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Archives of Orthopaedic and Trauma... Oct 2022Lateral patellar compression syndrome is one of the causes of anterior knee pain in young adults and resulted from tight lateral patellar retinaculum. The aim of our... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Lateral patellar compression syndrome is one of the causes of anterior knee pain in young adults and resulted from tight lateral patellar retinaculum. The aim of our study is to compare between open and arthroscopic release of lateral patellar compression syndrome in relation of functional outcome, time of surgical procedure, length of hospital stays, intraoperative and postoperative complications as bleeding, infection, recurrence, and patellar instability with 2 years of follow-up.
MATERIALS AND METHODS
80 patients, age (21-49 years), were divided randomly into 2 groups (A and B). Group A (40 patients) were treated with open release. Group B (40 patients) were treated by arthroscopic release. All these patients are diagnosed as lateral patellar compression syndrome depending on clinical features and MRI. All patients were assessed by Lysholm knee scoring scale before surgery and at periods of 2, 6 weeks, 6, 12, and 24 months after surgery.
RESULTS
There is significant difference in functional outcome, measured by Lysholm knee scoring scale, between preoperative and postoperative assessment periods in both groups (P < 0.001). There is significantly better functional outcome at 2 years of follow-up with arthroscopic release (P = 0.018). There is no recurrence in both groups, but there were 4 patients develop medial patellar instability in the group of open release.
CONCLUSION
Both open and arthroscopic lateral release for patients with isolated lateral patellar compression syndrome can be effective surgical procedures, but arthroscopic release can achieve better functional outcome.
TRIAL REGISTRATION
NCT, NCT04130412. Retrospectively registered on 3rd of June, 2020 at ClinicalTrials.gov.
Topics: Adult; Arthroscopy; Humans; Joint Instability; Ligaments, Articular; Middle Aged; Patella; Patellar Dislocation; Patellofemoral Joint; Syndrome; Treatment Outcome; Young Adult
PubMed: 33829300
DOI: 10.1007/s00402-021-03878-0 -
Orthopaedic Journal of Sports Medicine May 2021Numerous diagnostic imaging measurements related to patellar instability have been evaluated in the literature; however, little has been done to compare these findings... (Review)
Review
BACKGROUND
Numerous diagnostic imaging measurements related to patellar instability have been evaluated in the literature; however, little has been done to compare these findings across multiple studies.
PURPOSE
To review the different imaging measurements used to evaluate patellar instability and to assess the prevalence of each measure and its utility in predicting instability. We focused on reliability across imaging modalities and between patients with and without patellar instability.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
We performed a systematic review of the literature using the PubMed, SCOPUS, and Cochrane databases. Each database was searched for variations of the terms "patellar instability," "patellar dislocation," "trochlear dysplasia," "radiographic measures," "computed tomography," and "magnetic resonance imaging." Studies were included if they were published after May 1, 2009, and before May 1, 2019. A meta-analysis using a random effects model was performed on several measurements, comparing instability and control groups to generate pooled values.
RESULTS
A total of 813 articles were identified, and 96 articles comprising 7912 patients and 106 unique metrics were included in the analysis. The mean patient age was 23.1 years (95% CI, 21.1-24.5), and 41% were male. The tibial tubercle-trochlear groove (TT-TG) distance was the most frequently included metric (59 studies), followed by the Insall-Salvati ratio and Caton-Deschamps index (both 26 studies). The interobserver intraclass correlation coefficients were excellent or good for the TT-TG distance and Insall-Salvati ratio in 100% of studies reporting them; however, for the Caton-Deschamps index and Blackburne-Peel ratio, they were excellent or good in only 43% and 40% of studies. Pooled magnetic resonance imaging values for TT-TG distance ( < .01), Insall-Salvati ratio ( = .01), and femoral sulcus angle ( = .02) were significantly different between the instability and control groups. Values for tibial tubercle-posterior cruciate ligament distance ( = .36) and Caton-Deschamps index ( = .09) were not significantly different between groups.
