Factors Associated With an Increased Risk of Recurrence After a First-Time Patellar Dislocation: A Systematic Review and Meta-analysis

Background: Recurrent dislocations after a first-time lateral patellar dislocation may occur in more than 50% of patients and can cause long-term disability. Many factors have been suggested to influence the risk of recurrence. Purpose: To systematically review and quantitatively synthesize the literature for factors associated with an increased risk of recurrence after a first-time patellar dislocation. Study Design: Systematic review and meta-analysis of observational studies. Methods: A total of 4 electronic databases were searched to identify relevant studies published before February 7, 2019. A quality assessment was performed with the National Heart, Lung, and Bone Institute quality assessment score. Factors assessed for their effect on the recurrence rate were documented, and the rates of recurrence were compared. Pooled dichotomous data were analyzed using random-effects meta-analysis with odds ratios (ORs). Results: A total of 17 studies met the criteria for inclusion. The overall rate of recurrent dislocations after a first-time lateral patellar dislocation was 33.6%. An increased risk of recurrence was reported in patients with a younger age (OR, 2.61; P < .00001), open physes (OR, 2.72; P < .00001), trochlear dysplasia (OR, 4.15; P = .009), an elevated tibial tuberosity–trochlear groove (TT-TG) distance (OR, 2.87; P < .00001), and patella alta (OR, 2.38; P = .004). Sex, patterns of medial patellofemoral ligament injury, and history of contralateral dislocations were not found to be associated with an increased recurrence rate ( P≥ .05). In studies that reported on the presence of multiple risk factors, recurrence rates were 7.7% to 13.8% when no risk factors were present but increased to 29.6% to 60.2% when 2 risk factors were present and to 70.4% to 78.5% when 3 risk factors were present. Conclusion: Younger age, open physes, trochlear dysplasia, elevated TT-TG distance, and patella alta were key risk factors for the recurrence of lateral patellar dislocations. Despite being not infrequently cited as risk factors, patient sex and a history of contralateral dislocations were not found to be significant risk factors. The presence of multiple risk factors increased the risk, and the development of predictive instability scores in large patient cohorts using all established risk factors should be a focus of future studies.

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Risk Factors and Time to Recurrent Ipsilateral and Contralateral Patellar Dislocations

The American Journal of Sports Medicine ◽

10.1177/0363546517704178 ◽

2017 ◽

Vol 45 (9) ◽

pp. 2105-2110 ◽

Cited By ~ 56

Author(s):

Tyson C. Christensen ◽

Thomas L. Sanders ◽

Ayoosh Pareek ◽

Rohith Mohan ◽

Diane L. Dahm ◽

...

Keyword(s):

