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

Dong-Yeong Lee; Dong-Geun Kang; Ho-Seung Jo; Se-Joon Heo; Ji-Ho Bae; Sun-Chul Hwang

doi:10.1186/s43019-023-00189-z

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

Knee Surg Relat Res. 2023 Jun 22;35(1):18. doi: 10.1186/s43019-023-00189-z.

Authors

Dong-Yeong Lee¹, Dong-Geun Kang², Ho-Seung Jo³, Se-Joon Heo⁴, Ji-Ho Bae⁴, Sun-Chul Hwang⁵

Affiliations

¹ Department of Orthopaedic Surgery, Barun Hospital, Jinju, Republic of Korea.
² Department of Orthopaedic Surgery, College of Medicine and Gyeongsang National University and Changwon Hospital, Changwon, Republic of Korea.
³ Department of Orthopaedic Surgery, SMG Yeonse Hospital, Changwon, Republic of Korea.
⁴ Department of Orthopaedic Surgery, College of Medicine and Gyeongsang National University and Hospital, Jinju, Republic of Korea.
⁵ Department of Orthopaedic Surgery, College of Medicine and Gyeongsang National University and Hospital, Jinju, Republic of Korea. hscspine@hanmail.net.

Abstract

Purpose: This study sought to clarify treatment evidence to treat patellar dislocation by evaluating which treatment could yield better improvement of clinical outcomes for acute patellar dislocation in children and adolescents 18 years of age or younger.

Materials and methods: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials electronic databases were searched for relevant articles comparing clinical outcomes of conservative and surgical treatments for acute patellar dislocation in children and adolescents published from March 2008 to August 2022. Data searching, extraction, analysis, and quality assessment were performed on the basis of the Cochrane Collaboration guidelines. The quality assessment of each study was investigated using the Physiotherapy Evidence Database (PEDro) critical appraisal scoring system and Newcastle-Ottawa Quality Assessment Scale scores. To calculate the overall combined effect size for each outcome, Review Manager Version 5.3 (The Cochrane Collaboration, Software Update, Oxford) was employed.

Results: Three randomized controlled trials (RCTs) and one prospective study were investigated. In terms of pain [mean difference (MD) 6.59, 95% confidence interval (CI) 1.73-11.45, I² 0%], there were significantly better outcomes in conservative group. Nevertheless, there were no significant differences in any evaluated outcomes such as redislocation [risk ratio (RR) 1.36, 95% CI 0.72-2.54, I² 65%], Kujala score (MD 3.92, 95% CI -0.17 to 8.01, I² 0%), Tegner score (MD 1.04, 95% CI -0.04 to 2.11, I² 71%), or subjective results (RR 0.99, 95% CI 0.74-1.34, I² 33%) between conservative and surgical treatment groups.

Conclusions: Despite better pain outcomes with conservative group, the present study revealed no significant differences in clinical outcomes between conservative treatment and surgical treatment in children and adolescents with acute patellar dislocation. Since there are no significant differences in clinical outcomes between the two groups, routine surgical treatment is not advocated for treating acute patellar dislocation in children and adolescents.

Keywords: Medial patellofemoral ligament; Meta-analysis; Patellar dislocation; Patellar instability; Reconstruction.

Publication types

Review