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  • Kramer, Dennis E.  (5)
  • Yen, Yi-Meng  (5)
  • English  (5)
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  • English  (5)
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  • 1
    Online Resource
    Online Resource
    ISOLATED MPFL RECONSTRUCTION VS. TIBIAL TUBERCLE OSTEOTOMY AND MEDIAL RETINACULAR PLICATION FOR RECURRENT PATELLAR INSTABILITY: A MATCHED, COHORT ANALYSIS OF CLINICAL OUTCOMES COMPARING TWO TECHNIQUES
    SAGE Publications ; 2021
    In:  Orthopaedic Journal of Sports Medicine Vol. 9, No. 7_suppl3 ( 2021-07-01), p. 2325967121S0013-
    Details
    In: Orthopaedic Journal of Sports Medicine, SAGE Publications, Vol. 9, No. 7_suppl3 ( 2021-07-01), p. 2325967121S0013-
    Abstract: Historically, the most commonly utilized technique to address recurrent patellofemoral instability (PFI) was a combined proximal and distal realignment, specifically the tibial tubercle osteotomy (TTO) with a proximal medial retinacular plication/reefing/tightening/repair (MRP). Rising interest in the medial patellofemoral ligament reconstruction (MPFLR) over the last decade, now frequently performed as a more powerful isolated proximal realignment procedure, has prompted debate over the optimal technique to treat this common condition. Hypothesis/Purpose: The study hypothesis was that no difference would be detected in recurrent PFI rates or revision surgery rates between patients who underwent TTO-MRP vs. MPFLR. Methods: With cohorts derived from a large, single-center PFI database of 523 patients who underwent a variety of stabilization procedures, 114 eligible MPFLR patients were matched to 109 TTO patients based on age, gender, BMI, and TT-TG distance. Propensity score matching was conducted using logistic regression models to produce 1:1 matching, and a caliper of 0.2 standard deviations of the estimated propensity score was used to for the nearest neighbor matching algorithm. Final matching procedure resulted in 84 MPFLR patients and 84 TTO patients. These were compared on demographics and post-operative clinical results. Results: Demographic and radiologic comparisons of the cohorts are shown in Table 1, with the only difference between groups being an expected higher rate of patients with open physes in the MPFLR cohort. Table 2 shows the TTO-MRP group had longer follow up times, but comparable rates of return to sports. The MPFLR group had a higher rate of recurrent instability, but not to a significant degree, and a significantly higher incidence of revision patellar stabilization surgery (p 〈 0.001). The TTO group had a higher rate of additional knee surgery, the majority of which were implant removal for TTO screws. Conclusion: The TTO-MRP shows equivalent or superior results to the MPFLR for treatment of PFI. However, implant removal may be common with TTO, though this may be somewhat technique-dependent. In the current landscape of increasing interest and utilization of MPFLR as an all-encompassing PFI surgery, the influence of distal bony realignment to minimize recurrence should not be underappreciated. Tables/Figures: [Table: see text][Table: see text]
    Type of Medium: Online Resource
    ISSN: 2325-9671 , 2325-9671
    URL: Article
    DOI: 10.1177/2325967121S00139
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
    detail.hit.zdb_id: 2706251-X
    SSG: 31
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  • 2
    Online Resource
    Online Resource
    Descriptive Epidemiology of a Surgical Patellofemoral Instability Population of 492 Patients
    SAGE Publications ; 2022
    In:  Orthopaedic Journal of Sports Medicine Vol. 10, No. 7 ( 2022-07-01), p. 232596712211081-
    Details
    In: Orthopaedic Journal of Sports Medicine, SAGE Publications, Vol. 10, No. 7 ( 2022-07-01), p. 232596712211081-
