Patellar dislocations are common in the pediatric population, with incidence ranging from 29 to 43 per 100,000 patients, accounting for 2%-3% of all knee injuries.1,2 Risk factors for patellar instability include anatomic factors, such as patella alta, trochlear dysplasia, excessive femoral anteversion, genu valgum, an increased tibial tubercle to trochlear groove (TT-TG) distance, and others.3 Furthermore, skeletal immaturity, ligamentous laxity, and prior patellar dislocation are associated with an increased risk of recurrence.4,5

Several classification systems have been proposed for patellar instability.6, 7, 8 Prior studies have used classifications split into 4 categories based on clinical scenarios: syndromic, obligatory, fixed, and traumatic dislocations.9 Each category has a different pathophysiology that influences surgical considerations. Traumatic instability, the most common type, results in excessive patellar translation in extension that typically improves with progressive flexion. Syndromic dislocation can be associated with soft tissue laxity, osseous deformity, neuromuscular imbalances, or other systemic issues. Obligatory dislocation results in instability when the knee is flexed, but more concentric reduction in extension. Fixed dislocations cannot be reduced. The underlying pathophysiology as well as patient and family expectations must be considered when planning treatment for each type of instability. This article will focus on 2 techniques that can be applied to any of the aforementioned types of patellar instability in skeletally immature patients.