Anatomic physeal‐sparing MPFL reconstruction in skeletally immature patients shows favourable outcomes at a minimum of 24‐month follow‐up
Abstract Purpose Recurrent patellar dislocation is a prevalent orthopaedic issue among active paediatric and adolescent populations. Bony surgical procedures are not recommended in growing patients; therefore, the focus of surgery is on restoring the medial patellar ligaments, with different reconst...
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2024-10-01
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| Series: | Journal of Experimental Orthopaedics |
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| Online Access: | https://doi.org/10.1002/jeo2.70063 |
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| author | Panagiotis Ntagiopoulos Pierrenzo Pozzi Georgios Kalinterakis Dimitris Fligkos Triantafyllia Dimou Riccardo Compagnoni Paolo Ferrua Pietro Simone Randelli |
| author_facet | Panagiotis Ntagiopoulos Pierrenzo Pozzi Georgios Kalinterakis Dimitris Fligkos Triantafyllia Dimou Riccardo Compagnoni Paolo Ferrua Pietro Simone Randelli |
| author_sort | Panagiotis Ntagiopoulos |
| collection | DOAJ |
| description | Abstract Purpose Recurrent patellar dislocation is a prevalent orthopaedic issue among active paediatric and adolescent populations. Bony surgical procedures are not recommended in growing patients; therefore, the focus of surgery is on restoring the medial patellar ligaments, with different reconstructive techniques available. This retrospective case series focuses on the 2‐year outcomes of medial patellofemoral ligament (MPFL) reconstruction in skeletally immature patients with open physis. Methods Twenty‐four consecutive patients with patellofemoral instability and open growth plates underwent anatomic MPFL reconstruction with a physeal‐sparing technique. All subjects have had more than three episodes of true patellar dislocations. Preoperative radiographic examination included anteroposterior 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. The patients were questioned regarding complications and clinical outcomes using the visual analogue scale (VAS), Kujala and Paediatric International Knee Documentation Committee (Pedi‐IKDC) score. Variables were evaluated using paired t test with significance at p < 0.05. Results The mean age at the time of operation was 13.04 years (9–16 years). The cohort was followed for a mean duration of 38.66 months (24–86 months). The mean time from injury to surgery was 50.45 days (16–80 days). No growth arrest, limb‐length discrepancies or angular deformities were observed post‐operatively during the whole follow‐up period. No patellar re‐dislocations were recorded throughout the study period. The VAS score improved significantly from 5.67 (4–8) to 1.88 (0–4) (p < 0.01). The Kujala score improved significantly from 64.67 (44–81) preoperatively to 87.58 (77–100) post‐operatively (p < 0.01). The Pedi‐IKDC also increased significantly from 58.81 (34.80–77.70) preoperatively to 90.64 (70.70–100) post‐operatively (p < 0.01). The vast majority of patients (87.5%) returned to their pre‐injury activity level. Boys scored better than girls in VAS, Pedi‐IKDC and Kujala score post‐operatively, but these differences were not statistically significant. Conclusion Physeal‐sparing MPFL reconstruction in children and adolescents yields excellent midterm results and allows patients to return to sports without redislocation of the patella. Boys scored better than girls in VAS, Pedi‐IKDC and Kujala score post‐operatively, but these differences were not statistically significant. Level of Evidence IV: case series with no comparative group. |
| format | Article |
| id | doaj-art-10692612aeb84df1af5d2c4168e7aa57 |
| institution | DOAJ |
| issn | 2197-1153 |
| language | English |
| publishDate | 2024-10-01 |
| publisher | Wiley |
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| series | Journal of Experimental Orthopaedics |
