scholarly journals Acute-on-chronic transient lateral patellar dislocation with trochlear dysplasia

2021 ◽  
Author(s):  
Henry Knipe
Keyword(s):  
Patellar Dislocation ◽  
Trochlear Dysplasia ◽  
Lateral Patellar Dislocation

Patellofemoral Arthritis After Lateral Patellar Dislocation: A Matched Population-Based Analysis

2016 ◽  
Vol 45 (5) ◽  
pp. 1012-1017 ◽  
Author(s):  
Thomas L. Sanders ◽  
Ayoosh Pareek ◽  
Nicholas R. Johnson ◽  
Michael J. Stuart ◽  
Diane L. Dahm ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Cumulative Incidence ◽  
Patellar Dislocation ◽  
Trochlear Dysplasia ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Patellofemoral Arthritis ◽  
Level Of Evidence ◽  
Lateral Patellar Dislocation ◽  
Osteochondral Injury

Background: The rate of patellofemoral arthritis after lateral patellar dislocation is unknown. Purpose/Hypothesis: The purpose of this study was to compare the risk of patellofemoral arthritis and knee arthroplasty between patients who experienced a lateral patellar dislocation and matched individuals without a patellar dislocation. Additionally, factors predictive of arthritis after patellar dislocation were examined. The hypothesis was that the rate of arthritis is likely higher among patients who experience a patellar dislocation compared with those who do not. Study Design: Cohort study; Level of evidence, 3. Methods: In this study, 609 patients who had a first-time lateral patellar dislocation between 1990 and 2010 were compared with an age- and sex-matched cohort of patients who did not have a patellar dislocation. Medical records were reviewed to collect information related to the initial injury, recurrent dislocation, treatment, and progression to clinically significant patellofemoral arthritis (defined as symptoms with degenerative changes on patellar sunrise radiographs). Factors associated with arthritis (age, sex, recurrence, osteochondral injury, trochlear dysplasia) were examined. Results: At a mean follow-up of 12.3 ± 6.5 years from initial dislocation, 58 patients (9.5%) in the dislocation cohort were diagnosed with patellofemoral arthritis, corresponding to a cumulative incidence of arthritis of 1.2% at 5 years, 2.7% at 10 years, 8.1% at 15 years, 14.8% at 20 years, and 48.9% at 25 years. In the control cohort, 8 patients (1.3%) were diagnosed with arthritis, corresponding to a cumulative incidence of arthritis of 0% at 5 years, 0% at 10 years, 1.3% at 15 years, 2.9% at 20 years, and 8.3% at 25 years. Therefore, patients who experienced a lateral patellar dislocation had a significantly higher risk of developing arthritis (hazard ratio [HR], 7.8; 95% CI, 3.9-17.6; P < .001) than individuals without a patellar dislocation. However, the risk of knee arthroplasty was similar between groups (HR, 2.8; 95% CI, 0.6-19.7; P = .2). Recurrent patellar dislocations (HR, 4.5; 95% CI, 1.6-12.6), osteochondral injury (HR, 11.3; 95% CI, 5.0-26.6), and trochlear dysplasia (HR, 3.6; 95% CI, 1.3-10.0) were associated with arthritis after patellar dislocation. Conclusion: Patellar dislocation is a significant risk factor for patellofemoral arthritis, as nearly half of patients have symptoms and radiographic changes consistent with arthritis at 25 years after lateral patellar dislocation. Osteochondral injury, recurrent patellar instability, and trochlear dysplasia are associated with the development of arthritis.

