Surgical Management of First-Time Patellar Dislocations in Paediatric Patients May Lower Rates of Redislocation Compared to Conservative Management: A Systematic Review and Meta-Analysis

To assess whether early surgical intervention for first-time patellar dislocations in pediatric patients is superior to conservative management. We hypothesized that surgical intervention would lead to lower redislocation rates compared to conservative treatment. Three online databases (PubMed, MEDLINE, EMBASE) were searched from inception to 14 March 2024 to identify studies investigating the management options for acute first-time patellar dislocations in pediatric patients. Data pertaining to patient demographics, patient management, redislocation rates, and Kujala scores, evaluating function, were abstracted. Weighted means and meta-analyses were conducted to compare rates of redislocation, as well as Kujala scores. The quality of included studies was assessed using the MINORS criteria for non-randomized studies and the ROB2 tool for randomized controlled trials (RCT)s. A total of 11 studies and 761 patients were included in this review. The weighted mean postoperative combined rates of redislocation in the surgical group was 25.1%, compared to 46.4% in the conservative group at a mean follow-up of 53.2 months (12–168). The relative risk (RR) of redislocation was 0.82 (CI: 0.65–1.04, I2=0% p=0.11), favoring surgery compared to conservative management. A sub-group meta-analysis of two recent RCTs with 110 patients demonstrated a RR of redislocation of 0.53 (95% CI: 0.31–0.91, I2=0%, p=0.02) favoring surgery. Kujala scores among three comparative studies showed a mean difference of −2.7 (95% CI: −6.1–0.68, I2=0%, p=0.12), favoring conservative treatment. The weighted mean redislocation rate in 131 patients undergoing medial patellofemoral ligament reconstruction (MPFLR) was 3.1%, compared to 39.4% in 203 patients undergoing other surgical procedures, such as lateral release and medial imbrication, Roux-Goldwaith, and MPFL repair. Furthermore, the conservative groups experienced a complication rate of 0.9% compared to 2.9% across the surgical groups. Surgical management for first-time patellar dislocations in a pediatric population, particularly MPFLR, may be more beneficial in lowering redislocation rates than conservative management. No significant differences in Kujala scores were found.