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Review
. 2020 Sep 22;8(9):2325967120946446.
doi: 10.1177/2325967120946446. eCollection 2020 Sep.

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

Kaibo Zhang  1 , Hua Jiang  2   3 , Jian Li  1 , Weili Fu  1
Affiliations
Review

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

Kaibo Zhang et al. Orthop J Sports Med. .

Abstract

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.

Keywords: adolescents; nonsurgical treatment; primary patellar dislocation; surgery.

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Conflict of interest statement

The authors declared that there are no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
Flowchart of literature search and study inclusion.
Figure 2.
Figure 2.
Forest plot of the meta-analysis comparing the incidence of overall redislocations between surgery and nonsurgical treatment, regardless of follow-up time (fixed-effects model; Mantel-Haenszel [M-H] method). L, long term.
Figure 3.
Figure 3.
Forest plot of the meta-analysis comparing the incidence of redislocations between surgical and nonsurgical treatment, stratified by short- and long-term follow-up (fixed-effects model; Mantel-Haenszel [M-H] method). L, long term; S, short term.
Figure 4.
Figure 4.
Forest plot of the meta-analysis comparing the Kujala score after surgical or nonsurgical treatment for all patients, regardless of follow-up time (fixed-effects models; inverse variance [IV] method).
Figure 5.
Figure 5.
Forest plot of the meta-analysis comparing the Knee injury and Osteoarthritis Outcome Score (KOOS) score after surgical or nonsurgical treatment for all patients, regardless of follow-up time (fixed-effects models; inverse variance [IV] method).
Figure 6.
Figure 6.
Forest plot of the meta-analysis comparing the incidence of reoperations between surgical and nonsurgical treatment, regardless of follow-up time (fixed-effects model; Mantel-Haenszel [M-H] method).
Figure 7.
Figure 7.
Funnel plot to assess publication bias for the redislocation rate. RR, risk ratio.
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