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Gao Y, Wei C, Yang M. Exploring osteochondral damage patterns in acute patellar dislocation: insights into morphological associations and risk factors. Sci Rep 2024; 14:6652. [PMID: 38509137 PMCID: PMC10954683 DOI: 10.1038/s41598-024-57363-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 03/18/2024] [Indexed: 03/22/2024] Open
Abstract
Osteochondral damage (OD) is a significant outcome following acute patellar dislocation (APD), yet the factors contributing to its susceptibility remain unclear. The primary objective of this study was to assess the association between demographic characteristics, patellofemoral (PF) joint morphology, and the occurrence of OD. A retrospective analysis identified 74 patients with APD who underwent treatment in our unit between 2019 and 2022. All patients received MRI within a week of injury to assess OD, subsequently categorized according to the injury pattern. The Caton-Deschamps index (CDI), tibial tuberosity-trochlear groove distance (TT-TG), lateral trochlear inclination (LTI), sulcus angle (SA), patellar width (PW), patellar thickness (PT), and femoral condyle geometry were calculated from the MRI scans and compared between groups. The findings revealed that OD predominantly manifested in the lateral femoral condyle (LFC) region and the medial patella (MP) region. In our patient cohort, this study identified a significant association between sulcus angle and the incidence of OD in both MP and LFC regions. Additionally, a significant correlation was discerned between skeletal maturity and the incidence of OD in the LFC region within demographic characteristics.
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Affiliation(s)
- Yu Gao
- Department of Orthopedics, China-Japan Union Hospital, Jilin University, 126 Xiantai Street, Changchun, 130033, People's Republic of China
| | - Chunxiao Wei
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Jilin University, Changchun, People's Republic of China
| | - Modi Yang
- Department of Orthopedics, China-Japan Union Hospital, Jilin University, 126 Xiantai Street, Changchun, 130033, People's Republic of China.
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Dai R, Wu Y, Jiang Y, Huang H, Meng Q, Shi W, Ren S, Ao Y. Epidemiology of Lateral Patellar Dislocation Including Bone Bruise Incidence: Five Years of Data from a Trauma Center. Orthop Surg 2024; 16:437-443. [PMID: 38214094 PMCID: PMC10834195 DOI: 10.1111/os.13933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 05/21/2023] [Accepted: 05/23/2023] [Indexed: 01/13/2024] Open
Abstract
OBJECTIVE Systematic summary of the epidemiology of patellar dislocation is rare. This study aims to investigate sex-, age-, type-, injury causing events-, incidence of bone bruise and time from last injury (TFLI)-specific characteristics, and detail the epidemiological characteristics of patellar dislocation. METHOD In this descriptive epidemiological study, a total of 743 patients who have a history of lateral patellar dislocation with either first-time patellar dislocation (FPD) or recurrent patellar dislocation (RPD) between August 2017 and June 2022 at our institution met the inclusion criteria and were selected in this study. Patient characteristics including the type, gender, age, events leading to patellar dislocation, incidence of patellar bone bruise, and the time from last injury (TFLI) of patellar dislocation were retrospectively obtained and described. Magnetic resonance imaging scans (MRI) of the knee were reviewed for insuring bone bruise. RESULTS Among the 743 patients with patellar dislocation who required surgical reconstruction of the medial retinaculum, 418 (56.2%) had RPD and 325 (43.8%) had FPD. There were more females (65.0%) than males (35.0%) in patellar dislocation patients. Among the female patients, those aged <18 years had higher incidence (31.4%) of patellar dislocation. Among the male patients, those aged <18 and 19-28 years had higher incidence (16.8%) of patellar dislocation. Of all age groups, the prevalence rate of patellar dislocation was high in juvenile population and females, but with no statistical significance. The most common patellar dislocation-causing event was sport accidents (40.1%), followed by life accidents (23.2%). The incidence of left-knee patellar dislocation was slightly higher than that of right-knee patellar dislocation. The incidence of patellar bone bruise of RPD (63.2%) was significantly lower (p < 0.05) than that of FPD (82.2%). Patellar dislocation patients with bone bruise had shorter time from last injury (TFLI) than those without patellar bone bruise (p < 0.05). CONCLUSIONS The incidence of bone bruise of RPD was lower than that of FPD, and patients with patellar bone bruise may have a shorter time from last injury than those without bone bruise.
