The Relationship of the Femoral Physis and the Medial Patellofemoral Ligament in Children (original) (raw)
Related papers
The Relation of the Femoral Physis and the Medial Patellofemoral Ligament
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2010
Purpose: The purpose of this study was to determine the origin of the medial patellofemoral ligament (MPFL) relative to the distal femoral physis by use of an indirect radiologic method. Methods: Twenty radiographs from adolescent male and female subjects (10 samples from each group) were used. The subjects studied were all skeletally immature, with an open distal femoral physis. The radiographic technique described by Schöttle et al. was used to identify the origin of the MPFL. Imaging software was used to determine the approximate distance of the MPFL origin relative to the open growth plate of the subjects involved. Results: In all 20 radiographs the medial physis was found to be distal to the average MPFL insertion point. The mean location for the female physis was 2.7 Ϯ 1.1 mm distal to the MPFL origin. The mean location for the male physis was 4.6 Ϯ 2.4 mm distal to the MPFL origin. Conclusions: Based on an indirect radiographic technique, we found that the origin of the MPFL is just proximal to the femoral physis. Clinical Relevance: This information may be useful when planning medial retinacular surgical procedures in skeletally immature athletes to help avoid clinically significant physeal injury.
Anatomical reconstruction of the medial patellofemoral ligament in children with open growth-plates
Archives of Orthopaedic and Trauma Surgery, 2012
Recurrent lateral patellar dislocation is a common knee injury in the skeletally immature adolescent. In adults, anatomical reconstruction of the medial patellofemoral ligament (MPFL) is recommended, but due to the open physis, operative therapy in children is more challenging. We present a minimal invasive technique for anatomical reconstruction of the MPFL in children respecting the distal femoral physis. This technical note considers the important fact that the femoral insertion is distal to the femoral physis. Since the importance of an anatomical reconstruction respecting the femoral insertion of the ligament has been proven an insertion proximal of the physis has to be strictly avoided.
Orthopaedic Journal of Sports Medicine
Background: Medial patellofemoral ligament (MPFL) reconstruction is the treatment of choice for recurrent patellar instability in the skeletally immature patient. Avoiding the open physes during anatomic MPFL reconstruction is a challenge in this population. Purpose: To describe a novel method using magnetic resonance imaging (MRI) to determine the distance from the Schöttle point to the medial distal femoral physis among skeletally immature individuals with patellar instability. Study Design: Descriptive laboratory study. Methods: Preoperative MRI scans were analyzed from 34 patients with open distal femoral physes and lateral patellar instability. With the multiplanar reconstruction mode on a picture archiving and communication system (PACS), the location of the Schöttle point was determined according to previously reported distances from the posterior femoral cortical line and the posterior origin of the medial femoral condyle. This location was then extrapolated to the most medi...
Pediatric Patellofemoral Instability: Beyond the MPFL
Journal of the Pediatric Orthopaedic Society of North America
Pediatric patellofemoral instability is an increasingly common and debilitating problem. In recent years, there has been an improvement in diagnostic capabilities and greater knowledge of unique pediatric patellofemoral anatomy and pathophysiology. The spectrum of disease varies from a single traumatic dislocation, to recurrent dislocation, to obligatory dislocation in flexion or even fixed dislocation in severe or syndrome-associated cases. When treating pediatric patellofemoral instability, it is important to understand the benefits and limitations of nonoperative management. It is important to recognize the challenges imparted by the anatomy of the skeletally immature knee, specifically with regards to the physis, when considering surgical treatment. One must have a thorough understanding of common anatomic and pathophysiologic contributors to patellofemoral instability, such as coronal or axial plane malalignment, and concomitant osteochondral injury. For the very severe cases ...
Patellofemoral instability in skeletally immature athletes
PubMed, 2013
Background: Patellofemoral instability is a common cause of knee disability. Acute patellofemoral dislocation is the most common acute knee disorder in skeletally immature patients. In this group, the incidence of patellofemoral dislocation is approximately 43 per 100,000 individuals. The precise objective addressed in the paper: Medial patellofemoral ligament (MPFL) reconstruction has a significant role in the treatment of patellofemoral instability in skeletally immature patients. We evaluated the medium and long-term results results of MPFL reconstruction as the sole method of patellofemoral instability treatment and their relationship with the presence of other potentially associated factors. Methods: We conducted a prospective study with 35 young patients who underwent the same surgical technique between 2002 and 2009. Age, gender, patellar tilt, patella height, TT-TG, trochlear dysplasia, the Kujala score and the Tegner activity score were evaluated. Statistical analysis used SPSS ® 20. Results: The mean age of the patients was 15.9 years. High patella was observed in 10% of patients. All patients had TT-TG within a normal range. Trochlear dysplasia was found in 80% of the patients: 40% had Dejour's type A; 34% type B; 20% type C and 6% type D. The medium-term Kujala score (84 ± 9) significantly improved compared to the pre-operative score (54 ± 11). However, a decline in the long-term (78 ± 3) score was observed. The Tegner activity score showed a significant decrease. The long-term results were significantly lower when patients had trochlear dysplasia type B to D. Conclusions: A decade after isolated MPFL reconstruction, results remained satisfactory. Patients with trochlear dysplasia types B to D may benefit from associated trochleoplasty in a second intervention.
