Conservative Versus Tailored Surgical Treatment in Patients With First Time Lateral Patella Dislocation: a Randomized-controlled Trial

Abstract

BackgroundPatellar instability has a high incidence and occurs particularly in young and female patients. If the patella dislocates for the first time, treatment is usually conservative. However, this cautious approach carries the risk of recurrence and of secondary pathologies such as osteochondral fractures. An initial surgical treatment could possibly avoid these consequences of recurrent patella dislocation.MethodsA prospective, randomized-controlled trial design is applied. Patients with unilateral first-time patella dislocation will be considered for participation. Study participants will be randomized to either conservative treatment or to a tailored patella stabilizing treatment. In the conservative group patients will use a knee brace and will be prescribed outpatient physical therapy. The surgical treatment will be performed in a tailored manner, addressing the pathologic anatomy that predisposes to patella dislocation.The Banff Patellofemoral Instability-Instrument 2.0, recurrence rate, apprehension test, joint degeneration and the Patella Instability Severity Score will serve as outcome parameters. The main analysis will focus on the difference in change of the scores between the two groups within a two-year follow-up.Statistical analysis will use linear mixed models. Power analysis was done for the comparison of the two study arms at 2-year follow-up with regard to the BPII score. A sample size of N=64 per study arm (128 overall) provides 80% power (alpha=0.05, two-tailed) to detect a difference of 0.5 standard deviations in a t-test for independent samples.DiscussionAlthough several studies have already dealt with this issue, there is still no consensus on the ideal treatment concept for primary patellar dislocation. Moreover, most of these studies show a unified surgical group, which means that all patients were treated with the same surgical procedure. This is regarded as a major limitation as surgical treatment of patella dislocation should depend on the patient’s anatomic pathologies leading to patellar instability. To our knowledge, this is the first study investigating whether patients with primary patella dislocation are better treated conservatively or operatively with tailored surgery to stabilize the patella.Trial registrationThe study will be prospectively registered in the publicly accessible database www.clinicaltrials.gov.

Current concepts in the treatment of first-time patella dislocation in children and adolescents

“…There is disagreement about what procedure is indicated after the index injury. 23,24 Surgery needs to be considered individually for every patient. However, given that 50% to 70% of the children with first acute patellar dislocation will resolve without a second dislocation, routine corrective operation will not be justified for all patients.…”