Operative Management of Patellar Instability in the United States

Arshi, Armin; Cohen, Jerome; Wang, Jeffrey C.; Hame, Sharon L.; McAllister, David R.; Jones, Kristofer J.

doi:10.1177/2325967116662873

Cited by 68 publications

(24 citation statements)

References 50 publications

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“…While first-time dislocation may be successfully managed non-operatively with proper rehabilitation, bracing, and activity modification, up to 36% of patients have ipsilateral recurrent PFI [5]. While epidemiologic studies have demonstrated a relatively consistent incidence of PFI over time [1], studies have found an increasing incidence of surgery to treat PFI reflecting the trends towards earlier operative management of this condition [6].…”

Section: Introductionmentioning

confidence: 99%

Recurrent Patellofemoral Instability in the Pediatric Patient: Management and Pitfalls

Vellios

Trivellas

Arshi

et al. 2020

Curr Rev Musculoskelet Med

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Purpose of Review The purpose of the review is to discuss the relevant pathoanatomy, management, complications, and technical considerations for recurrent patellofemoral instability (PFI) in the pediatric population. Special consideration is given to recent literature and management of the patient with repeat instability following surgery. Recent Findings Patellar stabilization surgery is in principle dependent upon restoration of normal patellofemoral anatomy and dynamic alignment. Historically, treatment options have been numerous and include extensor mechanism realignment, trochleoplasty, and more recently repair and/or reconstruction of the medial patellofemoral ligament (MPFL) as a dynamic check rein during initial knee flexion. In skeletally immature patients, preference is given to physeal-sparing soft tissue procedures. While medial patellofemoral ligament reconstruction has become a popular option, postoperative failure is a persistent issue with rates ranging from 5 to 30% for PFI surgery in general without any single procedure (e.g., distal realignment, MPFL reconstruction) demonstrating clear superiority. Failure of surgical patellar stabilization is broadly believed to occur for three main reasons: (1) technical failure of the primary stabilization method, (2) unaddressed static and dynamic pathoanatomy during the primary stabilization, and (3) intrinsic risk factors (e.g., collagen disorders, ligamentous laxity). Summary PFI is a common orthopedic condition affecting the pediatric and adolescent population. Treatment of repeat instability following surgery in the PFI patient requires understanding and addressing underlying pathoanatomic risk factors as well as risks and reasons for failure.

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Section: Introductionmentioning

confidence: 99%

Recurrent Patellofemoral Instability in the Pediatric Patient: Management and Pitfalls

Vellios

Trivellas

Arshi

et al. 2020

Curr Rev Musculoskelet Med

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“…Given the multifactorial pathogenesis and lack of reliable operative results in the treatment of congenital, recurrent and chronic patellar dislocations many surgical techniques have been described and the gold standard treatment has yet to be identified. 2 …”

Section: Introductionmentioning

confidence: 99%

“…Interestingly, recent review articles about recurrent patella instability do not even mention this technique. 2 , 13 - 19 As compared with the procedures mentioned above, the Langenskiöld procedure consists of patella medialization within the synovium, distal patellar tendon realignment, VMO advancement, lateral release and in the case of congenital patella dislocation with external rotatory subluxation of the tibia on the femur, lengthening of biceps femoris and iliotibial band. The procedure has not been popularized in treating other challenging forms of patellar instability.…”

Section: Introductionmentioning

confidence: 99%

Modified Langenskiöld procedure for chronic, recurrent, and congenital patellar dislocation

