Management of first-time patellar dislocation: The ESSKA 2024 formal consensus-Part 2.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: Peter Balcarek reports consulting for Arthrex. Philippe Beaufils serves as the ESSKA Consensus Projects Advisor. Florian Dirisamer reports consulting for Arthrex and receives royalties from Arthrex Inc. Rene El Attal reports consulting for Arthrex, DepuySynthes and ZimmerBiomet. Geert Pagenstert reports consulting for DepuySynthes and Stryker. Joan Minguell reports consulting for Arthrex and Smith&Nephew. Petri Sillanpaa reports consulting for Inion LTD. Ramazan Akmeşe reports consulting for Smith&Nephew, and Jacek Walawski reports consulting for Arthrex, Moximed and Smith&Nephew. The remaining authors declare no conflicts of interest. 6. J Biomech Eng. 2023 Apr 1;145(4):041003. doi: 10.1115/1.4055886. Anatomical Characteristics Contributing to Patellar Dislocations Following MPFL Reconstruction: A Dynamic Simulation Study. Watts JC(1), Farrow LD(2), Elias JJ(3). Author information: (1)Department of Orthopedic Surgery, Cleveland Clinic Akron General, 1 Akron General Avenue, Akron, OH 44307. (2)Orthopaedic & Rheumatologic Institute, Cleveland Clinic Sports Health Center, 5555 Transportation Boulevard, Garfield Heights, OH 44125. (3)Department of Health Sciences, Cleveland Clinic Akron General, 1 Akron General Avenue Akron, OH 44307. Pathologic anatomy is a primary factor contributing to redislocation of the patella following reconstruction of the medial patellofemoral ligament (MPFL). A pivot landing was simulated following MPFL reconstruction, with the hypothesis that position of the tibial tuberosity, depth of the trochlear groove, and height of the patella are correlated with lateral patellar maltracking. Thirteen dynamic simulation models represented subjects being treated for recurrent patellar instability. Simplified Hertzian contact governed patellofemoral and tibiofemoral joint reaction forces. Pivot landing was represented with and without an MPFL graft in place. Measurements related to patellar height (Caton-Deschamps index), trochlear groove depth (lateral trochlear inclination), and position of the tibial tuberosity (lateral tibial tuberosity to posterior cruciate attachment distance, or lateral TT-PCL distance) were measured from the models and correlated with patellar lateral shift with the knee extended (5 deg of flexion) and flexed (40 deg). The patella dislocated for all models without an MPFL graft and for two models with a graft represented. With an MPFL graft represented, patellar lateral shift was correlated with Caton-Deschamps index (r2 > 0.35, p