Surgical versus non-surgical interventions for treating patellar dislocation

Smith, Toby O; Gaukroger, Andrew; Metcalfe, Andrew; Hing, Caroline

doi:10.1002/14651858.cd008106.pub4

Cited by 9 publications

(6 citation statements)

References 78 publications

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“…Recurrent patellar dislocation is a common and debilitating condition with multifactorial aetiologies associated with various pathoanatomical factors, which usually affects young active children and adolescents [6,20,26]. Of all the anatomical variants, increased femoral torsion is a potential risk factor for recurrent patellar dislocation, which may exert a persistent lateralizing force vector on the patella and lead to increased tension of the reconstructed medial patellofemoral ligament (MPFL), thus causing anterior knee pain, patellar maltracking, early cartilage degeneration, graft failure and patellar redislocation [8,10,19,21,24,28,30].…”

Section: Introductionmentioning

confidence: 99%

Distal femoral torsion is correlated with higher‐grade trochlear dysplasia and shorter anterior condyles in patients with patellar dislocation and increased femoral torsion

Hao,

Niu,

Huo

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose To describe the characteristics of femoral torsion in patients with different segmental torsion types and to evaluate the correlations between segmental torsion and the morphology of the femoral condyles and trochlea in patients with patellar dislocation and increased femoral torsion. Methods Between January 2021 and March 2023, 69 patients were included and classified into two groups according to the femoral segment contributing the most to total torsion: 32 patients in Group A (femoral neck and shaft torsion) and 37 patients in Group B (distal torsion). Trochlear dysplasia was evaluated using Dejour's classification and sulcus angle. The morphology of the femoral condyles was evaluated using the lengths and ratios of the medial and lateral condyles. Correlations between femoral torsion and morphology were evaluated. Results Total torsion was significantly correlated with femoral neck and shaft torsion (r = 0.882, P < 0.001) and distal torsion (r = 0.262, P = 0.030). Femoral neck and shaft torsion was significantly increased with increasing total torsion. The trochlear sulcus was flatter and more dysplastic, and the anterior condyles were shorter in Group B. Distal torsion was significantly correlated with the lengths of the medial and lateral anterior condyles (r = − 0.567, P < 0.001; r = -0.701, P < 0.001), sulcus angle (r = 0.611, P < 0.001) and Dejour trochlea type (r = 0.512, P = 0.001), while femoral neck and shaft torsion showed no correlations. Conclusion Femoral torsion is a complex of femoral neck and shaft torsion and distal torsion, especially femoral neck and shaft torsion. Distal torsion was significantly correlated with a flatter trochlear sulcus, higher-grade trochlear dysplasia, and shorter anterior condyles. The new findings highlighted the importance of the segmental evaluation of femoral torsion, which would facilitate understanding of the anatomical characteristics of femoral torsion in patients with patellar dislocation and increased femoral torsion and may lead to improvement in the surgical options regarding femoral torsion. Level of evidence Level III.

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Section: Introductionmentioning

confidence: 99%

Distal femoral torsion is correlated with higher‐grade trochlear dysplasia and shorter anterior condyles in patients with patellar dislocation and increased femoral torsion

Hao,

Niu,

Huo

et al. 2023

Knee surg. sports traumatol. arthrosc.

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“…Surgery is mainly reserved for concurrent injuries and when non-surgical treatment is unsuccessful [ 5 , 6 ]. Currently, recovery after non-surgical treatment is often incomplete with recurrent patellar dislocation and instability, reduced knee function, and later surgery commonly reported [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Physiotherapy Rehabilitation Post Patellar Dislocation (PRePPeD)—protocol for an external pilot randomised controlled trial and qualitative study comparing supervised versus self-managed rehabilitation for people after acute patellar dislocation

Forde

Costa

Cook

et al. 2023

Pilot Feasibility Stud

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Background Patellar dislocations mainly affect adolescents and young adults. After this injury, patients are usually referred to physiotherapy for exercise-based rehabilitation. Currently, limited high-quality evidence exists to guide rehabilitation practice and treatment outcomes vary. A full-scale trial comparing different rehabilitation approaches would provide high-quality evidence to inform rehabilitation practice. Whether this full-scale trial is feasible is uncertain: the only previous trial that compared exercise-based programmes in this patient population had high loss to follow-up. This study aims to assess the feasibility of conducting a future full-scale trial comparing the clinical and cost-effectiveness of two different rehabilitation approaches for people with an acute patellar dislocation. Methods Two-arm parallel external pilot randomised controlled trial and qualitative study. We aim to recruit at least 50 participants aged ≥ 14 years with an acute first-time or recurrent patellar dislocation from at least three English National Health Service hospitals. Participants will be randomised 1:1 to supervised rehabilitation (four to six, one-to-one, physiotherapy sessions of advice and prescription of tailored progressive home exercise over a maximum of 6 months) or self-managed rehabilitation (one physiotherapy session of self-management advice, exercise, and provision of self-management materials). Pilot objectives are (1) willingness to be randomised, (2) recruitment rate, (3) retention, (4) intervention adherence, and (5) intervention and follow-up method acceptability to participants assessed through one-to-one semi-structured interviews (maximum 20 participants). Follow-up data will be collected 3, 6, and 9 months after randomisation. Quantitative pilot and clinical outcomes will be numerically summarised, with 95% confidence intervals generated for the pilot outcomes using Wilson’s and exact Poisson methods as appropriate. Discussion This study will assess the feasibility of conducting a full-scale trial comparing supervised versus self-managed rehabilitation for people after acute first-time or recurrent patellar dislocation. This full-scale trial’s results would provide high-quality evidence to guide rehabilitation provision for patients with this injury. Trial registration ISRCTN registry ISRCTN14235231. Registered on 09 August 2022.

