nach oben

Knee Surgery, Sports Traumatology, Arthroscopy

Erschienen in:

14.07.2018 | Knee

Incidence of second-time lateral patellar dislocation is associated with anatomic factors, age and injury patterns of medial patellofemoral ligament in first-time lateral patellar dislocation: a prospective magnetic resonance imaging study with 5-year follow-up

verfasst von: Guang-ying Zhang, Hong-yu Ding, En-miao Li, Lei Zheng, Zheng-wu Bai, Hao Shi, Feng-jing Fan, Dan Guo

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 1/2019

Einloggen, um Zugang zu erhalten

Abstract

Purpose

To examine the predictors of the second-time lateral patellar dislocation (LPD) in patients after acute first-time LPD in a 5-year follow-up.

Methods

Data were collected prospectively from patients after acute first-time LPD with conservative treatment. Factors included sex, age at the first-time LPD, anatomical variants [trochlear dysplasia, patellar height, tibial tuberosity–trochlear groove (TT–TG) distance], and injury patterns of medial patellofemoral ligament (MPFL) in acute first-time LPD. Logistic regression was carried out to identify the independent risk factors for the incidence of the second-time LPD.

Results

The incidence rate of a second-time LPD was 35.5% (59 of 166) in the 5-year follow-up. Univariate analysis revealed significant differences in the incidence rate of the second-time LPD among age at the first-time LPD (P = 0.04), trochlear dysplasia (P = 0.003), patella height (P = 0.017) and the TT–TG distance (P = 0.027). Risk factors for the second-time LPD were age < 18 years at the first-time LPD [odds ratio (OR) 4.088], low-grade trochlear dysplasia (OR 7.214), high-grade trochlear dysplasia (OR 18.945), patella alta (OR 8.416), elevated TT–TG distance (OR 12.742), complete MPFL tear at its isolated femoral-side (OR 6.04) and complete combined MPFL tear (OR 5.851).

Conclusions

Trochlear dysplasia, elevated TT–TG distance, patella alta, age < 18 years at the first-time LPD, complete MPFL tear at its isolated femoral-side and complete combined MPFL tear in the first-time LPD are independently associated with a higher incidence rate of the second-time LPD.

Level of evidence

III.

Aragão JA, Reis FP, de Vasconcelos DP, Feitosa VL, Nunes MA (2008) Metric measurements and attachment levels of the medial patellofemoral ligament: an anatomical study in cadavers. Clinics (Sao Paulo) 63:541–544CrossRef

Arendt EA, England K, Agel J, Tompkins MA (2017) An analysis of knee anatomic imaging factors associated with primary lateral patellar dislocations. Knee Surg Sports Traumatol Arthrosc 25:3099–3107CrossRefPubMed

Askenberger M, Arendt EA, Ekström W, Voss U, Finnbogason T, Janarv PM (2016) Medial patellofemoral ligament injuries in children with first-time lateral patellar dislocations: a magnetic resonance imaging and arthroscopic study. Am J Sports Med 44:152–158CrossRefPubMed

Askenberger M, Ekström W, Finnbogason T, Janarv PM (2014) Occult intra-articular knee injuries in children with hemarthrosis. Am J Sports Med 42:1600–1606CrossRefPubMed

Askenberger M, Janarv PM, Finnbogason T, Arendt EA (2017) Morphology and anatomic patellar instability risk factors in first-time traumatic lateral patellar dislocations: a prospective magnetic resonance imaging study in skeletally immature children. Am J Sports Med 45:50–58CrossRefPubMed

Balcarek P, Ammon J, Frosch S et al (2010) Magnetic resonance imaging characteristics of the medial patellofemoral ligament lesion in acute lateral patellar dislocations considering trochlear dysplasia, patella alta, and tibial tuberosity–trochlear groove distance. Arthroscopy 26:926–935CrossRefPubMed

Balcarek P, Jung K, Ammon J et al (2010) Anatomy of lateral patellar instability: trochlear dysplasia and tibial tubercle–trochlear groove distance is more pronounced in women who dislocate the patella. Am J Sports Med 38:2320–2327CrossRefPubMed

