Assessing Femoral Anteversion in Patients With Bilateral Recurrent Patellar Dislocations.

Background: After first-time lateral patellar dislocation, 44% to 70% of patients sustain redislocations. Increased femoral anteversion (FA) is considered to result in increased lateralizing forces on the patella, which might predispose one to patellar instability. When recurrent patellar dislocations (RPDs) are bilateral, it is unclear if the FA is even more increased.

Evaluation of an Active Rehabilitation Program With Early Weightbearing and No Immobilization After Tibial Tubercle Distalization.

Background: Abnormal patellar height (patella alta) has been reported to be one of the main predisposing factors for recurrent patellar dislocation, and it can be surgically corrected by distalizing tibial tubercle osteotomy (DTTO). Rehabilitation after DTTO often includes limitations on weightbearing and restrictions on knee range of motion by means of bracing, increasing the risk of slow progression of the rehabilitation.

Hypothesis: An active rehabilitation program with no restrictions on weightbearing and range of movement would yield a low risk of postoperative complications and a fast recovery period.

Effect of accelerated postoperative rehabilitation after tibial tubercle distalisation: A randomised controlled trial protocol.

Patella alta is a clinical condition where the patella is positioned too proximal in relation to the femoral trochlea. Such an abnormality may cause patellar instability and predispose to recurrent patellofemoral dislocations and patellofemoral pain. There are no conclusive guidelines for determining a threshold for too high positioned patella, as several different methods have been described to measure patellar height.

A Randomized Controlled Trial Comparing a Patella-Stabilizing, Motion-Restricting Knee Brace Versus a Neoprene Nonhinged Knee Brace After a First-Time Traumatic Patellar Dislocation.

Background: A traumatic lateral patellar dislocation is a common injury in adolescents and young adults. The majority of first-time dislocations can be treated nonoperatively. Various types of knee braces are used for nonoperative treatment, but evidence on the most preferable bracing method is lacking.

The incidence of paediatric ACL injury is increasing in Finland.

Purpose: Anterior cruciate ligament (ACL) injury is a common knee injury in paediatric and adolescent patients. The population-based incidence of paediatric ACL injury is, however, unknown. Recent studies suggest increased ACL injury rates among adolescents, especially in active, sports-participating population.

Traumatic Patellar Dislocation and Cartilage Injury: A Follow-up Study of Long-Term Cartilage Deterioration.

Background: Patellofemoral cartilage deterioration and osteoarthritis are reported to be associated with recurrent patellar dislocation. However, the association between first-time traumatic patellar dislocation and cartilage deterioration is unknown.

Purpose: The aim of this study was to assess long-term cartilage deterioration in the patellofemoral and tibiofemoral joint after conservatively treated traumatic lateral patellar dislocation.

Medial patellofemoral ligament avulsion injury at the patella: classification and clinical outcome.

Purpose: To define medial patellofemoral ligament (MPFL) injury characteristics at the patellar attachment and clinical outcome in patients with primary traumatic patellar dislocation and MPFL avulsion injury at the patella.

Methods: Magnetic resonance imaging (MRI) was used to assess patients with primary (first-time) patellar dislocation and MPFL injury at the medial margin of the patella. Fifty-six patients with patellar attachment MPFL injury were enrolled in the study.

Incidence of knee dislocation and concomitant vascular injury requiring surgery: a nationwide study.

Background: Acute knee (tibiofemoral joint) dislocation is a serious knee injury, although population-based numbers and incidence rates of knee dislocation with or without concomitant vascular injury are unknown.

Methods: The study covered the whole adult population of 4 million persons (aged ≥ 18 years) in Finland during the 11-year period from January 1, 1998, to December 31, 2011. Data on hospitalization caused by acute knee dislocations and concomitant vascular injuries requiring operative treatment were obtained from the nationwide National Hospital Discharge Registry.

Medial patellofemoral ligament: anatomy, injury and treatment in the adolescent knee.

Purpose Of Review: Traumatic and nontraumatic patellofemoral instability (PFI) in children and adolescents is a complex problem. It is determined by a large number of mechanical and pathomorphologic conditions, mainly seen in nontraumatic dislocations.

Recent Findings: Although conservative treatment with a short immobilization, followed by early passive motion and isometric quadriceps strengthening, can be considered in real traumatic dislocations without any cartilaginous injury, a surgical intervention should be considered in atraumatic cases.

First-time patellar dislocation: surgery or conservative treatment?

Primary patellar dislocation injures the medial patellofemoral ligament (MPFL), the major soft-tissue stabilizer of the patella, which may lead to recurrent patellar instability. Recurrent patellar dislocation are common and may require surgical intervention. The variation in location of injury of the MPFL and the presence of an osteochondral fracture produces challenges in clinical decision making between nonoperative and operative treatment, including the surgical modality, to repair or reconstruct the MPFL.

Patellofemoral osteoarthritis in patients with operative treatment for patellar dislocation: a magnetic resonance-based analysis.

Purpose: the clinical role of patellofemoral (PF) osteoarthrosis (OA) in the outcome after PF stabilizing surgery is poorly understood. The study hypothesis was that PF cartilage lesions and OA are associated with a poor long-term outcome after PF stabilizing surgery.

Methods: the study cohort included thirty-seven patients who underwent PF stabilizing surgery by traditional nonanatomic procedures and were evaluated a minimum of 10 years (range 10-21) after surgery.

Femoral avulsion of the medial patellofemoral ligament after primary traumatic patellar dislocation predicts subsequent instability in men: a mean 7-year nonoperative follow-up study.

Background: The clinical relevance of medial patellofemoral ligament (MPFL) injury location in primary patellar dislocation has not been studied.

Hypothesis: Prognosis after primary traumatic patellar dislocation may vary by MPFL injury location.

Study Design: Cohort study; Level of evidence, 3.

Treatment with and without initial stabilizing surgery for primary traumatic patellar dislocation. A prospective randomized study.

Background: There is no consensus about the management of acute primary traumatic patellar dislocation in young physically active adults. The objective of this study was to compare the clinical outcomes after treatment with and without initial stabilizing surgery for primary traumatic patellar dislocation in young adults.

Methods: Forty young adults, thirty-seven men and three women with a median age of twenty years (range, nineteen to twenty-two years), who had an acute primary traumatic patellar dislocation were randomly allocated to be treated with initial surgical stabilization (eighteen patients, with each receiving one of two types of initial stabilizing procedures) or to be managed with an orthosis (twenty-two patients, including four who had osteochondral fragments removed arthroscopically).

A mini-invasive adductor magnus tendon transfer technique for medial patellofemoral ligament reconstruction: a technical note.

Patellar dislocations are associated with injuries to the medial patellofemoral ligament (MPFL). Several techniques for MPFL reconstruction have been recently published with some disadvantages involved, including large skin incisions and donor site morbidity. Arthroscopic stabilizing techniques carry the potential of inadequate restoration of MPFL function.

Arthroscopic surgery for primary traumatic patellar dislocation: a prospective, nonrandomized study comparing patients treated with and without acute arthroscopic stabilization with a median 7-year follow-up.

Background: No data exist whether patients with primary traumatic patellar dislocation benefit from initial arthroscopic medial repair surgery.

Purpose: To compare long-term outcomes of patients treated with acute arthroscopic stabilization for patellar dislocation with those treated nonoperatively except for removal of loose bodies.

Study Design: Cohort study; Level of evidence, 2.