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Introduction
Patella dislocation had multiples facets
.
Although considered a spectrum of disease
related to episodic or recurrent patella instability
regularly seen in older patient, congenital and
habitual dislocation of the patella are now under
stood as two distinct entities. A genetic etiology
is supported by many associated syndromes and
clinical findings seen in accordance with
congenital dislocation of the patella. These
pathologies are rare and more often encountered
in pediatric orthopedic practice.
Congenital patellar aplasia or hypoplasia
belongs to another heterogeneous group of
lower limb malformations (with sometime
patella dislocation) associated with multiple
genetic disorders.
The aim of this paper is to
highlight these
associated pathologies that could impact the
patient management
and try to answer to the
question: what should we think about or look at
in case of patella dislocation in children?
Episodic or recurrent
patella instability
This is the more benign and common expression
of the disease usually seen in healthy pre-or
adolescent. Classical predominance in children
or adolescent girls could suggest association
with benign local hyperlaxity. But clinicians
should also be aware of the
possible association
with occult and more serious general joint
hypermobility
. This association sometime
needs others investigations looking after
collagen abnormality or muscular disease that
could facilitate failure and recurrence after
stabilization surgery.
Joint hypermobility, is often confirmed by a
score of four or more (for adult) and six or
more (for children) on the nine-point
Beighton
scale
[10], one point is scored for each of the
following (fig. 1):
What should we think about
or look at, in case of patella
dislocation in children?
F. Chotel, A. Peltier, R. Kohler, J. Bérard
Fig. 1: Beighton criteria in order
to detect joint hypermobility.