Anchor proximal migration in the medial patellofemoral ligament reconstruction in skeletally immature patients

Kupczik, Fabiano; Schiavon, Marlus Eduardo Gunia; Sbrissia, Bruno; Vieira, Lucas de Almeida; Bonilha, Thiago de Moura

doi:10.1016/j.rboe.2013.01.002

Cited by 3 publications

(3 citation statements)

References 10 publications

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“…9,13,19,37,41 Therefore, anatomic MPFLR has to be distal to the physis to prevent recurrent dislocation (because of migration of femoral MPFL graft position if fixed proximal to the physis) and anisometric forces during knee flexion. 14,37,41 Further, femoral drilling channel position distal to the physis has been reported to be safe in terms of preventing injury to the physis and growth disturbance. 25,40 However, whether bony abnormalities (patellar height, trochlear dysplasia, and lateralization of tibial tubercle) must be addressed additionally is still unclear, and isolated MPFLR as a first-line surgical treatment in children with LPD without correction of osseous abnormalities has been reported to show promising results.…”

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confidence: 99%

Midterm Results After Isolated Medial Patellofemoral Ligament Reconstruction as First-Line Surgical Treatment in Skeletally Immature Patients Irrespective of Patellar Height and Trochlear Dysplasia

Schlumberger¹,

Schuster

Hofmann³

et al. 2021

Am J Sports Med

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Background: Medial patellofemoral ligament reconstruction in skeletally immature patients who experience lateral patellar dislocation has been reported to yield good results. Whether bony abnormalities such as patellar height and trochlear dysplasia should be addressed additionally is a topic of discussion. Purpose: To evaluate patient-reported outcomes and redislocation rates after isolated medial patellofemoral ligament reconstruction as first-line surgical treatment for lateral patellar dislocation in skeletally immature patients. Further, to analyze epidemiological, intraoperative, and radiographical factors influencing redislocation and clinical outcome. Study Design: Case series; Level of evidence, 4. Methods: Prospectively collected data were retrospectively analyzed for adolescent patients younger than 16 years who underwent medial patellofemoral ligament reconstruction between 2014 and 2018. Inclusion criteria were isolated medial patellofemoral ligament reconstruction with gracilis tendon and availability of accurate pre- and postoperative radiographs with the presence of open physes. The patients were questioned regarding further surgery, redislocation, and clinical outcomes using the Tegner Activity Scale, International Knee Documentation Committee (IKDC) Subjective Knee Form, Lysholm score, and Kujala score. The influence of diverse epidemiological, intraoperative, and radiographical parameters on the redislocation rates and clinical outcome was analyzed. Results: A total of 54 medial patellofemoral ligament reconstructions (49 patients) met the inclusion criteria. After 4.3 ± 1.7 years (range, 2.0-7.3 years), 45 reconstructions (83.3%) in 41 patients were available for follow-up. The distribution of trochlear dysplasia was as follows: type A and B, 19 cases (42.2%) each; type C, 6 cases (13.3%); and type D, 1 case (2.2%). Patellar redislocation occurred in 3 patients (6.7%). The mean Tegner, subjective IKDC, Lysholm, and Kujala scores at follow-up were 6.3 ± 1.6 (range, 3-9), 93.6 ± 8.8, 95.9 ± 7.4, and 97.9 ± 7.1, respectively. Patellar height and trochlear dysplasia had no influence on redislocation or clinical scores. The Lysholm score was lower in knees with intraoperative retropatellar chondral lesion grade ≥III versus ± 19.2 vs 96.9 ± 3.6, respectively; P = .023); likewise, the Kujala score was lower in knees that were grade ≥III versus ± 19.7 vs 98.1 ± 2.1, respectively; P = .015). Conclusion: Isolated medial patellofemoral ligament reconstruction as first-line surgical treatment in skeletally immature patients yields excellent midterm results, irrespective of patellar height and trochlear dysplasia. Redislocation still occurs in a certain number of patients, and a higher degree of retropatellar chondral lesion is a predictor for a worse clinical outcome.

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confidence: 99%

Midterm Results After Isolated Medial Patellofemoral Ligament Reconstruction as First-Line Surgical Treatment in Skeletally Immature Patients Irrespective of Patellar Height and Trochlear Dysplasia

Schlumberger¹,

Schuster

Hofmann³

et al. 2021

Am J Sports Med

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“…Yet, there have been reports of proximal graft migration and even subsequent graft failure when anchoring in the metaphysis. 7 In addition, anchoring in the metaphysis may be associated with less-than-ideal patellofemoral isometry, as our study found the anatomic origin of the MPFC to be at or more likely distal to the physis. Thus, we suggest that pediatric patients undergoing MPFL or MQTFL reconstruction, regardless of age, have the patellofemoral graft anchored distal to the physis to maximize patellar isometry, minimize physeal injury, and avoid risk of graft migration and failure.…”

Section: Discussionmentioning

confidence: 61%

“…The location has been reported to be proximal, at, or distal to the physis. 7,8 Our study utilized thin-cut high-quality CT scans of cadaveric specimens to directly follow the adductor magnus tendon to its insertion on the adductor tubercle. We found that the adductor tubercle was always at or distal to the physis.…”

