Skip to main content
Springer Nature Link
Log in

Patellofemorale Instabilität bei Kindern und Jugendlichen

Patellofemoral instability in children and adolescents

  • Leitthema
  • Published:
Die Orthopädie Aims and scope Submit manuscript

Zusammenfassung

Die patellofemorale Instabilität bei Kindern und Jugendlichen ist ein häufiges klinisches Problem, das meistens multifaktorielle Ursachen, wie assoziierte Genua valga, Hyperlaxität, Traumata oder auch sportliche Überbelastung, aufweist. Die genaue Diagnostik ist daher von großer Wichtigkeit um sämtliche Einflussfaktoren mittels Röntgendiagnostik und weiteren bildgebenden Verfahren (u. a. MRT, Torsionsanalyse) zu analysieren. Die Therapie sollte in jedem Fall personalisiert sein und kann von Fall zu Fall variieren. Die Autoren empfehlen konservative Maßnahmen (Physiotherapie, Gangschulung, Propriozeptionstraining, Orthesen) sowie ggf. patellastabilisierende Verfahren wie die MPFL-Plastik bei Ausbleiben eines konservativen Therapieerfolges.

Abstract

Patellofemoral instability is a common and clinically relevant disorder of multifactorial causes. Several concomitant problems such as genua valga, hyperlaxity, injuries or sports-related overuse may contribute to the development of instability and recurrent patellar dislocations. A thorough diagnosis is of paramount importance to delineate every contributing factor. This includes radiographic modalities and advanced imaging such as magnetic resonance imaging or torsional analyses. The authors recommend non-operative management (including physiotherapy, gait and proprioceptive training, orthoses) and, whenever non-operative measures fail, surgical patellar stabilization using, e.g. MPFL reconstruction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
€32.70 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Ireland)

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5

Abbreviations

MAD:

„Mechanical axis deviation“

MPFL :

Mediales patellofemorales Ligament

TG :

Trochlear groove

TT :

Tuberositas tibiae

Literatur

  1. Alm L, Krause M, Mull C et al (2017) Modified adductor sling technique: a surgical therapy for patellar instability in skeletally immature patients. Knee 24:1282–1288. https://doi.org/10.1016/j.knee.2017.08.051

    Article  PubMed  Google Scholar 

  2. Avikainen VJ, Nikku RK, Seppänen-Lehmonen TK (1993) Adductor magnus tenodesis for patellar dislocation: technique and preliminary results. Clin Orthop Relat Res 297(12):16. https://doi.org/10.1097/00003086-199312000-00004

    Article  Google Scholar 

  3. Bachman DR, Phillips D, Veerkamp MW et al (2024) MPFL reconstruction and implant-mediated guided growth in skeletally immature patients with patellar instability and genu valgum. Am J Sports Med 52:698–704. https://doi.org/10.1177/03635465231222934

    Article  PubMed  Google Scholar 

  4. Bayhan IA, Kirat A, Alpay Y et al (2018) Tibial tubercle–trochlear groove distance and angle are higher in children with patellar instability. Knee Surg Sports Traumatol Arthrosc 26:3566–3571. https://doi.org/10.1007/s00167-018-4997-0

    Article  PubMed  Google Scholar 

  5. Becher C, Schumacher T, Fleischer B et al (2015) The effects of a dynamic patellar realignment brace on disease determinants for patellofemoral instability in the upright weight-bearing condition. J Orthop Surg Res 10:126. https://doi.org/10.1186/s13018-015-0265-x

    Article  PubMed  PubMed Central  Google Scholar 

  6. Blanke F, Watermann K, Haenle M et al (2019) Isolated medial patellofemoral ligament reconstruction can be an effective procedure in patellofemoral instability with risk factors. J Knee Surg 33:992–997. https://doi.org/10.1055/s-0039-1688917

    Article  PubMed  Google Scholar 

  7. Deie M, Ochi M, Sumen Y et al (2003) Reconstruction of the medial patellofemoral ligament for the treatment of habitual or recurrent dislocation of the patella in children. J Bone Jt Surg Br 85-B:887–890. https://doi.org/10.1302/0301-620x.85b6.13730

    Article  Google Scholar 

  8. Featherall J, Metz AK, Froerer DL et al (2022) The Schöttle point is consistently located distal to the medial femoral physis in pediatric patients: a digitally reconstructed radiographic study. Am J Sports Med 50:3565–3570. https://doi.org/10.1177/03635465221125470

