Patellar dislocation: cylinder cast, splint or brace? An evidence-based review of the literature

Lisette M De Vree,Roger A P A Hessels,Menno I Gaakeer,Johanna P Van Gemert

doi:10.1186/1865-1380-5-45

Lisette M De Vree, Roger A P A Hessels + Show 2 more

Open Access

https://doi.org/10.1186/1865-1380-5-45

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Abstract

Patellar dislocations are a common injury in the emergency department. The conservative management consists of immobilisation with a cylinder cast, posterior splint or removable knee brace. No consensus seems to exist on the most appropriate means of conservative treatment or the duration of immobilisation. Therefore the aims of this review were first to examine whether immobilisation with a cylinder cast causes less redislocation and joint movement restriction than a knee brace or posterior splint and second to compare the redislocation rates after conservative treatment with surgical treatment. A systematic search of Pubmed, Embase and the Cochrane Library was performed. We identified 470 articles. After applying the exclusion and inclusion criteria, only one relevant study comparing conservative treatment with a cylinder cast, brace and posterior splint remained (Mäenpää et al.). In this study, the redislocation frequency per follow-up year was significant higher in the brace group (0.29; p < 0.05) than in the cylinder cast group (0.12) and the posterior splint group (0.08). The proportion of loss of flexion and extension was the highest in the cylinder cast group and the lowest in the posterior splint group (not significant). The evidence level remained low because of the small study population, difference in duration of immobilisation between groups and use of old braces. Also, 12 studies comparing surgical with conservative treatment were assessed. Only one study reported significantly different redislocation rates after surgical treatment. In conclusion, a posterior splint might be the best therapeutic option because of the low redislocation rates and knee joint restrictions. However, this recommendation is based on only one study with significant limitations. Further investigation with modern braces and standardisation of immobilisation time is needed to find the most appropriate conservative treatment for patellar luxation. Furthermore, there is insufficient evidence to confirm the added value of surgical management.

Highlights

Patients with patellar dislocations are common in the emergency department [1,2]
Studies were eligible for inclusion when the target intervention was a cylinder cast compared with a posterior splint van Gemert et al International Journal of Emergency Medicine 2012, 5:45 http://www.intjem.com/content/5/1/45
Eighteen articles were selected by screening the titles and abstracts of the 313 articles

Summary

Introduction

Patients with patellar dislocations are common in the emergency department (incidence 5.8-7 per 100,000 per year) [1,2]. Acute primary dislocations can be managed conservatively by immobilisation with a cylinder cast, posterior splint or removable knee brace or by surgical treatment (Figure 1). The most important complications of primary acute patellar dislocations are recurrence and continued disability [3]. It is important to determine the best treatment providing patellar stability and knee function. No consensus seems to exist on the most appropriate means of conservative treatment. The immobilisation time has not been standardised. As emergency physicians, are seeking the best possible way Review

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