Moiz Munim, Smith Nick, Smith Toby O, Chawla Amit, Thompson Peter, Metcalfe Andrew
Department of Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Orthop J Sports Med. 2018 Jun 11;6(6):2325967118766275. doi: 10.1177/2325967118766275. eCollection 2018 Jun.
The first-line treatment for patellar dislocations is often nonoperative and consists of physical therapy and immobilization techniques, with various adjuncts employed. However, the outcomes of nonoperative therapy are poorly described, and there is a lack of quality evidence to define the optimal intervention.
To perform a comprehensive review of the literature and assess the quality of studies presenting patient outcomes from nonoperative interventions for patellar dislocations.
Systematic review; Level of evidence, 4.
The MEDLINE, AMED, Embase, CINAHL, Cochrane Library, PEDro, and SPORTDiscus electronic databases were searched through July 2017 by 3 independent reviewers. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Study quality was assessed using the CONSORT (Consolidated Standards for Reporting Trials) criteria for randomized controlled trials and the Newcastle-Ottawa Scale for cohort studies and case series.
A total of 25 studies met our inclusion criteria, including 12 randomized controlled trials, 7 cohort studies, and 6 case series, consisting of 1066 patients. Studies were grouped according to 4 broad categories of nonoperative interventions based on immobilization, weightbearing status, quadriceps exercise type, and alternative therapies. The most commonly used outcome measure was the Kujala score, and the pooled redislocation rate was 31%.
This systematic review found that patient-reported outcomes consistently improved after all methods of treatment but did not return to normal. Redislocation rates were high and close to the redislocation rates reported in natural history studies. There is a lack of quality evidence to advocate the use of any particular nonoperative technique for the treatment of patellar dislocations.
髌骨脱位的一线治疗通常是非手术治疗，包括物理治疗和固定技术，并采用了各种辅助手段。然而，非手术治疗的结果描述不佳，且缺乏高质量证据来确定最佳干预措施。
对文献进行全面综述，并评估报告髌骨脱位非手术干预患者结局的研究质量。
系统综述；证据级别，4级。
由3名独立评审员检索截至2017年7月的MEDLINE、AMED、Embase、CINAHL、Cochrane图书馆、PEDro和SPORTDiscus电子数据库。遵循PRISMA（系统综述和Meta分析的首选报告项目）指南。使用随机对照试验的CONSORT（报告试验的统一标准）标准以及队列研究和病例系列的纽卡斯尔-渥太华量表评估研究质量。
共有25项研究符合我们的纳入标准，包括12项随机对照试验、7项队列研究和6项病例系列，共1066例患者。根据基于固定、负重状态、股四头肌锻炼类型和替代疗法的4大类非手术干预措施对研究进行分组。最常用的结局指标是库贾拉评分，汇总的再脱位率为31%。
本系统综述发现，所有治疗方法后患者报告的结局均持续改善，但未恢复正常。再脱位率较高，且接近自然史研究报告的再脱位率。缺乏高质量证据支持使用任何特定的非手术技术治疗髌骨脱位。
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