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2016 ; 1
(5
): 160-166
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Patella instability in children and adolescents
#MMPMID28461943
Hasler CC
; Studer D
EFORT Open Rev
2016[May]; 1
(5
): 160-166
PMID28461943
show ga
Patellar instabilities are the most common knee pathologies during growth.
Congenital dislocations are rare. Extensive, early soft tissue releases relocate
the extensor mechanism and may enable normal development of the femoro-patellar
anatomy.Conservative management is the preferred strategy after a 'first-time'
traumatic dislocation. In cases with concomitant anatomical predisposing factors
such as trochlear dysplasia, malalignment, malrotation or ligamentous laxity,
surgical reconstruction must be considered. The same applies to recurrent
dislocations with pain, a sense of instability or re-dislocations which may also
lead to functional compensatory mechanisms (quadriceps-avoiding gait in knee
extension) or cartilaginous lesions with subsequent patello-femoral
osteoarthritis. The decision-making process guiding surgical re-alignment
includes analysis with standard radiographs and MRI of the trochlear groove,
joint cartilage and medial patello-femoral ligament (MPFL). Careful evaluation of
dynamic and static stabilisers is essential: the medial patello-femoral ligament
provides stability during the first 20° of flexion, and the trochlear groove
thereafter.Excessive femoral anteversion, general ligamentous laxity with
increased femoro-tibial rotation, patella alta and increased distance between the
tibial tuberosity and the trochlear groove must also be taken into account and
surgically corrected.In cases with ongoing dislocations during skeletal
immaturity, soft tissue procedures must suffice: reconstruction of the medial
patello-femoral ligament as a standalone procedure or in conjuction with more
complex distal realignment of the quadriceps mechanism may lead to a permanent
stable result, or at least buys time until a definitive bony procedure is
performed. Cite this article: Hasler CC, Studer D. Patella instability in
children and adolescents. EFORT Open Rev 2016;1:160-166. DOI:
10.1302/2058-5241.1.000018.
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