Blønd Lars, Askenberger Marie, Stephen Joanna, Akmeşe Ramazan, Balcarek Peter, El Attal Rene, Chouliaras Vasileios, Ferrua Paolo, Monart Joan Minguell, Pagenstert Geert, Sillanpää Petri, Da Silva Manuel Vieira, Walawski Jacek, Beaufils Philippe, Dirisamer Florian
Orthopedic Department, Zealand University Hospital, Køge, Denmark.
Aleris Hospital, Copenhagen, Denmark.
Knee Surg Sports Traumatol Arthrosc. 2025 May;33(5):1925-1932. doi: 10.1002/ksa.12620. Epub 2025 Feb 20.
To provide recommendations for the treatment of patients with first-time patellar dislocation (FTPD). Part I focused on clinical presentation, symptoms, diagnosis, evaluation and imaging.
Fifty-four orthopaedic surgeons and one physiotherapist from 20 countries across Europe were involved in the consensus, which was the FTPD. The consensus was performed according to the European Society for Sports Traumatology, Knee Surgery and Arthroscopy consensus methodology. The steering group designed the questions and prepared the statements based on the experience of the experts and the evidence in the literature. The statements were evaluated by the ratings of the peer-review groups before a final consensus was released.
The consensus consists of 32 questions and statements, 13 of which will be reviewed in Part 1 of the review. There is an inverse correlation between the intensity of trauma leading to FTPD and the underlying pathoanatomic risk factors, meaning that low trauma intensity usually indicates more severe underlying abnormalities. In addition to the clinical investigation, patient age, family history, bilateral symptoms of instability and injury mechanism should be evaluated. However, reliance can be placed not only on clinical examination but also on magnetic resonance imaging scans as soon as possible, which are considered mandatory for evaluating predisposing factors such as trochlear dysplasia and patella alta and for detecting osteochondral lesions, with the exception of asymptomatic patients. Importantly, it must be recognized that in addition to recurrent instability, which affects approximately 25% of patients, a variety of symptoms are experienced by 50% of patients, such as pain, swelling, giving way, functional and psychological limitations, and a reduction in sports participation, all of which reduce their quality of life. The complications after medial patellofemoral ligament reconstruction in patients with FTPD have not yet been established; however, we know from cohorts of heterogeneous patients that the most common complications are patellofemoral pain, a reduced range of motion and patellar fracture. In total, there were 13 statements that were all accepted and achieved, 6 with strong agreements and 7 with relative agreements. The general median agreement was 8 (range 7-9). None were graded A, two were graded B, seven were graded C and 4 were graded D.
In relation to the management of patients with first-time patellar luxation, we have worked with 13 questions and based on these we have achieved consensus on 13 statements.
Level I, consensus.
为首次髌骨脱位（FTPD）患者的治疗提供建议。第一部分聚焦于临床表现、症状、诊断、评估及影像学检查。
来自欧洲20个国家的54名骨科医生和1名物理治疗师参与了此次关于首次髌骨脱位的共识制定。该共识依据欧洲运动创伤、膝关节外科与关节镜学会的共识方法进行。指导小组根据专家经验和文献证据设计问题并准备陈述内容。在最终达成共识之前，由同行评审小组对陈述内容进行评分评估。
该共识包含32个问题和陈述，其中13个将在本综述的第一部分进行讨论。导致首次髌骨脱位的创伤强度与潜在的病理解剖学风险因素之间存在负相关，这意味着低创伤强度通常表明潜在异常更为严重。除了临床检查外，还应评估患者年龄、家族史、双侧不稳定症状及损伤机制。然而，不仅要依赖临床检查，还应尽快进行磁共振成像扫描，对于评估诸如滑车发育不良和高位髌骨等易感因素以及检测骨软骨损伤而言，磁共振成像扫描被认为是必不可少的，但无症状患者除外。重要的是，必须认识到，除了约25%的患者会出现反复不稳定外，50%的患者还会经历多种症状，如疼痛、肿胀、打软腿、功能和心理限制以及运动参与度降低，所有这些都会降低他们的生活质量。首次髌骨脱位患者内侧髌股韧带重建后的并发症尚未明确；然而，从异质性患者队列中我们了解到，最常见的并发症是髌股疼痛、活动范围减小和髌骨骨折。总共有13条陈述全部被接受并达成，6条为强烈同意，7条为相对同意。总体中位数同意率为8（范围7 - 9）。无A级，2条为B级，7条为C级，4条为D级。
关于首次髌骨脱位患者的管理，我们围绕13个问题开展工作，并基于这些问题就13条陈述达成了共识。
I级，共识。
