The Management of Patellar Instability in the Skeletally Immature Patient

Patellar instability in the skeletally immature patient is a difficult problem and often frustrating to patients, parents, and surgeons. Patellar instability is common and estimated to occur in as many as 29 per 100,000 children. Recurrent instability and pain often follow the initial injury despite nonoperative treatment. Patellar instability in the skeletally immature population is especially challenging because the etiology is often multifactorial, and standard successful surgical techniques used in adults may risk injury to an open growth plate when used in children. The management of traumatic patellar dislocation in a skeletally immature patient is initially nonoperative, emphasizing early motion and quadriceps, and hip strengthening. For patients who fail nonoperative treatment, who have an associated chondral or osteochondral injury, or who are at high risk for recurrence, repair or reconstruction of the medial patellofemoral ligament is indicated.