Should we consider early surgery for patella dislocations?

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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.

To learn more about the treatment of patella instability complete the ‘Knee’ module in the FIFA Diploma in Football Medicine.

References

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

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Carlos Alberto Vieira de Melo
19 mars 2018 0:38

Na minha opinião, se foi a primeira luxação, devemos considerar o tratamento conservador, tendo como linha de raciocínio o exame físico e os exames de imagens

drlabelle
16 mars 2018 1:06

Thought provoking it is…. but we are missing a lot of valuable information in this summary and in the linked abstract. Unfortunately, this is not a source I have access to.

My wife is a methodologist so I know that without looking in depth at these articles I can’t draw any insights at all.

Outcomes – re-dislocation rate alone is not enough
1. What was the rate of surgical complication?
2. Were the return-to-play criteria for each study identical?
3. Was gender and level of competition matched?

Patrick L
http://www.biomechanicssrc.com

ANY
ANY
15 mars 2018 19:32

Anyway i have different believes pertaining to Patella dislocations. This syndrome has paved AWAY the lives and careers of most our great players within globe. However, the country like the Gambia my country has emulated more unproductive youth players as a result of mismanaged. On the matter surgery should be last option as this is a platform where most of us are motivated and love promote health.

metty
15 mars 2018 10:14

i strongly support the idea,leave alone patella dislocation but also recurrent shoulder dislocation,i have experienced so many such cases , surgery is the best RX.

Karamo B Touray
15 mars 2018 1:29

As far as my opinion on this is that surgery is irreversible when most part are opersted, there is a likelihood that the injured player might not return to competive football again. In my country the Gambia, countless of players are assisted by me not surgery especially when joints instability. We have checked and try uncooperative both conservative treatment and traditional physiotherapy especially countries that are well established in terms of football medicine.

Bangoura
11 mars 2018 20:07

En médecine du football les décisions chirurgicales doivent être accompagnées d une nécessite
Devant un cas de rupture alimentaire entraînant une éventuelle luxaton la décision chirurgicale s impose pour empêcher une éventuelleluxation recidivente le traitement le plus sur et le plus fiable
En conclusion une décision chirurgicale précise est la bonne

ion recidivente

Oola Stephen Kidega
08 mars 2018 17:49

Its a good insight into how patella injuries. However, I think its still early to draw conclusions based on meta-analysis even though its a good step in the direction to base on for routine clinical practice. I would suggest other studies using other methods to confirm this is done. How about the long term effects full recovery issues

stevengriffith
06 mars 2018 13:04

When I read the raw data the difference is not that significant. Where FIFA qualified and r recommended practitioners were compared that would be impressive. Many of us aware how soon a dislocation or subluxation are reset know the ischarmic response is negligible and FIFA teach us in shoulder to reset on or off the field. Minutes hours days weeks and months delayed extend the iscarmic response plus physical therapy has less side effects than surgery. The 12 month follow thru change and the 5 year recovery rate inverts the idea for surgery. However if the player is on a… Lire la suite »

Mateusz Stec
06 mars 2018 12:48

Thanks

nkuna felix
06 mars 2018 10:45

interesting but we need more researches on this outcome

Yannette
20 juin 2020 5:12

Este tipo de lesiones generan inestabilidad articular por esto es importante conocer inicialmente la condición musculoesqueletica del atleta y posteriormente idear planes personalizados para permitir el fortaleciendo muscular que aumentará la estabilidad dinámica de una de las articulaciones más utilizadas en la práctica del futbol como lo es la articulación patelofemoral.