Does surgical treatment produce better outcomes than conservative treatment for acute primary patellar dislocations? A meta-analysis of 10 randomized controlled trials

Abstract

Purpose: The objective of this study was to conduct the latest meta-analysis of randomized controlled trials (RCTs) that compare clinical results between surgery and conservative therapy of acute primary patellar dislocation (APPD), focusing on medial patellofemoral ligament (MPFL) reconstruction.

Methods: We performed a literature search in Embase, The Cochrane Library, PubMed, and Medline to identify RCTs comparing APPD surgical treatment with conservative treatment from the establishment of each database to January 2019. The methodological quality of each RCT was assessed independently by the two authors through the Cochrane Collaboration's "Risk of Bias" tool. Mean differences of continuous variables and risk ratios of dichotomous variables were computed for the pooled data analyses. The I² statistic and the χ² test were used to evaluate heterogeneity, with the significance level set at I² > 50% or P < 0.10.

Results: Ten RCTs with a sum of 569 patients (297 receiving surgical treatment and 263 receiving conservative treatment) met the inclusion criteria for meta-analysis. Pooled data analysis showed no statistical difference in the field of subluxation rate, Kujala score, patient satisfaction, and frequency of reoperation between the two groups. Tegner activity score and recurrent dislocation rate in the conservative group were significantly higher than those in the surgically treated group.

Conclusions: Conservative treatment may produce better outcomes than surgery for APPD in consideration of Tegner activity score. However, in view of limited research available, the interpretation of the discoveries should be cautious. More convincing evidence is required to confirm the effect of MPFL reconstruction.

Keywords: Acute; Conservative; Dislocation; MPFL; Patella; Primary; Surgery; Treatment.

Fig. 1

PRISMA flowchart of eligible studies selection

Fig. 2

Risk of bias graph: review authors’ judgements about each risk of bias item presented as percentages across all included studies

Fig. 3

Risk of bias summary: review authors’ judgements about each risk of bias item for each included study

Fig. 4

Forest plot of recurrent dislocation rate between two groups

Fig. 5

Forest plot of subluxation rate between two groups

Fig. 6

Forest plot of Kujala score between two groups

Fig. 7

Forest plot of Tegner activity score between two groups

Fig. 8

Forest plot of reoperation between two groups

Fig. 9

Forest plot of patient’s satisfaction between two groups