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J Knee Surg 2022; 35(10): 1056-1062
DOI: 10.1055/s-0042-1749079
Special Focus Section

Differences in Outcomes between Patellar Dislocations Managed in Emergent versus Non-Emergent Care Settings

Chad E. Cook 
1   Department of Orthopaedics, Duke University, Durham, North Carolina
2   Department of Population Health Sciences, Durham, North Carolina
3   Division of Musculoskeletal and Surgical Sciences, Duke Clinical Research Institute, Durham, North Carolina
,
Mohammad Saad
1   Department of Orthopaedics, Duke University, Durham, North Carolina
,
Christopher J. Tucker
4   Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
5   Department of Surgery, Uniformed Services University of Health Sciences, 4301 Jones Bridge Road, Bethesda, Maryland
,
Kyong S. Min
6   Department of Orthopedic Surgery, Tripler Army Medical Center, Honolulu, Hawaii
,
Richard B. Westrick
7   Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts
,
Daniel I. Rhon 
6   Department of Orthopedic Surgery, Tripler Army Medical Center, Honolulu, Hawaii
7   Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts
› Author Affiliations
Funding This research was supported in part by an appointment to the Department of Defense (DOD) Research Participation Program administered by the Oak Ridge Institute for Science and Education (ORISE) through an interagency agreement between the U.S. Department of Energy (DOE) and the DOD. ORISE is managed by ORAU under DOE contract number DE-SC0014664.
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Abstract

Patellar dislocations occur at a much higher rate in military than civilian populations. Past population-level studies have shown that surgical management is as good as or superior to conservative care and may reduce future reoccurrences. Although in acute cases and in civilian clinics, patellar dislocations are usually managed first in an emergent care setting, previous work suggests this can lead to increased costs. This study compared differences in downstream care type and intensity of services based on whether initial care occurred in emergent or non-emergent care settings. In our sample of 1,523 Military Health System (MHS) beneficiaries with patellar dislocation and 2-year follow-up, we found non-significant differences in costs, intensity of services, and rates of surgical repair regardless of whether the patient was initially seen in an emergent versus non-emergent care setting. Although we found significant increases in the use of imaging, patellar dislocation-related medical visits, and frequency of closed treatment approaches in emergent care settings, these values were very small and likely not clinically significant. These findings, which included all the patellar dislocations reported across the entire MHS in a 24-month period, suggest that neither emergent nor non-emergent care settings are likely to influence the long-term care received by the individual.

Keywords

patellofemoral pain syndrome - physical therapy - dislocation - military medicine

Disclaimer

The view(s) expressed herein are those of the author(s) and do not necessarily reflect the official policy or position of the Uniformed Services University, Brooke Army Medical Center, Madigan Army Medical Center, U.S. Army Research Institute of Environmental Medicine, the Department of the Army, the Department of Defense, or the United States Government.




Publication History

Received: 07 January 2022

Accepted: 15 March 2022

Article published online:
12 July 2022

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