Operative Healing Potential of Stable Juvenile Osteochondritis Dissecans Knee Lesions. Knee. 2016 Aug. DOI: 10.1016/j.knee.2016.03.005.
Redler L, Mayer G, Kalbian I, Nguyen J, Shubin Stein B, Strickland S. “Does Ligamentous Laxity Protect Against Chondral Injury in Patients with Patellofemoral Instability?” Poster presentation at: 2016 American Orthopaedic Society for Sports Medicine Annual Meeting. 2016 July 7-10; Colorado Springs, CO.
Christ A, Baral E, Koch C, Shubin Stein B, Della Valle A, Strickland S. “Patellofemoral arthroplasty conversion to total knee arthroplasty: retrieval analysis and clinical correlation.” Poster presentation at: 2016 European Society of Sports Traumatology, Knee Surgery, and Arthroscopy Annual Meeting. 2016 May 4-7; Barcelona, Spain.
Munch J, Sullivan J, Nguyen J, Mintz D, Green D, Strickland S, Shubin Stein B. “MRI Measurements Associated with Patellofemoral Instability.” Podium Presentation at: 2016 European Society of Sports Traumatology, Knee Surgery, and Arthroscopy Annual Meeting. 2016 May 4-7; Barcelona, Spain.
Johnson A, Shubin Stein B, Mintz D, Demehri S, Wolfe L, Cosgarea A. “Complications Following Tibial Tuberosity Osteotomy With and Without Distalization.” Poster presentation at: 2016 Arthroscopic Association of North America Annual Meeting. 2016 April 14-16; Boston, MA.
Liu J, Mintz D, Nguyen J, Munch J, Strickland S, Shubin Stein B. “MRI Validation of Tibial Tubercle Transfer Distance: A Clinical and Cadaveric Study.” Poster presentation at: 2016 Arthroscopic Association of North America Annual Meeting. 2016 April 14-16; Boston, MA.
Nwachukwu BU, So C, Schairer WW, Green DW, Dodwell ER. Surgical versus Conservative Management of Acute Patellar Dislocation in Children and Adolescents: A Systematic Review. Knee Surg Sports Traumatology Arthroscopy. 2016 Mar.; 24(3):760-7. DOI: 10.1007/s00167-015-3948-2. Review.
Redler L, Meyers K, Munch J, Dennis E, Nguyen J, Shubin Stein B. “Anisometry of Medial Patellofemoral Ligament Reconstruction in the Setting of Patella Alta and Increased Tibial Tubercle-Trochlear Groove (TT-TG) Distance.” Podium presentation at: 2016 American Orthopaedic Society for Sports Medicine Annual Meeting. 2016 July 7-10; Colorado Springs, CO.
Redler L, Strickland S, Shubin Stein B. “Patellofemoral Arthroplasty”. Master Techniques in Orthopaedic Surgery: Reconstructive Knee Surgery 4th Edition. In press.
Green DW. Surgical Treatment of Pediatric Patella Instability. In: Die Therapie Der Instabilen Patella. Zurich: AGA-Komitee-Knie-Patellofemoral; 2016: 80-90.
Shin YW, Trehan SK, Uppstrom TJ, Widmann RF, Green DW. Radiographic Results and Complications of Three Guided Growth Implants. J Ped Ortho. 2016
Munch JL, Sullivan JP, Nguyen JT, Mintz D, Green DW, Shubin Stein BE, Strickland S. Patellar Articular Overlap on MRI is a Simple Alternative to Conventional Measurements of Patellar Height. Ortho. J Sports Med. 2016 4(7).
Uppstrom TJ, Gausden EB, Green DW. Classification and Assessment of Juvenile Osteochondritis Dissecans Knee Lesions. Curr Opin Ped. 2016; 28(1):60-7.
Green DW. Editor. Pediatric and Adolescent Knee Surgery. USA: Wolters Kluwer Health; 2015
Green DW, Gausden EB. Medial Patellofemoral Ligament Reconstruction: Hamstring Technique. In: Pediatric and Adolescent Knee Surgery. USA: Wolters Kluwer Health; 2015: 140-147. [ISBN: 978-1451193350].
Green DW, Uppstrom TJ, Haskel JD. Bioabsorbable Fixation of Symptomatic Juvenile Osteochondritis Dissecans Lesions in Children and Adolescents. In: Pediatric and Adolescent Knee Surgery. USA: Wolters Kluwer Health; 2015: 207-212. [ISBN: 978-1451193350].
Green DW, Haskel JD, Shin YW. Applications of Implant-Mediated Guided Growth in Pediatric Knee Surgery. In: Pediatric and Adolescent Knee Surgery. USA: Wolters Kluwer Health; 2015: 327-335. [ISBN: 978-1451193350].
Gausden EB, Fabricant PD, McCarthy MM, Taylor SA, Weeks KD, Potter H, Green DW. MPFL Reconstruction in Children and Adolescents: A review of Surgical Indications and Treatment Options. JBJS Reviews. 2015; 3(10).
Green DW, Ladenhauf HN. Perspective: MPFL Reconstruction with Hamstring Autograft. Orthopaedics Today – Europe. Jun. 2014. Pages 72-73
Lurie B, Koff MF, Parina S, Feldman E, Amacker N, Zayas TD, Widmann RF, Green DW, Potter HG. Three-Dimensional Magnetic Resonance Imaging of Physeal Injury: Reliability and Clinical Utility. Journal of Ped Ortho. 2014; Apr.-May; 34(3):239-45.
Fabricant PD, Ladenhauf HN, Salvati EA, Green DW. Medial Patellofemoral Ligament (MPFL) Reconstruction Improves Radiographic Measures of Patella Alta in Children. Knee. 2014 Dec.; 21(6)1180-4. DOI: 10.1016/j.knee.2014.07.023. Epub 2014 Jul. 30.
Fabricant PD, Robles A, Downey-Zayas T, Do HT, Marx RG, Widmann RF, Green DW. Development and Validation of a Pediatric Sports Activity Rating Scale: The Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS). Am J Sports Med. 2013 Oct.; 41(10):2421-9. Epub 2013 Jul. 26.

