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Der Orthopade Oct 2019The latest results concerning patellar instability in children and adolescents lead to a better understanding of the underlying pathology. (Review)
Review
BACKGROUND
The latest results concerning patellar instability in children and adolescents lead to a better understanding of the underlying pathology.
OBJECTIVES
Determination of necessary diagnostic procedures and treatment of patellar instability in children and adolescents.
MATERIAL AND METHODS
Analysis of available literature based on a systematic MEDLINE analysis.
RESULTS
Diagnostics, risk factors und treatment of adult patellar instability are applicable in the treatment of children. A trend towards early surgical stabilization after primary dislocation was identified. Growth plate-preserving methods for autologous MPFL reconstruction can safely be used in children.
CONCLUSIONS
For children with a high risk of redislocation, primary surgical intervention should be performed. The necessary method must be determined by individual risk factor analysis.
Topics: Adolescent; Child; Growth Plate; Humans; Joint Dislocations; Joint Instability; Patellar Dislocation; Patellofemoral Joint
PubMed: 31101964
DOI: 10.1007/s00132-019-03754-1 -
Zhongguo Gu Shang = China Journal of... Mar 2017Patients who suffer from the recurrent patellar dislocation mainly show the recurrent dislocation of patellar, giving way, most patients have the history of trauma or... (Review)
Review
Patients who suffer from the recurrent patellar dislocation mainly show the recurrent dislocation of patellar, giving way, most patients have the history of trauma or dysplasia of keen joint. Traditional therapies of recurrent patellar dislocation include medical retinaculum placation, lateral retinaculum release, tibial tubercle osteotomy, femoral trochleoplasty etc. In recent years, with the development of anatomical and biomechanical researches on medial patellofemoral ligament(MPFL), more and more experts focus on the role of MPFL played in preventing the patellar dislocation. The treatment of recovering and correcting patellar tracking through MPFL reconstruction has been increasing gradually. However, till now, there was no therapy which could heal the recurrent patellar dislocation completely. The specific therapies of recurrent patellar dislocation are combination therapies, decided according to the anatomical and biomechanical conditions of patients, for recovering the stability of patients' patellar, the lower limb alignment and the function of keen-joint.
Topics: Femur; Humans; Ligaments, Articular; Medial Collateral Ligament, Knee; Patellar Dislocation; Recurrence; Tibia
PubMed: 29349972
DOI: 10.3969/j.issn.1003-0034.2017.03.020 -
Journal of Orthopaedic Surgery and... Oct 2020Non-surgical treatment of primary patellar dislocation has a high risk of recurrent dislocation; thus, we tried to identify injuries in which sites of the medial... (Meta-Analysis)
Meta-Analysis Review
Evaluation of risk correlation between recurrence of patellar dislocation and damage to the medial patellofemoral ligament in different sites caused by primary patellar dislocation by MRI: a meta-analysis.
PURPOSE
Non-surgical treatment of primary patellar dislocation has a high risk of recurrent dislocation; thus, we tried to identify injuries in which sites of the medial patellofemoral ligament (MPFL) were most associated with recurrent dislocation by analyzing relevant original literature in order to provide improved suggestions on early surgical treatment.
METHODS
According to the preset retrieval strategy, the original studies were retrieved until January 2020 using MEDLINE, Embase and Cochrane Library. Review Manager 5.3 software was used to summarize and compare the differences of recurrent dislocation of MPFL injuries at different attachments.
RESULTS
Although the incidence of recurrent patellar dislocation at the femoral attachment of MPFL was higher overall (femoral only vs. patellar only vs. combined: 37.6% vs. 32.3% vs. 35.8%), no statistical difference was found among the three groups (femoral only vs. patellar only, RR = 1.32 [95% CI 0.89-1.95]; P = 0.17) (femoral only vs. combined, RR = 1.15 [95% CI 0.59-2.22]; P = 0.68) (patellar only vs. combined, RR = 0.94 [95% CI 0.69-1.29]; P = 0.72). In addition, the sulcus angle of recurrent dislocation group is significantly greater than that in the non-recurrent dislocation group (MD = 3.06 [95% CI 0.42-5.70]; P = 0.02).
CONCLUSIONS
Based on the pooled data collected from the original studies available, the risk of recurrent patellar dislocation due to damage to the MPFL at different sites did not differ. Additionally, the sulcus angle in the group with recurrent dislocation was considerably higher when comparing with the group without recurrent dislocation, that is, the shallower and flatter of the trochlear groove, the higher the risk of recurrent patellar dislocation.
