Top

Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

07-12-2022 | Knee

Management of the first episode of traumatic patellar dislocation: an international survey

Authors: Riccardo D’Ambrosi, Filippo Migliorini, Simone Cerciello, Germano Guerra, Katia Corona, Laura Mangiavini, Nicola Ursino, Josip Vlaic, Mislav Jelic

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 6/2023

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.

Available only for authorised users

Cohen D, Le N, Zakharia A, Blackman B, de Sa D (2022) MPFL reconstruction results in lower redislocation rates and higher functional outcomes than rehabilitation: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 30:3784–3795CrossRefPubMed

D’Ambrosi R, Meena A, Raj A, Ursino N, Hewett TE (2022) Anterior knee pain: state of the art. Sports Med Open 8:98CrossRefPubMedPubMedCentral

Fu Z, Zhu Z, Chen H, Zhang S (2020) Surgical treatment is better than nonsurgical treatment for primary patellar dislocation: a meta-analysis of randomised controlled trials. Arch Orthop Trauma Surg 140:219–229CrossRefPubMed

Geraghty L, Zordan R, Walker P, Chao TW, Talbot S (2022) Patellar dislocation is associated with increased tibial but not femoral rotational asymmetry. Knee Surg Sports Traumatol Arthrosc 30:2342–2351CrossRefPubMed

Huntington LS, Webster KE, Devitt BM, Scanlon JP, Feller JA (2020) Factors associated with an increased risk of recurrence after a first-time patellar dislocation: a systematic review and meta-analysis. Am J Sports Med 48:2552–2562CrossRefPubMed

Koshino Y, Taniguchi S, Kobayashi T, Samukawa M, Inoue M (2022) Protocols of rehabilitation and return to sport, and clinical outcomes after medial patellofemoral ligament reconstruction with and without tibial tuberosity osteotomy: a systematic review. Int Orthop 46:2517–2528CrossRefPubMed

Liebensteiner M, Keiler A, El Attal R, Balcarek P, Dirisamer F, Giesinger J, Seitlinger G, Nelitz M, Keshmiri A, Frings J, Becher C, Kappel P, Wagner D, Pagenstert G (2021) Conservative versus tailored surgical treatment in patients with first time lateral patella dislocation: a randomized-controlled trial. J Orthop Surg Res 16:378CrossRefPubMedPubMedCentral

Ling DI, Brady JM, Arendt E, Tompkins M, Agel J, Askenberger M, Balcarek P, Parikh S, Shubin Stein BE (2021) Development of a multivariable model based on individual risk factors for recurrent lateral patellar dislocation. J Bone Joint Surg Am 103:586–592CrossRefPubMed

Liu JN, Steinhaus ME, Kalbian IL, Post WR, Green DW, Strickland SM, Shubin Stein BE (2018) Patellar instability management: a survey of the international patellofemoral study group. Am J Sports Med 46:3299–3306CrossRefPubMed

10.

Martinez-Cano JP, Chica J, Martinez-Arboleda JJ, Rincón-Escobar E, Zamudio-Castilla L, Renjifo M, Martinez-Rondanelli A (2021) Patellofemoral dislocation recurrence after a first episode: a case-control study. Orthop J Sports Med 9:2325967120981636CrossRefPubMedPubMedCentral

11.

Migliorini F, Driessen A, Quack V, Gatz M, Tingart M, Eschweiler J (2020) Surgical versus conservative treatment for first patellofemoral dislocations: a meta-analysis of clinical trials. Eur J Orthop Surg Traumatol 30:771–780CrossRefPubMed

12.

Migliorini F, Pilone M, Eschweiler J, Marsilio E, Hildebrand F, Maffulli N (2022) High rates of damage to the medial patellofemoral ligament, lateral trochlea, and patellar crest after acute patellar dislocation: magnetic resonance imaging analysis. Arthroscopy 38:2472–2479CrossRefPubMed

13.

Milinkovic DD, Jovandic I, Zimmermann F, Balcarek P (2022) The J-sign and the body mass index determine the disease-specific quality of life in patients with lateral patellar instability. Knee Surg Sports Traumatol Arthrosc 30:1672–1678CrossRefPubMed

14.

Musielak BJ, Premakumaran P, Janusz P, Dziurda M, Koch A, Walczak M (2021) Good outcomes of modified Grammont and Langenskiöld technique in children with habitual patellar dislocation. Knee Surg Sports Traumatol Arthrosc 29:1983–1989CrossRefPubMed

15.

Ng J, Broomfield J, Barbosa F, Bhangoo N, Geutjens G (2022) Low re-dislocation rate following Bereiter trochleoplasty for recurrent patellar instability with severe trochlear dysplasia. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-022-07201-1CrossRefPubMed

16.

Parikh SN, Veerkamp M, Redler LH, Schlechter J, Williams BA, Yaniv M, Friel N, Perea SH, Shannon SR, Green DW (2022) Patellar instability in young athletes. Clin Sports Med 41:627–651CrossRefPubMed

17.

