A modified Delphi consensus statement on patellar instability: part I

Eoghan T Hurley^{1

2}, Andrew J Hughes¹, Ian Savage-Elliott¹, David Dejour³, Kirk A Campbell¹, Mary K Mulcahey⁴, Jocelyn R Wittstein², Laith M Jazrawi¹; Patellar Instability International Consensus Group; Michael J Alaia⁵, Elizabeth A Arendt⁶, Olufemi R Ayeni⁷, Ashley J Bassett⁸, Kevin F Bonner⁹, Christopher L Camp¹⁰, Cordelia W Carter⁵, Jorge Chahla¹¹, Michael G Ciccotti¹², Andrew J Cosgarea¹³, Cory M Edgar¹⁴, Brandon J Erickson¹⁵, João Espregueira-Mendes¹⁶, Jack Farr¹⁷, Lutul D Farrow¹⁸, Rachel M Frank¹⁹, Kevin B Freedman¹², John P Fulkerson²⁰, Alan Getgood²¹, Andreas H Gomoll²², John A Grant²³, Safa Gursoy¹¹, F W Gwathmey²⁴, Fares S Haddad²⁵, Laurie A Hiemstra²⁶, Betina B Hinckel²⁷, Jason L Koh²⁸, Aaron J Krych¹⁰, Robert F LaPrade²⁹, Zachary I Li⁵, Catherine A Logan³⁰, Guillem Gonzalez-Lomas⁵, Brian J Mannino⁵, Martin Lind³¹, Bogdan A Matache³², Elizabeth Matzkin³³, Thomas F McCarthy³⁴, Bert Mandelbaum³⁵, Volker Musahl³⁶, Philippe Neyret³⁷, Clayton W Nuelle³⁸, Sam Oussedik³⁹, J L Pace⁴⁰, Peter Verdonk⁴¹, Scott A Rodeo²², Fiachra E Rowan⁴², Matthew J Salzler⁴³, Patrick C Schottel⁴⁴, Fintan J Shannon⁴⁵, Andrew J Sheean⁴⁶, Seth L Sherman⁴⁷, Sabrina M Strickland²², Miho J Tanaka⁴⁸, Brian R Waterman⁴⁹, Michael Zacchilli⁵⁰, Stefano Zaffagnini⁵¹

