There are no current guidelines for optimal management of first-time patellar dislocation in children and adolescents. This study was conducted to develop consensus-based guidelines for management of first-time dislocation in adolescents.

Methods

A 29-question, case-based, multiple-choice survey was developed after 2-rounds of iterations by 20 members of the Patellofemoral Research Interest Group (PF RIG) of the PRISM society. The survey contained two case scenarios of first-time patellar dislocation in adolescents - one with and one without an osteochondral fracture. The survey was administered to primary sports medicine and orthopedic surgeons of the PRISM Society in April 2020 and the responses were analyzed. Consensus-based guidelines were generated when at least 66% of the respondents agreed.

Results

81/276 (29%) members responded to the survey. 6 consensus-based guidelines (Table 1) were generated from those responses. Areas of discordance were noted. There was no consensus between conservative (60%) and operative (40%) treatment of contralateral patellar dislocation. Free-text analysis revealed several variables that influence the decision-making process.

Conclusion

There are changes in trends related to management of first-time dislocation in adolescents. MRI, though not recommended for all patients with first-time dislocation, was obtained by 51% of respondents. The survey provides details of conservative treatment, including the role and duration of bracing and physical therapy. For first-time dislocation with an osteochondral fracture, concomitant patellar stabilization is preferred over isolated fixation. Simultaneous guided-growth for genu valgum correction is recommended. There were several variables that influenced the decision-making process and there were several areas of discordance. Further research studies on these parameters could potentially improve outcomes.

Significance

This study would provide consensus-based guidelines for management of first-time patellar dislocation with or without an osteochondral fracture

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Management of First-Time Patellar Dislocation: A Survey of Prism Members

Management of First-Time Patellar Dislocation: A Survey of Prism Members

Purpose

Methods

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Significance

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Management of First-Time Patellar Dislocation: A Survey of Prism Members

Management of First-Time Patellar Dislocation: A Survey of Prism Members

Purpose

Methods

Results

Conclusion

Significance