Recurrent patellar dislocation: reappraising our approach to surgery

Area of Science:

• Orthopedic surgery
• Sports medicine
• Knee biomechanics

Background:

• Recurrent traumatic patellar dislocation management often involves surgical realignment.
• The optimal surgical approach, proximal soft tissue versus distal procedures, remains debated.
• Distal realignment procedures are associated with higher morbidity but may be indicated for severe cases with patellar maltracking.

Purpose of the Study:

• To compare the outcomes of proximal and distal surgical realignment procedures for recurrent traumatic patellar dislocation.
• To evaluate the efficacy of distal realignment for patients with significant patellar maltracking.

Main Methods:

• A cohort study of 23 patients with recurrent patellar dislocation who failed conservative management.
• Patients underwent either distal realignment (Elmslie-Trillat or Roux Goldthwaite) for lateral patellar subluxation or proximal medial patellofemoral ligament (MPFL) reconstruction.
• Pre- and postoperative functional scores (IKDC, Lysholm, Tegner) were assessed and analyzed.

Main Results:

• Both proximal and distal procedures resulted in significant functional improvements.
• Distal realignment procedures were associated with greater reported morbidity.
• No significant difference in functional improvement scores was observed between the two groups.

Conclusions:

• Distal realignment is beneficial for severe patellar maltracking post-dislocation.
• Proximal MPFL reconstruction is adequate for less severe cases.
• A management algorithm is proposed to guide clinical decision-making.