Balcarek P, Oberthür S, Hopfensitz S et al (2014) Which patellae are likely to redislocate? Knee Surg Sports Traumatol Arthrosc 22:2308–2314CrossRefPubMed

Balcarek P, Walde TA, Frosch S, Schüttrumpf JP, Wachowski MM, Stürmer KM (2012) MRI but not arthroscopy accurately diagnoses femoral MPFL injury in first-time patellar dislocations. Knee Surg Sports Traumatol Arthrosc 20:1575–1580CrossRefPubMed

10.

Balcarek P, Walde TA, Frosch S et al (2011) Patellar dislocations in children, adolescents and adults: a comparative MRI study of medial patellofemoral ligament injury patterns and trochlear groove anatomy. Eur J Radiol 79:415–420CrossRefPubMed

11.

Bitar AC, Demange MK, D’Elia CO, Camanho GL (2012) Traumatic patellar dislocation: nonoperative treatment compared with MPFL reconstruction using patellar tendon. Am J Sports Med 40:114–122CrossRefPubMed

12.

Brown GD, Ahmad CS (2008) Combined medial patellofemoral ligament and patellotibial ligament reconstruction in skeletally immature patients. J Knee Surg 21:328–332CrossRefPubMed

13.

Camp CL, Heidenreich MJ, Dahm DL, Stuart MJ, Levy BA, Krych AJ (2016) Individualizing the tibial tubercle–trochlear groove distance: patellar instability ratios that predict recurrent instability. Am J Sports Med 44:393–399CrossRefPubMed

14.

Casteleyn PP, Handelberg F (1989) Arthroscopy in the diagnosis of occult dislocation of the patella. Acta Orthop Belg 55:381–383PubMed

15.

Chhabra A, Subhawong TK, Carrino JA (2011) A systematised MRI approach to evaluating the patellofemoral joint. Skelet Radiol 40:375–387CrossRef

16.

Christensen TC, Sanders TL, Pareek A, Mohan R, Dahm DL, Krych AJ (2017) Risk factors and time to recurrent ipsilateral and contralateral patellar dislocations. Am J Sports Med 45:2105–2110CrossRefPubMed

17.

Conlan T, Garth WP Jr, Lemons JE (1993) Evaluation of the medial soft-tissue restraints of the extensor mechanism of the knee. J Bone Jt Surg Am 75:682–693CrossRef

18.

Dejour D, Le Coultre B (2007) Osteotomies in patello-femoral instabilities. Sports Med Arthrosc Rev 15:39–46CrossRefPubMed

19.

Dejour H, Walch G, Neyret P, Adeleine P (1990) Dysplasia of the femoral trochlea. Rev Chir Orthop Reparatrice Appar Mot 76:45–54PubMed

20.

Dejour H, Walch G, Nove-Josserand L, Guier C (1994) Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2:19–26CrossRefPubMed

21.

Desio SM, Burks RT, Bachus KN (1998) Soft tissue restraints to lateral patellar translation in the human knee. Am J Sports Med 26:59–65CrossRefPubMed

22.

Diederichs G, Issever AS, Scheffler S (2010) MR imaging of patellar instability: injury patterns and assessment of risk factors. Radiographics 30:961–981CrossRefPubMed

23.

Dietrich TJ, Fucentese SF, Pfirrmann CW (2016) Imaging of individual anatomical risk factors for patellar instability. Semin Musculoskelet Radiol 20:65–73CrossRefPubMed

24.

Elias DA, White LM, Fithian DC (2002) Acute lateral patellar dislocation at MR imaging: injury patterns of medial patellar soft-tissue restraints and osteochondral injuries of the inferomedial patella. Radiology 225:736–743CrossRefPubMed

25.

Erickson BJ, Mascarenhas R, Sayegh ET et al (2015) Does operative treatment of first-time patellar dislocations lead to increased patellofemoral stability? A systematic review of overlapping meta-analyses. Arthroscopy 31:1207–1215CrossRefPubMed

26.

