Surgical treatment of medial patellofemoral ligament injuries achieves better outcomes than conservative management in patients with primary patellar dislocation: a meta-analysis

Abstract

ImportanceLateral patellar dislocation is a commonly encountered disorder that affects mainly young and active adults and is associated with potential long-term morbidity. Primary traumatic dislocations can result in injury to the medial patellofemoral ligament (MPFL). There is controversy in literature about the superiority of early surgical intervention over conservative treatment of MPFL injuries.ObjectiveThe aim of this project was to undertake a meta-analysis to evaluate the clinical outcomes of the surgical management of MPFL injuries compared with conservative treatment in patients with primary patellar dislocation.Evidence reviewA systematic review of the English literature combining electronic databases Allied and Complementary Medicine (AMED), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase and MEDLINE ((Ovid) and PubMed) and the reference lists of the final studies was performed during the last week of June 2017 using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Four eligible randomised controlled trials comparing MPFL repair/reconstruction to conservative management met our inclusion criteria. They were identified and critically appraised, and the results were quantitatively evaluated giving data of a total of 171 patients. They were divided into two groups: surgically treated group (92 patients) and conservatively treated group (79 patients). The performed surgical procedures included: reconstruction and repair of the MPFL. The conservative management group included mainly physiotherapy. The outcomes evaluated were the rate of recurrent dislocation of the patella and the Kujala score.FindingsOur analysis showed high statistical significance favouring the surgical management in reducing the redislocation rate (6.74%) in comparison with the conservative group (28.5%) (P<0.001). The surgical group also demonstrated significantly higher Kujala score (70.8) compared with the conservative group (59.8) (P<0.001).Conclusions and relevanceContrary to the available current evidence in the literature, we report that the surgical management of MPFL injuries in patients with primary patellar dislocation results in a significantly reduced rate of redislocation when compared with non-operative management.Level of evidenceMeta-analysis, therapeutic type II.

Soft-tissue fixation is not inferior to suture-anchor fixation in reconstruction of the medial patellofemoral ligament using a nonresorbable suture tape

“…MPFL‐R is widely used in surgical therapy for patients with chronic patellofemoral instability and is characterized by a significant reduction in the patellar redislocation rate and by relevant improvements in functional outcome scores [20, 41]. In recent years, primary reconstruction of the torn MPFL has also been considered in patients with a high risk of recurrent instability after first‐time dislocation [9, 14, 20]. The observed risk of 60–70% of redislocation after conservatively treated primary dislocation has contributed to this paradigm shift [2, 15, 34, 47].…”

Akute und chronische Patellainstabilität – Empfehlungen zur Diagnostik, Risikostratifizierung und Therapie

“…Das Dogma der konservativen Therapie jeder Patella-Erstluxation ohne osteochondrale Flake-Fraktur darf mittlerweile als überholt angesehen werden. Auch wenn ein Teil der Patienten sicherlich gut konservativ behandelt werden kann, so stellen die zum Teil inakzeptablen hohen Reluxationsraten der jungen Patienten ein generelles konservatives Vorgehen sehr infrage 12 13 . Dementsprechend kann/sollte bei Patienten mit einem hohen Risikoprofil für eine Reluxation zu einer primär operativen Therapie geraten werden 14 .…”

Instabilidade Objetiva da Rótula: da Avaliação ao Tratamento

“…Apesar do tratamento conservador ser indicado como primeira linha de intervenção 43 , está associado a elevadas taxas de recidiva (13-52%) 45,46 e, assim, o tratamento cirúrgico tem, recentemente, ganho uma maior preponderância como intervenção principal nas luxações primárias da rótula. 47…”