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A modified Delphi consensus statement on patellar instability: part II.

Eoghan T Hurley1,2, Seth L Sherman3, Jorge Chahla4

  • 1Department of Orthopedic Surgery, New York University Langone Health, New York, USA.

The Bone & Joint Journal
|November 30, 2023
PubMed
Summary
This summary is machine-generated.

This study on patellar instability management found no unanimous agreement among 60 surgeons on procedures like medial patellofemoral ligament (MPFL) reconstruction or trochleoplasty. While strong consensus was reached on some aspects, key surgical and rehabilitation questions remain debated.

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Area of Science:

  • Orthopedic Surgery
  • Sports Medicine
  • Patellofemoral Instability Management

Background:

  • Patellar instability is a complex orthopedic condition requiring multifaceted management strategies.
  • Previous research (Part I) addressed aspects of patellar instability management.
  • This study focuses on establishing consensus for advanced surgical techniques and rehabilitation.

Purpose of the Study:

  • To establish consensus statements on key treatments for patellar instability.
  • To achieve expert agreement on medial patellofemoral ligament (MPFL) reconstruction, anteromedialization tibial tubercle osteotomy, and trochleoplasty.
  • To define consensus on rehabilitation protocols and return-to-sport criteria.

Main Methods:

  • Utilized a modified Delphi process involving 60 orthopedic surgeons from 11 countries.
  • Surgeons were divided into seven working groups based on subtopics.
  • Consensus levels were defined: consensus (80-89%), strong consensus (90-99%), and unanimous (100%).

Main Results:

  • Out of 41 statements, none achieved unanimous consensus.
  • 19 statements reached strong consensus, and 15 achieved consensus.
  • Seven statements did not reach the defined consensus threshold.

Conclusions:

  • While significant agreement was reached on many aspects of patellar instability management, unanimous consensus was not achieved.
  • Key areas lacking consensus include MPFL reconstruction specifics (anchors, fixation order), trochleoplasty indications/outcomes, and postoperative/rehabilitation protocols.
  • Further research and discussion are needed to address the identified areas of disagreement in managing patellar instability.