title: Surgical versus conservative management of acute patellar dislocation in children and adolescents: a systematic review.
abstract: OBJECTIVE
  The goal of this study was to perform a comparative review to determine whether there is a significant difference in the rate of repeat dislocation and clinical outcome between surgical and conservative management of acute patellar dislocation in children and adolescents.
  
  
  METHODS
  A systematic review of the MEDLINE database was performed. English-language clinical outcome studies with a primary outcome/treatment specific to acute patella dislocation in a paediatric population were included. Eleven studies met inclusion criteria; Chi-square analysis, independent t tests and weighted mean pooled cohort statistics were performed where appropriate.
  
  
  RESULTS
  A total of 470 conservatively managed and 157 operatively treated knees were included. Conservatively managed patients were on average 17.0 years and had a mean follow-up of 3.9 years; surgically managed patients were on average 16.1 years and had a mean follow-up of 4.7 years. Conservatively managed knees had a 31% rate of recurrent dislocation rate compared to 22% in surgical knees (p = 0.04). Trochlear dysplasia and skeletal immaturity confer greater risk for recurrent instability. Surgical treatment may provide clinically important quality of life and sporting benefit.
  
  
  CONCLUSIONS
  Surgical treatment of first time patella dislocation in children and adolescents is associated with a lower risk of recurrent dislocation and higher health-related quality of life and sporting function. There is a paucity of evidence on MPFL reconstruction for first time traumatic patella dislocation in this population.
  
  
  METHODS
  IV.
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA. nwachukwub@hss.edu.
authors.forename: Benedict U
authors.identifier: http://orcid.org/0000-0002-6170-7769
authors.initials: BU
authors.lastname: Nwachukwu
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.|University of Maryland School of Medicine, 620 W. Lexington St, Baltimore, MD, 21201, USA.
authors.forename: Conan
authors.initials: C
authors.lastname: So
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
authors.forename: William W
authors.initials: WW
authors.lastname: Schairer
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Green
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
authors.forename: Emily R
authors.initials: ER
authors.lastname: Dodwell
mesh_terms: D000293:Adolescent; D002648:Child; D006801:Humans; D031222:Patellar Dislocation / Q000601:surgery* / Q000628:therapy*; D011788:Quality of Life; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Adolescent; Medial patellofemoral ligament; Paediatric; Patellar dislocation; Patellofemoral dislocation