Risk Factors ◽

Cumulative Incidence ◽

Patellar Dislocation ◽

Patellar Instability ◽

Trochlear Dysplasia ◽

Patella Alta ◽

Time To Recurrence ◽

Lateral Patellar Dislocation ◽

Ipsilateral Recurrence ◽

First Time

Background: Previous studies have reported variable rates of recurrent lateral patellar instability mainly because of limited cohort sizes. In addition, there is currently a lack of information on contralateral patellar instability. Purpose: To evaluate the rate of recurrent ipsilateral patellar dislocations and contralateral patellar dislocations after a first-time lateral patellar dislocation. Additionally, risk factors associated with recurrent dislocations (ipsilateral or contralateral) and time to recurrence were investigated. Study Design: Cohort study; Level of evidence, 3. Methods: This population-based study included 584 patients with a first-time lateral patellar dislocation occurring between 1990 and 2010. A retrospective review was conducted to gather information about the injury, subsequent dislocations (ipsilateral or contralateral), and structural characteristics including trochlear dysplasia, patella alta, and tibial tubercle to trochlear groove (TT-TG) distance. Risk factors were assessed to delineate associations with subsequent dislocations and time to recurrence. Results: At a mean follow-up of 12.4 years, 173 patients had ipsilateral recurrence, and 25 patients had a subsequent contralateral dislocation. At 20 years, the cumulative incidence of ipsilateral recurrence was 36.0%, while the cumulative incidence of contralateral dislocations was 5.4%. Trochlear dysplasia (odds ratio [OR], 18.1), patella alta (OR, 10.4), age <18 years at the time of the first dislocation (OR, 2.4), elevated TT-TG distance (OR, 2.1), and female sex (OR, 1.5) were associated with recurrent ipsilateral dislocations. Time to recurrence was significantly decreased in patients with trochlear dysplasia (23.0 months earlier time to recurrence; P < .001), elevated TT-TG distance (18.5 months; P < .001), patella alta (16.4 months; P = .001), and age <18 years at the time of the first dislocation (15.4 months; P < .001). Risk factors for subsequent contralateral dislocations included patella alta and trochlear dysplasia. Conclusion: At 20 years after a first-time lateral patellar dislocation, the cumulative incidence of recurrent ipsilateral patellar dislocations was 36.0%, compared with 5.4% for contralateral dislocations. Trochlear dysplasia, elevated TT-TG distance, patella alta, age <18 years at the time of the first dislocation, and female sex were associated with ipsilateral recurrence. Trochlear dysplasia, elevated TT-TG distance, patella alta, and age <18 years at the time of the first dislocation were predictive of a statistically significant decrease in time to recurrence.

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Clinical and Imaging Predictors of Recurrent Ischemic Stroke: A Systematic Review and Meta-Analysis

Cerebrovascular Diseases ◽

10.1159/000490422 ◽

2018 ◽

Vol 45 (5-6) ◽

pp. 279-287 ◽

Cited By ~ 8

Author(s):

Frans Kauw ◽

Richard A.P. Takx ◽

Hugo W.A.M. de Jong ◽

Birgitta K. Velthuis ◽

L. Jaap Kappelle ◽

...

Keyword(s):

Ischemic Stroke ◽

Lower Risk ◽

Meta Analysis ◽

Cochrane Library ◽

Large Artery ◽

Cortical Lesions ◽

Level Of Evidence ◽

Risk Of Recurrence ◽

Increased Risk ◽

History Of

Background: Predictors of recurrent ischemic stroke are less well known in patients with a recent ischemic stroke than in patients with transient ischemic attack (TIA). We identified clinical and radiological factors for predicting recurrent ischemic stroke in patients with recent ischemic stroke. Methods: A systematic search in PubMed, Embase, Cochrane Library, and CINAHL was performed with the terms “ischemic stroke,” “predictors/determinants,” and “recurrence.” Quality assessment of the articles was performed and the level of evidence was graded for the articles included for the meta-analysis. Pooled risk ratios (RR) and heterogeneity (I2) were calculated using inverse variance random effects models. Results: Ten articles with high-quality results were identified for meta-analysis. Past medical history of stroke or TIA was a predictor of recurrent ischemic stroke (pooled RR 2.5, 95% CI 2.1–3.1). Small vessel strokes were associated with a lower risk of recurrence than large vessel strokes (pooled RR 0.3, 95% CI 0.1–0.7). Patients with stroke of an undetermined cause had a lower risk of recurrence than patients with large artery atherosclerosis (pooled RR 0.5, 95% CI 0.2–1.1). We found no studies using CT or ultrasound for the prediction of recurrent ischemic stroke. The following MRI findings were predictors of recurrent ischemic stroke: multiple lesions (pooled RR 1.7, 95% CI 1.5–2.0), multiple stage lesions (pooled RR 4.1, 95% CI 3.1–5.5), multiple territory lesions (pooled RR 2.9, 95% CI 2.0–4.2), chronic infarcts (pooled RR 1.5, 95% CI 1.2–1.9), and isolated cortical lesions (pooled RR 2.2, 95% CI 1.5–3.2). Conclusions: In patients with a recent ischemic stroke, a history of stroke or TIA and the subtype large artery atherosclerosis are associated with an increased risk of recurrent ischemic stroke. Predictors evaluated with MRI include multiple ischemic changes and isolated cortical lesions. Predictors of recurrent ischemic stroke concerning CT or ultrasound have not been published.

