Conservative Versus Surgical Treatment for Primary Patellar Dislocation
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Conservative Versus Surgical Treatment for Primary Patellar Dislocation. / Frings, Jannik; Balcarek, Peter; Tscholl, Philippe; Liebensteiner, Michael; Dirisamer, Florian; Koenen, Paola.
In: DTSCH ARZTEBL INT, Vol. 117, No. 16, 17.04.2020, p. 279-286.Research output: SCORING: Contribution to journal › SCORING: Review article › Research
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TY - JOUR
T1 - Conservative Versus Surgical Treatment for Primary Patellar Dislocation
AU - Frings, Jannik
AU - Balcarek, Peter
AU - Tscholl, Philippe
AU - Liebensteiner, Michael
AU - Dirisamer, Florian
AU - Koenen, Paola
PY - 2020/4/17
Y1 - 2020/4/17
N2 - BACKGROUND: Primary patellar dislocation is often the initial manifestation of patellofemoral instability. Its long-term consequences can include recurrent dislocation and permanent dysfunction of the knee joint. There is no consensus on the optimal treatment of primary patellar dislocation in the relevant literature. The main prerequisite for a good long-term result is a realistic assessment of the risk of recurrent dislocation.METHODS: We carried out a systematic literature search in OvidSP (a search engine for full-text databases) and MEDLINE to identify suitable stratification models with respect to the risk of recurrent dislocation.RESULTS: In the ten studies included in the current analysis, eight risk factors for recurrence after primary patellar dislocation were identified. Six studies revealed a higher risk in younger patients, particularly those under 16 years of age. The sex of the patient had no clear influence. In two studies, bilateral instability was identified as a risk factor. Two anatomical risk factors-a high-riding patella (patella alta) and trochlear dysplasia-were found to have the greatest influence in six studies. In a metaanalysis of five studies, patella alta predisposed to recurrent dislocation with an odds ratio (OR) of 4.259 (95% confidence interval [1.9; 9.188]). Moreover, a pathologically increased tibial tuberosity to trochlear groove (TT-TG) distance and rupture of the medial patellofemoral ligament (MPFL) on the femoral side were associated with higher recurrence rates. Patients with multiple risk factors in combination had a very high risk of recurrence.CONCLUSION: The risk of recurrent dislocation after primary patellar dislocation is increased by a number of risk factors, and even more so when multiple such risk factors are present. Published stratification models enable an assessment of the individual risk profile. Patients at low risk can be managed conservatively; surgery should be considered for patients at high risk.
AB - BACKGROUND: Primary patellar dislocation is often the initial manifestation of patellofemoral instability. Its long-term consequences can include recurrent dislocation and permanent dysfunction of the knee joint. There is no consensus on the optimal treatment of primary patellar dislocation in the relevant literature. The main prerequisite for a good long-term result is a realistic assessment of the risk of recurrent dislocation.METHODS: We carried out a systematic literature search in OvidSP (a search engine for full-text databases) and MEDLINE to identify suitable stratification models with respect to the risk of recurrent dislocation.RESULTS: In the ten studies included in the current analysis, eight risk factors for recurrence after primary patellar dislocation were identified. Six studies revealed a higher risk in younger patients, particularly those under 16 years of age. The sex of the patient had no clear influence. In two studies, bilateral instability was identified as a risk factor. Two anatomical risk factors-a high-riding patella (patella alta) and trochlear dysplasia-were found to have the greatest influence in six studies. In a metaanalysis of five studies, patella alta predisposed to recurrent dislocation with an odds ratio (OR) of 4.259 (95% confidence interval [1.9; 9.188]). Moreover, a pathologically increased tibial tuberosity to trochlear groove (TT-TG) distance and rupture of the medial patellofemoral ligament (MPFL) on the femoral side were associated with higher recurrence rates. Patients with multiple risk factors in combination had a very high risk of recurrence.CONCLUSION: The risk of recurrent dislocation after primary patellar dislocation is increased by a number of risk factors, and even more so when multiple such risk factors are present. Published stratification models enable an assessment of the individual risk profile. Patients at low risk can be managed conservatively; surgery should be considered for patients at high risk.
U2 - 10.3238/arztebl.2020.0279
DO - 10.3238/arztebl.2020.0279
M3 - SCORING: Review article
C2 - 32519945
VL - 117
SP - 279
EP - 286
JO - DTSCH ARZTEBL INT
JF - DTSCH ARZTEBL INT
SN - 1866-0452
IS - 16
ER -