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Incidence of second-time lateral patellar dislocation is associated with anatomic factors, age and injury patterns of medial patellofemoral ligament in first-time lateral patellar dislocation: a prospective magnetic resonance imaging study with 5-year follow-up

  • Knee
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To examine the predictors of the second-time lateral patellar dislocation (LPD) in patients after acute first-time LPD in a 5-year follow-up.

Methods

Data were collected prospectively from patients after acute first-time LPD with conservative treatment. Factors included sex, age at the first-time LPD, anatomical variants [trochlear dysplasia, patellar height, tibial tuberosity–trochlear groove (TT–TG) distance], and injury patterns of medial patellofemoral ligament (MPFL) in acute first-time LPD. Logistic regression was carried out to identify the independent risk factors for the incidence of the second-time LPD.

Results

The incidence rate of a second-time LPD was 35.5% (59 of 166) in the 5-year follow-up. Univariate analysis revealed significant differences in the incidence rate of the second-time LPD among age at the first-time LPD (P = 0.04), trochlear dysplasia (P = 0.003), patella height (P = 0.017) and the TT–TG distance (P = 0.027). Risk factors for the second-time LPD were age < 18 years at the first-time LPD [odds ratio (OR) 4.088], low-grade trochlear dysplasia (OR 7.214), high-grade trochlear dysplasia (OR 18.945), patella alta (OR 8.416), elevated TT–TG distance (OR 12.742), complete MPFL tear at its isolated femoral-side (OR 6.04) and complete combined MPFL tear (OR 5.851).

Conclusions

Trochlear dysplasia, elevated TT–TG distance, patella alta, age < 18 years at the first-time LPD, complete MPFL tear at its isolated femoral-side and complete combined MPFL tear in the first-time LPD are independently associated with a higher incidence rate of the second-time LPD.

Level of evidence

III.

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Authors and Affiliations

  1. Department of Ultrasonography, Shandong Provincial Qianfoshan Hospital of Shandong University, 16766 Jingshi Rd, Li-Xia District, Jinan, 250014, China

    Guang-ying Zhang, Hong-yu Ding, Feng-jing Fan & Dan Guo

  2. Department of Ultrasonography, Jinan Third People’s Hospital, Jinan, 250132, China

    En-miao Li

  3. Department of Radiology, Shandong Provincial Corps Hospital of Chinese People’s Armed Police Force, Jinan, 250014, China

    Lei Zheng

  4. Department of Orthopaedics, Shandong Provincial Qianfoshan Hospital of Shandong University, Jinan, 250014, China

    Zheng-wu Bai

  5. Department of Radiology, Shandong Provincial Qianfoshan Hospital of Shandong University, Jinan, 250014, China

    Hao Shi

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  1. Guang-ying Zhang
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The study was authorized by the local ethics committee and was performed in accordance with the Ethical standards of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Zhang, Gy., Ding, Hy., Li, Em. et al. Incidence of second-time lateral patellar dislocation is associated with anatomic factors, age and injury patterns of medial patellofemoral ligament in first-time lateral patellar dislocation: a prospective magnetic resonance imaging study with 5-year follow-up. Knee Surg Sports Traumatol Arthrosc 27, 197–205 (2019). https://doi.org/10.1007/s00167-018-5062-8

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