    Article  PubMed  Google Scholar 

  9. Fink C, Veselko M, Herbort M, Hoser C (2014) Minimally invasive reconstruction of the medial patellofemoral ligament using quadriceps tendon. Arthrosc Tech 3:e325–e329. https://doi.org/10.1016/j.eats.2014.01.012

    Article  PubMed  PubMed Central  Google Scholar 

  10. Goldthwait JE (1899) V. Permanent dislocation of the patella. The report of a case of twenty years’ duration, successfully treated by transplantation of the patella tendons with the tubercle of the tibia. Ann Surg 29:62–68

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Gurusamy P, Pedowitz JM, Carroll AN et al (2021) Medial patellofemoral ligament reconstruction for adolescents with acute first-time patellar dislocation with an associated loose body. Am J Sports Med 49:2159–2164. https://doi.org/10.1177/03635465211013543

    Article  PubMed  Google Scholar 

  12. Jaquith BP, Parikh SN (2015) Predictors of recurrent patellar instability in children and adolescents after first-time dislocation. J Pediatr Orthop 37:484–490. https://doi.org/10.1097/bpo.0000000000000674

    Article  Google Scholar 

  13. Kazley JM, Banerjee S (2019) Classifications in brief: the Dejour classification of trochlear dysplasia. Clin Orthop Relat Res 477(10):2380–2386. https://doi.org/10.1097/CORR.0000000000000886 (PMID: 31393338; PMCID: PMC6999944)

    Article  PubMed  PubMed Central  Google Scholar 

  14. Kepler CK, Bogner EA, Hammoud S et al (2011) Zone of injury of the medial patellofemoral ligament after acute patellar dislocation in children and adolescents. Am J Sports Med 39:1444–1449. https://doi.org/10.1177/0363546510397174

    Article  PubMed  Google Scholar 

  15. Kirby JC, Jones H, Johnson BL, Brenner ME, Wilson PL, Ellis HB (2024) Genu valgum in pediatric patients presenting with patellofemoral instability. J Pediatr Orthop 44(3):168–173. https://doi.org/10.1097/BPO.0000000000002576 (Epub 2023 Nov 28. PMID: 38014718; PMCID: PMC10836788)

    Article  PubMed  Google Scholar 

  16. Ladenhauf HN, Berkes MB, Green DW (2013) Medial patellofemoral ligament reconstruction using hamstring autograft in children and adolescents. Arthrosc Tech 2:e151–e154. https://doi.org/10.1016/j.eats.2013.01.006

    Article  PubMed  PubMed Central  Google Scholar 

  17. Lewallen LW, McIntosh AL, Dahm DL (2013) Predictors of recurrent instability after acute patellofemoral dislocation in pediatric and adolescent patients. Am J Sports Med 41:575–581. https://doi.org/10.1177/0363546512472873

    Article  PubMed  Google Scholar 

  18. Liu JN, Brady JM, Kalbian IL et al (2018) Clinical outcomes after isolated medial patellofemoral ligament reconstruction for patellar instability among patients with trochlear dysplasia. Am J Sports Med 46:883–889. https://doi.org/10.1177/0363546517745625

    Article  PubMed  Google Scholar 

  19. Liu JN, Steinhaus ME, Kalbian IL et al (2018) Patellar instability management: a survey of the international patellofemoral study group. Am J Sports Med 46:3299–3306. https://doi.org/10.1177/0363546517732045

    Article  PubMed  Google Scholar 

  20. Luhmann SJ, O’Donnell JC, Fuhrhop S (2010) Outcomes after patellar realignment surgery for recurrent patellar instability dislocations: a minimum 3‑year follow-up study of children and adolescents. J Pediatr Orthop 31:65–71. https://doi.org/10.1097/bpo.0b013e318202c42d

    Article  Google Scholar 

  21. Magnussen RA, Verlage M, Stock E et al (2017) Primary patellar dislocations without surgical stabilization or recurrence: how well are these patients really doing? Knee Surg Sports Traumatol Arthrosc 25:2352–2356. https://doi.org/10.1007/s00167-015-3716-3

    Article  PubMed  Google Scholar 

  22. Moiz M, Smith N, Smith TO et al (2018) Clinical outcomes after the nonoperative management of lateral patellar dislocations: a systematic review. Orthop J Sports Med 6:2325967118766275. https://doi.org/10.1177/2325967118766275

