Conservative management following patellar dislocation: a level I systematic review
Journal of Orthopaedic Surgery and Research, vol. 18, pp. 393
Abstract
BACKGROUND: Patellar instability is a common and disabling clinical condition. Treatment of acute primary patellar dislocation aims to reduce the risk of recurrence or painful subluxation and improve function. However, the actual clinical efficacy of any management modality following an acute dislocation has never been demonstrated in prospective or retrospective studies, and the optimal way in which the various management modalities should be used is at best unclear. METHODS: A search was conducted in PubMed, Bireme and Embase databases. Inclusion criteria followed the acronym PICOS, (P) subjects with patellar instability, (I) therapeutic interventions, (C) placebo or control or surgical treatments, (O) rate of dislocations and function, and (S) clinical trials. The Medical Subject Headings (MeSH) terms used were: (("patellar instability") OR ("patellar dislocation")) AND ((physiotherapy) OR (rehabilitation) OR ("conservative treatment") OR (therapy) OR (therapeutic)). The risk of bias was analysed using the PeDRO scale. RESULTS: Seven randomized controlled trials including 282 patients were considered. The quality of studies detailing the results of conservative treatment was higher than that of surgical procedures, but all studies have relatively low methodological quality. Four studies compared physiotherapeutic interventions with surgical procedures, and three studies compared conservative intervention techniques. CONCLUSION: An unstructured lower limb physical therapy programme evidences similar outcomes to specific exercises. Surgical management is associated with a lower rate of re-dislocation; however, whether surgery produces greater functional outcomes than conservative management is still unclear. The use of a knee brace with a limited range of motion, stretching and neuromuscular exercises are the most commonly recommended physiotherapy methodologies.
Authors 7
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Universidade do Estado de Santa Catarina
Affiliation as printed
Department of Physiotherapy, University of the State of Santa Catarina, Florianópolis, SC, Brazil
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Universidade do Estado de Santa Catarina
Affiliation as printed
Department of Physiotherapy, University of the State of Santa Catarina, Florianópolis, SC, Brazil
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Universidade do Sul de Santa Catarina
Affiliation as printed
Physiotherapy Department, University of South of Santa Catarina (Unisul), Florianópolis, SC, Brazil
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Universidade do Estado de Santa Catarina
Affiliation as printed
Department of Physiotherapy, University of the State of Santa Catarina, Florianópolis, SC, Brazil
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Filippo Migliorini corresponding Aachen Department of Orthopaedic, Trauma, and Reconstructive Surgery
University of Salerno · Ospedale di Bolzano · Universitätsklinikum Aachen · Azienda Sanitaria dell'Alto Adige · RWTH Aachen University
Affiliation as printed
Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy. migliorini.md@gmail.com
Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany. migliorini.md@gmail.com
Department of Orthopaedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100, Bolzano, Italy. migliorini.md@gmail.com
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University of Salerno · Queen Mary University of London · Mile End Hospital · Keele University
Affiliation as printed
Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, London, E1 4DG, England, UK
Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy
School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Stoke on Trent, ST4 7QB, England, UK
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Universidade do Estado de Santa Catarina
Affiliation as printed
Department of Physiotherapy, University of the State of Santa Catarina, Florianópolis, SC, Brazil
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