PATELLAR STABILIZATION PROCEDURES IN THE PEDIATRIC POPULATION: INCIDENCE AND DEMOGRAPHICS

BACKGROUND: Patellar instability is a relatively common condition in the young athletic population. There are multiple surgical options for management of patellar instability including medial patellofemoral ligament reconstruction (MPFL), tibial tubercle osteotomy (TTO), and lateral release, as well as different combinations of these procedures. Prior investigations of the adult population have demonstrated an increase in the amount of surgeries over time. In this study, we investigated the demographics and surgical treatment of patellar instability in pediatric and adolescent patients to determine if 1) there had been more surgeries performed year over year, 2) if there had been a change in the type of surgery performed over time, and 3) if age affected the type of surgery performed. METHODS: We queried a California statewide ambulatory surgery database (OSHPD) for all patients under 20 years old diagnosed with patellar instability or patella dislocations in the state of California from 2008-2016. Relevant ICD-9 diagnostic codes, ICD-10 diagnostic codes, and CPT procedural codes were used to identify and analyze this data. The incidence, concomitant procedures, demographics, hospital type, and insurance type were obtained to descriptively describe this population. RESULTS: 4590 patients under the age of 20 received outpatient surgery for patellar instability in 2008-2016. 1472 of the 4590 included concomitant cartilage procedures, while 2733 of the 4590 were patellar stabilization procedures. The average age was 15.5. Of the 4,590 surgeries, 59.6% were female and 40.4% were male. A total of 273 were surgeries were performed on under 13 year-olds, 1808 on 13-15 year-olds, and 2509 on 16-19 year-olds. Included in these 4590 surgeries were 2733 patellar stabilization procedures of interest. Trends were identified concerning the type of patellar stabilization procedures performed. In the youngest population, MPFL alone is performed most frequently (53% of under 13 cases), followed by lateral release alone (34%) and the combination of MPFL and lateral release (13%). For 13-15 year-olds, more lateral release alone procedures (42% of 13-15 cases) were performed. MPFL alone procedures were 40% of cases, with far less MPFL and lateral release combination procedures (13%), TTO and lateral release combination (3%), and TTO alone (2%). For 16-19 year-olds, the frequency of MPFL alone and lateral release alone each accounted for 40% of the patellar stabilization proce