First-time traumatic patellar dislocation: a systematic review

Area of Science:

• Orthopedics and Sports Medicine
• Traumatology
• Evidence-Based Medicine

Background:

• Acute patellar dislocations can lead to chronic instability, pain, and reduced athletic function.
• Current management strategies for first-time traumatic patellar dislocations lack a clear evidence-based consensus.
• A shift towards initial surgical intervention contrasts with traditional nonoperative approaches.

Purpose of the Study:

• To provide evidence-based recommendations for the diagnosis and treatment of first-time traumatic patellar dislocations.
• To determine optimal initial management strategies: operative versus nonoperative (closed) treatment.

Main Methods:

• Systematic review of Level I-IV studies.
• Analysis of 70 articles focusing on study design, follow-up duration, outcomes, and redislocation rates.
• Development of clinical recommendations based on synthesized evidence.

Main Results:

• Nonoperative management is generally recommended for initial treatment of first-time traumatic patellar dislocations.
• Specific circumstances warrant surgical intervention: osteochondral fractures, disrupted medial patellar stabilizers, lateral subluxation with contralateral normality, or failure to improve with rehabilitation.
• A second dislocation also indicates consideration for surgical management.

Conclusions:

• Initial nonoperative management is the preferred approach for most first-time traumatic patellar dislocations.
• Surgical intervention should be reserved for clearly defined clinical scenarios indicating a higher risk of poor outcomes.
• These recommendations aim to guide clinicians in optimizing patient care and outcomes for patellar dislocations.