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

Medicina ◽  
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.

Risk Factors and Time to Recurrent Ipsilateral and Contralateral Patellar Dislocations

2017 ◽  
Vol 45 (9) ◽  
pp. 2105-2110 ◽  
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.

scholarly journals Traumatic Patellar Dislocation and Cartilage Injury: A Follow-up Study of Long-Term Cartilage Deterioration

2017 ◽  
Vol 45 (6) ◽  
pp. 1376-1382 ◽  
Author(s):  
Essi E. Salonen ◽  
Teemu Magga ◽  
Petri J. Sillanpää ◽  
Tommi Kiekara ◽  
Heikki Mäenpää ◽  
...  
Keyword(s):  
Patellofemoral Joint ◽  
Patellar Dislocation ◽  
Cartilage Injury ◽  
Cartilage Lesions ◽  
Patellar Cartilage ◽  
Lateral Patellar Dislocation ◽  
First Time ◽  
And Cartilage

Background: Patellofemoral cartilage deterioration and osteoarthritis are reported to be associated with recurrent patellar dislocation. However, the association between first-time traumatic patellar dislocation and cartilage deterioration is unknown. Purpose: The aim of this study was to assess long-term cartilage deterioration in the patellofemoral and tibiofemoral joint after conservatively treated traumatic lateral patellar dislocation. Study Design: Case series; Level of evidence, 4. Methods: Twenty patients (mean age, 25 years) who sustained first-time traumatic lateral patellar dislocation with no previous patellofemoral instability symptoms were initially scanned with 1.5-T magnetic resonance imaging (MRI). A follow-up 3-T MRI was conducted, on average, 8 years after first-time lateral patellar dislocation. Subjective instability symptoms and Knee injury and Osteoarthritis Outcome Score were also assessed. Results: In the primary MRI, patellofemoral cartilage injury was seen in 14 of 20 patients (70%). Most (14/15) of the injuries were seen in the patellar cartilage, especially at the medial facet. On the follow-up MRI, patellofemoral cartilage deterioration was visible for all patients. The central patella ( P = .005) seemed especially prone to cartilage deterioration during the follow-up. Half of the patients (10/20) had grade 3-4 cartilage lesions in the patellofemoral joint in the follow-up MRI. In the primary MRI, only 1 patient exhibited tibiofemoral joint cartilage lesions, whereas at the time of follow-up, 10 of 20 patients exhibited tibiofemoral cartilage lesions. The majority of these lesions were considered clinically nonsignificant (International Cartilage Repair Society = 1) and were seen in the lateral compartment (6/10, 60%). Of the 14 patients (36%) with injury to the patellar cartilage, 5 reported subsequent instability of the patellofemoral joint, but this was not associated with more significant cartilage deterioration in the follow-up MRI compared with patients without redislocation. Conclusion: While recurrent lateral patellar dislocation is known to lead to degenerative process, a single first-time or infrequently recurring traumatic lateral patellar dislocation also seems to be associated with gradual cartilage deterioration. Traumatic lateral patellar dislocation might initiate gradual degeneration of the cartilage in the patellofemoral joint and can lead to the development of generalized knee osteoarthritis. Instability symptoms of the patellofemoral joint, however, were not related to the severity of the deterioration.

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

2019 ◽  
Vol 48 (10) ◽  
pp. 2552-2562 ◽  
Author(s):  
Lachlan S. Huntington ◽  
Kate E. Webster ◽  
Brian M. Devitt ◽  
John P. Scanlon ◽  
Julian A. Feller
Keyword(s):  
Risk Factors ◽  
Patellar Dislocation ◽  
Trochlear Dysplasia ◽  
Meta Analysis ◽  
Risk Of Recurrence ◽  
Multiple Risk Factors ◽  
Increased Risk ◽  
Lateral Patellar Dislocation ◽  
History Of ◽  
First Time

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.

