Medial patellofemoral ligament reconstruction using semitendinosus tendons: polyester suture augmentation versus nonaugmentation

Tissue Augmentation Techniques in the Management of Ligamentous Knee Injuries

Despite early reports of high failure rates in knee ligament repair techniques resulting in favor of reconstruction, newer advances in surgical technology have shifted the attention back to repair with the addition of various tissue augmentation techniques. Ligament repair preserves proprioceptors in the native ligament and avoids autograft tendon harvest, minimizing the complications associated with donor site ruptures in reconstruction techniques. Tissue augmentation has been successfully used in knee ligamentous and tendon repair procedures, as well as in some upper extremity procedures. This study provides a clinical update on the surgical techniques, biomechanics, and outcomes with the application of various tissue augmentation techniques in the ligaments surrounding the knee joint.

Surgical techniques for medial Patellofemoral ligament reconstruction: a systematic review and meta-analysis of level I and II studies

PURPOSE

To determine the most optimal surgical technique for medial patellofemoral ligament reconstruction (MPFLR).

METHODS

Three databases MEDLINE, PubMed, and EMBASE were searched from inception to December 13th, 2022, for level I or II studies comparing MPFLR techniques. The authors adhered to the PRISMA and R-AMSTAR guidelines as well as the Cochrane Handbook for Systematic Reviews of Interventions. Data on patient-reported outcome measures were recorded. Quality assessment was carried out using the MINORS and Cochrane Risk of Bias assessment tools. Certainty of evidence was carried out with the GRADE assessment tool.

RESULTS

Ten studies comprising 723 patients (723 knees) were included in this review. The weighted mean difference in Kujala, Lysholm, and IKDC scores comparing single- and double-tunnel patellar drilling techniques was 2.66 (95% CI -1.05-6.37, p = 0.16, I2 = 0%) with moderate certainty, 0.78 (95% CI -9.02-10.58, p = 0.88, I2 = 87%) with low certainty, and 1.71 (95% CI -2.43-5.86, p = 0.42, I2 = 0%) with low certainty, respectively. Double-suture anchor patellar fixation demonstrated greater Kujala scores than transpatellar fixation (87.1 ± 2.8 vs 84.0 ± 3.8, p < 0.001) with moderate certainty. Y-shaped graft patellar fixation demonstrated superior Kujala scores to C-shaped graft patellar fixation (95.9 ± 4.7 vs 91.3 ± 9.7, p = 0.001) with moderate certainty. Augmentation of femoral fixation with polyester sutures demonstrated superior Kujala scores (97.8 ± 6.4. vs 88.0 ± 6.3, p < 0.005) with low certainty. Four-stranded grafts demonstrated greater Kujala scores than two-stranded grafts (93.5 ± 2.6 vs 91.6 ± 3.5, p = 0.01) with low certainty.

CONCLUSION

The optimal MPFLR surgical technique is likely to utilize a four-stranded graft using either endobutton, double-suture anchor, or transosseous suture patellar fixation with polyester suture augmented interference screw femoral fixation. Orthopedic surgeons can consider employing such a technique to improve patient outcomes by conferring greater graft stability, strength, and function. Level of evidence Level II.

Protocols of rehabilitation and return to sport, and clinical outcomes after medial patellofemoral ligament reconstruction with and without tibial tuberosity osteotomy: a systematic review

PURPOSE

No consensus exists on rehabilitation programmes after medial patellofemoral ligament reconstruction (MPFLR) with or without tibial tuberosity osteotomy (TTO). This systematic review examined the content and timeline of rehabilitation (weightbearing, range of motion [ROM] and exercise therapy) and return to sport (RTS), as well as patient-reported outcomes after MPFLR with or without TTO.

METHODS

The PubMed, Cochrane Library, Web of Sciences, CINAHL and SPORTDiscus databases were searched from inception to December 2021. Studies that reported postoperative rehabilitation programmes and patient-reported outcomes for patients aged ≥ 18 years who underwent MPFLR with or without concomitant TTO were included.

RESULTS

Eighty-five studies were included, 57 of which were case series and only one randomised controlled trial on rehabilitation programmes. Non-weightbearing was set within one week post-operatively in approximately 80% of weightbearing programmes for MPFLR without and with TTO. Joint immobilisation was set within one week post-operatively in 65.3% and 93.8% of programmes for MPFLR without and with TTO, respectively. Weightbearing and ROM (≤ 90°) restriction were within three weeks post-operatively for > 50% of the programmes. Quadriceps strengthening was the most cited exercise therapy (33 programmes), most often initiated within two weeks post-operatively. However, few other exercise programmes were cited (only nine programmes). RTS was mostly noted at six months post-operatively (35 programmes). The weighted mean Kujala score was 87.4 points.

