Top

Published in:

01-06-2018 | Original Paper

Medial patellofemoral ligament reconstruction in children: do osseous abnormalities matter?

Authors: Sebastien Pesenti, Matthieu Ollivier, Jean-Charles Escudier, Mathieu Cermolacce, Alexandre Baud, Franck Launay, Jean-Luc Jouve, Elie Choufani

Published in: International Orthopaedics | Issue 6/2018

Abstract

Purpose

Management of post-traumatic patellar instability in children with osseous abnormalities is challenging because of the presence of an open physis. The aim of our study was to compare the rate of recurrence after isolated reconstruction of the medial patellofemoral ligament (MPFL) in children with or without osseous abnormalities.

Methods

The medical records of 25 children (27 knees) with recurrent patellar dislocation were reviewed. Each child underwent an isolated reconstruction of the MPFL using a hamstring graft. At the last follow-up, a clinical and radiographic evaluation was performed, including assessment of functional outcomes based on the Kujala score. Patients were compared in terms of the occurrence of a pre-existing osseous abnormality.

Results

The mean age at the time of the surgery was 13.8 years. Eleven patients had trochlear dysplasia (40%), three had a patella alta (11%) and seven had an increased TT-TG (26%). The recurrence rate was 3.7% (one patient), after a mean follow-up of 41.1 months. Recurrence was not more frequent in patients with preoperative anatomical predisposing factors. The mean Kujala score was 95. The mean time to return to practicing sports was 7.1 months.

Conclusions

Isolated MPFL reconstruction is an effective option for the management of post-traumatic patellofemoral instability in skeletally immature patients. The results of this technique seem to be independent on either proximal or distal misalignments such as trochlear dysplasia, patella alta, or increased TT-TG.

Zaidi A, Babyn P, Astori I et al (2006) MRI of traumatic patellar dislocation in children. Pediatr Radiol 36:1163–1170. https://doi.org/10.1007/s00247-006-0293-0 CrossRefPubMed

Kepler CK, Bogner E a, Hammoud S et al (2011) Zone of injury of the medial patellofemoral ligament after acute patellar dislocation in children and adolescents. Am J Sports Med 39:1444–1449. https://doi.org/10.1177/0363546510397174 CrossRefPubMed

Askenberger M, Arendt EA, Ekstro m W et al (2016) Medial patellofemoral ligament injuries in children with first-time lateral patellar dislocations: a magnetic resonance imaging and arthroscopic study. Am J Sports Med 44:152–158. https://doi.org/10.1177/0363546515611661 CrossRefPubMed

Petri M, von Falck C, Broese M et al (2013) Influence of rupture patterns of the medial patellofemoral ligament (MPFL) on the outcome after operative treatment of traumatic patellar dislocation. Knee Surg Sport Traumatol Arthrosc 21:683–689. https://doi.org/10.1007/s00167-012-2037-z CrossRef

Desio SM, Burks RT, Bachus KN (1998) Soft tissue restraints to lateral patellar translation in the human knee. Am J Sports Med 26:59–65. https://doi.org/10.1177/03635465980260012701 CrossRefPubMed

Wilson A, Afarin A, Shaw C et al (2013) Magnetic resonance imaging findings after acute patellar dislocation in children. Orthop J Sport Med 1:2325967113512460. https://doi.org/10.1177/2325967113512460 CrossRef

Lind M, Enderlein D, Nielsen T et al (2016) Clinical outcome after reconstruction of the medial patellofemoral ligament in paediatric patients with recurrent patella instability. Knee Surg Sport Traumatol Arthrosc 24:666–671. https://doi.org/10.1007/s00167-014-3439-x CrossRef

Nwachukwu BU, So C, Schairer WW et al (2016) Surgical versus conservative management of acute patellar dislocation in children and adolescents: a systematic review. Knee Surg Sports Traumatol Arthrosc 24:760–767. https://doi.org/10.1007/s00167-015-3948-2 CrossRefPubMed

Dejour H, Walch G, Nove-Josserand L, Guier C (1994) Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2:19–26CrossRefPubMed

10.

Hopper GP, Leach WJ, Rooney BP et al (2014) Does degree of trochlear dysplasia and position of femoral tunnel influence outcome after medial patellofemoral ligament reconstruction? Am J Sports Med 42:716–722. https://doi.org/10.1177/0363546513518413 CrossRefPubMed

11.

Crosby EB, Insall J (1976) Recurrent dislocation of the patella. Relation of treatment to osteoarthritis. J Bone Joint Surg Am 58:9–13CrossRefPubMed

12.

Sillanpää P, Mattila VM, Visuri T et al (2008) Ligament reconstruction versus distal realignment for patellar dislocation. Clin Orthop Relat Res 466:1475–1484. https://doi.org/10.1007/s11999-008-0207-6 CrossRefPubMedPubMedCentral

13.

