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Treatment of acute patellar dislocation

Hughston Orthopaedic Clinic, PC, Columbus, Georgia, and the Tulane University School of Medicine, Division of Orthopaedics, Sports Medicine Section, New Orleans, Louisiana

Jack C. Hughston, MD

Hughston Orthopaedic Clinic, PC, Columbus, Georgia, and the Tulane University School of Medicine, Division of Orthopaedics, Sports Medicine Section, New Orleans, Louisiana

To determine the effectiveness of nonoperative and operative treatment of initial acute patellar dislocation, we reviewed the charts of 399 patients with the diag nosis of an acute dislocation, seen during a 30 year period. One hundred patients (103 knees) met the criteria for inclusion in the study.

The average age of the patient at injury was 21.7 years (range, 9 to 72 years). Length of followup aver aged 8 years (range, 2 to 26 years).

Retrospectively, we divided the patients into two groups, according to the examination of their unaf fected knee. Group I (69 knees) showed evidence on examination of congenital abnormality of the extensor mechanism in the unaffected knee, indicating a predis position to dislocate with less significant trauma. Group II (34 knees) showed no clinically perceptible congenital predisposition to dislocate based on examination of the unaffected knee.

In the nonoperatively treated knees in Group I, there was a 52% (28/54) incidence of good or excellent results. The nonoperatively treated knees in Group II had a 75% (15/20) incidence of good or excellent results.

Acute dislocation occurred more frequently in males than in females. Recurrence was rarer in patients whose initial dislocation had occurred when they were over 15 years old.

Contrary to recently published reports, primary acute traumatic patellar dislocations can be treated with non operative therapy with good or excellent results. Initial evaluation should include examination of the uninvolved knee which, if found to have signs of congenital abnor mality, would indicate a worse prognosis.

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