AANA Lab Course 910 - Patellofemoral Joint Preservation-First-time Patella Dislocation- Risk Stratification and Osteochondral Solutions-Dr. Robert A. Magnussen, M.D., MPH

First-time Patella Dislocation- Risk Stratification and Osteochondral Solutions-Dr. Robert A. Magnussen, M.D., MPH

Pdf Summary

This presentation by Dr. Robert Magnussen addresses first-time patellar dislocations, focusing on risk stratification and osteochondral treatment options. Patellar dislocations are less common than ACL or meniscal injuries but notably cause significant disability, especially in young athletes. Epidemiologic data highlight higher injury rates in female gymnasts and boys’ football and wrestling, with girls showing a greater risk than boys in comparable sports.<br /><br />Traditionally, first-time dislocations are managed non-operatively using bracing, rest, ice, and physical therapy, while recurrent dislocations typically warrant surgery. However, non-operative management carries a high recurrence risk, reported between 20-50%. Patient-reported outcomes in those without recurrent dislocation still show reduced knee function and quality of life compared to controls, indicating room for improvement.<br /><br />Systematic reviews of randomized controlled trials comparing operative versus non-operative treatments reveal limitations, including short follow-up times and few studies focused on medial patellofemoral ligament (MPFL) reconstruction. There is increasing recognition that a one-size-fits-all approach is inadequate. Future care is likely to involve risk stratification, identifying patients at high risk for recurrence based on factors such as younger age, trochlear dysplasia, patella alta, and contralateral dislocation history, to tailor early surgical intervention accordingly.<br /><br />The presentation also covers osteochondral management in cases with loose bodies or cartilage injury. When possible, open reduction and internal fixation (ORIF) of osteochondral fragments is recommended to minimize post-traumatic osteoarthritis risk. Techniques include suture or screw fixation (metal or absorbable) or, if re-fixation is impossible, treatments like excision, marrow stimulation, osteochondral transplant, allograft, or autologous chondrocyte implantation.<br /><br />Overall, the key message is that improved outcomes may be achieved by individualized risk-based treatment strategies and appropriate osteochondral repair in first-time patellar dislocations.

Keywords

first-time patellar dislocation

risk stratification

osteochondral treatment

non-operative management

surgical intervention

medial patellofemoral ligament reconstruction

recurrence risk factors

osteochondral fragment fixation

post-traumatic osteoarthritis prevention

individualized treatment strategies