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Orthopaedic Journal of Sports Medicine Jan 2024Osteochondral injuries (OCIs) are common in patients with acute lateral patellar dislocation, which can produce both short- and long-;term adverse effects. However, the...
BACKGROUND
Osteochondral injuries (OCIs) are common in patients with acute lateral patellar dislocation, which can produce both short- and long-;term adverse effects. However, the pattern of these injuries warrants further analysis, especially in relation to patient age.
PURPOSE
To determine the overall prevalence of concomitant OCIs as well as the prevalence differences based on location and age after acute lateral patellar dislocations.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
A comprehensive search of PubMed, Embase, Web of Science, and Cochrane Library was completed from inception to July 20, 2022. All articles reporting the prevalence of OCI were included. The sample characteristics such as age, study design, magnetic resonance imaging diagnostic data, and the number of patients with OCI were extracted. The Methodological Index for Non-Randomized Studies (MINORS) was used for quality assessment. The overall and per-;site injury rates were calculated, and the prevalence was stratified by age-;group (≤16 and >16 years) and compared.
RESULTS
The systematic review included 39 studies involving 3354 patients. MINORS scores were 11.94 ± 1.98 and 16 ± 3.46 in the noncomparative and comparative studies, respectively. The overall prevalence of bone bruises and OCI was 89.6% (95% CI, 77.4%-97.7%) and 48.8% (95% CI, 39.0%-58.7%), respectively. In both overall and >16-year-old patients, the lateral femoral condyle (LFC) was the most common site of bone bruise (90.5% [95% CI, 84.0%-95.6%] and 91.5% [95% CI, 84.3%-96.9%], respectively); however, the medial patellar bruise was more common in patients ≤16 years (89.2% [95% CI, 82.9%-94.4%]). Among the pooled sites of OCI, the medial patella accounted for the largest proportion (36.9% [95% CI, 28.0%-46.3%]). OCIs were more common in patients >16 years (52.6% [95% CI, 39.4%-65.6%]) than in patients ≤16 years (46.6% [95% CI, 33.2%-60.3%]).
CONCLUSION
Bone bruises on the LFC were most prevalent overall and in patients >16 years, whereas bone bruises on the medial patella were more prevalent in patients ≤16 years. OCIs were frequently seen in patients >16 years, with the most common site being the medial patella.
PubMed: 38274015
DOI: 10.1177/23259671231220904 -
Journal of Orthopaedics Aug 2023Patellar instability can arise from a traumatic event with anatomical predisposing factors increasing the risk of dislocation. Accurate diagnosis is required to initiate... (Review)
Review
INTRODUCTION
Patellar instability can arise from a traumatic event with anatomical predisposing factors increasing the risk of dislocation. Accurate diagnosis is required to initiate appropriate treatment. We aimed to evaluate the patella apprehension test (PAT) as a method to diagnose patellar instability.
METHODS
The PRISMA diagnostic test accuracy checklist was followed. The review protocol was registered on PROSPERO with registration number CRD42022357898. Electronic databases, currently registered studies, conference proceedings and the reference lists of included studies were searched. A narrative synthesis evaluated the validity of the PAT as a method of diagnosing patellar instability.
RESULTS
A total of 4867 records were screened in the initial search. Of these, 34 articles satisfied the inclusion criteria, assessing 1139 knees of 1046 patients. The PAT was found to have a high sensitivity and specificity. Its intra and inter-rater reliability was highly variable among studies. Studies reporting patellar instability correction following surgery also found a decrease in the number of patients exhibiting a positive PAT.
CONCLUSION
Current evidence suggests that the PAT has a high sensitivity and specificity. The intra- and inter-rater validities of the PAT are widely variable due to its subjective nature. Thus, though the PAT can be used to provide a provisional clinical diagnosis of patellar instability, formal functional assessment and imaging should be performed to confirm the diagnosis. Further research should explore the association between a positive PAT and anatomical parameters. In addition, studies comparing the accuracy of the PAT and radiological investigations should be performed.
