Traumatic Patellar Dislocation Nonoperative Treatment Compared With MPFL Reconstruction Using Patellar Tendon

被引:165
作者
Bitar, Alexandre Carneiro [1 ]
Demange, Marco Kawamura
D'Elia, Caio Oliveira
Camanho, Gilberto Luis
机构
[1] Inst Vita, BR-01239040 Sao Paulo, Brazil
关键词
patellofemoral; dislocation; nonoperative; reconstruction; medial patellofemoral ligament; knee; MEDIAL PATELLOFEMORAL LIGAMENT; SOFT-TISSUE RESTRAINTS; 7-YEAR FOLLOW-UP; SURGICAL-TREATMENT; RANDOMIZED PATIENTS; NATURAL-HISTORY; REPAIR; CHILDREN; KNEE;
D O I
10.1177/0363546511423742
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
100224 [整形外科学];
摘要
Background: Over the long term, acute patellar dislocations can result in patellar instability, with high recurrence rates after non-operative treatment. Purpose: To compare the results of operative (reconstruction of the medial patellofemoral ligament [MPFL]) versus nonoperative treatment of primary patellar dislocation. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Thirty-nine patients (41 knees) (mean age, 24.2 years; range, 12-38 years) with acute patellar dislocation were randomized into 2 groups. One group was treated nonoperatively with immobilization and physiotherapy, the other was treated surgically with MPFL reconstruction; both groups were evaluated with minimum follow-up of 2 years. The Kujala questionnaire was applied to assess pain and quality of life, and recurrence was evaluated. Pearson chi(2) or Fisher exact test was used in the statistical evaluation. Results: The statistical analysis showed that the mean Kujala score was significantly lower in the nonoperative group (70.8), when compared with the mean value of the surgical group (88.9; P = .001). The surgical group presented a higher percentage of "good/excellent" results (71.43%) on the Kujala score when compared with the nonoperative group (25.0%; P = .003). The nonoperative group presented a large number of recurrences and subluxations (7 patients; 35% of cases), whereas there were no reports of recurrences or subluxations in the surgical group. Conclusion: Treatment with MPFL reconstruction using the patellar tendon produced better results, based on the analyses of posttreatment recurrences and the better final results of the Kujala questionnaire after a minimum follow-up period of 2 years.
引用
收藏
页码:114 / 122
页数:9
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