Surgical Management of Patellofemoral Instability in the Skeletally Immature Patient

Lauren H. Redler, MD; Margaret L. Wright, MD


J Am Acad Orthop Surg. 2018;26(19):e405-e415. 

In This Article


Although there is no universal classification of patellofemoral instability in pediatric patients, a proposed classification that may be useful for surgical planning includes four groups: syndromic, obligatory, fixed, and traumatic dislocations.[2] Surgical indications differ in these patients.

Syndromic dislocation occurs in patients with syndromes associated with ligamentous laxity or osseous deformity (eg, Marfan syndrome, Ehlers-Danlos, Down syndrome). Allografts should be used for medial patellofemoral ligament (MPFL) reconstruction in this group.[7] Obligatory dislocation results from tight lateral structures and occurs every time the knee is flexed, but reduces in knee extension. Fixed dislocation cannot be reduced even with knee extension. Obligatory and fixed dislocations may require additional soft-tissue procedures for stabilization beyond the lateral release and MPFL reconstruction techniques described in this review.[2]