Indicators, frameworks, and influencing factors for evaluating the performance of mental health programs in primary health care: a scoping review.

Lateral patellar dislocation (LPD) represents an important cause of knee injury in adolescents, with a reported incidence of 6–50 per 100,000 individuals aged 10–17 years []. Per definition LPD refers to the acute event of the patella dislocating laterally from the trochlear groove, whereas patellofemoral instability (PFI) describes the broader clinical condition characterized by recurrent dislocation, subluxation, or persistent instability of the patella [–]. Atraumatic lateral patellar dislocation predominantly affects young athletes, comprising 88% of cases, and approximately one-third progress to bilateral patellofemoral instability (PFI) with recurrent dislocations. While fewer than 1% of first-time LPDs are due to major trauma, most cases are linked to underlying anatomical risk factors [, ]. Treating PFI during growth is challenging, as nearly 50% of affected individuals develop patellofemoral osteoarthritis within 25 years []. Several anatomical and biomechanical contributors to atraumatic LPD have been identified, including trochlear dysplasia, patella alta, patellar tilt, lateralization (e.g., increased TTTG/TTPCL distance), and rotational malalignment [, , ]. High-risk motions like valgus loading during twisting exacerbate instability [, , –]. In response, individualized treatment approaches are emerging, aided by predictive tools such as the Patella Instability Severity Score (PISS) and Patella Instability Probability (PIP) Calculator [–]. Chronological age alone may not adequately reflect skeletal development in children and adolescents, as growth patterns and body size vary considerably between individuals of the same age [, –]. Previous studies have shown that femoral width correlates with overall femur length and body height, suggesting that it may serve as a surrogate marker for knee size during skeletal development [–]. Hirschmann et al. [] have recently advocated for tailored treatment strategies. Therefore, normalizing patellofemoral parameters to knee size may provide a more individualized framework for interpreting anatomical risk factors in growing patients.