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      Calc Function

    • Calcs that help predict probability of a diseaseDiagnosis
    • Subcategory of 'Diagnosis' designed to be very sensitiveRule Out
    • Disease is diagnosed: prognosticate to guide treatmentPrognosis
    • Numerical inputs and outputsFormula
    • Med treatment and moreTreatment
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    Patent Pending

    Recurrent Instability of the Patella (RIP) Score

    Predicts risk of recurrent instability after primary patellar dislocation.
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    When to Use
    Pearls/Pitfalls
    Why Use

    Patients with a first-time patellar dislocation (adults and adolescents).

    • Does not take into account uncommon risk factors such as excessive femoral internal rotation, excessive valgus limb alignment, or generalized patholaxity (e.g. as in Ehlers-Danlos syndrome).

    • Not applicable for obligate flexion dislocation.

    • Chondral or osteochondral fractures are managed differently.

    • Relevant to most presentations of first-time patellar dislocations.

    • Includes physeal status (physeal closure may be imminent).

    • Does not take into account the site of the medial patellar restraint tear (femoral tears have a higher rate of recurrent patellar instability).

    • Can be used to educate patients and parents on the risk of future patellar dislocations after the first episode.

    • Aid in discussion during informed consent for operative and nonoperative management of first-time patellar dislocators.

    • Can be an objective factor in deciding between operative and nonoperative management of a first-time patellar dislocation.

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    Yes

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Advice

    • Exam: in addition to standard knee examination plus patellar tracking, “J” and evidence of obligatory dislocation (flexion dislocators are appropriate for RIP scoring), assess internal rotation of the hip/femur in prone position. If >45 degrees, obtain rotational imaging study; assess laxity with Beighton scoring, and if elevated obtain a specific diagnosis, e.g. Ehlers-Danlos type.

    • Radiographs: in addition to assigning Dejour trochlear type, Caton Deschamps patellar height ratio, and tilt, assess mechanical axis for evidence of excessive limb valgus.

    • MRI: Assess TT-PCL in addition to TT-TG and patellar height; assess for chondral and osteochondral fracture and loose bodies (medial patella and lateral aspect lateral femoral condyle).

    Management

    Physical examination and imaging findings should be included to allow a rational final course of action.

    Critical Actions

    Assess for other factors that can influence the decision between operative and nonoperative management.

    About the Creator
    Dr. Mario Hevesi