Atualização em instabilidade patelar

Nilson Roberto Severino; Fabrício Roberto Severino; Osmar Pedro Arbix de Camargo; Luiz Gabriel Betoni Guglielmetti; Victor Marques de Oliveira; Ricardo de Paula Leite Cury

doi:10.1055/s-0040-1713389

Revista Brasileira de Ortopedia, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2021; 56(02): 147-153
DOI: 10.1055/s-0040-1713389

Artigo de Atualização

Joelho

Atualização em instabilidade patelar

Artikel in mehreren Sprachen: português | English

Nilson Roberto Severino

¹Grupo de Joelho, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Irmandade da Santa Casa de Misericórdia de São Paulo, Santa Casa de São Paulo, São Paulo, Brasil

,

Fabrício Roberto Severino

¹Grupo de Joelho, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Irmandade da Santa Casa de Misericórdia de São Paulo, Santa Casa de São Paulo, São Paulo, Brasil

,

Osmar Pedro Arbix de Camargo

¹Grupo de Joelho, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Irmandade da Santa Casa de Misericórdia de São Paulo, Santa Casa de São Paulo, São Paulo, Brasil

,

Luiz Gabriel Betoni Guglielmetti

¹Grupo de Joelho, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Irmandade da Santa Casa de Misericórdia de São Paulo, Santa Casa de São Paulo, São Paulo, Brasil

,

Victor Marques de Oliveira

¹Grupo de Joelho, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Irmandade da Santa Casa de Misericórdia de São Paulo, Santa Casa de São Paulo, São Paulo, Brasil

,

Ricardo de Paula Leite Cury

¹Grupo de Joelho, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Irmandade da Santa Casa de Misericórdia de São Paulo, Santa Casa de São Paulo, São Paulo, Brasil

› Institutsangaben

Abstract

Resumo

A instabilidade patelar é uma condição clínica multifatorial, que acomete um número expressivo de pacientes, ocorrendo devido a variações anatômicas, morfológicas da articulação e do alinhamento patelofemoral. O presente estudo de revisão e atualização da literatura teve como objetivos identificar e sumarizar os conceitos atuais sobre instabilidade patelar em relação aos fatores de risco associados, os critérios diagnósticos e os benefícios e riscos dos tratamentos conservador e cirúrgico. Para tanto, foi realizado um levantamento nas bases de dados eletrônicas MEDLINE (via Pubmed), LILACS e Cochrane Library. Conclui-se que o diagnóstico preciso depende da avaliação clínica detalhada, incluindo o histórico e possíveis fatores de risco individuais, além de exames de imagem. O tratamento inicial da instabilidade patelar é ainda controverso, e requer a combinação de intervenções conservadoras e cirúrgicas, levando em consideração tanto os tecidos moles quanto as estruturas ósseas, sendo estas últimas a razão mais comum para a escolha do tratamento cirúrgico, principalmente instabilidade patelar lateral.

