title: An Algorithmic Approach to the Management of Recurrent Lateral Patellar Dislocation.
abstract: High-level evidence supports nonoperative treatment for first-time lateral acute patellar dislocations. Surgical intervention is often indicated for recurrent dislocations. Recurrent instability is often multifactorial and can be the result of a combination of coronal limb malalignment, patella alta, malrotation secondary to internal femoral or external tibial torsion, a dysplastic trochlea, or disrupted and weakened medial soft tissue, including the medial patellofemoral ligament (MPFL) and the vastus medialis obliquus. MPFL reconstruction requires precise graft placement for restoration of anatomy and minimal graft tension. MPFL reconstruction is safe to perform in skeletally immature patients and in revision surgical settings. Distal realignment procedures should be implemented in recurrent instability associated with patella alta, increased tibial tubercle-trochlear groove distances, and lateral and distal patellar chondrosis. Groove-deepening trochleoplasty for Dejour type-B and type-D dysplasia or a lateral elevation or proximal recession trochleoplasty for Dejour type-C dysplasia may be a component of the treatment algorithm; however, clinical outcome data are lacking. In addition, trochleoplasty is technically challenging and has a risk of substantial complications.
authors.affiliation: Sports Medicine and Shoulder Service, MedSport, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan.
authors.forename: Alexander E
authors.initials: AE
authors.lastname: Weber
authors.affiliation: Sports Medicine and Shoulder Service, MedSport, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan.
authors.forename: Amit
authors.initials: A
authors.lastname: Nathani
authors.affiliation: Hospital for Special Surgery, New York, New York Long Island Jewish Medical Center, New Hyde Park, New York.
authors.forename: Joshua S
authors.initials: JS
authors.lastname: Dines
authors.affiliation: Hospital for Special Surgery, New York, New York.
authors.forename: Answorth A
authors.initials: AA
authors.lastname: Allen
authors.affiliation: Hospital for Special Surgery, New York, New York.
authors.forename: Beth E
authors.initials: BE
authors.lastname: Shubin-Stein
authors.affiliation: Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Arendt
authors.affiliation: Sports Medicine and Shoulder Service, MedSport, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan abedi@med.umich.edu.
authors.forename: Asheesh
authors.initials: A
authors.lastname: Bedi
mesh_terms: D000465:Algorithms; D001915:Braces; D003131:Combined Modality Therapy; D003661:Decision Support Techniques; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D019637:Orthopedic Procedures / Q000379:methods*; D031222:Patellar Dislocation / Q000175:diagnosis / Q000209:etiology / Q000601:surgery* / Q000628:therapy; D017847:Patellar Ligament / Q000601:surgery; D026741:Physical Therapy Modalities; D012008:Recurrence