Patellofemoral Arthritis After Lateral Patellar Dislocation: A Matched Population-Based Analysis

2016 ◽  
Vol 45 (5) ◽  
pp. 1012-1017 ◽  
Author(s):  
Thomas L. Sanders ◽  
Ayoosh Pareek ◽  
Nicholas R. Johnson ◽  
Michael J. Stuart ◽  
Diane L. Dahm ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Cumulative Incidence ◽  
Patellar Dislocation ◽  
Trochlear Dysplasia ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Patellofemoral Arthritis ◽  
Level Of Evidence ◽  
Lateral Patellar Dislocation ◽  
Osteochondral Injury

Background: The rate of patellofemoral arthritis after lateral patellar dislocation is unknown. Purpose/Hypothesis: The purpose of this study was to compare the risk of patellofemoral arthritis and knee arthroplasty between patients who experienced a lateral patellar dislocation and matched individuals without a patellar dislocation. Additionally, factors predictive of arthritis after patellar dislocation were examined. The hypothesis was that the rate of arthritis is likely higher among patients who experience a patellar dislocation compared with those who do not. Study Design: Cohort study; Level of evidence, 3. Methods: In this study, 609 patients who had a first-time lateral patellar dislocation between 1990 and 2010 were compared with an age- and sex-matched cohort of patients who did not have a patellar dislocation. Medical records were reviewed to collect information related to the initial injury, recurrent dislocation, treatment, and progression to clinically significant patellofemoral arthritis (defined as symptoms with degenerative changes on patellar sunrise radiographs). Factors associated with arthritis (age, sex, recurrence, osteochondral injury, trochlear dysplasia) were examined. Results: At a mean follow-up of 12.3 ± 6.5 years from initial dislocation, 58 patients (9.5%) in the dislocation cohort were diagnosed with patellofemoral arthritis, corresponding to a cumulative incidence of arthritis of 1.2% at 5 years, 2.7% at 10 years, 8.1% at 15 years, 14.8% at 20 years, and 48.9% at 25 years. In the control cohort, 8 patients (1.3%) were diagnosed with arthritis, corresponding to a cumulative incidence of arthritis of 0% at 5 years, 0% at 10 years, 1.3% at 15 years, 2.9% at 20 years, and 8.3% at 25 years. Therefore, patients who experienced a lateral patellar dislocation had a significantly higher risk of developing arthritis (hazard ratio [HR], 7.8; 95% CI, 3.9-17.6; P < .001) than individuals without a patellar dislocation. However, the risk of knee arthroplasty was similar between groups (HR, 2.8; 95% CI, 0.6-19.7; P = .2). Recurrent patellar dislocations (HR, 4.5; 95% CI, 1.6-12.6), osteochondral injury (HR, 11.3; 95% CI, 5.0-26.6), and trochlear dysplasia (HR, 3.6; 95% CI, 1.3-10.0) were associated with arthritis after patellar dislocation. Conclusion: Patellar dislocation is a significant risk factor for patellofemoral arthritis, as nearly half of patients have symptoms and radiographic changes consistent with arthritis at 25 years after lateral patellar dislocation. Osteochondral injury, recurrent patellar instability, and trochlear dysplasia are associated with the development of arthritis.

scholarly journals Patellofemoral joint alignment is a major risk factor for recurrent patellar dislocation in children and adolescents: a systematic review

2018 ◽  
Vol 3 (5) ◽  
pp. 287-297
Author(s):  
Martina Barzan ◽  
Sheanna Maine ◽  
Luca Modenese ◽  
David G Lloyd ◽  
Christopher P Carty
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Children And Adolescents ◽  
Lower Limb ◽  
Patellofemoral Joint ◽  
Patellar Dislocation ◽  
Recurrent Patellar Dislocation ◽  
Limb Alignment ◽  
Lower Limb Alignment ◽  
Sulcus Angle

