Vastus medialis advancement provides good clinical and functional outcomes for lateral patellofemoral instability
DOI:
https://doi.org/10.1016/j.rccot.2017.09.005Keywords:
patellofemoral lateral instability, vastus medialis advancement, treatmentAbstract
Background: Patellofemoral lateral instability is a condition of multifactorial origin, and has multiple options for its treatment. Vastus medialis advancement with arthroscopic assisted lateral retinacle replication (AALRR) is performed when there is no alteration of alignment or bone structure. The purpose of this study is to evaluate the clinical and functional results of patients with patellofemoral lateral instability (PFLI) treated with AALRR.
Material and methods: A descriptive, cross-sectional study was conducted from September 2014 to January 2016 on patients with PFLI treated with AALRR. The results before surgery and 12months after surgery, were evaluated using the Tegner-Lysholm and Kujala scales.
Results: The study included 6 patients, 5women (83.3%), and 1man (16.7%). The median age at first dislocation was 15.83 (7-30) ±8.47years. The affected knees were 4right (66.7%) and 2left (33.3%). The mean time from first dislocation to surgery was 10.08 (0.5-17) ±5.16years. The pre- and post-surgical evaluations using the Tegner-Lysholm and Kujala scales for the affected gender and side showed no statistically significant differences (P>.05). The pre-surgical median of the Tegner-Lysholm scale was 37.50 (6-78) ±26.66, and post-surgical, 88.17 (77-99) ±7.73 (P=.028). The pre-surgical and post-surgical median of the Kujala scale was 36.67 (2-77) ±29.703, and 84.83 (75-100) ±9.368, respectively (P=.027). The mean follow-up was 14.0 (12-18) ±2.44months.; Post-surgical apprehension was 100% negative. All patients responded that they would have a further operation in case of presenting with the symptoms again.
Discussion: The AALRR for the management of PFLI in patients without bone malformations or misalignment offers good clinical results.
Evidence level: IV.
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References
Weber AE, Nathani A, Dines JS, Allen AA, Shubin-Stein BE, Arendt EA, et al. An algorithmic approach to the management of recurrent lateral patellar dislocation. J Bone Joint Surg Am. 2016;98:417-27. https://doi.org/10.2106/JBJS.O.00354
Askenberger M, Janarv PM, Finnbogason T, Arendt EA. Morphology and anatomic patellar instability risk factors in first-time traumatic lateral patellar dislocations. Am J Sports Med. 2017;45:50-8. https://doi.org/10.1177/0363546516663498
Antinolfi P, Bartoli M, Placella G, Speziali A, Pace V, Delcogliano M, et al. Acute patellofemoral instability in children and adolescents. Joints. 2016;4:47-51. https://doi.org/10.11138/jts/2016.4.1.047
Fithian DC, Paxton EW, Stone ML, Silva P, Davis DK, Elias DA, et al. Epidemiology and natural history of acute patellar dislocation. Am J Sports Med. 2004;32:1114-21. https://doi.org/10.1177/0363546503260788
Jain NP, Khan N, Fithian DC. A treatment algorithm for primary patellar dislocations. Sports Health. 2011;3:170-4. https://doi.org/10.1177/1941738111399237
Nietosvaara Y, Paukku R, Palmu S, Donell ST. Acute patellar dislocation in children and adolescents. Surgical technique. J Bone Joint Surg. 2009;91:139-45. https://doi.org/10.2106/JBJS.H.01289
Desio SM, Burks RT, Bachus KN. Soft tissue restraints to lateral patellar translation in the human knee. Am J Sports Med. 1998;26:59-65. https://doi.org/10.1177/03635465980260012701
Panagiotopoulos E, Strzelczyk P, Herrmann M, Scuderi G. Cadaveric study on static medial patellar stabilizers: The dynamizing role of the vastus medialis obliquus on medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc. 2006;14:7-12. https://doi.org/10.1007/s00167-005-0631-z
Colvin AC, West RV. Patelar instability. J Bone Joint Surg Am. 2008;90:2751-62. https://doi.org/10.2106/JBJS.H.00211
Balcarek P, Oberthür S, Frosch S, Schüttrumpf JP, Stürmer KM. Vastus medialis obliquus muscle morphology in primary and recurrent lateral patellar instability. Biomed Res Int. 2014;2014:326586. https://doi.org/10.1155/2014/326586
Goh JC, Lee PY, Bose K. A cadaver study of the function of the oblique part of vastus medialis. J Bone Joint Surg Br. 1995;77:225-31. https://doi.org/10.1302/0301-620X.77B2.7706335
Arshi A, Cohen JR, Wang JC, Hame SL, McAllister DR, Jones KJ. Operative management of patellar instability in the United States. Orthop J Sports Med. 2016;4:1-7. https://doi.org/10.1177/2325967116662873
Beckert MW, Albright JC, Zavala J, Chang J, Albright JP. Clinical accuracy of J-sign measurement compared to magnetic resonance imaging. Iowa Orthop J. 2016;36:94-7.
