Surgeons in North America and Asia-Pacific Adopt Various Practices Regarding Surgical Indications, Graft Selection, and Imaging Assessment in Pediatric Patients With Patellofemoral Instability.

Abstract

Purpose: To characterize and compare current practice patterns in the evaluation and management of pediatric patellofemoral instability (PFI) between Asia-Pacific and North American surgeons.

Methods: A comprehensive survey developed by the Paediatric Research in Sports Medicine Society Patellofemoral Instability Research Interest Group assessed surgeon practices across evaluation, imaging, indications, and surgical techniques for pediatric patients with PFI. The survey was distributed to Asia-Pacific Paediatric Research in Sports Medicine members from 2024 to 2025 and compared against previously published North American data from 2018 to 2019. Responses were analyzed to compare regional practices.

Results: A total of 127 subjects were included. Fifty-six Asia-Pacific orthopaedic surgeons and 56 North American orthopaedic surgeons managing pediatric PFI completed the survey. Most (89%) indicated surgery for large, symptomatic osteochondral fragments, with 90% routinely performing concomitant medial patellofemoral ligament reconstruction. Marked regional variation was seen in graft selection: hamstring autograft predominated in Asia-Pacific (78% vs 23%, P < .001), whereas allograft was preferred in North America (59% vs 14%, P < .001). Fixation strategies in skeletally immature patients also differed, with Asia-Pacific surgeons more often using suture anchors at both the patella (75% vs 54%, P = .004) and femoral insertion (59% vs 26%, P < .001). Computed tomography use for rotational profiling (85% vs 7%) and tibial tubercle assessment (84% vs 2%) was markedly higher in Asia-Pacific. Patella-stabilizing braces (73% vs 30%) and longer immobilization were also more common regionally.

Conclusions: Significant regional variation exists in the management of pediatric PFI, particularly in graft choice, fixation technique, and imaging use.

Clinical relevance: There is no universal consensus on the surgical management of PFI, and variation in practice may influence patient selection, surgical strategy, and outcomes. By characterizing similarities and differences in practice among Paediatric Research in Sports Medicine surgeons across geographic regions, this study identifies key areas of variability that can inform future research and guide the development of evidence-based standards to improve consistency and quality of care worldwide.