    Abstract: Patellofemoral instability (PFI) occurs most commonly in pediatric and adolescent patients, with evolving indications for surgery and changes in surgical techniques over the past decade. Purpose: To characterize the demographic, clinical, and radiologic characteristics of a large cohort of patients undergoing PFI surgery and investigate longitudinal trends in techniques utilized over a 10-year period at a tertiary-care academic center. Study Design: Case series; Level of evidence, 4. Methods: Electronic medical records of patients younger than 25 years of age who underwent primary surgery for lateral PFI from 2008 to 2017 at a single center by 1 of 5 different sports medicine surgeons were retrospectively reviewed. Demographic, clinical, and radiographic parameters of instability were analyzed. Routine surgical techniques included medial retinacular plication/reefing/repair (MRP), medial patellofemoral ligament reconstruction (MPFLR), tibial tubercle osteotomy (TTO), or a combination thereof, with or without lateral retinacular release (LR) or lateral retinacular lengthening (LRL). Exclusion criteria, selected for potentially altering routine surgical indications or techniques, included fixed/syndromic PFI, a formally diagnosed collagen disorder, cases in which a chondral/osteochondral shear fragment underwent fixation or was 〉 1 cm in diameter, and body mass index 〉 30 kg/m 2 . Results: Of the 492 study patients (556 knees; 71% female; median age, 15.2 years; 38% open physes), 88% were athletes, with the most common sports participated in being soccer, basketball, dance, football, gymnastics, and baseball/softball. While 91% of the cohort had recurrent dislocations, the 9% with primary dislocations were more likely to have small osteochondral fractures/loose bodies ( P 〈 .001). Female patients were younger ( P = .002), with greater patellar tilt ( P = .005) than male patients. Utilization of MPFLR and TTO increased significantly over the study period, while use of MRP+LR decreased. Conclusion: Most patients younger than 25 years of age who underwent PFI surgery were skeletally immature, female, and athletes and had recurrent dislocations. The 〈 10% who had primary dislocations and underwent surgery were likely to have osteochondral fractures. Surgical techniques have changed significantly over time, with increasing use of TTO and MPFLR, while the use of MRP+LR/LRL has significantly decreased.
    Type of Medium: Online Resource
    ISSN: 2325-9671 , 2325-9671
    URL: Article
    DOI: 10.1177/23259671221108174
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2706251-X
    SSG: 31
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    Online Resource
  • 3
    Online Resource
    Online Resource
    SURGICAL MANAGEMENT OF PATELLAR INSTABILITY IN ADOLESCENTS WITH BODY MASS INDEX GREATER THAN 30
    SAGE Publications ; 2021
    In:  Orthopaedic Journal of Sports Medicine Vol. 9, No. 7_suppl3 ( 2021-07-01), p. 2325967121S0010-
    Details
    In: Orthopaedic Journal of Sports Medicine, SAGE Publications, Vol. 9, No. 7_suppl3 ( 2021-07-01), p. 2325967121S0010-
    Abstract: Recurrent patellar instability is a common condition often requiring surgical stabilization in adolescents. Obesity, defined as body mass index (BMI) greater than 30 kg/m 2 in adults, has been associated with poorer outcomes with many procedures including ACL reconstruction, spinal fusion, and joint arthroplasty. Data is limited regarding the results of surgery for patellar instability in adolescent patients with BMI 〉 30 kg/m 2 . Purpose: The purpose of this study was to report on rates of recurrent patellar instability following surgical management in adolescents with BMI 〉 30 kg/m 2 and to compare the rates of recurrent instability between different surgical procedures. Methods A retrospective review of patients who underwent surgical management of patellar instability at our institution was performed. Inclusion criteria included patients aged 19 and younger, with BMI 〉 30 kg/m 2 who were followed for least 12 months post procedure. Patients with underlying collagen or systemic disorders, a history of prior ipsilateral knee surgery, or an osteochondral fragment greater than 10mm were excluded. Complications were defined as any recurrent subluxation or dislocation, or need for subsequent instability surgery. A subgroup analysis was performed to compare recurrent instability rates within our cohort between patients who underwent medial retinacular plication versus all other procedures. Categorical variables were compared using Fisher’s exact test. Statistical significance of p 〈 0.05 was applied. Results: Fifty-five patients were identified. Mean age was 15.6±2.4 years. Mean BMI for this cohort was 34.9± 4.3 kg/m 2 . 