1
|
Hysing‐Dahl T, Inderhaug E. Rehabilitation after surgery for patellar instability. J Exp Orthop 2024; 11:e12062. [PMID: 38887658 PMCID: PMC11180699 DOI: 10.1002/jeo2.12062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 03/23/2024] [Accepted: 04/22/2024] [Indexed: 06/20/2024] Open
Affiliation(s)
- Trine Hysing‐Dahl
- Department of SurgeryHaraldsplass Deaconess HospitalBergenNorway
- Department of Clinical MedicineUniversity of BergenBergenNorway
| | - Eivind Inderhaug
- Department of SurgeryHaraldsplass Deaconess HospitalBergenNorway
- Department of Clinical MedicineUniversity of BergenBergenNorway
- Department of Orthopaedic SurgeryHaukeland University HospitalBergenNorway
| |
Collapse
|
2
|
Arrebola LS, Smith TO, de Oliveira VGC, de Oliveira PR, Wun PYL, de Carvalho RT, Pinfildi CE. Combined Hip and Knee Strengthening Compared With Knee Strengthening for Individuals With Lateral Patellar Dislocation: A Single-blind, Superiority, Randomized Controlled Trial. Arch Rehabil Res Clin Transl 2024; 6:100334. [PMID: 39006111 PMCID: PMC11240038 DOI: 10.1016/j.arrct.2024.100334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/16/2024] Open
Abstract
Objective To investigate whether a combined hip and knee muscle strengthening program is superior to a knee strengthening program for people after lateral patellar dislocation (LPD). Design Single-blind, superiority, randomized controlled trial with 48 weeks follow-up. Setting Physiotherapy out-patient clinic. Participants Forty individuals aged 16 or older, with a history of non-traumatic LPD were randomized to a knee-based strengthening (KBSG) or quadriceps and hip strengthening exercise (HQSG) program (N=40). Inclusion criteria included a positive apprehension sign, pain on palpation along the medial retinaculum, and J sign. Exclusion criteria included restricted range of motion (<90° knee flexion), and traumatic or postsurgical LPD. Interventions Concealed randomization was performed using random permuted blocks of size 4. Individuals received their corresponding exercise program according to randomization and group allocation: knee-based strengthening (n=20) or combined hip and quadriceps strengthening (n=20) twice weekly for 8 weeks over 16 appointments. Main Outcome Measures Primary outcome was the Lysholm Knee Score. Secondary outcomes included Numerical Pain Ratings Scale (NPRS) at rest and during effort, Norwich Patellar Instability Score (NPIS), Kujala Anterior Knee Pain Scale (AKPS), Lower Extremity Functional Scale (LEFS), 4 domains of the WHOQOL-Bref, and recurrence rate. Patient-reported outcome measures were assessed from the baseline to 48 weeks. Assessments were performed by a physiotherapist who was blinded to the group allocation. Data were analyzed by using a repeated-measures ANOVA model with Tukey's post hoc test after an intention-to-treat principle. Results At the primary time-point of 8 weeks, there were no substantial between-group differences in the Lysholm Knee Score: mean difference=-6.8 (95% CI -14.3 to 3.7); NPIS: mean difference=23.5 (95% CI 5.6 to 41.3); AKPS: mean difference=-1.54 (95% CI -8.6 to 5.6), NPRS at rest and during effort (mean difference=0.32 (95% CI -0.37 to 1); and mean difference=0.68 (95% CI -0.9 to 1.86); LEFS mean difference=-1.08 (95% CI -5.9 to 2.4), WHOQOL-Bref domains (physical health: mean difference=-0.12, (95% CI -1.26 to 1.02); psychological: mean difference=-0.32 (95% CI -2.04 to 1.4); social relations: mean difference=-0.7 (95% CI -2.2 to 0.82); environment: mean difference=0.44 (95% CI -1 to 1.9), and recurrence rate (P=.69). Conclusion This study indicates that combined hip and knee muscle strengthening is not superior to knee-based strengthening for LPD treatment. The limitations stemming from the underpowered nature of the trial must be acknowledged, concerning the potential oversight of moderate intervention effects.
Collapse
Affiliation(s)
- Lucas Simões Arrebola
- Department of Human Movement Sciences, Federal University of São Paulo (UNIFESP), Baixada Santista Campus, São Paulo, Brazil
- Physical Therapy Department, Institute of Medical Assistance to the State Public Servant (IAMSPE), São Paulo, Brazil
| | - Toby O. Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Vanessa Gonçalves Coutinho de Oliveira
- Department of Human Movement Sciences, Federal University of São Paulo (UNIFESP), Baixada Santista Campus, São Paulo, Brazil
- Physical Therapy Department, Institute of Medical Assistance to the State Public Servant (IAMSPE), São Paulo, Brazil
| | - Pedro Rizzi de Oliveira
- Department of Human Movement Sciences, Federal University of São Paulo (UNIFESP), Baixada Santista Campus, São Paulo, Brazil
- Physical Therapy Department, Institute of Medical Assistance to the State Public Servant (IAMSPE), São Paulo, Brazil
| | - Paloma Yan Lam Wun
- Physical Therapy Department, Institute of Medical Assistance to the State Public Servant (IAMSPE), São Paulo, Brazil
| | - Rogério Teixeira de Carvalho
- Department of Orthopaedics, Institute of Medical Assistance to the State Public Servant (IAMSPE), São Paulo, Brazil
| | - Carlos Eduardo Pinfildi
- Department of Human Movement Sciences, Federal University of São Paulo (UNIFESP), Baixada Santista Campus, São Paulo, Brazil
| |
Collapse
|
3
|
Abelleyra Lastoria DA, Hutchinson K, Tapadar T, Ahmad S, Smith T, Nicolaou N, Hing CB. Patho-morphology of patellar instability in children and adolescents: A systematic review and meta-analysis. Knee 2024; 48:166-196. [PMID: 38657526 DOI: 10.1016/j.knee.2024.03.009] [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: 01/15/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Children and adolescents have the highest incidence of patellar instability among the population. We aimed to identify patho-morphological and epidemiological factors associated with patellar instability, and to identify factors predisposing to recurrence in children and adolescents. METHODS Published and unpublished literature databases, conference proceedings and the reference lists of included studies were searched to the 14th of March 2024. Studies were eligible if they compared history characteristics, examination features and radiological parameters between patients with and without instability, or evaluated risk factors for instability recurrence. A random-effects meta-analysis was performed. Included studies were appraised using tools respective of study design. RESULTS The evidence was moderate to low in quality. Forty-five studies (including 9000 patients) were eligible. Tibial tubercle - tibial groove (TT-TG) distance (weighted mean difference [WMD] 5.96 mm, 95% Confidence Interval [CI]: 4.94 to 6.99 mm), sulcus angle (WMD: 13.93˚, 95% CI: 9.1˚ to 18.8˚), and Insall-Salvati index (WMD: 0.2, 95% CI: 0.16 to 0.23) were greater in patients with patellar instability. Risk factors for recurrent dislocation included age less than 18 years (Odds ratio [OR]: 2.56, 95% CI: 1.63 to 4.0), skeletal immaturity (OR: 1.79, 95% CI: 1.21 to 2.64) and presence of trochlear dysplasia (OR: 3.37, 95% CI: 1.85 to 6.15). CONCLUSION Knowledge of patho-morphological factors associated with patellar instability could help explain its pathophysiological processes, allowing for the design of treatment approaches and the identification of patients at risk.
Collapse
Affiliation(s)
| | | | - Thabia Tapadar
- St George's University of London, London SW17 0RE, United Kingdom
| | - Salwa Ahmad
- St George's University of London, London SW17 0RE, United Kingdom
| | - Toby Smith
- University of Warwick, Coventry CV4 7HL, United Kingdom
| | - Nicolas Nicolaou
- Sheffield Children's Hospital, Sheffield S10 2TH, United Kingdom
| | - Caroline Blanca Hing
- St George's University Hospitals NHS Foundation Trust, London SW17 0RE, United Kingdom
| |
Collapse
|
4
|
Irarrázaval S, Besa P, Fernández T, Fernández F, Donoso R, Tuca MJ, Lira MJ, Orrego M. Tibial tubercle to trochlear groove and the roman arch method for tibial tubercle lateralisation are reliable and distinguish between subjects with and without major patellar instability. J ISAKOS 2024; 9:272-278. [PMID: 38228271 DOI: 10.1016/j.jisako.2024.01.006] [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: 08/18/2023] [Revised: 12/20/2023] [Accepted: 01/08/2024] [Indexed: 01/18/2024]
Abstract
PURPOSE Patellofemoral (PF) instability recurrence depends on several factors including the relative lateralisation of tibial tubercle (TT) regarding the trochlear groove (TG). TT relative lateralisation quantification has long been a topic of debate. Multiple measuring techniques have been described including TT-trochlear groove (TT-TG), TT-posterior cruciate ligament (TT-PCL) and TT-roman arch (TT-RA), with no clear consensus regarding the most reliable index or pathologic threshold. We set out to determine the normal value range of each index and their association with age, sex and PF instability status. Also, this study aims to determine a reliable pathologic distance threshold to effectively predict patellar dislocation. METHODS Skeletally mature patients up to 45 years of age who presented a CT Scan and an MRI of the same knee between 2014 and 2018 were included and divided into subgroups based on history of PF instability. Three indexes (TT-TG, TT-PCL and TT-RA) were assessed by two independent observers blinded to instability history. ROC curves were performed for each index to obtain the cut point that better predicts instability. Univariate and multivariate models adjusted by age, sex, instability history and type of imaging technique were performed to test the influence of these variables. RESULTS 208 patients were included. Mean age was 27.93 ± 8.48 years, 67.3% were female and 71 patients (34.1%) presented major instability history. Good or excellent inter and intraobserver reliability was found for all three indexes. All indexes presented significantly different distributions between subjects with and without major instability (p < 0.001), except for TT-PCL. Different cut point values differing between imaging modalities were found: 11.4 mm for MRI TT-TG, 17 mm for CT TT-TG, 15.6 mm for MRI TT-RA and 18.2 mm for CT TT-RA. CONCLUSIONS All indexes studied had good or excellent inter and intraobserver reliability. Measurements between imaging techniques (CT and MR) are not interchangeable. Both TT-TG and TT-RA correctly distinguish between subjects with and without major instability, while TT-PCL does not, recommending caution when evaluated on its own. Specific threshold values depending on imaging technique should be considered for surgical decision-making. LEVEL OF EVIDENCE Level IV, Diagnostic Test.
Collapse
Affiliation(s)
- Sebastián Irarrázaval
- Department of Orthopedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, 8330077, Chile
| | - Pablo Besa
- Department of Orthopedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, 8330077, Chile.
| | - Tomás Fernández
- Department of Orthopedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, 8330077, Chile
| | - Francisco Fernández
- Department of Orthopedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, 8330077, Chile
| | - Rodrigo Donoso
- Department of Orthopedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, 8330077, Chile
| | - María Jesús Tuca
- Department of Orthopedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, 8330077, Chile
| | - María Jesús Lira
- Department of Orthopedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, 8330077, Chile
| | - Mario Orrego
- Department of Orthopedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, 8330077, Chile
| |
Collapse
|
5
|
Sasaki R, Niki Y, Kaneda K, Yamada Y, Nagura T, Nakamura M, Jinzaki M. The tibial tubercle-to-trochlear groove distance changes in standing weight-bearing condition: An upright weight-bearing computed tomography analysis. Knee 2024; 48:14-21. [PMID: 38479077 DOI: 10.1016/j.knee.2024.02.015] [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: 12/04/2023] [Revised: 01/20/2024] [Accepted: 02/27/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND The tibial tubercle-to-trochlear groove (TT-TG) distance and Insall-Salvati (I/S) ratio are widely used to determine the need for distal realignment in conjunction with medial patellofemoral ligament (MPFL) reconstruction in patients with recurrent patellar dislocation. A TT-TG distance >20 mm and an I/S ratio >1.3 are significant anatomical risk factors for patellar instability. However, these parameters have traditionally been measured using non-weight-bearing (NWB) imaging modalities. As patellar dislocation occurs during weight-bearing actions, these two parameters should be measured under weight-bearing conditions. Thus, this study aimed to measure the TT-TG distance and I/S ratio using upright full-weight-bearing (FWB) computed tomography (CT) scans and compare the data with NWB CT scans. METHODS This study included 49 knee joints of 26 healthy volunteers. CT images were obtained under both FWB and NWB standing conditions using a 320-detector row upright CT scanner. TT-TGs in the axial plane and I/S ratios in the sagittal plane were measured and compared. RESULTS The average FWB TT-TG distance was 20.3 ± 3.9 mm, whereas the average NWB TT-TG distance was 12.3 ± 4.7 mm. The TT-TG level was significantly higher in the FWB condition than that in the NWB condition (P < 0.001). The I/S ratios were comparable between the FWB and NWB conditions (P = 0.29). CONCLUSIONS The TT-TG distance in the standing weight-bearing condition was larger than the conventional TT-TG distance and surpassed the historical cutoff value of TT-TG, which may affect the indication of additional distal realignment in MPFL reconstruction for patellar instability.
Collapse
Affiliation(s)
- Ryo Sasaki
- Department of Orthopaedic Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Yasuo Niki
- Department of Orthopaedic Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan.
| | - Kazuya Kaneda
- Department of Orthopaedic Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Yoshitake Yamada
- Department of Diagnostic Radiology, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Takeo Nagura
- Department of Orthopaedic Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Masahiro Jinzaki
- Department of Diagnostic Radiology, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| |
Collapse
|
6
|
Qiao Y, Wu X, Wu J, Lu S, Zhao S, Zhao J. Double-Level Knee Derotational Osteotomy Yields Better Postoperative Outcomes Than Tibial Tubercle Transfer Combined With Medial Patellofemoral Ligament Reconstruction in Patients With Recurrent Patellar Instability and Severe Malrotation. Arthroscopy 2024:S0749-8063(24)00367-0. [PMID: 38777002 DOI: 10.1016/j.arthro.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 04/22/2024] [Accepted: 05/02/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE To assess the postoperative outcomes of double-level knee derotational osteotomy (KDRO) combined with medial patellofemoral ligament reconstruction (MPFLR) and to compare it with tibial tuber transfer (TTT) and MPFLR without derotational osteotomy in patients with recurrent patellar instability and a marked torsional deformity. METHODS From March 2020 to December 2021, patients with torsion deformity (combined femoral torsion [FT] and tibial torsion [TTn] ≥30°) were retrospectively included. The minimum follow-up time was 18 months. Patients who received KDRO and MPFLR were categorized as the KDRO group and patients who received a combined TTT and MPFLR were categorized as the control group. Preoperative and postoperative clinical symptoms, patient-reported outcomes (Kujala, visual analog scale, Lysholm, International Knee Documentation Committee, Tegner, and Knee Injury and Osteoarthritis Outcome scores), and imaging parameters (FT, TTn, patellar height, femoral trochlear dysplasia, congruence angle, patellar tilt angle, lateral patellar angle, lateral patellar translation, and tibial tubercle-trochlear groove distance) were analyzed. RESULTS In all, 36 patients were included with 18 in KDRO group and 18 in control group. The mean follow-up time was 30 (range 21-39) months. At the latest follow-up, no patient experienced redislocation in either group. Except for the FT and TTn in the control group, postoperative imaging parameters were significantly reduced to the normal range. KDRO group had a lower patellar tilt angle (P = .043, effect size 0.64). All clinical scores in both groups significantly improved postoperatively. The KDRO group had better functional scores than control group except the KOOS daily living activities subscore and the KOOS sports and recreation subscore. More patients in the KDRO group met the minimal clinically important difference for most patient-reported outcomes than the control group. Eight patients (44%) in the control group complained of postoperative anterior knee pain, compared with 1 patient (6%) in the KDRO group (P = .018). CONCLUSIONS KDRO combined with MPFLR was associated with better postoperative outcomes than TTT combined with MPFLR in patients with recurrent patellar instability and a torsion deformity. LEVEL OF EVIDENCE Level III, retrospective cohort study.
