Anatomic physeal-sparing technique for medial patellofemoral ligament reconstruction in skeletally immature patients with ligamentous laxity

AbouElsoud, Maged; Abdelhady, Amr; Elshazly, Ossama Abdelraouf

doi:10.1007/s00590-015-1618-1

Cited by 20 publications

(35 citation statements)

References 22 publications

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“…Interference screws or suture anchors provide secure fixation into the anatomic footprint of the MPFL and have been shown to be effective. 1,13,20,21,27 Alternatively, the MPFL graft can be looped around anatomic structures such as the MCL or adductor magnus tendon. 6,11,12 Although the soft tissue pulley technique does not place open physes at risk, it does not allow for anatomic reconstruction of the MPFL.…”

Section: Discussionmentioning

confidence: 99%

Medial Patellofemoral Ligament Reconstruction in Skeletally Immature Patients: A Systematic Review and Meta-analysis

Shamrock

Day

Duchman

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background: Given the proximity of the medial patellofemoral ligament (MPFL) femoral insertion to the distal femoral physis in skeletally immature patients, multiple techniques for femoral graft fixation have been described. Purpose: To systematically review the literature and evaluate outcomes and complications following MPFL reconstruction in skeletally immature patients. Study Design: Systematic review; Level of evidence, 4. Methods: A comprehensive literature search was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines through use of the PubMed, Embase, and Cochrane Central databases. All original, English-language studies reporting outcomes or complications following MPFL reconstruction in skeletally immature patients were included. Skeletally mature patients were excluded. Data regarding demographics, surgical technique, graft type, outcomes, and complications were recorded. Study quality was assessed by use of the modified Coleman methodology score. Statistical analysis was performed through use of chi-square and weighted mean pooled cohort statistics, where appropriate, with significance set at P < .05. Results: 7 studies that entailed 132 MPFL reconstructions (126 patients) met the inclusion criteria. Females comprised 57.9% of the cohort (73 females), and the mean age was 13.2 years (range, 6-17 years). Mean postoperative follow-up was 4.8 years (range, 1.4-10 years). All of the grafts used were autograft, with gracilis tendon (n = 80; 60.6%) being the most common. Methods of femoral fixation included interference screw (n = 52; 39.4%), suture anchor (n = 51; 38.6%), and soft tissue pulley around the medial collateral ligament or adductor tendon (n = 29; 21.9%). Pooled Kujala scores improved from 59.1 to 84.6 after MPFL reconstruction. The total reported complication rate was 25.0% (n = 33) and included 5 redislocations (3.8%) and 15 subluxation events (11.4%). No cases of premature physeal closure were noted, and there were 3 reports of donor site pain (2.3%). Neither autograft choice ( P > .804) nor method of femoral fixation ( P > .416) influenced recurrent instability or overall complication rates. Conclusion: These findings suggest that MPFL reconstruction in skeletally immature patients is a viable treatment option, with significant improvement in patient-reported outcomes and redislocation event rates of less than 5% at nearly 5-year follow-up. Further high-quality research is needed to determine optimal graft options and surgical technique while considering recurrent instability, donor site morbidity, and potential injury to the adjacent physis.

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Section: Discussionmentioning

confidence: 99%

Medial Patellofemoral Ligament Reconstruction in Skeletally Immature Patients: A Systematic Review and Meta-analysis

Shamrock

Day

Duchman

et al. 2019

Orthopaedic Journal of Sports Medicine

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“…Abouelsoud, 2015 1 Deie, 2003 8 Kumahashi, 2012 15 Lind, 2016 17 Matuszewski, 2018a 19 Matuszewski, 2018b 19 Nelitz, 2013 21 Nelitz, 2018 22 Pesenti, 2018 28 Uppstrom, 2019 40 Yercan, 2011 42 Benoit, 2007 2 Biglieni, 2011 3 Bonnard, 1990 4 Cootjans, 2013a 7 Cootjans, 2013b 7 Grannatt, 2012 11 Letts, 1999 16 Malagelada, 2018 18 Pesenti, 2017 27 Ronga The red bar indicates the 95% prediction interval. Prediction intervals illustrate which range of true effects expected to occur in similar studies in future settings.…”

Section: Random E Ects Modelmentioning

confidence: 99%

Recurrent patellofemoral instability rates after MPFL reconstruction techniques are in the range of instability rates after other soft tissue realignment techniques

