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 ex...
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| Veröffentlicht in: | The American journal of sports medicine 2008-12, Vol.36 (12), p.2301-2309 |
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| container_title | The American journal of sports medicine |
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| creator | Sillanpää, Petri J. Mäenpää, Heikki M. Mattila, Ville M. Visuri, Tuomo Pihlajamäki, Harri |
| description | 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.
Methods
The study group included 76 consecutive military recruits (72 men, 4 women), with a median age of 20 years (range, 19–22) at the time of dislocation. Thirty patients (group 1) underwent initial arthroscopic medial retinacular repair, and 46 patients (group 2) were treated without stabilizing surgery, including 11 who had osteochondral fragments arthroscopically removed. Patients with previous patellar dislocations or instability were excluded. Aftercare was identical in both groups. Redislocations, subjective symptoms, and functional limitations were evaluated after a median 7-year follow-up.
Results
Sixty-one (80%) patients participated in a follow-up examination. At final follow-up, 8 (23%) redislocations occurred in group 2 and 5 (19%) in group 1 (P = .84). Eight (23%) patients in group 2 and 3 (12%) in group 1 reported patellar subluxations (P = .18). In group 1, 81% regained their preinjury activity level compared with 56% in group 2 (P = .05). Functional outcomes were good in both groups (Kujala scores: 87 for group 1 and 90 for group 2) (P = .22). Regarding the presence of osteoarthritic characteristics in the patellofemoral joint, no statistically significant differences were found between the groups.
Conclusions
Initial arthroscopic medial retinacular repair was not followed by improved patellar stability nor reduced incidence of redislocations compared with nonoperative (except for removal of loose bodies) treatment. Acute arthroscopic medial retinacular repair allowed patients to better regain preinjury activity level than in patients not undergoing retinacular repair. The decision to stabilize the patella by initial arthroscopic surgery should be made with caution. |
| doi_str_mv | 10.1177/0363546508322894 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_69888002</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_0363546508322894</sage_id><sourcerecordid>1908235592</sourcerecordid><originalsourceid>FETCH-LOGICAL-c377t-e6b7d2c19cef932700c4069aab77a6d1d7266447150ae5307d1350272582c9d13</originalsourceid><addsrcrecordid>eNqFkdtLwzAUxoMobl7efZKC6Fv1JGluTzLmFQYOnM8lS9PZ0a4zaR_8701pURmIT7l8v3Py5TsInWG4xliIG6CcsoQzkJQQqZI9NMaMkZhSzvbRuJPjTh-hI-_XAIAFl4dohKXghHM5RrcT17y72pt6W5jotXUr6z6jvHbR3BWVDvuF022lm6DOdWPLUrvorvBlbcJdvTlBB7kuvT0d1mP09nC_mD7Fs5fH5-lkFhsqRBNbvhQZMVgZmytKBIBJgCutl0JonuFMBDtJIjADbRkFkWHKgAjCJDEqHI7RVd936-qP1vomrQpvOjsbW7c-5UpKCUD-BQmAUAqzAF7sgOu6dZvwiRQrkIQyprp20FMmhOSdzdNtn0uKIe1mkO7OIJScD43bZWWzn4Ih9ABcDoD2Rpe50xtT-G-OgOKMYx64uOe8Xtlf7v56-AuLsZia</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1908235592</pqid></control><display><type>article</type><title>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</title><source>Access via SAGE</source><source>MEDLINE</source><source>Alma/SFX Local Collection</source><creator>Sillanpää, Petri J. ; Mäenpää, Heikki M. ; Mattila, Ville M. ; Visuri, Tuomo ; Pihlajamäki, Harri</creator><creatorcontrib>Sillanpää, Petri J. ; Mäenpää, Heikki M. ; Mattila, Ville M. ; Visuri, Tuomo ; Pihlajamäki, Harri</creatorcontrib><description>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.
