Non-surgical treatment for acute patellar dislocation with special emphasis on the MPFL injury patterns

Kang, Hang Won; Wang, Fei; Chen, Bai Cheng; Zhang, Yingze; Ma, Lei

doi:10.1007/s00167-012-2020-8

Cited by 49 publications

(43 citation statements)

References 30 publications

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“…3): the overlap region, which is proximal to the patellar insertion and has the VMO attached to it, and the nonoverlap region close to the femoral origin without the overlying VMO. 24 Anatomically, the total length of the MPFL was approximately 58.8 mm, of which 20.3 mm (35%) was in the overlap region and 38.5 mm (65%) was in the nonoverlap region. 27 Sallay et al reported 94% patients with patellar dislocations had an avulsion of MPFL in their study, while Sanders et al reported the rate of the MPFL injury was 100% in their series.…”

Section: Discussionmentioning

confidence: 98%

“…In addition, the same midsubstance injury with or without the presence of a VMO attachment may result in different clinical outcomes. Kang et al 24 introduced a VMObased three-part classification for acute MPFL injuries that described the MPFL injuries in terms of their relationship with the VMO attachment: an overlap-region injury, a nonoverlapregion injury, and combined injuries. They reported that the outcomes of nonsurgical treatment are superior in the overlapregion injury than the nonoverlap region.…”

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confidence: 99%

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Surgical versus Nonsurgical Treatments of Acute Primary Patellar Dislocation with Special Emphasis on the MPFL Injury Patterns

Wang

Liu

et al. 2016

J Knee Surg

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The objective of the present study was to compare the clinical results of the surgical versus nonsurgical treatments of acute primary patellar dislocations with a medial patellofemoral ligament (MPFL) injury in the nonoverlap region with the vastus medialis oblique. In this study, 62 patients with an acute patellar dislocation and a concurrent MPFL injury in the nonoverlap region were randomly divided into two groups based on their birth years (even vs. odd years) and received either surgical or nonsurgical treatment. Of the 62 eligible patients, 30 were in the nonsurgical treatment group (Group 1) and 32 were in the surgical group (Group 2). Patellar stability tests and the Kujala knee questionnaire were performed, and radiographs were evaluated for patellar tilt and the lateral shift ratio by two blinded investigators. An osteochondral injury was noted in six (23.1%) patients from Group 1 and five (16.7%) patients from Group 2, with no statistical difference between the two groups. The mean Kujala score was 80.19 ± 5.07 and 93.57 ± 4.03 ( < 0.001) between the surgical and nonsurgical groups, respectively. The mean patellar tilt was 8.96 ± 1.64 and 6.83 ± 1.44 degrees ( < 0.001) and the lateral shift ratio was 11.08 ± 1.99 and 9.23 ± 1.96 ( = 0.001) between the surgical and nonsurgical groups, respectively. This study showed that the surgical treatment of MPFL injuries in the nonoverlap region achieved better clinical outcomes and improved subjective knee function compared with conservative therapy. Surgery should therefore be considered as the treatment of choice for these specific injuries.

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Section: Discussionmentioning

confidence: 98%

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confidence: 99%

Surgical versus Nonsurgical Treatments of Acute Primary Patellar Dislocation with Special Emphasis on the MPFL Injury Patterns

Wang

Liu

et al. 2016

J Knee Surg

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“…The location of MPFL injury along its horizontal length is variable in the literature [6,8,20,22,29,40]. Data Fig.…”

Section: Discussionmentioning

confidence: 99%

Anatomic patellar instability risk factors in primary lateral patellar dislocations do not predict injury patterns: an MRI-based study

Tompkins

Rohr

Agel

et al. 2017

Knee Surg Sports Traumatol Arthrosc

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for this injury due to clinician-perceived need for cartilage debridement. MPFL injury severity was complete rupture (N = 69, 44%), partial (N = 67, 43%), and none (N = 19, 13%). MPFL injury location was isolated femoral (N = 16, 10%), isolated patella (N = 26, 17%), isolated mid-substance (0%), multiple locations (N = 95, 61%), and none (N = 20, 13%). Chondral injury location was patella (N = 67, 43%), lateral femoral condyle (N = 11, 7%), multiple locations (N = 53, 34%), and none (N = 26, 17%). A majority (61%) of patellar chondral lesions were at its inferomedial aspect; all medial patellar retinacular partial injuries involved the inferomedial aspect of the patella, consistent with the insertion of the medial patellotibial ligament (MPTL). Skeletally immature patients had a greater risk of isolated patellar MPFL and chondral injury. No clear relationship was found between/across the location and/or severity of bone bruising, MPFL, or chondral injury. Clinical relevance Underlying anatomic patellar instability risk factors defined by MRI, do not predict injury patterns. MPFL and chondral injury, as well as bone bruising, are common following LPD. The medial patellotibial ligament is torn in patellar-based medial retinacular injuries, based on MRI injury location. Skeletal immaturity plays a role in the location of the injury pattern with isolated patellar-based MPFL/chondral injury being more common in the skeletally immature patient. Sex does not appear to be a factor in injury patterns after primary LPD. Knowledge of these injury trends will help focus the clinician in injury evaluation when managing primary patellar dislocations. Level of evidence Case series, Level IV. AbstractPurpose The primary goal was to describe the injury patterns in a population of primary (first time) lateral patellar dislocators (LPD) to lend clarity to commonly held notions about injury patterns in this population. Methods A prospective study identifying patients presenting with LPD between 2008 and 2012. Inclusion criteria were a history and physical exam consistent with primary LPD, and an MRI consistent with the diagnosis without other significant ligamentous injury. On MRI, location of cartilage, medial patellofemoral ligament (MPFL) injury, and bone bruising were noted. Severity was categorized as partial or complete for MPFL and cartilage lesions. Anatomic patellar instability risk factors (patella alta, trochlear dysplasia, increased TT-TG, and lateral patella tilt) were recorded and compared to the injury patterns. Results This study involved 157 patients; 107 patients were skeletally mature. Of the 157 patients, 26 had surgery

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“…Therapeutic exercise seems to play a primary role in each stage of recovery. At present, there is no evidence about the choice of exercises [67][68][69][70][71][72][73][74][75][76][77][78][79][80][81] .…”

Section: Rehabilitation Approachesmentioning

confidence: 99%

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

Vetrano

Oliva

Bisicchia

et al. 2019

Muscle Ligaments and Tendons J

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Primary traumatic patellar dislocation is common, particularly in young active individuals. A consensus on its management is still lacking. The present work provides easily accessible guidelines to be considered as recommendations for a good clinical practice developed through a process of systematic review of the literature and expert opinion, to improve the quality of care and rationalize the use of resources. Level of evidence: Ia.

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Non-surgical treatment for acute patellar dislocation with special emphasis on the MPFL injury patterns

Abstract: Therapeutic, Level IV.

Cited by 49 publications

References 30 publications

Surgical versus Nonsurgical Treatments of Acute Primary Patellar Dislocation with Special Emphasis on the MPFL Injury Patterns

Surgical versus Nonsurgical Treatments of Acute Primary Patellar Dislocation with Special Emphasis on the MPFL Injury Patterns

Anatomic patellar instability risk factors in primary lateral patellar dislocations do not predict injury patterns: an MRI-based study

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

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