J Knee Surg 2015; 28(04): 265-278
DOI: 10.1055/s-0035-1549017
Special Focus Section
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Patellofemoral Instability in Active Adolescents

Zachary Ries
1  Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
,
Matthew Bollier
1  Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
› Author Affiliations
Further Information

Publication History

09 August 2015

20 January 2015

Publication Date:
18 April 2015 (online)

Abstract

Patellofemoral instability is a common problem in the adolescent population. Patellar stability depends on a dynamic interplay between bony and soft tissue restraints. Several pathoanatomical factors increase the likelihood of patellar instability: patella alta, trochlear dysplasia, malalignment, and deficient proximal medial restraints. Treatment for first-time patella dislocations is typically nonoperative and includes bracing, early range of motion, and physical therapy. The only absolute indication for early surgery is a large osteochondral fragment that can be fixed. Surgical stabilization is indicated for chronic patellar instability and includes both proximal and distal realignment options. Medial patellofemoral ligament reconstruction is the treatment of choice in most adolescent patients with patella instability. Distal bony realignment procedures are reserved for skeletally mature adolescents.