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BMC Musculoskeletal Disorders Jan 2021Torsional malalignment has been considered as a risk factor for patellar dislocation. But the influence of patellar dislocation for torsional alignment development...
BACKGROUND
Torsional malalignment has been considered as a risk factor for patellar dislocation. But the influence of patellar dislocation for torsional alignment development remains unknown. The present study aims to investigate whether the torsional alteration of the hindlimb occurs after patellar dislocation in growing rabbits.
METHODS
In the present study, 30 one-month-old rabbits were included. The experimental group consisted of 30 left knees of rabbits which underwent patellar lateral dislocation. The control group consisted of 30 right knees of the rabbits which no surgical procedure was performed. The Computed Tomography (CT) scan was performed after the surgery and at the point the rabbits were skeletal mature (5 months post-surgery). The angles of femoral version and tibial torsion were measured using a three-dimensional method and analyzed between the experimental group and the control group.
RESULTS
After the surgery, the femoral version and tibial torsion in the experimental and control group were not significantly different. However, 5 months after surgery, the angle of femoral version in the experimental group (-5.50 ± 6.13°) was significantly different from that in the control group (-10.90 ± 4.74°) (P < 0.05). But the angle of tibial torsion in the experimental group (7.17 ± 7.25°) and control group (4.47 ± 6.34°) were not significantly different (P = 0.144).
CONCLUSIONS
From this study, patellar dislocation can lead to alteration of femoral version in growing rabbits. So patellar dislocation may affect on lower extremity alignment. These findings may develop pathology and etiology of patellar dislocation.
Topics: Animals; Femur; Hindlimb; Lower Extremity; Patella; Patellar Dislocation; Rabbits
PubMed: 33514348
DOI: 10.1186/s12891-021-03977-4 -
Clinics in Sports Medicine Jul 2014Patella instability can cause significant pain and functional limitations. Several factors can predispose to patella instability, such as ligamentous laxity, increased... (Review)
Review
Patella instability can cause significant pain and functional limitations. Several factors can predispose to patella instability, such as ligamentous laxity, increased anterior TT-TG distance, patella alta, and trochlear dysplasia. Acquired factors include MPFL injury or abnormal quadriceps function. In many cases, first-time dislocation can successfully be managed with physical therapy and other nonoperative management; however, more than one dislocation significantly increases the chance of recurrence. Surgical management can improve stability, but should be tailored to the injuries and anatomic risk factors for recurrent dislocation. Isolated lateral release is not supported by current literature and increases the risk of iatrogenic medial instability. Medial repair is usually reserved for patients with largely normal anatomy. MPFL reconstruction can successfully stabilize patients with medial soft tissue injury but is a technically demanding procedure with a high complication rate and risks of pain and arthrosis. Tibial tubercle osteotomy can address bony malalignment and also unload certain articular cartilage lesions while improving stability. Trochleoplasty may be indicated in individuals with a severely dysplastic trochlea that cannot otherwise be stabilized. A combination of procedures may be necessary to fully address the multiple factors involved in causing pain, loss of function, and risk of recurrence in patients with patellar instability.
Topics: Humans; Joint Instability; Patellar Dislocation; Patellofemoral Joint
PubMed: 24993410
DOI: 10.1016/j.csm.2014.03.011 -
Orthopaedics & Traumatology, Surgery &... Feb 2014Paediatric patellar instability encompasses many anatomic entities located along a continuum of knee extensor mechanism abnormalities. Major or minor clinical... (Review)
Review
Paediatric patellar instability encompasses many anatomic entities located along a continuum of knee extensor mechanism abnormalities. Major or minor clinical manifestations may occur at a variable age. In major forms with irreducible patellar dislocation or habitual patellar dislocation during knee flexion, shortness of the quadriceps is a consistent feature. A comprehensive aetiological work-up is in order, as syndromic conditions are common. Early surgical treatment is mandatory and should be performed by an experienced paediatric orthopaedic surgeon, as the procedure is technically challenging. Minor forms are more common; they are characterised by patellar dislocation or subluxation near terminal knee extension. The diagnosis may be difficult, particularly at the acute phase. Surgery is needed in patients with recurrent dislocation or functional impairments. The semiology of patellar instability has undergone considerable development in recent years, and a three-dimensional evaluation of patellar position can now be obtained using magnetic resonance imaging. Individually tailored surgical treatment "à la carte" remains a valid approach in 2013. However, new techniques for medial patello-femoral ligament reconstruction have modified the management strategies for adults and superseded many stabilisation procedures. Adapting these new techniques to paediatric patients and developing new procedures constitute major challenges.