CONCLUSION

Regardless of TTO addition to MPFLR, most studies restricted weightbearing and ROM only in the early post-operative period, with seemingly favourable clinical results. Limited information was available on post-operative exercise therapy.

Biomechanical Evaluation of Suture Tape Internal Brace Reinforcement of Soft Tissue Allografts for ACL Reconstruction Using a Porcine Model

Background:

Internal bracing of anterior cruciate ligament (ACL) surgery is a newer concept gaining popularity.

Purpose/Hypothesis:

To assess the biomechanical performance of soft tissue ACL reconstruction allografts reinforced with suture tape. It was hypothesized that load to failure would increase and cyclic displacement would decrease at time zero in the constructs reinforced with internal brace suture tape compared with those without suture tape augmentation.

Study Design:

Controlled laboratory study.

Methods:

We performed ACL reconstruction on porcine knees using bovine extensor tendon soft tissue allografts: 10 knees without (control) and 10 knees with (reinforced) suture tape reinforcement. An all-inside reconstruction technique was utilized with retrograde tunnel creation. An adjustable-loop device was used for femoral and tibial fixation of all grafts. The suture tape was placed through the tension loop in the femoral fixation construct and independently fixed in the tibia with an interference screw anchor. For each specimen, the authors recorded ultimate load, yield load, stiffness, cyclic displacement, and mode of failure. Outcomes between groups were compared using the Student t test.

Results:

There was a 33% decrease in mean cyclic displacement in the specimens with reinforced grafts (reinforced vs control: 3.9 ± 0.7 vs 5.8 ± 1.5 mm; P = .001). The reinforced grafts also had a 22% higher mean ultimate load (921 ± 180 vs 717 ± 122 N; P = .008) and a 25% higher mean yield load (808 ± 201 vs 602 ± 155 N; P = .020). There was no significant difference in stiffness between the reinforced versus nonreinforced grafts (136 ± 16 vs 132 ± 18 N/mm; P = .617). Three of the 10 control specimens failed at the graft, compared with 1 of 10 reinforced grafts. All other constructs in both groups failed at the tibial fixation site.

Conclusion:

Suture tape reinforcement of soft tissue grafts significantly decreased cyclic displacement while significantly increasing ultimate and yield loads without increasing graft construct stiffness during biomechanical testing at time zero in a porcine animal model.

Clinical Relevance:

The improved biomechanical performance of suture tape–reinforced graft constructs could allow patients to participate in earlier advancement of aggressive rehabilitation and potentially reduce failure rates as graft remodeling progresses.

Tape Augmentation Does Not Affect Mid-Term Outcomes of Medial Patellofemoral Ligament Reconstruction in Skeletally Mature Adolescent Patients

Purpose

To evaluate mid-term outcomes after medial patellofemoral ligament (MPFL) reconstruction with and without tape augmentation in the skeletally mature adolescent population.

Methods

All patients under age 18 with recurrent patellar instability treated with surgery at a single institution by a single surgeon from January 2013 through June 2017 were identified by current procedural terminology codes. Inclusion criteria were (1) primary MPFL reconstruction, (2) minimum 3 years’ follow-up, (3) skeletal maturity. Exclusion criteria were (1) bilateral MPFL reconstruction using different techniques on each knee, (2) prior surgery for patellar instability. Chart and imaging review was completed. Patients were contacted to complete a questionnaire, which included the International Knee Documentation Committee (IKDC) form.

Results

Fifty-one of 92 eligible patients completed questionnaires. Two patients were excluded. Twenty patients underwent 23 non-augmented MPFL reconstructions; 29 patients underwent 33 augmented MPFL reconstructions. Group demographics were similar. At 4.9 ± 1.2 years follow-up, mean IKDC scores were 77.4 and 79.4 in the nonaugmentation and augmentation groups, respectively. Significantly fewer patients in the augmentation group experienced further injury to their ipsilateral knee compared to the non-augmentation group (6% vs 30%, P = .019). Fewer knees in the augmentation group developed recurrent subjective instability or dislocation after initial surgery requiring surgical correction compared to knees in the nonaugmentation group, although this difference was not significant (6% vs 17%, P = 0.181). Overall patient-reported outcomes were similar between the 2 groups.

