Pediatric Patellofemoral Instability Surgery—Current Concepts

Patellofemoral instability is a common knee pathology affecting children and adolescents, with recurrence rates exceeding 50% in skeletally immature patients. Identification and stratification of anatomic risk factors for recurrence are essential. Trochlear dysplasia, patella alta, skeletal immaturity, and elevated tibial tubercle groove distance have been identified as anatomic predictors of recurrence. Emerging evidence is supporting more aggressive treatment and earlier surgical intervention in high-risk patients, even after a first-time dislocation. Medial patellofemoral ligament reconstruction remains the cornerstone of surgical treatment for this population, with physeal sparing techniques for skeletally immature patients. Concomitant distal realignment procedures may be indicated in selected patients. This review synthesizes the current and latest evidence on predisposing anatomic risk factors, surgical techniques, and outcomes to guide clinical decision-making in the management of pediatric patellofemoral instability.