Surgical versus nonsurgical treatment of primary acute patellar dislocation

Abstract

Background: To systematically review the efficacy of surgical versus nonsurgical treatment for acute patellar dislocation. Materials and Methods: PubMed, Cochrane, and Embase were searched up to February 12, 2019. After removing duplicates, preliminary screening, and reading the full texts, we finally selected 16 articles, including 11 randomized controlled trials and 5 cohort studies. The quality of the enrolled studies was evaluated by Jadad score or Newcastle–Ottawa scale. Meta-analyses were performed using odds ratio (OR) and standardized mean difference (SMD) as effect variables. The clinical parameters assessed included mean Kujala score, rate of redislocation, incidence of patellar subluxation, patient satisfaction, and visual analog scale (VAS) for pain. Evidence levels were determined using GRADE profile. Results: The 16 included studies involved 918 cases, 418 in the surgical group and 500 in the nonsurgical group. The results of the meta-analysis showed higher mean Kujala score (SMD = 0.79, 95% confidence interval [CI] [0.3, 1.28], P = .002) and lower rate of redislocation (OR = 0.44, 95% CI [0.3, 0.63], P < .00001) in the surgical group than the nonsurgical group, but showed insignificant differences in the incidence of patellar subluxation (OR = 0.61, 95% CI [0.36, 1.03], P = .06), satisfaction of patients (OR = 1.44, 95% CI [0.64, 3.25], P = .38), and VAS (SMD = 0.84, 95% CI [−0.36, 9.03], P = .84). Conclusion: For patients with primary acute patellar dislocation, surgical treatment produces a higher mean Kujala score and a lower rate of redislocation than nonsurgical treatment.

Atualização em instabilidade patelar

“…Portanto, novos ensaios clínicos randomizados de melhor qualidade metodológica foram recomendados. A ►Tabela 1- 4,8,26,35,36 mostra os resultados das revisões sistemáticas com metanálise comparando o tratamento conservador ao cirúrgico para luxação primária da patela.…”

“…Therefore, new randomized clinical trials of better methodological quality have been recommended. ►Table 1-4, 8,26,35,36 shows the results of systematic reviews with meta-analysis comparing conservative with surgical treatment for primary patellar dislocation.…”

Athletic Injuries

“…Non-weight-bearing status can typically be discontinued as tolerated by the patient. Controversy exists on surgical versus conservative management on primary traumatic patellar dislocation [32]; however, it is reasonable to begin with nonoperative management. Palpable defects of the parapatellar ligament structures, recurrent subluxation on initial examination, and findings of osteochondral lesion on imaging are indications for referral to orthopedic surgery.…”

Surgery for patellar dislocation has evolved towards anatomical reconstructions with assessment and treatment of anatomical risk factors

“…At present, however, consensus on the best treatment recommendations and guidelines for primary patellar dislocation is lacking [ 47 ]. A recent meta-analysis by Yang et al comprising 16 randomised controlled trials (RCT) or cohort studies published between 1986 and 2018 cautiously concluded that surgical treatment might also be more favourable than conservative treatment for patients with their first patellar dislocation [ 53 ]. This conclusion was based on the finding that surgically treated patients had higher Kujala scores (anterior knee-specific patient-reported outcomes) and a lower rate of re-dislocations compared with conservatively treated patients.…”

“…Nevertheless, due to the rapid development of surgical techniques during the past few decades, the conclusion was based on heterogenous study populations. Previous results have indicated that not all surgical techniques are as equally effective [ 2 , 5 , 46 , 50 , 53 ].…”