## 4 Discussion
Progression involves ROM activities and strengthening exercises such as wall squats, step-ups, lunges, and resistance-band drills. Proprioceptive training with tools like wobble boards and dynamic movements like lateralhops are added later. Advanced phases involve preparation for sports with glyometric drills and sport-specific agility exercises [37]. However, none of the articles provided detailed descriptions of the exercises performed. The predominant surgical intervention was the repair and reconstruction of soft tissue, particularly the medial compartment of the knee joint. Four studies reported that all participants in their surgical groups underwent MPFL repair exclusively [26; 28; 29; 30]. An arthroscopic procedure was used in two studies [26; 29], and an open procedure was used in two other studies [29; 30]. In biomechanical studies, some authors concluded that the MPFL accounts for approximately 50 to 70% of total lateral restriction, making it the primary medial stabilizer of the patella [38]. Some reviews [33] consider nonoperative treatment as the first option, but some studies associate this treatment with eventual recurrences. [PERSON] and [PERSON] monitored 100 patients treated non-operatively after patellar dislocation for 13 years on average. Of these patients, 44% had recurrence, and another 19% experienced subluxation and patellofemoral pain. All participants that received surgical management had a period of postoperative rehabilitation. Apart from two studies [22; 25], the postoperative rehabilitation program used in each study was identical to that used in the conservative group. The longest follow-up was in the study by [PERSON] et al., which had a mean duration of 7 years. Our study has some limitations. The follow-up duration in the studies analyzed significantly impacts the validity of their results. Short follow-up periods, such as 24 months, may fail to capture long-term outcomes like re-dislocation rates or functional recovery. In contrast, longer follow-ups, such as 7 years in some studies, provide a more comprehensive evaluation of the treatment's sustainability and risks of late complications. The variability in re-dislocation rates among studies could be attributed to differences in follow-up durations, patient demographics, and the severity of patellar instability at baseline, which must be considered in our results. Furthermore, there is no evidence of the rehabilitation treatment being adopted. This lack of specificity and in-depth descriptions significantly limits the possibility of extrapolating information about rehabilitation guidelines to follow. Additionally, sample representativeness is a concern. Many studies predominantly included younger or female participants, which limits generalizability to other populations, such as older adults or males. The statistical results of the Kujala score should be interpreted with caution due to a critical limitation in the dataset. Our analysis was based on data extracted from only 7 of the 10 articles included. This partial representation may introduce bias and reduce the robustness of our conclusions. Furthermore, the excluded studies might contain additional insights or data that could either support or contradict our results. Significant variability exists in the study designs, which limits any definitive conclusions. Further analysis revealed disparities based on age and severity. Younger patients or those with more severe instability benefited more from surgery, while mild cases responded well to conservative care. Sex differences were negligible in the outcomes, but sample representation varied. These limitations highlight the need for further comprehensive investigations to validate the findings and assess the true efficacy of surgical treatment relative to conservative approaches.