Treatment of First-time Patellar Dislocations and Evaluation of Risk Factors for Recurrent Patellar Instability.

Approximately one-third of skeletally mature patients with primary patellar dislocation will experience recurrent patellar instability over time. Because of the multifactorial combination of features contributing to overall stability of the patellofemoral joint, first-time patella dislocation presents a challenge to the treating physician. A detailed patient history, focused physical examination, and appropriate diagnostic imaging are essential for identifying risk factors for recurrent instability. Individual risk factors include young patient age, patella alta, trochlear dysplasia, and lateralization of the tibial tubercle. In combination these factors may pose even greater risk, and recently published predictive scoring models offer clinicians objective criteria to identify patients most at risk for recurrence. In patients at low risk of recurrence, nonoperative management can be effective, with "a la carte" surgical treatments gaining popularity in those with a higher than acceptable risk of re-dislocation.