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Patellofemoral osteoarthritis after Insall's proximal realignment for recurrent patellar dislocation.
[trochlear dysplasia]
The
aim
of
the
present
study
was
to
retrospectively
investigate
the
development
of
patellofemoral
osteoarthritis
after
the
historical
Insall
's
proximal
realignment
for
patellar
stabilisation
in
patients
with
recurrent
patellar
dislocation
.
Furthermore
,
risk
factors
for
recurrent
patellar
dislocation
and
for
patellofemoral
osteoarthritis
development
were
evaluated
.
Forty
-
two
patients
underwent
patellofemoral
stabilising
surgery
by
the
historic
Insall
's
proximal
realignment
;
they
were
evaluated
with
a
mean
follow-up
period
of
52
Â
months
.
Plain
radiography
was
used
to
document
osteoarthritic
changes
by
using
the
Iwano
classification
.
MRIs
obtained
at
the
latest
follow-up
were
evaluated
for
patellofemoral
cartilage
lesions
.
Univariate
and
multivariate
logistic
regression
analyses
were
performed
to
evaluate
the
influence
of
trochlear
dysplasia
,
tibial
tubercle-trochlear
groove
distance
and
patellar
height
on
redislocation
.
Pearson
's
χ
(
2
)
and
the
Spearman
's
correlation
tests
were
used
to
assess
a
possible
correlation
between
trochlear
dysplasia
and
patellar
dislocation
,
as
well
as
between
instability
and
development
of
patellofemoral
osteoarthritis
.
At
the
latest
follow-up
,
plain
radiographs
showed
a
significant
increase
in
patellofemoral
osteoarthritis
(
grades
II
-IV
according
to
the
Iwano
classification
)
in
18
patients
(
43
Â
%
)
compared
with
4
patients
(
10
Â
%
)
at
the
time
of
surgery
(
P
Â
=
Â
0
.
001
)
.
Patellofemoral
cartilage
lesions
(
grades
II
-IV
)
were
detected
in
18
patients
(
43
Â
%
)
on
MRI
.
Nine
patients
(
21
Â
%
)
had
at
least
one
incidence
of
redislocation
at
follow-up
.
Estimated
redislocation-associated
risk
factors
could
not
be
determined
.
Trochlear
dysplasia
had
a
significant
impact
on
patellofemoral
osteoarthritis
development
(
P
Â
=
Â
0
.
001
)
,
whereas
recurrent
patellar
instability
had
none
(
n
.
s
.
)
.
Insall
's
proximal
realignment
technique
leads
to
a
significant
progression
of
patellofemoral
osteoarthritis
.
No
risk
factors
for
redislocation
could
be
found
;
however
,
the
presence
of
trochlear
dysplasia
did
correlate
with
patellofemoral
osteoarthritis
.
IV
.
Diseases
Validation
Diseases presenting
"recurrent patellar dislocation"
symptom
trochlear dysplasia
This symptom has already been validated