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Knee Surgery, Sports Traumatology,... Sep 2023The aim of our study was to perform a systematic review and best knowledge synthesis of the present literature concerning the familial association and epidemiological... (Review)
Review
Familial association and epidemilogical factors as risk factors for developing first time and recurrent patella dislocation: a systematic review and best knowledge synthesis of present literature.
PURPOSE
The aim of our study was to perform a systematic review and best knowledge synthesis of the present literature concerning the familial association and epidemiological factors as risk factors for developing first-time and recurrent patella dislocation.
METHODS
The study was conducted according to the PRISMA guidelines and registered in PROSPERO. EMBASE and PubMed were systematically searched on the 5th of May 2022. Studies investigating participants with genetic and epidemiological risk factors for the first time as well as recurrent patella dislocation were included. The records were screened, and data were extracted independently by two researchers supervised by a third independent assessor.
RESULTS
A total of 6,649 records were screened, and 67 studies were included. Familial association was described as a risk factor for patella dislocation in 17 studies. One study found that participants with a family history of patella dislocation had a 3.7 higher risk for patella dislocation in the contralateral asymptomatic knee, and another study found a family history of PD in 9% of 74 participants. Eleven studies found an accumulation of patella dislocation across generations in specific families. Additionally, a range of genetic syndromes was associated with patella dislocation. Young age is a well-investigated risk factor for patella dislocation, but the results are inconsistent. Only five and eight studies investigated skeletal immaturity and gender as risk factors for patella dislocation, respectively.
CONCLUSION
There may be a familial association with patella dislocation, but further investigation is necessary to determine the strength and etiology of the association. There is weak evidence that epidemiological risk factors, such as age, skeletal immaturity, gender, and BMI are risk factors for patella dislocation.
LEVEL OF EVIDENCE
IV.
Topics: Humans; Patella; Recurrence; Patellar Dislocation; Risk Factors; Knee Joint; Joint Dislocations
PubMed: 36629887
DOI: 10.1007/s00167-022-07265-z -
The Journal of Arthroplasty Apr 2024Secondary patella resurfacing is often performed for dissatisfaction following primary knee arthroplasty where the native patella was retained. The purpose of this... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Secondary patella resurfacing is often performed for dissatisfaction following primary knee arthroplasty where the native patella was retained. The purpose of this meta-analysis was to evaluate outcomes of secondary patella resurfacing.
METHODS
The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting on patients who underwent secondary patella resurfacing after previous primary knee arthroplasty with retention of the native patella were considered eligible. The risk of bias was assessed using the Methodological Index for Non-Randomized studies tool. A random-effects model and the inverse-variance weighting method was used for meta-analysis. There were sixteen retrospective studies including 604 knees (594 patients) with a mean follow up of 42 months (range, 2 to 197).
RESULTS
An overall improvement in patient-reported outcomes (PROMs) was achieved in 53% of cases from pooled data available for 293 knees [95% Confidence Interval (CI) (0.44, 0.62), I=68% - moderate heterogeneity]. The pooled proportion of patients satisfied with the procedure was 59% [95% CI (48, 68), I = 70% - moderate heterogeneity] in a sample size of 415. There was a minimal rate (2%) of complication incidence when performing secondary patella resurfacing and a pooled rate of revision surgery of 10%.
CONCLUSIONS
An improvement in pain, satisfaction, and PROMs was achieved in slightly more than half of the patients following secondary patella resurfacing. However, studies lacked standardized objective selection criteria for the procedure and the available data was predominantly retrospective, with high heterogeneity and variation in outcome reporting.
Topics: Humans; Arthroplasty, Replacement, Knee; Patella; Retrospective Studies; Pain; Reoperation; Treatment Outcome; Knee Joint; Osteoarthritis, Knee; Knee Prosthesis
PubMed: 37871862
DOI: 10.1016/j.arth.2023.10.027 -
Orthopaedic Journal of Sports Medicine Jun 2024While the biomechanical properties of the native medial patellofemoral ligament (MPFL) have been well studied, there is no comprehensive summary of the biomechanics of... (Review)
Review
BACKGROUND
While the biomechanical properties of the native medial patellofemoral ligament (MPFL) have been well studied, there is no comprehensive summary of the biomechanics of MPFL reconstruction (MPFLR). An accurate understanding of the kinematic properties and functional behavior of current techniques used in MPFLR is imperative to restoring native biomechanics and improving outcomes.
