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Patellar Dislocation

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2. The Correlation between the Injury Patterns of the Medial Patellofemoral Ligament in an Acute First-Time Lateral Patellar Dislocation on MR Imaging and the Incidence of a Second-Time Lateral Patellar Dislocation Full Text available with Trip Pro

The Correlation between the Injury Patterns of the Medial Patellofemoral Ligament in an Acute First-Time Lateral Patellar Dislocation on MR Imaging and the Incidence of a Second-Time Lateral Patellar Dislocation To evaluate the correlation between the injury patterns of the medial patellofemoral ligament (MPFL) on magnetic resonance imaging in an acute first-time lateral patellar dislocation (LPD) and incidence of a second-time LPD.Magnetic resonance images were prospectively analyzed in 147 (...) and complete MPFL tear subgroups, respectively. Twenty-five cases (25/65, 38.5%), 11 cases (11/26, 42.3%), and 8 cases (8/47, 17%) were present in the isolated femoral-side MPFL tear (FEM), combined MPFL tear (COM), and isolated patellar-side MPFL tear (PAT) subgroups, respectively. Compared with the partial MPFL tears, complete tears showed higher incidence of a second-time LPD (p = 0.04). The time interval between the two LPDs was shorter in the complete MPFL tear subgroup (24.2 months) than

2018 Korean Journal of Radiology

3. Incidence of second-time lateral patellar dislocation is associated with anatomic factors, age and injury patterns of medial patellofemoral ligament in first-time lateral patellar dislocation: a prospective magnetic resonance imaging study with 5-year fol (Abstract)

Incidence of second-time lateral patellar dislocation is associated with anatomic factors, age and injury patterns of medial patellofemoral ligament in first-time lateral patellar dislocation: a prospective magnetic resonance imaging study with 5-year fol To examine the predictors of the second-time lateral patellar dislocation (LPD) in patients after acute first-time LPD in a 5-year follow-up.Data were collected prospectively from patients after acute first-time LPD with conservative treatment (...) . Factors included sex, age at the first-time LPD, anatomical variants [trochlear dysplasia, patellar height, tibial tuberosity-trochlear groove (TT-TG) distance], and injury patterns of medial patellofemoral ligament (MPFL) in acute first-time LPD. Logistic regression was carried out to identify the independent risk factors for the incidence of the second-time LPD.The incidence rate of a second-time LPD was 35.5% (59 of 166) in the 5-year follow-up. Univariate analysis revealed significant differences

2018 Knee Surgery, Sports Traumatology, Arthroscopy

4. Medial Patellofemoral Ligament Reconstruction: A Comparison of Single-Bundle Transpatellar Tunnel and Double-Anchor Anatomic Techniques for the Treatment of Recurrent Lateral Patellar Dislocation in Adults (Abstract)

Medial Patellofemoral Ligament Reconstruction: A Comparison of Single-Bundle Transpatellar Tunnel and Double-Anchor Anatomic Techniques for the Treatment of Recurrent Lateral Patellar Dislocation in Adults To compare the stability and clinical outcomes of 2 medial patellofemoral ligament reconstruction (MPFLR) techniques for the treatment of recurrent lateral patellar dislocation in adults.Ninety-one patients with recurrent patellar dislocation were randomly divided into 2 groups, undergoing (...) subjective scores. Clinical examinations were also performed, and redislocations or episodes of instability were recorded.Patients were followed up for a mean period of 41.11 ± 7.40 months (range, 29-62 months). At the final point, no recurrent patellar dislocations occurred, except in 4 patients with instability symptoms in group A; however, no significant difference between the 2 groups was seen (χ2 = 2.503, P = .114). The measurement results from computed tomography decreased significantly

2019 EvidenceUpdates

5. Operative Repair of Medial Patellofemoral Ligament Injury Versus Knee Brace in Children With an Acute First-Time Traumatic Patellar Dislocation: A Randomized Controlled Trial (Abstract)

Operative Repair of Medial Patellofemoral Ligament Injury Versus Knee Brace in Children With an Acute First-Time Traumatic Patellar Dislocation: A Randomized Controlled Trial A lateral patellar dislocation (LPD) is the most common traumatic knee injury with hemarthrosis in children. The redislocation rate is high. Varying operative and nonoperative treatments have been advocated with no consensus on the best treatment.(1) To evaluate if arthroscopic-assisted repair of the medial patellofemoral (...) ligament (MPFL) in patients with an acute first-time traumatic LPD would reduce the recurrence rate and offer better objective/subjective knee function compared with a knee brace without repair. (2) To study the presence of anatomic patellar instability risk factors (APIFs) and their association with a redislocation.Randomized controlled trial; Level of evidence, 1.This was a prospective series of 74 skeletally immature patients aged 9 to 14 years (38 girls and 36 boys; mean age, 13.1 years

