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Medial patellofemoral ligament reconstruction in children: do osseous abnormalities matter?

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Abstract

Purpose

Management of post-traumatic patellar instability in children with osseous abnormalities is challenging because of the presence of an open physis. The aim of our study was to compare the rate of recurrence after isolated reconstruction of the medial patellofemoral ligament (MPFL) in children with or without osseous abnormalities.

Methods

The medical records of 25 children (27 knees) with recurrent patellar dislocation were reviewed. Each child underwent an isolated reconstruction of the MPFL using a hamstring graft. At the last follow-up, a clinical and radiographic evaluation was performed, including assessment of functional outcomes based on the Kujala score. Patients were compared in terms of the occurrence of a pre-existing osseous abnormality.

Results

The mean age at the time of the surgery was 13.8 years. Eleven patients had trochlear dysplasia (40%), three had a patella alta (11%) and seven had an increased TT-TG (26%). The recurrence rate was 3.7% (one patient), after a mean follow-up of 41.1 months. Recurrence was not more frequent in patients with preoperative anatomical predisposing factors. The mean Kujala score was 95. The mean time to return to practicing sports was 7.1 months.

Conclusions

Isolated MPFL reconstruction is an effective option for the management of post-traumatic patellofemoral instability in skeletally immature patients. The results of this technique seem to be independent on either proximal or distal misalignments such as trochlear dysplasia, patella alta, or increased TT-TG.

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Acknowledgments

SP received grants from the Société Française de Chirurgie Orthopédique et Traumatologie (SOFCOT) and from the Société Française de Chirurgie Orthopédique Pédiatrique (SOFOP) and from the Association pour le Développement de la Recherche Médicale (ADEREM).

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Authors and Affiliations

  1. Paediatric Orthopaedics, Timone Children’s Hospital, Aix-Marseille University, 264, rue Saint Pierre, 13005, Marseille, France

    Sebastien Pesenti, Matthieu Ollivier, Jean-Charles Escudier, Mathieu Cermolacce, Alexandre Baud, Franck Launay, Jean-Luc Jouve & Elie Choufani

  2. Paediatric Orthopaedics, Timone Enfants, 264 rue St Pierre, 13005, Marseille, France

    Sebastien Pesenti

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  1. Sebastien Pesenti
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Correspondence to Sebastien Pesenti.

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Level of evidence: IV, case series

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Pesenti, S., Ollivier, M., Escudier, JC. et al. Medial patellofemoral ligament reconstruction in children: do osseous abnormalities matter?. International Orthopaedics (SICOT) 42, 1357–1362 (2018). https://doi.org/10.1007/s00264-017-3750-5

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  • DOI: https://doi.org/10.1007/s00264-017-3750-5

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