Anatomical reconstruction of the medial patellofemoral ligament in children with open growth-plates (original) (raw)
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Revista Brasileira de Ortopedia (English Edition)
The aim of this study was to evaluate the reconstruction of the medial patellofemoral ligament associated with the medial patellotibial ligament in skeletally immature patients. Method: This is a case series study in patients with patellar instability with open physis. In total, seven patients were evaluated: four males and three females were operated using the proposed technique. Patients with open physis who had more than two episodes of recurring patellar dislocation were included. No patients underwent additional procedures. The distance from the anterior tibial tuberosity to the trochlea grove (TT-TG) was measured in all patients. On physical examination, the inverted J-sign, the apprehension sign, and the knee range of motion parameters were used in the pre-and post-operative period. In addition, the Kujala and Lysholm scores were applied before and 12 months after surgery. The results were analyzed with the Wilcoxon test. Results: The mean age of the patients was 11.28 in both genders. Comparing the data of the pre-and post-operative period, the inverted J-sign was present in six patients (85.7%) vs. absent in one (14.3%). The apprehension sign was absent in cases in the postoperative period; the range of motion was 117.85 ± 8.09 vs. 148.57 ± 3.77. The Kujala score was 42.57 ± 8.9 vs. 88.57 ± 5.09 and the Lysholm scores were classified as excellent or good in 28.6% and 71.4%, respectively. Conclusion: The combined reconstruction of the medial patellofemoral ligament combined with the medial patellotibial ligament in skeletally immature patients with predisposing factors, presents satisfactory results without episodes of recurrence or residual subluxation; according to these preliminary results, it should be considered as a treatment option.
Dynamic–Anatomical Reconstruction of Medial Patellofemoral Ligament in Open Physis
Arthroscopy Techniques, 2020
Patellar dislocation is a common knee problem, 10 times more frequent in childhood and adolescence. Medial patellofemoral ligament is injured up to 94% of the time, and its reconstruction is effective in terms of stabilization of the patella. However, distal femoral physis can be damaged with different techniques of reconstruction, due to the location of the femoral footprint. The purpose of this Technical Note is to describe a quasi-anatomical and dynamic reconstruction of the medial patellofemoral ligament, using no tunnel in the femur, passing the graft behind the adductor tendon, and fixing it with one tunnel in the patella and one passage through the quadriceps tendon.
The Relationship of the Femoral Physis and the Medial Patellofemoral Ligament in Children
Journal of Pediatric Orthopaedics, 2014
Background: Patellar dislocations are common in skeletally immature athletes, and the medial patellofemoral ligament (MPFL) is an important primary restraint to lateral patellar translation. The relationship between the MPFL femoral origin footprint and femoral physis is unclear. The purpose of this study was to evaluate the MPFL femoral origin footprint and its relationship to the femoral physis in skeletally immature anatomic specimens. Methods: Six skeletally immature cadaver knee specimens were examined through gross dissection (group A: 1, 11, and 11 mo; and group B: 8, 10, and 11 y). Metallic markers were placed at the center of the MPFL femoral origin footprint. Computed tomography scans for each specimen were analyzed. The MPFL footprint width, and the vertical distances from the center and proximal extent of the MPFL footprint to the medial aspect of the physis were measured. Results: The mean width of the MPFL femoral origin footprint was 0.70 cm (0.48 to 1.09 cm) and 1.12 cm (1.03 to 1.29 cm) for groups A and B, respectively. The mean distance from the center of the MPFL origin footprint to medial aspect of the distal femoral physis was 0.90 cm (0.52 to 1.30 cm) and 0.40 cm (0.00 to 0.86 cm) distal to the physis for groups A and B, respectively. The mean distance from the proximal extent of the MPFL origin footprint to the medial aspect of the femoral physis was À0.55 cm (À0.28 to À1.03 cm) and 0.16 cm (À 0.34 to 0.64 cm) for groups A and B, respectively. Conclusions: All subjects were found to have a center of the MPFL origin footprint at or below the physis. The proximal extent of the MPFL origin footprint was found to extend above the physis in the 2 older specimens. Clinical Relevance: The relationship of the MPFL origin footprint to the femoral physis in the skeletally immature is not well understood. These dissections may be useful to surgeons performing MPFL reconstructions in skeletally immature patients.
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.
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.
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.
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 ...