Abstract
Background:
Non-operative management remains the standard of care for first-time patellofemoral dislocations without associated osteochondral injuries. While substantial research has identified predictors of recurrence and need for surgery, limited data exist on patients managed non-operatively who do not experience redislocation. Prior studies suggest this group may report worse outcomes compared to healthy controls, but their outcomes compared to operatively managed patients remain unclear.
Objectives:
This study aimed to compare patient-reported outcomes (PROs) between individuals treated non-operatively for a first-time dislocation without recurrence and those treated operatively. We hypothesized that PROs would be similar between groups at two years.
Methods:
Patients were drawn from the multicenter, prospective Justifying Patellar Instability by Results (JUPITER) cohort. 27 surgeons from 12 U.S. academic institutions enrolled patients with patellar instability from January 2017 to July 2022. Included were patients with a first-time dislocation who either underwent surgery or were treated non-operatively and had no recurrent instability within two years. Exclusions included patients with redislocation or missing treatment data. Baseline demographic and clinical characteristics (age, sex, BMI, Beighton score, pre-op J-sign, and apprehension) were compared. PROs (KOOS subscales, Pedi-FABS, Pedi-IKDC, Banff Patellar Instability Index 2.0, and Kujala) were assessed at baseline, 1-, and 2-years. Return to sport (RTS) was also recorded.
Results:
A total of 630 patients met inclusion criteria: 343 non-operative and 287 operative. Groups were similar in sex and BMI. The non-operative group was significantly older (16.6 vs. 15.8 years, p < 0.05) and had lower Beighton scores (3.1 vs. 3.8, p < 0.05), apprehension rates (70% vs. 82%, p < 0.005), and J-sign frequency (53% vs. 71%, p < 0.005). Baseline PROs were significantly higher in the non-operative group for KOOS-QOL, KOOS-Symptoms, IKDC, Kujala, and BANFF (p < 0.05). However, no significant differences in PROs were found between groups at one or two years. RTS rates (84% non-operative vs. 78% operative, p = 0.36) and return to the previous sport level (43% vs. 48%, p = 0.71) were also similar. The operative group showed greater PRO improvement from baseline to two years in IKDC, Kujala, and BANFF (p < 0.05).
Conclusion:
Patients treated non-operatively following a first-time patellar dislocation who do not experience a recurrent dislocation demonstrate similar patient-reported outcomes scores to those treated operatively following a first-time dislocation. Less than half of patients in either group return to sport at the same level or higher after first time patellar dislocation.