Management of patellar instability in skeletally immature patients

Abstract

• Surgical intervention is the treatment of choice for recurrent lateral patellar instability. • Surgery should be considered for first time lateral patella dislocations with osteochondral fractures or underlying anatomical risk factors. • Primary repair and nonanatomical imbrications/reconstructions have fallen out of favor due to abnormal biomechanics and high rates of recurrence. Anatomical reconstruction of the MPFL using a variety of auto and allograft tissues have yielded good outcomes and low redislocation rates. • Physeal sparing MPFL reconstruction techniques under radiological control are safe and do not cause growth disturbance. Allografts may be indicated for hyperlax patients. • Although no clear cutoff points exist, correction of valgus and excessive femoral anteversion should be considered when indicated. • Osteochondral and chondral injuries are common and should be addressed during surgery for instability.