Surgical versus non-surgical interventions for treating patellar dislocation

Smith, Toby O; Gaukroger, Andrew; Metcalfe, Andrew; Hing, Caroline

doi:10.1002/14651858.cd008106.pub4

Cited by 7 publications

(6 citation statements)

References 78 publications

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“…Recurrent patellar dislocation is a common and debilitating condition with multifactorial aetiologies associated with various pathoanatomical factors, which usually affects young active children and adolescents [6,20,26]. Of all the anatomical variants, increased femoral torsion is a potential risk factor for recurrent patellar dislocation, which may exert a persistent lateralizing force vector on the patella and lead to increased tension of the reconstructed medial patellofemoral ligament (MPFL), thus causing anterior knee pain, patellar maltracking, early cartilage degeneration, graft failure and patellar redislocation [8,10,19,21,24,28,30].…”

Section: Introductionmentioning

confidence: 99%

Distal femoral torsion is correlated with higher‐grade trochlear dysplasia and shorter anterior condyles in patients with patellar dislocation and increased femoral torsion

Hao,

Niu,

Huo

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose To describe the characteristics of femoral torsion in patients with different segmental torsion types and to evaluate the correlations between segmental torsion and the morphology of the femoral condyles and trochlea in patients with patellar dislocation and increased femoral torsion. Methods Between January 2021 and March 2023, 69 patients were included and classified into two groups according to the femoral segment contributing the most to total torsion: 32 patients in Group A (femoral neck and shaft torsion) and 37 patients in Group B (distal torsion). Trochlear dysplasia was evaluated using Dejour's classification and sulcus angle. The morphology of the femoral condyles was evaluated using the lengths and ratios of the medial and lateral condyles. Correlations between femoral torsion and morphology were evaluated. Results Total torsion was significantly correlated with femoral neck and shaft torsion (r = 0.882, P < 0.001) and distal torsion (r = 0.262, P = 0.030). Femoral neck and shaft torsion was significantly increased with increasing total torsion. The trochlear sulcus was flatter and more dysplastic, and the anterior condyles were shorter in Group B. Distal torsion was significantly correlated with the lengths of the medial and lateral anterior condyles (r = − 0.567, P < 0.001; r = -0.701, P < 0.001), sulcus angle (r = 0.611, P < 0.001) and Dejour trochlea type (r = 0.512, P = 0.001), while femoral neck and shaft torsion showed no correlations. Conclusion Femoral torsion is a complex of femoral neck and shaft torsion and distal torsion, especially femoral neck and shaft torsion. Distal torsion was significantly correlated with a flatter trochlear sulcus, higher-grade trochlear dysplasia, and shorter anterior condyles. The new findings highlighted the importance of the segmental evaluation of femoral torsion, which would facilitate understanding of the anatomical characteristics of femoral torsion in patients with patellar dislocation and increased femoral torsion and may lead to improvement in the surgical options regarding femoral torsion. Level of evidence Level III.

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Section: Introductionmentioning

confidence: 99%

Distal femoral torsion is correlated with higher‐grade trochlear dysplasia and shorter anterior condyles in patients with patellar dislocation and increased femoral torsion

Hao,

Niu,

Huo

et al. 2023

Knee surg. sports traumatol. arthrosc.

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“…37 Previous research focused on how trochlear dysplasia, joint alignment, patellofemoral soft tissue forces, and patient age contribute to the origin of LPD. 9,19,[23][24][25]39 This research highlights adolescent age, patella alta, and trochlear dysplasia as strong risk factors for acute and recurrent patellar dislocation. 3,18 More recently, researchers 37 have created predictive algorithms to identify individuals most at risk for recurrent dislocations, as a guide for interventional decision-making.…”

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confidence: 97%

“…12,19 In most cases, the primary treatment for initial LPD is nonoperative management (eg, bracing and physical therapy). 22,39 Surgical intervention may be necessary after a primary LPD associated with an osteochondral loose body. 19 A recent review demonstrated a lack of convincing evidence to change current practice guidelines for patients with first-time patellar dislocation (eg, nonsurgical vs surgical management).…”

mentioning

confidence: 99%

“…19 A recent review demonstrated a lack of convincing evidence to change current practice guidelines for patients with first-time patellar dislocation (eg, nonsurgical vs surgical management). 39 This is despite the fact that ~25% to 60% of primary dislocations will become recurrent, necessitating surgical intervention (eg, MPFL reconstruction and/or tibial tubercle osteotomy). 8,16,21,44 Even without recurrent dislocation, quality of life outcomes are often poor after a primary dislocation (eg, only 26% of patients with primary LPD are able to return to their desired sports activities without limitations).…”

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confidence: 99%

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The Importance of Medial Patellar Shape as a Risk Factor for Recurrent Patellar Dislocation in Adults

