Pediatric Patellofemoral Instability: Beyond the MPFL

Main Article Content

Kenneth M. Lin, MD
Alexandra T. Mackie, BA, PB-BS
Alexandra H. Aitchison
Aristides I. Cruz Jr, MD, MBA
Corinna C. Franklin, MD
Joseph T. Molony Jr, PT, MS, SCS, CSCS
Kevin G. Shea, MD
Daniel W. Green, MD, MS, FACS
Peter D. Fabricant, MD, MPH

Abstract

Pediatric patellofemoral instability is an increasingly common and debilitating problem. In recent years, there has been an improvement in diagnostic capabilities and greater knowledge of unique pediatric patellofemoral anatomy and pathophysiology. The spectrum of disease varies from a single traumatic dislocation, to recurrent dislocation, to obligatory dislocation in flexion or even fixed dislocation in severe or syndrome-associated cases. When treating pediatric patellofemoral instability, it is important to understand the benefits and limitations of nonoperative management. It is important to recognize the challenges imparted by the anatomy of the skeletally immature knee, specifically with regards to the physis, when considering surgical treatment.  One must have a thorough understanding of common anatomic and pathophysiologic contributors to patellofemoral instability, such as coronal or axial plane malalignment, and concomitant osteochondral injury. For the very severe cases such as obligatory dislocation in flexion, special techniques may be required to achieve stability of the patellofemoral joint.

Article Details

Section
Sports
Author Biographies

Kenneth M. Lin, MD, Hospital for Special Surgery

Division of Pediatric Orthopedics, Hospital for Special Surgery, New York, NY.

Alexandra T. Mackie, BA, PB-BS, Hospital for Special Surgery

Division of Pediatric Orthopedics, Hospital for Special Surgery, New York, NY.

Alexandra H. Aitchison, Hospital for Special Surgery

Division of Pediatric Orthopedics, Hospital for Special Surgery, New York, NY.

Aristides I. Cruz Jr, MD, MBA, Warren Alpert School of Medicine at Brown University

Department of Orthopaedic Surgery, Warren Alpert School of Medicine at Brown University, Providence, RI.

Corinna C. Franklin, MD, Shriner's Hospital for Children

Department of Orthopaedics, Shriner’s Hospital for Children, Philadelphia, PA

Joseph T. Molony Jr, PT, MS, SCS, CSCS, Hospital for Special Surgery

Department of Pediatric Rehabilitation, Hospital for Special Surgery, New York, NY.

Kevin G. Shea, MD, Stanford University School of Medicine

Department of Pediatric Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA

Daniel W. Green, MD, MS, FACS, Hospital for Special Surgery

Division of Pediatric Orthopedics, Hospital for Special Surgery, New York, NY.

Peter D. Fabricant, MD, MPH, Hospital for Special Surgery

Division of Pediatric Orthopedics, Hospital for Special Surgery, New York, NY.