Advertisement

Surgical treatment is better than non-surgical treatment for primary patellar dislocation: a meta-analysis of randomized controlled trials

  • Zhengdao Fu
  • Zhiqiang Zhu
  • Haitao Chen
  • Shiqin ZhangEmail author
Arthroscopy and Sports Medicine
  • 25 Downloads

Abstract

Background

At present, the best treatment for primary patellar dislocation (PPD) has not been unified. Moreover, meta-analyses comparing the non-surgical and surgical treatments of PPD are lacking. Thus, we aimed to compare the clinical efficacy of surgical or non-surgical treatment of PPD.

Methods

Randomized controlled studies of surgical and non-surgical treatments of PPD from 1966 to 2018 were retrieved from the following databases: PubMed, EMBASE, Cochrane Library, Wanfang Database, China Knowledge Network, Google Scholar, and Weipu Database. We screened for literature that met the inclusion criteria and extracted useful data for our meta-analysis.

Results

Nine studies, involving 492 patients, met the inclusion criteria and were analyzed in this study. The recurrence rate of patellar dislocation in the surgical group was lower than that in the non-surgical group (P = 0.04]). Subgroup analysis according to the follow-up time showed that the Kujala score (P < 0.001) and lower recurrence rate of dislocation (P = 0.05) than the non-surgical group in the short term. Subgroup analysis according to surgical year showed that the surgical group get higher Kujala score (P < 0.001) and lower recurrence rate of dislocation (P = 0.01) than the non-surgical group in recent years.

Conclusion

Surgical treatment can provide better clinical results in a short period of time, and patients may achieve good results within 10 years owing to the advances in surgical techniques and instruments. Thus, we recommend surgical treatment as the preferred treatment for primary patellar dislocation.

Keywords

Patellar dislocation Surgical Non-surgical Randomized controlled trial 

Abbreviations

PPD

Primary patellar dislocation

RR

Relative risk

CI

Confidence intervals

WMD

Weighted mean difference

TT-TG distance

Tibial tuberosity-trochlear groove distance

MPFL

Medial patellofemoral ligament

SD

Standard deviation

PEDro scale

Physiotherapy evidence database scale

Notes

Author contributions

ZDF carried out the entire procedure including the literature search and data extraction. He performed the statistical analysis, drafted the manuscript. ZQZ and HTC contributed to the statistical analysis and data extraction. SQZ conceived of the study, coordinated and participated in the entire process of drafting, and revised the manuscript. All authors have contributed significantly. All authors read and approved the final manuscript.

Funding

There was no external funding for this work.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

