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Comparison operative and conservative management for primary patellar dislocation: an up-to-date meta-analysis

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

The aim of this review was to compare the clinical outcomes between operative and conservative management for primary patella dislocation (PPD).

Methods

PubMed Medline, EMBASE, Google scholar, and the Cochrane Library were systematically searched for randomized controlled trials that compared operative technique versus conservative technique for PPD. The results of eligible studies were independently extracted and analyzed according to the following: patient’s satisfaction, Kujala score, Tegner score, and redislocation rate. Random-effect and fixed-effect models were adopted to calculate the weight mean difference and the odds ratio for continuous and dichotomous variables with 95 % confidence interval.

Results

Seven studies met the inclusion criteria, resulting in 402 (216 surgery and 186 conservation) patients available for the present study. A meta-analysis showed no significant differences between the two treatment groups in terms of patient’s satisfaction and Kujala score. However, significant differences in Tegner score (P < 0.00001) and redislocation rate (P = 0.002) were observed in favor of surgical treatment. In the subgroup analysis, surgical intervention achieved higher (P = 0.002) Kujala score in short term (<5 years), while conservation gained advantage (P = 0.003) in long term (>5 years). There was no significant difference in dislocation rate in long term.

Conclusions

Surgical treatment might provide better clinical results in short term. More persuasive evidence is still needed to proof the effect of surgical management in long time.

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References

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

    Article  PubMed  Google Scholar 

  2. 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 

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

    Article  PubMed  Google Scholar 

  4. Bassi RS, Kumar BA (2003) Superior dislocation of the patella; a case report and review of the literature. Emerg Med J 20:97–98

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  5. Hinton RY, Sharma KM (2003) Acute and recurrent patellar instability in the young athlete. Orthop Clin North Am 34:385–396

    Article  PubMed  Google Scholar 

  6. Ahmad CS, Stein BE, Matuz D, Henry JH (2000) Immediate surgical repair of the medial patellar stabilizers for acute patellar dislocation. A review of eight cases. Am J Sports Med 28:804–810

    CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  8. Desio SM, Burks RT, Bachus KN (1998) Soft tissue restraints to lateral patellar translation in the human knee. Am J Sports Med 26:59–65

    CAS  PubMed  Google Scholar 

  9. Hautamaa PV, Fithian DC, Kaufman KR, Daniel DM, Pohlmeyer AM (1998) Medial soft tissue restraints in lateral patellar instability and repair. Clin Orthop Relat Res:174–182

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

    Article  CAS  PubMed  Google Scholar 

  11. Sallay PI, Poggi J, Speer KP, Garrett WE (1996) Acute dislocation of the patella. A correlative pathoanatomic study. Am J Sports Med 24:52–60

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  13. Fithian DC, Paxton EW, Cohen AB (2004) Indications in the treatment of patellar instability. J Knee Surg 17:47–56

    PubMed  Google Scholar 

  14. Carney JR, Mologne TS, Muldoon M, Cox JS (2005) Long-term evaluation of the Roux-Elmslie-Trillat procedure for patellar instability: a 26-year follow-up. Am J Sports Med 33:1220–1223

    Article  PubMed  Google Scholar 

  15. Merican AM, Kondo E, Amis AA (2009) The effect on patellofemoral joint stability of selective cutting of lateral retinacular and capsular structures. J Biomech 42:291–296

    Article  PubMed  Google Scholar 

  16. 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 

  17. Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13

    Article  PubMed Central  PubMed  Google Scholar 

  18. 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 

  19. 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 

  20. 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 

  21. Camanho GL, Viegas AC, 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 

  22. Sillanpaa PJ, Mattila VM, Maenpaa H, Kiuru M, Visuri T, Pihlajamaki 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 

  23. 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 

  24. 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 

  25. 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 

  26. Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF (1999) Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of reporting of meta-analyses. Lancet 354:1896–1900

    Article  CAS  PubMed  Google Scholar 

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, People’s Republic of China

    Li-Wei Yao, Chao Zhang, Yang Liu, Dai-Gui Cao, Dong-Dong Xu & Shi-Qing Feng

  2. School of Public Health, Hebei Medical University, 361 Zhongshandong Road, Changan District, Shijiazhuang, 050031, People’s Republic of China

    De-Jin Li

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  1. Li-Wei Yao
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  2. Chao Zhang
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Correspondence to Shi-Qing Feng.

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Yao, LW., Zhang, C., Liu, Y. et al. Comparison operative and conservative management for primary patellar dislocation: an up-to-date meta-analysis. Eur J Orthop Surg Traumatol 25, 783–788 (2015). https://doi.org/10.1007/s00590-014-1523-z

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  • DOI: https://doi.org/10.1007/s00590-014-1523-z

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