PubMed: 37483643
DOI: 10.1016/j.jor.2023.07.005 -
Orthopaedic Surgery Sep 2023The tibial tubercle-trochlear groove (TT-TG) distance is now routinely utilized to help determine whether a realignment procedure is necessary for patients with patellar... (Review)
Review
Tibial Tubercle-Trochlear Groove Distance Has Better Diagnostic Reliability Than Tubercle-Posterior Cruciate Ligament Distance For Predicting Patellar Instability: A Systematic Review.
OBJECTIVE
The tibial tubercle-trochlear groove (TT-TG) distance is now routinely utilized to help determine whether a realignment procedure is necessary for patients with patellar instability. The tibial tubercle-posterior cruciate ligament (TT-PCL) distance has been explored as an alternative measurement. The aim of this study is to compare the reliability of TT-TG and TT-PCL; to explore whether there is a relationship between the TT-PCL and the TT-TG distance; to determine whether there is a relationship between the TT-TG and TT-PCL distances and knee rotation; and to compare the abilities of the TT-PCL distance and the TT-TG distance with predicted patellar instability.
METHOD
This systematic review was performed in accordance with PRISMA guidelines. Three databases, PubMed, EMBASE, and Cochrane Central Register of Controlled Trials, were searched from inception to September 2021 to identify clinical studies comparing TT-TG and TT-PCL distances to patellar instability. Data on patient baseline characteristics, TT-TG and TT-PCL distances, inter-observer reliability, and area under the receiver-operating characteristic curve (AUC) were recorded. The methodological quality of the studies was assessed using the quality assessment form recommended by the Agency for Healthcare Research and Quality (AHRQ).
RESULT
Twenty studies were included in the final analysis, comprising 2330 knees from 2260 patients. The current study showed that TT-TG and TT-PCL have similar observer reliability. The inter- and intra-observer reliability of TT-TG ranged from 0.807 to 0.98 and 0.553 to 0.99, respectively. The inter- and intra-observer reliability of TT-PCL ranged from 0.553 to 0.99 and 0.88 to 0.981, respectively. Six studies compared the AUC for predicting patellar instability and showed that TT-TG had better predictive performance than TT-PCL. Three studies reported a correlation between TT-TG and knee rotation, but no such relationship was found for TT-PCL. Eight studies reported a weak or moderate correlation between TT-TG and TT-PCL.
CONCLUSION
TT-TG and TT-PCL have similar inter- and intra-rater reliability (as measured by ICC), but TT-TG has greater discriminatory power to predict patellar instability than TT-PCL (as measured by AUC values and odds ratio). However, considering trochlear dysplasia and individual variations, future studies need to find more accurate and individualized methods to predict patellar instability.
Topics: Humans; Posterior Cruciate Ligament; Patellofemoral Joint; Joint Instability; Reproducibility of Results; Magnetic Resonance Imaging; Observer Variation; Tibia; Patellar Dislocation
PubMed: 37427672
DOI: 10.1111/os.13819 -
European Journal of Orthopaedic Surgery... Jul 2020After the first patellar dislocation, most patients report damage of the medio-patellofemoral ligament (MPFL) and surgical reconstruction is required. The purpose of...
INTRODUCTION
After the first patellar dislocation, most patients report damage of the medio-patellofemoral ligament (MPFL) and surgical reconstruction is required. The purpose of this study is to systematically review current evidence and to clarify the role of the gracilis and semitendinosus tendons as graft for isolated MPFL reconstruction.
MATERIALS AND METHODS
The present systematic review was conducted according to the PRISMA guidelines. The literature search was conducted in October 2019. All clinical trials using the semitendinosus and/or gracilis tendon grafts for isolated MPFL reconstruction in patients with patellofemoral instability were considered for inclusion. Only articles reporting a minimum of 12-month follow-up were considered. The PEDro score was used for the methodological quality assessment.
RESULTS
Data from 1491 procedures were collected. The mean follow-up was 36.12 months. There was comparability among the patient baseline. All the scores of interests (Kujala, Tegner, Lysholm) and range of motion scored better in the semitendinosus group. Moreover, in favour of the semitendinosus group, a statistically significant reduction of the revision surgeries and re-dislocations were evidenced. Apprehension test and persistent instability sensation found any statistical correlations.
