Noniatrogenic Medial Patellar Dislocations: Case Series and International Patellofemoral Study Group Experience

Date
2021-02-26
Language
American English
Embargo Lift Date
Committee Members
Degree
Degree Year
Department
Grantor
Journal Title
Journal ISSN
Volume Title
Found At
Sage
Abstract

Background: Most patellar dislocations occur in a lateral direction because of a summed lateral force vector and predisposing anatomic risk factors. Medial patellar instability is rare and is a well-recognized iatrogenic complication of an overly aggressive lateral retinacular release. Noniatrogenic medial patellar dislocations are rare. The management of these injuries is not well described.

Purpose: To describe the experience of the International Patellofemoral Study Group with patients with noniatrogenic medial patellar dislocation.

Study design: Case series; Level of evidence, 4.

Methods: Members of the International Patellofemoral Study Group (N = 64) were surveyed between October 2018 and April 2019. This group was chosen because of its wide referral base and interest in patellar instability. Specialists who had encountered a patient with medial patellar instability were sent a questionnaire inquiring about details of the case, including patient demographics, medical history, level of athletic competition, injury characteristics, and treatment. Cases were confirmed by physical examination records and, in some cases, with findings on advanced radiographic imaging.

Results: The survey response rate was 73% (47/64). Three of the 47 specialists (6.4%) reported they had seen a case of noniatrogenic medial patellar dislocation, for a total of 6 cases. Four cases were described as recurrent medial dislocations in the setting of hypermobile Ehlers-Danlos syndrome; 2 were treated nonoperatively, 1 underwent lateral patellofemoral ligament reconstruction, and 1 underwent derotational osteotomies. Two medial-sided patellar dislocations in collegiate athletes were sports-related injuries that required surgical debridement but no ligamentous reconstruction. None of the patients had persistent or recurrent instability at the time of their most recent follow-up.

Conclusion: Noniatrogenic medial patellar dislocations are extremely rare. This case review suggests that the treatment of first-time medial patellar instability in patients without known risk factors should follow the same principles as the treatment of lateral instability with no known risk factors, which is nonoperative management. For patients with documented risk factors and recurrence, surgery to address the risk factors may be appropriate.

Description
item.page.description.tableofcontents
item.page.relation.haspart
Cite As
Loeb AE, Farr J, Parikh SN, Cosgarea AJ. Noniatrogenic Medial Patellar Dislocations: Case Series and International Patellofemoral Study Group Experience. Orthop J Sports Med. 2021;9(2):2325967120985530. Published 2021 Feb 26. doi:10.1177/2325967120985530
ISSN
Publisher
Series/Report
Sponsorship
Major
Extent
Identifier
Relation
Journal
Orthopaedic Journal of Sports Medicine
Source
PMC
Alternative Title
Type
Article
Number
Volume
Conference Dates
Conference Host
Conference Location
Conference Name
Conference Panel
Conference Secretariat Location
Version
Final published version
Full Text Available at
This item is under embargo {{howLong}}