Conservative Versus Tailored Surgical Treatment in Patients With First Time Lateral Patella Dislocation: a Randomized-controlled Trial

Autor: Michael Liebensteiner, Daniel Wagner, F. Dirisamer, Geert Pagenstert, M. Nelitz, Johannes M. Giesinger, Gerd Seitlinger, Peter Balcarek, R. El Attal, Alexander Keiler, Armin Keshmiri, Ch. Becher, P. Kappel, Jannik Frings
Rok vydání: 2021
Předmět:
Male
musculoskeletal diseases
medicine.medical_specialty
Time Factors
Patellar Dislocation
Diseases of the musculoskeletal system
Tailored surgical treatment
Conservative Treatment
law.invention
03 medical and health sciences
Patellofemoral Joint
Study Protocol
0302 clinical medicine
Randomized controlled trial
law
Patella dislocation
Recurrence
Secondary Prevention
Medicine
Humans
Dislocation
Orthopedics and Sports Medicine
Orthopedic Procedures
Prospective Studies
Surgical treatment
Biosimilar Pharmaceuticals
Physical Therapy Modalities
Orthopedic surgery
030222 orthopedics
Braces
business.industry
Instability
030229 sport sciences
Patella
Osteoarthritis
Knee
musculoskeletal system
Brace
Surgery
Conservative treatment
Treatment Outcome
RC925-935
Sample size determination
Female
business
RD701-811
Zdroj: Journal of Orthopaedic Surgery and Research
Journal of Orthopaedic Surgery and Research, Vol 16, Iss 1, Pp 1-8 (2021)
DOI: 10.21203/rs.3.rs-382483/v1
Popis: Background Patellar instability has a high incidence and occurs particularly in young and female patients. If the patella dislocates for the first time, treatment is usually conservative. However, this cautious approach carries the risk of recurrence and of secondary pathologies such as osteochondral fractures. Moreover, there is also risk of continuous symptoms apparent, as recurrent patella dislocation is related to patellofemoral osteoarthritis as well. An initial surgical treatment could possibly avoid these consequences of recurrent patella dislocation. Methods A prospective, randomized-controlled trial design is applied. Patients with unilateral first-time patella dislocation will be considered for participation. Study participants will be randomized to either conservative treatment or to a tailored patella stabilizing treatment. In the conservative group, patients will use a knee brace and will be prescribed outpatient physical therapy. The surgical treatment will be performed in a tailored manner, addressing the pathologic anatomy that predisposes to patella dislocation. The Banff Patellofemoral Instability-Instrument 2.0, recurrence rate, apprehension test, joint degeneration, and the Patella Instability Severity Score will serve as outcome parameters. The main analysis will focus on the difference in change of the scores between the two groups within a 2-year follow-up. Statistical analysis will use linear mixed models. Power analysis was done for the comparison of the two study arms at 2-year follow-up with regard to the BPII Score. A sample size of N = 64 per study arm (128 overall) provides 80% power (alpha = 0.05, two-tailed) to detect a difference of 0.5 standard deviations in a t-test for independent samples. Discussion Although several studies have already dealt with this issue, there is still no consensus on the ideal treatment concept for primary patellar dislocation. Moreover, most of these studies show a unified surgical group, which means that all patients were treated with the same surgical procedure. This is regarded as a major limitation as surgical treatment of patella dislocation should depend on the patient’s anatomic pathologies leading to patellar instability. To our knowledge, this is the first study investigating whether patients with primary patella dislocation are better treated conservatively or operatively with tailored surgery to stabilize the patella. Trial registration The study will be prospectively registered in the publicly accessible database www.ClinicalTrials.gov.
Databáze: OpenAIRE
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