Methods
The study group included 76 consecutive military recruits (72 men, 4 women), with a median age of 20 years (range, 19–22) at the time of dislocation. Thirty patients (group 1) underwent initial arthroscopic medial retinacular repair, and 46 patients (group 2) were treated without stabilizing surgery, including 11 who had osteochondral fragments arthroscopically removed. Patients with previous patellar dislocations or instability were excluded. Aftercare was identical in both groups. Redislocations, subjective symptoms, and functional limitations were evaluated after a median 7-year follow-up.
Results
Sixty-one (80%) patients participated in a follow-up examination. At final follow-up, 8 (23%) redislocations occurred in group 2 and 5 (19%) in group 1 (P = .84). Eight (23%) patients in group 2 and 3 (12%) in group 1 reported patellar subluxations (P = .18). In group 1, 81% regained their preinjury activity level compared with 56% in group 2 (P = .05). Functional outcomes were good in both groups (Kujala scores: 87 for group 1 and 90 for group 2) (P = .22). Regarding the presence of osteoarthritic characteristics in the patellofemoral joint, no statistically significant differences were found between the groups.
Conclusions
Initial arthroscopic medial retinacular repair was not followed by improved patellar stability nor reduced incidence of redislocations compared with nonoperative (except for removal of loose bodies) treatment. Acute arthroscopic medial retinacular repair allowed patients to better regain preinjury activity level than in patients not undergoing retinacular repair. The decision to stabilize the patella by initial arthroscopic surgery should be made with caution.</description><identifier>ISSN: 0363-5465</identifier><identifier>EISSN: 1552-3365</identifier><identifier>DOI: 10.1177/0363546508322894</identifier><identifier>PMID: 18762668</identifier><identifier>CODEN: AJSMDO</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Adult ; Arthroscopy ; Biological and medical sciences ; Diseases of the osteoarticular system ; Endoscopy ; Female ; Follow-Up Studies ; Humans ; Injuries of the limb. Injuries of the spine ; Investigative techniques, diagnostic techniques (general aspects) ; Knee ; Knee Joint - pathology ; Ligaments, Articular - injuries ; Ligaments, Articular - pathology ; Magnetic Resonance Imaging ; Male ; Medical sciences ; Orthopedics ; Patellar Dislocation - pathology ; Patellar Dislocation - surgery ; Patellar Dislocation - therapy ; Prospective Studies ; Shoulder ; Sports medicine ; Surgery ; Traumas. Diseases due to physical agents ; Treatment Outcome ; Young Adult</subject><ispartof>The American journal of sports medicine, 2008-12, Vol.36 (12), p.2301-2309</ispartof><rights>2008 American Orthopaedic Society for Sports Medicine</rights><rights>2009 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c377t-e6b7d2c19cef932700c4069aab77a6d1d7266447150ae5307d1350272582c9d13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/0363546508322894$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/0363546508322894$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,780,784,21819,27924,27925,43621,43622</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=20965616$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18762668$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sillanpää, Petri J.</creatorcontrib><creatorcontrib>Mäenpää, Heikki M.</creatorcontrib><creatorcontrib>Mattila, Ville M.</creatorcontrib><creatorcontrib>Visuri, Tuomo</creatorcontrib><creatorcontrib>Pihlajamäki, Harri</creatorcontrib><title>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</title><title>The American journal of sports medicine</title><addtitle>Am J Sports Med</addtitle><description>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.
Methods
The study group included 76 consecutive military recruits (72 men, 4 women), with a median age of 20 years (range, 19–22) at the time of dislocation. Thirty patients (group 1) underwent initial arthroscopic medial retinacular repair, and 46 patients (group 2) were treated without stabilizing surgery, including 11 who had osteochondral fragments arthroscopically removed. Patients with previous patellar dislocations or instability were excluded. Aftercare was identical in both groups. Redislocations, subjective symptoms, and functional limitations were evaluated after a median 7-year follow-up.
