Surgical Treatment of Acute Patella Dislocations: Review of 13 Consecutive Cases from Keller Army Hospital

Owens, Brett D.; Jordan, Christopher P.; Ross, Amy E.; Nelson, Bradley J.; Taylor, Dean C.; DeBerardino, Thomas M.

doi:10.2174/1874387000802010082

Cited by 2 publications

(4 citation statements)

References 18 publications

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“…Immediate surgical repair of the injured medial patellar stabilizers, including the vastus medialis obliquus muscle and the MPFL is advocated in this situation which helps preventing redislocation [37]. In other studies by Camanho et al [16], Sallay et al [17], Ahmad et al [18], and Keller Army Hospital in USA [15], MPFL repair or reconstruction was performed at the time of surgery in patients diagnosed with PTPD along with MPFL lesion.…”

Section: Discussionmentioning

confidence: 99%

“…As per literature, MPFL repair or reconstruction along with OCF fixation is considered as essential management for PTPD [15,16,17,18] mainly to prevent redislocation and recurrent instability. Thus, the purpose of this study is to evaluate patellar stability after surgical management of acute PTPD treated with only OCF fixation without performing MPFL repair or reconstruction and without correcting underlying bony pathology.…”

Section: Introductionmentioning

confidence: 99%

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Clinical outcome of Patella stability after fixation of Osteochondral fracture in Acute Primary Traumatic Patella Dislocation without MPFL Repair or Reconstruction

Laddha,

Pancholiya,

Gaura

2022

Jcorth

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Introduction: Conservative management is advisable for acute primary traumatic patella dislocation (PTPD). Surgical treatment is reserved for osteochondral fractures (OCF), medial patello femoral ligament (MPFL) avulsion/tear, compound injuries, and any underlying bony abnormalities requiring correction. MPFL repair (at avulsed site) or reconstruction along with underlying bony correction in PTPD is controversial. The purpose of this study is to evaluate patella stability after fixation of OCF in PTPD without performing MPFL repair or reconstruction, even in the presence of any underlying bony abnormalities. Material and Methods: This is a retrospective study of eight patients who had PTPD with OCF along with MPFL injury who presented between 2016 and 2019. Pre-operative X-rays and MRI were done to assess the status of MPFL, identify the presence of OCF and to calculate Insall-Salvati index, Tibial Tuberosity-Trochlear groove distance and Trochlear dysplasia. All patients underwent surgery by open approach and OCF fixation by bioabsorbable pins or suture material. MPFL was neither repaired at avulsed site nor reconstructed and even no bony corrections were done. Results: Average size of OCF fragments is 15*7 mm and all involving medial facet of patella. Lysholm score improved significantly from 32.8 to 94.8 and Kujala score from 49.1 to 96 at the end of 6 months. None of the patient had patella instability till latest follow-up, average follow-up period is 4.5 years (3–6 years). Clinically, apprehension test was negative in all cases with full ROM. Post-operative imaging including X-ray and MRI showed complete healing of the OCF along with complete healing/regeneration of MPFL with same pre-existing bony abnormalities if present preoperatively. Conclusion: This study shows excellent patella stability and full knee function along with complete union of OCF and complete healing/regeneration of MPFL in PTPD even in the presence of underlying bony abnormality. Hence, in PTPD with OCF, there is no need to repair/reconstruct MPFL or to correct underlying bony pathology, only OCF fixation is required.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical outcome of Patella stability after fixation of Osteochondral fracture in Acute Primary Traumatic Patella Dislocation without MPFL Repair or Reconstruction

Laddha,

Pancholiya,

Gaura

2022

Jcorth

View full text Add to dashboard Cite

show abstract

“…The MPFL is the patella's primary medial soft tissue restraint and is often torn during a patellar dislocation ( Fig 6). 7,13 Since axial MRI views were either not performed in Wuhan or provided, the extent of the patient's MPFL damage was not fully identified before ultrasound imaging.…”

Section: Case Reportmentioning

confidence: 99%

“…5,6 Most first-time traumatic patellar dislocations are treated nonoperatively with a closed reduction technique unless there is evidence of osteochondral fracture, a displaced osteochondral fragment, or gross patellofemoral instability. 7,8 The presence of large amounts of sub-patellar effusion which may require aspiration of fluid, raises the likelihood of a significant osteochondral fracture. 4 While most patients affected by this injury report to a hospital emergency department for initial assessment and treatment, they may present to a chiropractic physician or general practitioner's office, especially in rural areas.…”

Section: Introductionmentioning

confidence: 99%