Which Technique Is Better for Treating Patellar Dislocation? A Systematic Review and Meta-analysis

Lee, Dong Hoon; Park, Youngjin; Song, Sang-Youn; Hwang, Sun‐Chul; Park, Jin-Sung; Kang, Dong-Geun

doi:10.1016/j.arthro.2018.06.052

Cited by 50 publications

(54 citation statements)

References 35 publications

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“…25 Assim, falhas no tratamento da luxação patelar podem levar à instabilidade patelar recorrente, dor persistente no joelho e até mesmo osteoartrose patelofemoral. 26…”

Section: Fatores De Riscounclassified

“…33 Entretanto, ainda existem controvérsias na literatura a respeito da indicação para o tratamento conservador ou cirúrgico. Alguns estudos encontraram altas taxas de recidiva e sintomas residuais de instabilidade associados ao tratamento conservador (até 44%), 13,14,26,34 e por esta razão, o tratamento cirúrgico tem sido preconizado, porém também apresenta taxas elevadas de recorrência (10 a 35%). 26 Uma revisão sistemática Cochrane 4 publicada em 2015 mostrou que embora haja alguma evidência para apoiar o tratamento cirúrgico na luxação patelar primária, a qualidade da evidência é muito baixa devido ao alto risco de viés e imprecisão nas estimativas de efeito dos estudos incluídos.…”

Section: Tratamentounclassified

“…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.…”

Section: Tratamentounclassified

“…Entretanto, ao comparar as técnicas de reconstrução do LPFM, a escolha do enxerto, o posicionamento deste enxerto ou a sua tensão, é difícil, dada a escassez de evidências clínicas de estudos comparativos. 26,42 A reconstrução do LPFM é indicada para pacientes que apresentam lesão ou deficiência do LFPM e que apresentam instabilidade recorrente sem evidência de mau alinhamento ósseo. O diagnóstico artroscópico também pode ser realizado antes da reconstrução do LPFM para identificar quaisquer lesões osteocondrais ou corpos livres.…”

Section: Reconstrução Do Ligamento Patelofemoral Medialunclassified

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Atualização em instabilidade patelar

Severino

Camargo

et al. 2020

Rev Bras Ortop (Sao Paulo)

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ResumoA instabilidade patelar é uma condição clínica multifatorial, que acomete um número expressivo de pacientes, ocorrendo devido a variações anatômicas, morfológicas da articulação e do alinhamento patelofemoral. O presente estudo de revisão e atualização da literatura teve como objetivos identificar e sumarizar os conceitos atuais sobre instabilidade patelar em relação aos fatores de risco associados, os critérios diagnósticos e os benefícios e riscos dos tratamentos conservador e cirúrgico. Para tanto, foi realizado um levantamento nas bases de dados eletrônicas MEDLINE (via Pubmed), LILACS e Cochrane Library. Conclui-se que o diagnóstico preciso depende da avaliação clínica detalhada, incluindo o histórico e possíveis fatores de risco individuais, além de exames de imagem. O tratamento inicial da instabilidade patelar é ainda controverso, e requer a combinação de intervenções conservadoras e cirúrgicas, levando em consideração tanto os tecidos moles quanto as estruturas ósseas, sendo estas últimas a razão mais comum para a escolha do tratamento cirúrgico, principalmente instabilidade patelar lateral.

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“…25 Assim, falhas no tratamento da luxação patelar podem levar à instabilidade patelar recorrente, dor persistente no joelho e até mesmo osteoartrose patelofemoral. 26…”

Section: Fatores De Riscounclassified

Section: Tratamentounclassified

Section: Reconstrução Do Ligamento Patelofemoral Medialunclassified

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Atualização em instabilidade patelar

Severino

Camargo

et al. 2020

Rev Bras Ortop (Sao Paulo)

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“…Therefore, future studies should control these factors." 1 The 2 studies comparing SB versus DB MPFL reconstruction in recurrent dislocations had insufficient data for meta-analysis and thus were qualitatively analyzed. They noted that Wang et al 2 reported that "DB MPFL reconstruction had lower rate of patellar instability compared to SB MPFL reconstruction, and there were no significant differences in patellar instability rate at 12 months and 48 months in DB MPFL reconstruction."…”

mentioning

confidence: 99%

Editorial Commentary: What Is the Optimal Management of First and Recurrent Patellar Instability? Patellofemoral Instability Management Continues to Evolve