Conclusions

There were no significant differences in patient-reported outcomes after MPFL reconstruction with or without tape augmentation. Tape augmentation significantly decreased the risk of subsequent ipsilateral knee injuries, although it did not show a significant difference in recurrent dislocations.

Level of Evidence

IV, therapeutic case series.

Wide Patellar Insertion Medial Patellofemoral Ligament Reconstruction with Internal Bracing

Medial patellofemoral ligament (MPFL) reconstruction is a common procedure to address MPFL deficiency. Various techniques have been reported, with the best method still being pursued. Previous studies have revealed the advantage of internal bracing and possible advantage of wide patellar insertion in MPFL reconstruction. Thus, we would like to introduce a technique that combines the internal bracing and wide patellar insertion in MPFL reconstruction, in which the critical points are proper location of the patellar and femoral tunnels and proper tensioning of the augmenting sutures and the whole graft complex. Our clinical experience indicates that the proper application of this technique can lead to satisfactory clinical outcome. We consider the introduction of this technique will provide more insight to MPFL reconstruction.

Return-to-Play Guidelines After Patellar Instability Surgery Requiring Bony Realignment: A Systematic Review

Background

Recurrent patellar instability can be treated nonoperatively or surgically, and surgical management may vary based on the causative pathology in the structures surrounding the patella. Although isolated soft tissue reconstruction is among the most common operative treatments, certain patient populations require bony realignment for adequate stabilization.

Purpose

To evaluate postoperative guidelines, including return to play and rehabilitation, after bony procedures involving the tibial tubercle for patellar instability.

Study Design

Systematic review; Level of evidence, 4.

Methods

A systematic review on return-to-play guidelines was conducted with studies published from 1997 to 2019 that detailed procedures involving bony realignment by tibial tubercle osteotomies and tibial tubercle transfers with or without soft tissue reconstruction. Exclusion criteria included animal or cadaveric studies, basic science articles, nonsurgical rehabilitation protocols, and patients with mean age <18 years. Studies were assessed for return-to-play criteria, rehabilitation protocols, and bias.

Results

Included in the review were 39 studies with a total of 1477 patients and 1598 knees. Mean patient age ranged from 17.5 to 34.0 years, and mean follow-up ranged from 23 to 161 months. All 39 studies described postoperative rehabilitation; however, only 16 studies specifically outlined return-to-play criteria. The most commonly cited return-to-play criterion was quadriceps strength (62.5%). Range of motion (50.0%), physical therapy protocols (18.8%), and radiographic evidence of healing (18.8%) were other cited objective criteria for return-to-play. Four of 16 (25.0%) studies described subjective criteria for return to play, including pain, swelling, and patient comfort and confidence. Of the 11 studies that described a timeline for return to play, the range was between 2 and 6 months.

Conclusion

The results revealed that 100% of papers evaluated lacked adequate return-to-play guidelines. Moreover, timelines significantly varied among studies. More clearly defined return-to-play guidelines after tibial tubercle transfer for patellar instability are required.

Management of the First Patellar Dislocation: A Narrative Review

First patellar dislocation is a common injury of the knee, involving often adolescents and the active population. The consequences of the first episode can be various and potentially disabling. Among these, acute patellar dislocation can often result in recurrent patellar instability. Recurrent patellar instability is certainly multifactorial but depends primarily on the injury of the medial patellofemoral ligament (MPFL), the major soft-tissue stabilizer of the patella. Some classifications are extremely useful in establishing the diagnosis and therapy in patellofemoral disease, in particular in terms of instability. Among those, Henri Dejour and WARPS (weak atraumatic risky anatomy pain and subluxation)/STAID (strong traumatic anatomy normal instability and dislocation) classifications are certainly the most frequently used. There is no clear agreement on the management of the first patellar dislocation. A conservative approach seems to be the first choice in most of cases, but the presence of patellar displacement or osteochondral fractures makes surgery mandatory at the beginning. In addition, there is no clear consensus on which surgical strategy should be used to approach first dislocation, in relation to the possible variation in location of the MPFL injury, and to the eventual presence of preexisting predisposing factors for patellar instability. MPFL reconstruction may theoretically be more reliable than repair, while there is no clear evidence available that osseous abnormality should be addressed after the first episode of patellar dislocation. A narrative review was conducted to report the etiology, the diagnosis and all the possible treatment options of the first patellar dislocation. Modern classifications of the patellofemoral instability were also presented.

