Arthroscopy: The Journal of Arthroscopic & Related Surgery
Systematic ReviewElmslie-Trillat, Maquet, Fulkerson, Roux Goldthwait, and Other Distal Realignment Procedures for the Management of Patellar Dislocation: Systematic Review and Quantitative Synthesis of the Literature
Section snippets
Methods
We performed a systematic review of the literature according to the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) with a PRISMA checklist and algorithm.9 The search algorithm according to the PRISMA guidelines is shown in Figure 1. A comprehensive search of PubMed, Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane, Embase, and Google Scholar databases using various combinations of the keywords “patellar,” “dislocation,”
Results
The literature search and cross-referencing resulted in a total of 6,684 references, of which 6,529 were rejected because of failure to fulfill the inclusion criteria (Fig 1). After reading the remaining full-text articles, other 117 articles were excluded because of insufficient details and uncertain diagnosis and outcome measures.
Finally, 38 articles were included, describing patients with patellar instability, dislocation, and maltracking. Results from the included studies were divided into
Discussion
The most important findings of this review are that distal realignment procedures performed alone or in combination with proximal procedures provide good clinical results both in the short-medium and in the long-term follow-up. Moreover, the rate of postoperative complication and recurrence, considered as dislocation or subluxation after surgical treatment, are very low.
Distal realignment procedures are commonly used to manage patellofemoral instability, lateral patellar overload, tilt,
Conclusions
Distal realignment procedures performed alone or in combination with proximal procedures for the management of patellar dislocation have shown good clinical outcomes and a low rate of recurrence highlighting the efficacy of these procedures. To date no randomized controlled clinical trials are available on the topic.
References (59)
- et al.
Distal realignment: Indications, technique, and results
Clin Sports Med
(2014) - et al.
Elmslie-Trillat procedure for the treatment of recurrent patellar instability
Arthroscopy
(2008) - et al.
Triple positioning of tibial tubercle osteotomy for patellofemoral disorders
Knee
(2014) - et al.
Treatment outcome of extensor realignment for patellofemoral dysfunction
Knee
(2005) - et al.
Functional outcome following modified Elmslie-Trillat procedure
Knee
(2006) - et al.
Tibial tubercle transfer on a medial periosteal pedicle—a report of a new technique
Knee
(2006) - et al.
Functional evaluation of the modified Elmslie-Trillat procedure for patello-femoral dysfunction
Knee
(2001) - et al.
Fulkerson procedure for chronic patella component dislocation after total knee arthroplasty
J Arthroplasty
(2009) - et al.
Proximal tibial derotation osteotomy for torsional tibial deformities generating patello-femoral disorders
Orthop Traumatol Surg Res
(2010) - et al.
A treatment algorithm for primary patellar dislocations
Sports Health
(2011)
The patellofemoral joint and its historical roots: The Lyon School of Knee Surgery
Knee Surg Sports Traumatol Arthrosc
Modern management of patellar instability
Int Orthop
Functional treatment of patellar dislocation in an athletic population
Am J Sports Med
Epidemiology and natural history of acute patellar dislocation
Am J Sports Med
A modified tibial tubercle osteotomy for patellar maltracking: Results at two years
J Bone Joint Surg Br
Patella instability: Building bridges across the ocean a historic review
Knee Surg Sports Traumatol Arthrosc
The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: Explanation and elaboration
BMJ
The revised CONSORT statement for reporting randomized trials: Explanation and elaboration
Ann Intern Med
Combined proximal and distal realignment procedures to treat the habitual dislocation of the patella in adults
Am J Sports Med
Ligament reconstruction versus distal realignment for patellar dislocation
Clin Orthop Relat Res
Long-term outcome of surgically-treated habitual patellar dislocation in children with coexistent patella alta. Minimum follow-up of 11 years
J Bone Joint Surg Br
Deterioration of long-term clinical results after the Elmslie-Trillat procedure for dislocation of the patella
J Bone Joint Surg Br
Surgical treatment of patellar dislocation in children with Down syndrome: A 3- to 11-year follow-up study
Knee Surg Sports Traumatol Arthrosc
Long-term evaluation of the Roux-Elmslie-Trillat procedure for patellar instability: A 26-year follow-up
Am J Sports Med
Modified Elmslie-Trillat procedure for instability of the patella
Knee Surg Sports Traumatol Arthrosc
Treatment of chronic patellar dislocation with a modified Elmslie-Trillat procedure
Arch Orthop Trauma Surg
A 10 year follow-up study after Roux-Elmslie-Trillat treatment for cases of patellar instability
BMC Musculoskelet Disord
Treatment of recurrent patellar instability with a modification of the Roux-Goldthwait technique
J Pediatr Orthop
Clinical and electromyographic results of proximal and distal realignment procedures in young patients with recurrent patellar dislocations
Am J Sports Med
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The authors report that they have no conflicts of interest in the authorship and publication of this article.