PURPOSE
To provide a comprehensive review of the biomechanical effects of variations in MPFLR, specifically to determine the effect of graft choice and reconstruction technique.
STUDY DESIGN
Systematic review.
METHODS
A systematic review was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 32 studies met inclusion criteria: (1) using ≥8 human cadaveric specimens, (2) reporting on a component of MPFLR, and (3) having multiple comparison groups.
RESULTS
Gracilis, semitendinosus, and quadriceps grafts demonstrated an ultimate load to failure (N) of 206.2, 102.8, and 190.0 to 205.0 and stiffness (N/mm) of 20.4, 8.5, and 21.4 to 33.6, respectively. Single-bundle and double-bundle techniques produced an ultimate load to failure (N) of 171 and 213 and stiffness (N/mm) of 13.9 and 17.1, respectively. Anchors placed centrally and superomedially in the patella produced the smallest degree of length changes throughout range of motion in contrast to anchors placed more proximally. Sutures, suture anchors, and transosseous tunnels all produced similar ultimate load to failure, stiffness, and elongation data. Femoral tunnel malpositioning resulted in significant increases in contact pressures, patellar translation, tilt, and graft tightening or loosening. Low tension grafts (2 N) most closely restored the patellofemoral contact pressures, translation, and tilt. Graft fixation angles variably and inconsistently altered contact pressures, and patellar translation and tilt.
CONCLUSION
Data demonstrated that placement of the MPFLR femoral tunnel at the Schöttle point is critical to success. Femoral tunnel diameter should be ≥2 mm greater than graft diameter to limit graft advancement and overtensioning. Graft fixation, regardless of graft choice or fixation angle, is optimally performed under minimal tension with patellar fixation at the medial and superomedial patella. However, lower fixation angles may reduce graft strain, and higher fixation angles may exacerbate anisometry and length changes if femoral tunnel placement is nonanatomic.
PubMed: 38855071
DOI: 10.1177/23259671241241537 -
Injury Oct 2023Acute patellar dislocation is a common knee injury in adolescents and adults that is associated with a high incidence of medial patellofemoral ligament (MPFL) injuries.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Acute patellar dislocation is a common knee injury in adolescents and adults that is associated with a high incidence of medial patellofemoral ligament (MPFL) injuries. The aim of this network meta-analysis was to compare the different operative and non-operative protocols for the management of primary patellar dislocation (PPD).
METHODS
We searched Medline, Embase, and CENTRAL databases. We included randomized controlled trials (RCTs) that compared operative and non-operative protocols for adolescent or adult patients with acute traumatic PPD. We sought to evaluate the clinical and functional outcomes of each management protocol by considering the results of Kujala score, Tegner activity score, redislocation rate, and subluxation rate. The effectiveness of the different management protocols was measured through frequentist network meta-analysis, using the Netmeta statistical package in R software. All treatment protocols were ranked using the netrank function, yielding P scores.
RESULTS
A total of 10 RCTs were deemed eligible. As per P-scores, open MPFL repair yielded the highest effectiveness with respect to Kujala score (P=0.81) and lowest odds for redislocation (P=0.14) whereas arthroscopic MPFL repair yielded the highest effectiveness with respect to Tegner activity score (P=0.85) and lowest odds for subluxation (P=0.21). Arthroscopic MPFL repair showed a significant reduction in redislocation and subluxation rate.
CONCLUSION
This network meta-analysis demonstrated arthroscopic MPFL repair is the most effective treatment protocol for the management of acute primary patellar dislocation.
Topics: Adult; Adolescent; Humans; Patellar Dislocation; Patellofemoral Joint; Network Meta-Analysis; Knee Joint; Patella; Joint Dislocations; Ligaments, Articular; Joint Instability
PubMed: 37473507
DOI: 10.1016/j.injury.2023.110926 -
The Knee Jun 2024Children and adolescents have the highest incidence of patellar instability among the population. We aimed to identify patho-morphological and epidemiological factors... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Children and adolescents have the highest incidence of patellar instability among the population. We aimed to identify patho-morphological and epidemiological factors associated with patellar instability, and to identify factors predisposing to recurrence in children and adolescents.
