Download PDF
J Knee Surg 2012; 25(01): 051-058
DOI: 10.1055/s-0031-1286199
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Patellar Dislocation in the United States: Role of Sex, Age, Race, and Athletic Participation

Brian R. Waterman
1   Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas
,
Philip J. Belmont
1   Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas
,
Brett D. Owens
2   Keller Army Hospital - John A. Feagin Jr. West Point Sports Medicine Fellowship, West Point, New York
› Author Affiliations
Further Information

Publication History

21 November 2010

18 June 2011

Publication Date:
04 October 2011 (online)

    Permissions and Reprints

Abstract

Patellar instability has been extensively studied in selected, high-risk cohorts, but the epidemiology in the general population remains unclear. A longitudinal, prospective epidemiological database was used to determine the incidence and demographic risk factors for patellar dislocations presenting to emergency departments of the United States. The National Electronic Injury Surveillance System was queried for all patellar dislocations presenting to emergency departments between 2003 and 2008. Incidence rate ratios (IRRs) were then calculated with respect to sex, age, and race. The hypothesis was that patellar dislocation is influenced by sex, age, race, and athletic participation. An estimated 40,544 patellar dislocations occurred among an at-risk population of 1,774,210,081 person-years for an incidence rate of 2.29 per 100,000 person-years in the United States. When compared with males, females showed no significant overall or age-stratified differences in the rates of patellar dislocation (IRR 0.85, 95% CI 0.71, 1.00; p = 0.08; p > 0.05). Peak incidence of patellar dislocation occurred between 15 and 19 years of age (11.19/100,000 person-years). When compared with Hispanic race, black and white race were associated with significantly higher rates of patellar dislocation (IRR 4.30 [95% CI 1.63, 6.97; p = 0.02], IRR 4.02 [95% CI 1.06, 6.98; p = 0.03], respectively). Nearly half (51.9%) of all patellar dislocation occurred during athletic activity, with basketball (18.2%), soccer (6.9%), and football (6.3%) associated with the highest percentage of patellar dislocation during athletics. Age between 15 and 19 years is associated with higher rates of patellar dislocation. Sex is not a significant risk factor for patellar dislocation. Black and white race are a significant risk factor for patellar dislocation when compared with Hispanic race. Half of all patellar dislocation occurs during athletic activity. This study was conducted on the Level of evidence II.

