Purpose: Isolated reconstruction of the medial patellofemoral ligament (MPFL‐R) has become the predominant stabilizing procedure in the treatment of recurrent lateral patellar dislocation (LPD). To minimize the risk of re‐dislocations, isolated MPFL‐R is recommended in patients with no significant trochlea dysplasia and tibial tuberosity trochlear groove distance < 20 mm on computed tomography (CT). Incidentally, these criteria are the same that are used to identify first time LPD patients where conservative treatment is recommended. The purpose of this study was therefore to compare MPFL‐R with active rehabilitation for patients with recurrent LPD (RLPD) in absence of the above mentioned underlying anatomical high‐risk factors for further patellar dislocations.Methods: RLPD‐patients aged 12–30 without underlying anatomical high‐risk factors for further LPD were randomized into treatment either with isolated MPFL‐R or active rehabilitation provided and instructed by a physiotherapist. All patients underwent diagnostic arthroscopy for concomitant problems. The main outcome measure was persistent patellar instability at 12 months. Knee function at baseline and 12 months was asses using the following patient reported outcomes measures (PROMS); KOOS, Kujala, Cincinnati knee rating, Lysholm score and Noyes sports activity rating scale.Results: Between 2010 and 2019, 61 patients were included in the study (MPFL‐R, N = 30, Controls, N = 31). Persistent patellar instability at 12 months was reported by 13 (41.9%) controls, versus 2 (6.7%) in the MPFL‐group (RR 6.3 (95% CI 1.5–25.5). No statistically significant differences in activity level were found between the MPFL‐group and the Controls at neither baseline nor follow up. The patients with persistent instability at 12 months did not score significantly lower on any of the PROMs compared to their stable peers, regardless of study group.Conclusion: Patients with recurrent patellar dislocations have a six‐fold increased risk of persistent patellar instability if treated with active rehabilitation alone, compared to MPFL‐R in combination with active rehabilitation, even in the absence of significant anatomical risk factors. Active rehabilitation of the knee without MPFL‐R improves patient reported knee function after one year, but does not protect against persistent patellar instability.Level of evidence: 1.

Surgical treatment of young patients with recurrent lateral patella dislocation (RLDP) is often recommended because of loss of knee function that compromises their level of activity or even their daily life functioning. This situation is comparable to young patients with an anterior cruciate ligament (ACL) rupture. The purpose of this study was therefore to explore the time from injury to surgery and the pre-operative symptoms and knee function of young RLPD patients scheduled for stabilizing surgery and compare this group to age and sex-matched ACL-deficient patients. Forty-seven patients with unilateral RLPD listed for isolated medial patellofemoral ligament reconstruction were included in the study (RLPD-group). This group was compared to an age, sex and BMI matched ACL patient group obtained from the Norwegian knee ligament registry (ACL-group) for the following outcome measures: the knee injury and osteoarthritis outcome score (KOOS) assessed on the day of surgery and time from injury to surgery. The RLPD-group scored significantly lower than the ACL-group for the three KOOS subscales “Pain” (73.6 vs. 79.8, p < 0.05), “Symptoms” (71.7 vs. 79.3, p < 0.05) and “ADL” (84.7 vs 89.5, p < 0.05). The lowest KOOS values were found for Sports/Recreation (53.5 vs. 51.3, p = 0.65) and Quality of life (37.6 vs. 36.7, p = 0.81). The average time from primary injury to surgery was 6 months for the ACL group and 31 months for the RLPD group. RLPD affected knee function as much as ACL deficiency, and was associated with more pain. Still the RLDP patients waited on average 5 times longer for surgery. The patients with RLPD consisted of patients who were examined for possible recruitment for a concurrent prospective randomized controlled trial comparing conservative treatment and isolated surgical medial patellofemoral ligament (MPFL) reconstruction (Clinical trials no: NCT02263807 , October 2014).