Medial Patellofemoral Ligament Repair Versus Reconstruction for Recurrent Patellar Instability: Two-Year Results of an Algorithm-Based Approach

Background:

Patellar instability remains a challenging problem for both the patient and surgeon. Medial patellofemoral ligament (MPFL) repair has historically had poor results, and due to this, there is currently a trend toward reconstruction.

Purpose/Hypothesis:

This study was undertaken to investigate experience with repair versus reconstruction of the MPFL using a multifactorial treatment algorithm approach. Our hypothesis was that there will be no significant difference in outcome scores between patients in the MPFL repair and reconstruction groups.

Study Design:

Cohort study; Level of evidence, 2.

Methods:

A total of 24 patients with recurrent (≥2) lateral patellar dislocations were included. All had failed nonoperative treatment for more than 6 months, and all were observed for a minimum of 2 years. First, magnetic resonance imaging (MRI) was used to find the location of the MPFL tear. A tilt test was used to determine whether a lateral retinacular lengthening was required to allow the patella to have neutral tilt. If the MRI showed a tibial tubercle–trochlear groove (TT-TG) distance greater than 20 mm, a tibial tubercle osteotomy (TTO) was recommended. An MPFL reconstruction was performed if the entire ligament was inadequately visualized on MRI or if it was torn from both insertion sites. Failure was defined as recurrent lateral patellar instability after surgery. As a secondary outcome measure, Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm score, and Tegner score were calculated.

Results:

All patients were evaluated with a mean follow-up of 51 months (range, 25-79 months). Sixteen patients initially underwent MPFL repair, 8 underwent reconstruction, and 3 also underwent TTO. MPFL reconstructions were performed in all patients who underwent TTO. One MPFL repair was to the anatomic femoral origin and 15 were to the patellar insertion corresponding to the site of tearing on MRI. A lateral retinacular lengthening was performed in 21 patients. There was 1 failure in the repair group (6%) and none in the reconstruction group. However, the patient who failed had a TT-TG distance of 26 mm but refused a TTO. She subsequently underwent revision with a TTO and MPFL reconstruction and did not have any further instability events. There were no significant differences between groups for any of the secondary outcome scores.

Conclusion:

Using an algorithm-based approach, MPFL repair or reconstruction may lead to clinically acceptable results at 2-year follow-up.

Reconstruction of the Medial Patellofemoral Ligament Using a Synthetic Graft With Arthroscopic Control of Patellofemoral Congruence

PURPOSE

To compare the results of reconstruction of the medial patellofemoral ligament (MPFL) using a synthetic graft (Poly-Tape) between knee joints in which the patella was reduced to the strict center and those in which it was slightly lateral to the center of the trochlea to determine whether patellar position within this range affects the results.

METHODS

Forty-six knee joints in 46 patients were examined retrospectively with a minimum follow-up of 2 years. The position of the patellar central ridge in the trochlea on arthroscopy immediately after reconstruction of the MPFL was measured. The joints were classified into group 1 (6 male and 12 female patients), in which the patella was reduced to the strict center of the trochlea, and group 2 (10 male and 18 female patients), in which the patella was reduced slightly lateral to the center. The mean age was 20.7 years in group 1 and 20.3 years in group 2. Knee joints were assessed using the Kujala score and the International Knee Documentation Committee (IKDC) subjective evaluation score.

RESULTS

The mean Kujala and IKDC scores improved significantly in both groups after surgery (both P < .001). There was no significant difference between the groups for any assessment before surgery or in the Kujala score after surgery (P = .075). However, the IKDC score after surgery was significantly better in group 2 (91.3 ± 9.1) than in group 1 (82.8 ± 13.1) (P = .012).

CONCLUSIONS

When recurrent dislocation of the patella was treated with MPFL reconstruction using a synthetic graft, subjective evaluations were better in knee joints in which the patella was repositioned slightly lateral to the center of the trochlea than in those in which the patella was reduced to the strict center, although there was no significant difference in knee function between them.

LEVEL OF EVIDENCE

Level III, retrospective comparative study.

Medial Patellofemoral Ligament Reconstruction With Concomitant Tibial Tubercle Transfer: A Systematic Review of Outcomes and Complications

PURPOSE

To examine the outcomes and complications of medial patellofemoral ligament (MPFL) reconstruction and concomitant tibial tubercle (TT) transfer.

