Evaluation of the Schöttle Technique in the Pediatric Knee

Huston, Kellen L.; Okoroafor, Ugochi C.; Kaar, Scott G.; Wentt, Christa L; Saluan, Paul; Farrow, Lutul D.

doi:10.1177/2325967117740078

Cited by 12 publications

(10 citation statements)

References 31 publications

(49 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…22,30 The surgical technique for adults and adolescents follows anatomic recommendations for graft placement. 25,31,32 Graft placement on the patella has been consistent, with many groups recommending a broad attachment along the medial border of the patella. 33,34 Avoiding large patellar drill tunnels can reduce the risk of patella fracture.…”

Section: Unique Anatomic Considerations For Mpfl Reconstruction In Sk...mentioning

confidence: 83%

Recurrent Pediatric Patellofemoral Instability-Beyond the MPFL

Lin

Mackie

Aitchison

et al. 2020

Journal of the Pediatric Orthopaedic Society of North America

View full text Add to dashboard Cite

Pediatric patellofemoral instability is an increasingly common and debilitating problem. In recent years, there has been an improvement in diagnostic capabilities and greater knowledge of unique pediatric patellofemoral anatomy and pathophysiology. The spectrum of disease varies from a single traumatic dislocation, to recurrent dislocation, to obligatory dislocation in flexion or even fixed dislocation in severe or syndrome-associated cases. When treating pediatric patellofemoral instability, it is important to understand the benefits and limitations of nonoperative management. It is important to recognize the challenges imparted by the anatomy of the skeletally immature knee, specifically with regards to the physis, when considering surgical treatment. One must have a thorough understanding of common anatomic and pathophysiologic contributors to patellofemoral instability, such as coronal or axial plane malalignment, and concomitant osteochondral injury. For the very severe cases such as obligatory dislocation in flexion, special techniques may be required to achieve stability of the patellofemoral joint.

show abstract

Section: Unique Anatomic Considerations For Mpfl Reconstruction In Sk...mentioning

confidence: 83%

Recurrent Pediatric Patellofemoral Instability-Beyond the MPFL

Lin

Mackie

Aitchison

et al. 2020

Journal of the Pediatric Orthopaedic Society of North America

View full text Add to dashboard Cite

show abstract

“…However, graft anchoring in this location may not be appropriate in the skeletally immature patient. 4 Avoiding physeal injury in the pediatric population has been described by identifying the Scho ¨ttle point and then aiming distal to the physis and anterior. 3,8 Some surgeons have alternatively opted to anchor the graft proximal to the physis.…”

Section: Discussionmentioning

confidence: 99%

Localization of the Adductor Tubercle in the Skeletally Immature: A Computed Tomography Study With Patellofemoral Surgical Implications

et al. 2023

View full text Add to dashboard Cite

Background: The adductor tubercle of the distal femur is utilized by surgeons as an anatomic landmark to identify graft anchor placement during medial patellofemoral ligament (MPFL) and medial quadriceps tendon femoral ligament (MQTFL) reconstruction for patellofemoral instability. In the skeletally immature population, its location relative to the physis has not been well defined. Purpose: To identify the location of the adductor tubercle relative to the distal femoral physis in skeletally immature individuals and gain insight regarding optimal graft anchor placement for pediatric patients undergoing MPFL and MQTFL reconstruction. Study Design: Descriptive laboratory study. Methods: Thin-cut computed tomography scans of 37 male cadaveric specimens (age, 4-16 years) were obtained from the New Mexico Decedent Image Database. A measurement protocol to identify the adductor tubercle was created with guidance from a fellowship-trained musculoskeletal radiologist. By utilizing axial, coronal, and sagittal views of knee computed tomography scans, the adductor magnus tendon was identified and followed distally to its insertion (adductor tubercle) on the distal femur. Distance from the midpoint of the adductor magnus tendon insertion relative to the physis in the proximal-distal orientation was measured. The anterior-posterior distance of the midpoint tendon insertion relative to the posterior femoral cortex line was also evaluated. Results: The midpoint of the adductor magnus tendon was at the physis in 30 specimens. One 8-year-old cadaveric specimen had an insertion 1.1 mm distal to the physis. In all specimens ≥15 years old (n = 6), the adductor magnus tendon insertion was distal to the physis with a mean distance of 2.73 mm. The location of the adductor tubercle was always posterior (mean, 5.1 mm) with respect to the posterior femoral cortex line. Conclusion: The location of the adductor tubercle in male pediatric patients is likely at or distal to the physis. Thus, the findings of this study directly conflict with previous studies that suggested a more proximal location. Clinical Relevance: Optimal graft anchor placement during MPFL and MQTFL reconstruction in the skeletally immature patient can be challenging because of the variability reported in previous studies of the medial patellofemoral complex origin relative to the physis. This study suggests that distal—rather than proximal—graft anchor placement might better help restore patellofemoral isometry.

show abstract

“…Huston et al 16 evaluated the method of Schӧttle et al 29 in pediatric patients and found it to be reproducible, with a small intraobserver variance. Although reliable in determining the MPFL origin intraoperatively, it is not a reliable method of measurement to determine the distance of the MPFL origin to the physis and should be used with caution in skeletally immature patients.…”

Section: Discussionmentioning

confidence: 99%

Relationship of the Medial Patellofemoral Ligament Origin on the Distal Femur to the Distal Femoral Physis: A Systematic Review

et al. 2020

View full text Add to dashboard Cite

Background: The relationship between the medial patellofemoral ligament (MPFL) and the distal femoral physis has been reported in multiple studies. Purpose: To determine the distance from the MPFL central origin on the distal femur to the medial distal femoral physis in skeletally immature participants. Study Design: Systematic review. Methods: A systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Multiple databases were searched for studies investigating the anatomic origin of the MPFL on the distal femur and its relationship to the medial distal femoral physis in skeletally immature participants. Study methodological quality was analyzed with the Anatomical Quality Assessment tool, with studies categorized as low risk, high risk, or unclear risk of bias. Continuous variable data were reported as mean ± SD. Categorical variable data were reported as frequency with percentage. Results: Seven articles were analyzed (298 femurs, 53.7% male patients; mean age, 11.7 ± 3.4 years). There was low risk of bias based on the Anatomical Quality Assessment tool. The distance from the MPFL origin to the distal femoral physis ranged from 3.7 mm proximal to the physis to 10.0 mm distal to the physis in individual studies. Six of 7 studies reported that the MPFL origin on the distal femur lies distal to the medial distal femoral physis in the majority of specimens. The MPFL originated distal to the medial distal femoral physis in 92.8% of participants at a mean distance of 6.9 ± 2.4 mm. Conclusion: The medial patellofemoral ligament originates distal to the medial distal femoral physis in the majority of cases at a mean proximal-to-distal distance of 7 mm distal to the physis. However, this is variable in the literature owing to study design and patient age and sex.

show abstract

Evaluation of the Schöttle Technique in the Pediatric Knee

Cited by 12 publications

References 31 publications

Recurrent Pediatric Patellofemoral Instability-Beyond the MPFL

Recurrent Pediatric Patellofemoral Instability-Beyond the MPFL

Localization of the Adductor Tubercle in the Skeletally Immature: A Computed Tomography Study With Patellofemoral Surgical Implications

Relationship of the Medial Patellofemoral Ligament Origin on the Distal Femur to the Distal Femoral Physis: A Systematic Review

Contact Info

Product

Resources

About