International Orthopaedics, 2014
Purpose Anatomically correct graft positioning at the femoral insertion site is a key factor in surgical reconstruction of the medial patello-femoral ligament (MPFL). Basically there are two techniques to define this point in fluoroscopy during surgery. The role of the anatomical femoral torsion on the accuracy and reproducibility of both procedures has not been clarified. Methods Twenty human anatomical leg specimens were dissected. The femoral insertion of the MPFL was marked by two K-wires. The position of the ligament insertion was determined fluoroscopically in the true lateral view as used in routine clinical practice. The anatomical MPFL insertion was compared to the radiographic landmarks which were recommended by two previous studies. The anatomical femoral torsion of the specimens was assessed by computed tomography scans. Results In true lateral view fluoroscopy, the mean distance of the femoral MPFL insertion was −0.2 mm distal to the vertical reference line intersecting the posterior point of Blumensaat's line. In the anteroposterior direction, the mean distance was −2.0 mm posterior to the femoral cortex reference line. There was no correlation between anatomical femoral torsion and the distance of the femoral MPFL insertion to the posterior cortex.
The Journal of bone and joint surgery. American volume, 2017
This study was conducted to evaluate the spatial relationship of the anterior cruciate ligament (ACL) and lateral collateral ligament (LCL) femoral footprint origins in knee specimens from skeletally immature donors as viewed on lateral radiographs. Fourteen cadaver specimens of skeletally immature knees from children between 7 and 11 years old at the time of death were examined through gross dissection. Metallic pins were placed at the center of the ACL and LCL femoral footprints, and computed tomography (CT) scans were performed. Sagittal plane CT images were merged to create a view analogous to an intraoperative C-arm image with overlaid ACL and LCL ligament footprints. Ligament origins were then measured as a percent of the epiphyseal depth (% P-A [posterior-anterior]) and height (% P-D [proximal-distal]). The ACL origin was centered at a point located 14% (14% P-A) of the total lateral femoral condyle (LFC) depth from the most posterior aspect of the LFC and 38% (38% P-D) of th...
Landmarks Used in Medial Patellofemoral Ligament Reconstruction Have Variable Topography
Arthroscopy, Sports Medicine, and Rehabilitation
Purpose: To describe the morphology of the adductor tubercle (AT), medial epicondyle (ME), and gastrocnemius tubercle (GT); to quantify their relationships to the medial patellofemoral ligament (MPFL) footprint location; and to classify the reliability of each landmark based on measurement variability Methods: Eight cadaveric specimens were dissected to expose the following landmarks on the femur: MPFL footprint, AT, ME, and GT. Using the MicroScribe 3D digitizer, each landmark was projected into a 3-dimensional coordinate system and reconstructed into a complex, closed polygon. For each specimen tubercle, the base surface area, volume, height, base:height ratio, sulcus point, and distance from the MPFL footprint center were calculated. Levene's test was performed to evaluate differences in variance of the morphologic parameters between the three osseous structures. Results: The ME had significantly greater variance in volume than the GT (P ¼ .032), and the AT (17.5 AE 3.9) and GT (19.5 AE 3.6) were significantly less variable in base:height ratio than the ME (95.3 AE 19.2; P < .001). The GT was the closest to the MPFL footprint center (7.1 AE 3.1 mm) compared with the AT (13.4 AE 3.6 mm, P ¼ .002) and ME (13.2 AE 2.7 mm, P ¼ .003). However, the tubercles were equally variable in terms of distance to the MPFL footprint center (P ¼ .86). Lastly, the sulcus point was estimated to be on average 1.9 AE 2.9 mm distal and 2.0 AE 2.0 mm posterior to the MPFL center point. Conclusions: The 3 major osseous landmarks of the medial femur have significantly different variances in volume and base:height ratio. Specifically, the variability and elongated morphology of the ME differentiated this landmark from the AT and GT, which demonstrated the most consistent morphology. Clinical Relevance: The results of this study may be useful to accurately locate landmarks for femoral tunnel placement and determine the isometric MPFL point during reconstruction.