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Physeal-Sparing Soft Tissue Realignment in Pediatric Patellofemoral Instability Patients: A Review of Treatment
Christian F Zirbes1, Alyssa Henriquez1, Alaowei Amanah1
1School of Medicine, Duke University, Durham, NC 27710, USA.
Insights
Global soft tissue procedures offer favorable outcomes for pediatric patellofemoral instability, including high return-to-sport rates. However, recurrent instability remains a challenge for nearly half of patients undergoing these physeal-sparing surgeries.
Area of Science:
- Orthopedic Surgery
- Pediatric Sports Medicine
- Biomechanical Engineering
Background:
- Patellofemoral instability is a prevalent pediatric condition, impacting approximately 50 per 100,000 children annually.
- Key anatomical structures like the medial patellofemoral ligament and vastus medialis obliquus are crucial for patellar stability.
- Physeal-sparing soft tissue procedures offer a viable approach for patellar realignment in pediatric patients.
Purpose of the Study:
- To conduct a rapid review of surgical interventions for pediatric patellofemoral instability.
- To evaluate post-operative outcomes and surgical complications associated with global soft tissue procedures.
- To synthesize evidence on functional outcomes and return to sport/play following these interventions.
Main Methods:
- A systematic search of the Medline database was performed to identify relevant studies.
- Included studies focused on pediatric patellofemoral instability treated with global soft tissue, physeal-sparing procedures.
- Data extraction focused on surgical management, functional outcomes, return to sport, and complications.
Main Results:
- Eight studies involving 270 pediatric patients (334 knees) were analyzed, with an average age of 10.6 years.
- Procedures reviewed included the three-in-one, four-in-one, medial/lateral release, and Galeazzi procedures.
- While generally favorable outcomes and high return-to-sport rates were observed, recurrent instability affected nearly 50% of patients.
Conclusions:
- A variety of global, physeal-sparing surgical options exist for pediatric patellofemoral instability.
- High rates of return to sport are achievable, but recurrent instability and dislocation persist as significant challenges.
- Future research should prioritize long-term outcomes, patient selection, and understanding the etiology of recurrent instability.
Abstract:
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.
