Traumatic patellar dislocation in children and adolescents: treatment update and literature review.

PURPOSE OF REVIEW: Traumatic patellar dislocation in children and adolescents is a complex problem resulting from a range of anatomic and mechanical conditions. A careful review of the literature demonstrates certain risk factors that predispose children to recurrent dislocation. With this understanding, these conditions can be managed more aggressively in the hope of an improved outcome. Additionally, a vast number of surgical procedures to correct patellar instability have been described, and recent cadaveric studies are now guiding surgical interventions. RECENT FINDINGS: Risk factors for recurrent dislocation may include various skeletal abnormalities, increased quadriceps angle, generalized ligamentous laxity, and family history. Recent anatomic and biomechanical studies have demonstrated that the medial patellofemoral ligament and the vastus medialis obliquus are the primary restraints to lateral translation and ultimately dislocation of the patella. Management should therefore be directed both at correcting anatomic abnormalities when indicated and at reconstruction of medial restraints to patellar tracking. SUMMARY: The recommendation for management of a traumatic patellar dislocation in a skeletally immature patient is initially conservative, emphasizing early motion and quadriceps strengthening. However, in patients for whom conservative management has failed or who are at particularly high risk for dislocation and require surgical intervention, repair or reconstruction of the medial patellofemoral ligament is the treatment of choice. Recent works have included investigation of less invasive techniques in children.

Anterior cruciate ligament injury in children: update of current treatment options.

As our society's interest in competitive athletics has grown, so has the participation of our youth. Unfortunately, along with this increase in participation has come a predictable increase in rate of injury. More specifically, anterior cruciate ligament injury in the skeletally immature individual is being recognized with increasing frequency and currently poses an unsolved clinical problem. Conservative management of midsubstance anterior cruciate ligament tears in the skeletally immature population has been shown to have an unfavorable prognosis related to functional knee instability, subsequent meniscal tears, and the development of early degenerative arthritis. Despite poor outcomes following conservative treatment, many orthopaedic surgeons have been reluctant to perform anterior cruciate ligament reconstructions in skeletally immature patients due to the potential for physeal injury and resultant growth disturbance. Although there is growing evidence in the literature suggesting that anterior cruciate ligament reconstruction in the adolescent population may be safely performed using anatomic, transphyseal techniques, there are insufficient data to provide concrete guidelines in treatment of anterior cruciate ligament injuries in the prepubescent population. Management of these injuries, therefore, must be based on the physiologic and skeletal maturity of the child. Anterior cruciate ligament reconstruction in the skeletally immature individual still poses a clinical problem with the safest and most effective techniques still evolving.