Traumatic patellar dislocation: nonoperative treatment compared with MPFL reconstruction using patellar tendon.
BACKGROUND
Over the long term, acute patellar dislocations can result in patellar instability, with high recurrence rates after nonoperative treatment.


OBJECTIVE
To compare the results of operative (reconstruction of the medial patellofemoral ligament [MPFL]) versus nonoperative treatment of primary patellar dislocation.


METHODS
Randomized controlled trial; Level of evidence, 1.


METHODS
Thirty-nine patients (41 knees) (mean age, 24.2 years; range, 12-38 years) with acute patellar dislocation were randomized into 2 groups. One group was treated nonoperatively with immobilization and physiotherapy, the other was treated surgically with MPFL reconstruction; both groups were evaluated with minimum follow-up of 2 years. The Kujala questionnaire was applied to assess pain and quality of life, and recurrence was evaluated. Pearson χ(2) or Fisher exact test was used in the statistical evaluation.


RESULTS
The statistical analysis showed that the mean Kujala score was significantly lower in the nonoperative group (70.8), when compared with the mean value of the surgical group (88.9; P = .001). The surgical group presented a higher percentage of "good/excellent" results (71.43%) on the Kujala score when compared with the nonoperative group (25.0%; P = .003). The nonoperative group presented a large number of recurrences and subluxations (7 patients; 35% of cases), whereas there were no reports of recurrences or subluxations in the surgical group.


CONCLUSIONS
Treatment with MPFL reconstruction using the patellar tendon produced better results, based on the analyses of posttreatment recurrences and the better final results of the Kujala questionnaire after a minimum follow-up period of 2 years.
Instituto Vita, São Paulo, SP, Brasil. isabela@vita.org.br
Alexandre Carneiro
AC
Bitar
Marco Kawamura
MK
Demange
Caio Oliveira
CO
D'Elia
Gilberto Luis
GL
Camanho
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D001915:Braces; D016009:Chi-Square Distribution; D002648:Child; D017679:Cryotherapy; D004599:Electric Stimulation Therapy; D005260:Female; D006801:Humans; D007103:Immobilization; D007593:Joint Instability / Q000601:surgery / Q000628:therapy*; D008297:Male; D031222:Patellar Dislocation / Q000601:surgery / Q000628:therapy*; D017847:Patellar Ligament / Q000293:injuries / Q000601:surgery*; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures / Q000379:methods*; D012008:Recurrence; D011795:Surveys and Questionnaires; D016896:Treatment Outcome