April 08, 2020
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Disagreement on treatment of patellofemoral instability remains among surgeons

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Despite an awareness for highly demanding surgical possibilities for patellofemoral instability among surgeons, published results showed disagreement among surgeons when selecting individual operative treatment, especially in cases of increased complexity.

Researchers sent an online survey consisting of 32 questions and three fictitious cases on patellofemoral instability to members of the Society for Arthroscopy and Joint Surgery. Researchers categorized the 541 experienced knee surgeons who responded to the survey into groups based on whether they were high- or low-volume surgeons. Researchers included surgeons treating more than 25% of their patients for patellofemoral instability or performing more than 50 patellofemoral instability cases per year in the high-volume group, while the low-volume group consisted of surgeons treating less than 25% of their patients for patellofemoral instability or performing fewer than 50 cases of patellofemoral instability per year.

Results showed 64% to 81% of surgeons preferred medial patellofemoral ligament reconstruction as surgical intervention in patients with recurrent patellar instability. Although 79% of respondents believed trochleoplasty can play a role in the treatment of recurrent patellar dislocations, researchers found 60% of high-volume surgeons ever performed a trochleoplasty vs. 21.8% of low-volume surgeons. Overall, 25% of respondents would not perform any surgical treatment on adolescents with patellar instability and on open growth plate. In addition, 95% of respondents would not treat patellofemoral instability with an isolated lateral release, according to results.

Researchers found 60% of high-volume surgeons ever performed a trochleoplasty for treatment of patellofemoral instability vs. 21.8% of low volume surgeons.
Researchers found 60% of high-volume surgeons ever performed a trochleoplasty for treatment of patellofemoral instability vs. 21.8% of low volume surgeons.

“This work may improve our understanding of the complexity of patellofemoral instability and thus sharpen the focus of physicians on all pathological details with significant influence on the patellofemoral joint,” the authors wrote. “It should help to identify complex patellofemoral instability cases in the day by day clinical work which should be transferred to a certified center with highly experienced surgeons. This will improve the overall outcome of complex cases and avoid revision cases due to pain or recurrent instabilities.” – by Casey Tingle

 

Disclosures: Geierlehner reports no relevant financial disclosures. Please see the study for all other authors relevant financial disclosures.