METHODS
Published and unpublished literature databases, conference proceedings and the reference lists of included studies were searched to the 14th of March 2024. Studies were eligible if they compared history characteristics, examination features and radiological parameters between patients with and without instability, or evaluated risk factors for instability recurrence. A random-effects meta-analysis was performed. Included studies were appraised using tools respective of study design.
RESULTS
The evidence was moderate to low in quality. Forty-five studies (including 9000 patients) were eligible. Tibial tubercle - tibial groove (TT-TG) distance (weighted mean difference [WMD] 5.96 mm, 95% Confidence Interval [CI]: 4.94 to 6.99 mm), sulcus angle (WMD: 13.93˚, 95% CI: 9.1˚ to 18.8˚), and Insall-Salvati index (WMD: 0.2, 95% CI: 0.16 to 0.23) were greater in patients with patellar instability. Risk factors for recurrent dislocation included age less than 18 years (Odds ratio [OR]: 2.56, 95% CI: 1.63 to 4.0), skeletal immaturity (OR: 1.79, 95% CI: 1.21 to 2.64) and presence of trochlear dysplasia (OR: 3.37, 95% CI: 1.85 to 6.15).
CONCLUSION
Knowledge of patho-morphological factors associated with patellar instability could help explain its pathophysiological processes, allowing for the design of treatment approaches and the identification of patients at risk.
Topics: Humans; Joint Instability; Adolescent; Child; Patellar Dislocation; Risk Factors; Patella; Recurrence
PubMed: 38657526
DOI: 10.1016/j.knee.2024.03.009 -
Physical Therapy Sep 2023The aim of this systematic review and correlation meta-analysis was to identify factors associated with kinesiophobia in individuals with patellofemoral pain (PFP) and... (Meta-Analysis)
Meta-Analysis
Kinesiophobia Is Associated With Poor Function and Modifiable Through Interventions in People With Patellofemoral Pain: A Systematic Review With Individual Participant Data Correlation Meta-Analysis.
OBJECTIVE
The aim of this systematic review and correlation meta-analysis was to identify factors associated with kinesiophobia in individuals with patellofemoral pain (PFP) and to identify interventions that may reduce kinesiophobia in individuals with PFP.
METHODS
Seven databases were searched for articles including clinical factors associated with kinesiophobia or interventions that may reduce kinesiophobia in individuals with PFP. Two reviewers screened articles for inclusion, assessed risk of bias and quality, and extracted data from each study. A mixed-effects model was used to calculate correlations of function and pain with kinesiophobia using individual participant data. Meta-analyses were performed on interventional articles; Grading of Recommendations, Assessment, Development, and Evaluation was used to evaluate certainty of evidence. Results were reported narratively when pooling was not possible.
RESULTS
Forty-one articles involving 2712 individuals were included. Correlation meta-analyses using individual participant data indicated a moderate association between self-reported function and kinesiophobia (n = 499; r = -0.440) and a weak association between pain and kinesiophobia (n = 644; r = 0.162). Low-certainty evidence from 2 articles indicated that passive treatment techniques were more effective than minimal intervention in reducing kinesiophobia (standardized mean difference = 1.11; 95% CI = 0.72 to 1.49). Very low-certainty evidence from 5 articles indicated that interventions to target kinesiophobia (psychobehavioral interventions, education, and self-managed exercise) were better in reducing kinesiophobia than physical therapist treatment approaches not specifically targeting kinesiophobia (standardized mean difference = 1.64; 95% CI = 0.14 to 3.15).
CONCLUSION
Higher levels of kinesiophobia were moderately associated with poorer function and weakly associated with higher pain in individuals with PFP. Taping and bracing may reduce kinesiophobia immediately after use, and specific kinesiophobia-targeted interventions may reduce kinesiophobia following the full intervention; however, the certainty of evidence is very low.
IMPACT
Assessment of kinesiophobia in clinical practice is recommended, on the basis of the relationships identified between kinesiophobia and other important factors that predict outcomes in individuals with PFP.
