Improving surgical treatment of patients with patellar instability

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Abstract

BACKGROUND: The high frequency and recurrence of chronic patellar instability and the lack of unified treatment techniques indicate the need for a comprehensive individualized approach in the diagnosis and surgical treatment of patellar instability.

AIM: To develop an algorithm and compare the anatomical and functional results of its use with those of traditional surgical treatment of patients with patellar instability.

MATERIALS AND METHODS: The functional results of the treatment of 194 patients with patellar instability were compared. Two groups of patients were formed. The surgical treatment techniques of the main group (n = 93) were based on the results of the preoperative examination, considering risk factors of instability development, established as a result of retrospective analysis of the control group (n = 101). The effectiveness of the algorithm was compared with the techniques of patellar stabilization used from 2010 to 2015. The Kujala, IKDC 2000, and Lysholm scales were used to assess the functional results of treatment.

RESULTS: Surgical treatment of instability aims to eliminate risk factors such as anomalies of the extensor apparatus of the knee joint and to repair or reconstruct damaged structures. Plasty of the medial patellofemoral ligament is the method of choice for patellar stabilization. In the case of dysplastic changes in the patellofemoral joint, combinations of proximal and distal knee joint surgeries were performed. Rotational lower-limb deformities were treated by corrective derotational osteotomy of the femur. Trochleoplasty was performed in cases of type B or D femoral block dysplasia. Patients with stiff lateral patellar retention underwent lateral release or extension tenotomy. In both groups, the functional status of the patients significantly (p < 0.05) improved 12 months postoperatively. The mean values of the functional scales increased because of the increased number of patients with excellent and good scores in the group. Higher values were recorded in the main group (Kujala, p = 0.038; IKDC 2000, p = 0.021; Lysholm, p = 0.032). Patellar dislocation recurred in 2 (1.9%) patients in the control group (p = 0.172).

CONCLUSIONS: The proposed algorithm helped verify the degree, type, and etiology of patellar instability and helped obtain better anatomofunctional treatment results in patients.

About the authors

Vladimir V. Khominets

Kirov Military Medical Academy

Email: khominets_62@mail.ru
ORCID iD: 0000-0001-9391-3316
SPIN-code: 5174-4433

MD, PhD, Dr. Sci. (Med.), Professor

Russian Federation, 6G Akademika Lebedeva str., Saint Petersburg, 194044

Dmitry A. Konokotin

Kirov Military Medical Academy

Email: konokotin.dmitry@yandex.ru
ORCID iD: 0000-0003-3100-0321
SPIN-code: 1625-0543

MD, captain of the medical service

Russian Federation, 6G Akademika Lebedeva str., Saint Petersburg, 194044

Alexey O. Fedotov

Kirov Military Medical Academy

Email: alexfedot83@gmail.com
ORCID iD: 0000-0002-9953-9385
SPIN-code: 3639-4352

MD, PhD, Cand. Sci. (Med.)

Russian Federation, 6G Akademika Lebedeva str., Saint Petersburg, 194044

Aleksey S. Grankin

Kirov Military Medical Academy

Email: aleksey-grankin@yandex.ru
ORCID iD: 0000-0002-4565-9066
SPIN-code: 1122-8388

MD, PhD, Cand. Sci. (Med.)

Russian Federation, 6G Akademika Lebedeva str., Saint Petersburg, 194044

Alexandr S. Vorobyev

Kirov Military Medical Academy

Author for correspondence.
Email: aleks.vorobev2000@mail.ru
ORCID iD: 0009-0006-8878-0145

cadet

Russian Federation, 6G Akademika Lebedeva str., Saint Petersburg, 194044

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Supplementary files

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1. JATS XML
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2. Fig. 1. Algorithm for choosing the approach for surgical treatment of patients with patellar instability. CT, computed tomography; MPFL, medial patellofemoral ligament; MRI, magnetic resonance imaging; RPI, risk of patellar instability

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3. Fig. 2. Kujala scale score 24 months after surgical treatment (p < 0.05)

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4. Fig. 3. IKDC scale score 24 months after surgical treatment (p < 0.05)

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5. Fig. 4. Lysholm scale score 24 months after surgical treatment (p < 0.05)

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