Clinical Scenario: Acute patellar dislocations during adolescence often lead to future patellar instability. Two common treatment options include nonoperative treatment or operative repair of injured structures. Focused Clinical Question: In adolescents with acute patellar dislocation, how does operative stabilization compare with nonoperative treatment for reducing dislocation recurrence? Summary of Key Findings: Three studies were included: 2 randomized controlled trials and 1 nonrandomized study. All studies compared operative and nonoperative treatment outcomes in adolescents who experienced an acute patellar dislocation. Each study included nonoperative treatment such as patellar bracing and quadriceps strengthening. The operative treatments utilized in each study included lateral retinacular release and medial retinacular repair. All 3 of the studies included a follow-up of at least 6 years. Two of the studies concluded there to be no significant difference between treatment groups regarding redislocation rate, pain, and function. The third study reported a lower redislocation rate following operative treatment. Clinical Bottom Line: Reviewed evidence suggests that outcomes are similar when comparing operative and nonoperative treatment approaches with little agreement as to which is the optimal plan of action. Strength of Recommendation: One level II randomized controlled trial and a level III nonrandomized study suggest that patellar dislocation recurrence rates are similar among operative and nonoperative treatment approaches, while another level II randomized controlled trial suggests that an operative approach is superior.
Julie A. Fuller, Heidi L. Hammil, Kelly J. Pronschinske and Chris J. Durall
Turner A. “Tab” Blackburn Jr.
Rehabilitation procedures for anterior instabilities of the knee were compiled in 1984. Since then these procedures have changed drastically. Immediate weight-bearing, immediate range of motion into full extension, and post-op Day 1 quadricep exercise are only three of the changes that streamline this rehabilitation process. Many of the biomechanical and healing restraints are still the same. But it appears that the human body heals much faster than the animal models used to predict successful treatment of anterior instabilities of the knee. As always, the pendulum swings and puts different emphasis on rehab ideas and techniques that were not used a few years ago. The present paper reflects the latest in this rehabilitation process.
Daisuke Kume, Akira Iguchi and Hiroshi Endoh
differs from that of adults’ ( 2 , 34 ). For instance, children rely more on oxidative metabolism and lower relative anaerobic contribution in the high-intensity domain than do adults during incremental quadriceps exercise ( 3 ). This is supported by a higher percentage of type I fibers ( 21 ), later and
Joseph B. Lesnak, Dillon T. Anderson, Brooke E. Farmer, Dimitrios Katsavelis and Terry L. Grindstaff
strength. 1 Isometric contractions and limited-motion open kinetic chain exercises (eg, short-arc quadriceps exercise) are used early in the rehabilitation protocol because they help strengthen the quadriceps muscle while minimizing stress on the healing graft. 11 Also, during the first 4 to 6 weeks
Dae-Hyun Kim, Jin-Hee Lee, Seul-Min Yu and Chang-Man An
to be answered. In agreement with the results of the present study, Gough and Ladley 17 reported that AD position during isometric contraction of the quadriceps was associated with higher EMG activity of the VM, VL, and RF than AP and resting NP. Katyal et al 28 showed that a 3-week quadriceps
Susan Y. Kwiecien, Malachy P. McHugh, Stuart Goodall, Kirsty M. Hicks, Angus M. Hunter and Glyn Howatson
strength loss on the days after eccentric quadriceps exercise in recreational athletes. 7 A 3-hour PCM application after a professional soccer match also reduced pain and strength loss on subsequent days. 8 In these studies, 7 , 8 participant thermal comfort was maintained while PCM packs were worn