Cricket pad splint is better than plaster cylinder for first patellar dislocation
Date First Published:
March 1, 2000
Last Updated:
April 11, 2001
Report by:
Martin Thomas, Research Fellow (Manchester Royal Infirmary)
Search checked by:
Paul Wallman, Manchester Royal Infirmary
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.
Search Details:
[({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.
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):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Patellar dislocation. The long-term results of nonoperative management in 100 patients. Maenpaa H and Lehto MU. 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 |
Author Commentary:
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.
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.