TY - JOUR
T1 - High rate of recurrent patellar dislocation in skeletally immature patients
T2 - a long-term population-based study
AU - Sanders, Thomas L.
AU - Pareek, Ayoosh
AU - Hewett, Timothy E.
AU - Stuart, Michael J.
AU - Dahm, Diane L.
AU - Krych, Aaron J.
N1 - Funding Information:
This study was made possible by the Rochester Epidemiology Project which is supported by the National Institute on Aging of the National Institutes of Health under Award Number R01AG034676. The findings and conclusions of this report are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health.
Publisher Copyright:
© 2017, European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).
PY - 2018/4/1
Y1 - 2018/4/1
N2 - Purpose: Patellar dislocation can occur in isolation or be associated with chronic instability. The goals of this study are to describe the rate and factors associated with additional patellar instability events (ipsilateral recurrence and contralateral dislocation), as well as the development of patellofemoral arthritis in patients who are skeletally immature at the time of first patellar dislocation. Methods: The study included a population-based cohort of 232 skeletally immature patients who experienced a first-time lateral patellar dislocation between 1990 and 2010. A chart review was performed to collect information related to the initial injury, treatment, and outcomes. Subjects were followed for a mean of 12.1 years to determine the rate of subsequent patellar dislocation (ipsilateral recurrence or contralateral dislocation) as well as clinically significant patellofemoral arthritis. Results: 104 patients had ipsilateral recurrent patellar dislocation. The cumulative incidence of recurrent dislocation was 11% at 1 year, 21.1% at 2 years, 37.0% at 5 years, 45.1% at 10 years, 54.0% at 15 years, and 54.0% at 20 years. Patella alta (HR 10.6, 95% CI 3.6, 36.1), TT-TG ≥ 20 mm (HR 18.7, 95% CI 1.7, 228.2), and trochlear dysplasia (HR 23.7, 95% CI 1.0, 105.2) were associated with recurrence. Similarly, 18 patients (7.8%) had contralateral patellar dislocation. The cumulative incidence of patellofemoral arthritis was 0% at 2 years, 1.0% at 5 years, 2.0% at 10 years, 10.1% at 15 years, 17% at 20 years, and 39.0% at 25 years. Osteochondral injury was associated with arthritis (HR 25.7, 95% CI 6.2, 143.8). There was no association with trochler dysplasia (HR 1.2, 95% CI 0.2, 5.0), recurrent patellar instability (HR 1.2, 95% CI 0.2, 7.2), gender (HR 1.3, 95% CI 0.3, 5.6), or patellar-stabilizing surgery (HR 0.7, 95% CI 0.2, 3.5) and arthritis. Conclusion: Skeletally immature patients had a high rate of recurrent patellar instability that was associated with structural abnormalities such as patella alta,TT-TG ≥ 20 mm, and trochlear dysplasia. Approximately 10% of patients experienced a contralateral dislocation and 20% of patients developed arthritis by 20 years following initial dislocation. Osteochondral injury was associated with arthritis. Level of evidence: Retrospective case series, Level IV.
AB - Purpose: Patellar dislocation can occur in isolation or be associated with chronic instability. The goals of this study are to describe the rate and factors associated with additional patellar instability events (ipsilateral recurrence and contralateral dislocation), as well as the development of patellofemoral arthritis in patients who are skeletally immature at the time of first patellar dislocation. Methods: The study included a population-based cohort of 232 skeletally immature patients who experienced a first-time lateral patellar dislocation between 1990 and 2010. A chart review was performed to collect information related to the initial injury, treatment, and outcomes. Subjects were followed for a mean of 12.1 years to determine the rate of subsequent patellar dislocation (ipsilateral recurrence or contralateral dislocation) as well as clinically significant patellofemoral arthritis. Results: 104 patients had ipsilateral recurrent patellar dislocation. The cumulative incidence of recurrent dislocation was 11% at 1 year, 21.1% at 2 years, 37.0% at 5 years, 45.1% at 10 years, 54.0% at 15 years, and 54.0% at 20 years. Patella alta (HR 10.6, 95% CI 3.6, 36.1), TT-TG ≥ 20 mm (HR 18.7, 95% CI 1.7, 228.2), and trochlear dysplasia (HR 23.7, 95% CI 1.0, 105.2) were associated with recurrence. Similarly, 18 patients (7.8%) had contralateral patellar dislocation. The cumulative incidence of patellofemoral arthritis was 0% at 2 years, 1.0% at 5 years, 2.0% at 10 years, 10.1% at 15 years, 17% at 20 years, and 39.0% at 25 years. Osteochondral injury was associated with arthritis (HR 25.7, 95% CI 6.2, 143.8). There was no association with trochler dysplasia (HR 1.2, 95% CI 0.2, 5.0), recurrent patellar instability (HR 1.2, 95% CI 0.2, 7.2), gender (HR 1.3, 95% CI 0.3, 5.6), or patellar-stabilizing surgery (HR 0.7, 95% CI 0.2, 3.5) and arthritis. Conclusion: Skeletally immature patients had a high rate of recurrent patellar instability that was associated with structural abnormalities such as patella alta,TT-TG ≥ 20 mm, and trochlear dysplasia. Approximately 10% of patients experienced a contralateral dislocation and 20% of patients developed arthritis by 20 years following initial dislocation. Osteochondral injury was associated with arthritis. Level of evidence: Retrospective case series, Level IV.
KW - Arthritis
KW - Contralateral
KW - Patellar dislocation
KW - Patellofemoral
KW - Recurrent
KW - Skeletally immature
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U2 - 10.1007/s00167-017-4505-y
DO - 10.1007/s00167-017-4505-y
M3 - Article
C2 - 28299386
AN - SCOPUS:85015149787
SN - 0942-2056
VL - 26
SP - 1037
EP - 1043
JO - Knee Surgery, Sports Traumatology, Arthroscopy
JF - Knee Surgery, Sports Traumatology, Arthroscopy
IS - 4
ER -