Awards

Patellofemoral Research Excellence Award. 2016. Arthroscopy Association of America/Patellofemoral Foundation. Awarded to an outstanding research project leading to improved understanding, prevention and treatment of patellofemoral pain or instability for “Anisometry of Medial Patellofemoral Ligament Reconstruction in the Setting of Patella Alta and Increased Tibial Tubercle-Trochlear Groove (TT-TG) Distance.”
Fellow Research Award – Clinical Science. 2016. American Orthopaedic Society for Sports Medicine. Awarded to the best papers in clinical science and basic science submitted by a sports medicine fellow for “Anisometry of Medial Patellofemoral Ligament Reconstruction in the Setting of Patella Alta and Increased Tibial Tubercle-Trochlear Groove (TT-TG) Distance.”
Patellofemoral Research Excellence Award. 2015. Arthroscopy Association of America/Patellofemoral Foundation. Awarded to an outstanding research project leading to improved understanding, prevention and treatment of patellofemoral pain or instability for “MRI Measurements Associated with Patellofemoral Instability.”
Philip D. Wilson, MD Award. 2015. Hospital for Special Surgery. Awarded to a fellow for excellence in orthopaedic surgery research for “Anisometry of Medial Patellofemoral Ligament Reconstruction in the Setting of Patella Alta and Increased Tibial Tubercle-Trochlear Groove (TT-TG) Distance.”
Excellence in Research Award. American Orthopaedic Society for Sports Medicine Development and Validation of a Pediatric Sports Activity Rating Scale. AOSSM Annual Meeting 2013.
AOSSM Herodicus Award Nominee Podium Presentation MRI Evaluation of the Medial Patella-Femoral Ligament (MPFL) After Acute Patellar Dislocation in Children. 2010.
Jacques Duparc Award presented at the EFORT Meeting (European Federation of National Orthopaedics and Traumatology) for the study Zone of Injury of the Medial Patella-femoral Ligament After Acute Patellar Dislocation in Children and Adolescents. 2010.

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Kneecap Dislocation Infographic