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European Journal of Orthopaedic Surgery & Traumatology

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01-12-2019 | Up-to date Review and Case Report • KNEE - PAEDIATRIC

Surgical management for recurrent patellar dislocations in skeletally immature patients

Authors: Filippo Migliorini, Björn Rath, Markus Tingart, Nadine Meisen, Jörg Eschweiler

Published in: European Journal of Orthopaedic Surgery & Traumatology | Issue 8/2019

Abstract

Background

Due to his multifactorial aetiology, treating patellofemoral instability can be a challenge for the orthopaedic surgeon. The incidence of patellofemoral instability shows a peak during adolescence, especially from 11 to 14 years old.

Aim

Several clinical studies focusing on recurrent patellar dislocations in skeletally immature patients have been published, reporting inconsistent or controversial results. Currently, there is a lack of consensus regarding the surgical management of these patients. The purpose of this study is to update current evidence and systematically review indications, treatments, and outcomes of surgical management for recurrent patellar dislocations in skeletally immature patients.

Methods

A comprehensive review of the literature was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis, the PRISMA Statement. The following electronic databases were accessed in February 2019: PubMed, Scopus, Google Scholar, CINAHL, EMBASE. All the articles treating surgical management for recurrent patellar dislocations in skeletally immature patients were considered for inclusion. For the methodological quality assessment, we referred to the Coleman Methodology Score (CMS). For the statistical analysis, we referred to the unpaired t-test to establish whether the results are statistically significant.

Result

The overall CMS resulted in 52.78 points, attesting a satisfactory methodological quality assessment to this systematic review. A total of 21 articles including 623 patients (577 knees) were evaluated. The overall mean age was 13.02 years. The mean follow-up was 46.61 months. The mean Kujala score improved from 58.94 ± 10.38 to 87.07 ± 7.68 points. The Lysholm score reported a pre- and post-operative mean values of 49.54 ± 14.20 and 88.32 ± 8.80, respectively. The mean Tegner Activity Scale scored 4.28 ± 1.22 at baseline, improving to 5.26 ± 0.83 post-operatively. A total of 4.19% of patients incurred into a major complication, while 9.6% sustained a minor one. We observed a total of 89 re-dislocations above 692 treated knees (12%).

Conclusion

The main findings of this study are that surgical procedures for skeletally immature patients affected by recurrent patellar dislocations are feasible and effective. Complications and re-dislocations occurred infrequently. It is of fundamental importance to treat precociously these patients in order to reduce the risk of further recurrences, to increase the level of sporting activity and improving the quality of life.

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Title: Surgical management for recurrent patellar dislocations in skeletally immature patients
Authors: Filippo Migliorini
Björn Rath
Markus Tingart
Nadine Meisen
Jörg Eschweiler
Publication date: 01-12-2019
Publisher: Springer Paris
Published in: European Journal of Orthopaedic Surgery & Traumatology / Issue 8/2019
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-019-02483-7

At a glance: The STEP trials

Springer Medicine

Surgical management for recurrent patellar dislocations in skeletally immature patients

Abstract

Background

Aim

Methods

Result

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Aim

Methods

Result

Conclusion

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