Conservative Versus Surgical Treatment for Repair of the Medial Patellofemoral Ligament in Acute Dislocations of the Patella

Camanho, Gilberto Luís; Viegas, Alexandre de Christo; Bitar, Alexandre Carneiro; Demange, Marco Kawamura; Hernandez, Arnaldo José

doi:10.1016/j.arthro.2008.12.005

Cited by 200 publications

(153 citation statements)

References 27 publications

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“…16 In contrast, a prospective nonrandomized Level II study of 76 patients comparing nonoperative treatment with acute primary repair did not show differences in patellar instability after a median 7-year follow-up. 17 The following year, however, the same group published a prospective randomized Level I study of 40 young adults comparing nonoperative treatment with surgical stabilization, including both primary repairs and some reconstructions, showing lower rates of recurrent instability after surgery.…”

Section: Discussionmentioning

confidence: 85%

Medial Patellofemoral Ligament Reconstruction Using a Modified “Reverse-Loop” Technique

Sampatacos

Getelman

2013

Arthroscopy Techniques

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Medial patellofemoral ligament reconstruction is a commonly performed procedure for patellofemoral instability. In recent years the surgery has evolved considerably as the anatomy and goals of reconstruction have become more defined. This has resulted in numerous surgical options involving various fixation devices. Furthermore, as biomechanical data accumulate regarding the importance of graft position and tension, surgical techniques for applying this knowledge with precision are needed. This technical note with an accompanying video details one such technique that may be applied to various methods of fixation, allowing for improved precision and possibly resulting in a stronger fixation construct.

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Section: Discussionmentioning

confidence: 85%

Medial Patellofemoral Ligament Reconstruction Using a Modified “Reverse-Loop” Technique

Sampatacos

Getelman

2013

Arthroscopy Techniques

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“…While some studies recommend surgical treatment after the first patellar dislocation, some recommend conservative treatment (15)(16)(17). Because the evidence in the literature is unsatisfying, no optimal treatment choice is available for this issue (18).…”

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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“…In what concerns to the action taken towards the MPFL, arguments for conservative treatment are: this was the first episode of an APD [13]; there were no anatomic variations, nor hyperlaxity criteria (MPFL rupture is not the cause, but a consequence of an APD). The arguments for surgical treatment, whether repair or reconstruction, are: since a medial arthrotomy was used, a MPFL repair would be a reasonable procedure; some prospective studies begin to show better long term results for MPFL reconstruction, compared to those observed with conservative treatment [14]. As our knowledge about the biomechanical importance of the MPFL evolves -mainly its role against lateral displacement during motion and under high lateral stresses [15] -the more orthopaedic surgeons consider MPFL reconstruction the mainstay of treatment, even in the context of a primary APD [16].…”

Section: Discussionmentioning

confidence: 99%

Open Reduction and Internal Fixation of an Osteochondral Patellar Fracture in an Eleven Year-Old Girl

Correia¹

2016

MOJOR

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Osteochondral patellar fractures in pediatric age can result from acute patellar dislocations (APDs). The purpose of this article is to document and discuss the surgical treatment performed to a young female patient diagnosed with an osteochondral fracture (OCF) of the patella in the first episode of an APD.We state the first episode of an APD in a 12 year-old girl, who presented with pain, edema and limited extension of the right knee, after a direct knee trauma. She had no predisposing factors regarding patellofemoral instability. This patient was treated at our Orthopaedic Surgery Department and then clinically (Kujala score) and radiographically evaluated, at 12 months of follow-up.The knee radiograms gave rise to the suspicion of a large inferior osteochondral patellar fragment. Operative treatment was decided and open reduction and internal fixation (ORIF) of the fragment was performed, through a medial parapatellar approach. The fragment dimensions were 24x18mm. The medial structures were addressed and repaired. The patient went through a rehabilitation programme and returned to full activities three months postoperatively. After 12 months of follow-up, there was full range of motion, no redislocation episodes and the Kujala score was 96.Open reduction and anatomic in situ internal fixation of the osteochondral fragment was mandatory in this case, due to its dimensions and location. We consider this a safe and efficient technique that allows osteosynthesis of the osteochondral fragment; the approach used makes possible the acute repair of the medial structures. There is still no general consensus about whether or not to reconstruct the medial patellofemoral ligament (MPFL) in the context of a primary APD.

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Conservative Versus Surgical Treatment for Repair of the Medial Patellofemoral Ligament in Acute Dislocations of the Patella

Cited by 200 publications

References 27 publications

Medial Patellofemoral Ligament Reconstruction Using a Modified “Reverse-Loop” Technique

Medial Patellofemoral Ligament Reconstruction Using a Modified “Reverse-Loop” Technique

Results of Conservative Treatment of First Time Acute Lateral Patella Dislocation

Open Reduction and Internal Fixation of an Osteochondral Patellar Fracture in an Eleven Year-Old Girl

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