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

Abstract

PurposeThis study aimed to explore the efficacy of medial patellofemoral ligament (MPFL) repair versus nonoperative rehabilitation treatment on the rate of patellar redislocation and functional outcomes in skeletally mature patients with traumatic, first‐time patellar dislocations. Materials and methodsMEDLINE, PubMed and EMBASE were searched from database inception to May 2022 for studies examining the management options for acute first‐time patellar dislocations. This study was conducted in accordance with PRISMA and R‐AMSTAR guidelines. Data on redislocation rates, functional outcomes including the Kujala score for anterior knee pain, and complication rates were extracted. A meta‐analysis was used to pool the mean postoperative Kujala score and calculate the proportion of patients sustaining redislocations using a random effects model. Quality assessment of included studies was performed for all included studies using the MINORS and Detsky scores. ResultsThis review included a total of 25 studies and 1,361 patients. The pooled mean redislocation rate in 15 studies comprising 798 patients in the rehabilitation group was 30% (95% CI 25–36%, I2 = 65%). Moreover, the pooled mean redislocation rate in 10 studies comprising 170 patients undergoing MPFL repair was 7% (95% CI 3–12%, I2 = 30%). The pooled mean postoperative Kujala score in 8 studies comprising 396 patients in the rehabilitation group was 82.5 (95% CI 78.3–86.8, I2 = 91%), compared to a score of 88 (95% CI 87–90, I2 = 76%) in 3 studies comprising 94 patients in the repair group. Range of motion deficits was reported in 3.8% of 893 patients in the rehabilitation group and 2.0% of 205 patients in the repair group. ConclusionMPFL repair resulted in a lower rate of redislocation, less knee pain, and noninferiority with respect to a range of motion deficits compared to nonoperative treatment for the management of acute first‐time patellar dislocations. Level of evidenceIV.

Characterizing recurrent infections after one-stage revision for periprosthetic joint infection of the knee: a systematic review of the literature

“…Each article's levels of evidence (LoE) was recorded using the Oxford Centre for Evidence-Based Medicine criteria [18]. The methodological quality of the studies included was evaluated through the methodological index for non-randomized studies (MINORS) criteria [19][20][21]. The MINORS score ranges from 0 to 18 for non-comparative studies and 0 to 24 for comparative studies, with a higher score reflecting higher quality.…”

“…The mean follow-up was 57.6 ± 31.8 months. Seventeen studies [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][34][35][36][37][38][39] reported sex data, and 43.3% were men, and 56.7% were women. The demographic data of the included studies are listed in Table 1.…”

Patients with discoid menisci have similar clinical outcomes to those without discoid menisci when undergoing surgical intervention: a systematic review

“…if trial is negative, were confidence intervals [CIs] calculated or post‐hoc power calculations performed?). The maximum score for trials with positive and negative findings is 20 and 21 points, respectively [34].…”

Patellofemoral Disorders in Soccer Players

“…82 A recent systematic review and meta-analysis found lower rates of redislocation and knee pain in first-time patellar dislocators treated with surgery compared with nonoperative management. 83 It is worth noting that despite reducing the rate of patellar dislocation, surgical interventions for PI have been associated with increased rates of complications including patellofemoral arthritis in some studies. 84 This highlights the complexity of managing patellofemoral disorders and underscores the importance of individualized treatment plans tailored to each patient's unique circumstances and needs.…”