Is the patella apprehension test a valid diagnostic test for patellar instability? A systematic review

Lastoria, Diego Agustín Abelleyra; Kenny, Bill; Dardak, Sara; Brookes, Charlotte; Hing, Caroline B.

doi:10.1016/j.jor.2023.07.005

Cited by 3 publications

(1 citation statement)

References 48 publications

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“…The treatment recommendations in case of no associated injuries are fairly uniform in recommending conservative treatment first [ 9 , 10 , 23 , 24 , 26 ]. In case a re‐dislocation occurs, or the patient demonstrates apprehension [ 1 ] or reports pain [ 10 ], the issue at hand is more complex and is labelled patellofemoral joint instability (PFJI) [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Promising results following derotational femoral osteotomy in patellofemoral instability with increased femoral anteversion: A systematic review on current indications, outcomes and complication rate

Klasan,

Compagnoni,

Grassi

et al. 2024

J. exp. orthop.

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PurposePatellofemoral joint instability (PFJI) can surgically be treated with a multitude of approaches, depending on the underlying pathology. In the presence of increased femoral anteversion, some authors have reported good results with a derotational distal femoral osteotomy (DeDFO). The purpose of the study was to investigate the indications, outcomes and complication rate of DeDFO for PFJI.MethodsA systematic review was performed according to the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta‐analyses) by searching Medline, Embase, Web of Science and Cochrane Library databases through 1 December 2023. Included were levels 1–4 clinical studies of skeletally mature patients undergoing a DeDFO for PFJI irrespective of concomitant procedures. Study characteristics, indications, radiological and clinical outcomes, surgical technique and concomitant procedures, re‐dislocation and complication rate were all analysed, as was methodological quality.ResultsA total of 12 studies including 310 patients (325 knees) were included. Three studies were cohort studies, all others were case series. The mean patient age across the studies was 22 years, and the mean follow‐up was 29.4 months. Femoral anteversion cut‐off was between 20° and 30°. Every study included at least one concurrent soft tissue, bony or combined procedure. Across all studies, one case of re‐dislocation was reported (0.3%) and four implant or osteotomy‐related complications (1.2%) were reported. All studies reported a statistically significant increase in clinical scores.ConclusionThis systematic review of DeDFO for patellofemoral instability in the presence of increased femoral anteversion demonstrates promising clinical results and an extremely low dislocation and complication rate. The heterogeneity of the cut‐off in anteversion and concomitant procedures, especially tibial tubercle osteotomy with seemingly identical results, indicates the need for high‐quality evidence for treating patellofemoral instability. Based upon this systematic review, we strongly recommend that DeDFO be added to the ‘menu à la carte’ of PFJI.Level of EvidenceLevel III Systematic Review.

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Section: Introductionmentioning

confidence: 99%

Promising results following derotational femoral osteotomy in patellofemoral instability with increased femoral anteversion: A systematic review on current indications, outcomes and complication rate

Klasan,

Compagnoni,

Grassi

et al. 2024

J. exp. orthop.

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Subjective grade of apprehension during the pivot‐shift test reflects patient‐reported outcomes more than conventional pivot‐shift test grade after ACL reconstruction

Nakamae,

Tsukisaka,

Deie

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeTo investigate whether the pivot‐shift test reflects patient‐reported outcomes 1 year after anterior cruciate ligament (ACL) reconstruction based on a multicentre prospective cohort study.MethodsThis study included patients who underwent primary ACL reconstruction using the hamstring tendons. The pivot‐shift test grades were determined according to the International Knee Documentation Committee (IKDC) form as 0, 1+, 2+ or 3+. In addition, patients' subjective apprehension during the pivot‐shift test were classified as 0 (no‐apprehension), 1+ (mild‐apprehension), 2+ (moderate‐apprehension) or 3+ (severe‐apprehension). In this study, a positive pivot‐shift test was defined as grade 1+ or higher.ResultsA total of 837 patients were enroled in this study. One year postoperatively, there was no significant difference in the Knee injury and Osteoarthritis Outcome Score (KOOS), IKDC score, Lysholm knee scale and Tegner activity scale between the positive (118 patients) and negative (719 patients) groups of the conventional IKDC grading of the pivot‐shift test. However, when divided into two groups based on the apprehension grading of the pivot‐shift test after surgery, the postoperative scores were significantly lower in the apprehension‐positive group (114 patients) than those in the apprehension‐negative group (723 patients) on the Tegner activity scale and KOOS Symptom, Sports/Rec and Quality of Life subscales.ConclusionsPatients' subjective apprehension during the pivot‐shift test after ACL reconstruction was significantly associated with the postoperative Tegner activity scale and three subscales of the KOOS. However, there was no association between the conventional IKDC grading of the pivot‐shift test and any patient‐reported outcomes postoperatively.Level of EvidenceLevel II.

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Exame físico em Reumatologia: membros inferiores

Magalhães

2023

Rev Paul Reumatol

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Este artigo apresenta, de forma sucinta, o exame físico das regiões do quadril, joelho, tornozelos e pés, contemplando as etapas de inspeção, palpação, avaliação da amplitude de movimento, força, além de destacar algumas manobras e testes frequentemente utilizados na prática clínica. Mesmo com os avanços da medicina no tocante aos procedimentos de investigação por imagem e laboratório, o exame físico continua a desempenhar um papel essencial na confirmação da história clínica, orientar o tratamento e também direcionar a necessidade de exames complementares. A boa técnica de exame físico não apenas qualifica o médico, mas também proporciona ao paciente uma avaliação abrangente e segura. Unitermos: propedêutica; exame; quadril; joelho; pé.

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Is the patella apprehension test a valid diagnostic test for patellar instability? A systematic review

Cited by 3 publications

References 48 publications

Promising results following derotational femoral osteotomy in patellofemoral instability with increased femoral anteversion: A systematic review on current indications, outcomes and complication rate

Promising results following derotational femoral osteotomy in patellofemoral instability with increased femoral anteversion: A systematic review on current indications, outcomes and complication rate

Subjective grade of apprehension during the pivot‐shift test reflects patient‐reported outcomes more than conventional pivot‐shift test grade after ACL reconstruction

Exame físico em Reumatologia: membros inferiores

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