Collapse
Affiliation(s)
- Yi Qiao
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiulin Wu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinlong Wu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Simin Lu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Song Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| |
Collapse
|
7
|
Zhou Y, Yu A, Wu X, Yao J, Tan H, Wang H, Lian C, Zhou A. Evaluating the reliability of the lateral femoral condyle measuring methods by different modalities for patients with lateral patellar dislocation. BMC Musculoskelet Disord 2024; 25:388. [PMID: 38762738 PMCID: PMC11102213 DOI: 10.1186/s12891-024-07495-x] [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: 11/26/2023] [Accepted: 05/06/2024] [Indexed: 05/20/2024] Open
Abstract
BACKGROUND A variety of measurement methods and imaging modalities are in use to quantify the morphology of lateral femoral condyle (LFC), but the most reliable method remains elusive in patients with lateral patellar dislocation (LPD). The purpose of this study was to determine the intra- and inter-observer reliability of different measurement methods for evaluating the morphology of LFC on different imaging modalities in patients with LPD. METHODS Seventy-three patients with LPD were included. Four parameters for quantifying the morphology of LFC were retrospectively measured by three observers on MRI, sagittal CT image, conventional radiograph (CR), and three-dimensional CT (3D-CT). The intra-class correlation coefficient was calculated to determine the intra- and inter-observer reliability. Bland-Altman analysis was conducted to identify the bias between observers. RESULTS The lateral femoral condyle index (LFCI) showed better intra- and inter-observer reliability on MRI and 3D-CT than on CR and sagittal CT images. The mean difference in the LFCI between observers was lowest on 3D-CT (0.047), higher on MRI (0.053), and highest on sagittal CT images (0.062). The LFCI was associated with the lateral femoral condyle ratio (ρ = 0.422, P = 0.022), lateral condyle index (r = 0.413, P = 0.037), and lateral femoral condyle distance (r = 0.459, P = 0.014). The LFCI could be reliably measured by MRI and 3D-CT. CONCLUSION The LFCI could be reliably measured by MRI and 3D-CT. The LFCI was associated with both the height and length of LFC and could serve as a comprehensive parameter for quantifying the morphology of LFC in patients with LPD.
Collapse
Affiliation(s)
- Yunlong Zhou
- Department of Orthopaedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- Orthopedic laboratory of Chongqing Medical University, Chongqing, 400016, China
| | - Anqi Yu
- Department of Orthopaedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- Orthopedic laboratory of Chongqing Medical University, Chongqing, 400016, China
| | - Xiaoan Wu
- Department of Orthopaedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- Orthopedic laboratory of Chongqing Medical University, Chongqing, 400016, China
| | - Jinjiang Yao
- Department of Orthopaedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- Orthopedic laboratory of Chongqing Medical University, Chongqing, 400016, China
| | - Hao Tan
- Department of Orthopaedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- Orthopedic laboratory of Chongqing Medical University, Chongqing, 400016, China
| | - Huaao Wang
- Department of Orthopaedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- Orthopedic laboratory of Chongqing Medical University, Chongqing, 400016, China
| | - Chengjie Lian
- Department of Orthopaedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- Orthopedic laboratory of Chongqing Medical University, Chongqing, 400016, China
| | - Aiguo Zhou
- Department of Orthopaedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
- Orthopedic laboratory of Chongqing Medical University, Chongqing, 400016, China.
| |
Collapse
|
8
|
Chen J, Sha L, Zhang X, Bao L, Li H, Zhao J, Xie G. Impact of sex and age on the lateralisation of the tibial tubercle in normal paediatric and adolescent populations. Knee Surg Sports Traumatol Arthrosc 2024; 32:1207-1215. [PMID: 38529701 DOI: 10.1002/ksa.12146] [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: 11/21/2023] [Revised: 02/21/2024] [Accepted: 02/28/2024] [Indexed: 03/27/2024]
Abstract
PURPOSE Numerous methods have been proposed to characterise tubercle lateralisation. However, their normal values and related changes remain unclear. Accordingly, it was aimed to determine the potential sex and age effects and determined the optimal individualised method of diagnosing lateralisation of the tibial tubercle in patients with recurrent patellar dislocation (RPD). METHODS Measurements included the tibial tubercle-trochlear groove (TT-TG) distance, tibial tubercle-posterior cruciate ligament (TT-PCL) distance and tibial tubercle lateralisation (TTL); and the proximal tibial width (PTW), trochlear width (TW) and trochlear dysplasia index (TDI), for adjustment. A two-way analysis of variance was used to determine the effect of age, sex and their interaction within the normal group. When the age effect was statistically significant, a nonlinear regression was created. Areas under the receiver-operating characteristic curve (AUCs) were calculated to assess diagnostic accuracy. RESULTS A total of 277 normal participants (mean [SD] age, 13.5 [2.6] years; 125 [45.1%] female) and 227 patients with RPD (mean [SD] age, 13.5 [2.6] years; 161 [58.1%] female) were analysed. It was found that in the normal group, in patients aged 7-10, TT-PCL distance (p = 0.006), TTL (p = 0.007) and TT-PCL/PTW (p < 0.001) were significantly larger in females than in males. A significant sex effect was also detected on TT-TG/TW (p = 0.014). TT-TG distance, TT-PCL distance, TTL and TT-PCL/PTW (in male patients) approached an established normal adult value of 12.3 mm, 20.9 mm, 0.64 and 0.28, respectively, with increasing age (p < 0.001). The AUC was greater for TT-TG/TDI and TT-TG/TW (p ≤ 0.01) and TT-TG/TDI outperformed TT-TG/TW in patients aged 15-18 (p = 0.004). CONCLUSIONS Tubercle lateralisation increased with age and was affected by sex, with the exception of TT-TG distance and TT-TG/TDI. TT-TG/TDI is the optimal method of diagnosing a lateralized tibial tubercle in patients with RPD. These findings assist with the evaluation of tubercle lateralisation in that they provide a proper protocol for paediatric and adolescent populations with RPD; and thus, will help determine whether medial tubercle transfer should be included among the tailored surgical procedures considered for the treatment of patients with RPD. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Jiebo Chen
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Sports Medicine, National Center for Orthopedics, Shanghai, China
| | - Lin Sha
- Department of Pediatric Orthopedics, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xueying Zhang
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Sports Medicine, National Center for Orthopedics, Shanghai, China
| | - Lei Bao
- Department of Radiology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hai Li
- Department of Pediatric Orthopedics, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Sports Medicine, National Center for Orthopedics, Shanghai, China
| | - Guoming Xie
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Sports Medicine, National Center for Orthopedics, Shanghai, China
| |
Collapse
|
9
|
Hurley ET, Anil U, Colasanti CA, McAllister D, Straus EJ, Alaia MJ, Campbell KA. Management of Patellar Instability: A Network Meta-analysis of Randomized Control Trials: Response. Am J Sports Med 2024; 52:NP7-NP8. [PMID: 38690620 DOI: 10.1177/03635465241242314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
|
10
|
Sheehan FT, Shah P, Boden BP. The Importance of Medial Patellar Shape as a Risk Factor for Recurrent Patellar Dislocation in Adults. Am J Sports Med 2024; 52:1282-1291. [PMID: 38557261 DOI: 10.1177/03635465241233732] [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] [Indexed: 04/04/2024]
Abstract
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.
Collapse
Affiliation(s)
- Frances T Sheehan
- Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Paras Shah
- Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Barry P Boden
- The Orthopaedic Center, a Division of CAO, Rockville, Maryland, USA
| |
Collapse
|
11
|
Hu F, Wang C, Du Y, Guo Z, Zhang K, Ma Y, Yang Y, Gong X, Wang H, Liu P, Shi W. Medial Patellofemoral Complex Reconstruction (Combined Reconstruction of Medial Patellofemoral Ligament and Medial Quadriceps Tendon-Femoral Ligament) With Semitendinosus Autograft Resulted in Similar Clinical and Radiographic Outcomes to Medial Patellofemoral Ligament Reconstruction in Treating Recurrent Patellar Dislocation. Arthroscopy 2024; 40:1264-1276.e1. [PMID: 37716628 DOI: 10.1016/j.arthro.2023.08.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 08/17/2023] [Accepted: 08/20/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE To compare clinical and radiographic outcomes of medial patellofemoral ligament reconstruction (MPFL-R) and medial patellofemoral complex reconstruction (MPFC-R) for recurrent patellar dislocation. Outcome measures were compared based on the Insall-Salvati index. METHODS Patients who were diagnosed with recurrent patellar dislocation and underwent either MPFL-R or MPFC-R (combined reconstruction of MPFL and medial quadriceps tendon-femoral ligament) were retrospectively analyzed. Group allocation was based on surgical procedure and patient characteristics were collected. Clinical assessments included patient-reported outcome measures (PROMs) and return-to-sports rates. Minimal clinically important difference analysis was performed. A subgroup analysis of PROMs was carried out between patients with an Insall-Salvati index ≤1.2 versus >1.2. The patellar tilt angle, lateral patellar displacement, and bisect offset ratio were measured pre- and postsurgery. Functional failures and complications were assessed. RESULTS Overall, 70 patients (72 knees) in the MPFL-R group and 58 patients (61 knees) in the MPFC-R group were included. Patient characteristics were comparable between the groups. At a minimum follow-up of 24 (mean, 50.6 ± 22.1) months, all PROMs were substantially improved (P < .001), without significant intergroup differences. The percentages of patients reaching the minimal clinically important difference were similar after MPFL-R and MPFC-R: 98.6% versus 93.4% (International Knee Documentation Committee), 97.2% versus 98.4% (Lysholm), 98.6% versus 100% (Kujala), and 77.8% versus 72.1% (Tegner). The subgroup analysis based on patellar height and the return-to-sport rates also suggested comparable results. Radiographic evaluation demonstrated significantly smaller lateral patellar displacements (P = .004) and bisect offset ratios (P < .001) but similar patellar tilt angles after MPFC-R. Four (5.6%) patients receiving MPFL-R and 2 (3.3%) patients receiving MPFC-R reported recurrence of functional instability, without statistically significant difference. CONCLUSIONS MPFC-R resulted in similar overall clinical and radiographic outcomes to MPFL-R in treating recurrent patellar dislocation. MPFC-R might not provide additional benefits for patients with an Insall-Salvati index >1.2. LEVEL OF EVIDENCE Level IV, therapeutic, retrospective cohort study.
Collapse
Affiliation(s)
- Fengyi Hu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Cheng Wang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Yingying Du
- Peking University Health Science Center, Beijing, China
| | - Zejing Guo
- Peking University Health Science Center, Beijing, China
| | - Keying Zhang
- Peking University Health Science Center, Beijing, China
| | - Yong Ma
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Yuping Yang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Xi Gong
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Haijun Wang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Ping Liu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Weili Shi
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China.
| |
Collapse
|
12
|
Schneble CA. Detailed Assessment of Confounders is Necessary for Valid Interpretation of the Results in Patellofemoral Cartilage Restoration Studies. Arthroscopy 2024:S0749-8063(24)00255-X. [PMID: 38554813 DOI: 10.1016/j.arthro.2024.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 03/21/2024] [Indexed: 04/02/2024]
Abstract
Cartilage restoration procedures have gained increased traction over the years as a treatment for chondral defects in relatively younger patients. A critical assessment of study populations for confounders is vital in order to interpret results in a valid manner. This is particularly true when assessing outcomes of cartilage restoration procedures in the patellofemoral compartment given substantial heterogeneity amongst patients within study populations. Patients often undergo additional procedures (prior or concomitant), have variable anatomy (malalignment, maltracking, and trochlear dysplasia), and variable chondral defect sizes, depths, and locations (lateral patellar facet, medial patellar facet, median patellar ridge, trochlea). Without an assessment of study populations for potential confounders that may influence the results, limited conclusions can be gleaned from any results pertaining to the outcomes of cartilage restoration procedures within the patellofemoral joint. Finally, there are many choices for cartilage restoration (osteochondral autografting, osteochondral allografting, autologous chondrocyte implantation, autologous matrix-induced chondrogenesis and PJAC), different clinical situations where one may confer benefit over the other, yet all seem to result in significant improvement for patients with acceptable failure rates.
Collapse
|
13
|
Tomasevich KM, Kantor AH, Metz AK, Hanson IT, Froerer DL, Rosenthal RM, Aoki SK. Mid-term outcomes of temporary medial distal femoral hemiepiphysiodesis with and without medial patellofemoral ligament repair for recurrent patellar instability in skeletally immature patients with genu valgum. J Pediatr Orthop B 2024; 33:119-129. [PMID: 37610091 DOI: 10.1097/bpb.0000000000001102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Genu valgum contributes to patellar instability, though outcomes following temporary hemiepiphysiodesis via eight plating are less understood. The purpose of this study was to evaluate the outcomes and need for additional procedures following temporary hemiepiphysiodesis for the treatment of pediatric genu valgum and patellar instability, as well as evaluating the utility of a concurrent medial patellofemoral ligament (MPFL) repair. Patients who underwent medial distal femoral epiphysiodesis for the treatment of genu valgum and recurrent patellar instability were identified. Inclusion criteria were minimum 1-year follow-up and lack of concurrent ligamentous reconstruction. Patients were contacted to complete a questionnaire which included the International Knee Documentation Committee (IKDC) form and questions pertaining to knee function and patient satisfaction. Thirty-one patients aged 12.0 ± 1.9 years underwent 47 guided growth procedures and were included in final analysis. Seventeen knees (36%) required subsequent surgery for patellar instability. All patients requiring subsequent surgery were female, compared with 70% of patients not requiring subsequent surgery ( P = 0.017). The MPFL repair group underwent fewer subsequent procedures to address instability, though this difference was NS (17 vs. 46%, P = 0.318). Mean IKDC score at 5.3 years follow-up among 18 survey respondents was 78.6. Medial distal femoral hemiepiphysiodesis may partially address recurrent patellar instability in skeletally immature patients with genu valgum. Concurrent MPFL repair may minimize the need for subsequent procedures to address recurrent instability. While correcting alignment may be helpful, patients should be aware of the potential need for further patellar instability surgery. Level of evidence: IV, case series.
Collapse
Affiliation(s)
| | - Adam H Kantor
- Department of Orthopaedic Surgery, University of Utah
| | - Allan K Metz
- Department of Orthopaedic Surgery, University of Utah
| | | | - Devin L Froerer
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | | | | |
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
Perez AR, Coladonato C, Sonnier JH, Saucedo ST, Avendano JP, Corvi J, Campbell M, Tjoumakaris FP, Cohen SB, Ciccotti MC, Freedman KB. Patients With First-Time or Recurrent Patellar Dislocation Have a Similar High Rate and Extent of Articular Cartilage Injury Observed on Magnetic Resonance Imaging. Arthrosc Sports Med Rehabil 2024; 6:100849. [PMID: 38261848 PMCID: PMC10794921 DOI: 10.1016/j.asmr.2023.100849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/20/2023] [Indexed: 01/25/2024] Open
Abstract
Purpose To use magnetic resonance imaging (MRI) scans to compare the prevalence of articular cartilage damage in patients with a single patellar dislocation versus those with multiple dislocations and to compare the locations and severity of chondral injury between the groups. Methods Patients with patellar dislocation between January 2017 and July 2021 were retrospectively identified. Patients with a documented history of patellar dislocation and an MRI scan of the affected knee were included. Patients with articular cartilage injury prior to the dislocation event were excluded. Articular cartilage injury was graded using a validated system: AMADEUS (Mean Total Area Measurement and Depth & Underlying Structures). Caton-Deschamps Index (CDI) scores and Dejour classifications of trochlear dysplasia were also collected. Data were calculated by performing t tests, Mann-Whitney tests, and χ2 or Fisher Exact tests to calculate P values for categorical data. Results In total, 233 patients were included: 117 with primary dislocations and 116 with recurrent dislocations. Articular cartilage injuries were present in 51 patients with primary dislocations (43.6%) and 68 patients with recurrent dislocations (58.6%, P = .026). On comparison of the groups, the recurrent group contained a significantly larger proportion of female patients (65.5% vs 46.2%, P = .004). There was no difference in lesion size, subchondral bone defect, presence of bone edema, or total AMADEUS score between groups (P = .231). Caton-Deschamps Index scores were not significant when comparing between groups; however, the Dejour classifications showed higher grades in the recurrent group (P = .013 for A-D grading scale and P = .005 for high/low grading scale). Subgroup analysis revealed that when cartilage damage was present, patients from the primary group had significantly more full-thickness lesions (P < .001) and lower AMADEUS scores (P = .016). Conclusions There was a similarly high prevalence of cartilage injury seen on MRI after both a primary patellar dislocation and a recurrent patellar dislocation. Chondral injury primarily affected the medial and lateral patellar facets and the lateral femoral condyle in both the primary and recurrent dislocation groups. However, the primary group showed an increased number of full-thickness lesions. There was no difference in lesion size, subchondral bone defect, presence of bone edema, or total AMADEUS score between the primary and recurrent groups. Level of Evidence Level III, retrospective comparative prognostic investigation.