| spelling | doaj-art-10692612aeb84df1af5d2c4168e7aa572025-08-20T02:52:48ZengWileyJournal of Experimental Orthopaedics2197-11532024-10-01114n/an/a10.1002/jeo2.70063Anatomic physeal‐sparing MPFL reconstruction in skeletally immature patients shows favourable outcomes at a minimum of 24‐month follow‐upPanagiotis Ntagiopoulos0Pierrenzo Pozzi1Georgios Kalinterakis2Dimitris Fligkos3Triantafyllia Dimou4Riccardo Compagnoni5Paolo Ferrua6Pietro Simone Randelli7Hip and Knee Unit Mediterraneo Hospital Athens GreeceU.O.C. 1° Clinica Ortopedica, ASST G. Pini‐CTO Milan ItalyHip and Knee Unit Mediterraneo Hospital Athens GreeceHip and Knee Unit Mediterraneo Hospital Athens GreeceHip and Knee Unit Mediterraneo Hospital Athens GreeceU.O.C. 1° Clinica Ortopedica, ASST G. Pini‐CTO Milan ItalyU.O.C. 1° Clinica Ortopedica, ASST G. Pini‐CTO Milan ItalyU.O.C. 1° Clinica Ortopedica, ASST G. Pini‐CTO Milan ItalyAbstract Purpose Recurrent patellar dislocation is a prevalent orthopaedic issue among active paediatric and adolescent populations. Bony surgical procedures are not recommended in growing patients; therefore, the focus of surgery is on restoring the medial patellar ligaments, with different reconstructive techniques available. This retrospective case series focuses on the 2‐year outcomes of medial patellofemoral ligament (MPFL) reconstruction in skeletally immature patients with open physis. Methods Twenty‐four consecutive patients with patellofemoral instability and open growth plates underwent anatomic MPFL reconstruction with a physeal‐sparing technique. All subjects have had more than three episodes of true patellar dislocations. Preoperative radiographic examination included anteroposterior 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. The patients were questioned regarding complications and clinical outcomes using the visual analogue scale (VAS), Kujala and Paediatric International Knee Documentation Committee (Pedi‐IKDC) score. Variables were evaluated using paired t test with significance at p < 0.05. Results The mean age at the time of operation was 13.04 years (9–16 years). The cohort was followed for a mean duration of 38.66 months (24–86 months). The mean time from injury to surgery was 50.45 days (16–80 days). No growth arrest, limb‐length discrepancies or angular deformities were observed post‐operatively during the whole follow‐up period. No patellar re‐dislocations were recorded throughout the study period. The VAS score improved significantly from 5.67 (4–8) to 1.88 (0–4) (p < 0.01). The Kujala score improved significantly from 64.67 (44–81) preoperatively to 87.58 (77–100) post‐operatively (p < 0.01). The Pedi‐IKDC also increased significantly from 58.81 (34.80–77.70) preoperatively to 90.64 (70.70–100) post‐operatively (p < 0.01). The vast majority of patients (87.5%) returned to their pre‐injury activity level. Boys scored better than girls in VAS, Pedi‐IKDC and Kujala score post‐operatively, but these differences were not statistically significant. Conclusion Physeal‐sparing MPFL reconstruction in children and adolescents yields excellent midterm results and allows patients to return to sports without redislocation of the patella. Boys scored better than girls in VAS, Pedi‐IKDC and Kujala score post‐operatively, but these differences were not statistically significant. Level of Evidence IV: case series with no comparative group.https://doi.org/10.1002/jeo2.70063kneeMPFLpaediatric surgerypatella dislocation |
| spellingShingle | Panagiotis Ntagiopoulos Pierrenzo Pozzi Georgios Kalinterakis Dimitris Fligkos Triantafyllia Dimou Riccardo Compagnoni Paolo Ferrua Pietro Simone Randelli Anatomic physeal‐sparing MPFL reconstruction in skeletally immature patients shows favourable outcomes at a minimum of 24‐month follow‐up Journal of Experimental Orthopaedics knee MPFL paediatric surgery patella dislocation |
| title | Anatomic physeal‐sparing MPFL reconstruction in skeletally immature patients shows favourable outcomes at a minimum of 24‐month follow‐up |
| title_full | Anatomic physeal‐sparing MPFL reconstruction in skeletally immature patients shows favourable outcomes at a minimum of 24‐month follow‐up |
| title_fullStr | Anatomic physeal‐sparing MPFL reconstruction in skeletally immature patients shows favourable outcomes at a minimum of 24‐month follow‐up |
| title_full_unstemmed | Anatomic physeal‐sparing MPFL reconstruction in skeletally immature patients shows favourable outcomes at a minimum of 24‐month follow‐up |
| title_short | Anatomic physeal‐sparing MPFL reconstruction in skeletally immature patients shows favourable outcomes at a minimum of 24‐month follow‐up |
| title_sort | anatomic physeal sparing mpfl reconstruction in skeletally immature patients shows favourable outcomes at a minimum of 24 month follow up |
| topic | knee MPFL paediatric surgery patella dislocation |
| url | https://doi.org/10.1002/jeo2.70063 |
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