A Treatment Algorithm for Primary Patellar Dislocations

Abstract

Context: Primary patellar dislocation continues to be a common problem facing clinicians today. These injuries are associated with significant morbidity and a substantial recurrence rate. Myriad operative and nonoperative options have been described to treat these injuries, although the evidence-based literature is sparse. Evidence Acquisition: PubMed was searched from 1970-2010 to identify publications on patellar dislocations, including clinical presentation, natural history, radiographic workup, and treatment. Results: The initial workup of a patella dislocation includes a history, physical examination, and radiographs. If there is evidence of a displaced osteochondral fragment or hemarthrosis, then magnetic resonance imaging should be obtained. The treatment of first-time patella dislocators has been controversial, and no study has demonstrated a clear benefit to early operative intervention. Conclusion: First-time patellar dislocations should be treated conservatively unless there is evidence of a displaced osteochondral fragment.