Keywords

patella - dislocation - patellofemoral - instability - epidemiology
 

  • References

  • 1 Devereaux MD, Lachmann SM. Patello-femoral arthralgia in athletes attending a Sports Injury Clinic. Br J Sports Med 1984; 18 (1) 18-21
    CrossrefPubMedSearch in Google Scholar
  • 2 Casteleyn PP, Handelberg F. Arthroscopy in the diagnosis of occult dislocation of the patella. Acta Orthop Belg 1989; 55 (3) 381-383
    PubMedSearch in Google Scholar
  • 3 Fithian DC, Paxton EW, Stone ML , et al. Epidemiology and natural history of acute patellar dislocation. Am J Sports Med 2004; 32 (5) 1114-1121
    CrossrefPubMedSearch in Google Scholar
  • 4 Macnab I. Recurrent dislocation of the patella. J Bone Joint Surg Am 1952; 34 A (4) 957-967, passim
    PubMedSearch in Google Scholar
  • 5 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 (5) 424-426
    PubMedSearch in Google Scholar
  • 6 Cofield RH, Bryan RS. Acute dislocation of the patella: results of conservative treatment. J Trauma 1977; 17 (7) 526-531
    CrossrefPubMedSearch in Google Scholar
  • 7 Nietosvaara Y, Aalto K, Kallio PE. Acute patellar dislocation in children: incidence and associated osteochondral fractures. J Pediatr Orthop 1994; 14 (4) 513-515
    CrossrefPubMedSearch in Google Scholar
  • 8 Hsiao MS, Owens BD, Burks R, Sturdivant RX, Cameron KL. Incidence of acute traumatic patellar dislocation among active-duty United States military service members. Am J Sports Med 2010; 38 (10) 1997-2004
    CrossrefPubMedSearch in Google Scholar
  • 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 (4) 606-611
    PubMedSearch in Google Scholar
  • 10 Schroeder T, Ault K. The NEISS sample (design and implementation) 1997 to present. U.S. Consumer Product Safety Commission Division of Hazard and Injury Data Systems. 2001. http://www.cpsc.gov/neiss/2001d011-6b6.pdf . Accessed October, 2009
    PubMed
  • 11 The National Electronic Injury Surveillance System. A Tool for Researchers. U.S. Consumer Product Safety Commission Division of Hazard and Injury Data Systems. 2000. http://www.cpsc.gov/neiss/2000d015.pdf . Accessed December, 2009
    PubMed
  • 12 Coding Manual NEISS. U.S. Consumer Product Safety Commission Division of Hazard and Injury Data Systems. 2007. http://www.cpsc.gov/neiss/completemanual.pdf . Accessed December, 2009
    PubMed
  • 13 Zacchilli MA, Owens BD. Epidemiology of shoulder dislocations presenting to emergency departments in the United States. J Bone Joint Surg Am 2010; 92 (3) 542-549
    CrossrefPubMedSearch in Google Scholar
  • 14 Waterman BR, Owens BD, Davey S, Zacchilli MA, Belmont Jr PJ. The epidemiology of ankle sprains in the United States. J Bone Joint Surg Am 2010; 92 (13) 2279-2284
    CrossrefPubMedSearch in Google Scholar
  • 15 Kirkpatrick R, Puffinbarger W, Sullivan JA. All-terrain vehicle injuries in children. J Pediatr Orthop 2007; 27 (7) 725-728
    PubMedSearch in Google Scholar
  • 16 Leininger RE, Knox CL, Comstock RD. Epidemiology of 1.6 million pediatric soccer-related injuries presenting to US emergency departments from 1990 to 2003. Am J Sports Med 2007; 35 (2) 288-293
    PubMedSearch in Google Scholar
  • 17 Quinlan KP, Thompson MP, Annest JL , et al. Expanding the National Electronic Injury Surveillance System to monitor all nonfatal injuries treated in US hospital emergency departments. Ann Emerg Med 1999; 34 (5) 637-645
    CrossrefPubMedSearch in Google Scholar
  • 18 Kerr ZY, Collins CL, Comstock RD. Epidemiology of weight training-related injuries presenting to United States emergency departments, 1990 to 2007. Am J Sports Med 2010; 38 (4) 765-771
    CrossrefPubMedSearch in Google Scholar
  • 19 Vollman D, Smith GA. Epidemiology of lawn-mower-related injuries to children in the United States, 1990-2004. Pediatrics 2006; 118 (2) e273-e278
    CrossrefPubMedSearch in Google Scholar
  • 20 Yard EE, Knox CL, Smith GA, Comstock RD. Pediatric martial arts injuries presenting to emergency departments, United States 1990-2003. J Sci Med Sport 2007; 10 (4) 219-226
    CrossrefPubMedSearch in Google Scholar
  • 21 Loder RT. The demographics of equestrian-related injuries in the United States: injury patterns, orthopedic specific injuries, and avenues for injury prevention. J Trauma 2008; 65 (2) 447-460
    CrossrefPubMedSearch in Google Scholar
  • 22 Birrer RB, Griesemer B, Cataletto MB. Pediatric Sports Medicine for the Primary Care. Philadelphia: Lippincott Williams & Wilkins; 2002
    Search in Google Scholar
  • 23 Caine D, Maffulli N, Caine C. Epidemiology of injury in child and adolescent sports: injury rates, risk factors, and prevention. Clin Sports Med 2008; 27 (1) 19-50 ; vii
