Lateral Patellar Dislocation

Watson, Richard; Sullivan, Breanna; Stone, Austin V.; Jacobs, Cale A.; Malone, Terry; Heebner, Nicholas R.; Noehren, Brian

doi:10.2106/jbjs.rvw.21.00159

Cited by 7 publications

(11 citation statements)

References 113 publications

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“…Thus, early functional training can be performed 13,18 . Moreover, due to muscle use, blood flow is increased, effectively reducing tissue edema and venous thrombus of the lower limbs and further speeding rehabilitation 25–27 . The findings of the present study were consistent with these previous reports.…”

Section: Discussionsupporting

confidence: 91%

“…13,18 Moreover, due to muscle use, blood flow is increased, effectively reducing tissue edema and venous thrombus of the lower limbs and further speeding rehabilitation. [25][26][27] The findings of the present study were consistent with these previous reports. After the "3-in-1" procedure for RPD, the ACB combined with GA controlled the pain score during activity to 40 or below.…”

Section: Rehabilitation Promotion Of Acbsupporting

confidence: 93%

See 1 more Smart Citation

Adductor Canal Block Combined with General Analgesia for Patients with Recurrent Patellar Dislocation Undergoing “3‐in‐1” Procedure Surgery: A Prospective Randomized Controlled Trial

Xiong

et al. 2023

Orthopaedic Surgery

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Objective: Patellar dislocation is a common injury in sports medicine. While surgical treatment is an important option, pain is severe after surgery. This study compared the analgesic effect and early rehabilitation quality between adductor canal block combined with general analgesia (ACB + GA) and single general analgesia (SGA) after recurrent patellar dislocation (RPD) for "3-in-1" procedure surgery.Methods: From July 2018 to January 2020, a prospective randomized controlled trial was conducted in analgesia management after RPD for "3-in-1" procedure surgery. The 40 patients in the experimental group received ACB (0.3% ropivacaine 30 mL) + GA, while the 38 patients in the control group received SGA. Patients in both groups received "3-in-1" procedure surgery, standardized anesthesia, and analgesia during hospitalization. The outcomes included the visual analog scale (VAS), quadriceps strength, Inpatient Satisfaction Questionnaire (IPSQ), Lysholm scores, and Kujala scores. Total rescue analgesic consumption and adverse events were also recorded. One-way analysis of variance (ANOVA) was used to compare continuous variables between groups and chi-square or Fisher's exact tests were used to compare count data. Nonparametric Kruskal-Wallis H tests evaluated ranked data.Results: No significant differences in resting VAS scores were observed at 8, 12, and 24 h postoperatively. However, the flexion and moving VAS scores of the ACB + GA group were significantly lower than those of the SGA group (p < 0.05). Meanwhile, the first triggering of rescue analgesics was advanced in the SGA group (p < 0.0001), and the dose of opioid analgesics was significantly higher (p < 0.0001). The quadriceps strength of the ACB + GA group was higher than that of the SGA group at 8 h postoperatively. The IPSQ of the ACB + GA group was significantly higher 24 h postoperatively. We observed no significant differences in Lysholm and Kujala scores between the two groups at 3 months after surgery. Conclusions:Early analgesia management of ACB + GA showed excellent analgesia effectiveness and a positive hospitalization experience for RPD patients undergoing "3-in-1" procedure surgery. Moreover, this management was good for early rehabilitation.

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Section: Discussionsupporting

confidence: 91%

Section: Rehabilitation Promotion Of Acbsupporting

confidence: 93%

Adductor Canal Block Combined with General Analgesia for Patients with Recurrent Patellar Dislocation Undergoing “3‐in‐1” Procedure Surgery: A Prospective Randomized Controlled Trial

Xiong

et al. 2023

Orthopaedic Surgery

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“…Additionally, the thresholds or cutoff values calculated in the current study were simply used to assess the anatomic risks of RPD, which is not the same as the critical thresholds for surgical indications, as the latter are mainly decided by multiple clinical and biomechanical studies to transform the radiographic results into clinical practice. However, diagnostic imaging is still one of the first steps to determine the predominant pathology of RPD and the basic components of treatment management [47].…”

Section: Discussionmentioning

confidence: 99%

Sulcus depth, congruence angle, Wiberg index, TT-TG distance, and CDI are strong predictors of recurrent patellar dislocation

