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

Authors
  • Xing, Xuewu1
  • Shi, Hongyu2
  • Feng, Shiqing2
  • 1 Tianjin First Central Hospital, First Central Clinical College of Tianjin Medical University, Tianjin, China , Tianjin (China)
  • 2 Tianjin Medical University General Hospital, Tianjin, China , Tianjin (China)
Type
Published Article
Journal
Journal of Orthopaedic Surgery and Research
Publisher
Springer (Biomed Central Ltd.)
Publication Date
Mar 24, 2020
Volume
15
Issue
1
Identifiers
DOI: 10.1186/s13018-020-01634-5
Source
Springer Nature
Keywords
License
Green

Abstract

PurposeThe 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.MethodsWe 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.ResultsTen 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.ConclusionsConservative 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.

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