Recurrent Patella Dislocations: Our Experience on the Outcomes of Non-Operative Treatment and Operative Treatments with Screw Fixation of Vastus Medialis Obliquis Tendon

Introduction: Patellar dislocation is a common acute knee disorders occurring mostly in children and adolescents. The management option can be non-operative or operative with many surgical techniques available based on the patho-anatomy of the disorder. There is challenge in the management in patients with generalized ligament laxity and other anatomical abnormalities. The aim of the study is to report the outcome of 17 patients with recureent patella dislocation treated conservatively and surgically through the medial patella-femoral ligament (MPFL) repair and anchoring screw fixation to distal femur.  Methodology: This is a retrospective study of 17 patients treated for recurrent lateral patella dislocations at Orthopaedic Hospital Wamakko, Sokoto, Nigeria between October 2016 and April 2022. Patients who met the inclusion criteria were fully evaluated and treated either conservatively or surgically. Results: The average follow up period was 2.2 years (range 2 to 3.2 years). The average presentation time was 6.5 Months (range 1 to 12 Months), and the average age at presentation was 24 years (range 16 to 34 years). There were 7 males and 10 females; the affected right knees were 7, and for the left knees were 8 with 2 bilateral knees affected. For the atraumatic patella dislocation group (n=10), the average Beighton score was 6 (range 2 to 9), and the Q angle, the trochlear morphology and the Caton-Deschamp’s index were all normal. Among the 17 patients in the study, 12 were treated conservatively, and 5 were treated operatively by plication of the medial patello-femoral ligament (MPFL) with subsequent screw fixation of the Vastus medialis obliquus (VMO) tendon to the distal femur. The average preoperative and postoperative Kujala scores were 68/100 and 94/100 points respectively, and that of Lysholm scores were 72/100 and 96/100 points respectively. Conclusion: Both conservative and surgical management for recurrent patella dislocation can offer satisfactory outcomes if patients were appropriately selected. In patients with generalised ligamentous laxity, MPFL plication repair with VMO screw anchorage to the femur can be a key to a successful and a desirable long-term treatment outcome.