Search Results (12)

Background/Objectives: Patellar instability in adolescents is a significant cause of short- and long-term morbidity and disability. Traditionally, patients with first-time patellar dislocation are managed nonoperatively, although most studies are not focusing on the adolescent athletic population. The primary objective of the current study was to compare patient-reported outcomes and complications in adolescent athletes who underwent surgery either after the first patellar dislocation or after the recurrence of the dislocation with a minimum postoperative follow-up of 48 months (48–75 months). Methods: A total of 39 adolescent athletes who underwent medial patellofemoral ligament (MPFL) reconstruction (Group A, after the first dislocation, and Group B, recurrent patella dislocation) were included in this study. In all the patients, the same MPFL reconstruction technique was applied using a semitendinosus autograft. The graft was fixed on the patella using a transverse tunnel and adjustable loop button fixation and, in the femur, using a tunnel and absorbable screw fixation. The tunnel was drilled obliquely to prevent penetration of the distal femoral physis. The preoperative and postoperative clinical and functional evaluations of the patients were conducted via the visual analog scale (VAS), the Lysholm Knee Scoring System, the Kujala Anterior Knee Pain Scale, and the Pediatric International Knee Documentation Committee (Pedi-IKDC), and the return to sports score was assessed via the Tegner Activity Scale (TAS). Results: At the latest follow-up, both groups demonstrated significant improvement in the Lysholm scores, with Group A achieving a mean of 92.57 ± 6.21 and Group B achieving a mean of 90.53 ± 8.21 (p = 0.062). Postoperatively, Group A achieved a mean Kujala score of 94.21 ± 9.23, whereas Group B reached 92.76 ± 12.39, with no statistically significant difference (p = 0.08). The Pedi-IKDC score improved postoperatively in both groups. In Group A, it increased from 67.98 ± 12.29 to 93.65 ± 4.1, and in Group B, from 56.21 ± 13.6 to 91.67 ± 6.21 (p = 0.067). The preoperative visual analog scale (VAS) score for pain was significantly lower in Group A (3.1 ± 1.13) than in Group B (4.2 ± 3.01, p < 0.01). At the latest follow-up, the VAS scores improved in both groups, with Group A reporting a mean score of 0.47 ± 1.01 and Group B 0.97 ± 1.32 (p = 0.083). The Tegner activity scores were similar between the groups preoperatively, with Group A at 7.72 ± 1.65 and Group B at 7.45 ± 2.09 (p = 0.076). Postoperatively, Group A had a mean score of 7.28 ± 2.15, whereas Group B had a mean score of 6.79 ± 3.70 (p = 0.065). The mean time to return to sports was significantly shorter in Group A (5.1 ± 1.3 months) than in Group B (7.6 ± 2.1 months) (p < 0.01). Overall, 84.61% of the patients returned to their previous activity level. Specifically, 95.2% (20/21) of patients in Group A achieved this outcome, whereas 72.22% (13/18) achieved it in Group B. Patient satisfaction was generally high, with 76% (16/21) of patients in Group A reporting being satisfied or very satisfied, compared with 77% (14/18) in Group B. Conclusions: MPFL reconstruction is a safe and effective procedure for both acute and recurrent patellar dislocation in adolescent athletes. While patients who underwent acute reconstruction returned to sport more quickly and showed higher absolute postoperative scores, the greatest overall improvement from preoperative to final follow-up was observed in those treated for recurrent instability. Both surgical approaches demonstrated high satisfaction rates and minimal complications, supporting MPFL reconstruction as a reliable option in both acute and recurrent cases. Full article

