First-time patellar dislocation: surgery or conservative treatment?

[trochlear dysplasia]

Primary patellar dislocation injures the medial patellofemoral ligament (MPFL ), the major soft -tissue stabilizer of the patella , which may lead to recurrent patellar instability . Recurrent patellar dislocation are common and may require surgical intervention . The variation in location of injury of the MPFL and the presence of an osteochondral fracture produces challenges in clinical decision making between nonoperative and operative treatment , including the surgical modality , to repair or reconstruct the MPFL . Current evidence suggests that not all primary dislocations should undergo the same treatment . MPFL reconstruction may theoretically be more reliable than repair , but the optimal time to perform additional bony corrections is not known . A normal or minor dysplastic patellofemoral joint may be suitable for nonoperative treatment , whereas a higher grade of trochlear dysplasia or other significant abnormalities may benefit from surgical treatment . In this paper , we present a treatment algorithm for primary patellar dislocation .