{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T10:12:34Z","timestamp":1784196754190,"version":"3.55.0"},"reference-count":38,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,2,19]],"date-time":"2025-02-19T00:00:00Z","timestamp":1739923200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,2,19]],"date-time":"2025-02-19T00:00:00Z","timestamp":1739923200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"},{"start":{"date-parts":[[2025,2,19]],"date-time":"2025-02-19T00:00:00Z","timestamp":1739923200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2025,2,19]],"date-time":"2025-02-19T00:00:00Z","timestamp":1739923200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"funder":[{"DOI":"10.13039\/100009026","name":"Smith and Nephew","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009026","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008542","name":"Arthroscopy Association of North America","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008542","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100013615","name":"American Shoulder and Elbow Surgeons","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100013615","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100011549","name":"American Orthopaedic Society for Sports Medicine","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100011549","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009885","name":"American Academy of Orthopaedic Surgeons","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009885","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100031014","name":"Vericel","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100031014","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["arthroscopyjournal.org","clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Arthroscopy"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To use expected value decision analysis to determine the optimal treatment for first time patellar dislocations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A meta\u2010analysis according to Preferred Reporting Items for Systematic Reviews and Meta\u2010Analysis guidelines and expected\u2010value decision analysis were performed. A decision tree addressing the clinical question (operative vs nonoperative) was created, and a meta\u2010analysis was performed to assess the probability of outcomes after operative compared with nonoperative treatment. In total, 70 patients were assessed regarding potential outcome preferences to a hypothetical injury. An expected\u2010value decision analysis was performed to systematically quantify the clinical decision. Statistical fold back analysis calculated optimal treatment, and a sensitivity analysis was performed to determine the effect of changing redislocation rates on the expected value.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Forty\u2010five participants (mean age 20 years [range 12\u201033], 58% male, 71% athletes) met inclusion criteria. Meta\u2010analysis of 10 randomized controlled trials with 624 patients revealed the probability of a \u201cwell\u201d outcome was significantly greater for operative treatment (59.3%, 95% confidence interval [CI] 53.7%\u201064.7%) than nonoperative treatment (44.7%, 95% CI 39.0%\u201050.5%). Subsequent redislocation rates with operative treatment were significantly lower (29.8%, 95% CI 24.5%\u201035.17%) compared with nonoperative treatment (44.7%, 95% CI 39.0%\u201050.5%). Medial patellofemoral ligament reconstruction showed an 88% probability of a \u201cwell\u201d outcome, and a 3% redislocation rate. Operative management had a greater chance of a well outcome (risk ratio 1.43; 95% CI 1.12\u20101.83,\n                      <jats:italic>P<\/jats:italic>\n                      = .005). The overall expected value for operative treatment was 6.09 versus 4.96 for nonoperative treatment. Secondary analysis of 27 articles for solely medial patellofemoral ligament reconstruction showed an expected value of 7.80 for operative treatment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Meta\u2010analysis showed more frequent favorable outcomes and lower subsequent dislocation rates with operative treatment. Decision analysis on the basis of healthy patient responses to hypothetical scenarios shows that operative treatment has a greater expected value for first time patellar dislocations than nonoperative treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level IV, economic study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1016\/j.arthro.2025.02.013","type":"journal-article","created":{"date-parts":[[2025,2,19]],"date-time":"2025-02-19T19:26:50Z","timestamp":1739993210000},"page":"3639","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":2,"title":["Operative Treatment Has Greater Expected Value Than Nonoperative Treatment for First\u2010Time Patellar Dislocations: A Meta\u2010analysis and Expected Value Decision Analysis"],"prefix":"10.1002","volume":"41","author":[{"given":"Andrew J.","family":"Recker","sequence":"first","affiliation":[{"name":"Atrium Health Wake Forest Baptist Medical Center Winston Salem North Carolina U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas W.","family":"Mason","sequence":"additional","affiliation":[{"name":"Wake Forest University School of Medicine Winston Salem North Carolina U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jelle P.","family":"van der List","sequence":"additional","affiliation":[{"name":"Atrium Health Wake Forest Baptist Medical Center Winston Salem North Carolina U.S.A."},{"name":"Wake Forest University School of Medicine Winston Salem North Carolina U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Garrett","family":"Bullock","sequence":"additional","affiliation":[{"name":"Atrium Health Wake Forest Baptist Medical Center Winston Salem North Carolina U.S.A."},{"name":"Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis University of Oxford Oxford England"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas A.","family":"Trasolini","sequence":"additional","affiliation":[{"name":"Atrium Health Wake Forest Baptist Medical Center Winston Salem North Carolina U.S.A."