72.7% of patients were female. All patients underwent either medial retincular plication, tibial tubercle osteotomy, MPFL reconstruction or combined procedures (Table 1). At a mean of 3.8 years, 16.4% of all patients had any recurrent subluxation or dislocation including 12.7% who had a recurrent dislocation, and 7.3% who required a revision patellar stabilization procedure. Subgroup analysis revealed that obese patients who underwent isolated medial retinacular plication had higher rates of recurrent subluxation or dislocation (24% vs 10%, p=0.272) including recurrent dislocation (20% vs 6.7%, 0.226), and had significantly higher rates of subsequent instability surgery (16% vs 0%, p=0.037) (Table 2). Conclusion: Adolescents with BMI 〉 30 who undergo patellar stabilization surgery have notable rates of recurrent subluxation or dislocation and subsequent instability surgery though comparable to results in non-obese patients. Obese patients who underwent medial retinacular plication had higher rates of postoperative instability and significantly higher rates of revision instability surgery compared to those who underwent MPFL reconstruction, tibial tubercle osteotomy or combined procedures. Tables/Figures: [Table: see text][Table: see text]
    Type of Medium: Online Resource
    ISSN: 2325-9671 , 2325-9671
    URL: Article
    DOI: 10.1177/2325967121S00109
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
    detail.hit.zdb_id: 2706251-X
    SSG: 31
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  • 4
    Online Resource
    Online Resource
    Surgical Management of Patellofemoral Instability in Adolescents with High Grade Trochlear Dysplasia
    SAGE Publications ; 2022
    In:  Orthopaedic Journal of Sports Medicine Vol. 10, No. 5_suppl2 ( 2022-05-01), p. 2325967121S0043-
    Details
    In: Orthopaedic Journal of Sports Medicine, SAGE Publications, Vol. 10, No. 5_suppl2 ( 2022-05-01), p. 2325967121S0043-
    Abstract: High-grade trochlear dysplasia (HGTD) has previously been identified as a risk factor for failure of surgical management of patellofemoral instability (PFI). However, limited data exists on the influence of the type of surgical procedure performed on postoperative outcomes in these patients. Hypothesis/Purpose: The purpose of this study was to identify the rates of failure of primary PFI surgery in patients with HGTD compared to those without HGTD and to assess the effect of the type of surgery on recurrent instability and return to OR. Methods: A retrospective review was performed on patients aged ≤19 years who underwent primary surgery for PFI at a single tertiary care center between 2008 and 2017. Patients underwent procedures including medial retinacular plication/reefing/advancement (MRP), graft-based medial patellofemoral ligament reconstruction (MPFLR), tibial tubercle osteotomy with or without MRP (TTO), or combined MPFLR + TTO. Exclusion criteria were BMI 〉 30kg/m 2 , surgery for fixation of chondral fractures 〉 1cm, and diagnosis of a syndromic disorder. Trochlear dysplasia was evaluated based on pre-operative MRI according to the Dejour classification system. Those with Dejour grade B or higher were designated as having HGTD. Comparisons were made between HGTD patients and non-HGTD patients, with logistic regression utilized to determine if surgery type was associated with recurrent PFI and revision PFI surgery. Results: 303 patients (mean age 15.1 years, 71% female) underwent primary surgical stabilization for PFI with median follow up time of 3.0 years. Approximately half (149/303, 49%) of the cohort had HGTD. Demographics were comparable between HGTD and non-HGTD patients (Table 1). HGTD and non-HGTD cohorts showed similar rates of post-operative instability, revision PFI surgery, and non-PFI secondary surgery. HGTD patients (Table 2) who underwent MPFLR had a 63% decrease in the odds of post-operative PFI compared to those who underwent MRP (OR=0.37; p=0.03). HGTD patients who underwent TTO had an 80% decrease in the odds of post-operative PFI compared to patients undergoing MRP (OR=0.20; p=0.002). Conclusion: Adolescents with PFI and HGTD have similar results after surgical stabilization to those patients without HGTD. Within the HGTD cohort, however, the type of surgery performed significantly influenced outcome. Patients with HGTD that underwent MRP had significantly more recurrent PFI and revision PFI surgery than patients that underwent other procedures, suggesting a limited role for this procedure in this sub-population of PFI patients. [Table: see text][Table: see text]
