Does Operative Treatment of First-Time Patellar Dislocations Lead to Increased Patellofemoral Stability? A Systematic Review of Overlapping Meta-analyses
Patellar dislocations account for roughly 2% to 3% of all knee injuries and are cited as the second most common cause of traumatic hemarthrosis of the knee. The injuries often result from a traumatic injury but can sometimes be the result of hyperlaxity. Patients who sustain a patellar dislocation often rupture the medial patellofemoral ligament (MPFL) because the distance the patella travels when it dislocates laterally often exceeds the distance the MPFL can stretch before rupture.
Many studies have sought to find the most effective treatment for first-time patellar dislocations. These treatments include conservative therapy, knee arthroscopy, and surgical reconstruction of the MPFL with or without fixation of an osteochondral fragment. Several studies have attempted to determine whether surgical treatment is more effective than conservative treatment for first-time patellar dislocations. Buchner compared 126 patients at a mean of 8.1 years after primary patellar dislocation who underwent surgical versus nonsurgical treatment, and they found no difference between redislocation and reoperation rates, functional and subjective outcomes, and level of activity. Similarly, Nikku compared operative and nonoperative treatment of primary patellar dislocations in 127 patients at a mean of 7 years’ follow-up and found no significant differences between treatment groups. However, Bitar did find better outcomes at a minimum of 2 years’ follow-up in patients treated operatively versus those treated nonoperatively for primary patellar dislocations. Other studies have also supported operative treatment.
Hence the purpose of this study was to perform a systematic review of overlapping meta-analyses comparing operative and nonoperative treatment of primary patellar dislocations to determine the cause of discordance and to determine which studies provide the best available evidence on this subject. The purposes of this study were (1) to conduct a systematic review of meta-analyses comparing operative and nonoperative treatment of primary patellar dislocations, (2) to provide an analytic framework for interpreting the presently discordant best available evidence to develop treatment recommendations, and (3) to identify gaps in the literature that require continued investigation. We hypothesized that operative treatment for primary patellar dislocations would provide lower rerupture rates than nonoperative treatment.