Operative Realignment of Patellar Malalignment in Children

Vähäsarja, Vesa; Kinnunen, Pentti; Lanning, P; Serlo, Willy

doi:10.1097/01241398-199505000-00002

Cited by 51 publications

(18 citation statements)

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“…The feeling of giving-way, a typical symptom of patellar malalignment, was significantly more common among girls. This is in agreement with the fact that patellar malalignment occurs mainly among adolescent girls (20).…”

Section: Discussionsupporting

confidence: 91%

Prevalence of chronic knee pain in children and adolescents in northern Finland

Vähäsarja

1995

Acta Paediatrica

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A questionnaire was sent to 967 schoolchildren, in two age groups, in northern Finland in order to investigate the prevalence of chronic knee pain. A response rate of 88.5% was achieved. Adolescents (aged 14-15 years) had significantly more knee pain (p < 0.0001) than children (aged 9-10 years). The total prevalence of chronic knee pain at the time of the evaluation was 18.5% among adolescents and 3.9% among children. There was no significant difference in the prevalence of chronic knee pain between boys and girls in these age groups. Overweight was not a predisposing factor in chronic knee pain.

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Section: Discussionsupporting

confidence: 91%

Prevalence of chronic knee pain in children and adolescents in northern Finland

Vähäsarja

1995

Acta Paediatrica

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“…More than 100 different operations have been described for the treatment of patellar instability, and these procedures typically involve a combination of lateral release, medial imbrication, distal realignment, and anteromedialization of the tibial tubercle 39 . The so-called gold-standard treatment for patellar instability has yet to be defined.…”

Section: Operative Treatmentmentioning

confidence: 99%

Patellar Instability

Colvin

West

2008

The Journal of Bone and Joint Surgery-American Volume

430

375

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Recurrent patellar instability can result from osseous abnormalities, such as patella alta, a distance of >20 mm between the tibial tubercle and the trochlear groove, and trochlear dysplasia, or it can result from soft-tissue abnormalities, such as a torn medial patellofemoral ligament or a weakened vastus medialis obliquus. Nonoperative treatment includes physical therapy, focusing on strengthening of the gluteal muscles and the vastus medialis obliquus, and patellar taping or bracing. Acute medial-sided repair may be indicated when there is an osteochondral fracture fragment or a retinacular injury. The recent literature does not support the use of an isolated lateral release for the treatment of patellar instability. A patient with recurrent instability, with or without trochlear dysplasia, who has a normal tibial tubercle-trochlear groove distance and a normal patellar height may be a candidate for a reconstruction of the medial patellofemoral ligament with autograft or allograft. Distal realignment procedures are used in patients who have an increased tibial tubercle-trochlear groove distance or patella alta. The degree of anteriorization, distalization, and/or medialization depends on associated arthrosis of the lateral patellar facet and the presence of patella alta. Associated medial or proximal patellar chondrosis is a contraindication to distal realignment because of the potential to overload tissues that have already undergone degeneration.

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“…In children, the surgical procedures historically involved a combination of lateral release, medial reefing, and the Roux–Goldthwait procedure [ 22 ]. However, these procedures do not adequately address the underlying pathology, and high failure rates have been reported [ 34 ]. Additional negative side effects of the Roux–Goldthwait procedure and tibial tuberosity transfer include increased patellofemoral pressure and patellar tendon shortening [ 1 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

Medial patellofemoral ligament (MPFL) reconstruction in combination with a modified grammont technique leads to favorable mid-term results in adolescents with recurrent patellofemoral dislocations

Wegmann

Würnschimmel

Kraus

et al. 2017

Knee Surg Sports Traumatol Arthrosc

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PurposeThe aim of the present study is to present the outcome of a cohort of adolescent patients with trochlear dysplasia and elevated tibial tuberosity trochlear groove (TTTG) distance suffering from recurrent patellar dislocation. Treatment consisted of medial patellofemoral ligament (MPFL) reconstruction and a modified Grammont procedure.MethodsMRI examinations were obtained pre- and postoperatively. Trochlear dysplasia was classified according to Déjour, and TTTG was measured on MRI. The Tegner Activity Scale and the Kujala Knee Score were assessed preoperatively and at follow-up. The Kujala Knee score and the IKDC 2000 knee score were documented at follow-up (median 50, range 20–61 months; SD 16.6).ResultsSeven knees of six patients (median age 16.5 years, range 14–17 years) with trochlear dysplasia and elevated TTTG distance (median 17 mm, range 16.1–21.9 mm; SD 2.8) were treated. Trochlear dysplasia was classified as Déjour type A in 1, type B in 5, and type C in 1 knee. The Kujala Knee Score significantly increased from values of 55 (range 17–88; SD 25.9) to 94 (range 73–100; SD 9.1) at follow-up (p = 0.028). TAS improved from preoperative 2 (range 0–7; SD 2.5) to 5 (range 4–9; SD 1.8) at follow-up (p = 0.034). Median IKDC 2000 Knee Score at follow-up was 89 (range 61–100, SD 13.4). No re-dislocations were encountered.ConclusionIn selected adolescents with recurrent patellofemoral instability, MPFL reconstruction in combination with a modified Grammont technique yields excellent functional outcome and could, therefore, help to avoid major procedures, such as osteotomies.Level of evidenceTherapeutic, Level IV.

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Operative Realignment of Patellar Malalignment in Children

Cited by 51 publications

References 0 publications

Prevalence of chronic knee pain in children and adolescents in northern Finland

Prevalence of chronic knee pain in children and adolescents in northern Finland

Patellar Instability

Medial patellofemoral ligament (MPFL) reconstruction in combination with a modified grammont technique leads to favorable mid-term results in adolescents with recurrent patellofemoral dislocations

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