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Ochsner Journal 2022Patellar instability is a common orthopedic condition in the pediatric population. Many factors contribute to patellar instability, including trochlear dysplasia....
Patellar instability is a common orthopedic condition in the pediatric population. Many factors contribute to patellar instability, including trochlear dysplasia. However, patellar instability and its treatments are not well documented in the literature for patients with osteogenesis imperfecta. After medial patellofemoral ligament (MPFL) reconstruction, a 17-year-old male with osteogenesis imperfecta had a patellar dislocation that resulted in a patellar fracture. The patient subsequently had a revision of his MPFL reconstruction, and at 2½ years postoperation has had no episodes of recurrent patellar instability. The combination of bone fragility, trochlear dysplasia, and strength of the allograft used for MPFL reconstruction compared to the patient's bone strength led to dislocation and patellar fracture. Research into alternative methods for patellar fixation and postoperative physical therapy protocols for patients with osteogenesis imperfecta is needed. Special considerations must be made for this patient population.
PubMed: 35355651
DOI: 10.31486/toj.21.0025 -
Journal of Orthopaedics and... Mar 2019Reconstruction of the medial patellofemoral ligament (MPFL) has been increasing as a surgical solution for treatment of recurrent lateral patellofemoral dislocation.... (Review)
Review
Reconstruction of the medial patellofemoral ligament (MPFL) has been increasing as a surgical solution for treatment of recurrent lateral patellofemoral dislocation. Recent attention has been given to fibers extending from the femur to the quadriceps tendon, proximal to the MPFL, termed the medial quadriceps tendon-femoral ligament. This article briefly reviews the proximal medial patellar restraints and surgical procedures for their reconstruction.
Topics: Humans; Knee Joint; Orthopedic Procedures; Patella; Patellar Dislocation; Patellar Ligament; Plastic Surgery Procedures
PubMed: 30915690
DOI: 10.1186/s10195-019-0525-3 -
Journal of Orthopaedic Surgery and... Oct 2021The aim of this study was to evaluate patellar morphological changes following surgical correction of recurrent patellar dislocation in children.
BACKGROUND
The aim of this study was to evaluate patellar morphological changes following surgical correction of recurrent patellar dislocation in children.
METHODS
A total of 35 immature children aged 5 to 10 years who suffered from bilateral recurrent patellar dislocation associated with abnormal patella morphology were enrolled in this study. The knees with the most frequent dislocations (treated with medial patellar retinacular plasty) were selected as the study group (SG), and those undergoing conservative treatment for the contralateral knee were selected as the control group (CG). Computed tomography (CT) scans were performed on all children preoperatively and at the last follow-up to evaluate morphological characteristics of the patella.
RESULTS
All the radiological parameters of the patella showed no significant difference between the two groups preoperatively. At the last follow-up for CT scans, no significant differences were found for the relative patellar width (SG, 54.61%; CG, 52.87%; P = 0.086) and the relative patellar thickness (SG, 26.07%; CG, 25.02%; P = 0.243). The radiological parameters including Wiberg angle (SG, 136.25°; CG, 122.65°; P < 0.001), modified Wiberg index (SG, 1.23; CG, 2.65; P < 0.001), and lateral patellar facet angle (SG, 23.35°; CG, 15.26°; P < 0.001) showed statistical differences between the two groups.
CONCLUSIONS
The patellar morphology can be improved by early surgical correction in children with recurrent patellar dislocation. Therefore, early intervention is of great importance for children diagnosed with recurrent patellar dislocation.
Topics: Child; Humans; Knee Joint; Patella; Patellar Dislocation; Radiography; Recurrence; Tomography, X-Ray Computed
PubMed: 34656140
DOI: 10.1186/s13018-021-02779-7 -
Knee Surgery, Sports Traumatology,... Jun 2021Increasing knowledge on the treatment of patellar dislocation has resulted in the development of new surgical techniques for patella stabilisation. National incidence...
PURPOSE
Increasing knowledge on the treatment of patellar dislocation has resulted in the development of new surgical techniques for patella stabilisation. National incidence and trends in surgery for patellar dislocation were examined using data from the Finnish National Hospital Discharge Register (NHDR). The hypothesis was that an increased understanding of the pathophysiology of patellar instability has increased the popularity of reconstructing damaged structures and modification of anatomical risk factors.
METHODS
Data from the years 1997-2016 were collected from the NHDR database using ICD-10 diagnostic codes and the Nomesco Classification of Surgical Procedures (NCSP) codes. Surgical procedures were categorised into subgroups representing the main surgical approaches of patellar dislocation. Total incidence of surgery for patellar dislocation and change in incidence during the study period were calculated.
RESULTS
A total of 9702 operations for patellar dislocation were performed during the study period. Median (IQR) patient age at time of primary surgery was 23 (18-34) years. The total incidence of surgeries remained stable across the study period at of 8.9 per 100,000 person-years. Incidences of ligament reconstruction, femoral osteotomies and osteochondral fragment reimplantation operations multiplied during the study period. Ligament reconstruction procedures were the most performed operations at the end of the study period.
