How to selectively treat acute patellar dislocation

  When patellar dislocation first occurs the joint will usually be significantly swollen at that time and there will be an accumulation of blood in the joint (caused by a tangential fracture of the osteochondral bone in the inner lower quadrant of the patella).  If there is no obvious free body formed by osteochondral fragments in the joint after MRI, and there is no obvious tear of the medial patellofemoral ligament, the patient may choose to undergo conservative treatment.  The steps I recommend for conservative treatment are as follows: 1. Arthrocentesis to draw out the accumulated blood in the joint; 2. Cotton splinting with pressure for at least one week to prevent further bleeding and swelling; 3. Splinting of the knee in the extended position for 3-4 weeks.  4. Practice straight leg raising and quadriceps contraction exercises every day; 5. After 4 weeks, remove the splint, start joint flexion exercises, strengthen muscle strength exercises, and gradually start heel lifting exercises and static squat exercises; 6. Review every two weeks at the clinic and adjust functional exercises according to the swelling and movement of the knee joint.  If there are obvious osteochondral blocks forming free bodies in the joint, and there are obvious tears in the medial patellar support band and medial patellofemoral ligament, I recommend immediate surgical treatment.  At this time, cleaning the small fragmented bone in the joint can prevent it from causing joint interlocking and affecting joint movement; while the osteochondral mass with a larger area can be surgically fixed with absorbable nails to the original tear site to prevent local osteochondral defects; surgical suturing of the medially torn supporting band and ligament tissue can further stabilize the joint and have a significant effect on preventing future recurrence.  After surgery, a gradual rehabilitation process is required to gradually restore the joint to its ideal functional state.