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Affiliation(s)
- Ruilan Dai
- College of Exercise and health Sciences, Tianjin University of SportTianjinChina
- Department of Sports MedicinePeking University Third Hospital, Institute of Sports Medicine of Peking UniversityBeijingChina
- Beijing Key Laboratory of Sports InjuriesBeijingChina
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of EducationBeijingChina
| | - Yue Wu
- College of Exercise and health Sciences, Tianjin University of SportTianjinChina
- Department of Sports MedicinePeking University Third Hospital, Institute of Sports Medicine of Peking UniversityBeijingChina
- Beijing Key Laboratory of Sports InjuriesBeijingChina
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of EducationBeijingChina
| | - Yanfang Jiang
- Department of Sports MedicinePeking University Third Hospital, Institute of Sports Medicine of Peking UniversityBeijingChina
- Beijing Key Laboratory of Sports InjuriesBeijingChina
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of EducationBeijingChina
| | - Hongshi Huang
- Department of Sports MedicinePeking University Third Hospital, Institute of Sports Medicine of Peking UniversityBeijingChina
- Beijing Key Laboratory of Sports InjuriesBeijingChina
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of EducationBeijingChina
| | - Qingyang Meng
- Department of Sports MedicinePeking University Third Hospital, Institute of Sports Medicine of Peking UniversityBeijingChina
- Beijing Key Laboratory of Sports InjuriesBeijingChina
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of EducationBeijingChina
| | - Weili Shi
- Department of Sports MedicinePeking University Third Hospital, Institute of Sports Medicine of Peking UniversityBeijingChina
- Beijing Key Laboratory of Sports InjuriesBeijingChina
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of EducationBeijingChina
| | - Shuang Ren
- Department of Sports MedicinePeking University Third Hospital, Institute of Sports Medicine of Peking UniversityBeijingChina
- Beijing Key Laboratory of Sports InjuriesBeijingChina
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of EducationBeijingChina
| | - Yingfang Ao
- Department of Sports MedicinePeking University Third Hospital, Institute of Sports Medicine of Peking UniversityBeijingChina
- Beijing Key Laboratory of Sports InjuriesBeijingChina
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of EducationBeijingChina
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Stavinoha TJ, Shea KG. Physeal Sparing Approaches for MPFL Reconstruction. Curr Rev Musculoskelet Med 2023; 16:598-606. [PMID: 38079082 PMCID: PMC10733270 DOI: 10.1007/s12178-023-09864-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE OF REVIEW To update and concepts for pediatric physeal-sparing patellofemoral stabilization surgery. RECENT FINDINGS Recent studies have demonstrated positive results in patellofemoral stabilization in pediatric populations with physeal-sparing techniques that limit the potential for physeal damage. Comprehensive analysis remains limited by population and technique heterogeneity. Physeal-sparing patellofemoral stabilization, most significantly through physeal-sparing reconstruction of the medial patellofemoral ligament complex remains a viable option for pediatric patients with recurrent patellofemoral instability.
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Affiliation(s)
- Tyler J Stavinoha
- Baylor College of Medicine, Children's Hospital of San Antonio, San Antonio, TX, USA.
| | - Kevin G Shea
- Baylor College of Medicine, Children's Hospital of San Antonio, San Antonio, TX, USA
- Stanford University, Lucile Packard Children's Hospital, Palo Alto, CA, USA
- Center for Academic Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
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Yi Z, Zhang X, Wu M, Jiang J, Xia Y. Factors associated with an increased risk of osteochondral injuries after patellar dislocations: a systematic review. J Orthop Surg Res 2023; 18:822. [PMID: 37915023 PMCID: PMC10621231 DOI: 10.1186/s13018-023-04265-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/04/2023] [Indexed: 11/03/2023] Open
Abstract
PURPOSE The purpose of the study was to summarize the available evidence and identify risk factors for osteochondral injuries (OCIs) after patellar dislocations. METHODS A systematic literature review was conducted in PubMed, Embase, Web of Science, Cochrane Library, and China national knowledge infrastructure from inception to December 22, 2022, according to the preferred reporting items for systematic reviews and meta-analyses guidelines. Studies regarding risk factors for OCIs after patellar dislocations were included. Literature search, data extraction, and quality assessment were performed independently by two authors. RESULTS A total of 16 studies with 1945 patients were included. The risk factors for OCIs after patellar dislocation were categorized into four main categories, including demographic characteristics, patellar depth and position, femoral trochlear morphology, and other risk factors in this study. Five and three studies supported the idea that male sex and skeletal maturation may be risk factors, respectively. Normal femoral trochlea (two studies) and complete medial patellofemoral ligament (MPFL) injuries (two studies) may be associated with the development of OCIs. Three studies show that ligamentous laxity or joint hypermobility may prevent OCIs. Patellar depth and position (eight studies) may not be associated with the development of OCIs. CONCLUSIONS Based on the available evidence, an increased risk of OCIs following patellar dislocation may be associated with male sex and skeletal maturation. Furthermore, normal femoral trochlea and complete MPFL injuries may increase the risk of OCIs, while factors such as ligamentous laxity or joint hypermobility may reduce the risk. LEVEL OF EVIDENCE Level IV, systematic review of Level II and IV studies.
