Treatment of lateral patella dislocation in the skeletally immature athlete

In skeletally immature athletes, lateral patellar dislocation (LPD) is a common knee injury, which can lead to recurrent patellar dislocations in about half of the cases. The medial patellofemoral ligament (MPFL) is frequently injured in an acute LPD. Initial management should be nonoperative. Surgical stabilization is recommended after failure of appropriate nonoperative management. Reconstruction of the MPFL is a preferred surgical option for stabilization of the patella against lateral dislocations. In the skeletally immature knee, surgical techniques to stabilize the patella have focused on MPFL reconstructions, as operations that involve bone are contraindicated. Despite several published techniques for MPFL reconstruction, only techniques that do not involve drilling or disruption of the periosteum near the femoral physes are safe for the skeletally immature knee. An algorithm for treatment of LPD in the skeletally immature patient is presented with specific discussion of surgical technique options.