Skip to main content
Top
Published in: BMC Musculoskeletal Disorders 1/2019

Open Access 01-12-2019 | Patella Dislocation | Research article

Recurrent lateral patella dislocation affects knee function as much as ACL deficiency – however patients wait five times longer for treatment

Authors: Truls Martin Straume-Næsheim, Per-Henrik Randsborg, Jan Rune Mikaelsen, Einar Andreas Sivertsen, Brian Devitt, Lars-Petter Granan, Asbjørn Årøen

Published in: BMC Musculoskeletal Disorders | Issue 1/2019

Login to get access

Abstract

Background

Surgical treatment of young patients with recurrent lateral patella dislocation (RLDP) is often recommended because of loss of knee function that compromises their level of activity or even their daily life functioning. This situation is comparable to young patients with an anterior cruciate ligament (ACL) rupture. The purpose of this study was therefore to explore the time from injury to surgery and the pre-operative symptoms and knee function of young RLPD patients scheduled for stabilizing surgery and compare this group to age and sex-matched ACL-deficient patients.

Method

Forty-seven patients with unilateral RLPD listed for isolated medial patellofemoral ligament reconstruction were included in the study (RLPD-group). This group was compared to an age, sex and BMI matched ACL patient group obtained from the Norwegian knee ligament registry (ACL-group) for the following outcome measures: the knee injury and osteoarthritis outcome score (KOOS) assessed on the day of surgery and time from injury to surgery.

Results

The RLPD-group scored significantly lower than the ACL-group for the three KOOS subscales “Pain” (73.6 vs. 79.8, p < 0.05), “Symptoms” (71.7 vs. 79.3, p < 0.05) and “ADL” (84.7 vs 89.5, p < 0.05). The lowest KOOS values were found for Sports/Recreation (53.5 vs. 51.3, p = 0.65) and Quality of life (37.6 vs. 36.7, p = 0.81). The average time from primary injury to surgery was 6 months for the ACL group and 31 months for the RLPD group.

Conclusion

RLPD affected knee function as much as ACL deficiency, and was associated with more pain. Still the RLDP patients waited on average 5 times longer for surgery.

