Patho-morphology of patellar instability in children and adolescents: A systematic review and meta-analysis.

Autor: Abelleyra Lastoria DA; St George's University of London, London SW17 0RE, United Kingdom. Electronic address: m1800817@sgul.ac.uk., Hutchinson K; Croydon University Hospital, London CR7 7YE, United Kingdom., Tapadar T; St George's University of London, London SW17 0RE, United Kingdom., Ahmad S; St George's University of London, London SW17 0RE, United Kingdom., Smith T; University of Warwick, Coventry CV4 7HL, United Kingdom., Nicolaou N; Sheffield Children's Hospital, Sheffield S10 2TH, United Kingdom., Hing CB; St George's University Hospitals NHS Foundation Trust, London SW17 0RE, United Kingdom.
Jazyk: angličtina
Zdroj: The Knee [Knee] 2024 Jun; Vol. 48, pp. 166-196. Date of Electronic Publication: 2024 Apr 24.
DOI: 10.1016/j.knee.2024.03.009
Abstrakt: Background: Children and adolescents have the highest incidence of patellar instability among the population. We aimed to identify patho-morphological and epidemiological factors associated with patellar instability, and to identify factors predisposing to recurrence in children and adolescents.
Methods: Published and unpublished literature databases, conference proceedings and the reference lists of included studies were searched to the 14th of March 2024. Studies were eligible if they compared history characteristics, examination features and radiological parameters between patients with and without instability, or evaluated risk factors for instability recurrence. A random-effects meta-analysis was performed. Included studies were appraised using tools respective of study design.
Results: The evidence was moderate to low in quality. Forty-five studies (including 9000 patients) were eligible. Tibial tubercle - tibial groove (TT-TG) distance (weighted mean difference [WMD] 5.96 mm, 95% Confidence Interval [CI]: 4.94 to 6.99 mm), sulcus angle (WMD: 13.93˚, 95% CI: 9.1˚ to 18.8˚), and Insall-Salvati index (WMD: 0.2, 95% CI: 0.16 to 0.23) were greater in patients with patellar instability. Risk factors for recurrent dislocation included age less than 18 years (Odds ratio [OR]: 2.56, 95% CI: 1.63 to 4.0), skeletal immaturity (OR: 1.79, 95% CI: 1.21 to 2.64) and presence of trochlear dysplasia (OR: 3.37, 95% CI: 1.85 to 6.15).
Conclusion: Knowledge of patho-morphological factors associated with patellar instability could help explain its pathophysiological processes, allowing for the design of treatment approaches and the identification of patients at risk.
Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Caroline B Hing is co editor-in-chief the Knee.
(Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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