Acute Lateral Patellar Dislocation in Adults

  • Alfonso Vaquero-Pintado
  • E. Carlos Rodríguez-Merchán


Patellar instability is one of the most common problems of the knee affecting young people. The majority of cases of patellar dislocation can be reduced with gentle medial force on the patellar and extension of the knee. In a recent systematic review, no differences were found in terms of redislocation with nonoperative treatment in comparison with the natural history of the injury. All nonoperative treatments assessed showed good patient-reported results, despite the type of treatment used. There is no consensus about the time of nonoperative treatment and the rehabilitation protocol. In recent years, there is a slight evidence that supports close-chain exercises of quadriceps and gluteus and early weight bearing over open-chain exercises. In recent years, there is a slight evidence for operative treatment in first-time dislocations over nonoperative treatment. However, there is not a gold standard surgical procedure for addressing patellar dislocation, and more than 100 different techniques have been published. Medial repair is no longer advised for the treatment of first-time patellar dislocation. Medial patellofemoral ligament reconstruction has gained popularity in the last years. It has the advantage of addressing injuries affecting femoral attachment of the ligament while providing a strong, anatomic, and reliable reconstruction. However, it is not used routinely for the treatment of an acute dislocation.


Patellar dislocation Lateral Adults Diagnosis Treatment 


  1. 1.
    Fithian DC, Paxton EW, Stone ML, Silva P, Davis DK, Elias DA, et al. Epidemiology and natural history of acute patellar dislocation. Am J Sports Med. 2004;32:1114–21.CrossRefGoogle Scholar
  2. 2.
    Hsiao M, Owens BD, Burks R, Sturdivant RX, Cameron KL. Incidence of acute traumatic patellar dislocation among active-duty United States military service members. Am J Sports Med. 2010;38:1997–2004.CrossRefGoogle Scholar
  3. 3.
    Macnab I. Recurrent dislocation of the patella. J Bone Joint Surg Am. 1952;34:957–67.CrossRefGoogle Scholar
  4. 4.
    Goodfellow J, Hungerford DS, Zindel M. Patello-femoral joint mechanics and pathology. 1. Functional anatomy of the patello-femoral joint. J Bone Joint Surg Br. 1976;58:287–90.CrossRefGoogle Scholar
  5. 5.
    Insall J, Goldberg V, Salvati E. Recurrent dislocation and the high-riding patella. Clin Orthop Relat Res. 1972;88:67–9.CrossRefGoogle Scholar
  6. 6.
    Ward SR, Terk MR, Powers CM. Patella alta: association with patellofemoral alignment and changes in contact area during weight-bearing. J Bone Joint Surg Am. 2007;89:1749–55.PubMedGoogle Scholar
  7. 7.
    Colvin AC, West RV. Patellar instability. J Bone Joint Surg Am. 2008;90:2751–62.CrossRefGoogle Scholar
  8. 8.
    Terry GC, Hughston JC, Norwood LA. The anatomy of the iliopatellar band and iliotibial tract. Am J Sports Med. 1986;14:39–45.CrossRefGoogle Scholar
  9. 9.
    Vieira ELC, Vieira EA, da Silva RT, Berlfein PA dos S, Abdalla RJ, Cohen M. An anatomic study of the iliotibial tract. Arthroscopy. 2007;23:269–74.CrossRefGoogle Scholar
  10. 10.
    Desio SM, Burks RT, Bachus KN. Soft tissue restraints to lateral patellar translation in the human knee. Am J Sports Med. 1998;26:59–65.CrossRefGoogle Scholar
  11. 11.
    LaPrade MD, Kallenbach SL, Aman ZS, Moatshe G, Storaci HW, Turnbull TL, et al. Biomechanical evaluation of the medial stabilizers of the patella. Am J Sports Med. 2018;46:1575–82.CrossRefGoogle Scholar
  12. 12.
    Kruckeberg BM, Chahla J, Moatshe G, Cinque ME, Muckenhirn KJ, Godin JA, et al. Quantitative and qualitative analysis of the medial patellar ligaments: an anatomic and radiographic study. Am J Sports Med. 2018;46:153–62.CrossRefGoogle Scholar
  13. 13.
    Senavongse W, Amis AA. The effects of articular, retinacular, or muscular deficiencies on patellofemoral joint stability: a biomechanical study in vitro. J Bone Joint Surg Br. 2005;87:577–82.CrossRefGoogle Scholar
  14. 14.
    Goh JC, Lee PY, Bose K. A cadaver study of the function of the oblique part of vastus medialis. J Bone Joint Surg Br. 1995;77:225–31.CrossRefGoogle Scholar
  15. 15.
