The results of a recent (relatively small) meta-analysis have suggested that early surgical treatment results in lower rates of re-dislocation, and better outcome scores, when compared with physiotherapy.
Patella dislocations typically occur after twisting injuries to the knee. They most commonly occur in young athletes and can be associated with significant morbidity. The vast majority of patella dislocations occur in a lateral direction. This disrupts the medial retinaculum and medial patellofemoral ligament (MPFL), creating a haemarthrosis. Unfortunately there is a high rate of recurrence, with rates approaching 50%. In most cases, when there has not been an associated osteochondral injury, a trial of rehabilitation is generally advised. This meta-analysis however suggests that we should at least consider early surgical management.
The paper has compared the clinical outcomes following the surgical management of MPFL injuries compared with conservative treatment in patients with primary patella dislocation. Four randomised controlled trials were included (a total of 171 patients). The surgical procedures involved either reconstruction or repair of the MPFL. The conservative management group received physiotherapy. The outcomes evaluated were the rate of recurrent dislocation of the patella and the Kujala score.
The results of the analysis favoured surgical management in reducing the re-dislocation rate (6.74%) in comparison with the rehabilitation group (28.5%) (P<0.001). The surgical group also had significantly higher Kujala scores (70.8) compared with the conservative group (59.8) (P<0.001).
While it is too early to consider a blanket recommendation suggesting early surgery for all cases of patella instability, this paper is thought-provoking. Perhaps we should be advocating early surgery in the more elite or high-demand player as well as those with more physical occupations.
Hussein A, Sallam AA, Imam MA et al. Surgical treatment of medial patellofemoral ligament injuries achieves better outcomes than conservative management in patients with primary patellar dislocation: a meta-analysis. Journal of ISAKOS: Joint Disorders & Orthopaedic Sports Medicine Dec 2017