Surgical medial patellofemoral ligament reconstruction versus non-surgical treatment of acute primary patellar dislocation: a prospective controlled trial

Background: Numerous diagnostic imaging measurements related to patellar instability have been evaluated in the literature; however, little has been done to compare these findings across multiple studies. Purpose: To review the different imaging measurements used to evaluate patellar instability and to assess the prevalence of each measure and its utility in predicting instability. We focused on reliability across imaging modalities and between patients with and without patellar instability. Study Design: Systematic review; Level of evidence, 4. Methods: We performed a systematic review of the literature using the PubMed, SCOPUS, and Cochrane databases. Each database was searched for variations of the terms “patellar instability,” “patellar dislocation,” “trochlear dysplasia,” “radiographic measures,” “computed tomography,” and “magnetic resonance imaging.” Studies were included if they were published after May 1, 2009, and before May 1, 2019. A meta-analysis using a random effects model was performed on several measurements, comparing instability and control groups to generate pooled values. Results: A total of 813 articles were identified, and 96 articles comprising 7912 patients and 106 unique metrics were included in the analysis. The mean patient age was 23.1 years (95% CI, 21.1-24.5), and 41% were male. The tibial tubercle–trochlear groove (TT-TG) distance was the most frequently included metric (59 studies), followed by the Insall-Salvati ratio and Caton-Deschamps index (both 26 studies). The interobserver intraclass correlation coefficients were excellent or good for the TT-TG distance and Insall-Salvati ratio in 100% of studies reporting them; however, for the Caton-Deschamps index and Blackburne-Peel ratio, they were excellent or good in only 43% and 40% of studies. Pooled magnetic resonance imaging values for TT-TG distance ( P < .01), Insall-Salvati ratio ( P = .01), and femoral sulcus angle ( P = .02) were significantly different between the instability and control groups. Values for tibial tubercle–posterior cruciate ligament distance ( P = .36) and Caton-Deschamps index ( P = .09) were not significantly different between groups. Conclusion: The most commonly reported measurements for evaluating patellar instability assessed patellar tracking and trochlear morphology. The TT-TG distance was the most common measurement and was greater in the patellar instability group as compared with the control group. In addition, the TT-TG, tibial tubercle–posterior cruciate ligament, and patellar tendon–trochlear groove distances were highly reproducible measurements for patellar tracking, and the Insall-Salvati ratio had superior reproducibility for assessing patellar height.

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“… ∥∥ References 3, 5, 7, 12, 13, 25, 30, 32, 47, 50, 53, 62, 69, 70, 78, 80 –82, 84, 89, 102, 109, 116, 119, 121, 122. …”

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confidence: 99%

Radiologic Measurements in the Assessment of Patellar Instability: A Systematic Review and Meta-analysis

White

Otlans

Horan

et al. 2021

Orthopaedic Journal of Sports Medicine

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“…The recurrence rate after the first patellar dislocation approaches 40%, and a history of a previous instability episode has been associated with the greatest risk of subsequent instability episodes. 3 Neri et al 4 describe the rupture of the MPFL between 95% and 100% of cases after acute lateral patellar dislocation. Huber et al 5 clearly show the alteration of the patellar biomechanics in knees with a MPFL injured.…”

Section: Discussionmentioning

confidence: 99%

Medial Patellofemoral Ligament Reconstruction: Use of All-Suture Anchors for Patellar Fixation and a Dynamic Femoral Attachment

Dalla-Rosa¹,

Nogales²,

Verdejo

et al. 2021

Arthroscopy Techniques

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The medial patellofemoral ligament is one of the most relevant structures preventing patellar dislocation. Numerous surgical techniques have been described to reconstruct this structure and patellar biomechanics. Complications after this procedure concern both patella and femur. This technique avoids tunneling the patella and the use of intraoperative radiographs by using the adductor magnus tendon insertion.

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“…Since Gomez et al introduced the MPFL reconstruction technique using a synthetic polyester ligament graft [ 20 ] and Avikainen et al presented their technique using abductor magnus tenodesis [ 4 ], the number of studies on MPFL reconstruction in cases of patellar instability have increased. The results of these studies have consistently shown efficacy in the reduction of recurrent patellar dislocations in patients receiving MPFL reconstruction compared to those treated non-surgically [ 2 , 47 , 53 , 54 ]. However, functionality outcomes have shown more inconsistent results [ 2 , 47 , 53 , 54 ].…”

Section: Discussionmentioning

confidence: 99%

“…The results of these studies have consistently shown efficacy in the reduction of recurrent patellar dislocations in patients receiving MPFL reconstruction compared to those treated non-surgically [ 2 , 47 , 53 , 54 ]. However, functionality outcomes have shown more inconsistent results [ 2 , 47 , 53 , 54 ]. In the literature, MPFL reconstruction continues to be the most recommended surgical management technique for patellar dislocation.…”

Section: Discussionmentioning

confidence: 99%

Surgery for patellar dislocation has evolved towards anatomical reconstructions with assessment and treatment of anatomical risk factors

Uimonen

Repo

Huttunen

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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Purpose Increasing knowledge on the treatment of patellar dislocation has resulted in the development of new surgical techniques for patella stabilisation. National incidence and trends in surgery for patellar dislocation were examined using data from the Finnish National Hospital Discharge Register (NHDR). The hypothesis was that an increased understanding of the pathophysiology of patellar instability has increased the popularity of reconstructing damaged structures and modification of anatomical risk factors. Methods Data from the years 1997–2016 were collected from the NHDR database using ICD-10 diagnostic codes and the Nomesco Classification of Surgical Procedures (NCSP) codes. Surgical procedures were categorised into subgroups representing the main surgical approaches of patellar dislocation. Total incidence of surgery for patellar dislocation and change in incidence during the study period were calculated. Results A total of 9702 operations for patellar dislocation were performed during the study period. Median (IQR) patient age at time of primary surgery was 23 (18–34) years. The total incidence of surgeries remained stable across the study period at of 8.9 per 100,000 person-years. Incidences of ligament reconstruction, femoral osteotomies and osteochondral fragment reimplantation operations multiplied during the study period. Ligament reconstruction procedures were the most performed operations at the end of the study period. Conclusion The incidence of surgical procedures for patellar dislocation remained unchanged during the years 1997–2016. Ligament reconstruction procedures increased in popularity. Surgical techniques have shifted towards the reconstruction of damaged structures and the modification of congenital anatomical risk factors for patellar dislocation. Diversified surgical techniques have enabled the tailoring and combining of stabilizing procedures according to the patient’s individual anatomy.

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Surgical medial patellofemoral ligament reconstruction versus non-surgical treatment of acute primary patellar dislocation: a prospective controlled trial

Cited by 30 publications

References 34 publications

Radiologic Measurements in the Assessment of Patellar Instability: A Systematic Review and Meta-analysis

Radiologic Measurements in the Assessment of Patellar Instability: A Systematic Review and Meta-analysis

Medial Patellofemoral Ligament Reconstruction: Use of All-Suture Anchors for Patellar Fixation and a Dynamic Femoral Attachment

Surgery for patellar dislocation has evolved towards anatomical reconstructions with assessment and treatment of anatomical risk factors

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