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Treating patella instability in skeletally immature patients.
[trochlear dysplasia]
The
purpose
of
this
study
was
to
comprehensively
and
systematically
review
the
current
evidence
for
orthopaedic
treatment
of
immature
and
adolescent
patients
with
acute
and
chronic
patellar
instability
.
We
searched
the
online
databases
PubMed
,
CINAHL
,
EMBASE
,
Cochrane
Central
Register
of
Controlled
Trials
,
and
Cochrane
Database
of
Systematic
Reviews
for
relevant
publications
on
patellar
instability
.
All
dates
and
languages
were
included
.
Twenty
articles
reporting
on
a
total
of
456
knees
in
425
patients
(
131
male
patients
,
294
female
patients
)
followed-up
for
56
.
7
±
42
.
2
months
on
average
were
included
in
the
analysis
.
Two
studies
focused
specifically
on
conservative
versus
surgical
treatment
in
acute
dislocations
and
reported
no
difference
in
outcomes
after
7
and
14
years
,
even
in
the
face
of
slight
trochlear
dysplasia
.
For
recurrent
instability
,
we
found
consistent
beneficial
effects
from
surgical
stabilization
on
clinical
scores
,
postoperative
stability
,
and
radiographic
assessment
.
There
is
no
evidence
for
growth
disturbance
with
surgical
patellar
stabilization
in
immature
patients
.
The
current
best
evidence
does
not
support
the
superiority
of
surgical
intervention
over
conservative
treatment
in
an
acute
patellar
dislocation
.
However
,
anatomic
variations
and
their
effect
on
healing
should
be
considered
and
included
in
decision
making
.
In
recurrent
patellar
instability
in
pediatric
and
adolescent
patients
with
normal
or
restored
knee
anatomy
,
reconstruction
of
the
medial
patellofemoral
ligament
(
MPFL
)
is
the
most
effective
treatment
option
and
can
be
done
safely
,
together
with
extensor
realignment
as
needed
.
Level
IV
,
systematic
review
of
mixed
-level
studies
.
Diseases
Validation
Diseases presenting
"acute dislocations"
symptom
trochlear dysplasia
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