Trial registration

The patients with RLPD consisted of patients who were examined for possible recruitment for a concurrent prospective randomized controlled trial comparing conservative treatment and isolated surgical medial patellofemoral ligament (MPFL) reconstruction (Clinical trials no: NCT02263807, October 2014).
Literature
1.
go back to reference Magnussen RA, Verlage M, Stock E, Zurek L, Flanigan DC, Tompkins M, et al. Primary patellar dislocations without surgical stabilization or recurrence: how well are these patients really doing? Knee Surg Sports Traumatol Arthrosc. 2015;25:2352–6.CrossRef Magnussen RA, Verlage M, Stock E, Zurek L, Flanigan DC, Tompkins M, et al. Primary patellar dislocations without surgical stabilization or recurrence: how well are these patients really doing? Knee Surg Sports Traumatol Arthrosc. 2015;25:2352–6.CrossRef
2.
go back to reference Mäenpää H, Lehto MUK. Patellofemoral osteoarthritis after patellar dislocation. Clin Orthop Relat Res. 1997;339:156–62.CrossRef Mäenpää H, Lehto MUK. Patellofemoral osteoarthritis after patellar dislocation. Clin Orthop Relat Res. 1997;339:156–62.CrossRef
3.
go back to reference Smith TO, Donell S, Song F, Hing CB. Surgical versus non-surgical interventions for treating patellar dislocation. The Cochrane database of systematic reviews. 2015;2:Cd008106. Smith TO, Donell S, Song F, Hing CB. Surgical versus non-surgical interventions for treating patellar dislocation. The Cochrane database of systematic reviews. 2015;2:Cd008106.
4.
go back to reference Balcarek P, Oberthur S, Hopfensitz S, Frosch S, Walde TA, Wachowski MM, et al. Which patellae are likely to redislocate? Knee Surg Sports Traumatol Arthrosc. 2014;22(10):2308–14.CrossRef Balcarek P, Oberthur S, Hopfensitz S, Frosch S, Walde TA, Wachowski MM, et al. Which patellae are likely to redislocate? Knee Surg Sports Traumatol Arthrosc. 2014;22(10):2308–14.CrossRef
5.
go back to reference Weber AE, Nathani A, Dines JS, Allen AA, Shubin-Stein BE, Arendt EA, et al. An algorithmic approach to the Management of Recurrent Lateral Patellar Dislocation. J Bone Joint Surg. 2016;98(5):417–27.CrossRef Weber AE, Nathani A, Dines JS, Allen AA, Shubin-Stein BE, Arendt EA, et al. An algorithmic approach to the Management of Recurrent Lateral Patellar Dislocation. J Bone Joint Surg. 2016;98(5):417–27.CrossRef
6.
go back to reference Schneider DK, Grawe B, Magnussen RA, Ceasar A, Parikh SN, Wall EJ, et al. Outcomes After Isolated Medial Patellofemoral Ligament Reconstruction for the Treatment of Recurrent Lateral Patellar Dislocations: A Systematic Review and Meta-analysis. Am J Sports Med. 2016;44:2993–3005.CrossRef Schneider DK, Grawe B, Magnussen RA, Ceasar A, Parikh SN, Wall EJ, et al. Outcomes After Isolated Medial Patellofemoral Ligament Reconstruction for the Treatment of Recurrent Lateral Patellar Dislocations: A Systematic Review and Meta-analysis. Am J Sports Med. 2016;44:2993–3005.CrossRef
7.
go back to reference Eitzen I, Moksnes H, Snyder-Mackler L, Risberg MA. A progressive 5-week exercise therapy program leads to significant improvement in knee function early after anterior cruciate ligament injury. J Orthop Sports Phys Ther. 2010;40(11):705–21.CrossRef Eitzen I, Moksnes H, Snyder-Mackler L, Risberg MA. A progressive 5-week exercise therapy program leads to significant improvement in knee function early after anterior cruciate ligament injury. J Orthop Sports Phys Ther. 2010;40(11):705–21.CrossRef
8.
go back to reference Grindem H, Granan LP, Risberg MA, Engebretsen L, Snyder-Mackler L, Eitzen I. How does a combined preoperative and postoperative rehabilitation programme influence the outcome of ACL reconstruction 2 years after surgery? A comparison between patients in the Delaware-Oslo ACL Cohort and the Norwegian National Knee Ligament Registry. Br J Sports Med. 2014;49:385–9.CrossRef Grindem H, Granan LP, Risberg MA, Engebretsen L, Snyder-Mackler L, Eitzen I. How does a combined preoperative and postoperative rehabilitation programme influence the outcome of ACL reconstruction 2 years after surgery? A comparison between patients in the Delaware-Oslo ACL Cohort and the Norwegian National Knee Ligament Registry. Br J Sports Med. 2014;49:385–9.CrossRef
9.
go back to reference Ahldén M, Samuelsson K, Sernert N, Forssblad M, Karlsson J, Kartus J. The Swedish National Anterior Cruciate Ligament Register: A Report on Baseline Variables and Outcomes of Surgery for Almost 18,000 Patients. Am J Sports Med. 2012;40(10):2230–5.CrossRef Ahldén M, Samuelsson K, Sernert N, Forssblad M, Karlsson J, Kartus J. The Swedish National Anterior Cruciate Ligament Register: A Report on Baseline Variables and Outcomes of Surgery for Almost 18,000 Patients. Am J Sports Med. 2012;40(10):2230–5.CrossRef
