Pediatric and Adolescent Knee Surgery by Cordasco Frank;Green Daniel;

Author:Cordasco, Frank;Green, Daniel;
Language: eng
Format: epub
ISBN: 9781451193350
Publisher: Wolters Kluwer
Published: 2015-04-24T00:00:00+00:00

CHAPTER

Theresa A. Chiaia

Sarah M. Baker

20

Rehabilitation following Patellar Instability

INTRODUCTION

Patellar dislocation is a common injury found in children and adolescents, accounting for 2% to 3% of all knee injuries.1 Four clinical categories of patellar instability for the pediatric and adolescent population have been described to conceptualize pathology: posttraumatic, syndromic, obligatory, and fixed.2 Traumatic dislocations are the most common and are then further categorized as first-time or recurrent dislocators.

There are many variables that can affect the course of postoperative rehabilitation such as the nature of the injury (traumatic or atraumatic), concomitant injuries and/or procedures, the level of dysfunction (development of compensatory patterns), the chronicity of the dysfunction, the degree of pathology, the age of the patient, and the surgical procedure. Predisposing factors must be recognized: prior history of dislocation, genetic, ligamentous laxity, skeletal dysplasias, collagen disorders, muscular imbalances, and/or faulty movement strategies.

The medial patellofemoral ligament (MPFL), a discrete component of the medial retinaculum, guides the patella to properly engage the trochlea during early knee flexion. MPFL reconstruction (MPFLR) uses allograft or autograft tissue tensioned to balance the patella within the trochlear groove—it is a soft tissue procedure which requires 12 weeks of healing (Fig. 20.1A).

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