2018 EvidenceUpdates

6. Conservative Versus Surgical Treatment for Primary Patellar Dislocation. (Abstract)

Conservative Versus Surgical Treatment for Primary Patellar Dislocation. Primary patellar dislocation is often the initial manifestation of patellofemoral instability. Its long-term consequences can include recurrent dislocation and permanent dysfunction of the knee joint. There is no consensus on the optimal treatment of primary patellar dislocation in the relevant literature. The main prerequisite for a good long-term result is a realistic assessment of the risk of recurrent dislocation.We (...) carried out a systematic literature search in OvidSP (a search engine for full-text databases) and MEDLINE to identify suitable stratification models with respect to the risk of recurrent dislocation.In the ten studies included in the current analysis, eight risk factors for recurrence after primary patellar dislocation were identified. Six studies revealed a higher risk in younger patients, particularly those under 16 years of age. The sex of the patient had no clear influence. In two studies

2020 Deutsches Arzteblatt international

7. Combined medial patellofemoral and patellotibial reconstruction with soft tissue fixation in recurrent patellar dislocation. (Abstract)

Combined medial patellofemoral and patellotibial reconstruction with soft tissue fixation in recurrent patellar dislocation. The medial patellofemoral and patellotibial ligaments (MPFL and MPTL) are the main passive restraints to lateral patellar translation. When nonoperative management of patellofemoral dislocations fails, surgical options can be considered to restore patellofemoral stability. Several reconstruction procedures of the MPFL with semitendinosus, gracilis, quadriceps tendon (...) , and synthetic grafts have been described. No clear superiority of one surgical technique over another is evident.Patients who suffered at least two documented episodes of unilateral patellar dislocation, confirmed radiographically and at clinical examination, underwent combined MPFL and MPTL reconstruction. Patients were regularly followed-up postoperatively at 2, 4, 8, 12, and 24 weeks, and then annually for a minimum of 2.5 years. Clinical and functional evaluations were performed using the modified

2020 Injury

8. Upper pole sleeve fracture of the patella secondary to patellar dislocation: A case report. Full Text available with Trip Pro

Upper pole sleeve fracture of the patella secondary to patellar dislocation: A case report. Upper pole sleeve fractures of the patella are rare in adolescents; however, they are serious injuries that require early diagnosis and treatment.We present a rare case of a 15-year-old girl who suffered a sleeve fracture at the superior pole of the right patella. The patient had a history of dislocation of the patella 2 weeks ago. Physical examination showed tenderness on palpation over the upper pole (...) of the patella and absence of active movement of the knee accompanied by swelling and joint effusion. A plain radiograph showed an avulsed fragment of the superior pole of the patella.Magnetic resonance imaging showed a superior pole patellar avulsion fracture and dysfunction of the knee extensor mechanism.Under general anesthesia, the patient underwent open surgery for reduction of the patellar fracture and reconstruction of the knee extension apparatus through an anterior approach.Six months after

2019 Medicine

9. Editorial Commentary: Risk Stratification Is the New "Standard of Care" Following First-Time Patellar Dislocation. Full Text available with Trip Pro

Editorial Commentary: Risk Stratification Is the New "Standard of Care" Following First-Time Patellar Dislocation. The standard of care for a first-time patellar dislocation without loose bodies or osteochondral fracture has been nonoperative treatment. However, studies that show high recurrent instability rates and low levels of return to unlimited activity have opened the door to consider early surgical stabilization in high-risk individuals. Risk stratification models have been developed (...) to identify those at highest risk of recurrent dislocation. Although the decision to operate on patients with a first-time dislocation remains controversial, surgeons should at the very least use readily available information to counsel patients regarding their relative risk of recurrence.Copyright © 2019 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

2019 Arthroscopy

10. Correction to: Short lateral posterior condyle is associated with trochlea dysplasia and patellar dislocation. Full Text available with Trip Pro

Correction to: Short lateral posterior condyle is associated with trochlea dysplasia and patellar dislocation. Unfortunately, the author name was incorrectly published in the original publication as Sébatien Lustig insted of Sébastien Lustig. The author name is corrected here by this Erratum. The original article has been corrected.

