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Meta-Analysis
. 2019 Jul;98(29):e16338.
doi: 10.1097/MD.0000000000016338.

Surgical versus nonsurgical treatment of primary acute patellar dislocation: A systematic review and meta-analysis

Fan Yang  1 , Wenlai Guo  2 , Qian Wang  3 , Zhe Zhu  2 , Congying Guan  1 , Shishun Zhao  1 , Baoming Yuan  4
Affiliations
Meta-Analysis

Surgical versus nonsurgical treatment of primary acute patellar dislocation: A systematic review and meta-analysis

Fan Yang et al. Medicine (Baltimore). 2019 Jul.

Abstract

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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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Literature search strategy and results.
Figure 2
Figure 2
Forest plot for mean Kujala score.
Figure 3
Figure 3
Sensitivity analysis for mean Kujala score. 3.1 Remove the cohort study. 3.2 Remove the RCT with the lowest score. 3.3 Remove the RCT with the sub-low score.
Figure 3 (Continued)
Figure 3 (Continued)
Sensitivity analysis for mean Kujala score. 3.1 Remove the cohort study. 3.2 Remove the RCT with the lowest score. 3.3 Remove the RCT with the sub-low score.
Figure 3 (Continued)
Figure 3 (Continued)
Sensitivity analysis for mean Kujala score. 3.1 Remove the cohort study. 3.2 Remove the RCT with the lowest score. 3.3 Remove the RCT with the sub-low score.
Figure 4
Figure 4
Subgroup analysis for mean Kujala score.
Figure 5
Figure 5
Forest plot for redislocation.
Figure 6
Figure 6
Subgroup analysis for redislocation.
Figure 7
Figure 7
Forest plot for subluxation.
Figure 8
Figure 8
Subgroup analysis for subluxation.
Figure 9
Figure 9
Forest plot for satisfaction of patients.
Figure 10
Figure 10
Sensitivity analysis for satisfaction of patients.
Figure 11
Figure 11
Subgroup analysis for satisfaction of patients.
Figure 12
Figure 12
Forest plot for VAS. VAS = visual analog scale.
Figure 13
Figure 13
Sensitivity analysis for VAS. VAS = visual analog scale.
See this image and copyright information in PMC

References

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