CONCLUSION
The incidence of surgical procedures for patellar dislocation remained unchanged during the years 1997-2016. Ligament reconstruction procedures increased in popularity. Surgical techniques have shifted towards the reconstruction of damaged structures and the modification of congenital anatomical risk factors for patellar dislocation. Diversified surgical techniques have enabled the tailoring and combining of stabilizing procedures according to the patient's individual anatomy.
Topics: Adolescent; Adult; Arthroplasty; Female; Finland; Humans; Joint Instability; Male; Patellar Dislocation; Patellofemoral Joint; Registries; Risk Factors; Young Adult
PubMed: 32948907
DOI: 10.1007/s00167-020-06277-x -
Current Reviews in Musculoskeletal... Nov 2023Obligatory dislocation of the patella (also known as habitual dislocation) is a rare subset of patellofemoral instability in which the patella dislocates every time the... (Review)
Review
PURPOSE OF REVIEW
Obligatory dislocation of the patella (also known as habitual dislocation) is a rare subset of patellofemoral instability in which the patella dislocates every time the knee is flexed. The problem arises due to contracture of the quadriceps muscles. Soft tissue lengthening procedures such as quadriceps tendon lengthening are the mainstay of treatment, in contrast to medial patellofemoral reconstruction (MPFL-R) for the more common recurrent lateral patellar dislocation. The current review explores the existing literature surrounding the pathophysiology and treatment strategies for this unique cause of knee instability.
RECENT FINDINGS
Flexion dislocation of the knee often presents in children when they begin to walk. It is also termed obligatory or habitual because the patella dislocates laterally with each flexion and extension cycle of the knee. In contrast to other forms of patellar dislocation, the displacement is painless in obligatory dislocation. Likewise, the underlying biomechanical cause of this issue is related to contracture of tissues lateral to the patella rather than disruption of medial soft tissues as seen in recurrent/traumatic dislocation or subluxation of the patella. A number of procedures have been described for management of obligatory dislocation of the patella, with the general consensus that a combination of procedures including release/lengthening of the proximal lateral soft tissues as a critical component for a successful outcome. Soft tissue release/lengthening has been performed for over 50 years to treat obligatory dislocation of the patella. This procedure must be used in combination with other proximal and distal reconstructive with careful intraoperative assessment of knee flexion and patellar tracking for satisfactory outcomes. Further research using standardized outcome measures is needed to identify the optimal step-wise approach in treatment of obligatory patellar dislocation.
PubMed: 37665483
DOI: 10.1007/s12178-023-09865-9 -
Orthopaedic Journal of Sports Medicine Dec 2022Patellar dislocation is a common injury in children and adolescents. There is a lack of information about concomitant osteochondral lesions in these patients.
BACKGROUND
Patellar dislocation is a common injury in children and adolescents. There is a lack of information about concomitant osteochondral lesions in these patients.
HYPOTHESIS
We hypothesized that the likelihood of chondral or osteochondral lesions would increase with each prior patellar dislocation and that the appearance of lesions in surgically treated children and adolescents would be influenced by age, sex, injury mechanism, and body mass index (BMI).
STUDY DESIGN
Case-control study; Level of evidence, 3.
METHODS
Inclusion criteria were (1) age <18 years, (2) surgical treatment with diagnostic arthroscopy of the knee including description of chondral and osteochondral lesions, and (3) maximum time period between the last patellar dislocation and presentation in our department of 6 weeks and maximum of 4 weeks between presentation and surgery. A total of 153 children (173 knees) with a mean age of 13.0 ± 2.1 years were included. All surgical reports and intraoperative arthroscopic imaging were analyzed retrospectively for the location and severity of lesions. The likelihood of lesions was calculated with multiple stepwise regression models regarding injury mechanism, number of dislocations, sex, age, physeal closure, and BMI.
RESULTS
The regression model to predict femoral lesions was statistically significant (χ[5] = 26.55; < .001) and identified male sex, BMI ≥25, traumatic injury mechanism, and physeal closure as independent factors associated with the appearance of femoral lesions. The second regression model predicting the appearance of patellar lesions was also statistically significant (χ[4] = 26.07; < .001) and identified the traumatic injury mechanism as a single independent predictor for patellar lesions.
CONCLUSION
BMI ≥25, male sex, and physeal closure were factors significantly associated with femoral chondral and osteochondral lesions in our cohort. In case of traumatic lateral patellar dislocation (LPD), the likelihood of patellar and femoral chondral and osteochondral lesions is significantly higher than in nontraumatic LPD. Early magnetic resonance imaging and surgical treatment should be considered in obese patients, male patients, and patients with physeal closure and after traumatic LPD.
PubMed: 36504671
DOI: 10.1177/23259671221134102 -
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 -
Orthopaedic Journal of Sports Medicine Jul 2023Recurrent patellar dislocation (RPD) and habitual patellar dislocation (HPD) in flexion are frequently encountered in children and adolescents.
BACKGROUND
Recurrent patellar dislocation (RPD) and habitual patellar dislocation (HPD) in flexion are frequently encountered in children and adolescents.
