Editorial Commentary: Patellofemoral stabilization for first-time dislocation in skeletally immature patients achieves excellent outcomes yet indications remain unclear.

Abstract

Historically, initial management of patellofemoral instability without osteochondral fracture consists of bracing and physical therapy, but up to 50% of skeletally immature patients may develop recurrent instability. Recent studies suggest that patients with first time dislocations may benefit from surgical stabilization. Risk stratification is essential; those with ligamentous laxity, increased patellar height, and trochlear dysplasia have higher failure rates with nonoperative management. Surgery in skeletally immature patients also entails risk. We recommend conservative management to the majority of patients with a first-time patellar dislocation. Patients with high-risk features are counseled candidly about their elevated risk of failure potentially requiring surgery.