Affiliations

¹ Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA.
² Department of Orthopedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA.
³ Orthopaedic Department, Lyon-Ortho-Clinic, Clinique de La Sauvegarde, Lyon, France.
⁴ Department of Orthopaedic Surgery, School of Medicine, Loyola University, Chicago, Illinois, USA.
⁵ Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA.
⁶ Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
⁷ Division of Orthopaedic Surgery, McMaster University, Hamilton, Canada.
⁸ The Orthopedic Institute of New Jersey, Morristown, New Jersey, USA.
⁹ Jordan-Young Institute, Virginia Beach, Virginia, USA.
¹⁰ Department of Orthopaedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA.
¹¹ Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA.
¹² Rothman Orthopaedic Institute at Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA.
¹³ Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, USA.
¹⁴ Department of Orthopedics, University of Connecticut Health Center, Farmington, Connecticut, USA.
¹⁵ Rothman Orthopaedic Institute, New York, New York, USA.
¹⁶ Dom Research Center, Clinica Espregueira Mendes, FIFA Medical Centre of Excellence, Porto, Portugal.
¹⁷ OrthoIndy Knee Preservation and Cartilage Restoration Center, Indianapolis, Indiana, USA.
¹⁸ Cleveland Clinic Orthopaedic and Rheumatologic Institute, Cleveland, Ohio, USA.
¹⁹ Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA.
²⁰ Department of Orthopaedic Surgery and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut, USA.
²¹ Fowler Kennedy Sports Medicine Clinic, Western University, London, Canada.
²² Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, USA.
²³ Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA.
²⁴ Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, Virginia, USA.
²⁵ Department of Trauma and Orthopaedic Surgery, University College London Hospitals, London, UK.
²⁶ Department of Surgery, University of Calgary, Calgary, Canada.
²⁷ Department of Orthopaedic Surgery, William Beaumont Hospital, Royal Oak, Michigan, USA.
²⁸ NorthShore Orthopaedic Institute, NorthShore University Health System, Evanston, Illinois, USA.
²⁹ Twin Cities Orthopedics, Edina-Crosstown, Edina, Minnesota, USA.
³⁰ Center for Regenerative Sports Medicine, Steadman Philippon Research Institute, Vail, Colorado, USA.
³¹ Department of Sports Traumatology, Aarhus University Hospital, Aarhus, Denmark.
³² Division of Orthopaedic Surgery, Department of Surgery, Laval University, Quebec, Canada.
³³ Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
³⁴ Stryker Orthopaedics, Mahwah, New Jersey, USA.
³⁵ Cedars-Sinai Kerlan-Jobe Institute, Los Angeles, California, USA.
³⁶ Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
³⁷ Department of Orthopaedic Surgery, Centre Albert-Trillat, Hôpital de La Croix-Rousse, Lyon, France.
³⁸ Department of Orthopedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri, USA.
³⁹ University College London Hospitals NHS Foundation Trust, London, UK.
⁴⁰ Children's Health Andrews Institute for Orthopaedics and Sports Medicine, Plano, Texas, USA.
⁴¹ Antwerp Orthopaedic Center, AZ Monica Hospitals, Antwerp, Belgium.
⁴² Department of Trauma & Orthopaedic Surgery, University Hospital Waterford, Waterford, Ireland.
⁴³ Department of Orthopedics, Tufts University School of Medicine, Boston, USA.
⁴⁴ Department of Orthopaedics and Rehabilitation, Larner College of Medicine, Burlington, Vermont, USA.
⁴⁵ Department of Trauma and Orthopaedics, Galway University Hospitals, Galway, Ireland.
⁴⁶ San Antonio Military Medical Center, San Antonio, Texas, USA.
⁴⁷ Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA.
⁴⁸ Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA.
⁴⁹ Department of Orthopedic Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA.
⁵⁰ Hofstra Northwell School of Medicine, New York, New York, USA.
⁵¹ IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.

PMID: 38037678
DOI: 10.1302/0301-620X.105B12.BJJ-2023-0109.R1

A modified Delphi consensus statement on patellar instability: part I

Eoghan T Hurley et al. Bone Joint J. 2023.

. 2023 Dec 1;105-B(12):1259-1264.

doi: 10.1302/0301-620X.105B12.BJJ-2023-0109.R1.

