Acute Patellar Dislocation in Children and Adolescents: A Randomized Clinical Trial

Palmu, Sauli; Kallio, Pentti; Donell, Simon T.; Helenius, Ilkka; Nietosvaara, Yrjänä

doi:10.2106/jbjs.g.00072

Cited by 400 publications

(369 citation statements)

References 22 publications

(28 reference statements)

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“…Buchner et al [23], in their retrospective study, separate patients who underwent diagnostic arthroscopy and refixation of the osteochondral fragment into a special group from conservatively and surgically treated patients. Sillanpaa et al [14] add those patients to a group of nonoperatively treated patients, whereas the authors of randomised studies, Nikku et al [24], Palmu et al [22], and Christiansen et al [21], regard the procedure as diagnostic and therapeutic, which is mandatory prior to final selection of operative or nonoperative treatment. In our study, diagnostic arthroscopy with simultaneous management of the essential osteochondral fragment was regarded as an operative treatment that could accompany repair of medial parapatellar structures and/or lateral retinacular release, if necessary.…”

Section: Discussionmentioning

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: Discussionmentioning

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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“…Patellar tilt and translation can be measured on MRI or CT images (taken with the knee extended and the quadriceps contracted or relaxed) [7]. Although non-operative treatment remains the gold standard of treatment after primary patellar dislocation without osteochondral fragments [8][9][10], recurrent dislocations in this population may benefit from surgical intervention. Reconstruction of the MPFL prevents lateral patellar dislocation, reporting good results in the treatment of children [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Medial Patellofemoral Ligament Reconstruction in Adolescents Affected by Patellar Instability

Testa

Pavone

Lucenti

et al. 2017

JFMK

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Patellar instability is a heterogeneous group of morphological and functional disorders of the knee extensor mechanism. The medial patellofemoral ligament (MPFL) has been recognized as being important in stabilizing the patella and preventing lateral patellar dislocation. Recurrent dislocations in the pediatric population may benefit from surgical intervention. The aim of this study is to retrospectively evaluate adolescent patients treated with surgical reconstruction of medial patello-femoral ligament. Between January 2009 and December 2014, seven patients with patellar instability were treated at the Department of Orthopaedics and Traumatology of the University of Catania, Sicily. Five patients (71.4%) were female and two (28.6%) were male. The mean age at the time of surgery was 14.9 ± 1.1 years (range 13-16 years). All cases were treated with reconstruction of the MPFL. Clinical outcomes and complications were reported. Mean follow-up was 26.1 ± 10.9 months (range 12-46 months). Evaluation at two years after surgery identified an average Knee Society Score (KSS) of 94.3 ± 7.4 (range 78-100). An excellent result was obtained in six patients (85.7%) and a good result was obtained in one patient (14.3%). A recurrence was reported in one patient (14.3%). This study shows that surgical treatment of patellar instability by reconstruction of MPFL leads to satisfying results at mid-term follow-up.

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“…For acute patellar dislocation in children and adolescents, a 2008 study by Palmu et al demonstrated no improved longterm benefits to acute operative repair compared with non-operative management, and advocated against routine operative repair of the torn medial stabilizing soft tissues for the treatment of acute patellar dislocation in children and adolescents. 2 …”

Section: Introductionmentioning

confidence: 99%

A novel method of reduction for first-time acute lateral patellar dislocations in children and adolescents

Ong

2015

CJEM

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Five pediatric patients with acute traumatic "first-time" lateral patellar dislocations were successfully reduced using a novel, atraumatic, and simple technique. Uniquely, unlike the traditional method of patellar reduction, the patellar dislocations were reduced without any direct manipulation of the patella. In co-operative patients, no analgesia was required. Further validation of the reproducibility of the effectiveness of this method for successful patellar reduction in pediatric and adult populations are required. RÉSUMÉCinq jeunes patients ont subi, pour la première fois, une luxation latérale, aiguë et traumatique de la rotule, réduite grâce à une nouvelle technique simple et non traumatique de remise en place. Étonnamment et contrairement à l'ancienne technique, la nouvelle façon de faire n'a nécessité aucune manipulation directe de la rotule. Chez les patients en état de coopérer, on n'a même pas eu besoin de recourir à l'analgésie. Toutefois, il faut poursuivre les études afin de valider l'efficacité reproductible de cette technique de réduction des luxations de la rotule chez les enfants et les adultes.

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Acute Patellar Dislocation in Children and Adolescents: A Randomized Clinical Trial

Cited by 400 publications

References 22 publications

Acute patellar dislocation in adolescents: operative versus nonoperative treatment

Acute patellar dislocation in adolescents: operative versus nonoperative treatment

Medial Patellofemoral Ligament Reconstruction in Adolescents Affected by Patellar Instability

A novel method of reduction for first-time acute lateral patellar dislocations in children and adolescents

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