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Patellar Instability Management: A Survey of the International Patellofemoral Study Group.
Liu, Joseph N; Steinhaus, Michael E; Kalbian, Irene L; Post, William R; Green, Daniel W; Strickland, Sabrina M; Shubin Stein, Beth E.
Affiliation
  • Liu JN; Section of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
  • Steinhaus ME; Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA.
  • Kalbian IL; Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA.
  • Post WR; Mountaineer Orthopedic Specialists LLC, Morgantown, West Virginia, USA.
  • Green DW; Pediatric Orthopaedic Surgery Service, Hospital for Special Surgery, New York, New York, USA.
  • Strickland SM; Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA.
  • Shubin Stein BE; Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA.
Am J Sports Med ; 46(13): 3299-3306, 2018 11.
Article in En | MEDLINE | ID: mdl-28985094
BACKGROUND: Although patellofemoral instability is among the most prevalent knee disorders, the management of patients with this condition is complex and remains variable, given the lack of long-term, high-level clinical outcome studies to compare various operative and nonoperative modalities. PURPOSE: To discover a consensus within treatment controversies in patellofemoral instability among experienced knee surgeons with a specific interest in the patellofemoral joint. STUDY DESIGN: Expert opinion; Level of evidence, 5. METHODS: A 3-step modified Delphi technique was used to establish a consensus. A 34-question, case-based online survey regarding patellofemoral instability was distributed to all active members of the International Patellofemoral Study Group. Consensus statements were generated if at least 66% of the respondents agreed and then redistributed to the same panel. Modifications to the consensus statements were made based on the iterative feedback process until no discordance was encountered in the third stage. RESULTS: Eight consensus statements were achieved. Nonoperative management is the current standard of care for a first-time dislocation in the absence of an osteochondral fragment or loose body requiring excision (100% agreement). In patients with a first-time dislocation with an operative osteochondral fracture requiring excision or repair, patellar instability should be addressed concurrently (89% agreement). Recurrent instability should be treated surgically, with most surgeons favoring medial reconstruction (77%-86% agreement). While there is general agreement that bony procedures should be performed to correct underlying bony deformities, there is no consensus regarding the most appropriate type of procedure performed. Lateral release should not be performed in isolation for the treatment of patellar instability (89% agreement). CONCLUSION: Despite the consensus generated in this study, our current understanding remains limited by a lack of high-level evidence as well as the numerous complex variables influencing treatment decision making. High-quality, multicenter randomized controlled trials, particularly those directly comparing specific surgical treatment methods while controlling for underlying risk factors, are needed to address these areas of uncertainty.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Patellar Dislocation / Consensus / Surgeons / Joint Instability Type of study: Clinical_trials / Guideline / Prognostic_studies / Risk_factors_studies Limits: Humans Language: En Journal: Am J Sports Med Year: 2018 Document type: Article Affiliation country: United States Country of publication: United States

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Patellar Dislocation / Consensus / Surgeons / Joint Instability Type of study: Clinical_trials / Guideline / Prognostic_studies / Risk_factors_studies Limits: Humans Language: En Journal: Am J Sports Med Year: 2018 Document type: Article Affiliation country: United States Country of publication: United States