An Algorithmic Approach to the Management of Recurrent Lateral Patellar Dislocation. (2nd March 2016)

• Record Type: Journal Article
• Authors: Weber, Alexander E.; Nathani, Amit; Dines, Joshua S.; Allen, Answorth A.; Shubin-Stein, Beth E.; Arendt, Elizabeth A.; Bedi, Asheesh
• Is Part Of: Journal of bone and joint surgery. Volume 98:Number 5(2016)
• Publication Date: 2016-03-02
• Subjects: Bones -- Surgery -- Periodicals; Joints -- Surgery -- Periodicals; Orthopedics -- Periodicals; Orthopedics; General Surgery; Bone Diseases; Joint Diseases; Bones -- Surgery; Joints -- Surgery; Orthopedics; Bot (anatomie); Gewrichten; Chirurgie (geneeskunde); Periodicals; Electronic journals; Periodicals; 617.47005
• DOI: 10.2106/JBJS.O.00354
• Languages: English
• ISSNs: 0021-9355

Abstract

Abstract : Update: This article was updated on May 11, 2016, because of a previous error. On page 421, in the legend for Figure 5-A, two of the lines identifying the Schöttle point were mislabeled. The sentence had previously read "The Schöttle point (star) 59 is 1 mm anterior to the tangent of the posterior femoral cortex (red line), 2.5 mm distal to the perpendicular of the superior border of the femoral condyle (white line), and immediately proximal to a perpendicular line from the superoposterior aspect of the Blumensaat line (blue line)." The sentence now reads "The Schöttle point (star) 59 is 1 mm anterior to the tangent of the posterior femoral cortex (red line), 2.5 mm distal to the perpendicular of the superior border of the femoral condyle (blue line), and immediately proximal to a perpendicular line from the superoposterior aspect of the Blumensaat line (white line)." An erratum has been published: J Bone Joint Surg Am. 2016 June 15;98(12):e54. High-level evidence supports nonoperative treatment for first-time lateral acute patellar dislocations. Surgical intervention is often indicated for recurrent dislocations. Recurrent instability is often multifactorial and can be the result of a combination of coronal limb malalignment, patella alta, malrotation secondary to internal femoral or external tibial torsion, a dysplastic trochlea, or disrupted and weakened medial soft tissue, including the medial patellofemoral ligament (MPFL) and the vastus medialis obliquus. MPFL reconstruction requires precise graft placement for restoration of anatomy and minimal graft tension. MPFL reconstruction is safe to perform in skeletally immature patients and in revision surgical settings. Distal realignment procedures should be implemented in recurrent instability associated with patella alta, increased tibial tubercle-trochlear groove distances, and lateral and distal patellar chondrosis. Groove-deepening trochleoplasty for Dejour type-B and type-D dysplasia or a lateral elevation or proximal recession trochleoplasty for Dejour type-C dysplasia may be a component of the treatment algorithm; however, clinical outcome data are lacking. In addition, trochleoplasty is technically challenging and has a risk of substantial complications.