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Characteristics of Patients With Primary Acute Lateral Patellar Dislocation and Their Recovery Within the First 6 Months of Injury

Dave M. Atkin, MD^*, Donald C. Fithian, MD^,, Kent S. Marangi, MD, Mary Lou Stone, RPT, Barbara E. Dobson, LVN and Cerrah Mendelsohn^||

^* St. Luke’s Health Care, San Francisco
Southern California Permanente Medical Group, San Diego
Community Orthopaedic Medical Group, Mission Viejo
^|| University of California at Davis, Davis, California

Address correspondence and reprint requests to Donald C. Fithian, MD, Department of Orthopaedic Surgery, 4647 Zion Avenue, San Diego, CA 92120

We prospectively studied the characteristics and early recovery of an unselected population of patients who had acute first-time lateral patellar dislocation. The recovery program used standardized rehabilitation, emphasizing range of motion, muscle strength, and return of function. Patients returned to stressful activities including sports as tolerated when they regained full passive range of motion, had no effusion, and when quadriceps muscle strength was at least 80% compared with the noninjured limb. Seventy-four patients met the enrollment criteria; 37 men and 37 women. The average age was 19.9 years, and preinjury sports participation was similar to that of ligament-injury patients. Four percent of patients (N = 3) had a history of birth complications, 3% (N = 2) had a history of lower extremity problems as an infant or child, and 9% (N = 7) had a family history of patellar dislocation. Radiographs revealed a 50% incidence (N = 37) of patella alta; all patients demonstrated lateral patellar overhang. Patients regained range of motion (mean, 0° to 132°) by 6 weeks. Sports participation remained significantly reduced throughout the first 6 months after injury, with the greatest limitations in kneeling and squatting. At 6 months, 58% of patients (N = 43) noted limitation in strenuous activities. The patients who had acute primary patellar dislocation were young and active. Most injuries occurred during sports, and few patients had abnormal physical features, contradicting any stereotype of an overweight, sedentary, adolescent girl whose patella dislocates with little or no trauma.

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