scholarly journals New trochlea - old patella. Do both fit together?

2019 ◽  
Vol 7 (6_suppl4) ◽  
pp. 2325967119S0023
Author(s):  
Peter Balcarek ◽  
Felix Zimmermann
Keyword(s):  
Patellofemoral Joint ◽  
Normal Values ◽  
Trochlear Dysplasia ◽  
Mpfl Reconstruction ◽  
Cartilage Defects ◽  
Control Group ◽  
Clear Correlation ◽  
Study Group ◽  
Contact Ratio ◽  
Patellar Tilt

Aims and Objectives: Trochlear dysplasia has been established as the most common and impactful predisposing factor of lateral patellar dislocation (LPD). In addition, a clear correlation between trochlear dysplasia and the development of cartilage defects and osteoarthritis in the patellofemoral joint has been established. Though current literature increasingly supports trochleoplasty procedures for the treatment of LPD only few data evaluated the actual improvements of the cartilaginous patella-trochlea congruence after deepening trochleoplasty procedure. The aim of this study was therefore to evaluate the patella-trochlea congruence before and after a deepening trochleaplasty and medial patellofemoral ligament (MPFL) reconstruction in severe trochlear dysplasia. The hypothesis was that the deepening trochleoplasty and MPFL reconstruction is able to correct patella-trochlea congruence to physiological parameters. Materials and Methods: The study group comprised 20 patients. All patients suffered recurrent LPD due to severe trochlear dysplasia and underwent a deepening ‘Bereiter’ trochleoplasty and MPFL reconstruction. Pre- and postoperative magnetic resonance imaging (MRI) investigations were used to assess the patella-trochlea contact ratio, the posterior patellar edge - trochlea groove ratio, and the lateral patellar inclination angle (patellar tilt). Measurements were obtained using open-source PACS workstation software (OsiriX v. 5.8.5, Pixmeo SARL, CH1233 Bernex, Switzerland). All parameters were compared to a control group of 20 at random selected patients without any medical history related to the patellofemoral joint. A paired two-tailed t-test was used to test for differences between the pre- and postoperative measurements within the study group. A one-way analysis of variance (ANOVA) with Bonferoni post-test adjustment was used to test for differences between all measurement series. The level of significance was set at 0.05. Results: Preoperatively, all parameters of the study group were significantly different when compared to the control group. This meant a reduced patella-trochlea contact ratio (0.38 ± 0.13 vs. 0.67 ± 0.09; p<0.001), an increased patellar lateralization (0.81 ± 0.10 vs. 0.98 ± 0.03; p<0.001), and increased patellar tilt (27.1° ± 7.7° vs. 9.4° ± 5.7°; p<0.001). Postoperatively, all parameters showed a significant improvement. The patella-trochlea contact ratio increased to a mean of 0.65 ± 0.11 (p<0.0001), patellar lateralization improved to a mean posterior patellar edge - trochlea groove ratio of 0.94 ± 0.06 (<0.0001), and patellar tilt reduced to a mean of 15.05° ± 4.2° (p< 0.0001). All parameters reached normal values when compared to the control group (all p >0.05). Conclusion: Findings of this study indicate that in severe trochlear dysplasia deepening trochleoplasty and MPFL reconstruction is able to correct patellar alignment und patellar-trochlear congruence to normal values.

Deepening trochleoplasty and medial patellofemoral ligament reconstruction normalize patellotrochlear congruence in severe trochlear dysplasia

2019 ◽  
Vol 101-B (3) ◽  
pp. 325-330 ◽  
Author(s):  
P. Balcarek ◽  
F. Zimmermann
Keyword(s):  
Contact Area ◽  
Medial Patellofemoral Ligament ◽  
Trochlear Dysplasia ◽  
Mpfl Reconstruction ◽  
Control Group ◽  
Study Group ◽  
Trochlear Groove ◽  
Contact Ratio ◽  
Patellar Tilt ◽  
Patellofemoral Alignment

