Acute dislocation of the patella. A prospective review of operative treatment

Vainionpää, S.; Laasonen, E. M.; Silvennoinen, Timo; Vasenius, Jarkko; Rokkanen, P

doi:10.1302/0301-620x.72b3.2341428

Cited by 120 publications

(61 citation statements)

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“…Surgery is mainly based on immediate medial repair and proximal realignment procedures. Various surgical modalities have been reported, beginning with open [11,12], through minimally invasive and arthroscopically assisted [13,14], to fully arthroscopic [15][16][17] procedures. Traumatic patellar dislocation causes a high incidence of injuries to the medial patellofemoral ligament (MPFL) [18], the structure recognised as the most important soft tissue, passive restraint to lateral patellar dislocation, especially in the first 30°of knee flexion [19].…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, primary surgery to the medial parapatellar aspect is focused on reconstructing the MPFL and surrounding soft tissues. On the other hand, the tendency towards immediate lateral retinacular release (LRR) [20] in the aforementioned studies is controversial: from "never" [21], through "in selected cases" [10,11,22], to "always" [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

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Acute patellar dislocation in adolescents: operative versus nonoperative treatment

Apostolović

Vukomanović

Slavković

et al. 2011

International Orthopaedics (SICOT)

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Purpose The purpose of this prospective non-randomised study was to compare the efficacy of two opposed methods, operative and conservative. Our hypothesis was that if the method was selected correctly, on an individual basis, the results should be approximately equal. Methods The study included 37 adolescents aged between 12 and 16 years, with a mean follow up of 6.1 years. The presence of a significant loose body, confirmed by precise imaging, was the key for selecting operative or arthroscopic treatment. In both groups of patients, we evaluated functional knee scores and the incidence of residual patellofemoral disorders.Results We confirmed our hypothesis using the t-test to compare functional results and a test for comparison of proportions for incidence of residual disorders. There was no statistically significant difference (p=0.091) between operatively and conservatively treated groups with regard to functional results. The same statistical outcome emerged when comparing incidences of re-dislocation (p=0.854), or other major patellar instabilities (p=0.856), between the groups. Conclusions The results obtained should not promote a non-operative method on the basis of lower risk, but do support an individual approach based on precise diagnosis and defined criteria.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Acute patellar dislocation in adolescents: operative versus nonoperative treatment

Apostolović

Vukomanović

Slavković

et al. 2011

International Orthopaedics (SICOT)

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“…While rigid stabilization and slow rehabilitation were recommended previously (23,24), earlier and more rapid rehabilitation is recommended at present (25). The negative effects of immobilization on the bone, cartilage, ligament, and muscle have been demonstrated (26).…”

Section: Discussionmentioning

confidence: 99%

Results of Conservative Treatment of First Time Acute Lateral Patella Dislocation

Gül¹,

Çetinkaya²,

Buyukkuscu³

et al. 2017

JAREM

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Objective: Acute patellar dislocations account for 2-3% of all knee injuries. Patients with first-time acute lateral patellar dislocations can be conservatively treated. This study aimed to evaluate the conservative treatment method and clinical outcomes in these patients.Methods: Between 2013 and 2016, patients with traumatic first-time acute patellar dislocation were retrospectively evaluated. Clinically, patients with positive knee joint medial retinaculum tenderness, joint effusion, and positive patellar scaring test results were evaluated. The diagnosis of these patients was supported using direct anteroposterior and lateral knee radiographs and magnetic resonance imaging. The patients' visual pain scale evaluations were performed before and after treatment. Kujala functional assessment scoring was performed only after treatment. Wilcoxon statistical analysis was used to evaluate dependent groups.Results: The mean follow-up period of the patients was 13 months (range, 7-34 months). Three patients were female and 12 were male. Fifteen patient's mean preoperative VAS (Görsel Ağrı Skoru) scores were 8.6 points (range, 7-10), and 1.4 points (range, 0-3) after treatment. The decrease in VAS score was statistically significant (p<0.05). The Kujala score was 87.2 (range, 80-96) in the final evaluations. According to this score, 5 patients were rates as excellent and 10 as good and there were no patients who were worse. Conclusion:The most important aspect of this study is the observation that conservative treatment can achieve good functional outcomes for MPFL tears from bone adherence sites during first-time traumatic patellar dislocation. We conclude that conservative treatment can provide a successful outcome when appropriate patient selection is done.

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“…Acute surgical repair of the medial parapatellar retinaculum and/or MPFL with various methods has been described to have a recurrence rate between 10% and 20% [7]. White and Sherman in a recent literature review on patellofemoral instability concluded that accepted indications for surgery in the acute setting to be osteochondral fragments, persistent patellar subluxation and detachment of the VMO and medial retinaculum from the medial aspect of the patella [8].…”

Section: Discussionmentioning

confidence: 99%