Tedeschi Roberto, Platano Daniela, Giorgi Federica, Donati Danilo
Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, 40136 Bologna, Italy.
Physical Medicine and Rehabilitation Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy.
J Clin Med. 2024 Sep 13;13(18):5434. doi: 10.3390/jcm13185434.
The optimal management of first-time patellar dislocations remains a subject of debate. While surgical intervention is often recommended to reduce the risk of redislocation, the benefits over conservative treatment regarding knee function and complication rates are not clearly established. This systematic review aims to compare the effectiveness of surgical versus conservative treatment in preventing redislocation and improving knee function, while also considering complication rates. A comprehensive search of databases, including PubMed, Scopus, and Web of Science, was conducted up to July 2024. Seven randomized controlled trials involving 411 participants were included. The primary outcome was the redislocation rate, with secondary outcomes including knee function, complication rates, and the need for re-interventions. The quality of the studies was assessed using the PEDro scale. Surgical treatment generally resulted in lower redislocation rates compared to conservative management. However, the improvement in knee function was inconsistent, with some studies showing no significant differences or even favoring conservative treatment. Surgical intervention was associated with a higher risk of complications and re-interventions, particularly in older studies with less advanced techniques. Surgical intervention appears effective in reducing redislocation rates but comes with a risk of complications. Conservative treatment remains a viable option, particularly for patients with lower activity levels or higher surgical risks. The decision between surgical and conservative management should be individualized, taking into account patient-specific factors and potential risks. Further high-quality research is needed to provide more definitive guidance.
首次髌骨脱位的最佳治疗方法仍是一个存在争议的话题。虽然通常建议进行手术干预以降低再脱位风险，但在膝关节功能和并发症发生率方面，与保守治疗相比，其优势尚未明确确立。本系统评价旨在比较手术治疗与保守治疗在预防再脱位和改善膝关节功能方面的有效性，同时考虑并发症发生率。截至2024年7月，对包括PubMed、Scopus和Web of Science在内的数据库进行了全面检索。纳入了7项涉及411名参与者的随机对照试验。主要结局是再脱位率，次要结局包括膝关节功能、并发症发生率和再次干预的必要性。使用PEDro量表评估研究质量。与保守治疗相比，手术治疗通常导致较低的再脱位率。然而，膝关节功能的改善并不一致，一些研究显示无显著差异，甚至支持保守治疗。手术干预与更高的并发症和再次干预风险相关，特别是在技术不太先进的早期研究中。手术干预似乎在降低再脱位率方面有效，但存在并发症风险。保守治疗仍然是一种可行的选择，特别是对于活动水平较低或手术风险较高的患者。手术治疗和保守治疗之间的决策应个体化，考虑患者的具体因素和潜在风险。需要进一步的高质量研究来提供更明确的指导。