Aims The aim of this study was to evaluate cartilaginous patellotrochlear congruence and patellofemoral alignment parameters after deepening trochleoplasty in severe trochlear dysplasia. Patients and Methods The study group comprised 20 patients (two male, 18 female; mean age 24 years (16 to 39)) who underwent deepening trochleoplasty and medial patellofemoral ligament (MPFL) reconstruction for the treatment of recurrent lateral patellar dislocation due to severe trochlear dysplasia (Dejour type B to D). Pre- and postoperative MRI investigations of the study group were compared with MRI data of 20 age- and gender-matched control patients (two male, 18 female; mean age 27 years (18 to 44)) regarding the patellotrochlear contact ratio, patellotrochlear contact area, posterior patellar edge-trochlear groove ratio, and patellar tilt. Results Preoperatively, all parameters in the study group indicated significant patellar malalignment, including a reduced patellotrochlear contact ratio (mean 0.38 (0.13 to 0.59) vs mean 0.67 (0.48 to 0.88); p < 0.001), reduced contact area (mean 128 mm2 (87 to 190) vs mean 183 mm2 (155 to 227); p < 0.001), increased patellar lateralization (mean 0.82 (0.55 to 1.0) vs mean 0.99 (0.93 to 1.1); p < 0.001) and increased patellar tilt (mean 25.8° (8.1° to 43.0°) vs mean 9.1° (0.5° to 16.8°); p < 0.001). Postoperatively, all parameters in the study group improved significantly and reached normal values compared with the control group. The patellotrochlear contact ratio increased to a mean of 0.63 (0.38 to 0.85) (p < 0.001), the contact area increased to a mean of 187 mm2 (101 to 255) (p < 0.001), the posterior patellar edge-trochlear groove ratio improved to a mean of 0.96 (0.83 to 0.91) (p < 0.001), and the patellar tilt decreased to a mean of 13.9° (8.1° to 22.1°) (p < 0.001) postoperatively. Conclusion Deepening trochleoplasty and MPFL reconstruction normalized the patellotrochlear congruence and patellofemoral alignment parameters. Modifying the dysplastic trochlea involves approximating the trochlear morphology to the shape of the patella rather than inducing a patella and trochlea mismatch. Cite this article: Bone Joint J 2019;101-B:325–330.

scholarly journals Outcomes After Deepening Trochleoplasty and Concomitant Realignment in Patients With Severe Trochlear Dysplasia With Chronic Patellofemoral Pain: Results at 2-Year Follow-up

2021 ◽  
Vol 9 (6) ◽  
pp. 232596712110104
Author(s):  
Felix Zimmermann ◽  
Danko Dan Milinkovic ◽  
Peter Balcarek
Keyword(s):  
Patellofemoral Joint ◽  
Trochlear Dysplasia ◽  
Case Series ◽  
Patellofemoral Pain ◽  
Control Group ◽  
Patellar Tilt ◽  
Level Of Evidence ◽  
Joint Stress ◽  
Kujala Score ◽  
Mri Scans

Background: Abnormal patellofemoral joint stress appears to have major relevance in a subgroup of patients with patellofemoral pain (PFP). Purpose: To evaluate whether patients with chronic PFP and trochlear dysplasia–induced patellofemoral joint malalignment benefit from a deepening trochleoplasty procedure with the aim of improving patellotrochlear congruence. Study Design: Case series; Level of evidence, 4. Methods: Included were 15 patients (male/female, 1/14; mean age, 30.3 years [range, 19-51 years]) with 8.8 years (range, 1-20 years) of chronic PFP and severe trochlear dysplasia. All patients underwent correction of patellotrochlear malalignment with deepening trochleoplasty and concomitant realignment procedures. The Kujala score and a numerical analog scale (0-10) for intensity of pain were used to assess symptoms preoperatively and at 12 and 24 months postoperatively. Pre- and postoperative magnetic resonance imaging (MRI) scans from the patients were compared with the MRI scans of age- and sex-matched controls regarding the patellotrochlear contact area and contact ratio, patellar tilt, patellotrochlear index, and lateral trochlear inclination (LTI) angle. Results: The Kujala score increased from a mean of 55 (range, 15-81) preoperatively to 82.5 (range, 53-98) after 12 months (95% CI, –42.56 to –12.37; P < .001) and to 84.2 (range, 59-99) after 24 months (95% CI, –44.29 to –14.11; P < .001). The intensity of PFP decreased from 5.7 (range, 3-10) preoperatively to 1.4 (range, 0-4) after 12 months (95% CI, 2.57 to 5.96; P < .001) and had a mean of 1.6 (range, 0-6) after 24 months (95% CI, 2.44 to 5.75; P < .001). Preoperatively, parameters in the study group indicated significant patellotrochlear malalignment, which improved and normalized (except for the LTI angle) postoperatively compared with the values of the control group ( P > .05). Conclusion: In a subgroup of patients with chronic PFP due to severe trochlear dysplasia, deepening trochleoplasty and concomitant realignment procedures significantly reduced pain and improved knee joint function while normalizing patellotrochlear congruence.

