Current concepts in the treatment of first-time patella dislocation in children and adolescents

Abstract

Background: Lateral dislocation of the patella is a common injury in children. It can occur in previously healthy and anatomically normal knees, but there are several abnormalities that predispose to patellar instability. Magnetic resonance imaging is an essential part of assessing for associated injuries and risk of further instability. Treatment aims to prevent redislocation, residual instability, osteoarthritis, and allow return to previous activities. The purpose of this review was to assess evidence for management of first-time patella dislocation in children and adolescents. Methods: Literature review was performed, accompanied by the current best practice by the authors. Results: Non-operative treatment is preferred, except where there are associated injuries such as osteochondral fractures that would benefit from surgery. The exact method of ideal non-operative management is not clearly defined but should focus on restoration of range of movement and strength with bracing as indicated. There seems to be a trend toward operative intervention that may well be inappropriate. Conclusion: Further prospective studies are required with focus on the younger patient to fully understand if there is an at-risk group that would benefit from early surgery. Level of evidence: level III.

Pediatric osteochondral fractures: clinical insights associate early diagnosis to early rehabilitation via arthroscopy

“…The growing prevalence of youngsters engaging in regular sporting activities has led to a rise in injuries caused by overuse, exhaustion, and inadequate warm-up and muscle strengthening such as acute patella dislocation, accounting for 2–3% of all knee joint injuries and ankle sprains contributing to 1/3 sports-related injuries [ 1 , 2 ]. OCFs consist entities highly related the aforementioned injuries [ 1 , 2 ]. Recent studies highlight the success of the operative treatment regarding quality of life [ 10 ].…”

“…Acute patella dislocation and ankle sprains consist injuries involving the lower limps of the youngsters that may result in free cartilage fragments inside the affected joint [ 1 , 2 ]. These types of fractures, commonly involving both bone and cartilage, constitute the result of the strength discrepancy between the ligamentous and the ossified elements of the aforementioned joints [ 3 – 5 ].…”

“…Osteochondral free fragments after patella dislocation are estimated from 37 to 94% [ 7 ]. The combination of the fact that acute lateral patella dislocation occurs in approximately 1 out of 1000 children under 17 years, accounting for 2–3% of all knee joint injuries, along with the known anatomical risk factors predisposing to patella dislocation dictates high vigilance for immediate recognition of such injuries [ 2 , 8 – 10 ]. On the other hand, free fragments originated from the medial talar rim and the middle third of the anterior–posterior aspect of the talus after a sprain are by far less common than regarding patella dislocation and often are missed [ 1 , 3 , 11 – 13 ].…”

Comparison of five different fluoroscopic methods for identifying the MPFL femoral footprint

“…[ 2 – 4 ]. While first-time dislocations can be managed conservatively, recurrent dislocations usually require surgical intervention [ 5 , 6 ]. MPFL reconstruction (MPFLR) is the mainstay of surgical treatment for recurrent patellar dislocation, which corrects the ligament deficiency and stabilizes the patella.…”

Quadriceps Muscle and Medial Retinaculum Combinate Effects on Patellar Instability during Knee Flexion

“…The risk of recurrent dislocation may be increased by anatomical problems, i.e., MPFL incompetence, trochlear anatomical changes, and tibial tubercle lateralisation [26- Patellar instability occurs when the patella does not slide correctly over the femur, causing a dislocation, and accounts for 2-3% of knee accidents with 6/100,000 patients' yearly incidence, rising to 29/100,000 in teenagers [16][17][18]. This condition can be caused by injury to the patellar ligaments, muscle imbalances, anatomical deformity, or changes in biomechanics, often leading to pain and disability [19][20][21].…”