1. Risk of Redislocation After Primary Patellar Dislocation: A Clinical Prediction Model Based on Magnetic Resonance Imaging Variables
- Author
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Elizabeth A. Arendt, Marc Tompkins, Julie Agel, and Marie Askenberger
- Subjects
Adult ,Joint Instability ,Male ,medicine.medical_specialty ,Adolescent ,Patellar Dislocation ,Patellar Dislocations ,Physical Therapy, Sports Therapy and Rehabilitation ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Recurrence ,Risk Factors ,Odds Ratio ,medicine ,Humans ,Orthopedics and Sports Medicine ,Prospective Studies ,Retrospective Studies ,030222 orthopedics ,Models, Statistical ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,Patella ,030229 sport sciences ,Magnetic Resonance Imaging ,Case-Control Studies ,Female ,Radiology ,Dislocation ,business ,Follow-Up Studies - Abstract
Background: First-time lateral patellar dislocations have historically been treated with a nonoperative approach; a clinical tool to predict patients who are most likely to redislocate may have clinical utility. Purpose: (1) To determine if there are discriminating factors present between patients who redislocated their patellas and those who did not after a first-time lateral patellar dislocation and (2) to use this information to develop a model that can predict the recurrence risk of lateral patellar dislocation in this population. Study Design: Case-control study; Level of evidence, 3. Methods: The study population included those with first-time lateral patellar dislocation, magnetic resonance imaging within 6 weeks, and 2-year minimum follow-up. Cohort A was from a prospective study with 2-year follow-up. Cohort B was a prospectively identified cohort with retrospective chart review. Follow-up was obtained clinically or via mail for patients without 2-year clinical follow-up. Results: Sixty-one patients (42%) out of 145 with primary lateral patellar dislocation had recurrent dislocation within 2 years. Stepwise logistic regression analysis demonstrated that skeletal immaturity (odds ratio, 4.05; 95% CI, 1.86-8.82; P = .0004), sulcus angle (odds ratio, 4.87; 95% CI, 2.01-11.80; P = .0005), and Insall-Salvati ratio (odds ratio, 3.0; 95% CI, 1.34-6.70; P = .0074) were significant predictors of redislocation. Receiver operator characteristic curves defined the cut points to be sulcus angle ≥154° and Insall-Salvati ratio ≥1.3. The probability of redislocation based on the presence of factors was 5.8% with no factors present and 22.7% with any 1 factor present, increasing to 78.5% if all 3 factors were present. Conclusion: This model demonstrates a high risk of lateral patellar redislocation when a patient presents with skeletal immaturity as well as magnetic resonance measurements of sulcus angle ≥154° and patellar height as measured by Insall-Salvati ratio ≥1.3. A patient will have a low risk of lateral patellar redislocation with the inverse findings.
- Published
- 2018