title: Acute patellofemoral instability in children and adolescents.
abstract: Patellofemoral problems are considered to be among the most frequent causes of knee pain in children and adolescents. Correcting bone abnormalities through specific and targeted interventions is mandatory in skeletally immature patients. Medial patellofemoral ligament (MPFL) reconstruction is the preferred procedure, but there are several important precautionary considerations that the surgeon must take into account. It must always be remembered that MPFL rupture is the result, not the cause, of an altered extensor mechanism; therefore, patellar stabilization with MPFL reconstruction is only the first step to be accomplished in the management of an MPFL rupture. If other anatomical alterations are encountered, alternative/additional surgical procedures should be considered. If MPFL rupture occurs without associated anatomical or functional knee alterations, an appropriate rehabilitation program after MPFL reconstruction should be sufficient to achieve a good outcome. In conclusion, an acute patellar dislocation should be managed conservatively unless there is evidence of osteochondral damage or medial retinaculum lesions. Osseous procedures are contraindicated in children, while MPFL anatomical reconstruction with "physeal sparing" is the primary surgical option.
authors.affiliation: Department of Orthopaedics, Università di Perugia, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Antinolfi
authors.affiliation: Department of Orthopaedics, Università Cattolica del Sacro Cuore, Policlinico Gemelli, Rome, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Bartoli
authors.affiliation: Department of Orthopaedics, Università Cattolica del Sacro Cuore, Policlinico Gemelli, Rome, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Placella
authors.affiliation: Department of Orthopaedics, Ospedale di Orvieto, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Speziali
authors.affiliation: Royal National Orthopaedic Hospital, Stanmore, London, UK.
authors.forename: Valerio
authors.initials: V
authors.lastname: Pace
authors.affiliation: Ospedale Nazionale di Lugano Civico e Italiano, Lugano, Switzerland.
authors.forename: Marco
authors.initials: M
authors.lastname: Delcogliano
authors.affiliation: Department of Orthopaedics, Ospedali Galliera di Genova, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Mazzola
keywords: instability; medial patellofemoral ligament; patellofemoral; pediatric; physeal sparing