CONCLUSION
The most commonly reported measurements for evaluating patellar instability assessed patellar tracking and trochlear morphology. The TT-TG distance was the most common measurement and was greater in the patellar instability group as compared with the control group. In addition, the TT-TG, tibial tubercle-posterior cruciate ligament, and patellar tendon-trochlear groove distances were highly reproducible measurements for patellar tracking, and the Insall-Salvati ratio had superior reproducibility for assessing patellar height.
PubMed: 34095324
DOI: 10.1177/2325967121993179 -
Medicina (Kaunas, Lithuania) Feb 2021Acute lateral patellar dislocation (LPD) is the most common acute knee disorder in children and adolescents, and may lead to functional disability. The purpose of this...
Acute lateral patellar dislocation (LPD) is the most common acute knee disorder in children and adolescents, and may lead to functional disability. The purpose of this study was to identify key differences and correlations of the patellofemoral joint (PFJ) morphology between intact and contralateral injured knees in a first-time traumatic LPD population aged under 18 years. The data were gathered prospectively from a cohort of 58 patients (35 girls and 23 boys). The prevalence and combined prevalence of patella alta (PA) and trochlear dysplasia (TD) in both knees of patients were evaluated using X-ray by two radiologists. The PFJ of patients' intact knees had a lower rate of TD (1.72% vs. 5.2%) and a less common combination of PA with shallow femoral sulcus (SFS) (22.4% vs. 44.8%) but more frequent PA (62.1% vs. 41.4%) compared with their injured knees. We noted statistically significant positive correlations (SSPCs) between the femoral sulcus angle (FSA) and PA in patients with intact ( = 0.37; < 0.005) and contralateral injured knees ( = 0.33; < 0.05). There were SSPCs between the FSA and PA in both gender and age groups of patients with intact and contralateral injured knees. The SSPCs between the FSA and PA of intact knees were higher in the patients with a more dysplastic PFJ anatomy (PA and TD) of the injured knees as compared to patients with only PA of the injured knees.
Topics: Adolescent; Aged; Child; Female; Femur; Humans; Knee Joint; Male; Patella; Patellar Dislocation; Patellofemoral Joint; Radiography
PubMed: 33652722
DOI: 10.3390/medicina57030206 -
Acta Orthopaedica Oct 2023The Banff Patellofemoral Instability Instrument (BPII) 2.0 is a patient-reported outcome measure (PROM) designed specifically for patellofemoral instability. We...
BACKGROUND AND PURPOSE
The Banff Patellofemoral Instability Instrument (BPII) 2.0 is a patient-reported outcome measure (PROM) designed specifically for patellofemoral instability. We translated and adapted the BPII 2.0 into Swedish and assessed its psychometric properties.
PATIENTS AND METHODS
The BPII 2.0 was forward- and back-translated. Children aged 10-16 years with patellar dislocation and instability or recurrent dislocation were recruited. Children completed the Swedish BPII 2.0 and KOOS-Child during their initial visit (t0) and 1 week later (t1). Internal consistency and test-retest reliability were evaluated using intraclass correlation coefficients (ICCs) for the BPII 2.0 and KOOS-Child scores comparison. Pearson correlation coefficients examined concurrent validity of the Swedish BPII 2.0 subscales with KOOS-Child subscales.
RESULTS
64 children (46 females), mean age 13.8 (10.0-16.3) years, participated. Time after patellar dislocation or surgery was 3-24 months. 55 patients (86%) returned the second BPII 2.0 and KOOS-Child after an average of 9 (5-22) days. There were no ceiling or floor effects for the total score of the new Swedish BPII 2.0 or for its subscales. BPII 2.0 demonstrated excellent internal consistency at t0 (ICC 0.96, 95% confidence interval [CI] 0.95-0.97) and at t1 (ICC 0.97, CI 0.95-0.98), as well as excellent test-retest reliability (ICC 0.97, CI 0.96-0.98). Concurrent validity of the BPII 2.0 subscales with KOOS-Child subscales was moderate to strong (rho 0.40-0.88).