Topics: Adolescent; Child; Cooperative Behavior; Early Medical Intervention; Humans; Image Interpretation, Computer-Assisted; Imaging, Three-Dimensional; Interdisciplinary Communication; Joint Instability; Magnetic Resonance Imaging; Orthopedic Procedures; Patellar Dislocation; Risk Factors
PubMed: 24412258
DOI: 10.1016/j.otsr.2013.06.014 -
The Journal of Bone and Joint Surgery.... Mar 2016High-level evidence supports nonoperative treatment for first-time lateral acute patellar dislocations. Surgical intervention is often indicated for recurrent... (Review)
Review
High-level evidence supports nonoperative treatment for first-time lateral acute patellar dislocations. Surgical intervention is often indicated for recurrent dislocations. Recurrent instability is often multifactorial and can be the result of a combination of coronal limb malalignment, patella alta, malrotation secondary to internal femoral or external tibial torsion, a dysplastic trochlea, or disrupted and weakened medial soft tissue, including the medial patellofemoral ligament (MPFL) and the vastus medialis obliquus. MPFL reconstruction requires precise graft placement for restoration of anatomy and minimal graft tension. MPFL reconstruction is safe to perform in skeletally immature patients and in revision surgical settings. Distal realignment procedures should be implemented in recurrent instability associated with patella alta, increased tibial tubercle-trochlear groove distances, and lateral and distal patellar chondrosis. Groove-deepening trochleoplasty for Dejour type-B and type-D dysplasia or a lateral elevation or proximal recession trochleoplasty for Dejour type-C dysplasia may be a component of the treatment algorithm; however, clinical outcome data are lacking. In addition, trochleoplasty is technically challenging and has a risk of substantial complications.
Topics: Algorithms; Braces; Combined Modality Therapy; Decision Support Techniques; Humans; Knee Joint; Orthopedic Procedures; Patellar Dislocation; Patellar Ligament; Physical Therapy Modalities; Recurrence
PubMed: 26935465
DOI: 10.2106/JBJS.O.00354 -
Asian Journal of Surgery Dec 2023
Topics: Humans; Adolescent; Quadriceps Muscle; Patellar Dislocation; Knee Joint; Muscle, Skeletal; Atrophy
PubMed: 37591744
DOI: 10.1016/j.asjsur.2023.07.148 -
Knee Surgery, Sports Traumatology,... Sep 2018To investigate the effects of early patellar dislocation on the tibial tubercle location.
PURPOSE
To investigate the effects of early patellar dislocation on the tibial tubercle location.
METHODS
Sixty knees from 30 healthy 1-month-old New Zealand white rabbits were randomly divided into two groups of 30 knees each. Group A (control group) comprised the left knees, which underwent no surgical procedures. Group B comprised the right knees, which underwent patellar dislocation surgery. Computed tomography (flexion 0°) was performed preoperatively and 6 months post-operatively. Measurements included the tibial tuberosity-trochlear groove distance (TT-TG) and tibial tubercle lateralization.
RESULTS
No significant difference in the TT-TG or tibial tubercle lateralization was found between the two groups preoperatively. Six months post-operatively, however, the mean TT-TG in Group A (no patellar dislocation) and Group B (patellar dislocation) was 1.0 ± 0.4 and 3.0 ± 0.7 mm, respectively (p < 0.05). The mean tibial tubercle lateralization also showed a significant difference between Groups A and B at 6 months post-operatively (0.5 ± 0.1 and 0.6 ± 0.0, respectively; p < 0.05).
CONCLUSIONS
Early patellar dislocation can lead to tibial tubercle lateralization and an increased TT-TG. Clinically, early intervention for adolescent patients with patellar dislocation will be important.
LEVEL OF EVIDENCE
Prospective comparative study, Level II.
Topics: Animals; Femur; Joint Instability; Knee Joint; Patellar Dislocation; Prospective Studies; Rabbits; Random Allocation; Tibia; Tomography, X-Ray Computed
PubMed: 28447139
DOI: 10.1007/s00167-017-4541-7 -
The Orthopedic Clinics of North America Oct 2020Patellar instability and associated patellar dislocation can result in significant pain, disability, and associated injuries in young athletes. The patellofemoral joint... (Review)
Review
Patellar instability and associated patellar dislocation can result in significant pain, disability, and associated injuries in young athletes. The patellofemoral joint is a complex articulation with stabilizing restraints, both medially and laterally, that help guide the patella into the corresponding trochlear groove as the knee cycles through an extension-to-flexion arc. In addition to soft tissue injuries, many osseous aberrancies can contribute to patellar instability in young athletes, including trochlear dysplasia, patella alta, and axial and coronal plane abnormalities. There is a role for nonoperative treatment in these young athletes; however, if recurrent or associated injuries are identified surgical intervention is warranted. Correct diagnosis of the underlying cause of the patellar instability is paramount to developing a surgical plan that will yield the most favorable outcome for these young athletes.
Topics: Adolescent; Child; Humans; Joint Instability; Orthopedic Procedures; Patellar Dislocation
PubMed: 32950217
DOI: 10.1016/j.ocl.2020.06.005 -
Journal of Orthopaedic Surgery and... Jan 2022Patellar dislocations in patients presenting with recurrent patellofemoral instability can damage the surrounding structures, limiting patient's participation to...
