Poor Prognostic Factors in Surgically Treated Habitual Patellar Dislocation in Children and Adolescents

Background/Objectives: Habitual patellar dislocation is a rare but debilitating form of patellofemoral instability in children and adolescents, frequently associated with underlying anatomical abnormalities and ligamentous laxity. Despite multiple surgical techniques, recurrence and suboptimal functional recovery remain concerns. This study aimed to identify the demographic, clinical, and imaging factors associated with postoperative recurrence and poorer functional outcomes in pediatric patients surgically treated for habitual patellar dislocation. Methods: A retrospective cohort study was conducted on pediatric patients treated between 2016 and 2024 for habitual patellar dislocation. Inclusion criteria required age ≤ 18 years, a minimum 12-month follow-up, and complete imaging documentation. Clinical evaluation included the Beighton hyperlaxity score, lower-limb alignment, and Lysholm Knee Score. Imaging parameters assessed patellar height (Caton-Deschamps Index), trochlear dysplasia, patellar tilt, patellar subluxation, genu valgum, and tibial tubercle-trochlear groove (TT-TG) distance. Surgical treatment consisted of individualized combinations of soft-tissue realignment, quadriceps lengthening, Roux-Goldthwait procedures, and MPFL reconstruction. Statistical analyses evaluated predictors of recurrence and postoperative Lysholm score. Results: Thirty-four patients (45 knees; mean age 12 years; 73.5% female) were included. Preoperative Lysholm scores improved from a mean of 73 to 94 postoperatively (p < 0.0001). Recurrence occurred in 32.35% of patients and was significantly associated with generalized hyperlaxity (p = 0.0041), trochlear dysplasia (p = 0.045), and lateral patellar subluxation (p = 0.039). Suboptimal postoperative Lysholm scores (<85) were observed in 11.76% of patients, all with recurrence, and were significantly associated with genu valgum (p = 0.0011) and patella alta (p = 0.036). No significant associations were found for rotational deformities or femoral condyle hypoplasia. Conclusions: Habitual patellar dislocation in children is multifactorial, and the likelihood of recurrence increases with cumulative risk factors such as hyperlaxity, trochlear dysplasia, lateral subluxation, patella alta, and genu valgum. Comprehensive preoperative assessment is essential to guide combined, individualized surgical strategies that optimize stability and functional recovery. No single technique is universally curative; rather, tailored multimodal approaches yield the most favorable outcomes.