Outcomes of MPFL Reconstruction Utilizing a Quadriceps Turndown Technique in the Adolescent/Pediatric Population

Abstract

Purpose: Recurrent instability following a lateral patellar dislocation is a common indication for surgical intervention. Several surgical procedures are described in the literature to address recurrent patellar instability. Medial patellofemoral ligament (MPFL) reconstruction utilizing the quadriceps turndown technique attempts to restore medial stability. Results of the quadriceps turndown technique have previously only been reported in adult populations. The purpose of this study was to assess the safety, efficacy, and patient-reported outcomes following a quadriceps turndown MPFL reconstruction in the pediatric and adolescent population. Methods: Records of all patients who underwent MPFL reconstruction using a quadriceps turndown technique between 2011 and 2018 were reviewed for demographics, risk factors, complications, mechanism of injury, and concomitant procedures. Return to activities of daily living (ADLs), return to presurgery level of sport, length of bracing, and recurrent instability were assessed with the administration of the Kujala Anterior Knee Pain Score. All analyses were completed using IBM SPSS Statistics 26. Results: Thirty-six knees [14 female (39%), 22 male (61%)] from 34 patients met inclusion/exclusion criteria. The average followup length was 35.9 ± 15.2 months. The average age was 16.3 ± 1.8 years at the time of surgery. The average time for resumption of ADLs was 8.1 ± 6.0 weeks after surgery. Ninetyfour percent of patients returned to preinjury level of sport at an average of 23.6 ± 12.0 weeks after surgery. Mean Kujala Anterior Knee Pain Score was 90.7 ± 10.3. Female patients (P < 0.001) reported significantly lower Kujala scores. Three patients (8%) experienced recurrent instability during ADLs and an additional 4 (11%) reported subjective feelings of instability only during sport or elevated activity. One knee required a return to the operating room for irrigation and debridement due to infection. Conclusion:This study demonstrates that the quadriceps turndown technique for MPFL reconstruction is a safe and effective procedure for the management of recurrent patellar instability in pediatric and adolescent patients. Level of Evidence: Level III-therapeutic.

Outcomes, Return to Sport, and Failures of MPFL Reconstruction Using Autografts in Children and Adolescents with Recurrent Patellofemoral Instability: A Systematic Review

“…Of the patients, 87% returned to the same level of sport as preoperatively, while 27% had to reduce their level of sport following MPFL reconstruction. These findings confirm the results of Fisher et al, who used a quadriceps turndown technique with 94% of patients returning to a pre-injury level of sport [ 49 ]. Liu et al found, in a retrospective study, that 94.5% of patients were able to return to sport at one year, with only 74% returning to the same level of play [ 50 ], with similar results found by Nelitz et al [ 39 ].…”

Hardware-free MPFL reconstruction in patients with recurrent patellofemoral instability is safe and effective

“…The last follow-up scores were 86.23 ± 7.71 versus 88.37 ± 3.71 at a 46.5 ± 20.9 months follow-up, respectively. These results agree with the findings of the present systematic review and are further supported by additional studies which have not been included because, though published in peer-reviewed journals, they did not meet our strict inclusion criteria [19,[39][40][41][42][43][44][45][46][47][48][49][50][51]. On the other hand, the complication profile of hardware-free fixation shares similarities with implantbased fixation techniques, including subjective instability, positive apprehension test, and redislocation [55].…”

“…Titles and abstracts were independently screened, and 27 articles were selected for full-text evaluation. Seven studies were excluded because of insufficient followup [19,[39][40][41][42][43][44] and seven more because Kujala Anterior Knee Pain Scale was not used or data were insufficient to evaluate post-surgical improvement [45][46][47][48][49][50][51]. Finally, eight studies met the predetermined eligibility criteria, and no additional studies were included after citation screening in the systematic review (Fig.…”

Martial Arts: Orthopaedic Injuries and Related Biomechanics

“…The quads-turndown technique can be an alternative for smaller knees. 18 For tibial tubercle osteotomies, the use of headless screws buried beneath the bone cortex decreases irritation upon returning to martial arts. For selected skeletally immature patients, a medial patellar tendon transfer 19 or Roux-Goldthwait procedure can be considered.…”