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Risk of bias and quality of evidence were evaluated according to the Cochrane guidelines. RCTs investigating differences between surgery and nonsurgical treatment in primary LPD were included. The outcomes evaluated were redislocation rate, reinterventions, and Kujala score at short\u2010, mid\u2010, and long\u2010term follow\u2010up, with subanalyses for the pediatric population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We included 510 patients from 10 RCTs in the meta\u2010analysis. Redislocation rate was 0.40 (0.25 to 0.66;\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .001) and 0.58 (0.29 to 1.15;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0= .12) at the short\u2010 and mid\u2010term follow\u2010ups, respectively, and the risk ratio for the need for further operations at 6 to 9\u00a0months' follow\u2010up was 0.14 (0.02 to 1.03;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0= .05), all favoring surgery. Concerning the Kujala score, an advantage of the surgical approach of 10.2 points (1.6 to 18.7;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0= .02) at short\u2010term follow\u2010up was seen, whereas long\u2010term follow\u2010up results were similar between the groups. The subanalysis of the pediatric population at heterogeneous follow\u2010up confirmed a lower risk of recurrence in surgery, with a risk ratio of 0.60 (0.26 to 1.37;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0= .22), although not significant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The literature documents a low number of high\u2010level trials. The meta\u2010analysis of RCTs underlined that the redislocation rate is higher with the nonsurgical approach compared with the surgical one. Moreover, when looking at the clinical outcome, more favorable findings were found with the surgical approach up to 6\u00a0years, whereas results seems to be similar at a longer follow\u2010up after either surgical or nonsurgical treatment of primary LPD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of evidence<\/jats:title>\n                    <jats:p>II, meta\u2010analysis of level I and level II randomized clinical trials.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1016\/j.arthro.2019.03.047","type":"journal-article","created":{"date-parts":[[2019,8,5]],"date-time":"2019-08-05T18:11:16Z","timestamp":1565028676000},"page":"2469-2481","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":45,"title":["A Meta\u2010analysis of Surgical Versus Nonsurgical Treatment of Primary Patella 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Rizzoli Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Zaffagnini","sequence":"additional","affiliation":[{"name":"2nd Orthopaedic and Traumatologic Clinic IRCCS Istituto Ortopedico Rizzoli Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Candrian","sequence":"additional","affiliation":[{"name":"Orthopaedic and Traumatology Unit Ospedale Regionale di Lugano, EOC Lugano 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