Patellar Dislocation In Adolescents Research Articles

Adolescent patellar osteochondral fracture following patellar dislocation

Patellar dislocations in adolescents may cause osteochondral fractures of the patella. The aim of this study was to review the outcomes of adolescent patients who underwent surgical intervention for patellar osteochondral fracture following patellar dislocation. Nine patients who underwent surgery for osteochondral fracture of the patella following dislocation were identified retrospectively. Following arthroscopic examination, if the fragment was large enough to support fixation, headless screws or bioabsorbable pins were used. Otherwise, the loose body was excised, and the donor site was managed with a microfracture. Postoperatively, patients were assessed using the International Knee Documentation Committee (IKDC) and Knee injury and Osteoarthritis Outcome Score (KOOS) outcome measures. The average age of the patients was 14.6 with average follow-up 30.2months. Four of the nine patients underwent fixation, while five patients underwent removal of loose body with microfracture. The average defect size in the nonfixation group was 1.2cm(2) compared with 3.2cm(2) in the fixation group. The IKDC scores for fixation and nonfixation groups were 63.9 (SD=18) and 76.1 (SD=11.7), respectively. The KOOS subscale scores for symptoms, function in sports and recreation, and knee-related quality of life were higher for the nonfixation group when compared to the fixation group. This is the first known series examining surgical outcomes of osteochondral fractures of the patella following patellar dislocations in the adolescent population. While patients without fixation were less symptomatic in this series, this may be attributable to more severe injuries in patients undergoing fracture fixation. Retrospective case series, Level IV.

Medial patella retinaculum plasty for treatment of habitual patellar dislocation in adolescents

The surgical technique, medial patellar retinaculum plasty, can almost restore both static and dynamic stability and verge on anatomical repair for the treatment of habitual patellar dislocation in adolescents. In accordance with the injury patterns of the medial patellar retinaculum through knee MRI, we repaired different injury sites with this surgical procedure. We reviewed this technique in 16 patients with an average age of 15 years. Retrospective review of charts and radiographs immediately after the surgery up to the latest follow-up (range 12-36 months) was undertaken. All patients were evaluated clinically and radiologically over an average of 20.7 months. The recovery of knee mobility results were good. No recurrence of patellar instability has been found. We think this could be a valid technique to treat habitual patellar dislocation in adolescents.

Galeazzi’s modified technique for recurrent patella dislocation in skeletally immature patients

BackgroundA large number of surgical techniques have been proposed for the treatment of recurrent patellar dislocation in adolescents, one of the most famous being Galeazzi’s semitendinosus tenodesis as modified by Baker. The aim of this study was to verify the mid-term results of this technique, the effectiveness of restoring the patellofemoral congruency, by both static and dynamic computed tomography (CT), and to determine whether the preoperative type of patellofemoral relationship affects the results. MethodsThe study included 14 patients (16 knees), with a mean age of 11.6years, Tanner stage ≤3, with at least two to three episodes of patellar dislocation. The patients underwent surgery using Baker’s modification of Galeazzi’s technique. All 14 patients were evaluated preoperatively and at least 4years afterward by static and dynamic CT. Clinical evaluation at follow-up was performed using the criteria described by Crosby and Insall. ResultsClinical results at follow-up were excellent in 62.5% and good in 37.5%. As preoperative evaluation showed a high patella in 7 out of 16 knees, two groups were considered: A, high patella; B, not high patella. The data obtained with static CT show that the patella reached a satisfactory congruence in all knees. The data obtained with dynamic CT showed different results between group A and B. A preoperative high patella remains high with quadriceps contraction and again shows the change of tilt and subluxation. In group B, the data obtained with dynamic CT are comparable with those obtained with static CT. Conclusions This technique produces good mid-term clinical results. However, the dynamic CT showed that in those patients with high patellas, semitendinosus tenodesis alone is not enough to stabilize the patella.

