Surgical versus non-surgical management for primary patellar dislocations: an up-to-date meta-analysis

Abstract

The aim of this up-to-date meta-analysis was to compare the effects of surgical versus non-surgical treatment of patients following primary patellar dislocation and to provide the best evidence currently available. A comprehensive literature search was conducted using multiple databases, including Medline, Embase, and Cochrane Registry of Clinical Trials. All databases were searched from the earliest records to May 2013. Eligible studies were selected, and data were extracted by two independent investigators. The primary outcome variable was the frequency of recurrent patellar dislocation. The other outcomes included knee function scores, patient-rated outcomes, and radiographic examination. If appropriate, meta-analysis of these variables was performed. Nine independent trials were found to match the inclusion criteria. The pooled results demonstrated that the incidence of recurrent patellar dislocation and Hughston visual analog scale was significantly lower in the surgical treatment group than that in the non-surgical treatment group (P < 0.05). There was no statistically significant difference between the two treatment groups in frequency of subsequent surgical interventions, percentage of excellent or good subjective opinion, Kujala score, pain score on visual analog scale, and severity of patellofemoral joint osteoarthrosis (P > 0.05). This up-to-date meta-analysis indicates that surgical treatment was associated with a lower risk of recurrent patellar dislocation, but a lower Hughston VAS than non-surgical treatment for primary patellar dislocation. More large high-quality trials and further studies are needed to overcome the limitations of small sample sizes, and varieties of different surgical procedures or non-surgical management strategies adopted in the included trials.

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.…”

“…Finally, only one paper [37] reported higher risk of patellofemoral osteoarthritis after surgical treatment. The main limitations of some of the previous reviews are that nonrandomized comparative studies were analysed along with RCTs [37,40], and also studies reporting outcomes of patients affected by recurrent dislocations were included [37].…”