Abstract
Background:
Patellofemoral instability (PFI) is a prevalent knee condition, especially in younger, active individuals. There is a multitude of risk factors that contribute to recurrent instability; however, a consensus of which factors are essential to assess prior to rendering treatment is variable among providers. Some factors may be overlooked which may affect prognosis following intervention. This led to the development of a PFI Compendium for Assessment and Treatment (PFI-CAT) by the Pediatric Research in Sports Medicine (PRiSM) Patellofemoral Research Interest Group (RIG) informed by literature review and iterative discussion.
Hypothesis:
A chart audit was conducted on the pre-operative documentation of PFI-CAT components among RIG surgeons prior to its development to evaluate the comprehensiveness and consistency of “real world” documentation for PFI. This study aims to show pertinent parameters are documented inconsistently during PFI evaluation and establish the utility for a standardized assessment tool like the PFI-CAT.
Methods:
Five orthopedic surgeons, with a high volume of patients with PFI, from 5 pediatric institutions across the United States completed a retrospective chart audit on 10 consecutive patients who were evaluated and treated surgically for PFI. Surgeons were asked to report on the documentation of 43 demographic, subjective, physical exam and imaging findings using the PFI-CAT. If pertinent findings were present in documentation, then how those findings were observed and documented was also reported. Statistical analysis was done to quantify the rate of documentation for each variable.
Results:
Six variables including laterality, range of motion (ROM), varus/valgus laxity, lateral patellar glide, and skeletal maturity were documented in all patient charts. There were inconsistent methods for assessing ROM, palpatory examination, laxity and lateral patellar glide. Plain radiographs and MRI imaging were included in the assessment of all 50 patients. Documentation consistency of other PFI-CAT components ranged from 0 to 96% of patient records. Trochlea dysplasia was not recorded in 18% of patients reviewed.
Conclusion:
A high variability exists in the documentation of PFI-CAT elements in patients being assessed for PFI among high volume surgeons. This may limit the inclusion of critical elements in retrospective, multicenter PFI research. These findings indicate the importance of systematically collecting these pertinent parameters in the evaluation of patients with PFI. Findings from this audit indicate areas for improvement in the consistency of documentation when evaluating patients with PFI. Information acquired through this audit will guide the next stage of PFI-CAT development via implementation to standardize documentation in PFI patients.
