The Schöttle Point Is Consistently Located Distal to the Medial Femoral Physis in Pediatric Patients: A Digitally Reconstructed Radiographic Study

Featherall, Joseph; Metz, Allan K.; Froerer, Devin; Rosenthal, Reece; Mortensen, Alexander J.; Ernat, Justin J.; Maak, Travis G.; Aoki, Stephen K.

doi:10.1177/03635465221125470

Cited by 3 publications

(2 citation statements)

References 25 publications

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“…The knee was then placed at 90° of flexion, and the Schöttle point was identified on the medial aspect of the knee on true lateral fluoroscopic views. 14 , 29 A small secondary incision was then made, and a guide pin was placed on the Schöttle point with fluoroscopic guidance. The graft was shuttled between layers 2 and 3 of the medial incision.…”

Section: Methodsmentioning

confidence: 99%

Comparison of Failure Rates at Long-term Follow-up Between MPFL Repair and Reconstruction for Recurrent Lateral Patellar Instability

Kruckeberg,

Wilbur,

Song

et al. 2024

Orthopaedic Journal of Sports Medicine

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Background: The medial patellofemoral ligament (MPFL) is the primary soft tissue restraint to lateral patellar translation and is often disrupted by lateral patellar dislocation. Surgical management for recurrent patellar instability focuses on restoring the MPFL function with repair or reconstruction techniques. Recent studies have favored reconstruction over repair; however, long-term comparative studies are limited. Purpose: To compare long-term clinical outcomes, complications, and recurrence rates of isolated MPFL reconstruction and MPFL repair for recurrent lateral patellar instability. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 55 patients (n = 58 knees) with recurrent lateral patellar instability were treated between 2005 and 2012 with either MPFL repair or MPFL reconstruction. The exclusion criteria were previous or concomitant tibial tubercle osteotomy or trochleoplasty and follow-up of <8 years. Pre- and postoperative descriptive, surgical, imaging, and clinical data were recorded for each patient. Results: MPFL repair was performed on 26 patients (n = 29 knees; 14 women, 15 men), with a mean age of 18.4 years. MPFL reconstruction was performed on 29 patients (n = 29 knees; 18 women, 11 men), with a mean age of 18.2 years. At a mean follow-up of 12 years (range, 8.3-18.9 years), the reconstruction group had a significantly lower rate of recurrent dislocation compared with the repair group (14% vs 41%; P = .019). There were no differences in the number of preoperative dislocations or tibial tubercle–trochlear groove distance. The reconstruction group had significantly more time from initial injury to surgery compared with the repair group (median, 1460 days vs 627 days; P = .007). There were no differences in postoperative Tegner, Lysholm, or Kujala scores at the final follow-up. In addition, no statistically significant differences were detected in return to sport (RTS) rates (repair [81%] vs reconstruction [75%]; P = .610) or reoperation rates for recurrent instability (repair [21%] vs reconstruction [7%]; P = .13). Conclusion: MPFL repair resulted in a nearly 3-fold higher rate of recurrent patellar dislocation (41% vs 14%) at the long-term follow-up compared with MPFL reconstruction. Given this disparate rate, the authors recommend MPFL reconstruction over repair because of the lower failure rate and similar, if not superior, clinical outcomes and RTS.

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Section: Methodsmentioning

confidence: 99%

Comparison of Failure Rates at Long-term Follow-up Between MPFL Repair and Reconstruction for Recurrent Lateral Patellar Instability

Kruckeberg,

Wilbur,

Song

et al. 2024

Orthopaedic Journal of Sports Medicine

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“… 9 , 10 Growing attention has been drawn to fluoroscopy-guided MPFL-R with autograft, which has demonstrated satisfactory efficiency for adolescents. 2 , 11 , 12 Nevertheless, the main concern arises from the risk of physeal injury. The distance from the MPFL origin to the distal femoral physis varies from 3.7 mm proximal to 10.0 mm distal in skeletally immature specimens.…”

mentioning

confidence: 99%

Arthroscopically Assisted Double-Bundle Medial Patellofemoral Ligament Augmentation With Physeal-Sparing Suture Fixation for Recurrent Patellar Dislocation in Skeletally Immature Patients

Hu,

Shi,

Wang

et al. 2024

Arthroscopy Techniques

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Physeal Location on the Distal Femoral Cortical Surface Is Consistently Proximal to Apparent Location on the Perfect Lateral Radiograph: A 3-Dimensional Digitally Reconstructed Radiograph Study

Rosenthal,

Froerer,

Metz

et al. 2024

J Am Acad Orthop Surg

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Introduction: The perfect knee lateral radiograph visualizes anatomic landmarks on the distal femur for clinical and scientific purposes. However, radiographic imaging is a two-dimensional (2D) representation of a three-dimensional (3D) physis. The aim of this study was to characterize the perceived radiographic projection of the femoral physis using perfect lateral digitally reconstructed radiographs (DRRs) and to evaluate discrepancies from this projection to the physis at the lateral and medial cortices. Methods: Pediatric patients from a cohort of CT scans were analyzed. Inclusion criteria were an open physis; exclusion criteria were any implant or pathology affecting the physis. CT scans were imported into 3D imaging software and transformed into lateral DRRs and 3D renderings of the femur. The physis was divided into four equal segments, with fiducial markers placed at the “anterior,” “midpoint,” and “posterior” points. Lines extended from these points in the lateral and medial direction. The vertical distance from these lines, representing the radiographic projection of the physis, was measured relative to the physis at the lateral and medial cortex of the femur on coronal CT slices. Results: Thirty-one patients were included. On the perfect lateral radiograph DRR, the physis on the medial cortex was located proximal to the visualized physis by 6.64 ± 1.74 mm, 11.95 ± 1.67 mm, and 14.30 ± 1.75 mm at the anterior (25%), midpoint (50%), and posterior (75%) locations, respectively. On the lateral side, the physis on the lateral cortex was proximal to the visualized physis by 2.19 ± 1.13 mm, 3.71 ± 1.19 mm, and 6.74 ± 1.25 mm at the anterior, midpoint, and posterior locations, respectively. Discussion: In this cohort of pediatric patients, the location of the cortical physis was, in all areas measured, proximal to the projection of the visualized physis as seen on the perfect knee lateral DRR. The distance from radiographic physis to cortical physis was greater at the medial cortex compared with the lateral cortex. Study design: Descriptive laboratory study. Level of evidence: III, observational radiographic anatomic study.

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The Schöttle Point Is Consistently Located Distal to the Medial Femoral Physis in Pediatric Patients: A Digitally Reconstructed Radiographic Study

Cited by 3 publications

References 25 publications

Comparison of Failure Rates at Long-term Follow-up Between MPFL Repair and Reconstruction for Recurrent Lateral Patellar Instability

Comparison of Failure Rates at Long-term Follow-up Between MPFL Repair and Reconstruction for Recurrent Lateral Patellar Instability

Arthroscopically Assisted Double-Bundle Medial Patellofemoral Ligament Augmentation With Physeal-Sparing Suture Fixation for Recurrent Patellar Dislocation in Skeletally Immature Patients

Physeal Location on the Distal Femoral Cortical Surface Is Consistently Proximal to Apparent Location on the Perfect Lateral Radiograph: A 3-Dimensional Digitally Reconstructed Radiograph Study

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