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Acute patellar dislocation remains a common injury in both adult and pediatric patients. Non-operative management has been advocated for patients without a history of recurrent instability. Although pathologic thresholds for consideration of operative management have previously been reported in adults, it is largely unknown in children. A retrospective review of all skeletally immature patients diagnosed with acute lateral patellar dislocation who had MRI imaging were included for analysis. An age-based control group was also identified. Six radiographic measurements were compared: lateral trochlear inclination (LTI), trochlear facet asymmetry (TFA), trochlear depth (TD), tibial tuberosity⁻trochlear groove (TT⁻TG), sulcus angle (SA) and patellar height ratio. A total of 178 patients were included for analysis (study: n = 108, control: n = 70). The mean age of patients in the study and control groups was 13.7 and 12.1 years respectively ( p ≤ 0.001). Study group patients had significant differences in all radiographic measurements including a decreased LTI ( p &lt; 0.001), increased TFA ( p &lt; 0.001) and SA ( p &lt; 0.001). The mean trochlear depth was 3.4 mm and 5.6 mm for patients in the study and control groups respectively ( p &lt; 0.001). Study group patients had an increased patellar height ratio ( p &lt; 0.001) and TT⁻TG distance ( p &lt; 0.001). Morphologic abnormalities may predispose skeletally immature patients to an increased risk of acute lateral patellar instability.

Radiographic Assessment of Anatomic Risk Factors Associated with Acute, Lateral Patellar Dislocation in the Immature Knee