BLOG: Model proposed to predict recurrent instability after first-time patellar dislocation

Issue: September 2016

Recurrent instability following first-time patellar dislocation has been reported in 15% to 44% of patients, which Shital N. Parikh, MD, noted in this Patellofemoral Update. He reviewed efforts to identify risk factors to predict failure of nonoperative treatment of patellar dislocation, including a prediction model for recurrent instability.

Perspective from Prof. Simon T. Donell, MD

The perspective on this topic is from Simon T. Donell, MD, of the United Kingdom, who suggests the emphasis should be on improving rehabilitation for patients with first-time patellar dislocation.

Patellofemoral Update focuses on the causes, prevention and treatment of patellofemoral disorders. The blog is sponsored by the Patellofemoral Foundation whose mission is to improve the care of individuals with anterior knee pain through targeted education and research. The Patellofemoral Foundation offers additional online education resources on its website.

Members of the Patellofemoral Foundation review and add clinical perspective to recently published studies on the causes, prevention and treatment of patellofemoral disorders. The twice monthly blogs are edited by John P. Fulkerson, MD, and can be found on www.healio.com/orthopaedics. To read all the Patellofemoral Update blogs, click here.

Perspective

Prof. Simon T. Donell, MD

Nonoperative treatment of first-time patellar dislocation (PD) is the standard treatment. As outlined by Parikh, PD is multifactorial. A number of points need to be considered. Patients with a family history of recurrent PD cope well with self-reduction. The more dysplastic the trochlea, the less likely there will be significant chondral damage. Loss of articular cartilage in the patellofemoral joint does not equate with pain; patellofemoral degeneration is a common incidental finding in patients older than 50 years. Finally, the Kujala score is not valid for assessing patellar instability. Therefore, the argument for undertaking an operation for first-time PD (to avoid chondral damage and to avoid further dislocation) is clinician-centric and not patient-centric. I would suggest at this stage that concentrating on improving rehabilitation by regaining torsional control of the femur through gluteal muscle exercises is still the better option.

Prof. Simon T. Donell, MD

Norfolk and Norwich University Hospital

United Kingdom

Disclosures: Donell reports no relevant financial disclosures.