Palavras-chave

patela - articulação patelofemoral - instabilidade articular - luxação patelar

Volltext

Referenzen

Referências
1 Smith TO, Davies L, Toms AP, Hing CB, Donell ST. The reliability and validity of radiological assessment for patellar instability. A systematic review and meta-analysis. Skeletal Radiol 2011; 40 (04) 399-414
2 Liu JN, Steinhaus ME, Kalbian IL. et al. Patellar Instability Management: A Survey of the International Patellofemoral Study Group. Am J Sports Med 2018; 46 (13) 3299-3306
3 Fithian DC, Paxton EW, Stone ML. et al. Epidemiology and natural history of acute patellar dislocation. Am J Sports Med 2004; 32 (05) 1114-1121
4 Smith TO, Donell S, Song F, Hing CB. Surgical versus non-surgical interventions for treating patellar dislocation. Cochrane Database Syst Rev 2015; (02) CD008106
5 Arendt EA, Fithian DC, Cohen E. Current concepts of lateral patella dislocation. Clin Sports Med 2002; 21 (03) 499-519
6 Koh JL, Stewart C. Patellar instability. Clin Sports Med 2014; 33 (03) 461-476
7 Franco BAFM, Sadigursky D, Daltro GC. Patellar position in patients with patellofemoral syndrome as characterized by anatomo-radiographic study. Rev Bras Ortop 2018; 53 (04) 410-414
8 Saccomanno MF, Sircana G, Fodale M, Donati F, Milano G. Surgical versus conservative treatment of primary patellar dislocation. A systematic review and meta-analysis. Int Orthop 2016; 40 (11) 2277-2287
9 Sillanpää P, Mattila VM, Iivonen T, Visuri T, Pihlajamäki H. Incidence and risk factors of acute traumatic primary patellar dislocation. Med Sci Sports Exerc 2008; 40 (04) 606-611
10 Panni AS, Vasso M, Cerciello S. Acute patellar dislocation. What to do?. Knee Surg Sports Traumatol Arthrosc 2013; 21 (02) 275-278
11 Cofield RH, Bryan RS. Acute dislocation of the patella: results of conservative treatment. J Trauma 1977; 17 (07) 526-531
12 Hawkins RJ, Bell RH, Anisette G. Acute patellar dislocations. The natural history. Am J Sports Med 1986; 14 (02) 117-120
13 Mäenpää H, Huhtala H, Lehto MU. Recurrence after patellar dislocation. Redislocation in 37/75 patients followed for 6-24 years. Acta Orthop Scand 1997; 68 (05) 424-426
14 Mäenpää H, Lehto MU. Patellar dislocation. The long-term results of nonoperative management in 100 patients. Am J Sports Med 1997; 25 (02) 213-217
15 Weber AE, Nathani A, Dines JS. et al. An Algorithmic Approach to the Management of Recurrent Lateral Patellar Dislocation. J Bone Joint Surg Am 2016; 98 (05) 417-427
16 Duthon VB. Acute traumatic patellar dislocation. Orthop Traumatol Surg Res 2015; 101 (01) S59-S67
17 Seitlinger G, Ladenhauf HN, Wierer G. What is the chance that a patella dislocation will happen a second time: update on the natural history of a first time patella dislocation in the adolescent. Curr Opin Pediatr 2018; 30 (01) 65-70
18 Arendt EA, England K, Agel J, Tompkins MA. An analysis of knee anatomic imaging factors associated with primary lateral patellar dislocations. Knee Surg Sports Traumatol Arthrosc 2017; 25 (10) 3099-3107
19 Askenberger M, Janarv PM, Finnbogason T, Arendt EA. Morphology and Anatomic Patellar Instability Risk Factors in First-Time Traumatic Lateral Patellar Dislocations: A Prospective Magnetic Resonance Imaging Study in Skeletally Immature Children. Am J Sports Med 2017; 45 (01) 50-58
20 Balcarek P, Oberthür S, Hopfensitz S. et al. Which patellae are likely to redislocate?. Knee Surg Sports Traumatol Arthrosc 2014; 22 (10) 2308-2314
21 Dejour H, Walch G, Nove-Josserand L, Guier C. Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 1994; 2 (01) 19-26
22 Santos Netto A, Brito MB, Severino FR. et al. Estudo da articulação patelofemoral por ressonância magnética: a variação da morfologia do ligamento patelofemoral medial. Rev Bras Ortop 2012; 47 (02) 204-209
23 Christensen TC, Sanders TL, Pareek A, Mohan R, Dahm DL, Krych AJ. Risk Factors and Time to Recurrent Ipsilateral and Contralateral Patellar Dislocations. Am J Sports Med 2017; 45 (09) 2105-2110
24 Sanders TL, Pareek A, Hewett TE, Stuart MJ, Dahm DL, Krych AJ. High rate of recurrent patellar dislocation in skeletally immature patients: a long-term population-based study. Knee Surg Sports Traumatol Arthrosc 2018; 26 (04) 1037-1043
25 Sanders TL, Pareek A, Johnson NR, Stuart MJ, Dahm DL, Krych AJ. Patellofemoral Arthritis After Lateral Patellar Dislocation: A Matched Population-Based Analysis. Am J Sports Med 2017; 45 (05) 1012-1017
26 Lee DY, Park YJ, Song SY, Hwang SC, Park JS, Kang DG. Which Technique Is Better for Treating Patellar Dislocation? A Systematic Review and Meta-analysis. Arthroscopy 2018; 34 (11) 3082-3093.e1
27 Souza PME, Gabetto MSS, Serrão MG, Vieira LAM, Oliveira DC. Patellofemoral Instability: Evaluation by Magnetic Resonance Imaging. Rev Bras Ortop 2013; 48 (02) 159-164
