Sillanpää, J Bone Joint Surg Am 2009 - Treatment with and without Initial Stabilizing Surgery for Primary Traumatic Patellar Dislocation

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Treatment with and without Initial Stabilizing Surgery for Primary Traumatic Patellar Dislocation

Sillanpää, Pihlajamäki, et al.·J Bone Joint Surg Am·2009·185 citations·RCT

Background

There is no consensus about the management of acute primary traumatic patellar dislocation in young physically active adults. The objective of this study was to compare the clinical outcomes after treatment with and without initial stabilizing surgery for primary traumatic patellar dislocation in young adults.

Methods

40 young adults, 37 men and 3 women with a median age of 20 years (range, 19 to 22 years), who had an acute primary traumatic patellar dislocation were randomly allocated to be treated with initial surgical stabilization (18 patients, with each receiving one of 2 types of initial stabilizing procedures) or to be managed with an orthosis (22 patients, including 4 who had osteochondral fragments removed arthroscopically).
After a median of 7 years, 38 patients returned for a follow-up examination.
Redislocations, subjective symptoms, and functional limitations were evaluated.
Radiographs and magnetic resonance images were obtained at the time of randomization, and 29 (76%) patients underwent magnetic resonance imaging at the time of final follow-up.

Results

A hemarthrosis as well as injuries of the medial retinaculum and the medial patellofemoral ligament were found on magnetic resonance imaging in all patients at the time of randomization.
During the follow-up period, 6 of the 21 nonoperatively treated patients and none of the 17 patients treated with surgical stabilization had a redislocation (p = 0.02).
4 nonoperatively treated patients and 2 patients treated with surgical stabilization reported painful patellar subluxation.
The median Kujala scores were 91 points for the surgically treated patients and 90 points for the nonoperatively treated patients.
13 patients in the surgically treated group and 15 in the nonoperatively treated group regained their former physical activity level.
At the time of follow-up, a full-thickness patellofemoral articular cartilage lesion was detected on magnetic resonance imaging in 11 patients; the lesions were considered to be unrelated to the form of treatment.

Conclusions

In a study of young, mostly male adults with primary traumatic patellar dislocation, the rate of redislocation for those treated with surgical stabilization was significantly lower than the rate for those treated without surgical stabilization. However, no clear subjective benefits of initial stabilizing surgery were seen at the time of long-term follow-up.

Copyright remains with the authors and publisher.

Treatment with and without Initial Stabilizing Surgery for Primary Traumatic Patellar Dislocation

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Treatment with and without Initial Stabilizing Surgery for Primary Traumatic Patellar Dislocation

Sillanpää, Pihlajamäki, et al.·J Bone Joint Surg Am·2009·185 citations·RCT

Background

There is no consensus about the management of acute primary traumatic patellar dislocation in young physically active adults. The objective of this study was to compare the clinical outcomes after treatment with and without initial stabilizing surgery for primary traumatic patellar dislocation in young adults.

Methods

40 young adults, 37 men and 3 women with a median age of 20 years (range, 19 to 22 years), who had an acute primary traumatic patellar dislocation were randomly allocated to be treated with initial surgical stabilization (18 patients, with each receiving one of 2 types of initial stabilizing procedures) or to be managed with an orthosis (22 patients, including 4 who had osteochondral fragments removed arthroscopically).
After a median of 7 years, 38 patients returned for a follow-up examination.
Redislocations, subjective symptoms, and functional limitations were evaluated.
Radiographs and magnetic resonance images were obtained at the time of randomization, and 29 (76%) patients underwent magnetic resonance imaging at the time of final follow-up.

Results

A hemarthrosis as well as injuries of the medial retinaculum and the medial patellofemoral ligament were found on magnetic resonance imaging in all patients at the time of randomization.
During the follow-up period, 6 of the 21 nonoperatively treated patients and none of the 17 patients treated with surgical stabilization had a redislocation (p = 0.02).
4 nonoperatively treated patients and 2 patients treated with surgical stabilization reported painful patellar subluxation.
The median Kujala scores were 91 points for the surgically treated patients and 90 points for the nonoperatively treated patients.
13 patients in the surgically treated group and 15 in the nonoperatively treated group regained their former physical activity level.
At the time of follow-up, a full-thickness patellofemoral articular cartilage lesion was detected on magnetic resonance imaging in 11 patients; the lesions were considered to be unrelated to the form of treatment.

Conclusions

In a study of young, mostly male adults with primary traumatic patellar dislocation, the rate of redislocation for those treated with surgical stabilization was significantly lower than the rate for those treated without surgical stabilization. However, no clear subjective benefits of initial stabilizing surgery were seen at the time of long-term follow-up.

Copyright remains with the authors and publisher.

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