# Arthroscopic Management of Patellar Instability in Skeletally Immature Patients: Current Concepts and Future Directions

## TL;DR

This paper reviews how arthroscopy is used to manage patellar instability in children and adolescents, highlighting current techniques and future innovations.

## Contribution

The paper provides a current review of arthroscopic techniques and emerging innovations for managing patellar instability in skeletally immature patients.

## Key findings

- Arthroscopy is essential for diagnosing and treating patellar instability in young patients.
- Physeal-sparing medial patellofemoral ligament reconstruction is the preferred stabilization technique for patients with open physes.
- Emerging innovations like robotic-assisted tunnel placement and bioengineered scaffolds may improve surgical outcomes.

## Abstract

Background/Objectives: Patellar instability is a common orthopedic condition affecting pediatric and adolescent populations, particularly during periods of rapid growth and increased sports participation. Recurrent patellar dislocation in skeletally immature patients is frequently associated with underlying anatomical risk factors such as patella alta, trochlear dysplasia, or increased tibial tubercle–trochlear groove distance. Methods: This narrative review summarizes the current evidence on the epidemiology, diagnostic approach, and arthroscopic management of patellar instability in skeletally immature patients. Results: Arthroscopy has become an essential tool in both the diagnosis and treatment of patellar instability, allowing for minimally invasive assessment of patellofemoral alignment, chondral pathology, and ligament integrity. It also enables precise surgical interventions such as physeal-sparing medial patellofemoral ligament reconstruction, which remains the preferred stabilization technique for patients with open physes due to its safety and efficacy. Emerging innovations, including robotic-assisted tunnel placement, bioengineered scaffolds for cartilage repair, and three-dimensional modeling for surgical planning, have the potential to improve outcomes and arthroscopic surgical precision in this population. Despite these advances, major challenges such as a lack of pediatric-specific outcome measures, variability in surgical indications and rehabilitation protocols, and limited long-term follow-up data remain. Conclusions: Optimizing outcomes in pediatric and adolescent patients with patellar instability requires individualized growth-aware strategies and multidisciplinary collaborations. By integrating technological innovation with patient-centered care, clinicians can continue to refine the arthroscopic management of patellofemoral instability in young patients.