Background/Objectives: The diagnostic guidelines for pediatric patellofemoral instability (PFI) remain incomplete. PFI remains a challenging issue as it affects the biomechanics of the knee joint, triggers anterior knee pain, and is linked to the development of early-onset osteoarthritis. The diagnostic process is complicated by numerous anatomical factors that must be considered. This review aims to consolidate current knowledge presented in the literature on radiological diagnostics for PFI in pediatric populations, with the application of all imaging techniques—including ultrasonography (US), magnetic resonance imaging (MRI), computed tomography (CT), and radiography (RTG)—which enable the evaluation of anatomical risk factors critical for the diagnosis, prevention, and treatment of PFI. Methods: A search of the PubMed/MEDLINE database was conducted to identify relevant studies from 1975 to 2024. The search terms were as follows: (patellar or patella) and (instability or displacement or dislocation) and (diagnostic or diagnosis or imaging or radiographic). A total of 2743 articles were retrieved, which were screened to yield 29 studies for further review. These studies were then divided into seven categories regarding the diagnostic methods: risk factors, tibial tubercle trochlear groove (TT-TG)/tibial tubercle posterior cruciate ligament (TT-PCL), MPFL injury and cartilage damage, patella and trochlear dysplasia, torsional abnormalities, coronal plane alignment, and genetics. Results: The methods presented statistically significant differences, with those most commonly used for the diagnosis of patella dislocation being TT-TG index, MPFL rapture, and trochlear dysplasia. Conclusions: In summary, multiple diagnostic tools, including MRI, CT, X-ray, and physical examination, are available for the assessment of PFI, each contributing to treatment decisions. Although MRI remains the primary diagnostic tool, further research is needed to establish more precise diagnostic criteria. Full article

Patellofemoral instability is a common condition in children, with an annual incidence of approximately 50 cases per 100,000 children. Instability of the patella involves a number of structures, such as the medial patellofemoral ligament and the vastus medialis obliquus, which can be used for patellar realignment in soft tissue, physeal-sparing procedures. In this rapid review, we aim to review the surgical interventions, post-operative outcomes, and associated surgical complications of global soft tissue procedures in the management of patellofemoral instability. A search of the Medline database was conducted to identify studies evaluating the treatment and outcomes of global treatment of pediatric patellofemoral instability. The included studies analyzed the surgical management of patellofemoral instability in pediatric patients, utilizing soft tissue global procedures and reported functional outcomes, return to sport or play, and post-operative complications. A total of eight studies were included, comprising a cohort of 270 pediatric and adolescent patients and 334 knees. The average patient age was 10.6 years, with 60.4% (163/270) patients being female, and the mean follow-up duration was 58.4 months. Of the eight studies, two examined the three-in-one procedure, three examined the four-in-one procedure, one examined a combination of medial and lateral release, and two examined the Galeazzi procedure. This review underscores the variety of global physeal-sparing surgical procedures available for treating patellofemoral instability. While outcomes are generally favorable, with high rates of return to sport, recurrent residual instability and recurrent dislocation remain significant challenges, with residual instability affecting nearly half of patients. Future research should focus on exploring long-term outcomes, optimizing patient selection, and identifying the causes of recurrent instability to further enhance patient outcomes and reduce complication rates. Full article