Section: Discussionmentioning

confidence: 99%

Localization of the Adductor Tubercle in the Skeletally Immature: A Computed Tomography Study With Patellofemoral Surgical Implications

et al. 2023

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Background: The adductor tubercle of the distal femur is utilized by surgeons as an anatomic landmark to identify graft anchor placement during medial patellofemoral ligament (MPFL) and medial quadriceps tendon femoral ligament (MQTFL) reconstruction for patellofemoral instability. In the skeletally immature population, its location relative to the physis has not been well defined. Purpose: To identify the location of the adductor tubercle relative to the distal femoral physis in skeletally immature individuals and gain insight regarding optimal graft anchor placement for pediatric patients undergoing MPFL and MQTFL reconstruction. Study Design: Descriptive laboratory study. Methods: Thin-cut computed tomography scans of 37 male cadaveric specimens (age, 4-16 years) were obtained from the New Mexico Decedent Image Database. A measurement protocol to identify the adductor tubercle was created with guidance from a fellowship-trained musculoskeletal radiologist. By utilizing axial, coronal, and sagittal views of knee computed tomography scans, the adductor magnus tendon was identified and followed distally to its insertion (adductor tubercle) on the distal femur. Distance from the midpoint of the adductor magnus tendon insertion relative to the physis in the proximal-distal orientation was measured. The anterior-posterior distance of the midpoint tendon insertion relative to the posterior femoral cortex line was also evaluated. Results: The midpoint of the adductor magnus tendon was at the physis in 30 specimens. One 8-year-old cadaveric specimen had an insertion 1.1 mm distal to the physis. In all specimens ≥15 years old (n = 6), the adductor magnus tendon insertion was distal to the physis with a mean distance of 2.73 mm. The location of the adductor tubercle was always posterior (mean, 5.1 mm) with respect to the posterior femoral cortex line. Conclusion: The location of the adductor tubercle in male pediatric patients is likely at or distal to the physis. Thus, the findings of this study directly conflict with previous studies that suggested a more proximal location. Clinical Relevance: Optimal graft anchor placement during MPFL and MQTFL reconstruction in the skeletally immature patient can be challenging because of the variability reported in previous studies of the medial patellofemoral complex origin relative to the physis. This study suggests that distal—rather than proximal—graft anchor placement might better help restore patellofemoral isometry.

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Evaluation of the Optimal Femoral Fixation Site for Medial Patellofemoral Ligament Reconstruction in the Skeletally Immature Patient

Masquijo¹,

Parikh²,

Kothari³

2023

Orthopedics

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The aim of this study was to assess which femoral fixation site, distal to the physis, most closely emulates the native medial patellofemoral ligament (nMPFL) length relationship in the pediatric knee. Lateral knee radiographs were taken incrementally, from 0° to 120° of flexion. The femoral origin of the nMPFL and 3 other MPFL femoral fixation sites distal to the physis were identified (P1, 1 cm distal to physis along the posterior femoral cortex; P2, 2 cm distal to physis along the posterior femoral cortex; P3, 1 cm distal and 1 cm anterior). Virtual MPFL lengths were measured from all sites. Measurement reliability was assessed using intraclass correlation coefficients. Primary comparison between simulated MPFL length at native and femoral fixation sites was made using a repeated measures analysis of variance at 30° flexion. Bivariate Pearson correlation was used to assess the relationship between fixation sites and nMPFL through the range of motion (alpha=0.05). The intra-class correlation coefficient for intraobserver reliability of MPFL length measurement was excellent. Analysis of variance showed virtual MPFL lengths from proposed femoral fixation sites at 30° were significantly different from nMPFL length ( P <.01). The P1 MPFL had the least difference in means compared with nMPFL (−2.6±1.8 mm). Correlational analysis showed that P1 MPFL had the closest relationship with nMPFL compared with other femoral fixation sites ( R =0.91, P <.01). The P1 MPFL had the length change most comparable to that of nMPFL (23.9±3.1 mm vs 13.3±2.85 mm) compared with the other simulated MPFLs. Femoral graft fixation site 1 cm distal to the physis in the lateral view along the posterior femoral cortex closely represents the length relationship of the nMPFL. [ Orthopedics . 2023;46(2):108–113.]

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Anchor proximal migration in the medial patellofemoral ligament reconstruction in skeletally immature patients

Cited by 3 publications

References 10 publications

Midterm Results After Isolated Medial Patellofemoral Ligament Reconstruction as First-Line Surgical Treatment in Skeletally Immature Patients Irrespective of Patellar Height and Trochlear Dysplasia

Midterm Results After Isolated Medial Patellofemoral Ligament Reconstruction as First-Line Surgical Treatment in Skeletally Immature Patients Irrespective of Patellar Height and Trochlear Dysplasia

Localization of the Adductor Tubercle in the Skeletally Immature: A Computed Tomography Study With Patellofemoral Surgical Implications

Evaluation of the Optimal Femoral Fixation Site for Medial Patellofemoral Ligament Reconstruction in the Skeletally Immature Patient

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