Soft-tissue realignment for adolescent patellar instability

Patellar malalignment or instability is a frequent problem in adolescents. Patients with persistent symptoms require operative correction with procedures often requiring osteotomies of the tibial tubercle. Insall described a soft-tissue procedure to correct instability in adults, and others have used this in adolescents. Short-term results have seemingly been satisfactory in the skeletally immature population. A long-term outcome study was performed to evaluate the effectiveness of soft-tissue realignment for patellar instability in adolescents. From 1980 to 1996, 54 patients (65 knees) underwent Insall proximal-distal soft-tissue realignment. No concomitant bony or other soft-tissue procedures were performed. Follow-up averaged 6 years (range, 2-15 years), assessing stability, strength, range of motion, and congruence angle on the Merchant's view. Eighty-seven percent had a good to excellent result; 8%, a fair result; and 5%, poor results.