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Correlates of Postpartum Depression in First Time Mothers Without Previous Psychiatric Contact

European Psychiatry ◽

10.1016/j.eurpsy.2016.07.003 ◽

2016 ◽

Vol 40 ◽

pp. 4-12 ◽

Cited By ~ 9

Author(s):

S.M. Sylvén ◽

T.P. Thomopoulos ◽

N. Kollia ◽

M. Jonsson ◽

A. Skalkidou

Keyword(s):

Risk Factors ◽

Depressive Symptoms ◽

Postpartum Depression ◽

Path Analysis ◽

Subjective Experience ◽

Delivery Mode ◽

Increased Risk ◽

First Time Mothers ◽

History Of ◽

First Time

AbstractBackgroundPostpartum depression (PPD) is a common disorder after childbirth. The strongest known predictors are a history of depression and/or a history of PPD. However, for a significant proportion of women, PPD constitutes their first depressive episode. This study aimed to gain further insight into the risk factors for PPD in first time mothers without previous psychiatric contact.MethodsWomen delivering in Uppsala University Hospital, Sweden, from May 2006 to June 2007, were asked to participate and filled out questionnaires five days and six weeks postpartum, containing inter alia the Edinburgh Postnatal Depression Scale (EPDS). Univariate logistic regression models, as well as a path analysis, were performed to unveil the complex interplay between the study variables.ResultsOf the 653 participating primiparas, 10.3% and 6.4% reported depressive symptoms (EPDS ≥ 12 points) five days and six weeks postpartum, respectively. In the path analysis, a positive association between anxiety proneness and depressive symptoms at five days and six weeks postpartum was identified. For depressive symptoms six weeks after delivery, additional risk factors were detected, namely depressive symptoms five days postpartum and subjective experience of problems with the baby. Caesarean section and assisted vaginal delivery were associated with fewer depressive symptoms at 6 six weeks postpartum.ConclusionsIdentification of anxiety proneness, delivery mode and problems with the baby as risk factors for self-reported depressive symptoms postpartum in this group of primiparas can be important in helping health care professionals identify women at increased risk of affective disorders in the perinatal period, and provide a base for early intervention.

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First-Time Acute Lateral Patellar Dislocation in Children and Adolescents: What About Unaffected Knee Patellofemoral Joint Anatomic Abnormalities?

Medicina ◽

10.3390/medicina57030206 ◽

2021 ◽

Vol 57 (3) ◽

pp. 206

Author(s):

Rasa Simonaitytė ◽

Saulius Rutkauskas ◽

Emilis Čekanauskas ◽

Liutauras Labanauskas ◽

Vidmantas Barauskas

Keyword(s):

Children And Adolescents ◽

Patellofemoral Joint ◽

Patellar Dislocation ◽

Functional Disability ◽

Trochlear Dysplasia ◽

Age Groups ◽

Lateral Patellar Dislocation ◽

Positive Correlations ◽

Femoral Sulcus ◽

First Time

Background and Objectives: 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. Materials and Methods: 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. Results: 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 (r = 0.37; p < 0.005) and contralateral injured knees (r = 0.33; p < 0.05). Conclusion: 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.

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Patellofemoral Dislocation Recurrence After a First Episode: A Case-Control Study

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120981636 ◽

2021 ◽

Vol 9 (1) ◽

pp. 232596712098163

Author(s):

Juan Pablo Martinez-Cano ◽

Julián Chica ◽

Juan José Martinez-Arboleda ◽

Erika Rincón-Escobar ◽

Laura Zamudio-Castilla ◽

...

