Double-Bundle Quadriceps Tendon Autograft for Reconstruction of the Medial Patellofemoral Complex to Manage Recurrent Patellar Dislocation in Patients With Open Physes

Zein, Assem Mohamed Noureldin; Hassan, Alaa

doi:10.1016/j.eats.2022.12.004

Cited by 3 publications

(4 citation statements)

References 28 publications

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“…All surgeries were performed by a single senior surgeon (Z.A.M.). For this study, we adopted a modification of the treatment technique described by Zein et al for MPFL reconstruction [ 19 ]. .…”

Section: Methodsmentioning

confidence: 99%

Outcomes of surgical treatment of patellar instability in children with Down syndrome

Zein,

Hassan,

Soliman

et al. 2024

J Orthop Surg Res

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Background patellar instability is a relatively frequent musculoskeletal disorder in children with Down syndrome (DS). However, such a condition has seldom been studied in the literature, even less its surgical treatment. Different techniques have been offered for this condition; the evidence for surgical options is scarce and primarily based on case reports or case series with few patients and heterogeneous techniques. Given this background, we aimed to evaluate the outcomes of a uniform kind of surgical procedure for such a condition that combined lateral soft tissue release, medial patellofemoral ligament (MPFL) reconstruction (using a partial-thickness quadriceps tendon autograft), the Roux-Goldthwait procedure, and V-Y quadricepsplasty (if needed). Materials and methods This retrospective study involved 11 skeletally immature patients (12 knees; 9 males and 2 females), 5.5 to 14.1 years of age, with DS who had patellofemoral instability (PFI) and were managed by this technique between October 2018 and March 2020. Preoperative radiography, CT scan, and MRI were performed to evaluate the physis status, lower limb alignment, patellar height, trochlear morphology, and any associated knee pathology. A functional knee assessment was done by using the Kujala score and the modified Lysholm score. Results The mean time of follow-up (± SD) was 47.7 ± 5.8 months (range: 39–56). Pre-operatively, the Kujala score (± SD) was 52.6 ± 14.3 (range: (31–74), and at final follow-up, it was 92.2 ± 4.4 (range: (88–98), showing a significant improvement (P < 0.001). The preoperative modified Lysholm score (± SD) was 54.3 ± 8.1 (range: 39–62), and at final follow-up it was 92.4 ± 5.3 (range: 82–96), showing a significant improvement (P < 0.001). All patients had a stable patella without a recurrence of instability and regained full ROM. There was no incidence of a patellar fracture or femoral physis injury. Conclusions Our proposed technique of combined soft tissue procedures, including lateral soft tissue release, MPFL reconstruction (using a partial-thickness quadriceps tendon autograft), the Roux-Goldthwait procedure, and V-Y quadricepsplasty, was an effective method for treating patellar instability in children with DS while avoiding physeal injury and patellar fracture. Functional scores and radiological outcomes were improved. Level of evidence IV; retrospective case series.

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Section: Methodsmentioning

confidence: 99%

Outcomes of surgical treatment of patellar instability in children with Down syndrome

Zein,

Hassan,

Soliman

et al. 2024

J Orthop Surg Res

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“…For this study, we adopted the treatment technique described by Zein and Hassan. 59 In brief, an arthroscopic knee examination was performed and included management of any intra-articular meniscal or chondral pathology as well as evaluation of patellar tracking. A partial-thickness QT autograft was harvested through a midline skin incision, measuring 7 to 8 cm long, 10 to 15 mm wide, and 2 to 3 mm thick.…”

