Acquired Distal Femoral Deformity After MPFL Reconstruction

Trionfo, Arianna; Shah, A.; Misaghi, Amir; Arkader, Alexandre

doi:10.55275/jposna-2020-126

Cited by 5 publications

(9 citation statements)

References 12 publications

(13 reference statements)

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“…Establishing the femoral tunnel to create such anisometry is technically demanding; however, the ease and accuracy of this task have been greatly improved with the technique described by Scho ¨ttle et al 15 Despite these advancements in MPFLR femoral tunnel technique, the placement of this tunnel in the pediatric patient remains increasingly challenging because of the risk of physeal injury. 16,18,23 In the pediatric knee, not only does the graft femoral insertion point require careful attention (anisometry), but so does the entire tunnel position relative to the open distal femoral physis (physeal injury avoidance). 10,11,17 The literature reporting the investigation of the relationship of the MPFL femoral attachment to the distal medial femoral physis is widely varied, with many studies providing conflicting results.…”

Section: -In-5mentioning

confidence: 99%

“…1,22 Establishing the femoral tunnel to create such anisometry is technically demanding; however, the ease and accuracy of this task have been greatly improved with the technique described by Schöttle et al 15 Despite these advancements in MPFLR femoral tunnel technique, the placement of this tunnel in the pediatric patient remains increasingly challenging because of the risk of physeal injury. 16,18,23…”

mentioning

confidence: 99%

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The Schöttle Point Is Consistently Located Distal to the Medial Femoral Physis in Pediatric Patients: A Digitally Reconstructed Radiographic Study

et al. 2022

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Background: Significant controversy surrounds ideal tunnel position for medial patellofemoral ligament (MPFL) reconstruction (MPFLR) in the pediatric setting. The start point for femoral tunnel positioning (the Schöttle point) relative to the distal medial femoral physis is not well defined. Previous studies provide conflicting data regarding position of the MPFL origin and the Schöttle point relative to the distal femoral physis. Hypothesis: The Schöttle point would be consistently distal to the distal medial femoral physis. Study Design: Descriptive laboratory study. Methods: The institutional picture archiving and communication system was queried for computed tomography (CT) imaging studies of pediatric knees. Data were imported to an open-source image computing platform. True lateral digitally reconstructed radiographs and 3-dimensional (3D) renderings were generated, and the Schöttle point was registered in 3D space. Then, 3D distance measurements were obtained from the Schöttle point to the distal medial femoral physis. Results: A total of 49 pediatric knee CT scans were included. Mean age was 13.0 ± 2.3 years. Mean minimum distance from the medial physis to the Schöttle point was 9.9 ± 3.0 mm (range, 3.4-16.1 mm). In 49 of 49 cases (100%), the Schöttle point was distal to the physis. Using a 6-mm reaming diameter would result in 3 of 49 (6%) femurs having violation of the distal medial femoral physis. Moving the start point 3 mm distally would result in 0 of 49 (0%) sustaining physeal injury. Conclusion/Clinical Relevance: The Schöttle point is consistently distal to the distal medial femoral physis. The mean minimum distance from the Schöttle point to the physis on the medial cortex is 9.9 mm. The Schöttle point provides a safe and reliable radiographic landmark for pediatric MPFLR, although reaming diameter should be considered.

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Section: -In-5mentioning

confidence: 99%

mentioning

confidence: 99%

The Schöttle Point Is Consistently Located Distal to the Medial Femoral Physis in Pediatric Patients: A Digitally Reconstructed Radiographic Study

et al. 2022

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“…23 Unique to the skeletally immature population, both varus and valgus growth arrest requiring corrective osteotomies have been described. 24 Preventive measures include soft tissue fixation on the femur as well as confirming drill position in the epiphysis under fluoroscopy and aiming away from physis. 24 Limited studies have been published evaluating complication rates with concomitant MPFL and TTO.…”

Section: Patellar Instabilitymentioning

confidence: 99%

“…All-inside 11% 19 4.6% 19 Chondral damage, deep infection, DVT, PE, failure of device 19,20 Inside-out 10% 19 5.1% 19 Incisional pain, saphenous vein or nerve injury, peroneal nerve irritation 19 TTO 7% 21 4.6%-6.2% 21,22 12-36% Removal of hardware, persistent pain, decreased ROM, hematoma, neuroma, tibial fracture 21,22 MPFL 5.1% 23 4.5% 23 Patella fracture, symptomatic hardware, wound complications, growth arrest 23,24 and arthroscopic Latarjet procedures. The failure and complication rates of shoulder instability procedures are dependent on multiple factors that are beyond the scope of this review.…”

