Lower redislocation rate with the surgical management of primary patellar dislocations

Study Type: Meta-analysis/Systematic Review
OE Level of Evidence: 2
Journal Level of Evidence: N/A
Nine randomized trials or quasi-randomized controlled trials containing 563 patients with primary patellar dislocations were included in this meta-analysis to compare the rate of recurrence between conservative and surgical management options. The rate of redislocation, subluxation, overall instability, and subsequent surgery were assessed, as well as pain and functional measures. The results from Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Not Reported
Conflicts: None disclosed
Why was this study needed now?
Acute patellar dislocation is a common athletic injury that results in a high rate of recurrent instability and dislocation. The ideal method of management for these injuries has not been identified. While conservative and operative treatment options have been compared in randomized trials, inconsistent results have limited the ability to make recommendations for clinical practice. A meta-analysis of available literature was needed to generate an estimate of effect, to better guide recommendations for the treatment of primary patellar dislocation.
What was the principal research question?
Is there any significant difference in the recurrence rate between the conservative and operative management of primary patellar dislocation?
Data Source: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for relevant articles published up to April 2015.
Index Terms: Search strategy provided in the appendix of the publication.
Study Selection: Eligibility criteria included: a randomized controlled trial or quasi-randomized controlled trial design; enrolled patients with primary patellar dislocation; and allocated patients to either conservative management, including bracing, splinting, taping, manual therapy, exercise therapy, electrotherapy, and education and advice, or operative management, including medial patellofemoral ligament repair/reconstruction, lateral retinacular release, and extensor mechanism realignment. Screening and selection were performed independently by two reviewers, with disagreement resolved by discussion and consensus, and, if necessary, consultation with a third reviewer. A total of nine studies, with data sampled from 563 patients, were selected for final inclusion.
Data Extraction: Data extraction was performed independently by two reviewers using a standardized form; disagreement was resolved through discussion and consensus, and, if necessary, consultation with a third reviewer.
Data Synthesis: Statistical analyses were performed using Review Manager software (RevMan 5.3). Continuous outcomes were expressed as standardized mean differences, and dichotomous outcomes as risk ratios, with associated 95% confidence intervals. Heterogeneity was assessed using the I-squared (I^2) statistic; all values above 60%, meta-analysis were deemed inappropriate.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.