Felus J, Kowalczyk B (2012) Age-related differences in medial patellofemoral ligament injury patterns in traumatic patellar dislocation: case series of 50 surgically treated children and adolescents. Am J Sports Med 40:2357–2364CrossRefPubMed

27.

Fucentese SF, von Roll A, Koch PP, Epari DR, Fuchs B, Schottle PB (2006) The patella morphology in trochlear dysplasia: a comparative MRI study. Knee 13:145–150CrossRefPubMed

28.

Hiemstra LA, Kerslake S, Loewen M, Lafave M (2016) Effect of trochlear dysplasia on outcomes after isolated soft tissue stabilization for patellar instability. Am J Sports Med 44:1515–1523CrossRefPubMed

29.

Hopper GP, Leach WJ, Rooney BP, Walker CR, Blyth MJ (2014) Does degree of trochlear dysplasia and position of femoral tunnel influence outcome after medial patellofemoral ligament reconstruction? Am J Sports Med 42:716–722CrossRefPubMed

30.

Jaquith BP, Parikh SN (2017) Predictors of recurrent patellar instability in children and adolescents after first-time dislocation. J Pediatr Orthop 37:484–490CrossRefPubMed

31.

Ji G, Wang S, Wang X, Liu J, Niu J, Wang F (2017) Surgical versus nonsurgical treatments of acute primary patellar dislocation with special emphasis on the MPFL injury patterns. J Knee Surg 30:378–384CrossRefPubMed

32.

Kang HJ, Wang F, Chen BC, Zhang YZ, Ma L (2013) Non-surgical treatment for acute patellar dislocation with special emphasis on the MPFL injury patterns. Knee Surg Sports Traumatol Arthrosc 21:325–331CrossRefPubMed

33.

Kepler CK, Bogner EA, Hammoud S, Malcolmson G, Potter HG, Green DW (2011) Zone of injury of the medial patellofemoral ligament after acute patellar dislocation in children and adolescents. Am J Sports Med 39:1444–1449CrossRefPubMed

34.

Kikuchi S, Tajima G, Yan J et al (2017) Morphology of insertion sites on patellar side of medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc 25:2488–2493CrossRefPubMed

35.

Köhlitz T, Scheffler S, Jung T et al (2013) Prevalence and patterns of anatomical risk factors in patients after patellar dislocation: a case control study using MRI. Eur Radiol 23:1067–1074CrossRefPubMed

36.

Lewallen L, McIntosh A, Dahm D (2015) First-time patellofemoral dislocation: risk factors for recurrent instability. J Knee Surg 28:303–309CrossRefPubMed

37.

Lewallen LW, McIntosh AL, Dahm DL (2013) Predictors of recurrent instability after acute patellofemoral dislocation in pediatric and adolescent patients. Am J Sports Med 41:575–581CrossRefPubMed

38.

Lippacher S, Dejour D, Elsharkawi M et al (2012) Observer agreement on the Dejour trochlear dysplasia classification: a comparison of true lateral radiographs and axial magnetic resonance images. Am J Sports Med 40:837–843CrossRefPubMed

39.

Nelitz M, Dreyhaupt J, Williams SRM (2018) Anatomic reconstruction of the medial patellofemoral ligament in children and adolescents using a pedicled quadriceps tendon graft shows favourable results at a minimum of 2-year follow-up. Knee Surg Sports Traumatol Arthrosc 26:1210–1215PubMed

40.

Nelitz M, Theile M, Dornacher D, Wölfle J, Reichel H, Lippacher S (2012) Analysis of failed surgery for patellar instability in children with open growth plates. Knee Surg Sports Traumatol Arthrosc 20:822–828CrossRefPubMed

41.

Nomura E, Horiuchi Y, Inoue M (2002) Correlation of MR imaging findings and open exploration of medial patellofemoral ligament injuries in acute patellar dislocations. Knee 9:139–143CrossRefPubMed

42.

