Category
Poster - Theoretical Proposal
Description
Context: Recurrent patellofemoral instability (RPI) resulting from acute lateral patellofemoral dislocation (LPD) is a common and serious occurrence in athletic individuals who traditionally treated their injury through conservative, non-operative, methods. However, surgical interventions such as medial patellofemoral ligament reconstruction have shown promising results regarding patient LPD reoccurrence rates, knee function, and overall quality of life. Currently there is much debate on which treatment is significantly better at treating RPI and more research is required to assist healthcare providers in selecting high quality treatment for the patients with RPI. Therefore, the purpose of this critical appraisal is to determine the effects of surgical intervention on RPI resulting from acute LPD in active individuals. Methods: A computerized search was completed in November of 2023 of Medline Ultimate, ProQuest, Cochrane Library, and PubMed Central databases. Terms used to guide the search followed the PICO search format. P: recurrent patellar instability, lateral patellar dislocation. I: Operative treatment, surgical treatment. C: Non-operative, conservative management, conservative treatment. O: Re-dislocation rate, knee function, quality of life, patient reported outcome measures. Studies that are to be included must be published within the last 10 years, compare MPFL-R to conservative treatment in an active population, assess for patellar re-dislocation rate, and measure patient knee function and quality of life utilizing patient reported outcome measures. Systematic reviews and meta-analysis were not included for analysis. The Physiotherapy Evidence Database (PEDRo) scale was used to determine the quality of included trials which can be found attached to this submission (Table 1). Results: The literature search produced a total of 89 studies. Of the 89 studies, 3 randomized control trials (Regalado et. Al., Straume-Naesheim et. al., and Bitar et. al.) met the criteria of inclusion. A total of 86 studies were excluded based mainly on their relevancy, outcomes measured, intervention performed, and participant age. All three of the included trials used the Kujala questionnaire to assess patient knee function and quality of life. Regalado et. al. and Straume-Naesheim et. al. found no significant difference in Kujala scores between the surgical and conservative knee treatment groups. Bitar et. al. found significant difference in Kujala scores between the surgical and conservative treatment groups (p = .001). All the authors found that patients who surgically treated their recurrent patellofemoral instability experienced significantly less recurrent patellofemoral dislocations than the conservative treatment group. Regalado et. al. found at 3 years re-dislocation occurred in surgical and conservative groups at 0% and 35% respectively. At 6 years, re-dislocation was 33% for the surgical group and 73% for the conservative (p = .02). Bitar et. al. found at 2 years surgical re-dislocation was 0% and conservative was 35%. Straume-Naesheim et. al. found at 1-year surgical re-dislocation was 6.7% and conservative was 41.9%. Conclusions: Based on the results of the clinical trials, patients should expect to see improvement in knee function and quality of life over time with both conservative and surgical treatment. Patients who may be athletes may want to consider surgical treatment for their recurrent patellofemoral instability as patellar re-dislocation rates were observed to be lower.
The Effects of Surgical Interventions Compared to Conservative Treatment in Active Individuals with First Time Patellar Dislocation and Recurrent Instability: A Critically Appraised Topic
Poster - Theoretical Proposal
Context: Recurrent patellofemoral instability (RPI) resulting from acute lateral patellofemoral dislocation (LPD) is a common and serious occurrence in athletic individuals who traditionally treated their injury through conservative, non-operative, methods. However, surgical interventions such as medial patellofemoral ligament reconstruction have shown promising results regarding patient LPD reoccurrence rates, knee function, and overall quality of life. Currently there is much debate on which treatment is significantly better at treating RPI and more research is required to assist healthcare providers in selecting high quality treatment for the patients with RPI. Therefore, the purpose of this critical appraisal is to determine the effects of surgical intervention on RPI resulting from acute LPD in active individuals. Methods: A computerized search was completed in November of 2023 of Medline Ultimate, ProQuest, Cochrane Library, and PubMed Central databases. Terms used to guide the search followed the PICO search format. P: recurrent patellar instability, lateral patellar dislocation. I: Operative treatment, surgical treatment. C: Non-operative, conservative management, conservative treatment. O: Re-dislocation rate, knee function, quality of life, patient reported outcome measures. Studies that are to be included must be published within the last 10 years, compare MPFL-R to conservative treatment in an active population, assess for patellar re-dislocation rate, and measure patient knee function and quality of life utilizing patient reported outcome measures. Systematic reviews and meta-analysis were not included for analysis. The Physiotherapy Evidence Database (PEDRo) scale was used to determine the quality of included trials which can be found attached to this submission (Table 1). Results: The literature search produced a total of 89 studies. Of the 89 studies, 3 randomized control trials (Regalado et. Al., Straume-Naesheim et. al., and Bitar et. al.) met the criteria of inclusion. A total of 86 studies were excluded based mainly on their relevancy, outcomes measured, intervention performed, and participant age. All three of the included trials used the Kujala questionnaire to assess patient knee function and quality of life. Regalado et. al. and Straume-Naesheim et. al. found no significant difference in Kujala scores between the surgical and conservative knee treatment groups. Bitar et. al. found significant difference in Kujala scores between the surgical and conservative treatment groups (p = .001). All the authors found that patients who surgically treated their recurrent patellofemoral instability experienced significantly less recurrent patellofemoral dislocations than the conservative treatment group. Regalado et. al. found at 3 years re-dislocation occurred in surgical and conservative groups at 0% and 35% respectively. At 6 years, re-dislocation was 33% for the surgical group and 73% for the conservative (p = .02). Bitar et. al. found at 2 years surgical re-dislocation was 0% and conservative was 35%. Straume-Naesheim et. al. found at 1-year surgical re-dislocation was 6.7% and conservative was 41.9%. Conclusions: Based on the results of the clinical trials, patients should expect to see improvement in knee function and quality of life over time with both conservative and surgical treatment. Patients who may be athletes may want to consider surgical treatment for their recurrent patellofemoral instability as patellar re-dislocation rates were observed to be lower.
Comments
Graduate