Management of patellofemoral instability in skeletally immature patients

INTRODUCTION: Patellofemoral instability, presenting as lateral patellar dislocation, is the most common acute knee condition encountered in the skeletally immature child. The age predilection of 10 to 17 years can be attributed to the adolescent growth spurt which leads to changes in lower limb alignment, increased participation in sports and high-risk activities or ligamentous laxity. A clear understanding of the anatomy and biomechanics of the patellofemoral joint, along with a thorough patient workup, can aid in making an individualized treatment plan for the affected child. Open physes in the skeletally immature patient of PFI pose significant challenges but preserving them is the first and foremost duty of the treating clinician.EVIDENCE ACQUISITION: A literature search was performed for all articles on pediatric patellofemoral instability, published in the last 20 years, through two platforms: PubMed and Scopus. After title and abstract screening, relevant articles were retrieved and analyzed. Our article was divided into anatomy, physiology, classification, radiological parameters, physical therapy, and surgical management of pediatric patients with patellofemoral instability. Most relevant and recent data was extracted from the selected studies and utilized in preparing our article.EVIDENCE SYNTHESIS: Open physes in the skeletally immature patient of PFI pose significant challenges but preserving them is the first and foremost duty of the treating clinician. The most important medial stabilizer, the MPFL, is insufficient in nearly every patient of PFI, but factors such as Q-angle, TT-TG distance and trochlear anatomy all contribute to the occurrence of dislocation. Despite all this, as a rule, the treatment of PFI in pediatric age group is still primarily conservative and surgical treatment should be considered very carefully and only after thorough evaluation, the exception being the presence of damaged osteochondral fragments in the joint.CONCLUSIONS: This review focused on the evaluation and management of PFI in skeletally immature patients.