Mid-term outcomes of temporary medial distal femoral hemiepiphysiodesis with and without medial patellofemoral ligament repair for recurrent patellar instability in skeletally immature patients with genu valgum

Abstract

Genu valgum contributes to patellar instability, though outcomes following temporary hemiepiphysiodesis via eight plating are less understood. The purpose of this study was to evaluate the outcomes and need for additional procedures following temporary hemiepiphysiodesis for the treatment of pediatric genu valgum and patellar instability, as well as evaluating the utility of a concurrent medial patellofemoral ligament (MPFL) repair. Patients who underwent medial distal femoral epiphysiodesis for the treatment of genu valgum and recurrent patellar instability were identified. Inclusion criteria were minimum 1-year follow-up and lack of concurrent ligamentous reconstruction. Patients were contacted to complete a questionnaire which included the International Knee Documentation Committee (IKDC) form and questions pertaining to knee function and patient satisfaction. Thirty-one patients aged 12.0 ± 1.9 years underwent 47 guided growth procedures and were included in final analysis. Seventeen knees (36%) required subsequent surgery for patellar instability. All patients requiring subsequent surgery were female, compared with 70% of patients not requiring subsequent surgery (P = 0.017). The MPFL repair group underwent fewer subsequent procedures to address instability, though this difference was NS (17 vs. 46%, P = 0.318). Mean IKDC score at 5.3 years follow-up among 18 survey respondents was 78.6. Medial distal femoral hemiepiphysiodesis may partially address recurrent patellar instability in skeletally immature patients with genu valgum. Concurrent MPFL repair may minimize the need for subsequent procedures to address recurrent instability. While correcting alignment may be helpful, patients should be aware of the potential need for further patellar instability surgery. Level of evidence: IV, case series.

Simultaneous MPFL reconstruction and guided growth result in low rates of recurrent patellofemoral instability

“…Percentages are reported out of the total 25 patients. performed simultaneous MPFL repair in addition to guided growth, noting that 36% required subsequent procedures for recurrent PFI [40]. Overall, our results align with past literature suggesting good radiographic deformity correction and short-term symptom resolution with simultaneous MPFL and guided growth procedures [22].…”

“…Ellsworth et al reported correction of genu valgum from 18.8° to 2.7° postoperatively in their patients with PFI, though their outcome data were presented in aggregate amongst all patients with coronal plane angular deformity with various knee pathologies [10]. Tomasevich et al performed simultaneous MPFL repair in addition to guided growth, noting that 36% required subsequent procedures for recurrent PFI [40]. Overall, our results align with past literature suggesting good radiographic deformity correction and short‐term symptom resolution with simultaneous MPFL and guided growth procedures [22].…”

“…Past work on this topic is limited, with few studies reporting on outcomes after IMGG for PFI in paediatric patients [11,18,38]. Simultaneous MPFL procedures and guided growth have only been described previously in a small series of patients [30], as a repair rather than reconstruction [40] or as part of a larger series on knee pathologies [10], and therefore this study sought to report on the outcomes of these procedures in paediatric and adolescent patients. The authors hypothesised that simultaneous MPFL reconstruction and guided growth would lead to low rates of recurrent PFI and may demonstrate to surgeons that simultaneous MPFL and guided growth is a viable surgical option for patients with recurrent PFI and genu valgum.…”