CONCLUSION
The Swedish BPII 2.0 showed excellent internal consistency as well as excellent test-retest reliability and is a reliable and valid questionnaire.
Topics: Female; Humans; Adolescent; Patellar Dislocation; Patellofemoral Joint; Reproducibility of Results; Sweden; Joint Instability; Quality of Life; Surveys and Questionnaires; Psychometrics
PubMed: 37905565
DOI: 10.2340/17453674.2023.21194 -
Orthopaedic Surgery May 2021To describe a surgical technique using suture tape for reconstruction of the medial patellofemoral ligament (MPFL). This technique restores the stability of the...
OBJECTIVE
To describe a surgical technique using suture tape for reconstruction of the medial patellofemoral ligament (MPFL). This technique restores the stability of the reconstructed ligament and has excellent postoperative outcomes.
METHOD
This is a retrospective analysis. From January 2016 to June 2018, 17 patients underwent MPFL reconstruction using high-strength suture (FiberTape; Arthrex) augmentation, with at least 12 months of follow up. There were 11 female and 6 male patients. The mean age at the time of MPFL reconstruction was 22.1 years (range 13-34 years). Clinical outcomes included pain level, knee range of motion, passive patellar hypermobility, and maltracking at follow-up. The lateral patellofemoral angles, congruence angles, and patellar tilt angles were measured in a skyline view by CT at 30° of knee flexion at 12 months. Functional outcomes were assessed using the Lysholm knee scoring scale, the SF-12 score, the Tegner score, and the Crosby and Insall grading system at yearly follow-up.
RESULT
No patients were lost at the last follow up. One patient had recurrence of patellar dislocation and none of the others had serious complications. The success rate of MPFL repair for preventing recurrent dislocations was 94.1% (16 of 17 knees). Fifteen knees had full range of motion of more than 130°. At follow-up, 2 knees were judged to have mild hypermobility and none had severe hypermobility or maltracking. Using the Crosby and Insall grading system, 12 knees (70.6%) were graded as excellent, 4 knees (23.5%) as good, 1 knee (5.9%) as fair to poor, and none as worse at the last follow-up assessment. In all patients, the Lysholm knee score (55.12 ± 13.52 vs 79.88 ± 7.50, P < 0.01), the SF-12 score (47 ± 9.53 vs 65.24 ± 12.82, P < 0.01), and the Tegner score (2.76 ± 1.39 vs 6.53 ± 1.70, P < 0.01) had improved at their 12-month follow up. Compared with preoperative radiological findings, there was a significant improvement in lateral patellofemoral angle (-10.24 ± 7.10 vs 6 ± 5.43, P < 0.01), patellar tilt angle (26.53 ± 7.23 vs 9.88 ± 4.24, P < 0.01), and congruence angle (29.59 ± 11.95 vs -8.65 ± 4.86, P < 0.01).
CONCLUSION
The use of FiberTape in MPFL reconstruction can improve the stability of the knee following surgery and has good midterm clinical results and low complication rates.
Topics: Adolescent; Adult; Female; Humans; Joint Instability; Ligaments, Articular; Male; Pain Measurement; Patellofemoral Joint; Range of Motion, Articular; Retrospective Studies; Suture Techniques; Young Adult
PubMed: 33749146
DOI: 10.1111/os.12945 -
Orthopaedic Journal of Sports Medicine Sep 2021Medial patellofemoral ligament (MPFL) reconstruction, MPFL repair, and nonoperative treatment are important treatments for patients with patellar dislocation. However,... (Review)
Review
BACKGROUND
Medial patellofemoral ligament (MPFL) reconstruction, MPFL repair, and nonoperative treatment are important treatments for patients with patellar dislocation. However, it is unclear which treatment leads to better outcomes.
PURPOSE
To determine the efficacy and safety of the 3 treatments in the treatment of patellar dislocation and compare the effect of MPFL reconstruction with MPFL repair, MPFL reconstruction with nonoperative treatment, and MPFL repair with nonoperative treatment.
