Sean Timothy O'Sullivan1,2, James A Harty3. 1. Department of Orthopaedic Surgery, Cork University Hospital & South Infirmary Victoria University Hospital, Cork, Ireland. seanysull92@gmail.com. 2. Tallaght University Hospital, Dublin, Ireland. seanysull92@gmail.com. 3. Department of Orthopaedic Surgery, Cork University Hospital & South Infirmary Victoria University Hospital, Cork, Ireland.
Abstract
BACKGROUND: Patellar instability is a disabling condition that limits the functional ability and physical aspirations of patients. There are multiple anatomical structures which stabilize the patella and surgical treatment is tailored to repair the underlying aetiology. AIMS: To evaluate the clinical and radiological outcome of patellar stabilization procedures in patients with recurrent patellar instability. METHODS: We analysed 34 patients (36 knees) (mean age, 26.6) with recurrent patellar instability who underwent patellar stabilization surgery from June 2009 to September 2014. Type of procedure was dependent on the concomitant aetiological factors; tibial tuberosity osteotomy (61.76%), medial patellofemoral ligament reconstruction (67.64%), lateral release (5.88%) and trochleoplasty (2.94%). Mean follow-up was 3 years (range 9 months-6 years). RESULTS: At follow-up, 77% of patients were satisfied with the overall outcome of the procedure. The mean IKDC was 66.7, Lysholm 74.9. Mean patellar height decreased significantly (P < .05) to anatomical values. Pre-operatively, the mean tibial tuberosity-trochlear groove distance was 14.66 mm (55.6% at borderline/abnormal level) and 81% showed evidence of trochlear dysplasia. Complications were found in 3 patients (8.33%), 2 of which had further episodes of instability. CONCLUSIONS: Patellar stabilization surgery is an effective method of treating patellar instability, resulting in stability of the knee in 94.4%. Despite this, patient dissatisfaction rates are quite high suggesting that this patient group, whilst mostly stable, remains significantly symptomatic from their knee. These positive results which are reflected in the recent literature represent a strong case for consideration of primary surgical stabilization in cases of patellar instability.
BACKGROUND: Patellar instability is a disabling condition that limits the functional ability and physical aspirations of patients. There are multiple anatomical structures which stabilize the patella and surgical treatment is tailored to repair the underlying aetiology. AIMS: To evaluate the clinical and radiological outcome of patellar stabilization procedures in patients with recurrent patellar instability. METHODS: We analysed 34 patients (36 knees) (mean age, 26.6) with recurrent patellar instability who underwent patellar stabilization surgery from June 2009 to September 2014. Type of procedure was dependent on the concomitant aetiological factors; tibial tuberosity osteotomy (61.76%), medial patellofemoral ligament reconstruction (67.64%), lateral release (5.88%) and trochleoplasty (2.94%). Mean follow-up was 3 years (range 9 months-6 years). RESULTS: At follow-up, 77% of patients were satisfied with the overall outcome of the procedure. The mean IKDC was 66.7, Lysholm 74.9. Mean patellar height decreased significantly (P < .05) to anatomical values. Pre-operatively, the mean tibial tuberosity-trochlear groove distance was 14.66 mm (55.6% at borderline/abnormal level) and 81% showed evidence of trochlear dysplasia. Complications were found in 3 patients (8.33%), 2 of which had further episodes of instability. CONCLUSIONS: Patellar stabilization surgery is an effective method of treating patellar instability, resulting in stability of the knee in 94.4%. Despite this, patient dissatisfaction rates are quite high suggesting that this patient group, whilst mostly stable, remains significantly symptomatic from their knee. These positive results which are reflected in the recent literature represent a strong case for consideration of primary surgical stabilization in cases of patellar instability.
Entities:
Keywords:
Dislocation; Patella stabilization; Recurrent instability; Surgery
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