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  1. Article: Acute dislocation of the patella. A prospective review of operative treatment.

    Vainionpää, S / Laasonen, E / Silvennoinen, T / Vasenius, J / Rokkanen, P

    The Journal of bone and joint surgery. British volume

    1990  Volume 72, Issue 3, Page(s) 366–369

    Abstract: We report a prospective study of 55 patients with acute primary patellar dislocation, all treated ... There were medial marginal fractures of the patella in 23 cases. Subjective results of the operation ... significant. At operation, rupture of the medial retinaculum of the patella was seen in all but one case ...

    Abstract We report a prospective study of 55 patients with acute primary patellar dislocation, all treated by operation and followed up for at least two years. Diagnosis was based on the history of a lateral displacement, with medial tenderness and a positive apprehension test; redislocations were excluded. Before operation, the difference in lateral shift on skyline views of the injured and control patellae was highly significant. At operation, rupture of the medial retinaculum of the patella was seen in all but one case. There were medial marginal fractures of the patella in 23 cases. Subjective results of the operation were excellent or good in 44 of the 55 at two years with a redislocation rate of only 9%. Most patients were able to return to the same level of sporting activity as before the injury.
    MeSH term(s) Adolescent ; Adult ; Female ; Humans ; Joint Dislocations/rehabilitation ; Joint Dislocations/surgery ; Ligaments, Articular/injuries ; Ligaments, Articular/surgery ; Male ; Middle Aged ; Patella/injuries ; Prospective Studies ; Recurrence ; Rupture ; Sports
    Language English
    Publishing date 1990-05
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 220626-2
    ISSN 2044-5377 ; 0301-620X ; 0447-9076
    ISSN (online) 2044-5377
    ISSN 0301-620X ; 0447-9076
    DOI 10.1302/0301-620X.72B3.2341428
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Acute Patellofemoral Dislocation: Controversial Decision-Making.

    Rund, Joseph M / Hinckel, Betina B / Sherman, Seth L

    Current reviews in musculoskeletal medicine

    2021  Volume 14, Issue 1, Page(s) 82–87

    Abstract: ... Patellar Instability Treatment by Early Results) prospective cohort study have been carefully developed ... Purpose of review: The topic of acute patella dislocations is controversial. Discussions revolve ... without osteochondral loose bodies or fracture is non-operative treatment. However, imaging for all first-time ...

    Abstract Purpose of review: The topic of acute patella dislocations is controversial. Discussions revolve around which individuals need early surgery, identification of risk factors, and rehabilitation protocol. The purpose of this review is to discuss the current recommendations for non-operative and/or operative management of first-time dislocators.
    Recent findings: Recent studies have made it clear that not all patellar dislocations are the same, not all patients do well with conservative treatment, and risk stratification can identify individuals at high risk of recurrence who would benefit from early surgical intervention. Risk factors that have been identified include younger age, skeletally immature, contralateral instability, trochlear dysplasia, patella alta, increased tibial tubercle-trochlear groove distance, and increased patella tilt. The PAPI (Pediatric and Adolescent Patellar Instability) RCT study and JUPITER (Justifying Patellar Instability Treatment by Early Results) prospective cohort study have been carefully developed, are under way, and will provide further guidance. In summary, the management of acute patellar dislocations is evolving. Surgery for patients with osteochondral loose bodies should include fixation as well as soft tissue stabilization. The standard of care for patients with an acute patellar dislocation without osteochondral loose bodies or fracture is non-operative treatment. However, imaging for all first-time dislocators is indicated to stratify risks and determine risk profile. If an individual is at high risk, soft tissue stabilization may be considered. Still, most patients will be treated non-operatively.
    Language English
    Publishing date 2021-02-01
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2407827-X
    ISSN 1935-9748 ; 1935-973X
    ISSN (online) 1935-9748
    ISSN 1935-973X
    DOI 10.1007/s12178-020-09687-z
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Acute patellar dislocation in children and adolescents. Surgical technique.

    Nietosvaara, Yrjänä / Paukku, Reijo / Palmu, Sauli / Donell, Simon T

    The Journal of bone and joint surgery. American volume

    2009  Volume 91 Suppl 2 Pt 1, Page(s) 139–145

    Abstract: ... of a randomized controlled trial of nonoperative and operative treatment of primary acute patellar dislocation in children less ... Background: The treatment of acute patellar dislocation in children is controversial ... to nonoperative treatment (twenty-eight knees) or operative treatment (thirty-six knees). Operative treatment ...