Topics: Humans; Kinesiophobia; Patellofemoral Pain Syndrome; Correlation of Data; Pain; Pain Measurement
PubMed: 37354454
DOI: 10.1093/ptj/pzad074 -
The Knee Dec 2023Trochlear dysplasia is a condition in which the femoral trochlea has an abnormal shape and function. Trochleoplasty aims to change the shape of the trochlea in order to... (Meta-Analysis)
Meta-Analysis Review
Sulcus deepening trochleoplasty versus bereiter trochleoplasty for high grade trochlear dysplasia: A systematic review and meta-analysis for clinical outcome and recurrent instability.
BACKGROUND
Trochlear dysplasia is a condition in which the femoral trochlea has an abnormal shape and function. Trochleoplasty aims to change the shape of the trochlea in order to stabilize an unstable patella. This study compared clinical outcomes and recurrent instability after surgery between sulcus deepening trochleoplasty (Lyon) and Bereiter trochleoplasty in patients with high-grade trochlear dysplasia.
METHODS
We conducted a meta-analysis comparing Bereiter and Lyon trochleoplasty based on PRISMA guidelines regarding clinical outcome and recurrent instability for high-grade trochlear dysplasia. Searching on five databases, we found 11 eligible studies with a total of 520 subjects to be analysed. Studies were qualitatively and quantitatively evaluated using Review Manager 5.4 or equivalent.
RESULTS
Both techniques showed no differences in sulcus angle, return-to-sport rate, and satisfactory rate. The IKDC and Kujala scores showed good outcomes but were not significantly different. IKDC score was not different after analysis between Bereiter and Lyon techniques. The pooled improvement of IKDC score on both subgroups was 24.39 (95% CI 21.14-27.65). A pooled analysis of 10 studies found that the Kujala score did not differ between groups with Bereiter and Lyon techniques. The total pooled mean difference of both groups was 25.87 (95% CI 21.70-30.05).
CONCLUSION
None of the techniques analysed highlighted an absolute superiority. Clinical relevance showed both techniques have good clinical outcomes, fewer complications, and recurrent instability for high-grade trochlear dysplasia.
Topics: Humans; Patellar Dislocation; Knee Joint; Femur; Patella; Joint Instability; Patellofemoral Joint
PubMed: 37925805
DOI: 10.1016/j.knee.2023.10.001 -
Journal of Clinical Orthopaedics and... Dec 2023This paper aims to systematically review and meta-analyse the available evidence regarding the clinical and radiographic outcomes of non-metal fixation methods in... (Review)
Review
INTRODUCTION
This paper aims to systematically review and meta-analyse the available evidence regarding the clinical and radiographic outcomes of non-metal fixation methods in treating patellar fractures compared to a control metal fixation group, in the hopes of bringing insight into their effectiveness.
METHODS
Two investigators systematically reviewed studies across 9 English or Mandarin electronic databases - Cochrane Library, EMBASE, Google Scholar, Medline, PubMed, Scopus, Web of Science, CNKI and Wanfang Data, in adherence to PRISMA guidelines. The inclusion criteria for study selection were: English or Mandarin comparative studies that evaluated clinical (Patient Reported Outcome Measures, incidence of reoperations and postoperative complications) or radiographic (time to union and incidence of secondary loss of reduction) outcomes of metal and non-metal fixation methods for patellar fractures. From an initial pool of 1269 studies, 19 studies involving 1612 patients were included in the meta-analysis after full-text evaluation and accounting for exclusion criteria.
RESULTS
Clinically, the reduction in reoperations (OR = 0.22, 95% CI [0.10, 0.51], P = 0.0003), direct (OR = 0.17, 95% CI [0.08, 0.33], P < 0.00001) and indirect (OR = 0.50, 95% CI [0.27, 0.93], P = 0.03) implant-related postoperative complications were significantly in favor of non-metal fixation. Radiographically, the decrease in time to union (SMD = -0.79, 95% CI [-1.11, -0.47], P < 0.00001) in the non-metal group compared to the metal group was also significant. The remaining results were comparable.
