Medial patellofemoral ligament and medial patellotibial ligament reconstruction in children: preliminary results (original) (raw)
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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.
Medial Patellofemoral Ligament Reconstruction in Adolescents Affected by Patellar Instability
Journal of Functional Morphology and Kinesiology, 2017
Patellar instability is a heterogeneous group of morphological and functional disorders of the knee extensor mechanism. The medial patellofemoral ligament (MPFL) has been recognized as being important in stabilizing the patella and preventing lateral patellar dislocation. Recurrent dislocations in the pediatric population may benefit from surgical intervention. The aim of this study is to retrospectively evaluate adolescent patients treated with surgical reconstruction of medial patello-femoral ligament. Between January 2009 and December 2014, seven patients with patellar instability were treated at the Department of Orthopaedics and Traumatology of the University of Catania, Sicily. Five patients (71.4%) were female and two (28.6%) were male. The mean age at the time of surgery was 14.9 ± 1.1 years (range 13-16 years). All cases were treated with reconstruction of the MPFL. Clinical outcomes and complications were reported. Mean follow-up was 26.1 ± 10.9 months (range 12-46 months). Evaluation at two years after surgery identified an average Knee Society Score (KSS) of 94.3 ± 7.4 (range 78-100). An excellent result was obtained in six patients (85.7%) and a good result was obtained in one patient (14.3%). A recurrence was reported in one patient (14.3%). This study shows that surgical treatment of patellar instability by reconstruction of MPFL leads to satisfying results at mid-term follow-up.
Children
Background: This study aimed to review the data available in the current literature concerning the complications and recurrence of instability following medial patellofemoral ligament (MPFL) reconstruction for patellar instability in young and adolescent patients (those <20 years old). Methods: A systematic review was performed based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Two independent reviewers searched the PubMed, Scopus, EMBASE, and Cochrane databases. The terms “medial patellofemoral ligament” or “MPFL” and “reconstruction” and “young” or “adolescents” or “children” were used. The inclusion criteria for the literature review comprised studies that reported the complications and recurrences of instability in patients who had undergone MPFL reconstruction for patellar instability. Results: In all, 332 patients were included in the review, of which 195 were females (63.5%) and 112 were males (36.5%), and they totaled 352 ...
Knee Surgery, Sports Traumatology, Arthroscopy, 2011
Purpose Patellar instability is a frequent condition in children and adolescents. The problem can be associated with malalignment resulting from different anatomical abnormalities. Several surgical procedures have been suggested for recurrent patellar dislocation consequent to failed conservative treatment. Methods We present an original surgical procedure for reconstructing both the medial patellofemoral (MPFL) and medial patellotibial ligaments (MPTL) by semitendinosus (ST) tendon with gracilis (G) autograft augmentation in skeletally immature patients with recurrent patellar dislocation. Results This technique is effective and permits satisfactory patellar congruency documented by static and dynamic CT. Conclusions The operation is associated with optimal functional results and is minimally invasive, causing no growth disturbance. Level of evidence Expert opinion, Level V.
Archives of Orthopaedic and Trauma Surgery, 2012
Background No standard surgical procedure for medial patellofemoral ligament (MPFL) reconstruction exists in skeletally immature patients with patellar instability. This study aimed to evaluate the clinical effectiveness of a novel reconstruction technique for the MPFL in patients with patellar instability because of non-closure of the epiphyseal line. Methods The ''sandwich'' method was fixation of the patella between a double-stranded semitendinosus tendon through the posterior third of the femoral insertion of the medial collateral ligament (MCL) as a pulley with a titanium interference screw in a single patellar tunnel. Five knees in five patients were studied: four with recurrent and one with habitual patellar dislocations. Subjects underwent MPFL reconstruction with or without lateral release. Patients were evaluated using pre-operative and post-operative physical and radiographic examinations, including apprehension testing, assessment of tilting and congruence angles, medial and lateral shift ratios under stress measured using X-ray imaging, and Kujala and Lysholm scores. Results No patient experienced recurrent post-operative episodes of dislocation or subluxation. By the final followup, patellar apprehension had disappeared in all patients. In addition, all patients showed significant improvement in the following: tilting angle, congruence angle, lateral shift ratio, Kujala score, and Lysholm score. Conclusions The MPFL reconstruction methods, using a double-stranded semitendinosus autograft and sparing the femoral physeal line in non-closure of the epiphyseal line, provide acceptable short-term results for the treatment of patellar instability.
