Xiaozuo Zheng1,2, Yang Hu3, Peng Xie4,5, Meijuan Cui4,6, Xuelin Ma7,4, Yu-E Feng7,4, Juyuan Gu7,4, Shijun Gao8,9. 1. Department of Orthopedics, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China. xiaozuo_zheng@163.com. 2. Key Laboratory of Biomechanics of Hebei Province, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China. xiaozuo_zheng@163.com. 3. The Second Department of Intensive Care Unit, Children's Hospital of Hebei Province, 133 Jianhua Street, Shijiazhuang, 050031, Hebei, China. 4. Key Laboratory of Biomechanics of Hebei Province, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China. 5. Department of Nuclear medicine, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China. 6. Department of medical records, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China. 7. Department of Orthopedics, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China. 8. Department of Orthopedics, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China. 13595933@qq.com. 9. Key Laboratory of Biomechanics of Hebei Province, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China. 13595933@qq.com.
Abstract
PURPOSE: The acute primary (first-time) lateral patellar dislocation is associated with a high rate of functional disability. There is no consensus as to the choice of surgical or non-surgical treatment for these patients. The aim of this study is to compare the clinical results between the surgical (reconstruction of the medial patellofemoral ligament [MPFL]) and non-surgical treatments for acute primary patellar dislocations. METHODS: Sixty-nine skeletally mature patients (69 knees) were included in this prospective non-randomized controlled trial. At least one predisposing factor for patellar dislocation (including patella alta, high lateral patellar tilt, trochlear dysplasia, and increased TT-TG distance) was identified in the included patients. Thirty patients were treated surgically with MPFL reconstruction, and the other 39 patients were treated non-surgically. The main outcome variable was patellar redislocation within a two year follow-up period. The Kujala questionnaire was applied for analyzing the pain and the quality of life. The additional surgeries due to patellofemoral problems were also recorded. RESULTS: Patellar redislocation occurred in eight patients in the non-surgical group, while no redislocation occurred in the surgical group (P < 0.05). Four patients in non-surgical group underwent further surgery due to patellar redislocation and poor function during the follow-up period. The Kujala score and the percentage of "good/excellent" results on the Kujala score of the surgical group were significantly better than that of the non-surgical group (P < 0.05). CONCLUSIONS: The surgical MPFL reconstruction achieved better clinical outcomes compared with non-surgical treatment for the acute primary patellar dislocation in the skeletally mature patients with the presence of abnormal patellofemoral anatomy. Surgery should be considered as the better choice for these specific patients.
PURPOSE: The acute primary (first-time) lateral patellar dislocation is associated with a high rate of functional disability. There is no consensus as to the choice of surgical or non-surgical treatment for these patients. The aim of this study is to compare the clinical results between the surgical (reconstruction of the medial patellofemoral ligament [MPFL]) and non-surgical treatments for acute primary patellar dislocations. METHODS: Sixty-nine skeletally mature patients (69 knees) were included in this prospective non-randomized controlled trial. At least one predisposing factor for patellar dislocation (including patella alta, high lateral patellar tilt, trochlear dysplasia, and increased TT-TG distance) was identified in the included patients. Thirty patients were treated surgically with MPFL reconstruction, and the other 39 patients were treated non-surgically. The main outcome variable was patellar redislocation within a two year follow-up period. The Kujala questionnaire was applied for analyzing the pain and the quality of life. The additional surgeries due to patellofemoral problems were also recorded. RESULTS: Patellar redislocation occurred in eight patients in the non-surgical group, while no redislocation occurred in the surgical group (P < 0.05). Four patients in non-surgical group underwent further surgery due to patellar redislocation and poor function during the follow-up period. The Kujala score and the percentage of "good/excellent" results on the Kujala score of the surgical group were significantly better than that of the non-surgical group (P < 0.05). CONCLUSIONS: The surgical MPFL reconstruction achieved better clinical outcomes compared with non-surgical treatment for the acute primary patellar dislocation in the skeletally mature patients with the presence of abnormal patellofemoral anatomy. Surgery should be considered as the better choice for these specific patients.
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