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      Patellar Instability Management: A Survey of the International Patellofemoral Study Group

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          Abstract

          Although patellofemoral instability is among the most prevalent knee disorders, the management of patients with this condition is complex and remains variable, given the lack of long-term, high-level clinical outcome studies to compare various operative and nonoperative modalities.

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          Outcomes After Isolated Medial Patellofemoral Ligament Reconstruction for the Treatment of Recurrent Lateral Patellar Dislocations: A Systematic Review and Meta-analysis.

          Daniel Schneider, Brian Grawe, Robert Magnussen … (2016)
          A patellar dislocation is a common knee injury in the young, athletic patient population. Recent trends indicate that the use of long-term nonoperative treatment is decreasing, and surgical intervention is more commonly recommended for those patients who fail initial nonoperative management with recurrent patellar dislocations. Medial patellofemoral ligament (MPFL) reconstruction has become increasingly utilized in this regard.
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            Acute patellar dislocation in children and adolescents: a randomized clinical trial.

            Simon Donell, Yrjänä Nietosvaara, Sauli Palmu … (2008)
            The treatment of acute patellar dislocation in children is controversial. Some investigators have advocated early repair of the medial structures, whereas others have treated this injury nonoperatively. The present report describes the long-term subjective and functional results of a randomized controlled trial of nonoperative and operative treatment of primary acute patellar dislocation in children less than sixteen years of age. The data were gathered prospectively on a cohort of seventy-four acute patellar dislocations in seventy-one patients (fifty-one girls and twenty boys) younger than sixteen years of age. Sixty-two patients (sixty-four knees) without large (>15 mm) intra-articular fragments were randomized to nonoperative treatment (twenty-eight knees) or operative treatment (thirty-six knees). Operative treatment consisted of direct repair of the damaged medial structures if the patella was dislocatable with the patient under anesthesia (twenty-nine knees) or lateral release alone if the patella was not dislocatable with the patient under anesthesia (seven knees). All but four patients who underwent operative treatment had a concomitant lateral release. The rehabilitation protocol was the same for both groups. The patients were seen at two years, and a telephone interview was conducted at a mean of six years and again at a mean of fourteen years. Fifty-eight patients (sixty-four knees; 94%) were reviewed at the time of the most recent follow-up. At the time of the most recent follow-up, the subjective result was either good or excellent for 75% (twenty-one) of twenty-eight nonoperatively treated knees and 66% (twenty-one) of thirty-two operatively treated knees. The rates of recurrent dislocation in the two treatment groups were 71% (twenty of twenty-eight) and 67% (twenty-four of thirty-six), respectively. The first redislocation occurred within two years after the primary injury in twenty-three (52%) of the forty-four knees with recurrent dislocation. Instability of the contralateral patella was noted in thirty (48%) of the sixty-two patients. The only significant predictor for recurrence was a positive family history of patellar instability. The mode of treatment and the existence of osteochondral fractures had no clinical or significant influence on the subjective outcome, recurrent patellofemoral instability, function, or activity scores. The long-term subjective and functional results after acute patellar dislocation are satisfactory in most patients. Initial operative repair of the medial structures combined with lateral release did not improve the long-term outcome, despite the very high rate of recurrent instability. A positive family history is a risk factor for recurrence and for contralateral patellofemoral instability. Routine repair of the torn medial stabilizing soft tissues is not advocated for the treatment of acute patellar dislocation in children and adolescents.
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              Predictors of recurrent instability after acute patellofemoral dislocation in pediatric and adolescent patients.

              Laura Lewallen, Amy McIntosh, Diane Dahm (2013)
              Patellofemoral instability is common in the pediatric and adolescent population, yet prognosis after the first dislocation has been difficult to determine.
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                Author and article information

                Journal
                Title: The American Journal of Sports Medicine
                Abbreviated Title: Am J Sports Med
                Publisher: SAGE Publications
                ISSN (Print): 0363-5465
                ISSN (Electronic): 1552-3365
                Publication date Created: October 11 2018
                Publication date Created: November 2018
                Publication date (Electronic): October 06 2017
                Publication date (Print): November 2018
                Volume: 46
                Issue: 13
                Pages: 3299-3306
                Affiliations
                [1 ]Section of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
                [2 ]Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
                [3 ]Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA
                [4 ]Mountaineer Orthopedic Specialists LLC, Morgantown, West Virginia, USA
                [5 ]Pediatric Orthopaedic Surgery Service, Hospital for Special Surgery, New York, New York, USA
                Article
                DOI: 10.1177/0363546517732045
                PubMed ID: 28985094
                SO-VID: d93ec8bb-c2b6-4d92-a97b-67ffe5918308
                Copyright © © 2018
                License:

                http://journals.sagepub.com/page/policies/text-and-data-mining-license

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