Sheehan,

Shah,

Boden

2024

Am J Sports Med

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Background: Research on the cause of lateral patellar dislocation (LPD) has focused on trochlear morphologic parameters, joint alignment, and patellofemoral soft tissue forces. A paucity of information is available regarding how patellar morphologic parameters influence the risk for LPD. Purpose/Hypothesis: The purpose was to assess whether patellar morphology is a risk factor for recurrent LPD. It was hypothesized that (1) patients with recurrent LPD would have decreased patellar width and volume and (2) patellar morphologic parameters would accurately discriminate patients with recurrent LPD from controls. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: A total of 21 adults with recurrent LPD (age, 29.7 ± 11.1 years; height, 170.8 ± 9.9 cm; weight, 76.1 ± 17.5 kg; 57% female) were compared with 21 sex- and height-matched controls (age, 27.2 ± 6.7 years; height, 172.0 ± 10.6 cm; weight, 71.1 ± 12.8 kg; 57% female). Three-dimensional axial fat-saturated magnetic resonance imaging scans were used to measure patellar medial, lateral, and total width; patellar volume; patellar medial and lateral facet length; the Wiberg index; and previously validated knee joint alignment and femoral shape measurements (eg, tibial tuberosity to trochlear groove distance, trochlear dysplasia). Results: The LPD group demonstrated reduced medial patellar width (Δ = −3.6 mm; P < .001) and medial facet length (Δ = −3.7 mm; P < .001) but no change in lateral width or facet length. This resulted in decreased total patellar width (Δ = −3.2 mm; P = .009), decreased patellar volume (Δ = −0.3 cm3; P = .025), and an increased Wiberg index (Δ = 0.05; P < .001). No significant differences were found for all other patellar shape measures between cohorts. Medial patellar width was the strongest single discriminator (83.3% accuracy) for recurrent LPD. Combining medial patellar width, patellofemoral tilt, and trochlear groove length increased the discrimination to 92.9%. Conclusion: The medial patellar width was significantly smaller in patients with recurrent LPD and was the single most accurate discriminator for recurrent LPD, even compared with traditional trochlear shape and joint alignment measures (eg, trochlear dysplasia, patella alta). Therefore, medial patellar morphology should be assessed in patients with LPD as a risk factor for recurrence and a potential means to improve treatment.

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“…Patellar dislocation is a frequent cause of morbidity among the young and physically active. 28,48 The reported incidence of primary patellar dislocation is variable per population, ranging from 6 to 112 per 100,000 persons and decreasing in likelihood as the population ages. 28,43,46 In addition to limiting physical function and causing pain, patellar dislocation places persons at greater risk of developing posttraumatic patellofemoral arthritis, with up to 76% of patients demonstrating articular cartilage damage after just a single patellar dislocation event.…”

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confidence: 99%

A Diagnosis of Vitamin D Deficiency Is Associated With Increased Rates of Primary Patellar Instability and Need for Recurrent Surgical Stabilization

Chang

Albright

Quinn

et al. 2023

Sports Health: A Multidisciplinary Approach

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Background: Vitamin D has been proven experimentally to affect musculoskeletal health. The purpose of this study was to identify the relationship between vitamin D deficiency and patellar instability. Hypothesis: Vitamin D deficiency is associated with an increased risk of experiencing primary patellar instability and recurrent patellar dislocation after primary surgical stabilization. Study Design: Retrospective comparative study. Level of Evidence: Level 3. Methods: A 1:1 matched retrospective study of 328,011 patients diagnosed with vitamin D deficiency was performed using the PearlDiver database. Incidence of primary patellar instability was calculated according to sex and age. Rates of primary patellar instability and surgical stabilization for recurrent dislocation were calculated with sex- and age-specific stratifications. Multivariable logistic regression was used to compare the rates of primary injury and recurrent stabilization while controlling for demographics and medical comorbidities. Results: A total of 656,022 patients were analyzed. The overall 1-year incidence rate of patellar instability in patients with vitamin D deficiency was 82.6 per 100,000 person-years (95% CI, 73.2-92.9), compared with 48.5 (95% CI, 41.4-56.5) in the matched control. Women were significantly more likely to experience primary patellar instability within 1 (adjusted odds ratio [aOR] = 1.45; 95% CI, 1.12-1.88) and 2 years (aOR, 1.31; 95% CI, 1.07-1.59) of hypovitaminosis D diagnosis. Patients aged 10 to 25 years with hypovitaminosis D were at greater risk of requiring recurrent patellar stabilization for both men (aOR, 2.48; 95% CI, 1.06-5.80) and women (aOR, 1.77; 95% CI, 1.04-3.02). Conclusion: Patients diagnosed with vitamin D deficiency experienced higher rates of primary patellar instability and have greater risk of requiring recurrent surgical stabilization for subsequent dislocations. Clinical Relevance: These results suggest that monitoring and proactively treating vitamin D deficiency in the physically active patient may lower the risk of suffering primary patellar instability or recurrence after surgical stabilization.

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Surgical versus non-surgical interventions for treating patellar dislocation

Abstract: Publication status and date: New search for studies and content updated (no change to conclusions), published in Issue 2, 2015.

Cited by 7 publications

References 78 publications

Distal femoral torsion is correlated with higher‐grade trochlear dysplasia and shorter anterior condyles in patients with patellar dislocation and increased femoral torsion

Distal femoral torsion is correlated with higher‐grade trochlear dysplasia and shorter anterior condyles in patients with patellar dislocation and increased femoral torsion

The Importance of Medial Patellar Shape as a Risk Factor for Recurrent Patellar Dislocation in Adults

A Diagnosis of Vitamin D Deficiency Is Associated With Increased Rates of Primary Patellar Instability and Need for Recurrent Surgical Stabilization

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