Recurrent Patellar Dislocation in Adolescents

Background: The clinical outcome of arthroscopic medial retinaculum plication (MRP) compared with vastus medialis plasty (VMP) for recurrent patellar dislocation in adolescents is unknown. Hypothesis: Arthroscopic MRP can yield similar results to open VMP for recurrent patellar dislocation in adolescents. Study Design: Randomized controlled clinical trial; Level of evidence, 2. Methods: Sixty adolescent patients were randomly divided into 2 groups to receive arthroscopic MRP and open VMP respectively. The patients were followed up at 3, 6, 12, and 24 months postoperatively and computed tomography (CT) scans were taken immediately after operation and at 12 and 24 months postoperatively to evaluate the position of the patella. Knee function was evaluated at 24 months postoperatively according to the International Knee Documentation Committee (IKDC), Kujala, Lysholm, and Tegner rating scales. For those who underwent operation more than 3 years previously, an additional review was taken to evaluate the latest patellar stability status. Results: The final follow-up time was 56.8 ± 21.5 months (range, 24-92 months) and 59.1 ± 24.7 months (range, 24-88 months), respectively, in the MRP and VMP groups. The CT examination showed that the correction of the patellar position deteriorated over time in both groups. The final patellar position was significantly better than that before surgery in the VMP group, but not in the MRP group. The VMP group had significantly better clinical results at each follow-up compared with the MRP group. The IKDC, Lysholm, Kujala, and Tegner scores were 62.5 ± 6.2, 70.7 ± 5.1, 76.6 ± 4.8, and 3.9 ± 0.7, respectively, in the MRP group, and 71.8 ± 7.1 (P < .001), 79.4 ± 5.5 (P < .001), 82.9 ± 4.8 (P < .001), and 5.1 ± 1.4 (P < .001), respectively, in the VMP group at the 2-year follow-up. Five patients (17.9%) in the MRP group and 2 patients (7.7%) in the VMP group (P = .267) experienced episodes of redislocation at the final follow-up. Conclusion: Arthroscopic MRP is less reliable for maintaining the corrected position of the patella and for functional recovery compared with VMP for recurrent patellar dislocation in adolescents.

Acute patellar dislocation in adolescents: operative versus nonoperative treatment

The purpose of this prospective non-randomised study was to compare the efficacy of two opposed methods, operative and conservative. Our hypothesis was that if the method was selected correctly, on an individual basis, the results should be approximately equal. The study included 37 adolescents aged between 12 and 16 years, with a mean follow up of 6.1 years. The presence of a significant loose body, confirmed by precise imaging, was the key for selecting operative or arthroscopic treatment. In both groups of patients, we evaluated functional knee scores and the incidence of residual patellofemoral disorders. We confirmed our hypothesis using the t-test to compare functional results and a test for comparison of proportions for incidence of residual disorders. There was no statistically significant difference (p=0.091) between operatively and conservatively treated groups with regard to functional results. The same statistical outcome emerged when comparing incidences of re-dislocation (p=0.854), or other major patellar instabilities (p=0.856), between the groups. The results obtained should not promote a non-operative method on the basis of lower risk, but do support an individual approach based on precise diagnosis and defined criteria.

Sonographic Evaluation of the Injuries After Traumatic Patellar Dislocation in Adolescents

Ultrasound Quarterly: December 2008 - Volume 24 - Issue 4 - p 245 doi: 10.1097/01.ruq.0000335225.71517.a5

Sonographic Evaluation of the Injuries After Traumatic Patellar Dislocation in Adolescents

Traumatic patellar dislocation (TPD) may be associated with other injuries requiring additional treatment. The superficial localization of the knee extensor apparatus and knee articular cartilage make them accessible to sonographic evaluation (ultrasonography [USG]). Prospective analysis of the value of USG in TPD. In 21 patients, 22 knees were examined by USG after clinical and routine radiographic evaluations. Based on USG findings, operative or nonoperative treatment was done (15 and 7 cases, respectively). In 17 knees, lesions of the medial patellofemoral ligament (MPFL) fibers were visible. In 16 knees, avulsion fractures of the patellar insertion of the MPFL were identified. Injuries of the femoral attachment of the MPFL or intramuscular hematoma of the vastus medialis obliquus (VMO) were present in 7 knees. Eleven osteochondral loose bodies and 1 nondisplaced osteochondral fracture were detected in 11 knees. Corresponding osteochondral lesions were localized in all cases. An osteochondral loose body that was identified by USG was confirmed intraoperatively or by computed tomographic scan in 91.6%, the osteochondral lesion localization in 81.8%, and avulsion fracture of the patellar attachment of the MPFL in 100% of knees. Overall, the USG findings were confirmed by these methods in 88.2% of knees. Ultrasonography is highly efficient in determining the extent of injuries after TPD in adolescents. Ultrasonography allows visualization of loose bodies, localization of osteochondral lesions, and, using a dynamic modification, allows precise assessment of the functional status of the MPFL. II.

Articular cartilage injury with acute patellar dislocation in adolescents. Arthroscopic and radiographic correlation.

Acute patellar dislocation and relocation produces major forces at the articular surfaces. Articular injury was assessed in 48 patients, 24 boys and 24 girls (mean age, 14 years), with acute, initial, noncontact patellar dislocations. Correlation of the findings of radiographic and arthroscopic examinations was done. Eleven of the 48 patients (23%) had radiologic diagnoses of articular injuries. Thirty-four of the 48 patients (71%) had arthroscopic evidence of articular damage, 32 osteochondral and 2 chondral injuries. Eight of the 28 (29%) arthroscopically identified osteochondral loose bodies (4 to 20 mm) were identified radiologically. Overall, only 11 of the 34 (32%) arthroscopically documented articular injuries were defined by preoperative radiographs. These standard radiographs provided limited information for management decisions. Poor results after patellar dislocation treatment may involve nonrecognition of articular compromise.