Effect of Isolated Medial Patellofemoral Ligament Reconstruction in Patellofemoral Instability Regardless of Predisposing Factors

2020 ◽  
Author(s):  
Jae Ik Lee ◽  
Mohd Shahrul Azuan Jaffar ◽  
Han Gyeol Choi ◽  
Tae Woo Kim ◽  
Yong Seuk Lee
Keyword(s):  
Medial Patellofemoral Ligament ◽  
Trochlear Dysplasia ◽  
Case Series ◽  
Patellofemoral Instability ◽  
International Knee Documentation Committee ◽  
Predisposing Factors ◽  
Mpfl Reconstruction ◽  
Patellar Tilt ◽  
Case Series Study

AbstractThe purpose of this study was to evaluate the outcomes of isolated medial patellofemoral ligament (MPFL) reconstruction, regardless of the presence of predisposing factors. A total of 21 knees that underwent isolated MPFL reconstruction from March 2014 to August 2017 were included in this retrospective series. Radiographs of the series of the knee at flexion angles of 20, 40, and 60 degrees were acquired. The patellar position was evaluated using the patellar tilt angle, sulcus angle, congruence angle (CA), and Caton-Deschamps and Blackburne-Peel ratios. To evaluate the clinical outcome, the preoperative and postoperative International Knee Documentation Committee (IKDC) and Lysholm knee scoring scales were analyzed. To evaluate the postoperative outcomes based on the predisposing factors, the results were separately analyzed for each group. Regarding radiologic outcomes, 20-degree CA was significantly reduced from 10.37 ± 5.96° preoperatively to −0.94 ± 4.11° postoperatively (p = 0.001). In addition, regardless of the predisposing factors, delta values of pre- and postoperation of 20-degree CA were not significantly different in both groups. The IKDC score improved from 53.71 (range: 18–74) preoperatively to 94.71 (range: 86–100) at the last follow-up (p = 0.004), and the Lysholm score improved from 54.28 (range: 10–81) preoperatively to 94.14 (range: 86–100) at the last follow-up (p = 0.010). Isolated MPFL reconstruction provides a safe and effective treatment for patellofemoral instability, even in the presence of mild predisposing factors, such as trochlear dysplasia, increased patella height, increased TT–TG distance, or valgus alignment. This is a Level 4, case series study.

Anatomic Risk Factors for Focal Cartilage Lesions in the Patella and Trochlea: A Case-Control Study

2019 ◽  
Vol 47 (10) ◽  
pp. 2444-2453 ◽  
Author(s):  
Luiz Felipe Ambra ◽  
Betina B. Hinckel ◽  
Elizabeth A. Arendt ◽  
Jack Farr ◽  
Andreas H. Gomoll
Keyword(s):  
Risk Factors ◽  
Trochlear Dysplasia ◽  
Cartilage Lesion ◽  
Patella Alta ◽  
Lesion Group ◽  
Control Group ◽  
Trochlear Groove ◽  
Patellar Tilt ◽  
Sulcus Angle ◽  
Cartilage Lesions

