Conservative Versus Surgical Treatment for Primary Patellar Dislocation

Frings, Jannik; Balcarek, Peter; Tscholl, Philippe M.; Liebensteiner, Michael; Dirisamer, Florian; Koenen, Paola

doi:10.3238/arztebl.2020.0279

Cited by 32 publications

(33 citation statements)

References 37 publications

(107 reference statements)

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“…Dislocators with high risk factors are suitable for the surgical treatment of medial patellofemoral ligament (MPFL), which plays an important role in restraining the patella. 18,54 Patellar dislocation is always accompanied by structural abnormality or even tears of MPFL. 17 Therefore, the restoration of anatomic structure by MPFL is very important for the treatment of patellar dislocation.…”

mentioning

confidence: 99%

Comparing Nonoperative Treatment, MPFL Repair, and MPFL Reconstruction for Patients With Patellar Dislocation: A Systematic Review and Network Meta-analysis

Liu

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Medial patellofemoral ligament (MPFL) reconstruction, MPFL repair, and nonoperative treatment are important treatments for patients with patellar dislocation. However, it is unclear which treatment leads to better outcomes. Purpose: To determine the efficacy and safety of the 3 treatments in the treatment of patellar dislocation and compare the effect of MPFL reconstruction with MPFL repair, MPFL reconstruction with nonoperative treatment, and MPFL repair with nonoperative treatment. Study Design: Systematic review; Level of evidence, 3. Methods: The PubMed, Web of Science, Cochrane Library, Embase, CNKI (China National Knowledge Infrastructure), and Wanfang databases were searched from inception to December 2020. Included were clinical studies that described the efficacy and safety of 2 of the 3 treatments, studies directly comparing the clinical effects of the 2 operative techniques, or studies comparing the effects of reconstruction or repair with nonoperative treatment. Two reviewers independently extracted data and assessed the quality of the included studies with the Cochrane risk-of-bias tools. The outcomes evaluated were postoperative redislocation rate, revision rate, complications, and Kujala score. We used traditional direct pairwise meta-analysis as well as network meta-analysis for comprehensive efficacy of all 3 treatment measures. Results: Twelve studies were included: 5 compared MPFL reconstruction with MPFL repair, 2 compared MPFL reconstruction with nonoperative treatment, and 5 compared MPFL repair with nonoperative treatment. The risk of bias was serious in 4, moderate in 4 and low in 4 articles. MPFL reconstruction led to significantly reduced redislocation and improved Kujala scores compared with MPFL repair and nonoperative treatment. MPFL repair led to reduced redislocation rates compared with nonoperative treatment but did not show an obvious benefit in primary dislocations. There was no significant difference among the 3 treatments in terms of revision rate and incidence of complications, although we found that treatment-related complications were least likely to occur in nonoperative treatment. Conclusion: The results of this review indicate that MPFL reconstruction decreases recurrent dislocation compared with MPFL repair or nonoperative treatment, but it has a higher possibility of complications. MPFL repair resulted in less postoperative redislocation than nonoperative treatment but did not show an obvious benefit in primary dislocation.

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confidence: 99%

Comparing Nonoperative Treatment, MPFL Repair, and MPFL Reconstruction for Patients With Patellar Dislocation: A Systematic Review and Network Meta-analysis

Liu

et al. 2021

Orthopaedic Journal of Sports Medicine

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“…Since, biomechanically, the bony morphology of the patellofemoral joint (PFJ) is a determining factor for patella tracking, its correction should be prioritised in this case. 7 In contrast to a proximal patella maltracking, which is typically observed in trochlear dysplasia, the patella of this patient lateralises distally and in deep flexion. 5 This section of movement is not addressable by trochleoplasty and the dysplastic shape of the patella presents a high risk of producing incongruent articulation between patella and trochlea.…”

Section: S Urgical P Lanmentioning

confidence: 57%

“…Patellofemoral instability has been shown to be associated with a variety of predisposing factors, such as the patient's age, a history of contralateral dislocations, skeletal immaturity or variations of normal anatomy. 1 – 7 Besides instability, which is defined by recurring dislocations, physiological patella tracking – in relation to the trochlear groove – is, in many cases, pathologically altered by the presence of predisposing anatomic risk factors. 5 These typically include lateral soft-tissue contractions or muscular imbalance, patella alta, 8 a pathologically lateralised tibial tubercle, 9 – 11 trochlear dysplasia, 12 , 13 genu valgum, 2 , 4 or torsional deformities of the femur or tibia.…”

Section: B Ackgroundmentioning

confidence: 99%

Closed-wedge Patelloplasty for the Treatment of Distal Patellofemoral Maltracking and Instability due to Severe Patellar Dysplasia: Case Report and Surgical Technique

