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Recurrent Patellofemoral Instability in the Pediatric Patient: Management and Pitfalls

  • Pediatric Orthopedics (N. Pandya, Section Editor)
  • Published:
Current Reviews in Musculoskeletal Medicine Aims and scope Submit manuscript

Abstract

Purpose of Review

The purpose of the review is to discuss the relevant pathoanatomy, management, complications, and technical considerations for recurrent patellofemoral instability (PFI) in the pediatric population. Special consideration is given to recent literature and management of the patient with repeat instability following surgery.

Recent Findings

Patellar stabilization surgery is in principle dependent upon restoration of normal patellofemoral anatomy and dynamic alignment. Historically, treatment options have been numerous and include extensor mechanism realignment, trochleoplasty, and more recently repair and/or reconstruction of the medial patellofemoral ligament (MPFL) as a dynamic check rein during initial knee flexion. In skeletally immature patients, preference is given to physeal-sparing soft tissue procedures. While medial patellofemoral ligament reconstruction has become a popular option, postoperative failure is a persistent issue with rates ranging from 5 to 30% for PFI surgery in general without any single procedure (e.g., distal realignment, MPFL reconstruction) demonstrating clear superiority. Failure of surgical patellar stabilization is broadly believed to occur for three main reasons: (1) technical failure of the primary stabilization method, (2) unaddressed static and dynamic pathoanatomy during the primary stabilization, and (3) intrinsic risk factors (e.g., collagen disorders, ligamentous laxity).

Summary

PFI is a common orthopedic condition affecting the pediatric and adolescent population. Treatment of repeat instability following surgery in the PFI patient requires understanding and addressing underlying pathoanatomic risk factors as well as risks and reasons for failure.

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  1. Sports Medicine and Shoulder Service Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, 10065, USA

    Evan E. Vellios

  2. Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA

    Myra Trivellas, Armin Arshi & Jennifer J. Beck

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  1. Evan E. Vellios
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Vellios, E.E., Trivellas, M., Arshi, A. et al. Recurrent Patellofemoral Instability in the Pediatric Patient: Management and Pitfalls. Curr Rev Musculoskelet Med 13, 58–68 (2020). https://doi.org/10.1007/s12178-020-09607-1

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