LAS VEGAS — Orthopedists who decide to surgically manage pediatric athletes with patellar instability, and lateral patellar subluxation in particular, should guard against complications, such as knee stiffness and patellar fractures, according to a presenter at the American Academy of Orthopaedic Surgeons Annual Meeting.
During a symposium here on the treatment and complications in adolescent athletes, Jennifer M. Weiss, MD, discussed loose body removal and the need to reconstruct the medial patellofemoral ligament (MPFL) as some indications for surgery to address patellar instability.
She said, however, a question that is not adequately addressed in the literature is whether to repair or reconstruct the MPFL in a young athlete with patellar instability. What’s more, it is not yet understood where exactly the MPFL detaches, according to Weiss.
“Perhaps sometimes the repair is happening in the wrong spot. But these repairs are not reliably preventing re-dislocation. So, reconstruction is my mode of stabilization if I am going to go in that direction,” she said.
MPFL reconstruction has been associated with good results, even in the presence of trochlear dysplasia, and can be helpful in some children, according to Weiss, who discussed her rationale for surgery.
“If there is a loose body, I am going to move to think about surgery. I am going to think about surgery if there is a laterally subluxated patella with normal alignment on the underside, if it is a repeat dislocator or a true failure of physical therapy. If it is their first time dislocating, I am not going to reconstruct their MPFL most likely. I am most likely just going to remove that loose body and rehab them,” she said.
To avoid medial instability as a possible iatrogenic complication, Weiss recommended not over-releasing the patient. “That is a complication that we can avoid,” she said.
For her surgical technique, Weiss said she will fix a semitendinosus graft to the patella with a suture anchor, but to avoid patellar fractures, does not drill completely through the patella. She also ensures the fixation is stable to avoid stiffness, which is another possible complication, and Weiss starts her patients on early motion. “I want to prevent recurrence of instability by encouraging rehab,” she said. – by Susan M. Rapp
Weiss JM. Symposium J: Treatment and complications in pediatric sports medicine. Patellar instability. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 24-28, 2015; Las Vegas.
Disclosure: Weiss reports no relevant financial disclosures.