In 2013 the Scandinavian Neurotrauma Committee (SNC) published updated guidelines for the initial management of minimal, mild and moderate traumatic head injuries (MTHI) that included serum analysis of protein S100B as a marker for brain tissue damage. This study reviews the effectiveness of the new guidelines in a clinical setting. For all patients admitted to Akershus University Hospital (AHUS) from June 30th 2014 to December 15th 2014 with MTHI a separate form was filled in recording the time, indication and result of any S100B sampling and/or head computer tomography (CT) examinations. Data from these forms were compared to information derived from the electronic patient records for patients with MTHI and related diagnoses and data from the laboratory for all patients that had undergone the S100B analysis within the same period. Five hundred seventy-five patients were identified with MTHI, S100B sampling was indicated for 223 (38.8%) patients and carried out for 188 (84.3%) of these patients. 69 (36.7%) of the patients had a negative S100B test, but a head CT scan was still performed in 31 cases despite the negative S100B test. In total the guidelines were followed for 362 of 575 patients (63.0%). 180 (31.3%) of the MTHI cases were discharged without further observation or CT examinations, including 38 (21.1%) as a direct result of S100B testing. No re-admissions or missed initial traumatic brain injuries were observed. The implementation of the updated SNC guidelines resulted in direct discharge of more than one third of the MTHI cases without further observation or CT examinations. One in five of these discharges was a direct result of S100B testing. However, compliance to the guidelines were poor and the guidelines were only followed in 40%. While this study showed benefits of implementing SNC guidelines to reduce the number of CT scans, additional training is needed for optimal use.

Background: Medial patellofemoral ligament reconstruction (MPFL-R) is the primary surgical intervention for recurrent lateral patellar dislocation (LPD). Isolated MPFL-R is recommended for patients without anatomic high-risk factors that predispose to further dislocations. Purpose: To compare instability recurrence in patients with recurrent LPD without underlying anatomic risk factors treated with MPFL-R versus active rehabilitation. Study Design: Randomized controlled clinical trial; Level of evidence, 1. Methods: Patients aged 12 to 30 years with recurrent LPD and no underlying anatomic high-risk factors for further dislocations—specifically, no severe trochlear dysplasia (Dejour D) and a tibial tuberosity–trochlear groove distance ≤20 mm on computed tomography—were randomized to receive knee arthroscopy with isolated MPFL-R followed by active rehabilitation (MPFL group) or knee arthroscopy without reconstruction followed by active rehabilitation (control group). The primary outcome was subjective persistent patellar instability at 3 years. Knee function at baseline and 1 and 3 years was assessed by the following patient-reported outcome measure (PROM) scores: Knee injury and Osteoarthritis Outcome Score (KOOS), Kujala Knee Score, Cincinnati Knee Rating System, and Noyes Sports Activity Rating Scale. Results: Between 2010 and 2019, 61 patients (72.1% female) were included in the study and randomized, with 30 assigned to the MPFL group and 31 to the control group. At 3-year follow-up, subjective persistent patellar instability was reported by 5 patients in the MPFL group (16.7%) versus 15 patients in the control group (53.6%), corresponding to an odds ratio of 5.8 (95% CI, 1.7-19.4; P = .003). Both groups reported significant improvements in all PROM scores from baseline to 3 years. However, no significant differences in PROM scores were observed between the groups at any follow-up time point. Conclusion: Isolated MPFL-R was more effective than active rehabilitation alone in preventing patellar instability after 3 years. Trial Registration: ClinicalTrials.org (NCT02263807).

Purpose: To determine the incidence and treatment strategy for patellar instability in the Norwegian healthcare system. Methods: Clinicians from all regional health regions were invited to contribute to the development of a cross‐sectional survey of the current national clinical practices for managing this patient group. A tailored questionnaire was developed to determine how many hospitals in Norway performed patellar stabilization surgery and which surgical procedures and postoperative routines were used. Specifically, the following variables were included: number of procedures performed in 2023, types of procedures, treatment of children, choice of graft for primary MPFL reconstruction, routine use of orthoses and postoperative restrictions. Results: A survey was conducted among 68 hospitals, of which 35 reported performing patellar stabilisation procedures. The total number of procedures recorded was 532, yielding an incidence rate of 9.6 per 100,000 people. The number of procedures varied significantly among hospitals, with most performing between five and 20. All hospitals conducted medial patellofemoral ligament reconstruction, while 28 included bony procedures, and only seven performed derotational osteotomies. The preferred graft was gracilis (89%), and the most common fixation method on the femur was intrerference screw (60%). Postoperatively, only 20% of hospitals routinely recommended orthoses, primarily after tibial tuberosity osteotomy (86%). Restrictions on knee flexion were advised by 86% of respondents for up to eight weeks, and weight‐bearing restrictions were recommended by all after tibial tuberosity osteotomy. Conclusions: This study offers an overview of patellar instability incidence and treatment in Norway, revealing significant variability in surgeries, procedures, restrictions, and follow‐up practices. This underscores the need for standardized guidelines and a national registry to improve patient outcomes and care quality. Future research should focus on evaluating long‐term outcomes of various surgical approaches and protocols to inform best practices. Level of Evidence: Level III.