High rate of recurrent patellar dislocation in skeletally immature patients

a long-term population-based study

Thomas L. Sanders, Ayoosh Pareek, Timothy Hewett, Michael J. Stuart, Diane L. Dahm, Aaron Krych

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1-7
Number of pages7
JournalKnee Surgery, Sports Traumatology, Arthroscopy
DOIs
StateAccepted/In press - Mar 15 2017

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Patellar Dislocation
Arthritis
Population
Patella
Recurrence
Wounds and Injuries
Incidence

Keywords

  • Arthritis
  • Contralateral
  • Patellar dislocation
  • Patellofemoral
  • Recurrent
  • Skeletally immature

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

High rate of recurrent patellar dislocation in skeletally immature patients : a long-term population-based study. / Sanders, Thomas L.; Pareek, Ayoosh; Hewett, Timothy; Stuart, Michael J.; Dahm, Diane L.; Krych, Aaron.

In: Knee Surgery, Sports Traumatology, Arthroscopy, 15.03.2017, p. 1-7.

Research output: Contribution to journalArticle

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title = "High rate of recurrent patellar dislocation in skeletally immature patients: a long-term population-based study",
abstract = "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.",
keywords = "Arthritis, Contralateral, Patellar dislocation, Patellofemoral, Recurrent, Skeletally immature",
author = "Sanders, {Thomas L.} and Ayoosh Pareek and Timothy Hewett and Stuart, {Michael J.} and Dahm, {Diane L.} and Aaron Krych",
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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

AU - Stuart, Michael J.

AU - Dahm, Diane L.

AU - Krych, Aaron

PY - 2017/3/15

Y1 - 2017/3/15

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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DO - 10.1007/s00167-017-4505-y

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SN - 0942-2056

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