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

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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.

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References

  1. Tsai CH, Hsu CJ, Hung CH, Hsu HC (2012) Primary traumatic patellar dislocation. J Orthop Surg Res 7:21

    Article  PubMed Central  PubMed  Google Scholar 

  2. Kepler CK, Bogner EA, Hammoud S, Malcolmson G, Potter HG, Green DW (2011) Zone of injury of the medial patellofemoral ligament after acute patellar dislocation in children and adolescents. Am J Sports Med 39:1444–1449

    Article  PubMed  Google Scholar 

  3. Sillanpää P, Mattila VM, Iivonen T, Visuri T, Pihlajamäki H (2008) Incidence and risk factors of acute traumatic primary patellar dislocation. Med Sci Sports Exerc 40:606–611

    Article  PubMed  Google Scholar 

  4. Colvin AC, West RV (2008) Patellar instability. J Bone Joint Surg Am 90:2751–2762

    Article  PubMed  Google Scholar 

  5. Arendt EA, Fithian DC, Cohen E (2002) Current concepts of lateral patella dislocation. Clin Sports Med 21:499–519

    Article  PubMed  Google Scholar 

  6. Burks RT, Desio SM, Bachus KN, Tyson L, Springer K (1998) Biomechanical evaluation of lateral patellar dislocations. Am J Knee Surg 11:24–31

    CAS  PubMed  Google Scholar 

  7. Stefancin JJ, Parker RD (2007) First-time traumatic patellar dislocation: a systematic review. Clin Orthop Relat Res 455:93–101

    Article  PubMed  Google Scholar 

  8. Balcarek P, Jung K, Ammon J et al (2010) Anatomy of lateral patellar instability: trochlear dysplasia and tibial tubercle-trochlear groove distance is more pronounced in women who dislocate the patella. Am J Sports Med 38:2320–2327

    Article  PubMed  Google Scholar 

  9. Beasley LS, Vidal AF (2004) Traumatic patellar dislocation in children and adolescents: treatment update and literature review. Curr Opin Pediatr 16:29–36

    Article  PubMed  Google Scholar 

  10. Atkin DM, Fithian DC, Marangi KS, Stone ML, Dobson BE, Mendelsohn C (2000) Characteristics of patients with primary acute lateral patellar dislocation and their recovery within the first 6 months of injury. Am J Sports Med 28:472–479

    CAS  PubMed  Google Scholar 

  11. Cash JD, Hughston JC (1988) Treatment of acute patellar dislocation. Am J Sports Med 16:244–249

    Article  CAS  PubMed  Google Scholar 

  12. Panni AS, Vasso M, Cerciello S (2013) Acute patellar dislocation. What to do? Knee Surg Sports Traumatol Arthrosc 21:275–278

    Article  PubMed  Google Scholar 

  13. Sillanpää PJ, Mäenpää HM (2012) First-time patellar dislocation: surgery or conservative treatment? Sports Med Arthrosc 20:128–135

    Article  PubMed  Google Scholar 

  14. Mäenpää H, Huhtala H, Lehto MU (1997) Recurrence after patellar dislocation. Redislocation in 37/75 patients followed for 6-24 years. Acta Orthop Scand 68:424–426

    Article  PubMed  Google Scholar 

  15. Vainionpää S, Laasonen E, Silvennoinen T, Vasenius J, Rokkanen P (1990) Acute dislocation of the patella. A prospective review of operative treatment. J Bone Joint Surg Br 72:366–369

    PubMed  Google Scholar 

  16. Feller JA, Amis AA, Andrish JT, Arendt EA, Erasmus PJ, Powers CM (2007) Surgical biomechanics of the patellofemoral joint. Arthroscopy 23:542–553

    Article  PubMed  Google Scholar 

  17. Amis AA, Firer P, Mountney J, Senavongse W, Thomas NP (2003) Anatomy and biomechanics of the medial patellofemoral ligament. Knee 10:215–220

    Article  CAS  PubMed  Google Scholar 

  18. Schöttle PB, Scheffler SU, Schwarck A, Weiler A (2006) Arthroscopic medial retinacular repair after patellar dislocation with and without underlying trochlear dysplasia: a preliminary report. Arthroscopy 22:1192–1198

