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Southern Medical Journal Feb 2023Reconstruction for a chronic patellar tendon rupture in a native knee is an uncommon surgical procedure. Although there have been case series investigating...
OBJECTIVES
Reconstruction for a chronic patellar tendon rupture in a native knee is an uncommon surgical procedure. Although there have been case series investigating patient-reported outcomes, there is no systematic review of these studies to date. The purpose of this review is to synthesize the literature on this procedure to better understand its outcomes, complications, and surgical technique options.
METHODS
A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify studies that reported outcomes and techniques of patellar tendon reconstruction for chronic disruption in native knees. Searches were conducted through MEDLINE using PubMed, Cochrane Database of Systematic Reviews, and clinicaltrials.gov.
RESULTS
Ten studies with 103 patients and 105 knees were included. Results for nonnative (arthroplasty) knees were excluded. The mean patient age was 40.3 years, and the mean postsurgical follow-up time was 53.8 months. Of the 105 knees, 75% received a hamstring tendon graft, whereas 13% received a bone-tendon-bone graft and 7% received a whole extensor mechanism allograft. The mean preoperative range of motion was 113.8°, which improved to 126.0° postoperatively. The mean preoperative Lysholm score was 58.6, which improved to 86.0 postoperatively; 100% of patients returned to their normal work activities and 76% returned to their prior level of physical activity. There were no major complications reported in any of the included studies.
CONCLUSIONS
Chronic patellar tendon disruption in a native knee is an uncommon injury that can result in significant limitations for patients. Although more research is needed to better elucidate which graft is best, outcomes after patellar tendon reconstruction for chronic tears appear to be satisfactory with current techniques.
Topics: Humans; Adult; Patellar Ligament; Knee Joint; Patella; Transplantation, Homologous; Tendon Injuries
PubMed: 36724537
DOI: 10.14423/SMJ.0000000000001515 -
Life (Basel, Switzerland) Dec 2021Chondral and soft tissue injuries can be associated with first time patellar dislocation, but it is unclear how common they are, and which tissues are affected. A... (Review)
Review
INTRODUCTION
Chondral and soft tissue injuries can be associated with first time patellar dislocation, but it is unclear how common they are, and which tissues are affected. A systematic review of the literature was performed to investigate the frequency, location, and extent of chondral and medial patellofemoral ligament (MPFL) injuries in patients following first time patellar dislocation.
METHODS
This systematic review was conducted according to the PRISMA guidelines. PubMed, Google Scholar, Embase, and Web of Science databases were accessed in November 2021. All the published clinical studies reporting the frequency, location, and extent of soft tissue lesions following first time patellar dislocation were accessed. Studies reporting data on habitual, congenital, or recurrent patellofemoral instability were excluded.
RESULTS
Data from 42 articles (2254 patients, mean age 21.6 ± 7.3 years) were retrieved. Ninety-eight percent of patients who experienced first time patellar dislocation demonstrated MPFL rupture at MRI. Forty-eight percent of MPFL ruptures were located at the patellar side, 34% at the femoral insertion site, and 18% in the midportion. Eighty-five percent of patients showed signs of patellar chondral damage at MRI, and trochlear chondral injuries were evidenced in 47% of patients. Intra-articular loose bodies were observed in 11.5% of patients. At arthroscopy, the medial facet and the crest of the patella more commonly exhibited chondral lesions than the lateral facet and femoral trochlea.
CONCLUSIONS
Most patients suffer chondral damage and MPFL tears following after a first time patellar dislocation.
PubMed: 34947891
DOI: 10.3390/life11121360 -
Gait & Posture Mar 2018Changes in patellofemoral joint (PFJ) stress are related to the development and course of PFJ dysfunctions. Different methods for PFJ stress calculation have been used,... (Review)
Review
Changes in patellofemoral joint (PFJ) stress are related to the development and course of PFJ dysfunctions. Different methods for PFJ stress calculation have been used, making the comparison of PFJ stress values across different studies difficult. The purpose of this study was to systematically review the methods for PFJ stress calculation and highlight the differences among the methods. A systematic literature search was conducted in Medline, Embase, CINAHL, SPORTDiscus and Web of Science databases. Included studies examined PFJ stress in subjects with or without musculoskeletal conditions. Of 12,670 identified studies, 53 were included, with a total of 1134 subjects evaluated. The main differences among the methods to calculate PFJ stress were: i) method to calculate PFJ contact area; ii) method to calculate a constant (coefficient k) that defines the relation between quadriceps force and PFJ reaction force; iii) the inclusion of adjustments for sagittal plane forces. Considerable variability in PFJ stress results was observed. The greatest PFJ stress value was 55.03 MPa during a dance jump and the lowest value was 1.9 MPa during walking at the speed of 1.4 m/s. Most studies applied methods which use data from previous studies. However, methods which use data from their own participants for most parts of the calculation might be preferred to minimize potential errors. When direct measures are not possible, a standard method could be applied to facilitate comparisons among studies.