Background:Focal cartilage lesions in the patellofemoral (PF) joint are common. Several studies correlated PF risk factors with PF instability, anterior knee pain, and PF arthritis; however, there is a lack of evidence correlating those factors to PF focal cartilage lesions.Purpose:To evaluate the influence of the anatomic PF risk factors in patients with isolated focal PF cartilage lesions.Study Design:Cross-sectional study; Level of evidence, 3.Methods:Patients with isolated PF focal cartilage lesions were included in the cartilage lesion group, and patients with other pathologies and normal PF cartilage were included in the control group. Multiple PF risk factors were accessed on magnetic resonance imaging scans: patellar morphology (patellar width, patellar thickness, and patellar angle), trochlear morphology (trochlear sulcus angle, lateral condyle index, and trochlear sulcus depth), patellar height (Insall-Salvati ratio and Caton-Deschamps index), axial patellar positioning (patellar tilt, angle of Fulkerson), and quadriceps vector (tibial tuberosity–trochlear groove distance).Results:A total of 135 patients were included in the cartilage lesion group and 100 in the control group. As compared with the control group, the cartilage lesion group had a higher sulcus angle ( P = .0007), lower trochlear sulcus depth ( P < .0001), lower angle of Fulkerson ( P < .0001), lower patellar width ( P = .0003), and higher Insall-Salvati ratio ( P < .0001). From the patients in the cartilage lesion group, 36% had trochlear dysplasia; 27.6%, patella alta; and 24.7%, abnormal patellar tilt. These parameters were more frequent in the cartilage lesion group ( P < .0001). Trochlear lesions were more frequent in men, presented at an older age, and had fewer associated anatomic risk factors. Patellar lesions, conversely, were more frequent in women, presented at younger age, and were more closely associated with anatomic risk factors.Conclusion:PF anatomic abnormalities are significantly more common in patients with full-thickness PF cartilage lesions. Trochlear dysplasia, patella alta, and excessive lateral patellar tilt are the most common correlated factors, especially in patellar lesions.

Morphology and Anatomic Patellar Instability Risk Factors in First-Time Traumatic Lateral Patellar Dislocations: A Prospective Magnetic Resonance Imaging Study in Skeletally Immature Children

2016 ◽  
Vol 45 (1) ◽  
pp. 50-58 ◽  
Author(s):  
Marie Askenberger ◽  
Per-Mats Janarv ◽  
Throstur Finnbogason ◽  
Elizabeth A. Arendt
Keyword(s):  
Magnetic Resonance Imaging ◽  
Risk Factors ◽  
Magnetic Resonance ◽  
Patellar Instability ◽  
Trochlear Dysplasia ◽  
Control Group ◽  
Skeletally Immature ◽  
Resonance Imaging ◽  
Patellar Tilt ◽  
First Time

Background: The incidence of primary lateral patellar dislocation (LPD) in children aged 9 to 14 years is 0.6 to 1.2 per 1000. Causation is assumed to be multifactorial, including anatomic variants of the patellofemoral (PF) joint that result in a higher risk of LPD. No publication has compared the morphology of the PF joint and anatomic patellar instability risk factors (APIFs) in a primary LPD population versus controls, defining children by skeletal maturity. Purpose: To characterize the PF morphology and APIFs (trochlear dysplasia, abnormal lateral patellar tilt, elevated tibial tubercle–trochlear groove [TT-TG] distance, patella alta) through magnetic resonance imaging (MRI) measurements in skeletally immature children with and without a primary LPD and to identify (potential) distinctive differences between these 2 groups. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A prospective series of 103 skeletally immature children aged 9 to 14 years with an MRI-confirmed primary LPD were matched with a control group of 69 children. The PF morphology and APIFs were assessed during a 2.5-year period with standardized MRI using sagittal and axial views. Results: In the LPD group, 79% had 2 to 4 APIFs compared with 7% in the control group. All major measurements of trochlear dysplasia were significantly different between the 2 groups. The mean central condylar height was significantly higher in the LPD group compared with the control group, resulting in a lower trochlear depth (2.3 vs 4.5 mm, respectively) and higher sulcus angle (156.7° vs 141.1°, respectively). The LPD group had significantly higher values of patellar height, Caton-Deschamps index (1.33 vs 1.15, respectively), lateral patellar tilt (21.1° vs 8.5°, respectively), and TT-TG distance (13.9 vs 9.8 mm, respectively) compared with the control group. The main divergent APIF was trochlear dysplasia (defined as trochlear depth <3 mm), seen in 74% of the LPD group compared with 4% of the control group. Elevated TT-TG distance as a single APIF was never present in the LPD group; patellar tilt was only seen in the LPD group. The most common APIF in the control group was patella alta (36%). Conclusion: There was a significant difference in mean values of all established APIFs between the children with a first-time LPD and the controls. Trochlear dysplasia was the main APIF, and together with lateral patellar tilt (≥20°), they had the strongest association with LPD.