Background: MPFL reconstruction in children with open physis may be challenging, as a major concern during the surgery is to preserve the distal femoral physis. The purpose of this study was to compare the complication rate and the patient-reported outcomes in skeletally immature patients who underwent MPFL reconstruction using an anatomic (A) or non- anatomic (NA) surgical technique. Methods: For this systematic review, the authors adhered to the PRISMA guidelines. The literature search was conducted from inception to 31 May 2024. Three databases were used: Pubmed, Scopus and Cochrane library. We included skeletally immature patients who underwent MPFL reconstruction for chronic or recurrent patellar instability. The included studies should describe the surgical technique, report clinical outcomes and complications. Patients with closed physis, prior ipsilateral knee surgery, concomitant surgical procedures except for lateral retinacular release, multiligament knee injury, congenital or acute patellofemoral instability, hyperlaxity or less than 12 months follow up were excluded. Risk of bias was assessed using ROBINS-I, MINORS and MCMS scores. Results: Data from 304 procedures were collected, of which 208 were performed using an anatomic technique and 96 using a non-anatomic technique. Patient age at the time of surgery ranged from 8 to 17 years. The follow-up time ranged between 12 and 116.4 months. Postoperative Kujala (−0.73, p = 0.55) and Tegner (−0.70, p = 0.80) scores were better in the anatomic group compared to the non-anatomic one. Higher rates of recurrent instability (OR 0.91; 95%CI 0.44–1.86, p = 0.85), redislocation (OR 1.21; 95%CI 0.42–3.51, p = 0.8), subluxation (OR 0.73; 95%CI 0.29–1.83, p = 0.62), a positive apprehension test (OR 0.92; 95%CI 0.27–3.13, p = 0.89), stiffness (decreased ROM) (OR 1.63; 95%CI 0.33–1.72, p = 0.54) and reoperation (OR 1.16; 95%CI 0.35–3.80, p = 0.8) were reported in papers using the anatomic technique. Conclusions: The findings of this systematic review reveal that there is no significant difference between anatomic and non-anatomic MPFL reconstruction techniques in terms of patient-reported outcomes and complications. Thus, the choice of surgical technique might be left up to surgeon’s preference. Further high-quality, pediatric-oriented studies with long-term follow–up are needed to better guide clinical decision-making. Full article

Background: Patella instability is one of the most common knee injuries in the adolescent patient. There are several pathoanatomic risk factors which should be assessed via several modalities, including X-rays, magnetic resonance imaging (MRI), or even CT scan. Objectives: We intend to review these risk factors along with the nonsurgical and surgical techniques used to prevent recurrent dislocations. Methods: We completed an extensive review of the recent literature concerning pediatric and adolescent patellar dislocation and subsequent treatment modalities. Results: We review in detail the risk factors such as patella alta, trochlear dysplasia, lateralization of the tibial tubercle or medialization of the trochlear groove (increased tibial tubercle to trochlear groove (TT–TG) distance), lower limb malalignment, excessive femoral anteversion and/or tibial torsion, and hyperlaxity. There are classification systems for dislocators, and a natural progression of instability that patients often proceed through. Only after a patient has continued to dislocate after bracing and physical therapy is surgical treatment considered. Surgical techniques vary, with the workhorse being the medial patellofemoral ligament (MPFL) reconstruction. However, there are a variety of other techniques which add onto this procedure to address other anatomic risk factors. These include the tibial tubercle osteotomy to address a large TT–TG distance or trochleoplasty to address the lack of a trochlear groove. Conclusions: Nonsurgical and surgical treatments for patella dislocators are tailored to the pathoanatomic risk factors in each patient. Full article

Background and Objectives: The immature skeleton in a pediatric population exposed to frequent physical activity might be extremely prone to injuries, with possible consequences later in adulthood. The main aim of this study is to present specific morphometric parameters and magnetic resonance imaging (MRI) morphological changes of the knee and patella in a physically active pediatric population. Additionally, we wanted to investigate the morphological risk factors for patellar instability. Materials and Methods: The study included the MRI findings of 193 physically active pediatric patients with knee pain. The participants underwent sports activities for 5 to 8 h per week. Two divisions were performed: by age and by patellar type. We evaluated three age groups: group 1 (age 11–14), group 2 (age 15–17), and group 3 (age 18–21 years). In addition, participants were divided by the patellar type (according to Wiberg) into three groups. The following morphometric parameters were calculated: lateral trochlear inclination (LTI), the tibial tubercle–trochlear groove distance (TT-TG), trochlear facet asymmetry (TFA), Insall–Salvati index, modified Insall–Salvati index, Caton–Deschamps index, articular overlap, morphology ratio and contact surface ratio. Results: We found a statistically significant association between patellar type groups in LTI (p < 0.001), TFA (p < 0.001), Insal–Salvati (p = 0.001) index, and Caton–Deschamps index (p = 0.018). According to age groups, we found statistical significance in the Caton–Deschamps index (p = 0.039). The most frequent knee injury parameter, according to Wiberg, in physically active pediatric patients was patella type 2 in boys and type 3 in girls. Conclusions: The MRI morphometric parameters observed in our study might be factors of prediction of knee injury in physically active children. In addition, it might be very useful in sports programs to improve the biomechanics of the knee in order to reduce the injury rate in sports-active children. Full article