Nwachukwu BU, So C, Schairer WW, Green DW, Dodwell ER (2016) Surgical versus conservative management of acute patellar dislocation in children and adolescents: a systematic review. Knee Surg Sports Traumatol Arthrosc 24:760–767CrossRefPubMed

43.

Panagiotopoulos E, Strzelczyk P, Herrmann M, Scuderi G (2006) Cadaveric study on static medial patellar stabilizers: the dynamizing role of the vastus medialis obliquus on medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc 14:7–12CrossRefPubMed

44.

Pfirrmann CW, Zanetti M, Romero J, Hodler J (2000) Femoral trochlear dysplasia: MR findings. Radiology 216:858–864CrossRefPubMed

45.

Philippot R, Boyer B, Testa R, Farizon F, Moyen B (2012) The role of the medial ligamentous structures on patellar tracking during knee flexion. Knee Surg Sports Traumatol Arthrosc 20:331–336CrossRefPubMed

46.

Placella G, Tei MM, Sebastiani E et al (2014) Shape and size of the medial patellofemoral ligament for the best surgical reconstruction: a human cadaveric study. Knee Surg Sports Traumatol Arthrosc 22:2327–2333CrossRefPubMed

47.

Putney SA, Smith CS, Neal KM (2012) The location of medial patellofemoral ligament injury in adolescents and children. J Pediatr Orthop 32:241–244CrossRefPubMed

48.

Sanders TL, Pareek A, Hewett TE, Stuart MJ, Dahm DL, Krych AJ (2018) High rate of recurrent patellar dislocation in skeletally immature patients: a long-term population-based study. Knee Surg Sports Traumatol Arthrosc 26:1037–1043PubMed

49.

Schoettle PB, Zanetti M, Seifert B, Pfirrmann CW, Fucentese SF, Romero J (2006) The tibial tuberosity–trochlear groove distance: a comparative study between CT and MRI scanning. Knee 13:26–31CrossRefPubMed

50.

Schöttle PB, Scheffler SU, Schwarck A, Weiler A (2006) Arthroscopic medial retinacular repair after patellar dislocation with and without underlying trochlear dysplasia: a preliminary report. Arthroscopy 22:1192–1198CrossRefPubMed

51.

Seeley M, Bowman KF, Walsh C, Sabb BJ, Vanderhave KL (2012) Magnetic resonance imaging of acute patellar dislocation in children: patterns of injury and risk factors for recurrence. J Pediatr Orthop 32:145–155CrossRefPubMed

52.

Shea KG, Polousky JD, Jacobs JC Jr et al (2015) The patellar insertion of the medial patellofemoral ligament in children: a cadaveric study. J Pediatr Orthop 35:e31–e35CrossRefPubMed

53.

Shea KG, Polousky JD, Jacobs JC Jr et al (2014) The relationship of the femoral physis and the medial patellofemoral ligament in children: a cadaveric study. J Pediatr Orthop 34:808–813CrossRefPubMed

54.

Shea KG, Styhl AC, Jacobs JC Jr et al (2016) The relationship of the femoral physis and the medial patellofemoral ligament in children: a cadaveric study. Am J Sports Med 44:2833–2837CrossRefPubMed

55.

Sillanpää PJ, Mäenpää HM, Mattila VM, Visuri T, Pihlajamäki H (2008) 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. Am J Sports Med 36:2301–2309CrossRefPubMed

56.

Sillanpää PJ, Peltola E, Mattila VM, Kiuru M, Visuri T, Pihlajamäki H (2009) 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. Am J Sports Med 37:1513–1521CrossRefPubMed

57.

Sillanpää PJ, Salonen E, Pihlajamäki H, Mäenpää HM (2014) Medial patellofemoral ligament avulsion injury at the patella: classification and clinical outcome. Knee Surg Sports Traumatol Arthrosc 22:2414–2418CrossRefPubMed

58.

