How to Evaluate and Treat Skeletally Mature Patients With Patellar Dislocation.
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SUBMITTER: Xu Z
PROVIDER: S-EPMC7953235 | biostudies-literature |
REPOSITORIES: biostudies-literature
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| S-EPMC10907910 | biostudies-literature
Project description:BackgroundA habitual patellar dislocation (HPD) is a rare condition in skeletally mature patients, especially for those with severe quadriceps contracture. Until now, no study has reported the effectiveness of tibial tubercle proximalization to lengthen the extensor mechanism in treating severe HPDs in skeletally mature patients.PurposeTo describe a novel comprehensive procedure that includes tibial tubercle proximalization, extensive lateral release, tibial tubercle medialization, and medial patellofemoral ligament (MPFL) reconstruction in treating severe HPDs in skeletally mature patients and to report its early clinical outcomes.Study designCase series; Level of evidence, 4.MethodsFrom January 2014 to May 2016, a total of 43 consecutive patients (47 knees) with HPDs were surgically treated at a single institution and were retrospectively reviewed. Among them, 11 skeletally mature patients (11 knees) with severe primary HPDs underwent the index comprehensive procedure. Results of patellar tracking were recorded preoperatively and at the final follow-up. The radiological assessment included radiographs in standard anteroposterior, true lateral, and axial views and computed tomography scans at full knee extension before surgery and at the final follow-up. Subjective patellofemoral function was evaluated with the Kujala functional score before the index procedure and at the final follow-up visit.ResultsThe 11 included patients were evaluated for a mean period of 34.9 months (range, 25-46 months). The mean knee flexion angle when the patella dislocated laterally was 25° (range, 10°-30°) preoperatively. Radiologically, there was a statistically significant improvement in the congruence angle, from 73.4° ± 17.0° preoperatively to -7.1° ± 5.8° postoperatively (P < .01) and in the lateral patellofemoral angle, from -65.6° ± 9.4° preoperatively to 6.1° ± 2.7° postoperatively (P < .01). The mean preoperative Kujala functional score was 42.9, and the mean postoperative Kujala functional score was 95.2 (P < .05). No patients reported a recurrence of patellar dislocation at the final follow-up visit.ConclusionThe novel comprehensive procedure, including tibial tubercle proximalization, extensive lateral release, tibial tubercle medialization, and MPFL reconstruction, effectively treated lateral HPDs in skeletally mature patients with severe quadriceps contracture.
| S-EPMC6429911 | biostudies-literature
Project description:Aberrant anatomy, such as patella alta, can be a risk factor for recurrent patellar instability or inferior clinical outcomes after medial patellofemoral ligament reconstruction. In patients with significant patella alta (Caton Deschamps Index >1.2), tibial tubercle distalization may be considered to improve outcomes. However, despite patellar instability commonly affecting pediatric patients, a distalization osteotomy is not feasible in this patient population due to the presence of open physes. Our article presents a technique describing an alternative soft-tissue distalization approach whereby patellar height is decreased by shortening the patellar tendon.
| S-EPMC8355506 | biostudies-literature
Project description:The inheritance of recurrent patellar dislocation (RPD) is konwn, but the susceptible gene remian unidentified. Here, we performed the first whole exome sequencing (WES) cohort study to identify the susceptible genes. The results showed eight genes were associated with this disease. Notably, the CPD gene showed the highest relevance based on its gene function and tissue expression. Single-cell sequencing results indicate that the CPD gene is involved in the pathophysiological process of RPD through granulocytes. Implicated pathways include NF-kappa B, MAPK, and Wnt/β-catenin signaling, potentially influencing CPD's role in RPD pathogenesis. This study identified the susceptible gene and investigate the potential pathogenesis of RPD, which provided a new prospect for the understanding of RPD. Besides, it would offer the theoretical basis for disease prevention and genetic counseling.
2024-05-01 | GSE244724 | GEO
Project description:The inveterate patellar dislocation is an uncommon entity. The most frequent findings correspond to a misaligned valgus associated with lateral patellar dislocation. When severe knee osteoarthritis is present, total knee arthroplasty is an option, whether it is associated or not with realignment of the extensor apparatus. We present a review of published literature on correction of inveterate patellar dislocation associated with knee arthritis and our surgical technique with a case of inveterate patellar dislocation associated with tricompartmental knee osteoarthritis, in which a total knee arthroplasty was performed associated with proximal and distal realignment of the extensor apparatus. Total knee arthroplasty is a useful procedure in knee osteoarthritis associated with inveterate patellar dislocation, which can be associated with techniques on the extensor apparatus to achieve an adequate patellar alignment.
| S-EPMC6470316 | biostudies-literature
Project description:In skeletally immature patients with recurrent patella dislocation that needs operation, how to increase the medial stability of the patella effectively without disturbance of the epiphysial plate is of concern. Through evaluation of multiple techniques that designed to avoid injury to the epiphysial plate, we found that medial patellofemoral ligament augmentation with high-strength nonabsorbable sutures is feasible and effective. Thus, we would like to describe this technique, whose critical point is the correct location and creation of the 2 femoral tunnels. We consider the introduction of the current technique will provide reasonable choices when operation is needed in this special group of patients.