Background: Patellar instability is the most common disorder of the knee during childhood and adolescence. Surgical treatment significantly reduces the rate of redislocation, but the underlying pathologies and pattern of instability may affect the results. We aimed to report the clinical and functional outcomes of the three-in-one procedure for patellar realignment in a cohort of skeletally immature patients with or without syndromes and various patterns of chronic patellar instability. Methods: We retrospectively investigated 126 skeletally immature patients (168 knees) affected by idiopathic or syndromic patellar instability, who underwent patella realignment through a three-in-one procedure. We classified the instability according to the score proposed by Parikh and Lykissas. Results: Patellar dislocation was idiopathic in 71 patients (94 knees; 56.0%) and syndromic in 55 (74 knees; 44.0%). The mean age at surgery was 11.5 years (range 4–18) and was significantly lower in syndromic patients. Syndromic patients also exhibited more severe clinical pattern at presentation, based on the Parikh and Lykissas score. The mean follow-up was 5.3 years (range 1.0–15.4). Redislocation occurred in 19 cases, with 10 cases requiring further realignment. The Parikh and Lykissas score and the presence of congenital ligamentous laxity were independent predictors of failure. A total of 22 knees in 18 patients required additional surgical procedures. The post-operative Kujala score was significantly lower in patients with syndromic patellar instability. Conclusions: The type of instability and the presence of underlying syndromes negatively affect the rate of redislocation and the clinical and functional outcome following patellar realignment through the three-in-one procedure. We recommend the consideration of alternative surgical strategies, especially in children with severe syndromic patellar dislocation. Full article

Patellar instability is a common pathology of the knee in pediatric patients. The management of this condition can be a challenge for the orthopedic surgeon, and a comprehensive understanding of the anatomy and biomechanics of the structures around the knee is of utmost importance in formulating a treatment plan. Predisposing factors can be related to: trochlear and patellar morphological abnormalities, ligamentous stabilizers, limb geometries in the axial plane, and patellar height abnormalities. Traditionally, first-time dislocators have been treated non-operatively; however, recent evidence suggests that certain factors are related to recurrent instability, and surgical treatment may be considered even after the first dislocation. It is important to keep in mind that younger children with open physes are not suitable candidates for certain surgical techniques. In this comprehensive review, we aimed to focus on the most up-to-date information on this topic and emphasize the importance of individualizing the treatment of pediatric patients. Full article

Patellofemoral instability is a frequent cause of knee pathology affecting quality of life among the pediatric population. Here, we present a prospective cohort study which included patients who had undergone surgical management using the lateral release and medial imbrication approach (LRMI) or medial patellofemoral ligament reconstruction (MPFL-R). The object of this study was to assess the quality of life among children that have undergone surgical treatment for patellar dislocation. Quality of life was assessed before and after surgery using the Pediatric International Knee Documentation Committee form (Pedi-IKDC), a questionnaire that aims to quantify knee functionality. Postoperative scarring was evaluated using The Stony Brook Scar Evaluation Scale. One hundred and eight patients were selected and grouped according to the type of procedure. Before surgery, the two groups had similar mean Pedi-IKDC scores (41,4 MPFL-R vs. 39,4 LRMI p = 0.314). Improvements were observed in the postoperative scores. The MPFL-R technique showed promising outcomes. When comparing the two surgical groups, there was a significant difference in favor of MPFL-R group (MPFL-R 77.71 points vs. LRMI 59.74 points, p < 0.0001–95% CI (11.22–24.72)). Using the Stony Brook Scar Evaluation Scale, a significant difference in scar quality in favor of MPFL-R was observed (4,5 MPFL-R vs. 2,77 LRMI p = 0.002). In conclusion, this study provides objective evidence-based outcome assessments that support the medial patellofemoral ligament reconstruction technique as the gold standard for patellofemoral instability. Full article

