Ricciuti Anthony, Colosi Katelyn, Fitzsimmons Kevin, Brown Matthew
Connecticut Children's Sports Medicine, 399 Farmington Ave., Farmington, CT 06032, USA.
Children (Basel). 2024 Oct 18;11(10):1261. doi: 10.3390/children11101261.
Patella instability is one of the most common knee injuries in the adolescent patient. There are several pathoanatomic risk factors which should be assessed via several modalities, including X-rays, magnetic resonance imaging (MRI), or even CT scan.
We intend to review these risk factors along with the nonsurgical and surgical techniques used to prevent recurrent dislocations.
We completed an extensive review of the recent literature concerning pediatric and adolescent patellar dislocation and subsequent treatment modalities.
We review in detail the risk factors such as patella alta, trochlear dysplasia, lateralization of the tibial tubercle or medialization of the trochlear groove (increased tibial tubercle to trochlear groove (TT-TG) distance), lower limb malalignment, excessive femoral anteversion and/or tibial torsion, and hyperlaxity. There are classification systems for dislocators, and a natural progression of instability that patients often proceed through. Only after a patient has continued to dislocate after bracing and physical therapy is surgical treatment considered. Surgical techniques vary, with the workhorse being the medial patellofemoral ligament (MPFL) reconstruction. However, there are a variety of other techniques which add onto this procedure to address other anatomic risk factors. These include the tibial tubercle osteotomy to address a large TT-TG distance or trochleoplasty to address the lack of a trochlear groove.
Nonsurgical and surgical treatments for patella dislocators are tailored to the pathoanatomic risk factors in each patient.
髌骨不稳定是青少年患者中最常见的膝关节损伤之一。存在多种病理解剖学危险因素，应通过多种方式进行评估，包括X线、磁共振成像（MRI），甚至CT扫描。
我们旨在回顾这些危险因素以及用于预防复发性脱位的非手术和手术技术。
我们对近期有关小儿和青少年髌骨脱位及后续治疗方式的文献进行了广泛回顾。
我们详细回顾了诸如高位髌骨、滑车发育不良、胫骨结节外侧化或滑车沟内侧化（胫骨结节至滑车沟（TT-TG）距离增加）、下肢对线不良、股骨过度前倾和/或胫骨扭转以及关节过度松弛等危险因素。对于脱位患者有分类系统，且患者通常会经历不稳定的自然进展过程。只有在患者经过支具固定和物理治疗后仍持续脱位时才考虑手术治疗。手术技术各不相同，主要术式是内侧髌股韧带（MPFL）重建。然而，还有多种其他技术可在此手术基础上用于解决其他解剖学危险因素。这些技术包括用于解决较大TT-TG距离的胫骨结节截骨术或用于解决滑车沟缺失的滑车成形术。
髌骨脱位患者的非手术和手术治疗是根据每个患者的病理解剖学危险因素量身定制的。