Farr

2018

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Patellar instability patients may present for evaluation after their first instability episode or after recurrent episodes. Current management differs for these 2 groups. The accepted "common denominator" of patellar instability is the medial patellofemoral ligament, or medial patellar restraints, to be more all-encompassing. These patients often have multiple contributing comorbidities (e.g., trochlear dysplasia, patellar alta, excessive lateral position of tibial tubercle). Historically, the recommended treatment for a first-time patellar dislocation was nonoperative because medial soft tissue repairs had not been proven more effective. Indications for primary repair of the medial patellar restraints are a single discrete tear identified on magnetic resonance imaging. In the case of recurrent patellar instability, medial patellofemoral ligament reconstruction, rather than repair/reef, has been the recommended approach. The keys to reconstruction remain: honor the anatomy and avoid overconstraint of the patella. For first time dislocation patients with trochlear dysplasia, patellar alta, and age <25 years, recurrent instability is common.

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Double‐bundle versus single‐bundle medial patellofemoral ligament reconstruction for recurrent patellar dislocation: A meta‐analysis

Wu,

Li,

Zhao

et al. 2024

J. exp. orthop.

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PurposeTo compare the clinical efficacy of single‐bundle versus double‐bundle reconstruction of the medial patellofemoral ligament (MPFL) for recurrent patellar dislocation (RPD) regarding knee function scores, postoperative complications, and imaging assessments.MethodsA computerized search of PubMed, Cochrane Library, Embase, China Biomedical Literature Database (CBM), China National Knowledge Network (CNKI), and VIP Database was performed for single‐bundle versus double‐bundle reconstruction of the medial patellofemoral ligament for treatment of RPD. Randomized controlled trials (RCTs) were evaluated for quality using the risk‐of‐bias evaluation tool recommended by the Cochrane Collaboration Network, and Cohort studies (CSs) were assessed using the Newcastle‐Ottawa Scale (NOS) scale. Meta‐analysis was performed using RevMan 5.3 software and STATA 16.0.ResultsThirteen studies were included, four randomized controlled studies, and nine cohort studies. The level of evidence for the four randomized controlled studies was Ⅰ, and the nine cohort studies were Ⅲ. A total of 862 (891 knees) patients were included, of which 448 (465 knees) underwent double‐bundle MPFL reconstruction and 414 (426 knees) underwent single‐bundle MPFL reconstruction. Kujala score (MD = 2.06, 95% confidence interval [CI] [0.11, 4.01], p < 0.05), Tegner score (MD = 0.39, 95% CI [0.11, 0.68], p < 0.05), International Knee Documentation Committee (IKDC) score (MD = 4.88, 95% CI [1.46, 8.31], p < 0.05), and postoperative recurrence instability (odds ratio [OR] = 0.12, 95% CI [0.04, 0.44], p < 0.05) were better in the double‐bundle group than in the single‐bundle group. Lysholm score (MD = 0.86, 95% CI [−0.76, 2.48], p = n.s), patellar tilt angle (MD = −0.22, 95% CI [−0.54, 0.10], p = n.s), patellar lateral shift rate (MD = −0.16, 95% CI [−0.41, 0.09], p = n.s), congruence angle (MD = 0.06, 95% CI [−0.41, 0.52], p = n.s), postoperative knee pain (OR = 0.39, 95% CI [0.14, 1.11], p = n.s), and additional postoperative surgical treatment (OR = 0.20, 95% CI [0.01−6.25], p = n.s) had no statistically significant differences.ConclusionsDouble‐bundle reconstruction of the medial patellofemoral ligament for RPD was superior to single‐bundle reconstruction in both knee function scores and postoperative recurrent patellar instability, and double‐bundle reconstruction of the medial patellofemoral ligament for RPD had better clinical outcomes.Level of EvidenceLevel Ⅲ, Ⅰ and Ⅲ studies.

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Which Technique Is Better for Treating Patellar Dislocation? A Systematic Review and Meta-analysis

Cited by 50 publications

References 35 publications

Atualização em instabilidade patelar

Atualização em instabilidade patelar

Editorial Commentary: What Is the Optimal Management of First and Recurrent Patellar Instability? Patellofemoral Instability Management Continues to Evolve

Double‐bundle versus single‐bundle medial patellofemoral ligament reconstruction for recurrent patellar dislocation: A meta‐analysis

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