28 Insall J, Salvati E. Patella position in the normal knee joint. Radiology 1971; 101 (01) 101-104
29 Blackburne JS, Peel TE. A new method of measuring patellar height. J Bone Joint Surg Br 1977; 59 (02) 241-242
30 Caton J. [Method of measuring the height of the patella]. Acta Orthop Belg 1989; 55 (03) 385-386
31 Portner O, Pakzad H. The evaluation of patellar height: a simple method. J Bone Joint Surg Am 2011; 93 (01) 73-80
32 Haj-Mirzaian A, Thawait GK, Tanaka MJ, Demehri S. Diagnosis and Characterization of Patellofemoral Instability: Review of Available Imaging Modalities. Sports Med Arthrosc Rev 2017; 25 (02) 64-71
33 Koh JL, Stewart C. Patellar instability. Orthop Clin North Am 2015; 46 (01) 147-157
34 Lewallen LW, McIntosh AL, Dahm DL. Predictors of recurrent instability after acute patellofemoral dislocation in pediatric and adolescent patients. Am J Sports Med 2013; 41 (03) 575-581
35 Yang F, Guo W, Wang Q. et al. Surgical versus nonsurgical treatment of primary acute patellar dislocation: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98 (29) e16338
36 Longo UG, Ciuffreda M, Locher J, Berton A, Salvatore G, Denaro V. Treatment of Primary Acute Patellar Dislocation: Systematic Review and Quantitative Synthesis of the Literature. Clin J Sport Med 2017; 27 (06) 511-523
37 Dolak KL, Silkman C, Medina McKeon J, Hosey RG, Lattermann C, Uhl TL. Hip strengthening prior to functional exercises reduces pain sooner than quadriceps strengthening in females with patellofemoral pain syndrome: a randomized clinical trial. J Orthop Sports Phys Ther 2011; 41 (08) 560-570
38 Cowan SM, Bennell KL, Crossley KM, Hodges PW, McConnell J. Physical therapy alters recruitment of the vasti in patellofemoral pain syndrome. Med Sci Sports Exerc 2002; 34 (12) 1879-1885
39 Longo UG, Berton A, Salvatore G. et al. Medial Patellofemoral Ligament Reconstruction Combined With Bony Procedures for Patellar Instability: Current Indications, Outcomes, and Complications. Arthroscopy 2016; 32 (07) 1421-1427
40 Dejour D, Le Coultre B. Osteotomies in Patello-Femoral Instabilities. Sports Med Arthrosc Rev 2018; 26 (01) 8-15
41 Fonseca LPRMD, Kawatake EH, Pochini AC. Lateral patellar retinacular release: changes over the last ten years. Rev Bras Ortop 2017; 52 (04) 442-449
42 Baumann CA, Pratte EL, Sherman SL, Arendt EA, Hinckel BB. Reconstruction of the medial patellotibial ligament results in favorable clinical outcomes: a systematic review. Knee Surg Sports Traumatol Arthrosc 2018; 26 (10) 2920-2933
43 Buchanan G, Torres L, Czarkowski B, Giangarra CE. current concepts in the treatment of gross patellofemoral instability. Int J Sports Phys Ther 2016; 11 (06) 867-876
44 Patel NK, de Sa D, Vaswani R, Kay J, Musahl V, Lesniak BP. Knee Flexion Angle During Graft Fixation for Medial Patellofemoral Ligament Reconstruction: A Systematic Review of Outcomes and Complications. Arthroscopy 2019; 35 (06) 1893-1904
45 Kang H, Zheng R, Dai Y, Lu J, Wang F. Single- and double-bundle medial patellofemoral ligament reconstruction procedures result in similar recurrent dislocation rates and improvements in knee function: a systematic review. Knee Surg Sports Traumatol Arthrosc 2019; 27 (03) 827-836
46 Sadigursky D, de Melo Laranjeira SM, Nunes M, Caneiro RJ, Colavolpe PO. Reconstruction of the medial patellofemoral ligament by means of the anatomical double-bundle technique using metal anchors. Rev Bras Ortop 2016; 51 (03) 290-297
47 Shamrock AG, Day MA, Duchman KR, Glass N, Westermann RW. Medial Patellofemoral Ligament Reconstruction in Skeletally Immature Patients: A Systematic Review and Meta-analysis. Orthop J Sports Med 2019; 7 (07) 2325967119855023
48 Fulkerson JP. Anteromedialization of the tibial tuberosity for patellofemoral malalignment. Clin Orthop Relat Res 1983; (177) 176-181
49 Longo UG, Rizzello G, Ciuffreda M. et al. 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. Arthroscopy 2016; 32 (05) 929-943
50 Nolan III JE, Schottel PC, Endres NK. Trochleoplasty: Indications and Technique. Curr Rev Musculoskelet Med 2018; 11 (02) 231-240
51 Carstensen SE, Menzer HM, Diduch DR. Patellar Instability: When is Trochleoplasty Necessary?. Sports Med Arthrosc Rev 2017; 25 (02) 92-99
52 Banke IJ, Kohn LM, Meidinger G. et al. Combined trochleoplasty and MPFL reconstruction for treatment of chronic patellofemoral instability: a prospective minimum 2-year follow-up study. Knee Surg Sports Traumatol Arthrosc 2014; 22 (11) 2591-2598
53 LaPrade RF, Cram TR, James EW, Rasmussen MT. Trochlear dysplasia and the role of trochleoplasty. Clin Sports Med 2014; 33 (03) 531-545
54 Zhang X, Attenello J, Safran MR, Lowenberg DW. Congenital internal rotation deformity of the distal femur presenting as patellofemoral instability and pain. J ISAKOS 2019; 4: 93-97