Section: Meniscus Repairmentioning

confidence: 99%

“…24 Preventive measures include soft tissue fixation on the femur as well as confirming drill position in the epiphysis under fluoroscopy and aiming away from physis. 24 Limited studies have been published evaluating complication rates with concomitant MPFL and TTO. A large, level III study demonstrated longer operative times when MPFL and TTO are performed together, but no difference in 30-day complication rates, hospital admission length, or readmissions compared with the procedures being performed alone.…”

Section: Patellar Instabilitymentioning

confidence: 99%

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Failure and Complication Rates in Common Sports and Arthroscopic Procedures: Reality Check

Taylor

Caldwell²,

Pearson³

2022

Sports Medicine and Arthroscopy Review

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Expectations following sports medicine and arthroscopic procedures have been elevated because of captivating modern-day media coverage of high-profile athletic injuries, surgery, and rapid return to sports. Unfortunately, this general perception may be misleading, and orthopedic sports medicine physicians must be aware of the harsh reality of the trials and tribulations associated with the subspecialty. The purpose of this review article is to provide an updated brief overview of the complications and failure rates associated with common arthroscopic procedures including rotator cuff repair, biceps tenodesis, Bankart procedure, Latarjet procedure, anterior cruciate ligament reconstruction, anterior cruciate ligament repair, meniscal repair, tibial tubercle osteotomy, and medial patellofemoral ligament reconstruction. Highlighting the complications is the first step toward early recognition, enhancing preventative measures, and successful management.

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Reimagined MPFL Reconstruction: Retinacular Fixation of the Doubled Hamstring Graft at the Patella and Suture Anchor-Based Femoral Fixation

Nazeer,

Goel,

Nazeer

et al. 2023

Advances in Orthopedics

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Background. Lateral patellar dislocation is frequently observed among teenagers and young adults. There is no consensus on the best type of graft or fixation strategy for the femur and patella, and complications such as iatrogenic patella fracture, tunnel malposition, and grafting failure are common. The objective of our research is to find out the functional outcome of a new method of medial patellofemoral ligament (MPFL) reconstruction, which involves two key components: (1) patellar fixation is accomplished by suturing the two limbs of the looped doubled hamstring graft in a divergent fashion to the retinaculum at the medial border of the upper half of patella and (2) the placement of a suture anchor tied to the graft at the isometric point on the medial femur condyle. Methods. This study is a retrospective assessment of patients who underwent MPFL reconstruction at our hospital between September 2018 and August 2020. Patients were monitored for at least 2 years after the initial procedure until August 2022. Results. A total of 29 patients were recruited for the study, with 22 being females and the average age being 30.38 years. During the postoperative period, none of the participants experienced instability, redislocation, patellar/femoral fractures, or abnormal distal femur growth. The Tegner–Lysholm knee score was good to excellent for 17 (58.6%) participants, fair for 10 (34.5%) participants, and poor for 2 (6.9%) participants. The Kujala anterior knee pain score was more than 80 for 19 (65.5%) participants. Conclusion. This research presents a significant achievement rate of the surgical procedure, accompanied by the mean Tegner–Lysholm knee score of 82.68 and the mean Kujala anterior knee pain score of 82.71. Notably, there were no complications observed in the postoperative period.

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Acquired Distal Femoral Deformity After MPFL Reconstruction

Cited by 5 publications

References 12 publications

The Schöttle Point Is Consistently Located Distal to the Medial Femoral Physis in Pediatric Patients: A Digitally Reconstructed Radiographic Study

The Schöttle Point Is Consistently Located Distal to the Medial Femoral Physis in Pediatric Patients: A Digitally Reconstructed Radiographic Study

Failure and Complication Rates in Common Sports and Arthroscopic Procedures: Reality Check

Reimagined MPFL Reconstruction: Retinacular Fixation of the Doubled Hamstring Graft at the Patella and Suture Anchor-Based Femoral Fixation

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