BACKGROUND
Patellar dislocations in patients presenting with recurrent patellofemoral instability can damage the surrounding structures, limiting patient's participation to recreational activities and quality of life. This study evaluated frequency, location, and extent of associated injuries in patients with recurrent patellar dislocation.
METHODS
This systematic review was conducted according to the PRISMA checklist. PubMed, Google scholar, Embase, and Web of Science databases were accessed in July 2021. All the published clinical studies reporting frequency, location, and extent of soft tissue lesions in patients with recurrent patellar dislocations were accessed.
RESULTS
Data from 9 articles (232 patients) were retrieved. The mean age of the included patients was 21.2 ± 5.6 years. 84.8% of patients suffering from recurrent patellar dislocations demonstrated patellar chondral defects: medial facet (34.9%), while patellar crest (34.8%) and lateral facet (17%). 27.8% of patients demonstrated trochlear chondral injuries.
CONCLUSION
Chondral defects of the medial facet and the crest of the patella are the most common in patients with recurrent patellofemoral instability.
Topics: Adolescent; Adult; Female; Humans; Joint Dislocations; Joint Instability; Male; Patella; Patellar Dislocation; Patellar Ligament; Patellofemoral Joint; Quality of Life; Plastic Surgery Procedures; Recurrence; Treatment Outcome; Young Adult
PubMed: 35101078
DOI: 10.1186/s13018-022-02911-1 -
The Journal of Emergency Medicine Jul 2020Patellar dislocations are a common orthopedic emergency with several variants. The rarer variants include rotational dislocations. These often require open reduction in...
BACKGROUND
Patellar dislocations are a common orthopedic emergency with several variants. The rarer variants include rotational dislocations. These often require open reduction in the operating room.
CASE REPORT
We report on a case of a combined rotational and lateral patellar dislocation in a young female. We suspected and made the diagnosis of a rotational dislocation after initial unsuccessful attempts at reduction under sedation. With the assistance of our orthopedic colleagues, we were able to perform a reduction of this patient's patella under sedation in the emergency department. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Awareness of uncommon patellar dislocations is an important area of knowledge for the emergency physician. A thorough understanding of indications and contraindications to closed reduction is important for efficient and safe management and disposition. Collaboration with orthopedic surgery colleagues is another important step in the evaluation of these patients.
Topics: Anesthesia; Emergency Service, Hospital; Female; Humans; Joint Dislocations; Patella; Patellar Dislocation
PubMed: 32456961
DOI: 10.1016/j.jemermed.2020.04.034 -
The Journal of Knee Surgery Mar 2012Patellar instability has been extensively studied in selected, high-risk cohorts, but the epidemiology in the general population remains unclear. A longitudinal,...
Patellar instability has been extensively studied in selected, high-risk cohorts, but the epidemiology in the general population remains unclear. A longitudinal, prospective epidemiological database was used to determine the incidence and demographic risk factors for patellar dislocations presenting to emergency departments of the United States. The National Electronic Injury Surveillance System was queried for all patellar dislocations presenting to emergency departments between 2003 and 2008. Incidence rate ratios (IRRs) were then calculated with respect to sex, age, and race. The hypothesis was that patellar dislocation is influenced by sex, age, race, and athletic participation. An estimated 40,544 patellar dislocations occurred among an at-risk population of 1,774,210,081 person-years for an incidence rate of 2.29 per 100,000 person-years in the United States. When compared with males, females showed no significant overall or age-stratified differences in the rates of patellar dislocation (IRR 0.85, 95% CI 0.71, 1.00; p = 0.08; p > 0.05). Peak incidence of patellar dislocation occurred between 15 and 19 years of age (11.19/100,000 person-years). When compared with Hispanic race, black and white race were associated with significantly higher rates of patellar dislocation (IRR 4.30 [95% CI 1.63, 6.97; p = 0.02], IRR 4.02 [95% CI 1.06, 6.98; p = 0.03], respectively). Nearly half (51.9%) of all patellar dislocation occurred during athletic activity, with basketball (18.2%), soccer (6.9%), and football (6.3%) associated with the highest percentage of patellar dislocation during athletics. Age between 15 and 19 years is associated with higher rates of patellar dislocation. Sex is not a significant risk factor for patellar dislocation. Black and white race are a significant risk factor for patellar dislocation when compared with Hispanic race. Half of all patellar dislocation occurs during athletic activity. This study was conducted on the Level of evidence II.
Topics: Adolescent; Adult; Black or African American; Age Factors; Aged; Athletic Injuries; Child; Female; Hispanic or Latino; Humans; Incidence; Male; Middle Aged; Patellar Dislocation; Sex Factors; United States; White People; Young Adult
PubMed: 22624248
DOI: 10.1055/s-0031-1286199