    Abstract Background: The treatment of acute patellar dislocation in children is controversial. Some investigators have advocated early repair of the medial structures, whereas others have treated this injury nonoperatively. The present report describes the long-term subjective and functional results of a randomized controlled trial of nonoperative and operative treatment of primary acute patellar dislocation in children less than sixteen years of age.
    Methods: The data were gathered prospectively on a cohort of seventy-four acute patellar dislocations in seventy-one patients (fifty-one girls and twenty boys) younger than sixteen years of age. Sixty-two patients (sixty-four knees) without large (>15 mm) intra-articular fragments were randomized to nonoperative treatment (twenty-eight knees) or operative treatment (thirty-six knees). Operative treatment consisted of direct repair of the damaged medial structures if the patella was dislocatable with the patient under anesthesia (twenty-nine knees) or lateral release alone if the patella was not dislocatable with the patient under anesthesia (seven knees). All but four patients who underwent operative treatment had a concomitant lateral release. The rehabilitation protocol was the same for both groups. The patients were seen at two years, and a telephone interview was conducted at a mean of six years and again at a mean of fourteen years. Fifty-eight patients (sixty-four knees; 94%) were reviewed at the time of the most recent follow-up.
    Results: At the time of the most recent follow-up, the subjective result was either good or excellent for 75% (twenty-one) of twenty-eight nonoperatively treated knees and 66% (twenty-one) of thirty-two operatively treated knees. The rates of recurrent dislocation in the two treatment groups were 71% (twenty of twenty-eight) and 67% (twenty-four of thirty-six), respectively. The first redislocation occurred within two years after the primary injury in twenty-three (52%) of the forty-four knees with recurrent dislocation. Instability of the contralateral patella was noted in thirty (48%) of the sixty-two patients. The only significant predictor for recurrence was a positive family history of patellar instability. The mode of treatment and the existence of osteochondral fractures had no clinical or significant influence on the subjective outcome, recurrent patellofemoral instability, function, or activity scores.
    Conclusions: The long-term subjective and functional results after acute patellar dislocation are satisfactory in most patients. Initial operative repair of the medial structures combined with lateral release did not improve the long-term outcome, despite the very high rate of recurrent instability. A positive family history is a risk factor for recurrence and for contralateral patellofemoral instability. Routine repair of the torn medial stabilizing soft tissues is not advocated for the treatment of acute patellar dislocation in children and adolescents.
    MeSH term(s) Adolescent ; Child ; Female ; Humans ; Male ; Orthopedic Procedures/methods ; Orthopedic Procedures/rehabilitation ; Patellar Dislocation/rehabilitation ; Patellar Dislocation/surgery ; Patient Selection ; Postoperative Care ; Prospective Studies ; Recurrence ; Tendons/transplantation ; Treatment Outcome
    Language English
    Publishing date 2009-03-01
    Publishing country United States
    Document type Journal Article ; Randomized Controlled Trial
    ZDB-ID 220625-0
    ISSN 1535-1386 ; 0021-9355
    ISSN (online) 1535-1386
    ISSN 0021-9355
    DOI 10.2106/JBJS.H.01289
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.MO 464: Show issues

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  4. Article ; Online: Acute patellar dislocation in children and adolescents: a randomized clinical trial.

    Palmu, Sauli / Kallio, Pentti E / Donell, Simon T / Helenius, Ilkka / Nietosvaara, Yrjänä

    The Journal of bone and joint surgery. American volume

    2008  Volume 90, Issue 3, Page(s) 463–470

    Abstract: ... of a randomized controlled trial of nonoperative and operative treatment of primary acute patellar dislocation in children less ... Background: The treatment of acute patellar dislocation in children is controversial ... to nonoperative treatment (twenty-eight knees) or operative treatment (thirty-six knees). Operative treatment ...

    Abstract Background: The treatment of acute patellar dislocation in children is controversial. Some investigators have advocated early repair of the medial structures, whereas others have treated this injury nonoperatively. The present report describes the long-term subjective and functional results of a randomized controlled trial of nonoperative and operative treatment of primary acute patellar dislocation in children less than sixteen years of age.
    Methods: The data were gathered prospectively on a cohort of seventy-four acute patellar dislocations in seventy-one patients (fifty-one girls and twenty boys) younger than sixteen years of age. Sixty-two patients (sixty-four knees) without large (>15 mm) intra-articular fragments were randomized to nonoperative treatment (twenty-eight knees) or operative treatment (thirty-six knees). Operative treatment consisted of direct repair of the damaged medial structures if the patella was dislocatable with the patient under anesthesia (twenty-nine knees) or lateral release alone if the patella was not dislocatable with the patient under anesthesia (seven knees). All but four patients who underwent operative treatment had a concomitant lateral release. The rehabilitation protocol was the same for both groups. The patients were seen at two years, and a telephone interview was conducted at a mean of six years and again at a mean of fourteen years. Fifty-eight patients (sixty-four knees; 94%) were reviewed at the time of the most recent follow-up.
    Results: At the time of the most recent follow-up, the subjective result was either good or excellent for 75% (twenty-one) of twenty-eight nonoperatively treated knees and 66% (twenty-one) of thirty-two operatively treated knees. The rates of recurrent dislocation in the two treatment groups were 71% (twenty of twenty-eight) and 67% (twenty-four of thirty-six), respectively. The first redislocation occurred within two years after the primary injury in twenty-three (52%) of the forty-four knees with recurrent dislocation. Instability of the contralateral patella was noted in thirty (48%) of the sixty-two patients. The only significant predictor for recurrence was a positive family history of patellar instability. The mode of treatment and the existence of osteochondral fractures had no clinical or significant influence on the subjective outcome, recurrent patellofemoral instability, function, or activity scores.
    Conclusions: The long-term subjective and functional results after acute patellar dislocation are satisfactory in most patients. Initial operative repair of the medial structures combined with lateral release did not improve the long-term outcome, despite the very high rate of recurrent instability. A positive family history is a risk factor for recurrence and for contralateral patellofemoral instability. Routine repair of the torn medial stabilizing soft tissues is not advocated for the treatment of acute patellar dislocation in children and adolescents.
    MeSH term(s) Adolescent ; Child ; Female ; Humans ; Male ; Orthopedic Procedures/methods ; Patellar Dislocation/rehabilitation ; Patellar Dislocation/surgery ; Patellar Dislocation/therapy ; Prospective Studies ; Recurrence ; Reoperation ; Treatment Outcome
    Language English
    Publishing date 2008-03
    Publishing country United States
    Document type Journal Article ; Randomized Controlled Trial
    ZDB-ID 220625-0
    ISSN 1535-1386 ; 0021-9355
    ISSN (online) 1535-1386
    ISSN 0021-9355
    DOI 10.2106/JBJS.G.00072
    Database MEDical Literature Analysis and Retrieval System OnLINE

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