Medial patellofemoral ligament reconstruction in children: do osseous abnormalities matter?
Résumé
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.
Mots clés
Humans
Knee Joint/surgery
Adolescent
Female
Male
Retrospective Studies
Risk Factors
Treatment Outcome
Child
Recurrence
*Increased tibial tuberosity-trochlear groove (TT-TG)
*Isolated reconstruction
*Medial patellofemoral ligament (MPFL)
*Patella alta
*Trochlear dysplasia
Bone Diseases
Developmental/*complications/surgery
Ligaments
Articular/injuries/*surgery
Patella/surgery
Patellar Dislocation/*surgery
Patellofemoral Joint/*surgery
Reconstructive Surgical Procedures/adverse effects/*methods