Operative versus closed treatment of primary dislocation of the patella Similar 2-year results in 125 randomized patients

Nikku, Risto; Nietosvaara, Yrjänä; Kallio, Pentti; Aalto, Kari; Michelsson, Jarl-Erik

doi:10.3109/17453679708996254

Cited by 192 publications

(132 citation statements)

References 12 publications

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“…Surgical realignment was compared with immobilization for 3 weeks followed by functional rehabilitation. The results were similar after 2 years (Nikku et al 1997). We have now reassessed the following by questionnaire after 5 years or more: subjective opinion, stability, knee score and later operations.…”

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confidence: 55%

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Operative treatment of primary patellar dislocation does not improve medium-term outcome

et al. 2005

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BackgroundThe best treatment for primary patellar dislocation has been the subject of debate. Surgery has been recommended for all patients or for special subgroups to improve outcome. We have previously reported similar 2-year results after closed or open treatment. This report concerns 127 patients who were re-evaluated by questionnaire at least 5 years after the primary onset.Patients and methods At baseline, the patients were randomized regarding closed treatment (57) or individually adjusted proximal realignment operation (70). All patients were re-evaluated after a mean follow-up of 7 (6-9) years.Results The outcomes were similar: the patient's own overall opinion was excellent or good after closed treatment in 81% of cases and after operative treatment in 67%. Mean Kujala and Hughston VAS knee scores were 90 and 94, respectively, after closed treatment and 88 and 89 after operative treatment. The proportions of stable patellae were 30% and 36% for closed treatment and operative treatment, respectively. In a multivariate risk analysis, there was a correlation between a Kujala score of less than 90 and female sex (OR: 3.5; 95% CI: 1.4-9.0), loose bodies on radiographs (4.1; 1.2-15), and also an initial history of contralateral patellar instability (3.6; 0.9-15). There were 2 risk factors for recurrent instability: initial contralateral instability (4.9; 0.9-28) and young age (0.9; 0.8-1.0/year). Girls with open tibial apophysis had the worst prognosis for instability (88%; 95% CI: 77-98).Interpretation We do not recommend proximal realignment surgery for treatment of primary dislocation of the patella.

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confidence: 55%

“…The aftercare was identical in groups C and O. We have previously reported this patient series in detail, including their 2-year outcome (Nikku et al 1997).…”

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Operative treatment of primary patellar dislocation does not improve medium-term outcome

et al. 2005

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“…White and Sherman in a recent literature review on patellofemoral instability concluded that accepted indications for surgery in the acute setting to be osteochondral fragments, persistent patellar subluxation and detachment of the VMO and medial retinaculum from the medial aspect of the patella [8]. The only prospective randomized clinical trial on conservative versus operative treatment after acute patellar dislocation was published in 1997 by Nikku et al [9]. Two to 5 years postoperatively they did not find any significant difference between groups in recurrent instability.…”

Section: Discussionmentioning

confidence: 99%

All-Inside Arthroscopic Proximal Patellar Realignment

Fahmy¹

2015

Orthop Muscular Syst

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“…A small number of older randomized trials comparing operative and nonoperative treatment of initial patellar dislocation found no benefit from immediate medial retinacular repair [51,52]. Currently, nonoperative treatment is indicated in acute first-time dislocators without associated osteochondral fracture or loose bodies.…”

Section: Nonoperative Managementmentioning

confidence: 99%

Patellofemoral Joint Instability: A Review of Current Concepts

Kader¹,

Matar²,

Caplan³

2016

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The patellofemoral joint remains the enigma of orthopedics and sports medicine. Patellar dislocation is a common problem in the younger and athletic population and it is more disabling than cruciate ligament injuries. The pathology is often multifactorial and complex with no one factor being the sole defining etiology. The current management of patella dislocation has been linked with poor patient satisfaction possibly due to a prolonged period of conservative treatment and the general tendency to delay surgical intervention. This review will address the main abnormal anatomical factors contributing to patellar instability, their clinical and radiological diagnoses, and the role of various surgical interventions, including the medial patellofemoral ligament reconstruction in stabilizing the patella.

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Operative versus closed treatment of primary dislocation of the patella Similar 2-year results in 125 randomized patients

Cited by 192 publications

References 12 publications

Operative treatment of primary patellar dislocation does not improve medium-term outcome

Operative treatment of primary patellar dislocation does not improve medium-term outcome

All-Inside Arthroscopic Proximal Patellar Realignment

Patellofemoral Joint Instability: A Review of Current Concepts

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