Patellar instability in children and adolescents.

Area of Science:

• Orthopaedic Surgery
• Paediatric Orthopaedics
• Biomechanics

Background:

• Paediatric patellar instability presents a spectrum of knee extensor mechanism abnormalities.
• Major forms (irreducible/habitual dislocation) consistently show quadriceps shortness and may indicate syndromic conditions.
• Minor forms involve patellar dislocation/subluxation near terminal knee extension, with diagnosis challenging in acute phases.

Purpose of the Study:

• To review the aetiology, diagnosis, and management of paediatric patellar instability.
• To highlight the importance of early surgical treatment for major forms.
• To discuss evolving diagnostic tools and treatment strategies, including new ligament reconstruction techniques.

Main Methods:

• Review of existing literature on paediatric patellar instability.
• Discussion of clinical manifestations and diagnostic challenges.
• Analysis of current and emerging surgical techniques, including 3D imaging and ligament reconstruction.

Main Results:

• Quadriceps shortness is a consistent finding in major patellar instability.
• Syndromic conditions are common and necessitate comprehensive aetiological work-up.
• 3D evaluation via MRI enhances patellar position assessment; tailored surgery remains valid, but new ligament reconstruction techniques are impacting adult management.

Conclusions:

• Early surgical intervention by experienced paediatric orthopaedic surgeons is essential for major patellar instability.
• Management of minor patellar instability requires tailored surgical approaches for recurrent dislocations or functional impairments.
• Adapting advanced techniques like medial patellofemoral ligament reconstruction for paediatric patients presents significant challenges and future research directions.