Surgical Management of Patellofemoral Instability in the Skeletally Immature Patient

Redler, Lauren H.; Wright, Margaret L.

doi:10.5435/jaaos-d-17-00255

Cited by 27 publications

(13 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Recognition and treatment of PFI have undergone considerable evolution in recent years, with more than 100 different surgical techniques reported in the literature [ 72 , 73 , 74 , 75 , 76 ]. In patients with a first-time dislocation without significant risk factors for recurrence and no osteochondral fracture, non-operative management is recommended [ 9 ].…”

Section: Treatmentmentioning

confidence: 99%

Coronal and Transverse Malalignment in Pediatric Patellofemoral Instability

Palmer

Podeszwa

Wilson

et al. 2021

JCM

View full text Add to dashboard Cite

Patellofemoral instability (PFI) encompasses symptomatic patellar instability, patella subluxations, and frank dislocations. Previous studies have estimated the incidence of acute patellar dislocation at 43 per 100,000 children younger than age 16 years. The medial patellofemoral ligament (MPFL) complex is a static soft tissue constraint that stabilizes the patellofemoral joint serving as a checkrein to prevent lateral displacement. The causes of PFI are multifactorial and not attributed solely to anatomic features within the knee joint proper. Specific anatomic features to consider include patella alta, increased tibial tubercle–trochlear groove distance, genu valgum, external tibial torsion, femoral anteversion, and ligamentous laxity. The purpose of this paper is to provide a review of the evaluation of PFI in the pediatric and adolescent patient with a specific focus on the contributions of coronal and transverse plane deformities. Moreover, a framework will be provided for the incorporation of bony procedures to address these issues.

show abstract

Section: Treatmentmentioning

confidence: 99%

Coronal and Transverse Malalignment in Pediatric Patellofemoral Instability

Palmer

Podeszwa

Wilson

et al. 2021

JCM

View full text Add to dashboard Cite

show abstract

“…65 Overall, operative intervention has been shown to result in adequate patient outcomes, satisfaction, and postoperative stability. 16,18,58,63,68,88 Improved knowledge about pathologies involving the patellofemoral joint has been a major driving force for tailored management. 90 With the increase in treatment approaches and research on patellar instability, it is imperative to analyze the types and quality of these investigations to determine the driving factors for current and future clinical practice.…”

mentioning

confidence: 99%

Assessment and Trends of the Methodological Quality of the Top 50 Most Cited Articles on Patellar Instability

Agarwalla

Yao

Gowd

et al. 2021

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

Background: Studies with a low level of evidence (LOE) have dominated the top cited research in many areas of orthopaedics. The wide range of treatment options for patellar instability necessitates an investigation to determine the types of studies that drive clinical practice. Purpose: To determine (1) the top 50 most cited articles on patellar instability and (2) the correlation between the number of citations and LOE or methodological quality. Study Design: Cross-sectional study. Methods: The Scopus and Web of Science databases were assessed to determine the top 50 most cited articles on patellar instability between 1985 and 2019. Bibliographic information, number of citations, and LOE were collected. Methodological quality was calculated using the Modified Coleman Methodology Score (MCMS) and the Methodological Index for Non-Randomized Studies (MINORS). Mean citations and mean citation density (citations per year) were correlated with LOE, MCMS, and MINORS scores. Results: Most studies were cadaveric (n = 10; 20.0%), published in the American Journal of Sports Medicine (n = 13; 26.0%), published between 2000 and 2009 (n = 41; 82.0%), and conducted in the United States (n = 17; 34.0%). The mean number of citations and the citation density were 158.61 ± 59.53 (range, 95.5-400.5) and 12.74 ± 5.12, respectively. The mean MCMS and MINORS scores were 59.62 ± 12.58 and 16.24 ± 3.72, respectively. No correlation was seen between mean number of citations or citation density versus LOE. A significant difference was found in the mean LOE of articles published between 1990 and 1999 (5.0 ± 0) versus those published between 2000 and 2009 (3.12 ± 1.38; P = .03) and between 2010 and 2019 (3.00 ± 1.10; P = .01). Conclusion: There was a shift in research from anatomy toward outcomes in patellar instability; however, these articles demonstrated low LOE and methodological quality. Higher quality studies are necessary to establish informed standards of management of patellar instability.

show abstract

“…26 Repair should only be considered for patients with an initial patellar dislocation who are undergoing a concomitant procedure (eg, osteochondral repair) because MPFL repair has been shown to result in just as many recurrent dislocations as nonoperative management and more recurrent dislocations than MPFL reconstruction. 31,35 MPFL injuries can occur at the femoral insertion, midsubstance, patellar attachment, or more than 1 of these sites. 11,15 MPFL injuries at the femoral attachment tend to be more common in adults, while MPFL injuries at the patellar attachment tend to be more common in children and adolescents.…”

mentioning

confidence: 99%

Prevalence and Site of Medial Patellofemoral Ligament Injuries in Patients With Acute Lateral Patellar Dislocations: A Systematic Review and Meta-analysis

Kluczynski

Miranda

Marzo

2020

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

Background: Medial patellofemoral ligament (MPFL) injuries are common in patients with acute lateral patellar dislocations, but the pattern of MPFL injuries is unclear, especially with respect to patient age. Purpose: The primary aim was to determine the prevalence of MPFL injuries according to the site of injury in patients with acute lateral patellar dislocations. The secondary aim was to compare the site of MPFL injuries in patients aged ≤16 versus >16 years. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic literature search was performed with PubMed, Embase, and CINAHL to identify articles published from January 1, 1999, to May 31, 2019, that examined the site of MPFL injuries in patients with acute patellar dislocations. The study design, sample size, age at injury, technique used for diagnosing MPFL injuries (magnetic resonance imaging, ultrasound, and/or surgery), and prevalence and site of MPFL injuries were extracted from each study. The pooled estimate of the proportion of MPFL injuries at each site was calculated (femur, patella, midsubstance, and combined sites of injury) as well as proportions stratified by age group (≤16 and >16 years). Results: The literature search yielded 420 unique articles, of which 52 were screened for eligibility; of these, 17 were excluded. Thus, a total of 35 articles (2558 patients) were included in the final analysis. The overall prevalence of MPFL injuries was 94.7% (95% CI, 91.2%-96.8%). Most MPFL injuries occurred at the patella (37.1% [95% CI, 30.8%-43.9%]), followed by the femur (36.8% [95% CI, 31.0%-43.0%]), combined sites (25.1% [95% CI, 20.7%-30.1%]), and the midsubstance (15.6% [95% CI, 13.2%-18.4%]). In patients aged ≤16 years, most MPFL injuries occurred at the patella (39.3% [95% CI, 27.9%-51.9%]), and in patients aged >16 years, most MPFL injuries occurred at the femur (47.2% [95% CI, 40.6%-54.0%]). Conclusion: The prevalence of MPFL injuries in patients with acute patellar dislocations varied by site of injury and by age. MPFL injuries at the patella were most prevalent overall and in children and adolescents, and MPFL injuries at the femur were more prevalent in adults.

show abstract

Surgical Management of Patellofemoral Instability in the Skeletally Immature Patient

Cited by 27 publications

References 45 publications

Coronal and Transverse Malalignment in Pediatric Patellofemoral Instability

Coronal and Transverse Malalignment in Pediatric Patellofemoral Instability

Assessment and Trends of the Methodological Quality of the Top 50 Most Cited Articles on Patellar Instability

Prevalence and Site of Medial Patellofemoral Ligament Injuries in Patients With Acute Lateral Patellar Dislocations: A Systematic Review and Meta-analysis

Contact Info

Product

Resources

About