Section: Methodsmentioning

confidence: 99%

“…Several MPFC reconstruction (MPFCR) techniques have recently evolved using different types of grafts and fixation implants. 15 , 33 , 56 , 59 …”

mentioning

confidence: 99%

“…Several MPFC reconstruction (MPFCR) techniques have recently evolved using different types of grafts and fixation implants. 15,33,56,59 Many MPFLR techniques use either patellar bony tunnels or sockets that place the proportionately smaller patella in children and adolescents at higher risk of fracture 1,28,44,48 and/or femoral tunnels that place the femoral physis at risk of injury. 50 Although the soft tissue pulley technique does not place open growth plates at risk, it does not allow for anatomic MPFLR and has inferior clinical results.…”

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Outcomes of an All–Soft Tissue Fixation Technique for Reconstruction of the Medial Patellofemoral Complex Using Double-Bundle Quadriceps Tendon Autograft for Recurrent Patellar Dislocation in Skeletally Immature Patients

Zein,

Allam,

Hassan

et al. 2024

Orthopaedic Journal of Sports Medicine

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Background: Patellar fracture, femoral physis injury, and recurrent instability are concerning complications in medial patellofemoral ligament (MPFL) reconstruction (MPFLR) techniques for recurrent patellar dislocation in children and adolescents. Purpose: To evaluate the outcomes of an anatomic all–soft tissue fixation technique for reconstruction of the medial patellofemoral complex (MPFC) using a double-bundle quadriceps tendon (QT) autograft for recurrent patellar dislocation in skeletally immature patients. Study Design: Case series; Level of evidence, 4. Methods: This retrospective study involved 24 skeletally immature patients (24 knees; 16 women and 8 men; age range, 9.5-15 years) with recurrent patellar dislocation who underwent MPFC reconstruction using a double-bundle QT autograft between September 2018 and January 2021. Only soft tissue suture fixation was used on the femoral and patellar sides of the 2 bundles of the QT. Radiographs, computed tomography, and magnetic resonance imaging were used to evaluate physeal status, lower limb alignment, patellar height and tilt, trochlear morphology, tibial tubercle-trochlear groove distance, and any associated knee pathology. Functional outcomes were assessed with the Kujala score, the visual analog scale (VAS) for pain, and the grading system of Insall et al.22 Results: The mean follow-up time was 40 ± 9.6 months (range, 28-56 months). At the final follow-up, the Kujala and VAS pain scores showed a significant improvement versus preoperative scores ( P < .001), and the passive lateral patellar glide showed a significant reduction ( P < .001). All patients had negative apprehension and J signs. Of the 24 patients, 23 regained full range of motion, while 1 patient had a knee flexion deficit. The patellar tilt angle improved significantly at the final follow-up ( P < .001). There was no patellar fracture, femoral physis injury, or recurrence of patellar dislocation. According to the grading system of Insall et al, the results were excellent in 15 knees (62.5%), good in 8 knees (33.3%), fair in 1 knee (4.2%), and no knees showed poor results. Conclusion: Reconstruction of the MPFC using a double-bundle QT autograft with an all–soft tissue fixation technique was an effective method for treating patellar instability in skeletally immature patients.

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Double-Bundle Technique for the Reconstruction of the Proximal Medial Patellofemoral Complex, Using the First Layer of the Quadriceps Tendon as a Graft

Martin-Alguacil,

Moral Nestares,

Fernández-Domínguez

et al. 2024

Arthroscopy Techniques

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Double-Bundle Quadriceps Tendon Autograft for Reconstruction of the Medial Patellofemoral Complex to Manage Recurrent Patellar Dislocation in Patients With Open Physes

Cited by 3 publications

References 28 publications

Outcomes of surgical treatment of patellar instability in children with Down syndrome

Outcomes of surgical treatment of patellar instability in children with Down syndrome

Outcomes of an All–Soft Tissue Fixation Technique for Reconstruction of the Medial Patellofemoral Complex Using Double-Bundle Quadriceps Tendon Autograft for Recurrent Patellar Dislocation in Skeletally Immature Patients

Double-Bundle Technique for the Reconstruction of the Proximal Medial Patellofemoral Complex, Using the First Layer of the Quadriceps Tendon as a Graft

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