Surgical Treatment of Patellofemoral Instability in Children: Lessons From a 10-Year Single-Center Experience

Abstract

Background: Patellofemoral instability (PFI) in children is a complex, multifactorial condition and a major challenge in pediatric orthopedics, yet no epidemiological data exist for the Moroccan pediatric population. Methods: We retrospectively reviewed 20 children (25 knees) treated for patellar instability over a 10-year period (2015-2025) in the pediatric trauma and orthopedic surgery department of the Children's Hospital of Rabat. Epidemiological, clinical, radiological, and therapeutic data were analyzed and compared with the international literature. Most patients were treated with a modified Insall procedure combining proximal realignment, a Roux-Goldthwait patellar tendon transfer, and medial patellofemoral ligament (MPFL) reconstruction. Results: Mean age at surgery was 10 years (range: 5-17), with a female predominance of 12/20 patients (60%). Bilateral involvement was present in 5/20 patients (25%), and no familial cases were recorded. Recurrent dislocation was more common (15/25 knees, 60%) than permanent dislocation (10/25 knees, 40%). Imaging confirmed the multifactorial anatomical basis of the disease, with trochlear dysplasia, patella alta, and an increased tibial tubercle-trochlear groove distance frequently identified. After a mean follow-up of five years, excellent results were obtained in 23/25 knees (92%), with 2/25 knees (8%) presenting recurrence and 1/25 knees (4%) presenting a wound infection with a favorable outcome. Conclusion: An individualized, "menu à la carte" surgical strategy adapted to each child's anatomical profile and growth potential provides satisfactory functional and anatomical outcomes in pediatric PFI, with results comparable to or better than those reported in the international literature.