Ramos

Burke

Lewis

et al. 2020

Journal of Children's Orthopaedics

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Purpose Langenskiöld described a reconstructive soft-tissue procedure for irreducible lateral congenital patellar dislocations. Paley further detailed the technique in the surgical management of congenital femoral deficiency. The aim of this study was to evaluate the outcomes of patients with congenital, chronic and recurrent patellar dislocations treated with the modified Langenskiöld procedure. Methods This is a retrospective case series. Between 2011 and 2018, 18 knees in 13 patients (mean age 15.8 years (sd 4.4; 12 to 29.9), nine female) with diagnoses of recurrent (six patients, eight knees), chronic (four patients, six knees) and congenital (three patients, four knees) patellar dislocations were treated with the modified Langenskiöld procedure. Results There were no recurrent lateral dislocations in the congenital or recurrent groups. One of the patients in the congenital group had an overcorrection with some medial patellar maltracking but until this time has not required any further surgery. In the chronic group two of the six knees developed further dislocations; these were both on the same patient, who had no dislocations until one year after surgery. Mean Kujala score was 83.7 (sd 17; 47 to 100) for all groups. In spite of preoperative knee flexion contractures of up to 30° in three patients (six knees), all patients had full extension postoperatively. Eight patients reported being satisfied with their outcome, one was somewhat satisfied, two were very dissatisfied, and two did not respond. Conclusion The modified Langenskiöld reconstruction provides a powerful correction for challenging cases of congenital and recurrent patellar dislocations. Re-dislocation as well as overcorrection can occasionally occur. Level of Evidence Level IV

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“…[2][3][4] Although isolated lateral retinacular and capsular releases were commonly performed for various patellofemoral pathologies, the indications for isolated release have narrowed. 2,[5][6][7][8][9] Whereas isolated lateral release is not recommended by most patellofemoral experts, it is still performed for lateral patellar instability by some surgeons. 10 This procedure is more commonly used in combination with medial patellofemoral ligament reconstruction.…”

mentioning

confidence: 99%

“…10 This procedure is more commonly used in combination with medial patellofemoral ligament reconstruction. 6,11 Despite studies reporting satisfactory results after isolated lateral release for the treatment of patellofemoral instability, other studies have shown an increase in not only medial instability but also lateral instability after lateral retinacular release. 12,13 Although several biomechanical studies have focused on the increase in medial patellar instability after lateral release, few have investigated the contribution of the lateral retinaculum and capsule to lateral patellar instability.…”

mentioning

confidence: 99%

The Biomechanical Effects of Limited Lateral Retinacular and Capsular Release on Lateral Patellar Translation at Various Flexion Angles in Cadaveric Specimens

Cancienne

Christian

Redondo

et al. 2019

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose: To determine the biomechanical effect of limited lateral retinacular and capsular release on lateral patellar translation as a function of constant force at various knee flexion angles. Methods: Six pairs of bilateral cadaveric knee specimens (12 knees) were obtained from a tissue bank, dissected, and potted in a perfect lateral position based on fluoroscopy. A direct lateral force was applied to the patella through an eye screw in the midpoint of the lateral patella, and each knee underwent testing in the intact state and after lateral retinacular and capsular release. All knees were tested at 0 , 10 , 20 , 30 , 45 , 60 , and 90 of flexion using a custom-machined jig on a materials testing system with a 20-N lateral force applied to the patella. Patellar displacement was recorded and compared for each specimen. Results: Lateral displacement was significantly greater at all degrees of flexion for the lateral-release specimens than for an intact lateral retinaculum (P < .05). Compared with intact specimens, lateral-release specimens experienced 30% more translation at 0 of flexion and between 6% and 9% more lateral translation at 10 to 90 of flexion. Conclusions: Lateral retinacular and capsular release results in significantly increased lateral patellar translation at all flexion angles compared with intact specimens. This finding suggests that the lateral retinaculum may function as a significant restraint to lateral translation even with intact medial soft-tissue restraints. Clinical Relevance: Arthroscopic and open limited lateral retinacular releases should be performed with extreme caution when treating lateral patellar instability given the lateral retinaculum's apparent role as a secondary restraint.

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Operative Management of Patellar Instability in the United States

Cited by 68 publications

References 50 publications

Recurrent Patellofemoral Instability in the Pediatric Patient: Management and Pitfalls

Recurrent Patellofemoral Instability in the Pediatric Patient: Management and Pitfalls

Modified Langenskiöld procedure for chronic, recurrent, and congenital patellar dislocation

The Biomechanical Effects of Limited Lateral Retinacular and Capsular Release on Lateral Patellar Translation at Various Flexion Angles in Cadaveric Specimens

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