Does surgical treatment produce better outcomes than conservative treatment for acute primary patellar dislocations? A meta-analysis of 10 randomized controlled trials

Abstract

Purpose: The objective of this study was to conduct the latest meta-analysis of randomized controlled trials (RCTs) that compare clinical results between surgery and conservative therapy of acute primary patellar dislocation (APPD), focusing on medial patellofemoral ligament (MPFL) reconstruction. Methods: We performed a literature search in Embase, The Cochrane Library, PubMed, and Medline to identify RCTs comparing APPD surgical treatment with conservative treatment from the establishment of each database to January 2019. The methodological quality of each RCT was assessed independently by the two authors through the Cochrane Collaboration's "Risk of Bias" tool. Mean differences of continuous variables and risk ratios of dichotomous variables were computed for the pooled data analyses. The I 2 statistic and the χ 2 test were used to evaluate heterogeneity, with the significance level set at I 2 > 50% or P < 0.10. Results: Ten RCTs with a sum of 569 patients (297 receiving surgical treatment and 263 receiving conservative treatment) met the inclusion criteria for meta-analysis. Pooled data analysis showed no statistical difference in the field of subluxation rate, Kujala score, patient satisfaction, and frequency of reoperation between the two groups. Tegner activity score and recurrent dislocation rate in the conservative group were significantly higher than those in the surgically treated group. Conclusions: Conservative treatment may produce better outcomes than surgery for APPD in consideration of Tegner activity score. However, in view of limited research available, the interpretation of the discoveries should be cautious. More convincing evidence is required to confirm the effect of MPFL reconstruction.

Isolated medial patellofemoral ligament reconstruction for recurrent patellofemoral instability: analysis of outcomes and risk factors

“…The number of different procedures described to reconstruct the MPFL in these patients is increasing exponentially, and assessment of these options has become a point of considerable research interest [ 23 , 24 ]. However, there has been no consensus concerning results, and debates are still ongoing [ 25 – 27 ].…”

One‐Stage Arthroscopic Multiple Ligament Reconstruction for Schenck IV Knee Dislocation

“…The traditional treatments of multiligament‐injured KD (MLIKD) include conservative treatment, 12 , 13 in situ suture surgery, 14 , 15 , 16 and ligament reconstruction surgery. 17 Although patients who receive operative treatment show better knee function than patients who do not receive operative treatment, 8 , 10 , 18 , 19 it is still unknown which surgical method is best for treating MLIKD. Some studies have shown satisfactory results when using the ligament reconstruction technique to treat MLIKD patients, 19 , 20 , 21 , 22 , 23 while others have shown that in situ ligament repair is more effective.…”

“… 17 Although patients who receive operative treatment show better knee function than patients who do not receive operative treatment, 8 , 10 , 18 , 19 it is still unknown which surgical method is best for treating MLIKD. Some studies have shown satisfactory results when using the ligament reconstruction technique to treat MLIKD patients, 19 , 20 , 21 , 22 , 23 while others have shown that in situ ligament repair is more effective. 24 , 25 , 26 , 27 , 28 Due to the heightened knee instability that is characteristic of Schenck IV KD, we chose ligament reconstruction as our treatment option, and the patients were encouraged to follow a strict rehabilitation program.…”

Patella dislocations and patellofemoral instability: a current concepts review

“…There is also growing evidence showing that the rate of re-dislocation is significantly lower following early operative reconstruction. 2,5,6,[62][63][64][65][66][67][68][69][70][71][72] Indications for surgery after a first episode dislocation may be influenced by using predictive tools as described above. This may result in cases being treated operatively which otherwise may have been treated nonoperatively.…”