Collapse
Affiliation(s)
- Andres R. Perez
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
| | - Carlo Coladonato
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
| | | | - Samuel T. Saucedo
- Drexel University College of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - John P. Avendano
- Robert Wood Johnson Medical School, New Brunswick, New Jersey, U.S.A
| | - John Corvi
- Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, New York, U.S.A
| | - Mike Campbell
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
| | | | - Steven B. Cohen
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
| | | | | |
Collapse
|
16
|
Wu Y, Zhou J, Li Y, Yu H, Li W, Guo P, Han Z, Guo L, Ma Z. Changes in the femoral trochlear induced with estradiol exposure, an experimental study on rats. J Orthop Surg (Hong Kong) 2024; 32:10225536241228344. [PMID: 38268395 DOI: 10.1177/10225536241228344] [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] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND It is well known that estrogen is closely related to bone and joint tissue. Findings indicate that estradiol, injected during pregnancy, passes through the placental barrier and reaches the fetuses in utero where it exerts its action. Since trochlea appears well established in the prenatal period, however, whether trochlear dysplasia is related to estradiol exposure has not been confirmed, and the pathological process of estradiol exposure-induced trochlear dysplasia remains unclear. This study aimed to establish an estradiol exposure animal model in fetuses and to analyze the morphology of the femoral trochlear in neonatal rats. METHODS 30 pregnant Wistar rats provided by the local Animal Center were assigned randomly into three groups, a high dose estradiol injection group, a low dose estradiol injection group and a blank control group. Gross, cross-sectional observation, histological staining measurement and microcomputed tomography of the rat offspring were conducted to evaluate the morphological changes of the femoral trochlea. RESULTS The incidence of trochlear dysplasia increased with the concentration of estradiol injection. Gross and cross-sectional observation showed a shallower trochlea groove in two groups with estradiol injection. Histological staining measurement indicated that the trochlear sulcus angle and trochlear sulcus depth were significantly different between the two groups with estradiol injection and the blank control group at 0,5 and 10 days after birth. Subchondral bone loss was observed in the two estradiol injection groups by micro-CT, and the bone loss was found to deteriorate over time. CONCLUSION In this study, estradiol exposure in fetuses had an adverse effect on intrauterine development and could induce trochlear dysplasia and bone loss in rat offspring. In addition, this study also showed that the higher concentration of estradiol injection in pregnant rats, the more incidence of trochlear dysplasia in rat offspring.
Collapse
Affiliation(s)
- Yu Wu
- Department of Orthopaedics Surgery, Baoding No 1 Central Hospital, Baoding, People's Republic of China
| | - Jin Zhou
- Department of Orthopaedics Surgery, Baoding No 1 Central Hospital, Baoding, People's Republic of China
| | - Yanjun Li
- Department of Orthopaedics Surgery, Baoding No 1 Central Hospital, Baoding, People's Republic of China
| | - Hetong Yu
- Department of Orthopaedics Surgery, Baoding No 1 Central Hospital, Baoding, People's Republic of China
| | - Weifeng Li
- Department of Orthopaedics Surgery, Baoding No 1 Central Hospital, Baoding, People's Republic of China
| | - Pengfei Guo
- Department of Orthopaedics Surgery, Baoding No 1 Central Hospital, Baoding, People's Republic of China
| | - Zitao Han
- Department of Orthopaedics Surgery, Baoding No 1 Central Hospital, Baoding, People's Republic of China
| | - Lan Guo
- Department of Orthopaedics Surgery, Baoding No 1 Central Hospital, Baoding, People's Republic of China
| | - Zhanbei Ma
- Department of Orthopaedics Surgery, Baoding No 1 Central Hospital, Baoding, People's Republic of China
| |
Collapse
|
17
|
Yi Z, Jiang J, Liu J, Ma M, Chen Y, Teng F, Yang A, Liu Z, Geng B, Xia Y, Wu M. Prevalence and Site of Concomitant Osteochondral Injuries in Patients With Acute Lateral Patellar Dislocation: A Systematic Review and Meta-analysis. Orthop J Sports Med 2024; 12:23259671231220904. [PMID: 38274015 PMCID: PMC10809874 DOI: 10.1177/23259671231220904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 07/31/2023] [Indexed: 01/27/2024] Open
Abstract
Background Osteochondral injuries (OCIs) are common in patients with acute lateral patellar dislocation, which can produce both short- and long-;term adverse effects. However, the pattern of these injuries warrants further analysis, especially in relation to patient age. Purpose To determine the overall prevalence of concomitant OCIs as well as the prevalence differences based on location and age after acute lateral patellar dislocations. Study Design Systematic review; Level of evidence, 4. Methods A comprehensive search of PubMed, Embase, Web of Science, and Cochrane Library was completed from inception to July 20, 2022. All articles reporting the prevalence of OCI were included. The sample characteristics such as age, study design, magnetic resonance imaging diagnostic data, and the number of patients with OCI were extracted. The Methodological Index for Non-Randomized Studies (MINORS) was used for quality assessment. The overall and per-;site injury rates were calculated, and the prevalence was stratified by age-;group (≤16 and >16 years) and compared. Results The systematic review included 39 studies involving 3354 patients. MINORS scores were 11.94 ± 1.98 and 16 ± 3.46 in the noncomparative and comparative studies, respectively. The overall prevalence of bone bruises and OCI was 89.6% (95% CI, 77.4%-97.7%) and 48.8% (95% CI, 39.0%-58.7%), respectively. In both overall and >16-year-old patients, the lateral femoral condyle (LFC) was the most common site of bone bruise (90.5% [95% CI, 84.0%-95.6%] and 91.5% [95% CI, 84.3%-96.9%], respectively); however, the medial patellar bruise was more common in patients ≤16 years (89.2% [95% CI, 82.9%-94.4%]). Among the pooled sites of OCI, the medial patella accounted for the largest proportion (36.9% [95% CI, 28.0%-46.3%]). OCIs were more common in patients >16 years (52.6% [95% CI, 39.4%-65.6%]) than in patients ≤16 years (46.6% [95% CI, 33.2%-60.3%]). Conclusion Bone bruises on the LFC were most prevalent overall and in patients >16 years, whereas bone bruises on the medial patella were more prevalent in patients ≤16 years. OCIs were frequently seen in patients >16 years, with the most common site being the medial patella.
Collapse
Affiliation(s)
- Zhi Yi
- Department of Orthopaedics, Lanzhou University Second Hospital, Orthopedic Clinical Medical Research Center of Gansu Province, Intelligent Orthopedic Industry Technology Center of Gansu Province, Lanzhou, Gansu, China
| | - Jin Jiang
- Department of Orthopaedics, Lanzhou University Second Hospital, Orthopedic Clinical Medical Research Center of Gansu Province, Intelligent Orthopedic Industry Technology Center of Gansu Province, Lanzhou, Gansu, China
| | - Jinmin Liu
- Department of Orthopaedics, Lanzhou University Second Hospital, Orthopedic Clinical Medical Research Center of Gansu Province, Intelligent Orthopedic Industry Technology Center of Gansu Province, Lanzhou, Gansu, China
| | - Ming Ma
- Department of Orthopaedics, Lanzhou University Second Hospital, Orthopedic Clinical Medical Research Center of Gansu Province, Intelligent Orthopedic Industry Technology Center of Gansu Province, Lanzhou, Gansu, China
| | - Yi Chen
- Department of Orthopaedics, Lanzhou University Second Hospital, Orthopedic Clinical Medical Research Center of Gansu Province, Intelligent Orthopedic Industry Technology Center of Gansu Province, Lanzhou, Gansu, China
| | - Fei Teng
- Department of Orthopaedics, Lanzhou University Second Hospital, Orthopedic Clinical Medical Research Center of Gansu Province, Intelligent Orthopedic Industry Technology Center of Gansu Province, Lanzhou, Gansu, China
| | - Ao Yang
- Department of Orthopaedics, Lanzhou University Second Hospital, Orthopedic Clinical Medical Research Center of Gansu Province, Intelligent Orthopedic Industry Technology Center of Gansu Province, Lanzhou, Gansu, China
| | - Zhongcheng Liu
- Department of Orthopaedics, Lanzhou University Second Hospital, Orthopedic Clinical Medical Research Center of Gansu Province, Intelligent Orthopedic Industry Technology Center of Gansu Province, Lanzhou, Gansu, China
| | - Bin Geng
- Department of Orthopaedics, Lanzhou University Second Hospital, Orthopedic Clinical Medical Research Center of Gansu Province, Intelligent Orthopedic Industry Technology Center of Gansu Province, Lanzhou, Gansu, China
| | - Yayi Xia
- Department of Orthopaedics, Lanzhou University Second Hospital, Orthopedic Clinical Medical Research Center of Gansu Province, Intelligent Orthopedic Industry Technology Center of Gansu Province, Lanzhou, Gansu, China
| | - Meng Wu
- Department of Orthopaedics, Lanzhou University Second Hospital, Orthopedic Clinical Medical Research Center of Gansu Province, Intelligent Orthopedic Industry Technology Center of Gansu Province, Lanzhou, Gansu, China
| |
Collapse
|
18
|
Yu J, Li Y, Zhang K, Yang R, Yang X, Gong M, Long C, Fu W. The accuracy of multiple regression models for predicting the individual risk of recurrent lateral patellar dislocation. BMC Musculoskelet Disord 2023; 24:948. [PMID: 38057697 DOI: 10.1186/s12891-023-07094-2] [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] [Received: 09/20/2023] [Accepted: 12/04/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Recurrent lateral patellar dislocation (RLPD) poses a significant threat to patients' quality of life due to knee pain, patellofemoral cartilage damage, and potential traumatic arthritis. Predictive scoring systems have been developed to assess the risk of RLPD; however, their relative accuracy remains uncertain. PURPOSE To investigate the accuracy of the multiple regression models to predict the individual risk of recurrent LPD. METHODS The Patellar Instability probability calculator (PIP), Recurrent Instability of the Patella Score (RIP), and Patellar Instability Severity Score (PIS) scoring rules were measured in 171 patients with a history of patellar dislocation and 171 healthy individuals. Three prediction models were calculated based on the data to predict the risk of recurrent lateral patellar dislocation. The inter-observer and intra-observer reliability of each measurement parameter was evaluated. The predictive capacity of the three-prediction model was investigated using the receiver operating characteristic curve. RESULTS In the case group of 171 patients, PIS accurately predicted recurrent lateral Patella dislocation in 143 patients. RIP was 96, and PIP was 83. The positive predictive values were 92.9%, 64%, and 68% respectively. In the control group of 171 patients, the PIS was validated in 160 patients who would not experience dislocations. RIP was 117, and PIP was 50. The negative predictive values were 85.1%, 60.9%, and 36.2%, respectively. The area under the curve score for the PIS was 0.866, and the RIP was 0.673. the PIP was 0.678. CONCLUSION RIP and PIP did not work to predict LPD. PIS can accurately predict recurrent lateral patellar dislocation. It can aid doctors in making treatment decisions. LEVEL OF EVIDENCE Level III, retrospective comparative study.
Collapse
Affiliation(s)
- Jiang Yu
- Department of Orthopedic Surgery/Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yijin Li
- Laboratory of Clinical Proteomics and Metabolomics, Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Kaibo Zhang
- Department of Orthopedic Surgery/Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Runze Yang
- Department of Orthopedic Surgery/Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaolong Yang
- Department of Orthopedic Surgery/Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Meng Gong
- Laboratory of Clinical Proteomics and Metabolomics, Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Cheng Long
- Department of Orthopedic Surgery/Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China.
| | - Weili Fu
- Department of Orthopedic Surgery/Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China.
| |
Collapse
|
19
|
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.
Collapse
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
| |
Collapse
|
20
|
Monaco E, Criseo N, Annibaldi A, Carrozzo A, Pagnotta SM, Cantagalli MR, Orlandi P, Daggett M. Medial Patellofemoral Ligament Reconstruction Using Gracilis Tendon Graft and "All Suture" Knotless Anchors for Patellar Fixation. Arthrosc Tech 2023; 12:e2329-e2334. [PMID: 38196870 PMCID: PMC10773230 DOI: 10.1016/j.eats.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/03/2023] [Indexed: 01/11/2024] Open
Abstract
Patellar dislocation is a frequent sports-related knee injury. The primary restraint to lateral translation of patella is medial patellofemoral ligament. Several treatments for patella dislocation have been described in the literature. The purpose of this Technical Note is to describe the surgical technique for medial patellofemoral ligament reconstruction using gracilis tendon and 2 knotless soft anchors, avoiding patella tunneling.
Collapse
Affiliation(s)
- Edoardo Monaco
- Department of Orthopaedic Surgery, S. Andrea Hospital, "Sapienza" University of Rome, Italy
| | - Natale Criseo
- Department of Orthopaedic Surgery, S. Andrea Hospital, "Sapienza" University of Rome, Italy
| | - Alessandro Annibaldi
- Department of Orthopaedic Surgery, S. Andrea Hospital, "Sapienza" University of Rome, Italy
| | - Alessandro Carrozzo
- Department of Orthopaedic Surgery, S. Andrea Hospital, "Sapienza" University of Rome, Italy
| | - Susanna M Pagnotta
- Department of Orthopaedic Surgery, S. Andrea Hospital, "Sapienza" University of Rome, Italy
| | | | - Pierfrancesco Orlandi
- Department of Orthopaedic Surgery, S. Andrea Hospital, "Sapienza" University of Rome, Italy
| | | |
Collapse
|
21
|
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.
Collapse
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.
| |
Collapse
|
22
|
Castagno C, Kneedler S, Fares A, Maier M, Gontre G, Weiss WM. Isolated medial patellofemoral reconstruction outcomes: A systematic review and meta-analysis. Knee 2023; 44:59-71. [PMID: 37531844 DOI: 10.1016/j.knee.2023.07.003] [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: 02/20/2023] [Revised: 06/03/2023] [Accepted: 07/16/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Treatment of patellar instability remains up for debate, and a combination of tibial tubercle osteotomy and medial patellofemoral ligament reconstruction (MPFLr) of the medial patellofemoral ligament (MPFL) has become the mainstay treatment for recurrent lateral patellar dislocation. Due to limited small studies, there remains a variety of surgical techniques still being practiced. The use of MPFL reconstruction, in isolation, has demonstrated promise. PURPOSE The purpose of this systematic review and meta-analysis is to investigate if isolated medial patellofemoral ligament reconstruction (iMPFLr) can safely and efficaciously restore knee stability and to present the patient demographics, surgical techniques, graft choices, clinical outcomes, and complications after iMPFLr for recurrent patellar dislocation (RPD). METHODS A review of the current literature according to Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, yielded 299 abstracts. Twenty-seven articles met the inclusion/exclusion criteria accounting for 1200 patients. Data was pooled and analyzed focusing on patient demographics, graft type used, Kujala, International Knee Documentation Committee (IKDC), Lysholm, Tegner, and complications. RESULTS Across all studies the weighted mean age was found to be an average of 24.5 years, BMI was 24.9 kg/m2, follow-up was 47.3 months, as 67% were female, TT-TG distance was 15.3 mm, and Caton Deschamps index 1.11. The pooled effect size difference of pre versus post assessment of Kujala was -2.8, IKDC was -4.5, Lysholm was -6.4, and Tegner was -0.74. The pooled complication rate was found to be 8% across all included studies. A subgroup analysis was also performed, specifically looking at how single bundle, double bundle, gracilis, semitendinosus and knee angle during fixation effect outcome data. CONCLUSION This systematic review and meta-analysis demonstrates that isolated MPFL reconstruction is a safe and effective treatment for recurrent patellar dislocations. Given the efficacy of isolated MPFL reconstruction, future investigations should aim to uncover the exact TT-TG distance, trochlear dysplasia, and patella alta grade for selecting patients to undergo this procedure. Furthermore, more primary research needs to be conducted on this topic due to the overall lack of published data from randomized controlled studies and no broad standardization of outcome measurements. LEVEL OF EVIDENCE (4) Systematic Review and Meta-Analysis.
