Surgical management of first‐time patellar dislocations in paediatric patients may lower rates of redislocation compared to conservative management: A systematic review and meta‐analysis
Bibliographic record
Abstract
Abstract Purpose The purpose of this study is to assess whether early surgical intervention for first‐time patellar dislocations in paediatric patients is superior to conservative management. We hypothesized that surgical intervention would lead to lower redislocation rates compared to conservative treatment. Methods Three online databases (PubMed, MEDLINE and EMBASE) were searched from inception to 14 March 2024 to identify studies investigating the management options for acute first‐time patellar dislocations in paediatric patients. Data pertaining to patient demographics, patient management, redislocation rates and Kujala scores, evaluating function, were abstracted. Weighted means and meta‐analyses were conducted to compare rates of redislocation, as well as Kujala scores. The quality of included studies was assessed using the methodological index for non‐randomized studies criteria for non‐randomized studies and the ROB2 tool for randomized controlled trials (RCTs). Results A total of 11 studies and 761 patients were included in this review. The weighted mean post‐operative combined rates of redislocation in the surgical group was 25.1%, compared to 46.4% in the conservative group at a mean follow‐up of 53.2 months (12–168). The relative risk (RR) of redislocation was 0.82 (95% confidence interval [CI]: 0.65‐1.04, I 2 = 0%, p = 0.11), favouring surgery compared to conservative management. A subgroup meta‐analysis of two recent RCTs with 110 patients demonstrated an RR of redislocation of 0.53 (95% CI: 0.31–0.91, I 2 = 0%, p = 0.02), favouring surgery. Kujala scores among three comparative studies showed a mean difference of −2.7 (95% CI: −6.1 to 0.68, I 2 = 0%, p = 0.12), favouring conservative treatment. The weighted mean redislocation rate in 131 patients undergoing medial patellofemoral ligament reconstruction (MPFLR) was 3.1%, compared to 39.4% in 203 patients undergoing other surgical procedures, such as lateral release and medial imbrication, Roux‐Goldwaith and MPFL repair. Furthermore, the conservative groups experienced a complication rate of 0.9% compared to 2.9% across the surgical groups. Conclusion Surgical management for first‐time patellar dislocations in a paediatric population, particularly MPFLR, may be more beneficial in lowering redislocation rates than conservative management. No significant differences in Kujala scores were found. Level of Evidence Level IV.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.012 | 0.034 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.015 | 0.035 |
| Bibliometrics | 0.006 | 0.005 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".