Dong-Yeong Lee1, Young-Jin Park2, Sang-Youn Song2, Sun-Chul Hwang2, Jin-Sung Park2, Dong-Geun Kang3. 1. Department of Orthopaedic Surgery, Armed Forces Daegu Hospital, Gyeongsan, Republic of Korea. 2. Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea. 3. Department of Orthopaedic Surgery, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea. Electronic address: whatttary@gmail.com.
Abstract
PURPOSE: To clarify the discrepancy in surgical options and present evidence to treat patellar dislocation by evaluating which of the techniques yields better improvement in stability and functional recovery for patellar dislocation. METHODS: The MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus electronic databases were searched for relevant articles comparing the outcomes of medial patellofemoral ligament (MPFL) treatment published up until August 2017. Data searching, extraction, analysis, and quality assessment were performed based on The Cochrane Collaboration guidelines. Clinical outcomes were evaluated using various outcome values in various techniques. For results with high heterogeneity, 95% prediction intervals (PIs) were also investigated. RESULTS: Eleven clinical studies were investigated. In patients with primary patellar dislocation, there were no significant differences in all evaluated outcomes between the conservative and surgical treatment groups. For patients with recurrent patellar dislocation, MPFL reconstruction was associated with a favorable Kujala score (mean difference, -8.91; 95% confidence interval, -14.05 to -3.77; I2 = 94%; 95% PI, -9.64 to -8.1) and Lysholm score (mean difference, -13.51; 95% confidence interval, -21.35 to -5.68; I2 = 96%; 95% PI, -14.86 to -12.16) when compared with soft tissue realignment surgery. CONCLUSIONS: Although surgical treatment of the MPFL for primary patellar dislocation is not superior to conservative treatment in restoring knee function and clinical outcomes, MPFL reconstruction is associated with more favorable clinical outcomes compared with medial soft tissue realignment surgery in patients with recurrent patellar dislocation. Double-bundle MPFL reconstruction seems to provide more favorable outcomes than single-bundle MPFL reconstruction, but this finding should be interpreted with caution because the evidence levels were low and were from only a few studies. LEVEL OF EVIDENCE: Level III, meta-analysis.
PURPOSE: To clarify the discrepancy in surgical options and present evidence to treat patellar dislocation by evaluating which of the techniques yields better improvement in stability and functional recovery for patellar dislocation. METHODS: The MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus electronic databases were searched for relevant articles comparing the outcomes of medial patellofemoral ligament (MPFL) treatment published up until August 2017. Data searching, extraction, analysis, and quality assessment were performed based on The Cochrane Collaboration guidelines. Clinical outcomes were evaluated using various outcome values in various techniques. For results with high heterogeneity, 95% prediction intervals (PIs) were also investigated. RESULTS: Eleven clinical studies were investigated. In patients with primary patellar dislocation, there were no significant differences in all evaluated outcomes between the conservative and surgical treatment groups. For patients with recurrent patellar dislocation, MPFL reconstruction was associated with a favorable Kujala score (mean difference, -8.91; 95% confidence interval, -14.05 to -3.77; I2 = 94%; 95% PI, -9.64 to -8.1) and Lysholm score (mean difference, -13.51; 95% confidence interval, -21.35 to -5.68; I2 = 96%; 95% PI, -14.86 to -12.16) when compared with soft tissue realignment surgery. CONCLUSIONS: Although surgical treatment of the MPFL for primary patellar dislocation is not superior to conservative treatment in restoring knee function and clinical outcomes, MPFL reconstruction is associated with more favorable clinical outcomes compared with medial soft tissue realignment surgery in patients with recurrent patellar dislocation. Double-bundle MPFL reconstruction seems to provide more favorable outcomes than single-bundle MPFL reconstruction, but this finding should be interpreted with caution because the evidence levels were low and were from only a few studies. LEVEL OF EVIDENCE: Level III, meta-analysis.
Authors: Justin M Walsh; Hailey P Huddleston; Mohamad M Alzein; Stephanie E Wong; Brian Forsythe; Nikhil N Verma; Brian J Cole; Adam B Yanke Journal: Arthrosc Sports Med Rehabil Date: 2022-02-05
Authors: Nilson Roberto Severino; Fabrício Roberto Severino; Osmar Pedro Arbix de Camargo; Luiz Gabriel Betoni Guglielmetti; Victor Marques de Oliveira; Ricardo de Paula Leite Cury Journal: Rev Bras Ortop (Sao Paulo) Date: 2020-11-02
Authors: Mohammad Keilani; Stefano Palma; Richard Crevenna; Camilla Gaudart; Timothy Hasenöhrl; Martin Reschl; Nadine Huto; Stefan Hajdu; Harald K Widhalm Journal: Wien Klin Wochenschr Date: 2019-11-11 Impact factor: 1.704