Collapse
Affiliation(s)
- Christopher Castagno
- Texas Tech University Health Science Center, Paul Foster School of Medicine, El Paso, TX, USA.
| | - Sterling Kneedler
- Department of Orthopedic Surgery & Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA
| | - Austin Fares
- Orthopedic Surgery and Sports Medicine, William Beaumont Army Medical Center, Fort Bliss, TX, USA
| | - Michael Maier
- Orthopedics and Sports Medicine, Baylor College of Medicine and St. Luke's Medical, Sugar Land, TX, USA
| | - Gil Gontre
- Texas Tech University Health Science Center, Paul Foster School of Medicine, El Paso, TX, USA; Texas Tech University Health Science Center, Department of Orthopedics & Rehabilitation, El Paso, TX, USA
| | - William M Weiss
- Orthopedic Sports Medicine, Arthroscopy, & Extremity Reconstruction; Department of Orthopedic Surgery & Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA
| |
Collapse
|
23
|
Li S, Gao L, Gong H, Cao L, Zhou J, Ke L, Liu Y, Tong Z, Li W. Recurrence rates and risk factors for recurrence after first episode of acute pancreatitis: A systematic review and meta-analysis. Eur J Intern Med 2023; 116:72-81. [PMID: 37330318 DOI: 10.1016/j.ejim.2023.06.006] [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: 03/15/2023] [Revised: 06/09/2023] [Accepted: 06/10/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND There are a certain number of acute pancreatitis (AP) patients who may suffer from multiple episodes and develop recurrent acute pancreatitis (RAP), but recurrence rates and associated risk factors for RAP vary significantly in the published literature. METHODS We searched PubMed, Web of Science, Scopus, and Embase databases to identify all publications reporting AP recurrence until October 20th, 2022. Meta-analysis and meta-regression were performed to calculate the pooled estimates using the random-effects model. RESULTS A total of 36 studies met the inclusion criteria and all were used in pooled analyses. The overall rate of recurrence after first-time AP was 21% (95% CI, 18%- 24%), and pooled rates in biliary, alcoholic, idiopathic, and hypertriglyceridemia etiology patients were 12%, 30%, 25%, and 30%, respectively. After managing underlying causes post-discharge, the recurrence rate decreased (14% versus 4% for biliary, 30% versus 6% for alcoholic, and 30% versus 22% for hypertriglyceridemia AP). An increased risk of recurrence was reported in patients with a smoking history (odds ratio [OR] = 1.99), alcoholic etiology (OR = 1.72), male sex (hazard ratio [HR] = 1.63), and local complications (HR = 3.40), while biliary etiology was associated with lower recurrence rates (OR = 0.38). CONCLUSION More than one-fifth of AP patients experienced recurrence after discharge, with the highest recurrence rate in alcoholic and hypertriglyceridemia etiologies, and managing underlying causes post-discharge was related to decreased incidence. In addition, smoking history, alcoholic etiology, male gender, and presence of local complications were independent risks for the recurrence.
Collapse
Affiliation(s)
- Shuai Li
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, No. 305 Zhongshan East Road, Nanjing, Jiangsu 210002, China
| | - Lin Gao
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, No. 305 Zhongshan East Road, Nanjing, Jiangsu 210002, China
| | - Haowen Gong
- Department of Medical Statistics, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu 210002, China
| | - Longxiang Cao
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, No. 305 Zhongshan East Road, Nanjing, Jiangsu 210002, China
| | - Jing Zhou
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, No. 305 Zhongshan East Road, Nanjing, Jiangsu 210002, China; Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), Jinling Hospital, Medical School of Nanjing Medical University, No. 305 Zhongshan East Road, Nanjing, Jiangsu 210002, China.
| | - Lu Ke
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, No. 305 Zhongshan East Road, Nanjing, Jiangsu 210002, China; Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), Jinling Hospital, Medical School of Nanjing Medical University, No. 305 Zhongshan East Road, Nanjing, Jiangsu 210002, China; National Institute of Healthcare Data Science, Nanjing University, Nanjing, Jiangsu 210010, China
| | - Yuxiu Liu
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, No. 305 Zhongshan East Road, Nanjing, Jiangsu 210002, China; Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), Jinling Hospital, Medical School of Nanjing Medical University, No. 305 Zhongshan East Road, Nanjing, Jiangsu 210002, China; Department of Medical Statistics, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu 210002, China
| | - Zhihui Tong
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, No. 305 Zhongshan East Road, Nanjing, Jiangsu 210002, China; Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), Jinling Hospital, Medical School of Nanjing Medical University, No. 305 Zhongshan East Road, Nanjing, Jiangsu 210002, China
| | - Weiqin Li
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, No. 305 Zhongshan East Road, Nanjing, Jiangsu 210002, China; Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), Jinling Hospital, Medical School of Nanjing Medical University, No. 305 Zhongshan East Road, Nanjing, Jiangsu 210002, China; National Institute of Healthcare Data Science, Nanjing University, Nanjing, Jiangsu 210010, China.
| |
Collapse
|
24
|
Samelis PV, Koulouvaris P, Savvidou O, Mavrogenis A, Samelis VP, Papagelopoulos PJ. Patellar Dislocation: Workup and Decision-Making. Cureus 2023; 15:e46743. [PMID: 38021800 PMCID: PMC10631568 DOI: 10.7759/cureus.46743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2023] [Indexed: 12/01/2023] Open
Abstract
Acute patellar dislocation (PD) is usually a problem of adolescents and young adults. In most cases, it is a sports-related injury. It is the result of an indirect force on the knee joint, which leads to valgus and external rotation of the tibia relative to the femur. PD is unlikely to occur on a knee with normal patellofemoral joint (PFJ) anatomy. Acute PD consists of an acute injury of the ligamentous medial patellar stabilizers in the background of factors predisposing to patellar instability. These factors are classified into three groups. The first group refers to the integrity of the ligamentous medial patellar restraints, particularly, the medial patellofemoral ligament (MPFL). The second group refers to an abnormal PFJ anatomy, which renders the patella inherently unstable inside the trochlea. The third group refers to the overall axial and torsional profile of the lower limb and to systemic factors, such as ligament laxity and neuromuscular coordination of movement. PD at a younger age is associated with an increased number and severity of patellar instability predisposing factors and lower stress to dislocate the patella. Acute primary PD is usually treated conservatively, while surgical treatment is reserved for recurrent PD. The aim of treatment is to restore the stability and function of the PFJ and to reduce the risk of patellar redislocation. Surgical procedures to treat patellar instability are classified into non-anatomic and anatomic procedures. Non-anatomic procedures are extensor mechanism realignment techniques that aim to center the patella into the trochlear groove. Anatomic procedures aim to restore the PFJ anatomy (ruptured ligaments, osteochondral fractures), which has been severed after the first incident of PD. Anatomic procedures, especially MPFL reconstruction, are more effective in preventing recurrent PD, compared with non-anatomic techniques. Theoretically, all factors that affect PFJ stability should be evaluated and, if possible, addressed. This is practically impossible. Considering that the MPFL ruptures in almost all PDs, MPFL reconstruction is the primary procedure, which is currently selected by most surgeons as a first-line treatment for patients with recurrent PD. Restoration of the axial and torsional alignment of the lower limbs is also increasingly implemented by surgeons. Non-anatomic surgical techniques, such as tibial-tuberosity osteotomy, are used as an adjunct to anatomic procedures. In the presence of multiple PFJ instability factors, acute MPFL reconstruction may be the treatment of choice for acute primary PD as well. Skeletal immaturity of the patient precludes osseous procedures to avoid premature physis closure and subsequent limb deformity. Unfortunately, restoration of the patient's previous activity level or participation in more strenuous sports is questionable and not easy to predict. In the case of competitive athletes, PD may prevent participation in elite levels of sports.
Collapse
Affiliation(s)
- Panagiotis V Samelis
- Orthopaedics, Children's General Hospital Panagiotis and Aglaia Kyriakou, Athens, GRC
- Orthopaedics, Attikon University Hospital, Athens, GRC
| | - Panagiotis Koulouvaris
- Orthopaedic Surgery, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Olga Savvidou
- Orthopaedics, Attikon University Hospital, Athens, GRC
| | - Andreas Mavrogenis
- Orthopaedics, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | | | - Panayiotis J Papagelopoulos
- Orthopaedic Surgery, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
- Orthopaedics, Attikon University Hospital, Athens, GRC
| |
Collapse
|
25
|
Deo H, Mohamed R, Ahmed G. Medium-term outcome of medial patellofemoral ligament reconstruction using synthetic graft. Knee 2023; 44:220-226. [PMID: 37672914 DOI: 10.1016/j.knee.2023.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/15/2023] [Accepted: 08/04/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Recurrent patella instability is a common and debilitating condition which affects mainly adolescents and young adults. Medial patellofemoral ligament (MPFL) reconstruction is the most popular surgical treatment for recurrent patella instability. The most common graft choice in the literature is ipsilateral hamstring tendon (gracilis or semitendinosis) but the complication rate remains high (11-26%). Conversely, there are very few papers on the use of modern, synthetic grafts. METHODS A total of 85 patients who underwent MPFL reconstruction using a modern, synthetic graft (Xiros, UK) from 2014 to 2022 were retrospectively reviewed. Exclusion criteria were patella alta, malalignment, trochlea dysplasia and significant pain between episodes of instability. The author has developed an operative technique which is anatomic, minimally invasive and reproducible. Pre- and post-operative Kujala and Oxford knee scores were collected and analysed. RESULTS The male to female ratio was 27:58, the average age was 28 years, and the follow up range was 1-9 years (mean follow up 4.84 years). We found a statistically significant improvement in mean Kujala and Oxford knee scores (P < 0.001) postoperatively. No major complications such as knee stiffness, soft tissue reaction, re-dislocation, patella fracture were identified in the series. There were nine minor complications (10.6%): five cases of medial knee pain, two cases of residual instability and two of superficial infection. CONCLUSION This study demonstrates that modern, synthetic graft is a viable option for MPFL reconstruction. The technique described, achieves good clinical outcomes with low complication rates when compared with the published literature.
Collapse
Affiliation(s)
- Hersh Deo
- James Paget University Hospital NHS Foundation Trust, Great Yarmouth, UK.
| | - Ramy Mohamed
- James Paget University Hospital NHS Foundation Trust, Great Yarmouth, UK
| | - Genena Ahmed
- James Paget University Hospital NHS Foundation Trust, Great Yarmouth, UK
| |
Collapse
|
26
|
Zhou K, Sun Z, Feng A, Guo H, Sun R, Niu Y, Liu L, Wang X. Derotational distal femur osteotomy combined with medial patellofemoral ligament reconstruction yields satisfactory results in recurrent patellar dislocation with excessive femoral anteversion angle and trochlear dysplasia. Knee Surg Sports Traumatol Arthrosc 2023; 31:4347-4354. [PMID: 37340219 DOI: 10.1007/s00167-023-07476-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 06/01/2023] [Indexed: 06/22/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the clinical outcomes of medial patellofemoral ligament (MPFL) reconstruction combined with derotational distal femur osteotomy in patients with recurrent patellar dislocation who had excessive femoral anteversion angle and trochlear dysplasia. METHODS Between 2015 and 2020, 64 patients (64 knees) with recurrent patellar dislocation, who had excessive femoral anteversion angle (≥ 25°) and trochlear dysplasia and were surgically treated using derotational distal femur osteotomy and MPFL reconstruction, were eligible for this retrospective study. These patients were assigned to two groups according to the grade of trochlear dysplasia. Group A (type A trochlear dysplasia, n = 33) and Group B (type B, C, D trochlear dysplasia, n = 31). Preoperative and postoperative patellar tilt angle (PTA), Caton-Deschamps index (CD-I), tibial tubercle-trochlear groove (TT-TG) distance and femoral anteversion angle were evaluated. Patient outcomes were assessed using the preoperative and postoperative International Knee Documentation Committee (IKDC) score, Kujala score, Lysholm score, Tegner score, and visual analog scale (VAS) score. RESULTS A total of 64 patients (64 knees) were evaluated in this study, with a mean follow-up period of 28.4 ± 3.6 months. There were no cases of wound infection, osteotomy site fractures, deep venous thrombosis of the lower extremities, or re-dislocation in the two groups during the postoperative follow-up period. All patients returned to full extension and flexion. The postoperative Tegner score, Lysholm score, Kujala score, IKDC score, VAS score, PTA, CD-I, TT-TG distance, and femoral anteversion angle were significantly improved compared with the preoperative status (P < 0.05). There was no significant difference between the two groups (n.s.). CONCLUSION MPFL reconstruction combined with derotational distal femur osteotomy showed satisfactory clinical outcomes during follow-up in patients with recurrent patellar dislocation who had excessive femoral anteversion angle and trochlear dysplasia. Even patients with high-grade trochlear dysplasia showed satisfactory results. For those patients, additional surgery is not necessary. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Kezhen Zhou
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Zhiwen Sun
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Ao Feng
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Hailong Guo
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Ran Sun
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Yingzhen Niu
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Lei Liu
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Xiaofeng Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China.
| |
Collapse
|
27
|
Fithian AT, Richey AE, Sherman SL, Shea KG, Pun SY. Association of Hip Dysplasia With Trochlear Dysplasia in Skeletally Mature Patients. Orthop J Sports Med 2023; 11:23259671231200805. [PMID: 37822419 PMCID: PMC10563471 DOI: 10.1177/23259671231200805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 05/19/2023] [Indexed: 10/13/2023] Open
Abstract
Background Developmental dysplasia of the hip (DDH) and trochlear dysplasia (TD) are distinct pathologies with several important features in common. In addition to shared risk factors, both forms of dysplasia cause abnormal joint kinematics and force transmission, predisposing patients to pain, injuries to cartilage and soft tissue stabilizers, and ultimately arthritis. Purpose To evaluate for an association between hip dysplasia and TD in skeletally mature patients with symptomatic hip dysplasia. Study Design Cross-sectional study; Level of evidence, 3. Methods A total of 48 patients with DDH who underwent periacetabular osteotomy were compared with 48 sex-matched patients who underwent hip arthroscopy for femoroacetabular impingement (FAI) between July 2014 and February 2021. All patients were skeletally mature. The Tönnis angle and lateral center-edge angle were measured on preoperative pelvis radiographs. Femoral version, trochlear depth, lateral trochlear inclination (LTI), tibial tubercle-trochlear groove distance (TTTG-d), and posterior lateral condylar angle (PLCA) were measured on preoperative magnetic resonance imaging scans of the symptomatic hip and ipsilateral knee. Continuous variables were compared between the patient groups using 2-sample t tests. Interobserver reliability was measured using the intraclass correlation coefficient. Results Patients with DDH demonstrated a reduced trochlear depth compared with patients with FAI (3.6 vs 4.6 mm; P < .001). There were no differences between groups in femoral anteversion, LTI, TTTG-d, or PLCA. Two (4.2%) patients with FAI and 17 (35.4%) patients with DDH had a trochlear depth <3 mm (P < .001). One (2.1%) patient with FAI and 7 (14.6%) patients with DDH had an LTI <11° (P = .027). There was no difference between groups in frequency of a convex proximal trochlea, patient-reported ipsilateral knee pain, or ipsilateral knee procedures. Conclusion Patients with DDH had reduced trochlear depth compared with patients with FAI, demonstrating a higher incidence of dysplastic trochlear features that may predispose patients to patellofemoral joint disease. Further research is needed to determine whether screening at-risk patients and treating TD will help to prevent symptomatic patellofemoral disease.
Collapse
Affiliation(s)
- Andrew T. Fithian
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Ann E. Richey
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Seth L. Sherman
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Kevin G. Shea
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Stephanie Y. Pun
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| |
Collapse
|
28
|
Johnson EE, Campbell MP, Reddy M, Paul RW, Erickson BJ, Tjoumakaris FP, Freedman KB, Bishop ME. Differences in the Severity and Location of Patellofemoral Cartilage Damage Between Instability Patients With and Without Patella Alta. Orthop J Sports Med 2023; 11:23259671231186823. [PMID: 37533500 PMCID: PMC10392508 DOI: 10.1177/23259671231186823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/11/2023] [Indexed: 08/04/2023] Open
Abstract
Background Patella alta is a risk factor for recurrent patellar instability. Differences in chondral injury in patients with patellar instability between patella alta and patella norma have not been evaluated. Purpose To analyze whether preoperative cartilage damage differs in severity and location between patellar instability patients with and without patella alta. Study Design Cohort study; Level of evidence, 3. Methods Patients with patellar instability who underwent patellar realignment surgery at a single institution with preoperative magnetic resonance imaging (MRI) scans were included. After measurement of Caton-Deschamps index (CDI) on MRI, patients were divided into patella alta (CDI ≥1.3) and patella norma groups. The area measurement and depth and underlying structures (AMADEUS) score was used to quantify cartilage defect severity on MRI. Results A total of 121 patients were divided into patella alta (n = 50) and patella norma (n = 71) groups. The groups did not differ significantly in sex ratio, age at MRI, body mass index, mean reported number of previous dislocations, or mean interval between first reported dislocation and date of MRI. A total of 34 (68%) of the patella alta group and 44 (62%) of the patella norma group had chondral defects (P = .625) with no significant between-group differences in defect size (P = .419). In both groups, chondral injuries most affected the medial patellar facet (55% in patella alta vs 52% in patella norma), followed by the lateral facet (25% vs 18%), and lateral femoral condyle (10% vs 14%). A smaller proportion of patients had full-thickness defects in the patella alta compared with the patella norma group (60% vs 82%; P = .030). The overall AMADEUS score was higher for the patella alta versus the patella norma group (68.9 vs 62.1; P = .023), indicating superior articular cartilage status. Conclusion Patients with patella alta had less severe cartilage injury after patellar instability, including a lower proportion with full-thickness defects and better overall cartilage grade. The location of injury when present was similar between alta and norma, with most defects affecting the medial facet, lateral facet, and lateral femoral condyle in descending frequency.