ImportanceThe complex interplay of risk factors that predispose individuals to recurrent patellar dislocation is poorly understood, especially in paediatric patients who exhibit the most severe forms.ObjectiveThe primary aim of this study was to systematically review the current literature to characterise the lower limb alignment, patellofemoral morphology and soft tissue restraints of the patellofemoral joint (PFJ) through medical imaging measurements in paediatric recurrent patellar dislocators and age-matched control participants. The secondary aims were to synthesise the data to stratify the factors that influence PFJ stability and provide recommendations on the assessment and reporting of PFJ parameters in this patient population.Evidence reviewA systematic search was performed using CINAHL, the Cochrane Library, EMBASE, PubMed and Web of Science databases until June 2017. Two authors independently searched for studies that included typical children and adolescents who experienced patellar dislocation and also had direct measures of structural and dynamic risk factors. The methodological quality of the included studies was assessed through a customised version of the Downs and Black checklist. Weighted averages and SDs of measures that have been reported in more than one study were computed. A fixed-effects model was used to estimate the mean differences with 95% CIs regarding the association of recurrent patellar dislocation with patella alta, tibial tuberosity to trochlear groove (TT-TG) distance and bony sulcus angle.Findings20 of 718 articles met the inclusion criteria. Thirty-one risk factors were found; however, only 10 of these measurements had been assessed in multiple articles and only four had both dislocator and control population results. With respect to controls, patients with recurrent patellar dislocations had higher TT-TG distance (p<0.01) and higher bony sulcus angle (p<0.01).Conclusions and relevanceBased on the current scientific literature, increased TT-TG distances and bony sulcus angles predispose children and adolescents to recurrent patellar dislocation. Besides these measurements, studies reporting on recurrent patellar dislocation in children and adolescents should also include characterisation of lower limb alignment in coronal and axial planes and assessment of generalised ligamentous laxity.Level of evidenceSystematic review of prognostic studies, Levels II–IV.

scholarly journals Patella dislocations and patellofemoral instability: a current concepts review

2021 ◽  
Vol 20 (3) ◽  
Author(s):  
Benjamin R Garrett ◽  
Michael L Grundill
Keyword(s):  
Patellar Dislocation ◽  
Surgical Intervention ◽  
Trochlear Dysplasia ◽  
Patellofemoral Instability ◽  
Tibial Tubercle ◽  
First Episode ◽  
Level Of Evidence ◽  
Lateral Patellar Dislocation ◽  
Consensus Statements ◽  
Patella Dislocations

ABSTRACT Lateral patellar dislocation affects young, active patients with an incidence rate of 5.8 per 100 000. The management of first episode dislocations is non-surgical in the majority of cases, unless associated pathology dictates surgical intervention. Approximately 40% of cases that are treated non-surgically will develop recurrent patellofemoral instability. Evidence supports surgical intervention in these cases; however, the best approach is debatable. Most research and consensus statements agree that medial patellofemoral ligament reconstruction (MPFLR) should be performed in most cases. Additional procedures can be used 'a la carte' according to certain conditions or pathology. A tibial tubercle osteotomy (TTO) is usually indicated in patients with maltracking and/or patella alta, but the direction and degree of correction must be carefully considered. Trochleoplasty is technically demanding and should be reserved for a select few patients with severe trochlear dysplasia. It should be performed by an experienced knee surgeon due to the high risk of inadvertent complications. Level of evidence: Level 5 Keywords: patellofemoral instability, patellar dislocation

scholarly journals The Results of Adductor Magnus Tenodesis in Adolescents with Recurrent Patellar Dislocation

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Krzysztof Malecki ◽  
Jaroslaw Fabis ◽  
Pawel Flont ◽  
Kryspin Ryszard Niedzielski
Keyword(s):  
Children And Adolescents ◽  
Patellar Dislocation ◽  
Peak Torque ◽  
Recurrent Dislocation ◽  
Quadriceps Muscle ◽  
Pain Scale ◽  
Mpfl Reconstruction ◽  
Recurrent Patellar Dislocation ◽  
Adductor Magnus ◽  
First Time

Recurrent dislocation of the patella is a common orthopaedic problem which occurs in about 44% of cases after first-time dislocation. In most cases of first-time patellar dislocation, the medial patellofemoral ligament (MPFL) becomes damaged. Between 2010 and 2012, 33 children and adolescents (39 knees) with recurrent patellar dislocation were treated with MPFL reconstruction using the adductor magnus tendon. The aim of our study is to assess the effectiveness of this surgical procedure. The outcomes were evaluated functionally (Lysholm knee scale, the Kujala Anterior Knee Pain Scale, and isokinetic examination) and radiographically (Caton index, sulcus angle, congruence angle, and patellofemoral angle). Four patients demonstrated redislocation with MPFL graft failure, despite the fact that patellar tracking was found to be normal before the injury, and the patients had not reported any symptoms. Statistically significant improvements in Lysholm and Kujala scales, in patellofemoral and congruence angle, were seen(P<0.001). A statistically significant improvement in the peak torque of the quadriceps muscle and flexor was observed for 60°/sec and 180°/sec angular velocities(P=0.01). Our results confirm the efficacy of MPFL reconstruction using the adductor magnus tendon in children and adolescents with recurrent patellar dislocation.

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