| S-EPMC8719299 | biostudies-literature
Project description:Background: Patellar dislocation is attracting considerable research interest. Purpose: To assess studies on patellar dislocation using a scientometric method to better understand the current status of research and explore future study directions. Study Design: Scoping review. Methods: The Web of Science Core Collection database was selected to retrieve publications on patellar dislocation. Articles and reviews written in English with patellar dislocation as the main topic were included. Conference abstracts, notes, letters, expert opinions, and animal studies were excluded. A total of 4632 articles were identified in our initial search. In addition, Excel 2019, CiteSpace 6.1.R1, and VOSviewer 1.6.9 were used to analyze the h-index, the most highly cited publication, publication essentials, and research themes. Results: A total of 1485 articles were included in our analysis, with 36,608 citations and an h-index of 93. Overall, 1494 institutions and 195 journals were identified from these studies. The United States (n = 531) was the most productive country. The institution and journal with the largest number of articles were the Hospital for Special Surgery (n = 59) and Knee Surgery, Sports Traumatology, Arthroscopy (n = 212), respectively. The article “Scoring of Patellofemoral Disorders” by Kujala et al in 1993 was the most highly cited reference. The most commonly found terms used were patellar dislocation, patellar instability, medial patellofemoral ligament, knee, recurrent patellar dislocation, and soft tissue restraints. Four topics were identified after clustering analysis of key terms: risk factors, medial patellofemoral ligament reconstruction, patellar dislocation in skeletally immature patients, and lateral retinacular release. Conclusion: This scientometric review of articles on patellar dislocation summarized the current status of research (countries, institutions, and authors) and identified potential research directions.
| S-EPMC9703555 | biostudies-literature
Project description: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.
| S-EPMC9820933 | biostudies-literature
Project description:BackgroundHabitual patellar dislocation in extension (HPD-E) is a distinctive subtype of recurrent patellar dislocation (RPD); HPD-E represents the most severe type of patellar maltracking in RPD. It has been reported that the presence of preoperative patellar maltracking is associated with a worse clinical outcome after medial patellofemoral ligament (MPFL) reconstruction (MPFL-R).PurposeTo describe the radiological characteristics of HPD-E and to compare clinical outcomes after MPFL-R among patients with and without preoperative HPD-E.Study designCohort study; Level of evidence, 3.MethodsFrom January 2012 to December 2015, a total of 230 consecutive patients (246 knees) with RPD were treated with MPFL-R alone or combined with tibial tubercle osteotomy. Among them, 28 patients diagnosed with HPD-E by preoperative 3-dimensional computed tomography (CT; HPD-E group) were matched in a 1:1 fashion to 28 control participants who did not show HPD-E (control group). Routine radiography and CT were performed to evaluate patellar height, trochlear dysplasia, tibial tubercle-trochlear groove distance, and torsional deformities. The mean patellar laxity index and lateral patellar translation assessed with stress radiography were measured preoperatively and postoperatively to quantify MPFL laxity. At minimum 2-year follow-up, patient-reported outcomes (Kujala, Lysholm, and Tegner scores), patellar maltracking, and redislocation rates were compared between the HPD-E and control groups.ResultsThe radiological characteristics of the HPD-E group were as follows: 89% (25/28) of patients had severe trochlear dysplasia (Dejour type B or D), and the mean femoral anteversion angle was 35.5° ± 4.7°. At the final follow-up, the HPD-E group had a significantly lower Kujala score (76.2 vs 84.5, respectively; P = .001), Lysholm score (75.4 vs 86.6, respectively; P < .001), and Tegner score (4.1 vs 5.8, respectively; P = .021) compared with the control group. The postoperative patellar laxity index (43% vs 19%, respectively; P < .001) and redislocation rate (25% vs 0%, respectively; P = .01) were significantly higher in the HPD-E group than in the control group.ConclusionPreoperative 3-dimensional CT is a reliable method of identfying patients with HPD-E. Treatment of HPD-E by MPFL-R alone or combined with tibial tubercle osteotomy resulted in a higher redislocation rate, more severe MPFL residual laxity, and lower patient-reported outcome scores compared with patients without HPD-E who underwent MPFL-R.
| S-EPMC7430086 | biostudies-literature
Project description:Prolonged dislocation of the patella is a rare condition and is often related to severe osteoarthritis (OA) of the femorotibial (FT) joint. For this condition's treatment, numerous surgical techniques using total knee arthroplasty (TKA) have been published. To the best of our knowledge, this case report is the first description of the use of lateral release alone to treat recurrent patellar subluxation with TKA. An interesting point in this case is that the patient had a good recovery after TKA in spite of quite a long-term (a duration of almost 55 years) dislocation of her patella and development of secondary OA. We describe a case that we treated by TKA for FT-OA with a prolonged patellar dislocation. We were able to obtain good patellar reduction without additional surgery by performing adequate lateral release of the patellar retinaculum. This clinical case indicates the usefulness of lateral patellar retinaculum release for obtaining stable patellar tracking in TKA for FT-OA with remaining lateral patellar dislocation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
| S-EPMC5365408 | biostudies-literature