Context:Patellar dislocation usually occurs to the lateral side, leading to ruptures of the Medial Patellofemoral Ligament (MPFL) in about 90% of the cases. Even though several prognostic factors are identified for patellofemoral instability after patellar dislocation so far, the appropriate therapy remains a controversial issue.Evidence Acquisition:Authors searched the Medline library for studies on both surgical and conservative treatment for patellar dislocation and patellofemoral instability. Additionally, the reference list of each article was searched for additional studies.Results:A thorough analysis of the anatomical risk factors with a particular focus on patella alta, increased Tibial Tuberosity-Trochlear Groove (TT-TG) distance, trochlear dysplasia as well as torsional abnormalities should be performed early after the first dislocation to allow adequate patient counseling. Summarizing the results of all published randomized clinical trials and comparing surgical and conservative treatment after the first-time patellar dislocation until today indicated no significant evident difference for children, adolescents, and adults. Therefore, nonoperative treatment was indicated after a first-time patellar dislocation in the vast majority of patients.Conclusions:Surgical treatment for patellar dislocation is indicated primarily in case of relevant concomitant injuries such as osteochondral fractures, and secondarily for recurrent dislocations.

BACKGROUND: Motion sensing input devices could provide a practical and low-cost alternative method for repeated range of motion measurements. This study aimed to assess the reliability, accuracy and time requirements of a motion sensing input device (Microsoft Kinect) for ROM measurements comparing it with goniometer based measurements and subjective estimation. MATERIAL AND METHODS: Full ROM was measured in 14 shoulder and elbow joints using the different methods. The order was randomly selected and each movement was measured twice. The results were recorded in degrees and the time measured in seconds. RESULTS: In general, there was a poor to moderate agreement between the Kinect system compared to the goniometer. There was a good agreement between the goniometer-based and the subjective technique. The Kinect-based technique showed excellent test-retest reliability. CONCLUSION: The Kinect system showed good test-retest reliability, but lower accuracy compared to goniometer-based measurements. Improvements in patient positioning and measurement protocol standardization must be made before its implementation in clinical practice.

Background:Arthroscopic debridement represents a salvage procedure for irreparable rotator cuff tears. It is important to accurately diagnose the patient for irreparable rotator cuff tears. The diagnosis and the therapeutic options must be explained to the patient. It is mandatory that the patient understands the primary goal of the arthroscopic debridement being reduction of pain, not improving strength or function.Methods:The procedure consists of 7 distinct steps to debride the soft tissues and alleviate pain.Results:Even though there is a lack of evidence that this procedure is superior to other therapeutic options, it has shown good results in patients with the main complaint of pain. Conclusion:The results reported in some studies should, however, be interpreted with caution, taking into consideration the substantial structural damage in irreparable defects.

Background:The role of nonoperative management for rotator cuff tears remains a matter of debate. Clinical results reported in the literature mainly consist of level IV studies, oftentimes combining a mixed bag of tear sizes and configurations, and are contradictory to some extent.Methods:A selective literature search was performed and personal surgical experiences are reported.Results:Most studies show an overall success rate of around 75% for nonoperative treatment. However, the majority of studies also present a progression of tear size and fatty muscle infiltration over time, with however debatable clinical relevance for the patient. Suggested factors associated with progression of a rotator cuff tear are an age of 60 years or older, full-thickness tears, and fatty infiltration of the rotator cuff muscles at the time of initial diagnosis. Conclusion:Non-operative management is indicated for patients with lower functional demands and moderate symptoms, and/or of course for those refusing to have surgery. Close routinely monitoring regarding development of tear size should be performed, especially in patients that remain symptomatic during nonoperative treatment. To ensure judicious patient counseling, it has to be taken into account that 1) tears that are initially graded as reparable may become irreparable over time, and 2) results after secondary surgical therapy after failed nonoperative treatment are usually reported to be inferior to those who underwent primary tendon repair.

Retrospective cohort study. Level IV.