Medial patellofemoral ligament and medial patellotibial ligament reconstruction in children: preliminary results

Abstract

ObjectiveThe aim of this study was to evaluate the reconstruction of the medial patellofemoral ligament associated with the medial patellotibial ligament in skeletally immature patients.MethodThis 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.ResultsThe 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.ConclusionThe 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.

Combined medial patellofemoral and medial patellotibial reconstruction for patellar instability: a PRISMA systematic review

“…In the analysed studies, most authors used hamstrings autografts, such as the gracilis tendon [37], preserving their tibial attachment [13,14,22,30,32]. In particular, two had free ends fixed in the tibia [24,29,31], eight used hamstrings [13,14,22,[29][30][31][32]37], and one used the medial portion of the patellar and quadriceps tendons using anchors to fix the grafts in femoral and tibial attachments [24].…”

“…Furthermore, in three studies femoral tunnel fixation was undertaken using interference screws, with the proximal end of the hamstring graft employed to reconstruct the MPFL [13,22,30], in three other studies anchors were used to fix the semitendinosus grafts to the femur [29,31,32], while in one study the free end of the graft was looped and sutured to the adductor magnus tendon [37].…”

“…The complications reported included wound infections [29,41], quadriceps atrophy and subjective instability complaints [32], limitation of the range of motion (ROM) [22,29] and effusion of the knee [13]. Three studies reported no complications in a total of 67 patients [14,30,31]. Wound complications, in a recent systematic review, were 11.9% overall, which may be related to extensive exposure and releases performed [42].…”

“…In the early 2000s, following the introduction of the isolated MPFL reconstruction, MPTL reconstruction fell out of favour. More recently, however, combined MPFL and MPTL reconstruction has been reported [13,14,[22][23][24][29][30][31][32].…”

Medial Patellofemoral Ligament Reconstruction and Nonanatomic Stabilization Techniques in Skeletally Immature Patients

“…At the end, the graft is secured at the proximal pole of the patella with bioabsorbable sutures. 32 In 2017, Sadigursky et al 33 (►Fig. 4C) described a variation of Giordano's 32 and Nietosvaara's 31 techniques.…”