Collapse
Affiliation(s)
- Emma E. Johnson
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | | | - Manoj Reddy
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - Ryan W. Paul
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | | | | | | | | |
Collapse
|
29
|
Moya-Angeler J, Jiménez-Soto C, Maestre-Cano D, de la Torre-Conde C, Sánchez-Jimenez RM, Serrano-García C, Alcaraz-Saura M, García-Paños JP, Salcedo-Cánovas C, Forriol F, León-Muñoz VJ. Early Identification and Treatment of Trochlear Knee Dysplasia. J Pers Med 2023; 13:jpm13050796. [PMID: 37240966 DOI: 10.3390/jpm13050796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 04/29/2023] [Accepted: 05/02/2023] [Indexed: 05/28/2023] Open
Abstract
A shallow sulcus characterizes trochlear dysplasia (TD) of the femoral trochlea, which can lead to chronic pain or instability of the patellofemoral joint. Breech presentation at birth has been identified as a risk factor for developing this condition, which an ultrasound can identify early. Early treatment could be considered at this stage, given the potential for remodelling in these skeletally immature patients. Newborns with breech presentation at birth who meet the inclusion criteria will be enrolled and randomised in equal proportions between treatment with the Pavlik harness and observation. The primary objective is to determine the difference in the means of the sulcus angle between the two treatment arms at two months. Ours is the first study protocol to evaluate an early non-invasive treatment for TD in the newborn with breech presentation at birth using a Pavlik harness. We hypothesised that trochlear dysplasia could be reverted when identified and treated early in life with a simple harness, as it is done with developmental dysplasia of the hip.
Collapse
Affiliation(s)
- Joaquin Moya-Angeler
- Department of Orthopedic Surgery, Hospital Universitario Reina Sofia, 30003 Murcia, Spain
- Instituto de Cirugía Avanzada de Rodilla, 30005 Murcia, Spain
| | | | - Domingo Maestre-Cano
- Department of Orthopedic Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain
| | | | - Regina M Sánchez-Jimenez
- Department of Pediatric Radiology, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain
| | - Cristina Serrano-García
- Department of Pediatric Radiology, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain
| | - Miguel Alcaraz-Saura
- Department of Pediatrics, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain
| | - Juan Pedro García-Paños
- Department of Orthopedic Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain
| | - César Salcedo-Cánovas
- Department of Orthopedic Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain
| | | | - Vicente J León-Muñoz
- Department of Orthopedic Surgery, Hospital Universitario Reina Sofia, 30003 Murcia, Spain
- Instituto de Cirugía Avanzada de Rodilla, 30005 Murcia, Spain
| |
Collapse
|
30
|
Patel NB, Oak SR, Rogers K, Crawford EA. The Onset and Development of Patella Alta in Children With Patellar Instability. J Pediatr Orthop 2023:01241398-990000000-00273. [PMID: 37104788 DOI: 10.1097/bpo.0000000000002420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
BACKGROUND Patella alta is an anatomic risk factor for patellar instability in adolescents that is also linked to the risk factor of trochlear dysplasia. This study aims to determine the age of onset and age-related incidence of patella alta in a pediatric population of patients with patellar instability. We hypothesized that patellar height ratios would not increase with age, suggesting a congenital rather than the developmental origin of patella alta. METHODS A retrospective cross-sectional cohort of patients was collected with the following inclusion criteria: patients aged 5 to 18 who had a knee magnetic resonance imaging performed from 2000 to 2022 and the International Classification of Diseases code for patellar dislocation. Demographic information and details of the patellar instability episode(s) were collected with a chart review. Sagittal magnetic resonance imaging was used to measure Caton-Deschamps Index (CDI) and the Insall-Salvati Ratio (ISR) by 2 observers. Data were analyzed to assess for associations between patellar height ratios and age of the first dislocation and to assess if the proportion of patients categorized as having patella alta changed with age. RESULTS The 140 knees included in the cohort had an average age of 13.9 years (SD=2.40; range: 8-18) and were 55% female. Patella alta was present in 78 knees (55.7%) using CDI>=1.2 and in 59 knees (42.1%) using ISR>=1.3. The earliest age patella alta was observed was at age 8 using CDI>=1.2 and age 10 using ISR>=1.3. There were no statistically significant associations between CDI and age without adjustment (P=0.14) nor after adjustment for sex and body mass index (P=0.17). The proportion of knees above the CDI threshold for patella alta to the knees below the cutoff did not show a significant change with age (P=0.09). CONCLUSIONS Patella alta, as defined by CDI, is seen in patients as young as 8 years old. Patellar height ratios do not change with age in patients with patellar dislocation, suggesting that patella alta is established at a young age rather than developing during the adolescent years. LEVEL OF EVIDENCE Level III-diagnostic, cross-sectional.
Collapse
Affiliation(s)
| | - Sameer R Oak
- University of Michigan Orthopaedic Surgery Department
| | - Kelly Rogers
- University of Michigan Orthopaedic Surgery Department
| | - Eileen A Crawford
- University of Michigan Orthopaedic Surgery Department, Ann Arbor, MI
| |
Collapse
|
31
|
Uimonen M, Ponkilainen V, Mattila VM, Nurmi H, Paloneva J, Repo JP. The influence of primary treatment approach on outcomes in patients with osteochondral fracture after patellar dislocation: a case series. Knee Surg Relat Res 2023; 35:10. [PMID: 37055823 PMCID: PMC10099836 DOI: 10.1186/s43019-023-00186-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/28/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND We characterized the relation of primary treatment approaches to the need of later surgical interventions and the outcomes of patellar dislocation in patients with patellofemoral osteochondral fracture (OCF). METHODS Overall, 134 patients with OCF were categorized in two groups according to treatment approach: primary surgery (operation within 90 days from injury) and conservative treatment. Data on surgical procedures, OCF characteristics, and patellofemoral anatomy were retrospectively collected. To measure subjective outcomes, 54 patients completed the knee-specific patient-reported outcome measures (PROMs) Kujala score, Tegner activity scale, the knee injury and osteoarthritis outcome score (KOOS) quality of life (QoL) subscale, and visual analog scale pain items. RESULTS The mean follow-up time was 4.9 years [standard deviation (SD) 2.7 years]. The primary treatment approach was surgery in 73 patients (54%) and conservative in 61 patients (46%) of whim 18 (30%) needed late surgery. Of primary surgery patients, the OCF was reimplanted in 45 patients (62%) and removed in the rest. Of all patients, 31 needed surgery in the later phase after the primary treatment approach (either reoperation or surgery after insufficient outcome of conservative treatment). In conservatively treated patients, OCF was smaller and patellofemoral joint malformation was more severe than in surgery group. Among patients who completed the PROMs, the outcomes appeared generally acceptable in both groups. CONCLUSIONS Although a majority of the primary treatment approaches for OCF after patellar dislocation were definitive, one-fourth of patients required surgery in the later phase. PROMs did not indicate major differences between the study groups.
Collapse
Affiliation(s)
- Mikko Uimonen
- Department of Surgery, Central Finland Hospital Nova, Hoitajantie 3, 40620, Jyvaskyla, Finland.
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - Ville Ponkilainen
- Department of Surgery, Central Finland Hospital Nova, Hoitajantie 3, 40620, Jyvaskyla, Finland
| | - Ville M Mattila
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Orthopaedics and Traumatology, Unit of Muskuloskeletal Surgery, Tampere University Hospital and University of Tampere, Tampere, Finland
- COXA Hospital for Joint Replacement, Tampere, Finland
| | - Heikki Nurmi
- Department of Surgery, Central Finland Hospital Nova, Hoitajantie 3, 40620, Jyvaskyla, Finland
| | - Juha Paloneva
- Department of Surgery, Central Finland Hospital Nova, Hoitajantie 3, 40620, Jyvaskyla, Finland
- University of Eastern Finland, Kuopio, Finland
| | - Jussi P Repo
- Department of Orthopaedics and Traumatology, Unit of Muskuloskeletal Surgery, Tampere University Hospital and University of Tampere, Tampere, Finland
| |
Collapse
|
32
|
Sharma N, Al-Mouazzen L, Kuiper JH, Gallacher P, Barnett A. Functional outcomes after Medial Patellofemoral Ligament Reconstruction show inverted J-shaped relation with Body Mass Index. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07391-2. [PMID: 37036473 DOI: 10.1007/s00167-023-07391-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 03/10/2023] [Indexed: 04/11/2023]
Abstract
PURPOSE Medial patellofemoral ligament reconstruction (MPFL-R) is a recognised surgical procedure for the treatment of recurrent patellofemoral instability with excellent outcomes reported. The aim of this study is to determine if body mass index can influence these outcomes. METHODS This is a single-centre retrospective analysis of a longitudinal patellofemoral database. Patients with recurrent patellar instability, without patellar alta or severe trochlear dysplasia were treated using a MPFL-R between 2015 and 2019 at The Robert Jones & Agnes Hunt Orthopaedic Hospital. The clinical efficacy following surgery was assessed by Kujula, International Knee Documentation Committee Score (IKDC), and EuroQol-5 score (EQ-5D) at baseline and up to 26 months post-operatively; their safety assessed by complication rate and requirement for further surgery. The effect of Body Mass Index (BMI) on clinical outcome was analysed using linear, curvilinear, and segmented models following propensity score weighting. RESULTS A total of 97 patients (97 Knees, mean age 25y) were analysed. Of these, 61 patients had a BMI < 30 kg/m2 (mean age 23y, mean BMI 24) of which 7 patients (12.3%) required additional surgery. A further 36 patients had a BMI > 30 kg/m2 (mean age 27y, mean BMI 36) of which 2 patients (5.6%) required additional surgery. The re-dislocation rate was 0% in each BMI group. Both groups had a significantly improved mean outcome following surgery, with improvements in mean IKDC above the minimum clinical important differences (MCID) of 20.5. BMI had an inverted J-shaped association with functional outcome, showing peak outcomes at BMI of 20.5 (95% CI 18.5 to 22.4; IKDC and Kujala) or BMI of 28 (EQ-5D index). No evidence for an association between BMI and complication risk was found. CONCLUSION BMI influences the functional outcomes in MPFL-R with an inverted J-shaped relation, without evidence it affected the complication or re-dislocation rate. In the absence of patella alta and severe trochlear dysplasia, an isolated MPFL reconstruction is a safe and effective procedure to treat patellar instability, with the best functional outcome in patients with a BMI around 20 to 21. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- N Sharma
- Robert Jones and Agnes Hunt Orthopaedic Hospital, Gobowen, Oswestry, SY10 7AG, UK.
- , 28 Buckingham Road, Penn, Wolverhampton, WV4-5TJ, UK.
| | - L Al-Mouazzen
- Robert Jones and Agnes Hunt Orthopaedic Hospital, Gobowen, Oswestry, SY10 7AG, UK
| | - J H Kuiper
- Robert Jones and Agnes Hunt Orthopaedic Hospital, Gobowen, Oswestry, SY10 7AG, UK
- Keele University, Stoke-on-Trent, UK
| | - P Gallacher
- Robert Jones and Agnes Hunt Orthopaedic Hospital, Gobowen, Oswestry, SY10 7AG, UK
| | - A Barnett
- Robert Jones and Agnes Hunt Orthopaedic Hospital, Gobowen, Oswestry, SY10 7AG, UK
| |
Collapse
|
33
|
Wei M, Kang H, Hao K, Fan C, Li S, Wang X, Wang F. Increased lower limb length ratio in patients with patellar instability. J Orthop Surg Res 2023; 18:221. [PMID: 36945045 PMCID: PMC10029240 DOI: 10.1186/s13018-023-03720-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/15/2023] [Indexed: 03/23/2023] Open
Abstract
PURPOSE Patellar height is a risk factor for patellar instability, correlated with the tibia length/femur length (T/F) ratio. This study aimed to explore the changes in the T/F ratio in patients with patella instability and the potential correlation with the morphology of the patellofemoral joint and extensor moment arm. METHOD A retrospective analysis was performed to assess the ratio of lower limb length morphological characteristics of the patellofemoral by full weight-bearing long-leg standing radiographs, magnetic resonance imaging, and computed tomography in 75 patients with patellar instability and 75 participants from a randomly selected control group from January 2020 to September 2021. A total of eight parts were measured, including mechanical tibia length/femur length (mT/F) ratio, anatomical tibia length/femur length (aT/F) ratio, hip-knee-ankle angle, femoral neck-shaft angle, femoral valgus cut angle, patellar height, Dejour classification, sulcus angle, trochlear angle, medial trochlear inclination, lateral trochlear inclination, patella tilt angle and patellar tendon moment arm to evaluate the difference of morphology between patient group and control groups. RESULTS The mT/F (0.840 ± 0.031 vs. 0.812 ± 0.026, p < 0.001) and aT/F (0.841 ± 0.033 vs. 0.808 ± 0.028, p < 0.001) ratios in the patient group were significantly greater than that in the control group. There was a significant correlation between patellar height and increased mT/F and aT/F ratios (p < 0.05). CONCLUSION Patients with patellar instability had a larger lower limb length ratio, and the change in lower limb length ratio was correlated with patellar height. LEVEL OF EVIDENCE IV
Collapse
Affiliation(s)
- Maozheng Wei
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Huijun Kang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Kuo Hao
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Chongyi Fan
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Shilun Li
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Xingkai Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Fei Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China.
| |
Collapse
|
34
|
Tanaka MJ, Sodhi A, Wadhavkar I, Kane K, Velasquez Hammerle MV, Mangudi Varadarajan K, Tornetta P. Redefining Trochlear Dysplasia: Normal Thresholds Vary by Measurement Technique, Landmarks, and Sex. Am J Sports Med 2023; 51:1202-1210. [PMID: 36942723 DOI: 10.1177/03635465231158099] [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] [Indexed: 03/23/2023]
Abstract
BACKGROUND Trochlear dysplasia is a known risk factor for patellar instability. Multiple radiographic measurements exist to assess trochlear morphology, but the optimal measurement technique and threshold for instability are unknown. PURPOSE To describe the optimal measurements and thresholds for trochlear dysplasia on magnetic resonance imaging (MRI) that can identify knees with patellar instability in male and female patients. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 3. METHODS Knee MRI scans of patients with patellar instability were compared with those of age- and sex-matched controls. Measurements of the sulcus angle, lateral trochlear inclination (LTI), and trochlear depth were performed on axial images using bony and cartilaginous landmarks. Receiver operating characteristic curve analysis was performed, with the area under the curve (AUC) describing the accuracy of each diagnostic test. Optimal cutoff values were calculated to distinguish between knees with and without patellar instability. AUC and cutoff values were reported for each measurement as well as for male and female subgroups. RESULTS A total of 238 knee MRI scans were included in this study (138 female, 100 male; age range, 18-39 years). Trochlear depth measurements had the greatest diagnostic value, with AUCs of 0.79 and 0.82 on bone and cartilage, respectively. All measurements (sulcus angle, LTI, trochlear depth) on bone and cartilage had an AUC ≥0.7 (range, 0.70-0.86), with optimal cutoff values of 145° (bone) and 154° (cartilage) for the sulcus angle, 17° (bone) and 13° (cartilage) for LTI, and 4 mm (bone) and 3 mm (cartilage) for trochlear depth. Optimal cutoff values in female patients varied from those in male patients for all measurements except for cartilaginous trochlear depth. CONCLUSION Normal thresholds for trochlear dysplasia varied based on the use of bony versus cartilaginous landmarks. Cartilaginous trochlear depth measurements had the greatest ability to identify knees with patellar instability. Furthermore, optimal cutoff values for all measurements except for cartilaginous trochlear depth differed between female and male patients. These findings suggest that sex-specific parameters of normal values may be needed in the assessment of risk factors for patellofemoral instability.