Topics: Female; Humans; Ligaments, Articular; Magnetic Resonance Imaging; Male; Patellar Dislocation; Patellofemoral Joint; Recurrence; Risk
PubMed: 33028358
DOI: 10.1186/s13018-020-01984-0 -
Journal of Orthopaedic Surgery and... Jun 2012Acute traumatic patellar dislocation is a common injury in the active and young adult populations. MRI of the knee is recommended in all patients who present with acute... (Review)
Review
Acute traumatic patellar dislocation is a common injury in the active and young adult populations. MRI of the knee is recommended in all patients who present with acute patellar dislocation. Numerous operative and non-operative methods have been described to treat the injuries; however, the ideal management of the acute traumatic patellar dislocation in young adults is still in debate. This article is intended to review the studies to the subjects of epidemiology, initial examination and management.
Topics: Arthroscopy; Humans; Patellar Dislocation; Risk Factors; Wounds and Injuries
PubMed: 22672660
DOI: 10.1186/1749-799X-7-21 -
Sports Medicine and Arthroscopy Review Sep 2012Primary patellar dislocation injures the medial patellofemoral ligament (MPFL), the major soft-tissue stabilizer of the patella, which may lead to recurrent patellar... (Review)
Review
Primary patellar dislocation injures the medial patellofemoral ligament (MPFL), the major soft-tissue stabilizer of the patella, which may lead to recurrent patellar instability. Recurrent patellar dislocation are common and may require surgical intervention. The variation in location of injury of the MPFL and the presence of an osteochondral fracture produces challenges in clinical decision making between nonoperative and operative treatment, including the surgical modality, to repair or reconstruct the MPFL. Current evidence suggests that not all primary dislocations should undergo the same treatment. MPFL reconstruction may theoretically be more reliable than repair, but the optimal time to perform additional bony corrections is not known. A normal or minor dysplastic patellofemoral joint may be suitable for nonoperative treatment, whereas a higher grade of trochlear dysplasia or other significant abnormalities may benefit from surgical treatment. In this paper, we present a treatment algorithm for primary patellar dislocation.
Topics: Humans; Joint Instability; Ligaments, Articular; Patella; Patellar Dislocation; Patellofemoral Joint; Recurrence; Risk Factors
PubMed: 22878653
DOI: 10.1097/JSA.0b013e318256bbe5 -
Clinics in Sports Medicine Oct 2022This article summarizes the latest research related to pediatric patellar instability. The epidemiology, patterns of patellar instability, and underlying pathoanatomy... (Review)
Review
This article summarizes the latest research related to pediatric patellar instability. The epidemiology, patterns of patellar instability, and underlying pathoanatomy are unique in children and adolescents. Information related to the natural history and predictive factors of patellar instability in young patients would allow for better patient counseling and management decisions. The components of nonoperative treatment for first patellar dislocation are outlined. Physeal-respecting surgical techniques, including medial patellofemoral ligament reconstruction in skeletally immature patients, are discussed. The indications and outcomes for quadricepsplasty to address more complex instability patterns are presented. Evaluation and management strategies for specific anatomic risk factors is provided.
Topics: Adolescent; Athletes; Child; Humans; Joint Instability; Ligaments, Articular; Patellar Dislocation; Patellofemoral Joint
PubMed: 36210163
DOI: 10.1016/j.csm.2022.05.005 -
Der Unfallchirurg Dec 2020The causes of patellofemoral instability (PFI) are complex. In accordance with the current literature a classification was developed which clearly weights all entities...
The causes of patellofemoral instability (PFI) are complex. In accordance with the current literature a classification was developed which clearly weights all entities and derives diagnostic and therapeutic consequences. It considers patellar instability and patellar maltracking or the complete loss of patellar tracking and differentiates into 5 types. Type 1: patellar dislocation without maltracking or instability with a low risk of redislocation. Type 2: high risk of redislocation, no maltracking. Type 3: instability and maltracking; reasons for maltracking are a) soft tissue contracture, b) patella alta, c) pathological tibial tuberosity trochlear groove (TTTG) distance, c) valgus deformities and e) torsional deformities. Type 4: massively unstable floating patella, which is based on a high-grade trochlear dysplasia. Type 5: maltracking without instability.
Topics: Humans; Joint Instability; Osteotomy; Patella; Patellar Dislocation; Patellofemoral Joint; Tibia
PubMed: 33201266
DOI: 10.1007/s00113-020-00912-5 -
Knee Surgery, Sports Traumatology,... Feb 2013Acute patellar dislocation is a common knee injury that occurs most often in adolescents, frequently associated with sporting and physical activities. Patellar...
