Risk Factors and Time to Recurrent Ipsilateral and Contralateral Patellar Dislocations

Christensen, Tyson C; Sanders, Thomas L.; Pareek, Ayoosh; Mohan, Rohith; Dahm, Diane L.; Krych, Aaron J.

doi:10.1177/0363546517704178

Cited by 172 publications

(183 citation statements)

References 28 publications

Supporting

Mentioning

168

Contrasting

Unclassified

Order By: Relevance

“…Specifically, the TT-TG distance, trochlear sulcus angle and lateral trochlear inclination angle showed particularly strong correlation coefficients, while the patella height (CDI) strongly correlated with the dynamic patellar tilt. These observations support the findings of previous studies, which have identified the trochlear shape and TT-TG as particularly strong predictive parameters for patellofemoral instability 42,43 . In this context, dynamic MRI could provide important valuable additional information to evaluate the influence of present risk factors.…”

Section: Discussionsupporting

confidence: 92%

Objective assessment of patellar maltracking with 3 T dynamic magnetic resonance imaging: feasibility of a robust and reliable measuring technique

Frings

Dust

Krause

et al. 2020

Sci Rep

View full text Add to dashboard Cite

Patellofemoral maltracking predisposes the patellofemoral joint to instability. The purpose of this study was to provide a reliable dynamic magnetic resonance imaging (MRI) measuring technique for patellofemoral maltracking, and to investigate the influence of anatomical risk factors (AF) on patellar maltracking. Ten patients (2 males,8 females, average 19 years) with clinical maltracking and 20 controls (10 males,10 females,average 28 years) were examined with a dynamic, multi-slice gradient-echo MRI sequence, during repetitive flexion(40°) and full extension, in an open-chain-active-movement. In a 30-s time frame three simultaneous transverse slices were acquired. Dynamic mediolateral translation and dynamic tilt were measured at defined positions, by two independent examiners. Reproducibility was tested in a set of five knees. Common AFs for patellar maltracking (tibial-tuberosity-to-trochlear-groove-(TT-TG)-distances, trochlea-sulcus-angle, trochlea-sulcus-depth, lateral-trochlear-inclination and Caton-Deschamps-Index) were analyzed in consensus, using standard static MRI sequences. In patients, dynamic mediolateral translation was significantly greater in patients (12.4 ± 6.9 mm vs. − 0.1 ± 2.3 mm, p < 0.001) and the patella was positioned significantly more laterally (17.5 ± 6.9 mm vs. 3.1 ± 2.4 mm, p < 0.001) compared to controls. During movement, the patella tilted 16.3 ± 13.1° laterally in patients and 1.9 ± 4.3° medially in controls (dynamic tilt) (p < 0.002). All AFs were significantly different between patients and controls. Pathological TT-TG-distances, Caton-Deschamps-Indices and trochlea-sulcus-angles strongly correlated with dynamic patellar translation and dynamic patellar tilt (p < 0.001). In the patient population, the primary pathologies for maltracking were lateralized-tibial-tubercle (n = 5), trochlea dysplasia n = 2, patella alta (n = 3). Interrater-reliability for translation and tilt-measurement was excellent (0.971/0.976, 95% CIs 0.939–0.986/0.950–0.988). Dynamic MRI reliably differentiates between abnormal and physiological patellar tracking. Dynamic tracking and tilt strongly correlate with measurable AFs, which reinforces their clinical use and validates the presented technique.

show abstract

Section: Discussionsupporting

confidence: 92%

Objective assessment of patellar maltracking with 3 T dynamic magnetic resonance imaging: feasibility of a robust and reliable measuring technique

Frings

Dust

Krause

et al. 2020

Sci Rep

View full text Add to dashboard Cite

show abstract

“…In the pediatric population, non-operative management of recurrent PFI has a high recurrence rate that can affect activities of daily life [5]. However, operative management is not without complications.…”

Section: Complications Of Stabilizationmentioning

confidence: 99%

“…Reasons for this adolescent predominance may include rapid skeletal growth with changes in lower extremity mechanics and alignment, ligamentous laxity, early sports specialization, and increase in high-risk activity level [4]. 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

View full text Add to dashboard Cite

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.

show abstract

“…18,[93][94][95][96] In some series, acute patellar dislocations have been up to 33% more frequent in female versus male adolescents, and moreover females have approximately double the risk of recurrent dislocations. 8,97,98 Some have attributed this discrepancy to females tending to have higher grades of underlying anatomical abnormalities relative to males. 97 Recurrent subluxations and dislocations can occur with relatively minor trauma or sports activities.…”

Section: Patellar Instabilitymentioning

confidence: 99%

The Pediatric Patella: Normal Development, Anatomical Variants and Malformations, Stability, Imaging, and Injury Patterns

Maloney

Stanescu

Ngo

et al. 2018

Semin Musculoskelet Radiol

View full text Add to dashboard Cite

We discuss the pediatric patella, with an emphasis on diagnostic imaging. Topics include normal patellar development, anatomical variants and their physiologic significance, genetic syndromes that alter the appearance of the patella, physiology of patellar tracking and stability, patellofemoral instability, and injury patterns and classification. Recognition of appropriate development on imaging prevents diagnostic error and unnecessary evaluation. Knowledge of the pertinent features of syndromes associated with morphological patellar abnormalities can aid in generating a succinct and relevant differential diagnosis. In patellofemoral instability, the patient's baseline anatomy, factors that predispose to instability, and the specific injuries that occur as a result are critical considerations for determining the course of treatment. Patellar sleeve fractures are unique to pediatric patients, and timely identification is critical to achieving an optimal treatment outcome.

show abstract

Risk Factors and Time to Recurrent Ipsilateral and Contralateral Patellar Dislocations

Cited by 172 publications

References 28 publications

Objective assessment of patellar maltracking with 3 T dynamic magnetic resonance imaging: feasibility of a robust and reliable measuring technique

Objective assessment of patellar maltracking with 3 T dynamic magnetic resonance imaging: feasibility of a robust and reliable measuring technique

Recurrent Patellofemoral Instability in the Pediatric Patient: Management and Pitfalls

The Pediatric Patella: Normal Development, Anatomical Variants and Malformations, Stability, Imaging, and Injury Patterns

Contact Info

Product

Resources

About