Results
Sixty-one (80%) patients participated in a follow-up examination. At final follow-up, 8 (23%) redislocations occurred in group 2 and 5 (19%) in group 1 (P = .84). Eight (23%) patients in group 2 and 3 (12%) in group 1 reported patellar subluxations (P = .18). In group 1, 81% regained their preinjury activity level compared with 56% in group 2 (P = .05). Functional outcomes were good in both groups (Kujala scores: 87 for group 1 and 90 for group 2) (P = .22). Regarding the presence of osteoarthritic characteristics in the patellofemoral joint, no statistically significant differences were found between the groups.
Conclusions
Initial arthroscopic medial retinacular repair was not followed by improved patellar stability nor reduced incidence of redislocations compared with nonoperative (except for removal of loose bodies) treatment. Acute arthroscopic medial retinacular repair allowed patients to better regain preinjury activity level than in patients not undergoing retinacular repair. The decision to stabilize the patella by initial arthroscopic surgery should be made with caution.</description><subject>Adult</subject><subject>Arthroscopy</subject><subject>Biological and medical sciences</subject><subject>Diseases of the osteoarticular system</subject><subject>Endoscopy</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Injuries of the limb. Injuries of the spine</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Knee</subject><subject>Knee Joint - pathology</subject><subject>Ligaments, Articular - injuries</subject><subject>Ligaments, Articular - pathology</subject><subject>Magnetic Resonance Imaging</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Orthopedics</subject><subject>Patellar Dislocation - pathology</subject><subject>Patellar Dislocation - surgery</subject><subject>Patellar Dislocation - therapy</subject><subject>Prospective Studies</subject><subject>Shoulder</subject><subject>Sports medicine</subject><subject>Surgery</subject><subject>Traumas. Diseases due to physical agents</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>0363-5465</issn><issn>1552-3365</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkdtLwzAUxoMobl7efZKC6Fv1JGluTzLmFQYOnM8lS9PZ0a4zaR_8701pURmIT7l8v3Py5TsInWG4xliIG6CcsoQzkJQQqZI9NMaMkZhSzvbRuJPjTh-hI-_XAIAFl4dohKXghHM5RrcT17y72pt6W5jotXUr6z6jvHbR3BWVDvuF022lm6DOdWPLUrvorvBlbcJdvTlBB7kuvT0d1mP09nC_mD7Fs5fH5-lkFhsqRBNbvhQZMVgZmytKBIBJgCutl0JonuFMBDtJIjADbRkFkWHKgAjCJDEqHI7RVd936-qP1vomrQpvOjsbW7c-5UpKCUD-BQmAUAqzAF7sgOu6dZvwiRQrkIQyprp20FMmhOSdzdNtn0uKIe1mkO7OIJScD43bZWWzn4Ih9ABcDoD2Rpe50xtT-G-OgOKMYx64uOe8Xtlf7v56-AuLsZia</recordid><startdate>20081201</startdate><enddate>20081201</enddate><creator>Sillanpää, Petri J.</creator><creator>Mäenpää, Heikki M.</creator><creator>Mattila, Ville M.</creator><creator>Visuri, Tuomo</creator><creator>Pihlajamäki, Harri</creator><general>SAGE Publications</general><general>Sage Publications</general><general>Sage Publications Ltd</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TS</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope></search><sort><creationdate>20081201</creationdate><title>Arthroscopic Surgery for Primary Traumatic Patellar Dislocation</title><author>Sillanpää, Petri J. ; Mäenpää, Heikki M. ; Mattila, Ville M. ; Visuri, Tuomo ; Pihlajamäki, Harri</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c377t-e6b7d2c19cef932700c4069aab77a6d1d7266447150ae5307d1350272582c9d13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Adult</topic><topic>Arthroscopy</topic><topic>Biological and medical sciences</topic><topic>Diseases of the osteoarticular system</topic><topic>Endoscopy</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Injuries of the limb. Injuries of the spine</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Knee</topic><topic>Knee Joint - pathology</topic><topic>Ligaments, Articular - injuries</topic><topic>Ligaments, Articular - pathology</topic><topic>Magnetic Resonance Imaging</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Orthopedics</topic><topic>Patellar Dislocation - pathology</topic><topic>Patellar Dislocation - surgery</topic><topic>Patellar Dislocation - therapy</topic><topic>Prospective Studies</topic><topic>Shoulder</topic><topic>Sports medicine</topic><topic>Surgery</topic><topic>Traumas. Diseases due to physical agents</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sillanpää, Petri J.