Shital N. Parikh, MD

According to published results, thick-shell sulcus-deepening trochleoplasty may yield clinical improvements and high satisfaction for skeletally immature patients with patellar instability and open distal femoral physes.

Regardless of patellar height and trochlear dysplasia, isolated medial patellofemoral ligament reconstruction yielded “excellent” midterm outcomes with low redislocation rates in skeletally immature patients, according to published results.

Published results showed particulated juvenile allograft cartilage implantation for patellofemoral chondral defects may yield satisfactory short-term outcomes and postoperative MRI appearance in pediatric and adolescent patients.

Medial patellofemoral ligament reconstruction may be a safe and effective treatment option for adolescent patients with patellar dislocations and instability, according to published results.

Medial patellofemoral ligament reconstruction in adolescent patients with patella instability results in less instability and subsequent surgery compared with no reconstruction surgery, according to presented findings.

When parents are faced with a decision regarding the optimal treatment for their child with an ACL injury, they commonly ask, “If this was your child, what would you do?” For most, the answer is easy. We want the best surgeon to decide the best treatment that has the best outcome and the least probability of a complication. Interestingly, the paucity of high-level evidence in this area does not support the general consensus of pediatric sports medicine experts. The pendulum continues to swing as historical dogma in the treatment of pediatric ACL injuries was to delay until skeletal maturity. However, recent advances in techniques have suggested a safe alternative is early surgical treatment of ACL injuries.

Patellar instability is more common in children younger than the age of 16 years with an incidence of approximately 43 per 100,000 children per year. Although more than 100 different surgical techniques for patellar stabilization have been described in the literature, medial patellofemoral ligament reconstruction has been increasingly accepted as the treatment of choice for most patients with recurrent patellar instability.

A 9-year-old boy fell from his bicycle onto his outstretched right hand. He had immediate pain and deformity at his elbow. He was seen at an outside hospital where, under conscious sedation, closed reduction for a right elbow dislocation was performed. Post-reduction anterior posterior and lateral elbow radiographs are shown in Figure 1. The patient was referred to our emergency department for further evaluation and management. He had mild weakness in the ulnar nerve distribution.