Collapse
Affiliation(s)
- Miho J Tanaka
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Orthopaedic Surgery, Boston University Medical Center, Boston, Massachusetts, USA
| | - Alisha Sodhi
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Orthopaedic Surgery, Boston University Medical Center, Boston, Massachusetts, USA
| | - Isha Wadhavkar
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Orthopaedic Surgery, Boston University Medical Center, Boston, Massachusetts, USA
| | - Kylynn Kane
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Orthopaedic Surgery, Boston University Medical Center, Boston, Massachusetts, USA
| | - Maria V Velasquez Hammerle
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Orthopaedic Surgery, Boston University Medical Center, Boston, Massachusetts, USA
| | - Kartik Mangudi Varadarajan
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Orthopaedic Surgery, Boston University Medical Center, Boston, Massachusetts, USA
| | - Paul Tornetta
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Orthopaedic Surgery, Boston University Medical Center, Boston, Massachusetts, USA
| |
Collapse
|
35
|
Drapeau-Zgoralski V, Swift B, Caines A, Kerrigan A, Carsen S, Pickell M. Lateral Patellar Instability. J Bone Joint Surg Am 2023; 105:397-409. [PMID: 36728086 DOI: 10.2106/jbjs.22.00756] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
➤ Patellar instability represents a common problem with an evolving understanding and multifactorial pathoetiology. Treatment plans should be based on the identification of contributing anatomical factors and tailored to each individual patient. ➤ Risks for recurrent instability are dependent on several patient-specific factors including patella alta, increased tibial tubercle-to-trochlear groove (TT-TG) distance, trochlear dysplasia, younger skeletal age, and ligamentous laxity. ➤ Cartilage or osteochondral lesions and/or fractures are commonly observed in first-time patellar dislocation, and magnetic resonance imaging (MRI) should be strongly considered. Advanced imaging modalities, such as computed tomography (CT) or MRI, should also be obtained preoperatively to identify predisposing factors and guide surgical treatment. ➤ Medial patellofemoral ligament (MPFL) reconstruction with anatomical femoral tunnel positioning is associated with lower recurrence rates compared with MPFL repair and has become a common and successful reconstructive surgical option in cases of instability. ➤ Lateral retinacular tightness can be addressed with lateral retinacular release or lengthening, but these procedures should not be performed in isolation. ➤ Tibial tubercle osteotomy is a powerful reconstructive tool in the setting of underlying skeletal risk factors for instability and can be of particular benefit in the presence of increased TT-TG distance (>20 mm), and/or in the setting of patella alta. ➤ The indications for trochleoplasty are still developing along with the clinical evidence, but trochleoplasty may be indicated in some cases of severe trochlear dysplasia. Several surgical techniques have indications in specific clinical scenarios and populations, and indications, risks, and benefits to each are progressing with our understanding. ➤ Combined femoral derotational osteotomy and MPFL reconstruction can be considered for patients with a femoral anteversion angle of >30° to improve patient outcomes and reduce recurrence rates.
Collapse
Affiliation(s)
| | - Brendan Swift
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Andrew Caines
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Alicia Kerrigan
- Division of Orthopaedic Surgery, The Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Sasha Carsen
- Division of Orthopaedic Surgery, The Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Michael Pickell
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| |
Collapse
|
36
|
Brutico J, Paul RW, Wright M, Destine H, Johnson EE, Bishop ME, Erickson BJ, Freedman KB, Tjoumakaris FP. Preoperative Patella Alta on Caton-Deschamps Index Is a Predictor of Outcome Following Isolated Medial Patellofemoral Ligament Reconstruction. Arthrosc Sports Med Rehabil 2023; 5:e523-e528. [PMID: 37101886 PMCID: PMC10123505 DOI: 10.1016/j.asmr.2023.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 02/14/2023] [Indexed: 03/13/2023] Open
Abstract
Purpose The purpose of this study was to determine whether a preoperative Caton-Deschamps index (CDI) ≥ 1.30, as measured by magnetic resonance imaging, is associated with rates of postoperative instability, revision knee surgery, and patient-reported outcomes in patients undergoing isolated medial patellofemoral ligament (MPFL) reconstruction. Methods Patients who underwent primary medial patellofemoral ligament reconstruction (MPFLR) between 2015 and 2019 at a single institution were assessed. Only those with at least 2 year follow up were included. Patients who had undergone a previous ipsilateral knee surgery, concomitant tibial tubercle osteotomy and/or ligamentous repair/reconstruction at the time of MPFL reconstruction were excluded from the study. CDIs were evaluated by three investigators based on magnetic resonance imaging measurement. Patients with a CDI ≥ 1.30 were included in the patella alta group, while those with a CDI between 0.70 and 1.29 served as controls. A retrospective review of clinical notes was used to evaluate the number of postoperative instability episodes and revisions. Functional outcomes were measured by the International Knee Documentation Committee (IKDC) and 12-Item Short Form Health Survey (SF-12) physical and mental scores. Results Overall, 49 patients (50 knees, 29 males, 59.2%) underwent isolated MPFLR. Nineteen (38.8%) patients had a CDI ≥ 1.30 (mean: 1.41, range: 1.30-1.66). The patella alta group was significantly more likely to experience a postoperative instability episode (36.8% vs 10.0%; P = .023) and was more likely to return to the operating room for any reason (26.3% vs 3.0%; P = .022) compared to those with normal patellar height. Despite this, the patella alta group had significantly greater postoperative IKDC (86.5 vs 72.4; P = .035) and SF-12 physical (54.2 vs 46.5; P = .006) scores. Pearson's correlation showed a significant association between CDI and postoperative IKDC (R 2 = 0.157; P = .022) and SF-12P (R 2 = .246; P = .002) scores. There was no difference in postoperative Lysholm (87.9 vs 85.1; P = .531). and SF-12M (48.9 vs 52.5; P = .425) scores between the groups. Conclusion Patients with preoperative patella alta, as measured by CDI had higher rates of postoperative instability and return to the OR with isolated MPFL reconstruction for patellar instability. Despite this, higher preoperative CDI was associated with greater postoperative IKDC scores and SF-12 physical scores in these patients. Level of Evidence Retrospective cohort study, Level IV.
Collapse
Affiliation(s)
- Joseph Brutico
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
| | - Ryan W. Paul
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
| | - Maggie Wright
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
| | - Henson Destine
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
| | - Emma E. Johnson
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
| | | | | | | | - Fotios P. Tjoumakaris
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
- Address correspondence to Fotios Tjoumakaris, M.D., Rothman Orthopaedics at Thomas Jefferson University, 125 South 9th St., Philadelphia, PA, 19130, U.S.A.
| |
Collapse
|
37
|
Dahm F, Syed H, Tomescu S, Lin HA, Haimovich Y, Chandrashekar N, Whyne C, Wasserstein D. Biomechanical Comparison of 3 Medial Patellofemoral Complex Reconstruction Techniques Shows Medial Overconstraint but No Significant Difference in Patella Lateralization and Contact Pressure. Arthroscopy 2023; 39:662-669. [PMID: 36328339 DOI: 10.1016/j.arthro.2022.10.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 09/29/2022] [Accepted: 10/18/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE The purpose of this study was to investigate biomechanical differences of medial patellofemoral ligament (MPFL) reconstruction, medial quadriceps tendon femoral ligament (MQTFL) reconstruction, and a combination of these techniques to restore lateral patellar constraint and contact pressures. METHODS Eight fresh frozen cadaver knees were mounted to a custom jig with physiological quadriceps tendon loading. Flexion angles and contact pressure (CP) were dynamically measured using Tekscan® pressure sensors and Polhemus® Liberty 6 degree of freedom (6DOF) positioning sensors in the following conditions: 1) intact 2) MPFL and MQTFL deficient, 3) MPFL reconstructed, 4) Combined MPFL + MQTFL reconstructed, and 5) MQTFL reconstructed. Lateral patellar translation was tested using horizontally directed 30 N force applied at 30° of knee flexion. The knees were flexed in dynamic fashion, and CP values were recorded for 10°, 20°, 30°, 50°, 70°, and 90° degrees of flexion. Group differences were assessed with ANOVA's followed by pairwise comparisons with Bonferroni correction. RESULTS MPFL (P = .002) and combined MPFL/MQTFL (P = .034) reconstruction significantly reduced patellar lateralization from +19.28% (9.78%, 28.78%) in the deficient condition to -17.57% (-27.84%, -7.29%) and -15.56% (-33.61%, 2.30%), respectively. MPFL reconstruction was most restrictive and MQTFL reconstruction the least -7.29% (-22.01%, 7.45%). No significant differences were found between the three reconstruction techniques. Differences in CP between the three reconstruction techniques were not significant (<.02 MPa) at all flexion angles. CONCLUSION The present study found no significant difference for patellar lateralization and patellofemoral CP between MPFL, combined MPFL/MQTFL, and MQTFL reconstruction. All 3 techniques resulted in stronger lateral patellar constraint compared to the native state, while the MQTFL reconstruction emulated the intact state the closest. CLINICAL RELEVANCE Various surgical techniques for medial patellofemoral complex reconstruction can restore patellar stability with similar patellofemoral articular pressures.
Collapse
Affiliation(s)
- Falko Dahm
- Holland Bone and Joint Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.
| | - Hassan Syed
- Holland Bone and Joint Program, Sunnybrook Research Institute, Toronto, Ontario, Canada; University of Toronto Orthopedic Sports Medicine, Women's College Hospital Toronto, Toronto, Ontario, Canada; Institute for Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Sebastian Tomescu
- Holland Bone and Joint Program, Sunnybrook Research Institute, Toronto, Ontario, Canada; University of Toronto Orthopedic Sports Medicine, Women's College Hospital Toronto, Toronto, Ontario, Canada
| | - Heng An Lin
- Holland Bone and Joint Program, Sunnybrook Research Institute, Toronto, Ontario, Canada; University of Toronto Orthopedic Sports Medicine, Women's College Hospital Toronto, Toronto, Ontario, Canada; Department of Orthopedic Surgery, Sengkang General Hospital, Singapore
| | - Yaron Haimovich
- Holland Bone and Joint Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Naveen Chandrashekar
- Department of Orthopedic Surgery, Wolfson Medical Center, Holon, Israel; and Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, Ontario, Canada
| | - Cari Whyne
- Holland Bone and Joint Program, Sunnybrook Research Institute, Toronto, Ontario, Canada; Institute for Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - David Wasserstein
- Holland Bone and Joint Program, Sunnybrook Research Institute, Toronto, Ontario, Canada; University of Toronto Orthopedic Sports Medicine, Women's College Hospital Toronto, Toronto, Ontario, Canada; Institute for Medical Science, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
38
|
Jiang J, Yi Z, Li J, Liu Y, Xia Y, Wu M. Medial Patellofemoral Ligament Reconstruction is Preferred to Repair or Reefing for First-Time Patellar Dislocation: A Systematic Review and Meta-analysis. Indian J Orthop 2023; 57:177-188. [PMID: 36777132 PMCID: PMC9880132 DOI: 10.1007/s43465-022-00770-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 10/21/2022] [Indexed: 11/07/2022]
Abstract
Purpose The purpose of this systematic review aimed to investigate the clinical outcome of medial patellofemoral ligament (MPFL) reconstruction, MPFL repair and medial reefing for patients with first-time patellar dislocation. Methods Databases of PubMed, EMBASE, Cochrane Library and Web of Science were searched up to May 8, 2022. Only articles treating first-time patellar dislocation with MPFL reconstruction, MPFL repair and medial reefing were included in the analysis. Eligible identification, data extraction, quality assessment and statistical analysis were performed by two independent reviewers. The primary outcome measures were the incidences of postoperatively redislocation and reoperation. The second outcomes were the Kujala functional score and complications (including infection, osteoarthritis, and loss of range of motion). Results Twenty-two studies involving 668 patients met the inclusion criteria. Of which, four studies involving 126 patients were in MPFL reconstruction group, ten studies involving 220 patients in MPFL repair group and 9 studies involving 322 patients in medial reefing group. Our results showed that the MPFL reconstruction (1.8%, 95% CI - 0.5 to 4.0%) had a significantly lower rate of postoperative redislocation and reoperation rate than the MPFL repair (15.4%, 95% CI 5.2-25.7%) and medial reefing (18.0%, 95% CI 9.3-26.7%). Besides, no significant differences were found in the Kujala score and complication rate among the three treatments. Conclusion The available evidence demonstrated that MPFL reconstruction could achieve significantly lower redislocation rate and reoperation rate than MPFL repair and medial reefing after first-time patella dislocation. Furthermore, there was not enough evidence to reveal that MPFL reconstruction provided better functional outcome compared with MPFL repair and medial reefing. MPFL reconstruction is a preferred surgical treatment for patients with first-time patellar dislocation. Level of Evidence Level IV, systematic review of Level I-IV.
Collapse
Affiliation(s)
- Jin Jiang
- Department of Orthopaedics, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730030 Gansu China
| | - Zhi Yi
- Department of Orthopaedics, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730030 Gansu China
| | - Junmin Li
- Department of Pharmacy, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730030 Gansu China
| | - Yan Liu
- School of Pharmacy, Lanzhou University, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730030 Gansu China
| | - Yayi Xia
- Department of Orthopaedics, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730030 Gansu China
| | - Meng Wu
- Department of Orthopaedics, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730030 Gansu China
| |
Collapse
|
39
|
Sinikumpu J, Nicolaou N. Current concepts in the treatment of first-time patella dislocation in children and adolescents. J Child Orthop 2023; 17:28-33. [PMID: 36755554 PMCID: PMC9900011 DOI: 10.1177/18632521221149060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 12/14/2022] [Indexed: 01/13/2023] Open
Abstract
Background Lateral dislocation of the patella is a common injury in children. It can occur in previously healthy and anatomically normal knees, but there are several abnormalities that predispose to patellar instability. Magnetic resonance imaging is an essential part of assessing for associated injuries and risk of further instability. Treatment aims to prevent redislocation, residual instability, osteoarthritis, and allow return to previous activities. The purpose of this review was to assess evidence for management of first-time patella dislocation in children and adolescents. Methods Literature review was performed, accompanied by the current best practice by the authors. Results Non-operative treatment is preferred, except where there are associated injuries such as osteochondral fractures that would benefit from surgery. The exact method of ideal non-operative management is not clearly defined but should focus on restoration of range of movement and strength with bracing as indicated. There seems to be a trend toward operative intervention that may well be inappropriate. Conclusion Further prospective studies are required with focus on the younger patient to fully understand if there is an at-risk group that would benefit from early surgery. Level of evidence level III.
