# Indications of Arthroscopy in the Treatment of Patellar Instability in Children

## TL;DR

This study examines the use of arthroscopy for treating patellar instability in children and finds it effective with low recurrence and good functional outcomes.

## Contribution

The study provides empirical evidence on arthroscopic treatment effectiveness for patellar instability in children using a flow chart-based approach.

## Key findings

- Arthroscopy showed a low recurrence rate (11.4%) and high functional scores (avg. 95.5 Kujala) in children with patellar instability.
- Recurrence was significantly correlated with the number of knots in medial reefing, not the procedures themselves.
- Medial reefing and MPFL reconstruction were commonly used, with lateral release also frequently performed.

## Abstract

Purpose

Understanding the relevant risk factors for patellar instability and the clinical and radiographic tests necessary to determine optimal treatment. This case series intends to evaluate arthroscopic indications in the treatment of patellar instability in children.

Methods

From 2013 to 2021, 33 patients (seven to 16 years of age) with 35 knees sustaining first-time dislocation with loose bodies, recurrent dislocation or subluxation, and habitual dislocation were arthroscopically operated on according to the flow chart. Periods of follow-up were two to 10 years (avg. 5.5 years). Follow-up assessment included the recurrence, complications (joint stiffness and excessive reduction), and the final function outcomes by using the Kujala score.

Results

Among 35 knees, there were two (5.7%) first dislocations, 30 (85.7%) recurrent dislocations, and three (8.6%) habitual dislocations, lateral release 27/35 (77.1%), medial reefing 23/35 (65.7%), reconstruction of the medial patellofemoral ligament (MPFL) 12/35 (34.3%). The major complication was a knee of extensive stiffness after medial reefing and lateral release. Recurrence was in 4/35 (11.4%) of knees, not correlated to lateral release (p=0.21), medial reefing, or reconstruction of MPFL (p=0.07); in about 23 knees of medial reefing, recurrence was significantly correlated to number of knots (p=0.045). The final functional results according to Kujala were 88-100 (avg. 95.5).

Conclusions

This study showed the role of arthroscopy in both medial reefing and reconstruction of MPFL in children by low recurrence rate and high Kujala score at final follow-up. There was no significant correlation between recurrence and the procedures as arthroscopic indications counted on the flow chart.