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To determine the effectiveness of nonoperative and operative treatment of initial acute patellar dislocation, we reviewed the charts of 399 patients with the diag nosis of an acute dislocation, seen during a 30 year period. One hundred patients (103 knees) met the criteria for inclusion in the study. The average age of the patient at injury was 21.7 years (range, 9 to 72 years). Length of followup aver aged 8 years (range, 2 to 26 years). Retrospectively, we divided the patients into two groups, according to the examination of their unaf fected knee. Group I (69 knees) showed evidence on examination of congenital abnormality of the extensor mechanism in the unaffected knee, indicating a predis position to dislocate with less significant trauma. Group II (34 knees) showed no clinically perceptible congenital predisposition to dislocate based on examination of the unaffected knee. In the nonoperatively treated knees in Group I, there was a 52% (28/54) incidence of good or excellent results. The nonoperatively treated knees in Group II had a 75% (15/20) incidence of good or excellent results. Acute dislocation occurred more frequently in males than in females. Recurrence was rarer in patients whose initial dislocation had occurred when they were over 15 years old. Contrary to recently published reports, primary acute traumatic patellar dislocations can be treated with non operative therapy with good or excellent results. Initial evaluation should include examination of the uninvolved knee which, if found to have signs of congenital abnor mality, would indicate a worse prognosis.

A case of osteochondral fracture following acute patellar injury has been presented, demonstrating the usefulness of air arthrography in diagnosis of selected cases.

The factors predisposing to recurrent dislocation and the results of conservative treatment were investigated in 79 cases of patellar dislocation. Patella alta and subluxation were significantly more common in patients without than in those with a history of injury. No single predisposing factor caused more redislocation than any other. The tendency to redislocation was significantly greater in patients younger than 20 years of age than in those older than 20 years of age at the time of primary dislocation. Corroborating reports in a large literature on the disorder, the present experience validates conservative management for primary dislocations and surgical treatment for redislocations of the patella.

Seventeen cases of acute, first time, lateral patellar dislocations without fracture treated by immediate surgical repair were reviewed and evaluated. Nine patellar tendon realignments and 8 medial side reefing procedures were performed. There were no recurrences of patellar dislocation. Twelve knees were painful, of which 8 were rarely painful. All but one patient were satisfied with their results and participated in any desired sport. Surgical repair of acute patellar dislocation is advocated in the young patient who anticipates future participation in athletics.

Seventy-four patients with patellar dislocations and subluxations were treated with a procedure described by Trillat. The Trillat method consists of stepwise correction of predisposing anatomic abnormalities including lateral retinacular release, patellar tubercle transfer, and advancement of the vastus medialis, if necessary. The follow-up period in 42 knees was from two to nine years with an average of 4.2 years. The results were excellent in six knees, good in 28 knees, fair in five knees, and poor in three knees. Thorough intraarticular examination is essential. If significant patellofemoral arthritis is present, a Maquet procedure should be performed.