CONCLUSION
Isolated MPFL reconstruction through semitendinosus tendon graft performed better than the gracilis in selected patients suffering from recurrent patellofemoral instability.
Topics: Gracilis Muscle; Hamstring Tendons; Humans; Knee Joint; Ligaments, Articular; Patellar Dislocation; Range of Motion, Articular; Plastic Surgery Procedures; Recurrence; Reoperation
PubMed: 32008097
DOI: 10.1007/s00590-020-02636-z -
Knee Surgery, Sports Traumatology,... Aug 2023To determine the reliability and diagnostic accuracy of tibial tubercle-trochlear groove (TT-TG) distance versus tibial tubercle-posterior cruciate ligament (TT-PCL)... (Review)
Review
PURPOSE
To determine the reliability and diagnostic accuracy of tibial tubercle-trochlear groove (TT-TG) distance versus tibial tubercle-posterior cruciate ligament (TT-PCL) distance, and to determine cutoff values of these measurements for pathological diagnosis in the context of patellar instability.
METHODS
Three databases MEDLINE, PubMed and EMBASE were searched from inception to October 5, 2022 for literature outlining comparisons between TT-TG and TT-PCL in patellar instability patients. The authors adhered to the PRISMA and R-AMSTAR guidelines as well as the Cochrane Handbook for Systematic Reviews of Interventions. Data on inter-rater and intra-rater reliability, receiver-operating characteristic (ROC) curve parameters such as area under the curve (AUC), sensitivity and specificity, as well as odds ratios, cutoff values for pathological diagnosis and correlations between TT-TG and TT-PCL were recorded. The MINORS score was used for all studies in order to perform a quality assessment of included studies.
RESULTS
A total of 23 studies comprising 2839 patients (2922 knees) were included in this review. Inter-rater reliability ranged from 0.71 to 0.98 and 0.55 to 0.99 for TT-TG and TT-PCL, respectively. Intra-rater reliability ranged from 0.74 to 0.99 and 0.88 to 0.98 for TT-TG and TT-PCL, respectively. AUC measuring diagnostic accuracy of patellar instability for TT-TG ranged from 0.80 to 0.84 and 0.58 to 0.76 for TT-PCL. Five studies found TT-TG to have more discriminatory power than TT-PCL at distinguishing patients with patellar instability from patients who do not. Sensitivity and specificity ranged from 21 to 85% and 62 to 100%, respectively, for TT-TG. Sensitivity and specificity ranged from 30 to 76% and 46 to 86%, respectively, for TT-PCL. Odds ratio values ranged from 1.06 to 14.02 for TT-TG and 0.98 to 6.47 for TT-PCL. Proposed cutoff TT-TG and TT-PCL values for predicting patellar instability ranged from 15.0 to 21.4 mm and 19.8 to 28.0 mm, respectively. Eight studies reported significant positive correlations between TT-TG and TT-PCL.
CONCLUSION
TT-TG resulted in overall similar reliability, sensitivity and specificity as TT-PCL; however, TT-TG has better diagnostic accuracy than TT-PCL in the context of patellar instability as per AUC and odds ratio values.
LEVEL OF EVIDENCE
Level IV.
Topics: Humans; Posterior Cruciate Ligament; Patellar Dislocation; Patellofemoral Joint; Joint Instability; Reproducibility of Results; Magnetic Resonance Imaging; Observer Variation; Tibia; Retrospective Studies
PubMed: 36877229
DOI: 10.1007/s00167-023-07358-3 -
Arthroscopy : the Journal of... Oct 2021The purpose of this systematic review is to ascertain the reported clinical outcomes and complication profiles of medial patellofemoral ligament (MPFL) reconstruction... (Review)
Review
PURPOSE
The purpose of this systematic review is to ascertain the reported clinical outcomes and complication profiles of medial patellofemoral ligament (MPFL) reconstruction performed using a superficial "swing-down" quadriceps tendon autograft.
