The analysis of the results of surgical treatment of patellar dislocation in children (literature review)

Relevance. Recurrent patellar dislocation is a frequent consequence of knee ligament injuries, especially in children and adolescents. Repeated dislocations cause joint instability, which entails the development of degenerative-dystrophic changes and a significant deterioration in the patient's quality of life. Despite the rarity of congenital patellar dislocation (0.45–1%), it is of particular clinical significance due to severe functional impairment. Objective: to summarize modern approaches to diagnosis, classification and treatment of congenital and posttraumatic patellar dislocation in children and adolescents with an emphasis on surgical methods, their modifications and clinical efficacy. Materials and methods. The literature and clinical cases were analyzed, including the experience of leading Russian clinics and original treatment methods (for example, the Gafarov and Akhtyamova method using an external fixation device, the Krogius-Volkov-Friedland operation). The article considers pathogenetic mechanisms of patellar dislocation, including anatomical and biomechanical changes, as well as features of congenital pathology. Results. Differentiated approaches to treatment depending on the degree of dislocation and severity of anatomical changes are presented. A clinical case of successful treatment of a patient with Down syndrome is described. The results of conservative therapy and surgical intervention in children are compared. The high efficiency of early arthroscopy and lateral release with Yamamoto suture application in patients with connective tissue dysplasia is emphasized. Modern low-traumatic techniques are described, including arthroscopic fixation of the medial patellofemoral ligament using anchor sutures. Conclusions. The choice of treatment tactics requires an individual approach based on the clinical picture, anatomical features and severity of pathology. In congenital forms, surgical treatment using combined techniques is mainly indicated. Early surgical intervention in children with signs of dysplasia allows to reduce the risk of relapses and improve remote functional results. Arthroscopic techniques are less traumatic and provide good clinical outcomes with proper diagnostics and technique.