Chen

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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PurposeTo characterize patellofemoral morphology, determine radiological cutoff values based on computed tomography (CT) images, and clarify predominant anatomic risk factors in young patients with recurrent patellar dislocation (RPD). MethodsA total of 212 knees (age 23.0 ± 5.3 years, female: male = 110:102) with CT‐confirmed RPD were enrolled for analysis. The control group was matched by age and sex (2:1). Patellofemoral and trochlear morphology, patellofemoral alignment, and other parameters were assessed by CT. Standardized methods were used for measurements. Receiver operating characteristic (ROC) curves and the areas under the ROC curve (AUCs) were used to assess accuracy in diagnosing RPD. The index of union (IU) was employed to identify a cutoff value for risk. A binary logistic regression model (Forward, LR) was constructed, and standardized coefficients were calculated to compare the relative strength of different predictors. Factors included in the model were employed to calculate distributions in the studied population. ResultsThe majority of measurements showed a significant difference between the RPD and control groups when comparing mean values. The AUC value was favorable for sulcus depth and significantly better than that for other trochlear morphology parameters (P < 0.0001). Cutoff values were 0.58 for the Wiberg index, 153.3° for the sulcus angle, 3.6 mm for the sulcus depth, 1.94 for the trochlear width ratio, 16.2° for the lateral trochlear inclination, 17.2° for the patellar lateral tilt, 25.5° for the congruence angle, 1.2 for the patellar height [Caton–Deschamps index (CDI)], 6.1° for the knee rotation, and 16.4 mm for the tibial tubercle–trochlear groove (TT‐TG) distance. A binary logistic regression model (χ2 = 20.826, P = 0.008) including the Wiberg index, sulcus depth, congruence angle, patellar height (CDI), and TT‐TG distance was constructed for RPD (P ≤ 0.015), which showed excellent diagnostic performance, as indicated by an AUC of 0.989 (95% CI, 0.979 to 0.998). Sulcus depth showed the strongest relationship with RPD, followed by the congruence angle and Wiberg index, as indicated by the standardized coefficients − 1.43, 1.02, and 0.97, respectively. Eighty‐seven percent of the RPD population had sulcus depth ≤ 3.6 mm. ConclusionsThis study provides a systematic reference of cutoff values based on CT data. The combination of five anatomic risk factors (sulcus depth, congruence angle, Wiberg index, TT‐TG distance, and CDI) may be an excellent predictor of RPD as initial risk assessment. Sulcus depth, as the most frequently observed anatomic risk factor, showed the best diagnostic performance among trochlear morphological parameters and the strongest relationship with RPD, followed by the congruence angle and Wiberg index. In clinical practice, the sulcus depth, congruence angle, Wiberg index, TT‐TG distance, and CDI with the proposed cutoff values can be used in combination to evaluate RPD. When assessing trochlear morphology, sulcus depth is recommended as the best radi...

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“…The standard of care for patients with an acute patellar dislocation without osteochondral loose bodies or fracture is conservative. However, a recent critical review that evaluated comparative studies regarding diferent approaches for the treatment of irst-time patellar dislocation reported no consensus and clear guidelines on management [25]. This study aimed to evaluate the current management and potential controversies amongst experienced knee surgeries in the treatment of the irst episode of patellar dislocation.…”

Section: Introductionmentioning

confidence: 99%

Management of the first episode of traumatic patellar dislocation: an international survey

D’Ambrosi

Migliorini

Cerciello

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose This international survey aimed to evaluate the potential controversies regarding the management of irst patellar dislocation amongst experienced knee surgeries in the treatment of the irst episode of patellar dislocation without osteochondral fragments. Methods An online survey was conducted from February 2021 to December 2021 to assess the global trend in the diagnosis and management of irst-time patellar dislocation without osteochondral fragments. The online survey was accessible on the homepage of the website of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA). The questionnaire consisted of multiple-choice questions and was divided into three sections. The irst section consisted of eight questions regarding demographic information, professional activity, and responder experience. The second section consisted of 13 questions regarding the approach to a irst patellar dislocation (clinical examination, imaging, and rehabilitation). The third section contained 2 questions concerning the relevance of patient characteristics to the therapeutic algorithm (age, sports, and pathoanatomical predisposing risk factors). Results A total of 438 orthopaedic surgeons worldwide completed the questionnaire. At the irst approach to diagnose a irst-time patellar dislocation, 251 (57%) of the surgeons requested plain radiographs, and 158 (36%) requested magnetic resonance imaging (MRI). In conservatively treated patients, 368 (84%) of the respondents recommended the use of a knee brace. Amongst them, 14 (3%) advocated its use for one week, 75 (17%) for two weeks, 123 (28%) for three weeks, 105 (24%) for four weeks, and 97 (22%) for six weeks. In conservatively treated patients, 215 (49%) of the surgeons recommended load to tolerance, 148 (34%) recommended 30% to 60% of the bodyweight, and 75 (17%) advised against weight-bearing. More than half of the surgeons considered a patient aged less than 35 years practising contact sports to be a candidate for the medial patello-femoral ligament (MPFL) procedure. In addition, a tibial tuberosity to trochlear groove distance (TT-TG) distance of 15 to > 20 mm (for > 75% of the surgeons) and a trochlea types C and D (for > 70% of the surgeons) were considered possible indications for direct surgical management. Conclusion At the irst approach to diagnose a irst-time patellar dislocation, plain radiographs and MRI should be performed. In conservatively treated patients, most of the surgeons recommend weight-bearing to tolerance and a knee brace during the irst four weeks, with range of motion of full extension to 30° during the irst 15 days and up to 60° for an additional 15 days. Surgical management should be performed in patients in the second and third decades of life practising contact sports and in those patients who present types C and D trochlea dysplasia and patella alta. Level of evidence IV.

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Lateral Patellar Dislocation

Cited by 7 publications

References 113 publications

Adductor Canal Block Combined with General Analgesia for Patients with Recurrent Patellar Dislocation Undergoing “3‐in‐1” Procedure Surgery: A Prospective Randomized Controlled Trial

Adductor Canal Block Combined with General Analgesia for Patients with Recurrent Patellar Dislocation Undergoing “3‐in‐1” Procedure Surgery: A Prospective Randomized Controlled Trial

Sulcus depth, congruence angle, Wiberg index, TT-TG distance, and CDI are strong predictors of recurrent patellar dislocation

Management of the first episode of traumatic patellar dislocation: an international survey

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