Clinical outcomes following nonoperative management of lateral patellar dislocation: a systematic review

Journal article

Background

First-line treatment for patellar dislocation is often non-operative and consists of physiotherapy and immobilization techniques, with various adjuncts employed. However the outcome of non-operative therapy is poorly described and there is a lack of quality evidence to define the optimal intervention.

Hypothesis/Purpose

To perform a comprehensive review of the literature and assess the quality of studies presenting patient outcomes from non-operative interventions for patellar dislocation.

Study Design

Systematic review

Methods

The Medline, AMED, EMBASE, CINAHL, Cochrane, PEDro and SPORTDiscus electronic databases were searched until July 2017 by three independent reviewers. The PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) guidelines were followed. Study quality was assessed using the CONSORT criteria for randomized controlled trials and Newcastle Ottawa Scale for cohort studies and case series.

Results

Twenty-five studies met our inclusion criteria including 12 RCTs, seven cohort studies and six case series, consisting of 920 patients. Studies were grouped according to four broad categories of non-operative interventions based on immobilization, weight bearing status, quadriceps exercise type and alternative therapies. The most commonly used outcome score was the Kujala score and the pooled re-dislocation rate was 31%

Conclusion

This systematic review showed that patient reported outcomes consistently improved following all methods of treatment but did not return to normal. Re-dislocation rates were high and close to the re-dislocation rates reported in natural history papers. There remains a lack of quality evidence to advocate the use of any particular non-operative technique for the treatment of patellar dislocation.

Authors: Moiz, M; Smith, N; Smith, T; Chawla, A; Thompson, P

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: SAGE Publications
• Journal: Orthopaedic Journal of Sports Medicine
• Volume: 6
• Issue: 6
• Publication date: 2018-06-11
• Acceptance date: 2018-02-16
• DOI: 10.1177/2325967118766275
• EISSN: 2325-9671
• Keywords: instability; patella; conservative; patellofemoral; knee injury