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Predictors of recurrent instability after acute patellofemoral dislocation in pediatric and adolescent patients.
[trochlear dysplasia]
Patellofemoral
instability
is
common
in
the
pediatric
and
adolescent
population
,
yet
prognosis
after
the
first
dislocation
has
been
difficult
to
determine
.
To
describe
the
demographics
of
pediatric
and
adolescent
patients
with
a
first
-time
patellofemoral
dislocation
and
to
determine
predictors
of
recurrent
instability
.
Case-control
study
;
Level
of
evidence
,
3
.
A
search
of
the
Mayo
Medical
Index
database
between
1998
to
2010
was
performed
,
and
2039
patients
were
identified
.
Inclusion
criteria
were
(
1
)
age
18
years
or
younger
,
(
2
)
no
history
of
patellofemoral
subluxation
/
dislocation
of
the
affected
knee
,
(
3
)
radiographs
within
4
weeks
of
the
initial
instability
episode
,
and
(
4
)
a
dislocated
patella
requiring
reduction
or
convincing
history
/
findings
suggestive
of
acute
patellar
dislocation
(
effusion
/
hemarthrosis
,
tenderness
along
medial
parapatellar
structures
,
and
apprehension
with
lateral
patellar
translation
)
.
Radiographs
were
evaluated
for
trochlear
dysplasia
(
Dejour
classification
)
and
patella
alta
(
Caton
-
Deschamps
and
Insall-
Salvati
indices
)
.
Skeletal
maturity
was
graded
based
on
the
distal
femoral
and
proximal
tibial
physes
(
open
,
closing
,
or
closed
)
.
A
total
of
222
knees
(
120
male
[
54
.
1
%
]
and
102
female
[
45
.
9
%
]
)
in
210
patients
with
an
average
age
of
14
.
9
years
(
range
,
9
-
18
years
)
,
met
the
inclusion
criteria
.
Twenty
-
four
patients
(
10
.
8
%
)
underwent
early
surgery
.
All
others
were
initially
treated
nonoperatively
.
Of
the
198
patients
in
this
group
,
76
(
38
.
4
%
)
had
recurrent
instability
,
and
39
(
51
.
3
%
)
of
these
required
surgical
treatment
.
Recurrent
instability
was
associated
with
trochlear
dysplasia
(
P
<
.
01
)
.
Patients
with
both
immature
physes
and
trochlear
dysplasia
had
a
recurrence
rate
of
69
%
(
33
/
48
)
,
with
a
hazard
ratio
of
3
.
3
.
Age
,
sex
,
body
mass
index
,
and
patella
alta
were
not
statistically
associated
with
recurrent
instability
.
Nonoperative
treatment
for
first
-time
patellofemoral
dislocation
resulted
in
a
62
%
success
rate
.
However
,
skeletally
immature
patients
with
trochlear
dysplasia
had
only
a
31
%
success
rate
with
nonoperative
management
.
Nearly
half
of
patients
with
recurrent
instability
required
surgical
intervention
to
gain
stability
.
Diseases
Validation
Diseases presenting
"subluxation/dislocation"
symptom
trochlear dysplasia
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