Systematic Review
Elmslie-Trillat, Maquet, Fulkerson, Roux Goldthwait, and Other Distal Realignment Procedures for the Management of Patellar Dislocation: Systematic Review and Quantitative Synthesis of the Literature

https://doi.org/10.1016/j.arthro.2015.10.019Get rights and content

Purpose

To evaluate clinical outcomes, rate of recurrence, and complications following distal realignment procedures (Elmslie-Trillat, Maquet, Fulkerson, Roux Goldthwait, and other distal realignment procedures) performed alone or in combination with proximal procedures for the management of patellar dislocation.

Methods

A systematic literature review was performed following the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). A search in 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,” “tibial transfer,” “Elmslie-Trillat,” “Roux Goldthwait,” “tibial tubercle osteotomy,” “Fulkerson,” “Maquet,” “procedure,” “clinical,” and “outcome.”

Results

Thirty-eight articles were included in the systematic review. A total of 1,182 knees belonging to 1,023 patients were grouped according to the duration of the follow-up period. The overall rate of recurrence was 7% (83 of 1,182 knees). Approximately 5.3% (28 of 520 knees) of the redislocation occurred in the short-medium term, and 8.3% (55 of 662 knees) occurred in the long-term.

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.

Level of Evidence

Level IV, systematic review of Level III and IV studies.

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.

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    The authors report that they have no conflicts of interest in the authorship and publication of this article.

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