Does different duration of non-operative immobilization have an effect on the redislocation rate of primary patellar dislocation? A retrospective multicenter cohort study

Kaewkongnok, Bo; Bøvling, Anders Sarkisian; Milandt, Nikolaj; Møllenborg, Celia; Viberg, Bjarke; Blønd, Lars

doi:10.1016/j.knee.2017.10.002

Cited by 16 publications

(14 citation statements)

References 27 publications

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“…A total of 13 studies ** examined patellar height, with 7 studies 1,7,13,16,18,28,36 finding an association between increased patellar height (patella alta) and the rate of recurrence. The threshold used to define patella alta in studies included in the meta-analysis ranged from a Caton-Deschamps index >1.2 to >1.45 in 4 studies 7,13,15,16 and an Insall-Salvati index >1.2 to >1.3 in 4 studies. 1,4,18,36 Meta-analysis of the 8 studies showed patella alta to be a significant risk factor for recurrence (OR, 2.38 [95% CI, 1.32-4.29]; Z = 2.88; P = .004; I 2 = 84%) (Figure 2.5).…”

Section: Resultsmentioning

confidence: 99%

“…However, this study 1 had a shorter follow-up period than the 2 others, which had follow-up periods of 6.9 and 10 years. Trochlear subchondral bone depth was examined by 3 studies, 1,16,31 with each study finding this measure to have no significant association with the recurrence rate. Trochlear facet asymmetry and trochlear subchondral lateral inclination were also reported by 2 studies 1,31 to have no significant association with the recurrence rate.…”

Section: Resultsmentioning

confidence: 99%

“…Similarly, none of the continuous measures of trochlear morphology, including trochlear subchondral bone depth, trochlear facet asymmetry, and trochlear subchondral lateral inclination, were found to significantly influence the recurrence rate. 1,16,31,32 It may be that the combined effect of individual measurements is required to significantly increase the propensity for dislocations.…”

Section: Discussionmentioning

confidence: 99%

“…A first-time (primary) patellar dislocation occurs in 23 to 42 per 100,000 people per year, with further dislocations reported in 17% to 66% of those who undergo nonsurgical management. 3,4,11,15,16,18,29,32 Recurrent patellar dislocations are associated with significant pain, increased risk of cartilage deterioration, reduced quality of life, and significant financial cost. 27,30 Recurrent patellar dislocations are the result of an imbalance of anatomic alignment and restraints, both bony and soft tissue, the latter including passive and active stabilizers.…”

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confidence: 99%

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Factors Associated With an Increased Risk of Recurrence After a First-Time Patellar Dislocation: A Systematic Review and Meta-analysis

et al. 2019

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Background: Recurrent dislocations after a first-time lateral patellar dislocation may occur in more than 50% of patients and can cause long-term disability. Many factors have been suggested to influence the risk of recurrence. Purpose: To systematically review and quantitatively synthesize the literature for factors associated with an increased risk of recurrence after a first-time patellar dislocation. Study Design: Systematic review and meta-analysis of observational studies. Methods: A total of 4 electronic databases were searched to identify relevant studies published before February 7, 2019. A quality assessment was performed with the National Heart, Lung, and Bone Institute quality assessment score. Factors assessed for their effect on the recurrence rate were documented, and the rates of recurrence were compared. Pooled dichotomous data were analyzed using random-effects meta-analysis with odds ratios (ORs). Results: A total of 17 studies met the criteria for inclusion. The overall rate of recurrent dislocations after a first-time lateral patellar dislocation was 33.6%. An increased risk of recurrence was reported in patients with a younger age (OR, 2.61; P < .00001), open physes (OR, 2.72; P < .00001), trochlear dysplasia (OR, 4.15; P = .009), an elevated tibial tuberosity–trochlear groove (TT-TG) distance (OR, 2.87; P < .00001), and patella alta (OR, 2.38; P = .004). Sex, patterns of medial patellofemoral ligament injury, and history of contralateral dislocations were not found to be associated with an increased recurrence rate ( P≥ .05). In studies that reported on the presence of multiple risk factors, recurrence rates were 7.7% to 13.8% when no risk factors were present but increased to 29.6% to 60.2% when 2 risk factors were present and to 70.4% to 78.5% when 3 risk factors were present. Conclusion: Younger age, open physes, trochlear dysplasia, elevated TT-TG distance, and patella alta were key risk factors for the recurrence of lateral patellar dislocations. Despite being not infrequently cited as risk factors, patient sex and a history of contralateral dislocations were not found to be significant risk factors. The presence of multiple risk factors increased the risk, and the development of predictive instability scores in large patient cohorts using all established risk factors should be a focus of future studies.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Factors Associated With an Increased Risk of Recurrence After a First-Time Patellar Dislocation: A Systematic Review and Meta-analysis

et al. 2019

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“…12 With this, the proprioception of the joint is also improved. 20 A reported downside to the brace is that it leads to slightly more redislocation of the patella after the treatment period has ended (0.29 per follow-up year) compared to immobilization treatment (0.12 per follow-up year) (see Table 1). 10…”

Section: Non-surgical Treatment Optionsmentioning

confidence: 99%

Plaster, splint, brace, tape or functional mobilization after first-time patellar dislocation: what’s the evidence?

