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

Abstract

PurposePatellofemoral 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.MethodsAfter 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.ResultsData synthesis showed a lower rate of recurrent patellar dislocation post-treatment in patients managed operatively compared to non-operatively (P = 0.01).ConclusionThe 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 slidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/8011948721221355.

Does Operative Treatment of First-Time Patellar Dislocations Lead to Increased Patellofemoral Stability? A Systematic Review of Overlapping Meta-analyses

“…[11][12][13][14] These studies were published between 2011 and 2014, with all 4 performing a meta-analysis. One study reported a conflict of interest, 11 whereas 3 did not.…”

Surgical versus conservative treatment of primary patellar dislocation. A systematic review and meta-analysis

“…Reviews without meta-analysis [32][33][34][35] recommended conservative treatment except in several specific circumstances, such as presence of osteochondral fractures. On the contrary, recent meta-analysis [37][38][39][40][41][42], showed that surgical treatment significantly reduces the risk of redislocation. Moreover, surgical treatment was shown to improve Hughston VAS [36][37][38]40] and Tegner [38,39] scores.…”

“…On the contrary, recent meta-analysis [37][38][39][40][41][42], showed that surgical treatment significantly reduces the risk of redislocation. Moreover, surgical treatment was shown to improve Hughston VAS [36][37][38]40] and Tegner [38,39] scores. Two papers [39,41] also reported higher Kujala score in short term (<5 years) follow-up, while evidence at six to nine years followup shifted towards conservative treatment.…”

“…Therefore, isolated LRR is indicated only to reduce pain secondary to lateral patella hyperpressure, increased patellar tilt (negative passive patellar tilt test), and medial and lateral patellar glide of two quadrants or less without bone abnormalities [29][30][31]. Several studies have been recently published on this topic: three narrative reviews [32][33][34], one systematic review without meta-analysis [35], six systematic reviews and meta-analysis [36][37][38][39][40][41] and one systematic review of overlapping meta-analysis [42], which actually included only four previous metaanalysis [36][37][38]40]. It is therefore clear that there is a growing interest around the subject, but at the same time no definitive conclusions have been reached.…”

Results of Conservative Treatment of First Time Acute Lateral Patella Dislocation

“…Cheng et al (20) examined seven randomized prospective studies in their recent review, in which they evaluated functional results of conservative treatment and surgical treatment for first acute patellar dislocation and recurrence rates. They found that while recurrence rates were higher after conservative treatment, functional scores were better.…”