10.
go back to reference Frobell RB, Roos EM, Roos HP, Ranstam J, Lohmander LS. A randomized trial of treatment for acute anterior cruciate ligament tears. N Engl J Med. 2010;363(4):331–42.CrossRef Frobell RB, Roos EM, Roos HP, Ranstam J, Lohmander LS. A randomized trial of treatment for acute anterior cruciate ligament tears. N Engl J Med. 2010;363(4):331–42.CrossRef
11.
go back to reference Meuffels DE, Poldervaart MT, Diercks RL, Fievez AW, Patt TW, Hart CP, et al. Guideline on anterior cruciate ligament injury. Acta Orthop. 2012;83(4):379–86.CrossRef Meuffels DE, Poldervaart MT, Diercks RL, Fievez AW, Patt TW, Hart CP, et al. Guideline on anterior cruciate ligament injury. Acta Orthop. 2012;83(4):379–86.CrossRef
12.
go back to reference Camp CL, Krych AJ, Dahm DL, Levy BA, Stuart MJ. Medial patellofemoral ligament repair for recurrent patellar dislocation. Am J Sports Med. 2010;38(11):2248–54.CrossRef Camp CL, Krych AJ, Dahm DL, Levy BA, Stuart MJ. Medial patellofemoral ligament repair for recurrent patellar dislocation. Am J Sports Med. 2010;38(11):2248–54.CrossRef
13.
go back to reference Christiansen SE, Jacobsen BW, Lund B, Lind M. Reconstruction of the medial patellofemoral ligament with gracilis tendon autograft in transverse patellar drill holes. Arthroscopy. 2008;24(1):82–7.CrossRef Christiansen SE, Jacobsen BW, Lund B, Lind M. Reconstruction of the medial patellofemoral ligament with gracilis tendon autograft in transverse patellar drill holes. Arthroscopy. 2008;24(1):82–7.CrossRef
14.
go back to reference Drez D Jr, Edwards TB, Williams CS. Results of medial patellofemoral ligament reconstruction in the treatment of patellar dislocation. Arthroscopy. 2001;17(3):298–306.CrossRef Drez D Jr, Edwards TB, Williams CS. Results of medial patellofemoral ligament reconstruction in the treatment of patellar dislocation. Arthroscopy. 2001;17(3):298–306.CrossRef
15.
go back to reference Ellera Gomes JL. Medial patellofemoral ligament reconstruction for recurrent dislocation of the patella: a preliminary report. Arthroscopy. 1992;8(3):335–40.CrossRef Ellera Gomes JL. Medial patellofemoral ligament reconstruction for recurrent dislocation of the patella: a preliminary report. Arthroscopy. 1992;8(3):335–40.CrossRef
16.
go back to reference Lim AK, Chang HC, Hui JH. Recurrent patellar dislocation: reappraising our approach to surgery. Ann Acad Med Singap. 2008;37(4):320–3.PubMed Lim AK, Chang HC, Hui JH. Recurrent patellar dislocation: reappraising our approach to surgery. Ann Acad Med Singap. 2008;37(4):320–3.PubMed
17.
go back to reference Slenker NR, Tucker BS, Pepe MD, Marchetto PA, Cohen SB. Short−/intermediate-term outcomes after medial patellofemoral ligament reconstruction in the treatment of chronic lateral patellofemoral instability. Phys Sportsmed. 2013;41(2):26–33.CrossRef Slenker NR, Tucker BS, Pepe MD, Marchetto PA, Cohen SB. Short−/intermediate-term outcomes after medial patellofemoral ligament reconstruction in the treatment of chronic lateral patellofemoral instability. Phys Sportsmed. 2013;41(2):26–33.CrossRef
18.
go back to reference Kita K, Tanaka Y, Toritsuka Y, Amano H, Uchida R, Takao R, et al. Factors affecting the outcomes of double-bundle medial patellofemoral ligament reconstruction for recurrent patellar dislocations evaluated by multivariate analysis. Am J Sports Med. 2015. Kita K, Tanaka Y, Toritsuka Y, Amano H, Uchida R, Takao R, et al. Factors affecting the outcomes of double-bundle medial patellofemoral ligament reconstruction for recurrent patellar dislocations evaluated by multivariate analysis. Am J Sports Med. 2015.
19.
go back to reference Granan LP, Bahr R, Steindal K, Furnes O, Engebretsen L. Development of a national cruciate ligament surgery registry: the Norwegian National Knee Ligament Registry. Am J Sports Med. 2008;36(2):308–15.CrossRef Granan LP, Bahr R, Steindal K, Furnes O, Engebretsen L. Development of a national cruciate ligament surgery registry: the Norwegian National Knee Ligament Registry. Am J Sports Med. 2008;36(2):308–15.CrossRef
20.
go back to reference Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD. Knee injury and osteoarthritis outcome score (KOOS)--development of a self-administered outcome measure. J Orthop Sports Phys Ther. 1998;28(2):88–96.CrossRef Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD. Knee injury and osteoarthritis outcome score (KOOS)--development of a self-administered outcome measure. J Orthop Sports Phys Ther. 1998;28(2):88–96.CrossRef