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Affiliation(s)
- Zhi Yi
- Department of Orthopaedics, Orthopedic Clinical Medical Research Center of Gansu Province, Intelligent Orthopedic Industry Technology Center of Gansu Province, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, Gansu, People's Republic of China
| | - Xiaohui Zhang
- Department of Orthopaedics, Orthopedic Clinical Medical Research Center of Gansu Province, Intelligent Orthopedic Industry Technology Center of Gansu Province, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, Gansu, People's Republic of China
| | - Meng Wu
- Department of Orthopaedics, Orthopedic Clinical Medical Research Center of Gansu Province, Intelligent Orthopedic Industry Technology Center of Gansu Province, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, Gansu, People's Republic of China.
| | - Jin Jiang
- Department of Orthopaedics, Orthopedic Clinical Medical Research Center of Gansu Province, Intelligent Orthopedic Industry Technology Center of Gansu Province, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, Gansu, People's Republic of China.
| | - Yayi Xia
- Department of Orthopaedics, Orthopedic Clinical Medical Research Center of Gansu Province, Intelligent Orthopedic Industry Technology Center of Gansu Province, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, Gansu, People's Republic of China.
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Migliorini F, Pilone M, Eschweiler J, Marsilio E, Hildebrand F, Maffulli N. High Rates of Damage to the Medial Patellofemoral Ligament, Lateral Trochlea, and Patellar Crest After Acute Patellar Dislocation: Magnetic Resonance Imaging Analysis. Arthroscopy 2022; 38:2472-2479. [PMID: 35157964 DOI: 10.1016/j.arthro.2022.01.044] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/26/2022] [Accepted: 01/30/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The primary outcome of interest of this study was to determine the frequency, location, and extent of chondral injuries and medial patellofemoral ligament (MPFL) tears, along with the rate of loose bodies, in the knee after acute primary patellar dislocation. The secondary outcome of interest was to conduct a multivariate analysis to investigate whether the presence of pathoanatomic abnormalities, including structural differences in the knees of the patients, is associated with the features of the lesions. METHODS Patients who underwent magnetic resonance imaging after primary acute patellar dislocation were identified from our institutional databases. We analyzed a total of 175 magnetic resonance imaging scans of patients aged between 14 and 25 years who were eligible for inclusion. RESULTS Chondral damage to the medial facet of the patella was present in 36 patients; patellar crest, 78 patients; and lateral patellar facet, 28 patients. One patient presented with chondral defects in the medial trochlear facet, whereas 118 patients showed chondral defects in the lateral trochlear facet. Loose bodies were present in 142 patients. A total of 161 patients (92%) showed MPFL damage. The patellar portion was affected in 119 patients. Of the patients, 28 showed a partially damaged MPFL (<50%), 42 showed MPFL damage greater than 50%, and 49 presented with a complete tear of the MPFL. MPFL lesions were observed on the femoral side in 42 patients. Fourteen patients presented with an avulsion fracture on the patellar side; 28 patients, on the femoral side. CONCLUSIONS The MPFL was injured in 92% of 175 patients after a first-time acute patellar dislocation. Chondral damage was most frequent at the patellar crest, followed by the lateral femoral epicondyle. No association was found between patella alta, the sulcus angle, the Q angle, the tibial tubercle-trochlear groove distance, trochlear and patellar dysplasia, and soft-tissue damage. LEVEL OF EVIDENCE Level IV, retrospective cohort study.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany.