CONCLUSION
This meta-analysis suggests that non-metallic internal fixation had similar if not superior outcomes to their metallic counterparts, with fewer implant-related complications and improved postoperative recovery. Given the higher re-operation rates associated with metallic fixation, non-metallic methods may be preferable from economic and safety perspectives. Nevertheless, more homogenous studies with standardised fracture configurations and treatment modalities are needed before declaring non-metallic fixation as the gold standard for patellar fractures.
PubMed: 38196499
DOI: 10.1016/j.jcot.2023.102314 -
European Journal of Orthopaedic Surgery... Dec 2023Poor outcomes and high complication and reoperation rates have been reported with tension-band wiring (TBW) in the management of patellar fractures and particularly the... (Review)
Review
PURPOSE
Poor outcomes and high complication and reoperation rates have been reported with tension-band wiring (TBW) in the management of patellar fractures and particularly the comminuted ones. The purpose of this study was to investigate the functional outcomes and complication rates of patellar fractures managed with open reduction and internal fixation (ORIF) with a plate.
METHODS
MEDLINE, EMCare, CINAHL, AMED and HMIC were searched, and the PRISMA guidelines were followed. Two independent reviewers extracted the data from the included studies and assessed them for the risk of bias.
RESULTS
Plating of patellar fractures is associated with satisfactory range of movement (ROM) and postoperative function and low pain levels. We found a 10.44% complication rate and a low reoperation rate. Reoperations were mainly performed for metalwork removal.
CONCLUSION
ORIF with plating of patellar fractures is a safe alternative in the management of patellar fractures and may be associated with a lower complication and reoperation rate compared to TBW. Future randomized prospective studies are needed to validated the results of the present systematic review.
Topics: Humans; Fractures, Bone; Fracture Fixation, Internal; Knee Injuries; Fractures, Comminuted; Reoperation; Retrospective Studies; Patella
PubMed: 37286819
DOI: 10.1007/s00590-023-03597-9 -
European Journal of Orthopaedic Surgery... Dec 2023Τhe main goal of this study was to compare the clinical results, including the complication rates and patient-reported outcomes, in patients who underwent surgery for... (Review)
Review
PURPOSE
Τhe main goal of this study was to compare the clinical results, including the complication rates and patient-reported outcomes, in patients who underwent surgery for recurrent patellar dislocation using different patellar tunnel fixation techniques. This study compared Medial Patellofemoral Ligament (MPFL) reconstruction implant free techniques against ones that used implants.
METHODS
The present systematic review was conducted according to the PRISMA guidelines. The literature search was conducted in January 2023. We included patients who underwent isolated MPFL reconstruction for recurrent patellar instability. Patients with confirmed concomitant or prior ipsilateral knee procedures, multiligament injury, severe patellar dysplasia or less than 6 months of follow-up were excluded. MINORS and MCMS scores were used for the assessment of methodological quality.
RESULTS
Data from 750 procedures were collected, of which 284 used implants to perform the procedure while in 455 an implant-free technique was used. Patient age at the time of surgery ranged from 11 to 60 years while the follow-up time of the studies ranged between 3 and 108 months. Postoperative Kujala (0.3, p = 0.89) and Lysholm (1.2, p = 0.26) scores were better in the implant-free techniques compared to implant-based. A higher rate of recurrent dislocation (OR 0.51; 95% CI 0.10-2.54, p = 0.4), subluxation (OR 0.20; 95% CI 0.40-0.88, p = 0.019) and stiffness (OR 0.76; 95% CI 0.33-1.72, p = 0.55) was noted in the implant-free techniques, while the implant-based techniques displayed increased incidence of patella fractures (OR 3.12; 95% CI 0.77-12.6, p = 0.09), reoperation (OR 1.69; 95% CI 0.78-3.65, p = 0.17) and infection (OR 2.07; 95% CI 0.46-9.32, p = 0.33).
CONCLUSION
There was no significant difference between the 2 techniques in terms of patient reported outcomes. Regarding complications, MPFL reconstruction using implants demonstrated significant higher rate of patella fractures while the implant free technique showed a greater risk of subluxation.
Topics: Humans; Infant; Child, Preschool; Patella; Patellofemoral Joint; Joint Instability; Patella Fracture; Joint Dislocations; Ligaments, Articular; Knee Injuries; Fractures, Bone; Patellar Dislocation
PubMed: 37127815
DOI: 10.1007/s00590-023-03559-1