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Operative versus non-operative management of patellar dislocation. A meta-analysis

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

Abstract

Purpose

Conservative management of patellar dislocation can result in recurrent instability in up to 60% of patients. Surgery is therefore advocated in an attempt to reduce the incidence of recurrent dislocation and instability. The purpose of this study was to compare the clinical outcomes of operative to non-operative treatment strategies for patients following patellar dislocation.

Methods

A systematic review of published and unpublished literature was undertaken. Following data extraction, a meta-analysis was conducted to compare the two treatment strategies. The methodological quality of the literature was assessed using the PEDro critical appraisal tool.

Results

Eleven studies were included, five randomised controlled trials (RCTs) and six non-RCTs. These assessed 403 patients managed conservatively, compared to 344 managed surgically. The findings of this study indicate that operative management of patellar dislocation is associated with a significantly higher risk of patellofemoral joint osteoarthritis (P = 0.04), but a significantly lower risk of subsequent patellar dislocation compared to non-surgical management (P < 0.01).

Conclusions

The meta-analysis indicates that there may be a difference in the incidence of patellofemoral joint osteoarthritis and rate of subsequent dislocation. However, this finding should currently be interpreted with great caution due to the demonstration of statistically significant publication bias, issues related to the methodological quality of the evidence base, and due to the variety of different surgical interventions currently presented within the literature.

Level of evidence

III.

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Acknowledgments

We would like to thank the library staff at the Norfolk and Norwich University Hospital’s Sir Thomas Browne Library for their assistance in gathering the articles used. We also thank Dr Helen Handoll, Mr Paul Jenkins and Dr Jane Mackintosh of the Cochrane Collaboration’s Bone, Joint and Muscle Trauma Group for their assistance in the design and development of the study’s protocol. We would also like to thank Mr Alexandre Bitar, University of São Paulo, Mr Risto Nikku, Helsinki University Central Hospital, Mr Martin Lind, Aarhus University Hospital, Denmark, Mr Petri Sillanpaa, Central Military Hospital, Helsinki, Finland, and Mr Matthias Buchner, University of Heidelberg, Germany for providing additional data used as part of the meta-analysis.

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Authors and Affiliations

  1. Faculty of Health, University of East Anglia, Norwich,, NR4 7TJ, UK

    Toby O. Smith, Fujian Song & Simon T. Donell

  2. Institute of Orthopaedics, Norfolk and Norwich University Hospital, Colney Lane, Norwich,, NR4 7UY, UK

    Simon T. Donell

  3. Department of Trauma and Orthopaedic, St George’s Hospital, Tooting, London,, SW17 0QT, UK

    Caroline B. Hing

  4. School of Allied Health Profession, Queens’ Building, University of East Anglia, Norwich,, NR4 7TJ, UK

    Toby O. Smith

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  1. Toby O. Smith
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Correspondence to Toby O. Smith.

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Smith, T.O., Song, F., Donell, S.T. et al. Operative versus non-operative management of patellar dislocation. A meta-analysis. Knee Surg Sports Traumatol Arthrosc 19, 988–998 (2011). https://doi.org/10.1007/s00167-010-1355-2

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  • DOI: https://doi.org/10.1007/s00167-010-1355-2

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