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

First-time athletic patellar dislocations are either treated surgically with medial patellofemoral ligament (MPFL) reconstruction or conservatively with bracing and physical therapy. Currently, there is no consensus on the best treatment for this condition. While outcomes are similar between treatment groups, operative treatment has been shown to yield lower redislocation rates and higher Kujala scores. Therefore, the aim of this study was to identify prognostic factors that favor operative treatment of first-time patellar dislocations. Data sources include PubMed, Cochrane, and Embase. PRISMA-P guidelines for systematic reviews were followed, and a literature search was conducted across three databases based on our search strategy. Articles were imported into Covidence, where they underwent primary screening and full-text review. After screening 133 potential articles, nine were included in the final review. There were two randomized control trials, six randomized prospective studies, and one non-randomized prospective study. All studies assessed both surgical and conservative interventions for the treatment of first-time athletic patellar dislocations. A total of 548 knees were included with a mode follow-up period of two years. Across all studies, 264 knees (48%) underwent conservative treatment, and 282 knees (52%) underwent operative management. The surgical intervention group had an average redislocation rate of 15.8%, while the conservative intervention group had an average dislocation rate of 35.7%. Identified prognostic factors for surgical intervention include the presence of osteochondral fragments, excessive Q angle, persistent patella subluxation, and patella alta. Six of the nine studies identified that surgical intervention led to lower redislocation rates and higher Kujala scores, resulting in overall improved outcomes compared to conservative treatment. Identification of the prognostic factors that favor surgical intervention serves to highlight how current treatment guidelines should be modified to avoid future complications of subluxation, patellar instability, or redislocation.