Patellofemoral Update
Patellofemoral Update
November 14, 2019
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MPFL reconstruction using epiphyseal femoral socket can avoid injury in children with patellar instability

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Daniel W. Green

According to study results, medial patellofemoral ligament reconstruction using an epiphyseal femoral socket with fluoroscopic guidance was an effective treatment for children with patellar instability that avoided physeal injury and subsequent growth disturbance.

“The take-home message is that the results of our paper demonstrate that patella stabilization surgery with [medial patellofemoral ligament] MPFL reconstruction can be performed safely and effectively in young patients with open growth plates,” study co-author Daniel W. Green, MD, from Hospital for Surgery, told Healio.com/Orthopedics.

Green and colleagues identified 54 knees in 49 skeletally immature patients who underwent physeal-sparing MPFL reconstruction. The mean age at time of surgery was 13.5 years. In all patients, a femoral socket distal to the femoral physis was used for graft fixation. Postoperative MRIs of the operative knee were used to assess physeal safety, and standing hip-to-ankle radiographs were used to assess development of the lower limb angular deformities and limb length discrepancy. Median radiographic follow-up was 2.2 years.

Results showed five patients had recurrent patellar instability at the most recent clinical follow-up. Of these, three patients underwent subsequent tibial tubercle osteotomy or revision MPFL reconstruction. Investigators noted the leg length between operated and nonoperated limbs was not statistically significantly different. The nonoperated and operated mechanical medial proximal tibial angle and mechanical lateral distal femoral angle measurement were not statistically significantly different. No evidence of physeal arrest was seen on postoperative MRI. The median distance from the physis to the socket at the aperture was 5.9 mm and was 7.1 mm from the physis to the distal end of the femoral socket. – by Monica Jaramillo

 

Disclosures: The authors report no relevant financial disclosures.