Frings

Freudenthaler

Krause

et al. 2020

Strategies in Trauma and Limb Reconstruction

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A bstract Background Patellofemoral maltracking is caused by different anatomical factors. Most of them are associated with a proximal maltracking, which alters the patella's engagement into the trochlear groove and predisposes the patellofemoral joint for instability. Different surgical techniques have been described to realign patellar tracking, however, most of which address proximal patellar maltracking. Aim The aim of this article is to demonstrate the influence of patella-related deformities on patellar tracking and to present a novel surgical technique for the treatment of distal patellar maltracking, caused by a severe patellar dyplasia. Case Description We report the case of a 23-year-old patient with a severe patellar dysplasia, presenting a distal patellar maltracking with recurring dislocations in deep flexion. Due to her instability, the patient was immobilised and dependent on the constant use of walking aids. Radiological images showed a concavely shaped patellar, which articulated exclusively with the lateral epicondyle and caused the patella to dislocate laterally, starting at a flexion angle of 60°. An anterior closing-wedge osteotomy was used to reshape and recenter the patella, which was complemented by a medial patellofemoral ligament reconstruction. At the 18-month follow-up, the patient presented pain free and fully remobilised, without the use of walking aids. Patellar tracking was reestablished, with a possible knee flexion until 140°. No redislocation of the patella had occurred. Conclusion Distal patellofemoral maltracking, caused by a severe patellar dysplasia, can successfully be treated with an anterior closed-wedge osteotomy of the patella. In combination with a medial patellofemoral ligament reconstruction, patellofemoral stability can be reestablished, to prevent further dislocations. Clinical Significance There are multiple factors, which may cause patellar maltracking. A thorough clinical and radiological preoperative analysis is mandatory, in order to clearly identify the underlying pathologies, as these may affect patellar tracking proximally or distally. How to cite this article Frings J, Freudenthaler F, Krause M, et al. Closed-wedge Patelloplasty for the Treatment of Distal Patellofemoral Maltracking and Instability due to Severe Patellar Dysplasia: Case Report and Surgical Technique. Strategies Trauma Limb Reconstr 2020;15(3):184-192.

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“…Depending on the patient's anatomic and demographic risk factors, the risk of recurrence after initial patellar dislocation can vary significantly. Accordingly, the expected success of conserva- tive or surgical treatment approaches depends greatly on the combination of various factors [52]. Predictive scoring systems like the patellar instability severity (PISS) score are helpful clinical tools that allow assessment of the risk of recurrent dislocation after initial patellar dislocation based on risk factors.…”

Section: Patellar Instability Severity Score (Piss)mentioning

confidence: 99%

Diagnostic Imaging of Patellofemoral Instability

Maas

Warncke

Leiderer

et al. 2021

Rofo

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Background Throughout the literature, patellofemoral instability (PI) is defined as an increased risk of re-/luxation of the patella within the patellofemoral joint (PFJ). In most patients it is caused by traumatic patella luxation or the existence of a range of predisposing anatomic risk factors leading to an unphysiological movement sequence within the PFJ also known as patellofemoral maltracking. In order to provide an individualized therapy approach, clinical and radiological evaluation of those risk factors of variable magnitude becomes essential. Diagnostic imaging such as magnetic resonance imaging (MRI), plain radiography, and computed tomography (CT) are straightforward diagnostic tools in terms of evaluation and treatment of PI. Method In this review we performed a precise analysis of today’s literature concerning the radiological evaluation of anatomic risk factors leading to PI. The purpose of the review is to present a logical compilation of the different anatomical risk factors causing PI and provide a straight overview of valuable radiological imaging techniques. Results and Conclusion PI is frequently based on a multifactorial disposition. The most relevant predisposing risk factors are trochlea dysplasia, rupture of the medial patellofemoral ligament (MPFL), patella alta, abnormal tibial tubercle to trochlea groove distance (TT-TG), femoral torsion deformities, and genu valgum. Although plain X-rays may provide basic diagnostic value, cross-sectional imaging (MRI, CT) is the standard radiological tool in terms of evaluation and detection of severity of predisposing anatomic variants leading to PI. Key Points: Citation Format

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Conservative Versus Surgical Treatment for Primary Patellar Dislocation

Cited by 32 publications

References 37 publications

Comparing Nonoperative Treatment, MPFL Repair, and MPFL Reconstruction for Patients With Patellar Dislocation: A Systematic Review and Network Meta-analysis

Comparing Nonoperative Treatment, MPFL Repair, and MPFL Reconstruction for Patients With Patellar Dislocation: A Systematic Review and Network Meta-analysis

Closed-wedge Patelloplasty for the Treatment of Distal Patellofemoral Maltracking and Instability due to Severe Patellar Dysplasia: Case Report and Surgical Technique

Diagnostic Imaging of Patellofemoral Instability

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