Nine studies, including 433 patients with primary patellar dislocation, were included in this systematic review and meta-analysis comparing surgical vs. conservative treatment. Pooled outcomes of interest included Kujala score, pain score, patient satisfaction, reoperation rate, and recurrence rate of patellar dislocation. The analysis revealed that for patients older than 20 years, surgical treatment resulted in significantly higher Kujala scores and lower recurrence rates compared to conservative treatment. However, for patients aged 20 years or younger, there was no significant difference between the two treatment approaches in terms of clinical outcomes. These findings suggest that while both treatment options yield similar outcomes in younger patients, surgery may be the preferred choice for patients over 20 years due to its lower recurrence rates and better functional outcomes.