The Knee, 2014
Background: Patellofemoral instability has previously been associated with patella alta. The purpose of this study was to evaluate adolescents undergoing MPFL reconstruction for standardized indices of patellar height on preand post-operative radiographs to determine if these radiographic parameters change after MPFL reconstruction. Methods: Twenty-seven children (mean age 14.9 years old) who underwent MPFL reconstruction without a distal realignment procedure were evaluated pre-and post-operatively for Insall-Salvati Ratio, Modified Insall-Salvati Ratio, and Caton-Deschamps Index by three blinded raters. Intrarater reliability and interrater reliability were calculated for each index, and means of each were compared pre-and post-operatively to determine if MPFL reconstruction was associated with improved patellar height. Results: All three indices of patellar height indicated that there was patella alta present in this cohort preoperatively. Furthermore, all three measures were significantly improved postoperatively (paired t-tests, P b 0.001 for all) to within normal childhood ranges. Interrater reliability was excellent for both the Insall-Salvati Ratio (ICC = 0.89) and Caton-Deschamps Index (ICC = 0.78), and adequate for the Modified Insall-Salvati Ratio (ICC = 0.57); intrarater reliability was excellent for all three (ICCs: 0.91, 0.82, 0.80 respectively). Conclusions: MPFL reconstruction in children using hamstring autograft was associated with consistently improved patellar height indices to within normal childhood ranges. This associated improvement of patellar height as measured on a lateral radiograph may subsequently improve patellofemoral mechanics by drawing the patella deeper and more medially into the trochlear groove.
Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2018
To report outcomes after combined medial patellofemoral ligament (MPFL) and medial patellotibial ligament (MPTL) reconstruction and test associations between prognostic factors and clinical outcomes. It was hypothesised that combined MPFL and MPTL reconstruction would result in significant improvement in function, and that outcomes would be associated with age, sex, Beighton score, concomitant articular lesions, and preoperative function. All combined reconstructions of MPFL and MPTL were reviewed. Inclusion criterion was minimum 2-year follow-up. Exclusion criteria were age at surgery ≥ 35 years and concomitant osteotomies. Kujala, Tegner and Marx scores were completed prospectively. Patients were evaluated at a minimum 2-year follow-up. Associations between potential prognostic factors and Kujala and Tegner scores were tested using bivariate analyses followed by multivariate regression models. Of 22 patients (26 knees), 19 (23 knees) met inclusion criteria, and 16 (20 knees) were ...
Indications for Medial Patellofemoral Ligament Reconstruction: A Systematic Review
Journal of Knee Surgery, 2015
Patellofemoral instability is reported as the second most common cause of traumatic knee hemarthrosis 1 and is commonly seen in young, active patients. 2,3 Complications following a primary patellofemoral dislocation include redislocation (15-49% 1,3-9 ), patellofemoral pain, 3,10 and patellofemoral osteoarthritis. 3,10 Subjective complaints of giving way, instability, decreased physical activity, diminished function, and reduced quality of life have also been described. Furthermore, studies have shown that up to 55% of patients are unable to return to their previous level of physical activity. 7,8 A long-term study by Cofield and Bryan reported on 48 acute primary dislocations treated conservatively and followed for an average of 11 years. 12 Only 25% of patients reported being asymptomatic, with the remaining patients having complaints ranging from a conscious limitation of their activities to avoiding all vigorous sports. In 1997, Mäenpää et al reported results of a longterm study (13-year mean follow-up) on conservative treatment of acute patellar dislocation. 9 In 25% of cases, retropatellar crepitation was observed during physical examination, which was interpreted as a sign of cartilaginous degeneration.