Sallay PI, Poggi J, Speer KP, Garrett WE. Acute dislocation of the patella. A correlative pathoanatomic study. Am J Sports Med. 1996;24:52-60. https://doi.org/10.1177/036354659602400110
Ahmad CS, McCarthy M, Gomez JA, Shubin Stein BE. The moving patellar apprehension test for lateral patellar instability. Am J Sports Med. 2009;37:791-6. https://doi.org/10.1177/0363546508328113
Koh JL, Stewart C. Patellar instability. Orthop Clin North Am. 2015;36:147-57. https://doi.org/10.1016/j.ocl.2014.09.011
Laurin CA, Dussault R, Levesque HP. The tangential X-ray investigation of the patellofemoral joint: X-ray technique, diagnostic criteria and their interpretation. Clin Orthop Relat Res. 1979;144:16-26. https://doi.org/10.1097/00003086-197910000-00004
Merchant AC, Mercer RL, Jacobsen RH, Cool CR. Roentgenographic analysis of patellofemoral congruence. J Bone Joint Surg Am. 1974;56:1391-6. https://doi.org/10.2106/00004623-197456070-00007
Aglietti P, Insall JN, Cerulli G. Patellar pain and incongruence. I: Measurements of incongruence. Clin Orthop Relat Res. 1983:217-24. https://doi.org/10.1097/00003086-198306000-00032
Dejour H, Walch G, Nove-Josserand L, Guier C. Factors of patellarinstability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc. 1994;2:19-26. https://doi.org/10.1007/BF01552649
Nomura E, Inoue M. Cartilage lesions of the patella in recurrent patellar dislocation. Am J Sports Med. 2004;32:498-502. https://doi.org/10.1177/0095399703258677
Henry JK, Craven PR. Surgical treatment of patellar instability: Indications and results. Am J Sports Med. 1981;9:82-5. https://doi.org/10.1177/036354658100900202
Nam EK, Karzel EP. Mini-open medial reefing and arthroscopic lateral release for the treatment of recurrent patellar dislocation. Am J Sports Med. 2005;33:220-30. https://doi.org/10.1177/0363546504267803
Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res. 1985:43-9. https://doi.org/10.1097/00003086-198509000-00007
Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O. Scoring of patellofemoral disorders. Arthroscopy. 1993;9:159-63. https://doi.org/10.1016/S0749-8063(05)80366-4
Gil-Gámez J, Pecos-Martín D, Kujala UM, Martínez-Merinero P, Montañez-Aguilera FJ, Romero-Franco N, et al. Validation and cultural adaptation of "Kujala Score" in Spanish. Knee Surg Sports Traumatol Arthrosc. 2016;24:2845-53. https://doi.org/10.1007/s00167-015-3521-z
Beighton P, Solomon L, Soskolne L. Articular mobility in an African population. Ann Rheum Dis. 1973;32:413-8. https://doi.org/10.1136/ard.32.5.413
Atkin DM, Fithian DC, Marangi KS, Stone ML, Dobson BE, Mendelsohn C. Characteristics of patients with primary acute lateral patellar dislocation and their recovery within the first 6 months of injury. Am J Sports Med. 2000;28:472-9. https://doi.org/10.1177/03635465000280040601
Shah JN, Howard JS, Flanigan DC, Brophy RH, Carey JL, Lattermann C. A systematic review of complications and failures associated with medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Am J Sports Med. 2012;40:1916-23. https://doi.org/10.1177/0363546512442330
Parikh SN, Nathan ST, Wall EJ, Eismann EA. Complications of medial patellofemoral ligament reconstruction in young patients. Am J Sports Med. 2013;41:1030-8. https://doi.org/10.1177/0363546513482085
