Femoral Avulsion of the Medial Patellofemoral Ligament after Primary Traumatic Patellar Dislocation Predicts Subsequent Instability in Men

Sillanpää, Petri; Peltola, Erno; Mattila, Ville M.; Kiuru, Martti J.; Visuri, Tuomo; Pihlajamäki, Harri

doi:10.1177/0363546509333010

Cited by 146 publications

(122 citation statements)

References 37 publications

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“…Individuals with a rupture of the MPFL possess a greater risk of recurrent patellar instability compared to those whose MPFL remain intact [45]. Since the MPFL may not be ruptured in all cases following FTPD even though there may be an elongation or partial tear, there may have been a difference between the groups in the proportion of MPFL deficit in each group [46,47]. This remains unknown as MRI was not normally undertaken as routine in the three study centres.…”

Section: Discussionmentioning

confidence: 99%

Rehabilitation following first-time patellar dislocation: A randomised controlled trial of purported vastus medialis obliquus muscle versus general quadriceps strengthening exercises

et al. 2015

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Purpose: Define whether distal vastus medialis (VM) muscle strengthening improves functional outcomes compared to general quadriceps muscles strengthening following first-time patellar dislocation (FTPD).Methods: Fifty patients post-FTPD were randomised to either a general quadriceps exercise or rehabilitation programme (n=25) or to a specific-VM exercise and rehabilitation regime (n=25).Primary outcome was the Lysholm Knee Score, secondary outcomes included the Tegner Level of Activity Scale, the Norwich Patellar Instability (NPI) Score, and isometric knee extensions strength at various knee flexion ranges of motion. Outcomes were assessed at baseline, six weeks, six months and 12 months.Results: There were statistically significant differences in functional outcome and activity levels through the Lysholm Knee Score and Tegner Level of Activity Scale at 12 months in the general quadriceps exercise group compared to the VM group (p=0.05; 95% CI: -14.0 to 0.0/p=0.04; 95% CI: -3.0 to 0.0). This did not reach a clinically important difference. There was no statistically significant difference between the groups for the NPI Score and isometric strength at any followup interval. The trial experienced substantial participant attrition (52% at 12 months). Conclusions:Whilst there was a statistical difference in Lysholm Knee Score and Tegner Level of Activity Score between general quadriceps and VM exercise groups at 12 months, this may not have necessarily been clinically important. This trial highlights that the recruitment and retention of participants from this population is a challenge and should be considered during the design of future trials in this population. Dislocation -Smith et al (2015) 3 Level of evidence: Therapeutic study, Level I Keywords: Quadriceps; vastus medialis oblique; exercise; patellar dislocation; trial VM versus General Quadriceps following Patellar Dislocation -Smith et al (2015) 4 VM versus General Quadriceps following Patellar IntroductionPatellar dislocation is a disabling musculoskeletal disorder which predominantly affects younger people who are engaged in multi-directional physically active pursuits [1]. The estimated incidence of patellar dislocation is between 7 [2] to 77 per 100,000 people per year [3], with a marginally greater incidence in females [2,4]. The term first-time patellar dislocation (FTPD) represents the first episode that the patella disengages completely from the femoral trochlear. It is sometimes termed primary patellar dislocation [5].Conservative (non-operative) treatment is the treatment of choice for FTPD. Quadriceps strengthening exercises are considered one of the principal management for people following FTPD [6,7]. A United Kingdom (UK) survey of physiotherapy practice has shown that quadriceps strengthening and specific-vastus medialis obliquus (VMO) or distal vastus medialis (VM) muscle strengthening or recruitment exercises were two of the most frequently used interventions for this population [1]. However, there remains controversy rega...

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Section: Discussionmentioning

confidence: 99%

Rehabilitation following first-time patellar dislocation: A randomised controlled trial of purported vastus medialis obliquus muscle versus general quadriceps strengthening exercises

et al. 2015

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“…33,51 Recurrent instability (including redislocation and painful subluxation) and complete dislocation are reported in up to one-third and one-half of patients, respectively, treated nonoperatively after traumatic, acute lateral patellar dislocation. 38 Likewise, MPFL rupture is considered the essential lesion of chronic lateral patellar instability. 24 MPFL reconstruction has become a popular procedure to restore normal patellar tracking, prevent symptoms of instability, and limit risk of chondral injury in patients with chronic lateral patellar instability who have failed nonoperative measures.…”

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confidence: 99%

Radiographic Reference Points Are Inaccurate With and Without a True Lateral Radiograph

2015

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“…21 Higher rates of redislocation and surgical intervention were seen in these groups of patients. 22 As a whole, first-time dislocators were found to have a low rate of subsequent dislocation. 23 Many studies have shown no significant differences in nonsurgical and surgical treatment groups on long term followup.…”

Section: Nonoperative Treatmentmentioning

confidence: 95%

Patellar instability – Changing beliefs and current trends

Surendran

2014

Journal of Orthopaedics

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Femoral Avulsion of the Medial Patellofemoral Ligament after Primary Traumatic Patellar Dislocation Predicts Subsequent Instability in Men

Abstract: An MPFL avulsion at the femoral attachment in primary traumatic patellar dislocations predicts subsequent patellar instability. The authors suggest that MPFL injury location be taken into account when planning treatment of primary traumatic patellar dislocation.

Cited by 146 publications

References 37 publications

Rehabilitation following first-time patellar dislocation: A randomised controlled trial of purported vastus medialis obliquus muscle versus general quadriceps strengthening exercises

Rehabilitation following first-time patellar dislocation: A randomised controlled trial of purported vastus medialis obliquus muscle versus general quadriceps strengthening exercises

Radiographic Reference Points Are Inaccurate With and Without a True Lateral Radiograph

Patellar instability – Changing beliefs and current trends

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