I.S.Mu.L.T. first-time patellar dislocation guidelines

Vetrano, Mario; Oliva, Francesco; Bisicchia, Salvatore; Bossa, M.; Carli, Angelo De; Lorenzo, Luigi Di; Erroi, Davide; Forte, Aldo Lo; Foti, Calogero; Frizziero, Antonio; Gasparre, Giuseppe; Via, Alessio Giai; Innocenti, Bernardo; Longo, Umile Giuseppe; Mahmoud, Ahmed Abdelaal Ahmed; Masiero, Stefano; Mazza, Daniele; Natali, Simone; Notarangelo, Christian; Osti, Leonardo; Padulo, Johnny; Pellicciari, Leonardo; Perroni, Fabrizio; Piccirilli, Eleonora; Ramponi, C; Salvatore, Giuseppe; Panni, Alfredo Schiavone; Suarez, Tania; Tarantino, Umberto; Vittadini, Filippo; Vulpiani, Maria Chiara; Ferretti, Andrea; Maffulli, Nicola

doi:10.11138/mltj/2017.7.1.001

Cited by 53 publications

(31 citation statements)

References 113 publications

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“…33 Despite reports of reduced recurrence rates after surgical management, nonoperative management remains the mainstay of treatment. 24,33,34 However, in a patient with a high risk of recurrence, surgery may be considered the preferred management option. 18 It would therefore be helpful to know which factors were most associated with an increased risk of recurrence.…”

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confidence: 99%

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

et al. 2019

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

et al. 2019

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“…Lateral patellar dislocations comprise 2% to 3% of acute knee injuries. 1 Various anatomic and patient factors predispose individuals to these injuries. These factors include generalized ligamentous laxity, as found in Ehlers-Danlos syndrome, as well as “miserable malalignment syndrome,” which is a combination of femoral anteversion, genu valgum, and external tibial torsion or pronated feet that leads to an increased Q-angle.…”

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“… 2 , 3 Patellar dislocations commonly occur during athletic activity, and over 90% are indirect injuries occurring through a valgus and torsional force on a flexed knee. 1 All acute patellar dislocations result in increased laxity of the medial patellofemoral ligament (MPFL), with 50% to 96% of post-dislocation patients having complete deficiency of the ligament during surgical exploration. 4 , 5 …”

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Medial Patellofemoral Ligament Reconstruction Using All-Soft Suture Anchors for Patellar Fixation

Makovicka

Hartigan

Patel

et al. 2018

Arthroscopy Techniques

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The medial patellofemoral ligament (MPFL), which is critical for both patellar stability and normal kinematics of the patellofemoral joint, is disrupted in most patellar dislocations. Consequently, MPFL reconstruction is advocated in recurrent dislocations to restore native patellar constraints. Fixation of the MPFL graft to the medial border of the patella can be achieved through various methods, each with its own benefits and drawbacks. We present a technique for MPFL fixation to the patella using all-soft suture anchors, theoretically decreasing the risk of patellar fracture and articular surface violation.

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“…I am not sure whether all these indications were initially conceived by the initiator, but the fact stands that biomechanical and clinical studies have demonstrated a high degree of patients' satisfaction, and low complication rates, and marked improvement in patientreported outcome measures. 4 Part and parcel of modern life is the high level of physical activity that may cause musculoskeletal ailments, but which we nevertheless wish to maintain for as long as possible. The present work is a careful retrospective review of a selected group of patients with pain and patellofemoral arthritis who underwent the procedure, and in whom especially the return to sport dimension was focused on.…”

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Editorial Commentary: Standing the Test of Time and Sport: Fulkerson Tibial Tubercle Osteotomy of the Knee

Maffulli

2018

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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A biplanar osteotomy aiming to anteromedialize the anterior tibial tuberosity to realign the patellofemoral joint described by Prof. Fulkerson is one of the classical operations to address many pathologies of the patellofemoral joint. The procedure is evidence-based and effective for the management of patellofemoral pain and osteoarthritis, confirming that the original ideas and concepts are still valid, and still stand strong. In high-demand patients, the Fulkerson osteotomy offers good opportunities of success in terms of return to sport. With the right indications, patients will gain several years of pain-free sports participation.

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I.S.Mu.L.T. first-time patellar dislocation guidelines

Cited by 53 publications

References 113 publications

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

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

Medial Patellofemoral Ligament Reconstruction Using All-Soft Suture Anchors for Patellar Fixation

Editorial Commentary: Standing the Test of Time and Sport: Fulkerson Tibial Tubercle Osteotomy of the Knee

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