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Acute traumatic primary patellar dislocation: long-term results comparing conservative and surgical treatment
Matthias Buchner1, Benjamin Baudendistel, Desiderius Sabo
1Orthopaedic Clinic, University of Heidelberg, Schlierbacher Landstrasse 200a, D-69118 Heidelberg, Germany. Matthias.Buchner@ok.uni-heidelberg.de
Objective:
This report evaluates the subjective, clinical, and functional long-term results comparing surgical and conservative treatment in patients with a primary traumatic patellar dislocation.
Design And Setting:
This retrospective clinical study focuses on patients with primary acute traumatic patellar dislocation. Patients with radiologic signs indicative of a predisposition for recurrent patellar instability were excluded from this study.
Patients:
A total of 126 patients were examined a mean of 8.1 years after initial treatment of their primary patellar dislocation.
Interventions And Main Outcome Measurements:
Patients were retrospectively divided into groups with conservative therapy (n = 63), diagnostic arthroscopy only (n = 20), immediate surgical reconstruction of the parapatellar ligament complex (n = 37), and refixation of osteochondral fragments (n = 6). Redislocation and resurgery rate, activity level, and subjective, clinical, and functional results were evaluated in these patients, and the outcomes in these groups were compared.
Results:
In the long term, functional results (as expressed in the Lysholm score) were excellent or good in 85% of the patients, and good subjective results were reported by 71%, but follow-up revealed a recurrence rate of 26% in the total study population. The high activity level before the initial trauma could not be completely regained after treatment. There was no significant difference between the surgically and conservatively treated groups in the redislocation and reoperation rates, level of activity, or functional and subjective outcomes.
Conclusions:
Even with a focus on acute traumatic etiology and when factors predisposing to recurrent instability are largely excluded, the redislocation rate after treatment of acute patellar dislocation is still high, despite good clinical and subjective results. Conservative management seems to be the treatment of choice in patients with acute patellar dislocation, provided that the generally accepted indications for surgery, such as evidence of osteochondral fragments and major defects of the parapatellar ligament complex, are given due consideration.