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.