Patellofemoral instability (PFI) encompasses symptomatic patellar instability, patella subluxations, and frank dislocations. Previous studies have estimated the incidence of acute patellar dislocation at 43 per 100,000 children younger than age 16 years. The medial patellofemoral ligament (MPFL) complex is a static soft tissue constraint that stabilizes the patellofemoral joint serving as a checkrein to prevent lateral displacement. The causes of PFI are multifactorial and not attributed solely to anatomic features within the knee joint proper. Specific anatomic features to consider include patella alta, increased tibial tubercle–trochlear groove distance, genu valgum, external tibial torsion, femoral anteversion, and ligamentous laxity. The purpose of this paper is to provide a review of the evaluation of PFI in the pediatric and adolescent patient with a specific focus on the contributions of coronal and transverse plane deformities. Moreover, a framework will be provided for the incorporation of bony procedures to address these issues. Full article

Patellar instability is a heterogeneous group of morphological and functional disorders of the knee extensor mechanism. The medial patellofemoral ligament (MPFL) has been recognized as being important in stabilizing the patella and preventing lateral patellar dislocation. Recurrent dislocations in the pediatric population may benefit from surgical intervention. The aim of this study is to retrospectively evaluate adolescent patients treated with surgical reconstruction of medial patello-femoral ligament. Between January 2009 and December 2014, seven patients with patellar instability were treated at the Department of Orthopaedics and Traumatology of the University of Catania, Sicily. Five patients (71.4%) were female and two (28.6%) were male. The mean age at the time of surgery was 14.9 ± 1.1 years (range 13–16 years). All cases were treated with reconstruction of the MPFL. Clinical outcomes and complications were reported. Mean follow-up was 26.1 ± 10.9 months (range 12–46 months). Evaluation at two years after surgery identified an average Knee Society Score (KSS) of 94.3 ± 7.4 (range 78–100). An excellent result was obtained in six patients (85.7%) and a good result was obtained in one patient (14.3%). A recurrence was reported in one patient (14.3%). This study shows that surgical treatment of patellar instability by reconstruction of MPFL leads to satisfying results at mid-term follow-up. Full article

Acute patellar dislocation remains a common injury in both adult and pediatric patients. Non-operative management has been advocated for patients without a history of recurrent instability. Although pathologic thresholds for consideration of operative management have previously been reported in adults, it is largely unknown in children. A retrospective review of all skeletally immature patients diagnosed with acute lateral patellar dislocation who had MRI imaging were included for analysis. An age-based control group was also identified. Six radiographic measurements were compared: lateral trochlear inclination (LTI), trochlear facet asymmetry (TFA), trochlear depth (TD), tibial tuberosity–trochlear groove (TT–TG), sulcus angle (SA) and patellar height ratio. A total of 178 patients were included for analysis (study: n = 108, control: n = 70). The mean age of patients in the study and control groups was 13.7 and 12.1 years respectively (p ≤ 0.001). Study group patients had significant differences in all radiographic measurements including a decreased LTI (p < 0.001), increased TFA (p < 0.001) and SA (p < 0.001). The mean trochlear depth was 3.4 mm and 5.6 mm for patients in the study and control groups respectively (p < 0.001). Study group patients had an increased patellar height ratio (p < 0.001) and TT–TG distance (p < 0.001). Morphologic abnormalities may predispose skeletally immature patients to an increased risk of acute lateral patellar instability. Full article