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To compare revision rate, anterior knee pain rate, patient\u2010reported outcome measures, complication, radiographic, and clinical outcomes after patellar resurfacing versus non\u2010resurfacing in total knee arthroplasty.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>PubMed, Medline, EMBASE, CENTRAL, and CINAHL databases were searched on 25 April 2021 to enroll randomized controlled trials that compared patellar resurfacing versus non\u2010resurfacing. We used the grading of recommendations assessment, development and evaluation (GRADE) framework to assess the certainty of evidence. Our primary outcome was revision rate and secondary outcomes was anterior knee pain rate. Outcomes were pooled using the random\u2010effect model and presented as risk ratio (RR), or mean difference (MD), with 95% confidence interval (CI).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Fifty studies (5586 knees) were included. Significant reductions in patellar revision rate (RR 0.41, 95% CI [0.19, 0.88]; <jats:italic>P<\/jats:italic>\u00a0=\u00a00.02; <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u00a024.20%) and non\u2010patellar revision rate (RR 0.64, 95% CI [0.55, 0.75]; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001; <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u00a00%) were seen after patellar resurfacing. Patellar resurfacing significantly reduced the anterior knee pain rate than nonresurfacing (RR 0.72, 95% CI [0.57, 0.91]; <jats:italic>P<\/jats:italic>\u00a0=\u00a00.006; <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u00a069.5%). Significant differences in patient\u2010reported outcome measures were found. However, these differences were inconsistent and lacked clinical importance. Patellar resurfacing resulted in a significant lower rate of patellar clunk (RR 0.58, 95% CI [0.38, 0.88]; <jats:italic>P<\/jats:italic>\u00a0=\u00a00.01; <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u00a00%), a higher patellar score (MD 1.24, 95% CI [0.67, 0.81]; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001; <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u00a073.8%), but prolonged surgical time (MD 8.59, 95% CI [5.27, 11.91]; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001; <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u00a088.8%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The clear relationship is that patellar resurfacing reduces revisions, anterior knee pain, and patellar clunk. It will be interesting to compare the initial cost with the revision cost when required and cost\u2010utility analysis with long\u2010term results in future studies.<\/jats:p><\/jats:sec>","DOI":"10.1111\/os.13392","type":"journal-article","created":{"date-parts":[[2022,12,7]],"date-time":"2022-12-07T21:52:26Z","timestamp":1670449946000},"page":"379-399","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":31,"title":["Patellar Resurfacing in Primary Total Knee Arthroplasty: A Meta\u2010analysis and Trial Sequential Analysis of 50 Randomized Controlled Trials"],"prefix":"10.1111","volume":"15","author":[{"given":"Xiumei","family":"Tang","sequence":"first","affiliation":[{"name":"West China School of Nursing, Sichuan University\/Department of Orthopedics West China Hospital, Sichuan University  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yue","family":"He","sequence":"additional","affiliation":[{"name":"West China School of Nursing, Sichuan University\/Department of Orthopedics West China Hospital, Sichuan University  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shi","family":"Pu","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital Army Medical University (Third Military Medical University)  Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Lei","sequence":"additional","affiliation":[{"name":"West China School of Nursing, Sichuan University\/Department of Orthopedics West China Hospital, Sichuan University  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0378-5662","authenticated-orcid":false,"given":"Ning","family":"Ning","sequence":"additional","affiliation":[{"name":"West China School of Nursing, Sichuan University\/Department of Orthopedics West China Hospital, Sichuan University  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital Army Medical University (Third Military Medical University)  Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiali","family":"Chen","sequence":"additional","affiliation":[{"name":"West China School of Nursing, Sichuan University\/Department of Orthopedics West China Hospital, Sichuan University  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9037-4756","authenticated-orcid":false,"given":"Zongke","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, West China Hospital\/West China School of Medicine Sichuan University  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,12,7]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0039-1681077"},{"key":"e_1_2_7_3_1","unstructured":"NG157 N.g. 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