Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Practice Guideline
. 2025 Dec;33(12):4197-4206.
doi: 10.1002/ksa.12637. Epub 2025 Mar 7.

Management of first-time patellar dislocation: The ESSKA 2024 formal consensus-Part 2

Peter Balcarek  1 , Lars Blønd  2 , Philippe Beaufils  3 , Marie Askenberger  4 , Joanna M Stephen  5 , Ramazan Akmeşe  6 , Rene El Attal  7 , Vasileios Chouliaras  8 , Paolo Ferrua  9 , Joan Minguell Monart  10 , Geert Pagenstert  11 , Petri Sillanpää  12 , Manuel Vieira Da Silva  13 , Florian Dirisamer  14 , Jacek Walawski  15
Affiliations
Practice Guideline

Management of first-time patellar dislocation: The ESSKA 2024 formal consensus-Part 2

Peter Balcarek et al. Knee Surg Sports Traumatol Arthrosc. 2025 Dec.

Abstract

Purpose: To provide recommendations for the treatment of patients with first-time patellar dislocation (FTPD). Part 2 focused on nonoperative treatment, bracing, rehabilitation, indications for surgery and surgical strategies.

Methods: The consensus was performed according to the European Society for Sports Traumatology, Knee Surgery and Arthroscopy consensus methodology.

Results: The consensus comprised 32 questions and statements, 19 of which will be presented in this part. Eight statements achieved strong agreement (median 9; range 7-9), and 11 statements achieved relative agreement (median 9; range 5-9). None were Grade A, 2 were Grade B, 11 were Grade C and 5 were Grade D. In summary, treatment decisions for FTPD should prioritize individualized care, balancing patient-specific risks and demands. Surgical options are increasingly considered for skeletally immature patients and those with increased recurrence risk. Medial patellofemoral ligament (MPFL) reconstruction is the preferred surgical technique for addressing medial soft tissue stabilizers, offering better outcomes than repair methods. Combining MPFL reconstruction with corrections of relevant bony risk factors might further reduce the risk of recurrence and revision surgery, although specific thresholds for intervention remain debated. Physical therapy is recommended as an essential complement to both operative and nonoperative treatments, but bracing offers no clear long-term benefit. Chondral or osteochondral lesions should be repaired when the defect is at least 1 cm² in the patellofemoral joint contact area. Fragment refixation or other cartilage restoration techniques are preferred, and delayed repair is favoured over fragment removal when immediate surgery is not needed.

Conclusion: The consensus consists of recommendations for evaluation and treatment strategies for managing FTPD. High levels of agreement were reached by experts throughout Europe. In areas without clear scientific evidence, this consensus aimed at providing recommendations and guidance on the basis of expert opinion and pointed out areas where further studies are necessary.

Level of evidence: Level I, consensus.

Keywords: MPFL; first‐time patellar dislocation; formal consensus; osteochondral lesion; outcome; patellar instability.

PubMed Disclaimer

Conflict of interest statement

Peter Balcarek reports consulting for Arthrex. Philippe Beaufils serves as the ESSKA Consensus Projects Advisor. Florian Dirisamer reports consulting for Arthrex and receives royalties from Arthrex Inc. Rene El Attal reports consulting for Arthrex, DepuySynthes and ZimmerBiomet. Geert Pagenstert reports consulting for DepuySynthes and Stryker. Joan Minguell reports consulting for Arthrex and Smith&Nephew. Petri Sillanpaa reports consulting for Inion LTD. Ramazan Akmeşe reports consulting for Smith&Nephew, and Jacek Walawski reports consulting for Arthrex, Moximed and Smith&Nephew. The remaining authors declare no conflicts of interest.

References

    1. Arendt EA, Askenberger M, Agel J, Tompkins MA. Risk of redislocation after primary patellar dislocation: a clinical prediction model based on magnetic resonance imaging variables. Am J Sports Med. 2018;46(14):3385–3390. - PubMed
    1. Askenberger M, Bengtsson Moström E, Ekström W, Arendt EA, Hellsten A, Mikkelsen C, et al. Operative repair of medial patellofemoral ligament injury versus knee brace in children with an acute first‐time traumatic patellar dislocation: a randomized controlled trial. Am J Sports Med. 2018;46(10):2328–2340. - PubMed
    1. 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(1):50–58. - PubMed
    1. Balcarek P, Oberthür S, Hopfensitz S, Frosch S, Walde TA, Wachowski MM, et al. Which patellae are likely to redislocate? Knee Surg Sports Traumatol Arthrosc. 2014;22(10):2308–2314. - PubMed
    1. Beaufils P, Dejour D, Filardo G, Monllau JC, Menetrey J, Seil R, et al. ESSKA consensus initiative: why, when and how? J Exp Orthop. 2023;10(1):101. - PMC - PubMed

Publication types