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Related Experiment Video

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Surgical versus non-surgical interventions for treating patellar dislocation.

Toby O Smith1, Simon Donell, Fujian Song

  • 1Faculty of Medicine and Health Sciences, University of East Anglia, Queen's Building, Norwich, Norfolk, UK, NR4 7TJ. toby.smith@uea.ac.uk.

The Cochrane Database of Systematic Reviews
|February 27, 2015
PubMed
Summary

Surgery may reduce recurrent patellar dislocation compared to non-surgical treatments for primary dislocations. However, the evidence quality is very low, making outcomes uncertain. More research is needed for definitive conclusions.

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Area of Science:

  • Orthopedic surgery
  • Sports medicine
  • Evidence-based medicine

Background:

  • Patellar dislocation involves the kneecap disengaging from the femoral groove.
  • Conservative physiotherapy is common post-reduction, but recurrence is frequent.
  • Surgical intervention is considered by some for recurrent patellar dislocations.

Purpose of the Study:

  • To evaluate the benefits and harms of surgical versus non-surgical treatments for primary or recurrent patellar dislocation.
  • To compare recurrence rates and patient-reported functional outcomes.

Main Methods:

  • Systematic review and meta-analysis of randomized and quasi-randomized controlled trials.
  • Searched multiple databases including Cochrane, MEDLINE, EMBASE, and PEDro up to October 2014.

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  • Assessed primary outcomes: recurrent dislocation frequency and patient-rated function scores; analyzed data using risk ratios and mean differences.

    • Main Results:

    • Six studies (344 participants) with very low-quality evidence were included.
    • Surgery showed a trend towards lower recurrent dislocation risk at 2-5 years (RR 0.53) and 6-9 years (RR 0.67), but with high uncertainty.
    • No significant differences in most function scores; Kujala score favored surgery at 2-5 years but non-surgical at 6-9 years. Higher complications in the surgical group.

    Conclusions:

    • Very low-quality evidence suggests potential short-term benefits of surgery for primary patellar dislocation, but high bias and imprecision lead to significant uncertainty.
    • No trials addressed recurrent patellar dislocation.
    • High-quality, multi-center randomized controlled trials are essential to clarify treatment effectiveness and long-term outcomes.