Surgical versus Nonsurgical Treatments of Acute Primary Patellar Dislocation with Special Emphasis on the MPFL Injury Patterns

Abstract

The objective of the present study was to compare the clinical results of the surgical versus nonsurgical treatments of acute primary patellar dislocations with a medial patellofemoral ligament (MPFL) injury in the nonoverlap region with the vastus medialis oblique. In this study, 62 patients with an acute patellar dislocation and a concurrent MPFL injury in the nonoverlap region were randomly divided into two groups based on their birth years (even vs. odd years) and received either surgical or nonsurgical treatment. Of the 62 eligible patients, 30 were in the nonsurgical treatment group (Group 1) and 32 were in the surgical group (Group 2). Patellar stability tests and the Kujala knee questionnaire were performed, and radiographs were evaluated for patellar tilt and the lateral shift ratio by two blinded investigators. An osteochondral injury was noted in six (23.1%) patients from Group 1 and five (16.7%) patients from Group 2, with no statistical difference between the two groups. The mean Kujala score was 80.19 ± 5.07 and 93.57 ± 4.03 ( < 0.001) between the surgical and nonsurgical groups, respectively. The mean patellar tilt was 8.96 ± 1.64 and 6.83 ± 1.44 degrees ( < 0.001) and the lateral shift ratio was 11.08 ± 1.99 and 9.23 ± 1.96 ( = 0.001) between the surgical and nonsurgical groups, respectively. This study showed that the surgical treatment of MPFL injuries in the nonoverlap region achieved better clinical outcomes and improved subjective knee function compared with conservative therapy. Surgery should therefore be considered as the treatment of choice for these specific injuries.

Surgical treatment of medial patellofemoral ligament injuries achieves better outcomes than conservative management in patients with primary patellar dislocation: a meta-analysis

“…This is consistent with the study conducted by Ji et al ,36 who performed an open repair of the MPFL based on their description to the MPFL injury pattern. They found that the femoral insertion of the MPFL is the main injury location in primary patellar dislocations and requires a ‘single-point fixation’ repair.…”

Functional Regions of the Medial Patellofemoral Ligament

“…After that, we compared the clinical results of the surgical versus nonsurgical treatments of acute primary patellar dislocations with a MPFL injury in the nonoverlap region with the VMO, and we concluded that the surgical treatment of the MPFL injuries in the nonoverlap region achieved better clinical outcomes and improved subjective knee function compared with the conservative therapy. 31 We confirmed our hypothesis that the MPFL with or without the VMO overlap is critical to the success of the treatment.…”

Clinical Outcomes After the Nonoperative Management of Lateral Patellar Dislocations: A Systematic Review

“…Four studies randomized both groups to nonoperative interventions. 2 , 39 , 45 , 49 Significant methodological weaknesses existed in the literature; information specifying the randomization protocol was lacking (eg, failing to specify who performed the random allocation sequence and enrolled/assigned participants) in up to 9 studies, ¶ 4 studies provided insufficient information regarding the interventions to permit replication, 2 , 7 , 35 , 46 4 did not specify the location of the population recruited, 7 , 24 , 38 , 46 3 studies provided no evidence for how the sample size was estimated (ie, showed no power calculations), 24 , 34 , 35 and 1 did not outline the follow-up period. 7 Only 3 studies satisfactorily reported CIs, making an assessment of the effect size difficult.…”