2019 Knee Surgery, Sports Traumatology, Arthroscopy

11. Early functional rehabilitation after patellar dislocation-What procedures are daily routine in orthopedic surgery? (Abstract)

Early functional rehabilitation after patellar dislocation-What procedures are daily routine in orthopedic surgery? Patellar dislocation and rupture of the medial patellofemoral ligament (MPFL) are frequently seen in daily orthopedic practice. Besides initial non-surgical treatment, surgery and subsequent rehabilitation are crucial for restoring stability in the femoropatellar joint. This study investigated current rehabilitation strategies after patellar dislocation because knowledge (...) and surgical treatment after patellar dislocation showed a tendency towards earlier functional rehabilitation after surgical MPFL reconstruction than after conservative treatment. Both surgical and conservative treatment involved initial restrictions in weight bearing, ROM, and use of movement devices and orthosis at the beginning of rehabilitation. The rehab protocols showed a significant earlier full weight bearing after surgical MPFL reconstruction (p > 0.001). Due to the presence of other parameters

2019 Injury

12. Sporting activity is reduced following medial reefing performed for patellar dislocation : A retrospective case series of 144 patients with a minimum follow-up of 24 months. Full Text available with Trip Pro

Sporting activity is reduced following medial reefing performed for patellar dislocation : A retrospective case series of 144 patients with a minimum follow-up of 24 months. Patellar dislocation is common in young and active patients. The purpose of this study was to determine sporting activity following the medial reefing of patellar dislocation.One hundred forty-four patients with objective patellar dislocation were treated between 2004 and 2013. Three groups were analyzed retrospectively (...) groups, a shift from high performance to recreational sports was found.Despite good clinical results, sporting activity was reduced following patellar dislocation treated with medial reefing. Also, a shift from engagement in high- to low-impact sports among the participants was noted.

2019 BMC Musculoskeletal Disorders

13. Risk Factors and Time to Recurrent Ipsilateral and Contralateral Patellar Dislocations (Abstract)

Risk Factors and Time to Recurrent Ipsilateral and Contralateral Patellar Dislocations Previous studies have reported variable rates of recurrent lateral patellar instability mainly because of limited cohort sizes. In addition, there is currently a lack of information on contralateral patellar instability.To evaluate the rate of recurrent ipsilateral patellar dislocations and contralateral patellar dislocations after a first-time lateral patellar dislocation. Additionally, risk factors (...) associated with recurrent dislocations (ipsilateral or contralateral) and time to recurrence were investigated.Cohort study; Level of evidence, 3.This population-based study included 584 patients with a first-time lateral patellar dislocation occurring between 1990 and 2010. A retrospective review was conducted to gather information about the injury, subsequent dislocations (ipsilateral or contralateral), and structural characteristics including trochlear dysplasia, patella alta, and tibial tubercle

2017 EvidenceUpdates

14. The Norwich Patellar Instability Score: Validity, internal consistency and responsiveness for people conservatively-managed following first-time patellar dislocation. Full Text available with Trip Pro

The Norwich Patellar Instability Score: Validity, internal consistency and responsiveness for people conservatively-managed following first-time patellar dislocation. This paper assessed the validity, internal consistency, responsiveness and floor-ceiling effects of the Norwich Patellar Instability (NPI) Score for a cohort of conservatively managed people following first-time patellar dislocation (FTPD).Fifty patients were recruited, providing 130 completed datasets over 12 months. The NPI (...) components account for 70.4% of the variability. Whilst the NPI Score demonstrated a flooring-effect for 13 of the 19 items, no ceiling effect was reported. There was high internal consistency with a Cronbach Alpha value of 0.93 (95% CI: 0.91 to 0.93). The NPI Score was responsive to change over the 12 months period with an effect size of 1.04 from baseline to 12 months post-injury.The NPI Score is a valid tool to assess patellar instability symptoms in people conservatively managed following FTPD.Level

2017 The Knee Controlled trial quality: uncertain

15. Anatomic patellar instability risk factors in primary lateral patellar dislocations do not predict injury patterns: an MRI-based study. (Abstract)

Anatomic patellar instability risk factors in primary lateral patellar dislocations do not predict injury patterns: an MRI-based study. The primary goal was to describe the injury patterns in a population of primary (first time) lateral patellar dislocators (LPD) to lend clarity to commonly held notions about injury patterns in this population.A prospective study identifying patients presenting with LPD between 2008 and 2012. Inclusion criteria were a history and physical exam consistent (...) with primary LPD, and an MRI consistent with the diagnosis without other significant ligamentous injury. On MRI, location of cartilage, medial patellofemoral ligament (MPFL) injury, and bone bruising were noted. Severity was categorized as partial or complete for MPFL and cartilage lesions. Anatomic patellar instability risk factors (patella alta, trochlear dysplasia, increased TT-TG, and lateral patella tilt) were recorded and compared to the injury patterns.This study involved 157 patients; 107 patients

2017 Knee Surgery, Sports Traumatology, Arthroscopy

16. Solitary Trochleoplasty for Treatment of Recurrent Patellar Dislocation Full Text available with Trip Pro

Solitary Trochleoplasty for Treatment of Recurrent Patellar Dislocation Solitary trochleoplasty for recurrent patellar dislocation offers a unique benefit in that it addresses the most important factor in patellar instability: the trochlear dysplasia.The trochlea is visualized through a lateral arthrotomy of the knee joint. An osteochondral layer is peeled off with curved chisels and extended into the intercondylar notch. A triangular bone block is removed from the subchondral bone to form (...) .3.Most patients with recurrent patellar dislocation have a dysplastic trochlea4, which is considered to be the primary reason for a recurrence. While interventions such as reconstruction of the medial patellofemoral ligament or femoral and tibial osteotomies also provide stability of the patella, they do not change the most essential factor of the instability-the trochlear dysplasia. The trochleoplasty addresses this underlying condition and reshapes the trochlea.

