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How to Evaluate and Treat Skeletally Mature Patients With Patellar Dislocation.

ABSTRACT: Although patellar dislocation is a knee disorder prevalent in adolescence and young adults, the evaluation and treatment of patients are complex and even enigmatic. Much of the literature fails to provide a detailed description of patient management. The purpose of this study is to introduce a method for the evaluation and treatment of patellar dislocation. This Technical Note will help guide clinicians in the clinical evaluation of patients and formulation of treatment plans.

SUBMITTER: Xu Z

PROVIDER: S-EPMC7953235 | biostudies-literature | 2021 Mar

REPOSITORIES: biostudies-literature

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How to Evaluate and Treat Skeletally Mature Patients With Patellar Dislocation.

Xu Zijie Z Zhang Hua H Yan Wenlong W Chen Jiaxing J Zhou Aiguo A

Arthroscopy techniques 20210208 3

Although patellar dislocation is a knee disorder prevalent in adolescence and young adults, the evaluation and treatment of patients are complex and even enigmatic. Much of the literature fails to provide a detailed description of patient management. The purpose of this study is to introduce a method for the evaluation and treatment of patellar dislocation. This Technical Note will help guide clinicians in the clinical evaluation of patients and formulation of treatment plans. ...[more]

PMID: 33738207

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Project description:BackgroundA habitual patellar dislocation (HPD) is a rare condition in skeletally mature patients, especially for those with severe quadriceps contracture. Until now, no study has reported the effectiveness of tibial tubercle proximalization to lengthen the extensor mechanism in treating severe HPDs in skeletally mature patients.PurposeTo describe a novel comprehensive procedure that includes tibial tubercle proximalization, extensive lateral release, tibial tubercle medialization, and medial patellofemoral ligament (MPFL) reconstruction in treating severe HPDs in skeletally mature patients and to report its early clinical outcomes.Study designCase series; Level of evidence, 4.MethodsFrom January 2014 to May 2016, a total of 43 consecutive patients (47 knees) with HPDs were surgically treated at a single institution and were retrospectively reviewed. Among them, 11 skeletally mature patients (11 knees) with severe primary HPDs underwent the index comprehensive procedure. Results of patellar tracking were recorded preoperatively and at the final follow-up. The radiological assessment included radiographs in standard anteroposterior, true lateral, and axial views and computed tomography scans at full knee extension before surgery and at the final follow-up. Subjective patellofemoral function was evaluated with the Kujala functional score before the index procedure and at the final follow-up visit.ResultsThe 11 included patients were evaluated for a mean period of 34.9 months (range, 25-46 months). The mean knee flexion angle when the patella dislocated laterally was 25° (range, 10°-30°) preoperatively. Radiologically, there was a statistically significant improvement in the congruence angle, from 73.4° ± 17.0° preoperatively to -7.1° ± 5.8° postoperatively (P < .01) and in the lateral patellofemoral angle, from -65.6° ± 9.4° preoperatively to 6.1° ± 2.7° postoperatively (P < .01). The mean preoperative Kujala functional score was 42.9, and the mean postoperative Kujala functional score was 95.2 (P < .05). No patients reported a recurrence of patellar dislocation at the final follow-up visit.ConclusionThe novel comprehensive procedure, including tibial tubercle proximalization, extensive lateral release, tibial tubercle medialization, and MPFL reconstruction, effectively treated lateral HPDs in skeletally mature patients with severe quadriceps contracture.

Dataset Information

How to Evaluate and Treat Skeletally Mature Patients With Patellar Dislocation.

Publications

How to Evaluate and Treat Skeletally Mature Patients With Patellar Dislocation.

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