Comparison operative and conservative management for primary patellar dislocation: an up-to-date meta-analysis

被引：11
作者：
Yao L.-W. [1 ,2 ]
Zhang C. [1 ,2 ]
Liu Y. [1 ,2 ]
Cao D.-G. [1 ,2 ]
Li D.-J. [1 ,2 ]
Xu D.-D. [1 ,2 ]
Feng S.-Q. [1 ,2 ]
机构：
[1] Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin
[2] School of Public Health, Hebei Medical University, 361 Zhongshandong Road, Changan District, Shijiazhuang
来源：
European Journal of Orthopaedic Surgery & Traumatology | 2015年 / 25卷 / 4期
关键词：
Conservative therapy; Meta-analysis; Patellar dislocation; Primary; Surgery;
D O I：
10.1007/s00590-014-1523-z
中图分类号：
学科分类号：
摘要：
Purpose: The aim of this review was to compare the clinical outcomes between operative and conservative management for primary patella dislocation (PPD). Methods: PubMed Medline, EMBASE, Google scholar, and the Cochrane Library were systematically searched for randomized controlled trials that compared operative technique versus conservative technique for PPD. The results of eligible studies were independently extracted and analyzed according to the following: patient’s satisfaction, Kujala score, Tegner score, and redislocation rate. Random-effect and fixed-effect models were adopted to calculate the weight mean difference and the odds ratio for continuous and dichotomous variables with 95 % confidence interval. Results: Seven studies met the inclusion criteria, resulting in 402 (216 surgery and 186 conservation) patients available for the present study. A meta-analysis showed no significant differences between the two treatment groups in terms of patient’s satisfaction and Kujala score. However, significant differences in Tegner score (P < 0.00001) and redislocation rate (P = 0.002) were observed in favor of surgical treatment. In the subgroup analysis, surgical intervention achieved higher (P = 0.002) Kujala score in short term (<5 years), while conservation gained advantage (P = 0.003) in long term (>5 years). There was no significant difference in dislocation rate in long term. Conclusions: Surgical treatment might provide better clinical results in short term. More persuasive evidence is still needed to proof the effect of surgical management in long time. © 2014, Springer-Verlag France.
引用
收藏
页码：783 / 788
页数：5
相关论文
共 27 条
[11]  
Cash J.D., Hughston J.C., Treatment of acute patellar dislocation, Am J Sports Med, 16, pp. 244-249, (1988)
[12]  
Sallay P.I., Poggi J., Speer K.P., Garrett W.E., Acute dislocation of the patella. A correlative pathoanatomic study, Am J Sports Med, 24, pp. 52-60, (1996)
[13]  
Stefancin J.J., Parker R.D., First-time traumatic patellar dislocation: a systematic review, Clin Orthop Relat Res, 455, pp. 93-101, (2007)
[14]  
Fithian D.C., Paxton E.W., Cohen A.B., Indications in the treatment of patellar instability, J Knee Surg, 17, pp. 47-56, (2004)
[15]  
Carney J.R., Mologne T.S., Muldoon M., Cox J.S., Long-term evaluation of the Roux-Elmslie-Trillat procedure for patellar instability: a 26-year follow-up, Am J Sports Med, 33, pp. 1220-1223, (2005)
[16]  
Merican A.M., Kondo E., Amis A.A., The effect on patellofemoral joint stability of selective cutting of lateral retinacular and capsular structures, J Biomech, 42, pp. 291-296, (2009)
[17]  
Smith T.O., Song F., Donell S.T., Hing C.B., Operative versus non-operative management of patellar dislocation. A meta-analysis, Knee Surg Sports Traumatol Arthrosc, 19, pp. 988-998, (2011)
[18]  
Hozo S.P., Djulbegovic B., Hozo I., Estimating the mean and variance from the median, range, and the size of a sample, BMC Med Res Methodol, 5, (2005)
[19]  
Nikku R., Nietosvaara Y., Aalto K., Kallio P.E., Operative treatment of primary patellar dislocation does not improve medium-term outcome: a 7-year follow-up report and risk analysis of 127 randomized patients, Acta Orthop, 76, pp. 699-704, (2005)
[20]  
Christiansen S.E., Jakobsen B.W., Lund B., Lind M., Isolated repair of the medial patellofemoral ligament in primary dislocation of the patella: a prospective randomized study, Arthroscopy, 24, pp. 881-887, (2008)
123