Patellofemoral Instability in Active Adolescents

Abstract

Patellofemoral instability is a common problem in the adolescent population. Patellar stability depends on a dynamic interplay between bony and soft tissue restraints. Several pathoanatomical factors increase the likelihood of patellar instability: patella alta, trochlear dysplasia, malalignment, and deficient proximal medial restraints. Treatment for first-time patella dislocations is typically nonoperative and includes bracing, early range of motion, and physical therapy. The only absolute indication for early surgery is a large osteochondral fragment that can be fixed. Surgical stabilization is indicated for chronic patellar instability and includes both proximal and distal realignment options. Medial patellofemoral ligament reconstruction is the treatment of choice in most adolescent patients with patella instability. Distal bony realignment procedures are reserved for skeletally mature adolescents.

A Combined Closing Wedge Distal Femoral Osteotomy and Medial Reefing Procedure for Recurrent Patellar Dislocation with Genu Valgum

“…Patellar instability, seen frequently in adolescents and young adults, often is associated with previous knee injury 12. It is caused by various factors, including genu valgum, trochlea dysplasia, femoral intorsion, and patella alta 12.…”

“…It is caused by various factors, including genu valgum, trochlea dysplasia, femoral intorsion, and patella alta 12. Whereas initial episodes of patellar dislocation typically are managed conservatively by immobilization and physiotherapy, chronic/recurrent dislocation and instability are treated primarily by surgery 3…”

“…Distal femoral osteotomy (DFO), though most commonly advocated as a treatment option for lateral-compartment osteoarthritis,9 recently has been found to be effective for chronic patellar dislocation as well 10111213. DFO helps to correct excessive Q angle and genu valgum deformity, both of which are commonly associated with patellar instability 12. Furthermore, biplanar closing-wedge DFO (CWDFO) provides better stability and promotes bone healing, due to increased cancellous bone surface area at the osteotomy site 9101415.…”

Large chondral fragment of the lateral femoral condyle treated with arthroscopic internal fixation in an elite young athlete

“…Osteochondral injuries in the pediatric population are welldocumented and most commonly caused by trauma, often following acute patellar dislocation, or a result of osteochondritis dissecans (OCD) [16][17][18][19][20][21][22]. Although osteochondral lesions usually have some degree of subchondral bone attachment, a cartilage fragment can occur in isolation.…”

Dynamic Evaluation of Patellofemoral Instability: A Clinical Reality or Just a Research Field? A Literature review

“…In more severe situations, PFI can lead to recurrent patellar dislocation, a disabling condition. The list of predisposing factors recognized for PFI is vast, including (but not limited to): patella alta, trochlear dysplasia, increased Q‐angle, muscular imbalance, increased femoral‐tibial torsion, genu valgus, hyperlaxity, and traumatic rupture of stabilizers such as the medial patellofemoral ligament.…”