Differences in Imaging and Surgical Management of Patellar Instability in Children and Adolescents Between Asia‐Pacific and North America: A Systematic Review

Purpose To compare diagnostic imaging practices and surgical interventions for patellofemoral instability in children and adolescents between Asia‐Pacific and North America. Methods A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guideline. Inclusion criteria were original surgical studies of patellofemoral instability in children or adolescent patients, with a sample size of more than 5, from either Asia‐Pacific or North America. Exclusion criteria included nonoriginal research, cadaveric/biomechanical studies, imaging‐only reports, unrelated diagnoses, and adult‐only cohorts. Data were synthesized descriptively by region. Results Sixty‐eight studies were included, with 15 from Asia‐Pacific and 53 from North America. The total sample size was 397 patients in Asia‐Pacific and 10,376 in North America. Magnetic resonance imaging, computed tomography, and radiographs were reported more consistently in Asia‐Pacific studies, whereas North American studies more frequently reported medial patellofemoral ligament reconstruction and tibial tubercle osteotomy. Asia‐Pacific studies more commonly reported medial soft‐tissue tightening, lateral retinacular release, trochleoplasty, and medial hemiepiphysiodesis. The included literature was predominantly Level III to IV evidence, with marked heterogeneity in study design, populations, and procedures. Conclusions This systematic review identified reported regional variation in the imaging and surgical management of patellofemoral instability in children and adolescents between Asia‐Pacific and North America. Asia‐Pacific studies more frequently described computed tomography use and soft‐tissue procedures, whereas North American studies more frequently reported medial patellofemoral ligament reconstruction and tibial tubercle osteotomy. These findings should be interpreted with caution because of heterogeneity in study design and a marked imbalance in sample size between regions. Level of Evidence Level IV, systematic review of Level I to IV studies.