2019

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With an incidence of 5.8 per 100,000 per year, patellar dislocations are commonly seen in the emergency department. Surprisingly, there are only a few studies available that focus on the results of the different non-surgical treatment options after first-time patellar dislocation. The aim of this review is to provide an overview of the most recent and relevant studies on the rationales and results of the non-surgical treatment for first-time patellar dislocation. Patellar instability mainly affects young and active patients, with a peak incidence of 29 per 100 000 per year in adolescents. The medial patellofemoral ligament, a main passive restraint for lateral translation of the patella, is torn in lateral patellofemoral dislocations. Treatment of first-time patellar dislocation can be either conservative or surgical. There are two options in conservative management of first-time patellar dislocation: immobilization using a cylinder cast or removable splint, or, second, functional mobilization after applying a brace or patellar tape. The current available literature of conservative treatment after a first-time patellar dislocation is little and of low quality of evidence. Conclusions should be drawn with care, new research focussing on non-surgical treatment is therefore strongly needed. Cite this article: EFORT Open Rev 2019;4:110-114. DOI: 10.1302/2058-5241.4.180016

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MRI as the optimal imaging modality for assessment and management of osteochondral fractures and loose bodies following traumatic patellar dislocation: a systematic review

Qiu

Fitzpatrick

Cohen

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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PurposeTo assess the imaging modalities used for diagnosis, as well as the management decisions of patients with osteochondral fractures (OCF) and loose bodies following traumatic patellar dislocation. MethodsAccording to the Preferred Reporting Items for Systematic Review and Meta‐analyses (PRISMA), MEDLINE, EMBASE, Web of Science, and PubMed were searched for results from January 1, 2000, to May 18, 2021, in two subsequent searches for English language studies that presented data on traumatic patellar dislocation. Quality of selected papers was assessed using the Methodological Index for Non‐Randomised Studies (MINORS) and the Risk of Bias (RoB) 2.0 protocol. Results were qualitatively synthesised, and descriptive statistics were calculated. ResultsForty studies totalling 3074 patients (1407 females) were included for the analysis. The mean age was 18.9 years (range 0–69). The population included 2446 first‐time dislocations. The imaging modalities used were: 71.1% MRI, 52.6% plain radiography, 12.1% CT, and 0.68% ultrasound. In the 25 studies that reported the number of OCF, a total of 38.3% of patients were found to have OCF. 43.3% of patients with a first‐time dislocation, and 34.7% of patients with previous dislocations, had at least one OCF. In the included paediatric studies (maximum age ≤ 18), the presence of OCF was detected by plain radiography in 10.1% of patients, MRI in 76.6% of patients, and CT in 89.5% of patients. For management of an OCF, the surgical options include fixation for larger pieces, excision for smaller pieces, and conservative management on a case‐by‐case basis. ConclusionsBased on the current available evidence, assessment and management of patellar dislocations and subsequent OCFs vary, with radiography and MRI as the main imaging modalities on presentation and particular benefit for MRI in the paediatric population. Findings from this study suggest the highest rate of OCF detection with MRI, and thus, surgeons should consider routinely ordering an MRI in patients with first‐time patellar dislocation. Regarding management of OCFs, the main indication for fixation was large fragments, while smaller and poor‐quality fragments are excised. Few studies choose conservative management of OCFs due to later requirements for surgical management. Future work should focus on large, high‐quality studies, and implementation of randomised control trials to form guidelines for imaging patellar dislocations and management of OCFs. Level of evidenceLevel IV.

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Does different duration of non-operative immobilization have an effect on the redislocation rate of primary patellar dislocation? A retrospective multicenter cohort study

Cited by 16 publications

References 27 publications

Factors Associated With an Increased Risk of Recurrence After a First-Time Patellar Dislocation: A Systematic Review and Meta-analysis

Factors Associated With an Increased Risk of Recurrence After a First-Time Patellar Dislocation: A Systematic Review and Meta-analysis

Plaster, splint, brace, tape or functional mobilization after first-time patellar dislocation: what’s the evidence?

MRI as the optimal imaging modality for assessment and management of osteochondral fractures and loose bodies following traumatic patellar dislocation: a systematic review

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