| | - Marco Pilone
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | - Jörg Eschweiler
- Department of Orthopedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany
| | - Emanuela Marsilio
- Department of Orthopedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany
| | - Frank Hildebrand
- Department of Orthopedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy; Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, London, England; School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Stoke on Trent, England
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Zheng L, Si XL, Zhang M, Zhang GY. Factors associated with acute articular cartilage lesions of the patella and lateral femoral condyle in acute first-time lateral patellar dislocation: A prospective magnetic resonance imaging study. Injury 2022; 53:2644-2649. [PMID: 35613966 DOI: 10.1016/j.injury.2022.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 05/09/2022] [Accepted: 05/13/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To identify risk factors of acute articular cartilage lesions of the patella and lateral femoral condyle in acute first-time lateral patellar dislocation (LPD). METHODS Magnetic resonance images were prospectively analyzed in 115 patients in an acute first-time LPD. Factors included gender, skeletal maturity, trochlear dysplasia, patellar height, and tibial tuberosity-trochlear groove (TT-TG) distance. Binary logistic regression analysis was carried out to identify the independent risk factors for the incidence of acute articular cartilage lesions of the patella and lateral femoral condyle in acute first-time LPD. RESULTS The incidence of acute articular cartilage lesion of the patella and lateral femoral condyle were 46.1% and 27% in acute first-time LPD, respectively. Univariate analysis revealed significantly higher incidence rate of acute articular cartilage lesion of the patella in male (P = 0.027), skeletally mature (P = 0.035), normal TT-TG distance (P = 0.043) and normal femoral trochlea (P = 0.031). Risk factors for the incidence of acute articular cartilage lesion of the patella were skeletally mature (odds ratio (OR): 2.324), normal TT-TG distance (OR: 2.824) and normal femoral trochlea (OR: 3.835). Univariate analysis revealed significantly higher incidence rate of acute articular cartilage lesion of the lateral femoral condyle in skeletally mature (P = 0.027) and normal femoral trochlea (P = 0.031). Risk factor for the incidence of acute articular cartilage lesion of the lateral femoral condyle was normal femoral trochlea (OR: 3.347). CONCLUSIONS For patients in acute first-time LPD, compared with other parameters, the normal femoral trochlea, normal TT-TG distance and skeletally mature are independent risk factors for the incidence of acute articular cartilage lesion of the patella, and the normal femoral trochlea is an independent risk factor for the incidence of acute articular cartilage lesion of the lateral femoral condyle.
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Affiliation(s)
- Lei Zheng
- Department of Radiology, Shandong Provincial Corps Hospital of Chinese People's Armed Police Forces, Jinan 250014, China
| | - Xiao-Lin Si
- Shandong First Medical University, Jinan 250014, China; Department of Ultrasonography, Shandong Provincial Qianfoshan Hospital, The First Hospital Affiliated With Shandong First Medical University, Jinan 250014, China
| | - Meng Zhang
- Shandong First Medical University, Jinan 250014, China; Department of Ultrasonography, Shandong Provincial Qianfoshan Hospital, The First Hospital Affiliated With Shandong First Medical University, Jinan 250014, China
| | - Guang-Ying Zhang
- Department of Ultrasonography, Shandong Provincial Qianfoshan Hospital, The First Hospital Affiliated With Shandong First Medical University, Jinan 250014, China.
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Abstract
Patellar instability is one of the most prevalent knee disorders, with dislocations occurring in 5 to 43 cases per 10,000 annually. Traumatic patellar dislocation can result in significant morbidity and is associated with patellofemoral chondral injuries and fractures, medial soft tissue disruption, pain, and reduced function, and can lead to patellofemoral osteoarthritis. Chronic and recurrent instability can lead to deformation and incompetence of the medial soft tissue stabilizers. Despite recent gains in understanding the pathoanatomy of this disorder, the management of patients with this condition is complex and remains enigmatic.