21.
go back to reference Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res. 1985;(198):43–9. Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res. 1985;(198):43–9.
22.
go back to reference Hjermundrud V, Bjune TK, Risberg MA, Engebretsen L, Aroen A. Full-thickness cartilage lesion do not affect knee function in patients with ACL injury. Knee Surg Sports Traumatol Arthrosc. 2010;18(3):298–303.CrossRef Hjermundrud V, Bjune TK, Risberg MA, Engebretsen L, Aroen A. Full-thickness cartilage lesion do not affect knee function in patients with ACL injury. Knee Surg Sports Traumatol Arthrosc. 2010;18(3):298–303.CrossRef
23.
go back to reference Rotterud JH, Risberg MA, Engebretsen L, Aroen A. Patients with focal full-thickness cartilage lesions benefit less from ACL reconstruction at 2-5 years follow-up. Knee Surg Sports Traumatol Arthrosc. 2012;20(8):1533–9.CrossRef Rotterud JH, Risberg MA, Engebretsen L, Aroen A. Patients with focal full-thickness cartilage lesions benefit less from ACL reconstruction at 2-5 years follow-up. Knee Surg Sports Traumatol Arthrosc. 2012;20(8):1533–9.CrossRef
24.
go back to reference Ageberg E, Forssblad M, Herbertsson P, Roos EM. Sex Differences in Patient-Reported Outcomes After Anterior Cruciate Ligament Reconstruction: Data From the Swedish Knee Ligament Register. Am J Sports Med. 2010;38(7):1334–42.CrossRef Ageberg E, Forssblad M, Herbertsson P, Roos EM. Sex Differences in Patient-Reported Outcomes After Anterior Cruciate Ligament Reconstruction: Data From the Swedish Knee Ligament Register. Am J Sports Med. 2010;38(7):1334–42.CrossRef
25.
go back to reference Cameron KL, Thompson BS, Peck KY, Owens BD, Marshall SW, Svoboda SJ. Normative values for the KOOS and WOMAC in a young athletic population: history of knee ligament injury is associated with lower scores. Am J Sports Med. 2013;41(3):582–9.CrossRef Cameron KL, Thompson BS, Peck KY, Owens BD, Marshall SW, Svoboda SJ. Normative values for the KOOS and WOMAC in a young athletic population: history of knee ligament injury is associated with lower scores. Am J Sports Med. 2013;41(3):582–9.CrossRef
26.
go back to reference Paradowski PT, Bergman S, Sunden-Lundius A, Lohmander LS, Roos EM. Knee complaints vary with age and gender in the adult population. Population-based reference data for the knee injury and osteoarthritis outcome score (KOOS). BMC Musculoskelet Disord. 2006;7:38.CrossRef Paradowski PT, Bergman S, Sunden-Lundius A, Lohmander LS, Roos EM. Knee complaints vary with age and gender in the adult population. Population-based reference data for the knee injury and osteoarthritis outcome score (KOOS). BMC Musculoskelet Disord. 2006;7:38.CrossRef
27.
go back to reference Roos E, Lohmander LS. The knee injury and osteoarthritis outcome score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes. 2003;1(1):64.CrossRef Roos E, Lohmander LS. The knee injury and osteoarthritis outcome score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes. 2003;1(1):64.CrossRef
28.
go back to reference Palmu S, Kallio PE, Donell ST, Helenius I, Nietosvaara Y. Acute patellar dislocation in children and adolescents: a randomized clinical trial. J Bone Joint Surg Am. 2008;90(3):463–70.CrossRef Palmu S, Kallio PE, Donell ST, Helenius I, Nietosvaara Y. Acute patellar dislocation in children and adolescents: a randomized clinical trial. J Bone Joint Surg Am. 2008;90(3):463–70.CrossRef
29.
go back to reference Sherman SL, Deasis DP, Garrone AJ, Voss EE, Oliver HA. Return to play after patellar stabilization. Curr Rev Musculoskelet Med. 2018;11(2):280–4.CrossRef Sherman SL, Deasis DP, Garrone AJ, Voss EE, Oliver HA. Return to play after patellar stabilization. Curr Rev Musculoskelet Med. 2018;11(2):280–4.CrossRef
30.
go back to reference Ardern CL, Taylor NF, Feller JA, Webster KE. Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: an updated systematic review and meta-analysis including aspects of physical functioning and contextual factors. Br J Sports Med. 2014;48(21):1543–52.CrossRef Ardern CL, Taylor NF, Feller JA, Webster KE. Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: an updated systematic review and meta-analysis including aspects of physical functioning and contextual factors. Br J Sports Med. 2014;48(21):1543–52.CrossRef
31.
go back to reference Eitzen I, Moksnes H, Snyder-Mackler L, Engebretsen L, Risberg MA. Functional tests should be accentuated more in the decision for ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2010;18(11):1517–25.CrossRef Eitzen I, Moksnes H, Snyder-Mackler L, Engebretsen L, Risberg MA. Functional tests should be accentuated more in the decision for ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2010;18(11):1517–25.CrossRef