Keyword(s):

Risk Factors ◽

Patellar Dislocation ◽

Case Control Study ◽

Trochlear Dysplasia ◽

Case Control ◽

Patella Alta ◽

First Episode ◽

High Grade ◽

Lateral Patellar Dislocation ◽

Control Study

Background: Lateral patellar dislocation can become a recurrent problem after the first episode. Identifying those patients who are at increased risk of redislocation is important for the treatment decision-making process. Purpose: To identify clinical and radiologic risk factors for recurrence of patellar dislocation after a first episode. Study Design: Case-control study; Level of evidence, 3. Methods: The study included patients with lateral patellar dislocation and a 1-year minimum follow-up who were seen between 2011 and 2018. Patients aged 10 to 65 years were included. Patient characteristics, physical examination (patellar apprehension, J sign), and radiographs were reviewed. The Caton-Deschamps and Insall-Salvati ratios were used to evaluate patella alta. High-grade trochlear dysplasia was defined as Dejour types B, C, and D. Results: A total of 130 patients (139 knees) with primary lateral patellar dislocation were included. Recurrent dislocation was seen in 83 knees (59.71%). Stepwise logistic regression analysis demonstrated that Caton-Deschamps ratio ≥1.15 (OR, 2.39; 95% CI, 1.09-5.22; P = .029), age <21 years (OR, 2.53; 95% CI, 1.11-5.77; P = .027), and high-grade trochlear dysplasia (OR, 4.17; 95% CI, 1.90-9.17; P < .001) were significantly associated with patellar redislocation. Based on the presence of these factors, the probability of dislocation after a first lateral patellar dislocation was 31.2% with no factors present, 36.6% with any 1 factor present, 71.7% with any 2 factors present, and 86.2% if all 3 conditions were present. Conclusion: The results of this study indicated that patella alta, high-grade trochlear dysplasia, and age <21 years were independent risk factors for patellar redislocation after a first episode, with an additive effect when they were present together. This may help to guide the type of treatment for these patients.

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Familial Recurrence of Cerebral Palsy with Multiple Risk Factors

Case Reports in Pediatrics ◽

10.1155/2011/307857 ◽

2011 ◽

Vol 2011 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Lawrence P. Richer ◽

Nancy A. Dower ◽

Norma Leonard ◽

Alicia K. J. Chan ◽

Charlene M. T. Robertson

Keyword(s):

Risk Factors ◽

Cerebral Palsy ◽

Maternal Effects ◽

Maternal Risk Factors ◽

Maternal Risk ◽

Risk Of Recurrence ◽

Multiple Risk Factors ◽

Increased Risk ◽

Potential Risk Factors ◽

Multiple Risk

The recurrence of cerebral palsy in the same family is uncommon. We, however, report on two families with two or more affected siblings. In both families, numerous potential risk factors were identified including environmental, obstetric, and possible maternal effects. We hypothesize that multiple risk factors may lead to the increased risk of recurrence of cerebral palsy in families. Intrinsic and maternal risk factors should be investigated in all cases of cerebral palsy to properly counsel families on the risk of recurrence. Recent studies of genetic polymorphisms associated with cerebral palsy are considered with reference to our observations in these two families.

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Risk assessment and management of primary patellar dislocation is complex and multifactorial: a survey of Australian knee surgeons

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine ◽

10.1136/jisakos-2020-000609 ◽

2021 ◽

pp. jisakos-2020-000609

Author(s):

Lachlan S Huntington ◽

Kate E Webster ◽

Brian M Devitt ◽

Julian A Feller

Keyword(s):