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Zheng L, Ding HY, Feng Y, Sun BS, Zhu LL, Zhang GY. Gender-related differences in concomitant articular injuries after acute lateral patellar dislocation. Injury 2021; 52:1549-1555. [PMID: 33097203 DOI: 10.1016/j.injury.2020.10.065] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/13/2020] [Accepted: 10/15/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To explore the gender differences in the concomitant articular injuries after acute lateral patellar dislocation (LPD). METHODS Magnetic resonance images were prospectively analyzed in 166 patients after an acute LPD. Concomitant articular injuries included bone contusion, medial patellofemoral ligament (MPFL) injury, articular cartilage lesion, and vastus medialis obliquus (VMO) lesion. Statistical analyses were performed between the patient's gender and the incidence of concomitant articular injuries in adolescent and adult subgroups. RESULTS The incidence of partial and complete MPFL tear in adolescent males and females were (45%, 50%) and (63.2%, 29.8%), respectively. Compared with adolescent females, adolescent males showed higher incidence of complete MPFL tear (P = 0.049). The incidence of articular cartilage lesion of patella in adolescent males and females were 40% and 21.1%, respectively. Compared with adolescent females, adolescent males showed higher incidence of articular cartilage lesion of the patella (P = 0.043). No correlations were identified in other injuries in the adolescent group. The incidence of partial and complete MPFL tear in adult males and females were (34.4%, 65.6%) and (56.8%, 37.8%), respectively. Compared with adult females, adult males showed higher incidence of complete MPFL tear (P = 0.036). The incidence of articular cartilage lesion of patella in adult males and females were 56.3% and 32.4%, respectively. Compared with adult females, adult males showed higher incidence of articular cartilage lesion of patella (P = 0.047). The incidence of VMO injury in adult males and females were 59.4% and 35.1%, respectively. Compared with adult females, adult males showed higher incidence of VMO injury (P = 0.044). No correlations were identified in other injuries in the adult group. CONCLUSIONS Compared with females, males predispose to complete MPFL tear and articular cartilage lesion of patella after acute LPD. Compared with female adults, male adults predispose to VMO injury.
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Affiliation(s)
- Lei Zheng
- Department of Radiology, Shandong Provincial Corps Hospital of Chinese People's Armed Police Force, Jinan 250014, China
| | - Hong-Yu Ding
- Department of Ultrasonography, Shandong Provincial Qianfoshan Hospital, The First Hospital Affiliated to Shandong First Medical University, Jinan 250014, China
| | - Yan Feng
- Department of Radiology, Affiliated Hospital of Binzhou Medical University, Binzhou 256600, China
| | - Bai-Sheng Sun
- Department of Radiology, Shandong Provincial Corps Hospital of Chinese People's Armed Police Force, Jinan 250014, China
| | - Ling-Ling Zhu
- Department of Radiology, Shandong Provincial Corps Hospital of Chinese People's Armed Police Force, Jinan 250014, China
| | - Guang-Ying Zhang
- Department of Ultrasonography, Shandong Provincial Qianfoshan Hospital, The First Hospital Affiliated to Shandong First Medical University, Jinan 250014, China.
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Kluczynski MA, Miranda L, Marzo JM. Prevalence and Site of Medial Patellofemoral Ligament Injuries in Patients With Acute Lateral Patellar Dislocations: A Systematic Review and Meta-analysis. Orthop J Sports Med 2020; 8:2325967120967338. [PMID: 33403210 PMCID: PMC7747126 DOI: 10.1177/2325967120967338] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/19/2020] [Indexed: 01/11/2023] Open
Abstract
Background Medial patellofemoral ligament (MPFL) injuries are common in patients with acute lateral patellar dislocations, but the pattern of MPFL injuries is unclear, especially with respect to patient age. Purpose The primary aim was to determine the prevalence of MPFL injuries according to the site of injury in patients with acute lateral patellar dislocations. The secondary aim was to compare the site of MPFL injuries in patients aged ≤16 versus >16 years. Study Design Systematic review; Level of evidence, 4. Methods A systematic literature search was performed with PubMed, Embase, and CINAHL to identify articles published from January 1, 1999, to May 31, 2019, that examined the site of MPFL injuries in patients with acute patellar dislocations. The study design, sample size, age at injury, technique used for diagnosing MPFL injuries (magnetic resonance imaging, ultrasound, and/or surgery), and prevalence and site of MPFL injuries were extracted from each study. The pooled estimate of the proportion of MPFL injuries at each site was calculated (femur, patella, midsubstance, and combined sites of injury) as well as proportions stratified by age group (≤16 and >16 years). Results The literature search yielded 420 unique articles, of which 52 were screened for eligibility; of these, 17 were excluded. Thus, a total of 35 articles (2558 patients) were included in the final analysis. The overall prevalence of MPFL injuries was 94.7% (95% CI, 91.2%-96.8%). Most MPFL injuries occurred at the patella (37.1% [95% CI, 30.8%-43.9%]), followed by the femur (36.8% [95% CI, 31.0%-43.0%]), combined sites (25.1% [95% CI, 20.7%-30.1%]), and the midsubstance (15.6% [95% CI, 13.2%-18.4%]). In patients aged ≤16 years, most MPFL injuries occurred at the patella (39.3% [95% CI, 27.9%-51.9%]), and in patients aged >16 years, most MPFL injuries occurred at the femur (47.2% [95% CI, 40.6%-54.0%]). Conclusion The prevalence of MPFL injuries in patients with acute patellar dislocations varied by site of injury and by age. MPFL injuries at the patella were most prevalent overall and in children and adolescents, and MPFL injuries at the femur were more prevalent in adults.
