title: Does Operative Treatment of First-Time Patellar Dislocations Lead to Increased Patellofemoral Stability? A Systematic Review of Overlapping Meta-analyses.
abstract: OBJECTIVE
  To conduct a systematic review of meta-analyses comparing nonoperative and operative treatment of patellar dislocations to elucidate the cause of the variation and to determine which meta-analysis provides the current best available evidence.
  
  
  METHODS
  A systematic review of the literature to identify meta-analyses was performed. Data were extracted for patient outcomes and recurrent dislocations. Meta-analysis quality was assessed using the Oxman-Guyatt and Quality of Reporting of Meta-analyses systems. The Jadad algorithm was then applied to determine which meta-analysis provided the highest level of evidence.
  
  
  RESULTS
  Four meta-analyses met the eligibility criteria: 1 Level I evidence, 2 Level II evidence, and 1 Level III evidence. A total of 1,984 patients were included (997 underwent surgery whereas 987 underwent conservative treatment). Three meta-analyses found a lower subsequent patellar dislocation rate in patients managed operatively compared with nonoperatively, whereas one did not find a difference in recurrent dislocation rates between the operative and nonoperative groups. When the results of all the studies were combined, the overall redislocation rate was 29.4% and the rate of recurrent instability episodes was 32.8%. Patients treated operatively had a 24.0% rate of repeat patellar dislocation and a 32.7% rate of recurrent patellar instability, whereas patients treated nonoperatively had a 34.6% rate of repeat patellar dislocation and a 33.0% rate of recurrent instability. In addition, 1 meta-analysis found a significantly higher rate of patellofemoral osteoarthritis in the operative group. No differences in functional outcomes scores were seen between treatments. Two meta-analyses had low Oxman-Guyatt scores (<4), indicative of major flaws.
  
  
  CONCLUSIONS
  According to the best available evidence, operative treatment of acute patellar dislocations may result in a lower rate of recurrent dislocations than nonoperative treatment but does not improve functional outcome scores.
  
  
  METHODS
  Level III, systematic review of Level I, II, and II studies.
authors: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.. Electronic address: berickso.24@gmail.com.
authors: Brandon J
authors: BJ
authors: Erickson
authors: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.
authors: Randy
authors: R
authors: Mascarenhas
authors: College of Physicians and Surgeons, Columbia University, New York, New York, U.S.A.
authors: Eli T
authors: ET
authors: Sayegh
authors: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.
authors: Bryan
authors: B
authors: Saltzman
authors: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.
authors: Nikhil N
authors: NN
authors: Verma
authors: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.
authors: Charles A
authors: CA
authors: Bush-Joseph
authors: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.
authors: Brian J
authors: BJ
authors: Cole
authors: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.
authors: Bernard R
authors: BR
authors: Bach
mesh_terms: D014943:Global Health; D006801:Humans; D007593:Joint Instability / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D007719:Knee Joint / Q000601:surgery*; D019637:Orthopedic Procedures / Q000379:methods*; D031222:Patellar Dislocation / Q000150:complications / Q000601:surgery*; D015995:Prevalence; D012008:Recurrence