Patellofemoral Instability in the Pediatric Population.

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Abstract

Conflict of interest statement: Prushoth Vivekanantha declares that he has no conflict of interest. Dr. Dan Cohen declares that he has no conflicts of interest. Dr. Devin Peterson declares that he has no conflicts of interest. Dr. Darren de SA is an advisory board member for Heron Therapeutics, a consultant for L.E.K Consulting, Atheneum Partners, and Stryker. He is a speaker for Bureau Member (Conmed Linatec) and a working group member for Pendopharm. 8. Orthop Traumatol Surg Res. 2014 Feb;100(1 Suppl):S125-37. doi: 10.1016/j.otsr.2013.06.014. Epub 2014 Jan 10. Patellar instability in children and adolescents. Chotel F(1), Bérard J(2), Raux S(2). Author information: (1)Hôpital Universitaire Femme-Mère-Enfant de Lyon, Hospices civils de Lyon, Université Claude-Bernard Lyon I, Service d'Orthopédie Pédiatrique, 59, boulevard Pinel, 69677 Bron, France. Electronic address: franck.chotel@yahoo.co.uk. (2)Hôpital Universitaire Femme-Mère-Enfant de Lyon, Hospices civils de Lyon, Université Claude-Bernard Lyon I, Service d'Orthopédie Pédiatrique, 59, boulevard Pinel, 69677 Bron, France. Paediatric patellar instability encompasses many anatomic entities located along a continuum of knee extensor mechanism abnormalities. Major or minor clinical manifestations may occur at a variable age. In major forms with irreducible patellar dislocation or habitual patellar dislocation during knee flexion, shortness of the quadriceps is a consistent feature. A comprehensive aetiological work-up is in order, as syndromic conditions are common. Early surgical treatment is mandatory and should be performed by an experienced paediatric orthopaedic surgeon, as the procedure is technically challenging. Minor forms are more common; they are characterised by patellar dislocation or subluxation near terminal knee extension. The diagnosis may be difficult, particularly at the acute phase. Surgery is needed in patients with recurrent dislocation or functional impairments. The semiology of patellar instability has undergone considerable development in recent years, and a three-dimensional evaluation of patellar position can now be obtained using magnetic resonance imaging. Individually tailored surgical treatment "à la carte" remains a valid approach in 2013. However, new techniques for medial patello-femoral ligament reconstruction have modified the management strategies for adults and superseded many stabilisation procedures. Adapting these new techniques to paediatric patients and developing new procedures constitute major challenges. Copyright © 2014 Elsevier Masson SAS. All rights reserved. DOI: 10.1016/j.otsr.2013.06.014