Topics: Adolescent; Adult; Aged; Biomechanical Phenomena; Female; Humans; Male; Middle Aged; Patellofemoral Joint; Stress, Mechanical; Walking; Young Adult
PubMed: 29353744
DOI: 10.1016/j.gaitpost.2017.12.018 -
Orthopaedic Journal of Sports Medicine Dec 2020Medial patellofemoral ligament (MPFL) injuries are common in patients with acute lateral patellar dislocations, but the pattern of MPFL injuries is unclear, especially... (Review)
Review
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.
PubMed: 33403210
DOI: 10.1177/2325967120967338 -
Orthopedics Sep 2016When secondary patellar resurfacing is performed, a uniformly and widely used scoring system that is validated for anterior knee pain caused by a retropatellar... (Review)
Review
When secondary patellar resurfacing is performed, a uniformly and widely used scoring system that is validated for anterior knee pain caused by a retropatellar degeneration will give more insight into the results of this procedure. The cause of anterior knee pain following total knee arthroplasty (TKA) is not always related to the patella itself. Other causes have been identified, such as an insufficient posterior cruciate ligament in the case of a posterior cruciate-retaining TKA or an internally rotated femoral and/or tibial component. Treatment of anterior knee pain following primary TKA with secondary patellar resurfacing is a controversial procedure with uncertain outcomes. The purpose of this study is to systematically review the available peer-reviewed literature on patient satisfaction and functional outcomes of secondary resurfacing. The authors performed a systematic computerized database search of the Cochrane Database of Systematic Reviews, MEDLINE, and EMBASE in October 2014. The quality of the included studies was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. A total of 15 articles met the inclusion criteria. In total, 148 (64%) of 232 patients were satisfied with the outcomes of secondary patellar resurfacing. A statistically significant improvement in knee scores was noted in all 9 studies that reported functional outcomes, although no clinically significant improvement in knee scores was observed. Reported complications include infections and impaired wound healing, patellar instability, and patellar fracture. Because the available evidence is of generally low quality, the results of this systematic review only support a weak recommendation for secondary patellar resurfacing if patient satisfaction and clinically important improvement of functional outcomes are the desired endpoints. [Orthopedics.2016; 39(5):e850-e856.].
Topics: Arthralgia; Arthroplasty, Replacement, Knee; Femur; Fractures, Bone; Humans; Joint Instability; Knee Joint; Pain, Postoperative; Patella; Patient Satisfaction; Posterior Cruciate Ligament; Tibia
PubMed: 27172365
DOI: 10.3928/01477447-20160509-05 -
Archives of Orthopaedic and Trauma... Nov 2016Anterior knee pain (AKP) is a frequent complication after total knee arthroplasty (TKA). Patelloplasty, defined as reshaping the patella for optimal tracking in the... (Review)
Review
INTRODUCTION
Anterior knee pain (AKP) is a frequent complication after total knee arthroplasty (TKA). Patelloplasty, defined as reshaping the patella for optimal tracking in the trochlea, has been proposed to reduce the rate of this complication in patellar retaining implants. Aim of this study was to analyze the available literature regarding the outcomes of patelloplasty and to assess its methodological quality.
MATERIALS AND METHODS
A comprehensive review of the English literature was performed using the keywords "total knee arthroplasty", "patelloplasty" and "patellaplasty" with no limit regarding the year of publication. All the selected articles were evaluated with the Coleman score.
RESULTS
Seven full text articles were retrieved. The initial cohort included 461 knees in the study groups and 465 in the control groups. At an average FU of 70.6 months 447 knees were reviewed in the study group and 447 in the control groups. The global rate of AKP after patelloplasty was 11.3 % which compared to 7.9 % in the patella resurfacing control group. No signs of specific patellar complications due to patelloplasty were reported. Average Coleman score was 66.9.
