Bilateral Medial and Lateral Patellofemoral Ligament Reconstruction in a Patient with Hypermobility Type Ehlers-Danlos Syndrome

Shubert, Daniel; McDonough, E Barry

doi:10.2106/jbjs.cc.18.00359

Cited by 4 publications

(3 citation statements)

References 25 publications

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“…The patellofemoral instability rates are > 50 % among patients with EDS 1 , and arthropathic changes in the patellofemoral joint and damage to the meniscus or ligaments have been reported to occur if improperly treated 4 . Conditions in which the patella is dislocated both medially and laterally are even rarer than medial patellar dislocation, and there are only 2 previous case reports of simultaneous medial and lateral patellar instability requiring MPFL and LPFL reconstruction 12,13 . One of the 2 case reports involved a patient with EDS, and the other described a patient without EDS, but both patients had a history of lateral release.…”

Section: Discussionmentioning

confidence: 99%

Bilateral Patellofemoral Ligament Reconstruction for Patellar Instability in Ehlers-Danlos Syndrome

Wako,

Ichikawa,

Koyama

et al. 2023

JBJS Case Connector

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Case: We report the case of an 11-year-old boy with Ehlers-Danlos syndrome (EDC) who exhibited simultaneous medial and lateral patellar instability. The patient presented with a medial patellar dislocation, and subsequently, the patella became very unstable both medially and laterally. Despite distal realignment, the patellar instability was so significant that he underwent simultaneous reconstruction of the medial and lateral patellofemoral ligament using the semitendinosus tendon, with a good result. Conclusion: Simultaneous reconstruction of the medial and lateral patellofemoral ligament is an effective method in cases of extreme patellar instability, such as the EDS case.

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Section: Discussionmentioning

confidence: 99%

Bilateral Patellofemoral Ligament Reconstruction for Patellar Instability in Ehlers-Danlos Syndrome

Wako,

Ichikawa,

Koyama

et al. 2023

JBJS Case Connector

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“…In dealing with EDSH patients with patellar instability, it is important to consider using allograft tissue for soft tissue procedures such as MPFL reconstruction given the intrinsic mechanical problems with autograft in this patient population [87]. Moreover, EDHS patients may suffer from combined medial and lateral patellar instability requiring reconstruction of both the medial and lateral patellofemoral ligaments in order to confer adequate stability [88].…”

Section: Additional Considerationsmentioning

confidence: 99%

Recurrent Patellofemoral Instability in the Pediatric Patient: Management and Pitfalls

Vellios

Trivellas

Arshi

et al. 2020

Curr Rev Musculoskelet Med

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Purpose of Review The purpose of the review is to discuss the relevant pathoanatomy, management, complications, and technical considerations for recurrent patellofemoral instability (PFI) in the pediatric population. Special consideration is given to recent literature and management of the patient with repeat instability following surgery. Recent Findings Patellar stabilization surgery is in principle dependent upon restoration of normal patellofemoral anatomy and dynamic alignment. Historically, treatment options have been numerous and include extensor mechanism realignment, trochleoplasty, and more recently repair and/or reconstruction of the medial patellofemoral ligament (MPFL) as a dynamic check rein during initial knee flexion. In skeletally immature patients, preference is given to physeal-sparing soft tissue procedures. While medial patellofemoral ligament reconstruction has become a popular option, postoperative failure is a persistent issue with rates ranging from 5 to 30% for PFI surgery in general without any single procedure (e.g., distal realignment, MPFL reconstruction) demonstrating clear superiority. Failure of surgical patellar stabilization is broadly believed to occur for three main reasons: (1) technical failure of the primary stabilization method, (2) unaddressed static and dynamic pathoanatomy during the primary stabilization, and (3) intrinsic risk factors (e.g., collagen disorders, ligamentous laxity). Summary PFI is a common orthopedic condition affecting the pediatric and adolescent population. Treatment of repeat instability following surgery in the PFI patient requires understanding and addressing underlying pathoanatomic risk factors as well as risks and reasons for failure.

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“… 34) Finally, successful outcomes were recently reported in a 35-year-old female with hEDS and bilateral iatrogenic medial and lateral patellar instability who was treated with simultaneous medial and lateral patellofemoral ligament (MPFL and LPFL) reconstruction. 35) …”

Section: Knee Abnormalities In Patients With Heds/jhsmentioning

confidence: 99%

Surgical Management of Shoulder and Knee Instability in Patients with Ehlers-Danlos Syndrome: Joint Hypermobility Syndrome

et al. 2020

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Ehlers-Danlos Syndrome (EDS) is a hereditary disorder of the connective tissue, which has been classified into numerous subtypes over the years. EDS is generally characterized by hyperextensible skin, hypermobile joints, and tissue fragility. According to the 2017 International Classification of EDS, 13 subtypes of EDS have been recognized. The majority of genes involved in EDS are either collagen-encoding genes or genes encoding collagen-modifying enzymes. Orthopedic surgeons most commonly encounter patients with the hypermobile type EDS (hEDS), who present with signs and symptoms of hypermobility and/or instability in one or more joints. Patients with joint hypermobility syndrome (JHS) might also present with similar symptomatology. This article will focus on the surgical management of patients with knee or shoulder abnormalities related to hEDS/JHS.

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Bilateral Medial and Lateral Patellofemoral Ligament Reconstruction in a Patient with Hypermobility Type Ehlers-Danlos Syndrome

Cited by 4 publications

References 25 publications

Bilateral Patellofemoral Ligament Reconstruction for Patellar Instability in Ehlers-Danlos Syndrome

Bilateral Patellofemoral Ligament Reconstruction for Patellar Instability in Ehlers-Danlos Syndrome

Recurrent Patellofemoral Instability in the Pediatric Patient: Management and Pitfalls

Surgical Management of Shoulder and Knee Instability in Patients with Ehlers-Danlos Syndrome: Joint Hypermobility Syndrome

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