Anatomic Reconstruction of the Medial Patellofemoral Ligament in Children and Adolescents With Open Growth Plates

Nelitz, Manfred; Dreyhaupt, Jens; Reichel, Heiko; Woelfle, Julia V.; Lippacher, Sabine

doi:10.1177/0363546512463683

Cited by 197 publications

(189 citation statements)

References 41 publications

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“…Therefore, the younger the child, the greater the risk of patellar instability, with redislocation rates ranging from 7.14% to 71% after the primary dislocation [23,24]. Consequently, the tendency of the surgeon is to perform soft tissue-based procedures, respecting the physeal and apophyseal integrity [13]. However, adolescent patients with closed growth plates can safely undergo bone realignment procedures [25].…”

Section: Discussionmentioning

confidence: 99%

“…Although it has been used successfully in adults [30,31], it could be indicated for use in adolescents, because it works toward preserving the original MPFL anatomy [13,32]. The procedure consists of the attachment of a semitendinosus tendon autograft near the proximal medial collateral ligament attachment on the femur, as a proxy for the femoral MPFL insertion site [33].…”

Section: Discussionmentioning

confidence: 99%

“…Although non-operative treatment remains the gold standard of treatment after primary patellar dislocation without osteochondral fragments [8][9][10], recurrent dislocations in this population may benefit from surgical intervention. Reconstruction of the MPFL prevents lateral patellar dislocation, reporting good results in the treatment of children [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

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Medial Patellofemoral Ligament Reconstruction in Adolescents Affected by Patellar Instability

Testa

Pavone

Lucenti

et al. 2017

JFMK

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Medial Patellofemoral Ligament Reconstruction in Adolescents Affected by Patellar Instability

Testa

Pavone

Lucenti

et al. 2017

JFMK

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“…Several techniques to reconstruct the MPFL have been advocated by various authors. 2,3 The MPFL insertion on the medial femur has been described as being distal to the adductor tendon insertion and proximal to the femoral insertion of the medial collateral ligament, which is in very close proximity to the medial aspect of the distal femoral growth plate. 1,5-7 Shea et al, 8 in an indirect radiographic study using lateral radiographs, reported that the insertion of the MPFL was 2 to 5 mm proximal to the distal femoral physis.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 Although ligamentous reconstruction in adults has proven to be efficient and is well described in the literature, a limited number of reports of MPFL reconstruction in children with open growth plates is available. Special attention should be focused on the anatomic relation of the MPFL insertion around the distal femoral physis, because the distal femoral physis contributes up to 70% of growth of the femur and 37% of overall lower limb growth.…”

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confidence: 99%

Medial Patellofemoral Ligament Reconstruction Using Hamstring Autograft in Children and Adolescents

Ladenhauf

Berkes

Green

2013

Arthroscopy Techniques

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Abstract:We introduce an anatomic reconstruction technique for the medial patellofemoral ligament using a free hamstring autograft in skeletally immature patients. We dock the 2 ends of the graft in the superior-medial patella using sockets and secure the femoral graft attachment in a socket tunnel distal to the physis. This technique minimizes the risk of injury to the growth plate and still enables accurate and successful anatomic positioning of the hamstring autograft.

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Anatomic physeal‐sparing MPFL reconstruction in skeletally immature patients shows favourable outcomes at a minimum of 24‐month follow‐up

Ntagiopoulos,

Pozzi,

Kalinterakis

et al. 2024

J. exp. orthop.

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PurposeRecurrent patellar dislocation is a prevalent orthopaedic issue among active paediatric and adolescent populations. Bony surgical procedures are not recommended in growing patients; therefore, the focus of surgery is on restoring the medial patellar ligaments, with different reconstructive techniques available. This retrospective case series focuses on the 2‐year outcomes of medial patellofemoral ligament (MPFL) reconstruction in skeletally immature patients with open physis.MethodsTwenty‐four consecutive patients with patellofemoral instability and open growth plates underwent anatomic MPFL reconstruction with a physeal‐sparing technique. All subjects have had more than three episodes of true patellar dislocations. Preoperative radiographic examination included anteroposterior and lateral views to assess patella alta and limb alignment. Magnetic resonance imaging was performed to evaluate trochlear dysplasia and tibial tubercle–trochlear groove (TT–TG) distance. The patients were questioned regarding complications and clinical outcomes using the visual analogue scale (VAS), Kujala and Paediatric International Knee Documentation Committee (Pedi‐IKDC) score. Variables were evaluated using paired t test with significance at p < 0.05.ResultsThe mean age at the time of operation was 13.04 years (9–16 years). The cohort was followed for a mean duration of 38.66 months (24–86 months). The mean time from injury to surgery was 50.45 days (16–80 days). No growth arrest, limb‐length discrepancies or angular deformities were observed post‐operatively during the whole follow‐up period. No patellar re‐dislocations were recorded throughout the study period. The VAS score improved significantly from 5.67 (4–8) to 1.88 (0–4) (p < 0.01). The Kujala score improved significantly from 64.67 (44–81) preoperatively to 87.58 (77–100) post‐operatively (p < 0.01). The Pedi‐IKDC also increased significantly from 58.81 (34.80–77.70) preoperatively to 90.64 (70.70–100) post‐operatively (p < 0.01). The vast majority of patients (87.5%) returned to their pre‐injury activity level. Boys scored better than girls in VAS, Pedi‐IKDC and Kujala score post‐operatively, but these differences were not statistically significant.ConclusionPhyseal‐sparing MPFL reconstruction in children and adolescents yields excellent midterm results and allows patients to return to sports without redislocation of the patella. Boys scored better than girls in VAS, Pedi‐IKDC and Kujala score post‐operatively, but these differences were not statistically significant.Level of EvidenceIV: case series with no comparative group.

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Anatomic Reconstruction of the Medial Patellofemoral Ligament in Children and Adolescents With Open Growth Plates

Abstract: Anatomic reconstruction of the MPFL that respects the distal femoral physis in skeletally immature patients is a safe and effective technique for the treatment of patellofemoral instability and allows patients to return to sports without redislocation of the patella.

Cited by 197 publications

References 41 publications

Medial Patellofemoral Ligament Reconstruction in Adolescents Affected by Patellar Instability

Medial Patellofemoral Ligament Reconstruction in Adolescents Affected by Patellar Instability

Medial Patellofemoral Ligament Reconstruction Using Hamstring Autograft in Children and Adolescents

Anatomic physeal‐sparing MPFL reconstruction in skeletally immature patients shows favourable outcomes at a minimum of 24‐month follow‐up

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