Acute patellar dislocation is a common knee injury that occurs most often in adolescents, frequently associated with sporting and physical activities. Patellar re-dislocation after the first episode appears to depend primarily on the medial patellofemoral ligament injury which represents the primary ligamentous restraint, providing about 50-60 % of the restraining force against lateral patellar displacement. Clinically, up to 94-100 % of patients suffer from medial patellofemoral ligament rupture after first-time patellar dislocation. Controversy regarding how patients with first patellar dislocation should be managed still exists. Though most authors have reported good results with the conservative treatment after a first-time dislocation, several circumstances may warrant surgical intervention. A surgical approach would be necessary in the presence of severe cartilage damage or a relevant disruption of the medial stabilizers with subluxation of the patella. In these cases, the repair/reconstruction of medial stabilizers should follow the treatment of the chondral injury. Medial patellofemoral ligament reconstruction may be a more reliable method of stabilizing the patella than its repair, which has limitations related to the medial patellofemoral ligament injury location. Nowadays, there is no evidence available where osseous abnormalities should be addressed in addition to restoring the medial patellofemoral ligament.
Topics: Adolescent; Athletic Injuries; Child; Female; Humans; Joint Instability; Ligaments; Male; Patella; Patellar Dislocation; Recurrence; Rupture
PubMed: 23242381
DOI: 10.1007/s00167-012-2347-1 -
Current Opinion in Pediatrics Feb 2004Traumatic patellar dislocation in children and adolescents is a complex problem resulting from a range of anatomic and mechanical conditions. A careful review of the... (Review)
Review
PURPOSE OF REVIEW
Traumatic patellar dislocation in children and adolescents is a complex problem resulting from a range of anatomic and mechanical conditions. A careful review of the literature demonstrates certain risk factors that predispose children to recurrent dislocation. With this understanding, these conditions can be managed more aggressively in the hope of an improved outcome. Additionally, a vast number of surgical procedures to correct patellar instability have been described, and recent cadaveric studies are now guiding surgical interventions.
RECENT FINDINGS
Risk factors for recurrent dislocation may include various skeletal abnormalities, increased quadriceps angle, generalized ligamentous laxity, and family history. Recent anatomic and biomechanical studies have demonstrated that the medial patellofemoral ligament and the vastus medialis obliquus are the primary restraints to lateral translation and ultimately dislocation of the patella. Management should therefore be directed both at correcting anatomic abnormalities when indicated and at reconstruction of medial restraints to patellar tracking.
SUMMARY
The recommendation for management of a traumatic patellar dislocation in a skeletally immature patient is initially conservative, emphasizing early motion and quadriceps strengthening. However, in patients for whom conservative management has failed or who are at particularly high risk for dislocation and require surgical intervention, repair or reconstruction of the medial patellofemoral ligament is the treatment of choice. Recent works have included investigation of less invasive techniques in children.
Topics: Adolescent; Biomechanical Phenomena; Child; Humans; Patella; Patellar Dislocation; Patellar Ligament; Risk Factors
PubMed: 14758111
DOI: 10.1097/00008480-200402000-00007 -
Clinical Journal of Sport Medicine :... Nov 2017The aim of this study was to evaluate clinical outcomes, rate of redislocation, and complications after conservative or surgical procedures used to treat primary acute... (Review)
Review
PURPOSE
The aim of this study was to evaluate clinical outcomes, rate of redislocation, and complications after conservative or surgical procedures used to treat primary acute patellar dislocation.
METHODS
A comprehensive search of PubMed, Medline, CINAHL, Cochrane, Embase, and Google Scholar databases using various combinations of the keywords "patella," "dislocation," "treatment," "acute," "primary" was performed. The following data were extracted: demographics, chondral defects and soft tissue lesions, outcome measurements, type of management, recurrence of instability, and complications.
RESULTS
A total of 2134 knees in 2086 patients were included, with an average age at dislocation of 20.3 years. The average Kujula score was 75.6 for patients treated conservatively and 88.7 for patients undergoing surgical treatment in the short-medium follow-up (less than 5 years); the average Kujula score was 87.5 for patients treated conservatively and 86.6 for patients undergoing surgical treatment in the long-term follow-up (more than 5 years). The rate of recurrence was significantly lower in the surgical group (25%) than in the conservative group (36.4%). The overall complication rate was 6.5% (29 of 441 knees) in the surgical management group. No complications were reported for patients treated conservatively.
CONCLUSIONS
Surgical treatment of primary acute patellar dislocation leads to significantly lower rate of redislocation and provides better short-medium clinical outcomes, whereas in the long-term follow-up, results of patients treated conservatively were as good as those of surgical patients. Further randomized controlled trials, describing anatomical abnormalities and soft-tissue integrity that may influence the choice of treatment, are needed.
LEVEL OF EVIDENCE
Systematic review, level IV.
Topics: Conservative Treatment; Humans; Patellar Dislocation; Recurrence; Treatment Outcome
PubMed: 28107220
DOI: 10.1097/JSM.0000000000000410