    Type of Medium: Online Resource
    ISSN: 2325-9671 , 2325-9671
    URL: Article
    DOI: 10.1177/2325967121S00438
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2706251-X
    SSG: 31
    Location Call Number Limitation Availability
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  • 5
    Online Resource
    Online Resource
    Radiologic Predictors of Failure of Patellofemoral Instability Surgery in Adolescents
    SAGE Publications ; 2022
    In:  Orthopaedic Journal of Sports Medicine Vol. 10, No. 5_suppl2 ( 2022-05-01), p. 2325967121S0050-
    Details
    In: Orthopaedic Journal of Sports Medicine, SAGE Publications, Vol. 10, No. 5_suppl2 ( 2022-05-01), p. 2325967121S0050-
    Abstract: Adolescents often benefit from surgical management of recurrent patellofemoral instability (PFI). However, the precise radiologic risk factors for failure of PFI surgery remains incompletely investigated. Hypothesis/Purpose: The purpose of this study was to determine the rate of failure, defined as recurrence of instability, in a large cohort of adolescent athletes undergoing primary surgery for PFI, and to identify preoperative radiologic risk factors for recurrence. Methods: A retrospective review was performed on patients aged ≤19 years who underwent primary surgery for PFI at a single tertiary care center between 2008 and 2017. Patients underwent procedures including medial retinacular plication/reefing/advancement (MRP), medial patellofemoral ligament reconstruction (MPFLR), tibial tubercle osteotomy with or without MRP (TTO), or combined TTO/MPFLR. Exclusion criteria were BMI 〉 30kg/m 2 , surgery for fixation of chondral fractures 〉 1cm, and diagnosis of a syndromic disorder. Preoperative magnetic resonance imaging (MRI) studies were reviewed, and radiologic parameters were recorded. Demographic and radiologic variables were compared between patients with and without subsequent PFI. Logistic regression was utilized to determine which imaging variables were associated with post-operative PFI. Results: 303 patients (mean age 15.1 years, 71% female) underwent surgery for PFI with median follow up time of 3.0 years. At final follow-up, 76/303 (25%) of patients experienced post-operative PFI, with 41 of these patients (54%; 14% overall) undergoing revision PFI surgery. Post-operative PFI patients were younger (14.3 vs 15.4 years; p 〈 0.001) and more likely to have undergone isolated MRP surgery (66% vs 35%; p 〈 0.001) (Table 1). Pertinent radiologic findings in recurrent PFI patients vs non-recurrence patients included open physes (62% vs 49%; p 〈 0.001), larger sulcus angle (163.9 vs 159.2; p 〈 0.001), larger patellar tilt angle (26.3 vs 23.6; p=0.04), and larger Caton-Deschamps Index (CDI) (1.3 vs 1.2; p=0.03) (Table 2). Each additional degree of sulcus angle increased the odds of recurrent instability by 5% (OR=1.05; p=0.002), while each additional year of age decreased the odds of failure by 23% (OR=0.77; p 〈 0.001). Conclusion: In conclusion, 25% of adolescents experienced post-operative PFI after primary patellofemoral stabilization surgery. However, such patients were more likely to be younger—a known risk factor for recurrence—and were more likely to undergo MRP, a procedure now largely replaced by MPFLR. Radiologic risk factors for failure included open physes, flatter trochlea, greater patellar tilt, and greater patella alta. Such data should guide treatment decisions and inform the risk of failure of surgical stabilization procedures in adolescents with PFI. [Table: see text][Table: see text]
    Type of Medium: Online Resource
    ISSN: 2325-9671 , 2325-9671
    URL: Article
    DOI: 10.1177/2325967121S00508
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2706251-X
    SSG: 31
    Location Call Number Limitation Availability
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