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

Saccomanno, Maristella F.; Sircana, Giuseppe; Fodale, Mario; Donati, Fabrizio; Milano, Giuseppe

doi:10.1007/s00264-015-2856-x

Cited by 45 publications

(39 citation statements)

References 41 publications

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“…With regard to the question of clinical relevance, the results of this study support the idea of other authors of normalizing TT-TG to individual patient size, as we observed several significant correlations between TT-TG and parameters of joint size and leg length in patients with PFI. It has been reported that surgical treatment significantly reduces the risk of patellar redislocation [14]. An increased tibial TT-TG can be surgically addressed by medial transfer of the tibial tuberosity, and using an index instead of the absolute TT-TG value can be helpful when indicating operative treatment.…”

Section: Discussionmentioning

confidence: 99%

The use of tibial tuberosity-trochlear groove indices based on joint size in lower limb evaluation

Ferlic

Runer

Dirisamer

et al. 2017

International Orthopaedics (SICOT)

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Purpose The correlation between tibial tuberosity-trochlear groove distance (TT-TG) and joint size, taking into account several different parameters of knee joint size as well as lower limb dimensions, is evaluated in order to assess whether TT-TG indices should be used in instead of absolute TT-TG values. Methods This study comprised a retrospective analysis of knee CT scans, including 36 cases with patellofemoral instability (PFI) and 30 controls. Besides TT-TG, five measures of knee joint size were evaluated in axial CT slices: medio-lateral femur width, antero-posterior lateral condylar height, mediolateral width of the tibia, width of the patella and the proximaldistal joint size (TT-TE). Furthermore, the length of the femur, the tibia and the total leg length were measured in the CT scanogram. Correlation analysis of TT-TG and the other parameters was done by calculating the Spearman correlation coefficient. Results In the PFI group lateral condylar height (r = 0.370), tibia width (r = 0.406) and patella width (r = 0.366) showed significant moderate correlations (p < 0.03) with TT-TG. Furthermore, we found a significant correlation between TT-TG and tibia length (r = 0.371) and total leg length (r = 381). The control group showed no significant correlation between TT-TG and knee joint size or between TT-TG and measures of lower limb length. Conclusions Tibial tuberosity-trochlear groove distance correlates with several parameters of knee joint size and leg length in patients with patellofemoral instability. Application of indices determining TT-TG as a ratio of joint size could be helpful in establishing the indication for medial transfer of the tibial tuberosity in patients with PFI. Level of evidence Level III

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Section: Discussionmentioning

confidence: 99%

The use of tibial tuberosity-trochlear groove indices based on joint size in lower limb evaluation

Ferlic

Runer

Dirisamer

et al. 2017

International Orthopaedics (SICOT)

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“…However, the recurrence rate of dislocation in the non-surgical group increased significantly after data aggregation. Moreover, predisposing factors for APPD were not equally distributed in the two treatment arms in most of the studies [18]. The anatomic factors that can predispose a patient to recurrent patellar instability include patella alta, genu valgum, torsional deformity, lateral patellar tilt, trochlear dysplasia, increased Q-angle, and elevated tibial tubercle-trochlear groove (TT-TG) distance [8].…”

Section: Efficacy Evaluationmentioning

confidence: 99%

“…Clinical randomized controlled trials (RCTs) have been conducted to compare surgery versus conservative treatment for APPD; the treatment that can best improve the clinical outcome is still debatable. Although, metaanalyses of related RCTs have been conducted [15][16][17][18], the latest one was published 3 years ago [19]. To offer the best evidence-based evidence available to the clinic, we performed 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.…”

Section: Introductionmentioning

confidence: 99%

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

2020

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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.

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“…Cryotherapy is useful in the first 48 hours of injury, but it can be used also in the following 3-4 weeks to address the joint effusion and the pain after exercise therapy and loading. Electrostimulation can prevent muscle atrophy, promote muscle strengthening, and facilitate functionally useful movements [82][83][84][85][86][87][88][89][90] .…”

Section: Physical Modalitiesmentioning

confidence: 99%

I.S.Mu.L.T. first-time patellar dislocation guidelines

Vetrano

Oliva

Bisicchia

et al. 2019

Muscle Ligaments and Tendons J

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Primary traumatic patellar dislocation is common, particularly in young active individuals. A consensus on its management is still lacking. The present work provides easily accessible guidelines to be considered as recommendations for a good clinical practice developed through a process of systematic review of the literature and expert opinion, to improve the quality of care and rationalize the use of resources. Level of evidence: Ia.

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

Abstract: Based on the available data, surgical treatment of primary patella dislocation significantly reduces the risk of patella redislocation.

Cited by 45 publications

References 41 publications

The use of tibial tuberosity-trochlear groove indices based on joint size in lower limb evaluation

The use of tibial tuberosity-trochlear groove indices based on joint size in lower limb evaluation

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

I.S.Mu.L.T. first-time patellar dislocation guidelines

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