    Article  PubMed  PubMed Central  Google Scholar 

  23. Nelitz M, Reichel H, Dornacher D, Lippacher S (2012) Anatomical reconstruction of the medial patellofemoral ligament in children with open growth-plates. Arch Orthop Trauma Surg 132:1647–1651. https://doi.org/10.1007/s00402-012-1593-5

    Article  CAS  PubMed  Google Scholar 

  24. Nelitz M, Wehner T, Steiner M et al (2014) The effects of femoral external derotational osteotomy on frontal plane alignment. Knee Surg Sports Traumatol Arthrosc 22:2740–2746. https://doi.org/10.1007/s00167-013-2618-5

    Article  CAS  PubMed  Google Scholar 

  25. Nelitz M, Williams SRM (2014) Anatomic reconstruction of the medial patellofemoral ligament in children and adolescents using a pedicled quadriceps tendon graft. Arthrosc Tech 3:e303–e308. https://doi.org/10.1016/j.eats.2014.01.005

    Article  PubMed  PubMed Central  Google Scholar 

  26. Palmer RC, Podeszwa DA, Wilson PL, Ellis HB (2021) Coronal and transverse malalignment in pediatric patellofemoral instability. J Clin Med 10:3035. https://doi.org/10.3390/jcm10143035

    Article  PubMed  PubMed Central  Google Scholar 

  27. Park SJ, Won SH, Park MS, Sung KH (2023) Normative values of tibial tubercle-trochlear groove distance and tibial tubercle-posterior cruciate ligament distance in children. Am J Sports Med 51(7):1785–1791. https://doi.org/10.1177/03635465231165521 (Epub 2023 Apr 24. PMID: 37092732)

    Article  PubMed  Google Scholar 

  28. Parikh SN, Nathan ST, Wall EJ, Eismann EA (2013) Complications of medial patellofemoral ligament reconstruction in young patients. Am J Sports Med 41:1030–1038. https://doi.org/10.1177/0363546513482085

    Article  PubMed  Google Scholar 

  29. Pilone C, Bonasia DE, Rosso F et al (2019) Medial patellofemoral ligament reconstruction and nonanatomic stabilization techniques in skeletally immature patients. Joints 07:98–106. https://doi.org/10.1055/s-0039-3400451

    Article  Google Scholar 

  30. Ponzoni A (1954) The results of Galeazzi’s operation in patellar dislocation. Minerva Ortop 5:192–193

    CAS  PubMed  Google Scholar 

  31. Roux C (2006) Recurrent dislocation of the patella: operative treatment. 1888. Clin Orthop Relat Res 452:17–20. https://doi.org/10.1097/01.blo.0000238832.88304.0e

    Article  PubMed  Google Scholar 

  32. Sadigursky D, de Laranjeira MSM, Nunes M et al (2016) Reconstruction of the medial patellofemoral ligament by means of the anatomical double-bundle technique using metal anchors. Rev bras ortop 51:290–297. https://doi.org/10.1016/j.rboe.2015.07.011

    Article  PubMed  PubMed Central  Google Scholar 

  33. Schneider DK, Grawe B, Magnussen RA et al (2016) Outcomes after isolated medial patellofemoral ligament reconstruction for the treatment of recurrent lateral patellar dislocations. Am J Sports Med 44:2993–3005. https://doi.org/10.1177/0363546515624673

    Article  PubMed  PubMed Central  Google Scholar 

  34. Schottle PB, Romero J, Schmeling A, Weiler A (2008) Technical note: anatomical reconstruction of the medial patellofemoral ligament using a free gracilis autograft. Arch Orthop Trauma Surg 128:479–484. https://doi.org/10.1007/s00402-007-0300-4

    Article  PubMed  Google Scholar 

  35. Seeley MA, Knesek M, Vanderhave KL (2013) Osteochondral injury after acute patellar dislocation in children and adolescents. J Pediatr Orthop 33:511–518. https://doi.org/10.1097/bpo.0b013e318288b7a0

    Article  PubMed  Google Scholar 

  36. Shah A, Parikh SN (2020) Medial patellofemoral ligament reconstruction with growth modulation in children with patellar instability and genu valgum. Arthrosc Tech 9:e565–e574. https://doi.org/10.1016/j.eats.2019.12.008

    Article  PubMed  PubMed Central  Google Scholar 

  37. Shea KG, Polousky JD, Jacobs JC et al (2014) The relationship of the femoral physis and the medial patellofemoral ligament in children: a cadaveric study. J Pediatr Orthop 34:808–813. https://doi.org/10.1097/bpo.0000000000000165

