Assessment of demographic and pathoanatomic risk factors in recurrent patellofemoral instability

Hiemstra, Laurie A.; Kerslake, Sarah; Lafave, Mark R.

doi:10.1007/s00167-016-4346-0

Cited by 52 publications

(43 citation statements)

References 51 publications

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“…Thus, surgical intervention could be considered for those with ISS more than 4 points after first-time LPD. The WARPS/STAID classification system demonstrated strong relationship with ISS, providing further validation of the scoring system [34]. The WARPS subset had mean ISS of 4.4 ± 1.1 (high chances of recurrence) and STAID subset had ISS of 2.5 ± 1.5 (less chances of recurrence).…”

Section: Patellar Instability Severity Scorementioning

confidence: 75%

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Predicting Risk of Recurrent Patellar Dislocation

Parikh

Lykissas

Gkiatas

2018

Curr Rev Musculoskelet Med

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Several demographic risk factors (age, skeletal immaturity, sex, bilaterality), mechanism of injury, and anatomic risk factors (trochlear dysplasia, patella alta, excessive tibial tubercle lateralization, increased patellar tilt) have been recognized. The combination of different risk factors, their relative contribution to instability, weightage of each factor, and multivariate analysis have led to the development of a prediction model and instability scoring system. If recurrent instability and poor outcomes could be predicted based on these prediction tools, then alternative treatment or early surgical intervention after first-time LPD could be considered. This information can also be used to predict contralateral LPD and failure of surgical treatment. Current prediction tools are mainly based on retrospective studies. In the future, prospective validation of these prognostic factors would be beneficial.

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Section: Patellar Instability Severity Scorementioning

confidence: 75%

“…Hiemstra et al profiled their patients into either WARPS or STAID category, with some having mixed characteristics [34]. WARPS meant Weak, Atraumatic, Risky Anatomy, Pain and Subluxation; STAID meant Strong, Traumatic, Anatomy Normal, Instability and Dislocation.…”

Section: Combination Of Risk Factors For Recurrent Lpdmentioning

confidence: 99%

Predicting Risk of Recurrent Patellar Dislocation

Parikh

Lykissas

Gkiatas

2018

Curr Rev Musculoskelet Med

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“…TD has consistently been associated with PI, and several studies 4,12,20,21,26,27,31 have identified it as either the primary or one of the strongest associated risk factors for instability or recurrent instability. Dejour et al 14 observed that in a population of patients undergoing surgical stabilization for PI, 85% had 2 radiographic signs of TD and 96% had 1 sign of TD, versus only 6% of the control group with any radiographic signs of TD.…”

Section: Discussionmentioning

confidence: 99%

Effect of Trochlear Dysplasia on Commonly Used Radiographic Parameters to Assess Patellar Instability

Pace

Cheng

Joseph

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Trochlear dysplasia (TD) is an important anatomic risk factor for patellar instability (PI). Several imaging-based risk factors for PI have been established, but it is unclear what effect TD has on these measurements, and the Dejour method of categorizing TD has been shown to be unreliable. The lateral trochlear inclination (LTI) is a quantifiable measurement of proximal trochlear morphology. Recently, a modified technique for measuring LTI referencing the posterior condylar angle has demonstrated near-perfect reliability and may serve as a new standard for quantifying TD. Purpose/Hypothesis: The purpose of this study was to evaluate how TD, expressed in terms of LTI, affects historically used measures of PI, including the sulcus angle (SA), tibial tuberosity to trochlear groove (TT-TG) distance, lateral patellar inclination (LPI), and Caton-Deschamps (CD) ratio. We hypothesized that lower LTI (ie, more dysplastic trochlea) will correlate with higher SA and TT-TG distances, increased patellar tilt, and more patella alta. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Patients aged 9 to 18 years treated for PI between January 2014 and August 2017 were queried. On magnetic resonance imaging (MRI), LTI, SA, LPI, and the TT-TG measured at the most proximal (pTT-TG) and distal (dTT-TG) aspects of the fully formed trochlear groove were measured on axial images. CD ratio was measured using sagittal MRI as well as lateral radiographs. All measurements were performed by 2 independent observers. Patients were included if there was a diagnosis of PI that was confirmed with a chart review and if there were appropriate imaging studies to analyze. Results: A total of 65 patients met inclusion criteria for this study. Average pTT-TG distance (15.7 ± 4.5 mm) was not significantly different from dTT-TG distance (15.7 ± 4.2 mm) ( P = .94). LTI had a weak but significant inverse correlation with pTT-TG ( r = –0.40; β = –0.15 mm; P < .001) and SA ( r = –0.43; β = –0.478°; P < .001). There was a moderate and significant inverse correlation of LTI with dTT-TG ( r = –0.593; β = –0.21 mm; P < .001) and with LPI ( r = –0.69; β = –0.54°; P < .001). There was a weak but significant correlation between LTI and the MRI-based CD ratio ( r = 0.279; β = 0.149; P = .005). Radiograph-based CD ratio did not show a significant correlation with LTI ( r = –0.189; P = .135). Conclusion: Smaller (ie, more dysplastic) LTI values correlated significantly with larger TT-TG, SA, LPI, and MRI-based CD ratio measurements. The relationship between SA and LTI is intuitive, but the relationship between LTI and the other analyzed variables suggests that they are dependent variables to TD and may not be consistent independent risk factors for PI. Together, these suggest that TD alters the radiographic interpretation of TT-TG and patellar tilt. The correlation between TD and patellar height is unclear and warrants further investigation.

