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

Diagnostic Pathology (Impact Factor: 2.6). 03/2014; 9(1):60. DOI: 10.1186/1746-1596-9-60
Source: PubMed


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:

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    • "Since then, several comparative trials for the treatment of primary patellar dislocation have been published and that allowed to update meta-analysis possible. " Cheng et al. 13 March 18, 2014 December 2013 3 1 "
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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.
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    ABSTRACT: Introduction: The purpose of this case study is to describe the evaluation and management of patellar dislocations. Clinical features: Acute lateral patellar dislocations are a common orthopedic condition that occurs when the confinement of the patella is disrupted from the patella-femoral groove often damaging the medial patellofemoral ligament. This condition has a high incidence of reoccurrence, is most common in adolescent females and athletes and has certain familial tendencies. A case study of an individual who dislocated their left patella while traveling abroad and the subsequent care received in Thailand, China, and the United States is included. Intervention and outcomes: Lateral dislocation of the patella has the potential for damage to the medial patellofemoral ligament and osteochondral fractures. The presence of large amounts of sub-patellar effusion may indicate the need for advanced imaging to rule out fracture. Non-operative treatment protocols including manual closed reduction of the patella, casting or splinting of the leg and rehabilitation exercises are most often employed in cases without osteochondral fracture. Patients without hemarthrosis or displaced osteochondral fragments that receive proper treatment can typically expect a full return to activity within 8-12 weeks from the time of injury. Conclusion: Acute patellar dislocations are a common orthopedic injury. When presenting without fracture, these injuries respond well to conservative treatments. Accepted for publication.
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    ABSTRACT: Purpose The goal of this study was to perform a comparative review to determine whether there is a significant difference in the rate of repeat dislocation and clinical outcome between surgical and conservative management of acute patellar dislocation in children and adolescents. Methods A systematic review of the MEDLINE database was performed. English-language clinical outcome studies with a primary outcome/treatment specific to acute patella dislocation in a paediatric population were included. Eleven studies met inclusion criteria; Chi-square analysis, independent t tests and weighted mean pooled cohort statistics were performed where appropriate. Results A total of 470 conservatively managed and 157 operatively treated knees were included. Conservatively managed patients were on average 17.0 years and had a mean follow-up of 3.9 years; surgically managed patients were on average 16.1 years and had a mean follow-up of 4.7 years. Conservatively managed knees had a 31 % rate of recurrent dislocation rate compared to 22 % in surgical knees (p = 0.04). Trochlear dysplasia and skeletal immaturity confer greater risk for recurrent instability. Surgical treatment may provide clinically important quality of life and sporting benefit. Conclusions Surgical treatment of first time patella dislocation in children and adolescents is associated with a lower risk of recurrent dislocation and higher health-related quality of life and sporting function. There is a paucity of evidence on MPFL reconstruction for first time traumatic patella dislocation in this population. Level of evidence IV.
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