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Affiliation(s)
- Melissa A Kluczynski
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
| | - Luis Miranda
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
| | - John M Marzo
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
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Strickland SM. Editorial Commentary: Medial Patellofemoral Ligament Repair Versus Reconstruction: Still a Question or a Clear Winner? Arthroscopy 2019; 35:2916-2917. [PMID: 31604513 DOI: 10.1016/j.arthro.2019.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 06/06/2019] [Indexed: 02/02/2023]
Abstract
Controversy persists regarding appropriate treatment of patellar instability. As surgeons move to a more aggressive approach, medial imbrication and medial patellofemoral ligament repair are waning in popularity whereas medial patellofemoral ligament reconstruction has become the standard of care. Techniques vary between surgeons, and consensus remains elusive.
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Incidence of second-time lateral patellar dislocation is associated with anatomic factors, age and injury patterns of medial patellofemoral ligament in first-time lateral patellar dislocation: a prospective magnetic resonance imaging study with 5-year follow-up. Knee Surg Sports Traumatol Arthrosc 2019; 27:197-205. [PMID: 30008056 DOI: 10.1007/s00167-018-5062-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 07/11/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE To examine the predictors of the second-time lateral patellar dislocation (LPD) in patients after acute first-time LPD in a 5-year follow-up. METHODS Data were collected prospectively from patients after acute first-time LPD with conservative treatment. Factors included sex, age at the first-time LPD, anatomical variants [trochlear dysplasia, patellar height, tibial tuberosity-trochlear groove (TT-TG) distance], and injury patterns of medial patellofemoral ligament (MPFL) in acute first-time LPD. Logistic regression was carried out to identify the independent risk factors for the incidence of the second-time LPD. RESULTS The incidence rate of a second-time LPD was 35.5% (59 of 166) in the 5-year follow-up. Univariate analysis revealed significant differences in the incidence rate of the second-time LPD among age at the first-time LPD (P = 0.04), trochlear dysplasia (P = 0.003), patella height (P = 0.017) and the TT-TG distance (P = 0.027). Risk factors for the second-time LPD were age < 18 years at the first-time LPD [odds ratio (OR) 4.088], low-grade trochlear dysplasia (OR 7.214), high-grade trochlear dysplasia (OR 18.945), patella alta (OR 8.416), elevated TT-TG distance (OR 12.742), complete MPFL tear at its isolated femoral-side (OR 6.04) and complete combined MPFL tear (OR 5.851). CONCLUSIONS Trochlear dysplasia, elevated TT-TG distance, patella alta, age < 18 years at the first-time LPD, complete MPFL tear at its isolated femoral-side and complete combined MPFL tear in the first-time LPD are independently associated with a higher incidence rate of the second-time LPD. LEVEL OF EVIDENCE III.