CONCLUSION
Most of the literature has barely sufficient methodological quality. Patelloplasty aims at reducing patellar thickness and improve its tracking with TKA. This procedure is a safe and easy option with no reported adverse effects. In the included studies, outcome seemed to be superior in comparison with isolated osteophyte removal and denervation with a lower rate of AKP. The included studies, however, report a lower rate of AKP following TKA with patellar resurfacing. Patelloplasty may have the potential to improve the outcome of patellar retaining implants.
LEVEL OF EVIDENCE
4, systematic review.
Topics: Arthroplasty, Replacement, Knee; Humans; Knee Joint; Osteoarthritis, Knee; Patella; Treatment Outcome
PubMed: 27687176
DOI: 10.1007/s00402-016-2577-7 -
Orthopaedic Journal of Sports Medicine May 2023Patellar chondral lesions can be particularly challenging to manage in younger and more active populations. (Review)
Review
BACKGROUND
Patellar chondral lesions can be particularly challenging to manage in younger and more active populations.
PURPOSE
To synthesize, organize, and summarize the results and complication rates of various patellar cartilage restoration techniques.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
We performed this systematic review according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the Medline, Embase, Scopus, and Cochrane databases. Studies were included that reported on surgical treatment of patellar chondral defects with ≥5 patients and 12 months of follow-up data. Relevant demographic data from the included studies were extracted, and patient-reported outcome scores, visual analog scale for pain results, return-to-sport rate, complications, and concomitant procedures were documented.
RESULTS
There were 24 studies that met the inclusion criteria, with a total of 575 patients (male, n = 239; female, n = 336). In total, 6 surgical techniques were utilized. In 9 studies, the surgical procedure of choice was osteochondral autograft transplantation (OAT); 8 studies evaluated autologous chondrocyte implantation (ACI); 3 evaluated advanced microfracture/autologous matrix-induced chondrogenesis; 1 evaluated osteochondral allograft transplantation (OCA); 1 evaluated particulate juvenile articulated cartilage; and 2 evaluated a synthetic osteochondral graft. No uniform functional outcome score or assessment was utilized across studies. OAT was predominantly used for smaller chondral lesions (<2 cm) and demonstrated minimal complication rates and satisfactory outcome scores. Advanced microfracture techniques showed promise, with improvement in outcome scores and zero complications. Matrix-induced ACI consistently exhibited higher mean improvement in the measured outcome scores and resulted in fewer complications when compared with previous generations of ACI.
CONCLUSION
OAT and ACI were the most studied procedures for isolated patellar chondral defects. Advanced microfracture techniques showed promise, but indications (ie, size) and variability in techniques need to be elucidated in higher-level studies. Further prospective studies comparing OCA and matrix-induced ACI for larger patellar defects are necessary to determine the superior technique.
PubMed: 37152547
DOI: 10.1177/23259671231153422 -
Osteoarthritis and Cartilage Feb 2016To review the association between patellofemoral joint (PFJ) imaging features and patellofemoral pain (PFP). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To review the association between patellofemoral joint (PFJ) imaging features and patellofemoral pain (PFP).
DESIGN
A systematic review of the literature from AMED, CiNAHL, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PEDro, EMBASE and SPORTDiscus was undertaken from their inception to September 2014. Studies were eligible if they used magnetic resonance imaging (MRI), computed tomography (CT), ultrasound (US) or X-ray (XR) to compare PFJ features between a PFP group and an asymptomatic control group in people <45 years of age. A pooled meta-analysis was conducted and data was interpreted using a best evidence synthesis.
RESULTS
Forty studies (all moderate to high quality) describing 1043 people with PFP and 839 controls were included. Two features were deemed to have a large standardised mean difference (SMD) based on meta-analysis: an increased MRI bisect offset at 0° knee flexion under load (0.99; 95% CI: 0.49, 1.49) and an increased CT congruence angle at 15° knee flexion, both under load (1.40 95% CI: 0.04, 2.76) and without load (1.24; 95% CI: 0.37, 2.12). A medium SMD was identified for MRI patella tilt and patellofemoral contact area. Limited evidence was found to support the association of other imaging features with PFP. A sensitivity analysis showed an increase in the SMD for patella bisect offset at 0° knee flexion (1.91; 95% CI: 1.31, 2.52) and patella tilt at 0° knee flexion (0.99; 95% CI: 0.47, 1.52) under full weight bearing.
