Adolescent patellar instability: current concepts review.

2.50
Hdl Handle:
http://hdl.handle.net/11287/620212
Title:
Adolescent patellar instability: current concepts review.
Authors:
Clark, D; Metcalfe, A; Wogan, C; Mandalia, Vipul; Eldridge, J
Abstract:
Patellar instability most frequently presents during adolescence. Congenital and infantile dislocation of the patella is a distinct entity from adolescent instability and measurable abnormalities may be present at birth. In the normal patellofemoral joint an increase in quadriceps angle and patellar height are matched by an increase in trochlear depth as the joint matures. Adolescent instability may herald a lifelong condition leading to chronic disability and arthritis. Restoring normal anatomy by trochleoplasty, tibial tubercle transfer or medial patellofemoral ligament (MPFL) reconstruction in the young adult prevents further instability. Although these techniques are proven in the young adult, they may cause growth arrest and deformity where the physis is open. A vigorous non-operative strategy may permit delay of surgery until growth is complete. Where non-operative treatment has failed a modified MPFL reconstruction may be performed to maintain stability until physeal closure permits anatomical reconstruction. If significant growth remains an extraosseous reconstruction of the MPFL may impart the lowest risk to the physis. If minor growth remains image intensifier guided placement of femoral intraosseous fixation may impart a small, but acceptable, risk to the physis. This paper presents and discusses the literature relating to adolescent instability and provides a framework for management of these patients. Cite this article: Bone Joint J 2017;99-B:159-70.
Citation:
Adolescent patellar instability: current concepts review. 2017, 99-B (2):159-170 Bone Joint J
Publisher:
British Editorial Society of Bone and Joint Journal
Journal:
The Bone & Joint journal
Issue Date:
Feb-2017
URI:
http://hdl.handle.net/11287/620212
DOI:
10.1302/0301-620X.99B2.BJJ-2016-0256.R1
PubMed ID:
28148656
Additional Links:
https://dx.doi.org/10.1302/0301-620X.99B2.BJJ-2016-0256.R1
Type:
Journal Article
Language:
en
ISSN:
2049-4408
Appears in Collections:
Exeter Knee Reconstruction Unit (EKRU); 2017 RD&E publications

Full metadata record

DC FieldValue Language
dc.contributor.authorClark, Den
dc.contributor.authorMetcalfe, Aen
dc.contributor.authorWogan, Cen
dc.contributor.authorMandalia, Vipulen
dc.contributor.authorEldridge, Jen
dc.date.accessioned2017-02-06T16:12:09Z-
dc.date.available2017-02-06T16:12:09Z-
dc.date.issued2017-02-
dc.identifier.citationAdolescent patellar instability: current concepts review. 2017, 99-B (2):159-170 Bone Joint Jen
dc.identifier.issn2049-4408-
dc.identifier.pmid28148656-
dc.identifier.doi10.1302/0301-620X.99B2.BJJ-2016-0256.R1-
dc.identifier.urihttp://hdl.handle.net/11287/620212-
dc.description.abstractPatellar instability most frequently presents during adolescence. Congenital and infantile dislocation of the patella is a distinct entity from adolescent instability and measurable abnormalities may be present at birth. In the normal patellofemoral joint an increase in quadriceps angle and patellar height are matched by an increase in trochlear depth as the joint matures. Adolescent instability may herald a lifelong condition leading to chronic disability and arthritis. Restoring normal anatomy by trochleoplasty, tibial tubercle transfer or medial patellofemoral ligament (MPFL) reconstruction in the young adult prevents further instability. Although these techniques are proven in the young adult, they may cause growth arrest and deformity where the physis is open. A vigorous non-operative strategy may permit delay of surgery until growth is complete. Where non-operative treatment has failed a modified MPFL reconstruction may be performed to maintain stability until physeal closure permits anatomical reconstruction. If significant growth remains an extraosseous reconstruction of the MPFL may impart the lowest risk to the physis. If minor growth remains image intensifier guided placement of femoral intraosseous fixation may impart a small, but acceptable, risk to the physis. This paper presents and discusses the literature relating to adolescent instability and provides a framework for management of these patients. Cite this article: Bone Joint J 2017;99-B:159-70.en
dc.language.isoenen
dc.publisherBritish Editorial Society of Bone and Joint Journalen
dc.relation.urlhttps://dx.doi.org/10.1302/0301-620X.99B2.BJJ-2016-0256.R1en
dc.rightsArchived with thanks to The Bone & Joint Journalen
dc.subjectWessex Classification Subject Headings::Orthopaedicsen
dc.titleAdolescent patellar instability: current concepts review.en
dc.typeJournal Articleen
dc.identifier.journalThe Bone & Joint journalen
dc.type.versionPublisheden

Related articles on PubMed

All Items in RD&E Research Repository are protected by copyright, with all rights reserved, unless otherwise indicated.