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Return to sport after patellar dislocation or following surgery for patellofemoral instability

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      Abstract

      Patellofemoral instability may occur in a young population as a result of injury during sporting activities. This review focuses on return to sport after one episode of dislocation treated no operatively and as well after surgery for chronic patellofemoral instability. With or without surgery, only two-thirds of patients return to sports at the same level as prior to injury. A high-quality rehabilitation programme using specific exercises is the key for a safe return to sporting activities. To achieve this goal, recovery of muscle strength and dynamic stability of the lower limbs is crucial. The focus should be directed to strengthen the quadriceps muscle and pelvic stabilizers, as well as lateral trunk muscle training. Patient education and regularly performed home exercises are other key factors that can lead to a successful return to sports. The criteria for a safe return to sports include the absence of pain, no effusion, a complete range of motion, almost symmetrical strength, and excellent dynamic stability.

      Level of evidence IV.

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      Most cited references 41

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      Biomechanical measures during landing and postural stability predict second anterior cruciate ligament injury after anterior cruciate ligament reconstruction and return to sport.

      Athletes who return to sport participation after anterior cruciate ligament reconstruction (ACLR) have a higher risk of a second anterior cruciate ligament injury (either reinjury or contralateral injury) compared with non-anterior cruciate ligament-injured athletes. Prospective measures of neuromuscular control and postural stability after ACLR will predict relative increased risk for a second anterior cruciate ligament injury. Cohort study (prognosis); Level of evidence, 2. Fifty-six athletes underwent a prospective biomechanical screening after ACLR using 3-dimensional motion analysis during a drop vertical jump maneuver and postural stability assessment before return to pivoting and cutting sports. After the initial test session, each subject was followed for 12 months for occurrence of a second anterior cruciate ligament injury. Lower extremity joint kinematics, kinetics, and postural stability were assessed and analyzed. Analysis of variance and logistic regression were used to identify predictors of a second anterior cruciate ligament injury. Thirteen athletes suffered a subsequent second anterior cruciate ligament injury. Transverse plane hip kinetics and frontal plane knee kinematics during landing, sagittal plane knee moments at landing, and deficits in postural stability predicted a second injury in this population (C statistic = 0.94) with excellent sensitivity (0.92) and specificity (0.88). Specific predictive parameters included an increase in total frontal plane (valgus) movement, greater asymmetry in internal knee extensor moment at initial contact, and a deficit in single-leg postural stability of the involved limb, as measured by the Biodex stability system. Hip rotation moment independently predicted second anterior cruciate ligament injury (C = 0.81) with high sensitivity (0.77) and specificity (0.81). Altered neuromuscular control of the hip and knee during a dynamic landing task and postural stability deficits after ACLR are predictors of a second anterior cruciate ligament injury after an athlete is released to return to sport.
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        Epidemiology and natural history of acute patellar dislocation.

        The goals of this study were to (1) define the epidemiology of acute patellar dislocation, (2) determine the risk of subsequent patellar instability episodes (subluxation and/or redislocation) during the study period, and (3) identify risk factors for subsequent instability episodes. Prospective cohort study. The authors prospectively followed 189 patients for a period of 2 to 5 years. Historical data, injury mechanisms, and physical and radiographic measurements were recorded to identify potential risk factors for poor outcomes. Risk was highest among females 10 to 17 years old. Patients presenting with a prior history of instability were more likely to be female (P < .05) and were older than first-time dislocation patients (P < .05). Fewer first-time dislocators (17%) had episodes of instability during follow-up than patients with a previous history of instability (49%) (P < .01). After adjusting for demographics, patients with a prior history had 7 times higher odds of subsequent instability episodes during follow-up than first time dislocators (adjusted odds ratio = 6.6, P < .001). Patellar dislocators who present with a history of patellofemoral instability are more likely to be female, are older, and have greater risk of subsequent patellar instability episodes than first-time patellar dislocators. Risk of recurrent patellar instability episodes in either knee is much higher in this group than in first-time dislocators. Copyright 2004 American Orthopaedic Society for Sports Medicine
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          Fate of the ACL-injured patient. A prospective outcome study.

          We followed 292 patients who had sustained an acute traumatic hemarthrosis for a mean of 64 months. The KT-1000 arthrometer measurements within 90 days of injury revealed the injured knee was stable in 56 patients and unstable in 236. Forty-five unstable patients had an ACL reconstruction within 90 days of injury. Surgical procedures performed > 90 days after injury included ligament reconstruction in 46 patients. Factors that correlated with patients who had late surgery for a meniscal tear or an ACL reconstruction (P < 0.05) were preinjury hours of sports participation, arthrometer measurements, and patient age. Follow-up data are presented for the patients divided into four groups: I, early stable, no reconstruction; II, early unstable, no reconstruction; III, early reconstruction; and IV, late reconstruction. No patient changed occupation because of the knee injury. Hours per year of sports participation and levels of sports participation decreased in all groups. Joint arthrosis was documented by radiograph and bone scan. Joint surface injury abnormalities observed at surgery and meniscal surgery showed greater abnormalities by radiograph and bone scan scores (P < 0.05). Reconstructed patients had a higher level of arthrosis by radiograph and bone scan.
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            Author and article information

            Affiliations
            [ ]Centre de medicine de l’appareil locomoteur et du sport, Unité d’Orthopédie et Traumatologie du Sport (UOTS), Swiss Olympic Medical Center, Service de chirurgie orthopédique et traumatologie de l’appareil moteur, University Hospital of Geneva (HUG) and Faculty of Medicine, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva, Switzerland
            [ ]Université Lille Nord-de-France, 59000 Lille, France
            [ ]Département universitaire de chirurgie orthopédique et de traumatologie, Hôpital Salengro, CHRU de Lille, rue Émile-Laine, 59037 Lille, France
            Contributors
            +41-22-372-79 -11 , Jacques.menetrey@hcuge.ch
            Suzanne.Gard@hcuge.ch
            Journal
            Knee Surg Sports Traumatol Arthrosc
            Knee Surg Sports Traumatol Arthrosc
            Knee Surgery, Sports Traumatology, Arthroscopy
            Springer Berlin Heidelberg (Berlin/Heidelberg )
            0942-2056
            1433-7347
            22 July 2014
            22 July 2014
            2014
            : 22
            : 10
            : 2320-2326
            25047793 4169614 3172 10.1007/s00167-014-3172-5
            © The Author(s) 2014

            Open AccessThis article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

            Categories
            Knee
            Custom metadata
            © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2014

            Surgery

            dynamic stability, patellofemoral, return to play, rehabilitation, dislocation

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