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Systematic review
Surgical treatment of medial patellofemoral ligament injuries achieves better outcomes than conservative management in patients with primary patellar dislocation: a meta-analysis
  1. Amre Hussein1,
  2. Asser A Sallam2,
  3. Mohamed A Imam3,
  4. Martyn Snow3
  1. 1Trauma and Orthopaedics, Warwick Hospital – South Warwickshire NHS Foundation Trust, Warwick, UK
  2. 2Department of Orthopedic Surgery and Trauma, Suez Canal University Hospitals, Ismailia, Egypt
  3. 3Arthroscopy Division, The Royal Orthopaedic Hospital, Birmingham, UK
  1. Correspondence to Dr Asser A Sallam, Departmentof Orthopedic Surgery and Trauma, Suez Canal University Hospitals, Ismailia 41111, Egypt; assersallam{at}hotmail.com

Abstract

Importance Lateral patellar dislocation is a commonly encountered disorder that affects mainly young and active adults and is associated with potential long-term morbidity. Primary traumatic dislocations can result in injury to the medial patellofemoral ligament (MPFL). There is controversy in literature about the superiority of early surgical intervention over conservative treatment of MPFL injuries.

Objective The aim of this project was to undertake a meta-analysis to evaluate the clinical outcomes of the surgical management of MPFL injuries compared with conservative treatment in patients with primary patellar dislocation.

Evidence review A systematic review of the English literature combining electronic databases Allied and Complementary Medicine (AMED), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase and MEDLINE ((Ovid) and PubMed) and the reference lists of the final studies was performed during the last week of June 2017 using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Four eligible randomised controlled trials comparing MPFL repair/reconstruction to conservative management met our inclusion criteria. They were identified and critically appraised, and the results were quantitatively evaluated giving data of a total of 171 patients. They were divided into two groups: surgically treated group (92 patients) and conservatively treated group (79 patients). The performed surgical procedures included: reconstruction and repair of the MPFL. The conservative management group included mainly physiotherapy. The outcomes evaluated were the rate of recurrent dislocation of the patella and the Kujala score.

Findings Our analysis showed high statistical significance favouring the surgical management in reducing the redislocation rate (6.74%) in comparison with the conservative group (28.5%) (P<0.001). The surgical group also demonstrated significantly higher Kujala score (70.8) compared with the conservative group (59.8) (P<0.001).

Conclusions and relevance Contrary to the available current evidence in the literature, we report that the surgical management of MPFL injuries in patients with primary patellar dislocation results in a significantly reduced rate of redislocation when compared with non-operative management.

Level of evidence Meta-analysis, therapeutic type II.

  • knee
  • dislocation
  • outcome studies
  • ligament

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Footnotes

  • Contributors All authors have contributed to the design of the work, analysis and interpretation of data. All authors have contributed to drafting the work and revising it critically. All authors finally approved the version to be published. Questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved by all authors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.

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