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Knee Injuries in the Youth Athlete: Patellofemoral

Summary: Much pathology of the patellofemoral joint is caused by anatomic variations or abnormalities that would require either realignment surgery or surgical recontouring (as in trochlear dysplasia) to correct. The efficacy and safety of recontouring procedures have not been proven, and realignment surgery that corrects all pathology present may be extensive. Fortunately, the majority of overuse or chronic problems of the patellofemoral joint can be treated successfully by nonoperative means. Acute injury of the patellofemoral joint, such as dislocation or osteochondral fracture, generally requires surgical intervention. Arthroscopic techniques can improve several types of patellofemoral joint symptoms and anatomic abnormalities with better visualization and less tissue disruption than open surgical methods. A thorough understanding of patellofemoral and knee functional anatomy allows the surgeon to perform an appropriate physical examination, order the most useful imaging studies, and design the best possible treatment plan for patients with symptoms that are acute, chronic, or acute superimposed on preexisting malalignment. The plan may include therapeutic exercise, antiinflammatory medications and modalities, bracing, and operative intervention.