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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 -
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 -
Knee Surgery, Sports Traumatology,... Sep 2023The aim of the study was to perform a systematic review and best knowledge synthesis of the present literature concerning biomechanical risk factors for developing... (Review)
Review
PURPOSE
The aim of the study was to perform a systematic review and best knowledge synthesis of the present literature concerning biomechanical risk factors for developing first-time and recurrent patella dislocation.
METHODS
The study was performed as a systematic review following PRISMA guidelines. PubMed and EMBASE were systematically searched. Studies investigating participants with risk factors for first-time as well as recurrent patella dislocation were included. The records were screened, and data extracted independently by two researchers supervised by a third independent assessor. The study was registered in PROSPERO.
RESULTS
A total of 6233 records were screened, and 50 studies met the inclusion criteria. The biomechanical risk factors: trochlear dysplasia, increased tibial tuberosity-trochlear groove distance (TT-TG), and patella alta were found to be statistically significantly associated with patella dislocation in several publications and were thus recognized as risk factors for patella dislocation. The soft-tissue stabilizers: longer and thinner MPFL ligament, increased number of type 2C and decreased number of type 1 muscle fibers, and joint laxity were found to be statistically significantly associated with patella dislocation in a few publications, but due to limited evidence, no conclusion was made on this matter.
CONCLUSION
There is strong evidence in the literature that abnormalities of bony stabilizers, trochlear dysplasia, increased TT-TG distance, and patella alta are risk factors for patella dislocation. There is less evidence that soft-tissue stabilizers are risk factors. The study emphasizes the importance of a thorough investigation of bony stabilizers in clinical decision-making.
LEVEL OF EVIDENCE
Level IV.
Topics: Humans; Patella; Patellofemoral Joint; Patellar Dislocation; Joint Dislocations; Joint Instability; Tibia; Ligaments, Articular; Risk Factors; Retrospective Studies
PubMed: 36854995
DOI: 10.1007/s00167-022-07255-1 -
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