METHODS
Three databases (PubMed, EMBASE, and MEDLINE) were searched from January 1, 2000, to April 06, 2020. Keywords used in the search included: "medial patellofemoral ligament" and "reconstruction". After screening based on inclusion and exclusion criteria, patient demographics, graft type, outcomes, and complications were extracted. Methodological Index for Non-Randomized Studies criteria were used to assess the quality of each included study.
RESULTS
Eleven studies were included, comprising data from 226 patients with mean follow up ranging from 12 to 38 months. All reconstructions used a superficial "swing-down" quadriceps tendon autograft fixed at 20-30 degrees of knee flexion where reported. Eight of eleven studies reported significant improvement in patient reported outcomes such as Kujala score, Lysholm score, and Tegner score. The mean preoperative Kujala score ranged from 35.8 to 82.1 (167 patients), while the mean postoperative Kujala score ranged from 88.4 to 94.8 (197 patients). The mean of the preoperative Lysholm score ranged from 43.3 to 79.3 (77 patients), while the mean of the postoperative Lysholm score ranged from 81.9 to 90.9 (99 patients). The I statistic for Lysholm and Kujala scores was 94% and 97%, respectively. Across data reported on 194 patients, there was no incidence of patellar redislocation, patellar fracture, or graft site morbidity.
CONCLUSION
The quadriceps tendon produced improved clinical outcomes with low rates of recurrent postoperative patellar dislocation. These data suggest that the quadriceps tendon remains a suitable alternative for MPFL reconstruction and should remain part of the arsenal of knee ligament surgeons.
LEVEL OF EVIDENCE
Systematic review of Level III and IV studies.
Topics: Autografts; Humans; Ligaments, Articular; Patellar Dislocation; Patellofemoral Joint; Tendons
PubMed: 33961979
DOI: 10.1016/j.arthro.2021.04.048 -
Journal of Orthopaedic Surgery and... Nov 2023The purpose of the study was to summarize the available evidence and identify risk factors for osteochondral injuries (OCIs) after patellar dislocations.
PURPOSE
The purpose of the study was to summarize the available evidence and identify risk factors for osteochondral injuries (OCIs) after patellar dislocations.
METHODS
A systematic literature review was conducted in PubMed, Embase, Web of Science, Cochrane Library, and China national knowledge infrastructure from inception to December 22, 2022, according to the preferred reporting items for systematic reviews and meta-analyses guidelines. Studies regarding risk factors for OCIs after patellar dislocations were included. Literature search, data extraction, and quality assessment were performed independently by two authors.
RESULTS
A total of 16 studies with 1945 patients were included. The risk factors for OCIs after patellar dislocation were categorized into four main categories, including demographic characteristics, patellar depth and position, femoral trochlear morphology, and other risk factors in this study. Five and three studies supported the idea that male sex and skeletal maturation may be risk factors, respectively. Normal femoral trochlea (two studies) and complete medial patellofemoral ligament (MPFL) injuries (two studies) may be associated with the development of OCIs. Three studies show that ligamentous laxity or joint hypermobility may prevent OCIs. Patellar depth and position (eight studies) may not be associated with the development of OCIs.
CONCLUSIONS
Based on the available evidence, an increased risk of OCIs following patellar dislocation may be associated with male sex and skeletal maturation. Furthermore, normal femoral trochlea and complete MPFL injuries may increase the risk of OCIs, while factors such as ligamentous laxity or joint hypermobility may reduce the risk.
LEVEL OF EVIDENCE
Level IV, systematic review of Level II and IV studies.
Topics: Humans; Male; Patellar Dislocation; Joint Instability; Patella; Knee Joint; Femur; Ligaments, Articular; Intra-Articular Fractures; Patellofemoral Joint; Risk Factors
PubMed: 37915023
DOI: 10.1186/s13018-023-04265-8 -
Knee Surgery, Sports Traumatology,... Apr 2021To assess the different surgical techniques and their outcomes following tibial tubercle transfer (TTT) in patients with patellar maltracking. (Meta-Analysis)
Meta-Analysis
PURPOSE
To assess the different surgical techniques and their outcomes following tibial tubercle transfer (TTT) in patients with patellar maltracking.
