Acute Traumatic Primary Patella Dislocation in Children and Adolescents:A Detailed Evaluation of the Impact upon the Results

Background and Aim: Through accurate assessment of the risk factors and structural characteristics of children presenting with acute patella dislocation, this study aimed to evaluate the probability of recurrence and the effects on treatment. Materials and Methods: Demographic and radiological evaluation was made of each case. Contributory factors to patellofemoral instability were investigated. Surgical treatment was applied to 4 (15.39%) patients and conservative treatment to 22 (84.61%). Functional status before and after treatment was evaluated using the Kujala patellofemoral scoring system. Results: The patients comprised 8 (30.77%) males and 18 (69.23%) females with a mean age of 13.46 years. In 15 (57.69%) cases, there were patellofemoral complaints before the dislocation. The Kujala score was determined as mean 54.27 pre-treatment and 84.81 post-treatment in the conservative treatment group and mean 48.00 preoperatively and 75.25 postoperatively in the surgically treated group. No recurrence of patella dislocation was observed in any patient during the follow-up of both groups. Conclusions: Although it seems to be simple surgical intervention, as patella dislocation surgery can involve several complications, the surgical program must be very well planned and only applied to cases where necessary. With case-by-case assessment, the probability of recurrence of patella dislocation will be removed.

Horizontal Inferior Patellar Dislocation in an Elderly Patient: A Case Report and Review of Literature

Intra-articular patellar dislocation due to acute trauma is considered a rare presentation and is less commonly encountered in practice than extra-articular patellar dislocation. This case study presents a rare type 2 inferior dislocation of the patella in an elderly patient which was successfully reduced and managed non-operatively.

Combined medial patellofemoral ligament and medial patellotibial ligament reconstruction in recurrent patellar instability:A systematic review and meta-analysis

BACKGROUND The medial patellofemoral ligament(MPFL),along with the medial patellotibial ligament(MPTL)and medial patellomeniscal ligament,aid in the stabilization of the patellofemoral joint.Although the MPFL is the primary stabilizer and the MPTL is a secondary limiter,this ligament is critical in maintaining joint stability.There have been few studies on the combined MPFL and MPTL reconstruction and its benefits.AIM To look into the outcomes of combined MPFL and MPTL reconstruction in frequent patellar instability.METHODS By May 8,2022,four electronic databases were searched:Medline(PubMed),Scopus,Web of Science,and Google Scholar.General keywords such as"patellar instability,""patellar dislocation,""MPFL,""medial patellofemoral ligament,""MPTL,"and"medial patellotibial ligament"were co-searched to increase the sensitivity of the search.RESULTS The pooled effects of combined MPFL and MPTL reconstruction for Kujala score(12-mo followup)and Kujala score(24-mo follow-up)were positive and incremental,according to the findings of this meta-analysis.The mean difference between the Cincinnati scores was also positive,but not statistically significant.The combination of the two surgeries reduces pain.According to cumulative meta-analysis,the trend of pain reduction in various studies is declining over time.CONCLUSION The combined MPFL and MPTL reconstruction has good clinical results in knee function and,in addition to providing good control to maintain patellofemoral joint balance,the patient's pain level decreases over time,making it a valid surgical method for patella stabilization.

Deepening trochleoplasty combined with balanced medial patellofemoral ligament reconstruction for an adequate graft tensioning

AIM To evaluate our modified deepening trochleoplasty com-bined with a balanced medial patellofemoral ligament(MPFL) reconstruction for soft tissue alignement. METHODS Thirty-three knees with with recurrent patellar dislocations and a trochlear dysplasia in 30 patients(m/f = 12/21, mean age 24 ± 9 years) underwent a combination of a modified deepening trochleoplasty and a balanced MPFL reconstruction for a medial soft tissue alignement. After a mean follow-up period of 29 ± 23 mo, patients' return to sports, possible complications as well as the clinical outcomes using the Kujala, International Knee Documentation Committee(IKDC) and Lysholm scoring were evaluated. Moreover, patients' satisfaction with the general outcome, the cosmetic outcome, the pre-and postoperative pain and a potential avoidance behaviour were assessed with additional standardized questionnaires which also included different visual analog scales. RESULTS There were no signs of a persistent instability. The Kujala score improved from a mean of 64 ± 16 points to 94 ± 9 points, the Lysholm score improved from a mean of 63 ± 17 to 95 ± 6 points and the IKDC score from 58 ± 11 to 85 ± 12 points, P < 0.0001, respectively. The assessment of pain using a visual analog scale showed a significant pain reduction from a mean of 4.8 ± 2.0 to 1.3 ± 3.4 points(P < 0.0001). Two of 26 cases(92%) who were engaged in regular physical activity before surgery did not return to full sporting activities. One patient felt that his sport was too risky for his knee and reported an ongoing avoidance behaviour. The other patient preferred to wait for surgery of her contralateral knee. Of the eight patients who were not engaged in sporting activities before surgery, three started regular sporting activities after surgery. In 31 of the 33 cases(94%), the patients were very satisfied with the clinical outcome of the surgery. Regarding the cosmetic results, no patients felt impaired in their self-confidence and in their clothing decisions. CONCLUSION Our technique shows a good clinical outcome in terms of the common scorings as well as in terms of pain, return to sports and patient satisfaction.