Risk Factors and Time to Recurrent Ipsilateral and Contralateral Patellar Dislocations

2017 ◽  
Vol 45 (9) ◽  
pp. 2105-2110 ◽  
Author(s):  
Tyson C. Christensen ◽  
Thomas L. Sanders ◽  
Ayoosh Pareek ◽  
Rohith Mohan ◽  
Diane L. Dahm ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cumulative Incidence ◽  
Patellar Dislocation ◽  
Patellar Instability ◽  
Trochlear Dysplasia ◽  
Patella Alta ◽  
Time To Recurrence ◽  
Lateral Patellar Dislocation ◽  
Ipsilateral Recurrence ◽  
First Time

Background: Previous studies have reported variable rates of recurrent lateral patellar instability mainly because of limited cohort sizes. In addition, there is currently a lack of information on contralateral patellar instability. Purpose: To evaluate the rate of recurrent ipsilateral patellar dislocations and contralateral patellar dislocations after a first-time lateral patellar dislocation. Additionally, risk factors associated with recurrent dislocations (ipsilateral or contralateral) and time to recurrence were investigated. Study Design: Cohort study; Level of evidence, 3. Methods: This population-based study included 584 patients with a first-time lateral patellar dislocation occurring between 1990 and 2010. A retrospective review was conducted to gather information about the injury, subsequent dislocations (ipsilateral or contralateral), and structural characteristics including trochlear dysplasia, patella alta, and tibial tubercle to trochlear groove (TT-TG) distance. Risk factors were assessed to delineate associations with subsequent dislocations and time to recurrence. Results: At a mean follow-up of 12.4 years, 173 patients had ipsilateral recurrence, and 25 patients had a subsequent contralateral dislocation. At 20 years, the cumulative incidence of ipsilateral recurrence was 36.0%, while the cumulative incidence of contralateral dislocations was 5.4%. Trochlear dysplasia (odds ratio [OR], 18.1), patella alta (OR, 10.4), age <18 years at the time of the first dislocation (OR, 2.4), elevated TT-TG distance (OR, 2.1), and female sex (OR, 1.5) were associated with recurrent ipsilateral dislocations. Time to recurrence was significantly decreased in patients with trochlear dysplasia (23.0 months earlier time to recurrence; P < .001), elevated TT-TG distance (18.5 months; P < .001), patella alta (16.4 months; P = .001), and age <18 years at the time of the first dislocation (15.4 months; P < .001). Risk factors for subsequent contralateral dislocations included patella alta and trochlear dysplasia. Conclusion: At 20 years after a first-time lateral patellar dislocation, the cumulative incidence of recurrent ipsilateral patellar dislocations was 36.0%, compared with 5.4% for contralateral dislocations. Trochlear dysplasia, elevated TT-TG distance, patella alta, age <18 years at the time of the first dislocation, and female sex were associated with ipsilateral recurrence. Trochlear dysplasia, elevated TT-TG distance, patella alta, and age <18 years at the time of the first dislocation were predictive of a statistically significant decrease in time to recurrence.

scholarly journals First-Time Acute Lateral Patellar Dislocation in Children and Adolescents: What About Unaffected Knee Patellofemoral Joint Anatomic Abnormalities?

Medicina ◽  
2021 ◽  
Vol 57 (3) ◽  
pp. 206
Author(s):  
Rasa Simonaitytė ◽  
Saulius Rutkauskas ◽  
Emilis Čekanauskas ◽  
Liutauras Labanauskas ◽  
Vidmantas Barauskas
Keyword(s):  
Children And Adolescents ◽  
Patellofemoral Joint ◽  
Patellar Dislocation ◽  
Functional Disability ◽  
Trochlear Dysplasia ◽  
Age Groups ◽  
Lateral Patellar Dislocation ◽  
Positive Correlations ◽  
Femoral Sulcus ◽  
First Time

Background and Objectives: Acute lateral patellar dislocation (LPD) is the most common acute knee disorder in children and adolescents, and may lead to functional disability. The purpose of this study was to identify key differences and correlations of the patellofemoral joint (PFJ) morphology between intact and contralateral injured knees in a first-time traumatic LPD population aged under 18 years. Materials and Methods: The data were gathered prospectively from a cohort of 58 patients (35 girls and 23 boys). The prevalence and combined prevalence of patella alta (PA) and trochlear dysplasia (TD) in both knees of patients were evaluated using X-ray by two radiologists. Results: The PFJ of patients’ intact knees had a lower rate of TD (1.72% vs. 5.2%) and a less common combination of PA with shallow femoral sulcus (SFS) (22.4% vs. 44.8%) but more frequent PA (62.1% vs. 41.4%) compared with their injured knees. We noted statistically significant positive correlations (SSPCs) between the femoral sulcus angle (FSA) and PA in patients with intact (r = 0.37; p < 0.005) and contralateral injured knees (r = 0.33; p < 0.05). Conclusion: There were SSPCs between the FSA and PA in both gender and age groups of patients with intact and contralateral injured knees. The SSPCs between the FSA and PA of intact knees were higher in the patients with a more dysplastic PFJ anatomy (PA and TD) of the injured knees as compared to patients with only PA of the injured knees.

