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[The treatment of patellar dislocation: a systematic review].
[trochlear dysplasia]
The
diagnosis
and
treatment
of
patellar
dislocation
is
very
complex
.
The
aim
of
this
study
is
to
give
an
overview
of
the
biomechanics
of
the
patellofemoral
joint
and
to
point
out
the
latest
developments
in
diagnosis
and
treatment
of
patellar
dislocation
.
The
authors
electronically
searched
Medline
,
Cochrane
and
Embase
for
studies
on
the
biomechanics
of
the
patellofemoral
joint
and
for
conservative
and
surgical
treatments
after
patellar
dislocation
.
We
extracted
baseline
demographics
,
biomechanical
,
conservation
and
surgical
details
.
Understanding
the
biomechanics
of
the
patellofemoral
joint
is
necessary
to
understand
the
pathology
of
patellar
dislocation
.
The
patellofemoral
joint
consists
of
a
complex
system
of
static
,
active
and
passive
stabilising
factors
.
Patellar
instability
can
result
from
osseous
and
soft
-tissue
abnormalities
,
such
as
trochlear
dysplasia
,
patella
alta
,
a
high
tibial
tuberosity
trochlear
groove
(
TTTG
)
distance
,
weaknesses
of
the
vastus
medialis
obliquus
or
a
lesion
of
the
medial
retinaculum
.
Recent
studies
have
focused
on
the
medial
patellofemoral
ligament
(
MPFL
)
and
have
shown
that
the
MPFL
is
the
most
significant
passive
stabiliser
of
the
patella
.
Following
patellar
dislocation
,
an
MRI
should
be
standard
practice
to
detect
an
MPFL
rupture
,
osteochondral
lesions
or
other
risk
factors
for
redislocation
.
An
acute
first
-time
patellar
dislocation
without
osteochondral
lesions
and
without
severe
risk
factors
for
a
redislocation
should
follow
a
conservative
treatment
plan
.
If
surgical
treatment
is
required
,
the
best
postoperative
results
occur
when
the
MPFL
is
reconstructed
,
leading
to
a
redislocation
rate
of
5
%
,
this
includes
cases
that
have
a
dysplastic
trochlea
.
Duplication
of
the
medial
retinaculum
show
very
inconsistent
results
in
the
literature
,
possibly
due
to
the
fact
that
the
essential
pathomorphology
of
patellar
dislocation
is
not
addressed
.
Addressing
the
exact
location
of
the
rupture
of
the
MPFL
with
a
suture
is
possibly
more
convenient
,
especially
after
first
-time
dislocation
with
associated
risk
factors
for
a
redislocation
.
Recent
literature
does
not
encourage
the
use
of
lateral
release
,
since
this
can
increase
patellar
instability
.
Indications
for
lateral
release
include
persistent
patellar
instability
or
pain
reduction
in
an
older
arthritic
subject
.
For
correcting
a
patellofemoral
malalignment
,
the
TTTG
distance
should
be
measured
and
a
medial
transposition
of
the
anterior
tibial
tubercle
hinged
on
a
distal
periosteal
attachment
should
be
considered
.
Cartilage
lesions
on
the
medial
facet
of
the
patella
are
a
contra-indication
for
medial
tubercle
transposition
.
For
cartilage
lesions
of
the
lateral
facet
,
antero-medialization
of
the
tibial
tubercle
can
be
successful
.
A
tubercle
osteotomy
can
be
efficiently
combined
with
MPFL
reconstruction
.
We
believe
that
patients
with
open
epiphyseal
plates
should
be
treated
with
duplication
of
the
medial
retinaculum
.
In
the
presence
of
patellar
maltracking
,
an
additional
subperiostal
soft
tissue
release
with
medialisation
of
the
distal
part
of
the
patellar
tendon
can
be
performed
.
It
seems
that
the
predominating
factors
for
patellar
dislocation
are
heterogenic
morphology
in
combination
with
individual
predisposition
.
Non-surgical
treatment
is
typically
recommended
for
primary
patellar
dislocation
without
any
osteochondral
lesions
and
in
the
absence
of
significant
risk
factors
for
redislocation
.
If
surgical
treatment
is
deemed
necessary
,
addressing
the
essential
pathomorphology
has
become
the
primary
focus
.
Diseases
Validation
Diseases presenting
"significant passive stabiliser of the patella"
symptom
trochlear dysplasia
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