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Surgical versus conservative management of acute patellar dislocation in children and adolescents: a systematic review

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The goal of this study was to perform a comparative review to determine whether there is a significant difference in the rate of repeat dislocation and clinical outcome between surgical and conservative management of acute patellar dislocation in children and adolescents.

Methods

A systematic review of the MEDLINE database was performed. English-language clinical outcome studies with a primary outcome/treatment specific to acute patella dislocation in a paediatric population were included. Eleven studies met inclusion criteria; Chi-square analysis, independent t tests and weighted mean pooled cohort statistics were performed where appropriate.

Results

A total of 470 conservatively managed and 157 operatively treated knees were included. Conservatively managed patients were on average 17.0 years and had a mean follow-up of 3.9 years; surgically managed patients were on average 16.1 years and had a mean follow-up of 4.7 years. Conservatively managed knees had a 31 % rate of recurrent dislocation rate compared to 22 % in surgical knees (p = 0.04). Trochlear dysplasia and skeletal immaturity confer greater risk for recurrent instability. Surgical treatment may provide clinically important quality of life and sporting benefit.

Conclusions

Surgical treatment of first time patella dislocation in children and adolescents is associated with a lower risk of recurrent dislocation and higher health-related quality of life and sporting function. There is a paucity of evidence on MPFL reconstruction for first time traumatic patella dislocation in this population.

Level of evidence

IV.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Benedict U. Nwachukwu, Conan So, William W. Schairer, Daniel W. Green & Emily R. Dodwell

  2. University of Maryland School of Medicine, 620 W. Lexington St, Baltimore, MD, 21201, USA

    Conan So

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  1. Benedict U. Nwachukwu
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  2. Conan So
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  3. William W. Schairer
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  5. Emily R. Dodwell
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Correspondence to Benedict U. Nwachukwu.

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This investigation was performed at the Hospital for Special Surgery.

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Nwachukwu, B.U., So, C., Schairer, W.W. et al. Surgical versus conservative management of acute patellar dislocation in children and adolescents: a systematic review. Knee Surg Sports Traumatol Arthrosc 24, 760–767 (2016). https://doi.org/10.1007/s00167-015-3948-2

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  • DOI: https://doi.org/10.1007/s00167-015-3948-2

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