Medial Patellofemoral Ligament Injuries in Children With First-Time Lateral Patellar Dislocations

Askenberger, Marie; Arendt, Elizabeth A.; Ekström, Wilhelmina; Voss, Ulrika; Finnbogason, Thröstur; Janarv, Per Mats

doi:10.1177/0363546515611661

Cited by 75 publications

(66 citation statements)

References 34 publications

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“…A recent MRI study demonstrated that nearly 100% of pediatric patients have structural damage to the MPFL following a single patellar dislocation [2]. MPFL injury combined with baseline structural abnormalities likely account for the high rate of recurrent patellar instability in the ipsilateral knee (compared to the contralateral knee).…”

Section: Discussionmentioning

confidence: 99%

High rate of recurrent patellar dislocation in skeletally immature patients: a long-term population-based study

Sanders

Pareek

Hewett

et al. 2017

Knee Surg Sports Traumatol Arthrosc

123

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Section: Discussionmentioning

confidence: 99%

High rate of recurrent patellar dislocation in skeletally immature patients: a long-term population-based study

Sanders

Pareek

Hewett

et al. 2017

Knee Surg Sports Traumatol Arthrosc

123

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“…More recently, studies have looked at the site of MPFL injury: patella, interstitial, femur, or a combination of those sites [3,7,17,22,23,42,43]. Knowing the location is important because the rate of redislocation is higher when there is an isolated femoral lesion [22,35] and acute repair may fare better when the lesion is solely patella based [10,11].…”

Section: Introductionmentioning

confidence: 99%

Anatomic patellar instability risk factors in primary lateral patellar dislocations do not predict injury patterns: an MRI-based study

Tompkins

Rohr

Agel

et al. 2017

Knee Surg Sports Traumatol Arthrosc

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for this injury due to clinician-perceived need for cartilage debridement. MPFL injury severity was complete rupture (N = 69, 44%), partial (N = 67, 43%), and none (N = 19, 13%). MPFL injury location was isolated femoral (N = 16, 10%), isolated patella (N = 26, 17%), isolated mid-substance (0%), multiple locations (N = 95, 61%), and none (N = 20, 13%). Chondral injury location was patella (N = 67, 43%), lateral femoral condyle (N = 11, 7%), multiple locations (N = 53, 34%), and none (N = 26, 17%). A majority (61%) of patellar chondral lesions were at its inferomedial aspect; all medial patellar retinacular partial injuries involved the inferomedial aspect of the patella, consistent with the insertion of the medial patellotibial ligament (MPTL). Skeletally immature patients had a greater risk of isolated patellar MPFL and chondral injury. No clear relationship was found between/across the location and/or severity of bone bruising, MPFL, or chondral injury. Clinical relevance Underlying anatomic patellar instability risk factors defined by MRI, do not predict injury patterns. MPFL and chondral injury, as well as bone bruising, are common following LPD. The medial patellotibial ligament is torn in patellar-based medial retinacular injuries, based on MRI injury location. Skeletal immaturity plays a role in the location of the injury pattern with isolated patellar-based MPFL/chondral injury being more common in the skeletally immature patient. Sex does not appear to be a factor in injury patterns after primary LPD. Knowledge of these injury trends will help focus the clinician in injury evaluation when managing primary patellar dislocations. Level of evidence Case series, Level IV. AbstractPurpose The primary goal was to describe the injury patterns in a population of primary (first time) lateral patellar dislocators (LPD) to lend clarity to commonly held notions about injury patterns in this population. Methods A prospective study identifying patients presenting with LPD between 2008 and 2012. Inclusion criteria were a history and physical exam consistent with primary LPD, and an MRI consistent with the diagnosis without other significant ligamentous injury. On MRI, location of cartilage, medial patellofemoral ligament (MPFL) injury, and bone bruising were noted. Severity was categorized as partial or complete for MPFL and cartilage lesions. Anatomic patellar instability risk factors (patella alta, trochlear dysplasia, increased TT-TG, and lateral patella tilt) were recorded and compared to the injury patterns. Results This study involved 157 patients; 107 patients were skeletally mature. Of the 157 patients, 26 had surgery

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“…Furthermore, MRI is of prime importance to localize possible medial patellofemoral ligament (MPFL) tears, which can be patellar, femoral or multifocal. In young children (aged 9 to 14), the patellar attachment site is the most commonly damaged, occurring a total rupture in more than half of the cases [9]. The second topic prone to discussion refers to treatment.…”

Section: Discussionmentioning

confidence: 99%

Open Reduction and Internal Fixation of an Osteochondral Patellar Fracture in an Eleven Year-Old Girl

Correia¹

2016

MOJOR

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Osteochondral patellar fractures in pediatric age can result from acute patellar dislocations (APDs). The purpose of this article is to document and discuss the surgical treatment performed to a young female patient diagnosed with an osteochondral fracture (OCF) of the patella in the first episode of an APD.We state the first episode of an APD in a 12 year-old girl, who presented with pain, edema and limited extension of the right knee, after a direct knee trauma. She had no predisposing factors regarding patellofemoral instability. This patient was treated at our Orthopaedic Surgery Department and then clinically (Kujala score) and radiographically evaluated, at 12 months of follow-up.The knee radiograms gave rise to the suspicion of a large inferior osteochondral patellar fragment. Operative treatment was decided and open reduction and internal fixation (ORIF) of the fragment was performed, through a medial parapatellar approach. The fragment dimensions were 24x18mm. The medial structures were addressed and repaired. The patient went through a rehabilitation programme and returned to full activities three months postoperatively. After 12 months of follow-up, there was full range of motion, no redislocation episodes and the Kujala score was 96.Open reduction and anatomic in situ internal fixation of the osteochondral fragment was mandatory in this case, due to its dimensions and location. We consider this a safe and efficient technique that allows osteosynthesis of the osteochondral fragment; the approach used makes possible the acute repair of the medial structures. There is still no general consensus about whether or not to reconstruct the medial patellofemoral ligament (MPFL) in the context of a primary APD.

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Medial Patellofemoral Ligament Injuries in Children With First-Time Lateral Patellar Dislocations

Abstract: Skeletally immature children are more prone to sustaining an MPFL injury at the patellar attachment site. Arthroscopic surgery and MRI complement each other in the investigation of MPFL injuries.

Cited by 75 publications

References 34 publications

High rate of recurrent patellar dislocation in skeletally immature patients: a long-term population-based study

High rate of recurrent patellar dislocation in skeletally immature patients: a long-term population-based study

Anatomic patellar instability risk factors in primary lateral patellar dislocations do not predict injury patterns: an MRI-based study

Open Reduction and Internal Fixation of an Osteochondral Patellar Fracture in an Eleven Year-Old Girl

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