This study compared the Insall-Salvati (IS), Blackburne-Peel (BP), and Kosh
ino-Sugimoto (KS) methods for measuring patellar malalignment in children.
The IS and BP methods were inaccurate because the traditional landmarks for
measurement were absent in the incompletely ossified pediatric knee. The K
S method is based on the midpoint of the patella, the distal femoral physis
, and the proximal tibial physis. The KS method applied to the extended kne
e was also inaccurate because of laxity in the patella ligament. However, t
he KS method applied to the flexed knee was the most accurate method for me
asuring patella malalignment in children.