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Acute and recurrent patellar instability in the young athlete
Richard Y Hinton1, Krishn M Sharma
1Department of Orthopaedic Surgery, Union Memorial Hospital, The Johnston Professional Building, #400, 3333 North Calvert Street, Baltimore, MD 21218, USA. lyn.camire@medstar.net
The Orthopedic Clinics of North America
|September 17, 2003
Summary
Patellar instability in young athletes often leads to long-term pain and impairment. Aggressive, tailored nonoperative treatment, addressing osteochondral injuries and MPFL tears, improves outcomes.
Area of Science:
- Orthopedics
- Sports Medicine
- Biomechanical Engineering
Background:
- Patellofemoral instability treatment literature often lacks rigorous methodology, including patient selection, injury definition, and follow-up.
- Traditional treatments for patellar instability, like immobilization and sporadic rehabilitation, frequently result in persistent retropatellar pain and extensor mechanism dysfunction in young athletes.
- Osteochondral injuries and medial patellofemoral ligament (MPFL) injuries are critical factors influencing outcomes in patellar instability.
Purpose of the Study:
- To critically evaluate current treatment paradigms for patellofemoral instability, particularly in skeletally immature athletes.
- To highlight the limitations in existing orthopedic literature regarding patellofemoral instability management.
- To emphasize the importance of accurate diagnosis, including MRI assessment of osteochondral and MPFL injuries, and the benefits of anatomic reconstruction focusing on MPFL restoration.
Main Methods:
- Review of existing orthopedic literature on patellofemoral instability treatment.
- Analysis of diagnostic modalities, including MRI, for assessing osteochondral and MPFL injuries.
- Evaluation of traditional versus modern treatment approaches, including nonoperative strategies and anatomic reconstructions.
Main Results:
- Many current reports on patellofemoral instability treatment exhibit methodological flaws.
- Aggressive, multidimensional, and outcome-responsive nonoperative programs are beneficial for most athletes initially.
- Concurrent osteochondral injuries significantly contribute to adverse outcomes, and MRI is crucial for their evaluation and assessment of MPFL injury extent.
Conclusions:
- There is a need for improved research standards in patellofemoral instability treatment, addressing patient selection, injury definition, and follow-up.
- Anatomic reconstruction procedures, particularly those restoring the medial patellofemoral ligament (MPFL), are gaining favor over nonanatomic extensor mechanism reconstructions.
- Early, aggressive nonoperative management combined with accurate diagnosis and consideration of MPFL function is key to optimizing outcomes for athletes with patellar instability.