Anatomical reconstruction of the medial patellofemoral ligament in children with open growth-plates

Aims and Objectives: Trochlear dysplasia is the most important risk factor to patellofemoral instability in adolescents, therefore trochleoplasty to reshape the trochlear groove is the treatment of choice in patients with severe trochlear dysplasia. However, in the presence of open growth plates there is a potential risk of injury of the distal femoral growth plate and subsequent growth disturbance. Therefore, most authors do not recommend trochleoplasty in skeletally immature patients. The effect of trochleoplasty on femoral growth when performed before closure of the distal femoral physis remains unclear. The hypothesis of the study was, that In patients with open growth plates and an expected growth of less than two years trochleoplasty does not cause growth disturbance of the distal femur. Materials and Methods: 18 consecutive adolescents (18 knees) with open physes and severe trochlear dysplasia underwent trochleoplasty. Pre- and postoperative radiographic examination included AP and lateral views to assess leg axis and patella alta. Preoperatively a radiograph of the left hand was performed to measure skeletal age. MRI was performed to evaluate trochlear dysplasia and tibial tubercle-trochlear groove (TT-TG) distance. Evaluation included pre- and postoperative physical examination with evaluation of leg length and leg axis, Kujala score, Activity Rating Scale (ARS) and Tegner activity score. Results: The average age at the time of operation was 12.6 y (range, 12.2 - 13.3) in girls and 14.5 y (14.0 - 15.4) in boys. The average follow-up after operation was 2.3 years after surgery (range, 2.0 - 3.0 years). At follow-up in all patients the growth plates of the knee were closed. Impairment of growth of the distal femur was neither found clinically nor radiographically. No recurrent dislocation occurred. The median Kujala score and median VAS showed significant improvement (p < 0.01). The activity level according to the Tegner activity score did not change statistically significant. Conclusion: In this study, trochleoplasty as a treatment for patellofemoral instability in patients with open physes and an expected growth of not more than two years showed good clinical results without redislocation and no growth disturbance. Therefore, in selected adolescent patients with severe trochlear dysplasia trochleoplasty can be safely performed up to two years before the projected end of growth.

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No Growth Disturbance After Trochleoplasty for Recurrent Patellar Dislocation in Adolescents With Open Growth Plates

The American Journal of Sports Medicine ◽

10.1177/0363546518794671 ◽

2018 ◽

Vol 46 (13) ◽

pp. 3209-3216 ◽

Cited By ~ 14

Author(s):

Manfred Nelitz ◽

Jens Dreyhaupt ◽

Sean Robert March Williams

Keyword(s):

Trochlear Dysplasia ◽

Patellofemoral Instability ◽

Trochlear Groove ◽

Growth Disturbance ◽

Growth Plates ◽

Leg Axis ◽

Kujala Score ◽

Open Growth Plates ◽

Open Growth

Background: Trochlear dysplasia is the most important risk factor for patellofemoral instability among adolescents; therefore, trochleoplasty to reshape the trochlear groove is the treatment of choice for patients with high-grade trochlear dysplasia. However, in the presence of open growth plates, there is a potential risk of injury to the distal femoral growth plate and subsequent growth disturbance. As such, most authors do not recommend trochleoplasty for skeletally immature patients. The effect of trochleoplasty on femoral growth when performed before closure of the distal femoral physis remains unclear. Hypothesis: For patients with open growth plates and an expected growth <2 years, trochleoplasty does not cause growth disturbance of the distal femur. Study Design: Case series; Level of evidence, 4. Methods: Eighteen consecutive adolescents (18 knees) with open physes and severe trochlear dysplasia underwent thin flap trochleoplasty. Pre- and postoperative radiographic examination included anteroposterior and lateral views to assess leg axis and patella alta. A preoperative radiograph of the left hand was performed to measure skeletal age. Magnetic resonance imaging was performed to evaluate trochlear dysplasia and tibial tubercle–trochlear groove distance. Evaluation included pre- and postoperative physical examination with evaluation of leg length and leg axis, Kujala score, and Tegner activity score. Results: The median age at the time of operation was 12.6 years (range, 12.2-13.3 years) for girls and 14.5 years (14.0-15.4 years) for boys. The mean follow-up after operation was 2.3 years after surgery (range, 2.0-3.0 years). At follow-up for all patients, the growth plates of the knee were closed. Impairment of growth of the distal femur was found neither clinically nor radiographically. No recurrent dislocation occurred. The median Kujala score improved significantly from 67 (range, 54-75) preoperatively to 89.5 (range, 78-96) at follow-up ( P < .01). The median visual analog scale showed significant pre- to postoperative improvement from 5 (range, 3-7) to 1 (range, 0-3) ( P < .01). The activity level according to the Tegner activity score did not change significantly. Conclusion: In this study, trochleoplasty as a treatment for patellofemoral instability of patients with open physes and an expected growth of not more than 2 years showed good clinical results without redislocation and with no growth disturbance. Therefore, for selected adolescent patients with high-grade trochlear dysplasia, trochleoplasty can be safely performed up to 2 years before the projected end of growth.

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Anatomic Reconstruction of the Medial Patellofemoral Ligament in Children and Adolescents With Open Growth Plates

The American Journal of Sports Medicine ◽

10.1177/0363546512463683 ◽

2012 ◽

Vol 41 (1) ◽

pp. 58-63 ◽

Cited By ~ 128

Author(s):

Manfred Nelitz ◽

Jens Dreyhaupt ◽

Heiko Reichel ◽

Julia Woelfle ◽

Sabine Lippacher

Keyword(s):

Medial Patellofemoral Ligament ◽

Trochlear Dysplasia ◽

Patellofemoral Instability ◽

Activity Score ◽

Anatomic Reconstruction ◽

Skeletally Immature ◽

Kujala Score ◽

Open Growth Plates ◽

Femoral Physis ◽

Open Growth

Background: Recurrent lateral patellar dislocation is a common knee injury in the skeletally immature adolescent. Because of the open physis, operative therapy in children is challenging. This study presents the outcomes of a minimally invasive technique for anatomic reconstruction of the medial patellofemoral ligament (MPFL) in children that respects the distal femoral physis. Hypothesis: Anatomic reconstruction of the MPFL in children that maintains the distal femoral physis will prevent redislocation, preserve the distal femoral physis, and improve knee function. Study Design: Case series; Level of evidence, 4. Methods: Twenty-one consecutive patients with patellofemoral instability and open growth plates underwent anatomic reconstruction of the MPFL that maintained the distal femoral growth plate. Preoperative radiographic examination included AP and lateral views to assess patella alta and limb alignment. Magnetic resonance imaging was performed to evaluate trochlear dysplasia and tibial tubercle–trochlear groove (TT-TG) distance. Evaluation included preoperative and postoperative physical examination, Kujala score, and Tegner activity score. Results: The average age at the time of operation was 12.2 years (range, 10.3-13.9). The average follow-up after operation was 2.8 years after surgery (range, 2.0-3.6). No recurrent dislocation occurred, but 2 patients with high-grade trochlear dysplasia still had a positive apprehension sign. The Kujala score significantly improved from 72.9 (range, 37-87) preoperatively to 92.8 (range, 74-100) postoperatively ( P < .01). The Tegner activity score decreased, but not significantly, from 6.0 (range, 3-9) preoperatively to 5.8 (range, 3-9) postoperatively ( P = .48). Conclusion: Anatomic reconstruction of the MPFL that respects the distal femoral physis in skeletally immature patients is a safe and effective technique for the treatment of patellofemoral instability and allows patients to return to sports without redislocation of the patella.

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Anterior Cruciate Ligament Reconstruction Timing in Children with Open Growth Plates: New Surgical Techniques Including All-Epiphyseal

Clinics in Sports Medicine ◽

10.1016/j.csm.2011.07.002 ◽

2011 ◽

Vol 30 (4) ◽

pp. 789-800 ◽

Cited By ~ 9

Author(s):

Eric J. Wall ◽

Gregory D. Myer ◽

Megan M. May

Keyword(s):

Anterior Cruciate Ligament ◽

Anterior Cruciate Ligament Reconstruction ◽

Ligament Reconstruction ◽

Cruciate Ligament ◽

Surgical Techniques ◽

Growth Plates ◽

Cruciate Ligament Reconstruction ◽

Open Growth Plates ◽

Anterior Cruciate ◽

Open Growth

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Forensic age assessment of the knee: proposal of a new classification system using two-dimensional ultrasound volumes and comparison to MRI

European Radiology ◽

10.1007/s00330-020-07343-1 ◽

2020 ◽

Author(s):

Jochen Herrmann ◽

Dennis Säring ◽

Markus Auf der Mauer ◽

Michael Groth ◽

Eilin Jopp-van Well

Keyword(s):

Growth Plate ◽

Age Estimation ◽

High Accuracy ◽

Forensic Age Estimation ◽

Two Dimensional ◽

Epiphyseal Growth Plate ◽

Growth Plates ◽

The Us ◽

Open Growth Plates ◽

Open Growth

Abstract Objectives To assess epiphyseal growth plate closure of the knee for forensic age estimation using an ultrasound (US)-based method and to compare the findings with MRI. Methods Thirty-three healthy male individuals (age, 14.4–19.3 years) were prospectively evaluated for epiphyseal growth plate closure of the right knee by recordings of two-dimensional US volumes and a high-resolution T1-weighted MRI sequence. The degree of epiphyseal growth plate closure was rated independently by two readers for each method using a modality specific three-point scale that differentiates between an open physis (S1), a partially closed physis (S2), and a closed physis (S3). Results The inter-rater agreement was high for the US (Cohen’s kappa (CK): femur 95.2%, tibia 81.3%, fibula 86.3%) and the MRI method (CK: femur 70.2%, tibia 90.8%, fibula 79.8%). The degree of growth plate closure associated positively with advancing age. The US system showed a clearer separation of median ages with lower overlap than the MRI system. Open growth plates on minors (< S3 on femur and tibia) were identified by US with higher sensitivity (1.0 vs. 0.7) and slightly lower specificity (0.7 vs. 0.85) compared with MRI. The examination time was substantially shorter on US than on MRI (2.65 ± 0.91 min vs. 24.72 ± 2.72 min; p < 0.001). Conclusions The US method for evaluation of growth plate closure of the knee can reliably assign male individuals to different ossification stages and identifies minors with high accuracy. More studies with larger numbers are needed to further evaluate this method. Key Points • US is feasible to determine the degree of epiphyseal growth plate closure of the knee, shows a high degree of reliability, and is comparable to MRI. • US of the knee can detect open growth plates on male minors with high accuracy. • US of the knee may be used as a fast, non-invasive imaging tool for forensic age estimation to identify male minors.

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