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Treatment for a fracture is based on the type of break, the bone affected, and the patient's age.
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Author Spotlight: Double Posteromedial Approach for Treating Posterior Cruciate Ligament Cysts
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Surgical versus non-surgical interventions for treating patellar dislocation.

Toby O Smith1, Andrew Gaukroger2, Andrew Metcalfe1

  • 1Warwick Clinical Trials Unit, University of Warwick, Coventry, UK.

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|January 24, 2023
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The evidence is insufficient to determine if surgery is better than non-surgical treatment for patellar (knee cap) dislocation. More high-quality trials are needed to compare surgical versus non-surgical interventions for patellar dislocation.

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Area of Science:

  • Orthopedics
  • Sports Medicine
  • Evidence-Based Medicine

Background:

  • Patellar dislocation, where the kneecap disengages from the femoral groove, affects up to 42/100,000 people, primarily those aged 20-30.
  • Recurrent dislocations occur in up to 40% of primary cases, significantly impacting quality of life and necessitating lifestyle modifications.

Purpose of the Study:

  • To assess the benefits and harms of surgical versus non-surgical interventions for primary or recurrent patellar dislocation.
  • To determine the optimal treatment approach for individuals experiencing patellar dislocation.

Main Methods:

  • A systematic review and meta-analysis of randomized and quasi-randomized controlled clinical trials.
  • Searched multiple databases including Cochrane, MEDLINE, Embase, and trial registries up to December 2021.
  • Included 10 studies (8 RCTs, 2 quasi-RCTs) with 519 participants, assessing outcomes like recurrent dislocation, function, and adverse events using GRADE criteria.

Main Results:

  • The certainty of evidence for all outcomes was judged as very low due to imprecision, risk of bias, and inconsistency.
  • Uncertainty exists regarding whether surgery reduces recurrent dislocation rates compared to non-surgical management.
  • Surgical intervention's impact on patient-rated knee function and adverse events remains unclear, with varied outcomes and wide confidence intervals.

Conclusions:

  • Current evidence is insufficient to definitively recommend surgical over non-surgical management for patellar dislocation.
  • There is a lack of adequately powered trials, particularly for recurrent patellar dislocations.
  • Future research should focus on well-designed, multicenter randomized trials with standardized intervention descriptions.