Primary and recurrent patellar dislocation: recommendation fordiagnostic evaluation, risk stratification and treatment

Abstract

The dogma that (every) primary patellar dislocation should be treated non-operatively is considered outdated. Therefore, every first-time dislocation, as well as every recurrent dislocation, should be fully diagnosed with regard to the injury pattern and anatomically predisposing risk factors. This enables the use of risk stratification models to assess the risk of recurrent episodes of instability, thereby supporting the clinical decision-making process. The reconstruction of the MPFL can be considered an established and successful treatment strategy for patellar instability. However, the additional correction of bony risk factors is often useful. In this context, the preoperative grading of the Jsign and dynamic assessment of patellar instability (dynamic apprehension test) are of utmost importance. These findings, combined with the radiographic imaging findings, can be used as a clinical decision aid for a bony correction procedure.