METHODS
A systematic search of the literature was performed in PubMed, EMBASE and Cochrane Library. Studies reporting patient-reported outcome measures (PROMs) or clinical outcome following: TTT in patients with patellar maltracking were included. Collected PROMs were Lysholm, Kujala, IKDC score, and VAS pain. Clinical outcome included reported clinical success, patient satisfaction, complications and removal of hardware (ROH). Overall pre-, post-operative and change scores were estimated using random-effects meta-analysis models. Results were reported as overall mean and per transfer direction.
RESULTS
A total of 26 studies and 761 patients (818 knees, mean age 35 years, mean follow-up 5.0 years) were included. In 73% of the studies, surgery was performed after failed conservative treatment. Transfer direction was anteromedial in 76% of all procedures. Overall Lysholm score improved from 61 to 91, Kujala from 52 to 85, IKDC from 53 to 81, and VAS from 6.2 to 2.5, respectively. Clinical success was reported in 79% of patients, and 80% of patients reported to have satisfactory results. Rates of complications and ROH were 13% and 29%, respectively.
CONCLUSIONS
TTT for management of patellar maltracking can lead to good results with clinically meaningful improvement, an overall clinical success of 79% and overall patient satisfaction of 80% when appreciating the underlying anatomic condition and using appropriate technique. The level of evidence was low, and large-scale prospective, comparative cohort studies with uniform outcome scales are needed to confirm these findings.
LEVEL OF EVIDENCE
IV.
Topics: Adult; Female; Humans; Joint Instability; Lysholm Knee Score; Male; Middle Aged; Osteotomy; Pain Measurement; Patella; Patellar Dislocation; Patellofemoral Joint; Patellofemoral Pain Syndrome; Patient Reported Outcome Measures; Postoperative Period; Tibia; Treatment Outcome; Young Adult
PubMed: 32594329
DOI: 10.1007/s00167-020-06114-1 -
Journal of ISAKOS : Joint Disorders &... Oct 2023To analyze the effect of patellofemoral anatomical variations (patella alta, increased tibial tubercle-trochlear groove [TT-TG] distance, and trochlear dysplasia) on... (Review)
Review
OBJECTIVES
To analyze the effect of patellofemoral anatomical variations (patella alta, increased tibial tubercle-trochlear groove [TT-TG] distance, and trochlear dysplasia) on clinical outcomes after isolated medial patellofemoral ligament (MPFL) reconstruction.
METHODS
A comprehensive search from PubMed, Embase, and the Cochrane Library databases was conducted to identify studies that compared outcomes based on the presence or absence of patella alta, elevated tibial tubercle-trochlear groove (TT-TG) distance, and/or trochlear dysplasia. Exclusion criteria included reviews and meta-analyses, studies that included patients who underwent associated bony procedures, and those reporting outcomes after isolated MPFL reconstruction with no comparison between varying anatomical groups.
RESULTS
After application of selection criteria, 19 studies were included. Patella alta was not predictive of failure or poorer outcomes among 13 studies; however, 2 studies demonstrated poorer patient-reported outcome scores and/or higher failure rates with increasing patellar height. Increasing TT-TG distance demonstrated a statistically significant correlation with poorer outcomes in only one study, whereas 12 other studies showed no association. Trochlear dysplasia resulted in worse outcomes and greater failure rates in 6 studies, while 10 studies showed no statistically significant correlation between trochlear dysplasia and postoperative outcomes.
CONCLUSION
Patella alta and increased TT-TG distance did not adversely affect outcomes following isolated MPFL reconstruction in the preponderance of reviewed studies. Data are mixed regarding the impact of trochlear dysplasia on the outcomes of isolated MPFL reconstruction.
LEVEL OF EVIDENCE
IV.
Topics: Humans; Patellar Dislocation; Patellofemoral Joint; Patella; Joint Instability; Recurrence; Patient Reported Outcome Measures
PubMed: 37562573
DOI: 10.1016/j.jisako.2023.08.001 -
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