Analysis of failed surgery for patellar instability in children with open growth plates

Nelitz, Manfred; Theile, Michael; Dornacher, Daniel; Wölfle, Julia V.; Reichel, Heiko; Lippacher, Sabine

doi:10.1007/s00167-011-1599-5

Cited by 94 publications

(78 citation statements)

References 41 publications

(101 reference statements)

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“…Nelitz et al did a study on 80 knees of 78 patients, aiming to evaluate whether specific measurements of the femoral trochlea can be assigned to the qualitative classification system of Dejour using the abovementioned measurements. They concluded that, by using a descriptive statistics using boxplot diagrams, none of the objective measurements of the femoral trochlea described in the literature could be assigned to the four-grade descriptive classification of trochlear dysplasia of Dejour as the median and average range of these measurements allowed no discrimination between trochlear dysplasia types B, C, and D. However, the threshold values used to discriminate between low-grade (Dejour type A) and high-grade dysplasia (Dejour types B-D) could be identified [24].…”

Section: Discussionmentioning

confidence: 98%

Role of magnetic resonance imaging in the evaluation of the anterior knee pain

Baz

Shantely

Hassan

et al. 2019

Egypt J Radiol Nucl Med

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Background: To review the most common causes of Anterior knee pain (AKP), with an emphasis on their MRI findings; 70 patients were included (24 males and 46 females). Their age range is 10-53 years with a mean ± SD of 28.8 ± 9.06 years. All patients performed MRI of the affected knee. Results: Eleven disease entities were encompassed in this study; the patellar causes were dominating, where the chondromalacia patella being found in 43% of cases (n = 30), patellar instability was found in 19% (n = 13), transient patellar dislocation was found in 7% (n = 5), patellar tendinopathy was found in 4% (n = 3), and bipartite patella was found in 1% (n = 1). Hoffa's disease was found in 14% (n = 10); the anterior meniscal tear was found in 13% (n = 9). Quadriceps tendinopathy was found in 3% (n = 2), and quadriceps tear was found in 4% (n = 3). Cartilage disease was found in 6% (n = 4); Osgood-Schlatter disease was found in 4% (n = 3); the coexistence of more than an entity was found in 13 cases (18.5%).Conclusions: MRI provided a safe and accurate modality in the diagnosis of different causes of AKP with a high specification in detecting the grades and the types of some diseases.

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Section: Discussionmentioning

confidence: 98%

Role of magnetic resonance imaging in the evaluation of the anterior knee pain

Baz

Shantely

Hassan

et al. 2019

Egypt J Radiol Nucl Med

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“…For these patients, the simple patellar re-alignment does not appear to be sufficient, and as adults these patients were offered MPFL reconstruction. Notably, more than half of the patients in our study showed a patello-femoral dysplasia, which plays a considerable role in recurrent dislocations (Nelitz et al 2012). Furthermore, the young age of the patients appears to favor recurrent dislocation (Buchner et al 2005).…”

Section: Discussionmentioning

confidence: 81%

Patella re-alignment in children with a modified Grammont technique

et al. 2012

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Background and purpose In skeletally immature patients, surgical options due to recurrent patella dislocation are limited, because bony procedures bear the risk of growth disturbances. In this retrospective study, we report the long-term functional and radiographic outcome in skeletally immature patients using the modified Grammont surgical technique.Patients Between 1999 and 2004, 65 skeletally immature knees (49 children) were treated with a modified Grammont procedure: an open lateral release and a shift of the patella tendon insertion below the growth plate on the tuberositas tibia, allowing the tendon to medialize. At mean 8 (5.6–11) years after surgery, 58 knees in 43 patients were evaluated by clinical examination, from functional scores (Lysholm, Tegner), and from radiographs of the knees.Results Mean Lysholm score was 82 postoperatively. Tegner score decreased from 6.2 to 5. Eight knees had a single dislocation within 3 months of surgery. 3 knees had repeated late dislocations, all with a high grade of trochlea dysplasia. 6 knees showed mild signs of osteoarthritis. No growth disturbances were observed.Interpretation The modified Grammont technique in skeletally immature patients allows restoration of the distal patella tendon alignment by dynamic positioning. Long-term results showed that there were no growth disturbances and that there was good functional outcome. However, patients with a high grade of trochlea dysplasia tended to re-dislocate.

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“…Axis deviations of the lower extremity such as genu valgum is one of further risk factors for failure of an isolated MPFLR [6,7]. Because genu valgum has been regarded as one of negative factors to increase the forced displacement of patella laterally and cause a J-sign during the nal extension of the knee [9,25].…”

Section: Discussionmentioning

confidence: 99%

“…For these patients, it may not be appropriate to apply medialization of the tibial tuberosity (TTM), which noticeably increased the patellofemoral and the medial tibiofemoral contact pressure, changed the balance of tibiofemoral joint loading [5]. MPFLR, is known as the most common surgical procedure for PRD, but genu valgum is one of further risk factors for failure of an isolated MPFLR [6,7]. Besides, more than 2 times greater risk of degeneration in the lateral femorotibial compartment was found in the circumstances of malalignment of 3 degrees valgus [8,9].…”

Section: Introductionmentioning

confidence: 99%

Closing-wedge Distal Femoral Osteotomy Combined with Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Dislocation with Genu Valgum

Jing¹,

Wang²,

Liu³

et al. 2020

Preprint

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Background: Medial patellofemoral ligament reconstruction (MPFLR) is a well-established procedure for addressing recurrent patellar dislocation (RPD) in young patients. However, for RPD with genu valgum, simultaneous MPFLR and closing-wedge distal femoral osteotomy (CWDFO) may be a promising procedure yet rarely reported. This study’s purpose was to observe and analyse the clinical and imaging findings of CWDFO combined with MPFLR for RPD with genu valgum.Methods: From May 2015 to Apirl 2018, 25 patients with RPD and genu valgum were surgically treated in our department. Anteroposterior long-leg, weight-bearing, lower-extremity radiographs, lateral radiographs and computed tomography (CT) scans of the patellofemoral joint were obtained, and the femorotibial angle (FTA), mechanical lateral distal femoral angle (mLDFA), weight-bearing line rate (WBLR), patellar height, patellar lateral shift (PLS) and tibial tubercle–trochlear groove (TT-TG) distance were analysed. Validated knee scores, such as the Kujala, Lysholm, visual analogue scale (VAS) scores and Tegner socres, were evaluated preoperatively and 2 years postoperatively.Results: 25 patients, with an average age of 19.8 years (14–27), were evaluated. All patients had been able to achieve a better sports level without any problems during the 2-year follow-up period. There has been no recurrence of patellar instability. Compared with preoperation, the FTA, mLDFA, WBLR and PLS showed statistically significant improvement following the procedure (p < 0.001). Meanwhile, no significant differences in the Insall index and TT-TG distance was found. The mean Kujala score, average Lysholm score, VAS score and Tegner socres showed significant improvement postoperatively.Conclusions: CWDFO combined with MPFLR is a suitable treatment for RPD with genu valgum, as it leads to significant improvement in the clinical and imaging findings of the knee in the short term.

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Analysis of failed surgery for patellar instability in children with open growth plates

Abstract: Retrospective study, Level III.

Cited by 94 publications

References 41 publications

Role of magnetic resonance imaging in the evaluation of the anterior knee pain

Role of magnetic resonance imaging in the evaluation of the anterior knee pain

Patella re-alignment in children with a modified Grammont technique

Closing-wedge Distal Femoral Osteotomy Combined with Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Dislocation with Genu Valgum

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