Nonoperative Treatment of Patellar Instability

Dixit, Sameer; Deu, Rajwinder S.

doi:10.1097/jsa.0000000000000149

Cited by 12 publications

(5 citation statements)

References 23 publications

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“…11 Although there is a lack of concordance in the literature regarding nonoperative treatment of PFI, standard of care treatment includes activity restriction (immobilization), physical therapy and patellar bracing. 12 These options are in line with the answers that we received. There was a wide variability regarding the type of immobilization which included knee immobilizer, knee hinge brace or patellar stabilization brace rather than knee immobilization.…”

Section: Discussionmentioning

confidence: 83%

Current Practice Trends in the Surgical Management of Patellofemoral Instability: A Survey of the Paediatric Research in Sports Medicine (PRiSM) Society

VandenBerg

Sarkisova

Pace

et al. 2021

Journal of Children's Orthopaedics

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Purpose Patellofemoral instability (PFI) in young athletes presents both diagnostic and management dilemmas for which consensus often does not exist. The purpose of this study was to identify trends in management of PFI in children and adolescents in the United States and nationwide. Methods A 27-question multiple choice survey was distributed in 2018 to the members of the Pediatric Research in Sports Medicine (PRiSM) Society regarding treatment of PFI in paediatric and adolescent patients. Results In all, 56 of the respondents who were orthopaedic surgeons that manage patellar instability in children and adolescents and had performed PFI surgery more than five times in the past year completed the entire survey. A total of 41% of respondents reported that surgery for fragment refixation or loose body removal was indicated when a loose body or osteochondral fragment was evident, regardless of fragment size. Overall, 74% reported that if surgery was performed for an osteochondral loose body, primary repair (36%) or reconstruction (38%) of medial patellofemoral ligament (MPFL) was also completed. A total of 89% of members reported MPFL reconstruction in the absence of alignment or rotational abnormalities, tibial tubercle lateralization or trochlear dysplasia in skeletally immature patients; 59% reported performing the MPFL reconstruction with hamstring allograft, while 30% prefer autograft (hamstring, quadriceps). For patients with significant trochlear dysplasia, 87% reported no surgical management of trochlea in first-time or in revision surgery. Conclusion There is a lack of consensus regarding optimal diagnostic and treatment algorithms in the management of PFI, however, consistent trends have emerged among paediatric sports medicine surgeons. Level of Evidence Level V – survey of expert opinion and experience

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Section: Discussionmentioning

confidence: 83%

Current Practice Trends in the Surgical Management of Patellofemoral Instability: A Survey of the Paediatric Research in Sports Medicine (PRiSM) Society

VandenBerg

Sarkisova

Pace

et al. 2021

Journal of Children's Orthopaedics

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“…Studies have shown that patellar dislocations predispose patients to earlier development of osteoarthritis and other degenerative bone changes, with an 11.9% increase in incidence at 20 years and 40.6% at 25 years [ 14 ]. The recurrence rate after a first-time patellar dislocation can be up to 44% [ 15 , 16 ]. Additionally, the patient’s history of left knee injury at age 4, 12 years before her patellectomy and greater than forty years prior to her official diagnosis of NPS, indicates that the patient was likely susceptible to severe patellar damage from trivial childhood activities.…”

Section: Discussionmentioning

confidence: 99%

“Knee-Ding” a Diagnosis: A Case of Nail Patella Syndrome

Dzhugarian,

Hamamah,

Frugoli

et al. 2023

Cureus

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Nail Patella Syndrome (NPS) is a rare genetic disorder with pathognomonic signs including dystrophic fingernails, iliac horns, and limb abnormalities, which commonly include hypoplastic development of the patellae, causing patients to experience patellar instability. This resulting patellar instability increases susceptibility to recurrent subluxations or dislocations in NPS patients. Since these anatomical abnormalities are present at birth or in childhood, early recognition may prevent the need for surgical intervention if appropriate preventive measures are taken. This case report describes a 54-year-old woman with a history of NPS, diagnosed later in adulthood, with a prior patellectomy at age 18 secondary to an unspecified left knee injury that occurred at age 4. A combination of radiographic and clinical findings are presented, which support the diagnosis of NPS, including dystrophic nails, left knee x-ray consistent with prior patellectomy, and right knee x-ray showing inferolateral subluxation of a hypoplastic patella. Additional signs associated with NPS are also discussed, including mood disorders, Raynaud’s, and a high hairline which may assist in early diagnosis. This case report emphasizes earlier identification of NPS by clinicians through recognition of signs and symptoms while also considering proactive measures to lessen recurrent subluxations or dislocations to preserve patellar integrity and reduce the need for surgical intervention.

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“…Rehabilitation protocols vary significantly based on the duration of immobilization and individual needs following the initial dislocation. While some authors recommend immediate mobilization, others suggest immobilization with a cast or brace for up to 6 weeks [29]. Nonetheless, there is a lack of clear evidence supporting the immobilization of the knee after patellar dislocation [9].…”

Section: Conservative Treatmentmentioning

confidence: 99%

Management of the First Patellar Dislocation

Ercan

2024

Surgery of the Knee - From Arthroscopic to Open Approaches and Techniques

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Acute primary patellar dislocation can occur due to high-energy trauma or be associated with facilitating factors. Following a comprehensive physical examination, computerized tomography and magnetic resonance imaging are necessary, along with anteroposterior and lateral knee radiographs, to diagnose additional injuries and assess underlying facilitating factors. Surgical treatments take precedence in the presence of facilitating factors such as patella alta, increased tibial tuberosity-trochlear groove distance, trochlear dysplasia, increased patellar tilt, and the presence of osteochondral fractures. However, in the absence of these factors, conservative treatment is usually sufficient. Additionally, there is no clear consensus on which surgical strategy to use in the approach to the first dislocation, considering the possible variability in the location of medial patellofemoral ligament (MPFL) injury and the ultimate presence of predisposing factors for patellar instability. While MPFL reconstruction may theoretically be more reliable than repair, there is no clear evidence on whether bone abnormalities should be corrected after the first patellar dislocation.

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Nonoperative Treatment of Patellar Instability

Cited by 12 publications

References 23 publications

Current Practice Trends in the Surgical Management of Patellofemoral Instability: A Survey of the Paediatric Research in Sports Medicine (PRiSM) Society

Current Practice Trends in the Surgical Management of Patellofemoral Instability: A Survey of the Paediatric Research in Sports Medicine (PRiSM) Society

“Knee-Ding” a Diagnosis: A Case of Nail Patella Syndrome

Management of the First Patellar Dislocation

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