Acute Patellar Dislocation in Children and Adolescent

8/6/2019 Acute Patellar Dislocation in Children and Adolescent

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Acute Patellar Dislocation in

Children and Adolescent: ARandomised Clinical TrialJ Bone Joint Surg Am. 2008;90:463-470.

doi:10.2106/JBJS.G.00072

Sauli Palmu, Pentti E. Kallio, Simon T. Donell,Ilkka Helenius and Yrjn Nietosvaara


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Introduction

Acute patellar dislocation is the most common

acute knee disorder in paeds and adolescent

May lead to functional disability Peak incidence 15y.o

43/100000 for pts below 16y.o


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Predisposing factor:

Patellofemoral dysplasia

Female Positive family history

Young age of on set ( risk of recurrent)


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Traditionally, treated non-operatively unless

susbstantial joint surface damage

Primary operative repair of the medial patella-stabilizing soft tissues became popular during

the 1980s

Not many study on pediatric population and

no reports comparing the results of operative

and nonoperative treatment


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Hypothesis

Primary operative repair of the injured

medial retinacular structures would

reduce the redislocation rate andimprove the results of treatment in

pediatric patients with an acute

patellar dislocation


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Aim

To compare the long term result in both

treatment group, non-operative and

operative

To identify possible risk factor for late poor

subjective and functional outcomes


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Material and Method


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Patient selection and demographic

data

All children younger than 16 with evident ofacute patella dislocation(APD) admited to A&E in1991 and 1992

P/E, xray, EUA, and diagnostic arthroscopy donein all

Diagnostic criteria for APD Lat dislocation patella needing reduction

Typical finding on arthroscopy Dislocatable under EUA

74 knees in 71 pts meet at least 1 of 3 criteria


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Inclusion criteria 1) the occurrence of an acute lateral patellar dislocation

within two weeks before treatment

2) no history of previous knee surgery or substantial kneeinjury

3) no major coexistent tibiofemoral ligamentous injuryrequiring repair

4) no large osteochondral fracture fragments (diameter

>15 mm) requiring fixation 5) a willingness of the patient and parents to participate.

10 knees were excluded


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Randomization and Treatment

64 Knees in 61 pt included in the study

Randomised according year of birth

Odd non-operative (28 knees) Even- operative( 36 knees)

+ve Fhx in 15 pts in both groups

Mean pre-injury Tegner activity scores = 5 inboth groups


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29 knees from operative group , disloctable

during EUA

Operative repair was performed by means of direct

absorbable suture placement at the site of injury without

aponeurotic or tendinous augmentations.

Lateral release was also performed in all except four knees

7 Knees not dislocatable

Only lateral release done


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After care was same in non-operative andoperative grp Those dislocatable under EUA, managed with removable

knee extension orthosis x 3/52 then patella-stabilizingorthosis for 3/52

Those not dislocatable, patella-stabilizing orthosis for 6/52

Thigh muscle exercise and FWB started as

tolerated All pts encourage to use orthosis during rehab

session and athletic act for 1st 6/12


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Follow-up

All pts were examined after 2 years

Interviewed by telephone at 6 years

Final phone interview after 14 years

Each follow up, assessed on Subjective result(excellent,good,fair,poor)

Hx of sublux

Time of recurrence

Hx of reoperation

Change in activity level Repeat patella dislocation

Outcomes were evaluated with the Hughston visual analogscale knee score , the Kujala score, and a subjective grade

The activity level was analyzed with use of the Tegner

activity scale


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Subjective result

After fourteen years, a good or excellentsubjective result was recorded for 21 (75%) of twenty-eight knees that had been

randomized to the nonoperative treatment group twenty-one (66%) of thirty-two knees that had been

randomized to the operative treatment group

Positive correlation between the final

subjective result and the Hughston visualanalog scale (p < 0.001) and Kujala scores ( p< 0.001).

Acute Patellar Dislocation in Children and Adolescent

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