Results of operative 4-in-1 patella realignment in children with recurrent patella instability

Malagelada, Francesc; Rahbek, Ole; Sahirad, Cyrus; Ramachandran, Manoj

doi:10.1016/j.jor.2017.11.002

Cited by 9 publications

(7 citation statements)

References 35 publications

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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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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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“…Patients who experienced acute or recurrent patellar dislocations have different patterns of chondral injuries [54,101,102]. Several risk factors which predispose to patellofemoral instability have been described, such as patella alta, malalignment syndromes, ligamentous hyperlaxity, and dysplasia [103][104][105][106]. Recent studies demonstrated that most patients with patellofemoral instability have two or more coexistent pathoanatomical risk factors which synergistically predispose to the dislocation.…”

Section: Discussionmentioning

confidence: 99%

Surgical strategies for chondral defects of the patellofemoral joint: a systematic review

Migliorini

Baroncini

Bell³

et al. 2022

J Orthop Surg Res

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Background The management of chondral defects of the patellofemoral joint is debated, and definitive evidence is lacking. This study systematically updated and summarised the current literature on the surgical management of isolated chondral defects of the patellofemoral joint, discussing techniques, outcome, pitfalls, and new frontiers. Methods This systematic review was conducted according to the 2020 PRISMA statement. In August 2022, PubMed, Web of Science, Google Scholar, and Embase databases were accessed with no time constrain. All the clinical studies investigating the surgical management of chondral defects of the patellofemoral joint were retrieved. Articles which reported data on patients with advanced to severe osteoarthritis were not eligible. Only studies with a minimum 24 months follow-up were considered. Studies which mixed results of patellofemoral and tibiofemoral joints were not considered. Results Data from 10 studies (692 procedures) were retrieved. The mean follow-up was 46.9 ± 18.2 months. The mean age of the patients was 34.0 ± 6.1 years, and the mean BMI was 25.9 ± 0.8 kg/m2. The mean duration of symptoms before the index surgery was 81.0 ± 24.0 months. The mean defect size was 3.8 ± 0.8 cm2. All the PROMs improved from baseline to last follow-up: VAS 0–10 (P = 0.04), Tegner (P = 0.02), Lysholm (P = 0.03), and International Knee Documentation Committee (P = 0.03). The rate of hypertrophy was 5.6% (14 of 251), the rate of progression to total knee arthroplasty was 2.4% (2 of 83), the rate of revision was 16.9% (29 of 136), and the rate of failure was 13.0% (16 of 123). Conclusion Current surgical strategies may be effective to improve symptoms deriving from chondral defects of the patellofemoral joint. The limited and heterogeneous data included for analysis impact negatively the results of the present study. Further clinical studies are strongly required to define surgical indications and outcomes, and the most suitable technique.

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“…In skeletally immature patients, standard TTOs such as the Trillat, Maquet, and Fulkerson are not suitable because of the risk to the proximal tibial physis and tibial tubercle apophysis. Options for physeal respecting distal realignment procedures include Galeazzi tenodesis, patella tendon shortening, modified Grammont procedure (medialization of the entire patella tendon and underlying periosteum, dissecting superficial to the open apophsysis), Roux-Goldthwait (translation and fixation of lateral half of the patella tendon, anteriorly, distally, and medially to the untouched medial half of the tibia), or combination procedures such as the "4 in 1" (lateral release, medial reefing, Insall tube realignment, and Roux-Goldthwait patella ligament transfer) and "3 in 1" procedure (Vastus medialis oblique (VMO) advancement, lateral release, and transfer of the medial third of the patellar tendon medially, sutured to the MCL and secured with anchors) ( Table 2) [34][35][36]. These aim to correct enlarged Q angles, similar to a TTO, but without threatening the physis or apophysis.…”

Section: Osseous Deformity Correction: Guided Growth or Osteotomymentioning

confidence: 99%

“…Therefore, recommended distal realignment procedures focus on soft tissue manipulations to minimize risk to the physis. These include the Roux-Goldthwait, modified Grammont, Galleazzi, and combination procedures [34][35][36]. Complications of these include incomplete correction, recurrent symptoms, patella tilt, increased PFJ contact pressures, anterior knee pain, and change in sport to non-weight bearing or lower level sport.…”

Section: Osseous Complicationsmentioning

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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Results of operative 4-in-1 patella realignment in children with recurrent patella instability

Abstract: The 4-in-1 patellar realignment is a good procedure in paediatric and adolescent patients with recurrent patella instability. Satisfactory results were observed with a minimal complication and redislocation rate in our series.

Cited by 9 publications

References 35 publications

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

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

Surgical strategies for chondral defects of the patellofemoral joint: a systematic review

Recurrent Patellofemoral Instability in the Pediatric Patient: Management and Pitfalls

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