    Article  PubMed  Google Scholar 

  19. Sillanpää PJ, Mäenpää HM, Mattila VM, Visuri T, Pihlajamäki H (2009) A mini-invasive adductor magnus tendon transfer technique for medial patellofemoral ligament reconstruction a technical note. Knee Surg Sports Traumatol Arthrosc 17:508–512

    Article  PubMed  Google Scholar 

  20. Camanho GL, Bitar AC, Hernandez AJ, Olivi R (2007) Medial patellofemoral ligament reconstruction: a novel technique using the patellar ligament. Arthroscopy 23:108.e1–108.e4

    Article  Google Scholar 

  21. Sillanpää P, Mattila VM, Visuri T, Mäenpää H, Pihlajamäki H (2008) Ligament reconstruction versus distal realignment for patellar dislocation. Clin Orthop Relat Res 466:1475–1484

    Article  PubMed Central  PubMed  Google Scholar 

  22. Reddy KR, Reddy NS (2012) Trochleoplasty and medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Indian J Orthop 46:242–245

    Article  PubMed Central  PubMed  Google Scholar 

  23. Lee JJ, Lee SJ, Won YG, Choi CH (2012) Lateral release and medial plication for recurrent patella dislocation. Knee Surg Sports Traumatol Arthrosc 20:2438–2444

    Article  PubMed  Google Scholar 

  24. von Knoch F, Böhm T, Bürgi ML, von Knoch M, Bereiter H (2006) Trochleaplasty for recurrent patellar dislocation in association with trochlear dysplasia. A 4- to 14-year follow-up study. J Bone Joint Surg Br 88:1331–1335

    Article  Google Scholar 

  25. Camanho GL, Viegas Ade C, Bitar AC, Demange MK, Hernandez AJ (2009) Conservative versus surgical treatment for repair of the medial patellofemoral ligament in acute dislocations of the patella. Arthroscopy 25:620–625

    Article  PubMed  Google Scholar 

  26. Bitar AC, Demange MK, D’Elia CO, Camanho GL (2012) Traumatic patellar dislocation: nonoperative treatment compared with MPFL reconstruction using patellar tendon. Am J Sports Med 40:114–122

    Article  PubMed  Google Scholar 

  27. Yamamoto RK (1986) Arthroscopic repair of the medial retinaculum and capsule in acute patellar dislocations. Arthroscopy 2:125–131

    Article  CAS  PubMed  Google Scholar 

  28. Buchner M, Baudendistel B, Sabo D, Schmitt H (2005) Acute traumatic primary patellar dislocation: long-term results comparing conservative and surgical treatment. Clin J Sport Med 15:62–66

    Article  PubMed  Google Scholar 

  29. Apostolovic M, Vukomanovic B, Slavkovic N et al (2011) Acute patellar dislocation in adolescents: operative versus nonoperative treatment. Int Orthop 35:1483–1487

    Article  PubMed Central  PubMed  Google Scholar 

  30. Nikku R, Nietosvaara Y, Aalto K, Kallio PE (2005) Operative treatment of primary patellar dislocation does not improve medium-term outcome: a 7-year follow-up report and risk analysis of 127 randomized patients. Acta Orthop 76:699–704

    Article  PubMed  Google Scholar 

  31. Hing CB, Smith TO, Donell S, Song F (2011) Surgical versus non-surgical interventions for treating patellar dislocation. Cochrane Database Syst Rev. CD008106. doi: 10.1002/14651858.CD008106.pub2

  32. Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O (1993) Scoring of patellofemoral disorders. Arthroscopy 9:159–163

    Article  CAS  PubMed  Google Scholar 

  33. Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res:43–49

  34. Flandry F, Hunt JP, Terry GC, Hughston JC (1991) Analysis of subjective knee complaints using visual analog scales. Am J Sports Med 19:112–118

    Article  CAS  PubMed  Google Scholar 

  35. Ahlbäck S (1968) Osteoarthrosis of the knee. A radiographic investigation. Acta Radiol Diagn (Stockh) Suppl 277:7–72

    Google Scholar 

  36. Jadad AR, Moore RA, Carroll D et al (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12

    Article  CAS  PubMed  Google Scholar 

  37. Higgins JPT, Green S (eds) (2011) Cochrane handbook for systematic reviews of interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration. www.cochrane-handbook.org