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“…37 Previous research focused on how trochlear dysplasia, joint alignment, patellofemoral soft tissue forces, and patient age contribute to the origin of LPD. 9,19,[23][24][25]39 This research highlights adolescent age, patella alta, and trochlear dysplasia as strong risk factors for acute and recurrent patellar dislocation. 3,18 More recently, researchers 37 have created predictive algorithms to identify individuals most at risk for recurrent dislocations, as a guide for interventional decision-making.…”

mentioning

confidence: 97%

“…12,19 In most cases, the primary treatment for initial LPD is nonoperative management (eg, bracing and physical therapy). 22,39 Surgical intervention may be necessary after a primary LPD associated with an osteochondral loose body. 19 A recent review demonstrated a lack of convincing evidence to change current practice guidelines for patients with first-time patellar dislocation (eg, nonsurgical vs surgical management).…”

mentioning

confidence: 99%

The Importance of Medial Patellar Shape as a Risk Factor for Recurrent Patellar Dislocation in Adults

Sheehan,

Shah,

Boden

2024

Am J Sports Med

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Background: Research on the cause of lateral patellar dislocation (LPD) has focused on trochlear morphologic parameters, joint alignment, and patellofemoral soft tissue forces. A paucity of information is available regarding how patellar morphologic parameters influence the risk for LPD. Purpose/Hypothesis: The purpose was to assess whether patellar morphology is a risk factor for recurrent LPD. It was hypothesized that (1) patients with recurrent LPD would have decreased patellar width and volume and (2) patellar morphologic parameters would accurately discriminate patients with recurrent LPD from controls. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: A total of 21 adults with recurrent LPD (age, 29.7 ± 11.1 years; height, 170.8 ± 9.9 cm; weight, 76.1 ± 17.5 kg; 57% female) were compared with 21 sex- and height-matched controls (age, 27.2 ± 6.7 years; height, 172.0 ± 10.6 cm; weight, 71.1 ± 12.8 kg; 57% female). Three-dimensional axial fat-saturated magnetic resonance imaging scans were used to measure patellar medial, lateral, and total width; patellar volume; patellar medial and lateral facet length; the Wiberg index; and previously validated knee joint alignment and femoral shape measurements (eg, tibial tuberosity to trochlear groove distance, trochlear dysplasia). Results: The LPD group demonstrated reduced medial patellar width (Δ = −3.6 mm; P < .001) and medial facet length (Δ = −3.7 mm; P < .001) but no change in lateral width or facet length. This resulted in decreased total patellar width (Δ = −3.2 mm; P = .009), decreased patellar volume (Δ = −0.3 cm3; P = .025), and an increased Wiberg index (Δ = 0.05; P < .001). No significant differences were found for all other patellar shape measures between cohorts. Medial patellar width was the strongest single discriminator (83.3% accuracy) for recurrent LPD. Combining medial patellar width, patellofemoral tilt, and trochlear groove length increased the discrimination to 92.9%. Conclusion: The medial patellar width was significantly smaller in patients with recurrent LPD and was the single most accurate discriminator for recurrent LPD, even compared with traditional trochlear shape and joint alignment measures (eg, trochlear dysplasia, patella alta). Therefore, medial patellar morphology should be assessed in patients with LPD as a risk factor for recurrence and a potential means to improve treatment.

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Surgical versus non-surgical interventions for treating patellar dislocation

Abstract: Publication status and date: New search for studies and content updated (no change to conclusions), published in Issue 2, 2015.

Cited by 9 publications

References 78 publications

Distal femoral torsion is correlated with higher‐grade trochlear dysplasia and shorter anterior condyles in patients with patellar dislocation and increased femoral torsion

Distal femoral torsion is correlated with higher‐grade trochlear dysplasia and shorter anterior condyles in patients with patellar dislocation and increased femoral torsion

Physiotherapy Rehabilitation Post Patellar Dislocation (PRePPeD)—protocol for an external pilot randomised controlled trial and qualitative study comparing supervised versus self-managed rehabilitation for people after acute patellar dislocation

The Importance of Medial Patellar Shape as a Risk Factor for Recurrent Patellar Dislocation in Adults

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