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Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-05-2012 | Knee

Analysis of failed surgery for patellar instability in children with open growth plates

Authors: Manfred Nelitz, Michael Theile, Daniel Dornacher, Julia Wölfle, Heiko Reichel, Sabine Lippacher

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 5/2012

Abstract

Purpose

Many surgical procedures have been proposed to treat recurrent patellar dislocation in children. In recent years, a more tailored approach considering the underlying pathology has been advocated. The aim of the study was to analyze a group of patients with recurrent patellofemoral instability after unsuccessful operative stabilization (Roux-Goldthwait procedure, lateral release, medial reefing or in combination) in childhood and adolescence.

Methods

A total of 37 children and adolescents with recurrent patellofemoral instability despite previous surgery were analyzed retrospectively. Radiographic examination included AP and lateral views to assess patella alta and limb alignment. MRI was performed to evaluate trochlear dysplasia and tibial tubercle-trochlear groove (TTTG) distance. As a control group, 23 age- and sex-matched adolescents that were treated with a favorable outcome after medial reefing alone or combined with a Roux-Goldthwait procedure were analyzed.

Results

Severe trochlear dysplasia (type B–D according to Dejour) as detected on MRI scans was found significantly more often in the study group (89%) than in the control group (21%). No statistical difference of patellar height ratio (Insall-Salvati index) and TTTG distance between the two groups could be found.

Conclusion

Of the measured parameters, only the incidence of trochlear dysplasia was increased. Trochlear dysplasia therefore seems to be a major risk factor for failure of operative stabilization of recurrent patellofemoral instability in children and adolescents. The results in children are in consensus with the literature in adults that a more tailored operative therapy including reconstruction of the MPFL and trochleaplasty has to be considered.

Level of evidence

Retrospective study, Level III.

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Title: Analysis of failed surgery for patellar instability in children with open growth plates
Authors: Manfred Nelitz
Michael Theile
Daniel Dornacher
Julia Wölfle
Heiko Reichel
Sabine Lippacher
Publication date: 01-05-2012
Publisher: Springer-Verlag
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 5/2012
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-011-1599-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Analysis of failed surgery for patellar instability in children with open growth plates

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

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