Collapse
Affiliation(s)
- Jaakko Sinikumpu
- Department of Pediatric Surgery and Orthopaedics, Research Unit of Clinical Medicine, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Nicolas Nicolaou
- Department of Paediatric Orthopaedic Surgery, Sheffield Children’s Hospital, Sheffield, UK
| |
Collapse
|
40
|
Smith TO, Gaukroger A, Metcalfe A, Hing CB. Surgical versus non-surgical interventions for treating patellar dislocation. Cochrane Database Syst Rev 2023; 1:CD008106. [PMID: 36692346 PMCID: PMC9872769 DOI: 10.1002/14651858.cd008106.pub4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Patellar (knee cap) dislocation occurs when the patella disengages completely from the trochlear (femoral) groove. It affects up to 42/100,000 people, and is most prevalent in those aged 20 to 30 years old. It is uncertain whether surgical or non-surgical treatment is the best approach. This is important as recurrent dislocation occurs in up to 40% of people who experience a first time (primary) dislocation. This can reduce quality of life and as a result people have to modify their lifestyle. This review is needed to determine whether surgical or non-surgical treatment should be offered to people after patellar dislocation. OBJECTIVES To assess the effects (benefits and harms) of surgical versus non-surgical interventions for treating people with primary or recurrent patellar dislocation. SEARCH METHODS We searched the Cochrane Bone, Joint and Muscle Trauma Group's Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, AMED, CINAHL, Physiotherapy Evidence Database and trial registries in December 2021. We contacted corresponding authors to identify additional studies. SELECTION CRITERIA We included randomised and quasi-randomised controlled clinical trials evaluating surgical versus non-surgical interventions for treating primary or recurrent lateral patellar dislocation in adults or children. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were recurrent patellar dislocation, and patient-rated knee and physical function scores. Our secondary outcomes were health-related quality of life, return to former activities, knee pain during activity or at rest, adverse events, patient-reported satisfaction, patient-reported knee instability symptoms and subsequent requirement for knee surgery. We used GRADE to assess the certainty of evidence for each outcome. MAIN RESULTS We included 10 studies (eight randomised controlled trials (RCTs) and two quasi-RCTs) of 519 participants with patellar dislocation. The mean ages in the individual studies ranged from 13.0 to 27.2 years. Four studies included children, mainly adolescents, as well as adults; two only recruited children. Study follow-up ranged from one to 14 years. We are unsure of the evidence for all outcomes in this review because we judged the certainty of the evidence to be very low. We downgraded each outcome by three levels. Reasons included imprecision (when fewer than 100 events were reported or the confidence interval (CI) indicated appreciable benefits as well as harms), risk of bias (when studies were at high risk of performance, detection and attrition bias), and inconsistency (in the event that pooled analysis included high levels of statistical heterogeneity). We are uncertain whether surgery lowers the risk of recurrent dislocation following primary patellar dislocation compared with non-surgical management at two to nine year follow-up. Based on an illustrative risk of recurrent dislocation in 348 people per 1000 in the non-surgical group, we found that 157 fewer people per 1000 (95% CI 209 fewer to 87 fewer) had recurrent dislocation between two and nine years after surgery (8 studies, 438 participants). We are uncertain whether surgery improves patient-rated knee and function scores. Studies measured this outcome using different scales (the Tegner activity scale, Knee Injury and Osteoarthritis Outcome Score, Lysholm, Kujala Patellofemoral Disorders score and Hughston visual analogue scale). The most frequently reported score was the Kujala Patellofemoral Disorders score. This indicated people in the surgical group had a mean score of 5.73 points higher at two to nine year follow-up (95% CI 2.91 lower to 14.37 higher; 7 studies, 401 participants). On this 100-point scale, higher scores indicate better function, and a change score of 10 points is considered to be clinically meaningful; therefore, this CI includes a possible meaningful improvement. We are uncertain whether surgery increases the risk of adverse events. Based on an assumed risk of overall incidence of complications during the first two years in 277 people out of 1000 in the non-surgical group, 335 more people per 1000 (95% CI 75 fewer to 723 more) had an adverse event in the surgery group (2 studies, 144 participants). Three studies (176 participants) assessed participant satisfaction at two to nine year follow-up, reporting little difference between groups. Based on an assumed risk of 763 per 1000 non-surgical participants reporting excellent or good outcomes, seven more participants per 1000 (95% CI 199 fewer to 237 more) reported excellent or good satisfaction. Four studies (256 participants) assessed recurrent patellar subluxation at two to nine year follow-up. Based on an assumed risk of patellar subluxation in 292 out of 1000 in the non-surgical group, 73 fewer people per 1000 (95% CI 146 fewer to 35 more) had patellar subluxation as a result of surgery. Slightly more people had subsequent surgery in the non-surgical group. Pooled two to nine year follow-up data from three trials (195 participants) indicated that, based on an assumed risk of subsequent surgery in 215 people per 1000 in the non-surgical group, 118 fewer people per 1000 (95% CI 200 fewer to 372 more) had subsequent surgery after primary surgery. AUTHORS' CONCLUSIONS We are uncertain whether surgery improves outcome compared to non-surgical management as the certainty of the evidence was very low. No sufficiently powered trial has examined people with recurrent patellar dislocation. Adequately powered, multicentre, randomised trials are needed. To inform the design and conduct of these trials, expert consensus should be achieved on the minimal description of both surgical and non-surgical interventions, and the pathological variations that may be relevant to both choice of these interventions.
Collapse
Affiliation(s)
- Toby O Smith
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Andrew Gaukroger
- Trauma and Orthopaedics, St George's University Hospital NHS trust, London, UK
| | - Andrew Metcalfe
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Caroline B Hing
- Department of Trauma and Orthopaedic Surgery, St George's Hospital, London, UK
| |
Collapse
|
41
|
O'Malley O, Choudhury A, Biggs A, Humdani AJ, Brown O, Smith TO, Ejindu V, Hing CB. Association between Patellofemoral Anatomy and Chondral Lesions of the Knee in Patellofemoral Instability. J Knee Surg 2023; 36:153-158. [PMID: 34187065 DOI: 10.1055/s-0041-1731351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Chondral injury is a serious consequence of patellar dislocation and patellofemoral instability (PFI). There is limited data on the relationship between radiological features such as sulcus angle and patellar height to the presence, location, and severity of chondral lesions. The purpose of this study was to determine the association of anatomical variants in patellofemoral instability with injuries sustained due to patellar dislocation. A cohort of 101 patients who had four or more episodes of dislocation or instability undergoing isolated arthroscopy or arthroscopies at the time of corrective realignment surgery were identified. The prevalence of chondral, ligamentous, and meniscal injuries was determined and correlated to the sulcus angle, tibial tubercle trochlear groove distance, and patellar height on magnetic resonance imaging (MRI) scans. A total of 101 patients was identified. At arthroscopy, the patella demonstrated the highest incidence of chondral injury (68%) followed by the trochlear groove (40%). Lateral meniscal injuries were noted in 6% of patients, medial meniscal injuries in 2%, and anterior cruciate ligament (ACL) injury in 3%. Chondral injuries were graded using the Outerbridge criteria and there was a correlation between more severe chondral injuries and a greater tilt angle (p = 0.05). The occurrence of injury to the lateral meniscus was associated with a higher Insall-Salvati ratio (p = 0.05). More severe chondral injuries are seen in patients with a greater tilt angle.
Collapse
Affiliation(s)
- Olivia O'Malley
- Department of Trauma and Orthopaedics, St George's Hospital, St George's University Hospitals National Health Service Foundation Trust, London, United Kingdom
| | - Aliya Choudhury
- Department of Trauma and Orthopaedics, St George's Hospital, St George's University Hospitals National Health Service Foundation Trust, London, United Kingdom
| | - Alexandra Biggs
- Department of Trauma and Orthopaedics, St George's Hospital, St George's University Hospitals National Health Service Foundation Trust, London, United Kingdom
| | - Alina J Humdani
- St George's Medical School, St George's University London, St George's University Hospitals National Health Service Foundation Trust, London, United Kingdom
| | - Oliver Brown
- Department of Trauma and Orthopaedics, St George's Hospital, St George's University Hospitals National Health Service Foundation Trust, London, United Kingdom
| | - Toby O Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Vivian Ejindu
- St George's Medical School, St George's University London, St George's University Hospitals National Health Service Foundation Trust, London, United Kingdom
| | - Caroline B Hing
- Department of Trauma and Orthopaedics, St George's Hospital, St George's University Hospitals National Health Service Foundation Trust, London, United Kingdom
| |
Collapse
|
42
|
Chen J, Li Q, Liu S, Fan L, Yin B, Yang X, Wang L, Xu Z, Zhang J, Quan Z, Zhou A. Prediction of Subsequent Contralateral Patellar Dislocation after First-Time Dislocation Based on Patellofemoral Morphologies. J Clin Med 2022; 12:jcm12010180. [PMID: 36614981 PMCID: PMC9820933 DOI: 10.3390/jcm12010180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/03/2022] [Accepted: 12/23/2022] [Indexed: 12/28/2022] Open
Abstract
The subsequent dislocation of a contralateral patellofemoral joint sometimes occurs after a first-time lateral patellar dislocation (LPD). However, the anatomic risk factors for subsequent contralateral LPD remain elusive. This study included 17 patients with contralateral LPD and 34 unilateral patellar dislocators. The anatomic parameters of the contralateral patellofemoral joints were measured using CT images and radiographs that were obtained at the time of the first dislocation. The Wilcoxon rank-sum test was performed, and a binary regression model was established to identify the risk factors. The receiver operating characteristic curves and the area under the curve (AUC) were analyzed. The tibial tubercle-Roman arch (TT-RA) distance was significantly different between patients with and without contralateral LPD (24.1 vs. 19.5 mm, p < 0.001). The hip−knee−ankle (HKA) angle, patellar tilt, congruence angle, and patellar displacement were greater in the study group than in the control group (p < 0.05). The TT-RA distance revealed an OR of 1.35 (95% CI (1.26−1.44]), p < 0.001) and an AUC of 0.727 for predicting contralateral LPD. The HKA angle revealed an OR of 1.74 (95% CI (1.51−2.00), p < 0.001) and an AUC of 0.797. The Patellar tilt, congruence angle, and patellar displacement had AUC values of 0.703, 0.725, and 0.817 for predicting contralateral LPD, respectively. In conclusion, the contralateral patellofemoral anatomic parameters were significantly different between patients with and without subsequent contralateral LPD. Increased TT-RA distance and excessive valgus deformity were risk factors and could serve as predictors for contralateral LPD. At first-time dislocation, the abnormal position of the patella relative to the trochlea may also be an important cause of subsequent LPD.
Collapse
Affiliation(s)
- Jiaxing Chen
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
- Orthopedic Laboratory, Chongqing Medical University, Chongqing 400016, China
| | - Qiaochu Li
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
- Orthopedic Laboratory, Chongqing Medical University, Chongqing 400016, China
| | - Sizhu Liu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Lin Fan
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
- Orthopedic Laboratory, Chongqing Medical University, Chongqing 400016, China
| | - Baoshan Yin
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
- Orthopedic Laboratory, Chongqing Medical University, Chongqing 400016, China
| | - Xinyu Yang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
- Orthopedic Laboratory, Chongqing Medical University, Chongqing 400016, China
| | - Linbang Wang
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Zijie Xu
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing 100191, China
| | - Jian Zhang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
- Orthopedic Laboratory, Chongqing Medical University, Chongqing 400016, China
| | - Zhengxue Quan
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
- Orthopedic Laboratory, Chongqing Medical University, Chongqing 400016, China
- Correspondence: (Z.Q.); (A.Z.)
| | - Aiguo Zhou
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
- Orthopedic Laboratory, Chongqing Medical University, Chongqing 400016, China
- Correspondence: (Z.Q.); (A.Z.)
| |
Collapse
|
43
|
Reinholz AK, Till SE, Crowe MM, Hevesi M, Saris DB, Stuart MJ, Krych AJ. Grooveplasty Compared With Trochleoplasty for the Treatment of Trochlear Dysplasia in the Setting of Patellar Instability. Arthrosc Sports Med Rehabil 2022; 5:e239-e247. [PMID: 36866307 PMCID: PMC9971888 DOI: 10.1016/j.asmr.2022.11.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 11/13/2022] [Indexed: 12/27/2022] Open
Abstract
Purpose To compare the clinical efficacy in the resolution of patellar instability, patient-reported outcomes (PROs), and complication and reoperation rates between patients who underwent grooveplasty (proximal trochleoplasty) and patients who underwent trochleoplasty as part of a combined patellofemoral stabilization procedure. Methods A retrospective chart review was performed to identify a cohort of patients who underwent grooveplasty and a cohort who underwent trochleoplasty at the time of patellar stabilization. Complications, reoperations, and PRO scores (Tegner, Kujala, and International Knee Documentation Committee scores) were collected at final follow-up. The Kruskal-Wallis test and Fisher exact test were performed when appropriate, and P < .05 was considered significant. Results Overall, 17 grooveplasty patients (18 knees) and 15 trochleoplasty patients (15 knees) were included. Seventy-nine percent of patients were female, and the average follow-up period was 3.9 years. The mean age at first dislocation was 11.8 years overall; most patients (65%) had more than 10 lifetime instability events and 76% of patients underwent prior knee-stabilizing procedures. Trochlear dysplasia (Dejour classification) was similar between cohorts. Patients who underwent grooveplasty had a higher activity level (P = .007) and a higher degree of patellar facet chondromalacia (P = .008) at baseline. At final follow-up, no patients had recurrent symptomatic instability after grooveplasty compared with 5 patients in the trochleoplasty cohort (P = .013). There were no differences in postoperative International Knee Documentation Committee scores (P = .870), Kujala scores (P = .059), or Tegner scores (P = .052). Additionally, there were no differences in complication rates (17% in grooveplasty cohort vs 13% in trochleoplasty cohort, P > .999) or reoperation rates (22% vs 13%, P = .665). Conclusions Proximal trochlear reshaping and removal of the supratrochlear spur (grooveplasty) in patients with severe trochlear dysplasia may offer an alternative strategy to complete trochleoplasty for the treatment of trochlear dysplasia in complex cases of patellofemoral instability. Grooveplasty patients showed less recurrent instability and similar PROs and reoperation rates compared with trochleoplasty patients. Level of Evidence Level III, retrospective comparative study.
Collapse
Affiliation(s)
- Anna K. Reinholz
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Sara E. Till
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Matthew M. Crowe
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, Florida, U.S.A
| | - Mario Hevesi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Daniel B.F. Saris
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Michael J. Stuart
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Aaron J. Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.,Address correspondence to Aaron J. Krych, M.D., Mayo Clinic, 200 First St SW, Rochester, MN 55905, U.S.A.
| |
Collapse
|
44
|
Patellar Tendon-Trochlear Groove Angle Measured on a Single Computed Tomography Slice of the Distal Femoral Trochlear Groove Is a Reliable Measurement for the Evaluation of Patellar Instability. Arthroscopy 2022; 39:1244-1250. [PMID: 36526511 DOI: 10.1016/j.arthro.2022.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 11/02/2022] [Accepted: 11/11/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE To verify the reliability of patellar tendon-trochlear groove angle (PTTG-A) measured by computed tomography (CT) and the clinical significance in evaluation of patellar instability. METHODS A retrospective study of hospitalized patients with knee pain or injury and had knee CT from January 2017 to June 2021 was performed. PTTG-A and tibial tuberosity-trochlear groove (TT-TG) distance were measured on CT. Spearman correlation analysis was analyzed between the 2 measurements. The intraclass correlation coefficient was determined for inter- and intraobserver reproducibility. The capacity of PTTG-A and TT-TG to predict patellar instability was evaluated by the receiver operating characteristic curve. Data from the control group were used to determine the pathologic thresholds and logistic regression analysis. RESULTS Included were 113 patients. There were 60 patients with the history of at least 2 episodes of patellar dislocation (study group) and 53 patients without a history of patellar dislocation (control group). The respective PTTG-A and TT-TG distances in the study group (35.2 ± 8.4° and 19.6 ± 4.6 mm) were significantly greater than those of the controls (20.8 ± 5.8° and 13.3 ± 4.5 mm) (P < .001). The correlation between the 2 measurements was strong (r = 0.730, P < .001). The inter- and intraobserver reliability of the PTTG-A were better than TT-TG distance in both groups. The AUC of PTTG-A was greater than that of the TT-TG distance (0.895 vs 0.769, respectively). With the cutoff value of PTTG-A and TT-TG being 26.3° and 16.3 mm, the value of the pathologic threshold of PTTG-A was 30.0°, with a dominance ratio of 16.88 (95% confidence interval 2.88-98.89, P = .002). CONCLUSIONS The PTTG-A measured on a single CT slice of the distal femoral trochlear groove is a more reliable measurement than TT-TG distance for the prediction of patellar instability. LEVEL OF EVIDENCE III; A retrospective cohort study.
Collapse
|
45
|
Frodl A, Lange T, Siegel M, Meine H, Taghizadeh E, Schmal H, Izadpanah K. Individual Influence of Trochlear Dysplasia on Patellofemoral Kinematics after Isolated MPFL Reconstruction. J Pers Med 2022; 12:jpm12122049. [PMID: 36556269 PMCID: PMC9786691 DOI: 10.3390/jpm12122049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The influence of the MPFL graft in cases of patella instability with dysplastic trochlea is a controversial topic. The effect of the MPFL reconstruction as single therapy is under investigation, especially with severely dysplastic trochlea (Dejour types C and D). The purpose of this study was to evaluate the impact of trochlear dysplasia on patellar kinematics in patients suffering from low flexion patellar instability under weight-bearing conditions after isolated MPFL reconstruction. MATERIAL AND METHODS Thirteen patients were included in this study, among them were eight patients with mild dysplasia (Dejour type A and B) and five patients with severe dysplasia (Dejour type C and D). By performing a knee MRI with in situ loading, patella kinematics and the patellofemoral cartilage contact area could be measured under the activation of the quadriceps musculature in knee flexion angles of 0°, 15° and 30°. To mitigate MRI motion artefacts, prospective motion correction based on optical tracking was applied. Bone and cartilage segmentation were performed semi-automatically for further data analysis. Cartilage contact area (CCA) and patella tilt were the main outcome measures for this study. Pre- and post-surgery measures were compared for each group. RESULTS Data visualized a trending lower patella tilt after MPFL graft installation in both groups and flexion angles of the knee. There were no significant changes in patella tilt at 0° (unloaded pre-surgery: 22.6 ± 15.2; post-surgery: 17.7 ± 14.3; p = 0.110) and unloaded 15° flexion (pre-surgery: 18.9 ± 12.7; post-surgery: 12.2 ± 13.0; p = 0.052) of the knee in patients with mild dysplasia, whereas in patients with severe dysplasia of the trochlea the results happened not to be significant in the same angles with loading of 5 kg (0° flexion pre-surgery: 34.4 ± 12.1; post-surgery: 31.2 ± 16.1; p = 0.5; 15° flexion pre-surgery: 33.3 ± 6.1; post-surgery: 23.4 ± 8.6; p = 0.068). CCA increased in every flexion angle and group, but significant increase was seen only between 0°-15° (unloaded and loaded) in mild dysplasia of the trochlea, where significant increase in Dejour type C and D group was seen with unloaded full extension of the knee (0° flexion) and 30° flexion (unloaded and loaded). CONCLUSION This study proves a significant effect of the MPFL graft to cartilage contact area, as well as an improvement of the patella tilt in patients with mild dysplasia of the trochlea. Thus, the MPFL can be used as a single treatment for patient with Dejour type A and B dysplasia. However, in patients with severe dysplasia the MPFL graft alone does not significantly increase CCA.
