Management of first-time patellar dislocation: The ESSKA 2024 formal consensus-Part 2.

Abstract

Purpose: To provide recommendations for the treatment of patients with first-time patellar dislocation (FTPD). Part 2 focused on nonoperative treatment, bracing, rehabilitation, indications for surgery and surgical strategies.

Methods: The consensus was performed according to the European Society for Sports Traumatology, Knee Surgery and Arthroscopy consensus methodology.

Results: The consensus comprised 32 questions and statements, 19 of which will be presented in this part. Eight statements achieved strong agreement (median 9; range 7-9), and 11 statements achieved relative agreement (median 9; range 5-9). None were Grade A, 2 were Grade B, 11 were Grade C and 5 were Grade D. In summary, treatment decisions for FTPD should prioritize individualized care, balancing patient-specific risks and demands. Surgical options are increasingly considered for skeletally immature patients and those with increased recurrence risk. Medial patellofemoral ligament (MPFL) reconstruction is the preferred surgical technique for addressing medial soft tissue stabilizers, offering better outcomes than repair methods. Combining MPFL reconstruction with corrections of relevant bony risk factors might further reduce the risk of recurrence and revision surgery, although specific thresholds for intervention remain debated. Physical therapy is recommended as an essential complement to both operative and nonoperative treatments, but bracing offers no clear long-term benefit. Chondral or osteochondral lesions should be repaired when the defect is at least 1 cm² in the patellofemoral joint contact area. Fragment refixation or other cartilage restoration techniques are preferred, and delayed repair is favoured over fragment removal when immediate surgery is not needed.

Conclusion: The consensus consists of recommendations for evaluation and treatment strategies for managing FTPD. High levels of agreement were reached by experts throughout Europe. In areas without clear scientific evidence, this consensus aimed at providing recommendations and guidance on the basis of expert opinion and pointed out areas where further studies are necessary.

Level of evidence: Level I consensus.