Materiały źródłowe

• #1 Patellar Dislocation: Workup and Decision-Making

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10631568/

  Acute primary PD is usually treated conservatively, while surgical treatment is reserved for recurrent PD. […] The aim of treatment is to restore the stability and function of the PFJ and to reduce the risk of patellar redislocation. […] Anatomic procedures, especially MPFL reconstruction, are more effective in preventing recurrent PD, compared with non-anatomic techniques. […] Unfortunately, restoration of the patient’s previous activity level or participation in more strenuous sports is questionable and not easy to predict. […] In the case of competitive athletes, PD may prevent participation in elite levels of sports. […] PD is still a riddle, in relation to its etiology, the risk of recurrence, and the selection of the appropriate treatment to obtain optimal long-term results for the patient, especially the athlete.

• #2 Patella Dislocation – How Long is Recovery Time? | Jeremy Burnham, MD

  https://www.jeremyburnhammd.com/patella-dislocation-dislocated-kneecap/

  A dislocated kneecap is a relatively common injury, particularly among young athletes. […] Recovery from patella dislocation typically takes several weeks. Depending on the severity of the injury, return to sports is usually assessed at 6-8 weeks. […] Surgical treatment is typically only necessary in severe cases where there is significant damage to the ligaments or tendons around the knee or there are recurrent dislocations. […] In general, 6 criteria are used to determine if athletes are ready to return to sport after a patellar dislocation. […] However, there is considerable variability depending on the severity of the injury and the type of surgical treatment performed. […] A patella dislocation is a serious injury. […] Patella dislocations can be very painful and may cause the knee to swell up.

• #3 Patellar Dislocation: Workup and Decision-Making

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10631568/

  Evaluation and treatment of acute (primary, first, traumatic) PD is crucial to prevent recurrent dislocation and to allow the patient to resume previous daily and athletic activities. […] Untreated PFJ instability may avert the patient from athletic participation and lower the patient’s self-confidence. […] Furthermore, persisting patellar instability results in chronic abnormal PFJ loads and, besides pain and discomfort, leads to PFJ arthritis and the need for reconstruction surgery. […] In the presence of PFJ instability factors, acute MPFL reconstruction may be the treatment of choice for acute primary PD as well. […] Surgical treatment is usually advised for recurrent PD. […] On the other hand, the reported risk of redislocation after conservative treatment is extremely high, affecting almost 30-50% of first-time dislocators.

• #4 Conservative management following patellar dislocation: a level I systematic review | Journal of Orthopaedic Surgery and Research | Full Text

  https://josr-online.biomedcentral.com/articles/10.1186/s13018-023-03867-6

  An unstructured lower limb physical therapy programme evidences similar outcomes to specific exercises. Surgical management is associated with a lower rate of re-dislocation; however, whether surgery produces greater functional outcomes than conservative management is still unclear. […] The efficacy of conservative management in adults with patellofemoral instability is still controversial. About one-third of patients treated conservatively have activity limitations 6 months to 3 years following the patellar dislocation, even in the absence of re-dislocation. Surgical treatment is associated with a low rate of recidivism and good outcomes and levels of sport participation. However, whether surgery is associated with better outcomes than conservative management remains unclear. […] According to the main findings of the present systematic review of level I evidence, surgical management is associated with a lower rate of re-dislocation; however, whether surgery promotes greater functional outcomes than conservative management is still unclear.

• #5 Conservative management following patellar dislocation: a level I systematic review | Journal of Orthopaedic Surgery and Research | Full Text

  https://josr-online.biomedcentral.com/articles/10.1186/s13018-023-03867-6

  Conservative treatment resulted in higher rates of recurrence of patellar dislocation compared to surgery. When comparing conservative treatments, the exercises were not well described, but exercises for the entire lower limb have effects similar to those concentrating on specific muscles, and the use of braces with controlled motion in the post-injury period is better than immobilization.

• #6 Patellar Dislocation: Workup and Decision-Making

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10631568/

  The presence of patella alta, TD, and age younger than 25 years was associated with a 70.4% risk of recurrence within five years after the primary dislocation, while the presence of TD and age 25 years has a 60.2% risk of recurrence. […] All studies show the synergistic effect of multiple risk factors on the risk of redislocation. […] Thus, in patients with multiple risk factors for patellar instability, early surgical treatment of the primary PD may be advisable. […] Current literature supports that the incidence of redislocation after MPFL reconstruction is lower, compared with rehabilitation; however, there is a relatively high incidence of complications such as continued apprehension and/or subluxation without dislocation. […] The decision between conservative or surgical treatment of primary PD is individualized, taking into account the presence of patellar instability predisposing factors.

