Cochrane patellar dislocation

Surgical versus non-surgical interventions for treating patellar dislocation.

Smith TO, Donell S, Song F, et al. The Cochrane database of systematic reviews 2015 · PMID 25716704 · doi:10.1002/14651858.cd008106.pub3

Question

In people with primary or recurrent lateral patellar dislocation, does surgery give better outcomes than non-surgical management?

Design

Cochrane systematic review and meta-analysis of randomised and quasi-randomised trials.

Patients

Adolescents and adults with a first-time (primary) lateral patellar dislocation.

Intervention

Surgical stabilisation (various soft-tissue and realignment procedures)

Comparison

Non-surgical management (bracing, physiotherapy)

Primary outcome

Recurrent dislocation and patient-reported knee function

Key result

Surgery was associated with a lower risk of recurrent dislocation, but the evidence was of low or very low quality and any difference in patient-reported function was uncertain.

Limitations

Small, heterogeneous, mostly older trials using a variety of procedures rarely including modern MPFL reconstruction; low-quality evidence.

Impact on practice

Most first-time dislocations without osteochondral fracture are still managed non-operatively, with stabilisation (typically MPFL reconstruction with or without bony realignment) considered for recurrent instability.