Wilkens¹,

Hannink²,

Groes³

2019

Knee Surg Sports Traumatol Arthrosc

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Purpose Recurrent patellofemoral instability is a common knee injury in skeletally immature patients. Many surgical techniques have been described in the literature, all with different success rates. Purpose of this study was to perform a systematic review and meta-analysis of the available literature to assess recurrent patellofemoral instability rates after surgical treatment using MPFL reconstruction techniques and other soft tissue realignment techniques in skeletally immature patients. Methods PubMed, Embase, Web of Science, and The Cochrane Library were searched to identify all original articles concerning the surgical treatment for patellofemoral instability in skeletally immature patients and that reported post-operative recurrent patellofemoral instability rates. Subsequently a risk of bias assessment was conducted and a meta-analysis was performed on reported post-operative recurrent patellofemoral instability rates after MPFL reconstruction techniques and other soft tissue realignment techniques. Results Of the 21 eligible studies (448 knees in 389 patients), 10 studies reported on MPFL reconstruction techniques using different grafts and fixation techniques and 11 reported on other soft tissue realignment procedures. In total, 62 of the 448 (13.8%) treated knees showed recurrent patellofemoral instability during follow-up. The overall pooled recurrent patellofemoral instability rate was estimated to be 0.08 (95% CI 0.02-0.16). For MPFL reconstruction techniques, the pooled recurrent patellofemoral instability rate was estimated to be 0.02 (95% CI 0.00-0.09). For the other soft tissue realignment techniques, the pooled rate was estimated to be 0.15 (95% CI 0.04-0.31). No statistically significant difference in recurrent patellofemoral instability rates between MPFL reconstruction techniques and other soft tissue realignment techniques were found (n.s.). There was a large variation in treatment effects over different settings, including what effect is to be expected in future patients. Conclusion This systematic review and meta-analysis found that recurrent patellofemoral instability rates after MPFL reconstruction techniques are in the range of instability rates after other soft tissue realignment techniques. The clinical relevance of this study is that it provides clinicians with the best currently available evidence on recurrent patellofemoral instability rates after surgical treatment for patellofemoral instability in skeletally immature patients. Level of evidence IV.

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“…7 The surgery associated with the MPFL has become a popular technique for management of cases of recurrent patellar instability in the moment. [8][9][10] However, for the primary traumatic patellar dislocation, whether MPFL repair is more effective than conservative treatment or not remains controversial. A randomized controlled trial (RCT) from Christiansen et al compared the efficacy between conservative and surgical treatment of MPFL repair in 80 patients with acute PPD and concluded that the treatment of MPFL repair was not superior to conservative treatment in terms of the redislocation rate and improvement of subjective knee functional.…”

Section: Introductionmentioning

confidence: 99%

Conservative versus repair of medial patellofemoral ligament for the treatment of patients with acute primary patellar dislocations: A systematic review and meta-analysis

Tian

Yang

Zuo

et al. 2020

J Orthop Surg (Hong Kong)

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Purpose: The aim of this study was to perform a meta-analysis to compare the effects of repair of medial patellofemoral ligament (MPFL) and conservative treatment in patients with acute primary patellar dislocation (PPD). Method: The databases we used to search the studies included MEDILINE, EMBASE, and Cochrane registry of controlled clinical trials. Five randomized controlled studies comparing the effects of MPFL repair versus conservative treatment with 300 acute PPD patients were included in the present meta-analysis. Primary outcome was redislocation rate and secondary outcomes included Kujala score, percentage of excellent or good subjective opinion, Tegner activity score, and knee injury and osteoarthritis outcome score (KOOS; pain, symptoms, and activities of daily living). Results: The outcome of the Kujala score was statistically significant between the two treatments and indicated that MPFL repair had a higher Kujala score than conservative treatment in patients with acute PPD. There was no significant difference between the two treatments regarding the redislocation rate ( p = 0.32), percentage of excellent or good subjective opinion ( p = 0.15), Tegner activity score ( p = 0.24), and KOOS ( p > 0.05). Conclusions: Based on the available data, MPFL repair did not reduce the risk of redislocation nor did it produce any significantly better outcome based on the clinical manifestations, including anterior knee pain and knee activities. Only the Kujala score was improved by MPFL repair compared with conservative treatment.

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Anatomic physeal-sparing technique for medial patellofemoral ligament reconstruction in skeletally immature patients with ligamentous laxity

Cited by 20 publications

References 22 publications

Medial Patellofemoral Ligament Reconstruction in Skeletally Immature Patients: A Systematic Review and Meta-analysis

Medial Patellofemoral Ligament Reconstruction in Skeletally Immature Patients: A Systematic Review and Meta-analysis

Recurrent patellofemoral instability rates after MPFL reconstruction techniques are in the range of instability rates after other soft tissue realignment techniques

Conservative versus repair of medial patellofemoral ligament for the treatment of patients with acute primary patellar dislocations: A systematic review and meta-analysis

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