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Steinberg N, Stern M, Tenenbaum S, Blankstein A, Zeev A, Siev-Ner I. Ultrasonography and clinical examination of knee injuries in pre- and post- menarche dancers. Res Sports Med 2018. [PMID: 29519163 DOI: 10.1080/15438627.2018.1447474] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This study aimed at evaluating whether the prevalence of knee injuries and morphological features are different among pre-and-post menarche dancers; Sixty-seven pre-and-post menarche dancers were screened for anthropometric parameters; knee laxity; patella femoral pain syndrome (PFPS), pathologies and anatomical structure of the knees. Both groups showed a high and similar prevalence of PFPS. The post-menarche dancers produced a significantly higher rate of Tanner stages 3-4 (p = .010), greater weight (p < .001) higher BMI (p = .003); and, higher prevalence of MCL pathology, pes planus, and scoliosis compared with pre-menarche dancers (p < .05). The pre-menarche dancers started dance practice earlier (p = .008); and, showed significantly higher prevalence of lateral laxity, patellar laxity, positive Lachman test and positive Drawer test compared with post-menarche dancers (p < .05). Interactions (menarche yes/no by PFPS no/one leg/both legs) were found for BMI (p = .044; η2 = .187), trochlear cartilage thickness (p = .020; η2 = 0.121) and tip of patella - trochlear groove distance (p = .024; η2 = .150). Pre-and-post-menarche female dancers demonstrated similar prevalence of knee injuries, with different body morphology.
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Affiliation(s)
- Nili Steinberg
- a The Wingate College of physical Education and Sports Sciences at the Wingate Institute , Netanya , Israel
| | - Myriam Stern
- b Department of Radiology, Sheba Medical Center, Tel hashomer, Israel. Affiliated to Sackler School of Medicine , Tel Aviv University , Israel
| | - Shay Tenenbaum
- c Department of orthopedic surgery, Chaim Sheba medical center Tel-Hashomer, affiliated to the Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Alexander Blankstein
- c Department of orthopedic surgery, Chaim Sheba medical center Tel-Hashomer, affiliated to the Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Aviva Zeev
- a The Wingate College of physical Education and Sports Sciences at the Wingate Institute , Netanya , Israel
| | - Itzhak Siev-Ner
- d Orthopedic Rehabilitation Dept ., Sheba Medical Center , Tel-Hashomer , Israel
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Hussein A, Sallam AA, Imam MA, Snow M. Surgical treatment of medial patellofemoral ligament injuries achieves better outcomes than conservative management in patients with primary patellar dislocation: a meta-analysis. J ISAKOS 2018. [DOI: 10.1136/jisakos-2017-000152] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Anatomic patellar instability risk factors in primary lateral patellar dislocations do not predict injury patterns: an MRI-based study. Knee Surg Sports Traumatol Arthrosc 2018; 26:677-684. [PMID: 28246877 DOI: 10.1007/s00167-017-4464-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 01/30/2017] [Indexed: 12/25/2022]
Abstract
PURPOSE The primary goal was to describe the injury patterns in a population of primary (first time) lateral patellar dislocators (LPD) to lend clarity to commonly held notions about injury patterns in this population. METHODS A prospective study identifying patients presenting with LPD between 2008 and 2012. Inclusion criteria were a history and physical exam consistent with primary LPD, and an MRI consistent with the diagnosis without other significant ligamentous injury. On MRI, location of cartilage, medial patellofemoral ligament (MPFL) injury, and bone bruising were noted. Severity was categorized as partial or complete for MPFL and cartilage lesions. Anatomic patellar instability risk factors (patella alta, trochlear dysplasia, increased TT-TG, and lateral patella tilt) were recorded and compared to the injury patterns. RESULTS This study involved 157 patients; 107 patients were skeletally mature. Of the 157 patients, 26 had surgery for this injury due to clinician-perceived need for cartilage debridement. MPFL injury severity was complete rupture (N = 69, 44%), partial (N = 67, 43%), and none (N = 19, 13%). MPFL injury location was isolated femoral (N = 16, 10%), isolated patella (N = 26, 17%), isolated mid-substance (0%), multiple locations (N = 95, 61%), and none (N = 20, 13%). Chondral injury location was patella (N = 67, 43%), lateral femoral condyle (N = 11, 7%), multiple locations (N = 53, 34%), and none (N = 26, 17%). A majority (61%) of patellar chondral lesions were at its inferomedial aspect; all medial patellar retinacular partial injuries involved the inferomedial aspect of the patella, consistent with the insertion of the medial patellotibial ligament (MPTL). Skeletally immature patients had a greater risk of isolated patellar MPFL and chondral injury. No clear relationship was found between/across the location and/or severity of bone bruising, MPFL, or chondral injury. CLINICAL RELEVANCE Underlying anatomic patellar instability risk factors defined by MRI, do not predict injury patterns. MPFL and chondral injury, as well as bone bruising, are common following LPD. The medial patellotibial ligament is torn in patellar-based medial retinacular injuries, based on MRI injury location. Skeletal immaturity plays a role in the location of the injury pattern with isolated patellar-based MPFL/chondral injury being more common in the skeletally immature patient. Sex does not appear to be a factor in injury patterns after primary LPD. Knowledge of these injury trends will help focus the clinician in injury evaluation when managing primary patellar dislocations. LEVEL OF EVIDENCE Case series, Level IV.
