Prognostic Factors of First-Time Athletic Patellar Dislocation That Favor Surgical Intervention: A Systematic Review

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Biomechanical Engineering

Background:

• First-time athletic patellar dislocations lack a consensus treatment approach.
• Both surgical (medial patellofemoral ligament reconstruction) and conservative (bracing, physical therapy) options exist.
• Operative treatment demonstrates lower redislocation rates and higher Kujala scores.

Purpose of the Study:

• To identify prognostic factors favoring operative treatment for first-time athletic patellar dislocations.
• To inform evidence-based treatment guidelines for patellar instability.
• To reduce complications such as subluxation and redislocation.

Main Methods:

• Systematic review following PRISMA-P guidelines.
• Literature search across PubMed, Cochrane, and Embase databases.
• Inclusion of nine studies (2 RCTs, 6 prospective randomized, 1 non-randomized prospective) involving 548 knees.

Main Results:

• Surgical intervention group had a 15.8% redislocation rate vs. 35.7% in the conservative group.
• Prognostic factors favoring surgery: osteochondral fragments, excessive Q angle, persistent patella subluxation, and patella alta.
• Six studies reported lower redislocation rates and higher Kujala scores with surgical intervention.

Conclusions:

• Prognostic factors can guide the selection of operative treatment for first-time patellar dislocations.
• Surgical intervention appears superior in reducing redislocation and improving functional outcomes.
• Treatment guidelines should incorporate these factors to optimize patient care and prevent recurrent instability.