Cricket pad splint is better than plaster cylinder for first patellar dislocation
- Report By: Martin Thomas - Research Fellow
- Search checked by Paul Wallman - Specialist Registrar
- Institution: Manchester Royal Infirmary
- Current web editor: Minnie Alexander - Senior Information Officer
- Date Submitted: 1st March 2000
- Date Completed: 30th June 2000
- Last Modified: 11th April 2001
-
Status:
Green (complete)
Three Part Question
In [patients with primary patellar dislocation] is [a plaster cylinder, a posterior (cricket pad) splint or bandaging] better at [reducing symptoms and preventing redislocation]?Clinical Scenario
A 20 year old woman presents to the emergency department having suffered her first lateral patellar dislocation 1 hour before. She has managed to reduce it herself. You know that surgery offers no advantage over conservative management, but wonder what is the best approach to initial immobilisation.Search Strategy
Medline 1966-06/99 using the OVID interface.[({exp patella OR patella$.mp} AND {exp dislocations OR dislocate$.mp OR dislocation$.mp}) AND {exp emergency treatment OR exp treatment failure OR exp treatment outcome OR treatment$.mp}] AND maximally sensitive RCT filter) LIMIT to human and english.
Search Outcome
79 papers found of which 75 irrelevant and 3 of insufficient quality for inclusion. The remaining paper is shown in the table.Relevant Paper(s)
| Author, date and country | Patient group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Maenpaa and Lehto Finland 1997 | 100 patients with primary patella dislocation. Plaster cylinder (60) vs posterior splint (17) vs bandage and brace (23) | Retrospective cohort | Redislocation incidence | Significantly higher (P <0.05) in bandage group | Not randomised. Immobilisation times vary between groups. Small numbers in splint and bandage groups |
| Late problems | No sigfnificant difference | ||||
| Range of movement | Significantly better (P < 0.05) in posterior splint group |
Comment(s)
The best evidence in this area is weak. Bandaging and bracing seem to give the worst outcome, while there is no significant difference in redislocation rate between plaster and posterior (cricket pad) splinting. The better range of movement found after posterior splinting suggest this is the best treatment overall. A well designed randomised controlled trial is required to further investigate this question.Clinical Bottom Line
Posterior (cricket pad) splinting offers the best overall outcome after primary patellar dislocation.References
- Maenpaa H and Lehto MU. Patellar dislocation. The long-term results of nonoperative management in 100 patients. Am J Sports Med 1997;25:213-217.