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Zhang GY, Zhu HX, Li EM, Shi H, Liu W, Zheng L, Bai ZW, Ding HY. The Correlation between the Injury Patterns of the Medial Patellofemoral Ligament in an Acute First-Time Lateral Patellar Dislocation on MR Imaging and the Incidence of a Second-Time Lateral Patellar Dislocation. Korean J Radiol 2018. [PMID: 29520187 PMCID: PMC5840058 DOI: 10.3348/kjr.2018.19.2.292] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Objective To evaluate the correlation between the injury patterns of the medial patellofemoral ligament (MPFL) on magnetic resonance imaging in an acute first-time lateral patellar dislocation (LPD) and incidence of a second-time LPD. Materials and Methods Magnetic resonance images were prospectively analyzed in 147 patients after an acute first-time LPD with identical nonoperative management. The injury patterns of MPFL in acute first-time LPDs were grouped by location and severity for the analysis of the incidence of second-time LPD in a 5-year follow-up. Independent t tests, chi-square tests and Kruskal-Wallis tests were performed as appropriate. Results Forty-six cases (46/147, 31.3%) of second-time LPD were present at the 5-year follow-up. Fourteen (14/62, 22.6%) and 31 cases (31/80, 38.8%) were present in the partial and complete MPFL tear subgroups, respectively. Twenty-five cases (25/65, 38.5%), 11 cases (11/26, 42.3%), and 8 cases (8/47, 17%) were present in the isolated femoral-side MPFL tear (FEM), combined MPFL tear (COM), and isolated patellar-side MPFL tear (PAT) subgroups, respectively. Compared with the partial MPFL tears, complete tears showed higher incidence of a second-time LPD (p = 0.04). The time interval between the two LPDs was shorter in the complete MPFL tear subgroup (24.2 months) than in the partial tear subgroup (36.9 months, p = 0.001). Compared with the PAT subgroup, the FEM and COM subgroups showed a higher incidence of a second-time LPD (p = 0.025). The time intervals between the two LPDs were shorter in the FEM and COM subgroups (20.8 months and 19.2 months) than in the PAT subgroup (32.5 months, p = 0.049). Conclusion A complete MPFL tear, isolated femoral-side tear and combined tear in a first-time LPD predispose a second-time LPD.
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Affiliation(s)
- Guang-Ying Zhang
- Department of Ultrasonography, Shandong Provincial Qianfoshan Hospital of Shandong University, Jinan 250014, China
| | - Hong-Xia Zhu
- Department of Ultrasonography, The Second People's Hospital of Liaocheng, Liaocheng 252601, China
| | - En-Miao Li
- Department of Ultrasonography, Jinan Third People's Hospital, Jinan 250132, China
| | - Hao Shi
- Department of Radiology, Shandong Provincial Qianfoshan Hospital of Shandong University, Jinan 250014, China
| | - Wei Liu
- Department of Ultrasonography, Shandong Provincial Qianfoshan Hospital of Shandong University, Jinan 250014, China
| | - Lei Zheng
- Department of Radiology, Shandong Provincial Corps Hospital of Chinese People's Armed Police Force, Jinan 250014, China
| | - Zheng-Wu Bai
- Department of Orthopedics, Shandong Provincial Qianfoshan Hospital of Shandong University, Jinan 250014, China
| | - Hong-Yu Ding
- Department of Ultrasonography, Shandong Provincial Qianfoshan Hospital of Shandong University, Jinan 250014, China
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