},{"name":"Wake Forest University School of Medicine Winston Salem North Carolina U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian R.","family":"Waterman","sequence":"additional","affiliation":[{"name":"Atrium Health Wake Forest Baptist Medical Center Winston Salem North Carolina U.S.A."},{"name":"Wake Forest University School of Medicine Winston Salem North Carolina U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,2,19]]},"reference":[{"key":"e_1_2_4_2_1","volume-title":"StatPearls","author":"Wolfe S.","year":"2024"},{"key":"e_1_2_4_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/03635465000280040601"},{"key":"e_1_2_4_4_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0039-3401817"},{"key":"e_1_2_4_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2014.12.001"},{"key":"e_1_2_4_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12178-020-09687-z"},{"key":"e_1_2_4_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13018-023-03867-6"},{"key":"e_1_2_4_8_1","doi-asserted-by":"publisher","DOI":"10.11138\/mltj\/2017.7.1.001"},{"key":"e_1_2_4_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000016338"},{"key":"e_1_2_4_10_1","doi-asserted-by":"crossref","unstructured":"SmithT.O. DonellS. SongF. HingC.B.. Surgical versus non\u2010surgical interventions for treating patellar dislocation.Cochrane Database Syst Rev2015CD008106.","DOI":"10.1002\/14651858.CD008106.pub3"},{"key":"e_1_2_4_11_1","doi-asserted-by":"publisher","DOI":"10.1177\/2325967114544021"},{"key":"e_1_2_4_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s43465-022-00770-w"},{"key":"e_1_2_4_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2022.05.005"},{"key":"e_1_2_4_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2017.08.246"},{"key":"e_1_2_4_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2011.09.007"},{"key":"e_1_2_4_16_1","first-page":"e123","article-title":"Preferred reporting items for systematic reviews and meta\u2010analyses: The PRISMA statement","volume":"3","author":"Moher D.","year":"2009","journal-title":"Open Med"},{"key":"e_1_2_4_17_1","first-page":"1454","article-title":"Introduction of a tool to assess Risk of Bias in Non\u2010randomized Studies\u2010of Exposure (2022)","volume":"44","author":"Sun Y.H.","year":"2023","journal-title":"Zhonghua Liu Xing Bing Xue Za Zhi"},{"key":"e_1_2_4_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2019-100806"},{"key":"e_1_2_4_19_1","volume-title":"R: A language and environment for statistical computing","author":"Team R.C.","year":"2016"},{"key":"e_1_2_4_20_1","doi-asserted-by":"publisher","DOI":"10.1177\/03635465020300060501"},{"key":"e_1_2_4_21_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546518770616"},{"key":"e_1_2_4_22_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546511423742"},{"key":"e_1_2_4_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2008.12.005"},{"key":"e_1_2_4_24_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0036-1592151"},{"key":"e_1_2_4_25_1","doi-asserted-by":"publisher","DOI":"10.1080\/17453670510041790"},{"key":"e_1_2_4_26_1","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.G.00072"},{"key":"e_1_2_4_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-012-1639-8"},{"key":"e_1_2_4_28_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-014-3271-3"},{"key":"e_1_2_4_29_1","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.G.01449"},{"key":"e_1_2_4_30_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-018-4243-x"},{"key":"e_1_2_4_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2008.03.012"},{"key":"e_1_2_4_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.knee.2023.07.003"},{"key":"e_1_2_4_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2008.01.021"},{"key":"e_1_2_4_34_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-012-2347-1"},{"key":"e_1_2_4_35_1","doi-asserted-by":"publisher","DOI":"10.1097\/BPO.0000000000002616"},{"key":"e_1_2_4_36_1","doi-asserted-by":"crossref","unstructured":"SmithT.O. DonellS. SongF. HingC.B.. Surgical versus non\u2010surgical interventions for treating patellar dislocation.Cochrane Database Syst Rev2015;Feb 26.CD008106.","DOI":"10.1002\/14651858.CD008106.pub3"},{"key":"e_1_2_4_37_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13018-021-02513-3"},{"key":"e_1_2_4_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2019.03.047"},{"key":"e_1_2_4_39_1","doi-asserted-by":"publisher","DOI":"10.1177\/23259671211026624"}],"container-title":["Arthroscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0749806325001343?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0749806325001343?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1016\/j.arthro.2025.02.013","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1016\/j.arthro.2025.02.013","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1016\/j.arthro.2025.02.013","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,15]],"date-time":"2026-03-15T08:49:31Z","timestamp":1773564571000},"score":1,"resource":{"primary":{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/10.1016\/j.arthro.2025.02.013"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,19]]},"references-count":38,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2025,9]]}},"alternative-id":["10.1016\/j.arthro.2025.02.013"],"URL":"https:\/\/doi.org\/10.1016\/j.arthro.2025.02.013","archive":["Portico"],"relation":{},"ISSN":["0749-8063","1526-3231"],"issn-type":[{"value":"0749-8063","type":"print"},{"value":"1526-3231","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,19]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Operative Treatment Has Greater Expected Value Than Nonoperative Treatment for First-Time Patellar Dislocations: A Meta-analysis and Expected Value Decision Analysis","name":"articletitle","label":"Article Title"},{"value":"Arthroscopy: The Journal of Arthroscopic & Related Surgery","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.arthro.2025.02.013","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2025 by the Arthroscopy Association of North America","name":"copyright","label":"Copyright"}]}}