Current concepts in the treatment of first-time patella dislocation in children and adolescents

BACKGROUND: Lateral dislocation of the patella is a common injury in children. It can occur in previously healthy and anatomically normal knees, but there are several abnormalities that predispose to patellar instability. Magnetic resonance imaging is an essential part of assessing for associated injuries and risk of further instability. Treatment aims to prevent redislocation, residual instability, osteoarthritis, and allow return to previous activities. The purpose of this review was to assess evidence for management of first-time patella dislocation in children and adolescents. METHODS: Literature review was performed, accompanied by the current best practice by the authors. RESULTS: Non-operative treatment is preferred, except where there are associated injuries such as osteochondral fractures that would benefit from surgery. The exact method of ideal non-operative management is not clearly defined but should focus on restoration of range of movement and strength with bracing as indicated. There seems to be a trend toward operative intervention that may well be inappropriate. CONCLUSION: Further prospective studies are required with focus on the younger patient to fully understand if there is an at-risk group that would benefit from early surgery. LEVEL OF EVIDENCE: level III.