    Article  PubMed  Google Scholar 

  38. Steiner TM, Torga-Spak R, Teitge RA (2006) Medial patellofemoral ligament reconstruction in patients with lateral patellar instability and trochlear dysplasia. Am J Sports Med 34:1254–1261. https://doi.org/10.1177/0363546505285584

    Article  PubMed  Google Scholar 

  39. Tan SHS, Ngiam EHK, Lim JY, Lim AKS, Hui JH (2021) Surgical management of patella Alta in patellofemoral instability: a systematic review and meta-analysis. Orthop J Sports Med 9(4):2325967121999642. https://doi.org/10.1177/2325967121999642 (PMID: 33997063; PMCID: PMC8072862)

    Article  PubMed  PubMed Central  Google Scholar 

  40. Vavken P, Wimmer MD, Camathias C et al (2013) Treating Patella Instability in Skeletally Immature Patients. Arthrosc: J Arthrosc Relat Surg 29:1410–1422. https://doi.org/10.1016/j.arthro.2013.03.075

    Article  Google Scholar 

  41. Vogt B, Toporowski G, Gosheger G, Laufer A, Frommer A, Kleine-Koenig MT, Roedl R, Antfang C (2023) Guided growth: angular deformity correction through temporary hemiepiphysiodesis with a novel flexible staple (FlexTack). Bone Joint J 105-B(3):331–340. https://doi.org/10.1302/0301-620X.105B3.BJJ-2022-0857.R1 (PMID: 36854319)

    Article  PubMed  Google Scholar 

  42. White AE, Otlans PT, Horan DP, Calem DB, Emper WD, Freedman KB, Tjoumakaris FP (2021) Radiologic measurements in the assessment of patellar instability: a systematic review and meta-analysis. Orthop J Sports Med 9(5):2325967121993179. https://doi.org/10.1177/2325967121993179 (PMID: 34095324; PMCID: PMC8142007)

    Article  PubMed  PubMed Central  Google Scholar 

  43. Wilson PL, Black SR, Ellis HB, Podeszwa DA (2018) Distal femoral valgus and recurrent traumatic patellar instability. J Pediatr Orthop 38:e162–e167. https://doi.org/10.1097/bpo.0000000000001128

    Article  PubMed  Google Scholar 

  44. Zhang Z, Cao Y, Song G et al (2021) Derotational femoral osteotomy for treating recurrent patellar dislocation in the presence of increased femoral anteversion: a systematic review. Orthop J Sports Med 9:23259671211057130. https://doi.org/10.1177/23259671211057126

    Article  Google Scholar 

  45. Chotel F, Bérard J, Raux S (2014) Patellar instability in children and adolescents. Orthop Traumatol Surg Res 100(1 Suppl):S125–S137. https://doi.org/10.1016/j.otsr.2013.06.014 (Epub 2014 Jan 10. PMID: 24412258)

    Article  CAS  PubMed  Google Scholar 

  46. Balcarek P, Oberthür S, Hopfensitz S, Frosch S, Walde TA, Wachowski MM, Schüttrumpf JP, Stürmer KM (2014) Which patellae are likely to redislocate? Knee Surg Sports Traumatol Arthrosc 22(10):2308–2314. https://doi.org/10.1007/s00167-013-2650-5 (Epub 2013 Sep 5. PMID: 24005331)

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Abteilung für Kinderorthopädie und Fußchirurgie, Orthopädisches Spital Wien-Speising, Speisinger Straße 109, 1130, Wien, Österreich

    Sebastian Farr & Matthias Pallamar

Authors
  1. Sebastian Farr
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Matthias Pallamar
    View author publications

    You can also search for this author inPubMed Google Scholar

Corresponding author

Correspondence to Sebastian Farr.

Ethics declarations

Interessenkonflikt

S. Farr und M. Pallamar geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Additional information

Hinweis des Verlags

Der Verlag bleibt in Hinblick auf geografische Zuordnungen und Gebietsbezeichnungen in veröffentlichten Karten und Institutsadressen neutral.

figure qr

QR-Code scannen & Beitrag online lesen

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Farr, S., Pallamar, M. Patellofemorale Instabilität bei Kindern und Jugendlichen. Orthopädie 53, 567–574 (2024). https://doi.org/10.1007/s00132-024-04530-6

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00132-024-04530-6

Schlüsselwörter

Keywords