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

Eoghan T Hurley1,2, Andrew J Hughes1, Ian Savage-Elliott1

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

The Bone & Joint Journal
|December 1, 2023
PubMed
Summary
This summary is machine-generated.

Consensus was reached on assessing physeal status in pediatric patellar instability and on early mobilization after nonoperative management. However, key areas like immobilization and medial patellofemoral complex (MPFC) repair indications remain debated among experts.

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Area of Science:

  • Orthopedics
  • Sports Medicine
  • Knee Surgery

Background:

  • Patellar instability is a common condition requiring effective management strategies.
  • The medial patellofemoral complex (MPFC) plays a crucial role in patellar stability.
  • Establishing expert consensus is vital for optimizing treatment protocols.

Purpose of the Study:

  • To develop consensus statements on the diagnosis and nonoperative management of patellar instability.
  • To define indications for medial patellofemoral complex (MPFC) repair.
  • To utilize the modified Delphi approach for expert agreement.

Main Methods:

  • 60 surgeons from 11 countries participated.
  • Surgeons were divided into seven working groups focusing on subtopics of patellar instability.
  • Consensus was defined by agreement levels: 80-89% (consensus), 90-99% (strong consensus), 100% (unanimous).

Main Results:

  • Out of 27 statements, 17 achieved consensus (3 unanimous, 14 strong consensus).
  • Unanimous agreement was found on assessing physeal status in pediatric patients and on early mobilization/resistance training post-nonoperative management.
  • Five statements, including knee immobilization and MPFC repair indications, did not reach consensus.

Conclusions:

  • Expert consensus was achieved on critical aspects of pediatric patellar instability assessment and post-nonoperative management rehabilitation.
  • Significant disagreement persists regarding the role of immobilization, orthobiologics, and specific surgical indications for MPFC repair.
  • Further research is needed to address the areas lacking expert consensus in patellar instability management.