STUDY DESIGN
Systematic review; Level of evidence, 3.
METHODS
The PubMed, Web of Science, Cochrane Library, Embase, CNKI (China National Knowledge Infrastructure), and Wanfang databases were searched from inception to December 2020. Included were clinical studies that described the efficacy and safety of 2 of the 3 treatments, studies directly comparing the clinical effects of the 2 operative techniques, or studies comparing the effects of reconstruction or repair with nonoperative treatment. Two reviewers independently extracted data and assessed the quality of the included studies with the Cochrane risk-of-bias tools. The outcomes evaluated were postoperative redislocation rate, revision rate, complications, and Kujala score. We used traditional direct pairwise meta-analysis as well as network meta-analysis for comprehensive efficacy of all 3 treatment measures.
RESULTS
Twelve studies were included: 5 compared MPFL reconstruction with MPFL repair, 2 compared MPFL reconstruction with nonoperative treatment, and 5 compared MPFL repair with nonoperative treatment. The risk of bias was serious in 4, moderate in 4 and low in 4 articles. MPFL reconstruction led to significantly reduced redislocation and improved Kujala scores compared with MPFL repair and nonoperative treatment. MPFL repair led to reduced redislocation rates compared with nonoperative treatment but did not show an obvious benefit in primary dislocations. There was no significant difference among the 3 treatments in terms of revision rate and incidence of complications, although we found that treatment-related complications were least likely to occur in nonoperative treatment.
CONCLUSION
The results of this review indicate that MPFL reconstruction decreases recurrent dislocation compared with MPFL repair or nonoperative treatment, but it has a higher possibility of complications. MPFL repair resulted in less postoperative redislocation than nonoperative treatment but did not show an obvious benefit in primary dislocation.
PubMed: 34604425
DOI: 10.1177/23259671211026624 -
Journal of Children's Orthopaedics Aug 2020Langenskiöld described a reconstructive soft-tissue procedure for irreducible lateral congenital patellar dislocations. Paley further detailed the technique in the...
PURPOSE
Langenskiöld described a reconstructive soft-tissue procedure for irreducible lateral congenital patellar dislocations. Paley further detailed the technique in the surgical management of congenital femoral deficiency. The aim of this study was to evaluate the outcomes of patients with congenital, chronic and recurrent patellar dislocations treated with the modified Langenskiöld procedure.
METHODS
This is a retrospective case series. Between 2011 and 2018, 18 knees in 13 patients (mean age 15.8 years (sd 4.4; 12 to 29.9), nine female) with diagnoses of recurrent (six patients, eight knees), chronic (four patients, six knees) and congenital (three patients, four knees) patellar dislocations were treated with the modified Langenskiöld procedure.
RESULTS
There were no recurrent lateral dislocations in the congenital or recurrent groups. One of the patients in the congenital group had an overcorrection with some medial patellar maltracking but until this time has not required any further surgery. In the chronic group two of the six knees developed further dislocations; these were both on the same patient, who had no dislocations until one year after surgery. Mean Kujala score was 83.7 (sd 17; 47 to 100) for all groups. In spite of preoperative knee flexion contractures of up to 30° in three patients (six knees), all patients had full extension postoperatively. Eight patients reported being satisfied with their outcome, one was somewhat satisfied, two were very dissatisfied, and two did not respond.
CONCLUSION
The modified Langenskiöld reconstruction provides a powerful correction for challenging cases of congenital and recurrent patellar dislocations. Re-dislocation as well as overcorrection can occasionally occur.
LEVEL OF EVIDENCE
Level IV.
PubMed: 32874366
DOI: 10.1302/1863-2548.14.200044 -
Arthroscopy Techniques Sep 2022Obligatory patella dislocation in flexion is an uncommon form of patellar instability, where the patella is located in extension and dislocates with every episode of...
