Comparison Between Surgical and Nonsurgical Treatment for Primary Patellar Dislocations in Adolescents: A Systematic Review and Meta-analysis of Comparative Studies

Abstract

Background: Whether surgical or nonsurgical management is more appropriate for primary patellar dislocations (PPDs) in adolescents (younger than 18 years) remains controversial. Purpose: To compare the clinical outcomes of surgical versus nonsurgical treatment for adolescents and children with PPDs. Study Design: Systematic review; Level of evidence, 3. Methods: There were 2 reviewers who independently searched the PubMed, Embase, Ovid, and Cochrane databases for English-language studies of randomized controlled trials (RCTs), quasi-RCTs, and observational studies comparing surgical with nonsurgical treatment for PPDs. The primary outcomes were redislocations, the Kujala score, and the Knee injury and Osteoarthritis Outcome Score (KOOS), and the secondary outcome was subsequent surgery. Results: A total of 6 studies were included in our systematic review and meta-analysis. Among patients younger than 18 years, surgery was associated with a lower redislocation rate compared with nonsurgical treatment within 5 years of treatment (risk ratio [RR], 0.58 [95% CI, 0.37-0.91]; P = .02; I 2 = 47%) but not beyond 5 years (RR, 0.80 [95% CI, 0.59-1.07]; P = .14; I 2 = 34%). However, surgery resulted in worse Kujala and KOOS scores compared with nonsurgical treatment. Yet, the treatment difference between the 2 groups tended to decrease over time. Conclusion: The available evidence suggests that for adolescents with PPDs, surgery was superior to nonsurgical treatment in the short term to reduce the redislocation rate but resulted in poorer outcomes of knee function based on the Kujala and KOOS scores. However, the superiority of either surgical or nonsurgical treatment in adolescents did not appear to persist in the long term.

Radiographic Evaluation of Pediatric Patients with Patellofemoral Instability

“…Radiographic assessments including the presence of open regional physes, trochlear dysplasia, patella alta, and axial malalignment assessments (e.g., tibial tubercle-trochlear groove, or TT-TG, distance) are among the strongest and most consistent across studies of these risk factors. Recurrent ipsilateral patellar dislocation occurs in 15% to 54% of pediatric patients following primary dislocation [1,7,15,16,[18][19][20][21], while contralateral dislocation is estimated to occur in 10-11% of pediatric patients [1,7,18]. Recurrence peaks during adolescence with most episodes occurring within 5 years of the first dislocation [15,18].…”

A 20-Year Retrospective Study of Children and Adolescents Treated by the Three-in-One Procedure for Patellar Realignment

“…Many papers in the current literature faced with the management of patellar dislocation in a pediatric population and several surgical techniques have been described to realign the patella in skeletally immature patients [ 6 , 30 ]. Currently, there is evidence that surgical treatment is superior to conservative treatment in reducing the recurrence of the dislocation [ 13 , 14 , 15 , 16 , 31 ]. In particular, the combination of proximal and distal procedures has demonstrated high effectiveness in preventing relapse [ 14 , 32 ].…”

A systematic review and meta-analysis comparing conservative and surgical treatments for acute patellar dislocation in children and adolescents

“…However, compared with our study, one study only analyzed redislocation and lacked analysis of other clinical results [ 42 ]. In addition, there were studies that did not include statistical analysis, so there were limitations in obtaining reliable results, and the level of evidence was low because level I and II studies (high quality studies) were omitted from the analysis or retrospective studies were included [ 9 , 43 ]. Unlike those studies, our study involved only RCTs and prospective studies (level I and II).…”