</creatorcontrib><creatorcontrib>Mäenpää, Heikki M.</creatorcontrib><creatorcontrib>Mattila, Ville M.</creatorcontrib><creatorcontrib>Visuri, Tuomo</creatorcontrib><creatorcontrib>Pihlajamäki, Harri</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Physical Education Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of sports medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sillanpää, Petri J.</au><au>Mäenpää, Heikki M.</au><au>Mattila, Ville M.</au><au>Visuri, Tuomo</au><au>Pihlajamäki, Harri</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>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</atitle><jtitle>The American journal of sports medicine</jtitle><addtitle>Am J Sports Med</addtitle><date>2008-12-01</date><risdate>2008</risdate><volume>36</volume><issue>12</issue><spage>2301</spage><epage>2309</epage><pages>2301-2309</pages><issn>0363-5465</issn><eissn>1552-3365</eissn><coden>AJSMDO</coden><abstract>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.
Methods
The study group included 76 consecutive military recruits (72 men, 4 women), with a median age of 20 years (range, 19–22) at the time of dislocation. Thirty patients (group 1) underwent initial arthroscopic medial retinacular repair, and 46 patients (group 2) were treated without stabilizing surgery, including 11 who had osteochondral fragments arthroscopically removed. Patients with previous patellar dislocations or instability were excluded. Aftercare was identical in both groups. Redislocations, subjective symptoms, and functional limitations were evaluated after a median 7-year follow-up.
Results
Sixty-one (80%) patients participated in a follow-up examination. At final follow-up, 8 (23%) redislocations occurred in group 2 and 5 (19%) in group 1 (P = .84). Eight (23%) patients in group 2 and 3 (12%) in group 1 reported patellar subluxations (P = .18). In group 1, 81% regained their preinjury activity level compared with 56% in group 2 (P = .05). Functional outcomes were good in both groups (Kujala scores: 87 for group 1 and 90 for group 2) (P = .22). Regarding the presence of osteoarthritic characteristics in the patellofemoral joint, no statistically significant differences were found between the groups.
Conclusions
Initial arthroscopic medial retinacular repair was not followed by improved patellar stability nor reduced incidence of redislocations compared with nonoperative (except for removal of loose bodies) treatment. Acute arthroscopic medial retinacular repair allowed patients to better regain preinjury activity level than in patients not undergoing retinacular repair. The decision to stabilize the patella by initial arthroscopic surgery should be made with caution.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>18762668</pmid><doi>10.1177/0363546508322894</doi><tpages>9</tpages></addata></record> |
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| subjects | Adult Arthroscopy Biological and medical sciences Diseases of the osteoarticular system Endoscopy Female Follow-Up Studies Humans Injuries of the limb. Injuries of the spine Investigative techniques, diagnostic techniques (general aspects) Knee Knee Joint - pathology Ligaments, Articular - injuries Ligaments, Articular - pathology Magnetic Resonance Imaging Male Medical sciences Orthopedics Patellar Dislocation - pathology Patellar Dislocation - surgery Patellar Dislocation - therapy Prospective Studies Shoulder Sports medicine Surgery Traumas. Diseases due to physical agents Treatment Outcome Young Adult |
| title | 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 |
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