Collapse
Affiliation(s)
- Andreas Frodl
- Department of Orthopedics and Traumatology, Freiburg University Hospital, 79106 Freiburg, Germany
- Correspondence:
| | - Thomas Lange
- Department of Radiology, Medical Physics, Freiburg University Hospital, 79106 Freiburg, Germany
| | - Markus Siegel
- Department of Orthopedics and Traumatology, Freiburg University Hospital, 79106 Freiburg, Germany
| | - Hans Meine
- Fraunhofer Institute for Digital Medicine, 28359 Freiburg, Germany
| | - Elham Taghizadeh
- Fraunhofer Institute for Digital Medicine, 28359 Freiburg, Germany
| | - Hagen Schmal
- Department of Orthopedic Surgery, University Hospital Odense, Sdr. Boulevard 29, 5000 Odense, Denmark
| | - Kaywan Izadpanah
- Department of Orthopedics and Traumatology, Freiburg University Hospital, 79106 Freiburg, Germany
| |
Collapse
|
46
|
D'Ambrosi R, Migliorini F, Cerciello S, Guerra G, Corona K, Mangiavini L, Ursino N, Vlaic J, Jelic M. Management of the first episode of traumatic patellar dislocation: an international survey. Knee Surg Sports Traumatol Arthrosc 2022; 31:2257-2265. [PMID: 36477349 DOI: 10.1007/s00167-022-07273-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE This international survey aimed to evaluate the potential controversies regarding the management of first patellar dislocation amongst experienced knee surgeries in the treatment of the first episode of patellar dislocation without osteochondral fragments. METHODS An online survey was conducted from February 2021 to December 2021 to assess the global trend in the diagnosis and management of first-time patellar dislocation without osteochondral fragments. The online survey was accessible on the homepage of the website of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA). The questionnaire consisted of multiple-choice questions and was divided into three sections. The first section consisted of eight questions regarding demographic information, professional activity, and responder experience. The second section consisted of 13 questions regarding the approach to a first patellar dislocation (clinical examination, imaging, and rehabilitation). The third section contained 2 questions concerning the relevance of patient characteristics to the therapeutic algorithm (age, sports, and pathoanatomical predisposing risk factors). RESULTS A total of 438 orthopaedic surgeons worldwide completed the questionnaire. At the first approach to diagnose a first-time patellar dislocation, 251 (57%) of the surgeons requested plain radiographs, and 158 (36%) requested magnetic resonance imaging (MRI). In conservatively treated patients, 368 (84%) of the respondents recommended the use of a knee brace. Amongst them, 14 (3%) advocated its use for one week, 75 (17%) for two weeks, 123 (28%) for three weeks, 105 (24%) for four weeks, and 97 (22%) for six weeks. In conservatively treated patients, 215 (49%) of the surgeons recommended load to tolerance, 148 (34%) recommended 30% to 60% of the bodyweight, and 75 (17%) advised against weight-bearing. More than half of the surgeons considered a patient aged less than 35 years practising contact sports to be a candidate for the medial patello-femoral ligament (MPFL) procedure. In addition, a tibial tuberosity to trochlear groove distance (TT-TG) distance of 15 to > 20 mm (for > 75% of the surgeons) and a trochlea types C and D (for > 70% of the surgeons) were considered possible indications for direct surgical management. CONCLUSION At the first approach to diagnose a first-time patellar dislocation, plain radiographs and MRI should be performed. In conservatively treated patients, most of the surgeons recommend weight-bearing to tolerance and a knee brace during the first four weeks, with range of motion of full extension to 30° during the first 15 days and up to 60° for an additional 15 days. Surgical management should be performed in patients in the second and third decades of life practising contact sports and in those patients who present types C and D trochlea dysplasia and patella alta. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Riccardo D'Ambrosi
- IRCCS Orthopedic Institute Galeazzi, Milan, Italy. .,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Aachen, Germany
| | - Simone Cerciello
- Department of Orthopaedics, A. Gemelli University Hospital Foundation IRCCS, Catholic University, Rome, Italy.,Casa di Cura Villa Betania, Rome, Italy.,Marrelli Hospital, Crotone, Italy
| | - Germano Guerra
- Department of Medicine, Health Sciences Vincenzo Tiberio, University of Molise, Campobasso, Italy
| | - Katia Corona
- Department of Medicine, Health Sciences Vincenzo Tiberio, University of Molise, Campobasso, Italy
| | - Laura Mangiavini
- IRCCS Orthopedic Institute Galeazzi, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | | | - Mislav Jelic
- Department of Orthopaedic Surgery, University Hospital Center Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| |
Collapse
|
47
|
Qiao Y, Xu J, Ye Z, Chen J, Zhang X, Zhao S, Xu C, Zhao J. Double-Tunnel Technique Was Similar to Single-Tunnel Technique in Clinical, Imaging and Functional Outcomes for Medial Patellofemoral Ligament Reconstruction: A Randomized Clinical Trial. Arthroscopy 2022; 38:3058-3067. [PMID: 35690254 DOI: 10.1016/j.arthro.2022.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/26/2022] [Accepted: 04/26/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE This study aimed to compare the clinical, functional, and imaging outcomes of single-tunnel (ST) and double-tunnel (DT) techniques for medial patellofemoral ligament (MPFL) reconstruction. METHODS Ninety-four patients with recurrent patellar instability were randomly divided into 2 groups, receiving either ST or DT MPFL reconstruction. Lateral reticulum release (LRR) and tibial tuberosity (TT) transfer were performed as combined procedures when necessary. Preoperative and postoperative clinical characteristics (symptoms and episodes of redislocation), functional outcomes (Kujala, Lysholm, Tegner, IKDC, and KOOS score), and radiological measurements (congruence angle, patellar tilt angle, lateral patellar angle, and lateral patellar translation) were analyzed. RESULTS The analysis included data from 90 patients with 48 patients in the ST group and 42 patients in the DT group. Patients were followed up for a mean period of 37.8 (range: 27-50) months in the ST group and 38.6 (range: 25-53) months in the DT group. Forty-three patients in the ST group and 40 patients in the DT group received combined TT transfer, and all patients underwent LRR. At the latest follow-up, 1 patient in ST group experienced redislocation, while no patient in the DT group sustained clinical failure (P = .347). Imaging measurements decreased significantly to the normal range postoperatively. No significant difference was noted between the postoperative radiological results of the 2 groups. All clinical scores significantly improved postoperatively, and no significant difference was observed between the 2 groups except for the higher Lysholm score (P = .031), KOOS symptoms score (P = .021) and KOOS knee-related quality of life score (P = .043) in the DT group. CONCLUSION Both techniques could equally mitigate the patellar lateral translation or redislocation. Our results demonstrate several significant differences in functional outcomes that favored DT MPFL reconstruction but no difference in clinical failure rates and radiological results between ST and DT MPFL reconstruction. LEVEL OF EVIDENCE Level I, randomized clinical trial.
Collapse
Affiliation(s)
- Yi Qiao
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Junjie Xu
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Zipeng Ye
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jiebo Chen
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xiuyuan Zhang
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Song Zhao
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Caiqi Xu
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
| |
Collapse
|
48
|
Muacevic A, Adler JR. Patterns of Associated Knee Ligament and Chondral Injuries in First-Time Traumatic Patellar Dislocation: A Retrospective Magnetic Resonance Imaging (MRI) -Based Study. Cureus 2022; 14:e31850. [PMID: 36579225 PMCID: PMC9792303 DOI: 10.7759/cureus.31850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction First-time acute traumatic patellar dislocation, when managed without a knee magnetic resonance imaging (MRI) scan, may lead to missed diagnoses of important associated knee injuries. The aim of this study was to ascertain the incidence of associated ligamentous and cartilaginous injuries in first-time traumatic patella dislocation. Methods This was a five-year retrospective study on patients aged 16-45 who had knee MRI scans showing the characteristic bone bruise patterns seen in traumatic lateral patellar dislocation. Anonymized data from the hospital picture archiving and communication system (PACS) was obtained with each scan reviewed by a consultant radiologist, a fellowship-trained orthopaedic knee specialist, and an orthopaedic registrar or resident. Results A total of 200 knee MRI scans were screened. 61 eligible knee MRI scans were included in the study. The patients' ages ranged from 16 to 42 years old, with a mean of 25 years. 73.8% were male. A medial patellofemoral ligament (MPFL) tear or rupture occurred in 58 of 61 knees (95%) with MPFL attenuation in three (5%) injured knees. Meniscal injuries were identified in 5 of 61 knees (8.2%), medial collateral ligament (MCL) injuries in 11 of 61 knees (18%), osteochondral injuries and loose bodies in 17 of 61 knees (27.9%), and anterior cruciate ligament (ACL) injury in one knee (1.6%). Conclusions This single-centre MRI-based study has provided information on the incidence of associated chondral and ligamentous injuries in patients with first-time acute traumatic patellar dislocation. This information will be useful for clinicians when counselling patients and will add to the available literature on this injury. An MRI scan should be obtained in cases of suspected first-time traumatic patellar dislocations, especially in active young patients, due to the incidence of other associated traumatic knee lesions that might need surgical treatment and lead to persisting knee symptoms if neglected.
Collapse
|
49
|
Wang HJ, Song YF, Ma Y, Lin L, Wang J, Wang YJ, Liu Y, Lu W, Wang F, Yu JK. Higher pathologic threshold of increased tibial tuberosity-trochlear groove distance should be considered for taller patients. Knee Surg Sports Traumatol Arthrosc 2022; 30:3760-3766. [PMID: 35579682 DOI: 10.1007/s00167-022-06992-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 04/21/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of this study was to evaluate the correlation between tibial tuberosity-trochlear groove distance (TT-TG) and body height or knee size, and to find height-related pathologic thresholds of increased TT-TG. METHODS One-hundred and fifty-three patients with recurrent patellar instability and 151 controls were included. The TT-TG was measured on axial computed tomography (CT) images. Femora width and tibial width were selected to represent knee size. The correlation of TT-TG and gender, body height, femora width, and tibial width was evaluated. The height-related pathologic threshold of increased TT-TG was produced according to Dejour's method. To combine TT-TG with body height and knee size, three new indexes were introduced, ratio of TT-TG to body height (RTH), ratio of TT-TG to femoral width (RTF), and ratio of TT-TG to tibial width (RTT). The ability to predict patellar instability was assessed by the receiver-operating characteristic (ROC) curve, odds ratios (ORs), sensitivity, and specificity. RESULTS In patients with patellar instability, TT-TG showed significantly correlation with patient height, femoral width, and tibial width respectively (range r = 0.266-0.283). This correlation was not found in the control group. The pathologic threshold of TT-TG was 18 mm in patients < 169 cm (53%), and the mean TT-TG was 21 mm in patients ≥ 169 cm (54%). There was significant difference in RTH, RTF, and RTT between the two groups. RTH, RTF and RTT have similar large area under the curve (AUC) with TT-TG. CONCLUSIONS TT-TG showed significant correlation with body height and knee size, respectively. The pathologic threshold of increased TT-TG was suggested to be 21 mm for patients [Formula: see text] 169 cm and 18 mm for patients [Formula: see text] 169 cm. Body height-related pathologic threshold provided a supplement for indications of tibial tuberosity medialization. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Hai-Jun Wang
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, No. 49 North Garden Road, Haidian, Beijing, 100191, People's Republic of China.,Peking University Institute of Sports Medicine, No. 49 North Garden Road, Haidian, Beijing, 100191, People's Republic of China
| | - Yi-Fan Song
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, No. 49 North Garden Road, Haidian, Beijing, 100191, People's Republic of China.,Peking University Institute of Sports Medicine, No. 49 North Garden Road, Haidian, Beijing, 100191, People's Republic of China
| | - Yong Ma
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, No. 49 North Garden Road, Haidian, Beijing, 100191, People's Republic of China.,Peking University Institute of Sports Medicine, No. 49 North Garden Road, Haidian, Beijing, 100191, People's Republic of China
| | - Lin Lin
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, No. 49 North Garden Road, Haidian, Beijing, 100191, People's Republic of China.,Peking University Institute of Sports Medicine, No. 49 North Garden Road, Haidian, Beijing, 100191, People's Republic of China
| | - Jian Wang
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, No. 49 North Garden Road, Haidian, Beijing, 100191, People's Republic of China.,Peking University Institute of Sports Medicine, No. 49 North Garden Road, Haidian, Beijing, 100191, People's Republic of China
| | - Yong-Jian Wang
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, No. 49 North Garden Road, Haidian, Beijing, 100191, People's Republic of China.,Peking University Institute of Sports Medicine, No. 49 North Garden Road, Haidian, Beijing, 100191, People's Republic of China
| | - Yang Liu
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, No. 49 North Garden Road, Haidian, Beijing, 100191, People's Republic of China.,Peking University Institute of Sports Medicine, No. 49 North Garden Road, Haidian, Beijing, 100191, People's Republic of China
| | - Wei Lu
- Department of Sports Medicine, First Affiliated Hospital, Shenzhen University, Shenzhen, 518000, China
| | - Fei Wang
- Department of Joint Surgery, Hebei Medical University, Third Affiliated Hospital, No.139 Ziqiang Road, Shijiazhuang, 050000, China.
| | - Jia-Kuo Yu
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, No. 49 North Garden Road, Haidian, Beijing, 100191, People's Republic of China. .,Peking University Institute of Sports Medicine, No. 49 North Garden Road, Haidian, Beijing, 100191, People's Republic of China.
| |
Collapse
|
50
|
Paul RW, Johnson EE, Hall A, Clements A, Bishop ME, Ciccotti MG, Cohen SB, Erickson BJ. Comparison of post-operative outcomes following anterior cruciate ligament reconstruction between patients with vs. without elevated tibial tubercle-trochlear groove (TT-TG) distance. Knee Surg Sports Traumatol Arthrosc 2022; 31:2446-2453. [PMID: 36224290 DOI: 10.1007/s00167-022-07191-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 09/30/2022] [Indexed: 02/14/2023]
Abstract
PURPOSE It is unclear if an elevated tibial tubercle-trochlear groove (TT-TG) distance is a risk factor for poor outcomes following ACLR. Therefore, the purpose of this study was to determine whether patients with an elevated TT-TG have an increased risk of retear following primary ACLR compared to controls with a normal TT-TG. METHODS All patients who underwent primary ACLR between July 2018 and June 2019 with an available preoperative magnetic resonance imaging (MRI) were eligible for inclusion. TT-TG distance was measured on preoperative MRI scans by two independent investigators. Clinical outcomes, return-to-sport rates, and Lysholm scores were compared between patients with a TT-TG < 12.5 mm (normal) and those with a TT-TG ≥ 12.5 mm (elevated). RESULTS Overall, 159 patients were included, 98 with normal TT-TG distance and 61 with elevated TT-TG distance. Patients with an elevated TT-TG distance had worse post-operative Lysholm scores than patients with a normal TT-TG distance (83.0 vs. 95.0, p = 0.010). In patients who received a bone-patellar tendon-bone (BTB) graft, an elevated TT-TG distance was associated with higher rates of subjective instability (13.0% vs. 3.0%, p = 0.041), reoperation (13.0% vs. 1.5%, p = 0.012), and post-operative complications (25.0% vs. 8.2%, p = 0.026), as well as lower ACL psychological readiness scores (324.1 vs. 446.7, p = 0.015). CONCLUSION Patients with an elevated pre-operative TT-TG distance have worse Lysholm scores than patients with normal TT-TG distance. Patients with an elevated pre-operative TT-TG distance who underwent ACLR with BTB grafts had significantly higher rates of subjective instability, reoperation, and post-operative complications. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Ryan W Paul
- Rothman Orthopaedic Institute, Philadelphia, PA, US
| | | | - Anya Hall
- Rothman Orthopaedic Institute, Egg Harbor Township, NJ, US
| | - Ari Clements
- Sidney Kimmel Medical College, Philadelphia, PA, US
| | - Meghan E Bishop
- Rothman Orthopaedic Institute, 645 Madison Avenue 3rd and 4th floors, New York, NY, 10022, US
| | | | | | - Brandon J Erickson
- Rothman Orthopaedic Institute, 645 Madison Avenue 3rd and 4th floors, New York, NY, 10022, US.
| |
Collapse
|