Summary

Arthroscopy and soft-tissue patella realignment can be a safe and effective solution for the management of persistent patellofemoral pain in pediatric and adolescent patients when non-operative management fails.

Abstract

Purpose

Patellofemoral conditions, such as pain and maltracking are extremely prevalent in children and adolescents. In cases where non-operative management fails, a diagnostic arthroscopy combined with arthroscopic soft tissue patella realignment technique has been described recently. This study aims to analyze the outcomes of arthroscopic intervention for managing refractory patellofemoral conditions in children and adolescents.

Methods

This was a retrospective analysis of a clinical series of consecutive pediatric and adolescent patients who underwent diagnostic arthroscopy with arthroscopic soft-tissue patella realignment between 2019 and 2022. Patients with previous ipsilateral knee surgery and less than two years of follow-up were excluded. The primary outcome was failure to improve symptoms or poor functional scores. Secondary outcomes included patient reported outcome measures at two years post-surgery (IKDC, KOOS, and Lysholm scores), return to sport without restriction (RTS), and complications.

Results

Twenty-seven knees (70% female) from 27 patients were included in the analysis. Successful outcome was reported in 92.9% of the patients with only two patients reporting recurrent symptoms. Median patient reported outcomes including IKDC scores, KOOS, and Kujala scores were 91±11, 91±9, and 91±2 respectively. The average age was 15.7±1.8 years at the time of surgery and the median follow-up length was 29.4±6.33 months. Complications, such as arthrofibrosis, were reported in three knees (11.1%).

Conclusion

This study demonstrates that diagnostic arthroscopy and soft-tissue patella realignment can be a safe and effective solution for the management of persistent patellofemoral pain in pediatric and adolescent patients when non-operative management fails.