Increased incidence of acute patellar dislocations and patellar instability surgical procedures across the United States in paediatric and adolescent patients

McFarlane, Kelly; Coene, Ryan P.; Feldman, Lanna; Miller, Patricia E.; Heyworth, Benton E.; Kramer, Dennis E.; Kocher, Mininder S.; Yen, Yi‐Meng; Milewski, Matthew D.

doi:10.1302/1863-2548.15.200225

Cited by 25 publications

(22 citation statements)

References 39 publications

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“…Of the 52 centers in the PHIS database, 39 were included in the analysis based on completeness of available data during the study period, based on previous methodology utilizing the PHIS database. 22,23,26 Demographic information contained within the PHIS database, including age, self-identified gender, selfidentified race and ethnicity, insurance status, ruralurban commuting area (RUCA) codes, and median family income by zip code, were collected. In the PHIS database, gender is characterized as male or female; ethnicity is defined as Hispanic or Latino, not Hispanic or Latino, or unknown; and race is categorized as Asian, Black, White, American Indian or Pacific Islander, multiracial, other, or unknown.…”

Section: Methodsmentioning

confidence: 99%

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Influence of Sex, Race/Ethnicity, and Socioeconomic Factors on Meniscal Treatment With Pediatric and Adolescent ACL Reconstruction

et al. 2022

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Background: The rate of anterior cruciate ligament (ACL) reconstruction is increasing over time in pediatric/adolescent populations, but there is less evidence to support how concomitant meniscal procedures are changing over time. There are also less data to suggest which characteristics are associated with meniscectomy versus meniscal repair treatment. Hypothesis: Age, sex, race/ethnicity, income, and insurance type may independently affect the rate of concomitant meniscal procedures and treatment modalities in pediatric patients with ACL reconstruction. Study Design: Descriptive epidemiology study. Methods: The Pediatric Health Information System database was queried for all patients aged ≤18 years who underwent ACL reconstruction with or without concomitant meniscal procedures from 2015 to 2019. Basic demographic data including age, sex, self-identified race/ethnicity, rural-urban commuting area code, predicted median income, and insurance status were collected. Linear regression was used to model trends and multiple logistic regression modeling was used to test for associations. Results: A total of 14,398 patients aged ≤18 years underwent ACL reconstruction during the study period, with 8337 patients (58%) having concomitant meniscal procedures with a 1.24-fold increase over 5 years. Of the concomitant meniscal treatment cohort, 41% had a meniscectomy and 59% had meniscal repair. There was a 0.82-fold change in meniscectomy and a 1.67-fold increase in meniscal repair during the study period. Male patients, older patients, Black race, living in an urban area, and those with nonprivate insurance had increased odds of undergoing a concomitant meniscal procedure (all P < .05). Patients of non-White race and those with nonprivate insurance had increased odds of having a meniscectomy versus meniscal repair (all P < .05). There were no associations detected between income bracket and the outcomes in this study. Conclusion: This study shows that in pediatric and adolescent patients undergoing ACL reconstruction, there was a rise in concomitant meniscal procedures from 2015 to 2019. In addition, patients of non-White race and those with nonprivate insurance have increased odds of undergoing meniscectomy versus meniscal repair.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Influence of Sex, Race/Ethnicity, and Socioeconomic Factors on Meniscal Treatment With Pediatric and Adolescent ACL Reconstruction

et al. 2022

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“…Apprehension test (Fairbanks sign) is positive when fast-protective quadriceps muscle activation is found as a consequence of pushing the patella laterally. 6 Clinical examination of the knee, including cruciate ligaments and menisci may be challenging in the acute phase.…”

Section: Assessment and Investigationmentioning

confidence: 99%

“…Treatment aims to prevent re-dislocation, residual instability, osteoarthritis and allows return to activities. 5 , 6 First-time patella dislocation has traditionally been managed non-operatively, although surgical management may be becoming more common in the pediatric cohort. 7 This is in part due to a lower rate of re-dislocation after surgery (22%), compared to non-operative care (31%).…”

Section: Introductionmentioning

confidence: 99%

Current concepts in the treatment of first-time patella dislocation in children and adolescents