scholarly journals Patella dislocations and patellofemoral instability: a current concepts review

2021 ◽  
Vol 20 (3) ◽  
Author(s):  
Benjamin R Garrett ◽  
Michael L Grundill
Keyword(s):  
Patellar Dislocation ◽  
Surgical Intervention ◽  
Trochlear Dysplasia ◽  
Patellofemoral Instability ◽  
Tibial Tubercle ◽  
First Episode ◽  
Level Of Evidence ◽  
Lateral Patellar Dislocation ◽  
Consensus Statements ◽  
Patella Dislocations

ABSTRACT Lateral patellar dislocation affects young, active patients with an incidence rate of 5.8 per 100 000. The management of first episode dislocations is non-surgical in the majority of cases, unless associated pathology dictates surgical intervention. Approximately 40% of cases that are treated non-surgically will develop recurrent patellofemoral instability. Evidence supports surgical intervention in these cases; however, the best approach is debatable. Most research and consensus statements agree that medial patellofemoral ligament reconstruction (MPFLR) should be performed in most cases. Additional procedures can be used 'a la carte' according to certain conditions or pathology. A tibial tubercle osteotomy (TTO) is usually indicated in patients with maltracking and/or patella alta, but the direction and degree of correction must be carefully considered. Trochleoplasty is technically demanding and should be reserved for a select few patients with severe trochlear dysplasia. It should be performed by an experienced knee surgeon due to the high risk of inadvertent complications. Level of evidence: Level 5 Keywords: patellofemoral instability, patellar dislocation

Factors Associated With an Increased Risk of Recurrence After a First-Time Patellar Dislocation: A Systematic Review and Meta-analysis

2019 ◽  
Vol 48 (10) ◽  
pp. 2552-2562 ◽  
Author(s):  
Lachlan S. Huntington ◽  
Kate E. Webster ◽  
Brian M. Devitt ◽  
John P. Scanlon ◽  
Julian A. Feller
Keyword(s):  
Risk Factors ◽  
Patellar Dislocation ◽  
Trochlear Dysplasia ◽  
Meta Analysis ◽  
Risk Of Recurrence ◽  
Multiple Risk Factors ◽  
Increased Risk ◽  
Lateral Patellar Dislocation ◽  
History Of ◽  
First Time

Background: Recurrent dislocations after a first-time lateral patellar dislocation may occur in more than 50% of patients and can cause long-term disability. Many factors have been suggested to influence the risk of recurrence. Purpose: To systematically review and quantitatively synthesize the literature for factors associated with an increased risk of recurrence after a first-time patellar dislocation. Study Design: Systematic review and meta-analysis of observational studies. Methods: A total of 4 electronic databases were searched to identify relevant studies published before February 7, 2019. A quality assessment was performed with the National Heart, Lung, and Bone Institute quality assessment score. Factors assessed for their effect on the recurrence rate were documented, and the rates of recurrence were compared. Pooled dichotomous data were analyzed using random-effects meta-analysis with odds ratios (ORs). Results: A total of 17 studies met the criteria for inclusion. The overall rate of recurrent dislocations after a first-time lateral patellar dislocation was 33.6%. An increased risk of recurrence was reported in patients with a younger age (OR, 2.61; P < .00001), open physes (OR, 2.72; P < .00001), trochlear dysplasia (OR, 4.15; P = .009), an elevated tibial tuberosity–trochlear groove (TT-TG) distance (OR, 2.87; P < .00001), and patella alta (OR, 2.38; P = .004). Sex, patterns of medial patellofemoral ligament injury, and history of contralateral dislocations were not found to be associated with an increased recurrence rate ( P≥ .05). In studies that reported on the presence of multiple risk factors, recurrence rates were 7.7% to 13.8% when no risk factors were present but increased to 29.6% to 60.2% when 2 risk factors were present and to 70.4% to 78.5% when 3 risk factors were present. Conclusion: Younger age, open physes, trochlear dysplasia, elevated TT-TG distance, and patella alta were key risk factors for the recurrence of lateral patellar dislocations. Despite being not infrequently cited as risk factors, patient sex and a history of contralateral dislocations were not found to be significant risk factors. The presence of multiple risk factors increased the risk, and the development of predictive instability scores in large patient cohorts using all established risk factors should be a focus of future studies.

