Acute dislocation of the patella: should these patients be operated on more often?

Primary patellar dislocations should be operated on more often after the first dislocation. The role of surgery for first-time traumatic patellar dislocations is emerging as a reasonable treatment strategy. In highly active patients under 25 years of age with a pathoanatomy predisposing to recurrent dislocation (trochlear dysplasia associated or not with patella alta) surgical treatment could be considered as a first line of treatment in the first-time patellar dislocation because the recurrence risk is unacceptably high. This recommendation is based on recurrence predictive models after a first-time patella dislocation and in cost effectiveness economic models. Moreover, we must incorporate individual circumstances and preferences (patient’s goals such as sports) into the decision protocols. Obviously we need high quality clinical trials describing anatomical abnormalities and medial patellofemoral ligament (MPFL) tear site, ideally multicentric ones, which compare surgical and conservative treatments after a first-time lateral patellar dislocation to definitely answer the question we ask ourselves in this paper.