Does early operative treatment improve outcomes of primary patellar dislocation? A systematic review

Background: Patellar dislocation is a common injury that frequently affects young, active patients. Management of acute primary patellar dislocation has historically been conservative; however, multiple randomized studies have recently been published comparing nonoperative and operative management of primary patellar dislocations. We hypothesized that early operative management of acute patellar dislocations would decrease recurrent instability and improve patient outcomes. Methods: A systematic review of the literature was undertaken to compare the risk of recurrent patellar dislocation and instability and patient-reported outcome scores of early operative intervention compared with nonoperative management of acute primary patellar dislocations. Results: Seven randomized controlled trials were identified. Patient populations and surgical techniques varied greatly among the studies, precluding meta-analysis. Three of seven studies reported decreased risk of recurrent dislocation and instability with operative treatment. Two of seven studies reported improved Kujala scores with operative management. Conclusions: There are currently insufficient data to determine whether operative management of primary patellar dislocations decreases the risk of recurrent dislocation or subjective instability. Clinical Relevance: Additional studies comparing modern surgical treatment with nonoperative management with careful assessment of known risk factors for recurrent dislocation are needed.