## 4 Discussion  
Ten articles with a total of 543 patients were included in this review. Seven articles were randomized studies [22, 24, 25, 26, 27, 28, 29], and two performed randomization according to odd or even birth years [23, 30]. One study was non-randomized [31]. All 10 studies only recruited participants who had a primary patellar dislocation [22, 23, 24, 25, 26, 27, 28, 29, 30, 31] and were followed with periodic checks for at least 2 years. The findings on the re-dislocation rates and Kujala scores underscore the advantages of surgical treatment, particularly in reducing re-dislocation rates and enhancing functional outcomes. Surgical intervention consistently showed lower re-dislocation rates (17.16%) than conservative methods (33.14%). Reconstruction or repair of the MPFL in surgical cases plays a pivotal role in restoring patellar stability and effectively addresses the anatomical deficiencies that are not directly targeted by conservative methods. This finding aligns with prior studies emphasizing the importance of stabilizing the patella to prevent recurrent dislocations, particularly in young and active individuals. Some case series also present encouraging results with MPFL reconstruction in the treatment of acute patellar dislocation. Using techniques that restore the anatomy and biomechanics of the MPFL is essential in surgery [33]. In addition to having a lower dislocation rate (\(p=0.023\)), the Kujala scores were higher for surgical treatment (averaging 89.8 versus 80.7 for conservative management), which indicated better pain control and functional outcomes (\(p=0.034\)). This significant difference underscores the functional advantages of surgical intervention in managing patellar instability, particularly in improving knee functionality and patient-reported quality of life. The higher score suggests that procedures such as MPFL reconstruction effectively address the anatomical and biomechanical causes of patellar instability [34]. By restoring proper alignment and joint stability, surgery not only helps to prevent recurrence, but also enhances knee function and reduces discomfort during daily activities and physical exertion. While conservative management achieved moderate Kujala scores, its reliance on physiotherapy and bracing appears insufficient for addressing severe instability or structural anomalies such as trokclear dysplasia or patella alta. These limitations likely explain the poorer functional outcomes and highlight the need for surgical intervention in complex cases. These results reflect those of [PERSON] et al., whose statistical analysis actually showed even better results in the surgical group [25]. Surgical interventions not only address the mechanical stability of the knee but also improve patient-reported outcomes related to mobility and quality of life, and they are recommended for cases where immediate and sustained functional improvement is critical. Nonetheless, the conservative group still achieved moderate Kujala scores, reflecting potential efficacy in cases of mild instability or contraindications to surgery, although the same functional benefits may not be achieved [25]. This was confirmed by [PERSON] et al., who outlined the management for first-time lateral patellar dislocation and emphasized using conservative treatment as the initial approach. Key components include brief immobilization, physiotherapy focusing on quadriceps strengthening, and gait re-education. Surgery was reserved for recurrent or complex cases and often involved MPFL reconstruction [35, 36]. Non-surgical management in all studies generally consisted of initial immobilization in a cast, splint, or locked orthosis, followed by active mobilization with physiotherapy. The aim of this approach is to restore stability, ROM, and strength, while minimizing the risk of re-injury. In each study, physiotherapy consisted of exercises to strengthen the muscles of the lower limbs, with a focus on the quadriceps femoris. Early exercises include quadriceps sets, straight-leg raises, and ankle pumps.