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Team Approach: Patellofemoral Instability in the Skeletally Immature

Gruskay, Jordan A. MD1; Strickland, Sabrina M. MD1; Casey, Ellen MD1; Chiaia, Theresa A. PT, DPT1; Green, Daniel W. MD, MS1; Gomoll, Andreas H. MD1

doi: 10.2106/JBJS.RVW.18.00159
Team Approach Review Articles

  • » Conservative management with bracing and physical therapy remains the treatment of choice following acute, first-time dislocation in adolescent patients, but certain high-risk individuals may benefit from a surgical procedure as a first-line treatment.
  • » The physical therapist is intimately involved in patient care regardless of the chosen treatment strategy and must set realistic expectations to improve compliance and to minimize frustration. Through comprehensive biomechanical evaluation, factors such as quadriceps and hip abductor weakness that contribute to patellar dislocation are identified and are addressed.
  • » Surgical intervention consists of medial patellofemoral ligament reconstruction alongside an á la carte approach to correcting other anatomic abnormalities. In the adolescent population, open growth plates dictate available surgical options, and care must be taken to avoid physeal damage.
  • » Given the propensity for recurrent instability, a thorough team approach is needed from the outset to successfully guide the patient through the treatment and recovery process.

1Departments of Orthopedics (J.A.G., S.M.S., D.W.G., and A.H.G.), Physiatry (E.C.), and Sports Rehabilitation (T.A.C.), Hospital for Special Surgery, New York, NY

E-mail address for A.H. Gomoll:

Investigation performed at the Hospital for Special Surgery, New York, NY

Disclosure: The authors indicated that no external funding was received for any aspect of this work. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked “yes” to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work (

Copyright © 2019 by The Journal of Bone and Joint Surgery, Incorporated
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