Pesenti S, Blondel B, Armaganian G, et al (2016) The lateral wedge augmentation trochleoplasty in a pediatric population. J Pediatr Orthop B 1. doi: https://doi.org/10.1097/BPB.0000000000000395

14.

Davis IS (2011) Landing pattern modification to improve patellofemoral pain in runners: a case series. J Orthop Sports Phys Ther 41:914–919. https://doi.org/10.2519/jospt.2011.3771 CrossRefPubMed

15.

Trentacosta NE, Vitale MA, Ahmad CS (2009) The effects of timing of pediatric knee ligament surgery on short-term academic performance in school-aged athletes. Am J Sports Med 37:1684–1691. https://doi.org/10.1177/0363546509332507 CrossRefPubMed

16.

Nelitz M, Dreyhaupt J, Reichel H et al (2013) Anatomic reconstruction of the medial patellofemoral ligament in children and adolescents with open growth plates: surgical technique and clinical outcome. Am J Sports Med 41:58–63. https://doi.org/10.1177/0363546512463683 CrossRefPubMed

17.

Vavken P, Wimmer MD, Camathias C et al (2013) Treating patella instability in skeletally immature patients. Arthroscopy 29:1410–1422. https://doi.org/10.1016/j.arthro.2013.03.075 CrossRefPubMed

18.

Malecki K, Fabis J, Flont P et al (2016) Preliminary results of two surgical techniques in the treatment of recurrent patellar dislocation: medial patellofemoral ligament reconstruction versus combined technique of vastus medialis advancement, capsular plasty and roux-Goldthwait procedure in tr. Int Orthop 40:1869–1874. https://doi.org/10.1007/s00264-016-3119-1 CrossRefPubMed

19.

Fabricant PD, Ladenhauf HN, Salvati EA, Green DW (2014) Medial patellofemoral ligament (MPFL) reconstruction improves radiographic measures of patella alta in children. Knee 21:1180–1184. https://doi.org/10.1016/j.knee.2014.07.023 CrossRefPubMed

20.

Ostermeier S, Stukenborg-Colsman C, Hurschler C, Wirth C-J (2006) In vitro investigation of the effect of medial patellofemoral ligament reconstruction and medial tibial tuberosity transfer on lateral patellar stability. Arthroscopy 22:308–319. https://doi.org/10.1016/j.arthro.2005.09.024 CrossRefPubMed

21.

Mani S, Kirkpatrick MS, Saranathan A et al (2011) Tibial tuberosity osteotomy for patellofemoral realignment alters tibiofemoral kinematics. Am J Sports Med 39:1024–1031. https://doi.org/10.1177/0363546510390188 CrossRefPubMedPubMedCentral

22.

Kita K, Tanaka Y, Toritsuka Y et al (2015) Factors affecting the outcomes of double-bundle medial patellofemoral ligament reconstruction for recurrent patellar dislocations evaluated by multivariate analysis. Am J Sports Med 43:2988–2996. https://doi.org/10.1177/0363546515606102 CrossRefPubMed

23.

Clark D, Metcalfe A, Wogan C et al (2017) Adolescent patellar instability. Bone Joint J 99–B:159–170. https://doi.org/10.1302/0301-620X.99B2.BJJ-2016-0256.R1 CrossRefPubMed

24.

Ambrožič B, Novak S (2016) The influence of medial patellofemoral ligament reconstruction on clinical results and sports activity level. Phys Sportsmed 44:133–140. https://doi.org/10.1080/00913847.2016.1148561 CrossRefPubMed

25.

Tompkins MA, Arendt EA (2015) Patellar instability factors in isolated medial patellofemoral ligament reconstructions--what does the literature tell us? A systematic review. Am J Sports Med 43:2318–2327. https://doi.org/10.1177/0363546515571544 CrossRefPubMed

Title: Medial patellofemoral ligament reconstruction in children: do osseous abnormalities matter?
Authors: Sebastien Pesenti
Matthieu Ollivier
Jean-Charles Escudier
Mathieu Cermolacce
Alexandre Baud
Franck Launay
Jean-Luc Jouve
Elie Choufani
Publication date: 01-06-2018
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 6/2018
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-017-3750-5

At a glance: The STEP trials

Springer Medicine

Medial patellofemoral ligament reconstruction in children: do osseous abnormalities matter?

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 6/2018

Three-dimensional navigation-guided percutaneous screw fixation for nondisplaced and displaced pelvi-acetabular fractures in a major trauma centre

Differential expression of adipokines in knee osteoarthritis patients with and without metabolic syndrome

Morphological variation of the anterior inferior iliac spine affects hip range of motion in flexion after rotational acetabular osteotomy

Hip osteonecrosis and pregnancy in healthy women

Heterotopic ossification around the knee after tibial nailing and ipsilateral antegrade and retrograde femoral nailing in the treatment of floating knee injuries

Pre-operative templating for knee arthroplasty shows low accuracy with standard X-rays