Article

Operative versus conservative treatment for patellar dislocation: a meta-analysis of 7 randomized controlled trials

Diagnostic Pathology (Impact Factor: 2.41). 03/2014; 9(1):60. DOI: 10.1186/1746-1596-9-60
Source: PubMed

ABSTRACT Purpose: Patellofemoral pathology is common, and patellofemoral dislocation mainly affects adolescents and young adults. We conducted a meta-analysis exclusively of RCTs to compare the clinical outcomes of patellar dislocation patients managed operatively versus non-operatively.
After systematic review of electronic databases and websites, a total of 7 RCTs reporting data on 402 subjects were included. The methodological quality of the literature was assessed using the PEDro critical appraisal tool. Mean differences (MDs) and risk ratio (RR) were calculated for the pooled effects. Heterogeneity was assessed using the I2 test.
Data synthesis showed a lower rate of recurrent patellar dislocation post-treatment in patients managed operatively compared to non-operatively (P = 0.01).
The results suggest a difference in outcomes between the treatment strategies. However the limited number of studies and high risk of inherent bias indicate that future studies involving more patients in better-designed randomized controlled trials will be required.Virtual slides: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/8011948721221355.

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    ABSTRACT: To conduct a systematic review of meta-analyses comparing nonoperative and operative treatment of patellar dislocations to elucidate the cause of the variation and to determine which meta-analysis provides the current best available evidence. A systematic review of the literature to identify meta-analyses was performed. Data were extracted for patient outcomes and recurrent dislocations. Meta-analysis quality was assessed using the Oxman-Guyatt and Quality of Reporting of Meta-analyses systems. The Jadad algorithm was then applied to determine which meta-analysis provided the highest level of evidence. Four meta-analyses met the eligibility criteria: 1 Level I evidence, 2 Level II evidence, and 1 Level III evidence. A total of 1,984 patients were included (997 underwent surgery whereas 987 underwent conservative treatment). Three meta-analyses found a lower subsequent patellar dislocation rate in patients managed operatively compared with nonoperatively, whereas one did not find a difference in recurrent dislocation rates between the operative and nonoperative groups. When the results of all the studies were combined, the overall redislocation rate was 29.4% and the rate of recurrent instability episodes was 32.8%. Patients treated operatively had a 24.0% rate of repeat patellar dislocation and a 32.7% rate of recurrent patellar instability, whereas patients treated nonoperatively had a 34.6% rate of repeat patellar dislocation and a 33.0% rate of recurrent instability. In addition, 1 meta-analysis found a significantly higher rate of patellofemoral osteoarthritis in the operative group. No differences in functional outcomes scores were seen between treatments. Two meta-analyses had low Oxman-Guyatt scores (<4), indicative of major flaws. According to the best available evidence, operative treatment of acute patellar dislocations may result in a lower rate of recurrent dislocations than nonoperative treatment but does not improve functional outcome scores. Level III, systematic review of Level I, II, and II studies. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
    Arthroscopy The Journal of Arthroscopic and Related Surgery 01/2015; 31(6). DOI:10.1016/j.arthro.2014.11.040 · 3.19 Impact Factor

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