Editorial Commentary: The Child of 2 Mothers: Hip Preservation and Hip Arthroplasty
Purpose: To describe the clinical history of a series of primary, lateral patellar dislocations and determine long-term predictors of recurrent instability while accounting for patients undergoing early operative management.
Methods: A large geographic database of more than 500,000 patients was used to identify patients who sustained a first-time lateral patellar dislocation between 1990 and 2010. Charts were individually reviewed to document demographics, radiographic measures including tibial tubercle to trochlear groove distance (TT-TG) and patellar length (PL), recurrent episodes of instability, and patellar stabilization surgery. A risk score that accounted for early surgical management was calculated using Fine and Gray competing risk regression, and its ability to stratify patients was examined using cumulative incidence curves.
Results: Eighty-one patients (mean age 19.9 ± 9.4 years, 38 male, 43 female) were identified and followed for a mean of 10.1 years (range 4.1-20.2). Thirty-eight patients (46.9%) experienced an episode of recurrent instability and 30 (37.0%) underwent patellar stabilization surgery, including 7 who did so before recurrent dislocation. A multivariate, statistically derived scoring system, the Recurrent Instability of the Patella Score (RIP Score), that employed age, skeletal maturity, trochlear dysplasia, and TT-TG/PL ratio to predict recurrent instability while accounting for patients managed surgically, was generated. The resulting RIP score stratified patients into low-, intermediate-, and high-risk categories, with 0.0%, 30.6%, and 79.2% 10-year recurrent instability rates, respectively (P = .000004), and an area under the curve of 0.875 (P = .00002).
Conclusions: Patients who sustain a first-time, lateral patellar dislocation can be readily classified into low-, intermediate-, and high-risk categories employing the RIP score based on age, skeletal maturity, trochlear dysplasia, and TT-TG/PL ratio. This long-term risk stratification holds significant potential clinical utility for determination of patients who are at high risk for recurrent instability after primary patellar dislocation. LEVEL OF EVIDENCE: Level III, retrospective comparative study.