• #7 A Review of Knee Dislocations

  https://pmc.ncbi.nlm.nih.gov/articles/PMC535529/

  The prognosis for patients who have sustained knee dislocations depends on the velocity of the injury, the amount of neurovascular damage, the treatment method, and the dedication to the rehabilitation program. […] The velocity of the dislocation plays a crucial role in the prognosis. Because high-velocity knee dislocations are associated with more extensive damage, it is unlikely that athletes who suffer these injuries will return to their original level of competition. […] In contrast, low-velocity knee dislocations have a relatively good prognosis. Shelbourne et al reported that 77% of patients who sustained low-velocity knee dislocations returned to some type of sport, and 19% returned to their previous level of competition. […] If arterial damage is repaired in a timely manner, the prognosis is generally good.

• #8 Knee Dislocation: Practice Essentials, Prognosis

  https://emedicine.medscape.com/article/823589-overview

  When treated expeditiously and appropriately, 60-70% of patients will have a painless, stable knee. Of the remaining patients, one half will eventually have reasonable function, whereas the other half will have a chronically unstable and painful knee. […] A systematic review has demonstrated that some level of sport participation is possible after multiligament knee injuries (MLKIs) for more than half of patients, but returning to preinjury levels of sport after surgical treatment is low, at just 22% to 33%. […] A study of 88 traumatic knee dislocations found those who were injured at a higher velocity were more likely to have additional injuries. Dislocations that occurred at a lower velocity were shown to have better overall outcomes, as did dislocations that occurred in isolation.

• #9 A Review of Knee Dislocations

  https://pmc.ncbi.nlm.nih.gov/articles/PMC535529/

  However, if the peroneal nerve is injured, the likelihood of a return to full activity is poor. […] The choice of treatment method has an immense effect on the prognosis. […] Although conservative treatment can yield good results, these results are generally unacceptable for athletes or high-demand patients wishing to return to full activity. […] Very good to excellent functional recovery is unlikely unless surgical repair is performed. […] Knee dislocations are uncommon injuries with very serious complications. […] It is vital that certified athletic trainers recognize the signs of a spontaneously reduced dislocation, immediately assess the neurovascular integrity of the limb, and carefully splint the limb for transport. […] Once the ligaments are repaired, the certified athletic trainer can play a significant role in the patient’s recovery. […] A comprehensive rehabilitation program tailored to the patient must be implemented as soon as possible. […] If neurovascular damage is limited and the rehabilitation program is followed, the prognosis for a return to full activity is generally good.

• #10 Patella Dislocation – How Long is Recovery Time? | Jeremy Burnham, MD

  https://www.jeremyburnhammd.com/patella-dislocation-dislocated-kneecap/

  In some cases, patella dislocations can damage the surrounding ligaments, nerves, or blood vessels. […] A patella dislocation, also known as a dislocated kneecap, is a very painful injury. […] After the knee cap goes back in place (either on its own or with the help of a healthcare provider), the ability to walk is variable. […] In some cases, the pain is minimal, and the knee stability is adequate to allow walking. […] A patella dislocation is a condition in which the patella (kneecap) becomes dislodged from its normal position. […] Symptoms of a patella dislocation include knee pain, swelling, and deformity. […] The pain or instability may be so severe that you can’t walk on it.

• #11 ScholarWorks

  https://scholarworks.boisestate.edu/td/1966/

  Lateral dislocation of the patella is a common injury in active adolescents and young adults. […] The aim of this study is to computationally evaluate patients that have undergone multiple surgeries to correct for recurrent lateral patellar dislocation and predict their clinical outcome. […] The overall aim of this study is to provide surgeons with a useful and validated computational tool that can predict the likelihood of patellar dislocation and differentiate, prior to clinical intervention, between a successful versus unsuccessful surgery, to determine the optimal treatment pathways for individual patients. Preliminary results are promising, but an improvement of the model and a larger clinical dataset are necessary to improve accuracy and comprehensively validate model performance.

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