Factors associated with an increased risk of osteochondral injuries after patellar dislocations: a systematic review

Abstract

Purpose The purpose of the study was to summarize the available evidence and identify risk factors for osteochondral injuries (OCIs) after patellar dislocations. Methods A systematic literature review was conducted in PubMed, Embase, Web of Science, Cochrane Library, and China national knowledge infrastructure from inception to December 22, 2022, according to the preferred reporting items for systematic reviews and meta-analyses guidelines. Studies regarding risk factors for OCIs after patellar dislocations were included. Literature search, data extraction, and quality assessment were performed independently by two authors. Results A total of 16 studies with 1945 patients were included. The risk factors for OCIs after patellar dislocation were categorized into four main categories, including demographic characteristics, patellar depth and position, femoral trochlear morphology, and other risk factors in this study. Five and three studies supported the idea that male sex and skeletal maturation may be risk factors, respectively. Normal femoral trochlea (two studies) and complete medial patellofemoral ligament (MPFL) injuries (two studies) may be associated with the development of OCIs. Three studies show that ligamentous laxity or joint hypermobility may prevent OCIs. Patellar depth and position (eight studies) may not be associated with the development of OCIs. Conclusions Based on the available evidence, an increased risk of OCIs following patellar dislocation may be associated with male sex and skeletal maturation. Furthermore, normal femoral trochlea and complete MPFL injuries may increase the risk of OCIs, while factors such as ligamentous laxity or joint hypermobility may reduce the risk. Level of Evidence Level IV, systematic review of Level II and IV studies.

Effect of Patellar Morphology on the Risk of Osteochondral Fracture after Patellar Dislocation: A Cross‐sectional Study

“…found that male sex was a risk factor for osteochondral injuries after PD. 14 , 27 Retzky et al . 28 also found that male sex was an independent risk factor for OCF after PD in pediatric patients.…”

“…Bone maturity is not only a risk factor for recurrent patellar dislocation, but it also increases the risk of OCF after PD. 27 , 32 , 33 Flachsmann et al . 34 found that uncalcified cartilage in skeletally immature patients weaves with subchondral bone, which may lead to the adolescent joint particularly susceptible to osteochondral shear fracture.…”