Conservative versus repair of medial patellofemoral ligament for the treatment of patients with acute primary patellar dislocations: A systematic review and meta-analysis

Abstract

Purpose: The aim of this study was to perform a meta-analysis to compare the effects of repair of medial patellofemoral ligament (MPFL) and conservative treatment in patients with acute primary patellar dislocation (PPD). Method: The databases we used to search the studies included MEDILINE, EMBASE, and Cochrane registry of controlled clinical trials. Five randomized controlled studies comparing the effects of MPFL repair versus conservative treatment with 300 acute PPD patients were included in the present meta-analysis. Primary outcome was redislocation rate and secondary outcomes included Kujala score, percentage of excellent or good subjective opinion, Tegner activity score, and knee injury and osteoarthritis outcome score (KOOS; pain, symptoms, and activities of daily living). Results: The outcome of the Kujala score was statistically significant between the two treatments and indicated that MPFL repair had a higher Kujala score than conservative treatment in patients with acute PPD. There was no significant difference between the two treatments regarding the redislocation rate ( p = 0.32), percentage of excellent or good subjective opinion ( p = 0.15), Tegner activity score ( p = 0.24), and KOOS ( p > 0.05). Conclusions: Based on the available data, MPFL repair did not reduce the risk of redislocation nor did it produce any significantly better outcome based on the clinical manifestations, including anterior knee pain and knee activities. Only the Kujala score was improved by MPFL repair compared with conservative treatment.

Comparing Nonoperative Treatment, MPFL Repair, and MPFL Reconstruction for Patients With Patellar Dislocation: A Systematic Review and Network Meta-analysis

“…They found that MPFL repair technique did not reduce the risk of postoperative redislocation, and MPFL repair led to better postoperative Kujala scores compared with nonoperative treatment (MD, -9.73; 95% CI, -15.90 to -3.57; I 2 ¼ 85%). However, Tian et al 50 included in their review the study of Palmu et al 37 , in which 7 patients in the surgical group underwent only LR; moreover, Palmu et al 37 did not analyze data from these 7 patients separately. The occurrence of this situation may have affected the results of Tian et al 50 Based on the existing DMA, researchers did not entirely agree on which treatment has a better clinical outcome; according to our analysis, the main reasons may be the level of evidence of the original studies, the risk of bias, and other surgical procedures that may be required for patellar dislocation, such as TTO, LR, and cartilage fracture refixation.…”

“…Tian et al 50 compared the efficacy of nonoperative treatment with MPFL repair in primary patellar dislocation in a systematic review and meta-analysis. They found that MPFL repair technique did not reduce the risk of postoperative redislocation, and MPFL repair led to better postoperative Kujala scores compared with nonoperative treatment (MD, -9.73; 95% CI, -15.90 to -3.57; I 2 ¼ 85%).…”

Management of the first episode of traumatic patellar dislocation: an international survey

“…Given the high rate of recurrence, tissue damage, and poor functional outcome, patellar dislocation for the first time causes significant morbidity and might represent a reason for sport retirement [6, 19, 27]. The recurrence rate following conservative management is approximately 25%; therefore, receiving proper treatment after the first episode of patellar dislocation has a considerable impact on the outcome [7, 20, 22, 24]. Although patellar dislocation is amongst the most prevalent first‐time knee disorders, the management of patients following the first patellar dislocation condition remains unclear and controversial [2, 17, 18].…”

MPFL repair after acute first-time patellar dislocation results in lower redislocation rates and less knee pain compared to rehabilitation: a systematic review and meta-analysis

“…One meta‐analysis [34] found that MPFL repair resulted in reduced redislocation rates when compared with non‐operative treatment for the management of recurrent patellar dislocation, but subgroup analysis did not show any obvious benefit in primary dislocation. Further, another meta‐analysis [59] found no significant difference in redislocation rates in patients with primary acute patellar dislocations. However, 25–40% of the studies included in these reviews focused on skeletally immature patients [34, 59], while this study focuses on skeletally mature patients.…”

“…Further, another meta‐analysis [59] found no significant difference in redislocation rates in patients with primary acute patellar dislocations. However, 25–40% of the studies included in these reviews focused on skeletally immature patients [34, 59], while this study focuses on skeletally mature patients. In addition, in one of these reviews [34], all patients in the non‐operative group of the included studies were immobilized for 2–4 weeks with subsequent physical therapy.…”