Every year, around 2,000 people in the UK undergo surgery for a kneecap that repeatedly pops out of place, at a cost of roughly £5 million to the health service. This matters because no one knows whether surgery or a structured programme of physiotherapy—called Personalised Knee Therapy—is the better long-term option for these patients, most of whom are teenagers and young adults. Recurrent patellar dislocation causes pain, cartilage damage, and leads to early arthritis, yet treatment varies widely across the country without evidence to guide it. The REPPORT trial will randomly assign 276 participants to either surgery or the non-surgical therapy and track their knee function, pain, and quality of life for two years. If the physiotherapy package proves as effective as or better than surgery, it could spare thousands of young people from undergoing an operation, reduce NHS costs, and provide clear national guidelines where none currently exist. If surgery proves superior, the trial will justify its continued use. Either way, the results will directly inform clinical practice and NICE guidance, ending the current guesswork in treating this disabling condition.
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Background Recurrent dislocation of the patella is a profoundly disabling condition mostly affecting people in their second and third decade of life. Recurrent dislocations markedly affect function and cause pain, cartilage and soft tissue injury and future arthritis. Recurrent patellar dislocation may be managed with physiotherapy or surgery. It is unknown which strategy is best with substantial variation in practice. Around 2,000 surgical cases/year are performed in the UK (cost~£5M). Non-surgical care including physiotherapy may be cheaper, safer and could be as, or more, effective. A randomised trial is urgently needed to determine which strategy is best for patients. Research Question For people presenting with recurrent patellar dislocation, which management decision between personalised knee therapy or surgical care most improves participant-reported function and which is the most cost-effective? Design A two-arm, multi-centre, pragmatic RCT with internal pilot. Health technologies Surgery versus a best non-surgical care package; Personalised Knee Therapy. Target Population Inclusion criteria: at least two (self-reported) lateral patellar dislocations in the same knee; age 16 or over. Exclusion criteria: open growth plates on standard care imaging (typically but not restricted to MRI); another knee condition which may cause instability; previous patellofemoral surgery; severe deformity requiring trochleoplasty or osteotomy surgery; previous entry into the trial (other knee); osteochondral/chondral injury requiring surgery; medial patellar dislocation; unable to adhere to trial protocols or complete questionnaires. Outcomes These have been agreed in close partnership with patients. Primary outcome: The four-domain Knee Osteoarthritis Outcome Score (KOOS4), a well-established instrument that evaluates knee-related pain, function, symptoms and quality of life, 18 months after randomisation. Secondary Outcomes: (Baseline, six, 12, 18 and 24 months after randomisation): KOOS4 (except 18 months); individual KOOS domains; Norwich Patellar Instability Score; health utility (EQ-5D-5L, also at three months); work or education status; PROMIS social activities scale; satisfaction with treatment; patient global impression of change; patellar dislocations; adverse events; further knee surgery; resource use. Sample size We will recruit 276 participants over 24 months across the UK to detect a 10-point difference in the KOOS4 score with 90% power and 5% significance, inflating 20% for loss to follow-up, and 20% for crossovers. The first nine months of recruitment will be used to assess study recruitment, time to intervention, crossover and adherence. Impact and dissemination The results will have an important impact on patients, as the best management of this condition is not known at present. Results will be presented in high-impact journals, a monograph and at conferences. With our PPI team members, we will produce lay summaries and disseminate through patient organisations, on websites and social media. We will inform policy makers such as NICE and other International clinical practice guidelines. By delivering and disseminating a high-quality trial, we will determine the best treatment for people suffering from this disabling and under-researched problem, leading to improved guidance and treatment decision making with a major impact on care in the UK and internationally.
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