Surgeon and physiotherapist approaches to operative or non-operative management of people with recurrent patellar dislocation: A case-based UK survey

Background: Physiotherapists are often key decision-makers on when to refer patients with recurrent patellar dislocation for surgical opinion. Limited guidance exists to aid this decision. Differences in orthopaedic surgeons’ and physiotherapists’ views on which patients and when to refer people for surgical consideration or non-operative care may affect outcome. This study aimed to explore orthopaedic surgeons and physiotherapists decision-making surrounding treatment opinions for patients with recurrent patellar dislocation. Methods: An online survey performed. UK registered and practicing orthopaedic surgeons and physiotherapists were invited to participate. The survey utilised two vignettes and a series of related questions to ascertain respondents' views on decision-making to surgical referral for people with recurrent patellar dislocation. Data were analysed using descriptive statistics and inferential statistical tests to explore factors related to responses. Results: 84 respondent surveys were analysed (38 surgeons, 46 physiotherapists). Overall, there was a low level of agreement amongst respondents for the management of the vignettes (k = 0.215, p=< 0.0005). Some disparity existed between the professions on the definition of recurrent patellar dislocations and the clinical features which may require an early surgical assessment. Physiotherapists were three times more likely to delay a surgical opinion for the vignettes presented in this study than the surgeons. Conclusion: This is the first study to investigate orthopaedic surgeons’ and physiotherapists’ views on decision-making around surgical or non-operative management for recurrent patellar dislocations. High-quality research is required to underpin explicit guidance on decision-making regarding management of recurrent patellar dislocation