Sinikumpu

Nicolaou

2023

Journal of Children's Orthopaedics

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Background: Lateral dislocation of the patella is a common injury in children. It can occur in previously healthy and anatomically normal knees, but there are several abnormalities that predispose to patellar instability. Magnetic resonance imaging is an essential part of assessing for associated injuries and risk of further instability. Treatment aims to prevent redislocation, residual instability, osteoarthritis, and allow return to previous activities. The purpose of this review was to assess evidence for management of first-time patella dislocation in children and adolescents. Methods: Literature review was performed, accompanied by the current best practice by the authors. Results: Non-operative treatment is preferred, except where there are associated injuries such as osteochondral fractures that would benefit from surgery. The exact method of ideal non-operative management is not clearly defined but should focus on restoration of range of movement and strength with bracing as indicated. There seems to be a trend toward operative intervention that may well be inappropriate. Conclusion: Further prospective studies are required with focus on the younger patient to fully understand if there is an at-risk group that would benefit from early surgery. Level of evidence: level III.

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“…Rates of patellar instability, and subsequent rates of medial patellofemoral ligament (MPFL) reconstruction (MPFLR), have been steadily increasing in the United States, especially in the active adolescent population. 9 Patellar dislocation occurs at a 3 to 5 times higher rate in 10- to 19-year-old patients compared with the general population. 25 Female adolescents 10 to 17 years of age experience the highest incidence (108/100,000 person-years) of patellar dislocation and the highest risk (36.8%) of recurrent instability.…”

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The Schöttle Point Is Consistently Located Distal to the Medial Femoral Physis in Pediatric Patients: A Digitally Reconstructed Radiographic Study

et al. 2022

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Background: Significant controversy surrounds ideal tunnel position for medial patellofemoral ligament (MPFL) reconstruction (MPFLR) in the pediatric setting. The start point for femoral tunnel positioning (the Schöttle point) relative to the distal medial femoral physis is not well defined. Previous studies provide conflicting data regarding position of the MPFL origin and the Schöttle point relative to the distal femoral physis. Hypothesis: The Schöttle point would be consistently distal to the distal medial femoral physis. Study Design: Descriptive laboratory study. Methods: The institutional picture archiving and communication system was queried for computed tomography (CT) imaging studies of pediatric knees. Data were imported to an open-source image computing platform. True lateral digitally reconstructed radiographs and 3-dimensional (3D) renderings were generated, and the Schöttle point was registered in 3D space. Then, 3D distance measurements were obtained from the Schöttle point to the distal medial femoral physis. Results: A total of 49 pediatric knee CT scans were included. Mean age was 13.0 ± 2.3 years. Mean minimum distance from the medial physis to the Schöttle point was 9.9 ± 3.0 mm (range, 3.4-16.1 mm). In 49 of 49 cases (100%), the Schöttle point was distal to the physis. Using a 6-mm reaming diameter would result in 3 of 49 (6%) femurs having violation of the distal medial femoral physis. Moving the start point 3 mm distally would result in 0 of 49 (0%) sustaining physeal injury. Conclusion/Clinical Relevance: The Schöttle point is consistently distal to the distal medial femoral physis. The mean minimum distance from the Schöttle point to the physis on the medial cortex is 9.9 mm. The Schöttle point provides a safe and reliable radiographic landmark for pediatric MPFLR, although reaming diameter should be considered.

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Increased incidence of acute patellar dislocations and patellar instability surgical procedures across the United States in paediatric and adolescent patients

Cited by 25 publications

References 39 publications

Influence of Sex, Race/Ethnicity, and Socioeconomic Factors on Meniscal Treatment With Pediatric and Adolescent ACL Reconstruction

Influence of Sex, Race/Ethnicity, and Socioeconomic Factors on Meniscal Treatment With Pediatric and Adolescent ACL Reconstruction

Current concepts in the treatment of first-time patella dislocation in children and adolescents

The Schöttle Point Is Consistently Located Distal to the Medial Femoral Physis in Pediatric Patients: A Digitally Reconstructed Radiographic Study

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