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“…The WARPS subtype has atraumatic onset of instability with significant risky pathoanatomy, while the STAID subtype has a traumatic onset with fewer risky anatomic features. 11,13 WARPS is an acronym that represents 5 clinical characteristics: weak, atraumatic, risky anatomy, pain, and subluxation. STAID is an acronym for clinical presentation of the following: strong, traumatic, anatomy normal, instability, and dislocation.…”

Section: Methodsmentioning

confidence: 99%

Age at Time of Surgery but Not Sex Is Related to Outcomes After Medial Patellofemoral Ligament Reconstruction

Hiemstra

Kerslake

2019

Am J Sports Med

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Background: Medial patellofemoral ligament (MPFL) reconstruction has become a well-accepted procedure for recurrent patellofemoral instability. Despite a growing volume of research assessing surgical results, the relationship of age and sex to outcomes after MPFL reconstruction surgery is unclear. Purpose: To investigate whether age at the time of surgery or sex influenced patient-reported quality of life and clinical outcome after MPFL reconstruction for recurrent lateral patellofemoral instability. Study Design: Cohort study; Level of evidence, 3. Methods: Between January 2010 and May 2016, 328 patients underwent primary patellofemoral stabilization. Demographic and clinical data were collected preoperatively. Patients completed the Banff Patellofemoral Instability Instrument (BPII) at the pre- and postoperative visits and were assessed clinically at 12 and 24 months. To assess the effects of age at surgery and sex on BPII, multiple linear regression models were fit predicting BPII at 12 and 24 months. An unadjusted regression was applied with the predictors being age at the time of surgery and sex. A second regression model was applied adjusting for age at first dislocation, grade of trochlear dysplasia, knee hyperextension, and the WARPS/STAID score—a measure of the risky patellofemoral instability characteristics of the patient. Results: Of 328 patients, 298 (91%) had complete data and minimum 12-month BPII scores available for analysis. There were 11 redislocations in the cohort (3.4%), all in female patients. When stratified by sex, baseline characteristics were not statistically different except for higher age at first dislocation ( P = .022) as well as higher WARPS/STAID scores ( P = .006) for males. Age at the time of surgery was statistically significant for each postoperative follow-up, with lower BPII scores apparent for each 10-year increase in age at the time of surgery. In the adjusted model, the WARPS/STAID score was significantly associated with the preoperative BPII score. For the 24-month postoperative BPII scores, age at time of surgery and preoperative WARPS/STAID score were both significant. Lower BPII scores were apparent for each 10-year increase in age at the time of surgery, as well as for lower scores on the WARPS/STAID classification. Conclusion: This study demonstrated that when adjusted for risky pathoanatomy, neither age at first dislocation nor sex influences patient-reported quality of life outcomes after MPFL reconstruction. Age at the time of surgery was correlated with outcome, with lower BPII scores apparent for each 10-year increase in age at the time of MPFL reconstruction.

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Assessment of demographic and pathoanatomic risk factors in recurrent patellofemoral instability

Abstract: III.

Cited by 52 publications

References 51 publications

Predicting Risk of Recurrent Patellar Dislocation

Predicting Risk of Recurrent Patellar Dislocation

Effect of Trochlear Dysplasia on Commonly Used Radiographic Parameters to Assess Patellar Instability

Age at Time of Surgery but Not Sex Is Related to Outcomes After Medial Patellofemoral Ligament Reconstruction

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