References

  1. 1.
    Dietrich TJ, Fucentese SF, Pfirrmann CW (2016) Imaging of individual anatomical risk factors for patellar instability. Semin Musculoskelet Radiol 20:65CrossRefGoogle Scholar
  2. 2.
    Longo UG, Rizzello G, Ciuffreda M, Loppini M, Baldari A, Maffulli N et al (2016) Elmslie-Trillat, Maquet, Fulkerson, Roux Goldthwait, and other distal realignment procedures for the management of patellar dislocation: systematic review and quantitative synthesis of the literature. Arthroscopy 32(5):929–943CrossRefGoogle Scholar
  3. 3.
    Stefancin JJ, Parker RD (2007) First-time traumatic patellar dislocation: a systematic review. Clin Orthop Relat Res 455:93CrossRefGoogle Scholar
  4. 4.
    Arendt EA, Fithian DC, Cohen E (2002) Current concepts of lateral patella dislocation. Clin Sports Med 21:499–519CrossRefGoogle Scholar
  5. 5.
    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 28:472–479CrossRefGoogle Scholar
  6. 6.
    Abramov M, Stock H (2013) Lateral patellar dislocation: mechanism of disease, radiographic presentation, and management. Conn Med 77:235–238PubMedGoogle Scholar
  7. 7.
    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 19:988–998CrossRefGoogle Scholar
  8. 8.
    Petri M, Liodakis E, Hofmeister M, Despang FJ, Maier M, Balcarek P et al (2013) Operative vs conservative treatment of traumatic patellar dislocation: results of a prospective randomized controlled clinical trial. Arch Orthop Trauma Surg 133:209–213CrossRefGoogle Scholar
  9. 9.
    Hernigou J, Chahidi E, Bouaboula M, Moest E, Callewier A, Kyriakydis T et al (2018) Knee size chart nomogram for evaluation of tibial tuberosity-trochlear groove distance in knees with or without history of patellofemoral instability. Int Orthop 42:2797–2806CrossRefGoogle Scholar
  10. 10.
    Panni AS, Vasso M, Cerciello S (2013) Acute patellar dislocation. What to do? Knee Surg Sports Traumatol Arthrosc 21:275–278CrossRefGoogle Scholar
  11. 11.
    Sillanpää PJ, Mäenpää HM (2012) First-time patellar dislocation: surgery or conservative treatment? Sports Med Arthrosc Rev 20:128CrossRefGoogle Scholar
  12. 12.
    Hing CB, Smith TO, Donell S, Song F (2011) Surgical versus non-surgical interventions for treating patellar dislocation. Cochrane Datab Syst Rev 36:CD008106Google Scholar
  13. 13.
    Yao LW, Zhang C, Liu Y, Cao DG, Li DJ, Xu DD et al (2015) Comparison operative and conservative management for primary patellar dislocation: an up-to-date meta-analysis. Eur J Orthop Surg Traumatol 25:783–788CrossRefGoogle Scholar
  14. 14.
    Zheng X, Kang K, Li T, Lu B, Dong J, Gao S (2014) Surgical vs non-surgical management for primary patellar dislocations: an up-to-date meta-analysis. Eur J Orthop Surg Traumatol 24:1513–1523CrossRefGoogle Scholar
  15. 15.
    Saccomanno MF, Sircana G, Fodale M, Donati F, Milano G (2016) Surgical versus conservative treatment of primary patellar dislocation. A systematic review and meta-analysis. Int Orthop 40:2277–2287CrossRefGoogle Scholar
  16. 16.
    Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O (1993) Scoring of patellofemoral disorders. Arthroscopy 9:159–163CrossRefGoogle Scholar
  17. 17.
    Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M (2003) Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther 83:713Google Scholar
  18. 18.
    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 91:263–273CrossRefGoogle Scholar
  19. 19.
    Nikku R, Nietosvaara Y, Aalto K, Kallio PE (2005) Operative treatment of primary patellar dislocation does not improve medium-term outcome. Acta Orthop 76:699–704CrossRefGoogle Scholar
  20. 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 90:463–470CrossRefGoogle Scholar
  21. 21.
    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 24:881–887CrossRefGoogle Scholar
  22. 22.
    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 25:620–625CrossRefGoogle Scholar
  23. 23.
    Bitar AC, D’Elia CO, Demange MK, Viegas AC, Camanho GL (2011) Randomized prospective study on traumatic patellar dislocation: conservative treatment versus reconstruction of the medial patellofemoral ligament using the patellar tendon, with a minimum of 2 years of follow-up. Rev Bras Ortop 46:675–683CrossRefGoogle Scholar
  24. 24.
    Regalado G, Lintula H, Kokki H, Kröger H, Väätäinen U, Eskelinen M (2014) Six-year outcome after non-surgical versus surgical treatment of acute primary patellar dislocation in adolescents: a prospective randomized trial. Knee Surg Sports Traumatol Arthrosc 24:1–6Google Scholar
  25. 25.
    Ji G, Wang S, Wang X, Liu J, Niu J, Wang F (2016) Surgical versus nonsurgical treatments of acute primary patellar dislocation with special emphasis on the MPFL injury patterns. J Knee Surg 30:378–384CrossRefGoogle Scholar
  26. 26.
    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 68:419–423CrossRefGoogle Scholar
  27. 27.
    Aglietti P, Buzzi R, De Biase P, Giron F (1994) Surgical treatment of recurrent dislocation of the patella. Clin Orthop Relat Res 308:8–17Google Scholar
  28. 28.
    Sillanpää PJ, Peltola E, Mattila VM, Kiuru M, Visuri T, Pihlajamäki H (2009) Femoral avulsion of the medial patellofemoral ligament after primary traumatic patellar dislocation predicts subsequent instability in men: a mean 7-year nonoperative follow-up study. Am J Sports Med 37:1513–1521CrossRefGoogle Scholar
  29. 29.
    Rhee SJ, Pavlou G, Oakley J, Barlow D, Haddad F (2012) Modern management of patellar instability. Int Orthop 36:2447–2456CrossRefGoogle Scholar
  30. 30.
    Zhao J, Huangfu X, He Y (2012) The role of medial retinaculum plication versus medial patellofemoral ligament reconstruction in combined procedures for recurrent patellar instability in adults. Am J Sports Med 40:1355–1364CrossRefGoogle Scholar
  31. 31.
    Du H, Tian XX, Guo FQ, Li XM, Ji TT, Li B et al (2017) Evaluation of different surgical methods in treating recurrent patella dislocation after three-dimensional reconstruction. Int Orthop 41:2517–2524CrossRefGoogle Scholar
  32. 32.
    Matsushita T, Oka S, Araki D, Nishida K, Tanaka T, Kanzaki N et al (2017) Patient-based outcomes after medial patellofemoral ligament reconstruction. Int Orthop 41:1147–1153CrossRefGoogle Scholar
  33. 33.
    Zheng X, Hu Y, Xie P, Cui M, Ma X, Feng YE et al (2019) Surgical medial patellofemoral ligament reconstruction versus non-surgical treatment of acute primary patellar dislocation: a prospective controlled trial. Int Orthop 43:1495–1501CrossRefGoogle Scholar
  34. 34.
    Bartsch A, Lubberts B, Mumme M et al (2018) Does patella alta lead to worse clinical outcome in patients who undergo isolated medial patellofemoral ligament reconstruction? A systematic review. Arch Orthop Trauma Surg 138(11):1563–1573CrossRefGoogle Scholar
  35. 35.
    Ren B, Zhang X, Zhang L et al (2019) Isolated trochleoplasty for recurrent patellar dislocation has lower outcome and higher residual instability compared with combined MPFL and trochleoplasty: a systematic review. Arch Orthop Trauma Surg 139:1617–1624CrossRefGoogle Scholar
  36. 36.
    Kang H, Zheng R, Dong C et al (2019) No influence of patellar fixation technique on clinical outcomes of double-bundle medial patellofemoral ligament reconstruction: a systematic review. Arch Orthop Trauma Surg 139(1):79–90CrossRefGoogle Scholar
  37. 37.
    Schüttler KF, Hoeger A, Heyse TJ et al (2018) Femoral tunnel widening is associated with tunnel malposition but not with clinical failure after medial patellofemoral ligament reconstruction with a free gracilis tendon graft. Arch Orthop Trauma Surg 138(7):979–984CrossRefGoogle Scholar
  38. 38.
    Dickschas J, Ferner F, Lutter C et al (2018) Patellofemoral dysbalance and genua valga: outcome after femoral varisation osteotomies. Arch Orthop Trauma Surg 138(1):19–25CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Zhengdao Fu
    • 1
  • Zhiqiang Zhu
    • 1
  • Haitao Chen
    • 1
  • Shiqin Zhang
    • 1
    Email author
  1. 1.Department of Orthopedic SurgeryHangzhou First People’s HospitalHangzhouChina

Personalised recommendations