  38. Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50:1088–1101

    Article  CAS  PubMed  Google Scholar 

  39. Sillanpää PJ, Mäenpää HM, Mattila VM, Visuri T, Pihlajamäki H (2008) Arthroscopic surgery for primary traumatic patellar dislocation: a prospective, nonrandomized study comparing patients treated with and without acute arthroscopic stabilization with a median 7-year follow-up. Am J Sports Med 36:2301–2309

    Article  PubMed  Google Scholar 

  40. Christiansen SE, Jakobsen BW, Lund B, Lind M (2008) Isolated repair of the medial patellofemoral ligament in primary dislocation of the patella: a prospective randomized study. Arthroscopy 24:881–887

    Article  PubMed  Google Scholar 

  41. Nikku R, Nietosvaara Y, Kallio PE, Aalto K, Michelsson JE (1997) Operative versus closed treatment of primary dislocation of the patella. Similar 2-year results in 125 randomized patients. Acta Orthop Scand 68:419–423

    Article  CAS  PubMed  Google Scholar 

  42. Palmu S, Kallio PE, Donell ST, Helenius I, Nietosvaara Y (2008) Acute patellar dislocation in children and adolescents: a randomized clinical trial. J Bone Joint Surg Am 90:463–470

    Article  PubMed  Google Scholar 

  43. Petri M, Liodakis E, Hofmeister M et al (2013) Operative vs conservative treatment of traumatic patellar dislocation: results of a prospective randomized controlled clinical trial. Arch Orthop Trauma Surg 133:209–213

    Article  CAS  PubMed  Google Scholar 

  44. Sillanpää PJ, Mattila VM, Mäenpää H, Kiuru M, Visuri T, Pihlajamäki H (2009) Treatment with and without initial stabilizing surgery for primary traumatic patellar dislocation. A prospective randomized study. J Bone Joint Surg Am 91:263–273

    Article  PubMed  Google Scholar 

  45. Smith TO, Song F, Donell ST, Hing CB (2011) Operative versus non-operative management of patellar dislocation. A meta-analysis. Knee Surg Sports Traumatol Arthrosc 19:988–998

    Article  PubMed  Google Scholar 

  46. Ma LF, Wang CH, Chen BC et al (2012) Medial patellar retinaculum plasty versus medial capsule reefing for patellar dislocation in children and adolescents. Arch Orthop Trauma Surg 132:1773–1780

    Article  PubMed  Google Scholar 

  47. Xie G, Zhao J, Huangfu X, He Y (2012) Medial patellofemoral ligament reconstruction using semitendinosus tendons: polyester suture augmentation versus nonaugmentation. Am J Sports Med 40:1365–1374

    Article  PubMed  Google Scholar 

  48. Rood A, Boons H, Ploegmakers J, van der Stappen W, Koëter S (2012) Tape versus cast for non-operative treatment of primary patellar dislocation: a randomized controlled trial. Arch Orthop Trauma Surg 132:1199–1203

    Article  PubMed  Google Scholar 

  49. Armstrong BM, Hall M, Crawfurd E, Smith TO (2012) A feasibility study for a pragmatic randomised controlled trial comparing cast immobilisation versus no immobilisation for patients following first-time patellar dislocation. Knee 19:696–702

    Article  PubMed  Google Scholar 

  50. Kang HJ, Wang F, Chen BC, Zhang YZ, Ma L (2013) Non-surgical treatment for acute patellar dislocation with special emphasis on the MPFL injury patterns. Knee Surg Sports Traumatol Arthrosc 21:325–331

    Article  PubMed  Google Scholar 

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Conflict of interest

All authors did not receive any financial payment or other benefits from any commercial entity related to the subject of this article. The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Orthopedics, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People’s Republic of China

    Xiaozuo Zheng, Kai Kang, Tong Li, Bo Lu, Jiangtao Dong & Shijun Gao

  2. Orthopaedic Biomechanics Laboratory of Hebei Province, Shijiazhuang, People’s Republic of China

    Xiaozuo Zheng, Kai Kang, Tong Li, Bo Lu, Jiangtao Dong & Shijun Gao

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  1. Xiaozuo Zheng
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Correspondence to Shijun Gao.

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Zheng, X., Kang, K., Li, T. et al. Surgical versus non-surgical management for primary patellar dislocations: an up-to-date meta-analysis. Eur J Orthop Surg Traumatol 24, 1513–1523 (2014). https://doi.org/10.1007/s00590-013-1400-1

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