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Preoperative Complete Patellofemoral Dislocation in Extension Predicts an Inferior Clinical Outcome After Medial Patellofemoral Ligament Reconstruction in Patients With Recurrent Patellar Dislocation
BACKGROUND: Habitual patellar dislocation in extension (HPD-E) is a distinctive subtype of recurrent patellar dislocation (RPD); HPD-E represents the most severe type of patellar maltracking in RPD. It has been reported that the presence of preoperative patellar maltracking is associated with a wors...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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SAGE Publications
2020
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7430086/ https://www.ncbi.nlm.nih.gov/pubmed/32864383 http://dx.doi.org/10.1177/2325967120938981 |
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author | Zhang, ZhiJun Song, GuanYang Ni, QianKun Zheng, Tong Cao, Yanwei Feng, Zheng Zhang, Hui Feng, Hua |
author_facet | Zhang, ZhiJun Song, GuanYang Ni, QianKun Zheng, Tong Cao, Yanwei Feng, Zheng Zhang, Hui Feng, Hua |
author_sort | Zhang, ZhiJun |
collection | PubMed |
description | BACKGROUND: Habitual patellar dislocation in extension (HPD-E) is a distinctive subtype of recurrent patellar dislocation (RPD); HPD-E represents the most severe type of patellar maltracking in RPD. It has been reported that the presence of preoperative patellar maltracking is associated with a worse clinical outcome after medial patellofemoral ligament (MPFL) reconstruction (MPFL-R). PURPOSE: To describe the radiological characteristics of HPD-E and to compare clinical outcomes after MPFL-R among patients with and without preoperative HPD-E. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: From January 2012 to December 2015, a total of 230 consecutive patients (246 knees) with RPD were treated with MPFL-R alone or combined with tibial tubercle osteotomy. Among them, 28 patients diagnosed with HPD-E by preoperative 3-dimensional computed tomography (CT; HPD-E group) were matched in a 1:1 fashion to 28 control participants who did not show HPD-E (control group). Routine radiography and CT were performed to evaluate patellar height, trochlear dysplasia, tibial tubercle–trochlear groove distance, and torsional deformities. The mean patellar laxity index and lateral patellar translation assessed with stress radiography were measured preoperatively and postoperatively to quantify MPFL laxity. At minimum 2-year follow-up, patient-reported outcomes (Kujala, Lysholm, and Tegner scores), patellar maltracking, and redislocation rates were compared between the HPD-E and control groups. RESULTS: The radiological characteristics of the HPD-E group were as follows: 89% (25/28) of patients had severe trochlear dysplasia (Dejour type B or D), and the mean femoral anteversion angle was 35.5° ± 4.7°. At the final follow-up, the HPD-E group had a significantly lower Kujala score (76.2 vs 84.5, respectively; P = .001), Lysholm score (75.4 vs 86.6, respectively; P < .001), and Tegner score (4.1 vs 5.8, respectively; P = .021) compared with the control group. The postoperative patellar laxity index (43% vs 19%, respectively; P < .001) and redislocation rate (25% vs 0%, respectively; P = .01) were significantly higher in the HPD-E group than in the control group. CONCLUSION: Preoperative 3-dimensional CT is a reliable method of identfying patients with HPD-E. Treatment of HPD-E by MPFL-R alone or combined with tibial tubercle osteotomy resulted in a higher redislocation rate, more severe MPFL residual laxity, and lower patient-reported outcome scores compared with patients without HPD-E who underwent MPFL-R. |
format | Online Article Text |
id | pubmed-7430086 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-74300862020-08-27 Preoperative Complete Patellofemoral Dislocation in Extension Predicts an Inferior Clinical Outcome After Medial Patellofemoral Ligament Reconstruction in Patients With Recurrent Patellar Dislocation Zhang, ZhiJun Song, GuanYang Ni, QianKun Zheng, Tong Cao, Yanwei Feng, Zheng Zhang, Hui Feng, Hua Orthop J Sports Med Article BACKGROUND: Habitual patellar dislocation in extension (HPD-E) is a distinctive subtype of recurrent patellar dislocation (RPD); HPD-E represents the most severe type of patellar maltracking in RPD. It has been reported that the presence of preoperative patellar maltracking is associated with a worse clinical outcome after medial patellofemoral ligament (MPFL) reconstruction (MPFL-R). PURPOSE: To describe the radiological characteristics of HPD-E and to compare clinical outcomes after MPFL-R among patients with and without preoperative HPD-E. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: From January 2012 to December 2015, a total of 230 consecutive patients (246 knees) with RPD were treated with MPFL-R alone or combined with tibial tubercle osteotomy. Among them, 28 patients diagnosed with HPD-E by preoperative 3-dimensional computed tomography (CT; HPD-E group) were matched in a 1:1 fashion to 28 control participants who did not show HPD-E (control group). Routine radiography and CT were performed to evaluate patellar height, trochlear dysplasia, tibial tubercle–trochlear groove distance, and torsional deformities. The mean patellar laxity index and lateral patellar translation assessed with stress radiography were measured preoperatively and postoperatively to quantify MPFL laxity. At minimum 2-year follow-up, patient-reported outcomes (Kujala, Lysholm, and Tegner scores), patellar maltracking, and redislocation rates were compared between the HPD-E and control groups. RESULTS: The radiological characteristics of the HPD-E group were as follows: 89% (25/28) of patients had severe trochlear dysplasia (Dejour type B or D), and the mean femoral anteversion angle was 35.5° ± 4.7°. At the final follow-up, the HPD-E group had a significantly lower Kujala score (76.2 vs 84.5, respectively; P = .001), Lysholm score (75.4 vs 86.6, respectively; P < .001), and Tegner score (4.1 vs 5.8, respectively; P = .021) compared with the control group. The postoperative patellar laxity index (43% vs 19%, respectively; P < .001) and redislocation rate (25% vs 0%, respectively; P = .01) were significantly higher in the HPD-E group than in the control group. CONCLUSION: Preoperative 3-dimensional CT is a reliable method of identfying patients with HPD-E. Treatment of HPD-E by MPFL-R alone or combined with tibial tubercle osteotomy resulted in a higher redislocation rate, more severe MPFL residual laxity, and lower patient-reported outcome scores compared with patients without HPD-E who underwent MPFL-R. SAGE Publications 2020-07-30 /pmc/articles/PMC7430086/ /pubmed/32864383 http://dx.doi.org/10.1177/2325967120938981 Text en © The Author(s) 2020 https://creativecommons.org/licenses/by-nc-nd/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (https://creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Article Zhang, ZhiJun Song, GuanYang Ni, QianKun Zheng, Tong Cao, Yanwei Feng, Zheng Zhang, Hui Feng, Hua Preoperative Complete Patellofemoral Dislocation in Extension Predicts an Inferior Clinical Outcome After Medial Patellofemoral Ligament Reconstruction in Patients With Recurrent Patellar Dislocation |
title | Preoperative Complete Patellofemoral Dislocation in Extension
Predicts an Inferior Clinical Outcome After Medial Patellofemoral Ligament
Reconstruction in Patients With Recurrent Patellar Dislocation |
title_full | Preoperative Complete Patellofemoral Dislocation in Extension
Predicts an Inferior Clinical Outcome After Medial Patellofemoral Ligament
Reconstruction in Patients With Recurrent Patellar Dislocation |
title_fullStr | Preoperative Complete Patellofemoral Dislocation in Extension
Predicts an Inferior Clinical Outcome After Medial Patellofemoral Ligament
Reconstruction in Patients With Recurrent Patellar Dislocation |
title_full_unstemmed | Preoperative Complete Patellofemoral Dislocation in Extension
Predicts an Inferior Clinical Outcome After Medial Patellofemoral Ligament
Reconstruction in Patients With Recurrent Patellar Dislocation |
title_short | Preoperative Complete Patellofemoral Dislocation in Extension
Predicts an Inferior Clinical Outcome After Medial Patellofemoral Ligament
Reconstruction in Patients With Recurrent Patellar Dislocation |
title_sort | preoperative complete patellofemoral dislocation in extension
predicts an inferior clinical outcome after medial patellofemoral ligament
reconstruction in patients with recurrent patellar dislocation |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7430086/ https://www.ncbi.nlm.nih.gov/pubmed/32864383 http://dx.doi.org/10.1177/2325967120938981 |
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