Smith TO, Donell S, Song F, Hing CB (2015) Surgical versus non-surgical interventions for treating patellar dislocation. Cochrane Database Syst Rev 26:CD008106. https://doi.org/10.1002/14651858.CD008106.pub3 CrossRef

59.

Steensen RN, Bentley JC, Trinh TQ, Backes JR, Wiltfong RE (2015) The prevalence and combined prevalences of anatomic factors associated with recurrent patellar dislocation: a magnetic resonance imaging study. Am J Sports Med 43:921–927CrossRefPubMed

60.

Zhang GY, Zheng L, Ding HY, Li EM, Sun BS, Shi H (2015) Evaluation of medial patellofemoral ligament tears after acute lateral patellar dislocation: comparison of high-frequency ultrasound and MR. Eur Radiol 25:274–281CrossRefPubMed

61.

Zhang GY, Zheng L, Feng Y et al (2015) Injury patterns of medial patellofemoral ligament and correlation analysis with articular cartilage lesions of the lateral femoral condyle after acute lateral patellar dislocation in adults: an MRI evaluation. Injury 46:2413–2421CrossRefPubMed

62.

Zhang GY, Zheng L, Shi H, Ji BJ, Feng Y, Ding HY (2017) Injury patterns of medial patellofemoral ligament after acute lateral patellar dislocation in children: correlation analysis with anatomical variants and articular cartilage lesion of the patella. Eur Radiol 27:1322–1330CrossRefPubMed

63.

Zhang GY, Zheng L, Shi H et al (2018) Correlation analysis between injury patterns of medial patellofemoral ligament and vastus medialis obliquus after acute first-time lateral patellar dislocation. Knee Surg Sports Traumatol Arthrosc 26:719–726CrossRefPubMed

64.

Zhang GY, Zheng L, Shi H, Qu SH, Ding HY (2013) Sonography on injury of the medial patellofemoral ligament after acute traumatic lateral patellar dislocation: injury patterns and correlation analysis with injury of articular cartilage of the inferomedial patella. Injury 44:1892–1898CrossRefPubMed

65.

Zheng L, Shi H, Feng Y, Sun BS, Ding HY, Zhang GY (2015) Injury patterns of medial patellofemoral ligament and correlation analysis with articular cartilage lesions of the lateral femoral condyle after acute lateral patellar dislocation in children and adolescents: an MRI evaluation. Injury 46:1137–1144CrossRefPubMed

Titel: Incidence of second-time lateral patellar dislocation is associated with anatomic factors, age and injury patterns of medial patellofemoral ligament in first-time lateral patellar dislocation: a prospective magnetic resonance imaging study with 5-year follow-up
verfasst von: Guang-ying Zhang
Hong-yu Ding
En-miao Li
Lei Zheng
Zheng-wu Bai
Hao Shi
Feng-jing Fan
Dan Guo
Publikationsdatum: 14.07.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 1/2019
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-018-5062-8

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Arthroskopie kann Knieprothese nicht hinauszögern

25.04.2024 Gonarthrose Nachrichten

Ein arthroskopischer Eingriff bei Kniearthrose macht im Hinblick darauf, ob und wann ein Gelenkersatz fällig wird, offenbar keinen Unterschied.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Ärztliche Empathie hilft gegen Rückenschmerzen

23.04.2024 Leitsymptom Rückenschmerzen Nachrichten

Personen mit chronischen Rückenschmerzen, die von einfühlsamen Ärzten und Ärztinnen betreut werden, berichten über weniger Beschwerden und eine bessere Lebensqualität.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 1/2019

Hamstring tendon autografts do not show complete graft maturity 6 months postoperatively after anterior cruciate ligament reconstruction

High short-term return to sports rate despite an ongoing healing process after acute meniscus repair in young athletes

Bioabsorbable screws, whatever the composition, can result in symptomatic intra-osseous tibial tunnel cysts after ACL reconstruction

High complication rate following dynamic intraligamentary stabilization for primary repair of the anterior cruciate ligament

Patients older than 50 years had similar results of knee strength and anteroposterior stability after ACL reconstruction compared to younger patients