METHODS

A systematic review of published literature on MPFL reconstruction and TT transfer was performed using the following databases: PubMed/Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), SPORTDiscus, and Cochrane. To be included, studies were required to present outcomes and/or complication data for MPFL reconstruction performed in combination with TT transfer. Each study was assessed for quality and level of evidence.

RESULTS

Five studies consisting of 92 knees met the inclusion criteria. Between 57% and 77% of the patients were female patients, and the mean age at surgery was 20.6 years (range, 19 to 31 years). The mean follow-up period was 38 months (range, 23 to 53 months). Postoperative outcome measures including the Lysholm score, Kujala score, International Knee Documentation Committee score, Knee Injury and Osteoarthritis Outcome Score, and visual analog scale score were similar to those previously reported for isolated MPFL reconstruction. Reported complication rates were lower than 15% and included wound infection, hardware irritation, and stiffness. Four studies were graded as Level IV evidence, and 1 study was graded as Level II evidence. Only 1 study scored greater than 50% in the quality analysis.

CONCLUSIONS

Results from the analyzed studies indicate that MPFL reconstruction combined with TT transfer is a safe and effective procedure, with a low to moderate risk of complications but overall favorable results. TT transfer is most often performed in conjunction with MPFL reconstruction in the setting of malalignment such as an increased TT-to-trochlear groove distance, and although the surgical indications may differ, the outcomes and risk profiles are similar to those of isolated MPFL reconstruction. With the recognition that these patients are difficult to standardize, additional well-designed studies are needed to further investigate the ideal surgical candidates for MPFL reconstruction with concomitant TT transfer.

LEVEL OF EVIDENCE

Level IV, systematic review of Level II and IV studies.

Effect of Medial Patellofemoral Ligament Reconstruction Method on Patellofemoral Contact Pressures and Kinematics

BACKGROUND

There remains a lack of evidence regarding the optimal method when reconstructing the medial patellofemoral ligament (MPFL) and whether some graft constructs can be more forgiving to surgical errors, such as overtensioning or tunnel malpositioning, than others.

HYPOTHESIS

The null hypothesis was that there would not be a significant difference between reconstruction methods (eg, graft type and fixation) in the adverse biomechanical effects (eg, patellar maltracking or elevated articular contact pressure) resulting from surgical errors such as tunnel malpositioning or graft overtensioning.

STUDY DESIGN

Controlled laboratory study.

METHODS

Nine fresh-frozen cadaveric knees were placed on a customized testing rig, where the femur was fixed but the tibia could be moved freely from 0° to 90° of flexion. Individual quadriceps heads and the iliotibial tract were separated and loaded to 205 N of tension using a weighted pulley system. Patellofemoral contact pressures and patellar tracking were measured at 0°, 10°, 20°, 30°, 60°, and 90° of flexion using pressure-sensitive film inserted between the patella and trochlea, in conjunction with an optical tracking system. The MPFL was transected and then reconstructed in a randomized order using a (1) double-strand gracilis tendon, (2) quadriceps tendon, and (3) tensor fasciae latae allograft. Pressure maps and tracking measurements were recorded for each reconstruction method in 2 N and 10 N of tension and with the graft positioned in the anatomic, proximal, and distal femoral tunnel positions. Statistical analysis was undertaken using repeated-measures analyses of variance, Bonferroni post hoc analyses, and paired t tests.

RESULTS

Anatomically placed grafts during MPFL reconstruction tensioned to 2 N resulted in the restoration of intact medial joint contact pressures and patellar tracking for all 3 graft types investigated (P > .050). However, femoral tunnels positioned proximal or distal to the anatomic origin resulted in significant increases in the mean medial joint contact pressure, medial patellar tilt, and medial patellar translation during knee flexion or extension, respectively (P < .050), regardless of graft type, as did tensioning to 10 N.

CONCLUSION

The importance of the surgical technique, specifically correct femoral tunnel positioning and graft tensioning, in restoring normal patellofemoral joint (PFJ) kinematics and articular cartilage contact stresses is evident, and the type of MPFL graft appeared less important.

CLINICAL RELEVANCE

The correct femoral tunnel position and graft tension for restoring normal PFJ kinematics and articular cartilage contact stresses appear to be more important than graft selection during MPFL reconstruction. These findings emphasize the importance of the surgical technique when undertaking this procedure.