Patellar Dislocation ◽

Patellar Instability ◽

Surgical Intervention ◽

Decision Making Process ◽

Recurrent Patellar Dislocation ◽

Surgical Decision ◽

Risk Of Recurrence ◽

History Of ◽

First Time ◽

Surgical Decision Making

ObjectivesRecurrent patellar instability following first-time lateral patellar dislocation is associated with a variety of bony, soft tissue and patient-related risk factors. The specific management of recurrent dislocation may vary depending on the presence and combination of these factors as well as the treating physician’s interpretation of these. Therefore, this study aimed to determine which factors Australian knee surgeons regard as increasing the risk of recurrence following first-time patellar dislocation and to characterise the surgical decision-making process of these surgeons in the management of lateral patellar instability.MethodsAn online survey was sent to all active members of the Australian Knee Society (AKS). The survey addressed (i) risk factors for recurrence following first-time patellar dislocation and (ii) the surgical decision-making process in treating patellar instability.ResultsSeventy-seven per cent (53 of 69) Australian Knee Society members responded. Factors identified by respondents as significantly increasing the risk of recurrence were a history of contralateral recurrent patellar dislocation (74% respondents), an atraumatic injury mechanism (57%), trochlear dysplasia (49%) younger age (45%), patella alta (43%) and generalised ligamentous laxity (42%). Forty-four per cent replied that there may be an indication for surgical intervention following first-time patellar dislocation with no apparent loose body present. All respondents would recommend operative management of recurrent patellar dislocation after a third episode, with 45% of surgeons recommending surgery after a second episode. The most common surgical procedures performed by respondents were medial patellofemoral ligament (MPFL) reconstruction (94%), tibial tuberosity medialisation (91%) and tibial tuberosity distalisation (85%). Only 23% of respondents consider trochleoplasty for primary surgical intervention.ConclusionSurgeons identified a large number of factors that they use to assess risk of recurrence following first-time patellar dislocation, many of which are not supported by the literature. The two highest ranked factors (history of contralateral recurrent patellar dislocation and an atraumatic injury mechanism) are without a significant evidence base. There was considerable variation in the criteria used to make the decision to perform a patellar stabilisation procedure. MPFL reconstruction was the most commonly used procedure, either in isolation or combined with another procedure.Level of evidenceCross-sectional study; expert opinion (Level V).

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The burden of cardiovascular disease risk factors in the Middle East: A systematic review and meta-analysis focusing on primary prevention

Current Vascular Pharmacology ◽

10.2174/1573406416666200611104143 ◽

2020 ◽

Vol 18 ◽

Author(s):

Akshaya Srikanth Bhagavathula ◽

Abdullah Shehab ◽

Anhar Ullah ◽

Jamal Rahmani

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Cardiovascular Disease ◽

Family History ◽

Primary Prevention ◽

Middle East ◽

Disease Risk ◽

Meta Analysis ◽

Middle Eastern ◽

History Of

Background: The increasing incidence of cardiovascular disease (CVD) threatens the Middle Eastern population. Several epidemiological studies have assessed CVD and its risk factors in terms of the primary prevention of CVD in the Middle East. Therefore, summarizing the information from these studies is essential. Aim: We conducted a systematic review to assess the prevalence of CVD and its major risk factors among Middle Eastern adults based on the literature published between January 1, 2012 and December 31, 2018 and carried out a meta-analysis. Methods: We searched electronic databases such as PubMed/Medline, ScienceDirect, Embase and Google Scholar to identify literature published from January 1, 2012 to December 31, 2018. All the original articles that investigated the prevalence of CVD and reported at least one of the following factors were included: hypertension, diabetes, dyslipidaemia, smoking and family history of CVD. To summarize CVD prevalence, we performed a random-effects meta-analysis. Results: A total of 41 potentially relevant articles were included, and 32 were included in the meta-analysis (n=191,979). The overall prevalence of CVD was 10.1% (95% confidence interval (CI): 7.1-14.3%, p<0.001) in the Middle East. A high prevalence of CVD risk factors, such as dyslipidaemia (43.3%; 95% CI: 21.5-68%), hypertension (26.2%; 95% CI: 19.6-34%) and diabetes (16%; 95% CI: 9.9-24.8%), was observed. The prevalence rates of other risk factors, such as smoking (12.4%; 95% CI: 7.7-19.4%) and family history of CVD (18.7%; 95% CI: 15.4-22.5%), were also high. Conclusion: The prevalence of CVD is high (10.1%) in the Middle East. The burden of dyslipidaemia (43.3%) in this region is twice as high as that of hypertension (26.2%) and diabetes mellitus (16%). Multifaceted interventions are urgently needed for the primary prevention of CVD in this region.

