背景:首次髌骨脱位的治疗仍然可变,支持或比较不同手术和非手术方式的证据有限。主要目的是为首次髌骨脱位后的非手术治疗的不同组成部分建立基于共识的指南。次要目标是制定与非手术治疗失败后的管理相关的指南。第三目标是建立基于共识的指南,以处理伴有骨软骨骨折的首次髌骨脱位。
方法:A29个问题,多项选择,基于病例的调查是由运动医学儿科研究协会的髌股研究兴趣小组的20名成员开发的。调查包括与人口统计信息有关的问题,首次髌骨脱位的处理没有骨软骨骨折,首次髌骨脱位伴2cm骨软骨骨折的治疗。这项调查由髌股研究兴趣小组成员进行了2轮迭代,最终调查由运动医学儿科研究成员进行,使用REDCap。当超过66%的受访者选择相同的答案时,就产生了基于共识的指南。
结果:157名合格成员中有79名(50%)做出了回应。61名是骨科医生,18名是初级运动医学医师。根据调查答复,生成了11项基于共识的指南。符合共识标准的包括初始膝关节X光片(99%共识),非手术治疗首次髌骨脱位无骨软骨骨折(99%),在受伤后的第一个月内开始物理治疗(99%),在2至4个月后(68%)使用支具(75%)恢复运动,并根据需要进行进一步随访(75%)。如果非手术治疗6个月后出现髌骨半脱位,建议手术治疗(84%)。首次脱位伴骨软骨骨折应考虑髌骨稳定(81.5%)。
结论:基于共识的指南为首次髌骨脱位伴或不伴骨软骨骨折的治疗提供了建议。在临床实践中注意到几个变化趋势和分歧领域。
结论:在缺乏高水平证据的情况下,在治疗首次髌骨脱位后的患者时,基于共识的指南可能有助于临床决策.这些指南强调了首次髌骨脱位的临床实践的发展趋势。没有达成共识的领域是未来研究的主题。
BACKGROUND: The management of first-time patellar dislocation remains variable, with limited evidence to support or compare different operative and nonoperative modalities. The primary aim was to establish
consensus-based
guidelines for different components of nonoperative treatment following a first-time patellar dislocation. The secondary aim was to develop guidelines related to management after failed nonoperative treatment. The tertiary aim was to establish
consensus-based
guidelines for the management of first-time patellar dislocation with a concomitant osteochondral fracture.
METHODS: A 29-question, multiple-choice, case-based survey was developed by 20 members of the Patellofemoral Research Interest Group of the Pediatric Research in Sports Medicine Society. The survey consisted of questions related to demographic information, management of first-time patellar dislocation without an osteochondral fracture, and management of first-time patellar dislocation with a 2 cm osteochondral fracture. The survey underwent 2 rounds of iterations by Patellofemoral Research Interest Group members and the final survey was administered to Pediatric Research in Sports Medicine members, using REDCap.
Consensus-based
guidelines were generated when more than 66% of respondents chose the same answer.
RESULTS: Seventy-nine of 157 (50%) eligible members responded. Sixty-one were orthopaedic surgeons and 18 were primary sports medicine physicians. Eleven
consensus-based
guidelines were generated based on survey responses. Those that met the criteria for consensus included initial knee radiographs (99% consensus), nonoperative treatment for first-time patellar dislocation without an osteochondral fracture (99%), physical therapy starting within the first month postinjury (99%), with return to sport after 2 to 4 months (68%) with a brace (75%) and further follow-up as needed (75%). Surgical treatment was recommended if there were patellar subluxation episodes after 6 months of nonoperative treatment (84%). Patellar stabilization should be considered for a first-time dislocation with an osteochondral fracture (81.5%).
CONCLUSIONS: Consensus-based guidelines offer recommendations for the management of first-time patellar dislocation with or without an osteochondral fracture. Several changing trends and areas of disagreement were noted in clinical practice.
CONCLUSIONS: In the absence of high-level evidence,
consensus-based
guidelines may aid in clinical decision-making when treating patients following a first-time patellar dislocation. These guidelines highlight the evolving trends in clinical practice for the management of first-time patellar dislocation. Areas not reaching consensus serve as topics for future research.