    Elias DA, White LM, Fithian DC. Acute lateral patellar dislocation at MR imaging: injury patterns of medial patellar soft-tissue restraints and osteochondral injuries of the inferomedial patella. Radiology. 2002;225:736–43.CrossRefGoogle Scholar
  16. 16.
    Zhang G-Y, Zheng L, Shi H, Ji B-J, Feng Y, Ding H-Y. Injury patterns of medial patellofemoral ligament after acute lateral patellar dislocation in children: correlation analysis with anatomical variants and articular cartilage lesion of the patella. Eur Radiol. 2017;27:1322–30.CrossRefGoogle Scholar
  17. 17.
    Dietrich TJ, Fucentese SF, Pfirrmann CWA. Imaging of individual anatomical risk factors for patellar instability. Semin Musculoskelet Radiol. 2016;20:65–73.CrossRefGoogle Scholar
  18. 18.
    Sanders TG, Morrison WB, Singleton BA, Miller MD, Cornum KG. Medial patellofemoral ligament injury following acute transient dislocation of the patella: MR findings with surgical correlation in 14 patients. J Comput Assist Tomogr. 2001;25:957–62.CrossRefGoogle Scholar
  19. 19.
    Askenberger M, Janarv P-M, Finnbogason T, Arendt EA. Morphology and anatomic patellar instability risk factors in first-time traumatic lateral patellar dislocations: a prospective magnetic resonance imaging study in skeletally immature children. Am J Sports Med. 2017;45:50–8.CrossRefGoogle Scholar
  20. 20.
    Kirsch MD, Fitzgerald SW, Friedman H, Rogers LF. Transient lateral patellar dislocation: diagnosis with MR imaging. AJR Am J Roentgenol. 1993;161:109–13.CrossRefGoogle Scholar
  21. 21.
    Le Corroller T, Dediu M, Champsaur P. Transient medial patellar dislocation: injury patterns at US and MR imaging. Skelet Radiol. 2009;38:519–23.CrossRefGoogle Scholar
  22. 22.
    Moiz M, Smith N, Smith TO, Chawla A, Thompson P, Metcalfe A. Clinical outcomes after the nonoperative management of lateral patellar dislocations: a systematic review. Orthop J Sports Med. 2018;6:2325967118766275.CrossRefGoogle Scholar
  23. 23.
    Mäenpää H, Lehto MU. Patellar dislocation. The long-term results of nonoperative management in 100 patients. Am J Sports Med. 1997;25:213–7.CrossRefGoogle Scholar
  24. 24.
    Erickson BJ, Mascarenhas R, Sayegh ET, Saltzman B, Verma NN, Bush-Joseph CA, et al. Does operative treatment of first-time patellar dislocations lead to increased patellofemoral stability? A systematic review of overlapping meta-analyses. Arthroscopy. 2015;31:1207–15.CrossRefGoogle Scholar
  25. 25.
    Smith TO, Donell S, Song F, Hing CB. Surgical versus non-surgical interventions for treating patellar dislocation. Cochrane Database Syst Rev. 2015:CD008106.Google Scholar
  26. 26.
    Amis AA, Firer P, Mountney J, Senavongse W, Thomas NP. Anatomy and biomechanics of the medial patellofemoral ligament. Knee. 2003;10:215–20.CrossRefGoogle Scholar
  27. 27.
    Tom A, Fulkerson JP. Restoration of native medial patellofemoral ligament support after patella dislocation. Sports Med Arthrosc Rev. 2007;15:68–71.CrossRefGoogle Scholar
  28. 28.
    Nikku R, Nietosvaara Y, Kallio PE, Aalto K, Michelsson JE. Operative versus closed treatment of primary dislocation of the patella. Similar 2-year results in 125 randomized patients. Acta Orthop Scand. 1997;68:419–23.CrossRefGoogle Scholar
  29. 29.
    Nikku R, Nietosvaara Y, Aalto K, Kallio PE. Operative treatment of primary patellar dislocation does not improve medium-term outcome: a 7-year follow-up report and risk analysis of 127 randomized patients. Acta Orthop. 2005;76:699–704.CrossRefGoogle Scholar
  30. 30.
    Palmu S, Kallio PE, Donell ST, Helenius I, Nietosvaara Y. Acute patellar dislocation in children and adolescents: a randomized clinical trial. J Bone Joint Surg Am. 2008;90:463–70.CrossRefGoogle Scholar
  31. 31.
    Dean CS, Chahla J, Serra Cruz R, Cram TR, LaPrade RF. Patellofemoral joint reconstruction for patellar instability: medial patellofemoral ligament reconstruction, trochleoplasty, and tibial tubercle osteotomy. Arthrosc Tech. 2016;5:e169–75.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Alfonso Vaquero-Pintado
    • 1
  • E. Carlos Rodríguez-Merchán
    • 1
  1. 1.Department of Orthopedic Surgery“La Paz” University Hospital-IdiPazMadridSpain

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