Traumatic patellar dislocation: nonoperative treatment compared with MPFL reconstruction using patellar tendon

Am J Sports Med. 2012 Jan;40(1):114-22. doi: 10.1177/0363546511423742. Epub 2011 Oct 19.

Abstract

Background: Over the long term, acute patellar dislocations can result in patellar instability, with high recurrence rates after nonoperative treatment.

Purpose: To compare the results of operative (reconstruction of the medial patellofemoral ligament [MPFL]) versus nonoperative treatment of primary patellar dislocation.

Study design: Randomized controlled trial; Level of evidence, 1.

Methods: Thirty-nine patients (41 knees) (mean age, 24.2 years; range, 12-38 years) with acute patellar dislocation were randomized into 2 groups. One group was treated nonoperatively with immobilization and physiotherapy, the other was treated surgically with MPFL reconstruction; both groups were evaluated with minimum follow-up of 2 years. The Kujala questionnaire was applied to assess pain and quality of life, and recurrence was evaluated. Pearson χ(2) or Fisher exact test was used in the statistical evaluation.

Results: The statistical analysis showed that the mean Kujala score was significantly lower in the nonoperative group (70.8), when compared with the mean value of the surgical group (88.9; P = .001). The surgical group presented a higher percentage of "good/excellent" results (71.43%) on the Kujala score when compared with the nonoperative group (25.0%; P = .003). The nonoperative group presented a large number of recurrences and subluxations (7 patients; 35% of cases), whereas there were no reports of recurrences or subluxations in the surgical group.

Conclusion: Treatment with MPFL reconstruction using the patellar tendon produced better results, based on the analyses of posttreatment recurrences and the better final results of the Kujala questionnaire after a minimum follow-up period of 2 years.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Analysis of Variance
  • Braces
  • Chi-Square Distribution
  • Child
  • Cryotherapy
  • Electric Stimulation Therapy
  • Female
  • Humans
  • Immobilization
  • Joint Instability / surgery
  • Joint Instability / therapy*
  • Male
  • Patellar Dislocation / surgery
  • Patellar Dislocation / therapy*
  • Patellar Ligament / injuries
  • Patellar Ligament / surgery*
  • Physical Therapy Modalities
  • Prospective Studies
  • Range of Motion, Articular
  • Reconstructive Surgical Procedures / methods*
  • Recurrence
  • Surveys and Questionnaires
  • Treatment Outcome