2018 JBJS Essential Surgical Techniques

17. Treatment of recurrent patellar dislocation via knee arthroscopy combined with C-arm fluoroscopy and reconstruction of the medial patellofemoral ligament Full Text available with Trip Pro

Treatment of recurrent patellar dislocation via knee arthroscopy combined with C-arm fluoroscopy and reconstruction of the medial patellofemoral ligament Recurrent patellar dislocations were treated via knee arthroscopy combined with C-arm fluoroscopy, and reconstruction of the medial patellofemoral ligaments. Between October 2013 and March 2017, 52 cases of recurrent patellar dislocation [27 males and 25 females; age, 16-47 years (mean, 21.90 years)] were treated. Arthroscopic exploration (...) . Post-operative fear was absent, and no patellar re-dislocation or re-fracture was noted during follow-up. At the end of follow-up, the patellofemoral angle (0.22±4.23°), lateral patellofemoral angle (3.44±1.30°), and lateral shift (0.36+0.14°) differed significantly from the pre-operative values (all, P<0.05). Furthermore, IKDC and Lysholm scores (87.84+3.74 and 87.48+3.35, respectively) differed significantly from the pre-operative values (both, P<0.05). These findings suggest that, in the short

2018 Experimental and therapeutic medicine

18. Femoral condyle osteochondral fracture treated with bone suture after acute patellar dislocation: a case report Full Text available with Trip Pro

Femoral condyle osteochondral fracture treated with bone suture after acute patellar dislocation: a case report Osteochondral fracture after acute patellar dislocation in teenagers is relatively common (up to 60% of cases of patellar dislocation), but poorly diagnosed. There are several treatments proposed for this type of injury, but none well defined in the literature. A male patient, 13 years old, with a diagnosis of osteochondral fracture of the lateral femoral condyle after acute (...) dislocation of the right patella. He underwent surgical treatment of the chondral injury, which consisted of suturing of the chondral fragment to the cartilage defect and, in a second approach, reconstruction of the medial patellotibial ligament and medial patellofemoral ligament with autologous flexor graft. Currently, the patient has been followed up for 16 months postoperatively for the suture of the chondral fragment and for 8 months for the ligament reconstruction. He has been evaluated through

2018 Revista brasileira de ortopedia

19. Predicting Risk of Recurrent Patellar Dislocation Full Text available with Trip Pro

Predicting Risk of Recurrent Patellar Dislocation Lateral patellar dislocation (LPD) is one of the most common injuries of the knee, especially in a young patient. It is multifactorial with several underlying risk factors. The purpose of this review is to present the most recent data concerning risk factors and their predictive value to estimate recurrent LPD risk.Several demographic risk factors (age, skeletal immaturity, sex, bilaterality), mechanism of injury, and anatomic risk factors (...) (trochlear dysplasia, patella alta, excessive tibial tubercle lateralization, increased patellar tilt) have been recognized. The combination of different risk factors, their relative contribution to instability, weightage of each factor, and multivariate analysis have led to the development of a prediction model and instability scoring system. If recurrent instability and poor outcomes could be predicted based on these prediction tools, then alternative treatment or early surgical intervention after

2018 Current reviews in musculoskeletal medicine

20. A new minimally invasive surgical technique for medial retinaculum repair following traumatic patellar dislocation Full Text available with Trip Pro

A new minimally invasive surgical technique for medial retinaculum repair following traumatic patellar dislocation A new surgical method is introduced offering a less invasive approach to reattach the medial retinaculum following acute patellar dislocation. This retrospective analysis comprised 12 cases of medial retinacular repair in 10 patients. The surgical technique achieved reinforced reattachment of the torn region of the medial retinaculum for improved patellar support and stabilization (...) . During follow-up, no recurrent patellar dislocations occurred, except where one patient reported a subjective feeling of patellar dislocation. The average Kujala score for our sample group after 2 years was 89.2. A plethora of methods are described in the literature to repair a tear to the medial patellofemoral ligament, which attaches at the superomedial patella. However, it is our contention that traumatic patellar dislocation invariably results in osteochondral avulsion at the inferomedial patella

2018 European Journal of Orthopaedic Surgery & Traumatology

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