Authors

Affiliations

¹ Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA.
² Department of Orthopedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA.
³ Orthopaedic Department, Lyon-Ortho-Clinic, Clinique de La Sauvegarde, Lyon, France.
⁴ Department of Orthopaedic Surgery, School of Medicine, Loyola University, Chicago, Illinois, USA.
⁵ Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA.
⁶ Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
⁷ Division of Orthopaedic Surgery, McMaster University, Hamilton, Canada.
⁸ The Orthopedic Institute of New Jersey, Morristown, New Jersey, USA.
⁹ Jordan-Young Institute, Virginia Beach, Virginia, USA.
¹⁰ Department of Orthopaedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA.
¹¹ Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA.
¹² Rothman Orthopaedic Institute at Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA.
¹³ Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, USA.
¹⁴ Department of Orthopedics, University of Connecticut Health Center, Farmington, Connecticut, USA.
¹⁵ Rothman Orthopaedic Institute, New York, New York, USA.
¹⁶ Dom Research Center, Clinica Espregueira Mendes, FIFA Medical Centre of Excellence, Porto, Portugal.
¹⁷ OrthoIndy Knee Preservation and Cartilage Restoration Center, Indianapolis, Indiana, USA.
¹⁸ Cleveland Clinic Orthopaedic and Rheumatologic Institute, Cleveland, Ohio, USA.
¹⁹ Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA.
²⁰ Department of Orthopaedic Surgery and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut, USA.
²¹ Fowler Kennedy Sports Medicine Clinic, Western University, London, Canada.
²² Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, USA.
²³ Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA.
²⁴ Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, Virginia, USA.
²⁵ Department of Trauma and Orthopaedic Surgery, University College London Hospitals, London, UK.
²⁶ Department of Surgery, University of Calgary, Calgary, Canada.
²⁷ Department of Orthopaedic Surgery, William Beaumont Hospital, Royal Oak, Michigan, USA.
²⁸ NorthShore Orthopaedic Institute, NorthShore University Health System, Evanston, Illinois, USA.
²⁹ Twin Cities Orthopedics, Edina-Crosstown, Edina, Minnesota, USA.
³⁰ Center for Regenerative Sports Medicine, Steadman Philippon Research Institute, Vail, Colorado, USA.
³¹ Department of Sports Traumatology, Aarhus University Hospital, Aarhus, Denmark.
³² Division of Orthopaedic Surgery, Department of Surgery, Laval University, Quebec, Canada.
³³ Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
³⁴ Stryker Orthopaedics, Mahwah, New Jersey, USA.
³⁵ Cedars-Sinai Kerlan-Jobe Institute, Los Angeles, California, USA.
³⁶ Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
³⁷ Department of Orthopaedic Surgery, Centre Albert-Trillat, Hôpital de La Croix-Rousse, Lyon, France.
³⁸ Department of Orthopedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri, USA.
³⁹ University College London Hospitals NHS Foundation Trust, London, UK.
⁴⁰ Children's Health Andrews Institute for Orthopaedics and Sports Medicine, Plano, Texas, USA.
⁴¹ Antwerp Orthopaedic Center, AZ Monica Hospitals, Antwerp, Belgium.
⁴² Department of Trauma & Orthopaedic Surgery, University Hospital Waterford, Waterford, Ireland.
⁴³ Department of Orthopedics, Tufts University School of Medicine, Boston, USA.
⁴⁴ Department of Orthopaedics and Rehabilitation, Larner College of Medicine, Burlington, Vermont, USA.
⁴⁵ Department of Trauma and Orthopaedics, Galway University Hospitals, Galway, Ireland.
⁴⁶ San Antonio Military Medical Center, San Antonio, Texas, USA.
⁴⁷ Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA.
⁴⁸ Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA.
⁴⁹ Department of Orthopedic Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA.
⁵⁰ Hofstra Northwell School of Medicine, New York, New York, USA.
⁵¹ IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.

PMID: 38037678
DOI: 10.1302/0301-620X.105B12.BJJ-2023-0109.R1

Abstract

Aims: The aim of this study was to establish consensus statements on the diagnosis, nonoperative management, and indications, if any, for medial patellofemoral complex (MPFC) repair in patients with patellar instability, using the modified Delphi approach.

Methods: A total of 60 surgeons from 11 countries were invited to develop consensus statements based on their expertise in this area. They were assigned to one of seven working groups defined by subtopics of interest within patellar instability. Consensus was defined as achieving between 80% and 89% agreement, strong consensus was defined as between 90% and 99% agreement, and 100% agreement was considered to be unanimous.

Results: Of 27 questions and statements on patellar instability, three achieved unanimous consensus, 14 achieved strong consensus, five achieved consensus, and five did not achieve consensus.

Conclusion: The statements that reached unanimous consensus were that an assessment of physeal status is critical for paediatric patients with patellar instability. There was also unanimous consensus on early mobilization and resistance training following nonoperative management once there is no apprehension. The statements that did not achieve consensus were on the importance of immobilization of the knee, the use of orthobiologics in nonoperative management, the indications for MPFC repair, and whether a vastus medialis oblique advancement should be performed.

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Conflict of interest statement

D. Dejour reports royalties or licenses from Corin, Arthrex, and SBM and consulting fees from Smith & Nephew, all unrelated to this study. M. K. Mulcahey reports consulting fees from Arthrex, unrelated to this study. J. R. Wittstein reports consulting fees from Geistlich, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Arthrex and Vericel, stock or stock options from ViewFi Health, all unrelated to this study. L. M. Jazwari reports grants or contracts from Arthrex, Mitek, Smith & Nephew, and Wolters Kluwer Health, both related and unrelated to this study, royalties or licenses and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Wolters Kluwer Health, and stock or stock options from Lazurite, all unrelated to this study.

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A modified Delphi consensus statement on patellar instability: part I

Affiliations

A modified Delphi consensus statement on patellar instability: part I

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical