Medial patellofemoral ligament reconstruction in children: do osseous abnormalities matter?
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Management of post-traumatic patellar instability in children with osseous abnormalities is challenging because of the presence of an open physis. The aim of our study was to compare the rate of recurrence after isolated reconstruction of the medial patellofemoral ligament (MPFL) in children with or without osseous abnormalities.
The medical records of 25 children (27 knees) with recurrent patellar dislocation were reviewed. Each child underwent an isolated reconstruction of the MPFL using a hamstring graft. At the last follow-up, a clinical and radiographic evaluation was performed, including assessment of functional outcomes based on the Kujala score. Patients were compared in terms of the occurrence of a pre-existing osseous abnormality.
The mean age at the time of the surgery was 13.8 years. Eleven patients had trochlear dysplasia (40%), three had a patella alta (11%) and seven had an increased TT-TG (26%). The recurrence rate was 3.7% (one patient), after a mean follow-up of 41.1 months. Recurrence was not more frequent in patients with preoperative anatomical predisposing factors. The mean Kujala score was 95. The mean time to return to practicing sports was 7.1 months.
Isolated MPFL reconstruction is an effective option for the management of post-traumatic patellofemoral instability in skeletally immature patients. The results of this technique seem to be independent on either proximal or distal misalignments such as trochlear dysplasia, patella alta, or increased TT-TG.
KeywordsMedial patellofemoral ligament (MPFL) Isolated reconstruction Trochlear dysplasia Increased tibial tuberosity-trochlear groove (TT-TG) Patella alta
SP received grants from the Société Française de Chirurgie Orthopédique et Traumatologie (SOFCOT) and from the Société Française de Chirurgie Orthopédique Pédiatrique (SOFOP) and from the Association pour le Développement de la Recherche Médicale (ADEREM).
Compliance with ethical standards
Conflict of interest
None of the authors declare any conflict of interest.
- 4.Petri M, von Falck C, Broese M et al (2013) Influence of rupture patterns of the medial patellofemoral ligament (MPFL) on the outcome after operative treatment of traumatic patellar dislocation. Knee Surg Sport Traumatol Arthrosc 21:683–689. https://doi.org/10.1007/s00167-012-2037-z CrossRefGoogle Scholar
- 13.Pesenti S, Blondel B, Armaganian G, et al (2016) The lateral wedge augmentation trochleoplasty in a pediatric population. J Pediatr Orthop B 1. doi: https://doi.org/10.1097/BPB.0000000000000395
- 18.Malecki K, Fabis J, Flont P et al (2016) Preliminary results of two surgical techniques in the treatment of recurrent patellar dislocation: medial patellofemoral ligament reconstruction versus combined technique of vastus medialis advancement, capsular plasty and roux-Goldthwait procedure in tr. Int Orthop 40:1869–1874. https://doi.org/10.1007/s00264-016-3119-1 CrossRefPubMedGoogle Scholar
- 20.Ostermeier S, Stukenborg-Colsman C, Hurschler C, Wirth C-J (2006) In vitro investigation of the effect of medial patellofemoral ligament reconstruction and medial tibial tuberosity transfer on lateral patellar stability. Arthroscopy 22:308–319. https://doi.org/10.1016/j.arthro.2005.09.024 CrossRefPubMedGoogle Scholar
- 22.Kita K, Tanaka Y, Toritsuka Y et al (2015) Factors affecting the outcomes of double-bundle medial patellofemoral ligament reconstruction for recurrent patellar dislocations evaluated by multivariate analysis. Am J Sports Med 43:2988–2996. https://doi.org/10.1177/0363546515606102 CrossRefPubMedGoogle Scholar
- 23.Clark D, Metcalfe A, Wogan C et al (2017) Adolescent patellar instability. Bone Joint J 99–B:159–170. https://doi.org/10.1302/0301-620X.99B2.BJJ-2016-0256.R1 CrossRefPubMedGoogle Scholar