Pauyo T, Park JP, Bozzo I, Bernstein M (2022) Patellofemoral instability part I: evaluation and nonsurgical treatment. J Am Acad Orthop Surg 30:e1431–e1442CrossRefPubMed

18.

Qiu RY, Fitzpatrick DWD, Cohen D, Kay J, Almasri M, de Sa DL (2022) MRI as the optimal imaging modality for assessment and management of osteochondral fractures and loose bodies following traumatic patellar dislocation: a systematic review. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-022-07043-xCrossRefPubMed

19.

Rueth MJ, Koehl P, Schuh A, Goyal T, Wagner D (2022) Return to sports and short-term follow-up of 101 cases of medial patellofemoral ligament reconstruction using gracilis tendon autograft in children and adolescents. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-022-04365-wCrossRefPubMed

20.

Rund JM, Hinckel BB, Sherman SL (2021) Acute patellofemoral dislocation: controversial decision-making. Curr Rev Musculoskelet Med 14:82–87CrossRefPubMedPubMedCentral

21.

Saccomanno MF, Maggini E, Vaisitti N, Pianelli A, Grava G, Cattaneo S, Milano G (2022) Sulcus angle, trochlear depth and Dejour’s classification can be reliably applied to evaluate trochlear dysplasia: a systematic review of radiological measurements. Arthroscopy. https://doi.org/10.1016/j.arthro.2022.08.039CrossRefPubMed

22.

Sillanpää PJ, Mäenpää HM (2012) First-time patellar dislocation: surgery or conservative treatment? Sports Med Arthrosc Rev 20:128–135CrossRefPubMed

23.

Smith TO, Chester R, Clark A, Donell ST, Stephenson R (2011) A national survey of the physiotherapy management of patients following first-time patellar dislocation. Physiotherapy 97:327–338CrossRefPubMed

24.

Tian G, Yang G, Zuo L, Li F, Wang F (2020) Conservative versus repair of medial patellofemoral ligament for the treatment of patients with acute primary patellar dislocations: a systematic review and meta-analysis. J Orthop Surg (Hong Kong) 28:2309499020932375CrossRefPubMed

25.

Watson R, Sullivan B, Stone AV, Jacobs C, Malone T, Heebner N, Noehren B (2022) Lateral patellar dislocation: a critical review and update of evidence-based rehabilitation practice guidelines and expected outcomes. JBJS Rev. https://doi.org/10.2106/JBJS.RVW.21.00159CrossRefPubMed

26.

Wierer G, Krabb N, Kaiser P, Ortmaier R, Schützenberger S, Schlumberger M, Hiller B, Ingruber F, Smekal V, Attal R, Seitlinger G (2022) The patellar instability probability calculator: a multivariate-based model to predict the individual risk of recurrent lateral patellar dislocation. Am J Sports Med 50:471–477CrossRefPubMed

27.

Xu Z, Song Y, Deng R, Zhang Z, Wang H, Yu JK (2022) Pathological thresholds of segmental femoral torsion in patients with patellar dislocation: influence on patellofemoral malalignment. Orthop J Sports Med 10:23259671221125216CrossRefPubMedPubMedCentral

28.

Zhao Z, Wang Y, Li J, Wang H, Bai X, Wang Q, Li Z (2021) Clinical outcomes and prognostic factors in patients with recurrent patellar lateral dislocation treated with isolated medial patellofemoral ligament reconstruction: a retrospective single-center analysis. Orthop J Sports Med 9:2325967121995803CrossRefPubMedPubMedCentral

29.

Zheng L, Ding HY, Feng Y, Sun BS, Zhu LL, Zhang GY (2021) Gender-related differences in concomitant articular injuries after acute lateral patellar dislocation. Injury 52:1549–1555CrossRefPubMed

Title: Management of the first episode of traumatic patellar dislocation: an international survey
Authors: Riccardo D’Ambrosi
Filippo Migliorini
Simone Cerciello
Germano Guerra
Katia Corona
Laura Mangiavini
Nicola Ursino
Josip Vlaic
Mislav Jelic
Publication date: 07-12-2022
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 6/2023
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-022-07273-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Management of the first episode of traumatic patellar dislocation: an international survey

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Please log in to get access to this content

Other articles of this Issue 6/2023

Sustained superiority in KOOS subscores after matrix-associated chondrocyte implantation using spheroids compared to microfracture

Anterior talofibular ligament remnant quality is important for achieving a stable ankle after arthroscopic lateral ankle ligament repair

In elite athletes with meniscal injuries, always repair the lateral, think about the medial! A systematic review

Medial meniscus posterior root tears and partial meniscectomy significantly increase stress in the knee joint during dynamic gait

Good clinical and radiological results following remnant-preserving posterior cruciate ligament reconstruction: a systematic review

The lasso-loop technique is equivalent to the simple suture technique in arthroscopic anterior talofibular ligament repair