A Treatment Algorithm for Primary Patellar Dislocations

Abstract

Context:Primary patellar dislocation continues to be a common problem facing clinicians today. These injuries are associated with significant morbidity and a substantial recurrence rate. Myriad operative and nonoperative options have been described to treat these injuries, although the evidence-based literature is sparse.Evidence Acquisition:PubMed was searched from 1970-2010 to identify publications on patellar dislocations, including clinical presentation, natural history, radiographic workup, and treatment.Results:The initial workup of a patella dislocation includes a history, physical examination, and radiographs. If there is evidence of a displaced osteochondral fragment or hemarthrosis, then magnetic resonance imaging should be obtained. The treatment of first-time patella dislocators has been controversial, and no study has demonstrated a clear benefit to early operative intervention.Conclusion:First-time patellar dislocations should be treated conservatively unless there is evidence of a displaced osteochondral fragment.

I.S.Mu.L.T. first-time patellar dislocation guidelines

“…Cryotherapy is useful in the first 48 hours of injury, but it can be used also in the following 3-4 weeks to address the joint effusion and the pain after exercise therapy and loading. Electrostimulation can prevent muscle atrophy, promote muscle strengthening, and facilitate functionally useful movements [82][83][84][85][86][87][88][89][90] .…”

Plication of The Medial Patellofemoral Ligament for The Treatment of Chronic Patella Dislocations and Refractory Patellofemoral Syndrome. A Retrospective Case Series and Review

“…This, however, remains controversial. According to a review included in a study by Jain, et al (2011), there is insufficient evidence to support immediate surgical stabilization of the patella after an initial dislocation, and only after a second dislocation should it be considered due to an increased risk of subsequent dislocations.3 In patients with lateral subluxations and repeat dislocations, the MPFL may be damaged or stretched and in need of repair. This procedure's utilization has increased in recent years, and in spite of a noted complication rate of 26%, [11] a number of retrospective studies claim excellent outcomes from 80-96% of patients improving even when used to repair previously failed surgical interventions for instability [2,[12][13][14][15].…”

Management of Acute Patellar Dislocation: A Case Report

“…1 These injuries can result in damage to the medial patellofemoral ligament (MPFL) and may cause osteochondral fractures. [2][3][4] The average incidence of first-time patellar dislocation is 5.8 per 100 000. 1,5 Of these patients who sustain a first-time patellar dislocation, 44% to 70% will experience a subsequent recurrent dislocation.…”

“…5 Up to 55% of those athletes do not return to their sporting activities, and 58% have restrictions with strenuous activity 6 months after their date of injury. 4 There is a higher risk of occurrence in adolescent females along with persons with multiple predisposing factors including increased quadriceps angle, patella alta, patellar hypermobility, vastus medialis weakness, increased femoral anteversion, and shallow femoral trochlear groove (Fig 1). 5,6 Most first-time traumatic patellar dislocations are treated nonoperatively with a closed reduction technique unless there is evidence of osteochondral fracture, a displaced osteochondral fragment, or gross patellofemoral instability.…”

“…7,8 The presence of large amounts of sub-patellar effusion which may require aspiration of fluid, raises the likelihood of a significant osteochondral fracture. 4 While most patients affected by this injury report to a hospital emergency department for initial assessment and treatment, they may present to a chiropractic physician or general practitioner's office, especially in rural areas. They often present with an already reduced patellofemoral joint and a history of feeling their knee "going out of place".…”