Research progresses in the treatment of patella dislocation
0
Citation
0
Reference
20
Related Paper
Abstract:
As the increase of people′s participation in sports activities, the number of patients with patellar dislocation is continuously increasing and patellar dislocation most frequently presents in children and adolescence. Once patellar dislocation occurs, it will bring serious psychological and economic burden to the patients, and it may lead to osteoarthritis or chronic disability. Acute patellar dislocation after conservative treatment has a high recurrence rate. The major risk factors for the recurrence of dislocation include patellar dysplasia, patella alta, increased tibial tubercle-trochlear groove distance and patella tilt. The therapies of recurrent patellar dislocation include femoral troehleoplasty, tibial tubercle transfer, medical retinaculum placation, lateral retinaculum release and the medial patellofemoral ligament reconstruction, which is widly used in current clinical, etc. For patients with different lesions or pathological features of patellar dislocation, individualized treatment plans should be developed.
Key words:
Patellar dislocation; Knee joint; Surgical procedures, operative; MPFLKeywords:
Medial Patellofemoral Ligament
Retinaculum
Patellofemoral joint
Congenital dislocation of the patella is a rare condition which manifests as a permanent and irreducible patella fixed on the lateral aspect of the femoral condyle, usually present at birth. This condition is to be distinguished from habitual or obligate dislocation, in which the patella dislocates and relocates from its normal position in the trochlear groove spontaneously with flexion and extension of the knee. Congenital dislocation of the patella is frequently associated with a flexion contracture at the knee, genu valgus, foot deformity and external tibial torsion, along with various conditions including arthrogryposis, Down syndrome, and nail-patella syndrome, among others. Surgical correction is the only definitive treatment for this condition, which typically includes lateral release, medial stabilization, distal patellar tendon realignment, and proximal extensor lengthening if needed. Outcomes following surgical correction are generally satisfactory, with an improvement in function, range of motion, and quality of life for patients. The aim of this paper is to review the current understanding of congenital and habitual dislocation of the patella and provide an updated overview of the diagnosis and surgical management of these conditions.
Cite
Citations (0)
Medial Patellofemoral Ligament
Subluxation
Lateral release
Conservative Management
Cite
Citations (2)
Cite
Citations (0)
Background: Lateral patellar dislocation can become a recurrent problem after the first episode. Identifying those patients who are at increased risk of redislocation is important for the treatment decision-making process. Purpose: To identify clinical and radiologic risk factors for recurrence of patellar dislocation after a first episode. Study Design: Case-control study; Level of evidence, 3. Methods: The study included patients with lateral patellar dislocation and a 1-year minimum follow-up who were seen between 2011 and 2018. Patients aged 10 to 65 years were included. Patient characteristics, physical examination (patellar apprehension, J sign), and radiographs were reviewed. The Caton-Deschamps and Insall-Salvati ratios were used to evaluate patella alta. High-grade trochlear dysplasia was defined as Dejour types B, C, and D. Results: A total of 130 patients (139 knees) with primary lateral patellar dislocation were included. Recurrent dislocation was seen in 83 knees (59.71%). Stepwise logistic regression analysis demonstrated that Caton-Deschamps ratio ≥1.15 (OR, 2.39; 95% CI, 1.09-5.22; P = .029), age <21 years (OR, 2.53; 95% CI, 1.11-5.77; P = .027), and high-grade trochlear dysplasia (OR, 4.17; 95% CI, 1.90-9.17; P < .001) were significantly associated with patellar redislocation. Based on the presence of these factors, the probability of dislocation after a first lateral patellar dislocation was 31.2% with no factors present, 36.6% with any 1 factor present, 71.7% with any 2 factors present, and 86.2% if all 3 conditions were present. Conclusion: The results of this study indicated that patella alta, high-grade trochlear dysplasia, and age <21 years were independent risk factors for patellar redislocation after a first episode, with an additive effect when they were present together. This may help to guide the type of treatment for these patients.
Medial Patellofemoral Ligament
Cite
Citations (18)
Medial Patellofemoral Ligament
Conservative Management
Cite
Citations (103)
Medial Patellofemoral Ligament
Patella fracture
Cite
Citations (137)
In a group of 25 patients with traumatic dislocation of the knee, four, all of whom had similar ligament and medial soft-tissue injuries, also had associated lateral patellar dislocation. In all four reconstruction was delayed because of their other serious injuries. Having encountered the combination of knee dislocation and lateral patellar dislocation in 16% of our patients, we believe that it may be less rare than is commonly believed. We think that it is important to maintain a high index of suspicion of possible patellar dislocation when medial structures have been severely damaged. Early recognition and immobilisation in extension can prevent fixed lateral dislocation of the patella.
Knee Dislocation
Medial Patellofemoral Ligament
Cite
Citations (4)
Patients who suffer from recurrent patellar dislocation frequently complain of diffuse pain around the knee, swelling and dislocation or subluxation of the patella. Anatomical abnormalities should be responsible for the condition, such as increased Q angle, a high-riding patella, dysplasia of the femoral condyles, abnormal shape of the patella, atrophy of the vastus medialis and hypertrophy of the vastus lateralis. We reviewed 45 reports about the treatment of recurrent dislocation of the patella. The current more than 100 methods can be classified as: lateral release, proximal realignment, distal realignment, proximal and distal realignment, patella-tomy and plastic repair of quadriceps. Of all these methods, proximal realignment is the best, but there has been no method which can successfully and generally repair the recurrent patellar dislocation.
Subluxation
Lateral release
Cite
Citations (0)