scholarly journals Patellofemoral Dislocation Recurrence After a First Episode: A Case-Control Study

2021 ◽  
Vol 9 (1) ◽  
pp. 232596712098163
Author(s):  
Juan Pablo Martinez-Cano ◽  
Julián Chica ◽  
Juan José Martinez-Arboleda ◽  
Erika Rincón-Escobar ◽  
Laura Zamudio-Castilla ◽  
...  
Keyword(s):  
Risk Factors ◽  
Patellar Dislocation ◽  
Case Control Study ◽  
Trochlear Dysplasia ◽  
Case Control ◽  
Patella Alta ◽  
First Episode ◽  
High Grade ◽  
Lateral Patellar Dislocation ◽  
Control Study

Background: Lateral patellar dislocation can become a recurrent problem after the first episode. Identifying those patients who are at increased risk of redislocation is important for the treatment decision-making process. Purpose: To identify clinical and radiologic risk factors for recurrence of patellar dislocation after a first episode. Study Design: Case-control study; Level of evidence, 3. Methods: The study included patients with lateral patellar dislocation and a 1-year minimum follow-up who were seen between 2011 and 2018. Patients aged 10 to 65 years were included. Patient characteristics, physical examination (patellar apprehension, J sign), and radiographs were reviewed. The Caton-Deschamps and Insall-Salvati ratios were used to evaluate patella alta. High-grade trochlear dysplasia was defined as Dejour types B, C, and D. Results: A total of 130 patients (139 knees) with primary lateral patellar dislocation were included. Recurrent dislocation was seen in 83 knees (59.71%). Stepwise logistic regression analysis demonstrated that Caton-Deschamps ratio ≥1.15 (OR, 2.39; 95% CI, 1.09-5.22; P = .029), age <21 years (OR, 2.53; 95% CI, 1.11-5.77; P = .027), and high-grade trochlear dysplasia (OR, 4.17; 95% CI, 1.90-9.17; P < .001) were significantly associated with patellar redislocation. Based on the presence of these factors, the probability of dislocation after a first lateral patellar dislocation was 31.2% with no factors present, 36.6% with any 1 factor present, 71.7% with any 2 factors present, and 86.2% if all 3 conditions were present. Conclusion: The results of this study indicated that patella alta, high-grade trochlear dysplasia, and age <21 years were independent risk factors for patellar redislocation after a first episode, with an additive effect when they were present together. This may help to guide the type of treatment for these patients.

The management of lateral patellar dislocation: state of the art

2017 ◽  
Vol 2 (4) ◽  
pp. 205-212 ◽  
Author(s):  
Elizabeth A Arendt ◽  
Simon T Donell ◽  
Petri J Sillanpää ◽  
Julian A Feller
Keyword(s):  
Patellar Dislocation ◽  
State Of The Art ◽  
Lateral Patellar Dislocation

Development of a Multivariable Model Based on Individual Risk Factors for Recurrent Lateral Patellar Dislocation

2021 ◽  
Vol 103 (7) ◽  
pp. 586-592
Author(s):  
Daphne I. Ling ◽  
Jacqueline M. Brady ◽  
Elizabeth Arendt ◽  
Marc Tompkins ◽  
Julie Agel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Patellar Dislocation ◽  
Individual Risk ◽  
Multivariable Model ◽  
Model Based ◽  
Lateral Patellar Dislocation ◽  
Individual Risk Factors
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