Study Aims to Resolve Controversies Around Treating Patellar Instability

This multi-center, prospective study will assess both operative and non-operative treatment of kneecap dislocations.

Patellar instability, or dislocation of the kneecap, is frequently seen in young patients. It is one of the most common knee problems as children and teens grow, and can lead to significant morbidity and arthritis.

Currently, treatment of patellar instability is based on physician preference. That’s where a new multi-center, prospective study comes in. The JUPITER (Justifying Patellar Instability Treatment by Early Results) study was prompted because of controversial treatment recommendations for one diagnosis. The study aims to resolve these controversies.

The First Study of Its Kind

“This study is the first of its kind, in that it’s following patients as they are being treated at 12 different sites around the country,” says Shital Parikh, MD, FACS, principal investigator of the study and co-director of Orthopaedic Sports Medicine at Cincinnati Children’s. “We are excited to be partnering with 25 surgeons from prominent centers throughout the U.S.”

The study aims to:

  1. Compare the outcomes of non-operative treatment with operative treatment for a first-time patellar dislocation.
  2. Compare isolated medial patellofemoral ligament (MPFL) reconstruction versus an ‘à la carte’ surgical approach in those who have recurrent instability.
  3. Identify risk factors that can help predict the best treatment for a patient based on their history, clinical evaluation and imaging.

Outcomes will be assessed at 6, 12, 24 and 60 months to evaluate function, activity level, quality of life and complications.

A second phase of the JUPITER study will look at the development of arthritis five and 10 years after the first dislocation of the kneecap.

Bringing Evidence to Treatment Plans

“We’re carrying out the study in a way that will answer a lot of questions with a high level of evidence,” Parikh says. “We want to have specific criteria that will help us determine if a patient should be treated non-operatively first, and if surgery is necessary, which procedure will be best for that particular patient.”

The first patients were enrolled in the JUPITER study in January 2017. The project has been supported by grants from the Pediatric Orthopaedic Society of North America (POSNA), the Arthroscopy Association of North America (AANA), and the University of Cincinnati.

“These findings will allow us to better standardize treatment protocols for patients based on age, risk factors and the type of instability they’re encountering,” Parikh says. “We’re looking forward to seeing the results that will come out of the study and incorporating them into our care.”

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