scholarly journals Autologous chondrocyte implantation combined with anterior cruciate ligament reconstruction: similar short-term results in comparison with isolated cartilage repair in ligament intact joints

2021 ◽  
Author(s):  
Julian Mehl ◽  
Matthias Feucht ◽  
Andrea Achtnich ◽  
Andreas B. Imhoff ◽  
Philipp Niemeyer ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Defect Size ◽  
Cartilage Defects ◽  
Control Group ◽  
Study Group ◽  
Short Term ◽  
Chondrocyte Implantation ◽  
Anterior Cruciate ◽  
Autologous Chondrocyte

Abstract Purpose Both acute ruptures of the anterior cruciate ligament (ACL) as well as chronic ACL insufficiency show a high association with focal cartilage defects of the knee. However, the results after combined ACL reconstruction and cartilage repair are not well investigated. The aim of the present study was to investigate the short-term outcomes after autologous chondrocyte implantation (ACI) in combination with ACL reconstruction and to compare the results with patients who underwent isolated ACI in ligament intact knees. Methods All patients who were registered in the German Cartilage Registry with ACI for focal cartilage defects in the knee joint in combination with ACL reconstruction and who completed the 24 month follow-up were included in the study group. A matched-pair procedure according to gender, defect location, defect size, and age was used to create a control group of patients with isolated ACI in ACL intact joints. The Knee Injury and Osteoarthritis Outcome Score (KOOS) and the numeric analog scale for pain (NAS) were used to assess the preoperative state as well as the clinical outcomes 12 and 24 months after surgery. Results A total of 34 patients were included in both the study group (age mean 33.3 ± SD 8.8 years) and the control group (33.6 ± 8.4 years) with a median defect size of 466 (25%-75% IQR 375–600) mm2 and 425 (IQR 375–600) mm2, respectively. In comparison with the preoperative state (median 67, IQR 52–75), the study group showed a significant increase of the total KOOS after 12 months (78, IQR 70–86; p = 0.014) and after 24 months (81, IQR 70–84; p = 0.001). The NAS for pain did not change significantly in the postoperative course. In comparison with the control group there was no significant difference for the total KOOS neither preoperative (control group median 67, IQR 52–73) nor at any postoperative time point (12 months: 82, IQR 67–93; 24 months: 81, IQR 71–91). Conclusion The clinical short-term outcomes after ACI at the knee joint in combination with ACL reconstruction are good and similar to the results after isolated ACI in ligament intact knees. Level of evidence III.

scholarly journals MPFL reconstruction and tibial tuberosity transposition in patients with patellar instability: May it troubleshots also trochlear dysplasia?

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
A. Castelli ◽  
E. Jannelli ◽  
E. Ferranti Calderoni ◽  
G. Galanzino ◽  
A. Ivone ◽  
...  
Keyword(s):  
Patellar Instability ◽  
Trochlear Dysplasia ◽  
Functional Results ◽  
Activity Level ◽  
Tibial Tuberosity ◽  
Mpfl Reconstruction ◽  
Trochlear Groove ◽  
Patellar Tilt ◽  
Sulcus Angle

