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Topic:

Patellar Instability

Issue:

Knee

Category:

Trauma

Title:

Consensus-Based Guidelines for Management of First-Time Patellar Dislocation in Adolescents

Author:

Parikh, Shital N. MD; Schlechter, John A. DO; Veerkamp, Matthew W. BA; Stacey, John D. DO; Gupta, Rajul MBBS, MS; Pendleton, Albert M. MD; Shea, Kevin G. MD; Friel, Nicole A. MD, MS; Molony, Joseph T. Jr PT, MS, SCS, CSCS; Yaniv, Moshe MD; Rhodes, Jason MD; Finlayson, Craig J. MD; Williams, Brendan A. MD; Ellington, Matthew MD; PRISM Patellofemoral Research Interest Group (PRISM PF RIG)

Journal:

Journal of Pediatric Orthopaedics

Date:

April 2024

Reference:

44(4):p e369-e374, DOI: 10.1097/BPO.0000000000002616

Level Of Evidence:

​

# of Patients:

79

Study Type:

Consensus-based guidelines using a survey

Location:

Multicenter (Patellofemoral Research Interest Group of the Pediatric Research in Sports Medicine Society)

Summary:

Guidelines for the management of first-time patellar dislocation, with and without concomitant osteochondral fractures, were developed through consensus among experts. Recommendations focus on imaging, nonoperative and surgical treatments, and management after failed nonoperative care.

Methods:

A 29-question, multiple-choice survey was administered to experts. Survey content included case scenarios and treatment options for first-time patellar dislocations. Consensus was defined as agreement among >66% of respondents.

Exclusions:

Not specified

Results:

Consensus Recommendations: Initial radiographs for all patients (99%). Nonoperative treatment for first-time patellar dislocation without osteochondral fracture (99%). Physical therapy starting within the first month postinjury (99%). Return to sport after 2–4 months with a brace (68%). Surgery for recurrent subluxation episodes after 6 months of nonoperative care (84%). Patellar stabilization for first-time dislocation with osteochondral fracture (81.5%).

Conclusions:

The guidelines provide structured recommendations for managing first-time patellar dislocation, addressing imaging, therapy, and surgical considerations. Areas without consensus point to gaps in evidence and opportunities for further research. These guidelines offer a practical framework for clinical decision-making in the absence of high-level evidence.

Relevance:

Limitations:

Perspective:

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