32.
go back to reference Eggerding V, Meuffels DE, Bierma-Zeinstra SM, Verhaar JA, Reijman M. Factors related to the need for surgical reconstruction after anterior cruciate ligament rupture: a systematic review of the literature. J Orthop Sports Phys Ther. 2015;45(1):37–44.CrossRef Eggerding V, Meuffels DE, Bierma-Zeinstra SM, Verhaar JA, Reijman M. Factors related to the need for surgical reconstruction after anterior cruciate ligament rupture: a systematic review of the literature. J Orthop Sports Phys Ther. 2015;45(1):37–44.CrossRef
33.
go back to reference Nomura E, Inoue M. Hybrid medial patellofemoral ligament reconstruction using the semitendinous tendon for recurrent patellar dislocation: minimum 3 years' follow-up. Arthroscopy. 2006;22(7):787–93.CrossRef Nomura E, Inoue M. Hybrid medial patellofemoral ligament reconstruction using the semitendinous tendon for recurrent patellar dislocation: minimum 3 years' follow-up. Arthroscopy. 2006;22(7):787–93.CrossRef
34.
go back to reference Nomura E, Inoue M, Kobayashi S. Long-term follow-up and knee osteoarthritis change after medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Am J Sports Med. 2007;35(11):1851–8.CrossRef Nomura E, Inoue M, Kobayashi S. Long-term follow-up and knee osteoarthritis change after medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Am J Sports Med. 2007;35(11):1851–8.CrossRef
35.
go back to reference Schottle PB, Fucentese SF, Romero J. Clinical and radiological outcome of medial patellofemoral ligament reconstruction with a semitendinosus autograft for patella instability. Knee Surg Sports Traumatol Arthrosc. 2005;13(7):516–21.CrossRef Schottle PB, Fucentese SF, Romero J. Clinical and radiological outcome of medial patellofemoral ligament reconstruction with a semitendinosus autograft for patella instability. Knee Surg Sports Traumatol Arthrosc. 2005;13(7):516–21.CrossRef
36.
go back to reference Christiansen SE, Jakobsen BW, Lund B, Lind M. Isolated repair of the medial patellofemoral ligament in primary dislocation of the patella: a prospective randomized study. Arthroscopy. 2008;24(8):881–7.CrossRef Christiansen SE, Jakobsen BW, Lund B, Lind M. Isolated repair of the medial patellofemoral ligament in primary dislocation of the patella: a prospective randomized study. Arthroscopy. 2008;24(8):881–7.CrossRef
37.
go back to reference Arendt E, Agel J, Moore A. First time lateral patella dislocations: characterizing their readiness for return to activity. Br J Sports Med. 2011;45(4):335–6.CrossRef Arendt E, Agel J, Moore A. First time lateral patella dislocations: characterizing their readiness for return to activity. Br J Sports Med. 2011;45(4):335–6.CrossRef
38.
go back to reference Witonski D, Keska R, Synder M, Sibinski M. An isolated medial patellofemoral ligament reconstruction with patellar tendon autograft. Biomed Res Int. 2013;2013:637678.CrossRef Witonski D, Keska R, Synder M, Sibinski M. An isolated medial patellofemoral ligament reconstruction with patellar tendon autograft. Biomed Res Int. 2013;2013:637678.CrossRef
39.
go back to reference Wang D, Jones MH, Khair MM, Miniaci A. Patient-reported outcome measures for the knee. J Knee Surg. 2010;23(3):137–51.CrossRef Wang D, Jones MH, Khair MM, Miniaci A. Patient-reported outcome measures for the knee. J Knee Surg. 2010;23(3):137–51.CrossRef
40.
go back to reference Magnussen RA, Trojani C, Granan LP, Neyret P, Colombet P, Engebretsen L, et al. Patient demographics and surgical characteristics in ACL revision: a comparison of French, Norwegian, and North American cohorts. Knee Surg Sports Traumatol Arthrosc. 2015;23(8):2339–48.CrossRef Magnussen RA, Trojani C, Granan LP, Neyret P, Colombet P, Engebretsen L, et al. Patient demographics and surgical characteristics in ACL revision: a comparison of French, Norwegian, and North American cohorts. Knee Surg Sports Traumatol Arthrosc. 2015;23(8):2339–48.CrossRef
Metadata
Title
Recurrent lateral patella dislocation affects knee function as much as ACL deficiency – however patients wait five times longer for treatment
Authors
Truls Martin Straume-Næsheim
Per-Henrik Randsborg
Jan Rune Mikaelsen
Einar Andreas Sivertsen
Brian Devitt
Lars-Petter Granan
Asbjørn Årøen
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2019
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-019-2689-7

Other articles of this Issue 1/2019

BMC Musculoskeletal Disorders 1/2019 Go to the issue