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Leiomyosarcoma of the Tracheostomy Site in a Patient with History of Laryngeal Squamous Cell Carcinoma

Case Reports in Oncology ◽

10.1159/000516797 ◽

2021 ◽

pp. 912-917

Author(s):

Zainub Ajmal ◽

Abdul Moiz Khan ◽

Lezah McCarthy ◽

Allison Lupinetti ◽

Syed Mehdi

Keyword(s):

Risk Factors ◽

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Head And Neck ◽

Squamous Cell ◽

English Literature ◽

Neck Region ◽

Multiple Risk Factors ◽

History Of ◽

Rare Malignancy

Leiomyosarcoma (LMS) of the trachea is an extremely rare malignancy with only a few reported cases in English literature. As such the diagnosis can be frequently missed or delayed. We present a case of a 69-year-old male who underwent tracheostomy for airway obstruction secondary to glottic squamous cell carcinoma and treated definitely with radiation therapy. Subsequently, the patient developed LMS of the tracheostomy site. The case further details multiple risk factors that could contribute to development of LMS including radiation exposure, prior malignancy, and chronic inflammation. These risk factors have been well established for LMS in other sites but less so in the head and neck region, which is the subject of our discussion. We also review the current guidelines for head and neck as well as limb sarcomas and discussed role of surgery or radiation and their accompanying challenges in management of this rare malignancy.

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Greater cardiorespiratory fitness reduces incidence of atrial fibrillation: a meta-analysis

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.200 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

C Verdicchio ◽

A Elliott ◽

R Mahajan ◽

D Linz ◽

D Lau ◽

...

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Risk Factor ◽

Cardiorespiratory Fitness ◽

Meta Analysis ◽

Exercise Stress ◽

Inverse Association ◽

Exercise Interventions ◽

Increased Risk ◽

Statistical Heterogeneity

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Atrial Fibrillation (AF) is the most common sustained cardiac arrhythmia affecting 1-2% of the global population, with the prevalence of AF increasing dramatically over the past two decades. Although low levels of cardiorespiratory fitness (CRF) and physical activity are predictive of cardiovascular disease onset and mortality, only recently has this emerged as a potential risk factor for AF. Purpose The aim of this meta-analysis was therefore to quantify the relationship between CRF, measured by a symptom limited exercise stress test, and incident AF. We hypothesised that there would be an inverse relationship between CRF and the incidence of AF. Methods The systematic literature review was conducted using PUBMED, MEDLINE and EMBASE databases, with seven studies meeting the inclusion criteria. A random-effects meta-analysis was then used to compare the multivariate risk estimates of the lowest CRF group from each cohort with the group of the highest CRF. Results Data from 206,925 individuals (55.8% males) was used for analysis with a mean age of 55 ± 2.5 years and a mean follow-up period of 10.3 ± 5 years. The total number of AF events across the studies was 19,913. The overall pooled risk of AF in the high-CRF group versus the low-CRF group showed a significant lower risk of incident AF in those with high-CRF (OR: 0.52, 95% CI, 0.44-0.605, p < 0.001). There was evidence of statistical heterogeneity between the studies (I2 = 81%, p < 0.001). AF incidence rates demonstrated an overall decline in rates across the CRF quartiles from low to high. The mean incidence rate for low-CRF was 21 ± 13.4 compared to 6.9 ± 0.7 per 1000 person-years for the high CRF group (p = 0.03). Conclusion There is an inverse association between a lower CRF and an increased risk of AF, with a higher level of CRF protective against AF. This study highlights that low-CRF may be an additional risk factor for AF along with already other established lifestyle-based risk factors such as obesity and hypertension. Exercise interventions should be promoted as a primary prevention strategy in those at risk of developing AF with known risk factors. Future studies are warranted to identify the mechanism(s) through which improved CRF confers a reduction in AF incidence. Abstract Figure. AF risk between high and low-CRF

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