Patellofemoral Instability in Children and Adolescents: Current Concepts Review
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Published:
Aug 20, 2024
Keywords:
Knee, patella, dislocation, patellofemoral instability, adolescent
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Abstract
Patellofemoral instability (PFI) is a common knee disorder in the skeletally immature patient. PFI presents challenges in this patient population that require an understanding of anatomy and biomechanics to formulate a treatment plan aimed at preventing redislocation and facilitating return to activity. In this review, the different presentations and therapeutic alternatives will be analyzed, providing a practical guide for the comprehensive management of this complex clinical condition.
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Masquijo, J. J., & Carabajal Mattar, M. (2024). Patellofemoral Instability in Children and Adolescents: Current Concepts Review. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 89(4), 403-415. https://doi.org/10.15417/issn.1852-7434.2024.89.4.1965
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Review article
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athletic participation. J Knee Surg 2012;25(1):51-7. https://doi.org/10.1055/s-0031-1286199
3. Moiz M, Smith N, Smith TO, Chawla A, Thompson P, Metcalfe A. Clinical outcomes after the nonoperative management of lateral patellar dislocations: A systematic review. Orthop J Sports Med 2018;6(6):2325967118766275. https://doi.org/10.1177/2325967118766275
4. Lewallen LW, McIntosh AL, Dahm DL. Predictors of recurrent instability after acute patelofemoral dislocation in pediatric and adolescent patients. Am J Sports Med 2013;41(3):575-81. https://doi.org/10.1177/0363546512472873
5. Christensen TC, Sanders TL, Pareek A, Mohan R, Dahm DL, Krych AJ. Risk factors and time to recurrent
ipsilateral and contralateral patellar dislocations. Am J Sports Med 2017;45(9):2105-10. https://doi.org/10.1177/0363546517704178
6. Willis RB, Firth G. Traumatic patellar dislocation: loose bodies and the MPFL. J Pediatr Orthop 2012;32 Suppl
1:S47-51. https://doi.org/10.1097/BPO.0b013e318256107b
7. Sanders TL, Pareek A, Johnson NR, Stuart MJ, Dahm DL, Krych AJ. Patellofemoral arthritis after lateral patellar
dislocation: A matched population-based analysis. Am J Sports Med 2017;45(5):1012-7.
https://doi.org/10.1177/0363546516680604
8. Tuxøe JI, Teir M, Winge S, Nielsen PL. The medial patellofemoral ligament: a dissection study. Knee Surg Sports
Traumatol Arthrosc 2002;10(3):138-40. https://doi.org/10.1007/s00167-001-0261-z
9. Smirk C, Morris H. The anatomy and reconstruction of the medial patellofemoral ligament. Knee 2003;10(3):221-7. https://doi.org/10.1016/s0968-0160(03)00038-3
10. Velasquez Hammerle MV, Tanaka MJ. Medial patellofemoral reconstruction techniques for patellar instability.
Arthroscopy 2023;39(6):1373-5. https://doi.org/10.1016/j.arthro.2023.01.006
11. Placella G, Tei MM, Sebastiani E, Criscenti G, Speziali A, Mazzola C, et al. Shape and size of the medial
patellofemoral ligament for the best surgical reconstruction: a human cadaveric study. Knee Surg Sports Traumatol Arthrosc 2014;22(10):2327-33. https://doi.org/10.1007/s00167-014-3207-y
12. Nomura E, Inoue M, Osada N. Anatomical analysis of the medial patellofemoral ligament of the knee, especially the femoral attachment. Knee Surg Sports Traumatol Arthrosc 2005;13(7):510-5. https://doi.org/10.1007/s00167-004-0607-4
13. Baldwin JL. The anatomy of the medial patellofemoral ligament. Am J Sports Med 2009;37(12):2355-61.
https://doi.org/10.1177/0363546509339909
14. Kang HJ, Wang F, Chen BC, Su YL, Zhang ZC, Yan CB. Functional bundles of the medial patelofemoral ligament. Knee Surg Sports Traumatol Arthrosc 2010;18(11):1511-6. https://doi.org/10.1007/s00167-010-1090-8
15. Philippot R, Chouteau J, Wegrzyn J, Testa R, Fessy MH, Moyen B. Medial patellofemoral ligament anatomy:
implications for its surgical reconstruction. Knee Surg Sports Traumatol Arthrosc 2009;17(5):475-9.
https://doi.org/10.1007/s00167-009-0722-3
16. Schöttle PB, Schmeling A, Rosenstiel N, Weiler A. Radiographic landmarks for femoral tunnel placement in medial patellofemoral ligament reconstruction. Am J Sports Med 2007;35(5):801-4. https://doi.org/10.1177/0363546506296415
17. Stephen JM, Lumpaopong P, Deehan DJ, Kader D, Amis AA. The medial patellofemoral ligament: location of
femoral attachment and length change patterns resulting from anatomic and nonanatomic attachments. Am J Sports Med 2012;40(8):1871-9. https://doi.org/10.1177/0363546512449998
18. Farrow LD, Alentado VJ, Abdulnabi Z, Gilmore A, Liu RW. The relationship of the medial patellofemoral ligament attachment to the distal femoral physis. Am J Sports Med 2014;42(9):2214-8. https://doi.org/10.1177/0363546514539917
19. Huddleston HP, Campbell KJ, Madden BT, Christian DR, Chahla J, Farr J, et al. The quadriceps insertion of the
medial patellofemoral complex demonstrates the greatest anisometry through flexion. Knee Surg Sports Traumatol Arthrosc 2021;29(3):757-63. https://doi.org/10.1007/s00167-020-05999-2
20. Christian DR, Redondo ML, Cancienne JM, Shewman EF, Farr J, Cole BJ, et al. Differential contributions of the
quadriceps and patellar attachments of the proximal medial patellar restraints to resisting lateral patellar translation. Arthroscopy 2020;36(6):1670-6. https://doi.org/10.1016/j.arthro.2020.01.058
21. Tanaka MJ, Chahla J, Farr J 2nd, LaPrade RF, Arendt EA, Sanchis-Alfonso V, et al. Recognition of evolving medial
patellofemoral anatomy provides insight for reconstruction. Knee Surg Sports Traumatol Arthrosc 2019;27(8):2537-50. https://doi.org/10.1007/s00167-018-5266-y. Erratum in: Knee Surg Sports Traumatol Arthrosc 2018 Nov 23; PMID: 30370440
22. Sochacki KR, Shea KG, Varshneya K, Safran MR, Abrams GD, Donahue J, et al. Relationship of the medial
patellofemoral ligament origin on the distal femur to the distal femoral physis: A systematic review. Am J Sports
Med 2021;49(1):261-6. https://doi.org/10.1177/0363546520904685
23. Baskar D, Stavinoha TJ, Sanchez M, Gupta A, Randhawa SD, Rohde MS, et al. Quantifying the relationship
between the medial quadriceps tendon-femoral ligament and patellar borders: A pediatric cadaveric study. Am J
Sports Med 2022;50(9):2433-8. https://doi.org/10.1177/03635465221103250
24. Shea KG, Polousky JD, Jacobs JC Jr, Ganley TJ, Aoki SK, Grimm NL, et al. The patellar insertion of the medial
patellofemoral ligament in children: a cadaveric study. J Pediatr Orthop 2015;35(4):e31-5.
https://doi.org/10.1097/BPO.0000000000000399
25. Stavinoha TJ, Shea KG. Physeal sparing approaches for MPFL reconstruction. Curr Rev Musculoskelet Med
2023;16(12):598-606. https://doi.org/10.1007/s12178-023-09864-w
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