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Medial Patellofemoral Ligament Reconstruction With Growth Modulation in Children With Patellar Instability and Genu Valgum.

ABSTRACT: Patellar instability is common in the second decade, and genu valgum is a risk factor for patellar instability. In skeletally immature patients, genu valgum can be gradually corrected using less-invasive, well-established, growth-modulation techniques. For skeletally immature patients with patellar instability and genu valgum, it would be desirable to address both instability and deformity. We describe our technique of physeal-respecting medial patellofemoral ligament reconstruction in skeletally immature patients using hamstring autograft and simultaneous transphyseal screw hemiepiphysiodesis to gradually correct genu valgum. The medial patellofemoral ligament reconstruction technique features posteromedial hamstring graft harvest, single patellar tunnel fixation without implant, and femoral attachment just below the distal femoral physis. The technique of growth modulation features percutaneous insertion of a single transphyseal screw through the distal medial femoral physis without interference with medial patellofemoral ligament graft placement. Our preliminary results have been encouraging with successful correction of genu valgum and satisfactory patellar stabilization without growth disturbances.

SUBMITTER: Shah A

PROVIDER: S-EPMC7189796 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Medial Closing-Wedge Distal Femoral Osteotomy with Medial Patellofemoral Ligament Imbrication for Genu Valgum with Lateral Patellar Instability.

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Double-bundle medial patellofemoral ligament reconstruction with a single patellar tunnel.

Project description:Medial patellofemoral ligament (MPFL) reconstruction is an established method to prevent patellofemoral instability. Nevertheless, the anatomy and the biomechanical behavior of native MPFL are still under investigation, but in recent years they have become more defined. We propose a technique for MPFL reconstruction based on the results of recent anatomic studies regarding the patellar insertion of the MPFL. A double-bundle MPFL is reconstructed by use of the semitendinosus tendon passed through a single patellar tunnel, which crosses the patella from the midpoint of its medial border until its superolateral corner is reached. This method permits a strong patellar fixation, potentially reducing the risk of patellar fracture compared with double-patellar tunnel techniques. Moreover, it requires no fixation devices at the patella and only a single interference screw on the femoral side.

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Patellar instability MRI measurements are associated with knee joint degeneration after reconstruction of the medial patellofemoral ligament.

Project description:ObjectiveTo qualitatively and quantitatively evaluate the 2-year magnetic resonance imaging (MRI) outcome after MPFL reconstruction at the knee and to assess MRI-based risk factors that predispose for inferior clinical and imaging outcomes.Materials and methodsA total of 31 patients with MPFL reconstruction were included (22 ± 6 years, 10 female). MRI was performed preoperatively in 21/31 patients. Two-year follow-up MRI included quantitative cartilage T2 and T1rho relaxation time measurements at the ipsilateral and contralateral knee. T2relative was calculated as T2patellofemoral/T2femorotibial. Morphological evaluation was conducted via WORMS scores. Patellar instability parameters and clinical scores were obtained. Statistical analyses included descriptive statistics, t-tests, multivariate regression models, and correlation analyses.ResultsTwo years after MPFL reconstruction, all patellae were clinically stable. Mean total WORMS scores improved significantly from baseline to follow-up (mean difference ± SEM, - 4.0 ± 1.3; P = 0.005). As compared to patients with no worsening of WORMS subscores over time (n = 5), patients with worsening of any WORMS subscore (n = 16) had lower trochlear depth, lower facetal ratio, higher tibial-tuberosity to trochlear groove (TTTG) distance, and higher postoperative lateral patellar tilt (P < 0.05). T2relative was higher at the ipsilateral knee (P = 0.010). T2relative was associated with preoperatively higher patellar tilt (P = 0.021) and higher TTTG distance (P = 0.034). TTTG distance, global T2 values, and WORMS progression correlated with clinical outcomes (P < 0.05).ConclusionMPFL reconstruction is an optimal treatment strategy to restore patellar stability. Still, progressive knee joint degeneration and patellofemoral cartilage matrix degeneration may be observed, with patellar instability MRI parameters representing particular risk factors.

| S-EPMC8763754 | biostudies-literature

Precise Arthroscopic Mini-trochleoplasty and Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Instability With Severe Trochlear Dysplasia.

Project description:More than 100 surgical procedures have been reported to address recurrent patellar instability. Trochlear dysplasia is the most common finding among the anatomic risk factors for recurrent patellar instability. Various studies have shown that trochleoplasty combined with medial patellofemoral ligament reconstruction is an effective technique to treat recurrent patellar instability. Nevertheless, trochleoplasty is still a daunting procedure for surgeons because of its multiple and gloomy complications. This article introduces a technique to treat recurrent patellar instability with severe trochlear dysplasia: precise arthroscopic mini-trochleoplasty (PAM trochleoplasty) combined with medial patellofemoral ligament reconstruction. This technique precisely removes the supratrochlear spur and trochlear bump, accurately reshapes the trochlear sulcus with minimal invasion and less osteotomy volume, and keeps the sulcus cartilage intact. The purpose of this technique is to develop trochleoplasty into a common and safe technique, which has good outcomes and low complications.

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