Operative versus non-operative management of patellar dislocation. A meta-analysis.

PURPOSE: Conservative management of patellar dislocation can result in recurrent instability in up to 60% of patients. Surgery is therefore advocated in an attempt to reduce the incidence of recurrent dislocation and instability. The purpose of this study was to compare the clinical outcomes of operative to non-operative treatment strategies for patients following patellar dislocation.

METHODS: A systematic review of published and unpublished literature was undertaken. Following data extraction, a meta-analysis was conducted to compare the two treatment strategies. The methodological quality of the literature was assessed using the PEDro critical appraisal tool.

RESULTS: Eleven studies were included, five randomised controlled trials (RCTs) and six non-RCTs. These assessed 403 patients managed conservatively, compared to 344 managed surgically. The findings of this study indicate that operative management of patellar dislocation is associated with a significantly higher risk of patellofemoral joint osteoarthritis (P=0.04), but a significantly lower risk of subsequent patellar dislocation compared to non-surgical management (P<0.01).

CONCLUSIONS: The meta-analysis indicates that there may be a difference in the incidence of patellofemoral joint osteoarthritis and rate of subsequent dislocation. However, this finding should currently be interpreted with great caution due to the demonstration of statistically significant publication bias, issues related to the methodological quality of the evidence base, and due to the variety of different surgical interventions currently presented within the literature.

LEVEL OF EVIDENCE: III.