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Recurrent Lateral Dislocation of the Patella in Children

  • Luis Moraleda-NovoEmail author
  • Primitivo Gómez-Cardero
Chapter

Abstract

Patellofemoral dislocation is the most common acute disorder in children and adolescents. Predisposing factors are commonly present: genu valgum, patella alta, trochlear dysplasia, femoral anteversion, external tibial torsion, or ligamentous laxity. Osteochondral fractures are commonly associated, and they need to be ruled out since they may cause degenerative arthritis and pain. In children and adolescents, a dislocation or subluxation that reduces spontaneously is the most common scenario. Sometimes, the episode is not even being recognized as a patellar dislocation. Limping or falling down because the knee gave way during normal walking may be the only symptom in the youngest children. MRI is useful to confirm diagnosis, to rule out osteochondral fractures, and to evaluate predisposing factors such as trochlear dysplasia or increased TT-TG distance. Conservative treatment of recurrent patellofemoral instability usually fails. MPFL reconstruction is the indicated surgical technique, accompanied by distal realignment or guided growth of the distal femur when needed. Since osteotomies of the tibial tuberosity cannot be performed during childhood, the Roux-Goldthwait technique is the surgical procedure performed for distal realignment. Congenital dislocation of the patella and patellar dislocation in syndromes such as nail-patella and Down syndrome are also discussed.

Keywords

Patellar dislocation Predisposing factors Genu valgum External tibial torsion TG-TT distance Patella alta Osteochondral lesion MPFL reconstruction 

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Authors and Affiliations

  1. 1.Department of Orthopedic SurgeryLa Paz University HospitalMadridSpain

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