CONCLUSION
Certain PFJ imaging features were associated with PFP. Future interventional strategies may be targeted at these features.
PROSPERO REGISTRATION NUMBER
CRD 42014009503.
Topics: Humans; Magnetic Resonance Imaging; Patellofemoral Joint; Patellofemoral Pain Syndrome; Tomography, X-Ray Computed; Ultrasonography
PubMed: 26471209
DOI: 10.1016/j.joca.2015.09.004 -
International Orthopaedics Nov 2016The purpose of this study was to determine the efficacy of surgical and conservative treatment in the prevention of recurrence after primary patellar dislocation. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
The purpose of this study was to determine the efficacy of surgical and conservative treatment in the prevention of recurrence after primary patellar dislocation.
METHODS
Studies were searched on MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and CINHAL from their inception to April 2015. All randomized controlled clinical trials comparing surgical versus conservative treatment after first patellar dislocation were included. Primary outcomes were: recurrent dislocation, subluxation, overall instability and subsequent surgery. Secondary outcomes included imaging, and subjective and objective clinical assessment tools. Methodological quality of the studies was assessed using Cochrane Collaboration's "Risk of Bias" tool. Pooled analyses were reported as risk ratio (RR) using a random effects model. Continuous data were reported as standardized mean difference (SMD) and 95 % confidence intervals (CIs). Heterogeneity was assessed using I².
RESULTS
Nine studies were included in the meta-analyses. Methodological quality of the studies was moderate to low. Meta-analyses showed that surgical treatment significantly reduces the redislocation rate (RR = 0.62; 95% CI = 0.39, 0.98, p = 0.04) and provides better results on Hughston VAS score (SMD = -0.32; 95% CI = -0.61, -0.03; p = 0.03) and running (OR = -0.52; 95% CI = 0.31, 0.88; p = 0.01). Conservative treatment showed less occurrence of minor complications (OR = 3.46; 95% CI = 2.08, 5.77; p = 0.01) and better results in the figure-of-8 run test (SMD = 0.42; 95% CI = 0.06, 0.77; p = 0.02) and in the squat down test (SMD = -0.45; 95% CI = -0.81, -0.10; p < 0.00001). No other significant differences could be found.
CONCLUSIONS
Based on the available data, surgical treatment of primary patella dislocation significantly reduces the risk of patella redislocation.
Topics: Conservative Treatment; Humans; Patella; Patellar Dislocation; Recurrence; Treatment Outcome
PubMed: 26202017
DOI: 10.1007/s00264-015-2856-x -
The Knee Dec 2022Chondral defects can be a particularly challenging clinical presentation. Because damaged cartilage does not heal itself, an evolution of multiple new surgical... (Review)
Review
INTRODUCTION
Chondral defects can be a particularly challenging clinical presentation. Because damaged cartilage does not heal itself, an evolution of multiple new surgical treatments designed specifically for cartilage repair and restoration have been introduced. Internal fixation has demonstrated good benefits in case reports and small qualitative studies. Our systematic review aimed to evaluate the effectiveness of internal fixation in the management of acute chondral fractures.
METHODS
A comprehensive search strategy was carried out using the NICE Healthcare Databases Advanced Search. The systematic review was prospectively registered with PROSPERO (CRD42022302976) and was performed in accordance with the PRISMA guidelines.
RESULTS
Eleven studies consisting of fifty patients were included in this systematic review. Seventy-eight percent of patients showed good results and twenty-two percent of the cases had excellent results. Ninety-two percent of patients returned to preoperative level of sport activities at the end of the follow-up period. All of them returned to the original activity level without pain, stiffness, or restriction of movement after 1 year latest. The majority of patients had no complications at all, good recovery time and satisfactory outcomes for pain and activity level. The only complications presented were patella instability and quadriceps weakness.
CONCLUSION
Internal fixation for acute chondral fractures is an effective method to treat acute chondral fractures in both adolescents and young adults that want to get back to an active lifestyle. However, more data examining the long-term functional status, quality of life (QoL), recovery post-injury and pain free sports activity involvement are needed.
Topics: Young Adult; Adolescent; Humans; Quality of Life; Fracture Fixation, Internal; Cartilage Diseases; Fractures, Cartilage; Joint Instability; Treatment Outcome
PubMed: 36257177
DOI: 10.1016/j.knee.2022.08.001