So, in case someone in here has been living in a box, this is Patrick Mahomes, the quarterback for the Kansas City Chiefs, who just won the Super Bowl last week and won the Super Bowl before that. On October 17, 2019, this young 24-year-old was doing a quarterback sneak and had a traumatic dislocation, first-time dislocation of his patella. This spurred Google searches all over the world. The patella little bone, that little malign bone, has never been so popular. It was so popular that Mo Bhandari, the newly crowned editor-in-chief of JBGS, had a whole series of podcasts with everyone wondering what they were going to do with Patrick Mahomes. He dragged a whole bunch of experts onto his podcast, and some of you may be in this room, and they went on discussing all the risks and benefits of surgery versus not in a first-time dislocator in these high-end athletes. Mo Bhandari, though, is the king of ortho-evidence, and he brought us back to ground and went through a review of the Cochrane Library. In fact, this issue was so big that the Cochrane Library has actually been revised since then. So this is actually a newer version in 2023, and you'd like to think that the nice little patella bone spurred that. Anyway, Cochrane Library, I won't go through it all, but the bottom line was, it is uncertain if surgery reduces the risk of redislocation. It is uncertain whether surgery improves patient-related knee function scores and made no difference to how satisfied patients were. We all know that all patients are not created the same, and all patella femoral joints are not created the same. So this got everybody thinking, many of our patients are different. Surely there's some that will do fine with no surgery, and some we should operate on right away because you know exactly what will happen, like with Corey's case. So classifications came up trying to stratify these patients. This was ours. We published in the early 2010s. Then Peter Balcrat came up with a patellar ISS. I can't put that together because it just doesn't work so well. So he put numbers on and points to the different risk factors for patellar instability. And if you take our kid here, our rugby player, he adds up to a big old one. So when you ask which patella are likely to redislocate, this boy scores quite lowly. Then Mario Havazy, who's younger and smarter than most of us, came up with the RIP, which was a much better acronym. And he did a similar thing looking at scores, but he is young enough to have made an online calculator. So I took the liberty of entering our young friend in here. And you can see he ended up with two points, which was an intermediate risk, which is only based on his age, and a 30% risk of redislocation. If you drill that down, though, he would be that middle line. Intermediate risk. And that 30% risk is at five or 10 years. But at one year, he's only at a 16% risk of redislocation. So in this young boy, when he has minimal risk factors, we'd never do conservative management. I don't treat anyone conservatively. He has extremely aggressive non-operative management, which means a really detailed rehabilitation program and core strengthening. He will get back to sport in three to four weeks. He'll have a very low risk of redislocurance, somewhere between 10% and 30%. And if he gets through a season, you can always change your mind in the off-season. If you operate on this kid, he ain't going back to sport, three to six months till they can return to sport. Sure, you might have reduced his risk of redislocation, but that might be where it was anyways. And all those risks of surgery. He might end up with a stiff knee, or an affected knee, or a DVT, or he might die. So then he won't be playing any more rugby. So thank you very much. And here's my plug to come to Munich.

Patrick Mahomes

patellar dislocation

surgery vs non-surgical treatment

classification systems

aggressive non-operative management