Knee Surg Sports Traumatol Arthrosc DOI 10.1007/s00167-014-3439-x
KNEE
Clinical outcome after reconstruction of the medial patellofemoral ligament in paediatric patients with recurrent patella instability Martin Lind · Ditte Enderlein · Torsten Nielsen · Svend Erik Christiansen · Peter Faunø
Received: 11 July 2014 / Accepted: 11 November 2014 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2014
Abstract Purpose Medial patellofemoral ligament (MPFL) reconstruction has recently been broadly accepted as primary surgical treatment in adults. Reconstruction techniques with osseous fixation in femur cannot be used for patients with open growth plates. Operative treatment of patella instability in children therefore is a challenge and requires alternative MPFL reconstruction techniques. Limited knowledge exists concerning outcome after MPFL reconstruction in children and adolescents. This study present clinical outcome in a consecutive single clinic series of children treated with paediatric MPFL reconstruction using a soft tissue femoral fixation technique. Methods Twenty-four MPFL reconstructions in 20 operated children aged 8–16 were included in the study. Indication for surgery was two or more patella dislocations. MPFL reconstruction was performed by looping the released gracilis tendon around the adductor magnus tendon insertion and through drill holes in the proximal medial patella edge. Clinical outcome was evaluated by Kujala score and NRS pain score preoperatively, at 1-year followup and final follow-up at 39 months. Outcome was compared with a cohort of 179 adult patients with recurrent patella instability operated with an adult MPFL reconstruction technique. Results Kujala score improved from 61 (13) to 81 (16). NRS pain score improved from 3.0 (3.1) to 1.5 (1.3) in activity. Four patients (20 %) experienced redislocation
M. Lind (*) · D. Enderlein · T. Nielsen · S. E. Christiansen · P. Faunø Division of Sports Trauma, Orthopaedic Department, Aarhus University Hospital, Tage Hansens Gade 2, 8000 Århus C, Denmark e-mail: [email protected]
within the first postoperative year compared with 5 % in an adult patient population. Five patients (25 %) experienced subluxations. One patient with a redislocation was re-operated with adult MPFL reconstruction technique. Cartilage injury was seen in six patients. Conclusions There are clinical relevant improvements in knee function and pain after MPFL reconstruction in paediatric patients. Patella stability after MPFL reconstruction using femoral soft tissue graft fixation in paediatric patients was inferior to MPFL reconstruction using bony femoral fixation in adult patients. Level of evidence Case–Control study, Level III. Keywords Medial patellofemoral ligament · MPFL · Patella instability · Ligament reconstruction
Introduction Over the last decade, reconstruction of the medial patellofemoral ligament (MPFL) has been established as the primary surgical treatment for recurrent patella instability in adults [2, 18, 23]. Treatment for recurrent patella instability in children and adolescents with open growth plates after patella dislocation is less well established. Conservative treatment after primary patella dislocation in patients
KNEE
Clinical outcome after reconstruction of the medial patellofemoral ligament in paediatric patients with recurrent patella instability Martin Lind · Ditte Enderlein · Torsten Nielsen · Svend Erik Christiansen · Peter Faunø
Received: 11 July 2014 / Accepted: 11 November 2014 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2014
Abstract Purpose Medial patellofemoral ligament (MPFL) reconstruction has recently been broadly accepted as primary surgical treatment in adults. Reconstruction techniques with osseous fixation in femur cannot be used for patients with open growth plates. Operative treatment of patella instability in children therefore is a challenge and requires alternative MPFL reconstruction techniques. Limited knowledge exists concerning outcome after MPFL reconstruction in children and adolescents. This study present clinical outcome in a consecutive single clinic series of children treated with paediatric MPFL reconstruction using a soft tissue femoral fixation technique. Methods Twenty-four MPFL reconstructions in 20 operated children aged 8–16 were included in the study. Indication for surgery was two or more patella dislocations. MPFL reconstruction was performed by looping the released gracilis tendon around the adductor magnus tendon insertion and through drill holes in the proximal medial patella edge. Clinical outcome was evaluated by Kujala score and NRS pain score preoperatively, at 1-year followup and final follow-up at 39 months. Outcome was compared with a cohort of 179 adult patients with recurrent patella instability operated with an adult MPFL reconstruction technique. Results Kujala score improved from 61 (13) to 81 (16). NRS pain score improved from 3.0 (3.1) to 1.5 (1.3) in activity. Four patients (20 %) experienced redislocation
M. Lind (*) · D. Enderlein · T. Nielsen · S. E. Christiansen · P. Faunø Division of Sports Trauma, Orthopaedic Department, Aarhus University Hospital, Tage Hansens Gade 2, 8000 Århus C, Denmark e-mail: [email protected]
within the first postoperative year compared with 5 % in an adult patient population. Five patients (25 %) experienced subluxations. One patient with a redislocation was re-operated with adult MPFL reconstruction technique. Cartilage injury was seen in six patients. Conclusions There are clinical relevant improvements in knee function and pain after MPFL reconstruction in paediatric patients. Patella stability after MPFL reconstruction using femoral soft tissue graft fixation in paediatric patients was inferior to MPFL reconstruction using bony femoral fixation in adult patients. Level of evidence Case–Control study, Level III. Keywords Medial patellofemoral ligament · MPFL · Patella instability · Ligament reconstruction
Introduction Over the last decade, reconstruction of the medial patellofemoral ligament (MPFL) has been established as the primary surgical treatment for recurrent patella instability in adults [2, 18, 23]. Treatment for recurrent patella instability in children and adolescents with open growth plates after patella dislocation is less well established. Conservative treatment after primary patella dislocation in patients