Medial patella-femoral ligament reconstruction using the anterior half of the peroneus longus tendon as a combined procedure for recurrent patellar instability

Background

Medial patella-femoral ligament reconstruction (MPFLR) using hamstring tendon is the main procedure for recurrent patellar instability. The anterior half of the peroneus longus tendon (AHPLT) has been proven to be a useful alternate to the hamstring tendon in knee ligament reconstruction. The purpose of this study was to evaluate the clinical outcome of MPFLR using the new graft.

Methods

Forty-five patients with recurrent patellar instability received MPFLR using the AHPLT. Tibial tubercle transfer and lateral release were also performed. Follow-ups were performed at 12 months and 24 months postoperatively, and computed tomography was performed immediately following the operation and at follow-up. The passive patella glide test was performed prior to surgery, during the operation, and at each follow-up point. Knee function was evaluated preoperatively and postoperatively using the International Knee Documentation Committee, Lysholm, Kujala, and Tegner rating scales.

Results

Forty patients were followed for 2 years and received complete serial computed tomography examinations and functional evaluations. The correction of the static patellar position remained through the follow-ups. Functional evaluations at 2 years revealed statistical significant improvement over preoperative status, with International Knee Documentation Committee subjective score, Lysholm score, Kujala score, and Tegner score.

Conclusion

AHPLT is a promising alternative graft for MPFLR, together with lateral release and tibial tubercle transfer, satisfactory static patellar position, and functional outcomes have been achieved in the treatment of recurrent patellar dislocation in adults.

Level of evidence

Level IV, case series.

Return to activity after medial patellofemoral ligament repair or reconstruction

PURPOSE

This study aimed to determine the ability of patients to return to activity after medial patellofemoral ligament (MPFL) reconstruction or repair for patellar instability.

METHODS

A systematic review was performed using multiple databases. Studies reporting outcomes with Tegner scores after repair or reconstruction of the MPFL were included. Surgical technique, Tegner scores, and episodes of recurrent patellar instability were recorded.

RESULTS

Ten articles with a total of 402 patients were included. The mean preoperative Tegner score was 4.7 (2.9 to 7.5). The mean postoperative Tegner score was 5.8 (4.0 to 7.7). Forty-nine patients (12.2%) had a recurrent episode of instability, 11 of whom required additional corrective procedures. There was a statistically significant larger failure rate among those who underwent MPFL repair (26.9%) than those who underwent reconstruction (6.6%) or medial retinacular repair/plication (16.5%).

CONCLUSIONS

Recurrent dislocation was higher in patients who underwent MPFL repair rather than reconstruction. However, repair and reconstruction had similar Tegner scores. Repair or reconstruction of the soft tissue structures contributing to patellofemoral instability is successful in returning patients to preinjury activity levels.

LEVEL OF EVIDENCE

Level IV, systematic review of Level II, III, and IV studies.

Surgical versus non-surgical management for primary patellar dislocations: an up-to-date meta-analysis

The aim of this up-to-date meta-analysis was to compare the effects of surgical versus non-surgical treatment of patients following primary patellar dislocation and to provide the best evidence currently available. A comprehensive literature search was conducted using multiple databases, including Medline, Embase, and Cochrane Registry of Clinical Trials. All databases were searched from the earliest records to May 2013. Eligible studies were selected, and data were extracted by two independent investigators. The primary outcome variable was the frequency of recurrent patellar dislocation. The other outcomes included knee function scores, patient-rated outcomes, and radiographic examination. If appropriate, meta-analysis of these variables was performed. Nine independent trials were found to match the inclusion criteria. The pooled results demonstrated that the incidence of recurrent patellar dislocation and Hughston visual analog scale was significantly lower in the surgical treatment group than that in the non-surgical treatment group (P < 0.05). There was no statistically significant difference between the two treatment groups in frequency of subsequent surgical interventions, percentage of excellent or good subjective opinion, Kujala score, pain score on visual analog scale, and severity of patellofemoral joint osteoarthrosis (P > 0.05). This up-to-date meta-analysis indicates that surgical treatment was associated with a lower risk of recurrent patellar dislocation, but a lower Hughston VAS than non-surgical treatment for primary patellar dislocation. More large high-quality trials and further studies are needed to overcome the limitations of small sample sizes, and varieties of different surgical procedures or non-surgical management strategies adopted in the included trials.