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Treatment with and without initial stabilizing surgery for primary traumatic patellar dislocation. A prospective

Petri J Sillanpää1, Ville M Mattila, Heikki Mäenpää

  • 1Central Military Hospital, Helsinki, Finland. petri.sillanpaa@uta.fi

The Journal of Bone and Joint Surgery. American Volume
|February 3, 2009
PubMed
Summary
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Surgical stabilization significantly reduced redislocation rates in young adults with traumatic patellar dislocation. However, long-term follow-up showed no clear subjective benefits of initial surgery compared to nonoperative management.

Area of Science:

  • Orthopedic Surgery
  • Sports Medicine
  • Traumatology

Background:

  • Management of acute primary traumatic patellar dislocation lacks consensus in young, active adults.
  • This study aimed to compare outcomes of surgical stabilization versus nonoperative treatment.

Purpose of the Study:

  • To evaluate clinical outcomes of initial surgical stabilization versus orthosis management for acute primary traumatic patellar dislocation in young adults.
  • To assess the rates of redislocation, subjective symptoms, and functional limitations after treatment.

Main Methods:

  • Forty young adults (median age 20) with acute primary traumatic patellar dislocation were randomized.
  • Groups received either initial surgical stabilization (18 patients) or orthosis management (22 patients).
  • Follow-up at a median of 7 years included clinical evaluation and imaging (MRI for 76% at follow-up).

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Main Results:

  • No redislocations occurred in the surgically treated group (17 patients), versus 6 in the nonoperative group (21 patients) (p=0.02).
  • Subjective outcomes (Kujala scores) and return to physical activity levels were similar between groups.
  • Articular cartilage lesions were detected in 11 patients at follow-up, unrelated to treatment.

Conclusions:

  • Initial surgical stabilization significantly lowers the rate of redislocation for young adults with primary traumatic patellar dislocation.
  • No significant subjective long-term benefits were observed with initial stabilizing surgery compared to nonoperative management.