Treatment of Primary Acute Patellar Dislocation

Longo, Umile Giuseppe; Ciuffreda, Mauro; Locher, Joel; Berton, Alessandra; Salvatore, Giuseppe; Denaro, Vincenzo

doi:10.1097/jsm.0000000000000410

Cited by 45 publications

(19 citation statements)

References 53 publications

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“…A few published systematic reviews and meta-analyses in the past 5 years have compared the efficacy of surgery versus nonsurgical treatment. There were 2 meta-analyses 15 , 33 that indicated that, when patient age and follow-up duration are not taken into account, surgery is associated with a lower recurrent dislocation rate and similar Kujala scores as nonsurgical treatment. When only considering the follow-up duration, 3 meta-analyses 27 , 29 , 34 further suggested a lower redislocation rate and better Kujala score with surgery than with nonsurgical treatment in the short term, but these benefits disappeared in the long term.…”

Section: Discussionmentioning

confidence: 99%

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

Zhang

Jiang

et al. 2020

Orthopaedic Journal of Sports Medicine

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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.

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Section: Discussionmentioning

confidence: 99%

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

Zhang

Jiang

et al. 2020

Orthopaedic Journal of Sports Medicine

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“…In this study, the total number of patients and the number of patients for each index were both higher than those reported in other meta-analyses of surgical and nonsurgical treatment of patellar dislocation published in the last 3 years. [2–4,6,34–36] The average follow-up time was 5.08 years. These factors all ensure the reliability of the results in this study.…”

Section: Discussionmentioning

confidence: 99%

Surgical versus nonsurgical treatment of primary acute patellar dislocation

et al. 2019

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Background: To systematically review the efficacy of surgical versus nonsurgical treatment for acute patellar dislocation. Materials and Methods: PubMed, Cochrane, and Embase were searched up to February 12, 2019. After removing duplicates, preliminary screening, and reading the full texts, we finally selected 16 articles, including 11 randomized controlled trials and 5 cohort studies. The quality of the enrolled studies was evaluated by Jadad score or Newcastle–Ottawa scale. Meta-analyses were performed using odds ratio (OR) and standardized mean difference (SMD) as effect variables. The clinical parameters assessed included mean Kujala score, rate of redislocation, incidence of patellar subluxation, patient satisfaction, and visual analog scale (VAS) for pain. Evidence levels were determined using GRADE profile. Results: The 16 included studies involved 918 cases, 418 in the surgical group and 500 in the nonsurgical group. The results of the meta-analysis showed higher mean Kujala score (SMD = 0.79, 95% confidence interval [CI] [0.3, 1.28], P = .002) and lower rate of redislocation (OR = 0.44, 95% CI [0.3, 0.63], P < .00001) in the surgical group than the nonsurgical group, but showed insignificant differences in the incidence of patellar subluxation (OR = 0.61, 95% CI [0.36, 1.03], P = .06), satisfaction of patients (OR = 1.44, 95% CI [0.64, 3.25], P = .38), and VAS (SMD = 0.84, 95% CI [−0.36, 9.03], P = .84). Conclusion: For patients with primary acute patellar dislocation, surgical treatment produces a higher mean Kujala score and a lower rate of redislocation than nonsurgical treatment.

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“…While the majority of patients do not suffer from recurrent dislocation, those suffering from recurrence are at higher risk of persistent symptoms as well as patellofemoral osteoarthritis [2,3,5]. As a result, management of acute patellar dislocations in an attempt to address the risk of recurrence in the acute setting remains under debate, with a recent increase in acute surgical management occurring with potentially more favourable functional status, recurrence and complication rates but conservative management continuing to show acceptable long-term outcomes [3,6].…”

Section: Discussionmentioning

confidence: 99%

“…Detailed anatomical illustration of the patellofemoral joint and surrounding structures at time of injury has thus become increasingly important aspect of initial evaluation following this injury [6-8]. This is typically achieved through MRI, which has an increasingly prominent role in helping dictate the definitive decision on nonoperative versus operative treatment in acute patellar dislocations [2].…”

Section: Discussionmentioning

confidence: 99%

Magnetic Resonance Imaging Features of Traumatic Patellofemoral Dislocation

Mohan

Ellanti

Lincoln

et al. 2018

Cureus

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Acute traumatic patellar dislocations are encountered with relative frequency, making up 3% of all knee injuries. Typically witnessed in younger patients following sporting injuries, this injury can be debilitating, potentially leading to recurrent dislocation, pain, reduction in activity and patellofemoral osteoarthritis.Management of this injury remains controversial, and as such detailed magnetic resonance imaging (MRI) is increasingly recommended to help illustrate the exact nature of osteochondral and soft tissue injury, with a view to assessing the anatomical sequelae of patellar dislocation as well as the potential of recurrence and dictating the need for either conservative or surgical management in the acute setting. As such, awareness of the typical MRI findings in traumatic patellar dislocations may potentially aid in pursuing appropriate intervention for this pathology.This case describes a 33-year-old gentleman presenting to the emergency department following patellar dislocation. After failed departmental closed reduction, this patient progressed on to definitive anatomical MRI assessment followed by acute surgical intervention in the form of medial patellofemoral ligament (MPFL) repair. This case allows for both illustration and discussion of typical radiological features associated with traumatic patellar dislocation.

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Treatment of Primary Acute Patellar Dislocation

Cited by 45 publications

References 53 publications

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

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

Surgical versus nonsurgical treatment of primary acute patellar dislocation

Magnetic Resonance Imaging Features of Traumatic Patellofemoral Dislocation

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