Obligatory patella dislocation in flexion is an uncommon form of patellar instability, where the patella is located in extension and dislocates with every episode of knee flexion. This results in dramatically altered patellofemoral kinematics and can be extremely debilitating due to extensor strength deficits and lack of knee confidence in flexion. Concomitant pathology, which is often seen, includes a tight lateral retinaculum and a shortened extensor mechanism. Lengthening the extensor mechanism is a critical part of successful patellar stabilization, and has not been well-reported. Herein, we present a technique of quadriceps lengthening for the treatment of obligatory patellar dislocation.
PubMed: 36185121
DOI: 10.1016/j.eats.2022.05.003 -
European Review For Medical and... Apr 2024This study aimed to investigate the clinical effects of combining knee extension mechanism (EM) with rearrangement in the treatment of recurrent patellar dislocation...
OBJECTIVE
This study aimed to investigate the clinical effects of combining knee extension mechanism (EM) with rearrangement in the treatment of recurrent patellar dislocation (RPD).
PATIENTS AND METHODS
Eighty-four patients with RPD admitted to the First Affiliated Hospital of Kunming Medical University were included. In this work, all patients received routine computed tomography (CT) examinations. In addition, the evaluation factors of EM combined with rearrangement therapy in RPD patients were analyzed using logistic regression.
RESULTS
Lysholm and Kujula scores, femoral canal width, patellar canal width, patellar tilt angle (PTA), and lateral patellar displacement (LPD) were significantly increased at 1 and 3 years after treatment (p < 0.05). LPA was significantly decreased, while the tibial tuberosity trochlear groove of the femur (TT-TG) demonstrated no considerable differences (p > 0.05). The good rate of the short-term Insall-Salvati index was 78.6%, and that of the long-term Insall-Salvati index was 76.1%. The combination of the knee extension device and rearrangement therapy has a higher rate of short-term and long-term Insall-Salvati index (ISI) excellence. In addition, the range of motion of the knee joint increased significantly, and the Q Angle decreased significantly (p < 0.05). Logistic regression analysis showed that age and ISI were highly correlated with the evaluation of therapeutic effects in patients with RPD.
CONCLUSIONS
EM combined with rearrangement in the treatment of RPD had positive short-term and long-term efficacy, high application value, and age, which can be popularized in clinical applications and have positive diagnostic value.
Topics: Humans; Patellar Dislocation; Male; Female; Adult; Knee Joint; Recurrence; Young Adult; Range of Motion, Articular; Adolescent; Tomography, X-Ray Computed
PubMed: 38708477
DOI: 10.26355/eurrev_202404_36047 -
BMC Musculoskeletal Disorders Mar 2022Great difficulty and more failures were the descriptions of the treatment of congenital patella dislocation in pediatric patients. This study aims to evaluate the...
BACKGROUND
Great difficulty and more failures were the descriptions of the treatment of congenital patella dislocation in pediatric patients. This study aims to evaluate the outcomes of patients with congenital patellar dislocations treated with the modified Langenskiöld procedure.
METHODS
The medical records of 16 knees in 11 patients with a diagnosis of congenital patella dislocation were collected from September 2016 to March 2019. They were treated with the modified Langenskiöld procedure. The mean follow-up period was 37.8 months. The outcome measures were the Lysholm score, Kujala score, patellar stability, and knee range of motion.
RESULTS
Eleven patients, namely, eight girls and three boys, with 16 knees were enrolled. The mean age at the time of operation was 3.1 years. The post-operative mean Lysholm score was 94.8 (SD 5.1; 87-100), whereas the Kujala score was 95 (SD 5.9; 86-100). There were no recurrent dislocations, and all patients had full extension postoperatively.
CONCLUSION
The modified Langenskiöld procedure is a promising solution for the treatment of congenital patella dislocations.
LEVEL OF EVIDENCE
Level IV; Case Series; Treatment Study.
Topics: Child; Female; Humans; Knee Joint; Male; Patella; Patellar Dislocation; Range of Motion, Articular; Treatment Outcome
PubMed: 35279144
DOI: 10.1186/s12891-022-05192-1