Abstract Purpose This study aimed to highlight short- and medium-term outcomes of combined medial patello-femoral ligament (MPFL) reconstruction and anterior tibial tuberosity (ATT) transposition surgery in patients with recurrent patellar instability and different degrees of trochlear dysplasia. Methods Between January 2014 and May 2019, 25 patients with patellar instability underwent a surgical procedure combining the lowering/transposition of the ATT and the MPFL reconstruction. Each patient were preoperative assessed by Kujala score, International Knee Documentation Committee (IKDC), Tegner activity level scale. The assessment of instability predisposing factors was carried out with patellar height, tibial tuberosity-trochlear groove (TT-TG) distance, trochlear dysplasia, sulcus angle, patellar tilt and MPFL injuries. Functional outcomes were evaluated with Kujala, IKDC and Tegner scores at 3, 6 and 12 months after surgery. Results The average age of the patients was 20 years (range 13–43 years). Pre- operative Caton–Deschamps index was pathological in 10 (40%). Sulcus angle was elevated in 13 patients (52%) and TT-TG distance was irregular in 17 patients (68%). Trochlear dysplasia was present in 13 patients (9 type A, 3 type B, 1 type C according to Dejour’s Classification). No re-dislocation occurred during the follow-up. There was a significant increase in the Kujala, IKDC and Lysholm scores after 3, 6 and 12 months, and the results were compared for the different follow-up times and patient’s trochlear dysplasia degree. Conclusion This prospective observational longitudinal study identified good clinical outcomes in patients who underwent MPFL reconstruction and ATT transposition for patellar instability. Finally, the different risk factors for patellar instability examined, particularly the presence of trochlear dysplasia, did not significantly influence the final functional results, which range from good to excellent without re-dislocation episodes.

scholarly journals ASSESSMENT OF THE LEVEL OF ALPHA-2 MICROGLOBULIN OF FERTILITY AT THE SYSTEMIC AND TISSUE LEVELS AS AN INDICATOR OF THE FUNCTIONAL STATE OF THE ENDOMETRIUM

2018 ◽  
pp. 26-30
Author(s):  
Yu. A. Lyzikova ◽  
N. M. Golubykh ◽  
A. E. Kozlov
Keyword(s):  
Normal Values ◽  
Endometrial Tissue ◽  
Reproductive Age ◽  
Control Group ◽  
Study Group ◽  
Reproductive Dysfunction ◽  
Female Patients ◽  
Estradiol Concentration ◽  
Concentration Levels

Objective: to determine the level of alpha-2 microglobulin of fertility in the serum and endometrium of female patients of reproductive age. Material and methods . 30 female patients of reproductive age were included in the study. According to the results of clinical and case history data, 20 (66.67 %) patients with reproductive dysfunction were included in the study group, 10 (33.33 %) healthy patients were included in the control group. The concentration levels of hormones (FSH, LH, testosterone, prolactin, estradiol, progesterone, fertility alpha-2 microglobulin) in the blood serum and the level of alpha-2 microglobulin of fertility in the endometrial tissue were determined by the method of enzyme immunoassay. Results . The female patients with reproductive dysfunction revealed changes in the concentration of sex hormones. The estradiol concentration was 0.22 (0.21-0.24) nmol/l in the study group of the patients, and 0.25 (0.24-0.28) nmol/l in the healthy patients (z = -3.37, p = 0.0007). The progesterone concentration was 9.57 (7.60-53.54) nmol/l in the study group of the patients and 5.37 (3.59-26.44) nmol/l in the healthy women (z = 1.78, p = 0.07). The level of alpha-2 microglobulin of fertility did not differ significantly in the patients of both the groups. The level of alpha-2 microglobulin of fertility in the endometrium was 0.87 (0.69-1.38) ng/ml in the female patients of the study group and 1.82 (1.38-5.81) ng/ml in the patients of the control group (z = -2.31, p = 0.02). Conclusion . The obtained results are indicative of the involvement of the endometrium in the development of reproductive dysfunction. The data on the levels of alpha-2 microglobulin of fertility in the endometrial tissue are promising for further study and determination of the boundaries of its normal values. Further research in this area will facilitate the development of a test to predict successful implantation.

scholarly journals FEMORAL TUNNEL FIXATION FOR MEDIAL PATELLOFEMORAL LIGAMENT RECONSTRUCTION IN THE GROWING PATIENT IS SAFE FOR FUTURE GROWTH

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0025
Author(s):  
Bruno Gross ◽  
Meagan J. Sabatino ◽  
Madison Brenner ◽  
Charles W. Wyatt ◽  
Philip Wilson ◽  
...  
Keyword(s):  
Medial Patellofemoral Ligament ◽  
Femoral Tunnel ◽  
Trochlear Dysplasia ◽  
Patellar Height ◽  
Mpfl Reconstruction ◽  
Skeletally Immature ◽  
Patellar Tilt ◽  
Significant Difference ◽  
Operative Limb ◽  
Future Growth