    CrossrefPubMedSearch in Google Scholar
  • 24 Crosby EB, Insall J. Recurrent dislocation of the patella. Relation of treatment to osteoarthritis. J Bone Joint Surg Am 1976; 58 (1) 9-13
    CrossrefPubMedSearch in Google Scholar
  • 25 Larsen E, Lauridsen F. Conservative treatment of patellar dislocations. Influence of evident factors on the tendency to redislocation and the therapeutic result. Clin Orthop Relat Res 1982; 171 (171) 131-136
    PubMedSearch in Google Scholar
  • 26 Virolainen H, Visuri T, Kuusela T. Acute dislocation of the patella: MR findings. Radiology 1993; 189 (1) 243-246
    PubMedSearch in Google Scholar
  • 27 Halbrecht JL, Jackson DW. Acute dislocation of the patella. In: Fox JM, DelPizzo W, eds. The Patellofemoral Joint. New York: McGraw-Hill; 1993: 123-156
    Search in Google Scholar
  • 28 Dejour H, Walch G, Nove-Josserand L, Guier C. Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 1994; 2 (1) 19-26
    CrossrefPubMedSearch in Google Scholar
  • 29 Hewett TE, Myer GD, Ford KR , et al. Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. Am J Sports Med 2005; 33 (4) 492-501
    CrossrefPubMedSearch in Google Scholar
  • 30 Hawkins RJ, Bell RH, Anisette G. Acute patellar dislocations. The natural history. Am J Sports Med 1986; 14 (2) 117-120
    CrossrefPubMedSearch in Google Scholar
  • 31 Cash JD, Hughston JC. Treatment of acute patellar dislocation. Am J Sports Med 1988; 16 (3) 244-249
    CrossrefPubMedSearch in Google Scholar
  • 32 Henry JH, Crosland JW. Conservative treatment of patellofemoral subluxation. Am J Sports Med 1979; 7 (1) 12-14
    CrossrefPubMedSearch in Google Scholar
  • 33 Hughston JC, Deese M. Medial subluxation of the patella as a complication of lateral retinacular release. Am J Sports Med 1988; 16 (4) 383-388
    CrossrefPubMedSearch in Google Scholar
  • 34 Landry SC, McKean KA, Hubley-Kozey CL, Stanish WD, Deluzio KJ. Neuromuscular and lower limb biomechanical differences exist between male and female elite adolescent soccer players during an unanticipated side-cut maneuver. Am J Sports Med 2007; 35 (11) 1888-1900
    CrossrefPubMedSearch in Google Scholar
  • 35 Atkin DM, Fithian DC, Marangi KS, Stone ML, Dobson BE, Mendelsohn C. Characteristics of patients with primary acute lateral patellar dislocation and their recovery within the first 6 months of injury. Am J Sports Med 2000; 28 (4) 472-479
    PubMedSearch in Google Scholar
  • 36 Porter PS, Salo D, Allegra JR. The epidemiology of patellar dislocations. Ann Emerg Med 2008; 52 (4) S124
    PubMedSearch in Google Scholar
  • 37 Owens B, Mountcastle S, White D. Racial differences in tendon rupture incidence. Int J Sports Med 2007; 28 (7) 617-620
    Thieme ConnectPubMedSearch in Google Scholar
  • 38 White DW, Wenke JC, Mosely DS, Mountcastle SB, Basamania CJ. Incidence of major tendon ruptures and anterior cruciate ligament tears in US Army soldiers. Am J Sports Med 2007; 35 (8) 1308-1314
    CrossrefPubMedSearch in Google Scholar
  • 39 Trojian TH, Collins S. The anterior cruciate ligament tear rate varies by race in professional women's basketball. Am J Sports Med 2006; 34 (6) 895-898
    CrossrefPubMedSearch in Google Scholar
  • 40 Kim TK, Chung BJ, Kang YG, Chang CB, Seong SC. Clinical implications of anthropometric patellar dimensions for TKA in Asians. Clin Orthop Relat Res 2009; 467 (4) 1007-1014
    CrossrefPubMedSearch in Google Scholar
  • 41 Hovinga KR, Lerner AL. Anatomic variations between Japanese and Caucasian populations in the healthy young adult knee joint. J Orthop Res 2009; 27 (9) 1191-1196
    CrossrefPubMedSearch in Google Scholar
  • 42 Harvey WF, Niu J, Zhang Y , et al. Knee alignment differences between Chinese and Caucasian subjects without osteoarthritis. Ann Rheum Dis 2008; 67 (11) 1524-1528
    PubMedSearch in Google Scholar
  • 43 Vainionpää S, Laasonen E, Silvennoinen T, Vasenius J, Rokkanen P. Acute dislocation of the patella. A prospective review of operative treatment. J Bone Joint Surg Br 1990; 72 (3) 366-369
    PubMedSearch in Google Scholar
  • 44 Kurock W, Sennerich T. [Diagnosis and therapy of traumatic patellar dislocation in the athlete]. Z Kinderchir 1987; 42 (3) 178-180
    PubMedSearch in Google Scholar
  • 45 Nikku R, Nietosvaara Y, Aalto K, Kallio PE. The mechanism of primary patellar dislocation: trauma history of 126 patients. Acta Orthop 2009; 80 (4) 432-434
    Search in Google Scholar
  • 46 Schappert SM. Ambulatory care visits to physician offices, hospital outpatient departments, and emergency departments: United States, 1997. Vital Health Stat 13 1999; 143 (143) i-iv ; 1–39
    PubMedSearch in Google Scholar