Consensus-Based Guidelines for Management of First-Time Patellar Dislocation in Adolescents
Shital N Parikh1, John A Schlechter2, Matthew W Veerkamp1
1Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Journal of Pediatric Orthopedics
|January 23, 2024
Summary
Consensus guidelines for first-time patellar dislocation recommend nonoperative treatment, early physical therapy, and return to sport in 2-4 months. Surgical intervention is advised for persistent subluxation or with osteochondral fractures.
Area of Science:
- Orthopaedic Surgery
- Sports Medicine
- Clinical Guidelines
Background:
- Management of first-time patellar dislocation lacks standardized evidence-based protocols.
- Significant variability exists in current operative and nonoperative treatment approaches.
Purpose of the Study:
- To establish consensus-based guidelines for nonoperative management of first-time patellar dislocation.
- To develop guidelines for managing failed nonoperative treatment and dislocations with osteochondral fractures.
Main Methods:
- A 29-question, case-based survey was developed and iterated by the Patellofemoral Research Interest Group.
- The survey was administered to members of the Pediatric Research in Sports Medicine Society via REDCap.
- Consensus was defined as >66% agreement on a survey response.
Main Results:
- Eleven consensus-based guidelines were generated from 79 respondent members (50% response rate).
- High consensus (99%) was achieved for initial radiographs and nonoperative treatment, including physical therapy within one month.
- Guidelines recommend return to sport in 2-4 months with bracing (75%), surgical intervention for persistent subluxation (84%), and patellar stabilization for osteochondral fractures (81.5%).
Conclusions:
- Consensus guidelines provide recommendations for managing first-time patellar dislocations, with or without osteochondral fractures.
- These guidelines reflect evolving clinical trends and identify areas for future research where consensus was not reached.
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