PURPOSE
To compare the radiological features of RPD and HPD in children and adolescents.
STUDY DESIGN
Cross-sectional study; Level of evidence, 3.
METHODS
Imaging data were collected from patients aged 9 to 15 years who received surgical treatment for HPD or RPD at a single institution between June 2015 and September 2020. The prevalence of trochlear dysplasia, tibial tubercle lateralization, and lower limb rotational deformity was assessed through hip/knee/ankle computed tomography (CT) using the following quantitative indicators: trochlear depth index, lateral trochlear inclination, sulcus angle, tibial tubercle-trochlear groove (TT-TG) distance, ratio of TT-TG distance to femoral width, TT-TG angle, femoral anteversion angle, and tibial external rotation angle. The morphology of trochlea and patella were graded on knee CT using the Dejour and Wiberg classification. The Insall-Salvati index and Caton-Deschamps index were used to evaluate the height of the patella on lateral view radiographs. To evaluate lower limbs malalignment, the mechanical lateral distal femoral angle and medial proximal tibial angle were measured on weightbearing full-length radiographs. The collected data were analyzed and compared between the HPD and RPD groups.
RESULTS
Enrolled were 15 patients (21 knees) diagnosed with HPD and 18 patients (22 knees) diagnosed with RPD. The age of first dislocation was significantly younger in the HPD group (7.6 ± 3.4 vs 11.2 ± 1.4 years; = 0.003). Knees in the HPD group had a significantly higher proportion of Dejour type C dysplasia (57.1% vs 4.5%; < .005) and Wiberg type 3 patella (66.7% vs 9.1%; < .001). There were statistically significant differences between the groups in the trochlear depth index (HPD vs RPD: 1.1 ± 1.7 vs 2.2 ± 1.5 mm; = .039), sulcus angle (170.3° ± 13.7° vs 157.3° ± 16.0°; = .007), Insall-Salvati index (1.1 ± 0.2 vs 1.3 ± 0.2; = .034), and tibial external rotation angle (31.3° ± 7.8° vs 38.4° ± 8.5°; = .009).
CONCLUSION
Patients in the HPD group presented with poorer trochlear and patellar development, lower patellar height, and less tibial external rotation compared with patients in the RPG group.
PubMed: 37465209
DOI: 10.1177/23259671231180574 -
Ugeskrift For Laeger Mar 2014In respect to the risk of recurrent patella instability, new biomechanical factors have been ruled out, and among these trochlear dysplasia is the most important single... (Review)
Review
In respect to the risk of recurrent patella instability, new biomechanical factors have been ruled out, and among these trochlear dysplasia is the most important single factor. The algorithm for operative intervention should be based upon X-rays and MRI scans. Medial implication is considered obsolete and distal realignment as well as lateral release procedures should be minimized, based upon deteriorating results. Reconstruction of medial structures becomes increasingly frequent, based upon good results, however, in cases of higher degree of trochlear dysplasia, trochleoplasty should be considered.
Topics: Biomechanical Phenomena; Femur; Humans; Joint Instability; Magnetic Resonance Imaging; Patellar Dislocation; Patellofemoral Joint; Radiography
PubMed: 25350888
DOI: No ID Found -
Orthopaedic Journal of Sports Medicine Aug 2014With improved understanding of the biomechanical importance of the medial patellofemoral ligament (MPFL), its reconstruction for patellar dislocation has become... (Review)
Review
BACKGROUND
With improved understanding of the biomechanical importance of the medial patellofemoral ligament (MPFL), its reconstruction for patellar dislocation has become increasingly popular. The aim of this systematic review was to critically determine the effectiveness of MPFL reconstruction for patellar dislocation.
HYPOTHESIS
MPFL reconstruction for patellar dislocation leads to a low redislocation rate with improved Kujala scores.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
A literature search was performed using Embase and Medline (Ovid) databases. Inclusion criteria included first-time and recurrent patellar dislocation, subluxation, or persistent instability with a minimum follow-up of 12 months and documentation of postoperative redislocation rate or Kujala score. The studies were systematically appraised, and a meta-analysis was performed.
RESULTS
Twenty-two studies were included: 2 randomized controlled trials, 3 parallel case series, and 17 case series. There were a total of 655 knees in the review, with an age range at time of surgery from 11 to 52 years. The pooled postoperative redislocation rate from all 17 case series showed a mean of 2.44%. The pooled preoperative Kujala scores from 12 case series showed a mean of 51.6 (95% CI, 46.71-56.49). The pooled postoperative Kujala scores from 16 case series showed a mean of 87.77 (95% CI, 85.15-90.39).
CONCLUSION
Although the studies were of low quality, the meta-analysis of 17 case series shows that MPFL reconstruction for recurrent patellar dislocation results in a significant improvement in Kujala scores, a low redislocation rate, and acceptable complication rate. Randomized trials would be needed to draw influences on the superiority of MPFL reconstruction compared with other treatments.
PubMed: 26535352
DOI: 10.1177/2325967114544021