Background: Medial patellofemoral ligament (MPFL) reconstruction has been shown to be a successful treatment for patients with recurrent patellar instability and is increasingly used to treat skeletally immature patients. Purpose: The purpose of this study is to compare radiographic parameters prior to and following an MPFL reconstruction with femoral tunnel fixation in the skeletally immature patient to investigate potential effects on the physis and future growth. Methods: Skeletally immature patients undergoing isolated MPFL reconstruction were retrospectively reviewed. Fixation of proximal MPFL was performed as a femoral socket using Schottle’s point with the entry approximately 5 mm distal to the physis (Figure 1). Patients with open growth plates and 1-year post-operative standing alignments were included. Radiographic measures of patellar tilt, patellar height, patellar subluxation, and trochlear dysplasia were compared pre-operatively and post-operatively on the operative limb. Pre- and post-operative coronal alignment and limb length measurements were compared between the operative and non-operative limbs. Results: Nineteen skeletally immature patients with an average age of 11.6 years (range 5-15) underwent isolated MPFL reconstruction. The average follow-up time was 24 months. No significant differences were found between the change in femur (0.49 mm, p=0.526) or total limb length (1.08 mm, p=0.241) when comparing the operative to the non-operative limb, with an average of 47 mm of growth in the operative limb seen during the time period. There was no significant difference in the change in LDFA between operative and non-operative limb as well as symmetric changes noted in the mechanical axis. The change in patellar tilt on the operative limb was found to be significant (12.78°, p=0.030), and the change in patellar height by Caton-Deschamps approached significance (0.08mm, p= 0.077). No significant difference was found with trochlear dysplasia measures. Conclusion: The present study suggests MPFL reconstruction with femoral tunnel fixation is safe and does not result in growth disturbance in skeletally immature patients. [Figure: see text]

scholarly journals Femoral Tunnel Fixation for Medial Patellofemoral Ligament Reconstruction in the Growing Patient is Safe for Future Growth

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0047
Author(s):  
Madison Brenner ◽  
Charles Wyatt ◽  
Aaron Zynda ◽  
Philip Wilson ◽  
Henry Ellis ◽  
...  
Keyword(s):  
Medial Patellofemoral Ligament ◽  
Femoral Tunnel ◽  
Trochlear Dysplasia ◽  
Patellar Height ◽  
Mpfl Reconstruction ◽  
Skeletally Immature ◽  
Patellar Tilt ◽  
Significant Difference ◽  
Operative Limb ◽  
Future Growth

Objectives: Medial patellofemoral ligament (MPFL) reconstruction has been shown to be a successful treatment for patients with recurrent patellar instability and is increasingly used to treat skeletally immature patients. The purpose of this study is to compare radiographic parameters prior to and following an MPFL reconstruction with femoral tunnel fixation in the skeletally immature patient to investigate potential effects on the physis and future growth. Methods: Skeletally immature patients undergoing isolated MPFL reconstruction were retrospectively reviewed. Fixation of proximal MPFL was performed as a femoral socket using Schottle’s point with the entry approximately 5 mm distal to the physis. Patients with open growth plates and 1-year postoperative standing alignments were included. Radiographic measures of patellar tilt, patellar height, patellar subluxation, and trochlear dysplasia were compared pre-operatively and post-operatively on the operative limb. Pre- and post-operative coronal alignment and limb length measurements were compared between the operative and non-operative limbs. Results: Nineteen skeletally immature patients with an average age of 11.6 years (range 5-15 years old) underwent isolated MPFL reconstruction. The average follow-up time was 24 months. No significant differences were found between the change in femur (0.49 mm, p=0.526) or total limb length (1.08 mm, p=0.241) when comparing the operative to the non-operative limb, with an average of 47 mm of growth in the operative limb seen during the time period. There was no significant difference in the change in LDFA between operative and non-operative limb as well as symmetric changes noted in the mechanical axis. The change in patellar tilt on the operative limb was found to be significant (12.78°, p=0.030), and the change in patellar height by Caton-Deschamps approached significance (0.08mm, p= 0.077). No significant difference was found with trochlear dysplasia measures. Conclusion: The present study suggests MPFL reconstruction with femoral tunnel fixation is safe and does not result in growth disturbance in skeletally immature patients. [Table: see text]

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